The twelve years from now to 2020 will be constrained by demographic imperatives, economic realities, and demands of sustainability, Asian development and climate change. Within those constraints we will have choices – how wisely can we make them?
In proposing a national health strategy, major points of agreement emerged quickly among the hundred delegates in the Health Strategy Stream. The 17 years less life expectancy experienced by Indigenous Australians was unacceptable, and to ensure more equitable care for people in remote socio-economically disadvantaged Australia was urgent. A more energetic approach to IT for a portable, personal medical record was proposed, essential for the decades of care for people with long-term continuing health problems such as emphysema. The continuing value of research was acknowledged. Chronic illness scares everyone, especially mental problems, and better linked up care is critical between public and private, health workforce and Commonwealth and States.
In the sub-group looking at prevention, I learned from the CEO of Woolworths, Michael Luscombe, that Coke Zero and Diet Coke cost one third less to produce than sugar-laden Coke. An interesting possibility exists for a conversation with Amatil, of tobacco fame and that now runs Coca Cola, for preferential pricing for the less health damaging Zero.
This, we agreed, was the kind of conversation that the prime minister could have with benefit with CEOs of major urban developers, food manufacturers and retailers in pursuit of making it easier for people to choose goods that do not screw up their health. Such a forum was recommended. Fresh food costs more for Indigenous and remote living Australians – but soft drinks don’t.
Get Crikey FREE to your inbox every weekday morning with the Crikey Worm.
Most preventive effort in relation to the chronic diseases, which are the top agenda worry, has concentrated upon influencing the behaviour of the individual – smoke less, eat less, exercise more. Yet the evidence from occupational health, road safety, and tobacco control is that action that modifies the environment to make healthier choices easier choices works far better than haranguing and preaching. Safer road and car design makes serious accidents less likely.
We have much ground to make up in preventing heart disease, diabetes and stroke. We have singled out these as lifestyle diseases, as though consenting adults choose to behave in ways that make them sick. However, the faulty lifestyle behaviours are generally deeply socially conditioned – prices and advertising affect our food choices, urban design determines our physical activity and our work makes us avoid physical activity. You can’t walk and compute simultaneously – not well, anyway – and millions are tethered to keyboards and screens for hours each day.
At 2020, the importance of confronting the supply side of these ‘lifestyle behaviours’ was recognised. Cities that encourage walking, public transport, sustainability, fresh food consumption and safety are ones that encourage good health. The opportunities for cross-portfolio and cross-industry discussion and action were discussed.
Taxes have not increased on tobacco products for years, and those on alcohol are low and on junk food non-existent. Each of these products has its price elasticity. Increasing the price reduces demand for tobacco. It could be tested out on junk food. Food should be labelled with red, orange or green markers (traffic lights) against fat, sugar and salt. There are a dozen easy things that could be done to make the environment more pro health. Income derived from the taxes could be used, Treasury permitting, because they have a severe distaste for hypothecated taxation for preventive programs – not to subsidise luxuries for the upper and middle classes.
Health literacy – the ability to make sense and exercise control over the world of health and health care – was seen as critical. We need both knowledge about health and illness and our bodies in relation to both, and also we all need better access to our personal medical records. These should be IT enabled and we should have access to information about the performance of the health system, as should those who invest in it.
Research can indicate new and better ways of providing prevention and care, but this needs an evidence-enabled responsiveness both from the community and also of course from among health service managers and clinicians. There is at present a curious negative attitude to information in many of our bureaucracies about our health: we do not yet conduct regular surveys of what we eat or weigh, in 14 years we have not repeated the original survey that drew attention to thousands of deaths a year by medical misadventure, and we do not make it easy for research to link medical records across hospitals, general practices, prescription data and Medicare.
Victoria has led Australia in taxing tobacco, decreasing consumption as a result and generating income for research and services to address tobacco addiction and help people to realise that tobacco advertising, now largely abolished, was seriously seductive and misleading. Building on the Victorian proposal, the prevention group proposed a wider preventive institution that included obesity and alcohol abuse in its brief. Taxes on junk food and alcohol could fulfil the same role as taxes on tobacco: the primary purpose is to make the use of these products less attractive. The preventive institution would also link health to urban planning and private exercise facilities.
Indigenous health attracted the attention of all sub-groups at the Summit. Diabetes, heart disease and alcohol problems account for a lot of the early deaths that reduce average life expectancy to a level 17 years below that of non-Indigenous Australians. The potential for tobacco control, fresh food security and alcohol control is high, and a proposal for a national commission that concentrated upon program development to bridge gaps in health and life experience in Australia received strong support from many quarters both within health and in the nine other major streams.
The prime minister visited the health strategy stream on Sunday morning (the health minister was there all the time) and pointed out how ludicrous it was that, with alarming rates for diabetes and obesity, we invested less than 2% of our health budget in prevention. We would, he said, need to be “blind to the future” not to attend to prevention. He spoke of the need for short term responsiveness from the health system – to waiting lists and crowded EDs now and the needs of an ageing population in the longer term. This combination of short and long term planning is what makes health policy development so difficult, he said.
Mr Rudd acknowledged that the commonwealth-state relations that expressed their dysfunctionality so strongly in health needed to be fixed. To that end he was meeting with state and territory first ministers every three months and health was one of seven topics on which agendas for action had been set and that were being monitored carefully for progress. A large investment in health, he said, clearly would be needed, but not until the policy questions had been answered. This promise offers much to people with chronic illness that lasts for years and requires care paid for by both the States and the Commonwealth.
Only a fragment of the Summit material has thus far been published and it will be weeks before it all becomes available. I was greatly moved by refreshment, youth and renewal of the event: I had a strong sense of participatory democracy, of people with ideas wanting to express them and to embed them in policies that could then be put into practice with a keen eye for what is best for Australia.
Fears that the Summit attendees would be a ‘white bread’ congregation were allayed by the diversity of those present. Parliament House felt less like the headquarters of a major accounting and management consulting corporation. Instead, its major assembly point was more like the packed, grand entrance to New York’s Metropolitan Museum of Art, milling with enthusiastic patrons on a winter Sunday afternoon. It felt like the Sydney Olympics, with volunteer ushers, scribes, and facilitators, crowds, chatter, laughter, youthfulness (my geriatric self included), optimism and anticipation, and a touch of tinsel. I felt pleased to be alive and delighted to be there.