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Government funds new hub for mental health

The Federal Government has launched a new research hub focused on preventing anxiety and depression.

To be known as the Prevention Hub, it is a collaboration between the Black Dog Institute and Everymind. It will receive $5 million in Government funding to bring together research, clinical education and policy experts to work on prevention strategies.

The Hub will implement and evaluate preventive strategies for anxiety and depression across three settings – workplace, education and healthcare.

The workplace strategies will include rolling out and testing online mental health tools and e-mental health and peer support programs to reduce mental health problems in the workplace.

Education strategies will focus on children, teenagers and their families by increasing the capability of educators and providing online prevention screening and referral tools.

Healthcare strategies will include an extension of an online screening mental health platform for GPs and the development of a framework to improve the mental health of our medical workforce.

Health Minister Greg Hunt said funding for the Hub was a continuation of the Government’s efforts to make mental health a priority.

An additional $338 million was allocated to mental health in this year’s Budget.

“This includes $73 million for suicide prevention to directly help people struggling with mental health challenges and more than $120 million for mental health research,” Mr Hunt said.

“Mental illness does not discriminate and is far more prevalent than most people realise. Nearly half of all Australians will experience mental illness in their lifetime. About one million adult Australians suffer from depression.

“Research has shown around 20 per cent of all cases of depression and anxiety could be prevented by delivering evidence-based prevention programs.

“This could potentially prevent thousands of cases of depression and anxiety each year.”

CHRIS JOHNSON

 

WHO public health awards for Western Pacific Region

Public health champions from the World Health Organization (WHO) Western Pacific Region were recognised at the 71st World Health Assembly in Geneva, Switzerland.

Dr Nazni Wasi Ahmad from Malaysia received honours for her innovative research using insects to treat people with diabetes, and the Korea Institute of Drug Safety and Risk Management (KIDS) for contributions to drug safety in the country.

“Dr Nazni Wasi Ahmad and the Korea Institute of Drug Safety and Risk Management have made outstanding contributions to public health in our Region,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.

“The recognition they are receiving today is a strong affirmation of the significance of that work, which positively impacts the lives of many people in Malaysia, the Republic of Korea and beyond.”

Dr Ahmad was awarded the Dr LEE Jong-wook Memorial Prize for Public Health for her research on the therapeutic use of maggots (fly larvae) to clear and expedite the healing of wounds and foot ulcers caused by diabetes. The maggots remove dead tissue and secrete antimicrobial substances that fight infection and promote healing.

The number of people with diabetes is growing around the world, and diabetic foot ulcers are a serious but relatively common complication. If these wounds are not properly treated and become infected, especially with antibiotic-resistant bacteria, it could result in needing to amputate the affected limb.

In Malaysia, about six per cent of patients attending diabetic outpatient facilities develop foot ulcers, and foot complications account for 12 per cent of all diabetes hospital admissions.

Dr Ahmad’s method is effective, affordable, simple and available at any time and in any healthcare setting, including small local clinics, said the WHO.

When accepting the award, Dr Ahmad said: “Today, our therapy is being practised in health clinics in most districts in Malaysia, including in hard-to-reach areas. It is easy to access and affordable for the people, especially socially and geographically disadvantaged groups.

“We brought our research findings from the laboratory to the bedside, and now we’re preventing limb amputation in diabetic patients in health clinics. This is in line with achieving the ultimate goal of primary health care as advocated by WHO—reducing exclusion and social disparities in health and organizing health services around people’s needs and expectations.”

KIDS received the 2018 United Arab Emirates Health Foundation Prize for its outstanding contribution to health development. The Institute works to improve health in the Republic of Korea by working on prevention and recognition of drug safety-related issues, supporting evidence-based decisions on drug safety, disseminating safety information, and increasing public awareness.

The country’s pharmacovigilance system to monitor the effects of medical drugs consists of 27 regional centres. In this decentralised system, KIDS functions as the focal point, gathering and reporting data from these centres.

The data are used to provide the Ministry of Food and Drug Safety with statistics, safety information and reports of all adverse events. The reporting system further feeds into Vigibase, the global database managed by the WHO Programme for International Drug Monitoring.

“Nationwide, KIDS operates 27 regional pharmacovigilance centres, promoting the reporting of adverse drug reaction cases and incorporating the data into the WHO international pharmacovigilance programme. We take various safety measures proactively and are keen to share with WHO and other countries our experience and achievements in drug safety management,” said Dr Soo Youn Chung of KIDS. 

