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MATT SMITH

cage fighters have nothingto fear from a new government review intocombat sports, according to the state’s big-gest mixed martial arts promoter.

Premier Will Hodgman has announced areview into combat sports and boxing justtwo years after the sports were scrutinised.

However, Dan Hyatt, the founder of Tas-mania’s largest mixed martial arts events com-pany, said the industry welcomed scrutiny.

The State Government has launched asurvey asking Tasmanians their thoughts oncombat sports and boxing.

The Australian Medical Association hasrenewed calls for the sports to be banned.

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BRING IT ON: Mixed martial artist, and owner of Hybrid Training Centre, Shaw Dean welcomes a review into the cage fighting industry.

Picture: LUKE BOWDEN

Combat sports come under fresh scrutinyFROM PAGE 1

Mr Hodgman said the new“organisations and disciplines”had emerged since the last re-view two years ago.

“The Standards for Boxingand Combat Sport Contestscame into effect two years agoand cover boxing and combatsports including judo, karate,wrestling and grappling andtaekwondo contests,” MrHodgman told the Mercury.

“In that time, they’ve prov-en to be an effective mechan-ism to manage boxing andcombat sport contests as wellas assisting with the develop-ment of organisations/govern-ing bodies within the sector.

“Since the standards weredeveloped, new disciplines andorganisations have emerged,so it’s appropriate we under-take a review to ensure thestandards continue to protect

the interests and safety ofthose involved in boxing andcombat sport activities.”

Mr Hyatt said the reviewwas proof that the Govern-ment was taking the legitimatesanctioning of combat sportsin Tasmania seriously.

“This is not only beneficialfor promoters and competi-tors, but it will also help bringeven more legitimacy to thesport and the general public’s

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opinion of it,” he said.“No one within the Tasma-

nian MMA scene is against thelegitimate sanctioning of com-bat sports and reviews such asthis will help push the sportforward.”

Two of the areas that the re-view is expected to focus on isinsurance and the level ofmedical professional presenceat the bouts.

Mr Hyatt said his company,

Valor, had had public liabilityinsurance worth $20 millionsince its inception three yearsago.

He added, “Valor currentlyuses experienced fight doctorBen Manion, of Queensland,and has done so across all 18events in five different citiessince 2012.

“Dr Manion is a registeredmedical practitioner and isvery experienced in over-

seeing combat sport events.”But AMA Tasmanian presi-

dent Tim Greenaway said allcombat sports including box-ing should be banned.

“There is increasing evi-dence for traumatic brain in-jury associated with headtrauma,” Dr Greenaway said.

“It seems inherently ridicu-lous that we would be permit-ting a sport where the potentialfor long-term harm is clear.”

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Bupa chief talks tough on affordability debate

INSURANCE: Bupa’s health insurance head, Dwayne Crombie, has called on health professionals to play a more active role in the affordability debate, saying they can’t just sit on the sidelines.

Mr Crombie, managing director of Bupa’s Australian health insurance business, argued there must be a focus on where premiums flowed to.

“For people who are worriedabout affordability ... you need to focus on where the money is going and it’s going on a whole lot of healthcare sectors, which in some cases are more expensive then they need to be and in some cases we are doing things to people which really aren’t providing any benefit at all,” he said.

The insurance boss said 85 to90 per cent of premiums went to paying hospitals, doctors and all the ancillary providers. He called for constructive talks about affordability and quality care after Medibank Private’s contract negotiations with Calvary Hospitals refreshed the debate. “They (clinicians/hospitals) can’t just sit on the sidelines and say you can’t interfere with our clinical freedom and we reserve the right to do whatever we want and use whatever expensive thing we want without some discussion about value for

money, that is simply not acceptable,” he said.

“If they do that then a wholelot of people will be forced out of private health insurance.”

Australian Medical

Association president Brian Owler said the level of behaviour and the “stand-over tactics” private health insurers were using against private hospitals had reached a new level. “When it comes to paying out and looking after the patients, the private health insurance behaviour has been less than optimal,” he said.

“If Medibank and Bupa areserious about reducing costs they should stop paying for therapies that are completely unproven and have nothing to do with the basic foundation of insurance, which is covering people for unexpected medical conditions that require procedures and treatments in hospitals.”

