“The implementation of primary health care (PHC) may well be one of the most significant systemic and ideological health reforms of modern times. Countries with stronger PHC systems have demonstrably more efficient, effective, and equitable health care. Primary health care can be considered a philosophy, an approach to the delivery and development of services and first contact health services. It is based on a social, rather than biomedical, model of health, with accessibility to and affordability of service as primary objectives.”

That is the powerful opening statement to a new systematic review investigating what are the core primary health care services that Australians living in rural and remote areas should be able to access.

Thanks to one of the researchers, Associate Professor Tim Carey, for reporting on the findings (which you can also read in full in BMC Health Services Research).

The review raises the tantalising question: if these core services can be identified, will this provide some obligation on funders to ensure they are available and accessible?

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What primary health care services should residents of rural and remote Australia be able to access?

Tim Carey writes:

The disparity in health outcomes between rural and remote Australians compared to their metropolitan counterparts is well established.

One way of helping to reduce this disparity is to have a clear idea of those primary care services that should be considered “core” or essential to any health service regardless of locality.

In metropolitan areas where a wide range of services is readily available, demarcating core services might not be necessary. In rural and remote places, however, where populations are dispersed, what services are most essential and how those services should be delivered are issues of fundamental importance.

A systematic review was undertaken to identify the services that could reasonably be considered “core”. That is, we wanted to find out what the essential package of primary care services were that any Australian, regardless of geography, had a right to expect access to.

We were also interested in understanding the methodology by which any particular researcher or research group arrived at a selection of core services.

The results surprised us.

This looks like an interesting project, using digital connections to engage the wider community in developing innovative solutions to a public health problem.

If you’re interested in making a pitch to VicHealth’s Seed Challenge, which aims to boost fruit and vegetable consumption in Victoria, you’d better get your running shoes on – the deadline is Friday.

Two pitches will receive up to $100,000 each and the opportunity to work with the Australian Centre for Social Innovation, according to Jerril Rechter, CEO of VicHealth.

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How do we improve fruit and vegetable supply and access?

Jerril Rechter, CEO – VicHealth

The Victorian Health Promotion Foundation has put a total of $200,000 for two projects on the table with an invite for anyone to help solve the ever-growing problem of food security and healthy eating culture.

VicHealth has posed the question via its Seed Challenge, which invites applications from anyone who thinks they can come up with a digital, sustainable, forward-thinking idea which motivate the agriculture, social innovation, digital and health sectors to work together.

Applications for the Seed Challenge close this Friday. The question asked is: “How do we improve fruit and vegetable supply and access, as well as develop and promote a culture of healthy eating in Victoria?”

Crikey journalist Amber Jamieson recently reported that the National Health and Medical Research Council is examining whether anti-wind farm campaigner Sarah Laurie has breached ethical codes of research conduct.

The NHMRC and the Australian Health Practitioner Regulation Agency were recently sent a dossier raising questions about the work of Laurie, CEO of the Waubra Foundation (an anti-wind farm activist group).

The dossier, whose author/s are not named, was forwarded to these agencies by the Public Health Association of Australia. It documents statements by Laurie about conducting interviews and other forms of research.

The Waubra Foundation has since put out a statement calling for ICAC or a Royal Commission to investigate the “anonymous and malicious” dossier.

“The Board of the Foundation considers that what has transpired, plus the contemporaneous and coordinated press campaign prominently featuring chronic critics of the Foundation’s works, is properly the subject of a referral to an ICAC or a Royal Commission,” the statement says. “To ignore the documented suffering of people, and openly to ridicule them, is not only unethical, it is immoral, if not criminal.”

The Waubra statement does not address the concerns raised by the dossier below. I wonder how long until we hear more on these matters from the NHMRC et al…

It’s important to challenge those who seek to demonise parents who use alcohol and drugs as “bad parents”, according to Donna Ribton-Turner, Director Clinical Services at UnitingCare ReGen.

Rather than scapegoating parents with alcohol and drug issues, they deserve appropriate support and care, she says.

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Stigmatising vulnerable families only makes things worse

Donna Ribton-Turner writes:

As the Mother’s Day afterglow recedes for another year and women everywhere get back to the work that will often go unrecognised over the next year, it is worth reflecting on particular challenges experienced by some of the most vulnerable mothers within our communities.

Being a mum is a tough job at the best of times. The pressures of parenthood take a toll on all of us at some point and the feeling of being overwhelmed by responsibilities to our children, others’ expectations and sheer exhaustion is a common one.

Some of us cope with these events, regather our energies and move on.  Some of us seek support from counselling or medication. Some of us self-medicate with alcohol and other drugs.

Jayashri Kulkarni:

Women admitted to psychiatry wards experience high levels of violence and sexual assaults, according to a report released this week by the Victorian Mental Illness Alliance Council.

