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