Health promotion and secondary prevention: response to Milat, O'Hara and Develin.

This paper responds to a recent HPJA article by Milat, O'Hara and Develin, which called for health promotion practitioners to be more closely involved in secondary prevention of Type 2 diabetes. It considers the resources currently available to health promotion in Australia, and examines and critiques the terminology of prevention used by Milat et al. The paper argues that Milat et al. give insufficient attention to the central role of social determinants of health in preventing Type 2 diabetes and in reducing health inequalities in the population. The paper agrees that increased health promotion involvement in Type 2 diabetes prevention programs may be beneficial, but argues that funds for such programs should come from the services that run them, not from the tiny health promotion budget. Given the current and projected scale of Type 2 diabetes in Australia, there is value in applying the concept of 'moving upstream' to this health issue. The paper concludes that, given current resources, the best use of Australia's specialist health promotion workforce is in 'upstream' programs that can benefit the whole population as well as those at risk of Type 2 diabetes.