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HealthSpeak Issue 24• April 2019

THE VOICE FOR HEALTH PROFESSIONALS FROM TWEED TO PORT MACQUARIE

North Coast Collective: A new shared vision for health care Mid North Coast and Northern NSW Local Health Districts have partnered with North Coast Primary Health Network in a new approach to mental health, alcohol and other drugs commissioning. See page 16

Mid North Coast Local Health District Northern NSW Local Health District

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Suicide prevention plans launched

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Isolated community gets GP clinic

Regional health

12 fact sheets

Marianne Trent

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Introducing a new vision for health: North Coast Collective Head Office 106-108 Tamar Street Ballina 2478 Ph: 6618 5400 CEO: Vahid Saberi Email: enquiries@ncphn.org.au Hastings Macleay 53 Lord Street Port Macquarie 2444 Ph: 6583 3600 Cnr Forth and Yaelwood Sts Kempsey 2440 Email: enquiries@ncphn.org.au Mid North Coast 6/1 Duke Street Coffs Harbour 2450 Ph: 6659 1800 Email: enquiries@ncphn.org.au Northern Rivers 2A Carrington Street Lismore 2480 Ph: 6627 3300 Email: enquiries@ncphn.org.au Tweed Valley 145 Wharf St, Tweed Heads 2486 Phone: 07 5589 0500 Email: enquiries@ncphn.org.au

editor Janet Grist

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e introduce readers to North Coast Collective (NCC) this issue (page 16). It’s a totally new approach to improving health outcomes with the first phase focusing on mental health. The ABC’s Dr Norman Swan has this month facilitated four

New faces herald new developments at NCPHN

Health Speak Contacts Editor: Janet Grist Ph: 6618 5400 Email: media@ncphn.org.au Clinical Editor: Andrew Binns Email: abinns@gmc.net.au Design and illustrations: Graphiti Design Studio Email: dougal@gdstudio.com.au Display and classified advertising at attractive rates HealthSpeak is published three times a year by North Coast Primary Health Network. Articles appearing in HealthSpeak do not necessarily reflect the views of the NCPHN. The NCPHN accepts no responsibility for the accuracy of any information, advertisements, or opinions contained in this magazine. Readers should rely on their own enquiries and independent professional opinions when making any decisions in relation to their own interests, rights and obligations. ©Copyright 2019 North Coast Primary Health Network Magazine designed by Graphiti Design Studio www.gdstudio.com.au Printed by Quality Plus Printers

HealthSpeak is kindly supported by

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workshops for NCPHN to explain NCC and to explore the issues around mental health with both the community and health and community service providers. These were held in Coffs Harbour and Ballina. In the feature on North Coast Collective, NCPHN’s CEO Julie Sturgess talks about the concept, the beginning stages and how it differs from traditional funding approaches. We also talk to the man behind an amazing new optimisation tool that will help NCC predict the

ceo Julie Sturgess

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018 has sped by and we are working on many exciting projects, not least the North Coast Collective (NCC) which you can read all about on page 16. It’s very early days for the NCC but we were delighted with both the community and service provider attendance at our introductory workshops on mental health and alcohol and other drugs held in Coffs Harbour and Ballina recently. Facilitated by the ABC’s Dr Norman Swan, we have made a great start to the first phase of NCC – improving the lives of those living on the North Coast with mental health issues and alcohol and substance use issues. In our community surveys, residents consider mental health issues and alcohol and other drugs to be their number one health concern. We look forward to working further with GPs, practice staff, allied

health providers and specialists to ensure the mental health services offered in our region are as relevant, useful and easy to navigate as we can make them. We will keep you posted as the North Coast Collective progresses. With this emerging reform in our approach, we have had some changes in the NCPHN organisational structure to reflect this shift and to efficiently operate in this new landscape.

We were delighted with the attendance at our workshops on mental health and alcohol and other drugs I’m delighted to be able to announce newly appointed Executive Directors at NCPHN. Tony Hendry is the Director of Corporate Services. Tony was previously Chief Financial Officer for both Queensland and

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health outcomes of particular services and programs and thus make decision-making around funding more transparent and accountable. Also in this issue, we talk to Local Health District Immunisation Coordinator Marianne Trent, who’s retiring after 27 years in the role. She has some fascinating insights into the anti-vaccination movement, and best of all is confident that the influence of the anti-vaxxers is waning and vaccination rates will rise. Northern Territory Health and will expertly lead our financial services team. Monika Wheeler has moved from her previous role to Director of Wellness – a wide-ranging portfolio dealing with chronic disease and also overseeing our Aboriginal health team. As you know, Monika has been with NCPHN for some years in senior roles and is a former adviser to Federal MP Tanya Plibersek. Glen James has been appointed as Executive Director of Mental Health. Glen was previously West Australian Manager of Neami National. This organisation delivered a range of mental health programs and psychosocial services. Mason Andrews is the new Executive Director of Digital & Marketing. Mason has many years’ experience in both IT and eHealth in NSW, Queensland and in national positions. Most recently he has worked in a role with the Queensland Government implementing a whole of government collaboration platform. These are exciting times for NCPHN as we further build our capability to support the North Coast region in developing a leading approach to primary healthcare which focuses on outcomes for consumers. healthspeak April 2019


Treating obesity within a global syndemic of malnutrition IT IS TIME TO RETHINK OBESITY WITHIN A BROADER SCHEMA OF SOCIAL, ECONOMIC AND ENVIRONMENTAL MALNUTRITION AS DR ANDREW BINNS EXPLAINS.

D O O F BIG EAL$ MEAL D

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espite it being a widespread issue, obesity is still regarded by many as an individual responsibility resulting from wrong choices and motivations. However, blaming an individual for inactivity and overconsumption is both unhelpful and inappropriate. A new report issued by the Lancet Commission shows the need to address this issue through a broader socioeconomic and environmental lens. Regardless of numerous studies and the best efforts of health professionals, obesity worsens. In the 2017 Global Burden of Disease analysis, high bodymass index (BMI) increased by 36.7% between 2007 and 2017, and by 127% between 1990 and 2017. It is the fourth leading risk factor for mortality in the world, with further increases predicted. Of the 192 countries in the survey, Australia ranked 31st, with 28.6% of the population obese. With statistics like these, a business as usual approach does not suffice. The recent Lancet Commission Report originally focused on obesity but underwent a progression to include undernutrition and climate change. The Commission comprises 26 experts from 14 countries. The co-chairs leading this report are Boyd Swinburn, Professor of Population Nutrition and Global Health in the School of Population Health, University April 2019 healthspeak

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of Auckland; and William Dietz, Milken Institute School of Public Health, George Washington University. The report describes the syndemic — or interaction of social, environmental and economic factors that promote and worsen disease — of obesity, undernutrition and climate change. The Commission explains that there are underlying human-made drivers and existing feedback loops that lead to malnutrition in all its forms, and that there is a need to achieve both healthy body weight for the population as

well as a healthy ecosystem for the survival of the planet. This global syndemic connects the trio of pandemics to common causes and, therefore, to strategies to address the problem. As a result, the vested interests of ‘Big Food’ — the multinational food and beverage industry with huge concentrated market power — are under the spotlight. As Professor Boyd Swinburn comments, “Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories. In reality, they are both driven by

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clinical editor Andrew Binns

Unhealthy diets pose a greater risk to morbidity and mortality than unsafe sex, alcohol, drug and tobacco use combined. the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes.” Boyd continues, discussing how obesity should be evaluated from the same perspective as environmental malnutrition: “Climate change has the same story of profits and power ignoring the environmental damage caused by current food systems, transportation, urban design and land use. Joining the three pandemics together as The Global Syndemic allows us to consider common drivers and shared solutions, with the aim of breaking decades of policy inertia.” According to the report, should the current trajectories of economic development, population growth and food provision continue, it is estimated that by 2050 the overall demand for food and animalbased food will increase by 50% and 70% respectively, with further destabilising effects of deforestation, species extinction and climate change acceleration. Continued page 30

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Kempsey celebrates milestone in suicide prevention

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he atmosphere at the launch of the Kempsey Community Suicide Prevention Action Plan in March was one of excitement as the Plan was unveiled after two years of community consultation and collaboration. Those involved in developing the Action Plan and present at the launch included community members, social service organisations, health providers, local council staff, the education sector, police, ambulance and those directly affected by suicide. The Kempsey Community Suicide Prevention Project was established late last year as part of the Australian Government’s National Suicide Prevention Trial. The Macleay Valley was identified as an area experiencing a higher than average incidence of suicide.

From left: Steve Mann, NPCHN; Patrick Conyhan, Julie Sturgess, NCPHN; Luke Hartsuyker MP; Mel Robinson and Kempsey Mayor Liz Campbell at the launch.

North Coast Primary Health Network (NCPHN) is providing the Suicide Prevention Project with a total of $380,000 in federal funding to design and implement the Suicide Prevention Action Plan 2019-2020. This includes funds to employ a Project Coordinator. The launch was held at the

Macleay Valley Workplace Learning Centre – the lead agency for the project - whose principal Mark Morrison is an inspiring community champion. NCPHN’s Chief Executive Julie Sturgess thanked Project Coordinator Melissa Robinson and Mark Morrison for their dedication to the successful

development of the Action Plan. Julie said with the Plan’s strategies agreed upon, the next phase was to put them in place. “Developing the Plan has been a great demonstration of the community coming together. We know that only community-led approaches can reduce the incidence of suicide,” she said. Mark Morrison said everyone was now working towards the same goals. “Through the generous support of North Coast Primary Health Network, it’s inspirational to witness groups and agencies working together towards preventing suicide. “I am confident under Melissa’s direction that we will have a lasting impact on the incidence of suicide within our community.”

Priorities identified in Lismore Suicide Prevention Action Plan O N TUESDAY 26 MARCH more than 30 community members and organisations involved with the development of Lismore’s Suicide Prevention Action Plan came together for its official launch at the Lismore Regional Gallery. North Coast Primary Health Network (NCPHN) provided Australian Government funding of $380,000 to employ a Coordinator for the project and to implement the initiatives laid out in the Plan. At the launch, Project Coordinator Bath Bird of LifeLine Direct emphasised that the Plan was the result of consultation across the broad community for more than a year. “Drawing up this Suicide Prevention Action Plan gave us a wonderful opportunity to involve people from all walks of life and develop a

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From left: Kevin Hogan, Cath Bird, Julie Sturgess and Niall Mulligan.

community-led approach to suicide prevention. “There is a real groundswell of support across the Lismore community to implement

practical suicide prevention measures. These include training opportunities to equip ourselves to recognise people who might be at risk

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of suicide and be able to offer them appropriate support.” NCPHN’s CEO Julie Sturgess thanked Cath Bird and the Lismore Suicide Prevention Collaborative for their work and said the launch was an exciting milestone in creating a community-led, multi-sector approach to preventing suicide. “This Plan has identified priority areas and now we can put in place local evidence-based approaches to improve mental health and wellbeing in the community.” The Collaborative funding also enabled the publication of an e-book called Don’t Let Suicide Kill You – 9 Stories of Survival and Recovery. The book shares the experiences of these local people and how they were supported to come back to their lives after attempting suicide.

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HealthPathways reaches 500!

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n April 9 staff from NCPHN and the Northern NSW Local Health District celebrated an impressive milestone with the comple-

tion of 500 HealthPathways. Congratulations to the many health professionals and PHN and LHD staff who have made this achievement possible!

Sullivan Nicolaides Pathology Lismore Laboratory Comprehensive pathology services across multiple disciplines 

24-hour on-call service at St Vincent’s Private Hospital 

Collective expertise of scientists and specialist pathologists 

Serving the evolving needs of the region, employing more than 100 local staff 

Supporting and training new generations of medical scientists In Ballina, staff from NCPHN and MNCLHD enjoyed cake to mark the 500 milestone. A celebration also took place in Coffs Harbour.

HealthPathways welcomes new GP Registrars

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he first GP Synergy registrar workshop of the year was held in February at Angourie Rainforest Retreat in Yamba. The HealthPathways team was on hand to welcome the GP Term 1s and 2s and to introduce them to the Mid and North Coast HealthPathways website. It was a great opportunity to welcome the registrars to our region with further workshops planned. HealthPathways not only provides clinicians with assessment and management information, but gives quick access to local service and referral information. This is especially beneficial for clinicians new to the area. We also highlighted new additions to the website which include Dental HealthPathways April 2019 healthspeak

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and a dedicated Patient Information website. Patient Information - Mid North Coast is a website for GPs to use with patients during a consult. It contains information and resources recommended by local health professionals for the community. Information is evidenced-based and meets Health Literacy standards. To access HealthPathways go to: Mid and North Coast HealthPathways Username: manchealth Password: conn3ct3d For HealthPathways enquiries, contact the Coordinators: Fiona.ryan@health.nsw.gov.au (MNC) or kkeyte@ncphn.org.au (NNSW).

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Healthy Towns brings seniors together

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he NSW Seniors Festival took place from in February this year. The theme of ‘Love your Life’ provided the perfect opportunity for NCPHN’s Healthy Towns program in Lake Cathie and South West Rocks to get involved. The Healthy Towns program works in partnership with local communities to design l initiatives that help improve health and wellbeing. There are six towns in the program, however Lake Cathie and South West Rocks both have a higher ageing population with 28.4% and 36.3% aged over 65, respectively. In Lake Cathie a celebratory morning tea was held at the Bowling Club, followed by a bus trip to the Seniors Expo at Port Macquarie. Attendees were presented with information about My Health Record and safe transition of care between health professionals. The morning tea also provided an opportunity for seniors to meet new people in their local area. Healthy Towns Senior Project

It was fantastic to be able to bring that information to the community as part of the Seniors Festival

Attendees were keen to hear about My Health Record and information about retirement planning at the Healthy Towns South West Rocks lunch during Seniors Week.

Officer Romayne Page said the event was appreciated by many. “About 28% of the residents who live in Lake Cathie are senior citizens, so this event offered them a way to connect to health services and educate them about living options going forward”. In South West Rocks, NCPHN worked in collaboration with Fair Trading NSW, Seniors Rights Service and Mid North Coast Community Legal

Centre to deliver a ‘lunch and learn’ experience at the South West Rocks Country Club. While enjoying a healthy lunch, seniors were provided information on navigating the aged care system, wills and power of attorney, My Health Record, and how to avoid scams. There was a chance to ask questions and chat further to service providers during the break. Healthy Towns Senior Project Officer Larah Kennedy said

Winter Strategy 2019: registration complete

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wenty-four general practices in Northern NSW have registered to be part of this year’s Winter Strategy Program. The Winter Strategy supports general practices to keep their most vulnerable patients with chronic diseases well, and to reduce their likelihood of being hospitalised this winter. It’s available for general practices and Aboriginal Medical Services in the Tweed Valley, Richmond Valley and Clarence Valley regions. Being part of the Winter Strategy program means that patients are given a special sick day action plan to help them manage their chronic disease, they receive a weekly phone call to monitor their health and wellbeing and have extra allied health support 6

available to them if necessary. This year marks the third year of operation for The Winter Strategy. A report is being

finalised on The Winter Strategy 2018. A story on the report will feature in the August issue of HealthSpeak.

