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The Health Wrap: The politics of health, STIs among Indigenous communities, IVF technology success, policing portion sizes and trans fats, US Presidential campaigns and research into depression

This fortnight’s Health Wrap is compiled by Ellice Mol, the Sax Institute’s Digital Communications Manager. Enjoy the Wrap and tweet us via @medicalmedia or @eleechimo if you have any ideas for future issues.

The politics of health

We start the wrap by acknowledging the biggest news of the fortnight – the emergence of Malcolm Turnbull as our new Prime Minister after last week’s dramatic #libspill.

But Croakey’s Michelle Hughes writes that it appears unlikely there will be much change in the political approach to public health issues under the leadership of the new Prime Minister, especially in relation to the Government’s Direct Action policy on climate change, if his first press conference is any indication.

As an announcement of the new cabinet was awaited, Croakey raised the question of whether all MPs, and especially government ministers, should be expected to undertake cultural safety training as part of their induction into Parliament, in the wake of #boomgate – the widely reported comments of Immigration Minister Peter Dutton – a former Health Minister – joking with the Prime Minister about climate change, as well as “Cape York time”.

One of the new PM’s first duties has been to sign the National Disability Insurance Scheme agreement, alongside NSW Premier Mike Baird and Victorian Premier Daniel Andrews, ABC Online reported. The report said the deals would cover 140,000 people, which is more than half of all Australians expected to be eligible for the NDIS once it is rolled out completely.

This fortnight, 9News noted that the first $1 billion had been delivered into former Prime Minister Tony Abbott’s Medical Research Future Fund, after laws to create the fund were passed in Parliament in August. Initially the independent National Health and Medical Research Council (NHMRC) was to be tasked with distributing the money from the fund, but under the legislation, an expert advisory committee will be set up to decide who gets the money. The controversial fund was previously dubbed a a $20 billion political ‘slush fund’ by Labor, and according to ABC News, Labor’s health spokeswoman Catherine King still has concerns about how the funds will be dispersed.

Meanwhile, the push to reform the health system continues, with The Australian reporting (paywall) that the Australian Medical Association has won an early concession out of much-anticipated Medicare reforms, after the head of the task force that is reviewing the Medicare Benefits Schedule (MBS) agreed any changes should be staggered to protect doctor and practice incomes. Professor Bruce Robinson’s comments came after he said a quarter of the services listed on the $21 billion MBS were not supported by evidence, while about 30 per cent of all healthcare treatments would be of little benefit to patients.

And health experts are debating the merits of any change to the current fee-for-service model of GP payments, following Federal Health Minister Sussan Ley warning that Australians would suffer if primary care reforms targeting chronic disease were not implemented. This article on Croakey outlined the challenges of a capitation model for patients with chronic disease, saying there were significant legal, constitutional, economic and practical barriers to overcome before such a model could be introduced into the Australian health system.

In NSW, Premier Mike Baird has rewritten his predecessor Barry O’Farrell’s state plan, to narrow the focus to a dozen key targets including tackling childhood obesity and reducing domestic violence, The Sydney Morning Herald reported. According to the report, Baird’s new document, ‘NSW: Making It Happen’, has dramatically reduced the number of targets that measure the government’s performance and has locked in the target of 81 per cent of people attending a hospital emergency room staying four hours or less, down from the 90 per cent target agreed to by the Council of Australian Governments.

*******

Research in action

Research that has made an impact on public health policy was recognised this week, as four NSW researchers whose work has changed the way we design and deliver healthcare  were honoured at the Sax Institute’s inaugural Research Action Awards.

The awards came as the recent Population Health Congress heard that public health advocates who take on powerful opponents often face a heavy price, whether as individuals who are intimidated, or as organisations that have to put valuable resources towards fighting vested interests. As reported on Croakey, the panel of public health masters gave many tips: find allies, use the right evidence, listen to others, share lessons and resources, and “just keep at it”.

Croakey also reported that the Congress heard a “tale of two countries” , where a stark contrast emerged between ground-breaking legislation in Wales that “locks health prevention into the whole of government” and Australia’s cuts to prevention and health promotion. The Welsh Well-being of Future Generations Act, described by the Wales Chief Medical Officer Dr Ruth Hussey, means that any public body or government must incorporate the environment, health and social principals into their decision making.

******

Concern over STI rates in Indigenous communities

The Kirby Institute’s annual surveillance report has revealed the number of cases of HIV, hepatitis C and other sexually transmitted infections are increasing in Aboriginal and Torres Strait Islander communities, despite declining or stabilising in the broader population, The Sydney Morning Herald reported.

The rate of HIV diagnosis among Indigenous people has reached 5.9 per 100,000, compared with 3.7 per 100,000 for non-Indigenous Australians, the report showed. The authors said there had been an increased effort to make testing more attractive, and the report showed substantially more people were being tested for HIV nationwide, which may account for the increase.

In a win for Indigenous health in the Bega and Eurobodalla shires in southern NSW, a $12,500 grant provided by the IRT Foundation will fund a new project that aims to provide Aboriginal Elders with culturally sensitive information on dementia risk, reported Australian Ageing Agenda. According to the article, dementia is three times more prevalent among the Aboriginal and Torres Strait Islander population aged over 60 compared to the general population. The new project is just one method that aims to bridge the gap.

