18 April 2017.

The Health Wrap is a regular feature on Croakey from the Sax Institute 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 Megan Howe, Publications and Marketing Manager, Sax Institute

Budget build up

With the Federal Government’s May Budget edging closer, media speculation has begun about what might be on the chopping block to save health dollars.

The Age reported that the Government was trying to allay fears it would cut the program that gives taxpayer-subsidised sick leave to living organ donors after the Department of Health started emailing prospective donors to say funding for the Leave for Living Organ Donors program would cease on June 30. They were told that if they wanted the subsidy, they would need to undergo surgery before July and lodge their claims by September. According to the report, Health Minister Greg Hunt confirmed the program was being re-assessed as part of the budget process, but said he was confident of “a very positive announcement in the near future”.

According to The Sydney Morning Herald, the “budget razor gang” is also looking at changes to the $10 billion Pharmaceutical Benefits Scheme (PBS) with the aim of cutting the price of medicines. The paper reported that Minister Hunt was close to finalising a new agreement with pharmaceutical industry body Medicines Australia that would bring down the cost of some drugs in exchange for price certainty and stability.

Meanwhile, an area that looks set to be expanded in the budget is the Government’s cashless welfare card trial, according to ABC News. It reported that a growing number of Coalition MPs have called for new trial sites to combat alcohol and drug problems in their regions.

The compulsory scheme, in which a cashless debit card quarantines 80 per cent of welfare payments and can’t be used for alcohol or gambling, has been trialled for about a year in two areas with large Aboriginal populations — Ceduna in South Australia and Western Australia’s East Kimberley.

Federal Liberal MP Rowan Ramsey, who represents Ceduna, told the ABC that the system should be further rolled out:

“I find it difficult to envisage a community that it wouldn’t work in. It doesn’t matter where you go, whether you go to Port Augusta or Adelaide or into the middle of Sydney.”

However, the proposal is not universally supported. The Greens have criticised the plan and Co-chairman of the National Congress of Australia’s First Peoples Rod Little said the two existing trials had not proven the concept worked.

“If you go in half-cocked to a program or a policy shift, when you don’t have the full evidence, it then will lend itself to further problems and it will cost more socially and economically to the Government.”

Funding for the NDIS has also been in the news, with The Australian reporting (paywalled) on a submission by mental health charity beyondblue to a parliamentary inquiry into the NDIS that claims the scheme will fail the mentally ill and cost more than projected.

The Neurological Alliance Australia has also released a position paper amid concerns that the needs of people with progressive neurological disorders are not being properly addressed by the NDIS, as this Croakey article outlines.

On the private health insurance front, the AMA released a report card giving its rating of the best and worst health insurers, while Croakey reported that the Private Health Insurance Ombudsman’s annual State of the Health Funds report showed an increase in complaints regarding a host of issues including refunds for cancelled memberships and administrative hurdles switching from one insurer to another.

Meanwhile, the ABC reported on a radical proposal to overhaul Australia’s health system put forward by economist Francesco Paolucci, the head of health policy at Murdoch University’s Sir Walter Murdoch School of Public Policy and International Affairs. He argues that people with private health insurance should be able to opt out of Medicare, in essence making a choice between public and private health insurers. He explains:

“This would clearly remove the duplication. Obviously, to make this efficient and affordable, subsidies are required targeting vulnerable groups (such as low-income and high-risk individuals). At the same time it would need to allow everyone to access the same services, both public and private, which would be nationally defined in a standardised package.”

Damning reports and calls for change

This fortnight has seen the publication of two reports into the status of Indigenous Australians, both of which make sobering reading.

After a 14-day visit to Australia, United Nations Special Rapporteur on the Rights of Indigenous Peoples, Victoria Tauli-Corpuz, presented a preliminary report to Government. As reported by The Guardian, she said while Australia’s Indigenous incarceration rates were among the worst in the developed world, it was the increasing rates of child removal that made Australia stand out as being particularly behind other nations.

The Sydney Morning Herald described the report as “scathing”, saying that it had declared Indigenous Australians were living in “appalling” conditions and young Aboriginal people in detention were “essentially being punished for being poor”.

It was followed by the release of a report by Oxfam, entitled ‘Moving Beyond Recognition: Respecting the Rights of Aboriginal and Torres Strait Islander Peoples‘, that called for a drastic overhaul of all areas of Indigenous policy and interaction with government, saying successive governments had failed to achieve meaningful change for Aboriginal and Torres Strait Islander peoples.

