This opinion piece by CEO VicHealth Todd Harper was first published at http://blogs.crikey.com.au/croakey/2009/09/10/who-will-be-the-first-boss-of-the-new-prevention-agency/

“If we could time shift back a few decades, most of us would be shocked at how ‘normal’ some risky behaviours were. Casual attitudes to drink driving and seat belts, for example, contributed to a catastrophic toll of road deaths.

With the wisdom of hindsight, laws that were then damned as being ‘nanny state’ laws are now seen as ‘no brainers’ – they are so obviously beneficial.

But it took a visionary approach –‘wisdom of foresight’ in the form of preventative health campaigns – to drive the attitude and behaviour changes that have become our cultural norms.

These campaigns changed our culture so effectively that most of us now see drink driving as dumb and wearing seatbelts as automatic. And Victoria’s road toll statistics have vindicated those seatbelt laws, having fallen from 1061 deaths in 1970 when seat belts became compulsory to 331 in 2003 – a 69% reduction.

We have come a long way from the days when panel beaters worried about a loss of business from safer driving regulations.

In hindsight, that preventative health foresight of the 1970s and ‘80s was enormously valuable. It led to investments in our future health that now deliver huge returns to all Australians in the form of lives saved and illnesses avoided, with all the associated economic, social and personal benefits. Tobacco control programs are an outstanding example. Since 1971 they have cost $176 million and generated estimated benefits worth $8.4 billion – a benefit/cost ratio of 50:1.

Yet health promotion continues to be under funded in proportion to its benefits, with just less than 2 per cent of our health budget spent promoting health.

Australia could be a very different country if we could make that wisdom of foresight one of our national characteristics – and reflect it in our funding. This is the challenge raised by the Preventative Health Taskforce in its final strategy.

The Taskforce’s recommendations map the way to a healthier Australia by setting out the evidence, the targets, and the enormous potential benefits of following the strategy’s course for such key areas as obesity, tobacco and alcohol.

Fortunately, to help us reach those targets, we have a bank of wisdom from which to draw, deposited by successful preventative health campaigns in Australia and overseas in areas such as tobacco control, HIV, and road safety. At the core of such campaigns are complex questions. How do we change our culture? How do we make it ‘normal’ to live in ways that promote health, not disease? How do we steer communities away from the chronic diseases that burden our health system, our economy and our daily lives?

Common to successful preventative health campaigns is an integrated approach that requires the resourcing of research. This is the foundation for the education, legislation and policy reform that ultimately leads to long-term cultural change.

The Taskforce’s recommendations on alcohol exemplify this multi-facet that truly encourage and reward healthy choices, through:

• economic levers such as taxation or subsidies
• legislative and regulatory measures
• boosting support for local communities and individuals, and
• increasing awareness that can over time influence our values of what is important in our general community.

Our tobacco campaigns have proven that pricing, for example, is an effective measure that can be applied to reducing alcohol consumption. Economic studies in other countries have found that a 10% price increase results in reducing total consumption across the population by an average of about 5%. And when alcohol prices rise, problems recede, including binge drinking, motor vehicle accidents, cirrhosis mortality and violence.

Other important across-the-board lessons from HIV/AIDS and road safety, along with tobacco, are that preventative health works most powerfully when it is politically non-partisan and involves the community at every step along the journey to achieving cultural change.

With tobacco and road safety we now have a community that understands the power of prevention, so much so that they expect, even demand, action from Governments. The community understands that without such action all of us pay the price: loved ones suffering preventable deaths and disease, paying the costs of treating the sick, lost workforce productivity or through pain and suffering caused by other people’s actions – smoking and drunk driving for example.

Governments have obliged recognising the wisdom and political gains to be made from smokefree laws and introducing drug driver testing.

This approach takes time – developing the knowledge and support needed is a long-term effort; which is why the Federal Government must implement the taskforce recommendations without delay. The National Preventative Health Strategy offers a once-in-a-generation window to exercise ‘the wisdom of foresight’.”