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The Health Wrap: Threats to public health; the weather report; Indigenous justice; research with impact

This fortnight’s Health Wrap is compiled by Megan Howe, Publications 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.

Threats to public health – new and old

There was news last week that scurvy, a disease most associated with 18th century sailors, is making a comeback in Sydney. A  doctor at a Sydney diabetes clinic discovered several of her patients with non-healing ulcers had severe vitamin C deficiency. The Sydney Morning Herald reported that many of the patients avoided fruit due to their diabetes, and overcooked their vegetables, reducing the vitamin C content. Professor Jenny Gunton, Director of the Centre for Diabetes and Obesity Research at the Westmead Institute for Medical Research said:

“In people who do not eat fresh fruit and vegetables, it is unfortunately possible to achieve vitamin C deficiency even in the presence of overweight or obesity.”

Meanwhile, debate over another emerging threat to public health – excessive sugar intake – continues to rage, with Professor Hal Swerissen and Professor Stephen Duckett from the Grattan Institute responding to critics of their recent report recommending a tax on sugary drinks in this article published on Croakey. In the Huffington Post, dental public health expert Matthew Hopcraft highlighted the toll sugar takes on oral health, and the BBC reported that the UK was pushing ahead with its plans for a tax on sugar-sweetened drinks from 2018, publishing draft legislation that outlines how the tax will work.

As we marked World AIDS Day on 1 December, NSW Health Minister Jillian Skinner announced that the state was on track to achieve the virtual elimination of HIV transmission by 2020, with new HIV diagnoses  at their lowest in more than four years while testing is at an all-time high. Stat News reported that the World Health Organisation had released new guidelines on HIV self-testing. The BBC revealed the  UK National Health Service (NHS) would now fund the game-changing “Prep” therapy, which dramatically reduced the risk of being infected with HIV for at least 10,000 people in a three-year clinical trial. The NHS lost a court battle in which it argued that responsibility for paying for the drug should fall to local health authorities.

The Australian reported (paywalled) that new hepatitis C drugs  topped the list of most costly medications subsidised on the Pharmaceutical Benefits Scheme (PBS)  in the 2015–16 financial year, according to an analysis by Australian Prescriber magazine. The magazine’s medical editor, John Dowden, said the investment had the potential to eradicate the disease.

And for a look back at some of the most significant real, imagined and controversial public health threats over the past 40 years, Emeritus Professor Simon Chapman gave us a glimpse of his new book, Smoke Signals, which brings together a selection of 71 essays from the prolific writer’s hundreds of opinion page articles, blogs, commentaries and editorials on topics ranging from tobacco control to wind turbines.


The weather report

Summer arrived alongside a warning that many Australians do not understand the dangers that heatwaves pose, and continued debate over what actually constitutes a “heatwave event”. The Sydney Morning Herald reported on a call by scientist and risk researcher Dr Thomas Loridan for authorities to consider a cyclone-like rating system to help people prepare for hot spells. He told the newspaper:

“When you hear warnings about tropical cyclones or bushfires, it’s scary. But when you hear a warning for a heatwave over the weekend, you tend to take it a bit more lightly.”

His comments came as the fallout from the tragic “thunderstorm asthma” event in Melbourne continued, with Victorian Premier Daniel Andrews announcing a$500 million investment into ambulance services as part of a comprehensive plan to improve response times.

Respiratory expert Professor Guy Marks called for a national health protection agency to ensure lessons learnt in one part of Australia are disseminated across borders.  In this article on The Conversation, he wrote:

“As a nation, we’re too small to afford the level of knowledge and expertise required to give high quality health protection in eight separate jurisdictions. Environmental hazards don’t generally recognise borders. Having agencies whose responsibilities ends at a line on the map makes no sense in dealing with problems like this.”.

Environmental health hazards were also the focus of an article on The Conversation by Emeritus Professor of Medicine David Shearman, who argued that coal-fired power stations need to be shut down on health grounds,  both due to the hazards to local communities from the pollutants they emit, and the health burdens of climate change caused by burning fossil fuels.


Research with impact

The Sax Institute has awarded its annual Research Action Awards to three researchers whose work has helped transform policy and practice in the fields of vaccine safety,  maternal and reproductive health and strengthening the Medicare System. Vaccine safety expert Associate Professor Kristine Macartney, health policy researcher Associate Professor Kees van Gool and women’s health advocate Associate Professor Angela Dawson were named as the winners of the awards, which were established in 2015 to recognise researchers whose work has made a real-world difference to health policy and practice, and to people’s health and wellbeing.

The way medical research is funded  in Australia was put under the microscope in an article on The Conversation, which argued the current funding model is trying to support too many medical researchers with too few dollars.  Andrew Whitehouse, Winthrop Professor at the Telethon Kids Institute, says a paradigm shift is needed in the way research is funded, suggesting greater scientific progress will be made through fewer but larger investments in targeted areas, rather than smaller investments across the sector.

Another medical research tradition coming under question is the 150-year-old peer review process by which papers are published in the world’s leading medical journals. This article on Stat News argued that two features of the secretive peer-review system “subvert the goals of science”: that the product of peer reviews generally can’t be seen by the scientific community, and that reviewers are almost always anonymous.

Meanwhile, the challenges of embedding evaluation of policies and programs across governments to guide better-informed decisions is the focus of a blog, by Sax Institute Senior Adviser Professor Don Nutbeam, first published by The Mandarin.


Indigenous justice and health

All politicians and policy makers have been urged to “read and absorb” the advice for stopping the over-incarceration of Aboriginal and Torres Strait Islander people, at the launch of Croakey’s new  #JustJustice book. The book, which is available free online, compiles more than 90 articles from more than 70 contributors published over the past 18 months at Croakey,

Professor Tom Calma AO, Chancellor of the University of Canberra, told the Sydney launch that everyone in the room had a responsibility to bring the issue of over-incarceration to the attention of their MPs.