This article on Croakey looked at how the two reports exposed a failure to engage and empower Indigenous communities, and outlined the 10-point prescription put forward by Oxfam to elevate the status of Indigenous people.

The reports came as Canadian First Nations woman Carol Hopkins told the World Congress on Public Health, held in Melbourne this month, that staggering rates of suicide among Indigenous communities worldwide could only be reduced by strengthening culture, rather than just focusing on issues such as drug and alcohol abuse.

As reported by the The Guardian, she explained why Indigenous knowledge systems and creation stories – often discounted as not being meaningful today – were crucial to wellbeing.

“Without a vision that’s grounded in that foundation, then we make the mistake of talking about just our deficits, the things that take our life, the things that cause us hurt and pain … if all we focus on is our deficits, if all of our systems of data focus on just the deficits, all of our indicators, our stories about what’s wrong with us, then how do we ever know what’s right with us? How do we ever know as a people when we achieve a sense of wellness?”

Her comments came as The Huffington Post reported that a community-led initiative between Elders from the Warlpiri community in the Northern Territory and mental health research organisation Black Dog Institute was  looking to crowdfund a mobile app aimed at tackling suicide through the use of ‘Kurdiji’ values, a Warlpiri word meaning ‘to shield or protect’.

You can also read this preview, published earlier at Croakey, of the First Nations Suicide Prevention World Leaders Dialogue held at the World Congress from co-convenors Summer May Finlay and Dr Vanessa Lee.

Finlay gained a standing ovation for her closing World Congress presentation on why self determination was critical for Indigenous health and wellbeing. Meanwhile, Senator Skye Kakoschke-Mooreo, speaking in Parliament House, outlined through some telling examples how Indigenous people have long been an “after thought” in policy making, but need to become a “first thought”. You can read both their speeches in this article on Croakey.

Croakey also published an article by Dr Karen McPhail-Bell urging the field of health promotion to acknowledge its complicity with colonising practices. It was published as part of Croakey’s Acknowledgement series, also featured in a presentation at the World Congress.

And here’s a note for your diaries: the fourth annual Indigenous Health May Day Twitter festival will be held on Wednesday, May 17. Read more about this year’s theme and see the links to previous #IHMayDay events in this call for expressions of interest at Croakey.

Spotlight on preventive health

The World Congress on Public Health also turned the spotlight on preventive health. In this article in The Australian (paywalled), Associate Professor Sonia Wutzke, Deputy Director of the Australian Prevention Partnership Centre, led by the Sax Institute, outlined how countries including Australia are investing in a new model of co-produced partnership research in a bid to tackle major public health challenges like chronic disease.  Under the model, academics and the end-users of the research work together every step of the way, to ensure the research is relevant to policy. She wrote:

“It’s not new for academics to work with policy makers but we are going beyond simple partnership research. All of our research is co-produced; projects have to be formulated with policymakers in the room.”

One of the areas the Prevention Centre is targeting is child obesity, and SBS reported on new research presented at the World Congress that showed most overweight and obese children in Australia can’t access weight management services.

Writing on The Mandarin, Dr Gary Sacks from the World Health Organization (WHO) Collaborating Centre for Obesity Prevention at Deakin University outlined findings from a landmark nutrition study involving more than 100 nutrition and policy experts from 53 organisations nationally, which is supported by the Prevention Centre. The research assessed the extent to which each jurisdiction in Australia is implementing recommended policies to improve population nutrition and create healthier food environments and provides a roadmap for each. Sacks said there were plenty of actions that each government could take right now to address the problem — at very little cost.

As reported by ABC News, research from Queensland’s QIMR Berghofer Medical Research Institute also focused on child obesity, looking to explore what it said were less-established parental-social factors as well as known dietary and physical factors. It found that obesity in adolescent girls but not boys is strongly associated with parents’ education and marital status, while obesity in boys is more strongly associated with take-away food consumption than in girls.

A new report from the Australian Institute for Health and Welfare estimates that overweight and obesity now accounts for 7% of the burden of disease in Australia, second only to smoking, with the most disadvantaged in society being the worst affected. Outlined in this Croakey report, the Impact of Overweight and Obesity as a Risk Factor for Chronic Conditions report links cardiovascular conditions (38%), cancers (19% — breast being the leading type), diabetes (17%), osteoarthritis (12%), chronic kidney disease (5.1%), dementia, asthma, gallbladder disease, gout and back pain to Australia’s burgeoning weight problem.

Diet was also the focus of new research by CSIRO, which found four out of five Australian adults are not eating enough fruit and vegetables. Sky News reported that of the nearly 150,000 people surveyed, one in two adults did not eat the recommended intake of fruit, while two out of three adults did not eat enough vegetables.

