Beyond the recent publicity around cuts to health and other portfolios, something deeply disturbing – even sinister – is occurring in Queensland.
The state government is implementing health policies on the run and cutting health jobs and services. This has happened before around the country and will eventually be turned around, albeit not before a deal of harm has been done.
Even this week, there is news of yet more cuts to prevention programs. But more disturbing still, and a move that should send alarm bells ringing around the country, is the Queensland government’s decision to gag health organisations, health professionals and public debate on health issues.
A number of of Queensland Health’s recent problems – from Bundaberg to payroll disasters – followed historical underfunding of key control processes, and came to light in part because concerned people had the courage to speak out.
There is a long history in public health of measures that were initially resisted or opposed, speedily becoming accepted as part of a modern, civilised society. We would not be one of the world’s longest-lived populations without advances in public health such as sanitation and safe water, safe food, safe environments, immunisation, control of infectious diseases, screening, speed limits, seat belts, random breath testing, and tobacco control.
Each of these advances met initial resistance. None of them – not a single one of the public health advances we now regard as vital – would have been implemented without public health advocacy.

A troubled history
There is nothing new about opposition to public health advocacy. When sanitary reforms were being debated in England in the 1850s, led by the pioneering epidemiologist John Snow, the London Times thundered, “We prefer to take our chances of cholera and the rest than be bullied into health by Mr. Snow”.
But Snow persevered, achieving changes that led the way to advances there and elsewhere. Since then, we have seen a plethora of public health advances because of pressure from health groups, whether professional organisations such as the Australian Medical Association (AMA), or issue-based non-governmental organisations (NGOs), such as the various cancer councils and the Heart Foundation.
These external pressures are often encouraged by health ministers who need help generating support for action in Cabinet and the community: after legislation or other action, they frequently express their appreciation to the organisations concerned.
It is reasonable and normal for governments to expect that public servants follow conventional protocols in relation to public comment. It is also reasonable to expect that NGOs engaged in advocacy do so in a sensible and civilised manner. It is, however, unreasonable and dangerous for governments to gag health NGOs, and to take action that will specifically preclude them from advocating for change.
Gagging order
Health departments traditionally fund large numbers of NGOs to carry out crucial work in the community. Queensland Health Department contracts with these NGOs will now be subject to censorship. Any NGO receiving 50% or more of its funding from the state will be precluded from advocating for state or federal legislative change – even from providing website links to other organisations’ websites that do so.
NGOs justifiably fear that the 50% figure is just a starting point, and that this censorship may ultimately apply to any funding. Many now dare not speak out. Even those not currently in receipt of funding but thinking of applying will feel constrained.
The condition relating to websites means that funded NGOs may not be able to provide links to organisations such as Cancer Council Australia, the Heart Foundation, or even the AMA and the World Health Organization, all of which advocate for legislative change.
Government-funded NGOs are often also funders of research, which may conclude that legislation or regulation is appropriate. The new Queensland Health approach will preclude reputable health organisations from even discussing the implications of such research.

An important 2007 paper showed that there was already cause for concern about suppression of information in the health sector. It noted international precedents where exposure and comment from outside government were crucial in preventing further public health catastrophes, such as the 1980 Black Report in the United Kingdom, the Chernobyl disaster in the Soviet Union, the SARS outbreak in China, and harmful mercury blood levels in the United States.
But why?
So what justification has the Queensland Government offered for its descent into the dark ages?
First, they assert that NGOs should focus on their “core activities”, not advocacy. But seeking action that will protect the health of the community is the most fundamental core activity for public health organisations. Even if they cannot understand this, it is outrageous that a government providing only some of an organisation’s funding should prohibit action carried out with funding from other sources.
Second, they state in relation to funded groups that “we would expect that organisation to conduct itself with the political impartiality of any other government sector.” This verges on the bizarre, given that by definition NGOs are not part of the “government sector”.
A third rationale now offered is that this condition will prevent abuses, such as the “Fake Tahitian Prince” scandal, and funding of NGOs to pursue political agendas. But any concerns in these areas should be addressed by protocols common to all governments (and indeed other funding agencies) about proper, well-monitored use of funds.
The fourth rationale is that the government is seeking “health outcomes, not political outcomes or social engineering outcomes”. The government is entitled to seek health outcomes from activities that it funds: but that is no justification for gagging the non-government sector.
