By Kellie Bisset

Reclaiming the policy debate

Will the national reform summit, planned for next month by peak bodies in the welfare, ageing, business and union sectors, kick Australia’s policy debate into a more sensible sphere? Many would be hoping so and the process will at the very least be very interesting to watch.

The SMH quoted Business Council of Australia chief executive Jennifer Westacott as saying the summit would remind the nation’s political leaders of the value of “people with different histories and viewpoints …[agreeing] on where we want to be as a country.”

“For too long, our politicians have been engaged in bitter personal conflicts, across different parties and within them,” she is quoted as saying.

Michelle Grattan rolled with this theme in her Grattan on Friday column in The Conversation, highlighting that leading bodies, including the Business Council of Australia, have decided to take up the baton and come together in a Climate Change Roundtable to progress a civilised discussion around the progressing climate change related issues. She said our system was being consumed by the “politics of demolition”, which “so outweighs the constructive aspects, all we’re left with is the participants screaming at each other and the public tuning out”.

In her annual federal budget analysis, Dr Lesley Russell said there was a lack of policy thread, and “a failure to realise that health is central to the well-being and wealth of individuals and nations and that wise investment in health systems helps create societal wellbeing and promote equity”.


Some opportunities for health reform

Writing for Croakey and The Conversation, Stephen Duckett and Peter Breadon said the upcoming COAG meeting presented an opportunity for some big-picture approaches to health reform. But they argued that a wholesale shakeup of health responsibilities was not necessary to achieve real gains, Instead, reform in the area of hospital pricing and blended payments for primary care could be effective, they wrote.

Those who live in the world of hospital policy have preventable adverse events and readmissions firmly in their sights as areas where real gains can be made in terms of improving care for patients. Private health insurers are also targeting these areas but in a somewhat different context. The AFR reported on a recent stoush between Medibank Private and Calvary Health Care over who should foot the bill for adverse events and readmissions.  Meanwhile, complaints about private health insurers are on the increase. Fears that gap fees and low levels of cover are pushing people into the public system have prompted the AMA and the Consumers Health Forum to call for a national inquiry into the private health insurance industry, Australian Doctor reported.

The issue of readmissions arising from ‘post-hospital syndrome’ was tackled by this piece on the KevinMD blog How hospitals can kill. Here’s what we can do about it. The article also looked at the issue of delirium in hospitals among elderly patients. Reducing unnecessary diagnostic testing – both hospitals and primary care – is another area ripe for reform, according to to this article in The Conversation, which said encouraging doctors to order less tests was hard – but we should keep on trying.

Doctors’ individual performance reporting was the subject of a Pro Publica investigative piece on patient safety, which made public the complication rates of 17,000 surgeons across the US. Croakey also looked at the issue of performance this past fortnight, with a piece from Jon Wardle on the patient safety case for registering naturopaths.

Meanwhile, primary care reforms that have resulted in Primary Health Networks replacing Medicare Locals may lead to poor outcomes for mental health patients as they wait for the transition to take effect, ABC medical reporter Sophie Scott reported. And Medical Observer reported on a federal government decision to retain its controversial After Hours GP Helpline – but as in a safety net capacity only.

Croakey also highlighted an important aspect of health reform this fortnight – when big, much-needed reforms such as the NDIS are rolled out, how do we avoid them steamrolling existing successes in the race for ‘new’ and ‘innovative’?


Violence, inequity, resilience and love

Professor Kerry Arabena, Chair for Indigenous Health at the University of Melbourne, has helped Croakey mark the importance of NAIDOC week by sharing an oration she recently delivered in Melbourne honour of Alick and Merle Jackomos. It deals with the importance of love in creating connections, champions and ways forward, amongst other things.

Croakey also celebrated another milestone, the incredible success of its #JustJustice crowdsourcing campaign, which saw more than 300 people donate $30,000 to fund a series on the the disproportionate impact over-incarceration has on Australia’s Indigenous communities. As well as individual supporters, the campaign has two premium supporters – Jesuit Social Services, and Frank Meany of One Vision. If you didn’t catch the wrap of the campaign, it makes inspiring reading. The first article in the series is by Darren Parker, a Ngunawal man and PhD candidate at Melbourne law school. This incredibly personal and raw account of violence and racism from within his own family, and the rock of resilience he found in his mother is heartbreaking but a long-read that should not be missed.

Family violence was the biggest reason why 63 out of every 1000 Aboriginal children in Victoria were in out-of-home care compared with five out of every 1000 non-Aboriginal children, State Commissioner for Aboriginal Children and Young People Andrew Jackomos told the Victorian Royal Commission into family violence, The Guardian reported.

The reason for Aboriginal resilience in the face of such overwhelming odds is the subject of a research project being conducted by the Telethon Kids Institute and Aboriginal communities. The researchers said such work would shift research in this area to a strengths rather than deficits approach.

This theme was echoed by Laurie Bamblett, a Wiradjuri man of NSW and adjunct research fellow at ANU, who recently gave a Parliamentary Library National Reconciliation Week Lecture on the term of Aboriginal disadvantage doing more harm than good.

It’s heartening to read about community-led initiatives that take new approaches to engagement and this ABC story reported on one such project – an Aboriginal mens’ camp in Victoria that is hoping to empower young men to improve community health and wellbeing.

