Australian cultural attitudes may inhibit health policy research
Mark Lock, Centre for Health and Society, The University of Melbourne
24 January 2008
I enjoyed the article and applaud efforts to improve health policy research capacity in Australia. I am currently a PhD student (writing-up stage) in the area of national Indigenous health policy, focused on the question of 'what is the nature of Indigenous peoples participation in national Indigenous health policy processes?'. I came to the PhD in health policy route via a very tangled route indeed, and with the benefit of hindsight, I would have been in a much stronger position if I had undertaken undergraduate training, especially in the political and social science disciplines. I've come into the research very deficient in the knowledge of theories and methods from those two perspectives, relying on the guidance of my overworked supervisors.
I want to address some underlying socio-cultural elements in Australian society that I think may be a factor in the lack of focus on health policy research. First, I am not a medical doctor but it was made clear to me very early-on in may career that if you want to make a difference in health then you have to be a doctor. Now over the years I've come to a greater understanding of this kind of attitude through, especially, sociological literature on medical dominance. Of the many facets of this perspective, I think that one that rings strongest for me is the reliance on hard-evidence generated through clinical trials, in contrast to a distant emphasis on research from on social, cultural and structural perspectives that impact on health and the health system. I think the prevailing (and deep seated) attitude is one of 'doctor knows best', therefore one should produce more doctors as opposed to health policy researchers.
Second, I have detected amongst health professionals (dietitians, health workers, nurses, health promotion officers, and doctors) a frustration that governments are just not acting according to the hard-evidence and that ''it's just politics'', and the emphasis quickly gets to focusing on making decision-makers more rational beings. In this kind of way of thinking, policy comes to mean "nothing but words". Therefore, promoting health policy research is seen as an unnecessary waste of time for many health professionals.
Third, in the Indigenous health area all efforts are directed to intervention style research at the local (community) level that makes a tangible difference to the communityas the research is conducted. It is a culture that discriminates against any kind of theoretical or analytical policy work especially at the national level, the type that I'm conducting and that is sorely lacking in Indigenous health policy.
Fourth, again another cultural aspect and one I suspect of being relevant for the wider Australian community as well as Indigenous peoples, is an emphasis on making changes through the health minister or prime minister in the vein of a ''just get it done'' attitude. I've noticed in the Indigenous affairs policy literature that researchers and political activists alike tend to focus exclusively on getting policy change to occur through the prime decision maker at the time (minister/prime minister), in the belief that this is where efforts should be made. From this view, the focus on politicians renders the entire health policy system and processes invisible, so why would you do research for/on it?
Finally, using the word 'policy' hooks into these attitudes, and I see changing attitudes about policy as one of my tasks as an Indigenous health researcher. Having a health policy component as mandatory for undergraduate degrees may make a difference over many generations of health professionals. I would like to see such a component specifically change the discourse around what is policy and what is it good for, that is the relevance of policy. I think that this is also a relevant issue to address in any proposals to change education systems, as the attitudes above also exist in universities and in the minds of those making decisions on what courses to fund.
Australian cultural attitudes may inhibit health policy research
24 January 2008
I enjoyed the article and applaud efforts to improve health policy research capacity in Australia. I am currently a PhD student (writing-up stage) in the area of national Indigenous health policy, focused on the question of 'what is the nature of Indigenous peoples participation in national Indigenous health policy processes?'. I came to the PhD in health policy route via a very tangled route indeed, and with the benefit of hindsight, I would have been in a much stronger position if I had undertaken undergraduate training, especially in the political and social science disciplines. I've come into the research very deficient in the knowledge of theories and methods from those two perspectives, relying on the guidance of my overworked supervisors.
I want to address some underlying socio-cultural elements in Australian society that I think may be a factor in the lack of focus on health policy research. First, I am not a medical doctor but it was made clear to me very early-on in may career that if you want to make a difference in health then you have to be a doctor. Now over the years I've come to a greater understanding of this kind of attitude through, especially, sociological literature on medical dominance. Of the many facets of this perspective, I think that one that rings strongest for me is the reliance on hard-evidence generated through clinical trials, in contrast to a distant emphasis on research from on social, cultural and structural perspectives that impact on health and the health system. I think the prevailing (and deep seated) attitude is one of 'doctor knows best', therefore one should produce more doctors as opposed to health policy researchers.
Second, I have detected amongst health professionals (dietitians, health workers, nurses, health promotion officers, and doctors) a frustration that governments are just not acting according to the hard-evidence and that ''it's just politics'', and the emphasis quickly gets to focusing on making decision-makers more rational beings. In this kind of way of thinking, policy comes to mean "nothing but words". Therefore, promoting health policy research is seen as an unnecessary waste of time for many health professionals.
Third, in the Indigenous health area all efforts are directed to intervention style research at the local (community) level that makes a tangible difference to the communityas the research is conducted. It is a culture that discriminates against any kind of theoretical or analytical policy work especially at the national level, the type that I'm conducting and that is sorely lacking in Indigenous health policy.
Fourth, again another cultural aspect and one I suspect of being relevant for the wider Australian community as well as Indigenous peoples, is an emphasis on making changes through the health minister or prime minister in the vein of a ''just get it done'' attitude. I've noticed in the Indigenous affairs policy literature that researchers and political activists alike tend to focus exclusively on getting policy change to occur through the prime decision maker at the time (minister/prime minister), in the belief that this is where efforts should be made. From this view, the focus on politicians renders the entire health policy system and processes invisible, so why would you do research for/on it?
Finally, using the word 'policy' hooks into these attitudes, and I see changing attitudes about policy as one of my tasks as an Indigenous health researcher. Having a health policy component as mandatory for undergraduate degrees may make a difference over many generations of health professionals. I would like to see such a component specifically change the discourse around what is policy and what is it good for, that is the relevance of policy. I think that this is also a relevant issue to address in any proposals to change education systems, as the attitudes above also exist in universities and in the minds of those making decisions on what courses to fund.
I hope these comments are useful.
Regards,
Mark Lock
PhD scholar
Centre for Health and Society
The University of Melbourne
Competing interests
None declared