In this latest edition of The Health Wrap, Associate Professor Lesley Russell covers new reports on mental health, Indigenous oral health, and My Health Record, and also provides a timely preview of tomorrow’s debate at the National Press Club asking the question: Private Health: Who benefits?
The Health Wrap also puts some context around COP 25, the global climate change meeting now taking place in Madrid, as well as reporting on developments in obesity policy, housing affordability, and the impact of vaccine hesitancy, from Europe to Samoa. And don’t miss the beautiful music clip.
Lesley Russell writes:
As the end of the year approaches, it is hard to keep up with the rash of new reports. Here are some I noted, along with brief summaries.
And a note of caution to Aboriginal and Torres Strait Islander readers: this column ends with a video that may contain images and voices of deceased persons.
Mental health
You can access the Interim report from the Royal Commission into Victoria’s Mental Health System, a number of succinct summaries and a video of the briefing event for the report’s release here.
This interim report contains a number of priority recommendations, described as “[laying] the foundations for a new approach to mental health”, to address immediate needs.
The Royal Commission’s website states that the majority of the Commission’s recommendations for change will appear in its final report, due in October 2020: “The final report will present a bold and innovative approach for transforming Victoria’s mental health system.”
The final report should be a cracker, given that the interim report is groundbreaking, both in its assessment of the current situation for Victoria’s mental health system (“the system has reached a point where it simply cannot help those who turn to it – let alone those in crisis”) and in the recommendations it puts forward.
These include: a new approach to mental health investment (a tax or levy), to ensure a substantial increase in funding for mental health; and establishing a residential mental health service designed and delivered by people with lived experience of mental illness.
As it stands, the interim report sets high expectations and a high bar for action from the Victorian Government, and will be a standard against which the Productivity Commission’s final report will be measured.
My Croakey colleague Marie McInerney did a sterling job tweeting out the report and the briefing in real time, and then pulling all the news together for an article.
By the way: did you catch Dr Stephen King’s Grace Groom Memorial Oration, sponsored by Mental Health Australia?
King is the presiding Commissioner for the Productivity mental health inquiry, and the oration commemorates the legacy of a former CEO of the then Mental Health Council of Australia, Grace Groom.
Private healthcare costs
Professor Stephen Duckett and colleagues at the Grattan Institute have been very busy this year turning out a series of thoughtful analysis of health system problems and, importantly, recommendations for addressing them.
His communication efforts around these reports offer a great blueprint for those who work in policy areas on how to get the word out and have your research and publications discussed in the public arena.
The latest report – the first of two about Saving Private Health – looks at reining in hospital costs and specialist bills. It recognises a key problem when it comes to managing out-of-pocket costs in the private system – that patients have little power to negotiate.
So the recommendation is that egregious billing should be challenged by a more powerful entity – the private hospital. Private hospitals should issue a single bill for each patient, covering all the costs of treatment – including doctors’ costs – and the hospital should be responsible for informing the patient in advance of any extra costs they will face.
I’m not sure this went down too well with the specialist doctors, or with the private hospitals, but it is definitely worth a serious discussion.
The federal president of the Australian Medical Association (AMA), Dr Tony Bartone, tweeted:
I have to say, I thought this was a jumbled mix of at least three trains of thought!
You can read the AMA Private Health Insurance Report Card (issued October 2019) here. There’s lots of advice, probably only effective for the very health literate, and no recommendations for improvements to the value of private health insurance.
The Australian Private Hospitals Association chief executive Michael Roff said the proposal would place an administrative burden on private hospitals and make them “quasi-employers” of doctors, upping indemnity insurance with the costs passed on to patients.
Interestingly, the Private Healthcare Association said the report had some good ideas, including the recommendation to hand patients a single bill.
Here are some media articles about the report:
The Conversation: Greedy doctors make private health insurance more painful – here’s a way to end bill shock.
Financial Review: Greedy doctors blamed for spiralling health costs.
Meanwhile, Health Minister Greg Hunt is off doing his own thing, described in one media article as “shaking up private health insurance”.
He is “working on a plan” to enable health funds to cover specialist treatment delivered outside hospitals (for example in hospital-in-the-home and rehabilitation settings) at a lower cost, starting with mental health and orthopaedics.
This could be a good thing, but will it rein in premium costs, especially if everyone who could benefit from these services accesses them?
Follow @PressClubAust and #NPC on Twitter tomorrow to hear more on these matters, with a National Press Club debate featuring Duckett, Bartone and the industry’s Dr Rachel David on the topic, Private Health: Who benefits?
