tag:theconversation.com,2011:/africa/topics/population-health-6990/articlesPopulation health – The Conversation2024-01-15T20:13:26Ztag:theconversation.com,2011:article/2194892024-01-15T20:13:26Z2024-01-15T20:13:26ZIs economic growth good for our health?<figure><img src="https://images.theconversation.com/files/569373/original/file-20240115-45156-73jxzx.jpg?ixlib=rb-1.1.0&rect=281%2C140%2C6428%2C4255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Given how wealth contributes to health on the personal, individual level, the case for economic growth being good for us might seem intuitive.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/is-economic-growth-good-for-our-health" width="100%" height="400"></iframe>
<p>Is <a href="https://www.investopedia.com/terms/e/economicgrowth.asp">economic growth</a> good for us? Put another way, we know that growing the economy is good for business and for creating jobs. But does it help everyone in society? One way to answer this question is to explore what it does for population health. </p>
<p>Our health is one of the most important aspects of our lives, considering how it affects our everyday comfort and ability to survive. Given how wealth contributes to health <a href="https://doi.org/10.1177/0022146510383498">on the personal, individual level</a>, the case for economic growth might seem intuitive. </p>
<p>However the picture gets murkier when looking at income <em>per capita</em>, where people both rich and poor depend upon a fluctuating economy. </p>
<p>There are also problems of interpretation. Most financial advice includes the disclaimer that the past does not predict the future. The <a href="https://doi.org/10.1093/jhmas/jrr076">same may be true</a> of the relationship between growth and population health. </p>
<h2>Economics and life expectancy</h2>
<p>There is a reliable <a href="https://doi.org/10.1111/ssqu.12638"><em>historical</em> correlation</a> between economic prosperity and trends in life expectancy, which is enough for many scholars to suggest that growth is generally a good thing. However, this is not to say that we can expect continued improvements in health whenever we see economic growth. </p>
<figure class="align-center ">
<img alt="Miniature human figures walking on a bar graph" src="https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569376/original/file-20240115-25-4ycpot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long-term historical trends show a very strong correlation between economic growth and increasing life expectancy.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1007/s42650-023-00072-y">As I argue in a recent paper</a>, a lot of this has to do with how governments understand growth: its purpose, how to get it, what to do with it once it happens.</p>
<p>As a political sociologist and epidemiologist, I understand health as a fundamentally political problem. I am not alone in this; scholars have connected politics to population health <a href="https://doi.org/10.1093/epirev/mxp002">since ancient times</a>. Nor is this an outmoded idea. Far from it. As of the time of this writing, after searching for the terms “politics” and “health” it seems Google has stopped counting at two billion hits.</p>
<h2>Politics and economics</h2>
<p>Economic growth is also a political subject — the inevitable talking point for candidates on the campaign trail. The problem is that too many scholars have come forward with concerns that growth can be <em>bad</em> for our health. </p>
<p>A <a href="https://doi.org/10.4324/9780203994320">classic sociological study published in 1897</a> found that suicide rates spike after sudden improvements in a society’s economic prosperity. <a href="https://doi.org/10.1016/S0167-6296(03)00041-9">Similar observations</a> come a century later, linking growth with an increase in poor health outcomes. There is also evidence that economic growth <a href="https://doi.org/10.1093/bmb/ldh005">harms public health</a> when governments do not plan for it carefully. </p>
<p>And then there is the story as economists tell it. A prevailing economic theory has supported <a href="https://www.investopedia.com/ask/answers/032415/what-are-some-ways-economic-growth-can-be-achieved.asp">tax cuts, trimming budgets, deregulation and other business-friendly policies</a>, but more and more economists are <a href="https://www.nytimes.com/2009/09/06/magazine/06Economic-t.html">recognizing that these tactics</a> can harm societies and <a href="https://www.imf.org/external/pubs/ft/fandd/2016/06/ostry.htm">even pose obstacles to growth</a>. </p>
<p>How, then, can these misgivings be harmonized with the long-term historical trends, which show a very strong correlation between economic growth and increasing life expectancy? This was the question I set out to answer in my recent research.</p>
<p>The answer to whether or not economic growth improves population health seems to be, “It depends.” More precisely, it’s a <em>qualified</em> yes: economic growth promotes health in <em>some</em> respects, for <em>some</em> countries, and <em>only in conjunction with other life-saving priorities</em>. </p>
<h2>Priorities and population health</h2>
<p>Arguably, many growing societies happen to be the same ones that <a href="https://doi.org/10.1111/padr.12141">invested in education</a> and other beneficial infrastructures, which explains the correlation with health. </p>
<figure class="align-center ">
<img alt="Group of graduates standing in a row wearing caps and gowns holding diplomas" src="https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569377/original/file-20240115-230384-62z6aj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Arguably, many growing societies happen to be the same ones that invested in education and other beneficial infrastructures, which explains the correlation with health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>By the same token we cannot expect better health to come from economic growth if the pursuit of growth ends up <a href="https://doi.org/10.1016/j.socscimed.2010.04.002">increasing income inequality</a>. Nor can we expect better health after slashing budgets allocated to key priorities such as education or health care. </p>
<p>Greece, for example, learned a hard lesson about austerity when its cuts to health-care programs for drug users resulted in a <a href="https://doi.org/10.1016/S0140-6736(13)62291-6">steep increase in HIV infections</a>.</p>
<p>And then there is the issue of how health is defined. When looking beyond life expectancy, other patterns emerge. </p>
<p>Medical research has found that economic development worsens cancer rates for example. <a href="https://doi.org/10.1016/j.ecolecon.2017.11.031">One recent study</a> links economic prosperity to higher incidence of most major cancer types. The authors suspect this may be an issue of industrialization, and they have a point. The rise of modern industry came with the innovation of <a href="https://doi.org/10.1016/j.biopha.2007.10.006">innumerable toxic substances</a>, many of which are suspected carcinogens. </p>
<h2>A better way to grow</h2>
<p>Such findings prompt the question of whether there is a better way to grow. For many researchers, the answer is obvious and the case for it clear: Yes. Absolutely.</p>
<p>The takeaway here would seem to be that growth <em>can</em> be good for health. However, it should by design benefit the ordinary citizens it presumes to serve. I and other researchers (including prominent economists like <a href="https://doi.org/10.1016/S0140-6736(99)90363-X">Amartya Sen</a>) agree that systems for education, health care and welfare, which support the everyday Jane, are the very <a href="http://dx.doi.org/10.1080/1464988032000051487">engines of growth</a>. This is because they enhance workforce capability and local purchasing power. They also promote health. </p>
<p>Investing in the systems that support populations — their earnings capability, their quality of life — appear to result in both growth and health. However, neglecting these priorities may well result in neither outcome.</p><img src="https://counter.theconversation.com/content/219489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew C. Patterson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The historical correlation between economic prosperity and increased life expectancy might suggest that growth is generally a good thing. However, other evidence points to the downside of growth.Andrew C. Patterson, Assistant Professor of Sociology, MacEwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952572023-02-22T15:31:47Z2023-02-22T15:31:47ZOver 90% of Rwandans have health insurance – the health minister tells an expert what went right<figure><img src="https://images.theconversation.com/files/498920/original/file-20221205-16-bcm2cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Xinhua/Cyril Ndegeya via Getty Images</span></span></figcaption></figure><p><em>In 2015 the United Nations General Assembly <a href="https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)">adopted</a> universal health coverage as one of the sustainable development goals. The aim of universal health coverage is to ensure that every person and community, irrespective of their circumstances, has access to the health services they need, at the time and place they need it, without the risk of financial devastation. Many countries have committed to the concept, which has resulted in numerous health reforms. The World Health Organization <a href="https://apps.who.int/iris/bitstream/handle/10665/361229/9789290234760-eng.pdf?sequence=1&isAllowed=y">recognises</a> Rwanda as one of the countries that are performing well on the goal of universal health coverage. The <a href="https://southafrica.cochrane.org/">Cochrane Centre</a> summarises and disseminates information on what works and what doesn’t in health care. Professor Charles Shey Wiysonge, director of Cochrane South Africa and senior director at the South African Medical Research Council, spoke to Rwanda’s health minister, Dr Sabin Nsanzimana, about the road map for universal health coverage in the country.</em> </p>
<hr>
<p><strong>Charles Wiysonge:</strong> What does universal health coverage look like in Rwanda? </p>
<p><strong>Sabin Nsanzimana:</strong> In the last decade, calls for increased efforts to achieve universal health coverage have grown. Many countries have committed to universal health coverage – particularly in Africa. This has resulted in numerous health reforms. </p>
<p>Rwanda’s President Paul Kagame was <a href="https://au.int/en/pressreleases/20190209/africas-leaders-gather-launch-new-health-financing-initiative-aimed-closing">appointed</a> by other African heads of state as the leader on domestic health financing in the AU Assembly Declaration in February 2019. The aim of the declaration was to increase investment in health and have member states spend efficiently and effectively to achieve better health outcomes.</p>
<p>In the last couple of decades Rwanda has improved the health and well-being of all its people. This was done through a combination of evidence-based and people-centred strategies and interventions. The country has been able to make the following substantial progress:</p>
<ul>
<li><p>On the supply side, the country has built a healthcare delivery system on primary healthcare. Individuals and communities are at the centre of our actions. The increased number of health facilities <a href="https://www.statistics.gov.rw/publication/1767">(from 1,036 in 2013 to 1,457 in 2020)</a> has improved the geographical accessibility of care. It’s also contributed to the reduction of the average time used by a Rwandan citizen to reach a health facility. The average <a href="https://www.who.int/news-room/feature-stories/detail/rwanda-s-primary-health-care-strategy-improves-access-to-essential-and-life-saving-health-services">time used to reach</a> the nearest health facility has fallen from 95.1 minutes in 2010 to 49.9 minutes in the past 10 years.</p></li>
<li><p>On the demand side, the risk pooling has been greatly improved as a result of the extension of <a href="https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020#:%7E:text=CBHI%20is%20a%20form%20of,setup%20and%20in%20its%20management.">Community-Based Health Insurance schemes</a>. These give the majority of the population access to healthcare services, and improve access to quality services. Insurance has also reduced out-of-pocket expenditures (which are 4% as a share of total health expenditure) in particular for the poor and most vulnerable people. Community-based health insurance covers <a href="https://www.rssb.rw/community-based-health-insurance-scheme-receives-financial-boost-from-ahf">over 85%</a> of the population. The percentage of the population with some kind of <a href="https://dhsprogram.com/pubs/pdf/FR370/FR370.pdf#page=74">health insurance</a> has increased from 43.3% in 2005 to 90.5% in 2020. This has helped to protect households against financial risks associated with sickness.</p></li>
<li><p>The government spending on health (15.6% as of the 2019/2020 financial year) has surpassed the <a href="https://au.int/sites/default/files/pages/32894-file-2001-abuja-declaration.pdf#page=6">15%</a> required under the 2001 Abuja Declaration. This shows the country’s high commitment to the development of health sector financing. </p></li>
</ul>
<p><strong>Charles Wiysonge:</strong> Where are the gaps and why do they exist?</p>
<p><strong>Sabin Nsanzimana:</strong> Progress towards universal health coverage is a continuous process. It responds to shifts in demographic, epidemiological and technological trends as well as people’s socio-economic status and expectations. If Rwanda is to meet the goal of achieving universal health coverage by 2030, we need to be far more ambitious to leave no one behind.</p>
<p>Additional health financing reforms and actions to maintain achieved gains and improve further health outcomes are needed. The fact that the country has achieved close to universal population coverage is in itself a great achievement. But there are still some people who are uninsured. We need to identify policy options to expand coverage to the hard-to-reach population in the informal sector. Health insurance has positively affected the use of services and equity. But further improvements are needed. We must extend the service coverage based on the need and reduce cost-sharing, especially for secondary and tertiary care.</p>
<p>Sustainability of health financing is also a critical issue. It requires finding innovative ways to mobilise domestic resources, adopting better resource pooling mechanisms and an effective strategic purchasing mechanism. These must ensure equity and efficient use of available resource and value for money.</p>
<p><strong>Charles Wiysonge:</strong> What else is needed?</p>
<p><strong>Sabin Nsanzimana:</strong> To move further and deeper towards universal health coverage calls for evidence-based policy reforms that would provide direction for a long-term model for service delivery (focusing on the primary healthcare level) and health financing in Rwanda. This will require adequate awareness among policy decision makers, and increased capacity in those areas and shared understanding of universal health coverage to support the necessary reforms.</p>
<p><strong>Charles Wiysonge:</strong> What can other countries on the continent learn from Rwanda’s experience?</p>
<p><strong>Sabin Nsanzimana:</strong> Strong leadership that sets a clear vision for the future is imperative. Countries need a development model that is inclusive. Such a model must consider gender equality, pro-poor policies, unity and solidarity.</p>
<p>Most important are robust institutions and legal frameworks driven by good governance, with:</p>
<ul>
<li><p>accountability, citizen participation, decentralisation </p></li>
<li><p>results orientation – performance contracts</p></li>
<li><p>investment in human capital – mainly capacity building.</p></li>
</ul><img src="https://counter.theconversation.com/content/195257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Shey Wiysonge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rwanda has built a healthcare delivery system on primary healthcare with individuals and communities at the centre.Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968472023-01-22T13:33:12Z2023-01-22T13:33:12ZHow can health data be used for public benefit? 3 uses that people agree on<figure><img src="https://images.theconversation.com/files/505224/original/file-20230118-11-g3s32x.jpeg?ixlib=rb-1.1.0&rect=118%2C9%2C2929%2C1694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Support for use of health data is conditional on whether the use has public benefits.</span> <span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Health data can include information about health-care services, health status and behaviours, medications and genetic data, in addition to demographic information like age, education and neighbourhood. </p>
<p>These facts and statistics are valuable because they offer insights and information about population health and well-being. However, they can also be sensitive, and there are legitimate public concerns about how these data are used, and by whom. The term “<a href="https://www.hdrn.ca/en/reports/social-licence-uses-health-data-report-public-perspectives">social licence</a>” describes uses of health data that have public support. </p>
<p>Studies performed in <a href="https://doi.org/10.9778/cmajo.20180099">Canada</a>, the <a href="http://dx.doi.org/10.1136/medethics-2014-102374">United Kingdom</a> and <a href="https://doi.org/10.1186/s12910-016-0153-x">internationally</a> have all found public support and social licence for uses of health data that produce public benefits. </p>
<p>However, this support is conditional. Public concerns related to privacy, commercial motives, equity and fairness must be addressed. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a health-care practitioner and a patient discussing a list of medications." src="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505278/original/file-20230119-20-m9gj43.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public support for use of health data is conditional on things like public benefits, attention to privacy and fairness.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our team of health policy researchers set out to build upon prior studies with actionable advice from a group of 20 experienced public and patient advisers. Studies have shown that health data use, sharing and reuse is a complex topic. So we recruited people who already had some knowledge of potential uses of health data through their roles advising research institutions, hospitals, community organizations and governments.</p>
<p>We asked these experienced advisers to exchange views about uses of health data that they supported or opposed. We also gathered participants’ views about requirements for social licence, such as privacy, security and transparency.</p>
<h2>Consensus views</h2>
<p>After hours of facilitated discussion and weeks of reflection, all 20 participants agreed on some applications and uses of health data that are within social licence, and some that are not. </p>
<p>Participants agreed it is within social licence for health data to be used by:</p>
<ul>
<li><p>health-care practitioners — to directly improve the health-care decisions and services provided to a patient.</p></li>
<li><p>governments, health-care facilities and health-system administrators — to understand and improve health care and the health-care system.</p></li>
<li><p>university-based researchers — to understand the drivers of disease and well-being.</p></li>
</ul>
<p>Participants agreed that it is not within social licence for:</p>
<ul>
<li><p>an individual or organization to sell (or re-sell) another person’s identified health data.</p></li>
<li><p>health data to be used for a purpose that has no patient, public or societal benefit.</p></li>
</ul>
<h2>Points of disagreement</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man and a woman sitting at a table with a computer screen" src="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505276/original/file-20230119-26-nlgrh6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The participants also had different views about what constitutes an essential requirement for social licence.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Among other topics, the participants discussed uses of health data about systemically marginalized populations and companies using health data. Though some participants saw benefits from both practices, there was not consensus support for either. </p>
<p>For example, participants were concerned that vulnerable populations could be exploited, and that companies would put profit ahead of public benefits. Participants also worried that if harms were done by companies or to marginalized populations, they could not be “undone.” Several participants expressed skepticism about whether risks could be managed, even if additional safeguards are in place. </p>
<p>The participants also had different views about what constitutes an <a href="https://www.hdrn.ca/sites/default/files/2022-11/Appendix%20C%20-%20Social%20licence%20for%20uses%20of%20health%20data%20-%20HDRN%20Canada%20%26%20GRIIS.docx">essential requirement for social licence</a>. This included discussions about benefits, governance, patient consent and involvement, equity, privacy and transparency. </p>
<p>Collectively, they generated a list of 85 essential requirements, but 38 of those requirements were only seen as essential by one person. There were also cases where some participants actively opposed a requirement that another participant thought was essential. </p>
<h2>Using the findings</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman working with data at a desk" src="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=541&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=541&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=541&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=680&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=680&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505277/original/file-20230119-24-9x1pi1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=680&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Potential benefits of health data use include better patient care, better health system planning and better understanding of disease and wellness.</span>
<span class="attribution"><span class="source">(Brittany Datchko/Graphic Journeys)</span></span>
</figcaption>
</figure>
<p>This work was funded by the Public Health Agency of Canada to inform the <a href="https://www.canada.ca/en/public-health/programs/pan-canadian-health-data-strategy.html">Pan-Canadian Health Data Strategy</a>. In parallel, an <a href="https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-03-toward-world-class-health-data-system.html">expert advisory group for the strategy</a> recommended that one or more public assemblies be established to provide advice and guidance. </p>
<p>We strongly agree with the expert advisory group’s recommendation to “give voice to people” as the Pan-Canadian Health Data Strategy is implemented. </p>
<p>The findings from our work may help focus the work of the Pan-Canadian Health Data Strategy and other initiatives aimed at expanding uses of health data. These initiatives should start by focusing on uses of health data that have clear public support. </p>
<p>We note that there could be many important benefits just from the users of health data that the 20 participants in our project supported: health-care practitioners; governments, health-care facilities and health system administrators; and university-based researchers. These benefits include better patient care, better health system planning, and better understanding of disease and wellness. </p>
<p>Our hope is that the work described in this article will be a step forward in a concerted and continuous effort to identify and act on increasing the uses of health data that members of the public support.</p><img src="https://counter.theconversation.com/content/196847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>P. Alison Paprica receives funding from the Public Health Agency of Canada and national and provincial research funders.</span></em></p><p class="fine-print"><em><span>Annabelle Cumyn participates in a research program that receives funding from CIHR. She is affiliated with the University of Sherbrooke and is a member on the Interagency advisory panel on research ethics. </span></em></p><p class="fine-print"><em><span>Kimberlyn McGrail receives funding from the Public Health Agency of Canada and national and provincial research funders. </span></em></p><p class="fine-print"><em><span>Julia Burt and Roxanne Dault do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are concerns about how health data are used, but research shows support for uses with public benefits by health-care providers, governments, health-system planners and university-based researchers.P. Alison Paprica, Professor (adjunct) and Senior Fellow, Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of TorontoAnnabelle Cumyn, Professor of Medicine, Université de Sherbrooke Julia Burt, Public Engagement Fellow, Faculty of Medicine, Memorial University of NewfoundlandKimberlyn McGrail, Professor of Health Services and Policy Research, University of British ColumbiaRoxanne Dault, Research coordinator, Groupe de recherche interdisciplinaire en informatique de la santé, Université de Sherbrooke Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737392022-01-21T02:39:03Z2022-01-21T02:39:03ZKids whose grandparents are overweight are almost twice as likely to struggle with obesity<figure><img src="https://images.theconversation.com/files/441235/original/file-20220118-25-113hyg.jpg?ixlib=rb-1.1.0&rect=52%2C52%2C6937%2C4380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/happy-grandparents-grandchildren-sitting-desk-600w-646595593.jpg">Shutterstock</a></span></figcaption></figure><p>School holidays can be a special time for extended families to gather. Children may see their grandparents at seasonal gatherings or as part of childcare arrangements to help working parents. New <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">research</a> suggests the biology, environment and the food they share contributes to children’s future health.</p>
<p>According to the World Health Organization, <a href="https://www.who.int/news/item/06-05-2021-the-unicef-who-wb-joint-child-malnutrition-estimates-group-released-new-data-for-2021">39 million children under five years are overweight</a>. Some 25% of Australian children and adolescents <a href="https://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary">are overweight or obese</a>.</p>
<p>How parents contribute to their offspring’s obesity risk is <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2010.00751.x">well established</a> but the link between grandparents and grandchildren has been less clear. Our <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">systematic review</a> of studies involving more than 200,000 people around the world confirms obesity is transmitted across multiple generations of families. We still need to figure out why and how to break this cycle. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-ways-to-get-your-kids-off-the-couch-these-summer-holidays-123918">4 ways to get your kids off the couch these summer holidays</a>
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</em>
</p>
