The #Health4NSW Twitter festival profiled key health issues ahead of the NSW election, engaging almost 900 participants on Twitter in a discussion that broadened election health debate beyond the usual focus on hospital spending and healthcare.
The rolling post below, compiled by the event’s moderators Ruth Armstrong and Melissa Sweet, summarises key points made by guest tweeters and also wider commentary. A news story will also be published.
The hashtag trended nationally from early in the day until mid-afternoon.
Acknowledgment of Country. Introductions
Ruth Armstrong, Melissa Sweet, Croakey News
@DrRuthAtLarge and @croakeyblog
Highlighting a policy gap: the needs of young Aboriginal people
Summer May Finlay, Croakey News, Aboriginal health researcher
@SummerMayFinlay
The health of young Aboriginal people
In the lead up to the election I feel it’s important to focus on areas often over looked. In Aboriginal health that’s very often young people.
Why do I think young Aboriginal people should be included in NSW policy priorities? I would like to see the next Generation enjoy life free of racism, stereotypes and discrimination. I also want them to be able to practice their culture & do whatever else they want.
Young Aboriginal people are our future. We need to invest in them for their success. Their needs should have separate polices and young people need specific programs. Why? Well their needs are different from older Aboriginal people. Their issues are different.
From the Lancet:
Despite Australia’s adolescents having one of the best health profiles globally, Indigenous adolescents have largely been left behind…Without a specific focus on adolescents, Australia will not redress Indigenous health inequalities.
I’m here not to tell you what young people’s priorities are or how young people want to have solutions considered. I’m 38. That makes me quite old by Aboriginal standards. I hope to impress on people the need to start thinking about young Aboriginal people and talking to them.
Did you know that NSW has the highest number (265, 685) of Aboriginal people of all states and territories? That’s a total of 33 percent of the total Aboriginal population.
A young population
Why focus on young Aboriginal people? 2016 Census showed the NSW Aboriginal & Torres Strait Islander population is younger than Australia’s overall population, with a median age 22 compared to the median age for non-Indigenous Australians: 38.
An election focus on Aboriginal young people is required because not only is the median age of Aboriginal people in NSW 22 – but 53 percent of the NSW Aboriginal population is under 24 compared to 31 percent of non-Indigenous people in NSW.
From the Lancet:
Indigenous communities are young, and adolescence (age 10–24) provides opportunities for population health gain. However, the absence of a comprehensive account of Indigenous adolescents health has been a barrier to effective policy.”
Overincarceration
Our kids being in jail, on remand or under other forms of supervision is going to have a negative impact on their ongoing health and wellbeing. We need to look at preventive measures such as Justice Reinvestment.
When asked if any of the #NSWVotes2019 election policies have addressed the concerns she was raising, with specific policies for young Aboriginal and Torres Strait Islander people in NSW, Summer replied:
The @kimberwalli Centre was a Liberal election promise at the last election. The Centre hopes to promote excellence among young Aboriginal people in Western Sydney. Would be keen to hear others!”
Out-of-home care
Also, too many of our kids are in out-of -home care. 38 percent of all children in care in NSW are Aboriginal. 38 percent!!! There needs to be a greater focus on prevention strategies to reduce the number of our kids in care.
A large proportion of Aboriginal children in care are from families on or near the poverty line. We need to address issues like poverty if we hope to reduce the number of Aboriginal kids in care. #Adoption is not the solution.
Isaiah Dawe, a young Aboriginal man who was in 17 Foster homes, understands being in care does not mean you’re cared for. Being in care can be as harmful or more for our kids, which means we need to find alternative solutions.
Education gaps
Indigenous students remain vastly underrepresented in higher education in Australia. According to Universities Australia, Indigenous people comprise 2.7 percent of Australia’s working age population, but only 1.6 percent of university domestic student enrolments.
Why don’t Aboriginal young people go to uni?
1. Cultural and geographic reasons
2. Social & racial isolation
3. First -in-family
4. Pathways, costs and financial support
5. No obvious benefit
6. Distrust of government institutions.
Young Aboriginal people are experts in their own health needs
The NSW Aboriginal Health Plan 2013-2023 is still current. It would be great if people could share initiatives that have been funded under the plan for young Aboriginal people.
So how should young Aboriginal peoples issues go into the NSW policy mix? First, stop and ask young people what they see are their priorities and solutions to issues they face. Much like the Barang Regional Alliance did with its Empower Youth Summit (which Summer covered for Croakey Professional Services).
Here are some young people talking about their needs at the #Barangyouthsummit. We need more forums like these!
Tune in to @GaryField_94 at 2:30pm today to hear more about what young Aboriginal people need in NSW in light of the upcoming election.
Thanks for letting me talk with you about young Aboriginal people in NSW and why they need to be front and centre in policy positions for the upcoming NSW election.
Public health perspectives
Patrick Harris and Ed Jegasothy, Public Health Association of Australia, NSW branch
@PHarrismusings and @edjegasothy
Patrick Harris tweeted:
In politics, health is often only considered in terms of hospitals and healthcare, but health and wellbeing of the population is a matter for many sectors of government and society – the social and environmental determinants of health.
How we move plays a big role in our health – directly and indirectly. Urban planning and transport influence how much physical activity we get, the quality of the air we breathe, the noise we’re exposed to and our mental health.
What will happen to recommendations from the #infrastructure inquiries #Westconnex #lightrail where #publichealth concerns are front and centre?
Especially #westconnex recommendation 2: ‘The NSW Government mandate the completion of a public health impact analysis as part of the wider economic analysis undertaken for future large scale infrastructure projects.’ (p xii)
And #lightrail ‘…many reporting anxiety, stress and depression, among other physical and mental health impacts… the impacts were not sufficiently taken into consideration at the onset of the project.’ (p. 109)
In short, how are the major parties going to make #infrastructure work for #publichealth !!??
I’m amazed by the amount of #infrastructure promises being bandied about. But for what? ‘Jobs and Growth’, $$ for developers?? What about the public interest and #publichealth ?
Referring to a landmark legal ruling against the proposed Rocky Hill mine, Patrick said this was a global win for #climatechange advocacy and asked: what does this mean for #publichealth?
When it comes to #climatechange action, the benefits are multiplied. Reducing carbon emissions from energy generation and transport will also reduce exposure to harmful air pollutants, as reported in The Lancet.
