Welfare Cuts to Refugees, AMSA Global Health Crossing Borders National Managers

Commentary

We live in a society founded on the values of fairness, reciprocity and freedom. Whether you call it a scallop or a potato cake, you’re a millennial or older than Phillip Ruddock, across lines of politics and race, these values hold true.

We would all like to think that in our moment of need we would be supported by our community. Daily across Facebook and the media, there are countless examples of people proudly going above and beyond for members of their community, even for complete strangers. The #sofaforlondon movement in the wake of the London Bridge attack earlier this year is a perfect example of this. People posted on social media offering beds (and salt and vinegar chips) to strangers who were left stranded in the attacks.[1] Examples of this exist at home as well, like the overwhelming response after the Victorian bushfires in the last decade. We are great at jumping into action when people need help. Why then, are Australians so happy to eschew these values when considering the question of refugees?

Many social and economic factors inform the health and wellbeing of humans. Housing insecurity, job hunting, lack of access to proper medical care, limited education pathways, lack of transport. These things pile up. Not only do refugees face these stresses with no supportive community or family, but also after years of trying to get to Australia, often fleeing horrific wars, genocides and famines.[2] At the time of their greatest need, the government resolves that the best thing to do it to lock them up and throw away the key.

The government decided in late August to cut welfare payments to 100 of the 400 people seeking asylum in Australia that have come to the mainland from regional processing centres for medical treatment.[3] They plan to extend the cuts to the other 300 people in this group in the coming months, including pregnant women, 37 babies and 90 children who attend school in Australia. This means they will stop receiving the paltry $200 a fortnight they have to support their family, and will also be kicked out of supported accommodation. With a name that would not be out of place in an Orwell novel, the “Final Departure bridging E visa” which stipulates these conditions, was given to 100 people with no notice.

As a young, qualified person with an acceptable grasp of the English Language and a good knowledge of the workings of Australian society, I know how hard it can be to find a job. These people who have been transferred to Australia for serious medical illness must find a way to support themselves in just three weeks, with the possibility of being deported at any time, a prospect sure to turn off any employer. To add insult to injury, the government has also stuck by its policy that those over 18 years old cannot access education or training programs, giving them even less opportunity to find jobs. This has huge implications for those at school. Why bother applying yourself and working hard, just to be barred from further education and face a desperate future?

Being transferred to Australia in the first place is no mean feat, as we have seen in several cases, such of that of Hamid Kazhei, who died on Manus Island of sepsis from a cut in his foot because the government would not transfer him to the mainland to get the attention he needed. Or the multiple pregnant mothers with pre-eclampsia who have been refused transfer and have no access to obstetric care. This shows that the group in question who did make it to Australia are extraordinarily resilient and are in genuine need of care.

There is strong evidence to show that reduction in funding for welfare has major effects on the health of newcomers. Eroding economic and social conditions negatively impacts on health by reducing access to healthcare, deterioration in mental health and increases domestic violence. [4]

The government has already made people seeking asylum vulnerable, through damaging policies that incorporate unnecessarily long processing times, keep people in detention under inhospitable conditions, offer few options for family reunification, deny full work rights and withhold social services. This new policy will further exacerbate the disadvantage that these people currently endure.

It is deeply concerning that post-arrival factors have a worse impact on the outcomes for children seeking asylum, than the trauma of the war-torn countries they come from.[1] A recent study published in the Journal of Paediatrics and Child Health showed that childrens’ environment after arriving in Australia had more impact on their physical health and wellbeing than the process of getting to Australia and the traumas they experienced before arriving.[5] Irresponsible policies like the recent welfare cuts contribute strongly to this observation. The government even went as far as threatening children in their letter about the Bridging E visa, writing to parents “Please remind your children that they will also be required to abide by Australian values and laws. Breaking Australian laws may result in their removal from the community.”[3]

The Government is pushing the financial burden to support asylum seekers on community and not-for-profit organisations, straining their already limited resources. Refugees and people seeking asylum are starting from a point of compromise. It is our obligation as a caring community that values equity to springboard them into starting their lives in Australia, rather than holding them back or providing a flimsy safety net. It’s time to say enough is enough and stop them bullying the most vulnerable members of our society.

