Category Archives: politics

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, politics, rapid learning health systems, research methodology, technology

Katz slam dunks….

  • Used the Harvard Nurses Health Study to develop an algorithm for food healthiness as determined by health outcomes from the study – a GPS for nutrition – CLEVER!
  • Offered to do this with Government in the early 2000s but was knocked back
  • Developed a proprietary algorithm called ONQI, owned by NuVal
  • Choosing higher scoring foods correlates with a lower risk of dying prematurely.
  • “The very government agencies that regulate the food supply are extensively entangled with the entities producing our food, from farm to factory. In comparison, we mere eaters of food have very little clout. The government may be just a little too conflicted on the topic of food to be in the business of putting the truth, the whole truth and nothing but the truth on at-a-glance display.
    Certainly the big food manufacturers, the makers of glow-in-the-dark snackattackables, should NOT be in the business of nutrition guidance whatever their inclination. That approach makes the fox look like a highly qualified security officer for the henhouse.
    Which leaves independent nutrition, and public health experts and private sector innovation. And here we are.
    Private-sector innovation often involves intellectual property, trade secrets and patent applications. It involves some entity making an investment and wanting a return. That is all true of NuVal, for better or worse. It wasn’t my plan – it was just the only way to get this empowering system into the hands of shoppers. Of note, the ONQI remains under the independent control of scientists, and not the business.”
  • This is a terrific strategy – worthy of emulation.

Source: http://health.usnews.com/health-news/blogs/eat-run/2013/06/11/nutrition-guidance-who-needs-to-know-what

Nutrition Guidance: Who Needs to Know What?

  June 11, 2013 

I am writing today about nutrition guidance and who needs to know what to make it useful.

Permit me to disclose right away that I am the principal inventor of the Overall Nutritional Quality Index (ONQI) algorithm, used in NuVal – a nutritional guidance system that stratifies foods from 1 to 100 on the basis of overall nutritional quality: the higher the number, the more nutritious the food. As the Chief Science Officer for NuVal, LLC, I am compensated for my continuous and considerable allocations of time and effort. But it was never supposed to be that way – and the reasons why it is are an important part of this story.

As to why this column now, there are two recent provocations. One is our ongoing work to complete the updated algorithm, ONQI 2.0, and the window that provides into a world of weirder foods than I ever even considered possible. The other is a paper published in the Journal of the Academy of Nutrition and Dietetics a few months back and a more recent exchange of letters related to that article. The article described the advantageous novelties of a nutritional profiling system, such as weighting nutrients for their health effects rather than counting them all the same. But this was less about novelty, and more about NuVal, since the innovations described have long been included in the ONQI.

[See: Debunking Common Nutrition Myths.]

Claims about alleged novelties that were already included in NuVal prompted a letter from my colleagues and me to the journal, which was published along with a response from the original authors. In that response, they acknowledged that the NuVal system included the so-called “novelties” and acknowledged that the ONQI is, to date, the only nutritional profiling system shown to correlate directly with health outcomes. So the real concern, the letter went on, is that the ONQI algorithm is proprietary and the details are not fully in the public domain.

Which brings us back to why NuVal is a private and proprietary system in the first place and whether or not it matters that certain details of the algorithm – which populate 25 pages or so of computer code written in a language called SAS – are not on a billboard. Why isn’t the ONQI public rather than private, and who really needs to know every detail of the algorithm for it to be useful? (All of the nutrients included in it, and the basic approaches used to generate scores, have been published.)

The ONQI, and NuVal, are a private sector innovation because the public sector said: no thanks. In 2003, I was privileged to be a member of a group of 15 academics invited to Washington, D.C. by then-Secretary of Health Tommy Thompson. A Food and Drug Administration task force had been formed to guide efforts related to the control of rampant obesity and diabetes, and we were a part of that effort. We gathered in a conference room with Secretary Thompson, the FDA Commissioner (Mark McClellan) and others, including the surgeon general and the heads of the National Institutes of Health and the Centers for Disease Control and Prevention.

[See: Why Aren’t Americans Healthier?]

We were each given one three-minute turn to offer up one good idea the FDA and other federal agencies might use to help combat the ominoustrends in diabetes and obesity. I used my turn to describe, in essence, the project that later became the ONQI. I suggested that the secretary might convene a totally independent group of top-notch experts in nutrition and public health, perhaps under the auspices of the Institute of Medicine.

The group should have no political or industry entanglements and should be allowed to work for as long as it took to convert the best available nutrition science and knowledge into a guidance system anyone could understand at a glance. I was thinking, in essence, of the equivalent of GPS for nutrition, so that no one trying to identify a better food in any given category would get lost, confused or misled by Madison Avenue.

[See: 10 Things the Food Industry Doesn’t Want You to Know.]

I waited two years for the feds to do something along these lines. When they didn’t, I decided to undertake the project myself, with the backing of Griffin Hospital in Derby, Conn. – a Yale-affiliated, not-for-profit community hospital, which owns the ONQI algorithm to this day. Other than this being a private rather than federal endeavor, all other aspects of the project were just as proposed to the U.S. Secretary of Health. When we completed the algorithm, I offered it again to the FDA. A scientist at the agency recommended a private-sector approach if I hoped to live long enough to see the system do its intended good.

Why didn’t the feds take on the project? We can all conjecture. I suspect it has something to do with the story Marion Nestle told us all in Food Politics, and the stories we routinely hear about the Farm Bill from the likes of Michael Pollan, Mark Bittman and others. The very government agencies that regulate the food supply are extensively entangled with the entities producing our food, from farm to factory. In comparison, we mere eaters of food have very little clout. The government may be just a little too conflicted on the topic of food to be in the business of putting the truth, the whole truth and nothing but the truth on at-a-glance display.

[See: Seeking a More Perfect Food Supply.]

Certainly the big food manufacturers, the makers of glow-in-the-dark snackattackables, should NOT be in the business of nutrition guidance whatever their inclination. That approach makes the fox look like a highly qualified security officer for the henhouse.

Which leaves independent nutrition, and public health experts and private sector innovation. And here we are.

Private-sector innovation often involves intellectual property, trade secrets and patent applications. It involves some entity making an investment and wanting a return. That is all true of NuVal, for better or worse. It wasn’t my plan – it was just the only way to get this empowering system into the hands of shoppers. Of note, the ONQI remains under the independent control of scientists, and not the business.

[See: Mastering the Art of Food Shopping.]

Which leads us back to the second question: Is it a problem for a system like this to be a private-sector innovation? Who, really, needs to know every detail of such an algorithm?

Consider that if you are shopping for a car, you do need to know if it comes with anti-lock brakes or all-wheel drive. But to decide if these are working for you, you don’t need engineering blueprints; you just need to drive in the snow. When shopping for a smartphone, you may want to know if it has GPS. But you don’t need the trigonometry equations on which the GPS is based to determine if it works; you just have to see if it helps you get where you want to go.

Nutrition guidance in general, and NuVal in particular, are just the same. What are the exact formula details? Who cares. We routinely rely on tools based on math and engineering most of us don’t understand – but we don’t need all that input to know if the tools are working for us. We just need the output. We need to be able to use them. People using NuVal have lost more than 100 pounds, and even over 200 pounds. Choosing higher scoring foods correlates with a lower risk of dying prematurely. More than 100,000 scores are on public display in 1,700 supermarkets nationwide. The ONQI is at least as transparent as any car or smartphone or computer.

[See: The No. 1 Skill for Weight Management.]

Let’s acknowledge: If you are reading this on a computer screen, neither of us truly understands the engineering involved in me writing it, using word processing software, attaching it to an email and sending it to my editor at U.S. News & World Report so she could post it in cyberspace, where you found it. But we do know it worked.

