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The Health Wrap: learning to swim, why children in some countries are getting shorter, the new variant, climate questions – and seasons greetings

Will the Albanese Government step up and do something meaningful to ensure affordable access to dental care for all Australians?

What might the new COVID variant mean for the festive season?

And why are children in Britain shorter than children in other countries in Europe?

These and other important public health questions are raised below by Adjunct Associate Professor Lesley Russell.

The quotable?

The Lowitja Journal recognises that structured knowledge systems of First Nations peoples, developed over millennia to underpin thriving and healthy communities, offer solutions to the survival and flourishing of First Nations peoples, and for the world.”


Lesley Russell writes:

The information roll-out around the ongoing pandemic and its consequences continues apace.

A recent paper in The Lancet Infectious Diseases has caught the attention of many who work in the COVID-19 area.

This research used the large data system collected by the US Department of Veterans Affairs to look at the long-term consequences for patients admitted to hospital for COVID-19 (between 1 March, 2020 and 30 June, 2022) and patients admitted to hospital for seasonal influenza.

It found that hospital admission for COVID-19 was associated with higher long-term risks of death and adverse health outcomes in nearly every organ system (except for the pulmonary system) and significant cumulative excess Disability-Adjusted Life Years (DALYs) than hospital admission for seasonal influenza.

The authors note that both viruses cause a substantial cumulative burden of health loss and they call for greater efforts to prevent hospital admission and greater attention to the care needs of people with long-term health effects due to either seasonal influenza or SARS-CoV-2 infection.New SARS-CoV-2 variants

Just in time for winter in the Northern Hemisphere, a new SARS-CoV-2 variant, JN.1, is on the rise.

An Omicron subvariant, JN.1 was first detected in the United States in September and is termed “a notable descendent lineage” of the Omicron subvariant BA.2.86 (also known as Pirola) by the World Health Organization (there’s a useful WHO table to track these subvariants here).

While wastewater monitoring shows a rapid rise in JN-1 in the United States, it is currently reported more often in Europe (see for example this report from Italy), but that might be a function of which countries have better reporting systems.

See more information from the WHO.The US Centers for Disease Control and Prevention has indicated that the continued growth of JN.1 infections suggests that the variant is either more transmissible or better at evading our immune systems than its BA.2.86 parent.

Do we have any idea who is tracking new variants in Australia?

Here’s what the website of the Communicable Diseases Genomic Network says:

“The CDGN VOC Working Group is responsible for ongoing monitoring and surveillance of SARS-CoV-2 variants literature and global events to inform Australia’s national approach in detecting and reporting of Variants of Concern (VOC), Variants of Interest (VOI) and Variants Under Monitoring (VUM), and mutations of interest reported in the literature. The working group is comprised of laboratory and government representatives with expertise in bioinformatics, genomic epidemiology, viral evolution, phylodynamics and medical microbiology.”

But there’s no mention of JN.1 and – apart from one mention dated August 2023 – it doesn’t appear that this website has been substantially updated since 2022.

The good news is that research suggests that the new COVID-19 vaccines formulated to target Omicron variant XBB. 1.5 appear to work against this newest variant.

Where are the patient supports for long COVID?

The Royal Australasian College of Physicians (RACP) has spoken out about concerns that patients with long COVID in Australia are being left without necessary support and treatment options.

The cessation of COVID-19-specific funding by Federal and State and Territory Governments has led to the closure of a number of long COVID clinics. According to an ABC investigation, at least five of 23 long COVID clinics have now closed or scaled back operations.

This news comes despite the call from the recent Parliamentary report on long COVID for – among other recommendations – that “funding be provided in partnership with state health departments for selected public hospitals to develop multidisciplinary long COVID clinics linked to nationally consistent referral guidelines for screening patients with challenging long COVID complications”.

That report also called for “a nationally coordinated research program, led by the Department of Health and Aged Care (preferably the Centre for Disease Control), to coordinate and fund COVID-19 and long COVID research”.

To date there has been no Federal Government response to the report.

See Governments urged to end the neglect of long COVID prevention and treatment published in Croakey Health Media.

Posted on 14 December, 2023

Moreover, as far as I can determine, none of the $50 million provided for long-COVID research at the time the report was released has gone out. Grant opportunities were announced in September and applications closed 1 November.

Note that on 20 December the terms will expire for all but one of the members of the advisory committee set up to provide input to the Health Minister on how this $50 million will be spent.

Clarification on who is eligible for new vaccine boosters

There has been a lot of confusion about the Australian recommendations for who should get the new COVID-19 vaccines. The Department of Health and Aged Care (DoHAC) has finally issued some clear advice, clearly presented.


