Lesley Russell writes:
With just days until the federal election, we are engulfed by analyses and arguments over statements and policies.
For many in health/healthcare too much of this misses the mark and there are concerns that – regardless of who wins government and even given the value of some of the commitments made to date – the reforms that are so needed will not eventuate.
We should hope that political leaders and bureaucrats watched The Drum (May 9) when Ellen Fanning led a great discussion on health reforms with doctor and journalist DR Norman Swan, Pat Turner from NACCHO, mental health expert Professor Ian Hickie, health policy wonk Professor Stephen Duckett and rural GP Dr Jenny May.
They might have learnt something. They might have learnt even more if there had been a consumer/patient on the panel!
The most remarkable and on-target assessment of what is needed for a health and wellbeing system that is fit-for-purpose in the 21st century was the #AusVotesHealth Twitter Festival (perhaps better described as a Twitter storm) on May 8, led by Croakey with a huge number of participants.
My Croakey colleagues have done a marvellous job of collecting up what was discussed. Please take the time to read these pieces, which are compiled at this link (with more to come).
My take-out: we absolutely know what must be done – all that is needed is vision, leadership, sustained funding and commitment and some political will.
Climate change and the environment
Labor has made a good effort to make climate change and the associated issues a key part of the election campaign, but the Prime Minister and the Coalition are not playing. They are convinced that current policies and action are sufficient.
This ABC News analysis will help you to compare the political parties’ election commitments on climate change.
Polling done for the Lowy Institute, released this past week, shows that Australians rate climate change as the top threat to the country’s “vital interests” with 64 percent seeing climate change as “a critical threat”. Six of ten poll respondents agree “global warming is a serious and pressing problem [and] we should begin taking steps now even if this involves significant costs”.
Several reports out this part week highlight how imperative it is to do more to address the global ramifications of this global problem.
Extinction crisis
The 2019 report from the Intergovernmental Science-policy Platform on Biodiversity and Ecosystem Services (IPBES) is the first update in this area since 2005 and the news is shocking.
About one million species around the world face extinction because of humans, with the pace of destruction up to 100 times faster than the natural rate over the past 10 million years. About one in eight animal and plant species will disappear unless action is taken to reduce the impacts of changes in land and sea use by humans. The panel’s chairman says the decline in biodiversity is eroding “the foundations of our economies, livelihoods, food security, health and quality of life worldwide”.
Australia has a sad record here. Since European settlement and introduced predators, hundreds of species have become extinct. Land clearing has destroyed more than 7.4 million hectares of threatened species habitat (an area larger than Tasmania) since 2000.
A report released in March by the Wilderness Society identified 48 threatened species of forest-dwelling vertebrate fauna living in areas subject to state-run logging operations.
Four of those species – leadbeater’s possum, swift parrot, western ringtail possum and regent honeyeater – are among the 20 bird and 20 mammal species most likely to become extinct within 20 years.
The current Federal Government has slashed the national environment budget by 38 percent, or $533 million, since taking office in 2013.
Experts have rated the response of political parties to the extinction crisis as “not adequate”. At least Labor has promised to establish a national environmental protection authority, a move the Coalition has derided as “green tape”.
Damnation
On the impact of dams and climate change on the world’s free-flowing rivers, a paper just published in Nature (sadly, behind a paywall but you can read a National Geographic summary here), finds that only 37 percent of rivers longer than 1,000 kilometres remain free-flowing over their entire length and only 23 percent flow uninterrupted to the ocean.
Very long free-flowing rivers are now largely restricted to remote regions of the Arctic and of the Amazon and Congo basins.
Free-flowing rivers provide food for hundreds of millions of people, deliver sediments crucial to agriculture, mitigate the impact of floods and droughts, and underpin biodiversity.
The report notes the poor river flow in the Murray-Darling basin which is threatening the Murray cod, listed as critically endangered on the IUCN Red List of Threatened Species.
While there are reports that Lake Eyre is filling as a result of Queensland floods, and could get to levels not seen since 1974, the Murray-Darling is missing out. There’s some wonderful ABC footage of rivers running into Kati Thanda / Lake Eyre here.