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information on retirement planning and legal advice was requested during Healthy Towns Action Planning workshops. “It was fantastic to be able to bring that information to the community a part of the Seniors Festival,” she said. For more information on the Healthy Towns program, visit ncphn.org.au/healthy-towns

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New blood test detects fibromyalgia Using blood samples and innovative techniques, scientists have detected a "molecular fingerprint" that is unique to the condition. Fibromyalgia affects 2 to per cent of the world’s population, mostly women. Chronic pain throughout the body is the main characteristic of fibromyalgia. However, many people with the condition often experience a wider range of symptoms with similarities to other conditions. This makes it challenging to diagnose. The new research led by Kevin Hackshaw, a professor at Ohio State University has managed to detect fibromyalgia in blood samples and differentiate it from other conditions. The study is published in the Journal of Biological Chemistry.

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Artwork lends vibrancy to NCPHN’s RAP Plan

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arlier this year the North Coast Primary Health Network’s Reconciliation Action Plan Working Group met in Grafton for the sixth time. The Working Group is made up of 12 members including Elders, community members, an NCPHN Board member and NCPHN staff members across the region. This meeting also had a special purpose – to judge the entries submitted to the NCPHN RAP Plan artwork competition. Six artworks were put before the Working Group produced by Aboriginal community members and all were judged to be winners of prize money of $500 apiece. These artworks will be used to illustrate and add colour to the final version of the RAP Plan. The Plan, approved by NCPHN’s Board late last year, has been sent to Reconciliation Australia for approval and likely to be launched in Reconciliation Action Week this year. NCPHN’s Acting Aboriginal Health Manager Kim Gussy said the art competition showcased a range of budding Aboriginal artists, some who were still at school through to community members creating art as a hobby. “We are also fortunate to have artwork designed especially for the NCPHN footprint by Frances Parker, a proud Yaegl women for use within the Reconciliation Action Plan. These pieces of art will bring both meaning and life to the finished RAP,” she said.

Top: Painting by Moesha Cameron of the Gumbaynggirr Nation, a Grafton High School student. Moesha’s painting is titled 2 Birrangi and is a story about Gumbaynggirr people coming together to hunt fish. Bottom: Painting by Bundjalung Nation man Mikey Watson of Goonellabah titled Our Future. This work was painted on Australia Day as local Aboriginal people came together.

Free, online health literacy training THERE’S A GREAT NEW resources for health care workers - www.teachback.org Teach-back is a simple yet effective educational tool used to check a patient’s understanding of health care advice and instructions. Key concepts include: • Making it clear that it is the healthcare provider’s responsibility to explain things clearly • An explanation of how people like to learn • Checking current understanding • Using plain language • Chunk and Check information • Asking your client to

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explain back in their own words • Explaining misunderstandings until understanding is achieved Included on www. teachback.org is a 30-45 minute module that teaches the method. This website also includes teaching tools, videos, resources and tips on how to put teach-back into practice. Julie Dixon, Executive sponsor, Director Planning, Population Health and Equity at South East Sydney Local Health District is thrilled with the teach-back website. “The health system places

a significant burden on patients, carers and families to ‘understand and use’ information. Not being able to understand leads to increasing vulnerability and inequity in health care delivery,” she said. Dr Alison Beauchamp from

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Melbourne University and coauthor of the website said: “Using teach-back makes a difference because it allows health providers to check if their patients or clients understand them, and then re-explain if necessary. “When people walk away from a health encounter with an understanding of their condition and what they need to do, then they have a more positive experience and are better placed to self-manage their own healthcare.” www.teachback.org is a collaboration between South East Sydney Local Health District and Deakin University.

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NCPHN funding and community efforts bring GP services to Stuarts Point

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he community of Stuarts Point and District (population of 1400) are now enjoying GP and pathology services in a new clinic, purpose built in the Stuarts Point Community Hall. Stuarts Point and District Community Organisation (SPADCO) members worked with North Coast Primary Health Network (NCPHN), under the community voices program after lack of access to health services was identified during community conversations. To better understand the needs of the community, a survey was distributed with over 400 responses. Access to a GP, wound care and pathology were the highest priority and after further consultations with over 70 community members and the Rural Doctors Network an outreach model was selected as the best way to attract a GP to the community. With funding jointly provided by NCPHN ($10,000 grant) and a local organisation, the health clinic at the Stuarts Point Hall became a reality. The Clinic opened its doors on 26 March and Nambucca Healthcare Centre is providing 1.5 days of GP services to the community At the unveiling, SPADCOs Des Breust acknowledged the important role North Coast Primary Health Network’s Aimee McNeill played in bringing a GP to the town. At that time Aimee was working as a Senior Project Officer for the Community Voices program. Aimee said it had been a pleasure working with the Stuarts Point community. “I am so pleased that after the health needs were identified by the community that NCPHN was able to support the solution.” Des Breust paid tribute to Aimee’s efforts. 8

Without Aimee’s support and encouragement over the past three years, we wouldn’t be where we are today

From left: Des Breust, Allison Tolson, Dr Nigel Humphries and Sheree Smith at the clinic's official opening.

also acknowledged for making the Hall available as well as the Stuarts Point Hall Committee and past and present SPADCO Committee members for their cooperation and support.

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Sleeping on side reduces stillbirth

The purpose built medical clinic at Stuarts Point Community Hall.

“Without Aimee’s continual support and encouragement over the past three years, we wouldn’t be where we are today. Her work in coming up with the GP Outreach concept and organising funding through NCPHN meant we succeeded in our aspiration to have a local GP,” he said. Des also paid tribute to four other major players: • Local pharmacist Kate Gunning who has been involved with SPADCO for the life of the project • Local business manager

Allison Tolson, a major sponsor who ensured the viability and success of the project • Sheree Smith, Practice Manager at Nambucca Health Care Centre, who worked with SPADCO to install a GP • Melinda Pavey, the Member for Oxley and Minister for RMS, who supported the project from day one and introduced Sheree Smith to the SPADCO Committee. Kempsey Shire Council was

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Expectant mothers can more than halve their risk of stillbirth by sleeping on their sides, research has found. A New Zealandled mega study also confirmed the risk of stillbirth associated with sleeping on the back applies to all pregnant women in the last trimester of pregnancy. The researchers’ advice to women from 28 weeks of pregnancy is to settle to sleep on their side and to start every sleep, including day-time naps, on the side. “It is common to wake up on the back, but we recommend that if this happens, women should simply roll back on to either side.” The study was published on April 2 in the Lancet group journal EClinicalMedicine,

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The benefits of My Health Record for pharmacy HealthSpeak had a chat with Coffs Harbour pharmacist Tanya Maloney who shared how she uses My Health Record in providing care to her patients.

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anya registered her pharmacy as a provider for My Health Record (MHR) in May 2017 after North Coast Primary Health Network (NCPHN) got in touch to explain the registration process and benefits. “It makes sense as a health professional to use the technology available to improve customer service. The training provided by NCPHN demonstrated a range of benefits for sharing, viewing and uploading of records. “And we are already realising the benefits in patient care. It’s particularly useful for viewing the records uploaded by GPs, hospitals and specialists. “Being able to access hospital discharge information for patients is really helpful as we can quickly see what medication changes have been made and take action on those. This includes patients with Dose Administration Aids needing new medication and delivery of their medication after a hospital stay.

Dr Tim Francis elected new NCPHN Chair

We don’t have to rely on what the patient tells us, as we can view medication changes quickly on our dispensing records.” Easy access to MHR also helps with compliance issues. “We can view the time between dispensings and identify potential issues with multiple prescribing by viewing data from sources such as other pharmacies, GPs, hospitals and specialists. In this way MHR allows us to discuss any difficulties with the patient in their medication review and help improve their health outcomes.” Tanya explained that because MHR is integrated with the pharmacy’s software (FRED)

fellow of the Royal Australian College of General Practitioners. He is also a graduate of the Australian Institute of Company Directors’ residential course. Tim has worked on the board of North Coast NSW Medicare Local, and more recently the North Coast PHN since 2012. The newly elected Deputy NCPHN Chair is Ballina GP Dr Chris Jambor.

For support with My Health Record, phone NCPHN’s My Health Record Program Manager Amanda Wilkinson on 6618 5436.

LOOKING FOR SOME NEW WHEELS? Lismore’s Southside Health and Hire Centre (in association with Southside Pharmacy) have a large range of quality BARIATRIC and standard equipment for hire or purchase including shower chairs, lifters, electric beds, wheelchairs, seating, walkers, commodes and more.

Tim Francis with his family

EARLIER THIS YEAR, GP anaesthetist Dr Tim Francis was elected by North Coast Primary Health Network’s Board of Directors to the position of Board Chair following Dr Tony Lembke’s resignation from the board late last year. Tim completed his General Practice training in the Nambucca Valley where he continues to live with his wife and young family. Tim is a

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staff can easily identify if a patient has a record and view their profile without interrupting their workflow. “It’s also a seamless process for uploading scripts dispensed to My Health Record as this happens automatically without us having to do anything. “ My Health Record also helps when dispensing and counselling patients.

Tanya said that a common scenario was when a patient had two different medication scripts and wasn’t sure which one was current, or if they should be ceasing a medication. “Previously we would have had to call the doctor’s surgery to confirm a dosage or a change to medication and there may have been a delay in receiving the information. Now we can view this easily through MHR. It saves time at both the pharmacy and at the doctor’s surgery.” Tanya encourages all pharmacies to become registered and emphasises that businesses can start to use the system slowly to minimise any potential impact on workflow.

SOUTHSIDE HEALTH & HIRE CENTRE Call us today on (02) 6621 4440 or come in and say hello at 5 Casino Street, South Lismore. Southside Health & Hire Centre Where your health is our total concern.

Nurse on Duty www.southsidehealthandhire.com.au

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HEALTH & SOCIAL CARE WORKFORCE TODAY AND TOMORROW

WHEN YOU THINK ABOUT HEALTH AND SOCIAL CARE WORKFORCE POST 2030, WHAT’S YOUR PREFERRED FUTURE? THIS IS A QUESTION FUTURIST REANNE BROWNE OF MELBOURNE’S THE FRIDAY LAB ASKED PARTICIPANTS AT HEALTH & SOCIAL CARE WORKFORCE TODAY & TOMORROW. IMAGE 1 FROM LEFT: ALIRA BAYNDRIAN, PROFESSOR SUSAN NANCARROW, ROBYN FITZROY AND A/PROF JACQUI YOXALL ENJOYING A CATCH UP. IMAGE 2 MANDY HOLLOWAY PRESENTING ON THE COURAGEOUS LEADERS MODEL. IMAGE 3 AUDIENCE PARTICIPATION FROM ADJUNCT PROFESSOR NICOLE TURNER. IMAGE 4 FROM LEFT: CLARE JONES, CHRIS GRAY, MICHAEL KEMP AND CHRISTOPHER WALKER FROM KEYSTONE HEALTH.

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When we think about the future, we often think of a single future - “the future”. Futurists, however, talk about a range of futures – moving beyond what’s possible, probable, plausible and preposterous, to what is called “preferred”. “The preferred future is a conversation that I think we miss out on,” said Reanna Browne, Founder & Futurist of The Friday Lab. “We don’t talk about it enough because we think the future is imposed on us. We feel subservient to the future.” So what is a preferred future and how do you achieve one? A preferred future is one you want to start

imagining now. It’s a chosen future – one that is meaningful and keeps you motivated to learn. To apply your preferred future you need to inform strategy and drive innovation: 1. Map the current state of the particular area of interest and understand the history of how it got to that state. 2. Establish a baseline for the ‘expected’ future if nothing changes. 3. Scan for trends that are driving change and the impacts they might have. 4. Extrapolate different futures and their associated implications. 5. Start building towards your preferred future by committing to small bets in the long game. “Remember, the future hasn’t happened yet,” said Reanna. “You’re more in control of it than you think.” Hear more from Reanna and other keynote speakers and watch the conference highlights at www.thecentrehki.com.au/future-healthworkforce

WHAT’S COMING UP FOR THE CENTRE? Revisiting Aboriginal Wellbeing A facilitated planning day was held on March 26 at the Yarrawarra Cultural Centre to design a conference series that will revisit Aboriginal wellbeing on the North Coast. Facilitated by Dr

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Mark Lock and Dr Mary-Claire Hanlon, this planning day brought together the various sectors working towards better health for Indigenous communities. More details to come in the next HealthSpeak. Healthy Retirement Join us for dinner on May 6 in Lismore and hear from Professor Andrea Maier as to how mobile technology is enhancing active ageing in Europe through the PreventIT program. We’ll also hear from some of our more local programs working towards healthier, more active retirement. Social Determinants of Health Webcast Series The social determinants of health (SDoH) are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. This webcast series, delivered in partnership with Health Justice Australia, will explore health justice partnerships and how to consider SDoH when planning health and social care. Artificial Intelligence in Healthcare Following the success of last year’s AI in Healthcare symposium we will once again invite a range of speakers to Southern Cross University Gold Coast Campus. Join us on 8 June and discover how to use AI responsibly in the health and social care space - stage one of your AI journey. To learn more and to register for these events visit www.thecentrehki.com/all-events

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Have you signed up for the Centre newsletter? Stay up-to-date with Centre news and events and hear about the latest innovations making a difference to health and social care. Delivered straight to your inbox once a month. www.thecentrehki.com.au The Centre is a consortium of some of the most effective and progressive services providers in the North Coast. Partners of the Centre recognise the need to support the health and social care sectors to push the boundaries and explore new frontiers in health.

Health & Social Care Workforce Today & Tomorrow was held on Thursday 28 February & Friday 1 March at Pacific Bay Resort Coffs Harbour. Highlights included - an introductory session from Reanna Browne - a “Rolls Royce” case study from Eastern Health - an engaging look into cultural responsiveness - a thought-provoking examination of planetary health and the Anthropocene effect - an emotive story of brain injury survival - an inspiring lesson on bringing courage into the workplace

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NORTH COAST PRIMARY HEALTH NETWORK

Health and Service Needs

A key role of North Coast Primary Health Network (NCPHN) is to identify local health needs and service gaps and, based on this evidence, prioritise activity to address those needs. As a part of this objective, NCPHN has recently published health needs assessment reports which include an extensive and detailed summary of the most current and relevant health and service data available relating to General Population health; Aboriginal and Torres Strait Islander health; Primary mental health; and Alcohol and Other Drug Treatment.

Tweed Heads Ballina

In addition to national and state health data, the reports include findings from the 2018 local health needs assessment community survey that was held in June 2018 and completed by 3,372 North Coast locals from Port Macquarie to Tweed Heads. Based on information presented in the reports, NCPHN will be launching the 2019 factsheet series over the coming months, in which health data is presented in a concise and visual way organised by LGAs and 11 health or priority group topics.

