Indigenous sexual health

BY AMA PRESIDENT DR MICHAEL GANNON

While successive governments have made significant efforts to address major chronic health problems experienced by Aboriginal and Torres Strait Islander people, sexual health issues are often left off the agenda. The rates of HIV and sexually transmitted infections (STIs) within Indigenous communities are increasing at alarming rates, and Aboriginal and Torres Strait Islander people are disproportionately affected by these conditions.

The serious consequences of untreated STIs are well documented, some of which are known have long-term effects on health. Syphilis, for example, is highly infectious and can cause heart and brain damage, while diseases such as gonorrhoea and chlamydia can lead to infertility and chronic abdominal pain. Not only do STIs affect a person’s physical wellbeing and further increase the risk of HIV infection, but the stigma attached to STIs can result in social isolation.

In 2015, the rate of syphilis among Aboriginal and Torres Strait Islander peoples was over six times higher than that of the non-Indigenous population, and in some remote areas, this rate rose up to a staggering 132 times higher. Indeed, almost 80 per cent of STIs among Indigenous Australians are found in remote communities, and a number of underlying risk factors such as poor access to health services, culturally inexperienced clinical staff, and a particularly young population contribute to such high infection rates.

In recent years we have seen significant progress in both the diagnosis and treatment of STIs and other preventable diseases. However, a syphilis outbreak across northern Australia has recently caused the number of STIs to rapidly rise and has already led to the death of at least four Indigenous Australians. This is completely unacceptable.

These statistics, while incredibly concerning, highlight a growing problem facing Indigenous Australians when it comes to their sexual health and wellbeing. It is clear that urgent action must be taken to address the high rates of STIs in Indigenous communities.

The Federal Government has shown some promise in addressing sexual health issues in Indigenous communities, by forming a Multi-jurisdictional Syphilis Outbreak Working Group to help prevent disease transmission and outbreak, and supporting the South Australian Health and Medical Research Institute to partner with the Aboriginal Nations Torres Strait Islander HIV Youth Mob to deliver awareness and education campaigns to Indigenous Australians across the country.

Yet, in March 2017, the Government confirmed the inexplicable scrapping of federal funding for both the Northern Territory AIDS and Hepatitis Council and the Queensland AIDS Council, all without conducting any community consultations or directly evaluating the programs themselves. For more than two decades, both services have delivered vital sexual health programs to remote and regional communities that experience difficulties accessing mainstream health services, and have developed close relationships with the communities that they serve. The cut in federal funding is set to bring these programs to an unfortunate and indefinite close, but it is services like these that play a key role in improving sexual health outcomes for Aboriginal and Torres Strait Islander people.

Living with a sexually transmitted disease is not just an individual health issue, but one that can impact the entire community. As HIV and STI rates for Aboriginal and Torres Strait Islander people continues to rise, we should not be cutting existing services aimed at improving sexual health practices in Indigenous communities.

The AMA understands that the Government has confirmed it will undertake an evaluation of a $24 million funding proposal to address STIs in Indigenous communities through eliminating syphilis, preventing HIV, health education, and STI screenings through outreach in vulnerable regions. However, we also understand that an outcome on this evaluation has yet to be announced.

The AMA would like to see the Government invest in areas to support ongoing efforts to address Indigenous sexual health problems, and ensure that culturally safe health care remains accessible to all Aboriginal and Torres Strait Islander people to help control the spread of STIs.

AMA letting legislators know its views on pharmacy review

Below is an edited version of the AMA’s submission to the Pharmacy Remuneration and Regulation Review Interim Report.

Overall, the AMA considers the recommendations, if implemented, will benefit consumers by improving access to affordable medicines and enhancing the quality of medicines related care provided by pharmacists.

The AMA’s submission focuses on the recommendations and options described in the interim report which impact patient care.

The recommendations and options relating to patient access to medicines and their experiences within pharmacies appear sensible and well considered.

