Proof of the pudding: health campaigns don't work
There is slim support for the belief that preventive public health policies -
(i) have brought obesity and lifestyle disease under control, or
(ii) are likely to in the future.
Public health experts routinely advise governments that the best way to address the long-term challenges facing the health system is to 'invest' more taxpayers' money in public health education and promotion policies. The latest version of this advice is that governments should invest more money in 'preventive' primary care to control the prevalence and contain the cost of 'lifestyle disease'.
* Preventive HEALTH TASKFORCE – TERMS OF REFERENCE
The differences between classic preventive medicine and public health education and promotion raise important questions about the case for more spending on prevention as an effective method of controlling lifestyle disease. When one elaborates on these differences, it helps to make sense of the evidence-based story told by decades of failed public health policy.
The experts and lobby groups tacitly admit what rising obesity levels amply demonstrate: that public health education campaigns have not been as universally successful as it was hoped they would be.
What they tend to suggest, though - to obscure just how unsuccessful these policies have been - is that the evidence does not yet show what works. They also like to suggest that rising rates of obesity show that not enough of the health budget goes to prevention.
The latest version of these diverting arguments is displayed in the Rudd Government's policy document: -
* individuals are absolved of their primary responsibility for the unhealthy lifestyle decisions they continue to make, and
* the lifestyle disease 'epidemic' is blamed on a lack of government-funded entitlement to preventive primary care.
JOHNSTON's EXTRACT FROM "NEW DIRECTION'S FOR AUSTRALIA'S HEALTH" WHICH RELATE TO Preventive HEALTH
Rarely considered are the real reasons -
* the limits of government authority over individual behaviour, and
* the importance of personal qualities in regulating it - why nearly 40 years of health promotion has coincided with ascending rates of lifestyle disease.
War on smoking
Instead, advocates of more spending on lifestyle disease prevention often draw false parallels with the success of the campaign against tobacco smoking. Yet the war on smoking is a special case. Bans on smoking in public places, and higher and higher tobacco taxes, are more of an example of public health regulation than health promotion.
The war on smoking has been more like traditional public health measures and the way governments have intervened to compel seatbelt use and attack drink-driving through enforced legislation. There are also huge differences between the kinds of behavioural change that anti-smoking and diet and exercise campaigns have each aimed to induce.
Anti-smoking campaigns have targeted a specific behaviour and cajoled individuals to decide to quit one bad habit. A similar example of behavioural change is the campaign to encourage condom use to prevent the spread of AIDS. DON'T AGREE THE GRIM REAPER ADVERTISING CAMPAIGN DID A LOT MORE THAT CAJOLE CHANGE IN PROMISCUITY AND DISEASE PREVENTION
Diet and exercise campaigns, by contrast, require people to actively do a series of things to change their lifestyle and to sustain those changes over the long term. The success of the anti-smoking campaign compared with the relative failure of healthy diet and exercise campaigns points to the real and demonstrated limits of the effectiveness of 'prevention.'
It is simply very difficult to induce people to initiate and sustain a series of changes to complex and often longstanding behaviours, and to continually decide to make healthy decisions about diet and exercise - no matter how hard, or in what form, governments push the healthy lifestyle message on those unwilling to act on that advice. UNLESS Preventive HEALTH PROGRAMMES PRESENT AND PACKAGE RECREATIONAL EXERCISE ACTIVITIES, AVAILABLE AT A LDREGS, INCORPORATING A LCCBSG, AS FUN AND ADDICTIVE, WHEREUPON THE INTERESTED ADULT WILL WANT TO IMPROVE THEIR DIET AND BODY SHAPE TO PERFORM BETTER IN THEIR CHOSEN REA
Merry-go-round
Nevertheless, prevention lobby groups such as the Australian Chronic Disease Prevention Alliance (ACDPA) - a combination of non-government prevention organisations formed in 2005 to press the governments for greater spending on prevention - continue to promise that 'investing in promoting increased levels of physical activity and healthy eating in Australians would reduce the burden of chronic disease now and in the future.' Hence a recent report by the Australian Centre for Health Research calls for a greater emphasis 'on personal lifestyle and wellbeing (Preventive care)' and 'on public health programs that keep people out of hospital,' which the report assumes 'should result in medium to long term reductions in overall expenditure,' as if this process is sure and seamless. ALL THE DATA ON OBESITY/TYPE 2 DIABETES, CHD, DEPRESSION, RECREATIONAL DRUG ABUSE CONFIRMS THE IN-EFFECT OF SUCH STRATEGIES
It is worth pausing to consider just what is riding on this assumption: ensuring the cost of Medicare does not become an unsustainable burden on future generations, as this report puts it.
* MEDICAL
PRESCRIPTIONS
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AGED CARE; AND
Despite what is at stake, the key question - perpetually glossed over and subsumed beneath the mantra that governments should spend more on prevention - is the only one that counts: does 'prevention' actually work?
It is therefore timely to review the evidence. Because when the assumptions are questioned and the evidence examined with a clear eye, what is revealed is that there is actually slim support for the belief that preventive public health policies - be they 'community-wide' or 'high-intensity' lifestyle interventions - have in the past brought obesity and lifestyle disease under control, or that they are likely to in the future.
Dr Jeremy Sammut is a research fellow at the Centre for Independent Studies. His paper The False Promise of GP Super Clinics, Part 1: Preventive Care is available at the CIS website.