From beautiful views on Flinders Island to attacks on public health in Aotearoa/New Zealand and the United States, and reasons to be concerned about the long-term impact of COVID-19 infection – this column’s latest edition takes a wide-ranging look at the health news that matters, and also brings some must-read good news.
Lung cancer screening, tobacco-related health disparities, and the many imperatives for reducing poverty are also covered.
The quotable?
The healthcare field has not generally been a participant in the great debates about poverty, focusing much more on the impact of social determinants on health outcomes and very little on income and jobs strategies, which live outside of healthcare.”
Lesley Russell writes:
So much has happened since the previous edition of The Health Wrap. Donald Trump’s re-election to the United States presidency and now the Administration and White House advisors he is assembling give real cause for concern about the future of health and healthcare – in the United States, and globally.
We managed to escape much of last week’s endless political analyses and discussions with a wonderful glamping and hiking trip to Flinders Island.
This is such a beautiful place, despite the awful history of Wybalenna for the palawa people of lutruwita/Tasmania.
There are pristine beaches, massive granite boulder outcrops, an interesting variety of indigenous flora and fauna and a great community feel.
We hiked and climbed and rock-hopped our way along beaches, through forested gullies and up peaks for spectacular views, all in amazingly warm and sunny weather.
This trip will definitely be included in the 2024 edition of The Hiking Wrap.
Trump, again
What does a second Trump presidency mean for health and healthcare?
This is a question I get asked a lot, and the fact is we don’t yet know.
But we can be sure that there will be major attacks on programs like Obamacare and Medicaid that expand access to health insurance and on other aspects of the social welfare safety net. At the same time there will be a downgrading of regulatory requirements and agencies that protect public health.
Trump and his team are announcing a complete reworking of the American government, claiming a mandate to do this (although Trump did not win 50 percent of the vote) and emboldened by what they learned in Trump’s first term.
A columnist at The New York Times, Peter Baker, writes that Trump “has rolled a giant grenade into the middle of the nation’s capital and watched with mischievous glee to see who runs away and who throws themselves on it”.
To my mind this is less mischievous glee and more about trying to destroy the foundations of American democratic government. This is highlighted by the nomination of Robert F Kennedy Jr to be Secretary of Health and Human Services.
The choice of Kennedy is described as “an indication of the contempt with which Trump holds the federal health establishment, including the National Institutes of Health and the Food and Drug Administration”.
The NIH is clearly in the cross hairs of the Trump Administration: MAGA Republicans are gunning for Dr Anthony Fauci for his role in the pandemic and Kennedy says that he wants to get rid of 600 NIH employees.
Kennedy has also said he wants to shift the focus of NIH to chronic diseases like obesity (not necessarily a bad thing) and he would cease research on infectious diseases and Alzheimer’s disease for “about eight years”.
Republican members of Congress as well as conservative think tanks like the Heritage Foundation have been floating long to-do lists for changing the NIH.
There’s an interesting discussion here of what these proposed changes – some of which are justified – might mean.
Dr Jay Bhattacharya, an NIH critic and one of the authors of the Great Barrington Declaration on the management of the pandemic, has emerged as a likely candidate to lead the agency.
And celebrity doctor Mehmet Oz, who has pushed the privatisation of Medicare, will serve as administrator for the Centers for Medicare and Medicaid Services.
(Yes, it does get worse with every announcement!)
There are reports that Trump’s economic advisors are talking with Republicans in Congress about cuts to Medicaid, the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, and other welfare programs, in order to cover the enormous costs of extending tax cuts for the wealthy and corporations.
Medicaid is the nation’s health insurance for low-income Americans and long-term care. It covers more than 90 million Americans. Rural populations, which tend to vote Republican, use supplemental nutrition programs more than urban dwellers do.
And there are Republicans who cannot wait to attack Obamacare, affecting millions of Americans, especially those with pre-existing conditions, who rely on it.
Income inequality and health
As Trump and Republicans rush to cut programs like food stamps to pay for more tax cuts that will predominantly benefit the well-off – and as Australia heads towards what promises to be a pretty nasty federal election campaign with the Coalition looking to adopt Trump-light policies – it’s worth considering a recent paper from Sir Michael Marmot that looks at the (very complicated) issue of the links between income inequality and mortality.
Marmot concludes that: “Income, education and social conditions are all unequally distributed in society and each may be playing a role in causing inequalities in health.”
