One hundred years ago the eminent physician who founded the public health department at Yale University wrote a definition of the discipline that is still used today.
Public health, said Charles-Edward Winslow, was “the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts”.
Included in that, he said, was “the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.”
One of the features of the world’s response to the Covid pandemic is that public health, and the chief health officers who lead the effort, have become enmeshed in politics.
In the USA Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the lead member of the White House Coronavirus taskforce, has been at loggerheads with President Trump’s dismissive approach to the pandemic. Trump has said he will sack Fauci after the election.
In the United Kingdom, Chief Medical Officer Professor Chris Whitty and Chief Scientific Advisor Patrick Vallance toyed with the aim of achieving “herd immunity” before the deathly cost of that approach became clear. Eight months later tracking, tracing and isolating the infected is still in disarray. Prime Minister Boris Johnson deserves some of the blame, but so too does decades of under investment in the public health system.
Closer to home in Australia, while the public health experts on the Australia Health Protection Principal Committee apparently work well together despite the political sparring of the Prime Minister and chief ministers, individual state health officers have come under attack.
In particular, Victoria’s CHO, Brett Sutton, has been on the end of vitriol from the Murdoch Press, and accused (without evidence, as I wrote here) of trying to cover up his role in the failures of hotel quarantine.
More important than the role of individuals, is the question of why Victoria’s system of contact tracing was so inadequate to the task in the early days – and why New South Wales was better.
So why do public health scientists find themselves at the heart of political battles?
We might see hostility to their work and to strong lockdowns and other action as of a piece with a general rejection of science by some politicians – similar to climate change denial.
That is not wrong, at least in some cases. But it ignores a deeper narrative.
It’s hard to overstate the importance of public health. Media headlines tend to emphasise miracle drugs and heroic surgeons. Public health is usually a quieter game. When it is working well, nothing happens.
Yet in the last century and a half, all the major improvements in human wellbeing have been public health stories.
First, dating from the middle ages to our own time , there was quarantine – involving community and sometimes government action to control plagues such as typhus, cholera, smallpox and the black death.
It was accepted, initially at the level of the village and then by national governments, that curtailing individual liberties was justified in the interests of the wider public.
That, by itself, is a significant political idea.
In the nineteenth century came what the history books describe as the “the great sanitary awakening” – the identification of filth as a cause and carrier of disease. That lead to an investment in sewerage and water supply systems, as well as governments taking responsibility for the disposal of waste.
Sanitation changed the way society thought about health. Once disease was an individual matter – and the victims were often blamed.
Now it became a social responsibility. Sanitation meant government spending on infrastructure, and that was predicated on a larger role for government, and therefore more taxes.
In London in the mid 1800s more than half the working class died before their fifth birthday. In New York at the same time, filth and garbage lay up to metre deep in the streets and smallpox and typhus ran rampant in the slums.
The rich could retreat to less crowded conditions, but it was increasingly recognised that all families were vulnerable to communicable diseases, and that social action was needed.
Over the next 100 years public works and the growth of government pushed diseases such as cholera out of the developed world.
As understandings of the role of bacteria grew, education in hygiene and general health became part of the effort and with that came publicly funded health systems, including subsidised vaccination programs.
The Centre for Disease Control and Prevention in the USA describes public health as being about entire populations. “These populations can be as small as a local neighbourhood, or as big as an entire country or region of the world…Public health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research—in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured.”
And, because it is about prevention, public health practitioners work to limit disparities in access to health services.
In other words, public health is innately and unavoidably political. It is to do with notions of the collective, and of social justice.
Add to this the problems of our own time, and our increasingly partisan political divides.
Judith Brett, in her recent Quarterly Essay on the coal industry in Australia, masterfully sketches how the mining industry moved from opposition to Aboriginal land rights in the 1970s and 80s to opposition to action on climate change in more recent times
The same lobby groups and methods that attacked the Mabo judgement and the so-called “black armband” view of history morphed easily into mocking climate change “alarmists” .
Brett describes how during the Howard Years a sharp binary emerged, with people concerned about women’s rights, multiculturalism, native title and action on climate change on one side, and on the other those who supported assimilation, opposed a “black armband” view of our history and promoted climate scepticism.
Brett doesn’t say this, but I would add that this is how ideas that are not innately party political – such as concern for human rights, or multiculturalism, or climate change – somehow ended up being seen as “left wing”. Once human rights was seen as a concern of the Liberal Party, for example – as befits its name.
Brett concludes that opposition to action on climate change is not only about the environment and the economy, but rather, perceived threats to “a certain kind of modern industrial society” built mostly by wealthy men.
Climate change action is a threat not only to that society, but also to the narratives that give meaning and cultural power to the achievements of captains of industry.
So how does Covid and public health, fit into this?
With the history in mind, it is easier to understand why those who emphasise individual liberty, responsibility, effort and reward over the demands of the collective are more likely to be hostile to the demands of public health.
We shouldn’t be surprised that public health officers have come under political attack. It’s inevitable.
Public health is to do not only with science, but also with values. Public health transforms societies. Its potency lies in the way that the values are informed by the science.
One suffers, and we are all weakened. It’s a powerful idea.
Margaret Simons is an award-winning freelance journalist and the author of many books and numerous articles and essays. She is also a journalism academic and Honorary Principal Fellow at the Centre for Advancing Journalism, University of Melbourne. She has won the Walkley Award for Social Equity Journalism, a Foreign Press Association Award and a number of Quill Awards, including for her reporting from the Philippines with photojournalist Dave Tacon.
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