The Health Wrap: Climate hell in a handbasket; getting SDOH traction; Indigenous engagement; new ideas in public health

By Kellie Bisset

Can we avoid going to climate hell in a handbasket?

As the Intergovernmental Panel on Climate Change (IPCC) published its Fifth Assessment Report, warning that preventive steps are critical to address climate warming, Australia’s  newly axed Climate Commission re-emerged as the Climate Council after a lightening speed community fund-raising drive that managed to raise $1 million in just a week.The Council’s assessment of the IPCC report can be found here.

On Croakey, Michelle Hughes writes in her piece ‘This is not a drill’ that  thanks to the IPCC, the Australian Climate Council and many others who share information, we will not be able to feign ignorance on the issue of climate change. She argues those who provide health services may face a host of new challenges in the forseeable future as a result of climate change.

Managing the fallout from social determinants of health may well be one. A report in The SMH says climate change will have an ‘irreversible’ effects on the world’s food supply chain, with the average price of key food staples forecast to double in 20 years

In some good news, this US report suggests that public awareness of the health impacts of climate change is increasing. It quotes a recent survey from the Maryland Department of Health and Mental Hygiene and George Mason University, which found 70 per cent of respondents thought air pollution was more important to personal health than obesity.

When dealing with  those who remain to be convinced about climate change – or any other areas of scientific consensus for that matter – this piece in The Conversation suggests that throwing more and more facts at them is counter-productive – even though this failed pattern of communication continues to play out. Don’t appeal to rational thought, the piece argues, and offers some tips for those at the pointy end of science denial conversations. Another equally interesting Conversation piece looks at why people reject science, which may help those striving to get their message across.

Meanwhile, Canadian researchers have launched what they say is the world’s first  environmental health atlas, to raise awareness about the ways that environmental influences affect human health. And US doctors have sounded the alarm about environmental toxins.

According to The Atlantic, for the first time ever, the American Congress of Obstetricians and Gynecologists has released a strong statement about the risks of environmental toxins to pregnant women and foetuses. And it is urging individual doctors to advocate for policy changes to protect women and babies from exposure.

Further, a study published in Paediatrics has found that maternal psychological distress combined with exposure to air pollution during pregnancy have an adverse impact on a child’s behavioural development. This is particularly interesting in light of the new Abbott Government’s plans to cut rail projects and build more roads. Reaction to this approach from the public health community can be found here.

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Challenge: getting traction on the social determinants of health

How to move social determinants of health up the policy agenda and avoid “biomedical drift” when it did finally make it to the table as an issue was the subject of recent discussion at the PHAA conference, reported on by Croakey here.

In the UK at least, Labour is talking up the importance of health in all policies. The Guardian reports shadow housing minister Jack Dromey as saying the decoupling of housing and health in public policy had been a mistake as good quality housing was “arguably the greatest contributor towards public health”.

Now that the Abbott Government has signalled the return of Work for the Dole and an expansion of controversial ‘welfare quarantining’ policies, it’s even more imperative that the public health community engage with debates about welfare reform, writes Gemma Carey.

“Our largest social institution – government – is set to pursue policies that increase stress, decrease control and prohibit the transition into work,” says Carey, a Research Officer with the St Vincent de Paul Society, National Council of Australia and Research Associate, Centre of Excellence in Intervention & Prevention Science.

Eva Cox has similar concerns. Writing for The Conversation, she says there is little evidence that  low payments and harsh conditions increase workforce participation, but the trend towards “evidence-free policy making” continues.

Geographical healthcare inequality was the focus of a new report released by the Grattan Institute this past fortnight. The report, Access all areas, finds that while progress has been made in some areas, it hasn’t materialised in places most in need. Writing for Croakey and The Conversation, The Institute’s Professor Stephen Duckett, says better use of pharmacists and nurse practitioners on less complicated presentations would free up the limited supply of GPs in some of the most underserved areas.

“If we continue with current policies, it will take 65 years before people in many parts of rural and remote Australia have the same level of access to general practitioner services as city dwellers do,” he writes.

Fiona Stanley meanwhile,  says we need to convince our new government that prevention is a crucial investment.

“Inequalities are bad for everyone’s health,” she writes at The Conversation. “We need to invest in social, environmental, and community infrastructure for health. And we need to ensure the budget is more evenly distributed…”

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The wheels of government … turning a little faster than usual?

As the momentum in Canberra to dismantle Labor’s reform agenda continues apace, health looks set for some heavy treatment. Health Minister Peter Dutton has signalled his intention to cut the health bureacracy – and the Australian National Preventive Health Agency, Australian Institute of Health and Welfare and National Health Performance Authority have been flagged as potential targets.