In particular, the AMA supports:

improvements to the PBS Safety Net which would enhance patients’ understanding and access, for example, the introduction of a central electronic system that automatically tracks individual patient PBS expenditure;
audits of pharmacy compliance with medicines dispensing requirements, such as correct medicines labelling and the provision of Consumer Medicines Information leaflets, in line with State/Territory legislation and Pharmacy Board of Australia and Pharmaceutical Society of Australia guidelines; and
improvements to electronic prescription systems and medication records to enhance continuity of care and reduce medication errors. However, the AMA notes that prescribing software would require updating to enable full electronic prescribing and that a small, but still significant, proportion of medical practitioners do not use these systems, especially in rural/remote locations with poor internet connections.

The AMA supports the Review recommendation that homeopathic products should not be sold in PBS-approved pharmacies. Selling these products in pharmacies encourages consumers to believe they are efficacious when they are not.

The AMA notes the interim report proposal that if pharmacists provide a service that is also offered by alternative primary healthcare professionals, the same Government payment should be applied to that service. While a service may superficially appear the same, it is important to recognise that the delivery, quality and comprehensiveness of that service may differ between health professionals and the context within which it is provided.

For example, a patient administered a flu vaccine in a pharmacy just receives a flu vaccine. A patient receiving a flu vaccine administered by a General Practitioner also receives a preceding consultation which includes a health assessment specific to that patient, based on a sound understanding of the patient’s past history and health needs.

This might include a check whether the patient’s other recommended vaccinations are up-to-date, whether a cervical screening test is due, a blood pressure check if appropriate, a check of the patient’s adherence and tolerance of any prescription medicines, and any other appropriate and (evidence-based) opportunistic preventative health care.

Even if the General Practice employs nurse practitioners to deliver the vaccine itself, a patient has first been assessed by a General Practitioner who continues to be close at hand if needed.

If the Commonwealth Government were to consider paying pharmacists to administer flu vaccines to high risk populations, the services provided by a pharmacist and a medical practitioner in this context would not be equivalent.

Clearly there would also need to be research on whether flu vaccinations in pharmacies are cost-effective in comparison to a flu vaccination in a General Practice clinic given the value-add provided in the latter service.

Any cost-benefit analysis would also need to take into account the indirect costs of delayed or missed diagnoses leading to higher cost care, that are more likely when care is fragmented by patients relying on health care provided by a pharmacist.

The AMA agrees with the recommendations in the interim report that government-funded services should be evidence-based and cost-effective. Pharmacy-based services that do not meet these criteria, such as the Amcal’s Pathology Health Screening Service targeting “relatively young and fit customers … for general health purposes … as opposed to risk assessment or diagnosis” should not be eligible for government funding.

The AMA’s earlier submission to this review expanded in some detail regarding the push by the Pharmacy Guild, motivated by revenue generation, to expand the scope of practice of pharmacists into the provision of medical services.

The AMA has already stated its views on the barriers imposed by current pharmacy location rules in its previous submission to the Review, and in numerous earlier submissions to Government. The AMA supports changes to pharmacy regulation which would allow more pharmacies and medical practices to be co-located. The current restrictions are inflexible and are difficult to justify in terms of public benefit.

AMA understands that the Australian Government has entered into an agreement with the Pharmacy Guild of Australia to continue indefinitely the current protections the rules provide to Guild members. However, the AMA is disappointed that the Government has made this decision despite the obvious benefits that would accrue by allowing access to high quality primary health care services in a way that is convenient to patients, enhances patient access and improves collaboration between healthcare professionals.

Facilitating collaboration between medical practitioners and pharmacists will only improve patient outcomes through less medication mismanagement and better medication compliance.

The AMA agrees there are benefits in future community pharmacy agreements being limited to remuneration for the dispensing of PBS medicines and associated regulation. This would allow pharmacy programs, such as medication adherence and management services currently funded under the Agreement, to be funded in ways that are more consistent with how other primary care health services are funded.

Given these programs are about providing health services, rather than medicines dispensing per se, it makes sense for them to be assessed, monitored, evaluated and audited in a similar way to medical services under the MBS.

Approximately $1.2 billion has been provided to pharmacies under the current community pharmacy agreement without this level of transparency and accountability. No evaluations of pharmacy programs under the Sixth Community Pharmacy Agreement have been made public.

Moving pharmacist health services outside of the Agreement would also open the way for more flexible models of funding, for example, support for pharmacists working within a General Practice team and other innovative, patient-focused models of care.

