Master of
Public Health

Speaker 1: [00:00:01] Good afternoon, everyone. I'm Patricia Davidson and I'm the vice chancellor of the University of Wollongong. And it's a pleasure to welcome each and every one of you today to talk about the future of public health. Public health is the science and practice of ensuring and improving the health of people and communities. And today, I'm really honoured to be here with you, with some of my exceptional colleagues. While we are just waiting for people to join and come in. Some of you might like to put in the chat where you are joining us from today. We're excited to have participants from all around the world. Also today is World AIDS Day, and I think the AIDS story is a phenomenal one of public health. I can remember working at Saint Vincent's Hospital in Sydney in the early eighties when the first cases of AIDS were being diagnosed and in fact at that time it was an unknown condition affecting, as we know, young gay men and through the power of science, the power of consumer advocacy, and the power of amazing health professionals, the story of AIDS has taken us from a highly stigmatized, unknown condition to one that is has global recognition with people all around the world working, using public health strategies to combat AIDS. So I can couldn't think of a better day to have this conversation with you today. But before we start, I would like to acknowledge country and on behalf of the University of Wollongong, I would like to acknowledge that country for Aboriginal Peoples is an interconnected set of ancient and sophisticated relationships. The University of Wollongong spreads across many interrelated Aboriginal countries that are bound by this sacred landscape, an intimate relationship with that landscape. Since creation from Sydney to the Southern Highlands to the South Coast, from freshwater to bitter water to salt, from city to urban to rural. The University of Wollongong acknowledges the custodianship of the Aboriginal peoples of this place and space that has kept alive the relationships between all living things. The University of Wollongong acknowledges the devastating impact of colonization on our campuses footprint and commit ourselves to truth telling, healing and inclusion. I would also like to acknowledge all first nations present here today and the University of Wollongong across our global footprint recognizes the sovereignty of First Nations people. So as I mentioned, my name is Patricia Davidson. I have the honor and privilege of being the Vice Chancellor of the University of Wollongong. And I'm here on our Wollongong campus today on Dhawaral Country. I'm a nurse by background, but have had the great privilege of working with many public health colleagues across my career and in my area of cardiovascular disease, which is my clinical specialty. I've seen significant advancements in public health strategies, and we're here about one of those today smoking cessation that has really made a huge difference to the lives of individuals. Many of us before the pandemic knew little about public health as a discipline. But as it's often said, many people have become armchair public health experts. We know now what epidemiology is and contact tracing and all of those principles. So here at the University of Wollongong, we're really glad to be able to share with you some experts that is going to really engage you in a conversation of what is the future of public health. This webinar is going to be recorded, so please be mindful of that and we'll send out the recording to you at the end of end of the week. Please put questions in the Q&A function as we go along and we'll try to do our very best to include those in in conversation. But let me introduce to you today some of my stellar colleagues, and I will try and abbreviate some of their bios. You've got some of their bios, but I think I'll sure you would much rather spend the time engaged in conversation. So firstly, let me welcome Stacy Carter, who is the professor and founding director of the Australian Centre for Health Engagement, Evidence and Values in the School of Health and Society at the University of Wollongong. And Stacey's expertize is in ethics and social research methods. As we know, particularly through COVID. Stacey's really lent her expertize in how we view people's perception of the value of vaccinations. So we all know that just telling people to do things doesn't work. We're also really honored to have one of our stellar alumni, Tanya Buchanan, who is the CEO of Cancer Council Australia and an expert on tobacco control. She is an honorary professor of practice here in the School of Health and Society. And we are also excited that she's been a great help in helping us renew and rejuvenate our Masters of Public Health, which will be offered next year, in view of the reason that the University of Wollongong has done that, no one can come through COVID without thinking that we will need a renewed conversation on the importance of value of public health and I'd also like to introduce to you one of our senior professors, Anthony Okley, and has really been a real world leader in developing activity guidelines for young people. He's done this all throughout the world, and he is leading an international study of movement behaviours in the early years. And this is called Sunrise. I encourage you to check it out. This involves 54 countries and 38 of these are in low and middle income countries. And I think that is the other great aspect of public health, because it sees that we are each on this planet inextricably linked. And so we just don't think about the community in which we are lived, but how the health and well-being of the world affects us. And last but not least, I proudly introduce to you Marlene Longbottom, and she is a Principal Research Fellow in the Ngarruwan Ngadju First People and Well-Being Research Center here at the University of Wollongong. Marlene is a very proud Yuin woman from Rosebery Park mission and she has extensive experience in working with First Nations people and in particular with Aboriginal and Torres Strait Islanders. And we are really excited by her research success in funding from the Australian Research Council. And also we're really proud to have the voice, the strong voice of Aboriginal and Torres Strait Islander people here with us as we look at the future of public health. So now I'm going to just put some questions to the panel, but please help me by going to the Q and A function, and please feel free to ask questions. So I'm now going to really put a very general question, and I'm going to ask each of our panelists to respond. I think the cOVID pandemic has been a real inflection point in the history of the world. And we cannot experience this pandemic, particularly on a global level, without really stopping and thinking about how we got to where we are, what we did well, what we didn't do well, and more importantly, what we can do to futureproof our health care services and in particular, public health, to make sure we don't see the death and devastation we have seen. So I'm going to start by asking each of the panelists and I'm going to put this to each of the panelists as an icebreaker to really ask them, what do you see other major public health challenges that we face? And the many people who are here on this webinar who are contemplating this question, maybe contemplating continuing their studies? What are the things that you're thinking about? And I'm going to start with Stacy. [00:09:44]

