Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action

6.3 Developing effective policies

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‘To support a health promoting society, broad structural reform is required not only within the health system but to address the structures, environments and institutions that influence and impact on the health of the population and the individual’ (Quote from submission)

As submissions and consultations noted, to date much of Australia’s prevention policy has been ad hoc, and has been developed to suit single rather than multiple issues managed by single departments rather than coordinated between government portfolios. The combined effect – while sometimes reflecting policies that are consistent with the objectives of the agency and portfolio but not necessarily in the interest of the wider society – has been to distort the health service mix, reduce the efficiency of the health system and to have favoured some medical and pharmaceutical services over lifestyle and community-based initiatives.

Policy failure within health and the wider economy provides an important rationale for the Strategy’s components. To be effective, prevention policy needs to maintain a balance across a comprehensive and complex set of approaches and settings, avoid cost shifting between levels of government, and encourage cross-sectoral initiatives that allow flexibility in supply. The introduction of new policies must be accompanied by quality assurance and accountability mechanisms. Appropriate responses will often include regulatory or system level initiatives.

For example:

• A person who is obese can receive subsidised pharmaceuticals and medical care, but will struggle to find public dietetic services, physical activity programs or multi-disciplinary weight loss services, even given evidence of cost-effectiveness.

Non-health policies can also have unintended negative consequences on people’s health.

For example:

• Approaches that favour the use of motor vehicles over active transport options.
• Urban design and land use that discourages activity and social connection.
• An education curriculum that does not adequately recognise the importance of health, nutrition and physical activity.

Health distortions of particular concern for prevention include:

• The differential funding arrangements across governmental and departmental budget silos. This is far from the ideal of a level playing field in which all services can compete equally for resources, regardless of modality, setting, stage of disease or delivery mode.
• The lack of accountability and quality assurance mechanisms for preventative health.

Reform options are set out by the NHHRC,[27] in various commissioned papers for the NHHRC and for this Taskforce, as well as in the wider health services literature. Some components of health reform have emerged, such as enrolled populations and electronic patient records. Health reform issues, especially for primary healthcare, are covered later in this chapter, although it is recognised that some of these issues are being addressed by other initiatives such as the Primary Health Care Strategy
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Examples of ways to address health impacts from non-health policy can include the introduction of health impact assessments in all policy development (for example, in urban planning, school education or transport), and the development of partnership models such as the Health in All Policies approach described below.

Example: the Health in all policies approach (HIAP)
The South Australian Strategic Plan provides the framework for the HiAP approach. In 2007, through the Adelaide Thinkers in Residence program, Professor Ilona Kickbusch developed a proposal for integrated policies and strategies around the broad theme of ‘Healthy Societies’. High-level commitment from both the central government agency (the Department of Premier and Cabinet) and the Health Department was obtained.[28]
Obesity was one of the areas included in the HiAP plan, building on the existing partnerships between the Department of Health with:

• Primary Industries and Resources of South Australia (PIRSA) through encouraging fruit and vegetable consumption
• Department of Transport, Energy and infrastructure (DTEI) through support of active transport
• Department of Education and Children’s Services (DECS) through the Right Bite school canteen program
• Department of Environment and Heritage (DEH) through the Healthy Parks Healthy People program
• Recreation and Sport through Be Active workplaces[29].

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