public health nursing in Australia

public health nursing in Australia

Viewpoint New threats to community/public health nursing in Australia Val McKinnon Community nursing has long been the mainstay of is in addition t...

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New threats to community/public health nursing in Australia Val McKinnon

Community nursing has long been the mainstay of

is in addition to DEEIYA funding and is primarily to

the community/public health sectors. Yet recent policy

provide Master of Public Health and related courses. The

changes have the potential for considerable impact on the

PHERP programs are based on consortia in 19 uni-

future of these areas of nursing in this country. Two

versities and research institutes, located for the main part

recent developments are worthy of scrutiny: the recent

in the mainland capital cities.

changes to the National Health and Medical Research Council (NHMRC), and the establishment of Public

While the PHERP-funded centres are positioned largely in

I lealth Education Program (PHEKP)-funded

and around medical schools, other public health discipline


tion programs.

areas are also involved, including health economics and administration, health promotion, environmental science,

The developments within the NHMRC and PHERP are

social and behavioural sciences and nutrition.

such that the profession needs to unite and find a voice,

departments are located in the universities that receive

to counter the threats to the educational, research and

PI IERP funding, yet they derive no financial benefits from

practice opportunities that have been available to

the program. As a consequence, they are at an obvious

community/public health nurses over recent years.

financial disadvantage and suffer accordingly in the

These changes should not go unchallenged, because

public's perception of quality and prestige. Again as a

their impact is likely to impinge on the more dis-

consequence, nurses are being attracted to the well-

advantaged sections of the community, those which

funded PHERP programs, which, unfortunately, do not

have traditionally relied on the services provided by

have the community-service orientation characteristic of

various categories of community-based nurses. The

courses in community/public health nursing. Moreover,

latter work in a range ol settings, including maternal and

additional benefits accrue to students enrolled in courses

child health centres, community health centres, school

funded by l'HERP, benefits not available to students in

health programs and domiciliary and other community-


based services.

eligibility to apply for state government public health trainceships.



programs; for example, the

Thus, as a (possibly unintended) conse-

In the recent past, all tertiary education programs gained

quence of PHERP, postgraduate community/public health

their funding from the Commonwealth department

nursing programs within health science faculties par-

responsible for underwriting education-currently, this is

ticipating in PI IERP are given low priority.

the Department of Employment, Education, Training and

Vol McKinnon is Associate Professor, Department of Nursing at the Victorian Institute of Technology.

Youth Affairs (DEETYA). Now the PHERP programs are

Another development which has the potential to impact


public health

on nursing research, and hence education and practice,

education, as a consequence of a financial advantage

results from the remodelling of the structure and modus

resulting from a joint partnership agreement with the

operandi of the NIIMRC. Noteworthy is the demise of the

Commonwealth Department of Health and Family

Public Health Research and Development Committee

Services. As a result of this joint funding arrangement,

(PIIRDC), which was responsible for public/community

the programs will receive an additional $10 million per

research funding and an overall new emphasis on large-

annum, until the year 2000, from the health sector. This

scale, 'big picture' projects. A newer, overarching research

; ^ 6 ^ M : ^ i ^ ^ ^ ; H y R S M G , .A«sf^UIA •

to dominate professional


''-\-'..:'COU4«*!AN VO^UMi 4 (2) APT&U-1997K

committee will oversee all NHMRC funding from this

ultimately increasing income disparities), and access for

year (NHMRC 1996). With the demise of the PHRDC,

those who are most in need is reduced (Short 1996).

concerns have been expressed that public health funding

Nursing has a long record of experience in providing

more generally will suffer.

Additionally, the positive

services and programs to the more disadvantaged

discrimination currently enjoyed by community/public

sections of the community, so a nursing presence is vital

health nurses is unlikely to continue, especially as many

if its traditional clientele is not to be further handicapped

seek funding for smaller-scale community studies, which

by the current agendas.

often utilise qualitative methods. At issue is the potential of an interest group, with arguably PHIiRP institutions and consortia are also well-placed

a limited perspective on direct service delivery, to exert a

and seeking to influence the community/public health

hegemonic influence on health policy and delivery. As a

research agenda, traditionally the role of medical schools.

consequence, there is a risk that the existing, alarming

This is being achieved through their interchange with the

health differentials could be exacerbated within the

Department of Health and Family Services, health

population. These concerns arc based on the assumption

ministers and other key bodies such as the NHMRC,

that it is unlikely any other adequately prepared group

which work together through networks such as the

could fill the vacuum resulting from a diminished

National Public Health Partnership (Oldenberg 1996).

community/public health nursing presence.

It would appear that, through these links, PHERP institutions have opportunities to play an increasingly

Education and research opportunities which have as their

dominant role in the community/public health sector.

focus a service orientation are required if disadvantaged

The present chairman of the PI IERP centre directors notes

groups are to receive the services traditionally provided

that PHERP-funded centres should be "an integral part of

by community/public health nurses. These opportunities

the development of effective public health networks at a

are a necessary prerequisite to providing appropriate

national and state level ... to achieve a reorientation of

services in a dynamic context such as we know today.

health services and improved clinical and health outcomes

How can nurses continue to respond appropriately to an

for the whole population" (Oldenberg 1996:8). To date,

increasing array of policy initiatives, including the ones

nursing has not assumed that it has a role in such

developed as a cost-cutting exercise? What can nursing

networks, despite its unique position in providing services

provide that conforms to the profession's ideals, while

that reach all population groups.

also responding to the current mandatory requirements of efficiency and effectiveness?

What cognate areas of

The outcome of these recent developments is that

knowledge and expertise are required to provide services

community/public health nursing education programs

in apparently disparate settings, such as community

have no financial guarantees, or even a clear future;

health centres, domiciliary nursing and hospital-in-the-

therefore, this nursing sector as a whole is under some

homc programs?


The threat of diminished educational and

important issues, and to articulate forcefully what it is that

research opportunities for nurses should be viewed

nursing can deliver, will mean that more powerful, less

seriously by the profession, because nurses have been

service-oriented groups could capture the education,

at the forefront in providing services to socially dis-

research and practice agendas in this country

Failure to confront these and other

advantaged, multicultural and isolated communities over many decades.


Equity questions are important in a climate in which

NHMRC 19% NHMRC - structures and functions for the 1997-

agendas concerned with shifting responsibility for health

1999 triennium. Nl [MRC, Canberra

care from the public to the private sector exist. These

Oldenberg B 1996 PHA and PHERP In Touch 13(3):8-16

involve adjustments whereby responsibility for the cost

Short S 1996

of health care is moved from the rich to the poor (thereby



Report of the conference of the International

Association of I lealth Policy. In Touch 13(3):4