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The Health Wrap: a treasure trove of recommendations for health reformers

Whoever forms government after the federal election will find plenty of inspiration – should they actually want to make meaningful reform – in this latest column from Associate Professor Lesley Russell.

The Health Wrap covers recommendations for reform across diverse and yet interconnected areas, including primary healthcare, obesity, the Indigenous health workforce, out-of-pocket costs, and for improving access to healthcare in rural, regional and remote Australia.

It also reports on moves in the United States to address misinformation, tackle the social determinants of health, and enhance the national public health infrastructure. And don’t miss the award-winning wildlife photography; it will take your breath away.


Lesley Russell writes:

It’s a constant complaint among policy wonks that nothing happens quickly in the federal Department of Health, even when the issues are crucial. But the first months of 2022 have seen a raft of long-awaited policy papers and national strategies released, often with surprisingly little fanfare given their potential impact.

It’s as if the Department and the Minister for Health are clearing out the closets and ticking off the “To Do” lists ahead of the upcoming election.

Of course, delivering fine words on paper is the easy part – it’s delivering meaningful actions that matter. So we must hope that there is bipartisan commitment to addressing the issues such as preventive health, obesity and workforce – and funding to ensure this can happen.

A media release from the Australian Medical Association reminds me that we are yet to see the Primary Health Care 10-Year Plan. The consultation period on the draft Plan closed in early November last year.  Now the AMA claims the Plan has been “dumped”.

Once much-vaunted by Health Minister Greg Hunt as representing the Morrison Government’s commitment to reforming the healthcare system to be “more person-centred, integrated, efficient and equitable”, in more recent months the Plan has not been mentioned. This even as the COVID-19 pandemic highlights the importance of primary care and the pressures facing GPs.

The submissions to the draft Plan from the major doctors’ groups placed a significant emphasis on continued fee-for-service and increased Medicare rebates (see, for example, this commentary from the RACGP and this article I wrote in October 2021).

These regressive approaches ignore the fact that the transition to model/s of primary care fit for the 21st century will require the adoption of innovative approaches to the delivery, organisation and financing of care and profound changes in culture.

Maybe this is why  the much-needed Primary Care Plan is foundering?


At last – a national obesity policy. Now what?

Australia’s National Obesity Prevention Strategy 2022 – 2032 was finally released on World Obesity Day.

This Strategy has been a long time coming (see Where is the National Obesity Strategy? published by Croakey in August 2021). Work began in 2018 when federal and state and territory governments agreed to work on a national strategy. The draft Strategy was released for comment in October 2021. You can read more about the development process here.

There was notably no political attention paid to the launch of this important policy to address a priority health problem that has huge impacts on Australians’ physical and mental health and healthcare costs.

In particular, there has been no federal leadership and no commitments to funding (unless, miraculously, there is support in the upcoming Federal Budget). That must lead to concerns about the potential of a national policy approach to deliver improved health outcomes.

As the document itself states – the current health and social supports don’t prioritise addressing obesity, despite the significant costs it imposes. Tackling obesity needs a multi-faceted and united approach across governments; clearly federal leadership is critical.

It is encouraging to see an accompanying framework for action (see figure below), and a specific approach for Aboriginal and Torres Strait Islander communities.

For the most part, the Strategy has been well received; the focus now is on appropriate and ongoing funding and effective action.

As Professor Jane Martin writes for MJA Insight, there is no time to waste in getting this important work underway. That same theme is echoed in an article by Dr Amy Coopes in Croakey Health Media.

Martin highlights that an important aspect of addressing obesity will be to implement effective policies to limit commercial influences on health such as unhealthy food marketing, accurate labelling, and a health levy on manufacturers of sugary drinks.

Ongoing evaluation, measuring changes over time, reporting, and sharing lessons will also be crucial.


Launch of first Indigenous health workforce plan

The first  National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021-2031 was released on 13 March. It was co-designed by federal and state and territory governments and the Aboriginal and Torres Strait Islander community-controlled health sector.

The involvement of First Nations opinion and expertise in the development of this strategic framework and implementation plan gives meaningful ownership to the communities for which they were developed.

This document supersedes the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework 2016–2023. The current status of the Commonwealth Aboriginal and Torres Strait Islander Workforce Strategy 2020-2024 is unclear.

The target is for Aboriginal and Torres Strait Islander people to represent 3.43 percent of the national healthcare workforce by 2031, to match their expected percentage of people in the working population.

The aim is to expand access to culturally safe care, improve the health of Aboriginal and Torres Strait Islander people and provide well paid, secure employment for these Indigenous people working within the healthcare system.

It is described as including a wide range of actions across the healthcare system to attract, recruit and retain Indigenous healthcare workers to the healthcare workforce across all roles, levels and locations.

There are six strategic directions to support the ongoing development of the size, capability and capacity of the Aboriginal and Torres Strait Islander health workforce:

  1. Aboriginal and Torres Strait Islander people are represented and supported across all health disciplines, roles and functions.
  2. The Aboriginal and Torres Strait Islander health workforce has the necessary skills, capacity and leadership across all health disciplines, roles and functions.
  3. Aboriginal and Torres Strait Islander people are employed in culturally safe and responsive workplace environments that are free of racism across health and all related sectors.
  4. There are sufficient numbers of Aboriginal and Torres Strait Islander students studying and completing health qualifications to meet the future health care needs of Aboriginal and Torres Strait Islander people.
  5. Aboriginal and Torres Strait Islander health students have successful transitions into the workforce and access clear career pathway options.
  6. Information and data are provided and shared across systems to assist health workforce planning, policy development, monitoring and evaluation, and continuous quality improvement.

However, at this time there does not appear to be any additions or changes to the scholarships, training and programs provided by the Commonwealth for the support of the Indigenous healthcare workforce.

The Executive Summary state: “Governments and Aboriginal and Torres Strait Islander community-controlled health peak bodies agreed: an appropriately skilled, available and responsive Aboriginal and Torres Strait Islander health workforce is critical for an efficient national health system” – as was perfectly highlighted by the COVID-19 pandemic.

This document is an excellent beginning, but to bring it to life so it can deliver on the promises for the future will require leadership, commitment, financial support, mentorship, and efforts to address racism from governments and the non-Indigenous educational and training bodies and organisations that operate within the broader healthcare system.

See responses from:

Indigenous Allied Health Australia

IAHA Chief Executive Officer and outgoing National Health Leadership Forum Chair, Donna Murray, said of the announcement:

“The Aboriginal and Torres Strait Islander health workforce brings a unique, dual cultural and clinical lens to their work. Growing the Aboriginal and Torres Strait Islander health workforce should be a priority for all governments, with investment in Aboriginal and Torres Strait Islander led and culturally responsive approaches across health, education, skills, training, and employment portfolios.”

National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners

NAATSIHWP Chairperson, David Follent, said: “Our communities must have access to culturally safe and responsive care no matter where they are, and a strong, valued and highly skilled Aboriginal and Torres Strait Islander Health Worker and Health Practitioner workforce is key to this end.”

NAATSIHWP CEO, Karl Briscoe, said: “We know better health outcomes are achieved when our Aboriginal and Torres Strait Islander health workforce are involved in our people’s health care as we possess a cultural intellect that isn’t able to be replicated by mainstream health professions.”

• To attend the launch of #CloseTheGap22 report from