The insurers have argued they are seeking the best quality care for their members and should not have to pay for what they deem to be “mistakes” by the hospital. One issue Medibank and Calvary cannot agree on in negotiations, which have broken down, is a list of 165 “highly preventable adverse events”, which Medibank has said it will no longer cover.

Dr Owler argued that to say

doctors were not interested in quality ignored the fact that it was doctors that constantly drove quality.

“I’ll put the reputation of doctors and hospitals before the reputation of private health insurers, particularly those that are trying to put profit before patients,” he said. “The big insurers want to go down a US-style managed care system, where they have a say in what treatments people can and can’t have and they will interfere in the doctor/patient relationship.”

He said the AMA must starteducating the public about what health insurance products were about and what they should provide. “People need to realise they can change funds easily.”

SARAH-JANE TASKER

‘They (clinicians/hospitals) can’t just sit on the sidelines’

DWAYNE CROMBIEBUPA

I’ll put the reputation of doctors andhospitals before the reputation of private health insurers.BRIAN OWLER, AMA

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Skinny on why ignorance makes us fat

MARK HARRIS

MANY medical professionalswrongly assume the growingranks of overweight and obeseAustralians are not sufficientlymotivated to lose weight.

Instead, our research sug-gests low health literacy maybe the culprit.

Health literacy means hav-ing a good understanding ofyour own health, the measuresyou can take to improve it andhow the healthcare system canhelp you.

One in five Australians havevery low health literacy, result-ing in reduced life expectancyand a poor quality of life.

While there are strong asso-ciations between poor healthliteracy, low socio-economicstatus and obesity, the causeand effects aren’t yet clear.

My team and I are attemp-ting to unpack this complex

issue. General practitioners(GPs) have an accepted role tohelp patients manage theirweight. Our research is show-ing that GPs and practice nurs-es (PNs) can do much betterwhen it comes to supportingpatients, particularly thosewith poor health literacy, tobeat the bulge.

We recently conducted astudy with GPs and PNs in 20practices in socio-economi-cally deprived areas in Adel-aide and Sydney.

We looked at their assess-ment and management ofoverweight and obese patientsand their attitudes and strate-gies for managing patientswith low health literacy.

Few reported assessing apatient’s health literacy.

This is important because,in previous research, we havefound that health professionalsoften confuse low health liter-acy with motivation.

More than half of the GPsand PNs reported regularly as-sessing diet, physical activityand body mass index (BMI).

While most provided brief ad-vice, goal setting and referralwas less frequently reported.

Of most concern was thatonly 15 per cent reported beingsuccessful in treating obese pa-tients and only 26 per cent en-joyed treating obese patients.

There are simple toolsavailable to assess health lit-eracy so that GPs can ident-ify patients at risk. SoundNational Health and Medi-

cal Research Council(NHMRC) obesity manage-ment guidelines are alsoavailable based on five keysteps: ask, assess, advise/agree, assist and arrange.

But unless clinicians areroutinely using these guide-lines, the problems remain.

That means we must tacklesome of barriers that frustratedoctors and practice nurses,particularly time pressuresand difficulties dealing with

patients who seem disen-gaged. We are currently as-

sessing how these guidelinescan be best incorporated intoGP practices and what sup-port regional primary careorganisations need to pro-vide to practices.

In this age when we aredrowning in informationabout lifestyle and weightmanagement, it is importantthat people with low health lit-

eracy are not left behind.Obesity levels in lower socio-economic groups in Australiaalready clearly exceed those inhigher socio-economic groupsand the disparity is widening.

Tailoring our approach tothe needs of those with lowhealth literacy is part of the so-lution to reversing this trend.PROFESSOR MARK HARRIS ISEXECUTIVE DIRECTOR OF UNSW’SCENTRE FOR PRIMARY HEALTHCARE.

One in five Australians have low health literacy, resulting in reduced life expectancy

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HOW IGNORANCE IS MAKING US FAT

MARKHARRIS

Many medical professionalswrongly assume the grow-ing ranks of overweight andobese Australians are notsufficiently motivated to

lose weight. Instead, our research sug-gests that low health literacy may bethe culprit.