Coffs Harbour

This article highlights some of the regional findings relating to health data of the North Coast footprint as an introduction to the Local Government Areas (LGAs) factsheets. To view these reports and find detailed LGA specific data, check: https://ncphn.org.au/needs-assessment. To stay up to date with new factsheet announcements, subscribe to one of NCPHN’s newsletters at: https://ncphn.org.au/subscribe-to-our-newsletter.

Port Macquarie

Concerning health statistics LOWEST IMMUNISATION RATES IN THE NATION

1 yr: NCPHN Australia 2 yrs: NCPHN Australia 5 yrs: NCPHN Australia

90.1% 92.2% 87.9% 88.6% 90.7% 95.7%

HIGHEST ALCOHOL CONSUMPTION IN NSW*

more than 2 standard drinks a day 14 years or older

NCPHN 24.4 NSW 16.5 Australia 18.1

HIGHEST RATE OF HEPATITIS C IN MALES IN NSW*

HIGHEST RATE OF MELANOMA IN NSW*

NCPHN 107.9 NSW 63.1

NCPHN 89.7 NSW 49.3

NSW

36,465.1 35,968.8

for Aboriginal People

NCPHN 41,426.3 NSW 20,705.2

HIGHEST RATE OF CANCERS COMBINED IN AUSTRALIA* NCPHN 545.88 Australia 497.4

Potentially preventable hospitalisations*

Hospitalisations for all causes* North Coast

HIGHEST RATES OF DIALYSIS IN NSW*

second highest rate in NSW

North Coast NSW

2,614.5 2,248.4

Top 5 causes in North Coast

Top 5 causes in North Coast

1. 2. 3. 4. 5.

1. Cellulitis 2. Urinary tract infections, including pyelonephritis 3. COPD 4. Iron deficiency anaemia 5. Dental conditions

Dialysis Digestive system diseases Nervous & sense disorders Symptoms & abnormal findings Injury & poisoning

* Per 100,000 population

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a publication of North Coast Primary Health Network

healthspeak April 2019


2018 Local Health Needs Community Survey

PARTICIPANTS

3,372

Top 3 personal health challenges 25.7%

1 1

# Weight #

6.5%

of respondents identified as of ABORIGINAL or TORRES STRAIT ISLANDER origin

9.5%

24.4% 23.6%

2

#

Mental health

3

#

Arthritis/ Osteoporosis

of respondents identified as LESBIAN, GAY, BISEXUAL or QUEER

28.7%

of respondents said they wouldn’t be able to get $2,000 for something important within a WEEK

40.9%

of respondents had PRIVATE HEALTH INSURANCE

15.3%

of respondents were BORN OVERSEAS

8.0%

of respondents were AGED between 15-24 YEARS

22.3%

of respondents were AGED 65 YEARS or older

26.2%

of respondents WORKED 35 or more HOURS a week

27.7%

of respondents were AGED over 65 YEARS

22.0%

of respondents didn’t have a regular Doctor (GP)

April 2019 healthspeak

Top 3 serious community health concerns

1

Drug and alcohol misuse

47.7%

2

Mental health issues

47.6%

3

Ageing issues

47.0%

Factors that decreased the likelihood of reporting good health DECREASED LIKELIHOOD Requires assistance for health care Has a mental health challenge Can’t access $2,000 65 years and over

$2,000

65+

years

Aboriginal and Torres Strait Islander

11.7% of survey respondents said they always (2.3%) or sometimes (9.4%) need help with self-care everyday activities such as eating, showering, dressing or toileting

a publication of North Coast Primary Health Network

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2018 Local Health Needs Community Survey Accessing services

28.3% of respondents said it was difficult to access a Doctor (GP) 2. Too long to wait for an appointment

1.Can’t get an appointment

46.7% of respondents said it was difficult to access a Specialists 23.8%

Psychiatrist

19.2%

Cardiologist

15.1%

General Surgeon

3. It costs too much

Orthopaedic Surgeon Paediatrician

26.4% of respondents said it was difficult to access Allied Health Professionals 38.1%

Dentist Psychologist

29.6%

Physiotherapist Optometrist

• Cost - 60.3% • Not covered enough by Medicare - 46.2% • Long wait - 37.3%

20.6%

14.1%

Dietician/ Nutritionist

Top 3 Challenges

11.1%

58.0% of respondents said it was difficult to access Alcohol and Other Drug (AOD) services 44.6%

Rehab

42.2%

Counselling

39.4%

Detox GP with knowledge in AOD Psychiatrist

25.3%

31.8%

Top 3 Challenges • Lack of services - 48.1% • Cost - 41.0% • Stigma/ Shame - 35.0%

14.2%

Top 3 Challenges

• Long wait - 57.8% • Cost - 56.4% • Distance of travel - 44.1%

12.1%

54.9% of respondents said it was difficult to access Mental Health Services Counselling

45.2%

GP with knowledge in mental health

38.0%

NSW Health community mental health Psychiatry

28.6%

Youth-specific services

16.2%

33.1%

Top 3 Challenges • Cost - 46.0% • Lack of services - 43.2% • Poor experience in the past - 29.1%

50.5% of respondents said it was difficult to access Aged Care Services 45.6%

Care packages/funding In-home domestic support

36.9%

General wellness support/social groups GP with knowledge/skills in aged care In-home medical care

29.8%

29.3%

Top 3 Challenges • Cost - 49.9% • Difficult to organise - 43.2% • Lack of services - 38.5%

25.1%

For an online version with references please go to: www.ncphn.org.au/needs-assessment/healthspeak-article

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a publication of North Coast Primary Health Network

healthspeak April 2019


Online therapies: improve mental health and easy to access By Sebastian Rosenberg Fellow, Centre for Mental Health Research, ANU and Ian Hickie, Professor of Psychiatry, University of Sydney

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ecently, the MBS Review Taskforce’s Mental Health Reference Group published its report and recommendations. They recommended a massive expansion of the $1.5 billion Better Access program, which enables Medicare-subsidised visits to psychologists and other health professionals. But simply striving to get more people into face-to-face care is a limited and expensive strategy. If we’re serious about improving access to mental health care, we need to look to online therapies. The evidence says they can be effective instead of, or as well as, seeing someone face-to-face.

Digital approaches Some studies have found online therapy to be as effective in reducing symptoms as face-toface therapy. This evidence is strongest in relation to depression, stress and anxiety. One meta-analysis of data from 3,876 adults found those who underwent internet-based cognitive behavioural therapy to treat symptoms of depression had better outcomes than those who didn’t use online therapies. They were also more likely to stick to their treatment. So self-guided internet-based cognitive behavioural therapy is a viable alternative to current first-step treatment approaches for symptoms of depression and anxiety. Online approaches vary, but commonly present a course of psychological therapy structured so the participant can track progress over time and seek further assistance if their situation deteriorates. As an example, Mindspot offers a three step online process of April 2019 healthspeak

therapy, beginning with information, followed by assessment, and finally, treatment. Treatment depends on the user’s needs and courses might cover mood issues, obsessive compulsive disorder, and posttraumatic stress disorder. People can elect to do a course independently, or could be referred by a professional, such as their GP. When health practitioners refer their patients into Mindspot they receive patient progress reports. These online therapies can be critical for reaching underserviced groups, such as young people and people living in rural areas. Other key advantages of these stand-alone digital approaches include 24/7 availability and the absence of fees that would otherwise be paid out-of-pocket for a consultation.

Team-based care online Perhaps the greatest opportunity for enhanced mental health service delivery is to start to use digital technologies to drive new models of care specifically designed to meet individual needs. For people with more com-

These online therapies can be critical for reaching young people and people living in rural areas. plex, disabling and persisting conditions, the international evidence clearly indicates bringing together a team of professionals is best practice. For example, a person with an eating disorder is likely to benefit from integrated, multidisciplinary care provided by a GP, a nurse, a dietitian, a psychologist, a peer worker, and so on. There are already some efforts to foster this online. An example can be found in the InnoWell platform, which service providers can use to bring together different professionals and resources to suit each patient’s needs. Using online assessment tools at the point of service request, those with milder needs are connected to a range of appropriate evidence-based apps and e-tools. Meanwhile, those with more complex needs are connected to care

a publication of North Coast Primary Health Network

including face-to-face services. As a proportion of the total, new clients into Better Access were 68% in 2008, 57% in 2009, and just 32.6% in 2016-17. This increase in repeat customers suggests two things. First, perhaps people did not get the help they needed or had problems too complex to be managed within the program. And second, there may be limits on how the program can continue to meet its goal of increasing access to mental health services. While the Medicare review relegated online therapies to “longer-term” reform, new digital and team-based approaches are key to driving improved models of increased access, at relatively low individual cost, to high quality mental health care. Australia’s e-Mental health strategy needs action. The Medicare review into mental health represents a significant opportunity to get future investments right. This means shifting from an access focus to how best to provide high quality, individualised services at scale – particularly to the disadvantaged. Reprinted with kind permission from The Conversation (www. theconversation.com/au) 15


Mid North Coast Local Health District Northern NSW Local Health District

NORTH COAST COLLECTIVE

A new vision for health care: North Coast Collective BACKGROUND

A N E W VI S I O N F O R H E A LT H C A R E N O R T H C O A S T C O L L ECT IV E

With quality, outcomes, and value the watchwords for health care in the 21st century, stakeholders around the globe are looking for innovative, cost-effective ways to deliver patient-centred, ‘smart’ technology enabled health care. For a long time, the Triple Aim was the guiding light used to help health care organisations plan their efforts. In the last few years the Quintuple Aim has emerged with these goals: 1. Reduced per capita cost of health care 2. Improved outcomes in Population Health 3. Improved patient experience 4. Better support for health providers to avoid burnout 5. Individual patient engagement In the UK, a key report published last year commissioned by the NHS found that a person-centred approach needed to become standard practice in health and social care. The report titled Shifting the Centre of Gravity also emphasises the need to move beyond primary health care to make health and wellbe-

ing ‘everyone’s business’. This approach and the approach of the new North Coast Collective is to address not only the health concerns of a person. It is aimed at addressing the social determinants affecting health by working hand in hand with all sections of the community to better address health care priorities. Social determinants of health are many and include:

• Housing instability/homelessness • Poor housing conditions • Incarceration or having a family member in jail • Malnutrition • Isolation and loneliness • Unemployment or under-employment • Domestic violence • Low income • Illiteracy

ABOUT NORTH COAST COLLECTIVE In its initial phase, North Coast Collective (NCC) is a regional collaboration between North Coast Primary Health Network (NCPHN), the Mid North Coast Local Health District (MNCLHD) and the Northern NSW Local Health District (NNSW LHD). We hope more organisations such as FACS, the Department of Housing and the Department of Education will join as NCC broadens its scope. The NCC Project is being managed by NPCHN with support from Deloitte and GHD Advisory. Both LHD Chief Executives - Wayne Jones of NNSWLHD and Stewart Dowrick of MNCLHD - are strong supporters of NCC and excited about the

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Wayne Jones

progression of the Collective. Introducing the first health provider workshop on NCC in Ballina in midApril, Wayne Jones said the Collective’s vision was to create a system that is better connected – “that puts the needs of patients and carers at its centre and gives them better lives.”

Stewart Dowrick

Since arriving at NCPHN last August, CEO Julie Sturgess has been working with staff and advisory bodies to get NCC off the ground. Improving the lives of those living with mental health issues on the North Coast is the first area of focus for the NCC. The April workshops in Coffs


Mid North Coast Local Health District Northern NSW Local Health District

A NE W VI S I O N F O R H EA LT H C A R E N O R T H C O A S T C O L L ECT I V E

WE KNOW IT’S GOING TO BE DIFFICULT, BUT AS THE FOUNDING MEMBERS OF NCC WE WANT TO DRIVE AND SUPPORT THE JOURNEY AHEAD

The ABC's Dr Norman Swan facilitated the introductory workshops in Coffs Harbour and Ballina.

Harbour and Ballina were the beginning of ongoing consultation with the community and care providers to develop the way ahead. Hosted by the ABC’s Dr Norman Swan, the workshops sought views about what could be done better to support people suffering from mental ill health or those with alcohol and drug use issues to live better lives. HealthSpeak spoke to NCPHN CEO Julie Sturgess about this new vision for mental health.

they see as important and exploring how funders allow us to challenge the ‘old silos’ of funding. This will all take time. It won’t always be easy, but we believe this approach will contribute to significantly improved outcomes for the North Coast. And if that is possible we must commit to the road. HS: Why here and why now? Julie: On the North Coast we already

HS: What brought you to the concept of the North Coast Collective? Julie: I’ve worked in health a long time

and witnessed the difficulty for consumers in navigating a system that is often set up in silos. I realised, like many others, that there is a need to do things differently to drive a change in health and wellbeing. Differently means we need to take a system approach where we work closely together to remove barriers and duplication to achieve better lives for people in the North Coast region. Of course, working in this type of relationship takes a commitment and trust between the parties. That is something that already exists in spades on the North Coast, with both CEOs of the LHDs (Stewart Dowrick and Wayne Jones) being extremely supportive of NCC. We are fortunate that NCPHN has such strong relationships with its LHDs. These relationships are crucial to making this work and the North Coast is

NCPHN CEO Julie Sturgess addresses the gathering at the NCC launch in Coffs Harbour.

recognised nationally for the innovation that these partnerships drive. I am grateful to Wayne and Stewart for embracing a new approach aimed at improving health outcomes, and for their commitment to phase one of the project. The Boards of the PHN and both LHDs are also very supportive of the fact that things need to change. We know it’s going to be difficult, but as the founding members of NCC we want to drive and support the journey ahead. And it is a journey…changing the system; potentially including how the community decides on what health results

have a region committed to improving health and wellbeing. We have a terrific community feel here and I believe our region is a manageable place to explore how we make NCC work. We’ve looked at the modelling around how we might invest and we know that if we invest together, making joint decisions, we will be able to provide more services for the community than investing in silos. HS: Can you explain how NCC is a different health care model? Julie: The NCC aims to work at a

systems level, it’s a much more regional approach. We have been driven to explore this model because our budget is finite, everyone’s budget is finite. As a region, we have to look at wiser ways of spending to get better outcomes. So our focus shifts to those outcomes that the community and the region want. The first health priority we are working with is developing an approach for commissioning services for those with A P R I L 2 0 1 9 | H E A LT H S P E A K

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Mid North Coast Local Health District Northern NSW Local Health District

mental health and alcohol and other drugs issues. We focussed on this first because when we spoke to the North Coast community these health needs were identified as their most important priorities. At the moment health buys health services, but when we look at total health outcomes the evidence identifies that medical services account for just 11% of these. Individual behaviours and social determinants have a much bigger role to play in overall health than medical services. This means that if we are hoping to drive a change and improve the mental health of our region we need to work collaboratively with other services which also influence these social determinants. A N E W VI S I O N F O R H E A LT H C A R E N O R T H C O A S T C O L L ECT IV E

HS: Could you tell us about the NCC modelling tool? Julie: One of the most important players

in the formation of North Coast Collective is Business Consultant Darryl Walker of GHD Advisory. Darryl has a background as an aeronautical engineer and moved from there into analytically-based management consultancy. For some time he’s worked with areas such as health, education and electricity distribution networks – industries that typically need more funding than is available to them – to support their decision making with analysis and mathematical optimisation. He is working on a priorities optimisation algorithm for us to use when we

NORTH COAST COLLECTIVE want to look at potential health services and their likely outcomes. It’s a really important piece of the puzzle for NCC, but also just one part of the big picture. We are working within a dynamic and complex system and when things are that complex we don’t necessarily make the best decisions. So Darryl is providing the technology we need to bring all the necessary elements together to support our decision-making.

