PM shares the love

Prime Minister Malcolm Turnbull put down his script while addressing the AMA’s National Conference to express his appreciation for the medical profession.

After telling conference delegates that his Government was committed to delivering good health policy – and after outlining what he considered to be the best bits of what the Federal Budget had delivered for the health sector – he said doctors were committed to love.

“I know that all you – all of your years of academic training, all of your years of clinical experience, all of the science and studying that’s dominated your lives – above all else what drives you is love for your fellow men and women. Love for your patients,” he said.

“You’ve committed yourselves to a life of service – undiluted. A commitment. A compassion. We thank you for it.”

The Prime Minister continued to leave his notes aside as he wound up his speech praising the state of Australia’s medical workforce.

“Our health system is the envy of the world,” Mr Turnbull said.

“Our skilled doctors, our nurses, all your allied professionals, work tirelessly to give the best possible care and your Government thanks you for that.

“Thank you for your dedication, thank you for your professionalism, thank you for your compassion.

“We will match you with a commitment to ensure that you have the resources at every level to continue to deliver the practical love that keeps Australians well.”

The Prime Minister’s speech was warmly received by a receptive audience. AMA President Dr Michael Gannon said it was indicative of the respect and influence the AMA has that the PM eagerly accepted an invitation to address the conference.

Peanut allergies in children

Earlier in his speech, Mr Turnbull committed a $10 million investment towards a research project for a new treatment for children with peanut allergies.

“That has the potential to benefit the people who deserve the highest level of support – our children,” he said.

“The research will help develop a new therapy for our children with peanut allergies to help incorporate peanut products as a regular part of their diet.

“What a difference that will make to children everywhere. It’s an example of innovative projects the Government is backing.”

Chris Johnson

Shorten says Government trying to silence doctors

AMA President Dr Michael Gannon assured delegates to the National Conference the association is independent and not “reading from the script any political party”.

His comments followed a conference address by Opposition Leader Bill Shorten, who suggested the staged thaw of the Medicare rebate freeze – as outlined in the Federal Budget – was the Government’s way of offering “cash for no comment”.

“If you like, it’s the minimum they can get away with paying to keep people silent,” Mr Shorten said.

“It’s like cash for no comment.

“I believe the Government has got a calculus here. What is the minimum they can pay to make healthcare issues go away as an election point?”

The Opposition Leader insisted his comments were a swipe at the Government and not at the AMA or other medical groups.

But when asked about it in a subsequent panel session, Dr Gannon told the conference the AMA engaged with all political parties equally and was not influenced by policy announcements.

“They’re in for a surprise if they think they can keep the AMA quiet,” he said.

Health Minister Greg Hunt agreed that the AMA was independent and told reporters that if Mr Shorten was attacking the AMA it was a “vile” thing to do.

Greens leader Richard Di Natale, who also spoke at the conference and delivered his own veiled criticism over recent commentary around climate change, said Mr Shorten’s remarks were directed at the AMA.

“How else would you construe it?” he told the media following his address.

“Now, I think the unfreezing of the rebate is happening way too slowly. But what the AMA does in response to Government policy is a matter for them.”

The May Budget lifts the Medicare rebate freeze, which was introduced by Labor and extended when the Coalition came to office. But it does it in stages – starting this year with bulk-billing incentives for GPs, continuing with other GP specialist consultations in 2018, specialist procedures in 2019, and diagnostic imaging services in 2020.

Mr Shorten released to the conference new independent costings of the rollout, which he said amounts to $2.2 billion in Medicare cuts over four years.

He said the Parliamentary Budget Office analysis showed that by completely lifting the freeze across the board from July 1 this year it would have cost $3.2 billion.

Doing it the way the Budget outlines, costs less than $1 billion.

Shadow Health Minister Catherine King also addressed the AMA National Conference and repeated Labor’s commitment to end the Medicare rebate freeze completely and all at once.

Chris Johnson

Funding to help tackle resistant bugs

Health Minister Greg Hunt used his address to the AMA’s National Conference to announce a $5.9 million investment from the Medical Research Future Fund (MRFF) to help address the growing threat of superbugs.

With the number of microorganisms such as bacteria, viruses or parasites becoming increasingly resistant to standard medical treatments such an investment was warranted, the Minister said.

Resistance results in standard medical treatments such as antibiotics, antivirals or anti-malarials becoming ineffective, allowing infections to persist and possibly spread.

“Infections are becoming increasingly difficult to treat, leaving healthcare professionals with limited – or in some instances zero – treatment options,” Mr Hunt told conference delegates.

“Australia has one of the highest rates of antibiotic use in the world and rates of resistance to some common antibiotics are increasing globally.

“Commercial returns on the discovery and development of new antibiotics is relatively low, so it is an area of research that doesn’t attract sufficient private sector investment.

“The research will be consistent with the achievement of the objectives of the National Antimicrobial Resistance Strategy 2015-2019, which was developed by the Australian Government in partnership with states and territories, academics, research organisations and industry.”

The strategy will include a focus on knowledge gaps in relation to the development and spread of resistance; and the development of new products, including diagnostic technologies and therapies, policies and approaches to prevent, detect and respond to resistance.

“The Coalition’s $20 billion MRFF provides a long-term sustainable source of funding for research that aims to improve health outcomes, quality of life and health system sustainability,” the Minister said.

“This investment in critical antimicrobial resistance research is part of the $65.9 million in MRFF disbursements announced in the Budget.

“The Turnbull Government is committed to supporting Australia’s talented researchers to find solutions to challenges that make a difference to patients’ lives.”

Chris Johnson

President highlights AMA influence

AMA President Dr Michael Gannon opened the 2017 National Conference lauding the political influence of the organisation he leads.

He told delegates that the past 12 months had been eventful and had resulted in numerous achievements in health policy.

“The AMA is a key player in Federal politics in Canberra. The range of issues we deal with every day is extensive,” Dr Gannon said.

“Our engagement with the Government, the bureaucracy, and with other health groups is constant and at the highest levels.

“Our policy work is across the health spectrum, and is highly regarded.

“The AMA’s political influence is significant.”

Describing the political environment over the past year as volatile – which included a federal election and two Health Ministers to deal with – Dr Gannon said the AMA had spent the year negotiating openly and positively with all sides of politics.

“Our standing is evidenced by the attendance at this conference of Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Greens Leader Senator Richard Di Natale, Health Minister Greg Hunt, Minister for Aged Care and Minister for Indigenous Health Ken Wyatt AM, and Shadow Health Minister Catherine King,” he said.

“Health policy has been a priority for all of them, as it has been for the AMA.”

While the Medicare rebate freeze was the issue to have dominated medical politics, there are still more policy areas to deal with in the coming year.

The freeze was bad policy that hurt doctors and patients.

“I was pleased just weeks ago on Budget night to welcome the Government’s decision to end the freeze,” Dr Gannon told the conference.

“The freeze will be wound back over three years. We would have preferred an immediate across the board lifting of the freeze, but at least now practices can plan ahead with confidence.

“Lifting the freeze has effectively allowed the Government to rid itself of the legacy of the disastrous 2014 Health Budget.

“We can now move on with our other priorities… We will maintain our role of speaking out on any matter that needs to be addressed in health.”

Dr Gannon said while the Medicare freeze hit general practice hard, it was not the only factor making things tough for hardworking GPs.

General practice is under constant pressure, he said, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care and are the most cost effective part of the health system.

“One of the most divisive issues that the AMA has had to resolve in the past 12 months is the Government’s ill-considered election deal with Pathology Australia to try and cap rents paid for co-located pathology collection centres,” Dr Gannon said.

“We all know that our pathologist members play a critical role in helping us to make the right decisions about our patients’ care. They are essential to what we do every day.

“It was disappointing to see the Government’s deal pit pathologists against GPs.

“The pathology sector is right to demand that allegations of inappropriate rents are tackled, and the GPs are equally entitled to charge rents that place a proper value on the space being let.

“The recent Budget saw the rents deal dumped in favour of a more robust compliance framework, based on existing laws. This is a more balanced approach.

