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Hodgson: The challenge for public health

The challenge for public health

Pete Hodgson calls on the public health sector to take a more active role on issues like housing, transport and social development.


Opening speech for Day Three of the Public Health Association National Conference, Palmerston North.

Thank you Madame President. Kia ora tatou.
I am delighted to be here and delighted to have a chance to make a few remarks and then to hopefully enter a period of dialogue with you or commentary from you.

It's my hope in the next few minutes to achieve two things. First to acknowledge the role of public health in New Zealand society and second to do the opposite, to admonish you for lacking ambition and to describe a challenge for you to consider.

But first the acknowledgement. We should start with this year's Public Health Champion (name). Please accept my congratulations on this thoroughly deserved recognition.

(Name) joins a now longish list of previous Champions of Public Health, and a roll call is in order:

Helen Glasgow1999
Paratene Ngata 2000
Judith Reinken and George Salmond2001
Louise Croot2002
Mason Durie2003
Pauline Barnett2004
Ann Shaw2005

Two other people deserve acknowledgement. One is Marty Rogers, whose work as President of the Public Health Association should be recognised fulsomely. The second is a sad one, Dr Lee, the Director-General of the WHO died hours before the opening of the World Health Assembly about six weeks ago. He was a frequent visitor to New Zealand, a person who had lived and worked in the Pacific and a person whose death was greeted in the world public health community with unreserved dismay.

He was active. His report prepared for the Assembly ranged assertively across many frontiers - the health worker shortage, universal access to affordable antiretrovirals, the elimination of the polio virus and much besides.

My final on the list of recognitions is this association. You are New Zealand's peak public health body. You are, I hope and I'm told, getting large and stronger and with luck also younger. It is important indeed that you exist.

You know, I know that gains in health are due to a very large extent to gains in public health and gains in the social determinants of health. That the big gains come from systematic societal shifts, a long way from the doctors rooms or the operating theatre.

That is why as Minister of Health I am delighted that we have low unemployment, or high participation rates in tertiary education, or a national environmental standard for air quality, or that our society values tolerance or that the working for families policy has been rolled out or that we got rid of market based rentals for state houses or that public transport is staging a comeback.

Like you I want to see more. I want to see New Zealand quicken its transformation to a higher wage higher skill society, to broaden its economic base further, to continue to upgrade infrastructure to increase ethnic tolerance further. As we do, and assuming we pay attention to social justice as we go, the health of New Zealanders will improve further.

Closer to your sphere of activity and influence I am delighted that the prevalence of tobacco smoking continues to drop, that a pulse of taxpayer funding is helping sewage upgrades in smaller poorer centres, or that a second pulse is doing the same thing for drinking water. I am delighted at the success so far of the meningococcal meningitis vaccine programme or at the results of that programme as carried on the front page of Monday's Herald.

Like you I want to see more. I want the prevalence of tobacco smoking to drop further, or all vaccination to be as successful as Menz B, or the suicide rate to fall further or the folic acid debate to come quickly to a head.

These are the contributions and the challenges of public health. Without the contributions we would have poor health, by rising to the challenges we will have better health.

But these challenges are not the same challenges I mentioned in my opening remarks.

In my opening remarks I made a rude admonition about lacking ambition and said I would describe a challenge for you to consider. What, you might ask, was all that about? Surely, you will have thought, this comment must be explained.

The theme of your conference, sustaining public health, will do as a starting point. I assert that sustaining public health is not enough. For me it infers that our aim is not to go backwards. For me it lacks ambition. We have just galloped quickly over the social determinants of health, and the role of public health in the New Zealand health system. I paid tribute to their very substantial role. So if these things are so important, it isn't enough to merely sustain them.

The trick is how to grow them and how to disseminate the influence of public health further.

Earlier this week I came upon a report from the Public Health Advisory Committee a sub-committee of the National Health Committee. It is called 'Health is Everyone's Business' and I am releasing it today. It is a report on the implications of a changing context for public health in New Zealand and I think it is a very good read.

So much so that the first three paragraphs of the Executive Summary follow.

"Because many of the strongest influences on health and wellbeing come from outside the health sector, effective action to sustain and improve the population's health cannot be solely the responsibility of the health sector. What people eat, their level of physical activity, their access to good housing, education and employment are only some of the important factors involved in determining health. Effective solutions to health problems often require collaborative action by key stakeholders joining together across sectors. While the public health sector is well placed to lead or support this collaborative approach, success will depend on other stakeholders accepting responsibility for the health consequences of their actions and for working with the public sector to improve the population's health.

The growing emphasis on a ' whole of government' approach to problems, the new responsibilities of District Health Boards and Primary Health Organisations for the health of the populations they serve and of local governments for 'well being', create significant new opportunities for the further development of strong, collaborative approaches to public health in action. So too the renewed awareness of the limits of curative approaches to diseases such as diabetes re-emphasises the importance of effective, inter-social, public health strategies for prevention.

The Public Health Advisory Committee has completed a project that explores these new opportunities and challenges for building a collaborative, prevention based approach to public health. Over the course of the project the committee has developed a set of approaches that provide 'building blocks' for improving overall health and for reducing health inequalities"

So you can see we are entering the territory of population health, which is the focus for DHB's and PHO's, we are exploring opportunities that are presented for local government with their new broader legislation and the obligations on them to develop long term plans consultatively, and the report acknowledges the fact that my Government declines to view issues in isolation and takes a multi-minister approach to many of the challenges of the day.

Later on, the report has a bunch of recommendations. Again, I offer a sneak preview, focussing somewhat on just a few that I think directly impact on delegates to this conference and the organisations where you all come from.

Here are the first four.
"That the Minister of Health endorses:

-Increased attention to influencing factors outside the health sector ('the wider determinants of health'), which can improve the population's overall health and reduce health disparities.
-Increased strategic capacity of public health agencies to identify new opportunities for health improvement, develop effective cross sectoral interventions and evaluate and learn from their outcomes.
-Increased operational capacity of public health agencies to establish and maintain collaborative ways of working across sectors and at national, regional and local levels to address the wider determinants of health.
-Mechanisms and support for central and local government agencies to assess the likely health impacts of their policies using techniques such as Health Impact Assessment"

You get the idea I'm sure, especially those of you who may have helped write it!

This report says to the Government, to me, that intersectional pandemic planning is good, so is the Healthy Eating Healthy Action strategy, but don't stop there. We need more.

In due course the Government will respond to the report. I am still a new minister and I have no expertise in public health. So I shall await Ministry advice.

But it feels pretty good to me, even if it is a teensy bit high level.

What it isn't, however, is the status quo. It isn't about merely sustaining public health. It is bigger and broader that that. It is about embedding collaboration deeper. It is about joining the agencies in society more strongly. It is about lifting the lens of a health impact assessment more routinely.

I am going to stop soon and we can begin that period of dialogue and commentary. As soon as I do stop, someone is going to ask me "yeah but what are you going to do about it?"

So I thought I would get in first.

What are you going to do about it?

Will you acknowledge that public health experts have a role to work more closely with PHO's, even if your initial advances are treated more with courtesy that enthusiasm?

Do you agree that we don't yet have sufficient capacity to embrace health impact assessments and that that capacity must grow?

If we can provide executive leadership at our place, can you help with public sector leadership, regional leadership and local leadership at your place?

Would you kindly get out of the frame of sustaining yourselves and move to a mindset of extending yourselves?

Thank you for your attention.


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