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The Health Wrap: Closing the Gap and issues of equity, big #auspol conversations, all about Zika, sadness at CSIRO

I’m delighted to be bringing you the first Croakey Health Wrap for 2016. After a break over December/January we’re wrapping February news on health and social policy. Enjoy the wrap and tweet us @SaxInstitute with any items you think should make it into the next issue at the end of the month.

Closing the Gap: what will it take?

Prime Minister Malcolm Turnbull delivered his first Closing the Gap report card, which revealed no progress had been made in raising the life expectancy of Aboriginal people and other results were mixed. The Age’s Michael Gordon pointed out the lack of backbench MPs in the chamber during the PM’s address and questioned why the troops had not rallied.

Croakey covered the report here, quoting Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda as saying there was still much goodwill, but Indigenous people were entitled to be cynical until change really arrived. His opinion piece in The Australian (paywalled) urged us all to be the generation that closes the gap – but warned that funds need to be earmarked for implementation if there was to be any hope of success.

The chairman of the Prime Minister’s Indigenous Advisory Council, Warren Mundine, said that unless the government had a strategy to bring Aboriginal people into the real economy with a focus on education and jobs, the gap would never be closed. Two articles in The Conversation picked up on this theme, arguing that building bridges into formal education was critical, as was focusing on early education.

CEO of the Orange Aboriginal Medical Service Jamie Newman joined other Aboriginal leaders in commenting on the report. He said the results should not be seen as ammunition to scrap the initiative, but rather should be viewed as a reason to stay the course.

[quote]Engagement and collaboration is happening; I don’t think we should lose sight of that, he told the ABC[/quote]

But Patrick Dodson offered a different view. He told the ABC Closing the Gap was doomed to fail because it hadn’t achieved buy-in from Aboriginal communities.

[quote]There’s a lot of aspiration and maybe good intention, but unless you get participation from Indigenous entities at a local level and community level, it’s not going to work.[/quote]

Meanwhile, a report by Monash University’s Castan Centre for Human Rights, highlighted the NT intervention as failing to deliver substantial reform in any of the areas covered by the Closing the Gap goals. It also said the intervention failed to meet Australia’s human rights obligations.

And Marie McInerney wrote a thoughtful Croakey piece on the new report released by Reconciliation Australia on the State of Reconciliation in Australia. It found that Australians’ knowledge of Aboriginal and Torres Strait Islander histories and cultures was limited but most Australians thought it was important to know more and supported changes to the school curriculum to reflect that.

A new resource to improve the quality of care provided to Aboriginal and Torres Strait Islander people in custodial and forensic systems was outlined on Croakey by Dayna Veraguth as part of the #JustJustice series. It’s worth a read here.

Dr Ruth Armstrong paid tribute to Neil Thomson and Paul Pholeros,  “two significant advocates, workers and innovators in the field of Aboriginal and Torres Strait Islander health” who both recently died. She writes:

[quote]Professor Thomson was well known and highly respected for his longstanding efforts to ensure that all stakeholders could access and share the best and most up-to-date information to inform Indigenous health policy and health care, while Paul Pholeros was an architect who turned his considerable talents to exposing and remediating the links between poor housing infrastructure and ill-health.[/quote]

Don’t forget the Indigenous health May Day 2016 – a Twitter festival on May 12 with the theme youth and families, and suicide prevention. Last year’s event was both physical and virtual and there are plans to do the same in 2016. Follow #IHMayDay16 for updates.

#auspol conversation – the latest chapter

It hardly seems like any time at all since Croakey was wrapping the last Budget but here we are again talking about what might – or might not – be on the table for health in the next one.

Marie McInerney has begun to collect budget submissions now the deadline has closed, and reports that the AMA and the Australian Healthcare and Hospitals Association have made the strong point that healthcare spending is not out of control.

Pathology Australia meanwhile, is planning a country-wide campaign over cuts to pathology, according to The Australian (paywalled), and its pre-budget submission warns that patients could miss out on lifesaving tests if there is no reversal of the $650 million cuts to pathology and diagnostic imagining.

Writing for Croakey and The Conversation, the Grattan Institute’s Stephen Duckett said the health headaches of 2016 were much the same as those from a decade ago, but with different severity and symptoms:

[quote]We start 2016 as we started 2015 – with big challenges for the health system and uncertainty as to how governments will meet them.[/quote]

On the issue of challenges, Health Minister Sussan Ley was grappling with a few this fortnight, including requests from private health insurers to increase their premiums. The SMH reported she wrote to the funds, asking them to lower their requested increases or justify asking for more. Smaller health insurance players said that limiting their ability to increase fees would threaten their viability.

