Budget deals massive blow to preventive health

The Australian National Preventive Health Agency has slipped into Hades as the tectonic plates of the National Commission of Audit's report and Treasurer Joe Hockey's budget shift and grind.

What a pity.

The agency was established in 2011. Let's be clear why it was a good idea, so that we can mourn its passing properly.

The major afflictions of our community are conditions such as heart disease, stroke, cancer, depression, and problems of bones and joints. None of these things are as preventable as whooping cough or polio, but the decline in heart disease in Australia in the past 50 years is deeply encouraging.

Through a combination of better treatment, less smoking and dietary change, we've more than halved death rates attributed to heart disease. Lung cancer death rates among men are falling. Lessening the effects of these disorders has a major preventive element in it.

The risks for heart disease relate closely to what we eat, how much we drink, our physical activity and more. Yes, these behaviours are ultimately matters of choice: we are, as George W Bush would say, the deciders.

But we're not really. The shopping environment influences what we buy. The advertising environment influences our purchases of alcohol. The economic environment determines where we can afford to live. Let's get real.

These are the shapers, the causes behind the causes. And we must attend to these things if prevention is to work.

Without legislation, we can kiss goodbye to tobacco control. Other countries label foods so people can work out which are the healthiest. New York City has legislatively eliminated trans fats from all prepared food.

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Set yourself a preventive agenda that seeks to achieve these lifestyle opportunity-promoters and you need strength, including at a national level. Individuals struggle to win these battles.

Groups such as the National Heart Foundation, cancer societies and others have been zealous. But the thought behind ANPHA was that it could become a counterweight to the big-time, burly avarice that drives health-destroying profiteering.

No wonder the alcohol industry will declare drinks all round in celebration when the bulldozers demolish ANPHA. Bewdy mate, drink up!

Most of the prevention that leads to a decrease in non-communicable disease is big picture, usually nationally. Unless the national goals are declared, states and territories are not able to prevent. Immunisation and epidemic control are similar. The track record of states acting without national leadership in relation to Indigenous health is not good.

The federal budget has purged the nation of several preventive mechanisms. The wiping out of ANPHA is the most visible. Second, the Preventive Health National Partnership Agreements have been broken.

These agreements included programs working with the states and territories to encourage better health at work.

But it is the politics of prevention that made ANPHA so important to our health future and so hated by those who wanted free rein to push their wares, no matter the health costs. "Get rid of food labelling," they beseech the government. "It infringes upon our liberty to sell what we want. Make health a matter of choice but diminish the consumer's capacity to choose intelligently."

Yes, ANPHA could support more research in prevention. From the perspective of big business, research is pretty innocent stuff and usually has little commercial impact. It's safe.

But when research becomes advocacy, that's when trouble starts. That's when those driven by profit start worrying, and when the political tectonic plates start grinding in response. Take tobacco as your example. Advocacy is what a national agency with muscle could do.

So, when ANPHA goes, that is what goes with it: the ability for an agency with clout to argue for changes that will help ensure a future in which it would be easier to choose to be healthy.

Instead, we are offered a research entity -- the Medical Research Future Fund -- that will search for cures in the future for illnesses that could be prevented today. What a weird business model.

Preventive opportunities in general practice will lessen as the specialty is hit with co-payments. We have no health policy from the Federal Government, so we are in the dark as to what they hope for the nation's health, what it believes its health state to be or where investment should be made.

So the Prime Minister is right in his assertion that prevention is a personal matter. Gone is the interest of the state in societal matters. Prevention as a national project is dead.

Professor Leeder is a member of the Menzies Centre for Health Policy at the University of Sydney, chair of the Western Sydney Local Health District Board and editor-in-chief of the MJA.