In her second edition of The Health Wrap for 2019, Dr Lesley Russell reports on a range of new research findings, covering the Aboriginal Health Worker workforce, global health and occupational health, amongst other news. She ends with some literary reflections on “life’s bright joys”.
Lesley Russell writes:
Greetings from the ski slopes of the Colorado Rockies, where the snow is great and (most days) the sky is blue. (Don’t tell Trump – he thinks the recent cold weather in the Midwest of the US proves there is no such thing as climate change!)
We are a little obsessed here with things Trumpian – you might find my piece for Inside Story interesting (at least the section where I examine what Trump has promised in terms of health-related domestic policy initiatives).
Call to action on Aboriginal Health Worker numbers
Research conducted by Australian National University and the National Aboriginal and Torres Strait Islander Health Worker’s Association (NATSIHWA) has shown a decline in the number of Aboriginal Health Workers (AHWs).
This is a call to action for increased educational and employment opportunities to attract and retain Aboriginal and Torres Strait Islander people into the healthcare sector. They fulfil a very important role in outreach, follow-up, recognition of and response to community needs, and the provision of culturally safe care.
The study used data from the 2006 and 2016 Census. It found that although the numbers of AHWs increased from 1009 to 1347 over that period, when compared to population growth, there was a considerable 13 percent decline.
The research also examined demographic factors such as age, gender and jurisdiction. It is disappointing to see there was a significant decline in the number of young healthcare workers.
The results of this research were published in the Australian and New Zealand Journal of Public Health and can be read here.
In a separate report on the ABC website, there was more bad news: the number of registered AHWs in the Northern Territory fell almost 17 percent over the six years to 2018, even though almost one-third of the Territory’s population is Indigenous. All of these losses came from the public health sector, rather than private or Aboriginal-controlled health services.
It seems that rigorous training requirements that often take students away from home, the resultant low completion rate, and salaries are key issues to be addressed. Racism and lack of cultural safety in workplaces have also been repeatedly identified as barriers facing Aboriginal and Torres Strait Islander health professionals.
Fly In Fly Out (FIFO) workers
A recent paper in the British Medical Journal looks at health behaviours of FIFO workers and their partners during on-shift and off-shift time frames. In some areas of Australia as many as 17 percent of adults are FIFO workers, mainly in the mining, construction and resources industries.
Compared with people with other types of employment, FIFO workers are more likely to smoke, drink excessive amounts of alcohol, and be overweight or obese. There is a prevalent drinking culture on FIFO mining sites, with social pressure to consume alcohol.
Some employers provide on-site recreational facilitates but workers often report that exercise opportunities are limited by long work hours and no opportunity for regular participation in team sports or recreation programs.
This research found that FIFO workers engage in less healthy behaviours than people in other types of employment.
The 12-hour work shifts common to FIFO work lead to fatigue, which is detrimental to performance. Their sleep quality was poorer and less time was available for relaxing during on-shift compared with off-shift days.
Both FIFO workers and partners reported exercising less during on-shift compared with off-shift periods. On average, both workers and partners reported exercising for more than 30 minutes per day (which is better than most blue collar workers). FIFO workers presumably benefit from having access to on-site recreational facilities may also promote displacement of prevalent unhealthy on-site behaviours, such as excessive alcohol consumption.
FIFO workers and partners reported poorer nutrition quality during on-shift compared with off-shift periods. This finding for both workers and partners seems to suggest that the problem is not entirely the result of on-site availability of healthy choices.
FIFO workers (mostly men) consumed more alcohol, on average, than partners. Workers and partners reported consuming more alcohol when off-shift, an effect magnified for workers.
This indicates that interventions should not exclusively concentrate on FIFO sites, but rather consider the personal, social and environmental factors associated with risky alcohol consumption in both work and home contexts.
Both FIFO workers and partners smoked more cigarettes when on-shift with the effect of shift magnified for partners (numbers surveyed were small). It may be that the added stressors of work days elicit more urges to smoke cigarettes for both workers, and the partners of absent workers. Smoking cessation interventions for FIFO workers might usefully incorporate advice on stress management.
