Sally Redman AO

Graduates, families and friends, congratulations on your achievements. It’s a fantastic day today, and I have really enjoyed being part of the ceremony. I would like to first acknowledge that we are here today on the traditional lands of the Gadigal people of the Eora Nation, and to pay my respects to elders past and present.

I’m really delighted to be with you today, to share in all these wonderful achievements. I know that they’re the product of such hard work over many years for you as graduates, and also for you families. It’s a really proud moment for all of us as parents, and indeed for those of us who are teachers and sharers of knowledge. Graduation is both a time of celebration and one of reflection about the future. You’re graduating from a university that is held in very high esteem for its excellence, both in Australian and internationally. UTS is ranked as the top young university in Australia, and among the top 200 Universities in the world. And indeed, nursing and midwifery was ranked number one in Australia, and number four in the world in the recent QS World University rankings. What a great preparation for a career in health. Fantastic.

You’ll be entering practice at a time of great change in the health sector. We currently spend about 10 per cent of our GDP on health, and this is predicted to continue to rise over the coming years. It’s fuelled by the ageing population and accelerating costs from new tests and diagnostics. So in the past we used to get one test, perhaps, now we might get three. At the same time, we’re seeing soaring rates of obesity, diabetes and mental illness, and sadly continuing health inequalities. Never has it been so important to make wise decisions about how we allocate our health dollars. I think UTS has a perfect tagline to help meet these challenges: Think. Change. Do. That’s a great summary of how to move from being a new graduate to being a leader in your field. Over the past 25 years or so I’ve had the privilege of leading both the National Breast Cancer Centre and the Sex Institute. These organisations have been charged with using evidence from research to improve health. I’ve had the opportunity to play a role in change in care in many diverse areas, from treatment and support for women with breast cancer, to better detection and treatment for ear infections in Aboriginal children.

My experience has been that change is hard, and that it takes a long time. It’s quite frustrating for someone like me who’s quite impatient. It’s frustratingly slow, and I have found that it’s really important to hold in front of me some sources of inspiration, some examples of where change has successfully occurred. So I thought today I would share with you one of my sources of inspiration. John Snow, who I think exemplifies the Think, Change, Do approach. John Snow was an apprentice surgeon during the 1831 cholera epidemic in London. This epidemic killed 50,000 in Great Britain alone, and it must have been pretty frightening because at the time they didn’t really know what caused cholera. In fact, the accepted wisdom was that it was caused by what they referred to as miasmas, which is poisonous gases arising from sewers, swamps, and particularly the Thames River in London. Snow spoke to many patients who all reported that their first symptoms were digestive problems, making him think that maybe the cause was polluted food or polluted water, rather than air. He became convinced that there were, um, that contagious diseases like cholera were caused by invisible parasites. This must have seemed quite fanciful at the time, sort of rather like talking about fairies or spirits rather than proper medicine. When a new outbreak of cholera hit London in 1848, Snow decided to investigate the causes in earnest. At that time water was delivered through communal water pumps, and he found that two companies were supplying water to the district affected by cholera. One of the companies sourced its supply from an area in the Thames known to be polluted by sewerage, and another operated in an area above the sewerage outlet. He conducted a study to compare the mortality rates in consumers of the two different sources of water. Can you imagine the effort here. No computers, no big databases, no research grants, no research assistants, and a busy commission dealing with patients who were dying. He had to develop new methods, and indeed, John Snow is known as the father of epidemiology because he developed techniques that are much the same as we use today, to find out about, say, the causes of bird flu, or food poisoning outbreaks. He found that nearly 90 per cent of the deaths were in houses supplied by the pump of the company using the polluted water. I know most of us who do research would love to see effects of such a big size. However as a result of his findings the authorities removed the handle of the pump providing the polluted water so that it couldn’t be used, and this would have saved the lives of many Londoners. The authorities though did this very reluctantly. They didn’t really believe Snow’s evidence, even though it was 90 per cent, and continued to spread lime because they thought this would kill off the real cause of cholera, miasmas.

This reminds me a little bit about the story of climate change. Sometimes we have such deeply held beliefs that they will stand even against the very best evidence. So Snow’s work helped us understand infectious disease, and it saved the lives of many of his patients. And indeed it’s really saved countless millions of lives since the 1860s. The things that inspire me about John Snow are his courage and creativity, and thinking of causes and solutions outside of the accepted wisdom, and his determination to pursue these in the face of what was quite strong opposition. His discoveries were based on, and arose from the problems he was seeing in his own patients. It was very real world research. It’s also such a great demonstration of the way that data can be used practically to understand the causes of disease and to develop the best solutions. It’s the power of evidence in informing health decisions. And over the next 30 years, while you’re in the full of your careers, wise decisions in healthcare are going to be more important than ever before.

The kind of healthcare we have in Australia in 50 years’ time is going to depend on you, and your appetite for the kind of courage, creativity, and commitment to evidence demonstrated by John Snow. I’m certain that there are many, many future leaders graduating today, and that you will find the best evidence from research to guide your decisions. I look forward to seeing the many improvements and innovations that I know you will deliver. Now Albert Einstein spoke of this, and he said, ‘To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination, and this marks our real advance with science.’ Actually, Thomas Edison put this much more simply: ‘If there’s a way to do it better, find it.’ Thank you.