Opinion & Commentary
Prevention is better than cure, but only if it works
According to the Rudd government’s preventive health care policy, ordinary Australians cannot be expected to look after their own health.
Having to read policy documents is often a hard way to make a living. But sometimes you simply can’t believe what you are reading.
This happened last year when the Labor Party released its GP Super Clinics policy document. Co-authored by Kevin Rudd and Nicola Roxon, it contained the follow statement.
‘Preventative health care needs to be made more accessible to ordinary Australians struggling to find the time in their busy lives to look after their own health. We can’t expect people to take better care of their health if we won’t help provide the health services they need to make this a reality.’
Not sure whether to laugh at the absurdity, or be outraged by the patronising tone, I was intrigued to figure out how anybody could endorse such an extraordinary notion.
Since the 1970s, public health experts have argued that ignorance is the reason people make unhealthy lifestyle decisions, and that governments, therefore, have a duty to conduct public health education campaigns that inform citizens about the lifestyle changes they need to make to protect their health.
For over thirty years, Australian governments have promoted the health benefits of quitting smoking, eating moderately, and exercising regularly—most memorably through the ‘Life! Be In It’ campaign. This has worked up to point, and the ‘easy’ work of prevention has now been accomplished.
Many middle-class people are converts to the cult of ‘wellness’: they have stopped smoking, improved their diet, and started to exercise. But many others, particularly lower-income people, prefer to live for the day and have not heeded the healthy lifestyle message. Recent major reports on public health policy in both the UK and Australia found that despite decades of spending on prevention programs, levels of physical activity have not increased, and obesity levels have spiralled. Obesity-related chronic disease already puts pressure on the health system, and it will accentuate the challenges we face as the population ages.
The health promotion message is well and truly out there, but why hasn’t it had the hoped-for impact? The answer is that we have expected health education campaigns to achieve impossible outcomes.
Prevention hasn’t worked because however intensively the health lifestyle message is pushed, lifestyle modification is a complex business that requires individuals to have the will, self-discipline, and impulse control to change longstanding unhealthy behaviours, which are often pleasurable. As international studies have found, the main reason anti-obesity initiatives have failed is that many people find it difficult to sustain lifestyle modifications in the long term.
Unfortunately, rather than acknowledging these limits to the effectiveness of prevention, public health experts are going further, to justify even greater public health spending.
In the popular public health discourse, obesity has been redefined as an ‘epidemic’—as if ‘victims’ passively contract obesity (they are infected, of course, by wicked and coercive fast-food advertising). Since the victims of this epidemic are concentrated in lower-income groups, obesity has also been classified as ‘health inequality,’ which makes it a ‘social problem.’ The blame for it falls on ‘a catastrophic failure of governments to implement effective evidence-based action.’
Even though government took health experts’ advice and spent millions on preventive education, it is now the government, rather than the individual, that the experts deem responsible for obesity, because it has not done enough to force people to drop their hamburgers and get off the couch. While this obviously ignores the role individuals play in continuing to make unhealthy lifestyle decisions, this argument has nevertheless managed to convince some politicians that governments must indeed take action to stem the ‘epidemic.’
Hence we have the truly remarkable, paternalistic policy endorsed by the Labor Party. The government’s policy documents acknowledge that public health campaigns had at least made most people aware of the lifestyle changes required to promote good health. But in Rudd and Roxon’s view, what ‘recent history’—the failure to curb obesity—really demonstrates is how the ‘system’ failed to provide help to turn ‘knowledge into practice.’ So-called ‘ordinary Australians’ therefore need Medicare-funded preventive health care, of course, because unless the government was prepared to help them, how could they be expected to take care of their own health! Just informing people what’s good for them and leaving them to do the right thing is apparently no longer enough.
So the Labor Party announced a brand new initiative—a national network of ‘Super Clinics’ to be located in lower-income communities. In a forerunner of the Prime Minister’s ‘One Stop Shop’ child care centres proposal, the government’s plan in health is to bring a range of allied health services under one roof, so Super Clinics can deliver what are ominously titled ‘lifestyle interventions.’ The government will pay whole teams of sleek middle-class health professionals to harass the bulging lower orders and ‘help’ them eat food they don’t like and get exercise they don’t want to take.
‘Life! The Government Will Make You Be In It’: this could be the slogan of the Super Clinics. But the government can’t make you be in it, and its policy is neither ‘evidence-based’ nor ‘effective.’ Unsurprisingly, studies show that even ‘high-intensity’ lifestyle interventions have little impact, especially on long-term diet and exercise habits. Why, then, is the government lumbering all of us with the cost of ineffective ‘preventive care’?
Cheered on the by the experts, the Rudd government is determined to unfurl a whole new range of preventive policies to try to contain the future cost of Medicare. Prevention’s better than cure, as they say. But the evidence suggests the government’s policies won’t work. It should let ‘ordinary Australians’ be, and help ordinary taxpayers instead. Millions of taxpayers’ dollars are already wasted every year preaching the virtues of brown bread, wheatgrass juice, and jogging to those who won’t be converted.
Dr Jeremy Sammut is a Research Fellow at the Centre for Independent Studies. His paper The False Promise of GP Super Clinics, Part 1: Preventive Care is at www.cis.org.au
