Amid concerns about a global increase in sexually transmitted infections (STIs), experts are urging increased testing in Australia for infections such as gonorrhoea, syphilis, and HIV, according to the latest edition of The Health Wrap.
Dr Lesley Russell also provides a comprehensive update on COVID-19, including concerns about its spread at the Paris Olympics, and brings health policy news from the United States, United Kingdom, Mexico and Aotearoa/New Zealand.
Meanwhile, many public health agendas – from climate action to abortion rights and gun control – have another strong advocate at the United States elections, with Governor of Minnesota Tim Walz announced as running mate to the Democratic presidential candidate Kamala Harris.
Gymnast Simone Biles receives a special mention, for her political commentary, as well as her skill and courage.
The quotable?
There are still far too many non-Indigenous-operated service providers being funded to deliver to our people, and they are doing so without consideration for what we really need, without the knowledge of how interconnected so many aspects of our lives and culture are, and without the understanding of how our communities and people think and feel.”
Lesley Russell writes:
Greetings from the mountains of Colorado!
Our days here are busy: a hike in the morning (we start early), work in the afternoons (American politics is keeping me busy) and evenings spent watching the Olympics (US coverage is terrible).
This week our mountain views have been hazy due to smoke from some serious wildfires in Colorado. Most of these are not yet contained.
United States politics
The US presidential race and the issues surrounding it are inescapable – both here and in Australia.
What’s exciting and hopeful is the extent to which Kamala Harris’ emergence as the Democrats’ presidential candidate has energised the political scene.
What’s shocking is the extent to which Trump and the MAGA Republicans have invoked the same old memes of sexism, racism and conspiracy theories against Harris. These attacks deny the current American demographic, which is increasingly more diverse and multiracial and highlight the deep divisions in American society.
The 2024 presidential campaign is taking place amid intense debates over such topics as immigration, growing racial and ethnic diversity in the United States, the changing American family, crime and reproductive issues.
The Pew Research Center has outlined how voters from the two parties have starkly different opinions on these.
To date these issues, sometimes referred to as “culture wars” or “woke” issues, have been addressed by both parties with very broad, ideologically-based statements. There has been little reference to specific policies.
Given that healthcare costs are a top concern for voters, it’s worthwhile exploring what Harris and Trump are offering.
Much has been made of what the conservative Project 2025 would look to have Trump implement if he is re-elected. The chilling plans for the Department of Health and Human Services are outlined here, and summarised here.
Julie Rovner, who has covered health issues on Capitol Hill for decades, wrote this article in January about what a second Trump term would mean for health. It still has currency.
Trump has made much of the Right to Try program, which he signed into law in 2018 (the program, which creates a new regulatory pathway for drug companies to provide investigational drugs to patients suffering from life-threatening diseases, is outlined here). However, to date the program has been little used; in 2023 it was only used for four drugs.
Harris inherits Biden’s health agenda, and we can expect her to build on this.
Biden’s presidency was shaped by huge healthcare decisions, including:
- A COVID-19 response that brought mass vaccinations and scaled up testing
- Revival of the “cancer moonshot” he first spear-headed as vice president
- Steps to close the gender gaps in medical research
- Executive orders to protect abortion access after the Supreme Court overturned Roe v Wade
- Medicaid demonstration waivers to allow the states to expand coverage
- Allowing Medicare to negotiated drug prices and limiting the cost of insulin.
Despite Republican opposition, he has come closer than any president to the elusive goal of universal health coverage. In 2024, 92.3 percent of the US population, or 316 million people, have some form of insurance coverage.
But accessibility and affordability remain key issues for many Americans and much of the work of the Biden-Harris Administration will be undone if Trump wins in November.
Harris has spoken out about how her views on healthcare were shaped by her mother, cancer researcher Shyamala Gopalan, who died of colon cancer in 2009.
Her views on a variety of healthcare issues are outlined here:
- She has previously supported Medicare for All with a private insurance option.
