The 42nd Annual Conference of the Public Health Association of Australia (PHAA) will be held in Melbourne next week, with the theme: A ‘fair go’ for health: tackling physical, social and psychological inequality.
In the article below, PHAA CEO Michael Moore talks to Marie about the aims of the conference and how the future of public health may change under a Coalition Government.
With Prime Minister-elect Tony Abbott famous for some of his views when he was Health Minister – “if people are obese it’s because they’re eating too much or they’re exercising too little”, Michael notes the challenge is likely to be in shifting the pendulum between personal responsibility and the need for structural change.
That might involve reframing the approach to issues like climate change, alcohol abuse and market interference, and the prospect of tougher opposition from strong interest groups like the Food and Grocery Council, which had already begun to back away to some extent on sensible food labelling reform.
With a range of keynote speakers, including former Health Minister Nicola Roxon, the conference is also keen to broaden the concept of social determinants of health to include psychological and emotional determinants, particularly around structural violence and health.
Michael Moore: The notion of the social determinants of health is very well known to the people coming to the conference but not to the broader community. When I’m asked to explain it, I say it’s about the good old Australian philosophy of giving everyone ‘a fair go’.” It’s what we used to call root cause analysis, or as (former Chair of the World Health Organisation Commission on the Social Determinants of Health) Sir Michael Marmot refers to as ‘the cause of the cause’.
That is the challenge to us over the next three or six years perhaps of the Coalition Government, to get an understanding of the relationship between personal responsibility – which in the past has been almost the total emphasis of Tony Abbott – and the idea of structural issues.
We saw this recently in Queensland where the State Government’s health blueprint had a big focus on personal responsibility, yet it also acknowledged it may have to intervene to address obesity. I think it would be naive for us to think the Coalition members simply have the idea that it’s all about personal responsibility: but it’s really about where we draw the line, where’s the balance.
Q: As you’ve noted, Mr Abbott is known for his focus on personal responsibility, through comments such as:
“It is estimated that obesity adds about a billion dollars a year currently to the nation’s health bill. Obviously I would rather that we didn’t have to spend that money because there was no obesity, but in the end if people are obese it’s because they’re eating too much or they’re exercising too little, and the answer is in the hands of those individuals.” (Four Corners 2005).
What does that tell us about the future of public health under a Coalition Government?
Michael Moore: Our President, Associate Professor Heather Yeatman, will explore that question early at the conference, talking about the ramifications of the new Government, the strategic direction of the PHAA and meeting challenges at local government, State and Territory and the Federal level.
In essence, our challenge is to ensure that newly elected MPs and the new Government understand the importance of the root causes of ill health and keep an appropriate perspective on the role of personal responsibility.
It was disappointing how little attention was paid during the election campaign to vital health issues – particularly around public health and prevention, so we don’t have a detailed sense of what the Coalition has in mind on a number of issues. Its health policy was very medically focused and I’ve been disappointed that when talking to the Coalition about even diabetes there is nothing about prevention and it’s all about GPs and medical intervention.
On the other hand, there are certainly enough people within the Coalition who understand the sorts of issues we’re on about, if they put it in more of a ‘root cause’ analysis. For example Andrew Laming, who was an ophthalmologist and has worked in developing nations and on Indigenous health issues.
Another element to keep in mind was the Senate Committee report on Australia’s response to the World Health Organisation’s (WHO) Commission on Social Determinants of Health report ‘Closing the gap within a generation’. The inquiry included members of the Coalition and produced what I thought was a very good and thoughtful response, without dissension.
We’re hoping we will also see a shift from Tony Abbott – who is a wonderful role model on fitness – to give some concession to the structural issues as well as to personal responsibilities. Given his interest, Indigenous health is probably the major area through which he could understand that well.
Q: Where do you see sticking issues and opportunities for change?
Michael Moore: Our approach is to be able to work with whoever is in government, and that’s a focus we’ll also be seeing at the conference. One of our keynotes is Victoria’s Health and Ageing Minister David Davis, who we have been working with around population health planning. He will be a good contrast with another speaker, Greens health spokesman Senator Richard di Natale, who is also a physician and has worked with Indigenous communities and in HIV in India. We’re also pleased to have former Health Minister Nicola Roxon as guest speaker at our conference dinner on Tuesday.
