By Kellie Bisset

On Closing the Gap

This fortnight, we learned that Australia’s progress in closing the gap on Indigenous disadvantage was, in the words of the Prime Minister, “profoundly disappointing”. The release of the Closing the Gap report, which showed targets on life expectancy, early childhood access, reading and numeracy and employment have remained unmet, drew widespread criticism and much commentary about the factors at the heart of such an abysmal result.

However, the report also showed progress in some key areas: the target of halving the gap in mortality rates for Indigenous children under five within a decade is on track, as is the target for increasing attainment of Year 12 or equivalent.

The Guardian reported the Prime Minister’s speech on the issue had prompted some Indigenous leaders who had attended Parliament to consider walking out , and some Coalition MPs did walk out of the chamber in response to Opposition Leader Bill Shorten’s reference to the impact the Government’s $500 million in cuts to Aboriginal services had had on efforts to improve the lives of Indigenous Australians.

In a piece for The Australian, social affairs writer Rick Morton said the fact that past investments had failed to deliver, wasn’t just about the money, pointing to the lack of self-determination embedded in policies as a factor in the failure. “The gap is not just a device; it is suffering,” he wrote.

The report’s release coincided with the seventh anniversary of the national apology to members of the Stolen Generations. The ABC reported the news had marred the apology anniversary and ahead of the report’s announcement, Croakey ran a piece from Healing Foundation CEO Richard Weston, which pointed out that many of the recommendations from the Bringing Them Home report still had not been implemented.

Meanwhile, the strength, resilience and courage of members of the Stolen Generations was on full display at a Healing Foundation forum and webinar held in Canberra last week, Telling Our Stories.

Around the same time, the Senate was conducting a hearing on Indigenous health. An AAP story carried by several media outlets highlighted the fact that no Coalition senators had attended.

In a piece for Croakey, Marie McInerney reported on the growing pressure to include justice targets to the nation’s Closing the Gap strategy. Her piece also contains a round-up of reaction on the report.

An Age editorial said the country had failed its First Peoples, and every comfortable Australian should be ashamed at the entrenched disadvantage faced by Indigenous people. Hear hear.

For an international perspective on deep-rooted discrimination, this piece in Canada’s Globe and Mail ‘Put an end to racism in the ER’ is worth a read.

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Persistent policy pickles

The Senate Select Committee on Health provided some interesting insights on health policy earlier this month. It heard that the Department of Health had not conducted in-depth analysis on the impact of the Government’s Medicare co-payment policy, and it heard from GPs about the lack of consultation before the policy was announced. Croakey highlighted the appearance of RACGP president Dr Frank Jones, whose simple message ‘countries with a strong primary healthcare system have better outcomes’ could not have been more eloquently put.

As for the fate of the co-payment, doctors groups have told the government to go back to the drawing board on the policy. But Health Minister Susan Ley said in a statement that her conversations on Medicare policy were ongoing, rejecting claims from doctors she had set a deadline for them to respond.

Federal MP Mal Brough weighed into the debate, telling an audience of doctors that the co-payment should be taken off the table full-stop because it didn’t make economic or health sense. And whether the Government still supported the co-payment in the wake of the Liberal party room spill motion was the subject of confusion.

In its pre-Budget submission, the Australian Healthcare and Hospitals Association said the Government should focus on cutting waste and unnecessary services rather than focusing on price signals and cutting spending.

And in a piece cross posted on Croakey from his blog, John Menadue discussed in the second of a three-part series on health reform, why reform is so difficult. He contends that consultation conducted with those inside the system – such as doctors or pharmacists – will not result in meaningful change, as these vested interests are concerned with preserving their own status quo. The first and third installments are worth reading too.

Professor John Dwyer has his own thoughts on what reform might look like – and he has also outlined these on John Menadue’s blog, Pearls and Irritations.

In a series of articles on health policy, The Conversation asked: what should health policy look like in 2015? And, given the government’s focus on the sustainability of  Medicare, it examined the notion of sustainability and what a sustainable health system actually looks like. It also looked at some common healthcare myths, including the notion that public healthcare is unaffordable.

And, with some interesting implications for policy, this article on community juries shows the difference in views on prostate cancer screening when men are presented with high-quality information.

In other important policy news, the Human Rights Commission report on Children in detention shone a light on existing detention policies and attracted many critics of government policy on immigration detention, including former Prime Minister Malcolm Fraser as Croakey reported.

But Prime Minister Tony Abbott attacked the Commission’s report as blatantly political and partisan, saying the best way to address the issues with asylum seeker detention was to “stop the boats”.

The PM’s address to the National Press Club raised a few eyebrows for its lack of references to public health or Indigenous health, as Croakey co-ordinator Melissa Sweet pointed out.

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The US vaccine debate: some lessons for communicating immunisation messages

An extensive vaccination debate in the US following record measles infection rates and a recent outbreak linked to California’s Disneyland has led to many articles exploring the issue of getting through to those who are anti-vaccination.

Unfortunate comments from New Jersey Governor Chris Christie and Kentucky Senator Rand Paul pushed even more heat into the debate and this Politico article gave an overview of how vaccine politics was thrown into the spotlight.

