When weighing up the various election policies through a health lens, some of the most important issues to consider are:

1. How do the policies address climate change, the major public health issue that we – as Australians, as the planet – are facing?

2. How are health inequalities addressed? Is there an explicit commitment to addressing the social determinants of health, and to implementing a health-in-all-policies approach?

3. What is the plan for improving Indigenous health, mental health, the situation of those living in poverty – especially children, and the health of asylum seekers (some of the most glaring areas of health inequalities).

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4. How do the policies address prevention, and are they upfront about the need to tackle the vested interests that contribute to so much poor health and unhealthy environments, particularly the coal, tobacco, alcohol, gaming and junk food industries?

5. How do the policies plan to ensure the sustainability and affordability of our health system? This requires major ongoing reform, and again being prepared to take on the powerful vested interests that tend to dominate policy agenda.

As to the above, a search of the Coalition’s health policy finds:

1. No reference to climate change and no response to calls for a national policy to deal with its health impacts.

2. No reference to health inequalities, the social determinants of health or health in all policies.

3. Only passing reference to Indigenous health and mental health. Mind you, as has been pointed out by the Australian Medicare Local Alliance, neither major party distinguished itself on Indigenous health so far this election.

4. Apart from Tony Abbott’s announcement that the Liberal Party will no longer accept tobacco donations, the policy gives no signal of intent to tackle the interests that contribute to poor health. (Update: indeed, their policies on gambling are exciting widespread concern).The title of the policy – The Coalition’s policy to support Australia’s health system – doesn’t inspire any sense that population health is understood, let alone a priority. The only mention of prevention is in the context of plans for a new national diabetes strategy. The policy fails to even mention the Australian National Preventive Health Agency, surely an ominous sign.

5. The policy explicitly endorses the importance of a universal health system: “strong public hospitals providing universal access to care will be a central pillar of our health system under a Coalition government”. But it leaves unanswered important questions around the fate of the architecture of national health reform that underpins this pillar, for eg does the Coalition support the National Health Performance Authority? It gives no indication that the Coalition has any plans for a reform agenda as groups like Mend Medicare would like to see. As this article at The Global Mail makes clear, the Liberal Party is heavily backed by the private hospital industry  – and Tony Abbott’s support for the private sector showed yesterday in his suggestion that private hospitals outperform public hospitals (a highly contestable statement given that less than half of the 570 private hospitals report quality and safety data to the MyHospitals website). The policy mentions hospitals 26 times, while primary care rates 15 mentions. The only mention of Medicare Locals is ominous, that there will be a review “ensure that funding is being spent as effectively as possible to support frontline services rather than administration”. Senator Richard Di Natale tweeted yesterday that he suspected the review may be “code for abolition”.

Bu perhaps it’s naive to expect that election health policies might offer a vision for the future. As the University of Sydney’s James Gillespie has written at The Conversation, the Coalition’s health policy seems mainly focused on keeping itself a small target. The policy is cautious and more focused on attacking PM Rudd than providing any visionary alternatives, he writes. Clearly it’s the politics, not the policy that is driving this policy document.

The policy will cost $340 million over the forward estimates and is structured under the headlines of supporting hospitals, timely access to medicines, and rebuilding primary care.

Its announcements include:

• The Health Minister will have the authority to list medicines recommended by the PBAC that do not cost more than $20 million in any of the first four years of listing. “We will help Australians get quicker access to new treatments.”  As one Croakey contributor notes below, it sounds like Peter Dutton and his advisors haven’t read Ben Goldacre’s book, Bad Pharma – and should.

• The Coalition will bring forward the full implementation of biennial bowel cancer screening by 14 years.

• It will invest $52.5million to expand existing general practices for teaching and supervision; invest $119 million to double the practice incentive payment for teaching in general practice/

• Provide 500 additional nursing and allied health scholarships for students and health professionals in areas of need and provide $40 million for 400 medical internships in private and non-traditional settings.

• The Coalition will work with the sector to provide a nationally coordinated approach to clinical trials, reduce complexity of ethics processes and where possible, rationalise the number of ethics committees.

