Topics

Environmental health

Environmental health Letters 16 April 2018 Free

Extreme heat threatens the health of Australians

To the Editor: Carey and colleagues are to be applauded for drawing attention to the potential impacts of extreme hot weather on the health of vulnerable groups in the community, particularly older people.1 However, in addition to the public health effects they covered, it is important to highlight the health impacts of high ambient temperature on Australian workers. The working population, ranging widely in age, is subject to many of the factors described in the article that influence vulnerability to heat illness, including chronic diseases and medications used to manage these. In addition, workers are often exposed to other heat stress factors, such as requirements to wear restrictive, impermeable personal protective clothing or to operate heavy machinery. Occupational circumstances may limit opportunity for acclimatisation, rest breaks, maintenance of adequate hydration or access to assistance if heat illness arises. A growing body of evidence shows associations between high ambient temperature and the risk of work-related injury.2,3 Importantly, this increased risk is not just observed among outdoor workers. Studies set in Adelaide2 and Melbourne3 have identified young workers (< 25 years of age) and male workers as being at increased risk of injury in association with increasing ambient daytime temperatures. Associations have also been observed between daily maximum temperature and risk of injury for workers engaged in occupations with the heaviest physical strength requirements (such as plumbers, paramedics and bricklayers).3 Moreover, a relationship has been observed between overnight temperatures and risk of injury for younger workers and female workers.3 In spite of climate projections for more frequent hot days and more severe heatwaves, there is currently a lack of specific and consistent policy and guidance targeting the work-related health impacts of hot weather.4 It is important that the health of workers and factors that influence their vulnerability to injury and illness are included in heat health discussions and are considered in the development of adaptive strategies.

Judith A McInnes · Peter Smith · Malcolm R Sim

Digestive system diseases Letters 2 April 2018 Free

Eradicating hepatitis C from the New South Wales prison system

To the Editor:In October 2016, we achieved the eradication and control of hepatitis C virus (HCV) in a New South Wales correctional centre, which we believe to be a first of its kind in NSW. HCV prevalence in NSW prisons is 30–40 times higher than in the community, where prevalence is about 1%.1,2 Elevated risk of HCV infection is associated with the high proportion of prisoners who have injected drugs, the rate of injecting in prison, and restricted or limited access to bleach and needle and syringe programs.3 The Justice Health and Forensic Mental Health Network (the Network) is responsible for health care in the NSW forensic mental health and criminal justice systems. The availability of direct-acting antivirals on the Pharmaceutical Benefits Scheme in March 20164 created an opportunity for the Network to cure all patients with HCV infection in one prison. The Compulsory Drug Treatment Program (CDTP) is run at the Compulsory Drug Treatment Correctional Centre — a stand-alone prison with a stable sentenced inmate population, where patients with repeat drug-related charges participate in comprehensive drug treatment and rehabilitation. Patients at this correctional centre have longer sentences than those in other centres, which allowed for the full course of treatment. The Network, Corrective Services NSW and Hepatitis NSW formed a partnership to ensure that patients were able to access health centres, have their medication scripted and administered, could undertake monitoring and were supported through the Network’s established nurse-led model of care.5 All 58 patients in the CDTP were offered screening, and 54 patients with risk factors were screened; of these, 18 patients had chronic HCV infection. After further work-up, including liver elastography to measure fibrosis, all patients were concurrently commenced on treatment. Of the remaining four patients who were not screened, all had recent negative HCV pathology results. Three months after the treatment, 15 patients achieved sustained virological response equating to cure of their chronic HCV infection, and three patients were released before final assessment.6 Concurrent treatment commencement with the direct-acting antivirals was recognised as an innovative measure in reducing re-infection, in conjunction with the more common practices of harm minimisation education and use of the hospital-grade disinfectant for general cleaning purposes offered by Corrective Services NSW to all incarcerated people. Throughout the course of the project, two new patients were admitted, screened, and returned negative HCV pathology results. A proactive screening approach with patient consent was adopted to ensure that new cases were able to be identified and treated to maintain elimination. Maintaining a prison HCV-free may mean that patients have to take some responsibility with regard to sharing needles with new inmates. A peer education approach is being developed to increase patients’ ownership of a prison’s HCV-free status. The CDTP treatment model, combined with ongoing screening of new admissions, is an innovative approach for eliminating HCV, and is considered suitable for adoption in similar-sized prisons across Australia. The Network is currently rolling out this approach within NSW.

