Indigenous health

Jan 31, 2012


Could special recognition for Aboriginal and Torres Strait Islander people in the Parliament and in the Constitution bring benefits for Indigenous health?

In the article below, Dr Enrico Brik, the pseudonym of a self-employed consultant and sometime writer and blogger who has worked for over a decade in various roles in health services policy and planning, suggests these are measures that should be considered.


How the Parliament could help improve Indigenous health

“Enrico Brik” writes:

Australian society is a beautiful youth with a disfiguring scar. It is a scar that shames us most because it was inflicted by our forebears.

Yet our gaze will not be averted: repeated surgery has failed to fade it; no amount of make-up or finery conceals it. We are on show with it to ourselves and the world.

That scar is the problem of Aboriginal health.

It is not the only wound on the Australian body politic, but it is surely the one that most disturbs and disgraces us.

If ever there was a case study for the social determinants of health, Australia’s failure over Aboriginal health is it: a young, rich, successful, first world nation-state, with an enviable health, medical and scientific system.

And what do have? By far the worst Indigenous health of all the OECD nations built on colonising occupation. Continue reading “Using Constitutional change to improve Indigenous health”

health financing and costs

Jan 31, 2012


Dr Lesley Russell writes:

Since 2006, Australian governments have committed to spending around $8 billion of new money on mental health.  Given the huge burden of mental illness and the unmet needs for mental health services, proper accountability for this expenditure is crucial to ensure that it is targeted at the areas of greatest need and is delivering better outcomes for people with mental illness.

As outlined in a paper published this week by The Medical Journal of Australia (, my colleagues Sebastian Rosenberg and John Mendoza and I found that establishing this accountability is not easy.

Federal and state budget announcements (and re-announcements) and the lack of publicly available reports perpetuate an environment characterised by opacity rather than transparency.

Despite dozens of plans and policies, spending between jurisdictions continues to be uncoordinated, lacking both accountability and a focus on patients’ needs.  It is impossible to verify whether jurisdictions really did spend what they reported.  Continue reading “Mental health funding: well targeted or just well meant?”

child health

Jan 31, 2012


Public health advocate Professor Mike Daube writes:

The finals this weekend of the KFC T20 Big Bash could have been better (especially if the Perth Scorchers had won), but the cricket was lively and would have made exciting viewing for many children as they watched all the KFC promos, as well as seeing their sporting idols associate themselves with KFC products in a steady flow of advertisements throughout the game.

But was it necessary for Foxtel to interrupt its telecast of the game for an interview with the Chief Marketing Officer of KFC, so that she could promote the product as an essential feature of the Australian summer, and tell us all about the modest charitable donations KFC makes as part of its promotional program?

Amazingly, the interview ran not only during the periods between play, but while the game itself was on – preventing the commentators from deliveries during the game. Continue reading “Junk food promotions by Foxtel: it’s just not cricket”

health reform

Jan 27, 2012


The National Mental Health Commission held its first meeting in Sydney this week, and one of its first priorities, according to Minister Mark Butler, is to deliver the first annual National Report Card on Mental Health and Suicide Prevention

In a related interview with the Sydney Morning Herald, the Commission’s chair, Professor Allan Fels, highlighted an issue whose importance extends well beyond mental health: the dominance of “the supply side” in health care.

“I’m very aware of what economists would call the demand side of the equation – the needs of the consumers and carers – and it’s important that mental health is not just led from the supply side,” he said.

Professor Fels said the Commission will hold six meetings a year – three in capital cities and three in rural and regional areas.

One of many questions about the new body is how it will work with its state counterparts.

Meanwhile, Dr Matt Fisher, Research Officer at the Southgate Institute for Health, Society & Equity at Flinders University, has been examining the draft roadmap for mental health reform that was released recently for public comment.

He suggests that it needs to harness the potential for wider social and economic policies to contribute to better mental health, particularly for those groups most at risk. Continue reading “Improving mental health: beyond a framework driven by health care suppliers”

health financing and costs

Jan 27, 2012


As the Government mounts its case for means testing of private health insurance rebates, a new report urges the Government to withdraw all support for private health insurance, on equity and efficiency grounds.

The report says private health insurance should be viewed as a form of industry assistance which subsidises queue jumping. It “is administratively expensive (technically inefficient in economists’ terms), distorts incentives and choices (allocatively inefficient), and does not satisfy any reasonable criteria of equity.”

Published by the Centre for Policy Development, the discussion paper, titled Private health insurance: high in cost and low in equity, is by John Menadue AO, a former Secretary of the Commonwealth Department of Prime Minister and Cabinet, and Ian McAuley, an Adjunct Lecturer in Public Sector Finance at the University of Canberra.

They say it is strange for a government with a stated policy of “social inclusion” to provide incentives for the well-off to opt out of sharing their hospital costs with other Australians.

They call for wider health reform, and greater sophistication in public debate about health policy.

“Rather than meaningless political rhetoric about private/public options – rhetoric which does not distinguish between funding and provision, and which suggests that without private insurance there would be no private sector in health care – the public debate should be about the division between use of market mechanisms and community sharing,” they say. Continue reading “Federal Government urged to withdraw all support for private health insurance”

environmental health

Jan 27, 2012


In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) highlights an article examining the relationship between caring for country and health.


Healthy country, healthy people: Involvement in land management has positive health benefits for Aboriginal Australians

Bradley Smith writes:

Aboriginal people have jurisdiction over roughly 20 percent of the country. It was hoped that such expansive land ownership would lead to successful agriculture and advance the economic wellbeing of Aboriginal Australians.

However, these lands are situated primarily in the Australian desert, and have limited agricultural value.

Fortunately, social expectation regarding land use has shifted from a focus on production and amenities, to a more multifaceted one, including tourism and conservation.

This allows Aboriginal people with cultural connection to the land, the opportunity to manage the country by applying Indigenous ecological knowledge (or ‘caring for country’).

Caring for country involves spending time on the land, removal of grasses through cool weather burning, gathering food and medicinal resources, protection of sacred sites, production of art and craft work, as well as intergenerational transfer of knowledge.

A paper recently published by David Campbell argues that for Indigenous Australians, being involved in caring for country can provide many advantages that are of benefit to both public and private health, and the environment. Continue reading “Caring for country is also good for Aboriginal people”


Jan 24, 2012


An ACCC investigation into breast imaging highlights broader concerns about a lack of regulation of unregistered health practitioners, writes Rebecca Johnson, Policy Advisor, Cancer Council Western Australia.


Why are health regulators leaving the heavy lifting to the ACCC?

Rebecca Johnson writes:

Early in January, the ACCC launched legal proceedings  against two commercial breast imaging operators, alleging that the operators engaged in ‘false and misleading conduct’ by marketing themselves as effective breast cancer detection services.

Both companies use devices based on electrical impedance – the speed at which mild electrical currents pass through tissue – and one uses a thermographic camera to image women’s breasts.

Neither of the devices are supported by evidence showing them to be effective in detecting breast cancer.  Yet they, and others like them, are spruiked to consumers, for a considerable fee, in a shower of pink.

Why the concern?   Continue reading “A call for regulatory action on unregistered health practitioners”


Jan 23, 2012


Croakey has a new feature: a listing of public health and health policy conferences.

Meanwhile, the organisers of a forthcoming conference on social media in healthcare have put out a call for help.


Seeking experts and ideas on social media and healthcare

Madeline Vaughan from Informa Australia writes:

Informa Australia is pleased to announce its inaugural Social Media in Healthcare conference, which will be held at the Radisson Blu Plaza Hotel Sydney, on 24-25th May, 2012.

We are currently seeking both local and international speakers and case studies for this event.

The influence of technology is pervasive in our modern world. Ours is a world of increased mobility – where smart phones and other mobile devices enable people to connect in any time and place, where a simple internet connection enables almost limitless access to content on any topic imaginable, and where individuals are communicating and sharing knowledge through social media on an unprecedented scale. Social media has infiltrated every aspect of life, and the healthcare sector is no exception.

However, the industry has been quite cautious in the uptake of these technologies, particularly in Australia.

This conference seeks to explore the possibilities that social media has for enhancing the healthcare sector.  Continue reading “Some news on health conferences. And any ideas for this one on social media and healthcare?”

health reform

Jan 23, 2012


In the article below, Sara Irvine from ShareLife Australia responds to a Croakey article about organ transplant policy by Anne Cahill Lambert that was published last month.


