• health reform
• minister of health

In developed countries, health systems are complex structures that may run even in the absence of a minister of health, and at least in Italy the idea of abolishing the ministry of health and de-centralising its powers has long been considered.

A key issue is, therefore, what can an ideal minister of health add, and what skills are required. To successfully finalise his activities, a minister of health should have a deep knowledge of the way the ministry—and the government at large—are working. Otherwise, the minister may will be overwhelmed by bureaucrats, and even the best initiatives will never be approved.

The minister must be able to communicate the value and importance of health related issues, in order to provide adequate support to them. The minister must also be able to communicate priorities in health, giving information on quantitative relevance of various issues on the health of the population. For instance, a minister of health should have adequate skills and prestige to explain in quantitative terms the health consequences of tobacco, BSE, and electromagnetic fields,¹ and give consequently rational priorities for interventions.

The minister of health is frequently seen as a technical job, and—at least in Italy—most health ministers over the past decade have been doctors. Not surprisingly, however, their impact even on important health related issues has been limited. Thus, none of them was able to implement a modern tobacco legislation despite several attempts and substantial support from public opinion.^2,3

Whatever the background of the ideal minister, he must be able to identify and select competent collaborators from various disciplines, including medical, social sciences, economics and ethics, and to organise multidisciplinary working groups. A minister should, in any case, be able to identify groups of competent and independent advisors to evaluate and review official acts and their implications. The minister should not have—present or past—conflicts of interest, including links with the pharmaceutical industry, private hospitals, or other health related economic activities. The minister must also have adequate time and competence to follow the organisation and efficiency of services provided by the ministry.

A minister should be able to organise budget and resource allocation—if required. Political attitudes will also be required to assess and balance various health related interests, including those of doctors and other health professionals, of hospitals and other public and private service providers, of the drug industry and regulatory agencies.

Throughout this editorial, we have not tackled the issues of ethnic background and gender, as they are neutral, and only for the sake of simplicity we have used “he” instead of “she” in the text. Within the relatively small political differences seen in most western Europe countries, even the political orientation is probably not vital. Left wing politicians tend to be more open to social and hence equity related issues, but health is such a basic requirement that most right wing politicians would not be willing to support or increase inequalities in health.