Showing posts with label report. Show all posts
Showing posts with label report. Show all posts

Thursday, 8 February 2024

Chair of ACTU Inquiry into Price Gouging and Unfair Practices does some plain talking about the relationship between 'intractable inflation' & the misuse of corporate power


Finally. A dark uncomfortable nexus that federal and state governments have tried to ignore, is exposed to the light of day.


INQUIRY INTO PRICE GOUGING AND UNFAIR

PRICING PRACTICES, Final report, February 2024


FOREWORD


I have welcomed the opportunity to chair this inquiry

for three reasons.


Firstly, there has been much discussion about

inflation and its causes including monetary and

fiscal policy, international factors, wages, supply

chain disruption and war. However, there is hardly

any discussion that looks at the actual prices

charged to consumers, the processes by which

they are set, the profit margins and their possible

contribution to inflation.


Secondly, there is also much discussion about

market power and its harms. But there is very little

discussion of any policies or actions that might be

taken to deal with the main harm: high prices.


Unreasonably high prices are not prohibited by

competition law. The ACCC, worthy though it is,

is restricted to looking at unlawful anti-competitive

agreements - for example, when competitors agree

on prices. If two firms, for example, coordinate

their prices without any illegal communication,

that behaviour is outside the scope of the Act. If

governments take actions which have the effect of

raising prices, that is also outside the scope of the

Australian Competition and Consumer Act.


In short, firms are free to charge as much as they

like. They can price gouge lawfully as long as there

is no unlawful collusion. This has given rise to a

policy gap – there is no set of government policies

about excessive prices. This report provides an

opportunity to examine whether this should be the

case at a time when Australians are so concerned

about the cost of living and the impact of prices on

their lives.


Thirdly, I am pleased to be engaged with the ACTU

in a prices inquiry because the concern of the Trade

Union movement is the impact of prices on the

costs of living of ordinary Australians. It has been

valuable to hear from ordinary people in this inquiry

rather than the ‘usual suspects’ that is businesses

and business organisations making economic

submissions about their prices.


Traditionally, the term price gouging has referred

to situations where sellers exploit a shortage of

essential goods and services to raise prices to

excessive levels. However, in the public mind

there is a wider meaning of the term: prices that

significantly exceed levels that would occur if there

was competition. Such prices substantially exceed

costs of supply and a reasonable level of profit.


What we have seen over recent years is a dramatic

increase in costs paid by consumers.


Some of the highest price increases occur in sectors which are characterised by having disproportionate market power, a level of power over their consumers, or a level of monopsony power over their supply chain and workforce.


At the same time as consumers experience significant increases in costs. Across food and grocery, energy, and financial services corporate profits are up.


Normally, inflation is a distributed experience, and the experience of those without market power being both squeezed on the supply and demand side is evidence of that. Some of Australia’s largest businesses, often supplying inelastic goods, are maintaining or even increasing margins in response to the global inflationary  episode.


This is a situation that warrants further investigation.


In particular, it warrants investigation of the state of competition in Australia and of the associated regulatory settings and to learn from the experience of ordinary people as to the impact of these matters.


In short, if there is a high price, it usually pays to investigate its causes – typically a lack of competition or a market shortcoming – and possible remedies.


During this inquiry for example it was observed that electric vehicle prices in New Zealand are considerably lower than in Australia. In probing the reasons, it was found that the difference is due to a little known unwarranted import restriction i Australia that does not apply in New Zealand. This explains why prices on electric vehicles are much higher than they should be.


The inquiry is very timely.


The world is facing an inflationary episode. The goal of central banks and governments across the world is to drive down the rate of inflation to a more sustainable level. While there has been an enormous amount of public discourse on the contribution of wages and employment to inflation, too little discussion has been on the role price setters have on broader inflation outcomes.


The Governor of the Reserve Bank of Australia, Michelle Bullock, has noted that the inflation Australia is experiencing now is ‘homegrown.’ This declaration makes the examination of price-setting behaviour by domestic firms more important, as we cannot simply say that prices have increased elsewhere and are simply being passed on. The exercise of market power and limits on competition in specific markets have exacerbated what began as a global problem.


This inquiry has conducted 5 public hearings, received over 750 public submissions and more than 20 detailed contributions from academics, experts, think tanks, unions, businesses, and thei representatives.


