Study questions ‘piece-meal’ health prevention funding

Less than 2% of total Federal Government health spending in Australia went towards public health efforts in 2019–20, according to a new study published in the Australian and New Zealand Journal of Public Health.
 
The researchers also say there is a significant lack of transparency over how and where that money is spent.
 
The study reports that, in the year analysed, 1.8% of overall health spending, or $140 per person, was directed towards public health initiatives like infectious and chronic disease protection, prevention and health promotion.
 
RACGP Expert Committee – Funding and Health System Reform member, Dr Michael Bonning, told newsGP preventive health spending is often overlooked due to the nature of the political cycle.
 
‘Governments are focused on the here and now and they work in election cycles of three to four years, depending on where they are,’ he said.
 
‘That gives them a very short time horizon for initiatives and to see outcomes public health and preventive activities take lifetimes to see value.
 
‘But we’ve got to think in terms of generations and lifetimes with preventive health funding, not election cycles and 10-year plans, because they ultimately draw us to short-term conclusions.’
 
What has been proven to be effective, Dr Bonning says, is the work done within general practice.
 
‘I often talk about the idea of the invisible general practice, or the invisible general practitioner, as their patients are rarely, if ever, seen in other parts of the health system because they are well managed and their preventative goals are met,’ he said.
 
‘We have touch points with more than 90% of Australians every year, which means there are opportunities to deliver public health interventions if they’re appropriately funded.
 
‘At the moment, much of that intervention in general practice is opportunistic, and therefore is often also unfunded.’
 
In its 2024–25 Federal Budget, the Government announced it had committed $1.3 billion to prevent illness, detect disease earlier, treat chronic conditions and ‘reaffirm the importance of community and elite sport in encouraging an active, healthy life’.
 
But Dr Bonning says the system could be transformed by raising the preventive health funding figure to 5% of the total health spend.
 
‘That is not a huge change for the system as a whole, but it has outsized impacts on not just people’s health, but also the productivity of our workforce and the health of our nation as a whole,’ he said.
 
‘We know that the return on investment for public health measures is exceptional, often resulting in multiple dollars returned for every dollar invested.’
 
Lead study author Professor Alan Shiell emphasises that the effectiveness of this funding is not just determined by the amount ‘but also how it is allocated’, which is hard to keep track of.
 
‘Our research uncovered a complex and piece-meal funding system,’ he said.
 
‘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.’
 
The research found significant variations in spending between states and territories, with the Northern Territory cost at $527 per person and Victoria at $110.
 
But it concluded that Australia’s experience differs from many other countries due to this state-based funding model.
 
‘Australia avoids some of the difficulties experienced elsewhere because funding is largely devolved to states in block grants; they shape their own investments,’ it reads.
 
‘The US, by contrast, prefers categorical funds for specific purposes.’
 
Dr Bonning agreed that public health funding needed to be tailored to the needs of different communities but the disparity between governments makes it hard to evaluate what is working.
 
‘There is always going to be some difference between those state and territory governments, because they can assess value and benefits to their own populations, which are slightly different and have slightly different needs,’ he said.
 
‘We need to make sure that that is reflected in how we fund public health initiatives.
 
‘However, the lack of transparency also means that we can’t reasonably then assess what is working really well and what should be delivered across the country.’
 
It recommends three ways to make the system more visible including resurrecting the annual reporting of public health spending, using Australian Institute of Health and Welfare definitions of when reporting public health spending, and satellite accounts to expand reporting.
 
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Federal Government funding preventive health research