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Preference: Infectious Diseases and Parasitology

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Single biggest health burden is cancer attributed to tobacco use

Cancer accounts for about one-fifth of Australia’s health burden, with tobacco use the biggest contributor, newly released figures reveal.

The Australian Institute of Health and Welfare (AIHW) has released research based on data sourced from the 2011 Australian Burden of Disease that shows cancer was the greatest cause of health burden in Australia, accounting for around one-fifth of the total disease burden.

AIHW’s burden of disease analysis is more than merely counting deaths or disease incidence and prevalence, burden of disease analysis takes into account age at death and severity of disease for all diseases, conditions and injuries, in a consistent and comparable way.

“This (burden) is calculated in terms of years of life lost due to early death from cancer, as well as the years of healthy life lost due to living with the disease,” AIHW spokeswoman Michelle Gourley said.

Almost half (48 per cent) of the total cancer burden in 2011 is from five cancers—lung, bowel, breast, prostate and pancreatic cancers.  However the single biggest burden —and almost one-quarter (22 per cent) of the total cancer burden can be attributed to tobacco use.

The report states that most (94 per cent) of this burden was due to dying prematurely, with only a small proportion of the burden due to living with a cancer diagnosis. Even though fewer people die from cancer than cardiovascular disease, the burden of cancer deaths is higher.

The AIHW report also found that Indigenous Australians experienced 1.7 times the cancer burden of non-Indigenous Australians. In particular, Indigenous males experience 2.3 times the lung cancer burden of non-Indigenous males, and Indigenous females 2.6 times the lung cancer burden of non-Indigenous females.

Australians living in rural Australia were also shown in the report to face a higher burden, especially the burden of lung, bowel, prostate and pancreatic cancers.

“Indigenous Australians experienced a cancer burden 1.7 times that of non-Indigenous Australians, and the gap was particularly notable when it came to lung cancer,” Ms Gourley said.

Further, poorer Australians found themselves with an increased rate of cancer burden, with people in the lowest socioeconomic group experiencing 1.4 times the cancer burden of people in the highest group. In particular, the rate of lung cancer burden in the lowest group is almost twice the rate in the highest group.

This report presents detailed findings on the burden due to cancer in Australia using results from the Australian Burden of Disease Study 2011.

Meredith Horne

[Perspectives] Orly Manor: public health leader in Israel’s health system

“Tikkun olam” translated from Hebrew means “to mend the world”, a maxim that has been at the heart of Orly Manor’s career. She is Professor of the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem, and has been a leading figure behind the Lancet Series about health in Israel. Her current research activities are divided between two main projects: one evaluating the quality of treatment of Israeli health care, the other being a long-term project investigating the developmental origin of adult diseases.

[Department of Error] Department of Error

Cohen AJ, Brauer M, Burnett R, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 2016; 389: 1907–18—In this Article, the following changes have been made to the supplementary appendix. In table 1, for the Pinault et al11 study, the country, the CEV (Stroke)-Relative Risk (95% CI), and the IHD-Relative Risk (95% CI) have been corrected (p 11); the second Pinault et al11 reference has been changed to Thurston et al (2016; p 11); a footnote has been added stating that the indicated data were from “Additional, unpublished analyses, provided by the principal investigator at the authors’ request” (p 12); the first Miller et al15 reference has been changed to Puett et al (2011); the LC-Relative Risk for Turner et al has been corrected (p 12); and the reference list has been updated.

[Correspondence] Stroke in ICD-11: the end of a long exile

In 1955, cerebrovascular diseases were reclassified as circulatory system diseases in the 7th edition of the International Classification of Diseases and Related Health Problems (ICD). WHO’s idea then was that stroke is a condition affecting blood vessels. This decision to reclassify cerebrovascular diseases seemed contrary to the pathophysiology and symptoms leading to mortality and morbidity, which are those of brain dysfunction. Moreover, the decision deviated from the principle of ischaemia of other organs (such as the intestines, kidneys, and the eye), which were listed under their respective organs in ICD-7.

[Correspondence] Body-mass index and all-cause mortality – Authors’ reply

Associations of measured body-mass index (BMI) with mortality within just a few years of the BMI measurement can be strongly distorted by reverse causality (ie, by life-threatening neoplastic, respiratory, vascular, or other diseases having caused weight loss before the BMI was measured). By contrast, associations of measured BMI with mortality several years after the BMI measurement should be little affected by reverse causality, although they can still be strongly affected by confounding, especially in populations in which low BMI is correlated with smoking.

Future Leader Receives AMA Award

A junior doctor and researcher, whose experiences as the child of refugee parents inspired her to establish a health promotion charity for migrants, refugees, and asylum seekers, has won the AMA Doctor in Training 2017 Award.

Dr Linny Phuong, a Paediatric Infectious Disease Fellow at the Royal Children’s Hospital Melbourne, was presented with the award by AMA President Dr Michael Gannon at the AMA National Conference 2017 in Melbourne.

Dr Phuong is the second winner of the Award, which was introduced in 2016 to recognise outstanding leadership, advocacy, and accomplishments of a doctor in training. The recipient is awarded a place at the AMA’s Future Leaders Program.

Dr Gannon praised Dr Phuong, the founder and director of the Water Well Project, for her contributions to teaching, medical education, research, and doctors’ wellbeing, as well as her professionalism and compassion towards children and their families.

“Dr Phuong exemplifies the characteristics of a caring doctor, an inspiring leader, and a tireless philanthropist and humanitarian,” Dr Gannon said.

Dr Phuong is highly regarded by her peers at the Royal Children’s Hospital where, as Deputy Chief Resident, she is in charge of the doctors’ wellbeing portfolio. She is also a successful medical researcher, having published several papers.

Dr Gannon also paid tribute to Dr Phuong’s awareness of the many challenges faced by refugee families in accessing health services, noting that five years ago, she founded the Water Well Project, a not-for-profit health promotion charity which improves the health and wellbeing of migrants, refugees, and asylum seekers by providing health literacy support and education. 

Meredith Horne

Germany set to introduce fines of up to €2,500 for failing to vaccinate

A new German law will be introduced obliging kindergartens to inform the authorities if parents fail to provide evidence that they have received advice from their doctor on vaccinating their children.

Parents refusing the advice risk fines of up to 2,500 euros under the law expected to come into force in June this year.

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

Germany has reported 410 measles cases so far this year, more than in the whole of 2016. A 37-year-old woman died of the disease this May, in the western city of Essen.

The German government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations. The children of parents who fail to seek vaccination advice could be expelled from their daycare centre.

Vaccination rules are being tightened across Europe, where a decline in immunisation, has caused a spike in diseases such as measles, chicken pox and mumps, according to the European Centre for Disease Prevention and Control (ECDC).

Italy made vaccination compulsory in May this year, after health officials warned that a fall-off in vaccination rates had triggered a measles epidemic, with more than 2,000 cases there this year, almost ten times the number in 2015.

In 10 European countries, cases of measles, which can cause blindness and encephalitis, had doubled in number in the first two months of 2017 compared to the previous year, the ECDC said last month.

Measles is a highly infectious vaccine-preventable disease, and globally still one of the leading causes of childhood mortality.

The World Health Organisation reports that the European Region includes highly effective and safe measles and rubella vaccines in their vaccination programs; however, due to persistent gaps in immunisation coverage outbreaks of measles and rubella continue to occur. 

The Australian Medical Association endorses the overwhelming scientific evidence that vaccination saves lives. Important immunisation information is available in the Australian Academy of Science publication, The Science of Immunisation: Questions and Answers, which is available at www.science.org.au/immunisation.html .

Meredith Horne

[Perspectives] Gerd Burmester: enduring leader in rheumatoid arthritis

Having been Professor of Medicine at Berlin’s Charité University Clinic for the past 23 years, Gerd Burmester is among the university’s longest-standing full professors. He leads a 100-strong Department of Rheumatology and Clinical Immunology, and is as committed to research in the laboratory as to work in the clinic. His team is collectively researching how to reprogramme the human immune system, with an emphasis on the molecular pathways that underpin autoimmunity across many diseases, but especially in rheumatoid arthritis (RA).