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11 September 2017.
The Health Wrap is a regular feature on Croakey from the Sax Institute and The Australian Prevention Partnership Centre communications team, which covers some of the interesting and important health news from the previous fortnight, including items covered at Croakey and elsewhere. Enjoy the wrap and tweet us @SaxInstitute with any items you think should make it into the next issue.
By Helen Signy, Senior Communications Officer at The Australian Prevention Partnership Centre, based at the Sax Institute.
Welfare reform: will it work to combat addiction?
This week, Social Services Minister Christian Porter stongly criticised “establishment doctors” for their failure to try something new when it comes to tackling addiction. He was referring to medical and treatment specialists’ condemnation of proposed Federal Government welfare reforms, led by AMA President Dr Michael Gannon in a speech to the National Press Club and in an open letter signed by nearly 1000 doctors, nurses, and health care workers from organisations such as the AMA, Uniting Care and St Vincent’s Health calling on Federal MPs to reject the proposal. Croakey has also reported on widespread oppositionto the measure in recent months.
The Government’s plan is to trial drug testing of 5000 new welfare recipients in Mandurah in Western Australia, Logan in Queensland, and Canterbury-Bankstown in New South Wales from January next year. If Newstart and Youth Allowance recipients test positive for substances such as ice, ecstasy and marijuana, 80 per cent of their payments will be put onto a cashless debit card.
The Australian Council of Social Service (ACOSS) has called on the government to strengthen the safety net, as reported by Croakey here, and Labor senator Pat Dodson told the Guardian that the government should focus on holistic solutions to alcohol, drug addiction and violence in Indigenous communities.
Some experts, meanwhile, warned that the plan would overwhelm drug treatment services in the trial sites, while other addiction specialists said the move would do nothing to combat addiction − you can read addiction specialist Associate Professor Adrian Reynolds’ take here. His view was echoed by Matt Noffs of the Ted Noffs Foundation as reported by ABC News:
This bill is not only going to fail, it will increase crime in the community and that should be a major concern for all Australians …Are you so foolish that you think simply quarantining someone’s money will stop them from using drugs?”
Despite the criticism of the plan, a Senate inquiry into the government’s overhaul of the welfare system this week recommended the legislation be passed, meaning the drug-testing proposal would go ahead, The Guardian reported.
Focus on smoking
Following the disturbing news that two in five pregnant teenagers in Canberra smoke, it is worth re-reading this piece from Professor Kerry Arabena, which tracks the sometimes perverse incentives that cause young people to continue the habit . Her conversation 10 years ago with a pregnant, smoking 15-year-old is a valuable reminder of the importance of really listening to those public health is trying to target. Arabena wrote:
Being a responsible adult, I first judged her and then chose to enlighten her with my deep knowledge of health messaging about smoking in pregnancy. Being non-confronting, I thought I would use my social work skills to invite her into the conversation… ‘So, smoking while pregnant, are we?’ She took a serious drag and said, ‘Well, at least I’m not doing heroin any more’.”
The need for continued anti-smoking messaging is clear, say Australian public health experts, who called in MJA Insight for reinstatement of mass-reach anti-smoking campaigns that target high smoking prevalence populations such as those with severe mental illness, those who have been recently incarcerated, and Aboriginal and Torres Strait Islander people. However, as one-time “QuitMan” Ben O’Mara explains in this article on Croakey, there remain important questions over the relevance and effectiveness of ‘traditional’ health promotion strategies.
In the UK, meanwhile, The Telegraph reported that Public Health England had releasedfindings of a major study into 60,000 11 to 16 year-old smokers, which found no evidence that e-cigarettes acted as a gateway to tobacco smoking – findings also supported by a large study in the United States, analysed on Forbes here. Experts in Australia are still strongly divided over the benefits and dangers of vaping. This excellent feature in The Guardian summarises these divisions, quoting cancer biologist Miranda Ween, who found her poster on the harms of e-cigarette flavours on the cells of the lungs vandalised on the floor at a medical conference where she was speaking on the issue.
Reasserting the value of science
The findings of the 2017 Australian Beliefs and Attitudes Towards Science (ABAS) survey, reported in The Conversation recently, paint an interesting picture of Australians’ attitudes to evidence.
Conducted by the Australian Centre for the Public Awareness of Science, and commissioned by the Department of Industry, Innovation and Science, the survey found most Australians are very pro-science and are quite highly engaged with science-related issues. While they think the pace of change is too fast, more than half of respondents would like to see new drugs released without waiting for clinical trials.
It’s a similar picture with Research Australia’s latest opinion poll, which confirms most people see health and medical research as a high spending priority, and that there is overwhelming support for embedding research in the health system.
So if research is so widely trusted, why does it not have more influence in policy?
A Danish study , published in the British Journal of Political Science and reported here, found that politicians were unlikely to change their prior beliefs, even in the face of overwhelming evidence. It’s a finding that seems to be born out in Australia, with growing concern that Australian public policy has developed a post-truth political culture. As the Mandarin reports, the recent Power to Persuade symposium acknowledged that this post-truth climate is making evidence-based policy harder, but provided some solutions that offer hope.
