World News

Gary Culliton brings you a round-up of the healthcare news making the headlines around the world.

Accord on the social causes of ill-health

The World Medical Association (WMA) has welcomed the global agreement on social causes of ill-health, at the recent United Nations Conference in Rio de Janeiro. The conference followed on from the ground-breaking work by Sir Michael Marmot from University College London and will now lead to the work being implemented across the world.

Dr Jose Luiz Gomes do Amaral, President of the WMA, who spoke at the conference, said that physicians had a key role in their own practices and hospitals, but they also had an advocacy role in their communities.

Dr Mukesh Haikerwal, Chair of the WMA Council, added: “This is important work for the medical profession to be driving forward and the WMA and its 100-member national medical associations have confirmed their readiness to participate, co-ordinate and advocate for the causes of ill-health outside illness itself to be addressed coherently, collectively and comprehensively.”

He added: “There is a growing movement, globally, that’s now seeking to address gross inequalities in health and length of life through action on the social determinants of health. We believe the medical profession can be major advocates for action on those social conditions that have important effects on health. The WMA can help doctors put pressure on national governments to take the appropriate steps to try to minimise these root causes of premature ill-health.” He said the WMA should also help to gather data on examples that were working, and help to engage doctors and other health professionals in trying new and innovative solutions.

Just 3% of doctors favour solo practice

The ability to achieve a work-life balance, work collaboratively with other providers, set work hours and ensure availability of electronic tools are the factors that will contribute to career satisfaction among Canada’s future physicians, according to a survey of 5,600 students and residents.

Other 2010 National Physician Survey (NPS) findings about students and residents indicated that solo practice has all but disappeared as a practice preference, with only 3 per cent of residents favouring it. Almost one-quarter of family medicine residents (23 per cent) intended to continue with a third year of training in an area such as emergency medicine.

Family medicine was the most popular specialty selection, followed by internal medicine, emergency medicine, paediatrics and obstetrics/gynaecology.

A total of 36 per cent of family medicine residents and 11 per cent of medical students were studying in satellite campuses.

“Work-life balance remains a main determinant of a satisfying practice,” the NPS concluded, “with 50 per cent of residents and 53 per cent of students identifying it as the most important factor.”

The NPS is conducted every three years by the Canadian Medical Association (CMA), the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. “Medical students and residents are well aware of how overwork may impact both on patient safety and their personal health and wellness,” Royal College President Dr Louis Hugo Francescutti said. “They’ve repeatedly indicated their preference for delivering care in a way that doesn’t negatively impact their professional and personal lives. Our system must find a solution to accommodate these changing expectations.”

The 2010 results also point to a revolution in practice management, with 82 per cent of second year residents reporting that they intend to use electronic medical records (EMRs). The survey analysis says this trend will likely influence the organisation of practices, since only 39 per cent of practising physicians now use EMRs.

Contract changes for GPs are announced

Changes to Britain’s General Medical Services (GMS) Contract for 2012-13 have been announced. This follows negotiation between the BMA’s General Practitioners Committee (GPC) and the NHS Employers organisation, on behalf of the Health Departments of England, Scotland, Northern Ireland and Wales.

These alterations mean there will be no pay rise for GPs. There will be a rise of 0.5 per cent to the GMS contract to help meet the costs of increased practice expenses, including pay increases for employed staff with a full-time equivalent salary of less than £21,000 (€24,570).

There will be piloting of arrangements that will allow patients greater choice of which GP to use; changes to what happens if a patient moves a short distance; allowing many people, where clinically appropriate, to stay in their current GP practice even if they move home; and the introduction of a new scheme that aims to reduce avoidable emergency department visits, as well as revisions to the Quality and Outcomes Framework, which provides resources to GP practices for delivering excellent care and best practice.

The one-year GP pilot will test two models by which patients in England can have more choice over which GP practice they use. Patients will be able to choose a GP practice near where they work or elsewhere, as long as it is within the two or three cities in the trial area (which are not yet announced).

This will give them far greater flexibility than the existing option, which limits people to having GPs near where they live.