- As the Attorney General of California, she focused on healthcare consolidation and clashed with major insurers, hospitals, and drug companies.
- Her record indicates she isn’t afraid to aggressively use anti-trust laws to keep companies from raising costs due to anti-competitive behaviour.
- She has cemented herself as the Democrats’ foremost advocate on abortion rights.
See also the summary in Croakey ICYMI, 25 July 2024.
Governor of Minnesota Tim Walz, who has just been announced as Harris’s running mate, has a strong record on many public health issues, reports STAT.
Also see: 55 Things to Know About Tim Walz, Kamala Harris’ Pick for VP, in Politico.
COVID-19 news
Last week my colleague Alison Barrett produced a great summary for Croakey of where things stand with COVID-19.
This may no longer be a pandemic, but the impact of the SARS-CoV-2 virus and its long term effects are far from over.
At this point I will plagiarise a tweet from Dr Sean Mullen, who lists a handful of studies that he thinks should convince you to take measures to prevent infection.
- A study in The Lancet of more than 16 million people demonstrating the risk of type 2 diabetes after COVID-19.
- A study in The New England Journal of Medicine that shows alarming accelerated cognitive decline in individuals infected with SARS-CoV-2, even after a recovery period.
- A study still in Preprint, using macaque monkeys, that reveals even mild and asymptomatic cases of COVID-19 can lead to brain inflammation and the formation of Lewy bodies (an indication for Parkinsons Disease) post infection.
- And a peer-reviewed study on rhesus monkeys which shows an increase in tau proteins (associated with a wide range of neuro-degenerative processes).
Note that Dr Mullen also includes a 2007 study on mice, which he says is essential for understanding the severity of coronavirus infections. My immunology expertise is not up to analysing this paper, so I have omitted it.
I would, however, add to the list of concerning consequences from SARS-CoV-2 infections a recent paper from The Lancet Psychiatry that links COVID-19 to long-term cognitive decline.
Others, with more knowledge in this area than I, may disagree with this list, but you have to admit – it’s thought-provoking!
These findings also provoke concerns about the long-term impacts of long COVID.
This week saw an article in The New England Journal of Medicine explaining how the new definition of long COVID was developed by the US National Academies of Sciences, Engineering, and Medicine.
One of the authors of that article produced a series of tweets about this new definition.
The Lancet also has a review of long COVID commissioned from Professor Trisha Greenhalgh and colleagues, as outlined in this X/Twitter thread.
COVID-19 and the Paris Olympic Games
Three years after the Tokyo Olympics were held amid strict precautions and without fans due to the global COVID-19 pandemic, the virus has once again forced athletes to withdraw from events at the Paris Olympic Games.
Who was surprised about that?
The International Olympic Committee is not releasing details about the numbers of people infected (no surprise there either) but there are reports more than 40 Australian Olympians have tested positive to COVID and other respiratory illnesses like influenza.
These include Australian swimmer Lani Pallister, who withdrew from the 1500m freestyle on July 30 after a positive COVID test.
But athletes who test positive are still allowed to compete in Paris (surprise!), so Pallister was part of the team that won gold in the 4×200 metre freestyle event on 1 August.
The IOC has said: “We have a protocol that any athlete that has tested positive has to wear a mask, and we remind everyone to follow best practices.”
There is little evidence of this (surprise again!).
The transmission of the virus in the athletes’ village and especially in the swim teams is likely due to poor ventilation, although some other theories are out there.
The 1 August edition of ICYMI from Croakey addressed several public health concerns at the Olympic Games, including the COVID-19 outbreak.
Closing the Gap report
Last month saw the release of the Productivity Commission’s annual data report on Closing the Gap.
I must confess that I have had little time to read this in detail, but it is important enough (and concerning enough) that I should make some note here of the findings.
Only five of the 19 measures monitored in the Productivity Commission’s report are considered to be on track to meet the 2030 targets. These are:
- Babies born at a healthy birthweight.
- The proportion of children enrolled in early childhood education.
- The proportion of people aged 25-64 who are employed.
