Thanks to Croakey readers and contributors who supported our #HealthMatters crowdfunding campaign, journalist Marie McInerney was able to attend the ALP Health Summit in Canberra on Friday to provide this detailed report of the topics discussed.
Below her article is a selection of the tweets that saw the #ALPhealthsummit hashtag trending for most of the day. McInerney also conducted several broadcast interviews with key speakers and participants, which will be posted at Croakey in coming days.
Marie McInerney writes:
Labor’s national health policy summit on Friday put health equity, prevention, and better integration of fragmented services at the heart of its health policy development in the lead-up to the next election.
The Federal Opposition, buoyed by the importance of health at the 2016 election, invited more than 150 health experts from different fields to ‘round table’ discussions on many of Australia’s most pressing health issues, and responded with its own big numbers.
Opposition Leader Bill Shorten officially opened and closed proceedings and sat in on a number of sessions.
Key members of his Shadow Cabinet were also on hand — Catherine King (Health and Medicare), Julie Collins (Mental Health and Ageing), Jenny Macklin (Families and Social Services), Mark Butler (Climate Change and Energy), Stephen Jones (Regional Services, Territories and Local Government) and Warren Snowdon (Indigenous Health) – along with a dozen or so other MPs.
There were no big announcements or new directions set, although a communiqué will be issued in coming days.
However, many of those attending said the event signalled that Labor was making a priority of health and that its show of Shadow Cabinet strength and the issues on the agenda recognised – at least tacitly – the need for whole-of-government or Health in All Policies (HiAP) approaches.
Participants told Croakey there were benefits in having a big crowd of people committed to improving health in the same room, sharing an agenda with people outside their own ‘silos’ and reiterating key issues and messages with politicians and advisors that they often don’t get to reach.
Those messages also went out more widely, with the hashtag #alphealthsummit trending top on Twitter nationally through the day.
“People in health might have heard much of what was discussed before, but not all the politicians and advisors necessarily have, and there’s some energy just in getting everyone together,” said Jennifer Doggett, chair of the Australian Health Care Reform Alliance (AHCRA) (and a Croakey editor).
It was all of course limited by the nature of the event which packed eight sessions on big picture topics – from prevention, hospitals, mental health, innovation and more (see the full list of topics in this earlier Croakey story) – into less than six hours, including keynote speech and lunch.
At the final plenary, session chairs had just a few minutes to give a wrap of the complex discussions they had led. But even that sent a strong policy signal when Mental Health Australia CEO Frank Quinlan observed that, in the time each chair spoke, someone in Australia had attempted suicide.
His summary of the mental health session was both poignant and a warning on the big gap between intent and political reality, saying mental health advocates had come to the summit with an agreed agenda, “no jockeying”, but still waiting for action on a reform process that had taken years.
Hunger for a long-term vision
Opening the summit, Shorten told delegates the Opposition wanted to build an “irresistible coalition for reform and change” and prepare a health policy ahead of the next election that answers “the hunger for a long-term vision”.
“We want to move beyond the boom and bust in healthcare policy in the recent past, the uncertainty created by deep cuts or sudden swerves in policy or funding.” (You can watch his speech on his Facebook page).
Shorten said it was not good enough that Australia allocates less than 2 cents in every health dollar to prevention measures, and he stressed the importance of reducing fragmentation in the system and improving continuity of care.
He spoke to the hearts of most delegates there that properly funded health care should be seen as an investment, not a cost.
Shorten talked about the health issues that most people bring to him at his ‘town hall’ meetings – anxiety about ice addiction, mental health and suicide, dementia (issues “not related to postcodes” he noted).
And he asked the sector for help in addressing obesity – bringing to mind comments from former Labor Health Minister Nicola Roxon in 2013 on her frustration at the lack of a “clear message” from health advocates on obesity prevention, versus the strong messages on tobacco.
But the media conference held by Shorten, King and Collins for the press gallery in the midst of the summit pointed to the difficulty in putting substantial health reform on the agenda. It elicited just one telling question on health (as was reflected in this write-up):
JOURNALIST: Mr Shorten you ran a fairly negative campaign on health at the election, do you rule out using things like text messages and cold phone calls in the next campaign, are you going to just run a positive health campaign?
In fact, there were many stories to be told from the summit, although those below are from the two concurrent sessions that Croakey was able to attend, but see below for tweets from others.
Mark Butler, a former Mental Health Minister, talked about the Better Access program that provides Medicare rebates for people seeing psychologists. Its first evaluation found that the richest 20 per cent of Australians received three times more of those Medicare dollars than the poorest 20 per cent.
“That’s not uncommon in these demand driven programs that rely very heavily on a whole range of supply factors but also rely on where the medical workforce is: the further you lived from the GPO the less likely you were to receive a Better Access visit, and the less likely it would be with a clinical psychologist,” he said.
That “postcode determined health” was also graphically illustrated by ConNetica Director John Mendoza. He said that Blacktown in Sydney’s west, with a population of 330,000 plus people, has not one private psychiatrist versus the north shore suburb of Mosman, whose 32,500 residents have access to 100 local psychiatrists – 1,000 times better access.
Mendoza urged Labor to put such data into the public domain and, when next in government, to set up a Health in All Policies subcommittee in Cabinet to match the power and purpose of the Expenditure Review Committee.
