more_vertHumanities and social sciences have had many positive influences on health experiences, care, and expenditure. These include on self-management for diabetes, provision of psychological therapy, handwashing, hospital checklists, the Scottish Government’s stroke guidelines, England’s tobacco control strategy, the response to the Ebola outbreak in west Africa and Zika virus in Brazil, and many more.1 Researchers have shown time and time again the political, practical, economic, and civic value of education and research in disciplines like anthropology, history, and philosophy.
Preference: Education
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Research suggests Australians confused about sun protection
Fewer than one in 10 Australians understand that sun protection is required when UV levels are three or above, according to research by the Cancer Council and QIMR Berghofer Medical Research Institute.
Melanoma is the third most common cancer in Australian men and women. Australia and New Zealand have the highest melanoma rates in the world with Queensland incidence rate of 71 cases per 100,000 people (for the years 2009-2013), vastly exceeding rates in all other jurisdictions nationally and internationally.
Melanoma is the most common cancer in young Australians (15–39 year olds) making up 20 per cent of all their cancer cases.
Heather Walker, Chair of Cancer Council Australia’s National Skin Cancer Committee, said the latest National Sun Protection Survey results showed a clear gap in Australians’ knowledge. Forty per cent of Australians are still confused about which weather factors cause sunburn.
“This new research shows that Australians are still very confused about what causes sunburn, which means people aren’t protected when they need to be,” she said.
“In summer 2016-17, 24 per cent of Australian adults surveyed incorrectly believed that sunburn risk was related to temperature, while 23 percent incorrectly cited conditions such as cloud cover, wind or humidity.
“It’s important for us to reinforce the message that it’s ultraviolet radiation that is the major cause of skin cancer – and that UV can’t be seen or felt. It’s a particularly important message this time of year. In autumn, temperatures in some parts of the country are cooling, but UV levels right across Australia are still high enough to cause serious sunburn and the skin damage that leads to cancer.”
Professor David Whiteman, Head of the Cancer Control group at QIMR Berghofer Medical Research Institute, said despite years of public education, encouraging Australians to protect their skin was an ongoing challenge.
“These findings show that very few Australians know when to protect their skin from the sun’s harmful rays,” he said.
“This is clearly a concern as it’s likely that Australians are relying on other factors, like the temperature or clouds, to determine when they need to slip, slop, slap, seek shade and slide on sunglasses.
“There is overwhelming evidence that, if used correctly, sunscreen prevents skin cancer – yet at the moment many Australians don’t even really understand when it’s required, and many are neglecting to use it altogether. We also know from previous research that 85 per cent of Australians don’t apply it correctly.”
Late last year, the Cancer Council National Sun Protection Survey showed that overall the proportion of adults slipping on clothing to protect themselves from the sun has decreased from 19 per cent to 17 per cent in the last three years.
The Cancer Council believes there is a need for Government to continue to invest in skin cancer campaigns to ensure adults remain vigilant about reducing their UV exposure.
“Australia hasn’t had Federal funding for a skin cancer prevention campaign since 2007 – this latest data suggests adults are becoming complacent about UV and demonstrates the urgent need for a refreshed national campaign,” Professor Sanchia Aranda, Cancer Council Australia Chief Executive Officer said.
Cancer Council’s SunSmart app provides local UV alerts and sun protection times and can be downloaded free on the App Store or Google Play.
MEREDITH HORNE
Unlocking the potential of girls
There are 600 million adolescent girls aged 10 to 19 living in the world today and 500 million of these are in developing countries.
In Plan International Australia’s new report, Half a Billion Reasons, CEO Susanne Legena says it is critical to invest in adolescent girls to create the necessary economic and social conditions to achieve the 2030 Agenda for Sustainable Development.
However, Plan believes this group is missing from Australia’s international development strategy despite being essential to a more prosperous future in developing countries.
“The world talks about focusing on ‘women and girls’ in aid and development, but in practice investments still target adult women or younger children, and adolescent girls aged 10 to 19 fall through the gap,” Ms Legena said.
Plan argues in the report, placing adolescent girls at the centre of aid and development enables benefits that can change the course of a girl’s life and a nation’s economy, reducing her risk of poverty and inequality and unlocking the demographic dividend that can accelerate a country’s economic growth.
