The other area that often doesn’t get appreciation is how we’ve been able to use existing regulatory regimes to achieve big outcomes. So when things were slowing down a bit in the smoke-free debate, we started to use OHS[184] laws to get PIN[185] notices dropped in hospitality venues, Crown Casino and others.

We also did a lot of work around engineering for prosecutions to occur under the TAP Act where we actually prepared the case pretty much and then handed it over to the Health Department and away they went. Then also with the ‘lights’ and ‘milds’, where again all of that work was done by the sector and then handed over to the ACCC[186] and then they ran with the case. In that way, capacity was built up gradually over time.

It’s one of the things tobacco has done really well because, picking up Lyn’s point about the capacity of tobacco control then filtering into other areas, that is one of the ones that has translated quite nicely.

A lot of areas like obesity, alcohol, sun safety, OHS have been using those techniques. If we can’t get the law reform we want now, then there are other ways that we can still achieve quite significant advances.

David Hill: That’s a good argument for having public health lawyers in-house.

Ann Westmore: And economists, too, as others have said.

Andrew Herington: I was just about to raise economy. When you go back, the work that the Anti- Cancer Council was doing was driven mainly by science and medicine. It had a hard edge - the sort of work that David (Hill) and Graham (Giles)[187] were doing was the core part of the argument to make the case that smoking was dangerous and a bad thing.

In the 10 years after VicHealth (was established), economic matters came into it much more. A lot of people aren’t aware that Jenny Macklin[188] was one of David White’s other advisors. Going back, I was having the argument with Peter Worland[189] about exactly what to do with VicHealth Foundation. Part of the problem was that the original idea was to raise some money to pay off the (tobacco company) sponsorships (of sporting organisations). But five percent was so much money it was hard to work out exactly what to do with the rest of the money.

Peter’s original idea was that we should have free school breakfasts. I said it would never work. Peter persisted and Jenny was arbitrating. We took a much more economic approach to it. Work that I did later on trying to document prices, similar to what Michelle has been doing, shifting over into taxation and price elasticity and looking at it within an economic framework was something that I don’t think a lot of other health campaigns haven’t made that shift. The fact that Quit has been so multi-disciplinary – legal economic, medical and scientific – that’s another route to success.

Michelle Scollo: I absolutely agree with that though, I have to say that having been brought in occasionally to present our findings to politicians nationally, a challenge we face in the other health areas is that politicians have got a bit blasé. All those Deloitte reports about how much different conditions are costing, they now add to more than twenty times Australia’s Gross Domestic Product. (Laughter) They’re not believable any more.

Paul Grogan: The guys in Treasury recognise that.

Todd Harper: That’s a really good point and it’s why some of the work around cost-effectiveness has been much more important. It carries much more weight with Treasuries than the cost of those diseases. The rest of it is just noise and you expect a big number.

If a meteorite hits Melbourne the cost would be astronomical. But there’s nothing you can do to prevent it. Unless it’s got something tangible so that if you do this, it will have this outcome, it’s fairly limited.

Terry Slevin: So we now have started talking about public health lawyers as a new category of lawyers. We haven’t yet started talking about public health economists and I think that is an important take away message .

Dorothy Reading: There are health economists. I don’t think you’re right there. The Grattan Institute[190] does some fairly interesting things in terms of public health and economic analyses.

Michelle Scollo: I wonder how the numbers compare. There are a large number of lawyers being trained across Australia and tobacco control in particular is a lawyer’s dream because it’s got all the elements of exposing defective conduct and injustice.

But how many health economists are there? I would think not many.

Andrew Herington: The forefront of health economics, which is mainly focussed on the high cost of hospitals, is how do you get into health promotion? It’s the sort of thing that Treasury officials are saying they are interested in for the next 40 years.

There’s a recent interesting example involving the Bendigo Hospital which has set aside $6 million out of their $700 million capital program. The CEO has said, ‘I’m going to take that $6 million and make some savings and invest that in health promotion because you can never build a hospital big enough to take all the people who will get sick in Bendigo if we do nothing.’

Just to take 1 per cent and make a shift, so that health promotion is no longer 2 or 3 per cent of health spending but is 5 or ultimately 10 percent. Getting traction on that argument and working out how to apply it across a whole series of things would be a fairly fundamental change.

Ann Westmore: Let’s have a 10 minute break now, and resume the discussion in the last session of the day.
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Witness to the History of Australian Medicine