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child health

Jul 29, 2011

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Thanks to Froncesca Jackson-Webb, for providing this update of the latest health and medical reading at The Conversation.

From scraping by to pizza and pie: how protein price drives obesity

By Rob Brooks, Professor of Evolutionary Ecology; Director, Evolution & Ecology Research Centre at the University of NSW

For the first time ever, the number of overweight people on Earth outweighs the number that are undernourished. From the obesity crisis flows a cascade of health and social problems: it burdens healthcare services, hobbles workforces and ruins lives.

Yet despite its tragic importance, we still don’t fully understand the causes of the obesity crisis. Energy-dense foods are definitely part of the problem though.

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Square eyes: how much TV is too much for kids?

By Chris Rissel, Professor of Public Health at University of Sydney

If you’ve ever sat your toddler down in front of the television to give yourself a few minutes of much-needed rest, you’re certainly not alone.

But for many parents, those few minutes of bliss that come with quiet kids can turn into hours.

The Longitudinal Study of Australian Children found kids as young as three years could turn on the television themselves and were watching more than nine hours a week.

*** Continue reading “The latest health & medical reading from The Conversation”

conflicts of interest

Jul 29, 2011

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Public health policy consultant Margo Saunders has taken a look at some recent reports from the US Institute of Medicine, and considers some possible lessons for Australia.

Margo Saunders writes:

While progress on so many health issues in Australia seems to be frustratingly slow, the US Institute of Medicine (IOM) is charging head with a raft of new initiatives.

Commissioned by government, private sector and non-profit organisations, these include a consensus report on preventive health services for women, a workshop on the gender-specific reporting of scientific data, and a consensus report proposing a national surveillance system for cardiovascular and chronic lung disease. The second report on front-of-pack food labeling systems is expected within the next few months.

As noted in an earlier post on the IOM, the Institute seems to occupy a particularly useful space, especially in the light of questions raised by Australian commentators about Australia’s health research infrastructure (do we need a research, reporting and evaluation capacity independent of government and the bureaucracy?) and about the divide between academic research and the needs of evidence-informed policy. Continue reading “Tackling the health issues left in the “too hard” basket: what can we learn from the US?”

As recently mentioned, there will be a health focus to a workshop on climate change in Melbourne this weekend that is being put on by the Green Institute.

One of the speakers is Senator Richard Di Natale, the Greens health spokesperson, who writes below that we need to focus more on the underlying causes of poor health.

On related themes, don’t miss this New York Times article which profiles an organisation working on the social causes of poor healt.  Health Leads trains about 1000 volunteers each year to staff resource desks in the waiting rooms of hospital clinics or health centers in Baltimore, Boston, Chicago, New York, Providence, R.I., and Washington.

At these sites, doctors now regularly “prescribe” a wide range of basic resources — like food assistance, housing improvements, or heating fuel subsidies — which the Health Leads volunteers “fill”, by applying their problem solving skills to identify resources anywhere they may be available.

Health Leads was co-founded by a Harvard University student, Rebecca Onie, in 1996 and up until a year ago, she thought that the organisation’s biggest obstacle would be getting doctors to pay attention to patients’ social needs.  But the organisation now gets so many referrals from doctors that it has waiting lists.

According to the report, Health Leads offers a model of how to develop a workforce to systematically address the social causes of illness.

Looks like an interesting idea with potentially wider application?

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The real crisis in health

Senator Richard Di Natale writes:

Not many people give up a career in medicine to become a politician. However, I still have the same goal: the good health of Australians.

Australia’s health care system isn’t bad. We spend less on health care than many other countries, about 9% of GDP (less than half of that spent in the USA), but most of us get access to high quality care when we need it.

But we are also one of the most hospitalised nations in the world, with more overnight beds per capita than any other OECD country. And even with the relatively high rate of hospitalisation, 60 per cent of our population is overweight, half the teeth of Australians aged 35-44 have some decay and alcohol abuse is costing our economy billions each year and rising.

Australia isn’t having a health crisis. We’re having a preventative health crisis. Continue reading “Getting to the root causes of health problems: some local and international perspectives”

aged care

Jul 29, 2011

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In the previous post, the University of Queensland’s Professor Philip Davies asked whether we’d been having “cappuccino-style” health reform – an approach focused on the milky froth of health sector institutions while leaving the underlying, thick, rich espresso of health care delivery largely untouched.

Robert Wells, Director of the Australian Primary Health Care Research Institute and Menzies Centre for Health Policy at the Australian National University, responded to the post:

Professor Davies’ assessment of health reform two years on is a sad reflection on missed opportunities. Fortunately, the focus on the froth rather than the coffee probably means that we are not that much worse off for the experience and if Medicare Locals and Local Hospital Networks are given the right incentives and flexibility we might well be better off.

Unfortunately some of the major failures of the recent reform process are that it leaves in place the key weaknesses of our system: vested professional interests with undue influence; unresolved Commonwealth/state tensions; and increased rather than streamlined bureaucracy.

