Dean’s Diary

So Australian Medical  Association President Dr Michael Aizen thinks that “lifestyle changes alone will be insufficient to treat” the hypertension, high cholesterol, ulcer, pain,  and other conditions that make up the $39.8 million paid out to subsidise Tasmanians’ on these drugs in 08/09 alone.  ( Drugs Figures reveal Lifestyle imbalance, Sunday Tasmanian July 18 )

 But Dr Aizen’s comments show the stupidity of our current health system. We spend billions of dollars trying to “treat” the diseases once they occur and virtually nothing on trying to prevent them from happening.

 We know what causes most illness,  we know how to fix them but why don’t we ? I’d Like to know what Dr Aizen thinks is the answer?

 Heart Foundation Chief Graeme Lynch stated in the same article “ unless we address the causes of cardiovascular disease, it will not be sustainable in the long term”. I’d say it is not sustainable now. How many stories do we see daily in the media about the gaps in all government services, and not only in health?  

 While Doctors do some amazing things, they also have to start to take some responsibility for the current poor health of many in the community and start to change what they say and do about the  problem.

 Everyone needs to accept that you  simply cant be healthy without regular exercise and a balanced diet,  and that is not going to change regardless of changes in medical science. Exercise must be prescribed and monitored just like drug use currently is,  as this  will produce better outcomes than what we see at present.

 While there is a role for Doctors and some medications,  they are currently doing the wrong job well  and the sooner everyone acknowledges this the sooner we can improve health outcomes.

 But until we see real reform of the services we offer to actually prevent rather than treat cardio vascular disease and ensure that there is a greater level of personal responsibility to follow health guidelines,  then what else will we see? More of the same!

 I am sure that many will be saying that health is a key federal election issue, my question is “What does that mean?” More doctors prescribing more drugs and more hospitals with more beds or will we see resources allocated to actually prevent illness and incapacity? And hopefully something better than a telephone coaching service!

It has been interesting to read recent media debate about Australia post trying to ask all posties to keep their weight below 100kg so they are able to do their work. Apparently the postie bikes have a maximum weight limit that means that a   driver weight of more then 100kg ( plus mail ) does not go over the safe operating levels for the bikes.

Well I see this as a clear cut health and safety issue that should not even be seen to be controversial at all. As an employer Australia Post have a responsibility to their staff to ensure that they  are working in a safe environment at all times. If the total weight of bike, mail and driver exceeds 145 kg then the operation of the bike  can no longer safely occur. I would suggest that it would be more of an issue if Aust Post actually allowed their workers to continue to use the postie bike if the user was in fact overweight.

Either way Aust Post cant win, do nothing and be sued for negligence and unsafe work practices or  enforce appropriate guidelines and be blasted by the media and the union movement.  Being overweight is not a “medical condition” it is not something you catch and it is certainly something that is caused by the individual. I remember the same “outrage” a few months ago when Myer put an older lady on sick leave because she could not squat down to empty cash draws that were a major part of her role.

I have also worked with many poeple  over the years who sustained a “work related” back injury. However the only aspect that was   work related was that it happened at work but was not caused by the work. Sure there are some people who sustain an injury at work, which is caused by the work itself, but many more injuries will occur over the next few years if companies cannot develop and enforce guidelines similar to what Aust Post and Myer have tried to do.  

We  cant afford the cost of health care now so how are we going to handle the  cost of dealing with further increases in weight and physical dysfunction due to inactivity if this is left to continue to spiral out of control? The single biggest cause of workplace injury is strains and sprains, but how many of these could be prevented if people exercised more? Also how many stress claims could be prevented with a fitter healthier workforce? That is what we should all be putting our energies into – not trying to say “it is not their fault”.

There is only 1 way we can deal with this situation and that is to create an acceptance of the need for everyone to accept responsibility for the own health and wellbeing. If you are overweight and at risk of injury as a result then it must be the individuals responsibility to    do something about it. Sure we owe it to people to provide support for healthy behaviours and work with all staff over time so that they are not simply thrown onto the scrap heap, but something has to give.

We  cant have it both ways. A business cant be held responsible for injuries sustained at work if they are not allowed to control the risk of the same occurring. Unions also need to recognise that their role is to protect the health and safety of their  members and NOT preventing some workers from doing high risk jobs is not helping anyone. And in the  long run will cost jobs and  livelihoods for many more if this type of approach  goes unchecked.

Its bad enough that we have to buy new super sized ambulances and hospital beds to accommodate the obese, but to now suggest that “it is not their fault” is only going to make the situation worse.

To change the behaviour of 22 million people will take  a combination of a carrot and a stick. While i do look forward to the rewarding of healthy behaviours, I also look forward to people being held accountable for their physical health, because I for one am sick of subsidising the health care and work related costs of  people who wont take responsibility for their own health.