These diverse perspectives are vital for a comprehensive understanding of the issues. Th public hearings in Melbourne, Sydney, Adelaide, Cairns, and Canberra have allowed us to directly engage with the community and hear a wide range of experiences and insights. These voluntary contributions have deeply enriched the inquiry.


As I stated when I agreed to conduct this inquiry, this is a serious examination of prices and competition in Australia.


This report summarises the key policy issues and draws on the submissions to develop a set of recommendations  on price and competition policy which, if adopted, would substantially improve competition and decrease the price pressure faced by ordinary families.


Prof. Allan Fels AO

Chair


The full 80 page report can be read online and downloaded at:

https://pricegouginginquiry.actu.org.au/wp-content/uploads/2024/02InquiryIntoPriceGouging_Report_web.pdf



Excerpt from Pages 5-6 of the report:


BUSINESS PRICING PRACTICES


The report analyses a selection of exploitative business pricing practices that enable the extraction of extra dollars from consumers in a way that would not be possible in markets that are competitive, properly informed and that enable overcharged consumers to readily switch from one supplier to another.


The fact that there is a quite widespread lack of competition in Australian markets means that pricing practices that might be accepted in very competitive markets are unduly exploitative of consumers in that setting.


Loyalty taxes set initial prices low and then sharply increase them in subsequent years when consumers cannot easily detect, question, or renegotiate them and where the ‘transaction costs’ of changing to other competitors are high. Examples come from banking, insurance, energy, and other areas. Loyalty schemes are often low cost means of retaining and exploiting consumers by providing them with low value rewards of dubious benefit. These schemes are also often badly run.


Drip pricing where firms only advertise part of a product’s price and reveal other prices later as the customer goes through the buying process is spreading including in airlines, accommodation, entertainment, pre-paid phone charges, credit cards and others.


Excuse-flation where general inflation provides camouflage for businesses to raise prices without justification is also more prevalent in the current environment. As inflation starts to fall excessive inflationary expectations and future cost increases can be built into prices.


Confusion pricing involves confusing consumers with a myriad of complex price structures and plan making price comparisons difficult and dulling price competition. It occurs more and more in areas such as telecommunications, financial or maintenance services and other fields.


Asymmetric or ‘rockets and feathers’ pricing is of much concern in the current environment especially as inflation is starting to come down. When costs rise prices go up quickly ‘like a rocket’ but when costs fall prices fall slowly ‘like a feather falling to the ground’. This practice of delaying price falls when costs have fallen can be very profitable for businesses. A recent example concerned meat prices when prices paid to farmers for lamb fell but retail prices did not, at least until there was publicity including from this inquiry about the delay.


Algorithmic pricing is the practice of using algorithms to set prices automatically (but taking account of competitor responses) raises issues about whether this reduces price competition and is analogous to cartel pricing.


Price discrimination which in its simplest form involves charging different consumers different prices for the same product enables businesses to set prices according to how much each consumer is willing and able to pay. It takes many forms. It is enabled by a lack of competition. If there were competition charging high prices to customers who wish to or have to pay higher prices would not be possible because competitors would bring those prices down to normal levels. This report identifies a number of examples ranging from banks (better rates from customers likely to leave them), electricity (better prices for business customers than for consumers even allowing for lower costs of supply) and medical specialists which offer vastly different prices for near identical services. Of particular concern is the rise of much greater use of price discrimination enabled by the rise of digital platforms, new technology, detailed customer data and sophisticated profit maximising pricing methodologies.


These practices all result from an economy which is insufficiently competitive and gives room for businesses to engage in exploitative pricing practices.


There is a case for a much more active public policy for investigating and analysing practices that operate at unwarranted cost to customers.



Friday, 15 December 2023

ACOSS and UNSW Sydney survey shows popular support for the Federal Government to intervene to directly tackle poverty and the wealth gap that is threatening Australia’s social and economic fabric

 

This snapshot makes an interesting read. However, participants' responses to questions asked may have elicited attitudes that do not extend beyond the period in which the actual survey was conducted.


"2,000 people from around Australia aged 18 years and above completed the 2023 survey.....

Participants were recruited via a market research panel coordinated by Qualtrics which operates a panel of potential participants who have signed up to be contacted for research participation opportunities."

[Australian Council of Social Service and UNSW Sydney (2023), Treloar C. et al, Community attitudes towards poverty and inequality, 2023: Snapshot report, p.12]



Australian Council of Social Service (ACOSS), media release,13 December 2023:


Most people support lifting incomes for those with the least


Three-quarters of people in Australia support an income boost for people with the least while less than a quarter think it’s possible to live on the current JobSeeker rate, new research by ACOSS and UNSW Sydney shows.


The latest report from the Poverty and Inequality partnership, Community attitudes towards poverty and inequality 2023: Snapshot report, also shows 74% think the gap between wealthy people and those living in poverty is too large and should be reduced.


The survey of 2,000 adults in Australia shows most people (62%) think government policies have contributed to poverty, while 75% think it can be solved with the right systems and policies.


  • More than two-thirds (69%) think poverty is a big problem in Australia

  • Just 23% agreed they could live on the current JobSeeker rate

  • Another 58% said they would not be able to live on that amount, while 19% were unsure

  • Three-quarters (76%) agree the incomes of people earning the least are too low and should be increased

  • Most people think no one deserves to live in poverty, and that unemployment payments should be enough so people do not have to skip meals (86%) and can afford to see a doctor (84%)


ACOSS Acting CEO Edwina MacDonald said: “This survey shows popular support for the Federal Government to intervene to directly tackle poverty and the wealth gap that is threatening Australia’s social and economic fabric.


Most people know it is simply not possible to live on the punishingly low rate of JobSeeker that traps people further in poverty. Instead, the majority of people think the government has a responsibility to look after those people struggling the most.


We know from the pandemic that the key to solving poverty is lifting income support payments. The government has no excuse not to bring them up to at least the Age Pension rate of $78 a day in the face of such strong public support.”


Scientia Professor Carla Treloar of the Social Policy Research Centre at UNSW Sydney & lead author of the report said: “Community attitudes can wield significant influence on social policy.


This research underscores the public’s awareness of policy impacts. The fact that the majority of people in Australia believe that government policies both contribute to and can solve poverty and inequality demands immediate policy reform. It’s time to address unjust policies failing those in need.”


UNSW Sydney Vice-Chancellor and President Professor Attila Brungs said: “The Poverty and Inequality Partnership between ACOSS and UNSW exemplifies our University’s vision for societal impact and the power of research to influence positive change.


The insights and robust evidence that the Poverty and Inequality Partnership provides are vitally important for understanding how we can do better for some of the most disadvantaged groups of people in our society.


Millions of Australians live with poverty and inequality. Highlighting community attitudes can help inform shifts in social policies that lead to better outcomes for us all.”


Mission Australia CEO Sharon Callister said: “This report makes clear that Australians want poverty eliminated in Australia, and that most people believe current levels of income support aren’t enough to survive and make ends meet.


For people who are receiving income support and access Mission Australia’s services, the current rate of JobSeeker is profoundly inadequate and simply does not help get people back into work. It often traps them and their families in survival mode and pushes them into rental stress and homelessness.


We hope that the government will start to take community expectations seriously and implement real solutions like adequate income support to end poverty and poverty-induced homelessness in Australia.”


Read the report at: https://bit.ly/communityattitudes2023



Wednesday, 15 February 2023

NSW State of Play 2023: governments being 'city-centric' has consequences that follow remote & outer regional populations to their graves

 

The Australia Institute, media release, 14 February 2023:


New analysis reveals residents born in Far West NSW are suffering substantially worse health outcomes than residents in Sydney.


People in Far West NSW are dying earlier than they should, from avoidable causes, and while suicide rates have steadied in Sydney, they are on the rise in the most remote parts of the state.


The report warns of serious and growing inequality in health outcomes between city and country residents and recommends immediate investment in the sector.


Key points:


  • Life expectancy: People born in the Far West have a life expectancy 5.7 years less than those in Sydney, with the divide worsening


  • Premature death: Residents in Far Western NSW are 2x more likely to die prematurely than those in Sydney


  • Avoidable death: ‘Potentially avoidable deaths’ are 2.5x more likely in the Far West than in Sydney


  • Suicide: Residents in the NSW Far West are 2x as likely to commit suicide than those in Sydney, with a clear upwards trend in suicide rates


Far West NSW is in serious need of medical attention. Where you live shouldn’t dictate how long you’ll live, but unfortunately in NSW it does” said Kate McBride, Researcher at The Australia Institute.


