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#LoveRural 2014

Nov 11, 2014


While there has progress in closing the gap between the health status of Indigenous Australians and that of non-Indigenous Australians, there is still much to be done. The Australian Institute of Health and Welfare (AIHW) report Australia’s Health 2014 shows that a large gap in health outcomes between Indigenous and non-Indigenous Australians still exists.

Perhaps the starkest indicator of this is that Indigenous children aged 0-4 years die at twice the rate of their non-Indigenous counterparts.  Life expectancy is 10 years lower for Indigenous boys and 9 years lower for Indigenous girls than their non-Indigenous counterparts. One third of Indigenous people have three or more long-term conditions. Incidence of diseases such as asthma and diabetes is significantly higher amongst the Indigenous population.

This fourth instalment of our series on issues in rural health by the NRHA describes why improving the health of Aboriginal and Torres Strait Islander peoples requires commitment, planning and funding security.

From the National Rural Health Alliance:

The greatest and most persistent challenge to Australia’s social policy is improving the health and wellbeing of its Aboriginal and Torres Strait Islander people. It has been a top priority for the NRHA ever since it was established. Continue reading “A call for funding certainty for Aboriginal and Torres Strait Islander community controlled organisations”

health and medical research

Sep 4, 2014


Jennifer Doggett writes:

In the era of Facebook and over-sharing on social media do we need to be as vigilant about protecting individual health information as we have in the past?

The tension between balancing privacy issues with access to data for researchers, managers and policy makers in the health sector was a common theme arising at the 4th Rural Health Scientific Symposium in Canberra yesterday.

Privacy is both a legal and an ethical issue, with privacy legislation governing access to personal information and ethics concerns being addressed through ethics committees attached to data collection and research bodies, such as the Australian Institute of Health and Welfare (AIHW) and universities.

Presenters at the Symposium, including representatives of AIHW, the Australian Health Practitioner Regulation Agency, the Australian Bureau of Statistics, the National Health Performance Authority and the Australian Primary Health Care Research Institute, provided delegates with a comprehensive overview of the types of data they collected and made available to researchers. All stressed their commitment to the highest standards of privacy and confidentiality.

Delegates at the Symposium commented on how useful the event was in informing researchers about the types of data being collected and analysed by these organisations.

“I had no idea there were so many sources of data around,” said one delegate from a rural health service. “I can’t wait to get back to the office and explore them further.”

Another delegate expressed her appreciation of the commitment from presenters to supporting health research. “It is an encouraging sign of the interest senior managers have in rural and remote health research that they have given up a day of their time to spend engaging with us in discussions about data issues,” she said.

Difficulties accessing data

In discussing the use of data in rural and remote health research, many delegates raised the issue of data privacy and described difficulties they had experienced in accessing data they wanted to use in their research due to privacy concerns.

In particular, the restrictions on linking and integrating datasets relevant to rural and remote communities were raised as a barrier to effective research in this area.

Some delegates questioned whether it was time to re-visit our privacy legislation and/or to have a community debate about whether current regulations reflect current community values and concerns about privacy issues.

Delegates pointed out that Australia’s main legislative instrument governing access to health data is the Privacy Act 1988, which was developed decades ago, before the advent of new technologies and social media facilitating the availability of publicly available personal information.

Some States and Territories also have their own legislation covering access to health information and data, which can also complicate access for researchers wanting to combine data collected by both jurisdictions.

Professor Sabina Knight, Director of the Mount Isa Centre for Rural and Remote Health James Cook University, thinks that we are ‘too sensitive’ about privacy concerns when accessing and using health data.

She said:

“Australia has a number of large geographic regions with low populations and these areas can have significant variations in demographics, health status and access to services.

We need to sensibly manage privacy concerns with the granularity of data required to effectively manage and plan services.  In practice, this means we need data on a town-by-town basis.  

We also need to be able to link data across State/Territory and Commonwealth boundaries in order to develop interventions that meet local needs.”

Professor Knight is confident that the community would support greater access to data by researchers if it was used to improve access and quality of health care.

