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The Health Wrap: Tackling big picture public health issues

Major public health issues facing Australians have been in the spotlight this fortnight including mental health, obesity and rising costs of healthcare. On a more light-hearted note, all you scientific evidence and health nerds may enjoy this video. Happy Friday.

Overlooked areas of mental health

It’s always appropriate to talk about how we can improve our understanding and acceptance of mental health, but National Mental Health Week helps us take stock of where we’re at and highlight key issues. In a thoughtful opinion piece for The Australian, chief executive of the Mental Health Council of Australia Frank Quinlan said it was a sensible time to examine DisabilityCare Australia (formerly the National Disability Insurance Scheme) in the context of psychosocial disability.

Psychosocial disability, he writes, is when people experience severe and lasting impacts on their everyday lives; impacts that reduce their ability to function and participate in society. In some cases it results in the need for constant, supervised care. It is a disabling condition that should not be overlooked by DisabilityCare, he says.

“Unfortunately, funding for health is never infinite, and herein lies the government’s first challenge: what is the entry criteria, and who makes the judgment about who is in, and who is out,” he asks.

“People with psychosocial disabilities often have complex support needs, but can also experience good days and bad. A fair and adequate assessment system should be in place that looks at whole-of-life situations and experiences, not just what is possible on a good day.”

National Mental Health Week wrapped up last week, coinciding with World Mental Health Day.

In another often overlooked area of mental health — rural mental health ­ — Mount Isa youth health advocate Alvin Hava has urged the newly appointed chairman for the Queensland Mental Health and Drug Advisory Council, Professor Harvey Whiteford, to visit rural regions of Queensland.

“I would encourage him to visit rural and remote communities who have historically had barriers to service delivery, whether it be retention of staff, or resources,” Mr Hava told The North West Star.

“I think it is pivotal that he listens to not only the public servants, but open up opportunities for the establishment of a grassroots community working group which can give him the real issues on the ground.”

And pharmacy student Ben Crough describes on Croakey how being poor and in a rural area is a double whammy when it comes to health.

Meanwhile Communications Minister Malcolm Turnbull has responded to a study from health promotion agency VicHealth, which found internet access can help people over 65 stave off loneliness and depression.

Mr Turnbull backed calls from the Agency for cheaper Internet access, saying affordability was a key issue, news.com.au reports.

VicHealth surveyed 25,000 people – including 8185 aged 65 or over – and found a clear correlation between income and web access.

The study found that 92 per cent of households with an income of $120,000 or more had access to the internet, falling to just 41 per cent of those with an income between $10,000 and $19,000.

Finally, research fellow with the Centre of Mental Health and Risk at Manchester University, Kirsten Windfuhr asks: ‘How dangerous is mental illness’ in a sensible piece for The Conversation.

She examines the media’s role, saying: “Reporting should be accurate and balanced, with the aim of fostering an open and honest debate about how we as a society keep people safe from individuals who are potentially at risk to themselves or others”.

The role of workplaces in addressing mental health was highlighted by Australian Medical Association (AMA) president Dr Steve Hambleton who used the awareness week to call for workplaces, employers, and employees to work cooperatively to develop and support working environments that promote positive mental health.

He cited the appalling finding by the Mental Health Council of Australia that nearly one in four Australians have witnessed discrimination in their workplace relating to mental illness.

***

We’re fatter than we thought

UK health watchdog, the National Institute for Health and Care Excellence, says doctors should not blame obese patients for their weight, The Telegraph reports.

With one quarter of adults in England classified as obese, the Institute recommends doctors avoid prescribing quick fixes to patients and instead refer them on to lifestyle-focussed programs such as WeightWatchers.

In order for patients to follow-up on this advice, their interactions with doctors should be respectful and non-blaming, the watchdog says.

It may be something Australian doctors need to consider as well, with a new report from the Baker IDI Heart and Diabetes Institute finding the extent of obesity problem is underestimated.  The  research found the usual method of measuring obesity had dramatically underestimated the problem, the Sydney Morning Herald reported. Fitting, then that the ACT Government has said it will be getting tough on obesity.

In a co-authored viewpoint for The Conversation, Baker IDI Obesity and Population Health head Anna Peeters — also a researcher on the study — discusses whether a small amount of excess weight should be cause for concern.

