The Health Wrap: Indigenous incarceration disgrace, let’s talk about smoking, Budget fairness test, all things Evidence

 

By Kellie Bisset

The disgrace of Indigenous incarceration rates

Following the successful crowdfunding of Croakey’s #JustJustice campaign, it’s timely to reflect on the release of the Amnesty International Report  A brighter tomorrow: keeping Indigenous kids in the community and out of detention in Australia. The report found that Indigenous youth incarceration is at its highest level in 20 years and that Indigenous kids are 26 times more likely to go to jail than non-Indigenous kids. Croakey has addressed the issues in the report here. And it quotes Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda as saying the findings are a national emergency.

Former Social Justice Commissioner Tom Calma lent his support to the #JustJustice campaign, calling for justice and mental health to be added to Closing the Gap targets. You can read his post on Croakey here.

The Northern Territory’s new paperless arrest laws are the antithesis of just justice, according to this comment piece in the SMH, which highlights yet another recent and tragic Aboriginal death in custody in Darwin. Another oped in The Drum says governments need to shift their investment from prisons to communities.

The need for concerted action is also highlighted in a new report from the Australian Institute of Health and Welfare’s, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. It shows the age-standardised imprisonment rate of Indigenous people increased between 2000 and 2014 (from 1,100 to 1,857 per 100,000 adults) while the non-Indigenous rate increased only slightly, resulting in an 82% increase in the gap over this period. The report notes that incarceration not only affects the health and wellbeing of those imprisoned, but also the health and wellbeing of their families and children.

More broadly on the issue of  funding, The Guardian reported a $100m boost to the Federal Government’s controversial Indigenous Advancement Strategy. And according to the ABC’s Lateline program, some Indigenous groups have raised concerns over the tying of grant monies to a demonstrated commitment to the referendum on constitutional recognition. This piece in The Guardian by Celeste Liddle says the debate over recognition is far more complicated than a black vs white issue, and the lack of recognition of the diversity of Indigenous views on the topic is an issue in itself.

Meanwhile, Flinders University launched the third stage report from its Managing Two Worlds Together Study, which looked at the Aboriginal patient journey and offered recommendations on how to improve it. And this article in The Conversation argues that federal and state government policy directions are jeopardising Indigenous peoples’ access to affordable and nutritious food, which is critical in addressing the health outcomes gap between Indigenous and non-Indigenous Australians.

Fittingly, The Secretariat of National Aboriginal and Islander Child Care (SNAICC) has announced the theme for its upcoming National Aboriginal and Torres Strait Islander Children’s Day as Little people, big futures. The day will be celebrated on 4 August and will recognise the strengths and culture of Indigenous children.

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Let’s talk about smoking

Against a backdrop of World No Tobacco Day, a conversation around Indigenous smoking rates took place this past fortnight. A supplement published in the MJA highlighted the work of the Talking About The Smokes project, a community-based participatory research method that has yielded important data on smoking and could pave the way for future research projects with Indigenous communities. Project leader Associate Professor David Thomas wrote this piece for Croakey and The Conversation about how the project has identifed a way forward. Launched by Federal Health Minister Sussan Ley, the research found  70% of Indigenous people said they wanted to quit, and half had tried in the past year.

A piece run in The Conversation discussed the endgame of tobacco control reform – a tobacco-free generation – and how legislation before the Tasmanian Parliament prohibiting tobacco sales to anyone born after 2000, could see us inching towards this goal. The Australian Sex Party and the Eros Foundation meanwhile, have called for tobacco sales to be restricted adults-only premises.

The international tide against tobacco has gained some momentum, with China about to roll out new anti-smoking laws that will make it an offence to smoke on public transport as well as restaurants and offices. Although in Indonesia, initial attempts to introduce tobacco control legislation appear to have stalled, as this article in The Conversation reports.

Big Tobacco is set to spend even more of its massive profits on legal fees, after it was announced that British American Tobacco and Philip Morris International had launched a legal suit against the British Government over plain packaging. And their subsidiaries in Canada said they would appeal a major court decision in Quebec to award C$15.6bn in damages in a class action suit launched by more than a million smokers and former smokers.

Scottish researchers have estimated that a public smoking ban in England has resulted in an 11,000 drop in the number of under 15s being admitted to hospital with nose, throat and sinus problems. And in a bid to minimise potential future damage from e-cigarettes, New Zealand researchers have called for them to be made available only through pharmacies.

