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The Health Wrap: Trump unleashed, alcohol warnings, wildfire alerts, health reform – and don’t we need some good news!

This year’s first edition of The Health Wrap could not be more timely, as Donald Trump, the 45th and 47th President of the United States, issues a stack of orders that are expected to undermine human rights, health and wellbeing on a variety of fronts.

Dr Lesley Russell also brings news from the US on alcohol warnings and wildfires, as well as health reform updates of note in the lead up to the Australian federal election.

The quotable?

It’s wild that a person who dedicated their life to public health [Dr Anthony Fauci] needs this protection – essentially against conspiracy theories.”


Lesley Russell writes:

Welcome to the first edition of The Health Wrap for 2025.

It looks like we are in for an “interesting” year on several continents – where interesting could mean worrying, exciting or challenging – for both politics in general and health and healthcare in particular.

I’m part of the Croakey Health Media team that will work hard to keep you plugged in and up-to-date on the issues.

I always start The Health Wrap off with a photo: so, to send the right vibe for 2025, here is a view with mountains and wildflowers taken on one of my favourite hikes in Colorado.

Gore Range from Piney Lakes Trail near Vail, Colorado

The Trump Redux era begins

As expected, many of Trump’s first actions as President will have dire consequences for health globally. He has signed executive orders announcing plans for the United States to resign from the World Health Organization (although note this actually requires Congressional approval), and withdrawing from the Paris Agreement. You can see all the executive orders signed to date here. 

Other smaller, nasty things are happening too: the Spanish translations of the Department of Health and Human Services webpages have disappeared, as have the webpages that provide information on women’s reproductive health.

KFF has complied a list of potential health policy administrative actions (ie actions that do not require congressional action) from the Trump Administration. There are few surprises on this list, which includes issues around abortion and contraception, Medicaid eligibility, vaccines, global health and, of course, Obamacare.

And then there’s whatever damage Elon Musk and Vivek Ramaswamy can do through the Department of Government Efficiency. They have described the way they will work to cut government spending as “axes and chainsaws, not butter knives and chisels”.

A number of healthcare programs are clearly on their list with the health of millions of Americans threatened.

It remains to be seen whether all or any of this will happen and how these initiatives will be received if they are implemented.

Nearly half (46 percent) of Americans say the country is headed in the wrong direction when it comes to the cost of healthcare. Opinions are largely divided along partisan lines, but nothing Trump has promised will do anything to improve the costs of healthcare, in fact his proposed changes to Obamacare and Medicaid will increase costs.

There are also major concerns about the dismissal of scientific and medical expertise and data by Trump and the people he has put forward to run the Department of Health and Human Services and its agencies.

In his farewell address to the nation, President Biden reminded Americans of what his Administration had achieved, including health issues such as reducing Medicare drug prices, veterans’ healthcare services and the millions of people who have gained health insurance under Obamacare.

He briefly addressed the challenges posed by climate change and the avalanche of misinformation and disinformation. He also touted the possibilities of Artificial Intelligence (AI) in medicine and the threats it can present to rights and privacy.

The concerns about the second Trump Administration extend to Australia, as outlined in my partner Bruce Wolpe’s book, first published in 2023 as ‘Trump’s Australia’ and just recently updated and republished as ‘What Trump’s Second Term Means for Australia’.

In the foreword to this new version, I updated the section I had written in ‘Trump’s Australia’ on the impact of Trump and Trumpism on health and healthcare in Australia. This has been published in Croakey.

See also Experts assess the health impacts of a Trump presidency, for America and the world.


California wildfires

From afar we have watched in horror as large parts of Los Angeles have been torched to the ground.

As I write this the fires are not yet out, but already thoughts turn to how thousands of people will rebuild their lives, their houses and neighbourhoods and their businesses.

The aerial photos highlight the immense clean-up task ahead, and this will be made more complicated by health hazards (asbestos, heavy metals and toxic chemicals in the ash, contaminated water supplies) and further threats ahead, when the rains finally come, from flooding and landslides.

During the wildfires there was a 16-fold increase in hospital visits for fire-related injuries, such as burns and smoke exposure.

Although the smoke’s immediate effect has begun to dissipate, the long-term effects of this microscopic pollution have been linked to an increased risk of heart attacks, strokes and serious lung damage.

A recently published study – done in California – shows that exposure to fine particulate matter in bushfire smoke is linked to a higher risk of developing dementia.

https://news.stanford.edu/stories/2025/01/assessing-wildfire-health-risks

Health officials are warning about risks related to water systems in the area. There are concerns about chemicals released when plastic piping (commonly used in earthquake-prone areas like California) melt. “Do Not Drink the Water” notices have gone up in fire-affected areas.

The wildfires have significantly impacted healthcare in the Los Angeles region, stressing hospitals, health clinics, first responders, and nursing homes as they deal with evacuation orders, power and water outages, and other challenges.

Road closures have made it difficult to transport patients, supplies, and healthcare workers. Many healthcare workers have also been impacted by evacuations or have lost their homes, making it difficult for some facilities to ensure adequate staffing.

While much of the media has focussed on the Hollywood stars who have lost their homes, the wildfires have had – and will continue to have – a disproportionate impact on socially disadvantaged groups.

This inequality is likely to be made even more egregious if Trump and the Republicans carry out their threats to link federal disaster aid to demands for changes in the state’s water rights and  environmental and climate change regulations.


On alcohol warnings – is Australia listening?

Earlier this month the US Surgeon General, Dr Vivek Murthy, released a Surgeon General’s Advisory on the causal link between alcohol consumption and increased cancer risk.

Alcohol is the third leading preventable cause of cancer in the United States, contributing to about 100,000 cancer cases and 20,000 cancer deaths each year.

The report shows only 45 percent of American adults are aware that consuming alcohol increases their risk of developing cancer.

It calls for Congress to authorise an update to the Surgeon General’s warning label on alcohol-containing beverages to include a cancer risk warning (the current warning label relates only to pregnancy) and for strengthening and expanding education efforts to increase general awareness.

The advisory also calls for a reassessment and revision of the guideline limits for alcohol consumption to account for increased cancer risk.It’s unlikely we will see any action from the Trump Administration on this issue. We might ask what does this new report mean for Australia?

A community survey conducted by the NSW Cancer Council in 2022 showed that 59 percent of participants were aware that alcohol use is a cause of cancer 77 percent of participants supported warning labels on alcohol and cancer on alcohol packaging.

Those are surprisingly impressive numbers; other surveys have found less awareness of the cancer risks of alcohol.  For example,  a survey conducted by Alcohol Change Australia in 2023 found that only 46 percent of respondents knew that alcohol causes cancer, while just 14 percent were aware it can lead to breast cancer.

Knowledge of the link between alcohol and cancer was lower among men, younger Australians, people living in regional areas, and people in lower income households.

However, 70 percent of people agreed that more needs to be done by governments to increase awareness of and reduce the harms caused by alcohol.

The National Alcohol Strategy 2019-2028 barely mentions the cancer risk or initiatives that might address this. A primary focus is on alcohol misuse and abuse and the harms that result from that, whereas even a small level of alcohol consumption can increase the risk of cancer.

The National Health and Medical Research Council guidelines advises healthy adults to consume no more than 10 standard drinks per week and no more than four on any given day. But even fewer drinks can increase the cancer risk.

The US Surgeon General’s report cites a 10 percent relative risk increase in breast cancer for women who consumed one drink a day and a 32 percent relative risk for those who consumed more than two drinks a day.

So where is government action on this? In short, restrained by political and economic concerns – and the power of the alcohol lobby.

A Department of Health and Aged Care spokesman recently said the Federal Government was monitoring the efficacy of public health warning labels from international experiences, including in Ireland.

So don’t expect any government action soon.


Review of Primary Health Networks

You can be forgiven if you were unaware that the Department of Health and Aged Care has a review of the Primary Health Network (PHN) business model and the PHN mental health flexible funding model underway (more information here).

The review, costing $2 million, is being done by the Boston Consulting Group. They are apparently working through the holiday season on this – or perhaps not. Certainly the expectation is that those who want to contribute to this review will have to give up their holiday time do so: submissions opened on 2 December and close in 22 January.

I only found out about this review when I read a scathing piece in The Medical Republic (although I should have read my colleague Charles Maskell-Knight’s The Zap more carefully – he listed it in his 9 December edition).

The gist of the barbed reporting from The Medical Republic is that how the Department uses PHNs and how they describe them are almost two entirely different things.

The Department states that: “PHNs assess the needs of their community and commission health services so that people in their region can get coordinated health care where and when they need it.” (And that’s what they ask submissions to respond to).

The article claims that the Department isn’t running PHNs in that way. It’s running them to deliver programs nationally that they develop and want funded quickly and directly.

That means there is no way the PHNs can be the epicentre of patient-centred care and healthcare system transformation.

Ironically, that’s just what Paresh Dawda and I concluded in our paper ,The role of Primary Health Networks in the delivery of primary care reforms, written in 2019.