The AMA would also welcome inclusion in future consultations undertaken prior to the finalisation of the next community pharmacy agreement, as proposed in the Review interim report. The AMA recognises the valuable contribution pharmacists make in improving the quality use of medicines.

Pharmacists working with doctors and patients can help ensure medication adherence, improve medication management, and provide education about medication safety. The AMA fully supports ongoing and adequate funding of evidence-based pharmacist services such as home medicine reviews and the provision of dose administration aids.

It is important that Government-funded pharmacy programs are monitored and evaluated for effectiveness and cost effectiveness to ensure the expenditure provides tax payers with value for money. The findings from these evaluations will help improve and strengthen the programs.

The AMA fully supports the recommendations made to enhance access to medicines programs for Indigenous Australians and to support Aboriginal Health Service pharmacy ownership and operations.

The full submission can be found at:

system/tdf/documents/AMA%20Submission%20-%20Interim%20report%20-%20Pharmacy%20remuneration%20and%20regulation%20review%20Jul17.pdf?file=1&type=node&id=46835

Australian Indigenous kids have the highest prevalence of impetigo

West Australian researchers at Telethon Kids Institute have confirmed dangerous skin infections in many Aboriginal children across northern Western Australia are too often unrecognised and under-treated.

This is despite untreated skin infections such as scabies and impetigo (school sores) can lead to life-threatening conditions such as kidney disease, rheumatic heart disease and blood poisoning.

About 45 per cent of Aboriginal children living in remote communities across northern Australia are affected by impetigo at any one time – the highest prevalence in the world – and scabies is endemic in some communities.

Telethon Kids paediatric infectious diseases specialist Dr Asha Bowen said the recently published study in Public Library of Science (PLOS)journal Neglected Tropic Diseases, found underlying skin problems aren’t always noticed or treated – paving the way for serious complications later on.

Dr Bowen said Aboriginal people in the north of Australia have some of the highest rates of skin infection in the world.

Yet it can be so common in these communities it is regarded as normal, both by health workers and the community.

“When Aboriginal children are assessed at hospitals, it’s often for a more acute condition like pneumonia or gastroenteritis, and that tends to be what the clinicians focus on,” she said.

It was something researchers had suspected but couldn’t previously demonstrate with solid data.

“Now, after conducting a clinical study where we assessed new hospital admissions and compared the results to past records, we have the data to back it up,” Dr Bowen said.

“And that means we’re in a better position to do something about it.”

There remains a need to address the problem by improving training and awareness, and providing tools to help doctors and other healthcare workers better recognise and treat skin infections early on.

The study, led by Dr Daniel Yeoh of the Wesfarmers Centre of Vaccines and Infectious Diseases at Telethon Kids Institute and the Department of Infectious Diseases at Princess Margaret Hospital, was facilitated and supported by WACHS Pilbara, and WACHS Kimberley.

The AMA recognises the terrible effect Rheumatic Heart Disease (RHD) is having on Indigenous people in Australia. The AMA also recognises that impetigo plays a deadly role in RHD. Every year, RHD kills people and devastates lives – particularly the lives of young Indigenous Australians. It causes strokes in teenagers, and requires children to undergo open heart surgery.

MEREDITH HORNE

The AMA’s 2016 Report Card on Indigenous Health can be found here: article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease

Political message in National Press Club speech

AMA President Dr Michael Gannon has called on all sides of politics to take some of the politicking out of health, for the good of the nation.

Addressing the National Press Club of Australia, Dr Gannon said some health issues needed bipartisan support and all politicians should acknowledge that.

“Some of the structural pillars of our health system – public hospitals, private health, the balance between the two systems, primary care, the need to invest in health prevention – Let’s make these bipartisan,” he said.

“Let’s take the point scoring out of them. Both sides should publicly commit to supporting and funding these foundations. The public – our patients – expect no less.”

During the nationally televised address, broadcast live as he delivered it on August 23, Dr Gannon warned political leaders that the next election was anyone’s to win and so they should pay close attention to health policy.

“Last year we had a very close election, and health policy was a major factor in the closeness of the result,” he said.

“The Coalition very nearly ended up in Opposition because of its poor health policies. Labor ran a very effective Mediscare campaign.

