Steven Miles may not wear the title of ‘Queensland Premier’ for much longer, but has earnt considerable respect for his focus on public health and prevention, not to mention his social media smarts, reports Marie McInerney.
Marie McInerney writes:
Might he be Australia’s first Premier for Public Health?
Queensland Premier Steven Miles is certainly bidding for the title in the lead-up to the state election on 26 October which, on current polling, he is expected to lose convincingly or end up in a minority government with Greens or independents.
Considered by many to have been a strong and reforming Health Minister through COVID-19, Miles is a prolific social media poster, sharing news and appearances pretty much daily on X/Twitter, Facebook and Tik Tok.
His posts include the standard range of state election health commitments, particularly new hospital infrastructure, notably satellite hospitals dotted across the state.
But he also addresses wider public health issues, recently posting about expanded access to safe abortions for women in rural and remote Queensland, primary healthcare in Cape York, a Food Farmers Commissioner to help growers stand up to big supermarkets, and urinary tract infection treatment via pharmacies.
Miles has highlighted expansion of the Patient Travel Subsidy Scheme, the latest in an innovative program converting vacant motels, offices and nursing homes into social housing and homeless accommodation, and promoted renewable energy, a ban on new oil and gas in the Channel Country — “promise made, promise kept”.
He’s done broadcasts, interviewing health workers about their roles, taken the passenger seat with an Aboriginal student learning to drive under a government program, and – in shades of former New Zealand leader Jacinda Ardern – been filmed counting down his achievements in 60 seconds. One of his latest posts is a genre-busting take on protecting women’s rights.
COVID-19 is perhaps one of the few public health issues he seems not to have tweeted about during the campaign.
Still, his campaigning on health stands in contrast to the national zeitgeist, where health policy is not centre stage politically – apart from kickback to the Albanese Government’s bungling of important public health concerns such as fossil fuel expansion, gambling advertising, and addressing inequalities for LGBTQIA+ people.
Miles’s focus on health also contrasts with the priorities of his Liberal National Party (LNP) rival for the top job, Opposition Leader David Crisafulli, whose social media feeds are – echoing his colleagues ahead of the recent Northern Territory election – filled with posts about youth crime, a central plank in the LNP’s election platform.
Declaring “Queenslanders are living in fear”, Crisafulli is promising (again and again) to “pass Adult Crime, Adult Time before Christmas if Queenslanders vote for change”.
That’s not to say Miles and the Labor Government over the past decade have been progressive on justice and child protection issues — as highlighted this week in a report by the Queensland inspector of detention services, who warned of “catastrophic consequences” of locking up young people in places ‘not suitable for detaining children’. And a recent article at Croakey about a young Indigenous boy who has been failed by the state is just one of many similar stories.
A recent media interview with Miles suggests, however, that he is at least trying to start an evidence-based conversation, as new NT independent MP Justine Davis did when talking about programs such as restorative justice and diversion programs to try to keep young people out of prisons.
Pressed on youth justice, he said it is “harder to tell the story” of efforts in early intervention because the TV media is “addicted to CCTV footage of crime”.
Rating on health?
Six weeks out from the election there is also a mixed verdict on the Government’s performance in health.
A number of national and Queensland public health experts who spoke with Croakey this week referred to Miles, who was Health Minister during COVID-19, as a “public health champion” and a reforming Minister, responsible for decriminalising abortion and legalising euthanasia.
Professor Melissa Haswell, from the School of Public Health and Social Work at the Queensland University of Technology, said Miles emphasised the importance of climate change in his first speech as Premier, stopped carbon storage and shale gas fracking in the Channel Country, and has brought in 50 cent fares for public transport, among other positives.
“So yes, from my perspective, he is a Premier for health in some really key ways,” she told Croakey, adding that she is shocked he is “not supported tons more for these bold actions”.
For others, he has been promising but disappointing. One expert, who asked not to be named, is concerned that Labor has “a blind spot” when it comes to root cases of health inequity and taking on the social and commercial determinants of health.
History suggests that an incoming LNP government is less likely to act on these sorts of issues. The new NT Liberal Country Party Government, which also ran on a ‘tough on crime’ platform, has scrapped climate change, remote housing and other important portfolios from its Ministry.
Experts point to the LNP’s “complete lack of any public health related policies going into the election”, other than, say, scrapping pill testing at festivals.
The LNP has also rejected the state’s renewable energy targets, withdrawn support for Queensland’s Truth and Treaty process, and left ongoing concerns about abortion laws after voting against decriminalisation five years ago.
