Public trust and controlling COVID-19

Australia’s success at so far controlling the COVID-19 pandemic underscores the country’s long history of taking a collective approach to public health.

It is an approach that suggests our attitudes and behaviour are different from some other countries, even those we have strong cultural ties with like the US.

Tens of thousands of years before colonial settlement, Australia’s Aboriginal people exemplified this notion of survival through the collective – the good of the group was put before the individual in strict rules about food gathering, hunting, marriage, birth and death.

Move forward to the more recent past and there are many examples in Australia’s public health policy where the individual and even family rights have been made secondary to that of the wider community.

Australians haven’t shirked accepting legislation and enforcement to drive behaviour whether it be making the wearing of seat belts and motorbike helmets compulsory, introducing smoking bans in public places, or ending family fireworks.

Australia is good at public health and has been refining the art, science and politics over many decades – if not centuries.

For example in the 1920s and 30s, in the midst of the Great Depression, Dr Vera Scantlebury Brown founded our modern maternal and child health service. By using research, political nous, and her skills and influence as a doctor and health administrator, she partnered with government to scale up across Victoria a system of universal maternal and child health services.

Fast forward to the late 60s and early 70s and the introduction of compulsory seat belts. Despite extensive evidence of the benefits of wearing seatbelts, many people simply didn’t put them on. But a public health campaign in favour of mandatory legislation was extraordinarily successful.

It brought together the powerful medical associations in alliance with other major lobby groups like the motor vehicle organisations, and was championed by politicians. The strategic use of government inquiries and standing committees was also important, as was intensive media campaigns. Together this shifted public opinion and by the early 1970s it was mandatory to wear seat belts in most states.

The carrot and stick approach in public health that combines reasoned persuasion with enforcement, has continued to gain wide salience and acceptance in Australia. We have seen it in relation to managing epidemics like HIV and AIDS.

Big public health campaigns helped establish the importance of the epidemic to the wider community, while research evidence of the health impacts further set the scene for compulsory legislation and enforcement - doctors were mandated to report cases of HIV as is the case with COVID-19 now, and anyone who knowingly infected another could be charged.

Some health measures have been easier to attain than others, and each campaign has its own unique features.

The legislation to curtail the ownership of firearms in Australia resulted from a massacre, combined with outstanding political leadership from then Prime Minister John Howard. There are still regular attempts by the firearms lobby to undermine this legislation and its enforcement. Vigilance is needed.

Similarly, the plain packaging on cigarettes in Australia has required political muscle and tenacity in the face of opposition from Big Tobacco.

In other areas there is still a lot of work to do. So far, we have failed to gain much traction on the major health benefits of curtailing gambling, reducing sugar in our food products, and limiting alcohol outlets.

The devastation of climate change on the health of the community is likewise yet to be tackled. The fossil fuel lobby groups remain in ascendancy here, despite the negative health impacts.

The issue of tackling domestic and family violence, while a major health and mental health issue, has also never attracted the sorts of resources that other issues such like road safety have. While not ignored, preventing domestic violence remains the poor cousin to the effort that goes into responding to the violence once it has occurred.

When it comes to COVID-19, the same commitment to collective responses and public campaigning has helped Australia to so far ‘flatten the curve’. The hospitals aren’t overwhelmed and the death rate compared with other countries is very low.

But here lies the dilemma – the more successful the outcomes, the harder it can be to ensure support for necessary collective measures that are weighing on people.

The social contract that allows politicians to invoke mandatory measures is based on a level of trust. They are holding our collective good (and health) as a community in their hands. The powers of the state are invoked to ensure that individual rights don’t compromise the collective health of us all.

There is a history to draw upon that shows that we are all better off with lower rates of smoking, fewer fatal car accidents, and fewer children being blinded by backyard fireworks. But we are clearly less trusting of the role of the state in relation to the use of technology and surveillance, as exemplified by the response to the government’s COVIDSafe tracing app.

The collective public health call to download the app is meeting fears of the potential for government to burrow into our private lives. While millions of us have signed up, many haven’t.

The history of the trustworthiness of our politicians isn’t as bright as that of our public health initiatives. Sometimes politicians can seem to be more interested in protecting themselves than the community, as reflected in recent efforts to criminalise whistle-blowers and journalists.

But the good news is that so far in the COVID-19 crisis that actions of our governments are being rewarded with greater levels of trust among Australians. Maintaining this trust will be crucial in the time ahead.

Trust in the state to manage our collective welfare is a marker of difference between ourselves and many other countries. It has a long history, but our politicians need to remember it is one which is conditional.

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