As recently previewed at Croakey, a public forum in Melbourne this week highlighted some critical questions about the public health challenges facing Victoria. Marie McInerney was there to provide the report below for the Croakey Conference News Service.
Marie McInerney writes:
It would have been – as suggested by forum moderator Michael Moore, CEO of the Public Health Association of Australia – the perfect occasion to announce a new smoking ban.
Victoria was for many years seen as a national leader in tobacco control. Now it’s the only state that has yet to adopt or announce a ban on smoking in semi-enclosed and outdoor eating areas.
Alas, there was no such announcement at the forum on Health Above Politics: Tackling the big public health issues facing Victoria – just a entreaty on this and a number of other issues to “watch this space”, as the Andrews Labor Government, still less than a year old, works on its policies.
But public health advocates say they may move to set up a Victorian Parliamentary Friends of Public Health committee to build on the common ground revealed by Labor, the Coalition, and Greens on key issues at the event, and the welcome cross-party commitment to principles of health prevention and promotion.
That could send important signals to the Federal Government in the wake of its decision to scrap the Australian National Preventive Health Agency.
But it also comes as Victoria sees its flagship prevention program Healthy Together Victoria whither away and as the state still lags on tobacco and alcohol reform.
Below are nine questions arising out of the forum.
1. Is Victoria up to tackling the big public health issues?
That was the underlying question put to the strong panel of speakers representing Victoria’s major political parties:
- Mary-Anne Thomas, Parliamentary Secretary for Health (Health Minster Jill Hennessy had a prior commitment)
- Hon Mary Wooldridge MP, Leader of the Opposition (Legislative Council), Shadow Minister for Health
- Colleen Hartland, Victorian Greens health spokesperson.
The forum was hosted by the Public Health Association of Australia (Victorian branch), together with the Australian Health Promotion Association (Victorian Branch) (AHPA), Australasian Faculty of Public Health Medicine (AFPHM), Australasian Epidemiological Association and The Doherty Institute.
It was staged out of concern that public health was not on the agenda at the November 2014 state election.
Not surprisingly, with just over an hour to cover complex issues ranging from end of life care to mental health (where Wooldridge had overseen a major and contentious service re-commissioning under the previous Coalition Government), the forum also prompted a number of other questions, as follows.
2. Will Victoria win the Dirty Ashtray award in 2016?
The Australian Medical Association awarded its Dirty Ashtray award to Victoria in 2014, saying it had lost its leadership mantle and fallen behind the other jurisdictions in its failure to protect non-smokers.
Public and parliamentary support is not the issue for Victoria’s continued failure to order an outright ban on smoking in outdoor eating areas, leaving it up to individual councils to consider. The Cancer Council says 70 per cent of Victorians are in favour, and both the Greens and the Coalition want it to be the next step in tobacco control.
“It should just happen, I don’t understand why it doesn’t,” Hartland told the forum. “I completely agree,” said Wooldridge. “The only impediment at this stage…is the Labor Government.” It was clear, she said, that Labor had not done the work on the issue in Opposition and was now catching up. “We need to continue the pressure so this is an issue the government can’t escape from.”
Thomas said the Andrews Government had brought forward proposed bans on smoking on the grounds of and near the entrances to hospitals and community health services, schools, childcare centres, kindergartens and preschools, and many government buildings including Parliament, courts and police stations.
It was aware of the “overwhelming public support” for a ban and committed to a range of smoking controls but would “take the time to do the work to take everyone with us. I would say ‘watch this space’,” Thomas said.
3. Does Healthy Victoria Together live on….but only in New Zealand?
The landmark Healthy Together Victoria program was heralded as “the largest and most rigorously planned population health intervention at a community level” in Australia”, but appears to have died a quiet death – in Victoria in any case.
Thomas said the Victorian Government was “extremely disappointed” that the Federal Government had “walked away” from the program – “without warning or consultation”. She said the state would continue to fund elements of the program – the Achievement program, the Healthy Eating Advisory Service, and Live Lighter – and “look for more opportunities to fund health prevention”.
But Wooldridge said the State Government should have stepped into the breach and committed another $20 million a year to keep the program alive.