• The Child Dental Benefits Schedule, which is due to commence in January 2014, is to provide access to $1,000 in Medicare dental benefits for eligible children. From 1 July 2014 funding is due to be provided to the States under the National Partnership Agreement for Adult Public Dental Services.  The Coalition will honour the arrangements under the National Partnership Agreement for Adult Public Dental Services and will continue to work with stakeholders, patient representatives and State and Territories to improve the scheme as necessary. At the expiry of the National Partnership Agreement for Adult Public Dental Services, the Coalition will seek to transition respective adult dental services to be included under Medicare.

***

Responses from Croakey contributors

On public health

Professor Simon Chapman, University of Sydney (re stopping tobacco donations)

Better late than never. The Liberals now join the Greens and Labor in telling Big Tobacco “we don’t want your blood money”. That leaves only the Nationals as a major party yet to show tobacco the door.

This is certainly an announcement of important symbolic importance. But the Liberal Party has deep connections with the Institute of Public Affairs, which receives money from British American Tobacco and probably other tobacco companies.

There will be nothing stopping the IPA from laundering tobacco donations to political parties, and that’s likely to only mean the Liberals. But will it do them any good?

Tony Abbott memorably went out of his way to say publicly on the morning of the 2012 High Court decision on plain packaging that he hoped the High Court would uphold the government’s intent on plain packs and reject the tobacco industry’s case.

He also has announced that a Coalition government will be keeping the Labor-announced major tax increases over the next four years. These will drive smoking down further, while bringing in over $5billion in revenue. Abbott while health minister in the Howard Government, introduced graphic health warnings on packs, hardly the action of a poodle for Big Tobacco.

***

Professor Mike Daube, Curtin University

Delighted by bipartisan approach to tobacco funding. That’s a big and important step forward.

Bowel cancer screening commitment is good.

Would have liked to see more about prevention programs: commitment to maintaining action on tobacco; firm action on alcohol; focus on obesity tsunami.

***

Nutritionist Rosemary Stanton

Reading through the Coalition’s health policy, prevention of non-communicable diseases seems limited to bringing forward

(a) bowel cancer screening (a good idea – although what is the policy when the faecal occult test reveals something that requires a colonoscopy – what is the policy for this procedure, currently very costly or subject to long waiting periods for admission to a public hospital),

and

(b) some vague thoughts on trying to bring the different diabetes organisations together (bests of British on that!).

Prevention of type 2 diabetes requires looking at obesity. It’s all very well and good to use increased services of allied health professionals, but they can’t address what is basically an obesogenic environment. And obesity is one of the major problems related to diabetes, it’s also relevant to bowel cancer, cardiovascular disease (which seems to have been forgotten), osteoarthritis and many other health problems.

The two major areas of preventing obesity have not been addressed – ie making it easier for people to be physically active and to choose healthier foods. These areas need to be addressed at a structural level rather than leaving them to individual consultation with an allied health professional.

The food supply is top heavy with junk foods and drinks – all advertised extensively (through TV, radio and print advertising and increasingly through advergaming directed at children and social media campaigns – such as those run by Coca Cola). Neither individuals or industry operated codes of practice are sufficient to tackle these problems.

For physical activity, we need more emphasis on public transport and local affordable facilities. (The Coalition seems to think more roads are more important than public transport or cycling facilities.) While local facilities such as walking paths, sporting fields, playgrounds, swimming pools etc) may be a local government responsibility, this is an area where fears of litigation have made local authorities prefer to remove facilities rather than face possible legal action. This is one area where federal govt could assist by removing ‘red tape’ systems that favour lawyers and litigation over provision of public areas suitable for physical activity.

On food, where is the policy that will help individuals make healthier food choices – especially those on lower incomes? Where is the policy to stop bombarding kids with ads for junk food and drinks, and adults with ads for alcoholic beverages. Where is the policy to tax alcoholic drinks on their alcohol content? Where is the policy to ensure fresh produce is available at a reasonable price to low-income people and those in more remote communities?

The rant about private health insurance rebates being removed is absurd. How can the Coalition describe those earning high salaries (which were the only ones with a cut to the PHIR) as ‘struggling’ under cost of living pressures?

