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'As such, our health system now seems to be
suffering from an identity crisis -- unsure whether
its focus is on making a person well or improving
their wellbeing. And like one in two Australians,
our health system is also struggling under the
added burden of chronic disease.'
In August 2015 the House of Representatives
Standing Committee on Health held the first of
a series of public hearings of its Parliamentary
Inquiry into Chronic Disease Prevention and
Management in Primary Health Care. The Inquiry
attracted more than 100 submissions.
As well, in its 2015 Budget the Federal Government
established the Primary Health Care Advisory
Group chaired by Dr Steve Hambleton. The Group
also includes Queensland pharmacist and former
PSA Queensland Branch President, Bruce Elliot.
In August 2015 it released a discussion paper,
Better outcomes for people with chronic and
complex health conditions through primary care,
which pointed out that 'our current health system
is not set up to effectively manage long-term
In his introduction to the paper, Dr Hambleton
said: 'we are facing some significant system
challenges that primarily relate to a shift in burden
of disease from infectious diseases requiring
episodic, or one-off care to chronic illnesses
that require more ongoing care with input from
multiple health care providers.'
'Care needs are more complex and requires
more maintenance and multiple professional
interactions across the health system.'
Stil i th 19t Centur
Rosemary Calder, the Director of the Australian
Health Policy Collaboration at Victoria University
in Melbourne, told Australian Pharmacist that
Australia has been very slow to respond to the
increase in chronic disease. And, while Australia is
making piecemeal progress we still operate in all
the silos from the 19th Century.
'We have a Private Health Insurance Review.
We have a Medicare Benefits Schedule (MBS)
pricing review. We don't have the two looked at
together as the fundamental insurance platform
for access to healthcare.
'Why not? Because we don't think about it that
way,' Prof Calder said.
'The Hambleton review is trying to think
about service models, and that is
peculiarly happening separately from
the funding review (The MBS review)
which funds the service model. Why
do it separately? If you understood
what the need is you wouldn't do
that,' Professor Calder said.
To place this in a historical perspective
she said that Australia shifted from
19th Century infectious disease and
trauma issues to 20th Century issues of trauma,
and since the late 20th and into the 21st Century
issues of chronic disease have prevailed.
'Much of which [chronic disease] is, in fact,
related to the social environment that we've
established -- sedentary work environments, fast
foods, packaged foods, bulk foods -- all the things
that are contributors to chronic disease.
'Our best economic investment possible is on
a healthy productive employable population.
That's what it needs to be about. It needs to be
about population-centred health care. And, for high
risk groups and established disease in individuals
we need excellent patient-focused services,
not care services.'
Professor Calder said that few people in the
population now work physically with the vast
majority of young people moving into sedentary
'Unless they are engaged in other physical
activity like sport they are already predisposing
themselves to health risk. Then you add the
pressure of work and the social environment in
which we mix, the way we access out food.
'There are suburbs where it is very hard to find a
fresh food outlet. You find prepared food outlets
and packaged food outlets but not fresh food.
'We've reached the point where we have to remind
people that eating fresh fruit and vegetables is a
part of a healthy diet!
'We don't even now have a strong family norm
about eating a prepared family meal together.
So the fabric of social behaviour has changed
dramatically in the past 30 to 40 years. And it is
directly affecting our health.
'But much more particularly we have no investment
in using our health services to capture people when
they are starting on that slippery slope. We don't
invest in health checks or health education. We only
invest in illness treatment. It's a 19th century model.'
ˆ Rosemary Calder
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