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Jul 14, 2015


Mark Lawrence and Christina Pollard write: The government has started the second phase of its awareness campaign for Australia’s year-old health star food-rating system. The A$2.1 million campaign is aimed at educating grocery buyers about how to shop for healthy food and encouraging the food industry to adopt […] Continue reading “A year on, Australia’s health star food-rating system is showing cracks”









By Kellie Bisset

RIP copayment

As Prime Minister Tony Abbott ended ongoing criticisms of the government’s GP copayment proposal by  declaring it “dead, buried and cremated”, health groups warned that the sting might just be in the tail. A Medicare rebate freeze until 2018 might save $1.3 billion but it would have negative consequences they said, including increasing out-of-pocket costs for patients as GPs were forced to increase their fees to keep pace with inflation.

Health Minister Susan Ley said the government had listened to the people who had made it clear they did not support the reform, the SMH said. And the AFR and ABC reported her flagging other potential funding models such as lump sum payments for doctors covering episodes of care and removing restrictions on bulk billing doctors from charging their own gap payments. The story even made the Wall Street Journal (paywalled).

The SMH reported a Cabinet leak suggesting the PM had made a veiled rebuke of former Health Minister Peter Dutton, saying the copayment issue had been mishandled. But a spokesperson for Mr Abbott’s office said that suggestion was inaccurate.

In the commentary that followed, further discussion was had around whether in fact there really was a Medicare sustainability crisis – a premise used to justify the need for the policy. This piece in The Age says not, arguing that far from being unsustainable, Medicare costs have remained remarkably stable. The Conversation conducted a fact check on the issue, and found that while spending on Medicare had doubled in the past decade as Susan Ley suggests, the message had been framed in such a way that overstated the impression of rising healthcare expenditure because the costs had not been deflated.

Writing for Croakey, Dr Tim Senior said that if anyone wanted to talk about increasing healthcare costs, they need look no further than the cost of private health insurance, for which the government recently approved a 6.2% increase. And this article from Amanda Biggs from the Parliamentary Library, republished on Croakey, looked at the policy implications of introducing private health insurance into primary healthcare.

Terry Barnes, who wrote the thinktank paper that re-ignited the copayment concept, wrote in the SMH that a debate was still needed on Medicare reform but it should be held in a depoliticised framework. Perhaps Croakey could offer a pot of gold for anyone who can make that happen?

For anyone who wants to revisit the chain of events, The Conversation produced this handy timeline. And for a handy dose of irony, try this Reuters story reporting on the French Government’s attempt to increase low-income earners’ access to doctors, but being attacked by elements of the medical profession concerned about the impact it would have on their fees.


Choice vs culture

Prime Minister Tony Abbott’s comments this week around the merits of funding services for Indigenous Australians who made the “lifestyle choice” of living in remote communities caused much discussion and attracted strong criticism.

Croakey’s compilation of coverage included statements from a number of key bodies, including NACCHO, whose chairperson Matthew Cooke said : “Time and again we see evidence showing that when you remove Aboriginal people from their land, they lose their sense of identity which has profound impacts on their health and wellbeing.”

And this from Public Health Association of Australia CEO Michael Moore: “If governments are seeking to save money by closing remote communities they are wrong.  The legacy of ill-health and social problems will be vastly more expensive to deal with than the current costs of providing vital services.”

Writing in The Age, Pat Dodson said the remarks meant the PM “didn’t get it” and highlighted the critical need for “Aboriginal values, priorities and concerns to be better understood by the whole nation, and by our leaders in particular”.

Fred Chaney, former Fraser Government Minister for Aboriginal Affairs, was quoted in The Australian (paywalled) as saying that taking Aboriginal people off country in the 1960s was socially catastrophic and the government could not wipe its hands of responsibility in policies like these.

The Government’s chief adviser on Indigenous Affairs, Warren Mundine, said it was wrong to equate thousands of years of connection to the land with a ‘sea change’ or retirement move.

On RN Drive, Cape York Indigenous leader Noel Pearson said the comments lacked historical perspective and reflected the ‘dismal’ state of national Indigenous policy. And Croakey coordinator Melissa Sweet called on researchers to document the health impacts of chaos in Indigenous affairs policy, which she said was impacting the wellbeing of individuals and communities. Concerns about the process and outcomes of the Indigenous Advancement Strategy led to a Twitter hashtag #IASLottery.

WA Premier Colin Barnett, whose government plans to close up to 150 of WA’s 274 remote Indigenous communities following a federal government announcement it would remove funding from essential services, said he believed the PM was committed to Indigenous issues even though the choice of words was “unfortunate”.

Christopher Pyne defended the PM, saying in The Australian (paywalled) that the calls for him to apologise were “hysterical”.

The University of SA’s Professor Peter Buckskin said Aboriginal identity was so closely connected to the land that a policy of forced removal would see an increase in mental illness within Indigenous communities.

This SMH editorial said the ‘lifestyle choices’ comment could also apply to white people living on remote farms who also demanded community services, and the West Australian argued that while it was not a lifestyle choice to wish to continue a tradition which for some stretches back tens of thousands of years, governments did in fact, “currently subsidise all manner of lifestyle choices, mostly in cities, including education, health and sports facilities, libraries, arts activities and public transport”.

A piece in The Conversation argued that using the term ‘lifestyle choice’ was a common tactic of governments when they wanted to distance themselves from funding responsibilities – a recent and obvious example being the important public health issues of obesity and chronic disease.

On other important Indigenous health issues, Croakey covered the launch of the Lowitja Institute’s ‘Recognise health’ initiative, a project that supports constitutional recognition as a pathway to better health and wellbeing for Aboriginal people. The initiative, which has the support of Australia’s leading medical groups, was also covered by the ABC here.