The statement that the Coalition will ‘reinvest in private health insurance “once fiscal circumstances allow” is a good example of weasel words. Why should there be a rebate for anyone taking out private health insurance. There is no rebate for people insuring their lives, cars, houses or other aspects of life. If the money spent on rebates for private health insurance were directed to public health and public hospitals, there would be no crisis in health care.

I am against giving the Health Minister sole responsibility for approving medicines where the costs is less than $20m (or any other figure). Health Ministers are not health experts and giving any one person such responsibility opens that person to persuasive tactics from those wanting their medicines approved in this way.

Where is some kind of policy on ‘shonky’ goods marketed under the TGA’s almost non-existent oversight?

*** 

On mental health

Sebastian Rosenberg, University of Sydney

I am flabbergasted that the issue of mental health is completely ignored in the Coalition’s health policy.

How can an issue with such currency only a few years ago now seem so far off the political radar? Within the past fortnight, major reports into mental health have been issued by the Mental Health Council of Australia and by a consortium of nearly 50 organisations led by Adjunct Professor John Mendoza.

Mental health in Australia remains in crisis.  The lifespan of people with severe mental illness has not improved over the past 30 years. Neither party has so far offered any solutions or commitments to change this pitiful situation, one in which suicide and self-harm are common, daily occurrences for our young people.

Even armed with increasing evidence about what works in mental health care and treatment and a suite of articulate and high profile advocates, the issue of mental health has uniquely found a way to disappear from public view, leaving literally millions of Australian people and families isolated and unhelped.  The electorate has repeatedly indicated its concern to see mental health fixed.  It seems a bizarre and tragic case study in reverse advocacy, one worth studying carefully.

It is even more curious because many if not most politicians have some level of intimate understanding of mental illness and the impact it can have on families. What permits such a  damaging and pervasive health and social issue to go unaddressed?  What makes it ok for our politicians not to speak about mental health? To ignore it?

I am not sure of the answer but clearly mental health has failed to demonstrate the merit of continuing attention.  I think this is at the heart of enduring stigma towards mental health – that spending money on crazy people would in itself be crazy.  Sophisticated arguments about the economic and productivity benefits to be derived by assisting people with a mental illness to find work don’t stack up against this prejudice.  Crazy.

The poverty of our so-called mental health system means the nature of care and treatment vary from place to place.  People don’t trust services to be available when and where they need them. People are helped to understand the risks and have confidence in cancer treatments. Can we say the same for mental health and if not, why not?  Stigma lives here.

The past decade has seen a stop/start attitude to mental health reform in Australia.  At the moment, we are practically at full stop. Governance of and responsibility for mental health is skewered on the federal/state divide. Let’s hope that before the campaign is over, the huge task of mental health reform can at least be considered by the major parties.  Nobody is expecting miracles.  Just some ongoing attention to one of the biggest health and social challenges facing 21st century Australia.

***

On Indigenous health

Dr John Boffa, Public Health Medical Officer, Central Australian Aboriginal Congress

It is vital that responsibility for Aboriginal health remains in the health department and is not transferred into PM&C.

I have published on the success of the transfer of health administration responsibility from ATSIC to the DoHA – we cannot go back to a situation where responsibility for health is back within a non-health literate bureaucracy.

It may well be useful to have PM&C responsible for some aspects of Aboriginal Affairs such as economic development and creation of employment in Aboriginal communities but not health and education these should stay out. PM&C could take over the FaHCSIA portfolio areas and this may well be useful and give these areas more clout.

***

NACCHO statement

Aboriginal people across the country today will be disappointed by the release of the Coalition’s health policy given the persistent appalling health gap between Aboriginal and non-Aboriginal Australians.

NACCHO Chair, Justin Mohamed said the seventeen page Coalition Health Plan dedicated only one line to Aboriginal health and provided no detail on the initiatives they would support to specifically improve Aboriginal and Torres Strait Islander health outcomes.

“Tony Abbott has previously expressed a commitment to closing the shameful health gap between Aboriginal and non-Aboriginal Australians.

“The Coalition signed the Close the Gap Statement of Intent in 2008 and plans to elevate Aboriginal affairs directly to the Prime Ministerial office if Tony Abbott wins Government in three weeks.

