From the MJA

Virginia Barbour

This issue of the MJA is especially large and diverse. One reason for the size of the issue is because of some process changes that we are making to how we publish, which will kick in at the beginning of 2026. We will be describing more about these changes on the Journal website over the next few weeks, including what you should expect for the Journal’s look and feel in 2026. However, the content mix and our priorities will not change and I’d like to use some of wide range of content in this issue to reflect on some of the areas that we see as our priorities to publish on. The research article by Verlis and colleagues on greenhouse gas emissions associated with anaesthetic gases1 highlights one of our longstanding interests — the now very well established association between climate change and health outcomes. This article reports that between 2002 and 2022, the main anaesthetic gas that contributed to greenhouse gas emissions in Australia was desflurane, and that reduction in its use since 2017 was associated with a reduction in the overall emissions rate associated with anaesthetic gases. This article is a good example of the type of research that needs to be actively encouraged for us to build a comprehensive knowledge base of how the causes of climate change can be understood and how actions to mitigate them can be developed, particularly within the health sector. A research article by Francia and colleagues on the epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)2 is especially important because this disease, which has an unacceptably large burden in Aboriginal and Torres Strait Islander populations, is almost entirely preventable. As the authors say, “the significant ARF and RHD burden among Indigenous Queenslanders, and vast disparity with non‐Indigenous populations, calls for an urgent whole‐of‐government response”. We agree. One of the Journal highlights of the year was the second NAIDOC week issue led by a team of Indigenous Guest Editors, a process that has helped the Journal commit to prioritising work on Indigenous health led by Indigenous researchers and communities. This year we were also very honoured to be presented with the artwork from Uncle Paul Scott that was displayed on the Journal’s cover, and to meet his community. The editorial from that issue “Indigenous Health Special Issue 2025: carving our path with spirit, strength and solidarity” powerfully explained that issue’s purpose — and an ongoing priority for the MJA “to prioritise, platform, and celebrate Aboriginal and Torres Strait Islander leadership and excellence through health, clinical and academic dialogue”.3 A research article by Ey and colleagues on non‐technical errors associated with deaths in surgical care4 also reflects a key interest for the Journal, which is the importance of culture in medical practice. What this article shows so effectively is that although technical errors are all too common in surgery, non‐technical errors — caused, for example, by poor communication, lack of effective teamwork, flawed decision making and inadequate leadership — are equally important. The article reinforces how important culture is in a health care organisation: for those who work there and, even more importantly, for those who receive care there. At the MJA, we also understand the importance of clinical guidelines informing practice across Australia and this year we have been fortunate enough to publish a number of these articles. This issue includes the first evidence‐based guidelines for Australia on male infertility.5 Infertility is common, with one in six couples affected, with male infertility contributing to up to 50% of infertility cases. As with all guidelines, publication is just the start and we are keen to promote their dissemination. A recent podcast from the first author, Darren Katz, put these guidelines in context (https://www. MJA.com.au/podcast/223/8/MJA‐podcasts‐2025‐episode‐21‐australias‐first‐male‐infertility‐guidelines). Finally, a narrative review on generative artificial intelligence (AI)6 in clinical practice is incredibly timely, given the acceleration of AI across health care and society more widely over the past year. AI is now part of everybody’s life — in both our personal and professional spheres — and is increasingly the focus of governments, professional bodies and journals. In this article, Scott and colleagues assess the current state of generative AI for clinical practice and propose a phased approach to implementation, beginning with uses that are uncontroversial, such as relieving clerical and administrative burden, through to those uses that will need more care and oversight, such as consumer‐facing applications. At the end of this year, I want to take the time to thank everybody who contributes to making the MJA what it is. This includes the dedicated Journal team, our external editorial advisory group (Box 1; https://www. MJA.com.au/journal/staff/MJA‐editorial‐advisory‐committee), the enormous numbers of reviewers (Box 2) and the many authors who submit to us every year. We understand that a journal like the MJA can only be successful through the support of the community that it serves, and we are very grateful for the trust placed in us by the Australian health care community. Box 1 – The MJA Editorial Advisory Group, November 2025 The MJA Editorial Advisory Group members are eminent clinicians and scholars who are valuable sources of ideas for the content of the Journal. They provide constructive criticism of the format and content of the Journal, and provide independent advice to the MJA Editorial Committee on appeals of editorial decisions, problematic articles, and complaints about the editorial process. Professor John AttiaProfessor Cheryl A JonesProfessor Toby Richards Associate Professor Lilon G BandlerAssociate Professor Zsuzsoka KecskesProfessor Christobel Saunders Professor Anthony CaponProfessor José Florencio Lapeña, Jr. (Philippines)Professor Susan Sawyer Professor Flavia M CicuttiniProfessor Christopher LeviProfessor Jenong-Wook Seo (Korea) Professor Paul B ColditzProfessor C Raina MacIntyreProfessor Lambert Schuwirth Professor Brendan S CrabbProfessor Jennifer MartinProfessor Joseph Sung (China) Professor Jaya DantasProfessor Patrick D McGorryProfessor Helena Teede Professor Anne DugganProfessor Catriona McLeanProfessor Philip G Truskett Professor David A EllwoodAssociate Professor Lucy MorganProfessor Robyn Ward Ms Alex FarrellProfessor Peter L Munk (Canada)Professor Steve Wesselingh Professor Peter G GibsonProfessor Debra NestelProfessor Paul S Worley Professor Marc GladmanProfessor Ian N OlverDr Catherine Yelland Professor Charles GuestProfessor Wilfred CG Peh (Singapore)Professor Neville D Yeomans Professor Claire L JacksonProfessor Anna RalphProfessor Jeffrey Zajac Box 2 – MJA reviewers, 31 October 2024 – 1 November 2025 Barbara-Ann AdelsteinCatherine BennettLucy BurrNigel W CrawfordPaul P FaheyPaul S Haber Hossein AdibiJulie BennettLouise M BurrellPhilip CrispinMichael O FalsterBridget G Haire Robert AdlerChristine ConstancePaul Robert BurtonTimothy CroftJillann F FarmerChristian R Hamilton-Craig Ebenezer Afrifa-YamoahBennettDanielle C ButlerPhilip CrowleyTim FazioStephen Hampton Kingsley AghoJill BensonTamara ButlerHernan CuervoEllen FinlayMark J Hanly Robert J AitkenDinesh BhandariRose CairnsPeter CursonDavid W FirmanIsabel Hanson Sarah AitkenNeera BhatiaRosemary CalderRachael CvejicRobert A FitridgePenny Haora Stuart AitkenHabib BhurawalaLeon CalyLucette CysiqueGerard J FitzGeraldRichard Wayman Harper Marie AlfordLaurent BillotPeter A CameronPetra CzarniakArthas FlabourisBenjamin Harrap Sam AlfredCatherine S BirmanEwan CameronEleonora Dal GrandeJoanne FlavelDylan Harries Sarah AliGlenda BishopAnna CampainDeepak DarshanDavid R FletcherMark F Harris Sonia AllanRenee BittounKarla J CanutoGhazaleh DashtiLeon FlickerRicci Harris Penny L AllenDeborah A BlackJonathan R CarapetisMike DaubeChristopher M FlorkowskiPatrick Harris John V AmerenaKirsten I BlackStacy M. CarterA. James M. DavesonDarran FooKatie Harris Robert AmeryJim BlackLeanne ChalmersEllen DaviesRachel FoongJessica Harris Nicholas AnagnostouChristopher F BladinAlex J ChamberlainEsther DavisMalcolm ForbesMary Ellen Harrod Austen AndersonBrooke BlakeleyRaymond ChanRichard O DayDavid Fraile NavarroGunter F Hartel David AndresenClaire BlewittSong ChanCaroline M de CostaJacqueline FrayneSamuel Harvey Melissa K AndrewNgaree BlowNiamh ChapmanAlan de CostaBecky FreemanAlys Havard Nicolas M AnsteyChristopher C BlythJudith L CharltonNicholas H de KlerkToby FreemanDavid Hawes Matthew H AnsteyPeter BoanJack ChenMark DeadyAlana GallNarelle L Haworth Linda Appiah-KubiCatriona M F BonfiglioliWinnie ChenJessica M DeanSiun GallagherWayne Hawthorne Bruce B ArnoldMichael A BonningIan R CheongRebecca DeansGreg GambleAndrew Hayen Rosalie AroniJennifer BoocockJenny ChestersGary DeedCaroline X GaoChristopher Hayes Christopher K ArthurRobert BootsAda S CheungKatrine Del VillarBradley J GardinerNoel E Hayman Nicholas AshboltJeffrey BorisAngela L ChiewJack DeLacyDarren GarveyRichard B Hays Susan Astley-HemingwayMark BougheyHuiJun ChihAnthony DelaneyLouise GatesGeorgie Haysom John R AttiaSarah BourkeClayton K ChiuClare DelanyDorota M GertigWilliam F Heddle Tim AungSimon D BowlerPhilip Young-Ill ChoiChris DelcherDereje GeteRobert D Henderson Scott AveryIan W BoydTerence Woon How ChongSarah M DennisAngela GialamasMichael Hendryx Oyekoya Taiwo AyonrindeFrances M BoylePeter F M ChoongKate DerryFiona GianniniMartin Hensher Peter D BaadeOwen BradfieldClara K ChowLeon Di StefanoBelinda GibbSubash Shanthakumar Heraganahally Michael BaigentClare BradleyJonathan ChristiansenJan E DickinsonAlison GibberdAna Herceg Suzanne Bain-DonohueCaitlin BrandenburgSusan ChuaJoanna DipnallNathan J GibbsMarta Hernandez-Jover Ross I BakerAnnette J Braunack-MayerEric ChungAnnette J DobsonKatherine GibneyAlan Herschtal Emily BanksGraeme A BrazenorIan D CivilKate DooleyJohn GibsonCharlotte Mary Hespe Phil G BardinPeter BreadonJonathan ClarkGregory J DorePeter G GibsonMark Hew Christopher J BarlowLauren BreenJacqueline C T CloseDannii DoughertyStephen Dean GillDavid G Hewett Karen M BarlowLindsey BrettTina CockburnMark W DouglasMarisa T GillesPeter Hewett Kristine K Barlow-StewartFraser J BrimsPaul B ColditzNicholas Martin DouglasMalcolm GilliesIan B Hickie Rahul D BarmanrayHelena C BrittClaire ColesRobert DowsettAmanda K GilliganDaryl Higgins Adrian BarnettPhilip N BrittonPeter J CollignonStephen J DuckettPaul P GlasziouCatherine L Hill Lorana BartelsClaire E BrolanRobert James CommonsGreg J DuncombeAnthony GloverAnne-Marie Hill Nicole L BartleyDaniel Brooks ReidKatherine M ConigraveVicki DurstonJoseph P GoneSusan L Hillier Shona Marie BatesJulia M L BrothertonMatthew C CookJeffrey DutschkePhillip D GoodPravin Hissaria Robert G BateySinan BrownJacqueline CoombeJohn R DyerAlexandra S GorelikRichard Hockey Malcolm W BattersbyLauren Julia BrownMichael D CooryRobert EleyStephen Roger GravesJay Hocking Fran BaumNicholas A BuckleyBonney CorbinRohan A ElliottEric GuazzoCarol L Hodgson Frank H BeardLiz BuckleySusan CorcoranAdrian ElliottJane M GunnChris B Holmwood Kerri BeckmannCharley BudgeonIngrid A CoxDavid A EllwoodLyle C GurrinNusrat Homaira Jana BednarzLuke BurchillTerry J CoyneNathan EmmerichJosephine Diana GwynnLouise Horstmanshof Mary K BelfrageJonathan G W BurdonSusanna CrambAdam EslickKylie GwynneRachel Horton Simon BellSonya BurgessPeter CrankMohamed EstaiThi Ninh HaRobert L Horvath Aminu BelloKharis BurnsDarrell H G CrawfordSue M EvansBronwyn B HaasdykClaire M Vajdic Noleen J BennettVincent Weng Seng LeeStacey McMullenJonathan PenmChristine T ShinerKees van Gool Paul HottonGraham Andrew LeeShannon McNeairAndrew PerryAlexis Leah ShubMegan Varlow Martin HowellKenneth LeeJohn J McNeilLaura PerryAmanda SibosadoAlejandro Vasquez Hernandez Jeremy HsuHan-Shin LeeRebekah E McWhirterMatthew J PetersGregory SillerKarl Vaz M Mamun HudaJames W LeitchSusan MendezGregory M PetersonSusan SilveiraDanya Vears Carolyn HullickRupert LeongNicole MercerJonathan PhamDavid SimmonsSree Krishna Venuthurupalli Peter C HunterMiriam T LevyLea MeroneSophie PittScott SimsDeborah Verran Jennifer HunterMichael H LevyPeter MiddletonAdam C PomerleauMatthew SimunovicKarin Verspoor Md Hamidul HuqueDiana LewisErica MillarThaddeus M PopeFreddy SitasElmer V Villanueva Zoë HydeBridget LewisCaroline Louise MillerCeleste PorsbjergTim SladeRenuka Visvanathan Jonathan HyettMonique LewisJulie MillerJennifer PowerDavid W SmithAditya Vyas Peter J IllingworthJoel LexchinTim MillerKaren PriceKate SmithAndrew Waa Abdul Qadir (Didir) ImranXia LiTalila MilroyH Miles PrinceDaniel SmithMelissa Wake Maria C InacioGary Y. H. LiewLouise E MitchellPeter ProcopisCarolynn L SmithKate A Walker Geoffrey K IsbisterHelen G LileyTess Moeke-MaxwellAnte ProdanJames SmithRobert J Walker James P IsbisterAshleigh LinBen W MolAlyssa PykePeter SmithAdrian R Walker Rodney T JacksonDaniel LindsayDavid MolloyRomana PylypchukJessamine SoderstromLucie K Walters Tina JanamianRaghu LingamAlicia MontgomerieMaria RacitiSze-Ee SohRichard Walton Jonine JanceyClare LittletonHannah C MooreJanette C RadfordTania C SorrellJeanette E Ward Garry L R JenningsAdam C. LivoriPatricia MooreNicola RahmanPeter SpeckSarah Ward Hubertus JersmannSerigne LoKim MoreySatish RajGeoffrey K SpurlingDavid A K Watters David JesudasonKamalini LokugeSusan J MorganAnna P RalphPreeyaporn SrasuebkulJared Watts Shilpa JesudasonJeffrey C L LooiWesley MorganIsuru RanasingheVelandai SrikanthMarianne F Weber Awachana JiamsakulDerrick LopezPeter MorleyNicole M RankinIngrid StaceyHeidi Welberry Thanjira JiranantakanCourtney LouisKirsten Claire MorleyMelissa RavenMaryke SteffensCameron Wells Peter G JonesJennie LouiseMeg E MorrisWilliam D RawlinsonPaulina StehlikMark Wenitong Mark A JonesNicole LowresDavid MountainPhillip ReadBrian Neil SteinJohn M Wentworth Michael P JonesChristine Y. LuAlison M MudgeDavid ReadSandrine StepienRobb Wesselingh Caitlin JonesMichaela LucasEimear Muir-CochraneMichael C ReadeRob StirlingJuanita L Westbury Benjamin JonesGuy L LudbrookPaul S MylesHelen K ReddelMartin R StocklerSeth Westhead Michelle JongenelisKristiana LudlowMelanie NadeauSusan J ReesNigel P StocksBen P White Louisa JormNatalie LukasVasikaran NaganathanBenjamin ReevesLouise StoneScott William White Matthew D JoseJohn LynchShanti NarayanasamyChristopher M ReidEmily StoneDavid C Whiteman Stephanie JowettAlan Shui Lun MaBushra NasirAlice M RichardsonMelissa StonehamAlexis Whitton Alia KaderbhaiAndrew I MacIsaacLeya NedumannilIan T RingMark StooveLisa J Whop Helena KajlichHeather G MackPariece NelliganElizabeth RixSimone I StrasserHelen M Wilcox Stefan C KaneMaria MackayMark R NelsonIain K RobertsonEdward StrivensKerrie Wiley Jonathan KarnonFinlay A MacraeJohn NewnhamStephen J RobsonDion StubStephen Wilkinson Ilan KatzRaglan MaddoxLinh NgoDavid M RoderBronwyn Gwenneth Ann StuckeyDavid Williams Judith M KatzenellenbogenParker John MaginGary NichollsMargaret J RogersSupriya SubramaniAnne Williams Margaret P KayChristopher G MaherBrooke NickelBenjmain RogersShuichi SuetaniCrystal Williams Eugenie KayakKylie-Ann MallittSuzanne NielsenLoreto Vanessa Tevah RoseClair SullivanDaniel Williamson Luise KazdaLinda MannClaire NightingaleBronwen RossThomas R SullivanAndrew Wilson Helen Isobel KeenGregory Bruce MannRaelene NixonElizabeth E RougheadJing SunMark Wilson John W KellyJo-Anne ElizabethHelen Christine NoonanDominic B RoweSuresh SundramRachel Wilson Michelle KennedyManski-NankervisAnna NoonanStacey L RoweTom R SutherlandRebecca J Winter Emma KennedyElizabeth MarlesSarah NorrisEmily S RudlingAaron L SverdlovEJ Wise Danelle KennyJohn E MarleyJohn B NorthGrant M RussellJerneja SveticicAdelaide Withers Ngaire M KerseSally MarottiJohannes NossentDeborah J RussellMelody TabaGary A Wittert Alison M KessonMathew D MarquesDon NutbeamRachel Sacks-DavisJade TamateaLi-Chuen Wong Ameneh KhatamiRobyn MarshMichael O’CallaghanGrant SaraRam TampiErica M Wood Nigar KhawajaPaul T MartinKim OatesKarinna SaxbyYamna TaoukLisa Wood Meegan Lesley KilcullenMarianne MartinelloJames O’beirneLionel SchachnaAvelina TarragoAlistair J Woodward Ross KincaidEsperanza MartinezFergus O’ConnorTheo SchallKerry Anne TaylorJeremy Woolley Adrienne C KirbyThomas H MarwickKerry-Ann F O’GradyChris SchillingLuc te MarveldeCassy Workman Edwin KirkJane MasonJeneva OhanMarkus SchlaichHiran ThabrewMelina Gattellari Worthington Kate KlootSiobhán MastersonMark OliverRichard John SchloeffelLena ThinJoachim Worthington Brian KoBen MathewsCatherine M OlsenAndre SchultzJosephine Suzanne ThomasMichael Wright Archana KoiralaVeronica MatthewsSjúrdur Frodi OlsenDavid W SchultzElizabeth ThomasRosemary Wyber Kairi KolvesDanielle MazzaIan N OlverJohannes SchwabeAlexander James ThompsonElizabeth J Wylie Paul A KomesaroffHelen McArdleJason J OngRuss J ScottKaren ThorpeCarol Wylie Kelvin M KongGeoffrey W McCaughanSuzanne G OrchardJames G ScottJames TibballsKatie Wynne Jayashri KulkarniJames McCawGerard Michael O’ReillyPaul A ScuffhamMaeghan ToewsSumit Yadav Ashwani KumarStephen P McDonaldJoshua OsowickiDeshan F SebaratnamDuncan Jake ToplissAnusch Yazdani Eeva-Katri KumpulaPatrick McElduffAmy Theresa PageHiran SelvaduraiAdrienne J TordaCatherine Yelland Marina KuninTroy McEwanKirsten R PalmerTarun Sen GuptaMandy TruongCarlo (Chino) Yuson Geetanjali LambaNeil W McGillJean PalutikofFaraz Vahid ShahidiDamon TumesDipti Zachariah Klay LamprellSteven McGloughlinYin ParadiesRenuka ShanmugalingamDavid James TunnicliffeJohn R Zalcberg Alexander LarcombePatrick D McGorryAdriana ParrellaShivanthan ShanthikumarShahid UllahNicholas Zdenkowski David M LawrenceMatthew Richard McGrailAndrew PartingtonDinberu ShebeshiMahesh UmapathysivamYuejen Zhao John A LawsonPeter B McIntyreStephanie PartridgeHarshvardhan SheoreyOwen Allan UngDeborah R Zion Paul D LawtonShannon McKinnDora PearceSimone SherriffCatherine VacherYvonne Anna Zurynski Suong LeAndrea McKivettOdette PearsonAmith ShettySanjyot Vagholkar Amanda Jane LeachCameron John McLarenRoxanna Pebdani Julie LeaskDaniel B McLaughlinCarmelle Peisah Katherine Jane LeeAlison McLeanStella Pendle

