There's still plenty more to achieve

MOST people know Roscoe Taylor as the person Tasmania turns to in the wake of disease outbreaks or environmental health threats.

As the director of public health, he is the voice people seek when they suspect something is wrong with the water in their town, or a communicable disease is spreading through the state.

As Dr Taylor has learnt, his response will not please everyone.

But for all the anxiety and late nights that outbreaks cause, they can be very satisfying for him to solve.

The problems that demand the bulk of his time - the "epidemics of the modern era" - offer no easily identified cause or quick solution.

Dr Taylor said the work involved in preventing and reducing the rise of chronic disease - and behavioural risk factors like smoking, physical inactivity, excessive drinking and obesity - had seen him stay in the job longer than expected.

"I thought, `I'll give this three years', but every day was different, every day was challenging, and there's an inexhaustable stream of things you can do more of in the prevention area," Dr Taylor said.

"I've discovered that some of the things you do take 10 years, literally - it's glacial sometimes."

Dr Taylor said he was just starting to see the results of his decade-long effort to reduce smoking, which saw it banned in certain areas including outdoor dining spots, in cars with children, and children's playgrounds.

"I was surprised at how hard that became. I actually expected the rates to decline more in keeping with the national rates, and it's only now where we can say we're definitely improving," he said.

Dr Taylor said he was aware his preventative work sometimes provoked claims of a "nanny state", but smoking bans and the mandating of iodine in bread had shown that regulatory controls were effective in improving people's health.

He said it could be hard to live with the public criticism, particularly in the wake of unsubstantiated water contamination and poisoning allegations at St Helens and Rosebery.

"There are groups of people within Tasmania who call for my position to be sacked, because they disagree with the information that we've produced," Dr Taylor said.

"The polarised nature of the debate means you get shot as the messenger, even though you're producing good health data and information to demonstrate what the health status of that community really is."

Dr Taylor said other challenges - water quality, meningococcal and salmonella outbreaks - had been surmountable, leading to more towns with drinkable water, the rollout of a meningococcal vaccine and better egg safety regulations.

But he said one of the greatest obstacles remained - encouraging investment in prevention "at a time of budget stringency".

"I have to say, it hasn't been easy to do more with less," Dr Taylor said.

"And one of the ironies about health spending, which is taking an ever-increasing share of the dollar, is that it actually subtracts money from the available resources to direct towards things that drive good health, such as education, housing and transport systems."

Dr Taylor said he wanted to see the system turned on its head, with more money put into prevention and local government-run health promotion rather than hospitals and acute care.

"We see a lot of money going into the healthcare system as the ambulance at the bottom of the cliff, where we know that a few more investments at the top of the cliff, in the form of a fence, would really help reduce the burden on healthcare providers," he said.

"I'm always struck by the fact that local government, for example, receives so little direct support in relation to health and wellbeing.

"Yet they're the actors that can actually make a huge difference, even if it's as simple as investing in cycle paths to promote physical activity."

Dr Taylor said it took "very bold governments" to champion serious investment in preventative health.

"The Tasmanian government's been very strongly supportive of public health act amendments, but they've been typically low- cost issues for them to deal with," he said.

"It's really quite hard sometimes to recognise the benefits and it takes sometimes decades to start measuring changes in health outcomes.

"The problem is, the electoral life cycle is much shorter than that."

Dr Taylor said he didn't know what the upcoming election would mean for public health and prevention.

"I wish I knew the answer to that question. I haven't had any indication," he said.

"But I look at my interstate colleagues sometimes with a little bit of apprehension, because we've seen in Queensland and South Australia that areas have been taken apart by an incoming government - not necessarily Liberal or Labor - that has decided to de-invest in prevention."

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