In her latest column, Adjunct Associate Professor Lesley Russell takes a deep dive into the latest news on COVID, climate and research integrity.
She also brings good news in Indigenous health, and reports on a project that found choir singing can provide important benefits for people living with dementia and their family and friends who support them.
The quotable?
Australia is one of the few countries with a developed research sector that does not have a research integrity watchdog, instead relying on research institutions to initiate and oversee investigations into their own researchers.”
Lesley Russell writes:
In the almost four years since the pandemic began, it’s been near impossible to write an edition of The Health Wrap without including some news and discussion about COVID-19 and its consequences: this edition is no different.
The previous edition of The Health Wrap looked at how the federal and state and territory governments of Australia have dropped the ball on pandemic management, even as it seems we are entering yet another wave of infections.
My concerns (and those of many others working in public health) were reflected in an article by Karen Middleton in The Saturday Paper on November 11.
She quotes Dr Suman Majumdar from the Burnet Institute, who says that the new wave of infections warrants more active measures, and it should not be a binary choice between personal responsibility and government edict. He also argues that better data would help significantly.
But increasingly, Australian government public health authorities are choosing not to make data on infections and hospitalisations regularly and publicly available.
A quote in Middleton’s article from AMA President Professor Steve Robson particularly caught my eye: “I don’t know what it is about masks that causes such a violent political reaction from some people.”
I’m a mask wearer – on public transport, especially on planes, in concert halls etc – and increasingly I’m in the minority. I’ve had a few querulous looks but have never been confronted about my mask-wearing. A healthcare worker in a hospital setting did tell me that I didn’t need to wear a mask!
I think mask wearing is important to protect from all respiratory infections, not just COVID-19. That view-point is justified by the findings of a recent paper published on JAMA Network Open.
It concludes: “Robust available data support the use of face masks in community settings to reduce transmission of SARS-CoV-2 and should inform future responses to epidemics and pandemics caused by respiratory viruses.”
Pandemic inquiries
Both Australia and the United Kingdom currently have government-sponsored inquiries into their government’s management of the pandemic. This work is critical to ensuring better future pandemic preparedness.
Australia
Prime Minister Anthony Albanese announced the long-awaited federal inquiry on September 21. The Terms of Reference are here.
See also the article from Professor Don Nutbeam Australia’s COVID-19 inquiry announced, as public health leaders highlight importance of learning pandemic lessons in Croakey Health Media.
The inquiry’s website says it will “give advice on what worked, what didn’t, and what we can do in the future”, including “opportunities for systems to more effectively anticipate, adapt and respond to pandemics”.
There was backlash over the fact that the Terms of Reference indicated that actions taken unilaterally by state and territory governments would not be part of the inquiry. However, Robyn Kruk, the Inquiry Chair, has indicated that she thinks the terms are broad enough for panel members to examine state and territory responses, including lockdowns.
Federal Health Minister, Mark Butler, now says it would be “extraordinary” to not examine the implications of lockdowns, social distancing rules and other public health measures rolled out by individual states.
While the Terms of Reference are unchanged, explanatory notes recently added to the inquiry’s website now indicate that “the inquiry will consider the roles and responsibilities of the Commonwealth Government, and state and territory governments in managing pandemic responses, the interaction between these tiers of government, and the overall cohesiveness of the joint Australian response”.
The work of the inquiry is going on out of the public view with nothing publicly reported to date. There is information about providing submissions and evidence to the inquiry here.
Submissions close on December 15.
United Kingdom
In contrast to Australia, there has been lots of public revelations (some quite salacious!) about the work of the public inquiry in the United Kingdom.
This inquiry was launched on 28 June 2022. The Terms of Reference are here.
The inquiry is divided into modules. There are currently five underway:
- Resilience and preparedness
- Core UK decision-making and political governance
- Impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK
- Vaccines and therapeutics
- Procurement
You can watch all the hearings on all the modules on the inquiry’s YouTube channel, here.
A recent hearing on 31 October for Module 2 (Core UK decision-making and political governance) took testimony from Lee Cain (former Director of Communications at 10 Downing Street) and Dominic Cummings (political advisor to Prime Minister Boris Johnson) and it is shocking, even given what we already knew about Johnson and his attitude to the pandemic. You can access the testimony here.
A media release from the British Medical Association described it as “laying bare the dysfunction at the heart of Government [at the time of the pandemic], a dismissiveness of expert advice, a failure to act quickly and a callous disregard for people’s lives.”
An editorial by Dr Richard Horton in The Lancet summarises with horror what the inquiry learned about the attitude of Johnson and his staff in early days of the pandemic, when they were “laughing at the Italians” and their concerns.