Each year, at the World Health Assembly held in Geneva, prizes are given to recognise expertise and accomplishments in public health.

The prizes have been established either in the name of eminent health professionals and international figures or by prominent foundations committed to supporting international and global public health. Nominations are submitted by national health administrations and former prize recipients and reviewed by specialized selection panels of each of the foundations awarding a prize. The WHO Executive Board, in its January session, designates the winners based on recommendations made by the selection panels.

The Dr Lee Jong-wook Memorial Prize for Public Health is given to an individual whose work has gone far beyond the performance of duties normally expected of an official of a government or intergovernmental institution.

The United Arab Emirates Health Foundation Prize is awarded to a person, institution or nongovernmental organization that has made an outstanding contribution to health development.

Other prizes presented at the World Health Assembly this year were: the Ihsan Doğramacı Family Health Foundation Prize to Professor Vinod Kumar Paul (India); the Sasakawa Health Prize to the Fundación Pro Unidad de Cuidado Paliativo (Pro Palliative Care Unit Foundation) (Costa Rica); and His Highness Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah Prize for Research in Health Care for the Elderly and in Health Promotion to Association El Badr, Association d’aides aux malades atteints de cancer (El Badr Association, Cancer Patient Association) (Algeria).

CHRIS JOHNSON 

 

[Comment] Offline: “The world has been warned”

What is the extent of the obligation health professionals have to the society in which they live? Beyond immediate patient care, a health worker will be an advocate for a properly financed and functioning health system. But what about the broader political context of health? To support publicly provided health services, governments must generate revenue. Adequate financing for health demands economic growth to create the fiscal space for investment. A health professional might reasonably have an interest in policies that ensure sustainable economic growth—for without that growth, health services will fall into disrepair and the quality of care will inexorably decline.

[Series] Investing in non-communicable diseases: an estimation of the return on investment for prevention and treatment services

The global burden of non-communicable diseases (NCDs) is growing, and there is an urgent need to estimate the costs and benefits of an investment strategy to prevent and control NCDs. Results from an investment-case analysis can provide important new evidence to inform decision making by governments and donors. We propose a methodology for calculating the economic benefits of investing in NCDs during the Sustainable Development Goals (SDGs) era, and we applied this methodology to cardiovascular disease prevention in 20 countries with the highest NCD burden.

Disease and wounds get Ministerial attention

Health Minister Greg Hunt used his AMA National Conference address to commit funding towards wound management and Human T-cell Lymphotropic Virus-1 (HTLV-1) programs.

As the keynote speaker at conference’s opening day, Mr Hunt praised the AMA, gave thanks to outgoing President Dr Michael Gannon, and repeated the Federal Government’s long-term health plan for the nation.

He wound up his remarks by announcing the new funding initiatives.

The Federal Government will provide $8 million to form a taskforce, in collaboration with the States and Territories, to combat emerging communicable diseases such as HTLV-1 in remote communities, he said.

Led by the Commonwealth’s Chief Medical Officer, Professor Brendan Murphy, the taskforce will bring together Aboriginal communities, relevant health providers, researchers, clinicians and all levels of Government.

The taskforce will investigate enhanced responses to communicable diseases, including the drivers behind the emerging prevalence of HTLV-1, a blood-borne virus, in remote communities.

It will do this in close collaboration with Aboriginal communities and develop a roadmap to respond to this issue, the Minister said.

“In terms of Indigenous health, one thing that is an unacceptable national shame is the level of transmissible sexual diseases,” Mr Hunt said.

“So the STIs and infections are at an unacceptable level. We will be investing $8 million to ensure that there is a response to the HTLV-1 virus. That’s working with Indigenous communities, under the leadership of the Chief Medical Officer and (Indigenous Heath Minister) Ken Wyatt.”

In relation to wound management, Mr Hunt recognised that it was a personal passion of many doctors.

He told conference delegates that the Government would embark on a comprehensive wound management program.

“I am referring wound management to the Medicare Taskforce for consideration,” he said.

“Secondly, there will be $1 million in relation to a wound management pilot program under the primary healthcare system. And thirdly, it will be the first priority of the new health system’s translation program under the MRFF (Medical Research Future Fund).”

The Minister also committed to legislating in the coming months with regards to medical indemnity, to ensure universal coverage and a level playing field.

That comment was received with instant applause from the conference floor.