James Blogg · James Wood · Colette McGrath · Camilla Lobo

Environmental health Letters 2 April 2018 Free

Tackling antimicrobial resistance globally

To the Editor:Your publication of a review on global approaches to antimicrobial resistance is timely.1 We especially note that antibiotic-resistant pathogens are not limited by borders, have greater impact on disadvantaged communities, and will require coordinated, high level government commitment to minimise their threat.1 In Australia, Indigenous communities bear a disproportionate burden of infectious diseases. This burden arises on a background of overcrowding, poorly built and maintained water and sanitation infrastructure, and colonisation of companion animals by human pathogens. The delivery of biomedically oriented health services leads to frequent use of broad spectrum antibiotics, promoting the development of multiresistant pathogens.2 The prominent multiresistant pathogen methicillin-resistant Staphylococcus aureus first emerged in hospitals, but, in Australia, it was soon identified in remote Indigenous communities.2 Health services have been unable to control its development and spread. As a consequence, community-acquired methicillin-resistant S. aureus is now the dominant strain of this bacterium in Central Australia, where Indigenous people are one-quarter of the population, but bear three-quarters of the S. aureus disease burden in Alice Springs Hospital.3 Primary health care is founded on full community participation and an intersectoral approach, incorporating education, housing and other sectors to complement health services.4 Housing for Indigenous communities remains inadequate, and government responses deficient, particularly in remote regions.5 As a result, even high quality health services have limited impact on Indigenous people’s health and wellbeing. Safe, secure, functioning housing that is appropriate for its occupants is a building block to manage other areas of Indigenous disadvantage.5 The deficit in appropriate housing contributes to bacterial colonisation, infection and development of antimicrobial resistance among Indigenous Australians.2 “Illness is a weapon” was intended as a metaphor for the resistance of Indigenous people to their ongoing colonisation.6 However, the threat of antibiotic resistance evolving through the neglected conditions in which some communities find themselves could make this metaphor more real than was likely intended. The spread of antibiotic-resistant pathogens in Indigenous communities and elsewhere is a global threat, which highlights the need to transform services for Indigenous people using approaches driven by communities and focused on their strengths.

