Even before Covid, it was impossible to hold public health research and the small band of professionals who make a living out of the discipline in high esteem. Overwhelmingly employed in the public sector, public health experts – I use that term loosely – tend to be nagging, interfering and ideological.
For them, there are no options other than to ban or tax, or conduct mainly ineffective public education campaigns. The very concept of cost-benefit analysis is alien to them, as is the option of leaving well enough alone.
Like some other disciplines, public health has been engaged in massive mission creep in recent years, with global health and climate change being elements of the latest frontier. You only have to check out the many public health master’s degree courses offered by Australian universities (full-fee offerings, by and large) to realise how off-beam the discipline has become.
Sure, there’s a bit of epidemiology and data analysis. One course even offers a unit in infectious diseases management. But apart from that, it looks like wall-to-wall political mush. You can study Gender and Women’s Health; Global Health Leadership; Culture and Society; Sexual Health; Public Health Program Management; Indigenous Health; and the list goes on.
But fear not, according to the blurb at one university, ‘you can make a greater impact in your current role and future-proof your career’. (It sounds like a script from Utopia.) You can also ‘impact health on a global scale’.
But here’s something you should know: a lot of these programs don’t have exams or textbooks. How good is that?
Let’s recall here what public health is supposed to be about. It’s about the health of the population as a whole, about preventing illness, injury and disability. It used to be mainly about detecting and preventing infectious diseases and ensuring hygienic public infrastructure.
Promoting healthy lifestyles to the public can be regarded as a legitimate part of public health, although whether this is done well or effectively is another issue.
In the historic past, various doctors and scientists played remarkable roles in the promotion of public health even though none of them would have regarded themselves as public health professionals. Edward Jenner’s work was vital to the development of vaccines. John Snow was able to demonstrate that contaminated water, not ‘bad air’, was responsible for the spread of cholera. Louis Pasteur discovered the link between microbes and the transmission of diseases.
These early heroes paved the way for fundamental changes to water and sewage systems, garbage collection, food safety regulations and the like. The evidence clearly points to the significant impact of these early public health interventions on life expectancy, an effect that was probably greater than all the improvements in medical technology.
Having achieved these successes, however, public health officials began to hunt around for other areas of interest to occupy their time. Making sure that vaccine programs are in order, that local water and sanitation services are up to scratch and that food safety regulations are evidence-based looks like a relatively mundane set of activities for public health campaigners seeking ‘to impact health on a global scale’.
Indeed, just prior to Covid, Professor Brett Sutton, Chief Health Officer of Victoria, was working on a project about public hospitals and climate change. The pity was that he hadn’t used his time to build an effective and decentralised public health workforce to deal with the threat of a pandemic, a threat that always was a possibility.
That it took over 12 months for Victoria to develop an effective track and trace capability and a statewide QR code is testament to the incompetence of public administration in that state. (It’s not actually clear how effective the track and trace team is, being unable to distinguish between Epping and North Epping, for example.)
The last 12 months have also starkly demonstrated the marked disagreements that exist between the public health experts whom the media seek out. (Disagreement among experts – how could that be?)
On the one hand, we have sensible and measured professionals such as Professor Peter Collignon, who is inclined to baulk at highly restrictive measures such as lockdowns and border closures. He acknowledges the risk of the disease spreading but also points to the harm of some of the measures designed to contain it.
On the other hand, there are the worrywarts, the public health professionals who massively exaggerate the numbers that could emerge as well as supporting hard lockdowns. Professor Mary-Louise McLaws warned that Christmas could be cancelled as a result of a fairly minor outbreak of Covid in Sydney’s northern beaches. While not a trained public health professional, Dr Norman Swan of the ABC fits into this category.
There is also the disturbing development of public health officials increasingly communicating in non-scientific fashion. Sutton, for instance, has taken to referring to Covid as ‘an absolute beast’. He also likened the Delta variant to highly infectious measles while providing no data to support this claim.
The bottom line is that public health is today a discipline with a deservedly bad reputation. If you were in any doubt, it’s been in daily evidence in Victoria. People who have had their businesses destroyed, parents who despair about schools being closed, those whose mental health has been harmed — they all deserve so much better.
Instead of politicians making assessments based on a cost-benefit basis including non-health factors, they have simply fallen under the trance of the false god of public health. That one of the most recent edicts in Victoria required everyone to wear masks while walking outside is all you need to know – there is no science to this, it’s just bossiness.
Initially, there might have been some sense to flattening the curve to ensure that our intensive care units were not overrun. But at some (unacknowledged) point, the objective became total suppression. A handful of cases (where most of the infected persons are hardly sick) then provided jumped-up public health officials with the excuse to impose restrictions on businesses, individuals and borders.
No doubt, the legacy of Covid will linger across many fronts. If the public becomes rightly sceptical of public health officials, that would be a good outcome. Rather than parroting the line that ‘I make no apology for keeping our citizens safe’, politicians might actually reach balanced assessments of repressive health orders in the future.
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