Health literacy means having agood understanding of your ownhealth, the measures you can take toimprove it and how the healthcaresystem can help you. One in five Aus-tralians have very low health literacy

resulting in reduced life expectancyand a poor quality of life.

While there are strong associa-tions between poor health literacy,low socio-economic status and obes-ity, the cause and effects aren’t yetclear. My team and I are attemptingto unpack this complex issue.

General practitioners have anaccepted role to help patients managetheir weight. Our research shows GPsand practice nurses can do much bet-ter when it comes to supportingpatients, particularly those with poorhealth literacy, to beat the bulge.

We recently conducted a study

with GPs and practice nurses in 20practices in socio-economicallydeprived areas in Sydney and Adel-aide. We looked at their assessmentand management of overweight andobese patients and their attitudes andstrategies for managing patients withlow health literacy. Few reportedassessing a patient’s health literacy.

This is important because, in previousresearch, we have found that healthprofessionals often confuse lowhealth literacy with motivation

More than half of the GPs and prac-tice nurses reported regularlyassessing diet, physical activity andbody mass index. While most providedbrief advice, goal-setting and referralwas less frequently reported. Of mostconcern was that only 15 per centreported being successful in treatingobese patients, and only 26 per centenjoyed treating obese patients.

There are simple tools available toassess health literacy so that GPs canidentify patients at risk. SoundNational Health and MedicalResearch Council obesity manage-ment guidelines are also availablebased on five key steps: ask, assess,advise/agree, assist and arrange.

But unless clinicians are routinelyusing these guidelines, the problemsremain. That means we must tackle

some of barriers that frustrate doctorsand practice nurses, particularly timepressures and difficulties dealing withpatients who seem disengaged.

We are currently assessing howthese guidelines can be best incorpor-

ated into GP practices and whatsupport regional primary care organ-isations need to provide to practices.

In this age when we are drowningin information about lifestyle andweight management, it is importantthat people with low health literacyare not left behind.

Obesity levels in lower socio-economic groups in Australia alreadyclearly exceed those in higher socio-economic groups, and the disparity iswidening. Tailoring our approach tothe needs of those with low healthliteracy is part of the solution toreversing this trend.

Professor Mark Harris is executive director of UNSW’sCentre for Primary Health Care and Equity.

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A weightymessageall in vainSUE DUNLEVY

THE real reason you can’t loseweight has been revealed. It’snot your motivation that’s theproblem but your ability tounderstand your doctor’sweight loss instructions.

A new study has found doc-tors aren’t making sure theirobese patients understandweight reduction messagesand aren’t enrolling them inweight loss programs.

Patients are also confusedby conflicting media reportsabout weight loss diets andwhether you should cut fat,carbohydrates or eat proteinand whether dieting works atall.

Professor Mark Harris,from the University of NSW,says the problem is doctorsdon’t realise their patientsdon’t understand their instruc-tions.

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Expert says fixing mental health can reverse chronic youth jobless rate

Plea for our young onesDUNCAN ABEY

ADDRESSING the mentalhealth problems among Tas-mania’s young could be themost effective way to reversethe state’s chronic youthunemployment situation,world-leading psychiatristPatrick McGorry says.

The executive director ofMelbourne-based NationalCentre of Excellence in YouthMental Health, or Orygen,Professor McGorry, said whatwas traditionally written off asteenage angst was often moreserious, for young people andthe economy.

In Hobart yesterday to talkto Tasmanian mental healthworkers and stakeholders, the2010 Australian of the Yearsaid the state had some of themost enthusiastic and talentedstaff in the country but thatmore government help wasneeded for the 50 per cent ofadolescents who would experi-ence poor mental health in thetransition to adulthood.

“Despite this, only 13 percent of young men and 31 percent of young women weregetting any kind of help at all,”Prof McGorry said.

“But hundreds of these peo-ple die each year, and the restare thrown on the economicscrap heap, which is especiallya problem down here with theunemployment rate.

“To be fair, the FederalGovernment has responded bydeveloping a program calledHeadspace, which is a good

first step, but it needs manymore resources and back up byboth federal and stategovernments.”

He described Orygen as anational incubator for youthmental health, whose 150researchers and six professorswork on treatments and skills,

as well as fresh approaches toimproving the psychologicalwellbeing of Australia’s young.

