# Principles of Public Health Practice/The publics of public health

Who or what are the various publics that we need to consider when we are thinking about and engaged in public health practice? Well, everyone in one sense or another. We can think about people in terms of gender, ethnicity, national origin, sexual orientation, age, work history, and so forth. We have to be careful not to cut people off with our definitions. It is easy for a government to only include citizens. There is a reason for this being done? Can you think what that reason is before you continue? See if you can identify some of the conflicts of interest that might exist between various groups of people. Remember, the publics include more than the people for whom we wish to develop interventions.

## 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
* Review the learning outcomes for this and earlier topics. Work through them to see how you are travelling in the subject. Are you getting what is going on? If not, what might you be able to do to improve your chances of gaining a better understanding? Who do you need to speak with? Where do you need to go for assistance (do not overlook your team members)? Be sure to read the stories and the background material. Obtain and scan through the references and resources. Put them in a safe place. You will want them later. View them here.
* View the playlist here.
* Mindmap the various publics mentioned in the videos of the playlist and be prepared to identify both the key issues and linkages between these publics during the lectorial. This will help you with your next assessment. Do not just respond to the surface of the videos. Ask yourself who else has a stake, positively or negatively, in what is being discussed in the videos. There are a number of them; but, they are relatively short for the most part. Do not watch all at once; break up your viewing and let things 'seep' in.
* Attend the lectorial and be prepared to engage in considering the topic constructively. Remember, there is more for you to gain a grip with than we can cover in the lectorials or, even, in the materials that we provide for you. At times, you will need to do some of your own research. Be guided by the learning outcomes.
Tutorial
* Download the tutorial sheet and prepare as instructed
* Progress your assignment and write out any questions or concerns that you might have. Think these through and see what answers you can come up with for yourself.
* Attend the tutorial having reviewed the tutorial sheet and having written down your concerns about your assignment. Be prepared to share your concerns and your provisional strategies for engaging these concerns.

## What is the role of THE public or various publics and their participation in terms of public health practice?

I am not happy with the idea that public health is what nations states and governments do for the people of the country. I like to say that public health is what a public does for and with its various sub-groups with public resources to improve the health of these groups. Is that a mouthful? Yep. And, it raises a number of questions such as: Does public resources mean such things as taxes? It could. It could also be about public resources such as goodwill or social capital. The public might mean the representatives of people such as elected officials fulfilling their public duties. Or, it could be the people (as citizens) holding their representatives accountable; think of the various people movements.
But, a great many people are not considered citizens of a nation. And, the citizens are what we usually mean by THE public. This is the difficulty of viewing public health as too closely tied to the nation state, or to national or state governments. Vulnerable groups, such as refugees, can often be ignored in terms of their basic human rights. Perhaps that is a good start for developing a definition of vulnerability--your claims to your rights can be easily ignored by those who have influence over you. This raises an important question for us. How can each of us participate in sharing resources beyond our immediate circles of influence?
Perhaps that is one of the better ways to think about the term public. It has something to do with the people beyond our immediate circle of influence. And, these are people for whom we still bear some responsibility as indicated by the Universal Declaration of Human Rights. It also implies that such people can hold us accountable for our actions, or, indeed, inaction.
Let's consider an example. Invisible Children may produce a public good using public resources, such as the Internet, to raise awareness and donations to implement various actions. Someone outside of my immediate circle of influence is advocating that it is critical to hold others accountable for their actions. They are seeking to use my authority as a citizen to insist that my elected representatives act. Additionally, they are encouraging me, as a fellow human who has any number of resources for influencing public opinion, to champion a cause. On the other hand, there are those who may seek to hold Invisible Children accountable as brokers working among conflicting special interest groups.
There is a system of public opinion or public expectation that affords people some latitude for action or for using resources to do some good. This system is often made up of a variety of alliances between groups seeking common cause to support a particular or a variety of issues. Therefore, public health is about more than governments creating interventions for problems that arise within a population in a country or region. Its about people being able to access the resources that they need to share in order to take control over the factors that influence their lives and their health. They do this as people living in families, groups, communities, as well as urban/rural, societal, national, regional and global contexts.

