JESS TEESDALE, MEMBER FOR BASS: We're so lucky to be here today. We've got Assistant Minister Rebecca White, Assistant Minister for Health, and we've also got Dr Zarrabi. And we're really excited to hear some of her story and to share her specialty. And thank you so much to the Charles Specialist Clinic for having us here and hosting today.
We know that women are often overlooked in a lot of ways when it comes to their health, and that's been for a variety of reasons for many years. And finally, our government's really taking steps under various incredible leadership at the top levels to make sure that women's health is getting the spotlight that it deserves.
REBECCA WHITE, ASSISTANT MINISTER FOR HEALTH AND AGEING: Thank you, Jess. Our government has made significant investments in women's health, including a nearly $800 million package launched before the budget last year that's seen improvements in access to new medicines, new options for treatment pathways across a range of different areas. But a lot of these investments, I guess, highlight the fact that there's more work to do. I'm very proud of the fact that we've been able to establish expert panels on women's health, with the first one taking a serious look at cardiovascular disease in women.
Cardiovascular disease is one of the leading causes of death for Australian women, but the symptoms are often misunderstood because a lot of what we know about how you might present with a heart attack are based on how the symptoms are described in a man as opposed to how they are presented for a woman. And so what we aim to do with our expert panel is to look at both where there are gaps in research, where there might be gaps in public understanding for women themselves about how to recognise the risk factors and the symptoms, but also how we might address some of the gaps in practice to make sure that when a woman presents to a health professional she's receiving the best possible care.
The expert panel is made up of individuals who represent different organisations like the Stroke Foundation, the Heart Foundation, Her Heart, alongside experts in research, in primary practice and specialist care. We will also be holding roundtables, one with stakeholders from the consumer space to understand from women themselves what their experience has been like, but also with stakeholders in the health space to understand from clinicians and the colleges, with respect to how the guidelines are drafted and how they're applied in education, to make sure that we can learn from them about how they are applying their work in practice and where the gaps might be. We hope to be able to conclude this work by the end of this year to provide strong advice to government about how we can make improvements for women's cardiovascular health in Australia.
We know that there are many fabulous cardiologists who are working right around the country, including here at the clinic in Launceston, and I'm pleased that Dr Zarrabi has been able to share with us some of her experience as the only female cardiologist working in this space in Tasmania. We know that oftentimes, women prefer to speak to a female health practitioner because they are able to share and be more vulnerable, and it's really exciting to have Dr Zarrabi working in Tasmania where she can offer her expertise to women in the north and the northwest of our state. And that's the case for the first time in the northwest of Tasmania for women to have access to a female cardiologist. Now she doesn't just support females in this space, she supports men as well. But I think her perspective is really interesting and I'm really very pleased that she's been able to join with us today, and what I hope she'll be able to share with you is examples of how the symptoms in women might be different compared to men. Because this is one of the gaps that I think exists in our community, is that a lot of women don't understand what symptoms to recognise in themselves. And one of the messages I want to give Tasmanian women is that they use their heart to look after everybody else. It's time that they prioritise themselves and protect their heart too.
So I'm going to ask Dr Zarrabi to share a few messages, and I'm happy to answer any questions afterwards.
DR LAYA ZARRABI, CARDIOLOGIST: We have many women patients with atypical chest pain, they present to emergency department with atypical chest pain or epigastric discomfort or left arm pain. Their presentation is different from men, and sometimes it may be misunderstood with other pathology such as gastroesophageal reflux disease or other muscle or musculoskeletal pain, and sometimes they triage later compared to men, later than men. And if they have been diagnosed with any cardiac issues, they referred for angiography or other cardiac investigations later compared to men.
So in terms of cardiac pathophysiology of women, it is very different from men because from a hormonal perspective, women are very different from men. And they have more issues in terms of early menopause, gestational diabetes, or if they experience preeclampsia, they are in higher risk of premature cardiovascular disease in earlier stages of their life. And they are not aware of these risk factors, and they are more aware of conventional cardiovascular risk factors such as high blood pressure, diabetes, or family history of cardiac disease, and they are not aware of these cardiovascular issues.
So we have a lot to work on these risk factors as well, and the main important thing is we have many restricted access to more facilities such as angiography cardiac MRI in northwest, and so we have a lot to work on these areas.
JOURNALIST: And doctor, is there a particular demographic of women that are perhaps at higher risk than other age groups or demographics?