But he said with mental ill-ness representing the most sig-nificant threat to vocationalsuccess — and also the biggestsource of new entrants to thedisability support pension — it

was in everyone’s interest toensure those who wanted towork were employment-ready.

“Nearly all the young peo-ple we speak to want to workand are not interested in end-ing up on the DSP, because it’sa life of marginalisation,” ProfMcGorry said.

“So let’s get them better andgive them every chance.

“And the best allies for us inmental health these days areeconomists, with the WorldEconomic Forum showing thatthe biggest threat to the econ-omy from non-communicablediseases is actually mental ill-

ness, which is twice as import-ant as cancer.”

He said it was important toinvest in community-based,preventive measures to easethe pressure.

“We have to put the ambu-lances at the top of the cliff, notat the bottom,” he said.

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We have to put the ambulances at the top of the cliff, not at the bottom.

Psychiatrist PATRICK MCGORRY

HEALTH FOR JOBS: Mental health expert and former Aussie of the Year Pat McGorry in town to talk up youth mental health services. Picture: KIM EISZELE

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Health system held hostage by politicsOne level of government must control hospitals, advises Martyn GoddardTHE future of the nation’s health system was in the hands of a room full of politicians last week, none of whom trusted any of the others.

It’s that lack of trust, ratherthan money and taxes, that is likely to derail any move to fix a broken system.

In the decade to 2013, theproportion of state and territory tax income — their own taxes plus GST — rose from 16 per cent to 24 per cent. At that rate, health will take up 36 per cent by 2023 and 53 per cent by 2033.

Something must be done.But the appalling state of Australia’s political life, and the near-absence of trust, makes real change difficult and perhaps impossible.

Some change to the tax system may eventually come out of the discussions, most probably a rise in the Medicarelevy, which seems to have less opposition than raising the GST. New legislation will be needed to ensure that money goes straight into health and hospitals, so state or federal governments cannot siphon it off for other purposes.

The states will never accepta simple inter-government agreement. The Abbott Government tore up an existing agreement that deprived the states of billions of dollars in health funding

and they won’t be caught like that again.

But even that sort of law will not stop federal or state governments from gaming the system — putting the new tax money in and taking existing funding out.

It will not stop the FederalGovernment further reducing the amount it gives to public hospitals or to its own programs like Medicare and the Pharmaceutical Benefits Scheme. And it will not prevent state governments from siphoning off existing health funding and replacing it with money from the new tax.

If that happens — and politicians will be politicians — we will be no further ahead. Our doctors and nurses will struggle harder and harder, waiting lists will get even longer and safety will be further compromised.

So what is the answer?The only way to fix the

problem of public hospital funding is to make one level of government, perhaps the states but preferably the Commonwealth, solely

responsible for all healthfunding — Medicare, the PBS,hospitals, the lot.

Unless someone has to takethe blame for inadequatefunding, each side will be ableto go on blaming the other andnothing will improve.

State or federal?There are arguments both

ways. The states alone haveexpertise to run publichospitals, the Commonwealthdoes not. Canberra has neverbeen about delivering servicesand an attempt to make themrun hospitals would end indisaster.

But the inability of thestates to raise enough moneyto run hospitals, even with theGST, means not only thattheir health systems suffer butall other state programs –education, transport, police –are crowded out. Everyonesuffers.

Increasing the GST or theMedicare levy will not fix theproblem for long, even if allthe money was obediently putinto health. Costs and demandare rising too fast for thosetaxes to keep up.

The only level of government capable of raisingenough cash is theCommonwealth. So we needCanberra to provide the cashand the states, probably undersome form of contract, tocontinue as the systemmanagers.

The reason this has nothappened already is theburning desire of politicians atall levels to preserve their ownpower while shuffling theblame to someone else. Thecurrent system allows them todo both.

One of the most promisingelements of the current debateis the agreement by many

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politicians that taxes have to rise. That’s new.

For the past 30 years, Liberal and Labor federal and state governments have been cutting taxes.

Now, on a list of the 18 richest countries in the world, Australia puts less of its wealth into taxation and public services than almost anyone else. Only the US spends less.

Any solution requires politicians to put aside short-term political advantage, to surrender power and accept more responsibility — and they must be able to trust one another.

