Pages: 10

The Introduction to Public Health Practice in Australia: The Organised Effort outlines the approach taken by authors to explaining the principles and practice of public health in the Australian system, what practitioners do, and the significance of the public health field historically and in contemporary contexts, including in addressing the COVID-19 pandemic. It positions public health as central to societal and economic development, as well as being of major importance to the lives of individuals, families, and communities and ecosystem health. The Introduction outlines the role of case studies in bringing theories and concepts alive, with a ‘challenge’ beginning each chapter to orient readers to issues and concepts that are more broadly applicable in everyday life and public health stories illuminating chapter content. The book's five-part structure is described as follows: the first part covers the field's history and fundamentals, the second part reviews the fundamental logic of public health practice by examining essentials of its toolkit, the third part explores the basic intelligence required for action and the infrastructure needed to use the intelligence for public health program delivery, the fourth part scopes public health interventions, and the fifth part considers contemporary decision points for public health policy and action and looks to public health futures.

Pages: 76

No chapter abstract available.

Pages: 22

This chapter provides an orientation to public health basics—its scope and purpose, definitions, what public health practitioners do, its underlying principles, its knowledge base, and core features of a public health system. Major public health successes over time, and factors contributing to them, are outlined. Contributions to public health from Australia are considered as well as those of the United Nations system. The chapter emphasises that public health is primarily concerned with the health of populations, rather than with the health of individuals, and the best health benefit for the most people is sought. Inevitably, as choices need to be made, political, moral, and financial considerations are the everyday concern of public health practitioners. A persistent tension in public health is highlighted—between a broad focus on the underlying social and economic determinants of health and illness, and a narrow focus on clinical conditions and biomedically based interventions.

Pages: 20

This chapter describes the origins and key developments in public health action internationally. It describes the positive historical contributions to public health around the globe such as from ancient societies, and the detrimental impacts of colonisation on the health of Indigenous communities. The chapter describes how social, environmental, economic and commercial, and political contexts, as well as values and beliefs about equity and causes of disease and judgements about who is worthy of concern, shaped development of the organised approach in public health practice. It describes how public health action began with localised efforts, then extended to national action and subsequently expanded to global efforts. The chapter also describes developments over time of theoretical understandings of population health and technological advances in public health interventions. It describes the expanding role of government and developments in infrastructure and health policy in Australia, in response to public health events. The later sections describe the implications of Australian law for national and local public health efforts as well as Australia's participation in more recent developments in international health policy and law.

Pages: 32

Over the last 100 years, health in Australia has improved substantially. Infant mortality, maternal mortality, and the prevalence of infectious diseases have been reducing. Life expectancy is higher for the population overall. However, noncommunicable diseases—such as diabetes, cardiovascular disease, cancers, and mental health conditions—have increased as social and economic conditions have exposed population groups to a range of risk factors. Concerning health differences within and between populations persist, notably, those between Indigenous and non-Indigenous Australians. Attention to the concept of wellbeing is increasing in Australia and internationally, as questions are asked about what is needed to bring about a shift away from using narrow economic indicators like gross domestic product (GDP) to measure what matters in society, and disease-related indicators to measure health system performance. While the COVID-19 pandemic revealed important strengths of the current organised effort, such as the decentralised public health system, it also highlighted critical weaknesses, such as the national-level coordination of a response, thus helping to set an agenda for continual system development that can enhance and sustain health and wellbeing for all people.

Pages: 140

No chapter abstract available.

Pages: 27

If health is to be improved, it is necessary to understand the factors that create health and the precursors and consequences of health problems so that appropriate action can be taken to promote health, to prevent illness or injury, or to ameliorate the consequences of disease and disability. On the basis of this knowledge, interventions can be designed, deploying a range of tools, and focusing on environments, on communities or individuals, on whole-of-society factors, or on all of these contributors to health and wellbeing. This chapter explores how we understand health and wellbeing, and how these concepts are understood in the practice of public health. Common methods are outlined by which health, disease, and their determinants are measured and monitored, and how we can understand the complex patterns which emerge from interactions between these determinants. Some of the theoretical or conceptual models that are used to explain the nature of health problems are reviewed, as well as how these models continue to affect the choice of public health strategies.

