Public Health Practice in Australia

The organised effort

Vivian Lin, Jim Smith, Sally Fawkes

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000246988
• Edition: 2
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Public Health Practice in Australia offers a thorough introduction to what public health practitioners do, and the 'effort' involved in improving the health of the public.This second edition has been fully revised and updated in line with current policies and practice. It highlights common threads that underlie seemingly disparate activities, ideas and entities that comprise the organised effort of public health practice. The emphasis is on securing and maintaining the conditions in society that enable people to live healthy and fulfilling lives.The authors examine the impact of historical, social, economic, environmental and political factors on the health of individuals, communities and populations. Taking an applied, multidisciplinary approach, they outline the strategies and tools that public health practitioners use to improve health outcomes: identifying infrastructure needs in the workforce, public and private sector organisations, and in regulation; gathering, analysing and using health data; applying interventions in health policy, provision of health services and health promotion. Public Health Practice in Australia draws on current international and Australian research and the interwoven case studies make the theories and concepts come alive. It is a valuable resource for students and professionals across the health sciences including public health, medicine, environmental health, health promotion, health information management and health administration.'The book is impressive in the completeness, clarity and consistency of the material covered, and for the way in which many of the theoretical issues are related to current practice. An extremely useful and valuable reference for both students and practitioners alike.' - Thomas Tenkate, Environmental Health

Part I
Background: The basics

1
What is public health?

Definitions and applications

Challenge

Imagine your dearest friend or relative has fallen dangerously ill. A few hours later, someone else very close to you comes down with the same symptoms, and within just one day all of your neighbours are similarly affected. It becomes clear that you are the only person who will remain healthy in your area. What would your reaction be? Would you feel that your obligations had been fulfilled when you ensured that each of your ill friends was admitted to a hospital where they would receive the best possible care? Would you make sure that your neighbours received the same kind of care? Or would you also start to wonder what experience or environment these people had shared, and how it was that you were spared from illness? If so, you would have moved from thinking about your private concerns for particular people (and for yourself) to a broader concern for what has been called the public domain or the common good. These kind of concerns, and the activities that follow from them, shape an important area of effort in the public domain. It is called public health.

Introduction: Not just public hospitals or ‘rats and drains’

Public health is not easy because different people hold strong opinions about what it is and is not. The meaning of 'public health' is very important to a wide range of people who work in the field (i.e. public health practitioners). In addition, the impact of public health actions is important to society as a whole.

Generally, what people think is meant by the term 'public health' depends on their awareness and level of engagement with the various elements that make up public health. Many are not aware of the scope of public health, and therefore the meanings and values ascribed to it are diverse. For example, some older people may think that public health is about past epidemics of flu or polio. A young mother may believe public health is all about child immunisation. A high school student may remember 'quit smoking' campaigns. A parent may conjure up an image from the 'Slip, Slop, Slap' campaign against skin cancer. A young person may recall a notice on an airport restroom door about condoms and safe sex. For others, public health means the public hospital system. Many also think of public health as the work of the historical health inspector—colloquially referred to as the 'rats and drains' part of local government's role of looking after 'rates, roads and rubbish'. Some health professionals might see public health as all those other health workers who 'do' public health work. In fact, all of these activities and messages are associated with modern public health practices; however, as you will see in the course of reading this book, the scope of public health is far greater than these important, but specific activities.

In the following chapters, we discuss some of the different ways in which the field of public health has been defined in the literature and how the practices of public health have been defined in different countries, along with the systematic underpinnings necessary for their delivery. Taking the perspective that what we do today is 'path dependent' (that is, historical decisions shape future choices) in relation to events over time and specific choices made by society, We will also provide a brief overview of the role of public health in history, and how the modern understanding of public health differs from the practices of our ancestors. Finally, we describe the health challenges facing Australia today, look at how well the Australian health system serves public health interests, and examine the place of public health in the Australian health system, including providing a sketch of its crucial relationship with other areas of public administration.

Society as the central feature: Not just the community or the country but also the world

No man is an island, entire in itself; every man is a piece of the continent, and part of the main ... Any man's death diminishes me, because I am involved in mankind. (John Donne, in Carey 1990: 344)

As Donne observed in the seventeenth century, no person is truly isolated from others. This is particularly true of public health, which starts with a concern for many people, and is connected with almost everything important to people's lives, experiences and well-being. Historically, public health initiatives were concerned with the welfare of those people whom a particular community, city or nation-state considered worthy of care, and this might (or might not) have included all the people who lived in a particular place. One of the distinguishing features of public health as it is understood today is that it is concerned with the well-being of allpeople, largely (although by no means always) without regard to how important or valuable they are to society.

In 1958 the eminent medical historian George Rosen described the relevance of public health to communities, and then expanded the notion of public health to include nations and the international community. He noted that:

Throughout human history, the major problems of health that men have faced have been concerned with community life, for instance the control of transmissible disease, the control and improvement of the physical environment (sanitation), the provision of water and food of good quality and in sufficient supply, the provision of medical care, and the relief of disability and destitution. The relative emphasis placed on each of these problems has varied from time to time, but they are all closely related, and from them has come public health as we know it today. (Rosen 1958: 25)

With regard to this wide range of problems, Rosen observed that:

The manner in which these have been handled has always been connected with the way of life of the community and the scientific and technical knowledge available to it ... In all countries, there are problems of community health that require social and political action guided by available knowledge ... the horizon of health workers today can no longer be limited to the local or even the national community but must extend to the international community. Today, we are all members of one another; and so each in our own community, we must strive toward a goal of freedom from disease, want, and fear. (Rosen 1958: 495)

Rosen was guided by what he (and other public health experts of this period) described as 'humanism'—a general concern for the well-being of allpeople, regardless of their status in specific societies, or even the society from which they came. At the time he wrote his text, public health experts were beginning to explore the possibility of international health programs, delivered and coordinated through the emerging bureaucratic institutions. the United Nations (UN) and the World Health Organization (WHO). Many people had long understood that epidemic disease, for example, was not confined to individual nations or communities and did not respect borders. However, prior to the latter half of the twentieth century, international health programs were restricted largely to the activities of colonial powers in their respective territories, and those of some charitable institutions, such as the Rockefeller Foundation. Subsequently, politicians and health experts around the world began to take important steps to approach public health from a global perspective, rather than being limited to the horizons of their own countries. Although this vision has not yet been achieved, a great deal of progress has been made in past decades to act upon this global perspective of public health. The international community is more interested in the health and well-being of people, regardless of which nation they come from. This is evident in international food-aid programs, war relief and coordinated efforts to control the spread of epidemic diseases from country to country. Events such as the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, the 2004 South–East Asia tsunami and 2009 H1N1 flu pandemic attest to the global nature of our health concerns and public health efforts.

The definitions

A science and an art

Given this breadth of concern and activity, what is a definition of public health? Rosen's statement about the focus of public health is similar to that provided by one of the early leaders of...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of tables and figures
• Abbreviations and acronyms
• About the authors
• Introduction
• Part I Background: The basics
• Part II Conceptual and analytical toolkit: Key concepts and frameworks
• Part III Public health infrastructure: Building blocks and the system of delivery
• Part IV Public health action: Key interventions from past to present
• Part V Public health challenges: Emerging issues and responses
• Appendices
• Useful resources
• Sources for definitions
• Bibliography
• Index