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<h2>Setting up for a lifetime of health issues</h2>
<p>Obesity among children and adolescents is associated with developing health problems. These include high blood pressure, cholesterol imbalance, insulin resistance, diabetes mellitus, accelerated growth and maturity, orthopaedic difficulties, psychosocial problems, increased risk of heart disease and premature mortality. </p>
<p>We examined the current global evidence on the association between grandparents who are overweight or obese and the healthy weight status of their grandchildren. We looked at 25 studies that involved 238,771 people from 17 countries. The combined data confirms obesity is transmitted multigenerationally – not just from parent to child but also from grandparent to grandchild.</p>
<p>We found children whose grandparents are obese or overweight are almost twice as likely to be obese or overweight compared to those whose grandparents are “normal” weight.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-ban-junk-food-in-schools-we-asked-five-experts-131566">Should we ban junk food in schools? We asked five experts</a>
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<h2>Nature and nurture?</h2>
<p>Further research is needed into how children’s obesity status is influenced by their grandparents but there are likely two pathways at work. The influence could be indirect via parents’ genes or occur directly through the roles played by grandparents in children’s upbringing. </p>
<p>Let’s start with biological factors. Both egg and sperm cells <a href="https://www.science.org/doi/full/10.1126/science.aad7977">contain molecules</a> that respond to the nutritional intake of parents. This means traits that are susceptible to high weight gain can be passed on from grandparents to parents and then to their grandchildren. And <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226269/">evidence shows</a> genetics, environmental factors, lifestyle and eating habits all play key roles in predisposing individuals to obesity.</p>
<p>What we eat and feed our family members can lead to the expression of certain genetic traits (a term referred to as epigenetics) which can then be <a href="https://pubmed.ncbi.nlm.nih.gov/27288829/">transferred</a> to successive generations. Due to shared familial, genetic, and environmental factors, obesity tends to aggregate within immediate families and studies have consistently reported an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421118/">intergenerational transmission of obesity</a> from parents to children.</p>
<p>Food intake can also influence health and biology across multiple generations. In Sweden, a <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13405">study reported</a> adequate food for paternal grandparents at ten years of age reduced heart disease and diabetes and increased longevity among their grandchildren.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baking cupcakes pulled from over by adult and child" src="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441236/original/file-20220118-19-b6z91d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Grandparents’ influence on their grandchildren’s obesity risk may be biological or a result of dietary choices.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-grandmother-granddaughter-cooking-on-1037964661">Shutterstock</a></span>
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<h2>Food and family</h2>
<p>So, grandparents’ weight status and choices about what and how much is eaten in their home could influence their grandchildren’s weight directly or via the children’s parents. These influences may be greater or less significant depending on the role grandparents play as primary care givers or in shared living arrangements. According to the recent Australia’s Seniors’ <a href="https://nationalseniors.com.au/research/health-and-aged-care/australian-grandparents-care">survey</a>, one in every four Australian grandparents provides primary care to their grandchildren.</p>
<p>Grandparents’ role as caregivers significantly affects children’s healthy eating knowledge, attitude, and behaviours. This might be seen in the meals shared, recipes passed down or special treats for loved ones. Such habits can add to childhood obesity risks, above and beyond genetic factors. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="family table with older man feeding young child" src="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441237/original/file-20220118-20992-17u4pao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Grandparents regular provide childcare and therefore meals.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/grandpa-feeding-girl-healthy-little-600w-227939680.jpg">Shutterstock</a></span>
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<strong>
Read more:
<a href="https://theconversation.com/more-than-one-in-four-aussie-kids-are-overweight-or-obese-were-failing-them-and-we-need-a-plan-114005">More than one in four Aussie kids are overweight or obese: we're failing them, and we need a plan</a>
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<h2>Working on prevention</h2>
<p>Our research shows the importance of including grandparents in obesity prevention strategies. In addition to parents, grandparents could be oriented to provide guidance on responsible feeding, recognising hunger and fullness, setting limits, offering healthy foods and using repeated exposure to promote acceptance. They can help encourage regular exercise and discourage coercive feeding practices on their grandchildren. </p>
<p>While our study shows a multigenerational link in the transmission of obesity, most of the available evidence comes from high-income countries – predominantly America and European countries. More studies, especially from low-income countries, would be helpful. </p>
<p>Further investigation into the effect of grandparents on grandchildren’s obesity across different races and ethnicities is also needed. Grandparents have varied social and cultural roles in the upbringing of their grandchildren around the world. More data could help design effective obesity prevention programs that recognise the vital importance of grandparents.</p><img src="https://counter.theconversation.com/content/173739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edmund Wedam Kanmiki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p><p class="fine-print"><em><span>Abdullah Mamun receives funding from NHMRC, ARC, Queensland Health, and Health and Wellbeing Queensland. </span></em></p><p class="fine-print"><em><span>Yaqoot Fatima received funding from NHMRC, MRFF, Western Queensland Primary Health Network, Tropical Australian Academic Health Centre, Queensland Health, and Health and Wellbeing Queensland. She is a member of the Indigenous Sleep Health Working Party of the Australasian Sleep Association.</span></em></p>Whether it’s a special treat or family traits, children’s risk of being overweight or obese is strongly linked to their grandparents.Edmund Wedam Kanmiki, PhD Candidate, The University of QueenslandAbdullah Mamun, Associate Professor, The University of QueenslandYaqoot Fatima, Senior Research Fellow, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1559582021-03-07T19:06:50Z2021-03-07T19:06:50ZWill the COVID vaccine make me test positive for the coronavirus? 5 questions about vaccines and COVID testing answered<figure><img src="https://images.theconversation.com/files/387400/original/file-20210303-17-5hxpnk.jpg?ixlib=rb-1.1.0&rect=1%2C10%2C997%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-face-mask-getting-vaccinated-coronavirus-1814780726">from www.shutterstock.com</a></span></figcaption></figure><p>COVID-19 vaccination is rolling out across Australia. So health authorities are keen to <a href="https://coronavirus.nt.gov.au/stay-safe/symptoms-testing/facts-and-myths">dispel myths</a> <a href="https://www.ncirs.org.au/covid-19/covid-19-vaccines-frequently-asked-questions">about the vaccines</a>, including <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html">any impact on COVID testing</a>.</p>
<p>Do the vaccines give you COVID, or make you test positive for COVID? Does the vaccine affect other tests? Do we still need to get COVID tested if we have symptoms, even after getting the shot? And will we still need COVID testing once more of the population gets vaccinated?</p>
<p>We look at the evidence to answer five common questions about the impact of COVID vaccines on testing.</p>
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Read more:
<a href="https://theconversation.com/do-i-need-to-register-for-a-covid-vaccine-how-will-i-know-when-its-my-turn-vaccine-rollout-questions-answered-156041">Do I need to register for a COVID vaccine? How will I know when it's my turn? Vaccine rollout questions answered</a>
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<h2>1. Will the vaccine give me COVID?</h2>
<p>The short answer is “no”. That’s because the vaccines approved for use so far in Australia and elsewhere <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/covid-vaccination-faqs.aspx#sick">don’t contain live COVID virus</a>.</p>
<p>The <a href="https://www.nytimes.com/interactive/2020/health/pfizer-biontech-covid-19-vaccine.html">Pfizer/BioNTech vaccine</a> contains an artificially generated portion of viral mRNA (messenger ribonucleic acid). This carries the specific genetic instructions for your body to make the coronavirus’s “spike protein”, against which your body mounts a protective immune response.</p>
<p>The AstraZeneca vaccine uses a different technology. It packages viral DNA into a <a href="https://www.nytimes.com/interactive/2020/health/oxford-astrazeneca-covid-19-vaccine.html">viral vector “carrier” based on a chimpanzee adenovirus</a>. When this is delivered into your arm, the DNA prompts your body to produce the spike protein, again stimulating an immune response.</p>
<p>Any vaccine side-effects, such as fever or feeling fatigued, <a href="https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-after-your-covid-19-vaccination-covid-19-vaccination-after-your-covid-19-vaccination.pdf">are usually mild and temporary</a>. These are signs the vaccines are working to boost your immune system, rather than signs of COVID itself. These symptoms are also <a href="https://immunisationhandbook.health.gov.au/resources/handbook-tables/table-common-side-effects-following-immunisation-for-vaccines-used-in-the">common after routine vaccines</a>.</p>
<h2>2. Will the COVID vaccine make me test positive?</h2>
<p>No, a COVID vaccine <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021">will not affect the results</a> of a diagnostic COVID test.</p>
<p>The current gold-standard diagnostic test is <a href="https://www.tga.gov.au/covid-19-testing-australia-information-health-professionals">known as nucleic acid PCR testing</a>. This looks for the mRNA (genetic material) of SARS-CoV-2, the virus that causes COVID-19. This is a marker of current infection.</p>
<p>This is the test the vast majority of people have when they line up at a drive-through testing clinic, or attend a COVID clinic at their local hospital.</p>
<p>Yes, the Pfizer vaccine contains mRNA. But the <a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">mRNA it uses</a> is only a small part of the entire viral RNA. It also cannot make copies of itself, which would be needed for it to be in sufficient quantity to be detected. So it cannot be detected by a PCR test. </p>
<p>The AstraZeneca vaccine also only contains part of the DNA <a href="https://vk.ovg.ox.ac.uk/vk/covid-19-vaccines">but is inserted</a> in an adenovirus carrier that cannot replicate so cannot give you infection or a positive PCR test.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">How mRNA vaccines from Pfizer and Moderna work, why they're a breakthrough and why they need to be kept so cold</a>
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</p>
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<h2>3. How about antibody testing?</h2>
<p>While PCR testing is used to look for current infection, antibody testing — also known as <a href="https://www.cdc.gov/coronavirus/2019-ncov/lab/serology-testing.html">serology testing</a> — picks up past infections.</p>
<p>Laboratories look to see if your immune system has <a href="https://theconversation.com/antibody-tests-to-get-a-grip-on-coronavirus-we-need-to-know-whos-already-had-it-134547">raised antibodies</a> against the coronavirus, a sign your body has been exposed to it. As it takes time for antibodies to develop, testing <a href="https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests.html">positive</a> with an antibody test may indicate you were infected weeks or months ago. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1366380200720621579"}"></div></p>
<p>But your body also produces antibodies as a response to vaccination. That’s the way it can recognise SARS-CoV-2, the next time it meets it, to protect you from severe COVID.</p>
<p>So as COVID vaccines are rolled out, and people develop a vaccine-induced antibody response, <a href="https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html">it may become difficult</a> to differentiate between someone who has had COVID in the past and someone who was vaccinated a month ago. But this will depend on the serology test used. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/antibody-tests-to-get-a-grip-on-coronavirus-we-need-to-know-whos-already-had-it-134547">Antibody tests: to get a grip on coronavirus, we need to know who's already had it</a>
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<p>The good news is that antibody testing is not nearly as common as PCR testing. And it’s only ordered under limited and rare circumstances.</p>
<p>For instance, when someone tests positive with PCR, but they are a <a href="https://theconversation.com/why-cant-we-use-antibody-tests-for-diagnosing-covid-19-yet-138519">false positive due to the characteristics of the test</a>, or have fragments of virus lingering in the respiratory tract from an old infection, public health experts might request an antibody test to see whether that person was infected in the past. They might also order an antibody test <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm">during contact tracing</a> of cases with an unknown source of infection.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-cant-we-use-antibody-tests-for-diagnosing-covid-19-yet-138519">Why can't we use antibody tests for diagnosing COVID-19 yet?</a>
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<h2>4. If I get vaccinated, do I still need a COVID test if I have symptoms?</h2>
<p>Yes, we will continue to test for COVID as long as the virus is circulating anywhere in the world.</p>
<p>Even though the COVID vaccines are looking promising in preventing people from getting seriously sick or dying, they won’t provide 100% protection. </p>
<p><a href="https://www.nejm.org/doi/10.1056/NEJMoa2101765">Real-world data</a> suggests some vaccinated people can still catch the virus, but they usually only get mild disease. We are unsure whether vaccinated people will be able to <a href="https://theconversation.com/can-vaccinated-people-still-spread-the-coronavirus-155095">potentially pass it to others</a>, even if they don’t have any symptoms. So it’s important people continue to get tested.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="COVID-19 testing sign" src="https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387902/original/file-20210304-24-axm8pz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s important people still get tested if they have symptoms, even after having the vaccine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hobart-tasmania-australia-april-18th-2020-1711813849">Kristen Sadler/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Furthermore, not everyone will be eligible to receive a COVID-19 vaccine. For instance, in Australia, <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021">current guidelines</a> exclude people under 16 years of age, and those who are allergic to ingredients in the vaccine. And although pregnant women are not ruled out from receiving the vaccine, it is not routinely recommended. This means a proportion of the population will remain susceptible to catching the virus.</p>
<p>We also are unsure about how effective vaccines will be against <a href="https://jamanetwork.com/journals/jama/fullarticle/2775006">emerging SARS-CoV-2 variants</a>. So we will continue to test to ensure people are not infected with these strains.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/uk-south-african-brazilian-a-virologist-explains-each-covid-variant-and-what-they-mean-for-the-pandemic-154547">UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic</a>
</strong>
</em>
</p>
<hr>
<p>We know testing, detecting new cases early and contact tracing are the core components of the public health response to COVID, and will continue to be a priority from a public health perspective.</p>
<p>Minimum numbers of daily COVID tests are also needed so we can be confident the virus is not circulating in the community. As an example, New South Wales <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/clinics-guidelines.aspx">aims for 8,000 or more tests</a> a day to maintain this peace of mind.</p>
<p>Continued vigilance and high rates of testing for COVID will also be important as we enter the flu season. That’s because the only way to differentiate between COVID and influenza (or any other respiratory infection) is via testing.</p>
<h2>5. Will testing for COVID stop as time goes on?</h2>
<p>It is unlikely our approach to COVID testing will change in the immediate future. However, as COVID vaccines are rolled out and since COVID is likely to become <a href="https://theconversation.com/coronavirus-might-become-endemic-heres-how-153572">endemic</a> and stay with us for a long time, the acute response phase to the pandemic will end. </p>
<p>So COVID testing may become part of managing other infectious diseases and part of how we respond to other ongoing health priorities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-might-become-endemic-heres-how-153572">Coronavirus might become endemic – here's how</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/155958/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meru Sheel receives funding from the Westpac Scholars Trust.</span></em></p><p class="fine-print"><em><span>Nothing to disclose.</span></em></p><p class="fine-print"><em><span>Charlee J Law does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even if you’re vaccinated, you still need to come forward for COVID testing, even if you have the mildest symptoms.Meru Sheel, Epidemiologist | Senior Research Fellow, Australian National UniversityCharlee J Law, Epidemiologist | Research Associate, Australian National UniversityCyra Patel, PhD candidate, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505442020-11-30T03:45:15Z2020-11-30T03:45:15ZWe modelled how a COVID vaccine roll-out would work. Here’s what we found<figure><img src="https://images.theconversation.com/files/371408/original/file-20201125-25-i4au1s.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C1000%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/truck-on-fast-express-road-motion-320983172">Shutterstock</a></span></figcaption></figure><p>How well we distribute and administer a COVID-19 vaccine will have massive health, social and economic ramifications. So attention is turning to vaccine supply chains and logistics.</p>
<p>Designing how best to vaccinate billions of people worldwide is complex. This is particularly so for large countries, such as Australia, where <a href="https://theconversation.com/creating-a-covid-19-vaccine-is-only-the-first-step-itll-take-years-to-manufacture-and-distribute-144352">distributing vaccine</a> to rural and remote areas is needed.</p>
<p>Despite numerous past pandemics and epidemics, very few studies globally have tackled the problem of designing and building an efficient vaccine distribution network. <a href="https://link.springer.com/content/pdf/10.1007/s10729-012-9199-6.pdf">Existing</a> <a href="https://www.sciencedirect.com/science/article/pii/S1366554520306189">studies</a> have also not fully considered all factors affecting vaccine distribution.</p>
<p>So our team designed a mathematical model to test different scenarios for COVID-19 vaccine distribution, which we have submitted for publication.</p>
<h2>What we took into account</h2>
<p>Our model looked at different ways to distribute COVID vaccine to 6.9 million Victorians, based on the number of residents <a href="https://www.abs.gov.au/statistics/people/population/population-projections-australia/latest-release">predicted in 2021</a>.</p>
<p>We modelled this using distribution via the <a href="https://discover.data.vic.gov.au/dataset/hospital-locations-spatial">state’s 325 medical centres</a>, which can be everything from big city hospitals to small medical centres in regional areas.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map of medical centres in Victoria" src="https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371419/original/file-20201126-17-p9fy0a.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This map shows the location and capacity of the 325 medical centres in Victoria, using data from Victoria’s health department.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We assumed most vaccine distribution would be by road and enough <a href="https://theconversation.com/keeping-coronavirus-vaccines-at-subzero-temperatures-during-distribution-will-be-hard-but-likely-key-to-ending-pandemic-146071">refrigerated vehicles</a> would be available.</p>
<p>We also factored into our model that certain sections of the community are at increased risk of exposure (for instance, city dwellers) and others are more susceptible to infection (for instance, aged-care residents and health-care workers). These people are not uniformly distributed around the state, affecting vaccine distribution logistics.</p>
<p>We then tested different scenarios to see how long vaccination would take.</p>
<p>Our research shows we need three key factors for success.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scientific-modelling-is-steering-our-response-to-coronavirus-but-what-is-scientific-modelling-135938">Scientific modelling is steering our response to coronavirus. But what is scientific modelling?</a>
</strong>
</em>
</p>
<hr>
<h2>1. Medical centres need to be big enough</h2>
<p>We calculated that if the capacity of the 325 medical centres is large enough, and if enough vaccine is available, the entire population of Victoria can be vaccinated within 60 days.</p>
<p>By capacity we mean the maximum number of vaccine doses each medical centre can administer. And this capacity depends on a range of factors including centres’ physical size, and having enough staff to administer vaccines.</p>
<p>This time frame or “target horizon” is the total number of days to vaccinate the population of Victoria. Although we have calculated this is possible within 60 days, the state or federal government will actually set this target.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/creating-a-covid-19-vaccine-is-only-the-first-step-itll-take-years-to-manufacture-and-distribute-144352">Creating a COVID-19 vaccine is only the first step. It'll take years to manufacture and distribute</a>
</strong>
</em>
</p>
<hr>
<p>To vaccinate all Victorians in 60 days, we calculated we would need a minimum of roughly 9,500 vaccine packs with 12 vaccines per pack, every day. This assumes one shot per person and adequate vaccines are available. A limited supply or a disruption to supplies might increase the administration period beyond 60 days.</p>
<p>If medical centres run at reduced capacity or existing capacity is not enough, this also increases the time taken to vaccinate. Conversely, if the aim is to vaccinate Victorians in under 60 days, our model suggests we need to boost our capacity to vaccinate.</p>
<p>This could be by using mobile vaccination units or hiring extra staff.</p>
<h2>2. Vaccines need to be shipped between medical centres</h2>
<p>We also show the importance of transporting vaccines between medical centres, known as transhipment. This allows medical centres short on vaccine to obtain doses from the nearest medical centres with extra supply.</p>
<p>Transhipment is also crucial when it comes to vaccinating the most vulnerable people. That’s because we can transfer vaccines from medical centres serving less-vulnerable populations to those with more residents in higher priority groups. Transhipment also allows us to transfer vaccines from areas with less exposure to areas of higher exposure. And it allows vaccines to reach remote areas.</p>
<p>However, transhipment places extra burden on road transport networks.</p>
<h2>3. Vaccine packs need to be the right size</h2>
<p>We also show it is important to get the vaccine pack size right. This seemingly minor detail had a significant effect on the overall period of vaccine administration.</p>
<p>We considered pack sizes that contain 5, 12, 20, 30 and 50 vaccines. Larger pack size significantly increases the need for transhipment between medical centres. That’s because larger packs would need to be broken up into smaller portions, then distributed to multiple medical centres.</p>
<p>We suggest governmental agencies carefully evaluate vaccine pack size when contracting and negotiating with vaccine manufacturers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/keeping-coronavirus-vaccines-at-subzero-temperatures-during-distribution-will-be-hard-but-likely-key-to-ending-pandemic-146071">Keeping coronavirus vaccines at subzero temperatures during distribution will be hard, but likely key to ending pandemic</a>
</strong>
</em>
</p>
<hr>
<h2>This is relevant to all Australia</h2>
<p>While we used Victoria as a case study, we can apply our model to other states and territories. </p>
<p>In particular, the importance of pack size, transhipment between medical centres, and considering extra capacity to vaccinate in a shorter amount of time will apply in every context. </p>
<p>Certainly, the results for other states and territories will depend on their number of available medical centres, population size and population distribution.</p>
<p>Our model helps decision makers strike a balance between the cost of building extra capacity to try to achieve population vaccination in a given time scale or accepting a less costly approach that takes more time.</p><img src="https://counter.theconversation.com/content/150544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’re on the road again. Getting enough COVID-19 vaccine to where it’s needed in a given time frame is the next logistical hurdle.Olga Kokshagina, Researcher - Innovation & Entrepreneurship, RMIT UniversityBabak Abbasi, Professor, Head of Department, Information Systems, RMIT UniversityMasih Fadaki, Lecturer, Supply Chain Management, RMIT UniversityNaima Saeed, Associate Professor of Supply Chain Management, University of AgderPrem Chhetri, Professor, Director, Global Supply Chain and Logistics Research Priority Area, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1489012020-10-28T18:04:29Z2020-10-28T18:04:29ZPeople’s bodies now run cooler than ‘normal’ – even in the Bolivian Amazon<figure><img src="https://images.theconversation.com/files/365866/original/file-20201027-15-1w7gjj0.jpg?ixlib=rb-1.1.0&rect=51%2C111%2C1377%2C959&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tsimane children look out over the Maniqui River, in the Bolivian Amazon.</span> <span class="attribution"><span class="source">Michael Gurven</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Feeling under the weather? Chances are you or your doctor will grab a thermometer, take your temperature and hope for the familiar 98.6 degrees Fahrenheit (37 degrees Celsius) everyone recognizes as “normal.” </p>
