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Preference: Indigenous Health

1

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

Enthused about Indigenous Medical Scholarship

It is pretty hard to imagine someone being more inspirational than Associate Professor Kelvin Kong.

Australia’s first Indigenous surgeon – having qualified as the first Aboriginal Fellow of the Royal Australasian College of Surgeons and specialising in otolaryngology, head and neck surgery – he is passionate about bridging the health gap between Indigenous and non-Indigenous Australians.

Hailing from the Worimi people of Port Stephens, he now practices paediatric and adult ear, nose and throat surgery at Newcastle, NSW. He also lectures there.

His career to date is impressive and he is hugely committed to helping others pursue their own goals. Describing Dr Kong as enthusiastic would be an understatement.

Included in his long list of accolades is the AMA Indigenous Medical Scholarship.

A young Kelvin was the scholarship’s recipient in 1997.

Australian Medicine asked Dr Kong how important it was then to receive the award and how it seems now in retrospect.

“At the time it was extremely important,” he said.

“It wasn’t a huge amount of money, but for me it was. It certainly wasn’t a little amount of money, but I wouldn’t have cared if it was five bucks.

“The biggest impact it had on me was being recognised by my colleagues and the medical fraternity as someone who is legitimate.

“I was being told that I can make a contribution. I stand very proud as a recipient of this scholarship. I hope it has paid off and I hope those who sponsored it believe their contribution was worthwhile.

“I was mid-career with my studies, year 3-4, and at a time when we are pouring beers, waiting tables and all that kind of stuff just trying to get through.

“This meant I could pay my bills and put food on the table and spend more time trying to feel normal.

“It is important in retrospect to acknowledge the pure fact that the AMA thought that this was a big enough issue to get its Board to recognise and seek to fund.

“That was huge. It says a lot about the AMA as an organisation that it had that vision.

“Medicine is hugely competitive, so to get some acknowledgement is very important. It gave me a lot of inroads into mentorship and leadership and allowed me to contact people with similar values to me.

“Australia is a diverse community and so is its medical community. This was normalising that it’s ok to achieve.

“In the Aboriginal community and in the wider community there can be this misconception that people are ‘getting in’ on the back of them being Aboriginal. The actual fact is, there are a lot of hugely talented people in the Aboriginal community who will make an enormous contribution to medicine.

“That was a great vision and I am eternally grateful for being given that morale boost.”

Dr Kong has used his scholarship, and all of the honours that followed, to help him play his part in addressing the disparity – not only in health outcomes, but in career opportunities – between Indigenous and non-Indigenous Australians.

“It is important to acknowledge the disparity of opportunities for people who live in the same country,” he said.

“We have a very robust medical industry. I know there is talk of maybe awarding two of these scholarships each year. I think it would be fabulous if there were ten.

“I was asking myself ‘how can the AMA enhance this more?’ and I thought that maybe one way is by increasing the number of scholarships – increasing the number of donors.

“There is a greater awareness among Australia and the medical community that this is genuinely important and we give value to it. It gives me that boost. It must give donors that boost too.

“We have this disparity in health outcomes, but there is a genuine desire in governments, in associations like the AMA, and in the community to address this.

“I am extremely lucky, first and foremost. I love my profession. I love my work. I love coming to work.

“As a Worimi man, I am heartened that we are as an Australian community seeking to address this disparity.

“I live a fantastic lifestyle. But my mother never had this opportunity, my Nan never had this opportunity.

“They would have done a better job.”

He says with a smile.

CHRIS JOHNSON

 Information about donations towards the Indigenous Medical Scholarship can be found at: donate-indigenous-medical-scholarship

 

 

 

Look after yourself, for everyone’s benefit

BY DR SANDRA HIROWATARI, CHAIR, COUNCIL OF RURAL DOCTORS

Hey doc, you look tired.

As I get older and more wrinkly, this comment seems to be a more frequent bugbear.

But you know, no matter how tired, it isn’t pleasant to be given that feedback – a mirror that states the haggard obvious.

But on the other hand, it touches me that the doctor-patient relationship has flipped a bit where my patient looks at me as someone that needs care.  For a moment, they care enough to see tiredness on my face.

Let’s unpack this tiredness.

Rural doctors on average work longer than their urban counterparts. This means less leisure time, less sleep time and less family time.

Forty per cent of rural doctors are international medical graduates (IMGs – overseas trained), like me, a duck out of water.  The tiredness for us is the added task of “fitting in”.  Generally, our nuclear family lives overseas.  Australian-based friends have yet to be fostered.

