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The Health Wrap: shining a light on Indigenous health; welfare watch; secondary causes of ill-health; talking research

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


Shining a light on Indigenous health

Aboriginal and Torres Strait Islander people are big users of social media, with platforms like Twitter and Facebook being used for news, communications, and connections. However, this immersion may have a downside, given the constant flow of traumatic news, cautions Associate Professor Bronwyn Carlson in a recent article for Croakey describing her research in this area.

It is a timely caution with last week’s release of the latest national suicide data highlighting the need both for safe conversations and for more resources for suicide prevention, according to the Hunter Institute of Mental Health. (More details on the ABS data follow below).

Such concerns may become even more pertinent once the Royal Commission into the Child Protection and Youth Detention Systems of the NT gets underway. The ABC reports that the commission’s first formal public sittings will be held in Darwin from October 14 to 27, with more scheduled for mid-November and late December. Meanwhile, harrowing reports are emerging from a civil trial in which four teenagers who were held at the Don Dale Youth Detention Centre are suing the NT Government.

An article in The Guardian also focused on what coroner judge Greg Cavanagh described as “horrendous” levels of domestic violence in the NT, following an inquest into the deaths of two women. Mr Cavanagh said violence in Indigenous communities is “literally out of control” and women are living terrible lives and enduring horrifying deaths. He said:

In my view some of the answers are likely to be found in the significant social-economic disadvantage experienced by Aboriginal communities in the Northern Territory. All of those factors that go to make up that disadvantage are in the context of what is becoming a cycle of generational family violence.

Meanwhile, a new report from the Australian Institute of Health and Welfare (AIHW) has found more than a third of the burden of disease experienced by Aboriginal and Torres Strait Islander people is preventable, with tobacco and alcohol use, overweight, physical inactivity, high blood pressure and diet contributing to illnesses, The Guardian reported.

It was timely, therefore, to hear about the need to decolonise health promotion and to move away from a deficit-focus, in a powerful series of tweets by Dr Karen McPhail-Bell, guest tweeting at @WePublicHealth.  By contrast, she described the strengths-based, participatory approach of the Deadly Choices initiative, using role modelling of strong Indigenous identity and leadership.

On a similar theme, a new series on Croakey called Acknowledgement aims to shine a light on the role that health systems and professionals have played in the colonisation of Aboriginal and Torres Strait Islander peoples.

As part of the series, Croakey published an apology from the Australian Psychological Society, a call by Professor Alan Rosen for mental health professionals to make a global apology to indigenous peoplesan article describing the horrific history of Australia’s “lock hospitals”, where Aboriginal people said to have “venereal diseases” were incarcerated on two remote islands off the coast from Carnarvon, Western Australia, and a follow-up exploring in more detail what can be learnt from newspaper coverage of these histories.

In the wake of the APS apology, psychologist Professor Tim Carey told CAAMA radio about the need for more widespread cultural safety training for health professionals, and for greater support at policy and practice levels for self-determination.

Meanwhile, an interesting article in The Conversation outlined results from the purpose-designed Yawuru Wellbeing Survey, which looked at what is important for this community in living a good life, showing the importance of strong connection to country, culture, family, community and identity.

It provided lessons for researchers working in this field, highlighting the importance of co-production of knowledge to prioritise the voices and inputs of Indigenous communities to ensure the right thing is being measured and the outcomes are relevant and meaningful.

A recent paper published in Australian Health Review also looked at this issue, describing the role non-Indigenous researchers can play in Indigenous health research, according to a summary published on the Web CIPHER website.  The study authors said:

Fostering partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development and can promote and enhance the emerging field of Indigenous inquiry.

In a story from the Sax Institute website, two Canadian scholars describe their time as interns at the Sax Institute, and in an interview, one working with the Knowledge Exchange team described what she learned about the importance of partnership research for Indigenous health.

In an article republished at Croakey from The Conversation, Dr Chelsea Bond explored the power and strength of “the politics of refusal” as exemplified by Adam Goodes and others.


Health and welfare

Continuing a theme seen in previous weeks, the social determinants of health featured heavily in the news this fortnight.

Most notably was discussion around and response to Social Services Minister Christian Porter’s announcement of a welfare reform plan.

The Age previewed the Minister’s initial Press Club announcement, saying that the Government would target groups identified as being at risk of becoming reliant on welfare payments in the long-term: students, young carers and young parents.

The Australian reported (paywall) that new rules may see parents lose welfare payments if they do not send their children to school, a plan which Kirsten Hancock analysed for The Conversation, saying it would be unlikely to boost school attendance. She said:

Obstacles to school attendance can include transport access, parental disability or mental illness. Simply cutting welfare will not solve these problems.

However, she acknowledged that a carefully designed policy linking welfare and absence might be useful, but only with appropriate supports available for vulnerable families.

An article published by The Mandarin demonstrated that the idea behind the welfare package may not be as revolutionary as the Coalition has claimed, saying withholding funds is at odds with the idea of investing money now to help build capability for the future. It said:

It remains to be seen which tendency guides decisions about reform and spending — the notion of spending money on early intervention to help people avoid being locked out of the job market, or the desire to push people off welfare and hope it works out alright.

Health leaders writing at Croakey urged the health sector to engage in the welfare debate, citing the significant implications of such welfare reforms for the community’s health and wellbeing, health inequalities, and for healthcare systems.

The CEO of UnitingCare ReGen, Laurence Alvis, wrote for the Croakey website that the Government should be cautious about adopting approaches that are based upon simplistic understandings of complex issues, such as alcohol and other drug dependence, and that do little to address the structural and social determinants of health.

