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The Health Wrap: funding conundrums; racism, health and justice; public health matters; bacon-gate fallout; Big Data wrap

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

Funding conundrums

Much has been said this past fortnight about how we should fund our health system – from the role of private health insurance to the expected outcome of the Federal Government’s Medicare review and planned cuts to the community healthcare sector.

Private health insurance has dominated much of the discussion. After announcing a private health insurance review, including a community survey, Federal Health Minister Sussan Ley said she wanted to look at whether policyholders were getting value for money. She told the AFR it “was clear” that consumers wanted action. Addressing the issue, The 7.30 Report highlighted the case of Michelle Henessey, who, despite having top cover, was left $20,000 out of pocket after being treated for breast cancer.

However, one option said to be on the table –  allowing private health insurers to play in the primary care space – has already come under fire. Writing in the SMH, the Grattan Institute’s Stephen Duckett said allowing private insurers into the general practice market would simply drive up prices.

[quote]There are a number of elements of the private health insurance market that warrant change, but expanding the insurer’s role in general practice is not one of them,” he said. [/quote]

Doctors don’t seem to be keen on the idea either. Medical Observer reports RACGP president Dr Frank Jones as saying such a move would act as a barrier to care.

The Government’s community survey has also generated debate over the question of whether health risk factors should be taken into greater account – for example by charging smokers higher premiums.

This prospect has been publicly welcomed by at least one insurer. NIB CEO Mark Fitzgibbon told the SMH that smokers should pay more and people could be rewarded for healthy activity such as walking a certain amount of steps per day.

Meanwhile, The Conversation carried a series of articles on the private health insurance issue.  This piece from Professor Elizabeth Savage looks at whether it warrants a taxpayer subsidy, and this one, again from Stephen Duckett, argues that the industry is “ripe for reform”. Another, from Ian McAuley, says it is time for a review on whether the government should fund the industry at all.

For a tongue in cheek look at the issue, head over to the SBS Backburner column, which says it’s obvious that the US should be our guiding light on health reform.

[quote]A former economist at the Department of Health told The Backburner that looking to America’s almost completely nonfunctional system as a model for Australia’s currently quite functional system is the only way forward.[/quote]

The government’s Medicare review remained a topic of discussion, with the AMA’s submission to the Review Taskforce arguing that to be effective, the review must be a single comprehensive update of the MBS rather than taking a fragmented approach that would focus mainly on cost savings.

According to Medical Observer, the RACGP also wants to see the taskforce broaden its scope to consider new MBS items that reward GPs for all of the “unseen” work they currently do outside of the consultation. And in its submission to the review, the Consumers Health Forum has argued for a rethink on fee-for-service medicine, which CEO Leanne Wells described as “throughput medicine” on The World Today.

According to an analysis from the BEACH program carried by Croakey and The Conversation, the ability of Medicare to sustain the healthcare needs of our ageing population is contingent on retaining a strong primary healthcare system without which, Australia’s healthcare costs would be much higher.

This came as news from the latest Professional Services Review (PSR) annual report showed that doctors were ordered to repay $4billion in Medicare claims and PSR investigations rose by 40%. The timing of the report and the government’s comments prompted the AMA to accuse it of politicising the PSR.

Over at the National Press Club, Michael Moore, Rod Wellington and Sheila McHale spoke on the topic “Hidden Harms – How concealed budget cuts are killing Australia’s health sector”. PHAA president Moore outlined the potential impacts of the planned $800 million in cuts to Flexible Funds to chronic disease prevention and he argued cuts to prevention contradicted the Government’s stated priorities around reducing the burden of chronic disease. You can watch the full address here and catch the Croakey coverage here.

An article in New Matilda questioned why this address received virtually no media attention, arguing that while it was important to be debating private health insurance, cuts to prevention and community care were a critical issue that needed some air time.

In other health policy news, the Government confirmed it would remove PBS subsidies from 17 common over-counter-medicines such as aspirin, and the full text of the Trans Pacific Partnership trade deal was released. Criticisms have already emerged about the potential impact the deal will have, although according to the SMH, Trade Minister Andrew Robb rejected some of the criticisms as “hysterical”. You can see Croakey’s coverage of the issue here.

*****

Racism, health and justice

As the American Public Health Association’s new president Dr Camara Jones put the issue of racism in health on the agenda at the recent APHA conference in Chicago, Mary Travis Bassett, commissioner of the New York City Department of Health and Mental Hygiene, told the Harvard T.H. Chan School of Public Health that public health professionals should not be afraid to call out racism when they saw it.