Speaker 2: [00:09:45] Thanks, Trish. I really agree with your idea that people became aware of public health perhaps for the first time during the pandemic, and public health really became visible during the pandemic. And I think this happened both in good ways that made people really aware of the expertise and the commitment and the infrastructure and also the real commitment to using evidence and in public health culture. I think that was a really positive thing. Possibly also in some not so good ways. So for some people, the experience of the pandemic was authoritarian or it felt illegitimate or it felt like it wasn't informed by public values. And not everyone had a great experience of being on the receiving end of public health in the pandemic, which I think really revealed something that we've always known in public health. Right, that public health is political. Public health is about values. And you can't extricate public health from paying attention to the politics and the values of health. So for me, I think a real public health challenge that we have to come to terms with now to learn from the pandemic is engaging with the ethics, with the values, with the politics of public health, and that public health ethics obviously is an area that I work in. And that's really about asking what is it just about action here? What's the legitimate action here? How can we act in ways that concordant with public values? I think kind of relatedly, the pandemic brought us together in a lot of ways, but it also did reveal some real fractures in society. It revealed that we're not all the same and not everyone had the same opportunities, the same experience, the same pandemic. So I think I think also the pandemic has really put front and center against what might be the oldest challenge to public health of all, which is the social determinants of health, that public health is always known that that people are healthy and not healthy, not just because of health services. They're healthy or not healthy because of all the social things that surround us, whether it's our housing, our income, education, our working conditions, our social inclusion, not experiencing discrimination, all of those things are really central. So I think for me, the big challenge is now committing again to a culture and perhaps more to a culture of having really inclusive, authentic conversations with communities about their values and what kind of health policy I think is justified and legitimate. And really putting the social determinants of health back at the heart of of public health action to try to make sure that we have real equity across the outcomes for public health. [00:12:14]

Speaker 1: [00:12:16] Thanks so much, Stacy. I think there's some really important messages there. Public health is political and for those newcomers to the field, I think you find that pretty soon once you start engaging in tobacco control or gun control or any of these issues, it is inherently political and the importance of exploration of values. So. Thanks so much, Marlene, over to you. [00:12:46]

Speaker 2: [00:12:48] Walawaani Njindiwan. That's greetings in my language, in the Dhawaral language of the Yuin nation. I just like to pay my respects to everyone here that's here today, both local in terms of on country in Australia or internationally, and to first nations people around the world who might be joining us as well. In order to answer that, I think and Stacy and Trish have just hit the nail on the head, like public health or anything to do with health is always political. And we cannot get away from the fact that race and racism is is one of the biggest, most challenges that we face today in terms of service delivery to underserved or multiply marginalized communities. And I think if as I reflect back, like Trish, you mentioned about the AIDS pandemic, and I remember as a young child, so this is going to show my age, the ads of the Grim Reaper and things like that. So those public health messages came through when I was I was a really young girl watching TV. So they're kind of all of those sorts of influences. But I think the one thing that COVID has actually brought out is, is something around and Stacey's touched on it, COVID actually exposed the social determinants of health. So those who are affluent, they were they were okay, you know, given given the parameters of their locations and where they lived. And then you had other populations of people, particularly First Nations people and nonwhite people who were in communities who were on the lower socioeconomic end of income, which meant that the highly dense populated communities, social housing, those sorts of things. So we saw a lot of enactment of the Public Health Act. That to me in certain circumstances was quite racialized and that's actually come out through the New South Wales Bosca data in terms of a report about infringements and breaches of COVID restrictions and and the pandemic and the enforcement of infringements. So when we start to unpack public health, it's not just about the delivery of health information or delivery of health services. It's actually as we as public health researchers, workers working in a system that can actually marginalize people further. And I think that's what we need to really understand, that the social determinants of health actually impacts people in lots of different ways. And I think that's reflecting on COVID, reflecting on the things that the major public health key messages that have come out there. And you can actually see where the social determinants of health are actually. Well, they're exposed. And I think with COVID, that really, really brought that home. [00:15:47]

Speaker 1: [00:15:49] Thanks Marlene. I think you drew out some really important points is that policy can be used for good or bad. I think certainly we've saw during COVID in Sydney a tale of two cities where marked difference in policy and strategies from the East and the West End. And your comments about race, racism and how it contributes to alienation and marginalization are just critical factors to consider in public health. Tanya, what do you think of the big challenges we face in public health at the moment? [00:16:29]

