National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (RACGP)

The RACGP and the National Aboriginal Community Controlled Health Organisation have recently launched an updated guide to assist healthcare providers to deliver best practice healthcare and prevent disease in Aboriginal and Torres Strait Islander populations.

The National guide to a preventive health assessment provides health professionals with the most up-to-date, best practice advice in preventive health for Aboriginal and Torres Strait Islander people.

This second edition of the National Guide comprises:

* the National Guide, which contains evidence statements, recommendations, risk calculation tables and an outline of the development of the guide
* the evidence base: the collection of evidence underpinning the guide and recommendations
* a child and adult lifecycle summary wall chart listing activities recommended at each age group.

The National Guide can be used in conjunction with the RACGP Guidelines for preventive activities in general practice "red book" and with the Medicare Benefits Schedule rebate item 715: Health assessment for Aboriginal and Torres Strait Islander people.

The National Strategic Framework for Rural and Remote Health

The National Strategic Framework for Rural and Remote Health promotes a national approach to policy, planning, design and delivery of health services in rural and remote communities.

The Framework has been prepared by the Australian Health Ministers' Advisory Council (AHMAC) Rural Health Standing Committee (RHSC). The RHSC includes representatives from the Commonwealth Department of Health and Ageing and from each state and the Northern Territory health departments. The National Rural Health Alliance and a range of other rural health stakeholders also provided input to the document.

The Framework is directed at decision and policy makers at the national, state and territory levels. It may also be used by communities and local health service providers to plan services and programs according to local needs. Overall it aims to improve health outcomes and return on investment for rural and remote Australians.

Analysis by National Rural Health Alliance

Recognising Early Symptoms of Ovarian Cancer.

NICE has launched a quality standard to help with recognising the early symptoms of ovarian cancer. It can be hard to diagnose the condition, since some of the symptoms of ovarian cancer are similar to those seen in more common conditions such as irritable bowel syndrome.

The quality standard consists of 8 quality statements that describe high-quality, cost-effective care for the condition. It says women aged 50 or above and reporting one or more symptoms occurring persistently, or frequently suggesting ovarian cancer, should be offered a CA125 test. Furthermore, women with raised CA125 should have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.

Recognising early symptoms of ovarian cancer is an online learning tool covering the signs and symptoms of ovarian cancer and diagnostic tests.

Ovarian cancer: recognising early symptoms in primary care is an audio module examining the importance of early diagnosis and prognosis, risk factors, and signs and symptoms.

These resources were developed independently by Target Ovarian Cancer and BMJ Learning.

Tools for quality & safety improvement in health care.

Since its commencement in 2006, The Australian Commission on Safety and Quality in Health Care (ACSQHC) has focussed on a number of high priority areas for safety and quality improvement in health care. In these areas, support for implementation by clinicians, healthcare organisations and governments is being progressively developed.

Over 200 implementation support tools are now available from the ACSQHC website. Subjects covered include clinical handover, core-hospital-based outcome indicators, falls prevention, medication reconciliation, infection prevention & control ..... and many more. A handy treasure chest well worth examination.

Farmer reaches out to rural men suffering depression

MARK COLVIN: A farmer from the Riverina has launched a program to reach out to rural men suffering from depression.

John Harper, is telling his own story as part of the 'Mate Helping Mate' project.

Mental illness in men costs $3b, says report

Mental illness in young men costs the Australian economy more than $3 billion per annum, a new report launched by Mark Butler, the Minister for Mental Health reveals.

The cost, which equates to $387,000 lost each hour, is largely due to the unfilled potential of men who drop out of work or education while suffering their problems in silence, experts say.

The federal government covers about 31% of the annual cost of mental illness in men and boys aged between 12 and 25 through direct health and welfare costs, says the report, Counting the Cost: The Impact of Young Men's Mental Health on the Australian Economy.

Sydney Morning Herald report

Ministerial press release.

Aboriginal mission plight highlights living conditions concern

CHRIS UHLMANN, PRESENTER: Australia's one of the richest countries in the world, Sydney the 7th most expensive city, yet just hours away from such privilege and wealth lies a community in turmoil and decay. The scale of the dysfunction locked inside the tiny Aboriginal mission of Toomelah is breathtaking. In recent week there's have been rumours of a government-led intervention, or of a complete relocation. Those rumours have amounted to nothing. But the people of Toomelah and the children living amidst the turmoil desperately need help. How has it come to this? Caro Meldrum-Hanna has this special report.

