The Health Wrap: fatal fractures, sugar tax, mental health and more

This fortnight’s  Health Wrap is compiled by the Sax Institute communications team. Enjoy the wrap and don’t forget to tweet us @SaxInstitute if you have any ideas you’d like to share.

Fatal Fractures

A major audit of the Australian and New Zealand Hip Fracture Registry (ANZHFR) by Neuroscience Research Australia has found that “five per cent of patients who break a hip will die in hospital, and up to 25 per cent will die within the year as a direct result of their injury”, according to reports in the Sydney Morning Herald and other outlets.

The grim news continues even for those who survive, finding that “half of hip fracture patients never fully regain their mobility… (and that) more than one in 10 patients will be discharged from hospital only to be admitted to an aged care facility as a result of their hip fracture”. As noted in the SMH article, hip fractures are the most serious and costly injuries resulting from falls among Australians aged over 50.

The audit of the ANZHFR found that roughly half of hip fracture patients who came into hospital had already sustained a low-trauma fracture, but only 20 per cent had been offered osteoporosis treatment. According to Professor Jacqueline Close from the Prince of Wales Hospital, this represents a missed opportunity, which could help cut fracture risk in the order of 30-60 per cent:

If we managed people who already had low-trauma fracture more efficiently we would make significant reduction to the rate of hip fracture in Australia… Australia hasn’t woken up to this yet.

Sticking with quality of life issues for senior citizens, a widely shared article by Croakey reported that Australian chef, food guru and Senior Australian of the Year (2010) Maggie Beer had called for a “revolution” in quality of food in aged care, hospitals and palliative care. In a keynote address at the Australian Palliative Care Conference in Adelaide, Ms Beer commented:

Food is medicine, the fuel of life. It’s what fires our appetite for life, no matter what age… you might think it a utopian ideal but there is no place for institutionalised food anywhere, not just aged care, but hospitals, organisations, schools, mental health facilities.

Croakey’s Marie McInerny reported in depth from the Australian Palliative Care Conference. You can catch up on all of the news from the conference here –  start by reading this article on the challenging, confronting and charged topic of too much treatment being given to patients at the end of their life. And don’t miss this intimate conversation about the roles of carers, including insights into the “hostage” syndrome.

No sugar-rush on sugar tax

While the evidence continues to stack up about the obesity epidemic facing Australia, when it comes to calls for a sugar tax, Prime Minister Malcolm Turnbull is not convinced.

The Age reported that “a 20 per cent tax on sugary drinks is being proposed by Australia’s leading health organisations as part of a tough new strategy to tackle obesity, which they now say poses a greater risk to the nation than smoking”.

The coalition of 34 high-profile groups including the Obesity Policy Coalition, Cancer Council, Royal Children’s Hospital Melbourne and the Stroke Foundation issued a report, Tipping the Scales, calling on the federal government to establish obesity prevention as a national priority. Other recommendations in the report include a ban on junk food advertising to kids and mandatory Health Star ratings on all foods by 2019.

News.com.au reported that Mr Turnbull had rejected the call for a tax, commenting:

I think we have enough taxes and there are enough imposts on us all when we go to the supermarket and we go shopping.

The size and impact of the global obesity epidemic was highlighted by a recent series of research papers published in The Lancet which found, according to The Guardian, that “poor diet is a factor in one in five deaths around the world.”

Mental health in the spotlight

 A landmark trial of a supportive text message services for survivors of suicide attempts was recently announced by NSW Minister for Mental Health, Tanya Davies. The service will provide words of support and information about how to access help to patients for up to a year after their discharge. The first trial site will launch shortly at Westmead Hospital in Sydney’s west, before expanding to Nepean and Blacktown, also in Sydney’s west.

At the launch Minister Davies stated that:

 Suicide has a devastating impact on individuals, families and communities, and we hope this trial will improve existing support for people when they need it the most.

The need for increased services and the use of innovative methods to reach those in need was highlighted by a recent report published by the Australian Bureau of Statistics, which found, according to The Age, “that the death rate of people using mental-health services in Australia is almost twice as high as the general population”.

Also published over the past fortnight was Croakey Conference News Service’s report from the recent MHS 2017 Conference – Profiling innovation and lived experience in mental health services. Check it out for a comprehensive review of the key issues and topics debated in Sydney.

