NACCHO Aboriginal #MentalHealth Alert : @AMAPresident calls for a national, overarching mental health “architecture”, and proper investment in both #prevention and #treatment of mental illnesses

 

“Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.

General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.”

AMA President, Dr Michael Gannon – Source: Australian Institute of Health and Welfare

Download the AMA 2018 Position Paper

Mental-Health-2018- Position-Statement

Read over 168 NACCHO Mental Health articles published over 5 Years

The AMA is calling for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults will experience a mental health condition in their lifetime, yet mental health and psychiatric care are grossly underfunded when compared to physical health, AMA President, Dr Michael Gannon, said today.

Releasing the AMA Position Statement on Mental Health 2018, Dr Gannon said that strategic leadership is needed to integrate all components of mental health prevention and care.

“Many Australians will experience a mental illness at some time in their lives, and almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague,” Dr Gannon said.

“For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

“Australia lacks an overarching mental health ‘architecture’. There is no vision of what the mental health system will look like in the future, nor is there any agreed national design or structure that will facilitate prevention and proper care for people with mental illness.

“The AMA is calling for the balance between funding acute care in public hospitals, primary care, and community-managed mental health to be correctly weighted.

“Funding should be on the basis of need, demand, and disease burden – not a competition between sectors and specific conditions. Policies that try to strip resources from one area of mental health to pay for another are disastrous.

“Poor access to acute beds for major illness leads to extended delays in emergency departments, poor access to community care leads to delayed or failed discharges from hospitals, and poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

“Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

“As with physical health, prevention is just as important in mental health, and evidence-based prevention can be socially and economically superior to treatment.

“Community-managed mental health services have not been appropriately structured or funded since the movement towards deinstitutionalisation in the 1970s and 1980s, which shifted much of the care and treatment of people with a mental illness out of institutions and into the community.

“The AMA Position Statement supports coordinated and properly funded community-managed mental health services for people with psychosocial disability, as this will reduce the need for costly hospital admissions.”

The Position Statement calls for Governments to address underfunding in mental health services and programs for adolescents, refugees and migrants, Aboriginal and Torres Strait Islander people, and people in regional and remote areas.

It also calls for Government recognition and support for carers of people with mental illness.

“Caring for people with a mental illness is often the result of necessity, not choice, and can involve very intense demands on carers,” Dr Gannon said.

“Access to respite care is vital for many people with mental illness and their families, who bear the largest burden of care.”

The AMA Position Statement on Mental Health 2018 is available at https://ama.com.au/position-statement/mental-health-2018

Background

  • 7.3 million Australians (45 per cent) aged 16 to 85 will experience a common mental health disorder, such as depression, anxiety, or substance use disorder, in their lifetime.
  • Almost 64,000 people have a psychotic illness and are in contact with public specialised mental health services each year.
  • 560,000 children and adolescents aged four to 17 (about 14 per cent) experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.
  • Almost one in three (30 per cent) of Indigenous adults suffered high or very high levels of psychological distress in 2012-13. Indigenous adults are 2.7 times as likely as non-Indigenous adults to suffer these levels of distress.
  • General practitioners manage mental health problems for Indigenous Australians at 1.3 times the rate for other Australians, and mental health-related conditions accounted for 4.4 per cent of hospitalisations of Indigenous people in 2012-13.
  • About $8.5 billion is spent every year on mental health-related services in Australia, including residential and community services, hospital-based services (both inpatient and outpatient), and consultations with GPs and other specialists.

(Source: Australian Institute of Health and Welfare)

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Dr Google will see you now ! NACCHO Aboriginal Health Alert @AMAPresident says Doctor #Google no substitute for a visit to your trusted ACCHO / Family GP.

 ” We live in a digital generation. People use their smartphones and the internet for absolutely everything in life, so it’s to be expected that they’ll use it in regard to their health, and we know that health is one of the main reasons that people access search engines like Google.

One of the reasons doctors do recoil in horror is that some of the quality of the information on the internet leaves a lot to be desired.

So when a patient presents to their GP or another specialist and says they’ve done their own research on vaccinations and they’ve spent 20 minutes and that’s meant to overcome hundreds, thousands of hours of research into different  ” vaccines, that’s the kind of thing that makes doctors upset.

But we need to be clever enough and sensitive enough to listen to people, and often they’ve done part of the work for us.

Dr Michael Gannon President AMA responding to a question about Dr Google from Lisa Barnes  6PR Breakfast Perth 3 January 2018

Will patients stop going to the GP?

 “According to Google, one in 20 Google searches are health-related. Google’s new health cards will include facts vetted by a team of “medical doctors”, the company says, and adds:

“Each fact has been checked by a panel of at least ten medical doctors at Google and the Mayo Clinic for accuracy.”

Google’s Isobel Solaqua also encouraged patients to still seek professional medical attention.

What we present is intended for informational purposes only — and you should always consult a healthcare professional if you have a medical concern.”

Google’s new function might be handy for giving patients more accurate information – rather than having people wind up on dusty message boards and forums with questionable advice.”

Source Dr Google will see you now :

 ” At the first sign of a headache (“brain tumour?”), aching joint (“dengue?”) or a rash (“measles?”) do you find yourself looking to Dr Google? If so, then there’s a chance that your real malaise warrants another moniker: cyberchondria.

With one in 20 Google searches a quest for health information, many of us are likely familiar with the anxiety that goes with compulsively searching online for real (or imagined) health issues.

But is all this googling actually paying off in terms of our health and wellbeing?

For some time, researchers have pointed out that our ability to find out almost anything health-related through a quick online search has its downsides.”

NACCHO would suggest you use Dr Google and download the NACCHO APP that can help you find one of the 302 ACCHO Clinics throughout Australia ( and make a booking with one of our real ACCHO Doctors)  

Download the NACCHO App HERE

And here is why

 ” Well, Dr Google should never, and will never, be a surrogate for a face to face consultation.

There’s a lot of skill in medical practice – sometimes it’s unseen to patients – but there is a skill in taking a history, performing an examination, working out which tests are and aren’t indicated, thinking about how you’re going to interpret those tests and what your follow-up plan is.”

Dr Michael Gannon on why you should see a real Doctor

Full Transcript of Interview

MICHAEL GANNON:   I think there’d be plenty of patients who would have positive experiences, and there’d be plenty of patients that are led down the garden path. I think that if you put into a search engine the basic symptoms, in my experience most patients end up diagnosing themselves with either leukaemia or a brain tumour. But if you ask for something very specific, there’s some very credible and very useful health information that gives patients an idea how to proceed.

GEOF PARRY:   Michael, I think the AMA has been concerned about Dr Google in this sense, that they’ve been presenting to doctors and some doctors have been getting a bit upset about it, and you’re sort of saying, isn’t it, that it’s a bit of a fact of life now and you have to work with it?

MICHAEL GANNON:   I think you’re exactly right, Geof. We live in a digital generation……….

See opening extract

But we need to be clever enough and sensitive enough to listen to people, and often they’ve done part of the work for us.

LISA BARNES:   You’re right though, it is about using a little bit of common sense and being a bit specific with what you’re searching for, isn’t it? Because I know I’ve used Dr Google, and yeah, I seem to come up with about 17 serious diseases that I’ve got. But if you narrow it down, you can use that information for good, can’t you?

MICHAEL GANNON:   You can. I mean, some of the State Health Departments have very high-quality information that’s available. I would encourage people to have a look at where the information’s coming from.

So, if the search engine directs them to a website of one of the learned Colleges or a State or Territory Health Department, one of the august bodies in the English-speaking world like Britain or the United States, you might get valuable information.

I use Wikipedia to look up genetic conditions and rare syndromes all the time and, although I have concerns about how often some of that information’s curated, overall it’s extremely good. It’s when people start googling individual symptoms they usually get led down the garden path.

GEOF PARRY:   Michael, I’m wondering whether it’s any different using Dr Google to, say, the sorts of things that the medical profession has had to counter in the past.

So – and I’m going to get criticised for this – but, say, iridology, where people have used iridology to sort of find out what they might be suffering from, or having their auras, their colours read, those sorts of things which, in some schools of thought, these are just quackery.

MICHAEL GANNON:   Yeah, well, you’re right, Geof. We worry a lot about the quality of the health information that’s out there.

Where this story started- I did an interview with a journalist at the Courier Mail in Brisbane, and it was based on a directive from the NHS in Britain, the NHS asking patients to try Google first. Now, that represents a failing health system.

We don’t have that problem in Australia. We hear individual stories, but overall the statistics show that it’s not hard to get an appointment to see a GP, and let’s not forget that 85 per cent of GP services are bulk billed – it costs nothing.

It represents, in a world where it’s increasingly difficult to find value for money for people on fixed wages, a visit to your GP represents value for money like no other I know in the whole community.

LISA BARNES:   And certainly, Michael, obviously the advice would be double check or get it confirmed by a doctor, don’t just take Dr Google at face value.

MICHAEL GANNON:   Well that’s exactly right, and people should never ignore danger symptoms, and individual human beings, the parents, guardians of young children, people caring for elderly relatives, et cetera, should never hesitate to seek medical attention.

The reality is that GPs and doctors in Emergency Departments do see sometimes odd and not particularly high value presentations, but we would never want a situation where someone second-guessed themselves and didn’t seek health care.

GEOF PARRY:   Yeah, is there a couple of risks – like quite serious risks – here? I mean, you can put your health at risk if you put your trust in something like Dr Google and they get it wrong, or are you just completely wasting time and wasting people’s time by going down that path?

MICHAEL GANNON:   Well, Dr Google should never, and will never, be a surrogate for a face to face consultation.

There’s a lot of skill in medical practice – sometimes it’s unseen to patients – but there is a skill in taking a history, performing an examination, working out which tests are and aren’t indicated, thinking about how you’re going to interpret those tests and what your follow-up plan is.

Medical care’s a lot more complicated than sometimes doctors get given credit for. Looking something up on a search engine can be a useful adjunct. We do need to do better with health literacy in our community. I’d love to see more biological sciences taught in high school, but for now it’s a useful tool that people can use to either give themselves reassurance or to make it clear they do need to see a doctor.

LISA BARNES:   Michael, we appreciate your time. Thank you.

MICHAEL GANNON:   Pleasure. Happy New Year to both of you.

LISA BARNES:   And to you. That’s Dr Michael Gannon, the AMA President

NACCHO Aboriginal Health Workforce : @AMAPresident launches 5 point plan to build #Ruralhealth workforce

 ” About one third of Australia’s population, approximately 7 million people, live in regional, rural and remote areas. These Australians often have more difficulty accessing health services than urban Australians, leading them to have a lower life expectancy and worse outcomes on leading indicators of health.

Death rates in regional, rural, and remote areas (referred to as ‘rural’ in this document unless otherwise specified) are higher than in major cities, and the rates increase in line with degrees of remoteness.”

AMA President, Dr Michael Gannon

Download the AMA Position Statement HERE

AMA Position Statement on Rural Workforce Initiatives

Picture above AIDA : South Australian University’s past and present Australian Rotary Health Indigenous Health scholarship recipients.