Health issues are a central part of the report’s focus.
Pregnancy-related complications are the leading cause of death for adolescent girls aged 15 to 19.
Plan believes there is overwhelming evidence that when adolescent girls have access to sexual and reproductive health information and services it can be life-saving. However Australian Government funding for family planning has halved over three years, from $46 million in 2013/14 to $23 million in 2015/16.
Australia’s geographical significance to developing countries in Half a Billion Reasons cannot be overlooked.
PNG is described as one of the most dangerous places to be a woman or girl, with sexual and physical violence having reached epidemic levels. Programs are desperately needed to address this crisis, even though PNG is one of the primary recipients of Australia’s aid and development.
Childhood marriage threatens girls’ lives and health, and it limits their future prospects. Adolescent pregnancy increases the risk of complications in pregnancy or childbirth. In the Solomon Islands, 22 per cent of girls are married by the age of 18 and 3 per cent married by the age of 15.
Almost one quarter of all teenage girls in Timor-Leste will fall pregnant and have a baby by the time they are 20 years old. In addition, some 19 per cent are married by the time they are aged 19, indicating a deep stigma and shame around early pregnancy.
Education is also listed in the report as central to changing lives of adolescent girls in developing countries. The World Bank has shown that for every year an adolescent girl remains in school after age 11, her risk of unplanned pregnancy declines by 6 per cent throughout secondary school.
Adolescent girls and young women make up 76 per cent of young people around the world who are not in school, training or employment.
In PNG, Plan estimates only 18 per cent of adolescent girls attend upper secondary school. In the Solomon Islands only 22 per cent of girls attend upper secondary school despite there being 50 per cent of young women aged 15 to 24 who are unemployed.
Plan in the report has called on the Government to develop a stand-alone action plan to achieve gender equality for adolescent girls through Australia’s foreign policy, trade, aid and development.
The United States has a road map, Global Strategy to Empower Adolescent Girls, produced in 2016 to tackle the barriers that keep adolescent girls from reaching their full potential. Plan believes the Department of Foreign Affairs recently produced Foreign Policy White Paper was a missed opportunity to tackle issues faced by adolescent girls.
“Whether we are trying to empower girls to further their education, avoid child marriage, access family planning services or escape gender-based violence, we cannot improve girls’ realities without first acknowledging that their challenges and needs are unique,” Ms Legena said.
A copy of Plan’s report can be found at: https://www.plan.org.au/~/media/plan/documents/reports/girls-report-2018/full-reporthalf-a-billion-reasonsdigital.pdf?la=en
MEREDITH HORNE
Will you still love me when I’m 84 (or 94)?
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY
One Saturday morning 10 years ago, I took a phone call from the nursing home where an elderly, moderately demented relative resided. The facility was humane, professional, warm and near our home. “We’re calling to let you know that we are about to send her to hospital.” This was unexpected. What was the problem? “She keeps holding her head to one side.” Had they considered calling her GP? “He’s not available on the weekend.” So I visited.
She was, indeed, holding her head at a strange angle, but happily wolfing down her lunch. “Can you straighten your neck?” I asked, demonstrating. She smiled and complied.
What it was all about I have no idea. But I felt pleased to have avoided her admission – ambulance, ED, unfamiliar ward, disorientation, perhaps a fall (with or without fracture), a week or 10 days in an alien place, perhaps an infection?
(Lest you imagine that I am dissing the GP, I’m not. He and his partner provided exemplary palliative care in her final days eight years later and high-quality service for the years in between. It’s the system that sucks.)
Recently, the AMA has made an extensive submission to the Aged Care Taskforce concerning residential aged care facilities.
This document derives largely from the practical experience of doctors doing their best – within the logistic constraints of workload and organisation – to provide care for older people. The AMA’s executive summary states:
An Aged Care Commission should be introduced to streamline the aged care system, and should include a role that ensures there is an adequate supply of appropriate, well-trained staff to meet the demand of holistic care to a multicultural, ageing population, and also to ensure the aged care workforce has clear roles and responsibilities.
