[The Lancet Commissions] The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

Sub-Saharan Africa’s health challenges are numerous and wide-ranging. Most sub-Saharan countries face a double burden of traditional, persisting health challenges, such as infectious diseases, malnutrition, and child and maternal mortality, and emerging challenges from an increasing prevalence of chronic conditions, mental health disorders, injuries, and health problems related to climate change and environmental degradation. Although there has been real progress on many health indicators, life expectancy and most population health indicators remain behind most low-income and middle-income countries in other parts of the world.

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

[Comment] Double-duty solutions for the double burden of malnutrition

In The Lancet, the NCD Risk Factor Collaboration1 describe trends in body-mass index (BMI), underweight, overweight, and obesity in almost 130 million children, adolescents, and adults from 200 countries worldwide. Findings of the study provide grounds for both optimism and concern. The good news is that from 1975 to 2016, the prevalence of undernutrition in children aged 5 years and older decreased, and obesity in some regions had slowed. The bad news is that the prevalence of overweight and obesity in adults (aged ≥20 years) and children and adolescents (5–19 years) in other regions of the world was increasing.

Federal Council communiqué – meeting of 17 and 18 November

Federal Council met in Canberra on 17/18 November. The meeting came in the midst of the political uncertainty arising from measures to deal with the citizenship status of federal politicians, the voluntary assisted dying debates in the parliaments of Victoria and NSW, and the strong majority poll in favour of same sex marriage reform announced during that week.

The President reported on his activities over the past three months since the last meeting of Council in August. Among the highlights were his attendance at the meeting of Confederation of Medical Associations in Asia and Oceania (CMAAO) in Tokyo in September and the Council meeting and General Assembly of the World Medical Association (WMA) in Chicago in October. The WMA adopted a modernised version of the Declaration of Geneva which was also adopted by Federal Council at its November meeting.

The Secretary General’s report focused on the breadth of submissions, Parliamentary committee appearances, and inquiries to which the secretariat has responded in the last few months, continuing a trend observed throughout 2017.

These included a submission on the security of Medicare cards; several reviews of training funding arrangements and workforce distribution; improving Medicare compliance; secondary use of Medicare data; coordinated advocacy with State and Territory AMAs to change the requirements for mandatory reporting under the National Law; medical indemnity changes; codeine scheduling changes; and ongoing negotiations with Minister Hunt on several issues including the future funding of after hours GP services.

The AMA’s engagement with the MBS Review process and the Private Health Ministerial Advisory Committee continue. Federal Council noted the release by Minister Hunt during October of the first tranche of reforms to private health insurance. Key reform areas remain under review including the scope of benefit cover in the proposed gold, silver, bronze, and basic policies; insurance cover of private patients in public hospitals; and a process to improve transparency of medical fees and out of pocket costs. This latter subject was a focus for discussion by the Council in one of its two policy sessions.

In considering an approach to improved transparency of medical fees and out of pocket costs, Federal Council noted the Government’s proposal to establish an expert working group to consider the most effective way to communicate medical fees and out of pocket costs. Federal Council also noted that informed financial consent was key but not uniformly practiced. Federal Council reiterated its position statement in support of doctors charging an amount appropriate to the service and the patient, while condemning excessive charging. Federal Council agreed principles to guide AMA input into the expert working group.

Federal Council noted the array of AMA’s public health advocacy including an appearance before a parliamentary inquiry into e-cigarettes and consideration of the AMA’s broader tobacco advocacy. Federal Council approved two public health position statements, one dealing with nutrition and the other, road safety. The Council passed unanimously a motion calling on greater transparency of the conditions under which the asylum seekers and refugees on Manus Island are being held and offering an independent assessment by doctors of the health situation.

Continuing areas of public health policy attention include men’s health, sexual diversity and gender identity, and social determinants of health. A new working group was established to review the AMA position statement on drugs in sport.

Federal Council received a presentation from Scott McNaughton, General Manager of Participation Pathway Design with the National Disability Insurance Agency (NDIA) in the second policy session. Councillors were interested to learn about the role of medical practitioners in providing NDIS assessments; and the processes to access appropriate medical and psychosocial supports for people with mental illness. The presentation provided essential information and highlighted the steps underway by NDIA to fully implement the NDIS.

The Equity, Inclusion and Diversity Committee of Council reported that it proposes to publish an annual report on progress to achieve equity, inclusion, and diversity in the AMA.

