With a new government in Canberra and good
prospects of stability for the next three years, it is the perfect time to
consider what could be done to develop and advance an agenda for prevention.
The Public Health Prevention Conference held in
Melbourne earlier this month canvassed a host of possibilities.
Prevention is rarely achieved quickly, and a
three-year time period allows for plans to be developed thoughtfully,
coalitions built, and resources allocated carefully and without haste.
There are two principal channels for prevention
that could be used to good effect.
First, we should accept that prevention can be
highly effective when applied in hospital, the GP surgery and the home.
This variety of prevention concentrates on the
individual; ensuring that they are immunised and encouraged (where possible) to
live in a way that reduces their risk of chronic illness by not smoking, having
their blood pressure checked regularly and taking part in screening programs.
As a nation, we are doing reasonably well with this
kind of prevention, something Minister for Health Greg Hunt concentrated on in
his video speech to the Melbourne conference.
He challenged the audience to come forward with
“your advice, your comments, frank and fearless as always”.
He concentrated on immunisation and cancer
prevention such as cervical and bowel cancer programs.
But treatments can be preventive, too. A senior
cardiologist friend of mine who works in New York said to me recently: “I used
to see lots of patients turning up in the ED with malignant hypertension. These
days I see virtually none.”
He credits this to the widespread use of
antihypertensives.
He accepts that these drugs are used irregularly by
many patients, but the cumulative effect of their widespread prescription, he
believes, has been to reduce the incidence of malignant hypertension. Maybe
he’s right.
The effective treatment for HIV prevents
transmission from affected people to their negative partners is another good
example.
Certainly, there are many opportunities for
prevention in clinical medicine, but time and financial pressures make it easy
for the busy practitioner to pass these over.
In view of this, it
would be beneficial on a national level if government and its departments
worked with specialist colleges, pharmaceutical companies and patients to set
an agenda to make the most of these ‘golden moments’.
Another kind of prevention
The second variety of prevention is much more
difficult and lies largely outside the purview of medicine: it received
extensive coverage at the Melbourne conference.
Six years ago, I attended a one-day meeting at
Parliament House convened by Senator Guy Barnett, who was concerned about the
rising rate of diabetes.
He gathered physicians, diabetes educators,
representatives of the food and advertising industries, patients, and several
politicians.
I chaired a working group of industry
representatives. We had a congenial conversation and agreed that we would need
to work together to create a healthier food environment.
Towards the end of the day, one member interrupted.
“Professor,” he said. “You’ve got the wrong people in the room today. You need
the CEOs. We can’t make decisions to change the composition of our products.
They can. And, by the way, you’re the wrong person, too.”
I accepted his criticism: it made sense. But who
would he suggest take my place?
“The Prime Minister,” he replied. “Only he would
have the authority to mix it with the CEOs.”
Perhaps this is logistically impossible, but only
something like it will enable the beginning of an agenda for prevention in our
communities.
Agendas that are set by top-level people, be they
politicians or business managers, have a better chance of changing things than
ones that come from people lower down the organisation — like my friends at the
diabetes workshop.
Such agendas do not require the ‘top dogs’ to do
all the barking but the top men and women need to endorse and value the
development of a strategy.
This is not for a moment to suggest that
grassroots-level efforts are out of place. Far from it. They can serve to
sensitise the people at the top to the need for change and suggest ways
forward.
But we do need top-level support to succeed. It
will take time to transact, but like concerns with the climate, the sooner we
start the better.
Published in the Medical Observer 24 June 2019 http://bit.ly/2WZEzAM