Virginia Barbour

In their 2024 work Who's afraid of gender?, Judith Butler1 charts the rise of an international so‐called anti‐gender ideology movement, in which the concept of gender operates as “phantasm”. That is, a site where disparate contemporary fears — be they around the future of work, family life, or other aspects of the world — gather and become weaponised for political ends. This weaponisation of gender is having far‐reaching impacts across the globe, including on public health policy and the practice of medicine.2 In one of the most striking recent examples, the United States under the Trump Administration is undertaking extraordinary attacks on sexual and reproductive health and rights, in part under the guise of “defending women from gender ideology extremism and restoring biological truth”.3,4 Australia too is seeing its share of backlash against gender equity in the sphere of health, including use of anti‐gender ideology discourse to mobilise opposition to health care access for transgender (trans) people.5,6 It is against this backdrop that the Medical Journal of Australia dedicates a special issue to the topic of gender and health. In doing so, we do not seek to prescribe specific definitions of “sex” or “gender” for adoption across health and medicine. These are often contested terms subject to evolving and varied scholarship, including growing recognition that they might defy efforts to map them neatly onto a “biological” and “cultural” binary.1 In line with the Sex and Gender Equity in Research (SAGER) guidelines,7 which the journal endorses, these terms should be clearly defined by authors and used with precision and consistency throughout their work. The goal of this special issue is to provide a platform for research and analysis that engage with what gender means for Australian health care in a manner informed by evidence, scientific rigour, a quest for equity and justice and, fundamentally, respect for the rights, dignity and perspectives of affected populations. Its curation was premised on an understanding of gender as “the structure of social relations and practices that are organised in relation to reproductive bodies”.8 The articles in this issue cover diverse ground. Harsha Ananthram and colleagues9 seek to unpack the term “obstetric violence” in the context of findings from recent inquiries into birth trauma in Australia and the United Kingdom. In Australia, practitioners who refuse to participate in abortion care should refer their patients onwards to a willing provider. Shelly Makeleff and colleagues10 argue that not enough attention has been given to how these referrals are carried out and propose strategies to promote person‐centred abortion referrals. The potential to improve the care of people with anxiety disorders through sex‐ and gender‐responsive management approaches is explored by Bronwyn Graham,11 who notes that sex and gender are relatively ignored in anxiety disorder research, medical curricula, and clinical guidelines. Findings from a cohort study done in New South Wales show that although the gender gap in the treatment and outcomes of ST‐elevation myocardial infarction (STEMI) has narrowed in recent years, the high disparity between male and female patients with STEMI is unlikely to close in the next decade.12 And a pharmacoepidemiology study from Kailash Thapaliya and colleagues13 highlights gaps in evidence and guidance for the prescribing of glucagon‐like peptide‐1 (GLP‐1) receptor agonists for women of reproductive age. Three articles in this special issue specifically address trans health. First, Kade Booth and colleagues14 discuss the disparities faced by trans and gender diverse people in accessing cervical cancer screening and vaccination against human papillomavirus, and propose several potential solutions. Second, a perspective article by Julia Moore and colleagues15 engages with the Independent review of gender identity services for children and young people, or Cass Review, commissioned by England's National Health Service and published in 2024.16 The authors critique the findings of the Review on several grounds, including a lack of representation of the views of trans adolescents, and ultimately conclude the review represents a “failure of evidence‐based medicine”. “Good medicine” they contend “is guided by the values of the patient, not those of a clinician, politician or commentator. A patient's goal of achieving optimal quality of life as a trans person requires respect”. This point is directly addressed by the third article on trans health in this issue, from Jayne McFadyen and colleagues.17 In 1987, the MJA published the report of a case series of eight gender diverse children.18 To correct what was termed their “cross‐gender behaviour”, these children had been administered “therapy” as inpatients for between six and 28 weeks. The report concluded that “the treatment of cross‐gender behaviour by means of inpatient therapy seems effective”. It continues to be cited in contemporary debates about young people's access to gender affirming care and about so‐called conversion therapy. Decades later, the MJA was approached by Jayne and her co‐authors with a request to consider an article in response to this work: Jayne is a trans woman who reasonably believes, on the basis of evidence available to her, that she was one of the children described in the 1987 article. The author team had undertaken an analysis of archived mental health records, published details from the 1987 case series, and Jayne's autoethnographic account of her treatment, and concluded that the inpatient treatment Jayne had received constituted a form of conversion therapy aimed at “extinguishing childhood behaviours deemed to be socially undesirable”. Despite the claim from the 1987 report that this treatment appeared effective, for Jayne the attempt to change or suppress her gender identity “served to delay self‐acceptance for two decades and caused long term harm”. As journal editors, at the forefront of our minds every time we decide to publish an article are questions about the potential harms that could result from our decision. We must ask ourselves: are we confident the findings reported are legitimate, produced ethically, analysed appropriately, and reported in a balanced and transparent manner? Could our decisions inadvertently contribute to undermining public trust in science or to supporting ineffective or even harmful medical practices? To mitigate these concerns, we take expert advice from peer reviewers and consider it carefully in the context of what has been previously published. We have no reason to believe that those involved in the 1987 MJA article had anything but the best intentions, given the knowledge and dominant gender norms of the day. But what is apparent is that the practices of medicine and scholarly publishing at the time did not place sufficient value on the views, experiences and preferences of the young people whose wellbeing was at stake. Genuine evidence‐based medicine requires epistemic pluralism, including understanding the value of patient voices. This is where the work of Jayne and her colleagues becomes particularly important. At the MJA, we appreciate the power imbalances at play here. These exist between medical experts with professional standing, a scholarly journal with an established national reputation, and a patient, who at the time the “inpatient treatment” was administered was a child. In this context, we are immensely grateful that Jayne and her co‐authors chose to entrust their work to the MJA for consideration. As editors, we are also grateful for the opportunity this experience has afforded us to reflect and act on what it means to demonstrate institutional accountability for past decisions. What constitutes the best care for trans young people should of course be up for debate, as is the case for all areas of medicine. It is the role of medical journals to ensure that this debate is rooted in humane values and is driven by evidence — of which the views of patients are an essential part.