Our report outlined some of the barriers that PHNs faced (and still face), some of the enablers that could help them drive changes in clinical practice and culture and provided suggestions about what would boost their capacity and capability to do this.

As far as I can determine, the last evaluation of the full PHN program, which was established in 2015, was undertaken in 2018. This was not released for some time, and indeed with the subject of an unsuccessful FOI request by Croakey and an article from me.

The PHN Program Performance and Quality Framework was not introduced until September 2018.

The most recent report on the performance and outcomes of the PHN program is from 2020-2021. More recent reports are available for individual PHNs; some PHNs are been quite active in terms of reviews and reports (see for example the website of the Hunter, New England and Central Coast PHN and their recent Commissioning Competency Review).

The Department’s website has a collection of performance and financial management reviews (audits) of selected PHNs here.

Last February the Australian National Audit Office (ANAO) released its report on Effectiveness of the Department of Health and Aged Care’s Performance Management of Primary Health Networks.

It found that the Department of Health and Ageing has been partly effective in its performance management of PHNs with “largely” fit-for-purpose compliance and assurance arrangements and “partly” fit-for-purpose performance measurement and reporting arrangements for PHNs.

Significantly, ANAO found that the Department has not demonstrated that the PHN delivery model is achieving its objectives.

The Medical Republic paper has an interesting (or is it scary?) diagram of where responsibility for PHNs sits in the Department. It’s a version of spaghetti junction and likely explains much of the current barriers to efficient operations and successful innovations.


Health and the federal election

No date for the federal elections has yet been announced, but it seems we are up and running in campaign mode early in 2025.

Indications are that health will be a key issue – it’s increasingly a cost-of-living issue as out-of-pocket costs keep rising.

Prime Minister Albanese and Health Minister Mark Butler have indicated that bulk billing and Medicare reforms will be on their agenda.

Butler recently said: “We’re focused on getting more doctors into the system, we’re focused on more bulk billing, and we’re focused on more options for urgent care.”

Those are the usual short-term, Band Aid fixes.

https://onlinelibrary.wiley.com/doi/10.5694/mja2.52562

There is however some cause for optimism as Butler has further indicated: “There is a long argument that we should blend that with more general payments, or bundle payments to GPs because what they do now is not deliver single episodes of service but they are more and more involved in delivering wraparound care for people with complex chronic conditions.

“I don’t think we’ll ever see a situation where there’s only annual payments and no fee for service. But I think we will see an increasingly blended future.”

Mike Steketee, writing for Inside Story, perfectly outlines why political parties find it so hard to move beyond the short-term fixes and scare campaigns to make some meaningful reforms and long-term investments in Medicare so that it is fit for the reality of patients’ needs and modern medical practice.

It’s useful to look back at this Croakey Health Media article from February last year which asks the tough questions about Medicare and the scale of the reform that’s needed.

https://www.croakey.org/beyond-the-back-slapping-and-asking-some-tough-questions-about-medicare-and-the-scale-of-reform-thats-needed-copy/

As I have often noted, not even the Band Aid fixes will be possible unless something is done about improving healthcare workforce issues.

Only 13 percent of the health and medical workforce is in regional, rural, or remote areas, which is insufficient to serve Australia’s 30 percent rural population.

Even in metropolitan areas it can often be difficult to get timely access to a GP or a specialist (just ask people who live in Canberra).

Will the Albanese Government take up the recommendations of the landmark Unleashing the Potential of our Health Workforce – Scope of Practice Review? It makes 18 recommendations that are being considered by the Federal Government.

Key among these is the establishment of a proactive, independent advisory body on health workforce (ie a new version of Health Workforce Australia that was abolished by the Abbott Government and has been sorely missed since).

As Professor Stephen Duckett points out, primary care involves more than GPs and this review shows how patients can better access care .

Implementing many of the recommendations will require collaboration between the Commonwealth and state and territory governments, as well as consultation with peak professional organisations, the Australian Health Practitioner Regulation Agency, patient groups, and the sector more broadly.

Further, it’s not clear how eager or ready the medical unions like the AMA and the RACGP are to negotiate in this space. See the AMA response to the Cormack report here and the RACGP response here.

My Croakey colleague Charles Maskell-Knight has also compiled a comprehensive overview of related commentary. Sadly I see many opportunities for delay and excuses for inaction!


Private health insurance remains in the spotlight

I think we can be fairly certain that one topic the political parties will not want on the election agenda is the cost (to consumers and the government) of private health insurance (PHI).

However, it is a perennial issue as every year the PHI funds look to increase their premiums and their profit margins.