“It doesn’t mean that all data has to be publicly available but if universities and health services could access more data it would definitely assist them in identifying and planning to meet the specific health needs of rural and remote communities,” she said.

A senior DoH manager, who asked not to be named, acknowledged researchers’ need for greater access to data but said that the key underlying issue governing access to health data should be consent.

The manager said:

“Just because we can access data, doesn’t automatically mean that we should access it. 

We need to be guided by the nature of consent given by consumers when providing their personal information to researchers and government agencies.

Particular caution should be exercised when linking and integrating data sets as the resulting information can go way beyond the limits of consent obtained when that data was collected.”

Lisa McGlynn, who heads the Health Group at the Australian Institute of Health and Welfare (AIHW), is circumspect about the prospect of relaxing privacy regulations, saying that legislation is paramount in protecting the privacy of individuals, organisations and communities.

Understanding the complexities and ethical issues sufficiently to be sure information is being used appropriately, and for the purposes that have been agreed requires oversight from experts skilled in specific areas of information management and ethics.

She said:

“It is important that our collection and use of health data reflects the expectations of the consumers, organisations and communities who have provided it, both in terms of protecting privacy and the use to which it is put.  

Protecting the privacy of individuals, communities and institutions has to be a priority and this requires an expert understanding of the data being collected and its potential use.

That said, if the correct protections are in place under legislation and information not able to be attributed to an individual or where appropriate consent is in place, people might also be willing that their data be used in an aggregated way to inform decisions like planning services, or research.”  

Also important to consider is the need for community ownership of data, an issue particularly important for disadvantaged communities and Indigenous peoples.

A researcher experienced in Indigenous health issues said: “Trust and respect are essential when going into a community to undertake research. It’s essential that the community retains ownership of its data and that the results of any analysis or research are returned to the community for their use.”

In response to a call for re-visiting privacy legislation at the conclusion of the Symposium, some delegates said the issue was more the perception of the privacy legislation than the reality.

“There might not be specific prohibitions for accessing specific types of data but the legislation can be interpreted different ways and often public servants can be risk-averse,” one delegate said.

“Every health executive I’ve asked for data has ‘pulled the privacy card’ at some point. Perhaps what we need is more support for researchers to challenge decisions by organisations and some education for all stakeholders on the specific provisions of the legislation.”

Another delegate questioned why healthcare identifiers are not being used to protect privacy in the provision of health data. “One of the reasons we established the system of healthcare identifiers was to support data linkage in research but no-one seems to be talking about these anymore,” she said.

The issue of privacy and other key topics arising over the two days of the Symposium will be highlighted in a Communique to be released shortly and available on the website of the Alliance.

• Jennifer Doggett is covering the 4th Rural and Remote Scientific Symposium for the Croakey Conference Reporting Service. The coverage is being compiled here.

• Follow the conference discussions on Twitter at #ruralhealthsymp, and presentations from Day 1 are available here.


Related issues have been covered previously at Croakey:



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


environmental health

Feb 24, 2014


Mark Taylor writes: The news that toxic chemicals may be triggering a rise in autism, attention-deficit hyperactivity disorder (ADHD) and dyslexia in the United States has rightly prompted concern among parents. But what contaminants are Australian children exposed to that might increase the risk of brain and developmental disorders?

In 2006, US researchers Philippe Grandjean and Philip Landrigan published a list of industrial and environmental chemicals that cause serious neurological and behavioural problems. The list included lead, methylmercury (from fish containing high levels of mercury), engine coolants, arsenic and a solvent called toluene.

The researchers recently added 12 new substances […] Continue reading “Toxic chemicals and pollutants affect kids’ brain development”


Feb 3, 2014


When journalists and others are reporting on the difficulties that people in rural and remote areas face in accessing mental health services, it is important to keep the big picture in mind, says Professor Tim Carey, a mental health academic at the Centre for Remote Health in Alice Springs.


Behind the headlines on rural and remote mental health

Tim Carey writes:

Problems with access to effective and efficient mental health services in rural and remote Australia have featured recently in the media.

