The range of Federal and State public health activities may be categorised as:
health protection, illness prevention, health promotion, and infrastructure development.

Health protection
is the enforced regulation of human behaviour to protect the health of the individual and fellow human beings.*

*Holman, C. D'A.J, Something Old, Something New: Perspectives on Five 'New' Public Health Movements. Health Promotion Journal of Australia. Vol. 2, No. 3, 1992.

Illness prevention
is about interventions which build on the skills of public health and clinical medicine to reduce the incidence and prevalence of disease occurrence or injury in individuals and populations.

Health promotion
is the process of enabling people to increase control over, and to improve, their health.+

+Charter from the first International Conference on Health Promotion, Ottawa, 1986.

Infrastructure development
ensures the building blocks (such as information systems, workforce, policy and regulatory framework) necessary to accomplish the activities of health protection, illness prevention and health promotion.

 

 

Australia’s public health infrastructure today

Federal, State and Territory Governments have been the major providers of public health services for the people of Australia, and each jurisdiction is responsible for creating its own institutional arrangements for public health programs, individual priorities and divisions of labor. Constitutional responsibilities in this area rest largely with the States and Territories. Local government is an important contributor at the service level having a central role in public health surveillance and action. The resources available to governments in achieving public health objectives are considerable and include universities, non-government and community organisations, and the workforce, programs and institutions of the primary health care system. Successful public health activities are carried out through multi-disciplinary teams, often with highly specialised expertise, using the range of regulatory powers available to the State with cooperation of the national level agencies.

Australian Government has a broad policy leadership and financing role in health matters, while the States and Territories are largely responsible for the delivery of public sector health services and the regulation of health workers in the public and private sectors.

All Australian governments are committed through the National Competition Policy to a consistent national approach to foster greater economic efficiency and improve the overall competitiveness of the Australian economy. The Policy requires that legislation should not restrict competition unless it can be demonstrated that the benefits to the community as a whole outweigh the costs, and the objectives of the legislation can only be achieved by restricting competition.

Future issues and challenges

  • Socio-behavioural pathologies
  • Ecological imbalance
  • Linking health outcomes to health financing
  • Health care reform
  • National competition policy
  • Multimedia and telecommunications

The Federal Government

National public health work is performed by the Public Health Division (and the Office of Aboriginal and Torres Strait Islander Health Services) of the Federal Department of Health and Family Services. Regulatory functions are provided by other organisations including the Australia New Zealand Food Authority (ANZFA), the Therapeutic Goods Administration (TGA), and other associated TGA agencies (e.g. the Environmental Health and Safety Unit, the Australian Radiation Laboratory, and the Nuclear Safety Bureau). The Australian Government thereby provides for a national regulatory framework which ensures environmental health and consumer protection for the Australian people.

Legislation and other important functions are carried out by the National Health and Medical Research Council (NHMRC), the Australian Institute of Health and Welfare (AIHW) and the Health Insurance Commission (HIC) which have been discussed in Section 2 of this paper.

In all cases, the Australian Government performs its activities in collaboration with State, Territory and local governments, and non-government, professional, and community organisations. Federal responsibilities include Medicare as well as special items such as nursing homes, home and other community care and disability services and child care. The newest legislation covers areas regarding food, nuclear codes, therapeutic goods and tobacco.

The national development of public health policy has regard for Australia's involvement in international public health issues. The Australian Government of Australia actively participates in the work of the World Health Organisation (WHO) under international treaty obligations. There is continued strategic support for international health industry networks through overseas health projects where AusAID, the Australian Government agency for the administration of Australia's international aid, is the primary contributor. Australia is a party to international agreements on a variety of issues including research cooperation, international drug treaties, radiation, and health care.


The Federal Government’s public health effort affects the health of the community directly through the following core functions.
  • Facilitate the development of national public health policy.
  • Facilitate ongoing planning, monitoring, reporting, research, training and evaluation of public health activities.
  • Facilitate the development of national consistency in policy standards, legislation and regulation, workforce competencies, environmental protection, disease prevention and outbreak control methods.
  • Foster and initially finance innovation in population health programs.
  • Conduct national programs in public health.
  • Advocate, build and strengthen a population health constituency with key players and with the public.
  • Conduct, in consultation with other partners, Australia’s international responsibilities and obligations in public health.

The State and Territory governments

Most core functions of public health have traditionally been the responsibility of the States and Territories. Under the various Health Acts (which usually cover environmental health, communicable diseases, food safety and tobacco controls), States and Territories pursue the following public health objectives.

  • Identify public health issues state wide through epidemiological surveillance.
  • Allow for timely intervention and monitoring of health outcomes.
  • Develop policy related to communicable diseases, environmental health, immunisation, food, radiation safety, workplace risk, water quality, drugs and poisons, and emergency management.
  • Organise preventive and early detection programs such as cancer screening, school health, etc.
  • Support population health literacy and health promoting behaviour.
  • Develop strategies for new and emerging health problems.
  • Give government the power to act quickly in public health emergencies.
  • Examine the effectiveness, and collaborate with all other government and non-government public health sectors and relevant authorities, to address public health issues and provide for an appropriately skilled public health workforce.