Mental health and FIFO workers
A recent report from Curtin University (commissioned by the WA Government) looked at the mental health and wellbeing of FIFO workers.
It found that 33 percent of workers experience high or very high levels of psychological stress and that they suffer more incidents of bullying and higher levels of burnout than non-FIFO workers.
The report made 18 recommendations for action, including: shorter work rosters, permanent rooms at accommodation camps; reducing the stigma of mental health; provision of support programs; training leaders; providing reliable communications for workers to talk to loved ones at home.
I missed this when in January Federal Regional Services Minister Bridget McKenzie announced the first major review of nursing since 2002 – so perhaps you did too. I hope that all the relevant groups will be actively involved in this important review,
The Terms of Reference for the review, entitled Educating the Nurse of the Future, encompass issues such as nursing education, career pathways, making nursing an attractive career option for both women and men, increasing the number of nurses in regional areas.
The review – which was foreshadowed in Croakey’s coverage of the 2017 Congress of Aboriginal and Torres Strait Islander Nurses and Midwives conference suggesting that Australia could be doing much more to optimise the use of nurse practitioners, especially in the areas of primary healthcare, chronic disease management and residential aged care – will be conducted by Professor Steven Schwartz from the conservative Centre for Independent Studies.
He is a well-qualified academic but it is not clear he is the right choice for this job. He has previously called for a market-driven system in healthcare.
However, this review is certainly needed. The nursing profession is essential for community based and acute care, for aged care and palliative care and for mental health services. Nursing numbers will be part of the upcoming debate over public hospital funding and will certainly emerge as a key issue from the Royal Commission into Aged Care Quality and Safety.
The most recent official analysis of supply and demand for nursing was done by Health Workforce Australia (sadly, now defunct). It predicted a shortfall of approximately 85,000 nurses by 2025 and 123,000 nurses by 2030 under current settings. Australia is already heavily reliant on overseas-trained nurses.
Clearly pay rates and working conditions are a key issue in attracting and retaining the nursing workforce. With an election due in NSW, this may affect the renegotiation of that state’s nurses award and then NSW is expected to set the benchmark for pay and conditions in the public sector.
Global “syndemic” of obesity, undernutrition, and climate change
Following on from previous Lancet Series on obesity (in 2011, 2015, 2017), this Commission looks at obesity in a much wider context of common underlying societal and political drivers for malnutrition in all its forms and climate change.
It was published in The Lancet on 27 January and features the work of an august list of scientists, including a number of Australians you will know.
The accompanying commentaries are also worth a read:
You should also read and file away two recent Croakey articles on the issues around obesity:
#ICYMI Productivity Commission Report
In a piece for Croakey, Jennifer Doggett identified a number of questions arising out of this Report on Government Services 2019 (released in parts over the period 22 January – 1 February), noted some gaps in its scope and suggested the lessons in the Report for future health policy development and program planning.
Make sure you read the health parts of this report, especially the mental health section.
I’m impressed because this report finally begins to make some progress towards answering questions around whether mental health services are efficient and effective, improve health outcomes (physical and mental), are delivered in ways that improve social and economic inclusion. It is not yet able to address issues of stigma and discrimination, but that will come.
The good news story of the fortnight
This isn’t a classic good news story, but I liked the message – and Anna Karenina is one of my favourite novels.
Here’s what the author of this column in the New York Times wrote about how reading Anna Karenina taught her about living with depression.
Tolstoy begins his novel with the now famous line about how all happy families are alike, all unhappy families uniquely unhappy. He calls back to that opening in his final pages: After Anna dies, the book’s other main story line resolves with a joyful wedding and the birth of a baby boy.
But the happy ending only irritated me. It was Anna’s tragic story that, paradoxically, improved my spirits. Though Anna’s tunnel vision killed her, it helped me stand back from my own narrow view for a more expansive look at my life. The clouds will descend again before too long, of course. But life’s bright joys can likewise rise up again, its great stories can lift me again, as long as I stay alive for them.”
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. You can follow Lesley on Twitter at @LRussellWolpe
Previous editions of The Health Wrap can be read here.