more_vertMisuse of the synthetic hormone has prompted the government to propose strict regulations, but some worry about potential consequences on women’s health. Sophie Cousins reports.
Preference: Government and politics
Work experience with the AMA
BY RICHE MOHAN, MEDICAL STUDENT, FLINDERS UNIVERSITY
In April of this year I was given the opportunity to spend a 6-week placement with the medical practice team at federal AMA in Canberra. I chose this placement to gain some insight into what the AMA does and how it is done. While there, I was able to see first-hand how advocacy happens, and meet the people working behind the scenes to pull it all together.
From day one of medical school we all begin to form an idea of what the AMA does and for some, this impression doesn’t evolve beyond a subscription with some perks. My time with the AMA helped me understand why it is so important for both doctors and patients and I hope to share my experience to spread this understanding.
During my placement, I met with directors and policy advisors, and was interested by the scope and breadth of their portfolios, as well as their ability to mobilise on any given topic depending on the priorities of the day. The 24-hour news cycle brought a new issue to the front pages of newspapers around Australia and the AMA was often called to inform debate. Some of the hot topics during my placement included the appropriate timing of vaccinations, out of pocket expenses for privately insured patients and mandatory reporting legislation for doctors. All these issues required evidence based, honest responses delivered in a manner which would not betray the trust of Doctors or the public.
Meanwhile, Government, private health insurers, hospitals, stakeholders and doctor and patient advocates are continuously formulating and debating policy which can change the way health care is delivered in Australia today and years from now. The challenge was in insuring that any changes would continue to empower excellent doctors to provide excellent patient care. I learned that this is a key difference between the AMA and other organisations; as the AMA is not just looking to improve working conditions for doctors as a union might, but instead looks to service the needs of its members and the people they serve, the patient. This is highlighted by the AMA Code of Ethics, hung on every office wall, which states: “Consider first the well-being of the patient”.
The above does not occur but for countless hours of hard work by both AMA staff and volunteer doctors around Australia who sit on the various councils and committees. The policy directions decided on at these meetings inform position statements and media releases; the potency of which should not be underestimated, as they form the basis of high level discussions which can result in real outcomes nationally. I came to realise that there are competing forces out there trying to fundamentally change how medicine is practiced and delivered in Australia, and that without diligent oversight, we are all at risk of being part of broken system.
The focus of my time at the AMA was to examine the evidence behind quality and safety-based hospital funding. The Independent Hospital Pricing Authority, in conjunction with the Commission for Safety and Quality in Healthcare (directed by COAG), has been tasked with implementing measures which will see hospitals being penalised with funding deductions for adverse events. These include sentinel events, hospital acquired complications and avoidable readmissions. Though introduced to achieve quality and safety improvements, evidence from around the world suggests that such penalties do not lead to long term outcome improvements. Instead, they ask that hospitals improve their standards, despite reduced funding.
The big take away for me was that those at the beginning of their careers, such as students and junior doctors, have the most to gain or lose by the decisions being made today. Though our learning and careers often become all consuming, it is important to stay engaged with these issues and support those acting on our behalf – particularly if we cannot participate ourselves. My placement allowed me to see firsthand how advocacy issues are raised, dissected, discussed and actioned and I gained an appreciation for the influence the AMA has; an influence we should support and guide through our participation.
Senate Seeking Action on Stillbirths in Australia
Labor Senator Kristina Keneally has wasted no time since joining the Senate earlier this year, in driving the establishment of a Senate Inquiry into Stillbirth Research and Education.
Six babies a day in Australia are stillborn. One in 135 births in Australia will be a stillbirth.
Senator Keneally told the Senate that rate of stillbirths in Australia have not shifted for two decades, a tragedy that is also personal. Senator Keneally’s daughter, Caroline was stillborn in 1998.
“Stillbirth is an often overlooked, under-investigated and ignored public health issue,” she said when recommending the Inquiry to the Senate.
“It has significant economic impact. Surely we, as a country, can do better than this. There are things that we know that we’re not telling parents that could help them prevent stillbirth, and there are things we could know better with better data collection and more coordinated and better funded research.”
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) welcomed the Senate Inquiry, adding: “A large proportion of stillbirths are unexplained and the causes need to be further explored.”
RANZCOG also said in its submission, it believed the areas in which there are substantial opportunities for improvement in outcome are with the detection and management of fetal growth restriction (FGR) and avoidance of intrapartum hypoxic death – together contributing about 8 per cent of all stillbirths.
