A spoonful of sugar helps the medicine go down

WORKING in public health is a serious business, but there are lighter moments to be savoured, and valuable lessons to be learned from them.

Lesson 1

People may not say exactly what they mean. Some years ago, a splendidly enthusiastic mayor spoke lyrically to me about the need to provide recreational facilities to encourage physical activity. “Mike”, he enthused, “we’ve got to help our young people be more procreative.”

Lesson 2

Check your messages carefully. After a former employee in the WA Health Department died, his widow left a message asking his erstwhile boss to speak at the funeral. The message, as delivered by a well intentioned personal assistant, asked if Dr X would deliver the urology.

Lesson 3

Check even the most carefully prepared documents. It is just possible that over the years my colleagues have been frustrated by my tendency towards what some unkindly described as “Mikeromanagement”. But it’s amazing how many typos and minor errors you can pick up. Perhaps my favourite came during my time as Director General of Health for WA. A massive document came to me for sign-off before it went through to the Minister and his Cabinet colleagues. Draft new mental health legislation, long overdue, had been worked on by countless dedicated public servants. The text was immaculate. It would have been even better if the Cabinet cover sheet had not been headed Daft Mental Health Act.

Lesson 4

Beware transcription errors. A once confidential tobacco industry summary of a 1983 Middle East tobacco control conference, into which one of the major companies had infiltrated a representative, reports that the organisers appreciated the support and assistance of some international experts. The summary that appears in the Tobacco Documents files presents a somewhat different picture, noting that they “welcomed Dr Kunze and Michael Daube and thanked them for the support and anal stance they provided”.

Lesson 5

Relish the integrity and consistency of politicians. The day before a national Ministerial Council meeting that would determine whether we would succeed with the campaign for mandatory folate fortification of bread-making flour, a journalist phoned the junior federal Minister whose support was crucial. He expressed doubts about the measure. Fiona Stanley, whose work with Carol Bower on folate has been so important, phoned the federal Health Minister. Shortly afterwards, the junior Minister called the journalist back saying that he might have been misunderstood and he was of course totally supportive of folate fortification. The measure went through and, like so many public health measures once opposed by commercial interests, has been stunningly successful.

Lesson 6

Be grateful for small mercies. In the early 1990s, an outbreak of Ross River virus in the southwest of WA generated international interest. We invited the local newspaper to send a photographer to get action shots of the appropriate concoction being carefully sprayed from a basket under a helicopter on to areas where mosquitoes were breeding. All went well and the newspaper got excellent photographs showing how the Health Department was doing all the right things in the right way. As soon as the photographer’s car had driven off and turned a corner, the entire basket under the helicopter fell into the water.

Lesson 7

Public health campaigners can expect to be attacked directly and indirectly by massive commercial interests and their allies. So, take the compliments when they come. Back in the 1970s, when I was starting modern tobacco campaigning in the UK, I would ask innocuous questions at tobacco company annual general meetings (AGMs), such as how many deaths the company’s products had caused during the previous year. After one AGM, the Rothmans’ chairman offered me generous funding to work on any campaign of my choice – other than tobacco. And during a later AGM, an angry shareholder stood up to castigate the company and its board for the decline in tobacco sales. He dramatically pointed across the room at me saying: “and that’s the bastard that’s doing it”.

Lesson 8

But don’t expect compliments from your friends. When speaking at a major conference, I was to be introduced by Todd Harper, CEO of the Cancer Council Victoria and long-time friend and colleague. I sat back happily waiting for kind words and compliments. “Of all the people I have known in public health,” Todd said, “Mike Daube is definitely one of them.”

Lesson 9

Check your emails before you send them. Some years ago, a colleague asked me for comment on an email from a distinguished and well intentioned clinician who had written about some people he had met overseas who were at the cutting edge of prevention. Splendid fellow though he was, I responded that he would not recognise the cutting edge of prevention if it attacked him while he was walking naked in the back streets of Vladivostok. I then, for reasons that still escape me, sent the email to the subject himself. No excuse – but for reasons that also escape me, for the next few years I stayed away from any conferences I thought he might be at.

Lesson 10

Colour descriptions can matter. During the campaign for tobacco plain packaging, federal Health Minister Nicola Roxon and her department dealt superbly with the evidence, the case for action and the tobacco industry’s ferocious opposition. Their only error was in the early stages to describe the proposed pack colour as “olive green” – generating protests from Australian olive producers, who did not want any form of association with a lethal product.

But there may also be occasions when the tobacco industry’s views on vegetables are worth quoting. My all-time favourite industry argument in support of their product came from a wonderfully inept Australian Tobacco Institute spokesman who was opposing bans on tobacco promotion. Qualifying the statement that cigarettes were harmful, he added “(but) … so are potatoes. Tobacco is in the same family. You inhale the fumes of potatoes when you’re cooking them”.

Lesson 11

Local advice may not always be best. When visiting a fairly remote country for a for a World Health Organization meeting, I asked about souvenirs for family and friends. I was solemnly assured that for the equivalent of a mere US$50, I could obtain a goat, a baby goat and two camels.

Lesson 12

Long before working in health, I learned that some advocacy campaigns are doomed to fail. In the 1960s in the UK, I was chairman of my university’s Conservative Association. Like others, I failed dismally in efforts to persuade two splendid elderly ladies from the Conservative Party Central Office to change the acronym for what was in those days the Federation of University Conservative and Unionist Associations, FUCUA (pronounced few-kew-ah), without explaining to them the possible alternative pronunciations. That had to wait until they retired.

Lesson 13

Learn from the humility of others. Some years ago, at an international conference, I was on a panel where four health advocates were asked to speak about successful campaigns. Three of us spoke about assorted wonders we had wrought, and the fine detail of our achievements. The last speaker was Michael Pertschuk, formerly Chairman of the US Federal Trade Commission, then doyen of American public health advocacy. He said not a word about his own successes, speaking only about other, mainly younger advocates whose work he admired. I would happily have sunk into the nearest hole in the ground.

Lesson 14

Someone can always do it better – even with humour. My talented dog Ollie (better known as Dr Olivia Doll, Senior Lecturer in the Subiaco College of Veterinary Science) recently attracted international attention after being appointed to the editorial boards of several journals. I thought her CV was pretty good, including research interests such as the benefits of abdominal massage for medium-size canines. But her canine colleague Dr Alice N Wünderlandt (assisted by Seattle whale researcher Dr Phil Clapham) recently had a conference abstract accepted with an innovative proposal to use trained ducks for oceanographic sampling. “In the event of terminal fuliguline failure, the depth-deceased is returned to the surface … Unserviceable units can then be processed in a standard convection oven at 230°C (450°F) and internally recycled with a sauce á l’orange.” Ollie will have to work hard to beat that.

Lesson 15

And finally – take the good news when it comes. Some years ago, I was sitting in my office in the university when I took a call from an American academic working on the history of tobacco who had worked out that the Mike Daube who had lived in Australia since the early 1980s was the same Mike Daube who was active in the UK in the 1970s. An earnest voice came on the line saying: “I’ve just discovered that you’re still alive”. Good news indeed.

Professor Mike Daube, AO, is professor of Health Policy at Curtin University.

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