The funds make arguments about increasing claims and costs, but it’s hard to see that they are struggling financially.

Data from the Australian Prudential Regulation Authority (APRA) show that in the September 2024 quarter 45.0 percent of the population has hospital cover and 54.7 percent had general (ancillary) cover. Interestingly, for hospital cover, there was a decrease in policies but an increase in the number of people covered compared to the September 2023 quarter.

I have written previously about the ongoing stoush between PHI funds and private hospitals, so it’s useful to see what the APRA data say.

There was a small increase (four percent) in the number of hospital episodes covered in the 12 months to the end of September 2024 and the costs of hospital treatments were up by 7.5 percent.

Patients’ out-of-pocket costs for hospital treatments were also up – by eight percent – over the same period, with an average cost of $432.14.

I can’t find profit data for the exact same time period, but APRA data for the year to March 2024 shows that the after-tax profits of PHI funds grew by 34 percent to a record $2.13 billion. Management expenses – salaries, executive bonuses, marketing – grew from $2.82 billion to $3.45 billion in that time frame.

The government-approved 2024 premium increase was an average of 3.03 percent, but these varies by fund and policy, and some increases were up to 5.8 percent. The PHI funds argue the costs they are paying out increased by between 8 to 10 percent last year.

Well maybe, if you also include management expenses. In some cases these must be quite substantial – have you seen the Bupa ads that run when the Australian Open tennis matches are on TV?

There is a table here that shows how PHI premiums have increased for every PHI fund over the years.

Late last year the Health Minister indicated that he had asked the PHI funds to reconsider their requests for premium increases for 2025 in the light of things like the benefit–payment ratio (how much of their revenue insurers are actually paying out to their members for procedures), profitability, and dividends to shareholders and management.

Butler made this statement at a press conference where he talked about the findings of the Commonwealth Ombudsman (who also serves as the PHI Ombudsman) on the issue known as “phoenixing” – the closure of, particularly, gold insurance products and then the opening of a new, essentially identical product at a much higher price.

The Commonwealth Ombudsman found that this practice is not strictly against the law but that funds are exploiting this loophole.

Butler said in response that this practice is “clearly against the spirit of the law”.

“It’s an underhanded, largely secret way of health insurers raising their prices outside of the usual approval process,” he said – but did not indicate that any action would be taken to prevent this.

Last week came the news that Butler has, for the second time, rejected at least some of the PHI funds’ requests for premium increases, saying these needed to be “justified and proportionate”.

The increases are due to take effect from 1 April and one factor surely playing into this decision is that an election focused in cost-of-living issues is looming.

Meanwhile the dispute between private hospital owner Healthscope and insurers continues.

Healthscope, now owned by a Canadian private equity group, operates 38 private hospitals. Its negotiations with two major private health insurers (Bupa and Australian Health Services Alliance) are reportedly at an impasse, with all contracts to be cancelled from March 4, leaving millions of people facing out-of-pocket costs for their private healthcare services.

Healthscope announced in November that it would be cancelling its contracts with Bupa from February 20, and Australian Health Services Alliance (AHSA) from March 4.

It comes after the insurers refused to pay a proposed hospital fee of $50 for same-day patients and $100 for overnight admissions.

Healthscope argued the fee was due to rising costs, but the insurers claimed Healthscope – owned by Canadian private equity group Brookfield – was extracting more profits for its members.

https://www.thenewdaily.com.au/life/health/2024/11/22/healthscope-drops-cover

Victorian hospital reforms (or restructure?)

The Allan Labor Government has announced a major overhaul of how Victoria’s public hospitals will be administered.

The Government is creating 12 health networks – each designed to service a population of at least 200,000. Details are lacking at this point, but it seems these new networks will look something like the Local Health Districts (LHDs) in New South Wales.

There is some more detail here but it seems that negotiations over the final structure will continue into 2025. The new networks are supposed to come online on 1 July.

The genesis of this work began in 2023. But an early proposal, in a so-called Health Services Plan, to merge the state’s 76 independent government health services was ruled out as “not fit for purpose” following backlash from hospitals and the public. Now every health service will retain its own identity and board of management. That seems complicated!

At the time the Health services Plan was put forward last August, the Victorian Government announced additional hospital funding of $1.5 billion and a new body, Hospitals Victoria, to oversee administration of the state’s hospitals. I can’t see any mention of that in the new proposal.

I guess for the moment, I’m with Professor Stephen Duckett on this.

https://www.healthservicesdaily.com.au/victoria-announces-12-health-networks/

Getting dental health on the election agenda – or in the Budget

It wouldn’t be an Australian election campaign without a push to get more affordable dental care for all Australians.

