By Kellie Bisset

NAIDOC Week – celebrations and reflections

As NAIDOC Week celebrated the richness of Aboriginal cultures with multiple events around the country, it’s timely to reflect on this year’s theme “We value the vision: Yirrkala Bark Petitions 1963”.
This year marks the 50th anniversary of the Yolngu people of Yirrkala in northeast Arnhem Land presenting the Yirrkala Bark Petitions to Federal Parliament.

More detail on the Petitions is available on the NAIDOC website, but in summary, they protested the Commonwealth’s granting of mining rights on land excised from Arnhem Land. They were the first traditional documents recognised by the Parliament and helped shape acknowledgment of Aboriginal people and their land rights.

Reflecting on the week, Dr Tim Senior, a GP working in Aboriginal health and regular Croakey contributor, blogged that it was important to celebrate NAIDOC Week and also time we moved on so that celebrating Aboriginal and Torres Strait Islander cultures was done in other weeks as well. “We need our political, social and economic systems to take on some Aboriginality,” he writes.

The week also saw the publication of the Medical Journal of Australia’s Indigenous health issue. There is much good reading, including this piece from Professors Sandra Eades and Fiona Stanley about the disturbing gap that remains in healthy child development in safe and secure environments – a gap that can only be resolved by full engagement of First Nations people and support and promotion at all levels of government.

Research published in the same issue shows that subsidising fruit and vegetables is associated with improvements in short-term health status indicators among disadvantaged Aboriginal children. A For Debate article also examines the complex issue of cultural competence in clinical medicine.

And Croakey co-ordinator Melissa Sweet looks at some social media success stories in the Indigenous health sector and how social media channels can be used for public health promotion and advocacy. Those interested in learning more about leveraging social media in health promotion might be interested in a seminar being run by the Australian Drug Foundation on 15 July. It’s not too late to RSVP. Details here.

Another significant development during NAIDOC Week was the agreement signed between the Australian Indigenous Doctors’ Association and Committee of Presidents of Medical Colleges. The agreement will contribute to closing the health outcomes gap by training more Aboriginal and Torres Strait Islander medical specialists, mentoring future community leaders in medicine and improving the ways specialists work with Aboriginal and Torres Strait Islander people.

And this article published on the First Peoples Worldwide site, nominates three reasons to care about Indigenous people for those whose priorities may lie elsewhere.

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Health equity: a road paved with treacle

Calls to address the issue of health equity are growing louder. Croakey featured one of them this past fortnight from Associate Professor Marilyn Wise, who recently addressed the Australian Health Promotion Association’s national conference. She raises questions around how society’s powerbrokers contribute to social injustice and health inequity and says we need to look beyond “what to do” and re-examine “who decides what to do”.

Another article, by Professor Robert Douglas for The Conversation, says it’s time for a debate about the “toxic effects” of Australia’s growing income inequality, and raises the question of how much play this will receive in the lead-up to the election.

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The power – and place – of evidence

Enough with the rhetoric, Royal Society President Sir Paul Nurse writes in The Observer; it’s time to make better use of evidence in shaping public policy decisions. This issue has been on the agenda in the UK recently, with the establishment of What Works policy advice centres and sustained attention from The Guardian, which has run a series of articles, the latest of which include a live chat summary on what it takes for policy makers to use evidence and a blog on how the worlds of evidence and policy can intersect.

In a similar vein, Harvard School of Public Health Dean Dr Julio Frenk writes on The Lancet Global Health Blog that while it’s important to acknowledge many things besides evidence shape policy, it is most certainly possible for research and policy to “walk together” and “scientifically derived evidence must be the guiding light”.

Despite its title, Evidence-based policy is the most meaningless phrase in politics today, this article in the London daily business commuter newspaper City A.M. isn’t against evidence so much as the use of ‘evidence-based policy’ as a buzz phrase. The author, Ryan Bourne, head of economic research at the Centre for Policy Studies, offers an interesting take on the important point that policy making must, by its nature, be a broad church.

In Sydney, Dr William Dietz told the 2013 Primary Health Care Research Conference that we need more practice-based evidence rather than evidence-based practice, according to the tweet stream, which has some rich pickings (search #2013phcconf).

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From policy to practice

DisabilityCare Australia is here and that’s great, says Tricia Malowney. But a recent launch event in Victoria left her wondering whether anything had changed – with everyone except disabled people thanked for their contributions to the scheme’s development and the lack of seating resulting in people in wheelchairs stuck at the back of the room looking at the backs of those in front. Writing on the ProBono Australia website, Ms Malowney reminds us that there is still rather a long way to go, but now this genie is out of the bottle, Australians with disabilities are no longer willing to accept second-class citizen status.

