In the latest edition of The Health Wrap, Associate Professor Lesley Russell puts together a compilation of pieces looking back over the past year globally and reports on its impact on happiness.
She also takes a look at Men’s Sheds, the recent World Health Organization (WHO) report on healthy ageing and ageism and the Productivity Commission’s report on of innovations in care for chronic health conditions.
Lesley Russell writes:
As we have passed the anniversaries of when the coronavirus pandemic was declared and when Australia first went into lockdown, we have been looking back at what we have learnt over the past year.
It’s a task made more poignant as we see the possibility of the relief that vaccinations can provide — if only we can get the roll-out to run smoothly and overcome a sizeable degree of vaccine hesitancy — and also the dangers posed by the emergence of new variants and the out-of-control situations in countries like Brazil, France and India.
Here’s a selection of review articles I have come across, encompassing what we have learnt in science, epidemiology, public health and about community and personal attitudes and behaviours.
- What we learned from tracking every COVID policy in the world. Thomas Hale, Croakey, 26 March 2021.
- Diving into 2021: Lessons from lockdown. ABC News, 20 December, 2020.
- What have we learnt so far from COVID-19? Professor Peter Doherty, Nature Reviews Immunology, 13 January 2021.
- What Can We Learn from Australia’s Covid-19 Response? Dr William Haseltine, Forbes, 24 March 2021.
- First Nations leadership during the COVID-19 crisis. Reconciliation Australia, 28 October 2021.
- The pandemic and Indigenous communities, locally and globally. Alison Barrett’s COVID-19 Wrap, Croakey, 17 March 2021.
- Indigenous leadership in pandemic delivers a blueprint to Close the Croakey, 19 March 2021.
- What I’ve Learned from the Pandemic Year. Wall Street Journal, March 20, 2021. A selection of essays from leaders in business, politics, science and the arts.
- COVID-19 reflections: the lessons learnt from the pandemic. Imperial College London News, 3 February 2021.
- 15 Lessons the Coronavirus Pandemic Has Taught Us. American Association of Retired Persons, 4 March 2021.
- One year on since lockdown began—our lives have changed but what lessons have we learned? BMJOpinion, 23 March 2021.
- Covid-19: Underfunding of health workforce left many European nations vulnerable, says commission. British Medical Journal, 16 March 2021. This article refers to the recent report, Rethinking policy priorities in the light of pandemics: a call to action, from the Pan-European Commission on Health and Sustainable Development.
- Dismantling the Anti-Vaxx Industry. Nature Medicine, 15 March 2021.
Healthy ageing and ageism
Last year the World Health Organisation launched the Decade of Healthy Ageing (2021–2030) with the aim of ensuring that older people (there are more than one billion people over 60 years of age in the world) can fulfil their potential in dignity and equality and in a healthy environment.
There are four action areas:
- Age-friendly environments
- Combatting ageism
- Integrated care
- Long-term care
And also four enablers:
- Voice and engagement
- Leadership and capacity building
- Connecting stakeholders
- Strengthening research, data and innovation
You can read the Action Plan – endorsed by World Health Assembly in August 2020 – here.
On 18 March 2021 the Global Report on Ageism was launched by WHO, the Office of the UN High Commissioner for Human Rights, the UN Department of Economic and Social Affairs, and the UN Population Fund.
Ageism is seen as an important social determinant of health that has been largely neglected until now. Like all forms of discrimination, ageism generates divisions and hierarchies in society and influences social position.
Ageism impacts all aspects of older people’s health. It shortens lifespan, worsens physical and mental health, hinders recovery from disability, and accelerates cognitive decline. It also exacerbates social isolation and loneliness and reduces access to employment, education, and healthcare.
In the pandemic the vulnerability of older people has been highlighted: it has taken the lives of many older people, and exposed ageism in different settings. This includes discrimination in access to health care and inadequate protection of older people in nursing homes.
The report highlights that ageism is institutional, interpersonal, or self-directed and summarises the best evidence on the scale, impacts, and determinants of ageism and the most effective strategies to address ageism.
However the report also highlights the inadequacy of the data, in particular the disproportionate focus on high-income countries and on ageism against older rather than younger people.
Because yes, young people can also experience ageism. It manifests itself most markedly once they are employed, especially in terms of pay and benefits (particularly for young women). Younger workers also report not feeling valued, being subject to negative age stereotypes, belittling comments, and being perceived as incompetent because they look young.
The evidence reviewed finds three strategies that are effective in reducing ageism:
- Policy and law can address discrimination and inequality on the basis of age and protect human rights.