Croakey readers have offered some advice to the new minister as he settles into the portfolio, including potential priorities for the first 100 days of government and terms of reference for, and possible contributors to, the review of Medicare Locals promised before the election. And in this Croakey piece, Professor Tarun Weeramanthri has some particularly pointed advice about the importance of staff not considered to be “frontline”. It takes a team effort to achieve a result, he argues, and sometimes critical members of the team don’t occupy the spotlight.

And advice from another quarter – the Consumer’s Health Forum – will be ongoing, according to this report in The Townsville Bulletin. The Forum has launched a “waste thermometer” that will measure money being wasted by poor government policy.

University of Wollongong Vice Chancellor Paul Wellings has also offered some thoughts on how the Abbott Government might consider achieving its election commitment to create a million new jobs by 2018. Writing in The Australian he says momentum supporting knowledge and innovation has dwindled, and an inconsistent approach to science and innovation policy has led to policy inertia, something he urges the Government to rectify.

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The wheels of US govt … not turning at all

As last ditch attempts to derail Obamacare led to the  shutdown of the US Government, many public health services ground to a halt, including the National Institutes of Health and the vast majority of services offered by the Centers for Disease Control and Prevention. For an outline of health services on hold, see here and here. According to this report from Wisconsin Public Radio, the shutdown threatens food provision for 9 million low income women and children who rely on the  Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC.

Dr Lesley Russell offers this handy explainer on Obamacare for The Conversation, for anyone who needs a refresher on the US Affordable Care Act. Dr Russell, a senior Research Fellow at the Australian Primary Health Care Research Institute, also penned this explainer for Croakey, on what the shutdown might mean for readers. And this interesting piece in The Nation looks at the history of opposition to health reform, and finds that it goes back as far as the 1930s.

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Achieving Indigenous engagement 

Two new reports on engaging with Indigenous communities have been released on the Closing the Gap Clearinghouse .The reports, both of which can also be downloaded on the NACCHO website, say that effective engagement must be through relationships built on trust, integrity and respect.

The reports came as the Australian Indigenous Doctors Association (AIDA) hosted its annual symposium in Canberra. AIDA president Dr Tammy Kimpton was tweeting from the event using the @IndigenousX Twitter handle. You can view the Guardian profile of Dr Kimpton here.

A further two reports have highlighted poorer health outcomes for Indigenous Australians in the areas of cancer and ageing. A new report from the Cancer Institute and AIHW says that while Indigenous Australians have a slightly higher cancer incidence rate, they are 50 per cent more likely to die from cancer than non-Indigenous Australians.

And a survey of Indigenous people from WA’s Kimberly region shows they are ageing at a quicker rate than non-Indigenous Australians. A piece by Professor Lesley Barclay and Associate Professor Tricia Nagel in The Conversation, says the Northern Territory has made some inroads into dealing with maternity care, chronic disease and substance misuse. While it’s no panacea, it could be a possible model to guide system improvement elsewhere, they suggest. However, there is still an underlying equity issue.

“The lack of staff adequately prepared to deal with the volume and acuity of infant illness and the lack of physical and mental wellness in remote Aboriginal communities would not be acceptable elsewhere in Australia,” they write.

Meanwhile this study of the Cairns-based Wuchopperen Health Service, reported by Croakey, points to Aboriginal Community Controlled Health Organisations as being an important part of the solution. These organisations have a wide-ranging impact on community wellbeing that extends far beyond the delivery of health care services, the study finds.

Confusion over how Indigenous health programs would be dealt with by the incoming government have been resolved to a degree with a departmental statement outlining that some programs will transfer to the Department of Prime Minister and Cabinet but funding responsibility for most Indigenous health services remains in the Health Department. Croakey has reproduced the statement here. 

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New ideas in public health

A new global health campaign created by two Melbourne brothers to address non-communicable diseases recently launched at Harvard University and featured at the University of Melbourne Festival of Ideas. The NCDFREE campaign, reported by Croakey here, is urging a rethink of our environments and how they impact on health – from urban design, to healthcare and an obesogenic  regulatory environment.

Another public health pairing has seen the Bill & Melinda Gates Foundation team up with  JPMorgan Chase & Co to fund technologies designed to fight disease in developing countries. This public-private partnership worth US $94 million is part of a growing trend when it comes to tackling “vexing global health challenges”, The Globe and Mail reports. A case in point is the joint project being forged by IBM, Johns Hopkins University and University of California, San Francisco to use data tools for public health. The partnership intends to use data to address illness and infectious diseases in real-time.