Creating cultural empathy and challenging attitudes through Indigenous narratives

The Creating cultural empathy and challenging attitudes project has two primary aims:

* to positively influence the health and wellbeing of Australian Indigenous people by improving the education of health professionals;
* to engage students with authentic stories of Indigenous people's experience of healthcare, both positive and negative, which enhance the development of deep and lasting empathy.

The project activities include:

+ Collection of 50 multimedia Indigenous stories, available to National Network members.
+ Creation of a National Network of educators who are interested in developing and trialling learning resources.
+ Mapping of potential learning from narratives to curricula.
+ Creation of learning materials by National Network members; and
+ Piloting learning activities with multidisciplinary health students across universities.
+ Project values
+ Integrity of goals, purpose and process through respectful engagement with Indigenous people, story provider empowerment and safety, and Indigenous governance of the research process.
+ Collaborative development of insightful and high quality learning materials by innovative health educators using the multimedia Indigenous stories.
+ Incorporation of Indigenous voices in all areas of the healthcare curriculum - rather than just within a cultural competency or cultural diversity unit.

Led by Edith Cowan University, this project includes The Combined Universities Centre for Rural Health, Curtin University of Technology, The University of Notre Dame, The University of Western Australia and Health Consumers Council (WA).

Many of the project materials are available to registered users only. Registration is free.

World Health Statistics 2012

World Health Statistics 2012 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage.

Reposted from : Health Blog@CSU

Child dental health survey 2007 : 30-year trends in child oral health (AIHW)

The Child Dental Health Survey provides national information on the dental health of children attending school dental services in Australia, and shows that decay is relatively common in Australian children. This publication describes trends in oral health of Australian children between 1989 and 2007. Over this period, caries has declined markedly in the permanent teeth of children aged 12, but declined far less in the deciduous teeth of children aged 6.

Media release

1800 011 511. 24-hour mental health help line launched

People with mental health problems will be able to access help any time of the day with the launch of new 24-hour help line in NSW. The line will operate seven days a week and provide a telephone triage assessment and referral service staffed by mental health clinicians. It will also offer local treatment options for general practitioners, police and ambulance officers.

Health Minister Kevin Humphries described the help line as a ground breaking service for people in distress, their families and carers. 'No matter where people live in NSW they will no longer have to search through complicated directories to get help,' he said.

People seeking assistance for mental health issues can call the line on 1800 011 511.

Mr Humphries said the Mental Health Line does not replace emergency services, and that people in life-threatening situations must still call 000 to receive immediate help.

Ministerial press release

Getting the wind up: exploring concern about the adverse health effects of wind turbines in Australia and Europe

This report, "Getting the wind up: exploring concern about the adverse health effects of wind turbines in Australia and Europe", by Neil Barrett of the Mount Alexander Sustainability Group, looks at the difference in the level of concern about adverse health effects from wind turbines in Australia, Denmark and Germany. In Denmark and Germany, where wind turbines are very common, there is hardly any debate, whereas in Australia the claims made by anti-wind groups threaten to bring the industry to a standstill. By providing evidence of the lack of concern about health effects in Europe, this report casts further doubt on the validity of "wind turbine syndrome".

Reposted from : NCAHS Library Clippings

Photo : "Electric cow" by Ian Sand on

Australian Guidelines for the management of absolute cardiovascular disease risk

The first Australian Guidelines for the management of absolute cardiovascular disease risk, developed by the National Vascular Disease Prevention Alliance (NVDPA) are now available. The guidelines incorporate and build on the previous NVDPA Guidelines for the assessment of absolute cardiovascular disease risk (2009) and consolidates a number of other evidence-based guidelines related to primary prevention of CVD.

The guidelines make recommendations for assessing and managing absolute CVD risk in adults aged over 45 years (35 years for Aboriginal or Torres Strait Islander adults) who are without known CVD. Special sections providing advice on preventing CVD for those with diabetes and chronic kidney disease are included where relevant.

