more_vertThis report aims to provide a more comprehensive picture of the full health loss attributable to diabetes and chronic kidney disease (CKD). It quantifies the impact of diabetes and CKD on the burden of other diseases for which there is evidence of a causal association (‘linked diseases’) to estimate the indirect burden caused by these 2 diseases. It uses disease burden estimates from the Australian Burden of Disease Study 2011 and extends the standard approach for analysis of risk factors to model diabetes and CKD as risk factors. When the indirect burden due to linked diseases was taken into account, the collective burden due to diabetes was 1.9 times as high, and CKD was 2.1 times as high, as their direct burden.
Preference: Infectious Diseases and Parasitology
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Contribution of vascular diseases and risk factors to the burden of dementia in Australia: Australian Burden of Disease Study 2011
This report describes a range of modifiable vascular risk factors for dementia, and estimates their individual and combined contribution to the burden of dementia in Australia. Vascular risk factors in this study include smoking, physical inactivity, mid-life high blood pressure and mid-life obesity, as well as vascular diseases that act as risk factors for dementia—diabetes, stroke, atrial fibrillation and chronic kidney disease. It uses burden of disease estimates from the Australian Burden of Disease Study 2011 and evidence in the literature that shows a link between these vascular risk factors and development of dementia in later life. It shows that about 30% of the total dementia burden in Australia is due to the joint effect of the vascular risk factors examined; highlighting the potential for preventing dementia and reducing dementia-related burden.
[Editorial] Reversing the rising tide of diabetes in China
The prevalence of diabetes (including both type 1 and type 2 diabetes) in China has increased significantly from 0·9% in 1980 to 11·6% in 2010, and China now has the largest number of people with diabetes in the world. According to the latest figures from the National Health and Family Planning Commission released on Nov 12, the total number of people with diabetes in China has reached 100 million and will keep growing. Awareness, treatment, and control of diabetes remain poor, making it one of the diseases with the highest death rates in the whole country.
[Editorial] The unacceptable reality of care for people living with dementia
For the first time, dementia has overtaken ischaemic heart disease as the leading cause of death in England and Wales, according to new figures from the Office for National Statistics. Almost 62 000—11·6% of all deaths—were due to dementia in 2015, and the mortality rate has more than doubled since 2010. The causes for this change include an ageing population, improved recognition, diagnosis, and reporting, but also treatment and prevention successes for other diseases. These figures also mean that an increasing number of people will live with dementia.
[Correspondence] Revising the ICD: stroke is a brain disease
The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was long overdue. The ICD-10 was based on outdated medical knowledge and concepts from the 1980s. Since then, science and practice have changed beyond recognition. The WHO neurology topic advisory group (TAG) for the revision of the ICD-10 was formed in 2009. In the ICD-10, cerebrovascular diseases were inconsistently and confusingly spread over several different chapters. In March, 2011, the Neurology and Circulatory TAGs, with contribution of WHO classification representatives and relevant WHO departments, agreed that in the ICD-11, all types of strokes should form a single block, and that this block should be placed in the nervous system diseases chapter.
[Correspondence] Revising the ICD: explaining the WHO approach
From the late 19th century, the International Classification of Diseases and Related Health Problems (ICD) has been the backbone of cause of death statistics. Over time, country uses of the ICD have moved beyond tracking mortality, and now include morbidity statistics, health financing, research, and clinical care. Regular revisions of the ICD are necessary to accommodate advances in medical knowledge. The product of the ongoing revision will be suitable for a digital environment and include electronic tools for coding, browsing, translation, review, and mapping.
[Perspectives] Typhoid fever
For generations of physicians, typhoid was one of a broad class of fevers linked to putrid air, best treated with bed rest, strengthening foods, and traditional standbys such as laudanum and bloodletting. By the end of the 19th century this view had been swept away: epidemiologists and bacteriologists disentangled typhoid from typhus and other fevers, and reframed it in terms of the presence or absence of a microorganism. But 20th-century public health campaigns discovered the limitations of a strictly scientific approach, and the tensions between treating an individual patient and addressing infectious diseases at the level of cities or nations.