Elizabeth Zuccala

This issue of the MJA brings a focus on chronic liver disease, which was the ninth leading cause of fatal burden in Australia in 2023 and which is largely preventable.1 Metabolic dysfunction‐associated fatty liver disease (MAFLD) is the most common chronic liver condition in Australia;2 however, to date there has been a lack of clear and current guidance on its detection and management. So why does MAFLD matter? If left unchecked, MAFLD will be an increasingly important public health issue. Although patients with MAFLD are most likely to die from cardiovascular disease or extrahepatic cancers, MAFLD can progress to advanced stages of liver disease, including cirrhosis and liver cancer.3 Additionally, MAFLD is a condition that often goes undetected, and is frequently asymptomatic, especially in the early stages, with many patients only diagnosed when undergoing tests for other reasons, or following up abnormal liver function tests.4 Aimed towards individuals working in primary care, Adams and colleagues present a consensus statement summary of evidence‐based recommendations covering key clinical areas such as screening and diagnosis of MAFLD, assessment of extrahepatic comorbid conditions and underlying liver disease, and monitoring over time. Importantly, MAFLD should be considered in people with obesity and/or type 2 diabetes, or two or more metabolic risk factors.5 As such, general practitioners are in a unique position to implement these guidelines, and assess and monitor patient's liver and metabolic health over time. Hepatitis C virus (HCV) infection, another important cause of liver disease, is fortunately one in which significant progress has been made towards elimination, with the overall hepatitis C notification rate declining by 36% from 2014 to 2023.6 This decline can partly be attributed to the availability of direct‐acting antivirals (DAAs), as well as primary prevention strategies. DAAs are oral medications that are highly effective and widely accessible in primary care — a model that helps to reduce waiting times and improve access to treatment. However, in some cases, people with HCV infection are referred to tertiary centres for management by non‐general practitioner specialists, but little is known about the clinical outcomes of DAA treatment in this context. To bridge this knowledge gap, Layton and colleagues described the cascade of care for a subset of 50 patients identified in the Coordinated Hepatitis response to Enhance the Cascade of Care by optimising existing Surveillance systems (CHECCS) cohort who had been referred to specialist care for HCV in Victoria.7 They found that most patients were offered appointments and attended, and that the majority of patients with HCV infections commenced treatment and achieved sustained viral response. However, patients with a recent history of injecting drugs were less likely to commence treatment in this setting, perhaps due to perceived stigma by hospital staff and other potential personal barriers to treatment, such as having to manage multiple health and social priorities.8 The authors conclude that while treatment outcomes for those referred to specialist care were good, this may not be ideal for some groups of patients who may be more successfully treated through other models of care. Progress is being made towards eliminating chronic liver disease, particularly through advancements in treatment of hepatitis C as we work towards the national target of hepatitis C elimination as a public health threat by 2030. However, strategies to sustain uptake of treatment are essential and may require evaluating which models of care work better than others.9 Assessment and management of MAFLD provides a new challenge and is one that is ideally suited to primary care. It too will require a sustained effort, but with a holistic approach to patient care and the ability to engage patients, general practitioners are ideally placed to implement the new guidelines, support patients with managing modifiable risk factors, as well as refer for specialist care when required.

Alison Williams

For decades much has been made of Australia's ageing population, particularly how best to manage the arrival of the baby‐boomer generation from a health, economic and societal perspective.1 At the same time, the individual people who interact with the aged care system have distinct priorities; for people in aged care this includes maintaining their independence, being treated with respect, and the management of medical conditions.2 Addressing the system‐wide, indeed society‐wide, stressors, while delivering service and health outcomes that align with the expectations of the ageing population remains a key challenge to the Australian health system. This Healthy Ageing issue of the MJA contains a series of articles that shine a light on the diverse elements of a modern multifaceted approach to healthy ageing and contribute to the evidence base that will drive the adjustments and changes needed to deliver an effective, efficient and respectful aged care system. The Royal Commission into Aged Care Quality and Safety highlighted experiences of substandard care of people accessing residential aged care and home care services.3 In a cross‐sectional population‐based study using data from the Registry of Senior Australians, Eshetie and colleagues4 analysed indicators of quality and safety of aged care for older Australians receiving long term residential aged care or home care packages during 2019. Their findings of marked variation in quality of care, particularly regarding antibiotic use, high sedative load, emergency department presentations, home medicines reviews, chronic disease management plans and waiting time for home care services suggest areas that may benefit from targeted quality improvement strategies. A narrative review by Inacio and colleagues5 discusses recent evidence of aged, community and health care models that may support older people to “age in place”. Evidence for the models supporting ageing in place is limited, although there is evidence for other benefits such as improving wellbeing. Complex multifactorial care interventions have the most compelling evidence for delaying or avoiding entry into long term residential aged care. The authors concluded that “No panacea exists for supporting all people to age in place, but care integration, collaboration among care settings, and multidisciplinary person‐centred clinical care that addresses health‐related decline and challenges are consistently reported to contribute to its success”. As the leading cause of hospitalised injuries and injury deaths among older Australians, falls remain a major public health issue in Australia;6 however, strategies to improve mobility and reduce falls in aged care are often limited by under‐resourcing of appropriate health services such as physiotherapy. In the era of telehealth, Dawson and colleagues report on the effectiveness of the TOP‐UP program, a co‐designed randomised controlled trial where participants in the intervention arm received a six‐month program of ten telephysiotherapy sessions for delivery of a tailored exercise program aimed at improving mobility and balance.7 Fewer intervention participants experienced falls during the program, and they also showed improvements in sit‐to‐stand performance, balance, gait speed, mobility goal attainment, and quality of life. These results provide robust evidence for the implementation of supported telephysiotherapy exercise programs to prevent falls and improve health and quality of life for people living in aged care. Delbaere and colleagues discuss the need for a comprehensive, system‐wide approach to falls prevention.8 Their perspective highlights recent innovations such as remote exercise programs delivered by telehealth, simulation‐based balance training such as safe landing techniques, and caregiver training, as well as summarising the evidence for a more traditional approach to falls prevention. Equity, cross‐sector collaboration, funding and ongoing evaluation are all important to measure the impact of new and emerging fall prevention strategies. There is also a need for further study of the efficacy and safety of tailored interventions for those in higher risk groups such as people living with dementia, osteoarthritis or Parkinson disease. Finally, the perspective by Foundas provides a timely and thought‐provoking discussion of dignity and respect in residential aged care.9 The new rights‐based Aged Care Act 2024 (Cwlth) that has recently come into effect brings with it new mandates to support residents of aged care facilities to have choices and take risks.10 Through such change, there is potential to enhance quality of life and gain enrichment through independence, empowerment and self‐determination. However, putting this into practice is likely to be challenging as we try to navigate legal, moral, and duty of care obligations. Acknowledging the benefits of risk taking and fostering a supportive environment as we move away from a paternalistic approach to risk, will assist aged care facilities, and indeed the broader aged care sector, in maintaining dignity of older people while providing both safety and autonomy.

Michael Skilton · Alison Williams · Wendy Morgan

This issue of the MJA features several articles that provide new guidelines and insights into the management and consequences of important clinical conditions. Updated guidelines on the management of gestational diabetes are now published.1 The 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation.2 These consensus recommendations, from Sweeting and colleagues, are important; the last time these guidelines were updated was in 2014.1 These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy. An HbA1C measurement is now recommended with first trimester antenatal blood tests to assist practitioners with risk stratification. There is also guidance on considerations that need to be made for early oral glucose tolerance testing in high risk women. As rates of gestational diabetes continue to rise, diagnosis and management of this condition are likely to be within the scope of practice for most generalist medical practitioners, especially in regional and remote areas with poor access to specialist teams. These recommendations are a welcome update for medical practitioners. Diabetes features in an article by Zhang and colleagues, which examined information from Diabetic Foot Services and linked it to Queensland Hospital Admitted Patient Data to assess the incidence, risk factors and length of stay for hospitalisations, with and without amputations, of people with diabetes‐related foot ulcers (DFU).3 This is again an increasingly common condition in the population as rates of diabetes and its related complications increase. The incidence of DFU‐related hospitalisations among people with DFU was high, although most did not involve amputations. The risk of DFU‐related hospitalisation was higher for people with deep ulcers or severe peripheral artery disease. The authors argue that these findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes‐related hospitalisations. In another clinically focused article in this issue, Seeley and colleagues analysed data from the Australian postural orthostatic tachycardia syndrome (POTS) Patient Registry to assess the symptom burden, quality of life, and diagnosis history of people with POTS in South Australia.4 This is the first Australian study based on data from a registry of people with physician‐confirmed POTS. The key findings were long delays between symptom onset and diagnosis despite seeing several physicians, reduced social engagement, high unemployment, and low quality of life for the relatively young people with POTS. The mean diagnostic delay in this study was longer than reported overseas, suggesting unique barriers in Australian health care. This will become more relevant in the future as infection with SARS‐CoV‐2 was the most common reported trigger for development of the condition. An article with important advice for physicians who support patients with genetic diseases is a summary of the recently updated guidance from the Office of the Australian Information Commissioner (OAIC) clarifying clinicians’ discretion to assist patients with notifying their relatives about genetic risk without breaching federal privacy laws.5,6 Tiller and Otlowski examine the clinician's role in this scenario.5 The authors discussed the challenge from the point of view of the patient, of their relatives and the clinician's role in managing expectations both from an ethical perspective but within an acceptable medico‐legal framework while practising in Australia. The authors conclude that “Now that the OAIC has clarified that relatives’ contact details can be collected from patients and used to notify them about their genetic risk, without breaching the Privacy Act, the development of a clinical guideline to assist clinicians would be timely. Consideration and guidance from privacy regulators in each state and territory about the interpretation of local laws would assist with this”. The MJA continues to be at the forefront of publishing guidelines and research that directly affect health policy and clinical practice.