Those in the Far West have significantly poorer health outcomes, inferior access to health services and face substantial financial challenges to access services.


Life expectancy, premature deaths, and ‘potentially avoidable’ deaths are key statistical indicators of whether our health system is working. It is clear from the analysis in this report, sirens should be sounding from the Far West of the state.


There’s a compelling case for significant investment across the continuum of care, from disease prevention to rehabilitation and ongoing care, in regional NSW.


The first release in a series, this report reflects a wider national trend: That the health system is failing those living in regional and remote Australia” said Kate McBride.


~~~~~~~~~~~~~~~~~~~~~~


RELATED RESEARCH

Kate McBride, The Unlucky Country: Life expectancy and health in regional and remote Australia. Part 1: NSW, February 2023.

FULL REPORT

~~~~~~~~~~~~~~~~~~~~~~


Excerpts from the McBride report:


Australia has the world’s third highest life expectancy at 84.3 years. However, this national average masks the fact that the ‘lucky country’ has some rather less lucky residents. In every state and territory, those in regional and remote areas have life expectancies several years lower than in the city.


New South Wales (NSW) is a stark example of this divide. Life expectancy in Far West NSW is 79.1 years compared to 84.5 years in Sydney. This more than five-year gap has grown from relative parity at the turn of the millennium to the current gap. Today, a person in far west NSW is more than twice as likely to die prematurely (under 75) than someone in Sydney.


While there are many possible reasons for this discrepancy, overall, people die of the same causes in urban and remote parts of NSW; a comparison of the top causes of death in each area reveals that the top 10 are almost identical. However, regional and remote people are dying younger and from preventable causes at much higher rates than those in Sydney. Deaths considered ‘potentially avoidable’ are more than two and a half times as common in the far west than in the state’s capital.


It has been known for years that there is a suicide issue in regional Australia. Suicide rates in far west NSW—already more than twice as high than those in Sydney—are continuing to rise, while those in urban areas remain steady. But while suicide is a significant problem, it is only the tenth leading cause of death in the region. Suicide tends to take people at a younger age than other causes and as a result can disproportionally skew life expectancy, having said this there are other factors likely at play.


In 2022, a NSW Parliamentary Inquiry into health outcomes and access to services in rural, regional, and remote NSW found that people outside urban areas had significantly poorer health outcomes, inferior access to health services, and faced substantial financial challenges to access services.


This divide between life expectancy in the cities and in the country is a problem that extends beyond far western NSW. The city/country divide exists across Australia, and it is growing. Inequity between Australians living in capitals and remote areas is a significant problem that demands government intervention, particularly concerning overwhelmed and under resourced health systems.”








































NOTE: I draw to the attention of "North Coast Voices" readers, living in what is the Australian Bureau of Statistics' Coffs Harbour-Grafton Level 4 Statistical Area, the fact that the combined populations of Clarence Valley and Coffs Harbour City have a projected life expectancy at birth which is 3.9 years lower than that of the population of the Greater Sydney metropolitan area. Only the projected life expectancy at birth for the Far West and Orana region has a worse comparative figure.

























The only differences are dehydration and suicide (more below) in the Far West being replaced by heart failure and breast cancer in Greater Sydney. The similarity in causes of death suggests that the factors driving lower life expectancy in the far west are not due to different physical conditions or different lifestyles, but to how causes of death are prevented and managed. [my yellow highlighting]





















Sadly, what the preceding paragraph is politely hinting at is that there is a culture within governments which tolerates and, perhaps even relies upon, inequality of access to health care along with an acceptance of delivery of poorer quality health care to those living in remote areas of New South Wales, as one of the tools which allows the provision of a much higher quality of health care to those living in metropolitan centres and inner regional areas on the fringes of major cities. 


That is where the bulk of the state's electorates and voter numbers are concentrated and, it will come as no surprise that ahead of the March 2023 state election little electoral growth was expected in the western half of New South Wales [Report of the Electoral Districts Redistribution Panel on the draft determination of the names and boundaries of electoral districts of New South Wales, 9 Nov 2020].


