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Jun 27, 2014

The Health Wrap: Big tobacco arguments; fad diets and pills; fairness, equality and human rights

Big tobacco arguments

This fortnight the plain packaging debate dominated the headlines, sparked by an article published a few weeks ago by The Australian claiming industry figures showed the legislation was failing to cut smoking rates.

The Australian’s figures and motives were questioned by Media Watch, but the newspaper hit back and continued to argue its case, even after the Federal Treasury released data showing that cigarette sales had dropped, according to an SMH article.

Plain packaging legislation was defended by an editorial in The Age newspaper, as well as by the Australian Medical Association (AMA) (reported by Croakey).  NSW Chief Cancer Officer  Professor David Currow also weighed in on the debate.

Professor Rob Moodie said the The Australian’s story was part of Big Tobacco’s strategy to discourage international efforts to implement similar legislation. Professor Nick Talley argued the strategy might backfire, if governments responded to claims that plain packaging was increasing the sales of cheaper cigarettes by raising cigarette taxation.

Internationally , Indonesia is struggling to enforce compliance with its warning labels on cigarette packets, Sky News reported.

UK doctors are pushing for a total ban on cigarettes for anyone born after 2000 according to this article in The Guardian.

And now experts are worried about the new Big Tobacco: as states across the US move to make marijuana legal in different forms, new products are reportedly flooding the market, with legal cannabis markets expected to grow by 64% across the US next year, ABC News reported.

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Forget the fad diets and pills

US celebrity health guru Dr Oz has been scolded by a Senate subcommittee about his promotion of “weight-loss miracles,” The Atlantic reported.

In Australia, a certain weight loss drug is making a comeback according to Ian Musgrave in The Conversation – worryingly, because it was banned in 1938 due to its lethal side effects, he says.

In contrast to other fad diets, gluten free eating – which is essential for people with coeliac disease but is now seeing a wider take-up – seems to be here to say, the New York Times said in an article. The author suggests this is because it addresses multiple concerns – food allergies, digestive health, genetic modification of grain – despite a lack of scientific evidence to support many health claims associated with the diet.

The problem of weight loss fads was discussed in this article on the KevinMD blog; David Katz said we are forever doomed to repeat the follies of dietary history unless we accept that we actually know enough already to eliminate almost all obesity and chronic disease.

Step one: eat more fruits and vegetables. The Sydney Morning Herald reported on a new study that found people who consumed a diet high in fruit, vegetables and certain grains delayed the onset of their first chronic disease.

Focusing less on fad diets, and instead looking at how we can change the food environment to make it easier to eat a healthy, balanced diet is the approach recommended by many experts. And now new Australian research has found introducing a tax based on volume – 20c a litre – on soft drinks and cordials would have greater health gains than a flat sales tax of 20% and be less of a financial burden, the Herald Sun reported.

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Preventing and screening for disease

Australians have one the longest life expectancies in the world but are living with growing levels of lifestyle-induced chronic illness, according to a new report from the Australian Institute of Health and Welfare. In this article, originally published on The Conversation and republished by Croakey, experts provided analysis of the report’s findings.

Australian Policy Online shared a worrying new study that found three quarters of Australians and New Zealanders admitted to hospital with severe heart conditions are not receiving the basic preventive care needed to reduce their chance of future heart attacks.

Only a third of Australians invited to participate in the national bowel cancer screening program returned a sample for analysis, the SMH said in an article reporting on the latest data from the Australian Institute of Health and Welfare.

In other screening-related news, Medical Observer reported on a new study that showed mammography screening programs were associated with a 28% reduction in breast cancer deaths, regardless of whether the women had the screen or not – reigniting the debate about the benefits and harms of screening programs.

And Croakey put out a call for readers to participate in a community jury discussing the system for prostate cancer screening – read more about that here.

A meta-analysis has added to the evidence linking sitting time with poorer health, revealing a statistically significant increased risk of bowel, endometrial and lung cancers associated with the highest levels of sedentary behaviour, Medical Observer said.

There are many reasons for sedentary behaviour, but did you know that hairstyle was a factor? On Croakey, the latest JournalWatch article by Dr Melissa Stoneham looked at one of the lesser-known reasons for avoiding exercise.

And over in the US, a journalist experimented with standing for a month – and although he concluded that a lot of standing is just as bad as a lot of sitting, the experience he had made for an entertaining read.

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Measuring hospitals and health systems

A media release from the COAG Reform Council republished by Croakey showed most states failed to meet targets for elective surgery and hospital emergency departments.

Happily, then, the NSW Budget has delivered additional funding to increase public hospital capacity, although the President of AMA NSW said the increased funding was not enough to make up for Federal cuts, Medical Observer reported.

Just how much funding has the Government cut from hospitals? The ABC’s Fact Check unit tested out Opposition Health spokesperson Catherine King’s claim that the Budget has cut $50 billion from the hospital system – and concluded that in fact, the Government is only cutting $2 billion from hospitals in the forward estimates, and whether or not there will be bigger cuts into the future is impossible to verify.

