Voiceover:
Welcome to The Raw Nerve, the official podcast of MS Australia, a conversation space for all things multiple sclerosis. Join us for news and views on the latest research, treatments and advocacy efforts, as well as candid and informative interviews with our community, those living with MS and their families and carers, together with leading clinicians, researchers, and advocates.
Jeremy Henderson:
Hello, welcome to The Raw Nerve, I’m your host, Jeremy Henderson. Thank you for joining us for this 2025 Federal Election special episode. Naturally enough, our focus is on health and we’ll be asking some big questions. Why should health be a major focus in the 2025 election? Has health been front and centre in the first few weeks of the campaign? And what would it take to change that? And we’ll talk to our guests about what they see as their community’s election priorities and their role in pushing those to the fore.
Joining us today, we have three wonderful guests. Dr. Lesley Russell is adjunct associate professor at the Leader Centre for Health Policy, Economics and Data at the University of Sydney and she’s also contributing editor at Croakey. Lesley, welcome.
Lesley Russell:
Thank you. I’m happy to be here.
Jeremy Henderson:
Also with us today, the CEO of the Public Health Association of Australia, Terry Slevin. Terry is also the adjunct professor at the National Drug Research Institute at Curtin University, and adjunct professor at the College of Health and Medicine at the Australian National University. Terry, thank you for your time today.
Terry Slevin:
Good day, Jeremy.
Jeremy Henderson:
And, last but not least, in our third chair, Mr. Rohan Greenland, CEO of MS Australia, the occasional host of The Raw Nerve and chair of Neurological Alliance Australia. The alliance representing over seven million Australians living with a neurological condition. Welcome, Rohan.
Rohan Greenland:
Thank you, Jeremy.
Jeremy Henderson:
Let’s get straight into this and a question for the three of you. Why should healthcare be a top priority in the 2025 election? Lesley, let’s start with you.
Lesley Russell:
Well, healthcare is always a priority because it’s something that affects every single Australian. That’s one advantage of having Medicare that the least of us and the most well-to-do of us all have the same stake in Medicare. Also, although Medicare is a social welfare issue, it’s also an economic issue. We’re only a productive society if we’re a healthy society and so I’m one of those people that think that we should talk about healthcare as an investment, it’s not a impost on the budget. It’s something that a country does not just because everyone deserves healthcare but because it makes us a better country, a more productive country, and boosts our economy.
Jeremy Henderson:
Terry, I wonder if I could ask you for your take?
Terry Slevin:
I guess I’d firstly challenge the question Jeremy, and rather than talk about healthcare, I want to talk about health. And my distinction between those things, and I absolutely agree with what Lesley’s said, there is a fundamental importance for all societies to provide care to people who are sick. But I also think there’s a fundamental responsibility to try and keep people as healthy as we possibly can, and that’s where our interest lies and that is the efforts that we have in terms of resource allocation and policy that keeps people healthy in the first place. Yes, when we’re crook, we all want and deserve the best possible care to help us to get better, to respond to that disease, whether it’s an infectious disease, whether it’s an injury, whether it’s chronic diseases, that is the largest proportion of the burden of disease in this and many countries.
But rather, we also want to see a focus on trying to ensure we are as healthy as we can be. And I suppose it’s not that far back that we should go in thinking about the impact of the threat of the COVID-19 pandemic. Now, the truth is, Australia did relatively well compared to much of the world and that was in large part due to a couple of factors. One is that we’re an island nation much away from the rest of the world’s population. And the fact that we had closed borders and control the timing at which that virus came into our population through fairly strict measures, and then being able to access an effective vaccine so as to blunt the most nasty effects of that disease. But all of that is based on a proper public health infrastructure. And that means a capacity not only to control borders, but also to have internal measures that reduce the transmission of infectious disease, but also an infrastructure to disseminate an urgent level immunisation. In the same way we can and should build our capacity and preparedness for the next pandemic.
We also need to focus on the things that we can and should do to control the chronic diseases of which we know MS is one. And the risk factors that drive those diseases. Now, that’s often not so much necessarily in terms of the healthcare system at all. Rather it’s the policies, practices, the levers that society have to try and boost the extent to which we are a strong and healthy population In the first instance.
