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Preference: Government and politics

Minnow ‘stares down’ Big Tobacco

Tobacco giant Philip Morris has been ordered to pay Uruguay US$7 million in damages and court costs after it lost a legal challenge to the South American country’s anti-smoking laws.

In a ruling hailed as a landmark outcome by public health advocates, the International Centre for the Settlement of Investment Disputes (ICSID) early this month rejected a claim by Philip Morris that Uruguay laws banning smoking indoors, increasing tobacco taxes and requiring cigarette packets carry prominent health warnings breached the terms of a 1998 trade agreement between the Latin American country and Switzerland.

The ICSID, a branch of the World Bank, judged that “the responsibility for public health measures rests with the government, and investment tribunals should pay great deference to governmental judgments of national needs in matters such as the protection of public health”.

Public Health Association of Australia past President Professor Mike Daube said the case was “a historic win for global public health”.

“It confirms the sovereign rights of all governments to protect the public’s health,” Professor Daube said. “Uruguay refused to be intimidated by Big Tobacco and has been completely vindicated.”

Under the Uruguayan laws, the Government ordered manufacturers of 12 different brands of cigarettes to increase the size of the health warnings on their packaging by 80 percent. The resulting costs forced Philip Morris to withdraw seven of the 12 types of cigarettes that it sold in Uruguay.

The case had been watched closely by health advocates worldwide. It was feared an adverse outcome for the Uruguayan government would have been a major setback for tobacco control measures, particularly in the developing world where smoking rates are continuing to increase.

Instead, the judgement has emboldened activists and policymakers to intensify their efforts to control tobacco.

Welcoming the tribunal’s decision, Uruguayan President Tabare Vazquez said that, “we have proved before the ICSID that our country, without violating any treaty, has met its unwavering commitment to the defence of the health of its people”.

In a statement following the ruling, Philip Morris Vice President Marc Firestone said his company had “never questioned the authority of Uruguay to protect public health and this case did not address broad issues on tobacco policies”.

But the case is expected to provide a boost to plans for countries such as Canada to follow Australia in introducing tobacco plain packaging laws.

Rob Cunningham, a senior policy analyst with the Canadian Cancer Society, told CTV News that the Uruguay case provided a very useful precedent for countries like Canada because the issues raised were similar.

“The tobacco industry claims these measures are invalid, but they keep losing these cases,” Mr Cunningham said. “That’s going to provide encouragement to governments to make sure their regulations are not only adopted but they are as comprehensive as possible.”

The ICSID ruling is the latest setback for the tobacco industry in its attempts to frustrate tobacco control measures and overturn plain packaging laws.

A legal challenge to Australia’s world-first plain packaging laws was thrown out by the High Court in 2012, and last year the Permanent Court of Arbitration rejected a claim by Philip Morris Asia that the legislation impinged on investor rights under the terms of a trade deal between Australia and Hong Kong.

Uruguay’s fight to control tobacco drew international support.

The US-based Campaign for Tobacco-Free Kids established a fund to help Uruguay and other small countries to fight legal challenges to anti-smoking laws, and drew contribution from Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

“It shows countries everywhere that they can stand up to tobacco companies and win,” Bloomberg Philanthropies founder Michael Bloomberg said. “No country should ever be intimidated by the threat of a tobacco company lawsuit, and this case will help embolden more nations to take actions that will save lives.”

Adrian Rollins

 

Sussan Ley holds onto Health portfolio

Sussan Ley has been re-confirmed as Federal Health Minister as Prime Minister Malcolm Turnbull backs stability and experience in the key battleground portfolio.

Implicitly backing his Minister against critics who accused Ms Ley of going missing when Labor ramped up its ‘Mediscare’ campaign, Mr Turnbull said he had the utmost confidence in his ministerial team, and defended the Coalition’s messages and tactics against what he said was an “unscrupulous” Opposition.

While some internal party critics complained Ms Ley was all-but invisible during the marathon eight-week Federal Election campaign, aside from a widely-reported remark early on in which she indicated she had been overruled by Treasury and Finance over the controversial decision to extend the Medicare rebate freeze to 2020, supporters said she was effectively muzzled by Liberal campaign directors keen to shut down health as an election issue.

AMA President Dr Michael Gannon defended both Ms Ley and Shadow Health Minister Catherine King, arguing that both had been pushed into the background by the increasingly presidential style of modern electioneering.

