Better Health For All

October 2018 and I flew 10,000 miles to Sydney to start my final year of training in a different system. It requires a very different ‘winter’ wardrobe!

I’m spending eight months hosted by South Eastern Sydney Local Health District and based at the oldest working hospital in Australia. Having been here almost two months I’m getting used to a host of new acronyms and a healthcare system which includes a combination of Public Health responsibilities at commonwealth, state and district level and a bigger role for fee paying services than in the UK.

What was clear from my first day here however was not the differences but the similarities. Discussions around an ageing population and a desire to integrate care and risk-stratify the population made me feel very much at home straight away. A stereotypical image of Australia is that it is universally active and ‘healthy’ but rises in obesity, diabetes and mental health are huge challenges here, just as in the UK. In addition the impact of climate change is becoming, albeit slowly, a big issue in a country that has already seen the impacts of increasingly adverse weather events, especially droughts, heatwaves and bushfires.

The health and wellbeing of the Indigenous population, aboriginal and Torres Strait islanders, is something that shouldn’t and cannot be ignored. Prior to colonisation the Indigenous population had a 60,000 year history here but have only been counted as part of the population (via the census) for the last 50 years.

Aboriginal people can expect to live at least 10 years fewer than everyone else in Australia. Virtually all health indicators show vast inequalities between the Indigenous and non-Indigenous populations. Despite making up only 3 per cent of the general population they constitute 28 per cent of the prison population. Rates of smoking are more than two and a half times that of the rest of the population. Indigenous children are more than 10 times as likely to be removed from their families and placed into state care as non-Indigenous children. The list goes on and on.

The term ’aboriginal people’ suggests a single homogenous group. In fact, the map below illustrates how Indigenous communities see the boundaries within their land rather than the states and territories which have emerged in the last couple of hundred years. Hundreds of separate regions with separate languages, customs and traditions.

During my placement in Sydney I’ll be based within the Eora nation and on the lands of the Gadigal people.

I’m placed with SESLHD (South East Sydney Local Health District). SESLHD is an organisation responsible for the health of almost a million people. It covers urban areas in some of Australia’s most prestigious neighbourhoods as well as areas of high deprivation and has the world’s second oldest national park within its boundaries. SESLHD covers nine hospitals with commissioning and management responsibilities for a range of community services and everything from pre-birth to palliative care. I guess Clinical Commissioning Groups are the closest ‘fit’ with local health districts.

I’ll be leading on a couple of work areas. Firstly, the development of an Environmental Sustainability Plan for SESLHD. Secondly, I’ll be investigating patient pathways looking for opportunities to reduce variation and integrate services across a number of areas, including paediatrics and Child and Adolescent Mental Health Services.

I’ve also been fortunate to be awarded a scholarship with the Deeble Institute, a research unit within the Australian Healthcare and Hospitals Association (AHHA), and I’ll be working with them to produce an evidence review around the role of accreditation in healthcare. This has already involved spending time in the national Capital, Canberra. I was part of a delegation from the AHHA who met with the Minister and Shadow Minister for Health in Parliament.

Finally a word on the Public Health training here. I’m discovering there are both similarities and differences with training in the UK. The Australasian Faculty of Public Health Medicine is responsible for a three-year public health training scheme for medics. Some of the states also run additional Public Health Officer training programmes for medical and non-medical staff – the largest of which is here in New South Wales. As part of my placement I’m spending time with trainees from both schemes and attending some of their training – and they’re social events of course!

So in summary, so far it is a great placement with great people and lots to learn. It doesn’t feel like Christmas as I write this in my shorts looking at the beach but the conversations about the Coca Cola truck confirm that it’s that time of the year and that some things in Public Health are universal!

I’ll be writing more about my time in Australia towards the end of my placement. I’m keen to reflect on what lessons I can bring back to the UK and consider what new opportunities there could be for registrars across the commonwealth in a post-Brexit world. In the meantime, I’ll be making an effort to tweet more about my time in Sydney so please feel free to follow me on Twitter and ask any questions @RyanSwiers.

Written by Ryan Swiers, Specialty Registrar in Public Health