more_vertBrooke Bauer is an infant-feeding specialist and founder of Nurture Project International, an NGO that provides lactation support, reproductive care, and nutrition support to families in emergencies. She is interviewed in Erbil, after a training session in a primary health centre in east Mosul.
Preference: Nutrition
644
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
Association between sedentary time and mortality across levels of frailty [Research]
BACKGROUND:
Sedentary behaviours are associated with adverse health outcomes in middle-aged and older adults, even among those who exercise. We examined whether the degree of frailty affects the association between sedentary behaviours and higher risk of mortality.
METHODS:
In this prospective cohort study, we used data from 3141 community-dwelling adults 50 years of age or older from the 2003/04 and 2005/06 cohorts of the US National Health and Nutrition Examination Survey. Time engaged in sedentary behaviours was measured using uniaxial accelerometers, and frailty was based on a 46-item frailty index. Mortality data were linked up to 2011. We used Cox proportional hazard models to estimate the hazard ratio (HR) of sedentary behaviour.
RESULTS:
We found that for people with low levels of frailty (frailty index score ≤ 0.1), sedentary time was not predictive of mortality, regardless of physical activity level (adjusted HR 0.90, 95% confidence interval [CI] 0.70–1.15). Among people who were vulnerable (0.1 < frailty index score ≤ 0.2) or frail (frailty index score > 0.2), sedentary time was associated with higher mortality only among those who were physically inactive (not meeting the criterion for moderate physical activity) (HR 1.16, 95% CI 1.02–1.33 for the group defined by 0.1 < frailty index score ≤ 0.2; HR 1.27, 95% CI 1.11–1.46 for the group defined by 0.2 < frailty index score ≤ 0.3; HR 1.34, 95% CI 1.19–1.50 for frailty index score > 0.3).
INTERPRETATION:
The effect of sedentary behaviours on mortality varied by level of frailty. Adults with the highest frailty level experienced the greatest adverse impact. Low frailty levels (frailty index score ≤ 0.1) seemed to eliminate the increased risk of mortality associated with prolonged sitting, even among people who did not meet recommended physical activity guidelines.
Rehydration study shows water still best choice
A Griffith Universitystudy has found that once food is consumed, water should be the drink of choice for most of us following a workout.
Ten endurance trained athletes aged between 18 and 30 cycled intensively for one hour on four separate occasions as a part of the small study that has been published in the peer-reviewed scientific journal Physiology and Behaviour.
Participants were provided with one beverage to drink as they desired following the exercise. The beverages included water (used on two of the trials), a carbohydrate-electrolyte (sports drink) Powerade or the milk-based drink Sustagen Sport.
In addition, on two occasions during recovery, the participants were given access to a variety of food which could also be voluntarily consumed.
“The fluid provided from all beverages was equally well retained, despite different consumption volumes, and resulted in participants’ body weights returning to near pre-exercise levels,” said Associate Professor Ben Desbrow from Griffith’s Menzies Health Institute Queensland.
“The findings from this study demonstrate that the consumption of food following exercise plays an important role in causing fluid retention when different beverages are consumed. The take home message was that when participants consumed a fluid containing calories (i.e. the Powerade or Sustagen Sport trials), their combined energy intake from the drink and food was greater than on the water trials.”
Associate Professor Desbrow said it was imperative, when making post-exercise nutrition recommendations, to consider beverage selection within the context of an individual’s broader health targets.
“For those with a weight loss goal, a calorie-free drink such as water is the perfect choice,” he said.
“It rehydrates equally effectively as other beverages, without supplying additional energy.”
MEREDITH HORNE
Breast or otherwise, new mothers need support
Non-breastfeeding mothers need greater support to help them feed their babies without being made to feel guilty, the AMA insists.
Releasing the AMA’s Infant Feeding and Parental Health 2017 Position Statement recently, AMA President Dr Michael Gannon said new parents who did not breastfeed their infants should be supported in their efforts to ensure their children receive optimal nutrition.
CHRIS JOHNSON
[Series] Human reproduction and health: an evolutionary perspective
According to life history theory, increased investment in reproductive function (physiology and behaviour) at different times throughout the life course affects the risk of many diseases and, ultimately, longevity. Although genetic factors contribute to interindividual and interpopulation variation in reproductive traits, the dominant source of variability is phenotypic plasticity during development and adult life. Reproductive traits in both sexes evolved sensitivity to ecological conditions, as reflected in contemporary associations of hormone concentrations with geographical setting, nutritional status, and physical activity level.