Speaker 3: [00:16:30] Thanks, Trish. Well, I will echo everything Stacy and Marlene said and pivot just a little bit. I think that, you know, as you said, the COVID pandemic made sure that every Australian knew what public health was and everyone now knows what epidemiology is. But I think that the big future challenge, certainly from my perspective, is we really need to have a focus on prevention and preventing ill health. And, you know, in terms of prevention, today really is a milestone day for public health. That marks the 10th anniversary of plain packaging legislation for tobacco products in Australia. And that was world first legislation and it had an enormous impact. But the thing that that legislation was really about was prioritizing the health of Australians over the profit making of an industry that sells deadly products. And so unfortunately as that, you know, show Magda's big health big national health check demonstrates and if you haven't watched too I would recommend it is that show really demonstrates what we see is that it's really actually quite difficult to make good health choices in Australia at the moment because Australians are subjected to a range of marketing and promotional activities that can often be quite manipulative. And what we see is companies prioritizing profit over health and taking the form of health washing often. So from a prevention perspective, what we know is that around half of all Australians suffer from a chronic illness, at least one chronic illness, and we know that many of those chronic illnesses are preventable. If we can make it easier for Australians to have healthy lifestyle choices and to be able to identify and reject misinformation. And one of the things we did see through the pandemic was rampant misinformation. And we saw how easy it was for that to take hold in the digital space and to persist and to circulate. And, you know, one of my favorite terms coming out of that sort of misinformation during the pandemic is the infodemic. You know, where we see this misinformation just. Getting a life of its own. And I think finally, from my perspective, and this is I think, you know, quite aligned with what Marlene and Stacy were saying, is that when we think about public health, we have to be really clear. We're not making this about personal responsibility. You know, it's far bigger. We have to take a systems approach and we really need to take account of the sort of social determinants of health. We need to apply an equity lens. And we really also need to look at the commercial determinants of health. And we need to hold big organizations who are prioritizing profit over health to account in terms of their practices. [00:19:13]

Speaker 1: [00:19:16] Well, thanks, Tanya. You've really raised some really important topics, in particular the intersection between business and health. And many people in Australia actually live in food deserts. And for some people who have just come today, just to find out a little bit about public health, I just encourage you, as you're driving through most more affluent suburbs, to count the number of McDonald's and KFC and go to less affluent suburbs and look for those, I think you'll be really surprised. And and it's a clear. Identification of the role that business can play in creating a substrate for poor health. And we all love Magda if we you know what? What a great woman she is. Now over to you, Anthony. In you're in the front line. I love seeing you all around the world with young people, you know, espousing the benefits of physical activity. In your sort of experience, what do you think is some of the challenges of the moment? [00:20:26]

Speaker 4: [00:20:28] Yeah, thanks, Trish. Look, without a doubt, the impact of climate change on health is something that is is highly topical. We've just come off the back of COP 27 where we not only were highlighted or aware of the environmental impacts, the economic impacts, but certainly the health impacts. So events like floods and droughts and the catastrophic weather that we're seeing more frequently, the prolonged periods of heat, all of those have a significant impact on health outcomes. We see in those areas where these weather events have been more pronounced, higher rates of malnutrition, obviously we see the more acute effects, such as the impact on infectious diseases, but also the impact on mental health. And that's often underestimated. And picking up on that, I think the other challenge is in the area of non-communicable diseases. So we're talking here about cardiovascular disease, cancer, diabetes, chronic respiratory diseases and mental ill health. And we know that these diseases are responsible for nearly three quarters of the deaths around the world. And it's not in high income countries, but it's low and middle income countries where they're experiencing this disproportionate burden of suffering from the effects of non-communicable diseases. And in many of these countries, it's the poorest who suffer the most. So there's an equity issue here as well. There are far fewer resources available for prevention of the treatment. The surveillance and the environments in which people grow up in don't support the ability to be able to make healthy decisions. The determinants there, particularly the social determinants, make it very difficult to treat something holistically. As Michael Marmot said, you know, you can go to a hospital and get treatment for a particular disease, but then what good is that if you come out and you're in the environment again, which puts you in that position in the very first place. So we need to be thinking more broadly, systems approaches, holistic thinking towards this. And thankfully, national leaders developed a 2030 sustainable development goal to reduce by one third premature mortality caused by n c ds, and that's largely through prevention and treatment and promoting mental health and wellbeing. But my fear is that we're not going to actually reach that goal by that time, but we won't see that reduction. And I think that's a big challenge that we have between now and 2030. [00:23:02]

