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Tuesday, 20 December 2011

Santa’s list - on being good or bad: the need for political success

There are at least three kinds of public service functions.  
1                     Those things that are associated with the perception that good is being done by government and carry political currency as vote getters.
2                     Those things that if government does bad will cost votes in the next election.
3                     The rest of the stuff that is morally the right thing to do and traditionally what civil governments did.
Santa Claus would likely easily get elected to government.  He swoops in once a year and gives out lots of goodies, does a phenomenal public relations job, and then disappears without having to accountable for his actions or inactions. 
Politicians would love to be Santa. They are however held accountable to the public every 3-4 years for the totality of their work.  So how to you decide who you vote for? 
·         Are you a staunch supporter of a single political party because of their ideological beliefs?
·         Do you vote out the incumbent because you didn’t like the way they handled a particular issue?
·         Do you retain the incumbent because they did something really good, or more likely you can’t recall a major blunder while they were in office?
·         Do you weigh the characters lined up in a public forum as if you were speed dating?
Churchill said it well when he stated that democracy is the worst form of government except for all the others that have been tried.  
So what has this got to do with public health?   How often have you bemoaned the lack of resources for public health?  Questioned why a needed program was sliced and diced?  Wondered why program X got funded when program Y would make a bigger difference? 
We are in an age where populous opinions run governments.  Near real time polling can provide quick feedback on decisions and the overall stature of the government.  What hurts governments the most are decisions that lose votes.   Doing nothing is next worst.  Doing the “morally” right thing for the public’s health is hardly on the page.  
New hospitals buy votes.  A long wait in the emergency lose votes.  Cutting prenatal education or family supports hardly goes noticed as most of those affected haven’t enjoyed the service in the past.   Shifting funds to new programs is seen as "doing” something and therefore politically correct. In a time where impoverishment and homelessness carry political currency as a form of collective charity, these become areas for investment.  It alleviates personal guilt when I know 'my government' is 'taking care of those in need'.
Moreover success breeds success.   We’ve gotten much better at replacing hips and knees and reducing the wait times, so of course it is politically valuable to seen as supporting such joints through more resources.    No doubt you can see the value in funding more cataract surgeries.   That we have progressed to a point where some of the value of the surgeries is being questioned by experts, has yet to deter the public who if told by “their” expert that they need the surgery will be dismayed if informed that they don’t qualify. And politicians can stand up and say, we have done so much to ensure that surgery is available, emergency rooms accessible, hospital and long term care beds are there we you need one.  Lately the push is to ensure that every Canadian has a family doctor, do you see a pattern developing in how to shift health care resources?
I’ve yet to hear a politician brag that there is a shelter bed available for you should you ever need one, or that there will be a nurse available to support you through your pregnancy and first years of being a new mother.  Or that you are expected to live  10 years longer and healthier than your parents, and three-quarters of that gain was due to public health efforts.   
So the holiday question, is how to make public health issues political currency so Santa will come and visit?  

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