Jeremy Lasek – PHAA
The PHAA was privileged to have Professor Tom Calma AO, one of Australia’s leading First Nations human rights and social justice campaigners and the Chancellor of the University of Canberra, deliver the annual Basil Hetzel Oration at our 2021 Public Health Conference.
Much of his address focused on Australia’s response to the COVID-19 pandemic, especially in Aboriginal and Torres Strait Islander communities. He praised the work done in, and by, local communities – urban, regional and remote – in grappling with the pandemic response.
“We continue to see the critical roles that our communities play on the news, every day and every night,” Professor Calma said.
“I particularly want to emphasise this today as we all struggle with rapidly changing environments and various lockdown protocols in our respective locations impacting everyday life, often for the greater good of the community.
“This reality was almost unimaginable two years ago. These are very challenging times. This is hard and it’s new to the majority of the Australian population who only ever experienced a pandemic on TV.”
Professor Calma paid tribute to the front-line workers, and all in the public health workforce, for the life-saving work they’re doing.
“The impact and hardship that is being experienced is not lost on me, or many in the population, I’m sure.”
He touched on many lessons learned from the pandemic, and many successes which should be celebrated.
“I mention the importance of celebrating these wins for several reasons, as we tend to bounce from issue to issue, putting out fires as quickly as we can,” he explained.
“This pace is not sustainable, and I particularly appreciate that there is a very real risk of public health burnout. We have a public health sector, and in health more broadly, that has been under immense pressure, like never before and for a long period.
“This is one reason amongst many that we need to take a minute to pause, acknowledge the successes and key learnings, to reset, to re-energise and relaunch.”
Professor Calma said it was important that many of the infection prevention and control measures such as hand hygiene are maintained once the pandemic is over. He described these simple steps as having “a significant positive impact in remote communities” and becoming normalised.
“We’ve also seen improved access to telemedicine with clear benefits to a wide range of clients, helping to improve access to fundamental services, particularly those in rural and remote settings,” he said.
The vital role of communications
Professor Calma said society has learned about the importance of clear, consistent, coordinated, timely and reliable communications, and the ramifications when this doesn’t occur.
“Our chief health officers are regularly communicating with the media directly, coming into households around the country, providing situational reports on a daily basis and outlining the next steps in the fight against COVID,” Professor Calma said.
“The ever-evolving role of social media is something public health continues to grapple with as a tool. We’re learning to embrace it to communicate and engage with the public and to use social media to counter misinformation.”
One of the few positives to come from the pandemic is that the world now has a much better understanding of the importance of public health and epidemiology, Professor Calma said.
“This is a great opportunity to build on this momentum, particularly as we expect to see the national preventive health strategy 2021-2030, and a new national tobacco strategy released in the near future.”
He said Australians should not underestimate the opportunities this may bring to improve the nation’s health and wellbeing, and foster an environment for Australians to thrive.
The pandemic, he said, has also been educative.
“Every evening, as we discuss and debate the intricate details and impacts of COVID responses and the vaccine rollouts, we become ‘experts’, and most of us now know what an epidemiologist actually does.”
The pandemic had also provided an opportunity to witness and acknowledge ‘Indigenous excellence’ where Australia’s First Peoples were often in the ‘driver’s seat’.
“The COVID-19 co-design process for example, has been exceptional and a refreshing opportunity to meaningfully collaborate for the community’s benefit. These tireless efforts do not go unnoticed and they bode well for the future.”
Professor Calma said Aboriginal and Torres Strait Islanders have often been in a position to lead, noting this was not the first pandemic to reach Australia.
He said since colonisation, the world’s oldest living culture has demonstrated time and again “how its resilience and experience continues to shine” and survive introduced diseases such as smallpox.
“Ask us,” he said.
“Listen to us. Share with us. We’re in the tent, and our challenge is to be invited to stay.”
The health risk, he said, for Australia’s First Peoples, remains too high to ignore.
He cited an article in the Australian New Zealand Journal of Public Health that found more than half of every Aboriginal and Torres Strait Islander adults – almost 300,000 people – were under increased risk of experiencing severe illness if they contracted COVID-19 and were unvaccinated.
That study found that 59 per cent of Aboriginal and Torres Strait Islanders were currently at risk due to pre-existing conditions resulting from “the root causes of health inequities stemming from colonisation and experiences of racism,” he said.
“It is just one reason why Closing the Gap and fostering a safe space for Aboriginal and Torres Strait Islanders to thrive is so, so important.
“Our children’s lives are undergoing major upheaval as a result of the pandemic. The footprint this will leave on their mental, social, emotional and physical health and well being are yet to be fully realised, yet we can see it unfolding” before us.
