Addressing the mental health and wellbeing of Australian youth must be high on the agenda for the Albanese Government, including through the Strengthening Medicare Taskforce, writes Adjunct Associate Professor Lesley Russell in her latest column.
The Health Wrap also looks at what can be learnt from health reform in Aotearoa/New Zealand, the COVID vaccine rollout in Australia, and the risks that climate change presents for the spread of the Zika virus. Also, competitions about our favourite trees and mammals are about so much more than the winners and losers.
Lesley Russell writes:
We have had days of endlessly shocking news about how former Prime Minister Scott Morrison undermined the principles of responsible and ethical government and still the news keeps coming.
Morrison took on joint responsibility for Health quite early in the pandemic, in March 2020, so now we must wonder what his role was in the sad litany of Australia’s early vaccine roll-out.
Yet to be analysed and understood are the impacts that Morrison’s hidden role as Minister for Health had on Australia’s response to the pandemic and specifically on the vaccine rollout. But an article by Samantha Maiden for News.com.au has kicked this off – she details how Operation COVID Shield co-ordinator Lieutenant General John Frewen struggled to report to both Morrison and Health Minister Greg Hunt.
As Professor Kathy Eagar sagely tweeted:
We had 3 Ministers, a Taskforce, a Secretary & a CMO plus all of their divisions, sections, branches etc of public servants & defence personnel all with the job of vaccinating vulnerable people as an urgent priority. What could possibly go wrong? And who is accountable now?”
Earlier this month the Australian National Audit Office (ANAO) released its audit of the distribution and delivery of COVID-19 vaccines by the Department of Health and Aged Care (DoH).
It also illustrated, amongst other things, the complexity of Frewen’s reporting lines.
The report concludes that the planning and implementation of the COVID-19 vaccine rollout was partly effective, becoming more effective over time, but there were some damning criticisms behind this conclusion.
- The planning and implementation of the vaccine roll-out to priority groups (for example, people aged care and Aboriginal and Torres Strait Islander people) was not effective.
- Initial planning efforts were not timely; detailed planning with the States and Territories was not completed before the rollout commenced.
- DoH under-estimated the complexity of administering services to the aged care and disability sectors.
- Targets for the rollout (both dates and numbers of people vaccinated) were not incorporated into planning until a later stage and early targets were missed.
ANAO recommended that DoH conduct a “comprehensive review” of the rollout by the end of this year, including recommendations to the Federal Government “about opportunities for improvement in the event of a future vaccination rollout”.
In its response to the audit, the DoH indicated that this review would likely be a part of the Albanese government’s planned inquiry into the pandemic response, the timing of which is “still to be agreed by government”.
In an article for Pearls and Irritations, my Croakey colleague Charles Maskell-Knight sees the ANAO report as giving DoH a C-minus grade on the vaccine roll-out. He argues that the examination of the vaccine roll-out, in particular that for aged care, should go beyond the ANAO focus on policy implementation to a review of policy selection.
Back in January, before he was elected, Albanese was asked about an inquiry into the management of the pandemic at a speech at the National Press Club. He said then it was “beyond doubt that you will need an assessment” and indicated that Labor had considered a Royal Commission.
A recent opinion piece in the Sydney Morning Herald goes some way to outlining what an inquiry might encompass and what form it might take.
Professor Stephen Duckett has just published a very useful and comprehensive (and peer reviewed) analysis of Australia’s public health management of the COVID-19 pandemic that will surely help drive the Government’s planned inquiry.
Duckett’s analysis looks at four health-related responsibilities of the Commonwealth Government during the pandemic (to provide national leadership; to manage external borders; to protect residents of residential aged care facilities; and to approve, procure and roll-out tests and vaccines) and the State Governments’ responsibilities (determining what public health measures are appropriate and implementing them; managing the hospital response).
He succinctly describes his analysis as discussing “why [the national government’s response] has attracted a thesaurus of negative adjectives”.
In an interview for The Mandarin, Duckett talked about the enormous pressures facing the healthcare system and the need to rebuild its capacity. I was pleased to see his advocacy for a health workforce planning agency.
COVID neurological risks
Now, to heighten the concerns about the long-term impact of infection with the SARS-CoV-2 virus, a study from researchers at the University of Oxford, published in The Lancet, shows the emergence of significant neuropsychiatric sequelae (dementia, epilepsy, psychosis and cognitive deficit or brain fog) in individuals that had COVID-19.