Processed meats need a closer look
OPINION
By Dr Alphonse Roex and Dr Heleen Roex-Haitjema
In October 2015, the authoritative International Agency for Research on Cancer (IARC) confirmed that processed meat causes cancer and red meat is a probable carcinogen (Table 1.1,2 ).
|
IARC Carcinogenic Classification Groups |
Likelihood to cause cancer in humans |
Type of meat |
Examples |
|
1 |
Causes cancer |
Processed meats |
Bacon, ham, sausages, hot dogs, hamburgers, ground beef, mince, corned beef, beef jerky, canned meat, offal and blood |
|
2a |
Probably causes cancer |
Red meats |
Meat from mammals: pork, veal, beef, bull meat, sheep, lamb, horse meat and, Meat from hunting: wild boars, deer, pigeons, partridges, quail and pheasants |
Table 1. Based on the IARC’s data on the carcinogenicity of processed meat and red meat.1,2
The IARC assessed more than 700 epidemiological studies regarding red meat and more than 400 provided data on processed meat. The IARC estimates that worldwide the consumption of diets high in processed meat results in approximately 34,000 deaths annually and diets high in red meat in 50,000 avoidable cancer deaths per year. Eating an extra portion of 50 grams of processed meat daily increases the relative risk of colorectal cancer by 18 per cent.
The strength of evidence that processed meat is a carcinogen is comparable with tobacco smoking and asbestos.3,4
Diets high in animal protein show a 75 per cent increase in total mortality, a 500 per cent increase in diabetes, a 400 per cent increase in cancer risk, and produce significantly higher levels of IGF1, a potent cancer-promoting hormone.5
Chronic diseases are responsible for considerable human suffering and contribute heavily to the burden of disease nationally. Australia’s ever increasing total healthcare expenditure has in 2016 for the first time surpassed 10 per cent of its Gross Domestic Product. It is estimated that 55-60 per cent of this total is spent on chronic disease management.
Nearly two years have passed since the World Health Organisation’s report on the categorisation of processed animal products as carcinogenic. The time has come that we doctors take the initiative to inform our citizens and create systems, processes and policies to protect our patients and communities from further harm from such known carcinogens. We were finally moved to show united leadership 60 years ago in regards to smoking. Ultimately, after roughly 7000 scientific publications showing the relationship between smoking and lung cancer, healthcare providers became advocates for the best available medical evidence trumping the lures of a treasured habit for many of their patients (and indeed, fellow colleagues).
The American Medical Association in the USA has led the way by calling on hospitals there to improve the health of patients, staff and visitors by (1) providing a variety of healthful food, including plant-based meals that are low in fat, sodium and added sugars, (2) eliminating processed meats from menus and (3) providing and promoting healthful beverages.6,7,8
Springmann et al. estimated the effects of consuming less – or no – animal products on global population health should a transition to a more plant-based diet be made leading up to 2050. Conclusions reached were a reduction in premature deaths, abundant economic benefits and reduced greenhouse gas emissions. Table 2.9
|
Healthier diets compared to present omnivorous diet |
Characteristics diets |
Human health benefits: millions of premature deaths avoided |
Economic valuation: value-of-statistical life approach. Trillion of AUD saved per year |
|
Healthy Global Diet (WHO) |
Less meat and sugar; More vegetables and fruit |
5.1 |
27.6 |
|
Vegetarian |
Minimal animal products: dairy and eggs only
|
7.3 |
36.8 |
|
Vegan |
No animal products: plant-based only |
8.1 |
39.4 |
Table 2. Human lives and money saved in 2050 if the world population would adapt more healthful diets. Based on publication M Springmann et al.9
We understand that our AMA is aware of the issue and we are engaging with its Public Health team.
The time for compassionate action and leadership on this important issue by the Australian medical profession has arrived. All medical administrators, procurement officers, caterers and doctors (in association with registered dietitians) should then feel encouraged, empowered and supported to play a role in implementing the elimination of processed meats in medical institutions.
