Perspectives

Lung cancer remains Australia's leading cause of cancer death, with a disproportionately high burden on Aboriginal and Torres Strait Islander peoples. The recent launch of the National Lung Cancer Screening Program (NLCSP) offers an exciting and critical opportunity to improve outcomes. However, the program's full potential may not be met due to substantial systemic shortfalls. Key challenges include inadequate access to multidisciplinary workforce, limited access to personalised medicine and a lack of a national clinical quality registry. To maximise the NLCSP's impact, strategic investment is urgently needed to strengthen clinical infrastructure, enhance research and ensure equitable access to care.

Fraser J. Brims

Natalie Taylor, Zhicheng Li, Cathelijne van Kemenade, Jackie Curtis, Patrick Bolton

Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim to improve sustainability and transparency within healthcare systems, they often conflict with fundamental aspects of medical professionalism and patient-centred care. This perspective explores how managerialism may negatively affect the medical profession, focussing on its impact on clinician autonomy, the changing nature of medical work, professional identity and collegial relationships within hospital settings. Key challenges faced by doctors include diminishing control over patient care, growing administrative burden, increasing burn-out, erosion of professional values and identity, and fragmentation of collegiality. To address these issues, this perspective advocates for institutional change such as hybrid governance models that integrate professional and managerial expertise to ensure managerial goals remain aligned with clinical realities. Professional bodies and institutions should empower doctors with managerial and leadership competencies to influence organisational change, reconcile clinical and managerial priorities, and uphold professional values and quality patient care within the evolving healthcare landscape. Effective reform requires the considerate integration of managerial systems into healthcare to strengthen, rather than undermine, the professional foundations and ethical values that give medicine its integrity and meaning.

Evelyn He, Behnam Shaygi, Anousha Yazdabadi, Christen D. Barras, Paul M. Parizel, Hamed Asadi

Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the aim of equivalence to community standards, will be an important step in reducing health inequalities for some of Australia's most marginalised people.

Thileepan Naren, Damien Linnane, Dallas Widdicombe, Jocelyn Chan, Stuart Kinner

There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article shows how specialty selection is likely driving many rural interested graduates away from rural pathways, perhaps never to return post-fellowship. The Australian Government has strongly invested in rural training, with greatly increased opportunities for end-to-end pathways and raised awareness of social accountability of training programs. However, specialty training pathways have been slow to change the selection criteria, which should align with supporting workforce diversity and distribution into rural areas. We highlight potentially untapped opportunities to directly address workforce distribution that require negligible financial costs to change criteria and processes.

Matthew R. McGrail, Jenny May AM, Katherine Logan

The scale and complexity of diabetes in rural and remote Indigenous communities is an urgent health issue. Progress in improving diabetes care, closing entrenched gaps and, ultimately, improving the health of Indigenous people and communities nationwide can be achieved with concerted, multidisciplinary, culturally informed evidence-based efforts

Natalie Nanayakkara · Sharon Atkinson‐Briggs · Alicia J Jenkins · Neale D Cohen

People experiencing homelessness should be prioritised in national cancer plans and policies to promote equitable access to cancer care and the health care system more broadly

Amy Stearn · Jennifer A Baldock · Julia N Morris · Joanne Flavel · Fran Baum

The continued rise in specialists’ fees and out-of-pocket cost is causing significant financial and access challenges for patients

Brendan Murphy

Journalism and independent media are important for supporting public health through contributing to a healthy information environment, fostering dialogue and respect for rights, making governments more transparent and accountable, and societies more informed, inclusive and sustainable

Bronwyn Fredericks · Neha Lalchandani · Melissa A Sweet · Alex Cramb · Carmel Williams

We stand at the beginning of the next bioscience revolution in asthma

Anthony Flynn · Wendy Edmondson · Alan James · Caroline Lodge · Vanessa M McDonald · Christine R Jenkins · John Blakey · Gary P Anderson

Cures for asthma will require a sustained, decade-long program of discovery science partnered with best clinical expertise

Gary P Anderson · Anthony Flynn · Phil G Bardin · John D Blakey · Shyamali C Dharmage · Paul Foster · Peter G Gibson · Adam Jaffe · Alan James · Christine R Jenkins · Sundram Sivamalai · Peter D Sly · Guy B Marks · Vanessa M McDonald · Judy Wetttenhall

Cure can be defined as the extended absence of disease activity without treatment and minimal likelihood of relapse

Dennis Thomas · Vanessa M McDonald · Peter G Gibson · Richard Y Kim

A combine-to-cure approach is essential, simultaneously preventing harmful exposures and directed at the underlying biological mechanisms

Denby J Evans · Peter D Sly · Paul Foster · Chantal Donovan

Elucidating the molecular architecture of disease and focusing on earlier, more malleable biological features will lead to cures

Aowen Zhuang · Dennis Thomas · Caroline Lodge · Jane E Bourke · John W Upham · Vanessa M McDonald · Peter AB Wark · Gary P Anderson

Research into the implementation of the guidelines on concussion and persisting post-concussion in the context of the differing Australian and Aotearoa New Zealand geographical areas will be important to ensure adequate uptake

Karen M Barlow · Jennie L Ponsford · Alice Theodom · Gill Cowen · Gavin A Davis · Vicki Anderson · Franz E Babl · David Cole · Jennifer Cullen · Stuart R Dalziel · Melinda Fitzgerald · Howard Flavell · Caroline Yates · Rebecca Kimble · John H Olver · Rhonda Orr · Mark Ralfe · Michael Rose · Nick Rushworth · Julia Treleaven · Gary Browne · Nathan Delang · Sarah Harris · Gary Mitchell · Sean Tweedy

Australia has the means to ensure that children and young people can thrive. We are in a critical period, and failure to act risks leaving a generation behind

Georgie Frykberg · Angelica Ojinnaka‐Psillakis · Planning Saw · Kevin Kapeke · Cham Kim · Amie Furlong · Susan Maury · Anna M H Price · Peter D Sly · Taylor Dee Hawkins · Khalid Muse · Pasi Sahlberg · Prue Warrilow · Fiona J Stanley · Jordan Cory · Carolyn Wallace · Adam Valvasori · Ngiare Brown · Craig A Olsson · Yichao Wang · Sharon R Goldfeld · Rosemary Calder · Kate Lycett

The promise of equity will be realised not through rhetoric, but through bold, deliberate and sustained action

Pasi Sahlberg · Trevor Cobbold

The lessons of early literacy reform show that strong evidence, when acted upon, drives better outcomes. By bringing together rapid ECEC reforms with unique, embedded cohorts (GenV and ORIGINS), Australia offers a globally unprecedented opportunity to unite rigorous early education and health research and practice at scale for lasting child wellbeing and population health

Melissa Wake · Jon Quach · Jacqueline Davis

The lessons of early literacy reform show that strong evidence, when acted upon, drives better outcomes. By bringing together rapid ECEC reforms with unique, embedded cohorts (GenV and ORIGINS), Australia offers a globally unprecedented opportunity to unite rigorous early education and health research and practice at scale for lasting child wellbeing and population health

Melissa Wake · Jon Quach · Jacqueline Davis