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The Health Wrap: an election with high health stakes, questioning reform efforts, and music for health and wellbeing

In her latest column, Adjunct Associate Professor Lesley Russell takes readers from the Rocky Mountains to lutruwita/Tasmania, Canberra, and Borroloola in the Gulf of Carpentaria, investigating wide-ranging health matters along the way, including how music can influence our physical and mental health.

The quotable?

Everyone knows that we can’t just do more of the same and get a health system that’s set up for the future.”


Lesley Russell writes:

The next few editions of The Health Wrap will come to you from our home at Keystone in the Colorado Rockies.

Most days here start with skiing or snowshoeing, and later we fire up the computers and get to  work.


#TasVotesHealth2024

By now I expect everyone knows that lutruwita/Tasmania is headed for a state election on March 23. As the only State currently with a Liberal Government, this is being watched closely by the political pundits.

The Tasmanian Premier, who has been working with a minority government for some time after a number of Liberal Party MPs retired or rebelled and moved to the crossbench, was forced to call an election a year ahead of schedule.

The dissenters were unhappy about the lack of transparency over a controversial deal with the AFL to build a publicly funded stadium on the Hobart waterfront and the proposed Marinus electricity link across Bass Strait and Rockliff’s conservative stance on social issues.

The pundits fully expect that, given Tasmania’s Hare Clark electoral system, the next government will also be a minority or coalition government.

This is reinforced by polling data suggesting Tasmanian voters are turning their backs on both major parties. Forty percent of voters said they would support the Jacquie Lambie Network, the Greens, and other independents.

When voters were asked in December about the most important issues for them in the election, healthcare (85 percent) cost of living (85 percent), access to a GP (76 percent) and cost of housing (69 percent) came out on top. A new football stadium did not rate.

Labor leader Rebecca White has positioned the election as a battle of priorities. She says cost of living relief is more important than a football stadium on Hobart’s waterfront. And she has supported providing extra money for regional hospitals and ambulance services, and funding rent incentives.

The question will be how to pay for this – although given that the current Rockliff Government has enmeshed the State finances in debt, it is somewhat churlish of them to be campaigning against Labor on the funding issue.

Tasmania’s public healthcare system is constantly in the headlines for negative reasons. The state’s four major public hospitals have had adverse findings in regards to deficiencies in care and sub-standard treatment.

Last August, Health Minister Guy Barnett urged Tasmanians to make use of alternative primary healthcare options where appropriate to avoid adding to the demand at public hospitals.

He claimed that almost 40 percent of all presentations to Emergency Departments in Tasmania in June 2023 were not urgent and may have been appropriate for treatment in an alternative health care setting, including virtual care and advice, mental health support, pharmacies, general practices, and Urgent Care Clinics (Tasmania now has four Urgent Care Clinics funded by the Commonwealth Government).

A summary of the data from the June 2022 report, Drivers of Tasmania’s Future Population Health Needs, highlights why more attention must be paid to Tasmanian health disparities.

Tasmania already has the oldest population of any State or Territory; the median age is projected to increase to 44.9 years by 2040.

Since 2009, the proportion of Tasmanians reporting excellent/very good health has declined and the proportion reporting their health as either good or fair/poor has increased. It is projected around 32.5 percent of Tasmanians will report their self-assessed health status as fair/poor by 2032 (compared to 21.7 percent in 2019).

Tasmanians are more at risk of having a long-term health condition than is the case nationally, even when age is taken into account.

Tasmania remains behind the national rate for several health risk factors, including obesity, smoking and vaping, alcohol use, physical activity, and consumption of fruit and vegetables.

Compared to the other states and territories, Tasmania has the poorest levels of educational attainment, and the lowest average weekly full-time earnings.

• Please join us at Croakey in using #TasVotesHealth2024 to share related news and create a collective platform.

Compilation of election headlines from The Mercury newspaper in Hobart
https://www.abc.net.au/news/elections/tas/2024/guides

National health reform matters

In the December 5, 2023 edition of The Health Wrap I wrote about the much awaited mid-term review of the National Health Reform Agreement (NHRA) 2020-2025, which was due for completion that month.

Little did I know that the final report of the review was already in the Government’s hands (It was publicly released, or at least put up on the APO website, on 7 December 2023).

Peter Breadon from the Grattan Institute has done an excellent job of summarising the report and what it means for healthcare reform in his recent article for Croakey Health Media, What will it take to unlock big health reform.

I would highlight just two points from the review.