Rural doctors in general do more.  This means more to learn, more procedures to become comfortable with, more tasks that simultaneously need to be done with our octopus arms. 

Our urban colleagues have a wealth of alternatives to distract, entertain, and rejuvenate themselves.  Recently while in Brisbane, I was amazed at the choices of fitness clubs, cinemas, swimming pools, yoga studios, theatre, bike paths.  We don’t have these energising resources.

Rural doctors generally have less family and friend support.  Those luxurious relationships are fostered on a Skype call (if we have internet) or on our rare visits to family over 500 km away.  Tired is one thing. Tired and alone makes you want to cry, to give up.  Especially after a tough event in the clinic or in the ED.

When we plan a holiday, there is a dread of finding a replacement, a locum.  A weekend break is not a break when it takes one day to leave the Outback, one day to return (if the roads are not flooded).  I calculate that it is an investment of over 24 hours to achieve an 18 hour break.  Having said that, I did do that long trip to Broome, a trip of 700 km, killing my first kangaroo, saw a movie at the famous cinema there, then went back on Sunday night.

So, what can be done?  Well, doctor, I needn’t teach you what you counsel your patients daily. In my mind, when we are running on empty the first step is NOT to fill the tank. Why?  Because the cycle continues, the problems are not solved.

Here is a different perspective – an age old sequence reworded that some of you will recognise.

The first step is to recognise tiredness, despair, loneliness, heart break, depression, unrelieved stress as conditions that need to be addressed. Now. Admission of a weakness is the first step to strength. Admit that there is a helplessness to solving this by yourself.

Next find someone to help you, someone you can trust.  Let this someone not be yourself. Get a GP. Meditation, church, prayer and pastors all are another form of support outside of yourself. Doctors’ support programs exist now in all States. In the Outback you have a support that is rare in the cities – the local indigenous Elder, the wise woman or man. Even two States away, I still contact my two “sista-mothers” when I am particularly low.

Then follow the advice given. Let it go, you do not need to be in the driver’s seat always. Talk about it. The advice may be difficult, like “say no, or move on”. Or the comment may be “you cannot meditate this away”. Doctors used to being in control find this step difficult. But remember that you have taken the first step of admitting a need for help.

Hey doc, are you looking tired?  Wishing you health and recovery, we need you.

Encouraging more doctors to go rural

The AMA has released its Position Statement – Rural Workforce Initiatives, a comprehensive five-point plan to encourage more doctors to work in rural and remote locations, and improve patient access to care.

The plan proposes initiatives in education and training, rural generalist pathways, work environments, support for doctors and their families, and financial incentives.

It says that at least one-third of all new medical students should be from rural backgrounds.

And more medical students should be required to do at least one year of training in a rural area to encourage graduates to live and work in regional Australia.

In releasing the Position Statement, AMA President Dr Michael Gannon noted that about seven million Australians live in regional, rural, and remote areas, and they often have more difficulty accessing health services than their city cousins.

They often have to travel long distances for care, and rural hospital closures and downgrades are seriously affecting the future delivery of health care in rural areas.

For example, Dr Gannon said, more than 50 per cent of small rural maternity units have been closed in the past two decades.

“Australia does not need more medical schools or more medical school places,” he said.

“Workforce projections suggest that Australia is heading for an oversupply of doctors.

“Targeted initiatives to increase the size of the rural medical, nursing, and allied health workforce are what is required.

“There has been a considerable increase in the number of medical graduates in recent years, but more than three-quarters of locally trained graduates live in capital cities.

“International medical graduates (IMGs) make up more than 40 per cent of the rural medical workforce and while they do excellent work, we must reduce this reliance and build a more sustainable system.”

The AMA Rural Workforce Initiatives plan outlines five key areas where Governments and other stakeholders must focus their policy efforts:

  • Encourage students from rural areas to enrol in medical school, and provide medical students with opportunities for positive and continuing exposure to regional/rural medical training;
  • Provide a dedicated and quality training pathway with the right skill mix to ensure doctors are adequately trained to work in rural areas;
  • Provide a rewarding and sustainable work environment with adequate facilities, professional support and education, and flexible work arrangements, including locum relief;
  • Provide family support that includes spousal opportunities/employment, educational opportunities for children’s education, subsidies for housing/relocation and/or tax relief; and
  • Provide financial incentives to ensure competitive remuneration.

