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evidence-based issues
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health & medical marketing
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Some questions to transform how we “do” health. Reporting from #AusVotesHealth Twitter Festival

Could our political leaders develop economic policies aimed at achieving better health, social and environmental outcomes?

Could we develop a food system based on principles of health and environmental sustainability?

Could the next Federal Government make one of their first announcements the appointment of an Indigenous person as Minister for Aboriginal Affairs?

Could we reform health services so that those in greatest need – for dental care, for example – have best access?

Could we ensure safe and secure housing is available to all people discharged from health services, especially those with mental illness?

Could Australians voting this weekend think of the health and wellbeing of future generations, rather than just their own hip pockets?

These and other transformative possibilities were flagged by participants in the recent #AusVotesHealth Twitter festival, as outlined below in our final report from the event. The article below follows the order of the Twitter festival program, and includes contributons from Professor Fran Baum, Professor Stephen Duckett, Dr Simon Judkins, Professor Sharon Friel, Associate Professor James Ward, Dr Lesley Russell, Kate Colvin, Professor Marc Tennant, Dr Ewen McPhee, Professor Melissa Haswell, Senator Richard di Natale, Paul Dutton, and others.

See our previous reports here.


Governing for Health

Professor Fran Baum AO,  Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University.
@baumfran, @crehealthequity

Today I’ve been meeting with Rumbalara community controlled health service and again so impressed by what they do. Massive investment needed in NACCHO services.

My book Governing for Health includes a Manifesto for Wellbeing – a guide for any political party which wants to govern for health of the planet & people rather than profit for corporations.

Public not private services are usually cheaper and provide better service.

Next point of Manifesto we need to see taxation as investment in our collective health and wellbeing and crucially in equity.

Don’t believe those who say low taxation if good because it is good only for those at the very top!


What are the major policies promising on health this election?

Professor Stephen Duckett, the Grattan Institute @stephenjduckett, @grattaninst.
Read more.

Those acknowledgements of country should not be simply issues of rote, but should remind us of the continuing disadvantage faced by Indigenous Australians, see here.

Overall Australia has a good health system, however you measure outcomes.

Here at the Grattan Institute, we’ve done our priorities for a new government in an Orange Book to parallel the Red and Blue books developed in the public service.  We had to prioritise, partly based on where the direction for change was clear.

One really important area where reform direction is not clear is primary care. The evidence is mixed, but clearly we probably need payment reform and new ways of delivering services, and yes, more $$.  See here.

We’ve just released a report on dental care – one of the big gaps in health care provision… Really pleasing that Labor has announced a big investment here, so too the Greens. More than two million Aussies miss out on dental care because of cost.

Primary Health Networks have a big role in the social determinants of health. What we said in Orange Book ‘Empower & instruct Primary Health Networks to work more closely with their local communities to change factors which contribute to ill health’. Drawing on this, see here.

Rural and remote is a big issue, partly driven by Indigenous status. The answer is to work with communities to address the causes and the causes of causes. Marmot’s work is a place to start.


Social justice – it’s a health issue

Dr Simon Judkins, Australasian College for Emergency Medicine
@JudkinsSimon, @acemonline

Patients presenting to regional, rural or remote Emergency Departments (EDs) have the same right to timely care as city patients. EDs have a strong role to play in delivering of specialist emergency care

ACEM works across Australia to develop, strengthen and support a skilled and confident workforce of emergency doctors in rural, regional and remote areas through the EMET Program, EMC/EMD training and the IRTP initiative.

EMET provides education, training and supervision to GPs, nurses, paramedics and allied health workers to develop their skills in treating critically ill or complex trauma patients. EMET training saves lives.

Each year more than a quarter of a million people seek help from an ED for their mental health.

People who present in mental health crisis are the group most likely to wait more than 24 hours for admission to a mental health ward.

Aboriginal and Torres Strait Islander people are over-represented in populations presenting to EDs seeking support in a mental health crisis

The national shortage of psychiatric beds and mental health services exacerbates the wait for access to appropriate care.

ACEM has released its Mental Health in the ED Consensus Statement to improve mental health care. Read it. Sign it.