This article written by  Professor Anne Duggan from the John Hunter Hospital and Luke Slawomirski from the Australian Commission on Safety and Quality in Health Care explores the idea of healthcare variation, analysing the results of a recent discussion paper showing regional variation in the rates of common hospital procedures in 2010-11: they say Australian patients may be getting unnecessary interventions or missing out on needed care depending on where they live or which health services they attend.

Health workforce policy is integral to ensuring our health system has capacity to cope with need. Health Workforce Australia is one of the agencies dismantled by the Federal Budget, and this analysis on the Croakey blog by Professor Simon Willcock examined the agency’s achievements and questions the future of health workforce development in Australia.

In the UK, the National Health Service has launched a site that will let the public compare hospitals in England based on safety indicators, according to this eHealth Insider article – but an expert on safety and quality said collecting and publishing data didn’t necessarily lead to better systems.

And Ambulance Victoria has launched its own real-time big data collection project, the SMH reported. The data will be used to help hospitals prepare for ambulance arrivals in a cheaper, more streamlined way, and will be available to researchers, the article said.

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More analysis on the Budget and primary care

Croakey provided comprehensive coverage on the impact of the Budget on primary healthcare this fortnight.

Professor Anthony Scott suggested an alternative co-payment model – but admitted it was hardly worth it, given the very small savings a co-payment provides compared with other policy options.

Public policy expert John Menadue wrote a thoughtful rebuttal of the co-payment plan on his blog (republished on Croakey here) and said private health insurance did not have a role to play in primary care.

And this post warned that a co-payment may signal a drop in private health insurance coverage – and an eventual collapse in the private health sector.

Adam Stankevicius, CEO of the Consumers Health Forum of Australia, analysed the latest Commonwealth Fund report comparing international health systems, highlighting the report’s finding that nations which are heavily based on private sector/health insurance models do poorly compared to those relying on taxpayer-financed health systems.

And now, in what must be good news to opponents of the co-payment measure, Prime Minister Tony Abbott has signalled that the Government may be open to alternative models, ABC news has reported.

Also on primary care, Jason Therowan, CEO of Barwon Medicare Local gave an eye-witness account of the impending move from Medicare Locals to Primary Health Networks.

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Some interesting Indigenous health reads

The Guardian website reported that a frontline Indigenous services program – the NSW and ACT Aboriginal Legal Service – will no longer receive funding, and the opposition says this decision shows the Government has abandoned its commitment to justice targets in closing the gap.

But Assistant Minister for Health Fiona Nash has announced the National Aboriginal and Torres Strait Islander Health Plan and said it would “recognise the links between health and the key social determinants of education, employment and community safety,” and that the Government was “committed to closing the gap by ending the cycle of disadvantage.”

A special Indigenous Health edition of the MJA is worth checking out. It included a report on the importance of Aboriginal community controlled health services, and an interesting article that suggested journalism can learn from the health industry’s efforts to decolonise healthcare – a message echoed in this Croakey article that explored racism in Australia.

A new program aims to tackle long-term poor health in some Indigenous communities by arming young leaders with knowledge of hygiene, health and bush medicine, SBS reported. The program, called Ngargin Doctors (young doctors) aims to teach young participants to look after themselves with basic lessons like the importance of nose blowing and how to make soap using native plants, the article says.

This Croakey wrap of the NACCHO Summit raises some worrying questions about whether federal funding uncertainty and cutbacks will jeopardise progress in improving Indigenous health.

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Fairness, equality and human rights

In the second edition of Wonky Health, Dr Tim Senior explained how Budget policies that promote inequality are also likely to be harmful for the community’s health.

This article by Shelley Mallett from the Brotherhood of St Laurence looked at the risks young people face in the crowded housing market, and how the Budget might make things even harder for this age group.

Homelessness is also a problem abroad. In Canada, a model of addressing homeless has seen some success for people living with mental illness, this article said. And the homelessness crisis in England has been described as a “perfect storm” by The Guardian.

Also on fairness and the Budget, Dr Helen Schultz wrote an article for Croakey about the impact of the changes on those with severe mental illness, saying these most vulnerable patients would  be hit hardest and would remain among the most disadvantaged members of society.

Professor Nick Talley wrote an opinion piece for The Guardian arguing refugees have a right to healthcare – and doctors have the right to treat them.

And Michelle Hughes provided an update on climate change news for Croakey – with some worrying statistics and warnings, given the likelihood that climate change will have its greatest impact on the most vulnerable members of society.

Professor Caroline de Costa wrote on why NSW abortion law should be decriminalised.

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Stay in touch

If you see news that you are keen to have covered in this fortnightly column, contact me on Twitter via @francesgilham, my colleague Kellie Bisset via @medicalmedia, or use the hashtag #healthwrap.

You can find previous editions of the Health Wrap here.

Frances Gilham is the Digital Communications Manager at the Sax Institute, a non-profit organisation that drives the use of research evidence in health policy and planning. Frances has qualifications in health science and communications, and has previously worked in nutrition and the public sector. She enjoys playing online, and using digital media technologies for conversations about health, health policy, and the importance of evidence.

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