Why can’t the Australian health system deliver on prevention?

Preventable chronic disease causes devastating impacts on Australia. As the leading cause of premature deaths and reduced quality of life, we would all know someone who has been affected.  As a GP working for over 25 years, frankly I’m tired of witnessing the impacts on people whose lives have been turned upside down by losing a family member well before their time, or from being diagnosed themselves.

From a political perspective, chronic diseases are not sexy, but they are very expensive. These conditions carry substantial social and economic impacts, estimated to cost the government and employers a massive A$109B annually (approximately 6% of our GDP)(1) through healthcare costs, reduced workforce participation and welfare support(2,3,4).

We are not alone, this is a global issue with the WHO releasing a statement in the midst of the COVID-19 pandemic in 2020 that: ‘The epidemic of non communicable diseases (NCDs) poses devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems. The socioeconomic costs associated with NCDs make the prevention and control of these diseases a major imperative for the 21st century”(5).

This impacts all of us

Most Australian adults have risk factors for the most prevalent preventable chronic diseases including 17.8 million of us who have multiple(6).  Low health literacy continues to be a barrier, with 60% of our population not having an adequate level of understanding to make informed decisions about their health(7), 47% have one or more of the 10 most common chronic conditions and 30% of working age people have at least 2 chronic conditions(6).  How can this be happening in 2022, with such easy access to almost limitless health information?

There is good evidence that current approaches to preventive care that enable early intervention and reduce the prevalence of chronic conditions target only certain subgroups of the  Australian population. The approach to preventive care is fragmented and often occurs in silos. An estimated 85% of our population visit a GP each year(8), but due to systemic pressures exacerbated by the SARS-CoV-2 pandemic such as the structure of remuneration for consultations and workforce issues, the ability of primary care to identify and record risk factors and deliver effective preventive care, is unfortunately suboptimal.  

Hidden in plain sight

Gaps in preventive care delivery can be highlighted  by the large numbers of Australians with undiagnosed chronic conditions that carry significant risk of complications, including 2.9M with hypertension (9), 1.5M with chronic kidney disease(10), 500 000 with diabetes(11) and an estimated 4M people with symptoms of depression that have not accessed professional support in the previous 12 months(12).  An interesting 2017 study in Melbourne of 149 000 patient records, for individuals aged over 45 years, identified that only 1.3% had their basic risk factors for cardiovascular disease recorded (blood pressure, smoking status and lipids)(13). 

Other important aspects of preventive care such as breast and bowel cancer screening are delivered through federally funded programs and respectively only 50% of eligible women(14) and 43.5% of eligible people(15) participated in these national programs in 2018-19. 

Inequity

There is persisting and substantial inequity in how chronic diseases are distributed in our community.  Aboriginal and Torres Strait Islander status, cultural and linguistic diversity and rural home residence postcode, continue to have a substantial impact on the risk of chronic disease(16).  People who have experienced trauma, individuals with disabilities and with mental health issues are also more likely to be impacted.

Looking ahead

So what needs to shift? There are many individuals, health professionals and organisations working very hard in this space. The Federal Government National Preventive Health Strategy 2021-2030 is an important step in the right direction. This document highlights the importance of a collaborative approach between individuals who use healthcare, all of the levels of healthcare providers and government, private industry, researchers and not for profit health organisations to make a difference in this space(2). How do we translate a great document into effective, equitable, holistic, culturally safe and non-fragmented approaches that actually make a difference to the health of all of our people?

Acknowledging the obstacles that exist in face to face preventive care access, that an estimated 91% of Australians own a smartphone(17) and 84% of us go online first to access health information (18), there is a fantastic opportunity to leverage digital health. If designed well, digital technologies can augment the vital work of primary care in Australia, providing a readily scalable way to more comprehensively identify risk factors for chronic disease and to promote access to preventive care. To ensure that all of us can access the information, resources and care that we need, well before we’ve stepped onto the chronic disease conveyor belt and to transform our healthcare system from treatment to prevention first, we need to work together.

This is the first in a series of blogs, designed to stimulate conversation about putting #preventionfirst and to connect with like-minded people who are equally passionate about the possibilities. Feel free to connect with me through LinkedIn if you are interested in joining the conversation and share with others in your network who are fellow disruptors : ).

REFERENCES

1. Australian Bureau of Statistics. Australian National Accounts: National Income, expenditure and product March 2022, Canberra.

2. Australian Department of Health. National Preventive Health Strategy 2021-2013, Canberra 2021

3. Crosland P, Ananthapavan J, Davison J, Lambert M, Carter R. The economic cost of preventable disease in Australia: a systematic review of estimates and methods. Australian and New Zealand Journal of Public Health 43 (5): Oct 2019:484-495 https://doi.org/10.1111/1753-6405.12925

4. Australian Government Productivity Commission Mental Health Inquiry Report, 2020, Canberra.

5. World Health Organisation (WHO) Global NCD Compact 2020-2030. September 2020, Geneva.

6. Australian Institute of Health and Welfare. Risk factors and participation in work. Cat. no. PHE 122, 2010, Canberra: AIHW.

7. Australian Commission on safety and quality in health care. National Statement on Health Literacy: Taking action to improve safety and quality. 2014

8. Australian Institute of Health and Welfare(AIHW). Medicare-subsidised GP, allied health and specialist healthcare across local areas: 2019-20 to 2020-2021. AIHW website, accessed 2 November 2022.

9. Australian Bureau of Statistics. National health survey 2014-15. ABS Canberra 29 March 2017 AIHW

10. Australian Institute of Health and Welfare 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra

11. Australian Bureau of Statistics. Australian Health Survey: Biomedical results for chronic disease. ABS. Canberra August 2013.

12. Australian Psychological Society. Stress and wellbeing: How Australians are coping with life. Stress and wellbeing in Australia survey 2015

13. Turner LR, Cicuttini F, Pearce C, Mazza D. Cardiovascular disease screening in general practice: General practitioner recording of common risk factors. Preventive Medicine, 99, June 2017;pp282-285.

14. AIHW Breastscreen Australia monitoring report 2021, Canberra.

15. AIHW National bowel cancer screening program monitoring report 2021, Canberra.

16. AIHW Rural and remote health report 22 Oct 2019, Canberra.

17. Deloitte 2019. Australia reaches peak smartphone. Mobile Consumer Survey 2019.

18. Australian Digital Health Agency. Safe seamless and secure: evolving health and care to meet the needs of modern Australia. Australia’s National Digital Health Strategy.