Following on from the previous blog on primary health care... Secondary prevention is a smart and essential part of health care also.
Secondary prevention is about early detection, early treatment and effective long term management. It saves patients a great deal of money and suffering, not to mention saving them from premature death. Early detection occurs in part through education – the Cancer council has recently been running ads that encourage people to keep an eye out for suspicious signs.
Doctors surgeries have their walls covered with posters encouraging people to keep an eye on their weight (by looking at which hole on their belt buckle that they are using), and encouraging men in particular to have regular checks.
There are the screening services like those provided by Breastscreen, endoscopy procedures that look for early danger signs, and simpler and less invasive procedures like the blood pressure and blood sugar checks we should all have after the age of 50.
The reason why we have these education and screening services is that early detection means simpler, less expensive treatment and better outcomes. It helps us detect a problem before we experience symptoms (like bleeding, pain, or even lumps), which can be critical. And it helps us overcome our natural complacency… if we feel well, we assume there is nothing wrong, when sometimes there is. Screening gives us the peace of mind we are well, and just in case we aren’t it puts on the road to early treatment and recovery… keeping us well.
It promotes wellness, it keeps us happy and healthy, and it is relatively inexpensive. At the same time, it is the kind of service that governments can cut without people noticing too much. And sadly, that is what short sighted governments who focus on election cycle time frames do.
The Abbott/Turnbull government’s move to introduce GP co-payments undermines secondary health care because it discourages people going to the doctor early and getting screening done. The freezing of the Medicare rebate (slowly) undermines secondary health care in the same way. Limiting people’s access to affordable medications through undermining the PBS has the same effect. And even providing funding windows for specific and emerging health problems undermines long term secondary prevention. Because when the special funding runs out… the service stops, regardless of its effectiveness.
In contrast, the Green believe that secondary prevention is exactly where we need to invest our health dollars. Greens leader Dr Richard Di Natale has today announced a proposal to expand the cover Medicare provides for a significant and growing health problem for Australia in general and Townsville in particular … better treatment for diabetes. And of course, there are other emerging health risks which we need to address now… mental health, oral health, dementia and aged care.
The Greens have the major parties worried because they understand the issues that matter to most Australians and they have workable solutions.
But it is not just about spending, it is also about saving.
Medicare currently funds many procedures for which there is limited clinical evidence that they are best practice. Last year Four Corners highlighted many areas of waste in health funding.
You can watch that episode of Four Corners by clicking this link.
But despite that, the government has not sought to address wasteful spending, just to restrict access to health for people who can’t afford to pay.
The Greens support a great deal more spending on primary and secondary health care, and believe that in turn good health will be affordable for all. We also believe that good health for us all is tied to managing the health of both our built and our natural environment.
When we draw all those threads together... our nation and our citizens will prosper as a result.
by Wendy Tubman
Primary prevention, efforts made to stop people getting sick in the first place, are the best strategies to ensure good health outcomes. Not only is this the least expensive approach, it also preferences wellness over the treatment of illness. It produces the best possible health outcomes for the smallest spend.
Australia has done primary prevention well in the past.
The ‘Life. Be in it.’ campaign was incredibly successful locally and was exported to the US in the 1980’s. Unfortunately, Federal funding was ceased in 1981 to redirect money to elite sports, and, while the program went into a hiatus, it was picked up by private interests and continues (in a much diminished form) to increase physical activity today.
‘Slip, Slop, Slap’ was an equally successful campaign. It markedly changed people’s behaviour in the sun and was responsible for seeing reductions in skin cancer rates. As often happens with successful campaigns, the government took its foot off the pedal (assuming the problem was fixed), behaviour changed again and we saw increasing prevalence of sun- related skin damage.
As a result that campaign has been effectively re-launched as Slip, Slop, Slap, Seek and Slide.
When AIDS blindsided the world in the mid 1980’s, Australia again responded with a very effective public education campaign:, The Grim Reaper Ads which encouraged people to wear condoms and not to share needles. AIDS affected every corner of the planet, but it left Australia relatively untouched… saving many individuals from a premature death or a shortened life time of health issues and saving the economy billions.
