Introduction by Croakey: Today marks World Health Day and the 75th anniversary of the World Health Organization (WHO), being celebrated under the theme #HealthforAll and with calls for a renewed drive for health equity.
You can read public health milestones since the WHO’s founding here and tweets at the bottom of this post marking the anniversary.
Today also marks the final day of Global Public Health Week (3-7 April) – #GPHW and #GPHW2023 – organised by the World Federation of Public Health Associations (WFPHA), which has been hosting Croakey’s @WePublicHealth Twitter account all week.
One of many events marking the week globally and here in Australia was a webinar on preparing public health professionals and associations for new challenges, as Marie McInerney reports below.
Marie McInerney writes:
Australian public health leaders this week warned about huge challenges to public health ahead, from climate change — where “winning slowly is losing” — to the risks of “wobbly democracies”, misinformation and powerful vested interests.
But they said the sector also has to address internal challenges, including inequitable access to its ranks for people from diverse and marginalised communities and ensuring the workforce has the skills, tools and the funding to address future challenges.
The Preparing Public Health Professionals and Associations for New Challenges webinar also heard calls for public health to drive ‘public health literacy’ among politicians and policy makers, and to take the opportunity offered by Labor governments across the mainland to secure funding for preventative health and non-COVID priorities, including for the Centre for Disease Control (CDC).
The expert panel webinar was co-hosted by the Australian Health Promotion Association (AHPA), Council of Academic Public Health Institutions (CAPHIA) and Public Health Association of Australia (PHAA). You can watch the 90-minute event in full, here.
It looked at current and future public health challenges, future proofing the public health workforce, working together for better investment and action, and it offered some excellent reading tips, a new roadmap to a state-of-the-art public health system in Queensland, and some great quotes.
Below are some takeaways.
Catastrophe, apocalypse and hope in the darkness
In her opening address, AHPA President Dr Gemma Crawford, Senior Lecturer in the Curtin School of Population Health, said the public health challenges now being faced are “not all new, but perhaps more accelerated, more visible, more pronounced, more global, more catastrophic”.
This brought to mind, she said, a quote from US writer and philosopher Susan Sontag: “Apocalypse is now a long-running serial: not ‘Apocalypse Now’ but ‘Apocalypse From Now On’.”
Crawford said she didn’t mean to sound gloomy, as she hoped her work attested to “staying the course” and finding optimism and hope — as US writer, historian and activist Rebecca Solnit has written, finding “hope in the dark and in the margins”.
Crawford also referenced the work on critical hope by Canadian academics Kari Grain and Darren Lund.
She said they have argued that “critical hope provides a space in which those invested in social justice – central to so much of our work – may concurrently consider both the despairing events of our current historical moment along with the varied, often unjust histories of those involved, while also moving forward with the development of programs and partnerships that may well generate changes that decrease suffering and dismantle unjust structures”.
“And I believe that just may be our mission,” she said.
At great risk of losing hard-earned gains
The panel was asked to nominate the big challenges ahead for health promotion and public health.
CAPHIA chair Professor Rebecca Ivers, an epidemiologist who specialises in injury prevention, nominated climate change, the commercial determinants of health – “they impact on everything that we do” – and post-COVID issues, warning that the pandemic has led to increasing medicalisation of the health system, particularly at the acute end.
“We are at great risk of losing the hard earned gains over many decades on NCDs [non communicable diseases], injuries and prevention work because of the focus on the pandemic,” she said.
PHAA president Tarun Weeramanthri, Adjunct Professor at the University of Western Australia and a former Northern Territory Chief Health Officer, also urged a “continuing conversation” about COVID, saying we are still in the midst of a public health emergency of international concern and need to continue to talk about appropriate, proportionate responses.
In particular, he said, a sense of solidarity and equity is essential to underpin public health responses, warning against an environment that acknowledges that COVID remains a risk for vulnerable groups but that “everyone else can forget [about it]”.
“The net effect surely should be that we all need to bear responsibility for our actions in society that could impact on vulnerable groups,” he said.
Agreeing that Australia needs to engage strongly on global issues, like conflict and healthy democracies – “on every international issue, we have people here who are experiencing it in real time, because their friends and family are affected” – Weeramanthri said public health needs to work much faster, particularly around climate and health.
“Winning slowly is losing for climate action,” he said, adding that sector is yet to develop mechanisms to “go faster together”, which requires new forms of collaboration, connection and partnership.
Crawford nominated issues around technology, data and misinformation, as well as climate, wellbeing and sustainability, cultural safety and inequality.
She said she is struck that AHPA members want to do more about climate change but are uncertain as to what adaptation or mitigation strategies might look like in context of their day-to-day roles.
Crawford also urged the need to improve democratic participation in the face of misinformation and “wobbly democracies”, saying political literacy is critical.
Address big gaps in own ranks
Ivers said another important challenge the public health sector needs to address is a “real equity gap” in its own ranks, where access to public health training in Australia is mostly available to people who can afford to undertake tertiary degrees, score high academically and are more likely to win Commonwealth-supported places giving subsidised access to postgraduate training in public health.