<p>But what is normal and why does it matter? Despite the fixation on 98.6 F, clinicians recognize that there is no single universal “normal” body temperature for everyone at all times. Throughout the day, <a href="https://doi.org/10.1001/jama.1992.03490120092034">your body temperature can vary</a> by as much as 1 F, at its lowest in the early morning and highest in the late afternoon. It changes when you are sick, goes up during and after exercise, varies across the menstrual cycle and <a href="https://doi.org/10.1136/bmj.j5468">varies between individuals</a>. It also tends to <a href="https://doi.org/10.1093/ofid/ofz032">decline with age</a>. </p>
<p>In other words, body temperature is an indicator of what’s going on within your body, like a metabolic thermostat. </p>
<p>An intriguing study from 2020 found that normal body temperature is about 97.5 F in Americans – at least those in Palo Alto, California, where the researchers took hundreds of thousands of temperature readings. That meant that in the U.S., <a href="https://doi.org/10.7554/eLife.49555">normal body temperature has been dropping over the past 150 years</a>. People run cooler today than they did two centuries ago. </p>
<p>The 98.6 F standard for “<a href="https://theconversation.com/normal-human-body-temperature-is-a-range-around-98-6-f-a-physiologist-explains-why-139270">normal body temperature</a>” was first established by the German physician Carl Wunderlich in 1867 after studying 25,000 people in Leipzig. But anecdotally, lower body temperatures in healthy adults have been widely reported. And a <a href="https://doi.org/10.1136/bmj.j5468">study in 2017 among 35,000 adults</a> in the U.K. observed a lower average body temperature of 97.9 F.</p>
<p>What might cause these subtle but important changes? And are these provocative hints of changes in human physiology occurring only in urban, industrialized settings like the U.S. and U.K.? </p>
<p>One leading hypothesis is that thanks to improved hygiene, sanitation and medical treatment, people today experience fewer of the infections that would trigger higher body temperatures. <a href="https://advances.sciencemag.org/lookup/doi/10.1126/sciadv.abc6599">In our study</a>, we were able to test that idea directly in a unique setting: among Tsimane horticulturalist-foragers of the Bolivian Amazon.</p>
<h2>Tracking temperature in the Tsimane</h2>
<p>The Tsimane live in a remote area with little access to modern amenities, and we know from firsthand experience that infections are common – from the common cold to intestinal worms to tuberculosis. Having worked with the Tsimane studying a variety of <a href="https://doi.org/10.1002/evan.21515">topics related to health and aging for two decades</a>, our team had a rich opportunity to observe whether body temperatures were similarly declining in this tropical environment where infections are common.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical workers interview a Tsimane woman" src="https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365863/original/file-20201027-19-eb3gw2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tsimane Health and Life History Project physician Karen Arce Ardaya and research assistant Juana Bani Cuata interview a Tsimane woman about recent illnesses during a medical checkup in 2007.</span>
<span class="attribution"><span class="source">Michael Gurven</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>As part of our ongoing <a href="http://tsimane.anth.ucsb.edu">Tsimane Health and Life History Project</a>, a mobile team of Bolivian physicians and researchers has been traveling from village to village monitoring health while treating patients. They record clinical diagnoses and lab measures of infection at each patient visit.</p>
<p>When we first started working in Bolivia back in 2002, Tsimane body temperatures were similar to what was found in Germany <a href="https://doi.org/10.7554/eLife.49555">and the U.S.</a> two centuries ago: averaging at 98.6 F. But over a relatively short period of 16 years, we observed a rapid decline in average body temperature in this population. The decline is steep: 0.09 F per year. Today Tsimane body temperatures are roughly 97.7 F.</p>
<p>In other words, in less than two decades we’re seeing about the same level of decline as that observed in the U.S. over approximately two centuries. We can say this with confidence, as our analysis is based on a large sample (about 18,000 observations of almost 5,500 adults), and we statistically control for multiple other factors that might affect body temperature, like ambient temperature and body mass. </p>
<p>More importantly, while having certain ailments, like respiratory or skin infections, was associated with higher body temperature during a medical visit, adjusting for these infections did not account for the steep decline in body temperature over time. </p>
<h2>A clear drop, unclear why</h2>
<p>So why have body temperatures decreased over time, both for Americans and Tsimane? Fortunately, we had data available from our long-term research in Bolivia to address some possibilities.</p>
<p>For example, declines might be due to the rise of modern health care and lower rates of lingering mild infections now compared to in the past. But while it may be the case that <a href="https://www.prb.org/bolivia/">health has generally improved in Bolivia</a> over the past two decades, infections are still widespread among the Tsimane. Our results suggest that reduced incidence of infection alone can’t explain the observed body temperature declines. </p>
<p>It could be that people are in better condition, and so their bodies don’t need to work as hard to fight infection. Or more access to antibiotics and other treatments means that duration of infection is lower now than in the past. It’s also possible that greater use of certain medications like ibuprofen or aspirin may reduce inflammation and be reflected in the lower temperatures. However, while lab measures of system-wide inflammation were associated with higher body temperature during patient visits, accounting for this in our analyses did not affect our estimate of the amount that body temperature declined per year.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tsimane man and boys after fishing." src="https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365865/original/file-20201027-21-xltuuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A Tsimane man and his sons return with a productive harvest of vonej fish.</span>
<span class="attribution"><span class="source">Michael Gurven</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Another possible explanation for the historical declines in body temperature is that bodies now don’t need to work as much to regulate internal body temperature because of air conditioners in the summer and heaters in the winter. While Tsimane body temperatures do change with the time of year and weather patterns, the Tsimane don’t use any advanced technology to regulate their body temperature. They do, however, have more access to clothes and blankets than they previously did.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Understanding why body temperatures are declining remains an open question for scientists to explore. Whatever the reason, though, we can confirm that body temperatures are below 98.6 F outside of places like the U.S. and U.K. – even in rural and tropical areas with minimal public health infrastructure, where infections are still the major killers.</p>
<p>We hope that our findings inspire more studies about how improved conditions might lower body temperature. As it’s fast and easy to measure, body temperature might one day prove to be a simple but useful indicator, like life expectancy, that provides new insight into population health.</p><img src="https://counter.theconversation.com/content/148901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Gurven receives funding from National Institutes of Health / National Institute on Aging. </span></em></p><p class="fine-print"><em><span>Thomas Kraft does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Normal’ body temperature has declined in urban, industrialized settings like the US and UK. Anthropologists find the trend extends to Indigenous people in the Bolivian Amazon – but why?Michael Gurven, Professor of Anthropology, University of California, Santa BarbaraThomas Kraft, Postdoctoral Scholar in Anthropology, University of California, Santa BarbaraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1446112020-08-31T15:32:30Z2020-08-31T15:32:30ZAfrican health research needs support: here’s one programme that’s working<figure><img src="https://images.theconversation.com/files/354623/original/file-20200825-18-7wce1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Investment health-related research is not adequate.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>African countries bear a disproportionate burden of infectious and noncommunicable diseases. More than <a href="https://www.who.int/news-room/fact-sheets/detail/hiv-aids">two thirds</a> of people living with HIV are in sub-Saharan Africa. It’s estimated that <a href="https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">over 85% of deaths</a> due to noncommunicable diseases are in low- and middle-income countries.</p>
<p>To help solve these health problems, academic institutions need stronger research capacity. </p>
<p>But the continent continues to lag behind other regions in research output. Less <a href="https://www.elsevier.com/connect/africa-generates-less-than-1-of-the-worlds-research-data-analytics-can-change-that#:%7E:text=Africa%20generates%20less%20than%201,data%20analytics%20can%20change%20that&text=Stories%20keeping%20journal%20authors%20in,industry%20developments%2C%20support%20and%20training">than 1%</a> of the world’s research is produced in Africa. </p>
<p>Investment in the capacity to do health-related research is not yet adequate. But this is gradually changing. One example is the <a href="https://wellcome.ac.uk/press-release/african-institutions-lead-international-consortia-%C2%A330-million-initiative">African Institutions Initiative</a>, a pan-African consortium that seeks to develop institutional capacity for research. Other investments have been made through the <a href="https://www.aasciences.africa/aesa/programmes/developing-excellence-leadership-training-and-science-africa-deltas-africa#grantees">DELTAS Africa programme</a>. The programme aims to produce researchers who can publish and lead locally relevant research to make an impact on health science, policy and practice. Another example is the Human Heredity and Health in Africa <a href="https://h3africa.org/">(H3Africa)</a> consortium, which empowers African researchers to be competitive in genomic science. </p>
<p>These investments should help health authorities to monitor population health, plan, allocate resources, innovate and deal with threats like epidemics.</p>
<p>In this article we look at one such investment and its contribution to the African population health research agenda. </p>
<p>We did an <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09147-w">assessment</a> of the Consortium for Advanced Research Training in Africa (<a href="http://cartafrica.org/">CARTA</a>). Our findings suggest that CARTA is successful in building high-level capacity for research related to public and population health in Africa. It is making a contribution to the emergence of a vibrant African academy able to lead world-class multidisciplinary research that makes a positive impact on health.</p>
<h2>Capacity building</h2>
<p>CARTA was launched in 2008. The aim is to develop sustainable health research capacity on the continent by training PhD fellows in public and population health and promoting research supportive environments. </p>
<p>More than 290 fellows from seven countries have taken part in the programme.
Fellows admitted by the consortium have produced over 800 peer-reviewed academic articles. Their subject areas have included infectious diseases, maternal and child health, sexual and reproductive health and other topics of public and population health significance. </p>
<p>These research areas are in line with the burden of disease and health system challenges in the region. An analysis of the output of CARTA fellows also sheds light on the status and capacity for public and population health research in African countries. </p>
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Read more:
<a href="https://theconversation.com/want-to-solve-complex-health-issues-train-scholars-to-think-across-disciplines-92188">Want to solve complex health issues? Train scholars to think across disciplines</a>
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<p>Our analysis also highlighted research gaps and made recommendations for future research.</p>
<p>The research into noncommunicable diseases was less extensive than the number of studies conducted on TB and HIV. This is despite the increased number of noncommunicable diseases being recorded in African countries. Considering the high burden of neglected tropical diseases in sub-Saharan Africa, there were also very few papers in this area. </p>
<p>The same trend was observed in infectious diseases like hepatitis B and C, despite the substantial burden of these diseases. Only a few fellows researched violence and injury. There were no studies on mental health and substance abuse among children and adolescents, despite their correlation and burden. </p>
<p>The growing number of articles published by CARTA fellows contributes to improved health research output of African academic and research institutions. Such contextually focused research could provide appropriate evidence-based information to guide policies and decisions aimed at addressing current disease burdens and future epidemics in Africa.</p>
<h2>The way forward</h2>
<p>Countries with low research output need to keep developing capacity. This can be done by training more PhDs and creating environments that enable research.</p>
<p>African governments should support capacity-building initiatives by prioritising research funding and considering the needs of young researchers. These investments can result in innovations that can help to solve public health problems. Such efforts should take into consideration the direct cost of such initiatives and the significant in-kind contributions of <a href="https://gh.bmj.com/content/bmjgh/5/6/e002286.full.pdf">African institutions and governments</a>. </p>
<p>Routine audits of the scope of research topics pursued by scientists must be done to ensure that neglected topics of developmental significance are being explored. </p>
<p>Capacity building activities by the current actors should include developing skills for knowledge translation. This will help to promote appropriate dissemination and use of emerging evidence to resolve persistent population and health challenges.</p><img src="https://counter.theconversation.com/content/144611/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jude Igumbor has previously held positions and undertaken research activities supported by organisations such as CDC; USAID; Atlantic Philanthropies; Medtronic Foundation, Johnson and Johnson, Comic Relief, Wellcome Trust, among others. </span></em></p>Less than 1% of the world’s research is produced in Africa.Jude Igumbor, Associate professor, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1371702020-04-30T06:32:27Z2020-04-30T06:32:27ZWe need to flatten the ‘other’ coronavirus curve, our looming mental health crisis<figure><img src="https://images.theconversation.com/files/331622/original/file-20200430-42935-r3h1ie.jpg?ixlib=rb-1.1.0&rect=5%2C5%2C992%2C553&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/exhausted-young-mum-sit-on-couch-1660546066">Shutterstock</a></span></figcaption></figure><p>The battle against the mental health consequences of the coronavirus pandemic is just beginning. <a href="https://www.abc.net.au/radionational/programs/breakfast/a-mental-health-response-plan-for-life-after-the-pandemic/12199906">Governments</a> and <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30168-1/fulltext">researchers</a> are mapping how best to prevent the predicted rise in mental health issues we face in coming months and beyond. </p>
<p>This involves not only preventing a wave of mental disorders from starting but also preventing increased difficulties in people already living with poor mental health.</p>
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<strong>
Read more:
<a href="https://theconversation.com/cant-sleep-and-feeling-anxious-about-coronavirus-youre-not-alone-134407">Can't sleep and feeling anxious about coronavirus? You're not alone</a>
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<p>Is <a href="https://www.abc.net.au/radionational/programs/breakfast/a-mental-health-response-plan-for-life-after-the-pandemic/12199906">more outreach the answer</a>, where mental health teams proactively go into the community to visit people in their homes?</p>
<p>Do we best focus on social policies and economic support to ease the financial and mental health pressure of job losses, isolation and increased stress?</p>
<p>What other evidence-based ways of flattening the mental health curve are there? And once these services start, how do we make sure <a href="https://www.abc.net.au/news/2020-04-29/mental-health-coronavirus-impact-beyond-blue/12196922">people actually use them</a>?</p>
<h2>Here’s what we face</h2>
<p>People are already reporting psychological distress during the pandemic. And we’re
just starting to collect Australian data. One preliminary study <a href="https://www.abc.net.au/news/2020-04-18/mental-health-and-coronavirus-how-australia-is-reacting-covid19/12159750">shows</a> about 30% of survey participants have moderate to high levels of anxiety and depression. <a href="https://www.blackdoginstitute.org.au/research/participate-in-our-research/for-people-without-a-mental-illness/mental-health-and-coronavirus-study">More</a> <a href="http://www.swinburne.edu.au/news/latest-news/2020/04/new-research-to-uncover-the-effects-of-covid-19-on-mental-health-in-australia.php">Australian surveys are</a> <a href="https://lens.monash.edu/@medicine-health/2020/04/08/1380027/how-are-you-living-with-covid-19-restrictions-in-australia">underway</a>.</p>
<p>Without this urgently needed data, we cannot model the likely increase in mental health burden that lies ahead, and the impact various measures could have.</p>
<h2>Flattening the mental health curve</h2>
<p>The “two-pronged” approach Australia is using to deal with the virus – preventing transmission and ramping up our health-care system to cope – also provides an excellent blueprint for managing the pandemic’s mental health impacts. </p>
<p>We need to focus on preventing new cases of mental disorders <em>and</em> we need to increase the capacity of our mental health-care system to manage any increase in people needing help.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331279/original/file-20200429-51489-g4f5xj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Here’s what we need to do to flatten the ‘other’ curve of mental health problems, to minimise distress and make sure our health system can cope.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>The federal government has <a href="https://www.health.gov.au/sites/default/files/documents/2020/03/covid-19-national-health-plan-supporting-the-mental-health-of-australians-through-the-coronavirus-pandemic.pdf">taken steps</a> to increase the capacity of our mental health-care system. </p>
<p>These have included introducing Medicare items for telehealth mental health consultations, boosting existing phone and online support services for the public and frontline health workers, and extending access to some psychosocial support services for mental health clients in the community.</p>
<p>While these measures are vital, on their own they will not flatten the mental health curve. These services can help people recover once they have developed a mental disorder, but they do not prevent these conditions in the first place. </p>
<h2>Some current policies are likely to help and need to continue</h2>
<p>Federal government action to support people through the economic shocks of COVID-19 – including <a href="https://theconversation.com/despite-huge-coronavirus-stimulus-package-the-government-might-still-need-to-pay-more-136503">JobSeeker and JobKeeper</a> payments, measures to reduce financial stress on mortgage holders and renters – will be crucial in flattening the mental health curve. </p>
<p>These policies must be kept in place for as long as possible if they are to prevent mental ill-health in the coming months and years. That’s because the links between <a href="https://theconversation.com/unemployed-and-at-risk-more-help-needed-for-those-out-of-work-52968">unemployment</a> or <a href="https://academic.oup.com/eurpub/article/23/1/108/464719?sid=a0014e13-8d72-4a5f-a3a6-bfdf1d0029b6">financial stress</a> and mental health conditions are significant.</p>
<hr>
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<strong>
Read more:
<a href="https://theconversation.com/90-out-of-work-with-one-weeks-notice-these-8-charts-show-the-unemployment-impacts-of-coronavirus-in-australia-136946">90% out of work with one week’s notice. These 8 charts show the unemployment impacts of coronavirus in Australia</a>
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<p>The government also needs to address some of the underlying issues that are key <a href="https://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/">social determinants of mental health</a> – to ensure equitable access to education, employment, and income and housing security – in the longer term (and beyond the current crisis).</p>
<p>This is vital if <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=14&ved=2ahUKEwiFoNmE_o7pAhUjg-YKHa6-C6cQFjANegQIBRAB&url=https%3A%2F%2Fwww.vichealth.vic.gov.au%2F%7E%2Fmedia%2Fresourcecentre%2Fpublicationsandresources%2Fhealth%2520inequalities%2Ffair%2520foundations%2Ffull%2520reviews%2Fhealthequity_mental-wellbeing-evidence-review.pdf%3Fla%3Den&usg=AOvVaw2E2e_YEDrDTqbkDaoldHF2">we are to address</a> the higher rates of mental ill-health in less advantaged people.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-in-4-people-with-a-mental-illness-develop-symptoms-before-age-25-we-need-a-stronger-focus-on-prevention-126180">3 in 4 people with a mental illness develop symptoms before age 25. We need a stronger focus on prevention</a>
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<p>We already have <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30057-9/fulltext">good</a> <a href="https://jhu.pure.elsevier.com/en/publications/recent-advances-in-the-prevention-of-mental-disorders">evidence</a> of the types of programs that prevent mental ill-health.</p>
<p>These programs can help counteract the impact of risk factors for mental ill-health that have escalated during the pandemic, such as <a href="https://theconversation.com/social-distancing-can-make-you-lonely-heres-how-to-stay-connected-when-youre-in-lockdown-133693">social isolation</a>, <a href="https://theconversation.com/try-these-8-tips-to-reduce-parenting-stress-during-the-coronavirus-pandemic-136381">parenting stress</a>, <a href="https://theconversation.com/covid-19-has-laid-bare-how-much-we-value-womens-work-and-how-little-we-pay-for-it-136042">workplace stress</a>, <a href="https://theconversation.com/how-coronavirus-has-transformed-the-grieving-process-136368">grief and loss</a>, and <a href="https://theconversation.com/what-governments-can-do-about-the-increase-in-family-violence-due-to-coronavirus-135674">family violence</a>.</p>
<p>So the federal government should consider a second mental health funding package to scale them up.</p>
<p>Here’s what the evidence says helps prevent mental ill-health in two major groups.</p>
<h2>Children, young people, their parents and carers</h2>
<p>The mental well-being of children, young people, their parents and carers should be a priority. Some parents are struggling with the loss of work. Others are working from home and home-schooling their children. All are less able to access their usual social supports.</p>
<p>Certain <a href="https://journals.sagepub.com/doi/full/10.1177/1049731517725184">parenting programs</a> can reduce the chance of <a href="https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/conduct-disorder">conduct disorder</a>, depression and anxiety among children. Many of these are designed for online delivery.</p>
<p>For instance, one <a href="https://www.jmir.org/2019/8/e13628/">evidence-based program</a> helps parents learn useful strategies that are particularly important now they are spending more time with their teens under trying circumstances.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331629/original/file-20200430-42918-s6rrdp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">One evidence-based program helps parents and teens.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-teenage-daughter-having-arguument-1095397952">Shutterstock</a></span>
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<p>Programs that provide practical and emotional support can help reduce the stress many parents are feeling. There is evidence programs involving <a href="https://www.rch.org.au/uploadedFiles/Main/Content/ccch/resources_and_publications/Home_visiting_lit_review_programs_revised_Nov2012(1).pdf">nurses visiting</a> parents with young children at home can lessen the risk of child maltreatment and therefore subsequent mental health issues.</p>
<p>We also have <a href="https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0242-3">evidence-based programs</a> to help children and young people acquire the social and emotional skills that contribute to resilience.</p>
<p>Most of these resilience programs are designed for schools but are often <a href="https://www.blackdoginstitute.org.au/docs/default-source/research/evidence-and-policy-section/prevention-of-depression-and-anxiety-in-australian-schools.pdf?sfvrsn=2">poorly implemented</a> due to the lack of time, resourcing and professional development to support schools and educators to deliver them. </p>
<p>So we need additional resources for schools and professional development for educators to better implement them.</p>
<h2>Adults and older Australians</h2>
<p>Adults also need strategies to promote their mental well-being, including <a href="https://community.mydigitalhealth.org.au/resource-list/">self-care</a>, and knowing when and how to ask for help.</p>
<p>As we are seeing, demand for mental health services in Australia <a href="https://www.abc.net.au/news/2020-04-29/mental-health-coronavirus-impact-beyond-blue/12196922">has decreased</a> and not increased, as expected, during the pandemic. This may reflect health concerns or difficulties people have accessing the right services. So we need to design service models that are safe and fit-for-purpose in the current climate.</p>
<p>Preventing work-related mental-health conditions is also important. This needs employers and employees <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwialfjXko_pAhVx6XMBHdewAbkQFjAAegQIAxAB&url=https%3A%2F%2Fwww.safework.nsw.gov.au%2F__data%2Fassets%2Fpdf_file%2F0012%2F320232%2FMentally-healthy-workplaces-in-NSW-discussion-paper-September-2017-SW08615.pdf&usg=AOvVaw1dWr8RREciecbLcnYHI9-z">to collaborate</a> to reduce the chance of these conditions developing.</p>
