'We ain’t seen nothin’ yet'

Human advance is conditioned by our perception of progress… it is time to end (the mismeasure of human progress by economic growth alone). The paradigm shift in favour of sustainable human development is still in the making. But more and more policy makers in many countries are reaching the unavoidable conclusion that, to be valuable and legitimate, development progress - both nationally and internationally - must be people centred, equitably distributed, and environmentally and socially sustainable.

The solutions

There are several clues provided in the deliberations above on how a fence should be built and who should build it - but there are also several obstacles.

Those responsible for treating the casualties in the valley can hardly be expected to also have expertise in fence building. And the fence builders cannot rely on resources being allocated from down in the valley: because the clinical imperative will always win the argument. And yet this is exactly how health systems are organised in most countries.

Don Berwick, CEO of the Institute for Healthcare Improvement has said “every system is perfectly designed to achieve the results it gets”. The focus of ambulances, hospitals and “health” departments is to save lives, and treat people with disease and injury - they are not designed to enhance the health of the general population or even “at risk” communities.

The Royal Australasian College of Physicians recognised that “health departments, by themselves, have little control over the underlying determinants of social and economic disadvantage” and they made recommendations to address the situation that have yet to be implemented.

One of the reasons that may account for the lack of progress in building the fence is the missing ingredient that Professor Syme realised during his challenging career. He advised that:

… to carry out those strategies successfully, we will have to work with the community as an empowered partner, which ultimately means changing our public-health model at a fundamental level. We will have to change the way we classify disease, train a new generation of experts, change the way we organise and finance public health education and research, and deal with our arrogance. These are very difficult and humbling challenges, but I know we can meet them. We really have no choice.

But previous surveys have documented a substantial gap in the community's understanding and attitudes about public health however, when people are well informed, they tend to emphasise that equity of access is an important criterion when making decisions on health care resource allocation. This is supported by evidence that justice is good for health.

In relation to community consultation, it appears that they are setting a good example for others to follow in Bayside (pdf file 155KB) but this will take time to emulate around the country. Meanwhile there is an imperative to act now as, sadly, it is children who are falling off the cliff more than adults. For the first time in history parents are predicted to outlive their children.

Rates of childhood obesity (pdf file 150KB) in Australia are at one of the highest among developed nations and rising at an annual rate of 1 per cent, a trend which suggests that half of all young Australians will be overweight by the year 2025.

While there has been much publicity surrounding the obesity issue, there is less awareness of the fact approximately one in four Australian children are vulnerable as a result of not reaching their full developmental potential at age five-years (pdf file 61KB). The implications of this on their future health and development have yet to be realised. More predictable is the prognosis for the one in five children who have a mental health problem.

When Professor Syme said, “we ain’t seen nothin’ yet” he was only referring to the fact that baby boomers with their multitudinous needs haven't even entered the older population yet. He was not factoring in the premature mortality among a relatively diminishing population that will need to be fit and healthy to deal with the burden of supporting the greying and demanding “me generation”. It is in the interests of the “me generation” to invest in their future guardians and it is in the interests of Australia to invest in children. In addition this makes economic sense and what better source than the comprehensive analysis by the World Bank to support this assertion with the latest evidence provided by Dr Fraser Mustard.