Public health sacrificed for business as usual

Photo: Alexandra Koch/Pixabay

The discipline of public health is said to have been born in 1854, when Dr John Snow removed the handle of the Broad Street water pump in Soho London, thereby saving lives by preventing the public from accessing water contaminated with cholera.

At the time the causative organism of the disease was not known, but Snow's actions based on “informed intuition” demonstrated the huge potential impact of effective strategies on the health of entire populations.

The discipline has grown and flourished since those early days — and saved many more lives than conventional medicine — but with little acknowledgement.

But where is it now when we so desperately need a planned, humane and scientifically-informed approach to the COVID-19 pandemic?

As nations scramble for quick fixes to this crisis, their concern is only for short-term political gain. The World Health Organization’s plea that we must take global action is falling on deaf ears.

“None of us are safe until we are all safe” is a profoundly important public health slogan, but out of step with the individualist mindset of capitalist governments.

Wealthy nations are turning a blind eye to the plight of less fortunate countries with pitifully low vaccination rates, as they urge their own fully-vaccinated citizens to queue up for booster shots in response to waning immunity and the emergence of new variants.

They have been warned repeatedly of the likely consequences for us all of going down this path. John Donne’s 1624 statement that “No man is an island” is even truer today than it was then.

It’s interesting to look back through a public health lens at what has unfolded in this country during this unique experience. Due to the federal government’s appalling and negligent leadership, whose only concern was to get good action footage of privately-run vaccine distribution centres and private companies jumping to develop strategies to ultimately take us nowhere, we struggled through a year in which the dirty secret was that not enough vaccine was available to meet our needs.

Consequently, at a critical moment when we should have been pulling out all the stops to make sure everyone knew what they had to do to stay as safe as possible, including vaccinating, this simply didn’t happen because there was none on the shelves.

At the time when we could have been persuaded to take collective action to stay safe from COVID-19, we were instead told “this is not a race”. Little wonder that the scepticism of millions who were left in the cold over 2020–21 has turned to anger as they are now told that it, in fact, is a race and that they will be punished if they don’t get moving.

Similarly, it became apparent at an early stage that using commercial hotels to quarantine overseas arrivals was unsafe, but rather than move to vigorously address the problem the federal government (whose responsibilities include quarantine) backpedalled, arguing the hotels were effective “most of the time”.

Simple health and safety risk assessment informs us that containment measures must be rigorous if the consequences of failure are severe. The consequences of virus “leakage” from hotels into major cities are nothing short of catastrophic. Containment “most of the time” is not good enough.

“Social marketing” is a sophisticated public health instrument that advises us that coercion alone is ineffective at bringing about behavioural change, and is most effective coupled with education and attitude change.

For example, the widespread acceptance of seatbelt use came about because we were persuaded we should do so while, in the background, the law changed to make it mandatory.

Health promotion is a branch of public health and has as a guiding principle the idea of “making the healthy choice the easy choice”.

To the contrary, in the past year the things we have needed to do for our collective health have been excruciatingly difficult, complicated and poorly-communicated.

Millions have suffered economically while rich companies and consultants have stuffed their pockets with government hand-outs.

We are now being urged to vaccinate or face punitive consequences, with minimal and, at times, confusing and contradictory information about how, where, and with what.

Entire groups of vulnerable disadvantaged people such as First Nations peoples, disabled and the elderly were prioritised at the outset as “1A” in a “plan” only to be completely overlooked until “COVID-19 zero” collapsed and we were all forced to confront pandemic reality. Anyone in those groups could be forgiven for feeling they had been made expendable in such dire circumstances.

The catastrophe of COVID-19 has presented us with a challenge of planetary proportions. Its unfolding is an event that one would expect might elicit a response drawing upon everything our skills, compassion and collective resources have to offer.

Instead, the response has been a self-interested scramble to return as quickly as possible to “business as usual”.

This will not end well.

[Andrew Smart is a health service employee.]