Another welcome remark was his insistence on ending the mandatory reporting practice.

“Our doctors… are under stress, under challenge and always facing difficult issues that affect their own mental health,” he said.

“We will continue to work, and I am utterly committed, to ending the mandatory reporting practice.

“We have worked together. There are one or two States who still have some issues, but on our watch, in our time, that will become a reality that every doctor who wants and needs help will be able to seek that help without fear.”

In closing, the Minister thanked Dr Gannon for his work as the AMA President.

Calling him a friend, Mr Hunt described Dr Gannon in terms of Olympic sports.

“More a decathlete meets Greco-Roman wrestler,” he said.

“He is skilled at close quarters grappling and he usually ends up pinning his opponent.

“But at the end of the day, he’s a fine doctor, a fine leader, and above all else, a fine person.”

CHRIS JOHNSON

 

AMA President opens his last conference

Dr Michael Gannon opened the AMA National Conference 2018 by figuratively saying goodbye.

In his last opening address as AMA President, which was at times emotional, Dr Gannon detailed a long list of achievements secured by the AMA during his two-year tenure.

And he poured praise on the organisation he said he enjoyed leading since 2016.

“I must say that it has been a huge honour and privilege to serve the AMA and the medical profession as Federal President,” Dr Gannon said.

“It is demanding, challenging, rewarding, and life-changing. The issues, the experiences, the depth and breadth of policy and ideas, and the interface with our political leaders and the Parliament are unique to this job.

“The responsibility is immense. The payback is the knowledge that you can achieve great things for the AMA members, the whole medical profession and, most importantly, the community, and the patients in our care.”

His address focused largely on the ground covered since the AMA met for national conference in 2017.

Describing it as a “very busy and very successful year for the Federal AMA,” Dr Gannon said time had passed very quickly in the job but much had been accomplished.

“Throughout the last 12 months, your elected representatives and the hardworking staff in the Secretariat in Canberra have delivered significant achievements in policy, advocacy, political influence, professional standards, doctors’ health, media profile, and public relations,” he said.

“We all worked tirelessly to ensure that health policy and bureaucratic processes were shaped to provide the best possible professional working environments for Australian doctors and the highest quality care for our patients.

“The unique role of the AMA in health advocacy is that we are looked to for commentary on the breadth and depth of health policy, social policy, and the health system.”

Dr Gannon said strong and robust advocacy led to a number of policy outcomes at the federal political level.

He said many organisations get nothing for their efforts, but the AMA never gives up.

“To be successful in Canberra, you have to learn to take the knocks along with the wins, then go back again and again for a better outcome,” he said.

“It is breathtakingly naïve to think it works otherwise. And that is what we have done, and keep doing.”

In 2017, the AMA launched its regular Safe Hours Audit Report, which gave added focus to the emerging issue of doctors’ health.

To enhance this focus on doctors’ health, AMA coordination of Doctors’ Health Services continues all around the country, with funding support from the Medical Board of Australia.

“We maintained a strong focus on medical workforce and training places, which resulted in the National Medical Training Advisory Network significantly increasing its workforce modelling work,” Dr Gannon told the conference.

“We secured a number of concessions in the proposed redesign of the Practice Incentive Program, as well as a delay in the introduction of changes.

“The AMA lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents. We focused on effective compliance, and achieving a fair balance between the interests of GP members and Pathologist members.

“We led the reforms to after-hours GP services provided through Medical Deputising Services to ensure that these services are better targeted, and there is stronger communication between them and a patient’s usual GP.

“We successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting. This potentially saves GPs thousands of dollars every year in legal and other compliance costs.

“We ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers. This avoided more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.

“We fundamentally altered the direction of the Medical Indemnity Insurance Review.”

The AMA campaigned on the issue of doctors’ health and the need for COAG to change mandatory reporting laws, promoting the WA model.

It led a nationally coordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.

It campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.

The 2018 AMA Public Hospital Report Card put the political, media, and public focus on the stresses and pressures on public hospitals and all who work in them. The current funding model, based entirely around payments for activity, discourages innovation and is inadequate in addressing the demands placed by an ageing population.

“We prosecuted the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee, my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy,” Dr Gannon said.

“This work was complemented by the launch of the AMA Private Health Insurance Report Card.

“We successfully lobbied for a fundamental change in the direction of the Anaesthesia Clinical Committee of the MBS Review. The Australian Society of Anaesthetists were grateful for our assistance and leadership. Many other Colleges, Associations and Societies have worked out that partnership with, rather than competing with, the AMA is the smartest way to get results.

