Continuing our rolling coverage of the #AusVotesHealth Twitter festival, which includes some alarming analysis on the health gaps between rural/remote and urban Australians, and a ten-point plan for improving Aboriginal and Torres Strait Islander health.
“Before you vote, consider the impact of policies on Aboriginal and Torres Strait Islander people,” says the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM).
The Climate and Health Alliance presents its scorecard on the major parties’ climate policies – which shows just how much work there is to do in public health advocacy.
And check out this introductory article with some calls to action for voters. Please join the discussion at #AusVotesHealth, which has been trending nationally.
Aboriginal and Torres Strait Islander health matters
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives
@CATSINaM
CATSINaM tweeted:
Importance of growing the Aboriginal and Torres Strait Islander health workforce especially nurses and midwives. The Getting em n keepin em report still relevant 17 years later http://ow.ly/HbXJ50u2jrt
#ClosingtheGap in heart disease among Aboriginal and Torres Strait Islander Australians requires urgent action https://www.mja.com.au/journal/2018/209/1/closing-gap-cardiovascular-risk-aboriginal-and-torres-strait-islander
Aboriginal and Torres Strait Islander #youthsuicide a national crisis “children as young as 10 are dying” https://www.smh.com.au/healthcare/leaders-urged-to-declare-aboriginal-child-suicides-a-national-crisis-20190319-p515fh.html
Close the Gap Peak Indigenous groups lead the way to improve the lives of Aboriginal and Torres Strait Islander people https://www.sbs.com.au/nitv/nitv-news/article/2019/03/28/buck-will-stop-us-indigenous-groups-meet-coag-historic-closing-gap-partnership1
Cultural Safety makes a difference and @CATSINaM can provide training to support Aboriginal and Torres Strait Islander people to feel Culturally Safe when they access health care
Caring for country and protecting the environment means protecting sacred sites and rivers
Aboriginal and Torres Strait Islander people continue to experience #racism in the health system, poor health outcomes, the highest incarceration rates, family violence and high rates of children in out of home care
Impact of overcrowding on the health of Aboriginal and Torres Strait Islander Australians – Our health in Our hands
According to Australian Council of Social Services “Aboriginal and Torres Strait Islander peoples are disproportionately affected by poverty and disadvantage” http://ow.ly/n4yQ50u2jND
#VoteACCHO
Donnella Mills, chair of the National Aboriginal Community Controlled Health Organisation: 10 great reasons why you should #VoteACCHO for Aboriginal Health in Aboriginal Hands
@NACCHOChair
Hi my name is Donnella Mills Acting Chair of @NACCHOAustralia & Board Director @Wuchopperen ACCHO in Cairns #FNQ : I’m a Torres Strait Islander woman with ancestral and family links to Masig and Nagir in the Torres Strait. My NACCHO Bio Page https://www.naccho.org.au/about/naccho-board/donnella-mills/
@NACCHOAustralia is this country’s peak Aboriginal and Torres Strait Islander #Health authority 145 #Aboriginal Community Controlled #Health member 302 clinics : https://www.naccho.org.au/about/
Aboriginal controlled health services provide about three million episodes of care each year for about 350,000 people. In very remote areas, our services provided about one million episodes of care each year. Download our 4 Page NACCHO FACT SHEET Here: https://www.naccho.org.au/wp-content/uploads/Key-facts-1-why-ACCHS-are-needed-FINAL.pdf
NACCHO has developed a set of 10 policy #Election2019 recommendations that if adopted, fully funded and implemented by the incoming Federal Government, will provide a pathway forward for improvements in our health outcomes. For more Info: https://www.naccho.org.au/media/voteaccho/
Recommendation 1: The incoming Federal Government must increase funding of Aboriginal Community Controlled Health Organisations to deliver primary health care services across Indigenous communities.
Recommendation 2: The incoming Federal Government must increase funding for capital works, infrastructure upgrades and Telehealth services through the Indigenous Australians Health Programme.
Recommendation 3: The incoming Federal Government must end rheumatic heart disease by funding preventive health programs within 15 rural and remote communities across the country.
