The message will fall on fertile ground. In fact, the new Australian government explicitly states on its website [WebCite] their goal to "focus on preventative health care and health promotion, to help keep Australians healthy and out of hospital". My key message on Friday will be how eHealth can support this process, emphasizing personal health applications. And I should also say that I feel that the shift towards preventive medicine is something with which all industrialized countries are struggling with. I often feel the "Ministry of Health" in any given country is more a "Ministry of Hospitals and Health Care Professionals" rather than a Ministry of Health (more on this below).
The speakers today in their opening remarks all emphasized the needed shift towards preventive medicine.
John Menadue from the Centre for Policy Development, and chair of the conference, made a number of remarks on the lack of focus on the delivery systems / supply side (focus has been on funding), work practices, quality and safety, and the "blame culture" in medicine (all of which are problems that are not necessarily unique to the Australian system), and - for me most important - the focus on a sickness model rather than a well-being model. He likened the present system to us lining up ambulances at the bottom of a cliff rather than installing handrails. He lamented the focus on the "medical model", i.e. our focus on hospitals (which should really be the last resort) rather than health. He cited evidence that 32% of burden of diseases is caused by preventable factors, yet only 2% of funding goes into preventive health care. He also talked about us perhaps having too high expectations for the health care system.
Reba Meagher, Minister for Health in NSW, also talked about the "ticking time bomb" of exploding health care costs due to chronic and largely preventable diseases. Australia is now among the top 5 fattest nations on earth, with half of the population being either overweight or obese (and 1/4 children under the age of 18 being overweight). She said that NSW is spending 28% of its budget on health, and with this trend continuing, in 2032 it will be 100%, e.g. there will be no money left for other sectors (no roads, no police...).
Christine Bennet, newly appointed chair of a commission "set up to overhaul Australia's crisis-ridden health and hospital system" (WebCite), started off lauding the Australian health care system as producing good outcomes (it is in the top 4 OECD countries by Life Expectancy ratings), and the waiting times are not as long as in Canada. But there are problems, including access, poor connectivity, workforce, out-of-hospital care, low investment in health promotion (2%), complex system, a "free good - somebody else's responsibility" mentality, and obesity.
My random thoughts on this: Essentially, I couldn't agree more, and many of these problems and solutions are similar on other industrialized countries. In my presentation on Friday I will show some slides showing the decline in overall cancer death rate (12% in the US between 1991 and 2003). A significant proportion of this decline (almost half - 40%!) is not due to any major breakthroughs in molecular medicine, gene therapy, or other expensive treatments, but can be attributed to a (relatively simple) behavioral intervention: smoking cessation (Thun, M. J et al. Tob Control 2006;15:345-347). This is for all
cancers together, not just lung cancer! The role for ehealth in supporting behavioral changes is - in my view - huge. And smoking cessation is only one of many healthy behaviors for which ehealth plays a role. More than one third of cancer deaths are attributable to nine modifiable risk factors (Lancet. 2005;366:1784-1793), of which smoking is only one. The other 8 factors are high body mass index, low fruit and vegetable intake, physical inactivity, alcohol use, unsafe sex, urban air pollution, indoor use of solid fuels, and injections from healthcare settings contaminated with hepatitis B or C virus, and at least the first 5 risk factors are modifiable and can be supported by behavioral ehealth interventions which are very similar to web-based tobacco interventions.
Interventions addressing these risk factors - in particular those addressing obesity, which is "the next tobacco" - have a vast impact not only on cancer, but also on chronic conditions like diabetes and cardiovascular diseases, which create a significant burden on the health care system.
Governments need to start funding programs such as Web-based lifestyle coaching and behavior-change interventions, easy (e-) access to professionals such as nutrition counselors, etc. And if I were minister of health, the first thing I would do is to develop a program where each citizen is equipped with a chipcard, letting them collect "Healthmiles", rewarding healthy behavior (such as choosing the "healthy" menu options in restaurants, joining fitness clubs etc.) with tax-breaks and other incentives. As Christine Bennett said, 78% of people understand the risks of their lifestyle decisions, but only 1/3 do something about it. We do need a constant reminder system for people, rewarding healthy choices. We also need to get rid of the "the insurance will pay" mentality.
One final thought that hit me when I heard all these numbers of what proportion is being spent for health and health care and preventive health care. When I hear numbers like "only 2% is spent on preventive medicine", then I start wondering what the denominator is. Presumably we are talking about the budget of the Ministry of Health? But then again, how narrowly do people define "preventive medicine"?. In my view, if the ministry/department of transportation decides to not build a highway but to build a network of bicycle lanes or improving the capacity for commuters to take their bike on the commuter train etc., this is a major contribution to "preventive medicine". Similarly, policy decisions that help to take cars off the road, make cars more expensive, make fruit cheaper, make more recreational and sports facilities accessible to the public, - in other words ANYTHING that entices people to get off their assess and to get out of their cars and to eat healthy - are major contributors to public health. I think all these kinds of policy decisions, even when made by other "departments", need to become part of our thinking and decision-making processes.
And by the way - I stopped counting the conferences where people talk about healthy behavior, but where participants are fed with candy and cakes (when I organized Mednet 2006 I insisted on healthy snacks, e.g. fruit only. Some participants complained, but I guess the majority got the message).
WebCite this page!
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