(From left: Ian Lee, Jessica Beinke, Bodie Rodman, Olivia O’Donoghue, Kali Hayward, Jonathan Newchurch, Dr Helen Sage and Cheryl Deguara).

 ” Indigenous medical students have three weeks left to apply for the 2018 AMA Indigenous Medical Scholarship.
 
Applications close on 31 January for the Scholarship, a program that has supported Aboriginal and Torres Strait Islander students to study medicine since 1994.  The successful applicant will receive $10,000 each year for the duration of their course.
Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.”
 
THREE WEEKS LEFT TO APPLY FOR 2018 AMA INDIGENOUS MEDICAL SCHOLARSHIP see Part 2 Below

Extracts from AMA Submission

There is a strong link between the health of Indigenous people in rural communities and their access to culturally appropriate health services.

The AMA believes that:

  • greater effort should be made to encourage Indigenous people to undertake medical or health professional training, and incentives provided to encourage Indigenous and non-Indigenous doctors and medical trainees to work in rural and remote Indigenous communities;
  • Aboriginal Medical Services should be resourced to offer mentoring and training opportunities in rural Indigenous communities to Indigenous and non-Indigenous medical students and vocational trainees; and
  • training modules, resource material and ongoing advice should be developed for, and delivered to, all medical schools and rural and remote medical practices on Indigenous health issues, Indigenous-specific health initiatives and culturally appropriate service delivery.

Addressing the mal-distribution of the workforce

There are a number of fundamental reasons why rural areas are not getting their fair share of the medical workforce. These include:

  • inadequate remuneration;
  •  work intensity including long hours and demanding rosters;
  •  lifestyle factors;
  •  professional isolation and lack of critical mass of similar doctors;
  •  reduced access to professional development;
  • reduced access to locum support;
  •  hospital closures and downgrading or withdrawal of other health services;
  •  under-representation of students from a rural background;
  •  poor employment opportunities for other family members, particularly partners;
  •  limited educational opportunities for other family members; and
  •  withdrawal of community services, such as banking, from such areas.

In 2016 the AMA conducted a Rural Health Issues Survey, which sought input from rural doctors across Australia to identify key solutions to improving rural health care.

The almost 600 doctors who took part in the survey said extra funding and resources to support the recruitment and retention of doctors and other health professionals was their top priority in trying to meet the health care needs of their patients.

Doctors also said that for there to be genuine improvements in access to health care for rural patients, there needed to be:

  •  funding and resources to support improved staffing levels and workable rosters for rural doctors;
  •  access to high speed broadband;
  •  investment in hospital facilities and equipment and practice infrastructure;
  •  expanded opportunities for medical training and education in rural areas;
  • improved support for GP proceduralists; and
  •  better access to locum relief.

AMA Press Release 9 January 2018

At least one-third of all new medical students should be from rural backgrounds, and more medical students should be required to do at least one year of training in a rural area to encourage graduates to live and work in regional Australia, the AMA says.

The AMA today released its Position Statement – Rural Workforce Initiatives, a comprehensive five-point plan to encourage more doctors to work in rural and remote locations, and improve patient access to care.

The plan proposes initiatives in education and training, rural generalist pathways, work environments, support for doctors and their families, and financial incentives.

“About seven million Australians live in regional, rural, and remote areas, and they often have more difficulty accessing health services than their city cousins,” AMA President, Dr Michael Gannon, said today.

“They often have to travel long distances for care, and rural hospital closures and downgrades are seriously affecting the future delivery of health care in rural areas. For example, more than 50 per cent of small rural maternity units have been closed in the past two decades.

“Australia does not need more medical schools or more medical school places. Workforce projections suggest that Australia is heading for an oversupply of doctors.

“Targeted initiatives to increase the size of the rural medical, nursing, and allied health workforce are what is required.

“There has been a considerable increase in the number of medical graduates in recent years, but more than three-quarters of locally trained graduates live in capital cities.

“International medical graduates (IMGs) make up more than 40 per cent of the rural medical workforce and while they do excellent work, we must reduce this reliance and build a more sustainable system.”

The AMA Rural Workforce Initiatives plan outlines five key areas where Governments and other stakeholders must focus their policy efforts:

·         Encourage students from rural areas to enrol in medical school, and provide medical students with opportunities for positive and continuing exposure to regional/rural medical training;

·         Provide a dedicated and quality training pathway with the right skill mix to ensure doctors are adequately trained to work in rural areas;

·         Provide a rewarding and sustainable work environment with adequate facilities, professional support and education, and flexible work arrangements, including locum relief;

·         Provide family support that includes spousal opportunities/employment, educational opportunities for children’s education, subsidies for housing/relocation and/or tax relief; and

·         Provide financial incentives to ensure competitive remuneration.

“Rural workforce policy must reflect the evidence. Doctors who come from a rural background, or who spend time training in a rural area, are more likely to take up long-term practice in a rural location,” Dr Gannon said.

“Selecting a greater proportion of medical students with a rural background, and giving medical students and graduates an early taste of rural practice, can have a profound effect on medical workforce distribution.

“Our proposals to lift both the targeted intake of rural medical students and the proportion of medical students required to undertake at least one year of clinical training in a rural area from 25 per cent to 33 per cent are built on this approach.

“More Indigenous people must be encouraged to train and work in health care, as there is a strong link between the health of Indigenous people in rural areas and their access to culturally appropriate health services.

“Fixing rural medical workforce shortages requires a holistic approach that takes into account not only the needs of the doctor, but also their immediate family members.

“Many doctors who work in rural areas find the medicine to be very rewarding, but their partner may not be able to find suitable employment, and educational opportunities for their children may be limited.

“The work environment for rural doctors presents unique challenges, and Governments must work collaboratively to attract a sustainable health workforce. This includes rural hospitals having modern facilities and equipment that support doctors in providing the best possible care for patients and maintaining their own skills.

“Finally, more effort must be made to improve internet services in regional and rural areas, given the difficulties of running a practice or practising telehealth with inadequate broadband.

“All Australians deserve equitable access to high-speed broadband, and rural doctors and their families should not miss out on the benefits that the growing use of the internet is bringing.”

The AMA Position Statement – Rural Workforce Initiatives is available at https://ama.com.au/position-statement/rural-workforce-initiatives-2017

Background:

·         Most Australians live in major cities (70 per cent), while 18 per cent live in inner regional areas, 9 per cent in outer regional areas, and 2.4 per cent in both remote and very remote areas.

·         Life expectancy is lower for people in regional and remote Australia. Compared with major cities, the life expectancy in regional areas is one to two years lower, and in remote areas is up to seven years lower.

·         The age standardised rate of the burden of disease increases with increasing remoteness, with very remote areas experiencing 1.7 times the rate for major cities.

·         Coronary heart disease, suicide, COPD, and cancer show a clear trend of greater rates of burden in rural and remote areas.

·         The number of medical practitioners, particularly specialists, steadily decreases with increasing rurality. The AIHW reports that while the number of full time workload equivalent doctors per 100,000 population in major cities is 437, there were 272 in outer regional areas, and only 264 in very remote areas.

·         Rural medical practitioners work longer hours than those in major cities. In 2012, GPs in major cities worked 38 hours per week on average, while those in inner regional areas worked 41 hours, and those in remote/very remote areas worked 46 hours.

·         The average age of rural doctors in Australia is nearing 55 years, while the average age of remaining rural GP proceduralists – rural GP anaesthetists, rural GP obstetricians and rural GP surgeons – is approaching 60 years.

·         International medical graduates (IMGs) now make up over 40 per cent of the medical workforce in rural and remote areas.

·         There is a health care deficit of at least $2.1 billion in rural and remote areas, reflecting chronic underspend of Medicare and the Pharmaceutical Benefits Scheme (MBS) and publicly-provided allied health services.

Part 2 Update

THREE WEEKS LEFT TO APPLY FOR 2018 AMA INDIGENOUS MEDICAL SCHOLARSHIP
 
Indigenous medical students have three weeks left to apply for the 2018 AMA Indigenous Medical Scholarship.
Applications close on 31 January for the Scholarship, a program that has supported Aboriginal and Torres Strait Islander students to study medicine since 1994.
The successful applicant will receive $10,000 each year for the duration of their course.
Fewer than 300 doctors working in Australia identify as Aboriginal and/or Torres Strait Islander – representing 0.3 per cent of the workforce – and only 286 Indigenous medical students were enrolled across the nation in 2017.
 
“The significant gap in life expectancy between Indigenous and non-Indigenous Australians is a national disgrace that must be tackled by all levels of Government, the private and corporate sectors, and all segments of our community,” AMA President, Dr Michael Gannon, said today.
 
“It’s evident that Indigenous people have a greater chance of improved health outcomes when they are treated by Indigenous doctors and health professionals.
 
“Indigenous people are more likely to make and keep medical appointments when they are confident that they will be treated by someone who understands their culture, their language, and their unique circumstances
“The AMA strongly encourages Indigenous students to apply for the Scholarship, which, along with the AMA’s annual Report Card on Indigenous Health and the work of the AMA Taskforce on Indigenous Health, is part of the AMA’s commitment to improving the health of Aboriginal and Torres Strait Islander Australians.”
 
Previous winners have gone on to become prominent leaders in health and medicine, including Associate Professor Kelvin Kong, Australia’s first Aboriginal surgeon.
 
Applicants must be currently enrolled at an Australian medical school, be in at least their first year of medicine, and be of Aboriginal and/or Torres Strait Islander descent. Further information, including the application form, can be found at https://www.ama.com.au/indigenous-medical-scholarship-2018
 
The AMA Indigenous Medical Scholarship was established in 1994 with a contribution from the Commonwealth Government. The AMA is seeking further donations and sponsorships from individuals and corporations to continue this important contribution to Indigenous health.
 
More information is available at https://ama.com.au/donate-indigenous-medical-scholarship. For enquiries, please contact the AMA via email at indigenousscholarship@ama.com.au or phone (02) 6270 5400.

 

NACCHO Aboriginal Health #Junkfood #Sugarydrinks #Sugartax @AMAPresident says Advertising and marketing of #junkfood and #sugarydrinks to children should be banned

 

 ” Poor nutrition has been linked to the reduced health outcomes experienced by Aboriginal and Torres Strait Islander people, contributing to conditions known to disproportionately affect this population, including type 2 diabetes, kidney disease and some cancers.

Twenty two per cent of Aboriginal and Torres Strait Islander people live in a household that has, in the past 12 months, run out of food and not been able to purchase more. Food insecurity increases for Aboriginal and Torres Strait Islander people who live in remote areas.

Efforts to Close the Gap must recognise the potential impacts of improved nutrition on health outcomes, as well as the implications of food insecurity “

AMA Position Statement on Nutrition 2018

Download AMA Position Statement on Nutrition 2018

Advertising and marketing of junk food and sugary drinks to children should be banned, and a tax on sugar-sweetened beverages should be introduced as a matter of priority, the AMA says.

Releasing the AMA Position Statement on Nutrition 2018, AMA President, Dr Michael Gannon, said today that eating habits and attitudes toward food are established in early childhood.