  1. The NHRA (and its subsequent Addenda) does not operate as a health system agreement, but as a technical hospital financing agreement and, while it has had success in this area (ie it has improved technical efficiency), its broader aspiration to take a system-wide approach and drive innovation and integration and improved health outcomes has not been realised (ie it has not delivered allocative efficiency and, as the population ages and complex conditions increase, the delivery of the right care in the right place at the right time is not happening).
  2. The review recommends the establishment of a national innovation and reform entity (the National Innovation and Reform Agency), authorised and resourced to work with jurisdictions and national bodies to establish priorities, develop innovative approaches and implement a long-term reform program driven by performance data and supported by an Innovation Fund.

This latter recommendation was music to my ears – I have long been advocating that Australia establishes the local equivalent of the Center for Innovation that was established under Obamacare within the Centers for Medicare and Medicaid Services (there is more information about this center here).

What can we expect in response to this review, with its clear statements about problems and needed reforms, from the Commonwealth and State and Territory Governments?

The Commonwealth has already committed to increasing its funding for public hospitals – the new addenda to the NHRA in 2025 will include an additional $13.2 billion over five years from the Commonwealth. This was part of a series of commitments made by National Cabinet in exchange for the States and Territories agreeing to double the annual increase in state funding for the NDIS.

Is this enough to stop the ongoing argy-bargy over funding? And will it deliver needed reforms?

As pointed out by Breadon: “Everyone knows that we can’t just do more of the same and get a health system that’s set up for the future.

“This investment shouldn’t crowd out reforms to make hospital care more efficient, or investment in prevention and primary care to keep people out of hospital in the first place.”

We might ask what happened/is happening with the funding provided under the NHRA Addenda 2020-2025 for new models of care?  These are outlined in the Long-term Health Reforms Roadmap which was agreed to by the Health Ministers in September 2021.

See my article in Croakey Health Media from 1 February, 2023: After years of reform recommendations and agreements, brave leadership is required.

And although the National Health and Hospitals Reform Commission was some years ago, many of its recommendations, specifically those that look to lessen the pressure on acute care services through better prevention and early intervention, are still relevant.


Whither the Australian Centre for Disease Control?

The establishment of the Australian Centre for Disease Control (CDC), an election commitment made by the Albanese Government, is underway, although as is increasingly becoming the case with health-related issues and this Government, information is in short supply.

There is next to nothing on the website of the Department of Health and Aged Care and on the website for the interim CDC.

A discussion paper was released in November 2022 and there was also a Stakeholder Consultation Report issued sometime in 2023.

There is a Statement of Intent, issued in November 2023, that outlines how the Commonwealth and State and Territory governments will work together and in partnership with Indigenous Australians to support the establishment and operation of the interim CDC (launched January 1 this year within the Department of Health and Aged Care and currently headed by Chief Medical Officer, Professor Paul Kelly) and a timeline for delivering an agreement to support the fully developed CDC. No indication is given of when this might be expected.

Just two short sentences outline the scope of the CDC. These are:

  • To facilitate, support, and strive to deliver better population health outcomes for all Australians.
  • To work with state and territory governments to prevent and control communicable and non- communicable diseases and protect Australia against future emergencies that affect human health.

The Statement outlines five objectives:

  1. Increase independence and strengthen evidence-based and transparent decision-making to maintain trust
  2. Improve national coordination of effort and efficiencies, with stronger partnerships, including across Commonwealth agencies and between jurisdictions
  3. Support national action through enhanced national capabilities, underpinned by the distinct and complementary roles and responsibilities of jurisdictions and the Commonwealth
  4. Enhance international connections
  5. Increase and productively utilise resources to support preparedness and response across all jurisdictions, including nationally.

The interim CDC has taken over the responsibilities of the department’s Chief Medical Officer Group. These include:

  • Health alerts
  • Emergency health management, including management of the National Medical Stockpile
  • Communicable diseases
  • National and international disease surveillance
  • Environmental health.

The interim CDC functions and services will expand throughout 2024.

At the Opening Plenary session of the Communicable Diseases & Immunisation Conference 2023 held last June, Kelly said this about the yet-to-be-established CDC:

“It will be a nationally coordinated body, led by dedicated experts and driven by science and data that will strengthen Australia’s emergency response and ability to protect and promote the health and wellbeing of all Australians.

