The future for public health

What is the future for public health in the twenty first century? Can we glean an idea about the future of public health from its past? As Winston Churchill once said ‘the further backward you look, the further forward you can see’. What then can we see in the history of public health that gives us an idea of where public health might be headed in the future? In the twentieth century there was substantial progress in public health in Australia. These improvements were brought about through a number of factors. In part, improvements were due to improved knowledge about the natural history of disease and its treatment. Added to this knowledge was a shifting focus from legislative measures to protect health, to the emergence of improved promotion and prevention strategies and a general improvement in social and economic conditions for people living in countries like Australia. The same could not, however, be said for poorer countries, many of whom have the most fundamental of sanitary and health protection issues still to deal with. For example, in sub-Saharan Africa and Russia, the decline in life expectancy may be an aberration or it may be related to a range of interconnected factors. In Russia, factors such as alcoholism, violence, suicide, accidents and cardiovascular disease could be contributing to the falling life expectancy (McMichael & Butler 2007). In sub-Saharan Africa, a range of issues such as HIV/AIDS, poverty, malaria, tuberculosis, undernutrition, totally inadequate infrastructure, gender inequality, conflict and violence, political taboos and a complete lack of political will, have all contributed to a dramatic drop in life expectancy (McMichael & Butler 2007).

Defences in medical negligence : to what extent has tort law reform in Australia limited the liability of health professionals?

Tort law reform has resulted in legislation being passed by all Australian jurisdictions in the past decade implementing the recommendations contained in the Ipp Report. The report was in response to a perceived crisis in medical indemnity insurance. The objective was to restrict and limit liability in negligence actions. This paper will consider to what extent the reforms have impacted on the liability of health professionals in medical negligence actions. After an analysis of the legislation, it will be argued in this paper that while there has been some limitation and restriction, courts have generally interpreted the civil liability reforms in compliance with the common law. It has been the impact of statutory limits on the assessment of damages through thresholds and caps which has limited the liability of health professionals in medical negligence actions.

'Any body is better than nobody?' Ethical questions around recruiting and/or retaining health professionals in rural areas

The literature on recruiting and/or retaining health professionals in rural areas focuses primarily on the development of recruitment and retention strategies and assessing whether such strategies are effective. The objective of this article is to argue that it is important for all stakeholders involved in rural recruitment and/or retention processes to consider their decisions and actions from an ethics perspective. Recruitment and/or retention processes are not value neutral and it is important to understand their ethical dimensions. Methods: From the literature, elements of the recruitment and/or retention strategies that have been employed were identified and organised in respect of levels of governance (namely, the levels of health system/government, community, and individual health professionals). The elements identified in these levels were subjected to analysis to identify their ethical dimensions and to determine whether a clash or complement of values arose at each level of governance or between governance levels. Results: There is very little literature in this area that considers the ethical dimensions of rural recruitment and/or retention processes. However, all policies and practices have ethical dimensions that need to be identified and understood as they may have significant implications for recruitment and/or retention processes. Conclusion: This article recommends the application of an ethics perspective when reflecting on rural recruitment and/or retention strategies. The collective decisions of all involved in rural recruitment and/or retention processes may fundamentally influence the 'health' (broadly understood) of rural communities.

Modern construction economics [Book Review]

The editor, Gerard de Valence, points out in the preface, this book is neither a textbook nor a guide to what is done by construction managers and construction economists – read quantity surveyors and the like. Rather, de Valence notes it comprises a collection of chapters each of which focus on matters at the industry level and, in doing so, illustrates that a substantially improved understanding of the building and construction industry can be gained beyond the economics of delivering projects. Before giving some thought to how far each of the chapters achieve this, it’s worth reflecting on the virtues of developing construction economics as its own discipline or sub-discipline in general economics and the bold manner by which de Valence is proposing we do this. That is, de Valence proposes partitioning industry and project economics - as explained in the preface and in Chapter 1. de Valence’s view that “the time seems right” for these developments is also worthy of some consideration.