IN THIS APPROACH, TO SUCCEED THREE THINGS ARE NEEDED. COMMITMENT, TRUST AND CURIOSITY We really need to bring in transparency, not just around the results of what we do, but the defensibility around our investment decisions at the moment. This modelling is critical in that it gives us a systems view to help us answer the many questions that commissioning throws up. HS: After the foundations are laid, what next? Julie: The project is laying the foun-

dations for what will be a long-term horizon on a new way of doing business. This is new territory for all involved and pretty new nationally as far as we

understand. In the first cycle of NCC, where mental health is the focus, NCPHN is partnering with the Local Health Districts. But before long we hope NCC will involve many more partnerships. During this first cycle, standing around and watching very intently we hope will be a range of stakeholders from other sectors – FACS and Housing and Education and Police and Emergency Services – who would be interested in the same health improvements as us. And they will no doubt be interested in seeing how we work together, how we might collaborate and jointly commission or contribute funding or resources towards those shared outcomes which we need to define. Hopefully in the next cycle of NCC we will have a much bigger cross section of stakeholders willing to contribute and participate towards shared outcomes. And this truly represent our cross sectoral approach to population health and wellbeing - that’s where we want to get to. Ultimately it’s moving towards a regional commissioning approach involving agencies and government departments across all sectors. Importantly, to succeed, three things are needed – commitment, trust and curiosity. The upfront work is about engagement and planning and workshops and developing outcomes. Even just reaching out and communicating with other sectors who we haven’t worked with before. It’s going to be a process.

THE PROJECT IS LAYING THE FOUNDATIONS FOR WHAT WILL BE A LONG-TERM HORIZON ON A NEW WAY OF DOING BUSINESS

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Mid North Coast Local Health District Northern NSW Local Health District

NEW TOOL WILL PREDICT HEALTH OUTCOMES

New approach

“There’ll never be sufficient funds to cover everything and we need a new collective approach to work more efficiently and effectively in improving health. An approach where funders, fund allocators and health providers work collectively to do better,” said Darryl. The intent of the new approach is that rather than taking an input approach, it takes an outcomes-based approach. NCC defines the objective in the broadest terms based on the Triple Aim of health. The optimisation tool

We will be using a multi-objective optimisation tool that will identify the most prudent and effective program outcomes for particular health needs. “It’s the initiator, the catalyst that is driving a whole lot of other things in our

Darryl Walker of GHD Advisory

approach. We’ve recognised that having the PHN and the Local Health Districts acting independently is inefficient and having the optimisation tool is the initiator for wanting to use the funds we have in the best possible way.” The tool set looks at the available pieces contributing to the ‘problem’ and puts them together in the best way possible to provide a solution. And it will also forecast health outcomes, an interesting innovation. The first project that NCC is tackling is how to achieve better lives for people dealing with mental health issues and/or alcohol and substance use on the North Coast. Measuring mental health burden

In order to try to understand the issues that need to be addressed, Darryl has focused on one component of the health jigsaw called ‘the mental health burden’ which can be measured in Quality-Affected-Life-Years (QALYs).

A NE W VI S I O N F O R H EA LT H C A R E N O R T H C O A S T C O L L ECT I V E

Some initial work that Darryl Walker of GHD Advisory did with NCPHN looked at the amount of money NCPHN spent last year on mental health and alcohol and other drugs (AOD), who the programs reached and what they achieved. Through this process we realised the uncomfortable reality that we don’t necessarily have all the answers to these questions. Why? Because health care needs are inherently complex. However, there is an opportunity to improve how and why we fund the regional health programs we do – and that’s the reason behind NCC.

THE TOOL SET LOOKS AT THE AVAILABLE PIECES CONTRIBUTING TO THE ‘PROBLEM’ AND PUTS THEM TOGETHER IN THE BEST WAY POSSIBLE TO PROVIDE A SOLUTION Darryl explained to improve population health we have to find out how much we can ‘buy back’ that mental health burden from the community. The burden is the number of people affected by particular mental health disorders multiplied by the effect it has on their lifestyle. “We’re looking at what is the combination of all those potential things we could do out there that has the best effect on the community. So we’re not looking at individual programs and saying yes or no, but understanding the efficacy of those individual programs which is proving challenging. We don’t know how effective some programs are because not a lot of research been done on their efficacy.” Understanding the efficacy of individual programs and collectively deciding what to do for the community is a really complex problem. “You have three large groups of disorders – affective, anxiety and substance misuse. And then beneath that you have your individual disorders, then you have all your different communities, different LGAs and within those you have different ethnicities, differing socio economic status and different age groups,” said Darryl. Continued page 39

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Goori Grapevine Health Care Practice students celebrate

I

n February, 16 health care practitioners travelled from all over the NSW North Coast to TAFE NSW Port Macquarie to celebrate the near-completion of their Certificate IV in Aboriginal and Torres Strait Islander Health Care Practice. Once they fulfil the remaining 300 workplace clinical hours of the 18-month course they will be the first-ever student cohort in the NSW North Coast to graduate with the nationallyrecognised qualification. The students – all of whom already work as Aboriginal and Torres Strait Islander (ATSI) health practitioners and identify as Aboriginal and Torres Strait Islander – completed their sixth and final block of the course’s theory component last week. The big milestone was celebrated with a dinner at The Mercure restaurant.

The health care practice graduates have completed more than 500 clinical hours.

TAFE NSW Manager Service Delivery Aboriginal Health, Daniel Morrison, said everyone was delighted to finish the face-to-face training blocks, each of which they travelled to TAFE NSW Port Macquarie to undertake. “I am really proud of my students for achieving such a momentous milestone. I know they will be valuable community members with the skills and knowledge they’ve gained over

the past 12 months,” he said. “The TAFE NSW Certificate IV in Aboriginal and Torres Strait Islander Health Care Practice empowers practitioners to offer streamlined care to patients, upskilling them to provide professional practice work in a clinical setting. The overarching goal is to improve health outcomes for our communities and families. “Our cohort received participation certificates at the Port Macquarie celebration dinner

and are looking forward to a course completion certificate once they hand in their workplace books in the coming weeks. “It’s been a real pleasure to watch these practitioners develop over time and I wish them all the best.” TAFE NSW partners with the Aboriginal Medical Service and several Local Area Health Districts to support and service qualifications that upskill the Aboriginal and Torres Strait Islander health care workforce. This first cohort of Certificate IV Aboriginal and Torres Strait Islander Health Care Practice students on the NSW North Coast travel from as far south as the Central Coast and Lismore in the north. They have already completed more than 500 clinical hours in their workplaces to fulfil the practical training the qualification requires.

Alliance supports Uluru Statement

T

he Board of the National Rural Health Alliance (NRHA) has voted unanimously to support the Uluru Statement from the Heart, following a lengthy consultative process with Council members. NRHA Chair, Tanya Lehmann, said the Board’s vote acknowledged the Uluru Statement and the Alliance’s support of the call for Constitutional reform to empower Aboriginal and Torres Strait Islander peoples and recognise their sovereignty with the land. Ms Lehmann said the Alliance Board had engaged with its 41 Council members, including Aboriginal and Torres Strait Islander organisations and stakeholders. This move was to ensure support for the Uluru Statement reflects the views of its members delivering health services to seven million people in rural, regional and remote Australia. “The Board’s vote to support the Statement from the Heart, and the activity that the Alliance already undertakes with its Council members and the broader Indig20

enous population across the country, is also underpinned by our recently approved Reconciliation Action Plan,” she said. “Some 65 per cent of Aboriginal and Torres Strait Islander people live in rural, regional and remote areas – they need to be involved in the decision making process. “Their voice needs to be recognised, accepted and included in the design of what

a publication of North Coast Primary Health Network

needs to happen to improve health outcomes and the delivery of appropriate services.” More than 250 Aboriginal and Torres Strait Islander elders, academics and delegates gathered at the 2017 National Constitutional Convention, with the main outcome being the Statement from the Heart. The Statement seeks substantive constitutional change and structural reform to recognise the rights and role of Indigenous people in Australian society. “We seek a Makarrata Commission to supervise a process of agreement-making between governments and First Nations and truth-telling about our history,” the Statement says. “We call for the establishment of a First Nations Voice enshrined in the Constitution. Makarrata is the culmination of our agenda: the coming together after a struggle. It captures our aspirations for a fair and truthful relationship with the people of Australia and a better future for our children based on justice and self-determination.” healthspeak Apri 2019


New grant to boost cancer screening for Aboriginal people

F

ollowing on from the successful Women's Cancer Screening Collaborative, North Coast Primary Health Network (NCPHN) has been awarded an Increasing Cancer Screening for Aboriginal and Torres Strait Islander People on the North Coast grant from the Cancer Institute NSW. Cancer is the second most common cause of death for Indigenous Australians after cardiovascular disease. Aboriginal people are less likely to participate in cancer screening programs, are more likely than other Australians to be diagnosed when cancer is at an advanced stage and have a 30 per cent higher cancer mortality rate than non-Indigenous Australians (Cancer Australia 2015).

In line with the National Aboriginal and Torres Strait Islander Cancer Framework and the NSW Cancer Plan, NCPHN will work collaboratively across a number of sectors. These are local Aboriginal Medical Services (AMSs), local general practices, the Northern NSW Local Health District, the Mid North Coast Local Health Dis-

trict and communities. The aim is to increase, breast, cervical and bowel cancer screening participation rates for Aboriginal people. We will also work towards reducing the burden of lung and prostate cancers for Aboriginal people. With funding from the Cancer Institute NSW and NCPHN Commonwealth funding from

2018 to 2020, we are pleased to be implementing a Quality Improvement Collaborative. In this Collaborative, participating AMSs and general practices will work alongside supporting organisations such as the North Coast Cancer Institute and BreastScreen North Coast to identify screening barriers and areas of care requiring improvement. In addition, the project aims to build health literacy and self-management capabilities for cancer screening and treatment services in the Aboriginal community and participating primary care organisations. For more information, contact Senior Project Officer Meg Baker at: mbaker@ncphn.org.au

First frontline Indigenous suicide prevention strategy

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esearchers from the Rural Clinical School at The University of Queensland have designed a suicide prevention strategy to help reduce the alarming suicide rate among Indigenous Australians in remote and rural communities. Almost 95 per cent of Indigenous Australians have been impacted by rates of suicide that are more than twice those of the broader community. Importantly, suicide is the leading cause of death among 5 to 17-year-old Indigenous children. Despite these alarming statistics there are currently no effective suicide intervention-training models specifically designed for Indigenous people. The University of Queensland’s Dr Bushra Nasir, a Research Fellow at the Fac-

April 2019 healthspeak

ulty of Medicine, said frontline education and intervention training was one of the most effective suicide prevention strategies available. “Using a co-design framework, we developed the Indigenous Network Suicide Intervention Skills Training (INSIST) program to enable Indigenous communities to

keep each other safe by increasing the knowledge, awareness and sense of connectedness between at risk groups and health services or support groups,” Dr Nasir said. “This was developed over three years in close collaboration with community members, service providers, education experts and mentors, as

a publication of North Coast Primary Health Network

well as drawing on existing models and previous research. “The co-design approach of the training led to successful uptake, and provided strong evidence on value and sustainability. The resulting program focuses on cultural importance and empowerment for Indigenous communities. “The program includes a mobile app to provide training refreshers, support resources, and intervention guides, provides further utility of the training package and its longterm sustainability. And the training provides participants with the necessary skills and knowledge to apply a suicide intervention model.” The findings of the INSIST team were presented at the 15th National Rural Health Conference in Hobart in March.

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World First: SCU scoping study shows benefits in naturopathic medicine

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esearchers at Southern Cross University have found naturopathic medicine favourable in the treatment of a range of chronic conditions after conducting the world’s first systematic scoping study on its clinical benefits. Published in the February issue of the Journal of Alternative and Complementary Medicine, the scoping study summarises the research evidence for whole-system, multi-modality naturopathic medicine. The research project took a year to complete and scoured the scientific literature for all papers that reported human research which evaluated the effectiveness of naturopathic medicine. Southern Cross’ research team of Professor Stephen P Myers

and Vanesaa Vigar included those papers where two or more naturopathic modalities were delivered by naturopathic clinicians to participants. Naturopathic medicine was found to be beneficial for a wide range of chronic conditions including cardiovascular disorders, musculoskeletal pain, type 2 diabetes, PCOS, depression,

anxiety, chronic pain, hepatitis C, menopausal symptoms, bipolar disorder, asthma and in increasing cancer survival time. “The study clearly shows for the first time the broad range of effectiveness of naturopathic medicine which has been demonstrated by clinical research,” said lead researcher Professor Stephen Myers.

“This study coupled with the large body of literature which demonstrates the effectiveness of individual naturopathic tools of trade (nutritional and herbal supplements and lifestyle interventions) means there can no longer be any doubt that naturopathic medicine is an effective approach to chronic disease.” The researchers identified 33 published studies involving 9,859 participants. The studies came from research conducted across the globe and included 11 USA; 4 Canada; 6 Germany; 7 India; 3 Australia; 1 UK; and 1 Japan (the paper from Japan covered a range of mainly chronic clinical conditions). The study is open access and available free online from the New York publisher, Mary Ann Libert, Inc at https://www. liebertpub.com/doi/10.1089/ acm.2018.0340

Preparing for the future By Professor Iain Graham Dean, School of Health and Human Sciences Southern Cross University

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edesigning the learning experience of healthcare students at Southern Cross University is an ongoing process. In the world of healthcare it is often the probable future that focuses the thinking. Politicians, business people, public servants and health care planners, along with health academics like to plan a future which minimizes risk and provides stability. However, globally there are forces at work which have the potential to derail this probable future, leaving the challenge of planning for a preferred future. With the full impact of technological change, health care will be shaped by the gene, the micro-chip, the nano technological evolution and healthcare history.

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Why do I write of these issues? Because the designing of the preferred healthcare future has started across the globe. In Australia, nurse education is being reviewed along with the various accreditation bodies and their roles. In planning future health services, questions are being asked about how health care can also be promoted and maintained, rather than designed around an acute care model of intervention. Those advancing technologies I alluded too are implicit in these debates. The consequences therefore for a Health and Human Sciences School at University are profound! This February just under 4000 health students arrived on campus. Our graduates will still be working in 2059-2069. What will healthcare look like then? Think back to 1969, those of you who were around! Given the impact of the technological revolution and the

fast changing health picture, how do Health Schools prepare a workforce to respond to these new challenges and opportunities? At the end of February two senior academics from the School of Health and Human Sciences, presented a paper at the Centre for Healthcare Knowledge and Innovation conference held at Coffs Harbour. The paper set out how the School was redesigning curricula and clinical experience for its students so that they were prepared for the preferred healthcare world. A

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difficult task given that a 19th century, craft-based model of care still remains. There are four pillars which this curricula work stands upon: Inter-professional learning, Indigenous and cultural safety; service-user partnerships and internationalisation. Curricula based on the framework of prepare, explore and apply are the driving force for the School’s planning. Working closely with new healthcare providers and nontraditional people-focused services we seek to create a new kind of health practitioner workforce. One which knows how to actively engage in lifelong learning and can promote health literacy and self-care. They also need to be technologically capable, display empathy and use emotional intelligence bounded by strong ethical framework. These skills and talents will help empower the individual who wants to design their own health future!