<p>So <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiJoaCzk4_pAhVn63MBHW-hDYIQFjAAegQIAxAB&url=https%3A%2F%2Fwww.safework.nsw.gov.au%2F__data%2Fassets%2Fpdf_file%2F0008%2F360449%2FSW09006-0518-418530-Review-of-Evidence-of-Interventions-to-Reduce-Mental....pdf&usg=AOvVaw02uL_sCLL9x5VSaCbsdukL">evidence-based</a> prevention programs are more relevant than ever as employers and employees confront new stressors, including changes in work practices caused by COVID-19. </p>
<p>People on the frontline of pandemic response efforts, such as health-care workers, should be a key target for prevention programs given the high levels of stress many have experienced.</p>
<p><a href="https://www.mentalhealthcommission.gov.au/getmedia/612f76a5-5d32-4710-bf75-c5c1e38c72f6/e-Health-interventions-to-reduce-older-persons%E2%80%99-loneliness.PDF">Tackling loneliness</a> is also vital and the elderly should be a prime focus.</p>
<p>The federal government has <a href="https://www.health.gov.au/initiatives-and-programs/community-visitors-scheme-cvs">increased funding</a> for the community visitors scheme, when volunteers visit older people to provide friendship and companionship, which is an excellent start.</p>
<p>Befriending initiatives could also work for other socially isolated people.</p>
<h2>Where to next?</h2>
<p>COVID-19 has disrupted our lives and our livelihoods, and the wide-ranging personal, social and economic impacts of this pandemic will continue to be felt for many months and years. </p>
<p>We already have a number of evidence-based approaches to prevent common mental health conditions and that can be scaled up immediately. We also need to support research to find new and more effective approaches.</p>
<p>But parallel efforts to encourage people to seek help if they are experiencing a mental health condition, and ensuring they get the right help, are also crucial. </p>
<p>This pandemic highlights the importance of innovation and trying to provide services in new and more accessible ways – whether through better use of <a href="https://www.emhprac.org.au/evidence/">digital mental health</a> programs, telehealth consultations or outreach services – to ensure people can still access mental health supports and services how and when they need them during these difficult times. </p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone
you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/137170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Carbone works for Prevention United, a mental health promotion charity that focuses on the prevention of mental disorders.</span></em></p><p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council. He is a Chief Investigator on the Centre for Research Excellence on Childhood Adversity and Mental Health. He is Chair of the Scientific Advisory Committee of Prevention United, Chair of the Board of Mental Health First Aid International, a member of the Alliance for Prevention of Mental Disorders and a member of the Association for Psychological Science.</span></em></p>We expect a steep rise in mental health problems as a result of the pandemic. But there are ways to flatten this curve, just as we’ve flattened the curve of infections.Stephen Carbone, Honorary, School for Population and Global Health, The University of MelbourneAnthony Jorm, Professor emeritus, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1262932019-12-03T16:19:13Z2019-12-03T16:19:13ZWhat we’ve learnt from building Africa’s biggest genome library<figure><img src="https://images.theconversation.com/files/301545/original/file-20191113-77310-1vdia49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The human genome was <a href="https://www.nature.com/scitable/topicpage/dna-sequencing-technologies-key-to-the-human-828/">first sequenced in 2003</a> by multiple research centres across the world. The breakthrough was hailed as the dawn of a new era. Genetics would swiftly transform our response to disease and lead to personalised medicine.</p>
<p>In the past decade there has been substantial progress in terms of <a href="https://www.ncbi.nlm.nih.gov/books/NBK19932/">studying</a> genetic factors giving rise to disease. But much of this has been focused on European populations. Little progress has been made in examining the factors associated with disease among Africans.</p>
<p>Until very recently, only a few hundred whole genome sequences of individuals within Africa had been completed. <a href="https://www.genome.gov/Funded-Programs-Projects/Population-Architecture-Using-Genomics-and-Epidemiology">Researchers</a> largely relied on genetic data from African-Americans. These have provided many new insights. But they don’t reflect the continent’s full genetic diversity.</p>
<p>Africa is known to be where humans originated. From Africa, they migrated to other parts of the world. This makes it the most genetically diverse region in the world. Diversity among other populations represents a subset of the diversity within Africa. </p>
<p>This genetic diversity provides unique opportunities to examine genetic factors associated with disease that can’t be examined in Europeans where diversity is much lower. This highlights the need for much larger studies of genetic causes of disease within Africa.</p>
<p>We conducted a <a href="https://www.cell.com/cell/ppt/S0092-8674(19)31120-1.ppt">study</a> to build one of the largest genome resources from within Africa. We developed a rich, diverse resource using genome wide data from 6,400 Ugandans – the Uganda Genome Resource. It included whole genome sequencing of nearly 2,000 people.</p>
<p>The study built on the long standing research programme of the <a href="https://www.mrcuganda.org/about/our-mission">Medical Research Council Uganda and Uganda Virus Research Institute</a>. Its aim has been to establish a clinical and genomic data resource to understand population health and disease in the region. </p>
<p>The team also incorporated data on 14,000 individuals from different parts of the continent. It did this in collaboration with the <a href="https://www.ukzn.ac.za/">University of KwaZulu-Natal</a> and the <a href="https://www.genome.gov/about-nhgri/Center-for-Research-on-Genomics-and-Global-Health">Centre of Genomics and Global Health</a>, National Institutes of Health. This allowed us to examine genetic determinants of traits within the population.</p>
<p>Around a quarter of the genetic variation identified had not been discovered before. We found a higher level of genetic diversity in the Ugandan population than seen in similar <a href="https://www.uk10k.org/studies/cohorts.html">studies</a> of European populations.</p>
<p>Modern Uganda appears to be a complex mosaic of genetic flow from many different communities that have migrated from surrounding regions within Africa – and from Europe or the Middle East. This gene flow appears to have occurred repeatedly, dating back from around 100 years ago to as long as 4,500 years ago.</p>
<p>Our work is an important step forward in African medical genetics research. But much more research is needed to understand how these genetic variants affect disease traits. That means looking at the functional effects of genomes on gene expression and protein levels. </p>
<h2>What we found</h2>
<p>In our study, we discovered ten new associations with blood traits, liver function tests and indicators of diabetes. Most of these new associations relate to genetic variants that are unique to the Ugandan population or very rare in non-Africans. These would not have been discovered even in very large studies of Europeans.</p>
<p>For example, we identified an association between a genetic variant that causes alpha-thalassemia, a blood disorder that leads to anaemia, and glycated haemoglobin levels, which are commonly used for diagnosis of diabetes. This genetic variant is found in 22% of Africans. It has become very common in some regions within Africa because it also protects against severe malaria. It remains very rare in other populations where malaria isn’t endemic. Our findings suggest that the utility of glycated haemoglobin as a diagnostic tool for diabetes may require re-evaluation in regions where alpha-thalassemia – a blood disorder that reduces the production of haemoglobin – is common. </p>
<p>The richness of the Uganda resource also offered us other opportunities. For example, we were able to study the extent to which genetic differences influence differences in traits among Ugandans relative to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557782/">previous studies</a> in <a href="https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1003520">European</a> populations. We found that heritability – the extent to which genetic differences encode differences in traits or diseases – may differ between Ugandans and Europeans. </p>
<p>We also found that height is less genetically determined in rural Ugandans relative to <a href="https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1003520">previous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557782/">European studies</a>. We think that this might relate to differences in the impact of environmental factors between rural Ugandan and European populations. For example, the genetic influences on height might be more limited by nutritional influences in early childhood.</p>
<p>Our findings highlight the usefulness of examining genetically diverse populations within Africa. They underscore how this can lead to new discoveries and help us understand the genetic encoding of traits that may be different within Africa relative to other populations.</p>
<h2>Next steps</h2>
<p>Africa is central to our understanding of human origins, genetic diversity and disease susceptibility. There is a clear scientific and public health need to develop large-scale projects that examine disease susceptibility across diverse populations across the continent. That work should be integrated with initiatives to improve research capacity in Africa.</p>
<p>We now need larger and more diverse studies of genetic causes of disease across the region. These will foster the development of new treatments that will benefit people living in Africa as well as people of African descent around the world.</p>
<p>Future work will look at individuals from other parts of Africa. The aim will be to get a deeper understanding of genetic diversity among indigenous hunter-gatherer populations. These include the Khoe-San populations in Namibia and South Africa and the rain forest populations in central Africa. In addition, we will be expanding current studies of genetic causes of disease to 100,000 individuals across the region.</p>
<p><em>The data was collected by researchers from universities and research institutes from Africa and the UK, including Queen Mary University of London, the University of KwaZulu-Natal, MRC/UVRI & London School of Hygiene & Tropical Medicine Uganda Research Unit, the US National Institute of Health and the University of Cambridge.</em></p><img src="https://counter.theconversation.com/content/126293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deepti Gurdasani receives funding from the Medical Research Council, and is currently a UKRI HDR-UK career development fellow. </span></em></p><p class="fine-print"><em><span>Ayesha Motala receives funding from the Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Segun Fatumo receives salary support from NIH grant U01MH115485 and the Makerere University-Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII). MUII is supported through the DELTAS Africa Initiative (grant 107743). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA), and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (107743) and the U.K. government.</span></em></p><p class="fine-print"><em><span>Pontiano Kaleebu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Africa is known to be where humans originated. This makes it the most genetically diverse region in the world. Diversity in other populations represents a subset of the diversity within Africa.Deepti Gurdasani, Postdoctoral Fellow, Queen Mary University of LondonAyesha Motala, Professor and Head Department of Diabetes and Endocrinology, University of KwaZulu-NatalPontiano Kaleebu, Director of the MRC/Uganda Virus Research Institute, London School of Hygiene & Tropical MedicineSegun Fatumo, Assistant Professor of Genetic epidemiology & Bioinformatics, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1215042019-08-16T04:14:43Z2019-08-16T04:14:43ZNo, eating chocolate won’t cure depression<figure><img src="https://images.theconversation.com/files/288093/original/file-20190815-136190-1d6p0b3.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you're depressed, the headlines might tempt you to reach out for a chocolate bar. But don't believe the hype.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-person-eating-sweets-173815130?src=J4SYOBmC2mFq6Ig9LKj6UQ-1-21">from www.shutterstock.com</a></span></figcaption></figure><p>A recent study published in the journal <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/da.22950">Depression and Anxiety</a> has attracted <a href="https://7news.com.au/lifestyle/health-wellbeing/dark-chocolate-could-boost-mood-study-c-378548">widespread media attention</a>. Media reports <a href="https://www.google.com/search?q=chocolate+depression&client=firefox-b-d&source=lnms&tbm=nws&sa=X&ved=0ahUKEwjYuqGh14PkAhXX73MBHRnOAysQ_AUIEygD&biw=1522&bih=687">said</a> eating chocolate, in particular, dark chocolate, was linked to reduced symptoms of depression.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1159459341696716800"}"></div></p>
<p>Unfortunately, we cannot use this type of evidence to promote eating chocolate as a safeguard against depression, a serious, common and sometimes debilitating mental health condition.</p>
<p>This is because this study looked at an <em>association</em> between diet and depression in the general population. It did not gauge causation. In other words, it was not designed to say whether eating dark chocolate <em>caused</em> a reduction in depressive symptoms.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-depression-what-we-know-dont-know-and-suspect-81483">What causes depression? What we know, don’t know and suspect</a>
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</em>
</p>
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<h2>What did the researchers do?</h2>
<p>The authors explored data from the United States <a href="https://www.cdc.gov/nchs/nhanes/index.htm">National Health and Nutrition Examination Survey</a>. This shows how common health, nutrition and other factors are among a representative sample of the population. </p>
<p>People in the study reported what they had eaten in the previous 24 hours in two ways. First, they recalled in person, to a trained dietary interviewer using a standard questionnaire. The second time they recalled what they had eaten over the phone, several days after the first recall.</p>
<p>The researchers then calculated how much chocolate participants had eaten using the average of these two recalls.</p>
<p>Dark chocolate needed to contain at least 45% cocoa solids for it to count as “dark”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-memory-9035">Explainer: what is memory?</a>
</strong>
</em>
</p>
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<p>The researchers excluded from their analysis people who ate an implausibly large amount of chocolate, people who were underweight and/or had diabetes. </p>
<p>The remaining data (from 13,626 people) was then divided in two ways. One was by categories of chocolate consumption (no chocolate, chocolate but no dark chocolate, and any dark chocolate). The other way was by the amount of chocolate (no chocolate, and then in groups, from the lowest to highest chocolate consumption).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-chocolate-is-an-aphrodisiac-4980">Monday's medical myth: chocolate is an aphrodisiac </a>
</strong>
</em>
</p>
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<p>The researchers assessed people’s depressive symptoms by having participants complete a short questionnaire asking about the frequency of these symptoms over the past two weeks.</p>
<p>The researchers controlled for other factors that might influence any relationship between chocolate and depression, such as weight, gender, socioeconomic factors, smoking, sugar intake and exercise.</p>
<h2>What did the researchers find?</h2>
<p>Of the entire sample, 1,332 (11%) of people said they had eaten chocolate in their two 24 hour dietary recalls, with only 148 (1.1%) reporting eating dark chocolate.</p>
<p>A total of 1,009 (7.4%) people reported depressive symptoms. But after adjusting for other factors, the researchers found no association between any chocolate consumption and depressive symptoms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288094/original/file-20190815-136186-kvk3wj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Few people said they’d eaten any chocolate in the past 24 hours. Were they telling the truth?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chocolate-bar-foil-on-gray-background-329714852">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>However, people who ate dark chocolate had a 70% lower chance of reporting clinically relevant depressive symptoms than those who did not report eating chocolate.</p>
<p>When investigating the amount of chocolate consumed, people who ate the most chocolate were more likely to have fewer depressive symptoms.</p>
<h2>What are the study’s limitations?</h2>
<p>While the size of the dataset is impressive, there are major limitations to the investigation and its conclusions. </p>
<p>First, assessing chocolate intake is challenging. People may eat different amounts (and types) depending on the day. And asking what people ate over the past 24 hours (twice) is not the most accurate way of telling what people usually eat.</p>
<p>Then there’s whether people report what they actually eat. For instance, if you ate a whole block of chocolate yesterday, would you tell an interviewer? What about if you were also depressed?</p>
<p>This could be why so few people reported eating chocolate in this study, compared with what <a href="https://www.forbes.com/sites/niallmccarthy/2015/07/22/the-worlds-biggest-chocolate-consumers-infographic/#718514644847">retail figures</a> tell us people eat.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-5-foods-are-claimed-to-improve-our-health-but-the-amount-wed-need-to-consume-to-benefit-is-a-lot-116730">These 5 foods are claimed to improve our health. But the amount we'd need to consume to benefit is... a lot</a>
</strong>
</em>
</p>
<hr>
<p>Finally, the authors’ results are mathematically accurate, but misleading.</p>
<p>Only 1.1% of people in the analysis ate dark chocolate. And when they did, the amount was very small (about 12g a day). And only two people reported clinical symptoms of depression and ate any dark chocolate.</p>
<p>The authors conclude the small numbers and low consumption “attests to the strength of this finding”. I would suggest the opposite.</p>
<p>Finally, people who ate the most chocolate (104-454g a day) had an almost 60% lower chance of having depressive symptoms. But those who ate 100g a day had about a 30% chance. Who’d have thought four or so more grams of chocolate could be so important? </p>
<p>This study and the media coverage that followed are perfect examples of the pitfalls of translating population-based nutrition research to public recommendations for health. </p>
<p>My general advice is, if you enjoy chocolate, go for darker varieties, with fruit or nuts added, and eat it <a href="https://theconversation.com/we-dont-yet-fully-understand-what-mindfulness-is-but-this-is-what-its-not-110698">mindfully</a>. — <strong>Ben Desbrow</strong></p>
<hr>
<h2>Blind peer review</h2>
<p>Chocolate manufacturers have been a good source of <a href="https://forbetterscience.com/2016/05/19/chocolate-is-good-for-your-funding/">funding</a> for much of the <a href="https://www.foodpolitics.com/2015/10/heres-why-food-companies-sponsor-research-mars-inc-s-cocoavia/">research</a> into chocolate products.</p>
<p>While the authors of this new study declare no conflict of interest, any whisper of good news about chocolate attracts publicity. I agree with the author’s scepticism of the study.</p>
<p>Just 1.1% of people in the study ate dark chocolate (at least 45% cocoa solids) at an average 11.7g a day. There was a wide variation in reported clinically relevant depressive symptoms in this group. So, it is not valid to draw any real conclusion from the data collected.</p>
<p>For total chocolate consumption, the authors accurately report no statistically significant association with clinically relevant depressive symptoms. </p>
<p>However, they then claim eating more chocolate is of benefit, based on fewer symptoms among those who ate the most.</p>
<p>In fact, depressive symptoms were most common in the third-highest quartile (who ate 100g chocolate a day), followed by the first (4-35g a day), then the second (37-95g a day) and finally the lowest level (104-454g a day). Risks in sub-sets of data such as quartiles are only valid if they lie on the same slope.</p>
<p>The basic problems come from measurements and the many confounding factors. This study can’t validly be used to justify eating more chocolate of any kind. — <strong>Rosemary Stanton</strong></p>
<hr>
<p><em><a href="https://theconversation.com/au/topics/research-check-25155">Research Checks</a> interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.</em></p><img src="https://counter.theconversation.com/content/121504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Depression is a serious, common and sometimes debilitating condition. And no, chocolate won’t help, whatever the headlines tell you.Ben Desbrow, Associate Professor, Nutrition and Dietetics, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1194282019-07-16T11:21:37Z2019-07-16T11:21:37ZWar’s physical toll can last for generations, as it has for the children of the Vietnam War<figure><img src="https://images.theconversation.com/files/282901/original/file-20190705-51258-1v9hipo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3820%2C2544&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People living in Vietnam today may still feel the effects of the war.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hanoi-vietnam-jan-2014-people-bicycles-1190156032?src=TjJSuIK3abFf4AK58txB_Q-1-4&studio=1">Kylie Nicholson/shutterstock.com</a></span></figcaption></figure><p>History often focuses on the immediate death toll of war. But hostilities can have longer-term consequences on a population’s health.</p>
<p>In <a href="https://doi.org/10.1177/0022343319846545">our new study</a> published on June 5, <a href="https://scholar.google.com/citations?user=KR5Sm2wAAAAJ&hl=en">we</a> <a href="https://scholar.google.com.au/citations?user=LzUtQKUAAAAJ&hl=en">investigated</a> <a href="https://scholar.google.com/citations?user=Z3wqo_4AAAAJ&hl=en">how</a> U.S. Air Force bombing in Vietnam during 1965 to 1975 affected disability rates in Vietnam in 2009.</p>
<p>Using a combination of national census and U.S. military data, we found a causal link between wartime bombing and disability rates 40 years after the Vietnam War. </p>
<p>Our work, completed with <a href="https://scholar.google.com/citations?user=NVRomQEAAAAJ&hl=en">Nguyen Viet Cuong</a> at National Economics University in Vietnam and <a href="https://scholar.google.com/citations?user=dO9FLkoAAAAJ&hl=en">Daniel Mont</a> at University College London, shows that wars inflict harms on the health of human populations that last for generations. </p>
<h2>Bombings and disability</h2>
<p>Our study looked at 14.2 million people across Vietnam. Approximately 8% of the population has a disability based upon an <a href="http://www.washingtongroup-disability.com/washington-group-question-sets/short-set-of-disability-questions/">internationally tested measure of disability</a>, including difficulties with seeing, hearing, walking and cognition.</p>
<p>As we expected, districts that were heavily bombed still have significantly higher disability rates 40 years later. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=784&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=784&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=784&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=985&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=985&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282795/original/file-20190705-51312-1bboeqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=985&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Number of bombs, missiles and rockets per square kilometer during the Vietnam War, by district.</span>
<span class="attribution"><span class="source">Michael Palmer, Nora Groce and Sophie Mitra</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=783&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=783&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=783&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=985&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=985&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282801/original/file-20190705-51284-18yqklg.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=985&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vietnam disability rates in 2009, by district.</span>
<span class="attribution"><span class="source">Michael Palmer, Nora Groce and Sophie Mitra</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Injuries and impairments sustained among people directly exposed to the bombing are not surprising. Walking the streets of Ho Chi Minh City, one can see the high number of elderly amputees, whose injuries likely stemmed from the war. </p>
<p>However, war may have other, hidden effects on the health of populations, including among people born after the war. </p>
<p>In our study, we looked more closely at the total number of bombs, missiles and rockets per square kilometer, and how that related to the proportion of people with disability at different ages. </p>
<p>In districts with high levels of bombing, disability rates were highest for people around 40 years of age, the group born in the late 1960s during the heaviest level of wartime bombing.</p>
<p>However, perhaps surprisingly, there also seems to be a relationship between the bombings and those born as long as 15 years after the war. In districts that saw more bombings, Vietnamese people born before around 1990 have higher rates of disability than those in other parts of the country.</p>
<p><a href="https://www.nytimes.com/2018/03/20/opinion/vietnam-war-agent-orange-bombs.html">As one New York Times story noted</a>, since the end of the war, more than 67,000 Vietnamese have been maimed by unexploded cluster bombs, losing limbs or eyes. Around 40,000 have lost their lives in such accidents.</p>
<h2>Preventing further damage</h2>
<p>It is difficult to disentangle exactly why bombing has these long-term effects on disability. </p>
<p>A likely explanation is that people in heavily bombed areas continue, many years later, to suffer from <a href="https://www.newyorker.com/news/news-desk/the-vietnam-war-is-still-killing-people">direct exposure to the bombing</a> and connected weaponry, including <a href="https://www.nytimes.com/2018/03/20/opinion/vietnam-war-agent-orange-bombs.html">unexploded bombs</a>, landmines and military herbicides more commonly known as <a href="https://www.nature.com/articles/nature01537">Agent Orange</a>.</p>
<p>People in areas that were heavily bombed are more likely to experience poor nutrition in childhood and have lower education. This, too, <a href="https://www.who.int/disabilities/world_report/2011/en/">may indirectly cause long-term disability</a>.</p>
<p>In Vietnam, <a href="https://doi.org/10.1371/journal.pone.0133623">health care services for the disabled</a> – such as rehabilitation and assistive devices like prostheses, wheelchairs and hearing devices – are limited in supply and quality. </p>
<p>To us, our findings underscore the importance of all parties involved in the war expediting the process of cleaning up the consequences and ensuring food security and adequate health services for people in conflict-affected zones. </p>
<p>Cleaning up the consequences of war is usually led by the government of the country, along with support from international donors <a href="https://www.unicef.org/newsline/02prvietlandmines.htm">like the U.N</a>. In Vietnam, U.S. assistance has been slow to materialize. <a href="http://vovworld.vn/en-US/current-affairs/vietnams-efforts-to-clear-bombs-and-mines-234444.vov">Funding support from the U.S.</a> started in 1993. U.S. humanitarian assistance to Vietnam has been increasing over the last decade, but is under threat <a href="https://www.scmp.com/week-asia/politics/article/2106460/trump-lays-time-bomb-vietnams-mine-clearing-efforts">under the current Trump administration</a>.</p>
<p>The toll of warfare is often assessed in terms of the number of people killed. However, we feel that warfare’s lasting and intergenerational consequences on health is an underacknowledged problem. The ravages of war extend far beyond the years it was waged.</p><img src="https://counter.theconversation.com/content/119428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Vietnam War ended in 1975. But it’s still harming the health of Vietnamese people born after the conflict ended.Michael Palmer, Senior Lecturer in Economics, The University of Western AustraliaNora Groce, Director UCL International Disability Research Centre, UCLSophie Mitra, Professor of Economics, Fordham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1122972019-03-12T06:16:01Z2019-03-12T06:16:01ZAustralia’s drought could be increasing Q fever risk, but there are ways we can protect ourselves<figure><img src="https://images.theconversation.com/files/263315/original/file-20190312-86690-1e20tfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sheep are among the most common carriers of Q fever.</span> <span class="attribution"><span class="source">Jorgen Haland/Unsplash</span></span></figcaption></figure><p>With several hundred cases diagnosed each year, Australia has <a href="https://core.ac.uk/download/pdf/43382528.pdf">one of the highest rates of Q fever worldwide</a>. </p>
<p>Q fever is a bacterial infection which spreads from animals; mainly cattle, sheep and goats. It can present in different ways, but often causes severe flu-like symptoms.</p>
<p>Importantly, the bacteria that cause Q fever favour dry, dusty conditions, and inhalation of contaminated dust is a common route of infection.</p>
<p>There are now fears the ongoing droughts in Queensland and New South Wales may be increasing risk of the disease spreading.</p>
<p>But there are measures those at risk can take to protect themselves, including vaccination.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/q-fever-a-former-soldier-is-suing-the-government-over-it-but-what-is-this-mysterious-disease-110218">Q fever: a former soldier is suing the government over it, but what is this mysterious disease?</a>
</strong>
</em>
</p>
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<h2>What is Q fever and who is at risk?</h2>
<p>Q fever is an infectious illness caused by the bacterium <em>Coxiella burnetii</em>, one of the most infectious organisms around. </p>
<p>Q fever is zoonotic, meaning it can transmit to people from infected animals. It’s usually acquired through either direct animal contact or contact with contaminated areas where animals have been.</p>
<p>Goats, sheep and cattle are the most commonly reported Q fever hosts, although <a href="https://www.wildlifehealthaustralia.com.au/Portals/0/Documents/FactSheets/Mammals/Q%20Fever%20in%20Australian%20Wildlife%20Jun%202013%20(1.4).pdf">a range of other animals</a> may be carriers. </p>
<p>Because of this association with livestock, farmers, abattoir workers, shearers, and veterinarians are thought to be at the highest risk of Q fever.</p>
<p>People who also may be at risk include family members of livestock workers, people living or working near livestock transport routes, tannery workers, animal hunters, and even processors in cosmetics factories that use animal products.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/urbanisation-brings-animals-and-diseases-closer-to-home-34415">Urbanisation brings animals and diseases closer to home</a>
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</em>
</p>
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<p>Q fever can be difficult to diagnose (it has sometimes been called “<a href="http://www.abc.net.au/tv/programs/landline/old-site/content/2015/s4271952.htm">the quiet curse</a>”). Infected people usually develop flu-like fevers, severe headaches and muscle or joint pain. These symptoms typically appear around two to three weeks after infection, and can last up to six weeks.</p>
<p>A small proportion of people will develop <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403045/">persistent infections</a> that begin showing up later (up to six years post-infection). These can include local infections in the heart or blood vessels, which may require lifelong treatment.</p>
<h2>Are Q fever rates on the rise?</h2>
<p>In Australia, 500 to 800 cases of Q fever (2.5 – 5 cases per 100,000 people) were reported each year in the 1990s according to the <a href="http://www9.health.gov.au/cda/source/rpt_4.cfm">National Notifiable Diseases Surveillance System</a>.</p>
<p>A national Q fever management program was designed in 2001 to combat this burden. This program provided subsidised vaccination to at-risk people including abattoir workers, beef cattle farmers and families of those working on farms.</p>
<p>Results were positive. Q fever cases decreased during the program and following its conclusion in 2006, leading to a historic low of 314 cases (<a href="http://www9.health.gov.au/cda/source/rpt_4.cfm">1.5 cases per 100,000 people</a>) in 2009.</p>
<p>But since 2010, Q fever cases have gradually increased (<a href="http://www9.health.gov.au/cda/source/rpt_4.cfm">558 cases or 2.3 per 100,000</a> were reported in 2016), suggesting further action may be necessary.</p>
<p>Every year, the highest numbers of people diagnosed are from <a href="http://www9.health.gov.au/cda/source/rpt_4.cfm">Queensland and NSW</a>.</p>
<p>And the true number of affected people is likely to be under-reported. Many infected people do not experience severe symptoms, and those who do may not seek health care or may be misdiagnosed. </p>
<h2>Q fever and drought</h2>
<p>The reason people are more susceptible to Q fever in droughts lies in the bacteria’s capacity to survive in the environment. <em>Coxiella burnetii</em> spores are very resilient and able to survive in soil or dust for many years. This also helps the bacteria spread: it can attach to dust and travel <a href="https://www.ncbi.nlm.nih.gov/pubmed/29764368">10km or more</a> on winds.</p>
<p>The Q fever bacteria is <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Health+topics/Health+conditions+prevention+and+treatment/Infectious+diseases/Q+fever/">resistant to dehydration and UV radiation</a>, making Australia’s mostly dry climate a hospitable breeding ground.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/farmers-experiencing-drought-related-stress-need-targeted-support-98239">Farmers experiencing drought-related stress need targeted support</a>
</strong>
</em>
</p>
<hr>
<p>Hot and dry conditions may also lead to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26228834">higher bacterial shedding rates</a> for infected livestock.</p>
<p>The ongoing drought <a href="https://www.health.nsw.gov.au/news/Pages/20180831_01.aspx">could allow Q fever</a> to spread and reach people who were previously not exposed. </p>
<p>One study suggested drought conditions were probably <a href="https://www.sciencedirect.com/science/article/pii/S0264410X09002102#bib13">the main reason</a> for the increase in Q fever notifications in 2002 (<a href="http://www9.health.gov.au/cda/source/rpt_4.cfm">there were 792 cases that year</a>). This was the fourth driest year on record in Australia since 1900.</p>
<p>We still need more evidence to conclusively link the two, but we think it’s likely that drought in Queensland and NSW has contributed to the increased prevalence of Q fever in recent years.</p>
<h2>How can people protect themselves?</h2>
<p>National guidelines for managing Q fever <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cdnasongs.htm">primarily recommend</a> vaccination. </p>
<p>The <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Factsheets/qfever-vaccine.pdf">Q-VAX® vaccine</a> has been in use since 1989. It’s safe and has an <a href="https://www.ncbi.nlm.nih.gov/pubmed/2323360">estimated success rate of 83–100%</a>.</p>
<p>However, people who have already been exposed to the bacteria are discouraged from having the vaccination, as they can develop a hypersensitive reaction to the vaccine. People aged under 15 years are also <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/q-fever">advised against</a> the vaccine.</p>
<p>Because the vaccine cannot be administered to everyone, people can take other steps to reduce risk. NSW Health recommends a series of precautions.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=614&fit=crop&dpr=1 600w, https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=614&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=614&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=772&fit=crop&dpr=1 754w, https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=772&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/263314/original/file-20190312-86693-1v955vf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=772&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Author provided/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
<hr>
<h2>What else can be done?</h2>
<p>Vaccination for people in high-risk industries is effective to prevent Q fever infection, but must be administered well before people are actually at risk. </p>
<p>Pre-testing requires both a skin test and blood test to ensure people who have already been exposed to the bacteria are not given the vaccine. This process takes one to two weeks before the vaccine can be administered, and it takes a further two weeks after vaccination to develop protection. This delay, along with the cost of vaccination, is sometimes seen as a barrier to its widespread use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/millions-of-australian-adults-are-unvaccinated-and-its-increasing-disease-risk-for-all-of-us-74991">Millions of Australian adults are unvaccinated and it's increasing disease risk for all of us</a>
</strong>
</em>
</p>
<hr>
<p>Awareness of the vaccine may also be an issue. A recent study of Australians in metropolitan and regional centres found <a href="https://sydney.edu.au/news-opinion/news/2019/03/11/increased-q-fever-vaccination-needed-for-rural-residents.html">only 40% of people</a> in groups for whom vaccination is recommended knew about the vaccine, and <a href="https://sydney.edu.au/news-opinion/news/2019/03/11/increased-q-fever-vaccination-needed-for-rural-residents.html">only 10% were vaccinated</a>.</p>
<p>We also need to better understand how transmission occurs in people who do not work with livestock (“non-traditional” exposure pathways) if we want to reduce Q fever rates.</p><img src="https://counter.theconversation.com/content/112297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas J Clark is postdoctoral fellow on the project ‘Taking the ‘Q’ (query) out of Q Fever: developing a better understanding of the driver of Q Fever spread in farmed ruminants’, which receives funding from from the Australian Government Department of Agriculture and Water Resources as part of its Rural R&D for Profit program and partner organisations; AgriFutures Australia, University of Melbourne, Meredith Dairy, University of Queensland, Australian Rickettsial Research Laboratory, University of Adelaide, Charles Sturt University, Goat Veterinary Consultancies (Goatvetoz), Victorian Department of Economic Development, Jobs, Transport and Resources (DEDJTR), Queensland Department of Agriculture and Fisheries (QDAF).</span></em></p><p class="fine-print"><em><span>Charles Caraguel is a primary investigator on the project ‘Taking the ‘Q’ (query) out of Q Fever: developing a better understanding of the driver of Q Fever spread in farmed ruminants’, which receives funding from from the Australian Government Department of Agriculture and Water Resources as part of its Rural R&D for Profit program and partner organisations; AgriFutures Australia, University of Melbourne, Meredith Dairy, University of Queensland, Australian Rickettsial Research Laboratory, University of Adelaide, Charles Sturt University, Goat Veterinary Consultancies (Goatvetoz), Victorian Department of Economic Development, Jobs, Transport and Resources (DEDJTR), Queensland Department of Agriculture and Fisheries (QDAF).</span></em></p><p class="fine-print"><em><span>Jane Heller is a primary investigator on the project ‘Taking the ‘Q’ (query) out of Q Fever: developing a better understanding of the driver of Q Fever spread in farmed ruminants’, which receives funding from from the Australian Government Department of Agriculture and Water Resources as part of its Rural R&D for Profit program and partner organisations; AgriFutures Australia, University of Melbourne, Meredith Dairy, University of Queensland, Australian Rickettsial Research Laboratory, University of Adelaide, Charles Sturt University, Goat Veterinary Consultancies (Goatvetoz), Victorian Department of Economic Development, Jobs, Transport and Resources (DEDJTR), Queensland Department of Agriculture and Fisheries (QDAF).</span></em></p><p class="fine-print"><em><span>Ricardo J. Soares Magalhaes is a primary investigator on the project ‘Taking the ‘Q’ (query) out of Q Fever: developing a better understanding of the driver of Q Fever spread in farmed ruminants’, which receives funding from from the Australian Government Department of Agriculture and Water Resources as part of its Rural R&D for Profit program and partner organisations; AgriFutures Australia, University of Melbourne, Meredith Dairy, University of Queensland, Australian Rickettsial Research Laboratory, University of Adelaide, Charles Sturt University, Goat Veterinary Consultancies (Goatvetoz), Victorian Department of Economic Development, Jobs, Transport and Resources (DEDJTR), Queensland Department of Agriculture and Fisheries (QDAF).</span></em></p><p class="fine-print"><em><span>Simon Firestone is a primary researcher on the project ‘Taking the ‘Q’ (query) out of Q Fever: developing a better understanding of the driver of Q Fever spread in farmed ruminants’, which receives funding from from the Australian Government Department of Agriculture and Water Resources as part of its Rural R&D for Profit program and partner organisations; AgriFutures Australia, University of Melbourne, Meredith Dairy, University of Queensland, Australian Rickettsial Research Laboratory, University of Adelaide, Charles Sturt University, Goat Veterinary Consultancies (Goatvetoz), Victorian Department of Economic Development, Jobs, Transport and Resources (DEDJTR), Queensland Department of Agriculture and Fisheries (QDAF).</span></em></p>Q fever is a flu-like infection that spreads to people from animals. The bacteria that causes it can withstand harsh environmental conditions – in particular, drought.Nicholas J Clark, Postdoctoral Fellow in Disease Ecology, The University of QueenslandCharles Caraguel, Senior lecturer, School of Animal and Veterinary Science, University of AdelaideJane Heller, Associate Professor in Veterinary Epidemiology and Public Health, Charles Sturt UniversityRicardo J. Soares Magalhaes, Senior Lecturer Population Health & Biosecurity, The University of QueenslandSimon Firestone, Academic, Veterinary Biosciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1070752019-01-09T22:32:24Z2019-01-09T22:32:24ZThe more women in government, the healthier a population<figure><img src="https://images.theconversation.com/files/253119/original/file-20190109-32127-cbiu5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canada's Minister of the Status of Women Maryam Monsef is pictured in the Library of Parliament on Parliament Hill, in Ottawa on Feb. 28, 2018. </span> <span class="attribution"><span class="source">(THE CANADIAN PRESS/Sean Kilpatrick)</span></span></figcaption></figure><p>In November 2015, Prime Minister Justin Trudeau formed the first gender-balanced cabinet in Canadian history. In announcing his cabinet, he ensured that half of his closest advisers (15 out of a total of 30) were women. </p>
<p>Canada’s gender-equal cabinet vaulted the country from <a href="http://archive.ipu.org/pdf/publications/wmnmap15_en.pdf">20th</a> to <a href="http://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2017/femmesenpolitique_2017_english_web.pdf?la=en&vs=1123">fifth place in the world</a> in terms of percentage of women in ministerial positions. </p>
<p>When reporters asked Trudeau about why gender parity was important to him, he retorted: “<a href="https://www.theglobeandmail.com/news/politics/trudeaus-because-its-2015-retort-draws-international-cheers/article27119856/">Because it’s 2015</a>.” His simple yet momentous response resonated with those committed to equity, diversity and inclusion. </p>
<p>As public health researchers, this got us thinking — if increasing the number of women in positions of power promotes gender equity, could it also promote population health and well-being? </p>
<p>Our findings, published recently in the journal <em>SSM - Population Health</em>, support the argument that yes, women in government do in fact advance population health.</p>
<h2>More women in power, fewer deaths</h2>
<p>We first dug into the research literature to see how male and female politicians might differ from each other. Compared to their male counterparts, female politicians are more likely to hold left-wing attitudes (with regard to issues such as civil rights, social equality and egalitarianism) <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev.polisci.11.053106.123839">and substantively advance women’s rights</a> in areas such as pay equity, violence against women, health care and family policy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/252956/original/file-20190108-32136-bn3960.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Deb Haaland is one of two Native American women who marked historic congressional victories in November 2018 as a record number of women were elected to the U.S. House of Representatives.</span>
<span class="attribution"><span class="source">(AP Photo/Juan Labreche)</span></span>
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</figure>
<p>Also, research has shown that <a href="https://opencommons.uconn.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1010&context=chip_docs">women in government tend to work in more collaborative and bipartisan ways</a> and employ a more democratic leadership style compared to men’s more autocratic style. Women are also more effective at building coalitions and reaching consensus.</p>
<p>Next, we examined whether there’s a historical association between women in government and population health among Canada’s 10 provinces. Between 1976 and 2009, the percentage of women in provincial government increased six-fold from 4.2 per cent to 25.9 per cent, while mortality from all causes declined by 37.5 per cent (from 8.85 to 5.53 deaths per 1000 people). </p>
<p>Using data from provincial election offices and Statistics Canada, we found that as the average percentage of women in government has historically risen, total mortality rates have declined.</p>
<h2>Women spend more on health and education</h2>
<p>This link does not of course mean that the increase of women in government has directly caused the decline in mortality. </p>
<p>To assess this, we regressed mortality rates on women in government while controlling for several potential confounders. Our findings support the hypothesis that <a href="https://doi.org/10.1016/j.ssmph.2018.08.003">women in government do in fact advance population health</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=518&fit=crop&dpr=1 600w, https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=518&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=518&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=651&fit=crop&dpr=1 754w, https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=651&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/252952/original/file-20190108-32151-1u7coax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=651&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">New Zealand’s Prime Minister Jacinda Ardern addresses Parliament in Wellington, N.Z., in May 2018 while pregnant with her first child. Many hope the 37-year-old will become a role model for combining motherhood with political leadership.</span>
<span class="attribution"><span class="source">(AP Photo/Nick Perry, File)</span></span>
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</figure>
<p>Interestingly, women in government in Canada have had a bigger effect on male mortality rates than on female rates (1.00 vs 0.44 deaths per 1,000 people).</p>
<p>We also found a pathway that connects women in government, population health and the potential role of partisan politics. In an earlier study, we found that <a href="http://dx.doi.org/10.1136/jech-2014-205385">four types of provincial government spending are predictive of lower mortality rates</a>: medical care, preventive care, other social services and post-secondary education. </p>
<p>When we tested government spending as a mediating factor, we found that women in government in Canada have reduced mortality rates by triggering these specific types of health-promoting expenditures.</p>
<h2>Women work in more collaborative ways</h2>
<p>We also found that there was no relationship between the political leanings of women in government — whether they belonged to left-wing, centrist or right-wing parties — and mortality rates. </p>
<p>Ideological differences among social democratic (e.g., NDP), centrist (e.g., Liberal), and fiscal conservative (e.g., Conservative) political parties seem to be less important to mortality rates than increasing the actual number of women elected to government. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=521&fit=crop&dpr=1 754w, https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=521&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/252957/original/file-20190108-32121-5676ky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=521&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scotland’s Prime Minister Nicola Sturgeon, left, walks with European Union Chief negotiator for Brexit Michel Barnier, prior to a meeting at EU headquarters in Brussels on Monday, May 28, 2018.</span>
<span class="attribution"><span class="source">(AP Photo/Emmanuel Dunand, Pool Photo via AP)</span></span>
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</figure>
<p>This finding supports the idea that women in government tend to work in more collaborative and bipartisan ways than their male counterparts.</p>
<p>It’s now 2019 and leading public health scholars still tend to downplay the potential effects of political determinants such as gender politics on population health. Instead, they opt to focus almost exclusively on individual and social determinants of health. </p>
<p>We believe gender politics matters in public health because it helps to determine “<a href="https://books.google.ca/books/about/Politics.html?id=fP6BAAAAMAAJ&redir_esc=y">who gets what, when and how</a>.” </p>
<p>We believe that electing more women in government not only promotes gender equality and strengthens democratic institutions but also makes real and substantive contributions to government spending and population health. </p>
<p>Given that women in government can bring about desirable changes in population health, let’s figure out how we can genuinely level the political playing field for women.</p><img src="https://counter.theconversation.com/content/107075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research shows that female politicians spend more on health and education, improving the well-being of a population.Edwin Ng, Assistant Professor, School of Social Work, University of WaterlooCarles Muntaner, Professor, Faculty of Nursing, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/978522018-06-10T20:04:59Z2018-06-10T20:04:59ZLife in a herd – and why in health watching symptoms is easy, but finding causes is hard<figure><img src="https://images.theconversation.com/files/221901/original/file-20180606-137285-1j05mpj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p><em>With a rollicking story to set the scene, this piece from two science communication experts explores the notion of population health – what is it, and why does it even matter?</em> </p>
<p><em>The article is part of our occasional long read series <a href="https://theconversation.com/au/topics/zoom-out-51632">Zoom Out</a>, where authors explore key ideas in science and technology in the broader context of society and humanity.</em></p>
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<p>Everyone knows we should exercise more, drink less, and stop scoffing junk food. Even committed smokers know that smoking is bad for them – but change isn’t easy. </p>
<p>The things that determine our health are complex and interwoven, and getting harder and harder to appreciate and communicate.</p>
<p>But whose responsibility is it to do this? And how can we start the right conversations? Last year we began working with <a href="https://preventioncentre.org.au/">The Australian Prevention Partnership Centre</a> to look at better ways to communicate the core messages of the field of population health science. </p>
<p>Over the course of talking with population health practitioners and researchers, we identified several key issues that affect how we all talk about what population health science is – and what it can do for us as a society. </p>
<p>But before we get into the details, let’s set the scene a little. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alan-alda-on-the-art-of-science-communication-i-want-to-tell-you-a-story-55769">Alan Alda on the art of science communication: 'I want to tell you a story'</a>
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</em>
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<h2>Picnic by a river</h2>
<p>An emergency physician, an intensive care specialist, and a population health scientist sat down for a picnic by a river.</p>
<p>Suddenly the doctors notice a body floating down the river!</p>
<p>They rush into the current to pull the man ashore, clear his airways, and start giving CPR.</p>
