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Shifting Australia’s healthcare focus from ‘treatment’ to ‘prevention’ may be our best hope in tackling a national chronic disease crisis, according to public health expert, Dr Sandro Demaio of VicHealth.
In 2021, almost half of Australians (47 percent) were estimated to have one or more chronic conditions; and this figure is set to rise as the proportion of people aged 65 and over reaches 16 percent by 2050. Meanwhile, nurses are in increasingly low supply, globally, with Australia’s shortfall to reach an estimated 100,000 by 2025.
While national health spend is trending upwards, just 1.3 percent of total health expenditure is currently allocated to prevention. This is despite CSIRO’s ‘Our Future World’ report highlighting that $1 invested in primary prevention is $14.30 saved later for the health budget.
“Chronic disease is our greatest health challenge, our largest health expenditure, and our biggest killer. With our population ageing and health workforce dwindling, we need to tackle it at the root,” Dr Demaio said, ahead of his speech at the Chronic Disease Management Conference.
What exactly should we invest in?
Dr Demaio believes a holistic program that promotes healthy eating, physical activity, and social connection is the most effective solution.
“By investing in these we can reduce the morbidity, mortality, complication, and functional disability rates of chronic illness, alleviating pressure on public health systems,” he said.
Statistics seem to agree, showing that dietary risks – including low fruit and fibre, or high sugar and sodium – are responsible for 7.3 percent of Australia’s disease burden.
Combined, these risks contribute 62 percent of the burden for coronary heart disease, 41 percent for type 2 diabetes, 34 percent for stroke, and 22 percent for bowel cancer.
Physical inactivity has also been identified as a primary cause for most chronic diseases, with active lifestyles known to delay or altogether prevent them.
Meanwhile, healthy social networks have been found to substantially reduce mortality risk. Socially isolated adults with coronary artery disease, for example, are 2.4 times more likely to die from a sudden cardiac event than those with good social connections.
As well as giving people longer and healthier lives, Dr Demaio believes investment in these areas makes economic sense.
“Delaying and preventing chronic disease will increase workforce participation and productivity, with positive knock-on effects for our financial wellbeing,” he said.
Funding models
To make the shift from treatment to prevention, an exploration of funding models may be needed. While health funding has been the subject of much scrutiny in recent years, even some newer models, like outcome based funding, may not be compatible with prevention programs, Dr Demaio highlights.
“The risk of outcome based funding is that it concentrates on treating the disease, not on preventing them in the first place,” he said.
“It is important that any new funding model integrates with preventative measures. We will likely need to go back to the drawing board and be innovative with our funding of programs that address ill health,” he said.
Dr Demaio believes a wellbeing economy approach is one of the key options that should be considered as Australia makes the switch to preventative healthcare.
“This would embed both a prevention framework and ensure a sustainable development approach to economic development. It would addresses the social, environmental and health needs of a population by prioritising societal wellbeing over economic growth,” he said.
Overcoming other barriers to prevention
Another major consideration in the shift to a prevention focused system is the need to address urgent care and hospitalisations, whilst also focusing on long term preventive strategies to prevent chronic disease in the first place.
While Victoria currently has an Early Intervention Investment Framework, Dr Demaio says we need to go one step further.
“We need to create a Prevention Investment Framework so that money can be prioritised upstream,” he said.
Sharing more expert insights about how a prevention based system might look in practice, Dr Demaio will present at the upcoming Chronic Disease Management Conference, hosted by Informa Connect.
This year’s event will be held 22-23 November at the Royal Randwick Racecourse. Learn more and register.
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