By Kellie Bisset

Ebola evidence goes Missing in Action

Ebola continued to dominate health headlines this past fortnight as Western media outlets turned their attention from the disease toll to the appropriate emergency response and the political ramifications of quarantine at home. A key theme in much of the debate was evidence – and the fact that it seemed to have become an ‘inconvenient truth’ ignored by those with other barrows to push.

As the number of new cases appeared to be slowing in hard-hit Liberia, the WHO reported nearly 14,000 total cases in eight countries and nearly 5000 deaths from the disease.

In the West there were false alarms – such as the 18-year-old woman who arrived in Australia from Guinea and was quarantined in Royal Brisbane and Women’s Hospital after developing a fever but tested negative to the disease. And there were confirmed cases, such as New York doctor Craig Spencer, who is recovering from the disease but whose return from Guinea sparked New York and New Jersey politicians to enforce tough new quarantine measures for people returning from  Ebola-affected areas. The move, which was repeated in Chicago, sparked criticism from health workers, who said it was a knee-jerk reaction that ignored the evidence. Reuters reported that a US nurse quarantined under the new rules planned to sue, arguing the quarantine breached her constitutional rights.

As calls to ban flights from Ebola-affected countries got louder, the CDC said such a ban would just make things worse and hamper efforts to control the disease. This strong public stance on the evidence didn’t stop the game of political football however, as Republican members of the US House Energy and Commerce Committee grilled CDC Director Tom Frieden over what they said was an “unacceptable response” to travel restrictions.

Quarantine also reared its head in Australia. University of Sydney academics Grant Hill-Cawthorne  and Adam Kanradt-Scott wrote this piece for The Conversation, reflecting on the potential damage from political interference in public health issues such as this. This strongly worded piece in the Huffington Post also called for an immediate end to politicising Ebola. And this article in The Guardian said the ‘unscientific’ approach to dealing with Ebola issues echoed the unfair stigma surrounding HIV/AIDS in the 1980s. Croakey also looked back on the AIDS panic with this reflection from Hilda Bastian.

As public health experts in the US reported Ebola panic had taken root,  a number of articles looked at the issue of risk and how public health messages should be communicated. The Atlantic examined the psychology of irrational fear – and why we’re more afraid of Ebola than the flu.

US infectious diseases expert Michael Osterholm said telling the truth, even when you didn’t know the answer, was the best way to avoid unnecessarily scaring the general public. New York City Health Commissioner Dr Mary Travis Bassett  earned praise for her calm approach to the news that Ebola had reached the city, and highlighted the important communications role public health officials play in times like these.

Australia appointed its own ‘Ebola tsar’, Professor Lyn Gilbert, to lead the public health response, the ABC reported. Professor Gilbert is an expert in infectious diseases at the University of Sydney and will assess and possibly overhaul infection control in Australian hospitals.

Meanwhile, the SMH reported that NSW Health Minister Jillian Skinner amended the Public Health Act to allow people suspected of being infected to be directed to undergo a medical examination. It also ran a story suggesting that some experts feared the local threat from the disease may have been underplayed.

Australia’s lack of response to the crisis has been criticised by public health groups such as the Australian Medical Association (AMA), Public Health Association of Australia (PHAA) and the Nursing and Midwifery Federation, Croakey reported. And former AMA president and Liberal candidate in last year’s federal election, Dr Bill Glasson, added to the chorus of voices calling on the government to send a medical aid  team to West Africa. Deputy Opposition Leader Tanya Plibersek confirmed Australian health workers would have access to a US field hospital if they became ill after she met with senior US Government officials, SBS reported.

Visiting Professor Larry Hollingworth, from the Institute of International Humanitarian Affairs at Fordham University, New York, also penned an open letter, on why sending Australian health teams to West Africa can make an important difference.

A piece by Sam Byfield from the Nossal Institute for Global Health, also posted on Croakey, looked at the factors behind the inadequate global response to the epidemic. And the WHO itself said it would publish a full report into its handling of the epidemic once things were under control.


Aboriginal Health: creating parity

The substandard state of Indigenous housing was highlighted by Croakey this past fortnight, with a report from the CRANAplus conference quoting architect Paul Pholeros saying the state of Indigenous housing was a disgrace, with Aboriginal people themselves being blamed for the state of their houses rather than the shoddy workmanship behind many of the problems.

Meanwhile the Australian Indigenous Doctors Association (AIDA) held its 2014 conference in Melbourne, and Marie McInerney reported on the highlights. Health workers are also telling their stories in a new three-part documentary series on NITV called I Heart My People. Some of their stories are outlined in this Croakey post.

The Royal Australian and New Zealand College of Physicians released new resources for Aboriginal and Torres Strait Islander mental health and, in the ACT, the Canberra Times reported on the role sport can play in raising awareness of Indigenous suicide.

As BHP Billiton donated $20 million to the Telethon Kids Institute, $5 million of which will be earmarked for Aboriginal projects in the Pilbara, the Centre for Aboriginal Economic Policy Research at ANU released a new report – Academic Perspectives on the Forrest Review: Creating parity. 