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Below are two pieces reviewing progress to date – by Dr Tim Woodruff, vice president of the Doctors Reform Society, and blogger Mark Bahnisch, as well as a link to a report on the challenges of reform implementation that is well worth reading.

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Important structural issues that contribute to inequity are yet to be addressed

Tim Woodruff writes:

Health reform was flagged as a major part of the election commitment of Federal Labor when it came to power in 2007. After input from a range of inquiries the Federal Government finally made some proposals, which faced substantial resistance particularly from state governments. Following a Council of Australian Government (COAG) meeting earlier this year, substantial agreement has been reached on what is proposed. It is now being implemented gradually.

There are two distinct parts to what the Federal Government has done and is doing.

Firstly there are funding commitments to various parts of the health system. Much of this should not really be regarded as reform as it is simply a recognition of the need for more funding.  Substantial increases in workforce have been funded but this is just recognition that there is a shortage. It is not reform. Continue reading “More reflections on health reform: so much more is needed”

chronic diseases

Jul 26, 2011

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Tomorrow marks the 2nd anniversary of the release of the National Health and Hospitals Reform Commission’s final report, A healthier future for all Australians.

For those whose memories have suffered under the subsequent onslaught of related documents, the report told us that there was a “compelling” case for reform, and that this should have three goals:

1. tackling major access and equity issues that affect health outcomes for people now;

2. redesigning our health system so that it is better positioned to respond to emerging challenges; and

3. creating an agile and self-improving health system for long-term sustainability.

Professor Philip Davies, professor of health systems and policy at the University of Queensland, weighs up what progress has been made with health reform.

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Has health reform been more than froth and bubble?

Philip Davies writes:

A former colleague once outlined to me the concept of ‘cappuccino-style’ health reform.  It was, he explained, an approach to reform which focused on the milky froth of health sector institutions while leaving the underlying, thick, rich espresso of health care delivery largely untouched.

Two years on from the launch of the National Health and Hospitals Reform Commission’s final report, by then Prime Minister Kevin Rudd, it is timely to assess the extent to which Australia’s current health reform efforts exhibit cappuccino-like characteristics.

Continue reading “Is this “cappuccino-style” health reform? Marking an anniversary…”

Media-related issues

Jul 26, 2011

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Kerrie Noonan and Peta Murray, from The GroundSwell Project, write:

Recently we wrote about social media resources in palliative care and how The GroundSwell Project uses social media to share our projects, connect with collaborators and promote community engagement in end-of-life related topics.

In our experience, social media is a great tool. However our latest school project on organ donation has taught us it can’t replace real life experience.

Our drama project is in its second year, and, informed by a public health approach to death, dying, and bereavement (see Allan Kellehear’s book Compassionate cities), it epitomises GroundSwell’s belief that young people –  when given the opportunity – can and will contribute significantly to community conversations about big ‘life and death’ topics such as transplant and organ donation issues (last year the topic was Motor Neurone Disease).

These young people are, after all our future carers, healthcare providers and policy makers! Why wait until children are ‘older’ to talk about death when it’s part of our everyday lives?

So for two months, GroundSwell facilitated an arts-focused encounter between Nic Bonfield’s Year 11 class of 19 students at Penrith High School and another eight people who have faced organ donation in the most intimate ways possible, as donor recipients, donor families, and health professionals.

Continue reading “A creative approach to engaging young people in discussions about organ donation”

consumer health information

Jul 26, 2011

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Professor Rachelle Buchbinder, a rheumatologist and clinical epidemiologist, writes:

In recent years, hundreds of Australians have undergone a controversial procedure for spinal fractures associated with osteoporosis.

The procedure, called vertebroplasty, involves placing a needle into the vertebra and injecting it with bone cement, to ‘fix’ the fracture, possibly by stopping the fragments of bone from moving and causing pain.

In 2009, I was co-author of one of two placebo-controlled trials, published in the New England Journal of Medicine, which reported that vertebroplasty was ineffective for osteoporotic spinal fractures (see here and here).

These findings were met with disbelief among those who perform the procedure, and some proponents suggested that vertebroplasty might still be useful for people with certain characteristics like more severe pain or more recent onset of symptoms.

To test this theory, the authors of the two trials combined the raw data for each person enrolled in their respective studies and then reanalysed the data as if patients were in a single large study (an ‘individual patient data meta-analysis’). Continue reading “Should the public purse fund a procedure that “the best available evidence does not support”?”

climate change

Jul 25, 2011

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Malcolm Turnbull drew upon several health and medical analogies in his recent, widely-reported speech on climate change, in which he urged respect for science, and called for action to prevent the “enormous injustice” facing the world’s poorest people.

“… the people in the world who will suffer the most cruelly will be the poorest and the people who have contributed the least to the problem,” he said.

Turnbull’s health references included:

• Ignoring the science of climate change is like “ignoring the advice of your doctor to give up smoking and lose 10 kilos on the basis that somebody down the pub told you their uncle Ernie ate three pies a day and smoked a packet of cigarettes and lived to 95.  Now that is how stupid it is and we have to get real about supporting and responsibly accepting the science.”