These guidelines are an important step as they provide a single preventive approach to first-ever CVD in Australia. Clinical decisions based on absolute risk can lead to improved health outcomes by identifying people most at risk and directing the right treatments to them.

Also available are :
* Management Guideline Quick Reference Guide
* Online risk calculator
* Guidelines for the Management of Absolute CVD Risk : Technical report
* Absolute risk videos
* Consumer resources

Media Release

Diabetes MILES study identifies many unmet needs in diabetes patients

Approximately 1.7 million Australians are currently living with diabetes, a family of complex metabolic conditions, affecting people of all ages, backgrounds and cultures. In addition to medical management, living successfully with diabetes requires attention to the behavioural, psychological and social aspects of the condition.

Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Australia was a national survey of Australians living with type 1 or type 2 diabetes. The aim of the study was to assess the impact of diabetes on the quality of life and psychosocial health and wellbeing of Australians living with the condition, and provide a baseline against which the results of future studies can be compared.

Report findings:
When it comes to the general health of people with diabetes:
* Adults with type 2 diabetes are more likely to indicate that their health has declined in the past year, as compared to adults with type 1 diabetes
* Adults with type 2 diabetes are also more likely than those with type 1 diabetes to report co-morbidities such as neuropathy, heart disease, peripheral vascular disease, and sexual dysfunction
When looking at the psychological and emotional wellbeing of people with diabetes:
* Adults with type 2 insulin-treated diabetes are more likely to experience symptoms of depression and anxiety than adults with type 1 diabetes or adults with type 2 diabetes who don't use insulin
* 35% of adults with type 2 insulin-treated diabetes experience moderate to severe depressive symptoms
* Adults with type 1 diabetes are more likely than those with type 2 diabetes to experience severe diabetes-related distress
* 28% of adults with type 1 diabetes experience severe distress
And what do people with diabetes have to say about the healthcare system?
* 49% of adults with diabetes have never been offered structured diabetes education. Of those that have received structured education, this is most likely to have occurred at or around the time of diagnosis.
* Half of adults with diabetes consider cost to be a barrier to healthcare
* Around half of adults with diabetes have not been asked what is important to them in managing their diabetes in the past three months
* Half had not received adequate information from their healthcare professionals in the past three months

The findings of this survey identify issues concerning self-management, quality of life, psychological well-being and unmet needs of adults with diabetes across Australia. The findings of the Diabetes MILES Australia 2011 survey provide a national snapshot of the quality of life and psychosocial well-being of Australian adults living with type 1 or type 2 diabetes.

Media release

15th NSW Rural Mental Health Conference

Bathurst is the venue for the 15th NSW Rural Mental Health Conference, 29 - 31 August 2012.

The conference is being hosted by the Western NSW Local Health District, and will be held in the new and unique Pit Complex on the famous Mount Panorama Racetrack. The conference theme Race to Recovery: Holden on / Moving Ford... will focus around the following :

* Service development initiatives / innovative models of care
* Integrated care / partnership models
* Meeting the needs of those with complex needs such as physical healthcare or drug & alcohol co-morbidities
* Mental health promotion, prevention and early intervention
* Rethinking the rural mental health workforce: workforce development and training initiatives
* Open category

Conference Secretariat: Sarah Hoekwater
Ph: 07 5502 2068 Fax: 07 5527 3298

A helping hand is extended online for depression

A new online counselling service, Headspace, is reaching out to those feeling isolated. eHeadspace began as an online trial for people suffering from drought in regional WA and, after a successful response, has been extended nation-wide.

SUMSearch 2.0 for physicians & med students : evidence-based literature searches

SUMSearch 2 is a meta-search tool which employ a number of novel techniques to collate medical evidence from a variety of information sources. SUMSearch 2 simultaneously searches for original studies, systematic reviews and practice guidelines from multiple sources and displays them accordingly.

According to its website, on the fly searches for reviews via SUMSearch are revised up to as many as 6 times while searches for guidelines and systematic reviews are revised once each. This form of searching is called contingency or backup searching. Search results are culled from PubMed, DARE and NGC and then merged and sorted.

Upon entering your search terms, SUMSearch 2 will search the following resources:

* PubMed MEDLINE for original studies; systematic reviews and guidelines
* Database of Abstracts of Reviews of Effectiveness (DARE)
* National Guideline Clearinghouse Agency for Health Care Policy and Research (AHCPR).

