<scp>VicHealth</scp> Is a Health Promotion Exemplar: Evidence Demands Bolstering Investment (Not Eroding It)

Just when upstream prevention is so urgently needed, the Victorian Government has taken a step in the opposite direction based on perceived ‘quick wins’ rather than a long-term systemic approach to health and wellbeing. In a myopic decision, the Victorian Government has recently announced its intention to ‘dismantle’ the Victorian Health Promotion Foundation (more commonly known as VicHealth)—well, at least the intention to absorb it into the Victorian Department of Health. This decision was the result of the Silver Review—an independent review of the public service model in Victoria commissioned by Treasury and focused on reducing waste and inefficiency, primarily from an economic lens [1]. The review recommended major reforms to ‘public entities’ with little consideration of the health and social impacts of the recommendations, and no evidence of the adoption of an equity lens in their formation [1]. Although we already know that health and economic conversations need to better align to ensure optimal population health outcomes [2], the review recommendations fell short of achieving this in a general sense, but particularly in the case of VicHealth. Indeed, the review and resultant decision have been made without any effectiveness study or strategy for demonstrating how costs will be saved through the proposed transition process. The decision has also contravened the multi-partisan political support that underpins VicHealth. The review and decision-makers did not engage with contemporary evidence about the Wellbeing Economy [3, 4], nor did they factor in the economic and fiscal benefits that underpin VicHealth's long-term and ongoing strategic investment in health promotion [5, 6]. Elaborating on these shortcomings is useful in demonstrating why the abolishment of VicHealth is both unwarranted and unwise. To provide some historical context, VicHealth was established in 1987 under the Tobacco Act. This means there is 38 years of learning that underpins VicHealth's organisational legacy. It was the first Health Promotion Foundation (HPF) established globally and has consistently been used as a model for innovation in other states of Australia, including Healthway in WA, Preventive Health SA, and Health and Wellbeing Queensland. Nationally, learnings from VicHealth helped shape the establishment of the Australian National Preventive Health Agency (ANPHA) (2011–2014) [7]; and globally VicHealth has influenced the establishment of HPFs in Thailand, Taiwan, Singapore, Malaysia and Tonga. VicHealth continues to provide foundational knowledge and guidance through its membership with the International Network of Health Promotion Foundations, of which it initiated in the early 2000s. VicHealth was also recently highlighted as a ‘thriving’ HPF within an editorial targeting the World Health Organization [8]. In addition, VicHealth has consistently partnered with peak professional bodies such as the Australian Health Promotion Association (AHPA), Public Health Association of Australia (PHAA), and the International Union for Health Promotion and Education (IUHPE), to deliver world-class health promotion conferences, training, and mentoring that have supported the development of a vibrant, contemporary and internationally respected health promotion workforce. Indeed, the Health Promotion workforce is critical to implementing programs, systems and structures to improve the lives of Australians. For example, a recent evidence-informed review to support the development of the South Australian health promotion workforce emphasised a long-standing tiered structure of the health promotion workforce, including health promotion practitioners (e.g., specialists) such as the IUHPE health promotion practitioner registration system; the wider health promotion workforce (e.g., those that contribute to health promotion work); and influencers of social determinants of health (e.g., those in other sectors that support health promotion actions) [9]. VicHealth supports this critical workforce at all levels of the model, whether within or through funding they provide to others. The Tobacco Act under which VicHealth was established set the standard for best practice health promotion foundation structure and funding. It set the stage for using ring-fenced taxes from tobacco sales as a mechanism to prevent the harms of smoking through an independent agency not subject to other health financing or political pressures [5, 6]. This funding model is referred to as a hypothecated tax, which is designed to prevent funds from becoming part of a government's general consolidated revenue and was the foundation for the first decade of VicHealth's existence. It has also underpinned the establishment of HPFs worldwide, particularly across the Asia-Pacific region. In this sense, VicHealth has provided national and international stewardship in, and the advancement of, health promotion. Due to VicHealth's reputation for excellence in innovation, it was able to expand its funding beyond hypothecated taxes and tobacco control and broaden its remit to support initiatives relating to obesity prevention, alcohol and other drugs harm minimisation, cancer prevention, and mental health promotion. In fact, it