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The Health Wrap: Pandemic life expectancy, medicines policy and climate bullying in the Pacific

Introduction by Croakey: Deaths from COVID-19 – and resulting rates of life expectancy – vary dramatically across the world and are analysed in the latest edition of The Health Wrap.

Among many other issues, Associate Professor Lesley Russell also asks why we know so little about the review of National Medicines Policy, announced by Health Minister Greg Hunt more than two years ago.


Lesley Russell writes:

How the pandemic is affecting life expectancy is a topic I have looked at several times and I keep coming back to as new data reveals stark differences between countries.

A paper just out in the BMJ looks at the effects of the pandemic on life expectancy and premature mortality in 2020 in 37 countries (it does not include Australia but does include New Zealand).

Reduction in life expectancy in men and women was found in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. There was no change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia, the United States, Bulgaria, Lithuania, Chile and Spain.

In terms of excess deaths, the highest rates were observed in Russia, Bulgaria, Lithuania, the United States, Poland and Hungary. More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women.

Russia’s soaring death rate

Last week there was a new analysis of Russian data from John Burn-Murdoch and his colleagues at the Financial Times. This comes as Russia is facing a surge in coronavirus infections. On November 4, 2021, there were 40,217 reported new cases and a record 1,195 deaths.

Moscow’s shops, schools and restaurants are closed for two weeks in a bid to stop infections.

The FT analysis shows that, to the end of September, Russia has recorded 753,000 excess deaths during the coronavirus pandemic, one of the highest tolls in the world. Russia ranks second to the United States in terms of absolute number of excess deaths and third behind Peru and Bulgaria on a per capita basis.

This is considerably higher than the number of excess deaths calculated by Reuters, which found that, between April 2020 and September 2021, there were 632,000 more deaths in comparison with the average mortality rate in 2015-2019.

The actual number of COVID-19 deaths in Russia is a matter of conjecture. The Federal Service for State Statistics (Rosstat) estimates that 462,000 people had died of COVID-19 as at the end of September. The country’s interagency coronavirus taskforce, a body including ministers and other officials to coordinate the pandemic response, attributed 203,549 deaths to the disease at the end of September.

The agencies say they use different approaches to collect the data. The taskforce receives daily updates from hospitals on cases where COVID-19 was the primary cause of death; Rosstat gets monthly data from civil registries.

Russia’s soaring death rate is due to sluggish public health and vaccination campaigns. Russia was fast to develop and launch its Sputnik V vaccine which has been available since December 2020, but take-up has been slow due to apathy and distrust. Only about 42 million of Russia’s 146 million inhabitants have been fully vaccinated, a rate well below most European nations.

It’s no surprise then that life expectancy in Russia has plummeted. In 2020 it fell to 71.5 years, compared with 73.3 years in 2019. The Health Minister linked this to both the coronavirus and “negative demographic trends”.

The situation will not be helped by growing rates of HIV/AIDS. In 2018 – the last year for which precise figures are available – AIDS took the lives of 37,000 people across Russia, with the rate of new infections rising by between 10 and 15 percent a year, according to the World Health Organization.

There are more than one million people living with HIV in Russia, according to official figures, although the true figure could be as high as 1.5 million or about 1 per cent of the population. It is estimated there are 200 new infections a day and only a third of those with the virus are receiving antiretroviral therapy.

A recent report in The Australian (note: behind a paywall) highlights that a coalmining region in Siberia is now the centre of Russia’s spiralling HIV/AIDS epidemic with infection rates approaching those in sub-Saharan Africa.

Life expectancy in US falls by 18 months

In July the US Centers for Disease Control and Prevention issued a report that showed life expectancy in the United States fell by a year and a half in 2020 to 77.3 years, the lowest level since 2003, primarily due to the deaths caused by the COVID-19 pandemic.

Deaths from COVID-19 contributed to nearly three-quarters, or 74 percent, of the decline and drug overdoses were also a major contributor. Preliminary estimates are that US drug overdose deaths rose nearly 30 percent in 2020.

Australia so far shows success of control measures

Australia is one of the few countries bucking the global trend of excess deaths and decreasing life expectancy due to the pandemic.

Newly released figures from the Australian Bureau of Statistics show that a boy born in Australia between 2018 and 2020 can expect to live to 81.2 years – up from 80.9 years in 2017 to 2019 – and a girl to 85.3 years, up from 85 years.

Analysts say this reflects Australia’s comparative success in controlling COVID-19 and its strong healthcare system.

In 2020, just 0.6 percent of all deaths in Australia – 898 – were due to COVID-19, compared with 73,766 in the United Kingdom (12 percent, making it the leading cause of death) and 345,323 in the United States (10 percent, the third leading cause after heart disease and cancer).

There are several key issues that emerge from these analyses:

  • Most of this work was done in 2020, ahead of the emergence of the Delta SARS-CoV-2 strain so the results for 2021 will arguably be worse, certainly in those areas where vaccination rates are lagging.

