WHO WILL PAY FOR PUBLIC HEALTH?

Public health, whatever else, concerns the health of the public.  It takes an interest in the well community whereas the health care system concentrates on general practice, emergency services, and hospital beds (and waiting lists for those beds) for people seeking to be as healthy as they can, but who are at present, sick. 

Public health supports clean and safe environments, immunisation, a secure and safe food supply, health education, healthy children, occupational health and safety, among others.  It takes a dim view of tobacco smoking, excessive eating and drinking, unsafe driving and conditions that send people crazy. Latterly, given the rise of obesity and diabetes, it has promoted changes in the community such as cycle-ways, green spaces, non-isolationist urban design and paths - all of which make it easier to exercise, easier to avoid cigarette smoke and easier to work out which foods to buy.  It has a broad reach and for something that consumes less than 2% of the health budget has done pretty damned well.

While several aspects of public health can be best developed locally, as the healthy cities movement of two decades ago showed, there is a big chunk of it that is state-wide.  It is unlikely that a mass media project conveys important messages only for a region of, say, NSW.  True, with Indigenous health, public health must take a local approach.  But even in that case, there are public health matters, such as housing policy, that require state-wide action. A moment’s reflection on flu epidemics supports the view that other public health problems require a national (if not international) public health response. 

For a secure public health future, we need policy and a strategy that links the federal to the local via the states and territories. That strategy could set goals.  The Preventative Health Taskforce, leading to the establishment of the Australian National Prevention Agency, provides an excellent national focus for public health.

With the decentralisation of the public hospital system as part of national health and hospital reform, great care is needed to ensure that we do not stuff up public health.  It is easy to neglect.  State-wide and national things can easily get run down.  I spoke with Tommy Thompson (the then Secretary of the US Department of Health and Human Services) in 2001 shortly after 9/11 and the anthrax scare was in full swing.  He was shocked to discover how run down the US public health services were, incapable of rising to the challenge.  Big investments in public health followed as part of the massive move to improve homeland security.
I am not suggesting we are facing an equivalent challenge to anthrax in the mail system, but we do face problems that cry out for public health energy, ranging from environmental concerns to Indigenous health, through childhood obesity, to the blindly ignored alcohol abuse problem in Australia.  Policy and strategy are needed.