“Consumptagenic” threats to health

Professor Sharon Friel, Director, School of Regulation and Global Governance (RegNet) and Professor of Health Equity, ANU College of Asia and the Pacific
@SharonFrielOz

We cannot improve health inequities through the health system alone. Trade, social, labour, education, planning, infrastructure policies each affect physical and mental health inequities.

Who benefits and who loses? Can all politicians ask themselves that question when deciding on policy. It matters for health equity. But of course it assumes they care.

For what purpose? When developing economic policies ask if they will achieve better health, social and environmental outcomes. No more perpetual economic growth as the end goal.

Great to see the political campaign focus on climate change. Remember that climate change, inequality and health inequities are tightly interconnected.

To address health inequities means addressing climate change, which means addressing the common underlying drivers – consumptagenic systems.

Consumptagenic systems are the institutions, policies, and values that are responsible for the exploitation of natural resources, excess production and hyperconsumerism that are harmful to the planet, entrench social inequalities and cause poor health.

Consumptagenic systems rely on people wanting to consume what the system produces, otherwise economies will not grow and wealth will not be accumulated. This creates excessive consumerism.

We need to talk about food systems – not as production and export machines but as a powerful way to improve human and planetary health.

the industrial food system and the influence of food and beverage corporations have profoundly altered what and how food is produced, distributed, and marketed within and between countries.

In Australia we now have an excess availability of foods to consume that are high in refined sugars, refined fats, and red meats. This is not good for NCDs.

Not only is it risky for NCDs. The industrial food system contributes globally to around 25 percent of all GHG emissions.

Politicians, lets ensure our food system is based on principles of health and environmental sustainability. Currently it is not.

Every politician should read @KateRaworth’s book, Doughnut Economics. To achieve social, health and environmental justice, we must operate within a Social and Planetary Boundaries Framework. Sounds like a good whole of government policy framework to me!

When asked, “Where should politicians begin: how do we get that fundamental shift rather than tiny steps?”, Friel replied: “Politicians, let’s ensure our food system is based on principles of health and environmental sustainability. Currently it is not.”


What do we want, when do we want it by? The first 100 days

Associate Professor James Ward, SAHMRI
@researchjames

 

Day 1 – First things first – how about an Aboriginal Minister to run Aboriginal Affairs-imagine that!! So overdue -we’re almost in the 2020s.

At day 5 – Genuine commitment to Close the Gap; include not only conditions that cause early death but all the conditions that make us sick. First step, all our health matters be put back in the health department.

Day 90 – EYYYAH— all us black fullas finally get our free car, house, scholarship, dog and One Nation is gawn, Tony Abbott’s gaaaawn, Nigel’s gawn, Izzy’s fully redeemed and @wildblackwomen make it big on the global stage!


Wrapping the election health news

Dr Lesley Russell, health policy analyst, contributing editor at Croakey News
@LRussellWolpe

In my segment, keen to explore, not details of individual policies, but the bigger picture – what is needed to get meaningful action on health/healthcare reform. Writing policies on paper is easy (I know, I’ve done that). Delivering them at the coal face is hard.

From my perspective, Labor has a suite of policies, the Coalition promises more of the same with narrow focus on hospitals, prescription drugs, biomedical research. Professor Stephen Duckett summed it up well for The Conversation.

Lots of room to point out what has not been offered to date policy-wise – will we see more health policies in tonight’s leaders’ debate? Also valid criticisms about the policies that have been offered to date – too much focus on hospitals.

Concerns that more must be done on prevention and primary care – that would help relieve burden on hospitals.

Fingers crossed Labor will push for innovation and sustainable investments in big reforms via Australian Health Reform Commission.

Coalition is just promising more of the same. 2019 Budget had Health Care Homes 2.0 – but have you heard Health Minister talk about this? Maybe as doomed to failure as HCH1.0? In fairness, ALP has promised more funds for HCH but not promoted this.

Things I would like to see analysed, discussed, policies, actions from next Government: Out of Pocket (OOP costs); social determinants of health (especially housing) in health policies; what’s fair government subsidy for aged care for wealthy Aussies; how to integrate mental health, substance abuse into primary care; workforce planning.

Where is workforce in election? Crucial to expanding dental care and mental health services, addressing rural disadvantage; quality and safety in aged care. Appropriately trained people working to full scope of practice keep costs down, help with burnout, improve access.

