Regional health worsened by chronic illness and poor service delivery - Australian CDC

The Australian Centre for Disease Control: Highway to health, argues vulnerable Australians are being failed by a health system designed to treat acute, not chronic illnesses.

According to the report, 90 per cent of deaths in Australia result from chronic conditions, which are disproportionately suffered by the most socio-economically disadvantaged groups.

This includes rural and regional Australians, who are likely to have twice as many chronic health risk factors, and lives two to three years shorter than those living in cities.

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A report tabled last year in the NSW Legislative Assembly similarly found the disparity in life expectancy between the cities and regions to be 2.2 years; 81.4 years compared with 83.6 years, respectively.

Gundagai general practitioner Dr Paul Mara said he was sceptical that an ACDC would help alleviate the burden on rural and regional health systems.

While Dr Mara agreed with the report's assessment of the problem, he argued more targeted resourcing, and more staff were self-evidently more important more research into well understood issues.

"We have a service crisis in rural and regional areas, and that's a workforce crisis," Dr Mara said.

"We have to think about different ways of doing things that aren't just pouring more money into programs that have already failed," he said.

"We spend $300m a year on training for general practice, yet the availability of general practice has gone down the toilet - it's been an abject failure."

While understaffed regional health networks, and consequent difficulty getting appointments is a barrier to better health outcomes, Shaun Perry said reluctance to ask questions of his doctors in Wagga slowed his diabetes diagnosis.

"It took 18 months, but that was probably my fault too because I never really asked questions," he said.

"I was in denial, and it wasn't until I started asking questions that I accepted I was diabetic.

"People in the country are a lot more casual about things like this, and don't go and see doctors as often as they should...plus it can be very hard to actually get an appointment."

Treating chronic health conditions is a wicked problem, requiring proactive public health measures that address environmental and systemic risk before chronic illnesses develop. Public health research in Australia has repeatedly shown the cost of managing chronic health conditions is far greater than prevention, as well as poorer patient outcomes.

"Chronic diseases aren't sexy, like the latest brain surgery or a global pandemic. We take a longer term, hard yards approach," Dr Mara said.

The political challenge of preventative health policy is that when it functions well, it is largely invisible to the public. Grattan have argued the ongoing challenge of creating long term policy designed to last beyond three year political terms and enacting reforms designed to prevent chronic health conditions will likely remain elusive.

"A recent multi-country study found that prevention is one of the first areas of spending to be reduced when government budgets are cut," said the report.

"This is largely because the lag between investment and payoff means prevention is not a salient issue either for the public or most interest groups."

"The prize on offer here is enormous," report lead author and Grattan Institute Health and Aged Care Program Director Peter Breadon said.

"Better chronic disease prevention would improve the quality of life of millions of Australians and save taxpayers billions of dollars in avoided hospital stays and other treatments.

"It's a long way to the top for Australian prevention policy, but a carefully designed and independent ACDC could put us on the highway to health," he said.

Mr Perry said breaking down concerns about being viewed as weak for talking to a doctor are essential to improving outcomes for people with chronic health conditions

"My father would have been lucky to go to the doctor twice in my life before he retired - that's the sort of culture we have," he said.

"I've seen what happens to people when they don't engage, and made a decision I didn't want to be like that.

"It's too late when you've already got the disease - you've got to try to catch it early. It comes down to your own responsibility to look after yourself."

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