We should be doing better on organ donation rates

Sara Irvine writes:

The Parliamentary Secretary for Health and Ageing, Catherine King recently announced: “In 2011, 1001 Australians and their families benefited from the legacy of 337 of their fellow Australians who last year became organ donors.”

It’s an improvement, but this country should be doing so much better.

We should not be celebrating an “Australian record”, so much as aiming to emulate the record of more successful countries overseas.

The world leader, Spain, last year beat its own record raising the bar to over 35 donors per million of population. Australia is at 14.9.

At Spain’s rates, Australia last year would have seen 783 donors, not 337. Continue reading “ShareLife responds: organ donation rates should be much higher”

conflicts of interest

Jan 20, 2012


Healthy Weight Week is due to kick off on Sunday. But Professor Mike Daube, Director of the Public Health Advocacy Institute at Curtin University, wonders whose interests are really being served by this initiative.


What have Coco Pops and Froot Loops got to do with healthy weight?

Mike Daube writes:

National Healthy Weight Week runs from January 22 – 29.  A worthy objective, but beyond a few platitudes what is it really promoting?

According to the website, Australian Healthy Weight Week is run by the Dietitians Association of Australia and sponsored by Meat & Livestock Australia.

The DAA media release for Australian Healthy Weight Week urges people planning to lose weight “to consider seeing an Accredited Practicing Dietitian as a first (rather than a last) resort” – which perhaps entails a touch of self-interest.

The Dietitians Association of Australia (DAA) also boasts a wide range of corporate partners including: Dairy Australia, Fonterra, Kelloggs, Meat and Livestock Australia, Unilever Australia, Nestle Australia and the Egg Nutrition Council.  All no doubt sell products that make important contributions to humanity; but also others of more doubtful value such as Allens confectionery, Kit Kat, Milky Bar, Chokito, Rolo, Smarties, Violet Crumble, Frosties, Coco Pops and Froot Loops.

Seeking a national healthy weight is a worthy objective, but the DAA would have more credibility if it dropped some of its associations with commercial sponsors, and perhaps even played a more active role in criticising some of their promotional activities.

• PS from Croakey: The Croakey Register of Influencers in Public Health covers some related issues.

The previous post highlights some of the challenges ahead for the new Health Minister Tanya Plibersek. Reducing Indigenous smoking rates is one of them, says Associate Professor David Thomas from the Menzies School of Health Research in Darwin and the Lowitja Institute.


Can Plibersek fulfil Roxon’s promises on cutting Indigenous smoking rates?

David Thomas writes:

Reducing Aboriginal and Torres Strait Islander smoking has been a central element in the Government’s efforts to Close the Gap. What does the new Health Minister Tanya Plibersek think of Nicola Roxon’s promise to halve the prevalence of Indigenous smoking by 2018?

Unlike us, politicians do not have an annual cycle of New Year’s resolutions that are quickly broken or forgotten by mid-January.  Politicians can make rash, seemingly bold, promises to fill a sound bite on any day.  These may be achievable or be proven to be embarrassingly impossible. Everyone remembers Hawke’s promise that no child will live in poverty.  Most are, of course, forgotten by all but a few pedantic political tragics and political foes. And timelines (like 2018) are usually so distant that the promising politician will be long gone and not accountable.

A new report (abstract freely available**) outlines the size of the task ahead.   Continue reading “Tackling Indigenous smoking: can the promise be kept?”


Jan 20, 2012


When asked to assess Nicola Roxon’s tenure as Health Minister, Croakey contributors gave varying responses (see here and here) late last year.

However, there was fairly wide agreement that she will be best remembered for her achievements in public health, especially tobacco control, where she helped to make Australia a world-leader in passing legislation mandating plain packaging of tobacco.

In the latest edition of the Journal of the American Medical Association, Andrew Mitchell and David Studdert from the Melbourne Law School at the University of Melbourne, review some of the potential legal challenges facing the legislaton.

Overall, their assessment is moderately upbeat. They conclude:

“…the Australian government has good prospects of winning this legal battle. It will be worth watching developments from abroad, not least because most of thelegal questions resemble those likelyto confront plain packaging initiatives elsewhere.”

(The full paper is not freely available. If you would like a copy, please leave your details below or email direct.)

