Sleepwalking into a sicker future - Grattan Institute

Australia’s governments aren’t doing enough to stop chronic disease before it starts. Instead, we have been sleepwalking into a sicker future that will condemn millions of Australians to avoidable disease and disability.

Australia’s healthcare system is facing interlocking crises. Every day the pandemic is still causing deaths, taking up hospital beds, and leaving people debilitated by long COVID.

Partly as a result, GP clinics, hospital wards, and emergency departments are overwhelmed. But there is another, slower-moving crisis that’s making these immediate crises worse: we keep getting sicker.

A rising number of Australians have one or more chronic conditions, such as diabetes and heart disease. As well as causing disease, disability and death – not to mention economic damage – these conditions make people more vulnerable to COVID-19 and other infectious diseases, and more likely to need GP or hospital care.

Federal Health Minister Mark Butler recently announced that there will be a radical overhaul of Medicare to help GPs respond, and he should be commended for it. But while managing chronic disease is important, we can and should also do much more to prevent it.

Nearly 40 per cent of the chronic disease burden in Australia is caused by factors that can be changed, such as obesity, alcohol and smoking. That amounts to well over $20 billion in healthcare costs a year. Our rate of obesity has tripled since 1980, so these costs will keep on rising.

Other countries are making progress on chronic disease prevention, but Australia is falling behind.

There are taxes on sugar-sweetened drinks in 85 other countries. There are none in Australia. More than 40 other countries have best-practice policies to reduce trans fats in foods, which cause heart disease. Australia doesn’t. Dozens of other countries have taken strong action to reduce excessive salt intake, which leads to cardiovascular disease and stomach cancer. Australia’s policies on salt are weak.

The health and financial gains from catching up would be huge. To take one example, 20 years ago the UK introduced a range of policies to cut salt intake. It worked, with salt consumption falling by nearly 10 per cent. The result has been an estimated 39,000 premature strokes avoided, and over 700 million dollars of government spending saved. Those savings will rise sharply over time, quadrupling by 2050.

Australia spends only about 2 per cent of our health budget on prevention, well below the average among wealthy countries. Australia’s prevention agency was abolished years ago, along with the national funding agreement for prevention programs.

There’s ample evidence that prevention policies can save lives, reduce pressure on hospitals, and help the economy. So why aren’t we doing more?

Just as healthy choices can be hard for individuals, putting prevention first can be hard for governments. There’s always something much more urgent to worry about. Powerful vested interests – such as the food, alcohol and gambling industries – will lobby against change that threatens to eat into their profits.

And prevention requires political patience – even if a government does take action, that government will probably be long gone by the time its policies are saving lives and dollars.

Ignored and under-funded

That’s why Australia needs the right institutions to make prevention a priority. Australia has systems to evaluate and fund other types of health investment. We have set up independent bodies that force us to focus on the future in areas from climate change to monetary policy. But prevention has been left behind.

Australia is one of the few countries in the world that doesn’t have a Centre for Disease Control – a health agency tasked with keeping people healthy. The Albanese government has promised to establish one, and it could help solve Australia’s prevention problem.

Prevention agencies have been shut down, ignored and under-funded before, in Australia and overseas. To avoid that fate, the Australian Centre for Disease Control (ACDC) must be truly independent, so that it can push governments to act, even when lobby groups or urgent crises get in the way.

It must have a strong focus on chronic disease, not just infectious disease, to target the biggest cause of illness. And it must identify cost-effective prevention actions that governments should take.

Even then, just setting up a new agency won’t be enough. Our governments must also lock in an enduring national funding agreement for prevention. It’s been almost 10 years since Australia last had one.

The new agreement should increase investment in prevention over time, and only fund interventions that the ACDC supports. And ACDC advice on regulatory reform must be tabled in parliament, so that the costs and benefits are front and centre in policy debates.

This new agency is an opportunity to pivot policy from sickness to health. Millions of Australians will be able to look forward to a longer and healthier life, provided the government seizes this opportunity to establish a strong, independent ACDC, and back it up with serious funding for prevention.

Peter Breadon

Health Program Director
Peter Breadon is the Health Program Director at Grattan Institute. He has worked in a wide range of senior policy and operational roles in government, most recently as Deputy Secretary of Reform and Planning at the Victorian Department of Health.

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