In his penultimate column for the year, Charles-Maskell Knight urges policymakers to put as much effort into addressing obesity as has been directed to reducing smoking rates, reports on the launch of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy 2025-2035, and investigates proposed reforms to increase access to hospital-in-the-home care.
Meanwhile, the National Aboriginal Community Controlled Health Organisation (NACCHO) is supportive of recommendations for improving healthcare for First Nations people in prison (as detailed in last week’s column) but stresses that reforms must include adequate funding for Aboriginal controlled community health services, for capacity building as well as related infrastructure and workforce development.
The Zap also brings the latest news in aged care and mental health, and notes a Medicines Australia campaign that looks very much like lobbying/public relations dressed up as public education.
The quotable?
If an organisation representing a regulated sector welcomes a change in regulation, one can safely assume the change will benefit the sector and not its customers.”
Charles Maskell-Knight writes:
The Australian Institute of Health and Welfare (AIHW) released the Australian Burden of Disease Study 2024, showing that living with overweight or obesity has overtaken tobacco as the new leading risk factor contributing to burden of disease.
AIHW spokesperson Michelle Gourley said Australians lost an estimated 5.8 million years of healthy life due to living with disease and dying prematurely in 2024.
“Over one-third of the total burden of disease and injury in Australia in 2024 could have been avoided or reduced due to modifiable risk factors included in the study,” she said.
Since 2003 there has been a fall of 41 percent in the age-standardised rate of total burden attributable to tobacco use.
The AIHW also found that “after adjusting for population ageing, there was a 10 percent decline in the rate of total burden between 2003 and 2024…driven by a 26 percent decrease in the rate of fatal burden, as the non-fatal burden rate increased by seven percent”.
The Public Health Association of Australia (PHAA) commented on the report. While welcoming the reduction in the disease burden due to tobacco use, PHAA CEO Adjunct Professor Terry Slevin noted that “smoking still accounts for 7.6 percent of the disease burden”.
“We can’t afford to be complacent,” he said, adding that we need to “take our foot off the accelerator of obesity”.
Options that he suggested include:
- reducing the marketing of unhealthy food
- sensible, honest, understandable food labelling
- introducing a health levy on high energy sugary drinks
- funding programs that will help drive down rates of overweight and obesity
- tackling the ubiquitous advertising of harmful products in our public places
- reducing the easy availability and supply of alcohol
- building physically activity into our daily lives through urban design transport options and liveable walkable neighbourhoods.
We know what to do – we just need to get on and do it. Policymakers now need to devote the same effort to addressing obesity that was directed to reducing smoking rates.
However, the steadfast refusal from both main political parties to consider a sugar tax or a ban on junk food advertising ban suggests they still don’t appreciate the need for action.
After the report was released Health Minister Mark Butler was asked, “What has your government done to tackle these rates of obesity?”
The only concrete action he could point to was the last Labor Government’s decision to fund Stephanie Alexander Kitchen Garden Programs in schools – over a decade ago.
Ministers and government
Minister Butler released the National Action Plan for the Health and Wellbeing of LGBTIQA+ People, and announced spending of $15.5 million “to kick-start system-wide improvements to give LGBTIQA+ people access to safe, appropriate and stigma-free health and wellbeing care”.
Croakey published an article on the plan by Nicky Bath, CEO of LGBTIQ+ Health Australia, and a summary of sector commentary on it.
Minister Butler also announced funding of an additional $107 million for the regulation and enforcement of new laws on vaping products.
He said that “vape shops around the country are closing and importantly, young Australians are finding it harder to purchase vapes… [The additional funding] will disrupt and deter the black market and ensure the Therapeutic Goods Administration is appropriately placed to regulate therapeutic vapes”.
Minister Butler joined Minister for Indigenous Australians Senator Malarndirri McCarthy and Assistant Minister for Indigenous Health Ged Kearney in launching, in partnership with Gayaa Dhuwi (Proud Spirit) Australia, the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy 2025-2035.
