On Health Budgets and Shifting Focus to Prevention
Challenger Seminar Series
On the 27th June 2024, IPAA Queensland, in partnership with Health & Wellbeing Queensland hosted a Challenger Seminar Series on Holistic Public Health from
Cradle to Grave: Challenging Assumptions and Achieving Equity.
During this event, an esteemed panel took to the stage to discuss important elements of preventative health at all ages, and shared their expertise and insights on the current challenges facing the sector.
We invite you to read the below segment from the event’s Q&A on the role of health budget and shifting focus to prevention rather than reaction in progressing positive change.
It is time to #keepinformed.
Professor Marina Reeves, UQ:
We might come back to the data question later if we have time or from the audience, because I think that’s an easy thing to say, and I agree with you, but how we do that isn’t always easy.
Bruce, your point around how do we make sure that we are training the next generation of health professionals and health professionals broadly defined, not knowing necessarily what the challenges that we are going to be facing in the future and how we best manage that is a big challenge for us at universities.
What I want to touch on now though is that we know that our health system is under pressure. It’s currently under pressure, and Deirdre, you spoke around the rising cost of the health budget outstripping that in GDP.
We know that as our population ages we’re going to have more chronic diseases. We’re going to have the next pandemic at some point that’s looming. And so our health system is only ever going to be under more pressure if we don’t change what we’re doing.
The health budget that came out earlier this month focused on putting patients first. It’s still very much around a sickness model of health, not a wellness model of health. And now that’s probably because they need to address the immediate crises that we’re dealing with right now. To make the changes that we need to make to get to a wellness model of health requires bold decisions, long-term investment, long-term commitment that is long than an election cycle will ever last. How do we get that change and that commitment from governments when we know that there’s a sweet spot in which things can happen, and what’s needed is going to be longer than that sweet spot?
How can we alleviate the pressures off the sickness health system to allow investment in prevention and wellbeing, which we know is good value for money?
Professor Bruce Abernethy, UQ 2032 Games Engagement:
Oh, ripping question. And of course logic says we should be investing in prevention, yet worldwide it’s not happening. So we’re not unique in that respect, though we have a particularly acute version of it, I think, in Australia, in part driven by short electoral cycles and in part driven by the intriguing funding of health with the divide between commonwealth and state and some of the perverse incentives that that creates.
But in order to get more visibility in it, I think our way in is through secondary prevention. Keeping people out of hospital and particularly readmission in the frequent flyers is a major issue, where the same kind of primary prevention strategies are still the most powerful one. This is sort of my preaching bit, for all investment in trillions, billions, whatever they are, there was Brazilians at one stage, of dollars into drug design and development, we still don’t have a drug that has anywhere near the efficacy, the cost-effectiveness, the multiple benefits of regular physical activity.
And so can we use that and balance with other things around secondary prevention? I think that gives us our best opportunity of demonstrating an impact where in short term, in terms of where the current demands might sit.
But one other story if I might, and I think in demonstrating that we have to also take an approach to government or our bosses, which is around if we can demonstrate savings through prevention, let’s see them reinvested in prevention and not reinvested into the illness bottom line. There are some great examples of where this hasn’t happened. If there are any dentists in the room, I apologize in advance. But one of the classic things with public health interventions around fluoridation was almost the elimination of childhood caries. Where did that saved money go? It went into the invention of a new profession called orthodontics. And so we’ve got the health economists would say, “Be really careful that we invest where the needs are and not where the existing services are.”
So I think there’s a broader approach here in terms of prevention, which is let’s demonstrate its efficacy using secondary prevention because of the shorter time scales. But let’s do that on a negotiated basis that demonstrable savings go back into prevention and not into the hospital bottom line.
Marina Reeves:
I couldn’t agree with you more. And again, that comes back to the data to be able to show the value of that. Now Helen, as a chair of a HHS board, Bruce said that we want to-
Helen Darch OAM, Chair, Mackey Hospital and Health Service Board:
He wants to take my money.
Marina Reeves:
… your HHS wants patients, and the activity-based funding models that are used within hospitals have drivers that aren’t necessarily patient-centered. What do you think is important for us to shift this model away from sickness to prevention?
Helen Darch:
Oh, goodness me, it sounds like wisdom of Solomon.
But I’d like to pick up on a point that you made, which is really that just about everything requires a multi-pronged strategy, and it requires longer time cycles to address. I think if I was to, I guess, throw out a challenge, it would be that in three years’ time we see the health funding model change so that in Queensland, for example, rather than seeing the $1.14 billion, which is very valued and much appreciated, but its focus is currently 1/6 of that expenditure is on physical beds, and 1/40 of that expenditure is on virtual care. I want to see that flipped around. Because we don’t want to keep building physical beds and we can never keep up with the demand there. We need to stop that, stop car parks, and actually invest much more in the virtual care angle so that we deliver better care closer to home.
There was an interesting article that came out yesterday put out by the World Economic Forum that looked at, I guess, the fate of China over the next 30 years. Their problems are ours, but amplified because of scale. They’re investing enormously in technology as the means of flipping that funding model. That would be my hope that we do really stop doing what we’ve always done because we just simply cannot possibly keep it up and flip that model around.