AMA report card on Indigenous oral health
I’m a frequent critic of the AMA, but one area where this organisation excels is in its oversight of and reports on Indigenous health (the AMA series of report cards is here).
This past week saw the release of an AMA Report Card on Indigenous oral health, written by Australian Healthcare and Hospitals Association staff.
Not surprisingly, the overall finding is that the state of oral health in Indigenous communities is unacceptable, with both adults and children having high levels of untreated tooth decay. Indigenous pre-school and primary school-aged children are more likely to be hospitalised for dental problems and are less likely to receive preventive care.
Of course one reason for this is that affordable dental services are just not available to many Indigenous people, and those that are seen to be culturally safe are even harder to find. Australia has fewer than 100 Aboriginal or Torres Strait Islander dental practitioners.
Meanwhile, as noted in the introduction to this Croakey article by Melanie Robinson, CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, the AMA has released a statement mourning the death of Kumanjayi Walker, and expresses its condolences to his family and to the Yuendumu community.
Climate news
Between now and December 13, the international community is gathering in Madrid for the 2019 UN Climate Change Conference, known as COP25 (read more about it at the official website, and via this analysis in the Guardian).
This comes on the heels of an exceptionally bleak report released on November 26 by the United Nations’ Environment Programme (as reported previously at Croakey).
The reports compares current rates of greenhouse gas emissions to the chief goals set by the 2015 Paris climate agreement: limiting an increase in global temperature to 1.5 degrees Celsius.
It warns that, at the current pace of greenhouse gas emissions, global temperatures will rise by as much as 3.9 degrees Celsius by 2100. Much greater efforts will now be needed to meet the Paris target.
A similar report from the World Meteorological Organisation finds that in 2018, emissions of carbon dioxide, methane, and nitrous oxide equalled or surpassed emissions in the previous year.
This led Mike Scrafton, formerly a Deputy Secretary in the Victorian Department of Sustainability and Environment, to write a piece in Pearls and Irritations stating “We’re screwed!”.
Tasmanian author Richard Flanagan was prompted to write an article for The Guardian titled “Scott Morrison and the big lie about climate change: does he think we’re that stupid?”
On November 28, the European Parliament voted 429 to 225 (with 19 abstentions) to adopt a climate emergency resolution.
I rather enjoyed hearing that France was putting the pressure on Australia to do more about addressing climate change targets if it wants to be part of a trade deal with the European Union.
In the US, the Fourth National Climate Assessment, produced by a team of 300 experts under the auspices of a 60-member Federal Advisory Committee, was suddenly released the day after Thanksgiving (thus guaranteeing it would be lost in the news).
Its Impacts, Risks and Adaption volume found that:
Climate change creates new risks and exacerbates existing vulnerabilities in communities across the United States, presenting growing challenges to human health and safety, quality of life, and the rate of economic growth.”
President Trump has dismissed the report, saying that “I don’t believe it”, and tweeting “Brutal and Extended Cold Blast could shatter ALL RECORDS – Whatever happened to Global Warming?”
From the European Union and the United Kingdom, to Samoa
The European Commission has recently published a series of reports that depict the profile of health systems in 30 countries.
The Country Health Profiles were issued with a Companion Report that shows some of the biggest trends in the transformation of the healthcare systems and draws key conclusions from the Profiles. You can access these reports through this summary page.
Here are some highlights from the Companion Report:
- Vaccine hesitancy is a major public health threat all across Europe.
- The digital transformation of health promotion and disease prevention can result in winners and losers. People who would most benefit from mobile health and other such digital tools may be the least likely to have easy access to it.
- Gaps in health care accessibility are still very much a reality in the EU. Both the clinical needs and socioeconomic characteristics of patients need to be accounted for when measuring access to health care and its many barriers.
- Skill mix innovations among the health workforce show great potential for increasing the resilience of health systems. Promising examples of task shifting among health workers are found across the EU, particularly when it comes to enhancing the role of nurses and pharmacists.
It’s interesting to read this report in conjunction with an article in the British Medical Journal that looks at the performance of the United Kingdom’s National Health Service compared with nine other high-income countries (including Australia and the United States).
The report looks at 79 indicators across seven domains – population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health.
The NHS has been under sustained financial pressure with cuts to health and social services in the face of increasing levels of demand – arguably a similar situation is increasingly the case in Australia.