The Minister also said she would target medical device cost inequities, arguing that prosthetics and devices such as pacemakers should not cost thousands more for patients using private hospitals.

Assistant Health Minister Fiona Nash meanwhile, said she would drop her private health cover after being questioned by an ABC Q&A viewer about why she did not solely rely on the public system.

A new voice was added to those calling on the Government to scrap private health insurance rebates – Murdoch University’s Associate Professor Francesco Paolucci. The Consumers’ Health Forum also aired its view that funds should be forced to give better value in order to attract subsidies and not be subsidised for non-evidence based treatments (Medical Observer, login required).

It looks like the battlelines are being drawn over the government’s consideration of outsourcing Medicare, pharmaceutical and aged care payments, as Labor accused the government of privatising Medicare and Sussan Ley argued that people wanted payments systems that were consumer friendly.

[quote]Everyday Australians use cards to make ‘tap and go’ payments, and apps to make payments, and yet Medicare has not kept up with these new technologies, she said.[/quote]

Commenting on the debate in The Conversation, UWA’s Associate Professor David Glance said updating the technology around Medicare and outsourcing the job was a sensible move on the face of it, but he questioned whether the government would be able to find an organisation capable of managing the process.

While Medicare and private insurance dominated the headlines, other policy developments included the government’s introduction to Parliament of legislation to legalise cannabis for medical or scientific purposes.

Croakey explored the issue of new models of primary care, and the benefits of bringing pharmacists into the primary care team to advise patients on medication management. Walter Kmet, CEO of WentWest, the Western Sydney Primary Health Network, outlined a new pilot of non-dispensing pharmacists in general practice that could show a new way forward and which draws on the concept of the medical home.

And El Gibbs wrote for Croakey on the issue of accessible and affordable housing for people with disabilities. She said the introduction of the National Disability Strategy and the National Disability Insurance Scheme were driving a more rights-based approach – including living in the community and accessing mainstream services. But this meant both public and private services needed to change considerably – and a big conversation was needed on how that might happen.

Health equity – the new conversation?

Croakey tackled the big, yet under-discussed, issue of health equity this past fortnight, with Croakey coordinator Melissa Sweet asking: when will creating a fairer distribution of health become a political force? And what’s required to get it there?

Croakey moderated a day-long Twitter festival on health equity to mark the launch of the Centre for Research Excellence in the Social Determinants of Health Equity’s new website. The success of the day was apparant – #healthequity16 trended nationally. Topics covered included what tax reform has to do with health, trade and health, and reflections on Closing the Gap.

The major equity issue of asylum seeker health gathered significant momentum, as doctor and church groups came out strongly against returning the 267 asylum seekers who are currently in Australia to immigration detention in Nauru. Dr Ruth Armstrong covered the force building behind #LetThemStay for Croakey.

Healthcare workers who spoke out included Sydney paediatrician Dr David Isaacs, who urged politicians to “think about what it would be like if their daughter or wife was trying to bring up a baby there”. And Dr Hasantha Gunasekera, who said the children were among the most traumatised he and his colleagues had seen “in 50 years of combined professional experience”.

The winner of the 2015 Gavin Mooney Memorial Essay Competition, Amin Ansari, focussed on how digital media was influencing coverage of asylum seekers and giving a voice to those who were previously unheard. You can see an extract from his essay here as well as an overview of the the #LetThemStay campaign.

Clash over CSIRO cuts

CSIRO’s decision to slash 350 jobs, with heavy impact being borne by climate science, prompted a major backlash from scientists within and outside the organisation.

CEO Larry Marshall said the changes were necessary as CSIRO reprioritised its energies on climate change mitigation rather than measurement. The Guardian reported Marshall saying some of the reaction had been emotional and he had no intention of changing course.

[quote]For that to happen someone’s going to have to convince me that measurement and modelling is far more important than mitigation. And at this point, none of my leadership believe that. They believe quite the contrary which is why we’re driving in this direction.[/quote]

A good round-up of the reaction to the announcement can be found on the Australian Science Media Centre’s Scimex website.

Some described the news as shocking, and Climate and Health Alliance President Dr Liz Hanna, said:

[quote]Axing these globally respected climate experts from the CSIRO will directly threaten the future health of Australians.[/quote]

Scientist John Church told the SMH that the announcement would break commitments Australia made at the Paris climate summit.

