Some worrying parallels between Italy and Australia’s health system challenges, as outlined in this commentary in The Lancet:
There are lessons to be learned from the current COVID-19 pandemic. First, the Italian decentralisation and fragmentation of health services seems to have restricted timely interventions and effectiveness, and stronger national coordination should be in place. Second, health-care systems capacity and financing need to be more flexible to take into account exceptional emergencies. Third, in response to emergencies, solid partnerships between the private and public sector should be institutionalised. Finally, recruitment of human resources must be planned and financed with a long-term vision.
Here’s how it works in practice. On Wednesday March 18, the Australian government announced a $715 million rescue package for the nation’s stricken aviation sector. Qantas management, grateful for the assistance, immediately sacked 20,000 workers
— Read on meanjin.com.au/blog/bastard-pandemic-v-bastards/
Unfortunately, we are quick to respond when there is an urgent risk to our own safety or those we care about; and quick to forget when the crisis has passed and the only perceivable danger is to ‘others.’ Our tendency to distance ourselves from those we view as alien or intrinsically different from us puts everyone in danger. It is a fundamental misunderstanding of a risk that is always there and that can be mitigated only through effective contingency planning, requiring trust and a common denominator of commitment to our shared humanity.
— Read on blogs.bmj.com/bmj/2020/03/18/covid-19-the-painful-price-of-ignoring-health-inequities/
The Nuffield Council on Bioethics has published a new policy briefing setting out the key ethical considerations relevant to public health measures being introduced to manage the COVID-19 pandemic in the UK.
We know the rich look after their own, but these injustices are not acts of God or mere sad facts of life to be shrugged at with resignation. There will be many terrible lessons to learn from this pandemic: one is a lesson that should have been learned long ago, that inequality kills.
BACKGROUND AND OBJECTIVES: Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence.
METHODS: The Salud al Día intervention, an educational video and interactive text messages throughout the child’s first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used.
RESULTS: A total of 157 parent-child dyads were randomly assigned to Salud al Día (n = 79) or control groups (n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04–2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04).
CONCLUSIONS: This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities.
An interesting study that would be interesting to replicate in the Australian context with culturally and linguistically diverse populations.
Those who needed to use health services the most, were more likely to not see a GP or specialist when they felt they needed to. In 2016, after adjusting for the effects of other patient characteristics, patients with high health needs were 3.3 times as likely as those with low health needs to report that there was a time when they felt they needed to see a GP but did not go.
It is now my turn to ask my Australian colleagues how concerned should you be? Do we have the plans, institutional trust and social conventions to get us through? The consequences of any perceived mishandling of the COVID-19 response could be severe, especially coming so soon after the national bushfire emergency of last summer.