An interim report from the National Health and Hospitals Reform Commission.*

Yawn.

Sounds more like a cure for insomnia than a contribution to the nation's health.

Perhaps not. Perhaps this report is different to the usual commission reports. In a covering letter the commission chair, Dr. Christine Bennett, writes:

"Good health is not just about health care – it requires us all to be active participants in looking after our own health..."

The document overview identifies four reform "themes." The first of these is:

"Taking responsibility: individual and collective action to build good health and wellbeing – by people, families, communities, health professionals, employers and governments;..."

Also in the overview we find the following (Capitalisations added):

"Good health is a PERSONAL, as well as a collective, responsibility."

"Ultimately, it is communities, families and individuals who must CHANGE BEHAVIOURS if we are to become a healthier nation."

The report quotes research from the Australian Institute of Health and Welfare that attributes 32% of the burden of disease in Australia to lifestyle risk factors. These include smoking, obesity, physical inactivity, excess alcohol consumption and poor nutrition.**

After the overview, introduction, etc, the first substantive section of the report is headed "Taking Responsibility." There the policy implications of "taking responsibility" are set out.

At this point the report really does degenerate into an insomnia cure. Substantive recommendations are buried amid so much politically correct jargon that it's hard to know how the commission proposes to get people to "take responsibility" or to "change behaviour."

While the report is disappointing when it comes to concrete proposals it does make a key point. The current model is unworkable. Unless we take some responsibility for our own health, public healthcare in Australia will collapse under the weight of demand from an aging population. Those that can afford it will buy themselves out of the system. The rest will have to put up with what will become third-world healthcare.

On the other hand, getting people to change behaviour is devilishly difficult.

Any suggestions?

* http://www.nhhrc.org.au/

**Personally I think 32% is an under-estimate

Steven

I agree about the 32%! How do they arrive at that figure? They must then, I guess, be attributing 68% to genetics and accidents. Even with poor genes, the avoidance of poor lifestyle choices will in my opinion greatly reduce the incidence of illness.

How do we get there though? I agree, it's a difficult one. For a start most young people see themselves as invincible and don't really give a rats about their health, until much later when the bad habits have already set in chain an accelerated degenerative process.

Education is key, and not just the outdated five foods group pyramid and its erroneous servings mantra either. People need healthy fats and oils which is often overlooked in that model, as too is the problem with its overly generous prescription of bread and cereal servings.

Advertising is another huge issue and one that could be tackled quite easily if government had the will. How difficult would it be to ban all junk food and alcohol advertising?

Cigarettes have made a comeback on our screens, which goes to demonstrate how easily it is for even long standing and widely supported legislation to be overturned through, in this case, the power of Hollywood and the irresponsible greed of the giant tobacco corporations.

Taxing is another tool government should be able to use to tip the balance more toward healthy rather than junk food, but this avenue is closed now we're stuck with an inflexible and non discriminatory GST.

I agree, this report is on the right track as far as trying to encourage greater personal responsibility for staying well. Hopefully, the government has the will to create a system based on wellness, rather than illness, which is what we have now and which is totally unsustainable.

As you point out, unless there is a major restructuring of how we think and manage health care, the wealthy will have ever greater access to the best of everything, while the rest of us will increasingly find ourselves with no choice but to accept second or third rate conditions.

Hi Bronwyn

You wrote:

"They must then, I guess, be attributing 68% to genetics and accidents."

Not necessarily. We all age and we're all going to die of something. At the end most of us will need, at the very least, palliative care. I suspect the biggest single "cause" of healthcare costs is old age. At best healthier lifestyles can postpone the day when old age causes us to need a lot of expensive medical care.

A more interesting question is "What percentage of AVOIDABLE healthcare costs may be attributed to poor lifestyle choices?"

In contemporary Australia I think the answer to that question must be close to 100%.

The avoidable costs are not insignificant. According to a report from Diabetes Australia (See:
https://www.diabetesaustralia.com.au/News--Events1/News/Media-Release---Growing-cost-of-obesity/) the number of people with type 2 diabetes exploded by 137% between 2005 and 2008. The DIRECT COST of treating Type 2 diabetes now runs at $8.3 bn pa. This is almost 10% of the total amount spent on healthcare.

Note that this is the direct cost. It excludes the strains put on family due to illness or days lost from work. The report estimates the indirect costs at about $50 bn.

There is a close link between Type 2 diabetes and obesity, lack of exercise and poor eating habits. Type 2 diabetes used to be a disease of, if not old age, then older age. Increasingly CHILDREN are today being diagnosed with type 2 diabetes. This is a TRAGEDY.

Presumably less obesity and more exercise would mean less type 2 diabetes, lower direct healthcare costs and happier children.

The NHHRC report does mention education.

Newflash. Anyone today who does not know that smoking, excessive consumption of alcohol and over-eating are bad for your health is probably so dim witted that no amount of education will help. As one who has to battle against a tendency to "comfort eat" I can attest that knowledge, and acting on that knowledge, are two different beasts.