Mistrust of vaccines

One of the lingering consequences of Donald Trump’s presidency is an increased suspicion of vaccines that is not just confined to the United States, where extreme anti-vaccine sentiment is consuming the MAGA base of the Republican party.

See also this article in The Sydney Morning Herald that quotes Professor Julie Leask on Australian anti-vaccine sentiments towards the COVID-19 vaccines.

Now data from the National Centre for Immunisation Research and Surveillance shows that Australia’s child vaccination rates have fallen for a second year, due to what experts ascribe to “lingering mistrust” – and also to the effects of the pandemic and the increasing difficulty in getting affordable access to primary care.

The proportion of Australian five-year-olds fully vaccinated with routine inoculations – including for polio, measles and hepatitis B – has fallen 1.4 per cent, from a peak of 94.8 per cent in 2020, to 93.4 per cent in 2022, with a continued decline in the first half of 2023. Declines in fully vaccinated coverage in Aboriginal and Torres Strait Islander children were greater than in children overall.

It’s not just early childhood vaccinations. In the past two years, the proportion of 15-year-old Australian girls and boys who had received at least one dose of the human papillomavirus (HPV) vaccine by their 15th birthday also slipped 1.3 per cent and 1.8 per cent respectively, to 85.3 per cent and 83.1 per cent.

Missed or delayed vaccinations have become persistent issues, posing ongoing challenges in safeguarding children against preventable diseases, UNICEF Australia said.

You can read more here.

It should be noted that vaccination rates for zoster (shingles), pneumococcal and influenza in older Australians increased over the time frames of the NCIRS report – undermining somewhat the arguments about the impact of affordable access to GPs.


Food security, nutrition and health

Last month the House of Representatives Standing Committee on Agriculture’s inquiry into food security released its report, Australian Food Story: Feeding Australia and beyond.

My reading of this report is that the focus is primarily on the ongoing viability of the agricultural industry; there are however some recommendations that relate to health and nutrition.

These are the key issues:

Recommendation 31: That the Australian Government, in conjunction with the State and Territory Governments, consider the feasibility of introducing a schools meals program.

Recommendation 32: That the Australian Government develops protocols that allow the Australian Research Council and the National Health and Medical Research Council to cross-fund research examining food, health and nutrition.

Recommendation 33: That as part of the development of a National Food Plan, the Australian Government facilitate the development of:

– Improved nutritional and dietary guidance.

– Community projects designed to improve localised food systems and food security.

– Supply networks aimed at local production, procurement, distribution and sale of fresh and nutritious food, especially by institutions such as hospitals, aged care facilities and schools.

– Programs aimed to educate groups within communities about affordable options to access (or grow), prepare, cook and share nutritious food.

Recommendation 34: That as part of the development of a National Food Plan, the Australian Government:

– Recognises the special circumstances of remote communities, including Indigenous communities, in the food supply chain.

– Makes provision for a more decentralised model of distribution in regions containing remote communities.

– Acknowledges community stores as an essential community service.

– Provides subsidies for community stores in remote locations so they can provide fresh food in regular quantities ar an affordable price.

– Amends the funding and governance of the Remote Air Services Subsidy Scheme to prioritise the efficient and affordable delivery of fresh fruit and vegetables to wet season impacted communities.

Recommendation 35: That the Australian Government assess progress towards implementing the recommendations made in the House of Representatives Standing Committee on Indigenous Affairs 2020 report on food pricing and food security in remote Indigenous communities.

A raft of recent reports highlight the need for a better focus on the affordability and availability of nutritious food. In a rich, first-world country, too many Australians do not have good nutrition and this shows up in the increasing toll of chronic conditions such as heart disease, diabetes and dental caries.

The Australian Bureau of Statistics National Health Survey Report 2021-2022 released this month has what the Food for Health Alliance calls “shocking diet data” that calls for urgent government action.

The survey shows that almost two-thirds of adults (65.8 percent) and more than a quarter of children (27.7 percent) are overweight or obese.

This brings into question the extent of the effective implementation of the National Obesity Strategy 2022-2032.

There is also an important role here for the National Preventive Health Strategy 2021-2030 and the soon-to-be established Australian Centre for Disease Control.

Meanwhile the prices of foods have been steadily climbing over the past few years, and as we approach the Christmas – New Year holiday season, there are lots of media stories about the cost of summer foods.

The impacts of climate change, like the current floods being experienced in Queensland, will only serve to increase food prices and make food shortages more frequent with impacts on agricultural production and the disruption of supply chains.

See the March 2022 report from Farmers for Climate Action here.


Climate and health updates

The above segment is the perfect segue into an update on climate change and health.