“That is a huge equity issue for people from community settings, people from diverse and marginalised communities, with really diverse experience, who would make truly wonderful public health professionals [but] are actually barred/shut out of the system,” she said.
Asked to nominate an opportunity for public health and health promotion, Crawford reflected on the concerns raised by Ivers, and offered two quotes from the first president of Johns Hopkins University in 1876, Daniel Coit Gilman:
First, that “it is one of the noblest duties of a university to advance knowledge, and to diffuse it not merely among those who can attend the daily lectures – but far and wide.”
Second, she said that, in his inaugural address, Gilman spoke about his vision for higher education: “It is a reaching out for a better state of society than now exists…it means a wish for less misery among the poor, less ignorance in schools, less bigotry in the temple, less suffering in the hospital, less fraud in business, less folly in politics…more lessons from history…more health in cities…more wisdom in legislation…more happiness.”
Panel members agreed the public health workforce is incredibly diverse and not just about health and health professionals – which raises some issues for defining competencies and accreditation etc.
“It can be those who count/see themselves as predominantly public health workers, those who say they contribute in some way without identifying as public health workers and those in other sectors who may be doing fundamental work on the determinants of health but don’t see themselves as public health workers or see the connection – education, housing etc,” Weeramanthri said.
Ivers agreed, quoting ANU Professor of Epidemiology and Public Health Emily Banks as saying “public health is the answer to just about everything”.
Ivers said the discipline is not just about health professions, but includes people working in policy, data analysts, health economists, economists – “arguably people sitting in Treasury who have never done a public health degree are critical to public health” – political scientists, qualitative researchers, people working in multicultural communities or environmental health, architects working in urban design…
Ivers said the sector needed a diverse, multidisciplinary workforce and to ensure there are appropriate pathways for entry and to training, industry opportunities, and up-skilling. It had to recognise the importance of diverse lived experience and skills sets and of partnership, especially with communities, to make sure the future workforce “has the tools to address the issues we’re facing”.
Address gaps between words and action
Weeramanthri also warned of the “huge gap” between words and action in acknowledgements by Australian governments of the importance of public health funding.
He said there had been multiple “words and commitments” from various governments over the years, including at least three national Cabinet statements about the need for greater investment in public health and workforce, but “we have not seen that translate into numbers on a budget paper yet.”
Ivers said the election of Labor governments across the mainland provided a powerful opportunity to highlight that Australia has a whole series of preventative/public health strategies, but very few with funded implementation or action plans and KPIs.
In her field, Australia has had an injury prevention strategy, highlighting it as a national priority, for decades. However, there had never been a single funded action plan and there was a real danger, she said, that the new National Preventive Health Strategy will remain largely unfunded.
“This is what peak bodies should be advocating on,” she said.
Asked later how to build political public health literacy with politicians and policy makers, Ivers said it was best done through good studies that show the economic benefits of investing in prevention, while Crawford spoke to the value of establishing and maintaining strong relationships with politicians and being available for public comment.
Weeramanthri recommended simple advocacy, using just six words: promote health, prevent disease, manage risk.
Stronger organisations and influence
The panel talked about the commitment of the public health sector and what it might look like in the future.
Said Weeramanthri: “What characterises our [PHAA] members is they’re joiners, they have paid money to do voluntary work for the sake of others.”
They also discussed efforts to build the influence of the sector, where all too often advocacy ambitions outstripped resources, highlighting the need for relationships with like-minded organisations, some in less traditional public health areas (Crawford) and not requiring organisations like the PHAA to lead on every issue if another was better placed to do so (Weeramanthri).
Weeramanthri talked about the importance of having a critical mass of people, that work could and should not be top down but also peer to peer, and that public health had to get better at working from the ground up, connecting with community groups, particularly on climate.
Crawford told the webinar her work “resides in the intersection of the social, the political and the personal” and that she was committed to working with associations because she supports “what can be achieved with a critical mass of like-minded individuals who are not afraid of frank and fearless conversations and critical dialogue towards shared aims”.
She welcomed growing involvement in Global Public Health Week, saying that now, more than ever, organisations need to “consider our social and ecological compact – deep recognition of our place in the world and our impact on it, but also the opportunities afforded to us by being a meaningful player in our global public health community”.
“We need to lead with open arms, hearts and minds,” she said, warning: “This is no time for empire building or siloed practice. The threats to the public’s health are real and they are urgent.”
Tarun Weeramanthri told the webinar he has just completed an independent review of public health services in Queensland and a 10-year roadmap, which the State Government is expected to respond to in the coming weeks. Read them here.
He said the adoption of risk management is a central theme, and that the recommendations for system reform don’t come down to a simple set of KPIs.
Rather, the review notes that this is not easy and requires an understanding of complex systems and complex change processes, but it identifies ways to “navigate a way through the complexity”.
A final quote
Shared by Dr Gemma Crawford, and from English epidemiologist and statistician Sir Austin Bradford Hill:
Statistics are people with the tears washed off.”
World Health Day
See Croakey’s archive of articles on public health