Critical analysis of chapter 1
Discuss about the Critique Of The Report- “Australia: The Healthiest Country By 2020”.
The essay is the critique of the report- “Australia: The Healthiest Country by 2020”, where various policy recommendations are made by the National Preventative Health Taskforce to reduce the alcohol consumptions, control tobacco, ad decrease the obesity rates (Australia National Preventative Health Taskforce 2009). There is wide ranging scope to these recommendations. Thus, the aim of the essay is to critique and identify the strength and weakness of the National Preventative Health Taskforce report, from te perspective of the environmental health promotion.
The chapter 1 of Taskforce reports deals with the building of the preventive health in the Australian communities. The vision, purpose and strategy for preventive health mentioned reflect the great deal of thinking and collection of evidence on the national health issues. It represents the consultations made with huge number of Australians working in diverse health related fields. Different organizations private, public, nongovernmental organisations are involved. The Australia’s call for action is based on the national and international research on the health issues and evidence from varied sources. The use of the bulk of evidence as witnessed from the graphs and charts supports the economic approach to public policy (Harrison and Robson 2011). It demonstrates the strong base for such healthiest perspective. Overall chapter signifies that the authors contributing to this bulk of information, and the number of studies being cited have various common features. The main one includes adoption of the “Public health approach”. It is known to be the healthiest norm by the economist Eric Crampton. It may be considered the strength of the approach (Drummond et al. 2015).
The Australia’s response to call for action and need for action appears convincing as both the opposing and diverse views are considered. There is high chance that despite being based on best possible evidence, it may be challenged by different interests groups. It is to be appreciated that the report also intends to build evidence for future action (Watson et al. 2014). The same is evident from the themes arising from the consultations. The need for action focuses on the chronic illness due to three main factors adding to the health care costs that are obesity, alcohol and tobacco. In this regard the report makes several policy recommendations for these diseases and addictions. It includes use of tax system to decrease the sedentary behaviour, and regulation in the tobacco manufacturing and packaging. The recommendation proposed by the Taskforce has wide scope. It is questionable if there is complete analysis underlying the recommendations. It is not clear if there is a rigorous assessment of the evidence on the discussed issues and is considered the weakness of Taskforce (Harrison and Robson 2011).
Critical analysis of chapter 2
While critiquing the economist approach and the healthiest approach, it can be said the economic approach takes into account all the benefits and costs. On the other hand the healthiest approach only considers the health benefits offered by the policy (Wutzke et al. 2017). The commitment to Australia- becoming the healthiest country cannot be disagreed as worse health outcomes are not preferred by anyone. However, there may be adverse impact on the environment as the health resources are scarce. There are overall different goals for sociality and individuals as a whole. Between health and other goals, there are tradeoffs recognised by economic approach. It is not justified to spend more resources on the prevention of illness as the resources utilised have an opportunity cost and these cannot be devoted to other public economic activities. The activities that are proposed to give benefits have not received the government’s funding. On the other hand the opportunity cost is reduced to the missed benefits of these activities. It means that there is no limit to budget as witnessed from the strategies mentioned in the chapter 1. Health promotion in this regard is an open ended commitment (Harrison and Robson 2011).
It can be said that the Taskforce strategies align with the ecological model of health promotion, as it focused on the multiple levels of influence on health behaviours. The Taskforce focuses on the individual factors influencing behaviour such as personality, beliefs of people as well as interpersonal factors such as interactions to create barriers to interpersonal growth for health promotion or provide social support. The taskforce also takes into considerations, the organisation factors to promote health through regulations on alcohol, community factors as well as public policy factors, which includes policy recommendations and laws. For example the awareness campaigns and teams are based on the ecological model (Sallis, Owen and Fisher 2015.). The Taskforce actions to burning health issues also seem to follow the health belief model. It is witnessed from the focus on the individual health related behaviours that cause sickness, perceived barriers to actions and exposure to factors that promote action. It is also evident from the bulk of the information collected for designing the short term and the long term interventions for obesity, tobacco and alcohol. It is also evident from the considerations for implementation such as communicating the target population about the steps involved in taking target actions. As per Sharma and Romas (2017) both the health belief model and ecological model are effective approach in designing the health promotion interventions by understanding the health behaviour. Further drawing on the behavioural economics and using financial incentives helps reinforce the behaviour change and motivate others to do the same. This also aligns with theory of reasoned actions and social cognitive theory. Such practices will develop community with people on same page in regards to healthy behaviour (Halpern et al. 2015).
Despite the benefits of the ecological model and the health belief model, there are several drawbacks on environment in regards to the strategies applied by the Taskforce. It is because there is jumble between the private and external cost. It may create the misleading information for the public who are worried about the cost being imposed on them by smokers. The policy changes recommended in the chapter 1 ignores the private benefits of behaviour at issue are being avoided. It means the people who are non-smoker or non-obese are likely to suffer for the cost. It may lead to socially wasteful policy choices as the cost benefit analysis may likely overstate the net benefits of policy (Drummond et al. 2015).