Better regulation that ensures #publichealth outcomes are across government business. Fund population health at much higher levels than the paltry amount (3% currently?). Focus on addressing #healthequity at the core of that additional funding.
The World Health Organization has just released guidelines about housing and health: clearly a major opportunity for a #publichealth and #housing policy push for #NSWVotes2019 but what might this emphasise?
Public transport options are #healthypolicy options but play second fiddle to roads, roads, roads. Is #publictransport a concern for voters in #NSWVotes2019 and what do they want to see?
Ed Jegasothy tweeted:
I don’t know about you, but we lost count… Planning, Transport & Infrastructure, Education, Water, Energy & Resources, Finance, Environment, Aboriginal Affairs, Multiculturalism, FACS, Housing, Industrial Relations,.
#Greenspace and #walkability also have a huge role to play in #Health4NSW. A recent Sydney study found that the least walkable neighbourhoods have higher rates of overweight and obesity. We can’t say if this is causal, but how does overweight and obesity improve if neighbourhoods aren’t conducive to physical activity?
We often see politicians focusing on the health of the economy as the main selling point of their platforms and criticism of other parties.
Can we consider health and wellbeing of the population as the key endpoint?
Surely, the function of govt is the welfare of the population?
Is @healthyfood on the agenda for #nswelection #nswvotes and what are the main intervention points to improve #regulation #foodgovernance?
#Health4NSW has anyone even mentioned the #sustainabledevelopmentgoals in #NSWVotes19?
So, why do we only rely on economic metrics and polling as success of a government?
When we think about intergenerational debt, we only think about economic costs – but what about human health costs to future generations from climate change, education, urban planning etc?
Ed’s tweets prompted a Twitter conversation about the health impacts of green space.
Health consumers are voters – what should they consider??
Walter Kmet, formerly of WentWest (primary healthcare), set the scene for his session with this Croakey article on The challenge of implementing integrated healthcare.
@WKmet
Walter Kmet tweeted:
Starting off with a pertinent question, Walter Kmet asked,
In @CroakeyNews, I did talk about the beds and hospital arms race – anybody seeing that as well?”
When asked what would be a better “race” for consumers, he replied,
Policy needs to focus on strengthening prevention and primary care to keep people out of hospitals.”
He then went on to talk about integrated care:
Integrated care is founded on organising services around consumers – not consumers organising themselves. How do we strengthen that approach?
One clear example is in #Mentalhealth – we’ve seen a continued investment balance move away from communities to the acute sector.”
Ruth Armstrong commented:
This was also a huge issue in the recent Victorian state election. Surely a better community sector will lead to less demand for the acute sector?
Walter Kmet:
No doubt – building community capacity and capability to effectively identify and deal with health issues early is a good investment.”
Jason Trethowen, ceo at headspace, commented:
So true! Mental Health was a such a big issue in Victorian election. 8,000 submissions just to inform the terms of reference for a Royal Commission into mental health. No point boosting Acute MH services without a balanced, responsive and coordinated community based MH system.”
Still on the topic of funding in the community, Kmet said:
An immediate option for state health systems is work with the Commonwealth to pool existing funds in their operational silos for across community integrated care initiatives #Health4NSW refer to examples like the Manchester Devolution. Bring #phn into the loop.”
Ruth Armstrong asked:
It was also interesting to read between the lines of your piece, about the disruptive nature of constant structural change in primary care. How can governments avoid this?
Walter Kmet:
Structure should follow strategy – continual structural change in the health system needs to be based on an agreed long term strategy based on evidence – and that evidence clearly points to the need for more prevention and primary care, not more hospital beds.”
New money/investment in health should always be applied to improving integrated care and breaking down the silos, not reinforcing them.’
Summer May Finlay asked:
Can you give us some examples of how this has occurred before? Or where silos have been reinforced?
Walter Kmet:
I’ll give you 2 … New emergency departments being built with a a plan and investment in how to keep people out of them. More money on fee for service items, eg, mental health, heart checks that increase volume not value.”
Sebastian Rosenberg added:
Walter is right and drawing on his experience from WentWest. This idea looks a lot like the recommendation made by the National Mental Health Commission in 2014. Time to stop funding governing policy.
Kmet replied:
Yes, indeed; nothing new here – in fact most reform can easily be based on what we already know and money that is producing low value care – accepting that up front investment in change is also critical.”
Dr Kean-Seng Lim, president of the NSW branch of the AMA, joined the conversation:
Dr Tim Senior and Dr Jon Wardle also highlighted potential for primary healthcare to be more proactive in supporting food security initiatives.
Research matters
Dr Megan Williams, Croakey News, Girra Maa Indigenous Health Discipline at Graduate School of Health at UTS
@MegBastard
Megan Williams tweeted:
On evidence-based policy
Evidence-based policy making-overview for the Australian Public Service Commission, by them. Yes it’s a challenge but #solutions well-identified. What’s the hold up?
Parliamentarians and Prime Ministers are supposed to have “policy design driven by analysis of all the available options, and not by ideology”, says the Australian Public Service Commission.
Australian Public Service Commission recognises, in #EBP we have ‘inherited ways of doing things’ ie the take-up of ‘New Labour’ ideas from the UK! Why not challenge that? Why no ‘southern theory’ as Rae Connell’s book explores #colonisation #neocolonialism
Who has read this? ‘Southern Theory’ by @raewynconnell. I’d love more of this please! Including on #EBP challenges #INDIGENOUS #methodologies and what Australia would look like if we designed systems for First Peoples First.
On out-of-home care
Referring to an Independent Review of Out of Home Care in NSW, Megan said: Here’s some evidence! About failure of out-of-home care #OOHC in NSW – the report by David Tune AO, and she urged politicians to base their decisions on this report.
Megan also quoted from Gary Banks AO: “Now I am not saying that policy should never proceed without rigorous evidence. Often you can’t get sufficiently good evidence”. So what is good evidence’? From whose perspective?! #INDIGENOUS #firstpeoplesfirst
“You can never have certainty in public policy. All policy effectively is experimentation. But that does not mean flying blind”: Banks AO.
To which Megan asked: What about #forcedadoption – now legal in NSW despite evidence?
