There’s an interesting analysis at Crikey today about the implications of Dr Andrew Pesce’s election as AMA president.
I wish I’d read it before giving a talk to health policy students at the ANU yesterday about lobby groups in health. Of course, you always end up preparing for these things at the last moment, generally late at night when the brain is frying rather than firing. I’ve already thought of some groups I should have mentioned but didn’t.
But here’s a quick summary of the talk anyway. Please add your additions and suggestions.
Lobby groups: professional
• The AMA is often called “the nation’s most powerful lobby group”, most recently in the SMH’s recent article previewing the presidential elections. Whether or not that is actually true is incidental, perception being reality. It’s who many journalists ring for comment on just about any development in health, whether or not the AMA spokesman actually has expertise in that area.
• The Pharmacy Guild. Their lobbying style is quite different to the AMA’s, as they operate largely behind closed doors and build their efforts around putting proposals and submissions into government. The national president Kos Sclavos once told me “we have more health economists than any other health group in Australia”. As well as 250 staff. But the real force is the reach of community pharmacy; it’s hard to think of a health professional with easier access to the community if governments get up their noses.
• Other professional and industrial organisations, ANF etc etc.
• There are also medical research institutes, but again their interests do not necessarily align with the broader public interest – often they are so reliant on industry funding, they are reluctant to speak up if it rocks the apple cart.
Lobby groups: business
• Pharma is the most obvious. Generally they do a very good job of influencing media coverage of their products, but often this is through third parties, so may not be obvious to a casual observer. As an industry, their image has taken a big hit in recent years.
• Other medical industries, eg surgical and devices companies
• Complementary products sector is big business despite the general public often viewing them as the ‘goodies’ (for some strange reason)
• Private health insurance lobby has to be judged one of the most successful, given the level of government support they receive despite widespread doubts about the value and merits of their product. Private hospitals also seem to do pretty well.
There is often a convergence between many professional and commercial lobby groups’ interests; for example, pharmacists flogging“non evidence based products”, and eminent medical experts and institutions lending their names and authority to marketing campaigns (see the Crikey Register of Influence for specifics)
• The un-health lobby groups – tobacco, alcohol, and food industries, to name just a few. They arguably have more influence over the community’s health than those described above.
So who represents the public interest?
This is a much tougher question to answer, though many may claim they do.
• Disease-based lobbies. The problem is that they are often narrowly focused and encourage the silo mentality that plagues health. Such groups are sometimes unduly influenced by commercial or professional interests.
• Patient groups. Again they are often focused around single issues and some, eg breast cancer, get more attention than others. Even those umbrella groups such as the Consumers Health Forum are representing their members’ interests, ie patients and that is not necessarily the same as the broader public interest.
• Groups such as the Public Health Association and CHOICE are attempting to represent the public health interest, but do not necessarily represent the broader community’s views.
Who represents those in greatest need, whether underserved groups such as Indigenous Australians or underserved issues such as the social and economic determinants of health?
Groups working in this area tend to be over-stretched and under-resourced. They are minnows compared to some of the sharks above.
The conclusion from all this is that much lobbying serves to reinforce the status quo in which society’s institutions, including government, tend to operate for the benefit of the well to do. More and better advocates are needed to agitate on behalf of the public interest in health, and especially on behalf of those in greatest need.
But as I said, this was all thought through late at night and in a great rush – it would be nice to hear others’ thoughts on these issues.
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Your talk sounds really interesting! How about some of the public health groups, such as the Quit campaigns? In my experience (in government as well as opposition) they can be very influential in their area of expertise. Also, I think it’s important to acknowledge that DoHA, while not a lobby group as such, can also play an important role in influencing government policy – contrary to the view the bureaucracy often likes to paint of itself as simply implementing Ministerial decisions.
Don’t forget the role of unions in terms of OH&S in the workplace; they can be ahead of the curve sometimes – eg: pushing for an investigation into the impact of nanoparticles on health. And let’s not forget asbestos and health and safety measures that we now take for granted.
There is a strong health consumer movement that works hard to present the broader consumer perspective on health care. The Consumers Health Forum is one such organisation but there are a number of state based organisations also.
In the ACT the Health Care Consumers’ Association (HCCA) has been working to present an informed consumer persepctive on health services for more than thirty years. HCCA is a body through which health care consumers can participate in policy, planning and service decisions that affect their health. We work to improve the quality and availability of health services, supports consumers to identify shared priorities about health, and represent these views to the ACT Government. While many of our members are consumers who have specific health issues, we advocate from the broader consumer perspective in order to develop and sustain services that are responsive, respectful, accessible and affordable to all.
The consumer movement has a strong interest in the safety and quality of health services and we work with health departments, academics, colleges, registration boards, accreditation agencies and other organisations to improve services.
It is our experience of the health services that is our strength: consumer organisations have learned to identify the system issues from individual experience.
Look back to the successes of the AIDS lobby in the 80s who took no prisoners. Bold as brass. And then in the same era was BUGAUP – Billboards Utilising Graffiti Against Unhealthy Products. Groups of motivated young doctors & others defacing tobacco hoardings in the dead of night with anti tobacco messages. Today we are a little too ‘whitebread’. Professionals talking to professionals in measured tones trying to score points. Perhaps we need some more bare knuckles though the previous President of the AMA (Australia’s most influential Union) may not have been the best example.
Thanks everyone for your comments (which I shall borrow if ever asked to do this presentation again). And Clive, I couldn’t agree more about the “whitebread” element. I so often find, when interviewing people for stories, that they are reluctant to say what they really think about issues on the record for fear of upsetting bureaucrats, colleagues, Ministers’ offices, potential funders etc. Even worse, sometimes they will say one thing off the record, and then mouth a completely opposing view in their official press release. I can count on two hands (or maybe one) the number of contacts I have who I feel confident will “tell it as they really see it” and be prepared to put their names to it. No wonder so much of our public debate is dishonest and unproductive. That has to feed through into policy.