The editorial concludes: “The lies, deceptions, and callous conceit that characterised the UK’s initial response to COVID-19 must surely bring some kind of reckoning.”
The UK edition of The Guardian summarised the damning testimony and appalling revelations from Cain and Cummings – crass and aggressive exchanges between Johnson and his advisors, the flip-flopping over pandemic decision-making and Johnson’s callous attitude towards the fate of older people (“COVID is nature’s way of dealing with old people”).
And in case you missed it: in the reshuffle of Prime Minister Rishi Sunak’s cabinet after the sacking of Foreign Minister Suella Braverman, Victoria Atkins has replaced Steve Barclay as the seventh Health Minister since 2016.
She takes up this position at a time when the National Health Service is facing one of the toughest periods in its 75-year history, including industrial action and record waiting lists.
Impacts on life expectancy
The Australian Bureau of Statistics (ABS) has just released the latest data on life expectancy. For the first time in some 30 years, life expectancy decreased in 2020-2022.
Life expectancy at birth for males was 81.2 years and 85.3 years for females, a decrease of 0.1 years for both. In contrast, over the past decade, life expectancy increased by 1.3 years for males and 1.0 years for females.
The gap in life expectancy between males and females is 4.1 years.
Australia has the third highest life expectancy in the world – only Monaco and Japan have higher life expectancies than Australia. Australia’s male life expectancy ranked second, and female sixth, internationally.
In the media release accompanying the report, the ABS Head of Demography, Beidar Cho, attributed the decrease in life expectancy to the fact that in 2022 the number of deaths over those expected increased by 20,000, with close to 10,000 of these being due to COVID-19.
Despite the relatively large increase in deaths, the effect on life expectancy was small because over half (56 percent) of all deaths in 2022 were of people aged 80 years and over.
In an article on the ABS data in The Australian, Cho was reported as saying that the decline in life expectancy was a “glitch” – a comment which I found glib at best and actually ageist and abhorrent.
Research has shown that in the first two years of the pandemic, Australia’s life expectancy continued to increase, in contrast to most other high-income countries. This was attributed to the initial relatively stringent restrictions and consequent low mortality rates.
When these restrictions were loosened, there were more COVID-19 deaths and more excess deaths.
There has however been some debate around the decline in life expectancy and we won’t know if this is a trend or a glitch until there are several years’ of data.
A 2019 paper published in The Medical Journal of Australia shows that the yearly increase in life expectancy in Australia was slowing prior to the advent of the pandemic, probably because the declines in mortality from cardiovascular disease and cancer have slowed.
I have regularly reported on the appalling decline in life expectancy in the United States due to both COVID-19 and the so-called “deaths of despair” from drugs, guns and suicides and on the “excess deaths” in the United States, the United Kingdom and Europe due to COVID-19 impacts on the healthcare system. See for example, The Health Wrap, March 15, 2021 here and The Health Wrap, October 19, 2022 here.
It would be awful if the current lack of attention from Australian Governments to the ongoing consequences of the pandemic (and perhaps I should also add obesity, mental health and drug abuse to this?) saw Australia also join that ignominious club.
A study just published in JAMA Internal Medicine shows how rapidly the pandemic and adverse health outcomes have affected life expectancy in the United States, which has seen over 1 million COVID-19 deaths.
Life expectancy for Americans has fallen from 78.8 years in 2019 to 77 in 2020 and 76.1 in 2022, undoing over two decades of progress. This puts the country far behind its wealthy peers.
The picture is especially concerning for men, whose life expectancy is now 73.2 years, compared with women’s 79.1. This 5.9 year gap is the widest between the two genders since 1996.
Australians’ experience of COVID-19
Professor Deborah Lupton, currently SHARP Professor in the Faculty of Arts & Social Sciences at the University of New South Wales, is engaged in many research areas that I write about and she has an impressive publication record.
Moreover, she works hard to communicate her work – there is so much to be found in browsing her blog This Sociological Life. There is a specific category for her work on COVID-19.
Lupton has just released the findings of Stage 4 of her “Australians’ Experiences of COVID-19” survey project. This survey of 1,000 people was conducted in mid-September 2023 at a time when most mitigations against the spread of COVID-19 previously implemented by governments and the medical and public health systems had been dropped and there was less frequent reports and news of the pandemic’s impact (the methodology and context for the survey project is discussed in more detail here).
The findings:
- The pandemic continues to badly affect Australians in terms of accumulated infections and prevalence of long COVID: 68 percent reported having had at least one COVID-19 infection to their knowledge, 13 percent reported three or more infections. Of those who reported COVID-19 infections, 40 percent had experienced long COVID.