We rely on private-sector innovation for a lot of important jobs, and even many that put our safety on the line. The private sector makes our cars and planes. We seem to be comfortable using these without scrutinizing patent applications. The private sector makes our computers, and smartphones and GPS systems, and we can tell whether or not these work, even if we don’t know how.

Why, then, is nutrition guidance different? The answer, I believe, is politics, profits and the inertia of the status quo. We are accustomed to vague nutrition guidance from conflicted sources, and those same sources are apt to imply there is something wrong with private-sector innovation and the intellectual property issues that come along with it. But if those issues don’t undermine the cars, and planes and navigation systems that get us from city to city and coast to coast, it’s not at all clear why they should be a problem when navigating among choices in a supermarket aisle.

[See: The Government’s MyPlate Celebrates Second Birthday.]

As a scientist, and not a businessperson, my preference would be to put the ONQI on a billboard for all the good it would do. But on this, I must defer to the businesspeople who have made the relevant investments and are entitled to safeguard potential returns. As for the scrutiny that all advanced systems should get, the ONQI has been shared with scientists at leading universities and health agencies around the world – but for private assessment and use rather than public display. Others like them who want to review the program need only ask.

We should all care that the military-industrial establishment seems opposed to putting the blunt truth about nutritional quality, as best we know it, on at-a-glance display. We should care that federal authorities responsible for nutrition guidance are also responsible, if only indirectly, for food politics and supply-side profits. That story may lack novelty. It may be old news. But it is nonetheless something everyone who eats does need to know – engineering blueprints not required.

healthcare, policy, politics

Diabetes set to become the largest epidemic in human history…

  • 600 million will suffer diabetes in 20 years, 2.3 million in Australia
  • Will kill one person every 6 seocnds (5.1 million people this year)
  • Affects developing economies just as much as developed economies
  • The US spends USD263 billion annually on diabetes
  • In 2013, AU will spend AUD11.4 billion, with 1 in 10 adults afflicted and 9500 deaths attributed.
  • Indigenous Australians have prevalence around 30%
  •  Western Pacific Islands have prevalence over 35%
  • Middle East (Saudi, Qatar, Kuwait) has a diabetes prevalence of 24%

 

Source: http://www.medicalobserver.com.au/news/largest-epidemic-in-human-history

‘Largest epidemic in human history’

DIABETES is likely to be “the largest epidemic in human history” with the number of people with diabetes predicted to surge to nearly 600 million in 20 years, including 2.3 million in Australia, experts say.

The latest edition of the International Diabetes Federation’s Diabetes Atlas, published today on World Diabetes Day, estimated that diabetes kills one person every six seconds and it will cause the deaths of 5.1 million people this year.

Professor Paul Zimmet, director emeritus of the Baker IDI Heart and Diabetes Institute, said the Diabetes Atlas group predicted 20 years ago that there would be 200 million people in the world with diabetes, but the predicted numbers for 2035 are almost double.

“Diabetes is likely to be the biggest health problem, the largest epidemic in human history,” he said.

The data showed that the majority of the 382 million people with diabetes today are aged between 40 and 59 and 80% of them live in low- and middle-income countries.

Professor Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute, said the data debunked the historical idea that diabetes was a rich man’s disease.

“It really is not, when we look at the distributions across the world because the largest numbers of people with it are clearly in the developing world, particularly in our region with 138 million [in the Western Pacific] and 72 million in South Asia,” he said.

In contrast, around 37 million have diabetes in North America and 56 million in Europe.

However, health expenditure on diabetes in North American was 263 billion, higher than any other region in the world.

Australia spent $11.4 billion on diabetes care in 2013, with one in 10 adults now having diabetes, and more than 9500 people died from diabetes in Australia in 2013.

Comparative prevalence rates were highest in the Western Pacific Islands, where 37% of the population in Tokelau had diabetes, 35% in the Marshall Islands and 35% in Micronesia.

