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The Health Wrap: Trump Time; new priorities for Medical Research Future Fund; a secure future for Indigenous kids

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

Welcome to Trumpland

No news wrap, even one focused on Australian health issues, can begin anywhere other than the biggest story of the decade: the election of Donald Trump as US President. Trump’s unexpected election has sent shockwaves throughout the entire world, with the opinion polling over the preceding months pointing to a comfortable Hillary Clinton victory. Statnews.com and Croakey both have excellent analysis of the implications of the health implications of a Trump presidency but the key takeaways are Obamacare, abortion, climate change and Indigenous issues.

While Trump is in many ways a blank slate, he has repeatedly pledged to repeal “the Affordable Care Act, also known as “Obamacare”. Fresh from his victory though, he has begun to soften his language, telling the Wall Street Journal on Friday:

Either Obamacare will be amended or repealed and replaced.

While that may be welcome news for many of the 22 million Americans who have secured health care plans under the Affordable Care Act, many are not so sure what will be left will be worth the paper it is printed on, as this article in Vox.com suggests.

But if it is bad news for the recently insured, it is even grimmer for a women’s right to choose. According to Christian Science Monitor, Trump is on the record as proposing to de-fund Planned Parenthood (which provides reproductive health services) entirely, as long as it continues to offer abortions. His now updated administration transition website includes a pledge to:

Protect innocent human life from conception to natural death, including the most defenseless and those Americans with disabilities.

Trump will also have the opportunity to appoint conservative judges to the powerful US Supreme Court. This likely means attempts to repeal Roe vs Wade (the legal decision that underpins a women’s right to choose) over the coming years.

The impact of a Trump Presidency on Indigenous issues is also major concern. The ongoing stand-off at Standing Rock, where around 200 American Indian tribes are fighting an oil pipeline on their lands in North Dakota, is expected to become even more contentious as both sides plan for a Trump presidency. At the Lowitja Institute International Indigenous Health and Wellbeing Conference in Melbourne (see below for more) delegates expressed shock at Trump’s election and concern over his past racist remarks and financial investment in Energy Transfer Partners, which owns the line.

Most diabolical for the health and survival of the planet, however, is Trump’s impact on the global fight to halt climate change. Trump is on the record as a climate change denier (he has called global warming a Chinese hoax) and, according to Vox.com, has committed to scrapping all the major regulations that President Obama painstakingly put in place to reduce US carbon dioxide emissions and, most critically, pledged to pull the US out of the Paris climate deal. As Jennifer Doggett notes in Croakey:

This is likely to have a number of health impacts globally, including increased incidence of infectious diseases, widespread food shortages, displacement of vulnerable populations and a range of other physical and mental health issues.

If all that is leaving you shell-shocked and dismayed then cheer yourself up by reading this great story in Croakey, “How a prescription for solar thermal treatment changed the health fortunes of a whole town”.

And just in at Croakey, public health nutritionist Dr Sinead Boylan highlights why training health professionals in climate change responses, lobbying and advocacy is vital, and reports on a newly launched international, multi-disciplinary research collaboration between academic institutions and practitioners across the world. The Lancet Countdown –Tracking Progress on Health and Climate Change will track the health effects of climate change, responses, and the benefits of responses, drawing out examples of best practice around the world.


On the homefront

Big news also came at home on the weekend, with a long-awaited announcement that at least some refugees held at Australia’s offshore detention facilities on Nauru and Manus Island will be able to be re-settled under a landmark “one-off” deal with the US. It followed growing concern at home and internationally, with thousands of doctors, health professionals and other human rights defenders having taken again to the streets in Australia and an open letter published in The Lancet by more than 1,300 health professionals and dozens of health organisations.

While everyone was still glued to their screens as the bombshell US election results were coming through, Health Minister Sussan Ley was making an important announcement in Canberra. Speaking at the Association of Australian Medical Research Institutes annual dinner, she unveiled the strategies and priorities of the planned $20 billion dollar Medical Research Future Fund which are focused on six areas: data and infrastructure; health services and systems; strategic and international horizons; trials and translation; capacity and collaboration; trials and translation; and commercialisation. Sax Institute CEO Professor Sally Redman welcomed the announcement:

The strategy represents a welcome direction which really looks like being a game changer in the way research is funded in Australia.

Research Australia CEO Ms Nadia Levin was also positive about the new strategic direction, saying:

The Strategy sets a comprehensive plan for the MRFF’s initial establishment. It has the potential to bridge the gap between research and delivering real health outcomes.

On the subject of major national investments, this Croakey two-parter has identified some serious issues with the National Disability Insurance Scheme. As part of her crowd-funded #CripCroakey series, author El Gibbs explores how the NDIS was meant to put an end to the “lottery” approach to support for people with disability, and challenges government and its administrators to live up to the promises of the legislation that governs it.

Australia has gone from being a global drug policy leader to the back of the pack over the past 30 years, according to UnitingCare ReGen CEO Laurence Alvis. Writing for Croakey, Laurence argues that the Abbott/Turnbull Governments’ cuts to the alcohol and other drug sector and downgrading of expert policy advice have left the country without a clear drug policy framework and increasingly ill-prepared to respond to emerging concerns.

Sticking with this theme, the recent Australasian Professional Society on Alcohol and other Drugs (APSAD) annual meeting focused on pill testing services, debt-reduction strategies, the innovative use of technology to deal with drug and mental health issues and drug use among LGBT communities.