Views expressed in the above Opinion piece are those of the authors and do not reflect official policy of the AMA.
The authors’ credentials are listed below:
Dr Alphonse Roex MD PhD, FRANZCOG
Senior Consultant Obstetrics and Gynaecology The Lyell McEwin Hospital South Australia
Senior Lecturer, The University of Adelaide
Medical degree: Utrecht University, the Netherlands
Specialist degree and PhD: Free University Amsterdam, The Netherlands
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health
Dr Heleen Roex-Haitjema, Paediatrician (not practising)
Certificate in Plant-Based Nutrition, Cornell University, New York
Certified Food for Life Instructor, The Physicians Committee for Responsible Medicine, Washington DC
Medical degree: Utrecht University, The Netherlands
Specialist degree: Free University Amsterdam, The Netherlands.
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health.
References
- Bouvard V, Loomis D, Guyton KZ et al. on behalf of the IARC Monograph Working Group. Carcinogenicity of consumption of red and processed meat. Lancet Oncology 2015.
- http://publications.iarc.fr/Book-And-Report-Series/Iarc-Monographs-On-The-Evaluation-Of-Carcinogenic-Risks-To-Humans. Volume 114 (2015).
- IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 83 (2004) Tobacco Smoke and Involuntary Smoking.
- IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 100C. (2012) Asbestos.
- Levine ME et al. Low Protein Intake is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism 2014;19:407-17.
- https://janeunchained.com/2017/06/23/ama-comes-out-against-serving-processed-meats-in-hospitals/
- http://www.pcrm.org/nbBlog/american-medical-association-passes-healthy-food-resolutions
- https://wire.ama-assn.org/ama-news/ama-backs-comprehensive-approach-targ…
- Springmann M. et al. Analysis and valuation of the health and climate change co-benefits of dietary change PNAS doi:10.1073/pnas. 2016; 1523119113.
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
Tracking the impact of climate change on health
The World Health Organisation (WHO) has launched the second round of its Climate and Health Country profiles – providing updated national level evidence on health risks and opportunities, and tracking progress.
The WHO UNFCCC Climate and Health Country Profile Project aims to provide country-specific, evidence-based snapshots of the climate hazards and health risks facing countries.
The project has strengthened the linkages between climate and health communities; promoted innovative research on national climate hazard and health impact modelling; and engaged an inter-ministerial network of climate and health focal points to develop, advance and disseminate the findings.
Climate change undermines access to safe water, adequate food, and clean air, exacerbating the approximately 12.6 million deaths each year that are caused by avoidable environmental risk factors.
Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress, and billions of dollars in direct damage costs to health.
WHO works with countries across the world to protect the most vulnerable populations from the health effects of extreme weather events, and to increase their resilience to long-term climate change.
At the same time, the policy decisions and polluting energy sources that are causing climate change are also causing direct health impacts, most notably contributing to the 6.5 million deaths each year from air pollution.
Through the 2015 Paris Agreement on climate change, countries have made commitments to cut carbon pollution, for example through promoting cleaner energy sources, and more sustainable urban transport systems, that will also protect and improve the health of their own populations. WHO is supporting countries to assess the expected health gains from their Paris commitments, and to promote policy choices that bring the greatest benefits both to health, and the environment.
The Lancet has called climate change: “The biggest global health threat of the 21st century.”
The Lancet’s report Managing the Health Effects of Climate Change, states that the effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk.
The next series of WHO’s climate and health country profiles will be released in 2019.
The just released list can be found at: http://www.who.int/globalchange/resources/countries/en/
The AMA’s Position Statement on Climate Change and Human Health can be viewed at: position-statement/ama-position-statement-climate-change-and-human-health-2004-revised-2015
MEREDITH HORNE
[Perspectives] Tuberculosis
No disease better illustrates the difficulties of early modern medical practice than tuberculosis. Arguments over heredity, nutrition, environment, and contagion all came together within the potent cultural frame of a condition that, by the early 19th century, killed about one in five Europeans. Rather than claiming thousands in swift, savage epidemics tuberculosis took its victims slowly, racking their bodies and exhausting their minds. Older names for the disease—consumption and pthisis (from a Greek word meaning to waste away)—reflect the way in which it seemed to destroy the body from within.