Unfortunately, that push rarely comes from with the major political parties (the Greens are an exception – they always push for dental care). I think the last time was in 2012  when Tanya Plibersek was Minister for Health in the Gillard Government.

Last September Health Minister Mark Butler said there were no plans to include dental care in Medicare in the near term.

He has acknowledged that including dental in Medicare is in the Labor Party’s platform and “completely makes sense”, but then says the Government’s focus is on dealing with the fundamentals of Medicare (as if the mouth is not a fundamental part of the body).

In April last year a #CroakeyLIVE webinar addressed the inequities in oral health care.  It’s timely to reread this.

Members of the National Oral Health Alliance have sent an open letter to the Prime Minister to prioritise oral health in the 2025-26 federal budget. The Alliance has outlined some very sensible first steps towards improving the oral health of Australians:

  • Appoint a Commonwealth Chief Dental Officer
  • Implement the Royal Commission into Aged Care Quality and Safety recommendations pertinent to oral health
  • Establish a Senior Dental Benefits Scheme as a step towards universal access
  • Increase funding for public dental services by the Australian Government by at least $500 million annually
  • Establish a Taskforce into Publicly Funded Essential Oral Healthcare
  • Address rural and remote oral health inequities
  • Fund and implement a codesigned National Oral Health Plan 2025-2034, which aligns with the social determinants of health and is grounded by the principles and objectives of the World Health Organization’s Global strategy and action plan on oral health 2023–2033.

These are issues worth getting behind.

https://oralhealth.asn.au/wp-content/uploads/2024/11/NOHA_Media-Release_Website.pdf

I have often thought that one problem in getting better government funding for dental care services, especially for preventive services, is that too many Australians (including Australian politicians) don’t see dental care as necessary until there is a problem.

Dental caries is a preventable disease. The primary major causative agent of dental caries is Streptococcus mutans which is found primarily dental plaque (sugar is a key factor in the formation of plaque). In addition to caries, this bacterium is responsible for cases of infective endocarditis.

Maybe if the education campaigns focussed more on this we might get more attention to prevention, especially for children and young people.

I also think we should worry about the Trump/Kennedy echo chamber here bringing up the issue of the fluoridation of water, specifically in the context of the upcoming election campaign.

A recent publication that linked higher fluoride exposure to lower IQs in children has stirred this issue further. Scientists immediately raised concerns about the quality of the review, including in a linked editorial published in JAMA. But misinformation is so easily promulgated these days. You can read more here.


Indigenous health in the news

Here is a great story about Indigenous knowledge making the Peel River near Tamworth healthier by involving and educating local schoolchildren.

Last week students from Tamworth, Peel, Oxley and Farrer Memorial Agricultural high schools in Tamworth joined Water NSW scientists, local First Nations Elders and the rangers at the site of two of 50 snags installed by Water NSW in the Peel River.

The snags are part of environmental offsets for the Chaffey Dam. They provide a habitat for Murray cod and silver perch, both nationally threatened species, as well as platypus, rakali and other aquatic life.

You can read more here. And there is more about how Water NSW is using dead trees as snags to create an eco-environment here.


The best of Croakey

Please join Croakey Health Media directors, members, contributors and readers for an open planning meeting via Zoom. Register here to join us, from 5-6pm AEDT, on Tuesday, 4 February, 2025.

https://www.croakey.org/please-join-us-in-making-some-healthy-plans-for-2025/

 The good news story

paper recently published in The Lancet gives an encouraging indication of how stem cell transplants can help restore sight in people with damaged corneas.

The treatment, given to just four people, seems safe and was effective long-term in three cases, but it needs to be tested in larger trials.

These patients had lost their sight because they had damaged the stem cell reservoir which is located at the edge of the cornea where it adjoins the white of the eye. Normally this reservoir provides a continuous supply of epithelial cells to the central cornea to maintain its healthy state.

The procedure involves grafting sheets of corneal epithelial cells on to the surface of the eye after the removal of the fibrous tissue that has caused blindness.

In people with severely damaged corneas, the current and most common treatment is corneal transplant. However, this option does not work if the outer edge of the cornea is damaged, such as in injuries caused by chemical or thermal burns.

A commentary in Nature described this study as a “world first”. Similar work is underway in Australia.

The Centre for Eye Research Australia, in collaboration with researchers at the Mawson Institute at the University of South Australia, is investigating the use of special contact lenses to transfer corneal stem cells onto the damaged part of the cornea where they multiply and regenerate the tissue.


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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