Australia spends only $140 per person a year on prevention and the money cannot be accounted for

Australia spends less than $140 per person per year on preventive health – three times less than several comparable countries – and fails to track how the money is spent or its cost-effectiveness

Mammograms are part of preventative healthcare

Australia spends less than $140 per person per year on preventive health – three times less than several comparable countries – and fails to track how the money is spent or its cost-effectiveness.

That’s the conclusion of a new paper which for the first time quantifies and attempts to track the flow of public health spending on prevention in Australia.

The analysis, led by La Trobe University emeritus professor Alan Shiell, found that the funding of public health in Australia was “inadequate, siloed, sporadic, short-term and piecemeal”.

The spending on prevention by governments amounts to less than 2 per cent of the health budget, the paper, published in the Australian and New Zealand Journal of Public Health, found.

The funds allocated per person to preventive health were likely to be inflated by Covid-19 spending, the authors found, with pre-­pandemic spending on public health hovering at about $100 per year. Spending on prevention in the UK is about 4 per cent of that country’s health budget and in Canada it’s almost 6 per cent.

There is no formal mechanism for tying the money that currently is spent on prevention to any evaluation of cost-effectiveness, as occurs with evaluation of new medicines or other medical treatments, Professor Shiell said.

“We cannot say … with any ­degree of certainty, how much is spent on what sorts of public health activity, what mechanisms are used to get the funds into the hands of the service providers, whether those mechanisms are fit for purpose or could be improved upon, or what percentage of the population has access to preventive programs of proven cost-­effectiveness,” Professor Shiell says in the paper.

There are significant differences between the amounts each state spends on preventive health. While Western Australia has set a target to spend 5 per cent of its health budget on prevention by 2029, other states, in particular Victoria, are winding back public health spending despite challenges as the population ages, chronic disease rates increase, and health systems buckle.

There is no annual reporting of spending on preventive health in Australia, and no major national report has reported on funding on public health for over a decade. That is an unacceptable situation, said the CEO of the Public Health Association of Australia, Terry Slevin. “You can’t manage it if you can’t measure it,” he said. “Every jurisdiction in Australia and ­nationally should be keeping score on this metric. The data is there. It’s just simply not aggregated and published. And it should be. It’s a fundamental piece of health information that goes to the heart of public decision making and policy making.

“This should be one of the fundamental pieces of planning infrastructure for dealing with our health system and making informed and intelligent decisions.”

Funding for public health is spent by both commonwealth and state governments who generally allocate the funds at a local level. Much of the money ultimately comes from GST collected by the commonwealth and then distributed state-by-state. Funding on prevention also flows through the National Health Reform Agreement and via national partnership agreements on health.

Mr Slevin said mechanisms to systemically measure and publish details of public health spending could be relatively simply implemented and would increase ­accountability for results amid a situation in which Australia’s acute care system was being overwhelmed and elective surgery wait lists at public hospitals are at all-time highs.

“Ultimately it’s a fool’s paradise to continue to chase the perception of having a world-class health system to fix the ills of the citizenry while ignoring the drivers that are sending people to acute care system,” he said. “It goes back to the simple proposition, if governments at state level or national level decide this is an important thing, with relative ease, they can put in place the investment in the long-term measures that take bravery and wisdom from our policy decision makers, and our politicians.

“It is an absolute policy no-brainer as long as you’re prepared to shake off the restrictions of a short political cycle.”

The authors of the La Trobe paper are calling for greater transparency in the reporting of spending via annual reporting on preventive health and the establishment of a mechanism for tying the funding of health promoting interventions to evaluations of their cost-effectiveness.

“We’ve got a formal body for drugs spending and medical technologies. What there isn’t is an equivalent for prevention in communities,” Professor Sheill said.