It has  been interesting to see the way the swine flu pandemic has played out around the world. Initially we were led to  believe that we were going to be in big trouble if the virus spread. News reports every hour about how many cases and where they were occurring scared the bejesus out of most of us.

Then the next phase was when they started to happen closer to home. First on the mainland, then locally and when we saw the first few deaths, who knew what was going to happen.

Now we appear to be in stage 3 where there are a few deaths, which are certainly tragic for those concerned but in reality so few to justify the huge media attention and concern. It is now obvious that the swine flu is quite mild for virtually all but the very young and old, usually with other medical complications,  which seem to be the actual cause of death.

We now also know that in any normal year we see more deaths form other forms of influenza that have gone on unreported. The questions  we must now ask ourselves are:

Why the panic about swine flu being worse than normal flu ?

Why have we thrown so many  resources into trying to tackle something that is nowhere near as serious as first  thought?

This shows that  when it comes to something in health that apparently is going to be a major issue we can immediately shift public policy to tackle its perceived  potential impact.

Clinics were set up, extra resources found within health departments, millions of dollars was made available for public awareness campaigns, staff were moved to different areas and basically in real terms this was done within only 2 weeks or so of the problem being discovered.

But when we look at the way we as a society have managed how we prevent heart disease, diabetes, osteoporosis and other conditions such as low back and other musculo skeletal injury, we keep doing the same old thing as we have always done.

Successive governments and ministers at both state and federal levels talk about prevention and how important it is,  but the problem is that NOTHING EVER CHANGES!!!

If, as we have seen with swine flu, whole armies of people can be mobilised to create awareness and deliver interventions, why on earth are we waiting for the same political and bureaucratic will to do something about increasing the health of the community?

It is simply not good enough on the part of our policy makers and the vested interests feeding off this ill health must be brought to account. If we can make change in such a rapid way with swine flue we must all demand that the same be done to support healthy lifestyles and to change the way we spend money on health.

The ridiculous thing about all this is that we have known about the impending crisis with inactivity, overweight and obesity and its health problems and what has  our response been? TALK!

So I challenge anyone to tell me that “it takes time” to change our focus. It does not have to take time, it just needs someone to actually do something to stop the focus on hospitals, doctors and  medication.

We think that global warming is potentially going to cost us all, well health care already is costing us an absolute fortune and what are we getting for it? MORE SICK PEOPLE.

When is our focus going to shift to having more healthy people?

It was interesting to read Kevins Rudd’s plan to reform the hospital system this week.  Sounded like an exercise in rearranging the deck chairs on the Titanic. There will be little change in outcomes without  real changes in preventing illness and disease, but I think you know my thoughts on that issue!

Anyway i noticed one policy proposal – “to have nurses in schools to ensure that kids get enough exercise” among other things. While there may be a role for appropriately trained nurses to deal with nutrition and other health issues, they are not the answer to exercise in schools.

I am sure that there are some who could do a good job, but why on earth would you use someone with absolutely no training in exercise design, programming and instruction be responsible for the same?  We currently have plenty of teachers who are failing in their duty to deliver daily PE because they have similar training deficiencies or they dont do it themselves!

My belief is that teachers should be responsible for the  delivery of daily PE   - but the reality is that not many classroom teachers in primary schools are doing their best in this area.  It should be a key KPI for all teachers and i am all for paying teachers more – as long as we get rid of the  poor ones ( and we have all experienced them in our years at school).

My solution to the problem is to have trainees aged around 18 + employed by the education department to assist the PE teacher in the delivery of daily PE and all the other physical education components. We simply cant afford to employ thousands more PE teachers or nurses for that matter and we will get a much bigger bang for our buck by using junior staff.

These trainees would need to completea Certificate 3 in Fitness and be trained to deliver daily PE as mentioned but also things such as

• Arranging lunch time sports
• Cleaning out sports store room – including minor repairs and maintenance of equipment and grounds
• Assisting with after school sports coaching and Active After Schools programs

Plus some of the  more menial administrative tasks that could be taken off the PE teacher so they can focus on program delivery and improvement.

These trainees can also spend time at a couple of schools and also health clubs which will help the industry by providing a new workforce that can help work with the older population once government policy catches up in regards to prevention and it would also help to set up a partnership with schools and the local health club.

This woudlalso create a fantastic career path those who may not be great sportspeople but are interested in non competitive fitness and exercise pursuits. ( which is one of te problems with our sports focussed PE programs in schools at the moment) This will also help create a “culture” of exercise and fitness amongst the kids and drive the move to more active lifestyles.

Those who are more academic can go through to a full degree and this way our PE teachers would end up being the best of the best. 

Anyway – I will try and have this proposal put in front of policy makers to see if there is some chance it it happening. In the meantime if any of you see Kevin 07 wandering the streets – tell him about it!