Medicus April 2016

C O MM E N T

Passing on the public health baton

Professor Mike Daube AO Professor of Health Policy Curtin University

W hen I started working on tobacco in 1973 from the Royal College of Physicians of London, public health campaigns (or “pressure groups” as they became known) didn’t exist. The then-novel approach we developed with ASH (Action on Smoking and Health), entailed a rigorous emphasis on sound science, clear priority objectives and policy targets, bringing health organisations together in coalitions – and a combination of senior medical figures and youthful energy. In retrospect, I am amazed by the generosity of those senior figures. They knew they wanted a campaign to change attitudes among media, communities and governments, but they weren’t sure what that meant. They showed faith in a young man with long hair and purple suits who took them into confrontation with the powerful and exceptionally well- connected tobacco industry and into a new kind of advocacy that generated public attention, assorted threats from tobacco companies, and attacks from the industry’s political and other fellow-travellers. They provided wisdom, guidance, and unwavering support. I recall as a turning point my decision to start asking questions at tobacco industry Annual General Meetings. I had bought one share in each major company so that I could attend their showpiece events and ask innocuous questions – such as how many deaths their products had caused during the year. I was worried that my Board might not support this, so didn’t tell them and thought I might lose my job.

But alongside those senior

I need not have worried. Their only question was whether they could go to the AGMs themselves. In passing, those AGMs brought me two wonderfully enjoyable episodes. After one AGM, the Chairman of Rothmans privately offered me funding to work on any campaign of my choice other than tobacco; a few years later, an angry shareholder got up to berate the same company about falling sales, pointed across the room and shouted angrily, “and that’s the bugger that’s doing it”. More than 40 years later, the basics have not changed. Cynical industries still knowingly promote harmful products; many governments and decision-makers are still more interested in supporting harmful industries than in protecting the public’s health; there is still a need for active campaigners. We have also learned that a few campaigners supported by professional organisations and health groups can over time achieve remarkable results, despite powerful and massively funded opposition. And happily, there are still senior health and medical figures willing to stand up for the health of the community – as the AMA has often shown. But alongside those senior figures (who, alas, now include me!), we need They can bring the energy, innovative thinking, passion and resilience that campaigning needs, and importantly an understanding of what influences public and political thinking in an era where new technologies rule, and the opposition is new generations of public health campaigners to carry the batons.

figures…we need new generations of public health activists to take up the challenges

even more cynical, dishonest and sophisticated. Succession planning is needed in

campaigning as elsewhere. I hope that I and my generation can be as supportive as my mentors of the 1970s – and as willing to allow others to take the lead. Passing on batons doesn’t mean disappearing from the scene. There is much work to be done; we can encourage, train, offer whatever lessons we have gleaned from our experience, write, and even make the occasional foray into media and advocacy. But we must also learn to stand back from some of our roles, and support the next generations of campaigners as they develop new approaches, take risks, become “go to” people – and field the 4am media calls! The British American Tobacco company, whose products have caused millions of deaths, recently tweeted: “Passion is what excites and inspires us. It’s what we look for in graduates.” Whether it is tobacco, alcohol, Aboriginal health and disadvantage, obesity or any number of other important causes, I can only urge young doctors and health professionals to show their passion by becoming involved in public health campaigns. We need you to take over! ■

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