In uncertain times for public health and prevention, what lessons can be drawn from the history of the short-lived Australian National Preventive Health Agency?
Croakey editor and journalist Jason Staines investigates.
Jason Staines writes:
The Australian National Preventive Health Agency (ANPHA) was barely three years old when the Abbott Government announced its demise in the “horror 2014 budget”, together with the end of a raft of other health initiatives and agencies, including Health Workforce Australia.
ANPHA was established in 2011 to strengthen Australia’s preventive health infrastructure, with responsibilities including providing evidence-based advice to health ministers, developing evidence and data, establishing national guidelines and standards, and supporting preventive health activity.
It was a recommendation of the National Preventative Health Taskforce, which in 2008 – 18 years ago – described such an agency as “long overdue”.
ANPHA’s 2012-13 annual report described its mission: “To be the catalyst for strategic partnerships, including the provision of technical advice and assistance to all levels of government and in all sectors, to promote health and reduce health risk and inequalities.”
Its first State of Preventive Health report, published in 2013, provided a national overview of chronic disease risks, including obesity and physical inactivity, tobacco use and harmful alcohol consumption.
The 2014–15 Budget provided no funding for ANPHA beyond June 2014 and forecast savings of $6.4 million over five years from its closure. The Government moved ANPHA’s functions and staff into the Department of Health even before legislation to abolish the agency had completed its passage through Parliament. That legislation ultimately failed in the Senate in November 2014.
At a University of Sydney seminar in 2014 examining the legacy of ANPHA – billed as “a wake for preventive health” – public health expert Professor Stephen Leeder described its abolition as “a pretty dumb thing to do”.
ANPHA, he wrote at the time, had offered the prospect of a national “counterweight to the big-time, burly avarice that drives health-destroying profiteering”.
The Consumers Health Forum of Australia told a Senate inquiry into the agency’s closure that: “The minimal savings the Government will realise from the abolition of ANPHA will be dwarfed by the rise of presentations of otherwise preventable chronic illnesses to the health care system.”
Professor Rob Moodie, who chaired the Federal Government’s National Preventative Health Taskforce, and is also a former CEO of VicHealth, believes the consequences of ANPHA’s closure went well beyond the disappearance of an organisational chart.
“We lost lots of expertise, coordination, institutional memory,” he told Croakey this week. ANPHA, he said, “should have been allowed to survive for much longer, so the capacity could get going”.
The argument made at the time was that prevention itself would not disappear. The Senate committee considering the abolition bill accepted that the Department of Health could carry on ANPHA’s work, concluding that transferring its roles and responsibilities should not diminish the Commonwealth’s commitment to preventive health programs and policies.
Back to the future
More than a decade later, however, the fate of ANPHA has new relevance.
In December 2025, the Victorian Labor Government accepted a public sector review recommendation to abolish VicHealth as a standalone statutory agency and absorb its functions into the state’s Department of Health.
The review described VicHealth’s work as important, but argued it did not need to be conducted independently and could be transferred without compromising service quality.
As with the abolition of ANPHA, the Government’s axe-wielding has generated widespread criticism and concern across the health sector and beyond.
What was lost with ANPHA? Moodie’s answer is that the structure of ANPHA mattered because it provided a dedicated national capability in an area where Australia has since struggled.
“If you look at alcohol and diet, food, obesity issues, Australia has done pretty appallingly,” he said.
Looking at the counterfactual – what might have happened had ANPHA survived – Moodie said Australia could have developed a more balanced approach to issues such as alcohol and unhealthy food, combining individual choice with stronger action on the environments influencing those choices.
“You’re not going to regulate to stop alcohol or to stop junk food, but you can do something around the advertising,” he said.
He points to sport as one visible example. “Look at any sport you watch and you’ll see KFC, McDonald’s, you know, the burgers. They’re all there, and it’s become so normalised.”
“The normalisation of really unhealthy food is part of Australian life now.”
Public health advocate Caterina Giorgi says Australia would have made far more headway in reducing alcohol-related harms. “In alcohol, ANPHA had started some important work on looking at strengthening alcohol marketing regulation at the federal and state and territory levels,” she said in a recent LinkedIn discussion .
“ANPHA had also established a community sponsorship fund and was buying out alcohol sponsorship of sports. If it had continued, perhaps we’d be further advanced on alcohol advertising regulation and there would be less alcohol sponsorship of sport.”
When ANPHA’s functions moved to Health, Moodie said the dedicated capability disappeared rapidly. “It dissolved very quickly,” he said. “Then you had nine years of not the slightest interest in anything around public health, other than writing strategies, and they’re not funded.”
Joanne Scarfe, an early ANPHA employee, said in the recent LinkedIn discussion that being outside the Commonwealth Department of Health and the larger bureaucracy, with its own strategic advisory committee, had allowed the agency to take “slightly swifter (maybe even braver) policy action”.
Scarfe said ANPHA had “fantastic leadership and the support of the broader Australian prevention community”.
Others note that ANPHA’s abolition meant a lot of health promotion was left to the states and territories, with varying degrees of commitment, expertise and capacity for investment.
