Report on Viral Hepatitis in Australia and Alignment with Sustainable Development Goals

Introduction: The Human Impact and SDG 3

A recent report from Hepatitis Australia highlights significant challenges in the nation’s progress towards eliminating viral hepatitis, a key target within Sustainable Development Goal 3 (Good Health and Well-being). The personal account of David Clune, diagnosed with hepatitis B and C in 1989, illustrates the profound health and social consequences of the viruses. His early life experiences in state care, marked by abuse and neglect, underscore the interconnectedness of social determinants with health outcomes, touching upon SDG 16 (Peace, Justice and Strong Institutions). The social stigma he faced, concurrent with the AIDS epidemic, led to social exclusion, further impacting his family’s well-being and forcing their emigration to Australia. His eventual access to life-changing care at Princess Alexandria hospital demonstrates the critical role of accessible, trusting, and effective healthcare systems in achieving SDG 3.

Key Findings from the Hepatitis Australia Report

Prevalence and Diagnosis Gaps

The report, titled “If hepatitis was 100 people,” provides a statistical breakdown of the estimated 300,000 people in Australia living with chronic hepatitis B and C, revealing significant gaps in diagnosis and care that impede progress on SDG 3, Target 3.3 (end the epidemics of communicable diseases).

• Hepatitis B: 69 out of 100 people are living with hepatitis B.
• Hepatitis C: 24 out of 100 people are living with hepatitis C.
• Co-infections: 4 are living with both hepatitis B and D, and 3 are living with both hepatitis B and C.

A critical finding is that only one in three people with hepatitis B are aware of their status. Furthermore, over half are not receiving the necessary care to monitor their condition, a major barrier to preventing liver disease and cancer.

Addressing Inequalities (SDG 10)

The report exposes significant health inequalities, a core concern of SDG 10 (Reduced Inequalities). The burden of viral hepatitis is not evenly distributed across the population.

• Migrant Populations: 70 out of 100 people with hepatitis B were born overseas, indicating a disproportionate impact on migrant communities who may not be aware of their risk.
• Stigma and Discrimination: Stigma associated with injecting drug use continues to be a barrier to accessing treatment for hepatitis C, even though 84 out of 100 people with the virus either no longer inject drugs or acquired it through other means (e.g., unsafe tattooing, pre-1990 blood transfusions).

These disparities highlight the need for inclusive and equitable health services to ensure no one is left behind.

Progress and Persistent Challenges in Treatment

Hepatitis C Treatment Uptake

While the introduction of direct-acting antiviral cures in 2016 has more than halved the number of people living with hepatitis C, the report notes that the uptake of this cure has declined significantly. This slowdown threatens the national goal of elimination. Many individuals who contracted the virus through non-injecting routes may not perceive themselves as being at risk and are therefore less likely to engage with medical services for testing and treatment.

Hepatitis B Care and Management

For hepatitis B, routine vaccination for those born in Australia since 2000 offers protection. However, this leaves older individuals and those born overseas vulnerable. The report stresses that a majority of those living with the virus are not receiving appropriate monitoring to determine if and when antiviral treatment should commence, failing a key aspect of long-term health management central to SDG 3.

Recommendations for Achieving 2030 Elimination Targets (SDG 17)

A Call for Urgent, Collaborative Action

The report concludes that without urgent and targeted action, Australia will fail to meet its commitment to the World Health Organization’s goal of eliminating viral hepatitis by 2030. Achieving this requires a multi-faceted approach grounded in the principles of SDG 17 (Partnerships for the Goals). The report recommends the following actions:

1. Implement urgent, population-wide testing initiatives.
2. Develop and deploy targeted education campaigns to raise awareness among at-risk groups.
3. Establish culturally safe care pathways to overcome barriers related to stigma and inequality, particularly for migrant communities.

Success is contingent on effective partnerships between government bodies, civil society organizations like Hepatitis Australia, and healthcare providers to ensure equitable access to testing, care, and treatment for all.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s primary focus is on public health, specifically the communicable diseases hepatitis B and C. It discusses diagnosis, treatment, prevention (vaccination), and the consequences of untreated infection, such as liver disease and cancer. The text explicitly mentions Australia’s commitment “to eliminate viral hepatitis by 2030, in line with global WHO targets,” which is a core component of SDG 3.

