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Interview with the Hon. Nicola Roxon: Getting Evidence Into Health Policy

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Interview with the Hon. Nicola Roxon: Getting Evidence Into Health Policy February 2017; Vol. 27(1):e2711701 doi: http://dx.doi.org/10.17061/phrp2711701 www.phrp.com.au Perspective – Interview Interview with the Hon. Nicola Roxon: getting evidence into health policy Nicola Roxona,b a Minister for Health and Ageing (2007–2011), Australian Government, Canberra, ACT b Sir Zelman Cowen Centre, Victoria University, Melbourne, Australia Article history Introduction Publication date: February 2017 Public health researchers and practitioners want to see their research Roxon N. Interview with the Hon. inform government decision making. It is not always clear to researchers Nicola Roxon: getting evidence into how evidence is used in policy decisions in a highly politicised environment health policy. Public Health Res Pract. with many competing demands. We spoke to the Honourable Nicola Roxon, 2017;27(1):e2711701. doi: http://dx.doi. former Australian Minister for Health and Ageing (2007–2011), to gain some org/10.17061/phrp2711701 insight into the process, and advice on how to engage most productively with government. Q: Often ministers and policy makers must try to make good policy decisions Key points in areas where evidence is incomplete or contested. What strategies or • Working with decision makers to processes did you employ when trying to make good public health decisions implement new health policy often at a federal level when the evidence was insufficient? What were the main involves finding a political ‘sweet spot’ challenges involved and how did you overcome them? where a good policy decision is also A: I think it is very rare for ministers or governments to want to make decisions good politics where evidence is incomplete or contested (provided the contest is real, • When communicating a new idea to not fabricated by vested interests). There are so many competing, worthy, a minister or decision maker, health evidence based causes – especially in health – that these will usually be advocates should aim to capture the given priority. However, in a crowded political agenda, having a worthy cause imagination of the decision maker rather isn’t always enough to capture the imagination of government. The biggest than overwhelm them with years of in- single mistake I saw when I was Health Minister was repeated over and over depth research again, by decent, hard-working researchers, medicos and advocates – and • Plain packaging for tobacco products it was the naive assumption that, because they were working on something is a great example of implementing good, or had developed a worthy project, the government would therefore act good health policy where trusted health organisations worked across political on it. groups, provided expert research and As a minister, I was able to act on some fabulous ideas, and I’m proud of supported the government to take action that. But many good ideas were not acted upon – often because of financial constraints, but also many other reasons played a role. Just because your idea is good, even worthy, isn’t enough. Q: So, how does evidence inform policy decisions in the real world? A: To get real decisions and actions in your area, you must think closely and carefully about who you are putting your evidence to, their needs and priorities, and why your proposal will help them. In a world where most interventions cost money – and, in health, usually a lot of money – simply appealing to their good nature is too simplistic. You need to make it easy for 1 Public Health Research & Practice February 2017; Vol. 27(1):e2711701 • doi: http://dx.doi.org/10.17061/phrp2711701 Getting evidence into health policy decision makers to see how acting on your idea is worth Q: What do you say to the researchers who feel that their taking up time, money and political energy. work is ignored? Knowing what is going on in the decision maker’s A: I am frustrated that governments are almost portfolio, what is troubling them, what is taking up their universally criticised for not taking action on public time and giving them sleepless nights helps you find health. Sometimes that criticism of governments is fair a way to fit your issue into their thinking space. Start and well based. We are right to expect courage and by putting yourself in the position of the minister you leadership from our governments. But, in truth, criticism want to take action. Do you know what they are trying to of governments is also sometimes lazy. It can be easier to achieve? Have you read any of their speeches or policies criticise a government for not acting on your issues than or recent interviews? Demonstrating your understanding to ask whether you’ve done all you can to help them take of their issues and pressures is good manners, but also that decision. helps you shape your pitch to their current interests or From the perspective of a former minister, I want to pressures. urge researchers, advocates and clinicians to assess For example, when the Australian Government whether they have done all they can to create a fertile announced health reform negotiations with the states, environment to encourage government leadership. When a few groups came to us with proposals that could they do, governments will provide leadership. be part of those discussions. Not all were successful, but it showed they were tuned in to opportunities, and Q: Can you give an example of this more courageous ready to make the most of them in a way that might suit leadership during your time as minister? government. A: One example is a cause close to my heart: Australia’s Even a scandal or problem can sometimes be a introduction of plain packaging for tobacco products. We chance to offer a helpful solution. It might help solve are proud to be world leaders in introducing our shocking the problem, or detract from it! Either way, this might be and ugly plain packs, and even more proud of the lively welcome. discussion and action it is generating elsewhere around The more in tune you are with the decision maker’s the world on the future of tobacco control. pressures, the more likely you are to be agile and think I have been very flattered, and often overwhelmed, laterally, to find good opportunities to raise your cause at by the recognition I get from introducing this measure. the right time. But the truth that ought to be acknowledged is that Q: When these opportunities present themselves, what is there were many people and many factors that made the best way to communicate? this courageous public health decision a good one for government, and easier than people imagine. A: Are you clear on what you would say and how you What made us choose this courageous path, when would say it if you got a brief chance to pitch your idea? A there were so many other competing issues on the table? lot of people talk about having an ‘elevator pitch’ – this is It offers a good case study about advocacy. the idea of what you would say if you were, by good luck, The work of so many researchers, advocates, doctors, in an elevator with the decision maker. Could you explain past governments, journalists and ordinary Australians your idea simply? And quickly enough? moved this seemingly courageous decision into a political The aim is to first capture the imagination of the ‘sweet spot’. Ultimately, it was a good policy decision that decision maker – get them to be interested in your idea, was good politics too. impressed with your focus and your offer to help them. It was an inexpensive policy with high impact; a I had too many meetings to recall where people policy with lots of supporters and a disliked opponent tried to download 20 years of in-depth research in (the tobacco industry); a highly visible policy that a 10-minute meeting – the minister needs to know it complemented other measures important to the is there, to appreciate your expertise or credibility, government, but perhaps less ‘sexy’. but they don’t need to be able to present a paper on On each of these issues, advocates and supporters it to the next technical meeting of the World Health of the initiative sought to make the necessary links to our Organization (WHO)! broader health reforms, our fresh focus on prevention and Stick to the headline message or your core thesis to our interest in Indigenous health. support a proposal – then you can leave the detailed And it helped that the public had responded well in summary for an adviser or official to mull over. the past to tobacco control interventions, showing the What you want from your meeting is to spark enough huge benefits of a comprehensive approach to tobacco interest that the minister asks for more work to be done control measures. The research was strong, and the on your issue – not that they decide to write a book on it. international treaty on tobacco (the WHO Framework Worse, your clear message will be diluted or lost if you try Convention on Tobacco Control) supportive. to do too much in a short meeting. 2 Public Health Research & Practice February 2017; Vol. 27(1):e2711701 • doi: http://dx.doi.org/10.17061/phrp2711701 Getting evidence into health policy Q: What role would you expect from civil society in this Developing alliances across consumers, clinicians, process? advocates and researchers will always be very powerful. The same proposal from multiple groups gives your A: The Cancer Council and Heart Foundation in Australia argument weight and depth. Instead of all asking for were the rolled-gold best examples of this on plain something slightly different, if you can agree on one packaging – they worked across political groups, and major initiative or a good starting point, it is a very much had expert research as well as highly responsive media more convincing request.
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