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Patience and persistence

In the week before leaving his home in Perth and moving his family to Canberra to take up his appointment as the new Chief Executive Officer of the Public Health Association of Australia, Terry Slevin went on the tour of the southwest of Western Australia.

“We went into a woodwork gallery and I had a sign made up on a nice piece of jarrah. It’s an old Chinese proverb, that says: The man who moves a mountain starts with very small stones.”

Terry says that in Public Health, while being patient for significant long-term outcomes is important, persistence is probably even more important and being impatient for those next steps is absolutely essential

“It’s a long-term process. I’ve got enough snow on the roof; I’ve been around in the early days when smoking rates in my hometown of Newcastle were around 40 per cent amongst men.  It’s a very different story now, but I’m still in a rush to make change. I’ve been in a rush to make change for 34 years. So being effective, being efficient, and ensuring your time is invested in useful, productive outcomes is critical. Improving public health is a long-term game. But let’s hurry up and make it happen.”

In an illustrious public health career spanning four decades, tobacco control, cancer control, and alcohol control, Terry has never shied away from a challenge.

After running tobacco campaigns in Newcastle from 1984 to 1987, he moved to Sydney where he ran the New South Wales Quit for Life campaign, as it was then called.

A move to the West Coast saw Terry work with a small public policy advocacy agency, the Alcohol Advisory Council in Western Australia. In that role, he was involved in establishing the standard drinks labelling which we see on our alcohol containers today.

But it would be the Cancer Council in Western Australia where he would find a long-term home.

“I’m really proud of a lot of the work that my team did at Cancer Council WA, l was involved in the skin cancer prevention program from the beginning of that role so 24 years of senior responsibility at the state and national level. I chaired the national skin cancer committee at one stage for Cancer Council of Australia and today we can see a reduction in skin cancer in Australia as a result of that work, particularly in the younger population.”

Terry was also involved in expanding the Cancer Council’s engagement in areas like nutrition, physical activity and alcohol and “really thumped the drum hard” about the link between alcohol and cancer.

“It became pretty clear to me that there had been evidence clearly linking alcohol consumption with cancer outcomes as early as the 1980s. But my observation to my colleagues in the cancer world was that we didn’t talk about that much and I wondered why and I pressed that boundary a fair bit locally, nationally and internationally.”

While Australians may now better understand the risks of skin cancer and the importance of sun protection, there’s not the same level of understanding about the long-term risks from alcohol. Terry says there are several reasons, including cognitive dissonance, the absence of a nation-wide social marketing campaign, and the power of the alcohol industry.

“Cognitive dissonance is an enormous challenge that we face in alcohol policy broadly. Think about what the policymakers and decision makers will do at the dinner table tonight and what they did last night. That absolutely influences and filters their beliefs with regard to evidence and their action with regard to policy. The reality is, everybody filters what they say, what they believe and what they support at a policy and political level, through that filter at the bottom of the glass they used at dinner last night.

“People are looking for ways to reinforce and to validate their own behaviour. So I think at the public health advocacy level, that’s our single biggest challenge.

“I remember as a kid in my early twenties working in the tobacco world, when I went into a meeting, if I walked through that door and there’s a packet of Winfield Blue in the top pocket, I knew the meeting wasn’t going to be easy when I was talking about tobacco.

“Today, you don’t see the packet of Winfield Blue, but nor do you see the wine glass rolled up in the sleeve when you go into a meeting with a policymaker or a politician. But it’s not hard to figure out [their influences and beliefs] when the conversation unfolds.”

Terry is also adamant we must challenge the alcohol industry and hold it accountable for the misinformation it propagates.

“We hear so often about the Australian drinking culture being the immovable beast to which all policy should bow down to. Where is this Australian drinking culture? Where does it come from? How’s it created? My contention is that very deliberately, systematically and ruthlessly created by the people who are selling the product and as a result, what happens when it comes to policy debates is the input often points to the fact that, oh, it’s the Australian drinking culture and we can’t change that. We can. And we must.”

Terry also agrees that the lack of a nationwide campaign to raise awareness of alcohol harm is a glaring deficiency.

“I sometimes get frustrated with policy debate in the alcohol space. I’ve heard in many meetings people point out that the evidence doesn’t support that alcohol education campaigns change behaviour, but I think that’s an overly simplistic understanding of how social marketing programs work to influence a long-term outcome.

“The first port of call, if we’re going to see reform on alcohol, is to ensure that everybody has a clear understanding of alcohol-related harm and its reach and impact. And yes, they can read that in policy documents and academic journals. But, it needs to be reinforced throughout a person’s life in the same way that we have to reinforce throughout people’s lives the impact of tobacco on health, the impact of adverse or excess sun exposure on skin cancer and the like.

“So those social marketing campaigns are an essential component of policy reform if the community is to understand and accept the prominence of alcohol-related harm. And the policymakers also need to see that as they watch the footy on the weekend or as they’re eating their dinner at night and watching the TV news or whatever source of info of the media they’re exposed to. They are people too, and they need to hear those messages outside of what crosses their desk.”

Terry says that the next step is political acceptability.

“If the community accepts the adverse effect between the link between smoking and health, then policy reforms that are about driving tobacco consumption down makes public policy scenes. If we can’t consistently sell that message of alcohol-related harm based on science, then making reforms and progress in the policy space is so much more difficult. So a social marketing campaign, I believe, is a fundamental building block to achieving reform in alcohol.”

Terry is excited about his new role with the Public Health Association of Australia and the challenges presented.

“So I remember saying to a few people that, to some extent, the Public Health Association of Australia invites people to pay money for the privilege of being a member of our organisation. And as a result of them joining up, we invite them to do more work on public health for the community benefit for free. So effectively we’re asking people to pay money to do more work for no financial reward.

“Not a great selling point, but there’s a lot of people who are members of our Association of roughly 2000 who put their heart and soul into to public health, whether it’s in their paid job, in their volunteer work, in many cases both, and they want to make a difference.

“They’re there to actually improve the community’s health and so we’re greatly privileged to have those members who do make that effort. My job is to make that as easy as possible for them to do so, to recognize and reward those efforts, and to give them even more reasons to be members of the Public Health Association.

“One of the ways I can do that is to help to ensure that the influence of the organisation when it comes to achieving those public health outcomes is the most it can possibly be.”

And what would Terry say to those contemplating a career in public health?

“The University of Western Australia each year invited me to go and talk to the graduates from the Masters of Public Health Program essentially to address that question. I say follow your passions. That’s really important. If you want to make money, you’re probably in the wrong game. Go and sell real estate or drive trucks up in the Pilbara is one of the lines I used when the mining boom was on. If you’re in the game to make a fortune, then you’re probably in the wrong game.

“Public Health wins don’t happen overnight and you’re not going to get a gift from the bloke who didn’t get lung cancer as a result of him not taking up smoking and you’re not going to get thank you card and a bottle of perfume from the lady who gets her breast cancer diagnosed at an early stage as a result of the work that you’ve done to establish a mammographic screening program.

“But the evidence is crystal clear. Public Health makes an enormous impact in the health of Australians and we have so many examples that we can nominate. The one that I’m familiar with in tobacco, in the skin cancer prevention and screening and early detection, improved survival in a range of cancers, but also the progress that’s been made in cardiovascular disease in road safety and many, many more. So if you want to have a career that is meaningful, will make a difference and leave the world a better place. Come and talk to us in public health.”

Jeremy Henderson

Jeremy Henderson is the Director of Communications at the Foundation for Alcohol Research and Education.

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