On the threshold of better futures

For the Journal, approaching its Centenary, birthdays are top of mind. Although appearing with rapidly increasing frequency, our own birthdays are usually cause for celebration. In Australian culture, the occasion usually involves the sharing of a drink — for many people, make that several — with friends and loved ones, reflecting on milestones achieved, but also looking at the path ahead.

Medicare, a Generation Y baby, is now in its 30th year. How is it maturing? In this issue's post-election policy pointer, Perkovic and colleagues (doi: 10.5694/mja14.00427) share their evaluation of how our universal health care funding system is growing up. Measuring it against the founding principles described by then federal health minister Neal Blewett in 1983, they argue that it has adapted to the increasing complexity of health care delivery, but that other urgent reforms are needed. The current fee-for-service model creates inefficiencies and is likely to generate increased costs with increasing numbers of providers. There is also considerable inequity around access, particularly for specialist services. The authors conclude that understanding the effectiveness and cost-effectiveness of interventions funded by Medicare will be crucial to its success in meeting rising demand.

In another birthday milestone, Australians who turn 18 years of age avail themselves not only of the right to vote but of the right to buy alcohol, should they wish to do so. This legal right is anticipated eagerly by many underage teenagers in (and many do not wait until they turn 18). But is it safe? Toumbourou and colleagues (doi: 10.5694/mja13.10465) argue that there is ample evidence to support raising the legal drinking age to 21. They contend that, at 18, young people are more vulnerable to alcohol-related harms than their 21-year-old counterparts. They also cite data suggesting that increasing the legal drinking age would reduce alcohol-related traffic crash injuries. Although the proposal is controversial, they believe that commonly raised objections can be refuted. Another measure to promote safe drinking is also discussed in this issue. A qualitative study of Western Australians aged 18–21 years by Pettigrew and colleagues (doi: 10.5694/mja14.00382) suggests that a “responsible drinking” campaign by DrinkWise may actually have had the opposite effect. Some of the young people sampled in the study reported that the advertisement may have encouraged them to drink more, rather than less.

For many people with cancer, each anniversary of their diagnosis is an important survival milestone — a cause for celebration and a time to reflect on what lies ahead. Yu and colleagues (doi: 10.5694/mja13.11134) present their findings on prostate cancer survival in New South Wales. In their report, they expand on an earlier study by accounting for stage at diagnosis, and investigate whether rural–urban disparities in mortality have improved. When adjusted for five prognostic factors, their data suggest that patients with a rural place of residence still have a higher risk of death. On a positive note, they found that overall survival increased during the study period, from 57.5% in 1992–1996 to 83.7% in 2002–2007.

Arguably, all of us should view a birthday as a cause for happy recognition. Here at the Journal, perhaps we could be forgiven for raising a glass in honour of reaching 100!