Friday, November 7, 2008

Dear Mr. Harper: Try a Post-Partisan Approach to Public Health Policy | Neill Seeman Essay

November 4, 2008

Dear Stephen,

In 2001, we worked on a historic legal challenge to expand free speech in this country. We fought so-called election “gag laws” (enacted federally in 2000) that limit spending by third party groups – of all ideological persuasions – during political campaigns. Although our arguments failed at the Supreme Court of Canada, this was a popular cause – applauded by many legal, academic, and media commentators across the political spectrum.

Under our line of reasoning, organizations opposed to, say, seal hunting should be constitutionally entitled to advertise during elections to promote their cause. The current law, one might argue, creates a "two-tier" system, where political parties are free to advertise during an election campaign within certain limits, yet third parties are silenced.

Building up to that landmark legal challenge, you reached out to people from a variety of political camps. Yet today, some members of the media and academia unfairly characterize you as intolerant of views that differ from your own; I know this to be untrue. Given your passion for the airing of different political views – the same passion that led you to doggedly challenge Elections Canada’s limitations on third party spending during campaigns – I have a suggestion on how to show global leadership during your new mandate: Pursue a postpartisan approach to the creation of effective public health policy.

As I argue in the current special edition of HealthcarePapers focused on obesity, “post-partisanship” is unlike “bipartisanship”. Bipartisanship is horse-trading – in its best incarnation, this means crafting patchwork legislation that allows all sides to feel satisfied that some thread of their vision or ideological essence found its way into law. The process plays to ego, not good policy.

In its worst incarnation, bipartisanship is merely rhetoric on the campaign trail, and nothing more. On the other hand, “postpartisanship”, a vision of politics championed by Governor Arnold
Schwarzenegger of California and New York Mayor Michael Bloomberg, is a more sophisticated decision-making model that breathes life into novel policy ideas to yield maximum, lasting impact.

In HealthcarePapers , I apply the vision of post-partisanship – elucidated in the book Radical Middle: The Politics We Need Now by Marc Satin – to health policy. I argue that the 10 political principles of post-partisanship Satin describes are ideally suited to public health, since public health policy-making, such as anti-obesity initiatives or mental health improvement strategies, necessarily requires long-term, multi-sector solutions that are enabled by strong legislative supports. Representatives wedded to a long-term public health cause also need to sustain lasting relationships across party lines in order to buttress the original legislation with interim evaluations, re-investments and other policy supports. Herein lies one of the practical benefits of a post-partisan approach to decision-making.

As noted by Satin, the 10 post-partisan principles are as follows:
1. Relationships are as important as convictions.
2. Criticism needs to be well-balanced by self-criticism.
3. There must be an overriding commitment to dialogue and deliberation.
4. There must be an overriding commitment to diversity of opinions and perspectives.
5. Compromise is not the only endgame.
6. Be simultaneously creative and practical.
7. Demonstrate a penchant for big ideas.
8. Support a bias for action.
9. Demonstrate concern with values and principles.
10. Have a long-term vision.

I believe that these 10 principles can provide the basis for a priority setting public health policy model that will temper political self interest. Under this vision, diverse decision-makers can come together from the outset of planning and policy debate; decision-makers can feel free to disclose their competing interests; and validated analytical techniques can be used to select the most innovative, unbiased and criteria-based ideas from among all those considered.

Post-partisan decision-making, in advance of landing on any final policy proposal, allows multi-sector partners to select weighted solution criteria (a process formally referred to as multi-criteria decision-making analysis). The process enables a neutral, independent commission with assigned legislative power (comprised of members nominated by all parties) to identify the cognitive and partisan biases that may have inadvertently crept into any final, recommended policy solutions.

This process can serve innovation. As the global financial crunch tightens its noose on governments, we require innovation in the service of better value. Public health is a good place to start. Unlike other domains of health care policy (such as hospital management), both the federal and provincial governments have constitutional jurisdiction over key areas germane to public health.

Federal constitutional authority extends to “peace, order and good government” and all matters not explicitly assigned to provincial authority. The Department of Health Act provides a federal mandate to protect against the spread of disease, to provide surveillance, to guide public health research (e.g. via the Canadian Institutes for Health Research) – and to advance the physical, mental and social well-being of Canadians.

Stephen: You have the unique opportunity to make post-partisanship the new culture of Parliament. A first step might be to create a multiparty committee of independent members from across Canada charged with designing the weighted criteria by which potentially high-impact public health policies should be assessed prior to design and implementation. The criteria might include: estimated policy magnitude; the effectiveness, if known, of current interventions; the ability to effect change in the near- and long-term; and cost effectiveness.