- Education can correct misconceptions, provide accurate information, and counter stereotypes.
- Intergenerational contact interventions are seen as most effective and also have a role in combating ageism against younger people.
What is Australia doing on this front?
My assessment is not much.
Part of the problem probably lies with inadequate data: the data on the Australian Institute of Health and Welfare website are very out-of-date, with virtually nothing from after 2016.
But inherently I think it’s a matter of culture (ageism) and the Commonwealth Government is focused solely (and arguably not very effectively) on aged care, as the Department of Health website highlights.
I did find this commissioned report Healthy ageing: developmental research report published June 2019 but no evidence that anything has been done with it.
There was once a National Strategy for an Ageing Australia, released in 2001 by the Howard Government, but as far as I can tell this has never been updated. I think this paper, Promoting Healthy Ageing in Australia, prepared by the Prime Minister’s Science, Engineering and Innovation Council (strangely found on the Royal Australian and New Zealand College of Obstetricians and Gynaecologists website – what does that say?) dates from the same era.
Various states and territories do have some work underway in this area. The Inner East Primary Care Partnership (the PHN in eastern Melbourne suburbs) has this report on Promoting Healthy Ageing in Australia, prepared by the National Ageing Research Institute.
Men’s Sheds and men’s health
A research paper out this month takes an international look at the impact of Men’s Sheds on users’ health.
Men’s Sheds are community-based organisations that deliver practical and social activities to encourage positive health behaviours. While they are popular in many countries – including here in Australia – and their health and wellbeing benefits are touted, there is surprisingly little research to assess the impacts of Sheds on improvements in men’s health and their potential role as a gendered preventative public health measure.
This study shows that Shed activities can help members with reported diagnosed health conditions to feel as though they can manage their illness and overcome adversity. They can also encourage members without existing health issues to engage in preventative health improvement measures. The Shed model is particularly effective for those men reluctant to engage with more formal healthcare services because it provides an inclusive and supportive ‘safe space’.
The paper also addresses the need for policymakers and practitioners to find novel ways to co-exist and work in partnership with such organisations to ensure a wide reach when planning male health interventions for those with and without existing health conditions.
Men’s Sheds in Australia
I went exploring what was happening with the Australian Men’s Sheds program.
The Australian Men’s Shed Association (AMSA) was established in 2007 and received its first Australian Government funding in May 2010. This funding was part of the implementation of the National Male Health Policy developed by the Gillard Government which provided $3 million over 4 years to support AMSA.
This government investment has continued in subsequent funding agreements (I believe funding was provided in both the 2014-15 and 2018-19 Budgets although I could not track this down).
A 2013 report undertaken for BeyondBlue found Men’s Sheds attract a high proportion of older men from regional and remote areas and from lower socio-economic areas – they are therefore ideally placed as a health intervention vector to reach priority populations groups at risk of poor health. Joining Sheds is often driven by significant life-events such as retirement, relocation or the death of a spouse.
Men’s Sheds are places for learning and for passing on practical skills. This lends a sense of purpose and feelings of worth to members. But they also facilitate health interventions, both directly and indirectly. The BeyondBlue report found Shed members scored significantly higher on physical functioning, general health, vitality, mental health and mental well-being than non-Shed members.
A 2016 evaluation of AMSA governance was generally positive but did recommend an increased focus on mental health-related activities, including through new health partnerships, to better address the Shedders’ top health priority.
In April 2019, just ahead of the last federal election and with funding about to expire in June, Health Minister Greg Hunt released the National Men’s Health Strategy 2020-30 – it was released under the banner of the Liberal Party, so as an election commitment, even though arguably it was a continuation of current programs in men’s health. You can access the Strategy document here.
At the time of the launch this was said to be funded at $19.7 million (presumably over the decade rather than over the forward estimates), $11.2 million of which was for the Men’s Sheds program. Again, I could not find this funding in the Budget Papers (in 2019 the Budget was not released until October).
However, the Department of Health website page on men’s health states that the Morrison Government has committed $16.7 million over four years to this.
It is very unclear how this money is being spent: currently $500,000 is available in each of two funding rounds annually for individual grants up to $10,000 (see for example this October 2020 call for applications and the outcomes for the previous round here).
The call for applications states that since 2013, $6.2 million has been spent on the Men’s Sheds program (ie fractionally less than $1 million/year) so the $11.7 million announced in April 2019 is presumably over the decade 2020-2030. It’s not clear what the $16.7 million over four years touted by the Department is for. There has no been a huge expansion in the number of Sheds over recent years; there were over 950 in 2016 and there are currently over 1000.
