By Kellie Bisset

Poll position

As the election race began, and those in the healthcare sector wondered if health might get a look-in at any point during the campaign, the Mend Medicare Coalition wasted no time in launching its own campaign calling for reform. As reported by Croakey, the Coalition released a report calling on leaders to spell out their pre-election plans for Medicare and arguing that Australia has outgrown its original system, designed to provide short-term episodic care rather than address the large amount of chronic and complex illness we see today. However, as Jennifer Doggett argues (also on Croakey), reforming fee-for-service medicine could be one of the six health policies we won’t be seeing this election campaign – along with others in the electoral too-hard basket such as the impact of climate change on health and more transparency over pharmacy’s funding deal with the Federal Government.

Doctor groups such as the AMA, Royal Australian College of General Practitioners and Rural Doctors’ Association of Australia, while not members of Mend Medicare, have urged the parties to address health issues in the campaign. If they don’t succeed, they can at least be pleased with a recent win: the Federal Government’s decision to defer for a year its controversial $2000 cap on education expenses. Although the move affects a large number of professionals, doctors and universities were particularly vocal in calling for the cap to be scrapped.

Former Treasury secretary Ken Henry meanwhile, has given his own assessment of how the major parties are handling the healthcare challenges that lay ahead. According to this report in the SMH, Henry says Australia is failing to rise to these challenges – and there won’t be enough money in the kitty to pay for the healthcare costs of our ageing population if we don’t act soon.

One suggested policy solution to saving dollars in health might be to cut the private health insurance rebate, according to a policy briefing paper by University of Melbourne health economist Dr Terence Cheng. Dr Cheng’s paper describes the 30% rebate as “expensive and fiscally unsustainable”, and comes as Private Healthcare Australia chief executive Michael Armitage called on the Government to quarantine the industry from further insurance subsidy cuts.

System stresses and solutions

When dealing with private partnerships in health it pays to be careful, writes Stephen Duckett on Croakey and The Conversation. Sounding a note of caution over the partnerships, which appear to be in vogue again, he says the arrangements have a chequered past and can be inherently risky because contracts are typically long term and can extend beyond the life of a particular Parliament.

And speaking to MJA Insight on the issue of primary care costs, Professor Duckett said remaining efficient was the only way to protect universal healthcare. In the same article, Professor Janet Hiller said giving GPs feedback about their cost impact on the system might help rein in spending.

Also on Croakey, Anne-marie Boxall, Janet Sansoni and Kathy Eagar ask, can activity-based funding reforms to public hospital pricing improve quality and make the system safer? It’s unlikely the Federal Government could use pricing to make an impact if acting alone, they argue, given its contribution to public hospital funding is not directed to specific hospitals or their clinical departments.

Another system issue gaining increasing traction in health policy circles is variation in care and how to minimise it. A new study in the MJA looking at the issue of cardiac care shows “disturbing variations” in hospital care across the country, according to a report in The Age.

As for emergency care, the latest report from the National Health Performance Authority shows that some hospitals are struggling to meet National Emergency Access Targets requiring hospitals to move 90% of patients through the ED within four hours. Meanwhile, similar targets in the UK have been dropped by many hospitals facing soaring patient demand, The Telegraph reports.

Soaring demand was an issue also addressed recently by Radio National’s The Health Report, which ran an interview with health economist Professor Nick Graves from Queensland University of Technology. Rationing, he said, would be far better overseen by a “faceless bureaucracy” – a Reserve Bank for health that could make the hard decisions unlike politicians, vulnerable to media attack.

We might also do better to address system stress if we joined the dots more often using the data we’ve got. At the very least we could get a more complete picture of public health, write University of Sydney health informatics researchers, Robert Steele and Andrew Clarke, in a new paper reported on by Government Health IT.

In New York, they’re doing just that and enjoying some success, an article on Socrata says. A new open data website, Health Data NY was released in March and contains information ranging from restaurant inspections to hospital-acquired infection rates and is “getting into the hands of people who will use it”.

Croakey also tackled the issue of data linkage this fortnight, with a piece from Executive Director of the Menzies Foundation Professor John Mathews, who says linking data to conduct research leads to important health benefits. But there are still barriers to using many of the administrative data sets used by governments.


Any hope for mental health reform?

The release of the report, Obsessive Hope Disorder: Reflections on 30 years of mental health reform in Australia and visions for the future, saw much commentary on the state of mental health reform and the likelihood of any real action. Sebastian Rosenberg from the University of Sydney’s Brain and Mind research Institute wrote in the Canberra Times that the document was one of the few independent reports on mental health services in Australia, where there is a paucity of systemic analyses and research. There is also no system to speak of, and therefore not even any cracks for people to fall through, he says, pointing out that “getting mental health care is a last-chance lottery”.