Pages: 25

This chapter considers how we can investigate and develop explanations for health patterns in a population, taking into consideration that they are influenced by a broad range of interconnecting factors, from physical environmental factors to the nature of individuals and society. The contribution of the health system to shaping health patterns will also be explored. The chapter starts with considering how causation can be investigated using epidemiological methods. Then the influences of physical and social environments, health care, and individual factors are discussed in turn, consistent with the broad models introduced in the previous chapter about determinants of health. The chapter concludes by suggesting that these theoretical perspectives are complementary and, when brought together, contribute to a systems-based understanding, or an ecological perspective, of health and illness.

Pages: 32

This chapter explores how we take action on patterns of health and illness in populations and how intervention approaches in public health—from health education to legislation—have evolved over time. It scopes the types of interventions that public health practitioners deploy, examines how these interventions are planned and evaluated, and considers how the demand for evidence-based practice requires active efforts to interpret the evolving knowledge base for practice. Attention is given to the challenges for practice that arise from the complexity of both interventions and the contexts in which interventions are introduced. While intervention approaches have changed over time, and the advent of digital technologies is creating new possibilities for interventions, the notion of these efforts being organised to have an impact on population health has remained.

Pages: 30

This chapter is concerned with the basic tools that assist us in making sense of the ‘mosaic’ of the health system, and its apparent lack of ‘rationality’. In discussing the underlying dynamics of health systems and health policy, the assumptions and the core contribution of political science and health economics are revealed. Definitions of a health system are introduced then how health systems have evolved, what health systems try to do, and the major typologies of health systems in the world are explored. In discussing the role of government in health systems, a question is raised about who governs. Key concepts in health financing and resource allocation, health services organisation, healthcare decision-making, and health policy development are explained. Finally, how health systems should be evaluated from a public health perspective is reviewed—or what the critical tests are for judging how well a health system is able to serve the social enterprise of public health.

Pages: 24

Ethics is concerned with the study of the rightness or wrongness of human actions and considers how we ought to act in any given circumstance by using reason. Ethics is a fundamental consideration in all areas of public health practice and research. Our understanding of ethical issues and how to make ethical decisions continues to mature as public health challenges arise. This chapter outlines and explores ethical principles and theories, how they are applied in public health, and tensions and challenges arising from ethical debates. Specific themes include international frameworks guiding our understanding of ethical issues of individual rights and social justice and, subsequently, public health ethics, health promotion ethics, environmental ethics, and public health research ethics.

Pages: 130

No chapter abstract available.

Pages: 44

Significant changes in the direction of contemporary public health development are reviewed in this chapter starting with the new policy thinking of the 1980s (as the foundation of the current approach), followed by the changing policy context of the 1990s and beyond, with COVID-19 providing a new catalyst for change. This policy discussion is followed by a survey of approaches taken to develop national public health strategies and programmes. The numerous organisations and players that drive and maintain the system are described, along with the challenges in ensuring a coordinated and collaborative effort as new issues and ways of working come to the fore. The Australian Centre for Disease Control (ACDC) represents a key step towards strengthening public health infrastructure and capacity, although its establishment will also create ripples of change across the system as organisations with functions relevant to the ACDC's mandate review their role in the public health ecosystem. One of these functions is prevention. Reorienting the health system more fundamentally towards prevention will require changed mindsets on the part of many more established players before major policy commitments, legislative changes, and infrastructure investments can happen.