The book’s timely publication comes as acting Aboriginal and Torres Strait Islander Socail Justice Commissioner Robynne Quiggin slammed the failure to act on 25-year-old recommendations from the Royal Commission into Aboriginal deaths in custody as “unforgiveable”, as reported by The Guardian.

And the Royal Commission into the protection and detention of children in the Northern Territory was told that new youth detention centres are not the answer to the youth detention issue, and will only lock the Territory into an endless cycle of incarceration, according to The Guardian. Former head of Queensland corrections Keith Hamburger, who gave evidence about shocking conditions in the Don Dale detention centre, called for an overhaul of the youth justice system, led by Aboriginal people and communities.

The need to look at the real story behind Indigenous disadvantage is also the focus of an article on The Conversation by Elise Klein from the University of Melbourne, in which she argued the recent Productivity Commission’s report, Overcoming Indigenous Disdavantage, not only took an approach focused on deficits and gaps, but failed to “look up” and extend its analysis to the government’s ideology, which she said underpinned the failures of policies. She wrote:

“It [the report] ignores the enduring will of settler society to continue to colonise. The narrative from the report is pernicious. The statistics weave a horrible story that legitimates interventionist approaches by government and continues to deny the agency of Indigenous people – except for the focus on negatives.”

Racism in the health system is the focus of a new policy statement released by the Australian Indigenous Doctors’ Association (AIDA). The Association argues that the most promising path to combat racism and close the gap in Indigenous health outcomes is to actively pursue “an equitable number of Indigenous doctors and other health professionals supported by a culturally safe health system”.

Meanwhile, Labor Senator Patrick Dodson warned that “Bigotry is back in favour” in his speech to Parliament during a debate on a bill introduced by Liberal Democrat Senator David Leyonhjelm to remove part two of the Racial Discrimination Act, which sets out the various prohibitions on offensive behaviour based on racial hatred. You can read Senator Dodson’s full speech on Croakey. He said:

“Nothing wrong with freedom, particularly if you’re from the ruling class. There’s a hell of a lot wrong with freedom if you’ve got to battle to experience if, if you’ve got to fight for it.”

However, in some more positive news, SEARCH (the Study of Environment on Aboriginal Resilience and Child Health), a unique partnership study into the health and wellbeing of urban Aboriginal children and their families in NSW, is set to continue its work as a platform to close the Indigenous health gap, after receiving a five-year NHMRC grant for more than $2.8 million. SEARCH is a partnership between researchers from a number of institutions, the Aboriginal Health & Medical Research Council (AH&MRC) and four Aboriginal Community Controlled Health Services (ACCHSs).

“This new funding will allow (SEARCH) to continue to follow the 1,600 children in the study into adolescence and early adulthood as well as develop new programs to tackle major health issues such as chronic disease, asthma and mental illness,” one of the study’s chief investigators, Professor Emily Banks, told The Sydney Morning Herald.


Health system reform

Health system reform has been in the spotlight this fortnight, with widespread media coverage of a new Productivity Commission report that canvasses the potential benefits of injecting more competition into six services: social housing; public hospitals; end-of-life services; public dental services; services in remote Indigenous communities; and government-commissioned family and community services.

The ABC said the report suggested public hospital patients could benefit from doctors and health services publicly reporting their performance, while The Sydney Morning Herald’s headline read: “Hospitals, housing and dental services ripe for privatisation, says Productivity Commission report”.

In this piece on Croakey, Melissa Sweet outlined some reasons to be cheerful about the report and in an article on The Conversation, Stephen Duckett played down concerns, writing: “The report is actually quite cautious and not too radical”.

The reform of government policies around private health insurance was the focus of two articles on  Croakey. Doctors Reform Society president Dr Tim Woodruff  suggested the Federal Government’s policy of subsidising private health premiums was driven by an ideological commitment to private health insurance, rather than a concern for equity and efficiency, while public health specialist Associate Professor Peter Sainsbury said the Productivity Commission report ignored the fact that the private health insurance industry was in desperate need of reform.

Meanwhile, NSW Premier Mike Baird told the National Press Club that  a “deep dive” into the state’s hospital data had helped improve the NSW hospital system. The data dredge revealed that elderly patients were waiting an average 83 days to be discharged from hospitals pending guardianship decisions, hindering efforts to meet emergency department discharge targets. As the Sydney Morning Herald reported, the figure was cut to 39 days, after the Premier’s Implementation Unit took on the problem.


End-of-life decisions

There has been a renewed focus on end-of-life issues this fortnight, as the Victorian Government announced it will introduce legislation into the Parliament next year to legalise voluntary assisted dying for terminally ill people in Victoria.

The Sunday Age reported that Premier Daniel Andrews shifted his views on euthanasia during his father’s lengthy and agonising battle with cancer earlier this year, however palliative care doctors have argued that legalising assisted dying could come at the expense of patients receiving end-of-life care.

The news came as euthanasia advocate Philip Nitschke launched a campaign to push for unrestricted adult access to a peaceful death. The Guardian reports that his new Exit Action organisation plans to co-ordinate direct action strategies and force legislative change.

While euthanasia advocates push for greater access to the controversial drug Nembutal, ethics experts such as Professor Paul Komesaroff from Monash University argued there was no need for such a move to improve end-of-life care. Writing on The Conversation, he argued that clarification of the current laws and an educational program about implementation of those laws could better alleviate the suffering of dying patients.


Other Croakey reading you may have missed this fortnight

 

 

A rural and remote health series

More from #JustJustice

Megan Howe is the Publications Manager at the Sax Institute. Follow @SaxInstitute or @meghowe68 on Twitter

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