However, comparative prevalence rates had also surged in the Middle East where around 24% of the population in Kuwait, Saudi Arabia and Qatar have diabetes.

These prevalence rates were similar to that seen in Aboriginal and Torres Strait Islanders, where more than 30% of the population had diabetes, and high prevalence rates were common in indigenous people around the world.

entrepreneurship, meaning, policy, politics

Bill Gates: Here’s My Plan to Improve Our World — And How You Can Help

From: http://www.wired.com/business/2013/11/bill-gates-wired-essay/all/

Bill Gates: Here’s My Plan to Improve Our World —
And How You Can Help

  • BY BILL GATES
  • 11.12.13
  • 6:30 AM

I am a little obsessed with fertilizer. I mean I’m fascinated with its role, not with using it. I go to meetings where it’s a serious topic of conversation. I read books about its benefits and the problems with overusing it. It’s the kind of topic I have to remind myself not to talk about too much at cocktail parties, since most people don’t find it as interesting as I do.

But like anyone with a mild obsession, I think mine is entirely justified. Two out of every five people on Earth today owe their lives to the higher crop outputs that fertilizer has made possible. It helped fuel the Green Revolution, an explosion of agricultural productivity that lifted hundreds of millions of people around the world out of poverty.

These days I get to spend a lot of time trying to advance innovation that improves people’s lives in the same way that fertilizer did. Let me reiterate this: A full 40 percent of Earth’s population is alive today because, in 1909, a German chemist named Fritz Haber figured out how to make synthetic ammonia. Another example: Polio cases are down more than 99 percent in the past 25 years, not because the disease is going away on its own but because Albert Sabin and Jonas Salk invented polio vaccines and the world rolled out a massive effort to deliver them.

Thanks to inventions like these, life has steadily gotten better. It can be easy to conclude otherwise—as I write this essay, more than 100,000 people have died in a civil war in Syria, and big problems like climate change are bearing down on us with no simple solution in sight. But if you take the long view, by almost any measure of progress we are living in history’s greatest era. Wars are becoming less frequent. Life expectancy has more than doubled in the past century. More children than ever are going to primary school. The world is better than it has ever been.

But it is still not as good as we wish. If we want to accelerate progress, we need to actively pursue the same kind of breakthroughs achieved by Haber, Sabin, and Salk. It’s a simple fact: Innovation makes the world better—and more innovation equals faster progress. That belief drives the work my wife, Melinda, and I are doing through our foundation.

WE WENT ON A SAFARI TO SEE WILD ANIMALS BUT ENDED UP GETTING OUR FIRST SUSTAINED LOOK AT EXTREME POVERTY. WE WERE SHOCKED.

Of course, not all innovation is the same. We want to give our wealth back to society in a way that has the most impact, and so we look for opportunities to invest for the largest returns. That means tackling the world’s biggest problems and funding the most likely solutions. That’s an even greater challenge than it sounds. I don’t have a magic formula for prioritizing the world’s problems. You could make a good case for poverty, disease, hunger, war, poor education, bad governance, political instability, weak trade, or mistreatment of women. Melinda and I have focused on poverty and disease globally, and on education in the US. We picked those issues by starting with an idea we learned from our parents: Everyone’s life has equal value. If you begin with that premise, you quickly see where the world acts as though some lives aren’t worth as much as others. That’s where you can make the greatest difference, where every dollar you spend is liable to have the greatest impact.

I have known since my early thirties that I was going to give my wealth back to society. The success of Microsoft provided me with an enormous fortune, and I felt responsible for using it in a thoughtful way. I had read a lot about how governments underinvest in basic scientific research. I thought, that’s a big mistake. If we don’t give scientists the room to deepen our fundamental understanding of the world, we won’t provide a basis for the next generation of innovations. I figured, therefore, that I could help the most by creating an institute where the best minds would come to do research.

