Preventing and managing chronic disease
The burden of chronic disease is particularly borne by disadvantaged communities and individuals who experience higher rates of chronic disease and greater exposure to associated risk factors.VCOSS Policy Advisor, Brooke McKail, argues that a broad social determinants of health approach to prevention and management of chronic disease in Australia is required that guarantees universal access to affordable and timely heath care.Australia needs to increase its investment in chronic disease prevention to reduce the burden of chronic disease on disadvantaged communities, and address the barriers that prevent people accessing timely, affordable health care.
Primary health presents an important opportunity to address some of the risk factors that can contribute to chronic disease, and to intervene early for people at risk. Equitable, affordable and timely access to primary health care is essential to reducing health inequities and effective early intervention and management of chronic disease. Universal healthcare is the most effective, efficient and equitable way to ensure the delivery of our commitment to the Australian public of adequate health care.
Chronic diseases in Australia are significant contributors to illness, disability and premature death. Chronic disease causes nine out of ten Australian deaths. The burden of chronic disease falls particularly on communities that are already facing disadvantage, including people on lower incomes and people in rural and remote Australia. For example, Australians aged 25-44 in the lowest socioeconomic group are nearly five times more likely to have a chronic health condition as those in the highest.
However, the World Health Organisation (WHO) has estimated that at least 80 per cent of all heart disease, stroke and diabetes are preventable, as are 40 per cent of all cancers.
Despite this, prevention has and continues to be an area of significant under-investment in Australia. In recent years Australia has invested a lower proportion of its health expenditure in prevention than most other OECD countries, with just 1.7 per cent of 2010–11 health spending on public health, or less than 0.2 per cent of GDP. In comparison, New Zealand invested seven per cent of total health expenditure in prevention. The recent termination of the National Partnership Agreement on Preventative Heath by the Australian Government, four years before its extended expiration date of June 2018, is an example of the lack of priority given to preventative health.
The NPAPH provided more than $870 million in funding over eight years for programs to reduce risk factors and prevent chronic diseases in schools, workplaces and the community. As well as a large investment in preventative health programs, the NPAPH included measurable targets for reducing risk factors for chronic diseases.
As a result of the termination of the NPAPH many successful programs will be forced to end, including those funded through the Health Together Victoria program.
Case study: Healthy Together Victoria, Wyndham
Healthy Together Victoria is a comprehensive preventive health initiative, funded through the National Partnership Agreement on Preventative Health, and designed to improve people’s health and wellbeing. Under the initiative a number of “healthy together communities” have been established across Victoria, including in Wyndham, west of Melbourne.
Only five per cent of adults living in Wyndham eat enough vegetables and about 53 per cent are overweight or obese. 25 per cent of women in Wyndham smoke, well above the national average. In the two-and-a-half years that Healthy Together Wyndham has operated, the program has reached about 54,500 residents. Two-thirds of Wyndham schools, kindergartens and childcare centres are involved in the program, along with 39 businesses.
To address increasing obesity rates and chronic disease, the team has been:
- working where people live, work and play – in workplaces, schools, kindergartens, child-care centres and sports clubs
- helping create the conditions for good health by ensuring all residents have access to healthy food, recreation opportunities, employment, housing, community services, education and transport; by reducing social exclusion; and by limiting the availability of alcohol
- helping to deliver statewide health campaigns and programs
- delivering healthy eating and exercise programs
- increasing access to community wellbeing services.
The Australian Government has also foreshadowed $596 million in cuts to Health Flexible Funds over the next four financial years. While there is not yet clarity about how these savings will be achieved, there is likely to be significant impact on funds that support services working in chronic disease prevention, substance use treatment and essential services in rural, regional and remote Australia.
VCOSS prepared a submission to the House of Representatives Standing Committee on Health inquiry into Chronic disease prevention and management in primary health care on behalf of the national, state and territory Councils of Social Service across Australia.
The submission made the following recommendations:
- Tackle health inequities by recognising the higher prevalence of chronic disease and greater exposure to risk factors among disadvantaged populations and work to improve health outcomes for disadvantaged Australians by addressing the social determinants of health.
- Adopt a broad social determinants of health approach to effective prevention and management of chronic disease, and strengthen and consolidate guarantees for universal access to essential health services including affordable primary health care, to provide a basis for good health and wellbeing over the life cycle.
- Sustain and increase investment in chronic disease prevention, including reversing foreshadowed reductions in funding to Health Flexible Funds that will reduce the capacity of community organisations to support vulnerable and disadvantaged communities.
- Introduce measurable preventative health targets and regular reporting on population health expenditure.
- Ensure Primary Health Networks operate as open and transparent organisations that work in partnership with all stakeholders, including consumer organisations and community service providers.
- Ensure Primary Health Networks are supported and resourced to actively engage consumers in the design and delivery of services
- Address the barriers that prevent equitable access to timely and affordable primary health care services, discourage early intervention to keep people well.
The Councils of Social Service have long called for a health system that promotes positive health outcomes for all people in Australia, regardless of their social or economic situation. We advocate against systemic barriers in the health system that lead to people having poorer health; and we work towards equitable access to income, education, secure housing and employment as some of the social factors that correlate so strongly with health outcomes. The COSS have developed a joint statement on health priorities.
 AIHW, Australia’s Health 2014, 2014, pp. 94.
 NATSEM, Health lies in wealth: Health inequalities in Australians of working age, Report No 1/10, September 2010, p. x.
 World Health Organisation, Prevention chronic disease: a vital investment, 2005.
 AIHW, Health Expenditure 2010-11, September 2012.
 AIHW, Australia’s Health 2014; Chapter 8 Preventing and treating ill-health, http://www.aihw.gov.au/australias-health/2014/preventing-ill-health/ , accessed 4 August 2015.