By Kellie Bisset
Foundations for good health
It’s good to see the discussion around social determinants of health getting louder. The Conversation has focused on this issue of late, and in past fortnight published several pieces, including this very clear and succinct article from Professor Sharon Friel from ANU. Professor Friel points out that the richest 20% of Australians can expect to live an average of six years longer than the poorest 20 per cent. You can’t hide from that statistic.
Deputy chair of the National Rural Health Alliance Professor Lesley Barclay paints a grim picture of how health risk factors play out in rural areas, where undersupply of health services is a problem, but by no means the only reason why geography is Australia’s biggest silent killer.
This piece from Associate Professor Susan Thompson from UNSW looks at the impact of the built environment (including our own homes) on health, and Kevin Volpp from the University of Pennsylvania explores whether paying people to make healthy choices will make a difference to health outcomes.
Problem gambling is another area tackled in The Conversation series. This article by Francis Markham and Martin Young argues that Big Gambling “has transferred, with industrial efficiency, billions of dollars from the pay packets of the working classes to the bank accounts of a super-rich elite”. The issue of gambling and its deleterious impact on health and wellbeing was also highlighted by Croakey this past fortnight, with a wrap of proceedings from the 5th International Gambling Conference in Auckland.
Croakey also published this piece from the Heart Foundation in Tasmania, about the paradigm shift that has occurred in that state towards a health in all policies approach and greater recognition that the social determinants of health is indeed a ‘thing’. However, Miriam Herzfeld, convenor of the Social Determinants of Health Advocacy Network of Tasmania, argues that while there are some positive signs, there is still plenty of room for the major political parties to lift their game in this area.
Croakey’s Marie Mcinerney brought to our attention an international focus on health equity, with calls to action from The Lancet, the World Health Organisation and World Bank President Jim Yong Kim.
And The New York Times addressed the issue of social determinants with a stark portrait of two US counties that highlight how the income gap meets the longevity gap. “Poverty is a thief,” the article quotes social justice Professor Michael Reisch as saying. “Poverty not only diminishes a person’s life chances, it steals years from one’s life.”
A sustainable framework for mental health
Current models of mental health care are economically unsustainable, according to a new report by Reachout.com by Inspire Foundation and EY (formerly Ernst and Young). NSW Mental Health Commissioner John Feneley launched the report, arguing we need to reconceptualise the way we think about mental health care and support, because putting more money into a failing system isn’t the answer. You can read Croakey’s coverage of the report here.
Australian Doctor reports on calls from the Royal Australian and New Zealand College of Psychiatrists to streamline funding of the mental health NGO sector. There are more than 800 NGOs in the sector and this should be addressed to ensure funds are as effectively targeted as possible, according to the college, which has written to Treasurer Joe Hockey on the issue.
Sean Parnell, health and freedom of information editor at The Australian, has written a moving, yet matter-of-fact account of his own depression and followed its publication with a series of tweets on what he learned from the experience. Croakey highlights them here.
Making health messages stick
Increasingly, the health community is recognising that simply ‘getting the message out’ is no guarantee of being truly heard. This study, published in Pediatrics, shows that health messages can be counterproductive. Some immunisation messages tested in the study made parents who were anti-vaccination even less likely to immunise their child, the reserachers found.
The Huffington Post blog also discussed the message challenge in a piece focused on abortion, and another US healthcare blog, KevinMD, looked at the issue from the perspective of dealing with cancer patients. Dr Don Dizon writes that when patients deliberately ignore the evidence, doctors should try getting to grips with their values, as these are just as critical in guiding patient care.
The University of Texas has recognised the power of effective health messaging with the announcement of a new Center for Health Communication. Former CDC Marketing Director Jay M. Bernhardt has been named as its director.
Former New York Mayor Michael Bloomberg is no stranger to both the positive and negative implications of public health communications. His public health reforms have attracted both high praise and heavy criticism, particularly his attempt to ban super-size soda sales in NYC. Under his watch, life expectancy has increased faster in New York City than in the US as a whole over the past decade, according to this piece in Governing. But as a study published in Preventive Medicine shows, it pays to determine the level of government intervention people will accept — Americans surveyed by researchers were not willing to accept general soda portion size restrictions, but they were more likely to approve of removing sugary drinks from school environments.