Pages: 26

This chapter describes the key force of the law in public health and the controversy in relation to the balance among legal interventions, individual privacy and rights, and commercial interests. With reference to historical foundations of public health law in Australia, the chapter examines basic features and concepts associated with the law and considers why and how laws are made in Australia. The chapter describes the evolution of public health law in Australia, traditional regulatory tools, and the differing roles of local, state, and national governments in public health. It also discusses issues associated with national uniformity, or lack thereof, between state/territory laws. It discusses the evolving purposes of public health law—initially to protect the health of communities, then also to prevent disease and injury and to promote health, and more recently to also reduce inequalities for disadvantaged communities. The chapter discusses more recent use of legislation and tools for managing and controlling future risks rather than reacting to health crises. It describes the close connection between public health law and the evolving needs and values of populations and unexpected health threats, such as the COVID-19 pandemic. The recognition and development of a range of appropriate regulatory approaches, varying from coercion and control to deregulation, including broad emergency powers, are discussed. The later part of the chapter examines the continued use of legislation in Australia as a public health tool for the management of contemporary public health issues, such as terrorism, climate change, and domestic violence, as well as emerging public health issues.

Pages: 23

This chapter reviews the information and knowledge base (or ‘public health intelligence’) that public health practitioners and organisations require for delivery of public health activities. It considers how data and research findings become information or intelligence that is useful for policy and practice, and the challenges for transforming information into appropriate decisions and actions. The model referenced for public health intelligence—DIRECT—provides the chapter's structure. It represents a process for public health professionals to work through as they seek to develop and implement evidence-based policy and practice: data, information, research, evidence, context, and translation.

Pages: 35

The delivery of public health services depends on having people and money. This chapter describes the organisation and utilisation of the most basic resources needed for action in Australia: the public health workforce and financing of public health activities. Investment and maintenance are required to build public health infrastructure (such as information systems, laboratories, and specialist workforces) just as they are needed to build other forms of public infrastructure (such as telecommunications and bridges). Equally important beyond the inputs into the system is the flexibility with which human and financial resources can be redeployed in relation to changing health needs in the community and the changing contexts for action. The relationship between these inputs is critically important in optimising the available human and financial resources for better population health. Funds can only be transformed into services if there is the right workforce.

Pages: 156

No chapter abstract available.

Pages: 27

This chapter describes how surveillance works at the core of disease control and distinguishes between surveillance and monitoring, surveying, and research, which have different purposes and design. The chapter explains how surveillance data inform public health action, ranging from communicable diseases control to planning other public health interventions for diseases newly discovered and understood, such as health problems related to the environment, occupational safety, chronic disease, and health service quality and safety. The theory of surveillance systems and the use of different types of surveillance systems in Australia are described. The question of who needs access to surveillance data and the complex communication required between the broad range of stakeholders such as local, state, and Federal Governments, public health units, and the media, is also discussed. The chapter also explains how surveillance contributes to the investigation and management of a communicable disease outbreak. How Australia undertakes and fulfils surveillance obligations in the international context is described. The practice of event-based surveillance is discussed, as is the use of big data to respond quickly to unusual emerging events such as the COVID-19 pandemic. The need in the future to develop an ecosystemic approach to surveillance to address complex health issues such as related to One Health is also discussed.

Pages: 36

This chapter discusses the evolution of environmental health practice, the conceptual underpinnings associated with this practice, and the various practice tools of legislation and enforcement, surveillance activities and reporting. It describes the roles of local, state, and federal governments in Australia and international agreements, in key practice areas such as food safety, work health and safety (WHS), vector-borne disease, wastewater management, chemical contamination, radiation safety, environmental health justice, Indigenous environmental health, food security, hazards to the natural environment, and hazards to human health such as from climate change. The chapter describes current environmental health policy frameworks and reviews some of the current and emerging areas for environmental health practice, and current issues and challenges facing public health today from an ecological perspective. It describes the shift in public health practice from protecting humans from environmental hazards on a more localised scale, to protecting the environment from human impacts on a global scale, to ensure environmental security and environmental sustainability. It discusses the need for improved preparedness, response, and recovery in the globalised organised effort.