Engaging law students to promote psychological health

Recent empirical evidence suggests that concern for the psychological health of law students is well justified. Traditionally, the legal curriculum has focused on the provision of substantive legal doctrinal knowledge. This approach has not always engaged students positively with their learning of law. This article considers some strategies that can be adopted by Law Faculties to better engage students with their legal education in order to promote their psychological health. These strategies are: ensuring that active learning occurs in lectures, demonstrating concern for students and their learning and skillful management of student expectations and the learning environment. Further, some self-help strategies that students can adopt for themselves are discussed. Combined, these strategies will enable students to engage more positively with their legal education.

A randomized trial of a telephone-delivered exercise intervention for non-urban dwelling women newly diagnosed with breast cancer : exercise for health

Physical activity is important following breast cancer. Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas. This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered, mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer. A randomized controlled trial comparing an 8-month intervention delivered by exercise physiologists (n = 73) to usual care (n = 70). Sixty-one percent recruitment rate and 96% retention at 12 months; 79% of women in the intervention group received at least 75% of calls; odds (OR, 95% CI) of meeting intervention targets favored the intervention group for resistance training (OR 3.2; 1.2, 8.9) and aerobic (OR 2.1; 0.8, 5.5) activity. Given the limited availability of physical activity programs for non-urban women with breast cancer, results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions.

A review of commuter exposure to ultrafine particles and its health effects

Ultrafine particles (UFPs, <100 nm) are produced in large quantities by vehicular combustion and are implicated in causing several adverse human health effects. Recent work has suggested that a large proportion of daily UFP exposure may occur during commuting. However, the determinants, variability and transport mode-dependence of such exposure are not well-understood. The aim of this review was to address these knowledge gaps by distilling the results of ‘in-transit’ UFP exposure studies performed to-date, including studies of health effects. We identified 47 exposure studies performed across 6 transport modes: automobile, bicycle, bus, ferry, rail and walking. These encompassed approximately 3000 individual trips where UFP concentrations were measured. After weighting mean UFP concentrations by the number of trips in which they were collected, we found overall mean UFP concentrations of 3.4, 4.2, 4.5, 4.7, 4.9 and 5.7 × 10^4 particles cm^-3 for the bicycle, bus, automobile, rail, walking and ferry modes, respectively. The mean concentration inside automobiles travelling through tunnels was 3.0 × 10^5 particles cm^-3. While the mean concentrations were indicative of general trends, we found that the determinants of exposure (meteorology, traffic parameters, route, fuel type, exhaust treatment technologies, cabin ventilation, filtration, deposition, UFP penetration) exhibited marked variability and mode-dependence, such that it is not necessarily appropriate to rank modes in order of exposure without detailed consideration of these factors. Ten in-transit health effects studies have been conducted and their results indicate that UFP exposure during commuting can elicit acute effects in both healthy and health-compromised individuals. We suggest that future work should focus on further defining the contribution of in-transit UFP exposure to total UFP exposure, exploring its specific health effects and investigating exposures in the developing world. Keywords: air pollution; transport modes; acute health effects; travel; public transport

Early childhood education

Young children are the most vulnerable and most at risk of environmental challenges, current and future. Yet, early learning around environment and sustainability issues and topics has been neglected and underrated in early childhood education even though there is an expanding body of research literature – from economics, neuroscience, sociology and health – that shows that early investments in human capital offer substantial returns for individuals and for communities and have a long reach into the future. Early childhood education for sustainability (ECEfS) - a synthesis of early childhood education (ECE) and education for sustainability (EfS) - builds on groundings in play, outdoor learning and nature education, but takes a stronger focus on learning about, and engagement with, environmental and sustainability issues. Child participation and agency is central to ECEfS and can relate, for example, to local environmental problem-solving such as water and energy conservation or waste reduction in a childcare centre, kindergarten or preschool, or young children’s social learning for Indigenous Reconciliation and cultural inclusivity. While the ECE field has been much slower than other educational sectors in taking up the challenges of sustainability, this situation is rapidly changing as early childhood practitioners begin to engage – it is fast moving from the margins of early childhood curriculum and pedagogic decision-making into the mainstream. This presents challenges, however, as ECEfS is somewhat misunderstood and misrepresented and, as a new field, is under-researched and under-theorised.