<p>But then they see another person in the water, face down. They rush out and drag her in. They clear her airways and do CPR.</p>
<p>But then a third body comes floating by!</p>
<p>Unexpectedly, the population health scientist gets up and starts running upstream along the river bank.</p>
<p>“Hey! Come back! Where are you going?” the others scream out to her. Looking over her shoulder she yells back:</p>
<p>“I’m going upstream to see who’s throwing all these people in!”</p>
<p><img width="100%" src="https://media.giphy.com/media/CPskAi4C6WLHa/giphy.gif"></p>
<p>A while later the population health scientist comes running back to the picnic. Dozens of treated survivors are staggering to their feet, and it looks like the other doctors have set up a mobile field hospital in place of the picnic. There’s even a politician cutting some sort of ribbon!</p>
<p>Breathless, the population health scientist runs into the field hospital.</p>
<p>“I’ve worked out who’s chucking the bodies in!” They all look up.</p>
<p>“It’s… big alcohol companies and big tobacco companies and big sugar companies and sedentary lifestyles and bad urban design and big car companies and capitalism and our desire for comfort and lazy options and a lack of green spaces! And the fact that apples rot but chocolate bars don’t. And other things! And I don’t want to seem like some sort of nanny state person but if we don’t do something about everything there’s gunna be more bodies coming down the river!”</p>
<p>The other doctors, the patients and the politician glare back at the population health scientist.</p>
<p>“Can’t you see I’m opening a grand new hospital!” the politician thumps. “Now’s not the time to be pointing fingers!”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/who-are-you-calling-anti-science-how-science-serves-social-and-political-agendas-74755">Who are you calling 'anti-science'? How science serves social and political agendas</a>
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</em>
</p>
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<h2>The problem</h2>
<p>A population health scientist told us the first part of this allegory as a way to explain the big challenge of this field: that there’s always a health emergency going on, and we all tend to focus far more on symptoms than causes. As a society we channel our health efforts much like those doctors dragging the bodies out of the water: focused on emergencies and cures.</p>
<p>In contrast, population health science wants us to look upstream, at the things that cause ill health in the first place.</p>
<p>But the second part of the allegory – which we added – also rings true. The messages of population health science are complex and diffuse, and run into challenges at the core of society. Every other day there are announcements extolling the virtues of exercise or healthy eating, or the evils of sugar or alcohol or junk food. But really, most of us already know these things.</p>
<p>Now we all understand that there’s no such thing as a “one-size-fits-all” approach to awareness-raising and behaviour change. You have to divide and conquer, and take smaller, digestible bites out of great big problems. </p>
<p>But our hunch was that the problems of communicating the lessons of population health science ran deeper than that – that, as a society, we haven’t had enough of the conversations about health that we need to have. Or rather, enough of the right kinds of conversations.</p>
<p>So we decided to built a series of podcast interviews with public health insiders.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221916/original/file-20180606-137318-p7fcib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Interviewing Penny Hawe, Professor of Public Health at the Menzies Centre for Health Policy at the University of Sydney.</span>
<span class="attribution"><span class="source">Will Grant and Rod Lamberts</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Why this approach? Two reasons. </p>
<p>First, by having a relaxed chat with population health practitioners and researchers, listeners get to relate to them more as people. To hear them, rather than read them, and to get a feel for what they’re like.</p>
<p>Second, by listening to these interviews, other population health science people might find out about aspects of their professional world that they wouldn’t necessarily see via the standard meetings, papers and policy pronouncements.</p>
<p>You can listen to the chats <a href="http://wholesomeshow.com/life-in-a-herd">here</a>. </p>
<h2>So what did we find out?</h2>
<p>As we discussed the communication of, and engagement with, population health science with a range of interviewees, several things stood out.</p>
<p><strong>1. Even people with the knowledge don’t – or can’t – always practise what they preach.</strong> </p>
<p>This was exemplified in a great story about an international nutritionists’ conference at which the lunch was, ironically, far from the standards that nutritionists would suggest people observe. As a group they were aghast at the junk food on offer, but were eating it because that was all that was there.</p>
<p><strong>2. Population health science has a naming issue.</strong> </p>
<p>It was often unclear to us during these chats whether we should refer to public health, population health, population health science, or epidemiology. </p>
<p>For people on the inside, the differences between those labels are (hopefully) clear and (definitely) important, but for us on the outside … not so much. </p>
<p>This name confusion probably doesn’t matter to outsiders, as long as we are getting the health guidance that we want and need. So perhaps an important question for population health folk to ask themselves here is: “does it matter if people know the differences between these interrelated areas?” </p>
<p>But at a deeper level, does the label “public” adequately reflect the fact that the discipline is focused on all the things that affect our health beyond the chemistry and biology of our bodies, and not just what’s in the “public” sphere? If my health behaviours affect your health outcomes – if my drinking or exercise creates norms in which it is more or less likely that you will drink or exercise – is that a matter of public health or “shared health”? </p>
<p><strong>3. Population health science appears – as best as we could see – to be unreconciled in its political nature, and shy about its goals.</strong> </p>
<p>Emerging researchers in the field are often trained in engaging with the policy process (talking with bureaucrats and so on), but not with the political process. </p>
<p>Moreover, some spoke of the fact that, if they were asked to articulate a clear vision of what they’d like for society, they’d come up blank. Stepping towards improved population health is great, but it helps to first be confident that all of us (both inside and out) agree on the directions in which we should be stepping.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221915/original/file-20180606-137309-1unq0bc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hanging with Summer May Finlay, a health and communications consultant, and University of South Australia PhD candidate .</span>
<span class="attribution"><span class="source">Will Grant and Rod Lamberts</span>, <span class="license">Author provided</span></span>
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<h2>Know your tribe - and others</h2>
<p>Life in the human herd is complex, and like it or not, we are unavoidably interdependent when it comes to our health. So conversations about the roles of population health, population health science, public health, and epidemiology in this picture are critical.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-part-of-a-social-group-making-sure-you-are-will-improve-your-health-81996">Are you part of a social group? Making sure you are will improve your health</a>
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</em>
</p>
<hr>
<p>But people can’t have these conversations if they don’t know even know what members of their own tribe are thinking, let alone what’s going on in the minds of the rest of the pack, herd, mob or flock. </p>
<p>We aren’t suggesting that we have all the answers, but we certainly hope we have contributed to expanding the conversation - have listen and tell us what you think!</p><img src="https://counter.theconversation.com/content/97852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Will J Grant has received research funding from the DIIS, he is also co-developer and co-host of The Wholesome Show. The series mentioned in this article was produced with some research funding for a studentship from The Australian Prevention Partnership Centre.</span></em></p><p class="fine-print"><em><span>Rod Lamberts has received research funding from the ARC Linkage grant program and the DIIS. He is also the co-developer and co-host of the Wholesome Show podcast. The series mentioned in this article was produced with some research funding for a studentship from The Australian Prevention Partnership Centre.</span></em></p>Life in the human herd is complex, and we are unavoidably inter-dependent when it comes to our health. Population health science looks at the things that cause ill-health in the first place.Will J Grant, Senior Lecturer, Australian National Centre for the Public Awareness of Science, Australian National UniversityRod Lamberts, Deputy Director, Australian National Centre for Public Awareness of Science, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/867332018-02-13T17:21:11Z2018-02-13T17:21:11ZMonitoring populations helps to put the right health services in place<figure><img src="https://images.theconversation.com/files/199247/original/file-20171214-27583-i52vca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Flickr/Isabel Sommerfeld</span></span></figcaption></figure><p>Fourteen years ago South African researchers <a href="https://www.sciencedirect.com/science/article/pii/S0140673608613999">first picked up</a> rising rates of high blood pressure in the population that led to people dying earlier than expected. </p>
<p>But it wasn’t in the bustling urban metropolis of Johannesburg in South Africa’s economic hub where this cardio-metabolic disease epidemic was first found. The trends – that people were increasingly dying from stroke – were picked up in one of the country’s most rural sub-districts.</p>
<p>The <a href="https://www.sciencedirect.com/science/article/pii/S0140673608613999">findings</a> contributed to South Africa’s National Department of Health drawing up a policy to introduce “integrated” primary health care. And through this policy, chronic conditions such as high blood pressure can be tested and treated at the clinics set up primarily to provide antiretrovirals to HIV positive people.</p>
<p>The discovery was not coincidental. It emanated from work done in a health and demographic surveillance system <a href="https://www.sciencedirect.com/science/article/pii/S0140673608613999">set up in 1992</a> in Bushbuckridge, Mpumalanga. The site is run jointly by the South African Medical Research Council and Wits University’s Rural Public Health and Health Transitions Research Unit.</p>
<p>The project collects population and health and socio-economic data on communities in an impoverished and developmentally constrained part of the country over a long period of time.</p>
<p>Health and demographic surveillance systems like these help researchers understand how factors around health, social and economic wellbeing affect people and the societies that they live in.</p>
<p>These systems are an important part of advanced population registration systems. And nations with complete systems are the world’s most developed. A key reason for this is that they can determine if services are meeting the needs of the population. </p>
<p>The site in Bushbuckridge is one of three surveillance systems running in South Africa. The other two sites are in rural Limpopo: <a href="https://academic.oup.com/ije/article/44/5/1565/2594575">Dikgale</a> at the University of Limpopo, and the <a href="https://www.ahri.org/research/">Africa Health Research Institute</a> in rural KwaZulu-Natal. These sites collectively follow a population of about 300 000 people.</p>
<p>The data being collected is expected to provide <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-741">deep evidence-based insights</a> into major health and socio-economic challenges facing the country which in turn will enable the government to design and evaluate targeted, evidence-informed policy solutions.</p>
<h2>Giving government a heads-up</h2>
<p>When surveillance systems work well, the information that is collected forms part of the national statistics platform of the country. It helps researchers understand detail and dynamics that they are unable to derive from a census. </p>
<p>This is because censuses are only able to see people at one point in time. Surveillance systems can provide detail on changing patterns and the processes affecting these changes. Together, the surveillance system data and census data give policymakers a sound basis to evaluate policies that are not working.</p>
<p>Surveillance system data provides deep and <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-741">granular insights</a> into the health and wellbeing of a community. They help governments understand the changing dynamics of a particular population. This, in turn, helps them understand what sort of interventions are needed. Here are some examples:</p>
<ul>
<li><p>Data will give a better idea of how and why people move between rural and urban areas and insights into what health and socio-economic services they are getting or being excluded from.</p></li>
<li><p>Tracking the number of pregnancies can provide valuable information about whether or not there are adequate maternal health and family planning services in place.</p></li>
<li><p>Looking at why people are dying is important to understanding if health services need to be adapted or preventative services strengthened.</p></li>
<li><p>Understanding how people’s levels of education and socio-economic status affect their wellbeing.</p></li>
</ul>
<h2>Falling through the cracks</h2>
<p>Surveillance systems do have challenges. One is that the data come from specific geographic locations. Researchers can’t easily tell what happens beyond these boundaries.</p>
<p>This is why it’s important to have surveillance systems in both rural and urban settings so that researchers can understand livelihoods and monitor bi-directional, migration flows linking poor, rural communities with urban centres.</p>
<p>With investment from the Department of Science and Technology, data and data systems from the current three centres are being harmonised, and <a href="http://saprin.mrc.ac.za/">four more surveillance systems</a> are being set up. Three will be in urban settings in Gauteng, eThekwini and the Western Cape and one in a rural setting in the Eastern Cape. This harmonised network is called the South African Population Research Infrastructure Network (SAPRIN), which is hosted by <a href="http://saprin.mrc.ac.za/">The Medical Research Council</a></p>
<p>The full SAPRIN platform will include 550,000 people –- around 1% of South Africa’s census population. The platform will form <a href="http://saprin.mrc.ac.za/SAPRINfactSHEET.pdf">a network</a> that will be able to generate high-quality evidence to respond to some of South Africa’s biggest issues, which include poverty, inequality, unemployment, education and poor access to effective health care.</p>
<p>It will do this by linking to the public sector’s health system records as well as public school attendance registers and have access to the statistics around social grants. This will help researchers understand how people are using the services that the government has made available.</p>
<h2>The bigger picture</h2>
<p>Inadequate or even misleading evidence for planning is a complex problem in all countries, but especially low and middle-income countries. It arises due to limitations in infrastructure, especially in poorer parts of the country, and the costs involved for people registering key events in their lives. </p>
<p>South Africa is not the only country in the developing world to have surveillance systems like this. The three surveillance sites in South Africa are part of a <a href="http://www.indepth-network.org/">network of 37 health and demographic surveillance system sites</a> in sub-Saharan Africa, comprising the <a href="http://www.indepth-network.org/">INDEPTH Network</a></p>
<p>A combination of national census, vital registration and localised health and demographic surveillance data can be expected to fill the evidence gap in developing countries. </p>
<p>This will enable planners to have immediate and longer-run feedback on the impact of policies and programmes designed to improve health care and socio-economic status. </p>
<p>For this reason, we can expect to see more investment in surveillance over time and a bigger push to combine datasets to understand what is going on and what is needed.</p><img src="https://counter.theconversation.com/content/86733/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark A. Collinson receives funding from the South African Department of Science and Technology and the National Institute of Health in the US. </span></em></p><p class="fine-print"><em><span>Kobus Herbst receives funding from the South African Department of Science and Technology and the Wellcome Trust.</span></em></p>Health and demographic surveillance systems are important to understand people and the societies that they live in.Mark A. Collinson, Reader in Population and Public Health, MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the WitwatersrandKobus Herbst, Chief Information Officer at the Africa Health Research Institute, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/783852017-05-30T03:01:20Z2017-05-30T03:01:20ZImproving Australia’s health requires better use of patient information<figure><img src="https://images.theconversation.com/files/171286/original/file-20170529-25247-u10r7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia's policies on preventing heart disease are based on outdated research from the US.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><a href="https://en.wikipedia.org/wiki/Australian_referendum,_1967_(Aboriginals)">Fifty years</a> after we passed a constitutional referendum to count Aboriginal and Torres Strait Islander people in the Australian Census, data limitations mean they are still not counted in many health statistics. </p>
<p>Take a recent report produced by <a href="https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/prevalence-of-cardiovascular-disease-cvd-in-australia">The Heart Foundation</a>, for example. This mapped hot spots for heart disease and stroke (cardiovascular disease) across Australia, but only for non-Indigenous Australians. The explanation in notes to the report indicates that:</p>
<blockquote>
<p>… due to the low population and insufficient ABS data, we are unable to provide a true representation of CVD [cardiovascular disease] prevalence in the Northern Territory… The CVD prevalence tables and maps are for persons aged 18+ only and do not include Aboriginal and Torres Strait Islander peoples.</p>
</blockquote>
<p>We lack this information because we do not link routinely collected health care and death data with information from the census. This prevents us from being able to know if we are making any progress towards reducing cardiovascular disease, which is a leading <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Aboriginal%20and%20Torres%20Strait%20Islander%20Deaths%7E10015">cause of death of Indigenous Australians</a>. However, they aren’t the only group who miss out – the health of all Australians depends on more data sharing.</p>
<h2>Preventing heart disease in Australia</h2>
<p>Population studies have long shown us that factors such as having <a href="https://doi.org/10.1161/01.CIR.79.1.8">high levels of cholesterol</a> place people at a higher risk of having a heart attack. Based on a person’s age, gender and a relatively small number of other factors, it is possible to work out his or her risk of having a heart attack or stroke. </p>
<p>Identifying those people at high risk allows effective treatments, such as cholesterol-lowering drugs, to be targeted at those who benefit most. </p>
<p>Let’s consider how we treat heart disease in Australia. Different types of data are held by different levels of government and by many organisations in our fragmented health system. This makes it almost impossible for researchers to combine clinical information (such as patients’ blood pressure readings) with data collected from hospitals indicating whether they were later admitted for a heart attack or stoke. </p>
<p>Because Australia lacks this information, <a href="https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf">current guidelines</a> for treating heart disease and stroke are largely based on a risk-prediction tool <a href="https://doi.org/10.1016/0002-8703(91)90861-B">derived from a US study</a> published more than a quarter of century ago. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=522&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=522&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=522&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=656&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=656&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171373/original/file-20170530-25198-vscb2x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=656&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Indigenous Australians are still not identified in much of our health data.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Researchers in the United Kingdom have developed new <a href="http://www.bmj.com/content/336/7659/1475">tools for assessing heart disease risk</a> for their population. Unlike Australian researchers, they were able to access de-identified information from 2.3 million patients attending a general practice, then link this data to over 140,000 cardiovascular events such as heart attacks. </p>
<p>This has enabled better targeting of prevention strategies for managing cardiovascular disease as doctors are more accurately able to assess a patient’s risk. </p>
<p>The Australian Bureau of Statistics has in the past <a href="http://www.abs.gov.au/websitedbs/d3310114.nsf/home/statistical+data+integration+-+case+study:+life+expectancy">linked the census with death statistics</a> to provide estimates of the gaps in life expectancy between Indigenous and non-Indigenous Australians. Despite these efforts, we lag behind countries such as New Zealand, which has a more holistic approach to using data to understand ethnic and socioeconomic disparities. </p>
<p>Access to data and the ability to analyse those data <a href="http://press-files.anu.edu.au/downloads/press/n2140/html/ch11.xhtml?referer=&page=21#">are seen as critical</a> to finding an evidenced-based way to reduce health disparities in New Zealand. Having better data has focused efforts to prevent both <a href="https://theconversation.com/why-are-aboriginal-children-still-dying-from-rheumatic-heart-disease-63814">rheumatic fever</a> (which can lead to a heart condition which many Aboriginal Australians also suffer) and cardiovascular disease in the Maori and Pacific populations. </p>
<h2>Other countries do it – we should too</h2>
<p>On the day before the 2017 federal budget, the government tabled the Productivity Commission’s report on <a href="http://www.pc.gov.au/inquiries/completed/data-access/report/data-access.pdf">the use and availability of data</a>. The report <a href="http://www.pc.gov.au/inquiries/completed/data-access/report/data-access-overview.pdf">advocated greater use</a> of both public and private data to: </p>
<blockquote>
<p>enable new products and services that transform everyday life, drive efficiency and safety, create productivity gains and allow better decision-making.</p>
</blockquote>
<p>The controversy surrounding the 2016 Census demonstrates some Australians have genuine <a href="http://www.abc.net.au/news/2016-03-15/berg-census-privacy-threat/7244744">fears</a> about how the data they provide will be retained and used. While we must put in place effective measures to protect against the malicious use of personal data, not using the information collected about Australians comes at a cost. </p>
<p>Other countries routinely use data to tackle important issues that are not being addressed in Australia. The Productivity Commission <a href="http://www.pc.gov.au/inquiries/completed/data-access/report/data-access-overview.pdf">report</a> (page 54) explicitly recognises this:</p>
<blockquote>
<p>Governments across Australia also hold lots of data, but are typically not using it to the extent that opportunities being taken overseas exemplify, and lack a comprehensive plan to do so in most cases.</p>
</blockquote>
<p>While the recent budget contains many <a href="http://budget.gov.au/2017-18/content/glossies/essentials/html/">spending announcements</a>, it takes more than money to improve the health and wellbeing of Australians. We also need information and knowledge that can only be obtained by making better use of existing national and local data resources.</p><img src="https://counter.theconversation.com/content/78385/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Clarke receives funding from National Health and Medical Research Council and the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Josh Knight receives funding from Australian National Health and Medical Research Council and has previously received funding from the New Zealand Health Research Council.</span></em></p><p class="fine-print"><em><span>Xinyang Hua does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While we must put in place effective measures to protect against the malicious use of personal data, not using the information collected about Australians comes at a cost.Philip Clarke, Professor of Health Economics, The University of MelbourneJosh Knight, Research Fellow in Health Economics, The University of MelbourneXinyang Hua, Research Assistant, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/738332017-05-16T06:40:32Z2017-05-16T06:40:32ZHow do we decide which disease to prevent next? Long-term studies help<figure><img src="https://images.theconversation.com/files/169482/original/file-20170516-11941-6scde0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long-term studies help us prevent the type of diseases that would otherwise land us in hospital.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/479614864?src=BHDr8Y45d2MVScSTyMV0hA-1-2&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Every time someone quits smoking, takes their child for a vaccination or has their blood pressure checked, they’re taking part in preventive health measures designed to reduce the chances of getting sick.</p>
<p>But how do doctors, public health departments and governments know which disease to help prevent next? And how do they know which people to target?</p>
<p>One of their most powerful weapons is the long-term population study or “longitudinal cohort study”. This type of study follows a large group of people, often for years or decades, collecting data to build up a comprehensive picture of health at a population level over time.</p>
<p>By including information from surveys – linked to other routinely collected data like hospital admissions, prescription medications and cancer registrations, and increasingly genetic information – these studies offer us a window to the health of the population. </p>