Tuesday, 22 June 2021

A NSW Legislative Council "Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales" has been underway since August 2020, but curiously its terms of reference do not mention gender bias

 

Gender bias takes many forms and the media perhaps more frequently reports on gendered income bias. Such as the longstanding pay gap between the average weekly full-time earnings of males and females, which predominately favours men. Currently Australia's national gender pay gap stands at 13.4 per cent. Or the end of working life disparity between the superannuation outcomes of men and women.


However, it has been apparent for many years now that the health professions, hospitals and governments carry a general societal bias against women into the healthcare sector and that bias barely rates a mention when governments establish terms of reference for parliamentary inquiries into aspects of health service delivery and outcomes.


The NSW Legislative Council Portfolio Committee No.2 - Health’s Terms of Reference for its current Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales is no exception to this lack of consideration of gender bias.


A bias which has the potential to disproportionally affect the health outcomes for females from low income families, those women who identify as Aboriginal or Torres Strait Islander and women living in regional, rural and remote areas.


So these articles below are a timely reminder that the existence of gender bias is indicated in Australia and also of the global scale of such bias.



Australian Institute of Health and Welfare“Cardiovascular disease in women”, report excerpt, July 2019:


1.1 A focus on women


Much of our knowledge of heart disease is based on research conducted primarily among men (McDonnell et al. 2018), which shapes our view of how cardiovascular disease impacts the Australian population. However, it is known that there are important differences between women and men in risk factors for CVD, in symptoms, and in treatment and outcomes.


Need for greater awareness


Many women are unaware of the risk that CVD presents to their health. Their knowledge about heart attack symptoms and CVD as a cause of death is less than optimal—in 2018, for example, only one-fifth (21%) of Australian women correctly perceived heart-related causes to be the leading cause of death (Bairey Merz et al. 2017; Flink et al. 2013; Heart Foundation 2018; Hoare et al. 2017).


2 Cardiovascular disease in women


Women presenting with CVD often have different symptoms than men. These symptoms may not be recognised as CVD, thus increasing the likelihood of a missed diagnosis.

Although men with heart attack typically describe chest pain or discomfort, women are more likely to have non-chest pain symptoms such as shortness of breath, weakness, fatigue and indigestion (Mehta et al. 2016; Wenger 2013), and frequently with worse consequences (Maas et al. 2011; McDonnell et al. 2018; Pagidipati & Peterson 2016).


Women generally present with CVD later in life than do men. Older women are also more likely to have other health conditions, making their CVD more complex to diagnose and treat, which in turn can lead to worse health outcomes (Bennett et al. 2017; Saeed et al. 2017).


Physicians are more likely to underestimate CVD risk in women, and this can influence their diagnosis and treatment (Wenger 2013). Research finds that younger women aged under 55 with acute coronary syndrome are more likely to be misdiagnosed and discharged from emergency departments than men (Bairey Merz et al. 2017; Saw et al. 2014).


Differences in treatment


A number of studies have identified disparities between women and men in CVD treatment and in outcomes. Women with acute coronary syndrome tend to receive fewer medications, are less likely to have their condition treated aggressively and have fewer invasive interventions (Kuhn et al. 2014, 2015, 2017; Pagidipati & Peterson 2016; Saeed et al. 2017).


Similarly, women with ST segment elevation myocardial infarction (STEMI: a type of heart attack) are less likely to receive invasive management, revascularisation or preventive medication at discharge (Khan et al. 2018). Women with stroke are more likely to have a delay in care than men, and are less likely to receive aspirin, statins or thrombolytics (Raeisi-Giglou et al. 2017).


Healthier women


An increased recognition of gender differences in risk factors, presentation, treatment and outcomes will contribute to improving women’s cardiovascular health in Australia.


The Australian Government, the Heart Foundation, the Stroke Foundation and other key stakeholders contribute by building awareness among the public and health-care providers about the risks of CVD to women’s health.


Chronic conditions, including CVD, and preventative health are a priority for action in the National Women’s Health Strategy 2020–2030 (Department of Health 2018). The development and delivery of a national campaign to promote awareness of the different risks for and symptoms of CVD in women is a key action in the current strategy. The ongoing monitoring of the impact of CVD is an important component of policy and programme initiatives that focus on women’s health.



