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Is the new National Preventive Health Agency facing bureaucratic capture?

Is the Federal Department of Health and Ageing trying to muscle in on the new Australian National Preventive Health Agency?

Margo Saunders, a public health policy consultant based in Canberra, investigates…

Discontented rumblings from public health advocates suggest that questions about the form and direction of the Australian Government’s commitment to preventive health extend beyond the nitty-gritty of diabetes care plans and Medicare Locals.

At stake is the credibility and independence of the Australian National Preventive Health Agency (ANPHA).  The ANPHA was specifically set up as a statutory agency distinct from the siloed structure of the Australian Department of Health and Ageing (DoHA), with a CEO who reports directly to the Minister.

However, concerns have emerged which suggest that DoHA, which is overseeing the formation of the new agency, may be finding it difficult to resist the temptation to retain control.

An Agency Establishment Section has existed for some time within DoHA’s Population Health Division, and Division staff were given the final time-frame at a recent meeting: the ANHPA is to be up and running by 1 January 2011.

This is an extraordinarily short time in anyone’s book, given that the legislation was only passed on 17 November 2010.

To meet this deadline, DoHA staff will be invited to submit expressions of interest for positions with the Agency, with an external recruitment process to follow.

While the DoHA-orchestrated process could be interpreted as a Department’s conscientious efforts to deliver on a Government commitment, especially where legislative delays have resulted in significant time pressures, some insiders interpret it as a deliberate attempt by DoHA Secretary Jane Halton to retain control and to ensure that key positions are filled by those with DoHA allegiances.

An early jostling for position may be understandable, given the confusion and lack of clarity that many inside and outside of DoHA believe currently exist about the functions and roles, particularly in terms of the carve-up of responsibilities for prevention-related policies and programs.

This is all quite different from the process that public health interests had expected, which would have begun with the recruitment of a CEO, whose leadership and management will be instrumental in establishing the agency’s tone and authority.

There is certainly no shortage of willing and qualified workers: it is fair to say that the prospect of a new national preventive health agency has resulted in enthusiastic public health professionals currently ensconced in non-government agencies (in Canberra if not elsewhere) racing home to sharpen up their CVs in the hope of being among the first to contribute their experience, skills and expertise.

For the ANPHA to establish itself quickly, it will need to be seen as part of the national and international public health network.

Experienced, motivated and expert staff with a sound knowledge of the drivers of preventable diseases and who understand the role of social marketing will be required if the agency is to successfully advise on approaches to behavioural change, including those which:

  • rely on ‘nudge’ theory and similar strategies;
  • improve the way our knowledge of ‘economic behaviouralism’ is applied to health-related choices;
  • profit from the public health and social marketing work of organisations such as Britain’s National Social Marketing Centre (NSMC) and The King’s Fund;
  • and clearly articulate the outcomes that can and cannot be achieved in the absence of wider structural and environmental reforms, including regulatory approaches.

And it will need to establish itself as an agency which is not subservient to DoHA.

Margo Saunders also writes on behalf of two other public health advocates who must remain anonymous for professional reasons.

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