The Royal Australasian College of Physicians (RACP) told the Senate Inquiry it believed: “Stillbirth is a tragic complication of pregnancy which often remains poorly understood within the health profession and the wider community. This impacts awareness and education as well as training and research.”
RACP encouraged the Committee to explore a range of options for reducing stillbirth rates in Australia, and improving care where stillbirths occur, including undertaking an Audit of current data and collection methodologies, and mandate annual reporting to a single agency with responsibility for stillbirth oversight. It also believes it is important for States and Territories to mandate the use of the Perinatal Society of Australia and New Zealand (PSANZ) guidelines and fund Medical Practitioner Education around them at least twice per year.
RACP also said organisations providing support groups following pregnancy loss should have their programs evaluated and, where proven effective, fully funded, to make them universally available. Also in the RACP submission was a view that current stillbirth research funding should be reviewed, and funds allocated to research that addressed specific stillbirth priority areas.
Sands, an Australian miscarriage, stillbirth and neonatal death charity, used the Inquiry to advocate for improved training in bereavement care for all health professionals.
The Stillbirth Foundation’s primary recommendation was a National Action Plan for Stillbirth be developed and implemented, in a process which involves key stakeholders such as medical practitioners, midwives and nurses, health bureaucrats, families who have experienced stillbirth and representative groups.
The Stillbirth Foundation’s chief executive Victoria Bowring said a strategic and well-considered policy approach from Federal Government was “long overdue”.
She added that an action plan would be a coherent policy roadmap to set out priorities, establish measured targets and the necessary funding behind it.
“Too often we see inconsistent medical care, a lack of awareness in the community, not enough coordination and investment in research and poor data collection and management,” she said.
“We have seen a similar approach recently with the national action plan for endometriosis being developed by the Federal Government, and a similar model could work for stillbirth.”
The Committee is due to report back with its recommendations when the Parliament resumes in early 2019.
Details of the Senate Inquiry into Stillbirth Research and Education, including submissions can be found at: www.aph.gov.au/Parliamentary_Business/Committees/Senate/Stillbirth_Research_and_Education/Stillbirth
MEREDITH HORNE
Nationals bitter on sugar tax ahead of election
Nationals Deputy Leader Senator Bridget McKenzie, whose portfolio responsibilities include Rural Health and Sport, has spoken out strongly against the introduction of an Australian tax on sugar sweetened beverages (SSBs).
“We know a sugar tax won’t address obesity, because other countries have tried it,” Senator McKenzie said in a statement.
Her Nationals colleague, Agriculture Minister David Littleproud MP, also said in the jointly issued statement: “Let’s not hurt our cane growers, who are already hurting due to low prices, with a government intervention which won’t help solve the problem.”
However, a June report published by the Medical Journal of Australia argues: Australia can no longer afford to wait for a tax on sugar-sweetened beverages.
The report was co-authored by Dr Alessandro Demaio, CEO for EAT and Alexandra Jones from the George Institute for Global Health.
The report reasons: “Governments worldwide are drawing on growing evidence to implement effective pricing policies for SSBs as one cornerstone of a comprehensive policy response.”
At least 30 countries, the Spanish Catalan region and seven cities in the United States have adopted SSB taxes. The World Health Assembly also says there is now sufficient evidence that effective taxation of SSBs are working as intended to reduce purchasing and consumption to support further uptake.
Demaio and Jones also cite in their article new evidence that suggests an agriculture sector will not suffer an adverse employment effect from an SSB introduction and sought to: “reminded governments to pair implementation with robust independent evaluation and to remain vigilant to policy interference by conflicted interests.”
The Australian Medical Association continues to call for a tax on SSBs to be introduced as a matter of priority. AMA President Dr Tony Bartone says the strong position on sugar is because doctors see the direct consequences of obesity every day.
“One of the best ways to achieve a change in consumer behaviour is with a sugar tax. The evidence is in. Price signals work,” Dr Bartone said.
“The AMA strongly supports the introduction of a sugar tax in Australia as part of a broad range of policies to combat obesity and improve the health of the population across all age groups.”
At this stage both the Government and Labor reject the AMA’s call for a tax on sugary drinks to reduce Australia’s obesity problem.
MEREDITH HORNE
American formula to beat breastfeeding
Donald Trump’s United States Administration has sparked outrage at the Word Health Assembly over tactics its delegation used to try to stymie an international resolution promoting breastfeeding.