She said its argument that it could not afford to do so was contradicted by its decision to declare two new public holidays for the state, at an estimated cost of $48.5 million a year in additional public sector wages (the vast majority borne by hospitals). (There is concern in public health circles too over the likelihood of an AFL Grand Final holiday spike in binge drinking).
Wooldridge said Healthy Together Victoria, launched by the former Coalition Government, was a “fantastic, system based approach to prevention” that had been sold on to New Zealand.
“They’re rolling it out, adapting it to the New Zealand environment…and Victoria has stopped it,” she said.
The program had applied a concentrated and coordinated prevention effort across 14 vulnerable local government areas. Wooldridge said funding ceased on 30 June 2015, but while councils were trying in different ways to maintain some momentum, the 120 Healthy Together Victoria public health workforce had been “dissipated”, with big losses too in expertise and commitment of community leaders.
4. What are the Victorian Government’s priorities?
Beyond the demise of Healthy Together Victoria, Thomas said the Andrews Government had demonstrated its commitment to helping all Victorians to “stay as healthy as possible for as long as possible” through a range of initiatives, including: the introduction of a free whooping cough vaccine, School Breakfast Clubs, its Ice Action Taskforce, and skin cancer prevention initiatives.
Over the last few months, she has been conducting consultations to develop Victoria’s Public Health and Wellbeing Plan for 2015-18, due to be delivered in September. She is also a member of the Victorian Finance Minister’s WorkHealth Advisory Group, set up since the election and headed by Cancer Council CEO Todd Harper, that will develop a strategy for taking primary health care into workplaces.
Thomas said the Public Health and Wellbeing Plan would also “send very strong signals” to the health workforce and others interested in health promotion and preventative health about the types of skills and capabilities that Victoria is going to need – both clinical and non-clinical, including youth and community workers, right through to urban planners, she said.
“So watch this space,” she said, “I think you’ll see we have made a profound leap in the quality of the Plan and the information and strategy it provides.”
But the Opposition MPs said security of workforce funding is also a crucial question, particularly with Healthy Together Victoria job losses.
Hartland said public and community health staff spend huge amounts of their time “doing the next grant application. “People have to know their funding is secured,” she said.
5. Will an AFL club make a stand against alcohol sponsorship and advertising? And should industry be at the table when it comes to preventative health initiatives?
There was bipartisan agreement that alcohol is a major health issue for Victoria – but concern among advocates that Victoria has a $45 million Ice Action Plan – “it’s all about ice, ice, ice, even though the evidence tells us there is no such epidemic”, said one – but no Alcohol Action Plan, nor a government yet “brave enough” to introduce major restrictions on the promotion of alcohol in sport.
Wooldridge said she was disappointed that the Federal Government’s decision to axe the National Preventative Health Agency meant an early end to its ‘Be the Influence – Tackle Binge Drinking’ campaign that signed up 16 major sporting associations, including the Football Federation of Australia and Netball Australia, to provide alcohol promotion-free sporting environments.
She said it was an approach that needs “sustained investment” – a message that she might like to take to her federal Coalition colleagues or, as moderator Michael Moore suggested, to the Australian Football League to see if just one club would be prepared to give up alcohol sponsorship or advertising. It’s an approach that Victoria pioneered with the establishment of VicHealth using funds collected from a tobacco tax to buy out tobacco sponsorship of sports and the arts.
Thomas said she had been quite shocked at a recent electoral event to meet an executive from the alcohol industry in “denial” about its harms. It underlined to her the need to educate and engage with industries like alcohol, food and gambling, “to take them on this journey with us”.
That engagement would be great, PHAA (Vic) president Brian Vandenberg said later, if it is to ask industries to support and not weaken evidence-based policy. But if it’s to involve them in devising preventative health strategies, he said, then it’s a “treacherous path to go down.”
“I think we in public health need to do more to highlight to the parties why it is ill-advised to work with the industry. For a start, the head of WHO is very clear that she opposes industry involvement in policy making, given their conflict of interest,” he said.
Former VicHealth CEO Rob Moodie and colleagues concluded in a recent study that “unhealthy commodity industries should have no role in the formation of national or international (non-communicable diseases) NCD policy”, saying that food and drink industries use similar strategies to the tobacco industry to undermine public health measures.
