[World Report] Charles Perkins Centre

Obesity and the diseases that are related to it are at the core field of Sydney’s Charles Perkins Centre, led by a man whose first area of research was locust behaviour. Stephen Simpson says his own varied background shows why this research body is different.

[Comment] Thresholds for safer alcohol use might need lowering

Guidelines for levels of alcohol use that pose a low risk to drinkers’ health are provided by many countries, usually based on meta-analyses of epidemiological studies.1–3 However, to devise such guidelines is challenging because alcohol is linked to poor health in various and complex ways. Injury, suicide, and assault, for example, are associated with drinking to intoxication, whereas regular alcohol consumption increases the risks of liver cirrhosis, gastrointestinal diseases, cardiovascular disease, dementia, and some types of cancer.

[Comment] Skeletal muscle channelopathy: a new risk for sudden infant death syndrome

Sudden infant death syndrome (SIDS) remains a leading cause of infant mortality, despite a steadily decreasing incidence since the 1990s.1 The reasons for this decline are debated, but it could be due to methodological reasons (eg, changes in reporting or advances in diagnosis of specific diseases) or a reduction of risks, such as an increase in supine sleeping position for infants, as advocated by the Back to Sleep campaign.2 A better understanding of the causes of SIDS is needed to identify infants at high risk and to develop interventions and guidelines that will prevent SIDS for all infants.

Tuberculosis continues to threaten regional health security

During a World Tuberculosis Day speech delivered in the Senate in March, International Development Minister Concetta Fierravanti-Wells sought to highlight the devastating outcomes tuberculosis is still having globally, including in Australia’s region.

TB is the world’s top infectious disease killer. In 2016, 1.7 million people died from TB – almost 4,700 each day.

Twelve of the world’s 30 highest TB burden countries are located in our region, accounting for nearly half of all cases of drug-resistant TB and TB deaths worldwide.

“Turning the page on TB – once and for all” is a Federal Government priority, Senator Fierravanti-Wells said.

In the 12 months to December last year, there were 10 million movements out of Australia. Two million Australians visited Pacific island countries and Oceania and another 3.1 million Australians visited South-East Asian countries.

“Thirty highest TB-burden countries are located in our region and account for nearly half of all cases of drug-resistant TB and TB deaths worldwide,” the Minister said.

“Papua New Guinea, which is four kilometres to our north, has a major TB problem and, in particular, a drug-resistant TB problem. That not only puts PNG at risk; it also puts Australians at risk.”

In 2014, Australia’s National Notifiable Diseases Surveillance System received 1,339 TB notifications, representing a rate of 5.7 per 100,000 population

However, the Department of Health notes Australia’s overseas-born population continued to represent the majority (86 per cent) of TB notifications and Australia’s Aboriginal and Torres Strait Islander population continue to record TB rates about six times higher than the Australian born non-Indigenous population.

The Department estimates the cost of treating a single patient with drug resistant TB can be up to $260,000 in Australia.

“TB not only affects individuals, but it also cripples communities; disrupts tourism, trade and investment and sets back regional economic growth and development,” Senator Fierravanti-Wells said.

The Minister said that in June last year, the Government announced a new partnership with the World Bank, targeting drug resistant TB in vulnerable communities in PNG.

Another way that Australia is contributing to the fight to end TB is through research.

With one in four people with TB not getting treatment through public health programs, WHO Regional Director for the Western Pacific, Dr Shin Young-soo, continues to urge Governments to do more.

“The TB rate is coming down in the region, but it’s not happening fast enough. We need to do much more to achieve our goal of ending the epidemic once and for all,” he said

MEREDITH HORNE

[Comment] The Lancet Commission on tuberculosis: building a tuberculosis-free world

The Sustainable Development Goals have prioritised ending the epidemic of tuberculosis by 2030. We are therefore at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000.1 We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline.2 Yet tuberculosis remains the leading source of infectious disease deaths globally, responsible for 1·7 million deaths in 2016.1 The UN’s High-Level Meeting on Tuberculosis, due to take place in New York, USA, later in 2018, represents a unique opportunity to secure a commitment from heads of state and governments for a coordinated global response to end the epidemic.