A Commission, if ever it happens, is an aspiration. Right now, staffing of residential aged care facilities is a disgrace. From the submission: “Our members have reported cases where nurses are being replaced by junior personal care attendants, and some residential aged care facilities do not have any nurses staffed after hours.”
The AMA illustrates the worsening problem.
Between 2003 and 2016, personal care attendants have risen from 55 per cent to 72 per cent of this full-time workforce. Registered nurses have decreased from 22 per cent to 15 per cent. Other skilled workers have declined proportionately. Nurse practitioners, a great asset in this context (based on overseas experience in systems such as Geisinger Health https://www.geisinger.org/about-geisinger) make up a tiny fraction of the workforce, as do allied heath professionals.
We are progressively accepting the need for integrated care between hospitals and the community for multi-morbid, frail patients. The crucial role, in this effort, of GPs and nurse coordinators is coming to be understood, and to some extent, resourced. This redeployment of staff and effort is no small deal – much change to be managed. In the light of this move, now is the time to take account afresh of what is needed to re-fit aged care facilities to participate more fully in providing integrated care.
The AMA document also explores the context within which residential aged care is provided. It points out that, in 2013, 32 per cent of the Australian population (5.8 million people) were born overseas. “This presents a major challenge in the form of incorporating different cultures into aged care, and communication with individuals [including families] who may have low levels of English literacy.” But this observation weakens when you consider the 2016 census figures that show that the percentage of the population not speaking English at home is only around 21 per cent.
Care for older Aboriginal and Torres Strait Islander people is another cultural challenge we have done little to accept.
The submission concludes by re-stating the centrality of workforce – adequate education, adequate funding, and adequate numbers. This is the problem demanding immediate attention.
AMA advocacy in diagnostic imaging funding and practice
BY DR ANDREW MULCAHY, CHAIR, AMA’S MEDICAL PRACTICE COMMITTEE
Diagnostic imaging may not always enjoy a high profile in the media but the AMA actively and continuously advocates on behalf of its members who provide diagnostic imaging services.
Some of the AMA’s activities are reported publicly, such as the AMA’s response to the Federal Parliament Senate inquiry into access to diagnostic imaging equipment. The AMA lodged a comprehensive submission covering the Government’s funding and regulation of diagnostic imaging equipment and the impact on equitable patient access. The submission was guided by the Medical Practice Committee with particular input from MPC member, Professor Makhan (Mark) Khangure, who is also the radiologist specialist representative on the AMA’s Federal Council.
The AMA was subsequently invited to provide evidence directly to the Senate Committee, which led to Professor Khangure speaking to Senators at a hearing held in Perth and sharing his knowledge and expertise from working in both the public and private sectors.
Diagnostic imaging also featured publicly and prominently in the AMA’s 2018-19 Budget Submission to the Federal Government. The AMA called for realistic funding and support for diagnostic imaging services under Medicare as one of its key priorities.
Other activities are more ‘behind the scenes’ but equally important in ensuring the AMA uses every opportunity to influence Government funding and regulatory decisions.
The AMA continues to monitor the Federal Department of Health’s implementation of the Medicare Benefits Schedule (MBS) Review, a mammoth project begun in 2015 to assess more than 5,700 MBS items to ensure they are aligned with contemporary clinical evidence and practice. Work to assess diagnostic imaging related MBS items is a large component of this task. The AMA’s focus is to ensure the review is conducted transparently and appropriately.
The AMA is a member of the Diagnostic Imaging Advisory Committee, which provides advice to the Federal Department of Health on Medicare funding and regulatory policies relating to diagnostic imaging. This is a long-running standing committee, separate to the MBS Review, which meets twice a year, providing the AMA with the opportunity to advocate specifically on behalf of radiologist and other specialist members providing diagnostic imaging services funded under Medicare. MPC member, Dr Gino Pecoraro, is the AMA’s current representative.
The AMA is also a member of the Diagnostic Imaging Steering Committee, which provides advice to the Australian Digital Health Agency to ensure that the development and implementation of shared electronic records protocols related to diagnostic imaging services are appropriate and effective. Professor Khangure represents the AMA on this committee which meets four times a year.