Hartland agreed, saying “in the long run, they’re going to employ people to do huge amount of PR to tell us they’re not the problem”.
There was also concern expressed after the forum that the Andrews Government has scrapped a liquor licence that had until now stopped new late night drinking venues opening in the inner city – particularly with the provision of temporary extensions to the ban to venues of all sizes for major events, including cultural and sporting events (like the AFL Grand Final) and on New Years Eve.
6. What’s the most effective way to close the gap in Indigenous health in Victoria?
There was clear tripartisan support on Indigenous health and a continued commitment to implementing Koolin Balit: Strategic Directions for Aboriginal Health 2012-2022, introduced by the former Coalition Government.
Both Thomas and Hartland agreed with Wooldridge on the fundamentals that:
- Aboriginal health policy “needs to be done by and with the Aboriginal community, rather than to and for them”, and
- Health is only one element of a broader perspective on social, cultural, emotional wellbeing, and preventive health strategies need to take that into account.
Here’s what the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) says are its priorities.
7. Is death and dying a public health issue in Victoria?
It is, and it’s under review, after Hartland secured support (after eight years of trying) for an inquiry into end of life choices.
Hartland is an advocate for voluntary euthanasia, saying it is “happening every day, in the dark. It needs to be out in the light.” A poll by the ABC’s Vote Compass before the 2014 state election found that 79 per cent of Labor voters and 71 per cent of Coalition voters supported medically assisted suicide.
Thomas said she is “always a little alarmed” when end of life debate leaps straight into euthanasia, without a more nuanced discussions on the benefits of palliative care.
Wooldridge was also cautious, but had been pleased to support the inquiry so it can do detailed work on the broader issues. She said the relatively paltry funding spent on helping people to die at home, highlighted in this Grattan Institute paper, was an “absolutely crucial issue”.
8. How do we put health above politics?
Wooldridge was Community Services and Mental Health Minister in the previous Coalition Government. Politics and health have been a family affair: her brother Michael was Health Minister in the Howard Government.
She said one of the challenges for action on prevention in health today is the increasingly short cycle in public debate and discourse and the demand – whether from media, politicians or public – for quick action and quick results when evidence on the benefits of prevention can take decades to emerge, if they can be demonstrated at all.
Her experience as a Minister was that making the argument for prevention in the face of urgent tertiary and acute demand was “exceptionally hard” and that public health advocates have to build the evidence base “so we can compete equally” for funding and focus, particularly given the role of prevention in slowing the projected growth in health spending in the future.
“This forum tonight is about taking politics out of preventative health. I actually think the more we can put politics in the better,” she said, pointing to the campaigning role the Herald Sun newspaper took on road safety by putting the road toll on the front page every day. Victoria also saw a similar campaign more recently on family violence, led by advocates, police and media, that saw the Andrews Government set up Australia’s first ever Royal Commission into family violence.
“We need to make sure that all politicians and all those engaged in the debate actually can’t do anything but support the preventative health initiatives we know need to occur,” Wooldridge said.
9. Where to from here?
The promise of bipartisan support on key issues like Indigenous health and tobacco control was welcomed, although there was concern that issues like the impact of climate change on health were not canvassed in depth.
Public health experts also welcomed the Andrews Government’s decision to widen the Hazelwood Coal Mine Fire inquiry and, potentially, to create a health conservation zone with an independent health advocate in the LaTrobe Valley, one of the state’s most disadvantaged areas.
“What was most inspiring was to have three strong female leaders who deeply understand public health and want to see it succeed,” said one of PHAA’s event organisers, Dr Bruce Bolam. “This is part of the story of why Victoria has been such a success story with health promotion and prevention in the past, but the next question is about commitment to particular initiatives.”
Much will ride on the strength of the Public Health and Wellbeing Plan and how it replaces the ambition and scope of Healthy Together Victoria, but Brian Vandenberg is hopeful that public health is at least back on the agenda in Victoria.
“I think we’ve got the attention of the political parties,” he said. “Public health slipped off the agenda at the last election but we have now started a conversation that will be important, as we move into the next electoral cycle. It’s time now to start talking about tangible policy reforms, and we’re pleased that all parties have opened the door to further conversations with us,” he said.
Croakey thanks all those who contributed to the Twitter discussions at #HealthyPolitics.