The word health can carry widely diverse meanings. To many, it refers to the hospital system and the management of disease, while to others it suggests a positive state of ‘wellness’ to be nurtured and enhanced.
Professor Iain Graham, head of the School of Health and Human Sciences at Southern Cross University, has recently called for a major shift away from the present arrangement, which in his view is tied to a 19th century disease-focused view of health, towards a far more preventative orientation. According to the old cliché, this could be likened to building a fence at the top of a cliff rather than having an ambulance wait at the bottom.
Beyond the obvious improvement in health outcomes, this would have strong financial advantages; money spent upstream on prevention is nearly always more cost-effective than treatment. Furthermore, with the financial demands of ageing populations, soon governments may have no choice but to abandon the well-worn ‘business as usual’ path and rethink their health strategies.
The importance of lifestyle choices
A shift towards prevention would give individuals a greater sense of personal involvement, and responsibility for their own health. Currently, around half of all premature deaths in Australia can be traced back to avoidable behaviours, and this percentage is slowly rising.
Following a balanced wholefood diet and exercising daily are probably the two most effective preventative strategies, as they help to fend off chronic diseases including type 2 diabetes, heart disease and cancer that are caused or exacerbated by unhealthy lifestyles. Other important steps include giving up smoking, avoiding excessive drinking, and being alert to breast changes. Sometimes the benefits are experienced much later in life: breast-fed babies experience lower levels of obesity and allergies during adulthood than their bottle-fed counterparts.
Tobacco in particular is Australia’s largest cause of preventable death, resulting in over 15,000 fatalities every year, and is linked to several chronic diseases. Fortunately, the number of Australian smokers is low, and has been dropping further in response to state bans on indoor smoking.
While the Federal Government estimates that anti-smoking campaigns have saved two dollars worth of treatment for every dollar spent, Democrat Senator and preventative health advocate Lyn Allison draws attention to the political donations that the government receives from tobacco companies Phillip Morris and BAT. She also points out that the annual $2 million spent on smoking awareness programs is dwarfed by the $5 billion that it collects in tobacco excise.
Obesity has more recently arrived on the scene as another major health issue associated with chronic disease. The figures alone show what a difference preventative programs could make: around nine million Australians are overweight, with 3.3 million in the high-risk obese bracket. About one in six children are affected, and with worsening health indicators among young people, we may soon see the long-term trend towards increased life expectancy start to reverse.
A ban on junk food advertising is supported by a majority of parents and a number of groups ranging from the Cancer Council to the Australian Medical Association, but has been dismissed by the Federal Government, which rejects the existence of an advertising-obesity link. The likelihood of obesity is also influenced by the built environment, in that suburban sprawl inhibits children’s exercise through car dependency and lack of ‘walkability’. With sprawl adding to other problems including climate change, to ask a dumb question, why are we continuing to build it?
The group that could perhaps benefit the most from a shift towards prevention is the Aboriginal population. Indigenous people have a life expectancy about 20 years less than that of other Australians, and when living in rural areas they often encounter patchy health services. Obesity rates among Aborigines are twice as high, and a disproportionate number suffer from diabetes and heart disease.
One key area where Australians are reducing their personal burden on the health system is through complementary therapies. However, this contribution still goes unrecognised by decision-makers; perversely, some politicians have publicly criticised the supplement industry, which is already strictly – some would say punitively – regulated in this country.
Unlike pharmaceutical drugs and GP consultations, naturopathy and supplements receive no government subsidies or GST exemptions. The 70% of the population that uses at least one natural health care product each year does so out of its own pocket.
According to the mainstream view, vitamin supplements are of use only to people whose daily nutritional intake is inadequate. The Victorian Government’s website ‘Better Health Channel’ suggests that this might apply to vegans, smokers, and pregnant and lactating women. However, some researchers and naturopaths disagree with these narrow guidelines on the basis that multivitamin supplementation has been shown to fend off disease while enhancing overall wellness.