I drew attention to similar issues in a recent article for The Conversation, republished by Croakey, that looked at health outcomes in Republican (red) versus Democratic (blue) states and how increasing partisanship aggravates this growing health divide.
This is due both to political party policies (the role for government in the provision of health and healthcare services) and personal ideologies (for example, the willingness to comply with public health guidance).
We saw in particular how this played out in the pandemic, in both the United States and Australia.
We also saw how poverty and income inequality were reduced in Australia as a consequence of the income support programs provided during the first years of the pandemic (see ACOSS report here).
A paper just published in The New England Journal of Medicine looks at how emergency financial measures adopted in the United States during the pandemic – pandemic stimulus checks plus improved unemployment insurance and child tax credits – led to an historic 50 percent reduction in the child-poverty rate and a 15 percent decrease in overall poverty.
Financial insecurity is a major driver behind cycles of poor mental health, disease, violence, crime, and incarceration – all of which, in turn, further entrench poverty, destabilise families, undercut public health and childhood education, and constrain people’s opportunities.
The author argues that “money is medicine” and that health status cannot be improved without addressing economic status.
Poverty has recently been estimated to be America’s fourth-leading risk factor for death, behind heart disease, cancer and smoking.
As far back as 1995, sociologists argued that social conditions like poverty should be seen as a “fundamental cause of disease” and not just a contributor to risk factors like heart disease, lung cancer and drug overdoses.
Australia’s new screening program for lung cancer
Beginning July 1, 2025, Australia will have a new screening program for lung cancer.
The program will use low-dose CT (computed tomography) scans to look for lung cancer in people at high-risk.
Those eligible for screening are aged between 50 and 70 years, have a history of at least 30 pack-years of cigarette smoking and are either still smoking or quit in the past 10 years, and have no signs or symptoms of lung cancer.
Access to screening will require a doctor’s referral. I assume this will be to the radiology department of a public hospital, but maybe private radiology will also be involved. I have not been able to determine the details.
Information on the website of the Royal Australian and New Zealand College of Radiologists indicates that the program is being implemented in partnership with the National Aboriginal Community Controlled Health Organisation (NACCHO) and Cancer Australia.
It is expected to prevent over 500 deaths from lung cancer each year.
A 2021-22 Federal Budget Measure tasked the Department of Health and Cancer Australia to work together to establish the feasibility of implementing a national lung cancer screening program. Medical Services Advisory Committee (MSAC) delivered advice to the Minister for Health to proceed with this program in July 2022.
A paper with the evidence and cost-effectiveness data that were presented to MSAC is on the Cancer Council website.
The 2023 Federal Budget included $264 million over four years for lung cancer screening, and $101 million per year thereafter.
The program must ensure it is available to those disproportionately affected by lung cancer, including First Nations people, people in rural and remote locations, people with a mental health condition, and people from non-English speaking backgrounds.
There are plans for mobile screening in rural and remote areas.
More information about the program is here.
Why thousands are marching for Māori rights
Aotearoa New Zealand is in political turmoil over the nature of the commitments made to Māori people in te Tiriti o Waitangi (the Treaty of Waitangi) and how those commitment should now be honoured.
There have long been problems with the Treaty – the English and Māori versions differ on what power the chiefs were ceding over their affairs, lands and autonomy, and over decades, the Crown has breached both versions.
But the interpretation of clauses in the document still guides legislation and policy today, while the Treaty underpins claims of Māori sovereignty.
A bill put forward by David Seymour, of the ostensibly libertarian ACT Party, would refine the Treaty. The bill is never expected to become law, but it is provocative, particularly in light of the way the current conservative coalition Government, led by Prime Minister Christopher Luxon, is attacking Māori rights.
Since taking office last November, the Government has repealed or reversed around a dozen policies supporting Māori rights, the Māori Health Authority has been abolished, and Māori language use in public services has been reduced.
These retrograde steps are due to the demands of two minor parties that helped Luxon form a coalition government: the ACT Party led by Seymour and NZ First led by Winston Peters, both of which campaigned against “race-based policies”.
Seymour secured Luxon’s support to put forward his Treaty Principles Bill which proposes to reinterpret the Treaty as applying to all New Zealanders.
His support comes from New Zealanders aggrieved about what they perceive as Māori special treatment. (There are such echoes here of the false arguments made against The Voice.)
