Divestment – medical students say no to fossil fuels

BY ALEX FARRELL, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION

In August, the Australian Medical Students’ Association (AMSA) put our money where our mouth is, and announced our intention to divest from fossil fuels. It was a significant moment, as Australian medical students joined the growing movement in the medical sector, including the American Medical Association, the British Medical Association and the Canadian Medical Associations.

Climate change is the biggest global health threat of this century. That was the conclusion of the Lancet Climate Change Commission, and a message that must be taken up with urgency by the medical profession. The impacts on health are clear; the increase in severe weather including drought and heat-waves, worsening air pollution and worsening of infectious and respiratory diseases.

Australian medical students have always been passionate about taking tangible steps to reduce their impact on the environment, and the AMSA project Code Green has previously run campaigns such as #MoveMindfully and worked to improve the sustainability of AMSA events.

However, this was our biggest step yet, driven by Code Green, and one I am exceptionally proud of our organisation for taking. For those who are unfamiliar, divesting from fossil fuels is moving investments to a bank or portfolio that doesn’t directly or indirectly fund the fossil fuel industry. It is an advocacy tool that redirects money away from problematic industries and towards ethical alternatives. It is also a statement – a public statement of where we stand as medical students on the fossil fuel industry and its impact on human health.

The announcement was made in an address to medical students from across the country at the 2018 AMSA Global Health Conference in Melbourne, and was supported unanimously by student representatives from all the Australian medical schools. It is a signal that young doctors are conscious consumers who will make decisions about their choices to shop and invest with social and environmental impacts in mind.

As future doctors of Australia, we want to invest in a healthy future. We know that there is more to medicine than just curing illness once our patients are already sick. We need to take into account the upstream factors that are making them sick, and the way our society and our environment affects our health.

Australia’s healthcare system is responsible for more than seven per cent of the nation’s total carbon footprint. Earlier this year, AMSA held a forum with a sustainability expert Dr David Pencheon, who founded the Sustainable Development Unit in the UK’s National Health Service. This unit successfully led the NHS to cut its carbon emissions by 11 per cent between 2007 and 2015. Whilst addressing the RACP Congress, Dr Pencheon said: “Doctors have nothing to lose, but the future.” As the ones who will see the impact of climate change play out in the lives and health of our patients, the current situation is no longer a status-quo we can accept. Many changes are necessary and possible, but for now, let’s keep it simple.

Divesting doesn’t require an overhaul of our health system. It doesn’t need a change in Government policy. It is simply a change of bank. Something that everyone, from the smallest student group, to the largest medical representative organisations and colleges, to clinics and hospitals, has the capacity to do.

Internationally, medical associations are leading the way on divesting from fossil fuels. We have already seen doctors use divestment as a tool for public health in Australia, like the work of Dr Bronwyn King from ‘Tobacco Free Portfolios’.

It is time that we join together to focus that energy and drive on climate change, following the example of Doctors for the Environment. Together, the investments that the medical industry make have a large impact. Let’s use that impact to join other global leaders to stand together for health, and against fossil fuels.

WMA backs WHO in call for more doctor involvement in fighting air pollution

The first World Health Organisation conference on air pollution was held in October-November in Geneva, Switzerland.

In its report on air pollution and child health, the WHO said health professionals should help shape public health policy on reducing the exposure of pregnant women, children and adolescents to air pollution.

The report adds that health professionals are trusted sources of information and guidance and play an important role not only in treating ill health caused by air pollution but also in educating families and patients about risks and solutions and communicating with the broader public and decision-makers.

This role must be amplified, and the broader health sector must become more engaged in preparing a comprehensive approach to addressing this crisis, the Who report states.

“Polluted air is poisoning millions of children and ruining their lives,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“This is inexcusable. Every child should be able to breathe clean air so they can grow and fulfil their full potential.”

The World Medical Association has echoed the call.

Speaking at the WHO conference, Dr Lujain Alqodmani from the WMA welcomed the call and said health professionals must be well informed about air pollution health risks and what measures can be taken to combat the crisis.

One suggestion would be to follow the example of Kuwait University, which has included air pollution as a main environmental health determinant in its medical curriculum.

She said at the WHO conference that the whole health workforce needed to be equipped with the right skills to address air pollution health risks as part of the initial clinical patient evaluation.

Medical education institutions should produce advocacy teaching materials about air pollution and health and be accessible through online tools to health workers and implemented by health care institutions.

“Physicians around the world are aware of air pollution. It impacts the quality of life for hundreds of millions of people worldwide, causing both, a large burden of disease as well as economic losses and increased health care costs,” Dr Alqodmani said.

