tag:theconversation.com,2011:/id/topics/public-health-136/articlesPublic health – The Conversation2024-03-28T03:27:34Ztag:theconversation.com,2011:article/2267322024-03-28T03:27:34Z2024-03-28T03:27:34ZNSW may end its COVID vaccine mandate for health workers. That doesn’t mean it was a bad idea in the first place<figure><img src="https://images.theconversation.com/files/584921/original/file-20240328-26-z9guow.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C4913%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-face-mask-getting-vaccinated-hospital-1954364125">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Months after COVID vaccines were introduced in 2021, governments and private organisations mandated them for various groups. Health and aged care workers were <a href="https://www.sciencedirect.com/science/article/pii/S2211883722000648?via%3Dihub">among the first</a> to need two doses to keep their jobs. </p>
<p>State and territory governments subsequently implemented <a href="https://doi.org/10.1016/j.vaccine.2021.11.056">employment and public space mandates</a> which required people to show proof of vaccination to enter hospitality venues and events. A constellation of private companies also required vaccines for their workers or patrons.</p>
<p>Vaccine mandates receive considerable attention when they’re introduced. For COVID vaccine mandates, policymakers offered reasoning including <a href="https://statements.qld.gov.au/statements/93754">protecting the vulnerable</a>, safeguarding health systems, and <a href="https://www.smh.com.au/national/australia-news-live-covid-19-infections-continue-to-grow-across-the-nation-regional-victoria-lockdown-restrictions-to-be-eased-20210908-p58pyj.html">making it possible</a> to open state borders and lift internal restrictions. <a href="https://gh.bmj.com/content/7/5/e008684">Experts</a> and the public sometimes debated the merits of these policies, but the reasons behind them were relatively clear. </p>
<p>By contrast, the removal of vaccine mandates often appears haphazard. <a href="https://theconversation.com/is-it-time-to-rethink-vaccine-mandates-for-dining-fitness-and-events-we-asked-5-experts-176356">Less is known</a> about how or why it happens, or how it should be done. </p>
<p>However, mandate removal may have just as much of <a href="https://theconversation.com/time-to-remove-vaccine-mandates-not-so-fast-it-could-have-unintended-consequences-180781">an influence</a> on people’s future attitudes and behaviour as mandate imposition. As <a href="https://www.abc.net.au/news/2024-03-26/nsw-health-covid-vaccine-requirements-healthcare-worker/103629276">New South Wales</a> considers removing its COVID vaccine mandate for health-care workers, it’s pertinent to explore how to abolish a vaccine mandate in the right way.</p>
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<h2>Why do mandates end?</h2>
<p>Many COVID vaccine mandates <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/medical-exemptions-to-mandatory-vaccinations-the-state-of-play-in-australia-and-a-pressure-point-to-watch/DAAD8CC98E04828A57F1DEB98B4751B5">terminated</a> when state governments stopped classifying the pandemic as an emergency. The mandates which remained in place covered workers in high-risk settings, but even some of these have since ended. </p>
<p>Queensland and Western Australia removed their COVID vaccine requirements for health workers in 2023, and this week NSW <a href="https://www.abc.net.au/news/2024-03-26/nsw-health-covid-vaccine-requirements-healthcare-worker/103629276">announced</a> it’s considering doing the same. </p>
<p>This is good news. Governments should treat vaccine mandates like other health policies and review them regularly in the context of changing evidence. Some <a href="https://www.mja.com.au/journal/2021/215/11/policy-considerations-mandatory-covid-19-vaccination-collaboration-social">criteria</a> governments should think about when implementing or removing vaccine mandates include:</p>
<p><strong>Disease burden in the community</strong></p>
<p>Governments should consider the rate of severe illness and availability of treatment options and hospital resources. In the case of COVID, the general population has developed high levels of hybrid immunity from vaccination and infection.</p>
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Read more:
<a href="https://theconversation.com/queensland-ruling-doesnt-mean-all-covid-vaccine-mandates-were-flawed-heres-why-224646">Queensland ruling doesn't mean all COVID vaccine mandates were flawed. Here's why</a>
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<p><strong>Population vulnerability</strong></p>
<p>Health-care workers are more likely to be exposed to disease, and they may transmit it to patients who are at high risk of serious outcomes. This is why NSW and some other states require staff in health or aged care to get <a href="https://www.lavan.com.au/advice/employment_safety/mandatory_influenza_vaccinations_the_new_norm">flu vaccines</a> each year. </p>
<p><strong>Vaccine effectiveness</strong></p>
<p>It matters how well the mandated vaccine prevents severe disease in people who are vaccinated, which COVID vaccines do well. But whether they reduce transmission to others is also relevant. Importantly, COVID vaccination <a href="https://theconversation.com/no-vaccinated-people-are-not-just-as-infectious-as-unvaccinated-people-if-they-get-covid-171302">reduces</a> but does not prevent disease transmission. Outside an emergency situation, this weakens the argument for mandating vaccination.</p>
<p>Another good reason to revisit NSW’s current two-dose mandate for health workers is the fact it’s obviously outdated. Although some other states and territories <a href="https://www.theage.com.au/politics/victoria/this-midwife-is-double-covid-vaxxed-but-she-s-still-banned-from-returning-to-work-20240208-p5f3eq.html">have required one booster</a>, this did not have to be regular or recent. </p>
<p>Having received two or three doses of the vaccine, often much earlier in the pandemic, is unlikely to offer protection against infection today. Most people – vaccinated or not – have now also developed some immunity through infection. </p>
<p>Since these policies don’t reflect current evidence or recommendations, leaving them in place could actually be damaging. It may erode trust and confidence in the health system and government, both for health-care workers and the public.</p>
<figure class="align-center ">
<img alt="A nurse putting on gloves." src="https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584928/original/file-20240328-26-dp7jw8.jpeg?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">
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<span class="caption">Health-care workers in a number of Australian jurisdictions need to be vaccinated against COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-nurse-mask-putting-on-gloves-1229815867">Rawpixel.com/Shutterstock</a></span>
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<h2>So how should we repeal mandates responsibly?</h2>
<p>While it’s important to review these policies in changing contexts, there’s a risk vaccine or mandate opponents will use this opportunity to claim mandates were never necessary. </p>
<p>No COVID decisions were perfect, and we should evaluate pandemic decision-making across a range of measures. But the circumstances and justifications for introducing mandates were very different from today. This distinction should be kept in mind when communicating changes in mandate policy. </p>
<p>For NSW and any other jurisdictions considering removing mandates, first, they should consult meaningfully with the community to drive decision-making and communication. This includes engaging with those who are subject to the mandate and those indirectly affected by it. </p>
<p>We applaud NSW Health for <a href="https://www.health.nsw.gov.au/news/Pages/20240325_01.aspx">consulting</a> with health workforce stakeholders. However, they haven’t described consulting with patients or vulnerable groups, who may worry mandate removal exposes them to untenable risk from their health-care providers. It’s important to prepare a communication strategy for this group, too.</p>
<p><a href="https://www.mja.com.au/journal/2021/215/1/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">Transparency is key</a> to maintaining trust in public health officials. When a decision is made to alter or remove a mandate, we recommend transparently explaining the decision and the data that informed it. For communicating about mandate removal, spokespeople could provide clear, simple data that compares the burden of disease or immunity rates at the time of implementation versus now. </p>
<p>It’s also crucial any announcement about mandate removal makes clear that vaccination is still recommended. NSW Chief Health Officer Kerry Chant framed the early messaging well, saying NSW Health would continue to <a href="https://www.health.nsw.gov.au/news/Pages/20240325_01.aspx">strongly recommend</a> employees stay <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">up-to-date</a> with their COVID vaccinations.</p>
<p>Finally, governments should provide clear and accessible legal and health guidance to private companies. These employers may still have mandatory vaccination policies in place, and need support on how best to consider or announce their removal. </p>
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Read more:
<a href="https://theconversation.com/unintended-consequences-of-nzs-covid-vaccine-mandates-must-inform-future-pandemic-policy-new-research-222989">Unintended consequences of NZ's COVID vaccine mandates must inform future pandemic policy – new research</a>
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<p>The abolition of COVID vaccine mandates is an important milestone in our journey out of the pandemic. At the same time, it means governments need to <a href="https://www.nature.com/articles/d41586-022-00495-8">ensure high voluntary vaccine uptake</a>. </p>
<p>This requires funding, efficient service delivery, support for health-care workers who administer vaccines, and persuasive public health campaigns. When governments manage mandate removal well, they make it easier for themselves to continue to protect the public against disease.</p><img src="https://counter.theconversation.com/content/226732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Attwell is a specialist advisor to the Australian Technical Advisory Group on Immunisation. She is a past recipient of a Discovery Early Career Researcher Award funded by the Australian Research Council of the Australian Government (DE19000158). She leads the "Coronavax" project, which is funded by the Government of Western Australia. She leads “MandEval: Effectiveness and Consequences of Australia's COVID-19 Vaccine Mandates” funded by the Medical Research Future Fund of the Australian Government. All funds were paid to her institution. Funders are not involved in the conceptualization, design, data collection, analysis, decision to publish, or preparation of manuscripts.</span></em></p><p class="fine-print"><em><span>Jessica Kaufman receives funding from the Australian government and the Victorian state government. She is the deputy chair of the Collaboration on Social Science and Immunisation.</span></em></p>The move makes sense at this stage of the pandemic. But abolishing a vaccine mandate needs to be done carefully so as not to damage public trust.Katie Attwell, Associate Professor, School of Social Sciences, The University of Western AustraliaJessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242542024-03-26T16:40:09Z2024-03-26T16:40:09ZWant to quit vaping? There’s an app for that<figure><img src="https://images.theconversation.com/files/579066/original/file-20240229-21-z0wh8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&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/young-woman-tattoos-on-arms-hands-2271193519">SeventyFour/Shutterstock</a></span></figcaption></figure><p>More Australians than ever are vaping, according to recently released data.</p>
<p>The National Drug Strategy Household Survey <a href="https://www.aihw.gov.au/getmedia/b8b298cc-6d3f-4ab0-a238-9bd63f300c09/national-drug-strategy-household-survey-2022-2023.pdf?v=20240229072409&inline=true#:%7E:text=interpreted%20with%20caution.-,Use%20of%20illicit%20drugs%20increases%2C%20driven%20by%20hallucinogens,million%20people%20had%20done%20so.">shows</a> the proportion of Australians aged 14 and over who, in 2022–2023, said they currently vaped was 7%. In 2019 it was just 2.5%. Users are most likely to be aged 18-24.</p>
<p>As we learn more about the potential harms of vaping, <a href="https://www.mdpi.com/2673-995X/4/1/3">many</a> will be keen to quit.</p>
<p>But because vapes have only been widespread in recent years, there is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460321000836">limited evidence</a> on how to go about quitting. With the addictive nature of nicotine-containing vapes, it can also be hard to stop vaping on your own.</p>
<p>Could apps be the answer? The <a href="https://www.statista.com/statistics/730101/australia-smartphone-ownership-by-age/">vast majority</a> of young people have a smartphone. And we know apps have helped people <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2770816">quit smoking</a>. So why not use apps to help people quit vaping?</p>
<p>But which apps are best? And which app <a href="https://mhealth.jmir.org/2019/7/e11926/">features</a> should you look for? Our <a href="https://mhealth.jmir.org/2024/1/e55177">recently published study</a> gives us some clues.</p>
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Read more:
<a href="https://theconversation.com/could-messages-from-social-media-influencers-stop-young-people-vaping-a-look-at-the-governments-new-campaign-224621">Could messages from social media influencers stop young people vaping? A look at the government's new campaign</a>
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<h2>We tested 30 apps</h2>
<p>We searched the Apple iTunes and Google Play stores in May 2023 to identify apps available in Australia claiming to help people quit vaping.</p>
<p>We then made a shortlist of 20 iOS apps and ten Android apps to assess for:</p>
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<li><p><a href="https://mhealth.jmir.org/2015/1/e27/">quality</a> (including ease of use, how it engaged users, appearance, and the information it conveyed)</p></li>
<li><p>the potential to <a href="https://mhealth.jmir.org/2019/1/e11130">change behaviour</a> (including setting goals, making an action plan, identifying barriers, monitoring progress and giving feedback).</p></li>
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Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
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<h2>Here’s what we found</h2>
<p>The highest rated app overall was the iOS app <a href="https://apps.apple.com/au/app/quit-smoking-stop-vaping-app/id1641262016">Quit smoking. Stop vaping app</a>. This had 19 out of 21 features known to help people change behaviour.</p>
<p>The highest rated app for Android devices was <a href="https://play.google.com/store/apps/details?id=com.despdev.quitsmoking&hl=en_US">Quit Tracker: Stop Smoking</a>, with 15 behaviour change features. </p>
<p>The highest rated app for both <a href="https://play.google.com/store/apps/details?id=org.instaquit.app&hl=en_US">Android</a> and <a href="https://apps.apple.com/us/app/quitsure-quit-smoking-smartly/id1523992725">iOS users</a> was the QuitSure Quit Smoking Smartly app. This had 15 behaviour change features for iOS users and 14 for Android users.</p>
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<a href="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Quit vaping app" src="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=308&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=308&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=308&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=387&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=387&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579068/original/file-20240229-20-gjbt99.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=387&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">This ‘Quit smoking. Stop vaping app’ had the most features known to help people change behaviour.</span>
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Read more:
<a href="https://theconversation.com/my-teens-vaping-what-should-i-say-3-expert-tips-on-how-to-approach-the-talk-196205">My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'</a>
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<h2>So what should I look for?</h2>
<p>There are key <a href="https://mhealth.jmir.org/2019/7/e11926/">app features</a> to look for in an app that could help you change your behaviour. These features also apply to apps helping people to quit alcohol, or to take more exercise, for instance. These features include:</p>
<ul>
<li><p><strong>full customisability</strong>, allowing individuals to tailor the app to their needs</p></li>
<li><p><strong>goal setting</strong>, allowing individuals to create their own goals, monitor their progress, then update them over time. This is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00915/full">more likely</a> to lead to positive behaviour change</p></li>
<li><p><strong>external help</strong>, allowing users to access more help or advice, directly from the app</p></li>
<li><p>apps that are <strong>easy to use</strong> or navigate, so users are more likely to stick with the app.</p></li>
</ul>
<p>But not all apps we assessed scored highly on these. On average, apps only had about nine out of 21 behaviour change features. And only 12 of the 30 apps included a goal-setting feature.</p>
<p>The overall quality of the apps was moderate – scoring about three out of five. While apps were easy to use and navigate, we found they were not always transparent in who funded or developed them.</p>
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Read more:
<a href="https://theconversation.com/how-apps-and-influencers-are-changing-the-way-we-sleep-for-better-or-for-worse-211749">How apps and influencers are changing the way we sleep, for better or for worse</a>
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<h2>Future apps</h2>
<p>Earlier research shows quit smoking apps <a href="https://mhealth.jmir.org/2019/7/e11926/citations">rate higher</a> for their potential to change behaviour than ones to quit vaping.</p>
<p>In one study, researchers found more than half of users of one quit smoking app were still not smoking <a href="https://formative.jmir.org/2023/1/e51658">after a month</a>.</p>
<p>So app developers could look at quit smoking apps to identify strategies and features to develop or update quit vaping apps.</p>
<p>App developers need to create apps with comprehensive goal-setting features. These apps need to be trialled or tested by the developer, users or an external party. This is important as, to our knowledge, no publicly available app has undergone such testing.</p>
<p>As many young people vape to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460322001319?via%3Dihub">relieve stress or anxiety</a>, future apps could provide extra features, such as meditation, cognitive behaviour therapy and relaxation.</p>
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<p>Apps need to align with current <a href="https://www.health.nsw.gov.au/tobacco/Publications/e-cigarette-young-people-guide.pdf">guidelines</a> on how to quit vaping, so evidence-based messaging is consistent. Unfortunately, information and guidelines on quitting vaping are in their infancy and vary across different countries or jurisdictions.</p>
<p>Developers also need to ensure they disclose who owns and paid for the app. Is it a commercial company, a research group, a government agency, or a not-for-profit? We found it difficult to tell during our analysis.</p>
<p>Last of all, quit vaping apps need to be updated and improved over time, to iron out bugs, make improvements as the evidence changes, and to respond to changes in how users behave.</p>
<p>In an ideal world, we’d see partnerships between app developers, people who vape, researchers and experts in health behaviour change to develop and update quit vaping apps – ones with the highest chance of actually shifting people’s behaviour.</p>
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<p><em>We wish to thank Lilian Chan, Rebecca Cerio, Sandra Rickards, Phillipa Hastings, Kate Reakes and Tracey O’Brien from Cancer Institute NSW for their assistance with this research.</em></p><img src="https://counter.theconversation.com/content/224254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona McKay has previously received funding from Cancer Institute NSW (which funded this study) and VicHealth.</span></em></p><p class="fine-print"><em><span>Matthew Dunn has previously received funding from Cancer Institute NSW and VicHealth, and currently receives funding from VicHealth. </span></em></p>Here’s what to look for when you’re browsing for apps.Fiona McKay, Associate Professor of Health Equity, Deakin UniversityMatthew Dunn, Senior Lecturer in Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2261172024-03-24T19:06:49Z2024-03-24T19:06:49ZWe’ve taken smoking from ‘normal’ to ‘uncommon’ and we can do the same with vaping – here’s how<p>Vaping is a pressing public health issue. While adult smoking rates continue to fall, vaping rates are rising. Some 7% of adults now <a href="https://www.bmj.com/content/384/bmj.q559">vape daily</a>, up nearly three-fold since 2019. Most alarmingly, the rate of current vape use – on a daily, weekly or monthly basis – among 18-to-24-year-olds has climbed from 5% in 2019 to 21% in 2023. </p>
<p>Nicotine, especially in high doses, is known to be <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-6-the-health-effects-of-e-cigarette-use/18-6-2-health-effects-of-e-cigarette-use-during-adolescence#_ENREF_4">harmful to brain development</a>. Vaping products also contain more than 200 chemicals, some of them known carcinogens. </p>
<p>While the research on long-term health harms of non-therapeutic vaping is still emerging, there is an urgent need for governments to act in the interests of public health.</p>
<h2>Historical parallels</h2>
<p>We have confronted youth nicotine addiction before. Lessons can be learned from Australia’s decades-long, world-leading efforts to control tobacco.</p>
<p>Firstly, global tobacco organisations <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-1-the-ecigarettemarket">now control</a> the vaping industry. Like smoking historically, vapes are aggressively marketed to young people.</p>
<p>In 1969, in the early years of tobacco control, <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-3-prevalence-of-smoking-adults">36% of adults smoked daily</a>, but prevalence was declining. Tobacco companies sought new young buyers for their products. They <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">flooded television and radio with advertising</a>, which rapidly drove up youth smoking. We are seeing the devastating effects today of tobacco-induced disease.</p>
<p>Anti-tobacco advocates in 1971 pressured a reluctant Commonwealth government to ban tobacco advertising. They used celebrity-studded, satirical television adverts showing smoking’s health harms, drumming up media attention, and lobbied politicians using international data showing the powerful effect cigarette advertising had on promoting youth smoking. </p>
<p>On the back of growing public outrage, politicians eventually <a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">banned tobacco advertising on television and radio by 1977</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-push-to-end-tobacco-advertising-in-the-1970s-could-be-used-to-curb-gambling-ads-today-200915">How the push to end tobacco advertising in the 1970s could be used to curb gambling ads today</a>
</strong>
</em>
</p>
<hr>
<h2>The rise of the Quit campaigns</h2>
<p>Despite this success, more was needed to drive down smoking. In 1978, the Commonwealth government and the NSW Department of Health funded a <a href="https://www.bmj.com/content/287/6399/1125">“Quit for Life” campaign</a> in northern NSW to discover how best to help smokers to quit.</p>
<p>It revealed that memorable ads – notably the famous <a href="https://www.youtube.com/watch?v=ZCkx610Gn6M&ab_channel=Freeman">“Sponge” ad</a> – combined with counselling and medical assistance were most effective. </p>
<p>“Quit”-branded campaigns were then rolled out in Western Australia (1982), Sydney and Melbourne (1983) and South Australia (1984). </p>
<p>The first Quitline providing guidance on accessing support was trialled in Sydney. In Victoria, a dedicated organisation, <a href="http://www.quit.org.au">Quit</a> Victoria, was established in 1985. From 1987, it received funding from the Victorian Health Promotion Foundation (VicHealth), using revenue from cigarette taxes.</p>
<p>Each campaign relied on the same tools: anti-smoking education complemented by a Quitline and other practical support for smokers to quit.</p>
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<h2>Banishing smoking from public space</h2>
<p>Tobacco companies pivoted to sport sponsorship in the 1980s to keep their brands in public view. In response, anti-smoking advocates pushed to close legislative loopholes allowing this “sports-washing”, and Quit Victoria began sponsoring sport.</p>
<p>But the problem of youth smoking <a href="https://link.springer.com/article/10.1007/s10552-008-9127-8">re-emerged due to a lack of co-ordinated national action</a>. By the mid-1990s, smoking prevalence among young people <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-teenagers">was back at 30%</a>. </p>
<p>Advocates pushed for a nationwide education campaign using a consistent message: “<a href="https://tobaccocontrol.bmj.com/content/12/suppl_2/ii9.short">Every cigarette is doing you damage</a>”. A nation-wide Quitline service was launched, as were new anti-smoking regulations, including smoke-free areas, stronger health harm warnings on cigarette packs, and increased taxation. <a href="https://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-teenagers">Youth smoking rapidly decreased</a>.</p>
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<p>However, success was not guaranteed, and advocates continued pressing. Through the early 2000s, <a href="https://www.tobaccoinaustralia.org.au/chapter-11-advertising/11-9-retail-promotion-and-access">each state progressively banned</a> point-of-sale tobacco advertising, including the visual display of packs. </p>
<p>A Commonwealth-led agreement with the states to co-ordinate their laws led to a nationwide indoor smoking ban from July 1 2007. And, in a world first, the Gillard government <a href="https://www.smh.com.au/politics/federal/a-decade-on-from-plain-packaging-what-is-the-result-20210709-p588e7.html">legislated the plain packaging</a> of tobacco, finally removing all tobacco branding.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-restrictive-vaping-and-tobacco-policies-are-fuelling-a-lucrative-and-dangerous-black-market-225279">Australia's restrictive vaping and tobacco policies are fuelling a lucrative and dangerous black market</a>
</strong>
</em>
</p>
<hr>
<h2>Three major lessons</h2>
<p>This history offers important lessons for the vaping crisis: </p>
<ul>
<li><p>the importance of a multi-pronged strategy, which includes stressing that vaping is addictive and unhealthy, and evidence-based advocacy to government </p></li>
<li><p>the need to provide appropriate supports to help people quit</p></li>
<li><p>a consistent, national approach targeting people of all ages, especially young people, before they become nicotine-dependent.</p></li>
</ul>
<p>Tobacco-control efforts were evidence-based, from the science of smoking’s health harms, to the power of cigarette advertising on youth, to the best response strategies.</p>
<p>Public education campaigns about the harms of vapes must also be evidence-based and sophisticated in their targeting of vaping’s appeal.</p>
<p>More than four decades of “Quit” campaigning show the value of complementary resources, including counselling and medical support. Practical supports to help people to stop vaping should be strengthened wherever needed. </p>
<p>Finally, the Commonwealth must continue to lead. The laws implemented by federal Health Minister Mark Butler on March 1 2024 enforce the existing ban on the import of all unregulated vapes, nicotine and non-nicotine alike. The <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/world-leading-vaping-legislation-introduced-to-parliament?language=en">second phase of laws</a> promised by the Commonwealth on March 21 enforces existing retail bans that have been widely flouted. It requires the states to assist.</p>
<p>This is a complicated issue of public policy because — despite what some opponents have suggested — <a href="https://simonchapman6.com/2024/03/17/vaping-theology-22-prohibition-has-never-worked-at-any-point-in-history-for-any-other-illicit-substance/">vapes are not prohibited, but regulated</a>. This means they are accessible by prescription for their original intended use: to quit smoking.</p>
<p>To make this work, the Commonwealth must encourage states to enforce bans. It must press for consistent laws across the country regarding the enforcement of vape-free areas. It must also seek a national approach to ensuring doctors and other healthcare providers have up-to-date evidence on prescribing therapeutic e-cigarettes for people seeking to quit smoking.</p>
<p>The health minister should be commended for the strong steps he has taken to tackle non-therapeutic vaping. The government should also take comfort in the knowledge it has the legacy of Australia’s considerable success in tobacco control on its side. </p>
<p>However, a challenge lies ahead with a politically motivated opposition and a Greens cross-bench. Both misrepresent current policy as “prohibition” when it is merely regulation to keep vapes away from young people. </p>
<p>We’ve taken smoking from “normal” to “uncommon”. We can do the same with vaping when these laws come into full effect, providing states and territories are equipped to enforce them.</p>
<p><em>Correction: This piece originally stated the rate of daily vaping among 18-to-24-year-olds has climbed from 5% in 2019 to 21% in 2023. In fact, 21% is current use – either daily, weekly or monthly.</em></p><img src="https://counter.theconversation.com/content/226117/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Holbrook receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Thomas Kehoe receives funding from the Australian Research Council and is an employee of Cancer Council Victoria.</span></em></p>Australia’s anti-smoking public health campaign has been hugely successful, and it offers lessons on how to tackle the rise in vaping.Carolyn Holbrook, Associate Professor in History, Deakin UniversityThomas Kehoe, Historian, Cancer Council VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2259862024-03-22T12:33:52Z2024-03-22T12:33:52ZEPA’s new auto emissions standard will speed the transition to cleaner cars, while also addressing consumer and industry concerns<figure><img src="https://images.theconversation.com/files/583580/original/file-20240321-17-nik9ky.jpg?ixlib=rb-1.1.0&rect=38%2C12%2C8588%2C5729&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Charging bays at the Electrify America indoor electric vehicle charging station in San Francisco.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ElectricVehiclesFancyChargers/c523cbda2a68423595229884d4da249b/photo">AP Photo/Eric Risberg</a></span></figcaption></figure><p>The U.S. Environmental Protection Agency released <a href="https://www.epa.gov/regulations-emissions-vehicles-and-engines/final-rule-multi-pollutant-emissions-standards-model">strict new emissions limits</a> on March 20, 2024, for cars built from 2027 through 2032. The final rule for Multi-Pollutant Emissions Standards caps a process that started almost a year earlier, when the Biden administration first proposed groundbreaking regulations that would essentially require automakers to make a <a href="https://theconversation.com/boosting-ev-market-share-to-67-of-us-car-sales-is-a-huge-leap-but-automakers-can-meet-epas-tough-new-standards-203663">substantial pivot toward electrification</a>.</p>
<p>The original proposal met significant pushback from carmakers and unions, who argued that the industry <a href="https://www.washingtonpost.com/climate-environment/2024/02/18/epa-electric-vehicles-car-rules/">needed more time to switch</a> from gas-powered cars to EVs. As a result, while the final target that this rule sets is very similar to the one that was initially proposed, the timetable in the final rule – especially in the earlier years – is relatively relaxed. </p>
<p>That means more carbon emissions in the short run. Politics is inevitably an important consideration in regulating major industries.</p>
<p>The new rule is projected to cut carbon dioxide emissions from passenger cars <a href="https://www.epa.gov/system/files/documents/2024-03/420f24016.pdf">by nearly 50% in model year 2032</a> relative to existing standards. This requires a broad shift toward EVs, but automakers have many options for complying. </p>
<p>For example, they could emphasize producing battery-electric vehicles or more mixed fleets that include large shares of <a href="https://www.caranddriver.com/features/a45498641/types-of-hybrid-cars-pros-and-cons-explained/">hybrids and plug-in hybrids</a>, plus cleaner gas-powered cars. EPA projects that under the rule, in model years 2030-32, battery-electric vehicles may account for <a href="https://www.epa.gov/system/files/documents/2024-03/420f24016.pdf">up to 56% of new cars</a>, up from <a href="https://apnews.com/article/epa-electric-vehicles-emissions-limits-climate-biden-e6d581324af51294048df24269b5d20a">7.6% in 2023</a>. </p>
<p>As a researcher who studies <a href="https://scholar.google.com/citations?user=h-2TvzUAAAAJ&hl=en">the electric vehicle industry and adoption of EVs</a>, I believe the new rule will nevertheless push electrification nationwide. There’s a lot of latent demand for this technology throughout the country, and this regulation will help bring that supply to broader populations. It also is likely to spur more installation of chargers and other supporting infrastructure.</p>
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<figcaption><span class="caption">The new rule will help slow climate change and save billions of dollars in health care costs.</span></figcaption>
</figure>
<h2>Impacts on consumers</h2>
<p>Traditionally, new fuel efficiency and emissions standards directly affect vehicle costs and often lead to higher prices at the dealership. However, the EPA projects that in the long term, driving electric vehicles, which <a href="https://www.washingtonpost.com/climate-environment/interactive/2023/electric-vehicle-charging-price-vs-gasoline/">cost less to fuel and maintain than gas-powered cars</a>, will save owners <a href="https://www.epa.gov/system/files/documents/2024-03/420f24016.pdf">US$6,000 on average</a> over the life of a new car. </p>
<p>Moreover, EVs bring broader benefits, such as improved air quality and reduced greenhouse gas emissions, which benefit society as a whole. </p>
<p>Fossil fuel combustion generates many harmful pollutants, including fine particulates, which have been linked to <a href="https://theconversation.com/heart-attacks-cancer-dementia-premature-deaths-4-essential-reads-on-the-health-effects-driving-epas-new-fine-particle-air-pollution-standard-223057">a range of negative health effects</a>. The EPA estimates that air pollution reductions triggered by the new rule will generate <a href="https://www.epa.gov/system/files/documents/2024-03/420f24016.pdf">US$13 billion in annual health benefits</a>.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/C4QmEsvutYQ/?utm_source=ig_web_copy_link\u0026igsh=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Building confidence in batteries</h2>
<p>One important feature of the new rule is that for the first time, the EPA has set forth explicit requirements for monitoring and ensuring the durability of EV batteries. This step recognizes that battery longevity is a pivotal factor in EVs’ value proposition and environmental impact. </p>
<p>The regulations delineate two primary benchmarks: The battery must retain at least 80% of its original capacity at five years or 62,000 miles and at least 70% after eight years or 100,000 miles. These requirements will help to standardize the <a href="https://www.recurrentauto.com/research/how-long-do-ev-batteries-last">wide variability in battery degradation</a> between different vehicle models. </p>
<p>Importantly, the health of batteries must be tracked via a monitor in the car that measures what is known as the vehicle’s state of certified energy – the amount of battery capacity left at full charge after accounting for degradation – and displays it to the driver. EV owners will have constant information about the health of their battery, expressed as a percentage of what the battery had when it was brand new. This feature will be especially useful for people buying used EVs, since it will help them assess how much battery power the car still has at the time of purchase.</p>
<p>These and other battery durability and warranty requirements are likely to play a pivotal role in the EV market, influencing both manufacturers’ engineering choices and consumers’ purchasing decisions. By setting clear standards, the EPA is driving the industry toward more robust and reliable battery technologies, which could enhance the overall attractiveness of EVs and accelerate their market penetration.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Biden speaks to reporters from the wheel of a new pickup truck." src="https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583581/original/file-20240321-18-ge6th9.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">President Joe Biden, a self-described ‘car guy,’ drives a Ford F-150 Lightning electric truck on May 18, 2021, in Dearborn, Mich.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ElectricVehiclesFederalFleet/8d61a7311ee84326b163a1cbd0ac7219/photo">AP Photo/Evan Vucci</a></span>
</figcaption>
</figure>
<h2>When is a plug-in running on electricity?</h2>
<p>Another item in the new regulations shows how the EPA has attempted to address manufacturers’ concerns. Since plug-in hybrids, or PHEVs, can run on either electricity or gasoline, regulators need some basis for determining how often they rely on one versus the other. The number that experts use in these situations, called the utility factor, is a calculation of <a href="https://doi.org/10.3390/wevj14110301">what fraction of the time a PHEV drives on electricity</a>.</p>
<p>Many researchers had argued that the EPA had <a href="https://theicct.org/wp-content/uploads/2022/12/real-world-phev-us-dec22.pdf">overestimated the utility factor</a> and warned that inflating the extent to which PHEVs operated on electric power could lead to regulations that put too much priority on these vehicles. Under the newly finalized regulations, the agency has adjusted the calculation to reflect a better understanding of how these vehicles operate in the real world. </p>
<p>For example, the adjustment in the utility factor for a model like the Prius Prime, with a 48-mile electric range, reduces the assumption of electric travel from the previous 65%-70% to about 55%. Similarly, for the Jeep Wrangler 4xe, with a 21-mile range, the utility factor is adjusted from around 40% to 30%.</p>
<p>These changes provide a more accurate reflection of PHEVs’ contribution to reducing emissions, which helps ensure that the regulatory framework aligns better with actual usage patterns. And by modifying the utility factor, the EPA may nudge manufacturers toward prioritizing more efficient PHEVs or shifting their focus toward fully electric vehicles. </p>
<h2>A clear signal to carmakers</h2>
<p>Changing auto efficiency standards has traditionally meant making incremental improvements in vehicle technologies, such as increases in engine efficiency. This new rule is much more aggressive and has a clear goal of driving a major shift toward EVs and other clean car types. </p>
<p>These standards can help companies set goals for the future by providing clear targets. Failing to meet EPA rules can <a href="https://www.epa.gov/enforcement/clean-air-act-vehicle-and-engine-enforcement-case-resolutions">incur tough penalties</a>. </p>
<p>In my view, these standards are an important step in the right direction to achieve U.S. climate goals, and they will serve as a stick that complements the monetary carrots funded by the <a href="https://theconversation.com/big-new-incentives-for-clean-energy-arent-enough-the-inflation-reduction-act-was-just-the-first-step-now-the-hard-work-begins-188693">Inflation Reduction Act</a>, which authorized tax credits and subsidies for EVs and charging stations. The new rule may not be a perfect policy from a pure climate perspective, but given automakers’ concerns and the political sensitivity of this issue, I believe it hits the target.</p><img src="https://counter.theconversation.com/content/225986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Jenn receives or has received funding from the Department of Energy, the Sloan Foundation, and the Transportation Research Board. He was a contributing author for the Intergovernmental Panel on Climate Change's 2021 Sixth Assessment Report.</span></em></p>The new rule isn’t a mandate for electric vehicles, but it will sharply increase their market share over the coming decade.Alan Jenn, Associate Professional Researcher in Transportation, University of California, DavisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237062024-03-19T12:23:24Z2024-03-19T12:23:24ZFemale mosquitoes rely on one another to choose the best breeding sites − and with the arrival of spring, they’re already on the hunt<figure><img src="https://images.theconversation.com/files/582309/original/file-20240315-26-7bf0sq.jpg?ixlib=rb-1.1.0&rect=30%2C0%2C6789%2C4468&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">_Aedes aegypti_, found across much of the U.S., spread Zika, dengue, chikungunya and other viruses.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/aedes-aegypti-mosquito-pernilongo-with-white-spots-royalty-free-image/1282216815">Mailson Pignata/iStock via Getty Images</a></span></figcaption></figure><p><em>Aedes aegypti</em> mosquitoes, one of the <a href="https://www.cdc.gov/mosquitoes/mosquito-control/professionals/range.html">most common species in the U.S.</a>, love everything about humans. They love our <a href="http://dx.doi.org/10.1126/science.adi8213">body heat and odors</a>, which enable them to find us. They love to feed on our blood to make their eggs mature. They even love all the standing water that we create. Uncovered containers, old tires and junk piles collect water and are perfect for breeding. </p>
<p>And with the advent of warm weather across the southern U.S., <a href="https://www.mosquitomagnet.com/articles/mosquito-season">mosquito breeding season is already underway</a>.</p>
<p>Given all the options that <em>Aedes</em> females have in urban areas, how do these cosmopolitan mosquitoes find the perfect site to lay their eggs? Scientists previously thought this was a solitary act, but now research shows that female <em>Aedes aegypti</em> mosquitoes – the main vector in the U.S. for diseases such as <a href="https://theconversation.com/explainer-where-did-zika-virus-come-from-and-why-is-it-a-problem-in-brazil-53425">Zika, dengue, chikungunya</a> and other viruses – can rely on one another for good reviews of breeding sites. </p>
<p>Our <a href="https://www.degennarolab.org/">Laboratory of Tropical Genetics</a> at Florida International University discovered a new behavior in which these mosquitoes <a href="https://doi.org/10.1038/s42003-024-05830-5">work together to find suitable egg-laying sites</a>. These findings, recently published in Communications Biology, show that mosquitoes regulate their own population density at breeding sites – an insight that could inform future mosquito control efforts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A half-dozen mosquitoes spread along the inside of a container." src="https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581972/original/file-20240314-30-jxgzpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Aedes aegypti</em> female mosquitoes laying their eggs in a laboratory breeding container.</span>
<span class="attribution"><span class="source">Kaylee Marrero</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Where and why female mosquitoes cluster</h2>
<p>Scientists know that female mosquitoes can be picky when it comes to where they lay their eggs. <em>Aedes aegypti</em> look for human-made breeding sites with relatively clean water, such as birdbaths, tires or even water-filled trash. But given two equal choices, you might expect them to spread evenly between the two. </p>
<p>On the contrary, when we released females in a two-choice test where both breeding site options were equivalent, we repeatedly found more mosquitoes in one chamber than in the other. Furthermore, this occurred irrespective of where the preferred chamber was positioned, whether the mosquitoes could touch water or whether mosquito eggs were already present at the breeding sites. </p>
<p>Female mosquitoes clearly were following one another in small groups to one breeding site rather than another – a newly discovered behavior in <em>Aedes aegypti</em> that we call aggregation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two ramekins, one with a few black spots in it, the other with many spots." src="https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581971/original/file-20240314-26-70qvqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&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 black spots in the container on the right indicate that <em>Aedes aegypti</em> females have chosen it as a place to lay their eggs over the identical site on the left.</span>
<span class="attribution"><span class="source">Kaylee Marrero</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The insects evidently preferred not to lay their eggs alone. When we tested 30 mosquitoes in our trials, they chose one site over another by a 2-to-1 margin. However, this changed as the test population increased beyond 30 mosquitoes. When we tested 60 or 90 females, the aggregation disappeared.</p>
<p>This tells us that females can regulate their own density at breeding sites – a response that likely is a mechanism to limit larval competition.</p>
<h2>Mosquitoes are smelling each other</h2>
<p>Mosquitoes largely sense the world through smell, using three families of <a href="https://www.britannica.com/science/olfactory-receptor">olfactory receptors</a>. These receptors detect odors when females are choosing where to lay eggs. But how do females sense each other to regulate their densities at breeding sites? </p>
<p>We explored this question by first placing 15 mosquitoes at one of our two test breeding sites. Other females seeking a place to lay preferred the unoccupied site over the one that was already occupied, even though we had already observed that the mosquitoes preferred not to lay their eggs alone. Something was directing them away from the occupied breeding site; we speculated that it might be carbon dioxide, which is an important cue for mosquitoes in all stages of their life cycle. </p>
<p>When female mosquitoes are looking for a blood meal, they fly toward the odor of CO₂, which all vertebrate animals <a href="https://theconversation.com/why-are-some-people-mosquito-magnets-and-others-unbothered-a-medical-entomologist-points-to-metabolism-body-odor-and-mindset-187957">exhale and release through their skin</a>. After feeding, they fly away from it, likely to avoid the risk of being killed by the host. </p>
<p>Mosquitoes also emit CO₂, and normally other mosquitoes can smell it, thanks to a receptor component called Gr3 in their olfactory organs. But when we released mutant females that lacked a functional Gr3 receptor to seek a place to lay eggs in our two-site test, we found that these insects, which could not detect CO₂, were willing to lay their eggs at preoccupied breeding sites. This suggested that normal mosquitoes might be avoiding the preoccupied laying site because they smelled CO₂ emitted by mosquitoes that were already there.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EUrOcquy8IU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Female mosquitoes lay eggs on or near still bodies of water.</span></figcaption>
</figure>
<p>To confirm this, we offered two unoccupied breeding sites to females seeking a place to lay. However, we increased CO₂ levels around one of the sites to between 600 and 750 parts per million, compared with the normal level of about 450 to 500 ppm at the other site. We found that <em>Aedes aegypti</em> females avoided the unoccupied sites with elevated CO₂. This behavior appears designed to keep occupied breeding sites from becoming too crowded. </p>
<p>Overall, we found that two families of receptors play a role in the interactions between <em>Aedes aegypti</em> females when they seek breeding sites. Odorant receptors detect an unknown odor, which draws females toward a site; gustatory receptors detect CO₂, which deters females from breeding sites when the carbon dioxide level is high. The balance between these attractive and repellent odors will ultimately determine whether a female chooses or avoids a particular site. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing common mosquito breeding sites around home, including gutters and pet dishes." src="https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582583/original/file-20240318-20-i9yyck.jpeg?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"></a>
<figcaption>
<span class="caption">Mosquitoes breed in many wet spots, large and small.</span>
<span class="attribution"><a class="source" href="https://www.cabq.gov/environmentalhealth/urban-biology/mosquitoes">City of Albuquerque</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Implications for mosquito control</h2>
<p>Suppressing mosquito populations in urban areas using <a href="https://www.cdc.gov/mosquitoes/mosquito-control/community/larvicides.html">biolarvicides</a> – pesticides made from live bacteria that are toxic to mosquito larvae – is a primary control strategy to limit the spread of deadly diseases such as West Nile virus and Zika virus. This is especially true for <em>Aedes aegypti</em>, which is the most common urban mosquito species that reproduces in artificial breeding sites that humans create. Other control tactics, such as <a href="https://undark.org/2019/10/25/when-residents-say-no-to-aerial-mosquito-spraying/">spraying pesticides over large areas</a>, target beneficial insects as well as mosquitoes and can be controversial. </p>
<p>Knowing that female <em>Aedes aegypti</em> use social cues to pick the best breeding grounds for their young and will move on from a breeding site when it becomes too crowded could lead to new control measures. Interrupting the female mosquito reproductive cycle would reduce the spread of mosquitoes and the spread of diseases that these insects carry.</p><img src="https://counter.theconversation.com/content/223706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaylee Marrero receives funding from the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Andre Luis Costa-da-Silva receives funding from the Centers for Disease Control and Prevention, the Southeastern Center of Excellence in Vector-borne Disease and the National Institutes of Health. Views expressed in this article are his own. </span></em></p><p class="fine-print"><em><span>Matthew DeGennaro receives funding from the Centers for Disease Control and Prevention (CDC), the Southeastern Center of Excellence in Vector-borne Disease and the National Institutes of Health. Views expressed in this article are his own.</span></em></p>Female mosquitoes don’t want to lay their eggs alone, but they don’t want sites that are too crowded either. Understanding what guides their choice could inform new control strategies.Kaylee Marrero, Ph.D. Student and Transdisiplinary Biomolecular and Biomedical Sciences Fellow, Florida International UniversityAndre Luis da Costa da Silva, Research Assistant Professor of Biological Sciences, Florida International UniversityMatthew DeGennaro, Associate Professor of Biological Sciences, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2250912024-03-07T05:30:28Z2024-03-07T05:30:28ZBabies in WA will soon be immunised against RSV – but not with a vaccine<figure><img src="https://images.theconversation.com/files/580326/original/file-20240307-22-um2200.jpeg?ixlib=rb-1.1.0&rect=142%2C194%2C8471%2C5548&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/pediatrician-doctor-examines-newborn-stethoscope-female-2278794293">Dragana Gordic/Shutterstock</a></span></figcaption></figure><p>This week, Western Australia <a href="https://www.wa.gov.au/government/media-statements/Cook-Labor-Government/Western-Australian-children-first-to-access-protection-from-RSV-20240305">announced</a> a state government-funded immunisation program against respiratory syncytial virus (RSV). It’s the first Australian state or territory to do so. </p>
<p>All babies under eight months old and those aged eight to 19 months at increased risk of severe RSV infection will be eligible for the immunisation in WA this year.</p>
<p>RSV can cause serious illness in children, and news headlines have welcomed WA’s impending rollout of “<a href="https://www.dailytelegraph.com.au/lifestyle/health/wa-to-become-the-first-state-offering-rsv-vaccinations-for-babies-in-australia/news-story/ffc9cac0ff8ff9ea98a958ee83ef6de7">vaccinations</a>” against the virus.</p>
<p>But this immunisation differs from other <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">routine childhood vaccines</a>.</p>
<h2>Why is RSV important?</h2>
<p>RSV is the <a href="https://pubmed.ncbi.nlm.nih.gov/35636455/">most common cause</a> of respiratory infection in young children. By the age of two, almost all children show <a href="https://www.nature.com/articles/s41598-021-88524-w">evidence</a> they’ve been exposed to the virus.</p>
<p>Estimates suggest <a href="https://pubmed.ncbi.nlm.nih.gov/35013434/">2-3%</a> of infants are hospitalised with RSV with infection involving the airways and lungs. Infants under three months are at <a href="https://pubmed.ncbi.nlm.nih.gov/32031631/">highest risk</a>. RSV can also have long-lasting effects on children – there’s a well-established link between RSV and subsequent <a href="https://pubmed.ncbi.nlm.nih.gov/31370064/">wheezing illnesses</a> and asthma. </p>
<p>RSV can also be a problem for the <a href="https://theconversation.com/an-rsv-vaccine-has-been-approved-for-people-over-60-but-what-about-young-children-221311">elderly</a> and people with underlying health conditions such as those with weakened immune systems. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/an-rsv-vaccine-has-been-approved-for-people-over-60-but-what-about-young-children-221311">An RSV vaccine has been approved for people over 60. But what about young children?</a>
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</em>
</p>
<hr>
<h2>How do we protect children against RSV?</h2>
<p>Antibodies are a key part of the immune system that protect people against many viral infections, including RSV. They’re usually generated in response to infection or a vaccine, and work by attaching to proteins on the surface of RSV, therefore preventing the virus from invading the cells that line the airways and lungs. </p>
<p>The problem in newborn babies (who are at the highest risk of severe RSV infection) is that previous vaccines have not generated sufficient antibodies to provide protection.</p>
<p>So, two strategies have been developed to protect young children against RSV. These strategies are both referred to as <a href="https://immunisationhandbook.health.gov.au/contents/fundamentals-of-immunisation#passive-immunisation">passive immunisation</a>, because children receive protective antibodies from outside the body. This is different to active immunisation where we give a child a vaccine so they can generate their own antibodies.</p>
<figure class="align-center ">
<img alt="A pregnant woman sits on a couch with her daughter, with a laptop on her lap." src="https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.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">Vaccinating pregnant women is one way to protect babies against RSV.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-black-woman-working-on-laptop-1817195420">Ground Picture/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Vaccination in pregnancy</h2>
<p>One way to deliver passive immunity to young infants is by vaccinating their mothers during pregnancy. Maternal immunisation has been shown to be effective at protecting infants from other infections, including <a href="https://pubmed.ncbi.nlm.nih.gov/34446538/">influenza, whooping cough</a> (pertussis), <a href="https://www.who.int/initiatives/maternal-and-neonatal-tetanus-elimination-(mnte)/the-strategies">tetanus</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974935/">COVID</a>. </p>
<p>By delivering a single RSV vaccine to pregnant women, antibodies are generated by the mother and transported across the placenta, providing passive immunity and protection to the baby for around the first six months of life. In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2216480">clinical trial</a>, giving an RSV vaccine in late pregnancy reduced RSV in young infants by approximately 70%. But RSV vaccines for pregnant women are <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia">not yet available</a> in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-is-everywhere-right-now-what-parents-need-to-know-about-respiratory-syncytial-virus-208855">RSV is everywhere right now. What parents need to know about respiratory syncytial virus</a>
</strong>
</em>
</p>
<hr>
<h2>What are monoclonal antibodies?</h2>
<p>The other passive immunisation strategy relies on manufactured long-acting antibodies (known as “monoclonal antibodies”), which can be delivered by injection to young children. </p>
<p>This is what will be offered in WA. Nirsevimab (also known as Beyfortus) is a long-acting antibody that Australia’s Therapeutic Goods Administration (TGA) <a href="https://www.tga.gov.au/resources/auspmd/beyfortus">approved</a> in November 2023. </p>
<p>Nirsevimab binds specifically to RSV and remains in the body for several months after injection. In a key <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2110275">clinical trial</a> nirsevimab was shown to reduce RSV infections by about 75% for up to five months. </p>
<p>Several European countries have recently implemented infant programs with nirsevimab and are <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.6.2400046">reporting</a> significantly lower RSV hospitalisation rates in babies. </p>
<figure class="align-center ">
<img alt="A baby's leg with a bandaid on it." src="https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.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">For babies, the injection will normally be given in the thigh.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bandaid-on-baby-after-shot-leg-774258127">Allen Mercer/Shutterstock</a></span>
</figcaption>
</figure>
<p>Antibody therapies in various forms have been used for more than a century for the prevention and treatment of a range of conditions, dating from “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898362/">serotherapy</a>” for tetanus, diphtheria and snake bite in the late 1800s.</p>
<p>Licensed antibody products are rigorously tested in clinical trials and through post-marketing surveillance to ensure their safety. </p>
<p>For <a href="https://pubmed.ncbi.nlm.nih.gov/36634694/">nirsevimab</a> specifically, the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2110275">clinical trial</a> mentioned above included over 1,400 infants. Adverse events were reported at similar rates in the nirsevimab and placebo groups, and no serious adverse events relating to treatment were reported. No significant safety concerns have been identified in the real-world rollout in the northern hemisphere either.</p>
<h2>When does RSV occur?</h2>
<p>RSV <a href="https://pubmed.ncbi.nlm.nih.gov/35083489/">usually takes hold</a> just before the flu season in southern states, and circulates year-round in tropical areas. While influenza almost disappeared during the <a href="https://pubmed.ncbi.nlm.nih.gov/32986804/">COVID</a> pandemic, there were <a href="https://www.nature.com/articles/s41467-022-30485-3">ongoing cases</a> of RSV, albeit with a disruption to the normal seasonal pattern. </p>
<p>Since 2022, RSV has resumed its normal seasonal pattern. The WA government says the immunisations will be available <a href="https://www.wa.gov.au/government/media-statements/Cook-Labor-Government/Western-Australian-children-first-to-access-protection-from-RSV-20240305">from April</a>, which is timely in anticipation of the 2024 season.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-is-a-common-winter-illness-in-children-why-did-it-see-a-summer-surge-in-australia-this-year-156492">RSV is a common winter illness in children. Why did it see a summer surge in Australia this year?</a>
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</em>
</p>
<hr>
<h2>What about other states and territories?</h2>
<p>Free access to an immunisation against RSV should significantly benefit young children and families in WA, keeping children out of hospital this winter. </p>
<p>Whether other states will follow WA’s lead is uncertain at this stage, and we don’t yet know whether nirsevimab will in time become part of the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>, meaning it would be available for free nation-wide. </p>
<p>Ensuring equitable access, particularly for those at greatest risk of severe RSV infection, must be prioritised to ensure maximum benefit for all children and families.</p>
<p>Nirsevimab is likely to be the first of many tools to prevent RSV in children. A maternal RSV vaccine is currently under assessment <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia.">by the TGA</a> and Pharmaceutical Benefits Advisory Committee (PBAC). A vaccine for older Australians, <a href="https://www.tga.gov.au/resources/auspmd/arexvy">Arexvy</a>, is registered and is also being assessed by the <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia">PBAC</a>, with additional vaccines expected to be available in the future. </p>
<p>These developments highlight the future of RSV prevention and also the significant potential for monoclonal antibodies to play a greater role in preventing infections as part of public health programs.</p><img src="https://counter.theconversation.com/content/225091/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Blyth receives funding from the Australian Department of Health and Aged Care, National Health and Medical Research Council and the Perron Trust for RSV-related research. He has previously been a member of the Australian Technical Advisory Group on Immunisation.</span></em></p><p class="fine-print"><em><span>Allen Cheng receives funding from the Australian Department of Health and Aged Care and the National Health and Medical Research Council. He is a member of the Australian Technical Advisory Group on Immunisation.</span></em></p>The RSV shot children in WA will get is a monoclonal antibody. Here’s what that means.Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, Telethon Kids Institute, The University of Western AustraliaAllen Cheng, Professor of Infectious Diseases, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2229462024-03-05T16:03:57Z2024-03-05T16:03:57ZTo stop teenagers vaping they need to see it as cringe, not cool<figure><img src="https://images.theconversation.com/files/579543/original/file-20240304-20-xtxrty.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5449%2C3788&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/london-uk-sept-8-2019-man-1498869299">Amani A/Shutterstock</a></span></figcaption></figure><p>The proportion of young people who vape has grown significantly over the last year. According to charity <a href="https://ash.org.uk/resources/view/use-of-e-cigarettes-among-young-people-in-great-britain">Action on Smoking and Health</a>, the proportion of young people aged 11 to 17 in Great Britain who have experimented with vaping has risen from 15.8% in 2022 to 20.5% in 2023. </p>
<p>Vapes often come in gratifying and seemingly innocuous flavours, such as bubblegum, candy floss and sherbet, and in colourful and enticing packaging that is likely to <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/cb.362?saml_referrer">appeal to younger consumers</a>. </p>
<p>What’s more, young people may see vaping as a safe alternative to smoking. A 2015 review from Public Health England stated that e-cigarettes were <a href="https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review">“95% safer” than cigarettes</a>. This messaging was meant for adults addicted to cigarettes – but it has led to the perception that vaping is not harmful. </p>
<p>Nevertheless, vapes can contain <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html#:%7E:text=The%20e%2Dcigarette%20aerosol%20that,to%20a%20serious%20lung%20disease">potentially harmful and addictive substances</a>, such as nicotine and flavourings linked to lung disease.</p>
<p>In response, the <a href="https://www.gov.uk/government/news/disposable-vapes-banned-to-protect-childrens-health">government has announced</a> several measures which aim to stop vaping appealing to younger consumers. This includes a ban on the sale of disposable vapes, restrictions on appealing vape flavours, introducing plainer packaging and tighter restrictions on how retailers display vapes.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/disposable-vape-ban-local-communities-voiced-their-concerns-and-the-government-has-listened-221906">Disposable vape ban: local communities voiced their concerns – and the government has listened</a>
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</em>
</p>
<hr>
<p>This a start, but more needs to be done. A public health awareness campaign that speaks directly to <a href="https://journals.sagepub.com/doi/full/10.1177/1179173X20945695">young people</a> who are currently vaping or more <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8270-3#:%7E:text=Vaping%20was%20more%20common%20overall,relatively%20low%20rates%20of%20vaping%20%2D">susceptible to vaping</a> and seeks to make it seem cringe, not cool, could help to break the connection between vaping and social approval. </p>
<h2>Why teens vape</h2>
<p>The popularity of vaping may be linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296881/">peer pressure</a> – young people might start vaping to fit in or to impress their peers by experimenting with new things. Young people are at a critical age where they are learning to <a href="https://www.nature.com/articles/nrn3313">assert their independence</a>, and place more value on the approval and support of their peers than their parents.</p>
<p>Teenagers’ brains are more sensitive to the feelings and excitement derived from taking risks than adults’ brains are. </p>
<p>When young people think their peers are observing them, they are more likely to take risks – the reward response is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075496/">amplified</a>. This has been linked with teenagers being more predisposed to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0273229721000368?casa_token=HiKmVsY9010AAAAA:z0t6E8qMRVSD9lWpwd-dvRiQbuqcX6C-iH0l_g7eKzLA3VMAbTrW3jFh0HEzfJsoxykHDJlfDJk">risky health behaviour</a>, like vaping. </p>
<figure class="align-center ">
<img alt="Person in hoodie seen from behind blowing smoke rings" src="https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579551/original/file-20240304-26-cyqhrj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teenagers are more predisposed to take risks with their health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-male-red-hoodie-vaping-smoking-1509908339">Chicken Strip/Shutterstock</a></span>
</figcaption>
</figure>
<p>There are huge numbers of posts on social media platforms that position vaping as exciting and fun to teenagers. Popular and trending hashtags include #vapetrick, #vapefam and #vapelife. These serve to create connections and draw teenagers into a community, feeding into their need for social approval among their peers. </p>
<p>To make vaping cringe among young people they need to see it as embarrassing, disgusting and culturally unacceptable – as young people are concerned with how others judge them. Role models who focus on the negative <a href="https://digitalcommons.wayne.edu/cgi/viewcontent.cgi?article=1781&context=oa_dissertations">social consequences</a> of vaping are likely be more effective in motivating young people to see vaping as cringe.</p>
<h2>Break the connection with cool</h2>
<p>One way to break the connection with social approval, in a way that would chime with young people, would be to to involve <a href="https://www.tandfonline.com/doi/full/10.1080/1553118X.2022.2042694">social media influencers</a>. Influencers carry significant credibility with teenagers, acting as <a href="https://wsj.westscience-press.com/index.php/wsshs/article/view/548">trendsetters</a> and affecting <a href="https://www.tandfonline.com/doi/full/10.1080/1553118X.2022.2042694">social norms</a>.</p>
