A sickness at the heart of public health

In an age of misinformation, why are we spending less on health education and disease prevention? This can’t be healthy for seniors.

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28 November 2024
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Read Time: 6 mins

Are alcohol-linked cancer prevention policies needed?

In Australia, 40% of cancers are preventable. Lifestyle behaviours such as smoking, obesity and diabetes are in part responsible.

Alcohol consumption plays a role in up to 5% of cancers, including mouth, larynx, stomach, oesophagus, colorectal, breast, pancreas, and liver. But experts say governments are not doing enough to drive this message home and that many people don’t perceive alcohol as a direct cancer risk.

The director of the International Agency for Research on Cancer, Dr Elisabete Weiderpass, says there is a need, globally, for prevention policies that would decrease drinking; decrease alcohol advertising or prohibit it altogether; limit accessibility to alcohol retail outlets (by restricting the hours when it can be sold); limit the age you can purchase alcohol; and increase the price of alcohol.

She says people are still confused, thinking that some drinking may have a beneficial health impact.

“There is no evidence that alcohol consumption, any quantity, has beneficial effects to health, in particularly in relation to cancer,” she said.

“There is a very clear dose-response relationship. The more alcohol an individual consumes, the higher of risk of several types of cancer.”

It is strangely curious that while the federal, state, and territory governments promote their commitment to improving the health of citizens by promoting strategies aimed at preventing disease, spending on health prevention measures has declined.

For example, we’re told the National Preventative Health Strategy 2021-2030 will improve our health and wellbeing at all stages of life. The strategy aims to ensure that:

All Australians have the best start in life

All Australians live in good health and wellbeing for as long as possible

Health equity is achieved for priority populations

Investment in preventive health is increased.

However, Australian Health and Welfare Institute (AHWI) figures show government spending on promoting health initiatives declined 30% ($2.3 billion) from 2022 to 2023.

The proportion of government public health expenditure to total government health expenditure was 2.9% in 2023-24, similar to pre-pandemic levels, and below the 5% target envisaged in the National Preventive Health Strategy.

The AHWI observed government spending on public health activities returned to previous levels after surging during the COVID-19 pandemic.

Public health expenditure is a component of Australia’s broader health spending that focuses on preventing disease, promoting health, and protecting populations, rather than treating individuals.  

Expenditure is reported against eight public health categories:

Communicable disease control

Selected health promotion

Organised immunisation

Environmental health

Food standards and hygiene

Screening programs

Prevention of hazardous and harmful drug use

Public health research.

What is public health spending?

Some 44% of public health spending goes on immunisation activities, so it seems the drop in spending is in part attributed to the reduced government and community focus, post pandemic, on vaccination campaigns.

Surprisingly, perhaps, spending on information campaigns and public education campaigns are a small part of total health spending.

Melbourne GP and co-host of the ABC Health Report, Dr Preeya Alexander, is a passionate supporter of spending more public money on prevention.

She said an example of the declining funding support for disease prevention education is seen in the recent roll-out of the respiratory syncytial virus vaccine in pregnancy. This was a valuable public health initiative, but it was not adequately supported by a public health campaign.

Dr Aexander is also disappointed that dietary and nutrition campaigns have been wound back.

“People still are eating under the recommended fruit and veg intake [and] they are unaware of the benefits of physical activity,” she told her co-host, Dr Swan.

“I just think... how have we reduced the amount of money being pumped into this by $2.3 billion from 2022 to 2023 ... when we still have so much that we could do in this space?

“I’m a GP sitting in the consulting room thinking, wouldn’t it be wonderful if people had more information on prevention.”

Dr Swan believes the role of the GP, as a key agent in preventative medicine – stopping people getting acutely ill and ending up in hospital – is understated and under resourced.

“… general practice is very poorly funded for preventative activities. You’re cycling fast to do the regular stuff with people who are acutely ill, and that’s about state governments,” he said.

The problem, he said, is due to the split system where the Commonwealth funds general practice and drugs and the state system funds hospitals, which “leads to having misaligned incentives”.

So, while GPs want to prevent people getting into hospital and getting sick, state systems focus “inordinately” on the hospital system and waiting lists and building new hospitals.

“We should be broadening the idea of what is public health activities and what is prevention, and it’s quite a narrow approach,” he said.

Dr Swan added that reliable information was needed more than ever because of the rise of disinformation.

“You know the old metaphor,” Dr Swan said. “Rather than sending the ambulance to the bottom of the cliff, you build a fence at the top of the cliff – and we are spending less money on the fence.”

Related reading: AIHW

Related listening: ABC Health Report