By Kellie Bisset 


Election fever – or is that malaise?

As Australia goes to the polls, we are slightly more enlightened about the major parties’ approaches to health than we were two weeks ago. But  many in health have pointed out during this campaign that their hopes for in-depth discussion and innovative ideas on the major health challenges facing our nation have been left unfulfilled.

So what are we left with? Well, Croakey has been diligently covering the campaign and has produced more than 30 items that take you through the issues from climate change and health to an analysis of the health debate between Tanya Plibersek and Peter Dutton. And to pull it all together, Michelle Hughes has produced a comprehensive election wrap that’s well worth reading. Visit this page for Croakey’s full election coverage, and if you haven’t had enough politics by then, here are some other sources of election news.

An interesting analyses of health policy statements this election has been produced by Joanna Heath at the Australian Financial Review and SBS offers this at-a-glance summary as does the SMH.

What will happen to Labor’s new health agencies if the Coalition wins government? This piece from Amy Corderoy and Daniel Hurst at Fairfax takes a look at what might be in store for the Australian National Preventive Health Agency, the National Health Performance Authority and Health Workforce Australia. And how will NACCHO survive under a change of Government? It’s pre-election analysis looks at the risk of cuts to Aboriginal health services.

The Australian’s Fran Foo explores how Tony Abbott might overhaul e-health and Simon Benson considers what might be in store for research considered “wasteful” in a story carried across News Ltd mastheads. Adam Shand, also writing at The Australian, quotes the chair of the federal government advisory panel on positive ageing as saying both sides of politics have ignored the “ageing tsunami”.

There were many commentaries from health sector experts during the campaign – too many to mention here. But a small selection might include Professor Christine Bennett’s MJA review of where we are at with health reform and some thoughts on a new way forward for Medicare from Dr Jeremy Sammut, writing at Business Spectator.  Dr Lesley Russell also penned this piece on sight and hearing – the unseen and unheard issues of this election campaign.

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Roadblocks to good patient care

Disrespect from one doctor to another is a patient care risk, writes Dr Heidi Roman on the KevinMD blog. Outlining some ground rules about how medical professionals need to behave with each other, Roman argues that interpersonal conflict makes interactions about one doctor’s  attitude and another’s  frustration. “The patient is lost,” she says. “And that’s just not okay.”

Another barrier to effective doctor-patient relationships is overzealous hand hygeine, according to Dr Karen Sibert, also writing on KevinMD. Noting that the WHO says use of gloves when not indicated is wasteful and does not reduce disease transmission, Sibert argues that precautionary glove wearing in unnecessary situations discourages normal human contact. “Shake hands when you meet, or take the hand of a frail old lady and just hold it for a moment,” she writes. “If we let gloves or anything else come between us and our patients, everybody loses.”

And Dr Allen Frances writes on the blog that deciding when to end treatment is just as important for the patient as the decision to start it. He says consumers have an important role in combating overdiagnosis. They should be active participants in their care and spend at least as much effort ensuring they  have the right diagnosis as they  would in buying a house.

A different slant on the hot topic of overdiagnosis comes from The Conversation, which examines the relationships between patient advocacy groups and the pharmaceutical industry. Wendy Lipworth and Ian Kerridge say that relationships with pharma may have synergies, but they can also have significant opportunity costs, making it important to ensure that they are disclosed and appropriately managed.

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Adversity, poverty and health

Some fascinating research published in the journal Science, looks at the issue of limits on human “brain bandwidth” in the context of poverty. The findings, reported on in this well-written piece in The Atlantic, show that poverty taxes the brain to such an extent that those experiencing it have limited remaining “bandwidth”  to help their situation. Extra study, searching for employment, or even paying the bills promptly for example, might literally be out of reach.

Poverty is on the rise in Australia, the Australian Council of Social Service claimed during the election campaign. A recent piece on The Conversation, sought to fact check this statement and found that measuring poverty rates is not straightforward. However, “while income poverty rates have remained stable over last decade within Australia’s growing population, the numbers of people experiencing deprivation of the basic opportunities … to participate in society have increased” it concluded.

A report by University of Toronto researchers meanwhile, shows food insecurity is causing almost four million Canadians to struggle to afford adequate amounts of food. The researchers also plan to examine links between incidence of food insecurity and the trajectory of chronic disease and long-term impact on child development.