Around particular issues, we have a huge effort ahead of us on climate change; for example, where we’re trying to get government to the next level, to see it as a health and economic issue.
Even if they are paying lip service to it, the Coalition certainly doesn’t feel it needs to take the sort of action we would think was necessary. I think we will need to slightly change our discourse, to still, of course, talk about the health issues associated with climate events, but also perhaps talk more about the impact of climate change on, for example, vector borne diseases, such as the possibility of malaria coming into Queensland, of dengue fever coming further south.
I think most people understand it’s better to spend a little bit on prevention than a whole lot of money on patching up – do we build the fence at the top of the cliff or send the ambulance to the bottom? But in our advocacy work there’s always someone with the opposite perspective, for example industry interests around issues of junk food.
We have seen the Food and Grocery Council back away to some extent from moves on improving food labelling. We’re not sure what the outcome will be but I think it illustrates that it’s probably going to be more difficult to do these sorts of things under a Coalition Government than it was under Labor.
Conservative governments tend to see these issues as about market freedom, but clearly they are ready to intervene, for example, to stop monopolies forming, so we need to reframe the issue so that it is about domination of markets not market interference.
Q: Your 2013 election priorities called for a modest increase in prevention to bring about substantial benefits in both health and costs in the years ahead, and noted opportunities for raising revenue of over $2 billion per annum – through taxes on alcohol, tobacco, soft drinks and pollution. Given its focus on a budget surplus, is the Coalition likely to be interested?
Michael Moore: Our election priorities argue that a modest increase in prevention spending now will bring substantial benefits in terms of both health and economic benefits in years ahead. We’ve called for the level of funding for prevention to rise from 2.2 per cent – which is madness – to 4 per cent of health expenditure.
I know the easy thing to say is that politicians only take the short-term view, but I don’t believe that. Certainly there’s a need for the quick wins, but actually most politicians would love to be perceived as visionary. We need to be able to convince the Coalition particularly around prevention on issues of chronic disease and obesity that a longer vision with some short-term interventions and actions will deliver in the long term.
With tobacco, I don’t think we’ll see a reversal of the gains – I think we’ve crossed the line on that – though we might see a slowing down of tobacco reform.
With alcohol, we may have to again reframe the issue. Alcohol policy really does have to be about more than public health. It includes law and order and violence, which are issues that go across both sides of politics.
Q: You also understand what it’s like to be on the other side of health advocacy, as a former independent MP and Health Minister in the ACT Government. What did you do well and not so well?
Michael Moore: I established the Healthy Cities program which remains, although under a different name, and smoking was banned in cafes and pubs under my watch.
The one I got wrong was to support a more relaxed attitude towards alcohol. It’s been really clear that as we’ve become more liberal with alcohol, we’ve got more problems. There are many more examples, of course, but these provide an insight.
Q: What are the main aims of the conference and what will be some highlights?
Michael Moore: As an annual conference of the PHAA, it is very much about networking and member engagement, and I expect we will end up with a number of resolutions, including one supporting constitutional recognition of Indigenous people, that will help drive our policy and advocacy over the next year.
We’re also very keen to broaden the concept of social determinants of health to include psychological and emotional determinants. We’ll see that in some of our keynotes, which include:
- World Federation of Public Health Associations President James Chauvin: the international challenges for public health practice with a focus on more effective advocacy.
- PHAA President Associate Professor Heather Yeatman: ramifications of the change of government and the challenges in ensuring ‘a fair go’ and better health for all Australians.
- Professor Sharon Friel, Professor of Health Equity at the Australian National University: the importance of the physical environment in health, including housing, transport, employment, income, education and social support.
- Professor Billie Giles-Corti, Director of the Melbourne University School of Population Health: the contrast in health outcomes and the policy implications between low density neighbourhoods on the urban fringes and intense redevelopment in inner city areas.
- Professor Darrin Hodgetts from the University of Waikato on structural violence and health. He will look at the increasing proportion of New Zealanders who are living in poverty, using a study of 100 households in Auckland to discuss impacts on families of conditionality and structural violence as core issues with adverse impacts.
- Professor Kerry Arabena, Chair of Indigenous Health at Melbourne University: the concept of regeneration, looking at relationship between healthy places and healthy people particularly in the context of Aboriginal and Torres Strait Islander people.
• Follow the conference news on Twitter at #PHAA2013.