MIC CAVAZZINI: Welcome to Pomegranate Health, a podcast about the culture of medicine. I’m Mic Cavazzini for the Royal Australasian College of Physicians. In episode 78 we heard from some physicians who found themselves taking up the role of advocate, not just for their own patients but for broader system change. Helen Young campaigned to get child refugees off Nauru, after seeing first hand the trauma caused by their detention. Jin Russell raised an army through social media to secure continued funding for unique longitudinal study in Aotearoa New Zealand.
And healthy policy lobbyist Patrick Tobin explained how physicians and the College as whole can best get the attention of parliamentarians. We heard an example of this in the last episode; the Healthy Climate Futures campaign calls on Government to make the healthcare system more resilient against the shocks of climate heating and extreme weather events. To complete this series, we’re going to hear what happens to advocacy issues after they land on an MP’s desk, and how they get churned through the Canberra machine to eventually become policy.
Dr Mike Freelander practiced for 37 years as a paediatrician in Sydney’s southwest before being asked to take a tilt at politics. In 2016 he was elected to the federal Division of Macarthur representing the Labor party and the people he’d spent his career attending to. Dr Katie Allen was elected in 2019 as the Liberal Member for Higgins near the centre of Melbourne. She’d worked for 28 years at the Royal Children’s Hospital, directed the Australian Centre of Food and Allergy Research and held a chair at the Uni of Melbourne.
The MPs were interviewed over a year ago for an RACP documentary called The Advocate’s Journey that was hosted by Perth respiratory paediatrician, Dr Rob Lethbridge.
ROB LETHBRIDGE: Dr Freelander, you used to be the head of paediatrics at Campbelltown. Hospital, you're a lecturer and according to your website, you've seen over 200,000 patients and so you obviously had a great deal of influence in your community. Why did you decide to make a leap into politics? And what new avenues does that give for advocacy?
MICHAEL FREELANDER: Well, I've always had an interest in politics. And what I was finding increasingly with my patients was that many of the issues they were coming to me for were not so much medical issues but more social issues; things like housing, things like schooling support, things like access to different forms of medical care. As you know my electorate, Southwest Sydney, we have a number of different disadvantaged groups, and I was writing lots of letters to politicians, lots of letters to government departments, and finding it very frustrating to support many families that were really struggling. So I had been asked on a number of occasions whether I would be prepared to stand and, you know, it's difficult when you've got a busy practice and you're enjoying what you do. But I decided in the end it and more or less out of frustration that I would give it a go, because I think that there are a lot of things we need to change in access to health care and support for families in Australia.
KATIE ALLEN: I think I've been asked that virtually every day that I was running. I think the thing for me is that when I became a doctor, I very quickly wanted to do more than see patients, I always want to try and fix the system. And in fact, that was what led me to do medical research, very interested in preventative health, very interested in public health, and always trying to work out why people coming into my door in the first place. And so, to me, politics is the next natural step from that. It's about getting inside government to try and help make the decisions that affect each and every one of us each and every day.
ROB LETHBRIDGE: So has it met your expectations? Have you been able to put forward some of those positions?
KATIE ALLEN: Well, actually, I have to say it's been intoxicating to be in Parliament. And when I sort of got into Parliament people said, “Oh you’ll find it terribly frustrating, because, you know, things take a long time to change.” And I said, “Are you kidding me? I've been in medical research where things can take years to change.” I mean, I spent eight years trying to change international infant-feeding guidelines, successfully, so we have “around six months and not before four months.” I'd like to say that's my eight years-worth of advocacy—it won't win the Nobel Prize, but certainly changed the lives of literally millions of children around the world. Well, in politics, things happen at lightning speed. People who come from the corporate world probably feel frustrated because they're at one end of the spectrum. But medical research is sort of at the slower end of the spectrum and politics is somewhere in between.
ROB LETHBRIDGE: Yeah, it certainly does take a long time and research and you've got an extensive background and research, obviously. And I was just wondering what intersection Do you think research has with advocacy?