Poll finds understanding gap between alcohol and disease

Many Australians are unaware of the links between alcohol consumption and a range of cancers and other diseases, according to a recently released survey.

But a vast majority of them believe they have a right to such information and that Governments have a responsibility to educate them.

A new poll, released by the Foundation for Alcohol Research and Education (FARE), reveals that Australians have a lack of understanding of the official drinking guidelines that could help keep them healthier.

The same poll also reveals that they want to know about the long-term harm associated with regular alcohol consumption, and they are increasingly of the opinion the alcohol industry is deliberately downplaying independent university research linking alcohol to a range of harm, including cancer and cardiovascular disease.

The Annual Alcohol Poll 2018: Attitudes and Behaviours, conducted by YouGov Galaxy, found that fewer than half of Australians are aware of the link between alcohol misuse and stroke (38 per cent), mouth and throat cancer (26 per cent) and breast cancer (16 per cent).

While 70 per cent of Australian adults are aware of the Australian Guidelines to Reduce Health Risks from Drinking Alcohol, only one in four of them (28 per cent) are aware of the content.

FARE’s Chief Executive Michael Thorn said the lack of knowledge of both the link between alcohol consumption and the risks of cancer and other chronic diseases, together with a clear understanding of how to avoid those risks, was extremely alarming.

“It really is a dangerous cocktail. Community awareness of alcohol’s link with a range of chronic health conditions remains low,” Mr Thorn said.

“In the case of alcohol’s link to breast cancer, the awareness is only 16 per cent. Nor are Australians armed with the knowledge that would reduce their risk of long-term harm. Only one in four Australians have some awareness of the actual content of the official drinking guidelines.”

Now in its ninth year, FARE’s national alcohol poll provides valuable trend data and insights into community perspectives on alcohol

This year, Australians were asked for the first time whether they thought they had a right to know about the long-term harm associated with regular alcohol use.

When advised that the World Health Organisation recognises that alcohol is linked to approximately 200 disease and injury conditions such as breast cancer, liver disease, mouth cancer and stroke, the vast majority of Australians (84 per cent) agreed that they had a right to that information, with 80 per cent of Australians reporting that Governments have a responsibility to educate Australians on this matter.

“If there is a silver lining here, it is that Australians clearly recognise their rights as consumers to be fully informed of the harm associated with the products they consume,” Mr Thorn said.

“The lesson here for Government is that it must do a better job of ensuring Australians fully understand the long-term harm from alcohol, and are given the information that would help them reduce that harm.”

The 2018 Poll findings make clear that the job cannot be left to the alcohol industry – 61 per cent of Australians believe that the alcohol industry would downplay independent university research findings linking alcohol consumption to a range of harm such as cancer and family violence.

Polling revealed that community perceptions of the alcohol industry have not improved since 2015, finding that the majority of Australians continue to believe that the alcohol industry targets people under the age of 18 years (55 per cent), and that it has too much influence with Governments (57 per cent).

The full is available at www.fare.org.au.

CHRIS JOHNSON

Senate notes World Tuberculosis Day

A cross-party motion in the Senate has recognised World Tuberculosis Day and noted the enormous contribution of 19^th century German physician Dr Robert Koch in combating the disease.

It has also highlighted the prevalence of TB in this region, particularly in Papua New Guinea, and Australia’s leadership in testing for and treating it throughout the Pacific.

Prior to March 24, which was World Tuberculosis Day, Liberal Senator Concetta Fierravanti-Wells, who is also Minister for International Development and the Pacific; Labor Senators Claire Moore (Shadow Minister for Women) and Lisa Singh; and Greens Leader Richard Di Natale combined to draw attention to TB and Dr Koch’s legacy.

