Editorial
Volume 47, Issue 12, December 2018

Prevention

Stephen A Margolis   
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Preventive healthcare: A core component of Australian general practice

The man who uses intelligence with respect to his diet, his sleeping habits and who exercises properly, is beyond any question of doubt taking the very best preventive medicines provided so freely and abundantly by nature.1

Prevention as a key aspect of healthcare is probably as old as history. Asclepius and Hippocrates in Ancient Greece focused medical care on the congruence between the person and their environment, with a special emphasis on physical exercise.2 In 2008, the World Health Organization reported that approximately 80% of cases of heart disease, stroke and type 2 diabetes mellitus could be prevented globally by addressing smoking, physical inactivity and unhealthy diets.3 

Prevention has been a core focus in Australian primary healthcare since the 1980s. The Royal Australian College of General Practitioners (RACGP) first published the landmark text Guidelines for preventive activities in general practice in 1989. This signature publication, affectionately known as the ‘Red Book’, is the key evidence-based reference resource for Australian general practice and is now in its ninth edition.4 Interestingly, what is common practice in Australia is only a new arrival in some other primary healthcare jurisdictions.5

In this edition of Australian Journal of General Practice (AJGP), we celebrate the centrality and success of GPs in expanding the net of preventive medicine to improve the health of our communities. Our snapshot includes a range of innovative and successful preventive health initiatives.

From Central Australia, Boffa et al report on reducing alcohol-related harm.6 Palmer et al discuss the central role of preventive health in relation to the crisis of poor cardiovascular health in those with severe mental illnesses.7 Tait et al take a broad perspective across heat-related illness, from advocacy to global warming awareness through to everyday advice for prevention in individuals.8 Practical advice for addressing risk taking in adolescents, a perennially challenging field, is addressed by Sanci et al.9 Ewald et al discuss the processes and challenges in quantifying the potential benefits and possible harms of preventive activities.10 And finally, Emery et al provide evidence-based processes to support shared decision making in preventive care.11

In summary, preventive healthcare is a key component of general practice in Australia, yet general practice funding in 2015–16 was <9% of Australia’s annual health budget.12 Therefore, while ‘expenditure in various areas of health has seen substantial increases, non-referred medical services (including general practice services) still represent a very small proportion of total government health expenditure’.13 We applaud GPs for their work in prevention and in encouraging funders to increase their support for this critical component of healthcare.


References
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  10. Ewald B, Del Mar C, Hoffmann T. Quantifying the benefits and harms of various preventive health activities. Aust J Gen Pract 47(12):842–45. Search PubMed
  11. Emery JD, Nguyen P, Minshall J, Cummings KL, Walker J. Chemoprevention: A new concept for cancer prevention in primary care. Aust J Gen Pract 47(12):825–28. Search PubMed
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