tag:theconversation.com,2011:/ca-fr/topics/world-health-organization-who-10417/articlesWorld Health Organization (WHO) – La Conversation2024-03-28T15:09:02Ztag:theconversation.com,2011:article/2266322024-03-28T15:09:02Z2024-03-28T15:09:02ZThe Gambia may allow female genital mutilation again – another sign of a global trend eroding women’s rights<p>The Gambia’s ban on <a href="https://africlaw.com/2016/01/19/banning-female-circumcision-in-the-gambia-through-legislative-change-the-next-steps/">female genital mutilation (FGM)</a> since 2015 is <a href="https://africlaw.com/2024/03/22/threats-to-endfgm-law-in-the-gambia/#more/-3155">under threat</a>. Proposed changes before parliament could permit <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12792">medicalised</a> female genital cutting and allow it for consenting adults. </p>
<p>This potential reversal has thrust the country into the <a href="https://www.theguardian.com/global-development/2024/mar/18/move-to-overturn-fgm-ban-in-the-gambia-postponed">global spotlight</a> as the latest example of the backlash against gender equality.</p>
<p>The Gambia’s criminalisation of FGM was not the first in west Africa but it came as a surprise. The president at the time, Yahya Jammeh, declared the <a href="https://gambia.unfpa.org/sites/default/files/pub-pdf/national_policy_for_the_elimination_of_fgm.pdf">rampant cultural tradition</a> a non-religious practice that caused harm. There was some dissent within the country but human rights groups <a href="https://apnews.com/general-news-9fb847c01f8e448c97f5d09b8a844cba">welcomed</a> the ban. </p>
<p>Jammeh, who was president from 1994 to 2016, also oversaw the passage of other progressive gender-related laws. The <a href="https://www.lawhubgambia.com/domestic-violence-act-2013">Domestic Violence Act 2013</a> provided a framework for combating domestic violence in all its forms (physical, sexual, emotional, economic) and protection in particular for women and children. The <a href="https://www.lawhubgambia.com/sexual-offences-act-2013">Sexual Offences Act 2013</a> expanded the definition of rape, broadened the circumstances in which individuals could be charged, and reduced the burden of proof in prosecutions.</p>
<p>Jammeh also <a href="https://security-legislation.gm/wp-content/uploads/2022/10/Childrens-Amendment-Act-2016.pdf">outlawed</a> child marriages in 2016. This was significant in country where <a href="https://dhsprogram.com/pubs/pdf/FR369/FR369.pdf">one in five young people aged 15-19 (19%)</a> are married. </p>
<p>In <a href="https://www.euractiv.com/section/development-policy/news/eu-cuts-aid-to-gambia-over-human-rights-concerns/">one of the world’s most aid-dependent countries</a>, these reforms were all central to international donor interests. And they helped to improve the country’s democratic reputation. But at the same time, they made it easy for the <a href="https://www.jstor.org/stable/48609039">autocratic</a> leader to get away with other excesses. He also mobilised religion to manipulate beliefs and sentiments, particularly affecting girls and women. For example, Jammeh <a href="https://www.theguardian.com/world/2016/jan/05/gambia-female-government-workers-headscarves-islamic-republic">mandated</a> that female government workers wear veils or headscarves when he declared his <a href="https://www.researchgate.net/publication/353945890_2020_Religious_Tolerance_in_the_Gambia">Muslim majority</a> country an Islamic state in 2016. </p>
<p>President Adama Barrow, Jammeh’s successor, has emphasised religious tolerance and has refrained from employing religious symbolism. Unlike the state-sponsored homophobia under the Jammeh regime, Barrow has downplayed homosexuality as a <a href="https://www.pulp.up.ac.za/edocman/edited_collections/queer_lawfare_in_africa/Chapter%2011.pdf">“non-issue”</a>.</p>
<p>I am a legal scholar and human rights practitioner with published research on <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=Q0j-E18AAAAJ&citation_for_view=Q0j-E18AAAAJ:u5HHmVD_uO8C">female genital mutilation</a>, <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=Q0j-E18AAAAJ&citation_for_view=Q0j-E18AAAAJ:zYLM7Y9cAGgC">gender equality and women’s rights</a> and <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=Q0j-E18AAAAJ&citation_for_view=Q0j-E18AAAAJ:_kc_bZDykSQC">governance</a> in The Gambia. It’s my view that Jammeh’s ostensible compliance with gender equality norms was selective and intended for the international gallery rather than a genuine commitment to women’s rights and democracy.</p>
<p>His tactical stance highlighted a broader trend. Autocratic African leaders often accommodate global gender norms to maintain domestic power dynamics. The result, for example, is <a href="https://journals.sagepub.com/doi/full/10.1177/00104140221074277">increased women’s political participation through quotas</a> along with a conservative approach to sexual and reproductive health and rights.</p>
<p>The Gambia experience also shows that western donors and multilateral institutions need to go beyond just pushing for reforms. Once they have got the reforms they advocated for, they should have a strategy for sustaining them. Forces that were opposed to the reform often regroup to campaign for its removal. </p>
<p>At its core, female genital mutilation <a href="https://www.pulp.up.ac.za/edocman/pulp_commentaries/protocol_to_ACHPR/Article_5.pdf">constitutes</a> a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.12792">violation</a> of the human rights of girls and women. These include the right to non-discrimination, to protection from physical and mental violence, and to health and life. </p>
<p>From a feminist perspective, the prevalence of FGM in numerous African nations revolves around upholding gender-specific norms and exerting control over women’s sexuality.</p>
<h2>Female genital mutilation in The Gambia</h2>
<p>Female genital cutting is a <a href="https://gambia.unfpa.org/sites/default/files/pub-pdf/national_policy_for_the_elimination_of_fgm.pdf">deeply ingrained practice</a>. It is driven by cultural beliefs and often performed by traditional healers. According to the most recent <a href="https://dhsprogram.com/publications/publication-FR369-DHS-Final-Reports.cfm">national survey</a>, a large majority of Gambian women aged 15-49 years (73%) have undergone female genital cutting. More alarming is an <a href="https://www.unicef.org/gambia/media/776/file/The%20Gambia%20Multiple%20Indicator%20Cluster%20Survey%202018.pdf">8% increase in the prevalence</a> of FGM among girls under the age of 14 – from 42.4% in 2010 to 50.6% in 2018. </p>
<p>Numerous health risks associated with all types of the practice have been documented by the <a href="https://www.who.int/en/news-room/fact-sheets/detail/female-genital-mutilation">World Health Organization</a> and <a href="https://gh.bmj.com/content/2/4/bmjgh-2017-000467#ref-5">systematic reviews</a>. These include severe pain, bleeding, infections and complications during childbirth and elevated rates of anxiety and other mental health disorders. This has led to <a href="https://eyala.blog/my-musings/repealing-the-endfgm-law-will-be-a-betrayal-of-women-and-girls-in-the-gambia-jama-jack">calls</a> for the practice to be banned in order to protect girls’ health and well-being.</p>
<p>The Gambia’s current struggle with the FGM ban reflects a complex interplay between cultural norms, religious beliefs, and the fight for gender equality. The potential repeal of the ban poses a threat to human rights of women and girls in The Gambia.</p>
<h2>Reversal of hard-won gains</h2>
<p>Though The Gambia is constitutionally secular, religion influences nearly every facet of society. Islamic fundamentalists in the country are known for attacks on religious minorities, including <a href="https://malagen.org/media-monitoring/hate-speech-alert-imam-fatty-attacks-ahmadis/">hate speech</a> against the Ahmadiyya Muslim community and the <a href="https://www.voicegambia.com/2023/05/11/rising-religious-tension-in-the-country/">Christian community</a>. </p>
<p>The main fundamentalist religious actors draw inspiration from and still support the exiled former dictator Jammeh. They are at the forefront of the <a href="https://africlaw.com/2024/03/22/threats-to-endfgm-law-in-the-gambia/#more-3155.">recent pushback</a> against the anti-FGM law. They argue that the ban violates their religious and cultural freedoms as guaranteed in the <a href="https://www.lawhubgambia.com/1997-constitution">1997 constitution</a>. </p>
<p>On 4 March 2024 a <a href="https://standard.gm/nam-to-seek-power-of-attorney-from-jammeh-to-sue-govt/">strong supporter of Jammeh</a> proposed a private member’s <a href="https://satangnabaneh.com/contesting-the-prohibition-of-female-genital-mutilation-in-the-gambia/">bill</a> in the National Assembly that seeks to overturn the ban.</p>
<p>The push to reassert traditional gender roles isn’t isolated to The Gambia. There is a global trend of rolling back progress on gender equality. This trend is characterised by attempts to limit <a href="https://www.pulp.up.ac.za/emerging-voices-series/choice-and-conscience-lessons-from-south-africa-for-a-global-debate">women’s bodily choices</a>, an <a href="https://www.ohchr.org/sites/default/files/Documents/Issues/Women/WG/Gender-equality-and-gender-backlash.pdf">increase in violence</a> against them, as well as <a href="https://www.pulp.up.ac.za/edited-collections/queer-lawfare-in-africa-legal-strategies-in-contexts-of-lgbtiq-criminalisation-and-politicisation">attacks</a> on LGBTQI+ communities. It reflects a broader political climate of backlash against women’s rights and gender equality as a weapon in the reversal of democratic achievements.</p>
<p>Attempts have been seen to reverse legal protections against women and girls in <a href="https://au.int/en/articles/kenyas-court-ruling-against-fgm-demonstrates-commitment-member-states-shun-practices">Kenya</a>. In Sudan, state-sanctioned violence and societal pressure is aimed at <a href="https://africanarguments.org/2019/07/against-laws-regime-sudan-women-protesters-want/">restricting</a> women’s public participation. Similarly, Tanzania previously enacted a policy barring teenage mothers from <a href="https://www.moe.go.tz/sw/nyaraka/waraka-wa-elimu-na-2-wa-mwaka-2021-kuhusu-kuingia-tena-shule-kwa-wanafunzi-wa-shule-za">attending</a> public schools, though this policy has been reversed. </p>
<p>This global context highlights how anti-rights movements, undemocratic norms and gendered politics are working together to erode women’s rights and exacerbate inequalities.</p><img src="https://counter.theconversation.com/content/226632/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Satang Nabaneh 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 potential repeal of the ban on female genital mutilation poses a threat to the well-being of girls in The Gambia.Satang Nabaneh, Director of Programs, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2218362024-03-13T12:37:43Z2024-03-13T12:37:43ZLeprosy cases are rising in the US – what is the ancient disease and why is it spreading now?<figure><img src="https://images.theconversation.com/files/581098/original/file-20240311-22-xteppq.jpg?ixlib=rb-1.1.0&rect=21%2C10%2C7167%2C4031&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Leprosy can be caused by two different bacteria, one of which was only identified in 2008.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/leprosy-bacteria-illustration-royalty-free-illustration/1193685361?phrase=leprosy&adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>The word “leprosy” conjures images of biblical plagues, but the disease is still with us today. Caused by infectious bacteria, <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">some 200,000 new cases are reported each year</a>, according to the World Health Organization. In the United States, leprosy has been entrenched for more than a century in parts of the South where people came into contact with armadillos, the principle proven linkage from animal to humans. However, the more recent outbreaks in the Southeast, <a href="https://epi.ufl.edu/2023/10/16/leprosy-in-florida-medical-experts-monitoring-unusual-new-cases-of-hansens-disease/">especially Florida</a>, have not been associated with animal exposure.</em></p>
<p><em>The Conversation talked with <a href="https://www.ae-info.org/ae/Member/Schwartz_Robert">Robert A. Schwartz</a>, professor and head of dermatology at Rutgers New Jersey Medical School, to explain what researchers know about the disease.</em></p>
<h2>What is leprosy and why is it resurfacing in the US?</h2>
<p>Leprosy is caused by two different but similar bacteria — <em>Mycobacterium leprae</em> and <em>Mycobacterium lepromatosis</em> — the latter <a href="https://doi.org/10.1309/AJCPP72FJZZRRVMM">having just been identified in 2008</a>. Leprosy, <a href="https://www.cdc.gov/leprosy/index.html">also known as Hansen’s disease</a>, is avoidable. Transmission among the most vulnerable in society, including migrant and impoverished populations, remains a pressing issue.</p>
<p>This <a href="https://doi.org/10.1111/ijd.15998">age-old neglected tropical disease</a>, which is still <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">present in more than 120 countries</a>, is now a growing challenge in parts of North America. </p>
<p>Leprosy is beginning to occur regularly within parts of the southeastern United States. Most recently, Florida has seen a heightened incidence of leprosy, accounting for <a href="https://doi.org/10.1001/jama.2023.13938">many of the newly diagnosed cases</a> in the U.S. </p>
<p>The <a href="https://doi.org/10.3201/eid2908.220367">surge in new cases</a> in central Florida highlights the urgent need for health care providers to <a href="https://www.hrsa.gov/sites/default/files/hrsa/hansens-disease/hd-surveillance-form.pdf">report them</a> immediately. Contact tracing is critical to <a href="https://iris.who.int/bitstream/handle/10665/336679/9789290228073-eng.pdf">identifying sources and reducing transmission</a>. </p>
<p>Traditional risk factors include zoonotic exposure and having recently lived in leprosy-endemic countries. Brazil, India and Indonesia have each <a href="https://www.who.int/news-room/fact-sheets/detail/leprosy">noted more than 10,000 new cases</a> since 2019, according to the World Health Organization data, and more than a dozen countries have reported between 1,000 to 10,000 new cases over the same time period.</p>
<h2>Why was leprosy stigmatized in biblical times?</h2>
<p>Evidence suggests that <a href="https://doi.org/10.1556/oh.2011.29038">leprosy has plagued civilization</a> since at least the second millennium B.C. </p>
<p>From that time until the mid-20th century, <a href="https://doi.org/10.1038/jid.1953.65">limited treatments were available</a>, so the bacteria could infiltrate the body and cause prominent physical deformities such as disfigured hands and feet. Advanced cases of leprosy cause facial features resembling that of a lion in humans.</p>
<p>Many mutilating and distressing skin disorders such as skin cancers and deep fungal infections were also confused with leprosy by the general public. </p>
<p>Fear of contagion has led to <a href="https://doi.org/10.53854%2Fliim-2904-18">tremendous stigmatization and social exclusion</a>. It was such a serious concern that the Kingdom of Jerusalem had a specialized hospital to care for those suffering from leprosy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bandaged feet and legs of a person with leprosy." src="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581102/original/file-20240311-139405-n6zvdy.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">Leprosy has sometimes been confused with other mutilating skin disorders.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/feet-of-a-leper-royalty-free-image/157530061?phrase=leprosy&adppopup=true">visual7/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>How infectious is leprosy?</h2>
<p>Research shows that prolonged in-person contact via respiratory droplets is <a href="https://doi.org/10.1186/s12879-023-08627-9">the primary mode of transmission</a>, rather than through normal, everyday contact such as embracing, shaking hands or sitting near a person with leprosy. People with leprosy generally do not transmit the disease once they begin treatment. </p>
<p>Armadillos represent the only known <a href="https://doi.org/10.3201%2Feid2112.150501">zoonotic reservoir</a> of leprosy-causing bacteria that threaten humans. These small mammals are common in Central and South America and in parts of Texas, Louisiana, Missouri and other states, where they are sometimes kept as pets or farmed as meat. Eating armadillo meat is not a clear cause of leprosy, but capturing and raising armadillos, along with preparing its meat, are risk factors.</p>
<p>The transmission mechanism between zoonotic reservoirs and susceptible individuals is unknown, but it is strongly suspected that direct contact with an infected armadillo poses a significant risk of developing leprosy. However, many cases reported in the U.S. have demonstrated an <a href="https://doi.org/10.3201/eid2908.220367">absence of either zoonotic exposure or person-to-person transmission</a> outside of North America, suggesting that transmission may be happening where the infected person lives. But in many cases, the source remains an enigma.</p>
<p>Some people’s genetics might make them <a href="https://doi.org/10.1056/nejmoa0903753">more susceptible to leprosy infections</a>, or their immune systems are less capable of resisting the disease. </p>
<p>Stigma and discrimination have <a href="https://doi.org/10.53854%2Fliim-2904-18">prevented people from seeking treatment</a>, and as a result, “concealed” cases contribute to transmission. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4mqZvCUtxGg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The number of leprosy cases in the U.S. has more than doubled over the past decade, and Florida has become a hot spot for it.</span></figcaption>
</figure>
<h2>How do you recognize it?</h2>
<p>Leprosy primarily affects the skin and peripheral nervous system, causing physical deformity and desensitizing one’s ability to feel pain on affected skin. </p>
<p>It may begin with loss of sensation on whitish patches of skin or reddened skin. As the bacteria spread in the skin, they can cause the skin to thicken with or without nodules. If this occurs on a person’s face, it may rarely produce a smooth, attractive-appearing facial contour known as lepra bonita, or “pretty leprosy.” The disease can progress to causing eyebrow loss, enlarged nerves in the neck, nasal deformities and nerve damage. </p>
<p>The onset of symptoms can sometimes take <a href="https://doi.org/10.1128%2FCMR.00079-13">as long as 20 years</a> because the infectious bacteria have a lengthy incubation period and proliferate slowly in the human body. So presumably many people are infected long before they know that they are.</p>
<p>Fortunately, worldwide efforts to screen for leprosy are being enhanced thanks to organizations like the <a href="https://www.st-lazarus.us/">Order of Saint Lazarus</a>, which was originally founded in the 11th century to combat leprosy, and the <a href="https://ahri.gov.et/">Armauer Hansen Research Institute</a>, which conducts immunologic, epidemiological and translational research in Ethiopia. The nongovernmental organization <a href="https://www.bombayleprosy.org/">Bombay Leprosy Project</a> in India does the same.</p>
<h2>How treatable is it?</h2>
<p>Leprosy is not only preventable but treatable. Defying stigma and advancing early diagnosis via proactive measures are critical to the mission of controlling and eradicating it worldwide. </p>
<p>Notably, the World Health Organization and other agencies provide <a href="https://doi.org/10.25259/ijdvl_278_2023">multi-drug therapy</a> at no cost to patients. </p>
<p>In addition, vaccine technology to combat leprosy is <a href="https://doi.org/10.1016/j.vaccine.2019.12.050">in the clinical trials stage</a> and <a href="https://doi.org/10.1021/acsinfecdis.3c00371">could become available</a> in coming years. In studies involving nine-banded armadillos, this protein-based vaccine delayed or diminished leprous nerve damage and <a href="https://doi.org/10.1038/s41541-018-0050-z">kept bacteria at bay</a>. Researchers believe that the vaccine can be produced in a low-cost, highly efficient manner, with the long-term prospect of eradicating leprosy.</p>
<p>If health care professionals, biomedical researchers and lawmakers do not markedly enhance their efforts to eliminate leprosy worldwide, the disease will continue to spread and could become a far more serious problem in areas that have been largely free of leprosy for decades. </p>
<p>The World Health Organization launched a plan in 2021 for achieving <a href="https://iris.who.int/bitstream/handle/10665/340774/9789290228509-eng.pdf?sequence=1">zero leprosy</a>.</p><img src="https://counter.theconversation.com/content/221836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof. Robert A. Schwartz is associated with the Order of Saint Lazarus, an international non-governmental organization committed to the fight against leprosy.</span></em></p>People often think of leprosy as a bygone disease, relevant primarily in biblical times. But in fact, it is still present in more than 120 countries, and the US is seeing an uptick in cases.Robert A. Schwartz, Professor and Head of Dermatology, Rutgers New Jersey Medical School, Rutgers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2218262024-03-07T21:28:26Z2024-03-07T21:28:26ZWhy ‘One Health’ needs more social sciences: Pandemic prevention depends on behaviour as well as biology<p>On March 11, 2024, <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">it will be four years since the World Health Organization characterized the SARS-CoV-2 outbreak as a pandemic</a>. And while COVID-19 continues to impact people globally, it is only the most recent in a long history of pandemics with likely origins in animals. Examples include <a href="https://www.cdc.gov/plague/transmission/index.html">plague</a>, which usually spreads from rodents to humans via infected fleas, and the 2009 <a href="https://www.cdc.gov/h1n1flu/general_info.htm">H1N1 flu</a>, also known as swine flu due to its <a href="https://doi.org/10.7554/eLife.16777">origins in pigs</a>. </p>
<figure class="align-right ">
<img alt="Purple spikes covered with a mossy yellow-green substance" src="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580289/original/file-20240306-30-gmkzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of Yersinia pestis bacteria, which causes bubonic plague, in a flea.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Given the animal origins of past pandemics, as well as the many recent cases of disease in people linked to animals — such as <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON497">anthrax</a>, <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON506">Middle East respiratory syndrome</a> and <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON504">avian influenza virus</a> — it is very likely that the next pandemic will again originate in animals. </p>
<p>In fact, <a href="https://doi.org/10.3390%2Fmicroorganisms8091405">over 60 per cent of emerging infectious diseases in people originate in animals. Among these, more than 70 per cent are associated with wildlife</a>. Our close interactions with animals and our shared environment is a major factor for why and how these pathogens spill over. </p>
<h2>Pandemic prevention</h2>
<p>Recognizing our interconnected health, there have been increased calls for <a href="https://doi.org/10.1016/S0140-6736(24)00066-7">primary pandemic prevention</a>, which focuses on reducing the chance of an outbreak occurring by preventing the spread of pathogens from animals to people.</p>
<p>One framework for primary pandemic prevention is called “One Health.” One Health recognizes the close links among human, animal and environmental health, whereby promoting health in one part of this triad promotes the health of all. </p>
<p>While this concept of interconnected health has gained awareness in western science in the past century, it is not new. Instead, it is a reflection of what <a href="https://doi.org/10.1126/science.abe2401">Indigenous Peoples have known and practised for millennia</a>. </p>
<h2>One Health</h2>
<p>Global recognition of One Health has been steadily increasing. For example, the formation of the <a href="https://globalohc.org/what-is-one-health">Quadripartite</a> — which consists of global organizations including the <a href="https://www.fao.org/home/en">Food and Agriculture Organization of the United Nations</a>, the <a href="https://www.unep.org/">United Nations Environment Programme</a>, the World Health Organization, and the <a href="https://www.woah.org/en/home/">World Organisation for Animal Health</a> — has been focused on mobilizing One Health. The Quadripartite is advised by the <a href="https://www.who.int/groups/one-health-high-level-expert-panel/members">One Health High Level Expert Panel</a>. </p>
<figure class="align-center ">
<img alt="Gloved hands injecting a cow" src="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580291/original/file-20240306-20-9ocphi.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">
<figcaption>
<span class="caption">A veterinarian vaccinates cattle against disease. Understanding farmers’ barriers to vaccinating livestock is key to successful disease prevention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Yet despite the interdisciplinary nature of One Health, many initiatives are still falling short. Discussions and decisions about One Health issues are often dominated by veterinary and human health sciences, sidelining the social sciences <a href="https://doi.org/10.1016/j.socscimed.2014.09.048">despite the crucial role</a> of disciplines like psychology, sociology, and communications in understanding human behaviour. </p>
<p>Social science researchers aim to understand people — their perceptions and concerns, their histories, their socio-political, cultural and environmental contexts, and their knowledge — with a view to understanding how structural disparities affect personal and societal behaviour, health and political power.</p>
<p>In interdisciplinary fields such as One Health, this understanding is paramount. One Health interventions include measures such as the vaccination of livestock to prevent spillover events to people, such as <a href="https://doi.org/10.1038/s41541-023-00769-w">Rift Valley fever</a>, which can affect both animals and humans. </p>
<p>The success of these interventions hinges not only on vaccine efficacy, but also on societal factors. For example, social scientists uncover <a href="https://doi.org/10.1371%2Fjournal.pone.0256684">barriers faced by farmers in accessing livestock vaccination services</a>. This ultimately improves access and ensures widespread livestock immunization, and therefore contributes to the primary prevention of future pandemics.</p>
<h2>Recognizing intersections</h2>
<p>Another key factor contributing to the successful implementation of One Health interventions is understanding gender dynamics in society. Often women bear the disproportionate caregiving burden, which impacts their access to health care for themselves and their livestock. Gender roles and responsibilities may also decide who interacts closely with animals, affecting possible disease exposure risks as well as <a href="https://doi.org/10.1080/13552074.2015.1096041">narrowing down the target group for educational efforts</a>. </p>
<p>Recognizing these intersections is crucial for developing inclusive and effective interventions.</p>
<p>And while animals may be the potential source of a future pandemic, it is also important to recognize the important positive contributions wildlife have made to our health and well-being, including their roles in the economy and <a href="https://www.indigenousfoodsystems.org/food-sovereignty">food security</a>, as well as their cultural significance. </p>
<p>The perception that animals are a threat to humans can lead to heightened public fears and apprehensions about wildlife, potentially reducing <a href="https://doi.org/10.1093/ilar.51.3.255">support for wildlife conservation</a>. </p>
<p>Addressing this issue requires a deeper understanding of public perceptions, values, priorities and behaviours — emphasizing the <a href="https://doi.org/10.7589/2014-01-004">necessity of integrating social science</a> in the development of informed, relevant and sustainable surveillance of potential infectious disease in wildlife and conservation programs. </p>
<h2>An interdisciplinary approach to pandemic prevention</h2>
<p>Even beyond the role of social science in understanding the complex systems in which health risks occur, social science can also bridge communication gaps between researchers, policymakers and communities. By integrating social science into One Health approaches, we ensure that initiatives are not only scientifically sound, but also socially and culturally acceptable, appropriate and equitable for all rights holders involved.</p>
<p>A movement towards a true, interdisciplinary and holistic approach to primary pandemic prevention will need a proactive approach to health and well-being instead of a reactive one. It will also require us to critically examine our current health systems to identify innovative solutions to ensure its resilience. </p>