On environment
Thinking of you all in dry lands where ‘development’ actions occur contrary to #evidence #landclearing #coal @battleforbylong #saynotoadani @michaeldaleyMP @BradHazzard
Guidance on #INDIGENOUS #Health4NSW research methods, positioning, ethics or questions needed? It’s all here at @LowitjaInstitut https://www.lowitja.org.au/
My current research includes influence of Aboriginal mothers’ health on kids including #OOHC #NAPLAN #healthcare #Health4NSW #sdoh See http://nsw-cds.com.au/Ngadhuri-nya TY @LowitjaInstitut 
Priorities for cancer control in NSW
Cancer Council NSW
@CCNewSouthWales
The NSW Cancer Council tweeted about their election campaign asks, summarised below (also see this video):
Every day in NSW, more than 120 people hear the words you’ve got cancer and too many families lose someone they love. The next NSW Government has the power to reduce the number of people who get cancer and ensure that people with cancer get the support they need.
In the lead up to the March 2019 election, Cancer Council is calling on the next NSW Government to commit to reduce the impact of cancer in our communities by protecting workers and patrons from second-hand smoke in pubs and clubs, banning tobacco vending machines and introducing a tobacco retail licence fee, removing junk food marketing from government owned property, and funding public lymphoedema services across NSW.”
Toughen up tobacco control
The NSW Cancer Council tweeted that:
In NSW smoke-free laws are failing to protect hospitality workers from exposure to secondhand smoke. One in five patrons of bars, pubs and clubs in NSW said they were exposed to secondhand smoke.
Smoking can occur in bars and clubs where only 25 percent of the area is open to the outside. The problem is that these places do not allow smoke to adequately escape, like it would in a completely outdoor area.
The Council found that the air quality inside bars and clubs is almost 5x worse than outside due to tobacco smoke. Hospitality workers are frequently exposed to these dangerous levels of smoke.
It’s simply not fair that people are putting their health put at risk simply for doing their job. The @NSWgovt needs to strengthen the Smoke-free Environment act to protect people working in a pub or club.
#Tobacco kills two in three long term users, yet it’s one of the most widely available consumer products on the market. Why is it that a product that kills 5,500 people in NSW each year is able to be sold without a licence?
Nine in 10 smokers are within walking distance of a tobacco retail outlet, making it easy for attempting quitters to make an unplanned purchase. We need to support smokers to quit by reducing the availability of tobacco.
Licence fees have successfully discouraged retailers from selling cigarettes in most states and territories. South Australia introduced a $200 annual licence fee in 2007, resulting in one-quarter of retailers stopping cigarette sales.
The NSW Government should do everything it can to protect the health of young people by encouraging businesses to stop selling cigarettes.
Tackle obesity-promoting environments
One in five NSW kids are overweight or obese. 80 percent of these kids will carry this weight into adulthood, putting them at risk of 12 different cancers.
Kid’s exposure to junk food ads influences their food preferences, food brand knowledge, encourages pester power and ultimately influences food intake.
Junk food ads dominate our environment, including on NSW Government owned property. Constant exposure normalises junk food and undermines parents’ efforts in teaching their kids healthy eating habits.
However, the NSW Government continues to take $$$ from junk food ads on public transport which counteracts their current strategies to tackle childhood obesity.
Three-quarters of the food ads that children see on NSW public transport are for junk food – how is it ok that the Big Food industry are telling our kids what they should be eating? Time to show leadership and protect our kids.
The NSW Premier is committed to reduce childhood obesity rate by five percent by 2025. Restricting junk food ads is one of the most cost-effective obesity interventions that will help achieve this target.
The ACT Government has removed junk food ads from buses with no loss in total revenue. Transport for London introduced a junk food ban on public transport two weeks ago. Seventy percent of NSW adults SUPPORT the removal of junk food ads.
It’s time for the NSW Government to have the courage to put our kid’s health before corporate wealth and remove junk food ads from state owned property.
Better care for people with lymphoedema
Lymphoedema is chronic swelling – often arms, legs or torso which can occur after cancer surgery or radiation therapy. More than 22,000 people in NSW are affected.
It is an incurable condition, if untreated, swelling gets worse causing physical and psychological distress. Also problems with mobility, activities of daily living and employability. But with good care from trained lymphoedema therapist, it’s manageable.
Lymphoedema is expensive; for example, the costs of a private therapist, compression garments, skin and wound products and time off work if hospitalised. Average out-of-pocket cost for moderate or severe lymphoedema are around $1,400.
Lymphoedema increases risk of cellulitis (painful, infected skin). Cellulitis = number 1 potentially preventable hospitalisation in NSW. Reducing risk of lymphoedema developing into cellulitis = reducing costs to health system for unnecessary hospitalisations.
Risks of lymphoedema decrease with early diagnosis and evidence based treatment. Highlighted in new NSW Government guidelines.
There’s not enough lymphoedema services in the NSW public healthcare system. Therefore many people are missing out on care in both rural and metropolitan regions.
Funding is needed for public lymphoedema services across NSW to ensure that people with lymphoedema have timely access to evidence-based care, regardless of where they live (watch this video).
Support the NSW Cancer Council election priorities campaign here.
How can social policy contribute to better health outcomes?
Tessa Boyd-Caine, Health Justice Australia
@HealthJusticeAu
Tessa Boyd-Caine tweeted:
I acknowledge the Traditional Custodians of the land on which we live and work, as well as the strength and resilience of Aboriginal people. I pay my respects to Elders past, present and emerging.
We also acknowledge the ground-breaking work Aboriginal-led organisations have done in innovating community-centred approaches to health, legal and human services: @NACCHOAustralia @ALS_NSWACT @AbSecNSW @ahmrc
What do these things have in common: mould in public housing, accumulated fines, and navigating Centrelink? They’re all health-harming legal needs: problems that lawyers can help with, that can drive or exacerbate poor health.
They’re also all examples of social need driven by social determinants: the many factors beyond the medical that effect people’s health. That’s why social policy plays a key role in supporting health and wellbeing.
At Health Justice Australia, we are the national centre for health justice partnership, driving systems change to improve health and justice outcomes for people vulnerable to unmet need.
We support health services to identify and respond better to family violence. This includes giving them not just the skills to identify the problem, but the tools they need to help patients move towards a solution.
We also work on: strengthening the move towards integrated care, particularly around the social drivers of poor health; outcomes measurement that drives social innovation and social impact in health; and community legal service planning, coordination and impact.
Why health justice partnership?
We know factors beyond the medical drive poor health #SDoH. Evidence shows there are people with intersecting health and legal problems who access health services with symptoms rather than seeking out legal solutions.
