Tim Flannery and colleagues at the new crowd-funded Climate Council (you can register support here) are setting a strong example in leadership and community engagement for the public health sector.
Their example also raises the question of whether public health – also facing cuts from the new Government – would have the community support and the leadership to respond similarly.
(Interestingly, Flannery highlights the need for health services to have good information about climate change to help prepare for the associated health risks as one of the reasons for the “moral imperative” for his work to continue, post the Government’s axing of the Climate Commission.)
Meanwhile, in the article below, health policy analyst Dr Lesley Russell investigates what Australia can learn from the public health leadership displayed by municipal politicians in the US, such as Michael Bloomberg, Tom Menino and Rahm Emanuel.
And she suggests we should be working towards having public health leaders elected into political office in Australia.
Where are Australia’s public health leaders?
Lesley Russell writes:
Despite its central role in health, public health is always, everywhere, the poor cousin to healthcare. Partly this is because of long-times frames for the delivery of outcomes, the difficulty of reporting on illnesses and accidents prevented in the future, and the urgency of treatments and care for illness and disability today.
But it is also because public health is about society, business and – critically – politics. Australia is not without public health champions, but they are not in the political sphere where they can really make things happen.
A paper published last year in the British Medical Journal made the case that the connection between health and societal progress has been severely weakened in recent times.
Nowadays in Australia public health policy is too often confined to issues of disease control when the need is to address the big issues affecting health that confront us in the 21st century – obesity, malnutrition, alcohol, tobacco, climate change and environmental pollution.
These challenges are not readily tackled through the healthcare system. They require public health approaches with recognition of the roles of urbanisation, the impact of modern media, the links between physical and mental health, the growing levels of social isolation, and health disparities.
The BMJ authors also make the case that public health advocacy “requires a political savvy not reflected in the mantras of evidence based policy.” That means leaders who see the big picture and are willing to take the political risks inherent in driving societal changes.
The importance of public health leadership in government is readily demonstrated in the work that is being undertaken in American cities like New York, Boston and Chicago. What can Australia learn from the roles played by municipal politicians such as Michael Bloomberg, Tom Menino and Rahm Emanuel?
New York City Mayor Michael Bloomberg has emerged as one of America’s leading public health advocates and has used his role to improve the health of New Yorkers through the implementation of a variety of creative, groundbreaking policies to increase access to healthy foods, provide opportunities and safe places for physical activity, and expand smoking bans.
Under his administration New York has imposed strict limits on artificial trans fats and required fast-food and chain restaurants to label their menus with calorie information. Much of the focus has been in low-income areas with the creation of the Healthy Bodega initiative, expansion of farmers’ markets that use the city’s Healthy Bucks coupons, and construction and improvement of playgrounds under the Schoolyards to Playgrounds initiative.
Mayor Bloomberg is a very rich man, and his route to politics and public health came through philanthropy. He helped build the Bloomberg School of Public Health at Johns Hopkins University into one of the world’s leading institutions of public health research and training.
Since being elected in 2001 he has expanded his work well beyond his city, and this will certainly continue when he steps down later this year. In 2007, he addressed the United Nations Framework Convention on Climate Change in Bali, and in 2010, he was elected Chair of the C40 Climate Leadership Group. In 2011, Bloomberg Philanthropies announced a $50 million commitment over four years to the Sierra Club’s Beyond Coal Campaign that is fueling clean air efforts and accelerating the transition to cleaner, cost-effective energy sources.
Bloomberg’s approach is to never to give up, and for the most part New Yorkers, who pride themselves on their fiercely independent style, have come to respect, and even like, his interventions in their lives. There is one glaring exception: his attempt to reduce obesity by limiting sales of large-size sugary drinks. This regulation was struck down by a state court and, unlike Mr. Bloomberg’s other health rules, never enforced.
In Boston, Mayor Thomas Menino, the city’s longest serving mayor, is also about to step down. Long before anyone else was talking about health disparities, Mayor Menino was addressing these through targeted and aggressive outreach. He acted to make restaurants smoke-free in 1998, at a time when such actions were definitely not popular or commonplace.
More recently he has followed New York’s example and implemented a Fit City program which examines how factors like community design, social policies, and resource distribution impact people’s healthy choices and physical health. And he has set goals and taken action to reduce the city’s carbon footprint.
Like Bloomberg, Menino’s public health credentials pre-date his election as mayor. In the early 1990’s, at the height of the AIDS epidemic, he was a little-known city councilor who took a public stance that needle exchanges should be considered as a means to slow the spread of HIV – thus demonstrating early his political courage.
In Chicago, Mayor Rahm Emanuel, former congressman and key advisor to President Obama, is a more recently elected mayor. Two years ago he launched “Healthy Chicago” – an ambitious public health plan to transform the health of Chicagoans by addressing issues including housing, nutrition, violence and cancer disparities with targets to be reached by 2020. The goal is healthy neighbourhoods, healthy homes and healthy people.
Ironically, as the president’s chief of staff in 2009, Emanuel urged Obama to delay action on his ambitious health care reforms – advice which was emphatically ignored. Only when Emanuel found himself personally responsible for the healthcare costs, productivity and quality of life of Chicago and its people did he find his public health policy backbone.
There are a number of issues that are common to these success stories. Foremost among them is that all three of these cities have strong, well-led and well-resourced departments of public health. This expertise was not built overnight, although it is undoubtedly true that good leaders and good governance attract a nucleus of good public health people.
Bold political leaders with far-sighted vision and a willingness to take risks are an increasingly rare and precious breed. But as these examples show, they can achieve so much.
This American leadership has also been about bringing others along with them. So the plans these leaders have implemented in their cities are not the province of public health departments alone, but look to bring in business and industry, healthcare professionals, urban planners, schools, communities of faith, and community groups as partners.
With a new federal government in power, it is timely to ask where those leaders are in Australia today and how can we build our public health expertise.
It is clear from the examples above that strong leaders in public health don’t necessarily come out of the public health sector, but it is also obvious that they need the backing of this sector to implement their ideas. We must also recognise that public health is not just for political leaders and bureaucrats, it is an essential element of every community.
In her address at the opening of the recent annual conference of the Public Health Association of Australian, PHAA President Heather Yeatman said:
“We are yet to embed the importance of public health within the community psyche, so that actions by governments that cut public services generate the public derision and backlash they deserve. At the moment cuts in public health services and programs do not even generate a whimper, let alone an uproar.”
We should take up her challenge to integrate public health into our communities and then perhaps we can increase the chances of getting public health leaders elected into political office.
• Dr Lesley Russell is Senior Research Fellow, Australian Primary Health Care Research Institute, Australian National University