ABC News recently reported that: “Three psychiatrists who regularly visit the major western centre of Dubbo will stop their trips following a decision by the local health district to stop paying for their travel.”

The article highlighted the problems faced in rural and remote areas when large amounts of funding are allocated to travel for visiting specialists at the expense of local clinical services. Without effective and sustainable alternatives, rural and remote residents will either miss out on services or be required to travel to metropolitan centres to access services.

Another article in Australian Doctor magazine began: “A new magnetic brain stimulation therapy should be a first-line option for all Australians with depression, psychiatrists say.”

The therapy is repetitive Transcranial Magnetic Stimulation (rTMS) and it was reported that there is robust evidence for its effectiveness in the treatment of depression. It was suggested that some patients may prefer rTMS as an alternative to antidepressants or when antidepressants fail.

Given that the equipment costs for rTMS are “upward of $100,000” and that a full course of rTMS costs between $8,500 and $10,000, it doesn’t seem reasonable to compare a course of rTMS with the far cheaper option of a course of antidepressants.

When first-line treatment options for “all Australians” are being recommended, it is crucial that rural and remote Australians are not excluded from considerations.

Regardless of its effectiveness, it is unlikely that rTMS would ever become a viable treatment option on a widespread basis for residents in rural and remote Australia. To have to travel to major centres for treatment and be dislocated from important social contexts in the process adds further financial and psychological costs to the treatment.

Both these articles illustrate the way in which the media highlights and emphasises psychiatric care in the treatment of mental health problems. There is no doubt that psychiatric care is an essential component of comprehensive and effective mental health service provision.

Psychiatric care, however, is also the most expensive element of the service package and, in a climate of scarce financial resources, it is important that full consideration, including efficiency and cost-effectiveness, is given to all effective treatment options.

Antidepressants, for example, are not the only treatment option for people with depression, nor the most effective in all cases. Some psychological treatments have strong evidence for effectiveness and, if patients are to be offered alternatives to antidepressants, psychological treatments are likely to be an attractive option in terms of cost-effectiveness.

In seeking to ensure that Australians living in rural and remote areas have adequate access to the full range of mental health services, consideration should be given to all evidence-based treatment options and service provision models.

The first article suggested that a greater focus on telehealth could help in promoting access to services without the expense of travel.

An example of a successful telehealth service in rural South Australia was featured as a case study by the Rural Health Education Foundation. When appropriate, telehealth could enable people in rural and remote locations to benefit from psychiatric services without incurring expensive travel costs.

Other options could also be explored that would improve access to evidence-based, effective, and efficient mental health treatments without requiring rural and remote residents to travel to metropolitan centres or tolerate lengthy waiting times in service provision.

Co-locating mental health clinicians such as psychologists and mental health nurses in primary care GP practices to provide evidence-based psychological interventions would facilitate greater continuity of care and would enable mental health problems to be addressed at an early stage.

Reinstating the maximum of 18 rebatable Medicare sessions for evidence-based psychological treatment through the Better Access initiative may also be a more cost-effective option than other treatment alternatives.

Quarantining time in public mental health services for the provision of evidence-based psychological treatments is another cost-effective option. Given that public mental health services are widespread in rural and remote locations, this is likely to be an attractive option financially since it would only require modifying existing staff roles not the recruitment of extra staff.

An innovative service adopting this approach has been evaluated as effective and efficient in remote Australia (a copy of the paper**, Effective and efficient: Using patient-led appointment scheduling in routine mental health practice in remote Australia, is available upon request to Croakey) where a close working relationship between psychiatry and clinical psychology ensures patients have a more expansive range of treatment options than would otherwise be the case.

Access to effective and efficient mental health treatments for people in rural and remote Australia is an urgent problem that requires innovative and sustainable solutions. The long-term viability of service provision must be part of the equation whenever treatment options are considered so that rural and remote residents can experience the same standard of health care that their metropolitan compatriots enjoy.

It is crucial that affordable and effective mental health treatments are accessible to Australia’s rural and remote citizens without them having to travel to major centres or experience long waiting periods for services.