There’s no single lightbulb moment when I changed my mind about that, but I tend to trace it back to a trip Melinda and I took to Africa in 1993. We went on a safari to see wild animals but ended up getting our first sustained look at extreme poverty. I remember peering out a car window at a long line of women walking down the road with big jerricans of water on their heads. How far away do these women live? we wondered. Who’s watching their children while they’re away?

That was the beginning of our education in the problems of the world’s poorest people. In 1996 my father sent us a New York Times article about the million children who were dying every year from rotavirus, a disease that doesn’t kill kids in rich countries. A friend gave me a copy of a World Development Report from the World Bank that spelled out in detail the problems with childhood diseases.

Melinda and I were shocked that more wasn’t being done. Although rich-world governments were quietly giving aid, few foundations were doing much. Corporations weren’t working on vaccines or drugs for diseases that affected primarily the poor. Newspapers didn’t write a lot about these children’s deaths.

This realization led me to rethink some of my assumptions about how the world improves. I am a devout fan of capitalism. It is the best system ever devised for making self-interest serve the wider interest. This system is responsible for many of the great advances that have improved the lives of billions—from airplanes to air-conditioning to computers.

But capitalism alone can’t address the needs of the very poor. This means market-driven innovation can actually widen the gap between rich and poor. I saw firsthand just how wide that gap was when I visited a slum in Durban, South Africa, in 2009. Seeing the open-pit latrine there was a humbling reminder of just how much I take modern plumbing for granted. Meanwhile, 2.5 billion people worldwide don’t have access to proper sanitation, a problem that contributes to the deaths of 1.5 million children a year.

Governments don’t do enough to drive innovation either. Although aid from the rich world saves a lot of lives, governments habitually underinvest in research and development, especially for the poor. For one thing, they’re averse to risk, given the eagerness of political opponents to exploit failures, so they have a hard time giving money to a bunch of innovators with the knowledge that many of them will fail.

By the late 1990s, I had dropped the idea of starting an institute for basic research. Instead I began seeking out other areas where business and government underinvest. Together Melinda and I found a few areas that cried out for philanthropy—in particular for what I have called catalytic philanthropy.

I have been sharing my idea of catalytic philanthropy for a while now. It works a lot like the private markets: You invest for big returns. But there’s a big difference. In philanthropy, the investor doesn’t need to get any of the benefit. We take a double-pronged approach: (1) Narrow the gap so that advances for the rich world reach the poor world faster, and (2) turn more of the world’s IQ toward devising solutions to problems that only people in the poor world face. Of course, this comes with its own challenges. You’re working in a global economy worth tens of trillions of dollars, so any philanthropic effort is relatively small. If you want to have a big impact, you need a leverage point—a way to put in a dollar of funding or an hour of effort and benefit society by a hundred or a thousand times as much.

One way you can find that leverage point is to look for a problem that markets and governments aren’t paying much attention to. That’s what Melinda and I did when we saw how little notice global health got in the mid-1990s. Children were dying of measles for lack of a vaccine that cost less than 25 cents, which meant there was a big opportunity to save a lot of lives relatively cheaply. The same was true of malaria. When we made our first big grant for malaria research, it nearly doubled the amount of money spent on the disease worldwide—not because our grant was so big, but because malaria research was so underfunded.

But you don’t necessarily need to find a problem that’s been missed. You can also discover a strategy that has been overlooked. Take our foundation’s work in education. Government spends huge sums on schools. The state of California alone budgets roughly $68 billion annually for K-12, more than 100 times what our foundation spends in the entire United States. How could we have an impact on an area where the government spends so much?

We looked for a new approach. To me one of the great tragedies of our education system is that teachers get so little help identifying and learning from those who are most effective. As we talked with instructors about what they needed, it became clear that a smart application of technology could make a big difference. Teachers should be able to watch videos of the best educators in action. And if they want, they should be able to record themselves in the classroom and then review the video with a coach. This was an approach that others had missed. So now we’re working with teachers and several school districts around the country to set up systems that give teachers the feedback and support they deserve.