The Conversation reported Chief Scientist Dr Alan Finkel as saying that the country needed to ensure climate science programs were funded elsewhere. In order for us to fulfil our international obligations we needed to preserve capacity, which could exist within and outside the CSIRO, he said.

Zika and ongoing infectious disease threats

As the WHO took the step of describing the Zika virus outbreak a Public Health Emergency of International Concern – the first time it has made that declaration since the Ebola crisis – countless commentaries and articles began to flow about the link between Zika and microcephaly in babies. It seems the evidence is definitely pointing strongly to a link, but experts can’t yet definitively say that one causes the other. This explainer in New Scientist is a good overview of what we know so far, although this piece in The Ecologist says some Argentine and Brazilian doctors suspect mosquito insecticide may be the cause. And this interesting piece in The Guardian asked, should we ignore our qualms about editing nature and just wipe mosquitoes off the face of the earth?

The WHO urged European nations to prepare for Zika before the onset of warmer weather as announcements of cases in Spain and England began to roll in. It’s unlikely there would be widespread transmission of Zika in Australia, wrote Professor Cameron Simmons and colleagues in MJA Insight, although some cases have already been reported in returning travellers. The Queensland Government has provided funds to step up testing for Zika and also announced it would roll out a $1 million public education campaign.

Australian scientists working to eliminate dengue fever told The Age they were in discussions with governments in South America to see if they could adapt their work to assist with the Zika outbreak.

In the US, President Barack Obama announced $1.8 billion in emergency funds to be directed at preparing for and responding to Zika – a move backed by the American Public Health Association. Meanwhile Medscape reported that vaccine trials for the disease may start by the end of the year.

This article in The Conversation explored the implications for human relationships and reproduction, in light of advice being given to women in affected countries to avoid becoming pregnant and for pregnant women from elsewhere to avoid travelling to Zika hot spots. Authorities in the US and UK have also advised those infected with Zika to abstain from unprotected sex for six months.

Forbes meanwhile, looked at the role Big Data could play in combating Zika and what lessons had been learned from Ebola when it came to analytics and disease.

Old enemies such as whooping cough however, are still wreaking havoc closer to home. The SMH reported that NSW had recorded one of its worst whooping cough outbreaks in 2015 – up 400% on the previous year. Some good news came out of WA, which reported the proportion of fully vaccinated five-year-olds had reached a record high of 92%.

In Melbourne, a public health warning was issued after four cases of measles were identified in one suburb. And in New Matilda, Michael Brull looked in depth at the University of Wollongong controversy over awarding a PhD to a vaccine skeptic, arguing that stripping the PhD was not the answer.

A grab bag of public health news

World Cancer Day sparked a conversation abroad and at home, where it was revealed that one in every three Australians don’t know how to protect themselves from the most common forms of preventable cancer. But a Cancer Institute NSW study also showed that sun smart campaigns had saved dozens of lives.

The SMH reported that the National Party was still accepting tobacco company donations and this opinion piece in The Guardian discussed movies being the last tobacco frontier, citing a WHO report which said 44% of all Hollywood films contain smoking.

This fabulous Croakey post asked why the toxic nature of cigarettes didn’t warrant a product recall, particularly as they could truthfully be labelled radioactive. The AFR celebrated the success of anti-tobacco campaigns, and looked at the lessons public health advocates focused on obesity were taking from this long-fought battle.

In other public health news, the Flint, Michigan water crisis continued to dominate headlines in the US, and this New York Times report said the problem of lead contaminated water was far more widespread than one city.

A seminar held in Sydney called Porn Harms Kids heard that Internet porn should be considered a public health crisis, as wide availability of porn was having major impacts on children’s behaviour. Loneliness was also singled out as a public health issue. In the UK, the Local Government Association said the consequences of loneliness were devastating and costly, and comparable to other major public health problems such as obesity.

A new study published in Annals of Internal Medicine has questioned the ‘fat and fit’ hypothesis, showing that obesity in otherwise healthy people was linked to nearly 7 cases of kidney disease for every 1000 people over five years compared with those of normal weight.

And the ongoing debate over the value of Body Mass Index (BMI) as a health indicator took a new turn with a study published in the International Journal of Obesity that said millions of Americans could be misclassified as cardiometabolically unhealthy using BMI as an indicator.

Other Croakey reading you may have missed this fortnight:

Kellie Bisset is Communications Director at the Sax Institute. Follow @SaxInstitute or Kellie via @medicalmedia on Twitter.

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