The nutritional news on Vegemite, ongoing questions and concerns about COVID management, and lessons from the public health response to an outbreak of acute rheumatic fever are among the topics covered in the latest column from Adjunct Associate Professor Lesley Russell.
The column also examines the health ramifications of ‘MAGA Mike’ being elevated to a powerful position in the United States House of Representatives.
“He is an election denier who was active in efforts to overturn the 2020 election on Trump’s behalf and who is still debating the 2020 results, a self-described evangelical Christian who is staunchly anti-abortion, anti-LGBTQI+ rights, anti-union, and anti-immigration,” writes Russell.
The quotable?
That the Morrison Government dropped the ball on funding the Rheumatic Fever Strategy must be added to their growing list of governance failures.”
Lesley Russell writes:
There is very disheartening news on several fronts about Australia’s management of the ongoing COVID-19 pandemic.
On 20 October, the Australian Government’s Chief Medical Officer, Professor Paul Kelly, declared that COVID-19 is no longer a Communicable Disease Incident of National Significance (CDINS), a move supported by the Australian Health Protection Principal Committee (AHPPC).
This follows the determination on 5 May by the World Health Organization (WHO) Director-General that COVID-19 no longer constituted a public health emergency of international concern (PHEIC). It’s worth noting, however, that the WHO has since continuously stressed the need for ongoing vigilance and precautions.
The AHPPC statement says:
With the wide availability and uptake of vaccination and oral treatments for COVID-19, the risks for the Australian population have reduced and public health measures taken by the Commonwealth, state and territory governments have changed accordingly.
Australia has shifted to managing COVID-19 consistent with other common communicable diseases, focusing on prevention, reducing transmission and management of serious illness, hospitalisations and death.”
A new page (dated 24 October) on the Department of Health and Aged Care (DoHAC) website lists “What we did about COVID-19”.
Perhaps we are to assume that the activities listed – things like providing COVID-19 tests to those at risk and providing mental health, financial and healthcare support – will no longer continue?
Certainly the public reporting of COVID-19 data (and presumably the collection of much of the data previously available) has changed at both the federal and state levels.
From 10 November the DoHAC will switch from reporting COVID-19 trends weekly to monthly. As it is, the reporting is of rolling 7-day averages which I find virtually useless. The covidlive.com.au website is much more useful.
I have not checked what all the states and territories are doing, but New South Wales has announced that from 20 October it will no longer publish the state’s weekly update on NSW Health’s website and social media channels.
Its website states: “At this stage of the pandemic, the best indicators of COVID-19 activity in the community are emergency department presentations and sewage surveillance.”
All the data show hospitalisations for COVID-19 increasing. On 27 October covidlive.com.au reported the following national data:
1239 people in hospital (up 153 from the previous week) with 33 people in intensive care.
Most of the COVID-19 presentations to EDs are young children aged 0–4 years and in those aged 65-years and older.
There were 1206 aged care resident and 511 aged care staff with COVID-19.
A recent article in The Sydney Morning Herald confirms what we all had intuited as family, friends and colleagues reported in with COVID-19 – cases are increasing, and this looks like the eighth wave (depends how you count). A little worrying given that it is (almost) summer!
Also see: Another COVID-19 wave is coming. Here’s how case numbers are trending and who needs a booster – ABC News.
And see the responses to the tweet above, including one comment ‘It’s everywhere at the moment’.
It was pretty shocking to hear NSW CMO Dr Kerry Chant say on ABC radio that testing for COVID-19 was unnecessary.
While she recommended that those who think they are infected stay home and “don’t share your germs around”, there was no advice about mask-wearing.
By contrast, the Victorian Department of Health is explicitly encouraging mask-wearing, as well as having meetings outdoors, where possible.
In the SMH article referred to above, CMO Kelly said Australia was now well protected by immunity built up through millions of vaccinations and previous infections and could afford to shift to a “new business as usual” response to COVID.
But the Commonwealth’s own data show 17.2 million Australians are not up-to-date on their COVID-19 vaccinations (this includes 408,500 Aboriginal and Torres Strait Islander people and 55 percent of residential aged care residents) and more than half a million people (including 71,400 Aboriginal and Torres Strait Islander people) are (still) completely unvaccinated.
The Therapeutic Good Administration has approved Pfizer’s and Moderna’s new monovalent XBB.1.5 vaccines but the Australian Technical Advisory Group on Immunization (ATAGI) has yet to make a decision on who should get these booster vaccines.
Poverty, hunger, homelessness and shoplifting
A recent article in the business section of The Sydney Morning Herald, headed “Stealing at the checkout: Is theft OK during a cost of living crisis?”, caught my eye.
It starts out by asking if the cost-of-living crisis has crunched your budget so that weekly grocery shopping becomes a stressful crisis, is it justifiable to “accidentally” scan through some items as cheaper products, or avoid scanning them at all?
Research from Monash Business School’s Australian Consumer and Retail Studies group in their latest Cost-of-Living and Consumer Deviance Spotlight report (released in September) offers insight into how Australian shoppers are feeling about “deviant” behaviours when shopping, from sampling the products in the fruit aisle and not paying, to simply taking items.