“Improving the nutrition and eating habits of Australians must become a priority for all levels of government,” Dr Gannon said.

“Governments should consider the full complement of measures available to them to support improved nutrition, from increased nutrition education and food literacy programs through to mandatory food fortification, price signals to influence consumption, and restrictions on food and beverage advertising to children.

“Eating habits and attitudes start early, and if we can establish healthy habits from the start, it is much more likely that they will continue throughout adolescence and into adulthood.

“The AMA is alarmed by the continued, targeted marketing of unhealthy foods and drinks to children.

“Children are easily influenced, and this marketing – which takes place across all media platforms, from radio and television to online, social media, and apps – undermines healthy food education and makes eating junk food seem normal.

“Advertising and marketing unhealthy food and drink to children should be prohibited altogether, and the loophole that allows children to be exposed to junk food and alcohol advertising during coverage of sporting events must be closed.

“The food industry claims to subscribe to a voluntary code, but the reality is that this kind of advertising is increasing. The AMA calls on the food industry to stop this practice immediately.”

The Position Statement also calls for increased nutrition education and support to be provided to new or expecting parents, and notes that good nutrition during pregnancy is also vital.

It recognises that eating habits can be affected by practices at institutions such as child care centres, schools, hospitals, and aged care homes.

“Whether people are admitted to hospital or just visiting a friend or family member, they can be very receptive to messages from doctors and other health workers about healthy eating,” Dr Gannon said.

“Hospitals and other health facilities must provide healthy food options for residents, visitors, and employees.

“Vending machines containing sugary drinks and unhealthy food options should be removed from all health care settings, and replaced with machines offering only healthy options.

“Water should be the default beverage option, including at fast food restaurants in combination meals where soft drinks are typically provided as the beverage.”

NACCHO Campaign 2013 : We should health advice from the fast food industry !

Key Recommendations:

·         Advertising and marketing of unhealthy food and beverages to children to be prohibited.

·         Water to be provided as the default beverage option, and a tax on sugar-sweetened beverages to be introduced.

·         Healthy foods to be provided in all health care settings, and vending machines containing unhealthy food and drinks to be removed.

·         Better food labelling to improve consumers’ ability to distinguish between naturally occurring and added sugars.

·         Regular review and updating of national dietary guidelines and associated clinical guidelines to reflect new and emerging evidence.

·         Continued uptake of the Health Star Rating system, as well as refinement to ensure it provides shoppers with the most pertinent information.

Aboriginal and Torres Strait Islander people

Food insecurity

Food insecurity occurs when people have difficulty or are unable to access appropriate amounts of food.13

It has been estimated that four per cent of Australians experience food insecurity,14 though it is likely the extent of the problem is much higher.

Food insecurity is associated with a range of factors, including unstable living situations, geographic isolation and poor health.

It is more prevalent in already disadvantaged communities. In households with limited incomes, food budgets can be seen as discretionary and less of a priority.

This can result in disrupted eating habits and an over-reliance on less nutritious foods.

Food insecurity can have significant health implications, such as increased hospitalisation and iron deficiency anemia (in children) and increased kidney disease, type 2 diabetes and mental health issues (among adolescents and adults).

Poor nutrition has been linked to the reduced health outcomes experienced by Aboriginal and Torres Strait Islander people, contributing to conditions known to disproportionately affect this population, including type 2 diabetes, kidney disease and some cancers.16

Twenty two per cent of Aboriginal and Torres Strait Islander people live in a household that has, in the past 12 months, run out of food and not been able to purchase more. Food insecurity increases for Aboriginal and Torres Strait Islander people who live in remote areas.17

Efforts to Close the Gap must recognise the potential impacts of improved nutrition on health outcomes, as well as the implications of food insecurity. The development and implementation of potential solutions must be led by Aboriginal and Torres Strait Islander people.

The nutrition of Aboriginal and Torres Strait Islander people living in remote communities may be heavily dependent on Outback Stores. The 2009 Parliamentary Inquiry ‘Everybody’s Business: Remote Aboriginal and Torres Strait Community Stores’ resulted in a number of practical recommendations to increase the availability and affordability of healthy foods in Outback Stores, many of which have not been implemented.

Recommendation

These Stores, in consultation with local communities, should prioritise and facilitate access to affordable nutritious foods.

The AMA Position Statement on Nutrition 2018 is available at https://ama.com.au/position-statement/nutrition-2018

 

NACCHO Aboriginal Health @AMAPresident Download AMA Pre-Budget Submission 2018-19 #Indigenous health reform – needs significant long-term investment

 

 ” It is unacceptable that Australia, one of the world’s wealthiest nations, cannot address health and social justice issues affecting Aboriginal and Torres Strait Islander people, who comprise just three per cent of the population. Funding for Aboriginal and Torres Strait Islander Health is inadequate to meet the burden of illness.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health ”

Extract from

AMA Budget Submission 2018-19

AMA President, Dr Michael Gannon, said today that the culmination of key reviews, under the guidance of Health Minister Greg Hunt, provides the Government with a rare opportunity to embark on a new era of ‘big picture’ health reform – but it will need significant long-term investment.

Releasing the AMA’s Pre-Budget Submission 2018-19, Dr Gannon said the key for the Government is to look at all health policies as investments in a healthier and more productive population.

“The conditions are ripe for a new round of significant and meaningful health reform, underpinned by secure, stable, and sufficient long-term funding to ensure the best possible health outcomes for the Australian population,” Dr Gannon said.

“The next Budget provides the Government with the perfect opportunity to reveal its health reform vision, and articulate clearly how it will be funded.

“We have seen years of major reviews of some of the pillars of our world class health system.

“The review of the Medicare Benefits Schedule (MBS) is an ambitious project.

“Its methods and outcomes are becoming clearer. Its best chance of success is if the changes are evidence-based and clinician-led and approved.

“A new direction for private health insurance (PHI) has been determined following the PHI Review.

“We must maintain flexibility and put patients at the centre of the system, but recognise the fundamental importance of the private system to universal health care.

“The Medicare freeze will be lifted gradually over the next few years.

“There is now a greater focus on the core health issues that will form the health policy battleground at the next election.

“There is no doubt, as shown at the last Federal election, that health policy is a guaranteed vote winner … or vote loser.

“Our Submission sets out a range of policies and recommendations that are practical, achievable, and affordable.

“They will make a difference. We urge the Government to adopt them in the Budget process.

“Health should never be considered an expensive line item in the Budget.

“It is an investment in the welfare, wellbeing, and productivity of the Australian people.

“Health is the best investment that governments can make,” Dr Gannon said.

The AMA Pre-Budget Submission 2018-19 covers:

·         General Practice and Primary Care;

·         Public Hospitals;

·         Private Health Insurance;

·         Medicare Benefits Schedule (MBS) Review;

·         Preventive Health;

·         Diagnostic Imaging;

·         Pathology;

·         Mental Health and the NDIS;

·         Medical Care for Older Australians;

·         My Health Record;

·         Rural Health;

·         Indigenous Health;

·         Medical Workforce;

·         Climate Change and Health; and

·         Veterans’ Health.

 The AMA Pre-Budget Submission 2018-19 is at https://ama.com.au/ama-pre-budget-submission

This Submission was lodged with Treasury ahead of the Friday, 15 December 2017 deadline.

Part 2 The gap in health and life expectancy between Aboriginal and Torres Strait Islander people and other Australians is still considerable, despite a decade of commitments to closing the gap.

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

The AMA values the progress being made in reducing early childhood mortality rates, and in addressing major risk factors for chronic disease, such as smoking. But if the Government is serious about building on this early but slow progress, it must create sustainable, long-term improvements by increasing funding and resourcing for culturally appropriate primary health care for Aboriginal and Torres Strait Islander people. It must also increase and properly resource the health workforce.

Many of the chronic health conditions experienced by Aboriginal and Torres Strait Islander people should not be endemic in a highly-developed country like Australia. Chronic diseases are known to be the main cause of the life expectancy gap between Indigenous and non- Indigenous Australians.

Despite some recent health gains for Aboriginal and Torres Strait Islander people, awareness and political will is frustratingly slow-moving. There is an urgent need for the Commonwealth to deliver on the well-documented research and national strategies showing how to tackle health inequalities and the social determinants of health.

Closing the gap in health outcomes means addressing: poverty; unhygienic, overcrowded conditions; poor food security and access to potable drinking water; lack of transport; and an absence of health services.

Every year, the AMA says that this situation is not acceptable, and every year governments fail to implement the health plans, recommendations, and strategies that will deliver improvements and hasten the closing of the gap in health outcomes.

The 2018-19 Budget is an opportunity to start properly funding and resourcing Indigenous Health.

AMA POSITION

The AMA calls on the Government to:

• prioritise Indigenous health funding in the 2018-19 Budget and fund Aboriginal and Torres Strait Islander health services according to need;

• support measures to increase the uptake of MBS and PBS items;

• fund and implement the National Aboriginal and Torres Strait Islander Health Plan;

• adopt the recommendations in the AMA’s Report Cards on Indigenous Health, in particular the recommendations in the 2016 Report Card calling for a target to eradicate new cases of Rheumatic Heart Disease (RHD); and the recommendations in the 2017 Report Card to address ear health (otitis media);

• given the strong link between health and incarceration, support the justice reinvestment approach to health by appropriately funding services that divert Aboriginal and Torres Strait Islander people from prison;

• commit to the principles of the Redfern Statement, which calls on all political parties to make Aboriginal and Torres Strait Islander affairs a key election priority;

• meaningfully address the disadvantage experienced by Aboriginal and Torres Strait Islander people by reversing cuts to the Indigenous Affairs portfolio;

• reinvest in health, justice, early childhood, and disability services, as well as services to prevent violence;

• increase investment in Aboriginal and Torres Strait Islander community-controlled health organisations to build their capacity to be sustainable over the long term;

• recognise that chronic disease in Indigenous communities is inextricably connected to the social determinants of health such as: poverty; inappropriately designed, unhygienic, overcrowded housing conditions; inadequate access to affordable food and potable water supplies; and an absence of health services;

• acknowledge the wealth of existing reports, Parliamentary inquiries, strategies, and plans to improve Indigenous health and close the gap, and start to fund and implement them; and

• fund national training programs to support more Aboriginal and Torres Strait Islander people to become health professionals to address the shortfall of Indigenous people in the health workforce.

 

NACCHO Aboriginal #EarHealthforLife @KenWyattMP and @AMAPresident Launch AMA Indigenous Health Report Card 2017:

 

 

” The Aboriginal and Torres Strait Islander population is reported to suffer the highest rates of otitis media in the world.  This unacceptably high prevalance has been known for at least 60 years.

The 2017 Report Card on Indigenous Health identifies chronic otitis media as a ‘missing piece of the puzzel for Indigenous disadvantage’ and calls for an end to the preventable scourge on the health of Indigenous Australians.”

