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The Health Wrap: latest on monkeypox, global food crisis, gun control and tips for ageing well

After taking a break from The Health Wrap to provide indepth election coverage, Associate Professor Lesley Russell is back on deck with a wide-ranging overview of the latest health news – locally, nationally and globally.


Lesley Russell writes:

After the tensions and excitement of the election campaign, it’s nice to return to The Health Wrap. As I wrote in the Post-Election Wrap, I’m buoyed by new hope and new optimism, but also very cognisant of the hard work and deal making that lies ahead.

There will be plenty of analysis and commentary to come on the Albanese Government’s work on health and healthcare issues. Every constituency has a list of their priorities and hopes are high that the new Government will deliver. See the Croakey Health Media compilation of calls for action here and Dr Tim Woodruff’s memo to Minister Mark Butler and colleagues here.

Albanese and his Cabinet must now balance these expectations with the reality of the fiscal mess they have inherited and managing the consequences of the rising cost of living.

I expect the Albanese Government to focus on delivering on their election commitments, and maybe those areas (like mental health) where the Morrison Government has not spent the funds that were allocated in previous budgets.

While there will be all sorts of pressures to do more, I anticipate that budget repair will be a key focus and some of the big issues, like dental care, will be delayed until the second term of government (yes, they are already planning a second term).

Expect The Greens and the usual prominent stakeholders to push back on such decisions, but I think Albanese will deflect criticism by showing progress in key areas – for example, with efforts to address oral health in aged care and an extension of the National Partnership Agreements for Adult Public Dental Services for a further four years as first steps towards universal dental care.

The October budget should give us a better idea of what is planned.

You can stay in touch with Federal Ministers via this Twitter list; this list of cross benchers is being updated. Croakey will start a list of the Shadow Ministers when more details are available.


Monkeypox raises pandemic fears

On 1 June, the World Health Organization (WHO) said more than 550 confirmed cases of monkeypox had been reported from 30 countries where it does not typically occur, that this is likely to be an under-estimate and that more cases are expected to be found.

Cases have been reported from Australia, a number of European countries, the United Kingdom and the United States. The cases reported to the WHO as of May 29 are listed here.

Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to but less severe than smallpox, which is caused by a related virus.

The virus was first discovered in laboratory monkeys in 1958, and the first case in humans was identified in 1970.  Despite the name, scientists think rodents are the main carriers of monkeypox in the wild, and that it has been circulating in these animals for a very long time.

Typically, it does not lead to major outbreaks and until now there has been just a handful of cases outside Africa.

The virus is spread via body fluids, skin contact and respiratory droplets. The majority of cases this year have been in young men, many of whom self-identified as men who have sex with men.

However, the virus is not transmitted through sex per se; there’s no evidence, for example, that it is passed through semen or vaginal fluids. It’s the skin-to-skin contact experienced during sex that can lead to transmission if one of the partners has monkeypox lesions.

After more than two years of living through a pandemic, it is understandable that news of a new virus spreading across the globe could cause alarm.

Health experts say that monkeypox is unlikely to create a scenario similar to that of the coronavirus. But there is cause for concern as there are more opportunities for relatively rare pathogens to get into new communities, find new hosts and travel to new places.

The WHO stated last week that monkeypox constitutes a “moderate risk” to overall public health at global level.

Perhaps we should be most worried that the early warning signs for this disease spread went largely unheeded.

Nigeria experienced a sudden large monkeypox outbreak starting in 2017 that continues to this day. Scientists think that perhaps the eradication of smallpox in 1980 and the cessation of use of smallpox vaccine — which offers some protection against monkeypox — created an ecological void that this poxvirus filled.

This outbreak, which prior to this year has infected a handful of international travellers, should have served as notice that it was only a matter of time before this poxvirus spread.

This possibility was recognised in 2019, when the London-based think tank Chatham House convened a meeting to discuss the risks, but attention was soon diverted by the arrival of the coronavirus pandemic.

One of the reasons why experts are less worried about monkeypox is that several vaccines are already available to prevent its spread. These vaccines have been primarily developed against smallpox, amid fears that it could be used as part of biological warfare (after smallpox was eradicated, the WHO consolidated the remaining stocks of the virus to two labs in Russia and the United States).

The United States has begun releasing smallpox vaccine from the Strategic National Stockpile to protect high-risk people. As an aside, those of us old enough to have received smallpox inoculation may be somewhat better protected from monkeypox.

The WHO is saying there’s no immediate need for mass vaccination against the poxvirus, but case studies to date indicate that the antivirals currently available for treatment are not very effective.

It seems that pox viruses have low evolutionary rates. However, the monkeypox sequences associated with the recent cases differ by about 40 mutations from viruses sequenced four years ago.

Diagram shared by Professor Richard Neher on Twitter.
Diagram shared by Professor Richard Neher on Twitter.

More information is available in this WHO summary and in this recent article in The Conversation.

The WHO held a global consultation on monkeypox over the past few days. For more information, see this Croakey article from my colleague Alison Barrett.


Preparations for the next pandemic

It’s an obvious segue from discussing the surprising spread of a viral disease in countries where it has not previously been seen to concerns about the status of preparedness for the next pandemic.

It is now a year since the Independent Panel for Pandemic Preparedness and Response called for the urgent implementation of a transformative package of interventions to end the COVID-19 emergency and make it the last pandemic of such devastation.

The Panel has just released a one-year progress report, “Transforming or Tinkering?: Inaction Lays the Groundwork for Another Pandemic”. It finds that the world remains dangerously unprepared for the next pandemic threat.

The Lancet has an excellent summary of this report, here.

Also relevant is the recently released WHO White Paper “Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience”. This outlines the Director-General’s proposals for strengthening this architecture. It supports the creation of a Global Health Emergency Council under WHO auspices and some targeted amendments to existing International Health Regulations governing emergencies.

For some member states this approach is inadequate. The United States wants IHR amendments that would require more timely reporting of disease outbreaks and greater transparency.

These issues were up for discussion at the World Health Assembly meeting held May 22-28. Led by the United States, the WHA approved a complex process for updating the IHR, but this means needed amendments will not be brought forward until 2024. That’s excruciatingly slow,

In the United States the Centers for Disease Control and Prevention has established a “weather service” to forecast what is likely to happen next in this pandemic and in future infectious disease outbreaks.

The Center for Forecasting and Outbreak Analytics starts with US $200 million in funding, and expects to have a staff of 100, one third of whom will be devoted to communications. You can access its website here.

In Australia, in the wake of the election, it’s time to think about what the Australian version of a Centre for Disease Control (and Prevention?) – an election commitment from the Labor Government – might look like.  And where is the public health workforce that will operate such a centre?

See “Will Australia finally get a Centre for Disease Control? If so, how might it work?” from Alison Barrett in Croakey Heath Media, and also this recent report on global health governance by Jennifer Doggett.


A looming international food crisis

The war in Ukraine is having severe ramifications for food availability internationally.

Ukraine is one of the “food baskets” that supplies three-quarters of the world’s top food commodities and Russia’s invasion of the country has caused catastrophic disruption to international food supply chains.

Wheat prices have soared by 50 percent this year and this could see more than 1.4 billion people short of food. This was recently discussed in Geraldine Doogue’s Saturday Extra Program on ABC radio (you can listen to the program here).

Rabobank warned earlier this month that the war would keep grain and food prices artificially high for at least a year.

Consulting firm McKinsey says the ongoing impact of the war in Ukraine could the loss of 30 million tonnes of wheat and oil seed in 2022, with flow-on impacts across Africa and other food-fragile regions. For example, low-income, food-importing countries like Egypt and Lebanon buy 70 to 80 percent of their imported wheat from Russia and Ukraine.

In the Horn of Africa, which is experiencing the worst drought in more than forty years, millions of people are facing severe hunger. This year’s rainy season appears likely to be the driest on record, and the United Nations and humanitarian agencies have warned this will deepen a humanitarian emergency in Ethiopia, Somalia and parts of Kenya.

Australia is also one of the world’s food baskets and may be able to fill some of the supply gaps.

National lobby group Grain Producers Australia has launched the Grain4Ukraine appeal which calls on Australian farmers to donate grain and display the Ukrainian flag on farm machinery.

Every year Australia produces enough food to feed the population several times over, yet Foodbank’s 2021 report shows that one in six adults and 1.2 million children in Australia went hungry last year.

Food relief is not only being sought by those who are homeless and unemployed, but also by working families, refugees, single parents, school leavers, First Nations People and retirees. One in three of these people are new to the situation that sees them struggling to meet their food needs.

Last week The Age editorialised about the need for the new Labor Government to step up to address international food security issues, especially in the Pacific region, even as it must also tackle cost-of-living issues at home.

News articles this past week warn of continuing price rises on groceries that will eat into household budgets, with the war in Ukraine, fuel costs, labour shortages and weather disasters inflicting “unprecedented” havoc on Australia’s food supply chains.

Researchers at the University of Melbourne, in collaboration with a wide-ranging group of stakeholders, have developed a roadmap for tackling the problems of rising food prices and food insecurity in Melbourne. Its principles are applicable elsewhere in the nation.

In the United States, where more than ten percent of households experienced food insecurity at some time during 2021, the Biden Administration has just provided US$2 billion in new funding to strengthen food supply chains that have been hard hit by pandemic workforce shortages.