So surprise, surprise – I’m once again bemoaning the lack of transparency in the health budget! A second review of AMSA commenced in September 2020 and is due by late June 2021. Perhaps that will answer some of these questions.
Accountability for spending in this area and information about outcomes matter because men’s health and wellbeing lags behind that of women. The Men’s Health Report Card 2019 produced by the Australian Men’s Health Forum summarises the state of male health this way:
“The facts are compelling. Our sons are less educated than our daughters. Our brothers die younger than our sisters. Our fathers are more likely to die at work than our mothers. Our male friends are more likely to die by suicide than our female friends.”
Breathtakingly simple innovations in prevention
When you read “breathtakingly simple innovations in prevention” in a news headline then of course you have to stop and read the whole story.
That’s how I learnt that this past week the Productivity Commission (PC) released a series of case studies under the heading of Innovations in Care for Chronic Health Conditions.
The PC starts by making the case we all know: chronic conditions are becoming more prevalent and costly; Australia has had some success at preventing ill-health but could do so much more; and making the case for prevention is complex and difficult.
The focus of the report is on initiatives that could prevent people’s chronic health conditions from deteriorating or that could improve their management.
Many of these are inexpensive, obvious fixes, but someone pulled together some out-of-the-box thinking to make them happen. A great example is the Turning Pain into Gain program. This is a 12-month program for people with persistent pain, operated by the Gold Coast Primary Health Network but initially developed in 2013 by a local pharmacist based on the realisation that many people were unable to access the local specialist pain clinic.
It combines one-on-one clinical service assessments, a six-session education program, allied health services and goal setting. Participants are supported to explore a range of strategies for living well despite pain, to lower their reliance on medication for pain management, reduce requirements for emergency care and attain better quality of life.
The report looks at innovative initiatives under five headings:
- Supporting people to manage their chronic conditions.
- Empowering the health workforce to deliver better outcomes. The focus here is on care teams and support roles.
- Building and sustaining collaboration. This includes the need to build opportunities to fund such collaborations.
- Improving the flow and use of information across the health system.
- Embracing funding innovations.
To summarise: the sorts of innovations highlighted require improved responsiveness to consumer preferences, greater recognition of the skills of health professionals, effective collaborative practices, better use of data for decision making by clinicians and governments, and new funding models that create incentives for better management or prevention of disease.
Nearly 10 million Australians currently live with chronic health conditions, yet the sort of successful innovative programs highlighted in the PC report only benefit a small fraction of these.
Most of the care people with chronic conditions receive is community-based, while they are living at home, and so improvements in self-management are essential. The report highlights that these are hard to achieve in practice but that supporting self-management is one step towards strengthening consumer partnerships and putting the patient at the centre of care.
What is needed alongside innovation are mechanisms for wider implementation, with adaptation to local needs where required, to deliver benefits to consumers, practitioners and governments.
The report found “substantial” barriers to the development and broader diffusion of healthcare innovations. These include the current design and allocation of health funding, with few incentives for interventions in primary care that improve chronic disease management and avoid hospital use.
For me, the key recommendations from the report are:
- Implementing innovative interventions on a larger scale depends on effective diffusion mechanisms and funding reform.
- Trials of blended payment models and pooled funding — supported by data and models that ensure interventions assist the people who face the highest risks of avoidable hospitalisation — offer a path towards funding reform.
It is clear there are some wonderful pockets of innovation in Australian healthcare, often centred Primary Health Networks and hospitals. I suspect they are driven more by individuals, and their personal relationships and willingness or ability to get around obstacles, than by the healthcare system frameworks (which may well be more problematic than helpful).
This means we should look at knowing more about these individuals, how they manage to overcome the barriers that restrict others, and how their efforts can be supported and encouraged.
It’s a sign of the painfully slow progress in this area that the WHO’s 2002 report, Innovative care for chronic conditions: building blocks for action, is still relevant.
The report presents a “road map” for countries and health systems to update their health care to meet the needs of chronic conditions. The proposed building blocks of the Innovative Care for Chronic Conditions Framework are relevant for both prevention and disease-management in health care settings. Recommendations are given for improving the quality of patient interactions, organisation of healthcare, community involvement, policy and financing systems.
Advice from the longest-running study on happiness
Even the editors were surprised that the 2021 World Happiness Report found that, amid global hardship caused by the coronavirus pandemic, self-reported life satisfaction across 95 countries on average remained steady in 2020 compared to 2019.