[quote]If we fail to explicitly talk about racism in health, especially at this time of public dialogue about race relations in this country, we may unintentionally bolster the status quo and enable the perpetuation of health inequities even as society is calling for change,” Bassett said.[/quote]

Closer to home, SBS tackled the issue, quoting the head of the Poche Centre for Indigenous Health and Well-Being, Dennis McDermott, saying that racism still exists in Australia’s health system – and it’s costing lives.

According to new UNSW research reported on The Conversation, a lack of culturally responsive and therapeutic community-based support for Aboriginal people with mental illness and cognitive disabilities means that police have become the “default frontline response” and this is sending this this group down a criminal justice rather than a healthcare path. Often, police did not recognise they were dealing with a healthcare issue, the article said.

[quote]They often assume Aboriginal people are drunk or having a drug-induced mental health episode.[/quote]

The authors of the research explored these issues in a series of articles, including this one which looks at the over-representation of Aboriginal  people with mental illness and cognitive disabilities in Australian prisons. Lateline also covered the issue – see the ABC treatment of the research here.

Responding to the reports, ANU Professor Tom Calma told The Guardian that evidence from the US showed the economics supported diverting funds from jailing offenders into community-based programs.

Growing pressure to tackle the over-representation of Aboriginal and Torres Strait Islander peoples in our justice system was the subject of a Croakey longread this fortnight. Also on Croakey, Mark Skulley wrote about the impact of the NT’s paperless arrest laws, the legality of which has been upheld by the High Court. And Julian Cleary reviewed a new series between Amnesty and Vice magazine called Over Represented which looks at Aboriginal and Torres Strait islander experiences in the justice system.

In some positive news on health, SMH, health editor Amy Corderoy looked at how the issue of providing care through Aboriginal community controlled health services is making real health gains including in immunisation rates.

And Amy Coopes summarised for Croakey, a new AIHW report, which found there had been small gains in primary health for Aboriginal and Torres Strait Islander people. Smoking status, diabetes management and blood pressure control all saw improvements but some areas slipped, such as child immunisations below 36 months, cervical screening and overweight and obesity, as measured by BMI.

*****

Public health matters

Australia, and many other countries, are not prepared for the health impacts of climate change – which is fundamentally a human health issue, according to a new report from the World Federation of Public Health organisations highlighted by Croakey this fortnight. And ahead of the Paris climate summit, Doctors for the Environment Australia are asking people to sign an open letter urging that Health Minister Sussan Ley join Malcolm Turnbull, Julie Bishop and Greg Hunt at the international talks in recognition that climate change is a threat to the health of future generations.

In other areas of public health policy, the federal government’s national diabetes strategy was launched, and makes a number of suggestions, including tightening controls around junk food advertising to children, though it says this could be done “through voluntary or compulsory codes of conduct”. Medical Observer reports that primary health networks are likely to be central to the plan.

The Our Watch organisation has joined with VicHealth and Australia’s National Research Organisation for Women’s Safety to launch Change the Story, Australia’s (and the world’s) first national framework for the prevention of violence against women and their children. Speaking at the launch in Canberra, Our Watch Chair Natasha Stott Despoja said the framework would be an evidence-based roadmap that governments could use to collectively prevent violence against women and children.

And in a nice article on the Centre for Health Journalism blog, Rebecca Johnson looked at the importance of reporters joining the dots between health policy and health outcomes. The piece looks at, among other things, the rationale behind a health-in-all-policies approach and argues that quality reporting can hold policy makers accountable for decisions that impact on health outcomes.

In international public health news, the UK braced for a round of public health cuts, in New Zealand, Auckland public health workers walked off the job in protest at their overstretched workforce, and a Pew Research Centre analysis of OECD data looked at what makes a good life and how countries ranked. Australia was listed fourth, ahead of the US but behind Norway, Iceland and Switzerland. And for those interested in the outcomes from the recent American Public Health Association annual conference, a wrap-up of media coverage from the event can be found on the APHA meeting blog.

*****

‘Bacon-gate’ fallout and other consumption issues

After the WHO description of processed meat as a group 1 carcinogen and the resulting storm of headlines internationally, the Organzation was forced to issue a clarifying statment pointing out it had not advised people to stop eating processed meats but to reduce their consumption in order to reduce their colorectal cancer risk. This Medscape article gave a good overview, and included a nifty infographic comparing the risk of cancer from tobacco smoking to that from eating processed meats. An article in The Conversation from Dallas English and Terry Slevin looked at the issue of communicating risk and unpacked the WHO advice and another, from Daniel Du Plooy, examined the issue of ‘science fatigue’ and what might lie behind people dismissing the WHO advice with the refrain “everything causes cancer”.