KATIE ALLEN: Oh, they're very similar. In fact, people say, “Do you miss medicine or do you miss research?” And I’ve said, “I haven't really stopped in some ways.” So being a local Member of Parliament for my constituency is a like being a doctor; people come and see me, they have problems, I try and solve them. And instead of, you know, solving the problems of food allergy, I'm now solving their problems with regards to visa and Centrelink. So it's still problem solving, it's still dealing with people in the general public. When you're running a campaign, it's like when you were trying to set up a research group; you've got an idea, you've got to raise funds, you've got to talk to the media, you've got to convince people come with you on the journey, there's ups and downs, it's often a lot of hard work and not much reward. And then being in Parliament is like being at an international research conference, actually. You go to an international conference and sometimes people don't speak your language, or sometimes they don't agree with you. And it's about the debate and the respectful debate to get a situation where the knowledge is found, or the compromise is found. And it’s the same here in Parliament.
MICHAEL FREELANDER: Look, there’s always collaboration. I mean, sure it’s a contest of ideas, and it can seem a bit nasty if you look at question time. But there is always collaboration, there's always a wish to try and resolve the major issues. The Committee work is certainly a demonstration of that. I’m the deputy chair of the Standing Committee on Health with Trent Zimmerman as the Chair, we work very cooperatively together, I get on very well with him. And you know, we have very similar ideas.
ROB LETHBRIDGE: And so do you get many doctors contacting you with their ideas from the community just because of your background in health?
MICHAEL FREELANDER: I do. I get people contacting me about a range of issues. You know, something they want for their patients. And they often ask, “What's the best way to go about lobbying for this?” There might be a new medication that's available overseas for a particular condition; some of the newer anti epileptics; there is increasingly a push for, to consider the use of medicinal cannabis in some situations. And sometimes the issues are not necessarily just with the Department of Health, it may be the TGA, or it might be with specific companies sometimes reluctant to import things into Australia, if there's not a big market.
ROB LETHBRIDGE: OK, so if a doctor was reaching out to their local MP who doesn't necessarily have a science background, what things do you think they should be saying to get their message across?
MICHAEL FREELANDER: Well, look, I think the worst thing you could do is to over-complicate things, and to provide too much information at once. I get hundreds and hundreds of emails every day, I do not have time to read every bit of every one of them. And so, if you're going to provide information, it needs to be clear, it needs to be succinct, and no more than two foolscap pages. And if they can provide that, then you're much more likely to be able to digest the information quickly, and send it to the appropriate department or appropriate Minister's office. So be simple, be succinct, and understand that your individual politician certainly may not be able to change things overnight, but we'll be able to keep pushing the issue if he thinks it's one of merit and significance. But it does take time.
KATIE ALLEN: So the first thing to say is know who your Member is. Know which party they belong to. Know if they're in Government. Read up their background. Read their first speech, because their first speech is their roadmap of why they're doing what they're doing and what they're wanting to achieve. And then go knowing that information because you're halfway there. You know, it's like, again as a doctor, when someone comes in you ask them not just about their abdominal pain, you ask them, “Are they married? Where do they live?” You know, you ask them things that contextualize the abdominal pain. And just like with a parliamentarian, you want to contextualize their background, so you can understand them better.
ROB LETHBRIDGE: And so it sounds like you think that people should try and play the political game somewhat, even if they're approaching you is that right? To have an understanding of the context.
KATIE ALLEN: So it's not a—I mean, some people call it a game—I think it's deadly serious. You know, politics is deadly serious. And it demeans it to say it's game-playing because it's understanding the process. So if you are looking for a medical research grant, you just wouldn't rock up to the CEO of the institute and say, “Give me money.” You'd say, “Well, what does this institute do? Has this institute got the ability to give out funding? How can I show them that I am a credible person who can do research in this institution?” No one rocks up without that preparation—so why would you rock up to a decision-making body which is quite sophisticated without any understanding at all of what is going on?
ROB LETHBRIDGE: So it's about having a respect for the process and a respect for the people that you're communicating with?