I agree that better education would be valuable but it probably won't be enough.

Steven

"Not necessarily. We all age and we're all going to die of something."

Yes, and I think lifestyle factors, genetics and accidents covers the causes of that demise, as I stated. Never mind, minor point really, you and I are definitely singing from the same hymnbook on this general issue.

"As one who has to battle against a tendency to "comfort eat" I can attest that knowledge, and acting on that knowledge, are two different beasts."

I agree, education is only a part of a whole raft of measures that are needed. But it could be argued that if we were truly educated as to which food stays with us and minimises hunger, and also on the correlation between junk food and mood as well as long term health, we'd all be a lot less inclined to comfort eat. The trouble is most people have little real education of the direct causal relationship between what they eat and their day to day health. Greater knowledge would make a huge difference, and this needs to start with our health professionals.

In the meantime, there is a lot more government could do. Stronger regulation on food additives, transfats and sugar content would be a good start, as well as the advertising bans I mentioned earlier.

If the "Interim Report" covers 392 pages, I for one am not looking forward to the Final Report, which would presumably have to cover all the changes from the Interim Report in detail, as well as observing any omissions, and highlighting any additions. Look out trees.

The basic problem with reports of this type is that they cannot (and indeed should not) deliver a complete, well-rounded and fully-worked solution. All they can realistically do is cover all the bases - i.e. ask all the right questions - and I have to say I believe this report achieves that objective rather well.

stevenlmeyer observes that:

>>it's hard to know how the commission proposes to get people to "take responsibility" or to "change behaviour."<<

I think the report made a fairly specific stab at this one:

One of its key statements in the Funding section states that it is "open to the evidence-based use of price signals, including the potential use of positive incentives or bonuses to encourage healthy behaviour"

In other words, it suggests that the government use that well-known and well-understood mechanism, bribery, together with its close companion, demanding money with menaces.

Carrot and stick, with money the means for both. Private Health Insurers might be allowed, for example, to rebate premiums in exchange for a monitored lifestyle improvement, or whack an excess on for smokers. At the moment, they theoretically can't do either.

Or perhaps on a wider scale the government could exercise more control over the Medicare Levy Surcharge - which, incidentally, the report proposes to lift by 0.75% to pay for Denticare - by rebating for proven "good behaviour" and penalising for bad.

It's all a bit Orwellian in scope. But in the end it all depends on how much we expect the government to look after our health, and how much we believe we should stand on our own two feet.

LOL Pericles,

The document is a bit "Orwellian."

Maybe something along the lines of the British Government funded "Skilled 4 Health" scheme could bring about changes in behaviour.

See: http://www.thisisexeter.co.uk/news/Success-health-fitness-scheme-means-place/article-546731-detail/article.html

"The city [Exeter] is the only one in the country to get Government funding to run the project, which aims to transform the health and well-being of parents and their children with the help of Exeter teachers.

"During the past two months, mums and dads have been learning to cook healthy meals and take part in sports."

There is a question mark in my mind about such schemes. Will the "mums and dads" continue to cook healthy and participate in sports with their children once the scheme ends and the novelty wears off?

I don’t think there are any quick answers to changing behavior. Look how long it took to make a dent in the incidence of smoking. Keeping the incidence of smoking down requires continuous effort.

One thing that impressed me about the report was the proposal to establish an independent national health promotion and prevention agency. We need an agency that will put prevention at the forefront of healthcare.

Coupled with that, I was impressed by the frank admission that we have no data on the efficacy of prevention methods. We really do need an agency that will gather and disseminate evidence on the efficacy of various interventions.

What did not impress me about the report was the attempt to link it to other agenda such as changing the built environment or saving the planet. It's not that I disagree with the authors' comments on these topic; but I think it makes the report lose focus at times.

Bronwyn I agree with you about education. It is not enough to know something without an understanding of psychological factors involved in unhealthy behaviours like overeating and smoking. Can motivation be taught? Is the rise in depressive illnesses a contributing factor?

Perhaps a holistic (or wholistic) approach is what is needed. Why do people overeat? Why do people smoke or drink in excess?

I like the Australia Institute's idea of a wellbeing manifesto and it relates well to a national health program.

http://www.wellbeingmanifesto.net/about.htm

For any real change, education is only one part. Education is not always effective when the root cause is not identified or ignored.

Population health is closely connected to population happiness. Reduce inequities and increase access to community support on many fronts and you may go some way to alleviating a growing national health problem.

While health is partly a personal responsibility, it does not absolve governments of their duty of care in providing high quality primary health care,care for the aged and providing the sort of environments that contribute positively to people taking more responsibility .

Pelican

Ditto to all you say, as usual! :)

Thanks for the link to the Australia Institute's wellbeing manifesto. It certainly makes for heartwarming reading and I was pleased to have the opportunity to endorse it.