Sibella Breidahl and Jasmin Sekhon

Crossing Borders For Health is AMSA Global Health’s project that aims to advocate for refugees and people seeking asylum. With arms covering Education, Advocacy and Projects we aim to give students a functional understand of the refugee crisis, with a focus on the Australian context, as well as contributing to the advocacy based around creating a fair and fast processing system for people seeking asylum in Australia. Jasmin and Sib are Crossing Border’s 2017 National Project Managers.

Conflicts of interes

None declared

Correspondance

jasmin.sekhon@amsa.org.au

sibella.harebreidahl@amsa.org.au

References

  1. The Guardian staff and Press Association (2017). #sofaforlondon: residents open their doors in wake of London Bridge attack. The Guardian.
  2. Marmot, M., Wilkinson R. (2003). Social Determinants of Health, The Solid Facts. [online] The World Health Organisation. Available at: https://books.google.com.au/books?hl=en&lr=&id=QDFzqNZZHLMC&oi=fnd&pg=PA5&ots=xVnIhIXLht&sig=VgESJrtwTaI0QSetN4CDEtU6k1E&redir_esc=y#v=onepage&q&f=false [Accessed 8 Sep. 2017].
  3. Robertson, J. (2017). Coalition to cut income support for 100 asylum seekers in Australia. The Guardian Australia.
  4. Simich, L., Beiser, M., Stewart, M. and Mwakarimba, E. (2005). Providing Social Support for Immigrants and Refugees in Canada: Challenges and Directions. Journal of Immigrant and Minority Health, 7(4), pp.259-268.
  5. Zwi, K., Rungan, S., Woolfenden, S., Woodland, L., Palasanthiran, P. and Williams, K. (2017). Refugee children and their health, development and well-being over the first year of settlement: A longitudinal study. Journal of Paediatrics and Child Health, [online] 53(9), pp.841-849. Available at: http://onlinelibrary.wiley.com/doi/10.1111/jpc.13551/full [Accessed 8 Sep. 2017].

 

 

 

Rise of Trump/Fall of Health

Issue 11 Volume 1
Commentary

As Donald Trump took the stage declaring victory as the 45th President of the United States and the Leader of the Free World, I had a sudden chilling realisation. This man, who has spent his entire life ignoring or actively working against the dangers of climate change, progressive social policy and a centralised state control healthcare system, now sits at the head of the American government, which sets the trends in policy and action in the Western world.

His often-repeated goal during campaigning was to “repeal and replace” Obamacare by relaxing legislation which prevents exploitation of the injured by private insurance interests, and removing funding for vital infrastructure in hospitals and speciality clinics, as well as sexual health and Planned Parenthood programmes. Although he has, so far, been unsuccessful in repealing Obamacare, he has not given up his crusade against basic healthcare provisions.

Under Trump’s direct guidance, Tom Price, head of the Department of Health and Human Resources, continues to reduce requirements for insurance companies to provide essential benefits, and works towards completely dismantling systems related to women’s or sexual health. Such a removal of support and shift away from women is concerning, as it appears to indicate the return of deep-seated sexism within governmental institutions which sets an example for the wider society.

While Trump has proven time and time again that he has little regard for females, this blatant attack seems like an extreme first step. People have been protesting the numerous unconstitutional and unethical executive orders streaming from the desk of the White House through large organised protests, rallies at offices of local governmental officials and online petitions. It is vital, however, that this momentum does not weaken: accepting this situation as the new ‘normal’ cannot be allowed to happen. Having to fight constantly is exhausting but essential. Without significant resistance, it is likely that Trump will be able push many of these bills through a Republican-dominated congress and into law.

Trump’s executive order to freeze funding and support for global aid serves to reinstate and expand Reagan’s 1984 ban on United States (US) foreign aid. All $9.5 billion USD of American global health funding will be restricted from being available to any non-government organisations providing or even discussing abortion with patients.[1, 2] These cuts will jeopardise the health of the world’s most at-risk individuals by removing access to education and preventative measures against sexually transmitted diseases, as well as all facets of maternal healthcare. The World Health Organization estimated that a total of 225 million women in developing countries were not using contraception, mainly due to lack of access and education.[3] With the implementation of this gag, it is expected that these numbers will rise significantly.