She and Health Sciences Professor Tim Olds use a new study published in the American Journal of Epidemiology   as a basis for their piece, discussing the finding that those most likely to die were normal weight study participants who lost weight, rather than overweight participants who stayed overweight.

***

Mixing sport with alcohol equals controversy

Public health professor Mike Daube from the McCusker Centre for Alcohol and Youth has slammed what he called “appalling censorship by Cricket Australia” after they refused to run an advertisement telling fans that alcohol and sport don’t mix.

Cricket Australia’s argument for not running the ad was that alcohol and sport can mix perfectly well, The Sydney Morning Herald reports.

Professor Daube told The Herald he believed Cricket Australia was keen to protect its alcohol sponsors from messages that might offend them, while doing nothing to stop alcohol promotion that might offend health-promoting sponsors.

In the context of taking action to improve health, it is fitting to point out a piece by Cancer Council Victoria CEO Todd Harper on how the political system works against effective public health action and leadership. Writing for Croakey, he says public health fails to attract the investment it should partly because of a lack of leadership, but also because it battles to sustain the interest of governments beyond the next crisis in the healthcare.

Meanwhile, in a controversial health debate, SBS Insight asks if expectant mums drinking alcohol is ever okay.

The program featured pregnant women, parents, doctors and those with Foetal Alcohol Spectrum Disorder, all sharing their experiences and expertise. National Health and Medical Research Council guidelines state that not drinking is the safest option for expectant mums.

***

Government goings on

Federal Health Minister Peter Dutton launched a salvo at Labor this week, telling the ABC’s Mark Colvin on PM that the former government was responsible for higher health care costs. His comments came as the AMA announced its yearly increase in doctor fees, lifting a standard GP consultation to $73, up $2.

“There are lots of things I’d like to do in Health but given Labor’s debt it is going to be tough for families when they go to see their doctor. It is going to be more expensive,” Mr Dutton told PM. “And this is a decision that Labor took because they had spent too much money.”

And from the other side, former Attorney General and health minister Nicola Roxon  stuck the boot into Kevin Rudd, describing him as a “bastard” and calling on him to quit Parliament.  In her John Button Memorial Lecture in Melbourne this week, Ms Roxon said: “Health and climate change were the two longest running ‘non-discussions’ for the first term of government, with some other contentious policies getting only cursory cabinet approval at the last minute”.

Jennifer Doggett’s Croakey take on Ms Roxon’s comments links to the full transcript of the speech. Doggett writes that Roxon’s ‘housekeeping tips’ for the Labor party could just as easily apply to the Coalition government. Also on Croakey,  Daniel Holloway, Communications Officer at the AHHA, and Sam Osborne, Project Officer at the AHHA, reflect on a recent symposium in Canberra where experts debated ‘Universal Healthcare and its challenges for the future’. Speakers at the Deeble Institute symposium discussed the many challenges of Australia’s health system, including waste and inefficiency, structural imbalances between public and private health insurance, and increasing supply and demand.

Shifting to the US, an article in The Australian described rising healthcare costs in the US as “sickening”. The opinion piece from Adam Creighton said the Congressional stand-off in the US – which has now ended  – was not as simple as “mean US conservatives deliberately shutting down the government to stop a caring president from healing sick, poor Americans”.

“The Republican-controlled US House of Representatives has every constitutional right to try to stymie Obamacare, which not one Republican voted for, and which remains deeply unpopular with Americans, and which four of the nine US Supreme Court judges said was unconstitutional,” he writes.

When the US Senate finally passed the Bill for ObamaCare, the New York Times wrote US President Barack Obama said it provided the opportunity to focus on a sensible budget that was responsible, fair, and helped hard-working people.

Slate’s headline says it all; ‘Obama Wins’. Reporter John Dickerson writes: “It was possible to see the seeds of this outcome just before Obama’s second term started. The President, no longer facing re-election, had written off negotiating with GOP leaders. He and his aides resolved that future budget negotiations would be founded on a hard line”.

***

Positivity  in addressing youth Indigenous Health

A new report from the Muri Marri Indigenous Health Unit at the University of NSW has addressed ways to improve the health and wellbeing of young Indigenous Australians.  In an opinion piece for the Sydney Morning Herald, an Aboriginal woman working in public health, Professor Lisa Jackson Pulver, says the report found youth programs that worked effectively emphasised the strengths of young people, encouraged positive behaviour and participation and supported culturally appropriate self-belief and self-esteem. Professor Pulver also offered her take on the report for Croakey.

The National Aboriginal Community Controlled Health Organisation (NACCHO) says the Muri Marri report highlights the importance of addressing the cause of poverty and other determinants of health as well as current issues; building on the strengths of culture, community and family; using a ‘bottom-up’ approach; and recognising the importance of leadership from Elders.

They quote the report’s lead author, UNSW Associate Professor Melissa Haswell, as saying:Conventional research practice requires us to identify and quantify a problem before we seek to solve it. But, for Indigenous disadvantage we’ve been stuck in this rut for far too long. Constant negativity is only reinforcing harm”.

Shadow minister for Indigenous Affairs Jenny Macklin says self-defeating discourse has been allowed to overshadow the good progress that has been made in areas of Indigenous disadvantage. Her piece in The Australian highlights progress in the relationship between Indigenous Australians and government to tackling areas in dire need of attention, such as health. The Labor Party helped to Close the Gap, she says, setting ambitious targets which meant the gap between Aboriginal and non-Aboriginal Australians was closing.

Finally, this NACCHO report says the Federal Government’s chief Indigenous advisor Warren Mundine has flagged a radical overhaul of the body that regulates Aboriginal corporations.

***

Smoking more deadly and veges helpful for blood pressure

Australian-first research from The Sax Institute’s 45 and Up Study* has found the damage from even light tobacco smoking is more severe – and associated with a higher risk of premature death – than previously thought.

Pack-a-day smokers have a fourfold greater risk of dying early, according to the research, presented at the Study’s annual collaborators’ meeting in Sydney.  News Limited national health reporter Sue Dunlevy reported on the research, which shows two-thirds of deaths in current smokers directly attributed to smoking.

Meanwhile, University of Western Australia research has found that vegetables rich in nitrates help to offset arterial stiffness and reduce blood pressure, thereby lowering people’s risk of heart disease. “What we found from the spinach study was that a meal rich in spinach could lower blood pressure and reduce arterial stiffness significantly within a few hours,” scientist Alex Liu told The West Australian.

***

Doctors who blog

Children’s anaesthetist and CareFlight doctor, Andrew Weatherall, blogs at theflyingphd as part of his PhD project which aims to shed new light on the injured brain. “It’s a project that comes from the clinical experience gained by working at CareFlight, where teams including doctors and paramedics go to accidents where patients might benefit from advanced level care immediately after the accident,” he writes. “In Australia, traumatic brain injury (TBI) is a significant cause of long-term deficit after traumatic injury (with estimates that it costs up to $8.5 billion per year).” You can also follow Dr Weatherall on Twitter.

***

Best tweets this week:

Emily Webb Hugh Jackson, paediatrician, who lobbied for introduction of child-resistant packaging, dies at 95 via http://fw.to/aL5KW2K

Prof Chris Semsarian ‏ Vitamin D ‘no effect’ on the healthy! Interesting http://www.bbc.co.uk/news/health-24473156

Simon Chapman ‏ New Oz study of mature epidemic finds 2/3rds smokers die, average of 10 years early. Worse than previous 1 in 2. http://mobile.abc.net.au/news/2013-10-11/smoking-risks-higher-death-disease-lung-cancer/5015588 

Dr Alessandro Demaio@WePublicHealth  At some stage – we as an Aus community must realise #healthcare, #education and even #broadband are investments! Not costs! #shorttermism

Other Twitter shout-outs go to @insightSBS; @theMJA; @WePublicHealth

If you have read an article that you think Croakey health wrap readers might be interested in, Tweet them to @MelissaLDavey or @medicalmedia. 

Other Croakey reading you may have missed this fortnight:

Housekeeping tips for the old and new government – Nicola Roxon

A backward step for community health in South Australia

Backyard Renovators Beware!

Shared decision making – from research into practice

The power of the ‘ick’ factor in organ donation

Why history lessons are an important part of medical education

You can find previous editions of the Health Wrap here.

*Melissa Davey is the Sax Institute’s Communications Manager. She was previously a health and medical reporter for the Sydney Morning Herald and the Sun Herald. She is completing her Masters of Public Health at the University of Sydney and has a strong interest in public health messaging, body image and mental health. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning. Twitter:@MelissaLDavey

 

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