And in the ongoing quest to pinpoint what messages might resonate to make people change their health behaviours, a project using hip hop to make healthy cool has seen musicians and doctors join forces. This report on the program by CNN is worth a look.

In New York, Mayor Michael Bloomberg is using the final months in his role to steer a self-esteem campaign for tween girls. Australia needs its own Bloombergs, Dr Lesley Russell writes on Croakey.

“Australia is not without public health champions, but they are not in the political sphere where they can really make things happen,” she writes.

What can public health learn about innovation from the arts, asks Rebecca Tooher, also on Croakey. Rebecca, a public health researcher who recently steered the discussion for the @WePublicHealth Twitter account, says that in public health “we can sometimes restrict our notion of innovation to anything that we haven’t seen in public health before”.

With that in mind, she suggests looking at arts innovators and what lessons they might have for public health practitioners.

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E-cigarettes – a runaway train?

Debate continues over the merits or otherwise of e-cigarettes; this piece in Nature gives a good overview of the issues. Recent interesting moves by the e-cigarette industry, which seems to be one step ahead of the regulators, have seen a major marketing push launched to coincide with the UK’s major quit smoking campaign ‘Stoptover’. The industry says it represents an important way for people to quit.

In Canada, Health Canada has been criticised for doing little to control the rapid spread of e-cigarettes, and even vendors have called for better regulation to remove the cowboys. And in the US, the FDA is under increasing pressure to issue some rules governing their sale. Medscape reports that Attorneys General from 41 states have asked the FDA to act, joining calls from 15 public health associations who wrote to President Obama urging him to nudge the FDA into action.

In the regulatory vacuum, small retailers are making some handsome profits, according to Bloomberg Businessweek. Mark-ups are as high as 200 to 400 per cent, the article says, making them more profitable than tobacco. And e-juice, the liquid heated and inhaled from e-cigarettes, is becoming an industry in itself. This article in the Mail Tribune says juices re big business, and many contain nicotine. One company even sells a juice called Dirty Ashtray, the article claims.

According to Sydney’s Sun Herald, the Federal Health Department has indicated it was looking at options for further regulation. Some retailers are selling e-juice without nicotine but others are illegally lacing their products, the story says.

The latest instalment on Croakey from Journal Watch highlights a regulatory idea for regular tobacco: that smokers carry a smartcard licence to buy  cigarettes. This would allow health authorities to track their behaviour and better tailor quit messages. The original piece was published in the MJA by University of Sydney Law School Professor Roger Magnusson and Chief Executive of the Cancer Institute NSW Professor David Currow.

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When evidence says no

The American Academy of Family Physicians has released its third ‘Choosing Wisely’ list, highlighting treatments and procedures that are common, but not backed by evidence. It is part of an ongoing campaign, launched last year, to reduce overtesting and overtreatment. The latest list contains advice to doctors such as: don’t prescribe antibotics for otitis media (glue ear) in children 2-12 years when the symptoms are not severe.

And according to data presented at the European Cancer Congress and reported in Medscape, the evidence for colorectal cancer screening is much stronger and clearer than that for either breast or prostate cancer screening, and funding should be directed accordingly. Another Medscape article reports a systematic review presented at the conference showing PSA screening does more harm than good.

“Overall, they found that the harms outweigh the benefits on a population level,” the article said, quoting the resarchers saying the results “should further discourage the use of routine PSA testing for prostate cancer in the general population”.

In Australia, a story in Medical Observer, notes that most  of the components of the ‘well-child check’ are poor predictors of outcomes in older children. And in the UK, a debate has erupted over the NHS policy of health checks for over 40s. Danish researchers whose 2012 Cochrane review showed health checks for over-40s did not reduce morbidity or mortality have criticised the program, and Dr Clare Gerada, chair of the Royal College of GPs, agrees with them. According to BBC news she said governments continued to promote health checks against good evidence.

Australian drug and alcohol experts have plenty of evidence at their fingertips when it comes to drug policy – they just need to get politicians and the media to take note, according to this piece in Croakey from James Beckford Saunders.

“While the Abbott government’s drug policy intentions are currently unknown, we hope that it will respect the evidence for the current policy framework and carefully consider its options for new drug policy initiatives,” he writes.

Other Croakey reading you may have missed this fortnight:

• A lesson from NZ on the hazards of punitive welfare reform
• Public health experts call for reform of “broken” Senate electoral system
• After the flash flooding; how one remote community recovered (and previewing the CRANAplus conference)
• Dr Philip Nitschke injects some humour into discussions about death and dying at CRANAplus conference)
• Illustrating the potential harms and benefits of social media
• Engaging commnity members as ambassadors for better health: the Aboriginal Health Council of South Australia
• Research highlights the resilience of remote area nurses