was a national initiator and innovator in many of these spaces—investing in research and strategy development long before many other state or Australian governments. More recently this has extended to addressing contemporary areas of public health such as digital health literacy, promoting food security, longstanding investment in burden of disease studies relating to intimate partner violence that has shifted the dial on the prevention of gender-based violence, and action on commercial determinants of health. These initiatives have consistently spanned health promotion research, policy and practice contexts, and almost always with a focus on reducing health inequities. In Australia, we have unequivocal and longstanding evidence that health promotion and preventive health interventions represent excellent value for money [10, 11]. VicHealth has long been considered a global exemplar in this regard. For example, VicHealth has a reasonably small annual budget (approximately AUD$45–47 million) for a population of approximately 7 million people. This contrasts with the broader Victorian health budget of AUD$30 billion. This small but important investment not only saves the Victorian health system multiple millions of dollars (fiscal savings) that far exceeds the current level of investment—particularly in relation to reducing the current preventable disease burden—but likely reaps significant cross-sectoral savings that reflect action on social determinants of health by influencing policy decisions in housing, education, justice, employment and environmental settings [10]. In addition, VicHealth's resourcing has been critical for advancing health promotion and prevention efforts focused on reducing health inequities among populations and groups most underserved and under resourced. This is important as people from equity-owed populations often have poorer health and social outcomes, which requires a high level of investment to address. In these instances, prevention and early intervention can reflect a significant cost saving for health and other sectors. VicHealth has taken a systems thinking approach in much of its work. Its most recent investments have explicitly focused on understanding and addressing the commercial determinants of health in its strategic outlook, positioning it as a global leader in this space. This is critical within the context of the current dismantling of VicHealth, as an independent body is able to take action on commercial determinants of health in ways that a government department cannot or at least not until politicians and governments stop working with harmful industries (such as tobacco, alcohol, gambling and extractive industries). The current model with quarantined funds and independent status enables VicHealth to undertake transformative longer term health promotion projects addressing the determinants of health without the pressures of short-term electoral cycles. Its model safeguards long term health and equity outcomes—exactly what it was (and is) designed to do. Importantly, past Australian experience at state (e.g., Living Health in SA) and national (e.g., ANPHA) levels indicates that when independent health promotion and preventive health bodies are absorbed back into larger government department of health structures, there is a pattern of further budget restraints resulting in reduced health promotion action and poorer population health outcomes. That is, the investment and subsequent work dissipates and the community suffers the consequences. Ironically, at a time when the Victorian Government is disinvesting in VicHealth, the Productivity Commission is calling for a National Prevention Investment Framework [11]. The Victorian Government is perfectly poised to encourage the Australian Productivity Commission to look at the investment it has made in VicHealth over the past 38 years as a guiding beacon for advancing prevention (and consequently productivity) in Australia. Instead, it is turning its back on VicHealth's unrivalled economic benefits. This is, simply, unfathomable. In the short space of time since the Victorian Government's announcement to dismantle VicHealth in response to the Silver Review, there has been an outcry and coalition of voices from significant national and global health promotion and prevention institutions and professions calling on the Victorian Government to reverse its decision and save VicHealth but to even go further, and bolster the level of investment it currently receives. This clear and consistent message has come from professional health bodies, local health services, non-government organisations, Aboriginal community-controlled organisations, spanning local, national and international levels. It has been achieved through open letters, petitions, engagement with Victorian politicians, and expressed support for the current VicHealth Board, CEO and its staff. We urge the Victorian Government to make an evidence-based decision in bolstering support for VicHealth, rather than the ill-informed and uneconomic recommendation to dismantle it. The authors have nothing to report. J.A.S., G.R., M.E. and G.C. acknowledge the Australian Health Promotion Association receives funding from VicHealth for the mentoring of VicHealth Fellowship recipients. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.