general practice

Dec 10, 2012

New SA report shows why governments are failing to control health spending

In September, the Queensland Government

Melissa Sweet — Health journalist and <a href=Croakey co-ordinator" class="author__portrait">

Melissa Sweet

Health journalist and Croakey co-ordinator

In September, the Queensland Government suggested that the Federal Government and the emerging Medicare Locals network should step in to fill the gaps caused by its health spending cuts.

SA appears to be heading in a similar direction, according to a recent report recommending sweeping changes and cuts to community and primary health care services.

The Review of Non-Hospital Based Services evaluated 235 services across metropolitan Local Health Networks. In its sights are practice nurse programs, services for youth, women and the elderly, health promotion programs, and an Aboriginal health workforce initiative.

The review says there is little reliable evidence to show that the primary health care sector is meeting objectives, and that “unlike the acute sector, there is no agreed standard approach to evaluating value for money effectiveness of primary healthcare services”.

The review – which is open to public comment until 4 February – warns that without better evidence about the impact of their work, “primary health care clinicians and administrators will continue to struggle to mount a case for retaining current levels of investment, to say nothing of attracting new investment, in primary health care. This is the reality of the fierce competition for resources that is part and parcel of modern government.”

However, a leading public health advocate Professor Fran Baum writes below that the review shows a poor grasp of the determinants of health and the international body of research evidence showing the value of community services and primary health care.

Professor Baum, Director, Southgate Institute for Health, Society & Equity at Flinders University, warns that the review’s recommendations would hit the community’s most disadvantaged members, at the same time as salaries and payments to medical specialists have been increasing.


Cutting disease prevention and health promotion won’t reduce health spending

Fran Baum writes:

All the international evidence suggestions we should be increasing investment in health promotion and primary health care, yet a report released in South Australia has chosen to ignore this rich evidence and recommends cuts to these areas.

Like other State governments, the South Australian Labor Government has suffered from falling state revenues (less house sales, less GST revenue). This has forced it to look for savings and inevitably health, by far the biggest spending department, has been in the firing line.

Health spending continues on an upwards trajectory so that in 2012-13, it was 129% higher than in 2001-02. The latest shot from the austerity trenches has been the publication of the McCann review available here.

This Review of Non-Hospital Based Services was led by Warren McCann from the Office of Public Employment and Review, and purportedly examined “the performance and outcomes of 235 individual non-hospital based services across metropolitan Local Health Networks (LHNs)”.

Its stated aim was “to identify opportunities to improve services or deliver them in a more efficient manner, as well as to achieve savings to contribute to SA Health’s budget savings strategy”.

The real game is revealed by the following: “Under the new national health care reform, many of the services that were subject to the Review will come under the responsibility of Medicare Locals. In light of this, the Review ensures our non-hospital based services will complement Medicare Locals, rather than duplicate or compete against them.”

Yes, you’ve got it – it is a State/Commonwealth cost shifting exercise once again!

SA Health’s “non-hospital based services” include a range of primary and community health programs in Adelaide.

The report recommends that: all the 40 FTE health promotion positions are cut, sweeping cuts are made to the already tiny women’s health and youth health services, Aboriginal workforce initiative and some support services to GPs.

These savings are a tiny drop in the tsunami of health spending that threatens to consume the entirety of State government budgets in about twenty years if nothing is done to stop it.

In many ways the McCann report provides a microcosm of why governments are failing to control health spending. Here I’ll expand on two of the reasons for this claim:

1. Poor understanding of the determinants of health

The report simply does not understand what makes populations healthy. This question is complex and requires a good understanding of the social determinants of health (the things in our everyday life – like social contacts, work, leisure, the quality of our housing – and the broader macro-political and economic environments in which we all live).

Primary health care and community health services should ideally interact with agencies and groups in a local community that impact on the social determinants of health.

In the past South Australia had a great network of community health services that did this very well. Typical activities were community gardens (also good for social interaction as well as learning about healthy food), advocacy work to ensure that disadvantaged clients gain access to health promoting services such as housing, legal advice and women’s shelters; working with local shopping malls to have them welcome walking groups, encouraging child care centres to provide healthy food, organise networks of community foodies to promote healthy weight through good healthy food. The list could go on and on.

Over the past five years this work has been progressively cut back and reshaped into a more medical model of community health, which isn’t able to do this important development work that builds health promoting social capital.