The goal in much of what we do is to provide seed funding for various ideas. Some will fail. We fill a function that government cannot—making a lot of risky bets with the expectation that at least a few of them will succeed. At that point, governments and other backers can help scale up the successful ones, a much more comfortable role for them.

We work to draw in not just governments but also businesses, because that’s where most innovation comes from. I’ve heard some people describe the economy of the future as “post-corporatist and post-capitalist”—one in which large corporations crumble and all innovation happens from the bottom up. What nonsense. People who say things like that never have a convincing explanation for who will make drugs or low-cost carbon-free energy. Catalytic philanthropy doesn’t replace businesses. It helps more of their innovations benefit the poor.

Look at what happened to agriculture in the 20th century. For decades, scientists worked to develop hardier crops. But those advances mostly benefited the rich world, leaving the poor behind. Then in the middle of the century, the Rockefeller and Ford foundations stepped in. They funded Norman Borlaug’s research on new strains of high-yielding wheat, which sparked the Green Revolution. (As Borlaug said, fertilizer was the fuel that powered the forward thrust of the Green Revolution, but these new crops were the catalysts that sparked it.) No private company had any interest in funding Borlaug. There was no profit in it. But today all the people who have escaped poverty represent a huge market opportunity—and now companies are flocking to serve them.

Or take a more recent example: the advent of Big Data. It’s indisputable that the availability of massive amounts of information will revolutionize US health care, manufac­turing, retail, and more. But it can also benefit the poorest 2 billion. Right now researchers are using satellite images to study soil health and help poor farmers plan their harvests more efficiently. We need a lot more of this kind of innovation. Otherwise, Big Data will be a big wasted opportunity to reduce inequity.

People often ask me, “What can I do? How can I help?”

Rich-world governments need to maintain or even increase foreign aid, which has saved millions of lives and helped many more people lift themselves out of poverty. It helps when policymakers hear from voters, especially in tough economic times, when they’re looking for ways to cut budgets. I hope people let their representatives know that aid works and that they care about saving lives. Bono’s group ONE.org is a great channel for getting your voice heard.

Companies—especially those in the technology sector—can dedicate a percentage of their top innovators’ time to issues that could help people who’ve been left out of the global economy or deprived of opportunity here in the US. If you write great code or are an expert in genomics or know how to develop new seeds, I’d encourage you to learn more about the problems of the poorest and see how you can help.

At heart I’m an optimist. Technology is helping us overcome our biggest challenges. Just as important, it’s also bringing the world closer together. Today we can sit at our desks and see people thousands of miles away in real time. I think this helps explain the growing interest young people today have in global health and poverty. It’s getting harder and harder for those of us in the rich world to ignore poverty and suffering, even if it’s happening half a planet away.

Technology is unlocking the innate compassion we have for our fellow human beings. In the end, that combination—the advances of science together with our emerging global conscience—may be the most powerful tool we have for improving the world.

complex adaptive systems, data saving lives, healthcare, meaning, musings, policy, politics, rapid learning health systems

The gist of my concerns…

Post-change makers festival closing event, here’s a first go at capturing my main beefs with the health system – a little rough around the edges but captures the gist:

 

  Appearance Reality Vision
Mission Brittle health system Bankrupt sickness market Sustainable learning wellness market
Universality Universal healthcare Safety net + PHI Universal
Payment Fee for care Fee for activity Fee for outcomes
Leadership Run by experts Run by amateurs Run by the finest minds
Levers Doctors in hospitals prescribing pharmaceuticals and performing procedures Unmanaged social determinants with doctors spruiking pills and procedures Actively managed social determinants featuring broccoli magnates

That said, and given the issues and concerns we discussed, I suspect some (if not all) of what needs to happen, has to happen alongside or entirely outside the existing system. Hmm.