Depending on the search focus, SUMSearch will search PubMed with the highest sensitivity filters developed by Haynes et al. As SUMSearch executes live searches of external websites in response to queries, it alleges that it is "always up-to-date."

Summary description

SumSearch 2.0 website.

New medical indemnity reports (AIHW)

The Australian Institute of Health and Welfare has released two new reports :

Public and private sector medical indemnity claims in Australia 2009-10

This report presents information on public and private sector medical indemnity claims for 2009-10. There were 9,415 medical indemnity claims open at some point during the year, including 2,900 new claims. A total of 2,647 claims were closed during the year. The main clinician specialties allegedly involved in the incidents giving rise to claims were General practice and Obstetrics and Gynaecology.

Australia's public sector medical indemnity claims 2009-10

This report presents data on the number, nature and costs of public sector medical indemnity claims for 2005-06 to 2009-10, with a focus on 2009-10 claims. There were more new claims in 2009-10 (1,620) than in any of the three previous years (about 1,130 to 1,270 claims per year). As in previous years, the three health services most often implicated were Emergency department, General surgery and Obstetrics.

Media release

The Cancer Directory (Cancer Council of NSW)

The Cancer Directory Website provides the community and health professionals with a useful, comprehensive online directory of trusted Australian cancer care resources that have been published since 2000 in print, audiovisual (AV) or electronic formats.

Cancer Directory contains over 1800 printed, audio visual and electronic publications from over 80 trusted Australian cancer care organisations - the Cancer Councils, Australian and State governments, major health services and large not-for-profit agencies. There are now over 700 publications translated into many of the 47 community languages.

Resources cover a range of cancer-related subject areas and target audiences:

* all common cancer types
* prevention, screening, early detection, screening, treatment, advanced cancer, palliative care
* coping with cancer, including psychosocial needs such as emotional and practical support, grief and loss, communication
* for women, men, children, adolescents, Aboriginal and Torres Strait islander peoples, people from other culturally and linguistically diverse communities, people with disabilities and health professionals. Where a resource is specifically designed for Aboriginal and Torres Strait Islander peoples it is marked as such or just as "Indigenous".

There is also a facility for adding new resources to the database, and an electronic newsletter providing updates

Researchers make progress in understanding breast cancer

A University of Queensland researcher has discovered 9 new genes that drive the development of breast cancer, taking the tally of all genes associated with breast cancer development to 40. Professor Sunil Lakhani from the UQ Centre for Clinical Research, along with an international team of breast cancer researchers lead by Professor Michael Stratton(Sanger Institute, UK), examined all the genes in the genomes of 100 cases of breast cancer.

Professor Sunil Lakhani said mutated cancer-causing genes (called driver genes) were different in different cancer samples, indicating that breast cancer is genetically very diverse. "Understanding the consequences of this diversity will be important in progressing towards more rational treatment," Professor Lakhani said. "The idea behind the work was to establish 'the landscape' of genetic changes in breast cancer with a view to understanding which genes drive a breast cell to become cancerous."

Workload measures for Allied Health Professionals (National Health Workforce Planning and Research Collaboration)

The aim of this project is to examine current data sources on workload measures for allied health professions, i.e. the number of services provided per FTE. These data are an important part of national workforce planning exercises for allied health professions. The objectives are to map and summarise existing data sources, and recommend priorities for future data collection.

Complementary and Alternative Therapies

Complementary therapies work with conventional medical treatment, while alternative therapies are those which offer alternatives to conventional diagnosis and therapies. Complementary medicine used together with conventional medicine is known as integrative medicine.

HealthInsite the Australian health information service, lists a large number of treatments and therapies with links to good sources of further information.

Overcoming challenges to improving quality

In the UK, the Health Foundation has been working with the NHS to deliver improvement through service and staff development programmes. All Health Foundation improvement programmes are evaluated so as to gather evidence of their impact and to better understand how it has been achieved. In Overcoming challenges to improving quality, a team of researchers looked at the factors that affected the likelihood of improvement methods being applied and new interventions adopted. 10 key challenges to improvement were identified that consistently emerged in the programmes evaluated.

