Two of The George Institute's experts will be speaking at a major public forum next month that will explore new ideas and innovations in global health.

Professor Bruce Neal, Senior Director of the Food Policy Division, and Dr Tracey Laba, Research Fellow in Health Economics, were specially invited to appear at the 2015 Global Ideas Forum in Melbourne, Australia. The Forum is an annual event aimed at bringing together people from different fields to present and collaborate on new solutions to global health problems. Being a public event, it is open not just to established experts but to all people interested in the issues.

Professor Neal was invited for his work on environmental determinants of high blood pressure and how changes in the food supply can be used to improve health. He said: "Events like the Global Ideas Forum are valuable opportunities for the public to engage with important issues like global health. Health affects everyone, so it's critical that the community has access to and can take part in these conversations."

Dr Laba was invited for her work on the translation of high-value, affordable healthcare interventions for chronic non-communicable diseases, with a particular focus on equity in the health system. She said: "It's always exciting to be invited to these events. Researchers can't do their jobs if they aren't in touch with what's happening out there in the community, so speaking at the Forum will benefit the speakers just as much as the audience."

The 2015 Global Ideas Forum will be held on 23 to 25 October at the Melbourne Convention and Exhibition Centre. Tickets, program and biographies of all the speakers are available at http://globalideas.org.au

Once named an 'emerging voice for global health', PhD student at The George Institute and University of Sydney Seye Abimbola has been appointed Editor-in-Chief of the upcoming BMJ Global Health.

BMJ Global Health will be an Open Access, online journal dedicated to publishing high-quality peer-reviewed content relevant to those involved in global health, such as policy makers, funders, researchers, clinicians and, crucially, frontline healthcare workers.

A medically qualified public health specialist, Seye spent seven years working to deliver health services and strengthen health systems in Nigeria. From 2009-10, he was a Rotary Foundation Ambassadorial Scholar at the University of Sydney where he worked on several projects at The George Institute. In 2007, he was awarded the British Medical Journal Clegg Scholarship and also won the joint Lancet and Global Forum for Health Research Essay Prize for “Young Voices in Research for Health.” In 2010, the Institute of Tropical Medicine in Belgium named him as an “Emerging Voice for Global Health”.

Seye was thrilled to receive the BMJ Global Health appointment. He said: "This role is a great honour and opportunity to expand the scope of global health discussion and debate, by including the voices and realities of people on the ground whose perspectives are often ignored, so that people who are able to help them have the right information to maximise the benefits of their investment and support.”

"I was first approached by BMJ a few months ago to ask if I would be interested in such a position and I leapt at the opportunity. What interests me about global health is that it puts a focus on addressing the needs of disadvantaged people all over the world, and having grown up in Nigeria, I have a personal connection to a lot of the issues."

For his PhD, Seye is studying the governance of primary health care in low- and middle-income countries. He is supported by international scholarships from the Sydney Medical School Foundation and the Rotary Foundation.

In his introductory editorial for BMJ Global Health, he writes: "One of the many things that the global health community is in agreement about is that we really do not know how to define global health – and this is not for want of attempts. My favourite characterisation so far is the description of global health as ‘a collection of problems rather than a discipline’; a collection of problems which ‘turn on the quest for equity’; equity in health indices within and between the national boundaries of high, middle or low-income countries." Read the full editorial.

Seye is currently assembling the journal's editorial team and the first volume is expected to be available in February 2016. The journal's editorial advisory board also includes Professor Anushka Patel, Chief Scientist at The George Institute.

Find out more about BMJ Global Health.

Executive Director of the George Institute for Global Health Australia, Professor Vlado Perkovic, has been appointed to a new panel that will help shape the future of Australia’s research sector.

The Health Translation Advisory Committee (HTAC) will advise the National Health and Medical Research Council (NHMRC), Australia’s premier body for administering medical research funding and issuing health and ethical guidelines.

The committee’s key aim is provide advice on how best to improve the translation of health and medical research into patient outcomes and health policy.

HTAC is one of five committees advising the NHMRC.

Professor Perkovic is joined on the panel by Professor Sharon Lewin, Professor Michael Nilsson, Professor Steve Webb, Professor Rosemary Calder, Professor Steve Wesselingh, Professor John Prins, Professor Sam Berkovic, Toby Hall and Associate Professor Clara Gaff.