Shout out to our NSW colleagues already doing this amazing work. @LegalAidNSW @MacarthurLegal1 @Justice_Connect @RLC_CEO @HumRivLegal @SEastSydHealth @Slhd @headspace_aus @StVHealthAust @WestSydHealth @SWSLHD @wnswlhd @MNCLHD @CCoastHealth @NSLHD @facsnsw
Many other social problems undermine access to justice and drive poor health. From fines, housing and social security, through to elder abuse and family violence, these are all issues where legal help can improve health outcomes.
That’s why partnerships between health, legal and social services can improve our ability to get people the help they need, when they need it!
What do we hope to see from here? We’ve got a list! And we’ve been talking to policy makers about how they can support the following:
- Innovative approaches that shift the policy focus from child protection to child health and welbeing.
- Building capacity & capability within healthservices to identify AND respond appropriately to people at risk of family violence, elder abuse
- Funding that enables services to work in collaboration, combining the expertise of different sectors and settings, to better meet the needs of the communities they serve
#NSWpol, we’d love to hear how you can support social innovation to tackle the underlying drivers of poor health. Funding? Policy frameworks? Commitments?
One area of intersecting health and legal need is the vulnerability of older people and the impact this has as our population ages eg through elder abuse.
We need to support people to age with health, justice and dignity. Are policymakers ready?
Our ageing population presents new challenges for health and human responding to complex needs of older people, and the systems in place to address them.
#Haveyoursay at one of a series of conversations later this month. http://ow.ly/39eS50mJ87
And for everyone sharing their experience of intersecting health and legal need, join us at Health Justice 2019 to share your insights and drive charge through practice, policy and research.
Vote 1 for climate action; it’s an emergency
John Van Der Kallen, NSW Chair of Doctors for the Environment Australia (Read his recent Croakey article)
@johnvanderkall1
John Van Der Kallen tweeted:
This should be the “climate election” as it is now urgent that we make changes to deal with climate change. This urgency has been outlined in the recent IPCC report.
We have just had the hottest January ever with record mean, maximum and minimum temperatures. The mean temp was 2.91°C above average long term average. This is a real climate emergency.
Heatwave events result in more people presenting to emergency departments especially kids and older people. Those in Western Sydney are suffering from the urban heat effect.
Even our food production is impacted by climate change. In those area of Australia where rainfall has declined, so has food production. We must make urgent changes if we are going to protect our future.
Our politicians need to know that we are serious when we want them to act on climate change. The Australian Medical Association agrees.
Dealing with pollution has immediate health benefits as well as mitigates against climate change. We should vote for candidates who will take pollution seriously.
There are 279 premature deaths each year in NSW due to the pollution from the five coal fired power stations. These same stations account for 361 new cases of type 2 diabetes and 233 low birth weight babies.
The next government needs to put a “price on pollution” which goes some way to compensate for the health damages they cause. Load based licencing already exists but needs to increase.
The CFPS should be required to reduce sulphur dioxide and nitrogen dioxide pollution to bring in line with Europe and the USA. Recently the EPA had an opportunity to review and tighten the licences on 3 CFPS but nothing changed!
2018 air quality data showed that air quality in NSW in worsening. 14 locations in NSW now have PM2.5 levels above the NEPM standards. 5 of these are in Sydney. This will result in more deaths, respiratory disease and cancers.
We need a NSW government that will reduce emissions and reduce pollution to protect human health.
Biodiversity is essential for human health. Nature provides us with medicines, clean water, good bacteria, clean air. We need to protect nature and biodiversity.
Spending time in nature reduces stress and improves wellbeing. More should be done to encourage people to spend time in nature.
The health sector accounts for seven percent of Australia’s total emissions. The health sector needs to reduce its own emissions. This could be done via a health sustainability unit such as in the UK.
Unconventional gas or coal seam gas is not the answer to dealing with climate change. The fugitive emissions alone from UCG is enough to outweigh any benefits over other fossil fuels.
In summary
1. We urgently need to mitigate against climate change. The impacts of climate change are occurring everyday and we are just seeing the beginning.
2. The solutions are good for our health. Reducing pollution. Protecting biodiversity. Improving our diets.
3. Transitioning away from fossil fuels.
4. Total and permanent ban on UCG/CSG.
5. Vote for a candidate that is going to take climate change seriously and make changes in the next parliament.
Climate and health, Indigenous health, health equity
Tim Senior, Croakey contributing editor, GP working in Aboriginal health
@timsenior
I’m a GP working in the Aboriginal Community Controlled Health Service owned and run by Tharawal people (as covered recently in the Sydney Morning Herald).
Understanding the local effects of climate change is important; you can find out more here – then talk to your politicians.
Legitimately, though, people in areas of mining are scared for their jobs. We do need a transition plan.
Where I live, we have seen the Thirlmere lakes dry up as a result of the drought (caused by climate change) and longwall mining.
Mining and burning coal is really harmful to health, especially those who mine it (as per this 2011 article, The mining and burning of coal: effects on health and the environment paywall).
We’ve heard a lot about how we need to promote health outside hospitals. These images show why. Obviously, that’s where most people are. (These are from classic papers, The Ecology of Medical Care)
I can’t help thinking that the State Government underestimates the complexity of managing health care. Here’s what happened with the new public-private partnership.
…And hospitals are having their training accreditation removed. Westmead ICU, Royal Prince Alfred, RPA, and Bankstown threatened. That’s the tip of an iceberg.
So I’ve been looking at the policy pages of the major parties. And there’s good and bad in all of them. How would you choose?
The Liberals are going to fund Healthy Harold! Any evidence for this approach?
Meanwhile, most of the commentary is taken up by stadiums (it seems to me). There’s not very much evidence on the health effects of subsidising professional sports stadiums. Here’s this, saying there may be some societal benefits, from a subsidy greater than zero, but not from the amount we usually subsidise.
There is also a lot of building of trains and light rails systems going on. And there is evidence that good public transport increases people’s physical activity, compared to car driving.
But there’s also a lot of road building, so, you know…
The potential for this to impact (often worsen) inequalities is definitely there, and unless it’s looked into specifically, they will usually worsen. For example, air quality.
Finally, a Treaty with Aboriginal people is there in the policy mix from Labor. 
Investigating critical health concerns
Wendy Bacon, investigative journalist
@Wendy_Bacon
Wendy has been doggedly following the impacts of the WestConnex motorway project upon affected Sydney communities, including through a citizen science air quality monitoring program. Follow her investigations here.