And in another article for Croakey, Miriam Vandenberg and Richard Eccleston explain why, despite the overwhelming evidence that inequalities in wealth, education and social status are strong influencers of health status, governments are slow to address them and instead focus on secondary causes such as smoking and diet. They cite, among other things, competing interests:

Politicians often talk about investing more in preventive health strategies but are all too often prevented from doing so by those who want every available health dollar invested in medical services.

Meanwhile, the latest Australian Bureau of Statistics report on causes of death in 2015 shows a concerning rise in suicides, with the number of Australians who took their own lives surpassing 3000 last year for the first time. ABC reports that while deaths from self-harm are three times more common for males than females, there was  26 per cent increase in the suicide rates among women. The report also showed that Aboriginal and Torres Strait Islander people are twice as likely to die by suicide as non-Indigenous people, with 152 deaths by suicide in 2015, up from 143 in 2014.

The Sydney Morning Herald reports that heart disease is still the leading cause of death, but dementia is now the second biggest killer, and the rate of deaths associated with the condition is growing.

 

Speaking of secondary causes of ill-health…

A new CSIRO report has found Australian diets are below the benchmark and worsening, with construction workers and junk food the main culprits, The Age reported.

Also on the topic of diet was a fascinating, worrying article for Medical News Today, which explored the growing-even-murkier associations between the sugar industry and research, that is said to have resulted in long-held nutrition advice around saturated fat as the main contributor to heart disease.

Along similar lines, a study published in the journal Circulation: Cardiovascular Quality and Outcomes described the lack of evidence to support the advice given to people with type 2 diabetes that they must tightly control blood glucose levels to prevent vascular complications such as kidney failure.

CBC News reported on the study, saying:

It’s a curious case of missing evidence. When a diabetes specialist searched the medical literature looking for proof to support the use of glucose-lowering drugs for Type 2 diabetes, he couldn’t find it.

A research paper published in JAMA found the use of wearable devices tracking physical activity failed to boost weight loss over and above standard interventions in a two-year randomised trial, according to an article on Med Page Today.

A study in BMJ found that people who carry a variant in the so-called “obesity gene”, FTO, react just as well to diet and exercise as those without it, according to the ABC.

And in more local research news, a new issue of NSW-based journal Public Health Research & Practice, out on 30 September, focuses on alcohol consumption and its effect on public health, covering topics such as liquor trading hours, prescribing of medications to reduce alcohol dependence and the prevalence of drug and alcohol issues among patients presenting to hospital emergency department. Read more in this Croakey article: Do trading restrictions reduce alcohol-related harms?


Around the world

A report from the recent Global Burden of Disease Study published in The Lancet found Australia was among the ten healthiest countries in the world.

According to The Sydney Morning Herald,  we received top marks for indicators associated with war, malnutrition, water access, sanitation and malaria but our result was dragged down by lower scores for suicide, alcohol, smoking, overweight, HIV, violence and disaster.

The SMH also covered another report, from the World Health Organization (WHO), that found 92 percent of the world’s population live in places where the pollution levels exceeded WHO limits, saying an estimated 3 million deaths each year were linked to outdoor air pollution, and that this rose to 6.5 million deaths in 2012 when indoor pollution figures were included.

In Indonesia this has been demonstrated starkly with news that toxic haze from forest fires may have caused 100,000 deaths.

In Finland, at a conference focusing on safety, a paper was presented showing helmets reduce the chances of a serious head injury by nearly 70 per cent, The Sydney Morning Herald said.

Good news from the Americas with the Pan American Health Organization announcement that they are the first region in the world to be free of measles, with no cases of the highly contagious disease originating in the Americas recorded in at least three years.

And The Washington Post has reported on new policies released by the US Government aiming to make findings from clinical trials of therapies and devices more widely available.

Meanwhile, the New Zealand Herald reported on surprising findings from a five-year study of 244,000 births, that showed babies born under midwife care had higher rates of adverse events than those whose mothers were looked after by doctors.


Talking research

Croakey looked at a new report by the Academy of Medical Science exploring how UK’s research environment should adapt to meet the complex health challenges the population will face by 2040. It suggests the need for reconfiguration of research so that it is far more transdisciplinary, and involves disciplines that would not usually be considered within the public health field.

Dr Diane Watson, former Chief Executive of the National Health Performance Authority in Australia, now Senior Adviser at the Sax Institute, wrote an opinion piece published in The Australian (and a longer version on the Sax Institute website) bout the importance of the accessibility of research, saying:

My experiences at the Bureau of Health Information in NSW and the National Health Performance Authority shows clearly that if evidence derived from big health data is going have the best chance of making a real impact, it must meet key criteria.

It must be credible and impartial, but the research also must be accessible, relevant to the intended audience and accessed by the right person at the right time.


Latest news in medical regulation

Journalist Marie McInerney covered the 12th International Medical Regulation Conference in Melbourne for the Croakey Conference News Service, providing wide-ranging coverage of the issues that keep medical regulators awake at night, including patient safety, cosmetic surgery and other burning questions, including some global challenges.

She also profiled a move towards proactive medical regulation – preventing fires as well as putting them out – as well as research suggesting patients should play a more active role in regulatory processes.


Other Croakey reading you may have missed:


Frances Gilham is the Digital Communications Manager at the Sax Institute. Follow @SaxInstitute or @francesgilham on Twitter.

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