The need for national leadership has been acknowledged by the state-based agencies in Victoria, Queensland, South Australia and Western Australia, which last year established the Prevention Agencies Chief Executive Forum (PACE Forum) – a strategic move to tackle the shared drivers of chronic disease.
“Preventable health conditions remain the leading cause of illness, disability and death in our country, and real progress in turning the tide demands collective action,” they wrote at Croakey.
Fast forward
VicHealth predates ANPHA by almost a quarter of a century. Established with bipartisan support in 1987, it became associated with landmark initiatives, including Quit and SunSmart.
Emeritus Professor Mike Daube said VicHealth grew out of Victoria’s then world-leading approach to tobacco advertising and subsequently became an influential model.
“It is quite bizarre that the Victorian Government should now be planning to abandon an approach that has been widely praised for its contributions to prevention over many years,” he told Croakey.
“There has to my knowledge been nothing even approaching a convincing case for making the change.”
Daube’s concern is not simply that VicHealth’s name might disappear.
“In a world where political controls over government agency funding and programs are becoming ever tighter, scooping up VicHealth’s funding into the Health Department will end the scope for innovation, collaboration, links with the non-government sector and support for advocacy that have had so much impact.”
The Victorian Government argues precisely the opposite, saying VicHealth’s preventive and public health work will continue and be better integrated into a health system that has changed substantially over the past four decades.
The proposal has nevertheless encountered significant resistance, across the health and community sectors, as well as politically. Both the Coalition and Greens say they would oppose the legislation needed to abolish the agency, leaving the Government facing difficulty passing the changes through the upper house.
Moodie is unequivocal about the proposal. “It’s a very silly plan,” he said. “It’s not going to save them any money if they do it properly. It’ll save the money if they just wipe out what VicHealth does.”
When functions move, does capability follow? That question goes to the heart of the comparison with ANPHA.
Associate Professor Jennifer Browne, from Deakin University’s Centre for Global Preventive Health and Nutrition, said moving functions into a government department does not necessarily preserve the specialist knowledge and continuity that accumulate inside a dedicated prevention agency.
“Often they’re career public servants, climbing the ladder, being shifted around to different areas, either within their department or sometimes different departments altogether,” she told Croakey.
“So you don’t have that corporate knowledge and that specialised public health knowledge. Often, when you’re meeting with people from the Department, it’s a different person every time. So again, you lose that continuity.”
Multiple risks
Associate Professor Carmel Williams, Director of the Centre for Health in All Policies Research Translation in South Australia, raised a similar concern.
“When you get reabsorbed into mainstream health systems and health departments, over time, and as the priority and realignment of the work of the agency becomes more aligned with the health system orientation of the Department, which I think is inevitable, it’s very hard to keep it completely separate,” she told Croakey.
Staff move into mainstream health service roles, she said, and specialist capability can erode with them.
“Then you lose the expertise, the prevention expertise, that is held within the prevention agencies, and then the capacity and capability of developing and implementing and evaluating effective and meaningful population health prevention programs can dwindle and can be lost to some extent.”
Williams said this problem is structural: acute health system pressures are immediate and politically visible, while the benefits of prevention often emerge over much longer periods.
“Because the health system’s needs are always immediate and very front of mind, and the benefits of prevention are future orientated and long term, it’s really easy for governments to realign those resources,” she said.
“When budgets become tight and health system pressures of the clinical and emergency system override, they will override the value of prevention and resources and positions will be moved away from prevention focus towards health system, hospital services and emergency clinical services. So they move back downstream.”
Moodie makes much the same prediction for Victoria. “It will go backwards very quickly because of the pressures within the Department to spend money on ambulances or acute medicine,” he said.
As VicHealth’s second CEO, Moodie said maintaining a degree of separation from government had always been central to the organisation’s role.
“We’re working with the government, not for the government,” was how he described the relationship. But that independence was never absolute. “On the other hand, the board has to report to their ministers. So, you know, the Minister does have control.”
For Moodie, one of the less tangible things at risk is VicHealth’s network of relationships outside government.
“One of the things that VicHealth has always been really good at is relationships with groups across Victoria that have funds and sports,” he said. “And the Department’s not particularly good at that.”
The shift upstream
The debate is also taking place against a changing understanding of what prevention entails.
Australia’s National Preventive Health Strategy 2021-2030 explicitly recognises that health is shaped by social, environmental, structural, economic, cultural and commercial conditions, many beyond the control of individuals or the health system itself.
Browne argues this distinction is crucial. “Prevention’s always been the poor cousin of health service delivery, sick care, in my view, within governments,” she said.
Where government prevention does occur, she said, it can gravitate towards a more medicalised model – immunisation, screening and other interventions delivered through clinicians.
“Which, of course, is important, but it’s different to this system-level prevention that VicHealth does, addressing the harmful commercial industries that drive the chronic diseases and a lot of the mental ill health that the population’s facing.”
Browne said VicHealth’s independence has allowed it to confront commercial determinants in ways government departments may find more difficult.