I just returned from the closing event for this: http://changemakersfestival.org/

I didn’t have a chance to properly speak with Jenny about our discussion, but got the impression that there simply wasn’t the kind of support for think tanks here that existed overseas.

That said, I did have a reasonable chat with Nicholas Gruen – an very interesting economist and thinker – and suspect there may be an alternate angle to pursue… will keep you posted.

data saving lives, healthcare, musings, policy, politics

Urologists… WTF?

If the urologists behaved any more egregiously, they’d be drifting into crimes against humanity. It’s good to see the Cancer Council calling this out for what it is: “A disservice to men”. It’s also time for these ghouls to cease veiling their self-interest as their patients’.

http://www.medicalobserver.com.au/news/cancer-council-urges-men-to-think-carefully-before-prostate-testing

Cancer Council urges men to think carefully before prostate testing

Catherine Hanrahan   all articles by this author

A DRAMATIC increase in prostate cancer cases has prompted Cancer Council NSW to call for men to think carefully before being tested, but urologists refute the suggestion men are being treated unnecessarily.

A new study shows the number of prostate cancer diagnoses in Australia jumped 276% over the 20 years from 1987 to 2007.

This is a result of increased testing, lead author Associate Professor Freddy Sitas of Cancer Council NSW, said.

He said that even if a positive result is correct, unless they operate, doctors have no foolproof way of knowing if the cancer is aggressive or relatively harmless.

“Saving lives is our priority, but we urgently need a better test,” Professor Sitas said.

“The tests have saved men with aggressive forms of the disease, but at a high cost.”

A 27% drop in the death rate was observed over the study period, he said.

However, the increase in new cases is much greater than this.

“This indicates that many men were diagnosed with cancers that would not have harmed them.”

However, the Urological Society of Australia and New Zealand has strongly refuted claims by the Cancer Council NSW that men have been done a “great disservice” by the growth in prostate cancer diagnoses, and have been subjected to unnecessary treatment.

“Twenty years ago we didn’t have a test to diagnose prostate cancer, which meant most men presented with advanced, incurable disease,” Professor Mark Frydenberg, the Urological Society’s Vice-President, said.

Many low risk cancers were more typically observed, not treated, he said, with active surveillance, now considered a mainstream pathway.

The University of NSW’s Professor Mark Harris says: “Until we have a better method of screening, men need to be fully informed about the pros and cons of testing.”

Cancer Epidemiol 2013; online 1 November

healthcare, politics

The future of Medicare

It was terrific to connect up with Anne-marie at the Progressive Australia conference. Looking forward to plenty of conversations around these themes…

The future of Medicare: it’s time to start talking

by 

28 October 2013 in New Progressive Thinking

On 1 February 2014 Australia will celebrate the 30th anniversary of Medicare. After all this time, Labor remains proud that it delivered universal health care to all Australians. During the recent election campaign, Tanya Plibersek, Minister for Health at the time, declared Medicare to be “an enduring symbol of our health system which represents the very best of Federal Labor”. She explained, “Labor is Medicare – we built it, and we’re the only party that Australians can trust to protect and strengthen it.”

The Coalition was slow to embrace Medicare – it vigorously opposed the idea of a compulsory health insurance scheme from the mid-1960s right up until the mid-1990s – but it is now a strong supporter of the scheme. When in government between 1996 and 2007, the Coalition demonstrated its commitment to Medicare by lifting bulk-billing rates (which are considered to be a foundation of universal access to health care) from 68.5% in 2003–04 to 78% in 2006–07. In response to this, Tony Abbott, as minister for health in the Howard government, declared that the Coalition was “Medicare’s greatest friend.”

The bipartisan support for Medicare in Australia stands in stark contrast to the partisan divisions over health care in the United States. The bitter and protracted feud there between Republicans and Democrats over ‘Obamacare’ recently reached a new low when members of the Tea Party movement demanded Obamacare be defunded, contributing to the 16 day shutdown of the federal government.

