By Kellie Bisset

Copayment confusion 

The prospect of the Abbott Government dumping its controversial copayment policy has been a hot topic of conversation this past fortnight but was all the speculation simply that?

Despite media suggesting the Prime Minister’s office was backing away from the politically charged policy, Fairfax reported Mr Abbott saying this week he was “bemused” by the reports “because that’s never been our position”.

According to The Australian, there was discontent among Cabinet ministers, who were split on how to redraft the policy and unhappy with what they said were mixed messages over its future. And The Guardian reported the Government was considering cutting rebates to GPs as one of a raft of options to address the sustainability of Medicare.

In any case, there was no shortage of advice for the Government on what it should do about the policy. Writing for The Drum, former Howard Government adviser Terry Barnes urged the government to fix the flaws in the policy rather than walk away from it.

However, the Australian Healthcare and Hospitals Association said it was time for the Government to move on. Sustainability was important said AHHA Chief Executive Alison Verhoeven, but not at the expense of primary care. An interesting piece in the Financial Review detailed the AMA’s attempts to negotiate on the issue, reporting its frustration at having been frozen out when so many other important issues, such as prevention, remained undiscussed.

While applauding reports of the copayment’s death, Deakin University’s Michael Vagg called on the Government to clarify urgently what it intended to do with the Medical Research Future Fund should the original funding source disappear. Medical research groups also appeared worried, with reports such as this, suggesting there would be some intense lobbying going on in Canberra in the lead-up to Christmas.

Meanwhile, Croakey offered up some potential notes for copayment eulogy writers from regular contributors GP Dr Tim Senior and MJA Editor Professor Stephen Leeder, who described the policy as a “thought bubble”.

Interestingly, a recently released paper from management consultants Deloitte said that reducing pressure on the overstretched UK National Health Service by putting an extra £72m a year into family doctors and practice nurses could save the system up to £1.9bn by 2020.

And NICE – the UK’s National Institute for Health and Care Excellence – said billions could be saved in health and right across the system if its evidence based approach was applied more broadly to public policy making.


#VicVotes – but what of health policy?

Croakey’s analysis of health policies aired during the Victorian election campaign raised some pertinent questions from people such as Christine Walker from the Chronic Illness Alliance, who pointed out that large sums had been promised for health infrastructure projects but there was little to no discussion about how money might be best spent to better integrate services for patients.

Both Tom Symondson from the Victorian Healthcare Association and the Grattan Institute’s Professor Stephen Duckett called out the fixation on hospital beds, with Symondson arguing all the major parties lacked a clear policy thread on how to reform the system and Duckett making the point that the conversation was so fixated on hospital beds one could be forgiven for thinking they were the key to health.

The Victorian Aboriginal Community Controlled Health Organisation and its key partners called on the incoming Government to introduce a comprehensive Aboriginal Cultural Safety Strategy, Croakey reported. They want to see more clinical placements in Aboriginal community controlled health organisations, more funding for cultural safety training, and importantly, each Aboriginal community adequately resourced with its own community based, locally owned and culturally appropriate primary healthcare facility.

And to put a #VicVotes perspective on the health impacts of climate change, Dr Jo McCubbin argued that neither of the major parties had made any thoughtful environmental policy statements, and medical student Tim Martin wrote that “Running for election without a plan to shut down coal-fired power stations when there are viable clean alternatives isn’t just negligent, it’s madness.”

Speaking about the broader health impacts of climate change, Wonky Health author Dr Tim Senior pointed out that the only way to maintain the extraction and use of fossil fuels is to choose someone and somewhere to sacrifice.


Overcoming Indigenous disadvantage

The Overcoming Indigenous Disadvantage report was released this past fortnight – a comprehensive report on Indigenous wellbeing.

Croakey highlighted the key points, and while the report noted some gains (e.g. overall mortality rates, child mortality rates), it also painted a stark picture of areas where there had been little or no improvement (literacy and numeracy, chronic disease) and areas that had worsened (psychological distress, adult imprisonment).

Moves to close down remote Indigenous communities in WA and SA have prompted an urgent response from the National Congress of Australia’s First Peoples, which has written to Prime Minister Tony Abbott urging him to intervene.  WA Aboriginal organisations urged the Barnett Government “not to turn their people into fringe dwellers” once again, as reported here on Croakey.

The Public Health Advocacy Institute WA is also seeking supporters for an advocacy campaign around the proposed closures.

And this powerful post on Croakey explores the damage that would flow from such a policy decision and a reminder that describing Australia as nothing but bush‘ before 1788 is to deny the vibrant Aboriginal culture and activity of re-white settlement Australia.

Professor Fiona Stanley, meanwhile, has described as “stupidity” the decision to transfer responsibility for 36 Aboriginal-controlled early childhood centres to the states, which could risk their funding. In general Australia needed to scale up its investment in early childhood and parental support to underpin the country’s future prosperity, the SMH reported her as saying.

Also writing in the SMH, Jenna Price addressed the risk of Australia’s welfare policies creating another stolen generation, but she reported that a group of grandmothers are fighting back for the rights of their families.

And Social Justice Commissioner Mick Gooda said Australia was witnessing one of the largest upheavals in Aboriginal and Torres Strait Islander affairs due to large-scale funding cuts and policy changes under the current government. The Guardian reported his comments came as the Australian Human Rights Commission social justice and native title report was tabled in Parliament.  The report showed the adult Indigenous imprisonment rate had increased by 57% between 2000 and 2013, and the rate of juvenile detention remained about 24 times that of non-Indigenous youth.

