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Curing an ailing system

By Rob Moodie - posted Monday, 8 October 2007


In late June Kevin Rudd and Nicola Roxon released Labor’s health policy Fresh ideas for Health and Future economy (The Age, June 29, 2007) which focused on preventative health care. It was immediately labelled as a wish list by Tony Abbott.

Well, what should we be wishing for in our health system? Given it’s an election year what should we be demanding from our political leaders to improve our health?

Let’s start with having a health system, not only an illness system - one that actively creates good health from birth and maximises our health to the grave.

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It needs to be smart, balanced, fair and simple. Let me explain.

Smart

We need to drastically change our systems thinking. Our money and effort is focused on illnesses after they’ve happened. We now need to ask at every step in the chain of illness, how could have this been avoided or prevented? How can, for example, the complications of diabetes be minimised if they occur; if they haven’t occurred then how can they be prevented; and how can the diagnosis of diabetes be prevented in the first place?

Smart systems prevent. We have had some great promotion and prevention successes in Australia - immunisation, tobacco control, road trauma, cancer prevention, reduction of cardiovascular disease to name a few. And they have had great results at very reasonable cost. But we only invest less than 3 per cent of our health budget on organised health promotion and prevention programs.

The Labor policy’s focus on preventive health care seems to be a move in the right direction. For example, it talks of one of the blue chip investments in health - tobacco control. It quotes Susan Hurley’s work showing that a 5 per cent reduction in smoking prevalence will save $1 billion from the Commonwealth coffers over the long term. So will Labor invest $100 million in anti-smoking programs needed to get the 5 per cent decrease, save the $1 billion and save an enormous amount of death and disease?

Early family life and early education have profound effects on our health. Smart systems invest heavily in early childhood development - which is not only in maternal and child health services but in universal child care, kindergartens and public primary education.

Smart also means investing in research and development - the amount invested in health services research (to know what can be improved) is miniscule compared to the budgets of the hospital systems. It means investing into researching the causes and solutions to our epidemics of physical inactivity, poor nutrition and their consequences of diabesity.

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Balanced

This is the art and politics of health. We need both public and private funds to support our health system. Our publicly funded health system needs to be maintained and enhanced - universal cover for treatment, care and prevention services, complemented by targeted programs for those with the poorest health.

Look to the US and we see a system out of kilter, publicly under-funded with the private system driven by voracious pharmaceutical and technology companies. Among comparable countries they have the highest costs of services, it is the least fair and has the poorest outcomes. We need the private system in Australia, but complementary to a supported and valued public system.

If you are ideologically opposed to a public system the best way to make sure it doesn’t work is to under fund it. There has been a sad and entirely preventable rise in poor dental health since the Commonwealth government pulled out its dental health scheme - and of course it has impacted most on the poorest.

The balance is also about solutions for our major health issues. Balance between, for example, technical solutions and those that require changes of our environment and changes of our behaviours. A good example is obesity - do we wait for the obesity pill or do we invest in universal programs (education, social marketing, regulation, amenity provision, public transport) to increase physical activity and improve nutrition?

Fair

Although we continue to enjoy healthy improvements in our life expectancy, there are major inequalities in the way life expectancy is distributed across Australia. The most disadvantaged are Aboriginal Australians, and life expectancy can vary by up to ten years across different suburbs in Sydney and Melbourne. So the system also has to work at “levelling up” - bringing those with the poorest health up to those with the best health, which requires changes in income distribution, and investment in education and employment. This is why we should cherish our progressive tax system as fundamental to a just society, where it is seen as a positive contribution to our own well being, and to that of others, not money “stolen” from us by governments.

Simple

This is the monster that we don’t seem to be able to deal with - federal versus state versus local governments - multiple layers of services disintegrating under the weight of an arcane, but seemingly immutable system of government. Simple means fewer, better integrated systems for funding and running preventive, primary and tertiary care services. Simpler for providers and for punters.

When we look to the future we should be ready to learn from other countries. And we shouldn’t automatically look to the US, but start having a much more in depth look at the northern European and Scandinavian experiences. Take, for example, the recent UNICEF report, An overview of child well being in 21 OECD rich countries. It examined 40 indicators of child well being and found that Netherlands, Sweden, Denmark, Finland, Spain, Switzerland and Norway had the highest level of well being with UK and US the lowest. (Australia could not provide enough data over all the dimensions to be included!).

We have to ask the question whether the top countries do better because they take fairness more seriously, and have more inclusive social policies, greater social cohesion, and more equal distribution of wealth and amenity?

In my darker moments I wonder if we are still committed to fairness in Australia. I sense that we have become meaner over the last ten years, less interested in the “fair go” although we still promote it as an essential Australian value.

So come election time look for the policy that is the smartest, the most balanced, the fairest and the simplest. It’s also likely to be the most affordable.

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This article is an edited version of one first published in The Age on July 2, 2007.



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About the Author

Rob Moodie is Professor of Global Health at the Nossal Institute for Global Health at the University of Melbourne. Between 1998 and 2007 he was the CEO of VicHealth. He is co-editor of three books, including Hands on Health Promotion. He is currently writing a book called Recipes for a Great Life with Gabriel Gate.

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