Another delegate urged governments of all stripes to stop designing health systems for “white, male 50 year olds” and to make them “for the person with kidney disease in the Torres Strait” – “the 50 year old will be fine”, she said.
Rosemary Calder, Director of the Australian Health Policy Collaboration, hailed the work of acclaimed urban designer Gil Penalosa, who transformed Bogota with his 8-80 litmus test: creating cities that are good for both 8 and 80-year-olds.
One delegate quoted the New Zealand Mental Health Commissioner as saying the markers for a healthy life include “a house, a job and a date on Saturday night”. “We don’t measure any of them,” he said.
Lack of data was a big issue across sessions – as always, but exacerbated by the Coalition de-funding a number of data collection, analysis and research organisations. Priorities that came up included measuring program impact and workforce issues, but also to have health data connected to other policy domains.
Amid many concerns about issues for rural and remote Australia, one advocate called on Labor to make sure all policies are “rural proofed”, saying that there were often unintended consequences to good policies when they did not test for quality and equity in more remote communities.
Others talked about their concerns at being left off the agenda (rare disease care, broader role for pharmacists, oral health, rehabilitation under the NDIS), being left out of reform discussions (nurses) or “ambushed” in a rapidly evolving reform process (aged care, pathology).
And Suicide Prevention Australia’s Sue Murray called for a national strategy on suicide prevention, providing a unified approach that also addresses children and young people (not as “little adults), saying many services currently were operating in a “vacuum”.
Walking the talk in Indigenous health
National Aboriginal Community Controlled Health Organisation (NACCHO) chair Matthew Cooke put Labor on notice to address racism in the health system, which Lowitja Institute CEO Romlie Mokak said was the “burning issue” in Indigenous health.
Cooke said the problem is not just in the way Indigenous people are treated in the system but also in how governments and their agencies exclude Indigenous organisations that should be involved “at every level of decision-making”.
He said NACCHO members had been “spearheading” self-determination for more than 40 years – a principle now being adopted by non-Indigenous people wanting to make community decisions about their health care and about health services and systems in communities.
“But Labor forgot us with Medicare Locals and the Liberals forgot us with the PHN (Primary Health Networks) transition… We were left out in the makeup of governance structures, clinical councils and community networks.
“We face a lot of arrogance, a lot of racism in the health system,” he said.
Cooke said a statement this week by Indigenous Health Minister Ken Wyatt, calling on PHNs to work with ACCOs was “very welcome”.
Wyatt has also reached out to Labor to get more traction on Indigenous health, Shadow Indigenous Health Minister Warren Snowden told Croakey. He said Wyatt has recently initiated regularly fortnightly meetings with him and Labor Shadow Assistant Minister for Indigenous Affairs Senator Pat Dodson during parliamentary sitting sessions.
Snowden said there would be differences in policies and approaches but, “all credit to Ken”, it was an effort to work collaboratively.
Indigenous health was a big focus on many of the sessions and raised by Shorten, but Labor’s vows to work in partnership with Aboriginal and Torres Strait Islander people and recognise Indigenous health leadership would have perhaps resonated even more if an Indigenous health expert had been among the session chairs at the summit.
Climate change “no brainers”
While the impact of climate change on health was not explicitly raised in the session summaries, Mark Butler talked about the “often enormous synergies” between good health policy and climate change/urban planning policies when he co-chaired the session on health inequalities and whole of government challenges.
And the reverse is also true, he said, talking about the recent heatwave in western Sydney that had broken records. Yet he said he had read that morning that the New South Wales Planning Department had just lost all its health care resources.
“That lack of integration of health care and planning, I thought we’d resolved ten years ago,” he said, adding that urban design for western Sydney to avoid the heat island effects that were going to be more prevalent “is a no brainer”.
Butler mentioned he had given up eating farmed meat ten years ago as a commitment to addressing climate change, but which also brought health benefits.
Citing the work of the late Professor Tony McMichael, he said there were similar benefits in driving down carbon emissions from cars (people walk more) and shutting down coal stations (good for air quality).
“We need to think about these things in more holistic way, not just thinking as policy makers in a health care area but policy makers who are committed to social justice and sustainability,” he said.
Where to from here?
Catherine King’s office said the next step will be to drill down deeper into priority areas raised at the summit, though there’s no detail yet on how that will happen. One of the specific ideas raised was for a national data summit on population health and accountability of health funding.
It will of course depend on how big a reform agenda Labor wants to develop and which of the competing vested interests it will need or want to take on to really address structural barriers – doctors, hospitals, states, the pharmaceutical industry, the private health sector – and whether it’s up to a fight against the food and alcohol industries and “nanny state” critics on prevention.
After the summit, Public Health Association of Australia CEO Michael Moore told Croakey there’s no point expecting immediate policy change, but he said consultations by King three years ago had led “probably the best we’ve seen on preventive health” from Labor last election.
He also expects to see the ideas that Labor is now canvassing filtering into parliamentary enquiries and reports.
Still, Jennifer Doggett warns that history should keep us cautious, pointing to this section from the 2009 National Health and Hospitals Reform Commission report.
She said: “Eight years on and we’re still saying the same things!”
* Thanks to Jennifer Doggett for her help in covering this event.
Tweets and photos
Here’s our #HealthMatters Honour Roll (some contributors have asked to remain anonymous).
Summer May Finlay
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