Taking stock of progress in public health
Thirty years ago I was in Canberra visiting the late, great Sidney Sax, one of Australia's master craftsmen of public health and health service planning, then at the top of his game.
He came to Australia in 1960 as one of the South African diaspora (in his case via the-then Rhodesia) who felt seriously constrained, as socially concerned public health practitioners and physicians, by apartheid.
In Australia, Sax made a dazzling array of contributions to aged care, beginning in geriatrics and long-term health care, and then moving to health services administration and social welfare, through State and Commonwealth health departments and commissions.
It was late Friday afternoon and we had finished our business. Sid invited me to his home for coffee before my flight home. As we pulled into his garage and he turned off the ignition key, he just sat, silently contemplating. After what seemed much more than a minute he turned to me with a wry smile and said, “I always like to stop at the end of the week and ask myself what was that all about?''
Good question. We might benefit from asking that of ourselves each week, whatever our professional craft.
Think for a moment about tobacco and our success in controlling it.
It has taken great effort to claw smoking rates down from 34 per cent in 1980 to less than 20 per cent today in most of Australia. But the important thing is that it has happened.
All that educating, lobbying, fighting, taxing, plain packaging and banning advertising has been 'about' something hugely worthwhile. Hundreds of thousands of premature deaths and years of disability have been avoided.
And in relation to the health of our Indigenous people, great progress has been made as control of community health services has moved increasingly into Indigenous hands
I was present in Perth in the late 1980s when Neal Blewett, then Federal Health Minister, and Gerry Hand, Minister for Aboriginal Affairs, were debating and laying the foundations for the first national Aboriginal Health Strategy.
It took Aboriginal participation with novel seriousness. Sitting beside Gerry throughout the conversation was Charles Perkins, his departmental adviser, whose views were not often the same as those of his minister! But they conferred on almost every point.
Thousands of people have since contributed valiant efforts to closing the gap between Indigenous and non-Indigenous levels of health, by no means always successfully or happily. But they have made remarkable progress in Indigenous maternal and infant survival, infection control and immunisation. Huge challenges persist in diabetes, obesity, heart disease, renal disease, mental illness, alcohol and tobacco control, violence and trauma.
But, on the figurative Friday afternoon, we can say, in answer to our pre-weekend question, that we have been 'about' making steady progress with a big and complex problem.
How can we keep important public health matters, which often need decades of slog, alive after the first media fizz has gone?
I once asked Neal Blewett how he kept HIV/AIDS on the Hawke Government agenda for so long and to such outstanding effect.
His answer was, “I created a crisis each week in Cabinet!” Maybe jest, but advocates Simon Chapman and Mike Daube, with whom I have discussed Blewett's comment, confirm its central truth.
As doctors, we can bring to public attention, regularly and repeatedly, the crises caused by domestic violence, for example.
The rewards can be wonderful in the long term if our advocacy slowly changes social attitudes, as we have seen happen in relation to tobacco, where smoking is no longer normal, and helps achieve the steady, small gains we have made in Indigenous health.
Published: 15 Jun 2015