“Rural workforce policy must reflect the evidence. Doctors who come from a rural background, or who spend time training in a rural area, are more likely to take up long-term practice in a rural location,” Dr Gannon said.

“Selecting a greater proportion of medical students with a rural background, and giving medical students and graduates an early taste of rural practice, can have a profound effect on medical workforce distribution.

“Our proposals to lift both the targeted intake of rural medical students and the proportion of medical students required to undertake at least one year of clinical training in a rural area from 25 per cent to 33 per cent are built on this approach.

“More Indigenous people must be encouraged to train and work in health care, as there is a strong link between the health of Indigenous people in rural areas and their access to culturally appropriate health services.

“Fixing rural medical workforce shortages requires a holistic approach that takes into account not only the needs of the doctor, but also their immediate family members.

“Many doctors who work in rural areas find the medicine to be very rewarding, but their partner may not be able to find suitable employment, and educational opportunities for their children may be limited.

“The work environment for rural doctors presents unique challenges, and Governments must work collaboratively to attract a sustainable health workforce. This includes rural hospitals having modern facilities and equipment that support doctors in providing the best possible care for patients and maintaining their own skills.

“Finally, more effort must be made to improve internet services in regional and rural areas, given the difficulties of running a practice or practising telehealth with inadequate broadband.

“All Australians deserve equitable access to high-speed broadband, and rural doctors and their families should not miss out on the benefits that the growing use of the internet is bringing.”

The AMA Position Statement – Rural Workforce Initiatives is available at position-statement/rural-workforce-initiatives-2017

CHRIS JOHNSON

 

Background:

  • Most Australians live in major cities (70 per cent), while 18 per cent live in inner regional areas, 9 per cent in outer regional areas, and 2.4 per cent in both remote and very remote areas.
  • Life expectancy is lower for people in regional and remote Australia. Compared with major cities, the life expectancy in regional areas is one to two years lower, and in remote areas is up to seven years lower.
  • The age standardised rate of the burden of disease increases with increasing remoteness, with very remote areas experiencing 1.7 times the rate for major cities.
  • Coronary heart disease, suicide, COPD, and cancer show a clear trend of greater rates of burden in rural and remote areas.
  • The number of medical practitioners, particularly specialists, steadily decreases with increasing rurality. The AIHW reports that while the number of full time workload equivalent doctors per 100,000 population in major cities is 437, there were 272 in outer regional areas, and only 264 in very remote areas.
  • Rural medical practitioners work longer hours than those in major cities. In 2012, GPs in major cities worked 38 hours per week on average, while those in inner regional areas worked 41 hours, and those in remote/very remote areas worked 46 hours.
  • The average age of rural doctors in Australia is nearing 55 years, while the average age of remaining rural GP proceduralists – rural GP anaesthetists, rural GP obstetricians and rural GP surgeons – is approaching 60 years.
  • International medical graduates (IMGs) now make up over 40 per cent of the medical workforce in rural and remote areas.
  • There is a health care deficit of at least $2.1 billion in rural and remote areas, reflecting chronic underspend of Medicare and the Pharmaceutical Benefits Scheme (MBS) and publicly-provided allied health services.

 

 

Indigenous Scholarship applications closing soon

Applications close on 31 January for the 2018 AMA Indigenous Medical Scholarship, a program that has supported Aboriginal and Torres Strait Islander students to study medicine since 1994. The successful applicant will receive $10,000 each year for the duration of their course.

Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.

“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community,” AMA President Dr Michael Gannon said.

“It’s evident that Indigenous people have a greater chance of improved health outcomes when they are treated by Indigenous doctors and health professionals.

“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances.

“The AMA strongly encourages Indigenous students to apply for the Scholarship, which, along with the AMA’s annual Report Card on Indigenous Health and the work of the AMA Taskforce on Indigenous Health, is part of the AMA’s commitment to improving the health of Aboriginal and Torres Strait Islander Australians.”

Previous winners have gone on to become prominent leaders in health and medicine, including Associate Professor Kelvin Kong, Australia’s first Aboriginal surgeon.

Applicants must be currently enrolled at an Australian medical school, be in at least their first year of medicine, and be of Aboriginal and/or Torres Strait Islander descent. Further information, including the application form, can be found at https://www.ama.com.au/indigenous-medical-scholarship-2018. 

The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.

More information is available at donate-indigenous-medical-scholarship. For enquiries, please contact the AMA via email at indigenousscholarship@ama.com.au or phone (02) 6270 5400.

 

Christmas message from AMA President

It has been a very busy and very successful year for the Federal AMA. 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.

