A chronic problem
Chronic disease has been big news this fortnight, with a widespread coverage on issues ranging from the “fat and fit” theory to a snapshot of the nation’s health showing that one in two people are living with a chronic illness.
The Australian Institute of Health and Welfare report on Australia’s health revealed that although chronic illness affects 50 per cent of people, 85 per cent say they are in good or excellent health. Australia’s Health 2016 also revealed that cancer is now the country’s leading cause of death, surpassing cardiovascular disease, as reported by news.com.au.
In this article on The Conversation, Professor Fran Baum from Flinders University wrote that the report highlighted significant health inequities, with people living in the richest areas likely to live up to four years longer than those in the poorest areas. She added:
“Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others.”
New findings from the Sax Institute’s 45 and Up Study presented at a conference in Sydney revealed that when it comes to preventing type 2 diabetes, the controversial “fat and fit” theory doesn’t apply. As reported by The Guardian, new research showed that people who are overweight or obese but physically active still have a much higher risk of diabetes than people of normal weight who are less active. Lead researcher Thanh-Binh Nguyen from the University of Sydney’s Prevention Research Collaboration said:
“Once you are overweight, being physically active doesn’t help you that much in terms of preventing type 2 diabetes. It helps you if you can manage to reduce your weight, so it’s important to continue to be physically active and to adopt a healthy diet.”
ABC’s The World Today reported on another piece of new research presented at the 45 and Up Study annual meeting, which looked at the economic burden of lifestyle-related diseases like stroke, heart attack and obesity in working people. Researchers from the George Institute found that such diseases cost federal and state governments hundreds of millions of dollars annually in direct health costs, prompting calls for greater investment in workplace-based interventions to promote healthy living.
According to this article on Croakey, our ageing population and the subsequent rise in chronic conditions has also led to Australia’s GPs working harder than ever, with the latest BEACH data showing that GPs managed 154 problems per 100 patient encounters in 2015-16, compared with 149 per 100 patient encounters in 2006-07.
The risk of chronic diseases like obesity may start from birth, according to The Sydney Morning Herald, which reported on a study showing children born by caesarean section were 15 per cent more likely to be obese as children, teens and young adults compared with those born vaginally.
Also on the topic of obesity, a Cancer Research UK survey of 3,000 people showed that three in four were not aware that being overweight increased the risk of cancers such as bowel, kidney, breast and ovarian cancer, according to BBC News.
And ABC News reported that a trial was underway in Tasmania – a state with smoking rates among the country’s highest – to offer pregnant women $50 shopping vouchers for quitting.
Indigenous child health in focus
The Conversation has been focusing on the health of Aboriginal children, with a series of articles highlighting conditions that are prevalent among Indigenous children, but virtually non-existent among non-Indigenous children, including trachoma and rheumatic heart disease. Young Indigenous Australians in the Northern Territory are up to 122 times more likely to have rheumatic heart disease than their non-Indigenous counterparts, says Jonathan Carapetis , Professor Paediatrics, Telethon Kids Institute. He writes:
“It seems far-fetched to think a sore throat or skin sore could take a lasting toll on your health, leading to heart failure and premature death. But this is the reality for many Indigenous children and young people in Australia’s most vulnerable communities.”
UK epidemiologist Sir Michael Marmot also highlighted the health gap between Indigenous and non-Indigenous Australia in areas including rheumatic heart disease and youth suicide, in his Boyer Lectures. As reported by the ABC, he suggested the traditional approach of treating the disease would not work to close the gap, which was the result of inequality. Instead, he said investing in early childhood development was the best way to deal with the inequality, and in turn, the disease.
It was a timely message, amid concerns that the Bubup Wilam Aboriginal Child and Family Centre in Melbourne will be forced to close next month, due to lack of funding, leaving 83 families with no access to critical early childhood support, as Croakey reported.
The Australian reported (paywall) on efforts to address another common problem among Indigenous children – middle ear infections, with ENT specialists, audiologists, Aboriginal health workers, scientists and administrators meeting in Newcastle to discuss a proposed national initiative to standardise an evidence-based approach to the infections, deafness and its educational effects.
ABC Triple J’s Hack program covered a Mission Australia Youth Survey which revealed that 10 per cent of young Indigenous men and five per cent of young Indigenous women rate their happiness as zero out of 10 – in contrast to 1.2 per cent of non-Indigenous men and women having such a low score for happiness.
Croakey reported on the first public sitting of the Royal Commission into the Protection and Detention of Children in the Northern Territory in Darwin, which was set up in the wake of the ABC Four Corners program’s shocking revelations about the mistreatment of young detainees at Darwin’s Don Dale facility. At a packed first hearing, one of the two Commissioners, Mick Gooda, said engagement of all parts of the Territory community, both Aboriginal and non-Aboriginal, would be critical to the success of the Royal Commission.
