Cost-effective solutions needed for our chronic disease crisis

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John Kelly

National CEO, Heart Fountation

Everyone agrees. Chronic disease is Australia’s greatest health challenge.

It accounts for 90% of all deaths and more than 85% of the national disease burden. The social and economic toll is immense.

There are, of course, a large number of diseases that are classified as chronic. But two stand out: cardiovascular disease and cancer. Each claims the lives of around 45,000 Australians a year. Together, they account for almost 60% of all deaths.

Both disease groups demand action and investment from government.

And while cancer attracts substantial attention, cardiovascular disease has become the poor cousin, with fewer control programs, less investment in research and inadequate support for prevention, both primary and secondary.

Why is this so? We are, to some extent, a victim of our own success. Strong research, action and advocacy in past decades has seen the mortality rates peak in the late 1960s when almost 6 in 10 deaths were caused by CVD - and then steadily fall to less than 3 in 10 today.

But there is no room for complacency.

While CVD is largely preventable, it is highly prevalent, with 4.2 million Australians living with some form of CVD.

The human toll is vast, with many premature deaths and many living with disability. For governments, the financial cost is also great. Cardiovascular disease is the most costly disease group of all, at $7.7billion a year in direct healthcare expenditure.

These costs are only going to escalate, partly as a result of an ageing and growing population, but also because some risk factors, especially overweight and obesity and physical inactivity are becoming more prevalent or failing to improve.

What needs to be done?

We know that around one third of the total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet.

There are a range of evidence-based, cost-effective interventions available to government to help address these risk factors and drive down mortality and morbidity rates. A comprehensive approach has seen dramatic reductions in smoking rates over the past three decades.

Today, smoking rates are down to 12.8% for the general population. And while rates remain high for some Australians, especially Aboriginal and Torres Strait Islander people, we are now looking for the next generation of policies that will take us to a tobacco-free society.

The same approach is needed to address our other great challenges – particularly obesity and physical inactivity.

Sadly, investment in public health in Australia lags well behind other OECD nations. Collectively, our Australian governments invest 1.4% of total healthcare expenditure in public health. New Zealand leads the OECD at 7% with Canada on 5.9%.

With political parties committed to ‘budget repair’, fiscal restraint is the order of the day. But ‘budget repair’ should not be an excuse for inaction.

Investment in prevention makes economic sense, helping to reduce future costs as people live longer, more productive disease-free lives.

But prevention needn’t impose a cost on government at all.

Some of the most effective measures actually put money into Treasury coffers while saving lives at the same time.

Tobacco taxes raise hundreds of millions each year while deterring young people from smoking in the first place and encouraging existing smokers to quit.

There are two opportunities for the Australian Government to raise more money while tackling chronic disease.

In our Budget submission, we have argued that the government could raise $3.3bn each year with two evidence-based revenue measures: alcohol tax reform and a health levy on sugary drinks.

These measures could not only raise much needed funds to off-set new public health interventions, but would also achieve important population health benefits.

A health levy on sugary drinks could raise at least $400m a year. The merits for the levy are sound. Mexico introduced an excise tax on sugar-sweetened beverages of approximately 10% in January 2014 as an anti-obesity measure. By December 2014, the purchase of taxed beverages had fallen by 12%. This demonstrates that even small levies on sugary drinks can result in a noticeable reduction in demand.

The Government has also been urged to take long-overdue action to reform alcohol taxation. The Foundation for Alcohol Research and Education (FARE) calls for modest reforms that could raise $2.9bn a year in revenue while driving a 9.4% reduction in alcohol consumption.

Both measures are easy to implement. Both are evidence-based. Both enjoy public support, especially when the funds raised are used to support health measures.

We argue that at least some of the funds raised by such ‘corrective taxes’ should be spent on cost-effective, evidence based prevention measures.

Few investments could be more effective than getting people to walk.

Investing in walking – and especially Heart Foundation Walking – should be a priority.

Walking is low cost, requires no membership or special equipment. It not only promotes physical and mental health, is socially inclusive and helps the environment.

While there are bucket loads of evidence to support the health benefits, one piece of research, published in the Medical Journal of Australia in February, stands out.

Conducted by researchers from the University of Newcastle, it shows a clear link between increased walking and decreased hospitalisation rates.

It found that walking an extra 40 minutes every day can reduce the number of days in hospital for Australians over 55.

People who increased their steps from 4,500 to 8,800 steps per day spent an average of one less day in hospital every three years. Even an extra 1,000 steps a day could reduce hospital bed days by 9 per cent.

The researchers noted that, with a day in hospital costing about $2,000, a reduction in hospital bed days of that dimension would result in a very positive impact on health care budgets.

While the Heart Foundation Walking program is the largest free walking network in Australia, with around 28,000 active participants, we need more people to be involved to have significant a population health impact.

Super-charging the program to reach quarter of a million Australians would be a worthy aim.

We are busy promoting the virtues of walking to government. They are perhaps best summed up the enthusiasm with which the US Surgeon-General, Vivek Murthy, has embraced walking through a national Step It Up! campaign and report - launched in 2015 - to promote walking and walkable communities.

The report - which is being compared to the Surgeon-General’s 1964 warning on the dangers of smoking - is based on definitive evidence that moderate physical exercise boosts health and cuts the chances of developing cardiovascular disease, diabetes, dementia, depression, colon cancer, anxiety and high blood pressure by 40 percent or more.

Launching his call to action, the Surgeon-General said: “We’ve really lost touch with physical activity. It has slowly vanished from the workplace. More and more kids in school don’t have time to exercise. The time has come to build activity back into our daily lives.”

That’s a message we are taking to politicians, to public servants and, most importantly, to the public.

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