In a similar vein, Patrick McGorry, Ian Hickie and John Mendoza, called on the major political parties to ditch the groundhog day of endless reviews and “finish the job” on mental health, Amy Corderoy reports in the SMH.

Mental health concerns and a raft of other health problems were highlighted by Croakey this fortnight in relation to the Federal Government’s decision to send asylum seekers to PNG. This post says there are real concerns over whether the Government can ensure it is meeting its duty of care under the policy. And this one (also published on The Conversation) raises the real risk of the new policy putting women asylum seekers at greater risk of violence. Finally, this piece gives an overview from the experts on the significant health impacts of this change in direction.


A new twist on the nanny state argument

Those who work in public health are very familiar with accusations of nanny statism from libertarians who believe health behaviours are a matter of individual choice. But the Federal Government’s recent decision to increase the tobacco excise to raise an extra $5.8 billion in revenue saw the nanny state argument taken to a whole new level. The Australian’s economics correspondent Adam Creighton wrote a piece arguing the policy “is being sold with the same flawed economic and moral arguments that underpinned Nazi Germany’s policies to stamp out smoking” and containing more than 10 references to Hitler and the Nazi regime.

In a vigorous response on Croakey, Mike Daube, Professor of Health Policy at Curtin University, described the article as “grotesque” and “offensive”.

“Just when you thought you had seen everything from the tobacco cheer squad, their arguments descend yet further into the gutter,” he writes.

Deakin University Philosophy lecturer Patrick Stokes also critiqued the piece on The Conversation, taking it apart on its philosophical merits.

“At its best, strident liberalism is a healthy bulwark against excessive paternalism and coercion,” he writes. “But these positions also rely on a hopelessly atomistic picture of what human beings are… [we are] far more radically interconnected and dependent upon others.”

The comments at the end of this piece make compelling reading – if only to reinforce what challenges public health professionals face in prosecuting the case for reform.

The excise announcement also saw some heat directed towards the Coalition over political donations from the tobacco industry. This article in The Global Mail looks at the issue in detail. The Australian’s health editor Sean Parnell, also covered the story, quoting former AMA president and new Liberal candidate Dr Bill Glasson saying he would lobby against the practice if elected.

Professor Simon Chapman meanwhile, has used a piece on The Drum, to urge the release of data on tobacco tax receipts and projections which, for the first time, were missing from the budget papers. This data is absolutely critical to the evaluation of Australia’s plain packaging law, he says.

Recent controversy in the UK over the Government’s decision to shelve plans over plain cigarette packaging and minimum alcohol pricing has seen the Welsh Government consider going it alone to introduce the public health measures. This piece, carried by Wales Online, says Health Minister Mark Drakeford is giving serious consideration to the idea.

South Africa is also considering alcohol reform via a Bill that could restrict alcohol advertising, and ban liquor-backed sport sponsorships.


Food politics: a battle for hearts and minds

Few would have received more nanny-state tirades than New York Mayor Michael Bloomberg, whose proposed ban on super-sized sodas has been blocked by a mid-level state appeals court. But lawyers for the city say the case should be heard in the State’s highest court. Whether the matter is resolved before Bloomberg leaves office at the end of the year is up in the air.

In Australia, Coca Cola has gone on the front foot over soda size, launching a campaign that includes increased availability of smaller portions and more emphasis on lower kilojoule options. This article by Probono Australia offers three expert views on whether the strategy is firm or fizzy.

The Australian Financial Review reports that the fight between the food industry and public health advocates is turning hostile, as Melbourne University Professor of Public Health Rob Moodie urged the Government to remove the Australian Food and Grocery Council from the negotiating table on front-of-pack labelling, suggesting they had the same conflict-of-interest level as tobacco companies.

The Greens meanwhile, have launched a policy to ban junk food advertising to kids, and WA Little Athletics has been criticised by Professor Mike Daube and other public health experts for its decision to continue accepting sponsorship from McDonalds. Their criticism comes as new research published in PLOS ONE shows that childhood has become “the critical period when socioeconomic inequalities in overweight emerge and strengthen”.

Another study in PLOS ONE says a single approach to obesity is implausible if not impossible due to findings that obesity that runs in families of people with type 2 diabetes is due to a large number of rare variants in many different genes. The authors discuss their research in this piece at The Conversation.

Food conflict of interest issues have emerged in the US, after JAMA Internal Medicine published a study showing that employees of food additive manufacturers wrote one of every five safety determinations submitted to the US FDA by the industry over the past 15 years.