ZARRABI: The presentation of women for heart attack is completely different most of the time from men. They have different presentations such as sometimes jaw pain, back pain, or sometimes epigastric pain. And from a [indistinct] feature of significant retrosternal chest pain, we have- anticipate from men with significant diaphoresis and nausea and vomiting. It's completely different in women. And it is misdiagnosed most of the times, it's confused with other conditions. So it can be a definite diagnosis for cardiovascular disease.
JOURNALIST: And is there a particular age group that is particularly at risk? Or like, smoking history or anything like that as well, do they link into it too?
ZARRABI: Smoking history, it is a risk factor for men and women, both of them. But we have special risk factors for women. And most of the data we have is related to men or men and women, and we don't have any special research on women because the physiology of the cardiac issues in women is completely different from men because of the physiology in cardiac function in women is different from men. They have tiny vessels compared to men, and the pathophysiology of pain is different from men, and so the presentation with acute chest pain is different from men. So it can be confused with other diagnosis, so awareness for patients and healthcare professionals, both of them are very important to make sure we work on both of these groups to make sure patients are aware of their risk factors, especially early menopause, gestational diabetes, or these sorts of things. And we should more focus on research only on women to get more information about the atypical features of cardiac issues in women.
JOURNALIST: And if there's someone sitting at home watching this tonight who might have some of the symptoms that you mentioned, what would your recommendation be to them?
ZARRABI: If women experience any chest pain, light-headedness, dizziness, or any discomfort in chest, or any shortness of breath, any palpitation, any fatigue, or any unusual symptoms, they should go straight to a medical professional, such as emergency department or a medical doctor, and they can discuss the situation with their medical doctor to understand more about their symptoms.
JOURNALIST: I guess, the round table. This is a really great blueprint. Is this something as, I guess, Assistant Health Minister that you're hoping to then implement across other areas of health as well?
WHITE: So we have previously had a National Women's Health Advisory Council that concluded its work in December last year. So this is an expert panel that will look specifically at cardiovascular disease for the next period, the calendar year. My job as Assistant Health Minister is to understand where there are disparities in access to healthcare or diagnosis for women in particular. And we know that cardiovascular disease is the leading cause of death for Australian women. After we complete this work, we will have an opportunity to look at other areas of healthcare for women where we have other disparities, where there's either delay in access to diagnosis or treatment or research that’s undercooked. So I am really interested to continue to develop this area of work, whether it's taken up across other areas of government will be a matter for those ministers.
JOURNALIST: And then just from a nuts and bolts perspective, is this costing- like how much is this work going to be costing the taxpayer? Nothing?
WHITE: No, the work of government is to make sure that we do thorough consultation and have a strong evidence base to develop policy from. So the people who are participating in this are experts in their field and then we'll be making sure that they're consulting as well with their networks to feed in through that forum to develop good policy. We all, at the end of the day, want good outcomes for everybody accessing our healthcare system, but we know that there are some areas where women face particular disadvantages or we don't have good knowledge of, and cardiovascular disease is one of those areas. So our work will be focused on making sure that we come up with good evidence-based solutions to some of the gaps that we see, whether it's in consumer education and information, making sure we've got better understanding through research about what we need to do, but also making sure there's good education for health professionals so they can more quickly diagnose and treat women presenting with cardiovascular disease.
JOURNALIST: Several rooms and wards at the LGH closed last week due to Legionnaires disease issues caused by the air conditioning. Is that acceptable in a modern Tasmanian hospital?
WHITE: Well it's obviously very worrying. Legionnaire’s disease is a very serious issue and I know this is a matter that's been put to the Health Minister here in Tasmania. Ultimately it's up to the State Government to explain what action they're taking, not only to address this outbreak but I would hope to prevent future outbreaks as the managers of the hospital system in the state.
JOURNALIST: Now it seems like this came to light because of good journalism because there was necessarily transparency from the State Government. Are you concerned, or should the public have been made aware that this had happened and that perhaps there might be wards within the hospital that had to be temporarily closed?
WHITE: Well I would hope that the Health Minister is communicating regularly with her hospital managers, because there's no doubt action would have been taken at the time to make sure both patients and staff and any visitors to the hospital were informed of this and kept safe. So I'd ask that those questions be directed to the Health Minister to properly explain.