Jeremy Henderson:
Thank you, Terry, and I’ll ask all three of you about what you see as the major health issues facing this nation. But Rohan, maybe a question for you. What do we know of Australian’s appetite generally for prioritising health at election time?
Rohan Greenland:
Well health consistently rates in the top issues, doesn’t matter which election you want to point at, health is always at or near the top. I remember when I started working for the Federal Health Minister, I was very quickly told that the Prime Minister got the most amount of mail through their front door. But very closely on the hills of the volume of messages and emails and letters was the health minister’s in tray. And that just reflects the importance that people place and feel in the health space. And I agree with Terry. I think you have to take a very broad approach to health. It’s not just the delivery of frontline services. It’s also very indirect things. It’s like the regulation of our food industry. It’s the obesogenic environments we live in that need attention to. So it’s a very holistic approach we need to take to health.
Jeremy Henderson:
Thank you, Rohan. Lesley, I wonder if I can ask you, so we’re about 18 days into the election campaign. What have we seen from the major parties that give us any indication about their prioritisation of health issues?
Lesley Russell:
Look, I have to say I’m fairly cynical about what we’ve seen. And in part it builds on what both Terry and Rohan have said, that what we are seeing are quick fixes. They’re really band-aids in a way. They’re substitutes for the really hard work of reform and restructure that needs to be done. And we see it because politicians want to be able to say, here is what I’ve done for health. And it’s much easier to present someone with an urgent care clinic, which may well be needed, and which I must say for the most part, despite what the AMAs and the RACGP says, this is an extremely popular gift to the public.
That’s a lot harder sell than to say, here is a program that’s going to keep you healthy and you won’t get a disease. So there’s a lot of money being spent. I think a lot of people who will benefit and hopefully those are the people who need to benefit. But I think it that’s money and effort that will not be available to do the sorts of things that have been recommended in a series of reports and reforms and recommendations that is now well in, goes back to the Gillard days and is a pile that must be as tall as I am in the basement of the Department of Health somewhere.
Jeremy Henderson:
Terry, how do we address that problem that politicians put forward short term fixes when what we need is long-term solutions?
Terry Slevin:
Jeremy, if I had the answer to that, I would’ve been able to retire 20 years ago.
Lesley Russell:
We all would’ve been out of business by now.
Terry Slevin:
Yes, that’s right. Listen, the reality is, and Lesley‘s right, there has been a lot of money thrown at health in this election that reflects the extent to which politicians understand and accept that health is important to people and the way they respond is largely in short term measures. We’ve had a look at the election commitments that are being made in health in the lead up to the 3rd of May election, and we calculate something like $16.9 billion has been committed. Now, that’s, many of them are over forward estimates not a single year. So it’s important not to over interpret the comparison, but in the context of Commonwealth spending roughly $100 billion a year in health. Australia spends about $250 billion a year from all source of state territory, private insurance, and the Commonwealth. So 16.9 billion commitments in this election shows that political parties want to ensure that people perceive they’re doing something about health.
Lesley Russell:
Well, and actually Terry, if I could interrupt, I think you’ve made the very good distinction, which I 100% agree with, between health and healthcare and what we are talking about here is healthcare.
Terry Slevin:
Yes, that’s right, Lesley. And I was going to list some of those and the big ticket items. We know GP, bulk billing and additional funding for public hospitals and then announcements about urgent care clinics, training for GPs, nurses and midwives, additional subsidy for pharmaceuticals, $780 million in capital expenditure across a number of jurisdictions for more hospitals and the like, and a $1 billion for more free mental health services. So pretty much all of those commitments are about treating people who are crook. No one questions the importance of treating people who are crook, but what’s clearly absent from the equation is any kind of meaningful commitment with regard to the future. Looking over the hill to the immediate problem and looking at what we can do in relation to making Australians healthier. And what we’ve done, the one exception to that, that’s worth acknowledging is that the ALP has committed to establishing Australia Centre for Disease Control and they’ve committed $251.7 billion over the forward estimates with another $73 million. Did I say billion? I said $251.7 million.
Lesley Russell:
Million. Yes.
