Amateur hour is over. It's time to get real on public health

Australia's public health preparedness has been lacklustre at best. Picture: Shutterstock
Australia's public health preparedness has been lacklustre at best. Picture: Shutterstock

Imagine going into a war with a battle plan that consisted of sitting around waiting for the enemy's next move and then responding on the fly with whatever you could lay your hands on. Imagine the rest of the plan was to counter setbacks with spin, pamphlets, blame shifting, and backgrounding against any critics.

Not really Napoleon's style, or Wellington's, or Marlborough's, or even that of today's military. Which is maybe why the federal government has a penchant for calling in the military to bail itself out of a fix.

To the military, planning, contingency planning, systems analysis and logistics are core priorities, not esoteric frills - certainly for those in the military whose preference is for winning.

It is long past time for our health departments, particularly the Commonwealth one, to gain much greater proficiency in these essentials, rather than focusing, more than good public policy would dictate, on dishing up to the minister what he or she may want to hear.

The chickens have come home to roost. Our hospitals are bulging with COVID patients, and so many people are infected that staff are in short supply, whether in hospitals, ambulances, pathology labs, airlines or other transport industries. These shortages threaten all the essentials: health and aged care, food supply, waste disposal, education, and large chunks of industry and commerce.

It has been abundantly clear, for a long time now, that while the states and territories generally have a degree of expertise in health planning - largely focused around the planning of hospitals and facilities - the Commonwealth doesn't, and it is not clear that it even understands the term. It's lost in a fog of roadmaps, frameworks and so-called "plans" which are unresourced and little more than glossy PR documents.

This has been particularly evident in the field of Aboriginal health, and a lack of real Commonwealth planning skills has contributed in no small way to the current decade of flatlining Indigenous mortality. To be fair, very recently the Commonwealth seems to have finally recognised that making progress may be connected in some way with resource allocation, although this owes as much to the willingness of the Prime Minister to listen to an extraordinary Australian Aboriginal woman, Pat Turner, and her colleagues, as it does to systematic health planning.

And, of course, the Commonwealth's various plans to deal with COVID aren't really plans in any meaningful sense of the word. The National Plan to Transition Australia's National COVID-19 Response is rich with "Measures may include", but contains nothing about the basics of planning as laid down and practised by numerous health agencies in Australia and around the world - in essence what's to be done, who is going to do it and when, what resources are needed, what does it cost and where's the money coming from, and crucially, monitoring and evaluation.


And so we have experienced problems with vaccine supply, quarantine arrangements, workforce issues and, most recently, approaches to managing Omicron which rely heavily on rapid antigen tests, which simply aren't available. A wing and a prayer will only take you so far.

And if the Commonwealth's grasp of health planning is vestigial, its comprehension of systems analysis seems non-existent. Systems analysis is about the interconnectedness of things, or as the World Bank puts it more formally: "Health systems analysis includes evidence on health system inputs, processes and outputs, and the analysis of how these combine to produce the outcomes. It considers politics, history, and institutional arrangements."

If you don't wish to be continually caught on the hop and engulfed by some "unexpected" threat like Omicron, then contingency planning is a must. It's all laid out in the WHO Guidance for Contingency Planning.

The world is an uncertain place, now more than ever. There is every chance that Omicron is so infectious that it may burn itself out. But you wouldn't want to bank on it, and there is a very real possibility that it could be replaced by an even nastier variant - more infectious and more lethal. And there are lots of other immediate or potential threats - many related to climate change (think vector-born diseases, natural disasters, hazards of fine particles associated with bush fires, threats to agriculture and food supply, mass migrations and conflict, to name a few). And of course there are the potential health threats from loss of biodiversity, nuclear weapons, chemical pollution, and dangerous new technologies, to also name a few. Some of these are on the horizon now, some are hopefully more remote, but none can be ignored. Preparedness is key to survival.

So this is a plea for the Commonwealth to urgently equip itself with the skills it needs to both deal with the world as it is and to prepare for an uncertain future. This means significant investment in health planning skills, with expertise in contingency planning and systems analysis. These skills need to be in-house, and the Commonwealth needs to attract and retain the best of the best to tackle these tasks of urgent national importance.

  • Ian Ring AO is a professor in tropical health and medicine at James Cook University and a former principal medical epidemiologist at Queensland Health.
This story Amateur hour is over. It's time to get real on public health first appeared on The Canberra Times.