Their motion insisted on the Senate noting that:

24 March is World Tuberculosis Day, and marks the anniversary of German Nobel laureate Dr Robert Koch’s 1882 discovery of the bacterium that causes tuberculosis;
tuberculosis is contagious and airborne, ranking as the world’s leading cause of death from a single infectious agent;
in 2016, 1.7 million people died from tuberculosis worldwide and 10.4 million people became sick with the disease, with over 60 per cent of cases occurring in countries in our region;
large gaps in tuberculosis detection and treatment remain, with 4.1 million cases of active tuberculosis that were not diagnosed and treated in 2016, including 600,000 children;
in 2016, Papua New Guinea had one of the highest rates of tuberculosis infection in the Pacific, with an estimated 35,000 total cases, including 2,000 drug-resistant cases, not taking into consideration the large number of cases that go unreported in many regions; and
tuberculosis is… the leading cause of death among HIV positive people globally.

Their motion went on to detail how HIV weakens the immune system and is lethal in combination with tuberculosis, each contributing to the other’s progress.

“It is now linked to non-communicable diseases like diabetes, and considered a preventable and treatable disease, however many current treatment tools – drugs, diagnostics and vaccines – are outdated and ineffective,” they said.

The Senate also recognised that the funding Australia is providing to support the testing and treatment of tuberculosis in PNG, including the joint program with the World Bank, is already leading to an initiative to achieve universal testing for tuberculosis in the township of Daru.

It also noted he commitment of up to $75 million over five years for Product Development Partnerships in the Indo-Pacific Health Security Initiative to accelerate access to new therapeutics and diagnostics for drug resistant tuberculosis, and malaria and mosquito vector control – an increase in funding to build on the successes of Australia’s previous investments.

Australia has a three-year $220 million pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria (2017-2019) – a fund that has supported tuberculosis testing and treatment to 17.4 million people since 2002, including over 8.2 million people in the Indo-Pacific region.

Through Australia’s endorsement of the Sustainable Development Goals in September 2015, it made what the Senators described as a bold commitment to end the tuberculosis epidemic by 2030.

“The scheduling of the first United Nations High-Level Meeting on Tuberculosis in September 2018… will set out commitments to accelerate action towards ending tuberculosis as an epidemic and provide Australia with an opportunity to showcase the success of our investment in tuberculosis in our region,” they said.

Their motion also called on the Australian Government to attend the UN High-Level Meeting this year, and commit to increased Australian action and leadership on research and development, prevention, testing and treatment as part of the global effort to eradicate tuberculosis.

CHRIS JOHNSON

Tobacco addiction grows from dirty deeds

A damning report launched at the 17th World Congress of Tobacco (WCTOH) shows the tobacco industry is increasingly targeting vulnerable populations in Africa, Asia, and the Middle East where people are not protected by strong tobacco control regulations.

The figures in The Tobacco Atlas are nothing short of alarming. In 2016 alone, tobacco use caused over 7.1 million deaths worldwide (5.1 million in men, 2.0 million in women).

Most of these deaths were attributable to cigarette smoking, while 884,000 were related to secondhand smoke. But while tobacco-related disease and death grows in some communities, so do tobacco industry profits.

The combined profits of the world’s biggest tobacco companies exceeded US $62.27 billion in 2015. This is equivalent to US $9,730 for the death of each smoker, an increase of 39 per cent since the last Atlas was published, when the figure stood at US$7,000.

“The Atlas shows that progress is possible in every region of the world. African countries in particular are at a critical point – both because they are targets of the industry but also because many have opportunity to strengthen policies and act before smoking is at epidemic levels.” said Dr Jeffrey Drope, co-editor and author of The Atlas.

In sub-Saharan Africa alone, consumption increased by 52 per cent between 1980 and 2016 (to 250 billion cigarettes from 164 billion cigarettes). This is being driven by population growth and aggressive tobacco marketing in countries like Lesotho, where prevalence is estimated to have increased from 15 per cent in 2004 to 54 per cent in 2015.

José Luis Castro, President and Chief Executive Officer of Vital Strategies, co-author of The Atlas said it: “Shows that wherever tobacco control is implemented, it works… People benefit economically and in improved health. And the industry rightly suffers.”

Gender inequity was also address at the WTCOH, highlighting the negative economic impacts of tobacco use on women – not just in healthcare costs resulting from tobacco-related illness, but also in the diversion of family income, from food and education to tobacco. The emphasis was that tobacco use drives families into poverty.