Future proofing research infrastructure

Scientists and academics came out swinging this past fortnight on the potential for Australia to lose critical research infrastructure if the future of funding for the National ­Collaborative Research Infrastructure Strategy (NCRIS) remained tied to the fate of the Government’s higher education reform package, which may not pass the Senate.

Vice Chancellors at the Group of Eight Universities took out newspaper advertisements saying a government decision to pull NCRIS funding if the reforms were not passed would be “dumb”. The SMH reported this was the first time the Group of Eight had used paid advertising as a protest since it was formed 16 years ago.

Writing in The Australian (paywalled), Andrew Trounson reported on one of the projects facing an uncertain future – a new migraine treatment being produced by researchers at the Institute of Health and Biomedical Innovation at QUT.

And in The Conversation, The ANU’s Professor Brian Schmidt wrote that just as roads, bridges and rail were critical infrastructure that underpinned Australia’s development, research infrastructure was just as critical to the nation’s economy, as it underpinned our scientific research and development. Examples included telescopes, leading edge imaging devices and the integrated marine observing system.

Another example, funded by NCRIS and developed by the Sax Institute, is the Secure Unified Research Environment (SURE), which allows sensitive human data to be used in linked data research projects without compromising privacy. SURE works as a remote computing environment for researchers – who can access this sensitive data securely from anywhere in the world without having to store it on their own devices. The technology provides a way to capture Australia’s untapped potential to answer important research questions using ‘big science’ while simultaneously addressing the critically important issue of data privacy and security.

Professor Les Field from the Australian Academy of Science and UNSW added his voice to the funding debate, asking “Why would you mothball over A$3 billion in cutting edge scientific equipment, for the sake of saving A$150 million? It is akin to shooting oneself in the foot. This move will effectively cripple much research activity in Australia, as well as have a negative impact on many parts of the economy.”


On matters of evidence

Homoeopathy doesn’t work, says the NHMRC – its final word on the issue after a fair amount of deliberation. The recently released statement received widespread coverage across Australia and internationally. Writing in The Australian (paywalled), Sean Parnell said taxpayers continued to fund the cost of the treatment but Health Minister Susan Ley said it wasn’t a simple matter to turn off the tap for a single treatment and broader considerations had to be taken into account. 

In other evidence news, this UK article looked at the impact of spending cuts that aren’t based on evidence, and this piece from the European Public Health Alliance said the principle of using science advice in health policy was still “a work in progress”.

A paper in the New England Journal of Medicine found that the vast majority of clinical trials have failed to find their way onto the main US federal registry within a year of completion – as required by law. And this alarming article from Dr Justin Coleman on Croakey looked at the level of research misconduct that is detected but goes largely unreported and manages to find its way into the scientific literature.

Experts have warned the public about a new book by a celebrity chef, a blogger and a naturopath promoting a paleo diet for babies that promotes a DIY baby milk formula made from liver and bone broth with 10 times the maximum recommended daily intake of vitamin A for babies. The release of the book has been delayed. A temporary victory for evidence?

“In my view, there’s a very real possibility that a baby may die if this book goes ahead,” Public Health Association of Australia President Heather Yeatman told the Women’s Weekly.

Apple’s new foray into medical research, with its new ResearchKit software platform, which gathers information from users that can be fed into medical research studies, has raised concerns among privacy advocates. On Croakey, Michelle Hughes wrote the move could be a game changer for research. Stanford researchers found 11,000 people had signed up to their study in a 24-hour period. This piece on the Mayo Clinic’s Social Media Health Network blog says the software will change research in ways we haven’t even thought of yet.

Apple also released it’s smartwatch, and while much has been written on this latest piece of technology, this article in Forbes said the device might have an unexpected health benefit – getting its wearers to stand up more. On the issue of standing vs sitting, the SMH’s Daisy Dumas looked at the growing body of evidence around the perils of too much time spent sitting. And a new study to be presented at American College of Cardiology (ACC) 2015 Scientific Sessions found each added hour spent sitting was associated with a 14% increase in coronary artery calcium score.

What can data tell us about the way we use and design health systems? A lot, writes Dr Lesley Russell, if only we could make more and better use of it. Croakey featured recent work by Dr Russell that analysed publicly available data on Medicare obstetric services and costs. Rosie Williams furthers this theme with her Croakey piece on the brave new world of open data and all of the benefits it can hold for a country and its citizens.


A spoonful of sugar

The WHO released its guideline on sugar consumption this fortnight recommending that adults and children reduce their daily intake of added sugars to less than 10% of their total energy intake. The Heart Foundation’s Sam Byfield covers the issue for Croakey here.

Burger King can see the writing on the wall it seems, quietly dropping soft drinks from its children’s menu and following similar moves from rivals McDonalds and Wendys, The Guardian reported. Another Guardian article claimed that taxing sugary drinks could save the NHS £15 million a year.

Some very interesting new research in PLoS Medicine shows that the sugar industry in the US influenced the National Institute of Health’s attempts to reduce dental cavities up to 50 years ago. USA Today reported on the study, which relied on internal industry documents to show “the industry knew sugar caused tooth decay as early as 1950 but pushed government researchers to focus on prevention strategies other than reducing sugar consumption”.

The industry funded research on enzymes to break up dental plaque and vaccines against tooth decay as a way to deflect attention from the simpler strategy of telling Americans to cut back on sugary drinks and snacks,” the article said.