“We launched a new AMA Fees List with all the associated benefits of mobility and regular updates.

“We saw a number of our Aged Care policy recommendations included in a number of Government reviews.

“We lobbied against what could easily have been an ill-thought-out UK-style Revalidation proposal. Our work resulted in a vastly improved Professional Performance Framework based around enhanced Continuing Professional Development.”

Dr Gannon said the AMA had provided strong leadership right across the busy public health landscape over the past year.

The AMA Indigenous Health Report Card focused on ear health, and specifically chronic otitis media.

The Federal Council endorsed the Uluru Statement from the Heart, acknowledging that Recognition is another key social determinant of health for Aboriginal and Torres Strait Islander Australians.

A product of a policy session at last year’s AMA National Conference was the subsequent updating of the AMA Position Statement on Obesity,

“I think that it is inevitable that we will eventually see a tax on sugar-sweetened beverages similar to those recently introduced in Britain and Ireland,” Dr Gannon said.

“In fact it is so simple, so easy, and so obvious, I worry that it will be seen by a future Government as a ‘silver bullet’ to what is a much more complex health and social policy issue.”

Position Statements on an Australian Centre for Disease Control; Female Genital Mutilation; Infant Feeding and Maternal Health; Harmful Substance Use, Dependence, and Behavioural Addiction; and Firearms were also highlighted.

“We conducted ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees,” he said.

“We promoted the benefits of immunisation to individuals and the broader community. Our advocacy has contributed to an increase in vaccination rates.

“We provided strong advocacy on climate change and health, among a broader suite of commentary on environmental issues.

“We consistently advocated for better women’s health services. And released a first ever statement on Men’s Health.”

New Position Statements were also released on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, Blood Borne Viruses, and Rural Workforce.

“We promoted our carefully constructed position statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, New South Wales and WA,” Dr Gannon said.

“That advocacy was not universally popular. Our Position Statement acknowledges the diversity of opinion within the profession…

“We led the medical community by being the first to release a Position Statement on Marriage Equalityand advocated for the legislative change that eventuated in late 2017.”

In July 2017, AMA advocacy was publicly recognised when the Governance Institute rated the AMA as the most ethical and the most successful lobby group in Australia.

Dr Gannon added that the highlight of the 2017 international calendar for him was the annual General Assembly of the World Medical Association.

“Outcomes from that meeting included high level discussions on end-of-life care, climate change and environmental health, numerous other global social and ethical issues, and seeing the inclusion of doctors’ health as a core issue in both medical ethics and professionalism,” he said.

“I get goosebumps when I read aloud the Declaration of Geneva. It is a source of immense personal pride that I was intimately involved with its latest editorial revision, only the fifth since 1948.

“But our focus remained at home, and your AMA was very active in promoting our Mission: Leading Australia’s Doctors – Promoting Australia’s Health.

“We had great successes. We earned and maintained the respect of our politicians, the bureaucracy, and the health sector.

“We won the support of the public as we have fought for a better health system for all Australians.”

Dr Gannon thanked his family, staff, the AMA Secretariat, Board and Federal Council.

CHRIS JOHNSON

[Comment] 2018 must be the year for action against NCDs

2018 is a pivotal year for progress towards the defeat of non-communicable diseases (NCDs). The 2011 Political Declaration on the Prevention and Control of NCDs, led by WHO’s then Assistant Director-General Ala Alwan, was a turning point in the history of global health. For the first time, and often in the face of severe resistance by governments and health-harming industries, nations accepted that chronic diseases were a critical force influencing human development. But since 2011, and despite much exclamatory rhetoric, momentum behind efforts to mobilise action against NCDs has stalled (and that is putting it politely).

[Editorial] False economy and global health security

Last week, the DR Congo declared a new outbreak of Ebola, with two confirmed cases, 39 probable cases, and 19 deaths reported as we went to press. The threat of a new outbreak highlights the need for a focused and coordinated response from a broad range of international governmental and non-governmental agencies and organisations. The 2014–16 west African Ebola epidemic, with nearly 30 000 suspected Ebola deaths and thousands more due to lack of access to an overwhelmed health-care system, was devastating and cost more than US$3·6 billion ($2·4 billion from the USA), with an estimated $2·2 billion in lost GDP in the affected countries.

[Series] Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs).