By Kellie Bisset

A little bit political

As the nation adjusted to the news of a new Prime Minister, it was still unclear at the time of writing whether Health Minister Tanya Plibersek would retain her position. The AMA wasted no time in calling for Kevin Rudd to put health front and centre at the upcoming election, urging him to scrap the Gillard government’s cap on tax deductions for work-related medical education expenses.

But writing on The Conversation and Croakey, Bob Wells suggests that the case for fixing the health system might be harder for Rudd to prosecute second time around and it might not be high on his immediate list of policy priorities.

Dr Lesley Russell’s analysis of the 2013-14 federal health budget, says the challenge for any new government post-election is that “too many Australians are missing out on the care they need … That will require more attention to issues like equity, out-of-pocket costs and quality”.

Before the political storm broke around the leadership, the week was peppered with valedictory speeches from departing members of Federal Parliament, including Liberal moderates Dr Mal Washer and Judi Moylan, whose legacy Michelle Grattan profiles in The Conversation.

And in Queensland, incoming state AMA president Dr Christian Rowan took the opportunity to warn that recent cuts to frontline health staff would place the state under threat of new and infectious diseases.

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On matters of policy

The National Health Performance Authority released its latest report, which echoes the comments on access mentioned above and finds a significant number of Australians delay seeing a doctor because of cost. At Croakey, Consumers Health Forum CEO Carol Bennett writes that the report provides the “starkest evidence yet” of considerable variations in Australians’ access to health care, despite our claim to a universal health system.

And Dr Michael Gliksman argues that the evidence on childhood deprivation and later risk of disease supports the view that income support to lift people (especially children) above poverty levels and well-funded public education and health programs are essential.

At KevinMD, Dr Robert Centor argues in a piece about the unintended consequences of well-meaning regulation that we desperately need to develop decision making processes that focus on both benefits and harms and develop logical means for balancing them. One example of unintended consequences from well-meaning regulation he says, is how the war on drugs has fuelled the hepatitis C epidemic.

The recently released Government Drug Policy Expenditure in Australia also focuses on the war on drugs. According to this SMH report from Amy Corderoy, it finds that while billions have been spent on law enforcement, funding for harm reduction has dropped – a move that does not match the evidence.

Other policies that received some attention include the Federal Government’s Federal Government’s four-year deal with Medicines Australia and its lack of response to PBAC recommendations on statins. Writing about the deal and its aftermath on The Conversation, Professor Philip Clarke describes the story as “a ripping yarn of non-evidenced-based policy making”.

And while a new report from the Auditor General said super clinics were “generally effective” it criticised the program for lacking rigour and focusing on marginal seats, according to this report by Sue Dunlevy in The Daily Telegraph.

New policy work is needed to combat diabetes, according to Diabetes Australia, which proposed at the National Press Club that a national strategy be established.

But by far the most significant policy speech award can be handed to US President Barack Obama, who declared the climate change debate over and announced plans to regulate carbon emissions from power plants. The timing has interesting ramifications for the Australian political landscape, as this World Today report notes.

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Some new developments in Aboriginal Health

NACCHO laid out a clear path for change with the launch of its Healthy Futures 10 point plan 2013-2030, a set of priorities and strategies to drive improvements in Aboriginal health outcomes. It also released a Report Card on Aboriginal Community Controlled Health Services compiled with the AIHW that looks at gains made and areas for improvement.

WA announced it would delay signing the Close the Gap Indigenous health agreement with the Federal Government but has provided interim funding to cover services. The deal expires on June 30 and The Guardian reports that all other states have given their in principle agreement to re-sign.

The Guardian’s series of profiles on the guest hosts of the @IndigenousX Twitter account are good reading. This past fortnight has seen profiles of Lisa Briggs and Ebony Allen. Ebony’s live tweets from the Indigenous Digital Excellence Agenda Summit (#IndigenousDX) highlighted innovations and offered some interesting analysis.

It followed a great week of insightful tweets from Lisa, NACCHO’s CEO, who will also sit on a new group set up to advise the Federal Government on improving mental health and suicide prevention programs for Aboriginal and Torres Strait Islander people.