Related: Election affirms the importance of health

“It seemed to me from afar that the Coalition didn’t want to talk about health in the campaign, and that they had silenced Minister Ley,” Dr Gannon said.

“It was very much the Bill and Malcolm show, with occasional guest appearances by Richard Di Natale, Barnaby Joyce, and Derryn Hinch,” Dr Gannon said. “I think that that’s the reality of the way media covers politics now, it does become very Presidential.

“I would have loved to have seen a greater depth of analysis in the debate on health and in other areas. But I think that says more about our media and our politics than it does necessarily about either Catherine or Sussan, two very capable women who have the interest of patients across Australia at their heart.”

Ms Ley embarks on her second term as Health Minister with a swathe of major issues outstanding, including the threat to bulk billing from the extended Medicare rebate freeze, and fears about the impact on care of reduced hospital funding and cuts to bulk billing incentives for pathology and diagnostic imaging services.

The New South Wales politician, who was appointed to the health portfolio mid-way through the Government’s first term after Peter Dutton badly bungled attempts to introduce a GP co-payment, has largely turned her attention to other issues, and in the last term of Government initiated a swag of reviews and inquiries, most of which have yet to be finalised.

The most crucial of these is the MBS Review Taskforce headed by Professor Bruce Robinson, which is assessing all 5700 items on the Medicare Benefits Schedule. The Minister insists the aim is to modernise the MBS, though some are wary that the process is primarily aimed at achieving cuts and savings.

In addition, the Minister has commissioned trials of the My Health Record e-health system and the Health Care Home model of care for patients with complex and chronic conditions.

Ms Ley has also to bed down the Primary Health Networks system which, among other things, is being charged with organising and coordinating access to mental health services at the local level.

Related: The opportunities of the new Australian Parliament

While Ms Ley has been confirmed in her current portfolio, the role of Minister for Rural Health, held by senior National Party politician Senator Fiona Nash in the last Government, has been passed on to junior Nationals Minister Dr David Gillespie.

Meanwhile, there is speculation that Ms King may be dumped as Shadow Health Minister amid factional manoeuvring in the Opposition for frontbench positions.

Opposition Leader Bill Shorten is expected to announce his frontbench team later this week.

Parliament is due to return on 30 August.

Adrian Rollins

Latest news:

Election affirms the importance of health

Another Federal election decided but with considerable uncertainty about the final result for a week or more after polling. Prime Minister Malcolm Turnbull has claimed victory following the concession of the Leader of the Opposition, Bill Shorten. At the time of writing the Health Minister has not been announced, nor the remainder of the Cabinet.

As the polling showed, health policy remained central to the election campaign and figured especially high in States such as Tasmania, where there are deep concerns about the capacity of the State Government to fill any void in Federal funding. The AMA has called for an open conversation about health care with the next Government, and also with the Opposition, the Greens, and the minor parties.

AMA President Dr Michael Gannon has used the election period to call on all political parties to consider good health policy for the future, including areas of health policy that had very little mention during the campaign, such as preventive health.

The AMA developed its election strategies before the start of the campaign through debate at Federal Council and engagement with the State AMAs. The document setting out the AMA’s key issues for the election was launched on 11 May and guided the AMA’s advocacy throughout the campaign period. In the week leading up to election day, the AMA published an analysis of the positions adopted by each of the three main parties against the AMA key issues. It was informative reading.

The cycle of the AMA’s internal elections has been completed this month with the election by Federal Council of Dr Beverley Rowbotham as Chair of Council. Dr Iain Dunlop was elected by the Board as Chair of the Board of Australian Medical Association Limited. The composition of the Board is relatively unchanged, other than the inclusion of Dr Gannon and Dr Tony Bartone as the incoming President and Vice President.

Federal Council will have a few new faces at its meeting in August, a welcome opportunity to bring some fresh ideas to the discussions at Council. New members of Council include the recently-elected Presidents of AMAV, Dr Lorraine Baker; AMAWA, Dr Andrew Miller; and AMA NSW, Associate Professor Brad Frankum. Also joining Council are the representatives of private specialist practice, Associate Professor Julian Rait; doctors in training, Dr John Zorbas; the Victorian area, Dr Jill Tomlinson; rural doctors, Dr Sandra Hirowatari; psychiatrists, Dr Steve Kiseley; and pediatricians, Dr Paul Bauert.

