14 December 2021

Strategy targets social determinants of health

Political Public Health TheHill

Anyone remember the old poem about the merits of putting a fence at the top of a cliff, rather than an ambulance down in the valley?

The new strategy looking to define the next 10 years of preventive health – the cheap fence often neglected in favour of expensive ambulances – has landed, with a strong focus on addressing inequities from birth and ensuring that Australians live healthier for longer. 

More than 20 health organisations will be receiving a cut of $23.7 million in funding over the next three years as part of the strategy. 

Much like the Primary Health Care 10 Year Plan, the National Preventive Health Strategy sets out long-term policy goals and is part of a push to shift the focus away from treating illness and disease after they occur. 

It has four broad aims: that all Australians have the best start in life, that all Australians live in good health and wellbeing for as long as possible, that health equity is achieved for priority populations and that investment in prevention is increased. 

Some of the more specific goals which sit underneath these include raising the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to at least 91% by 2031 and ensuring that regional and remote Australians have an additional three years of life lived in full health by 2030.

According to the strategy, around 38% of the country’s disease burden could be prevented through a reduction in modifiable risk factors like physical inactivity, tobacco use and dietary risks. 

Just tackling tobacco, alcohol and unhealthy foods alone is estimated to save $6 billion in health costs. 

These modifiable risk factors, according to the strategy, are best addressed through examining wider determinants of health, like social and environmental factors. 

“If an individual lives in a low socioeconomic area, it is not certain they will develop more chronic conditions or engage in higher levels of risk factor behaviour, but the likelihood is stronger and greater,” the report reads. 

“Furthermore, it often takes time for the connections between our environment and our health to manifest; for example, it may take decades or generations to experience the deleterious effects of living in food insecurity or in an area with high air pollution.”

Those of you with good memories may note that this is not the first national preventive health strategy; the first one came out in 2009, with big plans to make Australia “the healthiest country” by 2020. 

While the specific goals aren’t directly comparable, at the time the 2009 strategy came out approximately 32% of Australia’s total burden of disease was attributed to modifiable risk factors. 

As stated above, that proportion has since climbed six percentage points. 

But Australia has been caught in this cycle of championing preventive health measures for far longer than 10 years. 

That old adage about the fence, the cliff and the ambulance – the operative word here being old – comes from an 1895 poem by temperance activist Joseph Malins. 

While presumably written with Malins’ native Birmingham (and pet cause of temperance) in mind, passages from the poem, like the one reprinted below, have long been used in Australian primary health resources.

Better guide well the young than reclaim them when old,
For the voice of true wisdom is calling.
“To rescue the fallen is good, but ’tis best
To prevent other people from falling.”
Better close up the source of temptation and crime
Than deliver from dungeon or galley;
Better put a strong fence ’round the top of the cliff
Than an ambulance down in the valley.

With the latest National Preventive Health Strategy still yet to be implemented, here’s to more fences and fewer ambulances!

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