introduction - lga.sa.gov.au · web viewin the 21st century, different patterns of ill health...

South Australian Public Health Act 2011

What is Public Health?

January 2016

AcknowledgmentsThis Information Paper has been prepared by the Local Government Association of SA (LGA) with the assistance of Dr Chris Reynolds, Consultant specialising in public health and environment protection law, for the guidance of and use by member Councils. The LGA is the statutory peak body for Local Government in South Australia, representing all 68 Councils in the State.

This project has been assisted by the Department for Health and Ageing (SA Health).

The Information Paper was first issued in February 2013.

Enquiries regarding this publication should be directed to the LGA on 8224 2000

ECM 1260 LGA of SA SA Public Health Act – What is Public Health? of 12

Introduction

This Information Paper is written primarily for the benefit of Council Members and staff, but they are also available as a resource for the general public and students of environmental health and / or Local Government. Each paper is available on the LGA website www.lga.sa.gov.au/publichealth.

The Act was passed by Parliament in June 2011 and came into full operation on 16 June 2013. The Act replaces the Public and Environmental Health Act 1987.

The South Australian Public Health Act 2011 (the Act) does not fundamentally change the existing role of Local Government in public health. It seeks to provide streamlined and flexible processes and powers, which will enable environmental health officers to undertake more rapid assessments for public health risks and mobilise preventive as well as management strategies, which can control or minimise public health risks to the community. The Act is intended to enable public health officials to engage more effectively with all sectors of the community to advance public health.

A key feature is for Councils to develop a Regional Public Health Plan which will provide a strategic focus for public health activities within the region. Further, the Act facilitates more flexible administrative arrangements to address both traditional and new public health challenges. A Council’s functions (summarised below) are described in more detail in the Act, nonetheless a Council remains autonomous to determine its public health priorities and subsequent activities in its area.

The Act recognises Local Government’s role as:

public health authorities for their areas;

preserving, protecting and promoting public health within their areas;

cooperating with other authorities involved in the administration of the Act;

ensuring that adequate sanitation measures are in place in their areas;

identifying risks to public health within their areas;

assessing activities and development to determine and respond to public health impacts;

providing or supporting activities within their areas to preserve, protect or promote public health; and

providing or supporting the provision of immunisation programs for the protection of public health.

This does not mean that Councils have prime responsibility for every public health issue identified in their community, but they are best placed to recognise and understand them within the context of the other issues, needs and priorities of their communities.

The Act requires an effective partnership between State and Local Government to promote planning processes based on a shared understanding of public health issues and opportunities. In particular, the Act requires the Minister to consult with the LGA on the preparation of guidelines and any proposal to create or amend the State Public Health Plan or State Public Health Policy.


http://www.lga.sa.gov.au/publichealth

The goals of public health

The goals of ‘public health’ are to make lives longer, healthier and happier and Local Government has always been closely involved in delivering these outcomes.

Councils have long responded to insanitary conditions and regulated infectious disease. Their approval of land use planning and development and their provision of infrastructure all help to build safe and healthy environments. Council services and facilities, such as libraries and sport and recreation, all offer a sense of well-being and ‘community connectedness’, that contribute to the goal of building a healthy population. Long established responsibilities for food safety can also extend to collaborative projects that encourage healthy eating programs and reduce the incidence of lifestyle diseases within communities more generally. Wherever local community initiatives to improve public health occur Councils will almost certainly be seen to be close and active participants.

Laws have been central in the process of achieving good public health outcomes. The South Australian Public Health Act 2011 is the latest, replacing the Public and Environmental Health Act 1987 and for Local Government it is now its most important piece of public health legislation.

The Act recognises and supports a broad and emerging view of public health while maintaining its capacity to respond to long-established problems. In addition to its specific provisions, the Act, and the policies that accompany it, takes account of the fact that the community’s health and wellbeing is affected by many fields of regulatory activity, a number of which are undertaken at a Local Government level. This gives the Act a new co-ordination role via its broad objects and more specifically via its public health planning provisions. The Act is also quite different from its predecessors in the way that its specific powers are organised. These are more versatile and allow new generic approaches to respond to public health threats that are suited to dealing with a range of both existing and emerging issues, while also encompassing the traditional ‘sanitary’ concerns of public health practice.


The scope of public healthBroadly, public health is an organised process (i.e. undertaken by governments, community bodies etc) directed to preventing disease and promoting good health. It is aimed at communities though individuals benefit from public health interventions. Public health services should not be confused with the work of the health care system more generally (public hospitals, medical specialists and general practitioners etc), which mainly focuses on treating and curing people who are already sick. The South Australian Public Health Act 2011 provides both a focussed definition which establishes the boundaries or limits of public health (discussed below) while also accompanying this with a statement describing the generally accepted elements or contents of the term, which are set out in s3(2) as follows:

public health may involve a combination of policies, programs and safeguards designed—

(a) to protect, maintain or promote the health of the community at large, including where 1 or more persons may be the focus of any safeguards, action or response; or

(b) to prevent or reduce the incidence of disease, injury or disability within the community.