Minister McCarthy said: “First Nations people are twice as likely to die by suicide than non-Indigenous Australians, and the devastating impact on their loved ones and communities is enormous and ongoing.
“This Strategy provides a clear framework to work in partnership through the National Agreement on Closing the Gap to reduce suicide rates.
“I acknowledge Gayaa Dhuwi for leading the renewal of the Prevention Strategy and recognise the many contributions received from Aboriginal and Torres Strait Islander people, communities and organisations.”
Finally, Minister Butler announced that he had “presented a substantial package of reform proposals for consideration by the first meeting of the Private Health CEO Forum” on 13 December. The Forum was established following the Private Hospital Sector Financial Health Check released last month.
The proposals included:
- changes to improve access to ‘hospital in the home’ care, by requiring insurers to cover clinically appropriate and safe hospital-run models
- changes to make maternity care more accessible and affordable, by including maternity cover as a standard inclusion across a greater number of policies, instead of only ‘gold’ level policies
- changes to improve access to mental healthcare, by increasing the supply of internationally educated psychiatrists
- changes to make contract negotiations fairer between hospitals and insurers, by improving the “default benefits” system that guarantees funding for hospitals that don’t have a contract with an insurer.
Coincidentally, the Australian Medical Association (AMA) had released a statement earlier in the week calling for reforms to encourage greater uptake of out-of-hospital care – a call supported by Catholic Health Australia (CHA), which is calling for default benefits – the minimum insurers must pay for a treatment – to apply to out-of-hospital care.
In an ideal world, insurers should be happy to pay for out-of-hospital care, because it will be cheaper than the in-hospital care it replaces. The problem from the insurers’ perspective is that there is not a finite supply of morbidity, and any hospital beds freed up by patients receiving care at home will be filled by new patients, who will also be funded by insurers.
Indeed, Butler’s statement said that hospital in the home care would provide hospitals with “an important new funding stream”. This can only mean upwards pressure on private health insurance premiums.
Various doctor groups have been arguing for some time that maternity services should be included in a greater range of private health insurance policies, not only in “Gold” products.
If maternity services were included in “Silver” products, the many would-be parents currently purchasing Gold products, which cover services for the old such as joint replacements, would leave those products in droves, pushing up the price for the remaining older policyholders. (And, of course, the price of Silver products would also need to increase.)
Unless insurers are coerced to cut their profit margins or administrative costs, or reduce their inflated reserves, increased private hospital revenue means increased insurance premiums.
The Department of Health and Aged Care made two important announcements relating to aged care.
The first marked the beginning of the aged care Single Assessment System workforce, which brought together the Regional Assessment Service, Aged Care Assessment Teams, and independent Australian National Aged Care Classification assessment organisations.
The Department said the new system would improve older people’s experience by “providing a single pathway to access all government-funded aged care; supporting their shifting needs, without having to change assessment provider; ensuring access to assessments in regional, remote and rural areas; and gradually reducing wait times for an assessment”.
The second announcement was that older people undergoing an assessment would be able to choose to have their support plan added to My Health Record, allowing doctors and other health professionals to access the plan and take it into account in making treatment decisions.
The AIHW had a busy week, because as well as the Burden of Disease report, it released:
- updated data on mental health, including state and territory residential mental healthcare services, the mental health of people in prison, and mental health treatment use
- updated suicide and self-harm monitoring data on state and territory suicide registers and ambulance attendances for suicidal ideation, and suicidal and self-harm behaviours
- data on family, domestic and sexual violence; and cancer data.
It also updated reports on Heart, stroke and vascular disease; Diabetes; and Chronic kidney disease.
It released the new National preventive health monitoring dashboard tracking progress against the targets of the National Preventive Health Strategy 2021–2030 and the National Obesity Strategy 2022–2032.
The AIHW also released an updated report on Alcohol, tobacco and other drugs in Australia and a report on Maternity models of care in Australia.
Finally, it released Medicare bulk billing and out-of-pocket costs of GP attendances over time, finding an increase in the bulk billing rate since the introduction of higher bulk billing incentives in November 2023.