But primary prevention goes beyond education. All the measures that have been taken to reduce tobacco use… plain packaging, banning smoking in some places and relegating smokers to out-of the-way places, support to quit through the Quitline. All that has driven smoking rates in this country to 17%, from where we now lead the world in rates of non-smoking.
Councils have played their part… providing active transport options like great bike path networks, and, in bigger cities, providing end of trip facilities and integrating bike transport with other public transport options. They have provided gyms in the park, like what is currently available in Sherriff Park.
But there is more that can be done… like increasing the Walkability of suburbs.
Federally, we will push further for clear labelling of processed foods, taking the Traffic Light labeling system beyond a voluntary scheme to a mandatory one. We will push for greater availability of healthier choices for kids and the banning of junk food advertising being broadcast during prime viewing times for kids.
There is also a great deal of support for other measures, like a sugar tax.
In addition to what’s been mentioned, there are a great many more opportunities for the government to drive down health costs, and at the same time increase the general health of the population. But while we are focused on emergency department waiting times, and waiting times for elective surgery, our eye is off the real game.
The Greens don’t support cuts to health… but we do support a smarter spend. We recognise that an effective health system must be based on primary health care and preventative health care measures — such as health promotion, disease prevention, risk reduction and early intervention — in order to manage chronic disease, reduce ill-health and avoidable hospital admissions.
The Greens will work in government to achieve this and have established, clear policies on:
Health Care, and
Check them out by clicking the relevant link.
Greens policies, and all the examples of great primary health initiatives are innovation in action. Malcolm Turnbull is good at talking about innovation (and getting excited about it), but terrible at translating it into real world solutions.
Only the Greens are making sensible proposals in this space.
by Wendy Tubman
Wendy Tubman, the Greens candidate for Herbert is passionate about the local community and is working hard to connect with locals and discuss what matters to them. This campaign is not solely about getting elected, it is about giving voice to local people and how they see our shared future in the region.
Wendy is talking with her colleagues in the party about what matters to Townsville, but also what is important for Queensland's and Australia's future. Although this is a Federal election campaign, local, state and federal issues are impacting on us all, and Wendy believes good governance is about bringing all our representatives together to work on a shared vision for a great future.
Wendy has been at the markets talking to anyone who is interested in stopping to chat. She'd encourage more people to take the opportunity... it's our democracy and by getting involved at any level means not only do we get to keep it, but it reflects our needs, our hopes and our desires.
But Wendy says don't just stop and talk to her, talk to the other candidates, let them know what you care about, and make sure they are as focused on representing you as Wendy is.
Wendy was out during the May day marches talking with locals. The issues at QNI are a topic of concern for us all.
Regardless of how things play out at Yabulu, our region needs new jobs and new industries. Wendy stands for looking after workers who have lost their jobs (especially in circumstances like those surrounding QNI), in supporting the transition to new jobs and in creating opportunities for all people who want to work, but especially for youth and new workers in our region. Everyone deserves the opportunity to contribute.
People are cynical about politics and politicians... with good reason. Thankfully our cartoonists have the ability to combine those feelings with a good laugh.
But Wendy reminds you all... all candidates are not the same. It is a long election campaign... but don't switch off. Be well informed and choose wisely on July 2nd.
While it is risky to generalise, it would be uncontroversial to say that all Australians believe in a decent standard of health care for all.
Not many would suggest that if people want good health care they should pay for it, especially if their circumstances make it unaffordable. We do believe in looking after each other, and going the extra mile to help the less fortunate among us.
Yet we are seeing increasing levels of obesity, more and more people developing chronic diseases and suffering from chronic illnesses, and we are facing emerging mental health epidemics across all demographics. Despite the huge amounts we are spending.. our health is getting worse.
We are all concerned about the ever increasing cost of health care, to us as individuals, and to the society more broadly. And we are right to ask if money is being wasted.
The truth is that it is.
Not because we are employing too many doctors, nurses and allied health professionals. Not because more people aren't taking out private health insurance. And not because we don't have 'price signals' in the system. It is being wasted because spending is prioritised on the wrong things.
There is a solution to both problems, and we've known the answer for a very long time.
Primary health care is the business of preventing illness and maintaining wellness. It leads to better health outcomes and it is far less expensive.
But when governments talk about 'health' they are largely talking about treating illness. We know this based on how governments measure success.