Aajuli Shukla

We are very proud that this MJA Special Issue on Indigenous health — “Carving our path with spirit, strength and solidarity” — is the second to be edited by a team of Aboriginal and Torres Strait Islander Guest Editors: Professor Pat Dudgeon (Bardi), Professor Jaquelyne Hughes (Wagadagam), Associate Professor Michelle Kennedy (Wiradjuri), Professor Kelvin Kong (Worimi), Professor Odette Pearson (Eastern Kuku‐Yalanji and Torres Strait Islander), and Associate Professor Paul Saunders (Biripi). This Special Issue consists of work led by Aboriginal and Torres Strait Islander authors and that underwent careful assessment, discussion, and guidance by the Guest Editors across all stages of the editorial and publication process. The final published articles reflect the care that went into this undertaking. The Editorial1 for this Special Issue is a reflective piece by the Guest Editors, where they examine the vision and impact of this issue. This year, as last,2 we received many more articles than could be accommodated in one issue, and we plan to publish additional articles from this Special Issue process later in the year. At the MJA, we understand the privilege that it is to publish articles from Aboriginal and Torres Strait Islander researchers. We also understand that a journal like the MJA has a duty to acknowledge and address the imbalance of power that has led in the past to publication in the MJA being a hard and uncomfortable experience for many Aboriginal and Torres Strait Islander authors. As editors of this Journal, we have an ongoing commitment to ensuring that the MJA is a welcoming and respectful place for Aboriginal and Torres Strait Islander authors and their publications, and we look forward to receiving future submissions. For the MJA team, it has been an enormous privilege to work with the Guest Editors, and we thank them for their generosity in sharing their time and expertise. We are also very privileged to have on the cover of this Special Issue the powerful carving by Uncle Paul Scott that describes the issue's purpose (Box). His story is a reminder of a shared future: “a story of resilience, of shared journeys, and of walking together, side by side, with respect for each other and the land beneath our feet”. Box – Artist's story

on behalf of the <em>MJA</em> team

This issue of the MJA covers a wide spectrum of topics, ranging from nuclear war — possibly the biggest potential threat to human health — through to articles on a variety of topics of practical clinical relevance. Beginning with an editorial on nuclear war,1 this multijournal, international editorial is targeted to support work being undertaken at the World Health Assembly to lobby for the re‐establishment of a mandate at the World Health Organization (WHO) to address the health consequences of nuclear weapons and war. This editorial follows on from one published in 2023 from the same group of international authors, including from this journal.2 That editorial called for a range of actions, including a verifiable, timebound agreement to eliminate nuclear arsenals. The lack of progress on these aims makes this current editorial even more important. Medical professionals have a unique authority to advocate on the dangers of nuclear war and the editorial reinforces that: “Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations comprehensive study on the effects of nuclear war”. The urgency and rationale for these calls are clear. As this new editorial states, there is “compelling evidence of the catastrophic humanitarian consequences of nuclear war, its severe global climatic and famine consequences, and the impossibility of any effective humanitarian response”. We will continue to advocate with colleagues internationally on this threat. Turning to articles of immediate clinical importance, especially as we head into the southern hemisphere winter, this issue includes a highly topical pair of articles on respiratory syncytial virus (RSV) infection — a disease that predominantly affects infants, the most vulnerable in our community. The first, a research letter by Bloomfield and colleagues,3 reports exciting new information on the effect of nirsevimab immunisation of infants on RSV‐associated hospitalisations from Western Australia in 2024. This research letter describes outcomes after the approval of nirsevimab in November 2023 in Australia and then a commitment by the WA government to an age‐inclusive universal nirsevimab program. The research letter reports that “immunising 71% of infants prior to and during the RSV season was associated with 57% fewer admissions [from RSV]”. These are important initial results. Implementation and monitoring are ongoing on a national level; these results will be important for future programmatic planning. The second article, a narrative review by Barnett and colleagues,4 describes the current state of RSV preventives for children and outlines the logistical and other considerations for future immunisation programs. Finally, the MJA has an ongoing interest in publishing on climate and health and the last article I’ll highlight from this issue is a perspective by Bone and colleagues5 on the role of fans in protection from heat‐related illnesses. As the authors note, air conditioning has been widely adopted and is currently the leading cooling strategy used globally. But access to air conditioning is neither universally distributed nor used for a variety of reasons, including cost, leading to inequity in its actual utility. The authors acknowledge the intuitive appeal of air conditioning, especially in large public facilities (such as the one where I am writing this article). They discuss, however, the case for doctors and the wider public to better understand the rationale for the use of fans instead. As the climate changes and warms, equitable approaches to addressing the prevention and treatment of heat‐related illnesses are increasingly critical. As all these articles highlight, health, or the lack of it, is rarely a simple clinical issue. Solutions are not individual but often complex and intertwined. Effective health measures require whole‐of‐system approaches — financial, social and political.

Virginia Barbour

Australia continues to experience a high burden due to non‐communicable diseases,1 with cancer, cardiovascular diseases and neurological conditions among the disease groups causing the greatest burden.2 In this issue of the MJA, several articles explore patterns, drivers, inequities and potential interventions for non‐communicable diseases in Australia, including how centring Aboriginal and Torres Strait Islander knowledges and leadership is crucial to improving outcomes for affected communities. In a narrative review, Truong and colleagues3 discuss current knowledge of and research priorities for cancer in Aboriginal and Torres Strait Islander children. Research focusing on cancer in Aboriginal and Torres Strait Islander children is limited. Although the incidence of cancer overall appears to be lower in Aboriginal and Torres Strait Islander children compared with non‐Indigenous children, important gaps exist in survival outcomes. The authors argue that “… it is time to ensure parity in the progress of research in Aboriginal and Torres Strait Islander children,” and that “Any future research in this space should be co‐designed with Aboriginal and Torres Strait Islander communities with their priorities in mind, and should ideally be led by Aboriginal and Torres Strait Islander researchers”. Boyd and colleagues4 investigated cancer survival in a retrospective cohort study of notifications of invasive cancer to the Northern Territory Cancer Registry from 1991 to 2020. Encouragingly, five‐year cancer survival improved significantly from 1991–2000 to 2011–2020 for both non‐Aboriginal (males, 50.0% to 65.9%; females, 64.5% to 75.4%) and Aboriginal populations (males, 20.5% to 37.1%; females, 32.3% to 47.2%). However, for the most recent decade excess mortality five years after cancer diagnosis was 3.3 times higher for Aboriginal peoples compared with non‐Aboriginal peoples. The authors concluded that “While progress in screening, diagnostics and treatment has contributed to enhanced survival, there remains a crucial need to comprehensively address inequities, overcome barriers in culturally sensitive ways with initiatives led by Aboriginal peoples, and ensure accessibility to services”. Place‐based disparities in dementia prevalence were explored in research by Clarke and colleagues.5 Their cross‐sectional population‐based prevalence study used 2021 Australian census data to examine the nationwide prevalence of dementia and the intersection with rurality for Aboriginal and Torres Strait Islander and non‐Indigenous peoples. For Aboriginal and Torres Strait Islander peoples, the age‐standardised prevalence of dementia was 16.2 per 1000 persons, whereas for non‐Indigenous peoples, it was 7.4 per 1000 persons. The odds of dementia decreased significantly with increasing remoteness in non‐Indigenous peoples, but not in Aboriginal and Torres Strait Islander peoples. The authors concluded that their results “emphasise that geographic considerations are of crucial significance in dementia epidemiology, particularly for Aboriginal and Torres Strait Islander peoples,” and that “Place should inform targeted health care policy to address risk and protective factors for dementia prevention and care”. Finally, a smartphone‐activated volunteer responder (SAVR) program has operated in Victoria since 2018, utilising the GoodSAM app (https://www.goodsamapp.org/) to alert nearby registered volunteer responders to eligible out‐of‐hospital cardiac arrests. In a population‐based observational cohort study using Victorian Ambulance Cardiac Arrest Registry data, Delardes and colleagues6 examined survival to hospital discharge in cases of out‐of‐hospital cardiac arrest when an SAVR arrived before emergency medical services (EMS). They found that the risk‐adjusted odds of survival to hospital discharge, bystander cardiopulmonary resuscitation, and bystander defibrillation were higher for events in which SAVRs arrived before EMS than for those not attended by SAVRs. The study was limited by its retrospective observational design and inability to account for several potential confounding variables. In an accompanying editorial, Morrison and Simpson7 write that while it is often the technology which receives attention in SAVR programs, it is the volunteer responders themselves who are the foundation. They discuss the importance of responder density to the success of the programs in optimising outcomes after out‐of‐hospital cardiac arrest, the challenges of maintaining a committed responder community, and potential means to enhance responder experience. They also discuss the role of health services implementing SAVR programs in looking after the welfare of responders: “as responders commit to improving survival after out‐of‐hospital cardiac arrest, health services must commit to optimising responder wellbeing and experience”.

Wendy Morgan

How we fund our health system to achieve the most effective, efficient and equitable outcomes is high on the political agenda. Australia has just experienced a federal election dubbed “the health election” for one of the largest funding boosts to Medicare promised by both major parties.1 This issue of the MJA is dedicated to general practice — the bedrock of the health system that has arguably been in crisis for several years. A centrepiece of Labor's campaign on health was a pledge to build more bulk‐billing urgent care centres around the country. These centres aim to bridge the gap for urgent illnesses when patients cannot see their general practitioner and reduce pressure on emergency departments (EDs).2 In this issue of the MJA, Savira and colleagues3 conducted a scoping review to examine the effectiveness of urgent care centres. They examined studies conducted in clinics in the UK, Europe and the United States and found that the results with respect to reduction in ED visits were mixed. While some studies reported that the introduction of these clinics was associated with a reduction in ED visits, others often showed no changes or an increase in presentation to ED minor injury units. Importantly, most studies examined showed a reduction in hospital admission rates in places where urgent care clinics had been set up. Although most patients in consumer surveys examined were happy with the service, continuity of care was a concern expressed by both patients and practitioners. Even though the review was limited by the high heterogeneity of methodologies examined, it provides a warning about relying on a model without adequate governance and formal assessment of cost effectiveness. Indeed, a recent interim report by the Department of Health and Aged Care found that although the cost of seeing a doctor in an urgent care clinic is lower than in an emergency department, this cost is at least five times that of seeing a general practitioner for a standard consult.4 Continuity of care has been an ongoing issue in primary health care for several years. Unlike the UK and New Zealand, where patients are often enrolled into their local primary care clinics for care, in Australia most people can visit any general practitioner anywhere for care, which often leads to a significant amount of fragmentation of care and over ordering of investigations.5 The MyMedicare initiative that has been recently rolled out in Australia attempts to correct this. Bates and colleagues6 in their scoping review for this issue examined enrolment models in other countries to elucidate their impacts on continuity of care. They found little evidence that enrolment improved continuity of care; however, study populations had high levels of pre‐existing patient engagement with a usual general practitioner The review provided evidence that enrolment can be used to support other primary care reforms such as preventive care and management of chronic conditions, and demonstrated how other reforms, such as incentives or increased access to services, can affect uptake of enrolment. For MyMedicare to work, practices and patients need to see value in enrolment. This value proposition will be hard to make without more targeted research evaluating, and then demonstrating, the benefits of enrolment, not just for individuals who have a usual general practitioner, but for those who do not. Although the review noted that the MyMedicare scheme currently has limited incentives for patients, there have been proposals to tie in funding for chronic care plans and allied health visits to a patient's nominated general practitioner and practice on MyMedicare.7 This will likely pressure general clinics to enrol patients specifically to their clinics. The overarching problem most general practitioners have with investment in primary care is that often the governments do not seem to want to consult with them with regards to their experiences and opinions on how unprecedented levels of Medicare funding might best suit their patients. Most clinics currently run on the slimmest of margins and the bulk‐billing incentive still does not meet the gap that mixed billing currently provides most clinics.8 Without effective primary care most Australians will be left without adequate health care. A substantial proportion of research needs to be carried out on effective models of care focusing on general practitioners with general practitioners as a core part of the research and assessment team.

