Hope Alexander MPH

Archive for the ‘Hope’s Commentary’ Category

2009 Joanna Briggs Institute International Convention
“Ripples to Revolution: from bench to bedside!”
Adelaide, South Australia, November 18-20 2009.

Hope Alexander MPH – Community Consultant and Health Educator presented the following PowerPoint Presentation:

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10 Best Questions for parents to ask a child obesity expert – Focus Group

Below are Hope’s notes from the Focus Group.

I did query the title – my suggestion would be a consult the family doctor BEFORE going to see a “childhood obesity expert”, whoever that may be.

All present agreed on the first question “is my child too fat?”

In the un-ranked questions I asked “Does my child need a medical assessment?”. The reason being that a GP can rule out any underling medical condition.

A child may be fat for reasons other than poor diet, lack of nutrition/exercise etc. I was the only person who saw this as an important step. I did this in real life, taking one of my girls to the GP because she was too chubby and chunky at 8 years old.

I was advised to give her smaller portions and later as a teenager she took up swimming and at 14, I got her enrolled in a women’s basketball team. She ended up as an adult with a beautiful figure.

10 Best Questions for Parents to ask a child obesity expert

1. Is my child too fat?
2. What can I do as a parent to help my child have a healthy weight?
3. What can I do to prevent my child becoming obese?
4. What food should I be giving my child and how much?
5. How do I provide a nutritional diet on a budget?
6. Why is my child fat?
7. How could I motivate myself and my child to do more physical activity and make healthy food choices?
8. How much exercise should my child get?
9. Where can I get appropriate programs?How can I lobby the government or food companies to limit the availability of unhealthy food choices?

Other questions not ranked in the top ten

1. Where can I get information about obesity?
2. Do I need to get a medical assessment by a GP?
3. How can I make my child more comfortable about their weight?
4. How can I limit my child’s exposure to unhealthy food advertising?
5. What are the effects of childhood obesity?

The draft document “Guidelines for Human Biobanks, Genetic Research Databases & Associated Data” (July 2009) is being prepared for release for public comment.

The Office of Population Health Genomics (Public Health Division) WA Health has been coordinating the development of guidelines which provide principles and best practices for the establishment, management and operation of research biobanks and DNA databases in WA. The guidelines have been developed for WA Health but are intended for use by both government and non-government research organisations in WA.

Hope received formal acknowledgement that she “has been involved in the stakeholder consultation process, contributing to the two community consultation events which informed the development of the guidelines … also gave a presentation on the consumer perspective. An acknowledgement has been included on pages x and xii that mention her by name.”

http://www.genomics.health.wa.gov.au/home/

Norman Swan on The Health Report on ABC Radio National, 10 August 2009, interviewed Anne McKenzie who is a consumer advocate in the School of Population Health at the University of Western Australia, Hope Alexander, a consumer member of their Research Advisory Panel, and Kos Sclavos, president of the Pharmacy Guild of Australia. The topic of discussion was “Labelling of medications dispensed by pharmacists”.

Labelling of medications dispensed by pharmacists

“Health consumer advocates have uncovered what they feel might be an unacceptable level of pharmacists dispensing medications with ‘use as directed’ or equivalent on the label. They argue that this is dangerous and should not happen.”

The Health Report transcript can be read here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647591.htm

The Health Report transcript can be listened to here:
http://mpegmedia.abc.net.au/rn/podcast/2009/08/hrt_20090810_0841.mp3

The below article is a guest column written by Hope, that was published in the “Medical Forum WA”  magazine, Western Australia’s Independent Monthly for Health Professionals July, 2009 edition. Her article is on Page 10 and the orginal article can be accessed at http://www.medicalhub.com.au/component/option,com_docman/task,doc_download/gid,130/Itemid,228/

With the ageing population, what can the Australian health consumer expect in the way of primary health care, and by whom will it be delivered? One strategy to overcome the shortage of trained health professionals is to utilise the skills and strengths of nurse practitioners.

The article “On solutions to the shortage of doctors in Australia” states that:

• WHO estimates a current global shortage of 4.3 million health workers;

• Australia … compares unfavourably with other OECD countries in respect to doctor numbers;

• The overall shortage of doctors in Australia … is exaggerated by the disciplinary, cultural, and demographic misdistribution of the doctors relative to need and utility;

• Australia … is one of the most reliant of the OECD countries on foreign doctors; and

• An increase in spending on health promotion and disease prevention is essential.

“The majority of health professionals recognise that there is a gap in health service delivery in this country, and that nurse practitioners can contribute to filling that gap” (Cerasa, 2009).

Anecdotal evidence from patient X has a woman attending a GP surgery to have weekly dressings on her leg after day surgery. But can either of the two practice nurses reassure the patient that her wound is healing? No. Can the GP who sees the wound on an irregular basis? No, “It is OK.” What does that mean? So the patient returns to the surgeon to get a definite opinion. “Yes, the leg is healing, everything is proceeding as normal.”

If a consumer consulted a nurse practitioner specifically trained in wound care, the outcome would be much different. The skill and knowledge base would be there. Information would be given to the patient to best manage her condition: how often would dressings need to be done, for how long, and what the patient could do to resume her normal lifestyle. As a consumer, I have faith in the education and training of nurse practitioners. Many consumers have been let down by GPs who do not communicate, who do not share information and/or evidence, and who “do not want to treat old people” or “people with no money”.