Federal Council remains the centre of AMA’s medico-political discussions and debates. With each new President there is an opportunity to refresh the composition of the Councils and Committees of Federal Council, a task that is now complete.

A new Government will bring fresh opportunities for AMA engagement in what is now acknowledged as a central tenet for the Australian population – health policy that ensures a viable and sustainable system, but also ensures that all Australians have appropriate access to affordable care.

Family doctors: invaluable to health

As the new Chair of the AMA Council of General Practice, I am honoured to follow on from my predecessor, Dr Brian Morton, and wish to acknowledge him for his six years of leadership and service to the Council and to general practitioners.

It is certain that as a profession we will have some interesting times ahead of us as the dust from the Federal Election settles. If there is one thing we know for sure from the last few weeks, it is that putting health on the backburner is risky business. The Government must be in no doubt now that health is a priority, and that it will have to do more than it has to date to ensure vulnerable patients do not have to worry about whether or not they can afford to see their GP when required, and to have pathology and radiology investigations when requested.

Next week we will be celebrating general practice and the primary role played by Australia’s GPs, our family doctors, as frontline and holistic health care providers. Throughout Family Doctor Week (24-30 July), the AMA will be highlighting how invaluable the family doctor is to patient health, and to the health system more broadly.

We know from international comparisons that countries with a strong GP-led primary care system have lower rates of ill health, better access to care, reduced rates of hospital admissions, fewer referrals to other specialists, less use of emergency services, and better detection of adverse effects of medication.

The comprehensive care provided by our nation’s family doctors needs to be seen by Government as an investment rather than as an expense. With only 6 per cent of Australia’s total health expenditure on general practice, our family doctors have proven the value of their care. Ending the freeze on Medicare rebates, raising the rebates and lifting rates of indexation to cover the true costs of care must be at the top of the Government’s to-do list.

For most patients, our general practices are their medical home. If appropriately funded, rather than struggling for viability, we know we can do more to help our patients live the healthiest life they can. We can do this though appropriate health screening and life-stage assessments, through structured care that is patient-centred and planned, through greater use of innovative technology that not only empowers patients in managing their conditions, but enables us to monitor their progress, through better use of medicines, and through care that is streamlined and coordinated within our multidisciplinary health care team.

Family Doctor Week will highlight that, properly funded, the medical home has the potential to both improve the care patients receive, and to save on more costly downstream health costs.

Supporting general practices to bring non-dispensing pharmacists into the health care team is but one way Government can invest to deliver better patient outcomes and minimise avoidable hospital admissions. The AMA’s Pharmacist in General Practice Program would deliver $1.56 in savings for every $1 invested by ensuring the quality use of medicines, medication optimisation and increased medication compliance, reducing adverse drug events and hospitalisations as a result.

In rural and remote areas, Government needs to assist general practices with appropriately designed and implemented infrastructure grants to expand their facilities to better meet the complex health needs of people in these communities.

You can support us in supporting you by visiting the website family-doctor-week-2016 and downloading and displaying the poster and your Family Doctor Logo, and by using #amafdw16 if tweeting or sharing FDW content on social media.

In medicine, we are a community

When I participated in my first Federal Election at the age of 18, I didn’t see my individual voice or my individual vote as a contribution to democracy that carried much weight. If experience hadn’t already done so, the 2016 Federal Election would have dispelled me of that notion.

This year, as President of the Australian Medical Students’ Association, I have the opportunity of speaking to medical students around the country. Whenever I do, I try to take the time to remind them of the way they saw the profession of medicine when they first entered it. Those days and weeks when they realised that medicine is unlike many other undertakings; in medicine, we are a community.

Medical students throughout Australia form a group of 17,000. If you add doctors into the mix, you get a town the size of Toowoomba, where I grew up. All of us share a common experience and a common motivation to provide communities with the best attainable health. In this way, myself and the consultant on my ward round and the other 120,000 of us, medical students and doctors alike, are our own little team. There’s a powerful collegiality in medicine, and where that can be even partially harnessed we are a significant and credible force.

In fact, at early count, we are a force almost as significant as the number of votes between the two major parties in this Federal Election. 

This community of medical professionals has an ability to positively impact health that is far greater than the sum of its parts. As a community, we can drive a successful public health campaign; we can restore the health of a region after a time of crisis; we can drive the development and defence of good health policy for our nation.