Just one example of how McCann doesn’t get the value of such work – the report notes that the women’s health services do not contribute to chronic disease management, hospital avoidance and population health because they have “a stronger focus on social support, community engagement”.

Obviously McCann is not aware of the very large evidence base which shows that social support is crucial in recovery from illness (so reducing need for readmission to hospital) and for keeping people healthy.

2. Austerity measures are not fairly shared

All international evidence that is available confirms that the health systems which are most efficient and cost-effective are based on strong primary health care services.

If we want to stem the costs of health care we have to increase investment in community services and reduce the amount spent on hospitals.

In the past five years the salaries and payments to medical specialists have increased very significantly.

Far more could be achieved if McCann had been asked to systematically document these increases and shown the community that their much valued local health services were being lost because medical specialists have received considerable pay increases.

This is the community conversation that we need to have. Otherwise it is austerity for some and not for others. Ironically the cuts McCann recommends will affect the most disadvantaged of South Australia’s community because of salary increases for our most advantaged!

Finally, it was an irony that the McCann report was released when the Southgate Institute was being visited by Professor Ron Labonte (University of Ottawa).

He reminded us that the current austerity sweeping the world results from political decisions to bail out banks and from the increasing concentration of wealth. He also reminded us that we collect significantly less taxation as a percentage of GDP than we did 20 years ago.

Imagine a world in which McCann put his considerable economic skills to work to determine how much extra tax we could collect from the super-rich who use tax havens, and from corporations who have an army of taxation experts to help them reduce their taxation.

Then we could look forward to a McCann report that calls for increased investment in health promotion and community health on the grounds that prevention is cheaper than cure!

In the meantime if you’d like to object to the McCann’s review recommendations, consultations are open until 4th February.



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35 thoughts on “New SA report shows why governments are failing to control health spending

  1. Elizabeth Witton

    I am shocked at this review. Cutting (relatively inexpensive) community-based programs for health promotion and disease prevention does not add up to long term budget savings. Quite the opposite. McCann should be ashamed of this review, it is unintelligent and unimaginative and apparently supports the idea that it is OK to abandon disadvantage citizens by removing the very programs that help address their particular needs.

  2. Denise Manson

    Great to have Professor Baum’s evidence based analysis, but frankly blind freddie could see how shortsited this proposal is, very small short term savings for very large, long term costs, not to mention the cognitive dissonance of constantly receiving government health promotion advertising, while programs are cut. Having just completed cultural awareness training on Aboriginal and Torres Strait Islander attitudes towards health, which are entirely community focused, it seems we still have much to learn

  3. Kassi Rogue

    John Hill stated in his resignation “health spend is at record high level of $4.9 billion and we now employ more Dr’s and nurses than at any time in our state’s history”. This is nothing to be proud of when cuts are being made so drastically to primary health care. Slowing the progression of just one person’s diabetes and delaying their commencment to dialysis by 1 year saves the system $70,000. Not everything can be measured by $$, just ask someone on dialysis how their quality of life is? How can all these PHC projects be cut with nothing to replace them-as much as McCann wants us to believe Medicare Locals will there is no sign of this.

  4. Margaret Nelson

    Perhaps those left in public health and community health (diminished as it is) could take this opportunity to direct all the families and communities, who have been supported to build up their lives and communities, (instead of going into crisis) to take their issues to parliamentarians offices. And all the sick and needy people who have previously been supported through community health, to crowd the hospitals even more. We cant really measure what we’ve prevented if its been prevented, we can only measure numbers apparently and that’s all that matters. So isn’t it time to send community people to the offices of pollies, and the sick back to hospitals? Overcrowding? it doesnt matter because they wont admit anyone anyway. But they will get numbers. And to all the people who built up community health over the years. Thank you. Who dealt with loving kindness in transferring hope and belief, better health, brighter futures, developed educational opportunities and supported our families to better health with their children, thank you. And indiginous communities to gather and support each other in their learning, and refugees to know someone wants to support them to have a new beginning, (after living in the horrors that they have), thank you. And at a smidgeon of the cost of the medical system, with 100% more commitment and passion, I am deeply grieving your loss. RIP community health. Thank you Thank you Thank you.
    What has happened to the Labor party?

