Issue 16 / 12 May 2014

IF I were recruiting public and preventive health practitioners my pitch would probably go something like the 2010 Guide Dogs NSW/ACT ad where the job described is so arduous that everyone but the labrador pup drops out.

I’d tell applicants prevention can be hard to sell. You might convince individuals that taking an action (or ceasing one) is in their best interests but when you extend this to society you need to convince a lot of people — and those who govern it — that your good ideas will, in time, pay off.

You will encounter stiff competition for media attention and arguments from vested interests. Your ideas will be pilloried and, if you are lucky enough to gain a profile and some influence, you may well be called a nanny statist, a tofu-munching leftie or even (rather creatively) a swivel eyed loon.

This week’s MJA InSight begins with an idea for alcohol harm prevention, which, regardless of its merits, will be very hard to sell — raising the drinking age to 21 years. An MJA Perspective by some heavyweights in mental and public health argues the case and provides advice for making it happen.

The paper provoked robust responses from the experts approached for our news story, including the rather depressing thought from one commentator that, “I [doubt] whether the federal government is going to assume leadership on this issue — or for that matter any issue relating to preventive health”.

A pharmaceutical idea for prevention was in the spotlight at last week’s World Congress of Cardiology, and is the subject of our second news story. Researchers trialling the polypill (a fixed-dose combination of commonly used blood pressure and cholesterol-lowering medications, and aspirin) in people at high risk of cardiovascular disease believe that, if rolled out effectively and affordably, it has the potential to reach people who would never otherwise have had the opportunity to benefit from preventive care, but there are significant hurdles to overcome.

Nihlism can be one factor at play when we refuse to embrace ideas in health. The author of a comment article says this is a major contributor to patients’ failure to seek, and doctors’ failure to pursue, early diagnosis of lung cancer. Detecting a tumour at a resectable stage could be lifesaving, but old ideas about this deadly cancer are holding us back from the improved mortality rates we could be seeing.

In her blog this week, Jane McCredie takes a look at another factor that can skew and scuttle ideas in health — links with industry. It has long been known that, even when declared, such links can lead to bias in research, writing and practice. Recent revelations have made it clear that the problem is even worse in politics.

MJA Editor-in-Chief Professor Stephen Leeder recently highlighted the role of the Australian National Preventive Health Agency (ANPHA), as a “counterweight to the big-time, burly avarice that drives health-destroying profiteering” in the fierce and conflicted competition for government attention on matters of public health.

Disbandment of ANPHA and major changes in health care funding are mooted for this week’s federal Budget but is anybody really putting up a health policy? In a comment article Professor Leeder politely points out what such a beast might look like.

Ironically, just as the US is tentatively and controversially embracing universal health cover, Australia seems set to back away from it. President Barack Obama even used Twitter last week to encourage Americans to embrace preventive care.

Some well timed reports from the US on the health outcomes of enabling less advantaged patients to access affordable health care and medications prompted our third news story.

Back at my recruitment drive, it may well be down to me and the dog after I tell the candidates that sometimes, for reasons of politics, money or ideology, their good ideas — the ones that are actually working — will be abandoned. Does it really have to be that way?

Health policy expert Lesley Russell told InSight this week: “In theory, governments should lead but to do it effectively they need to base their decisions on evidence and then bring the community along with them.”

Now there’s a good idea!


Dr Ruth Armstrong is the medical editor of MJA InSight. On Twitter @DrRuthInSight


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