Pages: 34

This chapter provides a conceptual and historical perspective on population-based approaches to clinical and primary healthcare service delivery. It discusses primary, secondary, and tertiary preventive interventions and reviews fields such as infectious disease control, immunisation, and screening. Interventions discussed include control of sexually transmitted infections, early detection of maternal and child health (MCH) problems, and chronic disease such as women's cancer and bowel cancer, where organised approaches to health care for at-risk individuals have led to broader improvements in population health. In the context of demographic, technological, and epidemiological transition, the chapter describes the intersecting and complementary roles of the public health and primary healthcare sectors, and the urgent priority for an organised partnership between the two sectors. The chapter concludes with descriptions of current developments in general practice and public health such as moving towards shared ownership of the sectors, screening for noncommunicable disease (NCD) risk factors, consumer self-help, chronic disease self-management, digital health, and precision public health.

Pages: 29

Health promotion is evolving as a concept and maturing as an area of public health practice but remains concerned with collective and individual actions designed to enhance quality of life, reduce the burden of illness, and prolong life expectancy. It has a historical foothold in health education and local-level health issues. The 1986 Ottawa Charter for Health Promotion provided a set of principles and an integrated, systems-based approach for contemporary practice. This chapter explores the diverse methods and approaches used in health promotion, which draw on many disciplines. It shows how the issues focused on in health promotion are expanding. From a focus in the 1980s on behaviour change and chronic disease risk factors (such as tobacco use, diet, and physical activity), health promotion today also grapples with ecological factors associated with communicable diseases, emergencies, and fundamental societal forces underpinning multiple health issues (such as social inequalities and commercial determinants of health). Improving the relevance and quality of health promotion interventions and sustaining infrastructure support and capacity will be critical, enduring tasks.

Pages: 28

This chapter discusses how the often contested notion of vulnerability is conceptualised and outlines major international human rights conventions concerned with groups in the population that have been made vulnerable and disadvantaged by societal structures, processes, and environments. Public health responses to populations experiencing vulnerabilities have been shaped by the politics of cause and responsibility. Five case studies are presented to illustrate different population groups and the ways Australia's public health system has responded to their interests, capabilities, and needs. They focus on people with mental ill health; with disabilities; who are refugees; have chronic and terminal illness; and who are in prison. Case studies illustrate that public health responses to population groups who are more susceptible to adverse health outcomes have been generally positive, have varied over time in terms of their effectiveness, and reflect prevailing social values and the political climate of the time.

Pages: 70

No chapter abstract available.

Pages: 35

If the public health field is both an art and a science, then the practice of public health is about managing a constant set of tensions—between the evidence and the politics of decision-making, between expert views and community values, between government imperatives and interests of non-state actors—to steer a path forward. This chapter is concerned with what drives decision-making and how choices should be made in the face of competing needs and interests. It also raises questions about how the public health system should be governed in the face of these competing needs and interests. The chapter discusses the concept of governance, the choices in designing and allocating resources for public health programmes, the relationship between government and society, the evolving approaches to public sector management and their implications for public health practice, and emerging issues for global health governance.

Pages: 33

Rapidly evolving scientific knowledge and technology have opened new pathways for public health, health care, and social innovation. However, these advances are proving insufficient to address the complex, contemporary issues for health that are explicitly related to social, environmental, and political trends, such as recurrent and emerging infectious and noncommunicable diseases. A key challenge for Australia, and all societies, is preparedness. This requires cultivation of an organised approach in public health systems, one that integrates and implements a holistic framework for anticipating and analysing complex health issues and designing multilevel, multi-sector strategies for health protection, prevention, and health promotion. As well as looking at the driving forces that are rapidly changing contexts for, and health issues requiring, public health responses, this chapter explores how public health practitioners can systematically use futures enquiry to better understand and assess uncertainties, the potential for disruptive events and alternative futures, and possible ways forward in developing a public health system whose governance system and workforce are futures literate and futures-oriented.