Professor Amanda Lee of QUT, wrote in a recent Croakey article that “the greatest dismantling of public and preventative health services in recent Australian history” is now underway in Queensland as a result of budget cutbacks.
In the article below, she describes the likely impact of these cuts upon the population’s health, raises questions about Queensland’s responsibilities under COAG agreements, and pays tribute to the work of those losing their jobs.
Some of the stories the Queensland Government does not want told
Amanda Lee writes:
Public health practitioners are becoming increasingly distressed over the dismantling of preventative health in Queensland. One stated frustration is their lack of public voice.
Those working in non-government organisations cannot speak out because of new rulings preventing organisations receiving public funding above a certain level from commenting on government policy.
This is concerning as most public health improvements in western democracies have been initiated by such evidence-based advocacy. Worryingly, over 1,000 positions have gone already from this service sector in Queensland too.
Health practitioners who have lost their jobs are prevented from speaking out as a condition of severance. Those currently competing for the important remaining statewide roles (less than 4% of the previous number of clinical preventative positions) are understandably keen not to draw any attention to themselves. Colleagues still working within Queensland Health are bound by protocols to remain silent.
Press releases issued by professional associations, such as the Dietitans’ Association of Australia statement, have been picked up rarely by the media, which may not be surprising given the depth and breadth of the recent cuts and the range of issues raised.
But the views expressed privately by these individuals and organizations provide valuable insights into what has been lost with the demise of preventative health and nutrition promotion in Queensland. All are most worried about the effect on the community.
Comments consistent with the scientific evidence include:
- Preventative health services provide the front line for front line services in health; without this vanguard we will lose the battle against chronic disease in Queensland;
- These cuts effectively redefine the role of Queensland Health in a way that does not reflect COAG agreements to provide services that preserve, protect and promote the health of Queenslanders, as well as treat and manage disease;
- The effectiveness of clinical treatments will be undermined without ongoing improvement in the physical and social environments that promote healthy food choices;
- The prevalence of chronic disease risk factors and conditions will increase among the most vulnerable in Queensland; particularly poor growth and development of Aboriginal and Torres Strait infants and children, type 2 diabetes and renal disease amongst Indigenous and low income groups, cardiovascular disease in rural and remote communities, and overweight and obesity in all socio-economic groups with the exception of the highest quintile;
- Increased demand for the treatment and management of diet-related, chronic diseases will increase dramatically, in both the medium and long term, growing to be an extremely costly burden to the ill-health system and society;
- It takes ongoing, long-term commitment to improve the health of the community, and once the capacity to do this is reduced, it takes enormous effort and investment to reinvigorate services;
- More collaborative work is needed to prevent diet-related chronic conditions, not less; the stated rationale about potential duplication of services is akin to sacking violinists from the string section of an orchestra for playing the same tune!
Some more personal experiences hint at broader social and economic problems. In particular, several Indigenous nutrition workers who have lost their jobs have been the only members of their family in ongoing employment; their loss of income will have negative effects on the health determinants of their whole community. To a lesser extent, the negative economic impact of so many job losses risks adversely affecting the health of all Queenslanders too.
There has been some acknowledgement of “feeling sorry” for those who have lost their jobs.
But as a society, we should also be saying “Thank You” to those over a hundred and sixty preventative health practitioners as they are forced to walk away from their important roles and responsibilities.
So to those preventative health professionals working in nutrition promotion – Thank you for:
- Improving the food supply in our childcare centres, schools, health facilities, sporting clubs and stores, particularly those in rural and remote areas;
- Helping increase initiation and duration of breastfeeding;
- Group based healthy lifestyle programs like Lighten Up and Living Strong, which cost-effectively increase the prevalence of healthy weight, physical activity and healthy eating, especially in those regional areas where commercial programs are not available;
- Increasing intake of fruit and vegetables through the Go for 2 and 5 campaign and local activities;
- Developing and distributing tools, resources and training programs for evidence-based interventions, such as the NHMRC Dietary Guidelines, Growing Strong, Smart Choices, A Better Choice, Get up and Grow… and many other successful initiatives throughout Queensland.
More personally, a particular thank you to those Indigenous health practitioners who, against the odds, had completed higher education courses and applied their knowledge and skills tirelessly to improve the health of their communities – and who are now left struggling with yet another inequity.
Thank you to other health practitioners preparing to sell their homes and move inter-state/overseas where their professional expertise in preventative health is recognised and highly valued – a terrible brain drain from this state.
Thank you to the current students of nutrition, health promotion and public health who have worked diligently over at least three years to train as health professionals in these essential fields, only to have their career prospects pulled from under their feet before they could ever get started helping improve the health of Queenslanders.
Finally, thank you to all those who are in despair, seeing their life work and resultant achievements erode without due acknowledgement. You have made a tremendous contribution. Your heritage will continue, and eventually rise again, as common sense scrutiny of the scientific evidence dictates.
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