How to clear the ‘blinding fog’ of mystery on decision making in health prevention programs. Philip Darbyshire lays a challenge at the feet of those working on government public health programs in this follow-up piece on the Queensland health cuts.
As the news cycle moves on and some of the heat, perhaps momentarily, dissipates from the Queensland health cuts furore, I wonder what Croakey readers have learned over the past weeks. More importantly perhaps, I wonder what we as health professionals have learned about how to, and perhaps how not to advocate for and defend health services. Sadly, my view of the latter would be, ‘precious little’.
In my contribution I proposed four ‘killer questions’ that health professionals must able to answer if they are to advocate for and champion the value of the work that they do. I also suggested, rather tongue-in-cheek, various ways not to respond to them. I did not expect to find that almost every one of these would be the default position of the health promoters.
What we have read in almost every commentary (see here, here, here and here ) is a surfeit of ‘mourning’, ‘eulogies’, outrage, hand-wringing and apocalyptic visions of the doom and decline that is now sure to visit Queenslanders – to the extent that I almost expect to see the bodies mounting up along Queen Street mall any day now.
I readily acknowledge the ‘heartfelt’ nature of the commentaries and the genuine difficulties that sacked staff will face, especially since, as Sabina Knight noted, “Generations of health professionals have not ever known job insecurity.” Millions of other workers in the private and commercial sectors of our economy will of course have little comprehension or experience of such generational ‘job security’. I find it hard to believe however, that such sustained emoting will have the slightest influence on government or health board thinking.
Thus far, a tear of remorse emerging from Campbell Newman’s eye seems a more likely prospect than some kind of evidence or appreciation of outcomes being mentioned by the health professionals. What we read instead is the semi-liturgical listing of programmes and projects, each more worthily-named than its predecessor. Who, after all could possibly NOT want to fund a programme or service as eponymously wonderful as ‘Lighten Up’, ‘Living Strong’, ‘Growing Strong’, ‘Smart Choices’, ‘A Better Choice’, ‘Get up and Grow’ and so on. With such linguistic insulation, no wonder that defunding such programmes seems like drowning kittens.
Wonderful though these programmes may sound, we are still none the wiser from the Croakey commentaries as to whether they actually work, whether they make a demonstrably positive difference to the health and lives of the people concerned and what improvements they have made in relation to any key indicators of health and wellbeing. For instead of even a shred of evidence, we read only about how ‘vital’ the programmes are, how wonderful the staff are, how committed they are to their work, how tireless their efforts are, how important their jobs are to them, how diligent they have been at University and how much gratitude we owe them (examples here and here). Is this really the best we can do?
The only dissenting voice to this orthodoxy other than my own was Vern Hughes, who wrote that, “Prevention programs in these areas amount to little more than media and education campaigns that largely fail in modifying behaviours.” While Vern may well be right, so too may the health promoters, the problem is that because the discussions around the Queensland cuts and indeed the undertaking of the cuts themselves have been essentially an evidence-free zone, we simply don’t know.
This concern that the health promotion and prevention sectors see themselves as self-evidently worthy, successful and thus entitled to their share of the eternal ‘more resources’ that everyone in healthcare desires is not a new observation and others have expressed this more clearly than I. Martyn Goddard for example has argued that: “A blinding fog of ignorance and mystery surrounds the decisions being made on disease-prevention funding. Perhaps it is time we started to do the job better”. No ‘perhaps’ about it I’d say.
I am not so naive as to believe that politicians create health policy and make health funding decisions on the basis of rational thought and good evidence but I have to believe that strong evidence of positive and valuable outcomes will ultimately carry more weight than ‘heartfelt pleas’. I would also like to believe that the public health service as a whole is not fundamentally a giant job-creation scheme existing primarily to provide gainful employment for its staff and where any proven, beneficial, health outcomes are but a fortuitous by-product.
Let’s hope that the people running all of these health promotion and public health projects, programmes and departments have been collecting good data, not only about process, and ‘inputs’ (i.e. amount of ‘work done’), but also in some way, about outcomes and identifiable benefits. Let’s also hope that some of our university research departments are already planning the longer term ‘post-cuts’ follow up studies in Queensland that will provide a less febrile and more evidence-informed assessment of exactly what effects (positive, negative or otherwise) these policy decisions may have on Queensland and its people.
Philip Darbyshire is Professor of Nursing at Monash University, Adjunct Professor of Nursing at University of Western Sydney and Director at Philip Darbyshire Consulting Ltd. Read his blog or follow him on Twitter.