Speaker 1: [00:23:04] Well, thanks, Anthony. You're really given some important points. You know, we know that the climate change is real. It impacts adversely on our health. And I think we'll come back to that point of, you know, what are some of the challenges? I think we can't deny the profound effect that COVID has had on progression of public health initiatives. We already have seen excess deaths rising in many parts of the world, and the reasons for that a complex are multifactorial. Before we move on to the next question, I did want to I think it was a comment in the Q&A, but I just want to sort of recognize this. One of our participants talked about contracting COVID. And I think me personally, after not that it has impacted my health, but bearing witness to death and suffering around many health care workers around the world underscores the vulnerability of many people working at the front line and in health care situations. And, you know, also, as we think about many health strategies, one of the most tragic things that I think is now the weaponization of public health workers in many parts of the world. In years gone by, a Red Cross on a van or a hospital was a no go zone. But sadly, that is no longer the case. So I think thank you for raising that. And I think it's an important consideration as we move forward in how we make sure that we, you know, protect people working in public health. And now and I think we'll pick up Tony's excellent point about, you know, how what are the going to be the barriers to achieving the SDGs. But before we go there, I'd like to talk a little bit about technology and this can be a little bit controversial. I was actually on a call yesterday. And, you know, people sometimes are challenging. You know, there's an app for everything. My phone tells me there's an app for everything. And definitely during COVID, we've seen technology as really enabling many aspects of care from contact tracing out through to telehealth. But I'm really interested in, in particularly as we shape the future of public health, understanding a little bit about what your views and perspectives are and what are the opportunities and concerns in your areas. And Marlene, let me start with you this time. [00:25:43]

Speaker 2: [00:25:45] Thanks, Trish. I think technology is one of those places that it can be quite useful, but it can also be daunting and the equity lens comes in with that in terms of access to the Internet, but also the resources like a phone that has the technology like an iPhone or Android. Some people I know are still using flip phones, so access to online or e-health or telehealth can actually be inaccessible for certain communities, and particularly communities where in rural and remote areas, for instance, where is the signal and services is impacted by the weather. You have to have money for your credit, all those sorts of things in terms of access to the Internet and things like that. I think it's a we shouldn't, as public health assume that everyone has access to the NBN or the, you know, the, the internet. I know communities in the Shoalhaven and the Illawarra. A lot of young people, whilst they may have there's an assumption they may have access to phones, not all of them do. So I think in terms of technology, it can be used in different ways that can really help with pushing out the message. And we saw that with the Aboriginal community control sector with throughout the pandemic, who actually led the way in terms of, in my belief of communication and translation of really high technical, really important public health information to in ways in which the Aboriginal and Torres Strait Islander community could understand, but also used. And I'd just like to echo some of the sentiments that Tanya was talking about in terms of misinformation and disinformation. And I think, you know, a lot of Aboriginal people and a lot of Aboriginal communities where were targeted by Christian groups and faith based groups around, you know, the stain of the beast or, you know, so technology has its benefits, but it also has some limitations. But it also can be a site where over information can an exposure to information can actually be quite harrowing. And you have to sift through those conversations. So I had a lot of people and my family and friends networks asking me about things, so I would make sure that I'd share information that was accurate, that was given by, you know, the public health officials rather than a politician. So I think public health messages using technology are politicized, and that could also cause, you know, an overload of information. But also people get information misconstrued and things like that. So I think technology has its uses, but we've got to be mindful that there are some people who do and don't have access for whatever reason. [00:28:33]

Speaker 1: [00:28:35] Thanks, Marlene. And, you know, some people say, you know, that it's going to be, you know, digital access is now going to be a big determinant of health and wellbeing. Tony. [00:28:44]

Speaker 4: [00:28:46] Yeah. Thanks, Trish. Look, probably like me. Many of you have become interested in wearables and we talked before about phones and apps for everything and of course my phone links with my Apple Watch, which tells me the amount of activity that I do a day. It prompted me to stand up when I've been sitting for too long. And that's great because these commercial devices now tell us a lot of information. That information also gets captured by the but abide by the companies that that make these devices. And that has been used for research purposes. Obviously, there's some bias in the sample because you need to be able to afford one of these devices to be able to provide that data. But this whole area of device based measures, and I've become particularly interested in how we measure movement behaviors, physical activity, sedentary behavior and sleep and the benefit of these devices. And I'll hold up a couple to show you here the research grade devices that we use. This one here, we put on the wrist and this one here goes around people's waist with an elastic belt there. These can collect data in real time up to a month. And there's no need then for the participants to recall how much activity they've done, how much time they've spent sitting. And it reduces the social desirability around the reporting of those behaviors. But the challenges that we have with compliance with these devices, as you saw there, they're not small devices and you have to actually wear it for a period of time on a part of your body that you're perhaps not used to. In many of our studies, participants are concerned that these devices will track them. They will be able to tell where they are, who they're with, what they're doing. And so we have to reassure participants that that's not the case in some countries that we work in. If something is black, it's associated with witchcraft. So there's obviously need for education around that. And if something's read, there is a fear that it may actually suck blood from the person. So these things are things that we may not be aware of. Certainly until I had begun to do work internationally might be a challenge to collecting good quality data here and in some countries. Is the presence of wearing one of these devices can make you a target? Some of them are not waterproof, so it makes it difficult to wear them, particularly if you're doing a lot of swimming or water based activities and you need to get it back from the participants at the end of the monitoring period. And that's sometimes a challenge too, because it means that you have to do an extra visit or it means that they have to post them back. And the cost of these devices makes it also very difficult for many countries to be able to resource studies. They're worth between 200 and 350 USD each. But there are opportunities with this. I still think we're a little way off. We're doing some collaborative work with colleagues at the University of Surrey around how we can develop something that's much smaller, about the size of a $1 coin, which we think will make a great difference in terms of being able to get better compliance. We think if we can stick it somewhere like on the front of the thigh, maybe as a patch, then that might make it easier to wear because you can put it on and really forget that you've got it on there, and particularly if it's waterproof, if you can make it disposable. So at the end of the period that we don't have to worry about trying to get it back from the participants and if that can be cloud based. So we don't have to worry then about getting the information back and having to download it ourselves and get the information off the monitor. So all of that is a bit of a wish list. I'm told that we're about 5 to 6 years away, and obviously if we can make that really cheap too, that would be a great opportunity. [00:32:21]