<p>How vaping is depicted in <a href="https://journals.sagepub.com/doi/10.1177/10901981221086944">films and across media platforms</a>, such as online video channels, also requires careful monitoring. Limiting depictions of vaping and where it is present, presenting it as undesirable behaviour rather than as cool, may go some way to limit young people wanting to vape. </p>
<p>Stronger regulation of vaping content on social media platforms popular with younger people is essential, such as monitoring the use of popular hashtags. Some platforms have started to do this. TikTok displays a warning message stating “Be informed and aware” with a link to more information on <a href="https://www.tiktok.com/safety/en-gb/substance-support/">substance support</a> when anyone searches for vaping content. </p>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/20563051211008828">Education</a> programmes typically focus on teaching young people how to critically evaluate information they encounter online, not how social media algorithms affect the content pushed towards them. School education programmes should openly discuss the potential harmful impact algorithms can have on their consumption experiences.</p>
<p>Another measure to implement would be to raise the price of vapes. This has had a significant impact on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7147-9">reducing the rate</a> of young people smoking: they are likely to be more sensitive to changes in price than adults. A <a href="https://www.theguardian.com/uk-news/2024/feb/27/budget-2024-jeremy-hunt-vaping-tax-ni-cut-vapes-tax-cuts">planned tax increase</a> from the government on vaping in the 2024 budget could have a positive effect here. </p>
<p>But care also needs to be taken in limiting teenagers’ access to vaping products. When supply of the energy drink <a href="https://www.businessinsider.com/prime-ksi-logan-paul-drink-sparked-black-market-uk-2023-2?r=US&IR=T">Prime</a> – a product also popular among younger consumers – was limited, this led to a black market emerging. Young people went to great lengths to acquire the product as a status symbol to gain social approval. Making vapes difficult to acquire could lead to young people vaping to gain kudos among their peers.</p><img src="https://counter.theconversation.com/content/222946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Moorlock 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>Influencers could play an important role in encouraging teenagers not to vape.Emily Moorlock, Senior Lecturer in Marketing, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2246212024-03-01T03:45:31Z2024-03-01T03:45:31ZCould messages from social media influencers stop young people vaping? A look at the government’s new campaign<figure><img src="https://images.theconversation.com/files/579070/original/file-20240301-18-gh27cc.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1985&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/young-man-smoking-electronic-cigarette-looking-579690556">Alexandru Chiriac/Shutterstock</a></span></figcaption></figure><p>Vaping is on the rise among young Australians. Recent figures from the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey/contents/tobacco-and-e-cigarettes-vapes">National Drug Strategy Household Survey</a> show current use of e‑cigarettes among teenagers aged 14–17 increased five-fold from 1.8% in 2019 to 9.7% in 2022–2023. For young adults aged 18–24, use quadrupled from 5.3% to 21% over the same time period. </p>
<p>If these young Australians were using e-cigarettes to quit smoking, perhaps we would have slightly less to worry about. But many young Australians using e-cigarettes do so recreationally and haven’t previously been exposed to nicotine. Although we’re still learning about how vaping will affect health in the long term, we know e-cigarettes <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51890">are harmful</a>.</p>
<p>Reforms <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">introduced this year</a> by the federal government will be key to reducing rates of e-cigarette use among young Australians, while ensuring those who are genuinely using e-cigarettes to quit smoking have a pathway to do so. </p>
<p>It will take some time to see a reduction in e-cigarette use as a result of these reforms. We need to be patient, and give the laws time to work. Enforcement will be key. But if there’s anything we’ve learnt from decades of tobacco control, it’s that we need a comprehensive approach.</p>
<p>This is where the federal government’s <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-of-vaping-reform-and-launch-of-influencer-led-youth-vaping-campaign?language=en">latest initiative</a> – a social media campaign targeting youth vaping – comes in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-non-smokers-in-nz-are-taking-up-vaping-more-than-ever-before-here-are-5-reasons-why-185400">Young non-smokers in NZ are taking up vaping more than ever before. Here are 5 reasons why</a>
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</em>
</p>
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<h2>From television to TikTok</h2>
<p>Many will be familiar with the anti-smoking TV ads that have aired over the past several decades. Who could forget the “<a href="https://www.cancer.nsw.gov.au/prevention-and-screening/preventing-cancer/campaigns/quit-smoking-campaigns/sponge">Sponge</a>” campaign featuring tar being squeezed out of a sponge into a jar to represent the tar in the lungs of those who smoke.</p>
<p>Or the <a href="https://www.cancer.nsw.gov.au/prevention-and-screening/preventing-cancer/campaigns/quit-smoking-campaigns/terrie-anti-smoking-campaign">hard-hitting testimonial</a> featuring a former smoker named Terrie diagnosed with oral and throat cancer, who had her larynx removed. </p>
<p>But times have changed. Tobacco smoking <a href="https://pp.aihw.gov.au/reports/smoking/tobacco-smoking-ndshs">continues to decline</a> and young Australians spend a lot of their time on social media. For better or worse, platforms such as Snapchat, TikTok, YouTube and Instagram have <a href="https://doi.org/10.1177/2056305119886025">become a source of information</a> for youth. </p>
<p>And so we need to be creative with our campaigns. We need to present information in a fresh way.</p>
<p>The government’s new <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-of-vaping-reform-and-launch-of-influencer-led-youth-vaping-campaign?language=en">influencer-led youth vaping campaign</a> aims “to spark a conversation with the next generation of Australians about the harms of vaping and nicotine addiction”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1762620319968485798"}"></div></p>
<p>This campaign will feature a range of influencers seeking to combat the large amount of pro-vaping content on social media platforms. These influencers – people like Ella Watkins (a writer and actor), Ellyse Perry (a cricketer), Zahlia and Shyla Short (surfers), the Fairbairn Brothers (comedians), and JackBuzza (a gamer) – span multiple areas to ensure young Australians with diverse interests are reached. Some have vaped in the past and subsequently quit. </p>
<p>The government hopes these influencers will engage young people using their own unique style and tone, and communicate authentically about the harms associated with e-cigarette use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
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</em>
</p>
<hr>
<h2>The influence of influencers</h2>
<p>The campaign capitalises on what can be powerful <a href="https://www.verywellmind.com/what-is-a-parasocial-relationship-5210770">parasocial relationships</a>: one-sided relationships where a person becomes emotionally connected to a public figure such as a celebrity or influencer. Social media influencers are in our children’s bedrooms, bathrooms, and classrooms. Why not use them to promote healthy attitudes and behaviours?</p>
<p>Emerging <a href="https://journals.sagepub.com/doi/full/10.1177/2056305120912475">research</a> suggests the use of social media influencers in anti-vaping campaigns could be a promising strategy for improving the reach of public health messaging and engagement with the target audience. </p>
<p>In the context of vaccination, the use of social influencers in a campaign promoting the flu vaccine in the United States led to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240828">significant increases</a> in positive beliefs about the vaccine and marked decreases in negative attitudes toward it.</p>
<figure class="align-center ">
<img alt="A young woman vaping indoors." src="https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579073/original/file-20240301-28-wxfoog.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">Data shows vaping is on the rise among young Australians.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-young-vaping-girl-vapor-1024757749">Lifestyle and Wedding ph/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Will this campaign be effective?</h2>
<p>The use of social influencers to promote a healthy lifestyle is still a relatively new frontier in health communication, and whether this campaign will be effective is a tricky question to answer. </p>
<p>There are several <a href="https://www.tandfonline.com/doi/full/10.1080/17538068.2023.2249714">benefits to this approach</a>, such as leveraging the relationships influencers have built with their audience, enhanced authenticity, and meaningful communication of health information. </p>
<p>It also provides an opportunity to shift social norms. In the context of tobacco and vaping control specifically, public health has far fewer resources compared to the tobacco and vaping industries. The strategic use of social influencers can help organisations involved in health promotion to <a href="https://journals.sagepub.com/doi/full/10.1177/2056305120912475">overcome this commercial imbalance</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-i-help-my-teen-quit-vaping-201558">How can I help my teen quit vaping?</a>
</strong>
</em>
</p>
<hr>
<p>But there could also be risks associated with this campaign, such as the lack of control over the content an influencer may choose to share, and their actions and opinions on other topics, which may affect their credibility. Vetting influencers and implementing <a href="https://www.fda.gov/media/165158/download">risk mitigation plans</a> will be crucial steps for the government to take. </p>
<p>Specific details of the campaign are yet to be released, so we don’t know exactly how the influencers will be engaged to combat increasing rates of e-cigarette use among youth. But we will be closely watching this innovative approach.</p><img src="https://counter.theconversation.com/content/224621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Jongenelis currently receives funding from the National Health and Medical Research Council and the WA Health Promotion Foundation (Healthway). She is affiliated with the Australian Council on Smoking and Health and the World Federation of Public Health Associations' Tobacco Control Working Group.
Michelle has never received services, assistance, or support (whether monetary or non-monetary in nature) from the tobacco industry and/or e-cigarette industry. Michelle has never provided services, assistance, or support (whether monetary or non-monetary in nature) to the tobacco and/or e-cigarette industry.
</span></em></p>Times have changed. While in decades past we watched anti-smoking campaigns on TV, we now need anti-vaping messages on TikTok.Michelle Jongenelis, Associate Professor, Melbourne Centre for Behaviour Change, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2243122024-02-27T12:32:52Z2024-02-27T12:32:52ZE-bike incentives are a costly way to cut carbon emissions, but they also promote health, equity and cleaner air<figure><img src="https://images.theconversation.com/files/577761/original/file-20240225-22-nb9e6p.jpg?ixlib=rb-1.1.0&rect=7%2C15%2C5019%2C2916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man pulls his kids behind an electric bicycle near the pier in Huntington Beach, Calif.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-pulls-his-kids-behind-an-electric-bicycle-near-the-pier-news-photo/1311180585">Paul Bersebach/Orange County Register via Getty Images</a></span></figcaption></figure><p>E-bikes have captured <a href="https://velo.outsideonline.com/ebike/ebike-gear/5-e-bike-trends-we-expect-to-see-in-2024/">widespread attention</a> across the U.S., and for good reason. They are <a href="https://cleantechnica.com/2023/12/11/e-bikes-are-radically-more-efficient-than-electric-cars/">the most energy-efficient way</a> to move from place to place, providing exercise in the process, and offer enough assistance while pedaling uphill or into headwinds to make them usable for many types of riders. </p>
<p>Greenhouse gas emissions from e-bikes are much lower than those from either gasoline-powered or <a href="https://www.itf-oecd.org/good-go-assessing-environmental-performance-new-mobility">electric cars</a>. Some cities and states are encouraging the use of e-bikes by providing purchase incentives, often drawing on public funds dedicated to curbing climate change.</p>
<p>Currently, over 100 cities and states <a href="https://trec.pdx.edu/news/e-bike-incentive-programs-north-america-new-online-tracker">have or plan to launch e-bike incentive programs</a>, most funded by energy or environment initiatives. However, there has been little research on the effectiveness of these types of programs, how to design them or how to define goals. </p>
<p>We study transportation from many angles, including <a href="https://scholar.google.com/citations?user=I3wi1-EAAAAJ&hl=en">innovation</a>, <a href="https://www.researchgate.net/profile/John-Macarthur-4">sustainability</a> and <a href="https://scholar.google.com/citations?user=JltA3IAAAAAJ&hl=en">economics</a>. Our new study, published in the journal <a href="https://doi.org/10.1016/j.trd.2024.104114">Transportation Research Part D</a>, investigates the effectiveness of several types of e-bike purchase incentives and the investment required to induce additional e-bike purchases. </p>
<p>We found that incentives do spur extra e-bike purchases, but at a relatively high cost compared with narrowly defined climate benefits. We find that a public agency using a point-of-purchase discount would have to distribute about US$4,000 in incentives to generate one additional e-bike purchase. This is because over 80% of people who buy an e-bike would likely have bought one even without the discount. For perspective, it takes <a href="https://doi.org/10.1016/j.jeem.2017.01.002">about $30,000 worth of incentives</a> to induce an electric car purchase. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/8cAJzqjNx0I?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">California initiated a $10 million statewide program in 2023 that offers voucher incentives to low-income residents for purchasing electric bikes.</span></figcaption>
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<p>Nonetheless, e-bikes provide many other benefits. They make mobility easier and more affordable for many people, including <a href="https://doi.org/10.1016/j.trip.2023.100940">older adults and people with disabilities</a>. They bolster the case for <a href="https://orbit.dtu.dk/en/publications/cost-benefit-of-bicycle-infrastructure-with-e-bikes-and-cycle-sup">investing in bike paths and infrastructure</a>, which produce <a href="https://www.urban.org/urban-wire/why-us-cities-are-investing-safer-more-connected-cycling-infrastructure">economic, safety and mobility benefits for cities</a>. And they <a href="https://doi.org/10.1016/j.jth.2017.06.002">boost health by promoting exercise</a>. In our view, cities and states should assess e-bike incentive investments based on this broad range of benefits, rather than focusing solely on a narrow environmental objective.</p>
<h2>Not just a climate tool</h2>
<p>Clean technology incentives tend to be focused on a specific outcome – usually, reducing greenhouse gas emissions. This works well for most energy-related upgrades, such as replacing old air conditioners, improving home insulation and generating electricity from wind and solar power. Consumers want the services that these devices deliver – cool air, comfortable conditions indoors and electricity that’s available and affordable. The new devices simply deliver those familiar goods more sustainably. </p>
<p>E-bike incentives are different. They invite people to adopt a new technology that can fundamentally change recipients’ travel patterns. In fact, while replacing car trips with e-bike trips <a href="https://doi.org/10.1016/j.trd.2020.102482">can provide substantial climate benefits</a>, those benefits may be smaller than other benefits that are less widely measured. Focusing narrowly on reducing greenhouse gas emissions by replacing car trips means providing incentives to people who drive the most, or who drive the biggest gas guzzlers.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/C3lJZJpp8jH/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>But what about carless households, transit riders or bicyclists? For them, e-bikes can make it much easier to travel in most North American cities. That increased mobility could provide greater access to jobs, shopping or other important services, such as health care.</p>
<h2>Is investing in e-bike incentives worth it?</h2>
<p>Transportation is the <a href="https://www.epa.gov/ghgemissions/sources-greenhouse-gas-emissions">largest source of U.S. greenhouse gas emissions</a>. Electrifying as much of it as possible is an important strategy for slowing climate change. However, e-bike incentives – and, indeed, electric car incentives – are pretty expensive ways to reduce emissions. </p>
<p>The importance of e-bike incentives is that e-bikes are good at replacing car trips and make daily trips easier for people who rely on other options. These advantages provide two main classes of benefits from increasing ownership of e-bikes.</p>
<p>The first set of benefits comes from substituting car-based trips with e-bike trips. Transportation researchers think about a swap like this in terms of vehicle miles traveled.</p>
<p>If I used to drive to work but now ride an e-bike, many benefits will be proportional to the number of miles that I now cover by bike rather than by car. They include reduced traffic congestion, lower fuel and parking costs, increased physical activity and improved health, cleaner air and reduced greenhouse gas emissions. In North America, <a href="https://nitc.trec.pdx.edu/research/project/1041">about 60% of e-bike trips replace car trips</a>. </p>
<p>A second class of benefits comes from improvements in mobility. These effects are more complex to measure. For many people in U.S. cities who don’t own cars, the basic options for getting around are walking, public transit, ride-hailing services like Uber and Lyft, or riding a conventional bicycle. In almost all cases, e-bikes would get them to their destinations faster. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/rQhzEnWCgHA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A father explains how his family used electric cargo bikes to replace a car in Toronto and the Netherlands.</span></figcaption>
</figure>
<p>Carless households <a href="https://rosap.ntl.bts.gov/view/dot/63059">tend to have lower income</a> and lack mobility options. E-bike incentives can make travel more affordable and give people better access to jobs, health care, child care, shopping and other destinations. Such benefits likely far exceed any nominal greenhouse gas accounting from these transportation users. </p>
<p>E-bike purchase incentives are an investment in the broad benefits that e-bikes can provide. We believe they should be measured against the collective goals of the agency providing the incentives, whether its mission is transportation, equitable mobility, public health, economic development or environmental protection. </p>
<h2>Putting more people on two wheels</h2>
<p>Once there’s agreement that e-bikes are worth supporting for many reasons, the challenge is how to induce more e-bike use and realize those benefits.</p>
<p>Point-of-purchase discounts or vouchers are the most popular strategy, because they mimic other clean energy incentives, such as those for high-efficiency appliances or electric cars. Our study found that they are also the most efficient way to influence consumer behavior compared with other purchase incentives, such as rebates. </p>
<p>Other strategies could be more effective but need further research. For example, <a href="https://nextcity.org/urbanist-news/bike-libraries-are-increasing-access-to-bikes-across-america">e-bike lending libraries</a> let people test-ride e-bikes without ownership. And employers can <a href="https://transweb.sjsu.edu/sites/default/files/2051-Fitch-Ebike-Employer.pdf">provide e-bikes to employees</a> to help encourage more sustainable and affordable ways to get to work. </p>
<p>Partnering with community organizations or local mobility-oriented programs could be an effective way to get e-bikes into the hands of people who need them and couldn’t afford them otherwise. And giving e-bike owners more reason to use them, such as <a href="https://momentummag.com/is-it-time-governments-start-paying-people-to-bike-to-work/">payments for biking to work</a>, could increase e-bike use and subsequent benefits. </p>
<p>E-bike purchase incentives may be an expensive climate solution, but they also offer other important benefits. Carefully designed incentive programs could help many urban and suburban residents access a faster, healthier and cleaner way to get where they need to go.</p><img src="https://counter.theconversation.com/content/224312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher R. Cherry receives research funding from State and Federal Departments of Transportation and the National Science Foundation. He has consulted for micromobility operators and bicycling advocacy organizations.</span></em></p><p class="fine-print"><em><span>John MacArthur has received research support and funding from state and federal agencies, the National Science Foundation, micromobility operators and bicycling advocacy organizations.</span></em></p><p class="fine-print"><em><span>Luke Jones 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>Many incentive programs promote e-bike use, but they aren’t necessarily targeting the right people for the right reasons.Christopher R. Cherry, Professor of Civil and Environmental Engineering, University of TennesseeJohn MacArthur, Sustainable Transportation Program Manager, Transportation Research and Education Center, Portland State UniversityLuke Jones, Professor of Economics, Valdosta State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2206352024-02-23T13:50:45Z2024-02-23T13:50:45ZEarly COVID-19 research is riddled with poor methods and low-quality results − a problem for science the pandemic worsened but didn’t create<figure><img src="https://images.theconversation.com/files/577159/original/file-20240221-22-ttfzl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2070%2C1449&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic spurred an increase in COVID-19 research, much of it with methodological holes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-damage-royalty-free-image/1266909460">Andriy Onufriyenko/Moment via Getty Images</a></span></figcaption></figure><p>Early in the COVID-19 pandemic, researchers <a href="https://doi.org/10.1038/d41586-020-03564-y">flooded journals</a> with studies about the then-novel coronavirus. Many publications streamlined the peer-review process for COVID-19 papers while keeping acceptance rates relatively high. The assumption was that policymakers and the public would be able to identify valid and useful research among a very large volume of rapidly disseminated information.</p>
<p>However, in my review of 74 COVID-19 papers published in 2020 in the top 15 generalist public health journals listed in Google Scholar, I found that many of these studies used <a href="https://doi.org/10.1162/qss_a_00257">poor quality methods</a>. <a href="https://doi.org/10.1186/s12874-020-01190-w">Several other</a> <a href="https://doi.org/10.1038/s41467-021-21220-5">reviews of</a> <a href="https://doi.org/10.1371/journal.pone.0241826">studies published</a> in medical journals have also shown that much early COVID-19 research used poor research methods.</p>
<p>Some of these papers have been cited many times. For example, the most highly cited public health publication listed on Google Scholar <a href="https://doi.org/10.3390/ijerph17051729">used data</a> from a sample of 1,120 people, primarily well-educated young women, mostly recruited from social media over three days. Findings based on a small, self-selected convenience sample cannot be generalized to a broader population. And since the researchers ran more than 500 analyses of the data, many of the statistically significant results are likely chance occurrences. However, this study has been cited <a href="https://scholar.google.com/citations?hl=en&vq=med_publichealth&view_op=list_hcore&venue=kEa56xlDDN8J.2023">over 11,000 times</a>.</p>
<p>A highly cited paper means a lot of people have mentioned it in their own work. But a high number of citations is not <a href="https://doi.org/10.1089/ees.2016.0223">strongly linked to research quality</a>, since researchers and journals can game and manipulate these metrics. High citation of low-quality research increases the chance that poor evidence is being used to inform policies, further eroding public confidence in science.</p>
<h2>Methodology matters</h2>
<p>I am a <a href="https://scholar.google.com/citations?user=X1o1PaQAAAAJ&hl=en">public health researcher</a> with a long-standing interest in research quality and integrity. This interest lies in a belief that science has helped solve important social and public health problems. Unlike the anti-science movement <a href="https://theconversation.com/misinformation-is-a-common-thread-between-the-covid-19-and-hiv-aids-pandemics-with-deadly-consequences-187968">spreading misinformation</a> about such successful public health measures as vaccines, I believe rational criticism is fundamental to science.</p>
<p>The quality and integrity of research depends to a considerable extent on its methods. Each type of study design needs to have certain features in order for it to provide valid and useful information. </p>
<p>For example, researchers have <a href="https://www.sfu.ca/%7Epalys/Campbell&Stanley-1959-Exptl&QuasiExptlDesignsForResearch.pdf">known for decades</a> that for studies evaluating the effectiveness of an intervention, a <a href="https://www.britannica.com/science/control-group">control group</a> is needed to know whether any observed effects can be attributed to the intervention. </p>
<p><a href="https://doi.org/10.1111/dmcn.15719">Systematic reviews</a> pulling together data from existing studies should describe how the researchers identified which studies to include, assessed their quality, extracted the data and preregistered their protocols. These features are necessary to ensure the review will cover all the available evidence and tell a reader which is worth attending to and which is not.</p>
<p>Certain types of studies, such as one-time surveys of convenience samples that aren’t representative of the target population, collect and analyze data in a way that does not allow researchers to determine whether one variable <a href="https://doi.org/10.1017/S0033291720005127">caused a particular outcome</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WUErib-fXV0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Systematic reviews involve thoroughly identifying and extracting information from existing research.</span></figcaption>
</figure>
<p>All <a href="https://www.equator-network.org/">study designs have standards</a> that researchers can consult. But adhering to standards slows research down. Having a control group doubles the amount of data that needs to be collected, and identifying and thoroughly reviewing every study on a topic takes more time than superficially reviewing some. Representative samples are harder to generate than convenience samples, and collecting data at two points in time is more work than collecting them all at the same time.</p>
<p><a href="https://doi.org/10.1038/s41467-021-21220-5">Studies comparing</a> <a href="https://doi.org/10.1186/s12916-021-01920-x">COVID-19 papers</a> <a href="https://doi.org/10.1371/journal.pone.0241826">with non-COVID-19</a> papers published in the same journals found that COVID-19 papers tended to have lower quality methods and were less likely to adhere to reporting standards than non-COVID-19 papers. COVID-19 papers rarely had predetermined hypotheses and plans for how they would report their findings or analyze their data. This meant there were no safeguards against <a href="https://doi.org/10.1136/bmjebm-2020-111584">dredging the data</a> to find “statistically significant” results that could be selectively reported.</p>
<p>Such methodological problems were likely overlooked in the <a href="https://doi.org/10.1038/s41562-020-0911-0">considerably shortened</a> <a href="https://doi.org/10.1162/qss_a_00076">peer-review process</a> for COVID-19 papers. One study estimated the average time from submission to acceptance of 686 papers on COVID-19 to be <a href="https://doi.org/10.1038/s41467-021-21220-5">13 days, compared with 110 days</a> in 539 pre-pandemic papers from the same journals. In my study, I found that two online journals that published a very high volume of methodologically weak COVID-19 papers had a peer-review process of <a href="https://doi.org/10.1162/qss_a_00257">about three weeks</a>.</p>
<h2>Publish-or-perish culture</h2>
<p>These quality control issues were present before the COVID-19 pandemic. The pandemic simply pushed them into overdrive.</p>
<p>Journals tend to favor <a href="https://doi.org/10.1371/journal.pone.0010068">positive, “novel” findings</a>: that is, results that show a statistical association between variables and supposedly identify something previously unknown. Since the pandemic was in many ways novel, it provided an opportunity for some researchers to make bold claims about how COVID-19 would spread, what its effects on mental health would be, how it could be prevented and how it might be treated.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person with head in hands, elbows planted on stacks of paperwork and books littering a desk, glasses and laptop on the side" src="https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577161/original/file-20240221-26-tv7gdq.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">Many researchers feel pressure to publish papers in order to advance their careers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/surrounded-by-work-royalty-free-image/637293916">South_agency/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Academics have worked in a <a href="https://doi.org/10.1089/ees.2016.0223">publish-or-perish</a> <a href="https://doi.org/10.1177/1745691612459058">incentive system</a> for decades, where the number of papers they publish is part of the metrics used to evaluate employment, promotion and tenure. The <a href="https://theconversation.com/misinformation-is-a-common-thread-between-the-covid-19-and-hiv-aids-pandemics-with-deadly-consequences-187968">flood of mixed-quality COVID-19 information</a> afforded an opportunity to increase their publication counts and boost citation metrics as journals sought and rapidly reviewed COVID-19 papers, which were more likely to be cited than non-COVID papers.</p>
<p>Online publishing has also contributed to the deterioration in research quality. Traditional academic publishing was limited in the quantity of articles it could generate because journals were packaged in a printed, physical document usually produced only once a month. In contrast, some of <a href="https://doi.org/10.1002/leap.1566">today’s online</a> <a href="https://doi.org/10.1001/jama.2023.3212">mega-journals</a> publish thousands of papers a month. Low-quality studies rejected by reputable journals can still find an outlet happy to publish it for a fee.</p>
<h2>Healthy criticism</h2>
<p>Criticizing the quality of published research is fraught with risk. It can be misinterpreted as throwing fuel on the raging fire of anti-science. My response is that a critical and rational approach to the production of knowledge is, in fact, fundamental to the very practice of science and to the functioning of an <a href="https://doi.org/10.1057/palgrave.jors.2602573">open society</a> capable of solving complex problems such as a worldwide pandemic.</p>
<p>Publishing a large volume of misinformation disguised as science during a pandemic <a href="https://doi.org/10.1073/pnas.1912444117">obscures true and useful knowledge</a>. At worst, this can lead to bad public health practice and policy. </p>
<p>Science done properly produces information that allows researchers and policymakers to better understand the world and test ideas about how to improve it. This involves <a href="https://doi.org/10.1371/journal.pmed.1001747">critically examining the quality</a> of a study’s designs, statistical methods, reproducibility and transparency, not the <a href="https://doi.org/10.1016/j.jclinepi.2021.05.018">number of times it has been cited</a> or tweeted about.</p>
<p>Science depends on a <a href="https://doi.org/10.1007/s10654-023-01049-6">slow, thoughtful and meticulous approach</a> to data collection, analysis and presentation, especially if it intends to provide information to enact effective public health policies. Likewise, thoughtful and meticulous peer review is unlikely with papers that appear in print only three weeks after they were first submitted for review. Disciplines that reward quantity of research over quality are also less likely to protect scientific integrity during crises.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two scientists pipetting liquids under a fume hood, with another scientist in the background examining a sample" src="https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577167/original/file-20240221-22-hmviem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rigorous science requires careful deliberation and attention, not haste.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-scientist-drops-liquid-into-test-tube-royalty-free-image/127871289">Assembly/Stone via Getty Images</a></span>
</figcaption>
</figure>