- Respondents were equivocal about the extent to which COVID-19 is a continuing risk. For the most part they were not strongly supportive of continued preventive actions against infection such as face mask wearing and vaccination.
- There was a high take-up of the first three COVID-19 vaccines: 93 percent reported they had been vaccinated at least once, with 21 percent having had two doses and 36 percent with three doses. However, after three doses, the proportion drops considerably and only 36 percent said they were planning to get another vaccine in 12 months.
- Only 9 percent of respondents said that they always wore a face mask to protect themselves against COVID-19 when inside public places. A further 26 percent said that they sometimes used a mask in these settings. Support for face mask mandates for healthcare workerswhile at work was higher, with 58 percent in at least partial support.
- Respondents did not hold high trust in any COVID-19 information source, including medical experts and scientists. Doctors were considered the most trustworthy sources of COVID-19 information(60 percent), followed by experts in the field (53 percent), and Australian government health agencies (52 percent). News reports (17 percent) were among the least trusted. The youngest group of respondents was the least trusting of scientists and experts in the field.
- Respondents were divided about how well their governments were managing the pandemic. They were evenly divided between positive assessments (36 percent for both federal and state/territory governments) and more equivocal assessments: 34 percent (federal) and 32 percent (state/territory).
As Lupton acknowledges, these are pretty depressing findings.
See also Investigating the changing nature of risk, in a time of permacrisis, bad actors and misinformation. In this article for Croakey Health Media , Lupton reviews the latest edition of her book ‘Risk’ and reflects on changes since the first edition in 1999.
Climate change
Like COVID-19, climate change is a perennial topic for The Health Wrap. An article on ABC TV News about farmers facing successively mice plagues, floods and drought served to remind me of how intimately many Australians deal with the vagaries of the weather and the more sinister threats of weather patterns that are changing as a consequences of climate change.
A new analysis of international data by Climate Central scientists shows that the Earth just endured its hottest 12 months in the modern era, and probably the hottest in 125,000 years.
The findings show that our planet is closer than ever to the global warming benchmark of 1.5 degrees Celsius (2.7 degrees Fahrenheit) above preindustrial norms: this year average planetary temperatures were 1.3 to 1.4 degrees Celsius above 19th-century levels.
17 November was the first day that the global temperature exceeded 2°C above pre-industrial levels, reaching 2.07°C above the 1850-1900 average.
From Copernicus Climate Services.
The report warns that El Niño is only just beginning to boost temperatures and, based on historical patterns, most of this effect would be felt next year.
While Australia did not experience the same level of extremes compared to many other parts of the world, a hot and dry summer is expected – so life will continue to be difficult for many farmers worried about crops and feeding livestock. Already we are seeing reports of threatening bushfires around the nation, from northern Australia to Tasmania.
In sharing their analysis, the Climate Central scientists hope it will spur action and underscore its urgency as global leaders prepare to convene the annual United Nations climate change conference, COP28, later this month.
Bookmark this link to follow Croakey’s coverage of the meeting, and please join us at the hashtag #HealthyCOP28, to put a determined focus on climate action for health and justice.
Reports, conferences and papers on climate change and health
There’s a raft of things to report (albeit briefly) under this heading.
The 2023 report of The Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms has just been released. This has been well summarised by my Croakey colleague Dr Melissa Sweet here.
This past week the Croakey Conference News Service covered the HEAL Network conference which provided a great platform for sharing research, policies and collaborations around “Collective Action for Health, Environment and Climate” (follow #HEAL2023 on Twitter/X).
You can read Alison Barrett’s introductory article for the conference – Fire in the belly: collective action for environment, climate and health at HEAL2023 – here. And there will be follow-up articles to come.
A policy position paper from the Lowitja Institute recommends that the Australian Government funds the establishment of an Aboriginal and Torres Strait Islander Coalition on Climate and Health.
This recommendation has been presented to Members of Parliament.
The Biden Administration has released the Fifth National Climate Assessment and announced more than US$6 billion to strengthen national climate resilience.
Meanwhile, we are awaiting the release of the National Health and Climate Strategy, which should be imminent.
A reminder that Croakey Health Media has a large database of articles on climate change and its impacts here.
Addressing research misconduct
The Australia Institute is calling for the establishment of an independent research integrity watchdog in the wake of a new report that raises serious concerns about research misconduct, including data fabrication, falsification and plagiarism.
The two-part report, ‘Research Misconduct in Australia’, finds that over 500 Australian research papers have been retracted in the past 20 years due to concerns about their reliability.
The report sets out clear recommendations for creating a world-leading research integrity watchdog with teeth.
Part 1: The case for an independent research integrity watchdog
Part 2: Recommendations for creating a world-leading research integrity watchdog with teeth
Australia is one of the few countries with a developed research sector that does not have a research integrity watchdog, instead relying on research institutions to initiate and oversee investigations into their own researchers.
