more_vertThe nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions.
Preference: Statistics, epidemiology and research design
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[Correspondence] Implementing sexual and reproductive health care in humanitarian crises
We applaud the call made by Karl Blanchet and colleagues (Nov 18, 2017, p 2287)1 for more systematic and rigorous research on health interventions in humanitarian settings. However, we wish to highlight a key concern that the authors did not directly address in their paper: humanitarian health actors’ insufficient application of existing evidence, particularly with regard to sexual and reproductive health.
[Correspondence] Implementing sexual and reproductive health care in humanitarian crises – Authors’ reply
In response to our Series paper1 calling for more rigorous research on health interventions in humanitarian settings, we very much welcome the letter by Sarah Chynoweth and colleagues, which raises the important issue that humanitarian health actors can also fail to apply existing evidence, particularly with regard to sexual and reproductive health. In their letter, the authors note that there are proven examples of effective interventions for family planning, neonatal health, and sexual violence that the humanitarian community still fail to adequately deliver.
Health Budget steady as she goes
The AMA has labelled the 2018-19 Health Budget as “safe and steady”, but adds that it is notable as much for what is not to be found in it as it is for what is included.
Treasurer Scott Morrison has delivered a Federal Budget with an eye on the next federal election, promising tax relief for middle Australia, significant infrastructure investment and more funding for aged care.
On the health front, the establishment of a new 21st century medical industry plan to create more jobs and support more medical research projects is a major commitment.
This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV.
The Government will also provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.
It has dismissed a proposal for a single and separate Murray Darling Medical School, in favour of a network, in what AMA President Dr Michael Gannon has described as a better approach.
Mr Morrison said the plan was to get more doctors to where they are needed through a new workforce incentive program.
“This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region,” Mr Morrison said when delivering his Budget Address to Parliament on May 8.
Dr Gannon said many of the rural health initiatives outlined in the Budget are a direct response to AMA rural health policies and the AMA Budget Submission.
“We welcome the Government’s strong focus in this Budget on improving access to doctors in underserviced communities, particularly rural Australia,” Dr Gannon said.
“The decision to reject the proposal for a stand-alone Murray Darling Medical School, in favour of a network, is a better approach with the Government instead pursuing a policy that builds on existing infrastructure to create end-to-end medical school programs.
“However, while the Government has made a welcome commitment not to increase Commonwealth-supported medical school places, it has taken the unnecessary step of compensating medical schools with additional overseas full-fee paying places.
“This will not address community need, and instead simply waste precious resources.”
Dr Gannon said overall, the Government had delivered a safe and steady Health Budget, which outlines a broad range of initiatives across the health portfolio.
Necessary funding to aged care, mental health, rural health, the PBS, and medical research, were all welcome commitments.
“But some of the bigger reforms and the biggest challenges are yet to come,” he said.
“Due to a number of ongoing major reviews, this Budget is notable as much for what is not in it as for what is in it.
“The major reviews of the Medicare Benefits Schedule (MBS) and private health are not yet finalised, and the ensuing policies will be significant.
“We are pleased that indexation has been restored to general practice and other specialty consultations, but new and considerable investment in general practice is missing.
“Also, the signature primary care reform – Health Care Homes – did not rate a mention.”
Health Minister Greg Hunt described the Budget as a “record investment in health” and pointed to a previously announced commitment from the Federal Government to public hospitals.
“The Government will deliver more than $30 billion in additional public hospital funding under a five-year National Health Agreement, with funding increasing for every State and Territory, every year,” Mr Hunt said.
But Shadow Health Minister Catherine King said the Budget failed the health test.
The Government was persisting with a plan to cut $715 million from hospitals over the next two years, she said.
“Their hospital cuts are putting doctors, nurses and hospital staff under increasing pressure; forcing delays in surgeries; and making emergency department waiting times even worse,” Ms King said.
CHRIS JOHNSON
Looking forward to more significant announcements
AMA President Dr Michael Gannon said while there were “many significant and worthy announcements” in the Federal Budget, the bigger structural health reform announcements were yet to come.
He said the public hospital funding announcement was consistent with the COAG National Health Agreement, but the AMA Public Hospital Report Card shows how more funding will be needed over the long term.
“This will involve the States and Territories doing their bit to work with the Commonwealth to increase the funding to appropriate levels,” Dr Gannon said.
“The Government is to be congratulated on its ongoing commitment to medical research, and for its positive contribution to improving Indigenous health, especially eye health, ear health, and remote dialysis.
“The investments in aged care and mental health must be seen as down-payments with more attention needed in coming years and decades as community demand drastically increases.
“We need to see a more concerted approach from the Government in prevention. We need to keep people fitter and healthier and away from expensive hospital care.
“Good health policy is an investment, not a cost. We look forward to the finalisation of the private health and MBS reviews, and the reforms that will flow from those processes.
“We expect to see any savings from the MBS Review reinvested into the MBS in the form of new and improved items in a transparent way.
“We anticipate more significant health policy funding announcements ahead of the next election.”
CHRIS JOHNSON
Pic: Dr Michael Gannon with Health Minister Greg Hunt
Excerpts from Treasurer Scott Morrison’s Budget Speech 2018-19
Our national economy is strengthening, but it is also true that the benefits are yet to reach everyone. This will take more time. That is why it is important to stick to our plan. There is more to do. We cannot take a stronger economy for granted. We live in a very competitive world. If we make the wrong calls, other countries will ‘cut our lunch’. There is a lot to gain and much to lose. We can’t ease off.
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In this year’s Budget there are five things we must to do to further strengthen our economy to guarantee the essentials Australians rely on.