Policy makers and health service managers need to courageously explore the full range of evidence-based psychiatric, psychological, and social treatments to make a significant and sustained impact on the burden of mental health problems for individuals and communities in rural and remote Australia.

When journalists and media outlets are reporting on problems with access to mental health services in rural and remote areas, it would be useful if they could also help their audiences to keep this bigger picture in mind.

• Professor Tim Carey is Deputy Director and Head of Research at the Centre for Remote Health, a joint centre of Flinders University and Charles Darwin University, in Alice Springs. He is a member of the Centre of Research Excellence in Rural and Remote Primary Health Care.

** Carey, T. A., Tai, S. J., & Stiles, W. B. (2013). Effective and efficient: Using patient-led appointment scheduling in routine mental health practice in remote Australia. Professional Psychology: Research and Practice, 44, 405-414.



Oct 21, 2013


While the focus now is rightly on the communities at immediate risk from bushfires in New South Wales, those massive clouds of smoke that have hung over Sydney and elsewhere over the past week pose other health risks, say Martine Dennekamp and Fay Johnston from the Centre for Air Quality and Health Research and Evaluation.

Their research shows that around 340,000 premature deaths around the world each year can be attributed to smoke from ‘landscape fires’.  They say deaths and hospital admissions from lung problems have risen on days when severe smoke plumes affect Sydney’s air quality, and there is evidence of higher risk of cardiac arrests on bushfire-affected days in Melbourne.

In this article for The Conversation, they outline the risks – particularly for people with pre-existing heart or lung disease, pregnant women, young children, and the elderly –  and offer advice on what people can take to reduce their current exposure to bushfire smoke.


Martine Dennekamp and Fay Johnston write:

In recent days, we’ve seen dramatic pictures of thick smoke from bushfires hanging over Sydney. Our first thoughts are with people living in the immediate vicinity of the fires, and the threat to their lives and properties. But there’s another matter that affects a lot more people, and that is the health effect of bushfire smoke.

As bushfire smoke can cover very large areas, including major cities, it has the potential to affect millions of people and is a significant public health problem.

What we know

We know that healthy people tolerate brief episodes of smoke exposure quite well, but those with pre-existing heart or lung disease, pregnant women, young children, and the elderly are more likely to be affected by smoke.

Smoke consists of a very complex mixture of particles and gases, including carbon monoxide, nitrogen oxides, and volatile organic compounds. And increased concentrations of the secondary pollutant ozone have been noted during large fires.

On the population level, the major concern is the very small particles or PM2.5 – particles with an aerodynamic diameter smaller than 2.5 micrometres (µm) – that can penetrate deep into the lungs. These small particles in urban air have shown to have an effect on respiratory and cardiovascular health, even at concentrations well below the current air quality standards in Australia.

This naturally poses the question of what their health effects could be during bushfires, when their concentrations are many times higher and regularly exceed the air quality standards.

At a global scale, our team has estimated that around 340,000 premature deaths each year can be attributed to smoke from landscape fires. We have previously shown that on days when severe smoke plumes affected Sydney’s air quality, deaths increased by around 5% and hospital admissions for lung problems increased even more.

In Melbourne, we have shown that the risk of having a cardiac arrest was significantly increased on bushfire-affected days.

The studies of health effects of bushfires have usually focused on outcomes that can be obtained from routine data collections after a bushfire, simply because they are difficult to predict in advance. As a result, most research has focused on emergency presentations and hospital admissions.

But these outcomes are likely just the tip of the “health effects iceberg”. We need to look at other health outcomes, including the impact of bushfires on individuals, to properly advise policy makers and clinicians of appropriate public health messages and measures to put in place.

In the meanwhile, there are some things you can do to mitigate the impact of bushfire smoke.

What you could do

If you are in an area affected by smoke and fall in one of the higher risk categories, that is, you have a current heart or lung condition, are elderly, pregnant, or have young children, it’s advisable to try and minimise your exposure to smoke the best you can.

There are several measures that you can take to reduce your exposure to the bushfire smoke.

  • If the pollution is severe in your local area, people at particularly high risk should consider the practicalities of leaving the affected area until the air quality has improved.
  • Stay indoors and close windows and doors. If you have a well-sealed house this can delay the entry of smoke particles into your home, but it is only a temporary measure and completely depends on the structure of the house. If the house is not well sealed, smoke particles indoors will rapidly equilibrate with outdoor levels.
  • Avoid exercise, as this results in faster and deeper breathing and can increase your exposure to smoke up to tenfold.
  • If you have an air conditioner, set it to recycle so you don’t bring in outdoor air. If you have the option of adding a filter to your air conditioner, do so.
  • The best evidence for reducing personal exposure comes from the use of high efficiency particle air filters (HEPA filters). These have shown to significantly reduce particle concentrations indoors when there’s a high level of fire smoke.
  • If you feel the air in your home is getting uncomfortable, consider moving (even for a short period of time) to a cleaner, air conditioned environment like a shopping centre.

Apart from reducing your exposure to smoke, it’s important if you have a heart or lung condition that you have your medication and follow your treatment plan. People with asthma, for instance, should make sure they have a current asthma action plan and keep their blue reliever medication handy.

Exposure to bushfire smoke, either through planned burns or incidental bushfires, will always be a part of Australian life. We need to ensure that we are as prepared as we can be when such fires happen.

Martine Dennekamp is occupational and environmental epidemiologist at Monash University.

Fay Johnston is Senior Research Fellow in Environmental Epidemiology at the Menzies Research Institute Tasmania at University of Tasmania.

They are both researchers with the Centre for Air Quality and Health Research and Evaluation, a National Health and Medical Research Council (NHMRC) Centre of Research Excellence. Fay Johnston receives funding from the ARC, NHMRC, Bushfire CRC, and from fire management and environment agencies in NSW and Victoria.

This article was originally published on The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons licence.

 The latest report card on health and wellbeing in Australia – Australia’s welfare 2013 – paints a broad picture of a healthy and wealthy nation, but also maps entrenched and emerging disadvantage.

So too do two other recent reports that drill further down into some of the issues: the latest data from the Australian Bureau of Statistics on Household Income and Income Distribution 2011-12, and the Productivity Commission’s report on Deep and Persistent Disadvantage in Australia.

Australia’s Welfare 2013 is the 11th biennial  snapshot on welfare services from the Australian Institute of Health and Welfare (AIHW). Understandably it’s a big tome, but comes also as a summary, and is packed with accessible information and infographics.

The report notes that we’re living and working longer and are better educated than ever before, but many amongst us – particularly older people, Indigenous Australians, sole parents and their children, and people living in rural and regional areas – face ongoing health and welfare issues. The implications of an ageing population also loom across most indicators: health, housing, workforce, disability and more.

“Where we live, our family structure and our levels of education all affect the quality of our lives and how long we can expect to live,” said AIHW Director and CEO David Kalisch on releasing the report earlier this month.

This is particularly stark amongst Indigenous Australians – although the report records positive trends in housing, education and employment – and outside of major cities, where death and disability rates are higher and incomes and workforce participation lower.

 Drawing on its own and other reports, it notes that relatively disadvantaged members of the community live shorter lives and have higher rates of illness and disability, that  higher levels of education and income are associated with lower prevalence of risk factors to health (such as smoking and obesity), and that access to economic resources is positively linked to mental health and wellbeing, and optimal child development.

Australia’s welfare 2013: broad findings

Life, health and demographics

– Australian life expectancy for a boy born between 2009 and 2011 is 79.7 years, and for a girl 84.2 years—among the highest in the world.

– Life expectancy of Indigenous boys born between 2005 and 2007 (the latest data available) was estimated to be 67.2 years and 72.9 years for Indigenous girls, although the gap with non-Indigenous rates is closing.

– Age specific death rates among Indigenous Australians between 2007-2011 were at least double non-Indigenous rates in all age groups bar over 65 years and under 1 year, although they are still higher. The most pronounced difference comes between 24-54 years, at 4-5 times higher than the non-Indigenous rate.