Tasmanian journalist Martyn Goddard is an independent public policy analyst.

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Remote lands gain renal dialysis chairsRenal dialysis will bepermanently funded on South Australia’s remote Aboriginallands following an announcement by federal Assistant Health Minister FionaNash. It is understood that $6.3 million will be provided forremote infrastructure to establish dialysis units. Thiswould include four dialysis chairs in South Australia’s remote community of Ernabella,to be operated by WesternDesert Dialysis, an organisation based in the Northern Territory. Although the funding was welcomed by South Australian Health Minister Jack Snelling, he learned of the announcement by media release and called for “more conversation” about co-ordinating existing services.

YOUR STATEWA, SA & NT

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Pediatricians’ autism caseload has tripled in just five yearsEXCLUSIVE

SEAN PARNELLHEALTH EDITOR

Australian pediatricians are seeingmore new patients with autism,according to a study that showsthe proportion of first consult-ations taken up by the diagnosishas risen from 5 per cent to 15 percent in just five years.

Associate professor HarrietHiscock, from the Murdoch Child-rens Research Institute, yesterdaysaid a follow-up to her previousstudy, which was published in theMedical Journal of Australia, foundautism was taking up more of thepediatric workload.

Dr Hiscock said across morethan 7000 consultations by 180pediatricians, the proportion offirst-time visits where an autismdiagnosis was involved had risen

from 5 per cent in 2008 to 15 percent in 2013.

“Is it because parents are moreaware and are going to their doctorseeking a referral to a pedia-trician?’’ she asked.

“Is it the pediatricians who aremore aware?

“Unfortunately we just don’thave that kind of data in Australiato know for sure.”

The follow-up study, which hasyet to be published, comes as the

national disability insurance

scheme considers how to bestmanage demand based on need.

The Australian revealed thisweek that the number of childrenwith autism had caught plannersby surprise — making up half of allparticipants in a South Australiantrial — and raised questions ofhow the $22 billion disabilityscheme would operate.

While about one in 100 Austra-lians are thought to have autism,

or up to 2 per cent of school-agedchildren, Dr Hiscock said that esti-mates were difficult as not every-one was screened and the teststhemselves were largely subjectiveand the rate of best practice notknown.

A landmark Swedish study,published in the British MedicalJournal earlier this year, examinedpeople with autism-like symptomsover a 10-year period.

It found no increase in num-

bers, only that the type of peoplewho went undiagnosed in the pastwere now being diagnosed.

Dr Hiscock, who has been apediatrician for 15 years, said theSwedish study aligned with whatshe had seen in her practice.

“More recently, we’re seeingchildren on the milder end of thespectrum coming in for a diagnosisbut we’re not seeing an increase onthe more severe end of the spec-trum,” she said.

“Children with a milder form of

autism who just have problemsforming relationships, things likethat, may have slipped under theradar before, whereas those withmore severe symptoms wouldhave been harder to miss.”

While the follow-up studypicked up children who requiredan early diagnosis to benefit from aMedicare program, Dr Hiscocksaid the perception that autismmay have been overdiagnosed for

financial reasons didn’t ring true.“Parents don’t, in my experience,come with a perfectly well child,”she said.

After the study was completed,new diagnostic procedures wereintroduced for a broader categoryof Autism Spectrum Disorder.

It includes three levels of func-tionality which the NDIS — whileencouraging early intervention inautism cases — will use to deter-mine those most in need.

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Finding ways to repair the damageROB HULLS

About a year ago I met a woman from Britain whose daughter had been killed in a car crash. The driver was the daughter’s partner and was subsequently imprisoned. All lives had been destroyed by the tragedy, and none had been helped by the conventional justice system.

What had helped had beenthe participation of the surviving parties in a restorative justice conference — a supervised meeting in which the mother could not only tell the driver how she felt but get answers to questions that the trial process had not allowed.

In turn, he could apologiseand convey his remorse.

In other words, this was a process that helped repair some of the harm that the tragedy had caused — one that is available on a widespread basis in Britain and elsewhere, but is largely untested here.

The recent application by theCentre for Innovative Justice to the Legal Services Board was about exploring ways to implement this process in Victoria.