Some commentators argue that it’s up to scientists themselves to address the problem. Arizona State University’s Daniel Sarewitz, co-director of the Consortium for Science, Policy & Outcomes, writes in the The Guardian that it’s important to stop treating science denial like a disease. In fact, he concludes, maybe a little science denial is in order these days:
Much of science is on the verge of a crisis that threatens its viability, integrity, legitimacy and utility. This crisis stems from a growing awareness that much of the science being produced today is, by the norms of science itself, of poor quality; that significant areas of research are driven by self-reinforcing fads and opportunities to game the funding system, or to advance particular agendas; that publication rates continue to grow exponentially with little evidence that much of what is published actually gets read; and that the promises of social benefit made on behalf of many avenues of science are looking increasingly implausible, if not ridiculous.”
Towards big data heaven
Linked, de-identified health data are the Holy Grail for health researchers. Large scale retrospective analysis of real life patient outcomes, linked to other information about the determinants of health, can result in the identication of critical patterns and trends without having to conduct a clinical trial.
But Australia is being left behind in using big data for health, according to an analysis in the Medical Republic (registration required) – largely because until recently Australian researchers have had to wait years to gain access to data. By contrast, in Denmark GPs, specialists, pharmacists and hospitals all interact using a central database, through which each patient’s journey is tracked using a unique ID number.
The evidence of the benefits of big data for health is mounting. In Australia this week alone, it was reported that big data are being used in research projects to shed light on bipolar disorder − using whole genome sequencing of 1200 participants recruited from the Sax Institute’s 45 and Up Study cohort study − as well as the genetic causes of osteoporosis. And a recent US study is laying the groundwork to generate substantial evidence in favour of incorporating social determinants of health into electronic health record data – you can read more about what they found here.
Meanwhile, Professor Jon Karnon, from the School of Public Health, University of Adelaide, has suggested a shake up of how medical research applications to the NHMRC are assessed. He wrote in Croakey:
…without substantial changes to the way in which grant applications are assessed, the process will continue to incentivize high-cost research. A focus on value for money, analogous to the processes by which new technologies are assessed, could support more research and even higher returns to research funding.
The tragic news of what may be one of Australia’s youngest suicides − the death of a nine-year-old Aboriginal boy in Queensland this week − has thrown the mental health of Aboriginal and Torres Strait Islander people into the spotlight again.
As highlighted by Clinton Pryor’s epic walk across Australia, attempts to address Aboriginal and Torres Strait Islander health must take into account injustices such as homelessness, poverty, the failure of the justice system and oppressive policies. The Sydney Morning Heraldreported that Aboriginal people who suffered childhood trauma, such as being part of the Stolen Generations, were nearly three times more likely to develop dementia, especially Alzheimer’s disease, than others, while the Royal Australasian College of Surgeons told the Royal Commission into the Protection and Detention of Children in the Northern Territory that the impact of ear disease and hearing loss is a significant cause of Aboriginal and Torres Strait Islander children ending up in the justice system.
Meanwhile, the National Indigenous Times pointed out that children with developmental delays and behavioural problems in the Northern Territory are missing out on early treatment because health services aren’t available or the waiting lists are too long. And NACCHO highlighted concerns that Aboriginal and Torres Strait Islander people were being left behind in the roll out of the NDIS, with only 5 per cent of the 100,000 participants engaged in the scheme being Aboriginal and Torres Strait Islander, even though they are 70 per cent more likely to experience disability than the general population.
Croakey reported from the MHS Annual forum that relationships and storytelling are vital for healing in Indigenous communities. And writing in The Conversation, remote health expert Tim Carey explained why a traditional biomedical approach was not enough. As the Federal Government rolls out its $40 million plan to evaluate Indigenous health programs, he argued that it is important to understand health problems in the context of the real lives of Aboriginal and Torres Strait Islander people.
Especially in the area of Indigenous health, the health and medical community must be guided by what patients want, not just by what health professionals know how to do.
Meanwhile, this Croakey interview featured two visiting water protectors from the US, Janelle Cronin and Zachary Wamego, who gave presentations about the trauma and violence experienced by those defending the Standing Rock reservation’s water supply and sacred sites against the North Dakota Access pipeline. Although the stories they told were harrowing, Cronin and Wamego ultimately presented a message of hope, describing an upsurge in resistance and solidarity generated by Standing Rock.
Prevention is better than cure
Amid news of the worst ever flu epidemic and a national shortage of tamiflu, Australians are being urged to get vaccinated. The Sydney Morning Herald reported that AMA President Michael Gannon had expressed frustration at the low uptake of the flu vaccination, warning of the possibility of a future pandemic, while Health Minister Greg Hunt called for compulsory flu vaccinations for aged care workers following multiple flu-related deaths in nursing homes. This useful article in The Conversation explains why the outbreak has been so bad this year.
In more positive news, increased testing, early detection and fast treatment have led to a rapid decline in new HIV infection rates in NSW, meaning the state is on track to virtually eliminate HIV transmissions by 2020, according to a report in The Sydney Morning Herald.
The SMH also reported that the Australian-developed cervical cancer vaccine that has been administered to high school students for a decade could be replaced with a new, even more effective vaccine. The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended that the new vaccine Gardasil 9 be used in the school-age program, as it has been shown to prevent 90 per cent of cervical cancers worldwide, compared with 70 per cent with the original vaccine.