Australian Institute of Health and Welfare, Cardiovascular disease in Australian women — a snapshot of national statistics, June 2019:




Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.” [THE LANCET COMMISSIONS, The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030, 16 May 2021]

 

The Lancet, 19 June 2021:


Ana Olga Mocumbi (May 2021) “Women's cardiovascular health: shifting towards equity and justice”


Cardiovascular disease in women is understudied, under-recognised, underdiagnosed, and undertreated globally, despite being the leading cause of death in women worldwide, as highlighted by a new Lancet Commission.1 Several misperceptions contribute to this neglect, notably, the persistent view that cardiovascular disease primarily affects men or only women in high-income countries and results from poor lifestyle choices. The Lancet women and cardiovascular disease Commission1 identifies disparities in prevalence and outcomes of cardiovascular disease in women worldwide, delineates the substantial impact of socioeconomic deprivation in determining these differences, and proposes strategies to address these inequities, increase sex-related research, and support integration of care and strengthening of health systems.1


From 1990 to 2019 there have been large declines in cardiovascular disease age-standardised rates of death, disability-adjusted life-years, and years of life lost.2 There have been declines in age-standardised prevalence of coronary heart disease and stroke mortality rates in men and women in most parts of the world, with greater age-specific reductions in coronary heart disease in men than in women.3


Between 2010 and 2019, the age-standardised cardiovascular disease death rate increased or stagnated in many other parts of the world, including eastern Europe and countries in central, south, and east Asia.2 In a Canadian setting, the 30-day acute myocardial infarction mortality rates declined similarly for women and men from 2000 to 2009, but women younger than 55 years had an excess mortality risk compared with men of the same age.4 Under-representation of young people in clinical studies on cardiovascular disease, as well as worse risk profile due to comorbidities, might contribute to these slow improvements. Importantly, because of women's longer life expectancy, overall deaths from cardiovascular disease are higher in women than in men, and this excess number of cardiovascular disease deaths in women is likely to increase with population ageing. Moreover, the success in declining age-standardised cardiovascular disease mortality over the past decades has been limited to countries with a high Socio-demographic Index (SDI); some countries with a low SDI had the highest cardiovascular disease mortality rate shift from men to women.2


View related content for this article


Poverty continues to affect a considerable proportion of the world's population, determining unique patterns of non-communicable diseases, including cardiovascular disease in young women.5 In countries with a low SDI, where premature cardiovascular disease mortality is largely driven by poverty, poor access to care, and underuse of interventions of proven efficacy, women face the coexistence of an increased prevalence of cardiovascular disease, a rise in metabolic risk factors, and endemic infectious diseases such as tuberculosis, HIV/AIDS, and schistosomiasis. Furthermore, specific risk factors and conditions affect women in countries with a low SDI. Chronic exposure to biomass fuel is common in rural Africa and Asia and contributes to the burden of acute coronary events and stroke,6 affecting predominantly women; this exposure could partly explain the high occurrence of and sex differences in isolated right heart failure in non-smokers in these places.6, 7 Similarly, in poor countries women younger than 40 years are increasingly affected by neglected or poverty-related conditions, such as rheumatic heart disease and endomyocardial fibrosis.8,9 Moreover, maternal mortality remains unacceptably high. About 295 000 women died during and after pregnancy and childbirth in 2017.10 94% of these deaths occurred in low-resource settings, where the maternal mortality ratio was 462 per 100 000 livebirths versus 11 per 100 000 livebirths in high-income countries.10 Since cardiovascular disease is the leading non-obstetric cause of maternal mortality worldwide,11 one should consider the role of disparity in fertility rates, incidence of peripartum cardiomyopathy, and pre-existing uncontrolled arterial hypertension8 as potential determinants of maternal mortality. Indeed, there are a considerable number of maternal deaths due to cardiovascular disease in low-income and middle-income countries.12 Unfortunately, even in the USA, where the maternal mortality ratio was 17·4 maternal deaths per 100 000 livebirths in 2018, the maternal mortality ratio was more than double among non-Hispanic Black women (37·1 per 100 000 livebirths), with more than half of these deaths and near deaths being preventable, and cardiovascular disease being the leading cause.13 Inadequate access to quality and affordable health care along with long-standing health disparities plays a role in this disparity; additionally, social determinants of health can increase the risk of gestational diabetes, peripartum cardiomyopathy, caesarean deliveries, and future cardiovascular disease in neglected communities.


