Public health advocates need to get over the conceit that their work will inspire political action simply because it is worthy, according to Michael Thorn, Chief Executive of the Foundation for Alcohol Research and Education, and guest tweeter this past week at @WePublicHealth.
In the article below, he explains some of the background to a new campaign, Prevention 1st, and why he thinks public health advocates have been “left in the dust” by other interest groups.
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Michael Thorn writes:
Public health activists are despairing about the prospects of responding to what the Commonwealth Government’s Reform of the Federation White Paper describes as “Australia’s greatest health challenge”: chronic disease.
And it is largely our own fault.
That’s not to say the odds aren’t currently stacked against us.
The Abbott Government has been responsible for the near total dismantling of Australia’s national preventive health system.
It terminated the $370 million National Partnership Agreement on Preventive Health which was funding various programs including the hugely successful public health campaign behind Ararat’s transformation away from being one of Australia’s fattest towns.
It was only the shocking exposure of the conflicts of interest by the Assistant Minister for Health’s Chief of Staff that saved front-of-pack food labelling from a similar fate.
It closed the Australian National Preventive Health Agency and transferred its funding to the Department of Health, where the dollars have simply disappeared. And all this at a time when State governments such as Campbell Newman’s LNP in Queensland and Jay Wetherill’s Labor government in South Australia were also slashing health promotion and prevention funding.
As a proportion of overall health spending, Australia’s expenditure on preventive health has fallen to a low of 1.5 per cent. Contrast this with the New Zealanders at 7 per cent and the Canadians at 5.9 per cent.
It is a government that has demonstrated a deep suspicion of public health, and of public health advocates, for both ideological and base political reasons.
Putting preventive health back on the agenda
Against this background, the Foundation for Alcohol Research and Education and the Public Health Association of Australia quietly launched Prevention 1st in recent weeks; a campaign to put preventive health back on the political agenda as a response to increasing levels of premature death caused by chronic disease.
This is not a problem unique to Australia. The United Nations and the World Health Organization have recognised this and governments around the world have committed to reducing non-communicable (chronic) disease by 25 per cent by 2025. This will be tough challenge, even under the most propitious circumstances, because meeting this target relies heavily in the first instance on preventing occurrence of the disease.
The problem is that too much of Australia’s preventive health work has come to a standstill because of budget cuts and political inertia, despite the evidence that population-wide public health interventions are cost-effective and game changing.
Not that weak approaches to preventive health are the exclusive domain of the current Government. The previous Government’s record was mixed at best. Strong on tobacco, conflicted on obesity, indifferent about physical inactivity, and beyond the revenue raising alcopops tax, resistant to alcohol.
Putting past and present government records to one side, governments are simply paying positive lip service while actually dismissing preventive health as central to improving Australia health outcomes, including its ability to save lives and help with the budget bottom-line. Public health advocates must accept this is also our own fault.
Too timid
After attending the Australian Labor Party’s National Conference last weekend in Melbourne to promote Prevention 1st, I concluded that public health is being left in the dust by better-organised and more savvy special-interest groups.
Green groups are way ahead; so far, they even have their own party! Others; Indigenous, overseas aid, women’s and marriage equality groups, have been adept at extracting material commitments from Labor in its new National Platform well beyond any commitment on prevention in the health arena.
In these forums, public health has been timid or mostly absent.
Public health has never dreamed, let alone expected, a party commitment to introduce legislation within 100 days of forming government, such as the marriage equality groups extracted from Labor over the weekend.
Public health’s conceit is that the worthiness of preventive health, on its own, will inspire political action.
It won’t.
Too naive
Public health is blessed with many incredibly smart, connected and talented people, but it conducts its business in a terribly naïve manner. It politely speaks to Ministers and Shadow Ministers, holds academic forums and publishes valuable research.
However, unlike action on tobacco in a different era, public health has not been strident in its demand that parties commit to specific actions to address the risk factors that cause chronic disease. It certainly has not been able to take on big unhealthy industry in the way it successfully wrestled the tobacco industry.
Without clear commitments from political parties, governments will largely ignore preventive health. Governments may cast a few trinkets preventive health’s way, set up agencies with highfalutin names. They will not feel compelled to use corrective taxes, establish independent advertising regulators, ban sponsorship and restrict the availability of harm-causing products. These are the things that actually work.