“As I have noted, the Government appears to have learnt its lesson on health, and is now more engaged and consultative – with the AMA and other health groups.

“The next election is due in two years. There could possibly be one earlier. A lot earlier.

“As we head to the next election, I ask that we try to take some of the ideology and hard-nosed politicking out of health.”

In a wide-ranging speech, the AMA President outlined the organisation’s priorities, while also explaining the ground it has covered in helping to deliver good outcomes for both patients and doctors.

The AMA’s priorities extend to Indigenous health, medical training and workforce, the Pharmaceutical Benefits Scheme, and the many public health issues facing the Australian community – most notably tobacco, immunisation, obesity, and alcohol abuse.

“I have called for the establishment of a no-fault compensation scheme for the very small number of individuals injured by vaccines,” Dr Gannon said.

“I have called on the other States and Territories to mirror the Western Australian law, which exempts treating doctors from mandatory reporting and stops them getting help.

“We also need to deal with ongoing problems in aged care, palliative care, mental health, euthanasia, and the scope of practice of other health professions.

“In the past 12 months, the AMA has released statements on infant nutrition, female genital mutilation, and addiction.

“In coming months, we will have more to say on cost of living, homelessness, elder abuse, and road safety, to name but a few.

“Then there are the prominent highly political and social issues that have a health dimension, and require an AMA position and AMA comment.

“All these things have health impacts. As the peak health and medical advocacy group in the country, the community expects us to have a view and to make public comment. And we do.

“Not everybody agrees with us. But our positions are based on evidence, in medical science, and our unique knowledge and experience of medicine and human health.

“Health policy is ever-evolving. Health reform never sleeps.”

The address covered, among other things, health economics: “Health should never be considered just an expensive line item in a budget – it is an investment in the welfare, wellbeing, and productivity of the Australian people.”

Public hospital funding: “The idea that a financial disincentive, applied against the hospital, will somehow ‘encourage’ doctors to take better care of patients than they already do is ludicrous.”

Private health: “If we do not get reforms to private health insurance right – and soon – we may see essential parts of health care disappear from the private sector.

The medical workforce: “We do not need more medical school places. The focus needs to be further downstream.

“Unfortunately, we are seeing universities continuing to ignore community need and lobbying for new medical schools or extra places.

“This is a totally arrogant and irresponsible approach, fuelled by a desire for the prestige of a medical school and their bottom line.

“Macquarie University is just the latest case in point.”

And general practice: “General practice is under pressure, yet it continues to deliver great outcomes for patients.

“GPs are delivering high quality care, and remain the most cost effective part of our health system. But they still work long and hard, often under enormous pressure.

“The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.”

On even more controversial topics, Dr Gannon stressed that the AMA is completely independent of governments.

While sometimes it gets accused of being too conservative, he said, it was not surprising to see the reaction to the AMA’s position on some issues – like marriage equality.

“Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage,” he said.

“Things like bullying, harassment, victimisation, depression, fear, exclusion, and discrimination, all impact on physical and mental health.

“I received correspondence from AMA members and the general public. The overwhelming majority applauded the AMA position.

“Those who opposed the AMA stance said that we were being too progressive, and wading into areas of social policy.

“The AMA will from time to time weigh in on social issues. We should call out discrimination and inequity in all forms, especially when their consequences affect people’s health and wellbeing.”

Last year, the AMA released an updated Position Statement on Euthanasia and Physician Assisted Suicide.

It came at a time when a number of States, most notably South Australia and Victoria, were considering voluntary euthanasia legislation.

There was an expectation in some quarters that the AMA would come out with a radical new direction. But it didn’t.

“The AMA maintains its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life,” Dr Gannon said.

“This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia.

“Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity.”

The AMA also takes Indigenous health very seriously.

Dr Gannon travelled to Darwin last year to launch the AMA’s annual Indigenous Health Report Card, which focused on Rheumatic Heart Disease.

“In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure,” he said.

“It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

“RHD is perhaps the classic example of a Social Determinant of Health. It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

“The significance of challenging social issues like Indigenous health, marriage equality, and euthanasia is that they highlight the unique position and strengths of the AMA.