Rosalie Schultz

Social determinants of health Editorial 5 March 2018 Free

Tobacco retail density: still the new frontier in tobacco control

Reducing the number of tobacco sellers would make it easier for smokers to quit After four decades of intense and innovative tobacco control policies and programs, Australian governments have achieved large reductions in population level smoking rates. The focus of this comprehensive approach has been to reduce consumer demand for tobacco products through high tobacco taxes, emotive mass media campaigns, graphic health warnings on packages, subsidised smoking cessation services and treatments, smoke-free public spaces, and bans on all forms of tobacco advertising.1 However, despite early calls for restrictions on the number and location of tobacco retail outlets,2 Australia is falling behind other jurisdictions in adopting polices that seek to limit the supply of tobacco products. In the United States, for example, both San Francisco and New York have adopted regulations that cap the number of tobacco retailers in each city district, responding to the high concentration of outlets in low income neighbourhoods. The disproportionate concentration of tobacco retailers in areas of greatest socio-economic disadvantage also exists in Australia, as highlighted in the report by Melody and her colleagues in this issue of the Journal.3 In Australia, however, no policies specifically aim to reduce the currently very high number of tobacco retailers. While no jurisdiction has yet to reduce outlet density sufficiently to assess the impact on smoking rates, there is strong evidence that having fewer retailers reduces the level of impulse purchasing of cigarettes. Canadian research found that one-third of smokers, especially younger smokers, would smoke less if they simply had to travel further to buy cigarettes.4 In an Australian study, the mere sight of tobacco retail outlets prompted impulse purchases, even in the absence of point-of-sale displays of tobacco products at the checkout counter.5 Continually resisting not only the urge to smoke but also to purchase cigarettes make it incredibly difficult for smokers to quit. Tobacco control policies that make it easier and also prevent relapse are critical for reducing the more than 18 000 deaths caused by smoking in Australia each year.6 Not only are tobacco retailers more numerous in low income neighbourhoods, tobacco retailers in disadvantaged areas are also less likely to comply with regulations regarding the retail display, sale, and promotion of tobacco in stores.7 Populations at greatest risk of taking up smoking, continuing to smoke, and suffering from the health effects of smoking are therefore not only exposed to more retailers, but are also afforded the least protection by tobacco control laws. Reducing the number of tobacco outlets could be achieved by several complementary policy options. The introduction of a substantive annual tobacco licensing fee in South Australia led to an almost 25% decrease in the number of retailers in that state.8 This is in sharp contrast to New South Wales, where very few tobacco retailers stopped selling after a no-fee tobacco retailer notification scheme was introduced.9 As would-be ex-smokers report frequent relapsing when they consume alcohol, banning tobacco sales in licensed premises would both reduce the number of tobacco outlets and support quitting smokers where they are most vulnerable.5 Such a move is unlikely to encounter substantial resistance, as tobacco sales appear to be of limited financial importance to bars and clubs.10 Other options include permanently banning retailers from selling tobacco if they have been convicted of selling to underage smokers, and offering incentives that encourage retailers to stop selling tobacco, such as a subsidised program to help them sell more fresh fruit and vegetables. In 2009, tobacco outlet density was described as the “new frontier for tobacco control.”11 Nearly 10 years later, Australia — in so many ways a leader in tobacco control — has yet to develop policies for reducing its high density of tobacco outlets. It is essential to challenge the existing retail sales environment, which sees tobacco sold ubiquitously alongside everyday household items. Framing tobacco retail policies as assisting former smokers to remain abstinent is entirely in line with the highly successful approaches Australia already employs to reduce the heath burden of tobacco use. Limiting the number of outlets that sell tobacco products, reducing the concentration of outlets, especially in disadvantaged areas, and limiting which outlets can legitimately sell tobacco products must be priority policy goals. It is time for Australia to break through the tobacco retail frontier and lead the way in regulating the supply of tobacco products.

Becky Freeman · Suzan Burton

17 01239
Environmental health Research 5 March 2018 Free

The retail availability of tobacco in Tasmania: evidence for a socio-economic and geographical gradient

Objectives: To describe the retail availability of tobacco and to examine the association between tobacco outlet density and area-level remoteness and socio-economic status classification in Tasmania. Design: Ecological cross-sectional study; analysis of tobacco retail outlet data collected by the Department of Health and Human Services (Tasmania) according to area-level (Statistical Areas Level 2) remoteness (defined by the Remoteness Structure of the Australian Statistical Geographical Standard) and socio-economic status (defined by the 2011 Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage). Main outcome measure: Tobacco retail outlet density per 1000 residents. Results: On 31 December 2016, there were 1.54 tobacco retail outlets per 1000 persons. The density of outlets was 79% greater in suburbs or towns in outer regional, remote and very remote Tasmania than in inner regional Tasmania (rate ratio [RR], 1.79; 95% confidence Interval [CI], 1.29–2.50; P < 0.001). Suburbs or towns in Tasmania with the greatest socio-economic disadvantage had more than twice the number of tobacco outlets per 1000 people as areas of least disadvantage (RR, 2.30; 95% CI, 1.32–4.21; P = 0.014). Conclusions: A disproportionate concentration of tobacco retail outlets in regional and remote Tasmania and in areas of lowest socio-economic status is evident. Our findings are consistent with those of analyses in New South Wales and Western Australia. Progressive tobacco retail restrictions have been proposed as the next frontier in tobacco control. However, the intended and unintended consequences of such policies need to be investigated, particularly for socio-economically deprived and rural areas.

Shannon M Melody · Veronica Martin-Gall · Ben Harding · Mark GK Veitch

17 00765

Subscribe to MJA email alerts

No spam, you can unsubscribe anytime you want.

By providing your information, you agree to our Terms of Use and our Privacy Policy.

Thanks for Subscribing! Tell us more

Your email updates will use your name.

Good one! Your updates are coming

Thank you for subscribing to the MJA email alerts. Receive the latest content in your inbox.