health reform

Feb 23, 2012


The cry of “nanny state” is often used to oppose public health measures that are in the public interest but threaten powerful private interests.

Perhaps the cry of “class warfare” falls into the same category when it comes to social reforms that are in the broader public interest.

That is one question arising from suggestions the Government is unlikely to act on Gonksi’s recommendations for a more equitable, rational basis for funding schools, for fear of being accused of “class warfare”.

As Stephen Long, the ABC’s economics correspondent, wrote at The Drum: “The sad truth is that the “class warfare” is being waged in the opposite direction – as public money disproportionately subsidises wealthy schools, while the disabled, the disadvantaged, and sons and daughters of low-to-middle income earners are left to languish in underfunded schools denied a fair share of the pie.”

But education reformers have at least one advantage over their counterparts in health. Health reform advocate John Menadue has been arguing for quite a while that one of the reasons for the failings of health reforms to date is that they have largely been driven by health industry insiders.

Perhaps we would be in a different place today if there had been Gonski-style leadership of health reform.

In the article below, Carol Bennett, CEO of the Consumers Health Forum, argues that the health system has much to learn from Gonski’s recommendations.


The health system needs a Gonski

Carol Bennett, CEO of the Consumers Health Forum, writes:

From a public health perspective, the Gonski report provides a completely different lens through which to view, measure and fund service systems.

It is a view that is almost completely counter to the way governments and policy makers currently approach health systems.

The most fundamental difference is that Gonski begins with a focus on student achievement or real education outcomes.

In health, we are still stuck trying to look at throughputs and costs – an almost entirely provider focused approach where actual health outcomes are not even measured.

We are trying to run the system more efficiently, but take no real account of health outcomes.  Continue reading “Gonski review has a lot to teach the health system: Consumers Health Forum”

Quit smoking campaigns in the UK that promote nicotine replacement therapies (NRT) are wrong to discourage the “cold turkey” approach, and could learn a lesson from Australian efforts, suggests Simon Chapman, professor of public health at the University of Sydney.


Raising questions about the medicalisation of smoking cessation  

Professor Simon Chapman writes:

Two current UK government campaigns pull no punches about urging all smokers trying to quit to use drugs. One puts it bluntly: “Don’t go cold turkey”.

Another poster on display in the nation’s waiting rooms says: “There are some people who can go cold turkey and stop smoking. But there aren’t many of them.” (See picture at bottom of this post.)

That statement is manifestly incorrect and an enquiry should be undertaken into how such nonsense was approved for publication.  In 1986, just a few years after nicotine replacement therapies became available, the American Cancer Society stated: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer [1964] have done so unaided.”  How did they possibly manage to do it without drugs?

We have long known that if you survey ex-smokers and ask them what strategy they used on their final, successful quit attempt, around two-thirds to three quarters answer “cold turkey”. This was the case in the early days of NRT, and it remains so today. Continue reading “UK quit smoking campaigns come under fire”

Health inequalities

Feb 21, 2012


(Extra comments have been added to the bottom of the post, Feb 22)

For those with a concern for the community’s health, the Gonski review of schools funding is important reading, not least because of its strong focus on equity.

The report recommends that federal, state and territory governments, in consultation with the non-government school sector, should make reducing educational disadvantage a high priority in a new funding model, with resourcing to be targeted towards the most disadvantaged students.

Gonski and co identify “five factors of disadvantage that have a significant impact on educational outcomes in Australia”. They say: “At the student level these factors are socioeconomic status, Indigeneity, English language proficiency, and disability. At the school level, remoteness is demonstrated to have an impact on student outcomes.”

The inequities that the report identifies in education are related in many ways to the inequities that occur in the distribution of health, as well as in access to healthcare.

Its recommendations aim to ensure that “differences in educational outcomes are not the result of differences in wealth, income, power or possessions” and that “all students have access to a high standard of education regardless of their background or circumstances.”

