Health occupations

The psychosocial hazards of healthcare are well-recognized and are now subject to new legislation in Australia. Missing from this discussion has been the recognition of the second victim phenomenon—the distress experienced by healthcare workers involved in an adverse event, medical error or unexpected patient outcome—which appears to meet criteria for a psychosocial hazard. Organizations should ensure support for second victims by building a restorative and just culture, including ensuring all staff are educated on the second victim phenomenon and can support their colleagues, implementing a staff peer-support programme and ensuring that specialist mental health supports, such as an employee assistance programme, are geared towards supporting the second victim.

Sarah Michael

Jodie Bailie · Helen Dickinson · Briony Lipton · Marissa Shields

Allyson R Todd · Elena Wang · Stephanie R Partridge

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

By optimising existing investments and leveraging Australia’s strong universal foundation, we can enhance child and family health services and improve outcomes for all children and their families

Anna MH Price · Elodie O’Connor · Sharon R Goldfeld

Davide R Tomassoni · Iftah Amith

Telephysiotherapy could be incorporated into aged care to improve the lives of older Australians

Rik Dawson · Marina Pinheiro · Juliana Oliveira · Abby Haynes · Vasikaran Naganathan · Morag E Taylor · Nina Bowes · Karn Nelson · Jenny Rayner · Catherine Sherrington

Mark Schifter · Suma Sukumar

“Medicine is a social science and politics is nothing but medicine on a grand scale”1 Many MJA readers will be familiar with this oft quoted phrase from the 19th century German physician Rudolf Virchow. In his landmark report of a typhus epidemic, Virchow pointed out the links between poverty and the spread of disease. The role of the medical profession, it follows, is not simply to treat individual patients but to also attend to the social conditions that underpin poor health outcomes. Consideration of the social determinants of health, as we now call them, is a fundamental part of contemporary public health research and practice and an area the MJA frequently publishes on. In this issue of the Journal, for instance, research by Rubenis and colleagues2 investigates place‐based disparities in care for cardiovascular diseases. They find that despite recent improvements, patients living in regional and remote areas of New South Wales admitted to hospital with heart failure experience persistently higher in‐hospital mortality compared with their metropolitan‐dwelling counterparts. Likewise, writing in a perspective article, Robertson and colleagues3 explore the many barriers that exist to research participation by people with vision impairment and describe strategies for improving participation by changing information provision and data collection methods. Although it is widely accepted that the state of our social world has an enormous influence on health, the role of health experts in moving beyond merely describing and explaining to seeking to transform social conditions to improve health remains contested. This is especially when powerful interests are at play. In such cases, it is common for physicians and researchers to be extorted to stay in their narrowly defined biomedical “lane”, or for those within the profession to worry about tainting their appearance of objective, evidence‐driven thinking by engaging in debates of a political nature. Bilgrami and colleagues4 address this tension in an article on armed conflict and the role of physician advocacy. Globally, attacks on health care — such as the killing, kidnapping and arrest of health care workers, hijacking of medical supplies, obstruction of patients from accessing care, and the bombing, looting and occupation of health facilities — are on the rise. Despite these devastating events, the authors note “most medical associations and societies have been inconsistent when it comes to advocating for the protection of health care workers in conflicts. An argument commonly put forth in recent years is that such organisations must remain apolitical”. Bilgrami and colleagues contrast this approach with notable historical and contemporary examples of successful physician advocacy efforts, as well as with their view of the norms and responsibilities at the heart of ethical medical practice. Ultimately, they conclude that “physicians have been unconscionably silent in recent years and must now integrate professional and political activities if they are to live up to the highest ideals of the profession”. There are lessons here that extend far beyond the issue of armed conflict. In the United States, for instance, the coalescence of anti‐science and anti‐human rights agendas under the Trump administration has placed academic independence and public health under attack, including with direct effects in Australia.5,6 Researchers and practitioners are facing very tangible consequences for engaging with the social determinants of health, be it around gender, sexuality, race, or health inequities more generally.7 Grants are being cancelled.8 Public health programs are being dismantled.9,10 Universities are being intimidated.11 Credible health information is being censored12,13 and purveyors of misinformation are being elevated to high places.14,15 What recent events in the US have demonstrated is that regardless of whether scientific and medical institutions seek to appear apolitical, political actors nonetheless deeply appreciate the power that health and medical experts hold in our societies and are prepared to act accordingly in pursuit of their dangerous agendas. Virchow's instruction to the medical profession is as relevant today as it was over 150 years ago.

Elizabeth Zuccala

The term “culturally and linguistically diverse” (CALD) is widely used in Australian public health. We discuss the limitations of the term and how it masks distinct needs and experiences of various cultural groups

Ikram Abdi · Adeline Tinessia · Abela Mahimbo · Meru Sheel · Julie Leask

Hospital-in-the-home (HITH) models of care provide sustainable, patient-centred, value-based care; but how can we better recognise deteriorating HITH patients?

Mya Cubitt · Seok Lim

The VRGS has an important role in providing continuous medical coverage to complement the local visiting medical officer workforce in rural and remote hospitals

Shannon Nott · Georgia Wingfield · Amelia Haigh · Georgina M Luscombe · Anna E Thompson · Emily Saurman · Tim Shaw · Amy Von Huben · Kirsten Howard · Andrew Wilson

The Virtual Rural Generalist Service model effectively fills medical service gaps and makes rural medical and nursing positions more attractive and sustainable

Anna E Thompson · Emily Saurman · Shannon Nott · Andrew Wilson · Tim Shaw

Patients and carers who experience hospital-based virtual care perceive that it can provide good quality medical care and meet many of their needs

Anna E Thompson · Tim Shaw · Shannon Nott · Andrew Wilson · Emily Saurman