Recommendation 4: The incoming Federal Government must invest in ACCHOs, so we can address youth suicide
Recommendation 5: The incoming Federal Government must improve Indigenous housing and community infrastructure
Recommendation 6: The incoming Federal Government must allocate Indigenous specific health funding to Aboriginal Community Controlled Health Organisations.
Recommendation 7: The incoming Federal Government must Close the Gap at this Federal election by increasing range and access to Medicare items for Indigenous health workers and Aboriginal health practitioners.
Recommendation 8: The incoming Federal Government must improve Indigenous Pharmacy Programs
Recommendation 9: The incoming Federal Government must fund Aboriginal Community Controlled Health Organisations to deliver dental services.
Recommendation 10: The incoming the Federal Government must support the development of an Aboriginal and Torres Strait Islander Workforce Employment Strategy
@NACCHOAustralia is calling on all political parties to include these recommendations in their election platforms and make a real commitment to improving the health of Aboriginal and Torres Strait Islander peoples and help us Close the Gap. We need to #VoteACCHO.
Worth two in the bush
Amy Coopes, editor at Croakey News
@coopesdetat
I’m a final-year med student, journalist & editor at @croakeynews, and will be focusing my #AusVotesHealth session on #5percentforprevention (more on that from the @_PHAA_ later) & why it’s an especially crucial election priority https://twitter.com/_PHAA_/status/1123433715210838016 …
In #AusVotes19 I am located in the electorate of Farrer, where the sitting member, @SussanLey, holds a very comfortable 20.5% margin but will be rattled by a local #NSWVotes revolt over water rights & the Murray Darling basin, & a challenge from independent mayor Kevin Mack
Ley was, of course, Health Minister until 2017, when she was forced to resign amid an expenses scandal https://www.theguardian.com/australia-news/2017/jan/13/sussan-ley-quits-health-minister-turnbull-outlines-reform-expenses
As @terryslevin writes, “For every $50 we spend on health, less than $1 is spent on aiming to keep us healthy. It is unsustainable and makes no sense.” https://www.canberratimes.com.au/story/6081941/a-health-election-if-so-whats-absent-is-serious-national-disease-prevention/
For context, @stephenjduckett’s @conversationEDU #ausvoteshealth analysis provides a nice overview of where @AustralianLabor and @liberalaus diverge on health policy. In brief, it’s a question of money in the pocket versus money in the system
https://theconversation.com/what-are-the-major-parties-promising-on-health-this-election-116427
Only the @Greens have made an explicit #ausvoteshealth commitment to prioritising prevention, including the establishment of an independent Preventative Health Commission and publicly funded Denticare https://greens.org.au/sites/default/files/2019-04/Greens%202019%20Policy%20Platform%20-%20World%20Class%20Universal%20Health.pdf …
If you’re wondering what sorts of things a prevention-focused #ausvoteshealth government could consider funding, @AHPA_AU devoted an entire issue of its journal to this question, with some great suggestions https://onlinelibrary.wiley.com/toc/22011617/2018/29/S1 …
Australia spends $89 per person per year on preventative health ($2bn) – just 1.34% of all health expenditure – and this is declining, according to a 2017 @prevention1stau report. For context, treating chronic disease costs $27bn p.a.
For more on the defunct (for now) National Preventative Health Agency, this excellent #longread from @croakeyblog is worth your time https://croakey.org/the-politics-of-prevention/
The @prevention1stau folks have also drawn up a handy scorecard on the government’s preventative health policies and performance. Spoiler alert – it’s not pretty
Why does it matter though? It’s a few years old now, but I think this #longread from @amycorderoy gets to the heart of it. We are quite literally making ourselves sick. And there is a massive social gradient at play. https://croakey.org/longread-the-sickness-of-social-organisation-inequality-will-be-the-death-of-us/ …
We compare poorly on obesity and alcohol consumption among the @OECD and spend much more on public hospitals than we do on keeping people out of them.