Download AMA Indigenous Health Report Card 2017: A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities

2017 Report Card on Indigenous Health

“ This is a disease of poor people in poor countries as well as other indigenous minorities. These unacceptably high rates have been known for at least 60 years,

Chronic otitis media has lifelong impacts for health and wellbeing just like cardiovascular disease or diabetes – its effects are often ‘life sentences’ of disability and are linked to high rates of Indigenous incarceration.”

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Mr. John Singer said Indigenous children experience some of the highest rates of chronic otitis media in the world.

Download NACCHO Press Release

NACCHO Press Release response AMA release Indigenous Report card.doc

NACCHO welcomes the 2017 AMA Report Card on Indigenous Health: A national strategic approach to ending chronic otitis media See Part 2 below

  ” Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.’

The Hon Ken Wyatt launch speech see in full Part 5

Part 1 AMA Background

Otis media is a build up of fluid in the middle ear cavity, which can become infected.  While the condition lasts, mild or moderate hearing loss is experienced.

Otitis media is very common in children and for most non-Indigenous children, is readily treated. But for many Indigenous people, otitis media is not adequately treated.  It persists in chronic forms over months and years.

As this Report Card identifies, the peak prevalence for otitis media in some Indigenous communities is age five months to nine months; with up to one-third of six-month-old infants suffering significant hearing loss.  The effects of long periods of mild or moderate hearing loss at critical developmental stages can be profound.  During the first 12 or so months of life, a person’s brain starts to learn to make sense of the sounds it is hearing.  This is called ‘auditory processing’.  If hearing is lost during this critical period, and even if normal hearing returns later, life-long disabling auditory processing disorders can remain.

Chronic otitis media is a disease in communities with poorer social determinants of health.  It is a disease of the developing world.  It should not be an endemic ‘massive health problem’ in Australia – one of the healthiest and wealthiest countries in the world.  However the chronic otitis media crisis is occurring in too many of our Indigenous communities.

This Report Card calls for a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia, and a response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population.

Part 2 NACCHO welcomes the 2017 AMA Report Card on Indigenous Health: A national strategic approach to ending chronic otitis media 

The peak body for Aboriginal controlled medical services today welcomed the release of the AMA’s 2017 Report Card on Indigenous Health and joined its call for a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous children in Australia. This disease has long term disabling effects and social impacts in the Indigenous adult population.

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Mr. John Singer said Indigenous children experience some of the highest rates of chronic otitis media in the world.

“This is a disease of poor people in poor countries as well as other indigenous minorities. These unacceptably high rates have been known for at least 60 years,” Mr. Singer said.

Chronic otitis media has lifelong impacts for health and wellbeing just like cardiovascular disease or diabetes – its effects are often ‘life sentences’ of disability and are linked to high rates of Indigenous incarceration.

NACCHO calls on Australian governments to adopt the recommendations of the Report including embedding chronic otitis media and hearing loss in the Closing the Gap Strategy. However in addition to these principles specialist ear disease and hearing services must be provided to all Aboriginal children if this disease is to be tackled.

Like many chronic diseases impacting on the gap in life expectancy, otitis media is linked to poorer social determinants. “If we are serious about improving health outcomes for Indigenous people, governments at all levels must do more to improve education, housing and employment outcomes.” Mr. Singer said.

Indigenous led solutions must be at the center of any approach. Aboriginal people are more likely to access the care and support they need from an Aboriginal controlled organisation. The community controlled sector has the experience, history and expertise in working with Aboriginal communities and are best placed to work with governments on the report recommendations. Our members should be the preferred model for investment in comprehensive primary health care services.

Our members across the country are keen to work with governments on a systematic approach to the prevention, detection, treatment and management of otitis media,” Mr. Singer said.

NACCHO, its Affiliates and members will continue to work with the AMA in the hope that the report will be a catalyst for coordinated, sustainable government action to improve ear health among Aboriginal and Torres Strait Islander people.

Part 3 INDIGENOUS EAR HEALTH – AMA CALLS FOR ACTION TO END A ‘LIFE SENTENCE’ OF HARM

AMA Indigenous Health Report Card 2017: A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities

The AMA today issued a challenge to all Australian governments to work with health experts and Indigenous communities to put an end to the scourge of poor ear health – led by chronic otitis media – affecting Aboriginal and Torres Strait Islander Australians.

At the launch of the 2017 AMA Indigenous Health Report Card in Canberra today, AMA President, Dr Michael Gannon, said the focus on ear health was part of the AMA’s step by step strategy to create awareness in the community and among political leaders of the unique and tragic health problems that have been eradicated in many parts of the world, but which still afflict Indigenous Australians.

The Report Card – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – was launched by the Minister for Indigenous Health, The Hon Ken Wyatt AM.

“It is a tragedy that, in 21st century Australia, poor ear health, especially chronic otitis media, is still condemning Indigenous people to a life sentence of hearing problems – even deafness,” Dr Gannon said.

“Chronic otitis media is a disease of poverty, linked to poorer social determinants of health including unhygienic, overcrowded conditions, and an absence of health services.

“It should not be occurring here in Australia, one of the world’s richest nations. It is preventable.

“Otitis media is caused when fluid builds up in the middle ear cavity and becomes infected.

“While the condition lasts, mild or moderate hearing loss is experienced. If left untreated, it can lead to permanent hearing loss.”

Dr Gannon said that, for most non-Indigenous Australian children, otitis media is readily treated.

“The condition in the non-Indigenous population passes within weeks, and without long-term effects.

“But for many Aboriginal and Torres Strait Islander children, otitis media is not adequately treated. It persists in chronic forms over months and years. At worst, it is there for life.”

Estimates show that an average Indigenous child will endure middle ear infections and associated hearing loss for at least 32 months, from age two to 20 years, compared with just three months for a non-Indigenous child.

Dr Gannon said the AMA wants a national, systematic approach to closing the gap in the rates of chronic otitis media between Indigenous and non-Indigenous infants and children in Australia.

“We urgently need a coordinated national response to the lasting, disabling effects and social impacts of chronic otitis media in the Indigenous adult population,” Dr Gannon said.

“We urge our political leaders at all levels of government to take note of this Report Card and be motivated to act to implement solutions.”

The AMA calls on Australian governments to act on three core recommendations:

Recommendation 1:

That a coordinated national strategic response to chronic otitis media be developed by a National Indigenous Hearing Health Taskforce under Indigenous leadership for the Council of Australian Governments (COAG). This should build on and incorporate existing national and State and Territory level responses and include:

  •  a critical analysis of current approaches, and to identify the range of reasons that current chronic otitis media crisis persists;
  •  the development of a COAG Closing the Gap target about new cases of chronic otitis media and hearing loss in Indigenous infants and children under 12 years of age;
  •  a national otitis media surveillance program to monitor prevalence and support a targeted and cost-effective national response;
  •  a significantly increased focus on prevention – both primordial prevention with a focus on the social determinants of the disease, and primary prevention including family and community health literacy about otitis media;
  •  a central, adequately funded and supported role for primary health care and Aboriginal Community Controlled Health Services (ACCHS) in a systematic approach to the prevention, detection, treatment, and management of otitis media; and
  •  access to ear, nose and throat (ENT) specialists, particularly within ACCHS and other Indigenous-specific primary health care services, based on need

Recommendation 2:

That the national approach proposed in Recommendation 1 include addressing the wider impacts of otitis media-related developmental impacts and hearing loss, including on a range of areas of Indigenous disadvantage such as through the funding of research as required. This includes:

  •  a national approach to supporting Indigenous students with hearing loss that aims to remove disadvantage that they may face in educational settings;
  •  a national approach to developing hearing loss-responsive communication strategies in all government and non-government agencies providing services to Indigenous people including – but not limited to – health, mental health, justice, and employment services; and
  •  exploring the support role of the National Disability Insurance Scheme (NDIS) to Indigenous people with hearing loss

Recommendation 3:

That attention of governments be re-directed to the recommendations of the AMA’s 2015 Indigenous Health Report Card, which called for an integrated approach to reducing Indigenous imprisonment rates by addressing underlying causal health issues (including otitis media and related hearing loss and developmental impacts), with the expectation of appropriate action. The health issues to be addressed include mental health problems, cognitive disabilities, alcohol and drug problems, hearing loss, and developmental impacts associated with otitis media. 3

Part 4 : Background

  •  Indigenous children experience some of the highest rates of chronic suppuratives otitis media (CSOM) in the world.
  •  Chronic otitis media in infancy and childhood can affect Indigenous peoples’ adult health and wellbeing as much as cardiovascular disease or diabetes, and its effects are significant ‘life sentences’ of disability.
  •  Chronic otitis media has life-long impacts that bring greater risk of a range of adult social problems, not the least of which is incarceration. The association of chronic otitis media-related hearing loss and the high rates of Indigenous imprisonment has been noted for over 25 years now – but with little action evident

The AMA Indigenous Health Report Card 2017 – A National Strategic Approach to Ending Chronic Otitis Media and its Life Long Impacts in Indigenous Communities – is at https://ama.com.au/article/2017-ama-report-card-indigenous-health-national-strategic-approach-ending-chronic-otitis

Part 5 Ken Wyatt Speech

I’d like to acknowledge the traditional custodians of the land on which we meet – the Ngunnawal and Ngambri people – and pay my respects to their Elders, past and present.

I thank AMA President Dr Michael Gannon and Associate Professor Kelvin Kong of the Royal Australasian College of Surgeons for their words, and acknowledge:

  • AMA Secretary-General Anne Trimmer
  • Representatives from the College,
  • the AMA’s Indigenous Health Taskforce,
  •  the National Aboriginal Community Controlled Health Organisation (NACCHO), and Aboriginal medical centre

My Parliamentary colleagues, and distinguished guests.

Report Cards can be daunting, they can be challenging, and they can be inspiring – but above all, they are valuable.

They help provide foundations for informed decision making – something I thoroughly endorse.

And in the case of Indigenous health, they highlight issues that many of the more than 27,000 registered doctors, students and advocates who the AMA represents, deal with every day.

So I commend the AMA on its 2017 Report Card on Indigenous Health – the latest in a series of highly authoritative and respected reports on the crucial issue of Aboriginal Aboriginal and Torres Strait Islander health.

Over the past 15 years, this annual Report Card has highlighted priority issues such as low birth weight babies, institutionalised inequities and racism, government funding, medical workforce, rheumatic heart disease, and best practice in primary care.

I welcome this year’s Report Card, with its focus on ear health and hearing loss, which can have devastating impacts.

Compounding this is the fact that the most common ear afflictions are almost entirely preventable.

For all the wrong reasons, ear disease is highly prevalent in Indigenous children and repeated episodes can lead to hearing loss and deafness, if not treated early.

The impact of this can have lifelong effects on education, employment and wellbeing.

Nowhere have these consequences been more evident than in my home State of Western Australia, where significant numbers of hearing-impaired Aboriginal people have been unable to secure mining boom jobs, despite their best efforts and support from major companies.

While I agree with Dr Gannon that this Report Card can be ‘a catalyst for government action to improve ear health among Aboriginal and Torres Strait Islander people’, I would like to point out that the Turnbull Government has much work under way aimed at improving Indigenous ear health.

We are resolutely committed to turning this problem around.

