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If we weren’t so busy calling a horse race, how might we cover health in the run-up to the federal election?

It’s hard to turn a corner these days without running into someone who’s unhappy about mainstream media reporting of politics, and the lack of investigation and analysis of important policy matters.

These are global concerns, however, as Professor Robert Picard, Director of Research at the Reuters Institute for the Study of Journalism at the University of Oxford, outlined in a recent address to the National Press Club (worth reading in full).

While the world suffers information overload, he said the news media industry’s collapsing business model and the commercialisation of news values has led to an “an impoverishment of in-depth reporting and analysis”.

“The economic, technical, and social changes affecting news organizations have diminished their abilities to pursue the public interest orientation that was traditionally at the hearts of their enterprises,” he said.

In a subsequent interview for the Public Interest Journalism Foundation, Professor Picard suggested that collaboration between the community sector and journalists might help enable a more useful, contextual coverage that better services the community’s needs.

On a similar note, Croakey contributors were recently asked for suggestions as to how we all might contribute to a more useful coverage of health matters in the run-up to the federal election.

Croakey will also start an Election 2013 page to catalogue useful stories and resources that might be of use for all these parties. Suggestions from readers are most welcome.

A rather lengthy Q and A with Croakey contributors follows below.

Q1. Many sectors have a responsibility when it comes to the quality of our public debate about health. How would you advise the media to approach its election coverage of health? What can journalists and media organisations do to move beyond calling the “horse race”? What are some specific investigations that you’d like to see done?

Fiona Armstrong, Climate and Health Alliance
To ask questions about what the announcements mean for the community? Are they feasible? Realistic? Warranted? Affordable? Enough? In the public interest? Will they improve the health of the community broadly? Affect specific health conditions? Save money? Be guided by evidence? Reduce expenditure? Prevent illness? Prevent enough illness? Benefit health professional over patients? Address pressing health concerns? Are they in line with national and international health goals?

Lea McInerney, writer, researcher and facilitator
What do the parties have in mind in response to the increasing evidence for the part social determinants play in everyone’s health and wellbeing?
Linked to this, how do they plan to address rising inequality in Australia?
What do they plan to do to promote better dialogue and exchange across sectors i.e. to break down the silos among healthcare and other professionals (transport, housing, community services, employment, education etc) that prevent good collaborative solutions to complex problems?

Amanda Lee, Professor, School of Public Health and Social Work & School of Exercise and Nutrition Sciences, QUT
Investigation of policy platforms re preventative health and specific questions such as “do you support continuation of the Australian National Preventative Health Agency?”

Daryl Sadgrove, Chief Executive Officer, Australasian College of Health Service Management
We MUST take a long term view. All jurisdictions in Australia will be overwhelmed by costs by 2035. We need to hold the government to account on long term, systemic and structural changes that will assist with managing demand.

Ian McAuley, Fellow of the Centre for Policy Development
Journalists should avoid being caught on trivia and ask some basic questions of politicians:

Do you care about the community’s cost of health care, or only about the government’s fiscal cost?  If you want to shift health costs off budget on to private insurance, how would you preserve equity, avoid the moral hazard of private insurance, and control bureaucratic costs?

What role do you see for price signals in health care? Or do you believe health care should be free at the point of delivery?  Memo item – private insurance is not a market mechanism – it’s a way of buying out of the discipline of price signals

Should those with their own or third party deep pockets (private insurance, cover from sport clubs etc) be able to jump the queue for scarce health resources and make queues for public hospitals longer?

If you are not in favour of a single insurer, explain why?  (“We don’t want ‘socialized medicine’” is not an answer.)

Journalists should ask of advocates:

What principles should guide the allocation of health care resources, and why?

If the health budget is constrained, what health programs should be cut to pay for your program?

Tim Senior, GP working in Aboriginal health
I’d like to see coverage of health policy not be limited to discussion of hospitals and hospital beds. It would be good to see questioning around the importance of primary care, and what election commitments there were around this. I’d also like to see this move beyond a discussion about Medicare and bulk billing rates, though I won’t hold my breath.

It would also be nice to see a distinction between health policies, which usually means policies about the health system and a discussion of the health effects of all policies. Finding the evidence behind policy commitments would also be helpful, rather than just a he said, she said argument.