The individual jurisdictions organise their activities in a more similar than dissimilar way, to collaborate with all other public health sectors to develop and implement specific public health policy, programs and regulatory framework. Some states have adopted tobacco hypothecation as a way of funding tobacco control and other health promotion activities.

Local government

Within States and Territories, there are a large number of local government bodies that can perform public health service functions in a variety of ways with different emphasis from State to State, as determined in the respective Health Acts and Local Government Acts. Local councils vary with respect to the type (rural or metropolitan), the role they play, and the extent to which they respond to local needs.

The local government interacts with public health activities involving environmental management, economic development, public safety, maintaining roads, cultural and recreational development, land use planning and provision of community services. Strategic planning of service delivery at the local level may be perceived as a more business oriented approach. Goods and services once provided by local government councils may be supplied by contractors. Councils are now both providers as well as purchasers of services.

Universities and research institutions

Australia has a strong public health academic sector both in research and in education.

Australia has received four Nobel prizes in health related fields: Florey for the discovery of penicillin, Burnet for work in immunology, Eccles for the study of neurotransmission, and last year Doherty for his work in immunology. Continued success promises future achievements in the health areas. It is expected that there will be an increased investment in commissioned strategic research.

Eighteen universities and institutions in Australia offer public health workforce training programs. The establishment of the Public Health Education and Research Program (PHERP) enabled the expansion of post-graduate public health education. Additionally, PHERP supports public health training and research development through the provision of funds to academic centres of public health and by provision of funds to several institutions for specific initiatives (e.g. Aboriginal health, communicable diseases, training in health promotion practice). The role of preventive care is becoming increasingly significant and the current trend is to provide health promotion training to medical students through medical school curricula in Australia.

There is a strong orientation towards evidence based health practice and some health outcome programs that have been established in part through the support of the NHMRC and Federal, State and Territory Governments. The Australasian Cochrane Centre facilitates the preparation, maintenance and dissemination of systematic reviews of controlled trials regarding health care interventions that help influence service provision and clinical practice. The Centre is linked to the international Cochrane Collaboration. In addition, AIHW has established the Australian Health Outcomes Clearing House which assists in the dissemination of information to the public health sector.

There are other specific research institutions which play an important role in public health research efforts in Australia including national centres which focus on HIV/AIDS, immunisation and drugs and alcohol. Although the basis of their funding is governmental, they also receive significant funding from benefactors and grants. Health promotion foundations (e.g. Victorian Health Promotion Foundation) are an important source of health promotion research and training funds.

There are some 40 WHO Collaborating Centres in Australia that contribute to public health activities. These research institutions are recognised by the international health community for their excellence in laboratory medical research, health promotion and education. Their respective focus is wide reaching and includes issues such as virus research, biosafety, vaccine production, food controls, epidemiology on chronic disease, drug quality control, medical education, and health promotion.

NGOs, professional and community organisations

Non-government organisations have a significant role in building capacity for promoting health in communities, and in other sectors, and have often developed strong intersectoral working relationships. This sector comprises a range of services which are funded from a variety of government and non-government sources, and the public health activities that are carried out by the different organisations are increasing as more government services are contracted out.

Individual organisations generally focus on specific issues (e.g. heart disease, asthma, diabetes, and cancer), or on specific population groups (e.g. Aboriginals, people with HIV/AIDS, and the aged). They therefore have specific knowledge, experience and access to individuals and communities. The larger organisations (e.g. the National Heart Foundation, the various State Anti-Cancer Councils, and the Asthma Foundation) all have designated funding specifically for public health research and health promotion, have well-established credentials and play clear roles in health care and promotion.

A range of professional organisations (e.g. the Australian Public Health Association (PHA), the Australian Institute of Environmental Health (AIEH) and the Australasian Faculty of Public Health Medicine of the Royal Australasian College of Physicians) play significant roles in promoting the health of the Australian population. Their roles include workforce advancement through journals and specialised education, policy development and intersectoral networking. The workforce represented by the wide variety of professional associations includes academics, administrators, community nurses, social workers, school teachers, youth workers, and others.

Primary health care providers

The backbone of the community based primary health care system is the general practitioner. Doctors are seen by the community as the most authoritative source for information and advice on reducing health risks and for many provide the main source of public health education. Important functions include encouraging greater use of one-to-one clinical consultation opportunities (patient management rather than solely treatment based methodologies), planned screening of patients, group education activities, broader community development strategies with or without a multi-disciplinary approach, and involvement in population based policy and planning activities.

 


Divisions of General Practice were established in 1993 as groupings of general practitioners within specified geographic areas with the aim to improve local health service delivery and the health of their local communities by collaborating with the other sectors of the health system. This has been an important action in linking the medical sector with health promotion activities. Health professionals may also be encouraged to work in community health centres which are concerned with public health in general.

During the 1970s and 1980s, there was expansion in community based primary health care. In addition to 4,600 community health centres across Australia, there are also women's health centres and community controlled Aboriginal health services. They provide a range of medical, allied health and health promotion programs for defined population groups and geographical catchments. A growing number of community health services are successfully working with Divisions of General Practice, local and other government sectors, community and non-government organisations. They contribute to community understanding and support for government public health policies and have a key role in promoting health through their access to key people within the community and the knowledge of the local community and its needs.


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