Mourning the demise of public health nutrition in Queensland
Queensland will lose most of its health promotion and public health nutrition positions as part of the recent budget cuts, which were described in a recent Croakey article as “the greatest dismantling of public and preventative health services in recent Australian history”.
In the heartfelt article below, Dympna Leonard, who has worked in public health nutrition in north Queensland since 1992, says the impact will be devastating, particularly upon Indigenous health. (Update: also see the link at the bottom to a must-read article by psychiatrist and public health physician Ernest Hunter, Aborigines will bleed from cuts).
A eulogy for public health nutrition in north Queensland
Dympna Leonard writes:
Last month I mourned my father after his death at 92 years of age – he had lived a full and vital life, humorous to the last even when age become a burden. Old age is not for the faint hearted, he’d say. With my family, I mourned his loss but acclaimed his life, his wit and his achievements, with joy.
This month I am mourning again – this time mourning the loss for north Queensland of all that public health nutrition has initiated and achieved. Unlike my father’s life, this is a life cut short. On September 7, we were told that all of the public health nutrition positions and health promotion positions in regional Queensland are to be abolished. Only a handful of positions will remain – ironically in corporate office.
My farewell to public health nutrition is a north Queensland view – I don’t even attempt to pay due tribute to the work of all my colleagues across the state – but here in the north, this is what I mourn.
I mourn the loss of our work on food supply for remote communities – the food basket studies, mapping the cost and availability of basic foods, the RIST work (Remote Indigenous Stores and Take-aways) and the work with Menzies School of Health Research on the RIST electronic program for nutritionists to track sales of foods and drinks in the remote stores, the work with store groups to upskill their staff, and the partnership with the Jimmy Little Foundation to badge healthy food in the remote stores.
I mourn the ‘Growing Strong’ work we do on healthy eating in pregnancy and early life, especially for Indigenous mothers, babies and young children, our work to support breastfeeding which protects babies from gastro and other infections, and reduces the risk of diabetes and other chronic disease which decimate Indigenous adults.
And I mourn the ‘Sprinkles’ work with the Fred Hollows Foundation to prevent iron deficiency and anaemia in little kids – essential if we are to ‘close the gap’ in educational attainment.
I mourn our work for healthy food and healthy growth of children, to reduce the tsunami of junk food and soft drink that bloats them into obesity, even in childhood – more diabetes and heart disease, more kidney failure to come.
I mourn our work on healthy weight and healthy lifestyles for adults, the Nutrition and Physical Activity Brief Intervention, Living Strong and Lighten Up, all part of the fire power for our ‘frontline’ colleagues, dealing with chronic disease.
Then there’s our work on fruit and vegetable promotions. Veggie Man is back in his box – well, he has had his day and did good work, travelling across the north – but who will here to support next fruit and vegetable initiative?
I mourn the joint work with our health promotion colleagues and their collaborations with local governments to make physical activity part of everyone’s life, from the youngest to the oldest.
Then there is the work in the pipeline: policy documents that will impact of health and nutrition for years to come, currently the National Food Policy, then the planned National Nutrition Policy – who will contribute a north Queensland nutrition perspective there?
There is the work on scaling up the Fred Hollows intervention to prevent early childhood anaemia, the move to World Health Organisation growth charts so we can properly assess the growth of our children, the collaborations with remote stores to cut the sales of sugar laden soft drinks, the update of the survey ‘market basket’ in line with the revised dietary guidelines, the work needed on folate fortification, so it achieves the same benefits in remote Australia as it has elsewhere.
A short, sharp, intensive response works for a dengue outbreak or Yasi-style disaster (and we were trained to assist with disaster response as well). But chronic disease prevention needs a continued input, increasing investment and constant commitment.
And there will be commitment and investment again. Four years ago Queensland Health’s Chief Health officer reported that poor nutrition accounts for 16% of premature death and ill health In Queensland and two years ago, that obesity had overtaken smoking as the single greatest risk factor to the health of Queenslanders (Queensland Health. The Health of Queenslanders: Prevention of Chronic Disease 2008 and The Health of Queenslanders 2010).
In her introduction to her 2010 report, the Chief Health Officer warned ‘unless the challenge of the increasing burden on the health system is met by an increased focus on prevention …. there will be a never ending and increasingly expensive need for more beds to be provided in Queensland hospitals. There is indisputable evidence of the power of prevention.’
Government policy may have changed but these realities have not.
Eventually Queensland will invest in prevention once again – but in the meantime, the momentum of years of learning and experience will be dissipated.
Which brings me to what I mourn most of all. I mourn for my younger colleagues, Indigenous and non-Indigenous – their expertise devalued, their careers cut short, their commitment, their innovation, their humour, their drive and their energy – all discarded, when it is so badly needed. I mourn for the ones who have worked for twenty years, and for ten, for five and for two.
And I mourn for the cohort of eager, bright, young students, due to graduate in a few weeks time. We had the pleasure of hosting some during their student placements – what talent – and now, after years of hard work and study, they graduate to a professional wasteland.
My ole dad used to joke that he was well past his ‘use by’ date – he lived fourteen years longer than the average Australian male. By contrast Indigenous Australians have a life expectancy nearly 20 years less than other Australians - a huge gap.
Much of the work we did was aimed at closing that gap, so there is anger too – anger about the impact of these cuts on health, and especially on the health of Indigenous north Queenslanders
So, farewell public health nutrition in north Queensland. There is no joy in my farewell to compensate for this loss.
• In the Weekend Australian, psychiatrist and public health physician Ernest Hunter predicts that the Queensland Health cuts will have adverse effects for Aboriginal and Torres Strait Islander health.
He writes: “The loss of state-wide multi-disciplinary public health capacity – that is, population health teamwork – that will follow the fragmenting of the nutrition and other public health activities will further increase the risk that Aboriginal and Torres Strait Islander children will experience cardiovascular problems, diabetes and mental disorders later in life.”
He says the “the particular vulnerability of health promotion and indigenous health can be understood to reflect their priority in the political vision of Queenslanders’ health needs”.
Hunter also questions the political and public bad-mouthing of “non-frontline” staff. He writes:
… the documenting of activity and the liability-obsessed culture of government services is such that if there are substantial cuts to administrative staff with an expectation of the same levels of activity recording, there will be significant consequences for the amount of time clinicians can spend with their patients. – already a major issue.
When a team is required to play on with fewer members, the demands on the remainder left on the field is proportionally greater – and the clinicians I know are already flat out. I might add that the management and administrative staff with whom I have worked across two decades have done so with professionalism and dedication, and it is disingenuous to demean their contribution in the service of rationalising downsizing.
As Peter Dutton welcomes Queensland Health upheavals, an authority on remote area health warns about the long-term consequences