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The Health Wrap: Playing politics; gun violence back on the agenda; action on addiction and more

This fortnight’s Health Wrap is compiled by Megan Howe, Publications Manager at the Sax Institute. Enjoy the Wrap and tweet us via @SaxInstitute if you have any ideas for future issues.


Playing politics

International politics have loomed late over the Australian federal election, with the shock vote last Thursday by the United Kingdom to exit the European Union in the much-watched #Brexit referendum.

As this Croakey story noted, the Leave campaign had ignited much anxiety over the future of the National Health Service (NHS) under the EU, but the British Medical Journal and 60 eminent medical leaders warned that exiting the EU would have major implications for healthcare and research.

How or whether the result affects the Australian poll remains to be seen, as the campaigns enter their final week.

Prime Minister Malcolm Turnbull on Sunday finally officially launched the Coalition campaign, announcing an investment of $192 million for mental health reform, including commitments on suicide prevention. He also  guaranteed funding for youth mental health services, including headspace and six Early Psychosis Youth Services, following earlier concerns raised by high profile psychiatrist Professor Patrick McGorry (watch his address here and Health Minister Sussan Ley’s earlier comments, published by Croakey here).

Minister Ley had earlier promised an overhaul of private health insurance, with policies to be categorised as gold, silver or bronze, depending upon what they cover, which Croakey’s Melissa Sweet said, in this article, may have the unintended consequence of reminding voters of inequities in access to healthcare.

Over the past week, both politicians and the media have been mired in the tit-for-tat over Medicare privatisation, overshadowing coverage of some significant new health policies.

After what some, including The Daily Telegraph, dubbed a “Medi-Scare campaign”, Prime Minister Malcolm Turnbull was forced to abandon plans to outsource the IT functions of Medicare, as reported by Croakey and ABC News Online.

“Every element of Medicare, every aspect of Medicare that is delivered by Government today will continue to be delivered by Government in the future, full stop,” he said. “Medicare will never, ever, ever be privatised.”

The debate continued, with The Australian reporting (paywall) that the Australian Medical Association (AMA) backed the case for fixing the “rusty” Medicare payment system, and ABC News Online reporting on new Labor claims that children’s vaccination records could be sold off to private providers under a conservative government.

Writing on The Conversation, Stephen Duckett, of the Grattan Institute, argued that the now ditched plans to outsource IT functions didn’t put Medicare at stake, but the increasing role of consumer co-payments were a greater threat to our national public health system.

Croakey pointed out that clarity on the issue hadn’t been helped by Federal Health Minister Sussan Ley’s failure to agree to a head-to-head debate with her Opposition counterpart Catherine King.

Meanwhile, major health policy announcements made in the past fortnight included Labor ‘s hospital and primary care policies, and Coalition plans to revamp the private health insurance sector.

ABC News Online reported that Labor had pledged to increase hospital funding by $2 billion more than the Coalition if elected, although according to The Guardian, the ALP backtracked on a promise to provide decade-long hospital costings because longer-term agreement would be dependent on negotiations with the states and territories.

A series of public health initiatives would be funded to the tune of $300 million over four years, Labor announced. As detailed on Croakey, the commitments include establishing 50 Healthy Communities, developing Australia’s first national physical activity strategy and introducing a national nutrition framework, as well as addressing harmful drinking through a national alcohol strategy.

The Australian reported (paywall) that the measures announced by Opposition leader Bill Shorten also included $80 million to halve suicide rates over the next decade, including establishing  12 regional suicide-prevention pilot programs in places with high suicide rates, including in at least three Indigenous communities.

The package of preventive health measures was welcomed by the Public Health Association of Australia.

The Coalition announced $25 million to improve the provision of domestic violence support services, including developing an Indigenous workforce in the sector, according to The Australian (paywall).

Health Minister Sussan Ley also revealed plans to revamp the private health insurance sector if re-elected, including the introduction of to easy-to-understand categories for insurance policies – such as “gold, silver and bronze”, ABC News Online reported.

Just over a week out from the election, Croakey asked a range of health experts to take a a detailed “health history” of the Abbott/Turnbull Government’s performance, as well as “screening” Labor and the Greens on  health policy and promises.