In an attempt to highlight what he said was a lack of regulation in NSW around vaping in public places, Greens MP Jeremy Buckingham produced an e-cigarette and proceeded to vape in the upper house. Health Minister Jillian Skinner has already announced that the government will ban adults from buying e-cigarettes or accessories on behalf of minors, but the government has not moved to ban the devices from public places.

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Budget fairness test 

Prime Minister Tony Abbott rejected figures from the National Centre for Social and Economic Modelling (NATSEM)  showing that low-income families would be hardest hit by the latest federal Budget measures. As reported in The Guardian, he said the analysis was a fraudulent misrepresentation of the government’s figures. However, ANU academics conducted their own analysis and came up with the same conclusion. The Australian Council of Social Service (ACOSS) also assessed the issue, and found the Budget would strip $15 billion over four years from families and low-income people.

Budget measures that would see general patients pay a $5 copayment for prescriptions and have to spend more on drugs before they reached a new pharmaceutical safety net threshold , put Health Minister Sussan Ley in the spotlight. The Guardian reported her saying it was unlikely the measures (reintroduced from the previous year’s budget) would survive the Senate, but news.com.au said while there appeared to be confusion over their status, the measures looked set to stay on the table unless alternative savings could be found.

The Government pressed ahead with the $20 billion Medical Research Future Fund, announced in the previous year’s budget – introducing legislation to establish it and announcing an initial contribution of $1 billion. This is despite the fact that its original source of funding – the now defunct GP co-payment – has dried up.

It also faced questions over the logic of cutting $8 million from drug treatment and prevention programs at the same time as it was establishing a national taskforce to combat the growing impact of the drug ice. See how Croakey assessed the issue here. For those wanting a quick overview of the major budget savings, this Croakey post from the Parliamentary Library series of budget briefs offers  a summary.

In WA, the State Government came under fire for halving funding for Aboriginal health programs in its most recent budget, despite an evaluation report saying existing programs were delivering good value for money in terms of Closing the Gap on Aboriginal health outcomes.

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What’s new in policy 

The Government announced its pharmaceutical reform package, which it said would result in cheaper medicines and a more competitive community pharmacy sector. The reforms follow an agreement with the generic medicines sector and an in-principle agreement with the proprietary medicines sector and the Government said they would see a 50% drop in prices for common drugs. The package also included measures for pharmacists, allowing them to offer discounts of up to $1 per script and continues existing rules around where pharmacies can be located.

GPs were smarting over the news, according to Medical Observer (registration required), which reported anger over pharmacists receiving an injection of funding into primary care pharmacy programs at the same time as doctors were experiencing a Medicare rebate freeze. The AMA has vowed to fight the freeze, but was more welcoming of the Government’s announcement it would divert funds from the GP Rural Incentive Payment Scheme to areas of workforce shortage that needed them most.

Meanwhile, the SMH revealed it would cost the government $112 million to close the network of Medicare Locals established by Labor. The Government also announced the make-up of its Medicare Benefits Schedule Review Taskforce, and the Primary Health Care Advisory Group, which will look at primary health reform. Croakey looked at whether the gender representation on the Medicare Taskforce was appropriate.

The Australian (paywalled) reported that Health Minister Sussan Ley has proposed a new round of talks with states and territories on hospital funding. And the Minister also announced a new national strategy would be developed to address antibiotic resistance and reduce overuse of the drugs.

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Where policy, lifestyle choices and environments meet

The 2008 alcopops tax may have led to a marked reduction in alcohol-related harm among young people, the doctors’ website 6minutes (registration required) reported. However, The Conversation also carried a piece on the trend toward lower rates of youth drinking, which it said appeared to be a global shift and had begun before the tax was introduced.

For those young people who do engage in risky drinking, social media platforms such as Facebook may have a role in changing behaviour, University of Sydney research has found. The research showed an intervention using peer-to-peer messaging held some promise, the ABC reported.

In Europe, more than 20 bodies have resigned from the EU Alcohol and Health Forum. They said the forum’s failure to develop an alcohol strategy would not address the burden of alcohol-related harm.

More positive policy news has emerged from the US, where  the Obama administration looks set to issue a ban on trans fats. The move has been hailed as a victory for public health and follows similar bans in European countries. Denmark, for example, experienced a significant drop in mortality from cardiovascular disease following the move, according to a WHO report.