President Biden also announced that the White House will host a Conference on Hunger, Nutrition and Health in September. The Conference will focus on addressing five main issues: ending hunger, improving nutrition, improving physical activity, reducing diet-related illnesses, and closing disparity gaps by 2030.

A previous such conference, held under President Nixon in 1969, transformed American food and nutrition policies. It resulted in an expansion of the Supplemental Nutrition Assistance Program (SNAP) and the National School Lunch Program, as well as the establishment of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).


The gun debate in the United States

Last weekend was a long weekend in the United States to celebrate Memorial Day – a day for mourning the US military personnel who have died while serving in the nation’s armed services. It also marks the beginning of summer.

But this year the United States is mourning so much more than those who died in war: it is grieving over the latest carnage caused by school shootings and deeply divided over how to address this.

The degree of the problem is highlighted by the fact that even as the funerals of the 21 victims of the school shooting  in Uvalde, Texas were underway, gunfire continued to wreak havoc across the nation.

Since the Uvalde massacre on May 24, there have been 20  episodes in which four or more people have been shot. The victims include 16 children.

Shockingly, there’s a website that keeps track of such horrors, It has almost certainly been updated since I wrote this.

The trauma of school shootings impacts not just the families of those who die and the survivors, but the first responders and medical teams who are involved. The situation is made so much worse because the AR-15 assault rifle, which seem to be the weapon of choice, wrecks such havoc on children’s bodies.

I am often asked why the United States is so different in this regard to the rest of the developed world, and what can be done about it. I have no answers. But here are a few resources that might help in understanding what lies at the root of this issue.

Although gun control can be viewed as a public health issue, views about the right to own guns are deeply rooted in American history and culture. There are more guns in the US than there are people or cars. Most states allow guns to be carried openly and many do not require a permit.

The right to bear arms conferred by the second amendment to the Constitution has arguably been taken well beyond what the Founders intended when it was enacted (see this analysis in the Washington Post) and the paralysis over gun control stretches back to the divisions of the Civil War.

This is highlighted by the fact that Republicans, who consistently block any moves on gun control in the Senate, currently hold 18 of the 22 Senate seats from the 11 states of the old Confederacy.

In a nation where a segment of the population rejects any and all regulation of guns as an abridgment of freedom and another segment holds uncompromising anti-gun views, what can be done?

The Gun Policy in America initiative run by the Rand Corporation has been evaluating the available scientific evidence on the effects of gun laws on a wide range of outcomes, including homicides, suicides and mass shootings. (It’s worth noting that until last year, there was a 20-year freeze on federal funding for such research, for political reasons).

Child access prevention laws and background checks work, while “stand your ground” laws increase homicide deaths and there is no current evidence that banning assault weapons works.

And finally – a shocking piece of research shows that Americans are sad and angry about mass shootings for about four days. No wonder they are condemned to feel sad and angry so often!

Croakey recently published an article outlining why gun reform is so unlikely in the United States.

Bruce Wolpe, in an article for Ticker News says this: “Everywhere President Biden and members of Congress go, the shouts from the crowds are: ‘Do something!’ In Washington, this moral cause is governed by a raw political equation that has but one calculation: Will Senators Chris Murphy and Mitch McConnell agree on a gun control bill and urge Senators support it?”

Kentucky Senator McConnell has spent decades blocking gun control – he’s unlikely to yield now.


Ageing well means tackling prevention

The Albanese Government has renamed the Department of Health – it is now the Department of Health and Aged Care.  While this clearly reflects the stated intent to address the crisis in aged care, it somewhat disappointing to see that there is no stated focus on ageing (and doing this as well as possible).

A survey on what Australians think of ageing and aged care, commissioned by the Royal Commission into Aged Care Quality and Safety, found that almost all of those surveyed (people aged 70 and older) said they make lifestyle choices to keep themselves healthy. Most older Australians engage in a variety of activities including maintaining their health and exercising.

There is now so much evidence of what can contribute to physical and mental wellbeing in older people and help them to continue to live independent and enjoyable lives. The ten determinants identified for healthy ageing include physical activity, diet, self-awareness, outlook/attitude, life-long learning, faith, social support, financial security, community engagement, and independence.

It’s interesting that the focus in giving children a good healthy start in life is not echoed in giving older adults a good healthy-as-possible end to their lives.

Research published last month in Neurology shows that seven healthy habits and lifestyle factors may play a role in lowering the risk of dementia in people with the highest genetic risk.

The seven cardiovascular and brain health factors, known as the American Heart Association’s Life’s Simple 7, are: being active, eating better, losing weight, not smoking, maintaining a healthy blood pressure, controlling cholesterol, and reducing blood sugar levels.