Engaging with policy and politics is not always high in the priorities of medical professionals, not least because their workload leaves them little time for other endeavours. In addition, doctors and medical students don’t necessarily believe themselves to be inherently political, and at times face criticism when they step outside the clinical sphere. However, each of us came into this profession to improve the health of those who need us, and oftentimes that requires more than treating the patients who walk through hospital or clinic doors. 

I often frame the political relevance of the medical profession with the words of Rudolph Virchow: “Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and attempt their theoretical solutions: the politician, the practical anthropologist, must find the means for their actual solution.”

Elections can be won and lost over health, and doctors are at the coalface. If every one of our 120,000 strong community was to raise their voice on health issues affecting the populations we serve, Australia’s political discourse would be far richer for it. We would not all agree, and would in fact raise almost as wide a variety of views on health as can be imagined. However, it is from the clear enunciation of all of these views that sound health policy can be derived. 

In the years since my first Federal Election, I have learnt both in theory and through experience that an individual can have a significant impact on our country through their vote, and through their voice. I hope to learn again and again throughout my career the significance of the impact of 120,000 individuals, in particular. If each one of our community were to engage with the wider questions facing our nation’s health, all communities would be better for it.

Email: elise.buisson@amsa.org.au 

Twitter: @elisebuisson

 

Focus on rheumatic heart disease

 As the new President of the AMA I will, like my predecessors, chair the AMA’s Taskforce on Indigenous health. This recognises and emphasises the importance of the AMA’s efforts to improve the health and wellbeing of Aboriginal and Torres Strait Islander people, and our desire to keep ‘Closing the Gap’ initiatives at the top of our agenda.

The Taskforce, which was established in 2000, is comprised of representatives of the AMA Federal Council, AMA members and Indigenous health groups, including the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Australian Indigenous Doctors’ Association (AIDA).

The Taskforce is a robust and dedicated entity which identifies, develops and recommends Indigenous health policy and strategies for the AMA and oversees the AMA’s annual Report Card on Indigenous Health.

This year, the 2016 Report Card on Indigenous Health will focus on rheumatic heart disease (RHD) – a major preventive health issue that significantly affects Indigenous people, particularly those in remote areas. As AMA WA President, I supported legislative change to improve reporting and reduce the burden of disease in Aboriginal communities in Western Australia.

RHD is a classic example of the many preventable chronic diseases that are largely responsible for the health gap between Indigenous and non-Indigenous people, with its burden largely extinguished in other parts of the Australian community. We can no longer allow the prevalence of chronic diseases like RHD to remain unaddressed.

The 2016 Federal election provided an opportunity for the AMA to present all political parties and candidates with the issues that the AMA sees as vital in meeting the challenge of closing the health gap.

While we have seen some recent improvements in Indigenous health, particularly in reducing infant mortality and smoking rates, the AMA wants to see the Commonwealth commit to improving resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people.

The AMA has repeatedly said that it is not credible that Australia, one of the world’s wealthiest nations, cannot address the health and social justice issues that affect 3 per cent of its citizens. We say this again. The fact that it is our nation’s first people makes it an even greater moral imperative.

With the re-election of the Turnbull Government, the AMA will continue its call for long-term funding and commitments to Indigenous health. We will work closely with key ministers, government departments and other key stakeholders to ensure that appropriate action is taken.

As outlined in its Key Election Issues statement, the AMA urges the Federal Government to:

  • correct the under-funding of Aboriginal and Torres Strait Islander health services;
  • establish new, or strengthen existing, programs to address preventable health conditions that are known to have a significant impact on the health of Aboriginal and Torres Strait Islander people, such as cardiovascular disease (including rheumatic fever and rheumatic heart disease), diabetes, kidney disease, and blindness;
  • increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations. Such investment must support services to build their capacity and be sustainable over the long term;
  • develop systemic linkages between Aboriginal and Torres Strait Islander community-controlled health organisations and mainstream health services to ensure high quality and culturally safe continuity of care;
  • identify areas of poor health and inadequate services for Aboriginal and Torres Strait Islander people and direct funding according to need;
  • institute funded, national training programs to support more Aboriginal and Torres Strait Islander people become health professionals to address the shortfall of Indigenous people in the health workforce;
  • implement measures to increase Aboriginal and Torres Strait Islander people’s access to primary health care and medical specialist services;
  • adopt a justice reinvestment approach to health by funding services to divert Aboriginal and Torres Strait Islander people from prison, given the strong link between health and incarceration;
  • increase funding for family violence and frontline legal services for Aboriginal and Torres Strait Islander people;
  • appropriately resource the National Aboriginal and Torres Strait Islander Health Plan to ensure that actions are met within specified timeframes; and
  • support the establishment of a Central Australia Advanced Health Research and Translation Centre. Central Australia faces many unique and complex health issues that require specific research, training and clinical practice to properly manage and treat and this type of collaborative medical and academic research, along with project delivery and working in remote communities, is desperately needed.

