Breast cancer has received a great deal of publicity of late. The federal government's considerable funding allocations to the disease in the last budget were touted as marking both its recognition of the importance of the disease as a public health problem, and a sign of its commitment to women's issues. Yet the moves have been criticised and raise questions more generally about the allocation of public funds in dealing with health problems. KATH GELBER discusses the issues. On page 13, another report describes research findings on causes of breast cancer.
In the budget, the Labor government allocated $236.6 million over the next five years to continue and expand a screening program to assist in early detection of the disease. This includes $16.4 million over the next four years to set up the National Breast Cancer Centre to oversee research and development of clinical trials.
$3 million will be provided over three years to set up the Breast Cancer Foundation to raise money privately for breast cancer research. The foundation's patron is Annita Keating. A further $3 million will be provided to match anticipated donations of private funds.
The budget proposals provide no specific extra funding for medical research per se into breast cancer. The National Health and Medical Research Council (NHMRC), whose job it is to allocate funds for and organise research, is to be allocated a total of $95 million, which represents an allocation of $49 million above the restoration of its base funding, otherwise due to lapse at the end of 1994.
Breast cancer is clearly a huge public health issue. Since 1977 the incidence of breast cancer in Australia has increased 25%. One in 13 women will develop breast cancer during their lifetime, and six women die every day from the disease. Deaths from breast cancer are reduced by 30% if women aged between 50 and 69 have mammography every two years.
Such statistics have led to calls for better funding and higher research priorities to be devoted to breast cancer. However, criticisms have been made of the budget initiatives.
For a start, the allocation in the health budget was made possible by cutting other areas in the portfolio. That is, the size of the cake wasn't increased, the cake was merely sliced up differently. Areas that suffered were less politically sensitive than breast cancer.
Cuts to the health budget included a halving of the "waiting list strategy". Before the federal election, the promise was made that $100 million would be spent over four years to reduce public hospital waiting lists. This money remains unspent because it relied on the private hospital system's willingness to make public beds available. Not surprisingly, the offer hasn't been taken up. As a result, the money is now being diverted elsewhere.
The Pharmaceutical Benefits Scheme has been tightened up so that doctors will require authorisation from the Health Insurance Commission to prescribe some new and specialised drugs, such as anti-cancer drugs or powerful antibiotics, or drugs which cost more than $30. This move is expected to save $5.6 million in its first year.
In a more openly inequitable arrangement, the supply of free or concessional medicines is to be restricted to Australian residents, a measure which is expected to save the government $1 million a year.
Criticism of the funding allocation has come from other sources as well. Instead of high profile tactics such as the Annita Keating foundation, some members of the medical profession have called for higher across the board research funding.
The chairman of the medical research committee of the NHMRC, Professor Judith Whitworth, questioned the government's decision to establish a separate breast cancer foundation. Recognised structures already exist within the NHMRC to allocate research funding, and breast cancer has been an NHMRC priority for the past two years. Health minister Carmen Lawrence has also said she will write to the NHMRC, stating that the government would expect a substantial increase in research funding specifically for breast cancer.
Professor Sutherland, from the team studying breast cancer at the Garvan Institute of Medical Research at St Vincent's Hospital in Sydney, stated he believed funding for all medical research should be significantly increased, rather than the government setting aside research funds for specific cancers.
He added that he considered the whole of medical research in Australia to be under-funded.
Dr Brendan Nelson, president of the Australian Medical Association, criticised the fact that "not one cent is going to be spent on maintaining the infrastructure of our public hospitals". He added that the budget allocation "is still far below the government's pre-election promise to raise the level of medical research in Australia to 2% of our health spending".
Meanwhile the shadow minister for health, Bronwyn Bishop, has bought into the funding debate by directly counterposing funding for different health problems. She earned the wrath of the Australian Federation of AIDS Organisations by criticising the funding levels for AIDS research on the grounds that many more women die of breast cancer than of AIDS.
This enabled Carmen Lawrence to argue against pitting one disease against another for funding. While Bishop pulls her head back in, the ALP has been able to shirk the fact that its latest budget did exactly what Lawrence accuses Bishop of doing: high profile funding for breast cancer has been implemented at the cost of other items in the health budget.
Other factors which have been left entirely out of the debate include the need combat diseases such as cancer at the source — that is, to control the ever increasing presence of highly toxic chemicals and pollutants in our atmosphere, food and water.
Breast cancer will not be overcome by making it a political football. Funding research, detection and treatment at the expense of other health and environmental priorities means that the government is implementing very costly band-aid measures. Combating breast cancer requires more than that.