Threat to the economy
The Climate Council’s just-released report, Compound Costs: how climate change is damaging Australia’s economy finds that climate change is a major threat to Australia’s financial stability and poses substantial systemic economic risks.
In particular, the economic damage to Australia’s property and agricultural sectors will be very significant. There will be major impacts on food production.
These disastrous outcomes are only inevitable absent national, government-led actions and interventions. The report makes the case for a revised and strengthened national climate and disaster resilience strategy and action plan that significantly scales up efforts to prevent hazards from turning into disasters and increases disaster response capacity.
Other countries show what can be done
Britain was powered by sources other than coal for over 100 hours last weekend, the longest time since the start of the industrial revolution. Coal now accounts for under 10 percent of Britain’s power output and the government plans to phase out the country’s last coal-fired power plants by 2025. Even in a country known for its grey, rainy days, the public is installing solar panels at home in ever greater numbers.
In 2018, 40 percent of Germany’s electricity came from wind, solar, biomass and hydroelectric sources and only 38 percent from coal. The country is steadily retiring its coal and nuclear plants to cut carbon emissions and this will reduce greenhouse gas emissions by 40 percent by 2020 and by 95 percent in 2050 compared to 1990 levels.
In France, traditionally dependent on nuclear power, government plans released last November will triple onshore wind power capacity by 2030 and boost solar power capacity to bring renewables to 40 percent of the energy mix.
In the wake of the Fukushima nuclear disaster, the government pledged to reduced France’s dependence on nuclear power. France is Europe’s fourth biggest wind power producer, although electricity production from renewable wind sources currently accounts for only 5.5 percent of French electricity consumption.
I see quite a few turbines throughout the countryside on my walks in France. In contrast to Joe Hockey’s views, I think they are quite elegant and definitely not offensive.
International criticism for Australia’s climate wars
Australia’s failures are noted internationally.
The former climate czar at the United Nations, now climate leader at the World Bank, Christiana Figueres, recently backed four female independent candidates for House of Representatives seats (Zali Steggall, Kerryn Phelps, Rebekha Sharkie, Julia Banks) and condemned the local climate wars.
She referred to “extreme elements from both sides of the political spectrum” who had “frustrated sensible, forward-looking policies founded in what must be our most important guide — the science”.
Social sector groups call for strong action
Social sector organisations have banded together to urge political parties and candidates to commit to strong action to respond to the climate crisis, and clear policies that will support local communities, particularly people living in poverty who are hit hardest by climate change effects.
The joint Social Sector Climate Statement calls on the next federal parliament to support a range of policies including:
- Support for communities to develop local adaptation and resilience plans, including funds to develop an Australian climate change social vulnerability map.
- Support for improving energy efficiency in existing homes like mandatory energy efficient standards for private rental and public housing.
- Emissions reduction targets of at least 45 percent by 2030, and zero net emissions before 2050.
Alcohol harms
The 2019 Annual Alcohol Poll, released this week by the Foundation for Alcohol Research and Education (FARE), serves to highlight that Australia has a problem with alcohol.
The FARE website states the point succinctly: “Australia’s ‘get drunk’ club climbs to six million.”
The report shows a steady climb over the past decade of people drinking to get drunk and finds Australians are confused about low-risk and high-risk alcohol consumption.
FARE says the poll also highlights “how ambiguous and subjective the concept of ‘responsible drinking’ actually is when 68 percent of drinkers who consume eleven or more standard drinks on a typical occasion, consider themselves responsible drinkers.”
The level of ignorance about the associated health risks has reached “crisis point”, said FARE CEO Michael Thorn. It’s shocking to realise that one in 22 Australians die from alcohol-relates causes.
There is a good summary of the findings here on the ABC News website.
The Australian Institute of Health and Welfare statistics on alcohol risk and harm are worth reading (although they are dated and, based on the FARE poll, too optimistic about decreases in binge drinking).