JOURNALIST: Just on fuel, Angus Taylor and the Premier are out at a farm today. They're looking at some of the work that farmers are doing, particularly with diesel. Tas farmers have come out today saying that they don't think that there's enough supply of diesel, particularly in that they understand it could run out as early as April 20 in Tasmania. Is that concerning? Is that misinformation on their part? What's your perspective?
WHITE: So the Energy Minister's giving daily updates to the country on our diesel supply and our unleaded supply in each state and territory jurisdiction. And tomorrow, which is his regular Saturday update, he'll provide an explanation to Tasmanians and Australians on what supply is coming into the country. My understanding is that there is consistent supply of fuel into Australia until at least mid-May, and that is to be delivered right around the country. It's up to the Tasmanian Government to explain if there are any issues that they're seeing across the community here in Tasmania and I know that the opposition leader was standing with the Tasmanian Premier who I hope was able to explain that.
JOURNALIST: And are you concerned perhaps from a local agricultural perspective and a food security perspective, these farmers are coming into harvesting season and also planting season, and they said that they might be able to harvest everything, but we could see food issues or shortages later on. Are you concerned that potential diesel shortages could impact Tasmania's food security?
WHITE: I think there is a reason to be genuinely concerned about fuel supply when you look at what’s happening globally. And that's why the Energy Minister's been so transparent in providing daily updates about what's happening across the country but also weekly updates about supply coming into the country. I know from speaking to representative groups across Tasmania, including TasFarmers, that there are genuine concerns about making sure there's no disruption to the harvesting and the planting that's occurring across the agriculture sector. I also understand there is concern about the broader supply chain impacts because of cost escalations. This is a very complex and serious issue and that's why the government's called together national cabinets so that we've got representation from every jurisdiction working collectively on sure that we've got consistency of supply going to the places where it's needed most. There has been prioritisation of delivery of diesel to regional and rural areas in particular because we know how vital it is for our farmers and other producers in those parts of our economy to make sure they've got fuel supply. Because without them being able to do their job, we don't have food coming into supermarkets and we don't have supply chain security. So that is something we're very aware of and working hard with those industries to make sure we've got solutions for.
JOURNALIST: And Minister, I'm sure as you've been driving around the community seeing those petrol price boards, they're significantly higher than they were six weeks ago, even before Easter they've jumped up quite considerably, almost absorbing the fuel excise tax that was introduced to lower those pressures. Are you concerned by the increasing costs? There was one insider who told us that they think diesel could rise by as much as 61 cents this week. Is that concerning for you?
WHITE: I think many Tasmanians are really feeling the pinch when it comes to the cost of fuel, and it doesn't matter if you're a farmer or if you're a motorist just getting your kids to school. It's hard for people at the moment to absorb those rising costs and that's why we've cut the excise on fuel and we're looking at what else we can do across the supply chain to make sure there's continued delivery, so we don't have further disruption. I accept that this is a really challenging time. There’s global uncertainty. The global uncertainty and disruption to supply chains has impacted on nearly every single economy across the world. Australia is not immune from that, and we're working really hard with our partners, it's why the Prime Minister is in Singapore today, to make sure we've got a continual supply of fuel into our country, and that it's being distributed around our continent to the places where it's most needed.
JOURNALIST: In Queensland – last question – in Queensland, the Premier there supported opening refineries to, I guess, create some sort of sovereign domestic supply. Would you support something similar happening in Tasmania?
WHITE: We've got two refineries in Australia, down from six when we were last in government. Unfortunately, four of them closed under the Coalition's watch. So that does mean that we are somewhat constrained with respect to how we maintain sovereign capability in this country. And that's why we're working so closely with our partners, particularly in the South Asia region, to ensure we've got supply coming into the country because we have a co-dependency on them. And that's why the Prime Minister's in Singapore having those conversations. It is important that we recognise the fact that we are very connected. We need to make sure we maintain those relationships – which we are doing, we have strong relationships – because as a country we do depend on not only supporting the refineries we have here, in Australia, those two, and keeping them operating, but working with our partners to bring fuel into the country.
JOURNALIST: But would you support opening more, particularly one in Tasmania?
WHITE: I don't expect that's a very quick process. We are dealing with an emergency right now, we do have reliable supplies of fuel coming into the country, but it needs to be refined fuel. We only have two refineries in the country. It would take quite a while I imagine to establish a new refinery, and that’s not something I’m aware is being proposed for Tasmania.