It is desperately depressing that any health minister should use pejorative phrases such as “social engineering” to describe the aims of health organisations, and, by implication, the aims of his own and other health departments around the country.

No explanation has been offered as to why health, where advocacy has been so fundamental to our well-being over the years, is being singled out.
Dark days
The Queensland government’s approach has already met with some success. It has created a climate of fear. Beyond the AMA, whose Queensland president, Dr. Alex Markwell, has shown herself to be a true health leader, and some courageous public health academics, few in the state are willing to speak out, lest they be victimised and lose their funding.
These are dark days for public health in Queensland. The public health advocacy that has made our community so healthy will be hard to find. By contrast, commercial interests – in areas such as alcohol, tobacco, gambling, junk food, even firearms – are free to pressure governments at will.
Queensland, of all states, should have learned that gagging people in health from speaking out is a recipe for disaster. Censorship is the hallmark of a totalitarian regime; censorship in health sends out the signal loud and clear that the government neither understands public health nor cares for the future health of the community.
Other governments should condemn the Queensland approach though the Standing Council of Health Ministers; the Federal Government should bring all possible pressure to bear; and health professionals around the nation should use every available opportunity to make clear their distaste for this fundamentally unhealthy approach to public health.
Public health has been described as the conscience of the health system. It should be a matter of great concern for the entire community that any government is seeking to silence our conscience.
Jack Arnold
Director
Well it is too easy to say that this is the result that Queenslanders voted for until you get to the censorship proposal from Premier Cockup Newman.
As the addage goes, "I will defend to the death your right to hold a wrong opinion" but I won't support a politician who has a track record of unenviable disaster and plans to create a Queensland wide economic depression just to win brownie points with international bankers & kow-tow to foreign owned CSG corporations.
Perhaps The Conversation could investigate Newman's allegedly glorious Army career by interviewing some of his former serving colleagues. Then follow up by seeking the views of surviving & departed Brisbane City Council staff who watched Brisbane ratepayers have a huge debt burden built that will endure for decades after his time as Lord Mayor.
Richard Windsor
Mycologist
Methinks our author doth protest to much. Supression of information and censorship of health related information is rife from the NHMRC down. Just look at the unedifying spectacle of the withdrawal of the Draft Guidelines for ADHD. A processs so devoid of transparency and so tainted with the evidence of inappropriate pressure being applied that, in the eyes of consumers, the NHMRC will never have the public's confidence.
The censorship of clinical trial data, the censorship of research by the peer review process,the censorship of research by outcome based funding, the censorship (unwitting or otherwise) by the press, both lay and professional should all be cause for concern. The average punter with access to the internet will find no shortage of examples.
Rosemary Stanton
Nutritionist & Visiting Fellow at University of New South Wales
Thanks Mike, for speaking out on this issue.
Professor Marion Nestle's book Food Politics details the kind of gagging that has occurred in government advisory bodies and committees in the US. It's worth a read. Marion also has a blog where she updates issues.
Bruce Moon
Bystander!
Thanks Mike for the article.
The gag approach by the Newman Government needs to be seen as a precursor to what would probably occur should the current 'conservative' agenda be inculcated in Canberra.
Elsewhere in the media, critics are pointing to the ludicrous nature of this gag approach.
For example, Terry Sweetman in the Sunday Mail writes...
"I can understand the government's public disquiet - and its private frustration - at funded outfits that push ideas contrary to its policies…
Read moreBob Buckley
ASD advocate
Already, this issue is a political football with a federal Minister weighing in (see <a href="http://a4.org.au/a4/node/551" target=_blank >http://a4.org.au/a4/node/551</a>); although the federal Labor Government refuses to fund any advocacy or peak body for autism spectrum disorders despite the massive growth in numbers (over 1% of school students by 2009, and 18% growth per year - numbers doubling every 5 years) of this mostly severe or profound disability and reports of extremely poor outcomes (see http://www.abs.gov.au/ausstats/abs@.nsf/mf/4428.0).
The likely "unexpected consequence" of Qld's policy is that separate (unfunded) advocacy groups will function independent of funded NGOs ... and will be less constrained in their comments.
It is hard to imagine how Qld would participate effectively in developing an NDIS with its NGOs silenced.