Early this year, the AMA attended a stakeholder consultation meeting to discuss the Department of Health’s new ‘risk-based’ model of Medicare audit and compliance activities and its impact on medical practitioners providing diagnostic imaging services. The Department proposed a range of methods for identifying and remedying potentially non-compliant claiming of Medicare benefits. The AMA supports fair and transparent compliance processes and recommended educational approaches as a first step, with the goal of minimising unnecessary and invasive audits of individual practices or doctors.
Finally, as flagged in an article in this column last year, MPC has developed a new Position Statement on diagnostic imaging to formally bring together and promote the AMA’s full suite of diagnostic imaging policies. The Position Statement was endorsed by Federal Council last month and will be launched soon.
The AMA welcomes members’ views on advocacy priorities and strategies. If you have any comments or suggestions to make, please email them to president@ama.com.au
Poll finds understanding gap between alcohol and disease
Many Australians are unaware of the links between alcohol consumption and a range of cancers and other diseases, according to a recently released survey.
But a vast majority of them believe they have a right to such information and that Governments have a responsibility to educate them.
A new poll, released by the Foundation for Alcohol Research and Education (FARE), reveals that Australians have a lack of understanding of the official drinking guidelines that could help keep them healthier.
The same poll also reveals that they want to know about the long-term harm associated with regular alcohol consumption, and they are increasingly of the opinion the alcohol industry is deliberately downplaying independent university research linking alcohol to a range of harm, including cancer and cardiovascular disease.
The Annual Alcohol Poll 2018: Attitudes and Behaviours, conducted by YouGov Galaxy, found that fewer than half of Australians are aware of the link between alcohol misuse and stroke (38 per cent), mouth and throat cancer (26 per cent) and breast cancer (16 per cent).
While 70 per cent of Australian adults are aware of the Australian Guidelines to Reduce Health Risks from Drinking Alcohol, only one in four of them (28 per cent) are aware of the content.
FARE’s Chief Executive Michael Thorn said the lack of knowledge of both the link between alcohol consumption and the risks of cancer and other chronic diseases, together with a clear understanding of how to avoid those risks, was extremely alarming.
“It really is a dangerous cocktail. Community awareness of alcohol’s link with a range of chronic health conditions remains low,” Mr Thorn said.
“In the case of alcohol’s link to breast cancer, the awareness is only 16 per cent. Nor are Australians armed with the knowledge that would reduce their risk of long-term harm. Only one in four Australians have some awareness of the actual content of the official drinking guidelines.”
Now in its ninth year, FARE’s national alcohol poll provides valuable trend data and insights into community perspectives on alcohol
This year, Australians were asked for the first time whether they thought they had a right to know about the long-term harm associated with regular alcohol use.
When advised that the World Health Organisation recognises that alcohol is linked to approximately 200 disease and injury conditions such as breast cancer, liver disease, mouth cancer and stroke, the vast majority of Australians (84 per cent) agreed that they had a right to that information, with 80 per cent of Australians reporting that Governments have a responsibility to educate Australians on this matter.
“If there is a silver lining here, it is that Australians clearly recognise their rights as consumers to be fully informed of the harm associated with the products they consume,” Mr Thorn said.
“The lesson here for Government is that it must do a better job of ensuring Australians fully understand the long-term harm from alcohol, and are given the information that would help them reduce that harm.”
The 2018 Poll findings make clear that the job cannot be left to the alcohol industry – 61 per cent of Australians believe that the alcohol industry would downplay independent university research findings linking alcohol consumption to a range of harm such as cancer and family violence.
Polling revealed that community perceptions of the alcohol industry have not improved since 2015, finding that the majority of Australians continue to believe that the alcohol industry targets people under the age of 18 years (55 per cent), and that it has too much influence with Governments (57 per cent).
The full is available at www.fare.org.au.
CHRIS JOHNSON
Tobacco addiction grows from dirty deeds
A damning report launched at the 17th World Congress of Tobacco (WCTOH) shows the tobacco industry is increasingly targeting vulnerable populations in Africa, Asia, and the Middle East where people are not protected by strong tobacco control regulations.
The figures in The Tobacco Atlas are nothing short of alarming. In 2016 alone, tobacco use caused over 7.1 million deaths worldwide (5.1 million in men, 2.0 million in women).