To address the gaps highlighted by this Commission, current knowledge must be used to achieve health equity so that no one is disadvantaged from attaining their full health potential because of their social position or other socially determined circumstance. Reduction of disparities in clinical outcomes requires the prioritisation of high-impact solutions in under-resourced areas, involving tailored strategies for decentralised and integrated care, and support from global and regional partners to improve the availability of interventions for cardiovascular disease prevention and management. Front-line health workers with shared competences for cardio–obstetric care, digital health, and portable ultrasound should be used to deliver decentralised care, improve referral systems, and support surveillance of sex-related outcomes. Digital health provides opportunities to enhance the quality, efficiency, and safety of primary health care, as well as help address racial and ethnic disparities,14 but insufficient digital health competencies among front-line health workers are among the factors that hamper the adoption of digital tools and technologies.15 Finally, as emphasised in the Commission, peer-to-peer supporters and educators in local communities should be used to empower women in improving their ability to access, understand, appraise, and apply health information to promote good cardiovascular health.


In the midst of the COVID-19 pandemic, values of human dignity, solidarity, altruism, and social justice should guide our communities to ensure equitable share of wealth and leveraging of efforts towards the reduction of cardiovascular disease burden in women worldwide. The Commission's recommendations on additional funding for women's cardiovascular health programmes, prioritisation of integrated care programmes, including combined cardiac and obstetric care, and strengthening of the health systems accords with efforts to bridge the gap for the world's worst off.5 Such a shift in women's cardiovascular care would be a major step towards equity, social justice, and sustainable development.


I declare no competing interests.


References


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The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.

Lancet. 2021; (published online May 16.)

https://doi.org/10.1016/S0140-6736(21)00684-X


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Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.

J Am Coll Cardiol. 2017; 70: 1-25


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Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010.

BMJ Global Health. 2017; 2e000298


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Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years.

J Womens Health. 2014; 23: 10-17


5.Bukhman G Mocumbi AO Atun R et al.

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.

Lancet. 2020; 396: 991-1044


6.Bassig BA Dean Hosgood H Shu XO et al.

Ischaemic heart disease and stroke mortality by specific coal type among non-smoking women with substantial indoor air pollution exposure in China.

Int J Epidemiol. 2020; 49: 56-68


7.Stewart S Mocumbi AO Carrington MJ Pretorius S Burton R Sliwa K

A not-so-rare form of heart failure in urban black Africans: pathways to right heart failure in the Heart of Soweto Study cohort.

Eur J Heart Fail. 2011; 13: 1070-1077


8.Mocumbi AO Sliwa K

Women's cardiovascular health in Africa.

Heart. 2012; 98: 450-455


9.ZĂĽhlke L Engel ME Karthikeyan G et al.

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).

Eur Heart J. 2015; 36 (122a): 1115


10.WHO

Maternal mortality, key facts.

https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

Date: 2019


11.Kassebaum NJ Barber RM Bhutta ZA et al.

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.

Lancet. 2016; 388: 1775-1812


12.Heemelaar S Petrus A Knight M van den Akker T

Maternal mortality due to cardiac disease in low- and middle-income countries.

Trop Med Int Health. 2020; 25: 673-686


13.Bond RM Gaither K Nasser SA et al.

Working agenda for Black mothers: a position paper from the Association of Black Cardiologists on solutions to Improving Black maternal health.

Circ Cardiovasc Qual Outcomes. 2021; 14e007643


14.LĂłpez L Green AR Tan-McGrory A et al.

Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.

Jt Comm J Qual Patient Saf. 2011; 37: 437-445


15.Jimenez G Spinazze P Matchar D et al.

Digital health competencies for primary healthcare professionals: a scoping review.