Imagine what might be different if Australians were committed to ensuring that “differences in health outcomes are not the result of differences in wealth, income, power or possessions” and that “all Australians have access to a healthy environment and a high standard of health care regardless of their background or circumstances.”

Clearly it is not only health policy that might take a different tack.

Similarly, the solutions to some of the inequities identified by Gonski don’t really lie within the realm of school funding mechanisms.

Addressing inequities, whether these are reflected in health and/or education outcomes, requires broader social and economic action, including community development.

More fundamentally, it requires an electorate who understands these things matter, for society as a whole, as well as for those who are not currently getting a fair deal.

Below are some Gonski-related comments from Croakey contributors and below that are some extracts from the report, and (if you’ve still got the eyepower) some links to further reading.


If only Gonski was driving health reform

Professor Stephen Leeder, Director of the Menzies Centre for Health Policy at the University of Sydney and Chair of the Western Sydney Local Health District:

The Gonski Report is a refreshing and excellent document that takes the matter of equity seriously in ways that in health care we seem to have forgotten.

The report recognises that disadvantage and marginalisation require the investment of more resources to achieve relatively equitable outcomes. Equity is not equal amounts of cake for everyone with an appetite, but measured amounts according to need.

It would be wonderful to hear discussions such as the Gonski Report contains informing our deliberations about efficient pricing in the context of Activity Based Funding where an assumption appears to be that one national efficient price can be set for a clinical service irrespective of the socioeconomic or other marker of disadvantage of the patient.

And then Gonski also speaks about outcomes!!  Wow!  Not just activity!  Bring him on!




*** Continue reading “Some health-based analysis of the Gonski review of schools funding”

aged care

Feb 21, 2012


(This is the first in a series of two posts looking at social media and health).

Health service leaders are not famous for embracing engagement with the media or general public. This observation is not intended as any personal slight as the situation is the inevitable result of the systems they work in, and the expectations of their bureaucratic and political masters.

However, it seems a sign of the changing digital times that the Australasian College of Health Service Management (ACHSM) is one of the health organisations at the forefront of harnessing the online revolution for communications, education and engagement.

Yesterday, the ACHSM was live-tweeting from a meeting of Australian and Canadian health leaders. They shared some interesting information about health and aged care reform, as you can see from their Twitter feed.

They also shared links to useful material about health workforce planning,  the Independent Hospital Pricing Authority’s draft pricing plan, consultation papers for the development of an Aboriginal health plan, and the NSW Health Governance Review document (PDF alert).

On Radio National’s Life Matters program this morning, I gave this piece of citizen journalism as an example of how social media can benefit health and healthcare by helping to break down silos and hierarchies and to foster innovation, transparency and wider engagement.

The program’s presenter, Natasha Mitchell, also spoke with Debra Cerasa from the Royal College of Nursing Australia (RCNA) about the opportunities that social media is affording the nursing profession, their colleagues, patients and the wider community. (Declaration: I recently wrote a series of articles for an RCNA publication profiling how nurses are using social media for professional gains.)

Meanwhile, here is a selection of the ACHSM’s tweets from yesterday’s meeting.







Continue reading “If health service executives are embracing social media, what does it say?”

global health

Feb 20, 2012


Claire Maskell of Palliative Care Australia recently wrote for Croakey about inequities in global access to palliative care and pain management.

The article was a preview to the recent screening in Canberra of the award-winning documentary LIFE before Death.  It drew an audience of 200 people including parliamentarians, health professionals, members of the public and also the filmmakers, Mike Hill and Sue Collins, and some stars of the documentary.

Thanks to Claire and her colleagues for providing this wrap of the film, including some responses from audience members.


“Everyone should see this film” 

Claire Maskell writes:

Professor David Hill

LIFE before Death takes us to 11 different countries to investigate what Professor David Hill, former President of the Union for International Cancer Control (UICC) and a subject in the documentary, describes as a ‘medical emergency on a huge global scale,’ the fact that 80% of people who died last year around the world died in needless pain.

The film follows health professionals working in palliative care and their patients to illustrate the profound effect untreated pain has on quality of life and how, with access to palliative care services and medicinal opioids, this quality of life can be immensely improved.