Norm Stone
logged in via Facebook
It will be interesting to see if this principle is extended to other sectors, for instance education. Would religious schools be able to promote non educational material? Would the government schools be allowed to employ religious counsellors? Also I cannot see how the protesting is " too much" Richard Windsor - if suppression of information is rife this is worth a protest then more suppression is worth more protest.
Maddy Jones
logged in via Facebook
This already had been extended to other sectors - the Queensland Environmental defenders office has been defunded. Why would anyone fund an agency that allows citizens to exercise their lawful rights to challenge government decisions?
http://www.brisbanetimes.com.au/queensland/government-takes-razor-to-environmental-defenders-office-20120705-21ify.html
Norm Stone
logged in via Facebook
Exactly Maddy. Taxpayers involuntarily funding the promotion of ideas that they may well not hold themselves is a concept called free speech. The Queensland Government, and other potential conservative governments I suspect, treat funding as giving them a right to dictate terms. In fact it is the role of government to fund all sorts of organisations regardless of their political opinions. This is a concept called Democracy.
Wiel Maessen
logged in via Facebook
I've never seen government funding pro-smoking groups....
Is your concept of democracy only reserved for political correct groups?
It's either funding all or none....
Erik Streed
Lecturer in Physics at Griffith University
US tobacco farmers would be an example of a potent pro-smoking group which receives large amounts of US Federal and State level support. Not an issue in Australia since tobacco farming ceased in 2006. http://www.theaustralian.com.au/news/health-science/payout-deal-ends-tobacco-farming/story-e6frg8y6-1111112425673
Michael J. McFadden
Author
Erik, I may be wrong, and you're welcome to cite contrary information if you have it, but I believe the price support type programs in the US for tobacco were knocked out at least five, if not ten, years ago.
- MJM
Wiel Maessen
logged in via Facebook
Mention just one government that funds a smokers' rights group, Erik...Or a bar owners rights' group...
Erik Streed
Lecturer in Physics at Griffith University
Disruption payments to farmers relating to the US Master Settlement occurred until 2010 (page 5). Growing was deregulated (no price supports or quota limitations) in 2004. http://www.nationalaglawcenter.org/assets/crs/RS20802.pdf
This of course doesn't cover indirect subsidy, though infrastructure, state Ag school support, or quotes on alternative commodities.
Erik Streed
Lecturer in Physics at Griffith University
State of Nevada's support for the casinos.
Michael J. McFadden
Author
Thank you for the link Erik! Very interesting. It seems I was substantially correct although It's a bit complicated (I tend to pay more attention to the science end of things than the legal end) but evidently the taxpayers NEVER (or rarely?) supported tobacco farmers despite popular perception to the contrary! Some excerpts:
"Manufacturers, in
Read moreconjunction with the MSA, pledged $5.15 billion in payments to farmers to be
distributed over 12 years. Also, Congress approved $328 million in tobacco…
Wiel Maessen
logged in via Facebook
Casinos are a very bad example. One can barely call them a 'rights group', needing funding.
Additionally, governments have special interests in the existence of casinos as they generate a lot of tax income, especially in Nevada which gets most of its revenue from gambling and sales taxes. Besides, casinos are pretty 'political correct'.
Michael J. McFadden
Author
Erik, I'd have to agree with Wiel on this. The state of Nevada TAKES hundreds of millions of dollars from the casinos. In essence it robs them using taxes as the legal excuse. How is that translated into "funding" them? And the casinos are hardly a pro-smoking group: they're pro-profits, and if smoking decreased those profits they would ban smoking quite quickly.
- MJM
Vincent O'Donnell
Independent media analysis associated with the School of Media and Communication at RMIT University
There are precedents to these actions. The tax deductible status of charities who engaged in political activism was placed under threat by the Howard government and the present Labor administration is only slightly less hostile.
And the Howard government established strict protocols about public servants and the permissions needed for an officer to speak to the media.
Those protocols took on bizarre proportions. As a broadcaster, I once had to wait four hours for an public servant, who had delivered a paper to a public conference, to be granted permission to discuss the content of the paper on radio. Things are better now but such contacts remain restricted.