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Combating institutional racism in health on the North Coast

April 2019 healthspeak

Members of the RAP Work Group at their most recent meeting. From left: Lillian Moseley, Tony Seto (NCPHN), Mathan Maglaya (NCPHN), Uncle Michael Roberts, Aunty Lenore Parker, Uncle Roger Duroux, Susan Parker-Pavlovic (UCRH), Kim Gussy (NCPHN), Monika Wheeler (NCPHN) and Aunty Sue Follent.

access to health care?” Mr Mokak said many Indigenous people are victims of prejudice when seeking medical services and has suggested cultural awareness training for health professionals would reduce the incidence of racism.

Indigenous people when having a coronary event in hospital are 40% less likely to receive a stent or a coronary angioplasty Local action On the North Coast, with the support of the Northern NSW and Mid North Coast Local Health Districts, North Coast Primary Health Network and the University Centre for Rural Health (UCRH) in Lismore are actively working towards greater inclusion of Aboriginal people in designing and

delivering health services. In addition medical students, nursing and allied health students are taking part in cultural immersion experiences, and health professionals are being offered cultural safety training to provide a setting where Aboriginal people feel comfortable, welcome and safe. NCPHN’s Reconciliation Action Plan (RAP) is also proving to be a valuable platform for fostering closer relationships and greater understanding between NCPHN staff and Aboriginal community members across the region.

NCPHN’s RAP Plan The first Reconciliation Action Plan (RAP) meeting of interested NCPHN staff and Aboriginal and Torres Strait Islander community members from across the North Coast was held in Grafton in February 2018. Reconciliation Australia’s Action Plan program provides a framework for organisations to support the national reconciliation movement. Since the first meeting, RAP Work Group members met regularly for four-hour workshops to develop the Plan. In November last year

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Combating Racism in health on the North Coast

nstitutional racism has been identified in the Australian Government’s National Aboriginal and Torres Strait Islander Health Plan 2013-2023 as a significant barrier in the delivery of health care to Aboriginal and Torres Strait Islander people. Disturbingly, a 2017 report titled Addressing Barriers to Health Equity for Aboriginal and Torres Strait Islander people in Queensland’s public hospital and health services (Marrie, A & Bukal Consultancy Services) found unacceptable levels of racism. Based on audit results, 10 of the 16 hospitals and health services examined rated within the extreme range of institutional racism with the remaining six in the very high range. There is no reason to think that audit results of hospitals and health services in NSW and other states would be much different. Former Chair of the Social Determinants of Health Alliance, Martin Laverty, has no doubt racism sometimes comes into play when Indigenous Australians seek medical attention. “When an Indigenous person is admitted to hospital, they face twice the risk of death through a coronary event than a non-Indigenous person and concerningly, Indigenous people when having a coronary event in hospital are 40 per cent less likely to receive a stent or a coronary angioplasty. “The reason for this is that institutional racism is resulting in Indigenous people not always receiving the care that they need from Australia’s hospital system,” he explained Former Chief Executive of the Australian Indigenous Doctors’ Association, Dr Romlie Mokak, believes the burden of ill health is already greater among Indigenous people, but this isn’t recognised. “Whereas Aboriginal people may present to hospitals later and sicker, the sort of treatment they might get once in hospital, does not necessarily reflect that higher level of ill health. Why is it that the sickest people are not necessary getting the equitable

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A cultural awareness training group for health professionals conducted in Tweed Heads in 2017.

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NCPHN’s Board of Directors approved the draft plan which has now been sent to Reconciliation Australia for approval. NCPHN’s Incoming Executive Director, Wellness, Monika Wheeler, said that RAPs were having a positive impact across Australia in various ways. “Reconciliation Australia’s RAP Impact Measurement Report shows that people in RAP organisations have much higher levels of trust between each other (71 per cent compared to 13 per cent); are far less prejudiced (9 per cent compared to 70 per cent); and have greater pride in Aboriginal and Torres Strait Islander cultures (77 per cent compared to 51 per cent). “These are all great achievements internally for organisations. But not only are RAPs changing workplace culture and attitudes, they are laying the foundation for significant economic and social outcomes for Aboriginal communities,” she said. Under the RAP, NCPHN is: • Increasing the proportion of Aboriginal staff across the organisation to at least five per cent • Developing a commissioning framework to ensure Aboriginal services are preferred providers for Aboriginal specific health funding • Promoting and celebrating Aboriginal culture through Reconciliation Action Week and other culturally significant days • Building stronger relationships with the Aboriginal community controlled health services and other Aboriginal organisations and communities

Combating Racism in health on the North Coast 24

NCPHN’s Cultural Safety activities Over the past few years, NCPHN has regularly funded and organised cultural awareness training workshops for both the community and health professionals facilitated by local Aboriginal trainers. This year NCPHN is enhancing cultural safety training opportunities for health professionals.

People in RAP organisations have much higher levels of trust between each other; are far less prejudiced; and have greater pride in Aboriginal and Torres Strait Islander cultures Cultural safety in this context involves health professionals examining their own beliefs, behaviours and practices. It also works to ensure that their services are perceived as safe—by the patient rather than the provider. Such training includes the opportunity for self-reflection leading to enhanced cultural awareness. Through increased awareness, the practitioner can improve their skills in relating to and working with Aboriginal people. This is the first building block toward

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cultural safety. The first step towards enhancing cultural safety opportunities locally was through funding provided to Galambila Aboriginal Health Service via the Mental Health Access Improvement Project. Galambila has been working collaboratively with primary care providers providing services on Gumbaynggirr Country (located in and around the Coffs Harbour region.) The aim is to increase knowledge about Gumbaynggirr culture and build capacity regarding good practices for cultural safety within a health services context. Through this project Galambila developed the ‘Journey of Knowing’ publication, hosted yarning groups with local Aboriginal people and held cultural tours for health professionals. Subscribe to NCPHN’s weekly events newsletter to find out about cultural safety workshops coming up later this year in your region at: https://ncphn. org.au/events

UCRH’s Cultural Immersion program This program is led by the Aboriginal Health Academic Lead Emma Walke and educators from the Bundjalung Nation and is conducted in a range of settings, from the classroom to two-day cultural immersion stays on Country. Where possible, every student who attends the Lismore and Murwillumbah UCRH campuses receives an Aboriginal Health Orientation session. This includes short stay allied health, dental and medical students. HealthSpeak attended a session of the UCRH’s February Cultural Immersion program at Alstonville and spoke to Emma Walke and Associate Lecturer, Rural Clinical School, Susan Parker Pavlovic, about what the program offers health care students. For the past 10 years Emma has conducted cultural awareness training on the North Coast and has run the UCRH’s Cultural Immersion Program for five years. As well as the Cultural Immersion training offered each year for medical students, every six weeks Emma or Susan meet every allied health student who does a placement on the Centre’s Lismore and Murwillumbah campushealthspeak April 2019


cies to the experiences of a person aged 75. “All the things we’re talking about, that person will have experienced every single policy and their children will have also experienced such things or the results of them. That’s what intergenerational trauma is, a lot of fears passed onto your children as a result of what the parents endured.” Other policies discussed include the change to a Western diet early in the 20th century and how that’s affected Aboriginal people physically. The restrictions on hunting for food and less exercise. Susan and Emma are flexible in their approach as they say it’s all about what the students ask and want to know. “Sometimes it’s all about the Stolen Generation, other times it’s about assimilation policies and understanding how missions and reserves work. We

Students from the University of Western Sydney learning some traditional dance moves in 2017.

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From left: Susan Parker Pavlovic, Anthony Franks, Aboriginal Chronic Care Officer, Northern NSW Local Health District; Georgina Cohen, Programs Manager, Rekindling The Spirit and Troy Combo, Program Manager at Bulgarr Ngaru Aboriginal Medical Corporation, shared their background and health careers with medical students during January's two-day program in Alstonville.

The students had no idea that such practices took place here…they think it’s other countries that did such things

Combating Racism in health on the North Coast

es, more than 1,100 students a year. “These students are given threehour sessions – an orientation to Aboriginal health. The purpose is to get the students thinking about the last 119 years of history and how it affects the Aboriginal population. It’s very easy to see the health of our people today but not think about the reasons behind it. So we talk about all the past government policies that have affected Aboriginal people,” said Emma. Susan said these policies included The Stolen Generation, the process and the motivation of the government, what actually happened and the ongoing effects of intergenerational trauma. “I find when we talk about it, once the students are able to understand the cycle and what actually happened to families, they are quite gobsmacked about the process. For a lot of students, this policy is something they’ve not heard much about,” said Susan. Both Emma and Susan have personal stories that they share about the experience of The Stolen Generation which work well. Putting a human face on a policy gives it a much more powerful impact. “They are shocked when we present them with written evidence of exemption certificates and letters and correspondence. They are shown photos of small children with a cross drawn through the centre. A white person had excluded them as home help. People would say ‘I’ll take the one in the middle as long as they are strong.” “The students had no idea that such practices took place here…they think it’s other countries that did such things,” Susan said. Then the educators link past poli-

have a toolkit of personal stories and other things we share with them,” said Emma. Susan said it was important to give the students a safe space to ask such questions rather than jeopardise a relationship with a potential client by asking awkward questions. “One very important thing is that we make it clear to the students that nobody in this room is responsible for past injustices. Nobody here is being held responsible, but what you are responsible for is what you do with this information once you leave this room.” Emma and Susan also explain that they don’t expect to change people’s minds or win everyone over to their viewpoint. “It’s a spark for them to start thinking about things in a slightly different way. But also that if they still feel in some way negative to Aboriginal people, that’s fine – but they can’t bring that attitude into the health space. They have to shelve that when they walk through the clinic door,” Emma said.

a publication of North Coast Primary Health Network

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Immunisation Coordinator looks back on 27 years M

Profile Immunisation Coordinator Marianne Trent

ention the North Coast Public Health Unit’s Immunisation Coordinator Marianne Trent to any local health professional and they describe her as ‘a legend’ and a fantastic resource for information about immunisation. Marianne finishes work in April and retires in November. HealthSpeak sat down with her to talk about her career and the changes she’s witnessed in the vaccination landscape. There’s no doubt she’ll be missed – she has the benefit of 27 years’ experience in the field of Immunisation and Public Health. Marianne came to Australia after completing her nursing training in New Zealand in the late 1960s. It was 1978 and she was planning on a six-month working holiday, but ended up staying. With a clinical background in orthopaedics she worked as a lecturer at the Australian College of Nursing for eight years. But she had another specialty up her sleeve. “I was also teaching Quality Assurance. And every year the then matrons up here on the North Coast used to get someone up from Sydney for six months to teach a specialty. I was brought up here in 1985 to teach Quality Assurance and that was extended to a year. Recruitment was a bit different to what it is now, and they just said to me ‘Oh, you might as well stay.’” “So I worked for what was then the Health Education Services, the education branch of the regional health office. And I worked in this same building at 31 Uralba Street in Lismore until about 1992 when the regional office ceased to be and I lost my job.” Marianne had been working with the Crawford House audit team, and in 1992 when John 26

Immunisation Coordinator Marianne Trent believes we are coming out of a phase of not vaccinating.

Beard was the Director of the Public Health Unit he decided they needed a Public Health nurse but lacked funding. “I was excess to requirements but came with funds, so we talked and I told John I was confident I could adapt to the new role.” Marianne’s ‘training’ for her new position involved going down to Sydney for a week to see what a Public Health Unit did and returning as the Public Health Nurse, the TB Coordinator, the AIDS Coordinator and the Immunisation Coordinator. In 1992 Marianne recalls the Immunisation Schedule as being ‘very simple’. “We were still using the whole cell pertussis vaccines which meant we were getting side effects that we just don’t see in the vaccines now. “And when I first started in Public Health we were seeing hundreds of cases of measles up here. In 1998 we ran a campaign

We were still using the whole cell pertussis vaccines which meant we were getting side effects that we just don’t see in the vaccines now

where we offered measles vaccination to every child in primary school. “Until that time we constantly had cases of measles and we did have deaths.” Before those local measles deaths, the first time Marianne witnessed children dying was as a volunteer in Vanuatu in the 1970s. “They were dying from whooping cough and measles,

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something I’d never seen happen in New Zealand.” In fact Marianne used her Vanuatu experience to effectively counter an anti-vaccination article in The Echo written by Meryl Dorey of the Australian Vaccination Risks Network, previously known as the Vaccination Awareness Network or VAN. “Dorey was claiming that if people just ate a proper diet and took exercise and vitamins then they wouldn’t die from measles. “And my reply was that when I worked in Vanuatu in the ‘70s those kids had a perfect diet, they weren’t overweight, they never sat inside looking at a TV - they were outside playing. But they got measles in the morning and they were dead in the afternoon.” Marianne said dealing with the anti-vaccination movement had been a really interesting part of her job. “When I first started there was healthspeak April 2019


April 2019 healthspeak

From left: NNSWLHD Immunisation Officer Rachelle Deaker, Immunisation Coordinator Marianne Trent, Max Walker and School-Based Vaccination Coordinator Bernadette Williams at an Immunisation Conference in Melbourne.

We’ve had real success with Aboriginal immunisation. Our immunisation rates for Aboriginal people are phenomenal, beyond 95%. diseases. “I’d tell them that we now use less than 200 to protect against twice as many diseases. So vaccines have now been made smarter and that’s a really convincing argument for some parents.” The other useful argument is pointing out just how small the risk of vaccination side effects is.

