PANEL AT PHA CONFERENCE ON THE FUTURE OF PUBLIC HEALTH
Alison Blaiklock
4 September 2009
Introduction
Tena kotou, tena kotou, tena koutou katoa
Thank you very much for the opportunity to be part of this panel - and my appreciation toall the people whose advice and ideas have contributed to what I say
This is an environment in whichour public health system and actions are under real threat – three examples:
- The reduced funding and support for health promotion especially around nutrition as seen in the loss of Healthy Eating leadership and services
- Possible changes to regulatory frameworks, environmental legislation and local government which will impact on all of public health
- The reduced tax take from the recession, and the increasing costs of clinical services may mean less funding for public health next year.
So how do we ensure that there is a strong future for public health?
Here are five ways forward:
First - Leadership
In the past we have relied on the Ministry of Health for strategic direction – nowwe have lost that institutional leadership
So it is up to us as a sector to provide that leadership – leadership that (in Mason Durie’s words) hasto be distributed, networked, forward thinking and courageous.
Those of us in national workforce NGOs and academic positions have a special responsibility for this because we have more freedom and flexibility than those of us in statutory or issues focused organizations.
Accordingly PHA, Hauora.com and HPF have been developing a close working relationship and discussing how we work together on common causes in this environment.
Second –we must communicate the value and effectiveness of health promotion and public health
A lot of the dissatisfaction with the previous government was framed up as being about a “nanny state” and health promotion and public health got caught up in this.
We need to reframe the debate, work together to plan how we best communicate with this government and in this prevailing ideology - without losing our core values.
We need talk about the importance of prevention, responsible government, the smart state, our common concern and shared responsibility for the wellbeing of children. The latest OECD report has shown we are failing in that responsibility.
As Papaarangi has said, we need to reorient our sector to the rights and wellbeing of children and young people and the importance of the early years.
We need to show that promoting and protecting health reduces avoidable admissions and pressure on hospitals - and benefits employment, educational achievements, economic productivity, the environment and so on – the co-benefits thatPhilippa andher colleagues used to persuade this government to invest heavily in healthy homes.
We need to demonstrate the value of what we do -
- become better at using, gathering, analyzing, and publishing evidence;
- use Whanau Ora frameworks and tools
- make more use of program logic and outcomes approaches
- tell the success stories that abound in health promotion and public practice;
- use the powerful reportsand recommendations from the WHO Commission on Social Determinants of Health, and
- use international agreed on frameworks like Alma Ata and the Ottawa Charter.
As part of demonstrating the evidence for health promotion, we were honored to be able to publish “Reviews of Health Promotion Practice in Aotearoa New Zealand” edited by Louise Signal, Richard Egan and Lynley Cook.
We have to point out the dangers that would accompany the failure of our public health system – the risk of pandemics and other disasters.
We must keep talking about the importance of our core values – the values Louise and Grant talked about yesterday - includingour commitment to Te Tiriti o Waitangi, improving the determinants of health, equity, and Hauora being everyone’s right.
We need a symphony of voices – to not just rely on the courageous advocacy of PHA – and let’s especially pay tribute to Gay Keating’s courageous advocacy – but this needs all of us, from the influential stories of experiences of community organizations to the rigorous analysis of academics.
And we need to look at developing new voices such as the Prior Centre and ustilising the New Zealand Branch of the People’s Health Movement.
Third –Let’s ensure we have an effective, well-informed and sustainable public health workforce
We have serious issues around workforce, lack of critical mass, lack of senior practitioners in parts of our workforce, fragmentation, and so forth
We can use the fact that the first priority in the Ministry of Health’s current Statement of Intent is workforce development.
The Implementation of the Ministry’sTe Uru Kahikateaplan for public health workforce development has provided a very useful framework and we are making considerable progress.
An example - HPF is looking to establish a society of health promoters which will be part of a wider multi-disciplinary approach founded on shared values and ethics - thank you for the opportunity for Kathrine Clarke and us to discuss this at yesterday’s breakfast meeting.
You can find other examples of what we are doing on our website Please also check out
And we need to give priority to bringing on board young people and strengthening the Maori workforce – as with the lead Hauora.com and the Maori caucus of PHA have taken in both growing the Maori workforce and mentoring young people into leadership.
Fourth – Let’s find opportunities to develop a more effective public health system
The MRG report wants a “strong public health and disability system which provides world class quality care, both now and in the future.”
A world class public health service needs a high quality workforce - would utilize the expertise, experience and commitment of everyone in our workforce – and increase and strengthen our workforce.
And a world class public health service needswell designed systems.
The Ministerial Review Group (MRG) report talks about national, regional and local levels. So here’s an opportunity for us to talk with government about what should happen in public health at a national, regional and local level.
And we could look at what is best done by statutory agencies and what is best done by non-statutory agencies (including iwi, Maori providers, Pacific providers, PHOs and other NGOs).
We could explore how we can have effective relationships with the other statutory organisations (both in central and local government) and non-statutory organizations – including iwi, NGOs and businesses - that have roles, responsibilities and impact around the determinants of health.
Let’s remind the government of its responsibilities under health legislation to improve, promote and protect health and to recognize and respect Te Tiriti o Waitangi
Let’s challenge the ethics and evidence behind the suggestion in the MRG report that it may be cheaper to cure people than prevent them getting ill in the first place.
Let’s reframe the value for money proposition in a way that better reflects the values (and therefore benefits) inherent in good public health and health promotion practice. Without a good definition of ‘value’, value for money is meaningless.
And let’s do this, because at the very least we need to ensure a health system that continues to deliver improvements in Maori life expectancy and does much better for our children.
Fifth – Let’s build strategic relationships and alliances
- With our colleagues in Maori health – the issues for Maori health in this environment are similar to the issues in public health
- With politicians – in Government and across political spectrum
- With clinicians in primary care and specialist services. We can build on the relationships we have been developing because of the Primary Health Care Strategy and develop relationships with our influential clinical colleagues who know only too well the impact of determinants and inequities on health
- With the communities whom want our work to continue - and with the wider public who appreciate that some cliffs need fences
- With social movements – the children’s movement, human rights movements, the environmental movement.
Conclusion
So in summary – it’s about
- Leadership
- Communicating the value and importance of health promotion and public health
- Ensuring an effective, well-informed and sustainable workforce
- Finding opportunities to develop a more effective public health system, and
- Building strategic relationships and alliances.
There are parts of this that each of us can do now.
Let’s support each other and work together - because it’s going to take all of us to ensure the future.
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