A word for women

Vascular surgeon Dr Gabrielle McMullin sparked heated debate with her comments that it was safer for women surgical trainees to comply with requests for sex from their senior male colleagues than make a claim for sexual harassment if they wanted to protect their careers.

The Royal Australasian College of Surgeons criticised the comments and has since established an expert advisory group to deal with concerns of bullying, harassment and discrimination in the health sector, Medical Observer reported. And AMA president Dr Brian Owler wrote to AMA members urging them to speak up if they had experienced sexual harrassment.

Dr Caroline Tan spoke out about her experience in the wake of Dr McMullin’s comments and said the College should create an independent body to hear complaints about misconduct.

“This not going away. They need to face the music. I’m sure that’s going to be uncomfortable for them, but it’s going to be for the better,”  Dr Tan told The Age.

According to the UN, violence against women and girls “persists at alarmingly high levels”. The New York Times reported that more than one in three women worldwide said they had experienced physical violence in their lifetime, and one in 10 girls under 18 was forced to have sex.

The Conversation reported that one in six Australian women experienced physical or sexual violence by someone they know at some point in their adult life. Kathleen Baird and Deborah K Creedy from Griffith University wrote that midwives were ideally placed to identify women at risk of violence given that more than 300,000 women sought antenatal care in Australia each year.


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.


Aug 4, 2014


Rosemary Stanton and Christina Pollard write: Many people eat badly because far too much of their energy is provided by nutritionally worthless junk foods and drinks. Part of the problem is the push by the food industry to get us to buy food that may be bad for us but good for its business.

In the 1960s, we had between 600 and 800 foods to choose from, many of them […] Continue reading “Why bad food is good for business”


Apr 14, 2014


Sandra Jones writes: If you’re confused by food labels, you’re not alone. But don’t hold your breath for an at-a-glance food labelling system that tells you how much salt, fat and sugar each product contains. Australia’s proposed “health star rating” labelling scheme was put on hold in February, following pressure from the food industry. And it’s unclear whether the scheme will go ahead.

Marketers use a variety of tricks to make foods seem healthier and more appealing than their competitors, particularly when it comes to products aimed at children. One of the most powerful advertising tools a food manufacturer has is the packaging, as it’s what we look at immediately before deciding which food to purchase.

Next time you’re shopping for food, look out for these seven common labelling tricks: […] Continue reading “Fat free and 100% natural: seven food labelling tricks exposed”


Mar 23, 2014


Marie McInerney reports:

Here’s a challenge to Australian politicians, leading food retailers like Woolworths and Coles and perhaps consumers: make sure that every child in the country has access to affordable fruit and vegetables by 2017, “whatever their postcode”.

It was laid down last week by global health campaigner Alessandro Demaio who says Australia can’t address health inequity, nor its obesity emergency, when rural and remote communities have to pay $9 for six mushrooms or $4.50 for a small piece of broccoli.

Speaking at Congress Lowitja 2014: Many mobs, one vision: creating a healthy future, he urged Aboriginal and mainstream health services to “draw a line in the sand” and give both sides of politics till the end of this term of government to ensure:

“No matter where a child lives, in the centre of Sydney or the ‘red centre’, fresh produce will cost the same and be affordable.”

Poor diet, he said, was the biggest risk factor of disease worldwide and one that could “not be more evident” in rural and regional Australia.

Addressing poor diet should not be about “blame or the lack of sound personal choices” but a much more complex political and economic understanding.

“In short, when it comes to food and food production, we have a broken system,” he said.

But how to make prices or access to affordable healthy food equitable?

Should the Federal Government subsidise prices?

Should major retailers be required/enticed to play a role?

If so, would those of us who live in cities happily pay more at the checkout if it meant ensuring highly disadvantaged remote Aboriginal communities might be able to afford what we take for granted?

And would that all work?

One current study led by the Menzies School of Health may point the way.

The Stores Healthy Options Project in Remote Indigenous Communities (SHOP@RIC) will test the impact on consumption of fruit and vegetables, diet drinks and water in 20 remote Northern Territory communities of a 20 per cent price discount alone, and then with an in-store education program.

It notes:

“There is growing evidence that taxes and discounts on food and beverages could influence consumption patterns considerably, and thus improve health outcomes. Improved affordability has been associated with significant increases in the purchase and consumption of healthier foods.”

Demaio, a postdoctoral fellow in global health and non-communicable diseases at Harvard Medical School, recently made the case for action, noting several studies in Australia have highlighted the disparity in the cost of healthy food between urban and rural areas in South Australia, Queensland and the Northern Territory.

He told the Lowitja conference prices for healthy foods in remote areas can be more than 50 per cent higher than the cheapest available in metropolitan stores.

His co-author Kerin O’Dea, Professor of Nutrition and Public Health in the Health Sciences Division of the University of South Australia, was part of a study of food purchased in three remote Northern Territory communities over a 12-month period, which looked at food expenditure, estimated per capita intake, nutrient profile and density relative to daily requirements, and major nutrient sources. As the article noted:

The study found that one-quarter of total food expenditure was spent on non-alcoholic beverages, with 15.6 per cent spent on sugar-sweetened soft drinks. As little as 2.2 per cent of money spent went on fruit, and only 5.4 per cent on vegetables. Sugars contributed between 25.7 per cent and 34.3 per cent of energy, of which 71 per cent was refined sugar and sugar-sweetened drinks.

Further, white bread was a major source of energy and most nutrients in all three communities.

O’Dea says there have been a number of international responses to similar issues, including a promising New Zealand trial. In Canada, a new food subsidy program called Nutrition North replaced a long-established Food Mail program. According to this report, the old program subsidised shipments of most foods and some hygiene products, while Nutrition North only covers healthy foods.