Modelling shows that the whole of the immunisation program uses up something like 0.01% of the available immune system. “That’s a tiny part compared to the rest of the world that the body has to become immune to,” said Marianne. “You are looking at something very small and very controlled.” Since she began as Immunisation Coordinator in 1992, Marianne has also seen a lot of good news stories. “We’ve had real success with Aboriginal immunisation. Our immunisation rates for Aboriginal people are phenomenal, beyond 95%.” The Gardasil 9 HPV vaccine has also been really successful with Australia now in line to be the first country to get rid of cervical cancer. And meningitis is becoming much less common. “When I first started we used to get a couple of dozen Hib

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Until Marianne’s role is filled, Immunisation Officer Rachelle Deaker will be in the office on Wednesdays and is happy to field queries on 6620.7514. 27

Profile

meningitis cases every year, now we get one every three years in an unvaccinated child.” In addition the debilitating rotavirus has really been wiped out in the littlies. Marianne does acknowledge that some vaccines are better than others. An example is the continuing challenge to protect against whooping cough. “Unfortunately it’s just the nature of the bug, it’s very hard to get immunity. Even if I get natural whooping cough it’s not going to give me more immunity than the vaccine. “The other big milestone is getting the Boostrix vaccination (Diphtheria-Tetanus-Pertussis) into pregnant mothers which protects their young babies. Sadly, in the past 10 years we’ve lost a couple of babies who were too young to be vaccinated. Hopefully that will be a thing of the past as well.” Marianne believes on the North Coast we are coming out of a phase of not vaccinating. “The reason I think this is that so many teenagers are getting vaccinated now who weren’t getting vaccinated as a child, and those teenagers when they have kids will vaccinate their kids. Because most of them are very angry about not being vaccinated. “So I think within another generation we are going to have immunisation rates the same as everywhere else in Australia.” Marianne is looking forward to having free time to pursue travel, artwork and volunteer at her local school. But she knows she is really going to miss interacting with health professionals. “It’s been such a pleasure working with all the providers and I really enjoy the doctors and nurses ringing me. I’ve also enjoyed producing the Immunisation Updates for the Primary Health Network.”

Immunisation Coordinator Marianne Trent

no anti-vaccination sentiment around. People just vaccinated their kids. It was in the mid-90s that we starting seeing this opposition to vaccination on the North Coast, and in particular from VAN as they were in those days.” Marianne said it was difficult to get the facts on immunisation across in the ‘90s as any media release put out by the Public Health Unit would see the reporter go to VAN for their opinion. “Nobody was taking on the misinformation peddled by VAN until a man named Ken McLeod from the South Coast put in a 90-page complaint to the Health Care Complaints Commission. It was after that that people actually took them on. And it wasn’t until after McLeod’s complaint that the media stopped using VAN as spokespeople on the topic.” There are two facets to her work that have given Marianne the greatest enjoyment and satisfaction – teaching vaccine providers and working with them; and talking to mothers who are unsure about vaccinating. “If a mother would ring me up then they had an open mind. And the ones with a closed mind would never ring me. I would say 90 per cent of mothers who rang me would go on to either vaccinate fully or at least partially. They just needed someone to have the time to talk to them about it. And in some instances that took three meetings with them to actually get them convinced that vaccinating was the way to go.” She knows she was lucky to have the time to really engage with these uncertain mothers, as nurses and doctors don’t have the time. Marianne recalls some very persuasive arguments she used. “I used to explain to mothers that when I first started working as a nurse we used vaccinations like smallpox, diphtheria, tetanus and whopping cough. And we used over 2000 antigens or proteins to protect against five


Vegan or Mediterranean diet – which is better for heart health? By Markos Klonizakis Reader (Clinical Psychology), Sheffield Hallam University

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ardiovascular disease is responsible for more than 30% of deaths worldwide, and every year more people are being diagnosed with the condition. In 2015, more than 85 million people in Europe were living with cardiovascular diseases. But although the total number of people who suffer with cardiovascular disease increases, the number of those who die from heart and circulatory diseases is in steady decline. This is because treatment options, quality of care and access to healthcare have improved considerably since the middle of the previous century. Even though this is definitely a positive sign, it means that more and more people are living with cardiovascular disease – which can seriously impact quality of life and puts people at risk of sudden death. In the UK alone, healthcare costs relating to heart and circulatory diseases are estimated at £9 billion each year – while overall, the cost to the EU economy is close to £200 billion ($370 billion AUD) a year. It makes sense then that cardiovascular disease prevention is considered the number one target for many national healthcare services around the globe. Prevention includes encouraging people to eat a healthier diet, become more physically active and stop smoking. All three can provide multiple benefits – reducing risk for a range of diseases and conditions and improving quality of life.

Diets for a healthy heart For many people facing a diag28

nosis of cardiovascular disease, diet is one of the first things they might look to tackle. There are a number of healthy diets around – many of them associated with regions or countries, such as the New Nordic – which promotes eating root veg-

which does require abstaining from eggs, dairy, and honey too. In regards to cardiovascular disease protection, the available evidence is limited. However, what we know suggests that long-term vegans have lower total cholesterol than non-vegans.

On the other hand, we did find that participants who followed the vegan diet appeared to also have a reduction in a number of important micro-nutrients – such as B12 vitamin and iodine. This is despite us providing B12 supplements to participants. This is a serious finding: micro-nutrients are vitamins and minerals that our body needs in small quantities to function properly, while both iodine and B12 deficiency pose an important health risk.

Our recommendation

It is also important to be well informed before making any dietary changes etables, cabbage, apples, berries, fish and game among other things. The Japanese – which advocates the consumption of rice, cooked and pickled vegetables, fish, meat and soy beans – and the Mediterranean diet. The Mediterranean diet is a balanced diet, promoting the consumption of vegetables and fruits in addition to oily fish, olive oil, red wine, lean meats, nuts, and low-fat dairy products. It has been known since the late 1950s that it does offer cardioprotective benefits and several large and not so large studies have confirmed these findings since. Then there is the vegan diet – a plant-based, meat-free diet,

What works best? Our team explored the benefits of several regional and novel diets – including the New Nordic diet, the Mediterranean diet, the vegan diet and nitraterich ones – which are said to directly improve heart health. We looked into their cardiovascular effects both in the short and longer-term. In a recent study we compared the short-term effects of the Mediterranean and the vegan diet. Our findings suggest that, at least in the short-term, the Mediterranean diet improves significantly the availability of nitric oxide in our veins and arteries – which is important to maintain the good health of our vascular system. Nitric oxide is severely affected by the ageing process and is strongly related to the development of cardiometabolic diseases. So, the observed greater nitric oxide availability is very positive news. Our study also found that the vegan diet offers benefits in the reduction of cholesterol levels.

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Research has showed repeatedly that balanced diets are often more beneficial in the longer term – and our work strongly points to the same direction. In any case, it is probably best to avoid adopting popular trend diets– and make a choice around your individual needs. It is also important to be well informed before making any dietary changes. This is because in some cases, a change in diet does lead to deficits of micronutrients and vitamins. This can create a health risk which surpasses the benefits. So as far as reducing cardiovascular disease risk, our work suggests that it is probably better to look for a solution in the Mediterranean diet. This means eating more plant-based foods – such as fruits and vegetables, whole grains, legumes and nuts. You should also look to replace butter with healthy fats such as olive oil, as well as using herbs and spices instead of salt to flavour foods. Red meat should be limited to a few times a month, but you can eat fish and poultry at least twice a week. Enjoying meals with family and friends is also a big part of the Mediterranean diet and culture – as is drinking red wine in moderation (though this part is optional). Printed with kind permission from The Conversation (www. theconversation.com/au)

healthspeak April 2019


How to create a greener clinic There are many reasons for working to make your health practice as environmentally friendly as possible. Doing the right thing for the environment helps save endangered species, reduces the planet’s carbon footprint, saves your business money, and helps boost your reputation as a good corporate citizen. And taking the steps to make your practice more eco-friendly are not difficult. HealthSpeak has compiled a list of tips to help you create a more sustainable health care environment.

Switch off lights, computers, printers and appliances at the power point when not in use they will last longer and your power bills will be considerably reduced.

Add greenery

Adding plants to a work environment improves air quality, reduces work stress, makes the office more attractive and enhances productivity. Recommended plants for offices include: jade plant, peace lily, bromeliads, African violets, Mothers’ in law tongue and the parlour palm.

Environmental champion

Make one of your staff the clinic’s environmental champion – the staff member who keeps up to date with ways to improve the practice’s environmental footprint and calls regular meetings to talk about putting these ideas into practice.

Reduce meeting costs

When you can make a phone call instead of holding a meeting, send an email rather than posting. Conducting virtual meetings saves the cost of business trips.

Buy green

Set up a sustainable supply policy and guidelines and send a checklist to your suppliers asking about their sustainable products and services. Ask printers for recycled paper and replace defunct equipment with high-energy efficiency models with a long shelf life. Also look at your accounts and see where the money is unnecessarily spent. If stationery and paper supplies are costly, set up a task force to minimise paper waste. Two-sided printing is just one way to minimise waste.

April 2019 healthspeak

Turn it off

Reduce power consumption

Turn down the air conditioner lowering the temperature just one degree on a hot day can increase your energy costs by 10 per cent. Replace older light sources with LED lighting. Reduce energy consumption further by: • using cut-out switches to cut out standby power usage • Installing solar panels • installing automatic lighting sensors • having power supplied by green energy providers • choosing hybrid cars for your fleet • Reducing water and power consumption by running office dishwashers when full, fixing leaky taps and reducing the hot-water temperature setting.

Get staff involved

Recycle rubbish

Ensure that all patient-related information goes into your secure shredding bin, but everything else that can be re-used should be turned into scrap note paper or put into a ‘co-mingled’ recycling bin. Inedible food scraps can go into a green bin for composting or to feed a staff member’s chickens.

Encourage staff to use reusable cups instead of takeaway coffee containers and ensure everyone has their own mug. Schedule a regular office book, clothing or DVD swap day. If you have further ideas for greening medical practices, email: jgrist@ncphn.org.au and we will share them with our readers. And if you’d like to take your environmental advocacy further, you can join Doctors for the Environment NSW here: https://www. dea.org.au/become-a-member/

a publication of North Coast Primary Health Network

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Galambila’s Cultural Tour a hit with health professionals By Rhiannon Mitchell Indigenous Health Project Officer, NCPHN

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orth Coast Primary Health Network’s Aboriginal Health team and Galambila's Aboriginal Mental Health Access team recently partnered in delivering an interactive Gumbaynggirr cultural tour for health professionals in the Coffs Harbour district. The all day tour was designed to develop cultural awareness and provide a "Journey of Knowing for Well-being". The day began with a Welcome to Country followed by a Smoking Ceremony and Welcome Dance performed by Bularri Muurlay Nyanggan Aboriginal Corporation in front of Galambila Aboriginal Health Service. Participants then boarded a coach and travelled to Moonee Beach with an onboard cultural guide - Clark Webb - who provided an enlightening commentary as they moved around the picturesque Gumbaynggirr landscape. Arriving at Moonee Beach they enjoyed a casual morning tea and then their tour guide lead them

through a bush track to the shell middens before walking out to the spectacular Moonee Headland to hear yarns about the "two sisters". After this the group headed back on the bus and went through Central Bucca hinterlands and the Orara East State Forest en-route to the stunning location of “Niigi Niigi” (Sealy Lookout). Because of the wet weather, after heading up to Sealy Lookout, the tour continued down at the Local Aboriginal Lands Council site where everyone enjoyed lunch prepared by staff from Nyanggan Gapi Café. Further stories and some language education from Bularri Muurlay Nyanggan Aboriginal Corporation were exchanged. Following lunch participants heard from a range of health professionals working at Galambila Aboriginal Health Service and explored ways to embed the tour’s cultural learnings into day-to-day clinical practice. NCPHN has received great feedback from the 30 participants and will holding the next cultural tour on May 18. Registration details will be released soon.

From page 3

These predictions will affect the poorest countries most and, within countries, the poorest people disproportionately. Just as low and middleincome countries have been exploited by companies promoting tobacco and milk formula for infants, they have also been targeted by food and beverage companies pushing the consumption of energy-dense food and drinks. Such multinational companies tend to have enormous internal power with governments, with the issue of political donations contributing to this murky relationship, including here in Australia. The prevailing business model of these large companies that focuses on maximising profits leads to overconsumption of nutrient-poor food and beverages. Ross Gittins, Economics Editor for The Sydney Morning Herald (SMH) wrote in a recent article: “For instance, if the banks are now being criticised on all sides 30

Food systems have the potential to nurture human health and support environmental sustainability; however, they are currently threatening both for putting profits before people, why are governments – facing an epidemic of obesity and diabetes – so respectful of the food and beverage industry’s right to continue [to] fatten its profits by fattening us and our kids?” (SMH, January 30, 2019). The Lancet Commission report makes the pertinent point that at a time of inward-looking national governments, emerging populist movements in many countries, and some misguided

Aunty Jenny Skinner and Troy Robinson at the cultural tour's Smoking Ceremony

trust of data and science, strong international efforts and voices are needed. Governance is so often gradual, focused on individual choice and unable or unwilling to distance itself from strong business influence and short-term political goals. In turn, the report urges that to address human and environmental malnutrition worldwide, a shift is required toward a plant-based diet. It seems easy enough: doing so would mitigate obesity for obvious reasons, and address undernutrition because those diets are healthier and more accessible. Most importantly, it would curb climate change since growing plants will absorb carbon dioxide whilst production of meat, dairy, processed food and transportation adds to greenhouse gases. Food systems have the potential to nurture human health and support environmental sustainability; however, they are currently threatening both. Providing a growing global

a publication of North Coast Primary Health Network

population with healthy diets from sustainable food systems is an immediate challenge. Although global food production of calories has kept pace with population growth, more than 820 million people have insufficient food. Many more consume low-quality diets that cause micronutrient deficiencies and contribute to a substantial rise in the incidence of dietrelated obesity and diet-related non-communicable diseases, including coronary heart disease, stroke and diabetes. Unhealthy diets pose a greater risk to morbidity and mortality than unsafe sex, alcohol, drug and tobacco use combined. Because much of the world's population is inadequately nourished, and many environmental systems and processes are pushed beyond safe boundaries by food production, a global transformation of the food system is urgently needed to combat both human and environmental malnutrition, including obesity. healthspeak April 2019


The Search for Answers finance David Tomlinson

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ust after the start of the cold war in 1947, a group of economists, philosophers, businessmen and intellectuals converged on the small village of Mont Pelerin in Switzerland. The meeting held here ultimately changed the world. It included many people who later became household names and Nobel Prize winners: Friedrich Hayek, Karl Popper, George Stigler and Milton Friedman. Together they formed the Mont Pelerin Society, an institution dedicated to the principles of freedom. They tended to see themselves as capitalist resistance fighters, totally opposed to socialism, communism and government regulation in all forms. We know it as neo-liberalism. They began propagating their ideas in most western countries at a time when many were establishing the foundations of the welfare state and guided by the principles of Keynesian economics. For the next 30 years governments regulated and ran businesses, intervened heavily in the economy, financed medical research, set wages, provided pensions, attacked poverty and so on. The Mont Pelerin Society was not getting a lot of traction. But April 2019 healthspeak

We would still have to deal with the megacorporations that are out of control and playing one government off against another they persevered. When the OPEC oil crisis hit in the 1970s and Keynesianism failed to control the twin evils of rising prices and rising unemployment, the Mont Pelerin Society was ready to offer solutions. Society president Friedman argued persuasively to desperate politicians that a free market had all the answers. Think tanks all over the world dedicated to neo-liberalism were established and run with generous donations from sympathetic donors. The rest is history. Thatcher, Reagan, Blair, Hawke, Keating, the IMF, the OCED, the World Bank and even China all adopted the policies. Over the next 30 years neo-liberal free market polices became the norm and it seemed the fight was over. Some termed

it the end of history. But the GFC changed all that. Not everyone wins from the free market. Many of those who have missed out live in the west - and they are now in rebellion. Politics is in flux, many of our established institutions are under threat. It comes at a time when we are on the threshold of great changes in other areas. Neo-liberalism brought rapid economic growth but with it came the existential threat of climate change, huge environmental challenges, rapidly rising inequality as well as the potential disruptors of automation, artificial intelligence and genetic engineering. It is now abundantly clear that the neo-liberal free market model is unable to deal with these challenges. Climate change is the classic example of market failure and will require concerted government intervention and regulation. All these challenges could well be catastrophic unless prepared for and managed. The problem is that there is no coherent theory or set of ideas waiting in the wings to take over. Few people, except apparently for a high proportion of millennials, want to endorse socialism. Rampant capitalism

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would be unpopular and would not solve the problems we face. Simply bringing back Keynesianism would not work – the world has moved on. Tinkering at the edges of the free market is not likely to work either. But the hunt is on. Some ideas seem radical - but then so once were the concepts of a minimum wage, an old age pension, a 35-hour working week and four weeks paid annual leave. A plethora of books and thinkers (see Reading List below) are now emerging suggesting radical change. The most urgent problem is climate change. Our scientists tell us we are moving towards tipping points, which if reached, would instigate runaway climate change we would be unable to stop. Others, including economists and environmentalists say we have to move away urgently from the focus of constant growth. Exponential growth espoused by almost all politicians is of course unsustainable. That’s just maths. We are already living beyond the planet’s ability to support our lifestyles in the long term. Something has to change. Some economists say unemployment and inequality could be addressed by a universal basic income – a payment perhaps equal to the old age pension. It can be afforded. Every adult would receive the same amount and it would not be means tested. Most people would still take on work to boost their income but financial pressures would be reduced. If it worked as well as expected it would alleviate grinding poverty and homelessness. Trials in a number of countries are already underway.