Meanwhile, the ABC reported that human rights organisations were urging both the Northern Territory and Federal Governments to ban solitary confinement in youth detention to protect young people, while awaiting recommendations from the Royal Commission.
The Guardian reported on the community impact of the death of a 14-year-old Indigenous boy Elijah Doughty, who was allegedly struck by a ute while riding a motorbike, sparking a riot in a remote West Australian town.
The justice system’s impact on Indigenous adults was also in focus, with The Guardian reporting on the search for answers by the families of Indigenous man Jayden Bennell who died in a WA prison in 2013, and Indigenous woman Rebecca Maher, who died in police custody in the Hunter Valley, NSW, this year.
In some positive news, Croakey reported the history was made when Federal Parliament heard the maiden speeches of two new Labor MPs and Indigenous leaders – Senator Patrick Dodson, long-held as the ‘father of reconciliation’ and Linda Burney, the first Indigenous woman elected to the House of Representatives.
The independent Callinan review into NSW’s controversial “lock out” laws handed down its report, finding that the laws have reduced admissions to emergency departments and made Kings Cross and Sydney’s CBD safer places, but they have also come at a cost to the city’s vibrancy and employment opportunities.
The report suggested possible relaxation of the 1:30am lockout to 2:00am for live entertainment venues, and suggested the closing time for over-the-counter alcohol sales be relaxed from 10pm to 11pm and home delivery of alcohol be extended from 10pm to midnight across the state. The Daily Telegraph (paywall) covered the mixed reaction to the report, including comments from NSW Premier Mike Baird, whose government is yet to formally respond to the report, but who said it confirmed the measures had been successful in reducing alcohol-related violence. He said:
“What was overcrowded and violent has become safe and secure and that’s an incredible moment.”
Meanwhile, the Royal Australasian College of Surgeons warned that any relaxation of the liquor laws was not a “justified risk”, saying each extra hour of alcohol trade results in a significant increase in domestic violence, according to The Sydney Morning Herald.
The Federal Government’s release of the interim report of its Medicare Benefits Schedule (MBS) Review Taskforce provoked much discussion, with Croakey reporting that it raised concerns, particularly from the Australian Medical Association, that the process will be used as a cost cutting exercise, but was welcomed by organisations like the Consumer Health Forum, which argued that consumer perspectives were vital to the modernisation of Medicare.
Proposals outlined in the interim report include a requirement for mandatory health testing for pregnant women and new mothers, restrictions on GPs ordering services such as low back scans, and new limits on surgeons ordering multiple MBS items for a single service, according to The Australian (paywalled). There was also a proposed requirement for medical professionals to pass a test on their knowledge of MBS rules and billing requirements before gaining their Medicare provider numbers.
Croakey also reported that the Government’s pledged reform of the private health insurance industry would be led by senior public servant Dr Jeffrey Harmer, who will oversee the committee charged with developing new ‘gold, silver, bronze’ categories of insurance policies.
“Fears about Medicare are real and need to be taken seriously by whoever is in government. Our public health system is a highly valued piece of social infrastructure that is used by everyone, sometimes at some of the scariest times of their lives.”
On the world stage
Canadian public health experts have called for the development of national suicide prevention strategy, with dedicated federal funds. Writing in an editorial in the Canadian Medical Association Journal, they said suicide was the second leading cause of death among those aged 15 to 34 years, and the rate for Indigenous populations was staggeringly high.
In Russia, the Kremlin blamed moral lapses for a looming HIV epidemic, with the country reaching the milestone figure of more than one million people officially registered with HIV, as reported by ABC News Online.
Other Croakey reading you may have missed this fortnight:
- Desperately seeking health funding certainty in Cape York
- Health professionals urged to step up and advocate for therapeutic justice systems
- A toast to Sir Michael Marmot and his latest book
- Health professionals as vendors: the commercial erosion of evidence and ethics
- ‘Child protection is everyone’s business’ – some standout recommendations from SA’s Nyland Royal Commission
- Call for submissions to AHPRA review on use of chaperones to protect patients
- Jennifer Doggett replaces Tony McBride as head of AHCRA, as survey shows support for preventive health investment
- MarmotOz: prize tweets and prized SDOH conversations to mark Boyer Lectures
- Hon Ken Wyatt set to head up Indigenous Health?
- Conference preview: What are the big issues in international medical regulation?
Megan Howe is the Publications Manager at the Sax Institute. Follow @SaxInstitute or @meghowe68 on Twitter.