Jul 28, 2009

Prevention is impractical, but try telling that to the PM

Prevention is a health economist’s dream given the ageing of the population and the growth of chronic diseases. It's better than cure, PM Kevin Rudd agreed yesterday, three times. But is that really true?

Bernard Keane — Politics editor

Bernard Keane

Politics editor

“Prevention is better than cure,” the Prime Minister said yesterday, not once, but three times.

He has made much of the fact that currently we spend only 2% of our healthcare funding on prevention. Yesterday’s health reform report proposed a new, independent National Health Promotion and Prevention Agency and “shifting the curve” of health spending toward prevention.

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16 thoughts on “Prevention is impractical, but try telling that to the PM

  1. Stiofan


    In fact, why not go the whole hog and expose the complete and utter waste of Government funds across a whole range of dubious informational activities, ranging from the ad campaigns against domestic violence to the flood of glossy (and largely unread) annual reports from every government agency?

  2. Grog

    Good article Bernard, but I still would rather have bike paths than not. (though agree it’s dodgy to claim them as “health spending”

  3. stephen martin

    Some educational programs appear to work, for example quit smoking campaigns. Exercise programs and education starting at school would surely be beneficial to the long term health of children as they become adults,and could be incorporated into the curriculum (possibly they already are in some schools)

  4. David Sanderson

    Surely there is an unaddressed definition problem here. I, for one, would not have included spending on cholesterol-lowering drugs as part of the preventative health spend. Such treatments are more like the treatments for chronic conditions. Preventative health spending is mostly about the encouragement of behavioural changes (as outlined above).

    The idea that McDonalds, KFC and Hungry Jacks should have untramelled speech rights seems pretty fanciful. Obviously, their abilities to impose huge amounts of their ‘speech’ on to us is a function of their massive financial muscle. If we are going to allow them untrammeled rights to dishonestly (‘misleadingly’ is too euphemistic a term) promote their products then it would be equally fair and democratic to allow real estate property owners to build whatever they damn well please on their properties.

    Unlimited advertising is not free speech but unlimited property rights. We don’t allow unlimited real estate property rights, because of the community harm that would cause, so why should we allow the unlimited development of business properties (ie products and brands) regardless of the harm they cause?

  5. michael crook

    Well said David. Bernard, we really need to look at countries where community based medicine is proving its effectiveness. According to WHO statistics, (and Sicko) France has the most cost effective and “best” health system in the world. Community based health care in Cuba and Venezuela (which I experienced last year) provide very effective outcomes by training doctors to work within their own communities, a large part of which is preventative. Even the unfairly maligned British national Health Service rates far higher than our own both in service delivery and outcomes. We need to get the profit motive out of medicine, let the specialists buy a new porsche every 2 years, instead of every year, take the corporates out of the equation completely and consign the health insurance industry to the dustbin of history. PS have a look at the editorial in last weeks Green Left Weekly about the Cuban doctors working in East Timor.

  6. Stiofan

    Yep, when all else fails, beat up on McDonalds!

    David, your response is just a rant, unless you’re willing to say where you would draw the line on free speech. Your analogy with “real estate property rights” demonstrates this very clearly. The “community harm” that is often cited as a reason for restricting real estate property rights is too often a cover for private interests (more often than not, competing real estate property rights).

  7. Scott Grant

    I dispute the claim that corporate advertising has anything to do with free speech. It is far from free monetarily, and for that reason alone it is not free in the other sense.

    I would be quite happy to see junk food advertising banned. I like bike paths and I use bike paths, and to call it a “heavy” investment alongside road and rail is more than a bit disingenuous. Some things are just the right thing to do, whatever libertarian wingnuts wish to preach.

    But I would agree that doing these things in the name of preventive medicine ought to require some concrete evidence of benefit.

  8. Harry Mavros

    The elephant in the room here is the epistemological uncertainty that attends preventative health measures. In short, health “authorities” rarely know with any degree of certainty what causes health problems, and therefore, what remedy will work to prevent them.

    This will no doubt come as a shock to many people, who understandably trust that the “authorities” by virtue of their qualifications, letters after their name, and carefully crafted gravitas, have all the answers. Nothing could be further from the truth.

    Take, for instance, the biggest killer of Australians – cardiovascular disease (CVD). Surely, the authorities know what causes it, and therefore, how to prevent it? Hardly.

    Time after time, studies show that the preventative measures preached by the mainstream (i.e. avoiding saturated fats, eating a diet high in carbohydrates, increasing exercise to up to 5 hours/week) have yielded next to zero impact in preventing CVD. At the same time, studies have shown that diets high in fats and proteins, and low in carbohydrates, help to reduce obesity, improve blood sugar profiles and decrease blood triglycerides.

    Ok, so which message gets the tag as “preventative”?

    If the facts are contestable (and in so many cases, they surely are), then throwing buckets of money at preventative measures that may well be useless is not only wasteful, but bloody dangerous. Until we have secured more certainty on these issues (as we have on issues such as the smoking – lung cancer link), then treating the symptom actually makes more sense (counter-intuitive as it may be).

  9. Jenny Haines

    As a nurse of 32 years experience in the health system in a variety of roles, it still continues to amaze me that people understand so little about their health, and how to maintain it and what to do when they get sick. Prevention needs to be largely about educating people on what they need to do to stay healthy at all stages of their life, and the simple and basic measures they can take when they get sick to stop themselves getting sicker, eg the recent swine flu pandemic – simple measures like resting in bed, checking your body temperature regularly, drinking plenty of fluids, are all measures that in the past your mother would have taught you but now with the breakdown of the extended family into the nuclear and sub nuclear family, these messages do not seem to be transmitting from one generation to the next. This raises the question about health education in schools and universities, but would the students listen and retain, or just see it as more information that you learn for an exam, and forget immediately after. TV ads only work to a certain extent, so no I would not like to see money taken away from acute services to encourage people to exercise more. It would be a waste of money. But building a preventative approach into each persons learning for life, whether at school, university, church, holiday camp or whatever, seems to me to be the way to go.

  10. stephen martin

    From previous posts I know , at least I think I do, that Harry Mavros is a doctor,I wonder does he have an explanation for the falling CVD in Australia. From what he has just written it appears that CVD is something of a mystery. Studies apparently do not show that either exercise or diet has a noticeable beneficial effect of health. Surely falling smoking rates can not be entirely responsible?

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