- Provide tax relief to encourage and reward working Australians and reduce cost pressures on households, including lowering electricity prices,
- Keep backing business to invest and create more jobs, especially small and medium sized businesses,
- Guarantee the essential services that Australians rely on, like Medicare, hospitals, schools and caring for older Australians,
- Keep Australians safe, with new investments to secure our borders, and, as always,
- Ensure that the Government lives within its means, keeping spending and taxes under control.
That’s our plan.
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Tonight we announce a new 21st century medical industry plan to create more jobs in this fast growing sector of our economy. The health sector represents 7 per cent of our economy and 14 per cent of jobs. Our plan will provide more support for medical research projects, new diagnostic tools, clinical trials of new drugs, scientific collaboration, and development of new medical technologies that can be sold overseas. In particular we will back in Australian medical scientists through the largest single investment of the Medical Research Future Fund to date of $500 million over ten years for Australia to become a world leader in genomic research. This is about building another strong and competitive industry in Australia that will generate income and jobs, from the white coats in the labs to the workers making new medical devices on the shop floor.
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In rural and regional areas we have funded a plan to get more doctors to where they are needed through a new workforce incentive program. This plan includes the establishment of a new network of five regional medical schools within the broader Murray Darling Region. And we have moved to guarantee rural and remote access to dental, mental health and emergency medical services through increased financial support for the Royal Flying Doctor Service. Indigenous Australians also benefit from our $550 million commitment to address remote housing needs in the Northern Territory and $1.7 billion through our primary health care model. Our veteran centric reform package will continue with a planned additional $112 million in this Budget, as will our support for ongoing veterans’ mental health and employment initiatives. Finally, every dollar and every cent committed to delivering the National Disability Insurance Scheme remains in place and always will.
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Our new five year hospitals agreement, which is being signed onto by the States and Territories, will deliver $30 billion in additional funding, a one third increase over the previous five years. And following last year’s Budget, funding for Medicare and the Pharmaceutical Benefits Scheme or PBS has been guaranteed in legislation. This Budget includes an extra $1.4 billion for listings on the PBS, including medicines to treat spinal muscular atrophy, breast cancer, refractory multiple myeloma, and relapsing-remitting multiple sclerosis, as well as a new medicine to prevent HIV. Lifeline Australia will receive additional support as will funding for Mental Health Research, with $125 million over 10 years from the Medical Research Future Fund.
The Government will also provide $20.9 million to support parents and infants by funding tests for new conditions and ensure that debilitating conditions are picked up at the earliest opportunity. The Government will provide $154 million to promote active and healthy living, including $83 million to improve existing community sport facilities, and to expand support for the Sporting Schools and Local Sporting Champions programs.
***
Just because you are getting older does not mean you should have to surrender your dignity or your choices. We’re living longer. It’s a good thing. We want to preserve and increase the choices of older Australians. To support the choice of older Australians who wish to stay at home and avoid going into residential aged care the Government will be increasing the number of home care places by 14,000 over 4 years at a cost of $1.6 billion. By 2021-22, over 74,000 high level home care places will be available, an increase of 86 per cent on 2017-18. We will also be providing $146 million to improve access to aged care services in rural, regional and remote Australia. We will also provide $83 million for increased support for mental health services in residential aged care facilities, especially to combat depression and loneliness.
Health Budget at a glance
Highlights of the Health Budget
- The Medicare levy increase from 2 per cent to 2.5 per cent announced in last year’s Budget has been dropped. NDIS funding will now be reliant on ongoing revenue instead of the $12.8 billion projected to be raised by the levy increase over the forward estimates.
- Medicare funding to increase by $4.8 billion.
- The $30 billion five-year public hospital funding agreement.
- A $500 million 10-year medical research fund.
- A $83.5 millioninvestment from (2017-18 to 2021-22) for a new rural health initiatives that include a Junior Doctor Program, additional Royal Flying Doctor service funding and establishing a Murray-Darling medical schools network.
- An extra $1.4 billion for listings on the Pharmaceutical Benefits Schedule.
- Investment in new medicines.
- Extra $37.5 millionspending on the National Immunisation Program for flu, pertussis and meningococcal vaccinations.
- A $154 million healthy living promotion package.
- A $90.2 millioninvestment in mental health service improvements.
- $82.5 millionover four years for people in residential aged care services.
- Funding to promote healthy living and improve community and school sport facilities.
[Perspectives] Roger Glass: celebrating the Fogarty at 50
At the Fogarty International Center, “we’re small, but we’re catalytic”, says Roger Glass, the centre’s Director and Associate Director for International Research at the US National Institutes of Health (NIH). The Fogarty celebrates its 50th anniversary this month and has been under Glass’s leadership since 2006. By training scientists, supporting research, and building partnerships, the Fogarty serves a bridge between the NIH and the global health community. Since its creation in 1968, about 6000 scientists have received research training through its programmes and the centre funds about 500 projects.
[Obituary] David Albert Cooper
HIV researcher and global champion of patients’ rights. Born in Sydney, NSW, Australia, on April 19, 1949, he died there with a haemophagocytic syndrome on March 18, 2018, aged 68 years.
[Correspondence] Lassa fever in Nigeria: the tale of a reactive health system
The World Report by Talha Burki (Feb 24, p 728)1 described an unprecedented astronomical rise in Lassa fever cases in Nigeria, for which the first case was reported in 1969 and the epidemiology and endemicity are well understood. Failure of the Nigerian health system to prioritise preparedness activities has been detrimental for prompt control of Lassa fever, which requires robust laboratory facilities, trained health personnel, and coordinated epidemiological surveillance.2 Therefore, we propose a four-pronged plan to ensure consistent and proactive preventive activities that could ameliorate the high proportion of fatalities and long-term debilitation observed in outbreaks of Lassa fever.