New zest for public health optometry
Version of Record online: 29 OCT 2012
© 2012 The Author. Clinical and Experimental Optometry © 2012 Optometrists Association Australia
Clinical and Experimental Optometry
Volume 95, Issue 6, pages 567–568, November 2012
How to Cite
Cole, B. L. (2012), New zest for public health optometry. Clinical and Experimental Optometry, 95: 567–568. doi: 10.1111/j.1444-0938.2012.00810.x
- Issue online: 29 OCT 2012
- Version of Record online: 29 OCT 2012
This issue has a special focus on public health optometry. There is an editorial about our collective failure to provide eye care for significant neglected groups of people in Australia: this despite Australia's economic wealth and its universal health insurance scheme. The editorial is followed by four papers and two viewpoints on public health issues. Even the lead review by Professor Jacob Sivak has public health overtones. His review is about the success or otherwise of efforts that have been made to prevent the onset of myopia.
Public health covers a vast field and it is not easy to describe its scope in a single phrase. The phrase that I use is ‘public health is about organised systems for health protection’. It is about community action and organisation to prevent ill health, to restore good health, to reduce the morbidity of ill health, to improve life amenity for the sick and disabled and doing all of this cost effectively.
Public health has its origins in discoveries made centuries ago. It has long been known that quarantine (meaning 40 days) could control the spread of infectious diseases and was in systematic use in the 14th century. Vaccination was trialled by English aristocrat, Lady Mary Montague, in 1718 when she inoculated her own children with fluid from mild cases of smallpox, having observed the practice in Turkey, where her husband was the British ambassador. James Lind was a pioneer of the value of hygiene in the navy, as a means of preventing disease among seafarers and in 1747, long before anything was known about vitamin C, he conducted the first clinical trial to show that citrus fruit could prevent scurvy. John Snow pioneered the science of epidemiology, showing that the cholera outbreak in Broad Street, London in 1854 was due to contamination of the water supply by sewage. He did this before Robert Koch published the results of his tests of the germ theory of disease in 1890.
Public health really took off in the 20th century with all sorts of community action to prevent disease and reduce its morbidity. This was the era of social reform politics that brought about maternity and child welfare programmes, the development of public hospital services and national health insurance schemes. While health insurance schemes date back to the closing years of the 19th century, the first universal taxpayer-funded health scheme was the UK National Health Service introduced in 1948. Australia followed half-heartedly with the Menzies Government's National Health Act of 1953, designed to prop up private health insurance and to prevent the socialisation of medicine. It was not until 1974, under the Whitlam government, that there was universal coverage.
Optometry has been slow to embrace public health concepts. This is not surprising, as optometrists spend their workdays attending to the needs of individual patients and have no cause to think much about broader population issues. In any event, optometrists were not part of the political processes of decision-making in health during the early years of the 20th century. Optometry's first venture into public health was to pay some attention to the prevention of industrial eye injuries. American academic optometrist, Henry Hofstetter, published his book Industrial Optometry in 1956 and some Australian optometrists left their consulting rooms to screen vision in industry, conduct on-site eye examinations and supply heat-toughened prescription eye wear. The profession also advocated tougher vision standards for motor car drivers and regular testing of drivers' vision. It might be cynical but perhaps these early interests in public health optometry were motivated more by practice-building goals than the altruistic concern for better community health.
The stirrings of a wider interest in public health by optometry began in the 1970s, when the Australian College of Optometry established outreach clinics in the then new concept of Community Health Centres to provide low-cost eye care for the needy and disadvantaged in a multi-disciplinary setting, an idea that was met with sustained hostility by the profession fearful of the effect this might have on private practice. Less controversially, the Australian College of Optometry also went into partnership with the Association for the Blind (now Vision Australia) in 1972 to establish the first multi-disciplinary low vision clinic. In 1985, the College was charged with the management of Victoria's subsidised glasses scheme for the Victorian Health Department. Professor Brien Holden at the University of New South Wales with his colleagues did the same in NSW by founding the not-for-profit company VisionCare NSW in 1992. Not content with this, Brien Holden took on the world, as he has always been inclined to do, by founding the International Centre for Eyecare Education (ICEE) in 1999 to provide optometric care to needy communities around the world and to help those communities to develop their own optometric resources. This has now morphed into the Brien Holden Vision Institute Foundation that continues the work of the ICEE on a very large scale, including eye-care services to indigenous communities in remote Australia. At this time numerous Australian and New Zealand optometrists joined ‘eye camps’ to provide their services, often pro bono, in developing countries and outback Australia.
But public health optometry is more than providing eye care for the needy and disadvantaged. From the 1970s optometry also became a much more active participant in the setting of standards for eye protection, lighting and work place ergonomics through Standards Australia. It became engaged in research on visual ergonomics and on the relation between visual impairments and work performance to provide a proper empirical basis for setting vision standards for driving and various other occupations. In addition, optometry as the principal provider of primary eye care, has been drawn into public health programmes for prevention of vision loss from diabetes, age-related maculopathy and glaucoma, both as a participant in policy development and in implementation of those policies.
Public health is a very big and diverse field. Developing policies that work, are cost effective and based on good evidence is no easy task. In past years, optometry has been more a participant in policy implementation rather than in policy development. It is pleasing to note that a Public Health Optometry Group was established in June this year. This will bring together optometrists with an interest in public health and give an impetus to the profession's involvement in policy development. If you are interested contact the authors of the editorial that follows.