From the mountains of Japan to new scientific publications and concerns about the upcoming Australian summer, the impacts of the climate health crisis feature throughout the latest edition of The Health Wrap.
Other featured topics include public health issues at stake with the United States election, crises in maternity care, occupational hazards for female surgeons, and a salute to Emeritus Professor Stephen Leeder AO and his wide-ranging contributions to public health and health policy.
The quotable?
Air pollution and high temperatures are contributing to global increases in strokes.”
Lesley Russell writes:
My apologies to readers for a delayed edition of The Health Wrap, but once again I have been off on a hiking adventure – this time in Japan.
I spent five days hiking the Nakasendo Trail, or ‘Road Through the Central Mountains’, which as part of feudal Japan’s network of highways, ran between Kyōto and Tōkyō.
I walked from Magome through the Kiso Valley to Tsumago, Kiso-Fukushima, Narai, and Kiso-Hirasawa then on to Matsumoto. From there I travelled by train to the mountain town of Karuizawa and walked through the forests to Yokokawa.
Accommodation along the way was at beautiful local inns (ryokans), most of which had much- appreciated Japanese hot baths (onsen), and there were fabulous meals highlighting local produce.
Then, after a few days sightseeing in Tokyo, I headed to Mt Fuji for two days of glamping, hiking and exploring the local culture (and food).
Japan’s iconic mountain remains snowless so far this season, breaking a 130-year record. This year Japan had its hottest summer ever recorded.
I will write up this trip for the next edition of The Hiking Wrap (download your free copy of the The Hiking Wrap 2024 here). Stay tuned!
United States election looms
It’s impossible to escape the fact that the future fate of the United States looms large and I have been struck by how much attention Australians are paying to this election and how (rightly) concerned they are about the outcomes.
A Trump victory would have huge, undesirable consequences for health and healthcare both nationally and internationally and for the international organisations that address global health and climate change.
It’s extremely concerning that it appears Trump has committed to hand over responsibility for all of Health and Human Services (that would include the Centers for Disease Control and Prevention, the National Institutes of Health, the Food and Drug Administration and more) and the US Department of Agriculture to Robert F Kennedy Jr.
Trump has said about this: “I’m gonna let him go wild on health. I’m gonna let him go wild on the foods. I’m gonna let him go wild on the medicines.”
Trump has also indicated that Kennedy would “look after women’s health”– a very scary thought!
Kennedy is an anti-vaxxer and conspiracy theorist; he would be an absolute catastrophe for public health. You can see the sort of alarming but false claims he has made about childhood vaccines here.
Kennedy will have conservative allies in the Congress for this destructive work.
Already they have proposed eliminating CDC programs they say are not central to fighting infectious diseases.
And Republican Speaker of the House of Representatives, Mike Johnson, is claiming that he and Trump will abolish Obamacare.
The increasing harms of abortion bans (which extend much further than abortion and are affecting every aspect of women’s reproductive health) will serve to drive women to vote. Stories like this one published in ProPublica highlight the horror such bans are inflicting.
And then there’s the threat that Elon Musk will be in charge of “efficiency” in a Trump Administration.
Musk has said he would cut at least US$2 trillion from the budgets of federal agencies.
Current discretionary spending in the budget is US$1.7 trillion, meaning Musk’s promise would eliminate virtually all discretionary spending, which includes transportation, education, housing, environmental programs and some health programs.
He admits Trump’s plans will collapse the American economy, but says that it’s necessary for everyday Americans to experience “temporary hardship”.
This kind of talk sends a shiver down my spine. One journal’s headlines sums it up: MAGA’s Closing Pitch to Voters: Economic Pain and Health Care Sorcery.
Kamala Harris’s big health policy proposal is to expand Medicare to cover home care. The issues around this are discussed in a recent article in The New England Journal of Medicine (sign in required).
Make sure you watch Bruce Wolpe’s Zoom discussion with Melissa Sweet: Making sense of the US election.
See also:
- On the United States election, what are the stakes for global health?
- Exploring the implications of a Trump presidency for Australia’s security and health systems
- Treating the body politic.
I have also written an article for The Conversation (cross-published by Croakey) about the health impacts of political division.
