Ruth Armstrong: The pointy end

EARLIER this month, media reports from a survey conducted by the Australasian College for Emergency Medicine gained considerable traction.

The survey revealed that emergency department staff bears the brunt of inebriated patients’ disinhibited behaviour, with almost all respondents reporting that they had experienced verbal abuse, physical violence and threats from drunken patients.

Further results from the ACEM study are published in current issue of the MJA. They reveal that, in the early hours of a single day in 106 emergency departments (EDs) across Australia and New Zealand, one in seven patients were there as a direct result of a problem caused by alcohol.

There is no doubt those working in EDs are at the pointy end of society’s alcohol problem. The study is a stark reminder that much of what is done in health care is akin to chipping away skilfully at the tip of an iceberg.

But there is a mood for change, as we found in MJA InSight’s news story about the MJA study. ACEM and the AMA have recently begun to seek an active role in the conversation about what can be done at the cultural, regulatory and policy levels to reduce alcohol-related harm.

Another of our news stories highlights an MJA study that analysed outcomes for critically ill trauma patients treated in a specialist unit, to determine if presenting out of hours made any difference to survival. The “weekend effect” is a well-known phenomenon in most hospital departments, and it was certainly evident in this “pointy end” cohort. Leading experts say it shows resources are needed to provide “consistent and reliable acute surgical care 24 hours a day every day of the year …”, no matter when patients sustain an injury.

Our lead news story delivers some good news on the safety of influenza vaccination in children. An MJA study used active surveillance to demonstrate the safety of the vaccine in 893 children vaccinated at six Australian paediatric hospital clinics in 2013.

An editorial accompanying the study said ongoing surveillance of influenza vaccines in children was needed to pick up unexpected safety issues and monitor effectiveness: a directive with which our experts broadly agreed.

Our story uncovered some innovative options for such surveillance, as well as the important point that any surveillance method will need to include data collection from GPs, who are at the pointy end of both vaccine administration and adverse events.

In a presentation to the Brisbane Global Café ahead of the G20 Summit last week (reported in Croakey), public health expert Professor Fran Baum repeated the well accepted estimate that health care contributes only about 25% to population health, with 50% coming from social and economic development, 15% from biology and genetics, and 10% from the physical environment.

Social and economic development encompasses many things, including wealth and the way it is distributed. In a comment for InSight this week, two doctors weigh in on an economic initiative that has been causing increasing concern in medical circles — whether free trade agreements such as the Trans-Pacific Partnership will ultimately stifle the Australian Government’s ability to make decisions that are in the best interests of our health.

Far from being theoretical, the authors point out that this question is already being tested, with tobacco giant Phillip Morris taking legal action against the federal government’s plain packaging legislation, based on a trade agreement signed with Hong Kong in 1993. Our authors urge health professionals to “continue to demand greater transparency in trade negotiations to protect public health”.

Health professionals’ training rightly focuses on the pointy end of health, but chipping away at the tip an iceberg can sometimes feel overwhelming.

As doctors increasingly join the public health sector to question, promote, educate and advocate, we might just make a formidable team.
 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight