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  1. 1

    Mike Daube

    This piece quotes an earlier commentary from Vern Hughes from a group called Social Enterprise Partnerships in Victoria. Mr Hughes writes that “Population health and prevention programs seem to have made little impact on Australia’s epidemic of obesity or ongoing levels of alcohol abuse and tobacco-related illness. Presumably, if current programs were effective, the trends would be heading downwards”.

    Action on obesity and alcohol is light years behind that on tobacco, but where on earth does Mr. Hughes get the idea that we are not making on impact in reducing the death and disease caused by tobacco. Current programs are effective; the trends are heading downwards; and further measures such as plain packaging will ensure that these encouraging developments are maintained.

    It would be helpful if people like Mr Hughes bothered to check out what is actually happening before letting their biases get ahead of the evidence.

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  2. 2

    Amanda Lee

    Those readers interested in the evidence that preventive health services have been effective in Queensland could access the Report of the Chief Health Officer 2008, The Health of Queenslanders- Prevention of Chronic Disease, particularly Chapter 5, available at http://www.health.qld.gov.au/cho_report/2008/documents/2008choreport.pdf – or indeed in any of the recent articles that are conveniently omitted from this piece.
    Aside from the well-documented outcomes in tobacco control, the evidence includes measured impacts and outcomes at multiple stages along the causal pathway in other areas. For example, in 2007 the rate of measured (rather than self-reported) healthy weight among children in Queensland had reached levels 2-3% higher than in other states where comparable data was available. This equates to 1,200 fewer future cases of Type 2 Diabetes per year by 2015. The multi-strategy Go for 2 and 5 fruit and vegetable promotion program resulted, at its peak, in an extra intake of 1.1 serves per person per day throughout the state. This was confirmed by objective measurement of additional turnover of $9.8 million sales of fresh produce per month in Brisbane alone. Campaign targets were exceeded resulting in a technical saving of $55 million per year to the ill-health system.
    Adult physical activity participation rates had increased by 34% since 2004. Exclusive breastfeeding rates for the first six months had quadrupled, and the proportion of infants breastfed at one and six months had increased by over 5% points to 83% and 63% respectively.
    As is the case for most interventions in a complex public health system, the evidence is that a multi-strategic approach is required for effective advocacy. By not acknowledging the need for diverse perspectives, this piece is guilty of its own criticisms in not adopting an evidence-based approach.

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  3. 3

    Philip Darbyshire

    Thanks to Mike and Amanda for their considered responses. I feel myself coming over all Shane Crawford and wanting to say; “That’s what I’m talking ’bout”. Mike is absolutely correct about tobacco, although as Martyn Goddard explains, it might be slightly disingenuous were the health promotion lobby to claim sole credit for smoking reduction as a ‘health education’ victory.

    If I have, as Amanda suggests, missed any coherent arguments in Croakey against the Queensland cuts that were based more on evidence and demonstrated value than on outrage and indignation, then mea culpa indeed. “Conveniently” however, has nothing to do with it. I searched Croakey using key terms such as ‘Queensland’ and ‘cuts’ and cited the blogs or commentaries I found that responded to the news of these cuts. Amanda feels that I may have “omitted” something important here. I wish that this were true.

    The Queensland Health Report that Amanda helpfully cites is fascinating reading. I’m sure that it addresses some of the thorny concerns I raised about assessing the benefits of various health promotion and other awareness and education campaigns, while possibly raising others. I would not be surprised however to see some of its critics raising the Mandy Rice-Davies objection.

    One example will have to suffice. Eating more fruit and veg sounds like a wonderful idea but I’m not sure how excited the policy makers should be at the trumpeted benefits of people having an “extra intake of 1.1 serves per day”. Who knows what slips there may be ‘twixt veggies and lips? Should we worry rather than rejoice if the ‘extra serves’ of veggies were, for example, mostly fresh potatoes that were ultimately devoured as bowls of hot chips (with accompanying salt and sauce)? Or perhaps the serves were apples, that instead of inhabiting little Johnny’s lunchbox, ended up as the foundation of some mighty apple crumbles. Pertinent questions to ask one would think.

    I’m not a health economist but the bald idea that ‘sales of fresh produce’ increasing by $X million dollars translates to a health system saving of $XX million seems such a long bow to draw that Robin Hood on steroids would find it a challenge. Perhaps that’s the reason for the little ‘qualifier’ – “technical” saving. I wonder if a “technical saving” is like a “technical breach”?

    Amanda berates me for “not acknowledging the need for diverse perspectives”. I’d be wounded, if I had a clue what she meant. I cannot see a scintilla of basis for this presumption from my piece. I’m guessing that a “multi-strategic approach for effective advocacy” might mean that there are many different ways that people and communities can be helped and enabled towards better health. No argument at all from me there and by the same token, I think that there are ‘diverse’ forms of evidence, both qualitative and quantitative, that we need if we are to highlight and to demonstrate the acceptability, effectiveness and value of health programmes and services. Such diverse research approaches should also be capable of discovering the converse; what does not work and what has little demonstrable benefit. I have no difficulty at all in saying which of these services deserves to receive our hard-earned tax dollars in government funding. Here is a clue: the answer is not ‘both’.

    What I am not obliged to ‘acknowledge’, in deference to any notion of ‘diversity’, is the correctness of the ways that Amanda and others have responded to the cuts in their Croakey comments. I simply believe that their approach is wrong and have explained why. On that point we may agree to disagree.

    Amanda plays her parting shot as if it were an ace when it is barely a deuce. I criticised Queensland Health for their ‘slash and burn’ approach to these cuts that almost wilfully ignored any notion of evidence. I have called for a more ‘evidence and outcomes’ informed thinking, not only in relation to these cuts but across all of health funding. I have critiqued the predominant hand-wringing preciousness of responses that we have read to date and have cited specific examples of my concerns. I may not have joined the bandwagon of bluster but I can scarcely be guilty of “not adopting an evidence-based approach”.

    Philip Darbyshire

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