Across the nine different psychiatry hospital wards surveyed in Victoria, 85% of female inpatients felt unsafe during hospitalisation, 67% reported experiencing sexual or other forms of harassment and 45% of respondents had experienced sexual assault during an in-patient admission.

The report further described that when the women patients reported the incidents, 82% found the nurses to be “not at all helpful”.

The report reveals two major areas of concern – first, that violence against women patients occurs commonly and second, that the incidents are not appropriately dealt with.

Olav Nielssen writes: 

Just when we thought we were heading for a more tolerant and accepting attitude toward people afflicted by mental illness, a feature and a news article in Saturday’s The Australian quoting leaders in the area of forensic psychiatry have revived the old mental-illness-equals-axe-murderer stigma.

One of the articles was based on a recent paper published in the journal Acta Psychiatrica Scandinavica showing a higher rate of conviction for all violent offences by people with psychiatric disorders in Victoria.

The second article examined the random attack of a stranger by a person with mental illness, which research has shown to be a rare event; most violence by mentally ill people is directed toward family and acquaintances.

Both of The Australian’s articles quoted Professor Paul Mullen and Professor James Ogloff of Monash University, who are co-authors of the Acta Psychiatrica Scandinavica study.

This post offers an overview of health-related news from the Budget and a wrap of reaction.

Here are links to:

• Health and Ageing Budget statements

• A table giving a quick overview of health spends and cuts

• Ministerial press releases

• Closing the Gap press release

• The Treasurer’s speech

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The AMA has been campaigning hard against changes to tax deductions for work-related self-education that are likely, amongst other things, to reduce the attractiveness of conferences in exotic locations.

Paul Smith, political editor at Australian Doctor, has exposed one of the vulnerabilities of the AMA’s campaign with a story about its Queensland branch’s annual conference, to be held at a luxurious venue in Chile.

It would be interesting to know the total value of tax deductions claimed by doctors for such trips every year. A related topic worth investigating is inequities in access to continuing education for the various types of health professionals.

Another issue worth exploring is what the FOAM (Free Open Access Meducation) movement means for the medical conference industry. Are traditional medical conferences losing relevance?

Thanks to Paul Smith for allowing republication of his report below (part one is his original story, followed by AMAQ’s response.)

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AMA’s campaign for tax deductible conference travel stretches to Chile

Paul Smith writes:

The AMA’s campaign against plans to cap tax breaks for medical education has been hit by revelations its Queensland branch will hold its annual conference in Chile at a five-star hotel with “lagoon-style swimming pool”.

The six-day trip to Santiago includes an “air and land” package costing up to $6700 per doctor, with delegates — according to the AMA brochure — staying at the Grand Hyatt, “home to world class, multi-cuisine, restaurants [and] a lagoon-style swimming pool with a waterfall”.

Expected to attract 140 doctors, the September event includes four half-day conference sessions with around 20 hours of medical education on topics such as an “Overview of international health systems and standards — how does Australia stack up?”.

Concerns about the presence of man-made chemicals in our bodies should not deter women from breastfeeding, according to a new review of the scientific evidence.

The International Baby Food Action Network (IBFAN) says breastmilk contains protective agents and helps children develop a strong immune system. Breastfeeding can mitigate the effects of chemical exposure in the womb, whereas formula feeding does not afford any protection or mitigation.

The IBFAN statement also says formula feeding and industrial baby foods contribute significantly to environmental pollution.

Joy Heads, an experienced midwife and International Board Certified Lactation Consultant in Sydney, gives an overview of the new statement below.

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A useful source of information on breastfeeding and chemical residues

Joy Heads writes:

The reality of the presence of environmental chemicals has been on the world’s radar since the release of Rachel Carson’s book Silent Spring in 1962.

Today it is accepted that every human body contains many man-made chemicals that can cause harm. Human milk has a high proportion of fat and therefore fat soluble contaminants, including dioxins, can be very easily measured.

Expressed breastmilk used to be included in the Australian Basket Market Survey, now called Australian Total Diet Study (ATDS), because it was easy to collect from consenting women in postnatal wards.

Over the last few decades scare tactics have emerged, warning women about the perceived danger of breastfeeding.  I clearly remember one front page headline in a Sydney Sunday paper in the mid 70’s screaming: “DDT’s in breastmilk: mothers poisoning their babies.”

The press coverage of Florence William’s 2012 book: “Breasts: A Natural and Unnatural History”, which covers her investigations into the issue, did little to allay these fears.

It is therefore heartening that the International Baby Food Action Network (IBFAN) has just released “IBFAN Statement on Infant and Young Child Feeding and Chemical Residues” (2013), which presents objective and independent information for parents, carers and health professionals.