HEALTH is at a crossroads. Treasurer, Joe Hockey, recently told the Sydney Institute: “In health, it is more medical research combined with new technology and better global partnerships that will deliver better health outcomes”.
He is simply wrong.
Prevention is much more effective than cure. It is through this sort of ignorance that the Budget so strongly attacks primary and preventive health.
The unconscionable $7 GP co-payments is one attack. AMA president Dr Brian Owler called on the Senate to block this co-payment using the example of a person newly prescribed Warfarin constantly needing monitoring and blood tests – at $7 at time.
There have been great advances in health through medical research and technology. However, the most widespread advances have come through prevention. And prevention has been most successful when governments understand the extent to which health is socially determined and invest in efforts to improve health across the community.
This requires government intervention, an approach that is in direct contrast to the current reactionary political philosophy of small government, less intervention and strengthening personal rather than government responsibility.
Cholera is virtually unknown where there is clean water and sanitation. Following the discovery by the original epidemiologist, John Snow, and his colleague, Reverend Henry Whitehead, of the link between drinking water and cholera the British government embarked upon one of the greatest engineering feats of the 19th century – retro-fitting London with clean water and sanitation.
If our current “non-interfering” government was challenged with a cholera epidemic today the approach would be a media campaign advocating boiling water and proper disposal of faeces. Would it be prepared to regulate industry such as the Southwark and Vauxhall Waterworks Company – who were taking water from sewage polluted sections of the Thames and distributing it?
Clean water and sanitation are basic to public health, and so is immunisation, an example that requires medical research, but also requires government intervention.
Immunisation rates in children in Australia are around 90 per cent with governments striving for 95 per cent. This is already a brilliant achievement compared to almost anywhere in the world, but there are still specific pockets and specific populations that are vulnerable to vaccine-preventable diseases.
More work is needed across Australia and across our region. Federal Health Minister Peter Dutton has made clear his strong support for immunisation. And the Liberals have a good track record in this area starting with an effective intervention by Howard government minister, Michael Wooldridge.
Contrast this commitment with a Federal Budget that simply attacks public health and prevention. Some of the attacks might be indirect, or even unintended, but they will still have a profound impact.
The Australian National Preventive Health Agency has been dismantled. The National Partnership Agreement on Preventive Health has suffered a death blow with the withdrawal of Commonwealth funds. Both these actions are simply a process of cost (and responsibility) shifting to the States and Territories.
The $7 GP co-payments will provide a disincentive for young families, and the less well-off, to go to their GPs for vaccinations. When the socio-economically disadvantaged, such as self-funded retirees with a chronic condition, go to the doctor they have to find $7 again and again and again.
In Australia’s system of universal health care, wealth is irrelevant to appropriate care. The $7 co-payment marks a start to dismantling this system.
And the $20 billion research fund is a last-minute sop to justify this irresponsible co-payment policy. It is a “medical fund” rather than a “health and medical fund” consistent with Hockey’s view of health as a business with the potential for financial returns. Apparently, even medical research can put financial returns ahead of health and welfare.
This column is based on his address, as CEO of the Public Health Association of Australia, to the 14th National Immunisation Conference in Melbourne on June 17.