## Background

Who is responsible for what in public health? Well, democratic governments are certainly legally responsible for the health of their citizens. Non-democratic governments are at least morally responsible according to the Universal Declaration of Human Rights. In Great Britain, there is a renewed emphasis on both the Central and the Local Governments taking responsibility for the health of the people within their domains. This includes children and young people and their developmental needs, those who travel through or work in various local communities, and especial attention is to be focused on those living in the communities. Local authorities are responsible for safe and green public spaces and have a responsibility to ensure that planning for the future of space is accounted for. These authorities are also responsible for a number of regulatory functions that influence the life and health of the people who live, work or play in the municipality. There are a number of resources that are available to support this work and these would be valuable for Australians to consider as well (Buck & Gregory 2013).
One public that is easy to overlook is the public health workforce itself (CDC 2013). Additionally, the allied health professionals can be overlooked. Each of these professional groups are part of a complex and diverse workforce that often has difficulty integrating and coordinating their efforts. Many work in different jurisdictions and at different levels. Funding is often an issue and each group can end up competing for scarce resources. The report proposes a number of goals and strategies to deal with this. Specific goals include enhancing the education system, increasing the capacity of the current workforce, improving pathways into public health careers and strengthening systems to enable them to support the public health workforce (CDC 2013:6). In addition to the strategies that have been linked to each of the specific goals, a number of "cross-culting" strategies have been mooted: leveraging efforts across multiple stakeholders and constituencies, adopting shared leadership and developing advanced systems for measurement, evaluation and continuous improvement (CDC 2013:6).
Public health practitioners have a special responsibility for ensuring that the resources are available for refugees and asylum seekers who reach Australia. In Victoria, recent consultations have garnered a number of health related concerns and have outlined the sorts of resources that would be required to address these concerns. Importantly, these are to be coordinated with a number of other plans and frameworks influencing public health practice relating to those living in urban areas, and in rural and regional settings. They outline the priorities and groups for whom these priorities are of concern, particularly the disadvantaged and those whose particular circumstances results in poorer health outcomes than are attained in the broader community.
    The long-term planning and development priorities for Victoria’s health system are articulated in the Victorian Health Priorities Framework 2012–2022 and associated Metropolitan Health Plan 2012-2022 and Rural and Regional Health Plan 2012-2022. In conjunction with the Victorian Public Health and Wellbeing Plan 2011-2015, these policies have a particular emphasis on responding to the needs of those who are disadvantaged and at risk of poorer health outcomes compared to the wider community, including people from refugee backgrounds. The development of a Victorian Refugee Health and Wellbeing Action Plan is described in the Framework as a way to address these health disparities between refugees and the broader Victorian community (VDH 2013:1).
The Australian Indigenous Healthinfo Network has produced an important Summary of Australian Indigenous health (AIHIN 2013). This is a credible source of information derived from within one of the publics of which we need to be working constructively with as public health practitioners. The summary clearly lays out a number of important issues and strengths within the larger community of Indigenous Australians and points to additional resources that can be consulted. It is an excellent example of how a population can be engaged in identifying and framing its own issues in such a fashion as to inform other communities of good practice. You are encouraged to spend some time reviewing the material and following the links.
References and resources
    AIHIN (2013) Summary of Australian Indigenous health, 2012. Mt Lawley (WA): Australian Indigenous HealthInfoNet, Edith Cowan University. Access at: http://www.healthinfonet.ecu.edu.au/health-facts/summary.
    Buck, D. and Gregory, S. (2013) Improving The Public's Health: A resource for local authorities. London: The King's Fund.
    CDC (2013) Modernizing the workforce for the public’s health: shifting the balance — CDC Workforce Summit report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control. Available at: http://www.cdc.gov/osels/sepdpo/strategic-workforce-activities/ph-workforce/summit.html.
    VDH (2013) Consultation Summary--Victorian refugee health and wellbeing action plan. Melbourne: Victorian Department of Health.

## Learning Outcomes

What is the role of THE public or various publics and their participation in terms of public health practice?
Upon completion of this topic, through your own investigations, group preparation, tutorial participation and lectorial explorations, you should be able to:
   * Assess the strengths and limitations of using a concept such as citizenship to describe the PUBLIC in public health.
   * Identify and evaluate the usefulness of other ways of considering the publics of public health in terms of regional, state, national or international contexts.
   * Justify a position that either supports the use of the term vulnerable group or calls this categorisation into question in terms of PH interventions
   * Delineate the roles and functions of advocates, champions, brokers and alliances in terms of engaging special interest groups in PH policy development.