Meanwhile, Paul Smith, political editor of Australian Doctor, has published a lengthy review of Roxon’s time as Minister, in the January 20 edition of the magazinem, republished below with thanks. He also reminds us of the chequered history of health reform efforts, and that major systemic problems remain.


Roxon’s report card: the wins and the disappointments

Paul Smith writes:

It is a few moments after what turned out to be Nicola Roxon’s final speech to the AGPN conference, in November 2011. The auditorium in Melbourne is emptying as the delegates exit for lunch.

Sitting at one of the tables is a GP I’ve known for a long time — not a dyed-in-the-wool AMA hardliner, not someone ideologically opposed to everything that falls from a Labor minister’s lips. But Roxon has just been defending the declining value of patient Medicare rebates by claiming GPs’ incomes are “more than generous”, and he has a glum look on his face.

“She doesn’t seem to get it,” the doctor says. “Never has really.”

It’s true to say that at the end of her four-year tenure as health minister, the extent to which Ms Roxon lost the medical profession — the grassroots — had become stark. Perhaps this disconnect resulted from the axe taken to GP mental heathcare funding by the government, which RACGP president Claire Jackson described as a “slap in the face”. But the disenchantment began much earlier, and cut much deeper.

Understanding its source is important because it helps explain the complexity of Ms Roxon’s legacy. She was the politician who for a brief period claimed she was embarking on reforms “bigger than Medicare”. Such statements need quote marks now. They are only used ironically.

Yet there remain many health experts who describe her as exceptional. This is the voice of the public health lobby, who see her as someone who took up their cause, whether it was the introduction of tax on alcopops or her crusade to bring in plain packaging for cigarette packs. Continue reading “What did Minister Roxon achieve? Some wins. But the ambulance is still parked below the cliff”


Jan 20, 2012


In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) highlights concerns about over-reliance on the use of surrogate markers in health research, practice and policy.


Diabetes care reveals the pitfalls of surrogate markers

Christina Hagger writes:

‘What works’ in evidence-influenced health care is being overshadowed by ‘What can be measured’.

In a recent article in the BMJ (extract free, pay for full access), Yudkin and colleagues argue that the quality of medical practice is being infiltrated by an over reliance on surrogates being used as substitute predictors for clinically meaningful endpoints.

The US Institute of Medicine defines surrogates as biomarkers (such as glucose, blood pressure or lipids) that are based on epidemiologic or other scientific evidence and used to predict clinical benefit or harm.

Using diabetes as an example, the authors observe that much of the evidence for clinical interventions is based on results drawn from such surrogate markers rather than outcomes central to the patient experience such as vision loss, amputation or quality of life.

Furthermore, as the surrogate markers are generally more responsive to interventions than such ‘hard’ end points as renal failure, the authors suggest that many of the widely accepted strategies for diabetes may be based on artificially inflated expectations. Continue reading “What matters in healthcare? Surrogate markers or patients?”


Jan 19, 2012


The importance of social inclusion for mental health is highlighted in the draft mental health reform roadmap (which was covered in the previous post).

But what exactly is “social inclusion”? And what are the gripes of its critics? Thanks to the FlagPost blog of the Federal Parliamentary Library for providing some background and context…


Developing an effective agenda for social inclusion

Matthew Thomas writes:

In recent weeks, social inclusion has become a topic of some debate. This follows reports that, subsequent to his appointment to the social inclusion portfolio in last year’s front-bench reshuffle, Mark Butler was unable to define what social inclusion means. Continue reading “Social inclusion: what is it (and why some people just don’t get it)”

health reform

Jan 19, 2012


A draft of the Ten Year Roadmap for National Mental Health Reform has been released for comment and can be downloaded here.

The document outlines five key directions:

  1. Promoting Good Mental Health and Wellbeing and PreventingMental Illness
  2. Early Detection and Intervention
  3. Putting Consumers and Carers at the Heart of Services and Supports
  4. Supporting People to Participate in Society
  5. Making Services Work for People – Access, Quality, Integration and Coordination.

A mental health reform advocate, psychiatrist Professor Alan Rosen, who has previously written about the roadmap for Croakey readers (here and here), has concerns about both the content and processes involved.


The roadmap for mental health reform: Is the Federal Government trying to make a monkey out of us?