<p>We need to mobilize information and understanding across knowledge systems and elevate the critical role of social sciences to meaningfully integrate One Health into primary pandemic prevention in Canada.</p><img src="https://counter.theconversation.com/content/221826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaylee Byers receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues. </span></em></p><p class="fine-print"><em><span>Sarah Robinson receives funding from the Public Health Agency of Canada to strengthen communications and knowledge mobilization of One Health issues.</span></em></p><p class="fine-print"><em><span>Lara Hollmann and Salome A. Bukachi 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>Pandemics often have animal origins, so prevention is often dominated by health and veterinary sciences. However, social sciences’ role in understanding human behaviour is also crucial to prevention.Kaylee Byers, Assistant Professor, Faculty of Health Sciences; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLara Hollmann, Research Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversitySalome A. Bukachi, Associate professor, Institute of Anthropology, Gender and African Studies, University of NairobiSarah Robinson, Postdoctoral Fellow, Pacific Institute on Pathogens, Pandemics and Society, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2211552024-03-07T13:03:45Z2024-03-07T13:03:45ZWhy schools need to take sun safety more seriously – expert explains<figure><img src="https://images.theconversation.com/files/577546/original/file-20240223-16-azytla.jpg?ixlib=rb-1.1.0&rect=37%2C0%2C4195%2C2788&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization recommends formal school programmes as the key to preventing skin cancer.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-boy-having-sunscreen-applied-339150182">Paul Higley/Shutterstock</a></span></figcaption></figure><p>Despite the UK’s rainy climate, there is a one in six <a href="https://onlinelibrary.wiley.com/doi/10.1002/ski2.61">risk</a> of developing skin cancer. Children, especially, should take extra care as severe sunburn as a youngster more than <a href="https://www.skincancer.org/risk-factors/sunburn/">doubles</a> the chance of developing skin cancer later on. </p>
<p>But <a href="https://academic.oup.com/ced/advance-article/doi/10.1093/ced/llad458/7507665">new research</a> my colleagues and I conducted shows that less than half of primary schools in Wales have a formal sun safety policy.</p>
<p>With skin cancer rates continuing to rise by <a href="https://gettingitrightfirsttime.co.uk/medical_specialties/dermatology/">8% annually</a> in England and Wales, it’s a problem that’s not going away and the disease now accounts for half of all cancers. In 2020 alone, the cost of treating skin cancer in England was <a href="https://pubmed.ncbi.nlm.nih.gov/23554510/">estimated</a> to be more than £180 million.</p>
<p>There is hope, though. It is estimated that around <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">90% of skin cancers</a> are due to ultraviolet (UV) radiation exposure from the sun. This means they can be prevented through safer behaviour. </p>
<p>In the UK, though, many people still <a href="https://academic.oup.com/her/article/20/5/579/611761">underestimate</a> the link between sunburn and skin cancer. Research paints a worrying picture, revealing disparities in sun protection awareness and behaviour across different groups. Notably, <a href="https://academic.oup.com/her/article/20/5/579/611761">men</a>, people living in <a href="https://pubmed.ncbi.nlm.nih.gov/26875569/">low-income neighbourhoods</a>, those belonging to <a href="https://academic.oup.com/her/article/20/5/579/611761">lower socioeconomic groups</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28125871/">people of colour</a> are often found to be less informed about sun safety and are more likely to put themselves at risk. </p>
<p>With childhood a crucial time for learning healthy behaviour, teaching all children from a young age about sun protection could be one way to reduce future skin cancer rates. And the <a href="https://iris.who.int/bitstream/handle/10665/42678/9241590629_v1.pdf?sequence=1">World Health Organization</a> recommends formal school programmes as the key to prevention. </p>
<p>Overall, school-based interventions have been <a href="https://www.sciencedirect.com/science/article/pii/S0091743521000438">shown</a> to positively influence sun safe knowledge and behaviour. For example, <a href="https://doi.org/10.1093/her/cyt105">schools in Australia</a> with written policies show better sun protection practices than those without.</p>
<p>But in UK schools, the situation varies. The UK government’s Department for Education has issued <a href="https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education/physical-health-and-mental-wellbeing-primary-and-secondary#by-the-end-of-primary-school">statutory guidance</a> for England that children should leave primary school knowing about sun safety and how to reduce the risk of getting skin cancer. </p>
<p>In Scotland and Northern Ireland, it is not a legal requirement to teach sun safety in schools. And in Wales, while sun safety is recommended as part of the Welsh Network of Healthy Schools scheme, again there is no mandatory requirement to have a sun safety policy or to teach skin cancer prevention. Nor are there central UK resources provided to help schools in this area. </p>
<figure class="align-center ">
<img alt="The red, peeling sunburnt back and shoulders of a young girl." src="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being severely sunburnt as a youngster more than doubles the chance of developing future skin cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dangerous-sunburn-shoulders-young-girl-601094933">Alonafoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>My colleagues and I wanted to know how many schools have a sun safety policy, a formal document that sets out a school’s position with respect to the education and provision of sun safety. We also wanted to understand whether the existence of a policy varied by area or school characteristic, and what support schools need. </p>
<p>In 2022, we sent a survey to all 1,241 primary schools in Wales. In total, 471 schools responded. </p>
<h2>What we found</h2>
<p>We found that only 39% of responding schools had a formal sun safety policy. And of these, not all enforced them. Schools that had more children receiving free school meals and with lower attendance rates were less likely to have a sun safety policy.</p>
<p>We asked schools that did not have a policy to tell us the reasons why not. Thirty-five per cent of schools were “not aware of the need”, while 27% of schools had “not got around to it just yet”. Thirty schools (13%) said that a sun safety policy was not a priority at this time. Clearly, there is work to be done on raising awareness among schools and school leaders on the role they can play in this area.</p>
<p>Of course, schools are busy places. So, when asked to indicate what would encourage them to create a sun safety policy, 73% of schools said assistance with development, while 56% said resources to aid the teaching of sun safety. </p>
<p>Previously both Cancer Research UK and the Wales-based Tenovus Cancer Care charities have offered support and guidelines for schools but this support is no longer easily available. The England-based charity <a href="https://www.skcin.org/ourWork/sunSafeSchools.htm">Sckin</a> has a comprehensive and free sun-safe schools accreditation scheme. Some schools told us they based their policies on resources supplied by the local authority, but this was not consistent across Wales.</p>
<p>UV levels will soon rise in the UK and now is the time for schools to start thinking about sun protection. Having a formal sun safety school policy sets out the position of the school when it comes to sun safety. When enforced and communicated properly, this makes it clear to everyone (governors, teachers, carers and pupils) their individual responsibilities when it comes to staying safe. </p>
<p>But with fewer than half of schools in Wales having formal policies, and not all enforced, awareness of the importance of this issue and the potential role of schools is lacking. </p>
<p>It is therefore time for sun safety policies to become mandatory for primary schools across the UK. This could help to improve knowledge and behaviour for all age groups. But adequate support and guidance must be also given to schools to help them educate children about sun safety and protect them while they are at school.</p><img src="https://counter.theconversation.com/content/221155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Peconi received funding for the Sunproofed Study from Health and Care Research Wales through a Health Research Grant Award. She is also a volunteer with the charity Skin Care Cymru, a charity working to raise the profile of skin health in Wales. </span></em></p>Being severely sunburnt as a child more than doubles the chance of developing future skin cancer but less than half of primary schools questioned in new research have a sun safety policy.Julie Peconi, Senior Research Officer in Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2251972024-03-06T17:14:58Z2024-03-06T17:14:58ZGaza conflict: rising death toll from hunger a stark reminder of starvation as a weapon of war<p>The <a href="https://www.bbc.co.uk/news/world-middle-east-68434443">deaths of more than 100 Palestinians</a> who had been waiting for an aid convoy on February 29 were a grim reminder of the catastrophe unfolding daily in Gaza. While an independent investigation has yet to establish clear responsibilities for the tragedy, the toll from Israel’s assault on the Gaza Strip grows ever higher.</p>
<p>Five months into the conflict, deaths from hunger and thirst are <a href="https://edition.cnn.com/2024/03/04/middleeast/gaza-children-dying-malnutrition-israel-ceasefire-talks-intl-hnk/index.html">beginning to mount</a>. A report from the United Nations Office for the Coordination of Humanitarian Affairs quoted claims by the Ministry of Health in Gaza on March 3 that 15 children had <a href="https://www.aljazeera.com/news/liveblog/2024/3/6/israels-war-on-gaza-live-un-food-convoy-blocked-from-north-gaza-by-israel">died of malnutrition and dehydration</a> at Kamal Adwan hospital in northern Gaza, with another six considered to be at grave risk of dying. </p>
<p>Meanwhile, the director-general of the World Health Organization (WHO),
Tedros Adhanom Ghebreyesus, <a href="https://twitter.com/DrTedros/status/1764652624492515832">reported on March 4</a> that WHO visits to Al-Awda and Kamal Adwan hospitals found “severe levels of malnutrition, children dying of starvation, serious shortages of fuel, food and medical supplies, hospital buildings destroyed”. </p>
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<p>Addressing the UN security council on February 27, the deputy executive director of the World Food Programme, Carl Skau, warned of a <a href="https://www.wfp.org/news/wfp-deputy-chief-warns-security-council-imminent-famine-northern-gaza-unless-conditions-change">“real prospect of famine by May”</a>, saying there were more than 500,000 people in Gaza at risk.</p>
<p>He said: “Even before October, two-thirds of the people in Gaza were supported with food assistance. Today, food aid is required by almost the entire population of 2.2 million people. One child in every six under the age of two is acutely malnourished.”</p>
<h2>Weaponising starvation</h2>
<p>Starvation has always been used as <a href="https://theconversation.com/gaza-weaponisation-of-food-has-been-used-in-conflicts-for-centuries-but-it-hasnt-always-resulted-in-victory-221476">weapon of war</a>. And there is now a considerable body of international law which prohibits it and provides for the prosecution of those responsible for deliberate starvation in conflict.</p>
<p>Article 54 of the Geneva conventions <a href="https://ihl-databases.icrc.org/en/ihl-treaties/api-1977/article-54">clearly spells this out</a>. In May 2018, the UN security council unanimously adopted <a href="https://press.un.org/en/2018/sc13354.doc.htm">resolution 2417</a> after identifying 74 million people facing starvation as a result of armed conflict. </p>
<p>Resolution 2417 “strongly condemns the use of starvation of civilians as a method of warfare in a number of conflict situations and prohibited by international humanitarian law” and “strongly condemns the unlawful denial of humanitarian access and depriving civilians of objects indispensable to their survival”. </p>
<p>Intentional starvation is punishable as a war crime by the International Criminal Court (ICC) under article 8 of the <a href="https://ihl-databases.icrc.org/en/ihl-treaties/icc-statute-1998/article-8">Rome statute</a>. In December 2019, the 122 state parties to the ICC parties voted unanimously to <a href="https://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=XVIII-10-g&chapter=18&clang=_en">extend the court’s jurisdiction</a> to the use of starvation as a weapon of war. </p>
<h2>Food insecurity</h2>
<p>In his <a href="https://www.ohchr.org/en/documents/thematic-reports/ahrc5240-conflict-and-right-food-report-special-rapporteur-right-food">2022 report</a> to the Human Rights Council, the UN rapporteur on the right to food, Michael Fakhri, said that “conflict and violence were the primary causes of hunger, malnutrition, and famine”, rather than “because there was not enough food to go around”.</p>
<p>A report from the UN security council on February 13 2024 identified more than 330 million people at risk from food insecurity, most because of climate change – or, increasingly, armed conflict. The security council highlighted conflict or post-conflict famines in Syria, Myanmar, Haiti, and Yemen. </p>
<p>In Africa, the report said, 149 million people were living in food insecurity, notably in Sudan, where the World Food Program has said more than 25 million people scattered across Sudan, South Sudan and Chad are “trapped in a spiral” of food insecurity.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1765260588370854169"}"></div></p>
<h2>The right to food</h2>
<p>The right to food <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights">is enshrined</a> in the UN’s international covenant on economic, social and cultural rights. This recognises the right of everyone to an adequate standard of living, which includes access to “adequate food, clothing and housing, and to the continuous improvement of living conditions”. </p>
<p>Paradoxically, there is more than enough food produced in the world to feed everyone on the planet. But, despite being nine years into the UN’s <a href="https://www.un.org/nutrition/">“decade of action on nutrition”</a>, and despite eradicating hunger being the second of the UN’s sustainable development goals, world hunger is once again on the rise.</p>
<p>The UN’s <a href="https://unstats.un.org/sdgs/report/2023/The-Sustainable-Development-Goals-Report-2023.pdf">2023 report on its sustainable goals</a> says that 735 million people, more than 9% of the world’s population, suffer from hunger – 122 million more than in 2019. </p>
<p>The report also found that nearly 1.3 billion people rely entirely on imported food. This is where <a href="https://www.emerald.com/insight/publication/issn/1477-0024/vol/22/iss/3">trade agreements</a> and international trade law can play a significant role in supporting access to food. </p>
<p>In June 2022, a ministerial conference of the World Trade Organization produced a <a href="https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/WT/MIN22/W17R1.pdf&Open=True">declaration on the emergency response to food insecurity</a>, reinforcing the WTO’s commitment to improve the functioning and long-term resilience of global markets for food and agriculture. The conference also declared that members “shall not impose export prohibitions or restrictions on foodstuffs purchased for non-commercial humanitarian purposes by the World Food Programme”.</p>
<p>But the realisation of the right to food as a human right, and the success of the UN’s pledge to eradicate hunger by 2030, will rely on international cooperation and a balance between liberalising trade and protecting states’ agricultural industries. </p>
<p>In February 2007, 500 experts gathered in Mali for the World Forum for Food Sovereignty. They produced <a href="https://nyeleni.org/IMG/pdf/DeclNyeleni-en.pdf">the Nyéléni declaration</a>, which seeks to establish the “right of people to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems”.</p>
<p>The starving people of Gaza – and millions like them around the world – have been denied this basic right for decades. Their plight can be ignored for no longer.</p><img src="https://counter.theconversation.com/content/225197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leïla Choukroune 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>Children are particularly at risk from malnutrition as food supplies in Gaza run out.Leïla Choukroune, Professor of International Law, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231362024-02-24T14:08:11Z2024-02-24T14:08:11ZNigeria’s ban on alcohol sold in small sachets will help tackle underage drinking<figure><img src="https://images.theconversation.com/files/577320/original/file-20240222-16-aset0i.jpg?ixlib=rb-1.1.0&rect=3%2C6%2C1075%2C801&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sachet alcoholic drinks on display. </span> <span class="attribution"><span class="source">Kofo Belo-Osagie</span></span></figcaption></figure><p><em>On February 5, 2024, Nigeria’s National Agency for Food and Drug Administration and Control <a href="http://tinyurl.com/4h3usb97">announced</a> a ban on alcoholic beverages sold in sachets or bottles less than 200ml. The agency asserts that the ban will, among other benefits, protect underage children from easy access to alcohol. However, the Federal House of Representatives, Nigeria’s lower chamber of the national assembly, has asked that the ban be <a href="https://www.vanguardngr.com/2024/02/suspend-ban-on-alcoholic-drinks-in-sachets-pet-bottles-reps-tell-nafdac/#:%7E:text=The%20House%20of%20Representatives%20Committee,its%20investigation%20into%20the%20matter.">suspended</a> pending investigation. Medical sociologist Emeka Dumbili, who has <a href="https://scholar.google.com/citations?hl=en&user=Fek70KoAAAAJ&view_op=list_works&sortby=pubdate">researched</a> issues around young people’s use of alcohol and other psychoactive substances, explains why he believes the ban is needed and how it can work.</em></p>
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<h2>How bad is youth alcohol consumption in Nigeria?</h2>
<p>Alcohol consumption is growing among young Nigerians. Although alcohol consumption is not new to Nigerian society, historically only adults consumed it because drinking <a href="https://www.jstor.org/stable/220883?casa_token=WZLoim3ESs4AAAAA%3AUuAurxn7QSnHDbLh2bkJW-ftyWhRhU61T2zqeXGqQTroqQbjlAySCrq30jij75tlAh7lN5Fa08n3P3G4CKBHIne1ewsKxNjM4EJnNzxJKfy_O2XUDwxe">signified that one was an elder</a>. Unwritten rules constrained youths from drinking palm wine, which was the only available alcoholic beverage then. It was believed they were too immature to handle the intoxicating effects of alcohol. Nowadays, a rising number of Nigerian adolescents and young adults consume alcohol. Some even see drinking as <a href="https://link.springer.com/chapter/10.1007/978-3-031-04017-7_6">fashionable</a> and those who abstain as old fashioned. </p>
<p>Studies have shown that young Nigerians are consuming more alcohol. For example, studies published in <a href="https://www.ajol.info/index.php/njp/article/view/110285">2015</a>, <a href="https://journals.sagepub.com/doi/abs/10.1080/08897077.2021.1944952">2021</a> and <a href="https://www.ajol.info/index.php/jcmphc/article/view/245152">2023</a> found a 30%, 34% and 55.8% drinking prevalence among youths in Nigeria. </p>
<p>These statistics suggest that there will be more alcohol-related problems such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601673/">brain underdevelopment or damage</a>, alcohol-induced <a href="https://journals.sagepub.com/doi/full/10.1177/00220426231184151">sicknesses, truancy, violence, injuries</a> and death among young people than there used to be. </p>
<p>Existing studies not only show that youths are drinking, but reveal heavy drinking and drunkenness. These findings also echo a <a href="https://www.who.int/publications/i/item/9789241565639">World Health Organization report from 2018</a> which showed that the 22.5% prevalence of heavy episodic drinking among Nigerians aged 15 to 19 years was among the highest on the African continent. </p>
<h2>How do liquor sachets contribute to the problem?</h2>
<p>Research has shown that several factors are responsible for youth alcohol consumption in Nigeria. Chief among them is <a href="https://books.google.ie/books?hl=en&lr=&id=qnOyDwAAQBAJ&oi=fnd&pg=PR7&dq=Global+status+on+alcohol&ots=a2ksQEocgr&sig=dgRbP_sCOyG2LXTySU2dfuIvMMk&redir_esc=y#v=onepage&q=Global%20status%20on%20alcohol&f=false">unregulated alcohol marketing</a>. Alcohol corporations in Nigeria increasingly use aggressive marketing strategies, <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2016.1202930">advertising and sales promotions</a> such as buy-two-get-one-free that make different brands of such alcohol readily <a href="https://journals.sagepub.com/doi/10.1177/00220426221135765">available, accessible and affordable</a>.</p>
<p>Alcoholic beverages packaged in less than 200ml plastic bottles and sachets are affordable and widely available in retail shops, supermarkets, roadside kiosks and eateries in Nigeria. </p>
<p>They are also sold close to <a href="https://academic.oup.com/alcalc/article-abstract/58/6/628/7272955">primary and secondary schools</a>, where children spend time away from their parents. This is against international standard practices. </p>
<p>Sachet alcoholic beverages are also easy to carry and can be concealed from adults because of their small size. Young people can easily buy and drink them.</p>
<p>Another reason why sachet drinks are a problem is that they are spirit-based beverages with <a href="https://punchng.com/sachet-alcohol-ban-nafdac-lists-health-risks-as-firms-fear-losses/">high potency</a>. They can contain between <a href="https://www.ajol.info/index.php/ahs/article/view/194922">40% and 60%</a> alcohol, which is potentially <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2019.1615035">more harmful</a>. </p>
<p>There’s another reason too, related to another growing problem in Nigeria. Many youths now use different types of herbal sachet and plastic bottle alcoholic beverages as <a href="https://link.springer.com/article/10.1186/s12889-016-3163-1">aphrodisiacs</a> and <a href="https://www.ajol.info/index.php/ahs/article/view/194922">sex enhancers</a>. A <a href="https://www.ajol.info/index.php/ahs/article/view/194922">2020 study</a> found that 33.6% of adolescents used sachet alcohol before their last sexual intercourse. </p>
<h2>How effective are bans of liquor products?</h2>
<p>Well-coordinated enforcement of the ban can check the availability of sachet alcoholic beverages. This should reduce accessibility, consumption and related harms among young people. </p>
<p><a href="https://www.jsad.com/doi/abs/10.15288/jsad.2021.82.511">Uganda</a> has a ban, which has reduced the availability and consumption of sachet alcohol in that country. <a href="https://www.tandfonline.com/doi/abs/10.1080/00036840110102743?casa_token=HVq94RCTjUQAAAAA:ARU9QJAFeresjhcYe3pNfNixDCdRcGYRmMqLQeONqFVAQGwZTMs5uMennGxfeivRxElYLdCgj4mw">Research</a> in western countries has also shown that banning alcohol advertising reduces consumption. </p>
<p>For the ban to be effective, Nigeria should learn from <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-020-00280-8">Malawi’s</a> experience. There, the ban on sachet alcohol failed to produce the desired results due to the lack of coordinated and effective enforcement.</p>
<h2>Do state institutions in Nigeria have capacity to enforce the ban?</h2>
<p>It requires coordinated effort. As a regulatory body, the National Agency for Food and Drug Administration and Control may not implement the ban without the support of federal law enforcement agencies like the police. </p>
<h2>What else can be done to deal with youth drinking?</h2>
<p>Dealing with the problem of alcohol consumption among youths goes beyond placing a ban on sachet alcoholic beverages. Many young people in western countries are shunning alcohol consumption due to the rising awareness of the problems associated with drinking and also because of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13132">reduced peer pressure</a>. The decline in youth drinking in the west may also be due to effective policy implementation on alcohol marketing and the increased <a href="https://www.degruyter.com/document/doi/10.2202/1935-1682.1637/html">minimum drinking age</a>, especially in countries such as the US.</p>
<p>Nigerian agencies should learn from the reasons why youths in the west are avoiding alcohol. This will help when designing and sharing information to educate Nigerian youths and the public on the dangers of using sachet alcoholic products. </p>
<p>The awareness campaign should highlight the short- and long-term positive effects of the ban. This is important so that alcohol producers and marketers will not form alliances that will frustrate the purpose.</p>
<p>To disseminate information widely, social media platforms where young people are increasingly active should be prioritised without neglecting the traditional media. Health NGOs and other charities should also help spread information on the ban’s benefits, including the idea that “health is wealth”. </p>
<p>Nigeria should increase the minimum purchasing age from 18 to 21 years and enforce such regulations to deter early alcohol initiation and consumption.</p>
<p>To prevent the failure of the sachet alcohol ban, the federal government should ensure it’s enforced without corruption.</p><img src="https://counter.theconversation.com/content/223136/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emeka Dumbili receives funding from Alexander Von Humboldt Foundation, Germany (2019-2022). </span></em></p>The sachet alcoholic drinks ban in Nigeria can curb youth alcohol consumption. But government must improve enforcement and awareness strategies for success.Emeka Dumbili, Assistant Professor and Ad Astra Fellow, University College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2209412024-02-05T22:24:10Z2024-02-05T22:24:10ZThe uncertain fate of patients needing life-saving dialysis treatment in Gaza<p>More than 100 days into the brutal assault on Gaza, over <a href="https://news.un.org/en/story/2024/02/1146157">27,000 Palestinians have been killed — of whom 60 per cent have been children and women</a> — and 66,000 injured, according to the World Health Organization (WHO).</p>
<p>The destruction of Gaza’s health-care system has been catastrophic. The <a href="https://news.un.org/en/story/2024/01/1145317#:%7E:text=Hundreds%20of%20facilities%20hit,seven%20deaths%20and%2052%20injuries.">WHO says</a> that, as of Jan. 5, there have been more than 600 attacks on health-care facilities, with 26 out of 36 hospitals in Gaza severely damaged and 79 ambulances targeted. Over <a href="https://doi.org/10.1136/bmj.q203">300 health-care workers have been killed and over 200 have been detained by Israeli forces</a>. </p>
<p><a href="https://www.msf.org/letter-gaza-un-security-council">In an open letter</a> to the United Nations Security Council, Médecins Sans Frontières (MSF) president Christos Christou wrote: </p>
<blockquote>
<p>“Israel has shown a blatant and total disregard for the protection of Gaza’s medical facilities. We are watching as hospitals are turned into morgues and ruins. These supposedly protected facilities are being bombed, are being shot at by tanks and guns, encircled and raided, killing patients and medical staff.”</p>
</blockquote>
<p>Most of the resources within the collapsing health-care system in Gaza are directed towards treating acute trauma victims, such as the injured <a href="https://www.reuters.com/world/middle-east/baby-saved-gaza-rubble-after-mother-killed-israeli-strike-2023-12-29/">babies pulled from rubble</a>, the toddlers requiring <a href="https://www.reuters.com/world/middle-east/gazas-child-amputees-face-further-risks-without-expert-care-2024-01-04/">limb amputations</a> and the civilians suffering from <a href="https://reliefweb.int/report/occupied-palestinian-territory/gaza-strip-msf-treating-patients-severe-burns-following-airstrike">severe burn injuries</a>. This leaves patients with chronic life-threatening diseases, such as cancer, heart failure and end-stage kidney disease, with severely limited access to the ongoing medical care they need to survive.</p>
<h2>Patients unable to access care for chronic conditions</h2>
<p>As nephrologists and internal medicine physicians, we are gravely concerned about patients in Gaza with chronic diseases who are unable to access care. There are more than <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">1,100 dialysis patients, including 38 children, in Gaza</a>. </p>
<p><a href="https://kidney.ca/Kidney-Health/Living-With-Kidney-Failure/Dialysis">Hemodialysis</a> is a treatment for patients with kidney failure that involves removing blood from the patient’s circulation and circulating it through a dialysis machine that clears toxins and removes excess fluid. Without adequate dialysis, fluid and toxins accumulate and patients typically die within days to weeks from respiratory failure or cardiac arrest. </p>
<p>Dialysis is a resource-intensive therapy that requires a dialysis facility, dialysis machines, filters, water supply and fuel, along with a team of technicians, nurses and nephrologists. Each one of these components has been severely and directly compromised since Israel’s assault on Gaza. </p>
<p>Israel’s complete blockade of food, fuel and water has left over <a href="https://abcnews.go.com/International/500000-people-gaza-face-catastrophic-hunger-unrwa/story?id=106593939">500,000 Gazans facing catastrophic hunger</a> according to the United Nations Relief and Works Agency (UNRWA), and Gazan children face a <a href="https://www.unicef.org/press-releases/barely-drop-drink-children-gaza-strip-do-not-access-90-cent-their-normal-water-use">90 per cent reduction in access to water</a>.</p>
<p>Several hospitals, including Al-Aqsa, reported being completely out of fuel, putting all patients in grave danger, <a href="https://www.aljazeera.com/news/2024/1/13/blackout-in-gazas-al-aqsa-hospital-as-fuel-runs-out-babies-at-high-risk">particularly those on life support, babies in incubators and those requiring dialysis</a>. </p>
<p>Even before the current conflict, the 16-year blockade of Gaza put the lives of kidney failure patients at risk due to chronic shortages of fuel and medical supplies. Al Jazeera reports that since Oct. 7, <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">the number of patients at Al-Aqsa Hospital requiring dialysis has more than doubled</a> from 143 to about 300, including 11 children, who have just 24 dialysis machines between them. </p>