Medical practices going green all over the planet

The World Medical Association is urging physicians around the world to ‘go green’.
The WMA is offering physicians and their national medical associations a free online service, My Green Doctor, to add environmental measures and climate change awareness to their medical practices.
Dr Todd Sack, managing director of the service, said that most physicians and other health professionals who use My Green Doctor will save money by lowering office expenses.
My Green Doctor explains how the clinic starts its own Green Team that meets for a few minutes each week to make gradual changes.
Each step is described, so no environmental knowledge is needed. One American practice has been saving more than $2000 per physician year.
The benefits of going green will be seen almost immediately, with savings to electricity and water bills.
The program goes on to help the practice to adopt wise choices in chemicals usage, recycling, food choices, and transportation decisions.
Tools for teaching patients and families good environmental choices and climate change preparedness are also a big part of what My Green Doctor offers.
“Patients look to their health providers for role models,” Dr Sack said.
“When we recycle, keep organic gardens, bicycle to work or drive energy-efficient cars, our patients and neighbours pay attention.
“Now used by physicians in 35 countries, the WMA’s My Green Doctor program could be valuable for all members of national medical associations.”
My Green Doctor is a free service for WMA members who register at www.mygreendoctor.org. Members receive a free waiting room certificate – available in any language – just for registering.

[Global Health Metrics] Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity.

[Correspondence] Tackling the challenges of child health care

Richard Horton (July 14, p 106)1 noted the UK’s mediocre performance with respect to child health. As representatives of the European Public Health Association and the European Paediatric Association/Union of National European Paediatric Societies and Associations, we strongly endorse Horton’s call for greater integration between public health and paediatrics and are already working towards this goal. We have jointly called for greater emphasis on prevention to tackle the changing burden of childhood disease, increasingly dominated by long-term conditions, many of which are caused by modifiable behavioural and environmental factors.

Being heart smart could prevent cognitive decline in women

New research has revealed that cardiovascular risk factors, particularly high cholesterol, play a role in the development of cognitive decline, further highlighting the importance of kickstarting healthy heart habits earlier in life.

Professor Cassandra Szoeke, director of the Healthy Ageing Program at the University of Melbourne and lead researcher, said the results showed that strategies to target vascular damage are vital to prevent brain cell loss.

“Neurodegenerative brain disease works insidiously for decades before people are diagnosed with dementia – we need to stop it in its tracks, or ideally before it starts.”

“What you do now affects what you will be decades later.”

What did the study involve?

The Australian study, published in Brain Imaging and Behaviour, included 135 participants from the Women’s Healthy Ageing Project. These women had completed midlife cardiovascular risk measurement in 1992, followed by an MRI scan and cognitive assessment in 2012.

The researchers found that higher midlife Framingham Cardiovascular Risk Profile (FCRP) score was associated with greater White Matter Hyperintensity (WMH) volume two decades later, and was predominantly driven by the impact of HDL cholesterol level.

Structural equation modelling demonstrated that the relationship between midlife FCRP score and late-life executive function was mediated by WMH volume.

“We saw those with low brain volume lost even more volume over the next 10 years,” Professor Szoeke said.

The authors wrote that their results indicated that intervention strategies targeting major cardiovascular risk factors at midlife might be effective in reducing the development of WMH lesions and thus late-life cognitive decline.

Massive exercise changes aren’t needed – but being active every day is key

“We all know we should eat healthily and exercise, but we also know many people who start up a program are not participating 3 months later, and 12 months later even less are still participating,” Professor Szoeke said.

Going into the study, her research team had expected that women who did intense physical activity would have the best cognition down the track.

“We found it was those who did activity every day over the 20 years of follow-up. It could be walking the block or gardening or a mix of Saturday dancing, Sunday walking home, and Monday walking to work – but it is each and every day for 20 years.”

Professor Szoeke said the impact of the research should be a greater recognition that vascular risk is modifiable, If it’s left unchanged, this will lead to brain damage in the form of WMH, low brain volume and poor cognition.

She said modifying this risk doesn’t mean a huge lifestyle change. In fact, the benefit can be obtained from just being more active.

“Move often and eat healthily. Choose what works for you, change it as you need, and do it each and every day.”

Women are disproportionately affected by dementia

Women account for around two-thirds of all dementia cases. Understanding the reasons behind this is an issue close to Professor Szoeke’s heart.

She said while women generally live 3 to 4 years more than men, it is not just an effect of age. The fact that the symptoms, assessment, treatment, management and prevention of heart disease differs between men and women suggested that cardiovascular risk also plays a role.

