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The Health Wrap: Finding healthcare funds, gender inequity and violence, closing many gaps

This fortnight’s Health Wrap is compiled by Kellie Bisset, Communications Director at the Sax Institute. Enjoy the Wrap and tweet us via @saxinstitute if you have any ideas for future issues.

Finding the money to fund healthcare

In the end, the outcome from the latest Council of Australian Governments (COAG) meeting was a good deal different to proposals on the table at the beginning of discussions. State and territory leaders accepted an extra $2.9 billion in hospital funding until 2020 but rejected a controversial plan to have them, rather than the Commonwealth, collect taxes to fund health and education spending.

Prime Minister Malcolm Turnbull said the result was a wake-up call for state and territory governments:

They cannot any longer credibly ask the federal government to raise taxes for them to spend if they were not prepared to raise those taxes themselves.

The extra funds were met unenthusiastically, according to this Sky News report, which says the funding was part reparation for the $7 billion cut from State hospitals under the Abbott Government. But, as a number of state leaders pointed out, there is still a huge gap. And in return for the money, the states need to try to reduce demand for hospital services by giving chronically ill people better care to keep them out of wards”.

In the lead-up to the COAG meeting, the Government announced a “Healthier Medicare” package, which would see “Health Care Homes” established to allow GPs to better coordinate medical, allied health and out-of-hospital services. The package would also see greater emphasis on patient data to determine how the new system was performing and be trialed among 65,000 people.

The announcement was met with a wait-and-see reaction from AMA president Dr Brian Owler, who said it would be wrong to consider the changes as a panacea for hospital funding issues.

So while we support voluntary enrollment in a medical home, and a focus on complex and chronic disease, we are awaiting to see the details and how that’s going to fit into a bigger health plan,” he told The World Today.

The RACGP was more complimentary and said the government had taken its advice on board to put a greater focus on chronic disease. But PHAA CEO Michael Moore said there was still not enough emphasis on prevention. You can read Croakey’s comprehensive coverage of the issue here.

The concept of a medical home that is patient-centred is something that has gained traction in Australia in recent times and was the subject of a recent symposium hosted jointly by the Hospital Alliance for Research Collaboration and the Centre for Primary Health Care and Equity at UNSW.

This Croakey piece, by UNSW Professor Nick Zwar and Sax Institute publications manager Megan Howe, took a look at what the model might mean for Australian primary care and reported on the views raised at the symposium, including those of visiting expert Professor Kevin Grumbach, who said the US had adopted the patient-centred medical home model because old models of primary care were outdated and not working in the 21st Century.

Meanwhile, writing for Croakey, Amy Coopes explored what a patient-centred medical home might look like and highlighted a longread from the Commonwealth Fund looking at the issue.

With all the talk around hospital funding, Baker IDI Heart and Diabetes Institute CEO Tom Marwick made a good point in The Australian (paywalled): it might not be at the sexy end of the innovation agenda, but tackling waste and duplication in our health system has huge potential to make substantial differences to care and costs

We will have squandered the innovation agenda if we fail to use it as an opportunity to address the serious issue of waste in the health sector,” he wrote.

A piece at The Conversation touched on similar issues, arguing that hospitals in Australia should pay more attention to patient flow and adopt systems or design thinking used in other industries. This type of redesign was central to creating efficiencies, it said.

Also writing at The Conversation, Professor Jonathan Karnon from the University of Adelaide said that focusing energy on better performance measurement of hospitals across the country would be more beneficial than going back to the drawing board on hospital funding.

And Sean Parnell wrote in The Australian (paywalled) that the Medicare Review currently under way would be central to addressing the issue of curbing expensive scans and tests. He said medical decision making, rather than subsidies was the key.

But as Dr Steven Faux pointed out in this excellent Croakey read, medical decision making is a delicate dance, and ‘overservicing’ is not as black and white an issue as it may first appear.

As we head towards a Federal Election, discussion around all of these issues and more will become particularly important. Croakey has registered the hashtag #HealthElection16 for those who would like to participate in the debate on Twitter.

Croakey co-ordinatoor Melissa Sweet starts us off with five conversation starters on critical health concerns that she argues should be front and centre in the Federal election campaign.

****

Equity, violence, gender and misogyny

I refuse to look back in ten years’ time and admit that we could have done more to save innocent lives. We will get this right.

Victorian Premier Daniel Andrews vowed to take a systemic approach to addressing family violence this past fortnight, agreeding to adopt all 227 recommendations from the Royal Commission into Family Violence. Describing the funds needed to implement the recommendations as an investment rather than a cost, Andrews said more of the same policies would only mean more of the same tragedies. Amy Coopes took us through the key recommendations in her piece for Croakey and Gay Alcorn’s piece on the issue for The Guardian is also worth a read.

ABC TV’s Australian Story piece on Fiona Richardson details how, when Andrews asked her to be Victoria’s Minister for the Prevention of Family Violence, she wondered if he had an inkling of her family history of domestic violence. He had no idea, and the program details the personal and public journey Richardson decided to take in revisiting her past.

In the lead-up to the Commission’s report, Croakey ran an interesting piece looking at the issue of violence in two different domains – in the medical profession and among some groups of Aboriginal men.

It also ran a piece from Kristine Olaris, CEO of Women’s Health East, who argued that in the publicity around family violence, it’s important we don’t lose sight of the broader issue of sexual violence against women more generally. She discusses the importance of harassment, sexist culture and other issues that contribute to women’s fear of speaking out against violence.

Such a piece is particularly timely in a fortnight where US Republican presidential front runner Donald Trump suggested women who had abortions should be punished if abortion were banned in the US. Writing in Fairfax media, Jacqueline Maley said the incident should serve as a reminder to women who thought the equality fight was won that there are still plenty of people out there who think they are indeed lesser mortals.