<p>This has forced dialysis units to significantly cut treatments, with patients receiving two-hour sessions rather than the typically prescribed 3.5-hour treatments. Treatment frequency, typically prescribed three times weekly, are now only available one or two times per week. </p>
<p>This decrease in treatment time and frequency is grossly insufficient to sustain life. But in a health-care system under assault, patients are fortunate to receive any dialysis at all. </p>
<h2>Patients needing life-saving treatment</h2>
<p>Ismail Al Tawil was a 44-year-old patient in Gaza who died of kidney failure after he was unable to access dialysis. In an interview with Al-Jazeera’s AJ+ social media arm, <a href="https://www.instagram.com/ajplus/reel/C15bdLAOVVi/">his widow described desperately trying to get him to dialysis at Al-Shifa hospital</a>, but being shot at by Israeli snipers who surrounded the hospital. </p>
<p>She then attempted to access dialysis at Al-Awda and Kamal Adwan hospitals, but both facilities had insufficient capacity to treat him. </p>
<p>Since Oct. 7, <a href="https://www.hrw.org/news/2023/12/20/most-gazas-population-remains-displaced-and-harms-way">1.9 million people or 85 per cent of the population of Gaza have been internally displaced</a>, according to Human Rights Watch. This is a tremendous challenge for dialysis patients who are faced with the uncertainty of when, where or if they will access their life-saving therapy. </p>
<p>Anssam, age 12, was displaced from Jabaliya in northern Gaza to seek treatment in Deir El Balah in central Gaza. She had gone 15 days without dialysis and had to leave with her mother to receive life-saving medical treatment. <a href="https://www.thenationalnews.com/mena/palestine-israel/2023/12/18/gaza-dialysis-patients-hospital/">In an interview with <em>The National News</em></a>, Anssam said: </p>
<blockquote>
<p>“I hope for this war to end and for us to go back to the way we were, happy and playing, and to go back to doing dialysis three times a week… Now, without filters, I cannot have dialysis and so I will die. My life depends on dialysis.” </p>
</blockquote>
<h2>Loss of medical personnel</h2>
<p>Beyond the destruction of health-care facilities and a critical shortage of supplies, the loss of medical personnel may have the most devastating and longest-lasting impact on the health-care system in Gaza. </p>
<p>Dr. Hammam Alloh was one of the only nephrologists in Gaza, <a href="https://www.democracynow.org/2023/11/13/medical_workers_killed_colleagues_mourn_hammam">described as a committed physician and a beacon of light by his colleagues</a>. He was 36 years old and a father of two young children. He had hopes to expand dialysis care in Gaza and build a nephrology educational training program.</p>
<p><a href="https://www.cbc.ca/news/world/gaza-hamman-alloh-killed-1.7027623">He was killed on Nov. 12</a> by an <a href="https://www.frontlinedefenders.org/en/profile/hammam-alloh">Israeli airstrike to his family’s home</a>, where he was taking a short rest after a busy shift at Al Shifa Hospital. His loss resonated far beyond his family, patients and colleagues in Gaza. Dr. Alloh’s <a href="https://www.presstv.ir/Detail/2023/11/19/714879/humans-of-gaza-hammam-alloh-nephrologist-alshifa-hospital">courage and dedication has become a powerful source of inspiration</a> for physicians and health-care workers around the world. </p>
<p>Multiple sources have reported the number of civilians who have been killed by the bombs and bullets during the assault on Gaza. We may never know how many cancer patients will die from lack of chemotherapy; or diabetics from lack of insulin; or kidney failure patients from inadequate dialysis. The consequences of the collapsed health-care system in Gaza will be felt for years to come. </p>
<p>The <a href="https://www.cbc.ca/news/canada/chilling-effect-pro-palestinian-1.7064510">attempts to silence, intimidate and smear health-care workers</a> for calling out the atrocities in Gaza have been well documented. These efforts not only attempt to rob us of our freedom of speech, but of our professional and moral duty as physicians to promote global health and protect the vulnerable. </p>
<p>As physicians, we will not be silent as our colleagues in Gaza are being killed, as hospitals are being targeted and attacked, and as vulnerable patients are endangered. We <a href="https://news.un.org/en/story/2024/01/1145462">join the UN</a>, the <a href="https://doi.org/10.1016/S0140-6736(23)02627-2">WHO</a>, <a href="https://www.doctorswithoutborders.ca/msf-immediate-ceasefire-is-needed-in-gaza-to-stop-the-bloodshed/">MSF</a> and the <a href="https://www.bma.org.uk/what-we-do/working-internationally/our-international-work/bma-position-israel-gaza-conflict">British Medical Association</a>, along with millions around the world, who call for an immediate ceasefire and unimpeded humanitarian aid. </p>
<p>We stand in solidarity with the true health-care heroes of Gaza who continue to work in harrowing conditions, and we honour the legacies of those like Dr. Alloh who lost their lives while upholding the highest values of our profession.</p><img src="https://counter.theconversation.com/content/220941/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>Patients with kidney failure need regular dialysis treatments to survive. However, the equipment, supplies and medical staff needed for dialysis have been largely destroyed by the assault on Gaza.Ali Iqbal, Transplant Nephrologist, Assistant Professor of Medicine, McMaster UniversityAliya Khan, Clinical professor, Faculty of Health Sciences, McMaster UniversityBen Thomson, Masters of Public Health student, Bloomberg School of Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2205642024-01-05T14:54:09Z2024-01-05T14:54:09ZNew antibiotic zosurabalpin shows promise against drug-resistant bacteria – an expert explains how it works<figure><img src="https://images.theconversation.com/files/567989/original/file-20240105-24-a6i28q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5120%2C2880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carbapenem-resistant Acinetobacter baumannii is classified as a priority 1 critical pathogen by the World Health Organization</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-science-laboratory-portrait-beautiful-black-1922200124">Gorodenkoff/Shutterstock</a></span></figcaption></figure><p>Researchers have <a href="https://www.nature.com/articles/s41586-023-06799-7">identified</a> an entirely new class of antibiotic that can kill bacteria that are resistant to most current drugs. </p>
<p>Zosurabalpin is highly effective against the bacterium carbapenem-resistant <em>Acinetobacter baumannii</em> (Crab), which is <a href="https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed">classified</a> as a “priority 1” pathogen by the World Health Organization due to its growing presence in hospitals.</p>
<p>Crab <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137960/">can kill</a> up to 60% of people infected with it. It commonly causes infections of the urinary tract, respiratory tract and blood stream, potentially leading to sepsis. It is responsible for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913636/">around 20%</a> of infections in places like hospitals, care homes or other similar healthcare settings.</p>
<p>Antibiotics commonly work by crossing the cell wall that surrounds infectious bacteria to reach the vital machinery inside. Once inside the cell, antibiotics block that machinery in such a way as to either stop the bacteria from growing or to cause cell death. </p>
<p>Crab is a clinical challenge as it has a double-layered cell wall, a feature that microbiologists describe as “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/gram-negative-bacteria">gram negative</a>”. This means that antibiotics need to cross both layers to reach the vital machinery inside the bacteria to kill them and treat the infection. </p>
<p>An exception to this rule is penicillin-based antibiotics, where the target is in the cell wall itself. These antibiotics, known as <a href="https://www.bmj.com/content/344/bmj.e3236">carbapenems</a>, were derived from penicillin some 48 years after it was first discovered and still work in the same way. However, they have undergone clever chemical modification to prevent bacteria successfully evolving to resist them. This makes them a vital part of treating infections like those caused by <em>Acinetobacter baumannii</em>. </p>
<p>But Crab, the superbug version of this infection, has developed the ability to break down carbapenems, giving it an evolutionary upper hand, which has led to its rise to supremacy in hospitals. </p>
<h2>Zosurabalpin</h2>
<p>This new class of antibiotic, zosurabalpin, is shown to be highly effective against Crab both in the laboratory and in infected animals. Researchers tested zosurabalpin against more than 100 Crab samples from patients suffering from the infection. The research team, <a href="https://www.nature.com/articles/s41586-023-06799-7">found</a> that zosurabalpin was able to kill all of these bacterial strains. It could also kill the bacteria in the bloodstream of mice infected with Crab, preventing them from developing sepsis. </p>
<p>Crab has the ability to make a toxin called <a href="https://www.sciencedirect.com/topics/neuroscience/lipopolysaccharide">lipopolysaccharide</a> that it uses as part of its weaponry for infecting people and which it normally embeds into its outer cell wall. </p>
<p>Zosurabalpin works by blocking a molecular machine called <a href="https://www.nature.com/articles/s41586-023-06873-0">LptB2FGC</a> that transports the lipopolysaccharide toxin from the inside barrier to the outside one. This makes the toxin build up inside the bacteria, causing the Crab cells to die. Essentially, the bacteria pull the pin out of their own grenade but zosurabalpin stops them from being able to throw it. </p>
<p>This LptB2FGC mechanism is pretty unique to Crab, which has some advantages and disadvantages. The bad news is that zosurabalpin will only kill Crab infections and not those caused by other types of bacteria. This means doctors would need to accurately diagnose patients with this infection to decide if zosurabalpin would be the right drug. </p>
<p>But a major advantage is that the chance of antibiotic resistance emerging is reduced, as this resistance could only emerge from Crab and not other types of bacteria. Hopefully, this could extend the shelf life of this drug. </p>
<p>The researchers say they have already seen some mutations in the drug target, LptB2FGC. However, these only seem to reduce the effectiveness of zosurabalpin, rather than stopping it working entirely. The great news is that this is the first time an antibiotic has been reported to work in this way. It gives microbiologists a new avenue to explore ways to kill our bacterial enemies before they kill us. </p>
<figure class="align-center ">
<img alt="Close up of microscope with lab glassware." src="https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.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">Zosurabalpin is effective against the bacteria, Crab, which can kill up to 60% of people infected with it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/microscope-lab-glassware-science-laboratory-research-530971462">totojang1977/Shutterstock</a></span>
</figcaption>
</figure>
<p>Zosurabalpin is now in phase 1 clinical trial for use in patients infected with Crab. This early testing in humans will help the company developing the drug, Roche, to work out any side effects of the drugs as well as potential toxicity. Most importantly, they need to check that the drug works just as well in humans as it did in mice, and look to see if any antibiotic resistance emerges in the trial patients. </p>
<p>It’s early days and the failure rate for new antibiotic development is high, but scientists are rising to the challenge. This discovery offers significant opportunities to the scientific field as a whole and a vital lifeline in the fight against antibiotic-resistant infections.</p><img src="https://counter.theconversation.com/content/220564/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Cox receives research funding from UKRI, charities and industry.
He is Co-Director of the Antibiotic Discovery Accelerator (ABX) Network </span></em></p>Zosurabalpin is highly effective against dangerous bacterium Crab, which can kill up to 60% of people infected with it.Jonathan Cox, Senior Lecturer in Microbiology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2188792023-12-11T22:10:48Z2023-12-11T22:10:48ZAntimicrobial resistance now hits lower-income countries the hardest, but superbugs are a global threat we must all fight<figure><img src="https://images.theconversation.com/files/564957/original/file-20231211-23-x9nrkx.jpg?ixlib=rb-1.1.0&rect=907%2C341%2C5083%2C3646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While antimicrobial resistance is a threat to all humanity, a tale of two worlds emerges, highlighting the heightened vulnerability of low- and middle-income countries.</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/antimicrobial-resistance-now-hits-lower-income-countries-the-hardest-but-superbugs-are-a-global-threat-we-must-all-fight" width="100%" height="400"></iframe>
<p>Antimicrobial resistance (AMR) is one of the World Health Organization’s <a href="https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-challenges-for-the-next-decade?utm_source=STAT+Newsletters&utm_campaign=1931cb646b-MR_COPY_02&utm_medium=email&utm_term=0_8cab1d7961-1931cb646b-150708293">most urgent health challenges</a> for the next decade. While AMR is a global threat, a tale of two worlds emerges, highlighting the heightened vulnerability of low- and middle-income countries (<a href="https://data.worldbank.org/country/XO">LMICs</a>). </p>
<p>Misuse of antimicrobials worldwide has accelerated the evolution of <a href="https://www.who.int/health-topics/antimicrobial-resistance">antimicrobial resistance</a>. For instance, in many countries, antibiotics are available over the counter, and even when their use is more regulated, the Centers for Disease Control has estimated that in the United States, <a href="https://www.cdc.gov/antibiotic-use/data/outpatient-prescribing/index.html">one in three antibiotic prescriptions</a> were unnecessary. </p>
<p>Likewise, most of the antibiotics are not even given to humans. As much as 80 per cent of the total consumption is <a href="https://doi.org/10.1056/NEJMp1311479">used in livestock</a> to promote growth, and to treat or prevent infections. </p>
<p>This has facilitated bacteria and other microorganisms to become resistant to the drugs that were once effective in treating them — sometimes called <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">superbugs</a>. This problem was associated with <a href="https://doi.org/10.1016/S0140-6736(21)02724-0">4.95 million deaths</a> worldwide in 2019.</p>
<h2>A ‘silent pandemic’</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="clusters of round ivory shapes against a blue background" src="https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=570&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=570&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564438/original/file-20231208-17-v6wlih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=570&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Microscopic view of methicillin-resistant Staphylococcus aureus (MRSA) bacteria.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>If we don’t take action, things could get even worse. Reports predict that by 2050, AMR could cause <a href="https://amr-review.org/">10 million deaths</a> each year and cost the world <a href="https://www.who.int/news/item/22-06-2023-who-outlines-40-research-priorities-on-antimicrobial-resistance">US$100 trillion</a>. </p>
<p>Fortunately, many nations are now taking decisive steps toward controlling what the WHO calls a “<a href="https://www.who.int/news-room/articles-detail/global-antimicrobial-resistance-forum-launched-to-help-tackle-common-threat-to-planetary-health">silent pandemic</a>.” Acknowledging the gravity of the situation, high-income countries (<a href="https://data.worldbank.org/income-level/high-income">HICs</a>) such as the U.S. and Canada have <a href="https://doi.org/10.1016/S2214-109X(23)00019-0">implemented robust plans</a> encompassing surveillance, stewardship and policy reforms. </p>
<p>These efforts should undoubtedly be applauded. However, an important principle of the “<a href="https://www.who.int/news-room/questions-and-answers/item/one-health">One Health</a>” approach, which is often neglected, is that this is a global problem, and global collaboration should be prioritized. Low- and middle-income countries bear a <a href="https://doi.org/10.1080/14787210.2021.1951705">disproportionate burden</a> of AMR and require increased resource mobilization, knowledge sharing and international co-operation.</p>
<h2>Contrasting realities</h2>
<p>As a doctoral researcher, I study the evolution of antimicrobial resistance in bacteria, but as an immigrant from Mexico, I am deeply concerned with the disparity observed between high-income and low- and middle-income countries, and their contrasting realities. </p>
<figure class="align-center ">
<img alt="A row of three petri dishes with varying levels of growth" src="https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=240&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=240&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=240&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=302&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=302&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564955/original/file-20231211-17-l64ftv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=302&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antimicrobial resistance susceptibility lab tests.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For instance, there have been great efforts in <a href="https://doi.org/10.1016/S1473-3099(11)70054-8">regulating antibiotic consumption</a> in many HICs, where antibiotic use in livestock has decreased and antibiotics are only accessible under prescription. While there is still room for improvement, there is a less encouraging reality in some LMICs, where antibiotics are usually obtained easily <a href="https://doi.org/10.1016/S1473-3099(11)70054-8">without prescriptions</a> and sometimes used as a way to compensate for the <a href="https://doi.org/10.1080/14787210.2021.1951705">difficulty of accessing health-care professionals</a>. </p>
<p>Likewise, in some LMICs, antibiotic use in animals is predicted to <a href="https://doi.org/10.1073/pnas.1503141112">double by 2030</a> compared to the last decade.</p>
<p>A <a href="https://doi.org/10.1016/j.lana.2023.100594">recent report</a> exploring the burden of AMR in the Americas in 2019 showed the “multiple realities” of the problem. Not surprisingly, by 2019, the four countries with the lowest AMR-linked mortality rates (age-standardized) each had a financed national action plan to combat AMR, while none of the 10 countries with the highest mortality rates did. </p>
<p>Strikingly, <a href="https://www.unicef.org/wash">UNICEF reports</a> that more than half of the world’s population does not have access to safe sanitation and over 2.2 billion people still don’t have access to safe drinking water. This is extremely concerning for a variety of reasons, but good sanitation and hygiene is critical to <a href="https://www.who.int/teams/environment-climate-change-and-health/water-sanitation-and-health/burden-of-disease/wash-and-antimicrobial-resistance#:%7E:text=Improvements%20in%20water%20sanitation%20and,Action%20Plan%20to%20combat%20AMR.">limiting the spread of microbes and reducing the risk of infection</a>.</p>
<p>The current approach taken by most high-income countries is the equivalent of sheltering in the attic, making sure the fire alarm works correctly, while the basement is on fire.</p>
<h2>Worldwide spread</h2>
<figure class="align-right ">
<img alt="Infographic of resistant bacteria spreading around the globe" src="https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564440/original/file-20231208-19-jfdagi.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">
<figcaption>
<span class="caption">Resistant bacteria or resistance genes can spread across countries through travel, immigration, trade and even water and air circulation.</span>
<span class="attribution"><span class="source">(Centers for Disease Control and Prevention)</span></span>
</figcaption>
</figure>
<p>Resistant bacteria can evolve anywhere. Even if some countries manage to control the problem within their borders, the risk remains. Resistant bacteria or genes that allow bacteria to grow in the presence of the antibiotic can spread across countries through various means, including travel, immigration, trade and even natural processes like water and air circulation. </p>
<p>Such is the case of the resistance gene <a href="https://doi.org/10.1128/aac.00774-09">NDM-1</a>, which was first described in 2009. Only five years after the initial report, this resistance gene was present in virtually the <a href="https://doi.org/10.1111/1469-0691.12719">whole world</a>.</p>
<p>We have all observed the phenomenon of worldwide spread firsthand, as the COVID-19 pandemic vividly demonstrates how pathogens can <a href="https://coronavirus.jhu.edu/map.html">rapidly traverse the globe</a>. </p>
<h2>Communication and collaboration</h2>
<p>It is crucial for nations to enhance communication channels and promote education regarding AMR in several sectors, including the general public, health-care providers, farmers and veterinarians. In addition to this, there is a pressing need to establish robust surveillance systems that can promptly detect outbreaks and enable swift action. </p>
<p>Effective cross-border communication could be realized through standardizing surveillance systems. This would enable accurate comparisons of results between countries. Moreover, it facilitates the sharing of valuable resources, equipment, qualified personnel and access to training opportunities. </p>
<p>Both HICs and LMICs should collaborate closely to implement measures aimed at reducing infection rates, such as improved sanitation practices. This collaboration encourages the exchange of knowledge and expertise, enabling the adoption of best practices globally.</p>
<p>The United Kingdom government set a good example in August, when it allocated <a href="https://www.gov.uk/government/news/210-million-to-tackle-deadly-antimicrobial-resistance">£210 million</a> (about C$360 million) to tackle AMR across Asia and Africa over the next three years, understanding that this threat cannot be fought from its own trenches. These resources will increase surveillance in 25 countries where the AMR threat is highest, and will also be used to upgrade laboratories and strengthen the health workforce in those countries. </p>
<p>To effectively combat AMR, global co-operation is not a luxury but a necessity. HICs must recognize their responsibility to support LMICs in addressing this crisis. By sharing resources, knowledge and expertise, we can collectively mitigate the threat of AMR. </p>
<p>By safeguarding the effectiveness of antibiotics, we protect ourselves and future generations from the devastating consequences of antimicrobial resistance. Together, we can make a difference in the global fight against superbugs.</p><img src="https://counter.theconversation.com/content/218879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Domínguez has received funding from FRQNT, Concordia University and Mitacs. </span></em></p>The contrasting realities of antimicrobial resistance between high-income countries and low- and middle-income countries demands international co-operation to effectively fight superbugs.Laura Domínguez, Doctoral Researcher and Public Scholar, Biochemistry, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190922023-12-05T17:35:55Z2023-12-05T17:35:55ZNZ First fears over WHO regulations are misplaced – robust checks and balances already exist<p>When the new government lodged an urgent “reservation” against adopting amendments to World Health Organization regulations, it <a href="https://www.1news.co.nz/2023/12/01/coalitions-who-policy-leaves-public-health-expert-baffled/">baffled some expert observers</a> but signalled an early win for the NZ First party.</p>
<p>Under the heading “Strengthening Democracy and Freedoms” in its <a href="https://assets.nationbuilder.com/nationalparty/pages/18466/attachments/original/1700778597/NZFirst_Agreement_2.pdf?1700778597">coalition agreement</a> with the National Party, NZ First negotiated to:</p>
<blockquote>
<p>Ensure a “National Interest Test” is undertaken before New Zealand accepts any agreements from the UN and its agencies that limit national decision-making and reconfirm that New Zealand’s domestic law holds primacy over any international agreements.</p>
</blockquote>
<p>Why any of this should be needed is not clear – other than to support the implication New Zealand is being dictated to by the United Nations and is not in control of its own destiny. </p>
<p>In fact, detailed rules and processes governing how New Zealand applies international laws and treaties already exist, as does the requirement for a national interest analysis. </p>
<p>It’s important to remember, too, that New Zealand participates in creating new international legal rules because some of its (or any nation’s) most pressing problems cannot be solved unilaterally. </p>
<h2>Domestic versus international law</h2>
<p>The need for a collective response to contagious and dangerous diseases was one of the earliest examples of global cooperation. Today, the <a href="https://www.who.int/health-topics/international-health-regulations#tab=tab_2">International Health Regulations</a> of the World Health Organization (WHO) set out how this should happen. But individual governments are primarily responsible for implementing those regulations. </p>
<p>The COVID pandemic has triggered the negotiation of a new WHO treaty on pandemic prevention, preparedness and response. New Zealanders can <a href="https://www.mfat.govt.nz/en/peace-rights-and-security/our-work-with-the-un/have-your-say-improving-pandemic-prevention-preparedness-and-response-with-a-legal-instrument/">participate in the process</a> being run by the Ministry of Foreign Affairs and Trade. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-parties-two-deals-one-government-the-stress-points-within-new-zealands-coalition-of-many-colours-217673">Three parties, two deals, one government: the stress points within New Zealand's 'coalition of many colours'</a>
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<p>New Zealand governments have a long history of negotiating the wording of international treaties. They can also control the local impact of international agreements or treaties by entering “<a href="https://treaties.un.org/doc/source/publications/thb/english.pdf">reservations</a>”.</p>
<p>These mean a country will not be bound by specific parts of an agreement. This mechanism can make it more likely that countries will agree to a treaty overall, but it can also run the risk of creating different rules for different countries.</p>
<p>Many legal agreements have built-in mechanisms that allow for regulatory changes without requiring a formal revision of the entire treaty. The WHO’s International Health Regulations are a good example. </p>
<p>And ultimately, governments – including New Zealand’s – have the power to enter into, or withdraw from, any treaty.</p>
<h2>Measuring the national interest</h2>
<p>Of course, no government should sign up to anything not in its country’s best interests. But New Zealand has already developed clear, <a href="https://www.dpmc.govt.nz/our-business-units/cabinet-office/supporting-work-cabinet/cabinet-manual/7-executive-legislation-10">detailed rules</a> governing how and to what extent international agreements become part of domestic law. </p>
<p>Cabinet must <a href="https://www.dpmc.govt.nz/publications/requirements-international-treaty-cabinet-papers">approve any proposal</a> to sign or take binding action under a treaty. Significant changes in the operation of a treaty are also subject to careful oversight, with members of parliament playing an important role.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-winston-peters-right-to-call-state-funded-journalism-bribery-or-is-there-a-bigger-threat-to-democracy-218782">Is Winston Peters right to call state-funded journalism ‘bribery’ – or is there a bigger threat to democracy?</a>
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<p>But even before such scrutiny, a treaty must undergo a “national interest analysis” (NIA), with the <a href="https://www.dpmc.govt.nz/sites/default/files/2023-06/cabinet-manual-2023-v2.pdf">Cabinet Manual</a>, <a href="https://www.parliament.nz/media/10573/standing-orders-2023.pdf">parliament’s Standing Orders</a> and the <a href="https://www.mfat.govt.nz/assets/About-us-Corporate/Treaties-Model-instruments/International-Treaty-Making-Guide-2021.pdf">Ministry of Foreign Affairs and Trade</a> providing guidance. </p>
<p>The NIA process considers the reasons for becoming a party to the treaty, the advantages and disadvantages to New Zealand, and how the treaty will be implemented. Cabinet can then authorise the signing of the final text of the agreement, thereby approving it.</p>
<p>Signed agreements – either multilateral or bilateral – and their NIAs then go to the House of Representatives. From there they are referred to the Foreign Affairs, Defence and Trade Committee, which can look at the treaty itself or send it to a more appropriate select committee. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1730397088784191520"}"></div></p>
<h2>Affirming New Zealand sovereignty</h2>
<p>The requirement to send the agreement and the NIA to select committee acts as a further brake. The government can’t do anything for 15 sitting days or until the select committee responds, whichever happens first.</p>
<p>The select committee can make recommendations, including asking for more time to examine the treaty and the NIA, and seek public submissions. The government has 60 working days to respond to the select committee’s recommendations. </p>
<p>It’s also open to MPs to debate the treaty. While the government may decide <a href="https://theconversation.com/a-major-new-law-aims-to-improve-the-health-of-all-new-zealanders-so-why-doesnt-it-include-the-basic-human-right-to-health-184842">no action is required</a>, sometimes the proposed new treaty obligation means <a href="https://www.parliament.nz/media/10573/standing-orders-2023.pdf">new laws</a> are needed, or existing ones amended or repealed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fake-news-didnt-play-a-big-role-in-nzs-2023-election-but-there-was-a-rise-in-small-lies-216338">Fake news didn't play a big role in NZ's 2023 election – but there was a rise in 'small lies'</a>
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<p>New or changed laws give a government and parliament plenty of scope to influence if and how a treaty forms part of domestic law.</p>
<p>After these international and domestic processes are concluded, ratification can take place. Formal documents confirm that domestic procedures have been completed and the treaty is in force, along with any reservations that have been adopted.</p>
<p>The entire process affirms New Zealand’s sovereignty.</p>
<p>New Zealand has always been an active global citizen. It is party to over <a href="https://www.mfat.govt.nz/en/about-us/who-we-are/treaties/#:%7E:text=New%20Zealand%20is%20currently%20party,are%20not%20yet%20in%20force.&text=A%20treaty%20is%20an%20international,legally%20binding%20under%20international%20law.">1,900</a> treaties with multiple countries. </p>
<p>From direct participation in the formation of new agreements, through to assessing their impact, New Zealand has robust systems in place – all of which confirm domestic law holds primacy over any international agreements.</p><img src="https://counter.theconversation.com/content/219092/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>Despite demands for an urgent ‘reservation’ and ‘national interest test’ over new WHO regulations, New Zealand’s sovereignty is not at risk from international agreements or treaties.Claire Breen, Professor of Law, University of WaikatoAlexander Gillespie, Professor of Law, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2147982023-10-03T19:50:49Z2023-10-03T19:50:49Z‘We could eradicate malaria by 2040’ says expert after revolutionary vaccine is approved by WHO<p><em>The World Health Organization has <a href="https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization">approved</a> a new vaccine that scientists argue will be a game-changer in the fight against malaria, which kills half a million people in Africa every year. Trials have shown that the <a href="https://www.ox.ac.uk/news/2023-10-02-oxford-r21matrix-m-malaria-vaccine-receives-world-health-organization-recommendation">R21/Matrix vaccine</a>, developed by Oxford University together with the Serum Institute of India, reduces malaria by up to 75%. It can be manufactured cheaply and on a mass scale. The Conversation Weekly spoke to chief investigator Adrian Hill, who is also director of the Jenner Institute at the University of Oxford, about this revolutionary vaccine. Below are edited excerpts from the <a href="https://theconversation.com/the-long-road-to-a-new-malaria-vaccine-told-by-the-scientists-behind-the-breakthrough-podcast-214885">podcast</a>.</em></p>
<hr>
<h2>Why is the R21/Matrix vaccine a game-changer?</h2>
<p>We’re seeing about 75% efficacy by counting the reduction in numbers of malaria episodes over a year. The best vaccine prior to this was about 50% over a year, and lower than that over three years.</p>
<p>This is a material improvement, but that’s not the main improvement. The big difference is how you can manufacture it at a scale that is really needed to protect most of the children who need a malaria vaccine in Africa. </p>
<p>There are about 40 million children born every year in malaria areas in Africa who would benefit from a vaccine. Ours is a four-dose vaccine over 14 months, so you need about 160 million doses. We can achieve that. </p>
<p>The Serum Institute of India, our manufacturing and commercial partner, can produce hundreds of millions of doses of this vaccine each year, whereas the previous vaccine could be manufactured at a scale of six million doses a year from 2023 to 2026, according to Unicef reports. </p>
<p>The third real advantage of this vaccine is its cost. We were well aware that we couldn’t produce a US$100 vaccine. It wouldn’t fly for international agencies supporting the purchase and distribution of the vaccine in very low-income countries.</p>
<p>So where we are now is a price that’ll vary according to the scale, but at high volume it should be US$5 a dose.</p>
<h2>Why has developing a malaria vaccine been so difficult?</h2>
<p>People have been trying to make malaria vaccines for over 100 years. Well over 100 vaccines have gone into clinical trials in people. Very, very few have worked to any degree.</p>
<p>Malaria is not a virus, it’s not a bacterium. It’s a protozoan parasite, some thousands of times larger than a typical virus. A good measure of that is how many genes it has. Covid has 13, malaria has about 5,500. This is one of the reasons that malaria is super complex.</p>
<p>There are different parasite forms the first of which are injected by the mosquito into the skin and rapidly go to the liver. They spend a week multiplying there, and then they go into the bloodstream. And they are hugely different during these different stages. And the parasites grow at a rate of tenfold every 48 hours, multiplying furiously. </p>
<p>By the time they get to a really high parasite density, you will be very unwell. Or if you’re unlucky, you will die, typically from cerebral symptoms, a coma or from being severely anaemic. The parasites break open the red blood cells.</p>
<p>And then there’s yet another stage where the parasite changes again to a form that the mosquito can take up through its next bite and continue the life cycle by infecting somebody else.</p>
<p>So this is as complex as it gets with infectious pathogens.</p>
<p>Malaria typically goes through four life cycles and they’re all different. If you can get a really good vaccine for one of those, you will break the cycle of transmission. And that’s what we’ve been trying to do.</p>
<p>We’ve been working on targeting the so-called sporozoites, which is the form that the mosquito inoculates into your skin. We’re trying to trap it before it can get to the liver and carry on the life cycle.</p>
<p>Luckily, there are no symptoms of malaria at that stage. It’s a silent infection until it gets into the blood and starts multiplying inside your red blood cells. </p>
<p>So the sporozoite is a natural target to try and kill the parasite before it multiplies very quickly.</p>
<h2>Tell us about past attempts to develop a malaria vaccine</h2>
<p>Very early on people tried to use the whole microbe in the same way that vaccine pioneer Edward Jenner used the whole virus to inoculate against smallpox. Then the French microbiologist Louis Pasteur came along with bacterial vaccines, and so on.
In about 1943, there was a trial of the whole malaria parasite vaccine candidate in New York with zero efficacy. That put people off for a while.</p>
<p>It wasn’t until the 1980s when we could actually begin to sequence the genes in the parasite that new vaccination candidates appeared. And then within 10 years we had 5,000 candidates because everyone hoped that the gene they had sequenced might be a malaria vaccine. And of course almost all of those failed.</p>
<h2>Why aren’t vaccines for whole parasites effective against malaria?</h2>
<p>It’s the same reason that just getting infected once by malaria doesn’t give you protection against the next infection. </p>
<p>In the areas of malaria where we test our vaccines in Africa, some children get up to eight episodes in three or four months. They get quite unwell with the first and three weeks later they’re having a second bout and so on. Natural immunity doesn’t work until you’ve had a lot of different infections and that’s why adults are generally protected against malaria and don’t become very unwell. </p>
<p>The people who die of malaria in an endemic area are the <a href="https://www.who.int/news-room/fact-sheets/detail/malaria">young children </a> who may never have been infected before and die with their first infection when they’re one year old, or they might have had one or two episodes, but that wasn’t enough to give them sterilising immunity.</p>
<p>Malaria has been around for tens of millions of years. Not just in humans, but in the species that we were before we became humans.</p>
<p>It’s a very wily parasite and has developed <a href="https://academic.oup.com/femsre/article/40/2/208/2570118">immune escape mechanisms </a> of all sorts.</p>
<p>When you try to vaccinate, you suddenly find there’s some way the parasite gets around that, and it’s only when you get up to really extraordinarily high levels of antibodies that the parasite hasn’t seen before and hasn’t learnt to evolve against that it becomes effective.</p>
<h2>Will we ever eradicate malaria entirely?</h2>
<p>Malaria is very high on the list of diseases we want to eradicate. I don’t think it’s going to happen in five years or 10 years, but it should happen in something like 15 years. So 2040 would be a reasonable target. </p>
<p>Nobody’s suggesting we stop doing what we’re doing at the moment with bed nets and spraying and drugs. But now we have a new tool that may be individually more protective than any of the tools we’re using at the moment.</p><img src="https://counter.theconversation.com/content/214798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Hill receives funding from government and charitable funders of malaria vaccine development. He has received funding awarded to the University of Oxford from the Serum Institute of India to support clinical trials of the R21/Matrix-M vaccine. He may benefit for a share of any royalty stream to Oxford University from the vaccine.</span></em></p>People have been trying to make malaria vaccines for over 100 years. With the help of the revolutionary new R21/Matrix vaccine the disease could be eradicated by 2040.Adrian Hill, Director of the Jenner Institute, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2132662023-09-19T13:24:20Z2023-09-19T13:24:20ZChatbots for medical advice: three ways to avoid misleading information<p>We expect medical professionals to give us reliable information about ourselves and potential treatments so that we can make informed decisions about which (if any) medicine or other intervention we need. If your doctor instead “bullshits” you (yes – this term has been used in <a href="https://press.princeton.edu/books/hardcover/9780691122946/on-bullshit">academic publications</a> to refer to persuasion without regard for truth, and not as a swear word) under the deception of authoritative medical advice, the decisions you make could be based on faulty evidence and may result in harm or even death. </p>
<p>Bullshitting is distinct from lying – liars do care about the truth and actively try to conceal it. Indeed bullshitting can be <a href="https://theconversation.com/trump-isnt-lying-hes-bullshitting-and-its-far-more-dangerous-71932">more dangerous</a> than an outright lie. Fortunately, of course, doctors don’t tend to bullshit – and if they did there would be, one hopes, consequences through ethics bodies or the law. But what if the misleading medical advice didn’t come from a doctor?</p>
<p>By now, most people have heard of <a href="https://theconversation.com/unlike-with-academics-and-reporters-you-cant-check-when-chatgpts-telling-the-truth-198463">ChatGPT</a>, a very powerful chatbot. A chatbot is an algorithm-powered interface that can mimic human interaction. The use of chatbots is becoming <a href="https://theconversation.com/everyones-having-a-field-day-with-chatgpt-but-nobody-knows-how-it-actually-works-196378">increasingly widespread</a>, including for <a href="https://www.scientificamerican.com/article/ai-chatbots-can-diagnose-medical-conditions-at-home-how-good-are-they/">medical advice</a>. </p>
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Read more:
<a href="https://theconversation.com/chatgpts-greatest-achievement-might-just-be-its-ability-to-trick-us-into-thinking-that-its-honest-202694">ChatGPT's greatest achievement might just be its ability to trick us into thinking that it's honest</a>
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<p>In a <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1254334/full">recent paper</a>, we looked at ethical perspectives on the use of chatbots for medical advice. Now, while ChatGPT, or similar platforms, might be useful and reliable for finding out the best places to see in Dakar, to learn about wildlife, or to get quick potted summaries of other topics of interest, putting your health in its hands may be playing Russian roulette: you might get lucky, but you might not. </p>
<p>This is because chatbots like ChatGPT try to persuade you <a href="https://theconversation.com/chatgpts-greatest-achievement-might-just-be-its-ability-to-trick-us-into-thinking-that-its-honest-202694">without regard for truth</a>. Its rhetoric is so persuasive that gaps in logic and facts are obscured. This, in effect, means that ChatGPT includes the generation of bullshit.</p>
<h2>The gaps</h2>
<p>The issue is that ChatGPT is not really artificial intelligence in the sense of actually recognising what you’re asking, thinking about it, checking the available evidence, and giving a justified response. Rather, it looks at the words you’re providing, predicts a response that will sound plausible and provides that response. </p>
<p>This is somewhat similar to the predictive text function you may have used on mobile phones, but much more powerful. Indeed, it can provide very persuasive bullshit: often accurate, but sometimes not. That’s fine if you get bad advice about a restaurant, but it’s very bad indeed if you’re assured that your odd-looking mole is not cancerous when it is.</p>
<p>Another way of looking at this is from the perspective of logic and rhetoric. We want our medical advice to be scientific and logical, proceeding from the evidence to personalised recommendations regarding our health. In contrast, ChatGPT wants to sound persuasive <a href="https://www.embopress.org/doi/full/10.15252/embr.202357501">even if it’s talking bullshit</a>. </p>
<p>For example, when asked to provide citations for its claims, ChatGPT often <a href="https://www.embopress.org/doi/full/10.15252/embr.202357501">makes up references</a> to literature that doesn’t exist – even though the provided text looks perfectly legitimate. Would you trust a doctor who did that?</p>
<h2>Dr ChatGPT vs Dr Google</h2>
<p>Now, you might think that Dr ChatGPT is at least better than Dr Google, which people also use to try to self-diagnose. </p>
<p>In contrast to the reams of information provided by Dr Google, chatbots like ChatGPT give concise answers very quickly. Of course, Dr Google can fall prey to misinformation too, but it does not try to sound convincing.</p>
<p>Using Google or other search engines to identify verified and trustworthy health information (for instance, from the <a href="https://www.who.int/">World Health Organization</a>) can be very beneficial for citizens. And while Google is known for capturing and recording user data, such as terms used in searches, <a href="https://theconversation.com/chatgpt-is-a-data-privacy-nightmare-if-youve-ever-posted-online-you-ought-to-be-concerned-199283">using chatbots may be worse</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/chatgpt-is-a-data-privacy-nightmare-if-youve-ever-posted-online-you-ought-to-be-concerned-199283">ChatGPT is a data privacy nightmare. If you’ve ever posted online, you ought to be concerned</a>
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<p>Beyond potentially being misleading, chatbots may record data on your medical conditions and actively request more personal information, leading to more personalised – and possibly more accurate – bullshit. Therein lies the dilemma. Providing more information to chatbots may lead to more accurate answers, but also gives away <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1254334/full#B22">more personal health-related information</a>. However, not all chatbots are like ChatGPT. Some may be more specifically designed for use in medical settings, and advantages from their use may outweigh potential disadvantages.</p>
<h2>What to do</h2>
<p>So what should you do if you’re tempted to use ChatGPT for medical advice despite all this bullshit?</p>
<p>The first rule is: don’t use it. </p>
<p>But if you do, the second rule is that you should check the accuracy of the chatbot’s response – the medical advice provided may or may not be true. Dr Google can, for instance, point you in the direction of reliable sources. But, if you’re going to do that anyway, why risk receiving bullshit in the first place?</p>
<p>The third rule is to provide chatbots with information sparingly. Obviously, the more personalised data you offer, the better the medical advice you get. And it can be difficult to withhold information as most of us willingly and voluntarily give up information on mobile phones and various websites anyway. Adding to this, chatbots can also ask for more. But more data for chatbots like ChatGPT could also lead to more persuasive and even personalised inaccurate medical advice.</p>
<p>Talking bullshit and misuse of personal data is certainly not our idea of a good doctor.</p><img src="https://counter.theconversation.com/content/213266/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>What should you do if you’re tempted to use ChatGPT for medical advice? For starters, don’t use it.David Martin Shaw, Bioethicist, Department of Health Ethics and Society, Maastricht University and Institute for Biomedical Ethics, University of BaselPhilip Lewis, Research associate, University of CologneThomas C. Erren, Professor, University of CologneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2125022023-09-06T12:27:15Z2023-09-06T12:27:15ZTraditional medicine provides health care to many around the globe – the WHO is trying to make it safer and more standardized<figure><img src="https://images.theconversation.com/files/546464/original/file-20230905-503-nlkg3v.jpg?ixlib=rb-1.1.0&rect=3%2C9%2C2114%2C1400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ayurveda is one form of traditional medicine that can integrate aromatherapy. It's popular in South Asia. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ayurveda-aromatherapy-with-essential-oil-diffuser-royalty-free-image/1333713382?phrase=ayurveda&adppopup=true">Microgen Images/Science Photo Library</a></span></figcaption></figure><p>For approximately <a href="https://www.who.int/news/item/25-03-2022-who-establishes-the-global-centre-for-traditional-medicine-in-india">80% of the world’s population</a>, the first stop after catching a cold or breaking a bone isn’t the hospital — maybe because there isn’t one nearby, or they can’t afford it. Instead, the first step is consulting traditional medicine, which cultures around the world have been using for thousands of years.</p>
<p><a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">Traditional medicine</a> encompasses the healing knowledge, skills and practices used by a variety of cultures and groups. </p>
<p>Examples of traditional medicine include <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/herbal-medicine">herbal medicine</a>; <a href="https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763">acupuncture</a>; <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/tui-na">Tui Na</a> – which is a type of massage originating in China; <a href="https://www.nccih.nih.gov/health/ayurvedic-medicine-in-depth">Ayurveda</a> – which is an ancient system of promoting health through diet, exercise and lifestyle from India; <a href="https://www.britannica.com/science/Unani-medicine">and Unani</a> – which is another ancient system of health from South Asia, balancing key aspects of the mind, body and spirit. </p>
<p>In recognizing that traditional medicine and other alternative forms of healing are critical sources of health care for many people worldwide, the World Health Organization and the government of India co-hosted their first-ever <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Traditional Medicine Summit</a>. The summit took place in August 2023 in Gandhinagar, Gujarat, India. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/jW-B8BpLQJE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">August 2023 marked the WHO’s first global summit on traditional medicine.</span></figcaption>
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<p>The summit brought together health care policymakers, traditional medicine workers and users, international organizations, academics and private sector stakeholders from 88 <a href="https://www.who.int/countries">WHO member states</a>. Leaders at the summit aimed to share best practices and scientific evidence and data around traditional medicine. </p>
<p>As researchers interested in how to provide patients both in the U.S. and around the globe with the best <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">possible medical care</a>, <a href="https://scholar.google.com/citations?user=Wng1Wh0AAAAJ&hl=en">we were interested</a> in the summit’s findings. Understanding traditional medicine can help health care professionals create sustainable, personalized and culturally respectful practices.</p>
<h2>Critical health care for many</h2>
<p>In many countries, traditional medicine costs less and is <a href="https://doi.org/10.1093%2Fheapol%2Fczw022">more accessible</a> than conventional health care. And many conventional medicines come from the same source as compounds used in traditional medicine – <a href="https://doi.org/10.1021/acs.jnatprod.9b01285">up to 50% of drugs</a> have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">natural product root</a>, <a href="https://doi.org/10.1016/j.vph.2018.10.008">like aspirin</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man wearing a gray button-down shirt sorts bundles of dried herbs into eight piles, behind him is a wall of wooden drawers." src="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.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">An herbalist sorts herbs at the Great China Herb Company in Chinatown in San Francisco. Herbal medicine is one form of traditional medicine.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TravelTripSanFranciscoChinatown/c09c3fae7725457ca4e548ceda2a2f34/photo?Query=traditional%20medicine&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=377&currentItemNo=1&vs=true">AP Photo/Eric Risberg</a></span>
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<p><a href="https://doi.org/10.2147/PPA.S398644">Many factors</a> may influence whether someone chooses traditional medicine, such as age and gender, religion, education and income level, and <a href="https://doi.org/10.1155/2021/9962892">distance to travel for treatment</a>. Cultural factors may also influence people’s use of traditional medicine. </p>
<p>In China, for example, as more people have embraced Western culture, fewer have <a href="https://doi.org/10.2105/AJPH.93.7.1082">chosen traditional medicine</a>. In contrast, many African migrants to Australia continue to use traditional medicine to express their cultural identity and maintain <a href="https://doi.org/10.1186/s12906-021-03424-w">a cohesive ethnic community</a>. A patient’s preference for traditional medicine often has significant personal, environmental and cultural relevance.</p>
<h2>A framework for traditional medicine</h2>
<p>Countries have been pushing the WHO to study and track data on traditional medicine for years. In the past, WHO has developed a “<a href="https://www.who.int/publications/i/item/9789241506096">traditional medicine strategy</a>” to help member states research, integrate and regulate traditional medicine in their national health systems. </p>
<p>The WHO also <a href="https://www.who.int/teams/integrated-health-services/traditional-complementary-and-integrative-medicine">created international terminology standards</a> for practicing various forms of traditional medicine.</p>
<p>The practice of traditional medicine varies greatly between countries, depending on how accessible it is and <a href="https://www.who.int/publications/i/item/978924151536">how culturally important it is</a> in each country. To make traditional medicine safer and more accessible on a broader scale, it’s important for policymakers and public health experts to develop standards and share best practices. The WHO summit was one step toward that goal.</p>
<p>The WHO also aims to collect data that could inform these standards and best practices. It is conducting the <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Global Survey on Traditional Medicine</a> in 2023. As of August, approximately 55 member states out of the total 194 have completed and submitted their data.</p>
<h2>Acupuncture – a case study in safety and efficacy</h2>
<p>Some traditional medicine practices <a href="https://doi.org/10.7453/gahmj.2014.042">such as acupuncture</a> have shown consistent and credible benefits, and have even started to make it <a href="https://time.com/6171247/acupuncture-health-benefits-research/">into mainstream medicine</a> in the U.S. But leaders at the summit emphasized a need for more research on the efficacy and safety of traditional medicine. </p>
<p>Although traditional medicine can <a href="https://www.who.int/news-room/feature-stories/detail/traditional-medicine-has-a-long-history-of-contributing-to-conventional-medicine-and-continues-to-hold-promise">have a range of benefits</a>, some treatments come with health risks. </p>
<p>For example, acupuncture is <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#">a traditional healing practice</a> that entails inserting needles at specific points on the body to relieve pain. But acupuncture can <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know">cause infections and injuries</a> if the practitioner doesn’t use sterile needles or if needles are inserted incorrectly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two hands insert a needle into a patient's back, which is partially covered with a towel and which already has seven needles stuck in two lines." src="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Acupuncture is an example of a form of traditional healing that’s been implemented on a wide scale in the U.S. It has a variety of benefits, including no risk of addiction.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AcupuncturePainRelief/0b79ca38552c4b86a845bf4645755106/photo?Query=acupuncture&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=246&currentItemNo=1&vs=true">AP Photo/M. Spencer Green</a></span>
</figcaption>
</figure>
<p>Still, acupuncture is the most commonly used traditional medicine practice across countries, with <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">113 WHO member states</a> acknowledging their citizens practiced acupuncture in 2019.</p>
<p>Interestingly, <a href="https://news.va.gov/94087/battlefield-acupuncture-an-emerging-and-promising-alternative-to-risky-pain-medications/">battlefield acupuncture</a> has successfully treated many U.S. military members, for example, for pain reduction. It is simple to use, transportable and has no risk of addiction.</p>
<p>There’s also some evidence supporting the use of traditional medicine, including <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp">acupuncture</a>, <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Meditation.asp">meditation</a> and <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Yoga.asp">yoga</a> to treat post-traumatic stress disorder. </p>
<p>However, acupuncture practitioners aren’t trained in a uniform way across countries. To provide guidelines for best practice, the WHO developed standardized <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">benchmarks for practicing acupuncture</a> in 2021. The WHO aims to develop similar standards for other forms of traditional medicine as well. </p>
<p>Interest in traditional medicine is growing among those who have mainly used conventional medicine in the past. More research and collaborative efforts to develop safety standards can make traditional medicine accessible to all who seek it.</p><img src="https://counter.theconversation.com/content/212502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Ling Zhao received her medical training in China and PhD in the US. Her research focuses on novel interventions for chronic diseases. She has received research funding from NIH, including NCCIH. </span></em></p><p class="fine-print"><em><span>Paul D. Terry 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>More people are seeking out traditional forms of medicine, from acupuncture to herbal medicines. The WHO is working to develop standards to make these healing practices implementable on a wide scale.Ling Zhao, Professor of Nutrition, University of TennesseePaul D. Terry, Professor of Epidemiology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2113822023-08-29T13:33:51Z2023-08-29T13:33:51ZSouth Africa’s traditional medicines should be used in modern health care<figure><img src="https://images.theconversation.com/files/543417/original/file-20230818-15-8254at.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South African traditional healer Gogo Kamo uses technology to treat her patients remotely.</span> <span class="attribution"><span class="source">Getty</span></span></figcaption></figure><p>Traditional medicines are part of the cultural heritage of many Africans. About <a href="https://www.afro.who.int/regional-director/speeches-messages/african-traditional-medicine-day-2022">80%</a>
of the African continent’s population use these medicines for healthcare. </p>
<p>Other reasons include affordability, accessibility, patient dissatisfaction with conventional medicine, and the common misconception that “natural” is “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887317">safe</a>”.</p>
<p>The growing recognition of traditional medicine resulted in the first World Health Organization <a href="https://www.who.int/initiatives/who-global-centre-for-traditional-medicine/traditional-medicine-global-summit">global summit</a> on the topic, in August 2023, with the theme “Health and Wellbeing for All”.</p>
