Effective public health investment seems to be the crux of a healthier society. So why, oh why are we spending a grand total of $140 per person per year?
Last weekend, I attended the Australian Medical Student Assocation-run Global Health Conference.
Despite being entirely student run – and no doubt light on budget – the conference procured several heavy hitters for the program.
Public health and its myriad of – effective – approaches was a recurring theme.
Opening the academic program, South Australia’s chief public health officer Professor Nicola Spurrier touched on the principles that guide her approach to public health.
Sometimes, it’s as easy as taking the “handle off the pump”, said Professor Spurrier, refencing the well-known epidemiologist and public health legend Dr John Snow’s response to the cholera outbreak of 1854.
While not always this simple, or cost effective, innovative solutions are aplenty.
Victorian Health Promotion Foundation (VicHealth) CEO Dr Sandro Demaio traversed the globe in search of the crux of public health, leading him from education to global health organisations – namely the WHO – and ultimately landing him at an upstream, systems-based, multisectoral approach to public health.
Through the EAT Foundation, Dr Demaio was involved in publishing the Planetary Health Diet with the EAT-Lancet Commission which outlined the optimum diet for human health and environmental sustainability.
He now works with a $50 million yearly budget through VicHealth, which is currently working to roll out its 10-year strategy to move the focus of public health from individual to systemic change.
While there may be differences of opinion on exactly what the most effective multisector public health initiatives are, time and time again throughout the conference their effectiveness was emphasised.
So, riddle me this: the public health experts say it’s so, the science backs it up, the politicians seem to get the memo(doesn’t always hold much weight, I’ll give you that), so how are we spending a perilous $140 per person on public health across the nation?
That amounts to 1.8% of the total health spending – federal and state – according to the recent paper published in the Australian and New Zealand Journal of Public Health.
Some days, two plus two doesn’t quite make it to four.
Like so many health-related problems in Australia – I’m thinking workforce – it’s not just the dollar figure, it’s distribution.
Lead author of the ANZJPH-published paper Emeritus Professor Alan Shiell from La Trobe University said the research unearthed a “complex and piece-meal funding system”.
“While delegating funding decisions to the states and territories who understand local need is a strength of our current model, it leaves the public in the dark about exactly where the money is going and exactly how much is being spent on public health.
“It also makes it very hard for us to assess what difference public health spending is making.”
While I wouldn’t dare to suggest having the answers, it seems some people do – or at the very least have some cost-effective, evidence-based options.
My gauge on the blockage? So many functional public health initiatives are just that – a little too functional in presentation. They lack the silver bullet-esque, sexy packaging the public – and therefore politicians – unwittingly know and love.
“It was a Norwegian health minister who said to me, when I worked for the WHO, ‘Sandro, we know what to do, but we don’t know how to get reelected after we’ve done it’,” Dr Demaio told delegates at the conference.
We see the same problem with general practice and the funding of Medicare – it just doesn’t sound quite as sexy as a brand spanking new hospital.
But having spent considerable time with the doctors of tomorrow over the four-day conference, rest assured we are in good hands.
In the face of a health system under the pump, the next generation remains necessarily starry-eyed, committed and most importantly hell-bound on changing the world.
Dr Spurrier explained why she chose to speak at the conference.
“I’m really keen that we elevate the voice of youth,” she said.
“It’s so important going forward with all of the geopolitical and climate change issues that are facing the world. We have to be listening to the voice of youth.”
Perhaps we should put AMSA on refereeing a public health-tactics talk between Dr Demaio, Professor Spurrier, the federal health minister Mark Butler and their choice of others.
I think it could be fun.
The Australia Medical Students Association Global Health Conference 2024 took place 20-23 September at the National Wine Centre in Adelaide.