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The Health Wrap: the wellbeing budget, vaccine developments, and, from the United States, alarming stories and stunning views

What might Australia learn from Iceland and Aotearoa/New Zealand when it comes to developing a national wellbeing budget? Associate Professor Lesley Russell has some suggestions in her latest column.

The Health Wrap also investigates COVID vaccine developments, the terrible aftermath of the overturning of Roe vs Wade in the United States, and shares some stunning scenery, from Colorado to California.


Lesley Russell writes:

Australia is about to join Bhutan, Iceland, Finland, and New Zealand with Treasurer Jim Chalmers’ commitment to set his first budget – due October 25 – within a values framework that will begin to deliver economic policy in the context of national wellbeing.

When Chalmers proposed, from the Opposition benches in early 2020, the idea of including social and environmental outcomes alongside traditional financial indicators in the nation’s budget accounting, then Treasurer Josh Frydenberg described it as “laughable“.

He asked Parliament to imagine Chalmers delivering his first budget, “fresh from his ashram deep in the Himalayas, barefoot, robes flowing, incense burning, beads in one hand, wellbeing budget in the other”.

However, if Labor can use this approach to deliver meaningful budget reforms and outcomes beyond merely whether the numbers fall on the deficit or the credit side of the ledger, then the last laugh might be on Frydenberg.

Iceland serves as a good example of a country that was able to emerge from a financial collapse in 2008 to rank as one of the most egalitarian economies of the OECD. The country’s social welfare system including pensions is well targeted, reducing inequality further. Access to education and health care is universal, and socio-economic status appears to have a weaker influence on education or health outcomes than in most other OECD countries.

Iceland has also successfully trialled and implemented a four-day working week. Perhaps it’s little wonder that it currently ranks as the third happiest nation in the world.

Closer to home, there are lessons that Australia can learn from Aotearoa/New Zealand, which has set five budget priorities:

  1. Transition to a sustainable and low-emissions economy
  2. Social and economic opportunities
  3. Lifting Maori and Pacific peoples’ opportunities
  4. Reducing child poverty
  5. Improving mental health.

One lesson is that it will take time for these types of outcomes to be seen.

An article written for ABC News by economist Peter Martin reminds us how much has been hidden in recent federal Budget Papers.

Up until the 2014-15 Budget (memorable because it was so unfair in the budget cuts imposed on Health and Indigenous Affairs programs), the Budget Papers always contained a table that identified the impact of the Budget on 17 different types of households at different income levels.

That was removed by then Prime Minister Tony Abbott and Treasurer Joe Hockey (likely because, as Martin pointed out at the time, they didn’t want the winners and losers to become apparent) – and has not been seen since.

To quote Martin: “The [current] budget papers neither tell us what the budget will do to economic growth, nor what it will do to incomes, nor what it will do to the environment or anything else other than the budget’s bottom line.”

Australia has toyed with the idea of a wellbeing approach to budgeting before, under Prime Minister John Howard. In 2004 Treasury introduced a wellbeing framework for its own internal use. In 2008 the Australian Bureau of Statistics introduced a short-lived publication called Measures of Australia’s Progress that reported on 26 key indicators.

It will be essential for Chalmers and Treasury to select indicators that will make a difference to the nation – its ecosystems, communities and people – and that can be measured in meaningful terms. These should include measures of health and welfare (with specific assessments for Aboriginal and Torres Strait Islander peoples) and intergenerational equity, with a focus on education, climate change and poverty.

Australia’s move to a national wellbeing budget would mean it could join the Wellbeing Economy Governments partnership (WEGo) – a collaboration of national and regional governments promoting sharing of expertise and transferrable policy practices. Current members are Scotland, New Zealand, Iceland, Wales and Finland.

The idea of measuring national success beyond the limitations of the Gross Domestic Product (GDP) led to the formation of the Commission on the Measurement of Economic Performance and Social Progress at the request of French President Nicolas Sarkozy in 2007. The Commission, commonly referred to as the Stiglitz-Sen-Fitoussi Commission, recommended that governments shift from measuring economic production to measuring citizens’ wellbeing.