The Sydney Morning Herald reports that scientists and universities have, for the first time, united in a call to the Federal Government to establish an independent research misconduct body to protect taxpayers’ dollars from fraudulent or dodgy science.
It’s not clear however if their support is for the exact proposal outlined by the Australia Institute. It seems to me that they are proposing that universities retain more autonomy in the conduct of investigations.
At a time when research funds are increasingly in short supply and hard to access, we need to pay attention not just to ensuring that there is research integrity but also that research assessment (which often determines what projects get funded) is effective and appropriate.
A new paper, prepared for the Office of the Chief Scientist, looks at the difficulties researchers across science and the humanities confront under the current approaches to research assessment.
The paper’s authors summarised their findings in an article published in The Conversation, which criticises the current “publish or perish” approach that values the number of publications over the quality of research.
Chief Scientist Professor Cathy Foley agrees with the findings. She says the way individuals and institutions are measured on research success is not fit for purpose and has created perverse incentives which reinforce the “publish or perish” culture.
In an opinion piece in The Sydney Morning Herald Foley outlines why the current research ranking system does not focus on the right issues, ignores the collaborations across academia, industry and government that are necessary to solve the big, wicked problems, and needs reform.
She highlights that her predecessor as Chief Scientist, Dr Alan Finkel, has a very low research rating (known as the H-index) because he has done much of his work outside the university system.
“The H-index has been expressed to me as a version of what is commonly known as Goodhart’s law, to the effect that when a measurement becomes a metric it stops being useful because smart people, often in a privileged situation, are incentivised to game the system to their advantage. To what value?”
In case you missed it
Public Health Research and Practice – a peer-reviewed journal of the Sax Institute – has recently announced its awards for public health research with real world impact published over the past year.
This year’s Best Paper Award went to a team led by Dr Jessie Huang-Lung at the University of NSW for their paper on waiting times for cataract surgery in the public health system.
The researchers found that in the best-case scenario, patients wait around four months for surgery after diagnosis of a cataract, but in the worst-case scenario, that wait can be as long as two-and-a-half years in some parts of Australia.
An extended waiting time places people with impaired sight at heightened risk of falls, car crashes, and social isolation.
The paper shows that cutting wait times from 12 to three months would result in 50,679 fewer falls for older people, saving the health system $6.6 million nationwide over a three year period (this takes into account the cost of bringing the cataract surgery forward).
The Award for Best ‘In Practice’ Paper – which specifically recognises work authored by frontline practitioners – was won by a team led by Dr Michelle Gooey at Monash University for their paper on providing optimal care to people who seek treatment for obesity.
The researchers found a lack of services for the treatment of obesity at every level of the Australian healthcare system. They identified three key areas of challenge: the complexity of care required to manage obesity, lack of service capability and capacity, and the high out-of-pocket expenses incurred by patients.
To address these challenges, the authors outlined eight action areas as a starting point, including developing partnerships with people living with obesity; establishing clear referral pathways; and ensuring flexible and accessible service delivery.
The best of Croakey
As we anxiously wonder where needed healthcare reforms are on the Albanese Government’s agenda, a reminder, from the Minister for Health, of the value and effectiveness of Community Health Centres.
“Instead of a uniform model of care imposed from above, the Community Health Program funded states, local councils and community groups for a wide variety of projects in a truly bottom-up and iterative approach to policy formation,” said Butler in a recent speech at the Whitlam Institute (as reported in the article featured below).
See:
- How community hubs could contribute to better health for rural and remote Australians.
- 50 years on: legacy and lessons from Whitlam’s landmark Community Health Program
The good news story – Indigenous health
This is a new section for The Health Wrap – part of an effort to highlight the terrific work in Indigenous health that is being done at the coalface around the nation.
Please let me know if you have any success stories you would like to highlight.
In an article for Croakey Health Media, Associate Professor Sophia Couzos highlights the very positive findings of a report to the Department of Health and Aged Care on the benefits of integrating pharmacists into Aboriginal Community Controlled Health Organisations (the so-called IPAC project).
See also the related tweets below, from last year.
The good news story
Singing in a choir has been shown to have enormous benefits, filling our bodies with feel-good neurochemicals and increasing social connections.
The Rewire Musical Memories Choirs began as part of a research project through Melbourne University and Austin Health. The project found choir singing can provide important benefits for people living with dementia and their family and friends who support them.
The choir was only supposed to run for 20 weeks, but the singers refused to let it stop. Members of the choir raised money and set up philanthropic donations to continue the project. Eight years later, founding members are still singing together.
You can read more here.
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.