Most of these deaths were attributable to cigarette smoking, while 884,000 were related to secondhand smoke. But while tobacco-related disease and death grows in some communities, so do tobacco industry profits.
The combined profits of the world’s biggest tobacco companies exceeded US $62.27 billion in 2015. This is equivalent to US $9,730 for the death of each smoker, an increase of 39 per cent since the last Atlas was published, when the figure stood at US$7,000.
“The Atlas shows that progress is possible in every region of the world. African countries in particular are at a critical point – both because they are targets of the industry but also because many have opportunity to strengthen policies and act before smoking is at epidemic levels.” said Dr Jeffrey Drope, co-editor and author of The Atlas.
In sub-Saharan Africa alone, consumption increased by 52 per cent between 1980 and 2016 (to 250 billion cigarettes from 164 billion cigarettes). This is being driven by population growth and aggressive tobacco marketing in countries like Lesotho, where prevalence is estimated to have increased from 15 per cent in 2004 to 54 per cent in 2015.
José Luis Castro, President and Chief Executive Officer of Vital Strategies, co-author of The Atlas said it: “Shows that wherever tobacco control is implemented, it works… People benefit economically and in improved health. And the industry rightly suffers.”
Gender inequity was also address at the WTCOH, highlighting the negative economic impacts of tobacco use on women – not just in healthcare costs resulting from tobacco-related illness, but also in the diversion of family income, from food and education to tobacco. The emphasis was that tobacco use drives families into poverty.
WHO Regional Director for Africa, Dr Matshidiso Moeti, said: “The tobacco industry views this region as virgin territory to be exploited. They are targeting women and girls specifically and interfering in the adoption of tobacco control policies that will protect health when properly enforced.”
Tactics of fear by tobacco companies were also heard at the conference from several tobacco control advocates who had bravely fought violence or threats because of their advocacy against the expansion of smoking in their countries, including Indonesia and Nigeria.
Dr Lekan Ayo-Yusuf, Chair of the WCTOH Scientific Committee, said the research showed the need to look at the totality of the supply chain of tobacco products, and to follow the whole process from farming, through to taxation, through to point-of-sale restrictions.
WHO launched new guidance at WCTOH on the role tobacco product regulation can play to reduce tobacco demand, save lives and raise revenues for health services to treat tobacco-related disease, in the context of comprehensive tobacco control.
Many countries have developed advanced policies to reduce the demand for tobacco, but Governments can do much more to implement regulations to control tobacco use, especially by exploiting tobacco product regulation.
Dr Douglas Bettcher, WHO’s Director of the Department for the Prevention and Control of Non-communicable diseases (NCDs), said: “Tobacco product regulation is an under-utilised tool which has a critical role to play in reducing tobacco use.”
“The tobacco industry has enjoyed years of little or no regulation, mainly due to the complexity of tobacco product regulation and lack of appropriate guidance in this area. These new tools provide a useful resource to countries to either introduce or improve existing tobacco product regulation provisions and end the tobacco industry ‘reign’.
“Only a handful of countries currently regulate the contents, design features and emissions of tobacco products and tobacco products are one of the few openly available consumer products that are virtually unregulated in terms of contents, design features and emissions,” Dr Bettcher said.
A copy of The Atlas can be seen here: https://tobaccoatlas.org/.
MEREDITH HORNE
Aged Care Commission needed to address workforce issues
The AMA has made a detailed submission to the Government’s Aged Care Workforce Strategy Taskforce, arguing that the aged care workforce does not have the capability, capacity and connectedness needed to provide quality care to older people.
It calls for an Aged Care Commission to be introduced.
Australia has an ageing population that has multiple chronic and complex medical conditions, but older people face major barriers in accessing appropriate and timely medical care.
Medical practitioners must be supported by the Government and aged care providers to enhance and facilitate much needed access to medical care for people living in residential aged care facilities.
The submission argues that aged care providers need to be supported to ensure access to an appropriate quantity of well-trained staff who work in a rewarding environment with a manageable workload.
“This would ensure older people’s care is not neglected due to shortages of appropriate staff,” it states.