As an older consumer with a chronic condition brought about by medical treatment for another condition, I would say “Yes, I am willing to consult a nurse practitioner” for routine checks and most ailments. Part of the nurse practitioner training is to differentiate between serious and minor complaints. I see their role as being similar to triage. Instead of referring a patient to a GP, it may be a referral to an exercise physiologist, a dietician, or a massage therapist.

GPs are trained in the medical model, but many consumers, particularly those with chronic conditions, and older ones, would prefer a non-drug treatment, along the lines of the New Zealand “Green prescription”. In addition, consumers find it difficult to access a GP who is willing to write an Enhanced Care Plan. Excuses given are “it takes too much time” and “we don’t get paid enough”. Consumers may well ask “But what about us?”

Hope Alexander

July 2009

© Copyright Hope Alexander

Submission to the Commonwealth Government Department of Health and Ageing on the new National Women’s Health Policy 1 July 2009

Hope Alexander MPH, Consumer Representative and Health Educator, Perth, Western Australia.

Introduction

In any proposed new National Women’s Health Policy as submitted by the Australian Women’s Health Network there needs to be a balance struck between research, prevention, and treatment and care.

For all those sick women whose treatment is determined not by gender but by class and economic disadvantage where are their voices in this proposed policy?

Where are the recommendations around Foetal Alcohol syndrome so that Indigenous children can have the best start in life?

The emphasis should show balance, not the middle class mantra of prevention education without the recognition of the suffering of the poor and the marginalised in our health system.

Recommendations

• Breast prosthesis – eligible women to be given a voucher for their prosthesis/es similar to that given eligible people for hearing aids

• A voucher for say $350 per year to attend an accredited gym to undergo an exercise program designed by an exercise physiologist for weight loss and/or weight management

• The New Zealand Green Prescription be implemented nationally

• Programs to address the issue of foetal alcohol syndrome, particularly in Indigenous women

The rationale for the recommendations

• Breast prosthesis – eligible women to be given a voucher for their prosthesis/es similar to that given eligible people for hearing aids.Although the Medicare rebate is a welcome innovation, it still leaves some women with a problem. They do not have the cash to pay upfront for their prostheses. These can cost from between $350 up to $550 each and possibly beyond. For a woman requiring two prostheses, (double mastectomy) this could mean anything up to $1000, perhaps more. For a woman whose only income is the aged pension or other form of income support this outlay is not an option.

• A voucher for say $350 per year to attend an accredited gym to undergo an exercise program designed by an exercise physiologist for weight loss and/or weight management.

For those women who have suffered weight gain and body fat gain from cancer treatments (HEAL study, USA, 1996) and possibly other drug treatments some form of assistance is required. Women on pensions and other low incomes are unable to afford gym memberships, and thus are prevented from gaining access to rehabilitation exercise.

It is recognized that chronic conditions (eg cancer and cardiovascular disease) are becoming a greater burden on the public health purse, and will continue to do so. Rather than have the Federal Government spend around $15,000 per obese person on stomach stapling surgery, a more equitable option would be to invest $350 per year per woman, for those meeting the above criteria: weight gain from cancer and other drug treatments. This is a form of rehabilitation, thus returning these women to a more fully functional and hopefully independent lifestyle.

The costs of the consultations with the exercise physiologist can be met by Medicare, under the Enhanced Care Plan (ECP). Many GPs are reluctant or unwilling to put women on an ECP. The complaint is “it takes too much of my time” and “We don’t get paid enough” (personal communications).

• The New Zealand Green Prescription (1, 2) is a program that works, and has been evaluated. Because the populations of Australia and New Zealand are similar (both having Indigenous peoples and a diversity of cultures) there appears to be no reason why the Green Prescription could not work in Australia. More important, it may well be acceptable to Indigenous women in Australia, as was the “One heart many lives”(3) program acceptable to New Zealand Maori males.
• A national program to address the issue of foetal alcohol syndrome particularly in Indigenous women.

References

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1508188

http://www.sparc.org.nz/getting-active/green-prescription/how-it-works

http://www.oneheartmanylives.co.nz/

International Women’s Day Event – A Celebration – Free Workshop – All Welcome

“How to manage weight gain/body fat gain and/or sexuality difficulties after cancer treatment”

This interactive workshop session includes information and evidence on:

Weight gain and body fat gain after cancer treatment and sexuality difficulties after a cancer diagnosis.

Participating in this workshop will give hope and encouragement to women who experience these difficulties.

Women will be better able to manage and overcome some of the side effects associated with cancer treatments.

The workshop will be an information and awareness-raising event. Handouts will be available.

Date: Sunday 8 March 2009

Time: 12.30 – 1.30 pm

Place: Room A231, E Central TAFE, Royal Street, East Perth, Western Australia.

Facilitator: Hope Alexander (Masters Public Health),
Consultant & Health Educator, Former lecturer in New Opportunities for Women, TAFE.

This is an International Women’s Day event supported by the WA Office for Women’s Policy