It found for those Americans with European ancestry, the risk of dementia could be lowered by up to 43 percent. For African Americans, there was a 17 percent lower risk.

This study supports the idea that what is good for the heart is also good for the brain and that this holds true even when genetic risks are higher.

Falls are the leading cause of unintentional injury in older Australians. Nearly one in three older Australians have experienced a fall in the past 12 months and of these, one in five required hospitalisation.

Recent research from Macquarie University found that 36 percent of adverse events in nursing homes are due to falls.

The rate of head injuries for older Australians caused by falls has also doubled over the last decade, with head, hip and thigh injuries amongst the most common reports of falls-related medical emergencies.

Even when falls don’t cause an injury, they often trigger a loss of confidence in an older person and lead to an ongoing fear of falling. Over time, this can lead to the person limiting their movements and reducing their activity, which further increases the risk of falling.

Most falls, however, can be prevented and a person’s risk of injury can be reduced.

One systematic review showed that exercise reduced the rate of falls in community-dwelling older people by 21 percent, with greater effects seen from exercise programs that challenged balance and involved more than three hours per week of exercise.

Injury rates from falls have grown so significantly over the past 20 years in Australia that falls prevention must become a public health priority.

The National Falls Prevention for Older People Plan has not been updated since 2005.

In the 2018-19 budget, the Australian Government committed to developing a National Injury Prevention Strategy in recognition of the ongoing and substantial burden of injury in Australia and following the  expiration of the previous National Injury Prevention and Safety Promotion Action Plan (2004-2014).

Despite substantial work on this by the George Institute, the new strategy remains one of the many things left undone by the Morrison Government. The page on the Department of Health website has not been updated since June 2020.

The draft strategy that was released for consultation is here.

A final issue on healthy ageing – and one that links back to the issues around food insecurity – goes to the impact of food choices on life expectancy.

A recent paper in PLOS Medicine finds that sustained dietary change to healthier foods may deliver substantial health gains for people of all ages.

It is then dreadfully ironic that in searching for further Australian-specific information about this topic I came across a media release from the former Minister for Aged Care.  It urges senior Australians to eat well to boost their immunity to COVID-19 and overall health.

Let’s just hope the Albanese Government does a better job of delivering on these important issues.


In case you missed it

Physical therapy as a treatment option

Croakey Conference News Service recently worked with Exercise and Sports Science Australia to live tweet the sessions at their Research into Practice 2022 conference. There were some great examples of how physical activity is good medicine. See “The benefits are so profound, how can we get the health sector moving on this important intervention?”

A recent article (from the United States perspective – but very applicable here) is an interesting follow-on, especially given the discussions around the failure of Medicare to cover access to physical therapy programs: it asks “Is physical therapy a solution to the epidemic of unnecessary surgery?”.

The international impact of the US abortion debate

From the Public Health Association Australia: The potential global effects if Roe v Wade is over-turned.

Washington Post: The global stakes behind America’s abortion fight.

The Conversation: The end of Roe v. Wade would likely embolden global anti-abortion activists and politicians.

Chronic disease management in primary care during the pandemic

Medical Journal of Australia: The impact of COVID-19 on chronic disease management in primary care: lessons for Australia from the international experience

Healthcare workforce

Medical Journal of Australia: The 10-year anniversary of the Lost in the Labyrinth inquiry into registration processes and support for overseas-trained doctors: the good, the bad, and the ugly (sadly paywalled).

The Lost in the Labyrinth report from the House of Representatives Standing Committee on Health and Ageing is here.

These issues are particularly relevant given the Albanese Government has indicated that it will look to use overseas-trained health care workers to address the current workforce crisis.

Why did it take so long to develop a malaria vaccine?

MedScape:  It Took 35 Years to Get a Malaria Vaccine. Why?


The best of Croakey

During National Reconciliation Week, it was timely to celebrate the role of Aboriginal and Torres Strait Islander nurses and midwives in establishing Aboriginal Community Controlled Health Organisations and delivering comprehensive primary healthcare rooted in self-determination.

This article was published by Croakey Professional Services as sponsored content as part of a series celebrating the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives’ 25-year history of collective and individual activism. See the campaign portal.


The good news story

If you follow me on Twitter then you will know that I recently had a marvellous opportunity to spend some time in a remote Yolgnu community in North East Arnhem Land.  I fell in love with the country, the people, the culture and the art.

I’m also a big Aussie Rules fan.

So what better way to celebrate Reconciliation Week than to have Yolngu woman Sylvia Nulpinditj become the first woman to commentate an AFL match in her Yolgnu Matha language.

Read more here.


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.

 

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