Continued page 32 31


Local professor helps develop world-first cancer guidelines

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housands of prostate cancer patients around the world stand to benefit from new international guidelines developed with the help of Associate Professor Tom Shakespeare from the Mid North Coast Cancer Institute. The guidelines, developed by the Royal Australian and New Zealand College of Radiologists (RANZCR), outline how radiation therapy can be used to cure patients whose prostate cancer has returned after initial treatment. They offer a lifeline to those who previously had little to no hope. “This is a world first,” A/Prof Shakespeare said. “In the past, patients who have been diagnosed with recurrent prostate cancer have often been told it is incurable. “We now believe that these patients can be cured with radiation therapy.”

Prostate cancer patients need to see a radiation oncologist and a urologist In June 2018, the Royal Australian and New Zealand College of Radiologists released its position statement Informed Decision Making in the Management of Localised Prostate Cancer – A Patient-Focused Perspective. The statement highlights clear calls to action to ensure men with prostate cancer needing curative treatment are fully informed about their surgery and radiation therapy treatment options. According to A/Prof Sandra Turner of RANZCR’s Faculty of Radiology Oncology Council, best

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years, and the world class cancer treatment facilities and expert staff available on the Mid North Coast. “You could not get better results anywhere else,” he said. A/Prof Shakespeare expects to review the treatment results more formally in early 2019 as part of the Mid North Coast Cancer Institute’s quality assurance program.

Associate Professor Tom Shakespeare said early results showed up to 90 per cent of patients have had no relapse of their cancer.

The guidelines were developed after the RANZCR Faculty of Radiation Oncology Genitourinary Group held a national conference to review the new evidence and develop consensus guidelines. Previously none existed.

practice is for men to see a radiation oncologist as well as a surgeon (urologist) to receive accurate up-to-date information to help making the best decisions. “The decision about treatment comes down largely to the man’s choice based on having all the expert information and time to consider and discuss his options. More needs to be done to ensure men with prostate cancer advised to have curative treatment are referred to a radiation oncologist as well as the urologist to weigh up all options,” she said. View the informative document here: https:// www.ranzcr.com/whats-on/ news-media/262-expertsunite-to-empower-menwith-prostate-cancerposition-statement-release

A/Prof Shakespeare was a convenor of this conference, and a co-author of the guidelines which were published in the November 2018 issue of the international journal, Radiotherapy and Oncology. Here’s a link: https://www.thegreenjournal.com/article/S01678140(18)33342-5/fulltext A/Prof Shakespeare has already treated about 100 patients in Port Macquarie and Coffs Harbour during the past two years, following these guidelines. “It is early days but so far, by following the guidelines, we have more than a 90 per cent cure rate, with very few sideeffects.” A/Prof Shakespeare said. “These are amazing results considering in the past we would not have even treated these patients with radiation therapy.” The world-first guidelines cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, and the management of local prostate recurrence after definitive radiotherapy. A/Prof Shakespeare said the excellent results were due to the early adoption of the new guidelines, which had been in development for almost two

a publication of North Coast Primary Health Network

This article is reprinted with kind permission from The Pulse newsletter, a publication of the Mid North Coast Local Health District.

From page 32

We could also drastically cut the working week to give more leisure to those who are overworked. With automation and robotics, the nature of work will change without necessarily reducing incomes. We would still have to deal with the megacorporations that are out of control and playing one government off against another. If we adopt the right polices we could marshal in a golden era – a postindustrial civilisation. Some call it Utopia. But it is unlikely we have 30 years to do it. Readings: *Utopia For Realists: Rutger Bregman, Bloomsbury Press Doughnut Economics: Kate Raworth, Chelsea Green Publishing. *Inventing the Future: Nick Williams and Alex Srnicek, Verso Books *On the Future Prospects for Humanity: Martin Rees, Princeton University Press

healthspeak April 2019


Walking matters: we die from the feet up T

o walk is human nature. Anyone who can, does, even if it’s just from air-conditioned office to car to apartment, but how far or how fast is ideal for health? Our ancient ancestors peopled the globe walking or running every step, from out of Africa. I can imagine some stopping along the way if they found a good spot or when elders might be slowing down. Enduring human values. Continuing this story, unknown horizons would have beckoned. The adventurous young warrior bulls fed up with the mind-cave of crusty despotic elders: “So Bro, let’s go. What is around the other side of that hill?” Maybe nobody, or an unexpected interaction with a group of Denisovans or Neanderthals. And interbreeding. Was it consensual or rape? Whatever, the advancing dominant Cro-Magnons mutated and multiplied. The others vanished. Some travellers perhaps took 10,000 years to walk from Africa to Australia and not even in a straight line. Aboriginal DNA has a Denisovan contribution, suggesting an interaction somewhere around Siberia on that long walk. Back to now. Walking with purpose is the best way to stay alive longer and healthier and is mostly safe. Add hills or steps for a cardio component. Suboptimal habits include slouching, dragging feet, head thrust forward, hunched shoulders or mouth breathing. Basic training in awareness and posture can change the whole game. Having somewhere nice to walk makes all the difference too, away from noise, fumes and danger of traffic. Forest can be difficult to access but April 2019 healthspeak

tracks abound in our wonderful national parks, something to consider in ‘stop, revive, survive’ in that long drive. Urban ovals and parks offer good opportunities. Someday our Northern Rivers will have a rail-trail for us to walk unfenced, like our ancestors, for miles and miles. On the golf course some ride between holes in an electric buggy. Why walk when you can ride? Conversely, people in walking groups get great pleasure from the walking, talking

Someday our Northern Rivers will have a railtrail for us to walk unfenced, like our ancestors, for miles and miles

who have been on the run all their lives will answer, ‘Why should I stop just because I’m 65 or 75?’ But what about everybody else, those who have only ever run for the bus or to snatch a child from impending peril? It’s a use it or lose it thing because untrained muscles can give way. For example, one day walking on the beach, such a beautiful day and feeling good with the world, I felt like having a little run, something I hadn’t done for years. ‘Why not? I said to myself and took off at a sprint, meaning to stop when puffed, something cardiogenic and a personal challenge. After about a dozen paces, I suddenly felt someone kick me hard in the calf muscle. Spinning around, I found only

light airs David Miller myself on the empty beach. Straightaway I knew what had happened because patients in Emergency with similar stories had the same diagnosis, damage to the Achilles tendon. Walking home was slow and painful. Full recovery took a year and a moonboot. Walking matters. Tai-Chi Master Rod counselled, ’We die from the feet up.’ He also said, ‘The slower the walk, the closer to death’. Legwork plays a big part in continuing health. It may benefit brain health more than a crossword. Scientific research indicates that legs at work send signals to the brain, vital for the production of healthy neural cells.

and sharing energy, as well as discovering quaint places. Walking works the lower body. The upper body needs more. Our ancestors climbed. One way is Nordic Poles for hiking, to transform walking into a whole-body activity, the arms extend into quasi-front legs. My mate Ron has such terrible hip arthritis he was advised to have bilateral joint replacements. He lives in bush on the side of a rugged steep hill and could hardly get around. Nordic Poles give him stability with mobility and a breather from surgery. Ron gets around at such a clip it’s hard to keep up. Early humans would have been very good runners, for scouting and hunting. Running engages the body’s entire myofascial complex. But today, is it a safe and healthy practice? Those a publication of North Coast Primary Health Network

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A

Diving Into Glass Caro Llewellyn Penguin 322pp $32.99

briefs

New blood test detects fibromyalgia Sugar does not improve mood and it can make people less alert and more tired after its consumption -- according to a meta-analysis. The Lancaster University research team set out to examine whether sugar really

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ny book called a ‘tour de force’ by American writer Janet Malcolm is worth a read, and Caro Llewellyn’s work justifies the praise in spades. There is not a hint of self-pity in a memoir by an author diagnosed in her 40s with multiple sclerosis and having a major focus on her father, stricken by polio at the age of 20. Llewellyn had an unusual upbringing in Adelaide, a wild life in ‘swinging’ London, a son with an Australian blues musician and a glittering career among the literati in several countries. In the US she was befriended by Philip Roth and worked closely with Salman Rushdie as a senior staffer at the writers’ human rights organisation PEN. But that was well in the future when her charismatic father Richard, a hearty sailor, was struck down with a debilitating fever. This was the late 1950s, a time when polio was rampant and treatment was brutal and not always a success. “My father’s life lay in the hands of a roster of nurses, doing whatever they could without the one thing they needed to keep him alive, a ventilator. Each time a lack of oxygen caused his eyes to roll back in his head, the nurses slapped his face and prised open his eyelids and shone a bright torch into his marine-blue eyes, pleading ‘Stay with us’ over and over.” Although an ‘iron lung’ was produced from a locked storeroom, the parents of the paralysed man were told not to get their hopes up.

puts people in a better mood? Using data collected from 31 published studies involving almost 1300 adults, the team investigated the effect of sugar on aspects of mood, including anger, alertness, depression, and The researchers found that: • Sugar consumption has virtually no effect on mood, regardless of how much sugar is consumed or whether people engage

book review Robin Osborne

From an early age, I understood that life is chaotic – one day you could wake up and find everything has gone to hell “I have always had a very particular image of my father lying in this metal contraption with only his head stuck out,” she writes, “as though he were looking up at the blade of a guillotine, waiting for the drop.” While he survived, he recovered little movement and went on to marry the “tall, good-looking trainee nurse” who had tended to him, to father children and start a modern art gallery in Adelaide with first wife Jill who became a well-known poet. Later, with the help of a talented neighbour, Richard Llewellyn would develop a hoist to lift a wheelchair onto the roof of the family car, a VW Beetle no less, and in time work with the SA government and become a leading advocate for people with a disability. in demanding activities after taking it. • People who consumed sugar felt more tired and less alert than those who had not. • The idea of a 'sugar rush' is a myth The study was published at: Neuroscience & Biobehavioral Reviews, 2019; DOI: 10.1016/j. neubiorev.2019.03.016

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“Future generations of Australians have my father, and Becky [his second wife] in the wings making his work possible, to thank for helping to legislate for accessible public buildings, taxis that can transport people in wheelchairs, footpaths with ramps, accessible toilets.” He would receive the Order of Australia for his efforts. The author ‘discovered’ politics in the Thatcherite 1980s, attending rallies, visiting Northern Ireland and working in a secondhand bookshop - her introduction to the literary life. She would go on to write them, but not until returning to Sydney, getting involved with the Trotskyists, having a child and resuming contact with her father. Llewellyn worked in publishing, and was director of the Sydney Film Festival. Visiting New York to sign up writers for the Festival she was captured by a card in a newspaper booth – “Leap and the net will appear”. Back in Sydney she announced she would return to the city that never sleeps, despite not having a job. Then came the job at PEN and the organising of its World Voices festival, a star-studded event and a huge success, especially for an out-of-towner. The ardent runner had been in New York for three years when jogging in Central Park she felt her legs go numb beneath her. From there the diagnostic process for MS began, leaving her unimpressed by the coldness of many specialists. Although often angered, she was not greatly phased: “From an early age, I understood that life is chaotic – one day you could wake up and find everything has gone to hell. I had always lived with urgency and hunger. Now I knew why.” Since diagnosis she has barely stayed still, running a literary festival in Paris and taking up the directorship of Museums Victoria. From her father she learned the importance of never giving up, and the lesson was a valuable one, as this wonderful memoir shows. healthspeak April 2019


Move sooner to live longer T

he good news is that AusThere is considerable overlap tralians are living longer in the risk factors for these than ever before. However, diseases that come with aging. ageing comes with an increased Common to both is leading a potential for chronic disease. So, sedentary lifestyle, especially can these diseases be preafter middle life. Other reversvented or at least their ible risk factors—such as progression slowed? smoking, type 2 diabetes, By Andrew Two common hypertension, high choBinns diseases of older age lesterol, obesity, excessive are dementia and cardiac alcohol consumption, and a failure and both can signifipoor diet—are also relevant. cantly impair quality of life for For dementia specifically, many years. Prevalence rates for stroke, anxiety, depression and dementia in Australia are estisocial isolation are associated mated at up to 10% in those 65 risks. and over, rising to 30% in those A key recommended preven85 and over. For heart failure, tative measure is the adoption the prevalence was reviewed of a healthy, balanced diet. This in four studies - 1.5-2% of the can be achieved by following population. the Australian dietary guidelines Issues associated with sedenor following a Mediterranean tary aging, such as losing one’s dietary pattern, both of which memory due to dementia or recommend a high intake of becoming increasingly short of vegetables, moderate fruit, and breath on exertion as a result low or no processed foods. of heart failure, need to be However, it is physical exeraddressed in advance. Primary cise that is most vital for these prevention is important, and the chronic issues, with multiple earlier one adopts a healthier intervention trials suggesting a lifestyle the better: if modificareduction in risk of dementia of tion is left until after middle 20-40% with increased activity. age—around 50-65 years—the The question is then, how can chance of success sedentary people be diminishes. encouraged to To rely on move more even How can sedentary modern if they are curpeople be medicine to rently healthy, encouraged to move address these or with early more even if they are problems developcurrently healthy, or is unwise. ing chronic with early developing Drugs used disease? chronic disease? to treat the And what sort most commonly of advice for diagnosed type increasing physical of dementia, namely activity is helpful? Alzheimer’s disease, have had This cohort differs from those limited success despite millions who exercise regularly, and of dollars of research over the so alternative and integrated last 50 years. The increasing methods of movement need to stiffness of the heart caused by be encouraged. A good starting sedentary ageing can often repoint is to increase incidental sult in irreversible heart failure, exercise, where becoming more a condition that is also resistant active is gradually introduced to modern cardiac drugs. into daily activities, such as April 2019 healthspeak

Increase incidental exercise, such as household duties, carrying heavy bags, shopping, commuting to and from work, and climbing stairs

household duties, carrying heavy bags, shopping, commuting to and from work, and climbing stairs. These activities avoid extra costs, address time constraints, are not dependent on special skills or equipment, and bypass gym aversion. A recent article in The British Journal of Sports Medicine refers to this form of integrated exercise as the “best bang for buck for time unit” physical activity. Abandoning the notion that effective movement needs to occur over periods of 10 minutes or more, the contributors conclude that building a daily routine incorporating brief, sporadic bouts of high-relativeintensity incidental physical activity has numerous practical health benefits. It’s also espe-

cially attractive to those who are inactive, obese and in need of lifestyle intervention. The authors perceive the next step is to measure the effect of this activity via wearable monitors, and promote incidental activity through environmental and clinical programs. Meanwhile, a simple iPhone or Fitbit could be used to measure daily steps and stair climbing. Such technological feedback has proven to be surprisingly motivating. With respect to preventing heart stiffness or a lack of compliance leading to heart failure, a research team led by Dr Benjamin D. Levine, Professor of Internal Medicine at the University of Texas Southwestern Medical Center, concluded that two years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness in previously sedentary, healthy, middle-aged adults. This training may provide protection against the risk of heart failure with preserved ejection fraction by preventing an increase in cardiac stiffness. GPs are well placed to opportunistically advise their patients as to why they should take positive action to prevent major health issues later in life. With best results occurring from those who adopt healthy lifestyles before middle age, the path to long life begins with prevention, especially regular physical activity.