It also found that in 2023 “the annual GP bulk billing rate for the lowest socioeconomic areas was 87 percent compared with 68 percent in the highest socioeconomic areas”, and that for patients who were not bulk billed “people living in the lowest socioeconomic areas paid an average of $39…compared with an average of $47 in the highest socioeconomic areas”.
Ahpra announced the strengthening of processes to identify and minimise the harms of vexatious notifications against health practitioners, following a review by the National Health Practitioner Ombudsman.
Ahpra also announced that Health Ministers had approved a new Registration standard: Endorsement for scheduled medicines – designated registered nurse prescriber to allow “suitably educated and qualified Registered Nurses to prescribe Schedule 2, 3, 4 and 8 medicines in partnership with an authorised health practitioner [essentially a doctor or nurse practitioner] under a prescribing agreement”.
Ahpra said that “the endorsement will enhance access to high-quality, reliable medicines for all Australians, especially those in rural and remote areas… [and] help alleviate pressure points in both acute and primary care, where access to appointments is a challenge for healthcare consumers”.
The Commonwealth Ombudsman issued a statement on the practice of private health insurers “closing cheaper Gold-tier policies to new customers and releasing very similar Gold policies for new customers that were much more expensive”.
I have written an article for Croakey on this practice (now described as “product phoenixing”), covering reactions from Minister Butler, Private Healthcare Australia (the private health insurance lobby group), the Medical Technology Association of Australia, and the Australian Private Hospitals Association.
Attorney General Mark Dreyfus KC announced the opening of consultation on a draft National Plan to End the Abuse and Mistreatment of Older People 2024-2034. Submissions are due by 17 February 2025.
First Nations health
The National Aboriginal Community Controlled Health Organisation endorsed the recommendations of the National Review of First Nations Health Care in Prisons conducted by the Nous Consortium, subject to three fundamental principles:
- ensuring that solutions are driven and determined by Aboriginal and Torres Strait Islander peoples and communities
- guaranteeing adequate funding for Aboriginal controlled community health services (ACCHS) capacity building, infrastructure for ACCHS-led healthcare in detention facilities, and addressing workforce development needs through a needs-based funding model
- empowering ACCHSs to define and deliver primary healthcare tailored to their communities’ needs in places of detention.
“This is a pivotal moment for reform,” CEO Pat Turner said.
“Governments must urgently act on the Review’s recommendations, working alongside Aboriginal and Torres Strait Islander communities to develop solutions that uphold human rights and address the root causes of over-representation in detention.”
Consumer and public health groups
Mental Health Australia (MHA) released the results of a survey it had commissioned which found that “81 percent of Australian voters are concerned about mental health and 75 percent believe government needs to do more to address this issue”.
Over half of respondents (57 percent) said that cost of living increases had negatively affected their mental health in the last year.
MHA CEO Carolyn Nikoloski said “given these results, it’s no surprise that most voters feel current support for mental health is insufficient. Only one in five believe current mental health services in their community are adequate”.
The Older Persons Advocacy Network (OPAN) welcomed the release of an evaluation of the National Aged Care Advocacy Program (NACAP), which funds OPAN’s national nine-member network to support older people to access the care and services they need.
The evaluation found that 90 percent of the older people surveyed felt they had received better aged care services as a result support from OPAN.
Of course, the aged care system should ideally provide excellent services to everyone without the need for special advocacy.
Palliative Care Australia joined six other organisations and many clinicians in presenting an open letter to MPs with a medical background calling for urgent action to address ongoing shortages of critical pain relief medicines, including the removal of PBS patient contributions for medicines supplied under the Palliative Care Schedule. It estimates this would cost less than $15 million annually.
Trade unions
The Australian College of Nursing (ACN) announced it was offering “a new education program providing nurses and other health professionals in 22 Pacific Island countries and territories with life-saving skills through its immunisation course”.
The World Health Organization has funded 50 places on the course which will provide essential education in vaccine safety, administration, and strategies to improve immunisation coverage.