“The ACDC will build on existing capability within the Department of Health and Aged Care, using an all-hazards approach, fill critical gaps in Australia’s public health system by driving national data and linkages, leading the nation on One Health approaches to human health, and enhancing public health equity for all people in Australia.”

It’s such a big and important job to establish a new agency that will tackle the issues that undermine the health status of Australians; it’s essential that this is done with full consultation and co-design from all stakeholders and is not beholden to political ideologies, funding constraints and fights over turf.

https://www.phaa.net.au/Web/Web/News/Media-releases-2024/Urgent-call-for-Australian-Centre-for-Disease-Control-to–reconcile-COVID-19-health-advice.aspx

It’s fair to say the Government has been deluged with advice (I’m on the list of people with strong opinions here, particularly in light of my experience in the United States with how well and how poorly the US Centers for Disease Control and Prevention has operated).

See, for example, this recent article from Peter Breadon of the Grattan Institute: The three tests Australia’s new Centre for Disease Control must pass.

Croakey Health Media has a section where you can access all the articles on issues for and concerns about the Australian CDC that Croakey has published to date.

Most recently my Croakey colleague Alison Barrett has published two articles that provide some useful information and insights.

A single COVID-19 database to be administered by the CDC was a recommendation of the long COVID inquiry. Information in a recent edition of The Mandarin indicates that there is currently some confusion or obfuscation about what COVID-19-related data the CDC will collect.

There are also urgent calls for the CDC to reconcile COVID-19 health advice.


Long COVID

The much anticipated Government response to the report, Sick and tired: Casting a long shadow, from the House Standing Committee on Health, Aged Care and Sport  inquiry into Long COVID was released with minimal fanfare on 15 February.

Of the Committee’s 20 recommendations made under nine different headings, the Albanese Government supported eight, supported “in principle” another six, “noted” five, and did not support one. That means less than half of the report’s recommendations will be acted upon.

The response to this has been lukewarm at best.

In a joint media release, the community of people living with long COVID said that the Government’s actions thus far “fall woefully short in addressing the urgent needs of individuals suffering from long COVID”.

And this thread from Professor Deborah Lupton.

My Croakey colleague Charles Maskell-Knight, writing in his weekly Zap report, thought the response – which took longer than the report – was “probably not worth the wait”, and in a later article published by both Pearls and Irritations and Croakey Health Media, he called the response “an exercise in sophistry”.

In a media release accompanying the Government’s response, Health Minister Mark Butler announced “a stronger primary healthcare system to support people with Long COVID” and recognised the need for multidisciplinary team-based healthcare. But there are no new funds to support this.

Instead, the Minister cites previous announcements for MRFF funding and the Medicare funding announced in the 2023-2024 Budget.

Butler stated that the Government has developed a national plan to provide a framework for the health response to long COVID (which I guess we must now call PASC), informed by the recommendations of the report. This was also released on 15 February, again without fanfare.

The National Post-Acute Sequelae of COVID-19 (PASC) Plan states that it has three strategic priorities:

  1. Improving primary-care-based models of care available to people with PASC
  2. Informing the health sector and the community about PASC
  3. Supporting research to increase knowledge of PASC and guide future policy and clinical care.

Five pages of the 19-page plan are given over to what the Government says it is already doing to address these issues. Another page lists the Government’s ongoing responses to COVID-19.

It appears the Albanese Government will treat long COVID/PASC as a chronic condition under the National Strategic Framework for Chronic Conditions, which (apparently) is currently under review and update. While this work is cited in both the Minister’s media release and the National Past-Acute Sequelae of COVID-19 (PASC) Plan, I can’t find any reference to this effort on the website of the Department of Health and Aged Care.

See other recent articles at Croakey Health Media:


After The Voice

This month has seen the release of both the Productivity Commission’s first review of progress on the National Agreement on Closing the Gap and the Commonwealth’s Closing the Gap 2023 Annual Report.

The key message from both reports is that fundamental changes are required to deliver on the Agreement and close the gap on Indigenous disadvantage.

The forward to the PC review says this, in unambiguous language:

“Over the course of this review, it has become clear that in order to see change, business-as-usual must be a thing of the past. Across the country, we have observed small tweaks or additional initiatives, or even layers of initiatives, as attempts to give effect to the Agreement. However, real change does not mean multiplying or renaming business-as-usual actions. It means looking deeply to get to the heart of the way systems, departments and public servants work. Most critically, the Agreement requires government decision-makers to accept that they do not know what is best for Aboriginal and Torres Strait Islander people. Change can be confronting and difficult. But without fundamental change, the Agreement will fail and the gap will remain. We cannot afford to waste the opportunity that this Agreement presents.”

