Terminator says health is collateral damage of fossil fuels

Hollywood actor and former Governor of California, Arnold Schwarzenegger, has used a United Nations gathering in Germany to describe fossil fuels as a public health hazard.

At a sideline event of the 12-day UN climate talks in Bonn in November, Mr Schwarzenegger delivered a well-received speech that issued a challenge to world leaders.

A long-time outspoken environmental activist, the star of such blockbusters as The Terminator, Total Recall, Collateral Damage and Predator, urged governments everywhere to start labeling fossil fuels with a public health warning.

That health warning should state, he said, that their use could cause illness and death.

He praised the World Health Organization (WHO) for delivering on a 164-nation tobacco control deal in 2003 that resulted in health warnings on tobacco products.

But he added that a similar deal could be reached with regards to oil and coal products.

“Wouldn’t it be great now if they could make the same pact with the rest of the world to go and say, ‘let’s label another thing that is killing you – which is fossil fuels’,” he said.

“If you went to a gas station, it says that thing you’re pumping into your car is killing you.

“Pollution kills more than nine million people a year. Over 300,000 people will die over the course of this conference. That’s the population of Bonn.

“This is a massive tragedy. And as depressing and terrifying as it is, we are not talking about it enough,” he said.

WHO Director-General Tedros Adhanom Ghebreyesus called on conference delegates talk about building climate resilient health facilities in their home nations by 2013, which is a stipulation of the Paris Agreement.

He added that more investment was needed in the health sector.

“Climate change strikes at the heart of what it means to be human,” Dr Ghebreyesus said.

“Climate change is not a political argument in Fiji and other island nations. It’s everyday reality – whether that’s in the form of destructive storms, rising sea levels or increased risk of infectious disease.

“These communities need assistance to cope with a world that is changing in front of them.”

The Paris Agreement global climate treaty aims to limit rising temperatures to below 2˚C by reducing greenhouse gas emissions.

Fiji presided over the Bonn conference and was also the beneficiary of an initiative launched by WHO and the UN climate secretariat aiming to triple international financial support for action on climate-related health issues in the developing small island nations.

CHRIS JOHNSON

The wind against, Out Back

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

Professor Paul Worley, as you all are now aware, is our inaugural Rural Health Commissioner.

Just pick up any medical newsletter and you will get his background, credentials, experience and why he was appropriately chosen for this difficult role.

So rather than attempt another biography, I’d like to share a story he shared with some of us in a workshop we attended at the Rural Medicine Australia Conference in Melbourne. The subject was “When paying your bills is not enough” and was addressed to the RDAA Female Doctors group, mainly to an all-woman audience.

This story allows you to get to know a bit of his personal perspective*, and it may give you a glimpse of the man.

Paul rides his bike with his two sons in the countryside around Adelaide. You know, where the Tour Down Under is held. Gorgeous countryside, the rolling hills were for them to attack and conquer. And one morning they did. The three of them were in their glory, on top of the world, three athletic cyclists. This was so easy! What a super sport, didn’t they have such great stamina, quadriceps, speed?

Time to go home, they turned around and quickly realised they had been cycling with the wind on their backs. The road back home was another journey altogether, against the wind. Their lungs burned, lactic acid in those super quadriceps, stamina waning. This was really tough! They required frequent rest breaks, more hydration, and some internal resilience to get the job done. Same road, same equipment, they now had a new force to deal with, fighting this hidden powerful adversary. The way home was humbling.

Paul then summarised: pedalling with the wind on your back is like being a man in this medical workforce.

The journey, the achievement necessary to succeed appears to be the same for both men, women, IMGs, visible minorities, those with English as a second language.

But there are those of us who are pedalling against the wind. My extrapolation, I think those of us in Rural Australia are also pedalling against the wind.

