By Melissa Davey


Finally, (some) health policies get an airing

We’ve been hearing about boats, budgets and abolishing the carbon tax as the major parties ramp up their election campaigns, but it wasn’t until this week we heard a more detailed account from the Coalition about where they will focus their health policies. Addressing the media from St Vincent’s hospital in Sydney, shadow health minister Peter Dutton committed to complete the National Bowel Cancer Screening Program by 2020 if his party is elected, which Cancer Council Australia said would save 35,000 lives over 40 years.

Meanwhile, Kevin Rudd has been busy visiting Medicare Locals, telling health workers that Opposition leader Tony Abbott would cut 3000 Medicare Local jobs if elected. When asked about this during Mr Dutton’s health policy media conference, Mr Abbott said: ‘’There will be a review and the object of that review will be to try and maintain service while minimising bureaucracy associated with [Medicare Locals]. Can I say absolutely that no Medicare Local will close? I’m not going to say that.’’ Mr Abbott did say he would “preserve and improve” frontline health services. As for a policy on mental health, Mr Abbott simply said “not yet – soon”. With the election barely two weeks away, how soon is soon? Sane Australia has been left wondering if mental health has enough sex appeal for the leaders this election.

Mr Rudd, who this week said Labor would legislate to keep tobacco out of politics (Mr Abbott has also pledged the Liberal Party will no longer accept donations from the tobacco industry), used the second Leaders’ debate to attack Mr Abbott’s record as health minister. Sydney Morning Herald chief political correspondent Mark Kenny writes: “Mr Rudd capitalised first on the more flexible format of the people’s forum in Brisbane’s Broncos Leagues Club to accuse Mr Abbott of having “ripped” $1 billion from hospital budgets and of planning further cuts”. Mr Rudd did not have as much to say during the debate about what his own party had planned in the way of major health policies. But earlier in the week he announced a $250 million investment fund to help develop and commercialise regenerative medicine and promised funding to modernise Westmead Hospital.

As for what the community is hoping for in health, the director of the Menzies Centre for Health Policy at the University of Sydney, Professor Andrew Wilson, told 6minutes key concerns included growing out-of-pocket medical expenses, access to mental health and dental services, elective surgery waiting times in the public sector and availability of care in rural areas. Meanwhile, Australian Doctor described health as the ‘big mystery’ of the election campaigns from Labor and the Coalition so far. This Croakey piece by fellows of the Centre for Policy Development, Ian McAuley and John Menadue, offers plenty of suggestions for where the next health minister should focus their priorities. Fresh thinking and courage would be good places to start, writes Jim Gillespie for The Conversation. And these word clouds, compiled by Croakey co-ordinator  Melissa Sweet, reveal what Croakey contributors want to see as health priorities, with ‘Prevention,’ ‘Equity,’ ‘Indigenous,’ ‘Mental’ and ‘Access’ rating highly.

Many are hoping the upcoming National Press Club health policy debate will add clarity to how Health Minister Tanya Plibersek and Opposition Health Spokesman  Peter Dutton plan to address these issues. It will be hosted by the Consumer’s Health Forum (CHF), whose chief-executive Carol Bennett has supported a call by the Greens for an inquiry into rising direct health costs. “We need a frank debate on the future of Australia’s health system, not the blind support for Medicare which is now failing in its prime role to ensure equitable access to health care,” Ms Bennett said. The CHF has also joined forces with CHOICE and the Australian Council of Social Service to put pressure on MPs and candidates to ‘Stand up for Cheaper Medicines’, Croakey reports.

The Greens are only party to clearly outline their health policy priorities from early on in the campaign. They plan to invest more than half a billion dollars in mental health services across rural and regional Australia. It’s an area Rural Doctors Association of Australia president Sheilagh Cronin says has been “bypassed during the election campaign while billions of dollars was pledged for roads and rail infrastructure,” the Warwick Daily News reports. And Australian Medical Association president Dr Steve Hambleton has welcomed the Greens policy to ban the promotion of alcohol during children’s television viewing times, calling on the major parties to do the same.

