Professor Amanda Lee of QUT, wrote in a recent Croakey article that “the greatest dismantling of public and preventative health services in recent Australian history” is now underway in Queensland as a result of budget cutbacks.
In the article below, she describes the likely impact of these cuts upon the population’s health, raises questions about Queensland’s responsibilities under COAG agreements, and pays tribute to the work of those losing their jobs.
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Some of the stories the Queensland Government does not want told
Amanda Lee writes:
Public health practitioners are becoming increasingly distressed over the dismantling of preventative health in Queensland. One stated frustration is their lack of public voice.
Those working in non-government organisations cannot speak out because of new rulings preventing organisations receiving public funding above a certain level from commenting on government policy.
This is concerning as most public health improvements in western democracies have been initiated by such evidence-based advocacy. Worryingly, over 1,000 positions have gone already from this service sector in Queensland too.
Health practitioners who have lost their jobs are prevented from speaking out as a condition of severance. Those currently competing for the important remaining statewide roles (less than 4% of the previous number of clinical preventative positions) are understandably keen not to draw any attention to themselves. Colleagues still working within Queensland Health are bound by protocols to remain silent.
Press releases issued by professional associations, such as the Dietitans’ Association of Australia statement, have been picked up rarely by the media, which may not be surprising given the depth and breadth of the recent cuts and the range of issues raised.
But the views expressed privately by these individuals and organizations provide valuable insights into what has been lost with the demise of preventative health and nutrition promotion in Queensland. All are most worried about the effect on the community.
Comments consistent with the scientific evidence include:
- Preventative health services provide the front line for front line services in health; without this vanguard we will lose the battle against chronic disease in Queensland;
- These cuts effectively redefine the role of Queensland Health in a way that does not reflect COAG agreements to provide services that preserve, protect and promote the health of Queenslanders, as well as treat and manage disease;
- The effectiveness of clinical treatments will be undermined without ongoing improvement in the physical and social environments that promote healthy food choices;
- The prevalence of chronic disease risk factors and conditions will increase among the most vulnerable in Queensland; particularly poor growth and development of Aboriginal and Torres Strait infants and children, type 2 diabetes and renal disease amongst Indigenous and low income groups, cardiovascular disease in rural and remote communities, and overweight and obesity in all socio-economic groups with the exception of the highest quintile;
- Increased demand for the treatment and management of diet-related, chronic diseases will increase dramatically, in both the medium and long term, growing to be an extremely costly burden to the ill-health system and society;
- It takes ongoing, long-term commitment to improve the health of the community, and once the capacity to do this is reduced, it takes enormous effort and investment to reinvigorate services;
- More collaborative work is needed to prevent diet-related chronic conditions, not less; the stated rationale about potential duplication of services is akin to sacking violinists from the string section of an orchestra for playing the same tune!
Some more personal experiences hint at broader social and economic problems. In particular, several Indigenous nutrition workers who have lost their jobs have been the only members of their family in ongoing employment; their loss of income will have negative effects on the health determinants of their whole community. To a lesser extent, the negative economic impact of so many job losses risks adversely affecting the health of all Queenslanders too.
There has been some acknowledgement of “feeling sorry” for those who have lost their jobs.
But as a society, we should also be saying “Thank You” to those over a hundred and sixty preventative health practitioners as they are forced to walk away from their important roles and responsibilities.
So to those preventative health professionals working in nutrition promotion – Thank you for:
- Improving the food supply in our childcare centres, schools, health facilities, sporting clubs and stores, particularly those in rural and remote areas;
- Helping increase initiation and duration of breastfeeding;
- Group based healthy lifestyle programs like Lighten Up and Living Strong, which cost-effectively increase the prevalence of healthy weight, physical activity and healthy eating, especially in those regional areas where commercial programs are not available;
- Increasing intake of fruit and vegetables through the Go for 2 and 5 campaign and local activities;
- Developing and distributing tools, resources and training programs for evidence-based interventions, such as the NHMRC Dietary Guidelines, Growing Strong, Smart Choices, A Better Choice, Get up and Grow… and many other successful initiatives throughout Queensland.
More personally, a particular thank you to those Indigenous health practitioners who, against the odds, had completed higher education courses and applied their knowledge and skills tirelessly to improve the health of their communities – and who are now left struggling with yet another inequity.
Thank you to other health practitioners preparing to sell their homes and move inter-state/overseas where their professional expertise in preventative health is recognised and highly valued – a terrible brain drain from this state.
Thank you to the current students of nutrition, health promotion and public health who have worked diligently over at least three years to train as health professionals in these essential fields, only to have their career prospects pulled from under their feet before they could ever get started helping improve the health of Queenslanders.
