I'm calling for the PM to lead from the front on prevention

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.

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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.

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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.”

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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