The recent COAG meeting saw the release of the final report from its Advisory Panel on Reducing Violence against Women and their Children. There are a number of recommended areas for action, which Croakey’s Melissa Sweet outlined here and they include national leadership to challenge gender inequality and transform community attitudes.

Professor Nalini Joshi, the Chair of  Applied Mathematics at the University of Sydney, took to the National Press Club stage to call out the marginalisation of female researchers in Australian universities, whose numbers were increasing at the entry point, but whose levels of promotion to the upper echelons of academia had changed barely at all.

“Research in modern science is still conducted within organisational cultures that resemble a feudal monastery,” she said.

The issue of accepting sexual and gender diversity also came under the spotlight this past fortnight with the release of the review into the Safe Schools program, which some Coalition MPs including Senator Cory Bernadi had heavily criticised and which has now been amended. A piece at The Conversation argued that the debate itself was damaging, and framing gender diversity as a controversial issue only further marginalised young people who were struggling with their gender identity.

The ABC’s Q&A program also addressed the issue, hearing from audience member Carter Smith who urged politicians to “stop using in-pain children as political bullets“.

The SMH reported that hundreds of health professionals had signed an open letter to Prime Minister Malcolm Turnbull supporting the Safe Schools program. Victorian Premier Daniel Andrews meanwhile, vowed to leave the program untouched in his state. You can read the Croakey coverage of the Safe Schools issue, which it said should be viewed in public health terms, here.

****

Closing many Gaps

On the 10th anniversary of the Closing the Gap campaign, Croakey reflected on some of the continuing gaps that warrant greater discussion, such as gaps in political representation, caring for country, and gaps in imagination and respect. Professor Kerry Arabena and a host of other authors gave their perspective in this article, which raised a breadth of issues, including the importance of a healthy start to life.

“Determined, effective action during the first 1,000 days can catalyse equity across a person’s lifetime,” Professor Arabena said.

The coronial inquest into the death of Ms Dhu, a 22-year old Aboriginal woman who died in police custody in Perth after being imprisoned for unpaid fines, was the latest tragic reminder of the justice gap Aboriginal people continue to face. Croakey reported on the Change the Record campaign, calling on Western Australian Premier Colin Barnett to stop locking up vulnerable people for unpaid fines. More than 20 Indigenous and human rights organisations have signed an open letter to the Premier, which pointed out Ms Dhu was in a domestic violence situation at the time of her arrest.

And also writing for Croakey, Ethan Blue, from the University of Western Australia, outlined how Ms Dhu’s family and friends have not given up in putting the spotlight on her case, literally lighting up public buildings with her image in a bid to raise awareness about the injustice she experienced.

The Australian Red Cross has lent its weight to the push for justice reinvestment, urging for it to be made a national priority, and Croakey reported, as part of its JustJustice series, on a call from  Jesuit Social Services to raise the age of criminal responsibility. Other figures released from WA this past fortnight showed Aboriginal patients were discharging themselves from hospital against medical advice 10 times more often than non-Aboriginal patients. The ABC reported WA Director General of Health David Russell-Weisz as saying part of the problem was the “cultural capability” of staff and “institutionalised racism” in the health system.

Meanwhile The Australian (paywalled) reported on a Senate inquiry which heard that 2014 moves to streamline Indigenous affairs by the Abbott government “was poorly executed, failed to consult key indigenous groups and led to widespread confusion”. This article at The Conversation also explored how to reform primary health care to ‘close the gap’.

****

Climate change: the future is now

The World Meteorological Association released its Status of the Global Climate Report, which described the rate of climate change as alarming and unprecedented. Association secretary-general Petteri Taalas didn’t mince words:

The future is happening now. The alarming rate of change we are now witnessing in our climate as a result of greenhouse gas emission is unprecedented in modern records.

The Guardian also reported on new research published in the journal Nature Geoscience showing humans were injecting carbon dioxide into the atmosphere 10 times faster than at any point in the past 66 million years. Meanwhile, following the announcement of new research into health impacts of wind farms, Croakey put some questions to the NHMRC about the level and type of climate change related research in Australia. The answers can be found here.

****

Sugar tax a sweet policy – but not for some

While many public health experts welcomed the UK moves to introduce a sugar tax and urged Australia to follow suit, former Howard Government adviser Terry Barnes wrote on Croakey that tobacco excise and sugar taxes were heavy handed, regressive and lazy revenue grabs. He also took aim at ‘public health panjandrums’, public health lobby supernannies, and the entire population health division of the federal health department, arguing the laws of supply and demand did not work when it came to personal “guilty pleasures” such as smoking and drinking soft drink.

The UK sugar tax has not been popular with soft drink manufacturers.They threatened to sue the UK Government as the tax announcement saw their share prices take a dive.

However, this Croakey post advocated for stronger nutrition policy, pointing out that, given diet is one of the most modifiable risk factors for chronic disease, it should therefore be a key focus of government health policies. Dr Mark Lock, ARC Discovery Indigenous Research Fellow at the School of Medicine and Public Health, University of Newcastle, analysed the failure to progress a national nutrition policy, questioning the silence from Australian Government health ministers on the issue.

We all know it can be difficult to process how healthy certain foods are. This neat quiz tests your knowledge on how much sugar you think might be in common foods and drinks. The accompanying story on the ABC website, explains why WHO recommendations to limit sugar consumption to six teaspoons per day focuses purely on the downstream effects of poor dental health and weight gain.

A story in The Age reporting on University of Sydney research indicates perhaps a few more of us should take the quiz – it says more than half of Australians consume more than the maximum recommended daily intake of added sugars. And sugar sweetened beverages were nominated as the greatest source of added sugar in the Australian diet.

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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