VicHealth at a Crossroads - When Prevention Becomes Ideology

https://theconversation.com/why-scrapping-a-key-health-promotion-agency-makes-little-economic-sense-274978

The announcement that VicHealth may be absorbed into the Victorian Health Department has been met with apocalyptic language. We are told its abolition is “incomprehensible”, “a disaster”, even a threat to democracy itself. Defenders invoke Quit, SunSmart, and a golden era of public health success. They remind us that prevention saves money, boosts productivity, and delivers handsome returns on investment.

But behind the emotive rhetoric lies a more uncomfortable truth: VicHealth no longer resembles the evidence-led, pragmatic prevention agency it once was. What is being defended today is not effective health promotion, but an institution that has gradually substituted ideology for outcomes, particularly in tobacco and nicotine policy.

That distinction matters.

Few would dispute the basic principle that prevention is better than cure. But moving from that truism to the claim that VicHealth, as currently constituted, represents good prevention policy is an unjustified leap. Results, not intentions, must judge modern health promotion. In tobacco control, the central outcome is straightforward: fewer people smoking combustible cigarettes.

On that measure, the international evidence is no longer ambiguous. Jurisdictions that have embraced harm reduction and regulated access to lower-risk nicotine products are outperforming those that cling to abstinence-only models. Sweden, Japan, the United Kingdom, and New Zealand. These are not fringe examples, they are the global leaders in smoking decline.

VicHealth, by contrast, has aligned itself with a public health orthodoxy that treats all nicotine use as equally unacceptable, regardless of risk. This position contradicts decades of toxicological evidence, ignores population-level outcomes abroad, and actively undermines the most effective smoking cessation pathway ever observed: switching away from combustion. Calling this “prevention” does not make it so.

Much of the defence of VicHealth rests on return-on-investment figures. We are told it delivers $2.20 for every dollar spent. Quitline returns $1.24. SunSmart $2.22. These numbers are repeated with confidence, as though they settle the matter.

They don’t.

Most of these evaluations predate the current nicotine landscape. They say nothing about opportunity cost about the health gains foregone by opposing safer alternatives to smoking. They do not account for the downstream consequences of prohibitionist policies: illicit markets, loss of product standards, reduced cessation pathways, and the deterrence of smokers who might otherwise switch to dramatically lower-risk products.

In Australia, where prohibition dominates, smoking decline has slowed, illegal supply has exploded, and billions in excise revenue have disappeared along with any meaningful consumer protection. If prevention economics refuses to count these failures, then the accounting is incomplete by design.

Independence, meanwhile, is treated as a proxy for neutrality. But institutional independence without epistemic accountability is how groupthink solidifies. Over time, VicHealth has embedded itself within a closed ecosystem of like-minded NGOs, academic centres, and advocacy networks that rarely engage with dissenting evidence or affected consumers. The result is policy certainty without policy humility.

Nowhere is this clearer than in vaping. Consumer experiences, international evidence, and comparative policy outcomes are routinely dismissed as “industry narratives”, even when no industry involvement exists at all. An agency that cannot adapt to new evidence is not safeguarding democracy. It is safeguarding itself.

This inward turn is reinforced by the increasingly dominant framing of “commercial determinants of health”, which casts markets as adversaries and regulation as a moral instrument rather than a practical one. Yet this framing collapses under even mild scrutiny. Alcohol harm is managed through regulation, substitution, and consumer choice. Food harm through reformulation and incentives. Only nicotine is treated as uniquely intolerable regardless of the risk gradient.

Why are non-combustible nicotine products framed as threats rather than transitions? Why are adult smokers denied agency in the name of youth protection, when overseas evidence shows both goals can be achieved simultaneously? These are not scientific questions. They are moral ones. And they reveal how far health promotion has drifted from risk-based reasoning.

Absorbing VicHealth into the Health Department is being portrayed as an act of vandalism. It may instead reflect a growing recognition that prevention policy has become detached from measurable harm reduction. Independent agencies should exist to challenge short-termism, not to fossilise outdated models. If VicHealth were genuinely committed to reducing disease burden, it would be leading the conversation on regulated nicotine substitution, not obstructing it.

That it has not done so helps explain why its defenders lean so heavily on nostalgia.

This debate is not about whether prevention matters. It does. The real question is whether Australia’s prevention institutions are willing to evolve when the evidence does or whether they will continue to mistake moral certainty for public health success.

If VicHealth cannot make that shift, then preserving it in amber is not a victory for health, economics, or democracy. It is simply an admission that ideology has replaced outcomes and that, not reform, is what some are really trying to prevent.