On Croakey, Australian Medicare Local Alliance CEO Claire Austin answers an extensive list of questions from Croakey contributors about how this policy initiative is panning out a year down the track. A clear set of facts is always useful and can help remove some of the emotion from debates over where taxpayer dollars are being spent.

Another good policy idea, the National Bowel Cancer Screening Program, appears to be experiencing some troubles. An AIHW report says only 35% of eligible Australians were tested in 2011-12 and Cancer Council WA attributes the problem partly to inadequate Government funding, according to a report in the West Australian.

Private health insurance policy has taken another turn, with the government decision to no longer refund 30% of the cost of the loading paid by people who take out private health insurance after the age of 30. The move again raises questions over the efficiency of public subsidies for private insurance, writes Anthony Harris on Croakey and The Conversation. He contends that if we want high quality health care with choice, private insurance is not the only way we can have it.

As for interesting international policy initiatives, this NPR story describes how Oregon is adapting to US health reform – with some innovative ways of keeping patients out of emergency departments.

In the UK, Pulse reports that the NHS plans to extend its “friends and family test”, which is already being used to gather patient feedback on hospitals, and will roll it out to general practices next year.

The economics and policy world came to Australia’s doorstep this past fortnight, with health economists and policy makers gathered in Sydney for the 9th World Congress of the International Health Economics Association. Delegates paid warm tribute to the late Professor Gavin Mooney in whose memory an essay competition was launched this week by the Sydney School of Public Health at the University of Sydney, Inside Story and Croakey blog. The inaugural topic is climate change and equity.
The tweet stream can be found at #IHEA2013 plus check out NPHA’s reports of the Congress at #NHPAreporting.

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Science matters

We have plenty of programs in science, technology, engineering and mathematics (STEM) but no overarching framework to guide them, Chief Scientist Professor Ian Chubb told The Conversation recently following a Maths and Science Education symposium at the University of Canberra. In response, the Office of the Chief Scientist is developing one to prevent Australia from being left behind. A discussion document on the strategy can be found here.

The National Press Club also heard from Australian Academy of Science President Professor Suzanne Cory, who likened politicians’ inconsistent and unreliable approach to supporting research to building a rambling, shambolic patchwork of a house. Her address described investment in the creation of new knowledge as the essential foundation for a stable, resilient and healthy Australian future.

The Coalition’s medical research policy (flagged in the last Croakey Health Wrap) is a start, writes Professor Merlin Crossley on The Conversation. His piece looks at what we might need to consider if we really want to take a strategic approach to this issue.

And Federal Health Minister Tanya Plibersek announced her own research news – $13.5 million for research projects to improve primary care, including $2.5 million for a research partnership with Canada that will focus on chronic disease prevention and management.

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The rise of the superbugs

Croakey reports on a new paper released by the Office of the Chief Scientist that warns Australia faces a ‘post-antibiotic era’ in which children could die from minor scratches. The SMH reports Professor Ian Chubb saying that antibiotic resistance has the potential to become one of the world’s biggest public health challenges and requires a serious response from scientists, industry and the community. Interviewed on AM, Chief Medical Officer Professor Chris Baggoley also addressed the issue and discussed the relationship between antibiotic use in humans and animals.

A well-timed article on Science Alert offers some positive news. The website reports on the potential for a new antibiotic to fight bacterial resistance to antibiotics following early research being conducted at The University of Adelaide.

On the issue of infectious diseases more broadly, this Croakey post from an analysis in the Australian Health Review, says Australia will be vulnerable to the threat of infectious diseases unless we follow the lead of other countries and establish an independent authority for communicable disease control.

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Immunisation developments – for better and worse

From 1 July, changes to the National Immunisation Schedule will mean that children will receive two fewer injections as the number of combination vaccines increases. Kristine Macartney and Melina Georgousakis provide this good explainer on The Conversation.

Never far from the headlines, AVN has been referred to authorities again. This Medical Observer article says a paediatrician has reported the group to the NSW Health Care Complaints Commission over misleading information about anti-D shots on its Facebook page.

Despite the recent measles outbreak in Wales, a subset of parents are still ignoring immunisation messages, with some having been invited to present their child for MMR vaccination 15 times, according to BBC news.

And in the US, a change.org petition has sprung up in an attempt to prevent actress Jenny McCarthy from taking a host spot on the popular television show The View. McCarthy is an anti-vaccination advocate who has previously claimed that vaccination causes autism.

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What’s happening in mental health

There has been considerable activity around mental health, with a series of Government announcements detailing 15 new headspace centres, the opening of the first of nine early psychosis centres, $470 million given to the mental health Partners in Recovery initiative and a new Mentally Healthy Workplace Alliance.