SDG 10: Reduced Inequalities

• The article highlights significant inequalities in health outcomes and access to care. It points out that “stigma and discrimination” act as barriers to treatment, particularly for people who inject drugs. It also notes a disparity affecting migrant populations, stating that “Most people (70 out of 100) with hepatitis B were born overseas.” David Clune’s personal story of social exclusion due to his diagnosis further illustrates the theme of inequality.

SDG 16: Peace, Justice and Strong Institutions

• This goal is relevant through the personal history of David Clune. His experience of “abuse and neglect” while in state care, being “cycled through eight different homes, three youth detention centres, one adult remand centre and a psychiatric hospital,” points to a failure of institutions responsible for protecting children, which is an aspect of SDG 16.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” This is directly referenced when the article states that without urgent action, “Australia will not meet its commitment to eliminate viral hepatitis by 2030, in line with global WHO targets.”
• Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment…” The article connects hepatitis, a communicable disease, to non-communicable diseases by explaining that without treatment, it “can lead to liver disease and liver cancer.” The availability of a cure and treatment directly contributes to preventing premature mortality from these conditions.
• Target 3.8: “Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The article discusses issues of access to care, noting many people are “disconnected from care” and that the uptake of the hepatitis C cure has “declined ‘significantly'”. It also mentions the introduction of “hepatitis B vaccinations” in 2000 as a key public health measure.

SDG 10: Reduced Inequalities

• Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… origin… or other status.” The article highlights the social exclusion caused by “stigma and discrimination” and points to specific vulnerable groups, such as people who inject drugs and those “born overseas,” who face barriers to care and inclusion.
• Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome…” The report’s finding that “only one in three people living with hepatitis B know they have it, and more than half are not receiving the care they need” demonstrates a clear inequality of outcome in health that needs to be addressed.

SDG 16: Peace, Justice and Strong Institutions

• Target 16.2: “End abuse, exploitation, trafficking and all forms of violence against and torture of children.” David Clune’s backstory of experiencing “abuse and neglect” as a child in state care directly relates to the failure to achieve this target for all children.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• Hepatitis Prevalence/Incidence (Indicator 3.3.4): The article provides statistics that measure the scale of the problem, such as “300,000 people in Australia who live with hepatitis B and hepatitis C” and the breakdown that “69 of those 100 people are living with hepatitis B.” Tracking these numbers is essential for measuring progress toward elimination.
• Diagnosis Rate: The article implies this indicator by stating, “only one in three people living with hepatitis B know they have it.” An increase in this proportion would indicate progress.
• Treatment Coverage Rate: This is clearly implied when the article reports that “more than half [of people with hepatitis B] are not receiving the care they need” and that the “uptake of the [hepatitis C] cure has declined ‘significantly'”. Measuring the percentage of diagnosed individuals receiving treatment is a key indicator.
• Vaccination Coverage (related to Indicator 3.8.1): The article mentions that “people born in Australia since the year 2000 (when hepatitis B vaccinations began being routinely offered) are protected,” implying that vaccination coverage is a key metric for prevention.

Indicators for SDG 10

• Access to Services for Vulnerable Groups: The article points to the need for “culturally safe care pathways” and notes that “stigma and discrimination associated with injecting drug use remains a barrier.” An indicator would be the rate of treatment uptake among specific populations, such as migrants and people who inject drugs, compared to the general population.
• Reports of Discrimination: While not a quantitative figure in the article, the mention of “stigma” as a barrier implies that measuring perceived discrimination in healthcare settings would be a relevant indicator of inequality.

Indicators for SDG 16

• Prevalence of Abuse in Care Systems: David Clune’s story of “abuse and neglect” in state care implies that the number or proportion of children who experience violence or neglect within state institutions is a critical, albeit unstated, indicator for Target 16.2.

4. Table of SDGs, Targets, and Indicators

Source: theguardian.com