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After the election, where next for better health?

The Croakey News team writes:

For those who have been listening, the clear message from many health advocates in the months and years leading up to the 2019 federal election was that transformative changes are needed across many domains to tackle wide-ranging health concerns.

“Business as usual” will do little to address important determinants of health and health inequities, such as poverty, housing and food insecurity, and the over-incarceration of Aboriginal and Torres Strait Island people and related high rates of removal of children into out-of-home care.

And “more of the same” when it comes to climate-related policies – whether in the agriculture, transport, health, energy, social services and financial sectors, or any other area affecting our lives – is nothing less than catastrophic.

And, yet, that is exactly where we find ourselves in the wake of an election result that only a diehard Liberal National Party supporter, climate science denier (or Murdoch newspaper) could argue is good for the community’s health and wellbeing.

As many commentators have observed, the LNP Coalition was elected on the back of a fear campaign rather than because of a detailed policy agenda or a vision for a better future for all.

Just to recap, below are some of the key health-related policies that differentiated Labor from the LNP.

Other plans that could be added to this list include 250,000 new affordable rental properties over 10 years, and a fairer tax system.

If the LNP’s track record and election promises are any guide, we cannot expect the Government to take positive action in these areas – though it would be good to be proven wrong.

Perhaps Scott Morrison might take some advice from his colleague, Senator Arthur Sinodinos, about addressing the community’s concerns about climate change and out of pocket healthcare costs?

Labor’s policies were far from perfect.

Regular Croakey readers will know that we have published many articles critiquing Labor’s policies, in particular its reluctance to support the human rights and health of asylum seekers and refugees, to take on the powerful private health insurance industry, to commit to much greater investment in prevention, and to abandon harmful social policies such as income management.

Our compilation of health election scorecards made it clear that a number of groups rated many of the Greens’ health-related policies higher than Labor’s.

It’s a safe bet, however, that many voters would not have been aware of these assessments given the sorry state of so much media reporting of health issues, as well as systemic problems in the wider media landscape.

On the climate crisis, Labor fell far short of the mark, especially with its support for coal mining and fracking.

The call by the Greens to get fossil fuel funds out of politics is relevant to many wider public health concerns, including the need for more effective regulation of disease-promoting industries more generally.

Questions for health advocates

The election outcome raises questions about the impact of the health sector’s advocacy in the lead up to 18 May and more generally.

As Croakey editor Jennifer Doggett states:

What I find challenging is all the commentary around the fact that the LNP’s ‘small target, negative’ campaign trumped Labor’s ‘big ideas – policy focussed’ campaign.

It may well be true that policies and ideas don’t win elections but it’s challenging for advocacy groups who deal in ideas and policies and try to use them to influence change.

What does it say about the influence of the health sector when almost every single group rated Labor and the Greens as unequivocally better than the Coalition on pretty much every aspect of health policy?

Are we just talking to ourselves?

Are we so out of step with what the community wants that we are just irrelevant?

Or are we reflecting some consumer priorities and concerns but just not communicating them well enough or in the right way to be effective?”

Likewise, many of us in the Croakey team are struggling with a narrative that seems to have emerged in the mainstream media (and within Labor’s ranks too) suggesting one of the reasons Labor got into trouble is because its policies were too bold.

On the contrary: given the immensity of the challenges presented by the climate crisis, Labor’s vision was nowhere near bold enough for what the times demand. And a vision is of little use, if it can’t be clearly and powerfully communicated.

Doggett says:

Also challenging is the idea that Labor’s election agenda was some sort of radical paradigm-shifting vision – I think most of us would probably agree that while Labor was a country mile ahead of the LNP, in the scheme of things their policies were pretty ’small idea, fiddling around the edges’ sort of changes.

So what does this mean for the really big changes that most of us want to see? Such as ending private health insurance subsidies, moving away from fee for service healthcare, a social determinants approach to health etc?

Are these even worth pursuing given that even Labor’s baby steps in this direction were too big a target apparently?

Do we just need to wait until there is a major crisis before putting forward some better options as this is the only environment in which people are prepared to try something new?”

Doing the numbers

Croakey editor Dr Mark Ragg also suggested that the implications for progressive policy longer term are discouraging:

There are two real concerns from this election, apart from the unhappy result and the likely harshness of the next three years.

One is that only 44 percent of the population voted for the progressive side of politics, according to the latest count of the primary vote – predominantly ALP and Greens, but with small numbers supporting groups like Sustainable Australia, the Victorian Socialists and the Australian Progressives.

About 56 percent voted broadly conservative for the major parties, for centre-right groups like Centre Alliance, for independents, most of whom lean right, and for parties like One Nation and Katter’s Australia party.

It’s not even close. For the progressive side of politics to win an election, either the electorate has to move a long way to the left, or the progressives have to drift quite a way to the right. The latter is more likely than the former.

The other arises from the perception that a strong policy platform is too risky – a small target is the way to get elected. We had small targets for years with people like Kim Beazley and Simon Crean leading the ALP, and they were virtually indistinguishable from their opponents.

This was the first election for some time where progressives could really see a difference between the major parties. But the fact that there was a difference is now seen as the reason the ALP went down.

It’s going to be hard for progressives to have the guts to lay out clear policies in the future.”

Smarter, more focused advocacy

Croakey contributing editor Dr Megan Williams expects the election outcome means bad news for many determinants of Aboriginal and Torres Strait Islander health.