“Part of the thing that is so unique and important about VicHealth is that they boldly address the health-harming activities and practices of harmful commercial industries,” she said.
“They were world-leading in the 1980s when no one else was doing it. They went up against the tobacco industry and since then have done the same with alcohol, with unhealthy foods.
“An independent agency can be bold and can speak out about issues, can challenge commercial industries and do things that aren’t necessarily directly in line with what the government’s agenda is.”
Williams said short political cycles can also pull prevention back towards interventions that deliver quick results rather than structural change.
“We’re constantly going to be in this short-termism and not able to break away from that constant pull back to behaviour change and lifestyle drift, and not really tackling the underlying causes of the inequalities, the health and well-being of our populations in our society,” she said.
“That really needs that big focus on social determinants of health, health inequities and commercial determinants. All those things require that much more systems thinking, structural changes.”
For Yorta Yorta researcher Troy Walker, that does not mean individual behaviour is irrelevant. “Choices and individual behaviours are still incredibly important,” he told Croakey.
“However, there are systems, structures and high-end policy decisions that influence people unbeknownst to themselves.”
He points to passive smoking as a straightforward example of prevention changing the environment around individuals rather than relying on personal choice alone.
“An example might be the idea that smoking was once permitted in social venues, but as a result of strong research and public health advocacy and relevant political campaigns, the danger of passive smoke in these venues is now a thing of the past.”
Walker and Browne also emphasise that modern prevention needs to involve communities much earlier in decision-making.
“Being open to proper consultation, listening bi-directionally and establishing upstream decision-making that involves First Nations people as a part of its leadership should be key,” Walker said.
Browne said there was extensive evidence that policies and programs were more likely to work when affected communities were meaningfully involved in designing and leading them.
Filling the gaps?
The National Preventive Health Strategy 2021–2030 created a new overarching Commonwealth framework. It explicitly calls for a systems-based approach that addresses wider determinants of health, reduces health inequities and increases the focus on prevention. It also set a target for preventive health investment to reach five percent of total health expenditure across governments by 2030.
However, Australia is still well short of that target. The strategy remains unfunded, and the Australian Institute of Health and Welfare reported public health spending at 2.9 percent of total government health expenditure in 2023–24.
The Department of Health also continues to say it is developing a “blueprint for action” to guide implementation of the decade-long strategy.
The PACE Forum, created by Health and Wellbeing Queensland, Healthway in Western Australia, Preventive Health SA and VicHealth, has called for a national prevention investment framework, arguing that chronic disease prevention must be treated as a national priority. Its initial focus areas include food policy, First Nations health inequities, community-based prevention and demonstrating the economic and social value of prevention.
At a Commonwealth level, another institutional answer is now taking shape.
The Australian Centre for Disease Control became an independent statutory agency on 1 January this year, with an initial focus on preparing for, responding to and preventing public health emergencies. (The ANPHA legislation was finally repealed as part of the CDC set up.)
The CDC’s remit is intended to broaden over time, and its expansion into areas such as chronic disease will be considered after an independent review of its funding and operations in 2028. During the parliamentary inquiry, public health organisations argued that non-communicable disease prevention should be part of the CDC’s core role from the outset rather than deferred to a later phase.
This raises the question: does Australia need another dedicated national prevention institution, or should the CDC ultimately grow into that role?
In the LinkedIn discussion referenced earlier, health economist Professor Stephen Duckett questioned what value a new ANPHA would add over the existing CDC, and whether those benefits could instead be achieved by changing the CDC’s remit.
Moodie noted that the CDC has so far been focused, understandably, on the kinds of threats exposed by COVID.
Changing landscape
The debate is not necessarily about recreating ANPHA as it existed more than a decade ago. The prevention landscape has changed, as has the environment shaping Australians’ capacity to be healthy, including growing inequality, housing stress, growing polarisation and racism, the tide of misinformation and disinformation, and climate impacts.
Even the CDC now describes emerging public health threats as extending beyond infection to climate, environmental and demographic change.
While the work to advance prevention efforts nationally continues to face many barriers and challenges, much is at stake for health – nationally and locally – in the Victorian election.
The Victorian Opposition’s pledge to repeal Treaty and the prospect of One Nation having influence over policies affecting health and prevention are alarming many.
Meantime, supporters of VicHealth continue to advocate hard for its future, behind the scenes and in front of the cameras.
If VicHealth closes, one question will be whether almost four decades of accumulated expertise, partnerships and public identity can be preserved. Rob Moodie concedes that organisational form should not become an end in itself.
“I wouldn’t mind if VicHealth disappeared and the Government suddenly had a much, much better approach to public health and population health and prevention, and put a lot more funds into that,” he said. “But I just cannot see that happening.”
Asked what he thought prevention efforts in Victoria might look like five or 10 years after VicHealth being absorbed into the Department, his answer is unequivocal.
“A rather sad, wizened tree,” he said, “that’s dying.”
The lessons from APHA’s history underscore what is at stake.
See Croakey’s archive of articles on prevention
Add Comment