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How to work with the new government: some practical advice from former Health Minister Nicola Roxon

Former Federal Health Minister Nicola Roxon was guest speaker at the Public Health Association of Australia conference dinner in Melbourne last night, and had plenty of practical advice for public health advocates.

As Marie McInerney reports below, the former Minister believes “there are opportunities with any new government”, and advised developing relationships with as many potential political allies as possible, including prospective Australian Sports Party Senator Wayne Dropulich.

With Health Minister Peter Dutton and junior Minister Fiona Nash to be sworn into the Ministry today, Roxon said there were “great opportunities in the early days to be talking to and befriending them before you present them with a big list of demands.”

And at the bottom of the post, public health leaders analyse the likely impact of the end of the ministries for mental health, Indigenous health, disabilities and aged care.

***

Focus on alcohol and obesity, urges Roxon

Marie McInerney writes:

Former Labor Health Minister Nicola Roxon has advised public health advocates that action on alcohol and obesity may be their best opportunities to capture interest and support from the new Coalition Government.

She said initiatives to address alcohol issues in Indigenous communities could particularly engage Prime Minister Tony Abbott and would lead to a wider impact on the social determinants of health.

Proposals to curb obesity through tougher controls on processed foods or sugary drinks could also appeal to a new Government wanting to shape a broad health agenda.

Roxon told PHAA members that she was very proud of her role in securing plain packaging for tobacco products.

Whether or not other countries followed suit, she said the move – made possible by the work over decades by groups like the PHAA – had rallied tobacco control advocates around the world to know they could take on tobacco companies and win.

While she didn’t expect the new Coalition Government to take up the baton on further action, she did not believe it would back away from existing reforms. Still, she said, advocates should keep up the scrutiny and pressure to make sure changes were “bedded down”.

She was not so optimistic about the future of the Australian National Preventive Health Agency under the Coalition.

She said: “I don’t have very high hopes for its survival but I think its work has been really first class and I think we need to make sure we don’t go backwards from that, and use the work that’s been done as a launching pad for other things and where possible keep its influence continuing.”

Setting the agenda

Roxon said she had questioned the value in having a “former politician” speak at last night’s event. What she could offer – albeit, she noted, to a room of seasoned advocates – was insights on how decisions are made and priorities shaped.

“Some people here have said they’re a bit despondent about the next few years. I actually think that’s a misjudgement. There is opportunity to be had with any new government.”

The former Minister advised public health advocates to develop relationships with as many potential political allies as possible, including prospective Australian Sports Party Senator Wayne Dropulich.

“I think there is a risk for people to be dismissive about him because of the way the election process works. But you get a Senator who has a particular platform that aligns with your issues – if you guys don’t jump on them fast, you’re mad.”

Alcohol reform

Laying out areas where public health advocates could focus their campaigning, Roxon said alcohol was an increasingly pressing problem in Australia and arguments about the broader social harm it causes could shift debate. That had happened with tobacco control, she said, when evidence grew about the harm caused not just to smokers but others through passive smoking.

She said: “If I was in a new Government, a Prime Minister with a longstanding commitment to Indigenous health, I’d be looking at which preventative health measures would have a particular benefit in Indigenous communities but would not be just limited to them.

“I think alcohol is a prime example; I think the floor price is probably the best example, but I think you’ll have many others to talk about: foetal alcohol syndrome, low alcohol products, maybe the tax regime with some option for that.”

The new Prime Minister had made it clear, she said, he wanted a role in social policy.

She said: “For someone who hasn’t been particularly active in the social policy space, for him it’s Indigenous communities and for you that’s a big opportunity because so many of the social determinants of health and pressures that are similar across the country are magnified time and time again in Indigenous communities. It might be a really interesting time to find a way into that.”

Obesity challenge

Roxon had found frustrating the lack of a “clear message” from health advocates on what should be done on addressing rising obesity rates in Australia.

That lack of clarity was understandable, she said, given the complexity of the issue, but it had been “much easier” for the government to decide what to do next with tobacco when the messages were around “no amount of tobacco is safe” and on the need to stop young people becoming addicted.

She said: “In obesity…it makes it hard for a government to decide that will be their key thing without there being a much more focused ask from the broad coalition of people. Highly processed foods is obviously a good catch-call, we know we could have a good impact with sugary drinks….”

With the new Prime Minister’s passion for exercise and with Health and Sport combined in one ministry, Roxon noted a little wryly there was “an outside chance that a sport/healthy living/exercise regime” might take a bigger focus under the Coalition Government.

Advocacy action

With Health Minister Peter Dutton and junior Minister Fiona Nash to be sworn into the Ministry today, Roxon said there were “great opportunities in early days to be talking to and befriending them before you present them with a big list of demands.”

Dealing with constant requests for funding and decisions was overwhelming, she said. That could make some of the relatively modest asks in public health “extremely attractive”. It would also be strategic to have “on your lists” asks that were regulatory and without cost, and to find big bold ideas to capture the new Minister’s imagination that could be advanced through smaller steps.