<p>Public health heavily draws upon disciplines that are <a href="https://doi.org/10.1038/526182a">experiencing</a> <a href="https://doi.org/10.1177/1745691612462588">replication</a> <a href="https://doi.org/10.1371/journal.pmed.0020124">crises</a>, such as psychology, biomedical science and biology. It is similar to these disciplines <a href="https://doi.org/10.1146/annurev-statistics-031219-041104">in terms of its</a> incentive structure, study designs and analytic methods, and its inattention to transparent methods and replication. Much public health research on COVID-19 shows that it suffers from similar poor-quality methods.</p>
<p>Reexamining how the discipline rewards its scholars and assesses their scholarship can help it better prepare for the next public health crisis.</p><img src="https://counter.theconversation.com/content/220635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dennis M. Gorman 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>Pressure to ‘publish or perish’ and get results out as quickly as possible has led to weak study designs and shortened peer-review processes.Dennis M. Gorman, Professor of Epidemiology and Biostatistics, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236102024-02-22T13:43:36Z2024-02-22T13:43:36ZEPA has tightened its target for deadly particle pollution − states need more tools to reach it<p>Tens of millions of Americans, including many Texans like me, live in counties that will soon be <a href="https://www.epa.gov/system/files/documents/2024-02/table_annual-pm25-county-design-values-2020-2022-for-web.pdf">violating air pollution particle standards</a> for the first time. It’s not that our air is getting dirtier – it’s because the U.S. Environmental Protection Agency just <a href="https://www.epa.gov/pm-pollution/final-reconsideration-national-ambient-air-quality-standards-particulate-matter-pm">tightened its cap</a> on the <a href="https://doi.org/10.1029/2022GH000711">deadliest air pollutant: fine particulate matter</a>, or PM2.5.</p>
<p>The EPA acted because the Clean Air Act requires it to periodically <a href="https://www.epa.gov/criteria-air-pollutants/process-reviewing-national-ambient-air-quality-standards">review existing standards</a> for six major air pollutants to ensure that the targets protect public health. Its <a href="https://cfpub.epa.gov/ncea/isa/recordisplay.cfm?deid=354490">2022 scientific review</a> showed that fine particles increase rates of illnesses and death even when inhaled at levels below existing standards. </p>
<p>The EPA estimates that meeting its new standard would yield up to US$77 in health benefits for each $1 of control costs and would <a href="https://www.epa.gov/newsreleases/epa-finalizes-stronger-standards-harmful-soot-pollution-significantly-increasing">save up to 4,500 lives in 2032</a>. </p>
<p>Now, states must develop plans that meet the standard. As an atmospheric scientist who has <a href="https://scholar.google.com/citations?user=U4vSW6MAAAAJ&hl=en">studied air pollution</a> for a quarter century, I’m concerned that a lack of detailed measurement data will leave many states flying blind. </p>
<p>Furthermore, the <a href="https://www.epa.gov/system/files/documents/2024-02/naaqs_pm_reconsideration_ria_final.pdf">regulatory analysis</a> that the EPA issued alongside its rule focused only on a narrow set of local control options, neglecting some of the most important upwind sources of particulate matter. That myopic approach could lead to plans that save fewer lives – and at higher costs – than states could achieve with better data and more comprehensive strategies. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GVBeY1jSG9Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Fine particle pollution contributes to many deadly diseases, including heart attack, stroke, lung disease and cancer.</span></figcaption>
</figure>
<h2>What’s in a particle?</h2>
<p>The EPA’s <a href="https://www.epa.gov/pm-pollution/final-reconsideration-national-ambient-air-quality-standards-particulate-matter-pm">new standard</a> limits PM2.5, the smallest regulated particles, to 9 micrograms per cubic meter of air. This is the midpoint of a <a href="https://casac.epa.gov/ords/sab/r/sab_apex/casac/ar?session=32311776731473">recommended range</a> from the agency’s Clean Air Scientific Advisory Committee and a 25% cut from the prior cap. This new cap is <a href="https://www.airclim.org/air-quality-standards-worldwide">among the toughest in the world</a>.</p>
<p>Although federal standards lump all fine particles together as a single pollutant, they’re more like a stew of ingredients. Some, like sea salt, dust and black carbon, are emitted to the air directly as particles. Others, like sulfate, nitrate and ammonium, start out mainly as gases that interact in the atmosphere to form particles downwind. Organic carbon, the leading type of PM in many regions, originates as both gases and particles that react in complex ways.</p>
<p>Countless natural sources such as trees and soils, and human-made ones such as vehicles, factories and fertilizers, add various mixes of these ingredients to the stew.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic comparing PM2.5 to human hair and beach sand grains" src="https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576853/original/file-20240220-26-1zrtec.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fine particulates (red dots) are 2.5 microns in diameter – far smaller than the width of a human hair.</span>
<span class="attribution"><a class="source" href="https://www.epa.gov/system/files/images/2022-04/particulate-size.gif">USEPA</a></span>
</figcaption>
</figure>
<p>States operate <a href="https://www.epa.gov/system/files/documents/2023-06/PM_2022.pdf">more than 1,000 monitors</a> that measure the total amount of PM in the air. Unfortunately, only about 150 of those monitors are sophisticated versions called speciation monitors that <a href="https://www.epa.gov/amtic/chemical-speciation-network-csn">measure what the PM is made of</a> – information that’s critical for developing effective controls. Thousands of counties don’t even have a total PM monitor, despite satellite evidence showing that <a href="https://www.rff.org/news/press-releases/new-satellite-data-show-twice-as-many-americans-live-in-counties-not-meeting-fine-particulate-air-quality-standards-than-previously-thought/">many would exceed the new standard</a>.</p>
<p>When the EPA first regulated fine particles separately from coarse ones, known as PM10, in the late 1990s, it <a href="https://www.gao.gov/assets/rced-99-215.pdf">developed a plan</a> to routinely measure the content of PM at over 300 metropolitan sites. It also funded <a href="https://cfpub.epa.gov/si/si_public_record_report.cfm?Lab=NERL&TIMSType=PUBLISHED+REPORT&actType=Product&dirEntryId=161403&displayIt=Yes&searchAll=Climate+and+Modeling&showCriteria=0&sortBy=revisionDate&startIndex=51&subject=Climate+Change+Research">temporary Supersites</a> at which scientists intensely studied particles in eight of the most polluted cities.</p>
<p>When I worked on reducing particle pollution for Georgia’s air agency in the early 2000s, those speciation monitors and the <a href="https://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntryId=66293&Lab=NERL">Atlanta Supersite</a> provided crucial data to inform our efforts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of PM2.5 formation in the air." src="https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=341&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=341&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=341&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=428&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=428&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576871/original/file-20240220-18-k88ayo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=428&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Three major emissions form inorganic fine airborne particulate matter: nitrogen oxides (NOx), largely from cars and trucks; sulfur dioxide (SO2) from power plants and factories; and ammonia (NH3) from agriculture. Sunlight and chemical reactions in the atmosphere convert the emissions to new chemical species that can combine to form tiny particles known as PM2.5.</span>
<span class="attribution"><a class="source" href="https://energy.mit.edu/news/regulating-particulate-pollution-novel-analysis-yields-new-insights/">MIT Energy Initiative</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Now, about half of the speciation monitors are gone for lack of funding, and the EPA hasn’t announced a follow-up to its Supersite program. The agency’s inspector general <a href="https://19january2021snapshot.epa.gov/sites/static/files/2015-12/documents/pmreport20030930.pdf">warned as far back as 2003</a> that better measurements were needed to inform timely reductions of PM. Instead, Congress cut EPA’s budgets in the early 2000s, driving the <a href="https://www.tandfonline.com/doi/full/10.1080/10962247.2014.956904">closure of dozens of monitors</a> after the size of the network <a href="https://www.epa.gov/system/files/documents/2022-08/PM_2021.pdf">peaked in 2005</a>.</p>
<p>The composition of particles has changed dramatically since then as <a href="https://www.epa.gov/transportation-air-pollution-and-climate-change/smog-soot-and-other-air-pollution-transportation">vehicles have gotten cleaner</a>, <a href="https://www.epa.gov/power-sector/latest-emission-comparisons-pollution-controls">power plant emissions have plummeted</a> and <a href="https://doi.org/10.1038/s41586-023-06522-6">wildfires have intensified</a>. EPA tightened the PM2.5 standard in <a href="https://www.epa.gov/sites/default/files/2016-04/documents/2012_aqi_factsheet.pdf">in 2012</a> and again this year, so it’s more important than ever to know what these particles are made of now. </p>
<p>Many counties whose PM levels exceed the new standard lack speciation monitors and have never been the focus of an intensive scientific field study. Others lack sufficient data to develop a comprehensive plan.</p>
<h2>A Texas illustration</h2>
<p>My home state of Texas illustrates the data void. In the early 2000s, Houston <a href="http://dept.ceer.utexas.edu/ceer/texaqs/superfacts.html">hosted a Supersite</a> and various <a href="https://csl.noaa.gov/projects/2006/">other</a> <a href="https://www2.acom.ucar.edu/campaigns/discover-aq-houston">temporary</a> <a href="https://earth.gsfc.nasa.gov/acd/campaigns/tracer-aq">studies</a>. Today, our only <a href="https://gispub.epa.gov/air/trendsreport/2023/#pm2_5_composition">remaining speciation monitor</a> sits near the refinery-lined Houston Ship Channel, but our highest PM is measured <a href="https://www17.tceq.texas.gov/tamis/index.cfm?fuseaction=report.view_site&CAMS=1052">18 miles away</a>, where a busy interstate loop transects trendy neighborhoods near a concrete plant.</p>
<p>That data gap pales in comparison to the ones facing Hidalgo, Cameron and Webb counties along the Texas-Mexico border, home to the cities of McAllen, Brownsville and Laredo. Like Houston, their total particulate levels fall between the new and old standards. However, their particle pollution has never been analyzed in a major field study, and there’s no speciation monitor within <a href="https://tceq.maps.arcgis.com/apps/webappviewer/index.html?id=ab6f85198bda483a997a6956a8486539">over 100 miles</a>.</p>
<p>This isn’t just a Texas problem.</p>
<p><a href="https://www3.epa.gov/airquality/greenbook/map/mappm25both.pdf">Several regions</a> of California, Pennsylvania, Utah and Ohio, along with small portions of Alaska, Arizona, Idaho and Oregon, violated previous PM standards, so those states have some experience developing PM control plans. The new limit will require them to redouble their control efforts. </p>
<p>However, <a href="https://www.epa.gov/system/files/documents/2024-02/table_annual-pm25-county-design-values-2020-2022-for-web.pdf">various counties in 18 other states</a>, including Colorado, Florida, Michigan, Mississippi and Tennessee, have PM levels that fall between the previous and new standards. They will likely need to develop plans for the first time.</p>
<p>Cities such as Nashville, Tennessee; Kansas City, Kansas; Fort Lauderdale and Pensacola in Florida; and Hattiesburg and Gulfport in Mississippi also exceed the new standards but lack speciation monitors.</p>
<p><iframe id="ENtxQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ENtxQ/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>A need for broader controls</h2>
<p>Lacking better data, states may fall back on the types of strategies outlined in the <a href="https://www.epa.gov/system/files/documents/2024-02/naaqs_pm_reconsideration_ria_final.pdf">EPA’s regulatory analysis</a>. The agency suggested that states focus on controlling <a href="https://www.epa.gov/system/files/documents/2024-02/naaqs_pm_reconsideration_ria_final.pdf">local sources that directly emit particles</a>, such as road dust, agricultural dust and cooking emissions.</p>
<p>But this approach neglects particles that form from gases emitted far upwind. For example, ammonia from agriculture reacts with sulfur dioxide from coal burning and nitrogen oxides from various sources to form ammonium, sulfate and nitrate, which are among the <a href="http://dx.doi.org/10.1097/EDE.0000000000000297">leading components of particulate matter</a>. </p>
<p>Controlling ammonia is one of the <a href="https://www.newscientist.com/article/2296406-cutting-ammonia-emissions-may-be-the-best-way-to-reduce-air-pollution/">most cost-effective opportunities</a> to <a href="https://pubs.acs.org/doi/10.1021/es060379a">improve air quality</a>. Reducing emissions of this <a href="https://www.clean-air-farming.eu/en/activities/abatement-measures">long-neglected pollutant</a> will require better practices for managing livestock, fertilizers and manure on farms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Aerial view of a large power plant with tall smokestacks" src="https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577079/original/file-20240221-24-lwmpu1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&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 W.A. Parish coal-fired power plant in Fort Bend County, Texas, just west of Houston, is one of the largest SO2 emitters in the U.S. Three of its four units lack scrubbers.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:W.A._Parish_Generating_Plant_Aerial.jpg">RM VM/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Sulfur dioxide has <a href="https://www.epa.gov/air-trends/sulfur-dioxide-trends">already been slashed</a> but could be cut further by requiring outdated coal-fired power plants that still lack sulfur scrubbers – a technology <a href="https://lawcat.berkeley.edu/record/1111495">mandated at new plants since 1979</a> – to install them, switch to natural gas or retire. Nitrogen oxides can be reduced by replacing old trucks and installing industrial controls. Controlling all of these gases requires help from upwind counties but can achieve broader progress than local dust controls alone.</p>
<p>With growing shares of particulate matter coming from natural sources and wildfires, states will need all the help they can get to meet the tough new standard. Better data and upwind controls of ammonia and other gases can help states save lives and meet standards as cost-effectively as possible.</p><img src="https://counter.theconversation.com/content/223610/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Cohan has previously received research grants from the U.S. Environmental Protection Agency and serves on its Board of Scientific Counselors but is writing in a personal capacity. He worked from 2004-2006 for the Georgia Environmental Protection Division and has previously received research funding from the Texas Air Quality Research Program.</span></em></p>Reducing particle pollution can save thousands of lives, but states need more data to inform better controls. An atmospheric scientist explains what data and actions are needed.Daniel Cohan, Associate Professor of Civil and Environmental Engineering, Rice UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237292024-02-19T02:50:03Z2024-02-19T02:50:03ZAsbestos in mulch? Here’s the risk if you’ve been exposed<p>Mulch containing asbestos has now been found at <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">41 locations</a> in New South Wales, including Sydney parks, <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240211-asbestos-mulch-found-at-liverpool-west-public-school">schools</a>, <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240216-epa-to-conduct-priority-testing-at-sydney-schools">hospitals</a>, a <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">supermarket</a> and at least <a href="https://www.sbs.com.au/news/article/testing-for-asbestos-tainted-mulch-across-sydney-set-to-begin/0d6wo7hx6">one regional site</a>. Tests are under way at <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">other sites</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1759189770964721946"}"></div></p>
<p>As a precautionary measure, some parks have been <a href="https://www.reuters.com/world/asia-pacific/sydney-parks-cordoned-off-mardi-gras-event-cancelled-after-asbestos-concerns-2024-02-15/#:%7E:text=SYDNEY%2C%20Feb%2016%20(Reuters),toxic%20material%20from%20public%20spaces.">cordoned off</a> and some schools have <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">closed</a> temporarily. Fair Day – a large public event that traditionally marks the start of Mardi Gras – <a href="https://whatson.cityofsydney.nsw.gov.au/events/fair-day">was cancelled</a> after contaminated mulch was found at the site.</p>
<p>The New South Wales government has announced a new <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240215-new-asbestos-taskforce-to-support-investigation-into-mulch">taskforce</a> to help investigate how the asbestos ended up in the mulch.</p>
<p>Here’s what we know about the risk to public health of mulch contaminated with asbestos, including “friable” asbestos, which <a href="https://www.theguardian.com/australia-news/2024/feb/14/nsw-opposition-calls-for-central-register-of-sites-under-investigation-amid-asbestos-crisis#:%7E:text=The%20City%20of%20Sydney%20announced%20on%20Tuesday%20that%20friable%20asbestos,been%20found%20at%20Regatta%20Park.">has been found</a> in one <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240216-epa-to-conduct-priority-testing-at-sydney-schools">site</a> (<a href="https://www.smh.com.au/national/nsw/asbestos-found-in-multiple-sydney-parks-20240213-p5f4ep.html">Harmony Park</a> in Surry Hills). </p>
<h2>What are the health risks of asbestos?</h2>
<p>Asbestos is a naturally occurring, heat-resistant fibre that was widely used in building materials from the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/workplace-cancer/asbestos">1940s to the 1980s</a>. It can be found in either a <a href="https://www.safeworkaustralia.gov.au/safety-topic/hazards/asbestos/overview">bonded or friable</a> form. </p>
<p>Bonded asbestos means the fibres are bound in a cement matrix. Asbestos sheeting that was used for walls, fences, roofs and eaves are examples of bonded asbestos. The fibres don’t escape this matrix unless the product is severely damaged or worn. </p>
<p>A lot of asbestos fragments from broken asbestos products are still considered bonded as the fibres are not released as they lay on the ground.</p>
<figure class="align-center ">
<img alt="Bonded asbestos" src="https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asbestos sheeting was used for walls and roofs.</span>
<span class="attribution"><a class="source" href="https://theconversation.com/diy-renovators-now-most-at-risk-of-asbestos-cancers-3206">Tomas Regina/Shutterstock</a></span>
</figcaption>
</figure>
<p>Friable asbestos, in contrast, can be easily crumbled by touch. It will include raw asbestos fibres and previously bonded products that have worn to the point that they crumble easily.</p>
<p>The risk of disease from asbestos exposure is due to the <a href="https://www.asbestossafety.gov.au/asbestos-health-risks-and-exposure/asbestos-health-risks">inhalation of fibres</a>. It doesn’t matter if those fibres are from friable or bonded sources. </p>
<p>However, fibres can more easily become airborne, and therefore inhalable, if the asbestos is friable. This means there is more of a risk of exposure if you are disturbing friable asbestos than if you disturb fragments of bonded asbestos.</p>
<h2>Who is most at risk from asbestos exposure?</h2>
<p>The most important factor for disease risk is exposure – you actually have to inhale fibres to be at risk of disease. </p>
<p>Just being in the vicinity of asbestos, or material containing asbestos, does not put you at risk of asbestos-related disease. </p>
<p>For those who accessed the contaminated areas, the level of exposure will depend on disturbing the asbestos and how many fibres become airborne due to that disturbance. </p>
<p>However, if you have been exposed to, and inhaled, asbestos fibres it does not mean you will get an asbestos-related disease. Exposure levels from the sites across Sydney will be low and the chance of disease is highly unlikely.</p>
<p>The evidence for disease risk from ingestion remains <a href="https://iris.who.int/bitstream/handle/10665/350932/WHO-HEP-ECH-WSH-2021.4-eng.pdf">highly uncertain</a>, although you are not likely to ingest sufficient fibres from the air, or even the hand to mouth activities that may occur with playing in contaminated mulch, for this to be a concern.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1759390095805706324"}"></div></p>
<p>The risk of disease from exposure depends on the <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1445-5994.2011.02451.x">intensity, frequency and duration of that exposure</a>. That is, the more you are exposed to asbestos, the greater the risk of disease. </p>
<p>Most asbestos-related disease has occurred in people who work with raw asbestos (for example, asbestos miners) or asbestos-containing products (such as building tradespeople). This has been a tragedy and fortunately asbestos is now banned. </p>
<p>There have been cases of asbestos-related disease, most notably mesothelioma – a cancer of the lining of the lung (mostly) or peritoneum – from non-occupational exposures. This has included people who have undertaken DIY home renovations and may have only had <a href="https://www.mja.com.au/journal/2011/195/5/increasing-incidence-malignant-mesothelioma-after-exposure-asbestos-during-home">short-term exposures</a>. The level of exposure in these cases is not known and it is also impossible to determine if those activities have been the only exposure. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diy-renovators-now-most-at-risk-of-asbestos-cancers-3206">DIY renovators now most at risk of asbestos cancers</a>
</strong>
</em>
</p>
<hr>
<p>There is no <em>known</em> safe level of exposure – but this <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1445-5994.2011.02451.x">does not mean that one fibre will kill</a>. Asbestos needs to be treated with caution.</p>
<p>As far as we are aware, there have been no cases of mesothelioma, or other asbestos-related disease, that have been caused by <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/resp.14648">exposure from contaminated soils or mulch</a>.</p>
<h2>Has asbestos been found in mulch before?</h2>
<p>Asbestos contamination of mulch is, unfortunately, <a href="https://www.perthnow.com.au/news/wa/asbestos-mulch-fears-in-perth-southern-suburb-aubin-grove-ng-1b39c602956a6588f35f42b90be75e40">not new</a>. Environmental and health agencies have dealt with these situations in the past. All jurisdictions have strict regulations about removing asbestos products from the green waste stream but, as is happening in Sydney now, this does not always happen. </p>
<figure class="align-center ">
<img alt="Mulch" src="https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mulch contamination is not new.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/barking-mulch-617198870">gibleho/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What if I’ve been near contaminated mulch?</h2>
<p>Exposure from mulch contamination is generally much lower than from current renovation or construction activities and will be many orders of magnitude lower than past occupational exposures. </p>
<p>Unlike activities such as demolition, construction and mining, the generation of airborne fibres from asbestos fragments in mulch will be very low. The asbestos contamination will be sparsely spread throughout the mulch and it is unlikely there will be sufficient disturbance to generate large quantities of airborne fibres. </p>
<p>Despite the low chance of exposure, if you’re near contaminated mulch, do not disturb it. </p>
<p>If, by chance, you have had an exposure, or think you have had an exposure, it’s highly unlikely you will develop an asbestos-related disease in the future. If you’re worried, the <a href="https://www.asbestossafety.gov.au/asbestos-home">Asbestos Safety and Eradication Agency</a> is a good source of information.</p>
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Read more:
<a href="https://theconversation.com/asbestos-still-haunts-those-exposed-as-kids-in-mining-towns-9487">Asbestos still haunts those exposed as kids in mining towns</a>
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<img src="https://counter.theconversation.com/content/223729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Franklin is on the board of Reflections, a not-for-profit organisation for the asbestos awareness and support of people with asbestos-related disease. </span></em></p>The most important factor for disease risk is exposure – you actually have to inhale asbestos fibres to be at risk of disease. But asbestos needs to be treated with caution.Peter Franklin, Associate Professor and Director, Occupational Respiratory Epidemiology, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232832024-02-13T16:08:51Z2024-02-13T16:08:51ZLabour scaling back its £28 billion green pledge will impact UK housing – and public health<figure><img src="https://images.theconversation.com/files/575302/original/file-20240213-16-cnaxya.jpg?ixlib=rb-1.1.0&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/aerial-drone-sunrise-view-suburban-houses-1079721062">Shutterstock</a></span></figcaption></figure><p>The UK Labour party has <a href="https://www.theguardian.com/politics/2024/feb/08/labour-cuts-28bn-green-investment-pledge-by-half#:%7E:text=Labour%20announced%20the%20%C2%A328bn,flood%20defences%20and%20home%20insulation.">announced</a> its intention to reduce <a href="https://theconversation.com/labours-28-billion-green-investment-promise-could-be-watered-down-heres-why-222319">its £28 billion green investment pledge</a> to less than £15 billion if elected this year. The political fallout has been been largely focused on the party’s fiscal credibility and leader of the opposition Keir Starmer’s seeming proclivity for <a href="https://www.politico.eu/article/keir-starmer-labour-party-uk-election-u-turns/">U-turns</a>. </p>
<p>A crucial question so far overlooked is what impact the cut would have on <a href="https://theconversation.com/healthy-cities-arent-a-question-of-boring-or-exciting-buildings-but-about-creating-better-public-space-220456">public health</a>. The initial pledge included a key home-insulation plan to upgrade 72% – 19m homes – of the UK’s housing stock. </p>
<p>The revised plan, however, replaces that ambitious target with the more ambiguous statement that “millions of homes” will be refurbished. <a href="https://www.tandfonline.com/doi/full/10.1080/07352166.2023.2260029">Research</a> has long shown that uninsulated homes have consequences for health, especially for those living in poverty and in poor quality housing. This in turn places <a href="https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1070200/full">an extra burden</a> on an already over-stretched health service.</p>
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<img alt="A constructionn site." src="https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575304/original/file-20240213-16-hkrvur.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">
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<span class="caption">Labour plans to build 1.5 million homes.</span>
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<h2>Existing government failure</h2>
<p>The wider societal cost of poor-quality housing in the UK is estimated at <a href="https://www.brebookshop.com/details.jsp?id=327671">£18.6 billion a year</a>. Such costs, however, are often ignored when housing policy is being developed and implemented. </p>
<p>Labour promises to deliver 1.5 million homes by “<a href="https://labour.org.uk/updates/press-releases/how-not-if-labour-will-jump-start-planning-to-build-1-5-million-homes-and-save-the-dream-of-homeownership/">blitzing</a>” the planning system, but it has so far ignored the potential consequences for public health.</p>
<p>Of course, the failure to factor in health is by no means unique to Labour policy. It is already embedded in the government’s approach. <a href="https://doi.org/10.1080/07352166.2023.2260029">A recent academic review</a> of government housing and transport policy found that health is notably absent, despite well-established evidence that urban spaces are making us ill. This shows that on the occasions where health is included, it is lower in a hierarchy of priorities compared to other agendas such as growing the economy. </p>
<p>For many years, government housing policy has been shaped by the numeric gap between supply and demand, rather than the type or quality of the housing stock. The mechanisms for delivering have been based on land release and planning reform. Successive housing policies have mentioned involving communities and supporting their health, social, and cultural wellbeing. But there have been no clear targets for ensuring house retrofit and house building positively impact public health.</p>
<p>In his 2010 independent review on how to reduce
health inequalities in England, epidemiologist Michael Marmot <a href="https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf">showed</a> that prioritising health in urban policies, like housing and transport, can have significant health benefits for local populations. </p>
<p><a href="https://truud.ac.uk/briefings/">Our research project has shown</a> that health should be made a central factor in all national policy and guidance that shapes urban spaces. The World Health Organization <a href="https://unhabitat.org/global-report-on-urban-health-equitable-healthier-cities-for-sustainable-development">recommends</a> explicitly including health in housing policy – and tracking its impact with recognised metrics. UK politicians have largely failed to respond.</p>
<h2>Promising developments</h2>
<p>In addition to positive developments in government, such as the <a href="https://www.gov.uk/government/groups/building-better-building-beautiful-commission">Build Back Beautiful Commission</a>, the opposition also has some promising ambitions. Labour is pledging to deliver a <a href="https://labour.org.uk/wp-content/uploads/2023/05/Mission-Public-Services.pdf">“prevention-first revolution”</a>, in which it envisions a pro-active role for government in ensuring that everybody has the building blocks for a healthy life. </p>
<p>In its mission document for health policy, Labour says that retrofitting of millions of homes will “keep families warm rather than living in damp, mouldy conditions that give their children asthma”. The fact that the party is making explicit this link between housing and health signal is a potentially very positive step forward. </p>
<p>However, in all the furore about Labour scrapping its £28 billion pledge, this crucial link to public health has been entirely forgotten. Indeed, while Labour’s environmental policy has been carefully updated to revise and remove various targets, the preventative health agenda retains the now defunct promise to “<a href="https://labour.org.uk/wp-content/uploads/2023/05/Mission-Public-Services.pdf#page=13">oversee retrofitting of 19 million homes</a>”. This is perhaps indicative of the extent to which policymakers just don’t think about health when they think about housing. </p>
<p>While the Conservative pledges for the next parliament remain unclear, analysis of their existing policies in government <a href="https://doi.org/10.1080/07352166.2023.2260029">has found</a> a failure to think about or measure the way housing and urban development policis impact health. Instead, it is merely assumed that housing policies will have positive health outcomes. Rather than making such assumptions, policymakers should be putting public health considerations at the centre of all their decision making. </p>
<p>To ensure that the impact any given policy has on public health is <a href="https://www.youtube.com/watch?v=bhcJN2WKAvo&t=76s">measured</a> and <a href="https://truud.ac.uk/wp-content/uploads/2023/06/D2900_Walton_Truud-report_Health-evidence-in-a-complex-system__v3.pdf">acted upon</a>, health needs to be an explicit urban planning policy outcome. It needs to be clearly defined, measurable, and built into policy implementation and political discourse.</p>
<p>It is also important that different government ministries and relevant stakeholders focused on public health, planning and the environment work together more effectively. Unhealthy homes should be a priority for both the housing minister and the health minister. </p>
<p>Healthier people are more economically productive. They have a smaller financial footprint on the NHS. In the long term, better preventative health is a key part of solving some of the UK’s biggest economic challenges, from labour shortages and sluggish productivity growth to stretched public finances. </p>
<p>Too often government policy is not often designed with the long-term in mind. Instead, short-term economic outcomes and political gains <a href="https://blogs.bath.ac.uk/iprblog/2023/10/24/uk-government-climate-policy-developments-leave-a-health-shaped-gap/">are prioritised</a> – to the detriment of public health. </p>
<p>The best way for the government to protect public health is for every department to consider how their work impacts on it. If political and economic calculations about creating, scrapping and rescaling major projects continue to ignore health, however, politicians are likely to continue coming up with the wrong answers.</p><img src="https://counter.theconversation.com/content/223283/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research comes from the TRUUD project, a research programme based at the University of Bristol, that aims to reduce non-communicable disease (such as cancers, diabetes, obesity, mental ill-health and respiratory illness) and health inequalities linked to the quality of urban planning and development for use in discussions with government and the developer industry.