“There are documented examples of Aboriginal and Torres Strait Islander peoples experiencing racism, as with many Asian people in the context of COVID-19,” he said.
These include “comments in healthcare settings, that Aboriginal people don’t wash their hands, and over policing of Aboriginal and Torres Strait Islander peoples in relations to quarantine requirements”.
Professor Calma said the pandemic has exposed deep-seated and painful experiences of racism.
“It is well established that Aboriginal and Torres Strait Islander children, in particular, experience higher levels of racism in everyday life,” he explained.
“Further, Aboriginal and Torres Strait Islander peoples experience structural and systemic racism, which uniquely and actively manifests in many ways, including dispossession of land, child removal policies, a disproportionately high incarceration rates. These are expressions of the deep injustices of ongoing colonisation impacts that persist today.
“There are children in our community who are getting sick from racism. The symptoms they present with at clinics, hospitals and healthcare services may not be explicitly diagnosed as relating to racism, but the contribution of racism is there nonetheless.
“Child depression, anxiety, behavioural difficulties, sleep disruption and suicide risk are all linked to experiences of racial discrimination.
“There is ever-increasing evidence that racism is associated with obesity, high blood pressure, inflammation…and many of these conditions are associated with increased risk of severe illness if COVID-19 is contracted.”
The ‘shadow pandemic’
Professor Calma also described a “shadow pandemic” as COVID-19 impairs the nation’s mental health, overwhelming support services, and amplifying existing inequalities.
“The evidence clearly demonstrates that during the pandemic those who lost their jobs, or have a decrease in paid hours, experience worse mental health outcomes,” he said.
“This includes increased psychological distress, loneliness, depression, anxiety and self-harm, compared to those who have steady employment and financial security.”
Australia needed to do more to support those most vulnerable, especially the young, to prevent them from tipping into a mental health crisis.
Current and solid data was needed to inform policy making.
“In March this year, the Victorian Government announced an inquiry into the impacts of colonisation on Aboriginal people,” the University of Canberra Chancellor said.
“It’s a first of its kind in Australia and will examine the social, economic, and health implications of colonisation on Aboriginal and Torres Strait Islander communities.
“This work has the potential to make substantive and substantial change, acknowledging the hard truths of Australia’s reality in order to move forward and reconcile together.
“Such monumental opportunities highlight that even in the midst of a pandemic, we can always reflect to learn and keep our eyes open for such significant opportunities, to reset, re-energise and re-launch.”
‘Smoking is killing us’
Professor Calma said another societal challenge, smoking began at European colonisation and continues to cause tobacco-related morbidity and mortality.
“Not only did colonisation entrench tobacco use amongst Aboriginal and Torres Strait Islander peoples, it actively placed Aboriginal and Torres Strait Islander peoples at the bottom of the socio-economic ladder,” he said.
“Tobacco use killed one-third of all Aboriginal and Torres Strait Islander peoples today, and half of Aboriginal and Torres Strait Islander people aged over 45 years.”
He called for specific tobacco controls efforts to be introduced nationally for Aboriginal and Torres Strait Islander people, in the same way that Australia’s decision to enact the world’s first plain packaging legislation in 2012 inspired many other countries to follow.
“These types of cutting edge tobacco control activities need to continue and be expanded to actively drive further health improvements,” he said, and added the fight against tobacco was not over.
“You’ve got the next epidemic, vaping, and it’s coming in and we need to get across it very early,” he cautioned.
“Tobacco continues to be the single largest contributor to morbidity and mortality. We need to keep accumulating evidence about what works best to reduce smoking and continue to expand evidence-based policies.
“The next iteration of the National Tobacco Strategy simply must accelerate improvements in tobacco-related outcomes based on the available research.
“Given the magnitude of preventable tobacco-related deaths and disease, there is a clear need for sustained and adequate funding, such as what’s being proposed in the Preventive Health Futures Fund as proposed by the Public Health Association in its submission titled Build Back Healthier.”
Basil Hetzel was a world leading Australian medical researcher who in the 1960s led research in Papua New Guinea that identified the link between iodine deficiency and significant brain damage in unborn children. In 1956, Hetzel became a founding member of the South Australian Mental Health Association, and along with other members, went on to assist with the establishment of the crisis support service Lifeline which still runs today. In the 1980s Hetzel, supported by the Australian Agency for International Development, became an international advocate for iodine supplementation, which is now taken for granted with iodinated table salt. Hetzel was the Chancellor of the University of South Australia from 1992, shortly after its establishment, until 1998.