Closer to home, former adviser to Tony Abbott, Terry Barnes, argues that penalties could be effective in dealing with people who ignore evidence on prevention. Writing on The Drum, he says applying sticks rather than carrots might be politically challenging but should be considered. The comments in response to his article include at least one perspective arguing against the notion that people’s poor health is completely the domain of personal responsibility.
The idea of using laws to help people make healthy choices is an issue on the agenda of the Robert Wood Johnson Foundation, which has launched the Healthy People 2020 Law and Health Policy Project, an initiative designed to use the best available evidence to advance discussion about how laws and policies can guide people’s health and lifestyle decisions.
In the same vein, this Croakey post from Oxfam’s Duncan Green looks a survey of Whitehouse officials and how they interact with researchers and research evidence. It makes for fascinating reading.
In the UK, there are plans to help politicians to make evidence-informed choices with the trial of a parliamentary evidence information service. Its aim is to provide a resource that politicians and civil servants can draw on when making policy decisions and give them more ready access to the research community.
Obesity – a study in complexity
If ever there was an issue that demonstrates the complex interplay between health messaging and health behaviours, obesity is it. A study from researchers at Harvard School of Public Health, Brigham and Women’s Hospital, and Harvard Medical School released this week suggests there could be a genetic component to how fried foods affect individuals. And Swedish researchers reported that skipping breakfast in childhood increased the risk of metabolic syndrome in adulthood.
The ongoing discussion over saturated fat experienced a spike this week with the release of a new study in Annals of Internal Medicine questioning the role plays in heart disease. This story in the New York Times looks at the issue.
A study in Pediatrics says inappropriate parent feeding practices could be setting their infants on the path to obesity. And this article in The Conversation explores the issue of why dieting doesn’t work – discussing the physiological mechanism behind its failure.
Another Conversation article says that if people want to act on new WHO recommendations on sugar they need to consider all of the hidden sources of sugar in their diet.
According to the Daily Mail, the panel of health experts in charge of drawing up guidelines on sugar in Britain will not act on the new WHO recommendations and draw up its own guidelines instead. The article criticises several members of the panel,including its head Professor Ian MacDonald, for having links to the sugar industry.
Could monitoring poor food choices using Big Data help to determine whether public health interventions are making a difference? Canadian researchers are trying to find out.
So far, they have discovered that for each $10,000 decrease in median personal income, there was a fivefold increase in estimated monthly sales of soft drinks. A story on the project published on HealthCanal says that while “the link between food consumption and socioeconomics may seem obvious, [the] metrics provide accurate measurements over time, essential building blocks towards improving global health”.
The future for Aboriginal health and wellbeing
Warren Mundine’s speech to Congress Lowitja 2014 flagged the possibility of impending budget pain in, but he indicated he was trying to quarantine overall Aboriginal health dollars. This Croakey piece from Marie McInerny gives an overview and a link to the speech.
Croakey covered the congress in depth. It featured an address from Lowitja Institute Chair Pat Anderson, who discussed the success of Aboriginal medical services and cautioned that pressure on them to continually chase tied funding could push them into a narrow, purely medical model of service delivery, in contrast to the holistic model that lies at the heart of their success. Conference participants also heard a call for the wider community to stand in solidarity with Aboriginal and Torres Strait Islanders in the toxic race debate. The Congress followed on from the Institute’s conference on continuous quality improvement – a major success factor in improving Indigenous health, but one which experts say must be more equitably spread across communities.
Meanwhile, Croakey’s Melissa Sweet highlights a new Lowitja Institute report – The Shape of Things to Come: Visions for the future of Aboriginal and Torres Strait Islander health research. The report uses insights from futurists to look at how research might help improve Indigenous health and wellbeing in 15 years’ time.
Incarceration rates for Aboriginal and Torres Strait Islander people also received attention this past fortnight.
Tracker Magazine editor Amy McGuire writes that new laws for alcohol-related offences in NSW will have a disproportionate effect on Aboriginal people, particularly given that Aboriginal imprisonment rates are already dramatically higher than those of other Australians.
