By Frances Gilham

NSW election news

With a NSW state election coming up in March, discussion of state health policy has started to creep into the news.

SMH journalist Amy Corderoy reported on a public health debate held between NSW Health Minister Jillian Skinner, Labor’s opposition spokesman on health Walt Secord, and Greens’ spokesman John Kaye, writing: “For a debate that was supposed to be about preventative health, there sure was a lot of talk about hospitals.”

According to the article, during the debate Jillian Skinner announced funding for a foetal alcohol disorders specialist unit currently being piloted at Westmead Hospital, and Walt Secord announced that Labor would investigate expanding the Kings Cross alcohol restrictions.

Previously, NSW Labor had been criticised by the Australian Medical Association for its plan to establish four nurse-led walk-in treatment centres modelled on nurse-led clinics introduced in the ACT in 2010, the SMH said.

AMA (NSW) president Saxon Smith was quoted as saying, “there is actually evidence suggesting nurse-led clinics can make the quality of healthcare worse.”

Meanwhile, Jillian Skinner has been working closely to rebuild engagement with doctors, according to this Medical Observer article, which details an agreement between the Health Minister, the NSW branch of the AMA and the Australian Salaried Medical Officers’ Federation, aiming to increase communication between the groups and enhance doctors’ input into health policy.

Alzheimer’s Australia NSW has published its NSW Election Manifesto and the organisation has called for more funding into dementia, with a focus on enhancing quality of life for sufferers and their carers, Fairfax reported.

And while Jillian Skinner has pledged to ban the sale of e-cigarettes and associated liquids to children, the Heart Foundation has called for the government to go further, and apply the same restrictions that apply to cigarettes, banning ‘vaping’ in public spaces, this article said.


Considering the co-payment

The discussion around the future of Medicare, the co-payment and primary care continued.

Federal Health Minister Sussan Ley met key health consumer and community groups in Canberra to kick off consultation, with the Daily Telegraph reporting that the government remains set on bringing in a Medicare co-payment, despite public and backbencher concern.

A series of opinion pieces were published in various news outlets arguing for and against the introduction of a co-payment.

Liberal MP Teresa Gambaro wrote an article for The Australian arguing Medicare as it stands no longer meets Australia’s needs, and that a co-payment should be considered among a range of other suggestions.

Victoria University researcher Rosemary Calder said in the Sydney Morning Herald that a price signal completely misses the point of health reform, and explained why more than one lever would need to be pulled to get the health gains we want.

Adam Stankevicius, CEO of the Consumers Health Forum, wrote a post for Croakey questioning the association of price signals with value.

“Look at the mecca of health price signals, the United States, where health soaks up nearly double Australia’s expenditure in GDP terms,” he wrote.

Croakey also published a piece by Margaret Faux summarising a recent review of medical practitioner Medicare claiming and compliance. In it, she argued that there is little understanding of incorrect claiming and if we are to reform Medicare, we need to examine this topic to ensure internal efficiencies in the system.

Meanwhile, some of the key questions and challenges facing the impending Primary Health Networks were examined at Croakey by Andrew McPherson, CEO of the Grampians Medicare Local.


Alarming new smoking findings, and other research news

The Sax Institute announced that the first large-scale, direct evidence on smoking and mortality in Australia showed up to 1.8 million of our 2.7 million smokers will die from their habit if they continue to smoke.

The news got wide coverage, with stories on the ABC, the Herald Sun and the Sydney Morning Herald.

The Guardian interviewed the president of the Australian Council on Smoking and Health, Mike Daube, who said: “It is time for the Australian government to follow what the US did about 20 years ago and sue the tobacco industry for costs incurred because of smoking, and force them to make internal documents public. That would bring in tens of billions of dollars which would help the budget, and enable stronger action on smoking.”

And Professor Simon Chapman covered the research for The Conversation, explaining there was good and bad news to come from the study.

“The two stand-out results are that up to two-thirds of the deaths in current smokers were due to smoking (the bad news) and that death rates in former smokers who had quit before turning 45 were not different from those in the study who had never smoked (the very welcome news),” he wrote.

Dr Tom Calma AO, National Coordinator, Tackling Indigenous Smoking, wrote for Croakey that the research provides an important reminder that while we have had some significant wins in the war on Aboriginal and Torres Strait Islander smoking rates in recent times, the war has not yet been won.

In other research news, a new study has reignited the fluoride debate. The study linked fluoridated water to increased rates of hypothyroidism, but is highly flawed according to an analysis on The Conversation by a range of experts.

And The Australian published a series of articles looking at medical research in Australia (paywalled).

Andrew Trounsen wrote that 2000 medical researchers could lose their jobs in the next year as government grants failed to keep pace with a rapidly increasing workforce.

