The foundation of health care

The creation of a health promotion foundation is not only a strategy that will help people live healthier lives, but also contributes to cutting the cost of healthcare in general. The creation of such foundations is not a new concept. It has already been proven to work in Australia and Thailand.

The success of these examples points the way for South Africa to establish a similar institution and reap the benefits. While health promotion is cost-effective, many countries struggle to cope with the new realities of both communicable and non-communicable diseases at the same time.

It does not seem fair to ask states and the tax payer to foot the bill for non-communicable diseases that are caused by products such as tobacco and alcohol, when these products are manufactured by global multinationational companies with billions of rands of profit annually. Following the principle of “the producer/polluter pays” health promotion organisations such as Soul City are calling for a levy to be imposed on alcohol products and for this levy to be redirected into a health promotion foundation.

Soul City and the National council against smoking also believe that this levy needs to be extended to tobacco products as well. According to the World Health Organisation, “The development of Health Promotion Foundations is an innovative way of mobilizing new resources for promoting health and can support research, innovation, and the strengthening of health promotion capacities in the health sector and other sectors such as education, sport, the arts, environment and commerce.”

The WHO believes that Health Promotion Foundations work in a complementary way with Ministries of Health, and other relevant Ministries. Effective models for health promotion infrastructure exists in several countries (Switzerland, Thailand, Australia, Austria and Korea), says WHO’s website. But why should the average man on the street care?

VicHealth (Australia’s Victoria State’s health promotion foundation, started in 1987 with funding from government-collected tobacco taxes) makes the case for a health promotion foundation in a very elegant way when it says: “Today, we have a broader understanding of health than ever before. How much you earn, your social position, your level of literacy or your capacity to be involved in sport or creative activities that help connect you to others in your community are as important to determining your health and wellbeing as the medical care you receive when ill.”

VicHealth CEO Todd Harper said in March: “There’s absolutely no doubt that health promotion and illness prevention works, and is cost effective. Giving people information to help them make healthier choices and preventing disease before it occurs is nowhere near as costly as treatment and picking up the pieces once people are sick.” It’s all good and well to set aside sin tax for a special purpose, but how do you control the spending?

Healthway (the Western Australian Health Promotion Foundation) was established in 1991 under that country’s Tobacco Control Act 1990 as an independent statutory body reporting to the Minister for Health. Healthway’s sponsorship program provides funds to sport, arts and racing organisations in Western Australia in return for the promotion of health messages and the introduction of healthy environment policies.

A quick look at the Thai Health Promotion Foundation (ThaiHealth) is useful. ThaiHealth was established in 2001, the first organization of its kind in Asia. It is autonomous state agency outside the formal structure of government, but funded by ‘sin taxes’ collected from producers and importers of alcohol and tobacco.

The results of the survey carried out by the Thai National Statistics Office indicated that in 2007 there were 14.9 million alcohol drinkers (29.3% of the population of 15-year olds and above). This was a decrease from 16.2 million people, (32.7%) in 2004. Not too shabby a figure for a mere 3 years of active health promotion. The opportunity exists for SA to develop its own health promotion foundation, built on the examples from across the world.

Savera Kalideen, advocacy manager at Soul City, believes we stand a good chance of getting such an organisation off the ground in SA. “Australia and Thailand both have similar incomes to South Africa. Their cost of alcohol-related harm in relation to GDP is similar to ours. Yet, they have managed to make a difference in their countries through the mechanism of a health promotion foundation.

I see no reason why we can’t too, particularly given our current health challenges.” Kalideen says the issue is that our societal norms consider what is statistically risky behaviour – like drinking, smoking and engaging in unprotected sex — as “fun”, “exciting” and “having a good time”.

“A health promotion foundation would be able to spend not only money on communicating the correct messages, but also time on research, education, lobbying and the general promotion of health,” she says. “In time this will lead to a healthier and safer society for us all to live in, and allow us as individuals and as a society to redirect these precious resources elsewhere.”

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