David Thomas – Menzies School of Health Research, Darwin.
Last week in the Medical Journal of Australia, Rosalie Schultz from the PHAA Environment and Ecology Special Interest Group examined a government report into increased cancers and stillbirths near the Ranger uranium mine in the Northern Territory. The mine operated for forty years, with numerous spills, leaks and other radiation exposure incidents, until it closed in January this year.
The report confirmed the increased incidence of cancers and stillbirths in Aboriginal people living near the mine compared to the rest of the Top End. But it concluded that this increased incidence was unlikely to be due to ionising radiation from the mine. Similarly, there was inconclusive evidence about the role of higher levels of smoking and alcohol consumption in the region.
The government report is an epidemiologically rigorous exploration of the research question. But that is not where public health stops. Rosalie’s article also raises the bigger picture of ongoing concerns about the broader political, social and economic impacts of the mine, disrupting local Aboriginal peoples’ lives and undermining local Aboriginal self-determination, not just concerns about radiation-related disease.
This bigger picture is an essential element of the public health approach, and the approach of the Public Health Association of Australia.
It has been this way for a long time.
Reading Rosalie’s article, I remembered a short article I wrote as the NT Branch President in inTouch last century, when is it was still a paper-based newsletter sent out to all PHAA members: ‘How can PHA help stop uranium mining in Kakadu?’ Just as with her article, I explained that this issue was linked to the bigger picture of supporting Aboriginal self-determination and the importance to Aboriginal health of Aboriginal connections to land.
Public health people now talk about this bigger picture as the social and cultural determinants of health. We also now talk about the corporate determinants of health, just as the InTouch article many years ago talked about the enormous political pressure applied by the mining company, Energy Resources Australia, and Mirrar people’s justifiable distrust of political processes and research tainted by pressure from the company.
The title of the old inTouch article, emphasised public health action. The NT Branch, with support of the national secretariat in Canberra, had been lobbying politicians, using a PHAA policy opposing uranium mining adopted at the 1996 PHAA conference in Perth. PHAA now has 92 policies covering many aspects of public health to provide a secure foundation for its public health advocacy. These are regularly reviewed and revised in the lead up to annual conferences.
I was later told this inTouch article was bought up often by the Howard government officials with our national office just before they pulled our funding as a peak health organisation (other peaks were also defunded, it was that sort of a time). To their credit, PHAA never tried to distance themselves from this sort of public health informed advocacy or the short inTouch article or make me feel bad about it. Even though we suffered for a few years as subscription fees had to raised significantly to cover costs, PHAA remained clear that advocacy and talking back to government when the evidence called for it was an essential part of public health and PHAA could not be bought off.
Nowadays, PHAA’s thoughtful and rigorous contributions to policy debates are expected and generally well-received by government officials, even when they provide a different view to the government. However, the Morrison government has been attempting to curb advocacy by green groups and other charities through changes to Australian Charities and Not-for-profits Commission. PHAA has publicly joined with these groups to oppose these amendments.
Finally, it must be said that the important local public health concerns about uranium mines in Kakadu are both dwarfed and compounded by bigger immediate and existential public health concerns caused by climate change, and the, as yet inadequate Australian and global policy response. The release of the latest Intergovernmental Panel on Climate Change report earlier this month lays out the evidence of rapid and intensifying climate change, and the urgent need for strong and sustained reductions in CO2 emissions.