The National Health and Medical Research Council has awarded two major grants to teams at The George Institute for Global Health that will significantly improve the lives of people with type 2 diabetes around the world, particularly in India, Sri Lanka, Bangladesh and China. 

Diabetes is the world’s fastest growing chronic disease. Over 347 million people have diabetes with more than 80% of these living in low-middle income countries. 

The NHMRC funded the grants as part of the Global Alliance for Chronic Diseases (GACD), which comprises 10 of the world’s leading health research funding organisations and aims to reduce the global burden of type 2 diabetes and other chronic diseases by coordinating research across the world.

The grants totalling $2.5 million were awarded to Professor Anushka Patel, Chief Scientist of The George Institute for Global Health, and Associate Professor David Peiris, Head of Primary Health Care Research. 

Professor Robyn Norton, Principal Director of The George Institute congratulated Professor Patel and Associate Professor Peiris on this significant funding success.  “Funding like the GACD grants enable Australia and the research sector to play a critical role in effectively targeting the biggest burdens of disease and injury in the region, and The George Institute is privileged to have a role in this effort.”    

Type 2 Diabetes affects 113.9 million people in China, the largest number of any country in the world, and its prevalence is expected to continue rising.

According to Professor Patel:  “These grants will make an enormous difference in treating, preventing and managing Type 2 Diabetes, especially in areas with limited resources and poor access to needed healthcare.”

Professor Patel and her team received a grant of $1,256,500 to adapt and implement a lifestyle modification program to prevent type 2 diabetes in women with gestational diabetes living in India, Sri Lanka and Bangladesh. The research will involve conducting a randomised controlled trial of this program to determine whether it can be applied and affordably brought to scale in South Asia.

“If the intervention is found to be effective and scalable, the development of Type 2 Diabetes could be delayed or prevented in more than a quarter of a million young South Asian women over a 5-year period,” said Professor Patel.

Associate Professor Peiris and Professor Zhang Puhong from The George Institute China received a grant of $1,385,858 to support the development and trial of a digital intervention program to help people with type 2 diabetes better manage their condition and prevent complications. The trial will involve communities in Beijing and rural villages in China and employ mobile phone technologies to help overcome issues of access to effective health care. 

This project is a flagship study that will be conducted at the China Center for mHealth Innovation at The George Institute China.

By Professor Stephen Jan, Head of the Health Economics Program at The George Institute

There is a strong perception that fee-for-service medicine in Australia is a sacred cow. Entrenched over many years by strong interests it is easy to see it as an immovable part of the Australian health care system. Since its inception more than 30 years ago, the existence of Medicare - which almost exclusively makes payments using a price schedule for individual services and procedures - has reinforced this notion.

However, in the past few years there has been a growing chorus of voices highlighting the need for reform - implicating fee-for service medicine in the problems of fragmented care particularly experienced by people with chronic conditions as well as in the long-term escalation in costs in the health system (1-3).  Invariably, the solution posited has been that of ‘blended’ funding models with a focus on capitation-based payments for chronic and complex conditions. These remunerate providers according to patients enrolled in their practice rather than by individual consultation. This is seen to enable better co-ordinated management of such patients than a system which pays simply by individual items of service.  

At a recently convened roundtable meeting in Sydney, the George Institute for Global Health brought together a diverse group of participants representing organisations and interests across the health sector to discuss options for reforming the predominantly fee-for-service system in Australia. At the roundtable meeting, there was strong reinforcement of the need to shift toward blended payment models including capitated funding for chronic disease.

However, where much of the progress in this policy debate was made is that the meeting identified key features of a reform process to address barriers to change.  This is important because  a re-design of the way in which we pay doctors and other health providers may well look good on paper but is doomed to go nowhere without a workable plan for implementation that has strong support from key stakeholders.

