This year's budget was a missed opportunity to invest in preventative health measures, and to fix health inequalities through policies informed by the social determinants of health.
Each year, the budget is a chance for the federal government to set out their priorities, to say what is important to them and to look towards, at least, the near future. Health spending takes up a significant amount of both federal and state government spending, as well as an increasing amount from individuals.
But what is the reason for this spending? Is it to help keep Australians healthy, or to treat us when we get sick? Do we spend money to prevent people getting ill? How do we respond to future health challenges, such as climate change? How do we make sure that everyone's health gets looked after?
A 2017 report found that Australia spends 1.34 per cent of total health spending on preventative health. Other reports put the figure closer to two per cent. This is far less than comparable countries such as New Zealand, Canada and the UK. But preventing disease is not just about economics and budgets — it's about preventing suffering, pain, illness.
One of the strongest sets of indicators for poor health, and one of the most preventable, are what is known as the social determinants of health. In the 2016 Boyer Lectures, Professor Michael Marmot said that:
'Health and inequalities in health are closely linked to the conditions in which we raise our children, the education we get, the neighbourhoods in which we live, the work we do, whether we have the money to make ends meet, our social relationships, our care for the elderly.' In short, the social conditions we live in influence our health, and inequalities between us also have an impact on the state of our health.
These ideas are not new, or even particularly revolutionary. Put people in crowded, precarious housing, make treatments unaffordable and give them a pittance to survive on and, lo and behold, people get sick, and sicker.
"Health is one of those policy areas where simple, one-off, splashy interventions might grab the headlines, but far more prosaic measures are what actually make a difference long term."
Policy interventions that look at the social determinants of health would include raising the rate of Newstart, making housing more affordable and making sure everyone can get the healthcare they need. None of these got a look in on budget night.
The kinds of preventative policies that health experts recommend include efforts to reduce smoking rates, improve access to fresh fruit and vegetables and increase physical activity, mainly aimed at preventing illness such as heart disease and diabetes. Preventative health policies also look at which groups are more likely to have chronic diseases and allocate resources to working with them to improve their health. These groups include Aboriginal and Torres Strait Islander people, people with disability and people on low incomes.
Michael Moore, the chief executive of the Public Health Association of Australia, said that the lack of spending on preventative health initiatives in the budget meant that 'Australia's people will continue to experience avoidable chronic disease in the years ahead'.
The Australian Healthcare and Hospitals Association agreed, with chief executive Alison Verhoeven saying that 'the lack of any concrete action on preventive health is concerning — it has been allowed to slip down health budget priorities, despite its proven benefits in preventing big health bills later'.
The Consumers Health Forum of Australia said that there needed to be more of a focus on primary care, one of the key ways to deliver preventative interventions, instead of just funding hospitals. 'There is a strong case for greater emphasis on primary health care that focuses on local health services to respond to local need for integrated care, particularly for chronic illness.'
The peak body for general practitioners also thinks that more needs to be spent on primary health. 'Greater investment in general practice will mean fewer hospital admissions, less prescribing of expensive medication, and less need for pathology and diagnostic imaging.'
While the federal budget lacked the kind of preventative investment in health that many groups were looking for, there were significant funding announcements.
These included: an increase in medical research funding (total of $6 billion); an increase in hospitals funding (total $30.2 billion for new hospital agreement with the states); an increase in aged care funding, including 20,000 more high level care packages and funding for mental health of older people; an increase in Pharmaceutical Benefits Scheme funding, with additional drugs subsidised (total $2.4 billion); an additional $4.8 billion for Medicare (to $28.8 billion by 2022); and more funding for mental health (total of $338.1m), including for suicide prevention.
The federal government says this is an increase in spending, with the Minister Greg Hunt saying there is a '$12.4 billion increase in the health budget and a $414.5 billion investment in health, aged care and sport'.
But Macquarie University's Centre for the Health Economy said that this isn't true, with health spending actually falling. 'Services gaps are becoming larger in health, ageing and disability care, while quality is starting to suffer. As the ever-increasing march of ageing, health technology costs, and chronic disease continues unabated, Australians will either face worse health outcomes, or be asked to pay more for their health care if the Australian government does not respond.'
Part of these concerns are about the lack of funding for programs that will go towards building a significant preventative health focus. The federal government, through its control of Medicare funding for example, actually has significant policy levers it could pull that would influence the delivery of health programs.
Croakey's Jennifer Doggett summed the budget's lack of commitment to change as 'an A+ for public relations but ... a C for policy, due to its lack of an overall vision, key funding gaps and a failure to address the underlying causes of poor health and chronic disease'.
She goes on to make the point that 'the additional Medicare funding is going to unfreeze the indexation of the rebate — a welcome move in itself — but one which does nothing to change the fee-for-service funding system which prevents more effective management of chronic and complex conditions'.
For some groups in particular, this lack of focus on issues that are largely preventable comes after years of work to try and get them on the government's agenda.
Aboriginal and Torres Strait Islander groups say the federal budget has ignored their key issues and concerns and put them last. National Congress said that 'this budget leaves so many of us uncertain of the true value of our extensive consultations with government over the past year. So little of what we have said, like so little of what we have recommended, has been taken up by this government in this underwhelming budget.'
National Congress focuses on the lack of funding to meet the Closing the Gap targets. 'No new funding has been allocated to the strategy, despite a dire need for further community consultation and national co-operation between governments and our organisations.' The Australian Indigenous Doctors' Association agreed, saying they are 'concerned about the lack of targeted funding commitment around Closing the Gap. We maintain that measureable targets, accountability mechanisms and appropriately funded policy design and program delivery are essential to closing the gap on Indigenous disadvantage.'
The National Aboriginal Community Controlled Health Organisation (NACCHO) highlight the increased spending on 'preventing and treating complex chronic health conditions such as eye disease ($34.3 million) hearing loss ($30.0 million) and crusted scabies ($4.8 million)'.
Health is one of those policy areas where simple, one-off, splashy interventions might grab the headlines, but far more prosaic measures are what actually make a difference long term. Providing safe and affordable housing, ensuring that health care is accessible and affordable to everyone and making sure that income support is adequate would be an excellent start if we really want to make sure that everyone's health matters.
El Gibbs is a freelance writer specialising in the area of disability and social services and has over 15 years experience in the community and NFP sector, as well as politics. Find her on Twitter @bluntshovels