As for blogs, NACCHO featured a post from Don MacAskill, CEO of Awabakal Newcastle Aboriginal Co-operative, which says we must move away from a one-size-fits-all approach to Aboriginal Policy.

And for those with access to The Australian’s paywalled content, Noel Pearson has written an analysis of Peter Shergold’s speech on “personal and systemic failures in Indigenous policy”.

Croakey also showcased the tweeters in action at an Aboriginal and Torres Strait Islander health workshop held in Sydney as part of the APHA 21st national conference.

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Obesity, activity and living in healthy spaces

The American Medical Association’s decision to officially label obesity a disease got experts and the broader community talking about the merits of the approach. The news came as a paper was published in the latest issue of Academic Medicine suggesting a widespread anti-obesity bias among medical students.

Meanwhile, the SMH’s Melissa Davey reports that Australian state and federal ministers have agreed to adopt a voluntary star rating system for food labelling – a move described by public health expert Mike Daube as significant. And a new approach to food labelling in the UK will see all major supermarkets sign up to a consistent front-of-pack label that combines traffic light colour-coding and nutritional information and is designed to reduce consumer confusion.

In the US, Starbucks has moved to include calorie counts on its menus. Though a Russian public health official, in a perhaps misguided (or inspired depending on your view) attempt to keep citizens healthy, has urged them to make “patriotic” food choices and avoid “exotic cuisine”.

At the Australian Health Promotion Association Conference, which Croakey has covered extensively, Professor Helen Roberts, of University College London, summed up the inter-relatedness of obesity and environment with this great image: “Trying to change children’s health behaviours without trying to change the food and transport environment is like trying to teach them to swim in a pool full of alligators.”

A paper in the journal Obesity says neighbourhoods that include restaurants and businesses supportive of healthy eating choices can make a “measurable” difference to levels of obesity.

And while it doesn’t seem surprising that living near parks and gardens makes us happy, The Atlantic reports on research published in Psychological Science suggesting this has more of an impact on wellbeing than average neighbourhood income or crime rates.

After the US Environmental Protection Agency released what it described as its most comprehensive review to date on how the built environment directly affects our environment and public health, the 50th International Making Cities Liveable conference kicked off in Portland Oregon (tweet stream at #MCL50th).

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Grog and smokes

Smokers cost their companies $3000 each in lost productivity, according to US research in the journal Tobacco Control. Though good news has emerged from the US, with a new report from the Centers for Disease Control and Prevention showing that the adult smoking rate has dropped to 18 per cent. The US FDA has also stepped up on tobacco, the New York times reports, announcing that for the first time it would exercise its power (granted in 2009) to regulate cigarettes and other tobacco products. It has authorised the sale of two new products but rejected four others.

Another tobacco report, from our own Australian National Preventive Health Agency (ANPHA), addresses research priorities for tobacco control and aims to inform future policies and programs and encourage links between researchers policy makers and advocates.

And new guidelines being discussed by the Australian and New Zealand College of Anaesthetists advise that all smokers should be asked to quit before undergoing surgery.

This interesting Science Update blog post looks at the tobacco industry’s role in cigarette smuggling and Professor Simon Chapman argues the case for regulation of e-cigarettes in a BMJ opinion piece.

Croakey addressed the harms of alcohol consumption and advertising with two posts that made for compelling reading. WA Police Commissioner Dr Karl O’Callaghan’s keynote address to the National Alliance for Action on Alcohol’s recent Forum was a blunt assessment of the alcohol industry and where its leading us: if we don’t address our alcohol advertising culture and the relationship between young people and drinking, the police will have no choice but to spend 60% of their budget mopping up the fallout. Professor Mike Daube also shone a light on the unholy alliance between the alcohol industry and sport.

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Hospital goings on

GP patients aren’t clogging up hospital emergency departments as much as some might think, says new research published in the MJA and reported on HealthCanal. The paper suggests the AIHW methods used to categorise patients are flawed, which has implications for policy. Following the publication, the AIHW said it would review its methods.