Trump has made it clear that he is committed to the promises he made going into the election – promises which have the potential to jeopardise global health. The next step is likely to be severe cuts or the removal of foreign aid funding entirely, as Trump has expressed on multiple occasions that he has no intention of being “president to the world”. By internalising focus, Trump aims to disconnect America from the rest of the world – a process that has started with reduction and removal of aid and is predicted to continue with taxing of overseas goods.

The impact this will have on global health programs is not to be underestimated. Slashing America’s global aid support will only result in detriment for those people already suffering from the consequences of poor support for health services; a rise in disease, poverty and death are to be expected if this policy is to be implemented.

Australia has an opportunity, and a responsibility here to intervene. As a country with the wealth and resources to help, we would be passively condoning Trump’s gag policy if we do not aim to lessen its blow on developing nations. By increasing our international aid and presence, as well as encouraging other countries to do so, we can hopefully avoid the rise of neoliberalist nationalism we have seen in America, and help prevent its consequences to global health.

Most importantly, Australia needs to stand up against America on this issue. It is time for Australia to take the lead. By changing direction and taking a strong stand on healthcare and foreign aid, Australia could become a rally point for other nations – a model for them to work by and therefore improve the lives of millions of people who have already, and will be, affected by the rise of Trump.

Owen Burton

Owen Burton holds degrees of Bachelor of Biomedical Science (Griffith University) and Masters of Orthoptics (University of Technology, Sydney)

Acknowledgements

None

Conflict of Interest

None declared

Correspondence

oburton101@gmail.com

References

1. Filipovic J. The Global Gag Rule: America’s Deadly Export. Foreign Policy. 2017 March; 20.
2. Office of the Press Secretary, White House. White House. [Online].; 2017 [cited 2017 May 10. Available from: https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy.
3. Singh S, Darroch J, Ashford L. Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014. Guttmacher Institute; 2014.

 

Anti-vaccination: Separating Fact from Fiction

Issue 11 Volume 1
Commentary

Vaccines are indubitably one of the great successes of public health, on par with clean water and basic sanitation. They have saved millions of lives, and even eradicated infectious diseases such as smallpox.[1]

Yet, regardless of these achievements, the legitimacy and safety of vaccinations are still questioned. Earlier this year Australian One Nation Senator Pauline Hanson urged parents to take a non-existent “vaccine-reaction test”,[2] and United States (US) President Donald Trump called for a commission into vaccine safety.[3] Furthermore, the recent implementation of stricter childhood vaccination policies (No Jab No Pay; No Jab No Play) in Australia has raised contentious ethical issues regarding consent and balancing medical paternalism and parental autonomy in the provision of healthcare to children.[4]

Reasons behind vaccination hesitancy

For as long as vaccines have been around, there have been those who oppose them. Vaccine opposition began in early 1800s in Europe with the first vaccination mandates. Scientists, doctors, and members of the public questioned the scientific basis of vaccines, even citing that they would disturb with God’s “natural control over the balance between the blessed and the damned”.[5] The modern manifestation of vaccine objection is simply another iteration of this longstanding phenomenon.

Ironically, the great success of vaccinations in dramatically reducing, and even eradicating disease is contributing to their own downfall. As diseases like measles and polio are no longer endemic in Australia, parents no longer directly face the harms of these highly virulent and contagious diseases. Consequently, they may perceive the risks from vaccinations to be greater than the likelihood of contracting the very diseases they prevent.[5]

In fact, surveys of Australian parents show that the primary reason for vaccine hesitancy or objection is concerns about their safety[6] and a third of parents believe children are over-vaccinated. Newer vaccines, like the HPV vaccine, can be perceived to have a lower risk-benefit ratio, as they protect against diseases that are less prevalent or virulent. Older vaccines also face doubts, as the diseases they prevent are less common or even eliminated in the Australia, such as measles. Furthermore, concerns about adverse reactions to vaccination are growing. This could be attributed to the fact that such reactions are perceived to be more common than the diseases that they prevent.