And UK and French researchers have linked traumatic childhood experiences with an increased risk of early death. Risk of premature death (before age 50) increased by 66% for women who had suffered one traumatic experience by age 16 compared to those who were trauma-free, according to their study published in the European Journal of Epidemiology. It jumped to 80% for those experiencing two or more traumas.

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Addictive substances

The debate over e-cigarettes has gathered pace. In the US, the Food and Drug Administration is investigating the products and refusing their entry onto the market until they have been tested for safety, this article on ajc.com reports. The French Government announced in May, plans to ban e-cigarettes from public places. And more recently a French magazine for the National Consumers’ Institute caused a stir after testing 10 e-cigarette models and finding carcinogens and toxins. The risk could be overblown however, according to this report in The Local, which says the products are not risk-free but safer than regular cigarettes and should be considered as a quit smoking aid.

Tobacco is one of humanity’s great follies, writes Professor Stephen Leeder in an editorial in the AMA magazine Australian Medicine. Describing tobacco as “a good-news story with holes” he mentions the work of many public health giants in this area, including Professor Mike Daube from Curtin University, who says e-cigarettes pose a special hazard because they give tobacco companies an opportunity to circumvent current restrictions on advertising, price and packaging.

If the smoking war has only been partly won, the battle over alcohol is still a skirmish. And alcohol companies are targeting easy pickings, according to this Herald Sun article which describes how social media is being used to capture the underage drinking market. In some positive news, a new study in the MJA shows that risky drinking during pregnancy has dropped, However, the proportion of women who reported high-risk drinking did not change between 2007 and 2011.

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Palliative care – it’s everybody’s business 

You may have noticed a particular focus on palliative care this fortnight, with Croakey’s coverage of the 12th Australian Palliative Care Conference being held in Canberra. You can find the complete conference coverage here.

One of several interesting ideas to emerge from the conference is the notion that health economists have an important role to play in palliative care research to help ensure better use of health resources in end-of-life care. Professor Irene Higginson, Director of the London-based Cicely Saunders Institute, says end-of-life care often does not prolong peoples’ lives, and can be traumatic and expensive.

These comments are timely in light of a new Australian study published in the Journal of Palliative Medicine, which found that cancer patients are less likely to use emergency departments at the end of their lives if they are given early access to community-based palliative care.  

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Hopes, dreams and realities in Indigenous health

There was much discussion and interesting commentary this past fortnight about the 50th anniversary of Dr Martin Luther King’s “I have a Dream” speech. This piece about progress of social injustice and public health in America by former American Public Health Association presidents Dr Barry Levy and Dr Victor Sidel on the Oxford University Press blog is one of them.

But closer to home, Sol Bellear, chairman of the Aboriginal Medical  Service Redfern, took the opportunity to point out that he has a dream too: basic human rights for Aboriginal people. His piece on the NACCHO website is compelling reading. He describes the impact of King’s speech: “That was our moon landing, a feat, until then, considered impossible – the  rallying of people of colour around the globe to stand up against inequality and  injustice”.

And while some gains have been made, he questions why Aboriginal control of Aboriginal lives can work in health and land rights but not in all other aspects of life?

“Why, 50 years after  King’s speech, does the most basic human right – self-determination – still elude my people?” he asks. “Why, today, do we seem further away  from this dream than ever before?”

In a piece for the Australian Financial Review, executive chairman of the Australian Indigenous Chamber of Commerce Warren Mundine says he is tired of hearing that fixing the problems of Indigenous people will take time. It doesn’t have to, he argues – we all know what needs to be done, all we need is commitment and political will.

New ways of reducing the impact of chronic disease in Aboriginal communities will be addressed by a new national research centre based at the University of Adelaide, the ABC reports. The centre will examine how knowledge about chronic disease can best be applied in remote Aboriginal communities and will work collaboratively with NACCHO and the South Australian Health and Medical Research Institute. An issue of particular importance in remote communities has also been highlighted by a new report showing rates of iron deficiency anaemia in Aboriginal children are even higher than originally suspected.

In the ACT, community healthcare was also in the spotlight, with doctors, nurses and midwives at the Winnunga Nimmityjah Aboriginal Health Service in Narrabundah treating patients in tents in protest over what they say is a critical lack of space at the facility.