Adults appeared to be at particular risk of lasting brain fog, a common complaint among coronavirus survivors.
Some of the effects seen were fairly small – for example, it found that 4.5 percent of older people developed dementia in the two years after infection, compared with 3.3 percent of the control group – but the authors argue that the size of the study makes this 1.2-point increase in a diagnosis as damaging as dementia “worrisome”.
This research links in with that published earlier this year in Nature Communications from researchers at La Trobe University. They found indications that some of the neurological symptoms in long COVID are caused by amyloid clumps appearing in the brain that are similar to those that cause Alzheimer’s Disease and dementia.
American doctor, Eric Topol is always a good source of information on COVID-19 issues (you can follow him on Twitter @EricTopol). His recent opinion piece in the Los Angeles Times is a great summary of where things stand with Long-COVID research and treatments.
(See also more on these issues in the latest ICYMI column, including discussion about The Lancet article).
Concerns about youth mental health
The National Mental Health Survey revealed the annual prevalence of mental ill health in 16 to 24-year-old Australians had surged from 26 per cent in 2007 to 39 per cent in 2020-21 — an unprecedented increase of 50 percent in 15 years.
These rates of mental illness are double the level of the rest of the Australian adult population.
A survey conducted early in 2022 found one in four young Australians aged 16 to 24 years had thought about suicide over the past two years and 15 percent had attempted self-harm. Eighty-two percent of those surveyed said they had experienced mental health issues during COVID-19.
The prevalence of symptoms across the mental ill health spectrum has risen sharply in the past decade, even before COVID-19, and particularly in young women.
While there are programs designed specifically to address youth mental health it’s a case of all the eggs (not very many) in one small basket – just 164 communities will have headspace programs. A serious lack of access to services means too many young people go without proper support of treatment.
Other countries are also experiencing burgeoning youth mental health problems.
In a a nationwide survey in the United States, 44 percent of high school students said they feel “persistently sad or hopeless.” Even before the COVID-19 pandemic, suicide rates jumped 57 percent among kids and young adults ages 10 to 24, and have only worsened in some states since.
Dr Vivek Murthy, the US Surgeon General, says he is gravely concerned about the “unprecedented” obstacles facing young people – from climate change and racism, to the “culture of comparison” embraced by social media.
Speaking at a seminar on the State of Youth Mental Health held earlier this month, he said that he worried about children who are struggling in silence.
In Australia, the Children’s Commissioner, Anne Hollonds has talked about how addressing children’s mental health is more complex than blaming social media and requires investment in social housing and supports through schools.
Addressing the mental health and wellbeing of Australian youth must clearly be high on the agenda for the Albanese Government, and a facet of the current work of the Strengthening Medicare Taskforce.
It will require the best efforts of all the healthcare professionals who make up the mental health team.
To quote Hollonds: “You just have to ask how bad does it have to get before we recognise that we need to make children a national policy priority?”
Health reform lessons from Aotearoa/New Zealand
Back in April 2021, it was announced that New Zealand’s district health board system would be replaced with three new entities – Health New Zealand, the Māori Health Authority, and the Public Health Authority. The latter (a directorate of the Health Ministry) would be tasked with centralising the provision of public health services in New Zealand.
Legislation to implement these changes was introduced in October 2021 and passed into law in February 2022.
The Ministry of Health will be focused on policy, strategy and regulation. Health New Zealand will take over the planning and commissioning of services and the functions of the existing 20 District Health Boards in a move described as removing duplication and providing true national planning. The Māori Health Authority will work alongside Health NZ to improve services and achieve equitable health outcomes for Māori.
The new Public Health Agency (PHA) formally came into existence on 1 July 2022. It inherits most of the functions of the former Health Promotion Agency, including public health and population health policy, strategy, regulatory, intelligence, surveillance and monitoring. The agency will be responsible for coordinated responses to infectious disease threats such as COVID-19.
The PHA It will bring the existing 12 Public Health Units into a single operational service and is to have a greater emphasis on equity and the wider determinants of health such as income, education and housing. In addition, the PHA has been tasked with developing a public health strategy to meet the needs of Māori and integrating indigenous Māori and Pacific Islander knowledge into evidence-based health policy.
The Health Promotion Agency will move into Health New Zealand and become a shared service across Health NZ and the Māori Health Authority. This will provide capability and expertise for the design and delivery of health promotion campaigns across the system.
The information the New Zealand Government has provided to educate its citizens about the new health system is available here.