Finally, thank you to all those who are in despair, seeing their life work and resultant achievements erode without due acknowledgement. You have made a tremendous contribution. Your heritage will continue, and eventually rise again, as common sense scrutiny of the scientific evidence dictates.
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Previous related posts
• Mourning the demise of public health nutrition in Queensland
• Qld Health may be far from perfect but the changes are also problematic
• Qld health cuts are lazy, harmful and short sighted
• Overview of Qld Health changes
• On Budget Day for Qld, what can be expected from the health cuts?
One of the concerning features about much of the delivery of health care through public entities is encapsulated in Amanda’s comment that:
“Health practitioners who have lost their jobs are prevented from speaking out as a condition of severance. Those currently competing for the important remaining statewide roles (less than 4% of the previous number of clinical preventative positions) are understandably keen not to draw any attention to themselves. Colleagues still working within Queensland Health are bound by protocols to remain silent.”
Health care (like other services) demands adequate transparency to foster best practice, ensure accountable decisions and minimise the opportunities for fraud and corruption. Those issues permeate all organisations from the top down.
It is at times of unwarranted secrecy that we must rely on the professional organisations and the individuals who are independent participants in the process to speak out and inform us and our political representatives who are, after all, placed in positions of trust to make decisions on our behalf for the time being.
The loss of 50 jobs in Preventative Health in Cairns could have major impacts on some Indigenous communities where syphilis outbreaks can cause many other serious health issues, including for pregnant mothers.
Cairns MP and LNP newcomer Gavin King has only talked about 400 jobs with the Dept of Environment and 20 odd jobs in Tourism. This deception needs exposing. Why he forgot to mention the 50 dedicated preventative health care specialists from the Cairns Public Health Unit, who were all axed from their positions last week, is extraordinary. The staff cuts in this vital public health unit has failed to rate a mention in King’s radio interviews.
The Federal Government’s Initiative of ‘Closing the Gap’ in Indigenous health will remain unachievable in Queensland if only front line health service provision is relied upon.
In fact, not one media outlet has published this information. Maybe it is because Unions only protect those that are most vocal like the Nurses Union, a very large and powerful group of health workers, and the Union stance is to protect those that are front line. Many people work behind the scenes to make the nurses able to function efficiently and do their jobs.
Others such as those in Public Health, work to keep people out of hospital, and to stop the spread of infectious diseases.
When 50 health professionals from the Cairns Public Health Unit were told by the new Liberal National Party State Government that their services were no longer required, given just two weeks, to finish up, local State MP Gavin King, along with other media, failed to mention the decimation of these healthcare workers. King deliberately ignored this fact when he spoke to Fiona Sewell on ABC radio. He mentioned the 20 jobs axed from Department of Tourism, but all from Corporate Office in Brisbane. He mentioned the 400 jobs from the Department of Environment, but only 2 local jobs.
The majority of these positions are made up of nurses, doctors and other specialised health care workers who all have a mandatory tertiary qualifications in health, and many have a Masters of Public Health as well. These officers are each specialised in their own fields and have spent many years in their chosen career in public health.
The Cairns Public Health Unit services a population of over 250,000 people.
These specialised and dedicated team of professionals work to keep the general public informed of health risks like smoking, unsafe sex, handling bats etc), to stop the spread of infectious diseases (Hendra virus Dengue fever, tuberculosis, influenza, salmonella food poisoning etc), to maintain clean and safe drinking water (checking of water supplies for E coli or other contaminants), and many other activities that protect the population they serve. Much of their work involves in trying to improve conditions in Indigenous communities. After all, North Queensland has nearly half of the Queensland’s Indigenous population living here.
One such specialist, celebrated her 20 years with Queensland Health last Wednesday, only to discover two days later, that she no longer had a job. This person is known internationally for her work on improving Indigenous nutrition in Papua New Guinea and Far North Queensland. It beggars belief that this well-renown health professional has been put out on the scrap heap along with her colleagues.
Another dedicated specialist in sexual health has been overseeing a syphilis outbreak in a remote Indigenous community. Much of this work involves contact tracing and ensuring patients receive the appropriate treatment. Sexual health officers from Cairns have had to go to this community to help test and treat patients in order to eradicate this infection. Cases of the disease are still being reported.
It seems that those that are left in Corporate Office in Brisbane, think that Thursday Island is off the coast of Cardwell.
Queensland has taken a step back 20 years and will never achieve Closing the Gap in Indigenous health in Queensland, without the preventative work going on behind the front line services.
Thankyou and I’m sorry too