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

Our priority at all times is to provide value for your membership of the AMA.

As 2017 draws to a close, I would like to provide you with a summary of the work we have undertaken on behalf of you, our valued members.

General Practice and Workplace Policy

  • Our strong advocacy led to a decision to lift the freeze on Medicare patient rebates.
  • AMA coordination of Doctors’ Health Services around the country, with funding support from the Medical Board of Australia.
  • Launched the AMA Safe Hours Audit Report, giving added focus to the issue of doctors’ health and wellbeing.
  • Maintained a strong focus on medical workforce and training places, with the National Medical Training Network significantly increasing its workforce modelling and projection work following sustained advocacy by the AMA.
  • Secured a number of concessions in the proposed redesign of the Practice Incentive Program (PIP), as well as a delay in the introduction of changes.
  • Lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents, focusing on effective compliance, and achieving a fair balance between the interests of GP members and pathologist members.
  • Led the Reforms to After-hours GP services provided through Medical Deputising Services (MDSs) to ensure that these services are better targeted and there is stronger communication between the MDS and a patient’s usual GP.
  • Successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting, potentially saving GPs thousands of dollars annually in legal and other compliance costs.
  • Ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers, avoiding more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.

 

Medical Practice

  • Fundamentally altered the direction of the Medical Indemnity Insurance Review, discussing its importance to medical practice at the highest level, helping to ensure the review is not used as a blunt savings exercise, and saving doctors and their patients millions of dollars in increased premiums.
  • Led a nationally co-ordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.
  • Campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.
  • Campaigned on the issue of Doctors’ Health and the need for COAG to change mandatory reporting laws, promoting the WA model.
  • Launched the AMA Public Hospital Report Card.
  • Pressed the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee (PHMAC), my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy.
  • Launched the AMA Private Health Insurance Report Card.
  • Successfully convinced the Government to address concerns with the MBS Skin items, and will continue to do so with the MBS Review more broadly.
  • Successfully lobbied for changes to the direction of the Anaesthesia Clinical Committee of the MBS Review.
  • Launched a new AMA Fees List with all the associated benefits of mobility and regular updates.
  • Saw a number of our Aged Care policy recommendations included in a number of Government reviews.
  • Lobbied against the ill-thought-out Revalidation proposal, which resulted in a vastly improved Professional Performance Framework based around enhanced continuing professional development.
  • Successfully held off the latest attempt to have a non-Medical Chair of the Medical Board of Australia appointed.

 

Public Health

  • Launched the AMA Indigenous Health Report Card, which this year focused on ear health, and specifically chronic otitis media, in conjunction with the Minister for Indigenous Health, The Hon Ken Wyatt AM.
  • Led the medical community by being the first to release a Position Statement on Marriage Equality, and advocated for the legislative change that eventuated in late 2017.
  • Released the updated AMA Position Statement on Obesity, following a policy session at the AMA National Conference, which brought together representatives from the medical profession, sports sector, food industry, and health economists.
  • Launched the AMA Position Statement on an Australian Centre for Disease Control (CDC), which was welcomed by experts in communicable diseases.
  • Released the AMA Position Statement on Female Genital Mutilation, which provided a platform for the AMA to engage in advocacy on preventing this practice.
  • Released the AMA Position Statement on Infant Feeding and Maternal Health.
  • Released the progressive and widely-supported AMA Position Statement on Harmful substance use, dependence, and behavioural addiction (Addiction).
  • Successfully lobbied against the proposal to drug test welfare recipients, including a strongly worded submission to a Parliamentary Inquiry on the proposal, which resulted in defeat of the proposed measure in the Parliament.
  • Released the AMA Position Statement on Firearms, generating considerable media coverage and interest, in Australia and overseas. Most importantly, it is a factor in Australia maintaining its tough approach to gun control.
  • Released the AMA Position Statement on Blood Borne Viruses (BBVs), which called for needle and syringe programs (NSPs) to be introduced in prisons and other custodial settings to reduce the spread of BBVs. This policy has been promoted by other health organisations and saw the AMA create strong ties within the sector.
  • Ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees, including a meeting with the Minister for Immigration and Border Protection, The Hon Peter Dutton MP, and lobbying on behalf of individual patients behind the scenes.
  • AMA lobbying of manufacturers saw a change to the sale of sugar-sweetened beverages in some remote Aboriginal communities, which will improve health outcomes.
  • Promoted the benefits of Immunisation to individuals and the broader community. Our advocacy has contributed to an increase in child and adult vaccination rates.
  • Provided strong advocacy on climate change and health.
  • Consistently advocated for better women’s health services.
  • Lobbied for the establishment of a No-Fault Compensation Scheme for people adversely affected by vaccines.