Aajuli Shukla

In the year 2000, the XIII International AIDS Conference was held in Durban, South Africa. The Conference Report published in the MJA1 spoke of the disappointment in the results of a failed prevention trial, optimism for the next generation of vaccines, and findings from a pilot study of five patients who with potent therapy had achieved undetectable viral levels presented by Dr Anthony Fauci. During his closing address, Nelson Mandela2 focused the attention of the audience to the situation that was unfolding in Africa, and the need for action: The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale. There is a need for us to focus on what we know works. He spoke of the need for “… bold initiatives to prevent new infections among young people,” and urged international collaboration. A constant theme in all our messages has been that in this inter‐dependent and globalised world, we have indeed again become the keepers of our brother and sister. That cannot be more graphically the case than in the common fight against HIV/AIDS … Let us combine our efforts to ensure a future for our children. The challenge is no less. Meanwhile in Australia, local efforts to prevent HIV and other bloodborne diseases were facing the threat posed by the heroin epidemic. After the widely publicised suspension of an inner‐city needle and syringe outreach service in Sydney in early 1999, the NSW Parliament quickly passed legislation that would lead to the opening of Australia's first legal supervised injecting centre in 2001. Jump forward to 2025 and the Uniting Sydney Medically Supervised Injecting Centre is still operational and has had substantial successes over time,3 although this model has not been widely reproduced. In contrast, needle and syringe programs are widely implemented in Australia and form a key component of our National Strategies for preventing and treating bloodborne viral infections, of which hepatitis C virus is now a key focus.4 Despite their success, needle and syringe programs are not available to people in prisons in Australia. In this issue of the MJA, Houdroge and colleagues5 present modelling that supports the health and cost benefits of a proposed nationwide prison needle and syringe program, with about 900 new hepatitis C virus infections being prevented over the first five years of implementation and cost benefits of $2.60 per $1 invested in the program. In the accompanying editorial, Thompson and Levy6 write that it is “time to re‐think the role of prison needle and syringe programs”, and that “development and implementation of a prison‐based needle and syringe program in Australia would be an important advance for harm reduction in correctional facilities”. Both Houdroge and colleagues and Thompson and Levy highlight the strong human rights justification for providing prison needle and syringe programs. The United Nations Standard Minimum Rules for the Treatment of Prisoners7 — also known as the Nelson Mandela Rules, in honour of Nelson Mandela who spent 27 years in prison and who advocated for fair and humane treatment of all — establish, among other minimum standards, that imprisoned people should have access to the same standards of health care that are available in the community. As such, moving towards a prison‐based needle and syringe program will not only be important for meeting the goal of eliminating hepatitis C as a public health threat by 2030, but also would be in keeping with the legacy of Mandela: It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.7 In another research paper in this issue of the MJA, Bonney and colleagues8 find a relatively high rate of incidental findings in an international low‐dose computed tomography lung screening study. With the National Lung Cancer Screening Program beginning in July, the way in which incidental findings are reported will likely affect the net benefits and harms of the program. Towns and colleagues9 discuss the necessity for medical education to ensure that people in the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) community can always obtain culturally safe health care. They specifically focus on how to ensure that international medical graduates, particularly those who are originally from a country in which same sex conduct is criminalised, receive appropriate education to enable them to practice in a culturally safe manner that meets the health care needs of members of the LGBTQI+ community. Finally, a rare and uniquely Australian case of platypus envenomation.10 Platypus are one of only a handful of venomous mammals, with the males having a venomous spur on their hind legs. Moyer de Miguel and colleagues note that the envenomation results in severe pain that may be refractory, with a high risk of deep tissue infection. The three case reports in the literature thus far, including this one, have resulted from handling platypus. Like most of our Australian native animals, it is probably prudent to look but not touch.

Michael Skilton

“Medicine is a social science and politics is nothing but medicine on a grand scale”1 Many MJA readers will be familiar with this oft quoted phrase from the 19th century German physician Rudolf Virchow. In his landmark report of a typhus epidemic, Virchow pointed out the links between poverty and the spread of disease. The role of the medical profession, it follows, is not simply to treat individual patients but to also attend to the social conditions that underpin poor health outcomes. Consideration of the social determinants of health, as we now call them, is a fundamental part of contemporary public health research and practice and an area the MJA frequently publishes on. In this issue of the Journal, for instance, research by Rubenis and colleagues2 investigates place‐based disparities in care for cardiovascular diseases. They find that despite recent improvements, patients living in regional and remote areas of New South Wales admitted to hospital with heart failure experience persistently higher in‐hospital mortality compared with their metropolitan‐dwelling counterparts. Likewise, writing in a perspective article, Robertson and colleagues3 explore the many barriers that exist to research participation by people with vision impairment and describe strategies for improving participation by changing information provision and data collection methods. Although it is widely accepted that the state of our social world has an enormous influence on health, the role of health experts in moving beyond merely describing and explaining to seeking to transform social conditions to improve health remains contested. This is especially when powerful interests are at play. In such cases, it is common for physicians and researchers to be extorted to stay in their narrowly defined biomedical “lane”, or for those within the profession to worry about tainting their appearance of objective, evidence‐driven thinking by engaging in debates of a political nature. Bilgrami and colleagues4 address this tension in an article on armed conflict and the role of physician advocacy. Globally, attacks on health care — such as the killing, kidnapping and arrest of health care workers, hijacking of medical supplies, obstruction of patients from accessing care, and the bombing, looting and occupation of health facilities — are on the rise. Despite these devastating events, the authors note “most medical associations and societies have been inconsistent when it comes to advocating for the protection of health care workers in conflicts. An argument commonly put forth in recent years is that such organisations must remain apolitical”. Bilgrami and colleagues contrast this approach with notable historical and contemporary examples of successful physician advocacy efforts, as well as with their view of the norms and responsibilities at the heart of ethical medical practice. Ultimately, they conclude that “physicians have been unconscionably silent in recent years and must now integrate professional and political activities if they are to live up to the highest ideals of the profession”. There are lessons here that extend far beyond the issue of armed conflict. In the United States, for instance, the coalescence of anti‐science and anti‐human rights agendas under the Trump administration has placed academic independence and public health under attack, including with direct effects in Australia.5,6 Researchers and practitioners are facing very tangible consequences for engaging with the social determinants of health, be it around gender, sexuality, race, or health inequities more generally.7 Grants are being cancelled.8 Public health programs are being dismantled.9,10 Universities are being intimidated.11 Credible health information is being censored12,13 and purveyors of misinformation are being elevated to high places.14,15 What recent events in the US have demonstrated is that regardless of whether scientific and medical institutions seek to appear apolitical, political actors nonetheless deeply appreciate the power that health and medical experts hold in our societies and are prepared to act accordingly in pursuit of their dangerous agendas. Virchow's instruction to the medical profession is as relevant today as it was over 150 years ago.

Elizabeth Zuccala

As I am writing this Editor's Choice, I am in the process of preparing our house in Queensland for a cyclone, predicted to hit Brisbane in about 48 hours. The cover topic of this month's issue of the MJA is therefore very much at the front of my mind. This issue contains the seventh report of the MJA–Lancet Countdown on health and climate change, which examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement (https://doi.org/10.5694/mja2.52616). The analyses by Beggs and colleagues have some unsurprising but still concerning findings: the exposure to heatwaves in Australia is growing, which in turn increases the risk of heat stress; other health threats such as bushfires and drought — “features of the continent for millennia” — are amplified by climate change. Cyclones, as we are currently facing, are noted as major causes of economic losses. This year, the authors also report against a new indicator: climate litigation over the past decade. The findings are instructive: one case is “a legally significant acceptance, by government, of the science concerning the health impacts of climate change”. However, litigation is just one driver of change. As the authors note: “Nationally, regionally and globally, the next five years are pivotal in reducing greenhouse gas emissions and transitioning energy production to renewables. Australia is now making progress in this direction. This progress must continue and accelerate, and the remaining deficiencies in Australia's response to the health and climate change threat must be addressed”. Another perspective in this issue of the MJA discusses the importance of Australia endorsing a fossil fuel non‐proliferation treaty (https://doi.org/10.5694/mja2.52610). Colagiuri and colleagues outline the aims of the Fossil Fuel Non‐Proliferation Treaty and why it is relevant to health. Starkly put, we are not on track to meet the goals of the Paris Agreement — and as events in the United States unfold, it seems as if political will is shifting even further away from support for the agreement. The authors argue that the Fossil Fuel Non‐Proliferation Treaty is a way to directly address the key driver of the climate crisis. It has not been signed by Australia, perhaps unsurprisingly, though eleven Pacific nations, which well understand the risk, have signed on. Endorsing the Fossil Fuel Non‐Proliferation Treaty would, the authors argue, be “more than just a climate strategy for Australia; it represents a vital step towards advancing global health justice and fostering regional solidarity”. How pharmaceutical companies are progressing in their carbon emission plans is assessed in a research article by Burch and colleagues (https://doi.org/10.5694/mja2.52621). Drawing on publicly available documents on actions during 2015–2023 for the ten largest pharmaceutical companies operating in Australia, they show a very mixed set of results. Some have Science Based Targets initiative (SBTi)‐approved targets, monitoring, commitments and evidence of action; others have commitments to SBTi‐approved targets but limited publicly disclosed records; and others are without public commitments to achieving net zero emissions, and minimal or no SBTi‐approved targets. As the authors conclude, the companies are moving at different rates. Though this is just a snapshot, such monitoring and public documentation are vital for policy makers in supporting change. The final article I will highlight touches on a topic — snake bite and its sequelae — that may become more relevant as the climate warms and humans are more exposed to snakes (https://doi.org/10.5694/mja2.52622). In a study spanning 15 years, Isbister and colleagues analyse data from people bitten by snakes, whether they had an early collapse, and the features associated with the collapse. Not surprisingly, they found that early collapse is associated with poorer outcomes. Data on these patients are not easy to collect, but the conclusion that early collapse requires prompt identification and cardiopulmonary resuscitation is a useful clinical finding. Increasingly, the association between a changing climate and the effects on human health are becoming clearer and more urgent. If there is one overarching lesson from all these articles, it is that as every year passes, the importance of action becomes even necessary, and the time frame for action is shortening.

Virginia Barbour

Since 1914, when a Melbourne and a Sydney publication joined forces, Australia has had a national medical journal. The three perspective articles in today's issue of the MJA exemplify the unique frame of reference that a national journal brings to the Australian medical community. Perspectives are short pieces that discuss current questions in health care practice and policy. Sometimes commissioned by the Journal, but usually welcomed as submissions, they always present an expert, individual analysis of a topic of interest to our readers. In this issue of the MJA, Clifford and colleagues (https://doi.org/10.5694/mja2.52605) discuss the looming threat posed by synthetic opioids such as nitazenes, and call for greater national preparedness. Nitazenes are a class of drugs that, since 2021, have become well established in the illicit drug market in Australia, and have been implicated in 17 deaths since 2021. The authors assess the national situation with regards to these drugs and conclude that “there are sufficient signals to consider preparedness for an increase in opioid‐related harms”. Building on Australia's world‐leading experience in harm reduction, they note that people with lived and living experience of drug use must be central to preparedness planning and responses. Wyber and colleagues (https://doi.org/10.5694/mja2.52590) review the fragility of our country's access to the essential drug benzathine benzylpenicillin G, and the threat this poses to the management of syphilis and the prevention of rheumatic heart disease. These diseases, as the authors note, disproportionately affect Aboriginal and Torres Strait Islander people, who in turn are affected by a lack of reliable supply of high quality benzathine benzylpenicillin G. There are global issues with supply because of fragmented manufacturing. In 2023–24, we saw how Australia was able to respond to a supply disruption. Although many organisations were involved in the response, the authors note the important action of the National Aboriginal Community Controlled Health Organisations in disseminating key information that mitigated the effect of this disruption. They call for national strategic investment in domestically important products, including developing a sovereign manufacturing capability. Abdi and colleagues (https://doi.org/10.5694/mja2.52608) guide the reader through a thoughtful consideration of the term “CALD” (culturally and linguistically diverse), the history of its use in our national discourse, and the hidden, potentially negative effects of language. They note that as Australia moves towards greater inclusivity, our language must evolve to encapsulate the richness and complexity of the experiences of multicultural communities. These perspectives each present a scholarly consideration of an issue of national importance, and through this Journal reach a national readership. Having lived and worked in countries where a national medical journal was absent, or ineffective, I am reminded of the unique value of this part of our health system. In this time, as boundaries blur and as trust in traditional sources of information is questioned, that value only increases. The MJA has a history of engaging strongly in issues of national importance, alerting and giving voice to the Australian medical community. The Journal had an important role in sharing the dangers of thalidomide (https://doi.org/10.5694/j.1326‐5377.1961.tb70244.x and https://doi.org/10.5694/j.1326‐5377.1962.tb20203.x), providing a forum for the lively debate (https://doi.org/10.5694/j.1326‐5377.2000.tb139219.x) for Universal Healthcare (Medibank, the precursor to Medicare), and promoting an evidence‐based approach to prevention during the terrible early years of the HIV/AIDS epidemic (https://doi.org/10.5694/j.1326‐5377.1984.tb113138.x). As climate change and new pandemic agents present changing threats to health, having a continued national perspective on these issues is essential.