“The AMA will work with Government and other stakeholders to ensure that allegations of inappropriate rents are tackled effectively.

“We want to ensure that patients continue to access pathology services solely on the basis of quality.”

The AMA is a critical adviser to the Government on its roll-out of the Health Care Home trial.

It shares the Government’s vision for the trial, but will continue to provide robust policy input to ensure it has every chance of success.

The AMA has secured a short delay in the roll-out of the trial.

Other issues the President highlighted as areas the AMA is having significant influenced included: the Practice Incentive Program; My Health Record; Indigenous Health; After-Hours GP Services; the MBS Review; public hospitals; private insurance; and the medical workforce.

Chris Johnson

Malaria expert to head up WHO

Internationally recognised malaria researcher, Dr Tedros Adhanom Ghebreyesus from Ethiopia, will be the next Director-General of the World Health Organisation (WHO).

He will be the first African to lead the United Nations agency and will replace Dr Margaret Chan who steps down from the role at the end of June.

He will also be the first non-physician to lead WHO – holding a PhD in community health. His leadership of WHO is for a five-year term.

Dr Tedros, aged 52, was previously the Ethiopian Health Minister and the Foreign Affairs Minister, and was also the chairman of the Global Fund to Fights Aids, Tuberculosis and Malaria.

He has been elected to the Director-General’s post after winning the most votes from WHO’s 194 Member States during three rounds of secret ballots that began in January and culminated on May 23.

In a three-way face-off during the final vote, he first knocked off Pakistan’s Dr Sania Nishtar then defeated Britain’s Dr David Nabarro 133 votes to 50 (with some abstentions).

The agency has been criticised for its response to the Ebola epidemic in West Africa – particularly for missing warning signs of just how bad 2013 outbreak that went on to kill more 11,000 would be.

Before being elected, Dr Tedros committed WHO to responding to future emergencies more rapidly and effectively.

And he has promised to champion the health rights of the world’s poor.

“All roads should lead to universal health coverage. I will not rest until we have met this,” he said while campaigning for the role.

“(My vision as the new Director-General is of a) world in which everyone can lead health and productive lives, regardless of who they are or where they live.

“I promise I will get up every day, determined to make a difference. I am ready to serve.”

The campaign was controversial at times, with Dr Tedros being accused of covering up cholera epidemics in Ethiopia – accusations that have been vigorously denied.

His candidacy was also greeted by Ethiopian opposition groups as an attempt to improve the country’s profile and smooth over accusations of human rights abuses by its government.

Dr Tedros has listed his top priorities in the new role as: advancing universal health coverage; ensuring WHO responds rapidly and effectively to disease outbreaks and emergencies; putting the wellbeing of women, children and adolescents at the centre of global health and development; helping nations address the effects of climate change on health; and making the agency transparent and accountable

Chris Johnson

AMA urges bipartisan approach to enshrining marriage equality in law

The Australian Parliament should legislate for marriage equality and end the divisive public debate over same-sex marriage, says AMA President Dr Michael Gannon.

The AMA has called on the Government and the Opposition to work together to bring about marriage equality in Australia.

The AMA has written to Prime Minister Malcolm Turnbull and Opposition Leader Bill Shorten, urging a bipartisan approach to the issue.

Releasing the AMA Position Statement on Marriage Equality 2017, Dr Gannon said that excluding same-sex couples from the institution of marriage has significant mental and physical health consequences for lesbian, gay, bisexual, transgender, intersex, and queer/questioning (LGBTIQ) Australians.

“Discrimination has a severe, damaging impact on mental and physiological health outcomes, and LGBTIQ individuals have endured a long history of institutional discrimination in this country,” he said.

“This discrimination has existed across the breadth of society; in our courts, in our classrooms, and in our hospitals.

“Many of these inequalities have been rightly nullified. Homosexuality is no longer a crime, nor is it classified as a psychiatric disorder. The ‘gay panic’ defence is no longer allowed in cases of murder or assault, and same-sex couples are allowed to adopt children in most jurisdictions.

