The role of preventative health in improving the health of Australians
Posted 22/09/2010 by Amanda Biggs
Preventative health, with its longer term population-based strategies to promote wellness and prevent disease, is often overlooked by both policy makers and a public more focused on personalised primary care and hospital services. This is reflected in the level of expenditure on preventative health activities in Australia—just 2 per cent of total health expenditure. Yet, approximately 32 per cent of Australia’s total burden of disease can be attributed to modifiable risk factors that include smoking, alcohol abuse, physical inactivity, high blood pressure and blood cholesterol, low consumption of fruits and vegetables and overweight and obesity. It is now widely recognised that in order to stem the growth of chronic diseases, the major risk factors that contribute to them must be addressed. Successive reports continue to warn of the growth in preventable chronic diseases, the cost to the health system and the increasing burden on individuals—which is set to increase as the population ages. It is estimated that some 431 000 hospitalisations a year might be avoided if patients with chronic conditions were better managed through community-based primary care services.
However, although primary care plays a key role in managing chronic disease, there is clearly scope for actions that prevent disease or slow its development. Early intervention can reduce or eliminate the need for later, more intensive and costly care. Well-known examples of prevention include vaccination, cancer screening and health promotion. By tackling disease and its risk factors early, significant suffering can be averted, and costs reduced. For example, it has been estimated
that tobacco control programs in Australia prevented 400 000 premature deaths and saved $8.4 billion between 1975 and 1995.
Physical activity and nutrition
Australia has long defined itself in terms of sporting achievements, and flowing from that is a vision of a strong, healthy and athletic nation. The reality is different. The majority of Australian adults are either overweight or obese and 23 per cent of children aged between five and 17 are considered overweight or obese. Young Australians in particular are ignoring advice about nutrition, smoking and alcohol and they are increasingly inactive. Diet and nutrition play a major role in maintaining health and preventing chronic illness. It is estimated that inadequate fruit and vegetable consumption is responsible for 2.1 per cent of the total burden of disease in Australia. Just 9 per cent of the adult population consumes the recommended 5 serves of vegetables per day. Although 22 per cent of younger children meet the recommended vegetable consumption guidelines, only 5 per cent of 14–16 year olds meet the recommendations. Physical inactivity is the second most important risk factor that contributes to the burden of disease, morbidity and mortality in Australia. It is widely acknowledged that regular physical activity provides a large range of health benefits, ranging from reduction in risk factors for heart disease, high blood pressure, high cholesterol, diabetes and some cancers. Increased physical activity delivers fitness and stamina, increased energy and reduction in stress, anxiety and depression. Participation in physical activity also helps improve social and community networks and increases community cohesion and social connectedness. It leads to safer communities and reduces the sense of isolation many people experience in modern society. In short, it delivers a better quality of life for people of all ages.
Australia has not acted as positively to redress this trend towards greater inactivity as some other nations. Some commentators argue that sports funding continues to focus on achieving sporting greatness for an elite few at the expense of community based initiatives that could improve health outcomes for all Australians, regardless of their ability or background.
The World Health Organization warns that ignoring these issues will have dire consequences for health outcomes. These could include finding and initiating more suitable and equitable funding equations for elite and grass roots sports and activity programs. Other challenges include finding the right formula to work with state, territory and local governments to improve frameworks that promote activity, such as urban planning and transport infrastructure.
This growing recognition of the role of prevention in reducing the risk factors for chronic disease is reflected in the development of two key national health strategies released in 2009. The National Preventative Health Strategy recommended a range of measures—some controversial—to limit the consumption of alcohol and tobacco and reduce overweight and obesity. Key recommendations included: increasing the tobacco excise, requiring plain packaging of tobacco products, better nutritional information on food labels, and phased bans on junk food advertising to children and alcohol advertising during live sports broadcasts. Although some recommendations such as increasing the excise on tobacco have been implemented, the future of others—particularly the more contentious—remains uncertain. Prevention is also a key element in Australia’s National Primary Health Care Strategy. It called for initiatives to target high risk groups, expanding the Medicare Benefits Schedule to include more preventative health activities and more evidence-based approaches to preventative health care. Contributing to the evidence base this recent NHMRC-funded study evaluated 123 preventive interventions and estimated their cost-effectiveness. The most cost-effective interventions—likely to yield the greatest impact on population health at the lowest cost—include: taxation on tobacco, alcohol and unhealthy foods; limits on salt in basic food items; improving the efficiency of blood pressure and cholesterol lowering drugs; gastric banding for severe obesity and an intensive SunSmart campaign. This emerging body of research now presents policy makers with a range of policy options to address the burden of chronic disease and improve the health of all Australians. One way forward might be to explore a multi-sector approach, similar to the Health in all Policies agenda being implemented in South Australia. This approach recognises that health outcomes can be influenced by measures that are often managed by government sectors other than health. By integrating preventative health strategies across a number of policy sectors like agriculture, education, the environment, fiscal areas, housing and transport, it might be possible to improve population health and reduce the growing economic burden of chronic disease.
(post co-authored with Dr Rhonda Jolly)
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