From : NCAHS Library Clippings

eHealth Learning Centre

Health Minister Tanya Plibersek has launched an online "Learning Centre" which details how the Government's new electronic health record system will work for patients and practitioners. She said the new learning centre will inform and educate the public and healthcare professionals about eHealth and the personally controlled electronic health record system in the lead up to the July launch.

20 steps to equal health for rural people by 2020

In evidence last week to the Senate Inquiry into Factors affecting the supply of health services and health professionals in rural areas, the National Rural Health Alliance proposed a 20-point plan to reduce the poorer health status experienced by people in rural and remote areas.

Each element of the plan is specific enough to be adopted by governments as a new policy proposal and, between them, the 20 cover the lifetime path of an individual who might train, work, mentor and then transition to retirement - all within the rural and remote health sector.

The proposal begins its chronological path with action to attract more students from rural and remote areas into health science courses, and ends with initiatives to make better use of mature-aged practitioners who are willing to provide support and mentoring on a part-time basis to students and junior health professionals on placement or training in rural areas.

Intermediary elements include active recruitment of more Aboriginal and Torres Strait Islander people to health professions; positive modelling of rural practice by teachers at university; and a campaign to make sure students and new health practitioners are aware of the professional and family benefits of rural practice and the financial support that is available to assist them in making their professional contribution in rural areas.

Press Release

Time to care for the carers: mental health report

Much has been written about Australians struggling with mental health issues but the Wesley Mission wants the public to know about the struggles affecting the carers.

A national survey, Keeping minds well: Caring till it hurts, conducted by the Wesley Mission has found that 90% of relatives of people with a mental illness are suffering physically, mentally and financially.

The long term impact on the mental health and overall wellbeing of carers can be profound. A few hours respite each week or perhaps a quiet session with a counsellor can make a difference when young carers aren’t coping. Wesley Mission can help them cope.

The caring can’t stop but the damage to those caring can. Through comprehensive counselling and respite services Wesley Mission helps young carers manage their challenging roles and find hope on the other side.

ABC report

Australian budget 2012 : Health links

Health and Ageing portfolio budget details

Budget 2012-13 : information of relevance to Indigenous Health

Health budget "firm but fair" : Australian Health & Hospitals Association

AMA comments

All budget links

Primary Clinical Care Manual

The Primary Clinical Care Manual (PCCM) 7th ed., 2011 provides Clinical Care Guidelines and Health Management Protocols, especially for Scheduled Medicines Rural and Isolated Practice Registered Nurses and authorised Aboriginal and Torres Strait Islander Health Workers to administer and supply medications.

The PCCM 7th edition is the result of a successful partnership between Queensland Health staff and the staff of the Royal Flying Doctor Service (Queensland Section). The PCCM 7th edition is the principal clinical reference and policy document for health professionals working in rural and remote Queensland. It contains Health Management Protocols that support the advanced practice of authorised Aboriginal and Torres Strait Islander Health Workers, Scheduled Medicines Rural and Isolated Practice Registered Nurses, Authorised Sexual and Reproductive Health Registered Nurses and Immunisation Program Authorised Registered Nurses. These Health Management Protocols set out the circumstances, conditions and restrictions under which medicines listed in the Drug Therapy Protocols can be used.

Understanding safety data sheets for hazardous chemicals

This fact sheet by Safe Work Australia explains the information contained in a safety data sheet (SDS), what each section means and how to check if a SDS complies with the Work Health and Safety Regulations. By reading, understanding and following the information and instructions in an SDS, all chemicals should be able to be used safely in the workplace.

An SDS is a document that provides detailed information about a hazardous chemical, including:

* the identity of the chemical product and its ingredients,
* the hazards of the chemical including health hazards, physical hazards and environmental hazards,
* physical properties of the chemical, like boiling point, flash point and incompatibilities with other chemicals,
* workplace exposure standards for airborne contaminants,
* safe handling and storage procedures for the chemical,
* what to do in the event of an emergency or spill,
* first aid information, and
* transport information.