But public health should not focus its attention solely on the new Ministers, she said. It should think to who the future leaders and influencers may be: Opposition spokespeople, backbenchers on both sides, committee heads.

Advocates should also listen to new MPs’ maiden speeches for insights: about someone’s sister who died in a binge drinking incident, or a mother from cancer, or of their work for the Royal Flying Doctors Service.

“Unlikely people become your allies and often the only time you hear them talking about (something pivotal), it is in their first speech,” she said.

On public health advocacy

Roxon hailed the work done by public health advocates like the PHAA over decades in Australia, particularly in building the case on tobacco control. “I look at the things I am proud at having been able to do in government – most of them were the ones you suggested.”

She had also been proud last year to be chosen as the PHAA’s Sidney Sax Public Health medallist for outstanding public health work. ‘When people in my new life say send me a CV…that Sidney Sax Medal is very high on the list,’ she said.

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Some Twitter take-homes…

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What are the health implications of the streamlining of portfolios?

Public health leaders spoke to Croakey about working with the new Government and concerns about changes to a range of portfolios in the new Abbott Ministry, particularly the loss of individual portfolios in mental health, Indigenous health, disability and aged care.

PHAA CEO Michael Moore

“First of all, we are able to work with whoever is in government. I’ve had many meetings with (Health Minister) Dutton, and I look forward to working with him. It is a concern that there is only one woman in Cabinet and there has been much comment on that. I’m also disappointed that areas like aged care and disability, which are just so important, aren’t right up there. We have an ageing population, and the health, economic and broad societal ramifications of that are just so important that to not have them there is, I think, a fundamental oversight.

I understand where Prime Minister Abbott is coming from, to have more efficient (Ministry) titles….but the way we describe things, our language, is really important. If you don’t have something upfront, it tends to drop off the discourse. We simply can’t have ageing, disability, mental health, Indigenous health dropping off the discourse.”

Fran Baum, Professor of Public Health and Director of the Southgate Institute of Health, Flinders University

“I’m not a great believer in structures driving policies generally. You could have a Mental Health Ministry and it might not do good stuff anyway; for me, structures are only a very small part of the story, it’s whether or not you can open up policy spaces.

I’d be surprised if they did not have some focus on mental health. (On having mental health as part of the bigger Health portfolio), it’s an interesting one. I worry when we try to separate mental health from physical health because there’s such an overlap, so I think there needs to be more integration. What worries me most is (the lack of) response to the social determinants of health….I don’t think Labor had really risen to that either but I haven’t seen any evidence of serious interest in Coalition policies.”

Vanessa Lee, conference session chair, PhD Candidate, University of Sydney

“I think at the moment it’s about ‘watch this space’. There are big issues at the moment in the reduction of funding for health promotion reaching communities that has made such an impact on people’s health and well-being. When you’re talking about ‘closing the gap’, where are people going to find employment, which leads to housing, food, shelter?

It’s not a question of what the Ministries are, it’s a question of will they actually listen to communities and involve Aboriginal and Torres Strait Islander health experts in the process.

When I addressed Parliament on the Stronger Futures in the Northern Territory Bill, it was the Liberal MPs who asked me what was community governance and why was it so important. Let’s hope they listened to my answers.”

PHAA Victoria President Bruce Bolam

Speaking at the conference dinner last night, Bolam referred to the report A new way to talk about the social determinants of health published in the US by the Robert Johnson Wood Foundation, which looked at the different lenses through which Republicans and Democrats see health issues. This could guide public health advocates with the Coalition, he said.

“The lens we apply when speaking with the community and with politicians has to resonate with them. We have to recognise that issues of equity, if they are to be taken seriously, have to be understood as fundamentally non-political issues, as issues….all right-minded people will consider as important, justifiable, preventable.”

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A shaky start?

Meanwhile, over at Inside Story, health policy analyst Dr Lesley Russell highlights the separation of aged care from health, and says the new government has already indicated that “its focus will be more on the financial health of providers than on the health of the elderly – it will relax aged-care regulations and eliminate red tape, allow longer for accreditation, and claw back $1.2 billion that Labor had allocated for pay rises for aged-care workers.”

She notes that  seniors groups have attacked these moves, arguing that they will worsen the current crisis in aged care.

The Coalition’s health policies suggest we are looking at a case of  “back to the future.” Russell says:

“At a time when new ways are needed to deliver and pay for healthcare services – a health-in-all-policies approach, doing prevention better, tackling health inequalities and putting empowered patients at the heart of the healthcare system – Australia is headed back to the ideas of last century. The focus is on hospitals and acute care, boosting the profits of the pharmaceutical industry and private health insurers, and more doctors and nurses. The title of the Coalition’s policy says it all – it’s about supporting the health system, not about supporting patients.”

Russell says that in the absence of new policies, the real issue will be whether the new government will build on the reforms already under way, tear them down, or leave them languishing for lack of attention and resources. She predicts that the 2014–15 budget should make “interesting reading”.

• You can track all of Croakey’s #PHAA2013 coverage here.