Wednesday, September 30, 2009

Gender and Health

Today I attended a consultation for the National Women's Health Policy. This forum, held in Canberra, is the first of fifteen that will be held around Australia. There were around sixty participants and we worked in table groups to identify priority areas and also detail how we would go about making that happen.

The Commonwealth Government is developing a National Women’s Health Policy which will focus on encouraging specific health services for women and actively promoting participation of women in health decision making and management. I will post more about this in the coming week.

The National Men's Health Policy is currently in development and will focus on reducing the barriers men experience in accessing health services, tackling widespread reticence amongst men to seek treatment, improving male-friendly health services, and raising awareness of preventable health problems that affect men.

In February David Lovegrove, a member of the HCCA Executive Committee, attended a consultative forum at the Hellenic Club. This was one of 18 fora held in states and territories. The consultations have been written up by I have not been able to locate these online. I understand that the national men's Health policy will be finalised later this year.

This drew my mind to the broader the role of gender in our health. Gender is a key determinant of health and the ACT and Commonwealth governments are developing policies that recognise the specific needs of men and women so that programs and services will improve health outcomes.

In 2002 the World Health Organization (WHO) held a seminar on mainstreaming gender equity in health. This is now referred to as the Madrid Statement, (Pdf 208kb). It says:
"To achieve the highest standard of health, health policies have to recognize that women and men, owing to their biological differences and their gender roles, have different needs, obstacles and opportunities."

Gender mainstreaming is the process of consistently incorporating a sensitivity of gender differences in policy, planning, budgeting, and implementation of programmes and projects in order to overcome inequalities between men and women, boys and girls.

The Public Health Association of Australia has a policy on this. Their recommendations and resolutions are important to note in the context of the national health reform on men and women's health.

Friday, September 18, 2009

Consumer experiences of self managing chronic conditions

In August HCCA facilitated a workshop of around 50 consumers on behalf of the ACT Division of General Practice (ACTDGP). This workshop is part of Interprofessional Learning Project currently underway involving ANU and the ACTDGP.

Consumers were asked specifically about what helps them to self management their chronic conditions and what barriers they encounter in their self management. Participants worked in table groups to share their experiences and document their ideas.

A number of speakers also gave presentations to participants.

Russell McGowan (Pictured) talked about the national level reform in chronic conditions and also talked about his involvement with the Consumers Health Forum project on developing resources to support people to self manage their chronic conditions

Judy Stone, told the participants about the Interprofessional Learning programs currently underway in ACT Health

Other speakers included Susan Abbott (ANU), Amanda Plowright (SHOUT), Ann Thomson (RSI and Overuse Injury Association) and Jo Stewart, a peer leader for the Living a Healthy Life with Chronic Conditions workshops.


Knowledge of the system and their condition were identified as important enablers for consumers. Working with a doctor who is knowledgeable about the condition, treatment options and available supports was also important. Research, particularly using the internet, was mentioned as were self help courses as a way of gaining knowledge.

Some existing services were identified as significant enablers for managing chronic conditions: Job Access, psychology services, hydro pools and other services sere identified as desirable. Good medical services particularly GP services were also identified as enablers.

Participants identified the need for appropriate design for people with chronic conditions.

Participants repeatedly identified support from others, groups, families, friends, as important enablers for management of chronic conditions.

When communication channels are respectful, informed, inclusive and personable they were seen as enabling the management of chronic conditions. Effective communication between health providers facilitated by good record keeping was also identified.

Participants identified good treatment and plans to treat as important in enabling them to manage a chronic condition. This plan could include lifestyle factors. A multi pronged or holistic approach was mentioned.

Having plenty of money was identified as an enabler to self managing a chronic condition.

Participants identified that a positive attitude and determination are useful enablers.


Participants were very vocal about the need for health professionals to interact with them as people first. They want respectful, honest, considered and comprehensive communication about their situation.

Lack of Medical Profession Knowledge about chronic conditions was seen as a barrier to the management of those conditions and the variation between doctors knowledge was raised by participants.

Participants recognized that they needed to be well informed about their chronic conditions, however they were struggling to gather reliable information which would help them to successfully manage their chronic conditions. They were also concerned about the level of general knowledge in the community about chronic conditions.

The shortage of doctors in Canberra both GP’s and specialists was seen as a barrier to managing chronic conditions. This was reflected in many comments about waiting times to see doctors.

Participants identified specific areas of service deficit as a barrier to managing chronic conditions. These included, interpreter services, hydro therapy, rehab gyms, well resourced support groups, advice advocacy services, and service closures.

Carers were recognized by participants as central to their ability to self manage their chronic conditions and when carers were not available self management was threatened.

Participants were acutely aware of the need to provide well designed, accessible public spaces and transport and that when this did not exist it was a barrier to managing chronic conditions.

Poor dental services were identified as a barrier to self management of chronic conditions.

Isolation from community was a concern for participants.

Participants repeatedly highlighted the added costs associated with managing a chronic condition: home help, medication, therapy, tests and medical visits. Loss on income was also mentioned. Several participant also mentioned their concerns around transparency in decision making around the cost of ordering tests and intervention.

Participants were frank about their concerns about their experiences where they perceived a power imbalance in their interactions with the medical profession in managing their chronic conditions.

A report is currently being finalised for ACTDGP and will be available on the HCCA website soon.

Tuesday, September 15, 2009

GP Task Force Final Report

On 15 September 2009, the ACT Minister for Health, tabled the final report of the GP Taskforce in the ACT Legislative Assembly. The report is entitled General Practice and Sustainable Primary Health Care: The Way Forward and is available online (454kb Pdf)

The report presents the outcome of the ACT GP Taskforce’s debate and deliberation following consultation with a broad range of people and organisations

The final report provides the ACT Government with a range of recommendations that supports the provision of general practice and contribute to building a system of sustainable primary
health care for Canberra.

The Report covers issues including

  • Workforce Challenges such as workforce supply and better support for General Practice
  • Development of the non-medical workforce
  • Short and long term sustainability
  • Evolving service models
  • Access to primary care for Residential Aged Care Facilities
  • linking with Government's sustainable transport plan
  • Health Literacy and e-Health
  • Develop easy to read guidelines for the community and the profession on how to access health records


Tuesday, September 1, 2009

National Primary Health Care Strategy

The Primary Health Care Strategy has been released.

The Key Priority Areas are:

1. improving access and reducing inequity;
2. better management of chronic conditions;
3. increasing the focus on prevention;
4. improving quality, safety, performance and accountability.

Central to achieving this are:
  • patient-centred focus
  • eHealth system and
  • well educated and distributed workforce
The issues for consumers in accessing primary care have been identified and summarised in the document:
For individuals, the primary health care
services they access and the quality of
care that results can depend on where
they live, their particular condition, and
the particular service providers involved,
as much as their clinical needs and
circumstances. Many patients, particularly
those with complex needs, can either be
left to navigate a complex system on their
own or, even when supported by their
general practitioner (GP), be affected by
gaps in information flows and limited
ability to influence care decisions in other
services. (p.9 Strategy)

we will be very interested in following how this reform is implemented and how the community will be involved.