A United States supplemental program for women, infants and children (known as WIC) provides vouchers for disadvantaged households to buy specific foods (including low fat milk and wholegrain bread and rice) and US insurance companies offer rewards for healthy eating.

O’Dea says the difficulty in finding ways to meet the challenge in Australia on health and equity grounds is the lack of local evidence to prove the case. There’s no questioning the higher cost of food, as the Australian Preventative Task Force said:

A study in a remote Northern Territory Aboriginal community found that food in general cost 50 per cent more than in Darwin, and that families spent an average of 38 per cent of their income on food and non-alcoholic beverages, compared with 14 per cent for the average Australian household and 30 per cent for low-income non-remote Australian households.

What’s still not known is the most effective way to change that. That should emerge, she says, from the SHOP@RIC trial, of which she is part. “Until we get data like that locally it’s very hard for us to make an argument.”

However, she notes even the 20 per cent discount being trialled will still not come close to providing city prices for remote and, generally, significantly poorer households.

“For low income people we need more than parity,” she said.

Finally, as a city-based journalist fired up from the conference, I’m obliged to point here to a previous Croakey post which makes the important point that “one sized fits all” solutions can look appealing but cause all sorts of new problems (perhaps not least that the study will be perhaps be easier to undertake because community stores now operate under a licensing regime implemented under the Northern Territory Intervention.)

The secret weapon

Demaio, who is Melbourne born and raised, may be well known to Croakey readers and Twitter uses after his stint on @WePublicHealth last year.

Last year he co-founded NCDFREE, a global social movement against non-communicable diseases, which raised $US60,000 through crowd-funding and made three short advocacy films, one in collaboration with the World Health Organisation.

He told the conference climate change and non-communicable diseases were the biggest threats to global health – they also shared the same causative and mitigating factors, he said.

Demaio said young people are “our secret weapon in global and local health: globally connected like never before, native to technologies…driven and desperate for change…and combine traditional knowledge of health and medicine with a deep sense of social justice and appreciation of the social determinants.”

Also, he said, they have no choice: “They must be the generation that rises above the rhetoric, change is not going to come in the form we need from the generation they will replace.”

• You can track the Congress Lowitja coverage here.



Melissa Davey

Once you’re done with the Health Wrap, be sure to check out this Croakey round-up of health news to make you smile.


What about the children?

Regulation of alcohol advertising is failing to properly protect children and adolescents, and in some cases is enabling their exposure to alcohol advertising, according to this report from Australia’s National Preventive Health Agency.

The agency says the failings are largely due to advertising of alcohol during live sporting events and public holidays, and recommends media industry bodies develop stronger codes. Action around online alcohol promotions and sponsorships is sorely needed, it says. In response, the National Alliance for Action on Alcohol tweets that it’s “time to close the loophole” exposing Australian children to advertising by ending “the charade of industry self-regulation”.

Croakey provides this comprehensive overview of the report, which calls for closure of a loophole allowing free-to-air TV alcohol advertising before 8.30pm during live sports broadcasts on weekends and public holidays. The piece, by Croakey contributor Marie McInerney, also challenges the federal government to open up on defunding decisions, asking why the Alcohol and other Drugs Council of Australia was a target.

As Drink Tank writes: “The Abbott Government’s decision to defund the Alcohol and other Drugs Council of Australia was sudden, swift and unexpected. Past and present presidents of ADCA condemned the decision as ‘hasty and poorly considered’.”

Meanwhile, two Queensland academics have analysed an alcohol industry-sponsored DrinkWise campaign called ‘Drinking – do it properly,’ concluding that it promotes drinking as a “cool thing to do”.

The Health Wrap will give the final word on alcohol to public health professor Mike Daube and his response to a Crikey  piece by journalist Bernard Keene. Keane cited an anonymous senior public health figure as suggesting that public health experts are unwilling to work with the alcohol industry and therefore are “undermining campaigns to reduce drinking among at-risk groups” – a comment Professor Daube has a thing or two to say about.

Children’s rights are also a key focus for an Australian Human Rights Commission inquiry, which will investigate how life in immigration detention affects their health, well-being and development, and Croakey is helping to compile submissions.

Jaelea Skehan and Gavin Hazel from the Hunter Institute of Mental Health write that quality of life in childhood and adolescence has a significant impact on emotional, social and psychological development. They describe the unavoidable and significant impact that being in detention has on child health, with families often separated across detention facilities.

The immigration detention of children amounts to systematic child abuse, writes psychiatrist Professor Alan Rosen for Croakey, in a powerful piece that says Australians are being groomed by the federal government to be complicit in abuse of children in immigration detention, “ironically even while we are running national and state judicial commissions on the systematic abuse of children”. The issue also prompted this editorial from The Age.

Malignant brain tumours are the most common cause of cancer death in children, writes the Director of the Institute for Molecular Bioscience at the University of Queensland, Brandon Wainwright, for The Conversation. With his colleagues, he has identified 53 genes that appear to drive the development of the aggressive cancer, a step towards improving treatments.

Also writing for The Conversation, Professor of Environmental Science at Macquarie University, Mark Taylor, writes that some of the chemicals known to cause serious neurological and behavioural problems are still used in industrial products or are found in the environment, making keeping track of their use and distribution nearly impossible.

Caring for the elderly

A special report in the Washington Post explores the impact of adults becoming children again as they progress into old age and become unable to care for themselves. Families, often the first to provide ongoing care for their ageing relatives, will prove increasingly critical to America’s aged care system, the piece says. It’s part of a whole series on caregiving – at once eye opening, harrowing and beautiful.