<p>Traditional medicines are widely used in South Africa, with up to 60% of South Africans estimated to be reliant on traditional medicine as a <a href="https://www.sciencedirect.com/science/article/pii/S025462991400115X">primary source of healthcare </a>.</p>
<p>Conventional South African healthcare facilities struggle to cope with extremely <a href="https://health-e.org.za/2013/09/20/national-health-facilities-baseline-audit/">high patient numbers</a>. The failure to meet the <a href="https://health-e.org.za/2013/09/20/national-health-facilities-baseline-audit">basic standards</a> of healthcare, with increasing morbidity and mortality rates, poses a threat to the South African economy.</p>
<p>In my opinion, as a qualified pharmacist and academic with a <a href="https://scholar.google.co.za/citations?hl=en&user=FRGRtTQAAAAJ&view_op=list_works&sortby=pubdate">research</a> focus on traditional medicinal plant use in South Africa, integrating traditional medicine practices into modern healthcare systems can harness centuries of indigenous knowledge, increasing treatment options and provide better healthcare. </p>
<p>Recognition of traditional medicine as an alternative or joint source of healthcare to that of standard, conventional medicine has proven challenging. This is due to the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378874115301896*">absence of scientific research </a>establishing and documenting the safety and effectiveness of traditional medicines, along with the lack of regulatory controls. </p>
<h2>What are traditional medicines?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252219/">Traditional medicine</a> encompasses a number of healthcare practices aimed at either preventing or treating acute or chronic complaints through the application of indigenous knowledge, beliefs and approaches. It incorporates the use of plant, animal and mineral-based products. Plant-derived products form the majority of treatment regimens. </p>
<p>Traditional medicine practices also have a place in ritualistic activities and communicating with ancestors. </p>
<p>South Africa is rich in indigenous medicinal fauna and flora, with about <a href="https://www.sciencedirect.com/science/article/pii/S0254629913000215">2,000 species of plants</a> traded for medicinal purposes. In South Africa the provinces of KwaZulu-Natal, Gauteng, Eastern Cape, Mpumalanga and Limpopo are trading “hotspots”. The harvested plants are most often sold at traditional medicine <a href="https://www.sciencedirect.com/science/article/pii/S0254629919304776">muthi markets</a>. </p>
<h2>Uses of medicinal plants</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0254629911001190">Medicinal plants</a> most popularly traded in South Africa include buchu, bitter aloe, African wormwood, honeybush, devil’s claw, hoodia, African potato, fever tea, African geranium, African ginger, cancer bush, pepperbark tree, milk bush and the very commonly consumed South African beverage, rooibos tea. </p>
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Read more:
<a href="https://theconversation.com/we-tested-plants-used-for-contraception-in-south-africa-heres-what-we-found-182862">We tested plants used for contraception in South Africa. Here's what we found</a>
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<p>The most commonly traded medicinal plants in South Africa are listed below along with their traditional uses:</p>
<p>Buchu – Urinary tract infections; skin infections; sexually transmitted infections; fever; respiratory tract infections; high blood pressure; gastrointestinal complaints.</p>
<p>Bitter aloe – Skin infections; skin inflammation; minor burns.</p>
<p>African wormwood – Respiratory tract infections; diabetes, urinary tract disorders. </p>
<p>Honeybush – Cough; gastrointestinal issues; menopausal symptoms. </p>
<p>Devil’s claw – Inflammation; arthritis; pain.</p>
<p>Hoodia – Appetite suppressant.</p>
<p>African potato – Arthritis; diabetes; urinary tract disorders; tuberculosis; prostate disorders.</p>
<p>Fever tea – Respiratory tract infections; fever; headaches.</p>
<p>African geranium – Respiratory tract infections.</p>
<p>African ginger – Respiratory tract infections; asthma.</p>
<p>Cancer bush – Respiratory tract infections; menstrual pain.</p>
<p>Pepperbark tree – Respiratory tract infections; sexually transmitted infections.</p>
<p>Milk bush – Pain; ulcers; skin conditions.</p>
<p>Rooibos – Inflammation; high cholesterol; high blood pressure.</p>
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Read more:
<a href="https://theconversation.com/africa-is-a-treasure-trove-of-medicinal-plants-here-are-seven-that-are-popular-184189">Africa is a treasure trove of medicinal plants: here are seven that are popular</a>
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<p>There are many ways in which traditional medicine may be <a href="https://www.sciencedirect.com/science/article/pii/S0254629913002615">used</a>. It can be a drop in the eye or the ear, a poultice applied to the skin, a boiled preparation for inhalation or a tea brewed for oral administration. </p>
<p>Roots, bulbs and bark are used most often, and leaves less frequently. Roots are available throughout the year. There’s also a belief that the roots have the strongest concentration of “medicine”. Harvesting of the roots, however, poses concerns about the conservation of these medicinal plants. The South African government, with the draft policy on African traditional medicine Notice 906 of 2008 outlines considerations aimed at ensuring the conservation of these plants through counteracting <a href="https://www.gov.za/documents/policy-african-traditional-medicine-south-africa-draft">unsustainable harvesting</a> practises. </p>
<h2>Obstacles to traditional medicine use</h2>
<p>The limited research investigating <a href="https://www.sciencedirect.com/science/article/pii/S1744388121000852">interactions</a> posed should a patient be making use of both traditional and conventional medicine is a concern. </p>
<p>During the <a href="https://pubmed.ncbi.nlm.nih.gov/35615091/">COVID-19 pandemic</a>, many patients used traditional remedies for the prevention of infection or treatment. </p>
<p>Understanding which traditional medicines are being used and how, their therapeutic effects in the human body, and how they <a href="https://pubmed.ncbi.nlm.nih.gov/28686181/">interact with conventional medicines</a>, would help determine safety of their combined use. </p>
<p>Certain combinations may have advantageous interactions, increasing the efficacy or potency of the medicines and allowing for reduced dosages, thereby reducing potential toxicity. These <a href="https://pubmed.ncbi.nlm.nih.gov/28686181/">combinations</a> could assist in the development of new pharmaceutical formulations. </p>
<h2>Sharing information</h2>
<p>The WHO in its <a href="https://www.who.int/publications/i/item/9789241506096">Traditional Medicine Strategy for 2014-2023</a> report emphasised the need for using traditional medicine to achieve increased healthcare. </p>
<p>Key role players from both systems of healthcare need to be able to share information freely.</p>
<p>The need for policy development is key. Both conventional and traditional medicine practitioners would need to be aware of and engage with patients on all the medicines they are taking.</p>
<h2>Understanding the whole patient</h2>
<p>Patients often seek treatment from both conventional and traditional sources, which can lead to side effects or duplication in medications. </p>
<p>A comprehensive understanding of a patient’s health profile makes care easier. </p>
<p>This could also prevent treatment failures, promote patient safety, prevent adverse interactions and minimise risks.</p>
<p>A harmonious healthcare landscape would combine the strengths of both systems to provide better healthcare for all.</p><img src="https://counter.theconversation.com/content/211382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zelna Booth receives funding from National Research Foundation. </span></em></p>Using centuries of indigenous knowledge along with modern healthcare could benefit more people.Zelna Booth, Pharmacist and Academic Lecturer (Pharmacy Practice Division, Department of Pharmacy and Pharmacology, University of the Witwatersrand), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2099572023-07-21T12:26:43Z2023-07-21T12:26:43ZWHO expert cancer group states that the sweetener aspartame is a possible carcinogen, but evidence is limited – 6 questions answered<figure><img src="https://images.theconversation.com/files/538137/original/file-20230718-27-wh515o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3866%2C2590&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research on possible links between aspartame consumption and cancer is ongoing and far from conclusive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coffee-royalty-free-image/95061040?phrase=artificial%2Bsweetener">celsopupo/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The World Health Organization declared on July 14, 2023, that the widely used synthetic sweetener <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">aspartame could be a “possible” carcinogen</a>, or cancer-causing agent, on the basis of “limited evidence for cancer in humans.”</em> </p>
<p><em>But the agency also concluded that the currently available data does not warrant a change of the acceptable daily intake of aspartame at this time.</em></p>
<p><em>The Conversation asked chronic disease epidemiologist <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">Paul D. Terry</a>, public health scholar <a href="https://publichealth.utk.edu/people/jchen/">Jiangang Chen</a> and nutrition expert <a href="https://nutrition.utk.edu/people/ling-zhao/">Ling Zhao</a>, all from the University of Tennessee, to put these seemingly contradictory findings into perspective based on the available scientific evidence.</em></p>
<h2>1. Why is aspartame being classified as ‘possibly’ cancer-causing?</h2>
<p>Aspartame is an artificial sweetener that is added to many foods, candies, gums and beverages, such as diet soda. Because it is approximately <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food">200 times sweeter than table sugar</a>, smaller amounts of aspartame are added to foods, and they contribute considerably fewer calories. NutraSweet and Equal are well-known brand names for aspartame sold in packages for individual use. </p>
<p>The <a href="https://www.iarc.who.int/cards_page/about-iarc/">International Agency for Research on Cancer</a>, an entity within the WHO, evaluated findings from both human and animal studies of aspartame and cancer. The group noted some positive associations between <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">aspartame consumption and hepatocellular carcinoma</a>, a form of liver cancer. </p>
<p>This WHO group classifies degrees of evidence that an agent has cancer-causing potential as being “sufficient,” “limited,” “inadequate” or “suggesting lack of carcinogenicity.” “Limited” evidence, as it pertains to the WHO’s new announcement on aspartame, means that although there is some evidence for an association, that evidence cannot be considered “sufficient” to infer a causal relationship.</p>
<p>Ultimately, the group concluded that several limiting factors could possibly explain the positive associations in those studies. These include the small number of human studies available, the complexity of studying people’s dietary behaviors and possible bias from factors such as higher-risk people – for example, those with diabetes – selecting diet products more often and ingesting higher quantities of aspartame than the average consumer. Therefore, the classification of “limited evidence” implies the need for additional studies.</p>
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<figcaption><span class="caption">Aspartame is found in many products: diet soda, ice cream, cereals, toothpaste and even some medications.</span></figcaption>
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<h2>2. What are the current guidelines for aspartame consumption?</h2>
<p>The Food and Agriculture Organization’s <a href="https://www.fao.org/food-safety/scientific-advice/jecfa/en/#">Joint Expert Committee on Food Additives</a>, an international committee of science experts that is operated by both the WHO and the United Nations, currently <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released#">recommends a daily maximum</a> of 40 milligrams per kilogram of body weight for aspartame.</p>
<p>This amount of aspartame per day translates to approximately eight to 12 cans of soda, or approximately 60 packets of aspartame, for a person weighing 132 pounds (60 kilograms). For a child weighing 33 pounds (15 kg), it translates to between two to three cans of aspartame-sweetened soda per day, or approximately 15 packets of aspartame. Some individuals may consume more aspartame than this, but such high intake is not typical. </p>
<h2>3. Does the WHO’s new stance change that recommendation?</h2>
<p>Independently of the expert panel on cancer, the food safety group also evaluated the available evidence and concluded that there was no “convincing evidence” from either animal or human studies that aspartame consumption causes adverse effects within the currently established daily limits. </p>
<p>Based on assessments of the findings of both groups, the director of the Department of Nutrition and Food Safety of the WHO stated that, “while safety is not a major concern” at the doses in which aspartame are commonly used, “potential effects have been described that need to be investigated by more and better studies.” The American Cancer Society has also stated that it <a href="https://www.cancer.org/cancer/risk-prevention/chemicals/aspartame.html">supports further research into possible health concerns</a> related to aspartame.</p>
<p>It is important to note that people with the rare inherited disorder called <a href="https://my.clevelandclinic.org/health/diseases/17816-phenylketonuria">phenylketonuria</a>, or PKU, should <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food">avoid or restrict aspartame intake</a>. </p>
<h2>4. How can two consensus groups reach different conclusions?</h2>
<p>It is not uncommon for scientific consensus groups to differ in how they classify risk based on the results of published studies, even if more than one of those consensus groups is affiliated with the same agency or parent organization. </p>
<p>Whereas the WHO’s expert cancer group’s stance may appear to be more worrisome than that of the committee on food safety, in fact, the latter’s “no convincing evidence” is consistent with the cancer group’s “limited evidence” classification. Because, unlike the cancer group, the food safety committee considers risk of aspartame at specific consumption levels, the WHO as a whole continues to support the food safety committee’s existing recommendations for allowable daily aspartame intake of up to 40 milligrams per kilogram of body weight. </p>
<p>Of note, the committee’s recommended maximum daily intake is still more conservative than the current U.S. Food and Drug Administration’s <a href="https://www.cancer.org/cancer/risk-prevention/chemicals/aspartame.html">recommended maximum daily allowance</a> of 50 milligrams of aspartame per kilogram of body weight.</p>
<h2>5. How does aspartame compare to other sweeteners?</h2>
<p>Alternatives to aspartame include other <a href="https://theconversation.com/whats-the-difference-between-sugar-other-natural-sweeteners-and-artificial-sweeteners-a-food-chemist-explains-sweet-science-172571">artificial sweeteners</a> such as saccharin and sucralose, sugar alcohols like sorbitol and xylitol, naturally derived sugar-free sweeteners like Stevia and simple sugars, such as those in sugar cane, sugar beets and honey. </p>
<p>But, like aspartame, many of these sweeteners have been implicated in developing cancer. This list includes <a href="https://doi.org/10.1371/journal.pmed.1003950">acesulfame potassium, or Ace-K</a> – a synthetic calorie-free sugar substitute – as well as <a href="https://www.upstate.edu/news/articles/2023/2023-03-25-perl.php">sugar alcohols</a> and even <a href="https://doi.org/10.3390%2Fcancers14246042">simple sugar</a>. </p>
<p>The availability of a wide variety of approved sweeteners seems like a good thing, but studying the many possible risks associated with sweeteners is challenging, since <a href="https://www.science.org/content/blog-post/sugar-substitutes-surprise">people have complex diets and lifestyles</a>. </p>
<h2>6. So what should consumers do?</h2>
<p>For now, as is the case with aspartame, these sweeteners remain approved for human use because there isn’t sufficient evidence to support an association with cancer. And, <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936">as noted by the Mayo Clinic</a>, artificial sweeteners may play a beneficial role for some people who are <a href="https://doi.org/10.1016/j.eprac.2021.06.013">seeking to manage their weight</a> or control their sugar intake. Studies show that sugar <a href="https://doi.org/10.1136/bjsports-2017-097971">may be addictive for some individuals</a>.</p>
<p>When making a decision about consumption of sweeteners, consumers should consider factors like taste preference, body weight and composition, diabetes status and risk, possible allergic responses and the evidence that may result from ongoing and future studies. In certain cases, such as with individuals who have or are at future risk of diabetes, people should talk with their physician or other health care provider to determine the best choice. </p>
<p>One thing is clear: Scientific studies on aspartame consumption will continue, and it will be important for both consumers and the research community to continue weighing potential risks.</p><img src="https://counter.theconversation.com/content/209957/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>An expert panel found a potential association with liver cancer, but too little research exists to assume a causal connection. For now, the WHO left current consumption guidelines unchanged.Paul D. Terry, Professor of Epidemiology, University of TennesseeJiangang Chen, Associate Professor of Public Health, University of TennesseeLing Zhao, Professor of Nutrition, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2100532023-07-21T02:57:24Z2023-07-21T02:57:24ZGood news for 'weekend warriors’: people who do much of their exercise on a couple of days still get heart benefits<figure><img src="https://images.theconversation.com/files/538651/original/file-20230721-23-vk6bvb.jpg?ixlib=rb-1.1.0&rect=13%2C26%2C4468%2C2896&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/z4WH11FMfIQ">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Physical activity has <a href="https://bjsm.bmj.com/content/54/24/1451">established benefits</a> for health. The <a href="https://bjsm.bmj.com/content/54/24/1451">World Health Organization</a> recommends adults do a minimum of 150–300 minutes of moderate or 75–150 minutes of vigorous activity each week. This can include active transport from place-to-place, exercise for fun and fitness, energetic housework or physical activity at work. </p>
<p>These amounts can be accrued by being, as the <a href="https://bjsm.bmj.com/content/54/24/1451">WHO recommends</a>, regularly active throughout the week, or being a “weekend warrior” who does the bulk of their activity on one to two days only, which don’t need to be consecutive. </p>
<p>So far, experts haven’t fully established which of the two patterns is better for overall health. For many people, busy lifestyles may make it hard to be physically active every day. It may be more feasible to squeeze most physical activity and exercise into a few days.</p>
<p>Fresh <a href="https://jamanetwork.com/journals/jama/fullarticle/2807286">analysis</a> of the large <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a> database attempted to compare these two patterns of weekly activity and compare how they reduced cardiovascular risk for heart attacks, heart failure, irregular heart beat and stroke.</p>
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Read more:
<a href="https://theconversation.com/short-bursts-of-physical-activity-during-daily-life-may-lower-risk-of-premature-death-new-research-196304">Short bursts of physical activity during daily life may lower risk of premature death – new research</a>
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<h2>What the new study found</h2>
<p>Researchers analysed records from 89,573 participants who wore a wrist activity tracker for seven days and were tracked for cardiovascular events for over six years. </p>
<p>Those who did less than the WHO recommended 150 minutes of moderate-to-vigorous physical activity per week were considered inactive. About a third (33.7%) of participants were inactive. Some 42.2% were termed active “weekend warriors” (they did at least 150 minutes and more than half of it occurred within one to two days) and 24% were regularly active (at least 150 minutes with most activity spread out over three or more days). </p>
<p>Researchers considered the potential factors that could explain the link between physical activity and new cases of cardiovascular events, such as smoking and alcohol intake. They found both active groups showed similarly lower risk of heart attack (a 27% reduction for weekend warriors and 35% for regularly active people, compared with inactive participants). </p>
<p>For heart failure, weekend warriors had a 38% lower risk than inactive people, while regular exercisers had a 36% lower risk. Irregular heartbeat risk was 22% lower for weekend warriors and 19% lower for regularly actively people. Stroke was 21% and 17% lower for weekend warriors and regular exercisers, respectively. </p>
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<a href="https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="three women walking along outdoor path together" src="https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538653/original/file-20230721-19-57170c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&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">Busy people might find it easier to plan activity on the weekend.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lovely-group-three-senior-mature-retired-1421249321">Shutterstock</a></span>
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<h2>Not so fast. Some study limitations</h2>
<p>It is surprising the study’s authors define “weekend warrior” as those who do at least half of their activity in one or two days but did not consider the actual days of the week the activity was done. The main study results we describe above refer to doing most exercise in one or two days of the week, not a weekend pattern.</p>
<p>Closer examination of the study’s <a href="https://jamanetwork.com/journals/jama/fullarticle/2807286">supplementary data</a>, where data for Saturday and Sunday are presented, show those who are regularly active, but not those who exercise on the actual weekend, enjoy lower risk of stroke (20%).</p>
<p>Despite the many advantages the UK Biobank activity trackers have over <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2596007">questionnaire-based studies</a>, these trackers are not great at capturing strength-training exercise, such as weights or pilates, and other static activities that have <a href="https://academic.oup.com/aje/article/187/5/1102/4582884">established cardiovascular</a> health benefits.</p>
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Read more:
<a href="https://theconversation.com/poor-sleep-is-really-bad-for-your-health-but-we-found-exercise-can-offset-some-of-these-harms-163270">Poor sleep is really bad for your health. But we found exercise can offset some of these harms</a>
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</p>
<hr>
<h2>What other research in this area says</h2>
<p>There have been several questionnaire based studies in this area in <a href="https://academic.oup.com/aje/article/160/7/636/136697">the past 20 years</a>. </p>
<p>Our <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2596007">2017 study</a>, for example, combined data from 63,591 adults from England and Scotland and tracked them over 12 years. We looked at <a href="https://theconversation.com/weekend-warrior-exercise-is-it-good-for-you-70964">risk reductions</a> for death from any cause, cardiovascular disease and cancer causes. We found similar benefits among people who clocked at least 150 minutes of moderate-intensity physical activity or at least 75 minutes of vigorous-intensity physical activity in one to two sessions per week, compared with three sessions or more per week. </p>
<p>Our more <a href="https://www.nature.com/articles/s41591-022-02100-x">recent studies</a> used activity trackers and emphasised the flexibility of activity patterns that benefit the heart and circulation. We found doing short one-minute-long bouts of incidental vigorous physical activity three to four times a day can cut the risk of death from cardiovascular causes by <a href="https://www.nature.com/articles/s41591-022-02100-x">almost half</a>. </p>
<p>Similarly, in another study we found just 19 minutes of vigorous physical activity a week was associated with <a href="https://academic.oup.com/eurheartj/article/43/46/4801/6771381">40% reduction</a> in the risk of cardiovascular death, with steadily increasing benefits to the maximum amount of vigorous activity recorded (110 minutes a week linked to a 75% risk reduction). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aiming-for-10-000-steps-it-turns-out-7-000-could-be-enough-to-cut-your-risk-of-early-death-167447">Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death</a>
</strong>
</em>
</p>
<hr>
<h2>What it means for you and your routine</h2>
<p>Taken together, the <a href="https://jamanetwork.com/journals/jama/fullarticle/2807286">new study</a> and <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2596007">previous research</a> suggest the same thing: if it is difficult or impossible to find time to be active during a busy week, it is good enough to plan moderate to vigorous physical activities in a couple of weekdays or in the weekend.</p>
<p>That said, the study’s supplementary data show a clear advantage in being regularly physically active on most days of the week. This is not surprising considering it has been established that a good session of aerobic exercise, for example, improves heart health risk factors such as <a href="https://www.ahajournals.org/doi/full/10.1161/HYP.0000000000000196">blood pressure</a>, and <a href="https://link.springer.com/article/10.1007/s40279-021-01473-2">blood glucose</a> and <a href="https://lipidworld.biomedcentral.com/articles/10.1186/s12944-017-0515-5">cholesterol levels</a> for a day or longer. Such effects assist with the day-to-day management of these risk factors and provide better long-term protection against major heart and circulatory events.</p>
<p>But confirmation that how physical activity can be accumulated across the week for heart health benefits is relatively flexible is encouraging. It offers more opportunities for more people to be active when it is convenient and practical for them, which is considerably better than being inactive.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-exercising-your-good-arm-can-also-help-the-one-in-a-sling-200167">Why exercising your 'good arm' can also help the one in a sling</a>
</strong>
</em>
</p>
<hr>
<hr>
<p><em>Correction: this article has been updated to reflect additional information presented in the study’s supplementary material that shows the researchers’ use of “weekend warriors” does not refer to specific days of the week.</em></p><img src="https://counter.theconversation.com/content/210053/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>Too busy to exercise during the week? The good news is that getting moving on the weekend appears to be similarly good for your heart health.Emmanuel Stamatakis, Professor of Physical Activity, Lifestyle, and Population Health, University of SydneyMatthew Ahmadi, Postdoctoral Research Fellow, University of SydneyRaaj Kishore Biswas, Research Fellow & Biostatistician, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088442023-07-14T01:24:43Z2023-07-14T01:24:43ZDoes artificial sweetener aspartame really cause cancer? What the WHO listing means for your diet soft drink habit<figure><img src="https://images.theconversation.com/files/536737/original/file-20230711-23-sl30n6.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C3240%2C2155&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 International Agency for Research on Cancer (IARC), which is the specialised cancer agency of the World Health Organization, has declared aspartame may be a <a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">possible carcinogenic hazard to humans</a>. </p>
<p>Another branch of the WHO, the Joint WHO and Food and Agriculture Organization’s Expert Committee on Food Additives has assessed the risk and developed recommendations on how much aspartame is safe to consume. They have recommended the acceptable daily intake be 0 to 40mg per kilo of body weight, as we currently have <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">in Australia</a>.</p>
<p>A hazard is different to a risk. The hazard rating means it’s an agent that is capable of causing cancer; a risk measures the likelihood it could cause cancer.</p>
<p>So what does this hazard assessment mean for you?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1676478886287142912"}"></div></p>
<h2>Firstly, what is aspartame?</h2>
<p><a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">Aspartame is an artificial sweetener</a> that is 200 times sweeter than sugar, but without any kilojoules. </p>
<p>It’s used in a <a href="https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx">variety of products</a> including carbonated drinks such as Coke Zero, Diet Coke, Pepsi Max and some home brand offerings. You can identify aspartame in drinks and foods by looking for additive number 951. </p>
<p>Food products such as yogurt and confectionery may also contain aspartame, but it’s not stable at warm temperatures and thus not used in baked goods. </p>