At the very least, broad based consultations such as the roundtable represent key elements of an implementation strategy needed to bring on board the various interests that surround this issue. However consultation alone is not enough.  As important as the task of designing reform is the need to formulate appropriate change management strategies.  At the roundtable, we came up with a strategy with the following features:

• Recognising potential winners and losers and measures to ensure individual providers are not significantly disadvantaged. 
• Significant investment in the change management process to cover in particular the infrastructure costs incurred by individual practices/providers in transitioning to new payment systems. 
• Identifying sources of investment to adequately support this process. The recent freezes in Medicare rebates for instance has potentially created some fiscal capacity to enable such investment.
• An initial focus on programs of reform targeting populations of greatest need such as individuals with chronic conditions and disability including those with mental illness, Aboriginal and Torres Strait Islander populations, socioeconomically disadvantaged groups and rural and remote communities. Detailed involvement by these groups in planning and implementation is required.
• Staged implementation of individual programs of reform, building on existing programs such as the Medicare practice incentive payments, accompanied from the outset by rigorous evaluation and routine collection of data. These are likely to entail expansion of existing IT capacities, including data linkage   
• In the longer term, the roll-out of such reforms across the wider community

A key ‘take-home message’ from the workshop echoing various commentators who have previously looked at this issue is that current payment models which reward activity over outcomes need to be fixed. To bring about these recommended changes, overcoming potential implementation barriers through investment in change management is an important, if under-recognised, aspect of reforming this sensitive area of public policy in Australia.

References

1. Australian Government, Productivity Commission. Efficiency in Health. Commonwealth of Australia, Canberra April 2015. 
2. Fitzgerald J. Options for Finance in Primary Care in Australia. Deeble Institute Health Policy Issues Brief No 11. 6 July 2015 
3. Sivey P. New funding models are a long-term alternative to Medicare co-payments. Croakey, 21 Jan 2015  

It’s a practice that’s growing in popularity as a way to deal with the stresses and noise of modern life, and improving your mental and even physical health. But what exactly is mindfulness and does it really help?

Rooted in Buddist meditation techniques, mindfulness is described as “the practice of purposely focusing your attention on the present moment – and accepting it without judgment”. By taking the mind off the rush of everyday tasks, proponents say it helps reduce stress, improve mental wellbeing, and increase overall happiness. Perhaps as a consequence of this, there may also be physical health benefits like lowering blood pressure and reducing the risk of cardiovascular disease and stroke.

Mindfulness has become so popular that it has celebrity supporters,  a trending hashtag on Twitter, and even a peer-reviewed academic journal.

So what is the science behind mindfulness?

Associate Professor Maree Hackett of The George Institute’s Neurological and Mental Health unit says: "Mindfulness is an appealing way to reduce or prevent symptoms of stress, anxiety, and depression, and to improve sleep, thinking, and quality of life. Research in clinical groups of people with a specific illness, and non-clinical groups of people without illness, has shown mindfulness can improve the mental health of school children and adults alike."

Part of the appeal of mindfulness is in its simplicity and ease. "While you can learn mindfulness from a trained instructor or therapist, this may be costly," says Professor Hackett. "It is possible to learn mindfulness from information published online, in books, or in group sessions including activities such as yoga or Tai Chi. By its very nature mindfulness is a quiet, internal activity that can be practised in almost any setting. It is also cheap, requiring no expensive clothing, no fancy gear or special diet. Research also indicates that there are few reported side effects."

Professor Hackett notes that "at the moment, we don't know exactly how mindfulness works. Logic tells us that if we focus solely on the present moment, we are unable to ‘go over’ our previous mistakes and concerns, which are ways of thinking that are associated with symptoms of depression. If we can focus solely on the present moment, we are also unable to worry about future events or challenges, which are ways of thinking that are associated with symptoms of anxiety. By reducing symptoms of depression and anxiety, it is logical that our sleep, thinking and quality of life will improve."

If mindfulness is consistent with general approaches in mental health, then its flow-on benefits to physical health could be realistic too. Professor Craig Anderson, Director of The George Institute’s Neurological and Mental Health, says: “There is good evidence that various forms of meditation can reduce heart rate and blood pressure, so regular habitual mindfulness has the potential for positive effects on cardiovascular health. This could therefore mean improved wellbeing and prevention of serious illnesses such as heart attack and stroke.”

While mindfulness could be a helpful health tip, the experts say more research needs to be done before it can be considered a standard treatment for people with mental health issues.

"As always, we need more information on how useful mindfulness is in improving mental health," Professor Hackett says. "Most research so far has compared people practising mindfulness to people going about their daily lives with no other intervention. Right now, we do not know if mindfulness is as good as or better than other known effective interventions for reducing or preventing symptoms of stress, anxiety, and depression, and improving sleep, thinking, and quality of life."