In this article, Bob Graham, head of the Victor Chang Cardiac Research Institute, called for a moratorium on five-year research grants, saying that if they continued there would be less funding available for researchers.

And in a third article, Queensland University of Technology health researcher Adrian Barnett said the National Health and Medical Research Council should consider giving a cash prize to institutions with the highest success rates, to encourage fewer but more high quality funding applications.


New approaches needed in Aboriginal health

As the previous Health Wrap detailed, the release of the Closing the Gap report heralded some profoundly disappointing findings.

Paediatrician Professor Michael Gracey wrote that it should now be clear that our approaches to closing the gap over the past thirty years have not worked, and it is time for a new approach.

A series of new reports and research papers have followed the Closing the Gap report.

Research from South Australia found that the death rate for Indigenous Australians between 35 and 54 is six to eight times higher than that of the wider population, with alcohol abuse the main culprit, according to this Guardian piece.

Another report, also reported on in The Guardian, found Indigenous Australians in the Northern Territory who require surgery die an average of 12 years younger than the general population, because they suffer from higher rates of illnesses which make surgical procedures riskier or impossible to perform.

And research conducted by the University of Western Australia and the Heart Foundation found Aboriginal people experiencing their first heart attack or hospitalisation for certain heart conditions were on average 15 to 20 years younger than non-Aboriginal patients, SBS reported.

But it’s not all doom and gloom. In brighter news, the Sydney Morning Herald detailed how an Indigenous midwifery program in NSW is helping break down barriers and provide support for Aboriginal women and their families, especially those with limited support.

According to the article, the provision of antenatal care in a way that emphasises cultural understanding, trust and lack of judgement is resulting in a successful program for Aboriginal families in Sydney’s south-eastern suburbs.


Assorted health policy updates

In other policy news, the SMH reported that the Abbott government was considering abandoning the Australian census and replacing it with a smaller sample survey in the upcoming budget.

Researchers wrote an article on The Conversation that analysed a little-discussed proposal in the last federal budget to increase the level of co-payments for medications.

And Croakey covered a range of health policy issues this fortnight.

Senior health policy analyst and regular contributor “William Fogginwrote about the consultations occurring on reform of the federation, saying the government was yet to make a strong case for federation reform, and that it might be a solution in search of a problem.

Lesley Russell also wrote for Croakey on the subject of health reform, turning the spotlight on specialist fees and how they impact on the health budget.

Justin Coleman ‘the naked doctor’ blogged about the Choosing Wisely campaign, launching in Australia in April. This campaign focuses on cutting down the numbers of unnecessary medical tests and treatment and has been successful in the USA and Canada in reducing non-evidenced based interventions.

“We doctors are pretty comfortable navigating pathways of how to investigate and treat patients, but may have more trepidation taking the route which avoids intervention,” he wrote.

Michelle Hughes wrote about global divestment day, celebrating the success of the movement encouraging divestment from fossil fuels and encouraging others to follow suit, joining those like the Australian group Doctors for the Environment.

And Dr Tim Senior wrote his final Wonky Health column, where he investigated the novel idea of ‘Evidence-Based Voting’ – how does political ideology relate to health outcomes?

“It’s possible – perhaps even likely – that we maximise health outcomes by voting for parties with more redistributive policies and higher spending on health and welfare,” he said.


And finally, a wrap of nutrition and public health news

The US has released its updated dietary guidelines, and The Atlantic investigated what this might mean for the American diet.

Eggs are back, artificial sweeteners are not encouraged, and the time-tested basics – moderation and a focus on fruits, vegetables, and whole grains – are the focus.

Closer to home, the Dietitians Association of Australia (DAA) was under fire for perceived conflicts of interest due to its corporate partnership program and event sponsorship, which involves them working with groups such as Meat and Livestock Australia and Nestle. The article included a response from DAA’s CEO Claire Hewat.

And an article in The Guardian written by nutrition scientist Professor Susan Jebb addressed a similar issue. She wrote to defend her right to work with industry.

“While it is reasonable to start from the position that any association between scientists and industry may indicate a conflict of interest, that is not evidence, it is just a hypothesis,” she wrote.

“As someone who cares passionately about engaging the public in a debate about science, my greatest sadness is that in the absence of evidence, implying that bias exists and that there has been wrongdoing by scientists simply erodes trust and confidence in research and is a disservice to the public.”

The latest instalment of Journal Watch on Croakey explored new health promotion research into how outdoor gyms might benefit the elderly, with some positive results.

And in two other public health-related Croakey articles, time pressure as a social determinant of health was discussed, and Australia’s approach to addressing the global impact of non-communicable diseases was considered.

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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