Opinion piece by Todd Harper, CEO of Cancer Council Victoria. Published in the Herald Sun (p. 31) on 31/12/2018.
Stopping cancer before it starts makes sense. But increasingly, we are realising it makes great cents, too. In fact, the evidence is showing that preventing cancer is good value for money, offering positive returns on investments.
Recently, the Public Health Association of Australia named the 10 biggest successes in public health over the past 20 years. These programs, such as tobacco control, the National Cervical Screening Program, and SunSmart, have all had an immense impact on public health.
The PHAA argued that as well as the health benefits, the economic benefits of preventative measures are significant. So why does spending on preventing cancer and other diseases make up less than 2per cent of government health budgets?
This anaemic allocation has changed little in the past decade, even though we already know how to prevent more than a third of all cancers by investing in programs that reduce risk factors such as tobacco use, UV exposure, unhealthy weight, poor diet, alcohol abuse, and inactivity.
Better investment to reduce these kinds of risk factors makes sense when you consider that annual cancer diagnoses are set to grow from an estimated 138,000 this year to 150,000 by 2020.
So why is it that the prevention of cancers is so under-funded?
Partly, it’s about poorly defined property rights.
In some areas of health, including in the pharmaceutical sector, research opportunities are taken up in the expectation of a of securing a revenue stream.
By contrast, organisations dedicated to the science of prevention are typically motivated more by the public interest, and are more likely to freely share knowledge about programs that work to encourage a greater focus on such strategies. But we do still require other partners, including governments, to invest.
Partly, the problem is political. Public funding of health prevention can fall victim to short-term priorities, especially when new governments come to power wanting to put taxpayers’ cash behind different approaches.
But we know that effective prevention is a long game. Just think of road-safety programs, the Quit campaigns, SunSmart, occupational health and safety, HIV/AIDS: success was achieved over decades, through sustained funding and commitments from government and the community sector. But that kind of funding is now lacking - even in smoking, where we know that investing in prevention will deliver measurable outcomes. Despite tobacco taxes bringing in more than $12 billion per annum, less than 1c in every $10 in tobacco taxation is ploughed back into media campaigns that are proven to help smokers quit.
If we look at another public health issue linked to cancer - unhealthy weight - there’s clearly a need for urgent attention.
The Cancer Council recently launched a new campaign, “13 types of cancer”, which exposes the link between obesity and 13 types of cancer by depicting the toxic fat around internal organs.
Sugary drinks contribute the most added sugar to our diets, so the campaign focuses on how these beverages can lead to unhealthy weight gain.
Deakin Health Economics found this type of campaign was highly cost-effective. It estimated a $9.8 million investment could deliver a $51.3 million saving in healthcare costs and save 4540 year of life in full health.
Few governments in Australia have a plan to address childhood obesity, despite its role in cancer, heart disease and diabetes. Figures show that more than a quarter of Australian children are above their healthy weight.
Prevention programs are a solid, blue-chip health investment that pay dividends in lives saved, pain and suffering prevented, health costs reduced, and economic productivity improved.
Long-term investment and commitment to public health programs have demonstrated that behavioural and cultural change is possible. For example, SunSmart is one of the longest-running and most successful skin cancer-prevention programs in the world, preventing more than 43,000 skin cancers from1988 to 2010 in Victoria, averting 1400 premature deaths, and resulting in a net cost saving of $92 million.
On top of that, SunSmart prevented $713 million in productivity losses to the state economy over that same period. In fact, for every dollar spent on SunSmart, it is estimated that the program returned $2.22. Multiply that figure by every state and territory, and it’s clear this is a very smart investment. Similar examples of blue-chip investments can be found for anti-tobacco programs, bowel cancer screening, and programs encouraging physical activity and healthy diets.
We need far sighted leadership to invest in effective prevention. Governments that show such leadership will be rewarded with reduced expenditure, and better health outcomes and productivity.
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