Intended for healthcare professionals


The man from down under takes over

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:136

Christopher Zinn meets Don Nutbeam, the Sydney public health professor who is to take over as head of the Department of Health's public health division

Professor Don Nutbeam's curriculum vitae stretches to 40 pages, but he claims that the reason for its length is the demand on the international conference circuit for a speaker who will tell a few jokes. Even the eight page abridged version is so full of projects, policies, and publications from his past 10 years in Australia that it is hard to believe that he also managed to advise the Chinese government on non-communicable diseases and play for his beloved local soccer team as well.

But now 45 year old Don Nutbeam, who heads the department of public health and community medicine at the University of Sydney, is heading back to England, where he grew up, as the newly appointed head of the UK Department of Health's public health division. “I don't think I'm a typical public servant and I don't think I've been recruited to be a typical public servant,” he said in his campus office last week.

“I hope and expect to be able to use my technical skills. One of the hallmarks of my position in Australia is that I have been very actively involved in policy debate and policy formulation in a number of instances.”

His colleagues are sad to see him go because he has made significant contributions to defining national health priorities and has worked with politicians in the fields of HIV/AIDS, youth health, Aboriginal health education, and health promotion in China.

Professor Nutbeam, who gained his PhD and earlier qualifications at the University of Southampton (he is not a medical doctor but did an MA in health education before his PhD), said he applied for the job because he found the UK government's policy on public health “rather impressive.”

“It's one of the first and only public health policies in the world that overtly acknowledges the very direct impact that income, housing, education, local infrastructure, and transportation have on health.

“My role shall be as a public servant and I shall serve [as one] but if I felt I had any influence over events it would be to try and keep that [policy] alive.”

He feels that there has recently been an appreciable change in the UK government's attitude to public health and in its willingness to invest in higher education and research. It was the negative attitude of the UK government 10 years ago that encouraged him to move to Australia. He felt that there was a more open minded, broadly based, and dynamic atmosphere in Sydney.

But as in Britain, times have changed in Australia, and the pendulum has swung the other way. “I'd have to say the disinvestment in higher education and research and the general approach of government to pull back from its responsibilities in broad terms to promote health help you to think about taking up other options. If I was completely happy here I wouldn't have been looking.”

However, Professor Nutbeam's glory days in Australia have taught him a few lessons, which he intends to take back to England, particularly in relation to HIV/AIDS and drug use. There is now a vigorous national debate in Australia about the efficacy of so called legalised “shooting galleries” where heroin users can legally inject drugs. Professor Nutbeam has mixed feelings about the experiment, but he admires the radical approach that enabled it to be established.

“Australia had an approach to illicit drug use which did, and still does, demonstrate that it's not afraid to test and experiment; that showed people were thinking broadly and laterally about how to solve really difficult public health problems.”

His biggest impact on policy in Australia resulted from his role as head of a review to revise the national health goals. It involved “significant technical analysis and excruciating political negotiation between the states and federal government.”

Professor Nutbeam has also been involved in a review of HIV/AIDS education programmes and has an ongoing interest in the health of adolescents between the ages of 10 and 20, when behaviour, values, and attitudes are formed for life. “It is a focus on the young which has been a very strong hobby horse of mine for my entire career.”

The professor, who now has dual British and Australian citizenship, expects to take up his new role in October. He is supposed to give six months' notice to the university but says it is agreeably flexible, and he will maintain his chair as professor of public health to see through some of his PhD students.

He says one of the main things he will miss is the close engagement with Asia which many Australian academics enjoy. For the past three years he has headed a group working with the Chinese ministry of health to help develop a capac-ity to fight non-communicable diseases, such as heart disease and diabetes. “It's been marvellous to see the programme grow from a starting point where the Chinese had very narrow expectations of the programme to one where we have a lot of mutual trust and respect.”

Another pet project has been his work with Aboriginal and Torres Strait Islanders to establish in Sydney the first postgraduate public health course for indigenous students.

Professor Nutbeam says the course has an 85% retention rate, which he describes as very high. But he still feels that academics are better at describing the poor level of Aboriginal health with increasingly sophisticated statistical techniques than they are at forging partnerships with indigenous people to tackle the problem.

Professor Nutbeam, who is described as ambitious and a big-picture man, is already engaged in looking far ahead to where the long term priorities lie in the new century. He believes the globalisation of health issues will grow and the strong international dimension of HIV/AIDS, illicit drugs, and the reach of multi-national tobacco companies will call for an appropriately global response.

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Don Nutbeam: “I don't think I've been recruited to be a typical public servant.”

The UK's public health policy is one of the first in the world to acknowledge the impact that income, housing and education has on health