“The AMA was recently ranked the most ethical organisation in the country in the Ethics Index produced by the Governance Institute of Australia.

“People want and expect us to have a view – an opinion. Sometimes a second opinion.”

Chris Johnson

A transcript of the full address can be found here:
media/dr-gannon-national-press-club-address-0

How a father’s death sparked a career in medicine

As a 13-year-old, James Chapman’s life was turned upside down when his father was diagnosed with acute myeloid leukaemia. The decline was rapid and the treatment failed: just seven weeks after diagnosis, James’s father was dead.

“It was my shock introduction to serious illness and the health system,” says James, who is the winner of this year’s AMA Indigenous Medical Scholarship, which will provide the second-year student with $10,000 per year until he completes his medical degree at the University of New South Wales.

James’s father was an Indigenous man from Yuwlaaray Country on the western borders of Queensland and New South Wales, and James travelled back there with his grandfather and uncle to return his father to where he was born.

“It was the first time I’d been out to a remote Indigenous community, and it wasn’t until that trip that I learned about the cultural importance of what I was doing. It gave me an outlet to deal with my grief and a sense of belonging to a culture. It was a real connection and a bond that I can’t really explain.”

But the trip also opened James’s eyes to the issue of Indigenous health in remote communities.

“It was a huge wake-up call. I just hadn’t realised the extent of the problem.”

That was by no means the end of James’s family woes. Eighteen months after his father died, his uncle, with whom he’d travelled to his Dad’s country, had a heart attack and also passed away.

“From then on, I knew I wanted to be involved in Indigenous health, but I didn’t know how. I managed to get into an Arts program at Wollongong University where I was doing Indigenous studies and public health. But after only a year of doing that, my Mum was diagnosed with a brain tumour.”

It was successfully removed, but the surgery was complicated, and James’s mother developed a skull infection which required months of recovery. James took on the role of primary carer.

“From that point on I was always around doctors and I was seeing how the health system works and I got a feel for it. I guess I’d finally found what I wanted to do.”

He applied for an entry program for Indigenous students to study medicine at the University of New South Wales, and was accepted in 2016.

James says his focus remains on Indigenous health, and he’s optimistic that the current situation can be turned around.

“It comes down to the government allocating the right resources, as well as the medical institutions themselves and the importance they place on training Indigenous doctors and healthcare workers. It’s not going to happen tomorrow or next year, but if we keep promoting Indigenous people to enter the healthcare industry we can and will close this gap that exists.”

James says one thing that remained with him after his Dad passed away was that he never recalls seeing his father going to the doctor before his final illness.

“A big thing I want to advocate for is for Indigenous people, and especially men, seeking medical attention when they need it. We need to work to establish a trust between Indigenous people and the medical workforce.”

Click here for more information on the AMA Indigenous Medical Scholarship.
Donations towards the AMA Indigenous Medical Scholarship Foundation are tax deductible. If you’d like to donate, please click here.

AMA’s successful stand for sensible and safe pathology testing

BY PROFESSOR ROBYN LANGHAM, CHAIR, MEDICAL PRACTICE COMMITTEE

One could be forgiven for thinking that he AMA thinks little of pharmacists, given the nature of the media reports around the recent successful AMA campaign to stop Amcal pharmacies ordering unnecessary pathology screening tests.

The truth is quite the opposite. The AMA greatly respects the valuable contribution pharmacists make in improving the quality use of medicines. Pharmacists working with doctors and patients can help ensure better medication adherence, improved medication management, and also help in providing education about medication safety.

The AMA agrees that pharmacists’ expertise and training are under-utilised in a commercial pharmacy environment where they are necessarily distracted by retail imperatives.

That is why the AMA is fully engaged in the current review of pharmacy remuneration and regulation being undertaken by an independent panel appointed by the Federal Government.

In a comprehensive submission to the panel lodged last year, the AMA was supportive of alternate models of funding being explored that would encourage and reward a focus on professional, evidence-based interactions with patients. Our submission also supported ongoing funding of effective and cost-effective pharmacist medication management programs, particularly those targeting Aboriginal and Torres Strait Islanders, and a relaxation of the restrictive pharmacy location rules.