• “Would you allow yourself, your own body to be operated on by some medical theory that you picked up on the website or would you seek to get the most highly respected specialist in the field to operate on you?  We all know what the answer is.  That’s what we do with our own bodies.  What we’re talking about now is the future and the health of the planet.”

• “Some people would say, I trust that most would not, that as we have a vested interest in coal being burned, we should oppose action on climate change and, rather like the tobacco companies who sought to discredit the connection between smoking and lung cancer, muddy the waters on climate science in order to prolong the export billions from coal mining.”

Meanwhile, a health focus on climate change will also be on the agenda of a weekend workshop in Melbourne this weekend, that is being put on by the Green Institute.

Melanie Lowe, one of a number of health professionals on the program, writes below about some shared ground between obesity and climate change.

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What do climate change and obesity have in common?

Melanie Lowe writes:

Obesity and climate change are two of the greatest public health challenges facing Australia.

Over 60 percent of adults and 25 percent of children are overweight or obese, with high body mass being a major risk factor for conditions such as type 2 diabetes, cardiovascular disease and some cancers.

At the same time, the health effects of climate change are predicted to be extensive. These include increased illness and mortality from severe heat waves and other extreme weather events, an increase in allergenic pollens and the range and seasonality of mosquito-born infections such as dengue fever, fresh water and food shortages and increased rates of food and water-borne disease.

Whilst obesity and climate change may appear to be unrelated, there is a growing recognition that these are actually closely connected problems, having some shared causes and solutions.

There are three shared determinants of obesity and climate change. Continue reading “Action on climate change may also help our obesity problem”

infectious diseases

Jul 25, 2011

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During the swine flu pandemic, journalists in the US became concerned about inconsistencies in how jurisdictions handled the release of information about H1N1 cases and deaths.

According to the Association of Health Care Journalists (AHCJ), the disparate approaches – with some jurisdictions releasing specific information about the age, gender and residence of victims and others releasing little or no personal information – became the subject of news reports, distracting from health messages and inadvertently undermining public trust.

These concerns led to a meeting last year between health journalists and public health information officers, which led to the release last week of voluntary guidelines for journalists and public health officials deciding what information to release/report about deaths, epidemics, emerging diseases or illnesses.

The overarching principle for public health officials is to be open and to strive to release as much information as possible, to withhold information only when there is a clearly justified reason to keep it confidential, and to explain the rationale for any decision to withhold information. The guidelines also note the need to balance legal and ethical considerations around privacy.

They state:

Nothing deepens anxiety and erodes trust more than the perception that government officials are hiding information from the public. Responses can range from unnecessary anxiety to denial, instead of informed, appropriate actions. In a public health crisis, officials need to balance the requirement to protect the confidentiality of individuals’ health information against the need to keep the public informed and engaged. In media parlance, the “cover-up” can become a bigger story than the actual event.

Thus, it is important for public health officials to provide as much information as possible or allowed, and for journalists to provide context for information provided. When information is withheld, it is important for public health officials to explain why and for the media to also report why, to avoid creating unwarranted distrust.

Continue reading “A legacy of swine flu: guidelines for public health officials & journalists dealing with epidemics”

evidence-based issues

Jul 25, 2011

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In Sydney tomorrow, Gary Banks, chairman of the Productivity Commission, is due to officially launch the Centre for Informing Policy in Health with Evidence from Research.

Professor Sally Redman, the chief investigator of the Centre, explains below what it aims to do.

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Building an evidence base for informed health policy

Professor Sally Redman writes:

Sir Humphrey: Now in Stage Two you go on to discredit the evidence … You say it leaves some important questions unanswered, that much of the evidence is inconclusive, that the figures are open to other interpretations, that certain findings are contradictory, and that some of the main conclusions have been questioned. …

Minister Hacker: But to make accusations of this sort — you’d have to go through it with a fine-tooth comb?

Sir Humphrey: No, no, no. You can say all these things without reading it.

I have to admit to having lifted the above gem, from the BBC’s classic Yes Minister series, from a recent speech by Productivity Commission chairman Gary Banks to a South Australian economics think tank on the topic of “Evidence and social policy” – in this case relating to gambling.

Gary Banks has argued consistently and passionately over many years for the use of evidence in policymaking, not only because it helps to achieve the best results for the Australian community, but also because it helps to get good policy implemented when there is opposition to it, as illustrated with great humour and insight above.

As part of his campaign to get more evidence into policy, Gary Banks will help us launch an exciting new initiative in the health care sector – a National Health and Medical Research Council funded Centre of Excellence in increasing the use of research in health policy.

Governments across the world have recognised that the use of evidence from research in health policy can improve health outcomes and optimise resource allocation.

But there is little empirical evidence about what does and doesn’t work to increase the use of evidence from research in policy. Continue reading “Evidence into policy: what works?”