Writing for The Drum, Emily Millane has asked why neither of the major parties has recognised the massive social and economic ramifications of an increasingly ageing population. And finally, Michelle Grattan writes an interesting analysis of how Labor intends to use health to leverage itself this election for The Conversation. “Trying to punch home the message that Abbott will be a huge threat to health and education programs, Kevin Rudd has no intention of being deterred by the fact-checkers’ finding that the alleged $70 billion Coalition total funding hole is an exaggeration,” she says.


Protecting children from obesity

The pressure continues to grow on pregnant mothers to be as healthy as possible before falling pregnant and to maintain healthy habits throughout. A Scottish study that traced the children of more than 28,500 women found offspring of obese and overweight mothers were 35% and 11% more likely to die before the age of 55 years respectively than those of normal-weight mothers. The Herald Sun quotes study co-author, Rebecca Reynolds, saying: “Our results suggest that the intrauterine (womb) environment has a crucial and long-lasting effect on risk of premature mortality in offspring”. The researchers called for urgent strategies to help mothers to optimise their weight before pregnancy.

In more positive news about keeping children healthy, a study from the Harvard School of Public Health has found making children exercise while at school does not lead to them being less active at home. Published in the American Journal of Preventative Medicine, the study concluded: “school-based physical activity is a promising approach that can improve total daily physical activity levels of youth”. reports on previous research that suggested children had a built-in “activity stat” which regulated the total amount of energy they expended, and so raising their activity levels at school would not increase their overall activity – it would just shift it to school hours. Physical education at US  schools had taken a back seat to academic preparation in recent years, the report said. This has previously been flagged as an issue for Australian children.

And while obesity is an issue Australia-wide, with about 60% of adults classified as overweight, The Courier Mail has revealed Queensland towns top the nation for obesity rates. Bundaberg is the fattest town, with almost 24.5% of its population classified as obese. The rate for Kempsey, in NSW, was almost the same. It prompted doctors and nutritionists to call for mandatory cooking classes in schools. AMA President Dr Steve Hambleton was quoted as saying: “There’s a de-skilling of a generation. Everyone (in schools) should be taught how to prepare and cook food”.

A report from CNN health earlier this month suggesting childhood obesity rates in the US were dropping has been followed by this report, which claims the US obesity death toll has been “vastly underestimated”. The study found previous estimates that placed obesity-related deaths at 5% had overlooked generational differences in the way the obesity epidemic has affected Americans. Because younger generations have been exposed longer to risk factors for obesity, they were at even greater risk of becoming overweight or obese than previous generations, researchers said. Their adjusted figures placed obesity-related deaths in US adults aged 40 and up at 18 per cent.


From soldiers to teenage girls, mental illness doesn’t discriminate

A senior lecturer in social work, Ian Cummins, has described how the stigma and discrimination faced by people with mental illness is ongoing and strong. Writing for The Conversation, he described how people in hospital for mental health reasons rarely receive the ‘get well’ cards other patients do. “And while some sections of the media focus on mental illness in cases of violence, a rise in the number of people who are more of a risk to themselves goes unnoticed,” he says. He refers to a report from Manchester University which found murders committed by people who are mentally ill are at their lowest since data collection began in 1997. The report suggests complex patients are perhaps being more effectively managed. However, the suicide figures for people with mental illness are “startling” he says, at an average of three each day in England in 2010.

But in Australia, Police Union president Ian Levers argues dangerous mental health patients are being let into the community too early. However, Mr Levers acknowledges patients much more often pose harm to themselves than anyone else. The Union has called for an urgent funding increase for the sector for more hospital beds. “Too often police are called time and again to addresses, often several times a week, to assist people who are having mental health issues, whether they are self-harm issues or are behaving violently,” he said. “Police convey these people to hospital for treatment, only to find they have been released from hospital owing to a lack of resources and the whole cycle repeats itself a few days later.”