Int J Med Inform. 2020; 143104260

https://doi.org/10.1016/S0140-6736(21)01017-5

Copyright

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Wednesday, 3 March 2021

Royal Commission finds "the extent of substandard care in Australia’s aged care system is deeply concerning and unacceptable by any measure"

 

We consider that the extent of substandard care in Australia’s aged care system is deeply concerning and unacceptable by any measure. We also consider that it is very difficult to measure precisely the extent of substandard care, and that this must change. Australians have a right to know how their aged care system is performing; their government has a responsibility to design and operate a system that tells them; and aged care providers have a responsibility to monitor, improve and be transparent about the care they provide. The extent of substandard care in Australia’s aged care system reflects both poor quality on the part of some aged care providers and fundamental systemic flaws with the way the Australian aged care system is designed and governed. People receiving aged care deserve better. The Australian community is entitled to expect better.”  [Royal Commission into Aged Care Quality and Safety, A Summary of the Final Report, p.73]


Given the three volume interim report of the Royal Commission into Aged Care Quality and Safety was titled “Neglect”, the publication of the Final Report was not going to contain good news concerning the piecemeal approach taken by the federal government to what is now a predominately privatised health care sector.


Privatisation of the aged care sector has literally made millionaires of many founders and directors of residential aged care businesses.


According to a May 2019 Tax Justice Network – Australia and

Centre for International Corporate Tax Accountability & Research (CICTAR) reportTax Justice Network – Australia and Centre for International Corporate Tax Accountability & Research (CICTAR) report, Australia’s six largest family-owned aged care companies make a up a significant and growing portion of the aged care sector and they received over $711 million in annual federal funding to operate 130 facilities, with almost 12,000 beds. This was in addition to fees received from residents. While several of the largest family-owned aged care companies, owned by some of Australia’s richest families, have complex corporate structures, intertwined with trusts, that appear specifically designed to avoid tax.


The aged care system offers care under three main types of government subsidized service: Commonwealth Home Support Programme, Home Care Packages, permanent residential care and short-term respite care.


None of these service types have met the goals assigned to them under government policy and, the distressing examples of abuse and neglect which led to the creation of this Royal Commission have not disappeared as media reports during 2020 revealed [source source source source].


Regardless of whether a residential aged care business was privately-owned, corporate-owned or a not-for profit belonging to a religious institution, too many times in 2020 their individual residential aged care facilities were cited for a failure in one of all 8 of the Aged Care Quality Standards including those of concerning “consumer dignity and choice” and “personal care and clinical care”.


The Royal Commission’s Final Report Executive Summary tells us that:


The Aged Care Financing Authority reported that in 2018–19, there were over 3000 providers of aged care services. This included 873 residential aged care providers, 928 home care providers (as at 30 June 2019) and 1458 Commonwealth Home Support Programme providers.


However, a worryingly small percentage of the workforce employed by these 3,000 aged care services hold suitable qualifications. Out of the est. 366,000 paid workers only est. 15% had nursing qualifications or were accredited enrolled nurses in 2016.


The Final Report Executive Summary also tells us that:


In 2019–20, the Australian Government’s expenditure on aged care programs administered by the Department of Health was $21.2 billion. Older people are required to contribute to the costs of their care and accommodation if they can afford to do so through co-payments and means tested fees. People receiving aged care services contributed $5.6 billion to the cost of their aged care in 2018–19.


The Parliamentary Budget Office has projected that, over the next decade, Australian Government spending on aged care will increase by 4.0% a year, after correcting for inflation. This increase will mean that aged care spending will be growing significantly faster than the rate of all Australian Government spending (2.7%). By 2030–31, aged care will account for 5.0% of all Australian Government expenditure compared to 4.2% in 2018–19.


With the current Morrison Government having displayed a penchant for whittling down funding and services for the poor and vulnerable in our society, one would be foolish to suppose that Prime Minister & Liberal MP for Cook Scott Morrison would do no more than throw a financial sop at deficiencies in the aged care system.


On the heels of the Final Report, Morrison immediately committed to spend a paltry$452m on the sector and announced a further $189.9m in “temporary financial support” without a requirement that residential aged care providers spend it on increasing staff numbers and/or providing more qualified staffneeds identifed within a number of the 148 recommendations in the Final Report.


The full final report of the Royal Commission into Aged Care Quality and Safety is at https://agedcare.royalcommission.gov.au/publications/final-report


The Final Report Executive Summary opens at https://agedcare.royalcommission.gov.au/publications/final-report-executive-summary


The preceding Interim Report is found at

https://agedcare.royalcommission.gov.au/publications/interim-report