Common misconceptions regarding vaccines

Rare but severe adverse reactions to some vaccinations attract great public interest, and give rise to misconceptions or over-estimations regarding their harms. For instance, the 1955 Cutter Incident in the USA involved administration of 380,000 doses of incompletely inactivated polio vaccinations to healthy children, which resulted in 40,000 cases of abortive polio (a minor form that does not involve the central nervous system), 51 cases of permanent paralysis and five deaths. It also started a polio epidemic, leaving even more people in the community affected.[7]

This event severely undermined public confidence in the safety of vaccinations, even after it prompted the instigation much safer and stricter regulation of vaccines.[7] Incidents such as this undermine trust in vaccine safety, and these fears must be addressed in the community.

Commonly, anti-vaxxers also claim that while they are not against vaccinations themselves, they oppose the adjuvants and preservatives that are potentially harmful, like thiomersal. However, studies have not been able to identify any harmful effects related to thiomersal, and even so, it was removed from all Australian childhood vaccines.[8]

One of the most infamous controversies surrounding vaccine safety was Andrew Wakefield’s retracted 1998 paper that linked the Measles, Mumps and Rubella (MMR) vaccine to autism and bowel disease. His study was severely flawed, involving a sample of only 12 children, and Wakefield was deregistered and discredited. In comparison, a Danish retrospective cohort study investigated over 500,000 children who received the MMR vaccine and proved that there was no association between the vaccine and autism.[9]  Despite this, many of the general public still believe in the association between the MMR vaccine and autism as a consequence of Wakefield’s study.

Vaccine objection in the context of Australian vaccination policies

As of January 2016, the nationwide legislation called “No Jab No Pay” has been put into effect, removing conscientious objection from exemption criteria to immunisation requirements for Centrelink childcare payments worth up to $19,000. A press release by then Prime Minister Tony Abbott and Health Minister Scott Morrison stated that “the choice made by families not to immunise their children is not supported by public policy or medical research nor should such action be supported by taxpayers in the form of child care payments”.[10]

In contrast, public health experts believe that this policy is may be misplaced in its aims to reduce conscientious objection to vaccination, rather than addressing the more prominent barriers of access to services, logistical issues, and missed vaccination opportunities.[11] A policy such as this could also threaten the validity of a patient’s informed consent, which is outlined in the Australian Immunisation Handbook as being “given voluntarily in the absence of undue pressure, coercion or manipulation”.[12] This has generated a fresh debate into the ethics of mandating vaccines through paternalistic policy.

Statistics released in July 2016 show that following the implementation of this policy, 148,000 incompletely vaccinated children had caught up, including 5,738 children of parents with previous conscientious objections.[13]

Implications as medical professionals

Public attitudes towards vaccinations are complex, as they are affected by a wide range of sources, including the media, personal experiences, and health providers. A variety of strategies should be implemented to influence such attitudes. For instance, willingness to vaccinate could be encouraged by focusing on improving awareness of the risks of vaccine preventable diseases, rather than discrediting or refuting myths about vaccine dangers. An intervention based on this strategy showed that higher risk perception of diseases resulted in an increased willingness to vaccinate.[14] It was also shown that rates of conscientious objection were reduced in areas with more administrative barriers to obtaining one.

As future health professionals, we need to develop skills to practise evidence-based medicine. We need to be able to formulate our opinions based on verified facts, before helping parents to make informed decisions about vaccinations. We too can also be influenced by the vast amount of facts and misinformation disseminated about vaccinations in the media. Thus, it is our responsibility to stay up-to-date with the latest literature and separate fact from fiction, in order to provide the best care for our patients.

Elissa Zhang

Elissa is a 4th year medical student at UNSW. She currently conducts research on parental attitudes towards vaccine policies and media portrayals of vaccine safety at the UNSW School of Public Health and Community Medicine.

