By Kellie Bisset
Tobacco control was a dominant issue this fortnight, but Closing the Gap on Indigenous health inequality, barriers to evidence-informed policy, patient safety and immunisation were also on the agenda. Here are some highlights.
Towards a smoke-free zone
World No Tobacco Day on 31 May saw accusations levelled at the Queensland Government for simultaneously profiting from tobacco investments and withdrawing funds from smoking prevention programs. Only a week earlier, the state won the AMA’s annual Dirty Ashtray award.
On a positive note, a suite of new No Smokes Health Worker Guides was launched to provide health workers with a culturally relevant toolbox to tackle Indigenous smoking rates. The launch (as reported by NACCHO) coincides with the first anniversary of the multi-media No Smokes project, which uses humour, music and highly visual mediums to appeal to young Aboriginal and Torres Strait Islanders. It is funded by the Federal Department of Health and Ageing and is a project of the Menzies School of Health Research. (Note from Croakey: these details have been corrected from an earlier version).
And at a World Health Organisation meeting in Geneva, Department of Health and Ageing Secretary Jane Halton urged other nations to follow Australia’s lead and defy the tobacco industry.
TIME magazine marked Russia’s new smoking ban with a piece on whether smoking bans have worked internationally. Somehow, it managed to exclude ground breaking Australia from its analysis.
The film industry’s influence over smoking behaviours also attracted attention. This Medpage today article quotes a JAMA Pediatrics study showing that while tobacco’s prevalence in movies has decreased, alcohol has assumed a more prominent role. And public health groups have shamed the hit flick The Great Gatsby, launching a series of print ads noting the film represents smoking more than 150 times compared with only eight mentions in F. Scott Fitzgerald’s classic novel.
The advertising industry has also drawn fire, with US public health groups urging an investigation into a new Camel cigarettes campaign they say targets kids. At home, Mumbrella reports the Department of Health and Ageing has cleared the official V8 Supercars website of breaching advertising laws after it posted historic images of a Winfield branded car.
A study published in the journal Tobacco Control shows there is no evidence that heavy smokers who cut back significantly reduce their risk of premature death. The authors say the finding has implications for health education messages.
And what of electronic cigarettes, touted by some as a quit option? The UK’s National Health Service has announced they will be licenced and regulated as a quit smoking aid from 2016, bringing them under more stringent control. The Australian TGA says it has not authorised any e-cigarettes and outlines its position on its website.
And finally, a World Lung Foundation survey says that tobacco control advocates still have some work to do if they have any hope of counteracting Big Tobacco’s foray into social media.
Closing the Gap – where are we at?
The COAG Reform Council’s latest report card on government attempts to close the gap on Indigenous disadvantage has found there have been some improvements but much more work is needed.
Another report, by Professor Lesley Russell from the Menzies Centre for Health Policy, analyses the 2013-14 Federal Budget and shows that despite the significant monetary efforts to close the gap, in most areas this is yet to show real returns and progress will only come as a result of sustained and concerted effort.
The fifth annual Secretariat of National Aboriginal and Islander Child Care (SNAICC) conference was held in Cairns. A busy tweet stream (#SNAICC13) revealed active discussions around presentations from speakers such as former NZ Children’s commissioner Cindy Kiro and Canadian children’s rights advocate Professor Cindy Blackstock, who told the conference that Governments in Canada and Australia had failed their most vulnerable children.
The Guardian has addressed the issue of Aboriginal inequality with several recent articles, including this one on the modern-day removal of Aboriginal children from their families.
For his part, Tony Abbott has pledged to take personal responsibility for the lives of Indigenous Australians. He says he will make major policy changes if the Coalition wins government, though the ABC notes he has been less precise about their exact nature.
The ‘best possible evidence informs health policy’ but the reality is not so simple, writes Amanda Carne, from the Primary Health Care Research and Information Service. In this Croakey post, Amanda takes a look at a recent Australian Health Review article, which says packaging research for easy policy consumption is something researchers should consider.
The sentiment is echoed in this blunt Scientific American piece, which says if scientists can’t convince the public that their science matters, their work will die as government funding shrinks. The Research to Action website may have some solutions. It is running a blog series on how social media engagement can be used to promote research uptake.
Dr Andrew Clappison writes in a separate piece on the site that argues while the UK Government might say it’s committed to evidence-based policy, it appears to have no strategy for doing so. Wales though, may be up for the challenge. As this BMJ article reports, it is consulting on whether and how to adopt a ‘health in all policies approach’.
Perhaps some insights will emerge from Ireland, where the Irish Medicines Board is hosting the European Risk Summit on research-based policy making. But Sir Michael Marmot has eloquently set out the challenge they face. In a recent JAMA piece he writes that if it’s so difficult to come up with a consensus position on breast cancer screening (with more evidence than many other areas relevant to population health) “then evidence-based policy is a good deal more difficult than many would believe”.
Locally, Professor Andrew Scott takes up the evidence case on Croakey and The Conversation, arguing that for all their good intentions health workforce programs in Australia are suffering from a lack of evaluation, which must be built into program rollout if we want to stop the cycle of spending dollars with no evidence of their effects.
