more_vertThe health disadvantages of Indigenous peoples around the world have their roots in colonisation and discrimination and are related to a loss of autonomy over lands and culture. This history has profoundly affected social determinants of health, such as poverty and marginalisation, and contributed to higher rates of communicable and non-communicable diseases in Indigenous people, and life expectancies that are typically 5 years or more lower than in non-Indigenous populations.1,2 Despite persistent health inequities, Indigenous peoples are determining the path to healing their communities.
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[Editorial] Improving mental health in the workplace
In 1700, Italian physician Bernardino Ramazzini penned De Morbis Artificum Diatriba (Diseases of Workers), the first medical text to describe the ways environmental conditions or hazards associated with various livelihoods could present risks for health. Famously, Ramazzini is cited for encouraging physicians to extend the Hippocratic inquiry of patients to include: “What is your occupation?” Although workers’ experiences in the modern world are very different from those in the 17th century, occupational medicine is built on the same fundamental ideals—preventing and treating job-related injury and illness and maintaining health in the workplace.
[Editorial] Counting down to climate change
Climate change is commonly discussed in the context of its future impact, but the Lancet Countdown on health and climate change by Nick Watts and colleagues, published on Oct 30, exposes the urgency for a response as environmental changes cause damaging effects on health worldwide now. The comprehensive Review describes the first results of a global initiative, which will annually report on indicators of climate change and its effects on health. One alarming finding is how rising temperatures have influenced the transmission of infectious diseases.
[Comment] Fruits, vegetables, and legumes: sound prevention tools
Cardiovascular disease is the leading cause of death worldwide, accounting for a third of all deaths. Three of four cardiovascular deaths and more than 80% of premature deaths attributable to non-communicable diseases occur in low-income and middle-income countries.1 Thus, preventive strategies to tackle premature mortality and, particularly, cardiovascular mortality represent a major public health goal not only for high-income countries, but also for low-income and middle-income countries. The most effective and sustainable preventive strategies should rely on healthy diet and lifestyle.
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GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1260–1344. The full-text version of this Article has been updated so that the list of authors is displayed in the correct order, in line with the pdf version, rather than in alphabetical order. This correction has been made to the online version as of Oct 12, 2017.
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GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59—The full-text version of this Article has been updated so that the list of authors is displayed in the correct order, in line with the pdf version, rather than in alphabetical order. This correction has been made to the online version as of Oct 12, 2017.
Obesity rates around the globe soar
A study published in The Lancet has shown the number of obese children and adolescents (aged five to 19 years) worldwide has risen tenfold in the past four decades.
The new data shows that in 1975 there were five million obese girls, but by last year there were 50 million. The number of obese boys has risen from six million to 74 million in the same period.
The study was led by Imperial College London and WHO and shows that if current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.
It analysed weight and height measurements from nearly 130 million people aged over five years (31.5 million people aged five to 19, and 97.4 million aged 20 and older), making it the largest ever number of participants involved in an epidemiological study.
Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, says that obesity rates in children and adolescents have soared globally over the past four decades, and continue to do so in low- and middle-income countries.
“These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities,” Professor Ezzati said.
“We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”
The authors say that if post-2000 trends continue, global levels of child and adolescent obesity will surpass those for moderately and severely underweight youth from the same age group by 2022. In 2016, the global number of moderately or severely underweight girls and boys was 75 million and 117 million respectively.
The authors also indicate the large number of moderately or severely underweight children and adolescents in 2016 (75 million girls and 117 million boys) still represents a major public health challenge, especially in the poorest parts of the world.
Dr Fiona Bull, program coordinator for surveillance and population-based prevention of non-communicable diseases (NCDs) at WHO, said the study found that both overweight and obesity is a global health crisis today, and threatens to worsen in coming years.
WHO has also co-released its summary of the Ending Childhood Obesity (ECHO) Implementation Plan. The report specifies which approaches and combinations of interventions are likely to be most effective in tackling childhood and adolescent obesity in different contexts around the world.
Dr Bull said WHO was recommending that countries: “aim particularly to reduce consumption of cheap, ultra-processed, calorie dense, nutrient poor foods. They should also reduce the time children spend on screen-based and sedentary leisure activities by promoting greater participation in physical activity through active recreation and sports.”
A copy of WHO’s Ending Childhood Obesity (ECHO) Implementation Plan can be found here: http://www.who.int/end-childhood-obesity/news/Implm-Plan-Ex-Summ.pdf
MEREDITH HORNE
November is Asbestos Awareness Month
Australia has one of the highest rates of asbestos related illness in the world. Every year, thousands of Australians die from asbestos-related illnesses such as mesothelioma, asbestosis and lung cancer. It should come as no surprise. Hailed for its durability and affordability, asbestos enjoyed a heyday in Australian construction sites up until the mid-1980s. Such was our love affair with the product, it is estimated that one in three Australian homes contain some form of asbestos.
We now know that for all of asbestos’s hardiness and cost effectiveness, the characteristic it should be most defined by is its carcinogenic properties. Generations of Australians were exposed to asbestos through their occupation, through home renovations or simply through living in a house built with asbestos-containing materials. While the risk of developing asbestos-related diseases increases with the extent of exposure, no safe level of exposure exists.
With the benefit of hindsight, it is easy to see the abhorrence in the wilful cover-up that allowed thousands of Australians to continue to be exposed to a known carcinogen. The use of asbestos was largely discontinued in the 80s, however, it was not until 2003 that asbestos and all asbestos-containing products were banned.
Symptoms of asbestos-related diseases may take up to 30 years after initial exposure to develop, and the average latency period of mesothelioma is 45 years. Consequently, the end of the asbestos-related illnesses is generations away.
The month of November is Asbestos Awareness Month in Australia and it provides an important opportunity to reflect on our own risk of exposure, and that of our patients. The risk is not confined to the fibro weatherboard archetype that has become synonymous with asbestos; it can appear in roofing, gutters, vinyl flooring and in brick cladding. There is a risk of asbestos in any house built or renovated before 1987, yet many people are unaware that they are living with such a threat.
It is never safe to assume that your house does not contain asbestos. Asbestos Awareness has developed a number of materials to allow everyone from professional tradies, to DIY renovators to better understand the risks of asbestos. These tools are an essential starting place for anybody looking to undertake any home renovations and what you discover may save your life.
For more information visit: asbestosawareness.com.au
Georgia Bath
AMA Policy Adviser
[Correspondence] Turning the tide on NCDs by engaging the next generation
In The Lancet (July 22, p 346),1 Richard Horton asked why the global health community is failing to effectively respond to the global rise of non-communicable diseases (NCDs). A number of opportunities for progress were highlighted. Our two organisations, NCDFREE and the Young Professionals Chronic Disease Network (YP-CDN), are firmly committed to tackling the global challenge of NCDs through advocacy and collaboration that leverages the power of young people. We fully support the recommendations outlined by Horton, and these two organisations represent the beginnings of the bold social movement that is so urgently needed.
[Correspondence] From (re-)framing NCDs to shaping public health policies on NCDs and communicable diseases
A senior adviser to the Global Fund taught Richard Horton (July 22, p 346)1 some lessons that were drawn from the struggle against three communicable diseases—tuberculosis, malaria, and AIDS—that keep scourging global health. To raise funds to combat non-communicable diseases (NCDs), one should “translate [one’s] evidence into clear and simple political (not technical) messages”, “articulate why [one] need[s] money—what exactly will [one] spend it on and what will be the results of that investment”, “break down [one’s] broad global demands into tangible country-specific needs”, and “connect [one’s] case to the big political picture—give it meaning”.