The urgency and scale of threats to public health demand transformational change at all levels of society, including by those whose work in diverse sectors affects our health.
A key theme from the Congress was that we are living in transformational times, reflecting both the exponential pace of technological change and the escalating health impacts of climate change and inequality.
A related theme was the need for transformational changes across all spheres of society – and thus the work of public health – to address these concerns.
Three “killer facts” were put forward by Professor Sharon Friel, Professor of Health Equity from the School of Regulation and Global Governance (RegNet) at the Australian National University, in a presentation titled “Pursing a vision of a fair, sustainable and healthy world”.
These are that:
- Humans are killing the planet;
- We live in a profoundly unequal world; and
- Inequities in health are human made.
Professor Friel cited figures showing that life expectancy differs by more than 30 years globally, and that 63.5 million people were forcibly displaced by conflict by the end of 2015, including 21.3 million displaced across international borders.
She called for transformation in dominant worldviews – to shift the mainstream ideology of economic growth as a goal to it being a means to an end.
Professor Friel’s vision for transformation included macroeconomic policy being used to improve everyone’s lives and provide conditions that enable everyone to flourish; intolerance of racism and bigotry; inclusive societies that welcome difference; a kinder world – and all of this achieved with “the lightest of environmental touches”.
The wellbeing economy
Professor Ilona Kickbush, Director of the Global Health Centre and Associate Professor at the Graduate Institute of International and Development Studies in Geneva also presented a vision for a “wellbeing economy”.
This would need to be: adaptable in operating as a resilient network; integrative in locating systems of production and consumption within the broader biosphere; and empowering, as users would take control rather than having the passive roles of ‘consumers’.
Also calling for transformative changes in worldviews and practices was Professor Kerry Arabena, a descendant of the Meriam people from the Torres Strait, President of the International Association for Ecology and Health, and Chair for Indigenous Health at the University of Melbourne.
Current generations must take responsibility for transitioning to sustainability, she told conference delegates.
Rather than seeing ourselves as born into societies, Professor Arabena urged a transformative understanding of the place of humans in the world – “to embrace that we are born into ecosystems”.
Professor Arabena described an increasing convergence between Indigenous voices and those of other thinkers, scholars, and leaders, especially in relation to our collective responsibilities to care for country and the planet.
A rapidly changing world
Meanwhile, as the world grapples with how to respond to the “incredible” changes and challenges now facing us, public health could serve as a compass for future directions, suggested Dr Rüdiger Krech, the Director for Health Systems and Innovation at the World Health Organization.
Centring health in all policies could provide a useful compass for action, locally and globally, he said.
Dr Krech also urged the public health community to keep abreast of the exponential pace of technological innovation, which is bringing both opportunities and threats for public health.
Its potential to increase inequities and transform the nature of work and workplaces is also directly relevant to those working in the public health sector, many of whom face increasingly precarious working conditions.
Public health must urgently prepare for a rapidly changing world, Dr Krech said, predicting that innovation in the next five years will outpace anything we have seen previously, eclipsing even the scale of the industrial revolution of the 19th Century.
Dr Krech and other speakers also stressed the interconnections of a mobile world, where the health threats and quality of health systems in one country directly impact the health of people in other countries.
Global marketing and the role of governance
In a presentation by video, the Director General of the World Health Organisation Dr Margaret Chan said the globalised marketing of unhealthy products such as tobacco, alcohol, and highly processed foods is a critical factor driving the global epidemic of non-communicable diseases (NCDs).
Not a single country had succeeded in turning around the obesity epidemic, she said.
The health sector is often left bearing the brunt of decisions taken in other political realms, such as failures in trade and food policy that, for example, contribute to high rates of obesity and NCDs in Pacific nations.
Even within the health sector, an unhealthy balance of power means that a tiny proportion of health spending is dedicated to prevention (only 1.7 per cent in Australia).
Many speakers stressed the need for new approaches to political governance to centre health in all policies and to deliberatively tackle the influence of powerful, unhealthy industries.
New mechanisms for governance are needed to protect health into the future, Dr Krech said. We cannot leave it to business to determine what the world will look like in the future – this is the role of governments, he said.
The need to act preventively
Many speakers also spotlighted the need to use existing governance arrangements – including treaties in relation to trade, human rights, climate change and environmental agreements.
Professor Peter Doherty described regressive cuts to women’s health funding globally as a “crime against humanity” because of the devastating impacts they would have, especially for women and children.
“With things like climate change and women’s health, we need to act now and we need to act preventively; acting retrospectively for many of these things will be far too late,” Professor Doherty said.
Tackling violence against women
A number of Congress speakers called for transformation in the social norms around gender and violence in order to reduce the toll that violence currently takes on women and children in particular.
Dr Claudia Garcia-Moreno, a physician from Mexico who leads the World Health Organization’s work on violence against women, said there had been profound changes in community attitudes to smoking and drink driving over the past 30 years, and “we expect no less for violence against women”.
“We can and should be able to do this with concerted action, evidence, persistent advocacy and partnerships across sectors,” she said.
The Sustainable Development Goals included relevant targets for addressing violence against women and were an important recognition that achieving these goals is critical for gender equality, she said.
The Global Plan of Action, endorsed by WHO, has actions for member states and people at all levels, including government officials, health care providers, funder, and others.
One in three women have experienced sexual or physical violence, although there are differences in prevalence between and within countries.
Dr Garcia-Moreno said that in addition to affecting women’s health, there are intergenerational consequences for the children, such as depression, anxiety and behavioural problems.
Addressing violence against women requires a focus on: social norms around gender and violence; women’s education and empowerment; childhood exposure to violence, parenting programs; partner communication, learning to resolve conflict; harmful alcohol use; and legal interventions.
Leading examples in self-governance
Self-governance by communities offers great potential given the importance of self-determination for health and wellbeing, according to Ms Michelle Deshong, CEO of Indigenous Governance & Best Practice.
She provided a number of examples of effective self-governance in Aboriginal and Torres Strait Islander communities, including the Waminda South Coast Women’s health and Welfare Aboriginal Corporation from NSW.
Other examples of new and emerging forms of governance profiled at the Congress included the 350.org, the People’s Health Movement, and the Climate and Health Alliance.
Those working for public health were also urged to reflect upon their own governance processes and practices.
A number of speakers urged public health advocates and organisations to examine their own practices and to reflect upon their role in perpetuating racism and discrimination, including against women, people with disability and others.
The public health sector needs to move from being “gender blind to gender transformative”, the Congress was told.
Dr Young-Soo Shin, the World Health Organization’s Regional Director for the Western Pacific, stressed the importance of addressing inequities at all levels of governance.
He said, as public health professionals, “We must develop new ways of thinking for policy and program development”.