The TRUUD research project (<a href="https://truud.ac.uk/">https://truud.ac.uk/</a>) is funded by the the UK Prevention Research Partnership (<a href="https://ukprp.org/">https://ukprp.org/</a>).</span></em></p><p class="fine-print"><em><span>Geoff Bates receives funding as part of the TRUUD research project (<a href="https://truud.ac.uk/">https://truud.ac.uk/</a>), which is funded by the the UK Prevention Research Partnership (<a href="https://ukprp.org/">https://ukprp.org/</a>).</span></em></p>Too often government policy is not designed with the long-term in mind. Instead, short-term economic outcomes and political gains are prioritised - to the detriment of public health.Jack Newman, Research Fellow, School for Policy Studies, University of BristolGeoff Bates, Lecturer in Social Policy, Research Fellow, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230572024-02-08T13:39:27Z2024-02-08T13:39:27ZHeart attacks, cancer, dementia, premature deaths: 4 essential reads on the health effects driving EPA’s new fine particle air pollution standard<figure><img src="https://images.theconversation.com/files/574202/original/file-20240207-27-6crply.jpg?ixlib=rb-1.1.0&rect=37%2C7%2C5002%2C3347&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Large industrial facilities like this oil refinery outside Houston are major sources of fine particulate air pollution.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/CongressClimateEnvironmentalJustice/c07295f82f9646db873f5d96baf4f089/photo">AP Photo/David J. Phillip</a></span></figcaption></figure><p>The U.S. Environmental Protection Agency has <a href="https://www.epa.gov/pm-pollution/final-reconsideration-national-ambient-air-quality-standards-particulate-matter-pm">announced a new standard</a> for protecting the public from fine particulate air pollution, known as PM2.5 because the particles are smaller than 2.5 millionths of a meter. These minute particles can penetrate deeply into the body and have been linked to many serious illnesses. </p>
<p>The new rule sets an annual limit of 9 micrograms per cubic meter of air, down from the previous level of 12 micrograms. States will be required to meet this standard and to take it into consideration when they evaluate applications for permits for new stationary air pollution sources, such as electric power plants, factories and oil refineries.</p>
<p>Under the Clean Air Act, the EPA is required to set air pollution standards at levels that <a href="https://www.epa.gov/laws-regulations/summary-clean-air-act">protect public health</a>. In the four articles that follow, scholars wrote about the many ways in which exposure to PM2.5 contributes to cardiovascular disease, lung cancer, other illnesses such as dementia, and premature deaths.</p>
<h2>1. An alarming array of health effects</h2>
<p>Scientists have known since the 1993 <a href="http://dx.doi.org/10.1056/NEJM199312093292401">Six Cities Study</a>, which showed that people were dying faster in dirty cities than in clean cities, that exposure to PM2.5 increased the risk of lung cancer and heart disease. Subsequent research has linked fine particulates to a much broader range of health effects. </p>
<p>Once a person inhales PM2.5, “it causes an inflammatory response that sends signals <a href="https://theconversation.com/fine-particle-air-pollution-is-a-public-health-emergency-hiding-in-plain-sight-106030">throughout the body</a>, much as a bacterial infection would,” wrote public and environmental health scholars <a href="https://scholar.google.com/citations?user=1h3u230AAAAJ&hl=en">Doug Brugge</a> of the University of Connecticut and <a href="https://scholar.google.com/citations?user=SDWANZEAAAAJ&hl=en">Kevin James Lane</a> of Boston University. “Additionally, the smallest particles and fragments of larger particles can leave the lungs and travel through the blood.” </p>
<p>In Brugge and Lane’s view, evidence that PM2.5 could affect brain development, cognitive skills and children’s central nervous systems is particularly notable. They termed fine particle pollution an urgent global health threat. </p>
<p>“Developed countries have made progress in reducing particulate air pollution in recent decades, but much remains to be done to further reduce this hazard,” they observed. “And the situation has gotten dramatically worse in many developing countries – most notably China and India, which have industrialized faster and on vaster scales than ever seen before.”</p>
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Read more:
<a href="https://theconversation.com/fine-particle-air-pollution-is-a-public-health-emergency-hiding-in-plain-sight-106030">Fine particle air pollution is a public health emergency hiding in plain sight</a>
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<figcaption><span class="caption">PM2.5 particles are small enough to evade many of the body’s defenses.</span></figcaption>
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<h2>2. Aging the brain</h2>
<p>Medical researchers are looking closely at air pollution as a possible accelerator of brain aging. University of Southern California preventive medicine specialist <a href="https://scholar.google.com/citations?user=jxckDOcAAAAJ&hl=en">Jiu-Chiuan Chen</a> and his colleagues have found that older women who lived in locations with high levels of PM2.5 suffered <a href="https://theconversation.com/air-pollution-may-contribute-to-alzheimers-and-dementia-risk-heres-what-were-learning-from-brain-scans-148776">memory loss and Alzheimer’s-like brain shrinkage</a> not seen in women living with cleaner air.</p>
<p>Chen and his colleagues compared brains scans taken at five-year intervals of older women who lived in areas with varying levels of air pollution.</p>
<p>“When we compared the brain scans of older women from locations with high levels of PM2.5 to those with low levels, we found dementia risk increased by 24% over the five years,” Chen wrote. </p>
<p>More alarmingly, “(T)hese Alzheimer’s-like brain changes were present in older women with no memory problems,” Chen noted. “The shrinkage in their brains was greater if they lived in locations with higher levels of outdoor PM2.5, even when those levels were within the current (2021) EPA standard.”</p>
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Read more:
<a href="https://theconversation.com/air-pollution-may-contribute-to-alzheimers-and-dementia-risk-heres-what-were-learning-from-brain-scans-148776">Air pollution may contribute to Alzheimer’s and dementia risk – here's what we're learning from brain scans</a>
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<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CztmbrOOvA2/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>3. Disadvantaged communities have dirtier air</h2>
<p>As researchers in environmental justice have shown, facilities such as factories and refineries often are concentrated in low-income neighborhoods and communities of color. This means that these areas are exposed to higher pollution levels and face heavier related health burdens.</p>
<p>Regulations put in place under the Clean Air Act have greatly reduced levels of harmful air pollutants across the U.S. over the past 50 years. But when University of Virginia economist <a href="https://scholar.google.co.uk/citations?user=xw8Ml0QAAAAJ&hl=en">Jonathan Colmer</a> and public policy scholar <a href="https://scholar.google.com/citations?user=Z1sqTysAAAAJ&hl=en">Jay Shimshack</a> analyzed data tracing PM2.5 concentrations at more than 8.6 million distinct U.S. locations from 1981 through 2016, they found that the areas that were most polluted in 1981 <a href="https://theconversation.com/fine-particle-air-pollution-has-decreased-across-the-us-but-poor-and-minority-communities-are-still-the-most-polluted-143650">remained the dirtiest nearly 40 years later</a>.</p>
<p>“In 1981 PM2.5 concentrations in the most polluted 10% of census tracts averaged 34 micrograms per cubic meter,” the authors reported. “In 2016 PM2.5 concentrations in the most polluted 10% of census tracts averaged 10 micrograms per cubic meter. PM2.5 concentrations in the least polluted 10% of census tracts averaged 4 micrograms per cubic meter.” In other words, while all areas had cleaner air, people in the most polluted areas still were exposed to PM2.5 levels more than twice as high as people in the cleanest zones.</p>
<p>“For decades, federal and state environmental guidelines have aimed to provide all Americans with the same degree of protection from environmental hazards,” Colmer and Shimshack note. “The EPA’s definition of environmental justice states that ‘no group of people should bear a disproportionate share of the negative environmental consequences.’ On this front, our research suggests that the United States is falling short.”</p>
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Read more:
<a href="https://theconversation.com/fine-particle-air-pollution-has-decreased-across-the-us-but-poor-and-minority-communities-are-still-the-most-polluted-143650">Fine-particle air pollution has decreased across the US, but poor and minority communities are still the most polluted</a>
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<h2>4. Fine particle pollution hurts wildlife too</h2>
<p>Like the proverbial canaries in coal mines, wild animals can show effects of exposure to pollution that offer broader warnings. One example is wildfires, which produce high levels of gases and particulate matter.</p>
<p>Cornell University conservation biologist <a href="https://scholar.google.com/citations?user=ykHYzwEAAAAJ&hl=en">Wendy M. Erb</a> was studying wild orangutans in Indonesian Borneo when that island suffered large-scale wildfires. Orangutans are semi-solitary animals that communicate with each other through long, booming calls in the tropical forests where they live. </p>
<p>During the fires and for several weeks after the smoke cleared, Erb and her colleagues found that four male orangutans they were following <a href="https://theconversation.com/to-see-how-smoke-affects-endangered-orangutans-we-studied-their-voices-during-and-after-massive-indonesian-wildfires-208153">called less frequently than usual</a> – about three times daily instead of their usual six times. “Their voices dropped in pitch, showing more vocal harshness and irregularities,” Erb reported. “Collectively, these features of vocal quality have been linked to inflammation, stress and disease – including COVID-19 – in human and nonhuman animals.”</p>
<p>Erb hoped to see further study of how toxic smoke affects wildlife. “Using passive acoustic monitoring to study vocally active indicator species, like orangutans, could unlock critical insights into wildfire smoke’s effects on wildlife populations worldwide,” she observed.</p>
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Read more:
<a href="https://theconversation.com/to-see-how-smoke-affects-endangered-orangutans-we-studied-their-voices-during-and-after-massive-indonesian-wildfires-208153">To see how smoke affects endangered orangutans, we studied their voices during and after massive Indonesian wildfires</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archive.</em></p><img src="https://counter.theconversation.com/content/223057/count.gif" alt="The Conversation" width="1" height="1" />
On Feb. 7, 2024, the EPA strengthened the federal limit for annual levels of fine particulate air pollution, or PM2.5. Many serious health effects have been linked to PM2.5 exposure.Jennifer Weeks, Senior Environment + Cities Editor, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2226242024-02-05T14:20:21Z2024-02-05T14:20:21ZThirty years of rural health research: South Africa’s Agincourt studies offer unique insights<p><em>In 1992 a group of academics from the University of the Witwatersrand introduced a health and socio-demographic surveillance system in remote, rural South Africa to track and understand health and wellbeing in these environments. This initiative built on pioneering work by a Wits team to establish a health systems development unit in a typical rural setting. Agincourt, in the Bushbuckridge district in rural north-eastern South Africa adjacent to Mozambique, was a microcosm of the neglected health and socioeconomic systems in rural areas during apartheid.</em></p>
<p><em>The Agincourt research centre now covers some 31 villages and 120,000 people. It is one of the longest-running research centres of its kind in sub-Saharan Africa, attracting multidisciplinary scholars and researchers from around the world. The scale of data collection has led to groundbreaking research in many fields, including genomics, HIV/Aids, cardiovascular conditions and stroke, cognition and ageing. Stephen Tollman and Kathleen Kahn talk to Nadine Dreyer about what makes this Wits and Medical Research Council Unit different, particularly its focus on health and ageing.</em></p>
<h2>Why is this work so important?</h2>
<p>Before the end of apartheid in 1994, healthcare provision was skewed towards a minority population who represented only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636545">13%</a> of the country’s people. Healthcare for the majority of South Africans was woefully neglected. </p>
<p>As academics focusing on public health we wanted to understand rural South Africa, the people living away from the hospital, away from the train line, away from the supermarket or the town. Key to this was establishing a relationship of mutual trust and understanding between ourselves and those communities.</p>
<p>Drawing on early experiences with community-oriented primary care, we resolved to establish a longitudinal research and development platform. Today it covers some 31 villages in the Bushbuckridge area 500km from Johannesburg. This involved recording every member of every household – residents and temporary migrants.</p>
<p>We gathered valuable data on age, sex and gender, household type and income – producing a robust population “denominator”. To better understand evolving population dynamics, local field staff walked house-to-house meeting residents and recording data on vital events: who is born, who dies, who moves. In other words births, deaths and migrations.</p>
<p>We apply a simple concept called “person years”. At baseline, and with their consent, a person is enrolled. After five years, the person will have been there for five “person years”. Given a population of some 120,000 people, all followed up (including labour migrants) over 30 years, we can analyse and interpret data in a way that is not really possible with one-off, cross-sectional studies. </p>
<p>Today, the data generated over the past couple of decades is enabling work that was not possible in the early years. </p>
<h2>In 2013 a project was launched to focus on ageing. Why?</h2>
<p>Health and Aging in Africa: Longitudinal Studies in South Africa (<a href="https://haalsi.org/data">Haalsa</a>) was started to build understanding of the social, economic, biological, behavioural and mental health features that characterise rural people aged 40 years and above.</p>
<p>Ageing is not only about old people; it starts at birth, even earlier, because experiences at key periods influence a person’s life. </p>
<p>Some time ago, we noticed a reversal in mortality was under way. People were dying at a younger age during the height of the HIV/Aids epidemic. </p>
<p>For women living in Agincourt, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4312-x">life expectancy</a> dropped from about 74 years in 1993 to around 57 years in 2005, a loss of 17 years. For men, it dropped from about 68 years in 1993 to 50 years in 2007. </p>
<p>As a result, fostering orphans became a norm. The importance of the older generation – especially of women – stood out. Far from seeing older adults as simply requiring healthcare and support in their later years, it became clear that older rural women played fundamental roles in childcare and household food security. </p>
<p>Of course men were involved too, but because of the way in which apartheid was engineered, women were generally expected to remain in the rural reserves while men migrated to work in the mines and cities. </p>
<p>What makes research in Agincourt so interesting and relevant is the rapidly changing socio-economic profile of the area. </p>
<p>Today we see an increase in life expectancy thanks largely to the widespread uptake of antiretroviral therapies for HIV/Aids. For women, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4312-x">life expectancy</a> had returned to around 70 years by 2013. For men it had increased to around 61 years by 2013.</p>
<p>This means that South Africa is also a “greying society” and more people face an increased risk of developing multiple chronic conditions along with cognitive impairment associated with growing older.</p>
<p>The changes in older people kick in far earlier in situations of adversity. In all probability, signs of ageing you might encounter in a 65-year-old in a high-income country would start to manifest in people aged 45 to 50 in situations of pervasive poverty. </p>
<h2>What stands out when you look back over 30 years?</h2>
<p>When Agincourt started, life was very different. </p>
<p>In the early 1990s when we worked in a small suite of offices at Tintswalo Hospital, there was simply a “wind-up” phone in the entrance to the unit. Now we’re all on email and using mobile phones. </p>
<p>Bushbuckridge has become the land of the shopping mall. Even a person living in what previously was talked about as a deep rural area can now easily reach a mall by taxi or walking. </p>
<p>The pace of social change has been extraordinary. </p>
<p>There’s tremendous poverty. But people are spending money. Some of it may be on credit, some may be earned income or from other sources. </p>
<p>The proportion of households with dwellings <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4312-x">built</a> with either brick or cement walls increased from 76% in 2001 to 98% in 2013. The use of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4312-x">electricity</a> for lighting and cooking respectively increased from 69% and 4% of households in 2001 to 96% and 50% of households in 2013.</p>
<p>Migrant labour today involves large numbers of <a href="https://www.jstor.org/stable/90009869">women</a>, especially younger adults. </p>
<p>Our research identified a high prevalence of HIV/Aids among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417014/#:%7E:text=Disease%20acquisition%20seems%20to%20stop,high%20risk%20of%20HIV%20">older</a> people. As a result we piloted a home-based testing option for middle-aged and older adults, with promising results.</p>
<p>We are seeing an association between formal education and cognition. At a population level, <a href="https://karger.com/ned/article/55/2/100/226666/Incidence-of-Cognitive-Impairment-during-Aging-in">formal education</a> protects against conditions like dementia later in life – an insight that is important in an area with historically poor educational opportunity and attainment. </p>
<p>Another surprising – and welcome – finding is that levels of hypertension are <a href="https://pubmed.ncbi.nlm.nih.gov/36752095/">falling</a>. This is especially encouraging because sub-Saharan Africa is in the midst of a profound health transition with infectious diseases paralleled by rapidly rising cardiometabolic conditions. </p>
<p>Despite all these changes, we’re still asking the question that’s guided us from the start: How do you build flourishing societies in a context where jobs are scarce, migrant labour is deeply embedded, but where aspirations and the desire to live a life of meaning are evident?</p><img src="https://counter.theconversation.com/content/222624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Tollman receives funding from the SAMRC, Dept of Science and Technology SA, National Institutes of Health USA, UK Medical Research Council, and, previously, Wellcome Trust UK. He is affiliated with the SA Population Research Infrastructure Network and INDEPTH Network of population-based health and socio-demographic information systems.
</span></em></p><p class="fine-print"><em><span> Kathleen Kahn receives funding from the South African Medical Research Council, Dept of Science and Innovation SA, and the National Institute on Aging, USA.