Protecting, maintaining and promoting health while preventing disease and other causes of ill health are all key ideas in the defining of public health. But what of its boundaries or limits: specifically, how is an issue of public health concern to be distinguished from other issues? The South Australian Public Health Act 2011 provides a primary definition of ‘public health’ as follows:

public health means the health of individuals in the context of the wider health of the community;

What does this definition mean in practice? The key word is context – an individual’s health is protected as a representative of the wider community. Two examples may help explain this point.

1. A person in a restaurant who is affected by the tobacco smoke of another person sitting close by is affected as an individual and as a member of the public (any of whom might eat at the restaurant and be similarly affected). The passive smoking laws seek to protect the whole community of patrons who might be exposed to tobacco smoke; individual diners are protected in the context of that wider community. By contrast a person who has smoke blown deliberately in their face has been singled out and is the victim of an assault.

2. A person who chooses not to follow medical advice (to change an unhealthy diet or become more active) may be adversely damaging their own health but this does not directly impact on others in the community and private choices such as these are not in themselves public health issues. However the pressures on persons, their families and communities generally to over consume or remain sedentary, along with environments which tend to encourage excessive weight gain, provide the context which influences many people to make unhealthy choices. Broadly based policies that curtail these environments are protecting individuals in the context of the wider community and as such are expressions of public health concern.

There will also be occasions where a public health impact cannot be demonstrated by any proper assessment. In these cases the Act should not be used and a decision to do so risks being overturned on review or appeal. For example, disputes between neighbours or complaints about cluttered and unsightly properties do not necessarily threaten the health of others. In these cases, other ways of responding are more appropriate. These include mediation and mutual agreements, or if necessary orders made under the Local Government


Act 1999, the planning laws, the Local Nuisance and Litter Control Act 2016 or under the Environment Protection Act 1993.

The changing face of public healthAn introduction to public health should describe a little of the history of the discipline since this illustrates both its traditional and its changing face.

The 19th century industrial environment both in Europe and Australia remain boldly etched in the popular imagination as those of overcrowded slums, non-existent sanitation, gross pollution and for so many, dire poverty, collectively resulting in premature mortality from both epidemics and chronic infectious disease.

In the 21st century, different patterns of ill health have emerged. The ‘lifestyle’ diseases, though not infectious have taken hold, leading to an early and unnecessary death for so many. These diseases are now so significant that they demand a response grounded in legislation and public policy. The fact that they are increasing and are more likely to cluster in some communities than in others suggests that they are not the product of bad luck or some particular failing of individuals. Rather, ‘lifestyle’ diseases are caused by external factors and ‘unhealthy environments’ as much as a polluted physical environment was a cause of ill health in the 19th century. Responses to their causes properly and legitimately come within the scope of public health concern.

Both of these perspectives, the ‘old’ and the ‘new’ have been the focus of legislation. The first public health laws were designed to contain the infectious or communicable diseases (the acute and chronic killers of the 19th century) so environments and behaviours that risked the spread of these diseases could be controlled. They should continue to be as a future epidemic or public health emergency always remains a possibility and the South Australian Public Health Act maintains this tradition through its objects, principles and order making powers.

The Act also has the capacity to respond to ‘lifestyle’ (or non-communicable) disease in a number of ways: part 8 allows codes of practice to be developed by the Minister for any declared ‘non-communicable condition.’ While a breach of a code is not an offence, it can be the subject of an adverse report or an order to comply with the general duty. More generally, the Act also provides the links and opportunities (described below) to help create ‘healthy environments’ that invite people to be active and generally to feel part of their community. These are all designed to promote good health and wellbeing and reduce the burden of avoidable ill health. The Act does not direct this process but it supports and facilitates healthy decision making.

Over the current century new public health threats will emerge that cannot be defined or specifically regulated for at this time. The Act anticipates this and its general ‘outcomes based’ structure, implicit in the idea of risk or harm to public health (from whatever cause), will allow the Act to respond to new threats as they occur.

In summary, the South Australian Public Health Act is able to address the traditional established and emerging issues (the ‘known’ public health concerns) through its powers to make orders and control disease. However, its general outcomes based approach grounded in the general idea of ‘harm to public health’ allows it to respond also to new and unrecognised issues (the currently ‘unknown’ public health concerns). In this respect it is unique and the most visionary and far reaching of all Australian public health acts.


Public health across governments and within communitiesPublic health is often described as an ‘organised’ response to the challenges of keeping communities healthy, illustrating the importance of government involvement. In Australia, this is at all 3 spheres of government, national, state and territory and local. Each has defined and well accepted responsibilities creating a vertical structure where all levels have a clearly established role to play in advancing public health. Food regulation is a good example, the containing of communicable disease is another. However public health practice also has a horizontal structure that involves links between agencies and branches of government. For example decisions made within the planning and land use systems can, by determining the quality of the environment in which people live and the options they have, affect public health. Decisions made in the interests of protecting heritage, or reducing pollution, or that change transport patterns all impact on the wellbeing of individuals and, collectively, their communities. Decisions made in these areas potentially, are decisions that affect public health.