<p>Commercial names of aspartame include Equal, Nutrasweet, Canderel and Sugar Twin. In Australia the acceptable daily intake is 40mg per kilo of body weight per day, which is about 60 sachets.</p>
<p><a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#:%7E:text=How%20many%20packets%20can%20a,based%20on%20its%20sweetness%20intensity%3F&text=Notes%20About%20the%20Chart%3A,50%20mg%2Fkg%20bw%2Fd">In America</a> the acceptable daily intake has been set at 75 sachets. </p>
<h2>What evidence have they used to come to this conclusion?</h2>
<p><a href="https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released">IARC looked closely</a> at the <a href="https://cdn.who.int/media/docs/default-source/nutrition-and-food-safety/july-13-final-summary-of-findings-aspartame.pdf?sfvrsn=a531e2c1_5&download=true">evidence base</a> from around the world – using data from observational studies, experimental studies and animal studies. </p>
<p>They found there was some limited evidence in human studies linking aspartame and cancer (specifically liver cancer) and limited evidence from animal studies as well. </p>
<p>They also considered the biological mechanism studies which showed how cancer may develop from the consumption of aspartame. Usually these are lab-based studies which show exactly how exposure to the agent may lead to a cancer. In this case they found there was limited evidence for how aspartame might cause cancer.</p>
<p>There were only three human studies that looked at cancer and aspartame intake. These large observational studies used the intake of soft drinks as an indicator of aspartame intake. </p>
<p>All three found a positive association between artificially sweetened beverages and liver cancer in either all of the population they were studying or sub-groups within them. But these studies could not rule out other factors that may have been responsible for the findings. </p>
<p>A study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284800/">conducted in Europe</a> followed 475,000 people for 11 years and found that each additional serve of diet soft drink consumed per week was linked to a 6% increased risk of liver cancer. However the scientists did conclude that due to the rarity of liver cancer they still had small numbers of people in the study.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35728406/">In a study from the US</a>, increased risk of liver cancer was seen in people with diabetes who drank more than two or more cans of a diet soda a week.</p>
<p>The <a href="https://aacrjournals.org/cebp/article/31/10/1907/709398/Sugar-and-Artificially-Sweetened-Beverages-and">third study</a>, also from the US, found an increase in liver cancer risk in men who never smoked and drank two or more artificially sweetened drinks a day. </p>
<p>From this they have decided to declare aspartame as a Group 2b “possible carcinogen”. But they have also said more and better research is needed to further understand the relationship between aspartame and cancer. </p>
<p>IARC has four categories (groupings) available for potential substances (or as they are referred to by IARC, “agents”) that may cause cancer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cup of frothy soda" src="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536738/original/file-20230711-26-ln4ks.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">An Australian would have to consume unrealistic amounts of aspartame to reach the daily limit.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What does each grouping mean?</h2>
<p><strong>Group 1 Carcinogenic to humans:</strong> an agent in this group is carcinogenic, which means there is convincing evidence from human studies and we know precisely <em>how</em> it causes cancer. There are 126 agents in this group, including tobacco smoking, alcohol, processed meat, radiation and ionising radiation.</p>
<p><strong>Group 2a Probably carcinogenic to humans:</strong> there are positive associations between the agent and cancer in humans, but there may still be other explanations for the association which were not fully examined in the studies. There are 95 agents in this group, including red meat, DDT insecticide and night shift work.</p>
<p><strong>Group 2b Possibly carcinogenic in humans:</strong> this means limited evidence of causing cancer in humans, but sufficient evidence from animal studies, or the mechanism of how the agent may be carcinogenic is well understood. This basically means the current evidence indicates an agent may possibly be carcinogenic, but more scientific evidence from better conducted studies is needed. There are now <a href="https://monographs.iarc.who.int/agents-classified-by-the-iarc/">323</a> agents in this group, including aloe vera (whole leaf extract), ginkgo biloba and lead.</p>
<p><strong>Group 3 Not classifiable as a carcinogen:</strong> there’s not enough evidence from humans or animals, and there is limited mechanistic evidence of how it may be a carcinogen. There are 500 agents in this group.</p>
<h2>So do I have to give up my diet soft drink habit?</h2>
<p>For a 70kg person you would need to consume about 14 cans (over 5 litres) of soft drink sweetened with aspartame a day to reach the acceptable daily intake.</p>
<p>But we need to remember there may also be aspartame added in other foods consumed. So this is an unrealistic amount to consume, but not impossible. </p>
<p>We also need to consider all the evidence on aspartame together. The foods we typically see aspartame in are processed or ultra-processed, which have recently also been <a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">shown to be detrimental to health</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ultra-processed-foods-are-trashing-our-health-and-the-planet-180115">Ultra-processed foods are trashing our health – and the planet</a>
</strong>
</em>
</p>
<hr>
<p>And artificial sweeteners (including aspartame) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/#!po=59.3750">can make people crave more sugar</a>, making them want to eat more food, potentially causing them to gain more weight.</p>
<p>All together, this indicates we should be more careful about the amount of artificial sweeteners we consume, since they <a href="https://theconversation.com/the-who-says-we-shouldnt-bother-with-artificial-sweeteners-for-weight-loss-or-health-is-sugar-better-205827">do not provide any health benefits</a>, and have possible adverse effects. </p>
<p>But overall, from this evidence, drinking the occasional or even daily can of a diet drink is safe and probably not a cancer risk.</p>
<hr>
<p><em>Correction: this article originally stated each serve of soft drink in a study was linked to a 6% increased risk of liver cancer, however it was each additional serve per week. This has been amended.</em></p><img src="https://counter.theconversation.com/content/208844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>IARC has listed the artificial sweetener aspartame as possibly cancer causing. Here’s how to digest the findings.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085422023-07-11T21:02:29Z2023-07-11T21:02:29ZThe ethics of recruiting international health-care workers: Canada’s gains could mean another country’s pain<figure><img src="https://images.theconversation.com/files/536865/original/file-20230711-21-kbh5nf.jpg?ixlib=rb-1.1.0&rect=269%2C417%2C4223%2C2580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recruiting health workers from countries on the World Health Organization’s safeguard list without robust and reciprocal benefits for the countries sending them does not meet ethical standards. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canadians know we are facing a health workforce crisis, from the <a href="https://doi.org/10.1503/cmaj.1096049">estimated 6.5 million who do not have a primary care provider</a>, to those waiting months for <a href="https://www.camrt.ca/wp-content/uploads/2023/05/HHR_crisis_radiology_news_release_May_30_2023_FINAL.pdf">medical imaging</a> and hours in <a href="https://doi.org/10.1503/cmaj.230719">emergency rooms</a>. While the World Health Organization (WHO) declared the COVID-19 <a href="https://www.who.int/europe/emergencies/situations/covid-19">Public Health Emergency</a> over in May 2023, Canada’s health workforce crisis has no end in sight. </p>
<p>As researchers with the <a href="https://www.hhr-rhs.ca/en/">Canadian Health Workforce Network</a>, we see the roots of this crisis in <a href="https://www.policyschool.ca/wp-content/uploads/2021/12/HC5_Improved-Health-Care_Bourgeault.pdf">poor workforce planning</a> and the inadequate integration of <a href="https://doi.org/10.1186/s12960-022-00748-7">immigrant health workers</a>. The consequences of poor planning are evident, as are the <a href="https://doi.org/10.1177/08404704221095129">ethical ramifications</a> of solving our problems through global recruitment.</p>
<h2>Canada’s health workforce crisis is more than a national issue</h2>
<p>The Canadian Academy of Health Sciences and the Royal Society of Canada established an <a href="https://rsc-src.ca/en/programmes/canada%E2%80%99s-role-in-global-health-rsccahs-expert-panel">expert panel</a> to assess Canada’s role in global health and identify opportunities for Canada to “be true to its announced values of equity, human rights, and global citizenship.” </p>
<p>One way to promote Canadian health leadership is to align practices with the WHO’s <a href="https://www.who.int/publications/i/item/wha68.32">Global Code on the Practice of International Recruitment of Health Personnel</a>. This voluntary code was agreed to by all member states in 2010. Its key principles are ethical recruitment, a commitment to planning and international co-operation.</p>
<ul>
<li><p>Ethical practices include discouraging active recruitment from countries listed on the WHO’s health workforce support <a href="https://www.who.int/publications/i/item/9789240069787">safeguards list</a>, which identifies “countries with the most pressing health workforce needs related to universal health coverage.”</p></li>
<li><p>Robust health workforce planning strategies include strengthening health workforce data and implementing plans with a goal of health workforce sustainability and self-sufficiency. Robust data can ensure policies and planning are evidence-based, and document the impact of international recruiting on health systems. The goal should be sustainable, self-sufficient health workforces, including appropriate education, training and retention policies.</p></li>
<li><p>International co-operation between source and destination countries includes technical assistance and financial support to ensure benefits are mutual.</p></li>
</ul>
<h2>Why is the WHO Code important to reflect upon now?</h2>
<figure class="align-center ">
<img alt="Health workers in scrubs and white coats wearing face masks" src="https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recruiting and integrating internationally educated health personnel is part of proposed solutions to Canada’s health worker crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Recent Canadian health workforce reports identify the recruitment and integration of internationally educated health personnel (IEHPs) as part of the solution to the health worker crisis. The Parliamentary Standing Committee on Health held hearings on addressing Canada’s health workforce crisis, and the top four recommendations from its <a href="https://www.ourcommons.ca/DocumentViewer/en/44-1/HESA/report-10/">March 2023 report</a> all referenced IEHPs:</p>
<ul>
<li>greater collaboration between all levels of government and relevant stakeholders to streamline the process to recruit from countries that are known to train more health workers than they need domestically; </li>
<li>to provide more residency positions for international medical graduates; </li>
<li>expand pathways to <a href="https://www.mcc.ca/about/route-to-licensure/">qualifying for a licence to practice medicine in Canada</a> (licensure) for international physicians who have already completed their residency; and </li>
<li>support expedited pathways to licensure and practice. </li>
</ul>
<p>The <a href="https://cahs-acss.ca/assessment-on-health-human-resources-hhr/">Canadian Academy of Health Sciences</a> report also offers “pathways forward to ease the health workforce crisis,” including improving the integration of IEHPs.</p>
<h2>Provincial recruiting strategies</h2>
<p>Sub-national governments are also focused on international recruitment and integration. In British Columbia, <a href="https://www.healthmatchbc.org/Moving-to-BC/Immigration">Health Match BC</a> is assisting health professionals to immigrate, and <a href="https://news.gov.bc.ca/releases/2023HLTH0001-000013">legislation</a> now makes it easier for internationally educated nurses to work in the province. </p>
<p><a href="https://www.alberta.ca/health-workforce-strategy.aspx">Alberta</a> developed a health workforce strategy that includes attracting IEHPs. <a href="https://www.saskatchewan.ca/residents/moving-to-saskatchewan/live-in-saskatchewan/by-immigrating/saskatchewan-immigrant-nominee-program/browse-sinp-programs/applicants-international-skilled-workers/international-healthcare-worker-eoi-pool">Saskatchewan</a> launched an international health worker pool for <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/provincial-nominees/works.html">Provincial Nominee Program</a> candidates. <a href="https://healthcareersmanitoba.ca/buildyourfuturemb/">Manitoba</a> started recruiting health-care workers directly from the Philippines. </p>
<p>Ontario has both made it easier for health workers <a href="https://news.ontario.ca/en/release/1002650/new-as-of-right-rules-a-first-in-canada-to-attract-more-health-care-workers-to-ontario">from other provinces</a> to practice there, and also directed its licensing bodies to streamline integration processes for immigrants in the province with a <a href="https://www.cbc.ca/news/canada/toronto/college-temporarily-register-international-nurses-1.6555165">nursing or medical credential</a>.</p>
<p><a href="https://montreal.ctvnews.ca/quebec-on-track-to-recruit-1-000-nurses-from-french-speaking-countries-1.6339396">Québec</a> launched an international recruitment drive to hire over 1,000 French-speaking nurses in February 2022. </p>
<p><a href="https://www.cbc.ca/news/canada/new-brunswick/health-care-workers-new-brunswick-nurses-1.6736196">New Brunswick</a> partnered with Vitalité Health Network to send nurse recruiters to Senegal and Ivory Coast (countries on the WHO’s safeguard list). <a href="https://www.saltwire.com/atlantic-canada/news/nova-scotia-recruits-65-refugees-from-kenya-for-continuing-care-work-100810963/">Nova Scotia</a> has recruited 65 refugees from Kenyan refugee camps who will be employed in the continuing care sector. <a href="https://www.gov.nl.ca/releases/2022/exec/1103n02/">Newfoundland and Labrador</a> has launched a mission to recruit nurses directly from India.</p>
<h2>How compatible are these practices with the WHO Code?</h2>
<p>Recruitment and integration efforts have seen provinces develop novel and seemingly ethical plans to recruit IEHPs and provide them a pathway to practice in Canada. However, recruiting health workers from countries on the WHO’s safeguard list without robust and reciprocal benefits for the countries sending them fails the ethical test. </p>
<p>Merging employment and refugee selection channels also suggests ethical concerns beyond health workforce issues, since refugee systems are based on the <a href="https://freemovement.org.uk/briefing-is-labour-mobility-for-skilled-refugees-a-good-idea/">vulnerability individuals</a> face, not their occupational compatibility.</p>
<p>The absence of health workforce planning discussions is notable. Canada’s ability to approach self-sufficiency is limited by its lack of robust plans, and by the lack of data to support planning. This includes how <a href="https://doi.org/10.1186/s12960-022-00748-7">immigration fits into the health workforce</a>. The proposal to establish a <a href="https://www.canada.ca/en/health-canada/news/2023/03/statement-from-the-minister-of-health-and-minister-of-mental-health-and-addictions-and-associate-minister-of-health-on-the-coalition-for-action-for.html">Centre of Excellence on health worker data</a> can begin to address these gaps.</p>
<p>Siloed responses from health and international development government ministries means we miss opportunities to support international co-operation and <a href="https://www.balsillieschool.ca/wp-content/uploads/2022/12/Global-Skills-Mobility-Partnerships-ZAJ-RF-RH-LLB.pdf">develop integrative solutions</a> to health workforce issues beyond Canada’s own international recruitment efforts.</p>
<p>We encourage greater attention to these different facets of the WHO Code as national, provincial and territorial governments seek to address their present and ongoing health workforce challenges. This approach would be more in keeping with Canada’s role on the global stage than is presently the case.</p><img src="https://counter.theconversation.com/content/208542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Walton-Roberts receives funding from SSHRC. She is affiliated with Canadian Health Workforce Network.</span></em></p><p class="fine-print"><em><span>Ivy Lynn Bourgeault receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. Through the Canadian Health Workforce Network, she has received funds from Health Canada and Service Canada.</span></em></p>Recruiting internationally educated health workers is a key part of Canada’s proposed solution to the health worker crisis. But there are ethical questions about recruiting from foreign countries.Margaret Walton-Roberts, Chair professor, Geography and Environmental studies, Wilfrid Laurier UniversityIvy Lynn Bourgeault, Professor, School of Sociological and Anthropological Studies, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074782023-07-07T12:28:11Z2023-07-07T12:28:11ZTuberculosis on the rise for first time in decades after COVID-19 interrupted public health interventions and increased inequality<figure><img src="https://images.theconversation.com/files/535903/original/file-20230705-15-j8nls.jpg?ixlib=rb-1.1.0&rect=323%2C0%2C6192%2C4067&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tuberculosis is a dangerous bacterial infection of the lungs.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shot-of-a-young-man-coughing-while-hes-sick-royalty-free-image/1358069629?phrase=Coughing&adppopup=true">Moyo Studio/E+ via Getty Images</a></span></figcaption></figure><p>Before SARS-CoV-2, the virus that causes COVID-19, spread across the world in 2020, tuberculosis was responsible for more deaths globally than any other <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">infectious disease</a>. But thanks to <a href="https://doi.org/10.15585%2Fmmwr.rr6901a1">targeted public health efforts</a> in the U.S. and globally, tuberculosis cases had been <a href="https://doi.org/10.15585/mmwr.mm7212a1">steadily falling for decades</a>. </p>
<p>I am an <a href="https://scholar.google.com/citations?user=ECuj1XkAAAAJ&hl=en&oi=ao">infectious disease clinician and public health practitioner</a> who has been caring for underserved communities in the U.S. for more than two decades. </p>
<p>During the pandemic, it at first appeared that, as with many other common illnesses like the flu, <a href="https://www.who.int/news/item/27-10-2022-tuberculosis-deaths-and-disease-increase-during-the-covid-19-pandemic">COVID-19 prevention efforts reduced tuberculosis cases</a>, too. But tuberculosis numbers have quickly climbed back up to <a href="https://doi.org/10.1016/S1473-3099(22)00500-X">pre-pandemic levels</a>, marking the first time in decades that <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-2-tb-mortality">cases and deaths have risen globally</a>.</p>
<p>The pandemic not only interrupted important health interventions for tuberculosis, it also caused a <a href="https://doi.org/10.3389/fpubh.2020.00241">decrease in social and economic opportunities</a> for marginalized people around the globe. Together, these effects appear to have put a serious dent in the fight against tuberculosis. </p>
<p><iframe id="9iPuv" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/9iPuv/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Tuberculosis before and during COVID-19</h2>
<p>Tuberculosis is a contagious bacterial infection of the lungs that is normally spread <a href="https://doi.org/10.5588%2Fijtld.22.0685">through the air</a>. Most tuberculosis <a href="https://www.cdc.gov/tb/topic/basics/tbinfectiondisease.htm">infections are asymptomatic</a> and not contagious. </p>
<p>About 5% to 10% of <a href="https://doi.org/10.15585%2Fmmwr.rr6901a1">infected individuals</a> develop active tuberculosis, which is characterized by cough, fever, decreased appetite and weight loss. If left untreated, tuberculosis is a very contagious and dangerous disease that <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">can result in death</a>. </p>
<p>Total estimated tuberculosis infections globally have been <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-1-tb-incidence">falling for years</a>. The lowest number, 10.1 million cases, occurred in 2020, according to the World Health Organization. 2021 saw a significant increase in infections, to 10.5 million, the first rise in more than a decade. Global tuberculosis deaths followed a similar pattern, reaching a low point of an estimated 1.4 millions deaths in 2019, then rising to <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-2-tb-mortality">1.5 million in 2020 and 1.6 million in 2021</a>.</p>
<p>The number of confirmed cases of tuberculosis – infections detected through direct testing – tells a different part of the story. As testing efforts have improved, confirmed cases have been rising globally to a <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/covid-19-and-tb">peak in 2019</a>. As the coronavirus disrupted lives in 2020, confirmed cases of tuberculosis fell significantly before <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">quickly rising again in 2021</a>.</p>
<p>A similar pattern <a href="https://www.cdc.gov/media/releases/2022/s0324-tuberculosis-covid-19.html">played out in the U.S.</a> There was a sharp drop in confirmed cases in 2020 – mostly driven by lack of testing – followed by a <a href="https://www.cnn.com/2023/03/23/health/tuberculosis-2022-cdc-report/index.html">sharp rise back to pre-pandemic levels</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An man standing in a hospital next to a sign with TB Ward written on it." src="https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535922/original/file-20230705-19-ap4h7k.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">Places with limitations in access to health care, economic mobility and social stability – including many parts of sub-Saharan Africa and India – carry the highest numbers of tuberculosis cases every year.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-indian-patient-who-has-been-diagnosed-with-tubercolosis-news-photo/937243906?adppopup=true">Shammi Mehra/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Tuberculosis is a social disease</h2>
<p>Tuberculosis is a preventable disease, thanks to <a href="https://www.cdc.gov/tb/topic/basics/vaccines.htm">effective vaccines</a>, testing and treatments. But millions of people around the world still suffer from this disease, not because of a lack of medical knowledge, but because of <a href="https://doi.org/10.2105%2FAJPH.2010.199505">persistent social inequities</a>.</p>
<p>Unequal access to economic opportunities, limited health care, poor sanitation, crowded living conditions, malnutrition and <a href="https://doi.org/10.1016/s1473-3099(09)70282-8">illnesses such as diabetes or HIV</a> are all <a href="https://doi.org/10.5588%2Fijtld.12.0385">associated with increased risk of tuberculosis</a>.</p>
<p>In the U.S. in 2021, <a href="https://doi.org/10.1001/jama.2023.4899">racial and ethnic minority groups</a> accounted for more than 85% of tuberculosis cases, with <a href="https://www.cdc.gov/tb/topic/populations/healthdisparities/default.htm">71% of cases occurring in persons born outside the U.S.</a> </p>
<h2>Increased inequality causing more tuberculosis</h2>
<p>Even as the world witnessed a rapid <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/covid-19-and-tb">decline in confirmed cases in 2020</a>, experts were worried that interruption of prevention and treatment efforts might <a href="https://www.reuters.com/article/us-health-tuberculosis-who-idUSKBN26Z1VJ">result in a rise in tuberculosis</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign announced an emergency room is closed because of the pandemic." src="https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=598&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=598&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=598&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=751&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=751&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535925/original/file-20230705-17-7oyx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=751&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 COVID-19 pandemic disrupted many medical systems and increased inequality more broadly, leading to an increase in tuberculosis cases globally.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-exterior-of-the-mt-sinai-south-nassau-hosptials-news-photo/1355659170?adppopup=true">J. Conrad Williams Jr./Newsday RM via Getty Images</a></span>
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</figure>
<p>These fears were warranted. <a href="https://www.nytimes.com/2020/08/03/health/coronavirus-tuberculosis-aids-malaria.html">Many health experts</a>, along with the U.S. Centers for Disease Control and Prevention, have confirmed the pandemic disrupted access to tuberculosis testing and diagnosis. It is likely that many cases were missed because of the interruption of tuberculosis control activities, since funding, resources and staff were reassigned to assist in <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">COVID-19 control efforts</a>. Additionally, during health encounters, similarities in symptoms between COVID-19 and tuberculosis may have led to <a href="https://www.cdc.gov/media/releases/2022/s0324-tuberculosis-covid-19.html">missed diagnoses</a>.</p>
<p>The drop in confirmed cases seems to be, in large part, driven by a lack of testing. The rapid increase since the pandemic, and especially the rise in deaths, confirms that progress made in tuberculosis control over the past 20 years has stalled, slowed or reversed. These two troubling trends are also almost certainly connected to the increase in <a href="https://doi.org/10.3389/fpubh.2020.00241">inequality brought about by the pandemic</a>.</p>
<p>The existence of multigenerational households, overcrowding in low-income neighborhoods, lack of paid sick leave, inability to shield from the pandemic, use of public transportation and lack of health insurance all converged to heighten the risk of both COVID-19 and tuberculosis among the most vulnerable people. </p>
<p>Of course, the pandemic is not the only factor that has increased human hardship – and therefore, tuberculosis – in recent years. For example, Ukraine now has one of the <a href="https://doi.org/10.1016/S1473-3099(23)00220-7">world’s highest tuberculosis disease burdens</a> as a result of Russia’s invasion and the resulting harm to Ukraine’s medical, social and economic systems. Ongoing conflicts in other parts of the world, energy shortages and the effects of climate change and associated impacts on food security are expected to worsen the broader <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022">social and political determinants of tuberculosis</a>. </p>
<p>There are many <a href="https://doi.org/10.1371%2Fjournal.pntd.0000256">neglected diseases of poverty</a>, and tuberculosis is a great example of how social forces produce human disease. With an estimated <a href="https://doi.org/10.1183/13993003.00655-2019">one-third of the world’s population at risk for tuberculosis</a> today, fostering social justice interventions to reduce health inequities is a critically important step to relieving the global medical burden of this relentless disease.</p><img src="https://counter.theconversation.com/content/207478/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carlos Franco-Paredes 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>Tuberculosis is a preventable and curable disease, yet before the pandemic, it killed more people than any other infectious disease.Carlos Franco-Paredes, Associate Faculty Mycobacteria Research Laboratories, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088952023-07-04T15:11:40Z2023-07-04T15:11:40ZAspartame: popular sweetener could be classified as a possible carcinogen by WHO – but there’s no cause for panic<figure><img src="https://images.theconversation.com/files/535489/original/file-20230704-16-qfev1h.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5646%2C3764&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/double-cool-ice-soft-drink-cola-647315608">MMD Creative/Shutterstock</a></span></figcaption></figure><p>According to <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/whos-cancer-research-agency-say-aspartame-sweetener-possible-carcinogen-sources-2023-06-29/">reports</a>, the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), is set to declare the artificial sweetener aspartame as “possibly carcinogenic to humans”. </p>
<hr>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/26377607/">Aspartame</a> is about <a href="https://www.sciencedirect.com/science/article/abs/pii/0308814685901190">200 times sweeter</a> than sugar and is one of the most commonly used artificial sweeteners. It’s used particularly in “low calorie” or “diet” foods and beverages, but is contained in a wide variety of products including drinks, ice creams, chewing gums, confectionery, sauces and snacks.</p>
<p>We don’t have further information yet on what evidence the IARC will base this new classification on, but the WHO will publish the full data <a href="https://monographs.iarc.who.int/wp-content/uploads/2023/06/Meeting134-QA-June2023.pdf">on July 14</a>. </p>
