A report released this week, co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education, is titled “Preventive health: how much does Australia spend and is it enough”?
It is estimated that $27 billion annually is spent in Australia treating chronic disease which accounts for around a third of our annual health budget. But, Australia currently spends only $2 billion a year on this vital area ranking us 16th out of 31 OECD countries for per capita expenditure. This accounts for around 1.3% of Australian healthcare expenditure.
It is estimated that around 50% of Australians suffer some form of chronic disease being responsible for 83% of all premature deaths in Australia and around 66% of the total burden of disease.
In my opinion, there are many reasons why much lip service is given to preventative health, but little action follows as seen by the above report. Firstly, to examine the medical profession’s role in all of this, there is little emphasis placed on preventive health during the training of student doctors. The vast majority of their critical time is spent in hospitals dealing with very sick people with established diseases. There is little emphasis in medical courses on preventative measures, the variety of lifestyle factors and integrative techniques combining the evidence based aspects of pharmaceutical therapy, medical procedures and operative therapy, along with the proven aspects of complementary medicine.
Modern medicine is currently being practised by having the ambulance parked at the bottom of the cliff waiting for people to fall off and instead of fixing the rails at the top of the cliff i.e. prevention. What we do in medicine is build faster ambulances. I make the analogy that this is like the financial world waiting for people to go bankrupt and then they give them financial advice.
Practising doctors are overloaded and time poor. Doctors are certainly not rewarded for spending time with patients discussing the vital aspects of prevention. When a person with clear lifestyle issues such as obesity, cigarette smoking or the excessive use of alcohol, to name three key areas, is given a pill for cholesterol-lowering or BP and told in one sentence to lose weight, give up smoking and cut back their alcohol intake, the perception is the pills will do the job and they can continue the variety of forms of self-abuse.
Until the remuneration system is rearranged for doctors, rewarding the profession for spending time with patients and not for churning them through as quickly as possible, nothing will change in this area.
At a government level, more is needed in the “carrot and stick” department, again legislating to reduce the costs of healthy, fresh foods, such as fruit and vegetables and increase the cost for processed packaged foods, takeaway foods, the introduction of a sugar tax and continue heavy regulation of alcohol and cigarettes. Also, more needs to be done to encourage people to exercise, move more and spend less time sitting at work and at home. These initiatives do need to come at a government level.
I also believe life insurance and health insurance companies should be rewarding clients for healthy behaviour with financial incentives based on a variety of health parameters.
Another issue which is not really considered is that of convenience. Around 10 years ago I wrote a book titled “Diets Don’t Work”. One of the chapters in that book was, “Convenience is killing us”. One of the great paradoxes of life is that what seems good and fun at the time, and is easily accessible, is typically bad for you, which I believe is clear and obvious in our modern world.
Most importantly, however, is personal responsibility. With our modern, overloaded, time poor world, each individual needs to examine their day to day activity and behaviour. Basically, in life we have three choices — protection, life maintenance and urges. The protection aspect is obvious in that if you are in any sort of danger you need to bring in steps to protect yourself from that danger. But, for most of the day, most of us living in the modern world are not at any acute risk from violence or abuse and thus we’re left with life maintenance or following our urges.
Life maintenance involves focusing on the five keys of good health:
1) Quitting all addictions
2) 7–8 hours of good quality sleep
3) Eating less and eating more naturally
4) 3–5 hours of testing exercise per week
5) Happiness, peace and contentment
Following our urges is clearly the opposite of these five keys. Not suppressing urges can then lead to addictions. Whether this is ongoing cigarette smoking, consuming too much alcohol or using illegal drugs to the increasing pervasive urge of dependency on electronics. Rather than cultivating a good quality sleep habit, there is the urge to check messages and emails in the middle of the night. There is the urge to spend too much time sitting in front the television rather than exercising. There is the urge to overeat or even munch on unnecessary food whilst you are watching television.
With our urge-focused society, it is no wonder we’re seeing rampaging ‘diabesity’ and ongoing addictions.
Rather than laying the blame on poor government spending, inadequate medical emphasis on prevention or even shifting all of this back onto the individual, I believe we require a global societal approach to shift from the current disease based medical model to a prevention focus at each level of society.
The first aspect here is to start the discussion and thank goodness reports such as the subject of this article and others, such as the Obesity Initiative from the Royal Australasian College of Physicians. Hopefully, with the increasing emphasis on preventive health we will start to see a reduction in the carnage from chronic illnesses.