Speaker 1: [00:32:25] Thanks, Tony. Tanya, how are you using technology in your work? [00:32:29]

Speaker 3: [00:32:30] So I think technology can be a little bit of a double edged sword as as Marlene was discussing. And I think technology, you know, in terms of public health research, as Tony outlined, has some, you know, some really important benefits. But the thing that I see everyday in our work is really the important role that's being played by digital media and digital marketing. And so, you know, what what we know is that, you know, we can use these tools to promote good health. But actually, you know, commercial entities are also using these tools to promote their products that are not necessarily healthy. And they do so, you know, with far more money and far more people and far more resources than the public health sector probably has. And and digital marketing in particular is really quite complex now. And in fact, when you asked me about talking about tech, I have to confess, I'm the least tech person I know. And it gives me a little shiver of, oh, god, you know, like, how do I talk about these things? And I think that's one of the challenges is that the public health workforce really now needs to come to terms with technology. We need to understand what what technology means and understand that, you know, when we're doing public health campaigns, for example, we're no longer just putting an ad on the telly. You know, we requiring to do a lot of complex digital marketing. And when we look at what companies are doing, they're using very complex processes like social listening, artificial intelligence. They're using, you know, tools like Tony was talking about. So they're really, really leading the way. And, you know, additionally, of course, when we are interacting online, there's a lot of data being collected about us. So I guess what I would say is with good public health, digital marketing, we can reach people and we can we can influence good behavior change. But we also know that the challenges that industry has more money. And so when we think about that in an Australian context, we know that around one that adolescents in Australia are being subjected to around 100 promotions each week when they're online and they're, they're being targeted with the straight ad, but they're also getting a range of other ways that they're being targeted in terms of, you know, advertising games and apps and influencer behavior. So we need to be alert to that. And I think that that's just another reason why when we're talking about technology and we need to understand its role in marketing, we need to be really clear that we need to be looking at regulating marketing of, of, of companies in the digital space as well. [00:35:06]

Speaker 1: [00:35:08] Excellent points, Stacy. I think it must be fascinating in your field to see you explore values and beliefs. You know, the role of digital technology. [00:35:19]

Speaker 2: [00:35:21] You absolutely correct. So maybe to pick up on what Tanya was just talking about and to stretch it into the policy world, actually. So Tanya was talking about how much data there is being generated now and how that's being used by commercial actors. But public health decision making and health decision making generally is becoming increasingly data driven. And in fact, the new master of public health that you mentioned, which has a data science stream specifically to respond to this movement in public health towards data driven decision making. So technology I'm quite focused on in my research work is artificial intelligence, which is really automating those decisions. So not just using the data to drive the decisions, but building artificial intelligence technology that to at least some, some extent can make the decisions automatically in the place of a human. So this data driven this can really make a big contribution. And modeling in the pandemic actually was a really good example where I really big datasets from a local place could generate insights and and that allowed public health action to really respond to what was happening in real time. But when we automate decisions using artificial intelligence based on data, some real issues emerge. So a really great example is a study that was published in 2019 in Science by Ziad Obama, his group that was looking at an artificial intelligence algorithm that was already being used in health services in lots of places in the US. So this was an algorithm that was meant to automatically distinguish between people who were receiving services from the health service who needed lots of extra care because they were very high risk. So they needed extra services, extra access to resources, extra education and people who were lower risk. So they didn't need as much engagement, which seems like a really good thing to be able to do in a, in an objective kind of consistent way so that every we know that the people that need the extra help are getting the extra help. And it's very consistent with that idea of prevention that we've been talking about. But what Obama in his group found when he analyzed this algorithm was that when the developers put it together, the data that they'd use to represent need to represent high risk was health care costs. And so what the algorithm did was it learned that black Americans who actually had higher health risks needed less health services, because in the past they'd had less money spent on them. Their health care costs had been lower. So, in fact, the algorithm learned to reflect the structural discrimination that was already in the American health system and allocated more care to more privileged white Americans and less care to the less well off black Americans who really needed that care. So it's it's such a great example of the way that automating these decisions that can potentially be a real improvement technologically, but it can actually just exacerbate existing problems in society. And it can they can make the worse and automate that problem so that we're not paying enough attention to it anymore, because we have a tendency as humans to presume that the decisions that the machine makes are the right decisions. That's called automation bias and not to push back on those decisions. So I think that and lots of other issues are really going to be an important challenge for public health as we move towards a data driven paradigm and as we move towards a more artificial intelligence based, automated decision, decision making process in health policymaking. [00:39:00]