<p>While reports like these can understandably be worrying, there’s no reason to panic at this stage.</p>
<p>Aspartame was first approved for use by the US Food and Drug Administration (FDA) <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2013.3496">in 1974</a>, and ever since then there have been claims made about its potential effects on health. </p>
<p>Over time, aspartame has not only been linked to cancer, but also to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116212">other conditions</a> such as multiple sclerosis, blindness, seizures, memory loss, depression, anxiety, birth defects and death. </p>
<p>However, frequent evaluations by regulatory agencies such as the <a href="https://apps.who.int/food-additives-contaminants-jecfa-database/Home/Chemical/62">WHO</a>, the FDA and the <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">European Food Safety Authority</a> (EFSA) have found no evidence to support these assertions.</p>
<p>So far, the regulators have all agreed that it’s safe for a person to consume <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">40mg of aspartame</a> per kilogram of their body weight per day. That’s about 2.8g for a 70kg adult – and is much more than most people consume. </p>
<h2>What does ‘possibly carcinogenic’ actually mean?</h2>
<p>The safety of food additives is <a href="https://www.efsa.europa.eu/en/topics/topic/food-additive-re-evaluations">regularly reevaluated</a>. This is important as new evidence can emerge, especially with the development of different methods to assess the health effects of additives.</p>
<p>This year, aspartame has been reevaluated by two WHO agencies: the International Agency for Research on Cancer (<a href="https://www.iarc.who.int/">IARC</a>) and the Joint FAO/WHO Expert Committee on Food Additives (<a href="https://www.who.int/groups/joint-fao-who-expert-committee-on-food-additives-(jecfa)">JECFA</a>). </p>
<p>The two agencies have <a href="https://monographs.iarc.who.int/wp-content/uploads/2023/06/Meeting134-QA-June2023.pdf">very different remits</a>. The IARC looks at hazard and JECFA at risk. This distinction is important. For example, sunshine is a hazard as it can cause skin cancer, but the risk depends on the time spent in the sun and whether one uses sunscreen.</p>
<p>The IARC’s job is to investigate possible causes of cancer and identify hazards. In its <a href="https://monographs.iarc.who.int/">reports</a> (called monographs), it reviews all available evidence and classifies hazards into one of <a href="https://www.iarc.who.int/wp-content/uploads/2023/06/IARC_MONO_classification_2023_updated.png">four categories</a>: </p>
<ul>
<li>Group 1: carcinogenic to humans (sufficient evidence for cancer in humans)</li>
<li>Group 2a: probably carcinogenic to humans (limited evidence in humans, sufficient evidence in animals)</li>
<li>Group 2b: possibly carcinogenic to humans (limited evidence in humans, insufficient evidence in animals) </li>
<li>Group 3: not classifiable (inadequate evidence in humans or animals).</li>
</ul>
<p>Aspartame will reportedly be classified into group 2b. It shares this category with aloe vera leaves, electromagnetic radiation, the heart drug <a href="https://bnf.nice.org.uk/drugs/digoxin/">digoxin</a> and engine exhaust fumes, among <a href="https://www.bbc.com/future/article/20230630-aspartame-what-else-is-possibly-cancerous">many other things</a>. For all of these hazards, there is some limited data that suggests they might cause cancer – but nothing convincing. </p>
<p>These categories can be confusing, because they refer only to the strength of the evidence that something can cause cancer, not the degree of risk. Group 1 for example includes smoking, alcohol, <a href="https://theconversation.com/not-all-processed-meats-carry-the-same-cancer-risk-64622">processed meat</a>, plutonium and sunlight. There’s convincing evidence each one can cause cancer. </p>
<p>But the actual risks are very different and depend on amount and exposure. For instance, plutonium and smoking are best avoided, but there’s no reason to avoid processed meat or alcohol completely.</p>
<figure class="align-center ">
<img alt="A hand holds a cigarette." src="https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535511/original/file-20230704-29-7padyv.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">Smoking is known to cause cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/harmful-habit-hand-holding-cigarette-smoke-1885761310">Oakland Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>While the IARC assesses the hazard, it’s JECFA’s job to assess the risk and make a recommendation about the <a href="https://apps.who.int/iris/bitstream/handle/10665/37578/9241542705-eng.pdf">acceptable daily intake</a>. </p>
<p>Their assessment will also be published on July 14, but there hasn’t been an indication in the media reports what it will say. It’s possible the acceptable daily intake will remain at 40mg per kilogram of body weight, or it may be reduced. Without having access to the data, is impossible to predict. </p>
<h2>The evidence so far</h2>
<p>The last review of aspartame’s safety was <a href="https://www.efsa.europa.eu/en/press/news/131210">conducted by EFSA</a> in 2013. This review didn’t find any new evidence that aspartame causes cancer and confirmed previous reviews by other regulators.</p>
<p>One compound that was of particular interest was <a href="https://www.efsa.europa.eu/en/efsajournal/pub/3496">methanol</a>, which is formed in the gut when aspartame is broken down and converted into formaldehyde by the human body. Formaldehyde is a known carcinogen (group 1). However, the amount that can form after the consumption of aspartame is much lower than what the body produces naturally.</p>
<p>In the interim there has been some data from a French study, which asked participants to provide information about their diet and followed them up for several years afterwards. This research suggested high consumption of aspartame <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950">increases cancer risk</a>.</p>
<p>However, the results are difficult to interpret as obesity is <a href="https://www.wcrf.org/diet-activity-and-cancer/risk-factors/obesity-weight-gain-and-cancer">an independent risk factor</a> for cancer and people who are obese often use sweeteners. It’s also difficult to estimate aspartame intake accurately <a href="https://theconversation.com/a-whole-new-way-of-doing-nutrition-research-148352">from diet data alone</a>.</p>
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Read more:
<a href="https://theconversation.com/artificial-sweeteners-linked-to-diabetes-and-obesity-95314">Artificial sweeteners linked to diabetes and obesity</a>
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<p>It’s likely that the upcoming assessments will include this data and therefore provide a better estimate of aspartame’s risk. Until then, there is no reason for concern. Aspartame has been scrutinised for a long time and the classification of “possibly carcinogenic” suggests it’s unlikely there will be any major change in assessment or implications for consumers.</p><img src="https://counter.theconversation.com/content/208895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gunter Kuhnle has received research funding from Mars, Inc.</span></em></p>Reports have indicated the artificial sweetener aspartame will be classified as ‘possibly carcinogenic to humans’ by the WHO. Here’s what that means – and doesn’t mean.Gunter Kuhnle, Professor of Nutrition and Food Science, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065602023-06-29T12:16:40Z2023-06-29T12:16:40ZRingworm fungal infections are common in the US and are becoming increasingly resistant to treatment – 6 questions answered<figure><img src="https://images.theconversation.com/files/533284/original/file-20230621-19-utzvta.jpg?ixlib=rb-1.1.0&rect=0%2C43%2C7245%2C4772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ringworm is often easy to spot with its characteristic red rings on the skin.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/ringworm-illustration-royalty-free-illustration/1407269449?phrase=ringworm&adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>The World Health Organization considers antimicrobial resistance to be one of the most <a href="https://www.unep.org/explore-topics/chemicals-waste/what-we-do/emerging-issues/antimicrobial-resistance-global-threat#">serious threats for global health</a>. Similar to <a href="https://www.cdc.gov/drugresistance/about.html#">the way bacteria have developed resistance to antibiotics</a>, fungal infections throughout the world are <a href="https://doi.org/10.1038/s41579-022-00720-1">becoming more drug-resistant</a> and <a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">more deadly</a>.</em> </p>
<p><em>In early 2023, the New York State Department of Health reported two cases of <a href="https://medlineplus.gov/tineainfections.html">severe tinea</a>, a contagious type of ringworm infection. The Centers for Disease Control and Prevention later reported that they were caused by a species of fungus that has been <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219a4.htm">spreading throughout South Asia</a> over the past decade.</em></p>
<p><em>The Conversation spoke with <a href="https://rodneyerohde.wp.txstate.edu/">Rodney Rohde</a>, a medical laboratory professional and public health microbiologist, about the prevalence of ringworm and the growing threat of antifungal resistance around the world.</em></p>
<h2>1. What is ringworm and how common is it?</h2>
<p>When one hears the term ringworm, it likely conjures images of a nasty parasitic worm infection. However, a ringworm infection is a common infection of the skin caused by a fungus. Experts state that about <a href="https://my.clevelandclinic.org/health/diseases/4560-ringworm">20%-25% of the population</a> will experience a ringworm infection at any given time.</p>
<p><a href="https://www.cdc.gov/fungal/about-fungal-diseases.html">Fungi can be found almost anywhere</a> – soil, plants, surfaces, on the skin and in our bodies, and even in the air. Research shows that there are <a href="https://www.cdc.gov/fungal/diseases/ringworm/definition.html">up to 40 types of fungus</a> that can cause these ringworm infections, with the most common types being from the genuses <em><a href="https://en.wikipedia.org/wiki/Trichophyton">Trichophyton</a></em>, <em><a href="https://en.wikipedia.org/wiki/Microsporum">Microsporum</a></em> or <em><a href="https://en.wikipedia.org/wiki/Epidermophyton">Epidermophyton</a></em>. </p>
<p><a href="https://www.cdc.gov/fungal/diseases/ringworm/definition.html">Medical terms for ringworm</a> are “tinea” and “dermatophytosis.” Tinea and dermatophytosis are synonyms for a contagious fungal infection of the skin. Other names for ringworm are based on its location on the body – for example, ringworm on the feet is commonly called <a href="https://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/syc-20353841">athlete’s foot</a>, and ringworm associated with the groin area is referred to as jock itch. These are characterized by a persistent itchy rash that can appear flaky and cracked.</p>
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<figcaption><span class="caption">Ringworm is a fungal infection; it is not caused by a worm.</span></figcaption>
</figure>
<p>While anyone can be infected, ringworm is most commonly picked up in the following circumstances: </p>
<p>– A weakened immune system or an <a href="https://my.clevelandclinic.org/health/diseases/4875-lupus">autoimmune disease like lupus</a>.</p>
<p>– Playing a high-contact sport, like wrestling; this ringworm is called <a href="https://doi.org/10.3390/jcm11144066">tinea gladiatorum</a>.</p>
<p>– Profuse sweating, also known as <a href="https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis">hyperhidrosis</a>.</p>
<p>– The use of public showers or locker rooms.</p>
<p>– Handling or working with infected animals.</p>
<p>– Living in a subtropical or tropical region. </p>
<h2>2. How can you recognize ringworm?</h2>
<p>The hair, skin and nails of either fingers or toes are the likely landing spots for a ringworm infection. Signs and symptoms of an infection usually depend on which part of the body is affected, but generally may include hair loss and red, scaly, cracked skin. However, the most well-known sign that gives this infection its ironic and misplaced name – ringworm – is the hallmark ring-shaped rash.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Top view of a scalp with hair missing in the circlular shape of a ringworm infection." src="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&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">Ringworm commonly affects the scalp area and can cause hair loss.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/medical-illustration-of-ringworm-of-the-royalty-free-illustration/1293052667?phrase=ringworm">Viktoriya Kabanova/iStock via Getty Images Plus</a></span>
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<h2>3. How does ringworm spread?</h2>
<p><a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">Many fungi can be seen with the naked eye</a>, such as common mushrooms or bread mold. </p>
<p>Fungi can grow in two forms: yeasts, which are single round cells, and molds, which are made up of many cells forming long, thin, hairlike threads called hyphae. Some of them can exhibit both forms of growth and thrive in decaying organic material like soil or a plant. But fungi can also grow in unexpected places, such as on wallpaper. </p>
<p>Fungi are relatively easily transmitted because of their ability to survive on a <a href="https://asm.org/Articles/2023/March/The-Role-of-Bacterial-Biofilms-in-Antimicrobial-Re">diversity of surfaces, including medical devices</a>.</p>
<p><a href="https://www.merckmanuals.com/home/infections/fungal-infections/overview-of-fungal-infections">Fungal transmission</a> occurs via <a href="https://www.cdc.gov/fungal/diseases/ringworm/sources.html">three primary routes</a>: by coming into close contact with another person who has a ringworm infection; by touching an infected animal, be it livestock, pets or wildlife; or by contacting an infected surface.</p>
<p>Some types of <a href="https://www.aad.org/public/diseases/a-z/ringworm-causes">fungi can thrive where it’s warm and humid</a>. Ringworm occurs more frequently <a href="https://doi.org/10.3390%2Fjof8010039">in tropical areas </a> and during hot, humid summers. </p>
<h2>4. How can you reduce the likelihood of getting it?</h2>
<p>Some of the best ways to <a href="https://www.cdc.gov/fungal/diseases/ringworm/risk-prevention.html">reduce or prevent a ringworm or other fungal infection</a> include:</p>
<p>– Wash hands with soap and warm water.</p>
<p>– Have your pets checked regularly for ringworm. </p>
<p>– Wear shoes and socks that are made of lightweight, breathable materials to reduce moisture. </p>
<p>– Avoid walking barefoot in wet or humid areas like locker rooms or public showers.</p>
<p>– Clip fingernails and toenails regularly to keep them short and clean.</p>
<p>– Change socks and underwear at least once a day, since bacteria and fungi like most, humid environments. </p>
<p>– Avoid sharing clothing, towels, sheets or other personal items with others.</p>
<p>– For athletes involved in close contact sports like wrestling, shower immediately after practice or a match and keep all sports gear and uniform clean. </p>
<p>– Do not share sports gear such as helmets with other players.</p>
<h2>5. What treatments are there?</h2>
<p>A dermatologist can typically diagnose a ringworm infection visually, but in some cases a small skin scraping, hair or nail sample may be needed for microscopic examination.</p>
<p>There are <a href="https://www.aad.org/public/diseases/a-z/ringworm-treatment">several treatment options</a>, including antifungal medications prescribed by a physician or dermatologist or over-the-counter products sold as a cream or ointment. A dermatologist may also prescribe an oral pill such as griseofulvin or terbinafine.</p>
<p>Popular <a href="https://www.webmd.com/skin-problems-and-treatments/what-you-should-know-about-ringworm">over-the-counter products</a> include clotrimazole, sold as Lotrimin or Mycelex, or topical miconazole. For more severe cases, a doctor might prescribe options such as <a href="https://www.mayoclinic.org/drugs-supplements/itraconazole-oral-route/side-effects/drg-20071421?p=1">itraconazole medications</a> or <a href="https://medlineplus.gov/druginfo/meds/a682617.html">tolnaftate</a>.</p>
<p>Finally, in some cases a person may need to use antifungal shampoo and soap to clean themselves and sterilize bedding and clothing.</p>
<p>But treatments don’t always work.</p>
<h2>6. Why is antifungal resistance a growing problem?</h2>
<p><a href="https://www.weforum.org/agenda/2023/03/antimicrobial-resistance-superbugs-antibiotics/">Antimicrobial resistance</a>, including <a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">antifungal resistance</a>, is an ongoing global emergency. Experts estimate that drug-resistant infections caused <a href="https://www.unep.org/explore-topics/chemicals-waste/what-we-do/emerging-issues/antimicrobial-resistance-global-threat#">roughly 1.3 million deaths around the world in 2019</a>. By 2050 that figure could rise to 10 million deaths each year.</p>
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<figcaption><span class="caption">Rodney E. Rohde describes the seriousness of antifungal resistance.</span></figcaption>
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<p>Over the past 10 years, South Asia has been experiencing an <a href="https://www.cdc.gov/fungal/diseases/ringworm/dermatophyte-resistance.html">epidemic of antifungal-resistant ringworm</a> caused by the spread of a novel species of fungus called <em>Trichophyton indotineae</em>, which causes skin disease in both animals and humans. Experts believe that inappropriate use of topical antifungal and corticosteroid medications is likely driving its spread.</p>
<p>In February 2023, a New York City dermatologist reported to public health officials two cases in which unrelated patients with severe tinea caused by <em>Trichophyton indotineae</em> were not improving with oral antifungal treatment. A CDC report found that those were the first cases of <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219a4.htm">tinea from that species</a> in the U.S. One of the two patients had no recent international travel history, suggesting that it could be a case of local transmission of <em>Trichophyton indotineae</em> in the U.S.</p><img src="https://counter.theconversation.com/content/206560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney E. Rohde has received funding from the American Society of Clinical Pathologists, American Society for Clinical Laboratory Science, U.S. Department of Labor (OSHA), and other public and private entities/foundations. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See <a href="https://rodneyerohde.wp.txstate.edu/service/">https://rodneyerohde.wp.txstate.edu/service/</a>.</span></em></p>An aggressive, antifungal-resistant form of tinea, a contagious ringworm fungal infection, has appeared in the US, likely driven by overuse and misuse of antifungal medications.Rodney E. Rohde, Regents' Professor of Clinical Laboratory Science, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079062023-06-19T02:41:28Z2023-06-19T02:41:28ZIs it finally time to ban junk food advertising? A new bill could improve kids’ health<figure><img src="https://images.theconversation.com/files/532547/original/file-20230619-23-dyl4om.jpg?ixlib=rb-1.1.0&rect=41%2C0%2C5533%2C3686&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/food-delivery-black-woman-using-laptop-1855054825">Shutterstock</a></span></figcaption></figure><p>Today independent MP and former GP Sophie Scamps will <a href="https://www.afr.com/politics/federal/teal-push-for-new-junk-food-advertising-ban-20230617-p5dhcz">introduce a bill</a> into federal parliament that would restrict junk food advertisements aimed at children. </p>
<p>The bill would target advertising for unhealthy foods Australia’s health ministers have <a href="https://www.health.gov.au/sites/default/files/documents/2022/06/national-interim-guide-to-reduce-children-s-exposure-to-unhealthy-food-and-drink-promotion-2018-national-interim-guide-to-reduce-children-s-exposure-to-unhealthy-food-and-drink-promotion-coag-health-council-2018.pdf">previously defined</a>, including sugar-sweetened drinks, confectionary and unhealthy fast food meals. Advertising for these foods and drinks would be banned on television, radio and streaming services from 6am to 9.30pm, and banned altogether online and on social media. The proposal highlights one of our biggest health challenges and does something about it. </p>
<p>The share of Australian adults who are overweight or obese has <a href="https://grattan.edu.au/wp-content/uploads/2023/02/The-Australian-Centre-for-Disease-Control-ACDC-Highway-to-Health-Grattan-Report.pdf">tripled</a> since 1980. Today, about <a href="https://www.aihw.gov.au/reports/overweight-obesity/overweight-and-obesity/contents/summary#Change-over-time">a quarter</a> of Australian children are overweight or obese. The consequences are serious. Obesity increases the risk of a range of illnesses, such as diabetes, cancer, and heart disease, setting children up to develop chronic disease. The health care costs of obesity run into the billions of dollars each year, not to mention all the years of life lived with illness and disability, or lost to early death. </p>
<p>This isn’t the first time a ban on junk food advertising has been floated. But there is more reason than ever to make it happen.</p>
<h2>Why now?</h2>
<p>Unhealthy diets are the main cause of Australia’s obesity epidemic, and restricting advertising for unhealthy foods could help improve what we eat. </p>
<p>That’s why experts have been calling for advertising restrictions for years. Back in 2009, the Australian National Preventive Health Agency recommended them, and they have long been <a href="http://apps.who.int/iris/bitstream/10665/44416/1/9789241500210_eng.pdf">recommended</a> by the World Health Organization. They’re supported by evidence that advertising influences children’s <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.12445">diets</a> and <a href="https://www.mdpi.com/2072-6643/11/4/875">preferences</a>, <a href="https://www.who.int/publications/i/item/9789240041783">driving</a> cravings and feelings of hunger. </p>
<p>Even without this evidence, it would be a safe assumption that junk food advertising works. Otherwise, companies wouldn’t spend money on it, and they certainly do. </p>
<p>One <a href="https://academic.oup.com/heapro/article-abstract/37/6/daac155/6827736">study</a> found Australian advertising on sugary drinks alone costs nearly five times more than government campaigns promoting healthy eating, physical activity and obesity prevention. And companies carefully design advertising to <a href="https://www.who.int/publications/i/item/9789240041783">entice</a> children. Their strategies include promotional characters, gifts, and games and shifting advertising online to follow changing viewing habits. </p>
<p>Most parents don’t need any persuading to know advertising works, having seen younger children employ “pester power” and older children spend their pocket money on unhealthy options. That’s probably one reason <a href="https://australiainstitute.org.au/wp-content/uploads/2022/08/Polling-Advertising-on-TV-Web-1.pdf">two thirds</a> of Australians support bans on junk food advertising during children’s viewing hours. </p>
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Read more:
<a href="https://theconversation.com/are-you-living-in-a-food-desert-these-maps-suggest-it-can-make-a-big-difference-to-your-health-196477">Are you living in a food desert? These maps suggest it can make a big difference to your health</a>
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<h2>What’s taking so long?</h2>
<p>So why haven’t governments acted? When health bodies started calling for advertising restrictions nearly 15 years ago, the industry promptly came up with a plan of its own. Optional codes of conduct were drawn up for “responsible advertising and marketing to children”. But there are significant <a href="https://apo.org.au/sites/default/files/resource-files/2018-07/apo-nid183701_1.pdf">loopholes and gaps</a> in these codes, which are voluntary, narrow, vague, and consequence-free. </p>
<p>Predictably, self-regulation <a href="https://academic.oup.com/jpubhealth/article/39/4/787/2966185?login=true">hasn’t reduced</a> junk food advertising to children. While countries with mandatory policies have seen junk food consumption fall, it has <a href="https://pubmed.ncbi.nlm.nih.gov/29521031/">increased</a> in countries where the industry sets the rules.</p>
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<p>In the meantime, Australia and its children have been left behind. Since Quebec in Canada introduced the first ban back in 1980, <a href="https://academic.oup.com/nutritionreviews/article/77/11/787/5536919">more than a dozen</a> countries around the world have followed and more are planning to. The proposals being debated in our parliament are modelled on policies adopted in the United Kingdom in 2021. </p>
<p>This isn’t the only area where Australia has fallen behind when it comes to setting sensible food rules. We are not among the <a href="https://www.croakey.org/as-deadline-looms-public-health-experts-urge-government-to-act-on-trans-fatty-acids/">43 countries</a> with rules to reduce trans-fats, which cause cardiovascular disease, or one of the <a href="https://www.who.int/publications-detail-redirect/9789240056299">85 countries</a> with a tax on sugar-sweetened beverages, which are linked to diabetes. </p>
<p>Our policies to reduce salt consumption and improve food labelling are weaker than those in leading countries too. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-save-50-off-your-food-bill-and-still-eat-tasty-nutritious-meals-184152">How to save $50 off your food bill and still eat tasty, nutritious meals</a>
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<h2>It’s time to make healthy choices easier</h2>
<p>Unhealthy diets need to improve, but the simple answer of blaming the individual is the <a href="https://www.instituteforgovernment.org.uk/sites/default/files/2023-04/tackling-obesity.pdf">wrong one</a>. Unhealthy food choices are shaped by things like time pressures, cost of living pressures, the availability of fresh food and the marketing adults and children are constantly bombarded with. </p>
<p>That’s why governments need to make healthy choices cheaper, more convenient and more appealing, so that they can compete with unhealthy options. Taking advertising aimed at children out of the equation would be a good first step.</p><img src="https://counter.theconversation.com/content/207906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p>This isn’t the first time a ban on junk food advertising has been floated. But there is are good reasons to support a new push.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2075792023-06-14T14:03:20Z2023-06-14T14:03:20ZWhat if China really did develop COVID as a bioweapon? Here are the issues involved<p>China is facing renewed allegations that the COVID-19 outbreak was caused by a leak from one of their laboratories – and that this research is connected to biowarfare.</p>
<p>It is a <a href="https://www.bbc.co.uk/news/world-asia-china-57268111">question</a> asked pretty much since the pandemic was identified: was COVID-19 a natural outbreak or a disease that escaped from a Chinese laboratory in Wuhan? </p>
<p>A recent <a href="https://www.thetimes.co.uk/article/inside-wuhan-lab-covid-pandemic-china-america-qhjwwwvm0">report by the Sunday Times</a> claims the newspaper has seen evidence that China was developing dangerous coronaviruses in collaboration with the Chinese military for the alleged purposes of biowarfare. This research programme was the likely source of the pandemic, the report asserts.</p>
<h2>The allegations</h2>
<p>The new allegations are based on “hundreds of documents” including confidential reports and memos, emails and scientific papers, as well as interviews with <a href="https://www.state.gov/">US State Department</a> officials who have investigated the pandemic’s source. The report also claims that researchers from the Wuhan laboratory were taken to hospital with “COVID-like symptoms” in November 2019.</p>
<p>What caused COVID-19 has been investigated before, but these studies are not conclusive. The <a href="https://www.who.int/news/item/30-03-2021-who-calls-for-further-studies-data-on-origin-of-sars-cov-2-virus-reiterates-that-all-hypotheses-remain-open">World Health Organisation (WHO)</a> carried out an <a href="https://www.cfr.org/backgrounder/will-world-ever-solve-mystery-covid-19s-origin">inspection in January 2021</a>. </p>
<p>While their investigators could not clearly find a natural source for the disease, they also stated that suggestions COVID-19 leaked from a laboratory were “highly unlikely”. Yet the WHO said that China’s lack of transparency <a href="https://www.wsj.com/articles/who-china-hunt-covid-origins-11616004512">made the investigation difficult</a> and that this was a reason why they could not say either way.</p>
<p>China <a href="https://economictimes.indiatimes.com/news/international/world-news/china-rejects-us-reports-lab-leak-theory-on-covid-19-origin/articleshow/98281233.cms?from=mdr">still insists</a> there is no evidence that COVID-19 came from a laboratory.</p>
<p>The really interesting thing about the new report is not just that it says it has new evidence, but that it claims its data shows Chinese scientists were researching coronaviruses in relation to biowarfare. <a href="https://www.who.int/health-topics/biological-weapons#tab=tab_1">Biowarfare</a> is the deliberate use of disease and biological agents to cause harm.</p>
<p>A US investigator is quoted in the article as asserting that Chinese scientists were working on a vaccine. The allegation is that the Chinese military wanted a vaccine to inoculate their own population if they ever wanted to use the virus for biowarfare. With a vaccine, says the report, China “might have a weapon to shift the balance of world power”.</p>