“Given that, it is disappointing and somewhat surprising that he has not given a lot more focus in his Health Policy to solving the challenges in Aboriginal health.

“Focusing on bowel screening, diabetes management, dental health and building the medical workforce are welcome initiatives in the Coalition Policy but must be delivered by Aboriginal people to Aboriginal people if we are maximise their effect in Aboriginal communities.”

****

On private health insurance

Ian McAuley, Centre for Policy Development Fellow

In the Coalition’s health statement we see its perennial and unquestioning commitment to private health insurance, a financial intermediary which, even after the Government’s introduction of means testing last year, is costing $5.4 billion a year in budget subsidies.

The document claims a Coalition Government “will alleviate the burden on our public hospitals by reinvesting in private health insurance as soon as fiscal circumstances allow”.

Just how recurrent spending on a transfer program can be called “investment” defies any notion of accounting rigour, but we have become used to such slovenly economics in Coalition statements.

There is no evidence that using private insurance to push people into using private hospitals does anything to “alleviate the burden on our public hospitals”. Indeed, it is quite probable that private insurance has worsened the situation for public hospitals, because where the money goes so too do the resources – the nurses and surgeons.

Think of someone needing a hip or knee replacement, who knows that there is a long waiting list for a public hospital, but who is told that they can be accommodated at short notice in a private hospital, because that’s where the surgeons are now working. When someone is subsidised to gain priority access to a scarce resource, all that happens is that the queue is re-shuffled, and if those getting priority service have lesser needs than those they displace, then the queues become even longer.

Our private health insurance arrangements have never been subject to economic evaluation, such as a cost-benefit analysis. The Howard Government did make a reference to the Industry Commission in 1996, but that was only about how private health insurance should be subsidised, not whether it should be subsidised, and the final recommendation of that report was that there should be a broad public inquiry into our health system, including funding.

No government has had the courage to bring on such an inquiry.

Rather than providing any economic justification for subsidising private health insurance, Tony Abbott has repeatedly said “The private health insurance rebate is an article of faith for the Coalition.” and “Private health insurance is in our DNA”.

The case against using private insurance to fund health care is clear. It is an expensive and inequitable way to share our health care costs. For a start it is bureaucratically expensive – only 85 cents of every dollar passing through private health insurers goes to health care, compared with 95 cents which passes through the tax system and Medicare.  More importantly, because competing private insurers lack the market discipline that can be exercised by a single national insurer, such as those operating in Britain, Canada and the Nordic countries, health care costs tend to spiral out of control, as has happened in the USA.

The Liberal Party appears incapable of understanding that private insurance does nothing to bring market discipline to health care, because insurance of any kind, private or public, muzzles price signals. The attitude “MBF/BUPA/Medibank Private will pay for it” is exactly the same as the attitude “Medicare will pay for it”: it’s about replacing government dependence with corporate dependence, or, in the language of the “right”, replacing the “nanny state” with the “nanny corporation”.

More rational “right-inclined” governments, such as the Swedish Government, have retained their single national insurers, but have required those who can afford to do so to make uninsurable copayments before national insurance kicks in. In that way they bring a degree of market discipline to health care, while still providing a universal safety net. Importantly, they make sure that private hospitals can be part of the service-delivery network.  By contrast we have allowed private hospitals to become almost totally dependent on private insurance, which means that any criticism of private insurance is easily interpreted as a call for “socialized medicine”.

In 1987 the Liberal Party went to the election with such a market-based policy, proposing that people be required to pay $250 from their own pockets before Medicare would kick in. In relation to incomes, that’s equivalent to around $800 now.

Such a policy would mean that most people, most of the time, would make no call on any government support for their health care, and it would condition us all to think of the choices we make around our lifestyle and health care.  It would be even more fitting now than it was in 1987, for since then we have become much wealthier: ABS figures released last week show that Australian households, on average, now have more than $100 000 in reasonably liquid assets.  Australians, particularly those who are well off, have more capacity than ever before to pay for health care from their own pockets, while relying on Medicare as a safety net for those with high needs or limited needs.

