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The Health Wrap: Summer dangers; Health politics; Deadly doctors; Smog in the city

The first Health Wrap of 2017 is compiled by Barry Dunning, Communications and media manager at the Sax Institute. Enjoy the wrap and don’t forget to tweet us @SaxInstitute if you have any ideas you’d like to share.

Summer time and the living is dangerous

When Christmas, school and work holidays and the summer sun combine, it should be an opportunity for some well-earned rest and relaxation. But this year the holidays have been a time of danger in the water, on the road and even at the backyard BBQ.

The annual Aussie tradition of spending as much of summer time as possible in the water –  whether that’s the sea, a billabong or a backyard inflatable – has been rocked by an epidemic of drownings, particularly in NSW.

Since Christmas Day, at least 18 people have drowned in NSW, including three toddlers and, as reported by Sky News, former NSW Family Court Judge Richard Gee.  NSW Emergency Services Minister David Elliott offered the following sensible and important advice:

If you don’t know that your (swimming pool) fence is childproof, fix it. If you don’t know that a river is going to be running a current underneath it, don’t go into it. If you don’t know that a surf is safe, don’t enter the surf.

The spate of drowning also prompted water safety advocates to call for NSW to introduce mandatory swimming lessons in primary schools, amid concerns that some families can’t afford private  swimming lessons, as reported by The Sydney Morning Herald.

Out on the highways and byways of Australia, there has also been a horrific toll of tragedy, with 41 people killed on Australia’s roads over the Christmas and New Year holiday period, running from 23 December 23 to 3 January.

According to News.com.au, the worst day for road deaths was 27 December, when eight people died in road smashes, including a nine-year-old boy. Last year was a grim one on the roads, with road deaths rising for the second year, reaching almost 1300 in 2016, according to The Guardian. This ongoing tragedy touches every community and corner of the country. Stay safe out there.

If all that wasn’t scary enough, it’s also high season for mosquitoes, with mozzies invading backyards, bushwalks and water courses. For those traveling overseas, the risks are even greater with Zika, dengue and malaria a clear and present danger.

On The Conversation, Dr Cameron Webb has some good advice on which mosquito repellents are safe and which ones actually work. Dr Webb’s advice, which was also published in the latest edition of the Public Health Research & Practice journal, gives a big tick of approval to repellents containing DEET,  picaridin or ‘oil of lemon-eucalyptus’, and a warning to skip the “home-made”  repellents, or wristbands and patches – as they don’t work. He advised:

Some people are reluctant to use  “chemical” repellents and feel anxious about perceived health risks.

However, these products are used billions of times every year with very few reports of skin irritation or other adverse outcomes. You’re at far greater risk (from mosquito-borne disease) by not using these products…

Some “home-made” repellents containing essential oils can irritate the skin, so stick with products that are registered with the Australian Pesticides and Veterinary Medicines Authority.

Extreme weather events are also becoming an increasingly common summer experience, as is graphically shown by the Bureau of Meteorology’s latest annual climate statement. Watch the BOM clip at Croakey.


Deadly doctors and deadly ears

In more positive news, the ABC reported on the successful graduation of two new Indigenous doctors, Dr Lisa Waia and Dr Patricia Murphy,  from James Cook University in Townsville, just before Christmas. Dr Waia told the ABC that becoming a doctor and helping her community was something she’d been set on for many years:

I want to give back to my community and I want there to be equality across our nation in health, education and every aspect. Growing up in Indigenous communities you see the discrepancies in healthcare.

While their graduations are great news, there is a huge job of work to be done on this front. The same ABC report also noted that Department of Health figures show that only 261 out of the 85,510 medical practitioners employed in Australia in 2014 identified as Aboriginal or Torres Strait Islander. Reaching parity with their non-Indigenous counterparts would require approximately 2300 more Indigenous doctors.

The challenge to increase the number of Indigenous doctors in Australia even made news across the globe in India, with The Wire covering the empowering story of Vinka Barunga, from the Worrara tribe of the Mowanjum Aboriginal community via the remote town of Derby in Western Australia. She told The Wire of her determination to become a doctor and to be part of positive changes in her community:

One really can’t put a price on what Aboriginal doctors will bring to an Indigenous patient’s experience of hospital, of their illness and of healing. A bit of social and emotional support can work wonders. Having more Aboriginal doctors is definitely going to have a positive impact on Aboriginal and Australian health.

Sticking with positive news, Sydney’s Sun Herald dedicated its front page story the week before Christmas to a program which gives urban Aboriginal children in NSW access to surgery and therapy to prevent otitis media and hearing loss.

