Matters for further consideration
HEALTH NEEDS OF THE LATROBE VALLEY
Although there are many excellent health services in the Latrobe Valley and activity levels were increased during the mine fire, there was not a coordinated whole of health sector approach. Many key players such as general practitioners, pharmacists and specialists were as much in the dark about what was happening as their patients and customers. For example, there was no evidence of effective advocacy or mediation at a population level from the health professions. Action was left to the initiative of the Department of Health, which although commendable in some areas, was by nature partial and had the drawback of being seen as a Melbourne-based response. The full power and potential of health services was not used and the community was the poorer for it in terms of communication, empathy, solidarity and timely action. Community members advised the Board that there was a lack of representation from the Department of Health at the first few community meetings and consultations.224
To date, the Department of Health has not outlined how it will help improve the health of the Latrobe Valley in the aftermath of the fire. In comparison, DHS has sought and has received funding to provide psychosocial support, which commenced during the fire and will continue at least into 2015.
The Board takes a much broader view of the recovery and prevention issues relating to health than that demonstrated to date by the Department of Health. The prevention agenda should not focus just on preventing a recurrence of another coal mine fire in the Latrobe Valley, but also the prevention of further threats to health, which may be exacerbated by any future fires. Similarly the recovery agenda goes beyond the immediate short-term issue to responding to potential medium and long-term effects that the health study may well find. Although we may hope for the best we also need to plan for the worst.
There is a strong case for the health of the population of the Latrobe Valley to be substantially improved. Based on current health status information, this was justified before the Hazelwood mine fire and is even more necessary after it. Specific improvements are needed, such as preventing and managing respiratory conditions. System-wide improvements are also needed, such as strengthening community capacity and resilience, tackling the social determinates of health, and providing hope and optimism for the community. There is a need to both conserve and then improve the health of the population. The Department of Health has recognised this in its prioritisation of Latrobe Valley as one of the sites for the Healthier Together program, which is a community-based health promotion initiative. This action is commended and needs to be built on.
HEALTH CONSERVATION ZONE
One way of providing a focal point for the coordination and integration of health services is to nominate the Latrobe Valley as a priority area for action across the health continuum. This has been undertaken in the UK and US, for example, by governments declaring geographical areas with high levels of health disadvantage as ‘Health Improvement Zones’, ‘Health Enterprise Zones’ or ‘Health Action Zones’ (Judge & Bauld, 2006, pp. 341-344).225 The Victorian Government could consider such a designation for the Latrobe Valley utilising a new descriptor of ‘Health Conservation Zone’, which could also recognise environment dimensions. This would be a unique designation for the Latrobe Valley in a Victorian, Australian and global context.
The Victorian Government could require and encourage all relevant agencies and organisations to collaborate to protect and improve the health of the people of the Latrobe Valley. It is suggested that the Regional Office of the Victorian Department of Health could lead the development of an integrated ‘Health Conservation Plan’ for the Latrobe Valley. The Victorian Government could provide additional funding and other resources to enable this, together with legislative and regulatory measures where necessary.
The Health Conservation Plan for the Latrobe Valley could focus on the prevention and management of chronic diseases and the creation of supportive environments for health. A number of complementary elements are required including:
- health promotion/prevention (eg Healthy Together program)
- acute and subacute hospital care (public and private)
- rehabilitation, hospital in the home, aged care
- indigenous health, women and men’s health, health of minorities
- mental health
- alcohol and drugs services
- general practice, community health services, community agencies
- tertiary universities, the regional medical school
- local government health services.
Other sectors including education, agriculture, industry and businesses could be expected to contribute to and support the ‘Health Conservation Zone’. The Latrobe City Council could be charged with coordinating, assessing and publishing the health impacts of new policies and proposed new developments from these non-health sector organisations, within the framework of Victoria’s exemplary Public Health and Wellbeing Act. There is an opportunity to develop models of health improvement that focus on providing evidence and measures of service integration.
LATROBE VALLEY HEALTH ADVOCATE
A noticeable feature of the Hazelwood mine fire was a lack of health leadership at the local level. The Board found no examples of health professionals who took on the role of enabler, mediator and advocate for the health of the community. Rather this was left to local community members or officers of Melbourne-based government agencies, who inevitably were at some disadvantage.
This was a significant deficiency, as many community members expressed a lack of trust in Melbourne-based government officials, based on prior experience over several decades.
The Board considers that the Latrobe Valley needs a local health voice that can win the trust of the community and be a sound source of advice, mediation and advocacy on health-related matters for the local community. An independent appointment is essential to engender the respect of the community. The appointee should be based in the local community and be separate from ‘officers’ of governmental departments.
