VicHealth was established by an Act of Parliament in late 1987. But it was not a rapid process. It had taken Dr Nigel Gray, the then director of the Cancer Council of Victoria, over 19 years to bring his idea to fruition.
It took eight state health ministers before he found one, David White, sympathetic and able to implement his idea of using an earmarked tax on tobacco to buy out tobacco sponsorship, decrease tobacco consumption and fund other forms of tobacco control, health promotion and health promotion research.
Ten years later, the legislation was changed with the result that only the federal government was mandated to collect excise taxes, thus preventing states from collecting such taxes.
But the 10 years of support from all political parties meant that VicHealth continued unchanged. In 1998 I was lucky enough to be appointed CEO, inheriting a highly respected and effective organisation.
Health promotion foundations (HPFs) are by nature relatively lean and supple organisations that can understandably act faster, innovate and be a much stronger public voice and advocate for key health issues than government agencies. There is little doubt that even stronger voices will need to be heard in the next decades, as so much of our health (or ill health) will be determined by the actions of powerful commercial interests such as the tobacco, alcohol, junk food and beverage industries.
In partnership with leading NGOs such as the Cancer Council, National Heart Foundation, Diabetes Australia and the Australian Drug Foundation, VicHealth has promoted active transport, pushed for changes in urban planning, tobacco legislation, the regulation and granting of alcohol licences, the promotion and pricing of alcohol and has been a global leader in the promotion of mental health, to name but a few areas of activity.
VicHealth has had 24 years of investment in building the capacity of these major non-governmental organisations as well as in thousands of much smaller community groups. In addition it has helped build a cadre of epidemiologists, social scientists and health promotion researchers through designated research funding. Health promotion foundations can work across all levels of governments (national, state, provincial and local) with ease while also working across many disciplines and sectors.
By virtue of this independence and their strong networking and convening power, health promotion foundations can “play well above their weight”. This has been admirably shown by other HPFs such as Healthway, ThaiHealth, Health Promotion Switzerland and Malaysian Health Promotion Board. In Australia, the work of Health-way and VicHealth has greatly contributed to the development of the national preventative health strategy and the recent establishment of the Australian National Preventive Health Agency.
Staring death in the face
As was demonstrated at the United Nations high level meeting on non- communicable diseases (NCDs) held in September in New York, NCDs are now as much, or more, of a problem in low and middle income countries as they are in high income countries. NCDs like diabetes, cancers, cardio vascular and respiratory diseases strike harder and earlier in lower income countries and hit the poorest hardest.
The World Health Organisation predicts that they will be the major cause of death in Africa by 2030. Not only will greater advocacy be needed, but greater levels of research, work force development and programme implementation and evaluation will be required if we are to be able to effectively deal with the epidemics of tobacco, obesity and harmful consumption of alcohol, let alone mental health issues and the inequities that underpin all of these problems.
And what better way to fund these programmes than by using highly targeted and effective taxes or surcharges on tobacco and/or alcohol, which in turn reduce harmful consumption of unhealthy products? It may take a while to establish, but as we have seen from the work of Dr Nigel Gray, persistence and patience are key factors in successful health promotion.
Rob Moodie is Professor of Global Health at the University of Melbourne’s Nossal Institute and was CEO of VicHealth from 1998-2007.
This article originally appeared in the Mail & Guardian newspaper as a sponsored feature