This edition of The Health Wrap is compiled by Megan Howe, Sax Institute Publications Manager.
The postcode health lottery
The likelihood that you are obese, are fully immunised, have a caesarean, get the best medical treatment or develop cancer is likely to be vastly different depending on the postcode in which you live, according to major health reports that have been making news this fortnight.
The Australian Commission on Safety and Quality in Health Care’s Second Australian Atlas of Healthcare Prevention revealed there was a difference of up to 21-fold in whether patients with the same condition were given certain treatments depending on where they lived, The Sydney Morning Herald reported. It said Sydney’s eastern suburbs had the nation’s highest rate of lumbar spinal decompression procedures, while the Hawkesbury had one of the highest rates of appendix removal in the western world.
News.com.au reported that the Atlas had raised concerns that many women were missing out on less invasive and highly effective treatments for conditions such as heavy menstrual bleeding, as it showed that hysterectomy rates were much higher in some states, such as Victoria.
And The Australian (paywalled) focused on the report’s finding that the rate of caesarean sections varied by up to three times depending on where in Australia women give birth, with obesity rates likely to be a contributing factor.
Meanwhile, a new Australian Institute of Health and Welfare (AIHW) report revealed that cancers were responsible for a greater health burden in terms of years of life lost than any other health condition in the country. The report also showed that Aboriginal and Torres Strait Islander people, people in lower socioeconomic groups and those living in remote areas faced a far greater burden from cancer than other Australians, as reported by The Age.
Variations in immunisation rates across the country were also in the spotlight, with the latest AIHW Healthy Communities report outlining rates by suburb, and showing disparities between some neighbouring communities. The Sydney Morning Herald reported that Sydney’s 2000 postcode has the worst childhood vaccination rate in the country, with just 70.5 per cent of five-year-old children fully vaccinated in 2015–16, compared with the national rate of 92.9 per cent.
Vaccination researcher Associate Professor Julie Leask from the University of Sydney told SBS that rather than focus on anti-vaxxers in outlier communities like Byron Bay, more attention should be given to vaccinating the tens of thousands of children in suburban areas where infectious disease outbreaks were more likely given the close proximity of residents and the higher numbers of incoming travellers. She commented:
“Sure, there are these areas that have the low rates, but then you’ve got these big populations of under-vaccinated kids getting less attention.”
Health equity was also the focus of this article on Croakey, which outlined the findings of a new study that looked at how opening primary care to market forces could entrench disadvantage in Australia. This is despite it having the potential to increase objectivity, improve targeted delivery of services and reduce conflicts of interest.
The push to improve access to healthcare in rural and remote Australia by creating the new role of a National Rural Health Commissioner was put under the microscope by former National Rural Health Alliance CEO, Gordon Gregory, in this piece on Croakey.
And medical student and health journalist Amy Corderoy focused on the urgent need to fix health inequality in Australia in this essay in The Guardian, originally published inGriffithReview 56: Millennials Strike Back, in which she suggested along with tobacco taxes, we need to introduce a “snake-oil tax” on the many non-evidence based complementary and alternative medicines that are sold each year. She wrote:
“We need to start thinking of this waste of wellness dollars as an ethical issue. Because the money is needed elsewhere. And desperately.”
Decision making on Aboriginal health
The AIHW Healthy Communities report on immunisation brought some good news for Aboriginal health, showing that 94.6 per cent of Aboriginal and Torres Strait Islander five-year-olds were fully immunised – higher than than the national rate of 92.9 per cent. However, there was wide variation across Primary Health Network areas, ranging from 98.8 per cent in the Gold Coast (Qld) to 89.4 per cent in Western Victoria, as detailed by NACCHO.
While immunisation programs targeting Aboriginal and Torres Strait Islander people appear to be succeeding, this article at Croakey by Sara Hudson argued for a new co-accountable approach to evaluating what works and what doesn’t when it comes to government-funded programs aimed at Closing the Gap.
Based on her report Evaluating Indigenous programs: a toolkit for change, Hudson, Research Fellow and Manager of the Indigenous Research Program at the Centre for Independent Studies, said Aboriginal and Torres Strait Islander people must be the heart of decision making:
“Going forward, the government should vest greater decision-making power in Indigenous communities by creating a co-accountable approach to service-delivery management and outcomes. In this framework, communities could hold the decision-making capacity as to how and where money is spent for services, according to each community’s individual needs.
Her comments came as Victorian Aboriginal Community Controlled Health Organisation (VACCHO) CEO Jill Gallagher warned that co-design with community groups could not work if governments sought input after big decisions had already been made or if there was rushed consultation. Gallagher said the organisation was recently given two days to respond to a draft family violence plan “the size of a PhD”, in what she described as an example of governments not understanding how to work with Aboriginal communities, as reported by The Mandarin. She said:
“It’s not an equal partnership. We’re at their whim, and we’ve got to run to their agenda.”
Meanwhile, the Australasian College for Emergency Medicine urged an overhaul of Australia’s hospital emergency departments to make them culturally-appropriate for Aboriginal and Torres Strait Islander people. In a submission to the Federal Department of Health’s advisory group on Aboriginal and Torres Strait Islander health, the College called for more Aboriginal staff in EDs, and for non-Aboriginal staff to be trained in cultural competency.
And the National Indigenous Times reported that Australian National University was set to open a new pathway for Indigenous and rural students to become doctors and health professionals. From 2018, the University’s Medical School will offer a new Bachelor of Health Science program, with a minimum of 15 of its 50 positions reserved for Aboriginal and Torres Strait Islander and rural students.
Dollars and sense
The Federal Government’s long-running review of the Medical Benefits Schedule (MBS) was in the media spotlight, with The Sydney Morning Herald reporting that the Review Taskforce had recommended changes to home doctor services that provide after-hours visits. The medical deputising services faced stricter conditions on their Medicare billing practices, after the review found the dramatic growth in MBS-funded urgent after-hours visits was not due to clinical need, and did not represent value for money to the taxpayer.
However, ABC News reported that the National Association for Medical Deputising Services (NAMDS), which represents the services that provide after-hours visits, had warned that reducing the availability of after-hours doctors’ care would drive patients to hospital emergency departments and cost lives. NAMDS president Dr Spiro Doukakis said:
“Emergency departments across Australia will be flooded if these recommendations are pursued by the Government because our services will have no choice but to close.”
Meanwhile, medical publication Australian Doctor reported that another of the MBS Taskforce review committees looking into diagnostic imaging had recommended that GPs should be banned for ordering Medicare-funded knee MRIs on for patients aged 50 or older, amid a blowout in costs for the scans in older patients.
State and territory health funding was also in the news this fortnight, with the Fairfax press reporting that the ACT budget was putting a new focus on preventive health. The Territory had expanded Health Minister Meegan Fitzharris‘ portfolio to take in “wellbeing”, and released a new two-pronged strategy to reduce the rate of heart disease and diabetes, it reported.
In NSW, the Government announced a $63 million budget boost to provide more front-line child protection caseworkers, as well as $100 million to improve access to palliative care services, especially in country NSW. As reported by ABC News, NSW Premier Gladys Berejiklian said the money would fund extra services and training for hundreds of staff over the next four years:
“Whether you live in Sydney, whether you live in Western Sydney, whether you live in a remote community in rural and regional NSW, you will have access to greater care.”
The Queensland state budget pledged $916 million for new health infrastructure, including redevelopment of several hospitals, new mental health and primary care facilities, and upgrades to staff accommodation in rural areas, The Australian reported (paywall).
Push for prevention
A new Prevention 1st report has revealed that Australia spends just $89 per person per year on preventive health, significantly less than international peers. The report, Preventative Health: How much does Australia spend and is it enough, authored by Hannah Jackson and Alan Shiell from La Trobe University’s Department of Public Health and the The Australian Prevention Partnership Centre, found Australia’s $2 billion per year preventive health spend accounts for just 1.34 per cent of all health spending, considerably less than countries including Canada, New Zealand and the United Kingdom. As detailed by Croakey, the report suggests we must commit more funding to preventive health in order to stave off budget blowouts related to chronic disease.