WHO Regional Director for Africa, Dr Matshidiso Moeti, said: “The tobacco industry views this region as virgin territory to be exploited. They are targeting women and girls specifically and interfering in the adoption of tobacco control policies that will protect health when properly enforced.”

Tactics of fear by tobacco companies were also heard at the conference from several tobacco control advocates who had bravely fought violence or threats because of their advocacy against the expansion of smoking in their countries, including Indonesia and Nigeria.

Dr Lekan Ayo-Yusuf, Chair of the WCTOH Scientific Committee, said the research showed the need to look at the totality of the supply chain of tobacco products, and to follow the whole process from farming, through to taxation, through to point-of-sale restrictions.

WHO launched new guidance at WCTOH on the role tobacco product regulation can play to reduce tobacco demand, save lives and raise revenues for health services to treat tobacco-related disease, in the context of comprehensive tobacco control.

Many countries have developed advanced policies to reduce the demand for tobacco, but Governments can do much more to implement regulations to control tobacco use, especially by exploiting tobacco product regulation.

Dr Douglas Bettcher, WHO’s Director of the Department for the Prevention and Control of Non-communicable diseases (NCDs), said: “Tobacco product regulation is an under-utilised tool which has a critical role to play in reducing tobacco use.”

“The tobacco industry has enjoyed years of little or no regulation, mainly due to the complexity of tobacco product regulation and lack of appropriate guidance in this area. These new tools provide a useful resource to countries to either introduce or improve existing tobacco product regulation provisions and end the tobacco industry ‘reign’.

“Only a handful of countries currently regulate the contents, design features and emissions of tobacco products and tobacco products are one of the few openly available consumer products that are virtually unregulated in terms of contents, design features and emissions,” Dr Bettcher said.

A copy of The Atlas can be seen here: https://tobaccoatlas.org/.

MEREDITH HORNE

Aged Care Commission needed to address workforce issues

The AMA has made a detailed submission to the Government’s Aged Care Workforce Strategy Taskforce, arguing that the aged care workforce does not have the capability, capacity and connectedness needed to provide quality care to older people.

It calls for an Aged Care Commission to be introduced.

Australia has an ageing population that has multiple chronic and complex medical conditions, but older people face major barriers in accessing appropriate and timely medical care.

Medical practitioners must be supported by the Government and aged care providers to enhance and facilitate much needed access to medical care for people living in residential aged care facilities.

The submission argues that aged care providers need to be supported to ensure access to an appropriate quantity of well-trained staff who work in a rewarding environment with a manageable workload.

“This would ensure older people’s care is not neglected due to shortages of appropriate staff,” it states.

An Aged Care Commission could streamline the aged care system and to help ensures there is an adequate supply of appropriate, well-trained staff to meet the demand of holistic care to a multicultural, ageing population.

An Aged Care Commission would also ensure the aged care workforce has clear roles and responsibilities.

“Australia has an ageing population that is experiencing chronic, complex medical conditions that require more medical attention than ever before,” the submission states.

“For example, 53 per cent of residents in Residential Aged Care Facilities (RACFs) have dementia. This proportion will continue to grow over time, with projections reaching up to 1,100,890 people with dementia by 2056, which is estimated to cost Australia $36.85 billion by the same year.

“A recent study identified that residents of RACFs with dementia had direct health and residential care costs of $88 000 per year. Currently, the aged care system as a whole, and its workforce, does not have the capacity or capability to adequately deal with this growing, ageing population.”

The aged care system needs a strategy, the submission states, to ensure the workforce is appropriate to meet the demands of older people in the future. In order to improve the quality of the aged care workforce, the following is required:

An overarching, independent, Aged Care Commission that provides a clear, well communicated, governance hierarchy that brings leadership and accountability to the aged care system;
Medical practitioners need to be recognised and supported as a crucial part of the aged care workforce to improve medical access, care, and outcomes for older people; and
Aged care needs funding for the significant recruitment and retention of, and support for, nursing staff and carers, specifically trained in dealing with the issues that older people face.

