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The Health Wrap: health workforce under pressure, global health concerns, and democracy matters

As the pandemic puts healthcare workers and systems under relentless pressure, Associate Professor Lesley Russell delves into related research, as well as reporting on wide-ranging global health matters.

Leonard Cohen makes a guest appearance, as do some macropod friends from Kangaroo Island.


Lesley Russell writes:

A paper from Professor Marie Bismark and colleagues, just published in the Australian & New Zealand Journal of Psychiatry, looks at the prevalence and predictors of thoughts of suicide and self-harm among healthcare workers during the pandemic.

A summary of the paper can be accessed here, but the full paper is behind a paywall.

The research found that one in ten healthcare workers in Australia had thoughts of suicide or self-harm in a two week period durng the second wave of the pandemic between August and October 2020. Even among those who did not have such thoughts, high levels of burnout, anxiety, depression, and trauma symptoms were observed.

Although there is no comparative baseline data, it is recognised that, even before the emergence of COVID-19, Australian health workers had higher rates of suicide than those in other occupations.

Certain groups were more vulnerable, including those who had friends or family infected with COVID-19, were living alone, had poor physical health or prior mental illness, and increased income worries.

Regrettably, most healthcare workers with thoughts of suicide or self-harm did not seek professional help.

Source: Tweet by Professor Marie Bismark https://twitter.com/mbismark/status/1491250547877289989

In an interview with Sally Sara on ABC World Today, Professor Bismark said, “As the results started to come in, it gave me chills down my spine. To see my colleagues … doing everything they could to help patients in the hospital, and to know from this study that one in ten of them was struggling.”

Like so many others, she called for more attention and more care for healthcare workers.

In return, healthcare workers are desperate for the public to know and understand what’s been happening in public hospitals.

The ABC News website has their stories in their words, which highlight the very tough conditions so many are working under. Nurses and midwives from 150 public hospitals and health services across New South Wales went on strike yesterday to protest conditions including understaffing, lack of nurse-to-patient ratios, and an increased workload during the pandemic.

See some of the responses to the new study, via Twitter:


Medical training

Concerns about the wellbeing of health workers are also raised in the annual report on the 2021 Medical Training Survey from the Medical Board of the Australian Health Practitioner Regulation Agency (APHRA).

The Medical Training Survey (MTS) is a national, annual, profession-wide survey of all doctors in training in Australia. It asks about their experience of medical training across curriculum, workplace environment and culture, workload, training and educational opportunities and overall satisfaction.

Last year questions about the impact of COVID-19 on training were also included. Not surprisingly, the pandemic was seen as adversely impacting both training and personal lives.

More disturbingly, the findings highlight that there has been little improvement since previous surveys in issues around bullying, workplace harassment and discrimination:

  • There was no improvement in the percentage of trainees (35 percent) reporting that they had experienced and/or witnessed bullying, harassment and/or discrimination (including racism) in training. The most common sources of this behaviour were senior staff.
  • The majority (67 percent) of trainees who experienced bullying, harassment and/or discrimination did not report the incident. Of those who did, only 58 percent were satisfied with the follow-up.
  • There is a clear link between unprofessional behaviours and medical training, with 38 percent of trainees who experienced bullying, discrimination and/or harassment reporting moderate or major adverse impacts on their training.
  • Racism is rife with 52 percent of Aboriginal and Torres Strait Islander trainees who reported experiencing and/or witnessing bullying, harassment and/or discrimination.


Racism and health

Meanwhile, the February edition of the United States journal Health Affairs has ‘Racism and Health’ as its theme. While some articles consider how structural and other forms of racism affect health workers and workplaces, the edition’s focus is far broader. 

The issues covered relate to those around the health of minority groups in the US. The edition makes thought-provoking reading, and the statement that “Racism must be explored as a key driver of health outcomes and health disparities” clearly also applies in Australia.

In particular, I commend to you the overview paper that explains the path from systemic racism to poor health and provides examples of dismantling racist systems. A variety of excellent Health Affairs resources on racism and health is available here.

See also this Twitter thread by Croakey’s Dr Melissa Sweet summarising the Health Affairs articles, and this article just published at The Conversation by Professor Chelsea Watego and Associate Professor Lisa Whop: Racism is a public health crisis – but Black death tolls aren’t the answer.


Linking health and social services – payments mechanisms matter

Many who work in public health, myself included, have long been pushing for the transformation of general practice into primary health care. We have a long way to go on that journey, although Aboriginal Community Controlled Health Organisations are leading the way.

In the United States, Community Health Centers have been delivering primary health care services that include a range of social services for over fifty years (there’s lots more information on CHCs here). Now some of the Accountable Care Organisations (ACOs) that were set up under Obamacare are also trying to do this.

In an edition looking at Innovations in Care Delivery, The New England Journal of Medicine examines the integration of the social determinants of health into healthcare services.

The NEJM edition includes a fascinating paper that examines a program in Massachusetts that allows the state’s Medicaid ACOs to pilot evidence-based initiatives that address members’ health-related social needs in an effort to improve health outcomes and reduce total costs of care. The main focus of the social services was on provision of housing and nutrition services.

Just imagine what such an approach could deliver in address health inequities and disparities in Australia!

You can read the summary here; unfortunately the paper is behind a paywall.

Measuring the impact of these partnerships and the sharing of patient data were cited as the most common major challenges due to limited data infrastructure.

Referring patients to social service organisations was another major challenge, as integrating social needs support requires a large cultural shift in healthcare settings on the part of both providers and patients.

In particular, the Massachusetts study focussed on payment mechanisms.

Four payment mechanisms were used across the partnerships: (1) fee-for-service; (2) prospective payments; (3) retrospective payments; and (4) hybrid models of these payment methods.

Since 2018 Massachusetts has moved away from a fee-for-service approach for Medicaid, but this is still perpetuated in the payment system for social services, and there are concerns that this will not ensure value for money.

Despite this, the ACOs strongly agree that partnerships between ACOs and social service organisations offer significant potential to improve patient experience, assist with management of chronic health conditions, and reduce health disparities.

For those looking for more information on this, the May 2021 report on the MassHealth Accountable Care Organisation Program is useful reading and would provide some guidance for those policy wonks keen to institute similar programs in Australia.


Questions about the new National Medicines Policy

I return yet again to this topic, having previously addressed it in The Health Wrap edition of 8 November 2021

It seems that – once again – things are not on track and the Morrison Government is pushing to forego due process in order to meet its own (election-driven) timetable.

To review progress on the National Medicines Policy (NMP) review to date:

The Review, the first since 2000, was announced by Minister for Health Greg Hunt in 2019, although the Terms of Reference were not released until August 2021. It is led by an Expert Advisory Committee that includes a consumer representative.