more_vertCatherine Karr, Professor of Pediatrics and Environmental and Occupational Health Sciences at the University of Washington (UW) in Seattle, WA, USA, aims to improve child respiratory health, including among remote communities in Washington state. As a paediatric environmental medicine specialist and environmental epidemiologist, her work has centred on the environmental disparities that impact on child health. “Exposure to environmental pollutants, indoor or outdoor, can really affect children’s health”, says Karr.
Preference: Public and Environmental Health
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AMA President opens his last conference
Dr Michael Gannon opened the AMA National Conference 2018 by figuratively saying goodbye.
In his last opening address as AMA President, which was at times emotional, Dr Gannon detailed a long list of achievements secured by the AMA during his two-year tenure.
And he poured praise on the organisation he said he enjoyed leading since 2016.
“I must say that it has been a huge honour and privilege to serve the AMA and the medical profession as Federal President,” Dr Gannon said.
“It is demanding, challenging, rewarding, and life-changing. The issues, the experiences, the depth and breadth of policy and ideas, and the interface with our political leaders and the Parliament are unique to this job.
“The responsibility is immense. The payback is the knowledge that you can achieve great things for the AMA members, the whole medical profession and, most importantly, the community, and the patients in our care.”
His address focused largely on the ground covered since the AMA met for national conference in 2017.
Describing it as a “very busy and very successful year for the Federal AMA,” Dr Gannon said time had passed very quickly in the job but much had been accomplished.
“Throughout the last 12 months, 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,” he said.
“We all worked tirelessly to ensure that health policy and bureaucratic processes were shaped to provide the best possible professional working environments for Australian doctors and the highest quality care for our patients.
“The unique role of the AMA in health advocacy is that we are looked to for commentary on the breadth and depth of health policy, social policy, and the health system.”
Dr Gannon said strong and robust advocacy led to a number of policy outcomes at the federal political level.
He said many organisations get nothing for their efforts, but the AMA never gives up.
“To be successful in Canberra, you have to learn to take the knocks along with the wins, then go back again and again for a better outcome,” he said.
“It is breathtakingly naïve to think it works otherwise. And that is what we have done, and keep doing.”
In 2017, the AMA launched its regular Safe Hours Audit Report, which gave added focus to the emerging issue of doctors’ health.
To enhance this focus on doctors’ health, AMA coordination of Doctors’ Health Services continues all around the country, with funding support from the Medical Board of Australia.
“We maintained a strong focus on medical workforce and training places, which resulted in the National Medical Training Advisory Network significantly increasing its workforce modelling work,” Dr Gannon told the conference.
“We secured a number of concessions in the proposed redesign of the Practice Incentive Program, as well as a delay in the introduction of changes.
“The AMA lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents. We focused on effective compliance, and achieving a fair balance between the interests of GP members and Pathologist members.
“We led the reforms to after-hours GP services provided through Medical Deputising Services to ensure that these services are better targeted, and there is stronger communication between them and a patient’s usual GP.
“We successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting. This potentially saves GPs thousands of dollars every year in legal and other compliance costs.
“We ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers. This avoided more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.
“We fundamentally altered the direction of the Medical Indemnity Insurance Review.”
The AMA campaigned on the issue of doctors’ health and the need for COAG to change mandatory reporting laws, promoting the WA model.
It led a nationally coordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.
It campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.
The 2018 AMA Public Hospital Report Card put the political, media, and public focus on the stresses and pressures on public hospitals and all who work in them. The current funding model, based entirely around payments for activity, discourages innovation and is inadequate in addressing the demands placed by an ageing population.
“We prosecuted the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee, my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy,” Dr Gannon said.
“This work was complemented by the launch of the AMA Private Health Insurance Report Card.
“We successfully lobbied for a fundamental change in the direction of the Anaesthesia Clinical Committee of the MBS Review. The Australian Society of Anaesthetists were grateful for our assistance and leadership. Many other Colleges, Associations and Societies have worked out that partnership with, rather than competing with, the AMA is the smartest way to get results.
“We launched a new AMA Fees List with all the associated benefits of mobility and regular updates.
“We saw a number of our Aged Care policy recommendations included in a number of Government reviews.
“We lobbied against what could easily have been an ill-thought-out UK-style Revalidation proposal. Our work resulted in a vastly improved Professional Performance Framework based around enhanced Continuing Professional Development.”
