So here’s a telling turn of the circle in Canberra.

John Flannery, who is now packing up his media manager’s desk at the National Health and Hospitals Reform Commission (the Commission expired with the completion of its report), is about to return to the AMA – from whence he came.

For those with an interest in Flannery’s background and his thoughts about health reform, the universe and everything else, he has obliged us with the following:

“I joined the AMA back in 2001 when Dr Kerryn Phelps poached me from the office of Simon Crean, where I had been coordinating the then Opposition’s media around opposing the introduction of the GST.

I was at the AMA from January 2001 until April 2008, when I joined the NHHRC.

Prior to that:

1996-2000 – Media Adviser to Opposition Leader, Kim Beazley
1994-1996 – Media Adviser to Trade Minister, Bob McMullan
1990-1994 – Public Relations Manager, Australian Quarantine and Inspection Service, Canberra
1988-1990 – Freelance writer, PR consultant and quiz show writer, Sydney  – University Challenge, The Oz Game, Double Dare, Family Double Dare
1985-1988 – NSW Promotions Manager, International Public Relations, Sydney
1984-1985 – Public Relations Officer, Spastic Centre of NSW

I am a Communications graduate from Mitchell College (now CSU) in Bathurst.

I hope to use the knowledge and skills I gained at the NHHRC to help the AMA, under new President Dr Andrew Pesce, play a leading role in a new era of health reform through engagement with the Government and engagement with the other health professions, and by providing the public with informed and expert information about the health system.

This will involve championing the role of the medical profession, while at the same time working cooperatively with all stakeholders, especially patients and communities, to ensure all Australians, no matter where they live and no matter their means, can find quality health care and advice when they need it.”

The circle has turned, and the tune is changing at AMA headquarters.

I wish I’d read it before giving a talk to health policy students at the ANU yesterday about lobby groups in health. Of course, you always end up preparing for these things at the last moment, generally late at night when the brain is frying rather than firing. I’ve already thought of some groups I should have mentioned but didn’t.

But here’s a quick summary of the talk anyway. Please add your additions and suggestions.

Lobby groups: professional

• The AMA is often called “the nation’s most powerful lobby group”, most recently in the SMH’s recent article previewing the presidential elections. Whether or not that is actually true is incidental, perception being reality. It’s who many journalists ring for comment on just about any development in health, whether or not the AMA spokesman actually has expertise in that area.

• The Pharmacy Guild. Their lobbying style is quite different to the AMA’s, as they operate largely behind closed doors and build their efforts around putting proposals and submissions into government. The national president Kos Sclavos once told me “we have more health economists than any other health group in Australia”. As well as 250 staff. But the real force is the reach of community pharmacy; it’s hard to think of a health professional with easier access to the community if governments get up their noses.

• Other professional and industrial organisations, ANF etc etc.

• There are also medical research institutes, but again their interests do not necessarily align with the broader public interest – often they are so reliant on industry funding, they are reluctant to speak up if it rocks the apple cart.

Lobby groups: business

• Pharma is the most obvious. Generally they do a very good job of influencing media coverage of their products, but often this is through third parties, so may not be obvious to a casual observer. As an industry, their image has taken a big hit in recent years.

• Other medical industries, eg surgical and devices companies

• Complementary products sector is big business despite the general public often viewing them as the ‘goodies’ (for some strange reason)

• Private health insurance lobby has to be judged one of the most successful, given the level of government support they receive despite widespread doubts about the value and merits of their product. Private hospitals also seem to do pretty well.

There is often a convergence between many professional and commercial lobby groups’ interests; for example, pharmacists flogging“non evidence based products”, and eminent medical experts and institutions lending their names and authority to marketing campaigns (see the Crikey Register of Influence for specifics)

• The un-health lobby groups – tobacco, alcohol, and food industries, to name just a few. They arguably have more influence over the community’s health than those described above.

So who represents the public interest?

This is a much tougher question to answer, though many may claim they do.

• Disease-based lobbies. The problem is that they are often narrowly focused and encourage the silo mentality that plagues health. Such groups are sometimes unduly influenced by commercial or professional interests.

• Patient groups. Again they are often focused around single issues and some, eg breast cancer, get more attention than others. Even those umbrella groups such as the Consumers Health Forum are representing their members’ interests, ie patients and that is not necessarily the same as the broader public interest.

• Groups such as the Public Health Association and CHOICE are attempting to represent the public health interest, but do not necessarily represent the broader community’s views.

Who represents those in greatest need, whether underserved groups such as Indigenous Australians or underserved issues such as the social and economic determinants of health?

Groups working in this area tend to be over-stretched and under-resourced. They are minnows compared to some of the sharks above.

The conclusion from all this is that much lobbying serves to reinforce the status quo in which society’s institutions, including government, tend to operate for the benefit of the well to do. More and better advocates are needed to agitate on behalf of the public interest in health, and especially on behalf of those in greatest need.

But as I said, this was all thought through late at night and in a great rush – it would be nice to hear others’ thoughts on these issues.

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The incumbent president Rosanna Capolingua is not running again. According to the latest Oz Doc, the three presidential contenders (barring any last-minute entrants) are:

• Aniello Iannuzzi, a GP from Coonabarabran

• Gary Speck, an orthopaedic surgeon from Melbourne

• Andrew Pesce, an obstetrician from Sydney.

Given how much airtime the AMA president gets (far too much I reckon, relative to all the other interests in health that so often miss out), I think it’s only fair that the broader public should have a say in who gets the nod.

We could organise this along the lines of AMA Idol – it wouldn’t be so much about their policies or political strategies, but about how gentle they are to our ears, especially over breakfast.

Judging criteria could include things like whether they have a sense of humour, a pleasant voice, and a healthy dose of humility.

The election will take place at the AMA National Conference in Melbourne on May 29-31.