Australia is very pleased to host this, the 18th conference convened by the International Union for Health Promotion and Health Education. Health 2004 has deservedly attracted leaders from the community, academia and government from around the world. Our own Minister for Heath and Ageing, Tony Abbott, was unable to be here due to ANZAC Day commitment, so I am pleased to take his place in opening this conference.

Tonight we are being treated to inspiration, creativity and laughter - which as we all know, is the best medicine! - before the start of the scientific program tomorrow.
Disease does not recognise nations, borders or races; human frailty is, ultimately, the single thing that binds all of us together in the world.

But as the challenges for health administrators have become more global and more complex, we have also learned to share our knowledge and experiences, to create better outcomes for all the people we represent.

Nowhere is this more true than in the area of health promotion and prevention.
The global response to the Severe Acute Respiratory Syndrome showed the vital importance of international cooperation, communication, and sharing in combating new threats which can affect us all.

Each nation has its own problems and priorities - but we can face them more effectively, if we face them together - as we are at this conference.

Compared with many countries, including the industrially advanced societies, Australia has a strong commitment from government to health promotion, and an enviable record. Australia's life expectancy in 2002 was 80.4 years - 5th highest in the world and 7 years higher than it was 25 years ago.

This is largely the result of our success in reducing deaths from heart disease, stroke and motor vehicle accidents - all targeted by prevention programs.

The Australian Government's first major preventative health promotion campaign was launched in May 1979 - 25 years ago.

"Help Yourself" cost half a million dollars back then, and urged people to lose weight, eat good food, exercise, quit smoking, drink in moderation, and reduce stress.

Ralph Hunt, then Health Minister, commented: "I have become more and more convinced that the concentration on traditional curative medicine, with its associated high costs for both the Government and the individual, can add little to improving the nation's health status. I believe that can only be achieved by motivating individuals to take a responsible attitude for their own personal health care."

Well said - but unfortunately in 2004 the same messages - and new ones - are still needed in Australia, and around the world.

Too many deaths are still due to preventable causes. Despite higher levels of affluence and education, Australians continue to make lifestyle choices which threaten their health.

New problems have arisen - in particular, obesity and overweight.

The number of markedly overweight older Australians trebled between 1980 and 2000, to 940,000. A 1999-2000 study indicated that 60 per cent of all adult Australians were overweight, including two million who were obese.

Our concern is not about image, but about health, which is why I was chosen to Chair Australia's obesity taskforce in late 2002.

Obesity has implications for Type 2 diabetes, cardiovascular disease, high blood pressure, certain cancers, sleep apnoea, osteoarthritis, and psychological and social problems.

And it is not just the elderly. Obesity among children doubled in 12 years from 1985 to 1997, with warnings of an epidemic to come.

The word 'epidemic' is not inappropriate. While public attention focuses on exotic potential threats such as SARS and Avian flu - which are frightening - the threat to the nation's health, and to the federal health budget, from obesity and related disorders is with us now.

Much of medicine in developed countries has been caught up with high technology, high cost solutions which can at times create "medical miracles".

At the same time, public expectations have risen that if they are sick, they can be cured. In Australia, thanks to the Medicare system which provides universal subsidies for primary care, public hospital treatment and eligible medicines, even disadvantaged individuals CAN access top quality treatment.

Unfortunately, an unintended consequence of this may be that Australians - like other relatively wealthy nations - have become a bit blasé about maintaining their health - or just too pressured by other factors, such as meeting the mortgage, to worry about it enough.
Centuries ago, just about every type of affliction - including pregnancy in some cases - was blamed on evil signs, curses, witches and warlocks. Now, we are blaming many problems on just "bad luck" when all too often they are rooted in bad health management.

There are always reasons why people adopt unhealthy lifestyles, or fail to take screening tests which could warn them of problems before they become dangerous . They include ignorance, lack of alternatives, a misguided attempt to save money, the desire to be "cool" - or because they're easy.

But the cost to individuals, to their families and to the community can be very high. Aggregated at a national level, these costs are massive.