The cost of obesity 

As more Australian children opted to celebrate Halloween, conversations in the US turned once more to the holiday being a golden opportunity for the junk food industry. The usual attack on the Halloween food police was launched, but some more thoughtful discussion could be found at The Washington Post, which published this considered article on why the consequences of America’s obsession with candy could no longer be ignored.

Australians have their own problems with overweight and obesity, as new research from the Sax Institute’s 45 and Up Study revealed. Researchers looked at the hospital records of more than 200,000 people participating in the study and found that one in every six days in Australian hospitals is related to overweight and obesity among the over-45s – at a cost of $4 billion a year. They also found a direct association with increases in body mass index, chance of being admitted to hospital, number of days spent there, and cost to the system. This SMH article gives a good overview.

According to Dr Steve Wilson, as reported in 6minutes, Australia should follow the US and classify obesity as a disease. Though on the upside, it seems our practice of daylight saving may be acting as a form of harm minimisation. New research from the UK showed that kids’ physical activity was up to 20% higher during daylight savings time. The researchers looked at activity levels in children from nine countries, including Australia.

In terms of biological ageing, drinking sugary drinks could be as bad for your body as smoking, according to research published in the American Journal of Public Health. And energy drinks are the cause of an increasing number of emergency department admissions, Medical News Today reported.

This piece in Time looked at what works in achieving cut-through when it comes to getting teens to cut down or stop drinking soda. And Diabetes Insider reported that overweight crash test dummies are now being trialled because obese people are at a higher risk of getting injured or dying in crashes.

As The Conversation explored the link between non-communicable diseases such as obesity, cancer and mental health problems, research from Vanderbuilt University showed that women who were overweight were more likely to be in low-paying, strenuous jobs, compared with women who were average in size. The same impact was not found for men.


All things #Auspol 

The Federal Government announced it would scrap its rural classification system – a move welcomed by doctors’ groups as a victory for common sense. Doctors have long thought the system – and the way it determines which doctors get incentive payments to practice in the bush and which don’t – as unfair. claimed the decision was a victory for The Daily Telegraph, which has been campaigning on the issue.

However, just days earlier the National Rural Health Alliance (NRHA) warned that the Government’s policy on university fee deregulation would hamper efforts to get doctors to practice in rural, regional and remote areas. You can read their perspective in this Croakey post.

The NRHA is also concerned about the downstream effects on rural communities of the transition from Medicare Locals to Primary Health Networks. The NHRA’s Lesley Barclay and Dane Morling argued on Croakey it was important that hard-won gains in rural Australia as a result of Medicare Locals did not get lost in translation.

Other concerns raised this fortnight were directed towards the latest Australia-US Free Trade Agreement. Luigi Palombi, from Murdoch University looked at what this might mean for health in an article for The Conversation. And Green Left Weekly reported that 200 people gathered in Sydney’s Martin Place for a Hands Off  Medicare rally to protest the federal government’s GP co-payment.

The impact of our ageing population on the economy was the subject of a speech from Reserve Bank of Australia Assistant Governor Chris Kent. All would be well economically, he said,  as long as everyone worked a bit longer, Business Insider Australia reported.

In this fascinating extract carried by The Mandarin, former head of the Department of Prime Minister and Cabinet Peter Shergold offered insights into the effectiveness of the public service and whether it had become politicised.

Tributes to Gough Whitlam, a giant of Australian politics, flowed this past fortnight after  the former Prime Minister died, aged 98. Croakey and The Conversation carried this overview of his legacy. Croakey also posted this tribute from John Menadue, who knew Whitlam for 50 years and described him as “the most exciting and challenging public person I have met”.


Investing in our kids

A new report from UNICEF showed that 2.6 million children have sunk below the poverty line in the world’s most affluent countries since the global financial crisis hit in 2008. The report said that while Australian children had been shielded from the worse impact, 13% still live below the poverty line.

The Reporting on Health blog discussed a growing awareness in the US of the impact social determinants play in the trajectories of children’s lives, and quoted research showing children in low-income families hear 30 million fewer words than those born into well-off families.

This piece from the Huffington Post, meanwhile, looked at gender equity and the impact it has on the health of women and girls. And in Scotland, the BBC reported that while the gap between the health of the richest and poorest Scots is still stark, some gains have been made.

And this past fortnight Croakey addressed the issue of why the pathway to change on social determinants of health is so elusive for governments, and discussed the importance of addressing social and emotional wellbeing in a child’s early years.


Around the traps 

This one was too good to ignore. US tobacco company Reynolds has noted the irony in banning smoking from its company offices in the interests of workplace health and safety.

And here’s an  example of taking health messages to the masses. This UK scientist decided to film herself overdosing on 50 homeopathic sleeping pills. Unsurprisingly, nothing happened…

The last word goes to Dr Joshua M. Sharfstein who gave this keynote address to the conference Public Health in the Shadow of the First Amendment, where he was at pains to dispel the myth that public health professionals are a bunch of dour and humourless killjoys.


Other Croakey reading you may have missed this fortnight:

You can find previous editions of the Health Wrap here.

Contact me on Twitter @medicalmedia or my colleague Frances Gilham @FrancesGilham with story ideas for the Health Wrap.

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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