In similar vein, a Sax Institute Evidence Check Review commissioned by the Mental Health Commission of NSW, has found that while the conservative cost of mental illness to the community is more than $10 billion a year, there is little Australian research available on where those taxpayer dollars would be most effectively spent.
Always a hot topic, pharmaceutical industry marketing featured in several forums, including the latest in a series from The Global Mail. This piece by Ray Moynihan looks at the pace of Australian plans to increase transparency on marketing to doctors.
At The Conversation, Emeritus Professor Edwin Gale explores the issue of scientists and academics who do battle with the drug industry.
And also on The Conversation, Professor Chris Del Mar gives an update on his and other Cochrane reviewers’ attempts to have Roche make public its complete trial data on the antiviral drug Tamiflu.
Meanwhile, Europe has voted to increase clinical trials transparency, the All Trials website reports, and BMJ US news and features editor Edward Davies blogs about “big bang” scientific meetings and how much they actually contribute to patient care as compared with peer review.
All about e-health and using our data
As the Federal Government launched a smart phone app allowing parents to access and contribute to their child’s personally controlled eHealth record, Pulse+IT reported that consumer registrations for the PCEHR have reached a landmark figure of 250,000. While reaching the target of 500,000 registrations by 30 June looks unlikely, hospitals are now coming on board and the Government is rolling out new TV ads promoting the scheme.
It also launched a national strategy for cloud computing, which outlines ways to use cloud technology to boost innovation and productivity across Australia’s digital economy.
But in healthcare we are still in the early stages of innovation, a Sydney roundtable event on technology heard, with healthcare organisations sitting on huge untapped patient data resources. A somewhat larger event on a similar theme was the fourth annual international Datapalooza conference, where more than 2000 technology developers, healthcare professionals, researchers, policy makers and business leaders came together to look at the most innovative uses of health data.
Pulse +IT also reports on research in the Journal of the American Medical Informatics Association that shows while e-prescribing cuts down on errors, it can introduce new types of system errors and reduce the time spent on patient care.
Immunisation still trending
As The Conversation considered numerous immunisation questions, including whether anti-vaccinationists should get their own church in order to qualify for exemptions under new immunisation laws, NSW Health Minister Jillian Skinner told Parliament the Health Care Complaints Commission would investigate the Australian Vaccination Network (AVN).
Dr Melissa Stoneham from the Public Health Advocacy Institute WA, meanwhile, argued on Croakey that the public health community should do more to advocate for vaccination. And Dr Sara Gorman posed the question on the PLOS Medicine blog: Why are we still afraid of vaccines?
Media reporting on immunisation came under scrutiny, with the Australian Communications and Media Authority (ACMA) finding that WIN Television had breached the Commercial Television Industry Code of Practice. The breach related to WIN quoting the AVN’s Meryl Dorey saying medical literature had linked all vaccines with autism.
‘Patients’ is the operative word
The ABC’s World Today program has tackled the issue of patient safety, with an interesting three-part series from journalist Emily Bourke (part one here), who suggests there is a ‘silent epidemic of error’ in the Australian healthcare system. Similar concerns have been raised in the US: a strongly worded editorial in the Journal for Healthcare Quality says patients in most US hospitals may not be much safer today than they were 10 years ago.
A JAMA Internal Medicine paper finds that shared decision making is low for common medical conditions. And at Croakey, Dr Tim Senior argues the case for involving patients in medical education and urges us not to leave the patient behind in the push for more evidence-based medicine.
Wait times or ‘cycle’ times?
The COAG Reform Council also released its first report on the National Partnership Agreement on Improving Public Hospital Services. It found no State or Territory achieved every COAG target, but there were “some good improvements” in all jurisdictions.
From the Canadian perspective, a thoughtful piece from Doug Woodhouse on the Healthy Debate website addresses the merits of how wait times are measured. He argues that cycle time –from the beginning to the end of a treatment process (including treatment of complications) – should replace wait time as a key measure of health system performance.
Other Croakey reading you may have missed this fortnight:
• Beyond the “homebirth horror” headlines: some wider questions for the health system (and media)
• As the Earth approaches a critical tipping point, a reminder about why our biological wealth is critical for health
• Meat vs veg: how does a vegetarian diet stack up?
• A simple request: Evidence based alcohol policy – not partisan politics
• Weekend reading from the interwebs
• Occupy Healthcare – Social media do have the potential to revolutionize medicine
You can find previous editions of The Health Wrap here.
And some Twitter shout outs this week. Thanks for your contribution @NACCHOAustralia, @LRussellWolpe, @SimonChapman6, @JeremyPetch, @AmyCorderoy, @stephenpincock, @Research2Action, @reemarattan, @cochranecollab, @bmj_latest.
* Kellie Bisset is The Sax Institute’s Communications Director. She has worked in mainstream and medical journalism and communications for more than 20 years. During that time she edited both of Australia’s weekly medical publications for doctors, Australian Doctor and Medical Observer and developed a strong interest in health policy and evidence. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning.