Stephen Corbett, Director of Centre for Population Health, Western Sydney Local Health District
2015 marks the 25th anniversary of establishment of public health units in NSW and what follows are some reflections on the changes in public health practice and capability which have occurred over this period. Stephen Corbett has been the director of Centre for Population Health at Westmead since 2003 and between 1990-2003 was the Director of the Environmental Health, Food and Nutrition Branch of NSW Health.
The creation of public health units saw for the first time the entry into the workforce of a cadre of public health professionals well trained in epidemiology and statistics; skills which were put to immediate use in the restructuring of the systems of communicable disease notifications and surveillance, and in outbreak investigations. The information which these modern surveillance systems provided was central to the planning and development of preventive programs in vaccine preventable diseases and communicable disease in the decades which followed. These institutional capabilities were sharpened by the challenges posed by issues such as the control of the burgeoning HIV epidemic, large national food borne outbreaks such as the E coli/HUS outbreak in Garibaldi salami and hepatitis A in Wallis Lake oysters, and global communicable disease emergencies such as SARS, H1N1 influenza and in 2014, Ebola.
In my own field of environmental health there was a broadening of the scope of practice to include involvement in issues such as the prevention of childhood lead poisoning, the health impacts and control policies related to both outdoor and indoor air pollution, water quality and health, sewage pollution at Sydney beaches, and environmental health and housing conditions in Aboriginal communities in NSW. This involvement ranged from the gathering of evidence and conducting research to the development of whole of government responses to these prescient environmental hazards. One of the more noticeable improvements over this time has been the quality of the evidence, particularly that from quantitative risk assessment and exposure modelling, that is brought to bear on environmental health decision making. The diffusion of these new skills throughout our public health network has been impressive and hopefully will be of lasting benefit.
Advances in computing and judicious investment in surveillance system and database development have made possible the gathering of health intelligence on a previously unimagined scale. The investigation of the impacts of the 2009 heatwave in Sydney is a good example of the utility of this intelligence: in quick time data from ambulance call outs, emergency department attendances, hospital admissions, mortality and climate data was assembled and published.
The efforts by many to train and develop a new generation of public health professionals have borne fruit, and many NSW trainees are now in public health leadership positions nationally and internationally. Over this quarter century I have worked closely with a score of enthusiastic and committed trainees who collectively have both greatly enriched my own work, and enhanced the capabilities of the public health infrastructure in NSW.
The 24 hour news cycle and the availability of information through the internet have not, as is often suggested, irrevocably changed the nature of public health practice. Any reading of press reports of say the plague epidemics in Sydney in the years after Federation, or the building of the art deco gas vents for our expanding sewage network in the 1930s convey a familiar, and sometimes shrill, ring. I am in agreement with the public health historian Christopher Hamlin, who in his review of the life and achievements of Edwin Chadwick, the author of the first English Public Health Act in 1848 deduced that;
Public health is not ‘an obscure offshoot of medicine or a marginal division of civil engineering’, but a ‘vast and unexamined part of our culture’. Beneath the veneer and language of science and medicine hide our most primitive notions of what health is and what it should be, and under what circumstances governments can or should act to defend it.
What Hamlin acknowledges is that neither technical mastery nor technological innovation, be it the personal computer or the glazed self-draining sewage pipe, obviate the responsibilities of governments and public health officials to avoid hubris and complacency, to maintain a commitment to problem solving science, to be responsive to community concerns and, where appropriate, to calm fears by understanding and explaining public health risks and uncertainties.