Robert Oelrichs

As this issue of the MJA is published, the world will be celebrating International Women's Day on 8 March 2025 and the rights of women continue to be critical to health. As a general practitioner working in the sphere of women's health for several years now, I have seen the gradual shift towards a more conservative view of women's health and a lack of equity around the management of chronic health issues. Hormone replacement therapy to treat menopause, for instance, continues to be out of reach for many due to high costs and poor access. More broadly, women continue to have experiences with a health system that is often invalidating and traumatic. The impacts of these are especially worse for women from socially disadvantaged backgrounds, Indigenous women, immigrants and refugees, and women with disabilities. Menstrual issues are a common presentation in primary care and, despite their high prevalence and impact on daily functioning, they continue to be under‐reported and undermanaged. In this issue of the MJA, Wilson and colleagues (https://doi.org/10.5694/mja2.52596) report on heavy menstrual bleeding in a cohort of women participating in the Australian Longitudinal Study on Women's Health from young adulthood to midlife. The prevalence of heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years. Almost a third of the cohort reported heavy menstrual bleeding by middle age that has a significant impact on mood and social and physical functioning. Mean health‐related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding. Although the study was unable to examine conditions such as a history of fibroids or adenomyosis as a cause for heavy menstrual bleeding, most middle‐aged women in Australia struggle to access progesterone‐producing implants due to the cost and lack of access to the service (https://www.bayer.com.au/en/womens‐health‐collaboration). Worse, if the condition fails to respond to hormonal measures, as noted by my colleagues and I, women struggle to access gynaecological care for further treatment in the current cost‐of‐living crisis. Kirkman and colleagues (https://doi.org/10.5694/mja2.52602), in their research article in this issue of the MJA, found that of the 80 clinical guidelines in Australia they examined, there were varied levels of inclusiveness in dealing with sex and gender matters in health care and most guidelines were at the lower end of the inclusiveness scale. The majority of the 80 guidelines (46 of them) made no mention of clinical practice concerning gender. Only 12 developed ideas of gender in any detail, including discussion of topics such as gender inequality, transgender health and intersectionality. The remaining 22 either implied aspects of gender awareness without stating this or mentioned “psychosocial” or “cultural” considerations that could relate to gender, demonstrating at least awareness of the contexts within which people live. This has been a persisting issue for vulnerable populations that most guidelines are developed with a heteronormative focus on cisgender males. The lack of gender‐ and sex‐specific guidelines has likely impacted the understanding of the pathophysiology underpinning common clinical conditions in women such as endometriosis and adenomyosis. The MJA continues to publish important and innovative research into issues affecting marginalised and vulnerable communities. In this issue, Dissanayake and colleagues (https://doi.org/10.5694/mja2.52593) have published research examining the impact of Hope for Health, a culturally sensitive four‐month program supporting self‐managed health improvement based on dietary and lifestyle change for a community in northeast Arnhem Land. The program was led by a local steering committee of Yolŋu women, supported by a small Balanda (non‐Indigenous) team. The program, delivered in Yolŋu language and concepts, provided knowledge about metabolic health and the causes of modern lifestyle diseases. This information was shared in a supportive setting to encourage and allow people to make informed choices about how to manage the challenges of dietary and lifestyle improvement in their own way. Participants made tangible changes to their weight, but, most importantly, health behaviours that are linked to better health outcomes were improved. The intake of breads and cereals and sugar‐sweetened beverages declined, and the amount of walking and moderate and vigorous physical activity increased by a median of 103 minutes per day. The program's focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit. Clinical research is unlikely to provide long‐lasting improvement in health outcomes if it does not consider the needs and voices of the most marginalised and disadvantaged people. Doing so needs to become a national priority, as an increasing number of Australians struggle to maintain good health in these financially trying times.

Aajuli Shukla

Inequality in access to health services and the rising cost of the health system are both challenges to the Australian health system (https://www.health.gov.au/about‐us/the‐australian‐health‐system). A number of articles in this issue of the MJA are relevant to describing the nature of these challenges and how they may be addressed. The National Disability Insurance Scheme (NDIS) replaced a disability care system that was inequitable and provided limited choice and access to appropriate support. The self‐directed nature of the NDIS is designed to, at least in part, overcome these limitations and address deeply rooted barriers that hinder people with disability from fully engaging in society. In this issue, Disney and colleagues used NDIS data to quantify the inequalities in the allocation and use of NDIS support (https://doi.org/10.5694/mja2.52594). They found that older applicants, those who are women or girls, and those living in socio‐economically disadvantaged areas are less likely to be deemed eligible for the NDIS. As Smith‐Merry and Chang note in their associated editorial (https://doi.org/10.5694/mja2.52587), inequality of access is linked to social inequities, in addition to providing guidance for future research to inform a more tailored and inclusive approach to support provision. Obesity is a major contributor to the burden of disease in Australia and is strongly linked with social inequalities and disadvantage. After the failure of so many previous anti‐obesity medications (https://journals.biologists.com/dmm/article/5/5/621/3257/Anti‐obesity‐drugs‐past‐present‐and‐future), the glucagon‐like peptide‐1 (GLP‐1) receptor agonists provide perhaps a glimpse of light at the end of the tunnel. Supported by strong evidence of both weight loss and broader health benefits, and amidst a wave of viral celebrity engagement, their worldwide usage has skyrocketed. Within this context, Kanellis and colleagues discuss the role of GLP‐1 receptor agonists in obesity (https://doi.org/10.5694/mja2.52582), with a specific focus on identifying funding models and models of care relevant for Australia. By addressing these challenges, the potential of GLP‐1 receptor agonists to revolutionise obesity care in a sustainable and equitable manner can be fully realised. There are also challenges on the individual level for patients. The decline in bulk‐billing by general practitioners and the current cost of living crisis have affected affordability of health care for many people. Through analysis of Medicare bulk‐billing rates and out‐of‐pocket costs for non‐bulk‐billed general practitioner services, Saxby and Zhang highlight the differences in access to affordable health care on the basis of geographic region, with those in remote and socio‐economically disadvantaged areas of Australia having the highest out‐of‐pocket costs (https://doi.org/10.5694/mja2.52562). In their associated editorial, Rosenberg and Hickie describe three issues that require redress to improve the system to a level of fairness expected by the average Australian (https://doi.org/10.5694/mja2.52580). And finally, a medical history article that has less to do with modern challenges to the health care system, but rather provides a glimpse of health care challenges under extreme circumstances. Ariotti and Roberts‐Pederson present a fascinating look at the diaries written from inside the Changi prison camp complex by prisoner‐of‐war Australian medical officer Major Kennedy Burnside (https://doi.org/10.5694/mja2.52581). For the thousands of his fellow prisoners‐of‐war in Changi, his work there played an important role in minimising the impact of their living conditions on their health. Key aspects of his work highlighted include the diagnosis, treatment and prevention of malaria and the development of a dysentery vaccine. The photos that accompany the article, taken by Burnside, provide an insight into the nature of the pathology laboratory that he established and an intriguing glimpse of life within the complex. I would recommend readers to take the time to view the full collection available on the Australian War Memorial website. In one thought‐provoking section, the authors detail how Major Burnside pondered whether his endeavours while a prisoner‐of‐war would have any relevance to his post‐war career; he went on to have an illustrious career in medicine. Irrespective of his post‐war career achievements, the value of what he did in that period, under those circumstances, cannot be overstated. In the words of Ralph Waldo Emerson, “The reward of a thing well done, is to have done it”.

Michael Skilton

The extraction and burning of oil, coal and gas is overheating our planet. The result is a changing climate that is becoming more extreme and less predictable. According to the Bureau of Meteorology (https://media.bom.gov.au/releases/1250/preliminary‐summary‐of‐australias‐climate‐in‐2024), for instance, 2024 was Australia's second hottest year on record. With intensifying climate events like extreme heat, drought, flooding and bushfires, as well as associated threats to biodiversity and food and water security, come myriad adverse impacts on health. Two articles in this issue of the MJA speak to the health implications of the climate crisis and the policy responses required to rise to this challenge. Until recently, local transmission of Japanese encephalitis virus (JEV) in Australia was limited to the Torres Strait and Cape York. A widespread outbreak in 2022–23 in New South Wales, Queensland, Victoria and South Australia heralded that the country might be entering a new era in the epidemiology of this mosquito‐borne virus. Indeed, at the end of last year, Victoria reported its first case of JEV since the last outbreak (https://www.theguardian.com/australia‐news/2024/dec/31/japanese‐encephalitis‐case‐found‐in‐victoria‐prompts‐high‐risk‐warning). Dowsett and colleagues (https://doi.org/10.5694/mja2.52550) explain how a changing climate could be contributing to the emergence and spread of JEV in Australia through increases in rainfall, temperature and levels of evaporation and humidity, which in turn affect the interactions between JEV vectors, hosts and the environment. After reviewing Australia's JEV surveillance efforts to‐date, Dowsett and colleagues conclude that “there is a pressing need to shift from a reactive ‘surveillance and response’ approach to a more proactive, comprehensive ‘predict and prevent’ strategy, particularly in regional areas of Australia where populations are at greater risk”. Key recommendations for action include developing comprehensive surveillance systems that target multiple diseases with overlapping ecology and transmission (such as JEV, West Nile virus, and Murray Valley encephalitis virus), utilising multidisciplinary One Health approaches, and the creation of a central data repository to assist in the rapid detection and containment of outbreaks, potentially led by the nascent Australian Centre for Disease Control (www.cdc.gov.au). These efforts should be complemented by enhancing research capacity for the diversity of vector‐borne diseases that affect Australia and our region. Recognising that our population is already experiencing the impacts of climate change on health and wellbeing, in December 2023, Australia launched its first National Health and Climate Strategy (https://www.health.gov.au/our‐work/national‐health‐and‐climate‐strategy). Writing in the MJA, Beherns and their colleagues (https://doi.org/10.5694/mja2.52552) from the Australian Department of Health and Aged Care outline the core aims and elements of this landmark strategy, reflect on its first year, and discuss anticipated implementation challenges. The authors explain that “at the heart of the Strategy is an ambitious agenda to transform Australia's health system into one that is sustainable and climate resilient while improving care quality and health outcomes”. Since its launch, work has begun on 31 of the 49 actions within the Strategy, with 12 of those 31 actions completed or in the final stages of completion by the end of 2024. Planning has also commenced for a further 14 actions. One particularly important element of the Strategy is the ongoing development of a Health National Adaptation Plan (HNAP). These national plans are an initiative under the United Nations Framework Convention on Climate Change, and are intended to provide a national framework for countries to anticipate and manage climate‐related health risks. According to the latest global report from the Lancet Countdown on health and climate change (https://www.thelancet.com/journals/lancet/article/PIIS0140‐6736(24)01822‐1/abstract), as of December 2023, 43 of 82 (52%) countries that had committed to building climate‐resilient health systems through the COP26 Health Programme reported having developed an HNAP, up from just 6% the year before. Australia's commitment to developing its own national plan thus represents a significant step towards building climate resilience within our health system and bringing the country in line with global best practice on climate and health action. Overall, the success of Australia's National Health and Climate Strategy must be assessed in the long term and will undoubtedly face setbacks and resistance. It must also be judged in light of actions taking place in other areas of government, not least of which include the ongoing new approvals of fossil fuel projects and enormous financial subsidies to major producers and users of fossil fuels — actions that are incompatible with efforts to avoid the worst effects of climate change. Nonetheless, early progress on implementation of the Strategy is encouraging, especially given the arguably catastrophic national inaction on climate change and health that characterised the years preceding its announcement. Owing to its importance for Australia, planetary health is a core focus of the Journal and we encourage our authors to continue to submit research and analysis in this area.