Most Australians find it difficult to understand why some Americans are vehemently opposed to a scheme that aims to make health care more affordable, and they find the overblown rhetoric about its impact ridiculous. One of the most ludicrous statements made about the impact of Obamacare came from a 2012 Republican presidential candidate and Tea Party activist who said: “If Obamacare had been fully implemented when I caught cancer, I’d be dead.”

When Medibank was introduced in Australia during the 1970s (Medibank was the almost identical scheme that preceded Medicare), debates were heated, but only occasionally did they go beyond the pale; the most notable example was the anti-Medibank posters produced by a medical lobby group that portrayed Bill Hayden as a Nazi. For the most part, however, the tenor of debates in Australia over universal health care has been much more moderate than in has been in the US.

With Medicare now settled policy and the scheme achieving an almost sacred status in the national psyche, debate about its future has almost become sacrilegious. Any suggestion that it is no longer meeting its core objectives – of ensuring our health system is equitable, efficient and universal – sends its long-term advocates scurrying to its defence, fearful that past campaigns to destroy it will be revived. More recent converts to Medicare are also desperate to steer clear of debates about its effectiveness lest they be accused of being lukewarm supporters, harbouring secret plans to undermine it. In some ways, this refusal to have an open discussion about Medicare is just as harmful to progress as the highly ideological and extremist debates evident in the US.

In my recently published book, The Making of Medicare, co-authored with James Gillespie, we argue that we need to start thinking about how Medicare can be reformed so that it can meet the needs of 21st century Australians.

While Medicare has served us well, we need to remember that it was designed in the 1960s and 1970s to meet the problems of that period. Australia was, demographically, a much younger society then, and the health problems people faced normally required very short periods of treatment. Patients, for example, would go to a general practitioner with a minor, short-term complaint and the fee-for-service system worked well when people only occasionally went to the doctor. Hospitals worked on an entirely separate system that dealt with very serious illness, but they, too, were set up to deal with acute illnesses that were either cured or not; ongoing follow-up care after discharge from hospital was a rarity.

We are now living healthier and longer lives, but an ageing society brings with it a greater burden of chronic illness. Instead of short episodes of illness, ending in death or cure, the growing burden of disease comes from serious and continuing illnesses, such as diabetes, chronic heart disease and respiratory illnesses. These need ongoing care and management, often over a lifetime, and few people have the expectation of complete cure.

The Medicare system was not designed to support ongoing care and management. Instead, the fee-for-service system (which also preferences medical care over other health care services) fragments care into short episodes of discrete service delivery. As a result, our current health system is not able to provide optimal care to large numbers of people. Because Medicare was never designed to foster co-ordinated care, it is perhaps not surprising that it now struggles to achieve it.

The challenge for progressive thinkers now is to accept that Medicare is now struggling to meet its core objectives. Because debate about its future has largely been stifled, there are few realistic reform options for policymakers to consider. Fortunately, Labor has a proud history of developing robust health reform policy proposals in opposition. The original Medibank scheme was developed, fully costed and widely promoted under the Whitlam-led opposition during the 1960s and 70s. And the introduction of Medicare was secured by Labor when the Hawke-led opposition negotiated its historic price and incomes accord with the unions. The time is ripe, therefore, for Labor to stake its claims over the future of Medicare by kick starting a debate about how it should be reformed.

Anne-marie Boxall is speaking at the Building a Progressive Future conference, on the panel ‘When Government Fails’ at 4pm on Saturday 2 November. To see the agenda and get your tickets, click here.

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Institute for Health Metrics and Evaluation

 

This extraordinary resource by the Institute for Health Metrics and Evaluation was handsomely funded by the Gates Foundation and features interactive data visualisations across a range of country-based and global data sets. The data has been carefully curated and is very handy for looking at risk factors and causes.

IHME

http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow-diagram