<p>They allow us to better understand the relationship between risk factors and disease, and how people are managing their health over time. They also help us make better, informed decisions about changes likely to result in the best health outcomes - for individuals, the community and our health system.</p>
<p><a href="https://www.saxinstitute.org.au/our-work/45-up-study/">Long-term</a> <a href="http://www.alswh.org.au/">studies</a> are powerful as they allow researchers and public health officials to investigate and understand a wide range of issues, comparing the exposures and habits of people who have fallen sick with people who remain healthy.</p>
<p>Deaths from heart disease have dropped by around 80% since 1968, mainly because we have been tackling many of the key risk factors, such as smoking, high blood pressure and high cholesterol thanks to data from longitudinal studies such as the <a href="http://www.bmj.com/content/328/7455/1519">British Doctors Study</a> and the <a href="https://www.framinghamheartstudy.org/index.php">Framingham Heart Study</a>.</p>
<p>Findings from long-term studies also improve preventive health care, in everything from helping to <a href="http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">inform legislation</a> about smoking, to implementing <a href="http://www.aihw.gov.au/publication-detail/?id=60129557382">new practices and policies</a> on managing chronic lung disease, or helping to identify unanticipated side effects of popular and effective medicines, like those prescribed for <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168618">heartburn and reflux</a>.</p>
<h2>A key piece in the puzzle</h2>
<p>Long-term studies allow us to gather data on many different chronic diseases simultaneously. What this does, among other things, is allow decision makers to predict risk. If we can better do this, we can more easily determine where our stretched health care resources can be most effectively spent. This is critical to policymakers tasked with designing health systems that do the best job for the greatest amount of people.</p>
<p>For example, the <a href="http://www.nurseshealthstudy.org/">US Nurses’ Health Study</a>, which has been running for 40 years and involves more than 275,000 participants, has had a major impact on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981811/">public health</a>. These include <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981820/">regulations</a> on dietary trans fats, because of their links to heart disease, and establishing the positive impact of physical activity on cancer recurrence rates. </p>
<p>Here in Australia, <a href="http://www.alswh.org.au/">the Australian Longitudinal Study on Women’s Health</a> has been tracking the health of 58,000 Australian women in three different age groups for just over two decades. Its findings have been key to a series of government health policies and guidelines, such as on <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines">physical activity</a> and managing <a href="http://bladderbowel.gov.au/ncp/ncms/">urinary incontinence</a>.</p>
<p>These studies are also valuable tools to quantify the potential impact of preventive health measures. For instance, colleagues have calculated the costs of hospital admissions in Australia that are related to being overweight and obese at <a href="http://bit.ly/2mLOby2">A$4 billion</a>. That’s A$1 in every A$6 spent in hospitals for people aged 45 and over. Having access to such data provides a powerful financial incentive for governments and health funders to support preventive health programs to reduce the risk of obesity.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168041/original/file-20170505-27085-1mazlz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long-term studies can also tell us about the potential impact, say on hospital admissions, of preventive health measures.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/352316315?src=LmarXaZCEQ1fPNY9qcRacw-1-1&size=medium_jpg">from shutterstock</a></span>
</figcaption>
</figure>
<p>Another area key to government efforts in keeping populations healthy is better targeting health services and addressing the gaps between what we know about treating or managing ill health and what happens in practice. </p>
<p>Take the example of how to best prevent the recurrence of breast cancer. We know from clinical trials that using hormone-blocking therapies to treat early-stage breast cancer substantially reduces the risk of cancer returning, if medication is taken continuously for at <a href="https://springerplus.springeropen.com/articles/10.1186/2193-1801-3-282">least five years</a>.</p>
<p>But what we haven’t known until now is whether women were sticking to the full five-year treatment. By drawing on data from the <a href="https://www.saxinstitute.org.au/our-work/45-up-study/">45 and Up Study</a>, researchers have been able to establish that nearly <a href="https://springerplus.springeropen.com/articles/10.1186/2193-1801-3-282">six in every ten women</a> quit their hormone-blocking medication early, putting them at greater risk of their cancer returning. </p>
<p>This sort of information would be difficult, if not impossible, to gather by any other means than through a long-term study. This provides decision makers with essential real-world data, allowing them to design improved treatment plans for the 17,000 Australians diagnosed with breast cancer each year.</p>
<p>Evidence from long-term population studies needs to be considered alongside good quality evidence and data on what works in practice (such as randomised controlled trials or other intervention studies), cost effectiveness, community acceptability, and feasibility. </p>
<h2>New targets</h2>
<p>Data from long-term studies help us design and deliver preventive health strategies; they can help us target preventive health measures in ways we may not have known about otherwise.</p>
<p>For example, one area researchers and policy makers are trying to better understand is the interplay between mental health, disability and lifestyle-related illnesses. A recent <a href="http://drc.bmj.com/content/5/1/e000198">paper</a> using longitudinal data found adults with <a href="https://theconversation.com/explainer-what-is-diabetes-11842">type 2 diabetes</a> are five times more likely to have a lower quality of life and less social interaction in the five years after diagnosis compared to those without the condition.</p>
<p>Looking to the future, long-term studies could help us answer the big questions for which we currently don’t have data. What are the health impacts of e-cigarettes? Does excessive screen time affect cognitive function and how does it interplay with lifestyle-related illnesses such as obesity and type 2 diabetes?</p><img src="https://counter.theconversation.com/content/73833/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Banks has received research funding from the National Health and Medical Research Council, the Federal Department of Health and the Heart Foundation of Australia. She has been the Scientific Director of the 45 and Up Study since its inception: the views expressed in this article are her own.</span></em></p>Long-term studies help identify new risk factors for disease and how we might address them.Emily Banks, Professor of Epidemiology and Public Health, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677242016-11-14T19:08:53Z2016-11-14T19:08:53ZHow strong social networks can help migrants manage health risks better<figure><img src="https://images.theconversation.com/files/145015/original/image-20161108-16697-1c66pxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jamestown in Accra, Ghana, is home to many migrants from other parts of the country.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/davidstanleytravel/21799429649/in/photolist-gFepq2-gFg9Jo-drJ9sB-4E7DDu-gFhPkD-4E3oTP-gFi5nn-AreVC-gFb5mY-zdkLXk-zH3efK-zF14br-zbGKEv-znApUW-gFufAD-B9XvG-4E3ki8-4E7BmS-gFDG4A-fBdhQ5-4E7DMU-4E7AM9-4E3nG6-4E7Evf-4E7DXS-4E3pQa-BaEZe-4E3pCB-zD5ki1-4E3pov-4E3pbn-yyP9ft-yPU4SR-zua9Do-yPU59c-zJt6R5-yPKiaG-zKEtDG-yPU75B-8BZu9Y-zKEv7b-zJt7Lm-yPKjM9-yPU6Zr-zubEJ9-zLMc6z-CxGYWC-zvnbAF-BCviFb-HmXsSk">David Stanley/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Migration is a global phenomenon. In West Africa, about 33% of people have moved from their village of birth. In Ghana, inter-regional movement is a major contributor to <a href="http://migratingoutofpoverty.dfid.gov.uk/files/file.php?name=wp-13---awumbila-owusu-teye-2014-can-rural-urban-migration-into-slums-reduce-poverty-final.pdf&site=354">where people live</a>, with over 50% of the population living outside the villages they were born in.</p>
<p><a href="http://migratingoutofpoverty.dfid.gov.uk/files/file.php?name=wp7-internal-migration-remittances-and-poverty.pdf&site=354">Previous research</a> shows that the greater Accra region attracts the largest number of migrants by far. The general trend is that people <a href="http://www.migrationdrc.org/research/regions/ghana_africa.html">move from</a> the less economically endowed locations in the northern regions to find work in the relatively richer south. </p>
<p>Many of these migrants end up in poor neighbourhoods in the city’s urban centres because they cannot afford rents in better residential areas. On the margins of society, the poor conditions they live in make them susceptible to environmentally induced diseases such as malaria, cholera and typhoid. </p>
<p>To evaluate the health of migrants, research has traditionally mainly focused on geography, sexual ill health, the double burden of infectious and chronic diseases, the environment, wealth, income and health factors. </p>
<p>The <a href="http://ugspace.ug.edu.gh/handle/123456789/1071">research</a> shows that rural migrants and residents in poor communities have a higher burden of sexual ill health and suffer from both infectious and non-communicable diseases. These are also the major causes of death and disability. </p>
<p>In our <a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">study</a> we expanded the lens to understand patterns of disease by looking at lifestyle factors as well as social factors. These included how long migrants stayed in a place, what job they had, how religious they were and how often they ate “street meals”. </p>
<p>What our research points to is that a systematic policy framework to promote the active creation of social networks – at formal and informal work places and at places where people congregate for recreation or for worship – would make a dramatic difference in helping migrants better manage their health.</p>
<h2>The factors that affect migrants’ health</h2>
<p>Researchers have traditionally used a set of <a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">social factors</a> that look at migrants’ disease patterns to determine their health status. These have included living and working conditions, family wealth, health literacy, education, employment and the degree of autonomy in jobs, the quality of housing, ethnicity, and gender. </p>
<p>Environment factors also come into play. These include the quality of food and water, air and soil. For example, diseases thrive in areas where migrants live in degraded, overcrowded environments with poor sanitation. Overcrowding increases the risk and spread of respiratory diseases. This becomes worse when too many people use charcoal and firewood as cooking fuels.</p>
<p>In addition, social relationships have been shown to matter.</p>
<p>Urbanisation dramatically affects social relationships. For example, traditional lifestyles of family cooking and the sharing of home cooked food are replaced by out-of-home “street meals”. This has led to an increase in lifestyle diseases such as cardiovascular diseases and associated risk factors like obesity, high blood pressure, cholera and other diarrhoeal disease epidemics. </p>
<p>Social relationships also affect the social support networks migrants can rely on to access health care services.</p>
<p><a href="http://link.springer.com/article/10.1007%2Fs10708-016-9723-1">Our study</a> looked at the health status of migrants in Jamestown, a poorer neighbourhood in Accra. </p>
<p>We found that socio-demographic factors, individual lifestyles and the type of resources migrants could access through their social networks all played a part in how healthy, or not, they were.</p>
<p>Migrants face multiple health challenges. Hazardous working and poor living conditions as well as the fact that they have moved to new and unfamiliar terrain also play a part. For example, we found that migrants who had lived in the neighbourhood longer were more likely to have a better health status than those who had migrated recently. </p>
<p>The jobs they did also affected their health. Those employed in jobs involving physical activity such as masonry, welding and carpentry were more likely to say they were healthy compared to those who provided services, such as seamstresses, nurses and drivers. Migrants involved in sales such as trading, food vending and fish mongering also did not rate their health highly. </p>
<p>Migrants who bought food from food vendors were more likely to have a lower self-rated health status than those who didn’t. </p>
<h2>Social capital</h2>
<p>The association between poor migrants’ lifestyles and their health in poor urban neighbourhoods as well as how social capital mediates that association has been a largely neglected area of research.</p>
<p>Previous <a href="http://www.springer.com/us/book/9789400767317">research in Accra</a> on poverty and health has largely focused on the spatial distribution of inequalities in health. It has shown that there is uneven distribution of diseases with some places having higher prevalence of certain diseases than others. </p>
<p>But we found that those who felt that they had enough information on how to live successfully – including how to access health care from the host population in Jamestown – had a more positive outlook on their health. This confirms <a href="http://happierhuman.wpengine.netdna-cdn.com/wp-content/uploads/2014/06/P13.-Social-Isolation-in-America-Changes-in-Core-Discussion-Networks-over-Two-Decades.pdf">earlier research</a> that <a href="https://my.vanderbilt.edu/lijunsong/files/2015/09/Social-Capital-and-Health-2013.pdf">social capital</a> at the individual and interpersonal level is a major source for passing on information as well as a predictor of health. </p>
<p>This study is important because it provides some of the answers about existing health differentials for people living in disadvantaged neighbourhoods and points out some of the contributions that lifestyles can make. The findings have implications for policy. They can also help design improvements in areas of community health insurance schemes, strengthening community health care systems, and promoting communal and family support systems that are falling apart. </p>
<h2>Information and education are key</h2>
<p>As things stand, people who don’t get adequate information about health issues often resort to cheaper herbal medicines and unauthorised conventional medicines that are less effective in controlling diseases such as malaria, TB, cholera and even obesity. This not only endangers migrants’ health: it can also contribute to drug resistance. </p>
<p>Of course, health facilities should be improved so that migrants have access to affordable health services. Currently many have little or no access. </p>
<p>But the research highlights the need for intervention at a much more granular level. It shows that there is an urgent need for strong policies to support informal health education, health literacy and counselling to migrants as well as host populations about healthy living. </p>
<p>New policies should be developed to promote proactive social, familial and community support networks that facilitate better information about health. This would include information about healthy living, good hygiene and responsible sexual behaviour. </p>
<p>Strong networks would help facilitate discussions among community members about ways to avoid health risks associated with lifestyles, poor sanitary conditions and unprotected sex. They would provide the channels through which people could be armed with the necessary information to improve their lives, particularly their health. This, then, would encourage them to take the necessary steps to avoid risks.</p><img src="https://counter.theconversation.com/content/67724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Boateng does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vast numbers of people who migrate in search of a better life end up living in marginal conditions that put their health at risk. But individual lifestyle is also an important factor.John Boateng, Lecturer in Continuing and Distance Education, University of GhanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/675482016-10-26T19:09:06Z2016-10-26T19:09:06ZHow discrimination and stressful events affect the health of our Indigenous kids<figure><img src="https://images.theconversation.com/files/143210/original/image-20161026-4732-z13zpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Indigenous kids experience more major life events than non-Indigenous kids, and this can affect their health. </span> <span class="attribution"><span class="source">Rusty Stewart/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Footprints in Time, or its more formal title, the Longitudinal Study of Indigenous Children (LSIC), is approaching its tenth year of collecting data from around 1,700 Indigenous children, their families and teachers. It follows two cohorts of children: a group who were aged 6-18 months at the beginning of the study, and a group who were aged between 3.5 and 5 years.</p>
<p>LSIC broke new ground worldwide for studying the social, developmental and familial dynamics of a group of Indigenous children and their families. Data are collected from Indigenous families across Australia, from cities to remote locations. We can use these data to consider how our Indigenous children have grown up against a backdrop of efforts to resolve and improve long-term indicators of disadvantage.</p>
<p>The benefit of using longitudinal data for this kind of hindsight analysis is that we are looking at the same children and the same families; we can see what’s changed and how those changes have affected these children.</p>
<h2>Major life events</h2>
<p>Major life events have a significant influence, not only on the people involved, but flowing on to those around them. Things that happen to one family member may affect other or even all family members, including children. <a href="https://www.suicidepreventionaust.org/news/report-exposure-and-impact-suicide-australia-be-released-world-suicide-prevention-day">Recent research from the US</a> showed that every suicide has impacts that affect about 135 people.</p>
<p>Events may be either positive or detrimental, including birth, death, marriage, divorce, being a victim of violence or observing violence, or being a victim of property crime. The list of stressors is long and can include things like the inability to practice culture and language, or continually changing government policies and funding.</p>
<p><a href="https://www.dss.gov.au/about-the-department/national-centre-for-longitudinal-studies/centre-research-and-publications/research-summary-no1/2014-multiple-disadvantage">Research examined</a> the occurrence of stressful events over 12 months, and found that where fewer than three stressful events occurred, around 15% of children aged 4-11 were at high risk of emotional or behavioural difficulties. </p>
<p>This figure increased to 25% for families who experienced between three and six stressful events, while the percentage of children at risk of difficulties rose to 42% in families who experienced seven or more stressful events.</p>
<p>High <a href="https://www.dpmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-1-health-status-and-outcomes/122-all-causes-age-standardised-death-rate.html">Indigenous mortality</a> together with strong social connectedness within Indigenous communities may mean that, tragically, Indigenous children may observe the death of relatives and experience grieving more often than the general population.</p>
<p>LSIC reports that around 25% of all LSIC parents attend one to two funerals a year; while nearly another 25% may attend four a year, and almost 9% may attend five to ten a year.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143186/original/image-20161025-4729-pa0wab.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Number of funerals attended by primary carer over 5 years.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>A feature of longitudinal data is it offers the chance to compare different studies. A comparison between the LSIC data with another longitudinal child development study, Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC), shows that children in the Indigenous study were three times more likely than those in the Australian children study to have been affected by a death outside the household in the past 12 months.</p>
<p>Indigenous families were also:</p>
<ul>
<li><p>twice as likely to have moved house in the past year</p></li>
<li><p>three times as likely to have been affected by a relative outside the household being ill, and</p></li>
<li><p>six times as likely to have been suffering financial stress.</p></li>
</ul>
<p>One of the most striking results recorded in LSIC was that children experiencing seven or more major life events had average vocabulary test scores two points lower (out of 50 points) than Indigenous children experiencing fewer life events.</p>
<p>And a further unfortunate flow-on effect of cumulative stress is that stress on Indigenous parents results in increased smoking, which can substantially reduce the length and quality of the <a href="https://theconversation.com/indigenous-smoking-program-cuts-risk-widening-the-gap-29051">lives of Indigenous people</a>. LSIC data reports for each life event a parent experiences, their likelihood of smoking is 2.5% higher.</p>
<h2>Discrimination</h2>
<p>Beyond Blue has previously <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwjupKfXhdTPAhVFEpQKHc5jD9QQFgglMAE&url=https%3A%2F%2Fwww.beyondblue.org.au%2Fdocs%2Fdefault-source%2Fresearch-project-files%2Fbl1337-report---tns-discrimination-against-indigenous-australians.pdf%3Fsfvrsn%3D2&usg=AFQjCNEexGkgpIFza9d0ZvvW0vZwEW1KFA">highlighted</a> how the non-Indigenous population discriminates against Indigenous Australians. Their report shows one in five non-Indigenous Australians admits that they would discriminate against an Indigenous person in some circumstances.</p>
<p>This is upsetting on any level and begs the question of what these attitudes mean for the experiences of Indigenous people themselves, and of their children. LSIC data can help to provide answers.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143187/original/image-20161025-4699-16m8kwc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">LSIC parents’ experience of discrimination.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Looking at the data, parents who experience discrimination are less likely to report good or better health. In 2011, Indigenous parents experiencing discrimination generally reported fair or poor health at a rate 9% greater than parents who did not report discrimination.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143188/original/image-20161025-4699-txm5bh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Relationship between discrimination and self-rated general health.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>It’s not just the deleterious effects on the parents that are of concern, but the collateral and intergenerational flow-on impact to Indigenous children’s outcomes that demonstrate the effect of discrimination on the whole family.</p>
<p>At six to seven years of age, 57% of Indigenous children with a mother who reported discrimination had more social, emotional and behavioural difficulties. In comparison, 43% of children of non-discriminated mothers reported increased scores of social and emotional difficulties.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143189/original/image-20161025-4738-fqawsa.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Relationship between Mother’s experience of discrimination and child’s difficulties scores at 6-7 years of age.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The LSIC study, and a <a href="https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1337-report---tns-discrimination-against-indigenous-australians.pdf?sfvrsn=2">Beyond Blue report</a>, show discrimination is significant whether you ask the non-Indigenous or the Indigenous population. Discrimination causes harm to the mental and physical health of Indigenous people, and like cumulative stress, impacts strongly on the children of affected families from one generation to the next.</p>
<p>The effect of cumulative stress through multiple life events can be seen to cause harm to parents, through effects such as increasing smoking.</p>
<p>But some efforts to address the negative health outcomes from smoking are showing strong signs of success. The LSIC data shows us the percentage of Indigenous people who smoked inside the house was around 25% in 2008, and by 2014 had dropped to around 17% (across Australia data from 2013 was <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/ch3/">3.7%</a>).</p>
<p>In the most recent (unpublished) LSIC data, fewer than 15% of Indigenous people smoke inside their house. While this is still too high, this shows messages are getting through, and critical benefits to Indigenous people are being achieved through engagement with Indigenous communities and <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-tis-lp">education campaigns</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143203/original/image-20161025-4702-1s8k2i7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoking inside the house over time (Balanced panel n=950).</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>If concerted efforts can improve the lives of Indigenous people through addressing smoking, then the same should be possible for discrimination. Using authoritative data to speak out against discrimination is an important first step.</p>
<p>While Beyond Blue’s efforts in raising awareness of discrimination among the non-Indigenous population is commendable, more needs to be done. With powerful data sets like the LSIC resource, sharing and linking data across sectors can demonstrate not only the occurrence of events, but the impact of those events on individuals and families in the community.</p>
<hr>
<p><em>Tom Calma will be a keynote speaker at the first Longitudinal Data Conference, being hosted by the National Centre for Longitudinal Data today.</em></p><img src="https://counter.theconversation.com/content/67548/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Calma does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>High Indigenous mortality rates mean Indigenous children may observe the death of relatives and experience grieving more often than the general population.Tom Calma, Adjunct Professor, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/571192016-05-04T06:27:01Z2016-05-04T06:27:01Z‘Living here will make you fat’ – do we need a public health warning?<p>Governments have <a href="http://www.aihw.gov.au/australias-health/2014/preventing-ill-health/#t1">invested billions in efforts to prevent obesity</a>, yet Australians keep getting fatter, especially in areas of socioeconomic disadvantage.</p>