Take, for example, unsafe driving practices. World Health Day this year highlighted the cost of road injuries. Again, this is not just an issue for developing countries. In Australia, although our safety per kilometres travelled ranks high in world terms, the vast distances in country areas, and high dependence on motor transport mean a continuing heavy toll on the roads.

The overall cost of road trauma in Australia has recently been estimated at around $15 billion a year. The spotlight is always on the fatalities - every year around 1,600 people die on Australian roads, most of them young people and in particular young men.

But far more - about 22,000 - Australians are seriously injured each year on the roads. These people end up in hospital, in rehabilitation, and often with permanent disabilities, and the cost that they impose on the health system is often overlooked.

Some road accidents are caused by "acts of god", such as stray kangaroos - but many are due to human error which may have been avoided.

Everyone can see a broken leg, or a ruined face. Other effects of lifestyle and risk factors are more subtle. They start even before we are born - through the choices of the mother and the father - and may not show their effects until our later years.

Some risky lifestyle choices have become matters for the law - in the US, mothers have been prosecuted for smoking or taking drugs while pregnant. It would be convenient if we could force people to look after their health in other ways - but seriously I don't think we are ready for a law against being lazy or overweight!

Without compulsion, health administrators can only encourage people to do the right thing for themselves and their children, and in this, all levels of government, the community, the private sector, and of course - families and individuals - have a role to play.

The Department of Health and Ageing, of which I am the secretary, provides strategic leadership for these programs - and our focus on prevention and health promotion is stronger than ever.

More than one in every five dollars spent by the Australian Government currently goes through my department. The health sector as a whole accounts for about 9 percent of Australia's Gross Domestic Product - less than in some developed nations, but nonetheless a record high, and rising steadily.

This amount could expand exponentially if all consumer demand for medical services was met, especially given the ageing population. My department, working within the guidelines set by the Government, has to find ways of keeping our health system both healthy, and affordable.

A recent ground breaking study by the department showed that prevention of health problems, through promotion and education campaigns, IS a cost effective and efficient way to do that. The report analysed the economic and financial returns from public health programs in Australia over the past 30 years, considering five areas - smoking, heart disease, HIV/AIDS, immunisation, and road trauma.

It estimated that the cost to government of public campaigns on these issues had been $8.4 billion - a very large outlay; but the health and social benefits totalled more than $30.5 billion, nearly four times as much.

All programs led to significant health gains, and some showed exceptionally high returns. The HIV/AIDS program was estimated to have prevented nearly 7000 new infections, and measles vaccination saved $155 for every $1 invested.

The campaigns on coronary heart disease, parts of the HIV/AIDS program and the road trauma programs all cost the Government more than they avoided in treatment costs - but the report found all were justified by the significant health benefits to the community.

The report validated the Australian Government's investment in public health programs. Prevention is now recognised as a fundamental pillar of our health system - one of the world's best and most accessible - together with curative, rehabilitative and palliative care.

Of course, it is relatively easy to get a sick person to go to a doctor or a hospital. It can be harder to get people to pay attention, before they are sick - or know it. But health promotion, education, and preventative programs are not very effective unless the people to which they are directed - whether they are single people, families, older people, or young people - take up their messages.

As advertising companies know, it helps to have a catchy slogan - so on a lighter note, I thought I would suggest a slogan that sums up health promotion and disease prevention for the lay person.

The aim of all that we do in these programs, is to give people the tools to look after themselves better.

So my slogan is:
"Self health".
That's S_E_L_F.

Not self HELP - although that is part of it - because it would be about taking control before you NEED help. Prevention, not just cure.

And not "SHELF health" either - which all too often, in consumer societies, has become the expectation. That you can go to a supermarket shelf, pharmacy or a doctor and buy something to "make it better".

We are blessed today with a vast array of pills, potions, and procedures to make us feel better. But the truth is, they do not always work - and without any doubt, prevention is better, cheaper, more effective and a LOT less painful, than cure.

In sharing our knowledge and ideas, I hope we can make it easier for people and families in all of our nations to achieve good "self health".

And to maintain it.

Thank you.