Terry Slevin, CEO of the Public Health Association of Australia
For obvious reasons “the urgent” has also been “the important” in public health for much of 2020, and 2021 has seen that trend continue. It has been both vitally important and highly urgent that we manage all the challenging aspects of COVID-19. Assessing and communicating the risk, recommending responses, reinvigorating old public health measures, hygiene, physical distancing, isolation, quarantine, vaccines and so much more. In 2020 the world learned that without a healthy population, we cannot have a healthy economy.
And a quick scan of the international scene (nicely captured by Priscilla Robinson in her “CODE” series of reports on the way the pandemic is unfolding around the world) shows that the public health community in Australia has much to be proud of when it comes to the achievements of the past 15 months. Our national, state and territory governments have also responded well to the pandemic, largely by following expert public health advice, and should be commended for Australia achieving an envied international standard for the way we’ve managed the crisis.
But there is one major issue that remains important, yet struggles to become urgent.
Public health workforce.
Australia’s next generation of public health leaders are now waiting in the wings, preparing to step up to help ensure a healthy population. The past 12 months have demonstrated why we need more people qualified and trained up in public health, and the numbers signing on for courses this year reflect our community’s acknowledgment that this is now an urgent national priority. 2020 and 2021 have seen record numbers in applicants to public health tertiary education courses in Australia, and the story is similar internationally.
Research published in the Australian and New Zealand Journal of Public Health suggests a large growth in students graduating with public health qualifications in Australia over the last twenty years. The report shows in 2018 there were 2,023 students completing postgraduate courses in public health, a four-fold increase since 2001. There was also a three-fold increase in the number of bachelor graduates in public health courses over the same period. This represents an annual growth rate of six per cent for undergraduates and 8.4 per cent for postgraduate courses.
Most would agree that no education is wasted, especially public health education. However, the paper does not provide employment data on these graduates and the likelihood is that the large majority found post degree employment. The difficulty is that, anecdotally, many were either not in public health roles or were relatively peripheral to public health pursuits. Because public health jobs are too scarce.
We need to support and build the next generation of public health experts as quickly as possible. The research shows we have a willing and highly skilled cohort of people wanting to work in the field. This is an unmissable opportunity to better safeguard Australia against future public health emergencies. But the problem is, the job opportunities for newly-qualified public health professionals are not abundant due to a lack of government investment in the field.
This comes despite a commitment at meetings of National Cabinet on 26 June and 13 November last year to implement a new plan developed by the Australian Health Protection Principal Committee to boost Australia’s public health capacity and improve its long-term sustainability. These needs were highlighted more than ever during COVID-19 when it became clear the public health workforce is really overstretched.
The plan includes actions for state, territory and Commonwealth governments; including an enhanced national public health workforce training program, strengthening a formal surge plan, reviewing structures of public health units and enhancing the public health physician workforce capacity.
The Public Health Association of Australia (PHAA) is laying down a challenge to all governments in Australia to boost their commitment to develop the next generation of public health leaders. Recent correspondence between the PHAA and the NSW Minister for Health, Brad Hazzard, showed there is growing interest from governments in Australia to invest in public health workforce:
– The Hon. Brad Hazzard MP, NSW Minister for Health and Medical Research
At the time of the National Cabinet announcements, the public health field was greatly heartened by the commitment of our federal, state and territory governments to make new investment in our public health workforce a national priority. To date, however, there’s been no specific commitment from any Australian government to address the significant funding shortfall for public health, which lags well behind all other OECD countries.
This presents a major challenge in how well we can equip the country to deal with inevitable future pandemics, as well as the equally inevitable tsunami of chronic disease and other important public health challenges ahead. The PHAA is therefore calling on every Australian government to honour their National Cabinet commitments of 2020 and to use their 2021-22 budgets to invest appropriately to meet the future public health needs of the nation.
On 13 November 2020 the National Cabinet Statement endorsed the review led by Australia’s Chief Scientist Dr Alan Finkel of the contact tracing and outbreak management systems in each state and territory and agreed to adopt all 22 recommendations. The recommendations included “….states and territories should employ a permanent workforce for tracing and outbreak management, with senior public health leadership, and should have an additional surge workforce trained and at the ready. Contact tracing must never fall behind. In the event of an outbreak, every effort should be made to go hard and go early”.
We are hopeful that a subcommittee of the Australian Health Protection Principal Committee will be established to pursue two main initiatives as a means of advancing public health workforce for the future of Australia.
Firstly, the establishment of a national Public Health Officer Training Program, with all jurisdictions, including the Commonwealth, participating and creating opportunities for the recruitment and training of these public health leaders of the future. This needs to be a long-term commitment that will contribute to a strong and sustainable public health workforce, NOT a pilot program, and not a short-term initiative that evaporates during the next round of funding cuts.
Secondly, we need to conduct a thorough review of the public health workforce of Australia. This must lead to the development of a plan to address the many challenges in locking in a consistent, reliable pipeline for public health expertise in Australia for the long term. And once the plan is developed, it needs to be implemented.
This is how we will prepare ourselves to successfully face the next public health crisis, whether it is a pandemic resulting from a new viral infection, or the slower moving tsunami of chronic disease. We need our public health workforce expertise and capacity to protect the health of all Australians. This is not only an important issue, it’s an urgent one.
Terry Slevin is the CEO of the Public Health Association of Australia, and is also Adjunct Professor in the School of Psychology at Curtin University and Adjunct Professor in the College of Health and Medicine at the Australian National University.