Building Queensland's human capital: the case for health advocacy

Effective evidence-based government health policy and legislative reform cannot occur without input from non-government actors

In March 2012, Queenslanders overwhelmingly voted in the Liberal National Party. With a popular mandate, Premier Campbell Newman undertook a series of reform and cost-saving measures in the public sector. Public health activities fared badly. Units promoting mental health, exercise and dietary change, and reduced substance use were scaled back, and aspects of communicable disease control programs (eg, for tuberculosis and sexual health) were targeted. This particularly affected vulnerable and marginalised Queenslanders — rural communities, youth, Aboriginal and Torres Strait Islanders, sexual minorities, and people from refugee and migrant backgrounds.

In response to the global financial crisis, incoming governments around the world (not just in Queensland) have drastically reduced public health expenditure. Although Australia has been less affected, our federal and state budget deficits have put pressures on public health spending, including grants to community-based civil society and non-government organisations. Such organisations provide many public health services, including mental health support, HIV/AIDS prevention and care, health research, and home-based health and disability care. Once pared down or removed, it is difficult to re-establish such organisations. Links to marginal populations, community leaders, public health researchers, government, philanthropy, and other key state and national networks will need to be rebuilt.

Queensland media have reported many of these cuts. But what has received less attention is Minister for Health Lawrence Springborg's plan to insert into state funding contracts a clause banning government grantees from “advocating for state or federal legislative change if more than half their funding comes from the Queensland government”.1 With jobs and services at risk, most agencies will likely comply. Of the many issues raised, three are most striking. First, Queensland Health (QH) is placing controls not only on how the recipient agency spends state funding but also its other funding sources. Thus, any project cofunded by QH and non-state government or Commonwealth bodies will effectively be subject to QH requirements and political priorities. Second, health promotion work with marginalised populations is necessarily political, and distinguishing political advocacy from service delivery will be tremendously challenging. Third, the clause will effectively silence state government-funded civil society concerns about QH activities, or constrain collaboration with other state-based or national agencies able to raise public health concerns without fear of financial penalty.

Improvements in health outcomes occur through a whole-of-agency approach that builds alliances, gathers evidence and undertakes determined and effective advocacy.2 Robust policy requires that non-government actors have an opportunity to understand and question government action (or inaction). Good health advocacy is not hearsay — it is based on scientific evidence and the meritorious, well documented concerns of health system users. The Health Minister's argument that health funding should not be used for political advocacy is flawed. Public health is inherently political, because “like any other resource or commodity … some social groups have more of it than others … its social determinants are amenable to political interventions and are thereby dependent on political action (or more usually, inaction) [and] the right to ‘a standard of living adequate for health and well-being' (United Nations, 1948) is, or should be, an aspect of citizenship and a human right.”3

Nobel prize-winning economist Amartya Sen observed: “Providing health care is a matter of governance (and) so it has to be a political issue … it is the influence of the people on the government that would determine the quality of health care that a community gets.”4 Economists have long identified the relationship between health and development, in which health is generally considered to be a vital component of economic growth.

If the Queensland Government is sincerely committed to rebuilding Queensland's economic assets and implementing Premier Newman's “top priorities list” — to restore “openness and accountability” in government5 — then Queensland requires healthy and productive human assets. Health workers are obliged to advocate patient safety and fair, equitable health outcomes, using the best available evidence. QH must be open to transparently engaging with the broad-ranging health issues raised by all parties, including state-funded agencies, to progress the wellbeing of Queensland's financial lifeblood — its human capital.