Shoppers were asked to rate the justifiability of a range of behaviours given the current economic conditions. More than a quarter of consumers believed that blatant forms of retail theft were “a little” to “completely” justifiable.
The specific results: “taking an item without paying” was perceived as ”a little to completely” justifiable for 28 percent of shoppers; followed by “changing price tags on products’ (30 percent); “not scanning some items when using a self-checkout terminal” (32 percent); and “scanning items as cheaper items when using a self-checkout terminal” (37percent). You can read more about this report’s findings here.
It’s no surprise that shoplifting is in the spotlight, as thefts occurring at retail locations have increased dramatically. The Australian Bureau of Statistics June 2023 report showed a 17 percent annual increase in retail theft. Coles says that total stock loss, which includes theft, is up by 20 percent compared to last year.
In response to surging retail theft, stores have institutes covert security measures, self-checkout cameras and biometric trackers, raising questions about privacy and ethics.
The rise in theft is closely linked to a surge in grocery prices, which has strained households. This is a global issue, with similar reports from the United Kingdom and the United States.
Sadly, it’s all too easy to rationalise some of this behaviour when you look at the growth in poverty, hunger and homelessness in Australia and other supposedly wealthy countries.
The most recent ACOSS report on Poverty in Australia, 2023 shows that one in eight people, including one in six children, live in poverty. Some groups are very vulnerable: 34 percent of sole parent households and 25 percent of people living with disability live in poverty.
At the release of the Foodbank Hunger Report 2023, the Foodbank CEO, Brianna Casey, spoke to how this year’s report highlights just how many households are experiencing food insecurity or the first time and how reluctant these people are to ask for help, regardless of how dire the circumstances.
“It’s clear the cost-of-living is exacerbating the challenges facings those in vulnerable circumstances and forcing people to make compromises on what and when they are eating,” she said.
It’s shocking that in the past year 36 percent of Australian households (3.7 million households) experienced moderate to severe food insecurity and more than 2.3 million households were forced to skip meals or forego food for days.
Perhaps even more shocking, one that makes me really concerned about the level of food waste in my household, is that just 52 percent of households are highly food secure. That turns the notion of Australia as a wealthy country of the fair go on its head!
Aside from rising food costs, a key contributor to constrained budgets is the unaffordable cost of housing – and increasingly the unavailability of housing in areas where people want to live.
As outlined in a University of Queensland brief, housing unaffordability is no longer an individual problem for the poor or disadvantaged but a full-blown crisis and a problem even for many with good incomes.
As a consequence, more than 1,600 Australians are pushed into homelessness every month. Kate Colvin, the chief executive of Homelessness Australia, spoke in August about the rapidly rising number of people seeking help.
“A 7.5 percent increase in demand in just four months is unheard of. It forces homelessness services to make extremely tough decisions about who gets assistance,” she said. Women and children make up 74 percent of those accessing services.
There are more shocking statistics on homelessness in the Salvation Army’s report on the housing crisis, available here.
The situation is just as dire in the United Kingdom and the United States.
A report from the Joseph Rowntree Foundation entitled Destitution in the UK 2023 (destitution is such a Charles Dickens term – but arguably apt in that it seems to encompass the expunging of hope) finds a “shameful” increase in the number of people in the UK struggling to afford to meet their most basic physical needs to stay warm, dry, clean and fed.
In the United States – never an exemplar when it comes to social services for the less well off – food insecurity, decreasing for a decade, has begun to increase again.
A US Department of Agriculture report released last month found that more than 44.2 million Americans lived in households that struggled with hunger in 2022 — an increase of 10.3 million over the previous year. The situation is worst in southern states and rural areas.
An outbreak of acute rheumatic fever
The World Congress of Rheumatic Heart Disease has been held in Abu Dhabi this week, with speakers noting its disproportionate impact on Indigenous communities globally.
The October edition of the Australian and New Zealand Journal of Public Health has a long paper that examines the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community in the East Arnhem Land in the Northern Territory.
It makes essential reading for understanding what’s involved in managing such an outbreak: it outlines in some detail the clinical and community approaches taken and highlights the issues that must be addressed to prevent future such outbreaks.
Acute rheumatic fever is an autoimmune response to infection by group A Streptococcus bacteria. It is a preventable disease driven by poverty, poor housing and poor hygiene. In Australia, Aboriginal and Torres Strait Islander peoples in under-served and under-resourced regions experience the burden of ARF almost exclusively.
Rheumatic fever is endemic in this part of the NT, with an average of 6.4 cases diagnosed each year during the five years preceding the outbreak.
In August 2021, the NT Rheumatic Heart Disease Control Program identified an outbreak of ARF in an East Arnhem land community that ultimately involved 12 cases with onset between 1 July and 15 October 2021. Half of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis.
Here is my summary of what the authors wrote about worked and what didn’t.
- The remote setting is complex, and resources are constrained. Acute and primary care clinics currently do not have funding or capacity to deliver consistent outreach services to prevent ARF recurrences.
