Public health funding: A ‘complex and piecemeal’ system lacking transparency on government spending of taxpayer dollars

Pharma News: Less than 2% of government health spending is allocated to public health initiatives, including infectious and chronic disease protection, prevention, and health promotion. A first-of-its-kind analysis of public health funding has highlighted a concerning lack of transparency regarding how these funds are spent by Federal and State/Territory governments.

According to the findings, only 1.8% of overall health spending – or $140 per person – was dedicated to public health, with significant discrepancies across states and territories. For instance, the Northern Territory invested $527 per person in public health, while Victoria allocated only $110. In comparison, about 4% in the UK and close to 6% in Canada of the health budget is allocated to public health.

Emeritus Professor Alan Shiell from La Trobe University, the study’s lead author, emphasised “The effectiveness of public health funding isn’t just determined by how much funding is given, but also how it is allocated.”

He noted, “Our research uncovered a complex and piecemeal funding system. While delegating funding decisions to the states and territories who understand local need is a strength of our current model, it leaves the public in the dark about exactly where the money is going and how much is being spent on public health.”

Professor Shiell also pointed out that this lack of transparency complicated the evaluation of public health spending’s impact.

“It makes it very hard for us to assess what difference public health spending is making,” he stated.

During the 2022 election campaign, the Albanese Labor Government pledged to implement the National Preventative Health Strategy, which aims for at least 5% of total health spending to be invested in preventive health. However, recent Federal Budget allocations have not demonstrated a bold move toward this goal.

Federal Health Minister Mark Butler acknowledged the ongoing challenges, saying “It’s been a long-standing feature of our health system that we spend a bit less than 2% of our entire health spend on stopping people getting sick in the first place, and about two-thirds of that spend is on the vaccine program.

“But there is more that we should be doing in the area of prevention, particularly with the most significant, or at least the fastest growing cause of preventable illness, and that is around diet and activity and the flow on into diabetes, particularly type two diabetes. We’ve received a terrific report from the Health Committee of the Parliament on that which we’re working through.”

The study’s authors contend that the lack of transparency hinders accountability for funding decisions, making it difficult to assess whether reallocating resources could enhance system performance or whether increased spending would yield greater benefits. This opacity also prevents a comprehensive understanding of the funding model, complicating efforts to determine areas for improvement.

Adjunct Professor Terry Slevin, CEO of the Public Health Association of Australia, stressed the urgent need for a revamped government funding model for prevention.

“After a clear spike in public health spending due to the pandemic, investment in this area looks to have returned to pre-COVID levels,” he stated.

“We have a sophisticated system to determine the best investment in medicines – the Pharmaceutical Benefits Scheme (PBS). We need a similar system to ensure that proven, cost-effective public health programs receive consistent funding.”

Professor Slevin further added, “The Australian Centre for Disease Control could play an active role in developing this proposed funding model. Prime Minister Albanese is on the record as saying prevention will be one focus of the Centre.”

Head of The Australian Prevention Partnership Centre Nadia Mastersson said “This research should encourage discussion on how public health funding mechanisms in Australia can be improved to ultimately keep more Australians healthy and well.”

This research was supported in part by the Australian Prevention Partnership Centre through the National Health and Medical Research Council (NHMRC).

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