Most illness & death in Aust due to chronic conditions – 50% of us have at least one, account for 60% of disease burden & contribute to 90% of deaths. Importantly, many share modifiable risk factors which could, if addressed, reduce national disease burden by 1/3. 
Modelling from the @AIHW on #prevention suggests 14% of disease burden could be relieved by, variously:
•Everyone walking briskly for an extra 15 minutes every day, 5 days a week
•Sustained 3kg of weight loss by those in the at-risk obese/overweight population.
The differences are pretty stark when you contrast some of the data on things like heart and kidney disease and diabetes. 
Undeniable in all of this is the social gradient. All cause mortality is 1.5 times higher for the most disadvantaged people in our society, and the poorest males live 5.7 years less than their most advantaged counterparts (3.3 years for females)
In prevention terms this is even more pronounced. The poorest experience:
•Obesity burden 2.3x ^
•Sedentary lifestyle burden 1.7x ^
•Alcohol 1.9x (2.4x ^ in very remote areas vs cities)
•Illicit drug use 2.6x ^ (++ remoteness w meth & unsafe injecting).
This @natsem_uc paper suggests that closing the gap between richest & poorest, through action on #SDOH, could spare half a million Australians chronic illness, slash PBS scripts by 5.3m and save $2.3bn in annual hospital funding #ausvoteshealth http://library.bsl.org.au/jspui/bitstream/1/3102/1/Cost%20of%20Inaction%20on%20the%20social%20determinants%20of%20health2012.pdf …
Similar inequalities are seen in rural and remote areas, home to some 7 million Australians or 29% of the population. The mortality rate in very remote areas is 1.4x higher that seen in major cities, as are levels of chronic conditions and their drivers.
Hospitalisations are also telling — the rate is almost double in very remote areas, and potentially preventable admissions are markedly higher the further you get from the city.
Cost of and access to care are both issues, and this is exacerbated by disadvantage and remotenss remote areas. 14% of Australians are estimated to skip doctors visits, tests & scripts due to cost (for comparison, it’s 1 in 3 in the US).
So what can, and/or should we do? That’s a matter for a whole separate post-election #ausvoteshealth Twitterfest (#ausvotedhealth, perhaps @croakeynews team?), but #5percentforprevention, as recently pledged in WA, would be a good starting point https://www.mediastatements.wa.gov.au/Pages/McGowan/2019/04/Sustainable-Health-Review-provides-ambitious-blueprint-for-the-future-of-health-care-in-Western-Australia.aspx …
The @grattaninst also has some good #ausvoteshealth prescriptions in its annual Orange Book for 2019, including reform of GP payments to incentivise prevention activities and boosting PHNs to tackle #SDOH https://grattan.edu.au/wp-content/uploads/2019/04/916-Commonwealth-Orange-Book-2019.pdf …
We rounded up some of the prevention priorities and proposals from Australia’s health sector ahead of this year’s budget which also provides some great food for thought.
https://croakey.org/federal-budget-2019-20-preventive-health-priorities-from-the-health-sector/
I’ve run out of time, having barely scratched the surface, but hope I’ve been able to spur on the conversation around prevention & why it matters for health. Primary care is a key pillar but just as important are #HIAP — things like urban planning, food regulation.
There’s so much good work being done in this space — @cphce_unsw has some interesting stuff on the ’suburbanisation of disadvantage’ which is worth a look.
https://croakey.org/the-suburbanisation-of-disadvantage-a-critical-concern-for-public-health-and-planning-sectors/
This from the @cphce_unsw ahead of the last federal election, is relevant as ever, on the vital leadership role health can and must take.
#ClimateHealthEmergency
The Climate and Health Alliance
@Health_Climate
We acknowledge the traditional owners of the unceded lands on which CAHA operates and their elders past, present and future
We asked the major parties about their policies on the #climatehealthemergency Here’s how they stack up http://bit.ly/FESC19
We’re facing a #climatehealthemergency & your voice & actions are powerful Join us & pledge to take #climateaction http://bit.ly/OCOHCApledges
Check the first story from #AusVotesHealth. Thanks to everyone who has the hashtag trending nationally. More stories to come…