Getting the word out there on Indigenous health was a topic aired by Croakey this past fortnight as the NACCHO summit took place in Adelaide. This piece by John Thompson-Mills looks at the power of Twitter to disseminate discussions from important forums like the summit. Croakey has filed a number of other reports from the summit. Here are some you may have missed since the last health wrap. This one calls for more action on alcohol, drugs, STIs and HIV prevention, a program to improve the health of mothers and babies in Cape York, the importance of addressing “lateral violence” in Aboriginal communities, and bringing culturally appropriate health messages to communities across the country.

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Public health ponderings 

Are you a public health nerd? The US Centers for Disease Control and Prevention is hoping so. It has launched a campaign to promote careers in public health and, it seems, is hoping to capitalise on nerdiness being cool. Hopefully they have the pitch right – otherwise they risk offending a lot of smart people…

Using Big Data for public health raised it’s head again this fortnight, with a piece in The Conversation using long distance runners who participate in community running events as an example of how collecting data can be used to help people manage their own health and provide big picture information for the rest of us. Deutche Welle also looked at data mining for disease tracking, asking the question, this might be good for public health but does the public actually want it?

Mobile technology in public health also got some airplay. US public health departments have gone all App, according to this piece in TIME, which asks how effective they are likely to be. And this article in CIO says that while some pockets of healthcare have enthusiastically embraced mobile technologies, it is really only just the beginning in terms of realising the transformative benefits of this new way of working.

The collaborators in The Australian Prevention Partnership Centre, launched this week, are also hoping for some transformative change. They have a big-picture plan to reshape how researchers, policy makers and practitioners across the health system work together to tackle chronic disease. The centre has been funded by the NHMRC with co-funding from the Australian National Preventive Health Agency, the NSW Ministry of Health, ACT Health, HCF, and the HCF Research Foundation. It will be managed by the Sax Institute in Sydney in partnership with the Centre of Excellence in Intervention & Prevention Science in Melbourne and it plans to identify what works and what doesn’t in helping people make lifestyle changes to prevent chronic disease. Twenty eight investigators from three states and two territories and researchers from eight universities and research institutes are involved in its work.

The issue of using evidence to best effect has been put on the agenda in New Zealand with a new  report from the government’s chief science advisor Peter Gluckman. He argues that the approach to using scientifically rigorous evidence in recommending, implementing and evaluating new public policies is “highly variable”. And, according to this article from Business Desk, he has recommended appointing chief science advisors to the health, education, business, innovation and employment, transport, and internal affairs departments.

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Why hasn’t mental health improved?

Mental and substance use disorders are the leading cause of nonfatal illness worldwide, new research published in The Lancet says. Researchers from the US and Australia, led by Professor Harvey Whiteford from the University of Queensland, reported that the global disease burden of these disorders is greater than HIV/AIDS, tuberculosis and diabetes.

National Mental Health Commission Chairman Professor Allan Fels meanwhile, has written in The Australian that businesses and the economy more generally are paying too high a price for not paying more attention to mental health. Lost productivity and labour participation due to mental illness is costing $20 billion a year, he says, and is a waste of human potential.

A report from Public Health England looking at the link between screen time and mental health says too much time in front of TV and computer screens is causing increasing psychological problems, such as depression and anxiety, in children. However, a report in The Guardian, says this issue is complex, and needs to be carefully considered.

And in a piece for The Conversation, Professor Anthony Jorm looks at why we seem to be making such little progress on mental health, despite two decades of investment in mental health services. There could be several explanations, he argues, one of which might be that Australia has had a one-pronged approach to mental disorders, when a two-pronged approach is required for effective change.

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Eureka! Some good science news

When so much of the debate about health and science seems to focus on what’s going wrong, the Australian Museum Eureka Prizes are a nice opportunity to celebrate excellence and focus on some of the important gains that have been made. The full list of  this year’s winners can be found on the Australian Museum website. Professor Frank Caruso from the University of Melbourne took out the Leadership in Science Prize and Professor Rob Brooks from UNSW was awarded the prize for Promoting Understanding of Australian Science Research. The science photography prize is a must-see: Rob Wylie’s underwater image of a male Weedy Sea Dragon incubating eggs.

Other Croakey reading you may have missed this fortnight – don’t miss the piece below about Croakey’s new Twitter account @WePublicHealth:

You can find previous editions of the Health Wrap 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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