During the Twitter festival, she tweeted out some telling photographs of the development and spoke for the importance of citizen science projects.
Wendy tweeted:
Air quality is not good all over Sydney today but at the monitors near St Peters school in middle of WestConnex zone, it is worse. So far this year, rolling average over 10 PM 2.5 – national goal 8 u/gm3. There is no safe level as you know.
Rozelle interchange must not go ahead. Far too risky and could damage many homes. It is an air quality disaster. CPB, the company RMS has given contract to, don’t even have a design. This is the company that destroyed people’s quality of life for years in Haberfield, St Peters.
The Environmental Impact Statement took no quantitive account of air quality impacts and assumed it would be mitigated and all would be well. St Peters WestConnex is massive open wound like coal mine with other construction nearby.
Major parties need to wake up to the #airquality issue.
Dr Catriona Bonfiglioli from UTS joined the conversation:
Wendy Bacon also shared a personal story about abortion and noted that only in NSW is abortion still a crime. “If you have money, you can get one, but it’s not accessible or affordable, particularly outside cities,” she said. Read her article: Abortion – it’s time for change in NSW.
New government must act on medical devices to prioritise patients’ needs
Anthony Brown, Executive Director Health Consumers NSW
@HCNSW
Anthony Brown tweeted:
I acknowledge the Traditional Owners of the lands on which we are having these discussions and pay respects to Elders past, present and emerging. As non-Indigenous people, we have so much to learn from Aboriginal and Torres Strait Islanders’ understanding of health and how to involve people and communities.
All of the issues mentioned in #health4nsw so far are important to #HealthConsumers; the debate needs to include people’s real experience of health, illness, treatment and use of health services into every stage of care and every stage of planning.
Real democracy doesn’t stop with elections – health services need to involve us as #citizens all in the design of health services and health policies that impact on us – #NothingAboutUsWithoutUs.
With growing international concern about the safety of medical devices, the next NSW Government also needs to priorities patients’ needs – especially for people injured by medical devices. @ICIJorg #ImplantFiles
Last year’s Senate Inquiry into use of transvaginal mesh uncovered a lack of empathy for injured women, lack of follow up services, and failure of regulatory system to protect public – this is also true for people injured by other devices
Regulation of medical devices in Australia – regulatory issues are (mainly) a Federal responsibility, the Therapeutic Goods Administration. States are responsible for better services for injured people.
To give credit, @NSWHealth is recruiting mesh-injured women to help develop services for women injured by transvaginal mesh: a good first step, and this systemic involvement of patients is needed more generally.
We need to keep the discussion about medical devices going with @HCNSW and other consumer councils hosting a forum to discuss Unfinished Business: National Mesh Implant Forum on 5 April.
Brown extended Wendy Bacon’s concept of citizen science (as outlined in the previous session) to all health research. Imagine if consumers were front and centre!
Brown was asked, Do you have any examples of such collaboration that could act as a model? Breast cancer research comes to mind.
He answered, Yes – cancer research has many good examples as does mental health research. Here’s what consumer told us is important in such partnerships.
To finish where I started – INVOLVE us as citizens and health consumers in designing services & policies: as the World Health Organization states: “People have the right and duty to participate individually and collectively in the planning and implementation of their health care.”
How the next NSW Government could do more to prevent chronic disease
Kean-Seng Lim, NSW branch president, Australian Medical Association
@Keansenglim
Kean-Sing Lim tweeted:
Thanks for the opportunity to talk on Chronic Disease and how we can try to manage this better in NSW – I acknowledge the Traditional Owners of the lands on which we are having these discussions and pay respects to Elders past, present.
We are facing a tsunami of chronic illness, driving demand for health services at a rate faster than population growth. This is not just a problem with ageing but with actual illness.
As an Association, AMANSW sees the management of chronic disease to be vital to sustainable health care and a sustainable system.
The AMANSW Election Priorities document can be found here – it covers both state and federal levels and reflects the complexity of health and the funding system underpinning it.
Lim was asked, So many government policies at every level feed into chronic disease. As a GP and a medical leader, you must have a wish list?
He answered: Managing Chronic Illness is a systems problem. Our current health system and even the way we teach healthcare is heavily based on an episodic care model. It’s time for deliberate system design.
AMANSW election approach has three broad domains – Healthy Hospitals, Healthy Systems and Healthy Communities. We would like to see a National Health Strategy, which would be able to reliably inform a workforce and funding strategy.
When it comes to prevention, we need to look at everything from transport options, to green spaces, to urban design. A good place to start is looking at the Kaiser Chronic Disease pyramid.
When asked about AMA NSW’s advocacy for doctors in training, Lim replied,
A healthy system needs healthy practitioners. It’s the quadruple aim. Better patient experience, better population health outcomes, sustainable cost and improved provider satisfaction.
And a final tweet on doctors’ health from Health Consumers NSW
Safe patient care and minimum staffing in NSW public hospitals
Brett Holmes, NSW Nurses and Midwives’ Association
@nswnma
The NSW Nurses and Midwives’ Association (NSWNMA) is the registered union for all nurses and midwives in NSW. Membership comprises of those who perform nursing&midwifery work at all levels including management & education. This includes registered nurses & midwives, enrolled nurses & assistants in nursing.
Our role is to protect and advance the interests of nurses and midwives and our professions. We are also committed to improving standards of patient care & the quality of services in health and aged care services.
We are asking the people of NSW to vote for minimum nurse/midwife to patient ratios in NSW public hospitals to improve patient safety and to make sure nurses and midwives have the time they need to do their jobs properly.
For over a decade, nurses and midwives throughout our public hospitals have been working excessive overtime, on the brink of burnout and in fear of mistakes. Labor’s commitment to introduce guaranteed minimum nurse-to-patient ratios will be a huge weight off their shoulders, and allow them to deliver the safe patient care necessary, regardless of where they are in the state.
We believe that Labor’s commitment to deliver ratios means that safe staffing will be mandated in law and the system will not be vulnerable to manipulation as currently occurs. We have argued that guaranteed ratios on every shift and every ward is the only way to deliver safe patient care at the bedside.
The Liberal-Nationals pre-election announcement is disappointing, by comparison to what we’ve seen put forward from Labor. We’ve been arguing the case for ratios with the Liberal-Nationals for eight years and all we’ve had in return are empty promises.