A former New Zealand Attorney-General criticises the bill this way: “The Treaty is between the Crown and the Māori. Where Seymour goes wrong is thinking it’s an agreement between races, and that’s fundamentally wrong.”
An analysis by the Ministry of Justice warns that the bill “reduces Indigenous rights to a set of ordinary rights that could ne exercised by any group of citizens”.
Seymour’s bill is widely opposed – by left and right-wing former Prime Ministers, most of the country’s most senior lawyers, and thousands of Māori and non-Māori New Zealanders.
This week some 40,000 people walked in a hīkoi (long march) to the Beehive in Wellington to in protest. When asked why he wasn’t listening to them, Chris Luxon said he was focused on improving outcomes for Māori, “not this stuff”.
The reading of the bill was disrupted by a haka performance by Maori MPs, video of which went viral around the world.
So much is at stake for Māori New Zealanders.
This article, Colonisation, hauora and whenua in Aotearoa, outlines how breaches of te Tiriti o Waitangi have entrenched longstanding, preventable inequities in health and other important domains of social life.
This article, Understanding how whānau-centred initiatives can improve Māori health in Aotearoa New Zealand, highlights why the status the Treaty confers is so important for health.
As reported in Croakey’s ICYMI column recently, a statement by the Australasian Epidemiological Association warns that the bill “is not justified by robust policy analysis and will embolden racism”.
COVID updates
New research publications highlight (yet more) reasons to be concerned about the long-term impact of COVID-19 infection.
A new, large-scale, controlled study from South Korea shows that COVID-19 is significantly associated with an increased risk for autoimmune and autoinflammatory connective tissue disorders including alopecia, vitiligo, Crohn disease and ulcerative colitis, rheumatoid arthritis, and lupus.
The risk was especially pronounced in individuals with severe cases requiring intensive care, those infected during the Delta variant wave, and unvaccinated individuals.
Research from the United Kingdom shows that the proportion of babies born with a congenital heart abnormality increased by 16 percent after the first year of the pandemic.
The lead author of the study stated: “We need to determine if the SARS-CoV-2 virus directly causes the development of foetal heart problems during pregnancy, and if so, how the virus makes these changes in the heart.”
These findings are in line with those from another recent study, from China, which found 10.08 percent of newborns whose mothers had had COVID-19 group had cardiac abnormalities, compared with 4.13 percent in the control group.
“The significant increase in congenital abnormalities during the COVID-19 pandemic, particularly the early gestational infections associated with specific types of cardiac abnormalities, emphasises the need for ongoing monitoring and support for children born during the pandemic,” the authors concluded.
All of which points to the need for an ongoing focus on keeping vaccinations up-to-date.
So here’s the latest data from the Department of Health and Aged Care – definitely room for improvement!!
See also this recent Croakey article: Shining a light on questions and concerns about long COVID.
Sugar rationing protects against chronic disease
A study published in the journal Science shows that people who were restricted to limited amounts of sugar in the first few years of life were less likely to develop diabetes and high blood pressure decades later.
The study took advantage of a unique situation in the United Kingdom. The country was under strict rationing during World War II and its aftermath. When the rationing ended, in September 1953, the average sugar intake by people in Britain doubled, and has remained high.
The research found that those exposed to sugar rationing early in life had a 35 percent lower risk of diabetes and a 20 percent lower risk of high blood pressure in middle age. The onset of those chronic diseases was also delayed by four years for diabetes and two years for high blood pressure.
The research also showed that disease protection was greatest for those who had been conceived during sugar rationing and were babies while rationing continued.
There’s a health policy lurking in these findings!
Medicare Safety Net reform flies under the radar
I’m sure I am not alone among Croakey readers in my gratitude for all that Charles Maskell-Knight manages to uncover and then promulgate in his weekly The Zap contribution.
I consider myself a somewhat obsessed policy wonk who tries to follow pretty much everything that is going on, but some things just elude me. In my most obsessive/cynical moments, I think that this Federal Government doesn’t want us to know what is going on.
It was only thanks to The Zap that I discovered that an always controversial and (to my mind) poorly designed policy – Medicare Safety Nets – was up for review.
At a time when out-of-pocket costs are burgeoning such initiatives have never been more needed, but the history of these safety nets shows they have generated unintended side-effects and are fragmented and poorly targeted.
So why, given the importance, was this review launched without fanfare and with just 35 days to make submission on the matter? (Submissions closed last week.)