<p>Over the past two decades, the prevalence of obesity rose in adults from <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/33C64022ABB5ECD5CA257B8200179437?opendocument">19% to 28%</a>. The proportion who are overweight remained similar at around 38%. This means two-thirds of Australian adults are now overweight, with a <a href="https://theconversation.com/does-my-bmi-look-big-in-this-and-does-it-really-matter-35156">body mass index</a> (BMI) of 25–29.9, or obese (BMI >=30). </p>
<p>A new study published in <a href="http://bmjopen.bmj.com/content/6/5/e010405.full.pdf+html">BMJ Open</a> confirms that obesity is highest in Australians who live in areas of socioeconomic disadvantage. The age-adjusted odds ratio of being overweight or obese was determined for high and low levels of socioeconomic disadvantage. We analysed data collected from almost 37,000 patients based on their interactions with their general practitioners over two years (September 2011 to 2013). </p>
<p>This study is part of the larger <a href="http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-557">Sentinel Practices Data Sourcing</a> project. This aims to develop a surveillance system for monitoring chronic diseases within the Southeastern NSW Primary Health Network. </p>
<p>Patients’ area of residence was categorised using the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001">Socio-Economic Index for Areas</a> of relative socioeconomic disadvantage. Both men and women living in areas of highest socioeconomic disadvantage had a 29% higher risk of being obese. The opposite association was found for being overweight, at least in men (those in areas of lesser relative socioeconomic disadvantage were more likely to be overweight). </p>
<h2>What makes low-SES areas ‘obesogenic’?</h2>
<p>It is well recognised that an <a href="http://dx.doi.org/10.1016/j.socscimed.2004.08.056">inverse relationship</a> exists between socioeconomic status (SES) and obesity. But the reasons for this are not straightforward.</p>
<p>“Obesogenicity” (the sum of influences that physical surroundings have on promoting excessive weight gain) of neighbourhoods may relate to the food environment (inadequate access to local sources of healthy foods, such as supermarkets and greengrocers, or easy access to unhealthy foods, such as fast-food restaurants) or the physical activity environment (less green space, unsafe neighbourhoods). </p>
<p>In the US, it has been demonstrated that neighbourhoods in lower socioeconomic areas are more “obesogenic” than those in richer areas. This translates to higher levels of obesity in <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058500/">children</a> and <a href="http://epirev.oxfordjournals.org/content/29/1/129.long">adults</a>. But these findings are <a href="http://www.sciencedirect.com/science/article/pii/S135382921400104X">not directly transferable</a> to Australia. </p>
<p>A study of socioeconomically disadvantaged areas in Victoria ranked neighbourhoods using an index that included three domains:</p>
<ul>
<li><p>food resources (supermarkets, green grocers, fast-food restaurants);</p></li>
<li><p>recreational activity resources (gyms, pools, park space); and</p></li>
<li><p>walkability (four or more intersections within a 2km buffer, walking environment, neighbourhood safety). </p></li>
</ul>
<p>Surprisingly, neighbourhood “obesogenicity” was not associated with BMI of residents. It seems other factors may be at play. </p>
<h2>Supermarkets and shelf space</h2>
<p>Supermarket proximity may not necessarily reflect access to healthier foods. About 30% of supermarket shelf space comprises junk (or non-core) foods. However, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/19951246">shelf space</a> dedicated to non-core foods does not differ according to the location of the supermarket. </p>
<p>There is also no association between proportion of shelf space allocated to non-core foods and their purchase. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19951246">But low-SES Australian shoppers</a> do buy significantly more non-core foods than high-SES shoppers, especially chips and sugar-sweetened carbonated beverages and cordials. </p>
<p>This behaviour is likely to be driven by the <a href="http://jn.nutrition.org/content/133/3/838S.long">economics of food choice theory</a>: people on low incomes maximise energy availability per dollar. They buy foods that provide the most energy (usually with few other nutrients) for the least cost. This has been shown to influence food purchases in <a href="https://www.mja.com.au/journal/2009/190/10/role-energy-cost-food-choices-aboriginal-population-northern-australia">Indigenous communities</a>. </p>
<p>There may also be less segregation in Australia between neighbourhoods classified as high versus low SES. Or there may be less clustering of fast-food restaurants in low-SES neighbourhoods than occurs in the US. Also, people may not necessarily shop or eat out where they live, particularly if they commute to work and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953373/">access fast-food outlets</a> on their way home. </p>
<h2>Green space effects vary</h2>
<p>A study in NSW found that proximity of residence to green space was associated with undertaking more moderate-to-vigorous physical activity and having less sitting time in both men and women. </p>
<p>However, this activity translated into lower body weight only in women; those who lived close to green space had a <a href="http://www.ncbi.nlm.nih.gov/pubmed/23732654">10-20% lower risk</a> of being overweight or obese, respectively, compared to those who lived further from such areas. </p>
<p>It could be that men compensate for being active by eating more, regardless of where they live, but this hypothesis remains to be proven.</p>
<p>There is little doubt that state government investment to enhance green spaces may promote physical activity in middle-to-older-aged adults. This has to be a good thing, but the impact on obesity may not benefit everyone to the same extent. </p>
<h2>How can we reduce obesity in low-SES areas?</h2>
<p><a href="to%20include%20hyperlink">Our study</a> provides new insights for population health planning. The findings highlight a need for preventive health initiatives to be specific to gender and the socioeconomic attributes of the target population.</p>
<p>We propose that, in areas of highest socioeconomic disadvantage, primary care providers could have more streamlined approaches to direct obese patients to existing weight loss programs. These include the free government-funded, population-based <a href="http://www.gethealthynsw.com.au/">Get Healthy Information and Coaching Service</a>.</p>
<p>In areas of low socioeconomic disadvantage, efforts could be focused on preventing further weight gain in adults, particularly men, who are already in the overweight range. </p>
<p>Encouraging patients to keep a close eye on their weight could be achieved through routine weighing every time they attend their general practitioners. This is an <a href="http://ro.uow.edu.au/cgi/viewcontent.cgi?article=3034&context=smhpapers">effective strategy</a> and is relatively simple. However, recording of height and weight measures in general practices <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajr.12264/full">especially in regional settings</a> is much lower than optimal. </p>
<h2>The (large) elephant in the room</h2>
<p>The Australian government has been <a href="https://www.mja.com.au/journal/2016/204/6/australia-s-health-being-accountable-prevention">heavily criticised</a> over recent weeks for its lack of commitment to <a href="https://theconversation.com/balancing-the-health-budget-chronic-disease-investment-pays-big-dividends-46598">preventing chronic diseases within the primary health care</a> system. Less than 2% of health funding is <a href="http://anmf.org.au/pages/the-facts-on-australias-health-spending">spent on prevention</a>. </p>
<p>As part of the Primary Health Care Review, the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/healthiermedicare">“Healthier Medicare”</a> package focuses on treatment of chronic diseases, but ignores the elephant in the room – prevention of obesity. </p>
<p>Obesity is the most important cause of chronic conditions, including type-2 diabetes and cardiovascular disease. Surely it would make better economic sense to stem the tidal wave of obesity, which brings with it chronic diseases, rather than wait for the already overburdened health system to cope with the increasing prevalence of these conditions. </p>
<p>As well as a health services approach, population-level strategies are urgently required to influence dietary behaviours, with reach across all SES levels. </p>
<p>Other countries are ahead of the game in this regard. For example, <a href="http://www.economist.com/news/business/21588088-once-omnipotent-industry-fights-what-may-be-losing-battle-fizzing-rage?zid=305&ah=417bd5664dc76da5d98af4f7a640fd8a">Mexico</a>, <a href="http://www.spiegel.de/wirtschaft/soziales/umstrittene-zuckerabgabe-frankreich-fuehrt-cola-steuer-ein-a-806143.html">France</a>, <a href="http://www.treasury.gov.za/documents/national%20budget/2016/guides/2016%20People's%20Guide%20English.pdf">South Africa</a> and, most recently, the <a href="http://www.bbc.com/news/health-35824071">UK</a> have implemented <a href="http://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">sugar taxes</a> on soft drinks. Scandinavian countries and Ireland have <a href="http://whqlibdoc.who.int/publications/2004/9241591579.pdf">legislated a reduction of junk-food marketing</a> to children. In Australia, this relies on <a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1011/11rp09">voluntary adherence</a> by the food industry. </p>
<p>Perhaps neighbourhoods in pockets of high socioeconomic disadvantage need to carry a health risk message: “Living here will make you fat”. Or perhaps policymakers need to look at the glaringly obvious health data and shift resources to where they are most needed to prevent obesity.</p><img src="https://counter.theconversation.com/content/57119/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Charlton receives research funding from the Illawarra Health and Medical Research Institute and the Bloomberg Philanthropy Foundation. </span></em></p><p class="fine-print"><em><span>Abhijeet Ghosh works for COORDINARE - South Eastern NSW PHN as the Senior Consultant, Epidemiology & Evidence.</span></em></p>The government’s focus on treating chronic disease neglects the importance of obesity and the benefits of preventive health measures tailored to gender and socioeconomic circumstances.Karen Charlton, Associate Professor, School of Medicine, University of WollongongAbhijeet Ghosh, Researcher, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/484702015-10-20T03:46:09Z2015-10-20T03:46:09ZKenya needs a new plan to make contraceptives accessible again<figure><img src="https://images.theconversation.com/files/98410/original/image-20151014-15127-x3ywlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Blister-packs of the contraceptive drug Diane-35. In Kenya, millions of women do not have access to contraception methods. </span> <span class="attribution"><span class="source">Reuters/Regis Duvignau </span></span></figcaption></figure><p>Globally, the health community has recognised the importance of contraception in reducing the burden of unplanned pregnancies, encouraging smaller families and empowering women as a move to sustainable development in developing countries. </p>
<p><a href="http://www.guttmacher.org/pubs/FB-contraceptive-services-SSA.html">Research</a> shows there are significantly positive links between contraception and maternal and child survival, household well-being and women reaching their career goals and participating in nation-building.</p>
<p>Contraception also reduces chances of depression and anxiety among family members. And on a personal level, it elevates individual and household happiness levels and ensures higher investment in children.</p>
<p>Despite these vast benefits, the United Nations Population <a href="http://www.unfpa.org">Fund</a> estimates that while over 225 million women globally want to avoid pregnancy, they lack access to safe and effective contraception methods. </p>
<p>In Kenya, 18% of married women and 26% of unmarried women <a href="http://dhsprogram.com/pubs/pdf/PR55/PR55.pdf">lack access</a> to effective contraception. Nationally representative <a href="http://dhsprogram.com/pubs/pdf/fr229/fr229.pdf">surveys</a> consistently show that less than 40% of young women and adolescent girls who have had sex have used a contraceptive method. In one <a href="http://www.measuredhs.com/pubs/pdf/FR102/FR102.pdf">survey</a> only 29% of young girls who had sex in the month before the survey had used a contraceptive method. </p>
<p>Currently, just more than half of married women in Kenya use modern contraceptives such as intrauterine devices, also known as IUDs, and contraceptive implants under their skin. But the availability of contraceptives remains lowest among those in greatest need: </p>
<ul>
<li><p>poor and rural women and adolescents, </p></li>
<li><p>women without education, and </p></li>
<li><p>those who already have large families. </p></li>
</ul>
<p>There is also a growing need for married teenagers to have access to contraceptives. And there remains critical regional disparities in accessing contraceptives. In some regions only 3% of women use contraceptives. In Kenya, <a href="http://dhsprogram.com/pubs/pdf/PR55/PR55.pdf">59%</a> of women live in rural areas.</p>
<h2>The benefits of contraception</h2>
<p>Contraception is more than fertility control. It empowers couples and women to take charge of their fertility and to decide and schedule the number of children they have. </p>
<p>This not only has far-reaching benefits for individuals and couples, it also impacts on their households, communities and the society at large. </p>
<p>A review of the socio-economic benefits of contraception also shows it benefits <a href="http://www.guttmacher.org/pubs/social-economic-benefits.pdf">men</a>. It gives them more disposable income, allows better health outcomes for their households, mothers, wives and colleagues. It also results in more satisfying and longer-lasting relationships with their partners.</p>
<h2>The Kenyan crisis</h2>
<p>In the 1960s Kenya was a regional leader in providing contraceptive and family planning services. It launched the first official national family planning programme in sub-Saharan Africa. </p>
<p>Policy analyst Maura Graff from the Population Reference Bureau noted that the <a href="http://www.prb.org/Publications/Articles/2012/kenya-family-planning.aspx">increased use</a> of contraceptives in Kenya led to a decline in the total fertility rate. It decreased from an average of 8.1 children for each woman in 1978 to 4.7 in 1998. With rapid increases in planned childbearing, family incomes began to rise and the proportion of women earning wages also increased. </p>
<p>But from the mid 1980s, support and funding for family planning in Kenya waned massively. This resulted in major reversals in strategic gains. Contraceptive and family planning services in Kenya have yet to fully recover from this hiatus.</p>
<p>Kenya’s poor contraceptive service system has telling implications. In 2012, half a million induced abortions occurred in the country. In the same year, 70% of the women who were treated for complications after unsafe abortions were not on contraceptives. </p>
<p>Unintended births continue to contribute substantially to population growth in the country. Annually, thousands of Kenyan schoolgirls drop out of school because of unintended pregnancy. Research also shows rising risk of repeat abortion and its dangerous sequel among girls and women in the country.</p>
<p>There are several factors at the heart of Kenya’s contraceptive crisis, including poor political support. </p>
<p>There has also been little commitment to scale up successful family planning and contraceptive provision programmes and interventions. <a href="http://aphrc.org/publications/incidence-and-complications-of-unsafe-abortion-in-kenya-key-findings-of-a-national-study/">Research</a> shows contraception is one of the least frequently taught topics in Kenyan public and private schools. Consistent national communication remains weak. Several political leaders continue to publicly antagonise family planning and contraception.</p>
<p>Few Kenyan women who undergo treatment for unsafe abortion complications receive a contraceptive. This is partly because of the frequent stock-outs of critical contraceptive products which health facilities in Kenya experience.</p>
<p>A recent <a href="http://aphrc.org/publications/incidence-and-complications-of-unsafe-abortion-in-kenya-key-findings-of-a-national-study/">study</a> showed very few providers in Kenyan public health facilities knew how to perform a <a href="http://www.webmd.com/sex/birth-control/vasectomy-14387">vasectomy</a> or administer long-acting reversible contraceptives, such as an IUD or a contraceptive implant under the skin. </p>
<p>Poverty and longstanding regional inequities also perpetuate the exclusion of many people from accessing effective contraception. </p>
<p>There are several <a href="http://www.biomedcentral.com/1471-2458/15/118">myths and misconceptions</a> that circulate about contraception in Kenya. These include fears that some modern contraceptives cause cancer, infertility, and hurt people during sex. There are also widely-held beliefs that contraception facilitates promiscuity and sexual waywardness.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515408/">Opposition</a> to contraception by the country’s religious right remains fierce. Efforts to directly reach young people with contraceptives are resisted by different interest groups.</p>
<h2>Fixing the problem</h2>
<p>At least two of the new poverty alleviating sustainable development goals underscore the importance of contraception. Planned births, smaller families and access to effective contraception is key to achieving gender equality, women empowerment and a healthy life for all. </p>
<p>We need to raise awareness about contraception and improve public education about sexual and reproductive health. Every pregnancy should be wanted and families should have the number of children they can take care of. Unsafe abortions should be eliminated and girls should not drop out of school due to an unintended pregnancy. </p>
<p>Serving Kenyans who do not have access to contraception would prevent millions of unintended pregnancies, unplanned births, unsafe abortions, miscarriages and maternal and infant deaths. And this is very doable.</p>
<p>Bolstering contraceptive and family planning services in Kenya would require conscientious action from various sectors. This includes politicians, thought leaders, researchers, the media, health providers, educators, activists and development agencies, among others. </p>
<p>The task ahead of Kenya is attainable - but it demands that everybody, not just a section of the country, act.</p><img src="https://counter.theconversation.com/content/48470/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chimaraoke Izugbara works for APHRC. He receives funding from the Hewlett Foundation and Packard Foundation. He is also affiliated with the University of Gothenburg in Sweden.</span></em></p>Contraception gives women the choice of how many children to have and when to have them. This empowers them - but millions of women in Kenya do not have this choice.Chimaraoke Izugbara, Head of Population Dynamics and Reproductive Health and Director of Research Capacity Strengthening, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/151762013-09-03T04:35:03Z2013-09-03T04:35:03ZWhy hasn’t the mental health of Australians improved?<figure><img src="https://images.theconversation.com/files/30587/original/y88psvzq-1378179510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Given the money Australia has spent on mental health, it's surprising that population data doesn't show expected gains.</span> <span class="attribution"><span class="source">Ben Barnes</span></span></figcaption></figure><p>Despite two decades of investment in improving mental health services, the mental health of Australians has not improved. This may be because haven’t been spending money on the right approach and need to place greater emphasis on prevention. </p>
<p>In 1997, Australia had its first <a href="http://www.ncbi.nlm.nih.gov/pubmed/10789524">National Survey of Mental Health and Wellbeing</a>. The survey showed that mental disorders were common, and that many people who were affected did not seek or get professional help. </p>
<p>Other countries were also carrying out similar national mental health surveys at the time to help plan service development. They produced similar findings, leading to concerns about the “treatment gap in mental heath care” as a global problem. </p>
<p>In 2001, the World Health Organization (WHO) proposed <a href="http://www.who.int/bulletin/volumes/82/11/en/858.pdf">a ten-point plan</a> for addressing this treatment gap.</p>
<h2>Good reason to act</h2>
<p>The rationale behind closing the treatment gap seems unassailable. </p>
<p>There are treatments for mental disorders that are known to work and many people are not getting them. If we could get more of them into treatment, then the mental health of the population should improve.</p>
<p>Australia provides a good test of this approach; since the first survey in 1997, we’ve had major increases in the provision of mental health services. </p>
<p>From 1992 to 2004, real spending on mental health services by the Commonwealth increased by 149% and spending by the states and territories increased by 67%. Prescriptions per capita for antidepressants also increased dramatically, as did the number of psychological services funded by Medicare. </p>
<p>Between 1997 and 2007, there were decreases in the proportion of people with mental disorders who reported that their needs for care were unmet. But when we look at data on the mental health of the population, we <a href="http://www.ncbi.nlm.nih.gov/pubmed/22508594">can’t find the expected gains</a>. </p>
<p>Data from four mental health surveys that have been repeated at various points in time between 1995 and 2011 show no gains. If anything, there are trends for worsening mental health in some subgroups of the population.</p>
<h2>But why?</h2>
<p>There are several possibilities for why we haven’t seen any gains. Perhaps there’s been progress, but the steps forward have been too small to detect in our surveys. </p>
<p>Or progress may have been counteracted by other forces such as the global financial crisis, or natural disasters such as the drought – both of which could increase the risk for some types of mental health problems.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=680&fit=crop&dpr=1 600w, https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=680&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=680&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=854&fit=crop&dpr=1 754w, https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=854&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/30582/original/gxb52nfw-1378174069.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=854&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Truthout.org</span></span>
</figcaption>
</figure>
<p>It’s also possible that we’ve seen an increase in the quantity but not the quality of services. There’s some evidence, for instance, that <a href="http://www.ncbi.nlm.nih.gov/pubmed/23144164">psychotropic medications</a> are not always targeted at the right people. And that the psychological therapies delivered may not be the type research has shown to be effective.</p>
<p>Antidepressants are not effective for milder depressive disorders and some psychologists may only provide supportive counselling rather than evidence-based therapies such as cognitive behavioural therapy. </p>
<p>Another explanation, which I favour, is that Australia has had a one-pronged approach to mental disorders, when a two-pronged approach is required for effective change.</p>
<p>There are basically two ways of decreasing the number of people with mental disorders in the population. One is to reduce the number developing mental disorders (prevention) and the other is to shorten the length of time people have a disorder once it has developed (treatment). </p>
<p>In Australia, as well as other countries, we have put most of our eggs into the treatment basket and very few in the prevention basket. Critics might say that we can’t prevent mental disorders, but I think that on this score, they are wrong. </p>
<h2>The other prong</h2>
<p>Recently, Australian Rotary Health hosted <a href="http://apmd.org.au/event/australian-rotary-health-symposium">a national symposium</a> on prevention of mental disorders to review what is known and what needs to be done next. </p>
<p>Experts attending the symposium presented abundant evidence that preventing people from getting a mental illness is possible across their lifespan, from pre-birth to old age. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23186355">Prevention can be carried out</a> in many settings, including families, schools, tertiary institutions and workplaces. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/20528700">potential of the internet</a> to help people stay well needs to be explored, as does the impact of lifestyle factors, such as diet and exercise, on mental well-being.</p>
<p>Prevention requires a focus on the mental health of the population as a whole. By contrast, clinical services tend to focus on people with the more serious and persistent mental disorders. </p>
<p>There is one area in which Australia has applied such a population-health approach – suicide prevention. </p>
<p>In the late 1990s, Australia developed a <a href="http://www.health.gov.au/internet/main/Publishing.nsf/Content/mental-nsps">National Suicide Prevention Strategy</a> in response to the country’s high suicide rate. The focus was on community-based action, rather than improving clinical responses. </p>
<p>It may be a coincidence, but since the beginning of the strategy, Australia has had a steady decline in its suicide rate. Such a decline has not been seen in other comparable countries. There may be an important lesson here.</p>
<p>This is not an argument for reducing mental health services. They are necessary and underfunded for what they do – and they are clearly insufficient. </p>
<p>The next wave of mental health reform in Australia needs to focus on the second prong. We need to extend what has been achieved in suicide and develop a national prevention strategy for better mental health. </p>
<p>We may soon have a new minister for mental health; I hope he or she will seriously consider prevention as a way to garner better mental health for all Australians.</p><img src="https://counter.theconversation.com/content/15176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council, the Australian Government Department of Health and Ageing, beyondblue and Australian Rotary Health. He is an executive committee member of the Alliance for the Prevention of Mental Disorders and a board member of Mental Health First Aid Australia.</span></em></p>Despite two decades of investment in improving mental health services, the mental health of Australians has not improved. This may be because haven’t been spending money on the right approach and need…Anthony Jorm, Professorial Fellow and an NHMRC Australia Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.