Marina Reeves:
I guess that is one of the positives that came from COVID is us starting to do things differently.
Helen Darch:
Yeah, we can. We’ve proved it. Thank you.
John Kotzas AM, CEO, Queensland Performing Arts Centre:
Marina, I think I’m going to pick up on a philosophical shift and doing things differently.
I wonder if we reimagined literacy right from early ages and we included in literacy the whole idea of health and wellbeing. So we actually begin right at the curriculum level. We can’t go prenatal. But if we began with literacy and we actually talked not just about the literacy of reading in the world, but actually the literacy of surviving in a world that’s changing, and we talked more about what are the elements that are required to live a healthier life and in a more holistic way.
I have to just jump back to some of the slides that I saw before. I’m constantly horrified as a privileged person who lives here to see the huge gap between 82 and 51. It’s so confronting. That unless we actually do some big philosophical shift, I’m not sure that, and I’m not challenging what you’re both saying in terms of rearranging the budget, but unless we actually make a big philosophical shift as a collective community, then throwing money at the problem isn’t in itself going to resolve it. The needs that Helen has or that Bruce is talking about, that the active addressing of sickness is really important.
But how do we get ahead of that?
Marina Reeves:
And I think as you’ve all said, it needs to be a multi-pronged approach. One, there’s no one answer to this problem, to this huge challenge we face. I think your response there beautifully highlights why it’s so important that we have diverse perspectives when we’re trying to tackle these big challenges. Rob, I know you’ve got strong thoughts on this.
Dr. Robyn Littlewood, CEO, Health and Wellbeing Queensland:
I think that for us, we’ve got to have a mindset shift absolutely first. I think that we’ve got to then look at the funding model that we’ve got at the moment.
The model that we’ve got now is based around the work that we do every day. So somebody has to get really, really sick before we fund someone to fix them.
So for us, thinking about keeping people well, funding the system to keep people well, there’s your shift for me. So that’s a really good one. That’s going on in different parts of the world now already, and it’s actually working. It’s really something for us to think about.
But when you go back to what you’ve all said, the thing that we’ve got to do now today is that we’ve got to prove the worth. And so for us, it’s really important for us from the beginning because now we are now five, we can now show from being in 183 schools, 40,000 kids that we’ve got now. So we’ve got the data from them now showing that this actually works. So we’ve got that. We’ve got the data from our app. Podsquad is great. Please have a look for that. Please put that on your phone today before you walk out. But that’s 15,000 kids are on that now, and we’ve got the data from every single thing that they are doing right now.
You’ve got to get that and then you’ve got to use that for good and not evil, to show everybody the way that this can work, but show the value. So you do this first, causes this mindset shift, then you get the change in the funding. And then Bruce, what did you say in the end? You said-
Bruce Abernethy:
It was important at the time, but I really can’t remember it now.
Marina Reeves:
Secondary prevention.
Dr. Robyn Littlewood:
… secondary prevention. Absolutely. And that’s what the data shows. So you just do that and then we’re good.
Marina Reeves:
And so in case you didn’t hear, Rob’s checking your phones before you leave as well to make sure you’ve downloaded the app.
John, I want to go back to your response to your wishlist. What do you see, and you’ve touched on this a little bit, the importance of the arts for our health and wellbeing? But importantly, you talked about equity. You work at QPAC. You have wonderful array of arts that are showcased there. Not every Queenslander can access and benefit from those. How do we make sure that every Queenslander, regardless of where you live, regardless of your economic background, has access to the benefits that my father had in his little old man Greek choir?
John Kotzas:
Look, we know that three things that the arts do. While participating in the arts, they actually help people feel connected, they help people get a sense of identity, and they offer hope. One of the things that we need to do is move away from institutions like mine and actually get more communities connected in those areas.
Because I think a sense of wellness comes from a sense of having hope and a sense of feeling your purpose and place in a community. Whatever resources we can use, whether they’re physical skills or money to actually have equity and participation. One of our biggest frustrations is we work and live in a big block of concrete across the river. It’s the size of a city block.
There’s no front doors to it. But what we need to do is actually take that, break that metaphor, and go, “How do we spread this across the state? And how do we actively have people participate and feel connected to their community so that they understand their place in the world?”
Marina Reeves:
I think if we look at the, again, cradle to grave, we know a lot of that’s embedded at schools, particularly in primary school or prep. It’s then getting into those older ages. Once you leave those structured settings, how do we do it? But it doesn’t need to cost.
John Kotzas:
Well Marina, that’s why I really meant what I said before about re-imagining literacy. Because whether it’s artistic literacy or health and wellbeing literacy, it’s access to knowledge that actually enhances people’s lives. And so what we’ve got to do is put some basic effort into helping people understand what a good life is. A good life is not going to hospital to visit your parents. A good life is to share that life with them at home.
IPAA Queensland members can watch the entire event recording on the members portal.