Miles’s strategy, which includes hailing Queensland’s “health heroes”, is to remind voters of what happened in Queensland with the last LNP Government – headed by Campbell Newman – which crashed and burned in just one term from 2012.
In Parliament this week Miles marked the anniversary of the Newman Government’s 2012 “horror Budget”, handed down “with the Leader of the Opposition by his side”, which gutted the public service, sacking 14,000 people, including 4,400 healthworkers, among them 1,800 nurses and midwives.
It was “callous, cruel, heartless”, Miles said. “Austerity LNP style.”
It’s a memory that runs deep for many working in health in Queensland, including for the Public Health Association of Australia’s (PHAA) Queensland branch and Australian Health Promotion Association (AHPA).
Their joint 2024 state election platform recalls how the LNP “dismantled the public and preventive health workforce”, axing over 150 jobs in nutrition, sexual health, health promotion and Indigenous health.
“While this brought a small saving for that Government – current generations have been paying the price of poorer health and unsustainable healthcare expenditure due to fewer community-based prevention programs,” these organisations said.
Health consultant Kelly Dargan, a member of Croakey Health Media, was among those who lost their jobs, recalling this week that every public health unit across Queensland, including where she worked in 2012 in Charleville, “was closed and staff made redundant”, leaving just a small health promotion team in Brisbane to run statewide campaigns.
The cuts included alcohol and drug prevention workers, nutrition promotion and health lifestyle programs, sexual health workers, and environmental health professionals, as well as grant funding for programs run by not for profit.
For Charleville alone, Dargan said it meant there was “no local program or service delivery in that region and no place-based health promotion initiatives, which had included working with local governments to embed health communities principles in their strategic and operational planning”.
“It was also a significant loss of jobs in a small town of under 3,000 people,” she said.
Classic Queensland suburban story
In an expansive interview with Guardian Australia, Miles recently admitted to suffering shyness and anxiety on the public stage – “it doesn’t come natural to me”.
But he’s regularly referred to by the media as a political “attack dog”, famous for a pugilistic maiden speech when he was elected in 2015 that the Opposition broke with tradition and heckled him and, during the pandemic, filming himself ripping up a tax invoice asking Queensland to pay for their residents who quarantined in New South Wales.
A former Environment Minister, before he entered politics he trained with US presidential nominee Al Gore’s Climate Reality Project and campaigned in his first election as “Miles better for the (Barrier) Reef”.
Gore’s group hailed his elevation to Premier in December 2023, saying that in a very conservative state, home to over 50 major coal mines, Miles was one of the very few ministers “to hold the line on climate change and continue to advocate for solutions within the Queensland Government”.
Since then, Miles has committed to 50 percent emissions reductions targets by 2030 and 75 percent by 2035, plus an 80 percent renewable energy generation target by 2035 and entrenched public ownership of energy assets.
At a recent Queensland Prevention Symposium, Miles briefly described his origins and political motivations. His was, he said, “a classic Queensland suburban story…an example of the power of generational prosperity, the idea that the next generation will have more and better opportunities than the one before”.
His grandparents “didn’t have much”, but they worked hard so their children could get trade qualifications and good secure jobs. His parents worked hard, “created a loving home for me and my sister, and encouraged us to do well in school, that enabled me to get a scholarship and be the first person in my family to go to university”.
But, he said, “generational progress” is not inevitable, quoting research that Queensland children who are born this decade “will live a shorter life than their parents, for the first time ever in Australia”.
“We know poor health outcomes and obesity are disproportionately higher among the disadvantaged. Our surroundings no longer support healthy habits; cheap fast food and slushies are on every corner. We know prevention, early detection and addressing inequality and unhealthy environments are key to a better future for all Queenslanders.”
Wins across portfolios
Public health experts have pointed to many wins by Miles, across housing and homelessness, food security, reproductive rights, euthanasia, climate action, and volunteering Queensland to lead development of the National Obesity Strategy.
Indigenous health expert Professor Bronwyn Fredericks, who co-led the Queensland Productivity Commission’s 2019 inquiry into imprisonment and recidivism, remains deeply concerned at how both major political parties conflate levels of crime in Queensland.
However, she and Leonie Short, head of Ipswich-based Seniors Dental Care Australia, have welcomed the $1,000 rebate for energy bills that is now landing in Queenslanders’ accounts across the state – paid for, Miles tweeted, “by making mining billionaires pay their fair share”.
“People around me, particularly families and older people, are happy about it,” Fredericks told Croakey, also welcoming the introduction of a 50 cent cap on public transport charges, which Miles said was “as close to free as we could get”.