</span></em></p>Agincourt, the University of the Witwatersrand’s rural research centre 500km from Johannesburg, has documented the lives of 120,000 people over decades.Stephen Tollman, Director: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the WitwatersrandKathleen Kahn, Professor: Health and Population Division, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172642024-01-28T19:05:20Z2024-01-28T19:05:20ZMedicare turns 40: since 1984 our health needs have changed but the system hasn’t. 3 reforms to update it<figure><img src="https://images.theconversation.com/files/571353/original/file-20240125-29-9x8icz.jpg?ixlib=rb-1.1.0&rect=0%2C57%2C7719%2C4513&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/selective-focus-photography-of-assorted-color-balloons-Hli3R6LKibo">Ali Goldstein/Unsplash</a></span></figcaption></figure><p>Forty years ago, Medicare as we know it today was born. It was the reincarnation of the Whitlam government’s Medibank, introduced in 1975 but <a href="https://www.sciencedirect.com/science/article/abs/pii/0277953684902661">dismantled</a> in stages by the Fraser Liberal government. </p>
<p>Medibank was developed in the 1960s by health economists <a href="https://grattan.edu.au/news/remebering-richard-scotton-co-founder-of-medicare/">Dick Scotton</a> and <a href="https://openresearch-repository.anu.edu.au/bitstream/1885/159512/1/Daring_to_Dream.pdf">John Deeble</a>, when disease prevalence was different and the politics of reform were diabolical. </p>
<p>But the nation has changed since 1984, and so have our health needs. Medicare is now struggling to ensure the access to health care for millions of Australians we were once promised. </p>
<p>Let’s look at how we got here – and three radical changes we need to keep the Medicare promise into the future: making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care. </p>
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Read more:
<a href="https://theconversation.com/if-you-live-in-a-bulk-billing-desert-its-hard-to-see-a-doctor-for-free-heres-how-to-fix-this-204029">If you live in a bulk-billing ‘desert’ it's hard to see a doctor for free. Here's how to fix this</a>
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<h2>Free hospital care, but you might pay to see a GP</h2>
<p>One of my first jobs in the health system, in the days before Medicare and Medibank, was acting in charge of revenue collection for three public hospitals. A small subset of people could get free, albeit stigmatised, care. </p>
<p>We had bad debts, because some people couldn’t afford to pay their hospital bills and I was allowed by policy to recommend that some be written off. But for others I had to seek court authorisation to seize their wages to pay off their hospital debt. </p>
<p>Medibank changed that. Now all Australians can get public hospital care without any financial barrier.</p>
<figure class="align-center ">
<img alt="Doctor draws blood from patient" src="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.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">
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<span class="caption">Before Medicare and Medibank, patients often faced hospital care debts.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-laying-in-a-hospital-bed-next-to-a-man-dkZQfm1LLQE">National Cancer Institute/Unsplash</a></span>
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<p>But the financial barriers to seeing a GP or a private specialist (out of hospital) have remained. Doctors continue to charge what they like, with Medicare often only covering a portion of their fees. This has left many patients facing significant out-of-pocket payments.</p>
<p>When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service. </p>
<p>Over time, general practice evolved into group practices organised as partnerships. Next, they <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51038">consolidated and corporatised</a>. A handful of corporates now provide all <a href="https://www.accc.gov.au/system/files/public-registers/documents/ACL%20Healius%20%20-%20Statement%20of%20Issues.pdf">private pathology</a> (which tests blood and other tissues) and <a href="https://www.jacr.org/article/S1546-1440(07)00614-X/fulltext">radiology</a> (which provides imaging services) and a large proportion of GP care. </p>
<p>Corporates have not made the same inroads into most other specialties. But since the 1980s, states have reduced public hospital outpatient services. So patients are now more reliant on private medical specialists for care referred by their GP.</p>
<h2>Much has changed, but cost of living pressures remain</h2>
<p>Health-care needs have changed. As we live longer, we live with more diseases, many of which are chronic. The care required increasingly involves many different health providers and includes non-medical specialties such as podiatry, physiotherapy and psychology. </p>
<p>When Medicare was introduced, university education was offered for only a few of these professions. But their training has evolved and so too what they can do. This is particularly the case for nursing. It has evolved from an apprenticeship model to a profession with its own specialties. A subset – nurse practitioners – have the authority to diagnose and prescribe medication.</p>
<p>Broader technology trends have also had an impact on health care, as with all other sectors. Virtual care and telehealth <a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">proved their worth</a> during the early years of the COVID pandemic, just as generative AI is beginning to show its promise now.</p>
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Read more:
<a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">AI can help detect breast cancer. But we don't yet know if it can improve survival rates</a>
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<p>Medicare was first and foremost about efficiently removing financial barriers to access. It was introduced as part of an <a href="https://www.jstor.org/stable/20635272">agreement with the Labor movement</a> about reducing costs of living and, in particular, ensuring people could attend a doctor without having to worry about how they would pay for the visit.</p>
<p>However, <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">about 1.2 million Australians</a> deferred or missed out on seeing a GP because of cost in the 2022-23 financial year. Lower-income Australians have higher rates of missing out on care. </p>
<p>Medical fees aren’t regulated and so consumers face a lottery – not knowing whether a fee will be charged and having no control over that decision. Only about 52% of all Australians were <a href="https://www.health.gov.au/sites/default/files/2023-08/medicare-statistics-per-patient-bulk-billing-dashboard-2022-23.pdf">always bulk-billed</a> in 2022-23, down from 66% a year earlier. </p>
<p>So how can we get Medicare back on track towards its goal of universal health care for all Australians? Here are three radical reforms we should prioritise. </p>
<h2>1. Make GP care affordable for all</h2>
<p>Rebates are currently subject to political whim. The Liberal government (in office from 2013 to 2022) froze rebates, leading to increases in average out-of-pocket payments and reduced bulk-billing.</p>
<p>The first step in reducing costs as a barrier to GP care should be introduction of independent fee-setting. </p>
<p>Canadian Medicare – which was the model for Australia’s system – mostly has <a href="https://journals.sagepub.com/doi/full/10.1177/0840470421994304">no out-of-pocket payments</a>. Fees are set by negotiations, not politicians’ whims, and this is <a href="https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html#h-151558">enshrined in legislation</a>. </p>
<p>With independent fee-setting in place, a new scheme of “participating providers” should be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs.</p>
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Read more:
<a href="https://theconversation.com/what-if-medicare-was-restricted-to-gps-who-bulk-billed-this-kind-of-reform-is-possible-203543">What if Medicare was restricted to GPs who bulk billed? This kind of reform is possible</a>
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<p>If fees are set independently and fairly, extra billing over and above the fee is unjustifiable. Non-participating practices would not be eligible for Medicare benefits. </p>
<p>It’s anticipated the vast majority of practices would agree to participate. In Canada, the participation rate is roughly 100%, and bulk billing in Australia is <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-bulk-billing-by-primary-health-network-september-quarter-2023-24">still over 75%</a>.</p>
<p>Participating practices should also be eligible for additional grants to employ other health professionals to provide a more comprehensive range of services – such as physiotherapists and psychologists – to meet the contemporary needs of a population with increasing chronic illness. </p>
<p>If successful, these changes would mean all Australians can access a GP and other primary care services without any out-of-pocket costs.</p>
<h2>2. Deal with diagnostics</h2>
<figure class="align-center ">
<img alt="Blood vials" src="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.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">
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<span class="caption">The cost of processing tests varies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/green-pink-and-purple-plastic-bottles-0jE8ynV4mis">Testalize.me/Unsplash</a></span>
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<p>Despite the evolution of ownership and market structures, pathology and radiology services are still reimbursed by fees for each service (with complex rules about rebates when multiple tests are performed simultaneously). </p>
<p>But while both industries are expensive to set up and buy or lease equipment, the cost of processing an additional test or image is low and sometimes close to zero. This means Medicare pays pathology and radiology providers much more than the tests or images cost.</p>
<p>Both industries are also ripe for further technological change, with the quality of generative AI rapidly improving, and costs likely to further reduce.</p>
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Read more:
<a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">Blood money: pathology cuts can reduce spending without compromising health</a>
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<p>The uncapped fee-for-service model for pathology and radiology needs to be replaced by one in which the benefits of technological change are shared between shareholders and taxpayers, rather than all accruing to the former. </p>
<p>This could be done by replacing fee-for-service payments with a payment model used in the corporate world. Private and public providers could be <a href="https://grattan.edu.au/report/blood-money-paying-for-pathology-services/">invited to tender</a> to provide these services in certain areas, with conditions around geographic access, quality and no out-of-pocket payments for consumers. </p>
<p>The same model could also apply to other technology-intensive types of health care, such as radiotherapy for cancer.</p>
<p>These changes might be cost-neutral for government, and save consumers the $24 they currently pay out of pocket on every pathology test that is not currently bulk-billed and $122 on each non-bulk-billed diagnostic imaging test.</p>
<h2>3. Cover dental care too</h2>
<figure class="align-center ">
<img alt="Boy undergoes dental treatment" src="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.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">
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<span class="caption">Dental care is largely unaffordable.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/boy-in-blue-long-sleeve-shirt-drinking-from-a-feeding-bottle-loBRFqXm1QA">Lafayett Zapata Montero/Unsplash</a></span>
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<p>A major omission from Medicare from the start, and a source of continuing inequity, is oral health care. More than two million Australians <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">missed out</a> on oral health care because of cost in 2022-23.</p>
<p>A new scheme to <a href="https://grattan.edu.au/report/filling-the-gap/">slowly expand universal protection</a> against the costs of oral health care should be phased in over the next decade. This would eventually mean all preventive and basic dental care would be available for everyone, with no out-of-pocket payments. </p>
<p>This would require a parallel expansion of the oral health workforce (dentists and <a href="https://www.dentalboard.gov.au/Registration/Oral-Health-Therapist.aspx">oral health therapists</a>) and development of new payment models based on a participating practice model rather than simply introducing another unregulated schedule of oral health fees paid via Medicare.</p>
<p>Innovation <a href="https://www.health.gov.au/sites/default/files/2023-12/nhra-mid-term-review-final-report-october-2023.pdf">needs to be built into the Australian health system</a>. However, the foundations for innovation must be based on Medicare’s founding principles of addressing financial barriers to provide universal and equitable health care to all Australians. </p>
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Read more:
<a href="https://theconversation.com/expensive-dental-care-worsens-inequality-is-it-time-for-a-medicare-style-denticare-scheme-207910">Expensive dental care worsens inequality. Is it time for a Medicare-style 'Denticare' scheme?</a>
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<img src="https://counter.theconversation.com/content/217264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett, like all Australians, benefits from Medicare.</span></em></p>The health care world has changed a lot in 40 years, but Medicare hasn’t. Here are three areas for radical forms to the system that will achieve its aims of universal health care for all Australians.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214122024-01-23T19:00:02Z2024-01-23T19:00:02ZFor the new vape laws to succeed, these 3 things need to happen – or users may look to the illicit market<figure><img src="https://images.theconversation.com/files/570782/original/file-20240123-15-tpau1a.jpg?ixlib=rb-1.1.0&rect=17%2C511%2C5973%2C3476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-next-to-a-man-IktGJT61bG4">Ernst Gunther Krause/Unsplash</a></span></figcaption></figure><p>This year, the Australian government will progressively <a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">ban</a> the retail sale of all e-cigarettes, known as vapes. Vapers will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">only be allowed</a> to use nicotine vapes that comply with <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/vaping-hub/reforms-regulation-vapes">Therapeutic Goods Administration</a> (TGA) product requirements – and only to help them quit or manage their nicotine dependence, if prescribed by a doctor and dispensed by a pharmacy.</p>
<p>This will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">accompanied by</a> increased funding for law enforcement to prevent illegal importation of vapes, a public education campaign about the risks of vaping, and greater efforts to encourage smokers to only obtain their vapes on prescription.</p>
<p>But for the scheme to be successful, three things need to happen: vaping products that vapers will use need to be available, GPs need to be willing to write prescriptions, and pharmacies need to be able to meet the demand. None of these are guaranteed. </p>
<p>Failure to do so could see some people continue to use the illicit market for vapes, or to switch to traditional cigarettes. </p>
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Read more:
<a href="https://theconversation.com/from-today-new-regulations-make-it-harder-to-access-vapes-heres-whats-changing-218816">From today, new regulations make it harder to access vapes. Here's what's changing</a>
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<h2>The previous vape policy failed</h2>
<p>The new policy tightens the enforcement of a <a href="https://link.springer.com/chapter/10.1007/978-3-031-23658-7_1#Sec5">retail sales ban on vapes containing nicotine</a> first introduced in <a href="https://www.aph.gov.au/DocumentStore.ashx?id=b57abf1c-0e4f-49a5-a3a3-2bb02ea76bf3&subId=401164">2011</a>. This only allowed smokers to use nicotine vapes if they had been approved for smoking cessation (quitting) by the TGA and were prescribed by a doctor to help them quit smoking. </p>
<p>The TGA’s expectation was that nicotine vapes would eventually be produced that would be approved for prescription. When no vapes had been approved by 2021, the TGA <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-final/notice-final-decision-amend-current-poisons-standard-nicotine">reclassified nicotine</a> to allow doctors to prescribe unapproved nicotine vapes.</p>
<p>But these policies didn’t meet their objectives. <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">Fewer than 10% of vapers</a> obtained a prescription.</p>
<p>The TGA’s <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">impact assessment</a> of the 2021 policy shows it failed to prevent vaping among Australian youth or give smokers legal access to vapes. This was in large part because vape retailers illegally sold nicotine vapes as nicotine-free products (which were not banned) and sold colourful, flavoured disposable vapes that appealed to young people.</p>
<figure class="align-center ">
<img alt="Colourful vapes in a shop" src="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570790/original/file-20240123-27-bz731n.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">Retailers illegally sold nicotine vapes as ‘nicotine-free’ products.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-black-long-sleeve-shirt-holding-black-dslr-camera-hVcmxpYg1Gc">e Liquids UK/Unsplash</a></span>
</figcaption>
</figure>
<p>By the end of 2023, an <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">estimated</a> 1.3 million Australian adults were using vapes containing nicotine. The largest uptake was among young adults aged 18 to 24 and there was a worrying uptake among young people aged 14 to 17. More than <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">90% of vapes</a> were obtained illegally from retail vape stores and via internet sales.</p>
<h2>What are the new rules, and what are their aims?</h2>
<p>From January 1, the importation of disposable vapes <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">is banned</a>. </p>
<p>From March, there will be a <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">complete ban</a> on the import of non-therapeutic vape products. Importers of therapeutic vapes will need a licence and permit from the government’s Office of Drug Control to import them. </p>
<p>The government will <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/next-steps-on-vaping-reforms?language=en">later set product standards</a> that limit flavours, reduce permissible nicotine concentrations and require pharmaceutical packaging of therapeutic vapes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-teen-is-addicted-to-vaping-how-can-i-help-them-quit-and-manage-their-withdrawal-symptoms-208586">My teen is addicted to vaping. How can I help them quit and manage their withdrawal symptoms?</a>
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</em>
</p>
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<p>The policy <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">aims</a> to reduce adolescent vaping by 2026 while allowing adult smokers to use vapes for quitting and managing nicotine dependence, by making them easier to access. </p>
<p>But there are major challenges in achieving these goals. </p>
<h2>1. Enough therapeutic products</h2>
<p>The TGA will need to ensure there are enough products that meet their product standards and that vapers will use. </p>
<p>It’s unclear how vape producers will be encouraged to notify the TGA that their device meets standards and whether vapers will be interested in using them. </p>
<p>However, vapes exist with specified nicotine levels that could be plain-packaged, if required.</p>
<h2>2. Doctors will need to prescribe them</h2>
<p>The new regulations allow any medical or nurse practitioner to prescribe nicotine vapes for smoking cessation and to manage nicotine addiction. </p>
<p>Given the existing <a href="https://oia.pmc.gov.au/sites/default/files/posts/2024/01/Impact%20Analysis%20-%20Proposed%20reforms%20to%20the%20regulation%20of%20vapes.PDF">low uptake of vape prescribing</a> and strong discouragement from the <a href="https://www.ama.com.au/qld/news/Vaping-package-good-step-in-nicotine-control#:%7E:text=%E2%80%9CThere%20is%20little%20evidence%20to,use%20as%20a%20cessation%20aid">Australian Medical Association</a> and <a href="https://www.racp.edu.au/docs/default-source/advocacy-library/policy-on-electronic-cigarettes.pdf">medical colleges</a>, more medical practitioners will need to be persuaded to prescribe vapes. </p>
<figure class="align-center ">
<img alt="Doctor writes prescription" src="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570792/original/file-20240123-17-qtktw9.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">Uptake of vape prescribing has been low.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-patient-consulting-room-gp-surgery-2367985555">Stephen Barnes/Shutterstock</a></span>
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<p>GP guidelines for quitting recommend prescribing nicotine gum and patches, and vapes only if these products are unsuccessful. However, a <a href="https://pubmed.ncbi.nlm.nih.gov/38189560/">Cochrane review</a> of clinical trials found vapes were more effective for smoking cessation than nicotine gum and patches.</p>
<h2>3. Pharmacies need to dispense them</h2>
<p>There must be enough pharmacies prepared to dispense vapes. Pharmacy organisations are <a href="https://www.psa.org.au/nicotine-vaping-product-access-changes-coming/">cautiously supportive of the new regulations</a> but it’s unclear how many pharmacies will provide vapes. This may depend, in part, on demand for these products. </p>
<h2>Risks of the illicit market</h2>
<p>All of these challenges need to be met in two years. Failure to achieve these aims will sustain the illicit market for vapes. </p>
<p>Vapers who are unconcerned about the possibility of arrest for possessing vapes without a prescription (a <a href="https://www.criminaldefencelawyers.com.au/blog/is-vaping-illegal-in-australia/?utm_source=Mondaq&utm_medium=syndication&utm_campaign=LinkedIn-integration">criminal offence</a> in most states) may continue to use the illicit market.</p>
<p>Australian Border Force officials <a href="https://www.smh.com.au/politics/federal/smoke-alarm-warning-to-border-force-it-won-t-stop-vape-black-market-20240101-p5eujs.html">have conceded</a> they will not be able to prevent the illicit importation of vaping devices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-promotes-vaping-as-a-fun-safe-and-socially-accepted-pastime-and-omits-the-harms-203423">TikTok promotes vaping as a fun, safe and socially accepted pastime – and omits the harms</a>
</strong>
</em>
</p>
<hr>
<p>There is also a risk some vapers will switch to cigarettes which, while expensive, are readily available. Vapes are not without harm, but toxicological analyses <a href="https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01737-5">conclude</a> they are <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html">less harmful</a> than conventional cigarettes.</p>
<h2>What if the vape regulations fail?</h2>
<p>If the vape laws aren’t successful, regulators must find another way to meet the policy’s goals of minimising youth vaping and reducing the size of the illicit vaping market. </p>
<p>One way would be to allow the sale of approved vapes to adult smokers under much tighter regulations than apply to cigarettes. This could mean banning disposable vapes and restricting sales of other vapes to licensed tobacconists on the condition that they will lose their licence if they sell to youth. This could be enforced by requiring the installation of CCTV in stores, as occurs in US cannabis retail outlets. </p>
<p>This alternative model could include many of the other regulations proposed: only allowing approved vaping devices, plain packaging, flavour restrictions and no advertising. But this <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13663">model</a> wouldn’t require a doctor’s prescription or restrict dispensing to pharmacies.</p><img src="https://counter.theconversation.com/content/221412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wayne Hall has been a paid advisor to the Therapeutic Goods Administration on the safety and effectiveness of medical cannabis (2017-2019) and was a member of Australian Advisory Council on Medicinal Uses of Cannabis, Commonwealth Department of Health, February 2017-2021. He has advised the World Health Organization on the health effects of cannabis, 2019-2023. He has not received any funding from the alcohol, pharmaceutical, tobacco or e-cigarette industries. His past research on tobacco related topics was funded by the National Health and Medical Research Council. The opinions expressed in this article are those of the author and do not necessarily reflect the view of the organisation where he works or its funders.</span></em></p>If the scheme isn’t successful, some people may continue using illicit vapes, or to switch to traditional cigarettes.Wayne Hall, Emeritus Professor, The National Centre for Youth Substance Use Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2204562024-01-10T17:17:49Z2024-01-10T17:17:49ZHealthy cities aren’t a question of boring or exciting buildings but about creating better public space<figure><img src="https://images.theconversation.com/files/568630/original/file-20240110-27-hhywf8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Interstate 5 near downtown San Diego, US.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/aerial-view-on-concrete-road-8Nn49K7Snow">Abraham Barrera|Unsplash</a></span></figcaption></figure><p>The US developers of a 300ft glowing orb, <a href="https://www.theguardian.com/uk-news/2024/jan/09/developer-las-vegas-style-sphere-east-london-withdraws-plans">set to be built</a> in the middle of Stratford, east London, and accommodate upwards of 21,500 concert goers, have withdrawn their planning application. </p>
<p>Las Vegas, in the US, already boasts one such venue, known as Sphere. Citing its “extreme” disappointment at London residents not similarly benefiting from what a spokesperson said was its “groundbreaking technology and the thousands of well-paying jobs it would have created”, Madison Square Garden Entertainment (MSG) has decided the British capital is not one of the forward-thinking cities it aims to work with.</p>
<p>Campaigners have responded with glee, not least because, in response to concerns over the proposed structure’s potential noise and light pollution, developers had initially suggested they invest in blackout curtains. “Residents would be served far better by building social housing on the site,” a representative for Stop MSG Sphere London <a href="https://www.insidehousing.co.uk/news/campaigners-call-for-rejected-msg-sphere-site-to-be-turned-into-social-housing-84023#:%7E:text=London%20mayor%20Sadiq%20Khan%20ruled,negative%20impact%20on%20local%20residents%E2%80%9D.">reportedly said</a>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Quite how a city both caters to its residents’ needs and sustains its economy is an enduring debate. The tension is between innovation aimed at boosting investment (in this instance, in the entertainment industry) and what urban geographer <a href="https://www.versobooks.com/en-gb/products/917-waste-and-the-city">Colin McFarlne</a> terms the “right to citylife”. </p>
<p>Projects like the Sphere sit on one extreme end of what gets built in a city. The British designer Thomas Heatherwick recently highlighted what he sees as another extreme, though no less harmful: <a href="https://www.theguardian.com/artanddesign/2023/oct/19/demand-interestingness-thomas-heatherwick-rails-against-boring-buildings">“boring buildings”</a>. </p>
<p>In his new book, Humanise – a Maker’s Guide to Building Our world, Heatherwick <a href="https://www.penguin.co.uk/books/312740/humanise-by-heatherwick-thomas/9780241389799">says</a> “bland architecture” causes stress, illness, loneliness, fear, division and conflict. Research shows, however, that more than individual buildings, how the city is planned as a whole variously harms or improves people’s lives. </p>
<h2>The city as a complex system</h2>
<p>The physical and social environment of any given city are just two contributing factors in the complex system that shapes residents’ wellbeing. <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00047-X/fulltext">Public health research</a> has found a positive, non-linear relationship with a higher prevalence of mental health problems in more urbanised countries, particularly for anxiety disorders. </p>
<figure class="align-center ">
<img alt="People ice-skating outdoors in a city." src="https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568627/original/file-20240110-25-bcyhld.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">Copenhagen: public space is the very essence of urban life.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/people-on-ice-field-during-daytime-wCP9Mk0iisU">Brian Kyed|Unsplash</a></span>
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</figure>
<p>Mental health problems now account for over a third of the total burden of disease in adolescents in urban settings. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02238-9/fulltext">Research</a> shows that, for young people (a significant proportion of urban populations), health and wellbeing constitute major determinants in their future life prospects. </p>
<p>In Humanise, Heatherwick ignores this complexity. The book is a collection of thoughts, ideas, visuals and reflections on the role of contemporary architecture and architects. In it, the designer suggests that the world is facing a “global epidemic of inhuman buildings” and suggests a list of what to do and what not to do to achieve the reverse: “interesting buildings”. </p>
<p>Heatherwick sees cities as collections of buildings, of architectural objects. The problem here, of course, is that the various aesthetic merits of any given structure can be endlessly debated. </p>
<p>Some of Heatherwick’s arguments (“boring places contribute to division and war”; “boring buildings help to cause climate change”) are plainly simplistic. They also beg the question of who decides what is and what isn’t interesting. </p>
<p>As examples of interesting buildings that bolster people’s wellbeing, he cites, among others, the <a href="https://www.archdaily.com/363164/parkroyal-on-pickering-woha-2">Parkroyal Collection hotel in Singapore</a> and the <a href="https://www.ribaj.com/buildings/edgewood-mews-housing-london-north-circular-road-peter-barber-architects">Edgewood Mews housing project</a> in Finchley, north London for their generosity. </p>
<p>The first, he says, is “enthusiastic to share its wonder with everyone” and the second offers “more than minimum to the world”. </p>
<p>To me, though, these are extravagant architectural statements of capitalist power (the Singaporean hotel) and an over-designed fortress building (London’s Edgewood housing project).</p>
<figure class="align-center ">
<img alt="An overhead view of greenery in a city next to a road." src="https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568626/original/file-20240110-15-tzarot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Singapore’s Parkroyal Collection hotel.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aerial-view-of-cars-on-road-RG7jGL8wkCs">Meric Dagli/Unsplash</a></span>
</figcaption>
</figure>
<h2>Recognising the importance of public space in cities</h2>
<p>In the early 1900s, the German sociologist and philosopher, Georg Simmel, <a href="https://www.blackwellpublishing.com/content/bpl_images/content_store/sample_chapter/0631225137/bridge.pdf">hailed</a> the advent of a new urban condition. Compared to rural life, he said, the metropolis made people more individualistic, prioritised capitalist modes of production and intensified sensory exposure. As a result, he said: “Instead of reacting emotionally, the metropolitan type reacts primarily in a rational manner”. City dwellers were, Simmel said, less sensitive and further removed from “the depths of personality”.</p>
<p>Mid-20th century architects and planners further explored the socio-psychological damage wrought by urban expansion in the post-war era. In his 1971 book, <a href="https://www.udg.org.uk/publications/udlibrary/life-between-buildings-using-public-space">Life Between Buildings</a>, Danish architect and urban planner Jan Gehl underlined how, more than architecture, urban space itself had the potential to either harm or affirm social interactions. </p>
<p>The capitalist logic underpinning modernist urban planning was harming residents. More and more people were living in high-rise buildings. Open, green spaces were commodified. Private transport was prioritised. Gehl thought it was precisely in these daily situations, where people move between home and work and play, that cities should both “function and provide enjoyment”. </p>
<p>In over-emphasising the design of exciting buildings, Heatherwick overlooks this: that it is between and around buildings that you find the essence of urban life. </p>
<figure class="align-center ">
<img alt="A construction site." src="https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568628/original/file-20240110-28-5mjtu7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Architectural objects in themselves cannot tackle the issues city residents face.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aerial-view-photography-of-building-zaxoaZVazCs">Ricardo Gomez Angel|Unsplash</a></span>
</figcaption>
</figure>
<p><a href="https://books.google.co.uk/books/about/Towards_Cosmopolis.html?id=GzdsRAAACAAJ&redir_esc=y">Research shows</a> that urban policies have evolved since the 1970s, largely to try to shape cities for the better and to ensure better accessibility, better quality and diversity of housing, open spaces, more reliable infrastructure and more robust services. </p>
<p>After joining the World Health Organisation’s <a href="https://www.who.int/europe/groups/who-european-healthy-cities-network">healthy cities initiative</a> in 1987, Copenhagen developed a holistic urban policy. This included walkable streets, public transportation, diverse housing opportunities, more pointed social policies around ideas of community and using taxation to encourage smoking control. Nearly four decades on, the Danish capital <a href="https://radar.brookes.ac.uk/radar/file/1f3e2ab5-70f8-4a9a-85e6-6c9fda88a426/1/s11524-023-00798-9.pdf">continues to be upheld</a> as one of the world’s healthiest cities. </p>
<p>However “good” or “interesting” architecture might be, it cannot tackle poverty, social exclusion and public health on its own. But even <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00125-6/fulltext">high-rise buildings</a> can make a difference to people’s lives if they’re well designed and well regulated. How the built environment is shaped as a whole is crucial.</p>
<p>In denying MSG planning permission for a London Sphere, city authorities have prioritised residents’ concerns over private investment. Everyone benefits from public space and infrastructure being seen as public goods, not commodities.</p><img src="https://counter.theconversation.com/content/220456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Haim Yacobi 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>From lit-up orbs to bland office blocks, cities are full of buildings that people do or do not like. What really shapes how they live – for better or for worse – is urban planning.Haim Yacobi, Professor of Development Planning, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158932023-12-24T20:53:47Z2023-12-24T20:53:47ZA short history of sunscreen, from basting like a chook to preventing skin cancer<p>Australians have used commercial creams, lotions or gels to manage our skin’s sun exposure for nearly a century. </p>
<p>But why we do it, the preparations themselves, and whether they work, has changed over time.</p>
<p>In this short history of sunscreen in Australia, we look at how we’ve slathered, slopped and spritzed our skin for sometimes surprising reasons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-myths-about-sunscreen-and-why-theyre-wrong-125879">4½ myths about sunscreen and why they're wrong</a>