Terry Slevin:
Better get that right. And another, about $73 million annually into the future because clearly an investment of a Centre for Disease Control is very much a long-term commitment. And we’ve only recently discovered the coalition has now formally come out and made clear they will not support the establishment of a Centre for Disease Control. So we’ve only just had that in writing over the last couple of days. Now, other than that, there is no financial commitment and no policy commitment that we are aware of with regard to tackling some of the challenges. And Rohan mentioned one of them is obesity and enormously a complex challenge that we must tackle because it’s one of the major drivers of range of chronic diseases. And Rohan always points out that includes MS. But, you know, cardiovascular disease, cancers, diabetes, and much, much more. So that’s just one example.
To their credit, and it’s worth acknowledging the current Albanese government has made genuine commitments and made genuine policy change and investment in areas like tobacco and vaping. They’ve introduced and funded a lung cancer screening program and they’ve boosted some of the other existing screening programs and you know, we’ve got to be fair and account for what has been committed. Other than those, the pool’s pretty shallow when it comes to longer term commitments with regard to public health in Australia. And what we are looking to do is try and challenge politicians and political parties to think over the hill. Now we know that they know this, we know that the evidence is as clear to them as it is to the rest of us. The challenge is to see our political classes and governments see beyond the immediate and invest in the intellectual commitment of a healthier population into the future because they’re stopping bad things from happening.
And the illustration I point to is when we look at the pandemic. You can go in any room of 30, 50, 100, 2000 people and ask people to put their hand up if they had the COVID-19 vaccine. Then you can ask them to put their hand up if they think their life was saved as a result of the actions that controlled the pandemic. Nobody puts their hand up. Nobody believes they took an individual or personal benefit out of the preventive efforts that were made, and some are cranky that they underwent the vaccine under a level of duress. So there’s often the case that there is a perceived dis-benefit for public health initiatives and programs and policies. Few people understand the extent to which they might, they or their family might have individually benefited. And selling that concept, selling that individual benefit, has been the conundrum that’s dogged my 40 years in public health.
Lesley Russell:
Right. And a conundrum that’s now been made so much worse thanks to Trump and his ilk who have really undermined expertise and undermined the idea that sort of sits behind public health, which is that we all contribute, that we all have to contribute to it. That’s how vaccines work. You get 95% of the population vaccinated and the very, very few who can’t be vaccinated are protected. But Trump and Kennedy and aided and embedded by how easily it is to transmit information, disinformation, misinformation on social media have really undermined a lot of the work that Terry and the public health associations try so hard to do. And I don’t know how we get round that.
Terry Slevin:
Well, I can tell you that my opposite number in the US is in the process of suing the Trump government. But if we go down the Trump line, we’ll spend the rest of the conversation talking about USA.
Lesley Russell:
Yes.
Rohan Greenland:
There’s a couple of things I want to say and one is public health doesn’t have to be expensive, and in fact, there’s two measures that I’m supporting and encouraging the major parties to adopt. One puts money into government coffers and the other won’t cost a single cent on the forward estimates. And one is in terms of overweight and obesity, something that’s incredibly popular and is a health levy on sugary drinks. It’s got substantial evidence behind it. We know it’s popular and I rack my brains why governments, successive governments, have failed to implement it. It’s done widely overseas, introduced by conservative government in the UK. is a fantastic concept. And it’s gone nowhere in this country to date. The second thing I’ll mention too is investment in medical research. We have not heard the term medical research in this election at all, unless I’ve missed it, but I don’t think I have.
And we’ve been calling for investment in MS and neurological research. We want to see a neurological mission under the Medical Research Future fund. The Medical Research Future fund is grossly underspent. It’s off the forward estimate, so it’s no impact on government budgets. Each year the guardians of the fund write to the government, tell them how much money they can spend. That’s after they take into account costs, preserving the corpus, the fund that’s already there, it’s overcapitalised. It’s well beyond, it’s $20 billion. I think it’s up to around $23 billion. The guardians write to the government every year and to tell them how much they can spend on research. This year it’s over $1.2 billion available for spending. They’re just going to spend $650 million at most. So that’s half a billion dollars a year that is underspent on research.
And that’s underspent on Hope. It’s underspent on the missions for cures. Underspent on quality of life. And I cannot fathom why they’re not spending more on desperately needed medical research. But Lesley knows a lot about this. We should ask her for her views too.