I’d also like to see election health reporting look at the effect of policies on particular groups – Aboriginal and Torres Strait Islander health is a prime example where policy in Indigenous health will be made completely separately to other health policy. Finally, it would also be good to see politicians questioned about what is not in their policies, as well as what is there.

Andrew McAuliffe, Senior Director, Policy & Networks, AHHA
Perhaps a series of pieces on the lost opportunities of the National Health Reform agenda, tracking from the initial offerings of Rudd/Roxon to where we are now.  The aim of reduced blame game has become a pipe dream and the tension between states and Commonwealth are probably as bad as ever.

Jane Burns, CEO, The Young and Well Cooperative Research Centre
• Mental health policy spending and parity with health – what are the critical issues, why doesn’t it get traction

• Wellness related policy – why it doesn’t get traction and where the votes sit – including community attitudes (I.e. Kings College study) and how to create a more responsive political agenda that focuses on building the countries strengths

• Innovation in the policy debate and Australia as a potential leader in key issues like mental health, disability etc

• NBN and its role in innovation – rather than just infrastructure and what does that look like

• State vs. commonwealth issues – which is boring but impacts so significantly on families and people affected by mental illness and disability

Daniel Reeders, public health blogger and Tweeter
Ditch the notion of balance as objectivity.

Ditch the distanced stance that looks at strategy over subject matter – what Jay Rosen calls ‘the cult of savvy’.

Ditch the geek-macho stance that positions people who care more about subject matter as politically naive.

Associate Professor David Atkinson, WA
• How they envisage providing excellent local services by local people (Aboriginal Community Controlled Health Services are the only current model – but funding may be at risk), sustainable funding, improved models of corporate and clinical governance for Aboriginal health services (there are some good examples around as well as the not so good ones we hear about & or work within);

• How government run services can make a real and improving contribution when currently many are so bogged down in bureaucracy they have no capacity to respond to community needs and rarely provide culturally appropriate care; and

• How large national &/or state based programs can actually work (generally they don’t well and often are a complete waste of money).

• Medicare Locals are not the answer to any question I can think of in Aboriginal health but the opposition alternative may be to go back to State or national based mainstream funding, which would be worse.

• Aboriginal employment at all levels of the system, while not a panacea, is central to many of the changes required.  What is the situation: how many Aboriginal doctors, nurses and other health professionals and where are they working.  What proportion of the workforce and how is this changing over time (apart from doctors, where there has been a steady if inadequate increase, I suspect other areas are at best treading water.

School attendance – is 60% good enough???  What does either party actually plan to do about this (State issue I know but they talk about it).

Dr Rod MacQueen, addiction medicine physician, NSW
This is a huge issue, and it is in addressing this question that I regret the scarcity of specialist health reporters, who may better appreciate and describe the nuances and subtleties of many health issues. Even for people working in the field, there are many issues that do not have a simple or generally accepted answer. Recently, I was discussing big picture health issues with a family member who works and does research in a big teaching hospital, and it was clear that we see many issues from quite different points of view despite sharing an egalitarian world view.

Think of spending money on improving the blood pressure or lipid profile of the whole population by 5%, with a huge impact across the community but no necessary impact on an individual, and funding that by reducing the number of stents and coronary artery bypass grafts performed in hospital.

It’s not just doctor’s incomes that would be affected, those people who may benefit little from a population intervention, who already watch their weight and lipids, would possibly gain most from a stent or graft if it became necessary despite their own self care. Would they be happy with less operations? Is this fair?

The same problem applies to population weight loss efforts (when our governments reluctantly decide the issue can no longer be avoided) being funded instead of increasing numbers of gastric banding procedures.

My relative and I did agree, however, that the solution lies in accepting that there may not be a single correct approach, but failing to discuss these matters, letting big funding decisions be made in secret, and failing to monitor the outcomes on any decisions, will lead (indeed, has lead) to the worst outcomes, where more is spent to achieve less and errors are repeated over and over.

The process we support is science, that which has given us vaccination, sewage and clean water, good nutrition and so on. And science is not laboratory stuff or new iToys in the end, it is the community of people who fearlessly and openly publish and share ideas, thoughts, questions, insights, even if they are later shown to be partial truths or even wrong.

Perhaps creeping managerialism with its fear of uncertainty and risk has scared many away?

A specific investigation I would like to see is this – why are our policies on personal drug use still substantially unchanged from the 1970s? Why is an open discussion on cannabis decriminalisation impossible despite the evidence that the current laws may do more harm than the drug, for example? Where is the agitation to restart the ACT heroin trial, a scientific trial that would answer some Big Questions, which we nearly had in 1997 – that’s 16 years ago and opioid misuse and related deaths have not gone away. And why is it a 5 minute job to get some opioid (heroin, oxycodone, morphine, fentanyl patches) to inject but almost impossible to get started on methadone or buprenorphine, both of which are 1960s technology? What about meth/bup 3.2, where any appropriate person can visit any chemist and get their medication daily using a smart card, instead of queuing for hours every day in the one dismal but needlessly expensive clinic, then being told they have to get out more and get a job so they can “recover”?

Our public debate on this issue is either non existent, or even back to the shock-horror stuff of the Reefer Madness days. But these health problems have not gone away.

Vern Hughes, National Campaign for Consumer-Centred Health Care
The political debate about health care and health reform in Australia is appalling. It is dominated by industry interests, with political parties championing their preferred industry groups (the Coalition backs private sector providers and insurers, Labor backs public sector providers and their workforce unions).

Consumers are absent, not backed by either side.

The media reports the contest between public and private providers, and reproduces the exclusion of consumers and consumer interests from the public arena.

Will the eight month 2013 election campaign be any different?

The short answer is no, unless there is a concerted effort by citizens and consumer organizations to break the duopoly of industry interests that have a stranglehold over the public discussion. This is not easy, because the industry duopoly is buttressed by the political party duopoly, and consumer and community interests are outsiders, external to this deep-seated binary structure.

But breaking this structure is essential for health reform. Three things should be pushed throughout 2013 in trying to shift media reporting on health care away from captivity to industry interests:

First, journalists should be encouraged to probe and report on the private and public sector industry interests that lie behind the various health industry interventions in this year’s campaign.

Health insurers have financial interests in subsidies and rebates that are unrelated to health outcomes. Quantify them.

Medicare Locals have financial and professional interests in the preservation of Medicare Locals, which are structurally disconnected from health outcomes. Quantify the numbers and absence of correlation with health outcomes.

Medical specialists ride a gravy train through public hospitals, milking duplications in function. Quantify it.

Bureaucrats, not consumers, are the primary beneficiaries from hospital networks, primary care partnerships and service coordination alliances. Quantify the bureaucratization and probe the absence on impact on the consumer experience of care.

Second, investigate and report on the funding of health industry peak bodies. Question why taxpayers money props up professional associations of medical and allied health specialists, and industry lobby groups.  When a Communications Manager for a health industry peak (private or public sector) holds a press conference, ask them if their position is funded by health consumers (taxpayers) and why.

Third, treat hospitals as one part of the health system, and a minor part at that. The main business of health care happens at home and in communities. Examine the world-wide trend towards individualized funding and self-directed services in disability, aged care and mental health so that consumers in these situations can self-manage their support at home and in communities.

Then ask why all industry peaks (private and public) are dragging their feet on introducing individualized care packages in chronic illness, maternity care, palliative care, drug and alcohol rehabilitation and mental health.”

Dr Sue Page, GP, academic, and rural health advocate, NSW
Please understand that hospital wait times are not a federal issue so please ignore calls from “Prof Whatever” from “BigCityTeachingHospital” who wants to talk about the usual orthopaedics, ophthalmology, Emergency Dept and overall “bed block”, otherwise known as inefficient use of resources and mismanaged supply & demand.

This election is a chance to look at community based health services which is where 99% of health care takes place each year.

Yes, you will need to cultivate spokespeople outside your comfort zone like physios, dietitions, social workers, pharmacists and, god forbid, GPs.

Try to remember that GPs earned the same HSC and Med school grades, attended the same hospitals as new grads, and didn’t become stupid overnight when they chose to keep doing it all instead of restricting their practice to just one field. Oh, and they don’t all have to be rural so ask around your local area to see what is needed and look at things like private health fund and MBS spend per capita inequities by suburb.

Other ideas for investigations:

• Why are we afraid of capitation? How influenced are we by the UK? Are the reasons different in hospital versus community sector? Why don’t we allocate tax payer resources per capita wei