Relatively small, evidence-based investments by governments can reap huge health benefits. We also know that national leadership is crucial for health protection, prevention and promotion.
But governments don’t always accept those realities. What we’ve seen in recent years at the Commonwealth level is a cycle of boom and bust in public health:
A 10 year roadmap for action on obesity, tobacco and alcohol – now ignored; a National Preventive Health Agency – now abolished; an investment of almost $1 billion in preventive health – now gutted; and a focus on Closing the Gap in Indigenous health, and addressing health inequalities for other Australians – now virtually on the backburner.
Malcolm Turnbull and the Coalition Government would have Australians believe that we can’t afford to spend money on public health. My view – Labor’s view – is that we can’t afford not to.
The Government and other voices also see public health interventions as the thin end of the nanny state wedge. Some of those voices have platforms in the Senate, and in our national debate.
To counter those views and invest in public health, we need two things. First, we need loud and determined advocacy from the public health sector. You need to keep the pressure on governments – and oppositions for that matter – to focus and invest. And you need to do that fearlessly, without thought of retribution from governments.
The second thing we need is strong political leadership. That’s a job for me and my colleagues. We need voices in our parliaments and our parties that are committed to public health.
I’m proud to say that Labor demonstrated our commitment again in the recent election campaign, with a $300 million package to prevent chronic disease and promote health. It was good policy, and I thank many of you for your part in developing it. But we announced it late in the eight-week campaign, and it got a little lost in the argy-bargy. So I want to highlight three measures in particular.
First, we committed to developing Australia’s first National Physical Activity Strategy. Frankly, it is past time for the Commonwealth to devote its full attention to getting Australians moving more.
Strategies are useful, but implementing them requires investment. So Labor committed $30 million a year to the Physical Activity Strategy – roughly equivalent to Scotland’s investment in its world-leading plan.
Many Australians – and I have to admit, many politicians – think of physical activity in terms of sport. But our commitment was guided by those of you who participated in the Consensus Forum in Canberra last year. We want to get all Australians moving more – not just those who play sport. So we committed to developing policies that boost activity across all groups, settings and sectors.
Second, Labor committed to establishing 50 Healthy Communities across Australia. We had been impressed by the Healthy Together Communities in Victoria and the Obesity Prevention and Lifestyle program in South Australia, and wanted to roll the model out nationally.
Again, we put our money where our mouth was and committed $50 million a year. This level of investment would provide significant support to each of the Healthy Communities, helping them to address their unique challenges.
And again, our Healthy Communities commitment took a comprehensive view. Rather than investing in particular projects, we want to embed healthy attitudes and behaviours everywhere people live, learn, work and play. So our initiative was designed to be flexible, allowing communities to fund a range of strategies like, embedding coordinators in local government to increase activity and improve nutrition; working with food producers and distributors to make healthy food options available in schools and workplaces; and working with state and local governments to encourage activity, such as by building walking and cycling paths.
Third, Labor committed to continuing to drive down smoking rates. We are proud of our record on tobacco control, and glad that the Government has now adopted our plan to increase tobacco excise – which they initially mocked.
But some people and groups have proven stubbornly resistant to our efforts so far. So on the advice of Mike Daube and others, we committed $20 million to renew the national tobacco campaign. The Cancer Council said this would “yield substantial reductions in smoking and related death and disease”.
We also committed $30 million to target at-risk populations such as Aboriginal and Torres Strait Islanders and Australians with mental illness. We wanted to give Primary Health Networks and Aboriginal Community Controlled Health Organisations the resources and flexibility to develop and commission local responses.
Of course, Labor will not get the chance to implement these policies in this term of Parliament. After being routed in 2013, we came agonisingly close to reclaiming Government this year.
But we will continue to play a leading part in public health for as long as this Government lasts.
Social determinants and health inequality is one area where Labor will focus in this term of Parliament.
As I read the latest AIHW report on Australia’s Health this week, I was struck by how many reports like it I have read, and how little has changed. Report after report, followed by inaction and failure.
In a wealthy, egalitarian country, we should be shocked into action that Indigenous men and women die around 10 years earlier than non-Indigenous Australians. We should be shocked into action that people in the lowest socioeconomic areas are more than twice as likely to have diabetes and heart disease than people in the highest socioeconomic areas.
Some think of health inequality as affecting only some groups, like Indigenous Australians or the poor. But we should also be shocked that half of all Australians have a chronic disease. That one in four children are overweight or obese. That one in three people delay or avoid going to a dentist because of cost.
But Minister Ley’s media release on the report was titled ‘Australia’s Health 2016 reports a healthy nation’. And as the PHAA highlighted, funding for prevention initiatives has fallen from 2.2 per cent under Labor to 1.4 per cent now.
We have become numb to the overwhelming evidence of health inequality.
To be fair, as Michael Marmot reminds us in his Boyer Lectures, the ‘causes of the causes’ of ill health are complex. Almost everything about our lives and environments shapes our health – early childhood, education, urban planning, employment, the criminal justice system, and on and on.
So addressing health inequality is complex. It requires action across governments, portfolios, sectors, groups and communities. It will not be fixed overnight.
But complexity is not an excuse for governments to turn a blind eye. We must recommit to action on health inequality and its causes.
This is an abridged version of the speech delivered by Catherine King MP at the PHAA 44th Annual Conference & 20th Chronic Diseases Network Conference in Alice Springs on Monday 19 September 2016.