Croakey reported on the omission of justice targets from the Closing the Gap framework for improving Aboriginal and Torres Strait Islander wellbeing — a move that has been roundly criticised. The connection between incarceration and public health was addressed in this piece in The New York Times. Covering a new report released by the Vera Institute of Justice, it said the public health and criminal justice systems need to find a way to work together if the “epidemic of mass incarceration” is to be stopped.

In news that highlights the positive contribution of Aboriginal people in addressing major health disparities, the NSW Aboriginal Health Awards were held in Sydney. Aboriginal Health and Medical Research Council Chief Executive Sandra Bailey was inducted into the Hall of Fame and Health Minister Jillian Skinner presented awards to recipients in 11 categories whose work was helping to close the gap between the health of Aboriginal and non-Aboriginal people in the state.

The new SBS series First Contact has launched a debate about race relations in Australia. This post from Dr Chelsea Bond suggested White Australia really needed to reframe the questions being asked in this debate.

And in this powerful and passionate piece, Kelly Briggs, said she was not surprised in the least about the racism displayed in the show – it’s something she has experienced as a fact of life as an Aboriginal person living in Australia today.


Family violence finally on the agenda

Writing for Croakey about the inquest into the death of 11-year-old Victorian boy Luke Batty, Dr Chris Atmore said this and other recent tragedies had pushed family violence onto an election campaign agenda “for the first time any of us can remember”.

At the same time, the Lancet published a series of articles on violence against women and girls, which it described as a global problem of epidemic proportions. This article in TIME gives an overview.


Creating better healthcare systems – what collaborations might work?

Exploring synergies between the private and public sectors for better health is the subject of a live tweetchat to be run on Friday 5 December at 12am AEDT (Thursday 4 December, 1-3pm GMT) by The Guardian (#globaldevlive).

The chat will explore such issues as how to tackle the issue of profits over public interest and appropriate accountability measures.

Croakey addressed these issues in the context of Big Food this past fortnight, with a blog post from Cancer Council Victoria CEO Todd Harper calling out the health washing tactics of companies like Coca Cola and arguing that they shouldn’t get to sugar coat their image by aligning themselves with health promoting organisations.

On the other hand, Professor Diane Finegood, CEO of the Michael Smith Foundation for Health Research led an initiative that provided private spaces for Big Food to talk to public health and was surprised by the results.

Addressing The Australian Prevention Partnership Centre’s recent annual forum in Sydney, Professor Finegood said that tackling the complexity of the obesity epidemic would not be achieved by hurling slings and arrows at the food industry.

Collaborating to create healthy, liveable cities is the focus of a paper  published this week in the journal Public Health Research & Practice.

The National Liveability Study, led by Professor Billie Giles-Corti from the University of Melbourne,will measure cities’ liveability using a health lens, creating a set of national indicators that planners can use to create healthy neighbourhoods. It is a national project with buy-in from state and local governments and non-government organisations, and is featured in the first issue of the relaunched journal (formerly the NSW Public Health Bulletin), which has a focus on using systems approaches to address the problem of chronic disease.

On the issue of liveability, this piece in The Conversation looks at the importance of trees and green space generally to our health and wellbeing.

And for more on using systems approaches to tackle large-scale population health issues, this video outlines the work of the Johns Hopkins University’s Global Obesity Prevention Centre.


A mixed bag of #publichealth

In yet another chapter in the Nanny State Chronicles, an opinion piece in Canada’s Globe and Mail concluded that public health practitioners should “stick to their needles” because they had no place having an opinion on taxes, free trade, economic policy or corporate control.

Not a new argument to be sure, but the lovely response on the PLOS Public Health Perspectives blog from Dr Travis Saunders puts some beautiful counter arguments. Another nice response from Dr Ryan Meili can be found at the Huffington Post.

Meanwhile this Australian review of Boston physician Atul  Gawende’s new book Being Mortal is a nice overview of his thoughts on ageing, sickness, death and the role of medicine.

Medical Observer took a look at the issue of health literacy, in its report on the Committee on the Health Care Complaints Commission in NSW. After a year-long enquiry the committee has made a series of recommendations to protect the public against unscientific health and medical claims. And it found that public agencies needed to address a decline in health literacy that had left the public vulnerable to claims from groups such as the anti-vaccination lobby.

Food labelling was a hot topic in the US this past fortnight as the US Food and Drug Administration introduced new laws on point of purchase food labelling that will see calorie information made compulsory on a wide range of foods.Will it work? This New Republic piece takes a look at the issue and concludes it’s at least worth a shot.

Big Tobacco is gearing up its campaign to discredit plain packaging ahead of a Department of Health review of the laws’ effectiveness, The Age reports. For more on the plain packaging issue, a new book by Professor Simon Chapman and Dr Becky Freeman, Removing the Emporer’s Clothes, has just been released and can be downloaded for free here.

The American Public Health Association’s annual general meeting held in New Orleans attracted a large amount of attention on issues from Ebola to alcohol taxes, including 16,000 tweets. You can check out the Twitter activity at #APHA14 or read some of the news coverage here.

The WHO meanwhile, released a report into preventing drowning, a leading killer that takes the lives of 63,000 children worldwide each year. It is the first time the organisation has released a report exclusively on this issue.

And Croakey posted the latest chapter in its Poems on Public Health by Canberra poet Owen Bullock. There are four new pieces and you can check them out here.


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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