The Ideal Health Minister the Ideal Minister Of

888 EDITORIALS J Epidemiol Community Health: first published as 10.1136/jech.56.12.890 on 1 December 2002. Downloaded from Health minister systems thinking is needed, and a back- ................................................................................... ground in the health professions is an advantage. But when I think about the dozen or The ideal health minister so health ministers (federal and state) with whom I have worked and some- J Dwyer times struggled, it seems to me that the keys for success are a combination of ................................................................................... commitment to policy goals that stand above the dusty arena of politics, and the Has an ability to reinvent themselves strength to maintain control of the policy agenda. n November 2001, Dr Michael retain control over health policy against Dr Neal Blewett (health minister from Wooldridge, Australia’s health minister the depredations of the central agencies, 1983 to 1990 and one of the few not to Iof nearly six years, retired from politics the departments of prime minister, fade from the front bench immediately) at the age of 45. In retiring early, Dr treasury and finance, which are the may well be judged the most significant Wooldridge fulfilled his own longstanding natural enemies of this largest of the achiever in the portfolio over the past 30 prediction that the health portfolio would “spending portfolios”. The second key years. Dr Blewett will be remembered for be his political graveyard, and in this he test is the ability to do more than his success in reinstating universal ac- shared the fate of most Australian health this—to move beyond health financing cess to health care through Medicare, ministers over the past 30 years. It seems and into more substantive areas. and for his leadership of Australia’s prompt and successful strategies in that, in Australia, there is little chance of The task of the health ministers is also response to the HIV/AIDS epidemic. life in politics after health and the ideal complicated by a jurisdictional problem. Both of these initiatives have survived health minister needs the capacity for a Australia has a population of less than 20 second or third career as well as the abil- and now enjoy popular support (al- million people, and nine ministers of ity to live with political risk. though Medicare remains under con- health—one federal and eight for the Yet the health portfolio is a senior stant challenge from conservative gov- States and Territories. Responsibilities cabinet position, and health policy is a ernments that profess commitment matter over which government can be for all aspects of the health portfolio— while they chip away at the policy foun- won and lost. Our tax based system of policy, public health, and health care— dations). But at the time, they were universal access to medical, hospital and are divided and overlapping across the politically courageous, socially progres- subsidised pharmaceutical services, sup- two levels of government. We have no sive, and required the ability to extract plemented through private insurance shortage of ministerial attention, and a new money for health care. Ideal charac- teristics for a health minister. and private health services, ensures that large infrastructure of coordinating copyright. health is an electoral issue, and never mechanisms has grown up to enable J Epidemiol Community Health 2002;56:888 long out of the media and public debate. national action on key policy areas—like ..................... But not, apparently, a training post for research, food and drug policy, aborigi- future party leaders or prime ministers. nal health and public health. Author’s affiliations J Dwyer, Health Services Management, La Health remains a deeply contested In this setting, the ideal health minis- Trobe University, Victoria 3086, Australia and ground, and a test of strength for the ter needs a talent for coalition building Board Chair, Australian Resource Centre for minister. One of the key tests— towards a coherent policy agenda. Just Hospital Innovations regardless of the political colour of the understanding the dynamics and contra- Correspondence to: Professor J Dwyer; government—is the minister’s ability to dictions can take years for a novice, so [email protected] http://jech.bmj.com/ Health minister employment, social welfare, education, ................................................................................... housing, labour, etc, do will inevitably have much greater influence on population health than what the minister of The ideal minister of (public) health health does. The traditional public health approach to this problem has been to N Pearce attempt to “turn the health services into ................................................................................... public health services” and to attempt to on September 25, 2021 by guest. Protected persuade the health services to become Should be in a minister of public health, not a minister of interested in these broader issues. This is health not surprising; given that most public health workers have initially trained in clinical medicine, and have continued to am going to answer this question nursing) have been less successful. The work within the health services, albeit in indirectly, for two reasons. Firstly, second, and more important, reason is a different role after their conversion to Ibecause I don’t think it is possible to that I don’t think the question can be the public health approach that focuses make a prescription for the ideal minis- answered without first discussing what on prevention in populations rather than ter of health as so much depends on per- the role of the health services would ide- treatment of individuals. sonal skills and the current circum- ally be. However, I think it is time to recon- stances (apart from the need for her/him The fundamental problem for sider this approach. It has rarely if ever to be electable!). Some of the best New ministers of health, as well as public worked, for the obvious reason that Zealand ministers of health have had no health researchers and policy makers, is when public health attempts to influence obvious qualifications for the job, that the health services at most have a the health services it is a very small tail whereas other ministers with more minor influence on the health of a popu- trying to wag a very large dog, which relevant backgrounds (in medicine or lation. What the ministers of finance, wants to run in another direction. www.jech.com EDITORIALS 889 J Epidemiol Community Health: first published as 10.1136/jech.56.12.890 on 1 December 2002. Downloaded from People working in the health services transform the health services towards If this approach were adopted, then like to do what they were trained for, and public health as much as this is possible. the minister of health and the minister generally do very well—that is, treating However, the ministry of public health of public health would both clearly play illness in individuals, and they usually would tackle the real public health issues an important part in government, but have neither the time, the ability, or the at the population level. It would solely would require different skills. The first resources, to deal with larger issues of have a monitoring and advocacy role, not would need the skills required to run the health services (including public health prevention in populations. Their admin- only with regards to routine monitoring services at the individual level). The sec- istrators also usually have more urgent of death rates, the population burden of ond would require the skills needed to priorities. As a result of this well disease, etc, but also with regards to meaning but naive attempt to transform play a monitoring and advocacy part to monitoring and influencing the work of the health services, public health has ensure that the likely population health the other government departments and gone backwards internationally over the effects were taken into account in the ministries (including the ministry of past two decades. It has continually lost work of all other government depart- out to the “conventional” health services health). One way (but not the only way) ments and ministries, including the in battles for resources, and it has had to do this is through Health Impact ministry of health. little influence on the important public Assessments of the possible health ef- J Epidemiol Community Health health problems at the population level. fects of different policy options proposed 2002;56:888–889 by the other government ministries and Perhaps it is time to seriously consider ..................... departments. Health Impact Assessment another approach—that is, establishing Author’s affiliations a ministry of public health. Public health is not straightforward, but such quanti- N Pearce, Centre for Public Health Research, services for individuals (for example, tative estimates, however debatable and Massey University Wellington Campus, Private immunisation) would continue to be tentative, can play a key part in ensuring Box 756 Wellington, New Zealand delivered through the ministry of health, that health concerns are taken into Correspondence to: Professor N Pearce; and we would continue to attempt to account in economic and social policy. [email protected] Health minister year gestations and hence attitudes and ................................................................................... options available

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