<p>Claims that China was developing biological weapons have been made by <a href="https://www.washingtontimes.com/news/2020/jan/26/coronavirus-link-to-china-biowarfare-program-possi/">Dany Shoham</a>, a former Israeli intelligence officer and biowarfare expert. Others staunchly <a href="https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/">reject this accusation</a>. A <a href="https://www.dni.gov/files/ODNI/documents/assessments/Declassified-Assessment-on-COVID-19-Origins.pdf">US National Intelligence Council report</a> said of COVID-19: “We judge the virus was not developed as a biological weapon.”</p>
<h2>Next steps – more data?</h2>
<p>So, what could the rest of the world do about these new allegations – if anything?</p>
<p>The dispute over whether COVID-19 was created by Chinese scientists is still as hot as ever. States may feel they need more information.</p>
<p>We have already seen something similar happen in Syria in <a href="https://www.opcw.org/media-centre/news/2023/01/opcw-releases-third-report-investigation-and-identification-team">relation to chemical weapons</a>, which are said to have been used during the conflict there. Despite the former US president Barack Obama having called the use of chemical weapons a “<a href="https://www.politico.com/magazine/story/2016/07/obama-syria-foreign-policy-red-line-revisited-214059/">red line</a>”, Washington said it did not wish to act until they felt the evidence of chemical warfare was incontrovertible.</p>
<p>Like chemical weapons, bioweapons are terrible forms of weapons of mass destruction (WMD). Yet it is precisely because these armaments are so terrible that states have to be careful. Any allegation that a country has broken the rules on WMD will be controversial. Politicians will want to, and should, be sure of the facts.</p>
<p>One option then is for further investigation, possibly through an international organisation such as the WHO. But this would be a difficult investigation for a number of reasons.</p>
<p>Investigation would not only be hard because China <a href="https://www.orfonline.org/expert-speak/a-look-at-chinas-biowarfare-ambitions/">has yet to be fully transparent</a>. This issue is also problematic because of <a href="https://www.bureaubiosecurity.nl/en/node/711">dual use</a>. Biological research doesn’t necessarily mean biowarfare. Research is also carried out for good purposes – such as medical advances. And those two types of research look much the same. So even if China were developing a vaccine, was this for public health reasons or to create defences against biowarfare attacks from others?</p>
<p>It is also easy to hide biowarfare research. Scientific experiments typically happen in <a href="https://www.brandeis.edu/now/2021/july/bioweapons-samore.html">small and secretive facilities</a>, using equipment that can be dismantled quickly if there is any suspicion that inspectors are about to come knocking.</p>
<h2>Options for action</h2>
<p>What if the international community wants to take further action? States could make an official complaint that China may have violated the 1972 <a href="https://disarmament.unoda.org/biological-weapons/">biological weapons convention (BWC)</a>. The convention is a legally binding treaty that prohibits the possession and use of biological weapons. The US has previously said that it <a href="https://www.armscontrol.org/factsheets/bwc">“does not have sufficient information”</a> to determine whether China has complied with the BWC.</p>
<p>Complaints can be made through the <a href="https://www.un.org/en/">United Nations</a>. In 2022, the UN Security Council <a href="https://press.un.org/en/2022/15095.doc.htm">denied such a complaint</a> by Russia against Ukraine. States could appeal to the <a href="https://www.icj-cij.org/home">International Court of Justice</a>, but there may be legal issues with this – especially given that not all states are signed up to the BWC. States can also <a href="https://www.armscontrol.org/act/2022-09/news/russia-calls-meeting-biological-weapons-convention">call a special meeting</a> of the BWC signatories to discuss a possible violation of the convention.</p>
<p>A complaint would not necessarily do much. The BWC has been widely criticised because it does not have a <a href="https://www.armscontrol.org/act/2006-09/features/verification-bwc-last-gasp-signs-life">verification mechanism</a>, so it has little direct authority over what states do. Making a complaint, however, would at least raise the issue at the international level.</p>
<p>Another potential option is the <a href="https://disarmament.unoda.org/wmd/secretary-general-mechanism/">UN Secretary-General’s Mechanism for Investigation of Alleged Use of Chemical and Biological Weapons</a>. Yet this option is shaky as it allows for investigations into the actual use of bioweapons. But even if COVID-19 were shown to be a laboratory leak this would almost certainly have been accidental and not clearly a case of biowarfare. </p>
<p>Ultimately, of course, another option for the international community is that they do nothing. The Sunday Times article claims to present new data, but it is not indisputable. And even merely bringing up the issue of biowarfare with China would be diplomatically contentious and ruffle a lot of political feathers. </p>
<p>As such, the international community will not want to take the dispute over COVID-19 forward unless they have definitive evidence of a Chinese biowarfare programme. But, given the nature of biological research, we may never be able to get that certainty.</p><img src="https://counter.theconversation.com/content/207579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Bentley 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>There are many complex reasons why an international investigation would be difficult both diplomatically and practically.Michelle Bentley, Reader in International Relations, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061752023-06-08T12:30:25Z2023-06-08T12:30:25ZWHO’s recommendation against the use of artificial sweeteners for weight loss leaves many questions unanswered<figure><img src="https://images.theconversation.com/files/530408/original/file-20230606-14983-a38265.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C5798%2C3763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar alternatives go by many names including artificial sweeteners, low-calorie sweeteners and nonsugar sweeteners.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/food-service-tray-with-sugar-packets-salt-and-royalty-free-image/1000353706?phrase=artificial+sweeteners&adppopup=true">Marie LaFauci/Moment via Getty Images</a></span></figcaption></figure><p>Do low-calorie sweeteners help with weight management? And are they safe for long-term use?</p>
<p>This is among the most controversial topics in nutritional science. In early May 2023, the World Health Organization issued a statement that cautions <a href="https://www.who.int/publications/i/item/9789240073616">against the use of nonsugar sweeteners</a> for weight loss except for people who have preexisting diabetes. </p>
<p>The WHO based its new recommendation on a <a href="https://www.who.int/publications/i/item/9789240046429">2022 systematic review and meta-analysis of scientific studies</a> on nonsugar sweetener consumption in humans. This type of study reviews a large body of research to draw a broad conclusion.</p>
<p>Based on its interpretation of that large-scale review, the WHO recommended <a href="https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline">against using artificial sweeteners for weight control</a> and concluded that there may be health risks associated with habitual consumption of nonsugar sweeteners over the long term. However, the WHO also acknowledged that the existing evidence is not conclusive and that more research needs to be done.</p>
<p>As neuroscientists, we study how dietary factors such as sweeteners affect the brain’s ability to perform critical functions, including metabolism, <a href="https://www.schierlab.com/">appetite</a>, and <a href="https://kanoskilab.com/">learning and memory</a>. </p>
<p>We found the WHO’s advisory surprising based on the study’s equivocal results. Determining the answers to these questions is immensely challenging, and public health messaging around recommendations can send mixed messages.</p>
<h2>‘Healthy’ versus ‘unhealthy’ sugars</h2>
<p>Natural sugars like glucose and fructose, together with fiber and other nutrients, are found in many food sources that are considered healthy, such as fruit. However, these simple carbohydrates have been increasingly added into manufactured food products, especially beverages. Sugar-sweetened beverages are usually high in calories and offer little else in the way of nutrition.</p>
<p>In the early 20th century, food and beverage manufacturers began incorporating naturally and chemically derived substances that satisfy sweet cravings but contain significantly fewer calories than natural sugars – and, in some cases, zero calories. Sugar substitutes became particularly widespread in the 1950s with the increasing popularity of diet sodas. Since then, consumers have <a href="https://doi.org/10.1016/j.physbeh.2016.03.030">increasingly turned to these sugar substitutes</a> in their everyday lives. </p>
<p>Sugar substitutes go by many names, including high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, low-calorie sweeteners and, as termed in the WHO report, nonsugar sweeteners.“ These include synthetic compounds like sucralose, acesulfame potassium and aspartame, and naturally derived ones, such as those from the plant <em>Stevia rebaudiana</em>, among many others. </p>
<p>Each nonsugar sweetener has a unique chemical structure, but they all activate sweet taste receptors at very low concentrations. This means that you need to add only a tiny amount of them to sweeten your coffee or tea, as opposed to heaping spoonfuls of natural sugar.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/hAJrLMfpZBw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Nonsugar sweeteners are found in many soft drinks, sports drinks and energy bars.</span></figcaption>
</figure>
<h2>Sugar substitutes and the quest for weight loss</h2>
<p>Obesity and its associated metabolic conditions, <a href="https://theconversation.com/drugs-that-melt-away-pounds-still-present-more-questions-than-answers-but-ozempic-wegovy-and-mounjaro-could-be-key-tools-in-reducing-the-obesity-epidemic-205549">like diabetes</a> and cardiovascular disease, are now among the leading <a href="https://www.cdc.gov/obesity/data/adult.html">causes of preventable death</a> in the U.S. The <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022">obesity epidemic</a> has been linked in part to an increase in added sugar consumption over the past century. </p>
<p>In order to help address it, in 2015 the <a href="https://www.who.int/publications/i/item/9789241549028">WHO issued specific recommendations</a> to reduce sugar intake and adopt healthier diets. </p>
<p>But <a href="https://theconversation.com/a-taste-for-sweet-an-anthropologist-explains-the-evolutionary-origins-of-why-youre-programmed-to-love-sugar-173197">humans are hard-wired</a> to find the <a href="https://doi.org/10.1016/s0278-2626(03)00014-9">sweet taste of sugars pleasurable</a>, and the tastiness of real sugar makes it difficult for most of us to remove it from our diets. </p>
<p>Sugar substitutes were designed to help. The math seems straightforward: Replacing your favorite 12-ounce sugar-sweetened beverage that contains 150 calories with an artificially sweetened beverage of the same volume that contains zero calories should allow you to reduce the number of calories you take in each day and reduce your body weight over time. </p>
<p>But the science is not so straightforward. Research from <a href="https://doi.org/10.1080/17470218.2011.552729">both animal models and humans</a> indicates that <a href="https://doi.org/10.1172/jci.insight.167266">habitual nonsugar sweetener consumption</a> can lead to <a href="https://doi.org/10.2337/dc19-0734">long-term negative metabolic outcomes</a> and <a href="https://doi.org/10.3390/nu11122928">body weight gain</a>.</p>
<p>However, there are conflicting studies from <a href="https://doi.org/10.1016/j.appet.2016.05.011">animal models</a> <a href="https://doi.org/10.1038/s41430-019-0461-6">and humans</a> that have not found significant body weight gain associated with nonsugar sweeteners consumption.</p>
<h2>Parsing the health impacts</h2>
<p>Regardless of any potential benefits nonsugar sweeteners may have for weight control, their use must also be considered in the context of overall health. </p>
<p>Agencies like the WHO and the U.S. Food and Drug Administration periodically review available evidence and assess the safety of various food additives, including nonsugar sweeteners, for use in foods and beverages within what is called an <a href="https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners">acceptable daily intake</a> limit. In this context, the acceptable daily intake is based on the estimated amount of a specific nonsugar sweetener that can be safely consumed daily over one’s entire life without adverse effects on health.</p>
<p>Each agency sets its own daily allowance based on the best available data. But because these experiments cannot account for all possible conditions in which these substances are used in real life, it is critical that scientists continue to investigate the health effects of food additives. </p>
<p>The authors of the WHO report relied on three main types of published research studies to determine whether nonsugar sweetener consumption was linked to adverse health effects. The gold standard for assessing causation is what are called <a href="https://doi.org/10.1111%2F1471-0528.15199">randomized controlled trials</a>. </p>
<p>In these studies, people are randomly assigned to either an experimental group – which receives the experimental substance, such as a nonsugar sweetener – or a control group – which receives a placebo or different substance. Participants in both groups are then tracked for a period of time, typically weeks or months. The majority of studies involving randomized controlled trials on nonsugar sweeteners to date involve this type of comparison, with nonsugar sweeteners replacing consumption of natural sugar-sweetened beverages. </p>
<p>The analysis of almost <a href="https://www.who.int/publications/i/item/9789240046429">50 randomized controlled trials</a> on which the WHO based its recommendation found modest benefits of using nonsugar sweeteners for weight loss and determined that the habitual use of those nonsugar sweeteners did not lead to diabetes symptoms or indicators of cardiovascular disease. But it did find that the use of nonsugar sweeteners was associated with a higher ratio of total cholesterol to HDL, short for high-density lipoprotein, which is considered the "good cholesterol.”</p>
<p>That means that habitual consumers of artificial sweetener had more of the low-density lipoprotein, or LDL version, in their system. That form of “bad cholesterol” is a <a href="https://www.cdc.gov/cholesterol/ldl_hdl.htm">risk factor for heart disease</a>. </p>
<p>However, other potential adverse consequences of consuming nonsugar sweeteners may take more time to appear than can be identified in the limited time frame of a randomized controlled trial. </p>
<p>The authors also evaluated what are called prospective cohort studies. Those studies track participants’ self-reported use of sweeteners alongside health outcomes, oftentimes over many years. They also took into account case-control studies, which identify people with or without a certain health issue, such as cancer, and then use available health records and interviews to determine the extent of nonsugar sweetener use in their past. </p>
<p>Examination of the cohort and case-control studies found that regular consumption of nonsugar sweetener was associated with increased fat accumulation, higher body mass index and increased incidence of <a href="https://www.cdc.gov/diabetes/basics/type2.html">Type 2 diabetes</a>. Those findings differ from the outcomes of the randomized control studies. </p>
<p>Analysis of the cohort and case-control studies also concluded that a history of regular nonsugar sweetener use was linked to increased frequency of stroke, hypertension, other adverse cardiovascular events and, in pregnant people, an increased risk for premature birth. The frequency of cancer in nonsugar sweetener consumers was very low in general, though <a href="https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#">saccharin, an FDA-approved sweetener</a> found in many food products, was associated with a bladder cancer. </p>
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<figcaption><span class="caption">The history of artificial sweeteners.</span></figcaption>
</figure>
<h2>Caveats and takeaways</h2>
<p>On the face of it, these results are alarming, but they need to be taken with a grain of salt. As the WHO report points out, these studies have significant limitations that need to be considered. </p>
<p>Take, for example, in the cohort and case-control studies, that higher <a href="https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm">body mass index, or BMI</a>, was associated with greater nonsugar sweetener intake and poorer health outcomes. One possibility is that people with obesity used nonsugar sweeteners to help cut calories more than others without obesity. This makes it difficult to determine whether the disease is caused by sustained artificial sweetener use or by the other underlying conditions associated with obesity. </p>
<p>Additionally, the way nonsugar sweeteners are consumed is not controlled in these types of studies. So negative health outcomes could be associated with other affiliated harmful behaviors, such as more sugar or fat in the diet. </p>
<p>The picture is very mixed on both the benefits of nonsugar sweeteners for weight loss and their ties to adverse health issues. The WHO’s recommendation seems to have weighed the cohort and case-control studies over the randomized controlled ones, a decision that we found puzzling in light of the limitations of these studies for assessing whether nonsugar sweeteners have a causal role in disease.</p>
<p>As with all health-related choices, the science is complex. In our view, grabbing a diet drink to offset the calories in a slice of chocolate cake every once in a while will likely not be harmful for your health or lead to a significant weight change.</p><img src="https://counter.theconversation.com/content/206175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsey Schier receives funding from the National Institutes of Health (NIDCD).</span></em></p><p class="fine-print"><em><span>Scott Kanoski receives funding from the National Institutes of Health. </span></em></p>The WHO report concluded that habitual use of nonsugar sweeteners is linked to a modest increase in diabetes, hypertension and stroke. But the research it’s based on has limitations.Lindsey Schier, Assistant Professor of Biological Sciences, USC Dornsife College of Letters, Arts and SciencesScott Kanoski, Associate Professor of Biological Science, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2069322023-06-04T11:19:08Z2023-06-04T11:19:08ZRemoving antimicrobial resistance from the WHO’s ‘pandemic treaty’ will leave humanity extremely vulnerable to future pandemics<figure><img src="https://images.theconversation.com/files/529846/original/file-20230602-27-nnu80l.png?ixlib=rb-1.1.0&rect=17%2C80%2C1680%2C1219&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antimicrobial resistance is now a leading cause of death worldwide due to drug-resistant infections, including drug-resistant strains of tuberculosis, pneumonia and Staph infections like the methicillin-resistant Staphylococcus aureus shown here.</span> <span class="attribution"><span class="source">(NIAID, cropped from original)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></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/removing-antimicrobial-resistance-from-the-who-s--pandemic-treaty--will-leave-humanity-extremely-vulnerable-to-future-pandemics" width="100%" height="400"></iframe>
<p>In late May, the latest version of the draft Pandemic Instrument, also referred to as the “pandemic treaty,” was shared with Member States at the <a href="https://www.who.int/about/governance/world-health-assembly">World Health Assembly</a>. The text was made available online via <a href="https://healthpolicy-watch.news/wp-content/uploads/2023/05/DRAFT_INB_Bureau-text_22-May.pdf">Health Policy Watch</a> and it quickly became apparent that all mentions of addressing antimicrobial resistance in the Pandemic Instrument were at risk of removal.</p>
<p>Work on the Pandemic Instrument began in December 2021 after the World Health Assembly agreed to a global process to draft and negotiate an international instrument — under the Constitution of the World Health Organization (WHO) — to protect nations and communities from future pandemic emergencies.</p>
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Read more:
<a href="https://theconversation.com/drug-resistant-superbugs-a-global-threat-intensified-by-the-fight-against-coronavirus-135790">Drug-resistant superbugs: A global threat intensified by the fight against coronavirus</a>
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<p>Since the beginning of negotiations on the Pandemic Instrument, there have been calls from civil society and leading experts, including the <a href="https://www.amrleaders.org/docs/librariesprovider20/default-document-library/amr-as-substantive-element-of-the-international-instument-of-pandemic-prevention-preparedness-and-response.pdf?sfvrsn=300292c8_5&download=true">Global Leaders Group on Antimicrobial Resistance</a>, to include the so-called “silent” pandemic of antimicrobial resistance in the instrument.</p>
<p>Just three years after the onset of a global pandemic, it is understandable why Member States negotiating the Pandemic Instrument have focused on preventing pandemics that resemble COVID-19. But not all pandemics in the past have been caused by viruses and not all pandemics in the future will be caused by viruses. Devastating past pandemics of bacterial diseases have included <a href="https://www.who.int/news-room/fact-sheets/detail/plague">plague</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/cholera">cholera</a>. The next pandemic could be caused by bacteria or other microbes.</p>
<h2>Antimicrobial resistance</h2>
<figure class="align-right ">
<img alt="Yellow particles on purple spikes" src="https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of Yersinia pestis, the bacteria that cause bubonic plague, on a flea. Plague is an example of previous devastating pandemics of bacterial disease.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Antimicrobial resistance (AMR) is the process by which infections caused by microbes become resistant to the medicines developed to treat them. Microbes include bacteria, fungi, viruses and parasites. Bacterial infections alone cause <a href="https://www.tropicalmedicine.ox.ac.uk/gram/news/bacterial-infections-linked-to-one-in-eight-global-deaths-according-to-gram-study">one in eight deaths</a> globally.</p>
<p>AMR is fueling the rise of drug-resistant infections, including <a href="https://www.cdc.gov/tb/publications/factsheets/drtb/xdrtb.htm">drug-resistant tuberculosis</a>, <a href="https://www.cdc.gov/drugresistance/pdf/threats-report/strep-pneumoniae-508.pdf">drug-resistant pneumonia</a> and drug-resistant Staph infections such as <a href="https://www.cdc.gov/mrsa/index.html">methicillin-resistant Staphylococcus aureus</a> (MRSA). These infections are killing and debilitating millions of people annually, and <a href="https://doi.org/10.1016/S0140-6736(21)02724-0">AMR is now a leading cause of death worldwide</a>. </p>
<p>Without knowing what the next pandemic will be, the “pandemic treaty” must plan, prepare and develop effective tools to respond to a wider range of pandemic threats, not solely viruses.</p>
<p>Even if the world faces another viral pandemic, <a href="https://theconversation.com/when-covid-19-or-flu-viruses-kill-they-often-have-an-accomplice-bacterial-infections-187056">secondary bacterial infections</a> will be a serious issue. During the COVID-19 pandemic for instance, large percentages of those hospitalized with COVID-19 required treatment for secondary bacterial infections. </p>
<p>New research from Northwestern University suggests that many of the deaths among hospitalized COVID-19 patients <a href="https://news.feinberg.northwestern.edu/2023/05/05/secondary-bacterial-pneumonia-drove-many-covid-19-deaths/">were associated with pneumonia — a secondary bacterial infection that must be treated with antibiotics</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An illustrative diagram that shows the difference between a drug resistant bacteria and a non-resistant bacteria." src="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Antimicrobial resistance means infections that were once treatable are much more difficult to treat.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Treating these bacterial infections requires effective antibiotics, and with AMR increasing, <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">effective antibiotics are becoming a scarce resource</a>. Essentially, safeguarding the remaining effective antibiotics we have is critical to responding to any pandemic.</p>
<p>That’s why the potential removal of measures that would help mitigate AMR and better safeguard antimicrobial effectiveness is so concerning. Sections of the text which may be removed include measures to prevent infections (caused by bacteria, viruses and other microbes), such as:</p>
<ul>
<li> better access to safe water, sanitation and hygiene; </li>
<li> higher standards of infection prevention and control; </li>
<li> integrated surveillance of infectious disease threats from human, animals and the environment; and </li>
<li> strengthening <a href="https://www.cdc.gov/antibiotic-use/core-elements/index.html">antimicrobial stewardship</a> efforts to optimize how antimicrobial drugs are used and prevent the development of AMR.</li>
</ul>
<p>The exclusion of these measures would hinder efforts to protect people from future pandemics, and appears to be part of a <a href="https://www.nature.com/articles/d41586-023-01805-4">broader shift to water-down the language in the Pandemic Instrument</a>, making it easier for countries to opt-out of taking recommended actions to prevent future pandemics. </p>
<h2>Making the ‘pandemic treaty’ more robust</h2>
<p>Measures to address AMR could be easily included and addressed in the “pandemic treaty.”</p>
<p>In September 2022, I was part of a group of civil society and research organizations that specialize in mitigating AMR who were invited the WHO’s <a href="https://inb.who.int/">Intergovernmental Negotiating Body</a> (INB) to provide an <a href="https://amrpolicy.org/resources/recommendations-to-the-intergovernmental-negotiating-body-inb-concerning-amr-the-pandemic-instrument/">analysis on how AMR should be addressed</a>, within the then-draft text. </p>
<p>They outlined that including bacterial pathogens in the definition of “pandemics” was critical. They also identified specific provisions that should be tweaked to track and address both viral and bacterial threats. These included AMR and recommended harmonizing national AMR stewardship rules.</p>
<p>In March 2023, I joined other leading academic researchers and experts from various fields in publishing a special edition of the <a href="https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/issue/DC40B54126C7B273BD62EBEED9641D2A"><em>Journal of Medicine, Law and Ethics</em>,</a> outlining why the Pandemic Instrument must address AMR. </p>
<p>The researchers of this special issue argued that the Pandemic Instrument was overly focused on viral threats and ignored AMR and bacterial threats, including the need to manage antibiotics as a common-pool resource and revitalize research and development of novel antimicrobial drugs. </p>
<h2>Next steps</h2>
<p>While <a href="https://apps.who.int/gb/inb/pdf_files/inb4/A_INB4_3-en.pdf">earlier drafts of the Pandemic Instrument</a> drew on guidance from AMR policy researchers and civil society organizations, after the first round of closed-door negotiations by Member States, all of these insertions, are now at risk for removal.</p>
<p>The Pandemic Instrument is the best option to mitigate AMR and safeguard lifesaving antimicrobials to treat secondary infections in pandemics. AMR exceeds the capacity of any single country or sector to solve. Global political action is needed to ensure the international community works together to collectively mitigate AMR and support the conservation, development and equitable distribution of safe and effective antimicrobials.</p>
<p>By missing this opportunity to address AMR and safeguard antimicrobials in the Pandemic Instrument, we severely undermine the broader goals of the instrument: to protect nations and communities from future pandemic emergencies.</p>
<p>It is important going forward that Member States recognize the core infrastructural role that antimicrobials play in pandemic response and strengthen, rather than weaken, measures meant to safeguard antimicrobials. </p>
<p>Antimicrobials are an essential resource for responding to pandemic emergencies that must be protected. If governments are serious about pandemic preparedness, they must support bold measures to conserve the effectiveness of antimicrobials within the Pandemic Instrument.</p><img src="https://counter.theconversation.com/content/206932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Rogers Van Katwyk is a member of the WHO Collaborating Centre on Global Governance of Antimicrobial Resistance at York University. She receives funding from the Wellcome Trust and the Social Sciences and Humanities Research Council of Canada. </span></em></p>Drug-resistant microbes are a serious threat for future pandemics, but the new draft of the WHO’s international pandemic agreement may not include provisions for antimicrobial resistance.Susan Rogers Van Katwyk, Adjunct Professor, School of Global Health and Managing Director, AMR Policy Accelerator, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.