We learn quickly that the burden of untreated pain is not shared equally across the world and lies with low to middle income countries.

Gordon Gregory, Executive Director of the National Rural Health Alliance says, “I guess the most striking thing for me is the distribution. 15% of the world uses 94% of the medicinal opioids. I didn’t know that – that’s really striking – but it’s yet another tragedy on an international scale about distribution of resources, wealth and life options which has stunned me.”

Gordon Gregory

Perhaps the most difficult thing for the audience to comprehend was that the solution to ending this suffering is in essence quite simple.

We don’t need to spend money on investing in new drugs or technologies because we already have the solution – morphine. It is cheap to produce, easy to administer and highly effective in relieving pain. Continue reading “A call to prevent needless suffering: feedback from recent palliative care event”

aged care

Feb 20, 2012


How can vulnerable elderly patients be helped to navigate the fragmented health system?

In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports there is encouraging evidence to suggest that professional health system “navigators” might be able to help elderly people with chronic health problems to remain in their homes.

It would be interesting to know whether many elderly patients have access to such help, and to know more about how widely Australian health services employ such roles.


Helping the elderly navigate the health system

Petra Bywood writes:

Most people, at some time in their lives, will require the services of multiple healthcare providers, whether it is for an unexpected accident, acute illness, chronic condition, or for comorbidities that cross healthcare sectors.

Irrespective of the underlying condition, the transitions between healthcare services or providers are critical points at which care may become fragmented, potentially leading to delays, duplications and adverse outcomes for the patient. While negotiating transitions across care sectors may be frustrating and confusing for most patients, these challenges are exacerbated for elderly chronically ill patients and their caregivers.

Many strategies have been implemented at the organisational level to improve access to care and quality of care for the elderly as they navigate the health care system. One such strategy involves employing designated healthcare workers as patient, or system, navigators to “facilitate safe and effective transitions across healthcare settings”. Continue reading “Helping older patients with chronic diseases to navigate the health system”

chronic diseases

Feb 16, 2012


While the previous post makes a suggestion for how the Federal Government could ensure healthier, fairer food policy, in the article below health policy consultant Margo Saunders suggests workplaces (including government departments) could be doing more to promote good health.

She suggests that we need a bit of online activism, in the vein of The Parent’s Jury, to highlight unhealthy workplace practices, invite discussion and act as a forum for the exchange of information about effective health-promoting initiatives.


Workplaces could do much more for our health

Margo Saunders writes:

Australia is, as we are constantly reminded, in the midst of an epidemic of obesity which is fuelling an increase in chronic disease.  Two-thirds of Australian adults are overweight and one-fifth are obese. Even among people without weight worries, there is a growing awareness that looking after our health means not only reducing the risk of disease, in some abstract sense, but increasing the chances of feeling better, in a very real sense.

Why is it, then, that wherever we look, there are workplaces which undermine employees’ desire to achieve and maintain good health, particularly in relation to food and physical activity?

Health-promoting workplace initiatives have been supported in various States, including Queensland, Western Australia and Victoria, often in partnership with non-government health organisations. Some initiatives target blue-collar workplaces, where there are particular challenges relating to occupational norms, gendered attitudes, low health literacy and minimal availability, affordability and convenience of healthy food options.  Some programs, notably Victoria’s WorkHealth initiative, focuses on workplace-based screenings and health assessments.

Industry-focused workplace initiatives which target specific issues such as mental health, bullying, smoking, alcohol and drug use have been strongly supported by employers and unions.

It will take more than these scattered, well-meaning initiatives to make a real dent in the health of Australian workers as long as workplaces – white collar, blue collar and pink collar – persist in practices in which the ‘default option’ is the unhealthy option.