</strong>
</em>
</p>
<hr>
<h2>At first, suncreams helped you ‘tan with ease’</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Advertisement for Hamilton's Sunburn Vanishing Cream" src="https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1129&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1129&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1129&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1418&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1418&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562563/original/file-20231129-23-98jddw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1418&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This early sunscreen claimed you could ‘tan with ease’.</span>
<span class="attribution"><a class="source" href="https://trove.nla.gov.au/newspaper/page/11041390?searchTerm=Hamilton%20sun%20vanishing%20cream">Trove/NLA</a></span>
</figcaption>
</figure>
<p>Sunscreens have been available in Australia since the 30s. Chemist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120514/">Milton Blake</a> made one of the first.</p>
<p>He used a kerosene heater to cook batches of “sunburn vanishing cream”, scented with French perfume. </p>
<p>His backyard business became H.A. Milton (Hamilton) Laboratories, which still <a href="https://www.hamiltonsunandskin.com.au/history-of-hamilton">makes sunscreens today</a>. </p>
<p>Hamilton’s first cream <a href="https://trove.nla.gov.au/newspaper/article/128464119?searchTerm=Hamilton%20sun%20vanishing%20cream">claimed</a> you could “
Sunbathe in Comfort and TAN with ease”. According to modern standards, it would have had an SPF (or sun protection factor) of 2.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-does-sunscreen-work-what-is-spf-and-can-i-still-tan-with-it-on-88869">Explainer: how does sunscreen work, what is SPF and can I still tan with it on?</a>
</strong>
</em>
</p>
<hr>
<h2>The mirage of ‘safe tanning’</h2>
<p>A tan was considered a “<a href="https://trove.nla.gov.au/newspaper/article/21611069?searchTerm=sunburn%20lotion">modern complexion</a>” and for most of the 20th century, you might put something on your skin to help gain one. That’s when “safe tanning” (without burning) was thought possible.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Coppertone advertisement showing tanned woman in bikini" src="https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=862&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=862&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=862&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1083&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1083&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562843/original/file-20231130-27-l79asi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1083&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This 1967 Coppertone advertisement urged you to ‘tan, not burn’.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/91591049@N00/15224409766/in/photolist-pck5By-nY3gWR-86iQ6o">SenseiAlan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Sunburn was known to be caused by the <a href="https://www.cancercouncil.com.au/cancer-prevention/sun-protection/understanding-uv-radiation/what-is-uv-radiation/">UVB component</a> of ultraviolet (UV) light. UVA, however, was thought not to be involved in burning; it was just thought to darken the skin pigment melanin. So, medical authorities advised that by using a sunscreen that filtered out UVB, you could “safely tan” without burning.</p>
<p>But that was wrong.</p>
<p>From the 70s, medical research suggested UVA <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/exd.12388">penetrated damagingly deep</a> into the skin, causing ageing effects such as sunspots and wrinkles. And both <a href="https://www.cancercouncil.com.au/cancer-prevention/sun-protection/understanding-uv-radiation/what-is-uv-radiation/">UVA and UVB</a> could cause skin cancer.</p>
<p>Sunscreens from the 80s sought to be “<a href="https://theconversation.com/how-to-pick-the-right-sunscreen-when-youre-blinded-by-choice-125881">broad spectrum</a>” – they filtered both UVB and UVA.</p>
<p>Researchers consequently recommended sunscreens for <a href="https://www.sbs.com.au/language/english/en/article/skin-cancer-in-australia-what-are-the-risks-and-how-to-protect-yourself/sa022ydq1">all skin tones</a>, including for preventing sun damage in people with <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-skin-of-color/">dark skin</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sun-damage-and-cancer-how-uv-radiation-affects-our-skin-34538">Sun damage and cancer: how UV radiation affects our skin</a>
</strong>
</em>
</p>
<hr>
<h2>Delaying burning … or encouraging it?</h2>
<p>Up to the 80s, sun preparations ranged from something that claimed to delay burning, to preparations that actively encouraged it to get that desirable tan – think, baby oil or coconut oil. Sun-worshippers even raided the kitchen cabinet, slicking olive oil on their skin.</p>
<p>One manufacturer’s “sun lotion” might effectively filter UVB; another’s merely basted you like a roast chicken.</p>
<p>Since labelling laws before the 80s didn’t require manufacturers to list the ingredients, it was often hard for consumers to tell which was which.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-should-i-add-sunscreen-to-my-skincare-routine-now-its-getting-hotter-213453">How should I add sunscreen to my skincare routine now it's getting hotter?</a>
</strong>
</em>
</p>
<hr>
<h2>At last, SPF arrives to guide consumers</h2>
<p>In the 70s, two Queensland researchers, Gordon Groves and Don Robertson, developed tests for sunscreens – sometimes experimenting on students or colleagues. They printed their ranking <a href="https://trove.nla.gov.au/newspaper/article/116399802?searchTerm=guide%20to%20sunburn%20protection">in the newspaper</a>, which the public could use to choose a product. </p>
<p>An Australian sunscreen manufacturer then asked the federal health department to regulate the industry. The company wanted standard definitions to market their products, backed up by consistent lab testing methods.</p>
<p><a href="https://store.standards.org.au/product/as-2604-1986">In 1986</a>, after years of consultation with manufacturers, researchers and consumers, Australian Standard AS2604 gave a specified a testing method, based on the Queensland researchers’ work. We also had a way of expressing how well sunscreens worked – the <a href="https://theconversation.com/explainer-how-does-sunscreen-work-what-is-spf-and-can-i-still-tan-with-it-on-88869">sun protection factor or SPF</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sunscreen products with various SPF labels" src="https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=257&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=257&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=257&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=323&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=323&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562856/original/file-20231130-17-70ggq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=323&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Consumers could pick their product based on the sun protection factor or SPF.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/set-sunscreen-products-on-turquoise-background-2291735329">Shutterstock</a></span>
</figcaption>
</figure>
<p>This is the ratio of how long it takes a fair-skinned person to burn using the product compared with how long it takes to burn without it. So a cream that protects the skin sufficiently so it takes 40 minutes to burn instead of 20 minutes has an SPF of 2.</p>
<p>Manufacturers liked SPF because businesses that invested in clever chemistry could distinguish themselves in marketing. Consumers liked SPF because it was easy to understand – the higher the number, the better the protection.</p>
<p>Australians, encouraged from 1981 by the <a href="https://www.youtube.com/watch?v=b7nocIenCYg%22">Slip! Slop! Slap!</a> nationwide skin cancer campaign, could now “slop” on a sunscreen knowing the degree of protection it offered.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-pick-the-right-sunscreen-when-youre-blinded-by-choice-125881">How to pick the right sunscreen when you're blinded by choice</a>
</strong>
</em>
</p>
<hr>
<h2>How about skin cancer?</h2>
<p>It wasn’t until 1999 that research proved that using sunscreen prevents skin cancer. Again, we have Queensland to thank, specifically the residents of Nambour. They took part in a <a href="https://pubmed.ncbi.nlm.nih.gov/10475183/">trial</a> for nearly five years, carried out by a research team led by Adele Green of the Queensland Institute of Medical Research. Using sunscreen daily over that time reduced rates of squamous cell carcinoma (a common form of skin cancer) by about 60%.</p>
<p>Follow-up <a href="https://pubmed.ncbi.nlm.nih.gov/21135266/">studies</a> in 2011 and 2013 showed regular sunscreen use almost halved the rate of melanoma and <a href="https://pubmed.ncbi.nlm.nih.gov/23732711/">slowed skin ageing</a>. But there was no impact on rates of <a href="https://www.cancer.org.au/cancer-information/types-of-cancer/non-melanoma-skin-cancer">basal cell carcinoma</a>, another common skin cancer. </p>
<p>By then, researchers had shown sunscreen stopped sunburn, and stopping sunburn would prevent at least some types of skin cancer.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1729258841827635600"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-a-serious-ethical-problem-with-some-sunscreen-testing-methods-and-youre-probably-not-aware-of-it-195359">There's a serious ethical problem with some sunscreen testing methods – and you're probably not aware of it</a>
</strong>
</em>
</p>
<hr>
<h2>What’s in sunscreen today?</h2>
<p>An effective sunscreen uses one or more active ingredients in a cream, lotion or gel. The <a href="https://theconversation.com/explainer-how-does-sunscreen-work-what-is-spf-and-can-i-still-tan-with-it-on-88869">active ingredient</a> either works:</p>
<ul>
<li><p>“chemically” by absorbing UV and converting it to heat. Examples include PABA (para-aminobenzoic acid) and benzyl salicylate, or</p></li>
<li><p>“physically” by blocking the UV, such as zinc oxide or titanium dioxide. </p></li>
</ul>
<p>Physical blockers at first had limited cosmetic appeal because they were opaque pastes. (Think cricketers with zinc smeared on their noses.) </p>
<p>With microfine particle technology from the 90s, sunscreen manufacturers could then use a combination of chemical absorbers and physical blockers to achieve high degrees of sun protection in a cosmetically acceptable formulation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-check-should-we-be-worried-that-the-chemicals-from-sunscreen-can-get-into-our-blood-116738">Research Check: should we be worried that the chemicals from sunscreen can get into our blood?</a>
</strong>
</em>
</p>
<hr>
<h2>Where now?</h2>
<p>Australians have embraced sunscreen, but they still don’t apply enough <a href="https://www.cancervic.org.au/get-support/stories/australians-dont-apply-enough-sunscreen.html">or</a> reapply often enough.</p>
<p>Although some people are concerned sunscreen will block the skin’s ability to <a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">make vitamin D</a> this is unlikely. That’s because even SPF50 sunscreen doesn’t filter out all UVB.</p>
<p>There’s also concern about the active ingredients in sunscreen <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652235/">getting into the environment</a> and whether their <a href="https://www.fda.gov/drugs/news-events-human-drugs/spotlight-cder-science-new-fda-study-shines-light-sunscreen-absorption">absorption by our bodies</a> is a problem.</p>
<p>Sunscreens have evolved from something that at best offered mild protection to effective, easy-to-use products that stave off the harmful effects of UV. They’ve evolved from something only people with fair skin used to a product for anyone.</p>
<p>Remember, slopping on sunscreen is just one part of sun protection. Don’t forget to also slip (protective clothing), slap (hat), seek (shade) and slide (sunglasses).</p><img src="https://counter.theconversation.com/content/215893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Dawes 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>Early products focused on tanning. Others roasted you like a chicken. Which of these claims can you remember?Laura Dawes, Research Fellow in Medico-Legal History, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2187842023-12-12T19:53:39Z2023-12-12T19:53:39ZCanada owes its veterans new mental health tools: Access to psychedelic therapies is overdue<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/canada-owes-its-veterans-new-mental-health-tools-access-to-psychedelic-therapies-is-overdue" width="100%" height="400"></iframe>
<p>The Canadian Senate Subcommittee on Veterans Affairs recently released a striking report entitled <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/"><em>The Time is Now: Granting Equitable Access to Psychedelic Therapies</em></a>. </p>
<p>To address high rates of suicide and post-traumatic stress disorder (PTSD) among veterans, the report calls on Veterans Affairs Canada (VAC) to immediately implement “a robust research program funded by VAC and the Department of National Defence (DND) in partnership with Health Canada, the Canadian Institutes of Health Research, and all other relevant partners.”</p>
<p>With psychedelic research, Veterans Affairs Canada has a real chance to live up to its mandate “to provide exemplary, client-centred services and benefits that respond to the needs of veterans, our other clients and their families.” </p>
<p>As a psychedelics researcher with an interest in veteran health, I couldn’t be happier, especially with the Senate focus on timeliness, equity and access. </p>
<p>Not only is <a href="https://www.researchgate.net/publication/372244882_Knowledge_Synthesis_in_the_Science_of_Psilocybin_Scoping_Reviews_of_Clinical_and_Preclinical_Research">my PhD on the therapeutic application of psilocybin</a>, but my father was a veteran of the Canadian Forces, as is my brother and two uncles and both of my grandfathers. I grew up on Canadian Forces bases.</p>
<h2>Canada’s veterans</h2>
<p>Lt. Col. (ret’d) Jack Shore, my father, graduate of the <a href="https://www.btb.termiumplus.gc.ca/tpv2alpha/alpha-eng.html?lang=eng&srchtxt=APPRENTICE%20SOLDIER">Soldier Apprentice Program</a> and a United Nations Peacekeeper in the <a href="https://peacekeeping.un.org/sites/default/files/past/onucB.htm">Congo mission</a> of the early 1960s, passed away as I was working as a guest co-editor of a special edition of the <a href="https://jmvfh.utpjournals.press/toc/jmvfh/current"><em>Journal of Military, Veteran and Family Health</em></a>. The theme of the edition is “Therapeutic use of psychedelics, entheogens, entactogens, cannabinoids and dissociative anesthetics for military members and veterans.” </p>
<p>While my Dad rarely talked about his time in the Congo, he experienced what we would now recognize as moral injury, and most likely PTSD. These conditions directly shaped our family life and upbringing. That was before Sudan, Rwanda, the Yugoslav wars and Afghanistan.</p>
<p>My childhood on bases occurred in time of relative peace, but Canada has now had a few generations of soldiers experience active combat. </p>
<p>The <a href="https://patientsmedicalhome.ca/resources/best-advice-guides/best-advice-guide-caring-for-veterans/">629,000 veterans living in Canada have rates of depression, anxiety and substance use disorder that are higher than the civilian population</a>. <a href="https://doi.org/10.1002/jts.21956">One in seven is living with PTSD</a>. Veterans are <a href="https://www.mcgill.ca/maxbellschool/files/maxbellschool/ofha_veteran_homelessness_policy_brief_-_2023.pdf">two to three times more likely</a> to experience homelessness compared to the general population. </p>
<h2>Duty of care</h2>
<p>To veterans of the Canadian Forces and to their families, we owe a duty of care, and not just to provide services and access to novel treatments. We also have a duty to care enough to do the science well and to tackle the public policy challenges (including regulatory drug reform) necessary to provide Canadian veterans with effective care.</p>
<blockquote>
<p>“It is the Government of Canada’s duty to assure veterans that it is doing everything in its power, immediately, to respect its solemn commitment to support, at any cost, those who chose to defend us with honour.” — <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/">The Subcommittee on Veterans Affairs, Senate of Canada</a> </p>
</blockquote>
<p>The role of the VAC includes paying for the cost of health-care benefits and other services for veterans through the <a href="https://www.canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/health-care-plan.html">Public Service Health Care Plan</a> and supplemental treatment benefits. While this single-payer provider model has advantages, it relies heavily on VAC staff and managers to assess and approve plans of care. </p>
<p>Developing a psychedelics research program for veterans should be seen as a public health priority. It will most likely require an independent panel of experts and stakeholders, including veterans, to help shape the agenda in a timely manner for the VAC. </p>
<h2>Psychedelic therapies</h2>
<p><a href="https://cimvhr.ca/">The Canadian Institute for Military and Veteran Health Research</a> (CIMVHR), founded in 2010, is well positioned as the Canadian hub for military, veteran and family health research to provide the infrastructure to foster collaboration, ensure stakeholder engagement and work on the knowledge translation so necessary to rapidly developing the capacity and expertise of Canadian researchers.</p>
<p>We can build on the work of the U.S. Department of Veterans Affairs, which is <a href="https://clinicaltrials.gov/study/NCT05876481?term=Veteran&intr=Psilocybin&rank=1">currently conducting several psilocybin trials</a>, and the long-standing work of <a href="https://maps.org/">MAPS (Multi-disciplinary Association of Psychedelic Studies)</a> in advancing MDMA-assisted therapy for PTSD towards regulatory approval. We can also listen to the experts, such as Canada Health Research Chair in Mental Health Disparities Monnica Williams, who are calling for <a href="https://doi.org/10.1007/s11469-023-01160-5">greater equity and improved inclusion of BIPOC veterans and researchers</a>. </p>
<blockquote>
<p>“When we have tried everything in our toolbox but still cannot help our patients, it is truly time for some new tools.” —<a href="https://jmvfh.utpjournals.press/toc/jmvfh/9/5">Monnica Williams</a>, Canada Health Research Chair in Mental Health Disparities </p>
</blockquote>
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Read more:
<a href="https://theconversation.com/the-potential-of-psychedelics-to-heal-our-racial-traumas-218233">The potential of psychedelics to heal our racial traumas</a>
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<p>Psychedelic ketamine appears to have <a href="https://doi.org/10.1192%2Fbjo.2021.1061">positive but short-lived outcomes</a> in the treatment of mood disorders, and ketamine clinics require evaluation given recent <a href="https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine">FDA warnings</a> about risks of commercialized mental health telemedicine and take-home doses.</p>
<p>Ultimately, the Canadian public may want to reconsider the policy framework that still severely limits access to these promising compounds for researchers, clinicians and those in need. </p>
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Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
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<p>Veterans have taken it upon themselves to support each other and to advocate for change. <a href="https://heroicheartsproject.org/">The Heroic Hearts Project</a> helps veterans access psychedelic therapies and has long championed the potential benefits of plant medicine ceremony.</p>
<p><a href="https://www.heroicheartsproject.ca/">Heroic Hearts Canada</a>, which aims to provide Canadian veterans with equitable access to safe, effective and affordable psychedelic therapies, has recently partnered with University of Calgary for some <a href="https://www.ucalgary.ca/research/participate/study/16168/are-you-veteran-canadian-armed-forces-have-you-investigated-working-psychedelics-legally">important observational research</a>.</p>
<h2>Faster progress to medical use</h2>
<p>The time lag from drug discovery to patient care is often decades, prompting the expression “<a href="https://doi.org/10.1186/s41231-019-0050-7">valley of death</a>” to refer to the gap between bench science and bedside care. </p>
<p>Given the real mental health needs of Canadian veterans, and the known limits on effectiveness for current standards of care, we must aim for quicker progress towards medical use, <a href="https://www.unodc.org/res/WDR-2023/WDR23_B3_CH2_psychedelics.pdf">as both the United States and Australia have done</a>. However, this progress must not be at the expense of safety and quality, and definitely not simply for commercialization. </p>
<p>Thought needs to be given to the development, evaluation and quality assurance of accessible programs for veteran-centred care, with Veterans’ voices at the table. It is time for more emphasis on psychedelics-related <a href="https://doi.org/10.1016/j.psychres.2019.04.025">implementation science</a>, the study of methods to promote the uptake (and identify barriers) of research findings into routine clinical use in order to improve effectiveness of health services.</p>
<p>There is <a href="https://healthsci.queensu.ca/source/Psychedelics%2520Research/Psychedelic%2520Medicine%2520Report%2520-%2520Final.pdf">robust and mounting evidence to support regulatory approval for MDMA and psilocybin-assisted therapies</a>. Their availability and uptake by clinicians and the public is only a matter of time. </p>
<h2>The need for more diverse research</h2>
<p>Research funds now are best allocated towards large Phase 3 trials that treat wider cross-sections of the veteran community, to begin to assess the safety and efficacy of interventions such as the naturally ocurring and culturally significant psychedelic compounds <a href="https://doi.org/10.1080/00952990.2023.2220874">ibogaine and 5-MeO-DMT</a> <a href="https://www.proquest.com/openview/2d897baa8a8203979eaf5ee7deb9037e/1?pq-origsite=gscholar&cbl=18750&diss=y">and ayahuasca</a>, and to invest in knowledge translation, program evaluation and training researchers and clinicians. </p>
<p>Apart from new biomedical research, it is time we recognized the widespread personal use of psychedelics, including among veterans, and develop safer use guidelines for psychedelics like those in place <a href="https://www.canada.ca/en/health-canada/services/substance-use/alcohol/low-risk-alcohol-drinking-guidelines.html">for alcohol</a> and <a href="https://doi.org/10.1007/BF03404169">cannabis</a>.</p>
<p>While the Senate report does not mention cannabis, it is worth noting that veterans in Canada have been <a href="https://dimensionsretreats.com/dimensions-retreats-algonquin-elevate-veterans-only/#:%7E:text=The%2520program%2520does%2520not%2520include,mind%252Dbody%2520practices%2520in%2520nature.">approved for treatment with cannabis-assisted therapy</a>. </p>
<p>This includes the use of <a href="https://doi.org/10.1177/0269881121997099">cannabis as a psychedelic</a> and mimics the <a href="https://doi.org/10.1007/s40429-021-00401-8">preparation-session-integration protocols</a> of psychedelic therapies. This intervention is also worth rapid evaluation and possible expansion. </p>
<p>Given the pressing needs of Canadian veterans and the limitations of our current tools, the need for research on psychedelic therapies, as well as for timely and equitable access, is urgent.</p><img src="https://counter.theconversation.com/content/218784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ron Shore worked for, and consulted to Dimensions Health Centres in 2021 and 2022; he continues to own shares in the company.</span></em></p>One in seven Canadian veterans is living with PTSD. Developing a psychedelics research program for veterans should be a public health priority.Ron Shore, Research Scientist, Queen's Health Sciences and Assistant Professor, Department of Psychiatry, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2149162023-12-04T22:27:20Z2023-12-04T22:27:20ZPublic health errors: Why it’s crucial to understand what they are before assessing COVID-19 responses<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/public-health-errors-why-its-crucial-to-understand-what-they-are-before-assessing-covid-19-responses" width="100%" height="400"></iframe>
<p>Joe Vipond, a Canadian emergency room physician who was a strong supporter of masking during the pandemic, <a href="https://www.una.ca/1385/worlds-slow-recognition-of-airborne-transmission-of-covid-was-most-egregious-public-health-error-in-modern-history">said in a speech last year</a> that the slow recognition that COVID-19 is spread by airborne transmission resulted in what is likely “the most egregious public health error in modern history.”</p>
<p>The notion that governments can commit public health errors in response to a public health emergency like the COVID-19 pandemic — and that these errors can negatively impact a large number of people — has begun to receive attention from the <a href="https://www.forbes.com/sites/johndrake/2021/05/30/was-covid-19-a-failure-of-policy-or-a-failure-of-information/?sh=7e78786f457a">scientific community and the popular press</a>. Public health measures such as <a href="https://www.nytimes.com/2022/05/31/briefing/masks-mandates-us-covid.html">mask mandates</a>, <a href="https://www.telegraph.co.uk/news/2021/06/10/lockdowns-single-biggest-public-health-mistake-history-says/">lockdowns</a>, <a href="https://vinayprasadmdmph.substack.com/p/anthony-fauci-still-wont-admit-that">school closures</a> and <a href="https://doi.org/10.1136/bmjgh-2022-008684">vaccine mandates</a> are now widely discussed.</p>
<p>However, how can we investigate why governments err without understanding first what a public health error is, and is not? As a public health errors scholar, it strikes me how little research has been done <a href="https://doi.org/10.1097/PHH.0b013e3181bee698">on this topic</a>, and how much confusion exists around <a href="https://doi.org/10.1097/PHH.0b013e3181e030d3">what constitutes a public health error</a>.</p>
<h2>What is a public health error?</h2>
<p>In <a href="https://doi.org/10.1017/jme.2023.67">a new paper</a>, I clarify these issues, offer a new definition of the concept, and explain why studying errors contributes to our understanding of public health policy.</p>
<p>I suggest that a public health error occurs when, in retrospect, a policy choice worsens public health. This decision must either cause direct and significantly greater harm to the public or fail to effectively prevent harm, compared to other available options. Based on those criteria, there are two broad types of errors:</p>
<ol>
<li><strong>Error of action</strong>. Interventions that directly caused harm to population health and were worse than doing nothing at all.</li>
<li><strong>Error of omission</strong>. Failure to take action when measures were needed to protect the health of the population.</li>
</ol>
<h2>Errors of action</h2>
<p>Examples of the first type include public health interventions and campaigns. For instance, <a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">public health campaigns in the 1950s</a> using low-dose radiation to treat benign illnesses (that is, not for treating cancer), such as acne and <a href="https://global.oup.com/academic/product/ringworm-and-irradiation-9780197568965?cc=ca&lang=en&">ringworm</a>. Children and young adults treated with radiation showed an alarming tendency to develop <a href="https://doi.org/10.2105/AJPH.2018.304763">brain tumours, thyroid cancer and other ailments</a> as adults.</p>
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Read more:
<a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">A generation of Canadian children was given radiation treatment and never warned of the cancer risks</a>
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<p>Other examples include the approval of a faulty drug, like the drug <a href="https://doi.org/10.1093/toxsci/kfr088">Thalidomide</a> prescribed to pregnant women in the 1950s and 1960s for the treatment of nausea. The drug caused irreversible fetal damage, <a href="https://thalidomide.ca/en/">resulting in thousands of children being born with severe congenital malformations</a>. The painkiller <a href="https://doi.org/10.1503/cmaj.045206">Vioxx</a> that caused heart attacks and strokes is a more recent example of an error of action.</p>
<p>Erroneous guidelines provide yet another example of this type of error. For example, a recommendation in the United States <a href="https://doi.org/10.1056/NEJMms2206281">to give increased radiation doses to Black people</a> compared to other populations during X-ray procedures (a practice called “<a href="https://doi.org/10.1056/NEJMms2004740">race correction</a>”).</p>
<h2>Errors of omission</h2>
<p>The second category of errors includes instances of inaction or cases when public health officials were not doing enough to protect the public. For example, the failure to act against <a href="https://books.google.ca/books/about/The_Cigarette_Century.html?id=yybaN6j4IpEC&redir_esc=y">the harmful effects of tobacco</a>; the delayed action to reduce <a href="https://doi.org/10.1177/0096144215623954">child poisoning caused by lead paint inside U.S. homes</a>; or the time it took for government officials to respond to the <a href="https://doi.org/10.5942/jawwa.2016.108.0195">elevated levels of lead</a> found in the drinking water of residences in Flint, Mich. </p>
<p><a href="https://doi.org/10.1093/phe/phaa031">Health Canada’s delayed and inadequate response to evidence of addiction and misuse associated with the opioid OxyContin</a> is another example of an error of omission.</p>
<h2>The question of blame</h2>
<p>Naturally, when the public is harmed, people want someone to blame, and culpability (such as acts of negligence or carelessness) often becomes our central focus. While understandable, this approach is misguided. Instead, I strongly suggest focusing on the consequences of public health choices — and the systematic factors leading to these outcomes — rather than on blame.</p>
<p>Doing so (removing blame) better aligns with the <a href="https://doi.org/10.17226/1091">goal of public health</a>, which is to maintain and promote the health of populations. In this sense, public health errors of action or omission are contrary to this aim: causing or failing to prevent harm to the public, whether they are culpable or not.</p>
<p>That brings me to a possible definition of error. I <a href="https://doi.org/10.1017/jme.2023.67">define a public health error</a> as “an action or omission, by public health officials, whose consequences for population health were substantially worse than those of an alternative that could have been chosen, regardless of the causal processes involved in the consequences.”</p>
<h2>Back to COVID</h2>
<p>As the COVID-19 pandemic fades, but remains a prominent public health concern, I welcome the debate about whether public health responses could have been better. I suggest we follow four simple rules, rooted in my public health errors lens to better assess our actions:</p>
<ol>
<li><p>Stop focusing on blame (to err is human). Instead, assess the structural factors leading to negative outcomes, such as how science is interpreted, political pressure and decision-making procedures. After all, the goal is to improve and learn from mistakes rather than pointing out blameworthy actors. Allocating blame leads to unnecessary politicization of the process and findings.</p></li>
<li><p>Fight your biases and acknowledge that both the failure to act when measures were needed and <a href="https://doi.org/10.1136/bmj.m4074">the interventions in response to the virus</a> can either cause harm or fail to prevent harm to the public.</p></li>
<li><p>Be humble when interpreting the evidence. It is often difficult to compare different types of harms and benefits. Our actions (or inactions) can have both short-term and long-term effects on health and beyond.</p></li>
<li><p>Assess the impact of our public health measures on the most vulnerable, such as marginalized communities, the poor, disabled individuals and those struggling with addiction disorders. They might be the most susceptible to the consequences of our decisions.</p></li>
</ol>
<p>Moving forward, it is time to set aside our political and <a href="https://www.scientificamerican.com/article/the-covid-science-wars1/">scientific battles</a> so we can work together to examine our mistakes, preventing their recurrence in the future. This task is not easy and requires a thorough and transparent investigation. However, it is essential for protecting the public’s health and rebuilding trust in the medical profession.</p><img src="https://counter.theconversation.com/content/214916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Itai Bavli 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>As the COVID-19 pandemic fades, we may debate whether public health responses could have been better. But first we need to understand what public health errors are — and are not.Itai Bavli, Postdoctoral research fellow, Applied Ethics, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190152023-12-04T19:13:44Z2023-12-04T19:13:44ZCruel summer ahead – why is Australia so unprepared?<figure><img src="https://images.theconversation.com/files/563117/original/file-20231203-15-y3qp5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>2023 has shattered climate records, accompanied by extreme weather that has left a trail of devastation and despair, according to the <a href="https://wmo.int/news/media-centre/2023-shatters-climate-records-major-impacts">World Meteorological Organization</a> at COP 28. Some of the most significant extreme heat events were in southern Europe and North Africa, especially in the second half of July. Temperatures in Italy reached 48.2°C, and record-high temperatures were reported in Tunis (Tunisia) 49.0°C, Agadir (Morocco) 50.4°C and Algiers (Algeria) 49.2°C.</p>
<p>Heat-related deaths are on the rise globally. In 2019, a study in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01860-2/fulltext#:%7E:text=The%20authors%20estimate%20that%201,000%20were%20related%20to%20heat">The Lancet</a> attributed 356,000 deaths to extreme heat. A <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00198-9/fulltext">recent study</a> puts the excess deaths due to last year’s heatwaves in Europe at more than 70,000. The death toll of this year’s heat waves is as yet unknown, but likely to be much worse. </p>
<p>Extreme heat events are without doubt the greatest risk to the right to life caused by climate change. And this has major implications for those providing key social services to lessen inequality. </p>
<p>An extreme heat event <a href="http://www.bom.gov.au/australia/heatwave/knowledge-centre/understanding.shtml">occurs</a> when temperatures sit at roughly 5°C above average for three days or more – and particularly when this is coupled with high levels of humidity. These conditions pose serious health risks for older people, outdoor workers, people with chronic conditions, pregnant women, children, people living in poorly insulated housing or remote communities, people with reduced mobility, culturally and linguistically diverse communities, refugees, and people experiencing energy poverty and/or social isolation. </p>
<p>Our <a href="https://climatejusticeobservatory.com.au/">Climate Justice Observatory</a> has modelled how many more such days vulnerable people in Queensland will <a href="https://climatejusticeobservatory.com.au/climate-mapping/">face</a>.</p>
<p>Australia finally has a <a href="https://www.health.gov.au/resources/publications/national-health-and-climate-strategy?language=en">national climate health strategy</a>, launched on December 3, and not a moment too soon. It points to the development of a National Heat Health Action Plan that we needed in place at least five years ago. Some states also have strategies, the most comprehensive being South Australia, with its useful guide <a>Healthy in the Heat</a>. Melbourne, too, now has two Chief Heat Officers, one of six cities globally that are participating in an international movement to improve how cities handle heat in a warming world.</p>