“Most GPs were against the complete abolition of practice boundaries because of the potential negative impact on continuity of care, so we’re pleased that we have been able to agree this alternative, which will help commuters as well as patients who move out of a practice’s boundary but want to stay registered. It will be important to learn from the results of the pilots. The NHS is operating in a difficult financial climate and while GPs, like other doctors, won’t get a pay rise, we’ve worked hard to ensure practices get some compensation for rising expenses and that the changes made are consistent with good clinical practice,” the BMA’s GPC Committee’s Deputy Chairman Dr Richard Vautrey said.

‘End-game thinking’ on tobacco

The scientific session on tobacco cessation at the World Medical Association General Assembly in Montevideo, Uruguay, has praised New Zealand’s “end-game thinking” approach to tobacco cessation.

Dr Richard D Hurt, founder and Director of the Mayo Clinic Nicotine Dependence Centre, said that while most countries focus on reduction in tobacco consumption, New Zealand has a vision of a smoke-free society and has the courage and political will to achieve this.

New Zealand Medical Association (NZMA) Chair Dr Paul Ockelford, who attended the Assembly, said that while New Zealand has been fortunate that successive governments, supported by health professionals and the wider community, have been proactive in tackling this public health issue, “we have a moral and social responsibility to continue the momentum towards a smoke-free New Zealand. New Zealanders can be proud of our aspiration to be smoke-free by 2025. It is a testament to this commitment and our progress to date that we are recognised in this way by the international community”.

The NZMA position statement on tobacco control outlines the key steps that need to be taken and is strongly aligned with recommendations by international experts. These include plain packaging and graphic warnings to replace all brand imagery and a call for the Government to extend the smoke-free environment legislation to cover all locations where young people are present.

Action to make it more difficult for minors to obtain cigarettes is also recommended, with targeted research into smoking cessation to ensure that at-risk population groups, such as Maori and Pacific peoples, are reached.

Uproar over mental health services cuts

Cuts to mental health services available through general practice have come into effect in Australia.

Under changes announced in the May budget, the Australian government is cutting Medicare rebates for GP mental health services under the Better Access programme by up to 46 per cent.

Australian Medical Association (AMA) President Dr Steve Hambleton said that around one million patients each year benefit from GP mental health services funded through Medicare. “The changes coming into effect will slash over $400 million (€298m) from these key mental health services,” Dr Hambleton said. “This means that Medicare will treat mental health issues less favourably than physical ailments.”

The cuts have been the subject of a major Senate Community Affairs Committee Inquiry, which has received over 1,100 submissions from concerned organisations, health professionals, families and individuals affected by mental illness, and the general public.

“The Government has also ignored an independent evaluation showing that the Better Access programme is cost effective and is making a positive difference to the lives of people suffering from mental illness. The AMA wants a 12-month moratorium on the cuts to allow for proper consultation with the medical profession, patients affected by the cuts, and the community,” Dr Hambleton said.

Levels of biomass and coal ‘pose a health risk’

In many cities, air pollution is reaching levels that threaten people’s health, according to an unprecedented compilation of air-quality data released by the World Heath Organization (WHO) in Geneva.

The WHO estimates more than two million people die every year from breathing in tiny particles present in indoor and outdoor air pollution. The information includes data from nearly 1,100 cities across 91 countries, including capital cities and cities with more than 100,000 residents.
Persistently-elevated levels of fine particle pollution are common across many urban areas. Fine-particle pollution often originates from combustion sources such as power plants and motor vehicles. The great majority of urban populations have an average annual exposure to PM10 particles in excess of the WHO air quality guidelines recommended maximum level of 20 µg/m3. On average, only a few cities currently meet the WHO guideline values.

PM10 particles, which are particles of 10 micrometers or less, which can penetrate into the lungs and may enter the bloodstream, can cause heart disease, lung cancer, asthma and acute lower respiratory infections. The WHO air quality guidelines for PM10 is 20 micrograms per cubic metre (µg/m3) as an annual average, but the new data show that average PM10 in some cities has reached up to 300 µg/m3.

The WHO is calling for greater awareness of health risks caused by urban air pollution, implementation of effective policies and close monitoring of the situation in cities. In both developed and developing countries, the largest contributors to urban outdoor air pollution include motor transport, small-scale manufacturers and other industries, burning of biomass and coal for cooking and heating, as well as coal-fired power plants.