As with the present debate about data retention, democratic government as the servant of the electorate rather than the master, is long forgotten
Wiel Maessen
logged in via Facebook
"This talk of censorship is nonsense. The reality is that these groups wouldn't have a voice in the first place if it wasn't for the involuntary contributions of the taxpayer. They'll still be free to lobby and campaign as much as they like, they'll just have to do it on their own dime (or 49% of the taxpayers' dime, which is still extremely generous)."
http://velvetgloveironfist.blogspot.co.uk/2012/09/queensland-stands-up-to-sock-puppets.html
Miriam O'Brien
Consultant
Every so often NGO's are forced to go back to their objects, mission and strategic intent. This looks to be one of those times.
As long as NGOs don't think of themselves as an arm of government they have a chance at continuing to pursue their own chosen path and setting their own priorities.
If they have succumbed to thinking of themselves as beholden to the funding bodies rather than seeing them as at best allies or merely sources of revenue (when the interests of both parties are common), then they put at risk their identity and purpose, if not their long term survival.
From the government's perspective they are taking a risk that some important NGOs will stop doing government-funded programs. It's happened before and will happen again.
Erik Streed
Lecturer in Physics at Griffith University
What exactly constitutes advocating? Its understandable that the state would object to their funding being used to support lobbying rather than ostensible activity the contract was for. There are real dangers in starting self-perpetuating feedback loop, where the better lobbying organisations get more money to support more lobbying. That being said, restricting the ability of health based NGOs to comment on the impact of present or proposed policy is absurd since they are likely in the most qualified position to comment. Certainly any conflict of interest must be disclosed, but at the same time it would be difficult to find qualified commentary from people unrelated to the matter under discussion.
Michael J. McFadden
Author
Erik, you commented, " There are real dangers in starting self-perpetuating feedback loop, where the better lobbying organisations get more money to support more lobbying."
Very true. We just saw an example of a try for this kind of thing here in the US. California wanted to add $1/pack tax on cigarettes, part of which would have been dedicated to "tobacco prevention efforts." Antismokers here feel that one of the most effective "Tobacco prevention efforts" is tax increases to fund "tobacco prevention efforts."
Thus, the tax increase, if it had passed, would have been partly spent to promote a future tax increase to be partly spent on promoting a future tax to be spent on....
Fortunately people had enough common sense to vote the tax down, although the vote was very close and the Antismokers tried to overturn it with a recount effort.
Michael J. McFadden,
Author of "Dissecting Antismokers' Brains"
Yani Haigh
logged in via Facebook
Mike,
Given Australia is a signatory to The Ottawa Charter for Health Promotion and many other charters and agreements on the topic of health promotion, could you inform us on how the actions of the Queensland government fit within the agreed commitments that have been made todate?
Specifically...
'to reorient health services and their resources towards the promotion of health; and to share power with other sectors, other disciplines and, most importantly, with people themselves' ( http…
Read moreDavid Templeman
CEO Alcohol and other Drugs Council of Australia
Don’t advocate – big brother knows what’s best
Governments for years have attempted to make funding conditional on recipients toeing the party line. It’s an old fashioned concept and perhaps that’s why it’s struck a chord with Campbell Newman’s administration.
NGOs have apparently been told that any who receive more than half their funding from the Queensland Health Department won’t be able to advocate for legislative change at federal or state level as a condition of acceptance of funds. The…
Read moreNico
logged in via Twitter
Here in the UK the National Health Service is being dismantled, something UK politician Tony Benn told Michael Moore in the film Sicko would lead to revolution if a government announced it was doing it.
That is why the British government has avoided announcing this at every stage, lying about it from day 1 of the election campaign and accompanied by the press, particularly the BBC in acting to prevent most people in the UK from even knowing what is happening to the NHS, which is being reduced to a logo and a source of income for private healthcare corporations.
You may be up for an important struggle to make sure people know what is going on. If England and other parts of Europe are anything to go by, I would concentrate the greatest parts of your campaigning efforts precisely on an information campaign.
Richard Windsor
Mycologist
https://repository.uwa.edu.au/R/-?func=dbin-jump-full&object_id=14938&local_base=GEN01-INS01
It is cause for concern when a democratically elected government suppresses embarrassing information by hindering public health research or the publication of research findings. We conducted a survey of Australian public health academics to estimate the level of acts of suppression of research by Australian governments, to characterise these events, and to gather views on what interventions might be effective…
Read more