Short agreed the new fare was “fantastic, because we know that one of the barriers to healthcare is transport”, though she and others worry it is currently only guaranteed for six months, until just past the poll.
University of Queensland Associate Professor Nina Lansbury, who researches and teaches on Indigenous health, climate change and health, and water, sanitation and hygiene, nominated a number of “excellent” initiatives from the Labor Government, particularly for more remote Aboriginal and Torres Strait communities.
They include:
- Initiatives to deliver safe drinking water to First Nations communities – work that pre-dates Miles but was expanded by him beyond a pilot.
- The Queensland Healthy Housing program being piloted in Yarrabah and the Torres Strait island of Badu, a partnership between Queensland Health, Energy and Public Works, Housing, Shire Councils, health services and communities.
- Health and Wellbeing Queensland’s Gather + Grow Queensland Remote Food Security Strategy 2023–2032.
For the broader community, she also applauded:
- Free period care products to all Queensland public schools (from 2022)
- The newly- launched Queensland Women’s Health Strategy — “complete with funding”.
Health and Wellbeing Queensland
One of Miles’ biggest acts as Health Minister was to set up Health and Wellbeing Queensland, to reduce rates of chronic disease and inequity in health.
Doing so was “a major step forward in prevention and health promotion”, says Professor Andrew Wilson, co-director of the Menzies Centre for Health Policy and Economics at the University of Sydney and former Deputy Director General at Queensland Health.
“It creates an institutional base that recognises that prevention is broader than a responsibility of the health care sector,” he told Croakey.
Yet there are concerns in the sector about the agency which has tracked its first five years in new report, titled GenQ.: what it might look like under an LNP government, but also its approach now.
The PHAA and AHPA are disappointed that much of its focus and funding “is directed to clinically based interventions and research and not the broader range of prevention interventions needed to meaningfully impact on public health gain”.
In some ways, one expert said, Health and Wellbeing Queensland has “an impossible task”, given its remit does not extend to upstream social determinants of health, including housing and education, and that its funding is short-term, putting it at the “mercy of political cycles” and struggling therefore to disrupt intergenerational health issues.
But others see a lack of willingness to be bold and disruptive versus what an agency like VicHealth has done, particularly on the commercial determinants of health.
Wilson, who is former co-director of The Australian Prevention Partnership Centre, had other concerns about the Government’s health proposals in the leadup to the election, particularly that Miles has committed to a huge health and capital works program.
“While population growth and health care demand will require an expansion in capacity, it is unclear how that capital expansion fits with the changing models of care and whether the additional health workforce growth (and its recurrent costs) has been considered,” he said.
He also highlighted that Aboriginal and Torres Strait Islander communities in Queensland experience the largest health inequities – shown tragically in the recent coronial inquiry into the deaths of three Aboriginal women from rheumatic fever in remote Doomadgee.
“I haven’t seen commitments or statements that would reassure me that this is recognised,” Wilson told Croakey, referring to the summary of different parties’ positions on First Nations health published by the Queensland Aboriginal and Islander Health Council (QAIHC).
“How much either of the parties most likely to lead a new government are actually prepared to commit in funding terms to reducing health care inequity and addressing upstream determinants of health inequity is less clear,” Wilson said.
For Dr Katherine Cullerton, a senior lecturer in UQ’s School of Public Health, the freight assistance scheme to try to make food cheaper in remote communities is one of the Government’s public health highlights – though she would “love to see it evaluated and make sure it’s not one off”, and the 50 cent public transport fare as well.
Cullerton remembers being blown away when Miles took an early public stand against vested interests in food, when he declared that when obesity is framed as about personal choice “we let governments off the hook, we let the fast food industry off the hook, we let planners and developers off the hook, we let schools and supermarkets and doctors and employers off the hook”.
“I remember thinking, ‘oh my goodness, I cannot believe a Health Minister actually, one, gets this, and two, is saying this out loud’,” she said. “It was unbelievable.”
But then, presumably in the face of concerted lobbying from powerful food and advertising interests, there has been little follow through, including on the ban he announced on junk food and alcohol advertising on publicly owned assets, such bus stops, train stations and roadsides.
“It just hasn’t happened,” Cullerton told Croakey.
Miles suggests it’s a case of ‘watch this space’ – if he gets a chance.
He told Guardian Australia that being leader means he’s now being able to act on “things that I’ve really wanted to do for the whole time I’ve been in government”.
Providing the 50 cent public transport fare as an example, he said: “Sometimes when you first suggest a thing, people look at you like you’re mad. Then when you’re Premier and you suggest the thing, they go and find a way to do it.”