The Standard reports on calls from Aboriginal elder Lenny Clarke for the Federal Government to heed a UN report highlighting flaws in the treatment of Indigenous inmates with mental health issues.
At the same time, the ABC’s Lateline program has revealed that lack of healthcare options is keeping dozens of intellectually disabled Aboriginal people in prison. And another ABC piece reports on the number of Indigenous healthcare staff being a key to closing the health outcomes gap
Health dollars and how to spend them
Debate continues over the implications of introducing a $6 co-payment for GP consultations as flagged recently by Health Minister Peter Dutton. Writing in the The Canberra Times, Jeremy Sammut says a small payment does not represent a moral threat to Medicare. But Professor John Dwyer presents a different view.
“In truth, out-of-pocket expenses paid by us to support our healthcare are growing more rapidly than any other sector of the health system,” he writes. “Last year Australians spent more than $29 billion in this way. Those who cannot co-contribute are significantly disadvantaged. Healthcare in Australia is anything but ”free”. The inequity is palpable.”
At Croakey, Jennifer Doggett says an opinion poll published recently in the Fairfax press should be interpreted with caution, despite some commentators arguing that it shows the public will support a co-payment.
And Economics lecturer Peter Sivey says if the government is looking for Medicare savings it should focus on clawing back some of the $9 billion it pays to private hospitals. Writing for Croakey and The Conversation, he says the government should not allow private patient subsidies to grow unchecked at the expense of funding public services.
According to News Ltd’s Sue Dunlevy, Minister Dutton is considering the idea of paying pharmacists incentives to administer vaccinations, a prospect that is vigorously opposed by the AMA. However, he has ruled out allowing Coles and Woolworths to run pharmacies in supermarkets, she reports.
The SMH reports that the government is also considering a major overhaul of fee-for-service, and is looking at allowing private health insurers to cover Medicare gap fees. Health economist Jeff Richardson is reported as saying the move would be inflationary and “take the lid off the can” that has contained GP fees. Ian McAuley, a lecturer in public sector finance at the University of Canberra, makes a similar point in this post, arguing that the more private insurance is used to fund healthcare, the more expensive the healthcare system becomes.
If Australia is to move away from fee-for-service medicine we need a proper, rational debate on managed care, CEO of WentWest Medicare Local Walter Kmet writes for Croakey.
And don’t miss this beautifully written and engaging essay on prostate cancer screening by infectious diseases physician Frank Bowden, published at Inside Story.
And in other policy news…
Innovative models of care were on the agenda at a recent virtual forum hosted by the Agency for Clinical Innovation (ACI). The forum saw healthcare professionals and consumers connecting to showcase innovations making a difference to patient care across rural and regional NSW. The ACI’s Raj Verma outlines the story for Croakey here.
The ACT Government is rolling out a new healthy food policy that gives food outlets and vending machines in ACT Health facilities 12 months to increase healthy options for patients and staff, according to The Canberra Times. The new policy follows on the heels of the territory government’s plan to ban fruit juice and sugary drinks from public school vending machines.
New revelations from the SMH’s Amy Corderoy, say the Federal Government has paid nearly $1 million to wind up the Alcohol and other Drugs Council of Australia. Assistant Health Minister Fiona Nash told a Senate Estimates hearing that the decision to axe ADCA was made because it duplicated other services already being offered, Corderoy reports.
And finally, doctors opposing advertising policy guidelines released by the Australian Health Practitioner Regulation Agency (AHPRA), are galvanising support via a Change.org petition. Opponents of the guidelines say they place an unreasonable burden on doctors to have online testimonials of their services taken down, even if they appear on a website or social media that is not associated with them.
The AMA has also had something to say about AHPRA, in response to a Victorian Parliamentary report on the organisation’s performance. 6minutes quotes Victorian AMA President Dr Stephen Parnis as saying the organisation’s first 12 months were a “bureaucratic nightmare” but he now believes it is now moving in right direction.
Other Croakey stories you may have missed this fortnight:
- What did the marches in March reveal about community health concerns? And the global picture…
- TPP: Global concerns and actions at home
- SA election: ‘we want to control health costs but we’ll keep feeding the beast that fuels them’
You can find previous editions of the Health Wrap here.
* Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.