Wither 'welfare'? Reflecting on the proposed changes to the Australian Institute of Health and Welfare
The Australian Institute for Health and Welfare (AIHW) provides a critical evidence base and statistical analysis of the Australian population, helping to develop policy and strategies for the state and federal governments. In the recent budget, AIHW was ear-marked for merger into a new super agency the 'Health Productivity and Performance Commission' (along with Australian Commission on Safety and Quality in Health Care, Independent Hospitals Pricing Authority, National Health Funding Body, National Health Funding Pool Administrator and National Health Performance Authority). While details are scant, the absence of 'welfare' from the title of this governing body and inclusion of 'productivity' is ominous.
Established in 1987 as the Australian Institute of Health, its role was expanded to include welfare under the guidance of The Hon Brian Howe (the then Health Minister) in 1992. Below, Brian Howe reflects on the proposed changes to the AIHW and his original vision for the Institute and its integration of health and welfare functions. Critically, Brian argues that the integrity of AIHW and the evidence it provides should not be put at risk.
I have noticed that there was a proposal announced in the budget to merge the Australian Institute of Health and Welfare (AIHW) into a new-super agency. The agency is described as a Health Productivity and Performance Commission. It is intended to fold into this body various other health related bodies including the National Health Funding Body and the National Health Performance Authority. Apart from possible staff savings and an increased focus on performance outcomes it is hard to imagine what the States and the Territories will make of this omnibus body.
I was rather disturbed when I read about this proposal to see that there was no mention of social welfare or social services. As I recall the origins of AIHW the original purpose in expanding the role of the Australian Institute of Health was to create the possibility of decent national data and statics. These would cover the nation’s health and welfare – a difficult task in a federation where most health and welfares services are delivered by State and territory agencies reluctant to release information that may be used by other jurisdictions to their disadvantage.
On the other hand it is in the national interest that we are able to make comparisons within Australia as well as internationally. I was also very conscious the fact that data collected by social service agencies is fundamental to understanding the causes of various kinds of physical as well as mental diseases. It just made sense to build on the strong tradition in health to build good national data sets across to the area of social services including the fields of homelessness and public housing. As Henderson recognized in his enquiry into poverty, housing stress is leading cause of poverty in Australia and, of course, a driver of illness and disease. Similarly, we are increasingly realising that in a more rapidly ageing society we need to be very conscious of the close links between aged care and the design of primary health care.
Finally in designing the AIHW I was very conscious of the need to keep quite separate the collection and reporting of national information and trends in health and welfare from the task of policy formation often necessarily based on or at least informed by the data published by the Institute.
It is very important that the States and Territories see the published data as quite separate from the process of policy formation and strategies. This ensures that all jurisdictions are confident that the facts form a solid and independent evidence base that has not been manipulated in the interests of one level of government. We will have to wait and see whether on not this remains the case under the new ‘super agency’.
Most importantly, AIHW has won the confidence of all jurisdictions, through its integrity to objective statistical analysis of the health and welfare of the population, and should not be placed at risk.
Posted by Gemma Carey