Spotlight on our AFPHM members
Dr Stephanie Davis, Chief Health Officer, Department of Veterans’ Affairs
You currently hold the key role as Chief Health Officer in the Australian Department of Veterans’ Affairs. Can you tell us about your journey into public health?
My interest in public health started as a medical student, I think because I was interested in working in low resource settings and whenever I spoke with people who’d done that, public health came up and the approaches just seemed to appeal to me.
My interest in public health crystallised when I was doing my internship in Darwin where we spent so much time treating people who were extraordinarily sick, for conditions that could and should have been preventable. There was one patient I had in my surgical term; a young man who kept having repeated admissions for alcohol induced pancreatitis. We’d treat that admission, do surgery etc and then discharge him, not coincidentally back into homelessness, and he’d be admitted again maybe a week or so later with another bout.
After a couple of months of this, perhaps unsurprisingly, swabs taken from a pancreatic abscess during surgery grew a bacteria that was resistant to every antibiotic we had in the hospital, and we had to get antibiotics flown in from Melbourne. And I remember thinking, this feels wildly inefficient, so much effort and suffering that we could prevent. Surely there must be a better way of doing things.
The next year, I was lucky enough to get a job working at the Kimberley Population Health Unit in Broome, back in the days when they had a six-month public health resident placement. That was a fantastic opportunity for a junior doctor to do a combination of public health projects and communicable disease response in an amazingly beautiful area of Australia. Part of this job was reviewing results for the regional syphilis registry. Paper copies of the results of all syphilis tests taken anywhere in the Kimberley, positive or negative, were sent to the Population Health Unit and it was the resident’s job to review these and check the registry for previous results. Then you’d select one of the nine or so stamps big, old-fashioned ink stamps (from the designated stamp cardboard box) that recommended the next step (e.g. re-test in three months, check cord blood etc). This was 20 years ago but even then, the process felt slightly archaic.
Since then, I’ve done a variety of different jobs in public health and also kept a toe in the water of clinical medicine.
You’ve worked across diverse public health roles. Which achievements or initiatives stand out as defining moments in your career?
My career has been almost completely unplanned and follows no discernible logic, but on the whole has been enormously rewarding. There are a few standouts I’ll mention either as highlights or because I think they probably changed the direction of my career.
I was very lucky to deploy to work in South Africa with the World Health Organization in 2010 to help prepare for the 2010 FIFA World Cup. I worked closely with South African colleagues at the Ministry of Health and National Laboratory, and we built an event specific surveillance system that worked very well, essentially through bringing together different areas and levels of government departments, and other organisations that hadn’t always shared information regularly. The relationships and skills built through this work lasted beyond the event and continued to strengthen surveillance and communicable disease response. I was hugely proud when I found out the whole system had reactivated another mass gathering in 2013; the funeral of the great Madiba, Nelson Mandela.
Not long after I finished public health training, I was offered a job at the Australian National University to restart the Master of Applied Epidemiology program, which had been defunded a few years previously. Along with a small number of other people, I worked extremely hard on re-establishing the program including redesigning the curriculum and doing a lot of teaching and supervising. I really enjoyed this job and found it very, very rewarding and joyful to watch MAE scholars gain skills and confidence, especially those who had come from less traditional academic backgrounds. Several years of academia also made me much stronger in my understanding of epidemiology and methodological rigor in research, and sharper in my critical thinking skills.
Like many public health physicians, COVID was a defining time in my career. I was seconded from academia to work in the Commonwealth Department of Health for what I thought was going to be three months. That secondment ended up being almost two years and I finished it as one of the Deputy Chief Medical Officers. This was a job I felt wildly under-qualified for, but I suppose COVID was like that for many public health folk.
During COVID, I worked a lot on strengthening the primary care response, including setting up general practice respiratory clinics, and later on the vaccine roll out and safe opening of the national border. I’d come from a pretty operational background and so this was the first time I’d worked in the Federal government, which introduced me to a whole new world of acronyms, bureaucracy, and frequent frustration, but also the opportunity to be involved in really big policy.
As much as all these jobs have meant to me though, the one that I probably enjoyed the most was working as a public health registrar, and later a locum public health physician in the Pilbara. The job itself, with the opportunity to do applied epidemiology and hands-on outbreak response, make system changes and really get out in the community, was fantastic. And to top it off, the team was fantastic and that country is some of the most beautiful in Australia – what an amazing job where part of the role is actually getting to drive around and visit communities while doing such interesting work!
Public health relies heavily on collaboration. How do you build partnerships across government, clinicians, and communities to drive meaningful change?
I’m not sure I’ve got any great revelations about how to build strong partnerships, but it is something that I’ve thought about a fair bit, as I’d argue that collaboration and coalition building is the lynchpin of having public health impact.
It probably sounds really obvious, but the best partnerships I’ve been part of have been driven far more by strong personal relationships than by governance structures. MOUs or even funding agreements, (although bringing money to the table usually helps). And where I’ve seen, or been able to build strong relationships, this is done on the basis of trust.
To build trust, you’ve got to consistently demonstrate integrity, show up and actually listen, try and be helpful, and treat others with respect even, or especially, when you don’t agree with them. Where there are disagreements about the correct way forward, I always find it useful to bring people back to what are all trying to achieve – usually it’s ultimately the same thing in terms of good outcomes for the community, even if we don’t all agree on the same way of getting there.
I often go back to risk communication principles –so be honestand open, acknowledge what you don’t know or what you can’t change etc. And definitely leave your ego out of things if at all possible. It doesn’t matter how big or powerful your job title or your organisation is, if you’re trying to support change in a community, invariably the community and those working on the ground will know what they need better than you do, so listen to them!
Looking ahead, what innovations or shifts in public health practice do you believe will shape Australia’s future?
This is a really interesting question and one I’ve been reflecting on a bit. But I think I’ve got more questions than answers!
The most obvious shift is likely to be the use of big data and artificial intelligence, particularly on analysing large, linked data sets, and using data that we haven’t traditionally used for surveillance. I don’t think we’ve really grappled with how this might impact public health surveillance and response yet. I’m actually really enthusiastic about the potential for AI in public health as a lot of what we’ve traditionally done can be automated, but my worry is that we, as a public health community won’t step up to lead this, and instead the space will be taken over by those who are very good at doing clever analyses (or getting AI to do clever analyses), where there is a huge risk for misinterpretation because the people or machines in charge don’t understand the limitations of the data sources they’re using.
From a public health challenges point of view, the next twentyish years don’t feel as rosy as the last twenty, the COVID pandemic notwithstanding. We’ve got a continuing demographic shift to an older population, which I think will have profound impacts on our society from a social and economic perspective, but also increases access blocks to clinical care, and this is alongside the increasing frequency of emerging diseases due to closer human-animal contact and other threats from climate change.
All of this means prevention and keeping our population as healthy as possible is more important than it’s ever been. And I wonder if there’s a role for really rethinking the way that we do public health. I’m sure there will always be a role for vaccines, contact tracing, for shoe leather epidemiology and environmental inspections, but do we also need to consider how we can better empower the population as a whole to make more informed choices about their health? This will require a big shift in the way we communicate; the days of trust the public health expert feel long gone to me, accelerated by COVID but also linked to the greater dissemination of knowledge (and misinformation) via social media and the greater use of large language models that anyone can ask questions of.
I think as a public health community we really need to think about how we can shift our communication mechanisms to better reflect how most people are now accessing information. We also need to think about how we can use big data and artificial intelligence to learn about population-level risks and help us build healthier towns, cities and public policy. How we can use machine learning to build individual risk profiles that empower individuals and best target preventative measures, rather than increase inequity, which is a real risk?
To change how we do public health while being remaining true to its foundations of improving the health of the population as a whole will take some very hardworking, smart and committed public health leaders who can think originally, build coalitions and are willing to take risks. Luckily, from all the recent public health registrars I’ve met, I think they’re up for it.