An Aged Care Commission could streamline the aged care system and to help ensures there is an adequate supply of appropriate, well-trained staff to meet the demand of holistic care to a multicultural, ageing population.
An Aged Care Commission would also ensure the aged care workforce has clear roles and responsibilities.
“Australia has an ageing population that is experiencing chronic, complex medical conditions that require more medical attention than ever before,” the submission states.
“For example, 53 per cent of residents in Residential Aged Care Facilities (RACFs) have dementia. This proportion will continue to grow over time, with projections reaching up to 1,100,890 people with dementia by 2056, which is estimated to cost Australia $36.85 billion by the same year.
“A recent study identified that residents of RACFs with dementia had direct health and residential care costs of $88 000 per year. Currently, the aged care system as a whole, and its workforce, does not have the capacity or capability to adequately deal with this growing, ageing population.”
The aged care system needs a strategy, the submission states, to ensure the workforce is appropriate to meet the demands of older people in the future. In order to improve the quality of the aged care workforce, the following is required:
- An overarching, independent, Aged Care Commission that provides a clear, well communicated, governance hierarchy that brings leadership and accountability to the aged care system;
- Medical practitioners need to be recognised and supported as a crucial part of the aged care workforce to improve medical access, care, and outcomes for older people; and
- Aged care needs funding for the significant recruitment and retention of, and support for, nursing staff and carers, specifically trained in dealing with the issues that older people face.
Care of an older person involves a diverse range of professions. All providers of aged care services need to collaborate together to ensure the optimal level of care for the older person. The strategy will be able to provide an ultimate goal for the whole aged care workforce, which should include access to the older person in order for each workforce profession to be able to provide quality care for that older person.
There needs to be a focus on prevention to ensure older people remain healthy for as long as possible to remain in their own home, the submission states, but also to reduce demand and pressure on the aged care workforce.
“Medical practitioners, in particular GPs, regularly incorporate prevention methods as part of providing holistic health and medical care,” it says.
“This includes immunisation, screening for diseases, providing education and counselling to their patient, and also referring the patient to a specialist or allied health professional if required. It is therefore imperative that older people have access to a GP and other services provided by health professionals.”
In its submission, the AMA stresses that the current policy settings do not support GPs visiting RACFs, working after hours, or being available to answer telephone concerns about their patients.
“Our members report that continuity of care goes generally unacknowledged in many RACFs and a resident’s care management plan is not well known,” it says.
“This creates an environment where the default step for RACF staff may be to refer the patient to a hospital emergency department (ED). In a study of 2880 residents of RACFs presented to the ED, one third of presentations could have been avoided by incorporating primary care services.
“Reasons for decisions to transfer residents to an ED include limited skilled staff, delays in GP consultations, and a lack of suitable equipment.”
Medical practitioners also need to be supported within the broader health care system to provide high quality care in RACFs. For example, by local hospitals providing secondary referral, timely specialist opinion, specialist services and rapid referral pathways to advice and services.
Older people are often burdened with complex and multiple medical disorders that requires the regular attention of medical practitioners, quality nursing care and allied health care professionals.
Embracing Information and Communication Technology (ICT) potentially has huge benefits for the aged care sector. It can increase communication between healthcare providers, reduce administrative burden, and assist to improve the health and independence of older people.
Aged care providers require improved ICT systems that are interoperable with the My Health Record, in particular its Medication Overview feature. This would ensure medical health professionals have the tools in place to access all relevant medical information with all relevant stakeholders to improve prescribing and to reduce the risk of adverse reactions and interactions between medications.
“Although working with older people is generally a rewarding experience, it comes with multiple challenges,” the submission states.
“For example, older people can be highly reliant on an aged care worker, and many have behavioural conditions that make day-to-day tasks difficult, and sometimes dangerous for the carer to carry out if the older person’s mental health is not appropriately managed.
“Carers are known to have high rates of moderate stress and depression. The health and wellbeing of aged care staff must be considered for the wellbeing of the workers, and so this stressful environment does not deter people from wanting to work in the aged care sector, or force existing workers to leave.”