In his speech to Parliament on the day the Annual Report was released, the Prime Minister acknowledge this, saying, “We must find a better way – and we must do it together.”

Much of the 2024 Annual Report is taken up with lists of the Government’s funding commitments and “Key Achievements for 2023”.  This seems boastful, even cynical, when it is clear that many of these programs and much of this funding are not delivering the required outcomes.

For me, the saddest part about these annual exposés of government failure is that they mask the many community success stories and contribute to the sorts of public cynicism and criticism we saw emerge around the No campaign against The Voice.

The 2024 Implementation Plan, which is combined with the Annual Report, does not make clear the extent to which the policies and programs put forward are co-designed and implemented with Indigenous expertise and communities and delivered in ways that ensure they are appropriately targeted and culturally safe.

Moreover, I don’t see any recognition that many of the stakeholders in Closing the Gap have their own implementation plans.

For example, the Coalition of Peaks has an Implementation Plan for 2024 that is focussed less on individual programs and more on actions to give effect to the four Priority Reforms in the National Agreement.

These priorities are: formal partnerships and shared decision making;  building the community controlled sector; transforming government organisations; and shared access to data and information at a regional level.

These are the issues that should be a priority; without them as a foundation the Closing the Gap targets can never be reached. These are issues that ensure the necessary cross-portfolio, whole-of-government approaches.

Some useful resources on Closing the Gap:

  • The implementation plans for the States and Territories and the Australian Local Government Association are here.
  • The implementation tracker for all these plans is here.
  • The Australian Government’s Closing the Gap website is here.
  • The Closing the Gap Portal on the Australian Indigenous HealthInfoNet is here.
  • The Australian Human Rights Commission Close the Gap for Aboriginal and Torres Strait Islander health equity by 2030 community guide is here.
  • The Productivity Commission’s Closing the Gap Annual Data Compilation Report, July 2023 is here.
  • National Close the Gap Day falls on March 21 this year.

Make sure to read James Blackwell’s article, The Government is well behind on Closing the Gap. This is why we need a Voice to Parliament. This also includes some further reading with statements from Indigenous leaders and organisations.

Also see this video now featured on the Croakey homepage:


Best of Croakey

Charles Maskell-Knight wrote two articles looking at the findings of the recent Productivity Commission Report on Government Services 2024 on health.

https://www.croakey.org/the-health-system-is-under-stress-and-here-are-some-of-the-ways-that-is-affecting-patient-care/
https://www.croakey.org/digging-deep-into-the-latest-data-and-shining-a-light-on-important-questions-about-variations-in-access-to-healthcare/

Good news in Indigenous health

Indigenous women in Borroloola in the Gulf of Carpentaria are improving the health and prospects of the community’s youngest children with a program of daily learning and play.

Borroloola is considered the fifth-most disadvantaged community in Australia but its young children are defying a worrying downward trend in Closing the Gap data that shows Indigenous children in their first year of school are less ready than Indigenous children who went before them. For Borroloola children under five, there has been ­significant improvement across the five developmental ­domains.

You can read more about this success story here and here.

This has come about through the Indi Kindi program which employs local women (also a plus as this is a community where unemployment runs at around 75 percent).

Indi Kindi is supported by the Moriarty Foundation.


Another good news story

I recently watched a wonderful segment on the American PBS NewsHour program on medicine and music.

Dr Francis Collins, the former Director of the National Institutes of Health, and Renee Fleming, renowned opera singer, have teamed up to study how music can improve physical and mental health.

You can watched the PBS segment here, and a transcript is also provided.

And watch this YouTube video of Dr Collins and Renee Fleming talking about their Mind and Music program. And at the end they sing together – one of my favourites, Leonard Cohen’s Hallelujah!

This program also alerted me to the fact that the National Institutes of Health and the John F. Kennedy Center for the Performing Arts have partnered to expand the scope of an initiative that NIH has had with the National Symphony Orchestra for several years called Sound Health.

The partnership, in association with the National Endowment for the Arts, aims to:

  • Expand current knowledge and understanding of how listening, performing, or creating music involves intricate circuitry in the brain that could be harnessed for health and wellness applications in daily life
  • Explore ways to enhance the potential for music as therapy for neurological disorders
  • Identify future opportunities for research, and
  • Create public awareness about how the brain functions and interacts with music.

Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

 

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