IT’S an age-old saying that prevention is better than cure – yet it seems that one obvious place where this adage has not been applied is our struggling health system.
At a roundtable discussion held by WA Business News last week, some of the State’s most eminent health professionals and administrators were largely in agreement on many aspects of health reform.
To my untrained ear there seemed near total agreement that planning had often been focused on the wrong things, that reform was drastically needed and that not enough was being done to prevent health problems.
While there was some disagreement on the actual cost of future health, there was no doubt in the room that we simply can’t maintain economic prosperity if we continue along the current path.
So why, with all those in charge agreeing on so much, can’t we prevent the occurrence of the crises that currently plague our health system.
Clearly much of it lies in politics, both within the industry and the greater community, because the evidence is there that reform is not only needed, but can work.
To my mind Australian of the Year Professor Fiona Stanley offered a vision of the future when she referred to the past and highlighted the success of the AIDS advertising campaign of the 1980s, when a proactive scare campaign skittled the rise of HIV infection with a simple community message.
Sure it was controversial; anything that places health issues above perceived community values is bound to be.
But, importantly, for the cost of a modest advertising campaign with a budget that many corporations wouldn’t baulk at spending on their beer, car or bread commercials, billions of dollars may have been saved in medical costs.
And then of course there’s the personal cost and the numerous lives the HIV campaign may have saved, and the emotional wreckage it may have helped avoid.
In this case prevention certainly was better than cure, because the cure has yet to be found.
So why isn’t prevention as high on the agenda as it should be?
It seems part of the reason is tradition and another part is the enormous task of restructuring our systems to such a new way of thinking.
At the heart of this problem lies the same thing – people’s expectations that the hospital system will always be there to rescue them from injury or sickness, no matter what behaviours they may partake in or risks they may take.
Maybe this stems from the growth of community health systems during the middle of the last century, when a large range of big health issues were suddenly solved by simple medicines and a stay in hospital.
In a rich country such as Australia, a few buildings and well-educated people to run them were an affordable way of keeping us at the cutting edge of advanced society.
But, by proving we could solve such big problems so easily, did we create a rod for our own back? Quite possibly.
As our society has become richer, and despite the rising education that comes with that, it has accepted unhealthy lifestyles because medicine has promised it can undo the results of bad living. In many cases, health professionals have tried changing this, but the community and its leaders often aren’t listening.
Cigarette companies have fought doggedly to exist for years despite the obvious impact of their products.
Alcohol is taxed in a way that the excessive rocket fuels offer the best bang for the drinkers buck.
Junk food, from fizzy sugar drinks to fat-laden burgers, still eludes any penalty for its part in creating a generation of obese children and a health legacy we are all yet to contend with.
Those trying to change this are tagged with trying to create a ‘nanny state’. This claim is made principally by a part of the community that, despite one of the best education systems in the world, is its own worst enemy and is often egged on by opportunistic politicians that love that kind of hysteria.
There appeared to be no doubt in my mind that those who discussed this issue at the WA Business News forum agreed that changing community attitudes was the right pathway – most arguing that the population can be convinced if all clinicians supported it and politicians could be bipartisan.
For obvious reasons, both are tough asks – even though the AIDS campaign proves that the community can be won over and attitudes changed with good communication.
But that is the future, and therein lies the restructuring part of this issue.
All the communication in the world won’t overcome the years of neglect and poor attitudes to health, nor will it relieve the burden on a public health system that can’t cope with the current situation or undo decades of planning deficiencies.
Where would we find the extra dollars, or the community will, for a massive campaign of re-education that won’t show real results for decades?
And what about the risk of such a campaign being a disappointment if it can’t reverse other community failings – where increasing numbers of children slip outside the system in so many ways. How do we educate people we can’t reach? How much does health influence other lifestyle choices or vice versa?
One glaring extension of all this is the situation of Aboriginal health. The disease rates among our Indigenous people are proportional to their alcohol abuse, truancy problems and unemployment rates. We all know this is a cycle that is hard to break.
Yet evidence shows that improving health – even by way of simple things like chlorinated swimming pools – gives young Aboriginal children a better chance than their parents.
This is an extreme example of what is happening to a lesser degree in the rest of the population – yet it is so embarrassing and so isolated (in a population sense) that it may yet prove fixable.
This is a problem more prevalent in WA than almost anywhere else in Australia – particularly the eastern States.
Perhaps it is time that some of the oil and gas royalties and the GST funds being syphoned away from the West by Canberra were put to good use solving a major problem and international embarrassment in our back yard.
If we could create an economic turnaround through appropriate health policy (including accountable expenditure) aimed at prevention rather than cure in our relatively small Aboriginal community – perhaps we would have a successful model to convince the rest of the population that prosperity comes with thinking ahead.