We are in an era of zero-sum budgeting and fiscal challenge while tackling the steady, unyielding onslaught to our health care system from increasing rates of chronic disease such as diabetes, cancer, heart disease and asthma. Governments face a stark choice: innovate; or implode, borrowing against the future and creating further intergenerational inequity in order to sustain the health care system.

The good news is that you will not be the first to embrace postpartisanship. And we have seen dividends come from such an approach in the arena of public health. Consider that Gov. Schwarzenegger’s state has witnessed a dramatic percentage decline in teen pregnancy rates. This is especially impressive since it occurred during mass migration to the state of sub-populations with very high teen pregnancy rates such as those seen outside of California.

California’s ambitious plan to curb teenage pregnancy – as with the governor’s new leadership in the battle against childhood obesity through mandated school physical activity- and healthy-lunch initiatives – would never have taken place but for Mr. Schwarzenegger’s continued openness to opposing viewpoints.

Like any other political model, post-partisanship is just a suite of ideals that will only succeed if elevated to a science. In the pursuit of more innovative and cost-effective public health interventions, you possess the skills to make the approach work. This is the kind of politics Canada’s health system needs now.

Neil Seeman
Senior Resident in health system innovation
Massey College at the University of Toronto,
Adjunct Professor of Health Services Management
Ryerson University.
In 2001, legal and policy advisor to Prime Minister Stephen Harper
in Harper v. Canada (AG)
Email: neil.seeman@utoronto.ca

4 comments:

sharon said...

Sam....

I am very interested in what Neil Seeman has said .... and has to say.... but I need to research some elements before I can justify comment.

These researched elements would relate to more non-obvious impacts of sociology ,"timing"..... and checking to see whether the horse is still in the barn :)

sharon said...

From what I can see, Neil Sleeman is everywhere ......travelling in roadworthy vehicles ( mental health and obesity ) toward a destination of centralizing his concept of public health ......in the minds and lives of everyone..... in the entire world.
He is "everpresent" in both the top-down and bottom-up world. He is fresh-faced and a "keener"

Hey...... go for it! :)

He is calling for the design of a fulcrum and is looking for the lever(s) which will pivot upon it.
Interestingly he sees the top-down strengths as still central in the face of an almost completely disassembled health care ?system.
His academic background would find it logical to see the road for his vehicle to be traditionally constructed through policy supported legislation and law ....which is not untrue ....

However, if he is going to take a Durkheimian view he should do it at "both" the macro and micro level.
Macro says the entire society should be integrated as one big unit.
Micro says look at the "theory of rituals" in small groups

RE: Macro
Look no further than the UK for the impact of soliciting innovation on the clustering of experts and the tension created by non-performance.
Look no further than the halls of acadaemia where " publish or perish" is their favorite" tatt."
Their only salvation will be Medicine 3.0

RE: Micro

Here we have significant action brewing with a combination of JIT healthcare, reward interdependence, and "pockets of trust" forming in " clusters"( nonrational rationality is birthing ). In order for this to work there absolutley must be some reward interdependence over a long period of time. It is absolutely crucial for the "macro" perspective to link with the " micro".

In that search, Neil promotes politician-to-politician practices (anything wrong with this picture).
Focussing on the " management of factions" a good plan would be to integrate the functioning clusters and present them as viable examples to the decision-making head.

Sadly, the "functioning clusters" are not fully developed as key health provider stakeholders are not committed to a shared model of governance. Will they develop before Medicine 3.0 shuts them out?

In his essay Neil notes:

paste
As noted by Satin, the 10 post-partisan principles are as follows:

1. Relationships are as important as convictions.
2. Criticism needs to be well-balanced by self-criticism.
3. There must be an overriding commitment to dialogue and deliberation.
4. There must be an overriding commitment to diversity of opinions and perspectives.
5. Compromise is not the only endgame.
6. Be simultaneously creative and practical.
7. Demonstrate a penchant for big ideas.
8. Support a bias for action.
9. Demonstrate concern with values and principles.
10. Have a long-term vision.

end of paste

......Looking at public health again in a companioning of Macro /Micro Durkheimian perspectives:

1. Relationships are as important as convictions.
(Sherry Arnstein's ladder brings both ends to the middle)

2. Criticism needs to be well-balanced by self-criticism.
( would only work if a non-partisan third party provided this ( e.g. health ombudsman role)

3. There must be an overriding commitment to dialogue and deliberation.
( stage is set for this with the IEPCP project-based funding)

4. There must be an overriding commitment to diversity of opinions and perspectives.
( in a matrix-grouping this is doable at both ends )

5. Compromise is not the only endgame.
(JIT in healthcare and related Deming and Juran concepts must be replaced with acceptance of the conflict and domination that results from integration at the micro level. Attenuate it with reward interdependence.)