The UK food industry has also been outed on standards, with a report showing all of Britain’s multiple retailers have failed to achieve salt reduction targets in meat products required as part of the government’s Public Health Responsibility Deal.

But some good news has emerged from the gloom: the US Centers for Disease Control and Prevention says childhood obesity rates are falling among pre-schoolers in many states for the first time in decades. The decline is small but significant.


Health literacy: addressing disadvantage

Croakey addressed the ongoing issue of health literacy this fortnight, with a piece from Michelle Hughes about a new paper on integrating health literacy with healthcare performance. And Jennifer Doggett looked at a study published in the Australian Health Review that found telephone coaching can help people with chronic diseases (particularly the vulnerable and disadvantaged) to self-manage their conditions.

Another paper by Australian and UK researchers, published in the Journal of Health Psychology, looks at measuring health literacy in the context of shared decision making.

Health literacy has also been identified – alongside income, housing, nutrition and childhood development – in a new report from the Canadian Medical Association called “What Makes us Sick”. The report was based on online consultations and a series of “town hall” meetings with 1000 people across the country.

And Thomas LaVeist, a researcher who specializes in health disparities, tells the US Reporting on Health blog that vigilant journalism has an important role to play in highlighting health disparities.

What can doctors do to address health literacy issues? This blog post on KevinMD by Dr Mary S. Kelly offers some suggestions for simple interventions.


Aboriginal communities offer directions on health

Tackling Aboriginal male health issues is critical to closing the gap and improving life expectancy for Aboriginal people, according to a new blueprint unveiled by NACCHO in Canberra on Ochre Day. The 10-point blueprint calls on governments to invest in providing culturally appropriate care for Aboriginal men, who are less likely to seek out healthcare services. It also says priority funding should address mental health, social and emotional well-being and suicide prevention.

NACHHO’s first ever National Aboriginal Primary Health Care Summit will no doubt tackle some of these issues. It will be held in Adelaide later this month.

A summit held in Alice Springs July and sponsored by the Aboriginal Peak Organisations Northern Territory looked at alcohol policy and its impact on Aboriginal people and communities. The NACCHO website says summit delegates endorsed the call for a Board of Inquiry to provide the data and evidence that are needed for a comprehensive, evidence-based blueprint for tackling alcohol harm.

The Australian Greens marked National Aboriginal and Islander Children’s Day on August 4 with a statement saying the day should remind us that the health and wellbeing of Aboriginal and Torres Strait Islander children is still a long way behind that of other kids. The day was first observed by the Secretariat of National Aboriginal and Islander Child Care (SNAIC) in 1988 and the organisation provides resources to those wanting to celebrate the day. This year’s theme is Right Here, Right Now, Our Rights Matter. SNAIC’s resources include a YouTube clip, and Croakey points out that YouTube is becoming an important information resource for Aboriginal and Torres Strait Islander health. Some other great YouTube clips can be found here.


An unhealthy climate

Despite the current political focus on the costs of carbon pricing and emissions trading rather than the costs to health of climate change inaction, health advocates are still making efforts to be heard on this issue.

Dr Alessandro Demaio writes at The Conversation that the drivers of non-communicable disease are the same as the drivers of climate change.

And GP and regular Croakey contributor Dr Tim Senior turns his attention to a new book on the coal industry: Big Coal: Australia’s dirtiest habit, where health issues run throughout the story.

Healthcare needs to lead the fight against climate change according to this piece on by Gary Cohen and Dr Jeffrey E. Thompson. Given that climate change is fundamentally a health problem, the healthcare sector must admit its contribution to the problem (it’s a major polluter) and lead the way to a solution, they say.

Science Magazine meanwhile, has just released a special issue on climate change and, among other things, looks at the emerging threat of infectious diseases associated with global warming.


Breastfeeding week re-ignites debate

World Breastfeeding Week took place from 1–7 August to commemorate the Innocenti Declaration made by WHO and UNICEF policy makers back in 1990 to protect, promote and support breastfeeding. And the week saw its share of breastfeeding debates, including this interesting one at The Conversation, which discussed research suggesting breastfeeding increases a baby’s IQ. Comments from clinicians and researchers at the end of the article questioning the paper’s methodology inspired some heated comments from breastfeeding advocates.

CBS news reported on the latest CDC Breastfeeding Report Card, showing that breastfeeding rates in the US have risen to 77%. And an article in Medical Observer revisited the issue of when to introduce solid foods, with suggestions we should re-open the debate over whether four months, rather than the recommended six, might be more appropriate.

Some Twitter shout-outs, thanks to the following: @LizSzabo, @NHPAreporting, @simphilip, @MelissaLDavey,@RWJF_PubHealth

Previous issues of the Health Wrap can be found 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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