Senior public servant Kevin Buckett talks to Cathy Savage about environmental health issues and work in Australia

'I've been the director of environmental health for the Commonwealth government, based in Canberra, for the past 18 months. Australia is the size of western Europe, with a population of just 18 million. It's very different from Britain: the people are informal, there's lots of space and the whole country is obsessed by sport. It's great fun. The Australian civil service is much more informal than its British counterpart. We call them public servants and they come from anywhere - there's no public school tradition.

The system of government is a lot more confusing than the British one. There are two territories, six states, nine regional governments, and the Commonwealth (federal) government. There are about 720 local government bodies and they vary enormously, from Brisbane City at 1 million people to Peppermint Grove, which has a couple of hundred people, a shop and three streets. They often have their own regulations.

The Commonwealth government doesn't have a statutory role in environmental health and it had really dropped the ball before I joined. There wasn't much action going on and most public health work was clinical and medicine based. There has been a resurgence of thought on health since then. While the government has no specific brief, it does pay for tertiary health care through Population Health Committees and effective preventive health work could reduce that cost. At the moment environmental health gets just 2 per cent of the Population Health budget.

There are 12 people in my section and my job is really to facilitate and co-ordinate. We have just set up a national environmental health council called enHealth Council (with the idea of enable, encourage etc) and we have produced a national environmental health strategy with a three-year implementation plan. My section provides the secretariat support for the council, which has representatives from each state and each territory, and also representatives from the aboriginal department, Public Health Association and Consumers Association. EnHealth will meet four times a year; it's difficult to get everyone together from such a big country but it's very very important.

The highest priority for us is indigenous environmental health. The indigenous communities make up about 2 per cent of the population. They have much shorter life expectancy, higher disease, poorer respiratory health and many other problems. Some of these are due to poor nutrition and lifestyle habits, but there is also the fact that the communities feel disenfranchised and so there tends to be a high rate of illness associated with behaviour.

cultural differences
The environment is a problem in many of the rural areas where these communities live. There is often a high level of dust, high dog ownership and potentially poor water quality, but there is a lot of work going on to address these things. The thing to remember is that these communities have a different culture. Australia pursued years of assimilation policy with no benefit to anyone. These days aboriginal communities control their own health services. We are trying to support them with community development and training linkages. A national indigenous environmental health forum has been set up to raise issues to feed into enHealth.

Another major environmental health issue for Australia is urban sprawl, as cities grow beyond the capability of their services. Sydney alone has a population of 4 million people, while throughout the country, 90 per cent of people live in major cities. There is a breakdown in environmental health systems when urban development goes too fast. An example of where this can go wrong is three or four years ago in an area famed for oyster growing. Caravan sites and new homes sprung up, but there was no sewage infrastructure so the lake became contaminated and people ended up catching hepatitis A from eating the shellfish.

Skin cancer is a significant issue in Australia with very high incidence in Tasmania because of the ozone depletion. There are innovative things being done, particularly in shade creation, with schools and swimming pools using trees or canvas to produce shade for people. We have spots of contamination and industry; mainly lead mining and brick works but these are all in urban areas.

Australians' health on the whole isn't too bad, the population enjoys one of the longest life expectancies in the world and there is very tough anti-smoking legislation with good campaigns to back these up. The Aids strategy was very quick off the mark too, and has been very effective. Transport is a major problem though, as cities were pretty much all designed around car use over the last century or so, and public transport tends to be poor.

We try to work closely with Environment Australia, the department of environmental heritage. We manage a number of projects undertaken by contractors, often universities, dealing with issues like the greenhouse effect and response to global climate change. There are various other working groups dealing with research, the workforce, and economics.
One of the problems with environmental health is the difficulty of demonstrating economic benefit when the end results might not be known for 20 years. But there is a growing recognition in the country that physical, biological, chemical, environments do play a role in health outcomes. My view is that environmental health is in a unique position to provide the link between all activities that impact on health or the environment.

The biggest problem is the silo mentality, where everyone sits in their separate silo - planning, medicine etc and fails to work together. Environmental health is a multi-sectoral discipline. Environmental health practitioners are specialist generalists, if you like. Joint-working is still in its infancy in Australia. We need economic and information systems and we need to see health impact assessments in policy decisions. At the moment there are environmental impact assessments for every new development but the health component is patchy, generally based upon the working relationship between the health and environment departments. But I think we are getting there. It's all about to happen in a big way in Australia.'