Dr Gannon said the AMA had provided strong leadership right across the busy public health landscape over the past year.
The AMA Indigenous Health Report Card focused on ear health, and specifically chronic otitis media.
The Federal Council endorsed the Uluru Statement from the Heart, acknowledging that Recognition is another key social determinant of health for Aboriginal and Torres Strait Islander Australians.
A product of a policy session at last year’s AMA National Conference was the subsequent updating of the AMA Position Statement on Obesity,
“I think that it is inevitable that we will eventually see a tax on sugar-sweetened beverages similar to those recently introduced in Britain and Ireland,” Dr Gannon said.
“In fact it is so simple, so easy, and so obvious, I worry that it will be seen by a future Government as a ‘silver bullet’ to what is a much more complex health and social policy issue.”
Position Statements on an Australian Centre for Disease Control; Female Genital Mutilation; Infant Feeding and Maternal Health; Harmful Substance Use, Dependence, and Behavioural Addiction; and Firearms were also highlighted.
“We conducted ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees,” he said.
“We promoted the benefits of immunisation to individuals and the broader community. Our advocacy has contributed to an increase in vaccination rates.
“We provided strong advocacy on climate change and health, among a broader suite of commentary on environmental issues.
“We consistently advocated for better women’s health services. And released a first ever statement on Men’s Health.”
New Position Statements were also released on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, Blood Borne Viruses, and Rural Workforce.
“We promoted our carefully constructed position statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, New South Wales and WA,” Dr Gannon said.
“That advocacy was not universally popular. Our Position Statement acknowledges the diversity of opinion within the profession…
“We 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.”
In July 2017, AMA advocacy was publicly recognised when the Governance Institute rated the AMA as the most ethical and the most successful lobby group in Australia.
Dr Gannon added that the highlight of the 2017 international calendar for him was the annual General Assembly of the World Medical Association.
“Outcomes from that meeting included high level discussions on end-of-life care, climate change and environmental health, numerous other global social and ethical issues, and seeing the inclusion of doctors’ health as a core issue in both medical ethics and professionalism,” he said.
“I get goosebumps when I read aloud the Declaration of Geneva. It is a source of immense personal pride that I was intimately involved with its latest editorial revision, only the fifth since 1948.
“But our focus remained at home, and your AMA was very active in promoting our Mission: Leading Australia’s Doctors – Promoting Australia’s Health.
“We had great successes. We earned and maintained the respect of our politicians, the bureaucracy, and the health sector.
“We won the support of the public as we have fought for a better health system for all Australians.”
Dr Gannon thanked his family, staff, the AMA Secretariat, Board and Federal Council.
CHRIS JOHNSON
Snippets
President in good company
AMA President Dr Michael Gannon recently attended the World Medical Association Council Session in Latvia. Environmental health, reproductive health, pandemic influenza, nuclear weapons, and telemedicine were just some of the agenda items discussed. Dr Gannon can be found in this pic, just left of centre in a middle row (kind of).
Nobel Prize Winner for Leadership Development Dinner
Nobel Prize Winner Associate Professor Tilman Ruff is the keynote speaker at the AMA Leadership Development Dinner on Friday, May 25 at the National Portrait Gallery in Canberra. He is Co-President of International Physicians for the Prevention of Nuclear War (IPPNW, Nobel Peace Prize 1985); and founding international and Australian Chair of the International Campaign to Abolish Nuclear Weapons (ICAN), awarded the Nobel Peace Prize for 2017 “for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons and for its ground-breaking efforts to achieve a treaty-based prohibition of such weapons”.
For more info see: ausmed/safeguarding-planetary-health-banning-nuclear-…
Women remembered on Anzac Day
Senior member of the AMA, and retired colonel, Associate Professor Susan Neuhaus became the first woman to deliver the Anzac Day dawn service address at the Australian War Memorial in Canberra.
She used the occasion to highlight the often overlooked role of women in the armed services and in particular the Australian Defence Force.
Her full speech can be found at: https://www.awm.gov.au/commemoration/speeches/DawnService2018
[Series] Origins of lifetime health around the time of conception: causes and consequences
Parental environmental factors, including diet, body composition, metabolism, and stress, affect the health and chronic disease risk of people throughout their lives, as captured in the Developmental Origins of Health and Disease concept. Research across the epidemiological, clinical, and basic science fields has identified the period around conception as being crucial for the processes mediating parental influences on the health of the next generation. During this time, from the maturation of gametes through to early embryonic development, parental lifestyle can adversely influence long-term risks of offspring cardiovascular, metabolic, immune, and neurological morbidities, often termed developmental programming.