KATIE ALLEN: Yeah, absolutely. Yeah. And the thing is that people kind it’s dirty. Politics isn't dirty, it is a process that has a philosophy depending on which party you in, it has a process depending on whether your Federal State or Council, and has a purpose. And the purpose is also different depending whether your federal state and Council, and some people haven't taken the time to work out the difference. So if you go and ask for hospital funding and you don't understand that you should be asking the state government hospital funding, then you haven't done your homework, and you're going to be wasting your time. And you'll get a nice conversation with your with your Federal member, but they may not be as interested in helping you because clearly, you're not aware of the different processes.
ROB LETHBRIDGE: What's the science literacy like amongst your colleagues?
KATIE ALLEN: Oh, with that one, I probably think not as good as it could be. And I did actually do a little bit of a show of hands in in the party room, and there's definitely more people trained in humanities than in the sciences. And that's what I said when I failed at the state election, I said to the journalist who interviewed me and said, “Oh, you must be disappointed.” I said, “Well, I'd like to have snow-ploughed for others to come behind me. I want to make sure that we have more scientists and engineers and doctors and people who have practical problem-solving skills, putting their hand up to having a crack at it. It's not just for those who've done law and commerce and the humanities, or small business owners or unionists. It's got to be also people who are in the professions and people who have a science and technology background.” Now, what's surprising about parliament is people assume that someone who has no experience in the area doesn't know anything about that area. I actually been really impressed by how much parliamentarians know about so many things. So it's a bit like being a GP, you have to know a little bit about everything.
MICHAEL FREELANDER: The problem with health issues and lobbying about health issues in Parliament is that there is not a big group of people who are science-based to understand health all that well. They tend to leave that to the Health Minister or the Shadow Health Minister and the Health Department. And so sometimes it's just a matter of explaining the issue in relatively simple terms for the parliamentarian so you can get things done.
ROB LETHBRIDGE: So that does raise the fact that you've been in Opposition since entering politics. Has that made things more difficult for you?
MICHAEL FREELANDER: Being in Opposition is much more difficult than being in Government, that's one thing I've learnt very quickly. Doesn't mean that I can't still try and influence things, but obviously it's much harder from Opposition. And I've been lucky in Greg Hunt as Health Minister has given me access to him, and he's made it clear that if I do have concerns, I can contact his office and he will attempt to deal with it and he's been pretty good.
ROB LETHBRIDGE: So since entering politics, has it met your expectations?
MICHAEL FREELANDER: Well, look, I think I was pretty naïve, actually. I look back now and think, “What was I thinking?” Because it can be quite frustrating, getting change at a political and bigger picture level. But what I have found is that the concept of what we do in Parliament, for the general public, is really not where all the work is done. The hard work is done in Committees, the hard work’s done in how you lobby the Ministers and the different Departments to enact change. And I can see in some ways, I think, that I've made a little bit of a difference. Not as much as I would like, I admit. And there are some things that I really want to make sure that we get changed. The concept of child health, I think needs to change, and we need to look at earlier and earlier interventions and supports. And in we need to allow our families of all sorts, at least to have stability and least to have their kids having access to health care, access to education, and stable housing. And they're the sort of things that I really work hard on.
ROB LETHBRIDGE: So certainly sounds like persistence is vital in all of this?
MICHAEL FREELANDER: Absolutely.
ROB LETHBRIDGE: Yeah. And persistence is something that I think is important in medicine as well. When you're a clinician. Do you think that you developed as a doctor is still useful in this place?
MICHAEL FREELANDER: In a whole variety of ways they are. As a physician you're in it for the long run. You know, if something's important you do learn to stick at it. And I think that's one of the things that it taught me about politics that you do have to be persistent. And just because I want something doesn't mean it's going to happen. It's a matter of keeping on to the people who have the power to make change keeping on their doorstep.