The AMA’s Report Card calls for a national, systematic and strategic approach to address chronic otitis media and its impacts in Indigenous communities, and for this approach to be reflected in the Council of Australian Governments Closing the Gap targets.

I note the AMA recommends that any such national response be developed for COAG by a National Indigenous Hearing Health Taskforce, importantly under Indigenous leadership, and that it should build on and incorporate existing national, State and Territory-level responses.

In March, the COAG Health Council agreed to explore the feasibility of such a national approach to reducing the burden of middle ear disease.

The Queensland Department of Health has leadership of this proposal, and plans to take it to the Australian Health Ministers’ Advisory Council next week, when it is scheduled to consider the matter on 8 December.

Alongside this, the House of Representatives Standing Committee on Health, Aged Care and Sport Inquiry into Hearing Health and Wellbeing of Australia is calling for a national strategy to be developed and additional funding provided.

The recommendations of the committee’s report – titled ‘Still waiting to be heard’ – are currently being given detailed consideration by the Turnbull Government, as are the findings of the Department of Health’s independent examination of Commonwealth ear health initiatives.

The AHMAC work and the ‘Still waiting to be heard’ report will inform the way forward on Indigenous ear health.

It’s also pertinent to note a number of other initiatives that will contribute directly to improved ear health.

The Turnbull Government has committed to incorporating a social determinants and cultural determinants of health approach in the next iteration of the five-year Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan, due to be released in 2018.

As Dr Gannon has pointed out, ‘social determinants of health contribute to the development of ear disease …. and act as barriers to treatment and prevention.’

The release of the Cultural Respect Framework 2016–2026, which was endorsed by AHMAC early this year, will underpin the delivery of culturally competent health service delivery.

A culturally competent approach by health professionals is critical to the health and wellbeing of Aboriginal and Torres Strait Islander people who, like all Australians, have the right to safe, culturally comfortable care of the highest clinical standard.

Further, COAG is currently working to refresh the Closing the Gap targets, including the health targets.

Initiatives like these demonstrate the commitment of good minds and good people to tackling our nation’s most confronting health issue – Indigenous health.

That commitment is also reflected in Commonwealth funding. To improve ear health, a total of $76.4 million, from 2012–13 to 2021–22, is being provided through the Indigenous Australians’ Health Programme, and the National Partnership on Northern Territory Remote Aboriginal Investment.

This funding is increasing access to clinical services, including surgery. It is providing equipment, training health professionals and raising awareness of otitis media symptoms and the need for early treatment.

In the past year, this has resulted in around 47,000 patient contacts in more than 300 locations across Australia.

More than 200 surgeries were provided, and over 1000 health professionals received training in 80 locations.

More than 1000 pieces of diagnostic equipment were available across 170 sites; and clinical guidelines were made available nationally.

As well, under the Australian Hearing Specialist Program for Indigenous Australians, the Australian Government provides hearing services in more than 200 Aboriginal and Torres Strait Islander communities across Australia each year to help overcome distance, culture and language barriers.

Successful initiatives, such as Children’s Health Queensland’s Deadly Ears program, are making a difference. Deadly Ears has helped almost halve the rate of Chronic Otitis Media, working at 11 outreach services in rural and remote areas.

So, clearly, there is a large body of work underway at local, State and national levels – but just as clearly, we must continue our focus, build our partnerships and broaden our approach.

While primary care is fundamental to ear health solutions, we must work together with Aboriginal communities to advance other areas of life which impact on health and wellbeing.

The Turnbull Government understands this, and this is the basis for our whole-of-government policies, including housing, education, employment and health service delivery.

We are focussed on what works, so efficient and successful models of care can be shared and replicated.

We are concentrating on grassroots empowerment, to support local responsibility, and in turn, to grow personal commitment.

Finding ear health solutions is a shared responsibility – for all governments, the medical profession, health workers, and parents and their children.

Reducing ear problems is one of my top Indigenous health priorities, and I’m confident we can start to make real gains in this critical area.

While there is undoubtedly a way to go, evidence-based Report Cards like this will help ensure we are on the right track.

The Turnbull Government is listening.

I commend the AMA for its work, and look forward to continuing our shared dedication to better hearing for Indigenous people.

Thank you.

 

 

NACCHO Aboriginal Health #AIDAconf2017 @AMApresident speech #Indigenous health – Turning words into action

 ” At every opportunity, the AMA highlights the issues of housing, clean water, transport, food security, access to allied medical services, and other social determinants that contribute to chronic disease and act as barriers to treatment and prevention.

The AMA has said time and again that it is simply unacceptable that Australia cannot manage the health care of the first peoples, who make up just three per cent of our population.

When it comes to Indigenous health, the Federal Government needs to broaden its thinking.”

Dr Michael Gannon AMA President speaking at Australian Indigenous Doctors #AIDAconf207 21 September

Please note we hope to publish todays #AIDAconf2017 speech from Minister Indigenous Health Ken Wyatt on  Monday

I acknowledge the Wonnarua People – the traditional owners and custodians of the land, and pay respects to their elders, past and present.

My thanks to the Australian Indigenous Doctors’ Association for the invitation to speak here today. It is a great privilege.

Congratulations on your 20th Anniversary. You have come a long way.

Aboriginal and Torres Strait Islander people face adversity in many aspects of their lives.

There is arguably no greater indicator of disadvantage than the appalling state of Indigenous health.

Aboriginal and Torres Strait Islander people are needlessly sicker, and are dying much younger than their non-Indigenous peers.

What is even more disturbing is that many of these health problems and deaths stem from preventable causes.

The battle to gain meaningful and lasting improvements has been long and hard, and it continues.

I sit on the Western Australian State Perinatal and Infant Mortality Committee. Aboriginality is a depressingly regular theme in these Stillbirths and Neonatal Deaths.

I am proud to be President of an organisation that has for decades highlighted the deficiencies in Indigenous health services and advocated for improvements.

While there has been some success in reducing childhood mortality and smoking rates, the high levels of chronic disease among Indigenous people continue to be of considerable concern.

For the AMA, Aboriginal and Torres Strait Islander health is a key priority. It is core business.

It is a responsibility of the entire medical profession to ensure that Aboriginal and Torres Strait Islander people have the best possible health.

It is the responsibility of doctors to ensure that patients – all patients – are able to live their lives to the fullest.

Many of you will know that the AMA has a Taskforce on Indigenous Health, which I Chair.

The Taskforce develops and recommends Indigenous health policy and strategies for the AMA to champion with governments and other agencies.

Along with AMA leadership, the Taskforce has representatives from AIDA, NACCHO, the Royal Australian College of General Practitioners, and the Australian Medical Students’ Association.

The Taskforce has been working since 2000. The Taskforce helps the AMA develop its annual Report Card on Indigenous Health.

Download here

2016-ama-report-card-on-indigenous-health

These Report Cards comment on topical issues in Aboriginal and Torres Strait Islander health, and recommend solutions that we urge governments to embrace.

The consistent message in all of these Report Cards is that the health of Aboriginal and Torres Strait Islander people will not improve until the factors that contribute to poor health, the social determinants of health, are addressed.

This year, the AMA’s Report Card on Indigenous Health – to be released in November – will focus on ear health and hearing loss.

Aboriginal and Torres Strait Islander people in Australia suffer from some of the highest levels of ear disease in the world, and experience hearing problems at up to ten times the rate of non-Indigenous people across nearly all age groups.

Hearing loss has health and social implications, particularly in relation to educational difficulties, low self-esteem, and contact with the criminal justice system.

To address ear health issues among Aboriginal and Torres Strait Islander people, it will be necessary to continue raising awareness, improving strategies for prevention, providing funds for further research, and improving access to services.

The AMA hopes the Report Card will be a catalyst for government action to improve ear health among Aboriginal and Torres Strait Islander people.

All our governments must address the broader social determinants of health, which contribute to the development of ear disease.

At every opportunity, the AMA highlights the issues of housing, clean water, transport, food security, access to allied medical services, and other social determinants that contribute to chronic disease and act as barriers to treatment and prevention.

The AMA has said time and again that it is simply unacceptable that Australia cannot manage the health care of the first peoples, who make up just three per cent of our population.

When it comes to Indigenous health, the Federal Government needs to broaden its thinking.

For too long now, people working in Indigenous health have called for action to address the social issues that affect the health of Aboriginal and Torres Strait Islander people.

Education, housing, employment, sanitation, clean water, and transport – these all affect health too.

This is clearly recognised in the Government’s own National Aboriginal and Torres Strait Health Plan 2013-2023, yet we continue to see insufficient action on addressing social determinants.

One message is clear – the evidence of what needs to be done is with us.

There is a huge volume of research, frameworks, strategies, action plans and the like sitting with governments – and yet we are not seeing these being properly resourced and funded. We do not need more paper documents. We need action.

The AMA recognises that Indigenous doctors are critical to improving health outcomes for their Aboriginal and Torres Strait Islander patients.

Aboriginal and Torres Strait Islander doctors have a unique ability to align their clinical and cultural expertise to improve access to services, and provide culturally appropriate care for Indigenous patients.

But there are too few Aboriginal and Torres Strait Islander doctors and medical students in Australia.

My father grew up in Dowerin in rural WA. He had long lost the title of its best ever footballer before Lance ‘Buddy’ Franklin was born.

I grew up in Perth and went to primary school with Aboriginal kids. The same was true at high school.

Later in my University training and as a Doctor-in-training, I had regular exposure to a high proportion of Aboriginal patients at Royal Perth Hospital and King Edward Memorial Hospital.

But at University, I had little contact with Indigenous people.

In 2017, there are just 281 medical practitioners employed in Australia who identify as Aboriginal and/or Torres Strait Islander – representing only 0.3 per cent of the workforce.

In 2016, around 286 Indigenous students were known to be studying medicine. It is, as you in this room know, slowly changing.

The Indigenous medical workforce must grow significantly to achieve overall improvements in Indigenous health.

To help boost the number of Indigenous medical students, and ultimately doctors, the AMA has offered a scholarship to an Indigenous medical student each year since 1994.

Over the years, our Scholarship has helped support more than 20 Indigenous men and women to complete their medical degrees.

Our most recent Scholarship recipient, James Chapman, understands the importance of family, culture, and education.

At a young age, James saw both of his parents endure health problems, and unfortunately lost his father to acute myeloid leukaemia after a short battle with the disease.

While he did not realise it at the time, James has said his father was a victim of the gap that exists between Indigenous and non-Indigenous Australians.

His father’s death made him realise his potential to contribute to his fellow Indigenous populations by providing access to health services.

James now has a purpose to study medicine so that he can practise in rural and remote Australia, offering Indigenous people access to equal health care, and addressing a major socio-economic inequality in Australia.

He realises that closing the gap between Indigenous and non-Indigenous people isn’t a one-man job.

But he takes comfort in knowing that he can contribute and make a difference to his fellow Indigenous people’s lives – prolonging and preserving a culture that holds a very important place for himself and many others.

The AMA worked hard to achieve Deductible Gift Recipient (DGR) status for our scholarship, and we are actively seeking donations, hoping to award a second annual scholarship for the first time this year.

