By Frances Gilham

Striving for holistic health systems

Conversations about Australia’s health system continued this fortnight, with the Australian Healthcare and Hospitals Association holding an ‘Integrated Care Simulation’, gathering 85 health leaders to workshop major health policy initiatives.

Croakey reported on the event, saying a key theme that emerged from the role-playing exercise was the disconnect between different parts of the health system in Australia.

The site also published a report by Mark Metherell, who concluded that integrated care doesn’t come easily in Australia, even in a simulated environment where participants can think outside the box.

An article published by the UK’s Conversation suggested ‘lean thinking’ methods are questionable for the health system, and argued that any savings are likely to be modest, despite high-profile success stories and enthusiastic proponents.

Yet more evidence has emerged about the cost-effectiveness of general practice, with researchers who looked at data from the BEACH survey writing for Croakey that our GPs are treating more patients, for longer and for more conditions – costing our healthcare system far less than a specialist or an emergency department would.

And recent research from the Sax Institute’s 45 and Up Study supports this, finding patients with diabetes have a one-third lower rate of hospitalisation if they receive regular diabetes-related care from their GP.

On the cost efficiency – or not – of our health system, an interesting article by Australian researchers was published by The Conversation explaining the concept of patent ‘evergreening’ – a strategy pharmaceutical companies use to keep the cost of medicines (and their profits) high.

And Federal Opposition Shadow Ministers Catherine King and Andrew Leigh wrote on Croakey about why the Government needs to keep its veto power over private health premium rises to ensure they remain affordable for Australian families.

One way suggested regularly as a way to decrease health spending is to ensure that medical tests and treatments are evidence-based, effective and cost-effective, an aim that the new ‘Choosing Wisely’ Australian campaign wants to achieve, according to an article in Medical Observer.

Experts are worried about the decision by the Australian Health Workforce Ministerial Council to defer the inclusion of paramedics on the Australian Health Practitioner register, with lawyer Ruth Townsend writing for Croakey about the implications for clinical standards, patient safety and workforce needs.

And Professor Caroline de Costa from James Cook University also wrote for Croakey about another important legal issue: the debate in NSW parliament about decriminalising abortion in the state.

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Mental health matters

Mental health laws were also being debated this fortnight, with experts saying the changes to the Mental Health Act in NSW were not enough to protect patients, the SMH reported.

Martin Laverty, CEO of the Royal Flying Doctor Service of Australia, also wrote an opinion piece in the SMH arguing for an expansion of mental health services in remote Australia. He said large numbers of bush residents were missing out on care and not completing treatment plans.

Croakey covered a range of other mental health-related topics this fortnight.

UnitingCare ReGen CEO Laurence Alvis wrote about the importance of considering what actually works in creating online interventions to support people with mental illness, and the problems with ‘gimmicky’ apps that don’t do much more than create publicity for their inventors.

Dr Melissa Stoneham wrote about recent research exploring the Men’s Shed movement, and how they are making positive impacts on men’s health in Australia and globally.

And regular Croakey contributor Marie McInerney covered the latest report from the UN’s Intergovernmental Panel on Climate Change, and also posted a report from Dr Mark Braidwood about how climate change will affect mental wellbeing as well as physical health.

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Aboriginal health

Mental health issues facing our Aboriginal and Torres Strait Islander peoples were under discussion this fortnight, with The Australian reporting that mainstream suicide-prevention organisations were failing to address the ‘rising epidemic’ of Indigenous suicide, with Aboriginal health workers saying local groups were isolated from funding and service delivery.

A report was released as part of the ‘Close the Gap’ initiative, which said mental health services for Aboriginal Australians were inadequate and inappropriate, according to an article on ABC’s website.

Researchers from La Trobe University wrote an opinion piece for The Conversation arguing that nutrition was key to closing the Aboriginal life expectancy gap, and that this policy area was being sorely neglected.

Ross Gittins also addressed this in a detailed analysis of the economics of why, despite the money we are spending on ‘closing the gap’, we aren’t making much headway. He said we need to look at what works to ensure taxpayers’ dollars are being spent effectively.

The National Rural Health Alliance said in a Croakey piece that Aboriginal Community Controlled Health Organisations need more funding security if Australia is to keep up with any gains made in Indigenous health outcomes, saying this is particularly important for programs with long lead times (such as smoking cessation programs).

In happier news, the University of Queensland announced it will open a new research centre, thanks to the philanthropy of Greg Poche, which aims to improve Aboriginal health via a research program that will work collaboratively with Indigenous community organisations and health providers.

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The complexity of drug control policy

Prescription drug overdoses in the US place a substantial burden on hospitals and the economy, according to a new study of emergency room visits reported on by the LA Times.

The policy implications are complex and the answer won’t be simple, demonstrated by what happened after the latest crackdown on abuse of prescription painkillers in the US: a new epidemic has been slowly emerging, according to an article in The Atlantic.

Heroin use is increasing, as opioid addicts go in search of a cheaper, more accessible high, the article said.

An editorial in the UK’s Guardian has examined the results of a study comparing global drug control policies, which found no evidence of a direct link between the harshness of penalties and the number of drug users in a country.

This suggested different cultures and social pressures may be a bigger influence than government policy, the editorial said, indicating it was time for drug policy reform.

Australian academic Desmond Manderson responded to the report for The Conversation  with a fascinating examination of the ‘illegality’ of drugs, and why it continues despite the lack of evidence, encompassing ideas about racism, social anxieties, faith and fear.

And The Australian reported that Assistant Minister for Health Senator Fiona Nash had requested evidence about the growth in methamphetamine (‘ice’) use in regional and rural communities in Australia, with the Government planning a response to the epidemic.

Ernest Hunter, a medical practitioner from Cape York, reflected on ice use in remote Aboriginal communities such as his, and said while it’s not here yet – it’s coming.

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Healthy lifestyles: who is responsible?

NPR reported on the first soda tax to be passed in the US, with voters in Berkeley, California, passing the measure aimed at reducing the effects of sugar consumption on health, particularly increased rates of obesity and diabetes.

This type of community measure to tackle obesity aligns with how Americans are starting to view the condition, with Newswise reporting on a survey that showed perspectives were shifting from viewing obesity as a personal problem of poor individual choices, to seeing it as a shared community issue of risks related to food and inactivity.

At the other end of the spectrum, bbc.com reported on a pilot program showing promising results for obese children in Denmark, that involves extensive testing and changes to all aspects of the children’s lives.

And the Washington Post reported on a study in Lancet Diabetes & Endocrinology that found bariatric surgery could cut the risk of developing type 2 diabetes in people who are obese by 80%.

Professor Sandra Jones wrote an opinion piece for The Conversation exploring the launch of Coca-Cola’s newest product, due to hit the Australian market in 2015.

“Strongly promoted as “healthy” Coke elsewhere, Coca-Cola Life may do more to improve the company’s finances than the health of its consumers,” she said.

And with the G20 Leaders’ Summit in Brisbane in November, Croakey published slides by Professor Fran Baum outlining the three “best buys” for health equity, given as a five minute presentation at a pre-G20 thought-leadership forum.

Other articles on Croakey you might have missed:

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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