Many of the issues outlined in the submission can be rectified by improving the capability, capacity and connectedness of the aged care workforce. Currently, this workforce is not adequately trained to be able to care for older Australians, as older peoples’ care needs are growing in both complexity and volume.
In addition, although medical practitioners are well-equipped to provide quality medical care to residents living in RACFs, they are not adequately supported or remunerated to do so due to the range of issues described above. This has resulted in an unnecessary barrier to quality medical services for RACF residents.
“The aged care workforce needs clear leadership and accountability, which an Aged Care Commission could provide,” the statement says.
“Many aged care governance (and workforce) issues described above have already been addressed in recommendations to the Government as a result of the multiple aged care reviews. Now is the time to act on these recommendations to prevent more unacceptable examples of neglect and bad quality care in RACFs, and to give people living in RACFs the quality of life that they deserve.”
The full submission can be viewed at: ausmed/aged-care-commission-needed-address-workforce-…
CHRIS JOHNSON
[Comment] Nursing Now campaign: raising the status of nurses
There have been enormous developments in nursing over the past decades, with extended roles, nurse practitioners, and degree level education spreading globally and with, for example, prescribing by nurses now established in countries as different as Botswana and the UK.1 Nursing and midwifery make up almost half the global health workforce, are at the centre of most health teams, and have a massive impact on health.2 However, nurses and midwives will assume an even more extensive and influential role in the future for at least six powerful reasons.
Government focus on rheumatic heart disease
Rheumatic heart disease is receiving serious political attention, as the Federal Government makes inroads into addressing and improving the health of Aboriginal Australians.
Indigenous Health Minister Ken Wyatt has convened a roundtable in Darwin to look at charting a comprehensive roadmap to end rheumatic heart disease (RHD).
The roundtable brought together RHD and infectious diseases specialists, health professionals, Indigenous health advocates, philanthropists, service providers and government agencies.
“RHD and acute rheumatic fever take about 100 Aboriginal and Torres Strait Islander lives each year and many of these are young people,” Mr Wyatt said.
“The tragedy is compounded by the fact that RHD is almost entirely preventable, with many organisations, including governments, grappling strongly with pieces of the RHD elimination puzzle.
“Now, through this roadmap we are determined to tackle the whole challenge and eliminate this disease as a significant Indigenous public health problem.”
RHD is a long-term outcome of a condition called acute rheumatic fever (ARF), which typically occurs in childhood. As a result of ARF the affected person develops inflammation of the heart valves with resulting damage and malfunction. ARF typically precedes the RHD by decades.
RHD can be usually resolved if it is detected early, but people are being treated for the condition when it is too late. RHD is most accurately diagnosed using ultrasound.
Indigenous children and young adults in the Northern Territory are estimated to suffer from RHD at more than 100 times the rate of their non-Indigenous counterparts. The Kimberley is also an RHD hotspot, with two-thirds of all Western Australian Indigenous people suffering from RHD living in the region.
The Government has allocated $23.6 million under the Rheumatic Fever Strategy over the next four years. It is also working to address the underlying social and cultural determinants that contribute to RHD, including providing $5.4 billion to States and Territories to help them to provide remote housing, under a national agreement. While the Agreement is due to end on 30 June 2018, the Commonwealth has begun discussions with State and Territory Governments on future funding arrangements.
“While RHD affects children and young adults around the world, in Australia it is a sad reflection of the health gap between Indigenous and non-Indigenous children,” Mr Wyatt said.
“We know this is a disease of poverty, of overcrowding, of difficulty with access to health services.
“The roadmap will acknowledge there is no single silver bullet to eliminate RHD. We are now looking to tackle all the determinants – including environmental health, housing and education – as we work together to help strengthen these communities against this devastating disease.”
AMA President Dr Michael Gannon has repeatedly described the lack of effective action on RHD to date as a national failure; calling for an urgent coordinated approach.
At the launch of the AMA’s 2017 AMA Report Card on Indigenous Health, Dr Gannon said: “Governments must fund health care on the basis of need. There is no doubt whatsoever that funding and resourcing of Indigenous health does not meet the overall burden of illness.”
A copy of the AMA’s 2016 Indigenous Report Card, which focused specifically on RHD, can be found at: article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease
MEREDITH HORNE