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13 Mar 2019

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY

With a federal election imminent there are matters relating to medicine and health that are within the grasp of national Government to act upon. The feds can’t cover the entire waterfront and we should not waste time raising with them things that are out of range. But in relation to matters such as Medicare, general practice and national prevention programs, it would be good to know the options being proposed of those seeking our vote. We should use the moment of an election to say again what we are hoping the health system will achieve and what we might expect from it.

Health and medical care are so vast that radical change in their organisation and provision is extremely difficult to achieve and we should be sceptical of grand plans. Bill Gates of Microsoft, facing similar complexity in the world, didn’t do strategic planning but waited for promising opportunities to present themselves. We don’t need to tackle the entire system to improve it. 

More than money and fees

‘It’s the economy, stupid!’ may be true and politicians forget it at their peril, but for many voters there is a desire that politicians address us also at our deepest level, honouring our sense of destiny and moral commitment. This applies to health and health care as much as it does to immigration.

We want a vision of Australia’s healthy future and we want to hear a story of our progress to date and what its next chapter might be, how things can be better in the future and how we can help. Only a positive view of the future, connected to our moral purpose and to how we want to live as a nation will lead to effective and inclusive policy.

Vision, of course, means looking forward. We do not need threatening and dire statements about how bad things are (they aren’t). Imagine, a friend said to me recently, the outcome if Martin Luther King had announced ‘I have a nightmare!’ We need a dream that guides future developments. We also need policies to turn that dream into daytime reality.

Filling gaps

Between now and the federal election scheduled later this year, we have the opportunity to reflect on the changes – progressive and not progressive – in health care that have occurred in health in the past from years and where we wish the incoming national Government to provide more leadership. For example, how do we assess our recent intensive application of information technology to medical records, clinical care and health service management?  What gaps need to be filled? How have we done in responding to the need for integrated care for older people with multiple chronic conditions? And what about rising out-of-pocket costs?

Why not send your local Member contestants an email outlining your views on these and other matters close to your heart?

We can have a vision and plan to transform it into action and results.

Effective policy requires input from the community, not just experts

But policies are not neat prose or detailed architectural plans. Brian Head, a policy expert from Brisbane, says policy decisions are not “deduced primarily from facts and empirical models but from politics, judgement and debate. Policy domains are inherently marked by the interplay of facts, norms and desired actions. Some policy settings are data-resistant owing to governmental commitments.

“Information is perceived and used in different ways, by actors looking through different ‘lenses’. From this perspective, there is more than one type of relevant ‘evidence’”.1 Head speaks of “three lenses” of evidence — political know-how, systematic research, and professional practice. “The three-lenses approach suggests that there may be importantly divergent perspectives on whether and how to increase mutual understanding and shared objectives.”1

So policy may not yield all the results we seek, but we can at least be clear about what we, as health care professionals and Australian citizens value and wish to see enhanced in health. We can contribute. We can be at the policy table.

 

1 Head B. Three lenses of evidence-based policy. Aust J Public Admin 2008; 67: 1-11.


Published: 13 Mar 2019