The mental health impact of the contentious debate around the marriage equality postal plebiscite was raised by a number of organisations in recent weeks. According to this report in the Sydney Morning Herald, there has been a dramatic spike in demand for mental health services with digital youth service ReachOut reporting a “20 per cent surge in people accessing its online advice relating to LGBTIQ issues since August”.

Mental health campaigners, including former Australian of the Year Professor Patrick McGorry, fear the situation will worsen further as the campaign goes on. Opposition leader Bill Shorten has written to the Prime Minister Malcolm Turnbull to call for a “‘small increase’ in funding to help the counselling services keep up”, according to this follow-up piece in the SMH.

Concerns around mental health for young LGBTI Australians have also been noted in the Growing Up in Australia: Longitudinal Study of Australian Children. The study, which has followed the lives of thousands of children into adulthood since 2004, found that the risk of suicide and self harm was noticeably higher in same-sex attracted young Australians. You can read more about the study in this article on The Conversation.

Still with the issue of suicide and mental health among vulnerable communities, Gerry Georgatos wrote a powerful piece on Indigenous suicide for The Guardian entitled “We should weep, but more importantly, we should act to stop Indigenous suicides“. Georgatos, who has written extensively on issues of suicide and suicide prevention among communities across Australia, does not pull his punches in the piece, which is worth reading in full, and states that Aboriginal and Torres Strait Islander suicides are predominately borne of poverty and disparities.

On the same issue, the ABC published a heartbreaking long form, multi-media article on Aboriginal youth suicide – “An athlete who couldn’t outrun his past” – focusing on the tragic suicide of a talented Aboriginal youth from WA.

Celebrating 20 years of AIDA

Since the first Aboriginal doctor graduated in Australia in 1983, more than 300 other Aboriginal and Torres Strait Islander people have gone on to become doctors. The Australian Indigenous Doctors Association (AIDA) annual conference celebrated this 20-year milestone, and the Association’s role in contributing to the growth of this critical workforce through the strong support it provides to doctors and medical students. You can track conference coverage by Karen Wyld at this link.

In other welcome news, The NT News reported on a dramatic child mortality turn-around on Tiwi Islands. In the 1960s, half of all deaths recorded on the Tiwi Islands were of children aged 15 or under, mainly as a result of “low birthweights and poor maternal and child health,” according to Professor Wendy Hoy from the University of Queensland. With better health services, more children are surviving into adulthood, a fact reflected in the almost tripling of the Tiwi island population since 1986.

While the reports from the Tiwi islands are a bright spot, the continuing challenges faced by remote communities in accessing quality healthcare services was covered in a recent report that found “astoundingly high levels of staff turnover in the primary health care clinics of 53 remote Northern Territory communities.” The authors Dr Deborah Russell and Professor John Wakerman suggest a series of measures that could reduce staff turnover and provide better services to the communities in need:

More robust workforce models could include shared remote nursing positions; higher utilisation of remote nurse practitioners; and providing enhanced support for local Indigenous people (to move) into Allied Health Professions or nursing training.

This fortnight we also saw coverage of a new report which deemed Australia’s progress on Closing the Gap “woefully inadequate”, as reported by the ABC. UN Special Rapporteur on the Rights of Indigenous Peoples Victoria Tauli-Corpuz, who visited Australia earlier this year, released the hard-hitting report that stated the detention of young Indigenous children was “the most distressing aspect of her visit”:

Detention of those children has become so prevalent in certain communities that some parents referred to it as an achievement that none of their children has been taken into custody so far. The extraordinarily high rate of incarceration of Aboriginal and Torres Strait Islanders, including women and children, is a major human rights concern.

The challenges facing remote communities were also highlighted by another report, also covered the by ABC, which found that almost nine out of 10 adults in remote NT Indigenous communities lack basic literacy skills.

Finally on the issue of Aboriginal health, the ever popular Ockham’s Razor radio show reported on the ongoing issue of glue ear in Indigenous communities and how Don Palmer from the Malpa Institute is helping to train Indigenous and non-Indigenous young people to be health ambassadors in their communities.

The issue of glue ear, or otitis media, has the been the subject of long-term research and successful intervention by the Study of Environment on Aboriginal Resilience and Child Health (SEARCH), Australia’s largest long-term study of the health and wellbeing of urban Aboriginal children. You can read more about this and the other work being conducted by SEARCH here.