The new National Health and Climate Strategy has been widely welcomed by Australia’s health community, but concerns have been raised that it lacks key details about its implementation and – critically – lacks funding.

See these recent Croakey Health Media articles:

It seems to me that there are two critical issues for the strategy’s success – the phase-out of fossil fuels and the ability to take a whole-of-government, Health in All Policies approach, where climate and health leadership is supported throughout all Commonwealth policy planning.

Public Health Research and Practice has published a Climate Change Inequality Health Impact Assessment framework for health services to assess and address the unequal impacts of climate change on vulnerable and marginalised populations.

A recent editorial in The Medical Journal of Australia highlights the magnitude of the task ahead.


Why learning to swim is essential – and a reminder that it is fun

It’s been very hot in Sydney and people have been flocking to the beach, raising concerns about the increased number of drownings and near drownings.

Earlier this year Surf Life Saving Australia revealed NSW lifesavers conducted 1,200 rescues in a single week over the 2023 New Year holiday period as big crowds flocked to beaches – and that only tallied the people rescued in or near patrolled beaches.

Sydney’s the Northern Beaches have been labelled a “coastal black spot” for the second year running.

The National Drowning Report 2023 released earlier this year analysed fatal drownings across Australia between 1 July 2022 and 30 June 2023. During this time, 281 people lost their lives to drowning and many more were affected by non-fatal drowning injuries.

Most of these deaths (77 percent) were males and 2023 saw a spike in this demographic drowning while attempting a rescue. Drowning deaths in people aged over 65 represented 27 percent of fatal drownings in 2022-2023 and has shown a 43 percent increase in the past 20 years.

A report from the Australian Institute of Health and Welfare shows that, in 2021–22, Indigenous Australians were 1.2 times as likely to be hospitalised due to a drowning and submersion injury.

A 2022 study from the University of New South Wales has found that nearly half of the people who drown on Australia’s beaches are migrants. The study found that 47 percent of drowning deaths in Australia in the past 15 years were among people born overseas, and Indian migrants account for the largest proportion of that number.

As I was thinking about this issue – why isn’t learning to swim something taught at every school? – The Sydney Morning Herald published a heart-wrenching article about the lives of the families where a member didn’t fatally drown or miraculously survive but experienced what experts call a non-fatal drowning.

Royal LifeSaving Australia estimates there are an average of 492 cases of non-fatal drowning each year and some of these people are left permanently damaged. These victims are largely unseen and unheard.

The World Conference on Drowning Prevention was held earlier this month in Perth. A report from this conference via @WePublicHealth reminded us that learning to swim is not just about safety – it is also about the joy of “dancing in the water”.


British children are getting shorter

A recent paper published in The Lancet shows that British five-year-olds are up to seven centimetres shorter than children of the same age in Europe.

Children in Italy, Spain, France and Sweden are all much taller at age five, on average, than UK youngsters of the same age. The average height in Britain has stayed the same since the mid-1980s, whereas children in other countries, especially in Eastern Europe, have grown taller in the decades since.

Some experts are suggesting nutrition – and especially a lack of quality food – could be stunting the growth of children in the UK.

But there is also a policy that restricts benefits so that parents can only claim support for two children and this has been a key driver of child poverty in England and Wales, where a majority of children who have two or more siblings go hungry several times a month. The policy does not apply in Scotland and Northern Ireland, which are now the two places in the UK where child poverty rates are lowest.

You can read more here.
From The Living Standards Outlook 2023

The recently developed framework to measure and track the health and wellbeing of children and young people in Australia will hopefully prevent such a shockingly disparate situation from arising here (read more about this initiative at Croakey Health Media: New push to hold power to account for the health and wellbeing of children and young people).


Senate report on access to dental services

The Senate Select Committee into the Provision of and Access to Dental Services in Australia handed down its report last month. I’m not aware of any comments from the Minister for Health, Mark Butler, in relation to this.

As far as I can determine, the last time Butler mentioned dental care was a year ago, in December 2022, when he announced that the Child Dental Benefits Schedule (CDBS) would be funded for a further four years.

Ironically, the Senate Select Committee report finds children from priority groups – Aboriginal and Torres Strait Islander children, children living in rural and remote areas of Australia, and disabled children – experience significant barriers accessing appropriate dental services under the CDBS. The scheme is also under-utilised, for reasons that have not been explored.

The fifth review of the CBDS opened in 2022 and a report was submitted to the Minister in March 2023. It found that “broadly, the Act is achieving its aim of providing a legislative framework for paying dental benefits and supporting the administration of the CDBS”.