Increasing the number of Indigenous doctors is a goal, not just for the AMA, but for all of those involved in closing the gap and improving the health and wellbeing of Australia’s first peoples.

The AMA will continue advocating for an increase in the number of Indigenous doctors in Australia.

The AMA has been a persistent, sustained, and powerful voice on Indigenous health for decades.

During that time, much has changed for the better, particularly as a result of the Close the Gap campaign. Recent cuts to funding are a huge concern.

Despite good intention and considerable investment by successive governments, the disparity in health outcomes remains.

Each year, the Prime Minister delivers a report on Closing the Gap, which in recent years has been profoundly disappointing.

The Closing the Gap reports sadly are not delivering on positive outcomes to improve Indigenous health.

Nor do they deliver one extra doctor when and where they are needed most.

They certainly provide no new funding.

Achieving health equality for Aboriginal and Torres Strait Islander Australians is an incredibly difficult task.

There have been some gains, but we need to do more – much more.

We must ensure that our governments do not fatigue in this task. They have the support of the broader Australian community.

It will take time, but most of all it will take ongoing commitment.

Governments at all levels must make meaningful investment in Indigenous health, and work with Indigenous communities to develop solutions that address their unique health needs.

Local Indigenous communities and local Indigenous people have the knowledge and expertise. They know what works. Without using this experience, the gap will remain wide and intractable.

The AMA has repeatedly said that it is not credible that Australia, one of the world’s wealthiest countries, cannot address the health and social justice issues that affect three per cent of its citizens.

We will continue to work with governments to take action to improve health and life outcomes for Aboriginal and Torres Strait Islander people.

NACCHO congratulates the Australian Indigenous Doctors Association #AIDAconf2017 @AIDAAustralia for 2O years of strong leadership

 ” Since the first Indigenous doctor graduated in 1983, more than 300 other Aboriginal and Torres Strait Islander people have gone onto become doctors.

The Australian Indigenous Doctors Association (AIDA) has played an important role in contributing to the growth of this critical workforce through the strong support it provides Indigenous doctors and medical students,

This week AIDA will celebrate its 20th anniversary during its annual conference starting today .

A recent commitment to work with the Australian Government, National Aboriginal Community-Controlled Health Organisation (NACCHO) and the Council of Presidents of Medical Colleges (CPMC) will see further improvements in health systems capabilities to deliver appropriate services for Aboriginal and Torres Strait Islander peoples “

Karen Wyld is covering the #AIDAconf2017 conference for the Croakey Conference News Service 

Picture above : AIDA emerged from a conference of Aboriginal and/or Torres Strait Islander medical students and doctors in 1997

You can read some of the stories of its members in this publication

Download PDF Journeys into Medicine

AIDA Journeys-

Watch recent interview with Dr Mark Wenitong on NACCHO TV

Watch recent interview with Dr Ngiare Brown  on NACCHO TV

Karen Wyld is covering the conference for the Croakey Conference News Service and provides a comprehensive preview below. Karen Wyld is an author, consultant and freelance writer from South Australia. Of Aboriginal descent (Martu), she has a background in community development, social/health research, health workforce training, and Aboriginal community-controlled health. ( See  full info below )

Family Unity Success – 20 years strong,

This week, there will be more than a few doctors in the house at Cypress Lakes Resort in Pokolbin, New South Wales, when the Australian Indigenous Doctors Association (AIDA) holds its annual conference.

This year’s AIDA conference theme is Family Unity Success – 20 years strong, which is well reflected in the program. Featuring VIP guest speakers, informative sessions with inspiring leaders in health, and numerous cultural activities and networking opportunities, the program runs from Wednesday 20 through to Saturday 23 September 2017.

From little things, big things grow

AIDA is a strong, supportive network of over 500 doctors, medical students, and partner organisations. This year’s conference will be its biggest ever, with more than 360 registered delegates and speakers.

AIDA emerged from a conference of Aboriginal and/or Torres Strait Islander medical students and doctors in 1997. That inaugural event was held at Salamander Bay in the Hunter region of NSW. And in 2017 AIDA returns to NSW, this time Hunter Valley, for their 20th year celebration.

Since its inception, AIDA has been achieving its goals of contributing to equitable health and life outcomes and the cultural wellbeing of Indigenous people by reaching population parity of Indigenous medical graduates and supporting a culturally safe health care system.

The culturally-appropriate high-level support that AIDA provides members, especially Aboriginal and/or Torres Strait Islander medical students, is both a contributing factor to the association’s success and to an expanding Indigenous health workforce.

With a Secretariat led by CEO Craig Dukes, AIDA continues to grow from its base in Old Parliament House Canberra. The Board of Aboriginal and/or Torres Strait Islander doctors and a student Director provide direction to the Secretariat.

AIDA’s Student Representative Committee (SRC) is another means of supporting Aboriginal and/or Torres Strait Islander medical students. With representatives from most Australian medical universities, the SRC provides advice to AIDA on initiatives to support Indigenous medical students to succeed in their studies and personal career aspirations.

Through strengthening collaboration with key medical bodies and colleges, AIDA continues to influence the Australian health care system to work towards strategic changes within provision of health services for Aboriginal and/or Torres Strait Islander peoples.

Conference highlights

Starting on Wednesday 20 September, with member-only sessions and the AGM, this year’s AIDA conference has plenty to offer delegates. In the morning, James Wilson Miller and Laurie Perry of the Wonnarua Nation will conduct the welcome to Country. Dr Kali Hayward, AIDA President, and Dr Louis Peachey, AIDA Life Member, will present a session on the history of AIDA, and the vision for its future.

The agenda will be complemented with cultural activities, including a dance workshop and yarning circles. The day will finish with an evening gathering that includes a smoking ceremony, dance performances, unveiling of art, and Indigenous astronomy.

With renowned journalist and filmmaker Dr Jeff McMullen as MC, Thursday and Friday’s agenda has many informative sessions and skills-based workshops. AIDA has also attracted many Australian and international special guest speakers, including:

  • The Hon Ken Wyatt AM, MP, Minister for Indigenous Health
  • Senator Richard Di Natale, Leader of the Australian Greens
  • Professor Tom Calma, AO National Coordinator Tackling Indigenous Smoking, and Consultant to Commonwealth Health
  • Associate Papaarangi Reid, Deputy Dean Maori, Tumuaki, University of Auckland
  • Dr Michael Gannon, President of the Australian Medical Association
  • Mr Philip Truskett AM, Chair-Elect of the Council of Presidents of Medical Colleges, and AIDA Patron
  • Dr Martina Kamaka, Associate Professor, Department of Native Hawaiian Health, John A. Burns School of Medicine
  • Dr Nathan Joseph, Chairperson, Te Ora

A presentation by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council Ngangakaris on Thursday is another highlight in an agenda that features Aboriginal and Torres Strait Islander perspectives of health and wellbeing, and cultural activities.

Thursday evening, AIDA’s SRC will be hosting a networking event with sponsorship from National Aboriginal and Torres Strait Islander Health Workers Association (NATSIHWA). And on Friday night the Platinum Gala Dinner and awards ceremony will be held, MCed by Steven Oliver, Aboriginal writer, performer and comedian.

On the Saturday, an optional tour of Baiame Cave is offered to delegate and guests, or a choice of three specialised professional development workshops.

Moving forward with cultural safety

After presenting a VIP address in the plenary session on the Friday, the Hon Ken Wyatt MP will be participating in the Cultural Safety Panel. With his previous experience working within the health sector, and current appointment of Minister for Aged Care and Indigenous Health, Minister Wyatt’s contribution to this panel will be a conference highlight.

The cultural safety panel builds on recent work that AIDA has conducted in strengthening cultural competency within the Australian health sector. In 2016, AIDA conducted a survey to collate feedback from members on incidents of bullying, racism and lateral violence in the workplace. AIDA is now working on strategies to address the key issues that arose from the survey report.

A recent commitment to work with the Australian Government, National Aboriginal Community-Controlled Health Organisation (NACCHO) and the Council of Presidents of Medical Colleges (CPMC) will see further improvements in health systems capabilities to deliver appropriate services for Aboriginal and Torres Strait Islander peoples

Presidential perspectives

Dr Kali Hayward, AIDA President, is looking forward to celebrating the 20th year milestone with fellow AIDA members, by reliving AIDA’s history and acknowledging those who have contributed to its success.

Since the first Indigenous medical graduate in 1983, there are now over 300 Aboriginal and/or Torres Strait Islander doctors, specialists and surgeons. AIDA’s strong support of the Indigenous medical workforce and mentoring of Indigenous students in medicine has contributed to this outstanding growth in the number of medical practitioners.

Hayward acknowledges the supporting environment that AIDA’s conferences provide Indigenous medical students, and speaks highly of the Growing Our Fellows session. This provides Aboriginal and/or Torres Strait Islander medical students an opportunity to have a one to one conversation with a representative from fifteen medical colleges. With strong competition to get into college training programs, this is unique opportunity for students to discuss their career pathways through medicine.

Whilst the CEO and Secretariat have worked tirelessly to ensure this year’s conference will be special, AIDA’s strong reputation has meant that they received many offers of support. This has resulted in an enviable conference program. Dr Hayward says that AIDA is very appreciative of people giving their time, with many VIP speakers and guests eager to celebrate the 20th milestone.

Hayward also stated that she “…is very proud to be the current President. Proud of the students, and other AIDA members. And proud to be able to help create a safe environment for students and doctors to come together.”

Looking at how far AIDA has come since 1997, there is much to be proud of, and many examples of Family Unity Success to celebrate at the conference.

Join the conversation

Karen Wyld is covering the #AIDAconf2017 for the Croakey Conference News Service

Please join the conversations arising during and after the conference.

Karen Wyld is an author, consultant and freelance writer from South Australia. Of Aboriginal descent (Martu), she has a background in community development, social/health research, health workforce training, and Aboriginal community-controlled health. She currently has a draft novel long-listed for the 2017 Richell Prize. Read her recent articles for Al Jazeera, Monumental Errors, and for @IndigenousX: Ongoing administrative errors afflict the Indigenous Advancement Strategy. Follow on Twitter:  @1karenwyld

NACCHO Aboriginal Health News Alert @AMApresident speech National Press Club -Time for heavy lifting in Health

 

” Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our 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.

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.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

Dr Michael Gannon  : Pictured above after speaking at the National Press Club , meeting two new members of the NACCHO Communications and Digital Team Wendy Brookman and Oliver Tye

Beyond the Medicare freeze – Time for heavy lifting in Health

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

Good afternoon. It is a great honour to address the National Press Club for a second time as AMA President.

There have been many changes over the last twelve months.

There is no more talk of co-payments.

The cuts to pathology and diagnostic imaging bulk billing incentives have been reversed.

The general practice pathology rents issue has, for the most part, been resolved.

The Medicare freeze has a ‘use by date’. It can’t come soon enough.

The AMA wanted an immediate end to the freeze right across the Medicare Benefits Schedule. We did not get it.

But in 300 days’ time we will see a return to annual indexation of patient rebates to see GPs and other specialists.