It can be argued that the benefits to be obtained by the policy changes may only be attributed to the fraction of the total health costs. It does not mean that the policy implementation will increase the overall well being of the community although it reduces the cost and given the fact the prevention works. For instance the smokers may overestimate the adverse health effects of smoking. The positive impact in this situation is the right decision made by the uninformed consumers (Reeve and Gostin 2015). However, there is an advantage to the health promotion approach on the environment as there is range of options considered to achieve the objective. There are measures to change the physical environment of the patients such as banning the alcohol in the residential areas to prevent exposure to children at early life. Further, having restaurants only serving healthy food will make people give more effort to reach the unhealthy food and ultimately quit the same (Giles et al. 2016). These constitute the strength of the Taskforce. In future, it will lead to community that is focusing on the well being
The targets for obesity seem to be very ambitious to be reached by 2020 although the strategy is made of three multi layer phases. For obesity there are various interventions chosen that have long term effects such as making available the healthy food supplies and embedding the physical activity and healthy eating in everyday life. All the interventions in the phased approach works ate multiple levels such as personal development, com unity development, organisational and partnership development, effective provision of the health information and strategy development. Interventions like education centres will help children and adults make healthy choices. The Taskforce also provides the opportunities to the young people to take part in the activities like sports and others. Ban on marketing and advertising of the fast food will help children stay focused on healthy food habits. The focus on the maternal and child health improves the health pattern right since early years. The Taskforce also focused on the low income community (Harrison and Robson 2011, Giles et al. 2016, Watson et al. 2014).
The strength of these initiatives include the cutting down the health care cost and contributing the economy by tackling obesity and comorbidities such as cancer and cardiovascular disease. These initiatives by the Taskforce promote the community togetherness and the social cohesion of the group support. People get the opportunities to cut down depression and make new friends. In addition to the physical health it also improves the mental health. the physical activity and healthy eating helps decrease stress and depression. Community health hubs and food hubs are effective methods to foster the social justice (Rose 2017). Physical activity releases the endorphins that improves the individual mood, and exercises leaves calming effect on the body. It is an overall healthy way to tackle disease.
The strategies in chapter 2 align with the social cognitive theory as behaviour change targeted by the Taskforce include behavioural capability, self-efficacy, expectations, self control, observation and learning reinforcements, which are all the elements of the social cognitive theory (Bandura 2014). It may be particularly useful for the rural communities, and help understand the influence of social determinants of health and how past experiences affect health behaviour. The interventions like counselling describe behaviours of patients based on subjective norms. A positive subjective norm will receive in greater perceived control over unhealthy behaviour. There is high likelihood that intentions are governing changes in behaviour. It is in alignment with the theory of reasoned action and the planned behaviour (Montano and Kasprzyk 2015). Considering these theories are the strength of the Taskforce, as they support disease prevention and explain health behaviour.
There are several weakness associated with the above mentioned initiatives such as issues related to funding and lack of staffing. Further, it can be argued that the strategies are losing out to direct care. It means that the health promotion is being seen as unimportant to the staff such as nurses who are the frontline carers (Edelman et al. 2017). They are the most important people to deal with the direct patient care. Other weakness is the poor addressing of the factors such as poor understanding of the health promotion among the staff. The biggest weakness is the lack of training among staff. Poor skills and knowledge amongst staff leads to unsuccessful health promotion (Eldredge et al., 2016).
Conclusion
It can be concluded from the critical analysis that the heath costs created by certain activities are judged to be undesirable. The report indicates the role of government is to discourage such activities initiated by the individuals. Overall the Task force has set out some arbitrary targets for reducing activities causing increase in health care costs. The Task force effectively recommends the policy makers to fulfil those targets. However, the benefits of the policies and the social costs are not examined. It is questionable as the Taskforce asserts that the targets would be achieved through the targets chosen arbitrarily. It can be concluded that the National Preventative Health Taskforce Report has done great hard work in performing the cost benefit analysis. However, it bypassed the hard work required to make the calculations credible needed for analysing the public policy rigorously. The report well established in the second chapter obesity caused by the excessive eating, sedentary lifestyle and lack of physical activity reduced the positive health outcomes. However, it is not established that the policy recommendations would indeed reduce these things or work in desired fashion and would be beneficial. It is necessary for the policy makers to know how health benefits will flow from the changes made. The statistics are well cited by the Task force reports and host of data is presented. There should have been proper systematic assessment of the costs and benefits of the policies recommended.
References
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Harrison, M. and Robson, A., 2011. Prevention no cure: A critique of the report of Australia’s national preventative health Taskforce. Agenda: A Journal of Policy Analysis and Reform, pp.7-25.
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