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Five public health lessons from coronavirus

Introduction by Croakey: Tomorrow marks six months since Federal Health Minister Greg Hunt announced that Victorian health authorities had confirmed Australia’s first case of novel coronavirus, in a man from Wuhan who flew to Melbourne from Guandong on 19 January.

The Public Health Association of Australia (PHAA) has highlighted this anniversary to argue for increased investment in public and preventive health, including structures and workforce, noting that of 1,057 specialist doctor training positions in 2019, only 27 were public health doctors.

“Similarly, in rallying to the national COVID response, our wafer-thin line of public health workers and experts have had to abandon their important life-saving work in areas like cancer screening, immunisation and nutrition. They have been magnificent, yet stretched to breaking point,” CEO Terry Slevin said in a statement.

The news from Victoria today underscores the PHAA’s call for all Australian governments to urgently review the level of resources available for the ongoing battle against COVID-19.

Another seven people have died in Victoria since yesterday (five of these are linked to aged care facilities), with the state’s total number of cases now at 7,405, including 300 active cases in healthcare workers.

The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) has issued a statement (23 July) urging Aboriginal people across Victoria to take precautions.

Since the outbreak began, 37 cases have been confirmed among Aboriginal people in Victoria, with 19 currently active, including two in Ballarat, and some trends and spikes in Wyndham, Brimbank and Melton, the statement says.

VACCHO CEO Jill Gallagher AO said: “We know communities have been working hard to minimise any infections which has been quite successful to date, but we are entering a very challenging period. We are seeing alarming rates of community transmission – unlike the first lockdown period.”

Meanwhile, the six-month mark also brings this timely reflection by VicHealth’s CEO, Dr Sandro Demaio, who has identified five public health lessons from the pandemic thus far.


Sandro Demaio writes:

Coronavirus has put health at the top of the agenda for governments, businesses and communities all over the world. How can we seize this moment to make the future healthier for everyone?

Last month, VicHealth brought together leading experts for five weeks of in-depth discussions on how we can build back from coronavirus to create a healthier, sustainable, and more equitable Victoria.

Our Life and Health Re-imagined series has come to an end, but the work is just beginning.

As communities and public health practitioners plan their next steps in the coronavirus response and recovery, below are five key takeaways from the experts.

Week one: social change can happen quickly, so we shouldn’t be afraid to strive for it

In the first week of our series, we asked how can we reshape work to benefit everyone? as coronavirus exposed the lack of protections many workers, and those without work, do face.

Yet coronavirus also proved change can happen quickly with JobKeeper and JobSeeker payments and free childcare all established within weeks of local coronavirus cases escalating. So how do we ensure these quick actions lead to long-term benefits, particularly for those who need it most?

Our experts called for better work conditions (i.e. universal sick leave), ramping up workplace health and safety (for physical and psychological health), and implementing sustainable practices for people (work-life balance), and the planet (through work that provides shared social, health and environmental benefits).

Employment, and the economic consequences of a likely painful recession, could have profound impacts on the health of Victorians over the coming years. It has the potential to widen inequality, and affect already marginalised communities worst. It is time for our focus on such social determinants to become granular, and central to a post-coronavirus public health agenda.

Week two: think local and global to put healthy food solutions on the table

The week two discussion – Good food for all, how do we get there? –  sparked lively discussion on whether it was best to try and dismantle food systems shaped by powerful business interests, or focus on local efforts.

The answer? Both.

We know that food banks alone cannot solve food insecurity. To ensure affordable access to healthy, delicious and culturally-appropriate food we’ll need to support and work alongside local efforts (i.e. backyard farmers) as well as looking at bigger system changes (i.e. de-homogenising the supermarket aisles). What was clear though, is that the potential dividends to public health through a more equitable and sustainable food system are massive.

Week three: local living can thrive in the right conditions

During the first lockdown, we learned just how important our local neighbourhoods are, with individuals and families taking to the streets to get our essential exercise.

Urban Planner Anna Muessig described it as our streets becoming “places, not just corridors of movement,” in the week three discussion Streets for people – Lessons from a return to local living.

But not everyone lives in a neighbourhood where they can freely walk, cycle and enjoy outdoor space. Where there is designated, safe space for people, people will come. If we want Australians to be active in their neighbourhoods we need to create the infrastructure for them to do so conveniently and safely.

It is becoming clear that the current pandemic is causing communities to have a more proximal focus, could this be our chance to reimagine the DNA of our cities, towns and communities and put better health at the heart?

Week four: unless it’s equitable, it’s not working

During week four’s Equity during recovery discussion Professor Sir Michael Marmot urged us to “create the conditions for people to have the capability to lead lives they have reason to value.”

The coronavirus response around the world has shown how vital it is to keep equity at the heart of everything we do, and the dire consequences for when we fail to achieve this. At home, some responses to coronavirus have made things more equitable, for example, telehealth has improved access to medical care for people in regional communities.

Yet many others have exacerbated existing inequities, i.e. people in insecure jobs not having sick leave if they need to self-isolate.

Equity must be at the core of recovery, but what does that actually mean? And how do we move beyond well-meaning rhetoric to operationalise and embed progressive measures in the months and years ahead?

The discussion continues, but what we know is that we must learn from the successes and shortfalls of the past months and ensure that equity continues to be front and centre in our continued response and recovery.

Week five: uncertainty can be an opportunity to show strength

In the final week of discussion, we examined at how a crisis like coronavirus affects people through the lens of a natural disaster.

The idea of building resilience – or transilience – was key, with the mental health impact of coronavirus a significant challenge alongside the physical health crisis. The research driving the discussion also celebrated the fact that through coronavirus, there is now growing recognition of the critical links between health and wellbeing, and all other aspects of life.

Panelist Professor Anna Peeters said the pandemic made it clear that health is everyone’s business and that we need all sectors – not just health – engaged in prevention.

Former Health Minister Nicola Roxon highlighted the power of community in creating change. As health campaigners we can build momentum in the community, creating fertile ground for governments to act.

As we continue to rise to the challenges coronavirus presents, we must reflect on these discussions, iterate and improve our approaches and capitalise on this once-in-a-century window to strengthen the fundamentals of our public health approach.

This pandemic has brought immeasurable suffering and adversity, but with discussions and insights like those raised over the past five weeks, there is an opportunity to better support the health and wellbeing of the community today, tomorrow, next week, and into the future.


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