The extended freeze has been a major contributor to out-of-pocket expenses when patients see doctors.

We have a new Health Minister – Greg Hunt. He has been consultative and highly engaged with the health sector. He and I speak most weeks. He is a good listener.

He genuinely wants to be across the complexities of his portfolio.

The same can be said of Shadow Minister Catherine King and Greens Leader Richard Di Natale. They get health. They know how health policy affects people’s lives.

This is why Greg Hunt has played a key role in repairing the Government’s relationship with the major stakeholders in health – with the backing of the Prime Minister.

The health policy environment is much calmer, but this does not mean that everything has been fixed. Far from it. There is plenty of heavy lifting to do.

The lifting of the freeze has raised the curtain to allow a greater focus on the other health priorities that require Government action ahead of the next election. 2

These include long-standing structural issues around public hospital funding, private health insurance, the Review of the Medicare Benefits Schedule, and the My Health Record.

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.

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.

I cannot and will not cover all these issues in my prepared speech today. There is not time. I will highlight a few of the most pressing.

Health Economics

As I have stated many times, health is the best investment that governments can make.

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.

Despite constant claims to the contrary, often from governments, Australia’s health budget is not experiencing an expenditure crisis.

Commonwealth health expenditure is actually reducing as a percentage of the total Commonwealth Budget. 3

In the 2016-17 Budget, health was 15.8 per cent of the total, down from 18 per cent in 2006-07.

While health spending has reached a 10 per cent share of GDP, this is less than comparable countries.

France, Sweden, Germany, and Switzerland all spend 11 per cent.

The United States, with their managed care system of private medicine demands more than 17 per cent of GDP to provide worse health outcomes.

Our system may be the envy of many other countries, but that doesn’t mean we can’t or shouldn’t seek to improve it.

Public Hospitals

Our health system cannot improve without properly-resourced public hospitals.

The doctors, nurses, and other staff who work in them are some of the most skilled in the world.

In 2015-16, there were more than 6 million episodes of admitted patient care in Australia’s public hospitals.

Between 2011-12 and 2015-16, the number of separations rose by 3.3 per cent on average each year.

This was greater than the average growth in population over this period, which was 1.6 per cent.

In 2015-16, public hospitals managed 92 per cent of emergency admissions.

They provide services in a time of need. But they need support.

We are not meeting critical targets.

Against key measures, the performance of our hospitals is stagnant or declining.

Bed number ratios have remained static despite the celebrated opening of multiple shiny new hospitals.

Emergency Department waiting times have worsened and, in most cases, they remain well below the target set by governments to be achieved by 2012-13.

The percentage of ED patients treated in four hours has not moved over the past three years.

It is well below our target of 90 per cent. Elective surgery waiting times have worsened.

So when we talk about the need for secure, long-term, and adequate funding, we need to remember what that funding is for. 4

Only last month, it was suggested that there wasn’t enough ‘competition’ between public hospitals.

Competition? I can’t imagine the mother of a young child with suspected meningitis checking the internet at midnight to see which hospital might provide the most competitive offer.

No, that family would be rushing that child to the nearest ED.

We hear more and more about the idea of ‘docking’ funding to hospitals for what are deemed ‘avoidable readmissions’ and ‘acquired complications’.

Doctors take an oath to look after patients. They take it seriously.

They train their entire careers with the primary purpose to heal people. To make them better.

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.

Unfortunately, some complications are unavoidable.

Where there are errors, or where targets are not met, these are almost always due to not having the resources, the staff, or the time.

Taking funding away from hospitals would make things worse.

We need greater certainty and an increase in funding.

We call on the Federal Government and the States and Territories to listen to doctors in the lead-up to 2018 negotiations.

The concept of a 10-year funding agreement sounds attractive. But it must not become a plan to simply lock in chronic underfunding.

Private Health

Our public hospitals would not survive without the support of our private health system.

As a private practitioner who works in the public system, I am well placed to comment on the relationship between these two pillars of our health system.

Australia’s health system relies on the dual system of public and private health. The two complement each other.

Nearly 70 per cent of elective surgery occurs in private hospitals.

We often talk about private health offering choice – choice of doctor, choice of hospital. It’s why people take out insurance policies.

We talk about private health offering shorter waiting times – it’s a major benefit of the system. 5

But we also need to talk about private health as a critical component of taking pressure off the public system.

As a forceful advocate for public hospitals and those Australians who do not have the luxury of a choice, I am therefore an advocate for private health.

However, I am concerned. Very concerned.

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.

Doctors have a complicated relationship with private health insurance. Indeed, private health insurance itself is complicated.

There are more than 20,000 policy variations around the country.

They are littered with inconsistent terminology and a bewildering array of exclusions, caveats, carve-outs, and excesses.

There are policies out there that offer inappropriate cover.

There are cases where removal of metal is not covered. So, you have had your head caved in. A surgeon repairs the fracture and inserts a plate at midnight on a Saturday night. All covered by health insurance.

But they do not cover removal of that plate at a later date.

We have seen cases where mothers covered for pregnancy have been told their newborn baby cannot be looked after in the special care nursery.

We are calling for pregnancy cover to be included in all levels of policies, adding it to the risk equalisation pool.

It’s a natural part of life. Two thirds of pregnancies are unplanned. So let’s cover it properly, spread the cost appropriately, and make it affordable for more people.

The same applies to mental health services. Suffering anxiety, depression, or a situational crisis are all too common ‘speed bumps’ in life. They are not predictable. This is why we need insurance.

We need to put the concept of value back into private health insurance.

Market power has dramatically shifted in favour of the private health insurers.

They are deciding who can provide what treatment, and where they can provide it.

We have situations where clinical decision-making is being questioned, and overridden, in some cases, by insurers.

If this shift is allowed to flourish, it will undermine both the private and public systems. 6

Insurers are also insisting practitioners agree to the publication of their details, their fees, and allowing customer testimonials that they do not get to verify.

This is dangerous territory.

The consideration of clinical performance and the years of training to improve safety and quality cannot be captured in a customer ‘star rating system’.

Joint replacement surgery is a bit more nuanced and complicated than an Uber ride.

We note also that contracting arrangements with hospitals have ‘no pay’ clauses for adverse events.

Insurers should not interfere with the established safety and quality system that is achieved via the independent accreditation agencies.

The AMA will fight this deliberate drift towards United States style managed care – a system that performs worse than ours according to nearly every metric.

In the last decade we have seen the PHI industry move from one that was dominated by Mutual insurers, who have members, to for-profits, who have policy-holders and, of course, shareholders.

Private health insurance should serve the needs of health consumers who have paid for it.

Patients should not have health care options available to them curtailed for profits.

We see premiums rise five to six per cent every year, at the same time that people are facing increasing cost of living pressures.

It is no surprise that we see people downgrading or dropping their cover.

This has to stop. It requires careful Government action.

Doctors are not the affordability problem.

Too often we hear misguided and misinformed claims – usually from the very big, very powerful health funds – that doctors’ fees are the reason that premiums are rising. This is an appalling and deliberate lie.

As soon as a doctor charges one cent above the insurers’ scheduled fee or, where it exists, their known gap arrangement, the insurer reverts to paying only 25 per cent of the MBS scheduled fee.

That’s about $330 for a hip replacement, $170 for delivering a baby. The insurers actually save money!

In an admission to hospital that might cost $30,000, do you really think the doctor’s fee is the affordability problem in PHI?

The other argument is that doctor fees are creating out-of-pockets – and a disincentive to private health insurance. 7

But the statistics again disprove it. Doctors’ fees are only 16 per cent of insurer outlays.

Australian Prudential Regulation Authority (APRA) statistics show that 88.1 per cent of services are charged at no gap. That is, nothing to pay – zero dollars. The patient’s health insurance covers it.

A further 6.9 per cent are at a known gap of $500 or less.

Now reflect on the fact that the MBS hasn’t been indexed since 2013. Nor have the insurers indexed their payment schedules anywhere near health inflation, if at all.

APRA recently reported that insurers’ profits were up 17 per cent to $1.8 billion before tax for the 2016-17 financial year.

So governments and insurers set the underlying price for a service – and that price has largely been stagnant.

As a private practitioner, I can promise you that my insurance, my rent, my electricity, my staff wages, my supplies, are all increasing in cost.

Doctors have absorbed these costs. Just look at the combined no-gap and known-gap rate of 95 per cent.

Let’s have a look at the out-of-pockets.

The average known-gap cost for Anaesthesia is $96. So, a specialist doctor with 10 years of training and potentially 30 years of experience comes in to help out with an emergency Caesarean Section at 3.00am in the morning. Try getting your plumbing fixed for that price.

Look at the bulk billing rates in general practice. They too have held firm.

The medical profession has done its utmost best to protect patient access to affordable care.

But unless the ‘payers’ in the system start to work with us, it is simply not sustainable.

When we get instability, patients suffer. They lose access. They lose supply. They lose the quality of care they have a right to.

We will continue to participate in the Ministerial Advisory Committee.

But our patients need and deserve certainty. And so do doctors.

Medical Indemnity

An area of great concern to the medical profession has recently re-emerged.

I am talking about medical indemnity. Some of you may remember the indemnity crisis more than a decade ago. 8

The reforms and protections put in place by then Health Minister Tony Abbott are showing signs of stress.

While back in the UK recently, I saw what could happen here again without intelligent policy.

Medical indemnity in the UK is becoming unstable. The two major providers have pulled out of private Obstetrics. There is talk of pulling out of coverage in other high risk areas.

More than a decade ago, the AMA advocated tirelessly, brought together the profession, and worked with the Government to design a series of schemes that have been a resounding policy success.

They promote stability. They provide affordable insurance, which flows through to affordable care.

That has been the AMA’s strong message heading into the current review of indemnity insurance.

Thankfully, the Government has been receptive to our advice, and I am grateful to Minister Hunt for listening.

He was surprised to hear that annual premiums got as high as $126,000 a few years ago. And that’s after the support schemes’ contributions are taken into account.

We now have a review that is focussed on improving and building on the current policy success. It is not a savings exercise.

It removes a threat to a stable medical workforce.

Medical Workforce

For many Australians, access to a doctor remains a problem. People in rural Australia often find it difficult to access care in a timely fashion.

But the problem is not that we don’t have enough doctors. We have more doctors per head of population than the OECD average.

We are graduating record numbers of medical students, putting us well above the OECD average. But we are not providing enough prevocational and specialist training places for our medical graduates.

We must address workforce shortages in particular specialty areas.

Many people think that medical training finishes at the medical school gates. However, medical training is a much longer journey.

It requires an internship, a period of prevocational training and, ultimately, specialist training, which can last upwards of seven years.

I wrote recently that my training took seventeen and a half years, half my life when I opened my practice on my 35th birthday. 9

With record medical graduate numbers, the pressure this is placing on the medical training pipeline is widely acknowledged.

Next year we face a shortage of 569 first year advanced specialist training places.

The bottleneck of doctors in training waiting to get on to a specialist training program is growing, and the projections suggest it will only get worse.

This has implications for the community’s access to services, and the career aspirations of our best and brightest.

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.

With a looming oversupply of doctors, they have developed a $250,000 medical degree for those who are wealthy enough to be able to afford it.

With that kind of debt, their graduates will not work in areas where they are needed.

They will opt for more lucrative specialties in major metropolitan locations – assuming they can get a job at all.

It’s an example of greed trumping need, and governments need to work with the AMA to stop this from happening.

The evidence clearly shows that, if you select doctors from a rural background, or provide them with opportunities to train in rural areas, they are much more likely to work in a rural area.

We support Minister Gillespie and his idea for training hubs in the regions.

We will keep arguing about the problems with Bonding. We hope that more graduates will choose general practice or rural practice, or both. We will continue to argue for measures that will work.

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. 10

The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.

But the Government needs to do much more to recognise and reward quality general practice.

The Government is proceeding with its Health Care Homes trial and, while we share the vision of the trial, it is not without problems.

Significant questions also remain over the adequacy of funding for the trial, given the Government is asking GPs to do more for patients, but with no additional investment.

It will be a number of years before we learn what impact the trial has had for patients, health costs, and whether it relieves pressure on our hospital system.

General practice can’t wait that long. It is already under pressure and needs new investment now.

We must have everything funded and connected – strong primary care, led by general practice; properly resourced public hospitals; and a complementary private hospital sector underpinned by a stable private health insurance industry.

This is a handy ‘to do’ list for the Government.

I turn now to a couple of topics that have put the AMA is a different sort of spotlight.

Marriage Equality

The AMA gets accused of being too conservative.

So, it was not totally surprising to see the reaction to the launch of our new Position Statement on Marriage Equality a few months back.

The AMA position generated significant coverage in both mainstream and social media.

It also generated interest within our membership, the medical profession more broadly, and with the general public.

We received overwhelming support – in line with public opinion polls which indicate the majority of Australians support marriage equality.

Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage.

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. 11

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.

It is not our place to determine how we achieve marriage equality. That is for our legislators.

We hope this process goes ahead with honesty and respect.

Euthanasia and Physician Assisted Suicide

Last year, we 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. We 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.

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.

We are always there to provide compassionate care for each of our dying patients so they can end the last chapter of their lives without suffering.

We believe that governments must do all they can to improve end of life care for all Australians.

They must properly resource palliative care services and advance care planning, and produce clear legislation to protect doctors who are providing good end of life care in accordance with the law.

Of course, euthanasia is a matter for society and its Parliaments.

However, if new legislation does come into effect, doctors must be involved in the development of the legislation, regulations, and guidelines.

We must protect doctors acting within the law, vulnerable patients, those who do not want to participate, and the wider health system.

The AMA recognises that good quality end of life care can alleviate pain and other causes of suffering for the overwhelming majority of people. 12

There is already a lot that doctors can ethically and legally do to care for dying patients experiencing pain or other causes of suffering.

This includes giving treatment with the intention of stopping pain and suffering, but which may have the secondary effect of hastening death.

I reiterated all of this yesterday in an address to 40 MPs in Victoria, imploring them to legislate protections according to this ‘doctrine of double effect’.

Bills in South Australia and Tasmania have been defeated. I encourage politicians in Victoria to ‘put the horse before the cart’ and focus on the everyday issues in end of life care.

Our position does not appeal to everyone, least of all high profile euthanasia campaigners and their enthusiastic supporters in the media.

We also have members who differ in their view.

But our position, supported by the overwhelming majority of our Federal Council, is supported by the bulk of the medical profession.

There are medical, ethical, and moral responsibilities at the heart of the doctor-patient relationship, and we all take them and our oath, the Declaration of Geneva, very seriously indeed.

Aboriginal & Torres Strait Islander Health

So too, the AMA takes Indigenous health very seriously.

Last year, I travelled to Darwin to launch our 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.

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.

Smart policy. Saving money. Preventing heartache. The right thing to do.

I remain committed to partnering with other health professionals and champions of Indigenous health like Ken Wyatt and Warren Snowdon to continue to Close the Gap.

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.

We are completely independent of governments. 13

We rely near totally on member subscription income to survive. I can promise you, as a Board member, it is often a concern.

But unlike many other lobby groups, inside and outside the health industry, this gives us a total legitimacy to speak honestly, robustly, and without fear or favour in line with our mission – to lead Australia’s doctors, to promote the health of all Australians.

We have strong public support and respect as the peak medical organisation.

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.

The media demand that we have an opinion. And not just on bread and butter health issues. But also on social issues that have an impact on health.

Our view is never knee-jerk.

We consult our members and the broader medical profession. Often we encourage feedback from other health professionals – the ones who provide quality health care with us in teams.

We attract public feedback whether we like it or not. I can promise you that social media has taken this to a whole new level.

In the last year I have been criticised by the Pharmacy Guild, the College of Midwives, the Greens, One Nation, the ALP, the Coalition, pro-Euthanasia campaigners, E-cigarette enthusiasts, Anti-Vaccination campaigners, shareholders in Medicinal Cannabis enterprises, and the occasional celebrity chef.

And that is before I get home to my 13 year old daughter.

All of our consultation and engagement informs our policies, our views, our opinions.

Our opinions are not designed to be popular.

Many feel uncomfortable when we talk about healthcare standards for asylum seekers and refugees on Nauru and Manus Island.

We make Australians feel uncomfortable when we ask them to reflect on the amount they drink and the fact that licit drugs like tobacco and alcohol cause far more carnage than Ice ever will.

People might not like it when we use scientific evidence to inform our views on the limitations on the usefulness of Medicinal Cannabis, climate change and health, air quality, expanding adult and child vaccination programs, restricting Codeine use, or call for a tax on sugar-sweetened beverages.

But we believe we get it right most of the time. 14

We are the only body that can possibly represent the whole medical profession – from medical student to retired doctor, from Psychiatrist to Vascular Surgeon to Paediatrician, whether trained in Mumbai or at Monash.

From Busselton to Bundaberg, we will continue to fight for the health of our patients and their communities.

That is why governments take notice of our policies. They are informed by what our patients and what our members tell us, based on what is happening at the front line of health service delivery.

Conclusion

I want to finish today with a message to our political leaders.

Last year we had a very close election, and health policy was a major factor in the closeness of the result.

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.

I talked today about 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. 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.

 

NACCHO Aboriginal Health and #Smoking : @TheMJA #npc Mass-reach #anti-smoking campaigns must return

Disadvantaged groups are and should be a key focus of action to reduce smoking further. This has long been recognised, including in the report of the National Preventative Health Taskforce, which specifically called for action in relation to Aboriginal and Torres Strait Islander people and other highly disadvantaged groups, such as people with mental health problems,”

The evidence tells us that we need a mix of approaches. We need whole-of-community approaches, with measures such as tax increases and strong mass media campaigns, which benefit disadvantaged groups disproportionately. We also need specific targeted approaches, as this article notes: the Talking About the Smokes project and the Tackling Indigenous Smoking program have played valuable role in complementing mainstream activity.”

 Professor Mike Daube, professor of health policy at Curtin University, welcomed calls for further action on smoking prevalence in disadvantaged groups, and said that a mix of approaches was needed. Professor Daube told MJA InSight.

Read over 100 NACCHO Smoking articles published in past 5 years

NACCHO Aboriginal Health and Smoking : Download Tackling Indigenous Smoking Program prelim. evaluation report

TARGETED tobacco control strategies are urgently needed to tackle the “remarkably high” smoking rates in some high-risk groups, according to Australian authors, but leading public health experts say reinstatement of mass-reach campaigns should be a priority.

Writing in the MJA, Professor Billie Bonevski, a health behaviour scientist and researcher at the University of Newcastle, and co-authors said that the overall smoking prevalence in Australia was now 14%, but among population subgroups, such as those with severe mental illness and those who had been recently incarcerated, the rates were upwards of 67%.

Tobacco use among Aboriginal and Torres Strait Islander people also remained high, with the prevalence among Indigenous people aged 15 years and older being about 39% in 2014–15.

Listen to Podcast HERE

The authors said that a truly comprehensive approach to tobacco control should include targeted campaigns in high smoking prevalence populations.

“If we are truly concerned about this issue, we must focus more attention on the groups that are being left behind,” they wrote.

Novel, targeted interventions and increased delivery of evidence-based interventions was needed, the authors said, noting that tobacco harm reduction strategies, such as vaporised nicotine, should also be further investigated.

In an MJA InSight podcast, lead author Professor Bonevski said that smoking was still “almost … socially acceptable” in some subgroups, such as those from low socio-economic populations.

“People who have lower incomes end up smoking from a younger age and, by the time they reach adulthood, they are more heavily nicotine dependent and … it becomes much harder to quit,” she said. “This is a vicious cycle in terms of socio-economic status contributing to high smoking rates, and then high smoking rates contributing to poor health, and then poor health keeping you in that low socio-economic status group, and so on.”

Professor Simon Chapman, Emeritus Professor in the University of Sydney’s School of Public Health, said that targeting high smoking prevalence subgroups sounded sensible “until we unpack what targeting involves”.

“The world-acclaimed, highly successful Australian national Quit campaign has been scandalously mothballed since 2013. So, talk of fracturing what is now a zero-budgeted, non-operational population-wide campaign into multiple targeted campaigns is currently a ‘brave’ call,” he said.

Professor Chapman said that Australia’s main goal should be to restore our “family silver”: properly funded, mass reach campaigns that reach all subgroups.

He pointed to research, published in 2014, that found that the decline in smoking prevalence in Australia – from 23.6% in 2001 to 17.3% in 2011 – was largely due (76%) to stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns.

Professor Chapman said that higher smoking rates among disadvantaged groups were more likely to be explained by higher uptake, than by failure to quit.

He noted that 22.7% of the most disadvantaged people were ex-smokers, versus 26.9% of the least disadvantaged. “But only 53.5% of the least disadvantaged people have never smoked, compared with 62.9% of the most advantaged,” he said.

Professor Chapman said that labour-intensive interventions were inefficient in preventing uptake among young people.

“It remains the case that most kids who don’t start smoking and most smokers who quit do not attribute their status to a discrete intervention,” he said.

Professor Mike Daube, professor of health policy at Curtin University, welcomed calls for further action on smoking prevalence in disadvantaged groups, and said that a mix of approaches was needed.

See opening statement

 

Professor Daube said that strong action at the public policy and health system levels was crucial.

“At the policy level, this should include immediate resumption by the federal government of national mass media campaigns, which have, incomprehensibly, been absent over the past 4 years; and action to combat the tobacco industry’s cynical strategies to counter the impacts of tax increases and plain packaging,” he said.

“We also need more than lip service within health systems about the physical health of people with mental health problems, not least through support and assistance in quitting smoking. There are some who try, but they are the exception.”

Professor Daube said that the suggestion that vaporised nicotine may play a role in reducing smoking was “very speculative”, and still “some way ahead of the evidence”.

“[We] should await any determination by the [Therapeutic Goods Administration] as to their safety and efficacy,” he said.

Earlier in 2017, the TGA decided to uphold the ban on vaporised nicotine in e-cigarettes in Australia