There is an old saying 'What gets measured gets done'. Its roots go back to the 1500's, and the reason that it has survived is that it retains a kernel of truth.
When governments report on the state of the health system they typically quote only two measures... waiting time in Emergency, and elective surgery waiting times. The truth is emergency surgical procedures are almost always performed in a timely fashion, and emergency presentations at Emergency are almost always seen immediately. And that is the service working as it should.
In contrast... People requiring elective surgery are in most part evidence of the health system failing them.
If they require joint replacement, the question should be asked 'could their joints have been protected through all manner of preventative measures' (like diet, exercise, better shoes, better work conditions)?
If they require gastric banding, the question should be asked 'could a better, conservative management approach have prevented their obesity and the accompanying health issues' (like diet, exercise, education, making better nutrition information available, a sugar tax, subsidising fresh food).
If they require organ transplantation, could better lifestyle choices (like not smoking, drinking in moderation, better diet and exercise choices) have negated the need?
In many cases the answer is yes. But by not measuring physical and mental outcomes.. like body fat percentage, blood sugars and lipids, cardiac and respiratory output, the self reporting of wellness and happiness.. we are not measuring the real effect of our society on our health, and we are not seeking good health outcomes for all.
By measuring the treatment of illness we are in effect ensuring there are more illness to be treated.
With activity based funding (which encourages hospitals to perform more and more surgeries) we are making surgery the most likely outcome for patients when often the research suggests surgical outcomes are not the best option. Performing arthroscopies for osteoarthritis of the knee is a good example.
By measuring waiting times for non-urgent ED presentations and elective surgeries... we are making health more expensive and we are accepting poorer health outcomes for all.
A first step to fixing our health system, is to start measuring (or perhaps reporting) on the right things. Things like the percentage of the population who are in a healthy weight range. These things are measured reported in the background but are never held up primary evidence about the effectiveness of our health system.
Most of us would believe that if health ministers were held accountable for societal obesity levels, we would see a bigger focus on primary health care. And with that changed focus we will quickly a slowing in the rate at which people are getting heavier and more unhealthy.
But instead we have MP like Ewen Jones telling fat jokes.
But I'm not going to leave you with questions... or Ewen's terrible jokes. There are ways we can reform the health system, and this can be led Federally.
More about that in upcoming blogs
by Wendy Tubman
The take home message from the recent budget was jobs and growth. We know this because Scott Morrison repeated this mantra 13 times in a 30 minute speech. He also repeated the word plan 21 times, as if to reinforce the idea that economic thought bubbles (like giving States taxing powers) were a thing of the past. And following the speech, Liberal MPs dutifully followed their talking points and repeated key words Ad Nauseum, without actually saying very much.
The only plan the government seems to have is to cut tax for small business and the wealthy, and, over the next 10 years, cut tax to bigger and bigger businesses.
But where is the evidence that this approach leads to more jobs?
And, setting aside for a moment the significant problems of advocating for never-ending growth on a resource-constrained planet, where is the evidence that it leads to growth?
Mike Seccombe pulls the ‘tax cuts leads to more jobs and growth’ approach apart in The Saturday Paper.
In 2012, the US Congressional Research Service looked at the effect of reducing income tax rates since 1945.
It found that, in 1945 the top marginal tax rate was 90% but by 2012 it was 35%, and stated: “Analysis of such data suggests the reduction in the top tax rates have had little association with saving, investment or productivity growth.”
It also found that “the top tax rate reductions appear to be associated with the increasing concentration of income at the top of the income distribution”.
The Research Service also found that the approach increased growth in inequality (an issue we touched on in a previous blog).
But what about the Australian experience?
Investment - Bureau of Statistics data show that, since 1960, private business investment in Australia has trended slowly down as a share of GDP. Before the late 1980s, corporate tax rates averaged well above 40%. Since then, have been progressively reduced to 30%. But there has been no increase in investment as a result.
Economic growth - Up to 1988, the economy grew, on average, by 3.8% a year. Following reductions in corporate tax rates, growth dropped to 3% and is currently forecast at 2.5%.
Employment and Wages - The data show unemployment rates were lower when corporate taxes were higher, and that, since company tax rates have been lowered, the share of GDP going to wages has declined.
