If current policy and practice in the Australian health sector were adequate, the rates of chronic ill health, domestic violence and substance abuse would be far lower than they are. Statistics on, for example, the proportion of children who are overweight or obese (about 25%) before the age when they can be deemed responsible for their own well-being should galvanise governments into remedial action.
Human beings are complicated creatures and live within complex communities. The causes of ill health are not always clear, may have been operating decades previously — or before birth — and only some are under the individual’s control. Further, any attempt to differentiate the contributing factors that require a collective remedy from those that should remain an individual’s responsibility is always contestable.
To negotiate their way in the world, people need adequate life skills, supportive families, capable civic services and an effective health safety net when life capacities are deficient. For all of these, skilful public policy is necessary. In other words, advancing the well-being of the Australian people requires both policies and programs to support individuals on their personal life journeys; as well as policies and programs to guide community and government activities.
The Royal Societies of Australia, a collective voice for the state-based Royal Societies, has agreed to launch a new initiative termed “Preconditions of well-being”. The project aims to sketch a model of public well-being, in the form of a collection of policy settings that, as far as practicable, would enable the people of Australia to enjoy a healthy life from babyhood to their fading years, along with the ingredients of a feasible path to transition to that sunny situation from the present.
Rationale for involvement of The Royal Societies of Australia
In the early days of Australia’s colonial occupation, a Royal Society was established in each state, modelled on the Royal Society founded in London in 1660. The birth of the original Royal Society signposted the beginning of the European Enlightenment, the evolution of thought away from personal servility towards personal liberty; and away from religious rigidity towards curiosity-led, evidence-led enquiry.
The bedrock activity that cements the role of each Australian Royal Society in curating and advancing knowledge is the publication of a peer-reviewed journal. Each has done so for more than a hundred years. Peer review is not a guarantee of either objectivity or truth, but it narrows substantially the scope for error and establishes a platform for further advances in knowledge. In this, the societies follow in the tradition of the very first scientific journal, published in 1665. It is on this bedrock that advances in medicine, technology and innumerable other fields have been built.
The expansion of knowledge since then, at an accelerating rate especially since World War II, is a testament to the validity of the scientific method and the usefulness of the peer-reviewed journal as a vehicle for legitimising, disseminating and preserving advances in knowledge. But that very expansion has led to a proliferation of specialist journals to accommodate the immense volumes of new information, reflecting the splintering of scholarly endeavour and reinforcing disciplinary isolation — the silo effect.
Therein lies an immense challenge for politicians, public servants and others responsible for formulating public policy: how to glean the latest information from scholarly journals; how to mesh information from disparate disciplines; then how to reconcile conclusions from the scholarly literature with expressions of opinion from all points of the ideological compass. It’s a daunting challenge and one that politicians are all too often tempted to bypass in favour of a knee-jerk reaction when the press comes baying for action, or political blood. Who needs medical journals when the press demands a response on the latest juvenile crime by deadline today?
Given the worldwide expansion of medical knowledge and the depth of expertise in the professions that are custodians of that knowledge, it would be logical to assume that generalist learned societies that do not profess high status in medical circles would be unable to identify a niche that would warrant their hosting a new initiative. However, public policy conducive to well-being requires research and analysis that crosses and transcends the knowledge compartmentalised in disciplinary silos, far beyond orthodox medicine.
Knowledge of science, medicine, engineering, developmental biology, economics, law, public administration, intergovernmental relations and even philosophy and religion is required. Forums are needed to apply the scientific method systematically to a complex problem that has metaphysical, biophysical, socio-cultural and governance dimensions.
The interest of the Royal Society of Queensland, to take just one of these learned academies as an example, in community health dates back to the foundation of its predecessor Philosophical Society of Queensland in 1859. The first paper in its Transactions was on asphyxia, the second was on the ventilation of buildings. Other early papers covered public sanitation and the water supply for Brisbane. The scope of the Society’s activities has always been the gathering of evidence-led knowledge and application of scientific method, tools that are central to the challenges facing public health.
Further, there is a recurrent theme in the initiatives that the society has explored for policy implications in the past five years, such as the national electricity regime, mine rehabilitation and stewardship of the rangelands: it is the absence of a strong coordinating centre able to steer the capacities of those with knowledge towards a coherent conclusion. Knowledge resides in national, state and local governments, landholders and customers, the commercial sector, civil society groups as well as scientific institutions. Most parties involved are jurisdiction-bounded, partisan, sectoral, mistrusted, narrow in vision, captured by economic rationalism or chronically underfunded. Further, now-influential social media have come to be compromised by massive volumes of misinformation, partially valid information and disinformation.
In summary, policy nowadays requires non-partisan, multidisciplinary deliberative platforms with no commercial or partisan profile to defend. Therein lies the sharp edge of the dilemma facing Australia’s policy community: the bodies animated by public interest require public funding and are almost universally poorly resourced compared with the bodies with interests to advance, and in consequence are poorly equipped to enter policy debate.
Led initially by The Royal Society of Queensland, the Royal Societies of Australia have resolved to do the best they can with volunteer resources and are grateful that the editors of The Mandarin have agreed to offer space in its columns for a series of occasional opinion pieces, aiming in due course to build into a model outlining the preconditions for well-being, and aspiring en route to establishing a standing deliberative forum that will steer policy in effective directions.
We will aim to uncover theories of cause-and-effect that can lead to understanding the nodes in the health, education and other systems at which interventions are likely to be most cost-effective. Among many other themes, we will aim (although not in neatly prescribed order):
- to explain that what burst forth as contemporary ‘crises’ commonly have long preceding roots;
- to identify the metabolic, environmental and socio-economic pathways by which humans suffer ill health;
- to explain why conventional medicine has not promulgated and applied sufficiently effective remedies beyond acute remedies, noting the influence of providers and lobbyists;
- to resolve the tension between individual and collective responsibility in applying solutions;
- to articulate criteria by which those with influence over policy can differentiate between public and private interests and can discharge their responsibilities for public well-being.
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