The panel has now released an interim report revealing its likely recommendations to Government on the future of pharmacy funding and regulation.

The proposed recommendations pick up on many of the AMA’s suggestions and concerns, and, if implemented, would radically improve the transparency of pharmacy funding and refocus government investment on evidence-based and cost effective services.

Unsurprisingly, the Pharmacy Guild of Australia is highly critical of the report, slamming it as “without merit”, “ill-considered”, “threatening” and “undermining” as well as stating it has “serious concerns about the true intention of the review”.

Some of the key recommendations supported by the AMA include:

banning the sale of homeopathic products from pharmacies altogether;

physically separating other complementary medicines from “pharmacy only” (schedule 2) and ‘pharmacist only’ (schedule 3) in pharmacies to better help consumers understand that these medicines have not been assessed for effectiveness in the same way as S2, S3 and prescription medicines;

moving the funding of pharmacist services programs from the Guild-controlled Community Pharmacy Agreement to other government funding streams to improve transparency and facilitate coordination with other primary health care programs;

removing current bureaucratic barriers to medicines programs and pharmacy services that hinder access to indigenous Australians; and

changing the pharmacy location rules with potential to improve options for pharmacy co-location with general practices.

The AMA is very supportive of the interim report and lodged a favourable submission in response in July.

Unfortunately, the Guild has already brokered a deal with the Coalition Government to shelve any changes to location rules in the foreseeable future. It will be interesting to see what appetite the Government has for taking up the panel’s final recommendations, particularly given the next Federal election date is not so far away.

National Social Housing Survey: detailed results 2016

This report provides an overview of national-level, state and territory findings, as well as comparisons across public housing, state owned and managed Indigenous housing and community housing tenants. The report shows that the majority of tenants are satisfied with the services provided by their housing organisation, with community housing tenants the most satisfied. Tenants report a range of benefits from living in social housing and the majority live in dwellings of an acceptable standard.

Bush foods, a growing asset

Researchers at the University of Adelaide are building a so-called bush tucker bible to help highlight natural and unique products.

Professor Andy Lowe, Director of Food Innovation at the University, said the research aimed to preserve and evolve Australian food culture into a sustainable industry making the most of Indigenous traditional knowledge while also benefiting Indigenous communities.

Professor Lowe believes that with more than 30,000 plant species native to Australia, the opportunities are endless.

“There is reason why bush tucker ingredients like warrigal greens, rosella flowers, seablite and munyeroo could not become part of our food source stream,” Professor Lowe said.

“There’s a range of native greens that we could start consuming on a large scale that can be grown much more effectively in Australia.”

Native Australian foods are also being studied as an effective way to increase the health of Aboriginal and Torres Strait Islander people.

The latest data from the Australia’s Institute in Health and Welfare shows indigenous Australians are five times more likely than non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions (such as diabetes), and three times as likely to die of digestive conditions.

Wild yams and fish, traditional bush medicines, Aboriginal herbal remedies and even sand massages are all part of a holistic health program designed to address chronic disease in north-east Arnhem Land in the Northern Territory. The Hope for Health project was started by volunteers and Aboriginal Yoingu people on Elcho Island, aiming to tackle chronic health problems by incorporating traditional tratitional health practices and knowlegde with western medicine.

After crowdfunding $90,000, the group held its first health retreat camp on the island last year and started a journey to better health, returning to traditional foods, like shellfish and other foods found around the island.

Hope for Health said 85 per cent of participants showed a reduction in waist circumference, almost two-thirds had improved kidney function, and four in five people had reduced their blood pressure

Adrian Bauman, a professor of Public Health at the University of Sydney said: “The results among those 25 participants are impressive: they lost a clinically useful amount of weight, they had improvements in kidney function, blood sugar and blood pressure levels.”

Yolngu participant Valerie Bulkunu said the experience helped her make long-term changes, such as swapping two-minute noodles and cordial for more wholesome home-cooked food.

Hope for Health’s Kate Jenkins said the project’s success was also due to the hands on support provided in the local language, and the fact the project was driven by the community and guided by Yolngu leaders.

MEREDITH HORNE

Single biggest health burden is cancer attributed to tobacco use

Cancer accounts for about one-fifth of Australia’s health burden, with tobacco use the biggest contributor, newly released figures reveal.