Acknowledgements

Supervisor Prof. Raina MacIntyre, UNSW

r.macintyre@unsw.edu.au

Conflict of Interest

None declared

Correspondence

elissa.j.zhang@gmail.com

References

Greenwood B. The contribution of vaccination to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci. 2014;369(1645):20130433. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024226/ DOI: 10.1098/rstb.2013.0433

Australian Broadcasting Corporation. Pauline Hanson joins Insiders [Internet]. Sydney NSW: Australian Broadcasting Corporation; 2017 [cited 2017 May 29]. Available from: http://www.abc.net.au/insiders/content/2016/s4630647.htm

Wadman M. Robert F. Kenndey Jr. says a ‘vaccine safety’ commission is still in the works. Science [Internet]. 2017 Feb [cited 2017 May 29]. Available from: http://www.sciencemag.org/news/2017/02/robert-f-kennedy-jr-says-vaccine-safety-commission-still-works

National Centre for Immunisation Research & Surveillance [Internet]. Westmead NSW: NCIRS; 2016. No jab no play, no jab no pay policies; 2016 [cited 2017 May 29]; [all screens]. Available from: http://www.ncirs.edu.au/consumer-resources/no-jab-no-play-no-jab-no-pay-policies/

Bond L, Nolan T. Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception. BMC Public Health. 2011;11:943.

Rhodes A. Vaccination: perspectives of Australian parents [Internet]. Melbourne VIC: The Royal Children’s Hospital Melbourne; 2017 [cited 2017 May 29]. 6 p. Available from: https://www.childhealthpoll.org.au/wp-content/uploads/2015/10/ACHP-Poll6_Detailed-report_FINAL.pdf

Offit PA. The Cutter incident, 50 years later. N Engl J Med. 2005;352(14):1411-2.

National Centre for Immunisation Research & Surveillance. Thiomersal FactSheet [Internet]. Westmead NSW: NCIRS; 2009 [cited 2017 May 29]. 5 p. Available from: http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/thiomersal-fact-sheet.pdf

1. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002;347(19):1477-82.

2. Abbott T, Morrison S. No jab – no play and no pay for child care [Internet]. Canberra ACT: Parliament of Australia; 2015. 2 p. Available from: http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22media%2Fpressrel%2F3770236%22

3. Beard FH, Leask J, McIntyre PB. No jab, no pay and vaccine refusal in Australia: the jury is out. Med J Aust. 2017;206(9):381-3.

4. Australian Government Department of Health. The Australian Immunisation Handbook. 10th ed. Canberra ACT: Commonwealth of Australia; 2015. 575 p.

5. Doran M. Vaccination rates in children up since ‘no jab, no pay’ introduce, federal government says. ABC News. [Internet]. 2016 Jul 31. [cited 2017 May 20]. Available from: http://www.abc.net.au/news/2016-07-31/government-labels-no-jab,-no-pay-policy-a-success/7675172

6. Horne Z, Powell D, Hummel JE, Holyoak KJ. Countering antivaccination attitudes. Proc Natl Acad Sci USA [Internet]. 2015 Aug [cited 2017 May 29];112(33):10321-24. Available from: http://www.pnas.org/content/112/33/10321.full.pdf

 

 

Climate Change and Vector-Borne Disease in Kiribati

Issue 11 Volume 1
Commentary

In February 2016, I went on a New Colombo Plan-sponsored climate change research trip to Kiribati, a nation of low-lying atolls in the Pacific Ocean. The islands of Kiribati are on the equator halfway between Australia and Hawaii. One of the most important things that I learnt was how being sustainable is not that difficult at all, and that the people of Kiribati are absolute professionals at living in harmony with their environment. We travelled to Kiribati to research the social, economic and environmental effects of climate change. However, this trip also taught us much about ourselves and the society that we live in, Australia. It was an opportunity to see how those who contribute nothing to global pollution are suffering from the effects of climate change.