Our “winds” are:

The Tyranny of distance;
Lack of both medical and personal resources;
Insufficiency in the workforce;
Impossible rosters;
The need to be a GP and a specialist at the same time;
Third World chronic diseases;
Decrementing infrastructure with hospital closures;
Environmental hardships such as 50 degrees and dogs;
Lack of broadband internet;
Disrespect from our Urban critical colleagues;
Loneliness, depression, distance from family; and
Lateral violence.

If you haven’t thought of your journey from this light, just take a look from Paul’s perspective.

Dr Worley will affect you profoundly as the orchestrator of new Rural Pathways. I want you to know, I think he gets it, this new Rural Health Commissioner. I hope you meet him soon, he is familiar with Rural Medicine. But you will also find he knows humility, fighting against the wind. He knows us.

* With acknowledgement to his wife Liz for the idea.

Close the clean drinking water gap

BY AMA PRESIDENT DR MICHAEL GANNON

Safe drinking water is an indispensable human right. The leading national and international health bodies, such as the World Health Organization and the United Nations, all agree that safe drinking water is essential to sustain life, and a prequisite for the realisation of other human rights. The UN General Assembly explicitly recognises the human right to clean drinking water.

Having access to sufficient, safe, accessible and affordable drinking water is an important public health issue.

In developed nations such as Australia, it is often assumed that safe drinking water is accessible to all. However, this is not the case, particularly in many remote or very remote communities where artesian (bore) water is often the primary source of drinking and household water.

According to the Bureau of Statistics (2007), for discrete Indigenous communities the majority accessed bore water (58 per cent), while other sources of water included: town supply (19 per cent), river or reservoir (5 per cent), rain water tank (3 per cent), well or spring water (3 per cent), and other sources of water (2 per cent).

While the supply of potable water (defined as waterthat is safe to drink or to use for food preparation, without risk of health problems) impacts on all people living in remote areas of Australia, Aboriginal and Torres Strait Islander people are disproportionately affected.

Many Aboriginal and Torres Strait Islander people living remotely find it challenging to obtain water that is of sufficient quantity (and quality) to meet their needs.

In 2012, the Australian Bureau of Statistics estimated that there were more than 400 discrete Aboriginal communities across Australia, with the largest number in Western Australia. Data collected on over 270 remote WA communities indicated that the quality of drinking water did not meet the Australian standards, as outlined in the Australian Drinking Water Guidelines (ADWG), approximately 30 per cent of the time.

While the National Health and Medical Research Council (NHMRC) has responsibility for the ADWG, this is not a mandatory standard, with State and Territory Governments and local councils responsible for the implementation and monitoring of water quality and safety. Yet during the two year period 2012-2014, 80 per cent of remote Aboriginal communities in Western Australia failed to meet quality standard testing at least once.

There are obvious health consequences from drinking poor quality water. Some Aboriginal communities are known to have unsafe levels of chemical contaminants such as nitrates and uranium in the water. Nitrates and uranium occur naturally, and are common in the Goldfields and Pilbara regions.

‘Blue Baby Syndrome’ – where an infant’s skin shows a bluish colour and they can have trouble breathing – can be caused by excessive nitrates in the diet, which reduce the blood’s ability to carry oxygen. It can occur where prepared baby formula is made with well water. Water tested in over 270 remote communities in WA showed nitrate levels 10 times the recommended levels.

It is concerning that Aboriginal and Torres Strait Islander people living remotely often have no choice but to pay for safe drinking water. While the majority of us enjoy free, safe drinking water from the tap, those who can least afford it often have to pay just to ensure they are not drinking water sourced from rivers, streams, rivers, cisterns, poorly constructed wells, or water from an unsafe catchment.

The AMA is a member of the Close the Gap steering committee and the Public Health team has raised potable water as a Close the Gap target.

The solution may not just be in more bottled water. In communities without adequate recycling and waste disposal services, thousands of extra plastic water bottles create additional environmental problems.

Governments must invest in infrastructure, such as proper treatment facilities, water storage facilities and distribution systems to meet the changing demands of communities.

All Australians must have permanent and free access to safe water. It is a basic human right and it is difficult to understand how this hasn’t already been implemented and addressed.