The incarceration of Aboriginal and Torres Strait Islander people will continue as a major public health concern, at the same time as there being further erosion of community control in the law and justice space.

The Federal Government’s lack of attention to prevention generally and a dearth of new initiatives in family assistance programs are also important concerns, given Aboriginal and Torres Strait Islander populations are so young.

Williams says:

All public health professionals in this country should get into the position where they feel confident discussing issues that matter for Indigenous health, rather than worrying they can’t speak up in case they say the wrong thing.

I’d encourage all public health professionals to use the socio-ecological model and push their organisations to address the underlying determinants of health, rather than focus on individual risk factors.”

For Croakey contributing editor Dr Tim Senior, inspiration can be taken from a public health physician from Scotland, Sir Harry Burns, who urges health advocates to act locally rather than wait for governments to lead (see this recent report from the National Rural Health Conference).

Senior says:

Now is the time for us to act in our local areas on social determinants – to not call it social determinants, but to act on food security, on housing.

To identify local needs and solve them imaginatively locally. To be the people who care, who are on the phone to their MP, who are in the protests, who are consistently helping, to be the citizens with a shared future, not the self-interested economic units the government tell us we are.”

Likewise, as Croakey contributing editor Dr Lesley Russell has written:

The hard work of driving needed health and healthcare reforms will now only be possible at the community level … It can be done – because it already is.

The individuals and organisations involved in these innovative initiatives (and those who support them) must now shoulder an additional burden – to publicise and proselytise their work, to make sure it is evaluated and costed, and to work with peers and colleagues to expand such innovations.

There is a role here for public interest journalism (like Croakey) to make sure these good news stories are told and recognised and rewarded.”

Media accountability?

Media practices were a key determinant of the election outcome, not only because of News Corp’s bias, the often uncontested spread of disinformation, Clive Palmer’s advertising onslaught, and narratives that often reduced the election to a popularity pageant rather than a contest of ideas or principles.

The crisis in public interest journalism and a low level of climate literacy and health literacy amongst even senior journalists left many communities, especially in regional Australia, poorly served in the run up to the election.

Croakey editor Marie McInerney queries whether many rural and regional voters were able to consider the differences between LNP and Labor policies for their communities, in areas ranging from climate change to health, education, renewable energy jobs, refugee settlement programs and media policy.

She says:

That can’t happen without deep and wide local journalism across rural and regional Australia, from independent and informed local media and a well-funded ABC.

Yet the Nationals Leader Michael McCormack – a former editor of the Wagga Wagga Daily Advertiser – spoke just before the election to the National Press Club and didn’t raise concerns about declining rural and regional media coverage.

Former Nationals Leader Tim Fischer’s solution for amplifying rural and regional voices just before the election was not media reform and restoring ABC funding, but media training for Nationals MPs.”

Croakey editor Amy Coopes added:

Despite making reams of headlines and social media traffic in the lead-up to and during the campaign, water rights — a climate and environmental issue as much as a corruption one — appears not to have registered.

While the media discourse around climate and the environment seems to have intensified during this election cycle (though the tenor of it still threaded with false-balance skepticism), and there was all this talk about a ‘climate election’, this still seems like a low to zero priority with the majority of voters.”

Croakey editor Dr Ruth Armstrong has considered the election’s challenges to “people like us” at Croakey.

She says:

Many of us who work in health advocacy live in communities, and come from demographics, that are more likely to embrace reforms such as those proposed by the Labor party, than others.

We write, we read each other’s work, and fail to realise that these ideas are not progressing too far outside our ‘virtuous circle’.

If Croakey really is participatory action journalism we need to get out there and find the hard stories that don’t have neat, academic solutions.

We need to talk to people about what it is that they value and want, listen to and amplify their answers, and find ways to make the big ideas of health and social policy relevant and implementable.”

Searching for metaphors

Policy making is often described as like sausage making and no doubt there is some similar evocative metaphor for how elections are won and lost (suggestions, anyone?).

In conclusion, we offer a few takeaway thoughts. If a “public health” definition of health literacy includes “the degree to which individuals and groups can obtain, process, understand, evaluate, and act on information needed to make public health decisions that benefit the community”, then there is much work to do on this front.

Listening to communities about their concerns and what influenced their voting choices is critical for the health advocacy that is needed, now more than ever.

And, more than ever, health advocacy must be creative, collaborative, disruptive, determined, engaging, persuasive, persistent, and courageous.

As we’ve already pointed out, Aboriginal and Torres Strait Islander people and organisations have a long history of leading the way when it comes to advocacy and fighting for justice.

As intimated by the quotes below from film maker Damon Gameau, health advocates must focus on solutions, be driven by a concern and a vision for the future, and speak and act collectively.

Gameau has spent the last three years making a film called 2040, which he describes as “a visual letter to my daughter showing her what the world could look like that year if we put into practice some of the best solutions that exist today”.

It highlights “what we can fight for rather than fight against”, he writes in The Guardian. He adds:

Determination and passion are the most important renewable energy resources we have.

People working together with a common goal will shift vested interests and make implementing the solutions possible.”

• This article is published on behalf of the Croakey social journalism team. Contributors are: Dr Ruth Armstrong, Amy Coopes, Jennifer Doggett, Summer May Finlay, Marie McInerney, Dr Mark Ragg, Dr Lesley Russell, Dr Tim Senior, Dr Melissa Sweet, Mitchell Ward, and Dr Megan Williams.

Croakey published 59 stories in the lead up to the election. Check them out.

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