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The Health Wrap: public health, women’s health, mental health, Indigenous astronomy, and much more

In this latest edition of The Health Wrap, Associate Professor Lesley Russell updates readers on a slew of recent reports and other articles, ranging from obesity to women’s health rights, and also some suggestions for what Australian health reformers might learn from the United States military.


Lesley Russell writes:

A number of reports out this month highlight (yet again) the impact of growing rates of obesity on the health of Australians.

The WHO Non-Communicable Diseases country profiles 2018 shows that Australia has such a long way to go to meet the WHO global targets for obesity (see the figure below).

If you want to be depressed about where we are headed, there’s much more specific data about overweight and obesity in the Australian Institute of Health and Welfare (AIHW) report released in 2018 A picture of overweight and obesity in Australia 2017.

There are consequences, as the Australian Burden of Disease Study 2015 (despite the date, just out from the AIHW) demonstrates (see the graphic below).

The report finds that 38 percent of the burden of disease could have been prevented by removing exposure to risk factors such as tobacco use, overweight and obesity, and dietary risks.

Of course obesity was an issue at the recent Public Health Prevention conference. Read Croakey coverage here, along with Croakey’s collation of responses to Health Minister Greg Hunt’s announcement (at long last!) of the development of a National Prevention Strategy and Professor Anna Peeters’ piece on what we must get right in developing this strategy.

This latest Croakey article includes both analysis of the AIHW’s Burden of Disease study and comprehensive tweets from the conference.

As an aside, if you’ve been reading my writing for a while then you know that I have often promoted the approach taken by the National Prevention Strategy established under Obamacare – and now sadly languishing under Trump. Dr Corinne Graffunder from the CDC, who was a keynote speaker at the PHP conference, worked closely with us in the Office of the US Surgeon General on the development and implementation of the NPS.

In an article on the ABC News website, Terry Slevin (the Chief Executive of the Public Health Association of Australia) and a number of overseas experts made a strong case that the Government must do much, much more to tackle obesity. This includes effectively targeted education and awareness campaigns and well-funded, multi-faceted prevention strategies.

Meanwhile, an obesity expert is calling for greater regulation of weight loss programs, warning that the “anecdata” used to market such plans is seeing Australians diet themselves larger.

Dr Nicholas Fuller, director of the clinical obesity program at the University of Sydney’s Charles Perkins Centre, has recently called for greater regulation of weight loss programs, warning that they market through what he calls “anecdata” rather than clinical studies.

He has suggested a star-rating system for weight loss programs and products, including meal replacements and food delivery services, available online to be accessed by both patients and health professionals.

There was an announcement on June 11 that the Food and Agriculture Organisation of the United Nations and the World Obesity Federation have joined forces to promote healthier diets and sustainable food systems to curb the worrisome levels of obesity and overweight around the world.

The statement noted: “Simply asking individuals to change their behaviour cannot be very successful if the environment where they live and work continues to promote unhealthy habits”.


On NCDs, what could Australia learn from the US military?

Recent editions of The Health Wrap have had a lot to say about health crises due to (preventable) chronic conditions such as obesity, diabetes, opioid abuse, pain, depression and suicide.

A recent discussion piece in The New England Journal of Medicine makes the case that what is needed to deal effectively with chronic diseases and the current and next crises is a redesign of the healthcare system.

Not a new argument – but one that needs to be made again and again.

To my mind, the value of this article is its focus on how the healthcare system can tackle these problems and better integrate health and wellbeing alongside medical approaches.

It is important to address this in the Australian context because currently responsibility for every chronic disease crisis is dumped on the shoulders of the medical profession, who are constrained by a system that does not address the root causes. Consequently, costs are going up, outcomes are not improving and may be getting worse; the value of healthcare for producing health is declining.

The article goes on to outline the efforts to radically redesign the healthcare systems run by the US Department of Defense (DoD) and the Veterans’ Health Administration (VHA) to provide whole person and integrative care. Together these systems care for some 20 million Americans and (although no-one in the US would admit this) are almost the ultimate in socialised medicine.

It is anticipated that when fully implemented, the “Whole Health” approach, which involves proactive population health management, will see a 24.5 percent increase in access without the addition of further hospital beds or medical staff. It is conservatively estimated that the approach will return $2.19 on every dollar invested over six years.

It’s true that there have been some awful stories about the failures of the DoD and VHA health care systems, but this article definitely offers food for thought for Australian policy makers.

Because DoD and VHA provide total care for soldiers, veterans and their families, they are well placed to recognise and cost out the value of early investments in health as opposed to later, more costly spending in healthcare. Indeed, when I was working in the US on the National Prevention Strategy, the DoD was perhaps the most enthusiastic partner.

You can read more about the DoD’s health program here.  (Sadly I note that the link on that page to the National Prevention Strategy now goes nowhere – thanks Trump!). There is more information about the VHA program here.


Women and heart disease

This past week saw the Heart Foundation’s second Women and Heart Disease Forum (check out the tweets by following the hashtag #WHDForum2019).

Quote of the week was surely this: “Women’s heart disease is not a women’s problem, it is a societal problem”.

The forum coincided with the release of new data from the Australian Institute of Health and Welfare highlighting the impact of heart disease on Australian women.

Almost five percent of women aged 18 and over have one or more heart, stroke and vascular diseases and cardiovascular disease (CVD) caused three in ten deaths in 2016. Indigenous women are more twice as likely as non-Indigenous women to have CVD.

More must be done to prevent and treat CVD. Sadly, all that the recently released National Women’s Health Strategy 2020–2030 calls for is a campaign to promote awareness of the different risks for and symptoms of CVD in women.

Much is made of the fact that women don’t present with ‘typical’ symptoms of heart disease (although I think this is a way of saying they present with symptoms that are atypical for men but typical for women!) but now engineering studies are showing that the size and shape and structure of the heart and coronary blood vessels differ between the sexes.

But, as the AIHW resport points out, many chronic conditions, including CVD, share common risk factors that are largely preventable, such as tobacco use, risky alcohol consumption, overweight and obesity, physical inactivity, and high blood pressure. That promised National Prevention Strategy can’t come soon enough!

Finally, as highlighted at the Forum, more must be done to get more women into the field of cardiovascular medicine.


Paying attention to Indigenous aged care needs

This week, the Royal Commission into Aged Care Quality and Safety has turned its attention to aged care in remote areas. Hearings in Broome are looking at issues of access and inclusion, and the unique care needs of Indigenous Australians.

An article in The Conversation from Tony Broe reminds the Commission (and the Government) that the majority of Indigenous Australians do not live in remote areas, and aged care policy must consider the diversity of circumstances and needs of older Indigenous people across all locations.


Don’t miss these articles from Inside Story 

My colleague Jennifer Doggett has done a magnificent job of presenting the case around why mental health funds are so poorly targeted in The Personal and the Political.

She makes the case that Health Minister Greg Hunt’s professed desire to improve mental health services will require a willingness to challenge the way mental health care is funded and delivered.

“Australia’s provider-centred, episodic model of healthcare needs to be abandoned in favour of a coordinated consumer-focused system that works across jurisdictional and sector boundaries and prioritises patients with the greatest need.”

The article is also cross-posted at Croakey, together with this response from Professor Pat McGorry.

Neil Westbury and Michael Dillon, in an article entitled Indigenous Affairs: how we’re choosing by not choosing, point out the costs of continuing delay in substantive constitutional reform for Australia’s First Nations, noting that the implications affect not only Indigenous Australians but the nation as a whole.

This article is based on a Policy Insights Paper, Overcoming Indigenous exclusion: Very hard, plenty humbug, written by the authors for the ANU Centre for Aboriginal Economic Policy Analysis. The Mandarin described this as “a scathing assessment of Indigenous policy”.

As there is increasing focus on the inability of many women in Australia to be able to access abortion services (women in rural areas, women in Tasmania) this piece from me, Trump (and Pence) versus women’s health, highlights how American women’s rights and access to reproductive health services, including abortion, is being undermined under the Trump Administration.

While what is happening in states like Alabama is shocking, so is the fact that some Australian women don’t fare much better.

This is especially true for Indigenous women in remote areas, for whom the nearest clinic is a plane ride away. Figures from Marie Stopes Australia show that just 0.2 percent of regional GPs are trained to administer RU486 – the drug used in medical abortions.

This slide presentation outlines the limitations on Indigenous women’s equitable access to affordable and appropriate pregnancy and fertility choices.


Other recent reports of note

UNICEF Australia. Building Better Business for Children

An interim national baseline assessment of Australia’s policy and law shaping business activities that impact on children.

The report highlights several significant gaps in Australian policy, law and practice that leave children and carers vulnerable to adverse impacts of business activity, and potentially without remedy when these occur. These include:

  • Weaknesses in the regulation of marketing and advertising of unhealthy foods and beverages
  • Inadequate protections against child labour
  • Australia’s relatively limited paid parental leave scheme, and
  • Limited financial security for employees and their children experiencing domestic and family violence.

CSIRO. Australian National Outlook 2019

This report states that it’s guided by one question: What will Australia look like in 2060?

It signals that Australia will face decline unless it takes action on the significant economic social and environmental challenges currently facing the nation.

I like the report’s focus on the need to rebuild trust in government, business and media and to do more towards social cohesion.

I was somewhat shocked to find no mention of water policy anywhere, despite the attention given to climate change, the environment and preserving biodiversity.

ANAO. Evaluating Aboriginal and Torres Strait Islander programs

The Australian National Audit Office findings about the Department of the Prime Minister and Cabinet’s implementation and management of the Indigenous Advancement Strategy Evaluation Framework finds this is only partially effective and faces “substantial delays”.

Five years after the introduction of the IAS, PM&C is still in the early stages of implementing an evaluation framework.

You can read what PM&C had to say in 2017 about the high standards they intended for the Evaluation Framework here.  Then sigh because to date these are just fine words, unsupported by commensurate actions.

The Morrison Government has recently proposed a new agency within PM&C to manage Indigenous programs. This is likely to slow things down even more, at least in the short term.

Social Ventures Australia: SVA Perspectives: mental health

This is an evidence-informed perspective on what SVA believes is required to reduce the incidence, prevalence and impact of mental ill-health.

There is little that is new in this report, but there are some good case studies and it does make a strong case for ensuring that the voice and participation of people with lived experience of mental ill-health is embedded in all elements of program, service and policy design.


The good news – Indigenous astronomy and space

I’ve just discovered the Australian Indigenous Astronomy website. Lots of reading to do before I head off to hike the Larapinta Trail at the end of August!  This is really a fabulous resource. You can follow on Twitter @AboriginalAstro.

Teachers and educators can access resources for incorporating Indigenous astronomy into learning about science, mathematics, the arts, humanities and health via the University of Melbourne Indigenous Education portal.

And how good to know that the University of Melbourne has an academic appointee in Indigenous astronomy, Associate Professor Duane Hamacher (please let us know of other such appointments elsewhere).

And, in a recent announcement: Indigenous Australians are expected to become participants in the global satellite and space industry with the building of a ground station in Alice Springs – the first development of its kind on Aboriginal-owned land in Australia.

The picture is of an antenna currently on the Alice Springs property painted by local Arrernte artist Roseanne Kemarre Ellis.


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.

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