Health and medicine make good TV news and drama. Charles Sturt University’s Professor Deborah Lupton found that a third of all front pages of the Sydney Morning Herald ran a health story and that doctors were centre stage in many of these. When not starring in fall-from-grace news sagas as radiological-scan scammers or drug-company perk dippers, doctors could fill a casting-agency catalogue with archetypes, each of whom speaks to us about fundamental issues like trust, dedication, the taming of nature and the power to heal. From the dedicated and tireless family practitioner Dr Finlay of Dr Finlay’s Casebook (BBC TV, 1962–1971), to his sagacious and avuncular partner Dr Cameron. From the nightly news diet of pointy-head medical researchers announcing breakthroughs, to oracle-like pronouncements about avoiding the latest infectious disease, doctors, their healthcare citadels and technological accoutrements are ubiquitous in our lives.

The death of Victor Chang in 1991 drew headlines like “A brilliant giver of life”, “A man in a million”, and “Patients mourn a friend and saviour”, suggesting a Christ-like popular meaning for this doctor who could do all but raise the dead by transplanting that most sacred of organs, the heart. In television dramas, doctors are often portrayed as successful, benevolent and authoritative, with almost mystical power to dominate and control the lives of others and restore order and justice from chaos.

RPA, the eponymous cinéma vérité series set in Sydney’s Royal Prince Alfred Hospital, has rated the house down since it commenced seven years ago. Last year more than 2.5 million people couldn’t get enough of it every week, making it the 12th most watched program on Australian television. From the comfort of our homes we follow patients and their families as they put themselves in the healing and comforting hands of hospital staff, enduring heart- and often gut-wrenching operations. These are real people, not the buffed and scripted patients and staff of ER, another hospital drama that rates its socks off. They’re like our parents or workmates. Like us.

The seamless blending of the ordinary with the heroic in infotainment like RPA reinforces notions of medicine as an almost sacrosanct activity: healing the sick and saving lives. The idea that such services could ever be cut, or that every glimmer of hope should not be pursued relentlessly, have become popular profanities. Hospital waiting lists can be used at will by a political opposition to bludgeon governments. But when it comes to saving lives and improving quality of life through health improvement on a massive scale, the contributions of hospital clinicians need to be considered against the relatively unsung contributions of prevention and public health.

Prevention can come in the form of drugs, like blood pressure controlling medication and asthma inhalers, and through screening for disease in cases like cervical, breast, bowel and skin cancers where early detection is known to make a difference to survival or to quality of life if the Big Clock has already started speeding up. It can also come in more obtuse forms, like laws to deter high-risk behaviours and public awareness and advocacy campaigns designed to alter – sometimes over timeframes lasting years – the ways we perceive health-related issues, like affirming self-worth in children, or the idea that it’s irresponsible to drink and drive.

So imagine if the producers of RPA decided to develop a parallel series on saving lives through prevention. Immediately problems would arise about how to make it work as television. “Tune in next week to see if Betty’s blood pressure is still down!” Swallowing pills or generational cultural shifts about smoking just don’t have the same televisual appeal as a patient like your mum navigating a life-or-death operation. The paradox of prevention is that it succeeds when nothing happens. Few people sit up in bed at 3 am astonished at the thought they have not yet been badly injured or were born without a birth defect. It’s hard to make riveting TV out of a change across 20 years on the slope of a graph showing disease incidence. While every grateful patient knows their doctor’s name and hangs on every bedside word, who has any idea of those behind the epidemiological detective work that first leads to understanding of what causes disease? Or of the years of unglamorous expert committee work and community trials of ways to have people change health-related behaviours?

The first segment on the new program would be called Trojan horses, in which things invented for other purposes and later found to have other tricks up their sleeves get applauded. The first guest wheeled onto the set could well be not a doctor or health advocate, but the humble refrigerator. The invention and proliferation of refrigeration has had profound effects on world health. The ability to preserve food through cooling saw a rapid decline in the consumption of smoked, pickled and salted food, which was followed by huge falls in the incidence of stomach cancer in nations affluent enough to afford widespread use of domestic refrigeration. Add to this the benefits of reduced salt in a population’s diet for the incidence of hypertension and stroke, and we start to see a superhero in action.

Aspirin, first synthesised from willow bark by Felix Hoffmann in Germany in 1897, was first used for pain relief and remains the leading painkiller used worldwide, with hundreds of billions swallowed year round. But in the last 30 years, its value in preventing death from heart disease has added to its extraordinary reputation. It has been repeatedly shown that aspirin substantially reduces the risk of death and non-fatal heart attacks in people who’ve had a previous myocardial infarct or unstable angina pectoris, which often precedes a heart attack. Moreover, a randomised controlled trial in the USA studied over 22,000 male physicians between 40 and 84 with no prior history of heart disease to see if aspirin could prevent cardiovascular deaths in healthy people. The study was stopped early and the findings shouted from the rooftops when investigators found that the group taking aspirin had a substantial reduction in the rate of fatal and non-fatal heart attacks compared with the placebo group after four and a half years.