“Last year, the Australian Hidden Hearts report was released, showing that women have more heart disease, heart failure and stroke than men,” Professor Szoeke said.

“The Health Minister Greg Hunt has announced an update of women’s health policy. There has been $18 million announced for research to fill these gaps in knowledge, particularly highlighting issues not often focused on in traditional women’s health.”

She said the strategic areas for the new update reflect key issues for women, including mental health, dementia, chronic disease and healthy ageing.

“I hope we can quickly see major improvements with investment in these areas.”

Funding boost for microbiome research

Cutting-edge research into the gut microbiota is set to receive a significant funding boost from the federal government, allowing researchers to potentially unlock more mysteries of this new frontier of medicine.

Prime Minister Scott Morrison has committed $4 million to the UNSW’s Microbiome Research Centre (MRC) based at St George Hospital. The MRC, which is set to open in February 2019, is a collaboration between UNSW, the St George and Sutherland Medical Research Foundation, and the South Eastern Sydney Local Health District.

“What is happening in Australia is innovative, visionary and specialised. I never cease to be excited about the science community and how passionate the science community is.”

“The studies being done on the impact of the microbiome in mothers, infants and the future health of Australian children – that’s exciting”, Mr Morrison said at the time of the announcement.

What we know about the microbiome and the role it plays in our health

Professor Emad El-Omar, professor of medicine at the St George and Sutherland Clinical School and director of the MRC, told doctorportal that the funding boost would allow critical research to be undertaken in this “new frontier of medicine”.

“We’ve known about it for many years, but in the last decade is where we’ve seen a dramatic advancement in technology that has allowed us to study the microbiome better and better design studies to look at these trillions of bugs that live on us, within us, and contribute to normal health.”

“People are also becoming more aware of the impact the gut microbiome has on metabolism, the immune system, and how all of this could be implicated in many diseases.”

Professor El-Omar said that “probably the most basic thing we’ve discovered is having that normal microbiome, which is acquired in the first years of life, sets the barometer correctly for the rest of your life because it educates your immune system and allows you to have normal interactions with environmental exposures.”

Funding will support three research initiatives on the microbiome

The $4 million funding boost will go towards supporting three key areas at the MRC. The first is to enhance the bioinformatics capacity of the centre, which will be crucial to the success of the MRC. “We want this capacity to be fully integrated with our team, so we can understand the clinical questions and the biological questions we’re looking at”, Professor El-Omar said.

The MRC will look at the role the microbiome has in pregnancy and how this influences outcomes for mother and baby. “What we’re talking about here is being able to look at the microbiome and predict adverse events.”

“The idea is that you’d be able to define a signature that will tell you if someone is at increased risk of diabetes or pre-eclampsia, and this would allow us to pre-emptively change the future”, Professor El-Omar said

The MRC will also be conducting more research into the healthy microbiome and what this looks like.

“If we want to change the microbiome, we need to know what we want to change it to and what we’re aiming for. This study will hopefully tell us what the target is for any type of manipulation”, Professor El-Omar said.

Asthma deaths higher in women

Baby boomer women are at an increasing risk of dying from asthma, according to analysed new data from the Australian Bureau of Statistics.

Recently released figures show women with asthma aged between 55 and 64 are dying from the condition at a higher rate than the overall asthma-related death toll in Australia.

In 2017, a total of 441 deaths linked to asthma were recorded in Australia, comprising 300 females and 141 males.

The overall toll decreased by 14 from the previous year, but the deaths of women aged 55 to 64 doubled from 16 to 32.

According to the National Asthma Council Australia, the numbers suggest baby boomer women with asthma need to be extremely vigilant about managing their condition.

“Women in this age group are often juggling a host of responsibilities, from work to caring for children and ageing parents, and often put their own health last,” the Council’s chair Dr Jonathan Burdon AM said.

“It’s important that women prioritise time to effectively manage and actively monitor asthma symptoms, so their conditions do not get worse.

“Women have slightly higher prevalence rates for asthma, but we don’t have conclusive evidence as to why women are dying from asthma at more than twice the rate of men. This is happening globally, and studies suggest this is due to diagnostic, biological, lifestyle, societal or environmental circumstances.”

Dr Burdon said anyone living with asthma must never ignore or dismiss breathing problems and should have regular asthma check-ups with their GPs.

They should have an asthma action plan, follow proper instruction on how to use an inhaler, get a flu shot in winter, don’t smoke, avoid other people’s tobacco smoke, and make sure family and friends know what the asthma first aid steps are.