Speaker 1: [00:39:02] Stacy, I think the excellent points and certainly the business interests that you mention have access to those data as well. So you really make some excellent points there. It's great to see. We've got some questions coming in in the Q and A and and I'm going to start with a question from Professor Glenn Salkeld, who's had decades in public health. And he's asked the question, you know, how do we apply, you know, some of the lessons we've learned from previous success stories and, you know, the tobacco control one is that we've already outlined to face some of these new challenges. And Tony, can I start with you? [00:39:47]

Speaker 4: [00:39:48] Yeah, thanks, Trish. Look, I think that's a great question, and I think we've got really good examples from COVID of how we've done that. I mean, if you think about the father of public health, John Snow, and what happened in his story, you know, there were these people dying of cholera in London and they thought it was due to bad it. I thought it was due to rotting. Rubbish in cramped conditions and he was able to investigate who was getting sick, their symptoms, whereabouts they were getting sick, importantly. And where could they be exposed to what was causing the sickness? And he was able to track that it was due to infected water. And he did a simple thing and broke the handle off the water pump in Broad Street and actually stopped the cholera epidemic. So I think that those lessons about how he was able to investigate through good data that was available at the time map where these diseases or these outbreaks were occurring in the people who were getting sick. And method back to one particular source and use that to be able to stop the disease. And I think and we've seen good examples during COVID and where we've been able to I think remember at the start we all thought it was due to our services and coming in contact with services. And then we realized more that it was an airborne disease and that was due to the data that had been collected. And then we had contact tracing and then we were able to get messages about where there were particular outbreaks and messages about, you know, particular cedar events. And and therefore, if you were exposed to one of those, you should isolate to prevent that further risk. So I think that, you know, all of this traces itself back to John Snow and the way he was able to use data to be able to map accurately what was going on, what was causing it and how to stop it. And I think we've seen during COVID how data can be used beneficially to be able to prevent the spread of of the of the disease. [00:41:45]

Speaker 1: [00:41:47] Thanks. Thanks, Tony. There's some excellent examples there. And it really picks up that theme of data that that Stacey outlined. Another question, which I think is really important, relates to information and sharing and the role of misinformation and disinformation. Tanya, would you like to make some comments? And I you know, I think one of the things that sort of breaks my heart is the vaping. You know, how how did that morph into an issue where we've done so well in tobacco control and then all of a sudden vaping? So okay. So I think this relates a little bit to how we share information. [00:42:31]

Speaker 3: [00:42:33] Yeah, I think, you know, when we're talking about information and misinformation and disinformation, you know, I think we have to be really alert to the sort of practices of health washing where, you know, we're. Organizations or entities are wanting to sell a product. They wanting to make a profit. And they will do that in ways which promote themselves as being part of the solution to good public health or good health. Even though the products they're selling are not. And and, you know, and I think just to talk about misinformation and disinformation more generally, you know, it's not a simple task. So, you know, when you look at the sort of information that circulates on social media platforms, you know, it it it just circulates. And and it's very rarely, if ever, that fact checked. I think going back to, though, with the vaping story, you know, to Tony's point is that this was a relatively new technology data is emerging all of the time. And so what starts off, you know, with with some good marketing and a lack of data to demonstrate the harms of this, this activity then can sort of morph and continue to grow. But what we know now is that, you know, there is no good reason for people to be vaping. And the only people that really should be vaping are people who have having failed all other attempts at quitting smoking are doing so under the direction of a medical professional. So that's a question, that's a message that we are continuing to try to get out. And it requires many, many organizations to do that from government through just to to health agencies, because we're literally having to fight against organizations that are wanting to make profit off the sale of these products. [00:44:21]

