John Menadue.  Improving health outside the health portfolio

Mar 30, 2015

Ministers for Health in Australia are seen very largely as ministers in charge of health services rather than health. The fact is that some major issues causing poor health or which could be the means to improve health are outside the normal health portfolio.

  • Major health problems are caused by junk food, alcohol and tobacco. The Australian Institute of Health and Welfare tells us that tobacco smoking is the largest cause of preventable illness and death in Australia It estimated that in 2004/5 smoking related disease cost Australia $31.5 b. The AIHW also told us that in that year the consumption of alcohol was estimated to cost Australian society $15.3 b. The Director of the Alcohol Education and Rehabilitation Foundation said that the economic and social cost of alcohol was estimated to be $36 b p a. He added that about 30% of harm to children is caused by alcohol. The scourge of alcohol, smoking and junk food are best addressed through taxation and restrictions on advertising, particularly directed at children and not through the health portfolio.  The action by the Rudd /Gillard governments on plain packaging of cigarettes was the most important health reform in years.
  • Health improvement is made very difficult when the major sponsors of sport in Australia are interests associated with alcohol and junk food. Channel Nine’s cricket coverage with slats, heals and tubby has saturation coverage of alcohol and junk food. Australian cricketers and footballers line their pockets with money from alcohol and junk food companies. There is not much leadership or role modelling here They are complicit in promoting bad health habits and undo a lot of the good work on prevention. How can our sporting codes discipline players for excessive alcohol consumption, when the main sponsors of the codes are liquor companies?
  • Improvement in the health of indigenous people will mainly occur outside the health portfolio in areas such as employment, better diet, housing and education of young people together with reduced consumption of alcohol and drugs.
  • We know that because of social and economic disadvantage, the death rate for those with the lowest socio-economic status is 13% higher than the Australian average, and for those living outside capital cities it is 8%. Poverty is the principal cause of poor health in Australia. And the health portfolio has only a limited role in the fight against poverty
  • Education, childcare, including pre-natal, spacial planning, housing, trade (particularly relating to intellectual property in pharmaceuticals), population, transport, particularly for country people, taxation and social security, employment, justice and the environment, all have direct impacts on the health of Australians.
  • We are coming to appreciate how electronic health and the national broadband network offer great opportunities for improved health services, particularly for people in remote areas. But the NBN is not within the health portfolio.

In short, the health Minister and his department must have expertise beyond ‘health services’ and particularly economic expertise in a joined-up government approach.  Unfortunately they usually rank well down the ministerial and public service ladder.  There is reluctance by policy makers to look on healthcare as an industry and to apply the normal evaluative mechanisms which are applied to other industries. Such a blinkered view allows the development of an idea that health should be exempt from the normal economic considerations of efficiency and equity. It’s a notion that pushes economic thinking to one side, in the erroneous belief that economics is intrinsically illiberal and dismissive of human welfare.

For a country reviewing its healthcare industry, it is useful to take a broad view and consider the whole industry and not just that part of concern to the health portfolio…

We keep pouring money into hospitals. We never seem to appreciate that like the family refrigerator hospitals will always be kept full. Health problems are best addressed first in primary care, prevention and often outside the health portfolio



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