More generally though, public health is the responsibility of everyone; section 11 of the Act makes this point by establishing the principle that:

Individuals and communities should be encouraged to take responsibility for their own health and, to that end, to participate in decisions about how to protect and promote their own health and the health of their communities.

Ultimately people are responsible for their own health and are free to make choices. Public health laws are rarely coercive and they cannot force people to make healthy choices.

They can influence the context in which those choices are made by helping to make ‘healthy choices easy choices’ and in this way encourage individuals and communities to take effective responsibility for their health.

In summary, public health is everyone’s business across governments and communities. It is the concern of local, state, national and even international bodies. It is also the concern of persons, both as individuals and as neighbours. Within that very wide spectrum, Local Government has a long standing role and set of responsibilities which are continued in the new legislation.

The South Australian Public Health Act and Local GovernmentCommunities are referred to often in the objects, definitions and other provisions of the South Australian Public Health Act (as they are in the Local Government Act). Communities are all of the people living in a particular area or region, whether small or large. At the Local Government level communities comprise the people of the neighbourhoods and the towns and suburbs incorporated within each Council.

Local Government has always had a long standing role and responsibility for the administration of the public health laws within its communities. This is evidenced though the first public health law coinciding with the first laws that established modern Local Government administrations. From the start, Local Governments accepted that public health administration was core business. However it has also been a partnership where public health administration has always relied on the collaboration of a central co-ordinating agency (in South Australia initially the Central Board of Health and now SA Health) operating at the state level with Local Government operating at the neighbourhood level. This arrangement commenced with the first public health laws and continues to this day in an alliance that has lasted over 160 years.


The public health functions of Local Government are set out in section 37 of the Act and elsewhere and many reflect and reinforce this partnership.

Some functions are specific and re-state Local Government’s continuing and traditional role in public health, such as by ensuring that ‘adequate sanitation measures are in place in its area.’

Other functions are broader and reflect the outcomes based approach and the general objectives of reducing risks to public health that is the hallmark of the new Act (‘to have adequate measures in place within its area to ensure that activities do not adversely affect public health.’)

Some functions envisage co-ordination or the creating of links between Local Government’s various roles or with other agencies. Most importantly the links between planning and public health are expressed as a specific function, namely: ‘to assess activities and development, or proposed activities or development, within its area in order to determine and respond to public health impacts (or potential public health impacts).’

Co-ordination between Local Government and SA Health is envisaged generally in some functions (such as ‘to cooperate with other authorities involved in the administration of this Act’.) Others relate to specific issues notably immunisation. Here a separate section (section 38) establishes that ‘a council must provide, or support the provision of, immunisation programs for the protection of public health within its area’ and that SA Health will support these services. The section also envisages a Memorandum of Understanding between the Minister and the LGA, providing the umbrella under which these services operate.

Some specific functions in other parts of the Act, such as the preparation and maintenance of State and regional public health plans, further illustrate the importance of partnerships between Councils and also with SA Health as the central body responsible for the State plan on behalf of the Minister. More generally, many initiatives and functions undertaken in the interests of public health envisage collaboration between agencies. Some public health problems such as severe domestic squalor are complex to resolve and will require interventions by a range of services, with Local Government playing a prominent role.

Beyond the particular provisions and expectations of the South Australian Public Health Act, Local Government provides an extensive range of public and environmental health services. Some exist through other public health legislation such as the Food Act 2001 and its accompanying responsibilities for hygiene and safety. More generally, Councils also provide a significant but often unrecognised contribution to public health by providing public and social infrastructure such as footpaths and recreational facilities. This also includes community services such as playgrounds, sporting facilities, parks and lighting and public services such as home and community care, libraries and emergency management. All of these contribute to the health and wellbeing of individuals and their communities. Indeed, many of the day to day functions of Councils can be seen to have a role in advancing public health. The following table describes some key activities of Local Government and describes their potential links to the public health process.


Local Government activities Public health link

Waste management(refuse, onsite effluent, stormwater)

Communicable disease prevention

Environmental Health Safe food, safe water, control of vectors and pests, Immunisation

Building inspection Safe and suitable accommodation

Planning and development approval Separation of incompatible land uses including contaminated land

Infrastructure/Maintenance (footpaths, parks, shade etc.)

Provision of space and facilities for physical activity. Skin cancer prevention

Animal management Community safety

Sport and recreation Improved liveability, Physical activity, Community connectedness

Community services Healthy eating, Social infrastructure, Social inclusion

Emergency management Community wellbeing, Safety

Environment Protection of waterways, Management of hazardous substances


Public Health ResourcesFurther information regarding the Public Health Act or Regional Public Health Planning are available on the website www.lga.sa.gov.au/publichealth.


http://www.lga.sa.gov.au/publichealth

148 Frome StAdelaide SA 5000

GPO Box 2693Adelaide SA 5001

T (08) 8224 2000

F (08) 8232 6336

E [email protected]

introduction - lga.sa.gov.au · web viewin the 21st century, different patterns of ill health...

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