[Editorial] Turning climate change legislation into public health policy
The effects of climate change are inextricably entwined with health: ranging from the WHO estimate of 7 million deaths from breathing polluted air indoors and outdoors; through the impact of weather-related natural disasters; negative effects on crop yields and food security; and changing patterns of vector-borne diseases; to the shaping of social and environmental determinants of health. 2018 marks 10 years of the UK’s 2008 Climate Change Act, which mandated reduction of UK carbon dioxide emissions by 80% by 2050 to 1990 levels, and legislated an independent Committee on Climate Change.
[Editorial] Solitary confinement of children and young people
Last week, in a joint statement, the British Medical Association (BMA), the Royal College of Psychiatrists, and the Royal College of Paediatrics and Child Health called for an end to the solitary confinement of children and young people held in UK detention facilities. According to a survey from the HM Inspectorate of Prisons, 38% of boys detained in the UK have spent time in solitary confinement, physically and socially isolated from others, with almost no purposeful interaction or environmental stimuli, for periods that can stretch for up to 80 days.
[Seminar] Multiple sclerosis
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease.
Mapping the cost of health-related work incapacity
A Federal Government statutory authority is releasing new research that estimates the scale and cost of health-related work incapacity in Australia. And it looks at opportunities to improve the situation.
Comcare, the Government’s compensation insurer and work health and safety regulator, late last year established an innovative public-private initiative known as the Collaborative Partnership to Improve Work Participation.
It is focused on aligning the various sectors of Australia’s work disability system to deliver better outcomes for people with temporary or permanent physical or mental health conditions.
The Partnership includes the Australasian Faculty of Occupational and Environmental Medicine (AFOEM), the Departments of Social Services and Jobs and Small Business, the ACTU, the Insurance Council of Australia, insurer EML and experts Lucy Brogden, Chair of the National Mental Health Commission, and consulting Professor Niki Ellis.
AFOEM is leading work to strengthen the role of GPs in improving return to work outcomes for injured and ill workers – including helping GPs prescribe work as part of recovery.
Through a range of projects, the Partnership is working across sectors including workers’ compensation, life insurance, superannuation, disability support and employment services to improve disability employment and return to work rates for people experiencing work incapacity through illness and injury.
It is also the first time all the major compensation and benefit systems have been examined together to identify the flow of people through them, how the systems interact, and where they can be improved to deliver better health and productivity outcomes.
The Partnership commissioned Monash University to undertake the research. The resulting report The Cross Sector Project Mapping Australian Systems of Income Support for People with Health-Related Work Incapacity is now being released.
The study considered data and services across the systems that support people to work – workers’ compensation, disability support, veterans’ compensation, superannuation, life insurance and motor accident compensation.
Among other things, the study found that 786,000 Australians who were unable to work due to ill health, injury or disability received some form of income support in 2015-16.
Also, about $18 billion was spent on some form of income support in that year.
This research sheds new light on how many Australians have health conditions that impact their ability to work, and the cost for employers, Government and insurers. The numbers include 155,000 people in workers’ compensation and 469,000 people in social security.
Researchers also produced a conceptual map of Australia’s income support systems, showing the volumes of people, the types of income support they receive and how they might move through the various systems.
“These findings mark the first step in establishing an evidence base in a critical area of public health and social policy,” Comcare CEO Jennifer Taylor said.
“It gives us a basis for improving Australia’s service delivery model for supporting people with work-related injury or disability in their return to work.
“Australia’s benefit and compensation systems are siloed and operate with little reference to each other. There’s growing recognition that what happens in one system impacts others, and the costs often just shift between the systems.
“Considering the sectors as a whole rather than as independent systems will lead to a better understanding of how they operate in relation to each other, how they connect and where gaps or tensions exist.
“It’s clear that taking a cross-system view and a collaborative approach gives us a platform to design and trial new service offerings. We have significant opportunities to improve health and productivity for a very large number of working age Australians.”