- The proportion of land mass subject to Aboriginal and Torres Strait Islander people’s legal rights or interests.
- The proportion of sea area covered by Aboriginal and Torres Strait Islander people’s rights or interests.
Progress in some other areas has improved although not to the extent that 2030 targets will be met.
Most worrying are the key measures that are going backwards, including:
- The number of adults in prison.
- Suicide statistics.
- The number of children in out-of-home care.
The report highlights the gaps in data that are preventing a full assessment of progress towards Closing the Gap. For example, no data is available to track the proportion of Aboriginal and Torres Strait Islander women and children who have experienced family violence.
Since last year’s report, new data is only available for nine targets and parties to the National Agreement On Closing the Gap still cannot agree on an approach to measure priority areas.
“Holding governments accountable for change includes having the data to measure change – and there is still much we do not know,” said the Productivity Commission’s media release.
“For example, we still do not have a reliable source of data to assess whether Aboriginal and Torres Strait Islander communities have access to clean drinking water, sewerage treatment and electricity.
“Giving Aboriginal and Torres Strait Islander people the resources and authority to generate and control their own data in line with Indigenous Data Sovereignty principles will be a vital part of addressing these gaps.”
This year’s report provides insights into some of the factors that are crucial for improving outcomes and highlights the fact that there are pockets of good practice where outcomes were not just met but exceeded.
Coalition of Peaks co-convenor Catherine Liddle had additional insights: “There are still far too many non-Indigenous-operated service providers being funded to deliver to our people, and they are doing so without consideration for what we really need, without the knowledge of how interconnected so many aspects of our lives and culture are, and without the understanding of how our communities and people think and feel.”
The newly installed Minister for Indigenous Australians, Malarndirri McCarthy, has described some of the trends as “deeply troubling”. That is particularly true for incarceration rates.
In his address at the Garma Festival last week, Prime Minister Anthony Albanese promised economic empowerment for Indigenous Australians.
His remarks were welcomed by the Coalition of Peaks, but there is so much more that needs to be done. This includes improved housing and making good on the commitments for a broader suite of Indigenous rights reforms.
See also:
- The Guardian: ‘Deeply troubling’ trends found in first Closing the Gap report since voice referendum
- The Conversation: New Closing the Gap data shows more First Nations Australians are in prison. Why?
- ABC News: Timidity reigns as Anthony Albanese backs away from Makarrata at Garma Festival
- A compilation by SNAICC of news about the Productivity Commission report is here
- Croakey Health Media: As the Garma Festival begins, key groups send pointed messages to governments
- Croakey Health Media: The ZAP: latest health and aged care news, zinger quotes, and consultations not to miss.
Sexually transmitted diseases on the rise
A May 2024 report from the World Health Organization (WHO) highlighted that sexually transmitted infections (STIs) are increasing globally. The report states that four curable STIs – syphilis, gonorrhea, chlamydia, and trichomoniasis – cause more than one million infections daily.
In 2022, WHO member states set an ambitious target of reducing the annual number of adult syphilis infections by ten-fold by 2030, from 7.1 million to 0.71 million. But new syphilis cases among adults aged 15-49 years increased by over one million in 2022 reaching eight million.
“The rising incidence of syphilis raises major concerns,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. While there are the diagnostics and treatments needed to end this STI epidemic, he said the mechanisms to get them where they are needed are lacking.
The rise in STIs is not just confined to developing countries, although the situation is worst in Africa.
The United States is experiencing a rampant increase in syphilis, with over 203,000 cases reported in 2022 (the most recent national data available) – that’s the highest number reported since 1950.
Most disturbing within this trend is the rise in congenital syphilis (where the infection is transmitted from the mother to her unborn child). Over 3,700 cases were reported in 2022 and nearly 300 infected babies were stillborn or died in the first year of life. Because of systemic inequities, the Indigenous, Pacific Islander and Black communities are hardest hit – one in 155 Native American births was affected by congenital syphilis in 2022.
