Environmental health

Australia’s transition to renewables and zero carbon remains unacceptably slow

Paul J Beggs · Ying Zhang · Alice McGushin · Stefan Trueck · Martina K Linnenluecke · Hilary Bambrick · Anthony G Capon · Sotiris Vardoulakis · Donna Green · Arunima Malik · Ollie Jay · Maddie Heenan · Ivan C Hanigan · Sharon Friel · Mark Stevenson · Fay H Johnston · Celia McMichael · Fiona Charlson · Alistair J Woodward · Marina B Romanello

The health impacts of climate change demand Australia rapidly end its reliance on fossil fuels

Elizabeth Zuccala · Nicholas J Talley

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change

Lukoye Atwoli · Gregory E Erhabor · Aiah A Gbakima · Abraham Haileamlak · Jean‐Marie Kayembe Ntumba · James Kigera · Laurie Laybourn‐Langton · Bob Mash · Joy Muhia · Fhumulani Mavis Mulaudzi · David Ofori‐Adjei · Friday Okonofua · Arash Rashidian · Maha El‐Adawy · Siaka Sidibé · Abdelmadjid Snouber · James Tumwine · Mohammad Sahar Yassien · Paul Yonga · Lilia Zakhama · Chris Zielinski

Addressing the social determinants and the structural consumptogenic system is critically important if we are to avert a planetary health inequity crisis

Sharon Friel

Our efforts to prepare and respond to the challenges posed by climate change must focus on community support and recovery, providing sustainable financial security and social connectedness

George Braitberg

Eight drug treatments are currently recommended for people who do not require supplemental oxygen and six for those who do

Heath White · Steve J McDonald · Bridget Barber · Joshua Davis · Lucy Burr · Priya Nair · Sutapa Mukherjee · Britta Tendal · Julian Elliott · Steven McGloughlin · Tari Turner

To the Editor: Zhao and colleagues1 recently published an article highlighting the improved life expectancy for Aboriginal and Torres Strait Islander men in the Northern Territory over the past 20years.1 This is both important and welcomed. It reflects consistent and concerted work of countless individuals and organisations that are contributing to the improved health and wellbeing of Aboriginal and Torres Strait Islander men in the NT, despite limited resources to do so. It makes sense that we are beginning, albeit slowly, to see these inroads. One example of contributing to the positive outcomes for Aboriginal and Torres Strait Islander men’s health in the NT is the evolution of the Darwin Men’s Inter‐Agency Network (DMIAN). DMIAN is a network of men from across government and the non‐government organisation sector to collaboratively advocate for Aboriginal and Torres Strait Islander men in Darwin.2 DMIAN has enabled men’s health researchers to better understand and act on the wants and needs of the Aboriginal and Torres Strait Islander men in the community from the perspective that matters most: their own. As Zhao and colleagues1 point out, there is still a long way to go with improving the life expectancy of Aboriginal and Torres Strait Islander men, which sits 15.4years behind non‐Indigenous men. In addition, as the life expectancy of Aboriginal and Torres Strait Islander men increases, so too does that of non‐Indigenous men.1 So if we are to close the gap, we cannot afford to lose momentum on targeted action, particularly that relating to Aboriginal and Torres Strait Islander male health and wellbeing.3,4 There is still a need for this to be a recognised priority in the NT and nationally, and for primary health care and social services in the NT to be resourced appropriately. In particular, the Aboriginal Community Controlled Health Services and Aboriginal medical services have a key role to play and should be funded to develop, implement and evaluate health and social and emotional wellbeing programs for male clients, as this is severely lacking and is ultimately hampering progress in Aboriginal and Torres Strait Islander male health and wellbeing outcomes.4 While the National Men’s Health Strategy identifies Aboriginal and Torres Strait Islander men as a priority population,5 we also need substantially more investment in research and evaluation to find new innovate solutions.6 We hope the important work being done by individuals in health, justice, education and other social services sectors continues to be enabled to support Aboriginal and Torres Strait Islander men for the benefit of their communities and future generations.

Kootsy Canuto · Karla J Canuto · Jason Bonson · James Smith

The key themes from the 21 years of MSIC experience are that good policy, with clear legislation and careful management of clients within a harm reduction framework, can and does alleviate problems that may be perceived as inherent to the operation of such services

Carolyn A Day · Allison Salmon · Marianne Jauncey · Mark Bartlett · Amanda Roxburgh

Seafarers’ access to health care is limited, pre-employment screening is variable, and delayed presentations to Australian facilities are common in this vulnerable patient group

John J Bockxmeer · Nilukshi Ranwala

A 21-year-old man who migrated to Australia from Nepal 4 years previously was referred to a dermatologist