Best thing in this election campaign? ALP putting respect, honour, recognition for First Nations Australians and commitment to partnerships to address their issues and needs up-front at their campaign launch. Plus promise of Pat Dodson to Indigenous Affairs.

That’s the sort of vision, leadership I want to see in health. That’s what will really help the solve the issues.

In terms of getting things done on health/healthcare my exemplar is Dr Neal Blewett. There was a Minister for Health who could deliver on multiple fronts – and he had support from PM and Treasurer of the day. Vision, leadership, innovation, commitment.

Keep tweeting and retweeting and pushing for the very best in health / healthcare policy. (Don’t let the perfect be the enemy of the good.)


Everybody’s Home

Kate Colvin, Spokesperson for the Everybody’s Home campaign, and Manager – Policy and Communications, Council to Homeless Persons
@ColvinKate, @CHPVic

I’m tweeting from Wurundjeri and Boonerung country. I’d like to acknowledge the traditional owners of these lands and elders past, present and emerging.

It’s common misconception that homelessness is primarily caused by mental illness. Research shows that homelessness precedes mental ill health more than following from it.

Children who experience prolonged homelessness are especially susceptible to repeated experiences of homelessness later in life. That’s why rapid rehousing is so important for homeless families.

Delivering #HousingFirst (housing plus support) to people who have been homeless long-term results in better health – and fewer hospitalisations and emergency visits!

Housing instability and homelessness in early life has negative consequences for child development and mental health. That’s why we need to deliver housing families can afford!

Check out what the major parties are offering around homelessness. There are some crap things, some good things, and some that would be good if they were not so teeny tiny! I’m sorry to say that so far the Liberal policy to deliver social housing and reduce homelessness looks a lot like this!

But I have hope, there are 10 more days. Please can we have a plan to end homelessness.

Snaps to Australian Labor for committing to this big housing plan for 250,000 affordable rentals – if the states add in extra money to make it social housing, it will be the change we need.

Neither the Liberals nor Labor have committed enough to house women and children fleeing family violence, though the Labor commitment is a lot bigger. Check them out – Liberals statement; Labor’s statement.


Talking Teeth

Professor Marc Tennant, UWA
@MarcTennant

I have spent three decades working in and around dental health/public health and innovation in Australia and other places.

We are a team of many, many people from all over earth – there is more than 100 people working on things with us; from Jeddah to Utah and everywhere in-between.

We have graduate students focused on addressing inequality and building systems to reform health care in Australia and across the world.

A big focus of our effort is Aboriginal health. We are one of the early teams to work on addressing issues of rural and remote dental health care access for Aboriginal people.

A crazy (in today’s thinking) simple model of fly-in-fly-out support to locally owned and run Aboriginal Medical Service based dental clinics. The gold standard today.

Aboriginal Medical Services can have, run and look after fantastic dental services, it’s right. Proven over decades.

Just do it today! I want to see EVERY AMS in Australia with a dental service! EVERY SINGLE ONE!

Poor dental health has become a condition of poverty and marginalisation over the last five decades.

Today the “average” (actually does NOT exist) Aussie kid has less than one decayed tooth. In fact, over half of kids have NO decay.

But, a small minority of kids have LOTS of decay and suffer a lot. These are more often than not those for poor areas or are at the edge of society.

Why has decay dropped to such a low prevalence in society? Not actually a simple, clean one-line answer. Brushing, eating better, fluoride, toothpaste…. the list goes on.

Amazing turnaround!!! In 1960’s, a 12-year-old had 12 holes in their teeth – today less than ONE! AMAZING.

This started in the late 1960’s so many adults today have low decay levels too. BUT, there are pockets of trouble too!

This trend is now in adults too – the poor suffer far more than the rich with dental disease.

Why? The risk factors are higher for the marginalised, it’s harder to access good preventive care and more risk-taking activity.

Australia has two dental systems ­– private dental care, that are small independent businesses on the whole and are free to charge as they like. This is more than 85 percent of dental care.

AND, a small public system for those on health care cards or similar. Also, here we have Aboriginal Medical Service based dental services too.

PS We also have dental care in some tertiary hospitals for tough problems, cleft lip and palate, oral cancer, jaw fractures and more.

The public dental system is small, often under-resourced, especially as dental disease is now a condition of poverty. It’s the wrong way round now (private: public ratio)

Remember, the public dental systems are run by STATE governments – the federal government does not really have a role in dental (although there are some growing bits of funding now).