Although the UK spent the least per capita on healthcare in 2017, health service outcomes were good, but patient safety and population health were average or below average.
The report finds that in order to achieve health outcomes comparable to those of the other countries considered, at a time of growing demographic pressure, the UK must spend more to reduce the declining trend in social spending and increase the workforce supply and the provision of long-term care. Sound familiar?
The Australian data in this study that stood out for me were those around hospital care. Australian all-cause hospital discharges were up over the period 2010-2017, whereas in most countries this was down. This is presumably due in part to the fact that Australia has higher than average avoidable hospital admissions for diabetes and Chronic Obstructive Pulmonary Disease, highlighting the need for better management of these chronic diseases.
Meanwhile, in a reminder of the public health threat posed by vaccine hesitancy, the World Health Organization is blaming a deadly outbreak of measles in Samoa on an anti-vaccine messaging campaign, reports Agence France-Press and The Guardian. 
Audit report on My Health Record implementation
The Australian National Audit Office recently released its report into the effectiveness of the implementation of the My Health Record (MHR) by the Australian Digital Health Agency (ADHA) and the Department of Health.
Despite controversies that have continually surrounded MHR (to prototype of which was first introduced in 2012), the ANAO basically gave the recent implementation over the opt-out period a clean bill of health.
It found that implementation planning for and delivery of MHR under the opt-out model was appropriate and “largely effective” in achieving its objectives. But security risk management for the expansion program was found to be only “partially appropriate”.
The ADHA has not undertaken an end-to-end privacy risk assessment of the ongoing operation of the My Health Record system under the current model.
COAG National Obesity Strategy
Everyone who works in public health and worries about our growing rates of obesity and the associated costs ($12 billion or more every year) has been cheered by the announcement of a COAG commitment to develop a ten-year National Obesity Strategy.
Excitement is tempered by the fact that this is in its early stages of development and by the fact that we rarely hear Health Minister Greg Hunt (or the Prime Minister or the Treasurer) talk about this, so their level of commitment needs work.
A range of ideas and options have been developed and are available in the Consultation Paper. These are based on information gathered from two evidence reviews (Population level strategies support healthy weight and Addressing social commercial determinants healthy weight), and the outcomes of the Senate Select Committee Inquiry into the Obesity Epidemic (2018) and a National Obesity Summit in 2019.
They include warning labels on junk food, banning supermarkets from discounting chips and sweets, removing advertisements for unhealthy snacks from buses, and forcing manufacturers to reduce the of sugar, fat and salt in processed foods.
The paper also raises the possibility of government subsidies for fruit, vegetables and water, and a controversial volumetric alcohol tax. You can read more here.
A community consultation process is underway but closes it on December 15. If you haven’t had your say, please do so.
We can be certain that the food and drink companies likely to be most affected are not holding back. My Twitter feed has been full of promoted tweets from the largest beverage companies announcing that they have reduced sugar by seven percent. This is part of a commitment from the non-alcoholic beverage industry (made in June 2018 with the support of the Minister for Health) to reduce sugar across the industry by 20 percent by 2025. It’s also part of their commitment to have self-regulation rather than the law govern their products.
Expect to see much more of this! And note that reducing sugar in beverages will have dental benefits too.
Housing and homelessness
I’ve just discovered that Oliver Frankel and Susan Ryan compile a monthly digest in housing affordability and homelessness. The latest edition was published on John Menadue’s blog Pearls and Irritations on 29 November and covers a wide range of issues, including micro-houses and “meanwhile use” properties.
On related matters, I appreciated this essay from David Pearson on how, in order to end homelessness, we must change the way we think about the problem.
At the heart of his case is this financial analysis:
One Australian study demonstrated that over a 12-month period, the cost to state government services alone for a person who was chronically homeless was approximately $48,217.
However, if the same person was provided permanent supported housing, they would use $13,100 less in government-funded services per year.
So it actually saves (taxpayers) money to house the homeless rather than leaving them on the streets.”
The good news story
This is not so much a good news story as a lovely, rather sad, story with a great music video.
I found this article in The Mandarin, about How Indigenous songs recount deep histories of trade between Australia and Southeast Asia. It tells how, in 1983, the prolific Yolngu educator and musician, the late Mandawuy Yunupiŋu, composed his first ever popular song, Djapana: Sunset Dreaming (a song of homesickness for land and family).
And there is the most wonderful video of Yothu Yindi, on tour in the US, singing this song in a snowstorm. You can watch it (and watch it and watch it) here, and also below.
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.