Twenty-six years on from 1987, the Liberal Party seems to have abandoned market-based policies, in favour of corporate welfare for the financial sector.

***

On palliative care

Yvonne Luxford, Palliative Care Australia

I can certainly understand the Coalition’s focus on primary care – this is where most health care does, and should take place. It’s unfortunate that this primary care focus doesn’t expand on the potential of ongoing care in the community, both for aged care and palliative care.

In fact both palliative care and aged care are sadly missing from the policy.

There are some opportunities built in though. Currently the Palliative Care Foundation runs a small scholarship program to assist health professionals to expand their education in palliative care. As per the recommendations of the Senate Inquiry into Palliative Care in Australia, the Coalition policy could boost the Foundation so as to better meet the drive of the sector to improve their knowledge.

Additional internships could also be a boon to palliative care. If more doctors can be exposed to palliative medicine as interns we can hope that more will choose to specialise in this field, or simply to incorporate the learnings in whichever field of medicine they practice.

***

On workforce and general policies

Professor Andrew Wilson, Menzies Centre for Health Policy, University of Sydney

The devil is always in the delivery but:

1. Reinstating the ministerial delegated $20m responsibility for PBAC decisions is sensible, the increased limit necessary to allow for inflation. The challenge is that pharma can usually structure their proposed listing to come under the cap by limiting the target population. The risk is whether that target population actually reflects the real prescribed population (this is not a new risk). A newer risk is that there are a lot more niche medicines, ie targeting specific conditions.

2. The need for a National Diabetes Strategy with a much stronger prevention element is self-evident. However not clear what resources will be behind strategy other than the $30 million for research on curing type 1 diabetes which represents about 15% of all diabetes cases. T1 diabetes is disproportionately costly because f younger age of onset and higher complication rates.

3. The need for the guarantee on intern places is important (declaring my COI as I have a child studying medicine). I also think the additional subsidy to general practice teaching is good news as this remains a specialty that needs to expand rapidly. Nothing wrong with the scholarship proposal although shown to have limited workforce impact. I remain concerned that there is no additional support for supporting new nurse entry. The workforce modelling shows tis is the most critical future resource shortage and while we have expanded undergraduate training numbers, there will be a short term excess of nursing graduates who will be unable to find entry level positions and who will then look elsewhere.

I am also concerned that the additional GP teaching subsidy puts yet another price signal in the clinical placement arena will bring further efforts from public hospitals to charge for clinical placements. The independent Health Pricing Authority should be directed to accelerate its work on the teaching, research and training component of ABF for hospitals so there is a consistent approach to this across sectors.

4. Not totally clear on what is proposed on dental health but at least the interim commitment to continue current arrangements hopefully won’t see us going backwards.

5. Mixed messages here about private health insurance but at least without specific commitments they have left themselves room to undertake a major review of private health insurance if they get into office.

***

Professor John Dwyer, UNSW

No exciting policy announcements re our health system have been forthcoming from the Government or Coalition. They refuse to recognise the structural deficiencies that need correction if we are to give Australians the contemporary health system they need.

I stress the word health as much of the discussions centre on sickness.

Where will we find the leadership to take us on a journey to a single funder model integrating in a patient focused way Primary, community and hospital care/ $4 billion could be saved by a single funder model—9 departments of health for 23 million people?

No structure to see us focus on prevention is forthcoming despite the evidence from so many countries that having people enrol in an Integrated Primary Care model (team medicine) where patients and families are serviced to help them stay well rather than just treat illness is cost effective. It requires Medicare funding of teams of doctors, nurses and allied health practitioners in the one practice (not just physically located in separate practices but I the one building e.g..  Super GP clinics.

The only way we can afford timely quality hospital care into the future is through a reduction in the demand (need) for hospital services through better community care.

The PC remember has estimated that 700,000 plus admissions to public hospitals could be avoided by an effective community intervention in the three weeks prior to someone requiring admission.700000 x $5000 (average cost of an admission) = 350 million dollars tat could be available for the PC sector.

