Mike Daube, Professor of Health Policy at Curtin University, and other public health experts have been sounding the alarm about the Queensland Government’s efforts to gag health and community organisations and stop them from engaging in advocacy.
But according to Naomi Eisenstadt, a Senior Research Fellow at Oxford University, such constraints are not uncommon in times of austerity even if there is no official gag order, and many organisations have found that when funding gets tight, it can be harder to bite the hand that feeds you.
In the article below, first published by the VCOSS magazine, Insight, she describes the risks for the community sector in tough times – and offers some tips for how to maintain both influence and integrity.
Much of her advice is also pertinent for the public health sector and those working for evidence-informed policy more broadly. One of her suggestions is to use data in ways that do not reinforce prejudices or mislead – and she gives an example about the importance of using absolute risk data rather than simply relative risk estimates.
Interestingly, a recent review, published in the BMJ by Canadian researchers, suggests that most studies investigating health inequalities fail to do this.
The researchers found:
In our sample of 10 leading medical and public health journals, three quarters of all articles reported only relative measures of effect of social inequalities on health, and roughly half of these provided no information on absolute baseline risks. Despite widespread agreement that it is a best practice for reporting, only 7% of all articles reported both absolute and relative effect measures in the full text….Health inequalities are most commonly reported using only relative measures of effect, which may influence readers’ judgments of the magnitude, direction, significance, and implications of reported health inequalities…Following existing recommendations by reporting both absolute and relative measures will increase transparency, reduce systematic reporting biases, and improve the evidence base for policies aimed at reducing health inequalities.
****
How to maintain influence and integrity in times of austerity
Naomi Eisenstadt writes:
The role of the community sector has been evolving over time both in the United Kingdom and in Australia. Tensions have always existed between the sector and government and those tensions are often productive.
But more recently the very tight financial constraints in place in the UK have brought to the fore some of the key dilemmas facing a sector that wants to be both a provider of state services and a thorn in the flesh of the state; a sector that on the one hand wants a bigger role to play, while still having serious concerns about a shrinking state, even if that means an enlarged community sector.
So, what is actually happening at local level in Britain to community organisations? Both small and large voluntary bodies are facing big cuts to their funding.
Local authorities were encouraged by the previous Labour Government and the current Coalition Government to contract out their services to community organisations. There were three arguments in favour of such arrangements: they encouraged a diversity of providers, giving service users more choice; community organisations could be more innovative, demonstrating new ways of service delivery; and they were seen to be more responsive to their users than state provided services.
However, the downside to these presumed benefits is the ease with which funding can be reduced or cut all together. If a local government organisation wants to save money, they face the costs of redundancies to their own staff, and often the fury of local service users. Cutting an organisation for which there is a contractual relationship is considerably easier, and cheaper, and often politically safer than cutting directly provided services.
A period of substantial cuts to community organisations poses a number of dangers. The most obvious one is a loss of often well-used and highly regarded services. In Britain, this is already being felt, particularly among youth services which have been hard hit. Moreover, changes to benefit entitlements and rising unemployment are causing increased demand for the very services that are being cut, both in the statutory and voluntary sectors.
But the most serious risk is that the role of campaigning and advocacy also comes under threat in times of austerity. Organisations that both campaign and provide direct services will be more cautious about publicly criticising the government if they fear loss of income.
Organisations will become more inward looking, more competitive and less likely to collaborate as times get increasingly tough. Precisely when service users could benefit from stronger advocacy and better coordination of services, both the public and community sectors will be closing ranks and protecting their own existence. In Britain the private sector is offering to do more for less, a tempting prospect for cash strapped local authorities.
The danger is that an environment of funding threats will reduce the willingness of community organisations to actively campaign on the part of their beneficiaries. Fear of loss of funding may make service-providing organisations more risk averse in their advocacy activities.
How should the sector respond in these difficult times?
Having worked for many years both in non government organisations and as a public servant, I know how critically important it is to foster effective relationships with government. This is particularly difficult in Australia, given the federal and state structures, and, as is currently the case, given the challenges presented when power is held by different parties at different levels.
Balancing the need to maintain positive relationships so that influence is possible with the need to be seen to be speaking up for the rights and needs of members and service users is always difficult.
Below are some tips on how community organisations can maintain both influence and integrity.
1. Avoid the temptation to whinge about funding. I attend many ‘round table’ events, consultations, and conferences with Ministers present. Invariably organisations will complain about their own funding. This sounds to public servants and politicians like special pleading, and a stronger concern for the organisation rather than the issues which affect beneficiaries. I have never seen this tactic to be effective. Particularly when money is very tight, it is likely to irritate more than influence, and will also irritate community sector partners in the room who did not get their whinge in first.
2. No matter how difficult, try to find something that state or federal government is doing well for your beneficiaries. It sounds basic, but try not to treat individuals as if they neither understand nor care. This may be true, but it is not likely to win friends or influence policy.
3. In consultation with beneficiaries, choose the two or three really critical issues, and fight hardest on those issues. Make sure these are the issues that really affect users. For example, disability charities successfully argue for better car parking facilities; they don’t build car parks.
4. If possible, find common cause with other organisations. Government is more likely to listen to a range of groups making similar arguments, particularly if they are accompanied with real case studies that illustrate the problem. Try very hard to privately agree on policy lines and stick to them. Ministers love it when the charities themselves can’t agree on a way forward.
5. Related to the above, if possible, try to provide solutions that address what the government is concerned with as well as what will help your cause. This is particularly effective with public servants who will want to find solutions that politicians can accept.
6. Along with case studies, use data in ways that promote the cause but do not reinforce prejudices. There is always a temptation to exaggerate the problem or to present accurate data in ways that mislead. A classic one is that children from disadvantaged backgrounds are ten times more likely to be in trouble with the police than the general population. This implies that most children from troubled backgrounds are involved in criminality. In fact it is 10 per cent of children, versus one per cent of the general population. Using data can stigmatise precisely the groups an organisation is in business to support. It is unethical even if it is successful at raising funds.
Australia seems to have weathered the economic storm engulfing Europe and the US. In the UK we are facing very tough times, and our ability to mitigate the impact on the most vulnerable is severely tested.
The community sector has a crucial role to play as long as it argues the case for its beneficiaries and not for itself.
• Naomi Eisenstadt is the former Director of the United Kingdom Social Exclusion Task Force and is now a Senior Research Fellow at Oxford University. She was keynote speaker at VCOSS’s 2011 Congress.