And I commend to you Michelle Obama’s speech on women’s health – and why men should care about this.
COVID-19 Response Inquiry report
The Albanese Government has released the report into the Federal Government’s COVID-19 response.
This has been well covered by my Croakey colleagues, so I don’t propose to go into the report in detail (besides, I must confess I am yet to read all of the massive, multi-volume report); rather, I thought I would provide some links into analyses by others.
- Andrew Podger in The Mandarin: Health Department must listen to these lessons from our COVID-19 experience
- The Guardian: Australia’s pandemic plans were ‘grossly inadequate’, an inquiry has found. What lessons can be learned?
- The Conversation: Australia’s COVID inquiry shows why a permanent ‘centre for disease control’ is more urgent than ever
- The Conversation: Inquiry warns distrustful public wouldn’t accept COVID measures in future pandemic
- ABC News: Review of COVID response finds Australians unlikely to accept lockdowns again
- scimex: Expert reaction: COVID-19 Response Inquiry Report
- The Zap compiles responses from across the sector.
- Croakey editors have compiled responses to the report here: Pandemic planning and responses must address equity concerns: national inquiry
- See also: COVID inquiry produces a long to-do list for Centre for Disease Control.
I find it both curious and frustrating that, with the release of this report, the Albanese Government is essentially re-announcing its commitment to an Australian Centre for Disease Control, admittedly this time with significant funding attached ($251.7 million, presumably over four years).
It’s as if the preliminary work on the establishment of the CDC (for which $90 million was allocated) has not happened.
Perhaps, the resignation of Professor Paul Kelly, who led this work, means the establishment of the CDC will start again, de novo? (Although I note that the media release from Health Minister Butler states that “The interim Australian CDC will continue to operate as part of the Department of Health and Aged Care until the launch of the independent CDC.”)
It seems there’s no rush here: the permanent version of the CDC is expected to become effective on 1 January 2026, pending passage of legislation through Federal Parliament.
With a federal election due early next year, can we even be certain that this required legislation will be introduced and enacted? I can’t find any commitment from the Coalition for this new agency.
Maternity care in crisis in New South Wales
A series of recent articles have highlighted the perilous situation for women in rural and regional New South Wales needing reproductive health and maternity care.
We have looked on aghast at the situation in the United States, but in many respects this is little better.
Here are some of these articles:
- ‘No one had the staff to let me have a baby’: Women forced to drive hours to give birth .
- Rural mums put at risk by health care system in crisis
- Abortion is legal in Australia, but doctors say an ‘unspoken ban’ is robbing women in regional and rural areas of the right to choose
- “Unspoken ban” limiting access to abortions in NSW.
This is not an issue only in NSW. See, for example, this article from 2023: Maternity crisis: pregnant women left in despair as facilities disappear in regional Australia.
One major reason for this crisis is that private maternity facilities are closing as their use is declining. In the decade from 2012 to 2023, the number of babies born in private hospitals fell by 22 percent, as the birthrate declines.
At the same time more women are choosing to give birth in public hospitals, attracted by their models of care and the fact that out-of-pocket costs are limited.
Full reproductive health cover — including pregnancy and birth cover — is included only in gold insurance policies and out-of-pocket costs accrue even with top-level health insurance.
Gosford Private Hospital has announced it will close its maternity ward in March 2025, citing a 40 percent drop in patient numbers over a 10-year period.
Linked into this is the ongoing infighting over costs between private hospitals and the health insurance funds. I have written about this previously for The Health Wrap.
The views of the National Association of Specialist Obstetricians and Gynaecologists on this issue are here.
It is only a few months since the NSW Health Minister Ryan Park, in the wake of a State Government inquiry into birth trauma, offered an apology to women who were failed by the maternity care they received.
The worry that comes with whether a pregnant woman can give birth close to home must also constitute a form of trauma.
As a related issue, I note that the Department of Health and Aged Care has just released the summary of its review of the financial viability of private hospitals.
It’s not particularly informative and the conclusions are pretty anodyne. The report highlights that obstetrics and mental health are “two particular services of concern” becoming “increasingly difficult to offer”. (You can also read more about it in The Zap this week).
