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The Health Wrap: How are we doing on healthcare policy? Is climate change the next public health emergency? Lessons from Ebola

 

By Kellie Bisset

Healthcare spending – how does Australia compare? 

In the wake of so much talk recently about Australian healthcare costs being unsustainable, a series of articles this past fortnight has sought to address how we stack up internationally in what we spend and what we deliver.

The Conversation kicked off a series on international healthcare systems with a piece from the Grattan Institute’s Professor Stephen Duckett, who pointed out that much of the political speak has been focused on what we spend but not on what we get for our money. And we get quite a bit for our money compared with other countries, he said, pointing out that not one comparable country performs better than Australia on cost. The series also asked what we could learn from countries such as England, Singapore, the Netherlands and America and can be found in its entirety here.

The Age also reported that the independent Parliamentary Budget Office has questioned claims health spending is spiralling out of control and noted that health will account for only a small amount of the growth in government spending over the next decade.

***

Healthcare policy – how are we doing?

Writing for Croakey and The Conversation, Jim Gillespie, Deputy Director of the Menzies Centre for Health Policy took a look at the government’s first year in health. Despite the controversies surrounding health announcements, he argued there was still no overarching policy underpinning the initiatives.

Whether a GP copayment would make things better or worse, has remained a hot topic, with potential alternative policy models emerging from several sources. The Senate’s Community Affairs Reference Committee has advised the Government to dump the co-payment to avoid the long-term cost implications of removing money from primary care.

Former Howard Government policy advisor Terry Barnes said the Government should cut the copayment to $5 and give the amount to GPs as an incentive to cover practice costs. He described as “greedy” the AMA’s proposal of a $6.15 co-payment, the cost of which to concession car holders and under-16s would be met by the government. The resulting $580 million would be invested in general practice. Marie McInerney’s post for Croakey also looked at how the AMA proposal stacks up.

Even Nobel prize-winning medical researcher Rolf Zinkernagel weighed into the debate on a recent visit to Australia, telling the Sydney Morning Herald that he didn’t oppose a co-payment but using it to fund medical research was not a good idea. Heavy hitters in the medical research and university sectors meanwhile, have begun to agitate on behalf of the medical research future fund, forming an action group to advocate for the initiative.

Writing in The Australian, Christine Bennett and Brendan Crabb said the fund was a far sighted, smart investment in better health. They didn’t however, mention the co-payment or the impact of shifting the money from one part of the health sector to another. At least for the moment though, the two are inextricably linked, with the Australian Financial Review reporting Health Minister Peter Dutton saying the government would push through a smaller medical research fund if the co-payment proposals did not pass the Senate.

This piece from Brendan Bailes in The Conversation explored the Government’s seemingly contradictory approaches to science – plans to invest in the fund for example, as well as boosting dementia research and generally protecting health and medical research funding while simultaneously cutting funds for the ARC, CSIRO and ANSTO, removing the portfolio of science minister and its views on climate science. The UK Government’s chief science advisor Sir Mark Walport wrote in The Guardian that the need for scientists and policy makers to work together has never been greater.

Other policy-related Croakey posts from the past fortnight tackled:

***

Aboriginal health: policy “chaos” and creative solutions 

Continuing with our health policy theme, the past fortnight saw Indigenous leaders call on the government to address the policy and funding environment, which they said was “descending into chaos”. Croakey reported on the leaders’ statement, which said Budget cuts were impairing the ability of the community controlled health sector to deliver frontline services. These cuts include removing a third of the funding of the Tackling Indigenous Smoking program, an action that Kristin Carson wrote risks widening, not Closing the Gap.

The Guardian also reported John Pilger’s perspective, ahead of his appearance at the Festival of Dangerous Ideas – he said the budget was a “civil war of rich against poor” and Aboriginal people were at the coal face. And the ABC reported on widespread concern about Prime Minister Tony Abbott’s comments that white settlement ‘was the defining moment in the history of the continent’.

In a thoughtful piece for the Wonky Health blog, Dr Tim Senior explored how policy making might be different if the system was decolonised. Non-Indigenous Australians needed to talk about how, despite their best intentions, their “cultural world-views are constant re-colonisers, stamping all over any good intentions we had,” he said, using the recent Forrest Review as an example of a ‘knows-best’ approach that doesn’t consider what might actually work in practice.

In spite of the numerous obstacles, Indigenous Australians continue to find a multitude of creative approaches to health problems facing their communities. The Miwatj Health Aboriginal Corporation for example, has produced a documentary as part of its Tobacco program designed to address smoking rates of 70% among the Yolgnu people of East Arnhem Land. It is about to be screened in the UK, US, Sweden and Russia.

And a new video from Awabakal Newcastle Aboriginal Cooperative tackles the serious issue of ear disease among Aboriginal children head on with “a Deadly Koori kid” named L’il Mike, a rapping, energetic animated character who speaks directly to his audience – Aboriginal kids – telling them to listen up and giving them tips about ear health.

Meanwhile, the Australian Society for Medical research will hold an Indigenous health public forum in Melbourne in November with the theme Healthy start, strong family. The forum is free and open to members of the public

***

Lessons from Ebola

Western nations must step in and help developing countries fix their health systems to prevent future Ebola-type crises, this Croakey blog post from Alexandra Phelan argued. Phelan, who is an Adjunct Professor of Public Health law and Ethics at Washington’s Georgetown University Law Center, wrote that many deaths during the current epidemic could have been prevented had the West taken a more proactive approach.

Professor Lyn Gilbert and Associate Professor Ian Kerridge from the University of Sydney also examined lessons from the outbreak in a piece for The Conversation. They said the epidemic represented a moral failure: “Ebola fever is not a new disease. That so little progress has been made towards developing effective remedies, and that the progress has been driven more by military imperatives than concern for affected communities, is outrageous.”

Also writing for The Conversation, Associate Professor Isoken Tito Aighewi said that without better public health systems the outbreak would be hard to contain. There have been about 3500 cases  and 1900 deaths reported to date, largely in Guinea, Liberia, Nigeria, Senegal, Sierra Leone, and the Democratic Republic of the Congo. But now the disease has hit African cities such as Sierra Leone’s Freetown, it is about to take on another dimension, the Washington Post reported. The WHO has predicted up to 20,000 people could become infected and has issued a roadmap to scale up the international response. It also expressed concern about the unprecedented number of healthcare workers affected by the outbreak.

Africa’s Mail&Guardian reported that the level of hysteria around the outbreak was unprecedented and was causing discrimination against patients suspected of carrying the disease. Quarantine restrictions are causing serious food shortages in the affected areas, and worryingly, genetic studies show that the virus is mutating fast, a development that has implications for diagnostic tests and experimental treatments such as the Ebola vaccine, which is now being used in healthy people. For a history of the virus – this piece in Inside Story is worth a look.

***

Climate change – the next international public health emergency?

Should climate change be considered on a par with Ebola and be declared as a public health emergency of international concern?

Executive Secretary of the UN  Framework Convention on Climate Change Christiana Figueres, thinks we are not far off.

Addressing the first ever global conference on health and climate at WHO headquarters in Geneva, Figueres said at the heart of an effective climate change response was the challenge of taking responsibility for our actions and changing the patterns of the past 100 years. Following the conference, fifteen climate health organisations, including Australia’s Climate Health Alliance, called on the WHO to declare climate change a public health emergency and also urged the health sector to divest itself of fossil fuel investments.

Australian Research Council Future Fellow Professor Colin Butler attended the WHO conference and provided an overview for Croakey readers in this post. While he was there, the report into the Renewable Energy Target headed by businessman Dick Warburton was released. It’s recommendation to downgrade the target was roundly criticised, and this article on the ABC website from Perth GP Dr George Crisp pointed out that the recommendation will have implications for Australians’ health.

But even if we talk purely in economic terms, a new cost benefit analysis from researchers at Massachusetts Institute of Technology shows that cutting carbon emissions pays for itself. They studied three separate carbon reduction policies and found that the economic benefits of cleaner air could recoup more than 10 times the cost of implementing a cap and trade program.

Getting this message across to the public might be an uphill battle though if this Veritasium video  on what a selection of Sydneysiders think of climate change is anything to go by.

Achieving cut-through on the broader implications of climate change is a challenge, and one that was apparent following the release of the Hazelwood Mine Fire Inquiry. Marie McInerny took a look at this issue for Croakey.

***

An economic lens on social determinants

Commenting on the recent National Press Club Forum on the Social Determinants of Health, Croakey co-ordinator Melissa Sweet reminded us that getting this issue onto the political agenda is no easy task. She posted an edited extract from Social Determinants of Health Alliance Chair Martin Laverty’s address to the Press Club. It is well worth reading, and highlights NATSEM’s view that acting on this area is not just about equity (though many would argue that should be an end in itself) – it could also save the country billions.

The fortnight also saw the Senate Community Affairs Committee release the report of its inquiry into out-of-pocket healthcare costs. Writing on the issue for Croakey, Jennifer Doggett said the exercise demonstrated the important role inquiries such as these played in highlighting longstanding gaps in public health policy – despite the fact that political realities often meant that many sensible recommendations ended up gathering dust.

Also in a post for Croakey on housing affordability, Marie McInerney asked: who wins, who loses and why isn’t it on the political agenda?

The Washington Post carried a gripping read on a longitudinal study – known as the Beginning School Study – which has finally wrapped up after 25 years. Researchers from Johns Hopkins University followed children from the suburbs of Baltimore and looked at how their paths in life were affected by the economic and social circumstances they occupied in the first grade.

And this Reporting on Health blog post highlighted that jailing parents might have even more long-term impacts on children’s health than previously thought.

***

E-cigarettes – no consensus on the horizon

The release of a WHO report recommending restrictions on e-cigarettes – including on their indoor use and how they are marketed to minors – attracted a flood of views and highlighted the continued difference of opinion on whether they are a help or a hindrance.

Some experts said the report’s evaluation of the evidence was inaccurate, while others welcomed the report as thorough, comprehensive and important. The Conversation looked at the debate, running opposing views from Wayne Hall and Ross MacKenzie on whether Australia should lift its ban on the products.

The ABC reported meanwhile, that accidental poisoning from e-cigarettes appears to be on the rise, with many severe cases affecting children. And Forbes took a look at the toxic metals emitted during the vaping process, suggesting the health claims of e-cigarette manufacturers might be too good to be true.

A paper published in the journal Nicotine and Tobacco Research found that non-smoking teens were trying e-cigarettes and e-cigarette use was associated with intentions to try smoking.

***

Other Croakey articles you may have missed this fortnight:

You can find previous editions of the Health Wrap here. Contact me on Twitter @medicalmedia or my colleague Frances Gilham @FrancesGilham with story ideas for the Health Wrap.

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.

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