Alan Rosen writes:

The stated aim of the draft Ten Year Roadmap for National Mental Health Reform, released this week for comment, is “to guide future action and investment across Australia over the next ten years”.

Among others invited to do so, I provided detailed advice to the Department of Health and Ageing at a full day consultation in September, and in responding at length to two previous confidential drafts.

There have been marginal attempts at improvement from earlier drafts through the addition of suggested short to long-term actions and possible indicators for monitoring these.

The directions are essentially sound, but there are many stated, with no prioritising or timeframe for implementation. It is an in-principle statement.

Mark Butler, our federal Mental Health Minister, is quoted as saying, reasonably, that “it outlines what we intend to do over the long term and how we’ll get there”.  In other words, “you have to start somewhere”, but the trouble is that we have started here many times before. Continue reading “Mental health reform roadmap needs work”

chronic diseases

Jan 19, 2012


The information below has been provided by a new group, the National Campaign for Consumer-Centred Health Care.

It gives some background on the campaign’s aims, principles, membership and plans.

It also includes a call for people interested in working with Medicare Locals on behalf of consumers.

If you’ve any questions or comments for the new group, please post them below. Vern Hughes, the convenor, has agreed to write for Croakey addressing any issues raised.


Background to the formation of the National Campaign for Consumer-Centred Health Care

The health policy and health reform debate in Australia is thoroughly dominated by provider and practitioner peak bodies in both private and public sectors. Politicians take their policy cues from these peak bodies. Consumer voices are poorly-developed, under-resourced, and almost entirely ignored in public debate.

The National Campaign for Consumer-Centred Health Care is a response to this imbalance in the Australian health system and health reform process. It aims to generate a broad movement for transformational change in health policy towards consumer-centred health care.



Continue reading “Introducing the National Campaign for Consumer-Centred Health Care”

Australian Medical Association

Jan 19, 2012


The crew at The Medical Journal of Australia must be feeling rather pleased this week by the publicity and debate generated via this week’s edition, particularly the articles on Medicare by Dr Tony Webber and on corporatisation of medicine by Ray Moynihan.

Below is some wider commentary, reproduced from The Conversation, with articles from:

• James Gillespie, Deputy Director, Menzies Centre for Health Policy & Senior Lecturer in Health Policy at University of Sydney, argues that fundamental reform of Medicare is needed to address “major structural faults within the system”.

• Gawaine Powell Davies, Associate Professor at University of New South Wales and Director of the university’s Centre for Primary Health Care and Equity, calls for more effective funding mechanisms for healthcare.

• David Baker, Research Fellow at University of Canberra and The Australia Institute, and author of Bulky Billing: Missing out on fair and affordable health care, says it’s time to move beyond band-aid policies and make structural changes to Medicare to ensure greater value for the health dollar.

• Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation at University of Technology, Sydney, says Australia lags behind other countries in moving away from fee-for-service to develop better funding mechanisms.

Given such comments, it’s not surprising the AMA was set on framing the debate as being about simply a few “bad apples”, rather than indicative of broader systemic problems. Meanwhile, in an article in Tuesday’s Crikey bulletin, I argued the need to take a broad perspective to addressing wastage in the health system.


Medicare needs a fundamental rethink

James Gillespie writes:

The debate about Medicare has received a new focus with comments from Dr Tony Webber, the former director of the Professional Services Review – the body that regulates success to Medicare and Pharmaceutical Benefits Scheme benefits by health professionals. Continue reading “Beyond band-aids: Medicare needs structural reform”

health reform

Jan 16, 2012


Up to $3 billion of public money is wasted each year under Medicare, according to estimates by Dr Tony Webber, who headed the Professional Services Review for more than six years.

His article in today’s Medical Journal of Australia – which has drawn widespread media coverage – argues that poor policy (such as the Medicare Safety Net, “one of the most poorly thought-through pieces of health legislation”) and the practices of a “minority of unscrupulous and greedy practitioners” are responsible for this waste.

General practice management plans (GPMPs) and team care arrangements (TCAs) “have created opportunities for a bonanza for some practices”, he says. Obstetricians and ophthalmologists receive particular mention. Webber also questions the repeated use of procedures and investigations by some gastroenterologists and cardiologists in patients “whose clinical condition appears not to warrant them”.