Speaker 1: [00:44:23] Thank you. Thank you. And there's also a question from Emmanuel that he will comment really that in spite of the, you know, the desperate need for public health experts, sometimes the job opportunities are not as obvious or accessible, and certainly in many areas, not that well paid. So, you know, as we're coming to the end of the time together, I thought it might be useful for people to actually hear the back story. And I haven't given my colleagues any warning about this. My apologies in advance. But, you know, I think it'd be really great to hear what inspired and motivated you to go into public health. And you know what? What advice would you give to many of the people on the webinar today, and particularly the people who are thinking about a career in public health? So, Stacy, can I start with you? [00:45:27]

Speaker 2: [00:45:29] So, Trish, so like you, I began as a clinician, actually, and I was drawn to public health because of its commitment to populations and communities. So while I loved working with individual patients, I was really motivated to find a way that I could do work that would reach more broadly, that would reach more people at once, that would engage with the culture around health, that would engage with social values around health. So I really came to public health as a way of trying to move from that individual level to a much more community level. It's always hard to give people advice, isn't it, around public health, though, around careers generally. I think I would say the public health community is a wonderful community in general. Generally, people that work in public health are very supportive of their colleagues. They're very committed to their communities and very interconnected. And I really hear the struggle of finding work in areas that we want to work in. It is often really very challenging. But if there's any opportunity to network to reach out to the public health community, I think in general, I'm sure my colleagues would agree that you'll find the public health community to be very welcoming and and to be a network that might help to find those opportunities that you need. But also there's many opportunities often to learn from your colleagues in public health, because it's also a very strongly evidence based, research oriented way of working. And so the learning opportunities and also the employment opportunities often in my experience, come from getting plugged into those public health professional networks. [00:47:11]

Speaker 1: [00:47:13] Great advice, Stacy. Marlene. [00:47:15]

Speaker 2: [00:47:18] My journey into public health, where I actually research, which was when I was a very young person in my early twenties, a young mum, I had found that I didn't like working in childcare and looking after other people's children. So I found public health that or at least community health, the area that I was passionate about. And I'm an Aboriginal health worker by background and I come from the old school of public health. So before sorry, primary health care and public health. So the National Aboriginal Health Strategy DI is so I was mentored by some brilliant Aboriginal health workers back in the day and very fortunate to have still those connections in those communities. And they provided me with some really important guidance about how to deliver important health messages to Aboriginal and Torres Strait Islander communities so that they can make informed decisions about their health care. And I think when it comes to when I reflect back on maybe in my early twenties as an Aboriginal health worker speaking to elders about conditions, chronic conditions, that it was a very difficult thing for me because as a young person I had to shift the way in which I communicated and how I spoke to people about the health conditions. Because obviously speaking to an elder, you can't be speaking and telling them what to do. So I guess, you know, the information that I that I gathered in terms of all of the education that I completed, the the degrees, but it was actually the health worker who caused the out of Cairns time and the actual involvement and pain and suffering by Aboriginal health workers where we were doing things one on one, but also community based information and health promotion and health education, sorts of things. And my first job in public health was to evaluate a program called the Healthy White Program, and that came of me being part of motivated young person. I did seven months volunteer work in the Aboriginal health team in Rockhampton and I just volunteered my time because I realized that I needed that on in the job sort of experience and then that kind of flow flowed on from there with what what I did. And then I moved into different spaces from chronic disease into drug and alcohol, supporting families in family support. So I guess public health needs is it's not just about siloed health care, it's about looking at things in its entirety. And you can be focused on nutrition and dietetics or diabetes or nursing or an element of that. But actually that from an Aboriginal perspective, health cannot be separated from wellbeing and it's all encompassing. So coming back to those old go back to Tina's because it's healthy, is, is very holistic and your mind, body and spirit has to be healthy. And if your environment is unhealthy, well, what does that mean if your mental health is unhealthy, what does that mean? So it's it's very linked and you can't separate it. And and I think the idea of public health when working in specific areas, it enables you to look across those spectrums and you might find a niche area that you that you like and that you enjoy. But then there might be policy areas that you can say that you can fill a gap in. And I always come back to the World Health Organization and all of those old documents that was helpful. And I think if we're going to have health for all, we need to actually look at those health inequities and everyone can have a have a part to play in those because it's and like I said previously, the COVID actually highlighted those health inequities in the social determinants of health. And and I remember a lot of times, you know, I was talking to dietitians about, you know, healthy foods for Aboriginal people and being realistic about what are actually available in the community like, you know, fresh fruit and vegetables. Sometimes that's not there. So what's an alternative? Legumes, you know, not many Aboriginal people. Well, I didn't I didn't experience legumes until I was in my adult use and baked beans was what I knew. So, you know, these are the things that understanding where communities are coming from and how you can actually enhance their understanding is probably the best advice I can give, if that's any advice.

Speaker 1: [00:51:58] I think, you know, sharing your experience is really powerful, you know, and I think the role that indigenous methods and indigenous worldviews play is, you know, we have we have a lot to learn. So thanks for sharing, Marlene. Tanya. You know, you now you're this tobacco expert. Tell us about your journey. Well. 

Speaker 3: [00:52:23] Trish, like you, I started out as a as a nurse. And, you know, I moved out of that 1 to 1 clinical nursing and and worked in tobacco control initially, which was my first foray into public health in the UK. And and what became really apparent to me is that, you know, we can if we manage those, those social determinants and we can really start to use evidence and, and assist people to make healthy lifestyle choices and to address the systems that prevent it. You know, we can absolutely change population health outcomes. And so, you know, so when we talk about tobacco control, I mean, that's part of the issue. When we address tobacco control, what we're actually addressing is respiratory health, cardiovascular health, you know, a range of of health conditions that we can really start to improve outcomes for people. You know, and a lot of people. So. So for me, public health is really about addressing addressing population level outcomes, whether it's in tobacco control or alcohol or food and nutrition or physical activity. You know, they all contribute to us having better health outcomes for Australians. The one thing I would say is that to echo Stacy's comment is that the public health community are incredibly welcoming. And if it is a career that you are looking. You know, to pursue. You know, I've I think use your networks and if you don't have networks, think about how you can develop them through, you know, attending, you know, state and territory based activities like the Public Health Association activities or, you know, reaching out to colleagues at the university or in your organization. Because in my experience, public health people are pretty happy to share their experience and their knowledge and and to see people coming through. And and fundamentally, I think, you know, as someone who employs public health people, you know, having that most as a public health is a really important first step. And and being able to to demonstrate that you are qualified, that you're politically savvy at, that you have high emotional intelligence and really good stakeholder engagement skills are really crucial. [00:54:36][133.8]

Speaker 1: [00:54:38] Thanks, Tanya. Tony. What got you into public health and what what would you advice would you give some of your colleagues listening today? [00:54:49]

Speaker 4: [00:54:50] Yeah, Trish, I've always had a love of working with children, so I actually started my career as a physical and health educator. I worked in a school for for a number of years, and then I was very fortunate when I came back to do postgraduate study that I had a couple of mentors that introduced me to work on what back then was the the first statewide survey of children and adolescents, physical activity and health. And I think that really created in me an interest of public health. But more importantly, I began to understand from looking at the data and understanding what it was telling me about the inequities that exist. So why was it that children from particular backgrounds were less active, had unhealthy diets, didn't walk to school, maybe had less opportunity to participate in sport and other types of activities? And that generated interest in me and wanting to work with trying to address some of those inequities, whether that be through more descriptive or observational studies and even interventions. Then where we could start to work with those communities to try to to try to address that. It's been a labor of love. I've had many, many failures along the way, but I've learned a lot from those failures, and I think that's made me a better researcher. And just more recently, the opportunity to then understand and to actually see firsthand and observe what health looks like a different countries, particularly low and middle income countries. And I would encourage people with an interest in this to spend time in communities. If you want to make a difference, you have to get to know the people that you're working with. And the best way to get to know those people is to spend time with them. I've learned so much for my colleagues in low and middle income countries. They've taught me so much about public health. There are so many things that they do much better than we do in high income countries. And it's through engaging with them and understanding what their needs are that we can have a mutually beneficial relationship, where I can see how I might be able to support them in reaching some of their goals and what types of things they need. And often it's not what we think it is. 

Speaker 1: [00:57:03] Excellent points. Well, look, we're coming to the end of our time together. I found this to be a fascinating conversation. I'm so in awe of the work of these exceptional public health researchers and public health workers and all they do. I think in terms of the challenges we face in public health, I would think we've had some pretty, pretty clear messages. We know that public health is inherently political. We know that social determinants of health moderate the circumstances in which people are born, work, live and die. And we ignore those at our peril. We know that racism contributes to many health disparities. And we've also heard that, you know, our planet, Mother Earth, is under significant threat. I love Marlene's description of what health is. So, you know, it's it's not just a biomedical approach. And it's interesting, as clinicians, you know, we all realize that, you know, just giving people medication and doing procedures is not what health is all about. So this has been a wonderful conversation. Thank you to so many of our alumni and colleagues that have joined us, not just from Australia but all around the world. If you've registered for the webinar, you will get a copy of this for people that are who are considering a career in public health. I think we've heard loud and clear that your MPH is your ticker. There's a question in the chat about do internships work? You know, yes, absolutely. We've heard Marlene's story of volunteering, you know, try and get any experiences you can or work experience. And some of that is volunteering and some of it is paid. But I really encourage you to to go to our website. Have a look at our courses. And I think after this pandemic, this critical time in the history of the world, never before has the world needed, committed and competent and credentialed healthcare workers. I think we've also had the theme from all of our speakers that public health is evidence based, outcome driven, and I think importantly driven by principles of social justice and equity. So thank you so much, everybody, for joining us today. A really special thanks to my colleagues here today. It's great to hear a little bit more about your work and what motivates you and inspires you. I'm a very proud vice chancellor at the moment of exceptional people here at the University of Wollongong. Thank you for all you do and thank you for everybody for joining us today.