• health reform
• minister of health

In November 2001, Dr Michael Wooldridge, Australia’s health minister of nearly six years, retired from politics at the age of 45. In retiring early, Dr Wooldridge fulfilled his own longstanding prediction that the health portfolio would be his political graveyard, and in this he shared the fate of most Australian health ministers over the past 30 years. It seems that, in Australia, there is little chance of life in politics after health and the ideal health minister needs the capacity for a second or third career as well as the ability to live with political risk.

Yet the health portfolio is a senior cabinet position, and health policy is a matter over which government can be won and lost. Our tax based system of universal access to medical, hospital and subsidised pharmaceutical services, supplemented through private insurance and private health services, ensures that health is an electoral issue, and never long out of the media and public debate. But not, apparently, a training post for future party leaders or prime ministers.

Health remains a deeply contested ground, and a test of strength for the minister. One of the key tests—regardless of the political colour of the government—is the minister’s ability to retain control over health policy against the depredations of the central agencies, the departments of prime minister, treasury and finance, which are the natural enemies of this largest of the “spending portfolios”. The second key test is the ability to do more than this—to move beyond health financing and into more substantive areas.

The task of the health ministers is also complicated by a jurisdictional problem. Australia has a population of less than 20 million people, and nine ministers of health—one federal and eight for the States and Territories. Responsibilities for all aspects of the health portfolio—policy, public health, and health care—are divided and overlapping across the two levels of government. We have no shortage of ministerial attention, and a large infrastructure of coordinating mechanisms has grown up to enable national action on key policy areas—like research, food and drug policy, aboriginal health and public health.

In this setting, the ideal health minister needs a talent for coalition building towards a coherent policy agenda. Just understanding the dynamics and contradictions can take years for a novice, so systems thinking is needed, and a background in the health professions is an advantage.

But when I think about the dozen or so health ministers (federal and state) with whom I have worked and sometimes struggled, it seems to me that the keys for success are a combination of commitment to policy goals that stand above the dusty arena of politics, and the strength to maintain control of the policy agenda.

Dr Neal Blewett (health minister from 1983 to 1990 and one of the few not to fade from the front bench immediately) may well be judged the most significant achiever in the portfolio over the past 30 years. Dr Blewett will be remembered for his success in reinstating universal access to health care through Medicare, and for his leadership of Australia’s prompt and successful strategies in response to the HIV/AIDS epidemic.

Both of these initiatives have survived and now enjoy popular support (although Medicare remains under constant challenge from conservative governments that profess commitment while they chip away at the policy foundations). But at the time, they were politically courageous, socially progressive, and required the ability to extract new money for health care. Ideal characteristics for a health minister.