# Principles of Public Health Practice/Challenges and opportunities for public health futures

The future is not written, but conditions are in place that will need to be engaged? How will resources such as water be equitably distributed? How will sanctions against governments continue to hurt the populations that these governments have influence over. How will social media change us and public health? Can we win a war on drugs and can we survive the "peace"? What will happen to our mental health should forests disappear? How does architecture influence our social and cultural health? These questions and more give us something of an insight into the challenges and opportunities of public health in the future. Can you make a difference?

## Learning activity instructions

Each week we hold a lectorial and a tutorial. A lectorial is a short lecture followed by a group activity, and the tutorials are for discussion and practising group activities.
Lectorial
* View the playlist here.
* Review the requirements for the last assessment and bring questions to lectorial.
* Attend the lectorial.
Tutorial
* Bring your list of takeaway messages from previous presentations.
* Consider questions about the final assessment that you might wish to raise.
* Attend the tutorial and engage with the presenters.

## What will be the challenges to and opportunities for public health practice in Australia and globally during the next decade?

(a) I graduated from secondary college more than forty years ago. What have I learned? Well, in the main, I think that the last fifty years have gone pretty much the way a number of prescient people thought it might. Some were wiser than others. But, the people who got it basically right were the ones who kept a close watch on the human possibilities. Whatever happens with the advent of changes in technology, we remain remarkably the same. C. Fred Alford suggests that this is because, as people whose early formation in life is embedded in groups, we repeat the basic constellation of fundamental relationships which we never wholly resolve. I think that this is just about right.
(b) One thing that is substantively different than in any past human era is the fact of our global dispersion. Humans have found sufficient habitation on all of the continents of the planet except the Antarctic. And, we have colonised many of the islands. Yet, for the first time, we are everywhere all at once. This is something new. Incredibly, we have the means to be in voice and visual contact with anyone almost anywhere. This is new as well. In the past, face-to-face time could only be had through actual presence. Now, we can see each other and respond to subtle meta-communication from millions of miles away. But, I am not sure that most people have mastered basic team-work skills sufficiently well to cooperate in humanely addressing key concerns.
(c) E.F. Schumacher's prediction about running through our oil reserves by now has not been fulfilled. But, the situation may be worse than even he had expected. We have massive concrete highways being built in China that will absorb more resources than we had ever conceive possible to maintain a "high standard of living" across all levels of society. Additionally, massive amounts of money and material are being invested in skyscrapers that no one is likely ever to occupy--most people have not the wealth to do so. It is unlikely that China will be able to spend its way out its spiralling debt which would swallow whole countries and regions. As its economy continues to slow, Australia will be in dire straits as we have little left of what the world wants or needs except for our most basic primary industries. How long will they be able to prop up the economy?
(d) Yet, Australians have discovered Internet shopping in a big way. Much, if not most, of manufacturing has removed from Australia. Thus, we cannot add value to our primary resources. We are increasingly dependent on the service industries for employment. But, who will be able to pay for them? Still, there is a growing entrepreneurial community focusing on a transition towards self-sustainable living. It may be that our more recent migrants who have maintained their agrarian customs sufficiently will teach their neighbours how to make do. Of course, it would probably wise to pay attention to what our Aboriginal and Torres Strait Islander neighbours have been trying to say to us about sharing this land.
(e) You will no longer be able to gain an educated mind or an enlightened heart at most universities in Australia or, indeed, in most of the English-speaking world. Besides, you would not be able to afford it. However, you will be able to get a darn good education through your local neighbourhood house or community health centre and it will cost you a great deal less. You may not get a job; but, you will be able to contribute to the welfare of your community. Ironically, the only people who will be able to afford a university degree will be the wealthy and they will not need it, as it will not help them gain or maintain employment. It will be just another form of conspicuous consumption! The rest of us will be teaching our children and grandchildren in groups of scholars who are truly students sharing their quest for knowledge and joy in the learning with one another.
Or, is this all but a dream? It was ever thus with attempts at prophecy. But, please take the time to think about the public health implications of these situations or any others than you think are possible. This is good practice.

## Background

According to leading public health practitioners and policy makers, Australia will be facing a number of critical challenges in the future (Armstrong, Gillespie, Leeder, Rubin & Russell 2007). These include a rapidly changing population demographic that will transform patterns in the distribute of health status across the life-course. The burdens of paying for and allocating health related resources will be shifting as differences in expectation and capacity to meet these expectations is influenced by the larger economic context. Quality standards and safety protocols will require constant updating and the relationship between the public and private sectors will necessitate continuous negotiation on the part of governments and other providers. This will be especially important in terms of providing for equity among Aboriginal and Torres Strait Islander Peoples and Communities which increasingly are found in urban centres that are rapidly changing. Ecologically sustainable practices will be paramount across sectors. Other countries are facing similar patterns (WPH 2000).
In terms of economics, there will be a number of trends that will influence the public and, therefore, public health (Kent 2015). With an ageing workforce and a potentially shrinking tax base, issues of productivity come to the fore. How will Australians be able to match or exceed previous productivity outcomes unless there are significant changes in the use of technology, increased investment in other physical capital and considerable development and deployment of human capital that does not alienate workers, families and communities? Another critical factor will be the need to balance interest rates with the need for decreasing unemployment rates and increasing occupancy. This will be difficult in an environment where the tradition economic driver has been primary industry which will most likely continue to decline putting increased pressure on rising rates of household debt. This is related to an shift in consumption from goods to services. However, without some means of exporting products, balance of trade issues will make it difficult to maintain a higher standard of living across various segments of society. The islands of the Western Pacific face all of these issues and the additional issue of factors relating to climate change which will negatively influence the ability of governments to meet their public health obligations (Russell 2009).
References and Resources
Armstrong, B.K., Gillespie, J.A., Leeder, S.R., Rubin, G.L. and Russell, L.M. (2007) Challenges in health and health care for Australia. Medical Journal of Australia 187(9):485-489.
Russell, L. (2009) Poverty, Climate Change and Health in Pacific Island Countries: Issues to consider in discussion, debate and policy development. Menzies Centre for Health Policy. University of Sydney. POVERTY, CLIMATE CHANGE AND HEALTH IN PACIFIC ISLAND COUNTRIES ISSUES TO CONSIDER IN DISCUSSION, DEBATE AND POLICY DEVELOPMENT April 2009 Dr Lesley Russell Menzies Foundation Fellow Menzies Centre for Health Policy University of Sydney / Aust ralian National University and Research Associate United States Studies Centre University of Sydney
WPH (2000) Demographic Trends Influencing Public Health Practice. Washington Public Health (Fall):1-3.

## Learning Outcomes

What will be the challenges to and opportunities for public health practice in Australia and globally during the next decade?
Upon completion of this topic, through your own investigations, group preparation, tutorial participation and lectorial explorations, you should be able to:
   * Identify salient trends in social arrangements in Australia and globally and estimate their likely impact on the various publics of concern to public health educators, practitioners, and advocates.
   * Distinguish various economic trends in Australia and the Western Pacific Region and explain their significance for public health practice over the next decade.
   * Categorise the various global cultural and technological trends and predict how they might influence public health advocacy during the next ten years.
   * Summarise the various stances taken towards climate change and identify the challenges that these stances create for public health education.