Numbers alone aren’t enough to fix the staffing problems in our public hospitals. We must get to the root of the cause. Labor’s acknowledgement that shift-by-shift ratios are required is a gamechanger.
Of all the members of the interdisciplinary hospital team it is the nurse/midwife who provides the vital bedside 24/7 surveillance that picks up early signs of a deteriorating condition and initiates the early interventions that avoid more serious complications and negative outcomes for the patient. To do this effectively we need time to spend with every patient.
All members of the interdisciplinary healthcare team have a role to play in prevention of adverse outcomes; however the evidence describing the significant link between nurse/midwife staffing and patient outcomes provides a compelling case for mandated minimum staffing in inpatient settings.
The growing body of evidence clearly demonstrates that inadequate nurse staffing leads to an increase in negative outcomes for patients and ultimately a greater burden of cost to both the healthcare budget & society.
of discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%.
A study of discharge data from 36,529 Western Australian patients demonstrated that there was an increase in prevalence of adverse outcomes and complications for those patients who were exposed to understaffed shifts.
A new ratios system will mean guaranteed nurse-to-patient ratios in every ward, on every shift across all major and district NSW hospitals, creating a clear understanding of how many patients nurses and midwives will care for safely.
A change in Government would be a huge win for regional hospitals. For too long a patient’s care has been determined by their postcode. Labor’s commitment will guarantee nurse-to-patient ratios of 1:4 on day and afternoon shifts; and 1:7 on night shifts.
Staffing ratios are affordable. Victoria has operated a ratios system for many years & Qld has implemented ratios more recently. The cost of treating patients varies significantly from hospital to hospital for many reasons but there is nothing to suggest that ratios have blown out costs in Victorian public hospitals.
Nurse and midwife ratios save the system costs by reducing adverse events and complications, reducing length of stay, avoiding re-admissions, improving performance and enhancing recruitment and retention. Year on year, presentations to our public hospitals rise, and nurses and midwives are being forced to take on that increased workload. It’s not right and it’s not safe.
We know the Liberal-National’s preferred ‘NHPPD’ staffing system can be easily manipulated and rorted. Patients across NSW have already lost out on more than 40,000 hours of nursing care.
A Sydney hospital was so short staffed expectant parents were forced to deliver their baby alone, an inquest into their daughter’s death has heard. Her mother says no staff were present in the birth room, causing her husband to frantically call for help with an emergency buzzer. “He was pressing the buzzer, no one came,” she told Glebe Coroners Court.
Midwifery care are must be safe for women and their babies. Midwifery care should only be provided by midwives. All women must have access to midwifery led models of care. Newborns must be counted when determining workloads.
We welcome Labor’s commitment to implementing a minimum ratio of 1:3 for postnatal patients and for a review of the current “birthrate plus” maternity system. A of 17,674 women in 15 studies compared midwifery led continuity of care model with other models of care for woman and their babies.
The found that ‘women who received midwife-led continuity models of care were less likely to experience epidural, instrument birth, preterm birth <37wks, less all fetal loss before and after 24 weeks plus neonatal death.
Under Labor’s commitment of 1 nurse to 3 mothers in postnatal maternity units, mothers and newborn babies will finally get the support and education they need in those critical first few days. This is a first for NSW and long overdue.
Our overcrowded emergency departments and children’s wards have been crying out for nurse-to-patient ratios – finally these critical areas of our public hospitals will have a minimum standards, guaranteed in law.
Ratios = more nurses & midwives + safer patient care for all of NSW.
A new ratios system is a necessity for safe patient care and will stem the flood of overworked nurses & midwives leaving our public health system – attrition and burnout are real factors that numbers alone won’t fix.
Nurse and midwife understaffing has significant implications for workforce recruitment & retention. We commissioned ACIRRT research in 2002 to understand why nurses&midwives leave our profession and our members tell us those findings remain relevant today.
Changes in hospital systems have had major implications for the nature of our work. In combination these changes have lead to more stressful & less satisfying work that does not have the intrinsic rewards that nursing used to provide.
Over the last couple of decades there has been unrelenting focus on cost containment in public hospitals which means that patients are churned through the system much faster, they are sicker & their needs are much more acute. But without a matching increase in staffing.
The intensity of the care required, the level of responsibility, the scope of the roles, the level of flexibility demanded, the technical expertise and the demands of documentation & data collection has transformed nursing/midwifery work.
Nurses and midwives report that these changes mean that they simply do not have the time to provide care to the standard they want their patients to receive. The result is more stressful work that no longer provides the intrinsic rewards that nurses and midwives value.
Listening to the voices of young Aboriginal people from the Central Coast
Gary Field, Barang Regional Alliance
@Gary_Field94
Recently, at our Empower Youth Summit, young people identified that health and well-being means being physically, socially, emotionally and culturally well. Public transport and associated costs are a barrier to accessing help.
Mental health was spoken about, yet the great majority of young people agreed that they do not have the confidence to talk about mental health. Services need to include a safe place for young people to speak and meet.
Alcohol and drugs inpatient services need more beds. Want success? Value an integral part of the patient journey – the Aboriginal health worker – assists with all the compounding factors: DV, homelessness, drug and alcohol.
Let’s debunk the nine to five myth. Everyday I see our local AMS doing more than their funded obligations for our community. Always outside the nine to five hours. Always unfunded. Young people don’t live nine to five; nor should our services. #fundprogramsthatwork
Watch the videos mentioned below here.
What have we heard so far?
Ruth Armstrong & Melissa Sweet, Croakey News
@DrRuthAtLarge and @croakeyblog
Key election issues for Aboriginal and Torres Strait Islander women’s health
Keziah Bennett-Brook, Program Manager, Aboriginal and Torres Strait Islander Health Program, George Institute for Global Health
@Kez_bb
Keziah Bennett-Brook tweeted:
Thank you Croakey for having me. I’m a proud Torres Strait Islander woman, have grown up and live on Dharawal Country and work on Gadigal Country. I’m the Manager of the Aboriginal and Torres Strait Islander Health Program.
I am honoured to be surrounded by so many strong and proud Aboriginal and Torres Strait Islander women fighting hard for the rights of our people-today I’m tweeting on Aboriginal and Torres Strait Islander women’s health.
Aboriginal and Torres Strait Islander women have been and continue to be the pillars of our society and play active and significant roles at many levels within our families and communities, at local, state, and national levels.