Australia is also affected. A recent article in The Guardian is headed, STIs surge across Australia while resistance to antibiotic treatments ‘increasing rapidly’.
The Kirby Institute’s latest annual surveillance report of sexually transmissible infections in Australia shows diagnoses of gonorrhoea have doubled from 2013 to 2022, while cases of syphilis have tripled.
Aboriginal and Torres Strait Islander people continue to be disproportionately represented in the syphilis notification data, with notification rates in June 2023 seven times that of non-Indigenous people over the previous 12 months.
Congenital syphilis is being diagnosed in Australia at a higher frequency than has been seen in two decades. For example, 35 babies in Queensland have been diagnosed with congenital syphilis since 2009, with 13 of them dying.
Spokesperson for the Royal College of Pathologists of Australasia (RCPA), Associate Professor Caitlin Keighley, says regular testing is crucial.
“The rise in STIs such as gonorrhoea, syphilis, and HIV is a pressing public health issue that requires immediate attention in Australia,” she said in a recent media statement.
“Despite a concerning rise in cases, we are not seeing a corresponding increase in testing rates. This includes older adults who may not be forthcoming about changes in their sexual practices. Low testing levels mean that infections can go undiagnosed and untreated, leading to severe health complications and further transmission…
“Regular testing is crucial to early detection, effective treatment, and preventing the spread of these infections.”
See also this recent Croakey article: Investigating solutions to a syphilis crisis – lessons from remote Australian communities and Thailand.
The Department of Health and Aged Care website has a page allocated to national strategies for bloodborne viruses and sexually transmitted infections.
The page was last updated in May 2023 and a number of important strategies need to be updated. This includes the Fourth National Sexually Transmissible Infections Strategy 2018–2022, the Fifth National Aboriginal and Torres Strait Islander Bloodborne Viruses and Sexually Transmissible Infections Strategy 2018–2022, and the National Blood-borne Viruses and Sexually Transmissible Infections Surveillance and Monitoring Plan 2018–2022.
Review of Medicare Health Assessment items
My Croakey colleague Charles Maskell-Knight alerted us in The Zap to the fact that the Department of Health and Aged Care is reviewing Medicare health assessment items.
There’s a fact sheet about these Medicare items here.
This review is (belatedly) in line with recommendations made in 2020 by the MBS Review Taskforce. My comments on the final report of the Taskforce are here.
I’ve long been critical of Medicare health assessments: they are not effectively targeted and are set up to ensure only that GPs get paid for an annual activity. There is nothing to ensure that problems discovered as part of a health check are addressed (ie there is no focus on prevention and early intervention).
You can read my 2010 critique of Indigenous health checks here. I know that something written 14 years ago should be history, but it seems little has improved since 2010.
Data from the Australian Institute of Health and Welfare shows that in 2021-2022, 23 percent of Indigenous Australians received a health check, but only 45 percent received a follow-up service in the 12 months following their health check.
A discussion paper prepared by the Department for the review is here. It seems to agree in large part with my criticisms. For example, it makes the following points:
- A 2023 systematic (literature) review by Bond University’s Institute for Evidence Based Healthcare indicated that there is little published evidence to demonstrate the impact of general, broad-based health assessments on overall patient health outcomes. (Note: I could not find this review on-line.)
- Analyses of MBS claims information from 2018-19 to 2022-23 suggests there is only modest patient and provider engagement with health assessment services, with limited uptake of health assessment services by current patient target groups and marginal repeat use of the services where available annually.
- There is significant scope to improve the operation of the MBS primary care arrangements to support preventative health and early intervention.
Health news from the United Kingdom
Many health policy wonks have been keenly watching what the new Labour Government in the United Kingdom is doing to restore the increasingly decimated National Health Service.
The Government’s election pledges for the NHS are here.
Already the Starmer Government has commissioned Lord Ara Darzi (who produced the 2008 NHS review High Quality Care for All) to conduct an independent investigation of NHS performance. The time frame for this review is short – just two months – and it is seen as “warts and all” diagnostic assessment.
