Sunday, July 1, 2012

Australia's Health 2012 - Conference Report

A group of HCCA staff and consumer representatives attended Australia’s Health at the National Convention Centre in Canberra on Thursday 21 June 2012.  Australia’s Health is the biannual publication of the Australian Institute of Health and Welfare.  This year marks the 25th anniversary of AIHW and many of the presentations on the day involved some reflection on our community’s health status and identifying challenges.

What follows is a summary of some of the things I heard and found interesting. I have done my best to accurately document the issues and figures.  If you are interested to find out more then go to the AIHW website and have a look at the In Brief document, a 50 page summary of the 650+ page report.

David Kalisch, Director of AIHW, gave an overview of some of the new information contained in the report.  Overall we are healthier and living longer however the incidence of chronic disease and cancer is increasing.  Of particular note:
  • Our smoking rates in the 25 year period have improved markedly but smoking rates are still highest among those in lowest socio ec group and Indigenous rates of smoking are %50
  • 1 in four Australians are obese, and many of us do not eat enough fruit and vegetables nor undertake the level of physical activity that we  need to have in order to prevent illness.  This is especially the case for those people who experience social or economic disadvantage.
  • Screening rates for bowel, cervical and breast screening are improving outcomes with earlier detection of cancers.  The report states that national bowel cancer screening for people over 50 years old are 38%, cervical screening is at 57% and 58% of woman are accessing breast screening.

Mr Kalisch also noted that some of the gaps in service.  For example, there has been considerable commitment to general practice providing counselling advice for nutrition, exercise, weight loss, alcohol use and other lifestyle issues but the data shows that consumers haven’t been accessing GPs for these issues in the last decade and the pattern is not changing.  I was intrigued by this and see that there is a real issue for general practice. Perhaps this means that doctors are not the right people for us to see for prevention programs and that there is a role of nurses and allied health professionals?  I’m keen to see what Medicare Locals think about this and am keen to complete research into consumer perceptions and expectations.
  • Our health system is spending the most money on cardiovascular, oral health and mental disorders.
  • Our health workforce is ageing but we have an expectation that those currently in the workforce will continue working until they are 65 and older.  There was a series of chuckles from people behind me and one man commented, “Well, thank you”. I’m not sure that he was altogether serious.

Mr Kalisch identified that there is the data gap In primary care and that the AIHW need to focus their attention on this.  We also need to determine the type of data that we need to collect.  He indicated that there was interest in what people are being diagnosed with at their GP and what GPs doing about this.  He also indicated an interest in consumer experience of health services, including in general practice and community services.  Medicare Locals may play a role in this but AIHW are still determining how this can happen.

Mr Kalisch acknowledged that the community is expecting information to be presented in more accessible, engaging and understandable forms.  He commented that the AIWW is responding to this and that they are providing free access to material on the website.

Professor Jim Bishop – clinical oncologist, Executive Director of the Victorian Comprehensive Cancer Centre.
I was interested to see Prof Bishop in a different capacity.  I had briefly worked with him on a committee reviewing the Dental Act in 2009 when he was Commonwealth Chief Medical Officer.  He is a knowledgeable fellow and I find him to be a good communicator.  Prof Bishop now leads the Victorian Comprehensive Cancer Centre.

Prof Bishop looked back at the improvements in health care over the past decade with particular reference to Cancer.  He drew on a range of data from AIHW as well as the cancer registries and NSW Cancer Institute.  Early in his talk he referred to the Provocative Questions in Cancerby Harold Varmus. Why do obese people get cancer more often? How can some turtles live more than a century without ever developing tumours while mice can develop them in a year? Could treatments that hold tumour cells in check without destroying them keep people alive longer? Answering questions like these may lead to the next big cancer breakthroughs and are important questions for consumers to ponder.

