Health outcomes are about more than access to healthcare services: they are highly dependent on the social and economic determinants of health. Despite lip service to the importance of these factors and preventive health actions, the Australian healthcare system is relentlessly focused on treating sick people, with subsequent economic and social costs incurred by governments, society and individuals.
There is growing recognition that the only way to contain burgeoning healthcare costs and the burden of chronic illness and disability is to focus on prevention – even if this means moving funding from elsewhere in the health system. But despite lip service to this idea, the Australian healthcare system is relentlessly focused on treating sick people. The economic, productivity and social consequences of poor health are rarely used to offset spending on preventive health measures.
The history of improvements in life expectancy and health outcomes highlights the importance of addressing community health and well-being through the social and economic determinants of health. These include public health services that ensure clean drinking water, clean air, safe food supplies and infectious disease controls, preventive health services such as good nutrition and vaccinations, and social services that address poverty, housing, literacy, social justice and social isolation.
Australia lags behind similar OECD countries with its spending on preventive health. Investment in preventive health has been less than 2% of health expenditure for at least the past 10 years. (Reliable, consistent and up-to-date data are hard to find and the exact figures reported depend on definitions of prevention activities and public health.)
The emphasis on healthcare over health and disparities in funding are highlighted by Australia’s life expectancy figures (85.1 years for females and 81.1 years for males) versus healthy life expectancy (75.6 years for females and 71.9 years for males). And it’s concerning that life expectancy has dropped for the past two years. This is attributed to COVID-19 and its sequelae, obesity, diabetes and mental illnesses.
The National Preventive Health Strategy 2021-2030 sets goals for a healthier Australia, including an investment target of 5% of Commonwealth, State and Territory health expenditure to be directed to preventive health investments by the year 2030. However, to date, there has been no meaningful increase in funding. The biggest federal investments have been $30.1 million over four years in the 2022-2023 Budget and $91.1 million for the establishment of the Australian Centre for Disease Control in the 2023-2024 Budget.
The Australian Institute of Health and Welfare has a preventive health monitoring dashboard that tracks progress against the NPHS and the National Obesity Strategy 2022-2032. It shows progress has been limited or stagnant in many key areas, especially obesity. Meanwhile, the promised Australian Centre for Disease Control has never been more needed, but the Albanese Government has been slow to deliver; its formal establishment, which will require enacting legislation, is not due until 1 January 2026.
Australia does secondary prevention efforts such as vaccinations and cancer screenings well, but population-level, primary prevention efforts, especially around obesity and alcohol, have apparently fallen into the too-hard bin. This despite Australia’s internationally recognised, ongoing success with efforts to address skin cancer and tobacco use.
This is, arguably, a case of political ideologies winning out over the evidence. Successive governments of both major political parties have seen advertising junk food to children, warning labels on alcohol, curtailing the sale of sugar-sweetened beverages, and more accurate food labelling as issues for families and have looked for voluntary compliance from the food and beverage and advertising industries rather than invoking government actions. It is suggested that politicians are resistant to policy-based approaches to diet, alcohol, physical activity and obesity because they are concerned about community perceptions of such interventions as being those of a “nanny-state”.
This government hesitancy now also plays out around infection control, even as COVID-19 lingers and new viral threats are emerging. Australian governments have been slow to recognise and respond to the many lessons around prevention that have been learned from the COVID-19 pandemic, when mandatory approaches to isolation, mask-wearing and vaccination were credited with saving many lives and were, at least initially, largely accepted.
That “nanny-state” public response to prevention initiatives is not borne out by a series of national studies conducted by The Australian Prevention Partnership Centre which have consistently found strong, continued community support for government-led interventions to address chronic diseases. In the most recent survey, more than half of the respondents (55.4%) indicated the government is yet to go far enough with regulation and policies to help reduce the rates of lifestyle-related diseases such as diabetes, heart disease and obesity.
“There is consistently little endorsement of the nanny state conceptualisation of government intervention with the community increasingly looking to government for leadership on health policy,” says Dr Anne Grunseit, the lead investigator on these surveys.
Australia is heading into a federal election campaign, where healthcare has already been staked out as battleground territory. Opposition Leader Peter Dutton was Minister for Health when, in 2014, the Abbott Government abolished the Australian National Preventive Health Agency (set up under the Gillard-Rudd Government) and the National Partnership Agreement on Preventive Health (under which federal funding had supported State and Territory initiatives since 2008), so there is little chance of action on prevention from the Coalition.
Labor will be drawn to short-term, bandaid fixes like increased funding for bulk-billing urgent care clinics because these deliver results quickly and help address cost-of-living pressures. Health Minister Mark Butler is promising more fundamental reforms for Medicare and around managing chronic disease. It remains to be seen if he will get a second chance to tackle these wicked problems in health and, if he does, whether he will be brave enough and visionary enough to invest in the future with more attention and funding for prevention.
Lesley Russell has worked as a political advisor on health to Democrats in the US Congress and the Labor Party in the Australian Federal Parliament. She is an Adjunct Associate Professor at the Leeder Centre for Health Policy, Economics and Data at the University of Sydney.