As Croakey has covered on numerous occasions, the rate of ear disease and hearing loss among Indigenous Australians is 10 times that of the non-Indigenous population. Hearing infections left untreated can lead to hearing loss, speech and language delays, and can severely impeded kids’ ability to thrive in school.

Since the NSW Health-funded Hearing Ear health And Language Services (HEALS) was established in 2013, more than 800 kids have received ear nose and throat surgery or speech and language therapy, making a life-changing difference to these kids and their families.

Australia’s first Indigenous ear, nose and throat surgeon, Dr Kelvin Kong, speaking to the Sun Herald, explained the lifetime impact of untreated otitis media:

I looked after a 40-year-old Aboriginal gentlemen who had maggots in his ears. He was dishevelled, unemployed, he had been in and out of jail and he had maggots. In an urban centre. We’re not talking about out in some regional area. It’s disgraceful. I wonder if we met this gentleman when he was two years old and got him educated, could he have avoided the incarceration and the social injustices he endured.

While the HEALS program is making progress in NSW, the scale of the problem remains enormous. This issue was the subject of an opinion piece in The Australian (paywall) by the President of the Australian Society of Otolaryngology Head and Neck Surgery Dr Chris Perry.

Dr Perry pulls absolutely no punches in a piece that is well worth a read, finishing off on a note of optimism about a new campaign that will be launched this year on this issue:

The Ear Health for Life campaign… will draw together stakeholders from the health, social services, education and government sectors. It will raise awareness of this terrible problem, encourage preventive and early intervention action, and advocate for a co-ordinated national approach.

A nationally co-ordinated, evidence-based, benchmarked and multi-level response to the devastating rates of Aboriginal ear disease will boost Australia’s ability to close the gap. Join us in making this the year of ear health for all.

Finally, there have been calls for a dedicated shingles vaccine program to cater for Aboriginal and Torres Strait Islander people. Dr David Corbet and Dr Jenny Royle write on Croakey that the needs of Aboriginal and Torres Strait Islander people are not being met because there is not an Aboriginal and Torres Strait Islander specific program in the National Shingles Vaccination Program announced last year. Check the article out here.


Starting gun fired on health politics

On the political front, 2017 has begun with a push from the Federal Health Minister Sussan Ley to make significant changes to private health insurance.

Citing extensively from the private health ministerial advisory committee minutes and what appear to be high-level Government sources, The Australian (paywall) reported on what it described as a “radical plan”, whereby health fund members in regional and remote areas would be given larger Medicare payments or more generous insurance sub­sidies to compensate for a lack of services.

However, Australian Medical Association vice-president Dr Tony Bartone told The Sydney Morning Herald that making sure there was easy access to services was a higher priority, and urged greater investment in rural and regional facilities and action to ensure the appropriately trained workforce was available.

Earlier, The Australian (paywall) also reported on a Government plan to “streamline thousands of private health insurance policies into simple gold, silver and bronze categories as early as next month”, amid mounting pressure to help members find a better deal… to navigate the ‘murky world’ of policy variation.

Rising premiums, which are expected to increase again in April by an average of 5 per cent, are forcing an increasing number of health fund members to reduce or amend their cover. The scale of this is apparent, with The Australian reporting that exclusions are now found in 38.1 per cent of hospital insurance policies — compared with 27.3 per cent just three years ago

To round off this extensive coverage, The Australian also penned an editorial on the issue, offering broad support for some of the Government proposals, together with a wholly unsurprising call for wide-scale reform of the system.

Any reform that assists (private health insurance) members to find a better deal makes sense. Our universal system relies on a public-private funding mix and it is in the government’s interest to ensure private insurance remains an attractive option for those who can afford to help pay for their healthcare through individual effort…

The minister and her private health ministerial advisory committee are to be commended for their courage in looking at radical ideas. In the end, however, spiraling costs must be addressed by tackling over-servicing by doctors and inefficiencies in our public hospitals. The system is not sustainable without reform.

Given the scale of the coverage of the issue in The Australian this week, it’s clear the publication intends to push the barrow on this issue in 2017.

Croakey has also been looking at private health insurance issue over the past month, with this article by Dr Peter Sainsbury calling for an end to public subsidies of the industry, and another piece by Associate Professor Lesley Russell exploring the impact of private health insurance on equity and access in specialist healthcare.