This government has asked as a part of its re-election pitch… who do you trust on the economy?
A sane person certainly wouldn’t trust the Coalition, given the deterioration we have seen since they took charge.
I would suggest putting more faith in a Nobel prize-winning economist such as Joseph Stiglitz who says it is “Those at the top spend far less than those at the bottom, so that as money moves up, demand goes down.”
Numerous Coalition policies are shifting wealth towards the top… to those who won’t spend. It doesn’t take a rocket scientist (or a Nobel Prize winning economist) to tell you that their plans will have disastrous economic outcomes for most Australians.
It’s a recipe for more job losses, less growth, more inequality and social problems, growing deficits, and even more tax cuts for the wealthy.
Who can we trust on the economy… not Scott Morrison for one. And although you wouldn't know it if your only news was from the mainstream media... the Greens do have an economic plan.
by Wendy Tubman
The government has been making one amateurish error after another this year as they nervously watch their approval and support fall among voters.
No one believes the impending Double Dissolution is about the importance of re-establishing the ABCC, rather it is an excuse to try and 'clean out' the Senate of dissenting voices, and a chance to rush to an election before government support and the PM's approval slips too much further.
The much anticipated Budget has for some time been used as an excuse to not answer questions, and to avoid repeated gaffes. Everything was to be answered on Tuesday night. But the strange thing was that it left us with no real answers... perhaps an indication that the government doesn't have any.
One commentator after another has been suggesting the real plan is for budget talk to disappear as quickly as possible, and not hang around like Joe Hockey's 2014 stinker.
But as much as it was designed to fly under the radar, there is still plenty to criticise.
The Greens spokesperson for transport and infrastructure Senator Janet Rice said
“Turnbull’s much-trumpeted $50 billion infrastructure spend is just smoke and mirrors, mostly just reannouncing Abbott-era projects. Less than 10% is going to public transport, continuing the chronic underinvestment in our trains, trams and buses. We’re not going to ease congestion by continuing Tony Abbott’s addiction to great big polluting toll roads. Trying to fix congestion by building more roads is like loosening your belt to cure obesity – car use will inevitably expand to fill the space. A better budget would have prioritised trains, trams and buses, freeing up our roads for people who need them most."
Senator Scott Ludlam said:
"We will see thousands of wealthy retirees switch their investments from superannuation to property. That will squeeze lower income earners and first home buyers even further out of the market. Negative gearing already costs the community $4 billion a year, a cost that will no doubt rise further as people move their wealth out of superannuation and into property, forcing ordinary taxpayers to subsidise their investments. The capital gains tax discount costs closer to $7 billion annually. The government ran away from tackling these handouts, for fear of upsetting the property sector. More and more Australians are locked out of the housing market, and Mr Turnbull and Mr Morrison seem determined to make it worse. This budget confirms more than $110 million of annual funding to homelessness services comes to an end next year. They've locked in Tony Abbott's appalling $600 million cuts to affordable rental and housing programs."
Senator Larissa Waters said:
“Our Reef is suffering record coral bleaching driven by global warming but the Liberals are ripping out a billion dollars from clean energy, and funding for work on Reef water quality comes from cutting Landcare. True to its anti-science agenda, the Turnbull Government has locked in the Abbott Government’s cuts to the Great Barrier Reef Marine Park Authority and the Australian Institute of Marine Science. While environment funding is cut, the mining industry get another $100 million for exploration to dig up more fossil fuels to further cook the Reef’s corals. A better budget would have invested in clean energy, not dirty energy, to help save the 69 000 jobs the Reef provides. While the fossil fuel industry continues to get over $20 billion in subsidies, the Turnbull Government’s budget locks in the $1.3 billion slashed from the Australian Renewable Energy Agency."
But the Budget is perhaps best summed up by Greens Leader Senator Richard Di Natale:
"This Budget is a massive let-down, just like Malcolm Turnbull has turned out to be. The government is pretending it can afford unsustainable and unfair tax cuts for the big end of town by claiming fanciful levels of economic growth. While champagne will be flowing in board rooms across the country, these irresponsible cuts come at the expense of long-term funding for schools, hospitals and public services. Rather than reducing inequality the government has chosen to make it worse by cutting social support, university funding and health services. The government doesn't see the jobs of the 21st century in building wind turbines and public transport, they see them in building military hardware. The much-trumpeted $50 billion investment in infrastructure turns out to be a case of smoke and mirrors. It's just a repackaging of existing funding."