An article in The Conversation is critical of the new reforms and states that, absent changes in the funding model, they will fail. There are many similarities to Australia in that the primary care is split off from hospital services and there are parallel public and private hospital sectors.
There is much for Australians to watch here as New Zealand changes the way its health system is structured and how health services are delivered, moving from regional control and delivery to a more centralised approach. In particular, the new PHA might serve as a model for the promised Australian Centre for Disease Control (and Prevention).
The new head of the HPA, Dr Andrew Old, talked in a recent media interview about how he sees managing the COVID-19 pandemic in the future. He also notes that he learned lessons from the former Public Health Commission which was closed down after just three years in operation.
This is reminiscent of what happened to the Australian National Preventive Health Agency back in 2015. That was an independent body, which gave it more room to criticise policy-making but less protection from a vindictive sugar, alcohol and tobacco lobby. Old sees being integrated inside the Ministry of Health as helpful.
Abortion in Australia
As I wrote in the July 27 edition of The Health Wrap, dreadful stories are coming out of the United States in the wake of the Supreme Court decision that overturned the constitutional right to an abortion. One in three American women have already lost abortion access and more restrictive laws are coming.
These stories have Australian women worried about how protected their rights are. An article in The Guardian outlines how abortion rights were so hard-won in Australia.
Speakers at the National Rural Health Conference held earlier this month highlighted the inequities in access to abortion across Australia, especially in rural and remote areas. These issues were covered in an article by my Croakey colleague Dr Amy Coopes which you can access here.
In July, an InsightPlus article in The Medical Journal of Australia highlighted Australia’s “abortion deserts”.
Ideally, women should have access to surgical abortion in their local health district through the local hospital and access to medical abortion through a GP in their local area. But outside of the major cities, that is very far from the reality. Currently only one percent of regional and remote GPs can prescribe medical abortion drugs.
Distance and lack of medical services are big barriers to abortion for many women; so too is cost. A surgical abortion is only partially subsidised by Medicare and the out-of-pocket costs can be as high as $800. The median out-of-pocket cost for a medical abortion is $560.
The article makes a shocking point: the SCOTUS ruling that seems so unfair puts the United States on a footing similar to Australia – no constitutional right to abortion, no national legislation, state control, access difficulties and a lack of “normalisation” of abortion.
The Croakey article quotes Dr Danielle Mazza who says abortion services should be an essential element of “comprehensive women’s health care” offered in primary care.
Zika babies – the forgotten virus
It’s now more than seven years since the Zika epidemic in Latin America, but it did not turn into a pandemic and, as outlined in an article in the New York Times, Brazil (where the epidemic originated and which saw the highest numbers of infections) and the rest of the world have moved on.
Left behind are the damaged babies born to mothers infected with the virus who were born with microcephaly, unusually small heads that highlight the devastating brain damage the virus caused while they were still in utero. It is estimated there are some 3,500 of these children in Brazil and most of them are now around seven years old.
The virus is still circulating at a low level in Brazil and elsewhere in Latin America, as well as in South and Southeast Asia. But attention and funding have dried up after the global concerns faded and other diseases came to the fore.
This has left families struggling to help their children and scientists unable to answer basic questions about the virus and the danger it could pose.
There are no current outbreaks of Zika, although a significant outbreak did occur in India in November of 2021.
Health experts have warned that a new outbreak could happen at any time, requiring only a single mutation to generate a new variant of the virus. The virus is transmitted by mosquitoes, so climate change could also affect the areas where infection is likely.
Research shows that by 2050, if nothing is done to combat warming temperatures, more than 1.3 billion more people will be living in areas where Zika can spread. Half of these people would face temperatures allowing Zika transmission year-round.
The best of Croakey
Recent stories have raised concerns about failures to protect children’s health from junk food marketers.
The good news story
August 13-21 was National Science Week in Australia. There’s always lots to appreciate but I especially enjoyed the fierce competition around two events:
1. The ABC’s bid to find Australia’s favourite native tree
Watch Dr Ann Jones and Paul West tell the stories of eight remarkable trees here on iView.
I voted for the snow gum, although it was a tough call as I also love red river gums – which were voted number one.
2. Cosmos magazine’s Australian Mammal of the Year poll
I was surprised it came down to the dingo and the southern bent-wing bat – with the winner being … (see here).
Personally, I voted for the mountain pygmy possum. But I loved the ardent lobbying from Professor Euan Ritchie!
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.