Prevention may be better than cure, but it is also less well funded

As Australia's health system struggles with the growing burden of preventable disease, new analysis published today provides important insights into government research funding that is designed to help keep Australians healthy and out of hospitals.

The new examination of projects and grants issued through the Australian Government's Medical Research Future Fund (MRFF) is the first of its kind and has been published today in the Australian and New Zealand Journal of Public Health.

Researchers found that despite public health being a clear priority for the MRFF, many research projects classified as being about "public health" or "prevention" were more focused on clinical aspects, such as treatment and cure.

Paper co-author Hon. Associate Professor Leanne Coombe, from The University of Queensland, is also Manager of Policy and Advocacy at the Public Health Association of Australia. She says the findings demonstrate there is confusion around the definition of public health, and inadequate transparency when it comes to public health researchfunding in Australia.

"We have all heard the old adage that 'prevention' is better than 'cure'—and in public health research we are looking for ways to keep people healthy and stop people getting sick.

"We are also looking at what can be done to improve health at a population, rather than individual, level and to address the causes of health inequities between sub-groups within the population.

"So we examined research projects funded through key MRFF Initiatives related to public health, to uncover what type of research was being conducted and how much funding they were receiving.

"One of the most ironic and concerning findings related to project funding granted through the MRFF's specific 'Preventive and Public Health Research' Initiative. This Initiative is meant to focus on public health and over $238.8m in funding has been distributed under this banner since 2018.

"Counterintuitively, less than half of the research projects funded under this Initiative were actually public health-focused. This translates to less than 40c in every $1 spent in this Initiative truly going to public health and prevention.

"Even within those projects that were 'prevention' focused, there was little focus on primary prevention research—initiatives that stop Australians from getting sick in the first place, rather than early detection, treatment or slowing disease progression.

"To take the burden off the health system, we need to invest in genuine public health and prevention research," Associate Professor Coombe says.

Dr. Saman Khalatbari-Soltani from the University of Sydney School of Public Health says that a lack of public health and prevention focused research was also found in other MRFF Initiatives.

"The MRFF has 22 funded Initiatives. Overall, we found that only 57% of the 249 projects and around half of the funding granted through the six public health-related Initiatives included in the study were for genuine public health research.

"While the projects funded may still be very worthy and while there may be other public health projects funded through other Initiatives not analyzed in this study, it appears that prevention is taking a backseat to clinical research.

"In Australia today there are unfair and avoidable differences in health between different population groups, and this is one of our biggest public health challenges. To address this, funding needs to prioritize public health projects that target the root causes behind these inequities, such as our living conditions, our work, our social supports and so on."

Adjunct Professor Terry Slevin, CEO, Public Health Association of Australia, says a lack of genuine transparency around public health research in Australia is just part of the problem.

"Across the board, health prevention initiatives are grossly and outrageously underfunded, while treatment and clinical initiatives attract billions of dollars. For example, Australia has an 85-page National Health Prevention Strategy with virtually no funding attached to it.

"Everyone wants effective, accessible treatment for existing diseases. But the cost of treating them, particularly chronic diseases, is skyrocketing. If we do not boost investment in prevention, we will continue to suffer from, treat and pay for preventable chronic diseases for generations to come. Proper commitment to prevention research is a step in that direction.

"Australia has a Pharmaceutical Benefits Scheme and Advisory Committee that determines which proven medical treatments are funded by the government to make sure Australians can benefit from them. It's time Australia revisited how we fund public health research and programs, and created a similar model to ensure that proven, effective public health initiatives get the funds they need."