The US delegation is accused of not only vigorously talking down the resolution, but also of employing bullyboy tactics against other nations to get them to fall into line with America.
The worst accusation is that American diplomats threatened Ecuador with trade sanctions and a withdrawal of military assistance in the South American country’s fight against organised crime and gang violence.
The original resolution encouraged governments across the globe to “protect, promote and support breast-feeding,” but team USA fought against the wording and – according to reports from the meeting in Geneva – acted aggressively towards those supporting it.
The delegation was also reported to have threatened to cut US Government funding to the World Health Organisation.
Health advocates have described the antics as a clear example of the Trump presidency looking after its big business mates – this time in the multibillion-dollar infant formula and dairy industries.
“We were astonished, appalled and also saddened. What happened was tantamount to blackmail, with the US holding the world hostage and trying to overturn nearly 40 years of consensus on best way to protect infant and young child health,” Patti Rundall of the UK-based campaign Baby Milk Action told the New York Times.
The Russian delegation stepped in and modified the text of the resolution before reintroducing it. This cleared the way for it to be eventually passed, with US support.
The WHO and the AMA encourage breastfeeding on health benefits grounds, which is backed up by numerous high-level, peer-reviewed studies.
CHRIS JOHNSON
California takes an unhealthy step back
California has passed a 12-year ban on any city imposing a sugar tax on soft drinks.
The bizarre and retrograde move has sparked a backlash from healthcare groups across the State, who are now campaigning for a sugar levy to form a major platform of the 2020 election battleground.
The health groups want to see a soda tax initiative on the ballot that will help pay for public health programs. They are insisting the initiative should also enshrine in the State’s constitution the right of any local government to impose their own sugar taxes.
Chief executive of the California Medical Association Dustin Corcoran, who is behind the initiative, described sugar-induced obesity as a health crisis that needed to be urgently addresses.
“This initiative gives voters a real opportunity to do that,” he said.
“Big soda has been a major contributor to the alarming rise in obesity and diabetes.”
The proposal is for a two-cents-per-fluid-ounce tax, which would translate to an extra 24 cents onto the cost of a 12-ounce can of soda, or an extra $1.34 for a two-litre bottle of soda.
It could raise up to $1.9 billion annually.
The battle between healthcare groups and the soft drink industry is now in full flight.
The American Heart Association has vowed to have the new law rolled back.
“We were disappointed that the American Beverage Association and their member companies went to such great lengths to take away the right of Californians to vote for better health,” chief executive Nancy Brown said.
“We will be relentless in our work with communities across the State to improve public health through a statewide tax, and to restore the rights of Californians to vote for what they believe best supports health in their State.”
Health professionals are describing the antics that led California legislators to hand soda companies a 12-year reprieve as “extortion” from the powerful soda industry.
And they have promised to rain on the parade.
A statement from the California Dental Association said: “Big Soda may have won a cynical short-term victory but, for the sake of our children’s health, we cannot and will not allow them to undermine California’s long-term commitment to health care and disease prevention.”
CHRIS JOHNSON
NHS birthday protests
The NHS has turned 70, sparking large-scale public protests at the level of underfunding and privatisation of England’s national health service.
On July 5, 1948, Britain’s then Health Secretary Aneurin Bevan (from Labour’s post-war government of Clement Attlee) launched the National Health Service at Manchester’s Park Hospital.
That hospital is now known as Trafford General Hospital and the National Health Service simply as the NHS.
On its 70th birthday this month, tens of thousands of patients, public and NHS staff marched on Westminster in protest at the state of the service.
Although UK’s current Conservative Party Government has pledged another £20 billion (Aus$35.8 billion) to the NHS over the next four years, the growing concern is that much of that money will be given to private companies.
During the 2016-17 financial year, a total of £7.1 billion was given to private companies for NHS clinical contracts. Since 2013, a massive £25 billion has been awarded to non-NHS providers through a tendering process allowed under the Health and Social Care Act, which came into force that year.
Analytic studies are revealing increasing problems with the private sector services being provided, causing alarm among patients and political watchers.
Accounts of patient neglect, mismanagement, and endless waiting periods are reported daily.
Outsourcing of NHS services remains highly controversial.
Labour leader Jeremy Corbyn has called for an end to privatisation and for NHS staff not to be sub-contracted to private companies.
He addressed the protesting crowds, suggesting that profits sometimes end up in international tax havens.
“I don’t pay my taxes for someone to rip off the public and squirrel the profits away,” he said.