  5. Stephenson Amy

    Thank you Melissa for taking the time to say very concisely what I believe all community health and health promotion professionals in South Australia are thinking. Even though I have only worked in the area for a short time since graduation, I already see the immense benefits taking the time to get to know a community and helping them address the root causes of their health problems can have. Start Right Eat Right are just finishing a study with UniSA showing the significant improvements in children’s diets once their childcare centre becomes SRER accredited while at an individual level, the incredible feedback we receive everyday on the work local Community Foodies and Health Promotion Officers are doing is inspiring. It breaks my heart that one man, can overlook what is so obvious to all of us working in this area and have these potentially devestating consequences for the people of South Australia, especially those who are already at a disadvantage. I wish someone could explain to me how they expect to decrease hospital admissions or chronic disease rates in South Australia without a co-ordinated state wide approach? We as a state have invested so much time and money into getting true primary health care to the this point and they are happy to just throw it all away. Can’t we all just see the day someone from my generation reaches the top in 10-15 years time and says ‘wow, I’ve got this great idea, why don’t we try to stop people from getting sick before they get to the hospital, we’ll call it prevention’…. like no-one ever thought of it before…

  6. Janet Haydon

    I too agree with the sound and highly valued comments from Professor Fran Baum. There is plenty of evidence for the value of health promotion, locally, statewide, nationally and internationally which appears to be being ignored. You only have to see that people are living longer, smoking rates have dramatically reduced, but of course this means that there is a bigger strain on the hospital system – with more people around that need health care in thier later years – it is clear that our government prefer to ensure that our populations die younger as it would be economically better!

    If there are no measurable outputs or evaluations for some of these programs then we should be working towards building evidence for these programs, not just useing it as excuse to close it down. The results based accountability tool might be useful here for some – as the document clearly notes that there is often client feedback noting improvements – but this is clearly not enough for these short term thinkers.

  7. Jess Thomas

    I hope that the SA Government can see McCann’s recommendations for what they really are. A complete ‘shift the buck approach’ to try and balance the health budget. The health of South Australians is more important than a cost shifting exercise. Shame on you McCann for your short sighted views. As Professor Baum states, we need more emphasis on prevention and improving population health not just more hospital beds. If we slash funding to health promoting programs, as McCann suggests, how will we cope with the increased rates of poor health in the future? These cuts will hurt those who needs access to health promoting professionals and programs the most. Another kick in the guts for disadvantaged groups.

    Prevention is much cheaper than cure. Pay less now or more later, I just hope the politicians can see further then the next election. Strong political leadership is required to ensure the health of many South Australians. If your purpose is a more efficient health system all the evidence points to investments in primary health. Please do not go backwards, for you are gambling with the health of South Australians.

  8. jules ferguson

    I have been a consumer advocate in the southern region of Adelaide for many years and have now witnessed a health service that is short sightedly focused on the medical model and not totally focused or committed on a primary health care model.

    What happens when this occurs….a budget blow out!

    We have the KPMG report which states SA Health needs to work smarter to make savings that will better sustain a health service as the population ages.

    McCann obviously doesn’t see that prevention is better than cure and in the long run WILL save $$$$$$$.
    Surely he should see that prevention is better than cure and the emphasis needs to be on the social determinants of health and health equity. The research links primary health care and health promotion with positive health outcomes and shows that it strengthens PHC and improves population health and hospital avoidance, so will be cost effective.

    I am dismayed at the thought of recommending cuts to health promotion and PHC services including community foodies, eat well be active and so on as budget measures. The savings are minor compared to the rest of the health budget which has blown out due to not enough emphasis on health promotion. Is this just an excuse for cutting the health budget and shifting responsibilities onto the Commonwealth government for political gains.

    How can McCann and SA Health possibly have confidence in preventing chronic disease and hospital admissions by cutting the very programs that promote health, and the prevention of illness obtained from a short-sighted report from an individual with a poor grasp of the complexities of chronic illness prevention.

    How can SA Health seriously think that the Medicare locals will pick up the slack! They are over worked and under resourced as is! Try to get a GP appointment in a timely manner!

    I trust that the powers above will see this review with its short sighted recommendations as total rubbish and will have the foresight to ask the hard work dedicated people working at the grassroots of PHC as well as asking the consumers who use the services.

    The rhetoric comes to mind here-Patient centered care and health literacy. Hopefully comes to SA health too!

  9. Health Promoter

    Interesting that McCann suggests that the Australian Breastfeeding Association will pick up the work in breastfeeding health promotion. Does Warren McCann not realise that Minister Hill has only funded the ABA until June next year, and was otherwise going to cut all their funding until a bunch of nursing mums came to parliament to protest. This is just one of many assumptions in McCann around other people (e.g. Medicare Locals) are going to do this work anyway, so why should the State do it. Total cost shifting – but getting it so, so wrong.

  10. Katrina Reschke

    It amazes me that we are still having the same argument with whichever government of the day about adequate funding for health promotion activities as we have been for the last 30 years. As an employee of a program directly affected by funding cuts as a result of the McCann report I am angry and shamed that we still “don’t get it”! Short term solutions to balance budgets do not create long term solutions to health inequalities. As has previously been mentioned those South Australians hardest hit by the McCann report will continue to be the biggest drain on our health dollar. Working on a program that was providing accessible chronic disease self management support to Northern Adelaide Metropolitan residents helped to reduce the load on already strained outpatient services. Most of these people will now “fall through the cracks” until they next present at an Emergency Department because despite significant Medicare subsidies to GPs to provide early risk factor counselling/detection and chronic disease self management they mostly do not have the time or the inclination – so much for hospital avoidance!

  11. Katy Osborne

    Thanks for your well-argued case Fran. Hard to believe the McCann review is so short-sighed and can’t see how health promotion contributes towards hospital avoidance and reducing chronic disease. The savings outlined in this report are so tiny as compared to the overall ‘blow out’ in the health budget, and cutting health prevention activities will be so much more expensive in the long-term!!

  12. Delany Toni

    Thank you for your well informed view Fran. The McCann Review demonstrates a complete lack of awareness about what supports wellbeing. It also reflects a lack of understanding about the links between health promotion, community based support and illness prevention. Furthermore, the strategies proposed in the report are so short sighted that, if implemented, they are likley to increase burden on hospital services now and well into the future. There is an abundance of evidence about how prevention activities support the management of chronic health problems and hospital avoidance. It is unfortuante that this evidence has been overlooked during the preparation of a review that uses a supposed “lack of evidence” as a basis for cutting much needed programs in SA. I can only guess that the same narrow view was applied during the search for evidence as that applied during the writing of recommendations.

  13. Angela Roesler

    The awarenss programs promoted by the Primary Health Service are pivitol in supporting communities to develop resilience in many areas of their lives. The diversity of the programs available works because not ‘one size fits all’. I work in the community sector in regional South Australia and have personal experience with many of the programs/services that are in jeopardy….and this WILL flow through and impact on isolated communities that are disadvantaged. The process of this review was not inclusive of those involved with the programs at community level and the proposed cuts directly conflict with SA Strategic Plan on more than one target. Primary Health Service programs do reach our community, make a difference, prevent Chronic Disease and there IS evidence of this……we cannot let this happen! Our communities deserve to be supported to reach their full potential!

  14. Colin MacDougall

    Totally agree with Professor Fran Baum. the McCann review is nothing more than a bureaucratic report continuing decades of cost shifting between Australian and State governments. It fails miserably in a pretence to be a scientific document using evidence. It does not use evidence in a rigorous and scientific way. It fails also in addressing global health concerns about health and equity. Rather, it dresses up ideology and internal bureaucratic wrangling in a porous veneer of psuedoscience. The problem is that acute services have a history of overspending. The McCann solution is to ignore that overspending, and pay for it by cutting community based services. The McCann review fails its own standards. It purports to analyse against evidence but fails to deliver. The real solution is to apply the criteria about evidence and value for money to the services that blow the budget in the first place. Thinly disguised attempts at cost and blame shifting have never succeeded as serious policy debate. Best to consign this review as a worthy addition to the shelf containing ideologically inspired documents that fail to deliver on rigour and intellectual honesty. Does McCann really believe that his recommendations can improve population health equitably by cutting the already bleeding community health sector? I urge SA Health and the Minister of Illness Services to be honest. If you want to cut community services please have the political courage to do it. Don’t hide behind sham reviews. Just do it and go to the electorate with a platform of cutting community services. If you want to shift costs to the Commonwealth government please negotiate that through COAG. Please do not hide behind a blatantly partisan review with flawed methodology. It is deeply ironic to see a party called Labor gazump the modus operandi of neo-liberal governments intent on cutting government services. It should not be the way a government that badges itself as in the social democratic tradition behaves. Too many people have watched too many episodes of Yes Minister and the Hollow Men to believe this latest parody of public service. I urge the Minister for Illness Services to disclose the total cost of this flawed review.If the McCann review is implemented, the great irony is that a so called Labor government will have achieved what successive conservative administrations could not: namely dismantling community services that promote the social democrat cause.

  15. Raymond Bange

    Soft targets are nearly always the first to feel the impacts of cutbacks and those expenditures that don’t have an immediate visible impact on the community are likely to be the first to be affected.

    We have seen this in the past with changes to funding of vocational and tertiary education and the funding of research and development. Cutbacks are not evident for some years and then there is great anguish as the realisation dawns that Australia does not have the skllls base that it needs and is being passed by emerging nations who have invested in the future.

    Primary health care is a little like that – prevention is much more difficult to sell as a principle in the face of other immediate demands that capture public and political attention.

    I trust that powerful advocacy and public opinion will help to maintain an appropriate focus on this aspect of community healthcare and wellbeing.

  16. Michael Bentley

    Is South Australia not interested in the causes of the causes of poor health? They will only be exacerbated if the recommendations of the McCann review are implemented.

  17. Jim Douglas

    Well done Fran Baum in challenging the recommendations of the McCann Report.How short sighted to cut funding to Primary health Care at a time that we need it most.If Mc Cann had any understanding of the importance of Community Inclusion and Social Capital he would not cut funding.As recent as today we read of homelessness and a lack of support of those who are doing it rough,the value of community gardens, veggie swaps,healthy life style community centres as meeting places for new arrivals and countless health and welfare benefits by having a place to go and meet.This is another ‘Shifting the Costs” exercise that only every show up as a once off so called “saving’ in the Budget to make a few feel good.. Mc Cann should hang his head in shame for being used as another head kicker for the Government.

  18. Matt Fisher

    A recent report from the Australian Institute of Health and Welfare on Health Expenditure in Australia 2010–11 appears to reinforce Prof Baum’s message that State budget savings arising from cuts to public health programs as recommended by the McCann report are marginal and may be soon swallowed up by expenditure growth in other areas.

    The report defines Public health services as those “aimed at protecting and promoting the health of the whole population or specified population subgroups and/or preventing illness or injury in the whole population or specified population subgroups.”

    Looking at annual growth in total Australian health expenditure over the last 10 years, the report finds that the spending on public health services has made a negative contribution to spending growth since 2007-08 (p. 117).

    In national recurrent expenditure on health in 2010-11, the proportion spent on public health was 1.6%, while public hospital spending amounted to 31.5%, and contributed 35.4% of the growth in expenditure, in the same period.

    According to the report, South Australian spending on public health programs has fallen since 2008-09, while spending on public hospital services increased by around $300 million (pp. 133-135).

    Surely, maintaining or even increasing spending on programs to promote health and reduce disease would be a cost-effective investment as part of a suite of policies to manage the real drivers of growth in the State’s health costs.

  19. lawless angela

    The McCann review appears to ignore the substantial body of research linking primary health care and health promotion with positive health outcomes. The evidence would suggest that a strengthening of PHC, rather than the cuts recommended, is required to improve population health, chronic disease management and hospital avoidance.

  20. Toby Freeman

    South Australia has the greatest rates of overweight and obesity in Australia- It’s going to get worse if these recommendations are accepted, with cuts to a range of nutrition programs.

    As others have noted, the community engagement work that will be lost if these recommendations are accepted will mean those most marginalised and who find health services most difficult to access can be expected to be more alienated by the health system, and experience poorer health.

    The only forseeable outcomes of these cuts will be greater hospital expenditure, more obesity, and greater health inequities in our state.

  21. David Phillips

    I agree, prevention is better (and cheaper) than a cure!

  22. paul.laris -

    The real irony here is that these measures will actually exacerbate the very problem they are supposed to be addressing. McCann is trying to meet the growing costs of hospital care for chronic illness by cutting the services and resources which work to minimise its incidence. So yes, there will be (relatively minute) savings to shift into hospitals in the short term, but at the cost of a likely increase in the demand for those services over coming years. in a way, this is a transgenerational transfer of illness. More $ now for chronic illness among baby boomers, and less healthy middle and old age for gen x and y. Evidence-free policy making!

  23. Esther Connell

    Conclusions drawn in the McCann Report are confusing and demonstrate an ignorance of the understanding of the role of health promotion in improving chronic disease management, hospital avoidance and population health. It seems this report is an elaborate excuse for cutting the health budget and shifting responsibilities onto the Commonwealth government. This is a very disturbing step backwards, especially with the aging population and increasing prevalence of chronic disease.