Where do we need to go in dental health in Australia?

Everyone says dental should be part of Medicare. If I said the bill for that could be as large as the NDIS as a cost, you can see the problem.

And remember that most dental care is provided by small businesses where the government cannot control prices – there would be payment gaps!
Read more on Medicare Dental at https://croakey.org/a-new-publication-on-oral-health-catch-up-with-some-talkingteeth/ … It will explain in detail why that’s probably not achievable nor actually what would help Australians.

There are alternatives… We have seen some ­– targeted care for those in need subsidised by the government.

There are some efforts around to be targeted and maximising bang for buck. The most efficient models of providing good dental care are actually part of State government care systems.

State government dental care systems across Australia are run down, and the real opportunity now is to re-enforce them and grow them. Get some balance back into the nation

We now have dental workforce to do it!

In 2000, we were at a workforce crisis with a lack of dentists. Today, 20 years later, we have sufficient workforce coming though… In some places there are too many (Sydney and Melbourne) but as a nation we are now safe.

We need to get more dental workforce out of Nedlands, Double Bay and Toorak and into the rest of Australia – that’s the big effort for the next decade.

We need our dental focus to start with those in most need, the poor and marginalised (economically and geographically). This is where dental troubles are. They are not in Toorak or Double Bay.

And people in Toorak or Double Bay have access to care – some of the highest densities of dentists in the world are around those suburbs!!! True.

It is interesting that the Labor Party policy released last week has focused on the elderly. Demographic shift.

As I am explaining, dental disease is reducing in adults and those born from mid 1960’s forward are on the whole dental far better than their elders.

Focus on elder dental health is good! Australia is growing old and we still have dental troubles for people.

The maximisation of bang-for-buck from what I can see is for people to take their “voucher” (if Labor wins) and spend it in the public dental service. Help grow the safety net for others in need.

Obviously, where there is no public system, do use the local private practice but I just wish people would try their darndest to support their fellow Australians by helping grow the public system.

I should say, I am not employed either as a private or public dentist and take no money in sponsorship. I am an academic. (In addition, I do not have a share portfolio!)

And new things to think about. Telehealth is coming to dental. Yes, imagine screening teeth from images you take in your own bathroom.

Telehealth really going to be important in closing geographic gaps. Imagine screening kids to prioritise them for the dental team when they come to town.

There is a digital future in dentistry (I have seen experimental robots doing dental care! – it’s coming)’

An important initiative in dental will be big data and prediction. Well protected (privacy) coupled with good analysis is going to give us great tools to predict risk and predict where needs are.

We do need to see support going into the R&D of these big-data solutions in health. They will squeeze every bit of value from every dollar we spend on dental care. A digital future is coming to public health and dentistry.


Rural and remote health perspectives

Dr Ewen McPhee, a rural GP in Emerald, Central Queensland. President of the Australian College of Rural and Remote Medicine, and Past President of the Rural Doctors Association of Australia
@Fly_texan

Rural health is a key concern for Australia. Poor access, high death rates – preventable and accidental – and youth suicide.

Urban knowledge and urban views on solutions cannot be dumped in rural and remote Australia. Yet we reach for national agencies to deliver local solutions without empowering a community response.

The first national health debate that did not mention rural Australia. There is an over emphasis on Medicare bulk billing as a surrogate for quality and access. Rural health is a moral issue – it should not be political.

Community context involves understanding remote perceptions of health and wellbeing. Rural and remote context must address cultural and spiritual understandings of care. Local people can be powerful contributors to solutions.

“The country doctor has only himself to rely on: he cannot in every pinch hail specialist, expert, and nurse. On his own skill, knowledge, resourcefulness, the welfare of his patient altogether depends.” – Flexner A (1910).

There is good evidence, at national, state, regional, local, and individual levels that good primary care is associated with better health outcomes, lower costs (robustly and consistently), and  greater equity in health.

Australians living in rural and remote areas generally experience poorer health and welfare outcomes than people living in metropolitan areas. They have higher rates of chronic disease and mortality, poorer access to health services, are more likely to engage in behaviours associated with poorer health, and are over-represented in child protection and youth justice sectors.

What solutions are important?

• A National Rural Health Strategy – that engages rural and remote Indigenous and other Australians

• Health reform that strengthens primary care improving access and equity.

• Digital health is a boon for the bush – but it doesn’t replace doctors, nurses or other health professionals.

• Respect for the country – select and train rural people for careers in their regions – Fund regional universities to deliver health courses – shift sandstone medical places to the regions.

• People deserve the best we can give – rural and remote Australians deliver Australia wealth and profit – country people deserve better than myopic national responses.

What policies are important?

• Medical training should address the needs of communities not the needs of the doctors – regionalise specialist training – encourage rural research (but more importantly, take notice of the excellent work done already).

• Invest in social determinants – mental wellbeing, cultural safety and respect, infrastructure that empowers safe communities, affordable food ­ that would be novel…

Wouldn’t it be nice if we had a health system that looked after people from cradle to grave (and their teeth)?


Climate crisis: our future is now

Professor Melissa Haswell, QUT
@im4empowerment

I acknowledge the Traditional Custodians of this great Land – I hope so much that voters realise the intense responsibility we have right now to honour the values and nurturing processes of these Custodians for 65,000 years.

I urge voters to vote for candidates and parties that put the health and wellbeing of future generations first – we are in a climate emergency and we must act now to reduce our carbon and methane emissions ASAP.

Voters recognise that Aboriginal and Torres Strait Islander Australians have made their voice clear – vote to support the Uluru Statement from the Heart – it is a voice of hope and healing, showing the way forward for all

Australians from all walks of life are suffering high levels of stress, fear, isolation, disempowerment – vote for candidates and party that understands mental health, values social, emotional and spiritual wellbeing, recognises the climate emergency and protects our children

Australians – please recognise NATURAL GAS – METHANE is a potent fossil fuel with grave consequences for climate and health – it is not clean or green.

No gas expansion, no to fracking in NT, WA and SA, wind down CSG in Qld for health’s sake.


Other highlights

During the day, many other people dropped into the conversations and contributed.

Greens leader Senator Richard di Natale (or possibly staff members) tweeted:

We need to get dirty money out of politics – and the Greens have a plan to do it.

We are at a critical juncture both in Australia and around the world to act to tackle global warming and yet our government seems hell bent on taking us in the wrong direction

I’m proud to be one of the leading voices in Australian politics to advocate for greater investment in public health and prevention. We must find ways to keep people healthier throughout their lives rather than just treating illnesses once people get sick.

Addressing the social determinants of health is key to all Greens policies. We are committed to addressing inequities in society throughout our policy platform. Read more about our plan to create a fairer, more equal community.

We’ve been pushing for Medicare funded dental for almost a decade. I negotiated the first step with then health minister Tanya Plibersek and secured Medicare-funded dental care for 3.4 million children and now it’s time that we expanded this to include everyone.

The NDIS is only funded to support a fraction of the 250 000 people with severe mental illness that needs psychosocial support. We will provide an additional $450 million for community psychosocial services to bridge this gap.

We must address our unfinished business: treaties, healing, justice and truth. The Greens will work with First Nations peoples to introduce measures that support self-determination and recognise sovereignty.

We have a plan to fix Australia’s safety net and to improve health outcomes for all Australians by doing so.

We are proud to be the only major party to support the calls to #raisetherate [re Newstart allowance]/

I met with Trevor from VACCHO last week to talk about improving First Nations Health and how we can work together with First Nations peoples. Proud to be a supporter of these important health changes. The Greens will continue to fight for health equity across the health system.

Paul Dutton, from the Barkindji Nation, tweeted tirelessly throughout the day:

And many wider discussions also took place


The event trended nationally on Twitter for most of the day; during the 12-plus hours of the #AusVotesHealth Twitter festival, more than 1,500 people joined the discussion, sending nearly 7,400 tweets and creating more than 48 million Twitter impressions, according to Symplur analytics.

For the period of the Festival and its coverage at Croakey (7-14 May), Symplur Analytics report that 3,029 Twitter accounts participated in the #AusVotesHealth discussions, sending almost 13,000 tweets, and creating more than 80 million Twitter impressions.

Read the Twitter transcript here.

Reports from the #AusVotesHealth Twitter Festival will be compiled into an e-publication, which will be freely available from Croakey.org.

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