ACN is also mentoring and sharing knowledge with the Uganda Nurses and Midwives Union to improve care for mothers undergoing caesarean sections by implementing best practice guidelines as part of the ODENNA Africa Project, led by the International Council of Nurses.
The Australian Dental Association issued its regular pre-holiday message with “ten holiday hints to make this summer break an orally healthy one”. You have to give them marks for perseverance.
The Royal Australian College of GPs (RACGP) responded to a series of articles in The Australian newspaper on access to mental health by calling for “increasing Medicare rebates for GP mental health consults, and all consults lasting more than 20 minutes, to reduce patients’ costs and improve access to bulk billed general practice mental healthcare”.
The RACGP also called for “specific funding to general practices in disadvantaged areas to supplement the limited Medicare funding available for more complex mental health needs; and decoupling GP Focused Psychological Support (FPS) items from the Better Access Initiative”.
The RACGP also said that the NSW Bureau of Health Information report on public hospital and ambulance activity “highlights the urgent need for government to do more to ensure everyone can access affordable GP care”.
The College also called on the WA Government to match the state Opposition and commit to a free Meningococcal B vaccination program.
The RACGP used the release of the AIHW Burden of Disease report to call (yet again) for increased spending on general practice, particularly increasing “Medicare rebates, including for longer consultations, which are crucial to help patients manage chronic conditions like obesity and improve their health, and can save lives”.
The Royal Australian and New Zealand College of Psychiatrists released its pre-budget submission, urging the Government to implement the recommendations of the National Mental Health Workforce Strategy 2022-2032 “to address the ongoing workforce gap, and ensure timely access to care for all Australians”.
Industry groups
If an organisation representing a regulated sector welcomes a change in regulation, one can safely assume the change will benefit the sector and not its customers.
CHA issued a statement welcoming what it described as “the Government’s decision to support more flexible pricing” as part of the Support at Home program which begins on 1 July 2025.
CHA said that “by using pricing benchmarks instead of pricing caps, the sector can focus on delivering high quality care that meets the preferences of older Australians using pricing that reflects the true cost of providing services in the home”.
However, my reading of the fact sheet on this issue released by the Department on 12 December suggests that price caps will apply, but only from 1 July 2026.
Indeed, COTA issued a statement welcoming the Government’s decision to apply price caps from 1 July 2026.
Medicines Australia announced it was releasing “two new explainer videos [here and here] to educate Australians about the Pharmaceutical Benefits Scheme (PBS) and the regulatory and reimbursement process”.
Medicines Australia CEO Liz de Somer said “we know that Australians value the PBS but most people are not aware there is a delay of 466 days on average from the time a new medicine is approved for use by the TGA to when it is made available on the PBS”.
“Many people also don’t realise that some medicines don’t come to Australia at all because of the complexities of our systems,” she said.
Medicines Australia said the videos will be used as part of the “Stronger PBS” campaign.
I think it might be more accurate to describe it as a “More remunerative PBS” campaign.
Regular readers of this column will be aware of the stoush between the UK multinational Bupa and the north American multinational Brookfield playing out by proxy in the local Bupa health insurer versus Healthscope private hospitals contract war.
After Healthscope threatened to charge Bupa policyholders extracontractual copayments, Bupa initiated legal action, whereupon Healthscope gave three months’ notice of cancelling its contract with Bupa.
It is now reported that Bupa is paying specialists to encourage them to move planned admissions to non-Healthscope hospitals.
Australian Private Hospitals Association CEO Brett Heffernan said the move “would seem unconscionable but, perhaps, anti-competitive too”.
Parliamentary committees
The Government tabled its response to the Senate inquiry into assessment and support services for people with Attention Deficit Hyperactivity Disorder (ADHD)
In the worst tradition of Government responses to Senate inquiries, the response was presented 13 months after the report was tabled (that is, ten months late). The Government accepted only one of the fifteen recommendations (that the Commonwealth expedite the development of uniform prescribing rules to ensure consistency between the states), accepted nine “in principle”, and “noted” five.