[Articles] Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels.
[Comment] The black box warning on philanthrocapitalism
On Sept 21, 2016, Mark Zuckerberg and his wife Priscilla Chan announced plans to invest US$3 billion in a mission to “cure, prevent or manage all diseases” by 2100, part of an earlier promise to donate 99% of their stock in Facebook, a company Zuckerberg founded. It is the latest example in a growing number of pledges by billionaires to give away their wealth for social causes rather than pass it down to descendants. On the face of it, the pledge by Zuckerberg and Chan is generous, worthy, and inspired.
Health Care Homes must be tailored to Indigenous needs
I am continuing the important tradition of chairing the Taskforce on Indigenous Health as AMA President. The taskforce acts to identify and recommend Indigenous health policy strategies for the AMA.
On 8 October 2016, it was my privilege to chair my first meeting of the Taskforce. A number of important issues were discussed, including the AMA’s election priorities relating to Aboriginal and Torres Strait Islander health, the AMA’s support for the establishment of an Academic Health Science Centre in Central Australia, as proposed by Baker IDI Heart and Diabetes Institute and its partners, and the Indigenous health focus of the Medicare Benefits Schedule (MBS) Review.
One issue that was raised as being of particular concern was how the proposed Health Care Homes initiative will affect health care for Aboriginal and Torres Strait Islander peoples. The AMA supports the concept of Health Care Homes – a policy announcement made by the Coalition prior to the 2016 election, and we are pleased that the Australian Government has committed to an extended trial of the concept.
The AMA has concerns about the Health Care Homes model in relation to Indigenous health, and we assert that the specific health needs of Aboriginal and Torres Strait Islander people must be addressed through the scheme.
The concept of the medical home is not new in Australia. For many Australians, their local general practice is already their Health Care Home, and their GP, their primary carer. Patients whose care is well managed and co-ordinated by their GP are likely to have a better quality of life and to make a positive contribution to the economy through improved workforce participation. Health Care Homes should mean more expensive downstream costs can be avoided. Chronic conditions, if treated early and effectively managed, are less likely to result in the patient requiring hospital care for the condition or any complications.
The Health Care Home model has worked overseas and the evidence is of significant reductions in avoidable hospital admissions, emergency department use, and overall costs.
The AMA sees Health Care Homes as potentially one of the biggest reforms to Medicare in decades.
However, we know that, for the Health Care Home model to succeed, the Government needs to engage with and win the support of general practice. We also need to see greater detail about how the Health Care Home model will operate in remote and Indigenous communities.
Indigenous communities face a range of unique health problems and chronic diseases uncommon in our cities. A high turnover of medical practitioners and support services in these areas means continuity of care and follow up treatment can be difficult to maintain.
Trust is a vital component of health care, especially for Aboriginal and Torres Strait Islander peoples, and knowing and trusting a GP is critical in the management of chronic conditions. How the Health Care Home model will deliver consistent, ongoing GP care and management of chronic health conditions is not known, and the AMA has been urging the Government to provide greater details about funding and operation.
There is a degree of anxiety among the Aboriginal Community Controlled Health Organisation (ACCHO) sector that any announcements made by the current Government will result in cuts to Indigenous health. There is a strong view that building up the ACCHO sector is the best model of care for Aboriginal and Torres Strait Islander peoples, particularly as ACCHOs are the preferred provider of Indigenous health services.
ACCHOs, like Health Care Homes, need to be built on existing relationships and investment in models that work. The Government must not rush the Health Care Homes trial and, if it is to be successful, it must be adequately funded.
As a model, it has the potential to help close the gaps in health outcomes between Aboriginal and Torres Strait Islanders and non-indigenous Australians. The AMA’s position will be to closely monitor what works and what does not work, and work constructively with Government to ensure the necessary changes are made.