This report highlights some of the major public health success stories made in Australia in the past two decades, and the dramatic impact they have had on our health and wellbeing.

The public health measures showcased in this report have prevented an extraordinary amount of ill health and death in our communities.

The report acknowledges great decisions made by past political leaders – and gives powerful reasons for current and future leaders to make similar choices.

Had these actions not been taken, Australian society would have suffered dramatically increased ill health on many fronts, including in many cases a heightened rate of early and needless death.

Financially, our health system would have been overwhelmed by far greater costs, as well as significantly reduced public revenue.

This highlights that public health measures, which are often inexpensive to implement, more than pay for themselves.

Currently amounting to less than 2% of national health expenditure, public health investments are among
our most efficient health buys. They save expenditure through avoided sickness, hospitalisation and lost working productivity. Resourcing public health measures generally saves far more than it costs.

New resourcing of public health initiatives is essential if we are to reduce future national health expenditure (or even merely stem current rates of increase).

Public health is also about equity, and is concerned with achieving fair health and wellbeing for everyone, not just those with better resources.

Scope of this report

This report examines decisions taken or implemented during the past two decades, broadly covering the period 1997 to 2017.

The subject matter of the report covers the fields of tobacco regulation, cancer prevention and screening, immunisation and the spread of diseases, road safety, oral health care, gun safety and many others.

The report is largely concerned with preventive measures – public health programs and policies which forestalled illness from even occurring.

In some cases – such as immunisation and oral care– treatment services to individuals are integral to the measures taken. But this report is largely not concerned with health services that treat illnesses per se – activity which of course takes up a very large part of our health system.

The report focuses largely on decisions made at the Australian government level, but recognises that more detailed decisions and implementation at the state/ territory level were also essential. State and territory governments have often been crucial partners in national health objectives, and in most cases state and territory health services are the program deliverers or direct service providers of national initiatives.

Initiatives in areas of primarily state and territory responsibility (such as road safety and gun safety) which saw significant federal support or coordination are also recognised.

All of these achievements have proven vitally important to public health and so they are not presented in any particular order or hierarchy in this report.

Who made things happen?

Public health programs, policies, initiatives and key decisions are not made overnight. Usually there has been a large group of people doing work on the area over a number of years: researchers, advocates, clinicians, public officials and politicians.

All the matters covered in this report were the result
of painstaking research and sound science, policy development, advocacy and ongoing implementation by thousands of people and many organisations.

Often these efforts cross over multiple sectors of knowledge and expertise. As this is a summary report, the rich history of such efforts cannot be included here in all the detail which they deserve.

The efforts of all of these people must be acknowledged. However, this document specifically acknowledges the peak decision makers – ministers and other politicians – who chose to fund, legislate and implement the public health measures.

These decision makers come from all sides of politics, reflecting the importance of health that all politicians recognise. During the 20 years covered in this report, the Coalition formed the national government for 14 years, and Labor for 6 years.

Most measures had support across the political divide. At state and territory level Labor and Coalition governments alternated in periods of office.

For some (but by no means all) of these measures, there was opposition at the time they came onto the public agenda. Gun law reform is a good example. Yet many of these changes have since become so accepted as a routine health policy that their reversal would be unthinkable.

History has shown that governments and individual ministers were always politically rewarded for their decisions.