Just last week the WHO warned that Europe is once again at the epicentre of the pandemic as cases soar across the continent. There are fears there could be half a million more deaths by February 2022 as winter approaches, the rate of vaccination slows and public health measures are relaxed.

  • The worst outcomes in terms of both life expectancy and excess deaths are mostly in countries in Eastern Europe and South America – and, of course, the United States. As yet there is no good data from Africa and the Middle East. But it does seem that what links all these countries is the failure to promulgate effective public health measures such as social distancing and mask wearing.

I wrote about this issue for Inside Story in 2020. You can read my article here.


Australia is a climate change bully

No-one I know is feeling very proud of the way Australia is emerging from COP26 and it seems the Federal Government cannot and will not be shamed, cajoled or goaded into meaningful action on climate change.

Now there’s an emerging story of how Australia has attempted to bully small Pacific Island nations, tried to dilute regional climate declarations, and “greenwashed” aid to these countries, claiming projects were addressing global warming when there was little or no link to climate change.

These claims are made in a Greenpeace report, Te Mana o te Moana: Pacific Climate Report 2021, released in August. The report finds that national emissions reduction pledges like Australia’s would lock in between 2 and 3 degrees of global heating, a level incompatible with life in the Pacific.

Pacific leaders quoted in the report said Australia had acted to dilute regional climate declarations, most notably at meetings of the Pacific Islands Forum (PIF). PIF members apparently discussed expelling Australia in 2015 because it was obstructing a consensus on limiting warming to 1.5 degrees Celsius.

Australia’s climate change diplomacy is described as “highly un-human”.

The report includes an analysis of projects that Australia told the OECD were either “significantly focused” or “principally focused” on helping the Pacific adapt to climate change. It found that “hundreds of millions of dollars in Australia’s aid budget have been counted as ‘climate adaptation’ aid despite those funds being allocated to projects with no link, or at best a tangential link, to climate change”.

In 2018 Prime Minister Scott Morrison pulled Australia out of the Green Climate Fund, set up by the United Nations to help developing nations adapt to climate change and cut emissions.

At COP26 last week, Morrison promised an extra $500 million over five years to help Pacific and south-east Asian countries “enhance climate resilience for future infrastructure investments, including roads, schools and bridges”.

But he rejected calls for Australia to rejoin the Green Climate Fund, saying: “We want to make sure that the climate finance investments that Australians are making are invested in our back yard, among our Pacific Island family and among our south-east Asian partners and friends.”

Clearly this is an issue to be monitored.


Integrated care – lessons from the NHS

As we head into the federal election, a number of groups I’m involved with are thinking about what should be on the agenda.

Croakey Health Media is busy planning and working with a range of partners for #AusVotesHealth. See this comprehensive Twitter thread on a recent webinar from public health student Sienna Crabbmor.

One of the things on my list is better integration across healthcare services. And, of course, one of the problems is that while everyone agrees on the concept, there’s confusion about what that means.

So I’ll go for this, from a 2016 paper: “… integrated care cannot be narrowly defined, but should be seen as an overarching term for a broad and multi-component set of ideas and principles that seek to better coordinate care around people’s needs.”

Three major national pilot programs for integrated care have been initiated within the UK National Health Service (NHS) since 2008: Integrated Care Pilots (ICPs), Integrated Care and Support Pioneers (Pioneers), and New Care Model Vanguards (Vanguards).

All three pilot programs shared similar high-level aims, such as breaking down perceived barriers between service providers, better coordination between hospital and community-based health services and between health and social care, improving the ‘user-centredness’ of care, and providing more services in a community setting.

In a paper just published in the International Journal of Integrated Care, the independent evaluators of these programs collaborated to compare and synthesise findings from their studies. It makes fascinating reading.

Here’s a brief summary of their findings, focusing on issues I think are key for Australian efforts in this area:

  • There was no obvious evidence that each program built on the experiences of its predecessor in terms of refining models of care. This may reflect the modern tendency within government to deliver policy change through disconnected projects rather than as an ongoing process of policy evolution.
  • There was a general expectation that integrated care would result in a reduction in the level of unplanned hospital admissions and the relative importance of other objectives, such as improving patient experience or clinical quality, was less prominent.
  • Sites in all the programs also found it easier to make progress when implementing relatively discrete interventions rather than complex, multi-factorial system changes.
  • Similar reported barriers to progress were identified in each of the three programs. For example, difficulties with sharing data between organisations was a common and significant problem, notwithstanding the fact that information technology was seen as a potential catalyst for integration. There was little evidence that the NHS did much to address such consistent and common barriers.
  • Securing and maintaining sufficient engagement of team members was commonly a problem, particularly in relation to GPs, whose activities were generally central to many integration efforts.
  • Well organised health services have greater ability to successfully access multiple pilot programs, thus benefiting from more financial support.

The paper has a l