Federal Council received a report on the successful forum in October on reducing the risk of suicide in the medical profession which was convened jointly by Federal AMA, AMA NSW and Doctors Health Services Pty Limited. The two key themes that came from the forum were the impact of culture and the need for compassion. A full report will be published in due course.

At the conclusion of the meeting the Secretary General reminded Federal Council that 2018 is an election year for positions on the Council, with a call for nominations to go out to all voting members in February. Federal Council draws its standing from its representative structure, with representation of members from across the country, and all specialties and stages of practice.

Dr Beverley Rowbotham
Chair Federal Council

[Series] Public health information in crisis-affected populations: a review of methods and their use for advocacy and action

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality.

WHO discusses health strategies for our region

Low breastfeeding rates and “aggressive” baby formula marketing have been raised as an urgent issue by delegates at the World Health Organisation’s Western Pacific Regional Committee in Brisbane last month.

The annual meeting brings together ministers of health and senior officials from 37 countries and areas to decide on issues that affect the health and well-being of the Region’s nearly 1.9 billion people.

A new WHO regional action plan has been developed to strengthen protections for children from the harmful impact of food marketing.

WHO remains concerned that the baby food industry manipulates policies and practices by creating a positive public image as well as denying wrong-doing. WHO also believes evidence suggests that infant formula industry advertisements, gifts and sponsorships promote misconceptions and myths and ultimately have a negative impact on feeding practices.

Marketing of breast-milk substitutes, including infant formula, follow-up formula and growing-up milk, to caregivers continues to undermine breastfeeding in the first six months and continued breastfeeding beyond that age.

“The baby formula business is booming,” WHO’s regional director Dr Shin Young-soo said.

“And that is undermining breastfeeding.”

WHO believes that globally, 13 per cent of child deaths can be prevented with exclusive and continued breastfeeding.

Protecting children from the harmful impact of food marketing is critical in a region where more than 6.3 million children are overweight or obese. Countries were at the forum to develop a regional action plan to provide greater protection for children and support better health and nutrition, from birth onwards.

“When children are exposed to food marketing, their diets change,” Dr Shin said.

WHO and the Australian Government have also launched their first ever country cooperation strategy, on the sidelines of the 68th session of the WHO Regional Committee for the Western Pacific.

Issues discussed at the forum included: eliminating major communicable diseases, including measles and rubella, as well as mother-to-child transmission of HIV, hepatitis B and syphilis; financing of priority public health services; strengthening regulation of medicines and the health workforce; improving food safety; and health promotion for sustainable development.

Dr Shin Young-soo said the forum was important to the region because: “Our strength in solidarity is our best defence against whatever the future holds.”

It also provided a vision for WHO’s joint work with Australia over the next five years to improve the health of Australians and contribute to better health outcomes in the broader region.

Dr Shin said the strategy with Australia is the first of its kind, but it builds on a history of strong cooperation while also looking towards the future. Traditionally, country cooperation strategies are established between WHO and developing countries, where the Organisation has offices and provides direct support.

“I sincerely thank Minister Hunt and the Department of Health for their commitment to this strategy – and for paving the way for other high-income countries in this Region, with a new form of engagement that goes beyond the traditional donor country relationship,” he said.

Health Minister Greg Hunt, who attended the meeting, said the strategy: “Strengthens our systems to guard against emerging diseases at home and abroad, boosts our public health capacities and improves our already robust regulations to ensure we have safe and effective medicines and treatments.”

Australia’s breastfeeding guidelines are in line with WHO recommendations that infants up to six months should be exclusively breastfed. However, the Department of Health Australian National Breastfeeding Strategy expired in 2015.

The AMA believes that breastfeeding should be promoted as the optimal infant feeding method. AMA has also called for doctors and other health professionals to be appropriately trained on the benefits of breastfeeding, including how to support mothers who experience difficulties with breastfeeding.

AMA’s position statement can be read here: position-statement/infant-feeding-and-parental-health-2017 .

MEREDITH HORNE

[Correspondence] Treating cholera in severely malnourished children in the Horn of Africa and Yemen

Populations in Yemen, South Sudan, Somalia, and Ethiopia are experiencing starvation and concurrent outbreaks of confirmed or suspected cholera (acute watery diarrhoea [AWD]).1 Drought, conflict, and population displacement in these countries have led to increased food insecurity and a higher incidence of severe acute malnutrition (SAM).1 Limited access to safe water and poor sanitation have exacerbated cholera and AWD outbreaks and led to the dangerous comorbidity of cholera and SAM in young children.