This review was recommended as part of the final report from the MBS Review Taskforce (that was in 2020) but as far as I can determine, this topic has never been mentioned by Minister for Health Mark Butler.
The website states that in July 2024 the Medicare Safety Net Reform Working Group was established by the Department of Health and Aged Care but I cannot find a list of members of this working group.
The website has a consultation paper which is only 11 pages long. It’s just an explanation of how the Medicare Safety Net and the Extended Medicare Safety Net work, with no presentation of data or analysis of the issues.
There are six questions (pretty banal) for response (for example: “Does more need to be done to improve awareness and understanding of Medicare Safety Net arrangements in the community? How can this be achieved?”).
Strangely and sadly, the Pharmaceutical Benefits Scheme Safety Net and issues around Private Health Insurance are out of scope for this consultation process – as if people’s healthcare costs are siloed.
Submissions and survey responses will not be published by the Department – why not?
The submission from the Royal Australian College of General Practitioners (which is apparently not a member of the Medicare Safety Net Reform Working Group and wants to be) is here.
I also found a submission from the Royal Australasian College of Medical Administrators, here.
But my Googling turned up nothing else. It’s hard to believe the AMA did not have a say but there’s nothing on their website.
New tobacco report from US Surgeon General
The US Surgeon General, Dr Vivek Murthy, has released a comprehensive report on tobacco-related health disparities across different communities in the United States.
The report acknowledges significant progress in reducing overall tobacco use over the last 60 years but highlights persistent inequalities in tobacco use, second-hand smoke exposure, and tobacco-related health outcomes among various demographic groups.
It calls for governmental action, including policies to restrict flavoured tobacco products like menthol cigarettes (targeted primarily at Black Americans), to address these disparities effectively.
Trump has announced Fox News medical contributor Dr Janette Nesheiwat as his pick for Surgeon General. This is not a Cabinet level position, but it does require Senate confirmation.
Nesheiwat has promoted her own line of vitamins and dietary supplements, but she is seen as a reasonable choice for this public health position.
She is currently the medical director for a large provider of urgent care clinics and she has emphasised the benefits of getting vaccinated against COVID-19 and other infectious diseases.
Good news in Indigenous health
A recent paper published in BMC Public Health assesses the efforts and impacts of community‑controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security.
The story is one of slow success, set back by the COVID-19 pandemic.
It demonstrates the effectiveness of community‑led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities.
However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security – healthy diets are unaffordable for welfare‑dependant households.
This work was funded in part by a Medical Research Future Fund grant to The Australian Prevention Partnership Centre. You can read more about the Centre’s work in this space here.
Best of Croakey
The re-election of Donald Trump almost certainly means the withdrawal of the United States from any leadership role in addressing climate change.
See this recent Croakey article: It’s a devastating result for the world’s climate, but this is not ‘game over’.
This past week saw the G20 leaders’ summit in Brazil and the COP29 meeting in Azerbaijan.
The outcomes from both the G20 meeting and the COP29 meeting were very disappointing.
The G20 summit came to a sudden end after host country Brazil cancelled the key event meant to sum up its results, apparently over amid doubts about outcomes on climate change and global hunger
The COP29 meeting seems to have had more success with advances in health – climate commitments and a new finance goal to help developing nations.
But United Nations Climate Change Executive Secretary Simon Stiell acknowledged the mountain of work yet to be done: “So this is no time for victory laps. We need to set our sights and redouble our efforts on the road to Belém.”
As always, Croakey has been doing a great job helping us to follow these issues.
- Our healthcare system is at a climate crossroads. What will it look like in 2050?
- The mental health of young people should be prioritised at global climate negotiations.
- Global climate health leaders condemn COP29 outcomes
The good news story
I loved this story from the Kimberley region of Western Australia about two Aboriginal women who made their medical training dreams come true – and in doing so set a splendid example for all.
Dr Stephanie Trust is clinical director of the Wunan Health and Well-Being Centre in Kununurra which is owned and operated by Wunan Foundation, an East Kimberley Aboriginal development organisation.
Dr Catherine Engelke is senior medical officer at the nearby district hospital, in charge of delivering public health services across a swathe of Western Australia’s far-flung top end.
Both are descended from the Stolen Generations. As young women they became nurses and started their own families, leaning on each other for support. And then – they both went to medical school!
You can read more about their inspiring stories 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.