As always with the Abbott/Turnbull government... we are promised so much and offered so little. This budget is just par for the course.
Never has there been a more important time not to settle for 'more of the same' from tired old major parties who have either run out of ideas or else are beholden to their support base.. selling out the rest of us in the process.
It is now clear that the only real hope for change is to vote Green at the upcoming election.
by Wendy Tubman
Across the world we are seeing increasing levels of inequality – between developed and under-developed economies, and within national boundaries. In Australia the gap between rich and poor has been rising for over 30 years, and that has accelerated in the last decade and a half as we have moved away from a progressive tax regime and the means-testing of government financial support.
But is this a problem? According to those on the Right it isn’t. Their arguments include: our duty is to reward success and ‘lifters’ rather than ‘leaners’; that wealth accruing to the rich ‘trickles down’ to the poor; that income inequality is healthy because it inspires lower income earners to work
The arguments may, at first hearing sound plausible, but do they really stack up?
It has long been accepted, following the Whitehall studies, that your position within a large organisation, and within society as a whole, has a significant impact on your life expectancy and other health outcomes. Those higher on ‘the ladder’ clearly experience much better outcomes. In 2010, the Marmot review in Britain found that people living in poorer areas die on average seven years sooner, but also spend more of their lives with disability – an average total difference of 17 years.
These health inequalities are not just limited to life expectancy but also include infant mortality, mental health, physical health and so on. This is not a localised effect, the results having been largely replicated in a study that looked across 50 countries. In their 2009 book The Spirit Level: Why More Equal Societies Almost Always Do Better, Wilkinson and Pickett found a clear relationship between income inequality and health and social outcomes. See below.
Looking at all these indicators separately, the effect of income inequality is quite stark. (Note, a score of zero means no correlation, and a score of 1 or -1 means a perfect positive or perfect negative correlation.)
So we can see that income inequality has a significant impact on increased teenage births, higher imprisonment levels, mental illness, reduced levels of social trust and higher levels of obesity. There is also a notable effect on increased rates of homicide, reduced educational performance, and increased infant mortality.
Recent studies have investigated whether or not income inequality causes health and social problems, independent of other factors, and some rigorous studies have provided evidence of a relationship. Kondo, et al (2009) estimated that about 1.5 million deaths (9.6 per cent of total adult mortality in the 15–60 age group) could be averted in 30 OECD countries by reducing income equality below current levels.
Another study suggested that the loss of life from income inequality in the US in 1990 was the equivalent of the combined loss of life due to lung cancer, diabetes, motor-vehicle accidents, HIV-related causes, suicide and homicide.
As an indication of where Australia sits in relation to the rest of the world, see the chart below.
We're being outperformed by both Spain and Italy who both have much bigger domestic financial headwinds than us.
Significantly, the most (over) used argument by the Right –that income inequality may have positive effects on economic growth by providing incentives to work – while it may sound good at an LNP conference, in an IPA position paper, during budget speeches (that launch an election campaign), or during a doorstop interview, the evidence to support this is weak.
The relevant research unambiguously points towards positive and important society-wide outcomes being achieved through reducing the rich-poor divide. Even from a purely economic perspective, the very thorough work of Thomas Piketty has demonstrated that significant income inequality damages economic growth – the one strategy the government is relying on to return the economy to surplus.
Given that inequality is a major problem for us all, both economically and socially, this suggests that a return to more means-testing of government financial support programs, and a return to a more progressive taxation regime and a crack down on tax minimization by the wealthy, is needed .
If the government were serious about fiscal repair they would commit to the funding guidelines in Gonski, they would properly fund health, they would address the excesses of superannuation and cut back aggressively on negative gearing concessions, they would build a proper and effective social safety net, and they would make big business pay the appropriate amount of tax.
Whether or not the government is representing the interests of all Australians, present and future, will be partly revealed on budget night
by Wendy Tubman
The Townsville Greens will publish blogs considered to be of merit. The opinions expressed are those of the Author.