Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A bleak outlook for public health?

A bleak outlook for public health? “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness…. it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.….”. As this Journal has noted, December 1 marks the introduction of plain packaging for tobacco products. This world‐leading measure is being introduced as part of a comprehensive approach, following meticulous research, effective advocacy, and iron determination to act by committed Ministers with all‐party support. If any further justification were needed, it has been provided by the strength of Big Tobacco's opposition, along with once‐confidential industry research showing how important packaging is for tobacco companies in communicating with consumers of all ages. Our political leaders deserve great credit for pursuing this evidence‐based public health priority despite a fierce, expensive and misleading campaign from a lethal industry desperately worried that the plain packaging contagion may spread to other countries. Smoking in Australia is declining. While there is no scope for complacency, and much work yet to be done, trends are encouraging even in disadvantaged groups. Tax increases, advertising bans, well‐funded and hard‐hitting media campaigns, protection for non‐smokers, and a range of legislative and other support measures at both state and Federal levels have all played their roles as part of a comprehensive approach. Tobacco control in Australia is a beacon of hope both here and globally, showing that public health interests can triumph over the most evil and ruthless of industries. For tobacco control, at any rate, it is the best of times. Sadly, it appears that the lessons of tobacco have as yet not been well learned in other important public health areas. Action on alcohol lags decades behind. Despite evidence not only in scientific publications such as this, but also daily in headlines and on our television screens, increasing community concerns and tough talk from politicians, governments shy away from action that might offend the powerful alcohol industry and its allies. We also hear talk of concern from our leaders about obesity: how could they not be concerned when close to two‐thirds of the adult population and a quarter of our children are overweight or obese? There is now evidence that the rise in obesity has pulled the rug out from under some of the alcohol industry's desperate and dubious efforts to justify its activities on the basis that there might be some health benefits to the product. But the reality remains that at both Federal and state levels there is not even the start of a coherent policy response to this modern epidemic. Worse than this, there are early indications from incoming State and Territory governments that the fundamental infrastructure for public health, so long accepted as a core component of a modern health system, is under threat. Cuts announced by the new Queensland Government will damage the health system as a whole and appear to have targeted public health disproportionately, with no apparent thought to the consequences. The status of public health in Queensland has been downgraded: it is now the only jurisdiction where the most senior public health officer does not report directly to the CEO. The focus on protecting ‘frontline services’– defined as those where staff spend 75% or more of their time in direct patient contact – assumes that these are the only priorities for governments. Health protection, health promotion and system‐wide approaches to patient safety (surely an issue that should engage the attention of any Queensland decision‐makers) are not ‘frontline’ and so have become a soft target. Decentralisation to no less than 17 Areas, each of which will require their own bureaucratic structures, will see responsibility for public health devolved to Area Boards and administrators who will have little time for public health, less expertise and minimal resources. Even functions such as tuberculosis control are being devolved. Public health jobs are being cut disproportionately, as are public health services. Major programs in areas ranging from chronic disease and health promotion to alcohol and drugs have been ended or dramatically reduced. The public health workforce is being systematically dismantled. Grants to non‐government organisations addressing important public health concerns have been terminated or cut. Pioneering and evidence‐based programs with a proven success record (as in nutrition and obesity prevention) are to cease. Support for Aboriginal health programs, from chronic disease control to alcohol and drugs, has been cut, with the loss of key staff and services. Alongside the cuts, public health groups are being gagged. The Government's contracts with health NGOs require that any NGO receiving more than 50% of its funding from government is not permitted to advocate for legislative change at either state or federal level – or even to have a website link to organisations such as PHAA, the AMA, or WHO that do so. Fifty per cent today – who knows what tomorrow? Small wonder that most organisations and individuals working in public health, whether inside or outside government, are intimidated and unwilling to comment in the public arena. Meantime, the Queensland Government's first response to alcohol, gun control and gambling was to seek ways of making liquor licences and guns more accessible, and to offer further support for casinos. The policy response to Aboriginal alcohol problems is not only to do away with the hitherto successful Alcohol Management Plans for Aboriginal communities, but to reduce Aboriginal and other alcohol and drug services, as well as to cut funding for Queensland Network of Alcohol and Drug Agencies (QNADA) – the peak body that advocates for provision of such services. Evidence‐based approaches to HIV/AIDS with a good track record have been scrapped. Early indications from the new Northern Territory government are equally disturbing – policy on the run, worthwhile policies and programs scrapped, cut or under threat, and approaches to alcohol that seem focused at least in part on ensuring industry profitability; and the relatively new governments in New South Wales and Victoria have also cut funding for key public health programs. Public health advocacy over many years resulted in the establishment of a public health infrastructure and in the world‐leading tobacco control measures we can rightly celebrate. Public health organisations, leaders, practitioners and researchers must brace themselves for long‐term campaigns every bit as determined and co‐ordinated if we are to have any hope of countering the alcohol and junk food industries, and ensuring that a strong public health infrastructure is maintained around the country. Organisations and individuals concerned to promote and protect health have a duty to speak up and speak out. They must see advocacy for public health as a fundamental part of their work, whether leading the charge or providing support. They must convince governments and the community that public health is a frontline service, not a soft target. Otherwise, we will indeed face a winter of despair for public health, and hence for the health and wellbeing of the community. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

A bleak outlook for public health?

Download PDF
2 pages

Loading next page...
 