Webber says maladministration does not only occur with the MBS and the PBS. “On several occasions I came across significant cost-shifting between the states and the federal government. Medicare was being used to subsidise state health budgets. Private radiology and pathology services were used for public inpatients, Medicare benefits were used to fund staff specialist study tours and to buy essential equipment. This is against the provisions in the Council of Australian Governments National Health Care Agreement. When this was pointed out to officers in the DoHA, I was told not to say anything.”

Webber says that while most health professionals are motivated and ethical, colleagues feel let down by a system that often does not deliver a timely or cost-effective service with proper controls. “Many doctors I have spoken to are disillusioned by the inappropriate claiming and practice they are aware of,” he says.

Meanwhile, with impeccable timing, Brisbane GP and writer Dr Justin Coleman today launches a new project at Croakey, the Naked Doctor, which aims to encourage discussion and awareness of the opportunities to do more for health by doing less. It is a compilation of articles, books and other works that highlight overdiagnosis and overtreatment.

Coleman is a GP who works in Aboriginal and Torres Strait Islander health in Brisbane. He holds a Masters in Public Health, and is President of the Australasian Medical Writers Association. You can also find him on Twitter.

Naked Doctor is a work in progress. Comments and suggestions are welcomed.

Below are two items: an introduction to the project; and Naked Doctor’s first entries (some articles are from subscriber-only journals; if you are unable to access an article, please leave your details on the bottom of this post or email Croakey asking for a copy).

*** Continue reading “A new Croakey project: Naked Doctor, profiling overdiagnosis and overtreatment”

global health

Jan 16, 2012


Professor Gavin Mooney’s recent article, calling for Australia to stop “stealing” health professionals from South Africa, generated a strong response (see comments at bottom of his post).

Dr Peter Arnold, author of this book about South African doctors who have migrated to Australia, continues the discussion below.


Why South African doctors emigrate

Peter Arnold writes:

Economist Gavin Mooney, for whom I have considerable respect, should look at all the facts.

His piece, “Australia steals doctors, nurses from where they’re needed most needed”, might, like the recent article in the BMJ by Mills et al, paint an accurate picture in terms of dollars and numbers, but it completely overlooks the personal facts about the migrating doctors.

As my recent survey of 469 South African medical graduate immigrants* has revealed, as I have written in both the Journal of the Royal Society of Medicine  and the BMJ, and as has been appreciated by the editor of the South African Medical Journal, doctors usually leave sub-Saharan Africa because they are “pushed out” by many factors.

Few are “pulled” to Australia. Mills et al have subsequently acknowledged this aspect of the problem.

There is nothing ‘unethical’ or ‘unconscionable’ about any person deciding to leave home and hearth, family and friends, colleagues and career because of circumstances hindering their practice of their profession.

Corruption, diversion of money into armaments and the associated degradation of health and education infrastructure, crime, and now reverse discrimination (against whites in South Africa and Zimbabwe) make for compelling reasons to emigrate. Continue reading “Doctors have good reasons for leaving South Africa”

Media-related issues

Jan 13, 2012


Regular readers will know that Croakey takes a keen interest in innovation in health media and journalism, but most of the examples we’ve come across have been from the US. It makes a welcome change to be able to report some local news on this front.

The Health Reporter, an online publication dedicated to covering Australia’s health system, was launched this week. Thanks to one of the founders, Michael Riley (more of his bio details are at the bottom of the post), for answering a few questions about the new publication.

Q: How did the concept develop and who was involved?

The Health Reporter was born of the belief by its owners that Australia’s health system is important and large enough to have its own daily online news site producing original news content and opinion.

Secondly, while visiting my Dad in Royal North Shore hospital before he passed away in 2010, I saw the best and the worst of the health system. In one visit over two days, I noted 45 issues I knew would make great stories and heard another 100 from patients, families and staff. It was 50/50 between the good and the bad. And I knew that the dailies, electronic media and trade publications couldn’t cover them all.

I’m a great admirer of the stories being produced by the various health and medical reporters on the daily newspapers and in the many trade journals, blogs, industry websites and sector specific publications. But they can only cover so many stories or are restricted to a particular health industry or professional group. We also have some different approaches and ideas on news that will develop over coming months.  Continue reading “Introducing a new online publication: the Health Reporter”