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
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