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Health Politics: boundless win-wins

In a recent opinion piece in The Canberra Times Nicholas Stuart assessed the failings of the Abbott government (Stuart, 2014). It was an entertaining read, particularly – as so many political commentators do in the tabloid press  – as the personal character and idiosyncrasies of Abbott’s ministry are called into question. This ‘argumentum ad hominem’ (attacking the person) has superior power over, and is considerably easier than constructing the ‘argumentum ad rem’ (playing the ball) in cunning ways.

Personally I think that it is a defining characteristic of a mature democracy when we can discuss the substance rather than attack its spokesperson. Or the policy rather than its proponent politician. But several factors stand in the way of such maturity. Virtually all of these factors have something to do with the process of policy making, and less with the technicalities of moving a social problem toward its solution.

Deborah Stone in her wonderful book ‘Policy Paradox’ (2002) describes the power of symbols and imagery in shaping perceptions around policy. They are, she says, the core devices for shaping the political discourse.

Clearly, describing a politician as ‘the scallywag from central casting’ throws an immediate cloud of doubt on the person’s capacities to deal astutely with a nation’s pressing education issues. It may or may not have an ultimate effect on voter preferences, but I would maintain that policy imagery (like ‘Stopping boats’ or ‘Carbon tax’ for social problems that are infinitely more complex than the two-word rhetoric suggests) shapes popular perception far more profoundly than personal caricature.

The shrewd strategists (or , ‘spin doctors’, another two-word device) that scheme and plot on behalf of the front men and women in parliaments the world over of course don’t need political science texts to understand the compelling nature of appropriate imagery.

It is up to us, the policy entrepreneurs and issue advocates, to be as shrewd, cunning and astute in (a) exposing simplistic and biased ‘truisms’ or ‘factoids’; (b) distinguishing fact from perception,; and (c) seeing opportunities rather than barriers in the political game.

I think doing this well requires a finely calibrated moral spirit level, in which we – as those committed to health, equity and justice for all – must benchmark our actions against the needs of those that have no (or hardly any) voice in the political discourse.

Now, we all have different roles to play in this. Roger Pielke (2007)  distinguished between ‘pure scientists’, ‘science arbiters’, ‘issue advocates’ and ‘honest brokers of policy alternatives’. In his logic ‘how you see the world’ determines what archetypical role you assume.

If you see the world of democratic policy-making as one of open and balanced argument leading to consensus, the role you assume is different from one where simply the majority decides. This distinction is interwoven with ideas about science. For example, is it the value-free enterprise of discovery, or the construction and probing of alternative realities? Evidently, ‘value-free science’ in a ‘winner takes all’ democracy is a volatile if not outright dangerous combination.

The problem, really, is that our society does not seem committed to see the world with a strong moral sense. As an educator,iIt is simply stunning to witness cohort upon cohort of health students that has a firm belief in the infallibility of the evidence-based construction of value-free facts (or, as one of my students once blurted ‘We don’t want thoughts, we want facts!’) whilst walking through the political landscape like zombies.

There is much talk in higher education about reflexive learning, but that reflection seems to be bound with individualised and professional beliefs rather than critical social and political behaviour. In such an environment the creation of a credible and critical collective voice for equity is doomed.

As an illustration of what is needed, let’s look again at Nicholas Stuart who in his Canberra Times piece presented a perception as a truism: “The problem for Abbott is that politics is a zero-sum game: if one side’s winning, someone else is losing.” This may be true for sports (Australia’s official religion) but it is certainly not true for politics. In fact, the best politics make everybody win: unlike the economy or natural resources, where capital is finite, things like pride, courage, humility and satisfaction can be had in boundless amounts. These, too, are sources of political capital and political argument..

The trade-offs and complexities of addressing social and health inequities can and should move beyond ‘us vs them’, ‘in vs out’, ‘conservative vs progressive’ or ‘economy vs ecology’ we have seen since the 1990s. We can create a politics where we all win, the only thing we need to do is find the words.

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