More challenges for the NDIS

The ongoing challenges facing the National Disibility Insurance Scheme were highlighted in a number of reports over recent weeks. As reported in The Guardian, the chairman of the National Mental Health Commission, Allan Fels, has warned that the National Disability Insurance Agency (NDIA) lacks the resourcing to properly consider claims for psychosocial disability, potentially putting its rollout targets in jeopardy. Mr Fels also criticised the increasing use of phone calls to determine whether those with severe mental illness are eligible for the NDIS, an issue The Guardian reported on here.

Over at The Conversation, Alison Marchbank from Charles Darwin University wrote that the NDIS is failing to catch children with late-onset difficulties.  Based on the results of an NDIS pilot, she wrote:

Although developmental health checking is in place [in the NDIS], it is grounded in a medical view of “disease prevention” and “risk”, and its effectiveness relies on contact with parents. While the administrators [of the pilot] recognised partnerships with families are vital, they expressed concern that parents wouldn’t have the time or the support necessary to understand the impact of late onset developmental disability before having to tick a box to apply for funding.

Finally, the ABC reported that disability service providers across Australia are considering shedding their transport services because there is no funding commitment in the NDIS to directly cover the costs of maintaining vehicles.

Following the money

The always contentious issue of financial links between healthcare professionals and pharmaceutical and medical businesses as also been back in the headlines. Analysis undertaken for The Guardian  by health economists Professor Philip Clarke from the University of Melbourne and Dr Barbara de Graaff from the Menzies Institute for Medical Research in Tasmania, found that large pharmaceutical companies gave Australian doctors, nurses and pharmacists close to $12 million in fees and expenses to attend conferences and give talks in the six-month period to April 2017.

Under the Medicines Australia code of conduct, pharmaceutical companies are now required to disclose all payments made to healthcare professionals. The analysis found that the top 10% of recipients received 52% of the total funds, with the “top earner” receiving a total of $39,000. These figures do not include any funding or support provided by medical device companies, which are not currently required to disclose payments to health professionals.

Over in the US, the issue of pharma companies using doctors to push their products was a big story. The well-regarded science and health news outlet, Statnews, published an article under the name of Dr Robert Yapundich, titled “How pharma sales reps help me be a more up-to-date doctor.” The article raised a series of red flags for many readers and journalists, including those from HealthNewsReview. Subsequent analysis of the US government’s open payments database revealed that the doctor in question had received substantial funding from pharmaceutical companies, totalling almost $300,000 in recent years, which was not disclosed in the original article.

The story then took a turn for the even more bizarre. Speaking to HealthNewsReview,  Yapundich admitted that he didn’t actually write the article, providing only edits and suggestions. Further investigations appear to show that a public relations firm based in Washington D.C. may have ghostwritten the article on his behalf. Under sustained questions and criticisms from readers and media outlets, StatNews retracted the article and has now revised its policy for those who submit opinion articles.

Meanwhile, a recent story in the Herald Sun, and other outlets, at first glance appeared to show that the public’s faith in doctors was sliding, stating:

The first national survey of parental attitudes to GPs has revealed fewer than half had complete confidence in GPs to provide overall general healthcare to their child.

A more nuanced, and many would argue complete, picture later emerged. Digging through the research published by the University of Melbourne, ABC Media Watch found that when you added those that were ‘completely confident’ (44%) to those who were ‘mostly confident’ (45%), it turns out that almost nine in ten parents had confidence in their children’s GP.

Other Croakey news you may have missed this fortnight:

• It’s a long road to get more of us safely cycling, but when we arrive it’ll be worth the ride
• Supporters rally in the slow march to marriage equality
• True art: NZ’s ‘We Are Beneficiaries’ campaigns for a better welfare system
• Fit for purpose: change is afoot in the accreditation of Australia’s health workforce
• Using the data revolution to agitate for health policy
• As deindustrialisation gathers pace, what does this mean for the health of local communities?
• David Hill speaks up for #BoozeFreeSport – and damns sports administrators over moral failures
• $5,000 essay competition re-launches, with a focus on inequality and health
• Private health insurance policy: a dog’s breakfast?
• How the media oversold standing desks as a fix for inactivity at work
• New Zealand election: doctors call on parties to make health equity the norm

For help or more information

For people who may be experiencing sadness or trauma, please visit these links to services and support.

• If you are depressed or contemplating suicide, help is available at Lifeline on 131 114 or online. Alternatively you can call the Suicide Call Back Service on 1300 659 467.

• For young people 5-25 years, call kids help line 1800 55 1800

• For resources on social and emotional wellbeing and mental health services in Aboriginal Australia, see here.