Meanwhile Australian soldiers exposed repeatedly to combat and trauma in Afghanistan or Iraq face a 15-fold increase in risk of mental health problems such as post-traumatic stress disorder, reports David Wroe for the Sydney Morning Herald.  ”These findings covered post traumatic stress, major depressive syndrome, panic and other anxiety syndromes, and alcohol misuse,” the report said. And Herald health editor, Amy Corderoy, has revealed some startling statistics about the rate of self-harm among teenage girls. Citing figures from Health Statistics NSW, she reports that across NSW the rates of hospitalisation related to self-harm have doubled across all age groups and genders, although women aged 15 to 24 are far more likely to hurt themselves. You can read her related piece for Daily Life, which explores the question: why?


Australian-led breakthroughs highlight importance of research funding

There have been some brilliant examples of Australian researchers leading the way in the past fortnight, with genetic causes of some of the most devastating childhood epilepsies revealed through a landmark study jointly led by Melbourne researchers. As well as providing a pathway to treating epilepsy the research provides answers to patients and families who previously had little or no idea where epilepsy had come from, 9 News reports. The study’s co-leader Professor Sam Berkovic, director of the Epilepsy Research Centre at the University of Melbourne and Melbourne’s Austin Hospital, said not knowing the cause of epilepsy had been extremely frustrating for parents, doctors and epilepsy patients. “We’ve never really had the answer,” he said. “Now we do. This also stops the need for further searching and refines the treatments.”

Meanwhile, a study led by the University of Sydney’s Brain and Mind Research Institute appears to have busted the idea that chronic workplace stress increases heart-attack risk. Science Alert reports that what we really need to focus on is standard heart disease risks such as higher blood pressure and smoking. While job stress may not contribute, heart attack survivors who live alone and people exposed to extreme stress from events such as natural disasters or sporting events are all at greater risk of heart attack. In other heart-related Australian research, a flu-jab may stave-off heart attacks, according to a study from the University of NSW. Bloomberg Businessweek reports immunisation against the respiratory illness lowered the probability of heart attack by 45 per cent.

However, a key to Australians being able to carry out research like that mentioned above relies on funding security. The importance of longer funding cycles in cancer has been highlighted by the Dean of UNSW’s School of Medicine, Peter Smith, who used the University’s recent breakthrough in the treatment of neuroblastoma (a devastating childhood cancer) and melanoma to make his case. Researchers persisted over many years, 25 years after the pharmaceutical industry and their scientific peers had given up, he wrote. They could do so only because of long-term funding support from The Kids’ Cancer Project, funded by individuals, families and philanthropists. But not all researchers are so lucky, with conventional research funding models usually requiring researchers to reapply and compete for new funding every three years. Professor Smith described this as “a process that engenders uncertainty and bites into critical research time”.


Health system issues, changing doctors’ ways and better palliative care

In a blog post, internal medicine physician Kevin Pho considers how to get doctors to practice using updated guidelines and implement the latest evidence in their work. Paying for performance and financial penalties has not seemed to work, he says. In considering the issue, Dr Pho refers to a piece in the New Yorker by Atul Gawande, which examines why some innovations spread fast and others don’t. It came down to meaningful partnerships, Gawande’s piece claimed. “To change doctors’ behavior, partner with them,” Dr Pho wrote.  “Listen to and acknowledge what physicians are concerned about; medical malpractice and physician burnout, for instance. Propose solutions to these issues, even if it goes against your core politics.” It comes as this Croakey piece from GP Dr Tim Senior says Australia can draw important lessons from the UK’s Berwick Report on Patient Safety, which found a partial loss of focus on quality and safety as primary aims, inadequate openness to the voices of patients and carers and insufficient skills in safety and improvement among health system issues there.