Chronic Pain, Chronic Illness and Suicide Prevention

Suicide Prevention Australia has released its Chronic Pain, Chronic Illness and Suicide Prevention position statement which highlights the urgent need for increased attention and awareness of the mental health of sufferers of chronic pain and other chronic medical illnesses. The position statement references a 2006 Australian study which found that 21% of people who died by suicide experience physical health problems which may have contributed to their death. CEO of Suicide Prevention Australia, Ryan McGlaughlin said the paper highlights the need for the psychological impacts of physical conditions to be given equal attention to physical symptoms during treatment and prevention. Suicide Prevention Australia have recommended the development of collaborative models of care and integrated care pathways that are resourced, trialled and made universally available to help reduce the incidence of suicide among people with severe chronic illnesses, including chronic pain.

The "Resources page" of the Suicide Australia website also includes other position statements on topics including Social inclusion & suicide prevention, Stigma & suicide, and Youth suicide prevention in Australia.

Health Workforce 2025

Health Workforce 2025 (HW2025), commissioned by the Australian Health Ministers, provides medium to long-term national workforce planning projections for doctors, nurses and midwives. HW2025 projects the estimated numbers of professional entry students, postgraduate and specialist trainees that will be required for these professions between 2012 and 2025. It also contains detailed modelling on workforce supply, demand, training and distribution.

The report identifies a range of policy considerations covering workforce reform, training, immigration and geographical distribution. Health Ministers are working together to consider the options to ensure a more sustainable health workforce to meet the future health needs of the Australian community.

Health Workforce 2025 is comprised of three volumes. Volumes 1 and 2 are currently available.

Volume 1 contains the overall findings from a workforce planning analysis of the trends in the supply and demand of doctors, nurses and midwives in Australia.

Volume 2 contains detailed supply and demand projection results for midwives and registered and enrolled nurses by area of practice, as well as state and territory projections for all professions.

Volume 3 will contain detailed supply and demand projection results for the medical workforce, by specialty. It will be delivered to Health Ministers in late 2012.

RACGP Reaction.

National Report Card on Mental Health and Suicide Prevention : Report Card Survey

A National Mental Health and Suicide Prevention Report card is currently being developed by the newly formed National Mental Health Commission. The Commission is seeking your feedback on what information should be included in the Report Card to improve the lives of people experiencing mental health issues or at risk of suicide, and the lives of their families and carers.

Your opinion will help to shape the first and future Report Cards.

The brief community survey is now open for feedback until Thursday 31st of May 2012. See :

Western Australia Health Networks

Western Australia Health Networks is a group of over 2,500 consumers, doctors, nurses, midwives, allied health professionals, caregivers and policy makers dedicated to providing online health information and improving health services in the state of Western Australia. The website contains links to 17 internal Internet networks covering topical health service issues and health concerns.

Links to completed projects, models of care, publications and other resources provide a wealth of information across the 17 specialties. This is an interesting and innovative addition to Australian health websites.

Supervision and assessment of hospital based postgraduate medical trainees - 2012

The AMA has developed a Position statement on supervision and assessment of hospital based postgraduate medical trainees (2012) to ensure that appropriate policy, processes and infrastructure exists to support high quality supervision and assessment of hospital based postgraduate medical trainees.

The AMA's position covers:

Structures supporting effective supervision and assessment;
Assessment; and
Resourcing effective supervision and assessment.

It reflects what trainees need to navigate and be supported in their training as well as what supervisors need in terms of support, time and payment to provide training.

The Osteoporosis Model of Care

Amongst the recent addition of the resources on ARCHI is the Osteoporosis Model of Care, a multidisciplinary team-based model which aims to improve the detection and management of osteoporosis. This model of care, developed by the Bone and Joint Institute, Hunter New England Local Health District, is designed for patients over 50 years of age, who present to Emergency Departments with a minimal trauma fracture.

Resources available include : Planning and implementation tools, Patient Information materials, Treatment algorithms, Risk calculators and Referral templates.

Cervical screening in Australia 2009-2010 (AIHW)

Cervical screening in Australia 2009-2010 presents the latest national statistics monitoring the National Cervical Screening Program, which aims to reduce incidence, morbidity and mortality from cervical cancer. About 57% of women in the target age group of 20-69 took part in the program, with more than 3.6 million women screened in 2009 and 2010. Cervical cancer incidence in this age group remains at a historical low of 9 new cases per 100,000 women, and deaths are also low, historically and by international standards, at 2 deaths per 100,000 women.

Media release