The Carnegie UK Trust has released a report Wellbeing Around the World that looks at various perspectives on measuring social progress ten years after the Stiglitz-Sen-Fitoussi Commission.


New vaccines against COVID-19 variants are on the way

At a meeting on 28 June, the US Vaccines and Related Biological Products Advisory Committee recommended that the Food and Drug Administration tell COVID-19 vaccine-makers to reformulate boosters so they target the Omicron variant. The recommendation is aimed at bolstering protection before a possible (northern hemisphere) winter surge of illness.

The experts on the committee made this decision in the light of waning immunity combined with the emergence of new BA.4 and BA.5 variants and the possibility that other novel variants could emerge.

It is estimated that BA.4 and BA.5 are about three times less sensitive to neutralising antibodies from existing COVID-19 vaccines than the original BA.1 and BA.2 Omicron variants.

Pfizer has said it could have an updated vaccine targeting BA.4 and BA.5 ready to be distributed in October. But since then, Biden Administration officials have urged the firms producing vaccines to speed up production. For the moment, boosters for Americans younger than 50 have not been authorised.

An analogous committee that advises the World Health Organization recently declared that the vaccines should be reformulated to include a version of the Omicron variant, to broaden the immunity the vaccine induces. It stated that Omicron-only vaccines should only be used as boosters.

Unless Australia is acting now to order updates vaccines from Pfizer and Moderna (or – dare I suggest – manufacture them in Australia?) we will once again face delays in getting access to needed vaccine supplies.

It’s worth noting that a recent small Israeli study shows that a second COVID booster shot boosted antibodies in seniors, although it did not determine how long this higher level of protection lasts.

A commentary in JAMA said this: “Booster doses restore protection against infection back to higher levels and incrementally improve protection against severe COVID-19, but frequent booster vaccinations are expensive, inconvenient, and possibly inefficient.

“The optimal timing of booster vaccinations is therefore a priority unanswered question for vaccine developers and policy makers alike.”


Horror stories on reproductive healthcare

The news in the United States is already full of horror stories about how women are struggling to get reproductive healthcare services in the wake of the SCOTUS decision last month that overturned Roe v Wade.

A recent article in the Washington Post was headed “One month in, abortion bans are hell on Earth”. It makes dreadful reading.

Another article (After Roe, Pregnant Women With Cancer Diagnoses May Face Wrenching Choices) in The New York Times examines the urgent questions around the treatment of pregnant women with cancer in states where women are unable to terminate pregnancies.

The stories are not just about the awful crises for women, but also about what it means for the doctors and healthcare professionals who should be able to treat and care for them.

One particular story concerns the threats faced by a woman doctor in Indiana who provided an abortion to a 10-year who was six weeks pregnant after being raped.

The doctor has been the subject of much backlash, including false and misleading statements from the state Attorney General (recognised as a leader in the anti-abortion movement). But in recent days she has boldly spoken out, in an opinion piece written for the Washington Post.

She writes: “Today, in states with draconian abortion restrictions, we grapple with the heart-wrenching knowledge that our years of education, our honed practice, our teams’ painstaking preparations may be denied to patients who need us. Where the most vulnerable patients need our care, the government has tied our hands.”

It is very clear that the SCOTUS decision, and those of Republican-led states that have followed it, will worsen inequalities in reproductive care.

For example in Texas, Governor Greg Abbott claims the state provides expectant mothers “necessary resources so that they can choose life for their child”.

But Texas has some of the strictest Medicaid eligibility requirements in the country (a single parent with one child must earn $196 or less a month to qualify) and it is one of just a few states not to offer Medicaid coverage for a full year after birth.

On other fronts, anti-gay and anti-trans rhetoric and calls to roll back LGBTQ rights have grown bolder among Republican elected officials and candidates.

In all, over 300 bills to restrict LGBTQ rights have been introduced this year in 23 states, according to the Human Rights Campaign.

Democrats in the House of Representatives have acted to try to protect the rights that now appear under threat after Justice Clarence Thomas openly questioned whether the court “should reconsider” rulings that guaranteed access to birth control and same-sex couples’ right to marriage — two issues many Americans have viewed as settled law.

