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Tackling the health issues left in the “too hard” basket: what can we learn from the US?

Public health policy consultant Margo Saunders has taken a look at some recent reports from the US Institute of Medicine, and considers some possible lessons for Australia.

Margo Saunders writes:

While progress on so many health issues in Australia seems to be frustratingly slow, the US Institute of Medicine (IOM) is charging head with a raft of new initiatives.

Commissioned by government, private sector and non-profit organisations, these include a consensus report on preventive health services for women, a workshop on the gender-specific reporting of scientific data, and a consensus report proposing a national surveillance system for cardiovascular and chronic lung disease. The second report on front-of-pack food labeling systems is expected within the next few months.

As noted in an earlier post on the IOM, the Institute seems to occupy a particularly useful space, especially in the light of questions raised by Australian commentators about Australia’s health research infrastructure (do we need a research, reporting and evaluation capacity independent of government and the bureaucracy?) and about the divide between academic research and the needs of evidence-informed policy.

The IOM’s brainpower comes from university research centres and private and public sector experts, a number of whom occupy interesting positions at what may be thought of as the ‘ac-prac intersection’.

For example, a professor of pediatrics represents the American Academy of Pediatrics Health Literacy Advisory Committee, another professor is President and CEO of a state-based health literacy organisation, and senior academics in schools of public health include former senior health and medical officers at the federal, state, county and city levels. This mix of expertise ensures a strong focus on knowledge transfer.

Much of the IOM’s work also has theoretical and practical relevance to other countries, including Australia.  Several recent reports are of particular interest — not just because of what they say, but because their existence constitutes an important step in progressing these often-complex issues.

First, as mentioned in the footnote to my earlier post on the IOM, is the review of public health laws in the context of changing social and policy environments.

While Australia has barely a handful of academics generating a small smattering of publications (albeit excellent ones), we do have ‘experts’ capable of leading wider discussions.  Professor Roger Magnusson’s (U Syd) Australian Research Council-funded project on ‘Lifestyle wars: law’s role in responding to the challenge of non-communicable diseases’ (which also suggests that there is at least some research support for these topics) could easily be the subject of an IOM-style enquiry.

Another consensus report concerns a matter which has not gone un-noticed in Australia: equitable access to oral health care.  This report notes that, while lack of access to oral health care contributes to ‘profound and enduring oral health disparities’, opportunities exist to reduce the social, cultural, economic, structural and geographic barriers to access.

Australian health and medical authorities have echoed US concerns about access to care, resulting in proposals such as the National Health and Hospitals Reform Commission’s ‘Denticare’ scheme. The IOM’s call for ‘flexibility and ingenuity’ in addressing access barriers also carries strong overtones of Australian appeals for ‘innovation’ in policy development and implementation.  The report’s recommendations include increased health insurance reimbursements, more flexible responsibilities among health care professionals, and changes to dental recruitment, education, and training.

According to feedback generously provided to me by individual members of the Public Health Association of Australia’s Special Interest Group on Oral Health, Australia will also need to look at changes in education, financing and regulation to achieve more equitable access to oral health care.

Dr Alexis Zander believes that a health insurance scheme which includes dental health would encourage timely and regular access to care.  Dr Catherine-Anne Walsh agrees that oral health should be integrated into general health and that Australia should monitor forthcoming debates and actions around the IOM’s recommendations. She also notes that the report, while concluding that dental coverage should be provided for all low-income individuals and families, also highlights the need to address deficiencies in the collection, analysis, and use of oral health data.

Health literacy (defined as the capacity to obtain, process, and understand information needed to make appropriate health decisions) has been addressed by a series of reports, the latest being the summary of a workshop on opportunities to advance health literacy in the context of US health care reform.  The report includes presentations not only from high-level experts, but from speakers representing children, the elderly and other vulnerable populations.

The IOM’s approach to this issue has been typically collaborative, involving individuals from academia, industry, government, foundations and associations, and patient and consumer groups. The workshop itself was sponsored by 8 organisations, including non-profits, pharmaceutical companies, doctors’ organisations and managed care organisations.  The focus is not on producing research per se, but on bridging that divide between research and practice: ‘to move forward the field of health literacy by translating research findings to practical strategies that can be implemented.’

US Deputy Assistant Secretary for Health, Anand Parekh told workshop participants that the US has reached ‘a collective recognition that improving health literacy is essential to improving health and health care’ and has placed health literacy ‘at the center of the national health policy conversation’.  In the discussion which followed, health literacy expert Dr Scott Ratzan argued that leadership and enthusiasm are still needed, together with the involvement of those from other fields, including behavioural economics.

There are potential lessons from the IOM approach, even taking into account the need to fine-tune solutions to suit our circumstances.

The problem is not necessarily that things are not happening in Australia – the problem is the disjointed and uncoordinated nature of much research and thinking about health, particularly in relation to the more messy or ‘wicked’ issues. In Australia, for example, the importance of health literacy has been acknowledged but the agenda remains largely un-owned and uncoordinated.

It is clear that the IOM is progressing many health issues that would otherwise languish in the ‘too hard’ basket; is facilitating links between research, policy and practice; and is forging collaborations and partnerships across the government, non-profit and private sectors.

Can we claim to be doing the same?

***

PS from Croakey

Meanwhile, the IOM is due to release a report today that is expected to propose a tougher approval process for a wide range of devices like hip implants, hospital pumps and external heart defibrillators. The report, commissioned by the Food and Drug Administration, comes after several well-publicised recalls in recent years of devices that have failed in thousands of patients, causing numerous injuries. According to the New York Times, allies of the medical device industry have already begun an “extraordinary” campaign in Washington to discredit the report.

On related matters, the NYT also reports that some academics and medicos who receive pharma and other industry funding in the US are planning a “fight back” campaign against growing international concerns about the adverse effects of such conflicts of interests.