/lp/wiley/a-bleak-outlook-for-public-health-PJdImYNi6R

References (16)

Publisher
Wiley
Copyright
© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.2012.00939.x
pmid
23216475
Publisher site
See Article on Publisher Site

Abstract

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness…. it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.….”. As this Journal has noted, December 1 marks the introduction of plain packaging for tobacco products. This world‐leading measure is being introduced as part of a comprehensive approach, following meticulous research, effective advocacy, and iron determination to act by committed Ministers with all‐party support. If any further justification were needed, it has been provided by the strength of Big Tobacco's opposition, along with once‐confidential industry research showing how important packaging is for tobacco companies in communicating with consumers of all ages. Our political leaders deserve great credit for pursuing this evidence‐based public health priority despite a fierce, expensive and misleading campaign from a lethal industry desperately worried that the plain packaging contagion may spread to other countries. Smoking in Australia is declining. While there is no scope for complacency, and much work yet to be done, trends are encouraging even in disadvantaged groups. Tax increases, advertising bans, well‐funded and hard‐hitting media campaigns, protection for non‐smokers, and a range of legislative and other support measures at both state and Federal levels have all played their roles as part of a comprehensive approach. Tobacco control in Australia is a beacon of hope both here and globally, showing that public health interests can triumph over the most evil and ruthless of industries. For tobacco control, at any rate, it is the best of times. Sadly, it appears that the lessons of tobacco have as yet not been well learned in other important public health areas. Action on alcohol lags decades behind. Despite evidence not only in scientific publications such as this, but also daily in headlines and on our television screens, increasing community concerns and tough talk from politicians, governments shy away from action that might offend the powerful alcohol industry and its allies. We also hear talk of concern from our leaders about obesity: how could they not be concerned when close to two‐thirds of the adult population and a quarter of our children are overweight or obese? There is now evidence that the rise in obesity has pulled the rug out from under some of the alcohol industry's desperate and dubious efforts to justify its activities on the basis that there might be some health benefits to the product. But the reality remains that at both Federal and state levels there is not even the start of a coherent policy response to this modern epidemic. Worse than this, there are early indications from incoming State and Territory governments that the fundamental infrastructure for public health, so long accepted as a core component of a modern health system, is under threat. Cuts announced by the new Queensland Government will damage the health system as a whole and appear to have targeted public health disproportionately, with no apparent thought to the consequences. The status of public health in Queensland has been downgraded: it is now the only jurisdiction where the most senior public health officer does not report directly to the CEO. The focus on protecting ‘frontline services’– defined as those where staff spend 75% or more of their time in direct patient contact – assumes that these are the only priorities for governments. Health protection, health promotion and system‐wide approaches to patient safety (surely an issue that should engage the attention of any Queensland decision‐makers) are not ‘frontline’ and so have become a soft target. Decentralisation to no less than 17 Areas, each of which will require their own bureaucratic structures, will see responsibility for public health devolved to Area Boards and administrators who will have little time for public health, less expertise and minimal resources. Even functions such as tuberculosis control are being devolved. Public health jobs are being cut disproportionately, as are public health services. Major programs in areas ranging from chronic disease and health promotion to alcohol and drugs have been ended or dramatically reduced. The public health workforce is being systematically dismantled. Grants to non‐government organisations addressing important public health concerns have been terminated or cut. Pioneering and evidence‐based programs with a proven success record (as in nutrition and obesity prevention) are to cease. Support for Aboriginal health programs, from chronic disease control to alcohol and drugs, has been cut, with the loss of key staff and services. Alongside the cuts, public health groups are being gagged. The Government's contracts with health NGOs require that any NGO receiving more than 50% of its funding from government is not permitted to advocate for legislative change at either state or federal level – or even to have a website link to organisations such as PHAA, the AMA, or WHO that do so. Fifty per cent today – who knows what tomorrow? Small wonder that most organisations and individuals working in public health, whether inside or outside government, are intimidated and unwilling to comment in the public arena. Meantime, the Queensland Government's first response to alcohol, gun control and gambling was to seek ways of making liquor licences and guns more accessible, and to offer further support for casinos. The policy response to Aboriginal alcohol problems is not only to do away with the hitherto successful Alcohol Management Plans for Aboriginal communities, but to reduce Aboriginal and other alcohol and drug services, as well as to cut funding for Queensland Network of Alcohol and Drug Agencies (QNADA) – the peak body that advocates for provision of such services. Evidence‐based approaches to HIV/AIDS with a good track record have been scrapped. Early indications from the new Northern Territory government are equally disturbing – policy on the run, worthwhile policies and programs scrapped, cut or under threat, and approaches to alcohol that seem focused at least in part on ensuring industry profitability; and the relatively new governments in New South Wales and Victoria have also cut funding for key public health programs. Public health advocacy over many years resulted in the establishment of a public health infrastructure and in the world‐leading tobacco control measures we can rightly celebrate. Public health organisations, leaders, practitioners and researchers must brace themselves for long‐term campaigns every bit as determined and co‐ordinated if we are to have any hope of countering the alcohol and junk food industries, and ensuring that a strong public health infrastructure is maintained around the country. Organisations and individuals concerned to promote and protect health have a duty to speak up and speak out. They must see advocacy for public health as a fundamental part of their work, whether leading the charge or providing support. They must convince governments and the community that public health is a frontline service, not a soft target. Otherwise, we will indeed face a winter of despair for public health, and hence for the health and wellbeing of the community.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 2012

There are no references for this article.