In a powerful piece for her website, Coming of Age, Adele Horin has written about the anger people feel about the modern way of dying. “No-one at the Council On The Ageing had quite expected it,” Horin wrote, when they surveyed 1600 people in NSW aged 50-plus recently on a range of health issues and found a profound dissatisfaction with end-of-life care. When surveyed about the experiences of palliative care, respondents said things like: “Pain relief was not sufficient (liver cancer and secondaries). Father attempted to hang himself with dressing gown cord and died in psych hospital 2 days later which we felt was very inappropriate” and “My husband had cerebral metastasis, his quality of life diminished, he had severe headaches, lost all his independence, asked for help to die, stopped eating, forced to endure pointless suffering”.

And a group of experts have co-authored this piece for The Conversation about chronic kidney disease, posing the question: is it worth prioritising? They describe how the disease hasn’t received attention in World Health Organization priority documents, despite one in nine Australians over the age of 25 living with chronic kidney disease. This is more than the number living with chronic lung disease, stroke, heart failure, and all types of cancers combined.. But it is a significant health system burden, with health-care expenditure on chronic kidney disease in the US totalling US$60 billion in 2007.

“In Australia, the cost of treating end-stage kidney disease between 2009 and 2020 is estimated at $12 billion,” they write.


Political leaders must seek out the voices of female Indigenous leaders

A professor of Indigenous Health and Education at the University of Wollongong, Ngiare Brown, spoke recently of the importance of connections to culture and country as a social determinant of health. Her address to the inaugural NACCHO Aboriginal Community Controlled Health Services Summit in Adelaide has been summarised by Croakey here. “Exploring and articulating the cultural determinants of health acknowledges the extensive and well-established knowledge networks that exist within communities, the Aboriginal Community Controlled Health Service movement, human rights and social justice sectors,” she said.

Reporting from the summit, journalist John Thompson-Mills wrote for Croakey that “the road to closing the gap may finally have a corner in it”. He reported: three-quarters of the health gains made have been against Close the Gap Targets; there were two million episodes of health care, a 100% increase since the last report was tabled four years ago; and between 1991 and 2010 there was a 37% decline in overall Aboriginal and Torres Strait Islander mortality and a 62% improvement in infant mortality.

Meanwhile the Labor government intends to close the gap by unveiling three targets that promise to end high incarceration rates of Indigenous people, increase the number of Aboriginal people in higher education and ensure coverage of disabled Aboriginal people by DisabilityCare Australia, Patricia Karvelas reports for The Australian. But this analysis of plans for Indigenous Australians for The Guardian by Louise Taylor describes an important and missing voice from both major parties plans for Indigenous Australians – women. “It troubles me that the domain and face of national Indigenous leadership is portrayed consistently as Indigenous men,” she writes. “Noel Pearson. Warren Mundine. Mick Gooda. Mick Dodson. Patrick Dodson. Where are the women? When Rudd and Abbott speak of their Indigenous “mates”, they always name men.” In other news, the appointment of Indigenous leader Warren Mundine by Tony Abbott to head a new advisory board to tackle Aboriginal disadvantage has surprised some, Radio National reports.

Rugby League’s Indigenous players have stepped up to highlight the importance of Close the Gap for babies born to Aboriginal mothers, who die at more than twice the rate of other Australian babies.  This report features a heartfelt video from players including Johnathan Thurston, Sam Thaiday, Andrew Fifita and Nathan Merritt. “So many of us have become fathers recently and your world just changes immediately, you are responsible for this life,” Mr Thurston said. “Holding my daughter Frankie for the first time made me realise the importance of working to close the gap for future generations.”

Political leaders, take note.

Other Croakey reading you may have missed this fortnight:

You can find previous editions of the Health Wrap here.

Twitter shout-outs this week go to: @SANEAustralia, @CancerCouncilOz, @NACCHOAustralia, @Australiandr, @greensjeremy, @timsenior, @kevinmd

Melissa Davey is the Sax Institute’s Communications Manager. She was previously a health and medical reporter for the Sydney Morning Herald and the Sun Herald. She is completing her Masters of Public Health at the University of Sydney and has a strong interest in public health messaging and mental health. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning. Twitter: @MelissaLDavey

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