<p>But we still haven’t done the deep thinking and planning required to get communities ready – and the next El Nino driven southern summer is here. We need to take a human rights approach to assessing its potential impact.</p>
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Read more:
<a href="https://theconversation.com/too-many-renters-swelter-through-summer-efficient-cooling-should-be-the-law-for-rental-homes-214483">Too many renters swelter through summer. Efficient cooling should be the law for rental homes</a>
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<h2>How will access to health be affected?</h2>
<p>In 2016, a <a href="https://www.climatecouncil.org.au/uploads/b6cd8665c633434e8d02910eee3ca87c.pdf">Climate Council report</a> used existing data from the 2009 heatwaves in Australia to map increases in ambulance call outs, emergency department presentations as well as heat related deaths to indicate additional pressures on health system during hotter months.</p>
<p>This report found emergency call-outs jumped by 46%; cases involving heat-related illness jumped 34-fold; and cardiac arrests almost tripled in Victoria. In total, 374 excess deaths were recorded, a 62% increase on the previous year. </p>
<p>It also reported that </p>
<blockquote>
<p>although many states have taken significant steps to upgrade their heat and health warning systems since the deadly heatwaves of 2009, strategies vary considerably from state to state and focus primarily on reactive rather than long-term planning. </p>
</blockquote>
<p>However, there are things we can learn from various Western European countries that had “already taken significant strides in preparing their cities, industries and people for the threat of extreme heat”. There will be more lessons from this summer too. </p>
<h2>What is the impact on homeless populations?</h2>
<p>Homeless people need adequate shelter during a heatwave to avoid fatal consequences. Access to food is more difficult and food spoils more easily, plus there is additional need for increased amounts of water. Triggers for mental health and exposure to trauma increase as does the underlying issue that homeless people may have limited access to safe spaces during any extreme weather event. </p>
<p>In Australia, many air-conditioned spaces require people to undertake a commercial transaction to remain there. This begs an important question: do places like public libraries take on the role of “cool banks”, as they did in the UK during last year’s heatwaves there? </p>
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Read more:
<a href="https://theconversation.com/how-do-we-save-ageing-australians-from-the-heat-greening-our-cities-is-a-good-start-112613">How do we save ageing Australians from the heat? Greening our cities is a good start</a>
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<p>Heatwaves are also implicated in increasing rates of homelessness among those at risk. And while there are exciting examples of <a href="https://www.melbourne.vic.gov.au/sitecollectiondocuments/heatwaves-homelessness.pdf">strategies</a> from the City of Melbourne that could build resilience among homeless populations exposed to extreme weather events like free access to lockers and indoor pools, cinema tickets, maps of drinking fountains and support to homelessness support agencies for pop-up accommodations, more needs to be done – both on the ground, and in terms of modelling and planning.</p>
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<p>Current strategies in Australia include:</p>
<ul>
<li><p>a South Australian intervention using trauma informed extreme weather resilience education</p></li>
<li><p>a city-wide plan for heatwaves and homelessness put in place by the City of Melbourne. </p></li>
</ul>
<h2>Will heatwaves worsen mental health?</h2>
<p>Increased heatwaves have implications for mental health in terms of social connectedness, particularly among vulnerable groups. But extreme heat also affects mental health more broadly: it is <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00104-3/fulltext">already known</a> to lead to <a href="https://www.psychiatry.org/news-room/apa-blogs/extreme-heat-can-take-a-toll-on-mental-health#:%7E:text=Extreme%20heat%20is%20associated%20with,violence%20and%20increased%20substance%20use.">increased aggression</a> and <a href="https://theconversation.com/heatwaves-linked-to-an-increase-in-australian-suicide-rates-23254">increased suicide rates</a>. </p>
<p>And what about the mental health of those responding to these crises? Ongoing emergencies, placing ever-growing pressure on stretched social service responders, pushes people and systems to breaking point. </p>
<h2>What will be the impact on decent work?</h2>
<p>The idea of “decent work” is defined by the International Labour Organization (ILO), and is, in the <a href="https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1a0Szab0oXTdImnsJZZVQfUKxXVisd7Dae%2FCu%2B13J25Nha7l9NlwYZ%2FTmK57O%2FSr7TB2hbCAidyVu5x7XcqjNXn44LZ52C%2BIkX8AGQrVyIc#:%7E:text=This%20is%20work%20that%20respects,article%207%20of%20the%20Covenant.">description</a> of the UNHCR’s Committee on Economic, Social and Cultural Rights, employment that “respects the fundamental rights of the human person as well as the rights of workers in terms of conditions of work safety and remuneration” with “respect for the physical and mental integrity of the worker in the exercise of his/her employment”.</p>
<p>Some jobs will be far more affected by heat than others. A recent ILO <a href="https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_711917/lang--en/index.htm">report</a> had already targeted agricultural jobs, construction, sport and tourism as sectors affected by heat stress. The Treasurer’s latest <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150.pdf">Inter-generational Report</a> devotes a whole section to the productivity losses that will be caused by extreme heat.</p>
<p>So should the government provide JobKeeper-type payments to outdoor workers during heatwaves? What about those in the informal sector, such as workers who are delivering food by bicycle? Will companies accept the need for extreme heat labour safeguards? Should Centrelink <a href="https://www.theguardian.com/australia-news/2023/nov/20/centrelink-urged-to-suspend-mutual-obligations-during-periods-of-extreme-heat">suspend</a> mutual obligations during periods of extreme heat? </p>
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<img alt="" src="https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563131/original/file-20231203-15-9ym2lc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Should governments make special provisions in heatwaves for those who work outdoors?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What about electricity bills?</h2>
<p>Should utility companies be able to cut off power during an extreme heat event – even if all processes have been followed? </p>
<p>This has been hotly debated in the United States. While many US states have policies preventing power shutdown during the colder months, there are <a href="https://www.vox.com/climate/2023/7/21/23799004/invisible-consequences-extreme-heat-physical-mental-health">fewer clear policies</a> in place in terms of summer. </p>
<p>In Australia, there is no accurate picture of just what the lack of any coherent cooling strategy costs the public. Some low-income consumers have to <a href="https://powertogether.org.au/">choose</a> between turning on the air-conditioning or buying food. For some, it means utilities have cut off their power for falling behind on an unpaid bill, even in life-threatening heat. </p>
<p>Renters, who cannot easily install, upgrade or fix air-conditioning are also at threat. And should people be evicted during a heatwave? </p>
<p>Crucially, we need to have these debates now, not during a heatwave.</p>
<h2>Is there a right to air-conditioning or cooler spaces?</h2>
<p>On April 19 2022, the Queensland government <a href="https://statements.qld.gov.au/statements/94979">reported</a> that air-conditioning had been delivered for “every single classroom, library and staffroom in every single state school”. </p>
<p>Should the state bear the cost of air-conditioning for early childcare centres, aged care homes, prisons and schools? Should swimming pools be free in towns without free air-conditioned spaces? </p>
<p>We know that green spaces can significantly reduce heat, especially in cities. Do we have a right to green space and shade in our streets and towns? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-a-heatwave-the-leafy-suburbs-are-even-more-advantaged-53307">In a heatwave, the leafy suburbs are even more advantaged</a>
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</p>
<hr>
<p>Finally, will there be parts of Australia that are already difficult places to live and work in the summer months that tip over to become uninhabitable on a seasonal basis? If so, what happens to summer sport or agricultural activities, or tourism? </p>
<p>Governments need to think carefully about all these issues now and – most importantly – take action.</p><img src="https://counter.theconversation.com/content/219015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Harris Rimmer receives funding from the Australian Research Council. She is affiliated with UNAA Qld and Foundations for Tomorrow as a volunteer board member. </span></em></p>Australia is planning for a very hot summer, which will have far-reaching consequences for many people. It’s time governments took this more seriously and, importantly, took action.Susan Harris Rimmer, Professor and Director of the Policy Innovation Hub, Griffith Business School, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2189182023-12-01T13:38:30Z2023-12-01T13:38:30ZWho is still getting HIV in America? Medication is only half the fight – homing in on disparities can help get care to those who need it most<figure><img src="https://images.theconversation.com/files/562804/original/file-20231130-23-mq7ite.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2119%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Access to life-saving HIV prevention medications varies by race and other sociodemographic factors.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/aids-awareness-red-ribbon-royalty-free-image/1445701859">David Talukdar/Moment via Getty Images</a></span></figcaption></figure><p>As the globe marks another <a href="https://www.who.int/campaigns/world-aids-day/world-aids-day-2023">World AIDS Day</a> on Dec. 1, it’s crucial to both acknowledge the significant strides made in the global battle against HIV and recognize the persistent challenges that remain. While the United States had seen a <a href="https://www.cdc.gov/hiv/statistics/overview/ataglance.html">slow decline</a> in the overall number of new HIV infections from 2017 to 2021, a closer look at the data reveals <a href="https://www.cdc.gov/hiv/statistics/overview/in-us/incidence.html">persistent disparities</a> largely borne by LGBTQ people and <a href="https://theconversation.com/use-of-hiv-prevention-treatments-is-very-low-among-southern-black-gay-men-170794">communities of color</a>.</p>
<p>As a <a href="https://scholar.google.com/citations?user=DbZMkzUAAAAJ&hl=en">social epidemiologist</a> who proudly identifies as a gay Latino, I have a vested interest both personally and professionally in understanding and addressing the HIV disparities my communities face. It’s disheartening to realize that, despite available medical advances that can end the AIDS epidemic, these resources aren’t reaching those who need them the most.</p>
<h2>Tools in the HIV prevention arsenal</h2>
<p>When HIV/AIDS first emerged in the U.S. in the 1980s, <a href="https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline/">condoms were the only prevention strategy</a> available other than behavioral changes like abstinence. Since then, the development of effective medications has made it possible to live with HIV.</p>
<p>In the 1990s, researchers adopted the model of “<a href="https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/arv-therapy-as-prevention">treatment as prevention</a>,” which recognized that an HIV-positive person with a reduced viral load from taking their antiviral therapy medications had a lower likelihood of passing the virus to their sexual partners. This messaging was changed in recent years to <a href="https://www.idsociety.org/science-speaks-blog/2021/u--u-the-evidence-is-in.-spreading-the-word-that-undetectable--untransmissable-is-the-next-crucial-step/">“undetectable = untransmittable,” or U=U</a>, when a landmark study concluded that people living with HIV who are virally suppressed, or undetectable, through medications are not able to pass the virus on to a sexual partner.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/8q21PG1CdNs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">People who have undetectable levels of the virus are deemed to have untransmittable HIV.</span></figcaption>
</figure>
<p>In 2005, researchers introduced <a href="https://www.hiv.uw.edu/go/prevention/nonoccupational-postexposure-prophylaxis/core-concept/all">non-occupational postexposure prophylaxis, or nPEP</a>, which aimed to prevent infection in someone exposed to HIV by initiating antiviral therapy. </p>
<p>In 2012, the U.S. Food and Drug Administration approved the first <a href="https://www.hiv.uw.edu/go/prevention/preexposure-prophylaxis-prep/core-concept/all">preexposure prophylaxis, or PrEP</a> drug, which is an antiviral therapy that someone who has not been exposed to HIV takes daily to prevent infection. In 2021, the FDA approved the use of a <a href="https://www.hiv.uw.edu/go/prevention/preexposure-prophylaxis-prep/core-concept/all#recommended-regimens-dosing-hiv-prep-long-acting-injectable-">long-acting, injectable form of PrEP</a>, providing an alternative to daily pills. </p>
<p>While medical advancements have enhanced the options to prevent HIV, many aren’t reaching the people they are intended to treat. Of the estimated <a href="https://www.cdc.gov/hiv/group/racialethnic/other-races/prep-coverage.html">1.2 million people eligible for PrEP in the U.S.</a>, only 30% received a prescription in 2021.</p>
<h2>Racial disparities</h2>
<p>Gay and bisexual men continue to comprise around <a href="https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics/">two-thirds of new HIV infections</a> in the U.S. <a href="https://www.cdc.gov/hiv/policies/data/transgender-issue-brief.html">Transgender people</a>, <a href="https://www.vice.com/en/article/pkgnny/homeless-hiv-treatment">people who inject drugs</a> and <a href="https://www.cdc.gov/hiv/group/sexworkers.html">sex workers</a> also have disproportionate new infection rates. But cases are not distributed evenly by race. </p>
<p>The Centers for Disease Control and Prevention’s 2021 HIV Surveillance Report on groups at risk of HIV in 13 U.S. cities found that <a href="https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv-surveillance-special-report-number-31.pdf">nearly 80% of gay and bisexual men</a> engaged in condomless anal sex, with higher rates among white men than among both Black and Latino men.</p>
<p>However, between 2015 and 2019, white gay and bisexual men experienced a <a href="https://www.cdc.gov/hiv/group/msm/msm-content/diagnoses.html">17% decrease in HIV cases</a>. Black and Latino gay and bisexual men experienced no significant reductions. This is likely due to disparities in access to HIV prevention medication. Among those who were HIV negative, <a href="https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv-surveillance-special-report-number-31.pdf">only a little over 40% had used PrEP</a> in the past 12 months, with white men reporting higher use than both Black and Latino men. Among those who were HIV positive, 95% were actively using antiviral therapy, and there was little variation by race.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand holding orange PrEP pills above a clothed table with an open pill bottle" src="https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562805/original/file-20231130-25-n3chgy.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>
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<span class="caption">The first PrEP drug was approved in 2012, but access remains uneven across the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-latina-woman-taking-medicine-royalty-free-image/1320349143">Sara Jurado/E+ via Getty Images</a></span>
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</figure>
<p>Factors such as stigma, lack of access to and mistrust in health care, socioeconomic status, and cultural nuances that restrict access to PrEP likely contribute to the unchanging HIV burden <a href="https://www.cdc.gov/hiv/group/bmsm/prevention-challenges.html">Black</a> and <a href="https://www.cdc.gov/hiv/group/gay-bisexual-men/hispanic-latino/prevention-challenges.html">Latino</a> men, <a href="https://www.cdc.gov/hiv/policies/data/transgender-issue-brief.html#systemic-factors-that-contribute">trans people</a> and <a href="https://www.vice.com/en/article/pkgnny/homeless-hiv-treatment">people experiencing homelessness</a> face.</p>
<h2>Closing the PrEP access gap</h2>
<p>A recent systematic review of 42 different interventions to promote PrEP among gay and bisexual men in the U.S. found that the most promising involve addressing <a href="https://doi.org/10.1186/s12981-022-00456-1">various social and environmental factors</a> that restrict access and adherence. </p>
<p>Tackling access barriers at the community and health care levels can enhance public health initiatives to expand PrEP access, including addressing issues like stigma and medical mistrust. This can help effectively promote PrEP use among Black and Latino gay and bisexual men and reduce racial disparities in HIV infections.</p>
<p>It is also important to note that while HIV disproportionately affects certain groups, <a href="https://www.cdc.gov/hiv/group/racialethnic/africanamericans/diagnoses.html">people having heterosexual sex</a> are still at risk and need to be part of the HIV prevention solution.</p>
<p>World AIDS Day serves as a poignant reminder that the fight against HIV is not only a global endeavor but also one that requires a nuanced understanding of the unique challenges different communities face. Addressing disparities and tailoring interventions can help move humanity closer to a world where HIV is no longer a pervasive threat.</p><img src="https://counter.theconversation.com/content/218918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angel Algarin receives funding from the National Institutes of Health. </span></em></p>Two-thirds of new HIV infections are among gay and bisexual men. Although cases have decreased among white men, they have stagnated among communities of color.Angel Algarin, Assistant Professor of Health Promotion and Disease Prevention, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183412023-11-24T00:20:59Z2023-11-24T00:20:59ZTaylor Swift’s Brazil concert was hammered by extreme heat. How to protect crowds at the next sweltering gig<p>Electrifying music concerts and other mass events are increasingly under threat from severe weather events, such as extreme heat.</p>
<p>The tragic <a href="https://www.abc.net.au/news/2023-11-22/heatwave-humidity-warnings-follow-brazil-taylor-swift-fan-death/103132476">incident</a> at a Taylor Swift concert in Brazil recently, which resulted in the death of one fan, is a stark reminder of what can happen.</p>
<p>The concert took place in a stadium during a heatwave. Fans lined up for hours outside the Rio de Janeiro venue, with temperatures reportedly over 40°C. With the high humidity, this would have felt like almost 60°C, according to a measure known as the “<a href="https://www.weather.gov/ama/heatindex#:%7E:text=The%20heat%20index%2C%20also%20known,for%20the%20human%20body%27s%20comfort.">heat index</a>”.</p>
<p>As well as the fatality, fans <a href="https://www.news.com.au/entertainment/music/tours/taylor-swift-concert-goers-struck-with-seconddegree-burns/news-story/e1a597d52f642c46c1a8f45b5c816fdb">reported</a> burns after touching hot metal floors and railings.</p>
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Read more:
<a href="https://theconversation.com/extreme-weather-is-landing-more-australians-in-hospital-and-heat-is-the-biggest-culprit-216440">Extreme weather is landing more Australians in hospital – and heat is the biggest culprit</a>
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<h2>There have been other similar events</h2>
<p>What happened at the Swift concert is the consequence of insufficient preparation for extreme weather conditions during a large-scale event. However, this is not an isolated case. There is a <a href="https://www.billboard.com/lists/concerts-affected-climate-change-2023-full-list/july-4/">long list</a> of mass gatherings and events affected by extreme weather in 2023. </p>
<p>In August, a <a href="https://variety.com/2023/music/news/beyonce-dc-metro-trains-weather-delays-renaissance-1235689650/">Beyoncé concert</a> in a Washington DC stadium took place during severe weather conditions. This time it was heavy rain and lightning. Attendees were ordered to shelter in place.</p>
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<p>Lightning posed a direct threat to their safety. Those inside the stadium were directed to shelter under covered areas and ramps. Afterwards, several fans were reportedly treated for <a href="https://wjla.com/news/local/fedex-field-shelter-in-place-beyonce-concert-renaissance-tour-weather-lightening-rain-cover-thunderstorms-sunday-performance#:%7E:text=After%20a%20shelter,Nov%202023%2011%3A50%3A08%20GMT">heat exhaustion</a>. </p>
<p>The directive to shelter in place could have led to overcrowding in covered areas, potentially increasing the risk of incidents, such as a crowd crush.</p>
<p>Another US example was <a href="https://www.nbcnewyork.com/news/national-international/17-hospitalized-2-go-into-cardiac-arrest-at-ed-sheeran-concert-amid-extreme-heat/4497016/#:%7E:text=,working%20during%20the%20Ed">Ed Sheeran’s concert</a> at a Pittsburgh stadium during a July heatwave. </p>
<p>Some 17 people were hospitalised. Health emergencies included heat exhaustion and two cardiac arrests (when the heart stops beating).</p>
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<h2>We must prepare</h2>
<p>Climate change makes extreme weather events more frequent and intense. So risk assessments should include detailed weather monitoring and structural assessments for outdoor set-ups to ensure shade structures, for instance, can cope with crowds.</p>
<p>Contingency plans for a rapid response are also needed. These need to include plans to supply water or protective equipment (such as plastic ponchos) and timely safety directions and information. </p>
<p>Such planning should encompass not just the likelihood of extreme weather but also its potential impact on infrastructure, crowd control and emergency medical responses.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-burning-man-to-woodstock-to-fyre-festival-what-turns-a-festival-into-a-disaster-212859">From Burning Man to Woodstock to Fyre Festival: what turns a festival into a disaster?</a>
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<h2>Artists play a role too</h2>
<p>While the primary onus of safety lies with event organisers and venues, artists can also play a significant role in public safety during extreme weather. So we need to keep them informed about identified potential risks and planned countermeasures.</p>
<p>For instance, artists can influence crowd behaviour positively and prevent catastrophic outcomes, such as a crowd crush. They can appeal for calm or can announce any planned evacuation procedures.</p>
<p>In the most recent incident, Swift <a href="https://www.insider.com/taylor-swift-crew-give-water-fans-during-hot-brazil-concert-2023-11">paused her show</a> to ask crew members to distribute water to fans.</p>
<h2>Be safety aware</h2>
<p>People who attend mass events also need to <a href="https://www.sciencedirect.com/science/article/pii/S0925753523002345">be aware</a> of the safety issues related to extreme weather and be prepared.</p>
<p>Public education campaigns can help, as can effectively disseminating safety information to empower attendees to make informed decisions.</p>
<p>For instance, an event organiser can send a text message to all attendees to warn of upcoming weather conditions and a reminder to bring water or wear sunscreen. </p>
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<em>
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Read more:
<a href="https://theconversation.com/astroworld-tragedy-heres-how-concert-organisers-can-prevent-big-crowds-turning-deadly-171397">Astroworld tragedy: here's how concert organisers can prevent big crowds turning deadly</a>
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<h2>We can expect more of these events</h2>
<p>The tragic incident at the Swift concert and similar examples are not isolated but indicate a broader trend. With climate change, extreme weather events will pose a more common risk at such mass gatherings. </p>
<p>So we need to recognise and integrate this into how we plan for, and assess the risk associated with, future events. This is vital to ensure these gatherings remain celebratory landmarks rather than avoidable disasters.</p><img src="https://counter.theconversation.com/content/218341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Milad Haghani receives funding from the Australian Research Council (Grant No. DE210100440). </span></em></p>One fan died and others reported burns at the Swift concert. And we’re going to see similar incidents at future concerns if we don’t start planning for extreme weather.Milad Haghani, Senior Lecturer of Public Safety, Disaster Resilience & Urban Mobility, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2181222023-11-24T00:11:40Z2023-11-24T00:11:40ZLess than 75% of Queenslanders have access to fluoridated water – and it’s putting oral health at risk<figure><img src="https://images.theconversation.com/files/561235/original/file-20231123-25-usixfe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5792%2C3864&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/6-year-old-boy-drinking-water-1805710462">Yulia Raneva/Shutterstock</a></span></figcaption></figure><p>Health-care professionals have recently called on the Queensland government to mandate <a href="https://www.abc.net.au/news/2023-11-20/qld-fluoride-access-issues-tooth-decay-dental-care-oral-health/103099734">fluoride in drinking water</a> across the state, where water fluoridation coverage lags behind other Australian states and territories. </p>
<p>But what are the benefits of adding fluoride to our drinking water supplies? And why do more than one-quarter of Queenslanders not have access to a fluoridated drinking water supply, while most other Australians do?</p>
<h2>First, what is water fluoridation?</h2>
<p>Fluoride is a naturally occurring mineral best known for its role in strengthening our teeth. When our teeth come into regular contact with fluoride, this makes them more resistant <a href="https://pubmed.ncbi.nlm.nih.gov/10916327/">to dental caries</a>, or decay.</p>
<p>Water fluoridation is a public health program which works to reduce dental decay at the population level. It involves adding a very small amount of fluoride to public water systems which supply tap water. In Australia, the recommended levels of fluoride in public water supplies range from <a href="https://pubmed.ncbi.nlm.nih.gov/31868926/">0.6 to 1.1 mg per litre</a>. </p>
<p>The idea of water fluoridation was pioneered in the United States. In 1945, Grand Rapids, Michigan became the first city in the world to <a href="https://www.cdc.gov/fluoridation/basics/anniversary.htm">fluoridate its water supply</a>. Water fluoridation was cited by the US Centers for Disease Control and Prevention as <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm">one of ten great public health achievements</a> of the 20th century.</p>
<p>Fluoride has been added to water supplies in Australia for seven decades, starting in Beaconsfield, Tasmania, in 1953. Today, <a href="https://www.abc.net.au/news/2023-11-24/fluoride-dental-care-dentistry-water-queensland-government/103128018">over 90% of Australians</a> have access to fluoridated water. </p>
<p>The majority of <a href="https://legislation.nsw.gov.au/view/html/inforce/current/sl-2017-0419">Australian states</a> and territories <a href="https://www.health.vic.gov.au/publications/code-of-practice-for-fluoridation-of-drinking-water-supplies-health-fluoridation-act">have laws</a> requiring the fluoridation of public water supplies, with the exception of Queensland, which has left the decision up to <a href="https://www.abc.net.au/news/2023-11-20/qld-fluoride-access-issues-tooth-decay-dental-care-oral-health/103099734">individual local governments</a>.</p>
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Read more:
<a href="https://theconversation.com/four-myths-about-water-fluoridation-and-why-theyre-wrong-80669">Four myths about water fluoridation and why they're wrong</a>
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<h2>The evidence</h2>
<p>The scientific consensus is that water fluoridation is a safe and effective way to improve oral health. The <a href="https://ada.org.au/policy-statement-2-2-1-fluoride-use">Australian Dental Association</a>, the <a href="https://www.who.int/publications/i/item/9241563192">World Health Organization</a> and the <a href="https://www.iadr.org/science-policy/position-statement-community-water-fluoridation">International Association for Dental Research</a> are among the bodies which endorse water fluoridation as a public health measure. </p>
<p>To support and maintain a program like water fluoridation on such a large scale, we need to routinely collect evidence it works.</p>
<p>The <a href="https://www.adelaide.edu.au/press/titles/ncohs">National Child Oral Health Study 2012-14</a>, which I was involved in, gathered data on more than 24,000 children across Australia. The evidence demonstrated <a href="https://pubmed.ncbi.nlm.nih.gov/29869803/">water fluoridation was effective</a> in preventing dental caries. Another analysis I worked on of more than <a href="https://pubmed.ncbi.nlm.nih.gov/25558897/">5,000 children in Queensland</a>, published in 2015, showed water fluoridation reduced dental decay by 40%.</p>
<figure class="align-center ">
<img alt="A girl smiles and points at her teeth." src="https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561238/original/file-20231123-19-bq225y.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">Water fluoridation protects against tooth decay.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-happy-little-patient-sitting-on-1855461733">AnnaStills/Shutterstock</a></span>
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<p>Studies reviewed by the <a href="https://www.nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health">National Health and Medical Research Council</a> (NHMRC) in 2017 showed water fluoridation can reduce the incidence of dental caries by 26% to 44% in children and adolescents, and by 27% in adults. Earlier evidence has similarly shown fluoridation is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/28092105/">fewer caries in adults</a>. </p>
<p>Water fluoridation has also been found to be <a href="https://pubmed.ncbi.nlm.nih.gov/22452320/">highly cost-effective</a> – investment in these programs can result in significant savings through improved population oral health.</p>
<h2>Can fluoridation reduce inequalities in oral health?</h2>
<p>Social factors such as background and income are associated with oral health. For example, <a href="https://pubmed.ncbi.nlm.nih.gov/25394849/">people who are poorer</a>, from culturally and linguistically diverse backgrounds, or from <a href="https://theconversation.com/collaborating-with-communities-delivers-better-oral-health-for-indigenous-kids-in-rural-australia-141038">First Nations communities</a> will often have poorer oral health compared with the overall population.</p>
<p>My research shows exposure to fluoridated water is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30931771/">reduced inequality in child oral health</a> related to household income and Indigenous status. We would expect to see this because of the passive mechanism of fluoride delivery. That is, people can benefit just by drinking fluoridated tap water, regardless of their socioeconomic circumstances. </p>
<h2>Potential side effects</h2>
<p>Dental <a href="https://pubmed.ncbi.nlm.nih.gov/17652199/">fluorosis</a> (changes in the colour of tooth enamel) is a known side effect of water fluoridation. But dental fluorosis can also result from intake of fluoride from other sources, such as fluoridated toothpaste and fluoride applications during procedures at the dentist when children are young. Dental fluorosis in Australia is mostly very mild to mild and not associated with long-term <a href="https://pubmed.ncbi.nlm.nih.gov/26763813/">oral health consequences</a>.</p>
<p>The NHMRC’s <a href="https://www.nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health">2017 review</a> concluded water fluoridation poses no other risks which should be cause for concern. </p>
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<img alt="A hand holds a glass under the tap, filling it with water." src="https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561240/original/file-20231123-29-hpkib2.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">
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<span class="caption">The majority of Australia’s drinking water supplies are fluoridated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-pouring-water-into-glass-kitchen-1928623259">New Africa/Shutterstock</a></span>
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<p>However, fluoridation has historically been somewhat controversial. One of the reasons so many local councils in Queensland have opted out is vocal opposition from small groups.</p>
<p>An argument recently raised against fluoridation suggests early life intake of fluoride is associated with childhood development, particularly <a href="https://pubmed.ncbi.nlm.nih.gov/31856837/">lower IQ scores in children</a>. Much of evidence for these arguments has come from poorly designed research or from areas with <a href="https://theconversation.com/fluoride-very-high-levels-in-water-associated-with-cognitive-impairment-in-children-216840">very high levels</a> of natural fluoride and other heavy metals.</p>
<p>But child development is an important issue, so it’s understandable this has caused concern.</p>
<p>Several large reviews have recently investigated this potential link. The reviews published in <a href="https://pubmed.ncbi.nlm.nih.gov/32382957/">2020</a>, <a href="https://www.journals.uchicago.edu/doi/10.1086/711915">2021</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/37120936/">2023</a> all concluded fluoride exposure in the context of water fluoridation is not associated with lower cognitive abilities in children.</p>
<p>My colleagues and I also ran <a href="https://pubmed.ncbi.nlm.nih.gov/36214232/">an Australian study</a> to investigate this issue. We collected data from a nation-wide sample of more 2,600 children. We found exposure to fluoridated water in early childhood was not associated with any impact on child development. </p>
<p>This again shows us water fluoridation as practised in Australia and internationally is safe for children.</p>
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Read more:
<a href="https://theconversation.com/collaborating-with-communities-delivers-better-oral-health-for-indigenous-kids-in-rural-australia-141038">Collaborating with communities delivers better oral health for Indigenous kids in rural Australia</a>
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<h2>Where to from here?</h2>
<p>While the most significant gaps in Australia are in Queensland, some other parts of the country are missing out on fluoridated water too, including many <a href="https://pubmed.ncbi.nlm.nih.gov/36825829/">rural towns in Victoria</a>.</p>
<p>Water fluoridation has been a cornerstone of population prevention of <a href="https://www.healthdirect.gov.au/tooth-decay">dental decay</a>, which can lead to other oral and general health issues. </p>
<p>It’s important water fluoridation programs are supported, maintained and expanded where possible by all levels of government and health organisations.</p><img src="https://counter.theconversation.com/content/218122/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Loc Do receives funding from the National Health and Medical Research Council.</span></em></p>Fluoride is a naturally occurring mineral best known for its role in strengthening our teeth and making them more resistant to decay.Loc Do, Professor of Dental Public Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.