You might remember drug use was also a major issue in the US election. The devastating opioid epidemic (if you have 20 minutes read this harrowing piece from Statnews.com ) was a key concern in the rustbelt states that delivered victory to Trump. At the same time, seven additional US states legalised marijuana for personal use or medical reasons on Tuesday. This brings the number of states where marijuana is legalised in some form to 26 states and the District of Columbia.

Speaking of highly addictive substances, sugar remains firmly in the headlines. Last week the Committee of Presidents of Medical Colleges convened a national health summit on obesity in Melbourne, which canvassed recommendations including a tax on sugary drinks and restrictions on junk food advertising to children. You can read more about that one here.

The role of nutrition research in undermining public health policy was further canvassed in Croakey, with Dr Justin Coleman writing that:

The science of nutrition is a conflicted mess. One of the difficulties the authors faced in reaching statistical significance was that most studies are sponsored. For every article you read by an independent nutritionist…many more have industry ties, if you dig hard enough.

Despite more awareness than ever – among the public, media and health specialists – of the damaging health impacts of sugar, Croakey editor Melissa Sweet is not too optimistic about real action:

At this stage, though, it’s looking like the industry is winning on most fronts. Especially in Australia, where governments have little appetite for picking a fight for the sake of public health.

In contrast to sugar, Australia has taken world-leading strides forward on tobacco control. Much of this is due to a broad alliance between policy makers, campaigners, health professionals and the research community. Writing in The Mandarin  Professor Emily Banks sets out the need for health researchers across all sectors to go beyond simply publishing their findings, arguing that researchers need to work in partnership with policy makers, experts and the community in order to see research knowledge have a real impact.

Too much excellent research languishes on dusty shelves or behind paywalls in journals only researchers read. It is not just the politics of an issue or the lack of funding to implement a policy that prevents research from seeing the light of day (although both of these can be challenges). Too often, the right research is not getting into the right hands at the right time to make a difference. To make an impact, researchers must dedicate the same degree of intellect, rigor and passion to the translation of their research findings into policy outcomes as they do to generating their findings.

Despite the wins, there are still many tobacco challenges ahead and we can’t rest on our laurels, argues in The Conversation. He says Australia’s tough tobacco regulations have been a catalyst for the industry to develop sophisticated marketing practices. According to Greenland, companies are gaming the system by anticipating regulatory impact and then using unregulated marketing elements to overcome it.


Committing to a secure future for Indigenous kids

The first Lowitja Institute International Indigenous Health and Wellbeing Conference took place last week in Melbourne. The importance of cultural security for Indigenous children was at the centre of a call to action issued by delegates at the conclusion of the conference –  a timely one given the warning earlier in the week from leading health advocates that planned Federal Government changes to childcare funding will have “a devastating impact” upon Aboriginal and Torres Strait Islander children, families and communities.

One of the highlights for many in attendance or following via social media was the speech by Canadian Chief Wilton Littlechild, who helped to lead a seven-year investigation by Canada’s Truth and Reconciliation Commission into the removal of tens of thousands of Indigenous children from their families in what he calls the country’s “saddest, darkest (and) most unknown history”.

Another keynote speaker at the conference, Professor Karina Walters from the Choctaw nation of Oklahoma, outlined her work in exploring the impact of historical trauma on many generations, and an innovative health intervention that seeks to transcend it, by walking in the footsteps of the tribe’s ancestors along The Trail of Tears.

The Federal Government recently announced it would ask the Australian Law Reform Commission to examine the factors leading to the over representation of Aboriginal and Torres Strait Islander people in our prison system, and consider what reforms to the law could “ameliorate this national tragedy”. Writing as part of Croakey’s #JustJustice series, Dr Megan Williams says any inquiry must urge better healthcare for Indigenous people while they are in prison – including the right to Medicare – and intensive support when they are first released. She wrote:

The majority of Aboriginal and Torres Strait Islander people in prison have been there before, often multiple times. High rates of re-incarceration and post-release death signal that they do not receive enough assistance under current programs and policies.

In discussing the current crisis of over-incarceration, it is important to acknowledge the ongoing impact of the Stolen Generations, says Rosemary Roe, a Yamatji woman. You can watch an interview conducted on Whadjuk Nyoongar country at Walyalup (Fremantle) with Rosemary here.

Still on the topic of #justjustice and Indigenous incarceration, CEO of the Healing Foundation Richard Weston, wrote that Australia must deal with the unfinished business of the Stolen Generations through telling the truth of our history.

We know that Indigenous children experience middle ear disease earlier, more often and with more complications than non-Indigenous children and that, left untreated, this can cause huge long-term problems for hearing, speech and language development, which in turn affects their long-term health and social outcomes. This NITV piece by Tharawal Aboriginal Corporation CEO Darryl Wright looks at a Government-funded model for providing speech and language services for urban Aboriginal children that has been shown to work and which has potential to be scaled up to benefit a larger proportion of children.

What price automation?

Last but not least, over the coming decade we will need to consider what actions we take as automation makes a significant (potentially catastrophic) number of jobs obsolete. Given how important work is to self-identity and mental health, and the serious economic implications of a future where there is not enough jobs to go around, this is a major public health issue. A growing number of people argue that a universal basic income may be the solution. Read this piece in The Guardian to find out more.


Other Croakey reading you may have missed this fortnight:

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