‘Strong case’ for more preventive funding in Australia: Study

Australia lags behind similar OECD countries with its spending on preventive health, analysis published this month in The Lancet Public Health journal suggests.
 
The article, ‘The burden and trend of diseases and their risk factors in Australia, 1990–2019’, looked at 14 similar countries and how the trajectories for different conditions compared.
 
It notes a six-year increase in life expectancy in that timeframe – a shift it attributed to a ‘drastic decline’ in mortality for ischemic heart disease, stroke, and tracheal bronchus and lung cancer – but raised concerns over the rise in anxiety and depressive disorders.
 
Authors, led by Associate Professor Shariful Islam at Deakin University, also analysed overall spending on health, including on preventive health, indicating that while Australia spends more than average overall, it spends less on prevention.
 
They cited studies showing health expenditure in Australia was higher per capita than the OECD average (at $7772 compared to $4561) in 2018–19 – but that preventive health only accounted for 1.34% of that total compared to an average of 2.8% in OECD countries.
 
‘Australia spends only about 0.13% of GDP on prevention, presenting a strong case for increasing investment in preventive health in Australia,’ they wrote.
 
For Dr Michael Bonning, a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), the suggestion makes sense.
 
‘I think Australia needs to enthusiastically drive towards a target of 5% of health spending to be allocated to prevention,’ he told newsGP.
 
‘We have to have a target, I think that target has to be 2030.
 
‘This is all about meaningfully changing the way we think about health expenditure, and where the best investments are in health.
 
‘At the moment Australia spends less than 2% of health funding on prevention and that doesn’t accurately reflect the importance of prevention in the wider health system.
 
‘Prevention has significant positive downstream effects that have seen a huge return on investment.’
 
The article for The Lancet research, which was funded by the Bill & Melinda Gates Foundation, also identified tackling the impact of non-communicable diseases and ageing as a particular challenge.
 
Describing Australia as having ‘one of the best health-care systems in the world’, the authors said there has been a substantial increase in health expenditure per capita over the past few decades.
 
According to their assessment, the country’s ranking for age-standardised deaths and life expectancy at birth improved, while its standing for years of life lost (YLL) and years of life lived with disability (YLDs) remained constant.
 
However, for healthy life expectancy (HALE), Australia went down from eighth in 1990 to 10^th in 2019 compared to other countries looked at for the study.
 
‘To ensure continuous delivery of effective and high-quality care and guide preventive efforts to improve population health, understanding the burden of disease and its risk factors in Australia is crucial,’ the authors wrote.
 
They note the country ranks better for diabetes and stroke than most comparator countries, and that both diseases were included in the 2016 National Health Priority Area.
 
For mental health, the findings were different, with researchers finding Australia’s rankings for anxiety and depressive disorders are worse than most comparator countries.
 
Along with falls, it identified them as ‘areas of concern’.
 
‘These findings suggest that primary prevention and health promotion services may have been insufficient to tackle these issues,’ they wrote.
 
‘Therefore, there is a need for strategies targeting mental health and the prevention of falls in Australia.’
 
They contended a rise in anxiety disorders could be linked to greater awareness, as well as ‘heightened societal pressures and expectations, and social isolation and loneliness’.  
 
It is view shared by Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine.
 
‘Most mental illnesses are caused by our context and the social environment we live in,’ she told newsGP.  
 
‘Genetic factors are much less common determinants of mental health on their own, and the biological causes are just as much the result of societal and lifestyle choices as genetic predispositions.  
 
‘We need to stop stigmatising and enabling blame of individuals when the solutions are to be found in our society.
 
‘It’s a view we should be taking about with our patients.’
 
For Dr Andronis, the trusted position of GPs is a powerful one in this context.
 
‘Biologically, I think we often reach too quickly for the script pad,’ she said.
 
‘We should be exploring psychosocial factors much more because that then gives the person a balanced and fair assessment of what’s going on and gives them more options.
 
‘We often underestimate the capacity of people to be able to make social decisions that work in their favour – and GPs have a lot of positive influence in people’s lives and they’re trusted.’
 
According to Dr Andronis, better funding to carry out such preventive work is part of the solution, which would include more support for social workers, and mental health nurses to provide wider team-based care in general practice. She also thinks an expansion of social prescribing is needed.
 
According to the Lancet article, the burden of disease is ‘strongly influenced’ by broader social and environmental factors – a point also taken up by Dr Bonning.
 
‘All of these things go together, they are not independent of one another,’ he said.
 
‘If you build a better, healthier society, whether it be physical health, whether it be tobacco use, whether it be activity, whether it be walkable cities, you also improve mental health.
 
‘If you make preventative interventions on mental health, you generally improve other aspects of health.
 
‘So none of these happen in isolation.’
 
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