
There is a well-known gap in time between when there is sufficient evidence to take public health action, and when public health action is implemented. In the biomedical world this gap in time is 17 years. In public health the time can be in multiple decades.
Given how long this work takes, I think one of the most important characteristics of public health leadership is perseverance. The Cambridge dictionary defines perseverance as “the quality of being someone who continues to make an effort to achieve their aims, even when this is difficult or takes a long time”. In public health there can be multiple barriers to implementation, for example, political will, insufficient budget, lack of priority given to prevention activities, or research translation gaps.
Perseverance means when these challenges arise, the mindset is to look for ways through or around the obstacle, never giving up. This is inherently a problem-solving task, out-persevering those who are less invested in the positive public health outcome. Sometimes it involves a pause, awaiting a time when change is more likely to occur, but maintaining vigilance to identify when the time is right to pursue the intervention again. The implication for this long length of time for implementation is we need to work with our colleagues over time and even over generations to bring about change. The recent example of termination of pregnancy legislative reform in South Australia is an example of people working together over a fifty-year period to bring about reform, passing the baton between generations, waiting until the moment when reform was politically possible to bring about change.
The other unfortunate aspect of public health practice is that perseverance must extend beyond the intervention being implemented. Because many of the actions we take are inherently political, involving legislation and parliamentary process, these can be reversed when the will or political climate changes. Termination of pregnancy reform and reproductive rights in general have been seen to go backward in other countries. In Australia this is always a threat and perseverance, along with vigilance is required to ensure there can be no backtracking on the gains made.
Because interventions prevent, we can also fall into the trap of thinking there is no need to deal with an old and managed threat, only to find that gaps in our defense are exploited. For example, we have seen a return of syphilis infection, with multiple outbreaks across Australia. Perseverance here relates to ongoing advocacy for the basic structures of public health, such as disease surveillance, community education and health promotion, access to testing and treatment for everyone, even when others have forgotten about the threat or believe it has passed. We truly are required to persevere over the decades, holding hands with those who go before us in chains of control over time, and never forgetting what has been learnt from actions of our colleagues many years in the past.
Perseverance; a critical skill for public health leaders!
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