KATIE ALLEN: Well, I kind of think that when I was doing medical research, I never invested in one project, because if you do, it always takes a long time for one project to go ahead. So you sort of invest in a few different projects—a diversified portfolio, I suppose. So it's the same in politics, I've got myself involved in quite a lot of different projects. And I used to my, my researchers, “If it's a good idea, stick with it. It's not what percentage are successful per year. It’s does it ever become successful?” So I had 100% success rate, because I never gave up. So, it's just how long you in the game, you know, you either die or you give up.
But I'm hoping to be in politics for a long time. And I hope that the things that I champion, get over the line, eventually. And you just have to take the opportunities when they come and don't push against the door, that's not ready. Push a little bit. And if it's a really good idea it takes one push in it's the door is open. But the good ideas are worth sticking with because they’re gold. Sometimes they're the time’s a bit early, or maybe they need a bit more work on it. And it is like gold mining, medical research is like gold mining.
ROB LETHBRIDGE: Great. And could you give us a brief rundown about how you try and put forward your positions in Parliament and in politics, like what's the process that you have to go through as an MP to get your voice heard?
KATIE ALLEN: Well, I think the most important thing is to understand the political process. You’re a member of a Government and the Government has an executive. So it's a bit like when you're a member of Medical Research Institute, the executive of making decisions about how money will be distributed, but you can influence that. So you put your ideas forward, and you hope that they'll fund them. And that's the same when you start off being a young new MP, a Member of Parliament, you spend time convincing Ministers that your ideas are good ones. And you do that through a whole lot of different ways. And so there’s the party room itself. There’s opinion pieces—so I have a KPI for myself that I write regular opinion pieces. You float ideas, you have a lot more opportunity when in Government to speak to the Parliamentary executive on a regular basis. And that might be in a formal setting where you make time to see the Minister. Might be an informal setting, because you have a good relationship with them. Or it might be I sent the letter, I then text her or him and then I'm sitting in a Division and I remind her or him.
Because if you know where the current is going, you can get into the deal flow more easily. For instance, if the government wants to invest in women in STEM, then then I'll say to my constituents, “Why don't you try and line up with this program or this grant initiative.” So what I have is an opportunity to know where the current of political thought is going, and what programs and policies that are lining up that will help the constituents that I represent. And sometimes I also represent medical research groups or public health groups or medical advocacy groups as well because they’re my pet interests. And education and women and climate action and you want to take on the big ideas and you want to take on the big strategies, but you also want to get a few small wins as well. So you want to have a bit of a diversified portfolio
MIC CAVAZZINI: Many thanks to Katie Allen and Mike Freelander for contributing to this episode of Pomegranate Health. With a change of government two weeks ago, Dr Freelander may now have the opportunity to see some of his personal vision enacted. Dr Allen sadly lost her seat, but she was replaced by another Fellow, Michelle Ananda-Rajah whose specialty is infectious diseases. We also saw the arrival in Parliament of paediatric neurologist Monique Ryan running as an Independent and the return of gastroenterologist David Gillespie for the Nationals. And representing the RACP in the Government of Aotearoa-New Zealand is infectious-diseases physician Ayesha Verral. It’s certainly a comfort to know that there are such strong champions of health policy on all sides of Parliament, at state level too.
If these recent episodes have piqued your interest, go to racp.edu.au/advocacy to find out what other campaigns you can get involved in. And at RACP Online Learning you’ll find a step by step explainer on how to make your voice count as well as new courses on cultural safety and addiction medicine.
To stay connected with colleagues take a look at the RACP Online Community. It’s basically a social media app for physicians, but much more powerful. There are chat rooms for different faculties and special interest groups and behind each of these is useful document library where you can easily find resources that have been shared. There’s also a database for helping trainees and mentors find the right fit. From the RACP homepage look at the quick link labelled ROC to get more information and view an explanatory video. Or just go ahead and download the app for Android or iPhone. It’s called “RACP- the ROC.”
Speaking of apps, you can subscribe to this podcast via Spotify, Castbox, Apple Podcasts, Pocket casts or any pod browser. For the late adopters, there’s even an email alerts link at the webpage racp.edu.au/podcast. I’m Mic Cavazzini, and this podcast was recorded on Gadigal country. I pay my respects to the storytellers who came long before me.