Australians, on average, live some of the longest lives in the world, in one of the wealthiest economies. However, despite relative wealth and longevity, significant disparities exist in health and well-being across our diverse population. Many may be living longer, but not all, and many are not necessarily living well. Nearly half of the population lives with one or more chronic diseases, with our world-renowned health system doing its best, but struggling to keep up. Helping more people be healthier for longer presents many untapped opportunities.
In Australia, the greatest and increasing demand for health system services arises from chronic conditions, including prominent NCDs of the heart, lungs, kidneys, cancers, stroke, and diabetes. Australian Chronic Disease Prevention Alliance members are among those supporting people living with chronic diseases and working to reduce chronic disease impacts on people and communities.
Australia’s Universal Health Coverage (UHC) model, established in the mid-1980s as a taxpayer-funded ‘universal health insurance’, draws on public funds for Medicare and a Pharmaceutical Benefits Scheme to help cover and subsidise many, but not all health care costs. These go some way to ensuring our right to health, supplemented by an incentivised private health insurance system and out-of-pocket costs. But with more than half of Australians living with one or more chronic disease, good health isn’t universal, and the costs needing to be covered by the health system are increasing, for people living with long term chronic disease and governments, insurers, and communities. Australia’s UHC model is overwhelmed.
For UHC to be comprehensive, adequate, equitable and sustainable, focussing on fixing health service components to manage and treat illness is necessary, but not sufficient.
With the costs of chronic diseases increasing, a logical approach is to reduce the chronic disease burden in the first place. Around 38% of Australia’s chronic disease burden can be reduced or prevented by addressing modifiable risk factors – mainly unhealthy diets, tobacco and alcohol use, physical inactivity, high blood pressure and high blood glucose. The cost of chronic disease increases the further a disease progresses: it costs less when risk is reduced or disease is detected early, and even less to be prevented. Exposure to chronic disease risk factors disproportionately impacts populations who also experience disparities in access to risk assessment, screening for early detection, and affordable, appropriate and adequate treatment and care for chronic diseases.
For example, chronic conditions contribute to around 64% of the disease burden among Aboriginal people and Torres Strait Islanders, 2.6 times higher rate of preventable hospitalisation, and account for 70% of the life expectancy gap compared with non-Indigenous populations. People living in remote areas of Australia, where limited and delayed access to preventive, community and primary health services are common, are up to 2.5 times more likely to be hospitalised for potentially preventable reasons including chronic conditions. Others who experience a high burden of chronic disease are people who migrated to Australia more than 10 years ago and have low English language proficiency, and people living in poverty with limited means to access enablers of health – such as good housing, nutritious food and adequate income to cover out-of-pocket medical costs. These priority populations tend to have higher exposure to negative social determinants of health and risk factors.
Identifying a preventive approach has been the priority for much of the global response to COVID‑19 and has been demonstrated time and time again for infectious diseases. Similarly, early detection of disease or risk of infectious and chronic diseases improves outcomes and minimises interactions with the health system in the long run. Yet, defying logic, reducing chronic disease risk and prevalence is rarely prioritised with the same necessary, sense of urgency we see for preventing infectious diseases.
Recently in Australia there have been positive signs of renewed attention to preventive health. For instance, the National Preventive Health Strategy 2021-2030 aims to contribute to national and global targets for NCDs by supporting health behaviour and reducing risk factors with health literacy, promotion, and counselling, and by specifically attending to wider factors to support people to live healthier lives – such as addressing social, cultural, and commercial determinants of health. The recently elected Australian government has also signalled a commitment to a more balanced approach to health and chronic disease with actions like the establishment of a new national Centre for Disease Control to include NCD prevention, and the Federal Treasurer is leading national conversations about ‘measuring what matters’ as part of a new well-being economy approach, recognising healthy people and communities as among enablers of prosperity. Most recently, the Department of Foreign Affairs and Trade announced new international development partnerships to support the detection and early treatment of NCDs; and health promotion, mental health awareness and suicide prevention, in the Pacific and South East Asia region recognising that “Improving the health and wellbeing of communities ... is critical to ensuring our region’s security, prosperity and stability".
These high-level commitments from Australia’s leaders signal the increasing importance being placed on promoting and protecting health for prosperity. They illuminate untapped opportunities for both health ministries and within the health system for UHC, as well as for those intersecting with these systems and sectors to reap co-benefits. With governments around the world contemplating the resilience of their existing or nascent models of UHC, a note of caution: it’s essential to integrate health promotion and preventive health as fundamental to the viability and sustainability of health systems, well-being and prosperity of people and economies, and the security of nations.
As we look to the UN High-Level Meeting on UHC this September, we join the chorus calling for governments to deliver health and prosperity for all by investing in helping people to be as healthy as possible, for as long as possible –prioritising preventing chronic disease is a key to that vision.