Part of the problem is that the achievements in reducing smoking have disguised how hard it is today to achieve commitments to policy change. The anti-smoking campaign was led both from outside and from within government, where there were resources and access to decision-makers to mount and maintain policy momentum.
Unfortunately, little of this government infrastructure remains. Twenty years of budget cuts, outsourcing and reorganisations have diminished the bureaucracy and much of the public policy formulation is now outsourced to civil society organisations.
This is why Prevention 1st is so important.
Public health advocates seeking policy change to mitigate the risks of smoking, consuming alcohol, poor diet and sedentary behaviour need to become much more demanding.
The lesson from the ALP’s National Conference is that the only winners are those who are vociferous in their demands for strong and firm commitments from political parties.
Find out more about ‘Prevention 1st’
• This article is cross-posted from DrinkTank.
Wholeheartedly support Michael’s contentions.
If health advocates have been left in the dust by other interest groups, and I think we have, it is for many of the reasons outlined here, but more.
Yes we have tended to a view that what we do do is inherently good and worthy, just because it is, and that this will be enough to create change. As outlined, it isn’t.
We have rarely taken the overwhelming evidence generated by many smart and committed people and shaped it into compelling and strident messages for change. Visibly, unashamedly and unitedly.
And while the evidence for necessary changes to public health is unequivocal, and at a policy level I’m committed to advocating for evidence based policy design and budgeting, HiAP, the central place of equity and SDOH, etc, evidence only gets us so far.
It engages the head, generally, and depending on the kind of language used (which in health is frequently alienating), even then, only some heads will be engaged.
Harking back to my social work training, We also need to engage the heart and hand.
Understanding what motivates people, how that can be engaged, and then translated into action.
Fully applying theories of change with a range of integrated strategies means our approach will necessarily look like different things for different audiences at different times. But that all three must be engaged – head, heart and hand – in the right mix, simultaneously, seems obvious..
In many quarters, particularly in parts of community health, to get strident, to challenge systems, to be organized and sophisticated campaigners is a bit foreign, sometimes a bit corporate and at other times a bit uppity. Which is a bit odd since social equity and campaigning is where Victorian community health at least, frequently had its union organizing roots.
Unlike other successful campaigns, like marriage equality, we have generally failed to engage and mobilize broader coalitions of partners outside of health, and within the community.
Imagine how much more likely of success public health might be of generating a 100 days response from government if their political futures depended on it.
Where are the full page ads showcasing the top tier corporates who support public health initiatives?
Where are the frequent polls illustrating voters desire for change to how our health system operates and is funded?
Why isn’t the electorate brought into a debate about how public health directions might influence their voting intentions?
Why don’t we know what every member of parliaments view is in relation to various public health initiatives?
These strategies and more are pretty standard campaign approaches among other more successful interest groups. If there’s conceit to be challenged, I wonder if there’s something about gelato looking a little more outside of itself.
Fully support the introduction of Prevention 1st!
…and in the second last para, by gelato, I mean health looking a little more outside of itself… Thanks tiny iPad autocorrect window…
Thanks Michael for this useful and timely challenge to public health advocacy. In response I have three (quick) related observations:
1. It is telling that you categorise those with a concern for the environment, foreign aid, Aboriginal and Torres Strait Islander people, and women’s and marriage equality as somehow separate to public health. To my mind, these are all important public health concerns. Is there any more important public health issue than climate change? (Sometimes I wonder whether public health practitioners who are not actively working for climate change action are simply fiddling while Rome burns.) So for me, this comment highlights the pitfalls of a narrow, reductionist focus around tobacco, alcohol etc. It also reminds me, as Tim Senior has written at Croakey previously, of the potential for learning from the Aboriginal and Torres Strait Islander health sector about more holistic understandings of health and determinants of health.
2. The difficulties of gaining policy traction are not simply issues for Australia but reflect the wider ascendancy of neoliberalism, as defined by the WHO:
http://www.who.int/trade/glossary/story067/en/
3. I agree with Jason re the disconnect between so much public health advocacy and the wider community. So much of the work of public health (with notable exceptions) seems very top-down, rather than being genuinely embedded in communities and part of communities, and responsive to communities.
Thanks again Michael, really appreciate you sharing this article with Croakey readers. Cheers, Melissa
It is a curious thing that the Liberal Party seems to think that allowing a large proportion of the population to have worse health (and education) is a path to national prosperity and harmony.
Perhaps it’s just about being top dog – born to rule.