Researchers at the University of Kent have developed a novel way to help elderly people remain independent for longer, creating an intelligent ‘avatar’ which would detect whether people are in pain and alert emergency services. The avatar would appear as a figure on a television screen, a tablet computer or as a hologram, say the researchers, who are taking part in a project to support Britain’s ageing population. It could monitor heart rate and blood pressure, remind people to take medication and would know if someone had fallen over or was in pain.

Food industry battles

Assistant Health Minister Fiona Nash is back in the headlines. In recent weeks, her former chief of staff resigned after it was revealed he had an interest in a firm that lobbied for junk food companies. She also came under fire for ordering the Health Department to take down its food rating website hours after it went live, even though she had not met with major public health bodies including the Heart Foundation and Cancer Council.

Now, Senator Nash has been censured in the Senate over conflict of interest claims, with Labor and the Greens claiming she misled the Upper House several times in recent weeks over her former chief of staff’s links to the confectionery industry. The ABC reports the parties used their superior numbers in the Senate to interrupt Question Time and pass a censure motion, calling on Senator Nash to resign. And Marie McInerney documents how Senator Nash put in a performance worthy of Yes Minister at a Senates Estimates hearing.

Meanwhile Croakey reports on a NACCHO health promotion campaign that went viral: Isn’t it about time we took health advice from the fast food industry? The tweet (below) reached more than three million people over the past week in Australia, North and South America, Europe, Canada, South East Asia and the UK.

Finally, the World Health Organization has advised that the daily allowance for a person’s sugar intake should be halved to six teaspoons, with draft guidance published by the international body recommending the dramatic reduction to help avoid growing health problems including obesity and tooth decay.

Diet obsessions

The debate over saturated fat is hotting up, writes Professor of Public Health at the University of Auckland Grant Schofield, for The Conversation. He writes that many people believe eating fat seems to do little harm and can add some benefit when combined with eating less processed sugars and other carbohydrates.

“The thing is that science isn’t a democracy,” he writes. “We don’t have a vote and the most popular hypothesis wins. We deal with evidence, and as such we should be prepared to constantly change our mind as new evidence emerges.”

Society’s obsession with finding the ideal diet and reaching an ideal weight has led to some resorting to dangerous methods to achieve the ‘perfect’ body. The Conversation reports on a study from the Medical Journal of Australia, which found a growing number of Australians are illicitly using the drug clenbuterol to lose weight and build muscle mass.

By doing so, they’re putting themselves at risk of a heart attack – the drug is only legally prescribed in Australia as an airway dilator for horses. Calls to the NSW Poisons Information Centre about exposure to the drug rose from three in 2008 to 27 in 2012, the study found. Meanwhile, The Conversation reports on the sad and disturbing prevalence of pro-anorexia websites which they say are flourishing on the internet.
Many people try to keep tabs on their weight by endlessly checking the scales, but Dr Melissa Stoneham explores a recent study on the impact of scale watching in this piece for Croakey.  Regular self-weighing has been a focus of attention recently in the obesity literature, she writes, receiving conflicting endorsement.

But she writes that a new study, titled Daily Self-Weighing and Adverse Psychological Outcomes: A Randomised Controlled Trial published in the American Journal of Preventive Medicine investigated the impact of a daily self-weighing weight loss intervention and found it did not cause adverse psychological outcomes among overweight and obese adults. But she adds that good health isn’t always measured in kilograms, and that for many trying to shed kilos, the elation from that initial weight loss can be brought to a screeching halt when the scales stop moving.

Rural and Indigenous health funding boosts urged

Rural doctors have urged the federal government to boost regional healthcare in its May budget, with better targeted incentives to help attract doctors outside the capital cities, the Northern Star reports. In its budget submission the Rural Doctors Association of Australia president Dr Ian Kamerman said all rural health investment needed to be targeted to lay the groundwork for a stronger workforce in the future.

Rural communities have a health advocate in medical student Skye Kinder, who has been named the City of Greater Bendigo’s Young Citizen of the Year for her dedication to rural health promotion, The Age reports. At just 22, she has worked with leading researchers and represented Australia in conferences abroad, spending much of her time working to raise awareness of the key issues that exist in rural health to encourage change, using social media as a key tool.

Meanwhile, vulnerable families will be hard-hit by funding cuts, writes Summer May Finlay for Croakey, with Prime Minister Tony Abbott  making significant changes to Aboriginal and Torres Strait Islander affairs in the short time he has been in office. Last year the government announced it would cut $3.5 million from the National Family Violence Prevention Legal Services over the next three years.

Finally, an Australian-first dementia risk-reduction program has been launched for Indigenous communities in a new Alzheimer’s Australia campaign aimed at reducing the disadvantage gap, The Australian reports.

Health system costs

A new report by the Grattan Institute says a better pricing system for public hospital treatment would show where costs are too high, and free up $1 billion for more and better healthcare. The gulf between treatments in high- and low-cost hospitals in Australia is vast, with no good reason for such variation, the report says, urging state governments to make three key reforms.

These are: paying hospitals for treatments on the basis of an average price once all measurable avoidable costs have been removed; making data available to hospitals so they can compare themselves to their peers; and governments getting tougher and holding hospital boards to account when they fail to control costs.

But in this post for Croakey, a health policy analyst writes under a pseudonym about why the latest Grattan report is based on inadequate data. The report uses past estimates of resource use to estimate current resource use, he writes, which is unreliable and highly variable.

Healthy bloggers

Broome Docs is a website aimed at rural and country doctors but provides interesting reading for general health enthusiasts as well. It’s a fascinating insight into the working lives of doctors in the country who have to deal with all kinds of situations thrown their way.

