By Kellie Bisset 

Putting the social determinants of health front and centre

The impact of social disadvantage on healthcare and other important ‘downstream’ factors was a focus of the past fortnight as Australia marked Anti Poverty Week.

This piece on Croakey from Marie McInerney pulls together the findings from Anti Poverty Week research reports as well as a series of films on disadvantage and a host of other relevant documents.

As for developments in the evidence, a recent study in BMC Public Health showed that dropping out of high school early was associated with later illness and disability, even after socioeconomic status was taken into account. You can read The Pump Handle science blog’s take on the study here.

The American Journal of Public Health turned its attention to homelessness, with a special issue focusing on public health efforts in the area. The American Public Health Association’s Public Health Newswire offers this summary.

A feature in The Globe and Mail looks at how Canada might address the problem as it hosts the first National Conference on Ending Homelessness.

And a piece in The Atlantic reports on a recent study published in Proceedings of the National Academy of Sciences, which explores how the stress of childhood poverty affects emotional regulation in adulthood.

The British Medical Association in Scotland meanwhile, says the latest statistics on health inequality mean inequality impact assessments should be carried out across all areas of government policy. Chairman of the BMA in Scotland Dr Brian Keighley told the BBC that inequalities had never been so apparent for those living in the most deprived communities. “No matter how many task forces and inquiries politicians establish they are no substitute for action,” he is quoted as saying.

The WHO also joined the debate about inequality in Britain, with a new report suggesting young people who were not working or studying were a “public health time bomb waiting to happen”.

Inequality is certainly an issue for the US, according to this CNN feature on “the most unequal place in America”, Lake Providence, Louisiana. This is where the difference between the ‘haves’ and the ‘have-nots’ is as obvious as those who live on one side of the lake compared with those unlucky enough to live on the other.

Closer to home, a report from the National Seniors Australia Productive Ageing Centre says older people are struggling to pay for medical care because they are prioritising basic essentials such as food and transport.

This Adelaide Advertiser report from a forum in Adelaide says South Australia could save up to $170 million a year in hospital costs if it invested in a fairer society. But an opinion piece in The Australian rails against the concept of social determinants of health, arguing it is a waste of time and urging Health Minister Peter Dutton to “close the door” to social determinants “lobbyists”.


New solutions urged for Closing the Gap

There is an increasing  recognition that non-Aboriginal people really can’t make Indigenous people healthy, writes Ian Ring, professorial fellow at the Australian Health Services Research Institute at the University of Wollongong.

His piece in The Australian says it is time for Aboriginal communities to play a more central role in the design and conduct of their own services, given some of the best health services in Australia are run by the Aboriginal community controlled sector. This and other key issues need to be considered by the Mundine review, he says.

The Liberal member for the WA seat of Hasluck Ken Wyatt has raised similar concerns, arguing that the new government has to move away from old approaches to funding Indigenous health and education.

Speaking on the 20th anniversary of the release of the Burdekin Report into the human rights of people with mental illness, Dr Tom Calma AO and Professor Pat Dudgeon reflect on Croakey that there have been some important improvements for Aboriginal people but little has changed on the ground. A shorter version of  this article was published in The Australian, which also ran a piece by Anthony Dillon from the University of Western Sydney looking at the issue of Aboriginality and mental health, suggesting culture should not be over-emphasised in determining the mental health needs of Aboriginal people and how they access services.


Problems plaguing health systems

Why can’t all patients have access to data about how their health system and individual doctors perform, asked the Grattan Institute’s Professor Stephen Duckett in a lecture to the Consumers Health Forum? Jennifer Doggett reports on the lecture for Croakey, and highlights the point that if even ‘expert patients’ find the system difficult to negotiate, reform is surely needed.

Jennifer also makes the case for workforce reform, in a separate Croakey piece, which says ensuring Australia has a flexible, skilled and sustainable health workforce is one of the most important challenges facing Health Minister Peter Dutton.

The Primary Healthcare Research and Information Service (PHCRIS) has published a series of policy reviews looking at the challenges for health systems globally. This Croakey summary wraps them up in a neat little package. Fragmented healthcare is highlighted as one issue, but this could be at least partially addressed if we made better use of routinely collected data, according to a report in the Australian Financial Review.