Elizabeth Zuccala

This first 2025 issue of the MJA marks the beginning of a year in which a new US president takes office and in which Australia will have a federal election. Health is always a social and political issue and should not be confined to health portfolios. As the World Health Organization recognises, “population health is not merely a product of health sector programmes but largely determined by policies that guide actions beyond the health sector” (https://www.who.int/activities/promoting‐health‐in‐all‐policies‐and‐intersectoral‐action‐capacities). One of the most critical ways in which wider policies can affect health is in the way that they recognise, count and subsequently provide for the diversity of a country's population. With regard to multiculturalism, the Australian Government's Multicultural Access and Equity Policy from 2018 (https://www.homeaffairs.gov.au/about‐us/our‐portfolios/multicultural‐affairs/about‐multicultural‐affairs/access‐and‐equity) notes that its aim is to ensure that “Australian Government programs and services meet the needs of all Australians, regardless of their cultural and linguistic backgrounds”. Despite this, the 2024 review Towards fairness: a multicultural Australia for all (https://www.homeaffairs.gov.au/multicultural‐framework‐review/Documents/report‐summary/multicultural‐framework‐review‐report‐english.pdf) noted “systemic barriers faced by individuals from diverse backgrounds within the healthcare and mental health systems”. In regard to LGBTIQA+ individuals, the policy framework is fragmented although, in 2023, the federal government began developing a draft action plan — LGBTIQA+ Health and Wellbeing 10 Year National Action Plan (https://www.health.gov.au/committees‐and‐groups/lgbtiqa‐plus‐health‐and‐wellbeing‐10‐year‐national‐action‐plan‐expert‐advisory‐group). Several articles in this issue of the MJA reinforce the importance of developing policy coherence and that policies and structures well beyond the health sectors have a direct impact on health outcomes. Possibly one of the most important ways that needs are determined at a population level is the census, next due to be conducted in Australia in 2026. In a letter commenting on the next census, Saxby and Hammoud (https://doi.org/10.5694/mja2.52542) express the concern that many have felt over the discussion of collection of data on LGBTI+ Australians in the 2026 census. After a change of heart by the Australian Government, the 2026 census will include a question on sexual orientation and gender identity. However, as Saxby and Hammoud note, it is not clear if the census will, if it does not align with best practice in collecting these data, provide the evidence base needed for future policy. As they conclude, “Ultimately, health equity is unachievable without data equity. The future of health equity depends on the informed actions we take today to ensure our data accurately reflects the diversity of the entire Australian population”. Inclusivity — in this case of surveys — is the topic of a perspective by Maheen and King (https://doi.org/10.5694/mja2.52545). Population surveys can provide information on a wide variety of health outcomes and health service use and, in their turn, inform health policy. Maheen and King argue that current surveys do not adequately capture the diversity in culturally and linguistically diverse populations in Australia. Although they note that most surveys capture the minimum core data that the Australian Bureau of Statistics suggests are needed, few report all 12 standard indicators. The authors argue that population surveys are both failing to adequately include individuals from culturally and linguistically diverse populations, especially from the most vulnerable groups, and are not capturing the diversity of these populations, including their migration status at time of arrival. As the authors note, without collecting adequate information in population surveys, they will not reflect the diversity within Australian multicultural communities. Finally, a research article by Spierings and colleagues (https://doi.org/10.5694/mja2.52551) provides essential insights into the knowledge and attitude of one key population group — Aboriginal and Torres Strait Islander people — in relation to coronavirus disease 2019 (COVID‐19) vaccination. Though vaccination was offered early to Aboriginal and Torres Strait Islander people, little was previously known about the attitudes within this group. The author group, which comprised Aboriginal and non‐Indigenous authors, reported the results from the Yarning About COVID project. They found that the respondents had a high level of trust in the COVID‐19 vaccines and were well informed about them. They suggest that Aboriginal community controlled health organisations — an important part of the Australian health care sector — were critical in these levels of trust, which argues for their key role in future health messaging. All these articles reinforce how critical is the social and political framework that health exists within. These are topics that the MJA is keen to explore and welcomes submissions on.