Other Croakey reading you may have missed this fortnight

Turmoil for Queensland doctors as contracts introduced

Change Day 2013 6th March 2013

GP co-payments and over servicing, what does the evidence tell us?

Medical Board responds to concerns about new social media policy

Social determinants of health: building bridges between sectors and tackling racism

Hazelwood mine fire: health risks and public health response options

Hazelwood open-cut mine fire: a slow burning public health issue?

On breaking down the barriers between health and legal issues: insights from @fionalander as @wepublichealth

Wind farms: no reliable evidence of health risks, says National Health and Medical Research Council

‘No comment’: now the Medical Board tests social media landscape with advertising guidelines

You can find previous editions of The Health Wrap here. Got a story you think the Health Wrap should highlight? Contact @MelissaLDavey or my colleague Kellie Bisset @medicalmedia on Twitter.

Melissa Davey is the Sax Institute’s Communications Manager. She was previously a health and medical reporter for the Sydney Morning Herald and the Sun Herald. She is completing her Masters of Public Health at the University of Sydney and has a strong interest in public health messaging, body image and mental health. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning. Twitter: @MelissaLDavey



Feb 19, 2014


Gary Sacks writes: The influence of the food lobby has come into the public spotlight over the past week, with revelations that Assistant Health Minister Fiona Nash’s chief-of-staff, Alastair Furnival, has strong links to the food industry. Furnival previously worked as a lobbyist for several food companies and is the co-owner of a firm that has represented […]  Continue reading “Big Food lobbying: tip of the iceberg exposed”


Feb 5, 2014


Kathy Chapman writes: Most people doing their grocery shopping are probably blissfully unaware of the industry lobbying and backroom politics that determines what information appears on food labels.

So let’s start with some background. For almost two years, a Commonwealth government-led initiative involving public health and consumer groups, industry organisations as well as state government health authorities has been working to develop an interpretive front-of-pack food labelling scheme.

Continue reading “Industry winning the fight against better food labelling”


By Kellie Bisset 

Putting the social determinants of health front and centre

The impact of social disadvantage on healthcare and other important ‘downstream’ factors was a focus of the past fortnight as Australia marked Anti Poverty Week.

This piece on Croakey from Marie McInerney pulls together the findings from Anti Poverty Week research reports as well as a series of films on disadvantage and a host of other relevant documents.

As for developments in the evidence, a recent study in BMC Public Health showed that dropping out of high school early was associated with later illness and disability, even after socioeconomic status was taken into account. You can read The Pump Handle science blog’s take on the study here.

The American Journal of Public Health turned its attention to homelessness, with a special issue focusing on public health efforts in the area. The American Public Health Association’s Public Health Newswire offers this summary.

A feature in The Globe and Mail looks at how Canada might address the problem as it hosts the first National Conference on Ending Homelessness.

And a piece in The Atlantic reports on a recent study published in Proceedings of the National Academy of Sciences, which explores how the stress of childhood poverty affects emotional regulation in adulthood.

The British Medical Association in Scotland meanwhile, says the latest statistics on health inequality mean inequality impact assessments should be carried out across all areas of government policy. Chairman of the BMA in Scotland Dr Brian Keighley told the BBC that inequalities had never been so apparent for those living in the most deprived communities. “No matter how many task forces and inquiries politicians establish they are no substitute for action,” he is quoted as saying.

The WHO also joined the debate about inequality in Britain, with a new report suggesting young people who were not working or studying were a “public health time bomb waiting to happen”.

Inequality is certainly an issue for the US, according to this CNN feature on “the most unequal place in America”, Lake Providence, Louisiana. This is where the difference between the ‘haves’ and the ‘have-nots’ is as obvious as those who live on one side of the lake compared with those unlucky enough to live on the other.

Closer to home, a report from the National Seniors Australia Productive Ageing Centre says older people are struggling to pay for medical care because they are prioritising basic essentials such as food and transport.

This Adelaide Advertiser report from a forum in Adelaide says South Australia could save up to $170 million a year in hospital costs if it invested in a fairer society. But an opinion piece in The Australian rails against the concept of social determinants of health, arguing it is a waste of time and urging Health Minister Peter Dutton to “close the door” to social determinants “lobbyists”.


New solutions urged for Closing the Gap

There is an increasing  recognition that non-Aboriginal people really can’t make Indigenous people healthy, writes Ian Ring, professorial fellow at the Australian Health Services Research Institute at the University of Wollongong.

His piece in The Australian says it is time for Aboriginal communities to play a more central role in the design and conduct of their own services, given some of the best health services in Australia are run by the Aboriginal community controlled sector. This and other key issues need to be considered by the Mundine review, he says.

The Liberal member for the WA seat of Hasluck Ken Wyatt has raised similar concerns, arguing that the new government has to move away from old approaches to funding Indigenous health and education.

Speaking on the 20th anniversary of the release of the Burdekin Report into the human rights of people with mental illness, Dr Tom Calma AO and Professor Pat Dudgeon reflect on Croakey that there have been some important improvements for Aboriginal people but little has changed on the ground. A shorter version of  this article was published in The Australian, which also ran a piece by Anthony Dillon from the University of Western Sydney looking at the issue of Aboriginality and mental health, suggesting culture should not be over-emphasised in determining the mental health needs of Aboriginal people and how they access services.


Problems plaguing health systems

Why can’t all patients have access to data about how their health system and individual doctors perform, asked the Grattan Institute’s Professor Stephen Duckett in a lecture to the Consumers Health Forum? Jennifer Doggett reports on the lecture for Croakey, and highlights the point that if even ‘expert patients’ find the system difficult to negotiate, reform is surely needed.

Jennifer also makes the case for workforce reform, in a separate Croakey piece, which says ensuring Australia has a flexible, skilled and sustainable health workforce is one of the most important challenges facing Health Minister Peter Dutton.

The Primary Healthcare Research and Information Service (PHCRIS) has published a series of policy reviews looking at the challenges for health systems globally. This Croakey summary wraps them up in a neat little package. Fragmented healthcare is highlighted as one issue, but this could be at least partially addressed if we made better use of routinely collected data, according to a report in the Australian Financial Review.

The report quotes the Productivity Commission’s assessment that Australia’s “poor use” of its information databases is likely to come to the attention of Treasurer Joe Hockey’s commission of audit. “A failure to exploit this evidence would be a missed opportunity,” it says.

What impact will repealing the carbon tax have on the health system? This Croakey post urges readers to respond to the calls for public comment on the carbon tax repeal bills. Some have already offered their views, with Fiona Armstrong from the Climate and Health Alliance arguing the health sector and the community are ill prepared for what lies ahead. It’s time for the health community to speak louder in the debate, she says.

On the issue of struggling systems, its important to remember that amid all the sound and fury over website glitches surrounding the new Obamacare Health Insurance Exchange, the big picture of US healthcare reform doesn’t get lost, activist and columnist Sally Kohn writes for CNN.

“You know what’s relatively easy? Fixing a website. You know what’s really hard? Ensuring access to affordable, quality health insurance for every single American and improving our broken health care system in the process, ” she writes.

Articles on the Obamacare issue are ubiquitous but this Guardian article gives an overview for those who’d like to catch up.


All things Public Health

As the American Public Health Association prepared for its 141st Annual meeting in Boston to kick off on 2 November (follow @APHAAnnualMtg and hashtag #APHA13 or visit the conference blog), New Public Health spoke with APHA executive director Dr Georges Benjamin about the conference theme “Think Global Act Local”. More than 10,000 people are expected to attend the event.

The range of public health challenges being grappled with internationally is a stark reminder of the importance of gathering collective public health intelligence.

Reports in the past fortnight give just a taste of the task ahead. Thailand may be facing its worst Dengue epidemic in 20 years, the WHO is concerned about a potential polio epidemic across the Middle East and one in five Chinese adults now has hypertension.

Public Health England is looking at how to best manage the risk of the elderly dying during cold weather. And though its a story on a smaller scale, this piece about the US city of Pevely, Missouri, no longer having enough money to fluoridate its water is an eyebrow raiser.

Chlamydia rates in Australian 12 to 15 year-old girls are at concerning levels, with the disease having been identified as the most frequently reported sexually transmitted infection. (This interesting day-in-the-life feature – Meet the woman who tells your exes they may have an STD – is a nice explanation of why sexual contact tracing is rather more effective when done by a third party.)

But those who oppose the role the public health professionals should play in our lives are still out there shouting loudly. This piece in Spiked attacks public health professionals as “beligerent academics”  espousing an “unchallengeable doctrine” of health at all costs.

Would it help to provide unrelenting reminders about the evidence of benefits led by the public health community? Perhaps not but this article in Vaccine News Daily is good reading anyway. It summarises a piece in the American Journal of Public Health looking at the role played by public health measures in eliminating malaria in the American South during the 1930s. As the WHO reminds us though, there are many more hills to climb when it comes to combating infectious disease. The war against drug-resistant TB needs to be strengthened, it argues, describing the problem as a public health crisis.

The issue of superbugs featured in several media outlets this past fortnight. Two US outlets, Frontline and NPR, offered overviews of the broader issue and The Conversation discussed research in The Lancet showing honey did not show promise as an alternative to antibiotic treatments of wound sites.

If you haven’t already encountered @WePublicHealth, now is the time to have a look. It’s a Croakey initiative to encourage public health flavoured citizen journalism. GP Dr Tim Senior took the chair last week and a selection of his tweets – on Indigenous health, general practice and more – can be found at this Croakey post. This week’s guest tweep is Dr Ewen McPhee.


Time to Quit

Monday is the most popular day to give up smoking, according to a paper published in JAMA Internal Medicine and reported on by NBC. Perhaps this series of photographs on how smoking ages the face among a series of identical twins could be employed as an incentive. The images were part of a study published in the journal Plastic and Reconstructive Surgery. 

A new report from the National Health Performance Authority reminds us that while smoking rates might have decreased overall, there is considerable variation across geographic areas. In a third of all local areas for example, the percentage of adults who smoked daily was as high as 20 per cent.

Some good public health news has emerged from Queensland, with Health Minister Lawrence Springborg considering a plan to extend the power of local councils to ban smoking in public areas such as parks and tourism areas.

And the BMJ has finally banned tobacco-funded research, reversing its earlier position, which was based on an anti-censorship premise. At the time of writing, the US FDA was poised to make a decision on regulating e-cigarettes. This article by Medpage Today says it’s likely that new rules will bring the products under the agency’s authority and request their compliance with age, marketing, and packaging restrictions. In the meantime, individual US jurisdictions are moving ahead with their own laws. In Massachusetts, a bill placing e-cigarettes under the state’s existing tobacco control law is being considered.

An article by Fairfax journalist Julia Medew explores the issue of annual lung cancer screens for heavy smokers. While some believe the move would have a big positive impact, others say a high number of false positives would mean the cost of a screening program would outweigh the benefit.


The darker side of Halloween

Children across the country may well have a sugar hangover this morning after the week’s Halloween festivities, and this article in the MJA asks whether confectionary manufacturers are exploiting an American tradition to peddle junk food to kids.

“Concerns about the celebration of Halloween in Australia should go beyond indignation at multinational corporations imposing a new cultural event,” say the authors, from the University of Melbourne’s Nossal Institute for Global Health. “Evidence is mounting that corporate behaviour involving marketing and distributing of unhealthy commodities is a driver of the growing global non-communicable disease epidemic.”

Celebrities have also been called out this fortnight for their lucrative sponsorship deals to market junk food to their young fans. Health groups attending the Healthy Beverages Summit in Los Angeles called on pop music princess Katy Perry to stop promoting Pepsi and released a video to drive home their point.

UK public health expert Professor John Ashton has also taken aim at Big Food, arguing that recent pledges from manufacturers to cut their saturated fat levels  are a drop in the ocean in the fight against obesity. A voluntary ‘responsibility deal’ signed between industry and government “lacked credibility”, the BBC reported him saying.

Melbourne University Professor of Public Health Rob Moodie had his own things to say about the industry: “These industries are modern-day vectors of disease, just as mosquitoes might be for malaria,” he told the SMH.

In a move that has astonished scientists, the European Food and Safety Agency has approved health claims for fructose-sweetened products. Kerin O’Dea writes for Croakey that the rationale for approval oversimplifies the issue.

According to this story from the ABC’s PM program, the tide may be turning against junk food manufacturers. It looks at a Credit Suisse report warning its clients to prepare for a backlash as the evidence about harms from sugar emerges and calls for action grow louder. However, Mike Daube, Professor of Health Policy at Curtin University, believes obesity is here to stay, writing in the SMH that there is little will from governments of any colour to regulate industry or attempt to solve the problem.


Food fights, and some new numbers to chew on 

An article in the BMJ and a story aired by the ABC’s Catalyst program questioning the role of saturated fat in heart disease has sparked considerable reaction from medical experts. In this article for The Conversation, Sydney University’s Professor David Sullivan, explains why the BMJ piece is flawed. The Catalyst piece has been roundly criticised for putting patient health at risk, with part two of the series also being called into question over the way it presented the evidence on cholesterol lowering drugs, whose benefits it claimed were exaggerated.

“The conclusions presented in the ABC Catalyst program are not supported by the Heart Foundation or the vast majority of the medical and scientific communities  across the country and internationally,” the Heart Foundation said in a statement.

The Conversation also carried a piece from Griffith University’s Professor Ian Hamilton Craig explaining the weight of evidence in favour of cholesterol lowering drugs that underpins current recommendations.

Ever wondered what’s in a chicken nugget? Muscle fat, connective tissue, organ tissue and bone bone fragments according to a paper published in the American Journal of Medicine.

“I was floored. I was astounded,” one of the paper’s authors told The Atlantic about his experience of looking at the nuggets under a microscope. The paper has been criticised by the US National Chicken Council, which said the researchers’ findings were only relevant to the samples they tested rather than the large number of nuggets on the market.

As part of its Healthy Communities series, the National Health Performance Authority has released a report on obesity rates by Medicare Local area. This companion document  to the smoking report mentioned earlier, found the rate of obese or overweight adults varied from 49% in Eastern Sydney to 79% in Western NSW.

Meanwhile, a piece on the UK public policy blog Public Finance, says tackling physical inactivity must be addressed in public health policy making, otherwise the National Health Service will go bankrupt “and our children will not have a health service that is free at the point of use”.

Other Croakey reading you may have missed this fortnight:

You can find previous editions of the Health Wrap here.

If you tweet an article you think might interest Croakey health wrap readers, cc me @medicalmedia or my colleague Melissa Davey @MelissaLDavey.

  • 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.

By Kellie Bisset

Poll position

As the election race began, and those in the healthcare sector wondered if health might get a look-in at any point during the campaign, the Mend Medicare Coalition wasted no time in launching its own campaign calling for reform. As reported by Croakey, the Coalition released a report calling on leaders to spell out their pre-election plans for Medicare and arguing that Australia has outgrown its original system, designed to provide short-term episodic care rather than address the large amount of chronic and complex illness we see today. However, as Jennifer Doggett argues (also on Croakey), reforming fee-for-service medicine could be one of the six health policies we won’t be seeing this election campaign – along with others in the electoral too-hard basket such as the impact of climate change on health and more transparency over pharmacy’s funding deal with the Federal Government.

Doctor groups such as the AMA, Royal Australian College of General Practitioners and Rural Doctors’ Association of Australia, while not members of Mend Medicare, have urged the parties to address health issues in the campaign. If they don’t succeed, they can at least be pleased with a recent win: the Federal Government’s decision to defer for a year its controversial $2000 cap on education expenses. Although the move affects a large number of professionals, doctors and universities were particularly vocal in calling for the cap to be scrapped.

Former Treasury secretary Ken Henry meanwhile, has given his own assessment of how the major parties are handling the healthcare challenges that lay ahead. According to this report in the SMH, Henry says Australia is failing to rise to these challenges – and there won’t be enough money in the kitty to pay for the healthcare costs of our ageing population if we don’t act soon.

One suggested policy solution to saving dollars in health might be to cut the private health insurance rebate, according to a policy briefing paper by University of Melbourne health economist Dr Terence Cheng. Dr Cheng’s paper describes the 30% rebate as “expensive and fiscally unsustainable”, and comes as Private Healthcare Australia chief executive Michael Armitage called on the Government to quarantine the industry from further insurance subsidy cuts. Continue reading “The Health Wrap: Mending Medicare, system stresses, nanny state debates, an unhealthy climate”