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Health&Lifestyle

Giving children more power than they can manage

Power tends to corrupt and be liked and absolute power corrupts befriended by absolutely” is a statement attrib- their children uted to Sir John Dalbergor out of Acton (1834 –1902). sheer By Chris He was talking about the laziIngall political conversation of ness is the time whereby popes someand monarchs were deemed times difficult infallible. to determine. The purpose of this article is However, to explore the idea that while the end result is the child is we easily connect Acton’s quote gifted more power than they with the politicians in our are able to manage. As an realm, we do not do so with our example, how many parents children. We understand some would allow their three-yearpoliticians can easily become old child to dictate whether ‘corrupted’ and self-centredly they should hold their hand use their position or authority or not as they cross the road? to benefit themselves. Parents Parents assume their power too are powerful creatures, in in this situation and either positions of some authority, and take their child’s hand or pick we have numerous examples them up, lest they are hurt. over time of that authority being Yet these same parents can be corrupted in itself, to their heard asking the child what children’s detriment. they would like to eat What then of that night, as if the converse the child has argument, their parents’ Even as adolescents, whereby knowledge our children do not children around food understand the effect can be choice. their innocence and corrupted You can beauty can have on themselves tell if a child some adults, who can by sharing is too powerlead them astray power with ful in a relationtheir parents? ship, as they will Politicians as adults behave differently have a good knowledge of the for other carers, such as their moral map they need to take teachers. into the job, some life experiI can hear you saying ‘but ences around consequence and what of children’s rights, their ultimately a knowledge of the autonomy, their voice to be choices required if they are not heard?’ and my only answer is to be corrupted. How difficult is that I believe you can respect it then for a child who is given and love children without sharpower to know how to respond? ing power with them. In my role as a paediatrician I It is almost as if we have see power-sharing parents ‘corthrown the baby out with the rupting’ the relationship with bathwater, believing children their children on a moment to have some intrinsic wisdom moment basis. Whether they about making right choices. do this because of a philosophiI believe we should trust our cal leaning (their own parents arm more as adults, as we do did the opposite), a need to love our children and we know 36

more than them about most a completely different face. things, most of the time. Their Parents are up against a experience is limited, and this flotilla of dot-coms entering is the telling point. Even as the child’s world through social adolescents, our children do not media, games and society in understand the effect their ingeneral. The nine-year-old who nocence and beauty can have on is worried about her outfit, the some adults, who can lead them 11-year-old boy who needs to astray. Telling your 14-year-old play the violent video game daughter she needs to be home because his friends do, and the before 10 o’clock is a necessary adolescent girl who needs to protective act. It is likely she will sleep with her phone under not see it in that light. her pillow at night because of So giving children too many FOMO (fear of missing out) choices can be dangerous are all examples of children for them, though it being pressured by can I believe also forces outside their corrupt their beparents’ control. Giving children too haviour (‘spoil’ This article many choices can them). is written in be dangerous for Thankfully, the spirit of them, though it can I the optimisa support believe also corrupt tic plasticpiece for the their behaviour ity inherent vast majority in children is of parents out their salvation. The there who love three-year-old who has their children dearly and a tantrum and stamps their foot may be too afraid to exert their is often scowling, though the in- authority over them. All power sistence on them saying ‘please’ to you, I say. inevitably leads to them wearing

a publication of North Coast Primary Health Network

healthspeak April 2019


Health&Lifestyle

Prescription monitoring and what it means

D

rug-related deaths in Ausfactors such as a patient taking tralia have almost doubled higher doses of medicines, risky over 10 years, largely because of combinations of medicines, or the increased use of opioids. In where a person may be seeing 2016, middle aged people using multiple prescribers for the combinations of prescripsame or similar medition drugs were the cines. In rare cases, most likely to die a they may be seeking By A/Prof drug-related death. more medicines Suzanne Neilsen, Monash Addiction Prescription than they need for Research Centre, monitoring aims themselves so they Monash University to tackle this issue can supply them to by allowing health others. professionals prescribing or The software links the dispensing high-risk medicines health-care providers to adto see a patient’s prescription ditional information includhistory. ing the patient’s prescription But as a new prescription history. From there, it’s up to the monitoring program, SafeScript, health-care professional to use is rolled out across Victoria, we that information to inform their need to tread cautiously. clinical decisions. First, our health professionAnecdotal reports suggest the als and systems will need to be information is useful. After a sixproperly equipped to deal with month trial starting in western the volume of people who will Victoria, the system has already be identified by this program as identified a few thousand “at needing support. And second, risk” patients. evidence from the US tells us But the system is still in its restricting access to prescription very early stages, so we don’t drugs may drive people towards yet have information about using illicit drugs instead. longer term, or patient specific outcomes, such as whether preWhat is SafeScript? scription drug-related harms are Right now SafeScript is optional decreasing, or whether patients for doctors and pharmacists, but are receiving appropriate care will become mandatory in April when risks are identified. 2020. The system automatically What are the concerns? captures a range of high-risk Although the system identifies medicines, such as strong pain certain risky behaviours, it’s up medicines, and medicines to the health-care professional for anxiety and sleep. These to assess whether the patient remedicines are generally those quires treatment for a substance commonly implicated use disorder, or if it is in drug-related safe for a patient deaths. to continue When a to supply a When a health-care health-care high-risk professional goes to profesmedicine to prescribe or dispense sional goes them. a listed high-risk to prescribe Typicalmedicine, they will see or dispense ly, GPs and a green, amber or red a listed pharmacists high-risk are not conpop-up notification medicine, they fident talking will see a green, about such topics. amber or red pop-up To address this, a notification. number of voluntary training They will be alerted to risk sessions are being run across the April 2019 healthspeak

state to upskill health-care proPossible harms viders in having these difficult International experience and conversations. research with prescription A telephone hotline has also monitoring has been inconclubeen established for GPs to sive. A recent large review seek clinical advice could not determine regarding patient whether prescripcare. tion monitorWith the A doctor ing programs implementation of may choose decreased prescription monitoring, to preor increased we need to increase scribe drug fatal or capacity of both treatments, non-fatal evidence-based such as budrug overtreatment and harm prenorphine, doses. reduction services for depenThe review dence to strong did however pain medicines. identify three studies They may also decide to in the United States that refer the patient to a pain sershowed heroin overdoses invice, or a drug treatment service. creased after the implementation But where there are likely to of prescription monitoring. be a greater volume of patients We don’t know if we’ll see the referred to these services, there same patterns in an Australian are also significant concerns setting. But restrictions on access around access. to prescription drugs may mean In Australia, there is a need to some people shift to using illicdouble the capacity of alcohol itly sourced drugs, and this could and drug treatment services to increase harms. meet current needs. This means With the implementation of if a referral is made, there may prescription monitoring, we need be delays in accessing care. to increase capacity of both eviReferral to a pain service dence-based treatment and harm may be more appropriate for reduction services. We know that some patients, though waiting drug treatment capacity does not lists for Further, in regional and meet current needs – and these rural areas where prescription needs are about to grow. drug problems are often higher, treatment access may be more Reprinted with kind permission limited. from The Conversation

a publication of North Coast Primary Health Network

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Health&Lifestyle

Healing trauma with Guided Drawing

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rt therapy is a young proing an archetypal structure that fession, yet for thousands applies the philosophy of Jungian of years art has been used to Depth Psychology to universal, express emotional, cultural and formal elements such as a line or spiritual needs. a circle or a square. Adults draw A form of psychotherapy, art with closed eyes and both hands, therapy is not about learning using chalk crayons or finger art techniques or producing paints on large sheets of paper. aesthetically pleasing pictures Cornelia explains that drawing and special skills or talents are rhythmically with both hands not required. does not involve imagery, but the Art Therapy is suitable for direct expression of one’s ‘Felt all age groups and is practiced Sense’. in a variety of mental health “Traditionally art therapy is institutions, also in prisons, associated with the creation of nursing homes and schools. It images, followed by meanhas proved a valuable ing making of these. therapeutic tool Guided Drawing, for those who however, is Drawing have suffered predominantly rhythmically emotional, a movement with both hands physical, and body does not involve substance and therapy. Cliimagery, but the sexual abuse. ents are given direct expression of It is used in the the idea, that one’s ‘Felt Sense’ context of famthey can apply ily therapy, social a ‘self-massage’. In work, counselling and this case the focus is personal development. on their physiological sympDrawing, painting and sculpttoms such as experienced pain ing can be a way to find answers and tension, which individuals to unresolved questions. They draw to begin with, just like “it can provide nurturing, structure feels”. and inspiration in times of stress, “Not the image of the lump in burnout and disease. It can heal my stomach is drawn, but how it old wounds, transform emotionlumps. This may be drawn with al turbulence and show the way lots of pressure in a tight up and out of spiritual depression. down scrubbing, or as tightening Art Therapy, similar to music spirals of pain. In the next move therapy and drama therapy, clients then apply crayons or finhas the invaluable advantage ger paint, employing their “inner of allowing expression without massage therapist” in order to words. find movements that will release Art therapist and Director of the tension or soothe the pain. the Institute for Sensorimotor “This concept is easily underArt Therapy Cornelia Elbrecht stood by even the most troubled is well known in the Northern individuals. It is empowering, Rivers and is offering a new acbecause clients can work out credited online training course through rhythm, movement for mental health professionals and choice of art materials what on the topic of Guided Drawing. they need and experience the She is not only an art therapist immediate results. Over time with over 40 years of experience, this bottom-up process begins but also an accredited Somatic to explore the history of these Experiencing trauma therapist. tensions, postures and attitudes, Guided Drawing is a body-fowhich may lead to an unfolding cused drawing technique provid- and rewriting of one’s personal

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Cornelia Elbrecht

and trans-personal life story,” table discussions and filmed said Cornelia. therapy sessions, which can be Trauma is characterised by viewed in your own time. feelings of helplessness and overThe course is accredited as whelmedness. The latest research professional development with in neurobiology has ACA, ANZACATA and shown that being PACFA. It is suitable able to find an acfor all mental This concept is tive response to health profeseasily understood troubling bodysionals who are by even the sensations and looking for a nonmost troubled emotions is the verbal medium to individuals most effective add to their tools. way of treatment. Participants will The seven-week receive a Certificate online training course in Healing Trauma with presented by Cornelia and her Guided Drawing at completion art therapy faculty members of the course. features more than 21 hours of professionally produced video. To find out more, go to: www. The weekly structure includes sensorimotorarttherapy.com/ theory, case histories, roundonline-course

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healthspeak April 2019


ONCE WE RECOGNISE THE SCALE OF THE PROBLEM AND IT’S BIGGER THAN THE FUNDS, WE THEN HAVE TO DECIDE WHAT WE’RE NOT GOING TO SPEND MONEY ON RIGHT NOW. IT’S LIKE A BIG TETRIS PUZZLE

From page 19

Drilling down

Darryl said much more granularity is needed in analysing the regional health landscape. “Even down to how many people have a particular health issue, where they are, what their symptoms are, and importantly. And you could ask, so what? If someone has Post Traumatic Stress Disorder what does that mean in terms of the community, the individual, how will that effect their life? “Is the effect on their life worse than someone living with an alcohol problem or dementia? While we’re not making those people compete with each other we do need to recognise competing needs and prioritise what we spend on. “And once we recognise the scale of the problem and it’s bigger than the funds we

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then have to decide what we’re not going to spend money on right now. It’s like a big TETRIS puzzle.” Long-term vision

“Importantly we’re setting out to understand the problem in an analytical way and understanding the potential solutions out there in the same language so we can start matching solution and problem. “We’re looking at what the gaps are for those things currently untreated or we don’t have solutions for – because we haven’t been able to fund them or the solutions aren’t there. And the final part is that we’re not looking at the landscape on a year by year basis, we’re looking at it long term.” And in time NCC will be equipped to inform health professionals about the most effective treatment programs for various health conditions.

Then go to https://nacchocommunique.com/ and sign up for their Wednesday job alerts. April 2019 healthspeak

Millions of elderly people have a form of dementia that has been misdiagnosed as Alzheimer's disease, according to researchers. One expert called it the most important dementia finding in years. The condition, limbic-predominant age-related TDP-43 encephalopathy, or Late, shares similar symptoms to Alzheimer's, but it is a distinct disease, the journal Brain reports. It may partly explain why finding a dementia cure has failed so far. Up to a third of Alzheimer's in elderly people may instead be Late, says the international team of researchers, although both dementias can co-exist. Late appears to affect the "oldest old" - people over 80 - according to the work that looked at evidence from thousands of post-mortem results. One in five in this age group has it, meaning the public health impact of the disease will be large, say the researchers. Unlike Alzheimer's, it tends to cause a more gradual decline in memory, they believe. Having a better understanding of Late might lead to the discovery of new treatments, say the researchers. They are working to find diagnostic tests and targeted treatments for different types. Read the research published in Brain here: https://bit.ly/2ITstqm

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Profile for North Coast Primary Health Network

HealthSpeak April 2019  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...

HealthSpeak April 2019  

North Coast Primary Health Network is a not for profit organisation established to respond effectively to local health care needs. Focussed...