Controversies in Public Health Public Lecture Series 2009
Presented by the School of Public Health
A lecture series of six important controversies affecting us all.
- 20 May: Testing to monitor chronic disease: less is more?
- 1 July: Welcome back Nanny? Civil liberties versus the public good
- 5 August: The kindest cut of all: did we get it wrong on circumcision?
- 9 September: Is the genetic revolution overhyped?
- 12 October: Obesity: is the food industry more part of the problem than part of the solution?
View this lecture online at SlowTV
- 19 November: Whither primary health care in Australia?
Testing to monitor chronic disease: less is more?
Professor Les Irwig, Professor of Epidemiology
Screening and Test Evaluation Program, School of Public Health, University of Sydney
Monitoring patients with chronic conditions - for example, high blood pressure or high cholesterol – is a common reason for repeat visits to health practitioners; yet there is little evidence about what monitoring should be done and how often. This talk presents new research which suggests that visits to monitor changes in some chronic condition are too frequent and, besides wasting resources, may result in poorer health.
Welcome back Nanny? Civil liberties versus the public good
The Hon. Tony Abbott MP, Federal Member for Warringah, Shadow Minister for Families, Housing, Community Services and Indigenous Affairs
Professor Mike Daube, Professor of Health Policy, Curtin University of Technology and President, Public Health Association of Australia
The kindest cut of all: did we get it wrong on circumcision?
Dr Alex Wodak, Director of the Alcohol and Drug Service, St Vincent’s Hospital
Australia should encourage infant male circumcision. Male circumcision reduces the incidence of female to male HIV transmission by about two thirds. The proportion of new HIV infections in Australia accounted for by heterosexual transmission is steadily increasing while infections attributed to male to male sex is dropping. These trends are even more striking in North America and Western Europe. Australia should do this in 2009 to help control HIV in 2029. The case for infant male circumcision on other grounds is also very strong and getting stronger. The considerable benefits far exceed the small risks and costs. Infant male circumcision is a question that many young parents are confused about as education offered to parents is often extremist and not based on evidence.
Is the genetic revolution overhyped?
Professor Wayne Hall, NHMRC Australia Fellow and Professor of Public Health Policy, School of Population Health, University of Queensland
“Genomic medicine” was the phrase used by Francis Collins to describe what he predicted would be the transformation of medicine by the use of genomic knowledge to increase our ability to prevent and treat human disease. In 1999 he predicted that within 10 years “predictive genomic medicine” and personalised medicine or “pharmacogenomics” would be a routine part of medical practice. In the former healthy individuals would be screened to identify those who carried alleles that increased their susceptibility to common diseases, such as cancers and heart disease, and those at higher genetic risk would be advised to change their behaviour (e.g. exercise, eat a healthier diet) or be offered drugs or other medical treatment to reduce their chances of the developing these diseases. Patients would also be routinely screened by their physicians who would tailor their treatment to their genome to maximise its effectiveness and minimise adverse events. The predictions about predictive genomic medicine have yet to come to pass; personalised medicine is with is but primarily based on the genetics of cancer cells than on the genomes of their hosts, the patients. Genomic medicine illustrates the common trajectory for many new technologies: enthusiasts overstate their likely impact and foreshorten the time frame within which their benefits will be delivered; they are often unwittingly abetted by critics of new technologies whose fears about their misuse depend implicitly upon accepting many of the claims made by their proponents.
Professor Ron Trent, Professor of Medical Molecular Genetics, University of Sydney and Head, Department of Molecular & Clinical Genetics, Royal Prince Alfred Hospital
New genetic discoveries are regularly featured in the media. We are also being exposed to a new form of DNA knowledge called direct-to-consumer DNA testing. The latter promises benefits in many areas including relationship testing, life style DNA tests and DNA tests for important medical problems. Much is promised about the benefits of genetic knowledge but is it all hype or is there real potential for health benefits?
Obesity: is the food industry more part of the problem than part of the solution?
View this lecture online at SlowTV
Dr Rosemary Stanton OAM
In the 1960s, Australians could access 600-800 foods, many only available seasonally. The average supermarket now stocks around 30,000 food items, including almost 2,000 different snack foods. Our modern food supply is undoubtedly plentiful, microbiologically safe, cheap and convenient, but has choice gone mad? Do we really need to use fragile resources or make food available every hour of every day? No one suggests that the modern food supply is solely responsible for excess weight, but neither could anyone deny that it is a major factor in creating a society where the majority of adults and a quarter of our children are now overweight or obese. We have two major problems that need urgent attention: overconsumption of food and overuse of the world’s increasingly scarce energy and water resources. The food industry is involved in both. Can we leave this diverse industry to solve these problems or is it time for governments to step in?
Dr Derek Yach, Director - Global Health Policy, PepsiCo
Food companies have contributed to the development of a food system that now provides adequate and safe food to billions of people worldwide. Nutrition crises related to over and under nutrition however remain common. This presentation will outline the role food companies are increasingly playing in contributing solutions to both sets of problems. Emphasis will be given to the role of science, multistakeholder approaches and government incentives as major means of accelerating progress. The importance of tackling high levels of mutual distrust between the private and public sectors will be stressed and practical ways of working together without compromising any sides autonomy proposed.
Whither primary health care in Australia?
Brought to you by the Faculty of Nursing and Midwifery and the School of Public Health.
Professor Mary Chiarella, Faculty of Nursing and Midwifery, the University of Sydney.
The need to embrace primary health care is re-emerging both globally and nationally. At its most positive it is seen as a means of empowering communities and localising health care deliveries. At a more pragmatic level it is being touted as a potential solution to spiralling tertiary health costs and an unsustainable future health care system. But if we are to move to strengthen our primary health services, what changes do we need to make, not only as health professionals, but as citizens? This presentation will focus on three controversial issues: the need to redefine the health care workforce with the associated need to review the way we interact with the community and the need to acknowledge and address what has been described as “the oligopoly of health” if we are to provide a system that offers greater equity of access to primary health care services.