In response and on a trial basis, the Victorian Government could consider the creation of a Health Advocate for the Latrobe Valley with core responsibilities for health monitoring, advocacy and facilitation of better health for the community. As part of the role, the Health Advocate could report annually on key issues affecting the health of the people of the Latrobe Valley.
The Health Advocate could also act as a champion for the Health Conservation Zone, and be actively engaged in the governance and follow up arrangements for the long-term health study.
There are historical and international precedents for such an appointment. For example, the first government sanctioned health advocate was the Medical Officer of Health for Liverpool in England. Dr William Henry Duncan was appointed in 1847 to champion improvements in the unsanitary conditions that were causing epidemics of cholera (Ashton, 1989, pp. 413-419). In Australia, the first Medical Officer of Health for Sydney, Dr William George Armstrong, was appointed in 1898.226
Later day examples internationally include positions such as Health Ombudsman, Health Broker, Health Navigator and Health Advocate. The Victorian Government has recently embraced the concept of an advocate for vulnerable groups, such as seniors, children, and people with disability. An extension of this concept focused on the health needs of a priority population, such as in the Latrobe Valley, is both logical and desirable.
Importantly, the proposed Health Advocate role would not replace, duplicate or compete with the responsibilities of the Chief Health Officer or the Health Services Commissioner. Rather, it provides a focal point at local level to ‘champion’ the health needs of the Latrobe Valley in terms of prevention, health services delivery, a supportive health promoting environment, and responsible industries.
Key competencies of the Health Advocate Latrobe Valley could be:
- monitoring and assessing the health of the public
- policy, planning and program development
- communication, collaboration and partnering
- foundational clinical competencies
- professional practice.
Had a Health Advocate for the Latrobe Valley been in place at the time of the Hazelwood mine fire, the health and social impacts could have been much less. The Victorian Government’s development of the concept of a Health Conservation Zone and a local Health Advocate could provide leadership both nationally and internationally.
HEALTH EXPERT ADVISORY MECHANISMS
In his statement to the Board, Mr Lapsley advised that he engaged an expert panel to peer review the fire extinguishment strategy.227 Mr Lapsley told the Board that:
… simply one of the most important things that I saw was the expert panel, a group of externals to come in and they were coaching and supporting what was done to make sure Incident Controllers in the mine, mine staff, were understanding what was a very complex environment of safety, the geotechnical parts, the water balance and how in which we used fire suppression activities.228
The Department of Health and EPA also utilised external sources to provide guidance during the Hazelwood mine fire. The Department of Health sought peer reviews of the Carbon Monoxide Response Protocol and the PM2.5 Health Protection Protocol. The peer reviews (some of which were critical) were sought after the protocols were already in place and there is no evidence before the Board that the protocols were revised after receipt of the peer reviews.
The Chief Health Officer sought advice from the Environmental Health Standing Committee, a respiratory physician and a public health physician, prior to issuing her temporary relocation advice on 28 February 2014.
The Board is of the view that it was appropriate for the emergency services, Department of Health and EPA to seek assistance from external sources to assist in the management of the complex emergency. However, key differences in the approaches taken were the timing of the advice sought from external sources and the extent of the advice sought. Emergency services utilised external sources to assist in the decision-making process, whereas the evidence suggests that the Department of Health and EPA utilised external sources to provide advice after a decision had already been made.
The Board considers that in the event of a future health emergency, it would be beneficial for the Department of Health and in particular the Chief Health Officer to have the ability to seek support from sources external to the Department, before and throughout the event.
From 1 July 2014, the Emergency Management Commissioner is the responsible officer for all major emergencies that require health service and public health responses, unless otherwise specified in legislation. The Chief Health Officer will support the Emergency Management Commissioner in decision-making concerning major emergencies relating to public health. To assist with this process, the Department of Health and Emergency Management Victoria should consider establishing a standing Public Health Emergency Expert Panel or similar mechanism, which will offer advice on health/medical policies and protocols relevant to major public health emergencies.
The prior establishment of the Public Health Emergency Expert Panel or similar mechanism would be recognition that major public health emergencies are likely to be complex and fast moving, and that additional expertise may be required at short notice to complement that provided by the Department of Health and the Chief Health Officer. The utility of the Public Health Emergency Expert Panel or similar mechanism would be increased if it consisted of senior experts with competencies in key fields such as air and water pollution, infectious diseases and hazardous materials, and include experts drawn from Victoria, nationally and internationally as required.