Greater recognition and response for treating eating disorders

Federal Health Minister Greg Hunt has launched the Butterfly Foundation’s National Agenda for Eating Disorders.

The Butterfly Foundation will receive an additional $1.2 million over the next two years to roll this out nationally through the National Eating Disorders Collaboration.

The goal of the National Agenda is to ensure Australia has a national approach to help people with eating disorders and to establish a bank of information around what works, so people suffering from this disease can access the best treatment for their needs.

The Agenda was developed in consultation with Australia’s eating disorders experts and those with a lived experience of an eating disorder.

Launching the National Agenda in September, Mr Hunt said that the Federal Government was committed to bringing together State and Territory governments and industry to deliver a consistent response in treating and supporting people with eating disorders.

The Government in the Budget this year announced it will provide almost $3 million for more support and better treatment for people suffering from eating disorders.

Eating disorders not only affect an individual’s relationship with food, but also body image, confidence, mental health, and overall health.

In May, Minister Hunt requested the Medical Benefits Schedule Review Taskforce investigate options for Medicare coverage for the treatment needs of those people with an eating disorder, including physical, psychological, behavioural, nutritional, occupational and social needs. The aim is to increase the skills of health professionals to identify and respond to eating disorders through a nationally consistent approach.

The Butterfly Foundation’s Chief Executive Christine Morgan believes this is critical because currently the foundation believes that only 25 per cent of Australians with an eating disorder currently seek treatment.

“The Agenda addresses critical areas of health system reform and identifies the priorities needed to provide access to evidence-based multi-disciplinary treatment and dosages to any Australian with or at risk of an eating order,” Ms Morgan said.

Mr Hunt also announced funding of $1.7 million to support expansion of the 1800 ED HOPE national helpline, allowing 1800 ED HOPE’s hours to be increased so it remains open from 8am to midnight seven days a week. This expansion will happen by February, 2018.

The telephone helpline is the only of its kind in Australia.

The Butterfly Foundation welcomed the support for the hotline saying they are committed to: “Ensuring there is no divide between those who can afford treatment and those who can’t.”

Ms Morgan said the announcement marked a milestone in Australia’s recognition and response to people living with an eating disorder.

“The launch of the first National Agenda for Eating Disorders, coupled with the Minister’s restated commitment to a review of Medicare to more comprehensively cover the needs of those with eating disorders, constitutes the policy realignment that has been sadly lacking to date,” she said.

The Butterfly Foundation has also recently launched an Australian-first Youth Intensive Outpatient Program in Sydney, a low cost program, costing families $120 per patient per week over the 10-week program.

The AMA expressed support for a nationally coordinated approach in order to develop effective and consistent practices in preventing and addressing the incidence of unhealthy body image and eating disorders. The AMA’s position paper Body Image and Health can be found here: position-statement/body-image-and-health-2002-revised…

Anyone needing support with eating disorders or body image issues is encouraged to contact Butterfly’s National Helpline on 1800 33 4673 or support@thebutterflyfoundation.org.au

MEREDITH HORNE

[Editorial] Imagine a world free from hunger and malnutrition

On Sept 15, the UN Food and Agriculture Organization (FAO) published its annual comprehensive report, The State of Food Security and Nutrition in the World: Building Resilience for Peace and Food Security. Since its first publication in 1947, this annual report has been called The State of Food and Agriculture, but this year’s title has been expanded to include the word nutrition. Also for the first time, this year’s report has a wider authorship group including UN Partners—the International Fund for Agricultural Development (IFAD), UNICEF, the World Food Programme (WFP), and WHO.

[Editorial] A multisectoral approach to childhood development

On Sept 20, at Financing the Future: Education 2030, a high-level UN conference in New York City, NY, USA, international leaders pledged to end the global education crisis. Without immediate action, by 2030 an estimated 825 million of the 1·6 billion young people in the world will be unable to reach their full potential—a catastrophic failure to meet Sustainable Development Goal 4: inclusive and quality education for all. But investment in education alone is not enough. The Lancet Series on Early Childhood Development highlighted health, nutrition, child protection, and safe peer environments, in addition to education, as factors that contribute to ensuring success for young people.