When we talk about women’s health generally, it’s worthwhile thinking about what we mean and in particular, who we are talking about? Who are we leaving behind?
Too often the discourse around women’s health fails to take into account or recognise the experiences and key health concerns of Aboriginal and Torres Strait Islander women as different to those faced by broader society.
Understandings of Aboriginal and Torres Strait Islander women’s health often focus on a western biomedical model and can exclude Aboriginal knowledge and perspectives.
See @MLongbottom13 article highlighting how a national data set can have gaps when it comes to Aboriginal and Torres Strait Islander women and violence.
You cannot ignore a holistic concept of health as not just physical but social, emotional, cultural and spiritual health and wellbeing of individuals and communities, and an existing knowledge base of more than 60 000 years regarding women’s well being.
Prioritise services that look out for our mob. The First Response project provides evidence and critical insight into how the primary healthcare workforce can be supported to provide trauma-informed care that is culturally safe.
I’d like to take the opportunity to point out some of the Aboriginal women I have the privilege of working alongside who are champions for Aboriginal and Torres Strait Islander women and families – @anne2_11 @kathleenclapham @MLongbottom13 @julieanncoombes.
Ongoing effects of colonisation including racism, intergenerational trauma, stolen generations and loss of land MUST be addressed in relation to their effects on cultural continuity and wellbeing, particularly poignant when it comes to our women and family violence.
Check out @NACCHOAustralia news alerts relating to Aboriginal and Torres Strait Islander women’s health.
Our health matters
El Gibbs, People With Disability Australia
@bluntshovels
I live and work on Darug and Gundungurra land, which always was, and always will be Aboriginal land. I pay respect to elders, past, present and emerging. I’d like to thank all Aboriginal and Torres Strait Islander people who contributed and worked on #Health4NSW
I’m going to mostly chat about disability-related things in NSW, with a focus on the social determinants of health, because that always matters when we talk about health, particularly for disabled people. Accessibility matters – in health, housing, transport, everywhere.
One of the biggest issues for our health in NSW has been the dismantling of the NSW Disability public sector, and the withdrawing of all services for the 90 percent of disabled people not on the NDIS.
When the NDIS was introduced in NSW, there was bipartisan support for the ending of state/public disability services. As you can imagine, this has been a bit of a disaster for disabled people.
90 percent of us won’t have an NDIS plan. The NDIS has also made it very clear that they won’t fund supports for anyone they say has a health-related disability, which they say should be supported by the health system. Yeah, right.
When I wrote about this before the last NSW election, the then Minister said: “Under the NDIS an eligible person with a disability, which may include episodic disabilities such as mental illness, will be appropriately supported”
Yeah, nah, that’s not what has happened. There was a big inquiry last year about how the NDIS is going in NSW, and this kept coming up over and over.
Lots of organisations raised what has happened – @PWDAustralia (where I work) said :”The wind-up of ADHC has caused significant hardship for people with disability.”
So it will come as no surprise that the main thing that disability groups are calling for this election is a new Disability Inclusion Minister, responsible for making sure mainstream services include us.
Below are the election platforms from @PDCNSW, @nswcid and us, all saying the same things:
Physical Disability Council of NSW
Council for Intellectual Disability
People with Disability Australia.
As part of this removal of NSW disability services, NSW Disability Advocacy is also being totally cut, when other states and territories are expanding their advocacy services. @StandByMeNSW
This means the end of representative services – peak bodies – of disabled people who can talk to government, with considerable expertise, about how to make sure we are included.
After all, we’re 20 percent of NSW’s population.
If you want to read more about advocacy, and why it matters, check out this report.
You can see some of the campaigning we’ve been doing, including rallies, social media blitzes, meeting with MPs, days at Parliament etc, for the last two years. 
This ask, about inclusion and about funding advocacy, is included in the Building Better Communities platform from the NSW Council of Social Service.
NCOSS are also doing a nifty policy tracker, so you can see what the parties think about the different policy areas.
The key takeaway is that there’s more than the NDIS when it comes to disability, and the supports we need. Disabled people have the right to be able to access what non-disabled people can access, like housing, transport and yes, health services.
How many health facilities are accessible? Does your practice have adjustable exam tables, wide doorways, room for disabled people to move around, and get in the actual building?
Is your health facility near accessible transport? If not, why not and what are you doing to change that? Do the people you work with have safe, affordable and accessible housing?
The point I am making is that making the community accessible is a job for all of us, not just those of us that find it inaccessible. Health workers, of every kind, have a key role to play with including disabled people.
Fund disability advocacy, and make sure we have the supports we need.
Transitioning mining communities, and the determinants of health
Brad Webb, Samaritans, tweeting from Newcastle
@bradjameswebb
To say that @IndigenousX has opened my eyes to Aboriginal Australia would be an understatement. I am in awe of the diversity of this land and its traditional owners.
It influences my work, my leadership, and my personal growth. 60,000 years of continuous culture is something Australia should be celebrating…and respecting.
I am the CEO of Samaritans Foundation (@SamaritansNews), but the usual disclaimer applies. Tweets and the views expressed today are my own.
Samaritans is an NGO operating in the Newcastle, Lake Macquarie, Central Coast, Hunter, Mid-North Coast, and Central West of NSW. This includes the lands of the Awabakal, Biripi, Darkinjung, Dunghutti, Gumbaynggir, Kamilaroi, Wanaruah, Worimi, and Waridjuri nations.
We have over 800 staff who deliver services across a range of areas from disability services, housing and homelessness, early learning, family support and preservation, mental health,
I am here because of a tweet I wrote in response to The Guardian article by @Jo_Tovey about the call from @GregPiperMP, @AlexGreenwich, and @givejoeago for major parties to commit to a 10-year transition strategy for coalmining communities.
In my tweet I noted that the impact of the structural transition away from fossil fuels will be keenly felt by Hunter communities. These are communities in which we operate. We care about these communities.
I am by no means an expert in structural transition. I lived and worked in Newcastle during the period of BHP’s decline, and ultimate closure, in 1999. There were positive outcomes for the city from this, but these also came at a human cost.
At this point, I should shout out to Emeritus Professor Dave Adamson – @ProfDaveadamson – who is the Knowledge Manager at @compass_housing. I owe a debt of gratitude to Dave, whose work in the communities of Wales has parallel to the conversation here today.