 Closing the gap in health and life expectancy between Indigenous and non-Indigenous people is an achievable task – it is also an agreed national priority.

The Federal Government must build on existing platforms and ramp up its ambitions to achieve health equality for Aboriginal and Torres Strait Islander people. Without commitment and action from our national leaders, the gap will remain wide and intractable. The Taskforce will inform the AMA’s advocacy in ensuring that this does not remain the case.

 

[Editorial] Brexit and junior doctors’ contracts: the real threats to the NHS

On July 6, junior doctors in England’s National Health Service (NHS) voted 58% to 42% to reject the final contract offer from the UK Government. The rejection follows 3 years of negotiation and the first all-out strike for English doctors in 40 years. Some have expressed surprise at the result given that the British Medical Association supported accepting the latest offer. Although many junior doctors acknowledged that they may not receive an improved offer, a situation confirmed by Secretary of State for Health Jeremy Hunt’s decision to impose the contract, they were unwilling to vote in favour of what they say is an attempt to stretch existing staff over 7 days without increasing spending.

Health policy in play as Coalition licks wounds

AMA President Dr Michael Gannon has intensified the pressure on the Coalition to dump its Medicare rebate freeze policy following an admission from Prime Minister Malcolm Turnbull that health policy concerns swayed many voters away from his party.

“The Prime Minister, the Coalition, have had the scare of their life,” Dr Gannon said. “If they do survive, it’s time for them to listen about how elements of their health policy could be improved and let’s start with number one – unfreezing the rebate.”

As the shockwaves from the extremely tight Federal election result continue to reverberate, Mr Turnbull said it was clear that Labor’s message that the Coalition posed a threat to Medicare had fallen on “some fertile ground”.

“What we have to recognise is that many Australians were troubled by it. They believed it, or at least had anxieties raised with it. It is very clear – it is very, very clear – that Barnaby [Joyce] and I and our colleagues have to work harder to rebuild or strengthen the trust of the Australian people in our side of politics when it comes to health. There is no question about that,” Mr Turnbull said.

“Barnaby [Joyce] and I and my colleagues are as committed to Medicare as any other Member in the Parliament. That’s a fact.

“However, there was some fertile ground in which that grotesque lie could be sown. There is no doubt about that. It was a grotesque lie. Very cynical, very dishonest, but very effective.”

In comments that raise the prospect the Coalition will re-visit its health policies, the Prime Minister flagged that he and his colleagues would need to address perceptions they were not committed to Medicare.

“We have to recognise that there is a real issue for us if people voted Labor because they genuinely believed or they feared that we were not committed to Medicare, because that is not the case. So that is why Barnaby and I, as we reflect on this and our colleagues reflect on this, that is something that is an issue we have to address,” Mr Turnbull said.

Dr Gannon told ABC radio the election result had shown just how important health policy was for voters, and it was clear that the Medicare rebate freeze, combined with earlier polices such as the GP co-payment, meant Labor’s scare campaign on Medicare had resonated with voters.

“If we go back to the first co-payment model in 2014, which came out of the much-maligned Budget that year, if we look at Co-payment Mark II which came out later that year, it possibly showed that health policy was being run out of Treasury,” Dr Gannon said. “The Coalition has realised maybe too late…that people do worry about their health, they do vote on it, they do regard it as one of the major issues when they decide how to vote.”

Dr Gannon said the AMA had been campaigning hard on convincing the Coalition to join Labor and the Greens in committing to reinstate Medicare rebate indexation: “That was number one in the AMA’s campaign. We repeatedly asked the Coalition to unwind the freeze. Other elements of Coalition policy leant themselves to the scare and I think they’ve paid for it at the polling booth”.

Health has been a highly politically charged area of policy since the Coalition, led at the time by Tony Abbott, twice attempted to introduce a co-payment for GP visits. A backlash led by the AMA forced it to abandon the idea, and instead the Coalition reinstated a freeze of Medicare rebates first initiated by Labor, and has sought to make savings in other areas of health, including big cuts to public hospital funding and the abolition and reduction of bulk billing incentives for pathology and diagnostic imaging services.

During the election, Labor campaigned heavily on health care, and claimed that a proposal to outsource Medicare payments to the private sector was part of a broader but hidden agenda of the Coalition to privatise Medicare.

At the time, Dr Gannon publicly rebutted the claim, arguing that there was “never any suggestion that anyone was even remotely looking at privatising Medicare”, and Mr Turnbull tried to shut the issue down by declaring the Coalition would not look to outsource the Medicare payments system.

Reflecting on the election, Mr Turnbull blamed the issue for much of the plunge in Coalition support at the ballot box.

“This was a shocking lie,” Mr Turnbull said. “But the fact that significant numbers of people believed it or at least believed it enough to change their vote, tells us that we have work to do…That is a very clear lesson.

“We have to do more to reaffirm the faith of the Australian people in our commitment to health and to Medicare. Now, that commitment is there, but plainly there were concerns.”

Dr Gannon said that, whatever the outcome of the election, the AMA stood ready to work with all sides of politics to deliver better health policy.

“The Prime Minister has had the scare of his life and, if he is returned, I think he’ll be looking to hear ways that he can come up with an improved health policy. The Australian people have shown how dearly they hold it,” he told ABC News Radio. “The AMA is prepared to work with the Coalition, with the Labor Party, with the crossbench, to try and come up with health policy that’s good over the next three years. And we’re particularly determined to come up with health policy that will serve this nation for 10, 15 years into the future.”

Adrian Rollins

 

Nation’s health only partly on track

Australia is making progress in reducing rates of smoking and dangerous drinking but is losing the battle to rein in weight gain, high blood pressure, and salt and sugar consumption, according to a national snapshot of health trends.

Australia’s Health Tracker, produced by the Australian Health Policy Collaboration with the support of 50 public health organisations, shows that the nation is making good progress toward reducing drinking and smoking, with the proportion of adults drinking at risky levels trending down toward 18 per cent and the country on track to cut the number of adults who strike up on a daily basis down to 10.6 per cent by 2025.

But adults and children are continuing to put on weight, eating too much sugar (and salt) and not doing enough exercise, according to the tracker.

It shows that more than 63 per cent of adults are overweight or obese, along with more than a quarter of children, and almost a half of adults and 70 per cent of children are eating too much sugar.

The tracker found that people are not doing enough exercise, particularly in light of their energy-rich diets – just 55 per cent of adults and less than 10 per cent of teens meet physical activity recommendations.

These readings underline concerns that not enough is being done to reduce the incidence of chronic disease by changing behaviour and encouraging healthier lifestyles.

According to the authors of the Health Tracker, 50 per cent of Australians have a chronic disease, and they estimate that almost a third of such illnesses could be prevented by eliminating smoking, losing weight, cutting down on drinking, taking exercise and reducing blood pressure.

“Chronic disease is the biggest health challenge of the twenty-first century,” the authors said. “Australia lags well behind comparable countries in tackling the risk factors for preventable chronic diseases.”

But, they said, “much of Australia’s chronic disease burden is preventable or capable of significant amelioration”, and urged that there be “population-level interventions that target risk factors shared by many population groups and communities”.

There have been concerns that preventive health has been undermined in recent years by Federal Government policies and cutbacks, including the abolition of the Australian Preventive Health Agency, reducing spending on public health education campaigns, funding cuts for community organisations and programs undertaking preventive health activities and reduced policy emphasis on public health initiatives.

But both the Coalition and Labor have committed to trialling new models of chronic care in the primary health sector centred on general practice as the ‘home’ of health care and involving remuneration based not only on fee-for-service but also incorporating regular payments tied to the management of individual patients with complex and chronic illnesses.

But Public Health Association of Australia Chief Executive Officer Michael Moore said action was now needed.

“A lot of promises were made before the election to fight chronic disease,” Mr Moore said. “This research is the first of its kind, and should be taken as not only a warning, but as a call to action. What we need to see is action from the elected Government.”

Australia’s Health Tracker  can be viewed at: https://www.vu.edu.au/sites/default/files/AHPC/pdfs/australias-health-tr…

Adrian Rollins