This interesting journal article on obese people’s perceptions of news reporting on obesity shows that obese people feel ridiculed and stigmatised by news articles that place emphasis on levels of personal responsibility rather than wider societal factors.

Stigma is also the word many parents have used to describe the “fat letter” that UK parents have received if their child is classified as overweight as part of the national child measurement program. The Royal Society of Public Health has called for the letters to be overhauled and other mechanisms to be looked at instead, such as healthy food vouchers.

In the US, Medpage Today reported that doctors’ uneasiness about discussing obesity might be one of the reasons it continues to rise. And the ABC highlighted research from Cambridge that indicated people’s ability to resist food was partly caused by genetics.

The issue of geography and the role it plays in healthy eating choices was the subject of this Canadian article which described parts of Toronto as “food swamps” swimming in an overabundance of unhealthy foods. Some Australian research also investigated the link between where you live and proximity to a bottle shop, pub or club and found the impact on health was greater for those in disadvantaged areas compared to people in well-off areas.

People in disadvantaged areas were more likely to rate their long-term health as poor if there was an on-licence alcohol outlet, such as a pub or restaurant, within 400 metres, or a bottle shop within 800 metres,” said Dr Hannah Badland, lead author of the research, which was supported by the Australian Prevention Partnership Centre and published in Drug and Alcohol Review.

In New York, home of public health policies that have led to major health gains for its residents, the city council is considering a new policy that would require any meal linked to toy giveaways for children to meet nutritional standards. Melissa Stoneham covered the issue for Croakey.

In Australia, families are spending up big on toddler milk – to the tune of $150 million a year – despite the fact that it is not necessary and there is evidence it leads to overnutrition. The ACCC is currently considering re-authorising a voluntary code that governs formula companies and has called for public submissions on the issue. The agreement prohibits the advertising of infant formula directly to the public but this Croakey article argued that toddler milks, which are advertised, are a ‘Trojan horse for infant formula, with similar labels that cross-promote products, confuse consumers and undermine breastfeeding”.

*****

E-health, Big Data and tech things

The Senate Community Affairs Legislation Committee paved the way for an opt-out personally controlled electronic health record, which will now be called My Health Record and trialed in Queensland and NSW. The committee supported the Health Legislation Amendment Bill, which was subsequently passed by Parliament.

[quote]“This will help deliver better health outcomes for patients for the first time and cut down on unnecessary risks and inefficiencies in the system currently frustrating doctors,” Health Minister Sussan Ley told AAP.[/quote]

Meanwhile, Medical Observer reported  that the Office of the Australian Information Commissioner had undertaken a series of audits of general practice e-health privacy compliance in seven clinics and found all failed the requirements “sometimes for simply not activating the screensaver lock”.

New Scientist tackled the issue of Big Data this fortnight, speaking to experts who argued that getting the most out of Big Data was about much more than making systems compatible. Rather it was about “working like Google” and scaling up systems that could maximise the cloud to work across billions of users.

Information Week looked at the Precision Medicine Initiative Cohort Program, a $130 million program being run by the US National Institutes of Health aiming to study the records of one million people over time in a bid to learn which people will respond to certain drugs, which are at risk of certain disease, and which of them maintain their health and fitness as they age. All of the people in the cohort would have their genomes sequenced to add exponentially to the value of this Big Data and recruitment for the trial will take place over the next three years.

In Australia, such an adventure is already underway, as the annual meeting of the Sax Institute’s 45 and Up Study heard last week (#45andUp2015). The Study – Australia’s largest – has been running for a decade, is following more than 260,000 people over time has been used by more than 580 researchers to investigate a range of issues pertinent to health and ageing.

Last week’s meeting heard about a new partnership with the Garvan Institute, which will see genome sequencing of blood samples from 2000 study participants to help create the Medical Genome Reference Bank.  The Bank, which will also contain samples from the ASPREE cohort at Monash University, will help researchers to identify normal genetic variation compared with genetic variation caused by disease. The meeting theme was opportunities and challenges of big data, and the Garvan’s Associate Professor Marcel Dinger told the meeting that genome sequencing would revolutionse the health system, with huge drops in the cost of genome sequencing creating major possibilities for personalised healthcare.

The Garvan also made news this past fortnight with its DreamLab App, which aims to create a smartphone ‘super computer’ by pooling users’ smartphone computing power and allowing the Institute to crunch data thousands of times faster.

Big Data it seems, is on the minds of educators as well. New York University School of Medicine has added the subject to its course requirements.

[quote]”If you don’t have these skills, you could really be at a disadvantage in terms of the way you understand the quality and the efficiency of the care you’re delivering,” Associate Dean Marc Triola told Med City News.[/quote]

*****

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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