6. Be simultaneously creative and practical.
[better drain the moat and lower the drawbridge around the ivory castle :) ]

7. Demonstrate a penchant for big ideas.

[ can we change this to " take the time to completely assess big ideas before running off to be first at the gate" :) ]

8. Support a bias for action.

Now here is a "key" statement. But this action must be multi-focal, differentiated, and consist of short,mid and long-term proveable results
with circular service dependence and cost independence.
Does an academic or politician know how to do that?

9. Demonstrate concern with values and principles.

Yes, let's have the decision-making tree for policy ethics echo some other goal than " economically viable"

10. Have a long-term vision.

Well now, this could turn this list into a circular dependent activity if you take this goal back to Sherry Arnsteins ladder ( see 1.)

NOTE: I usually only blog to Canadian Medicine ( Sam Solomon) so this will also ? appear there.

Neil Seeman said...

Thank you Sharon for these (generous and provocative) comments. Candidly, the post-partisanship vision is something I've stumbled upon; my attraction to it is based on my personal life journey and events of an unpredictable nature. It is (happily) taking on some resonance, with many young people around the world connecting to me in relation to it. I would only wish that the concept of scientific solutioning via post-partisanship takes off as successfully as the "Partisans" (i.e. the old-Left-turned neoconservative movement) took off in the 1960s. Now is the moment in time for an antidote to partisan bickering begun 50 years ago.

Intriguingly, you mention Web 2.0 and 3.0; there are clear overlaps here. 2.0 (and SNA), in my view, proves that innovation is random and unexpected. As you suggest, the traditional academic route toward innovation is dying as new rapid-action publication models fluourish. This is deeply relevant to post-partisanship, since post-partisanship preaches some of the very same principles as 2.0: transparency, radical unyielding diversity of opinion, and unexpected connections among ideas.
Funny that you mention Durkheim. I confess to being confounded and awed by Durkheim, though there is in Durkheim a call for social innovation, again something which can be enabled via post-partisanship. My "call to arms" is not to abandon our biases, but to acknowledge we all have them, and, via post-partisanship, create an independent cognitive check to ensure good public health policy gets created through a "bias detection model". I suppose the way I've fashioned it at present is top-down but it needn't be. I will need to build a theory of how to merge top-down and bottom-up approaches to post-partisanship. Again, thank you for the comments. Neil Seeman

sharon said...

Neil

People of passion... coupled with "direction" are attractive to "searchers" (e.g. the young attracted to your vision)

Red flags go up for me when I see a comment like this

paste from your comment

'the post-partisanship vision is something I've stumbled upon; my attraction to it is based on my personal life journey and events of an unpredictable nature.'

end of paste

well.... let's all revisit Chaos Theory then ... or fractal geometry ( Mandelbrot ).

Is there anything wrong with this?

Yes ... it is limited by " vision"
e.g.
I am a fan of having a " cornerstone" perspective we can all return to.... to reset the dial... but the world has moved on and we are exponentially replicating "cornerstone" ideas, ethics and " apparent ".....everything. (web 2.0)
Far more significant is to look at the "pattern" produced by the " replication" ( leads to web 3.0)

e.g. I recently made a report that uses a picture of two men talking through a membrane where garbled letters are translated into cohesive message on the other side.
The joke of it is..... the " shape of the membrane" is birthed from a "Julia Set"
( quote
' another cardioid with associated circles! Not exactly the same, but close. In fact, there are lots of these tiny little clusters. You can find them along the filaments connecting everything together.'
end of quote)
source: http://aleph0.clarku.edu/~djoyce/julia/julia.html

therefore what the picture portrayed is " the reverse is true" ....which is what I was really trying to get across to a " top-down" group perspective talking about how a foundation could provide mezzanine financing to innovation in healthcare........
.............but no one noticed....

What they were currently doing in reviewing Pasteurs Quadrant is ' not exactly the same ... but close' :)

....as we both know "close" is only good in hand grenades and horsehoes ..... and these "small deviations" have grown unchecked so exponential replication presents as both visible ...and threatening as the "geometric rate" is running too fast( almost) for us to stop it.

Summary

Vision is no longer enough. Innovation is no longer enough.
A " pattern of proven performance with measured consistent results ' far exceeds a " flavour of the month" approach.

What was old ... is new again ..."trust" and " reciprocity" under a sign that says" in business since 1805 :)

.... there's a pattern there, don't you think?

And I think Stephen Harper has a good perception on how to send this " tried and true " message to us.
I also agree with you when you say in your letter to the Prime Minister
'Yet today, some members of the media and academia unfairly characterize you ( Harper) as intolerant of views that differ from your own; I know this to be untrue.'