“However, LGBTIQ-identifying Australians will not enjoy equal treatment under Australian law until they can marry.

“It is the AMA’s position that it is the right of any adult and their consenting adult partner to have their relationship recognised under the Marriage Act 1961, regardless of gender.

“There are ongoing, damaging effects of having a prolonged, divisive, public debate, and the AMA urges the Australian Parliament to legislate for marriage equality to resolve this.”

Former AMA President, and long-time same-sex marriage campaigner, Kerryn Phelps said the medical profession has carefully considered the health consequences of continued discrimination and has now made an “emphatic statement” that it should end.

“I think politicians now have a duty of care to the community to make sure marriage equality is introduced as soon as possible,” Dr Phelps said.

While there is no definitive data on the number of Australians who identify as LGBTIQ, same-sex couples made up approximately 1 per cent of all Australian couples in the 2011 Census, and more than 3 per cent of respondents to a 2014 Roy Morgan survey identified as homosexual.

People who identify as LGBTIQ have significantly poorer mental and physiological health outcomes than those experienced by the broader population. They are more likely to engage in high-risk behaviours such as illicit drug use or alcohol abuse, and have the highest rates of suicidality of any population group in Australia.

“These health outcomes are a consequence of discrimination and stigmatisation, and are compounded by reduced access to health care, again due to discrimination,” Dr Gannon said.

“The lack of legal recognition can have tragic consequences in medical emergencies, as a person may not have the right to advocate for their ill or injured partner, and decision-making may be deferred to a member of the patient’s biological family instead.

“Marriage equality has been the subject of divisive political and public debate for the best part of the past decade.

“It is often forgotten that, at the core of this debate, are real people and families. It’s time to put an end to this protracted, damaging debate so that they can get on with their lives.

“As long as the discrimination against LGBTIQ people continues, they will continue to experience poorer health outcomes as a result.

“LGBTIQ Australians are our doctors, nurses, police officers, teachers, mothers, fathers, brothers, and sisters. They contribute to this country as much as any Australian, but do not enjoy the same rights.

“It is time to remove this discrimination.”

The AMA Position Statement on Marriage Equality 2017 is at position-statement/marriage-equality-2017.

Chris Johnson

[Comment] Looming threat of Asian tobacco companies to global health

The Indonesian Government is considering a ministerial decree that could triple cigarette production by 2020.1 The proposed decree follows unsuccessful bills2 to boost tobacco growing and “farmer prosperity”,3 despite concerns about health and child labour practices.4 If adopted, manufacturers would be required to use at least 80% locally sourced leaf, and a 200% excise tax would be imposed on cigarette imports. The measures follow the takeover of Indonesia’s major cigarette manufacturers by transnational tobacco companies (TTCs), which raises the concern that imports will displace domestic production.

[Correspondence] Health economics

Joseph L Dieleman and colleagues1 assessed, measured, and extrapolated time trends and relationships between economic development, demographic transition, and health financing indicators to estimate health spending by source for 184 countries in 2013–40. In developed countries, health expenditures increase rapidly according to ageing of the societies. Considering the limited increases in governmental incomes, it is important to restrict health expenditures to make a health system sustainable. Notably, prepaid private insurance played an important part in the health system of many high-income countries in Dieleman’s study.

[Correspondence] Open letter to WHO DG candidates: keep policy and priority setting free of commercial influence

In May, 2017, WHO Member States will meet in Geneva for the 70th World Health Assembly (WHA) and a new WHO Director-General (DG) will be elected. As public-interest non-government organisations (NGOs) involved in global health governance and the prevention and treatment of chronic diseases, we believe that a fundamental consideration for Member States when electing the DG will be how the new leadership will ensure appropriate interactions with alcohol, food, pharmaceutical, and medical technology industries.

[Editorial] UK air pollution and public health

The UK Government released its latest consultation documents for controlling air pollution on May 5. Under European law, the UK has a legal obligation to protect public health by minimising the impact of environmental pollutants, including particulate matter and nitrogen dioxide. The UK has been in breach of the European directive since 2010, and has been the target of legal action by environmental groups.