– More than 3 million Australians (14 per cent) now are aged 65 and over, nearly 3 times as many as 40 years ago – including nearly 425,000 aged 85-plus, a sixfold increase.

– The number of young people is up by only 21 per cent over that time (32 per cent of the population versus 46 per cent in 1972).

– Infant mortality was 3.8 per 1,000 live births in 2011 – the lowest rate on record. Indigenous infant mortality rates remain much higher (6.6 per 1,000 live births according to limited data) although there has been a significant closing of the gap in recent years.

– 4 million Australians (nearly 1 in 5) have some form of disability.

Poverty and income support

– Government pensions and allowances were the main source of income for 1 in 4 households in 2009–10. Perhaps seen through an election lens, one report lamented taxpayers were ‘forking out’ more for welfare than health care – perhaps understating the realitiy that more than half of the spend is on the aged pension.

– Despite spending an estimated $12 billion on income support and welfare services, 13 per cent of households (2009) are considered to live in relative income poverty.

 Workforce trends

– The report says people in their 60s are ‘increasingly choosing to work’ rather than retire – though that may be as much to do with changing pension and super entitlements as choice.

– Women are taking less time off work after having children, and are doing this later in life, but young adults continue to struggle to get a foothold in employment.

– Currently we have around 2 adults of ‘traditional working age’ (15–64) for every person of ‘dependent’ age (over 65 or under 15). By 2032 this figure will drop to 1.7.

– The community services workforce grew by 24 per cent between 2006 and 2011.

Housing and homelessness

– The average number of people per household dropped between 1986 and 2001, but remained steady to 2011 at 2.6. The report attributes this to more young people staying at home for longer, yet empty nesters – families with no children at home – are forecast to exceed those still with children by next year for the first time.

– In another new trend, there are now more households with a mortgage (36 per cent) than those who own their homes outright (33 per cent). Ten years ago the reverse was true.

– The number of lower income households in ‘housing stress’ – paying more than 30 per cent of their gross incomes on housing – rose from 19 per cent in 2003-04 to 22 per cent in 2009–10.

– Lone person households are expected to be the fastest growing household type in coming decades.

– 105,000 Australians were homeless in 2011.

Deep and persistent disadvantage

The report also looks at the complexity in disadvantage, with 5 per cent of adults experiencing multiple disadvantage. This too is the focus of the Productivity Commission report, which drills down into the characteristics and extent of deep disadvantage in Australia, noting that disadvantage is a ‘multi-dimensional concept’: about impoverished lives (including lack of opportunity) not just low income.

The report’s nuanced discussion about differences in educational performance between children of low and high socioeconomic backgrounds saw one front page newspaper report declare ‘Genes a reason poor kids struggle at school’.  That in turn attracted this warning at The Conversation against ‘blaming the victim’.

As does Australia’s Welfare 2013, the Productivity Commission paper identifies lone parents and their children, Indigenous Australians, people with a long-term health condition or disability, and people with low educational attainment as most vulnerable to long-term disadvantage.

It also notes most people in these groups are able to avoid deep and persistent disadvantage, through: their personal capabilities and family circumstances; the support they receive; the community where they live (and the opportunities it offers); life events; and the broader economic and social environment.

Household income distribution

Finally, new Australian Bureau of Statistics (ABS) data on Household Income and Income Distribution 2011-12 showed that income inequality in Australia has decreased. This is good news, of course, but – as this analysis by my VCOSS colleague points out – the ABS digs into the data further to show a more complex picture about ‘low economic resource’ households.

Marie McInerney works part-time as a writer and editor for the Victorian Council of Social Service (VCOSS).


general practice

May 30, 2013


Anthony Scott writes:

If you live far from a city, you are likely to be in poorer health than your urban counterparts; you’re also less likely to use health-care services and if you do, you’ll have to wait longer for care. In rural areas, almost one-third (29%) of patients wait 24 hours or more to see a GP for an urgent appointment. Waiting times for emergency hospital care are also getting worse in rural areas but improving in major cities.

If you live in the country, your GP is more likely to have qualified in Europe, the Indian sub-continent, or Asia, than Australia. GPs from overseas are forced to work in rural areas for a fixed period after they arrive, with around 40% of doctors in rural areas qualified in other countries.

These GPs fill an important gap; in the absence of effective policies to encourage Australian-trained GPs to work in rural areas, we will continue to rely on overseas-trained doctors for some time. This is a very cost-effective policy for Australia, but the ethics of depleting the supply of doctors from developing countries are murky.

Many of these doctors want to eventually work in the city, and so they are difficult to retain once their obligatory time in the bush is completed.

Continue reading “Country practice: recruiting doctors to work in the bush”

health and medical research

May 21, 2013


“The implementation of primary health care (PHC) may well be one of the most significant systemic and ideological health reforms of modern times. Countries with stronger PHC systems have demonstrably more efficient, effective, and equitable health care. Primary health care can be considered a philosophy, an approach to the delivery and development of services and first contact health services. It is based on a social, rather than biomedical, model of health, with accessibility to and affordability of service as primary objectives.”

That is the powerful opening statement to a new systematic review investigating what are the core primary health care services that Australians living in rural and remote areas should be able to access.

Thanks to one of the researchers, Associate Professor Tim Carey, for reporting on the findings (which you can also read in full in BMC Health Services Research).

The review raises the tantalising question: if these core services can be identified, will this provide some obligation on funders to ensure they are available and accessible?


What primary health care services should residents of rural and remote Australia be able to access?

Tim Carey writes:

The disparity in health outcomes between rural and remote Australians compared to their metropolitan counterparts is well established.

One way of helping to reduce this disparity is to have a clear idea of those primary care services that should be considered “core” or essential to any health service regardless of locality.

In metropolitan areas where a wide range of services is readily available, demarcating core services might not be necessary. In rural and remote places, however, where populations are dispersed, what services are most essential and how those services should be delivered are issues of fundamental importance.

A systematic review was undertaken to identify the services that could reasonably be considered “core”. That is, we wanted to find out what the essential package of primary care services were that any Australian, regardless of geography, had a right to expect access to.

We were also interested in understanding the methodology by which any particular researcher or research group arrived at a selection of core services.

The results surprised us. Continue reading “A surprising lack of clarity around the definition of core primary health care services”

National Rural Health Conference 2013

Apr 10, 2013


One of the clear themes from the National Rural Health Conference has been the importance of social connections and online support for health and wellbeing.

On a related note, there have been many discussions about how social media is powering advocacy for rural and remote health, and the importance of online connections for health service development and delivery.

In the wake of the Coalition’s NBN policy launch yesterday, conference delegates have been directing some pointed tweets to @TurnbullMalcolm. 

Parri Gregory, who kindly volunteered to help with Croakey’s coverage of the conference, reports below on some of the discussions about telehealth and social media.


No wonder #ruralhealthconf has been trending

Parri Gregory writes:

It may have been the magic of a wand that sparked uproarious laughter on Monday morning, at the start of the first full day of the National Rural Health Conference (NRHC) in Adelaide, but by the end of the day the magic of technology and its utility within the health field was high on the agenda of many delegates.

The wand in question belonged to James Fitzpatrick, former NRHC Master of Ceremonies, Young Australian of the Year (2001), Fellow of the Australian Rural Leadership Foundation and current researcher at the Telethon Institute for Child Health Research.

James’s enthusiasm was matched by Tanya Lehmann from Country Health SA, who was dressed as a circus ring master complete with whip, and the pair acted out a theatrical quarrel between managerialism and creativity in the health context, resulting in the obvious conclusion that both are needed for success.

Following this bright start to the day, the technology theme began with a Top 20 presentation from Deborah Smith, of the Consumers Health Forum of Australia. Deborah’s presentation, called “One voice matters, many voices make a difference”, explained that in the online world, the barrier of distance disappears.

She said that, as consumers from all locations are critical to the development of health policy, these voices can be – and should be – heard in an online environment. Continue reading “Online connections are critical for rural and remote health and healthcare #NBN”