Where are policies to tackle the increasing inequity that sees the biggest growth in health expenditure coming from Australians’ wallets. There is much more structural change that is urgent, Inter-professional learning in universities to break down the silo mentality among health professionals, shortening medical education, speeding up entry into post graduation vocational training, establish some rural based medical schools for rural students and so much more.

***

The Australian Healthcare & Hospitals Association

The AHHA welcomed the support and investment in primary care services and the apparent softening of the Coalition’s position on Medicare Locals.

“It is hoped that the Coalition’s intention to reduce bureaucracy and duplication across agencies will flow on to health services in the form of greater transparency and streamlining of funding arrangements and a reduction in the reporting burden which will free up resources to be directed to patient care.  There is always a risk that indiscriminate cuts will just redirect work and responsibilities to the remaining staff and service providers.”

“The Coalition has supported the current Government’s dental reform program including the Medicare child dental benefits schedule and the National Partnership Agreement on Adult Public Dental Services. The Coalition’s commitment to pursue inclusion of adult dental services in Medicare is an important step towards universal dental care in Australia and progress in this area will be watched closely.”

“The commitment to fast-track the implementation of the National Bowel Screening Programme is welcomed as an example of a commitment to effective evidence-based preventive programs.  A greater focus on prevention is critical to improving health outcomes and reducing costs.”

***

On changes to the PBAC listing process

Pharmacologist Gillian Shenfield

Overall it seems to be a document full of platitudes, generalisations and feel good comments. Still I guess it is an electioneering paper.

I would support more devolution to local control of hospitals ie give the Boards more power. But it is not clear to me how they intend to achieve this.

If they really intend to back the PBAC decisions I would support that initiative but I don’t think they’ve costed it!

I’m not fully in support of the Clinical Trials proposal as, all too often, new ‘Wonder Drugs’ are often found to be less effective and have more side effects than first claimed. They also cost a fortune.

I’m no expert on bowel cancer but I do know that there have been a number of recent articles suggesting that screening has numerous problems and may not be cost effective or save as many lives as claimed.

*****

Clinical pharmacologist Professor Ric Day, UNSW

Good to support integrity of PBAC system – do not allow sectoral lobbying of health minister or government to over-ride PBAC.  Lifting the Cabinet approval ceiling to $20M sensible.

Saving money via lower generic prices as are achieved elsewhere ought to be a priority.  Giving some more independence to TGA via some ‘public’ as opposed to ‘cost recovery’ funding, currently unlike any other equivalent world agency, would be a good reform.  Then Product Information, evidence requirements for CAM efficacy claims, auditing activities etc of this important agency could be ramped up in the public interest.

Funding active use of Medicare data to evaluate the return on investment for expenditure on medicines should be a major priority – examples of Denmark and other countries where this has been achieved.  We invest $8 or so billion per annum in the PBS but spend very little to see if the gains ‘promised’ actually occur

****

Pharmacy consultant Ron Batagol

Pleased to see a commitment to restoring sanity to the PBAC approval process, and a return to take the advice and special expertise of that Committee, instead of having a motley collection of cabinet pollies making decisions to withhold life-saving new medicines from PBS inclusion when they have been recommended by PBAC after consideration of all the pharmacoeconomic and cost/benefit issues.

Also, it would be great if they would really concentrate on enhanced primary care and peel away some of the layers of bureaucracy in public health that all Labor Governments seem to build in and sustain for their health programmes.

Finally, and I am surprised and disappointed that neither Party has suggested this, I believe that since we all know that a large proportion of chronically ill people, who are better treated in the own community, move frequently in and out of hospitals to be stabilised and returned home, why not provide funds for GPs to re-train on a structured, accredited sessional basis in ED, and other key hospital clinical areas such as cardio-thoracic, so that they could then manage, under a funded programme,  chronically ill patients within their own community, who may otherwise be sent to hospital for acute stabilisation,  and, of course,  assess those who need transfer to an acute hospital setting.

Whilst such a programme may need to include additional equipment and treatment facilities in GP clinics, and appropriate structured liaison arrangements with para-medic services, it would, over time, save a huge proportion of expensive hospital costs, including lowering emergency department costs and demands.