The Australian Healthcare and Hospital Association (AHHA), Australian Council of Social Service (ACOSS), Refugee Council of Australia, and the Climate and Health Alliance also released their political “scorecards”, as outlined on Croakey.


Indigenous policy

Labor’s shadow minister for Indigenous Affairs, Shayne Neumann, outlined the party’s policies on Indigenous issues, and responded to the historic Redfern Statement during a visit to the Redfern headquarters of the National Congress of Australia’s first Peoples (Congress), as detailed by Croakey.

He  acknowledged and welcomed the Redfern statement as, “a declaration of powerful and uncomfortable truths, that reflects upon our past and informs our future as a truly reconciled nation” and committed to reinvest c $57 million for Indigenous families and education centres over three years.

Bipartisan support for the Statement was vital to make real change to Aboriginal and Torres Strait Islander health, according to the Public Health Association of Australia.

One area critical to closing the gap in infant mortality rates between Aboriginal and non-Aboriginal populations is getting Aboriginal maternity care right, according to this article  published on The Conversation, which outlined why it is important to support Aboriginal women’s choice give birth on country.

“It’s safer to encourage and support all birthing choices than to silence women if choices are not respected,” the authors wrote.

ABC News Online reported that a new digital mental health screening program that aims to assess the social and emotional wellbeing of pregnant Aboriginal women is to be piloted in Western Australia. The tool is intended to be used for early intervention and as an alternative mental health screening tool to the Edinburgh Postnatal Depression Score, which may not be culturally safe or accurate among Aboriginal people.

The issue of Indigenous justice was also making news, with Julian Cleary from Amnesty warning that changes to the NT Bail Act would result in many more children, particularly Indigenous children, being locked up, in this open letter published on Croakey.


State of play

While eyes were firmly focused on the upcoming Federal Election, governments in Queensland and NSW handed down state budgets this fortnight, with implications for a range of health services.

In NSW, Treasurer Gladys Berejiklian  pledged a funding boost of almost $1 billion to drive the state government’s “hospital building boom”, treat more patients in emergency departments and tackle childhood obesity. But The Sydney Morning Herald reported that the NSW budget fell short of the projected funding needed to keep pace with the rising burden on the public health system and does not address the looming funding cliff.

In Queensland, health funding will be redirected to address clinical genomics, domestic violence, the threat of infectious disease in the tropics and the need for new models of care, according to The Australian (paywall), which reported that health workers would play a key role in the state’s $198.2m domestic violence response, with $2.1m over four years reallocated to establish high-risk teams and $700,000 for training next year.


Gun violence back on the public health agenda

The Orlando massacre has again put gun control in the political and media spotlight, with the American Medical Association labelling gun violence “a very public health crisis,” and pledging to actively lobby the US Congress to end a funding ban on federal health research into the issue.

“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” said Association president, Dr Steven Stack.

The Association’s position was supported by public health researchers in an article on The Conversation US, in which Sandro Galea, Dean of Boston University’s School of Public Health, wrote that as many people died from firearms as from car accidents in the US each year.

“This is clearly a public health issue, and one with a solution – the control of widespread gun availability. This approach has been shown to work in countries like Australia, ” he wrote.

But legal commentator Trevor Burrus, writing in Forbes, argued that gun violence was not a “public health crisis,” because, strictly speaking, “public health” deals with the provision and distribution of public goods, such as air and water, and “bullets do not float around in the air, randomly finding victims and then multiplying to infect more”.

CNN reported that the Orlando massacre had failed to prompt enough bipartisan support for the Senate to adopt new gun control measures that would have strengthened background checks and prevented suspected terrorists from obtaining weapons. A  protest by Democrats over their chamber’s lack of action on gun control later shut down the House of Representatives, earning praise from President Barack Obama, according to ABC News Online.

While US Federal funding for research into gun violence might not be forthcoming, the California Legislature allocated $US5 million toward the creation of a new research centre dedicated to providing data on the efficacy of current gun control laws, The Daily Californian reported.

Such data is emerging in Australia, with a  new research paper by Professor Simon Chapman and colleagues revealing the impact of the gun law reforms and buy back programs introduced by Prime Minister John Howard 20 years ago. From 1979-1996 (before gun law reforms), 13 fatal mass shootings occurred in Australia, whereas from 1997 through May 2016 (after gun law reforms), no fatal mass shootings occurred, and rates of all suicides and homicides in Australia had declined since the gun buyback policy, as detailed in The Sydney Morning Herald.

Writing on The Conversation, Professor Chapman said:

“When it comes to firearms, Australia is far a safer place today than it was in the 1990s and in previous decades. We have the leadership of John Howard to thank for this.”


Action on addiction

The consumer watchdog, the Australian Competition and Consumer Commission (ACCC),  is taking two e-cigarette companies to the Federal Court over allegations they misled consumers by claiming their products are not harmful despite allegedly containing toxic chemicals. The news was welcomed by health advocates, who argued it strengthened the case for proposed Victorian laws that would regulate electronic cigarettes in the same way as traditional tobacco products, The Guardian reported.

New research covered by medical website MedPage Today showed that teens using e-cigarettes were six times more likely to transition to smoking conventional cigarettes in early adulthood than those who never “vaped”.

But, this article on The Conversation UK argued that while the rising popularity of e-cigarettes could well result in a large population of long-term nicotine users who use e-cigarettes rather than smoking, it was likely most of those would be ex-smokers, producing a vast public health gain.

“We must be careful not to restrict smokers’ access to e-cigarettes, or over-state the potential harm of their use, if this will put people off making the transition from smoking to vaping. To do so would deny us one of the greatest public health improving opportunities of the last 50 years,” Professor Marcus Munafo wrote.

Looking at other drugs of addiction, The Guardian reported that the fourth Global Drug Survey revealed many Australians believed they were drinking too much alcohol and want help to drink less. The survey of nearly 5,000 Australians also suggested that the high and rising prices of drugs such as ecstasy and cocaine were not deterring Australians from using them.


Health and our environment

Former Australian of the Year Professor Fiona Stanley has written to all candidates from the major parties  ahead of the July 2 poll on behalf of Doctors for the Environment Australia, asking them to respond to four key measures, which she says are an “insurance policy” against the devastating impacts of climate change, Croakey reported.

The Climate and Health Alliance also released its pre-election scorecard, rating the major parties and media poorly for a lack of focus and debate on the potentially catastrophic risks of climate change to health.

While welcoming the renewed political focus on disease prevention following the release of the Prevention 1st election platform, Dr Liz Hanna, Visiting Fellow at the Australian National University and President of the Climate and Health Alliance, wrote on Croakey that the absence of any recognition of the greatest future health challenge facing humanity, that of global environmental degradation, was a glaring oversight.

Her comments came after it was revealed air pollution had become a major contributor to stroke for the first time, with unclean air now blamed for nearly one third of the years of healthy life lost to the condition worldwide.

An environmental health threat affecting coal miners,  deadly black lung disease, was also in the spotlight, with a new study finding that tougher coal dust monitoring standards are needed in Australia to prevent its spread. ABC News Online reported that in Queensland, there are seven cases of the disease which was thought to have been eradicated three decades ago.

Another major threat to our future health, antimicrobial resistance, was brought to the fore with the release of the Australian Commission on Safety and Quality in Health Care’s landmark report outlining the most comprehensive picture of antimicrobial resistance, antimicrobial use and appropriateness of prescribing in Australia to date.

Professor John Turnidge, wrote on Croakey that the report contained important messages for both healthcare providers and consumers on what actions we can take now to limit the increase in antimicrobial resistance in Australia.

“High and inappropriate antimicrobial use has accelerated the process of increasing resistance worldwide, including in Australia,” he warned.

Concerns were also raised that Australian nursing homes are contributing to the creation of superbugs, with ABC News Online reporting on findings that antibiotics were being inappropriately prescribed in up to 20 per cent of cases.

Finally, in some good news, we learned that your morning coffee won’t kill you – as long as it’s not too hot. The Guardian covered the news that the  World Health Organisation has cleared coffee of causing cancer, but a detailed investigation found that very hot drinks may be linked to cancer of the oesophagus, or gullet.


Other Croakey reading you may have missed this fortnight:

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