Intouch Public Health

Terry Slevin

I was recently invited by ABC Radio Adelaide to talk about our policy asks ahead of the March 2026 state election. The invitation followed the release of our association’s South Australian Branch election platform on 13 February. The host of the Mornings programme, Rory McLaren, opened with a question about the “Smoke Free Generation” policy.

“Is this common sense, or is it a radical idea?”

It forced me to reflect upon my 40 years of working in public health, much of which has been fighting for policies to improve the health of people in Australia, and beyond. Most of the policy ideas we advocate for start as the latter (a radical idea) and, over time, become the former (common sense).

There are many examples of policies we have fought to see adopted, which were considered or depicted as radical — and even outlandish — when first floated, but which are now as routine as crossing the road (at the traffic lights of course).

 

Even an incomplete list of these policies is long. We might note obvious examples like mandating seatbelts, blood alcohol limits for driving on our roads and Random Breath Testing to enforce them, banning the service of alcohol to intoxicated people, implementing smoke free areas including aeroplanes, public transport, offices, and even pubs. Health warnings on cigarette packets, banning the advertising of tobacco on television and radio, banning of tobacco sponsorship of sport, the arts and other cultural pursuits were all depicted as radical by the tobacco companies.

Whether or not donating to political parties is radical or sensible depends, however, if you ask the National Party.

All of the examples above, opponents claimed, would variously “threaten the Australian way of life”, turn us into a ”nanny state”, constrain our freedoms leaving us a “dictator state”, be impractical, unaffordable, result in “political suicide” by the government which implements them, and any number of unthinkable outcomes.

And yet, they now seem so obvious, so mundane, so routine, so last week.

Let’s not forget that many of these reforms in this category work by reducing the consumption of unhealthy products. The industries which profit from the sale of these products have fought every change, every reform, every restriction to their ability to normalise, market, promote or sell their products. They’ve also aggressively resisted measures to educate consumers about the truth concerning their unhealthy products.

Even something so simple as alerting people of the health risks to unborn babies if pregnant women drink alcohol has attracted vehement and well-resourced industry opposition for many years.

But there are also public health policy reforms that were seen as radical, even though they were not undermining commercial interests. “No hat, no play” policies in schools to protect kids from the sun were seen by some as too heavy an impost on schools, teachers, and parents and carers. Some people predicted that introducing HPV vaccines for high school students would to lead to greater promiscuity.

Perhaps the greatest example of the balance in public health policies and public liberties was the COVID19 pandemic lockdowns, both in Australia and around the world. There remains a legitimate debate about the relative benefits and harms of the significant restrictions of movement and freedoms that were imposed during those extraordinary times as an under-prepared world sought to curb the devastating pandemic.

There are always benefits and harms to weigh up in any public policy discussion, and they should be given genuine consideration. Ultimately being “proportional” is key. Determining what meets that test is the challenge.

So, what might be the seemingly outlandish, radical, or unthinkable policies that would advance public health, only to become very “ho-hum” soon after their implementation?

Six months ago, a social media ban for under 16s was in that category. Now it seems many jurisdictions are keen to follow Australia’s lead, including Denmark, France, Spain, Germany, and more.

And what’s next?

How many people think greater controls on the marketing of alcohol, junk food and gambling, particularly when aimed at kids, is a good idea? The answer is lots of people! So is such an idea radical? I am sure many will spin it that way… the commercial media companies, the alcohol junk food and gambling industries — of course.

The masses? They’re on board.

We’re back to the conundrum in which many policy reforms backed by sound evidence and with the support of the public are opposed — frequently by the very industries which fear losing market share and profits — and sometimes by political forces looking to curry favour with powerful interest groups, or a particular demographic in the ever-shifting political environment.

Sometimes inertia is the greatest enemy of reform. Changing almost anything requires energy, effort, a willingness to take a risk, and even risk being unpopular.

But most public health advances require change of some kind. And change is easily depicted as radical. But time and time again discourse shifts and yesterday’s radical idea becomes tomorrow’s normal. Or more simply, just common sense with the subsequent question:

“Why didn’t we do this earlier?”

 

Adjunct Professor Terry Slevin is CEO of the Public Health Association of Australia

[The editors thank Prof Mike Daube for the images used to illustrate this article].