As Q and A wrapped up on Monday night, one particularly poignant tweet caught my eye.
“Just tells you how much we don’t matter.”
It was one of a series of tweets from a Wiradjuri woman, Kath Grant, who lives in Sydney (you can see them at the bottom of this post).
She was disappointed that Indigenous health was squeezed in for a few rushed minutes at the end of the program, when Selwyn Button, the CEO of the Queensland Aboriginal and Islander Health Council, asked whether Closing the Gap funding would continue to go largely to mainstream rather than community controlled services (more background from him about this is here).
It’s not as if there aren’t topical issues to discuss. As previously reported, a concerted campaign is pushing, via mainstream and social media, for national signup to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, which is due to expire at the end of June.
And there are many other questions about Indigenous health that could have been put to Minister Tanya Plibersek and her Opposition counterpart Peter Dutton, including about the accountability of Medicare Locals in this area, and the health implications of Tony Abbott’s plan to move Indigenous affairs into Prime Minister and Cabinet.
It wasn’t only how the show ended that gave such an insight into the relationship between the distribution of power and health.
It spoke volumes that the host Tony Jones chose to have the first, agenda-setting question come from the president of the AMA, Dr Steve Hambleton.
This launched us into yet more discussions about public hospitals, hospital financing and the blame game (notably, these were not issues nominated as priority topics by Croakey contributors).
As so many tweets suggested (the two below are from Carol Bennett of the Consumers Health Forum and Dr Tim Woodruff of the Doctors Reform Society), this time might have been better spent talking about public health or the concerns and experiences of those using health services.
There were some noteworthy moments. Peter Dutton gave a hint that he may be softening on his previously stated plans to abolish Medicare Locals (although really the surprise would only be if he did actually go ahead with abolishing them, as such a move would leave him looking pretty silly, given the widespread support for retaining them, even if under another name).
But we were left still wondering about the fate of the Australian National Preventive Health Agency and the National Health Performance Authority under a Coalition Government, and the extent of Dutton’s plans for privatising the management of public hospitals.
Of course, some issues will always miss out within the time and format constraints of Q and A. But the program is one of the few opportunities that we’ve had in the mainstream media for some serious health policy debate in the run-up to the federal election.
Both Plibersek and Dutton missed an opportunity to tell us their story about why health matters – to the country, to communities, to individuals – beyond bunfights over hospital services and financing and the sort of jargon that must be mind-numbing for general audiences.
Those looking for big-picture visions for the future were left disappointed. Where was the insightful discussion of two transformative shifts that have such sweeping implications for our future health: climate change and the digital revolution?
As for any serious discussion about the social determinants of health… We can get some insights into why the program failed to address such matters from a new study based on interviews with 20 former federal, state or territory health ministers.
Many of the ministers spoke of the power of the media in pushing the interests of the medical lobby and acute care.
As one Minister said:
“From what I’ve observed, the job of many Ministers for Health has been to keep the lid on things and put out the inevitable bushfires and even then it’s just pouring money into stopping the emergency waits and reducing elective surgery lists – you know, it’s all the acute sector because that’s where the media and the political noise of powerful stakeholders unite to get political action.” (State/Territory, ALP, 2000s)
The researchers heard “account after account” describing how doctors and their professional bodies, especially the AMA, wielded considerable power over decision making in both Labor and Liberal-led governments, and used it to ensure the health minister’s focus remained on providing acute care services.
Each minister recounted stories of how health became a front page story when doctors’ lobby groups spoke to the media about how lives would be threatened by a change to service provision or failure to allocate more funding to acute care from an already stretched health budget. About half described how, in this environment, their efforts and successes in public health could not compete.
(More detail about this study is in this recent article for Inside Story, giving an update of developments in social determinants of health in Australia, which was also republished at The Conversation).
Whether Tony Jones realised it or not, by throwing the first question to the AMA, he was simply reinforcing longstanding media traditions of promoting a medical rather than a health policy debate.
Which brings us to this very useful suggestion for the next Q and A on health policy.
Perhaps we would end up with more enriching conversation about our health if Q and A invited ministers from the other portfolios that have such a profound influence over health.
Perhaps this approach would even put Indigenous health front and centre, given this sector’s deep understanding of the importance of the social determinants of health and holistic understandings of health, as per this definition:
“Health is… not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community. It is a whole of life view and includes the cyclical concept of life-death-life.”
Meanwhile, here are Kath Grant’s tweets, which she sent as Q and A wrapped up.
And here is a reminder of why it is important for powerful media outlets to focus the attention of politicians and the community on what happens to the Closing the Gap agreement and related programs and funding…
Some more reading on the health Q and A:
• The experts respond, via The Conversation
• Plibersek by a healthy margin: Upstart