The main action as a result is the formation of a Private Health CEO Forum “to bring together leaders from private hospitals, private health insurers, medical groups and independent experts to develop short-term options for government consideration and to commence work on long-term reforms to strengthen the sector’s financial viability”. I did not see any reference to consumers having a role in this forum.
While Butler acknowledged private hospitals are “fundamentally important” to the broad operation of the entire healthcare system, he said “there will be no silver bullet from Canberra or funding solution from taxpayers to deal with what are essentially private pressures in this system”.
Looks like yet another issue where the Minister does not want to do the hard work of reform.
In case you missed it
Countdown on health and climate change
The eighth annual global report of The Lancet Countdown on health and climate change reveals soaring health risks of persistent global inaction over the climate emergency.
See also this Croakey article: As Spain mourns, new report reveals a world in peril from climate inaction.
Australian 2024 State of the Climate report
The latest CSIRO and Bureau of Meteorology report on the State of the Climate highlights that Australia’s climate is continuing to heat up. On land, Australia has warmed by an average of 1.51°C since 1910 and oceans have heated up by 1.08°C on average since 1900.
As a consequence, extreme fire dangers are increasing and marine heatwaves are becoming more intense and frequent. There are serious implications for Australia’s environment and communities.
Occupational hazards of being a female surgeon
Childbearing has been a particular barrier to successful recruitment and retention of women in surgery.
A recent paper in JAMA Surgery finds that pregnant surgeons are more likely to have major pregnancy complications (the average obstetric complication rate for surgeons in the US ranges between 25 percent and 82 percent, considerably higher than that in the general US population at five percent to 15 percent).
The paper proposes a framework for the protection for pregnant surgeons and sees this as essential for attracting talented students into surgery, retaining talented surgical trainees and faculty, and protecting pregnant surgeons and their foetuses.
Links between air pollution and health
Air pollution and high temperatures are contributing to global increases in strokes. These are the findings of a study published in The Lancet Neurology.
Meanwhile an Australian study has highlighted how air pollution irritates the lungs, fires up the immune system and causes systemic inflammation and increased levels of immunoglobulin E, an antibody associated with allergies.
They have linked air pollution to the development of a peanut allergy in childhood.
Another Australian-led study of schoolchildren in China has found relationships between air pollution and poor cognitive performance and ADHD. You can read more here.
Good news on Indigenous health
This is really a “potentially good news story” – it will require some widespread implementation of a new model of care for Aboriginal and Torres Strait Islander adolescents to deliver good news on improved health outcomes.
A paper just published in The Medical Journal of Australia proposes a model of primary healthcare that is specifically focussed on the needs of adolescents – a time in the lives of Aboriginal and Torres Strait Islander people when the gap in morbidity and mortality widens between them and their non‐Indigenous counterparts, and when a difference in mortality between genders also occurs.
The paper claims that 80 percent of excess mortality among Aboriginal and Torres Strait Islander adolescents is preventable within the current health system, and that there are many opportunities to optimise future health and intergenerational health.
It sees building a culturally competent healthcare workforce as an essential component of this model of care.
It also requires strengthening Aboriginal and Torres Strait Islander community‐controlled and mainstream primary healthcare and the involvement of state, territory and federal governments.
Best of Croakey
As we watch the devastation caused by floods in Spain – these coming in the wake of relentless summer heatwaves in the Northern Hemisphere, we wonder what the upcoming summer holds for Australia.
The experts say it’s “unpredictable” and that we should “prepare for anything”.
So I’m drawn to this recent Croakey article that provides some answers to keeping hope alive in an era of planetary health crisis.
Another good news story
The Menzies Centre for Health Policy and Economics is changing its name: it will now be known as the Leeder Centre for Health Policy, Economics and Data.
The name change honours the remarkable career and contributions of Emeritus Professor Stephen Leeder AO to health policy and systems worldwide.
The Centre was originally established in 1999 as the Australian Health Policy Institute, becoming The Menzies Centre for Health Policy in 2006 with a grant from the Sir Robert Menzies Memorial Foundation. The Centre formally added expertise in Health Economics in 2021, and now in 2024, acknowledges inclusion of expertise in Data in its new name.
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.