The Australian Institute of Health and Welfare (AIHW) has released research based on data sourced from the 2011 Australian Burden of Disease that shows cancer was the greatest cause of health burden in Australia, accounting for around one-fifth of the total disease burden.

AIHW’s burden of disease analysis is more than merely counting deaths or disease incidence and prevalence, burden of disease analysis takes into account age at death and severity of disease for all diseases, conditions and injuries, in a consistent and comparable way.

“This (burden) is calculated in terms of years of life lost due to early death from cancer, as well as the years of healthy life lost due to living with the disease,” AIHW spokeswoman Michelle Gourley said.

Almost half (48 per cent) of the total cancer burden in 2011 is from five cancers—lung, bowel, breast, prostate and pancreatic cancers. However the single biggest burden —and almost one-quarter (22 per cent) of the total cancer burden can be attributed to tobacco use.

The report states that most (94 per cent) of this burden was due to dying prematurely, with only a small proportion of the burden due to living with a cancer diagnosis. Even though fewer people die from cancer than cardiovascular disease, the burden of cancer deaths is higher.

The AIHW report also found that Indigenous Australians experienced 1.7 times the cancer burden of non-Indigenous Australians. In particular, Indigenous males experience 2.3 times the lung cancer burden of non-Indigenous males, and Indigenous females 2.6 times the lung cancer burden of non-Indigenous females.

Australians living in rural Australia were also shown in the report to face a higher burden, especially the burden of lung, bowel, prostate and pancreatic cancers.

“Indigenous Australians experienced a cancer burden 1.7 times that of non-Indigenous Australians, and the gap was particularly notable when it came to lung cancer,” Ms Gourley said.

Further, poorer Australians found themselves with an increased rate of cancer burden, with people in the lowest socioeconomic group experiencing 1.4 times the cancer burden of people in the highest group. In particular, the rate of lung cancer burden in the lowest group is almost twice the rate in the highest group.

This report presents detailed findings on the burden due to cancer in Australia using results from the Australian Burden of Disease Study 2011.

Meredith Horne

Service acknowledged at the highest levels

Prime Minister Malcolm Turnbull put it in a nutshell when he told doctors they were dedicated to service.

Addressing the AMA’s National Conference in Melbourne on May 27, Mr Turnbull captured the theme of the three-day event when he put down his speaking notes to express appreciation for the medical profession.

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

“Our health system is the envy of the world. 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 was the star attraction at the conference, which was bursting with high-profile and influential speakers who gathered to further the debate on the nation’s healthcare policies.

Opposition Leader Bill Shorten addressed the conference and also thanked the medical profession for its commitment.

But he added his observation the Government was trying to silence doctors with its staggered thawing of the Medicare rebate freeze.

“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 AMA has praised the Budget decision to lift the freeze, while also noting the announcement wasn’t everything doctors had hoped for.

AMA President Dr Michael Gannon added that the Government – or any political party – should not be fooled into believing the AMA will be quiet about advocating for issues it believes in.

Health Minister Greg Hunt repeated his praise for doctors while again outlining his plan for the national health system.

Shadow Health Minister Catherine King expressed Labor’s commitment to public hospital funding and to an immediate blanket lifting of the Medicare rebate freeze.

Greens Leader Richard Di Natale, a doctor himself, poured praise on the profession – noting the strong and positive stance the AMA has taken on marriage equality, while also delivering a caution over messaging around climate change policy.

Minister for Indigenous Health and Aged Care Ken Wyatt joined in on two policy sessions; Olympic and Commonwealth Games athlete Jane Flemming illuminated a panel on tackling obesity; news and media personalities Paul Bongiorno and Julie McCrossin moderated separate policy sessions; and actors presented an excerpt of a new play Women Doctors in War.

Beyond the valuable contributions the high-profile personalities made to the National Conference, the event was also well-served by a string of other guest speakers and panellists, as well as by the AMA leadership.

The conference addressed in detail many of the serious issues confronting the medical profession, including doctors’ health and wellbeing; disease and threats beyond borders; organ donation; obesity; health care in violent situations; and tobacco control.

Chris Johnson