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)