  24. Kerryn Eades

    Some amazing work in health promotion is currently being done and to think it will be cut without considering the ‘bigger’ picture and long term benefits of cost effective program’s such as community foodies. Health promotion initiatives empower people with the knowledge and skills in order to live healthy lives and minimise the time spent in hospital across the life span. Protecting out future generations and economy requires emphasise on health promotion initiatives.

  25. Elizabeth Becker

    Health workers in the Community and Primary Health area have built up partnerships with community members for many years to foster healthier communities and provide real pathways to better health for community members, beyond mere information provision. The cuts anticipated by this review will have a deep impact on this low cost and high impact work. Fran’s comments are very welcome in shining a light on these important issues.

  26. Anaf Julia

    We need health investment through tax reform, not further austerity measures imposing an unfair burden on the least advantaged

  27. Amy Teasdale

    Health promotion is vital in the prevention of chronic disease and hospital admissions. It empowers communities to make better choices relating to their health. By reducing spending in this area, the government think they are saving money, but clearly they are not looking long term. Disease prevention should be the focus of the government otherwise health spending will continue on its unsustainable, upward trend.

  28. Emma Tonkin

    It is encouraging to hear this response from Professor Baum and to know that someone with her wealth of experience is weighing in on this complex issue. It is extremely disturbing to me to see the years of work and research into health promotion fall by the wayside due to a short-sighted report from a single observer with a poor grasp of the complexities of chronic illness prevention and the social determinants of health and disease. I was shocked at the clear ignorance of the substantial evidence linking health promotion with chronic disease management, hospital avoidance and population health in the report. Cutting funding to health promotion would constitute a considerable step backwards for all three objectives.

  29. Gwyn Jolley

    I agree. It is clear that the McCann review was set up as an excuse to cut SA state funding to health promotion. This is very short-sighted and ignores the long term benefits of keeping people healthy. Services and practitioners do not seem to have been consulted as the decision was already made. Instead of cutting funds to community based services that address the needs of the most disadvantaged, government should be looking to control huge increases in medical costs and a tax system that allows the very wealthy to avoid paying their share.

  30. Rosemary Neal

    The health implications of cutting prevention and early intervention services are clearly indicated in a chart entitled “Adverse Childhood Experiences and Health and Well-Being Over the Lifespan” on Page 42 of the Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery, 2012 (Funded by the Australian Government Department of Health and Ageing): (You need to register to download the document but it’s just so that ASCA can track where the document is going.)

  31. Kaye Mehta

    I totally agree with Fran’s analysis of the situation. How can McCann and SA Health possibly have confidence in preventing chronic disease and hospital admissions by cutting the very programs that promote health, and prevent illness, such as community-based nutrition programs? The programs they are cutting, such as Community Foodies, have spent years building engagement with the community to change health behaviours – it is outrageous to think that with a single person’s review based on poor understanding of health determinants, all this good work will be stopped. The savings are miniscule compared to the rest of the health budget, and the damage to the community’s health is potentially great. Putting the onus on Medicare Locals to pick up the work gives no guarantee to the community that services will continue.

  32. Jane Littleton

    The McCann report seems to undervalue lower cost community support that helps keep the disadvantaged and poorer parts of the community from needing more expensive care. Over the last 5 years the government has supported already wealthy specialists with pay rises. They now plan to penalize the most disadvantaged by cutting services that help them to improve their quality of life thus saving the government the cost of more expensive treatment that are needed without smaller preventative programmes.

  33. Louise Townend

    If the McCann review is implemented the impact on the health of South Australians – particularly those from communities which already bear a disproportionate burden of economically related ill health – is likely to be extremely negative, both in the short and long term. Comprehensive Primary Health Care, including community health and health promotion, are cost-effective as well as efficacious and socially just ways of promoting the health of all South Australians. Instead of cutting the funding to these vital services a Government with ‘health for all’ at its core should advocate for increased funding through a fairer taxation base such as that adopted in several Scandinavian countries which enables them to boast that their citizens enjoy the best health in the world. Let’s make THAT vision a reality!

  34. Clare Phillips

    I agree, prevention is better than a cure and the emphasis needs to be on the social determinants of health and health equity. So let’s support the work currently being done in this area in SA, rather than reducing it to a minimum. The evidence is there, now we need some strong political leadership.

  35. Gavin Mooney

    Yes Fran, agreed and I think we have to keep banging the public health drum that this is a low taxed country, that poverty and inequality are the big killers and the way to address these is through higher taxes.

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