Writing about the Alliance announcement, Sam Mostyn, a Commissioner with the National Mental Health Commission, says many managers are unsure about how to respond to mental illness in the workplace and there is an obvious need for more practical guidance and support.

The NSW Mental Health Commission hosted a mental health forum with the University of Sydney, where Yale University Professor of psychology Larry Davidson said achieving proper representation for people living with mental illness was a civil rights issue.

And two new names featured in the mental health arena. Dr Lesley van Schoubroeck has begun work as the head of the new Queensland Mental Health Commission, and Victorian Senator Jacinta Collins replaced Mark Butler as the new federal Minister for Mental Health and Ageing. Some articles, including one by Crikey Canberra correspondent Bernard Keane, have raised questions over portfolio fit, given Senator Collins’ conservative stance on issues pertinent to mental health such as gay rights and reproductive health.

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Our complex relationships with food

We vastly oversimplify the reason people become obese, Dr Barbara Berkeley writes on the Kevin MD blog, criticising the positions of so many on this issue, which “are so angrily and unassailably black and white”. Dr Berkeley is not overly enthused about the American Medical Association’s recent decision to classify obesity as a disease either.

This Forbes piece, sub-titled ‘the good, the bad and the ugly’ also picks over the fallout from the decision and what it might mean. An article in aeon magazine takes an even broader view, contending that obesity may be bigger than all of us. It explores possible candidates for a “global hidden factor” (Stress? Lack of sleep?) that might explain why people are getting fatter.

A Croakey post from Dr Melissa Stoneham details a piece in the latest edition of Journal Watch, which looks at the issue of energy drinks being a potential health hazard and particularly alarming for young people. Are we doing enough, she asks, to protect our kids from these products?

Meanwhile, a small but interesting study published in the American Journal of Clinical Nutrition supports the hypothesis that’s it’s possible to become addicted to food. Researchers from Boston Children’s Hospital found that consuming high GI meals appears to stimulate the parts of the brain related to craving and reward.

Any parent who has stood in the supermarket, struggling to make an informed choice for their kids on the nutrition content in some packaged foods will most likely be unsurprised by a new report from the US Prevention Institute. The report found that 84% of products reviewed did not meet basic nutritional standards, despite making health claims.

It’s hard to talk about food without talking about Big Food – but what role should they and other industries play in shaping public health? The issues are explored in this PLOS blog by Atif Kukaswadia, who says the work of the Conflict of Interest Coalition might offer some guidance.

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A random wrap of interesting overseas news

The fallout from the Care Quality Commission scandal in the UK (short précis here from the last Health Wrap) has seen the Government move to tighten up the rules. The Independent reports that directors of all healthcare organisations will be subject to compulsory “fit and proper” tests to prove they are up to the job and powers to prosecute health bosses will be increased.

In China, the Government is legislating in a rather different way, with a new law, “Protection of the Rights and Interests of the Elderly People”, that will require family members to visit and care for their aged parents. This AlJazeera report provides an overview, addressing the broader issue of China’s ageing population. SBS also reported on the story, giving a local perspective.

The US continues to wrestle with the abortion issue. The widely publicised filibuster in the Texas Senate by Democrat Senator Wendy Davis, who was trying to block a Republican abortion bill, has started something bigger, writes Jim Hightower in The Austin Chronicle. And North Carolina has just passed changes to abortion laws that Republicans say will make the procedure safer for women but which critics say just hampers their access to quality care. This Washington Post article gives a bird’s eye view of the wave of abortion limitations being imposed in Republican states.

At home, Anne Summers reminds us that abortion in Australia is most definitely still on the agenda and there’s no denying that this is a federal election issue.

In journal land, JAMA has ditched the artwork on its covers, ending nearly 50 years of tradition. And The Lancet has launched The Lancet Global Health – its first open-access journal.

And finally, The Atlantic reports on the growing body of scientific evidence that reading is good for you – as if you needed any more convincing…

Shout outs to the following tweeps for their helpful activity on Twitter this part fortnight: @sandrodemaio @MelissaLDavey @LRussellWolpe @LizSzabo @preventionist @phcris @NHPAreporting @CREreducingHAI @AustAgeAgenda @NACCHOAustralia @timsenior

Other Croakey reading you may have missed:
* Who uses complementary and alternative therapies in regional South Australia?
*Cancer patients push for election commitment on genetic patenting
*One hundred and fifty ways the nanny state is good for us
*Rethinking accepted wisdom on why people choose to visit an emergency department rather than see their GP
*On the contradiction at the heart of our search for better leadership
*Northern Territory prisons totally smoke free

For previous editions of The Health Wrap, see here

* 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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