Labor had a resounding win in the State election, but public health advocates argue more needs to be done to keep us healthy, and COVID is not the only threat.
MF: It is tempting for governments to throw all their resources at quashing COVID-19. How important is it to not let public health issues become crowded out by the pandemic noise?
HP: The COVID-19 pandemic has put the importance of public health in the spotlight, and in particular the Australian public health response has highlighted the importance of prevention. We now need governments to apply the same level of dedication they’ve used to prevent the spread of COVID-19 in Australia to all the other health issues. Cancer, sexually transmitted infections, mental health challenges, the health impacts of climate change – all this and more existed pre-pandemic, and it continues to burden our communities.
MF: The State Government has committed to increasing investment in disease prevention, including increasing investment to at least 5 per cent of the total budget by 2029. Why is this important, and will it be enough?
HP: The WA health and mental health systems face enormous financial pressures and a growing disease burden associated with increased chronic disease and mental health challenges, an ageing population, and widening health inequities. It’s just not feasible or sustainable to keep spending more and more public funds on acute and emergency-based services without also investing in the other end of the spectrum. We need to ensure that we achieve a balance of investment across service types, and this means investing more in prevention, which is desperately underfunded in WA. This will help to keep people well in their communities and out of hospitals in the first place. Five per cent would be an excellent target to reach – the challenge is getting there over the next eight years. We want to see benchmark reporting on prevention expenditure start immediately.
MF: Are you concerned of a looming “syndemic” caused by rising rates of non-communicable disease such as heart disease, type 2 diabetes and cancer, and what can be done to turn it around?
HP: Organisations like Cancer Council have been raising the alarm about the impact the pandemic has had on cancer diagnoses for example, and there are concerns that more people will die from preventable diseases as they hold back on visiting their doctor. To tackle this, a good starting point for the WA Government would be to implement all of the recommendations from the Sustainable Health Review Final Report, including increased investment in prevention. The answers are right in front of the government – they just need to get moving.
MF: What is the role of doctors, particularly GPs, in trying to curb rising rates of lifestyle diseases? Should they be more proactive with their patients, even if they risk being too intrusive?
HP: Everyone working in the health system has a role to play in curbing chronic disease, including GPs. But it’s unhelpful for the focus to be purely on individual behavioural change. Policies that create supportive environments to help encourage healthy behaviours, and increased investment in prevention will provide the most benefit. One of the most important things all doctors can do to help generate change at a population level is to support calls for the implementation of evidence-based policies that we know work to address the key risk factors of chronic disease.
MF: The State Government hasn’t committed to your call to introduce a minimum unit price for alcohol. Why is this important and doesn’t it risk getting light to moderate drinkers off-side?
HP: In WA, alcohol is promoted and sold at dangerously cheap prices. We know there is a strong link between alcohol price, alcohol use, and alcohol-related harm – as the price of alcohol increases, use decreases in the general population and among heavier drinkers. A minimum unit price for alcohol would set a price below which drinks cannot be sold. One of the reasons it is an effective policy is because it is a targeted measure that would reduce alcohol use among the heaviest drinkers, while having minimal impact on low-risk drinkers. This is because low-risk drinkers drink fewer drinks overall and buy less cheap alcohol than heavy drinkers.
MF: Likewise, would a ban on unhealthy food and drink advertising at state-owned assets really change behaviour, especially in adults?
HP: There’s very clear evidence that exposure to food marketing has impacts on children’s nutrition knowledge, preferences, purchase behaviour, consumption patterns and diet-related health. Why are our kids being targeted with junk food ads on their way to school? Advertising works – that’s why junk food companies invest so much in it. It means more sales for them. Obesity-related illnesses are set to cost WA hospitals over $610 million a year by 2026, yet the government is still selling advertising space to the very companies and products that are making us sick. A ban on advertising of unhealthy food and drinks on all state-owned assets would support broader obesity prevention strategies.
MF: On a positive, the State Government has committed to maintaining the current restrictions on electronic gaming machines in WA. Why are pokies so bad for public health?
HP: West Australians just need to look across the country to see the devastating effect pokies have on the physical, social, and mental health of individuals, families, and communities. These machines are purposefully designed to be highly addictive. Moderate to severe problem gambling results in suicide, relationship breakdown, financial difficulty, mental health problems such as anxiety and depression, and crime. Gambling particularly affects vulnerable groups in the community, such as people from low socioeconomic backgrounds, and often has inter-generational impacts.
MF: Climate change remains an inconvenient truth for many politicians. What commitment is needed by governments and why?
HP: A healthy WA community is impossible to achieve without a healthy environment. We know that governments really cannot commit enough to address the impacts of climate change. Action is needed now. While a focus has been on a target of net zero emissions by 2050, to have a real impact this needs to be moved forward to 2040. Luckily in WA we have several key strategic documents released in 2020, including the Climate Health WA Inquiry Final Report, that provide a blueprint for the WA Government to tackle the issue of climate change. These reports highlight there’s a lot the health sector can do to help reduce its own emissions and contribute to designing and implementation adaption plans for the changing climate.
MF: Are groups such as Healthway still necessary and why?
HP: WA is lucky to have an organisation like Healthway, whose core role is to promote and facilitate good health and activities which encourage healthy lifestyles. Many people are unaware of just how much Healthway does for our state. It not only provides funding to sport, arts and community events and programs to help reduce children’s exposure to unhealthy products, but Healthway’s local investment in prevention research and its focus on translation has resulted in an acceleration of research into practice in WA.
MF: The Association of Australian Medical Research Institutes recently warned that a decline in philanthropy and revenue from international students meant fewer medical research careers would be supported? How would this impact public health?
HP: The AAMR identified these risks in the context of COVID-19. Public health research and research on preventative approaches is an important part of health research generally; something which the Sustainable Health Review Final Report has picked up, and which requires continued and sustainable investment. It is vital that governments continue to support health and public health research, and that we work to support groups who may be disproportionately affected by the ongoing impacts of COVID-19 and the generation of revenue for research, including women.