One of the great writers, thinkers and humanitarians of Australian medicine – Emeritus Professor Stephen Leeder – will be celebrated at a special event at the University of Sydney this Thursday.
The details are here, but in the meantime below are some short excerpts of some of Professor Leeder’s most recent writings (with links to the full articles).
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Australian Medicine: Top sales pitch needed for investment in prevention
I was once asked by Malcolm Turnbull, serving on a Parliamentary committee inquiring into health care, what I would do if today I had awoken to discover that I was the Minister for Health.
I replied that I would immediately have closed the blinds, taken to my bed and tried to go back to sleep on the assumption that this was just a ghastly nightmare.
Finish the article here.
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SMH: We’re all in the waiting room on the federal government’s health policy
Since coming to power last year, the federal government has not offered the community a health policy or even a story about what it intends to do. Instead, we are saturated with pronouncements that healthcare as we know it is unsustainable, meaning that the annual costs grow at a rate faster than our growth in productivity.
Although proclaimed as news, “unsustainability” in this sense has been about for decades and we have not fallen off the edge of a flat earth because of it. While the search for efficiency makes good sense, the thought that the current financial arrangements for healthcare pose a threat comparable to a new strain of virulent bird flu lacks credibility. We can be thoughtful about how we handle this problem and not panicked.
The unsustainability mantra has been accompanied by several wild swipes at gnats in the system. The proposal of adding a $6 fee to all bulk-billed general practice consultations has received extraordinary airplay. Perhaps it is because it carries an aura of Medicare-bashing, or perhaps because of latent class warfare; it’s muscular to wallop those people whom we consider to overuse the system, generally those who live west of where we do. But the meagre revenue collected from this novelty, not counting transaction costs in its collection, would be without impact on the costs of healthcare. Not much policy sense there, I’m afraid.
Finish the article here.
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Steve Leeder’s Better Health Blog: Toxic environments and diabetes: what are they, how they happen and what we can do about them
(A presentation by Stephen Leeder and Shauna Downs)
When considering the effect of the environment on diabetes we want you to see it from two angles – the way the environment causes diabetes and the way in which the environment determines who receives adequate treatment for diabetes.
First, with regard to the effect of the environment on diabetes, we know that all human health and disease is ultimately a manifestation of the interplay between our genes and the environment in which we live. For diabetes, we realise that the environment plays a major role in provoking insulin resistance leading to type 2 diabetes. We speak of obesogenic environments where excessive supply of fat and carbohydrate and lack of exercise lead to the development of diabetes, most spectacularly apparent in Pacific nations such as Nauru and Tonga. There, indigenous diets rich in root crops, fish and seafood have been replaced by ones from the economically advanced nations including Australia and NZ that are high in fat and cheap processed foods including turkey tails and mutton flaps (1).
Second, with regard to how the environment affects how we treat patients with diabetes. The environment is critical to determining whether treatment will be adequate for patients suffering type 1 (10% of all diabetics worldwide) and type 2 diabetes. With effective treatment theoretically available that can be applied to both forms of diabetes, most notably insulin for type 1 and for 40% of type 2 diabetes and complication surveillance for both, environmental forces including poverty, migration, politics that lack a concern for equity and war limit the availability to all who need it of this care. These environmental factors determine who shall live and who shall die, and who will suffer.
The environment therefore plays an important role in both the natural history and what we might call the unnatural history, where we apply therapies, of diabetes, associated with the origin of the disease in the vast majority of cases (type 2) and the destiny of those who suffer from it in virtually all cases – type 1 and type 2 alike.
Finish the article here.
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Steve Leeder’s Better Health Blog: Managed care need not be a health hazard
The NSW minister for health, Jillian Skinner, announced March 20th affirmative funding of $120M over three years to Western Sydney, Central Coast and the Greater Western NSW local health districts to enable the development of integrated care models.
Concurrently, the federal minister for health, Mr Dutton, is looking for ways to spend the billions of health dollars more efficiently. This is a worthy goal and there are examples of health systems where humane care is mixed with efficiency that deserve his attention. Many make excellent use of private enterprise.
Several large private health insurers in Australia have moved in the past twenty years beyond reimbursement to members and health care providers for clinical services into the direct provision and management of care
These services have included telephone-based coaching for insured members to assist them manage chronic health problems and assistance with healthy lifestyle behaviour. The big users of private cover are, as expected, the people with multiple long-term problems and it is in the interest of all health care providers – public or private – to ensure that these people receive efficient care and avoid where possible unmanaged deteriorations in their health that, usually after weeks, lead to hospital admissions.
Finish the article here.
