This week, we put the spotlight on cancer inequities, the social determinants of mental health, imperatives for transforming global food systems, and health workforce strategies in an era of global boiling.
Also, Professor Stephen Duckett breaks out the sarcasm font in responding to the Fels inquiry on price gouging.
The quotable?
Transforming food systems worldwide provides a uniquely powerful means of addressing the global climate, nature and health emergencies while offering a better life to hundreds of millions of people.”
Spotlight
Mental health
Researchers from the United Kingdom, United States and Canada have developed a road map for addressing the social determinants of mental health – such as poverty, loneliness and discrimination.
Writing in World Psychiatry, they argue for a social determinants perspective to be fully integrated into the biopsychosocial model of mental health and illness.
Addressing the social determinants of mental health will reduce gross inequities in the mental, physical and social outcomes that arise as a result of poor mental health, they say.
They define the social determinants of mental health as “the set of structural conditions to which people are exposed across the life course, from conception to death, which affect individual mental health outcomes, and contribute to mental health disparities within and between populations”.
They include factors such as income, employment, socioeconomic status, education, food security, housing, social support, discrimination, childhood adversity, as well as the neighbourhood social and physical conditions in which people live, and the ability to access acceptable and affordable healthcare.
“Importantly, our chances of being exposed to protective or harmful social determinants of (mental) health are ‘shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices’. Such determinants are therefore not randomly or benignly distributed within or between populations, but are manifested by systems and institutions of power that often produce and reproduce intergenerational inequities in people’s opportunities to realise safe, secure, prosperous and healthy lives.”
The authors recommend that mental health be measured as a standard outcome in the evaluation of any policy, programme or intervention targeting social determinants.
Global food systems
Food systems are fuelling some of the greatest and gravest challenges facing humanity – notably persistent hunger, undernutrition, the obesity epidemic, loss of biodiversity, environmental damage and climate change, according to a new report.
It says the costs of current food systems are far larger than their contribution to global prosperity, and describes what would be involved in transforming today’s food systems to an inclusive, health-enhancing and environmentally sustainable global food system.
“Transforming food systems worldwide provides a uniquely powerful means of addressing the global climate, nature and health emergencies while offering a better life to hundreds of millions of people,” it says.
However, the report also acknowledges the “enormous” challenges involved, including in “negotiating change across a multitude of diverse stakeholders with unequal power and varying prospects from the transformation”.
It cites evidence that embracing equity and inclusion is key to making a transformation politically viable and thus essential for success.
The report summarises the findings of a four-year investigation by the Food System Economics Commission.
Cancer inequities
In recent days, the World Health Organization released a new report showing “striking inequities in the global cancer burden”, on global inequities in cancer, but the headlines were much more preoccupied with one man’s cancer. As Australian Medical Association president Professor Steve Robson observed, it’s an opportunity to reflect on inequities in cancer care – and there is more reading on related here, from The Medical Journal of Australia.
Climate
Bolstering health systems to cope with the impacts of climate change events: A review of the evidence on workforce planning, upskilling, and capacity building
Researchers from Macquarie University have undertaken a rapid systematic review investigating how workforce planning, upskilling and capacity building can help boster health systems to cope with climate impacts.
As global CO2 emissions continue to rise and the ‘era of global boiling’ takes hold, the health workforce must cope with the challenge of providing care to increasing numbers of patients affected by climate change-related events, such as hurricanes, wildfires and floods, the researchers report.
Their review identified four themes about workforce impacts: absenteeism, psychological impacts, system breakdown, and unsafe working conditions.
They identified six responses and preparations themes: training/skill development, workforce capacity planning, interdisciplinary collaboration, role flexibility, role incentivisation, and psychological support.
“This review provides an overview of some of the deleterious impacts of climate events on the health workforce, as well as potential strategies for the health workforce to prepare or respond to climate events,” they reported.
“Future studies should assess the implementation and effectiveness of these strategies to ensure a continuously improving healthcare system, and a well-supported health workforce.”
COVID
In an interview with Scientific American, Dr Maria Van Kerkhove, interim director of the WHO’s Department of Epidemic and Pandemic Preparedness and Prevention, discusses COVID complacency among individuals and governments, misinformation and disinformation, the politicisation of COVID interventions, and “reduced fiscal space, mental space and political space to talk about COVID”.
#AusPol
Price gouging
The social determinants of health – including food and housing insecurity and financial stress – and healthcare inequities are highlighted prominently in the Inquiry into Price Gouging and Unfair Pricing Practices, conducted by Professor Allan Fels for the Australian Council of Trade Unions.
The report says high out of pocket charges are a key barrier to access healthcare in Australia, and calls for a contemporary study of specialist fees backed by an analysis of restrictions on competition and of the role of information and balances between patients and specialists to be “commenced as soon as possible”.
It also calls for the National Competition Policy Review to review limitations on competition amongst specialists, and for the Australian Health Practitioner Regulation Agency to, separately, review specialist fees and the policy steps that could be taken to reduce them.
Pharmaceutical industry practices are also scrutinised.
Health policy expert Professor Stephen Duckett switches on his sarcasm font in responding to the report. 
Democracy matters
The Australian Electoral Commission’s latest release on political donations raises many public health concerns.
Taxation for health
As taxation policy continues to dominate the headlines, there are many related health issues at stake.
Consultation open
Croakey readers have until 4 March to comment on Federal Government plans for a New Vehicle Efficiency Standard. Doctors for the Environment Australia described it as “one part of the overhaul of Australia’s transport that is needed to save lives on the roads”.
Human rights
The abstract follows below for this article by Behrouz Boochani and Dr Claire Loughnan, Human rights and the white saviour pattern in Australia’s immigration detention industry.
“For seven long years, the refugee men imprisoned at the Manus Island detention centre (prison) had their rights denied under Australia’s harsh border security policy. They did not appear into public view as the worthy subjects of human rights. However, when the Sri Lankan Nadesalingam family were finally released in mid-2022 and returned to their former home in Biloela, a small town in the Australian state of Queensland, it was celebrated as an example of Australia’s fundamental generosity and its underlying humanitarianism.
“Their release is a temporary fracture in Australia’s story of preventable deaths, physical violence, torture, mental illness and despair, and the mundane violence of its border system. Using Makau Mutua’s analysis of the human rights system, we reflect on how the Australian government presents itself as the saviour of particular individuals. The cruel paradox is that this reveals a familiar pattern: the government grants freedom with one hand, and jails with the other. Nothing changes for most of those who remain incarcerated or on temporary visas, either offshore or in Australia.”
Celebrating primary health care nurses 
Appointments 
Check the Queensland Premier’s X/Twitter feed: his focus on addressing housing insecurity is non-stop. 
Global health
Public health
Commercial determinants
Youth are powerful allies in responding to the commercial determinants of health, and public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health, according to this paper in Health Promotion International.
Read the statement from Congress
Read: Increasing food insecurity severity is associated with lower diet quality 
Healthcare
While this JAMA Forum article on private investment in healthcare has a US focus, it raises questions for Australia too.
“In healthcare, the corporatisation train has left the station, and is accelerating rapidly on lightly regulated tracks,” the authors conclude. “What remains needed is thoughtful policy that builds some guardrails, applies the breaks where appropriate, and avoids derailment when patients could suffer.”
#CroakeyREAD
Opportunities
Events
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