All the CIJ’s work, in fact, isabout identifying ways to prevent crime or harm from escalating, as well as making the justice system more efficient and effective.

This is what four separate

commonwealth-funded projectshave been about.

One concerns ways in whichprivate legal services can be made more affordable, with findings later built on by the wider ranging Productivity Commission inquiry.

Subsequent projects have been about improving the justice system’s response to sexual offending, as well as intervening early in family violence, the latter being launched by Australian of the Year Rosie Batty.

These reports have gainedtraction right around Australia and are contributing to reform that will stem the damaging effects of crime and ultimately place less demand on our courts.

Equally, the work of the Mental Health Legal Centre — an independent community legal centre that offers training to students from a range of disciplines across RMIT — aims to prevent the spiral of harm that interaction with the justice system can have.

After all, rarely do legal issues present themselves in isolation.

It makes sense, then, to offera multidisciplinary response.

This is what the MHLC’s application to the Legal Services Board sought to facilitate — bringing in qualified health workers to help clients address their associated legal and health problems in a way that may see them less likely to be entrenched in the criminal justice system.

It was disappointing, then, that last week’s opinion piece in this section failed to recognise the value of early intervention

or even grapple with what these projects might mean — collapsing its argument instead in completely inaccurate suggestions that work like this may come at the expense of legal aid.

As a former attorney-generalI know the value of processes that good governments have the courage and integrity to follow.

As a former AG who maderecord increases to legal aid, I also know the importance of adequate resources.

Most relevantly, I know thevalue of reform that may ultimately reduce demand on our legal system and therefore free up more legal aid funding.

What a shame that this doesnot seem to be understood by commentators scrambling to see conspiracy where there is none.

Efforts to improve our justicesystem should go beyond politics. They’re a life-long imperative that all of us should share.

Rob Hulls is director of the Centre for Innovative Justice at RMIT University.

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THE HON SUSSAN LEY MP Minister for Health Minister for Sport

MEDIA RELEASE

30 July 2015

Ten stellar stories of health and medical

research Ten Australian research grants that led to ground-breaking medical discoveries and

Research Projects. The Minister for Health Sussan Ley said the stories were further evworld-leading standing in medical research.

It is exciting, pioneering work and this publication serves to highlight only a few of the many

being commercialised. They offer hope not only for better health for Australians, but new jobs and new industries for our country.

hard-working researchers, who are among the best in the world, and why we have

The stories include the development of an exciting new technique to train the immune system to identify and attack cancer cells, a new device that can detect and stop epileptic seizures as they happen and the development of a new naturally-occurring acid to suppress appetite. The spotlighted National Health and Medical Research Committee research was chosen for its innovativeness and potential to make a difference to the lives of Australians and people

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worldwide. The researchers are from universities and institutions across the country, reflecting the breadth of talent throughout the nation. Ten of the Best 2014 highlights: Professor Christine Feinle-Bisset, University of Adelaide ($744,646) This project developed an appetite-suppressing fatty acid that naturally occurs in the body into a non-invasive treatment for obesity. Ingestion of the fatty acid has been shown to reduce energy intake by 18% compared to placebo. The team is now collaborating with industry partners to develop their discoveries into new obesity treatments.

One of the main reasons why epilepsy can be so debilitating is that the onset of seizures is unpredictable. Current treatments are not effective for all people, and the side effects can be substantial. Professor Cook and his team developed a device that can detect seizures as they are happening and rapidly respond with a counter-stimulation to stop it in its tracks. With more tweaking, they hope to create a portable device that can be implanted in people with epilepsy and prevent them from having seizures. Associate Professor Phillip Darcy, University of Melbourne ($428,603)

exploited to go undetected by the human immune system. By modifying white blood cells, he and his team have found a way to train the immune system to identify and attack cancer cells, while leaving healthy cells unharmed. The approach is now being tested in clinical trials. Dr Noel Faux, The Florey Institute of Neuroscience and Mental Health and CSIRO ($292,639)

s colleagues identified two blood-This discovery takes us one step closer to being able to test for the disease using blood samples, and detecting it before clinical symptoms show. After validating the results, the teasetting. More information can be found at http://www.nhmrc.gov.au/guidelines-publications/r54 ENDS

James Murphy 0478 333 974

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