The Consumers Health Forum (CHF) described the Government’s response “lukewarm at best and…only offers minor improvements”.
I think “lukewarm” is far too generous an adjective.
Greens Senator Jordon Steele-John commented that “it has taken the Australian Government over a year to respond to this report”.
“This delay is disappointing, and in that time, the situation has got worse for so many people… the Government’s response does not reflect the urgency of the situation, nor commit to the scale of changes needed to improve the lives of ADHDers,” he said.
The Australian Association of Psychologists (AAPi) was even harsher, warning that “disgraceful government neglect on ADHD reforms fails millions of Australians”.
AAPi President, Sahra O’Doherty, said the response was “a glaring failure to prioritise the mental health needs of Australians”.
The Government response “will provide little relief for the high demand for and barriers to accessing appropriate services, and will continue to perpetuate the stigma of ADHD within the community”, O’Doherty said.
International
The World Health Organization (WHO) published its first-ever report on drowning prevention, which showed a 38 percent drop in the global drowning death rate since 2000 – which the WHO described as “a major global health achievement”.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said the decline was “proof that the simple, practical interventions that WHO recommends work”.
However, drowning remains a major public health issue, with about 300,000 people drowning every year, 90 percent of them in low- and middle-income countries.
The report found that globally almost half of all drowning deaths occur among people below the age of 29 years, and a quarter occur among children under the age of five years.
According to the latest report by Royal Life Saving Australia (RLSA), the Australian experience is quite different, with 57 percent of drownings in 2022-23 among people aged 45 years or more.
While Australia deaths from drowning in children aged 0-4 years have halved between 2002-07 and 2017-22, drowning deaths in the cohort aged over 65 have increased by 43 percent over the same period.
RLSA said that “swimming is encouraged for older people as an excellent way to stay fit; however, promoting swimming and water safety skills and prioritising tailored prevention interventions in this age group is a major priority”.
Finally
As we approach the holiday season, some news about chocolate.
The British Medical Journal published an article by a group of authors from the Harvard TH Chan School of Public Health reporting on an investigation of the associations between dark, milk, and total chocolate consumption and risk of type 2 diabetes in three US cohorts.
The good news: increased consumption of dark, but not milk, chocolate was associated with lower risk of type 2 diabetes.
The not so good news: increased consumption of milk, but not dark, chocolate was associated with long term weight gain.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for our next column, which we plan to publish in mid-January.
Department of Health and Aged Care
Draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia
16 December
Department of Health and Aged Care
Draft National STI Strategy
18 December
Department of Health and Aged Care
Medical Research Future Fund Australian Brain Cancer Mission – consultation on the refreshed Roadmap and Implementation Plan
20 December
House of Representatives Standing Committee on Health, Aged Care and Sport
Inquiry into the health impacts of alcohol and other drugs in Australia
31 December
Department of Health and Aged Care
National Lung Cancer Screening Program Guidelines
5 January 2025
Senate Community Affairs Committee
Health Legislation Amendment (Modernising My Health Record—Sharing by Default) Bill 2024
10 January 2025
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia
16 January 2025
Senate Community Affairs Committee
Access to diagnosis and treatment for people in Australia with tick-borne diseases
17 January 2025
Department of Health and Aged Care
Healthy Food Partnership Reformulation Program: Wave 3 Category Definitions and Targets
17 January 2025 (extended from 3 January 2025)
Food Standards Australia and New Zealand
Nutrition Labelling – Health Star Rating and Nutrition Information Panel
17 January 2025
Department of Health and Aged Care
Residential Care Service List (explaining what care and services aged care homes must provide to all permanent residents and residential respite recipients).
20 January 2025
Department of Health and Aged Care
Review of Primary Health Network Business Model and Mental Health Flexible Funding Model
22 January 2025
The Treasury
Pre-budget submissions
31 January 2025
Attorney General’s Department
Draft National Plan to End the Abuse and Mistreatment of Older People 2024-2034.
17 February 2025.
Department of Health and Aged Care
National Health and Medical Research Strategy – Webinar Survey
28 February 2025
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
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