It will take a “whole-of-government” approach to reduce the burden on Tasmania’s health system, according to the Heart Foundation Tasmania.
And that involves investing far more into preventative health, and taking the portfolio out of the Health Department.
The Sunday Examiner last week began a preventative health series, looking at the current “crisis” in acute health, and what’s needed to make Tasmania Australia’s healthiest population.
The government’s current five-year plan puts $6.4 million into preventative health measures, largely focused on reducing smoking and obesity.
While the Heart Foundation Tasmania supports the 24 initiatives in the plan, chief executive Graeme Lynch said it was not enough to make a real difference.
“Overall, the strategies in the plan are good,” he said. “The focus on tackling obesity and tobacco control defines two of the biggest and the lowest hanging fruit in Tasmania to make a difference.
“The problem is the plan is not getting the attention it should get because of where the governance for it sits, and it’s grossly underfunded to actually go anywhere near the laudable vision of Tasmania having the healthiest population in Australia by 2025.”
The foundation’s most recent budget submissions (2017-18 to 2020-21) outline a number of key initiatives and investments that cross government departments and take a “wholesome” approach.
Included is better infrastructure that encourages walking, cycling and physical activity; easier access to affordable healthy food; and better support through the education system and communities for young families, children, and disadvantaged people.
There’s a false reality that exists in the Australian population that not maintaining a healthy weight is the new norm... We need to break those norms down.
“All of those things require a whole-of-government approach and the logical place for that to be is reporting directly to the premier, because through that, other agencies can be encouraged, and in fact even directed, to make investments in the health and wellbeing of Tasmanians,” Mr Lynch said.
“The Health Department certainly has a role and responsibility here, but for the broader issues, definitely a body that reports directly to the premier is ideal. And we would actually go one step further and say that body should report directly to the Parliament so it’s accountable to the whole parliament, not just to the premier.”
The total spend would need to go from less than 2 per cent of the health budget, as it currently receives, to a minimum of 5 per cent, he said.
“And that is still below the benchmark of countries like New Zealand and Canada, for example, where they spend up to 8 per cent of the health budget in preventative health strategies.”
The percentage of Tasmanians with chronic health problems is high compared to the rest of Australia.
However, Mr Lynch said if you compared the state to other similar-sized populations around Australia with similar social and economic profiles, away from major cities, the health outcomes are similar.
“That’s because health outcomes are directly linked to social and economic disadvantage and health inequities,” he said. “So if you look at rural Victoria, rural WA, or even pockets of Melbourne and Sydney, you’ll find health outcomes by local government area that are a lot worse than here in Tasmania, but when you compare states, you find that, because we’ve got a much higher proportion of people living with inequity, that we compare worse.”
However, he said, there wasn’t anywhere in Australia where levels of obesity, smoking or chronic disease were low.
“So, we just happen to be the worst, but even if we were the best, similar to Victoria, NSW or Queensland, it’s still a huge issue.”
Mr Lynch said relying on individuals taking responsibility for their own health would not work.
“For lots of Tasmanians who are struggling to get through one day to the next, to get food on the table, they’re wondering about security and employment - if you’ve got all of those issues, then your health is not going to be a major priority.
“So to go down the road of saying people should take individual responsibility for their own health, that’s fine if people are educated and have a job. But there are lots of people who need support and assistance through healthier environments, social marketing campaigns, programs to assist them in making healthy choices, so that healthy choices become the easy choices. We’re not going to make a difference in Tasmania until we start to do that.”
Mr Lynch said people needed to change their idea of “normal”.
"There’s a false reality that exists in the Australian population that not maintaining a healthy weight is the new norm. Somebody who is slightly overweight or obese, that’s a normal thing, and not to be physically active is a normal thing.
“We need to break those norms down.”
The big problem in Tasmania, and in Australia more broadly, according to Mr Lynch, is “big tobacco” encouraging people to smoke and “big food” encouraging people to eat fast, convenient food.
“So the average person is getting bombarded everyday with marketing and advertising to encourage them to make unhealthy choices.
“We have to have some investment to combat that. We’re never going to be able to spend as much as big food and tobacco, but we can do things to lessen the impact.”