Public service workplaces and health organisations are among the key culprits when it comes to unhealthy environments.  I recently worked in a health department where the vending machines were full of junk food and the Social Club raised funds by selling junk food in the staff kitchens. Continue reading “A proposal for busting unhealthy workplaces”

environmental health

Feb 16, 2012


Food policy is such an important – and contested – space that we should have a Food Minister, in Cabinet, according to Michael Moore, CEO of the Public Health Association of Australia, and Associate Professor Heather Yeatman of the School of Health Sciences at the University of Wollongong.


Making the case for a Ministry for Food

Michael Moore and Heather Yeatman write:

Strange bedfellows have been calling for the establishment of a Ministry for Food in the Federal Government.  The idea is for the Government to take greater responsibility for creating a healthy, sustainable food system by creating a Ministerial portfolio for food to coordinate whole-of-government action, headed by a Cabinet Minister.

In other words, government should focus a number of existing and potential policy activities on the thing they have in common – food.

Following the launch of A Future for Food 2 by the Public Health Association of Australia (PHAA) (available here), Kate Carnell, the CEO of the Australian Food and Grocery Council (AFGC) joined in the call.  The press release from the AFGC stated “Industry has echoed calls by the PHAA to establish a Ministry of Food to ensure Australia has a safe, affordable, nutritious and sustainable food supply into the future.”

The complexity of food policy and the range of stakeholders are behind these calls for a joint approach.  The food system includes production and trade, processing, retailing, marketing and promotion through to the health impact of what people eat.  It includes science, research and waste and must include economic impact, employment, productivity, national security and much more. Continue reading “Why Federal Cabinet should include a Minister for Food”

public health

Feb 16, 2012


This post may be of particular interest to doctors who are interested in writing, or those interested in the links between medicine and creativity.

It comes from Lis Bastian, Chief Executive Officer of Varuna, The Writers’ House, at Katoomba in the Blue Mountains.

Lis Bastian writes:

In March we’re holding the inaugural Dr Eric Dark Memorial Dinner and “Doctors Who …” Create, Innovate, Advocate & Collaborate program.

Dr Eric Dark (1889-1987) was a first World War hero, medical practitioner, medical writer, early environmentalist and rock climber, and one of Australia’s leading advocates for improving social, economic and environmental conditions to build the “health of the nation” (more about him is at the bottom of this post).

Varuna, now a national residential writers’ house, was once his home. Dr Dark wrote a number of books, including “Medicine and the Social Order”, and his legacy is being celebrated with the inaugural Dr Eric Dark Memorial Dinner at the Fairmont Resort on Saturday 10th March. The Blue Mountains community is invited to attend this event to celebrate the life of one of its leading early members.

The lecture will be presented by Associate Professor Grant Blashki, of the Nossal Institute for Global Health & Melbourne Sustainable Society Institute, co-founder of Doctors for the Environment Australia and lead editor of General Practice Psychiatry published by McGraw Hill.

It will be followed by a Q & A panel: Doctors Writing/Righting the World.

From the personal to the political, the panel and their audience will be invited to discuss how creativity, innovation, advocacy and collaboration can contribute to building the “health of the nation.” Continue reading “Doctors writing and righting the world: a Varuna event paying tribute to Dr Eric Dark”

rural and remote health

Feb 16, 2012


If you are a health professional, teacher or police officer working in rural or remote areas (with a population of less than 25,000 people), this survey about workplace safety may be of interest. You have until February 24 to complete it.


Time to reduce violence against country professionals

Dr Jenny May writes:

Many rural and remote professionals—particularly doctors, nurses, teachers and police—are vulnerable to violence in the workplace.

Often rural professionals work alone and sometimes it is tricky to access support easily.

Given the tremendous impact that violence can have on the safety of rural and remote professionals, not to mention their willingness to continue to work in the bush, it is critical that the right tools and strategies are put in place to reduce their exposure to violence as much as possible.

Enter stage right an innovative national project, Working safe in rural and remote Australia. This project aims to explore a community-based approach to reduce workplace violence and improve safety for rural and remote health professionals, teachers and police. Continue reading “A survey on workplace safety that may be of interest to health professionals, teachers and police officers working in rural and remote areas”