At the 2015 Australian Indigenous Doctors Association’s (AIDA) annual conference in Adelaide last week, the Royal Australasian College of Surgeons (RACS) renewed its call to increase the number of Indigenous medical graduates training as surgeons, Scoop reported. RACS Dean of Education, Associate Professor Stephen Tobin, said despite the many disadvantages faced by many Indigenous Australians, the college was well poised to help grow a specialist Indigenous workforce.

Meanwhile, Prime Minister Malcolm Turnbull was urged by Indigenous Advisory Council head Warren Mundine to continue Tony Abbott’s focus on Indigenous affairs, ABC Online reported.

*******

IVF technology success

Medical news website 6minutes (registration required) has reported on new findings that show an increase in the birth rate for frozen embryo transfers in the five years to 2013 which suggests the success rate now matches that of fresh embryo IVF cycles.

However, a woman’s advancing years remain an impediment to IVF success which, according to the Australian Women’s Weekly, has prompted experts to call for women over 40 who publicly announce their success with IVF to declare whether their success was aided by the use of a younger donor egg.

“When a woman’s using her own eggs, the pregnancy rate become very low as a woman approaches her mid-40s and is effectively zero by 45. And that is really corrected by the use of younger donated eggs,” Fertility Society of Australia president Mark Bowman told the Australian Financial Review in an effort to highlight the social challenge of helping women over 40 conceive.

Meanwhile the The Sydney Morning Herald reported that a leading fertility specialist has called on the NSW Education Department to introduce the subject of egg-freezing technology to students aged over 16.

*******

Policing portion sizes and trans fats

Journal Watch on Croakey looked at an Australian study that compared the typical portion size of a variety of foods served by adults and children to serving sizes specified in the Australian Guide to Healthy Eating (AGHE). The study revealed a mismatch between guidelines and the mean typical portion sizes served by both parents and children for all foods, except for soft drink and milk. Some suggest the disparity is the reason for the ‘obesity epidemic.’ The Australian Financial Review reported on new research published in the University of Cambridge’s Cochrane Database of Systematic Reviews that produced conclusive evidence that people consume more food or non-alcoholic drinks when offered larger portions or when they use larger items of tableware. The researchers say policies that successfully reduce the size and appeal of larger portions could reduce the quantity of food people consume.

The Guardian reported on a UK study that suggested a ban on the use of trans fatty acids (TFAs) in processed foods in England could save 7,200 lives by 2020 by cutting heart disease. The researchers say that eliminating TFAs from processed foods such as cakes and biscuits is an achievable target for public health policy, sparking a row over the prevalence of trans fats. A spokeswoman for the Food and Drink Federation, which represents food manufacturers, said the UK government had already concluded that current intake levels of TFAs did not pose a health risk to consumers.

A timely call for food systems change in health was also delivered by Melbourne doctor and global non-communicable disease campaigner Alessandro Demaio at the recent Population Health Congress. He called for a world in which we “measure prosperity in health terms and talk about global health crises and global environmental crises in the same way we talk about global financial crises,” Croakey reported.

*******

US Presidential campaigns highlight healthcare policies

In her presidential campaign, Hillary Clinton announced an ambitious $10 billion policy plan to treat opiate addiction using scientific and medical approaches, reported The Fix. The plan centres on five goals: empowering communities to prevent drug use among young adults; ensuring resources and treatments are available to those with addictions; equipping first responders with naloxone to reverse opiate overdose; ensuring healthcare providers will receive appropriate training and be required to consult with prescription monitoring programs to prevent ‘doctor shopping’. Clinton wishes to end mass-incarceration by providing “treatment over prison for low-level and non-violent drug offenders.”

Meanwhile, economist Paul Krugman praised areas of Donald Trump’s presidential campaign including his populist approach to healthcare policy, in an op-ed in the New York Times. The left-leaning Krugman says Republican Jeb Bush, who is running his own presidential campaign, has accused Trump of being a “false conservative” due to his “deviations from current Republican economic orthodoxy: his willingness to raise taxes on the rich” and “his positive words about universal healthcare”.

*******

Social media, diet and mental health

A number of studies into mental health issues have made headlines this fortnight. The Herald Sun reported that research on 467 teenagers found that the pressure to be available online 24-hours a day related to poorer sleep quality and lower self-esteem as well as higher anxiety and depression levels.

“This means we have to think about how our kids use social media, in relation to time for switching off,” said lead researcher Dr Heather Cleland Woods of the University of Glasgow.

A study which analysed data from 26 studies found the more fish people ate, the less likely they were to have depression, The Washington Post reported. In an Australian study, junk food consumption was linked to smaller brain size and depression in older people, reported ABC Online. The report revealed the alarming findings on the effects of an unhealthy diet on the hippocampus. “The quality of people’s diets is related to their risk for depression in particular,” Associate Professor Felice Jacka, from Deakin University told the ABC.

Meanwhile The Guardian reported on new research that found around one-fifth of emergency ambulance callouts in Victoria, Queensland, NSW, Tasmania and the ACT combined were related to self-harm, poor mental health or substance abuse.

“We’ve made the findings publicly available because it’s really important that we have timely and detailed information on mental health and its impact on the community to start a detailed discussion on how to address it,” said the paper’s lead researcher, Belinda Lloyd from drug research centre Turning Point.

Other Croakey reading you may have missed:

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