The report quotes the Productivity Commission’s assessment that Australia’s “poor use” of its information databases is likely to come to the attention of Treasurer Joe Hockey’s commission of audit. “A failure to exploit this evidence would be a missed opportunity,” it says.

What impact will repealing the carbon tax have on the health system? This Croakey post urges readers to respond to the calls for public comment on the carbon tax repeal bills. Some have already offered their views, with Fiona Armstrong from the Climate and Health Alliance arguing the health sector and the community are ill prepared for what lies ahead. It’s time for the health community to speak louder in the debate, she says.

On the issue of struggling systems, its important to remember that amid all the sound and fury over website glitches surrounding the new Obamacare Health Insurance Exchange, the big picture of US healthcare reform doesn’t get lost, activist and columnist Sally Kohn writes for CNN.

“You know what’s relatively easy? Fixing a website. You know what’s really hard? Ensuring access to affordable, quality health insurance for every single American and improving our broken health care system in the process, ” she writes.

Articles on the Obamacare issue are ubiquitous but this Guardian article gives an overview for those who’d like to catch up.


All things Public Health

As the American Public Health Association prepared for its 141st Annual meeting in Boston to kick off on 2 November (follow @APHAAnnualMtg and hashtag #APHA13 or visit the conference blog), New Public Health spoke with APHA executive director Dr Georges Benjamin about the conference theme “Think Global Act Local”. More than 10,000 people are expected to attend the event.

The range of public health challenges being grappled with internationally is a stark reminder of the importance of gathering collective public health intelligence.

Reports in the past fortnight give just a taste of the task ahead. Thailand may be facing its worst Dengue epidemic in 20 years, the WHO is concerned about a potential polio epidemic across the Middle East and one in five Chinese adults now has hypertension.

Public Health England is looking at how to best manage the risk of the elderly dying during cold weather. And though its a story on a smaller scale, this piece about the US city of Pevely, Missouri, no longer having enough money to fluoridate its water is an eyebrow raiser.

Chlamydia rates in Australian 12 to 15 year-old girls are at concerning levels, with the disease having been identified as the most frequently reported sexually transmitted infection. (This interesting day-in-the-life feature – Meet the woman who tells your exes they may have an STD – is a nice explanation of why sexual contact tracing is rather more effective when done by a third party.)

But those who oppose the role the public health professionals should play in our lives are still out there shouting loudly. This piece in Spiked attacks public health professionals as “beligerent academics”  espousing an “unchallengeable doctrine” of health at all costs.

Would it help to provide unrelenting reminders about the evidence of benefits led by the public health community? Perhaps not but this article in Vaccine News Daily is good reading anyway. It summarises a piece in the American Journal of Public Health looking at the role played by public health measures in eliminating malaria in the American South during the 1930s. As the WHO reminds us though, there are many more hills to climb when it comes to combating infectious disease. The war against drug-resistant TB needs to be strengthened, it argues, describing the problem as a public health crisis.

The issue of superbugs featured in several media outlets this past fortnight. Two US outlets, Frontline and NPR, offered overviews of the broader issue and The Conversation discussed research in The Lancet showing honey did not show promise as an alternative to antibiotic treatments of wound sites.

If you haven’t already encountered @WePublicHealth, now is the time to have a look. It’s a Croakey initiative to encourage public health flavoured citizen journalism. GP Dr Tim Senior took the chair last week and a selection of his tweets – on Indigenous health, general practice and more – can be found at this Croakey post. This week’s guest tweep is Dr Ewen McPhee.


Time to Quit

Monday is the most popular day to give up smoking, according to a paper published in JAMA Internal Medicine and reported on by NBC. Perhaps this series of photographs on how smoking ages the face among a series of identical twins could be employed as an incentive. The images were part of a study published in the journal Plastic and Reconstructive Surgery. 

A new report from the National Health Performance Authority reminds us that while smoking rates might have decreased overall, there is considerable variation across geographic areas. In a third of all local areas for example, the percentage of adults who smoked daily was as high as 20 per cent.

Some good public health news has emerged from Queensland, with Health Minister Lawrence Springborg considering a plan to extend the power of local councils to ban smoking in public areas such as parks and tourism areas.