The health insurance sector
The current 30-40% private health insurance rebate represents a $2.6 billion subsidy, and a missed opportunity for other health funding that may have otherwise included preventative measures. This is seen by the Australian Consumers Association as a misallocation of government health spending,
Fortunately, in Australia we are lucky to have a private health insurance industry that has some stake in the good health of its customers. Several funds encourage their members to try a range of natural therapies, and these consultations are often partially reimbursed.
The American ‘health’ system, recently the subject of Michael Moore’s exposé Sicko, is a reminder of what can happen when universal health coverage, common to most developed countries, is abandoned in favour of a free market approach. Health insurers, some of which are linked to the hospital system, spend little or nothing on preventative programs. They sometimes refuse to cover needed tests, and disease remains the primary focus.
Screening – necessary or unnecessary?
Support for a more preventative approach has also been voiced by the Medical Industry Association of Australia, the industry body for companies that supply medical equipment.
With finite state government health budgets, there is the tricky question of how money is ultimately allocated. Low bulk-billing levels in some areas, under-servicing in some rural districts, and the Aboriginal health First World/Third World divide are a counterpoint to commercially motivated over-servicing of private hospital patients and the rich.
This can manifest in the over-use of screening techniques among healthy people, some of which carry a small health risk from the associated radiation exposure. Despite the fact that such activities are amply rewarded under the Commonwealth Medical Benefits Schedule, they might not be the most cost-effective means of improving health outcomes across the population.
Are the politicians doing enough?
With voices in favour of preventative health on all sides of politics, it would be easy to mistakenly believe that the paradigm shift advocated by Professor Iain Graham is already underway. The reality appears to be different. According to Senator Lyn Allison, Australia spends only 2% of its health budget on prevention, with the remainder going to hospitals and pharmaceuticals. Are we still tinkering around the edges?
The persistence of old thinking can be partly traced to the use of hospital funding as a reliable election vote-winner. Unlike prevention, which is only a concept, a hospital is a tangible building, and these already large edifices tend to expand their range of specialist facilities as some rural hospitals and clinics face closure.
Last year, the Federal Government launched the Australian Better Health Initiative, a four-year program that includes health checks for 45 year-olds (a time in life at which chronic conditions can develop), and includes Lifestyle Prescriptions (‘Lifescripts’) as an alternative to drug prescriptions. However, the Australian Traditional Medicine Society draws attention to the fact that the Initiative provides no role for complementary practitioners.
A federal election is fast approaching, and Labor’s health policies, unveiled in June as part of its Fresh Ideas, Future Economy package, emphasise prevention. These address lifestyle issues and disease prevention, while advocating longer GP consultations. Again, the potential contribution of naturopathy seems to have fallen off the radar.
Senator Lyn Allison draws attention to the fact that while the US and Canada both have preventative health taskforces, no equivalent body yet exists in Australia.
Existing outside the mainstream frame of reference is Dr. Patch Adams, an American doctor and social activist famous for originating the idea of the clown doctor as a means of cheering up sick children. Never afraid of confronting what he saw as unhealthy in the US medical system, his patients were treated free of charge at his Gesundheit Institute, and he refused to carry malpractice insurance.
Through his researches and experiences, Adams tried to identify the roots of health in its broadest sense. To demonstrate how cultural myopia causes us to look in the wrong direction, he points out that so far he has been unable to discover one paragraph in a psychiatry textbook that is devoted to happiness.
In addition to the individuals, he sees ill-health operating at a wider societal level. The prevalent adult way of existence in industrialised countries, with its increasing loneliness, loss of meaning and general boredom, may encourage disease. Adams’ prescription is to banish this greyness with love, friendship, community, creativity, and contact with nature. To this mix, he would add play, laughter and child-like behaviour.
Such a radical change in priorities may have an even greater positive effect on health outcomes than any proposals offered by political groups and health organisations.
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