In the same fortnight, the SMH reported that if Indigenous Australia was ranked alongside the world’s sovereign states that it would have the 12th highest suicide rate, an appalling statistic that the NT News described as a humanitarian crisis.

“A lot of problems come from a history of mainstream services not including Aboriginal people,” Professor Pat Dudgeon, Mental Health Commissioner and University of WA researcher, told The Guardian.

The Guardian and a number of other media outlets also reported on the House of Representatives Standing Committee report Alcohol: hurting people and harming communities, which recommends fetal alcohol spectrum disorder (FASD) be recognised as a disability for the purposes of welfare payments and educational support.

And as awful as it was to read the comments from former Labor MP Gary Johns about Aboriginal women being used as welfare “cash cows”, this piece from Patricia Karvelas on The Drum is a well argued slap down. Have a read.


The case for defining health and medical research 

Universities are calling on the federal government to adopt a description of medical research so that innovative solutions don’t miss out on funding under the Medical Research Future Fund, The Australian reported (paywalled). “Many non-medical disciplines, including IT, chemistry, physics, engineering and maths all make robust contributions to the medical science, but are not technically medical and health research,” reporter Julie Hare wrote.

It’s an interesting point, particularly in light of the already existing competition for research funds between biomedical research and health services research. The McKeon Review supported the latter as a way to forge a “stronger connection between health and medical research, and the delivery of health-care services”.

And it comes as the government released its National Science and Research Priorities. You can read Chief Scientist Ian Chubb’s summary and a reaction on the health priorities on The Conversation.

Tensions over which research merits public money are playing out in the US, where the House Appropriations Committee has voted to defund the Agency for Healthcare Research & Quality, which generates reports on health services cost and quality, medical practice patterns, care access and outcomes. At the same time, the National Institutes of Health is looking at billions of dollars in extra funding, Politico reported. The article quoted commentators as saying the increase was huge in light of straightened economic times, but the issue of research transcended the political spectrum, particularly when talking about cures for heart disease, cancer and diabetes. The US funding bills will however, also cut services such as  family planning programs in a move the American Public Health Association executive director Dr Georges Benjamin described as “immoral” as they targeted the most disadvantaged.

Closer to home, Croakey reported on the winding up of the Australian Primary Health Care Research Institute (APHCRI), with Deb Turnbull, Chair of the Research Advisory Board, arguing that targeted, priority driven primary health care research, firmly embedded with the key stakeholders groups, i.e. policymakers, consumers and service providers, was too important to leave to the lottery of mainstream academic research funding. However, she flagged that the Department of Health was considering options for investment in future primary health care research as part of a Departmental wide approach to the support of research.

Those interested in the potential for crowdfunding research might like this post on Science Alert about raising public interest in spending money to investigate the genome of the golden mussel, which might say just as much about science communication as it does about crowdfunding.

Meanwhile, Canada has launched its largest health research portal, which will give researchers more opportunities to conduct long-term population health studies and use linked data sets to carry out more comprehensive analyses.


The health-politics nexus

Much has been written about the ethics of the Australian Border Force Act and the restrictions it will place on health workers, making them criminally liable for disclosing any aspects relating to their work with asylum seekers. Croakey also looked at the issue, with this piece from doctors with experience treating asylum seekers on what detention means for the health and wellbeing of these patients.

And in this Croakey post, the pictures told the story, as doctors rallied around the country to protest about the nature of the Act and its erosion of their ability to advocate for their patients.

General practice needs better advocates too if we are to prevent primary care from being eroded, according to Australian Doctor, which took the step of running a front-page editorial attacking professional bodies for their lack of influence and leaving GPs in the political wilderness.

In other example of health and politics intersecting, this piece on Croakey drew attention to the Shenhua Watermark Coal donation to the new Gunnedah Rural Health Centre. It also raises the issue of how much comparable funding the energy sector gives to both the Coalition and Labor.


All things public health 

UK public health spending is under a price attack, with a £2oo million proposed spending cut being criticised as potentially costing the NHS an extra £250 million in extra abortion and maternity services.

British authorities confirmed there was a bird flu outbreak in northwest England but said the public risk was very low. The Philippines has reported its second case of MERS, which the BBC said had now killed 500 people worldwide. Reuters reported meanwhile, that Ebola has not run its course and is still infecting 30 people a week. The news came as an independent panel of public health experts released its assessment of the WHO’s response to the Ebola crisis. This article in The Scientist reported the panel found that the WHO did not possess the capacity or organisational culture to deliver a full emergency public health response.

In the area of climate change and health, this piece in the New York Times looked at the issue in detail and tried to unravel the complexity. And in a related note, this SMH article reported that climate scientists had written to climate skeptic MPs and offered to brief them on what the science said about climate change.

Croakey looked at the issue of environment and health in this post that considers the evidence around what impact housing regeneration might have on health and wellbeing as well as health inequalities. It focuses on work being done in Glasgow, known as “the sick man of Europe”. At the same time, the BBC reported on research showing that children living in the most deprived areas of Wales have a 70% higher death rate than those in the most affluent areas.

US News & World Report revisited the issue of gun control being a public health issue this past fortnight in a piece that is worth a look.

And in the realm of social media, research highlighted in Croakey looks at the effectiveness of social media apps in addressing sexual health issues among men who have sex with men.


Other Croakey reading you may have missed this fortnight:

You can read previous Health Wraps here. Got an idea for The Health Wrap? Contact me on Twitter @medicalmedia.

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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