Meanwhile, Sydney’s Prince of Wales Hospital says it is facing “an unprecedented reduction in services” so it can cut its budget by 30%, though Health Minister Jillian Skinner said frontline services were “going up not down”.

Over in the UK, the NHS is in all sorts of strife over allegations that its Care Quality Commission (CQC) covered up underperformance at certain hospitals. The scandal has led to an admission from outgoing NHS chief Sir David Nicholson that the NHS is home to a “culture of denial” when it comes to dealing with patient complaints. This is something Kay Sheldon would no doubt agree with. Her story as told to the Daily Mail is a first-hand account of what it was like to blow the whistle on the CQC.

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Overdoing it just won’t cut it anymore

This Croakey piece is worth singling out both for its heart and its important central theme. Written by Dr Justin Coleman, it is based on his plenary address to the Qld RACGP Annual Clinical Update in Brisbane last month, and argues there is an ethical imperative to tackle overdiagnosis and overtreatment. “As a GP, I am a gatekeeper to a most powerful, expensive, superb and dangerous health system and I must never forget that sometimes my job is to shut the gate,” he writes.

In similar vein, Iona Heath’s viewpoint piece in JAMA Internal Medicine, questions how long it will take before a 2012 Cochrane review showing antihypertensive drugs don’t reduce mortality or morbidity in healthy adults with mild hypertension will take to filter through to the real world of clinical practice. This, she says, is an example of waste that does neither the system nor the patients any good.

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Genetics law modified

In a landmark decision, the US Supreme Court has ruled that companies cannot patent human genes, overturning a ruling that allowed the company Myriad Genetics to hold patents on genes with links to breast and ovarian cancer.

This useful article in The Conversation analyses the decision and says, while US patent law does not directly affect Australian patent law, the decision is likely to have an impact on an upcoming case to be heard by the Full Federal Court in August.

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Trials and tribulations

The Global Mail continues its series on pharmaceutical transparency, with two pieces from Mike Seccombe. One picks apart the workings of how Greens Senator Richard Di Natale’s Therapeutic Goods Amendment (Pharmaceutical Transparency) Bill 2013 was scotched by the major parties. The other looks at how much scrutiny should be placed on small pharma company gifts to doctors.

Looking at pharma activity from another angle, a BMJ analysis piece has called for the results from unpublished or abandoned studies to be made public.

And in other research developments, the Federal Government has released 15 strategic research priorities to focus the national research effort and has grouped them under the five top challenges from Chief Scientist Ian Chubb. They are: living in a changing environment; promoting population health and wellbeing; managing our food and water assets; securing Australia’s place in a changing world; and lifting productivity and economic growth.

Perhaps they should include the growing issue of science denial? This fascinating article from Mother Jones looks at the science behind why people reject science – and offers a glimmer of hope as to how we might appeal to their sensibilities in order to get the point across.

The folks over at the Cochrane Collaboration are doing their bit to get timely research evidence out there. Their new Publish When Ready model will see all Cochrane Reviews and Protocols published on the Cochrane Database of Systematic Reviews eligible for immediate publication, (after pre-publication editorial processes have been followed) rather than waiting for monthly publication dates to roll around.

ANPHA also launched its National Preventive Health Research Strategy (2013-2018) at a symposium hosted in Canberra. And as the countdown to election day begins, the Coalition has released its medical research policy.

Other Croakey reading you may have missed this fortnight:
* So you want to make an app? Some helpful hints
* Wrapping some tweet-reports from the Australian Health Promotion Association conference
* Some big challenges for health promotion (including the “converging crises” of environmental degradation and social injustice)
* International conference puts spotlight on corporate power as a health threat – and calls for Health in All Policies
* Previewing the Australian Health Promotion Association conference

You can find previous editions of the Health Wrap here.

Twitter shout outs this week go to: @bmj_latest, Ebony [email protected], @NACCHOAustralia, @LRussellWolpe, @SimonChapman6, @cochranecollab, @kevinmd, @AboutTheHouse, @sophiescott2, @TIMEHealthland, @amednews, @EvidenceNetwork.ca, @RWJF_PubHealth, @preventioninst, @LizSzabo.

* 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.

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