Information Accountability Framework for a Trusted Health Care System

Trusted health care outcomes are patient centric. Requirements to ensure both the quality and sharing of patients’ health records are a key for better clinical decision making. In the context of maintaining quality health, the sharing of data and information between professionals and patients is paramount. This information sharing is a challenge and costly if patients’ trust and institutional accountability are not established. Establishment of an Information Accountability Framework (IAF) is one of the approaches in this paper. The concept behind the IAF requirements are: transparent responsibilities, relevance of the information being used, and the establishment and evidence of accountability that all lead to the desired outcome of a Trusted Health Care System. Upon completion of this IAF framework the trust component between the public and professionals will be constructed. Preservation of the confidentiality and integrity of patients’ information will lead to trusted health care outcomes.

Theorising a framework for contemporary health literacies in schools

While schools are mandated to teach health education, there is considerable disjunction between government and community expectations, definitions of health literacy, and what schools are currently teaching. Health literacy in the health sector tends to be dominated by a pathogenic approach, where the health of a person is generally referenced against states of illness. In this paper we argue for a salutogenic approach to health literacies. Further, we utilise mainstream literacy theories and models to propose a robust framework for health literacy in schools that accounts for the complexity of health and well being in contemporary society.

Why perform pro-social behaviours? Understanding the key sources of perceived value in preventative health services

In maintaining quality of life, preventative health is an important area in which the performance of pro-social behaviours provides benefits to individuals who perform them as well as society. The establishment of the Preventative Health Taskforce in Australia demonstrates the significance of preventative health and aims to provide governments and health providers with evidence-based advice on preventative health issues (Preventative Health Taskforce, 2009). As preventative health behaviours are voluntary, for consumers to sustain this behaviour there needs to be a value proposition (Dann, 2008; Kotler and Lee, 2008). Customer value has been shown to influence repeat behaviour (McDougall and Levesque, 2000), word-of-mouth (Hartline and Jones, 1999), and attitudes (Dick and Basu, 2008). However to date there is little research that investigates the source of value for preventative health services. This qualitative study explores and identifies three categories of sources that influence four dimensions of value – functional, emotional, social and altruistic (Holbrook 2006). A conceptual model containing five propositions outlining these relationships is presented. This study provides evidence-based research that reveals sources of value that influence individuals’ decisions to perform pro-social behaviours in the long-term through their use of preventative health services. This research uses BreastScreen Queensland (BSQ), a cancer screening service, as the service context.

Setting a new agenda: Developing an Aboriginal and Torres Strait Islander women's health strategy

The Australian National Aboriginal and Torres Strait Islander Women’s Health Strategy was developed to reflect the health priorities of Aboriginal and Torres Strait Islander women, as identified by Aboriginal and Torres Strait Islander women themselves. This article describes the process used by the Australian Women’s Health Network to develop the strategy. The women involved in the research used the talking circle method and engaged with Aboriginal and Torres Strait Islander women through a process referred to as ‘talkin’ up’, where women ‘talk back’ to one another about issues that matter to them. In this article, we describe the power of the talkin’ up process, as a way for Aboriginal and Torres Strait Islander women to identify their own issues, discuss them in context and talk in a culturally safe environment. The strategy which emerged from this process is an accurate reflection of the issues that are important to Australian Indigenous women and highlights the improvements needed in Aboriginal and Torres Strait Islander women’s health to strengthen and underpin women’s health, Indigeneity and their sense of well-being as Aboriginal and Torres Strait Islander women.