MEETING NOTES :: 31 July 2024 :: Ross Gittins

:: Meeting Notes

Further insights into prevention: The largest leap in life expectancy occurred towards the end of the 1960s through to around 2010, where we enjoyed an unprecedented extra 20 years in life expectancy within that short period of time. Its thought this is mostly due prevention and subsequently improved treatment of cardiovascular disease (given that other determinants hadn’t changed that much during this time – prior to this period, nutrition and control communicable diseases).

The consequences of the current overweight and obesity epidemic on the health of Australians is not clear. Modelling from 20 years ago implied we would see a commensurate change in mortality as obesity rates increased. This has not happened in Australia (though it is happening in the US). It is possible that the health benefits derived from other medically mediated health interventions have cushioned us against the harsher, more immediate impacts of obesity, especially in Australia where these services are more equitably distributed than say in the US. One consequence for Australia is that the cost of our healthcare is increasing significantly as it carries the burden of increased obesity. On this basis, healthcare is drawing funds away from other socially beneficial investments (education, housing) as our burden of disease rises.

Additional preventive opportunities: Restrictions on advertising, front of package labelling, sugar taxes all work. Additional levers available to support prevention that have not been canvassed including AI, social media, a focus on children via school meals and extra targeted education. In the past, business has been able to protect their interests, but this needs to change.

Healthy aging: As people age today, it’s not obesity and diabetes that feature, but cognitive impairment, frailty, gait disorders and loss of executive function, which all impacts their capacity to “”produce”, usually long before disease processes manifest. Healthy aging should protect us from excess population and excess capitalism.

If prevention is so good, how come it never gets properly funded: Because the medical profession has a vested interest in keeping the ambulances at the bottom of the cliff. But given that the most impactful prevention efforts are delivered outside the healthcare sector, it should never come down to a trade off between healthcare and prevention. AHPHA was attempt to do just this during the Rudd years, but it fell prey to the neoliberals when government changed in 2013.

The Economics of Loneliness: A important driver of wellbeing in older adults, independent of their age and vitality. Disconnection from work, friends dying, social activities, purpose. The capitalists have driven a competitive, profit-driven agenda for decades which has served them very well, but been hard on people – contrary to what economics is supposed to be able. It should be possible to reorient the agenda such that wellbeing is prioritised while economic prosperity is preserved.

Neoliberalism: the belief that what’s good for the Business Council is good for all of us – dominated policy making for 20 – 30 years, but manifestly did not work and is no longer viable. This realisation has re-opened the opportunity for old ideas to be updated and re-attempted e.g. ANPHA was established during Rudd/Gillard/Rudd but was the first thing to be cut by the Abbott/Tony Shepherd razor gang… now could be the right time to try something like this again, though updating for the technological age that we’re now in i.e. social media, AI etc.

In Praise of Idleness by Bertrand Russell. Productivity increases over time should have liberated more time for leisure, but what has instead happened is we’ve raised the levels of income required to achieve past comforts e.g. we now have two parents working when before only one was required. If a society lands a productivity improvement, it can be taken in money or it can be taken in leisure. Keynes predicted that by 2030, people would only need to work 15 hours per week to maintain living standards. What he didn’t predict correctly was that our society would be so materialist as to prefer to cash it out instead of working less. Governments shouldn’t aim to increase happiness, but instead focus on reducing unhappiness. Young doctors are expressing a desire to work fewer hours and better fulfil their obligations to their families.

Social vs Political Determinants of Health: The retirement age doesn’t necessarily need to be increased if the benefits of productivity are properly distributed i.e. to the people and not business (after Picketty). These dynamics are political decisions (via wages and tax policy), not emergent social phenomena. Should the argument be that Australia can no longer afford rampant inequality and is choosing a different, fairer, more sustainable path.

Rural – Urban healthcare equity: Address geographic coverage of medical care by tying access to Medicare to specific geographies. This could get around constitutional issues regarding civil conscription of doctors and dentists, but does not seem like an approach that policy makers are comfortable with.

Impact of AI on equality: AI has been sold on the basis that it will free us up to paint and write poetry, but instead what we’ve got is the AI painting and writing the poetry, and humans working harder than ever, with profits draining to the AI firms. How can the technology be used so that it doesn’t cause untold harm? Can AI be used to support primary prevention? How can the AI be used to nudge behaviours in favour of healthy lives? There is significant human agency still in play – stronger unions etc. – workers can still insist on getting their cut. If capitalists get all the proceeds, and households don’t get anything, then the whole system grinds to a halt. Balance between labour and capital is required to ensure the system is sustainable.

Population and the environment: More humans typically mean more negative environmental impact. Despite fertility rates plummeting in advanced economies, the economic impact of those remaining humans is rising as their individual consumption rises.

:: Reform Digest

PRIMARY CARE REFORM

Investing in value-based primary care: a pathway to sustainable healthcare | European Heart Journal | submitted by PaulN

Medicare hits middle age, and the future for our GPs is uncertain | MJA InSight+ | submitted by JohnV

Dialling 000 saves lives. Dialling 222 will save billions and lives – Medical Republic submitted by JohnV

Australia can afford to bulk bill all GP visits. So why don’t we? | The Conversation submitted by KerryG

ORAL HEALTH

‘Denticare’ is the goal, but it’s a long road ahead | Medical Republic featuring and submitted by LesleyR

Government response to the Senate report: A system in decay: a review into dental services in Australia | submitted by LesleyR

PREVENTION

Why preventing long-term sickness in the UK is an economic necessity | The Guardian | submitted by KerryG (related: Report by the Tony Blair Institute)

UK must move towards disease prevention to save economy and NHS, says expert | The Guardian | submitted by KerryG