[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.

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GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1345–1422—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.

Lead poisoning a top risk factor for pre-eclampsia

More than a century since a Brisbane doctor found that lead in paint destroyed children’s lives, new research from Griffith University concludes that it is a major risk factor for pre-eclampsia.

Pre-eclampsia is a disease which kills more than 75,000 women around the world each year and is responsible for 9 per cent of all fetal deaths.

Scientists from Griffith University have published their findings in Environmental Research, which measured blood lead levels of pregnant women who experienced pre-eclampsia and control groups of women who did not experience preeclampsia.

“We combined the data from a number of clinical trials to conduct a powerful analysis of pre-eclampsia research,” said Dr Arthur Poropat from Griffith Health.

Along with Dr Mark Laidlaw from RMIT University, the team found that blood lead levels are the strongest predictor of whether a pregnant woman will develop pre-eclampsia, with even relatively low levels of lead increasing the risk of the condition.

“There is a clear dose-response relationship between maternal blood lead and pre-eclampsia: doubling the blood lead level results also doubles the risk of pre-eclampsia,” Dr Poropat said.

Pre-eclampsia is a potentially fatal disease, in which pregnant women develop high blood pressure and protein in their urine due to kidney malfunction, potentially leading to cardiac and/or kidney failure, and eventual disability or death.

Reducing exposure to lead remains an important health issue in Australia because lead can be found in various sources throughout the environment.

Dr Poropat said women are exposed to lead in many ways, including lead paint, lead contaminated soils, lead water pipes, shooting lead bullets at firing ranges and other sources. Women can even be exposed by handling or washing lead contaminated clothes.

“Fortunately, most people in Australia are not at risk of lead poisoning as they are not commonly exposed to lead via their occupation or the environment. However there are certain well-documented risk areas within the country including the industrial regions of Broken Hill (NSW/SA), Mount Isa (QLD) and Port Pirie (SA).

“Regardless of where women are located or their lifestyle, women should be aware of the risks associated with lead poisoning if they are preparing to become pregnant or are currently pregnant,” Dr Poropat said.

Lead, a naturally occurring metal found in the earth’s crust, has a wide variety of uses in manufacturing. Unlike many other naturally found metals, lead and lead compounds are not beneficial or necessary for human health, and can be harmful to the human body. Infants, children and pregnant women are at the greatest risk of harm from lead.

Professor Mark Taylor from Macquarie University in Sydney led a study that was published earlier this year which was the first comprehensive snapshot of industrial lead contamination in Australia.

This study found that while concentration of lead in the air in major cities is now largely below limits of detection, contaminated soil and dust is causing problems in backyards.

Professor Taylor believes that regulation has reduced concentrations of lead in air largely below limits of detection in our major cities. However, he warns homeowners need to be careful, especially if they live in the inner city or have homes built before the 1970s.

MEREDITH HORNE

[Comment] Second Raffles Dialogue on Human Well-Being and Security

In an increasingly unpredictable world, human wellbeing and security are under threat as never before. As the global community strives to achieve the Sustainable Development Goals (SDGs), it is clear that the time of realising easy gains is over. Going forwards, innovation (ie, the successful development of invention) will have a crucial role in ensuring humanity’s future survival. The world faces a complex range of interconnected political, economic, financial, social, and environmental challenges.

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GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1343–420—Data in Figure 5 have been amended. These corrections have been made to the online version as of Sept 18.

[Editorial] Minamata Convention on mercury: a contemporary reminder

History provides us with valuable lessons. The tragic Minamata Bay disaster in Japan is a stark reminder that exposure to the element mercury and its compounds can impact human health, causing irreversible neurological damage and other issues such as psychosis. Earth’s health is also at risk. In the 2013 Global Mercury Assessment, the UN Environment Programme (UNEP) reported that environmental mercury emissions can reach up to 8900 tonnes annually, of which 90% consist of anthropogenic emissions from processes such as artisanal gold mining, which is often unregulated and involves the forced labour of marginalised communities.