Dave developed a model called Deep Place, which is about working with people and organisations that want to develop stronger local economies, work towards social justice and equitable outcomes and achieve sustainability.
Tredegar is a fairly typical disadvantaged small town in the Heads of the Valleys area of South Wales. This region saw the steady decline of both coal and steel production over a period of time, culminating in the closure of the last steelworks in Tredegar in 2001. The report on this work can be found here.
It will come as no surprise that there are significant health inequities in areas that have experienced industrial transition.
There is a whole section in the report that explores health and I am not going to speak on behalf of @ProfDaveadamson. However, there is a pearl in the report that really resonates with me and has direct bearing on the question of economic development.
The Deep Place report references a report from the Federation of Small Businesses Scotland and the role of local procurement in sustaining economies. I find this particular reference fascinating, because it speaks to the role of government policy.
But back to the Deep Place report:
As part of the foundational economy, health services are both a major employer and a major consumer of goods and services.
As a consumer, the health service offers considerable potential for local economic impact. Current procurement practice tends toward centralised and consortium purchasing for very sound reasons of economies of scale.
Beyond the highly specialised goods and services required by health care organisations, there is considerable opportunity for more local purchasing patterns, particularly in the supply of food and basic services such as cleaning, caring and ancillary services.”
This is a very interesting concept and one that extends beyond health services to other government services. In the regions we operate in there are not only health services, but prisons and schools.
I am not suggesting that government services aren’t thinking about this. However, I am noting that it needs to be one of the levers that government has at its disposal. Clearly the trade-off between cost savings and economic impact to a region needs to be modelled.
Coming back to thinking about communities in transition, this needs to be on the table. As a community transitions from a major industry, such as coal, it is tempting to look for another big industry to take its place. But that is not always realistic in my view.
Okay, so having said that finding a replacement industry isn’t always a panacea, I will give an example of an exception.
I am from a town called Guyra on Anaiwan country in the northern tablelands of NSW. Like many rural towns, it was suffering from decline that was hastened by the final closure of the abattoir, which was a major employer.
In 2005, a 20 hectare glasshouse facility was constructed by Costa Group just outside the town. A further 10 hectare glasshouse was added in 2015. Then in 2018 a further 10 hectare expansion was announced, which would take the number of employees to 750.
None of this is without controversy – a new venture such as this impacts on many stakeholders, and comes with a potential social cost. But there is no doubt that it has been an economic shot in the arm for the town (see this article in The Land newspaper).
When it comes to healthcare, the town currently supports three GPs. In a rural community of 2,027 people (2016 Census), this represents a positive number when compared to the national FWE per 100,000.
Guyra also has a good public hospital (Multi-Purpose Service, thanks @HNEHealth) and NGO provided aged care facilities. Despite this, it doesn’t fare well on measures of health.
So a transition plan needs to not only consider economics, but also the other determinants including social cohesion.
Which brings me to a final point about the work we all do, and it is something I have seen across the day.
I was originally inspired to join the human services sector because of the social determinants of health. I was inspired by the work of Professor Fran Baum – @baumfran – and Professor Sir Michael Marmot – @MichaelMarmot.
Every day I reflect on this and point my teams towards the broader ecosystem called society.
This is the NSW Human Services Outcomes Framework (see more here).
It is a useful frame for me to come back to, time and time again, to remind people that there are no simple answers.
I have one minute left, so here is a plug.
I believe it is not good enough that in NSW care leavers are significantly more likely drop out of school, to face homelessness, and to end up unemployed. If young people leaving care are to thrive, they need more supports than the average teenager, not less.
For this reason, I’m supporting The Home Stretch campaign’s call-to-action to send an online letter to the NSW Premier and Opposition Leader. If you want to join me, visit here.
@The_HomeStretch has more information, including the NSW report.
Gun control, what’s at stake?
Stephen Bendle, Australian Gun Safety Alliance
@AustGunSafety
Stephen Bendle tweeted:
We will start by acknowledging the Traditional Owners of country throughout Australia and recognise their continuing connection to land, waters and culture. We pay our respects to their Elders past, present and emerging.
The Australian Gun Safety Alliance is a coalition of voices leading the public debate on gun safety. It wants to hold Governments to account for the existing National Firearms Agreement and provide a balanced view on gun control and community safety.
We acknowledge that the vast majority of legal firearm owners are good people. However, we don’t think it should be easier to get a gun, to get more guns or get more powerful guns.
Nearly 90% of the Australian public regularly say they are happy with our current gun laws, or indeed would like them stronger.
A small percentage of Australians own guns. A smaller percentage want to dismantle the fundamentals of the NFA that has helped keep Australian families and children safe.
A recent statistical analysis showed that without our gun reforms it could be predicted that approximately 16 mass shooting incidents could have been expected to occur between 1996 and February 2018.
The Liberal Democrats, One Nation and the Shooters, Fishers and Farmers party could hold the balance of power and be able to introduce all types of concessions to increase access to firearms. Where is the public safety in that?
Liberal Democrats firearm policies
One Nation firearm policies
Shooters Fishers and Farmers firearm policies
There are now over 1 million guns in NSW. That is about 1 in every 8 people around you.
The ABC’s Anthony Green says the rural seats will not only be the likely deciders of the election but makes usual prediction calculators redundant.
Bendle was asked: I note that you have written to both major parties calling on them to adopt your policy positions not to weaken gun control. Has there been any response as yet
He answered: The major parties are committed to gun safety. It is the smaller parties that I have mentioned that have clear policies to undermine the NFA.
The Australian Gun Safety Alliance asks all NSW voters to take care with their votes and make sure that the smaller parties don’t hold the balance of power and wield enormous influence over amendments, additions and changes to legislation designed to appease shooters.
NSW voters should do everything they can to avoid it being easier to get a gun, or get more guns, or more get more powerful guns. 90 percent of Australians are watching and will thank you.
(Also see this article by Professor Simon Chapman)
Reflections and feedback
Paul Dutton, @PaulDutton1968, from the Barkindji Nation, provided an energetic stream of commentary and analysis during the day, and a selection will be published in a separate article at Croakey.org.
Analytics
The hashtag trended nationally on Twitter from early morning until mid afternoon. Symplur analytics show that from 7-12 March, there were 895 participants, more than 5,000 tweets and more than 33 million Twitter impressions using the hashtag. Read the Twitter transcript here.
Thanks to all participants, contributors, readers, and tweeters.
Please keep using #Health4NSW