- The Lancet: The UK Government’s mandate for change must prioritise transformation of the public’s health
- BMJ: Darzi 2.0: A full diagnostic assessment of the NHS may require uncomfortable investigations
The new Government must also deal with the first report from the UK COVID-19 Inquiry.
This comes with ten recommendations and a six-month timeline for a response and a plan of action. Read more in this recent Croakey article, Red teams may help to improve pandemic responses, and other lessons from abroad.
See: Starmer may fix the NHS, but wholesale change is needed in our Western societies for better health, by Professor Stephen Leeder, who makes this comment:
Health and illness are socially determined. It is at that level that change must occur and for which we must win community support for greater equity and sustainability – as we know full well from our search for a solution for that other great challenge of our time, global warming.”
In case you missed it
A quick round up of all the interesting, important and useful health information that has recently arrived in my email in-box.
Mental health reforms urgently needed
From Professor Ian Hickie and Dr Sebastian Rosenberg: Mental health reform: where are we in 2024?
Big changes in New Zealand health structures
New Zealand’s government sacked the entire board of Health New Zealand (Te Whatu Ora) last week, replacing it with a sole commissioner.
The Australian: Pervasive myth of centralisation unravels in NZ.
Andrew Little, who was the Minister for Health when Health NZ was formed in 2022, responds: Health NZ board sacked: Reform shouldn’t be this bad or hard.
Cancer patients need dental health reforms
Together with the oral and neck cancer team from the Chris O’Brien Lifehouse, I recently published this paper: This year sees an opportunity for long-needed oral health reforms. Cancer patients, in particular, stand to benefit.
Via Twitter/X, I also learned about this paper, making almost exactly the same case, for cancer patients in the United States: Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better.
This 2023 article from me in Inside Story is also relevant: The dental divide: Australian health policy doesn’t treat it that way, but dental care is a medical issue.
No improvements in aged care nutrition
A comprehensive survey of nutrition in Australian residential aged care has found that 40 percent of residents were malnourished, including six percent who were severely malnourished.
These findings likely underplay the extent of the problem as it did not include nursing home residents with dementia, who are known to be at high risk of malnutrition.
The Monash University media release on this publication is here.
Mexico’s bold new law on nutrition and sustainability
Mexico’s new Law on Adequate and Sustainable Nutrition is a major step in global food policy.
It combines the prevention of non-communicable diseases with sustainability and makes Mexico a leader in food system transformation.
See commentary on this law in The Lancet here.
Health literacy in Australia
MJA Insight: How can we improve health literacy in Australia?
Links between family incarceration and children’s health
Washington Post: Study examines link between family incarceration, children’s health. The original study is here.
Good news in Indigenous health
This animated video, with lyrics in both English and the Martu language (which is spoken by communities living in and around the Gibson and Great Sandy Desert area of Western Australia), aims to promote washing faces and ears and brushing teeth for children (and maybe their parents too). You can access the video and additional information here.
The best of Croakey
Register here to join a webinar on #BetterCare pathways for knee osteoarthritis – from 5-6pm AEST on Tuesday, 13 August.
Read more: Join us for a #CroakeyLIVE on better care for people with knee osteoarthritis
The good news story
Like many, I have been enjoying the television coverage of the Paris Olympic Games, and, like many, have been so admiring of the skill and courage of gymnast (and now multiple gold medal winner) Simone Biles.
She has overcome the mental health issues that struck her down during competition at the Tokyo Olympic Games in 2021 to return to stardom – and always with that amazing smile.
She is also a great team player and sportswoman, always with encouragement for both her team members and those who are her competitors.
So I nominate Simone as the good news story and I nominate this tweet from her as the best political commentary on the nastiness that has been part of the announcement of Kamala Harris as the Democrats’ presidential nominee.
I’m also including this tweet where Americans Simone Biles and Jordan Chiles bow to Rebeca Andrade as she wins gold in the women’s floor final in a great display of sportsmanship.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