Akshay Flora · Priya Garg · Karen Cheung · Deshan F Sebaratnam · Monisha Gupta

To the Editor: We endorse the call of Flavel and colleagues1 for improved data on, and greater attention to inequities in, social determinants of health. People with disability experience poorer health than the general population. Much of this disparity is attributable to entrenched disadvantage in social determinants of health such as employment, housing, and violence.2 Ongoing impacts from the coronavirus disease 2019 (COVID‐19) pandemic may increase disparities in social determinants and health outcomes for people with disability. Yet people with disability remain largely invisible in key data sources.3,4 Disability identifiers are included in several national surveys conducted by the Australian Bureau of Statistics (eg, the Survey of Disability, Ageing and Carers5 and General Social Survey6) and some of the longitudinal datasets mentioned by Flavel and colleagues. However, survey data have limitations: they are based on a population sample, capture data at specific time points, and rely on self‐report information (eg, on income, service use). National surveys typically exclude individuals living in settings such as boarding houses and welfare institutions, where people with disability are over‐represented. Administrative datasets complement survey data. They capture more detailed and often continuous data on individuals, their contact with services and related outcomes. Regrettably, disability status is rarely collected in administrative datasets in Australia. Work is underway on the National Disability Data Asset,7 comprising linked data from multiple state, territory and national administrative sources. This asset will require a robust and consistent basis for identifying individuals with disability, beyond the subset of people identified by their contact with disability‐specific programs or payments. Australia urgently needs a nationally agreed, consistent disability identifier to leverage the opportunity provided by the National Disability Data Asset to identify and monitor disparities in health and social determinants experienced by Australians with disability. Development of such a disability identifier is essential to build a strong evidence base to deliver better outcomes and reduce health inequities. Crucially, people with disability and their representative organisations must be involved as key drivers and decision makers at every stage of development and implementation of the to‐be‐developed national disability identifier.

Nicola Fortune · Jodie Bailie · Gwynnyth Llewellyn

Given the unique geographic, socio-economic and health care system considerations, Australasian-specific research evaluating trauma care verification is essential

for the Trauma Care Verification and Quality Improvement Writing Group †

To the Editor: We write in response to Reid and colleagues’1 article on congenital cytomegalovirus (CMV). While many countries worldwide have established congenital CMV screening programs, Australia urgently needs to recognise the importance of targeted congenital CMV screening and tracking its outcomes. Our 2019–2020 study tested the feasibility and acceptability of a parent‐completed targeted congenital CMV saliva polymerase chain reaction (PCR) screening program in Victoria.2 Parents of infants who did not pass their newborn hearing screening at four Victorian maternity hospitals completed their infants’ saliva swabs in the hospital or at home. The program was feasible with a 76% participation rate, and all 96 swabs (100%) were completed within the required 21days from birth, despite the majority being completed at home. Furthermore, more than 90% of families found the screen easy to do, thought it was a good idea, and were glad their baby had congenital CMV screening. However, there were challenges: false positive screens due to CMV contamination in breast milk, and excessive time taken from completing the screen to return of results due to reliance on the only laboratory in the state accredited to process saliva CMV PCR. We now have the means to overcome these challenges, determine whether universal congenital CMV screening in Australia is warranted, and systematically track outcomes of targeted congenital CMV screening. For 2years from October 2021, Murdoch Children’s Research Institute’s Generation Victoria (GenV) is recruiting a whole‐of‐state infant–parent cohort, collecting over 110000 saliva swabs from newborns to test for CMV using novel CRISPR technology at the Walter and Eliza Hall Institute of Medical Research.3 Our study, funded by the National Health and Medical Research Council, will determine the population prevalence of congenital CMV, develop a rapid bedside point‐of‐care test for congenital CMV screening, and establish whether universal congenital CMV screening is cost‐effective. In addition, the Australasian Congenital CMV Registry has been recently established to track outcomes of congenital CMV.4 These initiatives will pave the way for Australia to emerge as a leader in congenital CMV screening, better recognise this undetected condition of public health importance, and provide personalised care to affected children.

Emma Webb · Cheryl A Jones · Valerie Sung

No single surveillance system is perfect, but integrating data from multiple sources can provide comprehensive and reliable signal detection

Allen C Cheng · Jim P Buttery

Evidence-based respirator selection, fit testing, fit checking, and proper use are all vital for staff and patient safety

Micah DJ Peters

An Indigenous-led study aims to empower and support Aboriginal and Torres Strait Islander women to be smoke-free

Michelle Kennedy · Hayley Longbottom

mRNA vaccine development will continue to accelerate, and further improvements to the technology may mitigate some of the current limitations

Isabella Overmars · George Au‐Yeung · Terence M Nolan · Andrew C Steer

The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels

Simon Quilty · Norman Frank Jupurrurla · Ross S Bailie · Russell L Gruen

The current lack of a national strategy for Indigenous adolescent health in Australia is a glaring gap

Seth Westhead · Quinton Appleby · Brittney Andrews · Tina Brodie · Alex Brown · Karla Canuto · Josh Cooke · Mahlia Garay · Thomas Harrington · Djai Hunter · Corey Kennedy · Jaeda Lenoy · Olivia Lester · Hannah McCleary · Odette Pearson · Lorraine Randall · Rachel Reilly · Hamish Rose · Daniel Rosendale · Jakirah Telfer · Peter Azzopardi

Longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance

Luke P Dawson · Emily Andrew · Michael Stephenson · Ziad Nehme · Jason Bloom · Shelley Cox · David Anderson · Jeffrey Lefkovits · Andrew J Taylor · David Kaye · Karen Smith · Dion Stub

Progress has been sluggish, and social factors and access to major health service schemes need much more attention

Ian T Ring · Kalinda Griffiths

Our multicomponent intervention is a highly translatable primary care approach to reducing smoking by pregnant Indigenous women

Gillian S Gould · Nicole M Ryan · Ratika Kumar · Leah C Stevenson · Kristin V Carson‐Chahhoud · Christopher Oldmeadow · Joley Foster · Simon Deeming · Katherine Boydell · Christopher M Doran · Andrew Searles · Joerg Mattes · Louise Atkins · Marilyn Clarke

It may be safe to de-label many patients because their reactions do not meet anaphylaxis criteria

Beau Z Carr · Kymble Spriggs · Samar Ojaimi · Elizabeth Leahy · Sara L Barnes