CHRIS JOHNSON

New precision UV sensors helpful, but shouldn’t replace good sun protection

Wearable UV sensors are increasingly marketed to help people tailor their sun exposure to their Vitamin D needs, but there are warnings they could cause more harm than good.

An array of personalised UV meters are now available as wristbands, patches and clothing clips linked to smartphone apps, alerting users when they have received enough UV radiation for their body to produce sufficient Vitamin D, but not so much as to increase their skin cancer risk.

New sensor measures sunburn-causing rays

Last month RMIT University researchers headed by Professor Vipul Bansal announced a breakthrough in UV sensor precision, having developed an invisible ink that directly measures UVA, UVB (which causes sunburn) and UVC, and changes colour at different UV saturations.

Professor Bansal told doctorportal: “Previous sensors have been unable to distinguish between the different types of rays, and had to rely on estimates based on total UV, which means they suffered from significant accuracy problems.”

For instance, one randomised controlled trial of 91 people found those who were given old-generation UV sensors experienced more frequent sunburns than those not given sensors at all (OR:1.60). The authors concluded either sensor inaccuracies or user behaviours could be to blame.

Professor Bansal said his team’s new generation of precision sensors would be available by 2020 at a cost of around $1 a day in forms such as stickers and wristbands.

“Personally, I’m vitamin D deficient so I’m always worried about how much time I should spend in the sun,” he told doctorportal. “I was passionate about this work because people like me need some sort of tool to give them an idea what’s enough sun exposure, and what’s too much.”

Currently, the Cancer Council Australia recommends that if the UV index is 3 or above – as calculated by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) – people should wear full sun protection including sunscreen, sleeved clothing and a hat.

However, Professor Bansal said dark-skinned people had difficulty relying on the UV index, as it was a “blunt tool” that failed to take into account variations in UV-absorption rates according to skin tones.

The RMIT sensors have been developed in six different colours to be matched to individuals’ particular skin tones.

Users urged not to completely rely on sensors

Adjunct Associate Professor Craig Sinclair, Head of Prevention at the Cancer Council Australia, told doctorportal accurate UV sensors could be valuable education tools by revealing how quickly UV causes harm to the skin. However, he urged users not to rely on sensors to determine whether or not to apply sun protection.

“In the summer months, especially in the middle of the day, you really need to put sun protection on before you head outside because sunburn can happen so quickly,” he said.

He added: “There is no evidence to suggest that regular use of sunscreen has any impact on Vitamin D levels, especially given the intensity of UV in most of Australia, and the ability of the body to convert that to Vitamin D.”

Associate Professor Sinclair said it was risky for people to self-assess their skin type when deciding on sun protection measures.

“Having dark skin might be the equivalent of SPF 3 or 4 or 5. There’s definitely some protective benefit from dark skin but it doesn’t overcome the primary message – come the summer months, everyone needs sun protection.”

He added: “We don’t want these UV sensors to potentially cause more harm than good if they delay the time people use sun protection.”

Professor Bansal told doctorportal he strongly supported the Cancer Council’s sun safety messages. He suggested that people who used wearable sensors follow sun safety guidelines as per usual, and apply sunscreen to the device.

“The sensor will change more slowly if the wearer applies sunscreen to it, and will indicate when they have had enough exposure,” he said.

The Cancer Council recommends the SunSmart phone app, which advises Australians when to use sun protection.

WMA calls for stronger physician-led health care systems worldwide

World Medical Association President Dr Yoshitake Yokokura has called on world leaders to strengthen healthcare systems based on physician-led primary care.

Using a United Nations General Assembly meeting in New York discussing non-communicable diseases (NCDs), Dr Yokokura welcomed the Political Declaration on the prevention and control of NCDs.

The emphasis of the declaration is on strengthening the link between NCDs and the social-economic and environmental determinants of health.

Dr Yokokura added, however, that he regretted the declaration does not include clear and measurable commitments.

He said the WMA is particularly concerned by the lack of specific commitments and targets for funding. The WMA is advocating for the inclusion of more NCDs to avoid a silo approach.

“Health care professionals see first-hand the devastating impact of NCDs on patients and their families,” Dr Yokokura said.

“Physicians are treating an increasing number of cases and are seeing more and more complex cases. NCDs are increasing the bill and burden on already under-resourced health care systems.

“In the light of the expected increased demand for 18 million more health workers, primarily in low and lower middle-income countries by 2030, healthcare system strengthening is of the utmost importance to reduce the growing burden of NCDs.”

The WMA called for UN member states to use the momentum of the declaration to set ambitious country targets, to commit to additional funding for NCDs and to draw up policies and measures in country action plans which aim to support.

CHRIS JOHNSON