Cuts to health promotion in Victoria prompt a call to action for the sector

Introduction by Croakey: Health promotion and public health professionals have been urged to engage with their professional organisations and advocate for greater political and public appreciation for the value of prevention.

The call came from David Towl, Victoria and Tasmania Co-President of the Australian Health Promotion Association (AHPA), when commenting on impending Victorian Government cuts to health promotion funding that are expected to affect 45 community health services.

The Victorian Healthcare Association (VHA), AHPA, Council of Academic Public Health Institutions Australasia (CAPHIA), Public Health Association of Australia and service providers have called on the State Government to abandon the planned cuts.

Towl told Croakey today: “My personal perspective – which may not be the perspective of AHPA – is that population health and professional peak bodies who are concerned about the issue of low investment in – and defunding of – prevention, need to collaborate to raise the importance of prevention in the public discourse.

“We have seen the traction gained by agencies like AMA [the Australian Medical Association] on the lack of growth in the Medicare rebate. This has been a consistent and concerted effort by GPs and the medical workforce – and now everyone thinks their GP isn’t being paid enough.

“People need to join and participate in their professional associations. They are only as strong as their membership, are largely volunteer run.

“It’s a bit chicken and egg – for us to have the impact we need, our associations need to be resourced to do the advocacy and lobbying work. This will only happen if people join their associations. The best way to ensure that you get value for your membership fee, is to participate in your association.”

Towl recently guest tweeted for Croakey’s rotated, curated Twitter account @WePublicHealth using the hashtag, #StoptheCutsVictoria. A summary follows below.

David Towl writes:
When I was new in my career, a colleague said: “The best social marketing health promotion can be involved in, is the social marketing of itself.”

It’s always stuck with me…if prevention is better than the cure…do we need to remind people?

Health promotion is a workforce that’s 90 percent female, focuses on those most in need, offers a 1:14 return on investment ratio, and prevents hospital admission.

Cutting 10 percent of funding cuts the ability to implement programs. This isn’t duplication as Premier Daniel Andrews suggests. This is community implementation.

Services across Victoria have been looking at the implication of the Victorian Government cuts. I’ve spoken to colleagues wrestling with what to cut from budgets that will have the least impact. I’ve heard from students now unsure if they will get a job on graduation.

Speaking to colleagues – for some this will mean job losses, for others its means not filling vacancies or cutting implementation or evaluation costs.

Indexing of grant revenue isn’t keeping up with rising costs of service delivery. Services can’t take a 10 percent cut without impacting outcomes. High quality health promotion is cost-efficient. Prevention only comprises two percent of the entire health budget.

These are arbitrary cuts to an already under resourced program at a time of significant change and reform. The comments of the Premier were unfounded and unkind to a passionate skilled workforce.

There’s no doubt that the State Budget will be brutal. Victoria is lucky to have community health. It’s a primary care and prevention safety net that recognises the structural and social impediments to good health. Community health and its health promotion programs protect hospitals.

Defunding health promotion and community at a time when hospitals are under such strain is narrow-minded. It doesn’t look to the future. It doesn’t look past the next election cycle. After all, you can’t cut a ribbon on someone not ending up with chronic disease.

Health promotion at work
Below are some examples of the types of health promotion provided by community health services in Victoria.

These programs aren’t necessarily at risk in the cuts by State Government. But all services impacted by cuts are having to make tough choices about what the cuts will mean.

The Community Health Health Promotion (CHHP) program is Victoria’s second highest funding stream for prevention. It employs more than 500 health promotion practitioners across the state. The program was established 20 years ago. It used to be called Integrated Health Promotion

CHHP funded programs, need to focus 70 percent of their effort on health promotion focused on healthy eating, physical activity or tobacco control.

CHHP takes an equity lens to its work and plans on four-year cycles aligned to the State Health and Wellbeing Plan.

CHHP delivers programs from other agencies like:

@VicKidsEatWell
@AchievementVic
@HEAS_Vic
@VicGovDE.
History repeats
In the last 15 years, we have seen funding cuts to health promotion across Australia.

In 2012 in South Australia, in Queensland in 2012 when the health promotion workforce was decimated in a single day under the Newman LNP.

These are certainly not Victoria’s first cuts.

In Victoria, in ending the National Partnership Agreement on Preventative Health, the Abbott Government defunded Healthy Together Victoria in 2015.

This isn’t CHHP’s first cut either. A 40 percent cut in ~2010 was reduced to 15 percent after successful advocacy.

Could the health promotion sector have been prepared – or even prevented the cuts to Community Health Promotion in Victoria? The irony of trying to prevent a cut is not lost on me.

Prevention is better than the cure right? We shouldn’t be having this argument.

Do we need to do a better job to let politicians and Treasury see we are more valuable than more hospital beds? Is it just that we don’t see outcomes in election cycles?

Is it reasonable for Government to cut funding to a program that ensures they are better equipped in a crisis? Having trusted local relationships in a crisis is beneficial to Government. But these relationships come at a cost…

Looking ahead
With my time being the thumbs of @WePublicHealth coming to a close, I’m reflecting on what I’ve learnt about the cuts to health promotion funding in Victoria and what our opportunities are to prevent arbitrary and irresponsible cuts happening in the future.

The @WePublicHealth feed has taught me of the myriad of important health and social issues competing for space and oxygen this past week. I’ve learnt lessons and had important reminders on #VoiceToParliament, #OralHealth, #RuralHealth, #Racism #Equity and more.

These competing issues, each as important as the other, have told me we can’t drop the ball on this. To reduce risk of future cuts, there needs to be some advocacy into the future.

We can’t rely on prevention being better than the cure and hoping others believe it.

So what is there to do? We need a committed and coordinated platform that translates the benefits of health promotion and prevention for everyday voters and those they vote for.

What can you do? We all have a role we can play. Here’s my two cents: If you’re talking health promotion. Talk not only about what it’s doing, but about what it’s preventing. Take the opportunity to profile your work with decision makers and celebrate the work of others.

If you haven’t already…join your professional association. Professional associations are dependent on their members. Better than just joining, volunteer, represent. Professional associations need to partner and to skill their members on how to engage in advocacy.

As professionals we need clear asks for politicians and funders – and outcomes we can demonstrate if they come through with the policy and resources we request.

Five percent of the Health Budget invested in prevention by 2030 is one consistent ask that is getting traction across jurisdictions.

Postscript from Croakey: A spokesperson for Community Health First said its representatives had met with the Minister’s office to discuss these cuts and the impact they will have on health promotion services across Victoria.

“The more we invest in health promotion, the more disease we prevent, the healthier our communities become and the less we rely on costly ambulance, emergency, and hospital services,” the spokesperson said.

“We look forward to continuing these constructive conversations with the Minister and the Victorian Government to ensure we can continue to work closely together to keep our communities healthy and supported.”

Make sure your check out the full piece and Croakey's other work in the community health space via their website: https://www.croakey.org/cuts-to-health-promotion-in-victoria-prompt-a-call-to-action-for-the-sector/