There is a large focus in the international community on the environmental implications of climate change. Whilst this is highly significant, the impact of climate change on the health of local communities also needs to be brought to attention. When I think of this impact on local people, Kiribati is the first place that comes to mind. Climate change is responsible for an array of health issues, primarily the rise in communicable diseases as a result of the climate change-induced El Nino Southern Oscillation (ENSO) effect [1]. Vector-borne diseases such as malaria and dengue fever are particularly relevant. Increase in average global temperatures due to raised levels of greenhouse gases essentially accommodate these epidemics [2]. Without firstly responding to the health issues that these populations face as a result of climate change, many of the other issues cannot be addressed. In Kiribati, it is crucial to take measures to avoid future health consequences such as communicable diseases, as these people are so susceptible to the effects of climate change.
The people of Kiribati are said to be the most vulnerable to the implications of climate change because of the close proximity of the inhabitants to the coastal regions of their islands. The ENSO effect is characterised by irregular warming of the eastern equatorial Pacific Ocean, and is responsible for raising average temperatures and inducing higher rainfall in the Asia Pacific region. Kiribati itself is only two metres above sea level, and so faces challenges in this domain. This is a very significant issue for cooler regions where there is limited experience or resistance to vector-borne infectious diseases [3].

Vector-borne diseases have many factors at play, such as host resistance, the environment, urbanisation and the pathogens themselves. The severity and prevalence of vector-borne diseases depends heavily on the climate, and thus directly correlates with the ENSO climate cycles. Temperature, rainfall and humidity are especially important concerns for vector-borne diseases [4]. According to the ‘The Sting of Climate Change’ report, ‘warmer conditions allow the mosquitoes and the malaria parasite itself to develop and grow more quickly, while wetter conditions let mosquitoes live longer and breed more prolifically’ [5]. There is an overall increase in the potential for disease transmission due to the change in the ecology of vectors. This is characterised by quicker mosquito breeding cycle (thus, higher concentrations), increased biting rates, and shortened pathogen incubation periods [6]. If rainfall is excessive, pooled water can form, which creates breeding sites for mosquito larvae. There are many factors that operate in these scenarios, and so there is no one direct link between climate and mosquito populations.

For both dengue and malaria, some of the most effective control measures to reduce the burden are long-lasting insecticidal bed-nets, indoor residual spraying with insecticides, seasonal malaria chemo-prevention, intermittent preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective anti-malarial medicines [7]. These measures have dramatically lowered malaria disease burden in many Pacific Islander settings over the years. Thus, prevention is limited to vector-control measures, which are very difficult to monitor.

Visiting Kiribati gave me insight into the reality of climate change and its current impacts on health. It is clear that there is a distinct connection between climate change and vector-borne diseases. This poses particular challenges for developing nations where consequences of climate change are most pronounced. My experiences in Kiribati showed us raw, personal stories, and we strongly believe it is imperative to take action immediately.

 

Acknowledgements

None

Conflict of Interest

None declared

Correspondence

e.longhurst1012@gmail.com

References

References

  1. Reiter P. Climate change and mosquito-borne disease. Environmental health perspectives; 2011. 141 p. 121
  2. Ebi KL, Lewis ND, Corvalan C. Climate variability and change and their potential health effects in small island states: information for adaptation planning in the health sector. Environmental Health Perspectives; 2006, 1957-1963 p.
  3. Haines A, McMichael AJ, Epstein PR. Environment and health: 2. Global climate change and health. Canadian Medical Association Journal; 2006, 729-734 p.
  4. Woodruff R, Whetton P, Hennessy K, Nicholls N, Hales S, Woodward A, Kjellstrom, T, Human health and climate change in Oceania: a risk assessment. Canberra: Commonwealth Department of Health and Ageing; 2003.
  5. Perry M. Malaria and dengue the sting in climate change. Reuters; 2008. Available from: http://www.reuters.com/article/us-climate-disease-idUSTRE4AJ2RQ20081120
  6. Bezirtzoglou C, Dekas K, Charvalos E. Climate changes, environment and infection: Facts, scenarios and growing awareness from the public health community within Europe. Anaerobe; 2011, 2 p.
  7. Githeko AK, Lindsay SW, Confalonieri UE, Patz JA. Climate change and vector-borne diseases: a regional analysis. Bulletin of the World Health Organization; 2000. 1136-1147 p.