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Concerns about the future of public health in Tasmania (& some killer tweets)

Wonky Health columnist Dr Tim Senior is quite the wordsmith, as per this recent tweet:

Wonky Health columnist Dr Tim Senior is quite the wordsmith, as per this recent tweet:

Meanwhile, another of Senior’s recent tweets prompted public health consultant Miriam Herzfeld to sound the alarm below about budgetary threats to the work of the public health sector in Tasmania.


Miriam Herzfeld writes:

I acknowledge Tim Senior for prompting me to write this article about the state of public health and population health in Tasmania. His tweet linked to the Public Health Association of Australia’s most recent conference stated:

“Did you know, while you were doing your everyday stuff, there were a group of people protecting your health?”
(18 September 2014)

This statement caught my attention as this is exactly what public health is about – it couldn’t be put more simply and profoundly.

Public health often operates in the background. Yes, there are times when public health stories hit the local newspapers/TV/radio (and there are of course dedicated online publications that focus specifically on public health), but generally speaking medical and hospital-focused stories are the order of the day.

And certainly in the political space, there is a well-established history of clinical prominence.

This is despite the enumeration of health as a human right in international agreements, which recognise that protecting and promoting health ought to be a priority of the highest order.

Without our health we have no certainty and we undoubtedly limit our quality of life. This leads me to ask the question – doesn’t the protection and promotion of health therefore deserve the highest attention of all levels of Government?

Many people in the wider community would probably define public health in terms of preventing epidemics, containing environmental hazards and encouraging healthy behaviours.

But it is much more than this. Public health recognises not only biological and environmental hazards but also the underlying drivers of health – the social determinants of health.

It champions the need for the promotion and improvement of health – to build resilience among populations so they can better withstand threats to health.

Public health recognises the need for collaborative action with non-health sectors – work which again is often ‘in the background’, yet fundamentally important.

As stated by Tasmania’s Director of Public Health in the most recent State of Public Health Report:

“Health inequities are evident across many specific health outcomes in Tasmania with clear evidence of social gradients and disparities in health status. These are avoidable in many cases because they relate to the conditions in which people are born, grow, live, work and age – including inequities in power, money and resources that give rise to these conditions.

These powerful underlying influences are collectively known as the social determinants of health, which need to be systematically addressed to achieve lasting change.

The focus for prevention cannot be on health risk factors alone. Policy and regulatory engagement by non-health sectors is also needed to address the underlying social and environmental causes of unhealthy behaviours and inequitable health outcomes.” 

Public health is strongly linked with the practice of population health. Population health seeks to describe and understand health problems, and initiate action accordingly: “Population health and public health are the combination of sciences, skills and beliefs directed to the maintenance and improvement of the health of all people through collective or social actions.” 

Knowing all this, let me return to my earlier question – doesn’t the protection and promotion of health deserve the highest attention of all levels of Government?

If the answer is ‘yes’, then what is the Tasmanian Government doing to protect and build capacity within Population Health in the Department of Health and Human Services (which in Tasmania includes Public and Environmental Health Services, Cancer Screening and Control Services, and Population Health and Wellbeing)?

To those of us on the outside, it appears, not a lot.

Population Health in Tasmania has suffered greatly already as a result of the Federal Government’s abolition of National Preventative Health Partnership Agreements.

Indeed, the Tasmanian Government attributes a reduction in Population Health funding to the cessation of National Partnership Agreements in budget forward estimates until 2018.

We certainly didn’t see the Tasmanian Government come out fighting when the Federal Government announced this decision.

This leaves me wondering just how much value our Government places on protecting and promoting the health of Tasmanians?

What isn’t apparent in the budget papers is how else Population Health will be impacted by the Tasmanian Government’s budget.

We’ve heard that a record amount of funding has been made available for health in Tasmania. So where is it being directed?

As members of the public, we’ve read that 700 public service jobs will go – but no ‘front line’ positions, only ‘back room’ workers.

Does this include our colleagues in Population Health – are they in the ‘back room’? And what if they are, does this make their roles less important? Quite the opposite!

We’ve been told that Government Departments need to find savings – just how much will the Government be looking to save from Population Health? How very short-sighted!

It is deeply concerning to me – as a public health practitioner, as a parent and a member of the community – that there is no obvious evidence that the Tasmanian Government elected in March values the protection and promotion of health. Let’s hope that this changes.

As health advocates, it is important that we continue to uphold the importance of population health, public health and health promotion, and raise our voices.

Health, after all is not merely the absence of disease or infirmity; it is a state of complete physical, mental and social well-being – and it is not possible to attain health for Tasmanians without the work of both ‘back room’ and ‘front-line’ Population Health practitioners.

• Miriam Herzfeld is a consultant, and Convener, Social Determinants of Health Advocacy Network (Tasmania, Australia)


Post Script from Croakey

Some similar themes were raised in this previous article by a senior public health leader from WA, Professor Tarun Weeramanthri, Something that’s needed saying for quite some time: the health system relies on more than the frontline players.

At the PHAA conference in Perth last week, Professor Weeramanthri was awarded the Sidney Sax Public Health Medal.

A statement by PHAA CEO Michael Moore said:

“Professor Weeramanthri is among the longest-serving Chief Health Officers in Australia, with more than ten years combined at the helm across the Northern Territory and Western Australia. 

He is a highly-respected and accomplished individual and an exemplar of the 21st century Chief Health Officer: scholar, physician, and advocate for health. 

His steadfast commitment to social justice, his dogged determination in championing preventive health and investment by governments, his capacity to embrace and lead change and his ability to infuse the same passion for – and commitment to – public health in others are exceptional. 

Most remarkable is his unwavering commitment to public service, his faith and knowledge of what good can be achieved through working in government and his personal endeavours in making a difference to the lives and wellbeing of communities he has – and continues to – serve.”




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