Lesley Russell:
Yes. Well, the short answer is I have no idea why they’re not spending that money. There’s $3 billion sitting there at a time when Australia is losing. We’re not sure exactly how much, but of the order of $400 million of US funds from not just NIH, but funds that go to marine science and animal science and those sorts of things. And one of the things that was a critique of the work that, the MRFF has had some reviews done. And one of the critiques is that it focuses a lot on illnesses that kill people, not illnesses that have a large element of disability associated with them. And I think we might put, I was going to say, I think we might put MS in that category. So cancer and cardiovascular disease get totally hit gets lots of money and things like arthritis and MS and things that have a huge burden of disability, but not mortality don’t.
So some of that I think goes to how the priorities are set. But regardless of how those priorities are set, it is the minister who has the final say in terms of what the money is spent on. Theoretically, there’s supposed to be a route into the MRFF for consumer voices, and I just think they get drowned out by research scientists who have spent years learning how to work the system, in part because the system is so bloody hard to work. So they’re masters at working the system and getting what they want, which may not be what is needed even. It’s very hard to criticise money that’s spent on research because I started out my life as a lab bench research scientist, so I know that one of the things that really works in research is what’s called serendipity, which is that you never know where the next miraculous finding is going to come from. And it probably isn’t going to come from targeted directed research. It’s going to come from some sort of blue sky funding.
Jeremy Henderson:
So talking about miraculous, that might be a nice segue into this next question. So, and maybe a question both Lesley, for you, in terms of your association with Croakey the Health Blog, and also you Rohan, as a former journal, but what do we think it would take to push health to the forefront of the federal election news cycle and what responsibility do we think the Australian media have to ensure that health coverage is in the mix?
Lesley Russell:
You go first, Rohan.
Rohan Greenland:
Well, I think health is at the top of the tree. We were seeing Medicare cards waved around all the time and billions of dollars in commitments being made. But again, public health is not there. Medical research is not there. And from my perspective too, we’re not seeing anything in the neurological space in, we don’t even properly count neurological disease in Australia. There’s no national neurological data set. We’d like to see a commitment to fully fund the development of a neurological data set. Because we simply don’t count it fully. so we don’t actually know how many people have neurological disease in Australia. We calculated around $7 million. but you know, it’s some very basic things need to be put into train. You know, we’ve signed up to the WHOs new global action plan for neurological conditions, but there’s no national action plan.
So, I think to make politicians listen, honestly, we’ve got to make more noise. It’s the squeaky wheel that often gets the oil and I think, we have been behind the eight-ball in the neurological space more generally because we are, have been, there’s 600 different neurological conditions. We haven’t really had a very strong collective voice before, but we’re hoping to change all that with the work of the Neurological Alliance.
Lesley Russell:
Well, you’re certainly right that you need to have a voice and you need to be speaking endlessly, endlessly the timeframes along. And it’s always, I mean, look at how long it took to get the NDIS. Look at how long it took to get Obamacare for that matter. There are a couple of things that I think are not on the table that perhaps people, the voters don’t articulate very well, but are really at the heart of what they care about. They do care about access. Can I get to a GP? Can I get to a hospital when I need it? Okay. Some of that is being tackled. The other thing that goes on, particularly for people with chronic illnesses and people who are older and frailer, is the fragmentation of care and how difficult it is if you need to see more than just your GP, to get all that care, to line it all up. Sometimes it’s just a matter of transportation and parking, but other times it’s just the way the medical system itself is set up.
The other thing that I think that’s the always the unresolved issue is what is the relationship between public and private and how much value are we getting out of that 8 billion or more dollars that we spend on the private health insurance rebate? Particularly at a time when we’re now seeing that one of the main reasons why families take out private health insurance is so that women who are going to give birth can apparently have their choice of doctor, and now we’re seeing the private maternity sector go down the drain. So people who’ve been paying private health insurance are going to have to rely on the public hospitals, which is yet another drain on the public hospitals. So, I’m throwing up a number of issues that definitely fall into the if not too hard, the very hard basket and require some thought.
But you could start small with doing things like addressing fragmentation. You could start small with doing things like having more community health centres, more ways of delivering primary care that looks like the Aboriginal Health Services, where you get as much healthcare in the primary care sector as, maybe not as, as absolutely needed, but a lot more than you get with just the visit to a GP.