Meanwhile, in more positive news, The Sydney Morning Herald covered a new report from the NSW Bureau of Health Information that shows NSW patients are now less likely to die within 30 days of being hospitalised for major conditions than they were in 2009, with the greatest improvement seen in deaths after hospitalisation for ischaemic stroke.

Research round up

In what is reportedly the single, largest donation to complementary medicine research in Australia, The Sydney Morning Herald reported that vitamin mogul Marcus Blackmore is donating $10 million to Western Sydney University. The donation, described as “no strings attached” and to be split from Blackmore’s personal philanthropic trust The Blackmore Foundation and the natural health company Blackmores, will fund scholarships, post-doctoral fellowships and support for international visiting scholars at the National Institute for Complementary Medicine.

The article reported concerns from leading public health advocates, including from Friends of Science in Medicine executive member Ken Harvey, who said Blackmores research had previously been presented to indicate a benefit to some of its products where there was none. Citing how Blackmores’ marine oil extract Lyprinol® had been labelled by  A Current Affair as an “ADHD breakthrough”, he was quoted as saying:

“I certainly support good research into traditional medicines but the dangers of it being funded by the Blackmores and Swisses of the world are fully evident in that ADHD ‘breakthrough’.”

The Fairfax media reported on controversy surrounding a major Universities Australia research project into sexual assault, which gathered information from more than 1800 victims of rape, attempted rape, sexual assault and harassment, but later announced that findings for individual universities would not be made public. The revelation prompted students who contributed sensitive information to describe how they felt “betrayed”, and concerns were raised about a lack of ethics approval for the survey component of the study.

The media revelations led to an announcement that Universities Australia had gained a commitment from all 39 universities involved to simultaneously release the data on sexual assaults on their campuses. The peak body’s chairman and Vice-Chancellor of the Western Sydney University, Barney Glover said:

“We all recognise the importance of this issue, there have been all-too-frequent concerns expressed and it was time that we came together with this high on our agenda, and we resolved to address it.”

In this article on The Conversation, criminology lecturer Bianca Fileborn explored the ethics of sexual assault research, writing that research with sexual assault victim-survivors can present heightened ethical challenges, meaning it must be handled with particular skill, care and respect.

Also on the subject of research rows, Medical Observer (registration required) published an interesting article about the US Women’s Health Initiative (WHI) trial of combined hormone replacement therapy (HRT) which, back in 2002, was abruptly halted over concerns about breast cancer. The published findings prompted millions of women to abandon the medication. MO reports that 15 years later one of the principal investigators of that trial, writing in Climacteric, the journal of the International Menopause Society (IMS), has questioned the statistics underpinning the decision to stop it and highlighted differences among the investigators about how the material was presented to the public.  

Meanwhile, Australian researcher and Nobel prize laureate Professor Barry Marshall, who famously ingested the bacteria Helicobacter pylori to prove its association with gastric ulcers, is now on the path to another breakthrough involving the bacteria, ABC News reported. Professor Marshall and researchers at the University of Western Australia have identified how the bacteria produces a waxy shield that protects it from stomach acid, a finding that could lead to the development of new treatments to stop the bacteria surviving in the stomach.

On the world stage

Cuts to government spending on public health in the UK will lead to more people becoming ill, which will put the NHS under further strain, a parliamentary report warns. Evidence submitted to the select committee inquiry showed that the public health budget for England was cut by £200m in 2015-16 and will shrink by a further £331m by 2021, with the report describing the cuts as “not only shortsighted but counterproductive”, according to The Guardian.

In the US, funding has been withdrawn from the United Nations Population Fund (UNFPA), an agency that promotes family planning in more than 150 countries, on the basis that the agency supports or participates in a program of coercive abortion or involuntary sterilisation in China – a claim disputed by the Fund.

Meanwhile, there’s been a new outbreak of MERS (Middle Eastern Respiratory Syndrome) in Saudi Arabia, with 10 people contracting the coronavirus after an outbreak in a haemodialysis unit in a hospital, Reuters reports.

And while Zika virus may have dropped off the front pages, Stat News reports that an experimental Zika vaccine has gone beyond initial safety testing for the first time, with scientists launching a Phase 2 trial of a vaccine to protect against the virus.

In another vaccination development, Médecins Sans Frontières (MSF) has hailed successful trials of a new rotavirus vaccine that could endure scorching temperatures for long periods as a “game changer”, saying it has the potential to save the lives of almost 500,000 children a year, as detailed by The Guardian.