 We promoted our carefully-constructed Position Statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, NSW, and WA.

I would like to thank Dr David Gillespie for his contribution to the Rural Health portfolio, and hope that his legacy will be seen in the success of the new Rural Health Commissioner, a position the AMA lobbied for and supports.

In the New Year, we will release new Position Statements on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, and Rural Workforce.

As your President, I have had face-to-face meetings with Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Health Minister Greg Hunt, Shadow Health Minister Catherine King, Greens Leader Dr Richard Di Natale, and a host of Ministers and Shadow Ministers.

We also organised lunch briefings with backbenchers from all Parties to promote AMA policies.

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

I have met regularly with stakeholders across the health sector, including the Colleges, Associations, and Societies, other health professional groups, and consumer groups.

As your President, I have been active on the international stage, representing Australia’s doctors at meetings in Zambia, Britain, Japan, and the United States.

The highlight of the international calendar was the annual General Assembly of the World Medical Association. Outcomes from that meeting included high level discussions on End-of-life care, numerous ethical issues, Doctors’ health, and an editorial revision of the Declaration of Geneva.

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

We have had great successes. We have earned and maintained the respect of our politicians, the bureaucracy, and the health sector. We have won the support of the public as we have fought for a better health system for all Australians.

We have worked hard to add even greater value to your AMA membership.

May I take this opportunity to wish you, your families, and loved ones a safe, happy, and joyous Christmas, and a relaxing and rewarding holiday season. I hope you all get some quality private and leisure time – you deserve it.

Dr Michael Gannon
Federal AMA President

Long-term investment for serious reform

The AMA has delivered its Pre-Budget Submission 2018-19 to the Government and released it publicly while calling for a new era of big picture health reform.

In releasing the submission, AMA President Dr Michael Gannon said the Government had a rare opportunity for initiate serious health reform, due the culmination of a number of key health policy reviews.

But, he said, any reform will need significant long-term investment.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.”

Dr Gannon said the Government needed to now look at all health policies as investments in a healthier and more productive population.

He said there was now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner – or vote loser,” Dr Gannon said.

“Our submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make.”

The AMA Pre-Budget Submission 2018-19 covers:

  • General Practice and Primary Care;
  • Public Hospitals;
  • Private Health Insurance;
  • Medicare Benefits Schedule (MBS) Review;
  • Preventive Health;
  • Diagnostic Imaging;
  • Pathology;
  • Mental Health and the NDIS;
  • Medical Care for Older Australians;
  • My Health Record;
  • Rural Health;
  • Indigenous Health;
  • Medical Workforce;
  • Climate Change and Health; and
  • Veterans’ Health.

The submission can be found at ama-pre-budget-submission

It was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

CHRIS JOHNSON

Unacceptable kidney transplant rate for Indigenous Australians

AMA President Dr Michael Gannon has called for urgent attention in addressing the gap between Indigenous and non-Indigenous Australians accessing kidney transplants.

Figures just released show that Indigenous patients are 10 times less likely than non-Indigenous patients to be added to the waiting list for a kidney donation transplant.

About 13 per cent of patients receiving dialysis treatment in Australia are Indigenous. Only 241 of 10,551 patients with a functioning kidney transplant are Indigenous.

Some renal experts have pointed to a racially-based bias, suggesting some non-Indigenous doctors favour non-Indigenous dialysis patients.

Other specialists in the field insist the gap is not fuelled by racism.

During an interview with the ABC, Dr Gannon said these figures were unacceptable and more needed to be done to ensure Indigenous Australians received transplants when needed.

“I’m shocked by those figures. A ten-fold gap is entirely unacceptable,” Dr Gannon said.

“The topic of racism in our health system is an uncomfortable one for doctors, nurses, but it has to be one of the possible reasons for this kind of disparity.

“If there’s reasons why Aboriginal and Torres Strait Islanders are not being transplant-listed, they need to be investigated, but the problems need to be fixed.”

Dr Paul Lawton, a specialist at the Menzies School of Health Research, told the ABC that while Australian kidney specialists were well meaning, there was a “structural racism” that had led to low transplant rates for Indigenous patients.

“Currently, our system is structured so that us non-Indigenous, often male, middle-aged white kidney specialists offer kidney transplants to people like ourselves,” Dr Lawton said.