The US news came as research published in the journal Gut, showed a link between overweight an obesity in adolescence and bowel cancer later in life. The BBC quoted the authors as saying the study shed light on the increasing incidence of colorectal cancer in younger adults. And The Guardian  reminded us about the interplay between health and environment with a report about new evidence in Occupational and Environmental Medicine suggesting a link between fat deposits and raised cortisol levels caused by exposure to traffic noise.

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First, do no harm

As the ABC’s Four Corners aired a compelling program about the culture of bullying trainee surgeons and other young doctors, the Royal Australian College of Surgeons came out in support of making surgeons’ individual performance data publicly available. On her blog, re-posted by Croakey here, change agent Mary Freer discussed bravery, and using social thinking to shift the entrenched culture of intimidation and bullying in our health services.

At the AMA’s national conference in Brisbane, doctors voted to ramp up the political pressure around climate change, and they passed an urgency motion requesting the government to review the Border Force Act, which they said had the potential to gag doctors from speaking out about the treatment of refugees being held in detention centres.

The Royal Australasian College of Physicians also released a position statement on treatment of asylum seekers, a key plank of which is calling on the Government to end detention. A Croakey post from RACP President Professor Nick Talley outlined the issues. And this video, launched with the college’s statement, is well worth watching.

A new book has been released that says the company that sold and distributed Thalidomide knew of the drug’s dangers six months before it was pulled from the market. Silent Shock, by the Australian lawyer for Thaolidomide victim Lynette Rowe, details evidence that was not previously public. This Guardian article tells the story.

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All things Evidence 

What will come of universities accepting third party funds for research chairs? It depends on your point of view, several of which were aired by The Conversation this past fortnight after news emerged that Sydney University will have a new $1.3 million research position in integrative medicine funded by Blackmores. Ken Harvey and Paul Komesaroff debated the issue in this post and Simon Chapman explored it in his Smoke Signals column.

Croakey paid tribute to David Sackett, a giant of evidence based medicine who has died, aged 80. Despite advances in thinking around EBM, Sackett battled opposition to his ideas from the establishment all his life.

A blog in the Huffington Post looked at the many challenges clinicians faced when trying to implement EBM in their practices, including the variability in data and a widespread lack of epidemiological skills in clinical medicine. Author Dr Brian Secemsky said it was important young doctors understood this context so they could get the most out of an evidence based approach to clinical practice.

Patient preferences can also be a roadblock to evidence. A MedPage Today survey showed that two thirds of doctors said their patients resisted efforts to minimise unnecessary tests and prescriptions. A story in Medical Observer (registration required) also reported on geneticists calling for GPs to resist patient pressure for unnecessary genetic tests. Despite the challenges, there is hope for doctors struggling with patient opinion. MedPage Today also ran this piece on why ‘Less is More’ is the next big thing for medicine.

From evidence based medicine to evidence informed policy – this Conversation article detailed how the stars aligned between research, policy and practice in Queensland’s Landscape Resilience Program. If only the same could be said about climate change. On Croakey, Professor Colin D Butler looked at why the Lancet’s 2009 paper saying climate change was this century’s greatest threat to health has not had the impact on the scientific literature or in the health community that might be expected. (This is an article well worth reading).

Evidence on the negative effects of prolonged sitting is making its way through the system, with new British guidelines recommending office workers stand for two hours a day. More than half of total sitting time is racked up at work, according to a paper in the Australian and New Zealand Journal of Public Health. There have been a number of studies published on sitting’s effect, including a link to diabetes and cardiovascular risk and research from more than 200,000 people in the Sax Institute’s 45 and Up Study showing a link between sitting time and increased risk of premature death.

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A grab-bag of public health goodies

More evidence has emerged to show that negative, fear-based messages in public health don’t work. Even training doctors in communications skills doesn’t mean parents will be convinced to vaccinate their kids.

And in Belfast, a new public health campaign is rolling out coughing bus shelters to alert people to the early warning signs of lung cancer. Video games are emerging as a vehicle to communicate important health messages, and a good read in Vox contends that better journalism will lead to better public health.

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Other Croakey reading you may have missed this fortnight

The great articles from #ruralhealthconf are below and are also compiled at this link –

• How the arts-contributed “substance and soul” to #ruralhealthconf
• Is it time to rethink the possibilities for rural health?
• On the importance of place (and produce) for rural health
• What will it take to improve rural health? Internet, internet, internet…
• Profiling success stories and challenges at #ruralhealthconf
• #Ruralhealthconf kicks off with songs tweets and a call for fair care

You can read previous Health Wraps here. Got an idea for The Health Wrap? Contact me on Twitter @medicalmedia.

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.