The Happiness Report uses data from the Gallup World Poll, which asks respondents to rate their current life satisfaction on a zero-to-ten scale, with a 10 representing “the best possible life for you.”
The top three countries were Finland, Iceland and Denmark, with Australia coming in 12th. Even in the United States (rated 14th), despite the societal tumult, there was no significant change from the previous report.
The experts say the report is good news regarding global resilience; it seems stressors such as those everyone has experienced this year encourage people to craft a different, big-picture concept of happiness. And this can improve resilience.
The Washington Post, in covering this story, listed a number of strategies for being happier and improving resilience. Do you agree with this list?
- Look for awe-inducing experiences – such as when the rover Perseverance touched down on Mars. There is some interesting research to show that awe in nature is healing.
- Seek social support and give it. The global “happiness effects” of generosity increased last year, the report found, and making a donation correlated with higher life satisfaction and positive affect. That finding tracks with a number of studies that testify to the well-being boosts of acts of kindness and volunteering.
- Give yourself some (psychological) distance. In particular, the advice recommends practicing temporal distancing, which involves imagining how you’ll feel about a current stressor sometime off in the future, perhaps a year from now, after it’s passed.
- Reappraise, and look for meaning. Finding personally relevant positive meaning in trying experiences, a technique known as positive reappraisal, can broaden and boost outlook. A 2015 review of studies on older adults showed that positive reappraisal is “an adaptive coping strategy for older adults with wide-ranging benefits”, including for physical health.
One of the longest-running studies on happiness is the Harvard Study of Adult Development – which naturally also looks at the issues of ageing. The project has followed 724 men since they were teenagers in 1938. (Approximately 60 men, now in their 90s, are still left.)
The group consisted of men from various economic and social backgrounds. President John F. Kennedy was part of the original group.
Over this time frame, with questions asked every two years, researchers have collected masses of information about the participants’ health and mental and emotional wellness.
The study has revealed that close relationships, more than money or fame, are what keep people happy throughout their lives. Relationships protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes.
In case you missed it
From the “To Be Read/Analysed” file:
- Researchers return to find out fate of children involved in landmark FASD study. ABC News report, 10 March 2021.
In 2009, a generation of young children in the Fitzroy Valley communities were assessed for fetal alcohol spectrum disorder (FASD).
It was found one in eight children had physical and mental impairments linked to their mother’s alcohol consumption during pregnancy — one of the highest rates recorded among the handful of studies that have been done.
The local women’s centre, which facilitated the study, has invited researchers back for a 10-year follow-up.
- Cancer screening and COVID-19 in Australia. Australian Institute of Health and Welfare. 24 March 2021.
This report looks at the impact of the coronavirus pandemic on cancer screening in 2020.
The impact of COVID-19 was clearest for BreastScreen Australia: there was a drop in screening mammograms early in 2020, but this had returned to pre-COVID-19 numbers in September 2020.
- Oral health as a human right: support for a rights-based approach to oral health system design. ScienceDirect, 18 February 2021.
On how the exclusion of oral health from the universal health care systems of many countries reduces its rights status.
Note that World Oral Health Day was 20 March.
- Nature and extent of violence, abuse, neglect and exploitation against people with disability in Australia. Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. 16 March 2021.
This is the latest research report, conducted by the Centre of Research Excellence in Disability and Health, from the Disability Royal Commission.
- Achieving impact from Australian science. Speech to the National Press Club by Australia’s Chief Scientist, Dr Cathy Foley. 17 March 2021.
The best of Croakey
Members of the Croakey team — Jennifer Doggett, Dr Ruth Armstrong, Nicole MacKee and Cate Carrigan — have comprehensively covered the #ShiftingGearsSummit convened by the Consumers Health Forum of Australia, via Twitter, articles and podcast, and with more to come.
You can bookmark this link.
The good news story
Last week I listened to a wonderful discussion, sponsored by the New York based Belleview Literary Review and Medscape, on “COVID writing goes viral”.
It featured Dr Danielle Ofri (essayist, editor, and practicing internist) in conversation with Dr Eric Topol (cardiologist, scientist, and author – these days famous for his excellent tweeting on the science and epidemiology around the pandemic) and Dr Abraham Verghese (best known as the author of “Cutting for Stone” but also a practicing clinician with an interest in infectious diseases).
It was exciting and challenging and so interesting. You can access the talk on YouTube 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.