“It both makes me sad and angry that in Australia in the 21st century, we see such great disparities in access to good quality care.”

Indigenous Health Minister Ken Wyatt said he was disheartened with the figures and wanted to focus on building a heightened awareness of the issue over the next year.

According to Kidney Health Australia, about 30 of 800 kidney transplants performed each year are received by Indigenous Australians.

This under-representation can be attributed to a variety of reasons such as comorbidities, delays in listing and significant tissue matching issues. Importantly, the outcomes from transplantation are considerable poorer than among non-indigenous people.

To improve access to transplantation by Aboriginal and Torres Strait Islander renal patients, there needs to be a better understanding of how to address the barriers. There also needs to be improved support services for patients.

Kidneys for transplantation are largely from deceased donors. There are very few living kidney donors in Aboriginal and Torres Strait Islander communities, due to burden of disease and likelihood of comorbidities evident. Increasing live donations or listing more people on the waiting list is very unlikely to see improvements, given the burden of disease experienced and current barriers in the system.

The reasons for poor access to transplantation experienced by Aboriginal and Torres Strait Islander Australians are complex and can be attributed to:

• The greater burden of comorbid illness amongst Aboriginal and Torres Strait Islander dialysis patients leading to fewer patients being judge medically suitable;

• The shortage of living and deceased donors from within Aboriginal and Torres Strait Islander communities;

• The length of time on the waiting list and matching system;

• The challenges in delivering appropriate health services to people living in remote areas who might also have low health literacy and not speak English as a first language;

• The dislocation that follows from moving to transplant centres in distant capital cities; and

• The high complication rate, particularly in terms of early infectious complications leading to poor transplant outcomes, including substantially higher death and graft loss rates.

The poorer outcomes among those who receive transplants are due to higher rates of rejection, less well-matched kidneys, higher rates of infection and infection-related deaths. There are downsides to transplantation.

Prior to transplantation, these include a requirement for significant work up tests and assessments which require visits to major centres. After transplantation there is the prospect of a post-operative stay and side effects away from home and supports. The number of medications usually increases, and there is an increased risk of infections and cancers

CHRIS JOHNSON AND LUKE TOY

 

Coordinated approach needed to improve Indigenous ear health

Ear health is the focus of the 2017 AMA Indigenous Health Report Card, with doctors calling on all Governments to works towards ending chronic otitis media.

Releasing the Report Card in Canberra on November 29, AMA President Dr Michael Gannon challenged the Federal Government and those of the States and Territories to work with health experts and Indigenous communities to put an end to the scourge of poor ear health affecting Aboriginal and Torres Strait Islanders.

The Report’s focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

“It is a tragedy that in 21st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that for most non-Indigenous Australian children, otitis media is readily treated, but for many Aboriginal and Torres Strait Islander children, it is not.

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

The Report Card, A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities, was launched in Parliament House by Indigenous Health Minister Ken Wyatt

Mr Wyatt commended the AMA on its 2017 Report Card.

Over the past 15 years, he said, the AMA’s annual Report Card on Indigenous Health has highlighted health priorities in Australia’s Aboriginal peoples and communities.

“Reports can be daunting and they can be challenging,” the Minister said.

“But above all, they can be inspiring.”

Mr Wyatt said it was a tragedy that the most common of ear infections and afflictions were almost entirely preventable.

Yet left untreated in Indigenous children, they had lifelong effects on education, employment and well-being.

“It’s not somebody else’s responsibility. It’s the responsibility of all of us,” he said.

“Hearing is fundamental.”

Shadow Indigenous Health Minister Warren Snowdon also commended the AMA on its report.

He said the Government and the Opposition worked collaboratively on Indigenous health issues.

“We’re not interested in making this a point of political difference, we’re interested in making it a national priority,” he said.

Green’s Indigenous Health spokeswoman Senator Rachel Siewert welcomed the Report and stressed the importance of addressing Indigenous health issues.

Australia’s first Indigenous surgeon, ear, nose and throat specialist Dr Kelvin Kong, who is also the Chair of the Australian Society of Otolaryngology Head and Neck Surgery’s Aboriginal Health Subcommittee, received the report with enthusiasm.

He said cross-party support on this issue had been “phenomenal”.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

The Report calls on Governments to act on three core recommendations: namely, that a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG); that the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required are addressed; and that attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

The AMA Indigenous Health Report Card 2017 A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities can be found at article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

 CHRIS JOHNSON