Warning signals over NDIS

Sticking with national health issues, the ABC reports on ‘grave concerns’  surrounding the National Disability Insurance Scheme (NDIS) if the problems in the ACT are repeated on a national scale. ABC Social affairs correspondent Norman Hermant reports that:

In the ACT enrollment in the NDIS may eventually be 35 per cent more than originally estimated, participants are experiencing a shortage of support workers, the NDIS web portal continues to frustrate users and some care providers say the rates they are being paid by the scheme make it unsustainable.

The NDIS stopped enrolling new participants in the ACT last September because it had already reached the target estimate of participants. According to the ABC, if the estimates of participants are out across the country, it could call into question the basic assumption of the NDIS — that 460,000 participants are expected on full rollout out in 2019, with a budget of $22 billion.

Of course, none of these concerns will come as a surprise to avid Croakey readers, with the #CripCroakey series covering concerns surrounding the NDIS months ago. If you missed this one, start here.

Meanwhile, the recent Centrelink debacle, in which a litany of “inhuman errors” has caused many thousands of people distress and anxiety, is a reminder that chronic stress is a profoundly important threat to health and wellbeing that is often under-recognised and poorly understood, according to a Croakey #LongRead by Dr Matt Fisher, a Research Fellow at the Southgate Institute for Health, Society & Equity at Flinders University in Adelaide.

Also on Croakey, there is a must-read article on the gaming of hospital waiting lists and the desperate need for reform. University of Western Australia academics Professors Marc Tennant and Estie Kruger take us through the realities and realpolitik of waiting lists. For those who don’t work directly at the coal face, this one is a real eye-opener.


Bye bye OTC codeine

Shortly before Christmas, the Therapeutic Goods Administration made a decision that painkillers containing codeine, such a Nurofen Plus, will no longer be available over the counter from February 2018.

As reported in The Guardian and many other media outlets, there are already limits or bans on the sale of codeine over the counter in the US, most of Europe, Hong Kong, Japan and UAE.

The decision has long been a contentious one, with doctors welcoming the move but pharmacists opposing, saying it will clog up GP clinics and increase health costs, without effectively identifying those addicted to the drug. Given the extensive publicity (some would say hysteria) surrounding Australia’s ice epidemic, the impact of prescription drug abuse has often flown under the radar.

In America, prescription drug abuse is a full-blown epidemic. As reported by The Washington Post, opioid overdose deaths in the US surpassed 30,000 in 2015. While some of these deaths are now linked to heroin, they almost all have their roots in prescription drug abuse, particularly the notorious drug oxycontin. The paper reports:

Much of the current opioid predicament stems from the explosion of prescription painkiller use in the late 1990s and early 2000s. Widespread painkiller use led to many Americans developing dependencies on the drugs.

When various authorities at the state and federal levels began issuing tighter restrictions on painkillers in the late 2000s, much of that demand shifted over to the illicit market, feeding the heroin boom of the past several years.


Smog and the City

At home and abroad, pollution and smog remain a big issue. Here in Australia, the Sydney Morning Herald reports that atmospheric and respiratory specialists have slammed Australian fuel quality and emissions standards as “appalling”.

These doctors and health experts criticised a government review of vehicle emissions and air pollution for under-reporting the health risks, sidelining the Minister for Health, and potentially putting thousands of Australians’ lives at risk. According to the SMH, a Government reviewed release just before Christmas:

Acknowledges 1483 premature deaths in 2012 were due to outdoor air pollution (a sharp increase from 882 in 2005), about half of which could be attributed to road transport pollution. It indicates the cost to the Australian economy from these premature deaths at $7.8 billion…

But environmental scientists say these figures are understated, with one study estimating around 3000 deaths a year in Australia are attributable to air pollution. They say the government’s modelling also overlooks recent research and extrapolates from OECD data in ways that may significantly discount the current Australian health costs and contribution of pollution to local mortality and morbidity rates.

Air pollution is a serious concern in Australia, but thankfully it is not yet a total crisis. Other parts of the world are not so lucky.

The Guardian reports that millions of people in China rang in the New Year shrouded in a thick blanket of toxic smog, causing road closures and flight cancellations as 24 cities issued alerts that will last through much of the week. For much of the past decade, Chinese cities have battles toxic fog caused by cars, heavy industry and climate change.

Earlier in December, Paris and London were shrouded in toxic smog and many developing cities like Lahore and New Delhi experience this on a frequent and deadly basis.

If there is one sliver of good news, it’s that the scale and visibility of the problem is forcing some countries to take radical action, such as planning to ban diesel cars, offering free public transport, and increasing solar generation.


Catch up on Croakey

There’s been some amazing end-of-year and best-of wraps from Croakey, which if you missed first time around you should definitely check out:

 

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