This led to two interesting (maybe confused or disturbing are better words here?) votes in the House of Representatives last week.

On Tuesday 47 House Republicans joined Democrats in supporting a bill that would recognize same-sex marriages and inter-racial marriages at the federal level.

On Thursday only eight Republicans  voted to protect an individual’s access to contraception and ensure health-care providers are not penalised for prescribing it. (What were these men and women thinking and what sort of world do they want American women to live in?).

Neither bill is likely to pass in the Senate.

Read the NPR story here.


In case you missed it

Some recent reports that I think are interesting, useful and/ or important.

Parliamentary documents

The Australian Parliamentary Library Briefing Book on the issues likely to figure in the 47th Parliament (which commences July 26) is now online. There are great summaries of a huge range of issues including the environment, budget issues, the factors that affect Australia’s prosperity, social welfare, health and aged care, and foreign policy.

We are unlikely to see the Red and Blue Briefing Books prepared by the Office of Prime Minister and Cabinet for the incoming government – so this is the next best thing. It is probably the best briefing material that the Independents and Greens will get.

The Parliamentary Budget Office has released its 2022 Election Commitments Report. This details and aggregates the budget impacts of the election commitments made by the Coalition, Labor and The Greens. Only one independent member of parliament, the Member for Indi, Dr Helen Haines, chose to be included.

Domestic violence reports

The National Plan Stakeholder Consultation Final Report and the National Plan Victim-Survivor Advocates Consultation Final Report, which will play important roles in informing the development and implementation of the next National Plan to end Violence against Women and Children 2022-2032 were released by the Minister for Social Services, Amanda Rishworth, on July 14.

This month also saw the release of a seminal report by Dr Anne Summers for the Paul Ramsay Foundation. The report, entitled The Choice: Violence or Poverty, looks at the consequences of domestic violence in Australia today. It’s a sad and disturbing story of what Summers describes as a “dire choice” for many women. ABC TV’s Q and A program recently hosted a discussion about the report, with a focus on some of the research and policy gaps identified.

Last week it was announced that Federal, state and territory governments have agreed to finalise and release the new national 10-year plan aimed at ending violence against women and children in October.

Priorities for the newly established Domestic, Family and Sexual Violence Commission, which will monitor implementation and track progress against targets under the national plan, were also discussed. The Government has committed $22.4 million over five years to establish the National DFSV Commission as recommended by the House Standing Committee on Social Policy and Legal Affairs Inquiry into family, domestic and sexual violence.

The loneliness epidemic  

If you are a regular reader of The Health Wrap, then you will know I often return to examining the health impacts of loneliness.

Loneliness is now recognised as a social determinant of health, a factor that greatly influences overall health outcomes. In recent years, it has also been described as an epidemic and elevated to a public health crisis that has been intensified by the COVID-19 pandemic.

The Mandarin recently published an excellent research round-up on loneliness in the elderly.

Recent research from the Universities of Wollongong and Sydney finds that lockdown loneliness has lingered for many Australians. Even though most restrictions have been lifted, social networks that were disrupted by the pandemic have not been stitched back together in the same way.


The best of Croakey

This article, cross-posted from The Conversation, can be read here.


The good news story

Bison (or buffalo) once roamed the plains of North America in enormous numbers and were an integral part of the culture of Native Americans until they were hunted almost to extinction as white men and women moved west.

Now Indigenous tribes are leading the effort to bring back the bison – a victory not only for the sake of biodiversity, but for the entire ecosystem they nurture.

Grazing bison leave more than dung behind. Their aggressive chewing spurs growth of nutritious new plant shoots, and their natural behaviours — the microhabitats they create by rolling in the ground, the many birds that forged symbiotic relationships with them — trickle down the food chain.

The InterTribal Buffalo Council, which began as a modest coalition of fewer than 10 tribes in the early 1990s, will soon count 76 tribes across 20 states from New York to Hawaii among its members, managing a total of more than 20,000 animals across 32 million acres.

You can read more here.


More stunning views

Following on from Rocky Mountains photos in the previous edition of this column, here are some more views shared by @LRussellWolpe, from travels in Colorado and California.


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

 

 

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