***

On bowel cancer screening

Cancer Council Australia

The Coalition’s commitment to complete the National Bowel Cancer Screening Program by 2020 would save 35,000 lives over the next 40 years, according to Cancer Council Australia.

Cancer Council Australia CEO, Professor Ian Olver, congratulated Shadow Health Minister Peter Dutton on the announcement, which included a $46 million commitment to add two new age groups to the screening program from 2015.

Under the Coalition plan, the remaining age groups would be added over the following five years, making bowel cancer screening available every two years for all Australians aged 50 to 74.

Professor Olver said the Coalition’s commitment was the best thing any future Australian government could do to reduce the nation’s cancer burden.

“Cancer Council’s analysis shows that by completing the screening program by 2020, we could prevent around 35,000 bowel deaths over the next 40 years – or an average of about 875 deaths a year.

“The Coalition should be congratulated for committing to the completion of the program, which was introduced by a Coalition government in 2006.

“Completing the program by 2020 would be the best thing any government could do to reduce the nation’s cancer death toll.”

Professor Olver said he hoped the ALP would also commit to a fully implemented bowel cancer screening program by 2020 during the election campaign.

***

On prevention

Luke van der Beeke, Marketing for Change

I support the emphasis placed on clinical research and the streamlining of the grant application and approvals process.  I also welcome the targeting of chronic disease and note the multiple references to diabetes in the policy.

But the term ‘prevention’ was notably absent from the document.

Also notable was the barely passing mention given to Indigenous health and mental health services.  Our consistent failure to adequately provide for the health needs of Indigenous Australians and those with mental illness concerns me greatly.  Aside from the moral imperative to provide for the most vulnerable in our society there is also a strong economic argument for early intervention and prevention.

I’m not surprised there is heavy emphasis on the education and training of the medical workforce and it has my full support.  I’m also very pleased to see reference to the Implementation and Expansion of Bowel Cancer Screening Programme.  I only hope that this (along with other early detection screening programmes) are supported by effective, insight-led social marketing programmes.  Health communication campaigns have their place, but they are not holistic in nature and rarely result in sustainable behaviour change.  I’d also like to see more emphasis given to prostate cancer, which along with suicide is a far too often overlooked killer of Australian men.

The policy states that: “universal access to care will be a central pillar of our health system under the coalition government.”  This is a worthy aim.  However, having watched what was perhaps the world’s only true universal health care system (The NHS) be effectively privatised by the Conservatives, statements such as: “devolution of responsibility” concern me.  This is the sort of terminology along with “’small government”, “shared burden”, and of course “we’re all in this together” that was a precursor to austerity, cuts to health (primary and public) and the rise of GP Consortia in the UK.

The reality is that our current health system is inefficient and not able to meet the needs of the Australian population.  This is particularly true for the disadvantaged.  This is precisely why both sides of politics must invest in prevention.  It’s simple really.  The most cost-effective way to tackle many non-communicable and chronic diseases is to prevent their onset.

A mixed bag.

***

Consumers health forum:

“This policy is a good start in describing how a Coalition government will invest in the health and wellbeing of Australians, but we look forward to hearing further commitments around key areas of health, including in the areas of Mental Health, Palliative Care, Indigenous Health and Aged Care.

 ****

Inaction and inertia 

And finally, don’t miss Lesley Russell’s analysis of health and the election at Inside Story, where she argues for “long-term structural reforms that reward improved health outcomes, focus on keeping people out of hospitals, optimise workforce capabilities, utilise new technologies effectively, respond to patient and community needs, and preserve the principles that Medicare was founded on”.

She warns that the biggest threat to the Australian healthcare system may come simply from inaction and inertia – from politicians who are unable or unwilling to tell the electorate what their plans and policies are and voters who are not sufficiently engaged to push their elected representatives to lay out their policy proposals and costings for scrutiny.

She says: “Under such circumstances unpleasant and unanticipated surprises will inevitably surface in the days following 7 September.”

I subscribe to Crikey because I believe in a free, open and independent media where news and opinions can be published that I can both agree with and be challenged by.

As a Crikey subscriber I always feel more informed and able to think more critically about issues and current affairs – even when they don’t always reflect my own political viewpoint or lived experience.

Jess
Singapore

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