Terry Slevin:
I might jump in if I can, Lesley.
Lesley Russell:
Yes.
Terry Slevin:
And offer a couple of observations and one is I’m not so sure we should give away and I’m also not so sure we should think small. Two observations at a jurisdictional level recently that shows we can and will, I think, make progress. In Western Australia they commissioned a sustainable health review in 2018, and they reported in 2019. It was chaired by Robin Crook who all said, shared the covid response inquiry recommendation from that Sustainable Health Review for Western Australia. The first recommendation was to increase the investment in public and preventive health to 5% of health expenditure in Western Australia by 2029. We’ve since pursued the western Australian government and since then it’s been labor governments. And in the last two Western Australian elections, each premier at the time wrote to us and recommitted to that target.
Now, most recently, the week before the Western Australian election in March of this year, Premier Court wrote saying they would continue to pursue that objective. So I had a chance to point out to the premier that he has three budgets to get there, and that all of a sudden has focused their attention on defining what is in the public and preventive health basket and what’s not. And so there’s a lot of work going on with a fair amount of haste in Western Australia to address that specific question because they know we will keep them to account. The other development has been in South Australia with the establishment of the Preventive Health Agency in that state. Passed through the upper house in December of last year. There’s actually a very clear and simple piece of legislation that gives genuine levers to senior levels of the South Australian government to prosecute preventative health efforts in that jurisdiction.
The third observation I’ll make is while I accept, and public health has always been a case of relentless incrementalism. We make lots of small steps forward and they’ve been important. Tobacco control’s been a great example. But I actually think there’s a systemic challenge. And the systemic challenge is we don’t have a system by which we properly assess and fund public and preventive health efforts. So if we look at the PBS, the Pharmaceutical Benefits Scheme has a Pharmaceutical Benefits Advisory Committee. PBAC is the gatekeeper for drugs going into the funding pipeline of the PBS. And it is an uncapped pipeline. We have the medical benefits scheme and the medical benefits advisory committee has a similar role for that program, which again is uncapped and determines what medical services will be funded by the Commonwealth Dollar. We need a public health benefits scheme that captures those programs that are proven effective and cost-effective to advance the health of Australians. And we need, similarly, an expert gatekeeper committee that determines the criteria by which programs will or won’t be admitted into that funding stream.
And once they are, they are ongoing. Long gone should be the days of programs where we have effective initiatives to help improve people’s eating, improve their physical activity, reduce their alcohol consumption, and there’s been many programs that have proven effective on that front, but many have gone by the wayside because of the short term funding cycle. So, on a systemic level, we need to think big and change the system, change the system in a manner that ensures that the drivers of in ill health are tackled. And the programs that are effective in tackling those drivers are embedded into our health system so as to generate benefits for the current and future generations to build a much healthier Australia. So there’s three notions for you to wrestle with.
Jeremy Henderson:
Thank you, Terry. So look, I think we’ve touched upon a lot of gaps, a lot of challenges, some failings, some head scratches. Maybe to just to bring it all home on a positive note, I wonder if you’re prepared to give me your election predictions. What are we going to see at this election?
Terry Slevin:
Well, Jeremy, I was predicting a Labor win in 2019, so I’m 100% with a crap record and stop making predictions as a result. So I’ve got no idea. So I’ll let Rohan hang himself out to dry on that one.
Rohan Greenland:
Well honestly you know, most of the pundits are suggesting that Labor are ahead in the polls at this stage and may scrape over the line in their own right. I just hope people who are elected are elected on the basis that, and the great British Prime Minister said the first duty of a minister is, Benjamin Israeli back in 1872, said, the first duty of a minister is the health of the people. And I want to see people elected who are committed to the health of the people.
Lesley Russell:
And I think the Australian election is going to turn on exactly the same thing that the US election turned on, which is people’s hip pocket issues. That’s what’s really driving them. Health is one of those, but it’s certainly not the only one. We’ve still got what, two more weeks to go? Lots can happen between now and then, but I think that’s how they’re going to vote in terms of who’s going to deliver the maximum for me and my family. I suspect that we’ll have a minority government with a good slab of independence, and I think that will be a very good, if it’s a Labor teal independence, minority government, I see the possibility of some good work being done out of that. I certainly recall that when Julia Gillard had a minority government, it was Anthony Albanese who did the all the hard work of corralling up the votes that she needed on everything.