Monash University’s Insurance Work and Health Group, led by Professor Alex Collie, was asked to develop a high-level system map of the current Australian service delivery model for supporting people with a work-related injury or disability in their return to work. The project also analysed and mapped system-related data and data gaps.
The project scope included investigating five categories of services: return to work services; healthcare and treatment; job finding or employment services; functional support services; and case management services.
The Monash team mapped 10 major systems of income support in Australia: employer provided entitlements; workers’ compensation (short tail and long tail schemes); motor vehicle accident compensation (lump sum and statutory benefits); life insurance (income protection and total and permanent disability schemes); defence and veterans’ compensation and pensions; superannuation; and social security.
The report estimated the number of people accessing income support and associated costs from each of the systems during 2015-16 and identified opportunities for improvements in the various systems.
Potential improvements include information and data sharing to provide greater understanding of the systems of income support; and better aligning service models – particularly through reforming GP certification and work capacity assessment – to reduce overlap and improve service delivery.
The Collaborative Partnership is considering these recommendations and working towards addressing the opportunities for change. Members are already examining ways to improve data sharing between the various compensation and benefit systems to get a better understanding of how they interact and how they can work together more effectively.
CHRIS JOHNSON
The Cross Sector Project report can be found on the Partnership’s website: http://www.comcare.gov.au/collaborativepartnership
PICTURE: Comcare CEO Jennifer Taylor launching the Collaborative Partnership to Improve Work Participation.
[Correspondence] Planetary health: a new sociopolitical framework is urgently needed
We welcome the Lecture by Samuel S Myers (Dec 23, 2017, p 2860)1 on planetary health. Paul J Crutzen assigned the term Anthropocene to “the present, in many ways human-dominated, geological epoch”.2 The capacity of mankind to shape its own habitat is a major environmental force. More than 15 000 scientists proclaimed that urgent changes are needed to avoid the consequences of humanity’s impact on the environment and reverse the trend of collapsing the delicate planetary health.3
Taiwan wants back in as a WHA observer
Taiwan has put out a call for international support for it to be allowed to participate in this year’s World Health Assembly, the decision-making body of the World Health Organisation.
Between 2009 and 2016, Taiwan had been invited to attend the WHA as an observer. No invitation was sent last year.
In 2017, pressure from Beijing resulted in the WHA refusing to invite Taiwan to attend the forum, which was the 70th World Health Assembly.
Taiwan’s application to observe most of the WHO’s technical meetings was also declined.
When asked during a media conference at the time why Taiwan was not invited to 70th WHA, the head of WHO Governing Bodies Timothy Armstrong said it was due to an “absence” of a cross-strait understanding.
“Negotiations are still ongoing,” he said. “Anything is possible.”
So Taiwan is seeking an invitation to this year’s WHA.
“Taiwan was not invited to attend the 70th World Health Assembly as an observer in 2017. For many years, however, it has participated in the WHA and WHO technical meetings, mechanisms and activities; steadily contributed to enhancing regional and global disease prevention networks; and dedicated its utmost to assisting other countries in overcoming healthcare challenges in order to jointly realise WHO’s vision that health is a fundamental right,” it says in a statement.
“Therefore, there is widespread support that Taiwan should be invited to attend the WHA.
“Located at a key position in East Asia, Taiwan shares environmental similarities for communicable disease outbreaks with neighbouring countries and is frequently visited by international travellers.
“This makes Taiwan vulnerable to cross-border transmission and cross-transmission of communicable disease pathogens, which could lead to their genetic recombination or mutation, and give rise to new infectious agents.
“However, because Taiwan is unable to attend the WHA and is excluded from full participation in related WHO technical meetings, mechanisms, and activities, it is only after much delay that Taiwan can acquire diseases and medical information, which is mostly incomplete. This creates serious gaps in the global health security system and threatens people’s right to health.”
Taiwan has also been keen of late to highlight its international successes in both medical breakthroughs and global assistance.
In recent years it has transformed from aid recipient to assistance provider. It has established many disease prevention systems. Taiwan insists it needs the WHO to protect the health of its own people, but that it can also contribute greatly to global health protection.
“With an interest in making professional health contributions and protecting the right to health, Taiwan seeks participation in the 71st WHA this year in a professional and pragmatic way, in order to become a part of global efforts to realise WHO’s vision for a seamless global disease prevention network,” its statement says.
Interestingly, the WHO’s own constitution states:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
CHRIS JOHNSON