A strong, effective public health workforce has been critical to Australia’s successes in preventing the worst of COVID-19. But gaps have been revealed – gaps that can be readily eliminated to help Australia fight off this – and any future – pandemic.
The public health workforce at the forefront of the COVID response is made up of a diverse range of professionals: epidemiologists, public health nurses and physicians, contact tracers, behavioural scientists, outbreak modellers, genetic tracers. Public health workers have long worked from the shadows but are now being recognised for their contributions.
While frontline health workers – nurses and doctors – have rightly received tremendous accolades for their bravery and commitment to duty in extremely challenging circumstances, the reality is that under 5% of those infected by the virus are ending up in the hospital system. But the other 95% can’t be ignored – to do so would be letting the epidemic spread uncontrolled. For every positive case, an army of workers sifts through the individual’s recent movements and contacts, reaches out to them, tracks their health and further movements – in order to stop the virus in its tracks. Genetic data is used to understand – and then block – the pathways that the virus is taking through Australian society. Public health workers also engage with communities in all languages and cultures to help spread appropriate information and to fight misinformation. They understand that what happens inside bodies is dependent on what happens outside bodies, on having the right supports, resources, awareness and relationships in place, not just in the hospital, but in the whole community. They are the unsung heroes of our collective response.
Australia has been incredibly well served by its public health workers. In the US – where there have been almost 6 million cases and almost 175,000 deaths – local public health departments have lost 50,000 jobs between 2008 and 2017 and budgets were cut by a quarter. America’s national Prevention and Public Health Fund was pillaged over many years. Contact tracing – the mainstay of Australia’s success – has been underused in the US and the United Kingdom – another heavily affected country – is still trying to figure out how to do it.
Compared to the fiascos overseas, it is no wonder that some are calling for Australia’s public health workers to be nominated for Australian(s) of the Year. Despite that, the recent second wave has highlighted potential weaknesses.
On Friday, the secretary of the health department and former Chief Medical Officer Brendan Murphy praised NSW’s response to COVID-19 in “effectively stamp[ing] out an outbreak of a similar size to that in Victoria”. He lauded NSW’s contact tracing and strong public health teams in each local health district and highlighted NSW’s decentralised structure and strong “leadership from public health physicians”.
NSW’s Public Health Officer Training Program has been in place for 30 years and has trained 182 specialist public health workers – many of whom have been critical to the response over the past eight months. By comparison, there have been claims that the number of public health officers in Victoria has been in decline for 18 months before COVID hit Australia.
The failure to invest in public health and prevention is widespread across Australia. We spend less than 2% of national health expenditure on public and preventive health. These limited funds do not only cover infectious disease preparedness but activities to prevent obesity and heart disease and to improve nutrition.
At the recent NSW election, there were massive promises by the victorious Liberal government for hospitals – billions for Randwick, Westmead, Nepean, Liverpool hospitals to treat those already sick – but investments in keeping people out of hospital are scant.
We all now realise the importance of a well-trained, well-supported public health workforce. The epidemiologists and modellers, the contact tracers, those communicating with us through social media or the phone or through our TVs.
First of all, NSW’s successful Public Health Officer training program should be expanded across the country into every jurisdiction. This would create a cadre of professionals in each local government area with the skills and connections needed to manage and prevent local outbreaks.
Funding for public health education – which was cut in 2010 – should be revived to ensure training programs are offering high quality cutting-edge programs for the future workforce.
In the COVID era, public health training should become a requirement of those leading our health system. It would perhaps surprise us to know that none of the last six national Chief Medical Officers held a degree in public health – though the current Acting CMO Paul Kelly has a PhD in public health.
All of our Master of Public Health students across the country should be trained in contact tracing so that they can serve as surge capacity for any future wave or future pandemic. And as has occurred across the country, Schools of Public Health should continue to provide staff and students to buttress the national and local COVID responses.
Australia’s public health workforce has played a critical role in keeping Australians safe. The conversation about strengthening its capacity is not one we can delay.
Professor Joel Negin has been the Head of the School of Public Health at the University of Sydney since November 2015. Joel graduated from Harvard and Columbia Universities and then worked for a number of years in sub-Saharan Africa on health and development projects before moving to Australia. In those years, he lived and worked in South Africa, Zimbabwe, Botswana and Kenya and collaborated with governments, the World Bank, academic institutions and United Nations partners. Joel holds grants from the NHMRC and the Department of Foreign Affairs and Trade focused on strengthening health systems in low and middle income countries. He maintains collaborations in Uganda, Vietnam, Indonesia and Fiji and maintains a passion for capacity building in the Asia-Pacific region.