Prime Minister Theresa May has defended the NHS, hailing it as a huge success and insisting its future was secured with the extra government funding.
Protests were held around the same time of a service of celebration at Westminster Abbey for NHS staff, as well as thousands of tea parties around the country to mark the 70th anniversary.
Yet while some politicians, staff and patients hailed the NHS as a “unifying ideal” for the British people, critics demanded answers to the system’s management failures and funding shortfalls.
The official line celebrating the milestone, stated on the NHS70 website, is: “Over the last 70 years, the NHS has transformed the health and wellbeing of the nation and become the envy of the world.
“The NHS has delivered huge medical advances and improvements to public health, meaning we can all expect to live longer lives.
“It is thanks to the NHS that we have all but eradicated diseases such as polio and diphtheria, and pioneered new treatments like the world’s first liver, heart and lung transplant.
“In more recent times, we have seen innovations like mechanical thrombectomy to improve stroke survival, bionic eyes to restore sight, and surgical breakthroughs such as hand transplants.”
CHRIS JOHNSON
(File photo)
[Comment] Action on Salt China
Cardiovascular disease (CVD) is the major cause of death and disability, about 80% of which occurs in developing countries.1 Raised blood pressure from as low as 115/75 mm Hg is a risk factor for CVD. Excessive salt consumption is the leading cause of raised blood pressure.2 Salt intake among adults in most countries is about 10 g/day.3 WHO has recommended a 30% reduction by 2025 with a long-term target of less than 5 g/day. Many governments in high-income countries have started implementing action plans predominately by setting salt reduction targets for processed food.
[The Lancet Commissions] Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission
Sexual and reproductive health and rights (SRHR) are fundamental to people’s health and survival, to economic development, and to the wellbeing of humanity. Several decades of research have shown—and continue to show—the profound and measurable benefits of investment in sexual and reproductive health. Through international agreements, governments have committed to such investment. Yet progress has been stymied because of weak political commitment, inadequate resources, persistent discrimination against women and girls, and an unwillingness to address issues related to sexuality openly and comprehensively.
Government recognises failing men’s health
The Federal Government will establish a National Male Health Strategy.
To run from 2020 to 2030, the announced strategy is in response to the poorer health outcomes experienced by Australian males compared to females.
The Government hopes to identify what is needed to improve male health, and will develop the strategy in consultation with key experts and public feedback.
Health Minister Greg Hunt used the occasion of Men’s Health Week in June to announce the plan, saying developing a good strategy was important because more males die at every stage of life.
“Males have more accidents, are more likely to take their own lives, and are more prone to lifestyle-related chronic health conditions than women and girls at the same age,” Mr Hunt said.
In April, the Government also announced further funding for Men’s Sheds to support the mental health and overall wellbeing of Australian men. The funding is a part of the total $5.1 million that the Government is providing to the Australian Men’s Shed Association over the three years to June 2019.
AMA President Dr Tony Bartone said the AMA was pleased the Federal Government recognised that Australian males have poorer health outcomes, on average, than Australian females. He welcomed the announcement of the strategy.
The AMA called for a National Men’s Health Strategy in its Position Statement on Men’s Health 2018, released in April.
“An appropriately-funded and implemented National Male Health Strategy is needed to deliver a cohesive platform for the improvement of male health service access and men’s health outcomes,” Dr Bartone said.
He said it was important medically because Australian men are less likely to seek treatment from a general practitioner or other health professional, and are less likely to have the supports and social connections needed when they experience physical and mental health problems.
Dr Bartone said Australian men should regularly take the opportunity to do something positive for their physical or mental health.
“Book in for a preventive health check with a trusted GP, get some exercise, have an extra alcohol-free day, or reach out to check on the wellbeing of a mate,” Dr Bartone said.
The AMA Position Statement called for a major overhaul of men’s health policy, including a new national strategy to address the different expectations, experiences, and situations facing Australian men.
Dr Bartone said that the AMA looked forward to engaging with the Federal Government to develop initiatives to address the reasons why men are reluctant to engage with GPs, and the consequence of that reluctance.
The AMA wants investment in innovative models of care to overcome such barriers.
In 2008, the Rudd Labor Government developed a National Male Health Policy, the first for Australia. Part of this program’s funding enabled an Australian Longitudinal Study on Male Health to build a strong evidence base in male health. The study can be found here: https://tentomen.org.au/
The AMA Position Statement on Men’s Health 2018 is at position-statement/mens-health-2018
MARIA HAWTHORNE and MEREDITH HORNE