More also needs to be done to address injuries to children, which cost the nation about $2 billion over a decade, according to a 10-year national review of childhood injuries that found nearly 700,000 children ended up in hospital with an injury between 2002 and 2012. ABC Newsreported that the authors were urging the Federal Government to introduce a national injury prevention plan.
In some news welcomed by public health experts, the NSW government announced it was set to ban its hospital cafes, staff kiosks, vending machines and catering services from selling sugar-sweetened beverages with no nutritional value – the first state to take such action. The restriction is part of NSW Health’s new “Healthy Choices in Health Facilities” policy framework, which also limits the amount of junk food that can be sold to 25 per cent of a cafeteria or vending machine’s offerings and requires most food to have a health star rating of 3.5 or above, Fairfax media reported. NSW Chief Health Officer Dr Kerry Chant said:
“We are working toward a 5 per cent reduction in overweight and obesity rates in adults by 2020 and there’s no better way to start than right here on our own doorstep.”
The move comes after ABC News reported on a study that found soft drinks sold in Australia have higher levels of glucose, which is linked to an increased chance of developing heart disease and type 2 diabetes.
Meanwhile, a new study published in the American Journal of Clinical Nutrition confirmed that too many French fries can be a killer, showing that those who eat fried potato two or more times each week have double the chance of dying compared to those who eat none, as reported by news.com.au.
BBC News reported on new global study that showed you don’t have be in the obese weight category to be at risk of dying from illnesses related to excess weight, with more than 2 billion children and adults globally found to suffer from health problems linked to being overweight. Of the 4 million deaths attributed to being overweight in 2015, nearly 40% were not considered clinically obese.
In other preventive health news, an interesting article in The Sydney Morning Herald outlined how Sweden had slashed its smoking rate to 5 per cent by adopting a “harm reduction” strategy that has involved largely replacing deadly cigarettes with a product called snus, that gives users both nicotine and tobacco, without raising the odds of dying in the same way that smoking does.
And this Croakey article from the Cancer Council Western Australia gives an insight into selling health messages on Facebook, including how to measure key outcomes and how to use the data to inform campaign evaluations and future communications activities.
A devastating cholera epidemic in Yemen that is killing one person every hour has seen the closure of the main airport and prevented many human rights workers from entering the country, according to ABC News.
The epidemic compounds what The Sydney Morning Herald described as “the worst humanitarian disaster since World War II” – a famine affecting Yemen, Nigeria, South Sudan, Somalia and and other East African countries that has seen up to 23 million people at risk of starvation.
The Guardian reported that the global push to eradicate polio had been set back by two separate outbreaks of polio in the Democratic Republic of the Congo, and, in an article entitled “America’s Hidden HIV epidemic”, the New York Times revealed that America’s black gay and bisexual men have a higher HIV rate than any country in the world.
In some more positive news reported by BBC News, the number of children dying worldwide of diarrhoea fell by a third between 2005 and 2015, according to a new study that suggested better access to clean water and sanitation was key.
The global bid to tackle antibiotic resistance saw the World Health Organisation classify antibiotics into three categories for the first time in its latest edition of the essential medicines list. Stat News reported that the list divides antibiotics into three categories: the “access” antibiotics that should be go-to drugs for common infections; the “watch” category for which growing resistance is a problem; and the final “reserve” category for those drugs that should only be used to treat infections for which other options have failed.
And finally, the long running Flint drinking water contamination crisis in Michigan, United States, continues to make waves, with The Guardian reporting that five Michigan officials, including the head of the state health department, have been charged with involuntary manslaughter in connection with the crisis. The charges relate to the death of a 85-year-old man who contracted Legionnaires’ disease and died after the city’s water source was changed to cut costs.
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