The next regular segment would be called Grandma was right, where folk wisdoms eventually anointed by epidemiology get invited up on stage. First up in this segment might be Professor Cres Eastman from Westmead Hospital and South Australia’s Professor Basil Hetzel, for over 20 years leading figures in a worldwide effort to reduce the incidence of iodine deficiency disorders (IDD). Onto the desk they would place a small pile of iodised salt to symbolise what 1.5 billion people who live in iodine-deficient areas can’t get without help from the outside world. Iodine deficiency is by far the world’s leading cause of mental retardation. Endemic mental retardation in turn causes untold other health problems downstream associated with the inability to learn, retarding entire regional health profiles. In 1990, UNICEF estimated that 750 million people were affected by goitre, 43 million had IDD brain damage and 100,000 children were born each year with iodine-deficiency cretinism. Since the launch of the 1990 program to end iodine deficiency, each year 85 million newborns have been protected from IDD. The achievements of this program have been nothing less than revolutionary.

Tasmania, for years the butt of national jokes about family sleeping patterns, is home to Professor Terry Dwyer of the Menzies Centre for Population Health Research. But for parents of newborns, Dwyer and his team have changed forever the way we think about sleep. They were among the first to show through research that babies who slept on their stomachs were at higher risk of cot death (SIDS). Along with warnings about not smoking in homes with babies, advice to parents about sleeping babies on their backs has halved the national incidence of SIDS in a decade. Their photos deserve to be on the cover of every good-parenting magazine.

Perth’s Professor Fiona Stanley would then come on down for her research and advocacy in reducing neural tube defects. Each year about 80 babies in Australia are born with the birth defect spina bifida. At least 80 percent of those with spina bifida have an Arnold-Chiari malformation (where two parts of the brain, the brainstem and the cerebellum, are longer than normal and protrude down into the spinal canal) and associated hydrocephalus or fluid on the brain requiring a mechanical shunt to relieve the fluidic pressure. Other chronic problems include impaired mobility, bladder and bowel dysfunction, and curvature of the spine.

Neural tube defects can be prevented by reducing the incidence in all pregnancies, or by terminating affected pregnancies. Folate can be acquired naturally through fruits, dark-green leafy vegetables, and dried beans and peas, through folic acid fortified cereals or via folic acid vitamins. It is now well established that supplementation with folic acid plays a role in reducing by more than 70 percent the risk of neural tube defects in babies. In Australia the rate of spina bifida in live births more than halved between 1987 and 1996, from 7.1 to 3 per 10,000 births, reflecting both widespread advocacy about the importance of folate and increased in-utero investigation and terminations.

The next segment in our program, Nanny for a day, allows viewers into the world of those who never tire of trying to get us to stop doing dangerous things. The undisputed Australian champions here are in road safety and smoking control. Despite the ritual post-holiday weekend calls for all cars capable of travelling more than 120 kilometres per hour to be banned (and that’s all of them, right?), Australia’s road toll has fallen faster than that of any other nation. In 1981, 3,321 Australians were killed on the roads. Despite population growth, 18 years later this had fallen 47 percent to 1,759.

When intergalactic archaeologists one day rake over Australian soils they will find the ashtray started disappearing from public life around now, joining in antique shops the spittoon, which left restaurant tables for oblivion early last century thanks to efforts by hygienists to prevent the spread of tuberculosis. In the early 1960s, nearly 70 percent of men smoked. Today, it’s down to 22 percent. Women’s smoking has fallen from a high of 33 percent in the mid-1970s to be today around that of men. Adult per capita tobacco consumption fell 61 percent between 1961 and 1998. Reflecting this, male lung cancer, the leading cause of cancer death, has fallen 17 percent in the ten years from 1987 to 1997, but in the same period has risen 24 percent in women, reflecting changing smoking patterns that commenced 20 to 30 years ago.

Everyone likes to see a prodigal son return home, so a routine segment in the new series would be Jekyll and Hyde. Here much-maligned public health villains would be publicly rehabilitated. The motor car, vilified for decades for killing, maiming and polluting, would be demonstrated to have also saved an incalculably large number of lives and immeasurably improved the standards of living of billions. Next to be released from the public stocks would be the mobile phone. Smeared in recent years as a cancer-causing suspect, interviews with ambulance drivers, firemen and police would reveal how one in four mobile users have used them to call up 000, truncating the critical golden hour in emergency cases of profuse bleeding, head injury and heart attack. Mobile phones almost certainly save far more lives than they might claim through their as yet unproven contribution to rises in relatively uncommon cancers like brain cancer.

Finally, alcohol – and not just red wine – would be brought in from its health Siberia. The Australian Institute of Health and Welfare’s latest attempt to quantify national death and hospital usage from drugs showed that the net health effect of alcohol consumption in the community is now positive in the over-65 age group: more older people have heart disease prevented by their alcohol use than their livers pickled or their bodies mangled by drunk drivers. While most attention has been on wine’s health-enhancing properties, population evidence on other forms of alcohol shows that they have similar protective effects too.