Care of an older person involves a diverse range of professions. All providers of aged care services need to collaborate together to ensure the optimal level of care for the older person. The strategy will be able to provide an ultimate goal for the whole aged care workforce, which should include access to the older person in order for each workforce profession to be able to provide quality care for that older person.

There needs to be a focus on prevention to ensure older people remain healthy for as long as possible to remain in their own home, the submission states, but also to reduce demand and pressure on the aged care workforce.

“Medical practitioners, in particular GPs, regularly incorporate prevention methods as part of providing holistic health and medical care,” it says.

“This includes immunisation, screening for diseases, providing education and counselling to their patient, and also referring the patient to a specialist or allied health professional if required. It is therefore imperative that older people have access to a GP and other services provided by health professionals.”

In its submission, the AMA stresses that the current policy settings do not support GPs visiting RACFs, working after hours, or being available to answer telephone concerns about their patients.

“Our members report that continuity of care goes generally unacknowledged in many RACFs and a resident’s care management plan is not well known,” it says.

“This creates an environment where the default step for RACF staff may be to refer the patient to a hospital emergency department (ED). In a study of 2880 residents of RACFs presented to the ED, one third of presentations could have been avoided by incorporating primary care services.

“Reasons for decisions to transfer residents to an ED include limited skilled staff, delays in GP consultations, and a lack of suitable equipment.”

Medical practitioners also need to be supported within the broader health care system to provide high quality care in RACFs. For example, by local hospitals providing secondary referral, timely specialist opinion, specialist services and rapid referral pathways to advice and services.

Older people are often burdened with complex and multiple medical disorders that requires the regular attention of medical practitioners, quality nursing care and allied health care professionals.

Embracing Information and Communication Technology (ICT) potentially has huge benefits for the aged care sector. It can increase communication between healthcare providers, reduce administrative burden, and assist to improve the health and independence of older people.

Aged care providers require improved ICT systems that are interoperable with the My Health Record, in particular its Medication Overview feature. This would ensure medical health professionals have the tools in place to access all relevant medical information with all relevant stakeholders to improve prescribing and to reduce the risk of adverse reactions and interactions between medications.

“Although working with older people is generally a rewarding experience, it comes with multiple challenges,” the submission states.

“For example, older people can be highly reliant on an aged care worker, and many have behavioural conditions that make day-to-day tasks difficult, and sometimes dangerous for the carer to carry out if the older person’s mental health is not appropriately managed.

“Carers are known to have high rates of moderate stress and depression. The health and wellbeing of aged care staff must be considered for the wellbeing of the workers, and so this stressful environment does not deter people from wanting to work in the aged care sector, or force existing workers to leave.”

Many of the issues outlined in the submission can be rectified by improving the capability, capacity and connectedness of the aged care workforce. Currently, this workforce is not adequately trained to be able to care for older Australians, as older peoples’ care needs are growing in both complexity and volume.

In addition, although medical practitioners are well-equipped to provide quality medical care to residents living in RACFs, they are not adequately supported or remunerated to do so due to the range of issues described above. This has resulted in an unnecessary barrier to quality medical services for RACF residents.

“The aged care workforce needs clear leadership and accountability, which an Aged Care Commission could provide,” the statement says.

“Many aged care governance (and workforce) issues described above have already been addressed in recommendations to the Government as a result of the multiple aged care reviews. Now is the time to act on these recommendations to prevent more unacceptable examples of neglect and bad quality care in RACFs, and to give people living in RACFs the quality of life that they deserve.”

The full submission can be viewed at: ausmed/aged-care-commission-needed-address-workforce-…

CHRIS JOHNSON

[Comment] Disease Control Priorities, 3rd edition: improving health and reducing poverty

In 1993 the World Bank published the first edition of Disease Control Priorities in Developing Countries (DCP1), an attempt to systematically assess the cost-effectiveness of interventions for the major sources of disease burden in low-income and middle-income countries.1 World Bank staff in the early 1990s were just beginning to receive requests from countries to finance projects to control AIDS and non-communicable diseases (NCDs). A major motivation for DCP1 was thus to identify reasonable responses in resource-constrained environments to the emergence of AIDS and to the growing burden of NCDs.