4 December 2017.

The Health Wrap is a regular feature on Croakey from the Sax Institute and The Australian Prevention Partnership Centre communications teams, which looks at how the media has covered some of the top public health stories making headlines in recent weeks.  Enjoy the wrap and tweet us @SaxInstitute with any comments or suggestions.

US tobacco companies forced to admit smoking kills

After a 19-year battle with the US Department of Justice, US tobacco companies have finally been ordered to run a series of newspaper and prime time TV ads admitting that smoking kills and is addictive.

A 2016 ruling found Altria, RJ Reynolds, Lorillard and Philip Morris USA had violated civil racketeering laws and defrauded the American people. But it has taken more than a decade of litigation to agree on the wording of the corrective statements, which will run across major TV and print networks for a year, says this ABC News report. It also quotes Cancer Council WA spokeswoman Kelly Kennington on the importance of a similar advertising campaign in Australia:

We’ve showed this ad already to a collection of smokers and the majority of them have been really alarmed and angry that the tobacco industry has been able to behave like this over the years – particularly the fact that they’re admitting they intentionally design cigarettes to be more addictive.”

Meanwhile, Dr Ross MacKenzie, Eric LeGresley and Mike Daube have published a commentary and podcast in the Medical Journal of Australia arguing that governments should consider litigation against the tobacco industry to recover the massive health care costs associated with use of their products. While litigation can be lengthy and costly, they argue, the potential returns are enormous.

And more good news on the anti-smoking front from one of the last bastions of public cigarette smoking, Japan. The Tokyo Metropolitan Government is reportedly considering a raft of measures to rein in passive smoking in time for the 2020 Olympics. According to the New York Times’ Tokyo bureau chief Motoko Rich, smoking could be banned indoors in most public places early next year, while smokers will be confined to specially designated zones outdoors. He wrote:

Not so long ago, smoking was as much a part of the culture as obedience … In Japan, a country where individuals are reluctant to stand out, many people say that if such a smoking ban is imposed, they will have no choice but to follow it.”

Still, there’s no room for complacency. A number of public health advocates warned delegates to the recent Oceania Tobacco Control Conference (OTCC) in Hobart that the industry continues to infiltrate policy and engage in divide-and-conquer tactics against public health advocates, as reported by Croakey.

Of particular concern is the often vitriolic debate over e-cigarettes, which the conference heard is threatening the unity of the anti-tobacco lobby. For a detailed account of how this is happening and a summary of the evidence to date, The Verge reports that the vaping controversy is following Big Tobacco’s playbook:

E-cigarettes are the latest in a series of products tobacco companies have claimed reduce the risk of smoking. Public health officials have long urged independent testing of the tobacco industry’s reduced-harm claims — just as they are for e-cigarettes today — earning the wrath of reduced-harm activists who see their calls for evidence as condemning smokers to “quit or die.”

Paying for hospital care

Is private health insurance worth it? That’s the question being asked by a range of media including the ABC7News and News Limited since investment advisers Morgan Stanley suggested it might be more cost effective to pay the Medicare Levy than private health cover.

With a steady fall in Australians taking out cover and confidence in the public hospital system continuing to grow, the articles quote Morgan Stanley’s Executive Director Daniel Toohey as saying the government should refuse any premium increases until the industry sorts itself out.

The news follows another report in The Australian (paywalled) about the Morgan Stanley report into private health funds and hospitals in Australia, which quoted Toohey as saying that reversing the declining participation in private health cover would likely require “value” rather than “discounts”. He said:

Participation is beyond the tipping point and now subzero. Existing policy settings have lost their efficacy. Recently announced reform measures such as prostheses and higher maximum excesses should help soften near term premium hikes but do not fix the affordability issue or underlying claims inflation.

Health Minister Greg Hunt has recently announced a number of changes that will help private health insurers reduce premium increases. And further landmark measures to reduce public hospital costs were announced with the release of the IHPA (Independent Hospital Pricing Authority) Pricing Framework for Australian Public Hospital Services 2018-19, which states that public hospitals will have to absorb the costs of avoidable complications such as pressure injuries, infections and falls.

The Australian reported (paywalled) that the move, aiming to improve quality standards and reduce costs in public hospitals, could see hundreds of millions of dollars in funding withheld. Recent estimates suggest as many as 9.9 per cent of hospitalisations involve a hospital-acquired complication, most commonly relating to childbirth and cardiovascular complications.

The National Safety and Quality Health Service (NSQHS) Standards have already succeeded in improving infections and the treatment of in-hospital cardiac arrest. The second edition of the standards, released this week, place a new focus on high risk groups, as reported in this Croakey analysis.

But there are concerns about changes to the way the Commonwealth funds public hospitals. Associate Professor Helen Dickinson from UNSW, Sydney, suggests in The Conversation that withdrawing funding for hospitals’ mistakes probably won’t lead to better patient care. 

The vicious cycle of poverty, obesity and chronic disease

Two in three Australian adults are overweight or obese – a 28 per cent increase since 1995 – and one in five children is overweight before they start school, according to the Australian Institute of Health and Welfare’s latest report into overweight and obesity.

The AIHW highlighted geographic and socioeconomic disparities in obesity, with low socioeconomic status associated with higher BMIs. The most disadvantaged children were 1.5 times more likely to be overweight or obese compared to children from the most affluent areas, according to a report in The Sydney Morning Herald.

These findings were born out in the 2017 Australia’s Health Tracker by Socioeconomic status report, released by the Australian Health Policy Collaboration, which highlights how 10 million Australians who fall into the lower socio-economic quintiles are at much greater risk of poor health.

Writing in The Conversation, the Collaboration’s Ben Harris and Rosemary Calder explain the poorest 40 per cent of the population are much more likely to be obese, less likely to participate in physical activity, and much more likely to smoke. They wrote:

There’s a vicious feedback loop – if your health is struggling, it’s harder to build your wealth. If you’re unable to work as much as you want, you can’t build your wealth, so it’s much tougher to improve your health.”

They call for increased spending on prevention and early intervention – currently standing at 1.3 percent of the Australian health budget compared to countries such as New Zealand, Finland and Canada, which spend around six percent on prevention. This past fortnight has also seen a focus on failures in alcohol policy, with an event marking the 40-year anniversary of a landmark report released by a Senate committee chaired by Senator Peter Baume: Drugs in Australia – an Intoxicated Society.

Bean counters in the UK have a different plan, meanwhile, with outrage sparked by proposed new policies by clinical commissioning groups across England that could see patients banned from surgery indefinitely unless they quit smoking or lose weight – a move likely to impact the most disadvantaged, according to commentators.

You can hear the reaction from Ruth Robertson of the King’s Fund and Professor Helen Stokes-Lampard of the Royal College of GPs in this BBC report.

Meanwhile, Croakey noted a new report from the UK, examining how non-health charities can help address the social determinants, while Dr Tim Woodruff examined whether a basic income guarantee could be a health-promoting welfare reform helping six million Australians.