In summary: alcohol use was responsible for 5.1 percent of the total burden of disease and injury in Australia in 2011; 28 percent of the burden due to road traffic injuries; 24 percent of the burden due to chronic liver disease; 23 percent of the burden due to suicide and self-inflicted injuries; and 19 percent of the burden due to stroke.
The fact that these statistics are so old, and we have heard not a word about alcohol abuse and treatment during the election campaign, are stark statements in their own right about where this growing problem sits on the list of public health priorities.
If politicians want to tackle domestic and community violence, address factors in suicide and mental illness, reduce the incidence of foetal alcohol syndrome, and fight a war on cancer, then they must do more to reduce this public health problem.
This is not an easy task. This is exemplified by a paper just published in in the US that finds policies designed to stop pregnant women from drinking, including posting warning signs in bars and restaurants and defining drinking while pregnant as child abuse or neglect (admittedly a particularly American approach!), are actually associated with worse health outcomes for babies (specifically low birth weight and premature birth).
One reason, the researchers say, is that the policies can actually discourage women from seeking prenatal care.
Tackling homelessness
Homelessness places increasing demand on emergency hospital services: homeless people are six times more likely to present at emergency departments, their hospital stay is three times longer than the general population, too often such patients are discharged back into homelessness, and so they are four times more likely to return.
I recently stumbled across information about the in-reach program at Royal Perth Hospital (RPH) to address the needs of those patients who present at the Emergency Department (ED) and are identified as homeless or at risk of homelessness (as covered at Croakey in 2018).
There are evaluations to support the effectiveness of this programs, and dollar figures on the savings that can be achieved, but more importantly, it offers some dignity and a better quality of life to people who have fallen on hard times. It’s a great story, explored a little here.
The Homeless Team in-reach program commenced in 2016 as a collaboration between RPH and Homeless Healthcare (HHC) General Practice. It is based on the UK Pathway model and provides GP care, enhanced care coordination and discharge planning to improve the continuity of care for RPH patients experiencing homelessness.
It also links these patients with services that address the underlying psychosocial determinants to enable stabilisation of their health. It is run in conjunction with clinics at Drop-In Centres, Alcohol and Drug Rehabilitation Centres, Youth Clinics and Transitional Housing.
A second evaluation report on the program, conducted by the University of Western Australia, was released in February. There has been a dramatic decrease in the number of homeless patients presenting to the ED with 54 percent of Homeless Team patients having fewer ED presentations in the year following first contact with the team. There has also been a significant decrease in the number of inpatient admissions and average number of days spent as an inpatient.
In all, these changes are equivalent to an aggregate cost saving of $4.6 million and a cost saving of $7,302 per person.
If you are interested in more details, a report issued in May 2018 examines the baseline health and psychosocial profiles of the RPH Homeless Team patients, and describes the model of care, patient flow and patterns of contact with HHC GP and community-based support services.
I’m sure (well, I hope I’m sure) that there are some similar programs around Australia. This initiative highlights the necessity and the value of acute care, community care and social welfare services working together and shows that the current fragmentation of services, federal/state and territory divides, siloes between health and social services, and lack of appropriate funding mechanisms can be overcome.
It is certainly what all Local Health Networks and Primary Health Networks should be working towards as a better way to address the pressures on public hospitals and to tackle the rising problem of homelessness. It would be great to hear from healthcare workers at the coalface about their experiences with this and similar programs.
The good news story
There are two contenders this week:
- The #AusVotesHealth Twitter Festival
Many congratulations to all involved!
- Maybe an antidote for the box jellyfish venom?
Good news for swimmers in northern Australia – Australian scientists working at the University of Sydney think they may have an antidote for the deadly venom of the box jellyfish.
The poison causes tissue death and extreme pain. The research team used Crispr gene-editing technology to identify genes involved in the envenoming process. This revealed a range of possible new treatment targets, including cholesterol and sphingomyelin molecules.
The researchers then investigated whether the venom could be counteracted by two cyclodextrins, sugars that are known to reduce the level of cholesterol present in cell membranes. When tested in mice, the cyclodextrins reduced pain and significantly reduced tissue death, although there was no effect on swelling.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. You can follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