One the very interesting things Prof Bishop spoke about was the innovation of genomics.  Now, I don’t pretend to have followed much of his talk about this topic and but did catch a few things.  He was suggesting that an understanding of genomics can identify high risk populations and there are markers for early detection from blood test which will help consumers to modify our behaviours to reduce likelihood of developing cancer.  He also talked about new classifications for cancer and that research has found ways to turn off some cancer cells.  This has a positive effect on treatment as they can find individuals who will and will not respond.  Anyway, the key message here is that genomic are developing rapidly and we need to know more about it.

The Victorian Comprehensive Cancer Centre: Prof Bishop stressed that co-location will not improve outcomes alone.  It is about bringing the strength of the partner organisations: university research capability, links to general practice, and application of computer science with the high quality treatment program from the Peter McCallum Cancer Centre and surgical treatment expertise from other partners.  He signalled that one of the challenges is for proud organisations with long histories to let go of their independence and contribute to the collective.
Cancer burden on individuals and our health services is substantial.  The drivers of success so far are tobacco control, earlier interventions and new therapeutics.  Prof Bishop identified areas for work in the future:
  •  - Use of new evidence, especially about genomics
  •  - Enhance services and access for high risk groups for early intervention
  •  - We need to make a deeper impact on those cancers with poor prognosis such as lung, bowel, pancreas, and adult leukaemia.  The 5 year survival rates for these cancers is poor. The Pancreas 4% Lung 16%.  Dr Bishop stated that localised breast cancer has 5 year survivor rates of 98% which he attributes to screening and adjuvant therapy.
  •  - Comprehensive cancer centres offer hope of rapid progress in these areas.

Professor Bishop talked about the importance to have an increased focus on people living in rural communities and on the fringes of large metropolitan centres.  He commented that 5 year survival rates for people living in the outer suburbs of capital cities are akin to outcomes for people living in rural areas.  He stressed that this is not just about access  as many people in these areas have a poor hand of disadvantage, with low screening rates, high smoking rates, high levels of obesity and low rates of physical exercise.  He referred to this as bands of disadvantage.  Prof Bishop also mentioned that people in these areas are also diagnosed with cancer at a later stage and he commented that suggests a failure in general practice and primary care. Dr Bishop told the audience that when he was in NSW they found that there is under-referral rate for lung cancer, which means that people with lung cancer do not get referred to specialists.  He went on to say that evidence based treatments improve survival rates for lung cancer and that this is not acceptable.

Andrew Refshauge Chair, AIHW
Dr Refshauge has a long history in medicine and reflected on 25 years of practice and the  AIHW. The First AIHW report was in released in 1998 when health spending was $18bn annually; it has now increased to $128bn.  The cost of health care has grown at the rate of between 7-10%  each year.  This is most concerning as it is much higher than inflation (and indexation). 

We are now living longer, living healthier lives with less disability.  We have reduced smoking rates from 25% to 15% of the population but there are some communities that have smoking rates of up to 50%, including aboriginal communities.  There has been improvement in cancer survivor rates, as Prof Bishop outlined.

There are emerging issues of concern with the population increasingly becoming fat and slobby, with relatively high rates of chronic lung disease, diabetes and heart disease.
Transport accidents are on the rise. Motor vehicle accidents are increasing by 1.8% each year. Interestinly, cycle accident rates are increasing at 6% per year and has increased 25% per year for men between 45-55 years old.  He referred to the MAMIL Syndrome affecting emergency departments around the nation, Middle Aged Men In Lycra.

Dr Refshauge commented that our major concern continues to be the health of our Aboriginal and Torres Strait Islander peoples. He commented that our response to their health needs is “seriously deficient”.  Dr Refshauge reflected on his experience at the Redfern Aboriginal Medical Services.  He learnt that it is only when you provide services with people will get you results   If you don’t work with the people you will not get the results you want.  You achieve some positive results if you deliver services to people and for people but needs to be a hand in hand response, listening and sharing with each other.  This made my heart sing, to hear an experienced and committed leader talk about the need to value the role consumers play in our own health.

Darlene Cox
Executive Director

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