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Time to get serious about preventative health.

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Friday 7 September 2007

Charles Worringham, senior lecturer, Faculty of Health, Queensland University of Technology


Time to get serious about preventative health

Time to get serious about preventative health. We all have a rough idea of the problem. Our public hospitals are overstretched, there are waiting lists, and for some, waiting lists for waiting lists. There are more of us and we're ageing, so these pressures keep increasing. We've been training too few doctors. Progress in medical science continually brings us new tests and treatments, and therefore higher demand and cost as well as benefits. We spend about $100 billion on health each year, of which two-thirds comes from government. Inflation in the health sector runs at a steady annual rate of 7-8%. We have many bright spots in our public and private health care, but certainly not an integrated or seamless health system. With its emphasis on treatment, some people even call it a "sickness system".

Much of this pressure arises from conditions that are - to a great extent - preventable. We've been hearing a great deal about lifestyle diseases recently, the obesity epidemic, metabolic syndrome, diabetes, and the like. Meanwhile our old favourites heart disease and stroke haven't gone away. Along with genetic factors outside our control, the likelihood of developing many conditions is indisputably influenced by a person's level of cardiorespiratory fitness. This in turn is related to a whole series of other risk factors. Decreased mortality and morbidity with improved fitness has been documented whether you're fat, thin, or average, apparently well or have one of a growing list of diseases that now extend beyond the cardiovascular and metabolic, to include, for example, depression.

So here's an idea for the Feds. After passage of the relevant law, you, and all other Australians over the age of 12, would be able to take the following preventative health journey. Let's see where it starts. In your birth month (just to spread things out a bit), you can receive a Medicare funded general health check from your GP. Unless you're considered medically at risk, you'll also undertake a free sub-maximal cardiorespiratory fitness test - walking or jogging on a treadmill, administered by an accredited exercise physiologist. Your fitness will be reported as being at one of five levels - A-E, if you like, based on whether you're in the top fifth of the population for your gender and age group, the second fifth, and so on. You'll then receive advice about your health, eating and exercise habits, and, if recommended by your doctor, qualify for up to, perhaps, three Medicare-funded visits to a nutritionist, psychologist, physiotherapist, or other specialist, to help you on your way.

Six months later, you repeat the GP visit and exercise test. If you moved from the lowest category to the next-to-lowest, and if your doctor certifies that you complied with any other requirements such as recommended disease screening for your age and gender, you'll receive a payment from the Commonwealth of, say, $300, tax-free, on the spot. Thereafter, for every six months you show that you have maintained your fitness and continued to comply with other recommendations, you receive another payment, though this would decline to a more nominal sum in the order of $50, over time. The incentives will also taper off at the top, so those who are already healthy and fit would receive a token sum to recognise their contribution to controlling the nation's health care costs. Maybe enough to pay for their petrol, or their bike maintenance. Those with the poorest fitness, who have the highest risk of lifestyle disease, will have the greatest incentive to participate and to improve.

If you become injured or sick between one test and the next, your doctor can certify this and re-start you at the lower level. If you do well for a time but slack off and go backwards, there's no penalty but a waiting period before being eligible again. We don't want to promote yo-yo health habits.

The whole scheme would be entirely voluntary - all carrot, no stick. There are certainly people with disabilities and conditions that would preclude their taking part - and some variations on the tests could be devised for many. But even if not, everyone stands to benefit from the health resources freed up over time by decreasing the levels of preventable disease.

Unlike many expensive health promotion campaigns that cannot guarantee results, this scheme would reward verifiable and sustained voluntary improvements in the health-related fitness of individuals, and its costs, perhaps 2% of what we now spend on health without even counting the savings, would therefore be tightly linked to its benefits.


Charles Worringham  

Senior Lecturer  

Faculty of Health  


Independent candidate for the federal seat of Ryan.