- Sustainable and dedicated ARF and Rheumatic Heart Disease (RHD) program funding continues to be a challenge. At the time of the outbreak, the three-year Rheumatic Fever Strategy funding provided by the Australian Government had ceased (on 30 June 2021) and there was a funding gap of over one year.
- The outbreak of ARF came before East Arnhem Land experienced its first outbreaks of COVID-19 but there were community lockdowns and restrictions on travel and visitors. These factors could have meant reduced primary prevention activities such as the treatment of skin sores and affected provision of timely ARF secondary prophylaxis.
- Some excellent work was done with the community – as highlighted by the fact that all but one of 86 contacts were traced and tested. Community awareness and support for public health measures was generated using Facebook, Yolŋu Radio and videos in Yolŋu Matha dialects and English. The local clinic also distributed bars of soap via the school and provided hygiene advice.
- The key conclusions were that there is a critical need to strengthen delivery of ARF secondary prophylaxis, and for improvements to the social determinants of health in the region.
That the Morrison Government dropped the ball on funding the Rheumatic Fever Strategy must be added to their growing list of governance failures.
A new strategy went into effect 2 February 2022 (expires 30 June 2025). Funding of $12 million was provided to cover this work in the NT, Queensland, South Australia and Western Australia.
There is a Federal Government commitment to ending rheumatic heart disease by 2031, but advocates are adamant the goal will not be met unless there’s a major increase in investment and a radical shift in the way overcrowding is tackled in remote communities.
MAGA Mike
Last month the business of the US Congress was brought to a halt for three weeks because House Republicans caved to the Trump Make America Great Again (MAGA) extremists.
They firstly threw out Kevin McCarthy, the Speaker of the House of Representatives, on the basis that he worked with Congressional Democrats and the White House to pass legislation to keep the government functioning, and then they could not agree on who should be McCarthy’s replacement
Representative Mike Johnson from Louisiana, the man finally elected as Speaker, after three others had been nominated and then withdrawn, is known as MAGA Mike.
He is an election denier who was active in efforts to overturn the 2020 election on Trump’s behalf and who is still debating the 2020 results, a self-described evangelical Christian who is staunchly anti-abortion, anti-LGBTQI+ rights, anti-union, and anti-immigration.
He is the least-experienced speaker in more than a century, elected to Congress just seven years ago and having never held a committee chair. An article in The Nation on the new speaker summed it up by positing that Mike Johnson’s main qualification for the job, in the eyes of his colleagues and Trump, was that he’s neither a Democrat nor a democrat.
To date, in his seven years in Congress, Johnson has focussed mostly on anti-abortion and gay rights issues. He has an A+ rating from Susan B. Anthony Pro-Life America. For the last three Congresses he has received a 0 on the congressional scorecard of the LGBTQ+ advocacy group Human Rights Campaign.
He is expected to use his new power to push these issues and perhaps to try once again, to undo Obamacare.
In the short-term, he will need to tackle Financial Year 2024 appropriations before the 17 November deadline (cutting Medicare, Medicare, Social Security and social welfare programs will surely be on the agenda) and find a way forward on the numerous “extenders” of health legislation that expired at the end of September.
These include the Pandemic and All-Hazards Preparedness Act, funding for community health centres and anti-opioid programs, and the PEPFAR program to combat AIDS and HIV.
In case you missed it
On Inside Story, a great summary from Mike Steketee about where we are on Medicare and healthcare reforms, Medicare’s Forty-Year Update.
I think he’s a tad optimistic but he does acknowledge that “If the history of healthcare in Australia shows anything it’s that reforms are hard-won”.
Also on Inside Story, a piece from me on The Dental Divide, with a focus on why better integration of dental and medical care should be an urgent priority for patients with congenital heart disease and oral cancers.
This article also produced the quotable quote in the latest #ICYMI column at Croakey:
It’s time for the Federal Government to make the system changes and introduce the financial incentives across both the public and private sectors that will push medicine and dentistry into a partnership to improve health and health outcomes for all Australians, starting with those most affected by poor dental and oral health.”
There’s an interesting article in Health Affairs on The Future of COVID-19 Vaccine Development.
In Science, a paper on Demographic and hormonal evidence for menopause in wild chimpanzees. Scientists have discovered that older female chimps experience changes in hormones similar to female humans entering menopause.
The timing of these hormone changes is also similar to humans. There’s a good summary in The Washington Post here.
The 2023 State of the Food Supply Report: A Five-Year Review from the George Institute for Global Health shows overall uptake of health star ratings on intended products has remained static at 36 percent for the past three years, dropping from 40 percent since the targets were set in 2019.
The Guardian carried an article about this report; it’s available here.
Best of Croakey
This story is very topical given the bushfires in Northern NSW and Southern Queensland: Amid global health push to phase out fossil fuels, new Australian data highlights heat risks.
The good news story
Just what we needed: a paper analysing the benefits of Vegemite!
Happy Little Vegemites™! An analysis of the contribution of yeast extract spreads and tomato-based sauces to nutrient intake adequacy in Australia. Available here.
Great work from Professor Clare Collins and her colleagues – this paper is out just as Vegemite celebrates its 100th birthday.
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.