And she passed, I’ve forgotten how many pieces of legislation, but well ahead of pretty much anybody else. But I do think we need a bit of bravery and a bit of vision. And I think to be honest, that’s what the population would like. And are we going to get that or not? Question mark?
Terry Slevin:
Yes. And I guess I’ll weigh in and I’ll probably, if there is a prediction to be made lean more heavily in the direction that Lesley‘s articulated, I suspect it will be a minority government. And if that’s the case, I think there are some genuinely progressive views in what will probably the majority of the cross bench in the lower house. And of course we’ve always got the chunk complexities of the Senate. But I’m optimistic that there will be a government that takes an interest in health and I hope public health and some of the drivers of that. One of the things we haven’t talked about is a broader kind of social determinants of health, and I think a really practical rubber hits the road issue.
Lesley Russell:
Except that at least these days, politicians actually are willing to talk about social determinants of health because I’m old enough to remember when, that was a term you didn’t dare bring up.
Terry Slevin:
Sure.
Lesley Russell:
So at least they’re talking about it.
Terry Slevin:
Yes. But the extent to which they then have an understanding of what they can do to support those things is a different challenge. And I think there’s a really tangible example, and that is the extent to which Australians are the biggest losers in the world from gambling. And there’s clear pressure and I think genuine support on both sides of the house at the moment as reflected by the the Murphy Report for reforms and the extent to which Australians are losing close to $32 billion a year. Australians gamble about $244 billion a year, and if you reflect on my earlier quote, about 250 billion spent on health, it’s a pretty eye watering number. But I think there is a sufficient of an understanding that that is an important consideration. And I’m optimistic that things like the blocks that we’ve seen in taking up some of the recommendations of the Murphy report to back off on those losses, which is a far bigger driver of cost of living can pressures in many Australian households will get some attention and we’ll get some attention to tackling some of those.
What now we refer to as commercial determinants of health influences the influences of the junk food manufacturers, the influence of the alcohol industry and others who continue to profit from the kind of excesses that are driving chronic disease. So I’m optimistic that if we do have a genuine minority government with influence of a cross bench, that cross bench can negotiate some better policy outcomes perhaps in the public domain with a government kicking and screaming. But I can tell you with some confidence behind the scenes, there are many members of both the government and opposition at the moment who would like to see their parties more responsible in some of those policy areas. But they’ve been conscious of the extent to which their parties has been overly captured by those very big commercial interests. So I guess, you know, if you stay in public health for 40 years, you’ve got to be, by definition an optimist, remain an optimist and else keep on having a crack at getting worthwhile policies over the line. And so from that point of view I’m hoping that we still have some worthwhile work to do after the 3rd of May.
Lesley Russell:
I have one more, much more prosaic thing that I often talk about in terms of how we need to integrate social determinants of health into our healthcare system and that is you get all these kids who show up at the ED with acute asthma attacks. You send them back to homes where people smoke, where there’s mould, where there’s air pollution from nearby highways, and you know for sure that if you don’t do something about that, that kid is going to be back in the ED pretty quickly, multiple times. What we need is something in the system that addresses that issue so that the issue that’s seen in a clinical setting can be addressed in a social setting.
And unlike the NHS and unlike even Medicaid in the United States, we don’t have a healthcare system that talks to our social welfare system. And that would also go Rohan to people with disabilities who need a lot of medical care, but they need a lot of other sorts of care that’s not delivered in a clinical setting. So that would be, that’s not quite what you are talking about, Terry, but it covers the same sorts of issues, really.
Jeremy Henderson:
Thank you, Lesley. Some big challenges, but also some big opportunities ahead. We’ll have to wait until at least the 3rd of May to see whether our panel’s election predictions come true. For now, I’d like to thank our three guests, Dr. Lesley Russell, Terry Slevin, and Rohan Greenland. Thank you all for sharing your expertise, your insights, and your advocacy asks with us ahead of the federal election. And to our listeners, thank you for joining us on the Raw Nerve.
Voiceover:
Thanks for listening to the Raw Nerve, the official podcast of MS Australia. To hear more, subscribe to our podcast today at msaustralia.org.au/podcast.