It noted that “although the program has been operating for nine years, uptake of the CDBS has not reached desired levels and remains below 40 percent. Furthermore, the review identified marked inequities experienced by children from priority groups – children living in rural and remote locations, First Nations children, and children with disability – and the significant barriers they face in accessing appropriate services under the CDBS”.

The Review Committee provided 21 recommendations to improve access to and utilisation of the CDBS and implement targeted strategies for vulnerable cohorts but I have not been able to find any government response to the report.

The four-year funding commitment, made without program changes ahead of the report from the review suggests that nothing further will happen in the foreseeable future.

My Croakey colleague Charles Maskell-Knight sees the Senate inquiry as a lost opportunity to deliver a set of actionable recommendations to provide affordable access to dental care for all Australians. Sadly, I must agree.

Will this report join the growing pile in the Department of Health and Aged Care basement, or will the Albanese Government step up and actually do something meaningful?

In recent weeks I have contributed to two SBS programs highlighting the need for dental reforms.


Other updates

COP28

The Lancet characterises Health Day at COP28 as a “hard-won (partial) gain”.

Julia Gillard’s speech on climate and health at COP28 (given in her role as Chair of the Wellcome Trust) is here.

Read Michael Jacobs report’s from COP28 for Inside Story Magazine here and here.

Health reform funding

National health reform – what’s beneath the hood?  A must read from Charles Maskell-Knight.

The Independent Health and Aged Care Pricing Authority has published the Pricing Framework for Australian Hospital Services 2024-2025 along with the consultation report.

Life expectancy in the United States

US Life Expectancy Creeps Up as Covid Deaths Fall.

But the country’s health has not fully rebounded from the pandemic, according to new data from the CDC.

Life Expectancy Finally Increased: Why That’s Not Really a Cause for Celebration.  The virus is still winning,

The Life-and-Death Cost of Conservative Power

New research shows widening gaps between red and blue states in life expectancy.

Abortion ramps up as a political issue in the United States

The Supreme Court’s decision to eliminate the constitutional right to abortion in Dobbs v Jackson Women’s Health Organization, which left the question of abortion access to the states, has resulted in mass confusion and chilling effects for both medical providers and patients seeking care.

The appalling case in Texas – Kate Cox’s Texas abortion: the lie at the heart of overturning Roe v Wade is now in plain sight.

The US Supreme Court has now confirmed it will review the controversial case Alliance for Hippocratic Medicine v Food and Drug Administration (FDA), which concerns potential restrictions on the use and availability of mifepristone in America and that first arose from litigation in Texas. Mifepristone is the first medicine in a two-step regimen approved for medication abortion care in the United States. Medication abortion is the most common form of abortion care in the United States. The use of medication abortion through telehealth has not surged since the Dobbs decision and prevented the crisis from worsening.

You can read more here.


Best of Croakey

As the year draws to a close and we reflect on what has been achieved, and what needs more work, I hope you will spare time to ponder how important and useful Croakey has been in your work and ideas and conversations.

This is the best of public interest journalism. If you can, please consider a contribution to keep Croakey growing and thriving and coming to you with all the news in 2024.


Indigenous health good news story

Many congratulations to the Lowitja Institute on the launch of First Nations Health and Wellbeing – the Lowitja Journal.

To quote from the first editorial:

The Lowitja Journal recognises that structured knowledge systems of First Nations peoples, developed over millennia to underpin thriving and healthy communities, offer solutions to the survival and flourishing of First Nations peoples, and for the world.”


The good news story

The good news story this week is also an Indigenous story – it’s so wonderful to be able to report good news like this.

The extinct language Kalkutungu from the Kalkadun lands around Mt Isa has been revived, thanks to the efforts of ninety-four-year-old Uncle Cecil Moonlight (the last living fluent speaker of the Kalkutungu language), several linguists, and Kalkutungu peoples who have worked across decades.

This is the first officially extinct language to be revived and now it will be taught in schools in the area.

“You can’t have culture without language. It is beyond words how powerful, emotional and spiritual it is to be able to use our language again,” Kalkuntungu man William Blackley said.

You can read more here.

And here is a video of Kalkadun woman Sheree Blackley talking about the language revival.


Best wishes

Even for those of us sitting on the sidelines this has been a tough year politically around the world, so I’m grateful that my personal life has been happily filled with friends and family, lots of work, some great travel and amazing hikes, great books to be read, and good health.

I hope you can say the same and I send you my best wishes for the holiday season and the New Year ahead.

My friend Sean Kelly summed up the politics pretty well in this article for The Monthly – What Kind of Year Has it Been?

And this photo – taken after a climb to the top of Black Powder Pass in the Colorado Rockies – sums up the rest.


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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