The New York Post offered some free advice to politicians – don’t jump into the middle of an issue that shouldn’t be an issue. And another Politico piece argued it was critical for the nation’s health that vaccination did not become a political football.

The Washington Post ran a piece suggesting that anti-vaxxers could not always be easily dismissed as irrational, on the contrary, it said they were highly rational people who were really antisocial NIMBYs leveraging off the community-minded spirit of the rest of us. Who are these people really? A Pew Research Centre Report released during the height of the debate said they were more likely to be younger parents who believed vaccination was a parental choice rather than a community obligation.

In a bid to challenge these views, PublicHealth.org released a guide debunking vaccine myths. And Californian public health officials have had to issue warnings to parents urging them not to throw ‘measles parties’ which are based on the misconception that catching the disease will confer stronger natural immunity on kids.

An article in Canada’s National Post said that vaccine skeptics were merely a symptom of a broader problem: the rise of the “health truther” – people who are skeptical of mainstream science and ‘impervious to worldly arguments’ because their skepticism is a form of religion. Canada has had its own measles outbreak in Toronto, which led Health Minister Rona Amrose to urge parents refusing to vaccinate that they had a responsibility to their community.

This piece in Beacon News suggested it might be too late or hard to even try to persuade those with entrenched views and rather, focus on those who are ‘vaccine hesistant’ who may be more open to balanced information. However, this blog from a former anti-vaxxer makes a very interesting read – it details how she eventually came to see the movement as a conspiracy theory cult. Only last month, anti-vaccination campaginer Dr Sherri Tenpenny cancelled her Australian tour, citing security concerns from “pro-vaccine extremists”.

What might be the impact of personal pleas? ScienceAlert reminded us of Roald Dahl’s powerful argument for vaccination, republishing in 1988 letter – urging parents to vaccinate their children.

Closer to home, NSW mother Wendy Holborow recently shared her terrible family story – the death of her 10-year-old daughter Lisa from measles complications in a bid to convince parents not to to take the gamble of failing to vaccinate. She had contracted the disease as a baby, grown into a seemingly healthy young girl and at 10 was diagnosed with subacute sclerosing panencephalitis (SSPE) which eventually killed her.

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Wind farms – more research on the cards

A major review on wind farms and health led by Professor Bruce Armstrong has concluded there is no consistent evidence that they make people sick, but the NHMRC has agreed to fund more research into the issue because the existing evidence is not good enough.

This news raised the ire of Greens Senator Richard Di Natale, who said the research was not a good use of taxpayer dollars and asked whether the NHMRC would also be funding research into chemtrails and alien abductions.

Professor Simon Chapmanalso questioned the decision, writing in The Conversation that it would be wrong if funding for the research was being diverted from other under-researched health areas. However, outgoing NHMRC CEO Professor Warwick Anderson (who will be succeeded by Professor Anne Kelso  in April) said the level of public concern over wind farms meant it was important to conduct high-quality research to determine whether there was clear evidence of a link between turbines and symptoms.

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Food, funding and fighting obesity

The big food news this fortnight was a much discussed BMJ investigation highlighting financial links between sugar industry and key UK public health experts. Commenting on the investigation, BMJ acting head of research Elizabeth Loder said the sugar industry was “using methods that seem borrowed wholesale from the pharma playbook”. The investigation received widespread coverage, prompting experts at the centre of the storm to issue a detailed rebuttal of the accusations.

The issue of cholesterol was back on the table as the US Dietary Guidelines Advisory Committee announced it would remove cholesterol as a ‘nutrient of concern’ in its next version of the guidelines. It didn’t however, change its position on the need to avoid high blood levels of bad cholesterol.

And a paper in the BMJ journal Open Heart found that the original dietary guidelines on saturated fat were not backed by solid evidence, calling for a review. However, experts suggested it would be a mistake to change current advice and rejected suggestions people should be reaching for the butter.

A paper in The Lancet Diabetes & Endocrinology addressed the difficulty of addressing the problem of obesity with diet and exercise, arguing that it should be regarded as a treatment-resistant disease. That’s a clinical view. This article in Scientific American looked at the problem from a public health perspective, and argued that rather than targeting obesity as a whole, we might have more success if we targeted more measurable things like reducing soft drink consumption.

On the other end of the spectrum, this piece in The Conversation tackled the significant problem of under-nutrition, particularly among Australia’s elderly population.

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Ebola – it’s not over yet

As the US announced it would withdraw its troops from the fight against Ebola in West Africa, this piece in the New York Times said public health officials were nowhere near close to announcing the outbreak was over.

Croakey coverage of Greens Senator Richard Di Natale’s visit to Liberia and Sierra Leone also makes sobering reading. Senator Di Natale said the death toll did not do justice to the impact of Ebola, which he said was “not a natural disaster, it is a disease fostered by poverty”.

Another worthwhile read on the Health Affairs Blog by Professor George Anas looks at what Ebola teaches us about public health in America and the importance of basing public health messages on science, not fear.

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A big list of Croakey reading if you missed it since the December Health Wrap:

You can find previous editions of the Health Wrap here.

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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