And the BMJ has finally banned tobacco-funded research, reversing its earlier position, which was based on an anti-censorship premise. At the time of writing, the US FDA was poised to make a decision on regulating e-cigarettes. This article by Medpage Today says it’s likely that new rules will bring the products under the agency’s authority and request their compliance with age, marketing, and packaging restrictions. In the meantime, individual US jurisdictions are moving ahead with their own laws. In Massachusetts, a bill placing e-cigarettes under the state’s existing tobacco control law is being considered.

An article by Fairfax journalist Julia Medew explores the issue of annual lung cancer screens for heavy smokers. While some believe the move would have a big positive impact, others say a high number of false positives would mean the cost of a screening program would outweigh the benefit.


The darker side of Halloween

Children across the country may well have a sugar hangover this morning after the week’s Halloween festivities, and this article in the MJA asks whether confectionary manufacturers are exploiting an American tradition to peddle junk food to kids.

“Concerns about the celebration of Halloween in Australia should go beyond indignation at multinational corporations imposing a new cultural event,” say the authors, from the University of Melbourne’s Nossal Institute for Global Health. “Evidence is mounting that corporate behaviour involving marketing and distributing of unhealthy commodities is a driver of the growing global non-communicable disease epidemic.”

Celebrities have also been called out this fortnight for their lucrative sponsorship deals to market junk food to their young fans. Health groups attending the Healthy Beverages Summit in Los Angeles called on pop music princess Katy Perry to stop promoting Pepsi and released a video to drive home their point.

UK public health expert Professor John Ashton has also taken aim at Big Food, arguing that recent pledges from manufacturers to cut their saturated fat levels  are a drop in the ocean in the fight against obesity. A voluntary ‘responsibility deal’ signed between industry and government “lacked credibility”, the BBC reported him saying.

Melbourne University Professor of Public Health Rob Moodie had his own things to say about the industry: “These industries are modern-day vectors of disease, just as mosquitoes might be for malaria,” he told the SMH.

In a move that has astonished scientists, the European Food and Safety Agency has approved health claims for fructose-sweetened products. Kerin O’Dea writes for Croakey that the rationale for approval oversimplifies the issue.

According to this story from the ABC’s PM program, the tide may be turning against junk food manufacturers. It looks at a Credit Suisse report warning its clients to prepare for a backlash as the evidence about harms from sugar emerges and calls for action grow louder. However, Mike Daube, Professor of Health Policy at Curtin University, believes obesity is here to stay, writing in the SMH that there is little will from governments of any colour to regulate industry or attempt to solve the problem.


Food fights, and some new numbers to chew on 

An article in the BMJ and a story aired by the ABC’s Catalyst program questioning the role of saturated fat in heart disease has sparked considerable reaction from medical experts. In this article for The Conversation, Sydney University’s Professor David Sullivan, explains why the BMJ piece is flawed. The Catalyst piece has been roundly criticised for putting patient health at risk, with part two of the series also being called into question over the way it presented the evidence on cholesterol lowering drugs, whose benefits it claimed were exaggerated.

“The conclusions presented in the ABC Catalyst program are not supported by the Heart Foundation or the vast majority of the medical and scientific communities  across the country and internationally,” the Heart Foundation said in a statement.

The Conversation also carried a piece from Griffith University’s Professor Ian Hamilton Craig explaining the weight of evidence in favour of cholesterol lowering drugs that underpins current recommendations.

Ever wondered what’s in a chicken nugget? Muscle fat, connective tissue, organ tissue and bone bone fragments according to a paper published in the American Journal of Medicine.

“I was floored. I was astounded,” one of the paper’s authors told The Atlantic about his experience of looking at the nuggets under a microscope. The paper has been criticised by the US National Chicken Council, which said the researchers’ findings were only relevant to the samples they tested rather than the large number of nuggets on the market.

As part of its Healthy Communities series, the National Health Performance Authority has released a report on obesity rates by Medicare Local area. This companion document  to the smoking report mentioned earlier, found the rate of obese or overweight adults varied from 49% in Eastern Sydney to 79% in Western NSW.

Meanwhile, a piece on the UK public policy blog Public Finance, says tackling physical inactivity must be addressed in public health policy making, otherwise the National Health Service will go bankrupt “and our children will not have a health service that is free at the point of use”.

Other Croakey reading you may have missed this fortnight:

You can find previous editions of the Health Wrap here.

If you tweet an article you think might interest Croakey health wrap readers, cc me @medicalmedia or my colleague Melissa Davey @MelissaLDavey.

  • 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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