Virginia Barbour

The end of the year is a good time to reflect on why a journal like the MJA does what it does, who supports the Journal's work, and the headwinds that journals are navigating. The MJA publishes high quality research and commentary that aims to inform health policy and influence medical practice in Australia. Our process is largely one of curation of what is submitted to us, combined with commissioning on issues we identify as important. We prioritise for publication articles that report on or discuss conditions with a high burden of disease, that are likely to have an effect on policy or practice, support Aboriginal and Torres Strait Islander health and wellbeing, and articles that report on uniquely Australian topics. Articles go through a rigorous process that includes editorial assessment, peer review, author revision in response to peer review, and, after acceptance, expert structural editing. We hope that this process — essentially a collaboration between authors, editors and reviewers — will ensure that, by the time an article is published, it is the best representation of the authors’ work. In the 12 months to 31 October 2024, the MJA received 1598 articles, of which 196 were accepted; we publish around 10–12 in each issue. Each issue is a curated mix of content; some, such as the theme issues on surgery (https://www.mja.com.au/journal/2024/220/5), general practice (https://www.mja.com.au/journal/2024/220/9), women's health (https://www.mja.com.au/journal/2024/221/7), infectious diseases (https://www.mja.com.au/journal/2024/221/4), child and adolescent health (https://www.mja.com.au/journal/2024/221/10), and the special issue on Indigenous health (https://www.mja.com.au/journal/2024/221/1), have a specific focus. This end of year issue has no specific theme; its diversity, however, collectively reflects the Journal's priorities. We hope these articles will interest you as readers and support you in your clinical practice or research as much as we were fascinated by them as editors. The research articles include an analysis of the cost of treating hypertension (https://doi.org/10.5694/mja2.52522), participation in the national bowel screening program by people with severe mental illness (https://doi.org/10.5694/mja2.52521), an analysis of out‐of‐hospital cardiac arrests (https://doi.org/10.5694/mja2.52532), and an analysis of the Northern Territory health workforce (https://doi.org/10.5694/mja2.52507). Perspectives include the need for targeted prevention and treatment of stroke in young women (https://doi.org/10.5694/mja2.52516), and a review of the evidence of persistently replicating SARS‐CoV‐2 as a driver of long COVID (https://doi.org/10.5694/mja2.52517). We are proud to also publish in this section a thoughtful article, “Decolonisation, Indigenous health research, and Indigenous authorship: sharing our teams’ principles and practices” (https://doi.org/10.5694/mja2.52509), by a collective of Aboriginal and non‐Indigenous researchers, who work together in two Aboriginal‐led research teams. In the decisions we make at the MJA, we are supported on a daily basis by many reviewers who give their time and expertise to help us provide what we think is an essential service: high quality evidence‐based research and commentary to support decision making in health care. In the past 12 months, they submitted between them 855 reviews. We provide below a list of the reviewers who have reviewed for us in the past 12 months and we are grateful to all of them for what they do to support the MJA. We are also very grateful to the members of our Editorial Advisory Group, who provide ongoing expert advice. This year we are especially grateful to the Guest Editors for the July special issue on Indigenous health that we published in association with the Lowitja Institute (https://www.mja.com.au/journal/2024/221/1). Their work in curating this special issue is one that we were very proud to support as part of the MJA's ongoing commitment to excellence and leadership in Aboriginal and Torres Strait Islander led health research. In 2024, more than 100 countries, representing about half of the world's population, have had the chance to vote in regional, national or local elections. Perhaps, more than ever before, the evidence base for science and medicine have been on the ballot and it is not clear that it has been on the winning side in every case. In reflecting back on what we do, the role of peer‐reviewed journals such as the MJA will be even more crucial over the next few years in helping navigate the vast amount of medical information that exists. We are very grateful for everyone that supports the work that we do at the MJA, and who does work themselves in evidence‐based health research and policy making. Now, more than ever, this work is crucial to support a functioning and evidence‐informed society. The MJA Editorial Advisory Group, November 2024 The MJA Editorial Advisory Group members are eminent clinicians and scholars who are valuable sources of ideas for the content of the Journal. They provide constructive criticism of the format and content of the Journal, and provide independent advice to the MJA Editorial Committee on appeals of editorial decisions, problematic articles, and complaints about the editorial process. John Attia Lilon G Bandler Anthony Capon Flavia M Cicuttini Paul B Colditz Brendan S Crabb Jaya Dantas Anne Duggan David A Ellwood Alex Farrell Peter G Gibson Marc Gladman Charles Guest Claire L Jackson Cheryl A Jones Zsuzsoka Kecskes José Florencio Fabella Lapeña, Jr Christopher Levi C Raina MacIntyre Jennifer Martin Patrick D McGorry Catriona McLean Lucy Morgan Peter L Munk Debra Nestel Ian N Olver Wilfred Peh Anna Ralph Toby Richards Christobel Saunders Susan Sawyer Jeong‐Wook Seo Lambert W Schuwirth Joseph Sung Helena Teede Philip G Truskett Robyn Ward Steve Wesselingh Paul S Worley Catherine Yelland Neville D Yeomans Jeffrey Zajac MJA reviewers, 31 October 2023 – 1 November 2024 Jason Abbott Lisa M Abbott Karen Adams Oyelola Adegboye Barbara‐Ann Adelstein Stephen Adelstein Hossein Adibi John Adie Susannah Ahern Chris Alderman Sarah Ali Nicole L Allard Penny L Allen Janaki Amin David John Amor Craig S Anderson Robert Anderson Catarina Ang Nigel R Armfield Amit Arora Kingsley Asiedu Deborah A Askew Eugene Athan John J Atherton David N Atkinson John R Attia Oyekoya Taiwo Ayonrinde Leon A Bach Kathryn Backholer Tony Badrick Michael Baigent Jannine Bailey Suzanne Bain‐Donohue Ross I Baker Eileen Baldry Zoe Baldwin Lilon G Bandler Bridget Barber Ruth A Barker Kristine Kay Barlow‐Stewart Rahul D Barmanray Amanda Barnard Adrian G Barnett Dylan Dominic Barth Tarun Bastiampillai Marijka Batterham Malcolm W Battersby Frank H Beard Kenneth Beath Lorri Beatty Paul J Beggs Justin Beilby Katy JL Bell Scott C Bell Simon Bell Derrick A Bennett Julie Bennett Jill Benson Stephanie Best Neera Bhatia Laurent Billot Justin Bilszta Marie M Bismark Habtamu Bizuayehu Deborah A Black J Andrew Black Kirsten I Black Christopher F Bladin Tony Blakely Paul Blaschke Melissa Jane Bloomer Peter Boan Angie Bone Michael A Bonning Kade Booth Jeffrey Boris Jessica Botfield Eric Bouffet Mark Boughey Lisa Bourke Asha C Bowen Simon D Bowler Annette J Braunack‐Mayer Ruanne Brell Bruce J Brew Fraser J Brims Peter J Bristow Julia M L Brotherton Anthony James Brown Katharine Brown Claudia Bruno Jamie Bryant David J Buckley Liz Buckley Nicholas A Buckley T Jared Bunch Hayden Burch Luke Burchill Sally A Burrows Jane A Buxton Oyungerel Byambasuren Gerard J Byrne Dominique A Cadilhac Rosemary Calder Emily Joy Callander Ian D Cameron Peter A Cameron Anna Campain David G Campbell Lewis Campbell Ben J Canny Karla J Canuto Cheryl Carcel Phillip J Carson Judith Cashmore Gillian E Caughey Elena Cavazzoni Blake S Cavve Steven J Chadban Leanne Chalmers Sonia Chanchlani Manju Chandrasegaram Jenny Chang Jack Chen Bernard Man Yung Cheung Derek P Chew Angela L Chiew HuiJun Chih Philip MC Choi Stephanie KY Choi Clara K Chow Eric P F Chow Intifar Chowdhury Kate Churruca Tainya Clarke David Coghill Neale D Cohen Paul B Colditz Catherine Coleborne Jacinta M Coleman Samantha Colledge‐Frisby Alex Collie Peter J Collignon Philippa Collin Josielli Comachio Robert James Commons Luke B Connelly Mark S Cooper Matt Cooper Michael D Coory Vincent J Cornelisse Colin Hilton Cortie Christopher Coulter Sean Cowlishaw Stephen Cox Terry J Coyne Simon Craig Susanna Cramb Gregory Crawford Julia L Crilly Philip Crispin Simon R Crouch Andrew Crowden Mark Crowther Alana R Cuthbert Mark Daglish Eleonora Dal Grande Kathryn Daley Carlton D Dampier Benjamin Daniels Jaya A R Dantas Jai N Darvall Mike Daube A James M Daveson Stephanie J Davies Ian D Davis Joshua S Davis Stephanie Davis Susan R Davis Angela Dawson Carolyn A Day John F de Campo Caroline M de Costa Barbara de Graaff Bouke de Jong Anthony Dear Katrine Del Villar Anthony Delaney Clare Delany Sarah M Dennis Jane Desborough John A Devereux Haryana M Dhillon Terrence H Diamond Hugh G Dickson Christianna Digenis Joanna Dipnall George Disney Loc Giang Do Annette J Dobson Jodie M Dodd Xenia Dolja‐Gore Susan M Donath Katina D'Onise Paul J Douglas Jenny A Doust James Dowty Andrea Driscoll Olaf H Drummer Stephen J Duckett Johan A Duflou Pascal Duijf Gregory J Duncombe Karen Maree Dwyer John R Dyer Diana Egerton‐Warburton John W Eikelboom Robert H Eikelboom Paul Eleftheriou David H Ellis Pete M Ellis David A Ellwood Elissa Elvidge Jon D Emery Guy D Eslick David Espinoza Mohamed Estai Claudia Estcourt Sue M Evans Christopher K Fairley Kristy Fakes Michael O Falster Jonathon P Fanning Jillann F Farmer Michael Farrell Daniel M Fatovich Stuart Faulkner Jane Christine Fazio Deirdre Fetherstonhaugh David W Firman Matt Fisher Robert A Fitridge Gerard J FitzGerald John L Fitzgerald Arthas Flabouris Stephen C Flecknoe‐Brown John I Fleming Darran Foo Malcolm Forbes Kevin D Forsyth David Fraile Navarro Peter Franklin John K French Frank A Frizelle Lara Fuller Clara Gaff Nicholas Gall Seana Gall Edward J Gane Lydia Garside Coral E Gartner Gail Garvey Madlen Gazarian Alison Gibberd Nathan J Gibbs Peter G Gibson Peter R Gibson Gerard Francis Gill Stephen Dean Gill Lynn H Gillam Allan R Glanville Rebecca Glauert Stacy K Goergen Day Way Goh Lisa Gold Rimma Goldberg Matthew R Golden David E Goldsbury Judith Gomersall Phillip D Good Belinda Goodwin Alexandra S Gorelik Rebekah Grace Patricia Graves Melissa J Green Suetonia Green Tim J Green Jerry R Greenfield Trisha Greenhalgh Jennene Greenhill Jessica A Grieger Sonia R Grover Luke E Grzeskowiak Eric Guazzo Pascale Guitera Hasantha Gunasekera Monisha Gupta Lyle C Gurrin Thi Ninh Ha Dandara Haag Bronwyn B Haasdyk Mohsen Habibian Penny Hagen Sally Hall Dykgraaf Christian R Hamilton‐Craig Mark J Hanly Isabel Hanson Damian Harding Stephen Harfield David Harley Benjamin Harrap Ian A Harris Katie Harris Mark F Harris Jo Harrison Simon J Harrison Stephanie Harrison Roger J Hart Gunter F Hartel Mary Anne Hartley Lara Harvey Rubayyat Hashmi Alys Havard Andrew Hayen Christopher Hayes Richard B Hays Christopher H Heath Geoffrey S Hebbard Michael A Henderson Martin Hensher Subash Shanthakumar Heraganahally Ana Herceg Helen E Herrman Charlotte Mary Hespe Martha Hickey Peter Higgs Joanna Hikaka Andrew G Hill David R Hillman Kenneth M Hillman Sarah N Hilmer Dana A Hince Pravin Hissaria Danielle Hitch Peter G Hobbins Alberta Hoi Michael J Hollands Caroline SE Homer Preben Homoe Thai Phuoc Hong Gary Hooper John Hopper John D Horowitz Robert L Horvath Elizabeth D Hotham Paul Hotton Nehmat Houssami Jessica Howell Martin Howell Wendy Hu Catherine E Huggins Jaquelyne Hughes Lisa Hui Rod W Hunt Roger W Hunt Arnagretta Hunter Jennifer Hunter Peter C Hunter Elizabeth Hurrion Sarah J Hyde Zoë Hyde Jonathan A Hyett Susan Ieraci Maria C Inacio Warrick J Inder Joan Ingram Geoffrey K Isbister Katherine Z Isoardi Rowena G Ivers Christopher Jackson Claire L Jackson Melinda Jackson Theresa Jacques Farzana Jahan Sharon James Stacey K Jankelowitz Edward D Janus Edward Jegasothy Charles G Jenkinson Awachana Jiamsakul Liza Johannesson Sarah Johnson Brian D Johnston Alexandra Jones Michael P Jones Scott Jones Michelle Jongenelis Robert N Jorissen Matthew D Jose Joanne Joseph Preeti Avinash Joshi Manjul Joshipura Craig Phillip Juergens Nadarajah Kangaharan Jonathan Karnon Judith M Katzenellenbogen Margaret P Kay Karuna Keat Damien Kee June Keeling Michelle Kehoe Nicholas A Keks Justin Kenardy Debra S Kennedy Emma Kennedy Michelle Kennedy Suzanne Kennewell Danelle Kenny Katherine Kenny Dev A S Kevat Ehsan Khan Karen Kiang Ganessan Kichenadasse Hansoo Kim Joosup Kim Michael G Kimlin Lara Anne Kimmel Jeffrey Klausner Christopher S Kneebone Taryn Knox Jonathan Koea Pamela Konecny Kelvin M Kong Viola Korczak Zeff Koutsogiannis Leonard Kritharides Estie Kruger Eeva‐Katri Kumpula Ronald Labonte Luise Patricia Lago Vinay Lakra Stephen B Lambert Riki Lane Aleksandra Lange Alexander Larcombe Michael Larkin Sarah L Larkins Anne‐Marie Laslett Zohra Lassi Dennis Lau Namson Shon Chung Lau Kate Laver David M Lawrence Minh Le Cong Bernard Arnaud Leckning Karin Leder Adriene Lee James C Lee Stephen R Leeder Amy Legg James W Leitch Christopher N Lemoh Peter J Lewindon Xia Li Xue (Snow) Li Winston Spencer Liauw Michael Libman Leanne Liddle Susan Liew Vidya S Limaye Ivan Lin Anthea Lindquist Daniel Lindsay Damien Linnane Clare Littleton Dan Liu Andrew R Lloyd Serigne Lo David Long Derrick Lopez Susan M Lord Paula Lorgelly Jeanne Louw Michaela Lucas Guy L Ludbrook Sanja Lujic Ronald Ma Gustavo Machado Andrew I MacIsaac Heather G Mack John S Mackenzie Rona Macniven Richard Cawley Madden Guy J Maddern Parker John Magin Farah Magrabi Karen Magraith Robert Mahar Colin J Mahoney David Majewski Ashanya Malalasekera Allison Malcolm Arunima Malik James Leslie Mallows Linda Mann Jo‐Anne Elizabeth Manski‐Nankervis Danielle Manton Victoria J Mar Ben J Marais Tania P Markovic Susan Marks Nathaniel S Marshall Jennifer H Martin Kaka Martina Marianne Martinello Thomas H Marwick Lester Mascarenhas Siobhán Masterson Heather Mattner Richard Matzopoulos Danielle Mazza Scott McAlister Sally M McCarthy Peter McCluskey Stephen P McDonald Alison McEwen Forbes McGain Julie McGaughran Richard G McGee Peter McGeorge Steven McGloughlin Matthew Richard McGrail Iain McGregor Peter B McIntyre Andrea McKivett Donald McLeod Brendan McMullan Danielle McMullen Kathleen McNamee Ryan Mead‐Hunter Graham N Meadows Niamh Meagher Jacqueline K Mein Tracy Lee Merlin William J Milford Jeremy L Millar Robert Miller Llew Mills Rachel Milte Alyssa Milton Gita D Mishra David James Mitchell Geoffrey K Mitchell Francis Mitrou Michael Montalto Julia K Moore Michael J Moore Robyn Moore Philip Morgan Susan J Morgan Peter Morley Jedidiah Morton Robert G Moses Robert F W Moulds David Mountain Alison M Mudge James Muir Zachary Munn Cammi Murrup‐Stewart Danielle Muscat Vasi Naganathan Balakrishnan (Kichu) R Nair Sanjay Nandurkar Alison J Nankervis Natasha Nassar Merrilee Needham Amanda Louise Neil Mark R Nelson David A Newby Evan D Newnham John Newnham Yee Ching Ng Sam Ngan Son H Nghiem Danielle Ni Chroinin Gary Nicholls Suzanne Nielsen Rosemary L Nixon Antony Nocera Alicia Norman Robert Norton Vicki O'Donnell Patrick Oakley Jeremy J N Oats James O'beirne Carly Oboudiyat Penny O'Brien Anne O'Connor Daniel Bogale Odo Nicholas J Osborne Joshua Osowicki Jessica Pace Ellie Paige Andrew John Palmer Adriana Parrella Carmen Parter Nalini Pati Sue Pavord Christopher Pearce Odette Pearson Roxanna Pebdani Carmelle Peisah Yang Peng Jonathan Penm Charana Perera Gregory M Peterson Naomi Pfitzner Richard K S Phoon Robert W Pickles S Praga Pillay Dino Pisaniello Sabrina W Pit Michael Pollanen James Pollard C Dimity Pond Phillippa J Poole Michelle Porter Christopher John Poulos Jeffrey Presneill Karen Price Jenny Proimos Susanna Margaret Proudman Mark Putland Rennie Qin Helen E Quinn Steve Quinn Miia Rahja Eamon P Raith Satish Raj Anna P Ralph Geetha Ranmuthugala Jonas Ranstam Melissa Raven Jennifer S Reath Helen K Reddel Stephen Reddel Susan J Rees Christopher Reid Ian R Reid Joel Rhee Alice M Richardson Drew B Richardson Damien Riggs Malcolm D Riley Ian T Ring Marco Rizzi Vijay Roach Fiona Robards Kathryn Victoria Roberts Chris Robertson Iain K Robertson Paul G Robertson Jo Robinson Kerry Robinson Jenny M Robson Leigh Roeger Benjmain Rogers Margaret J Rogers Loreto Vanessa Tevah Rose Jacqueline Roseleur Sebastian P Rosenberg Andrew Ross Bronwen Ross Glynis P Ross Stacey L Rowe Bosco Rowland Amanda Roxburgh Darren B Russell Fiona Russell Courtney Ryder Bandana Saini Jonathan M Samet Mina Sarofim Sarah Sasson Christobel M Saunders John Saunders Rebecca B Saunderson Feby Savira Andrea L Schaffer Chris Schilling Markus Schlaich Violeta Schubert Tim Schultz Kate Scoles James G Scott Paul A Scuffham Holly Seale Deshan F Sebaratnam Paul J Secombe Rhiann Sue See Marie‐Claire Seeley Leonie Segal Tarun Sen Gupta Sanjaya N Senanayake Stefan Serban Hannah Seymour Anthony Shakeshaft Shokoofeh Shamsi Rashmi Sharma Md Shajedur Rahman Shawon Dinberu Shebeshi Daisy Shepherd Heather Shepherd Kirsty Short Alexis Leah Shub William Sievert Kyra Sim David Simmons Andrew H Singer Leda Sivak Dana Rose Marie Louise Slape Janet K Sluggett David P Smith Jane Smith Hayley Smithers‐Sheedy Jennifer Smith‐Merry Thomas L Snelling Hayden A Snow Jessamine Soderstrom Tania C Sorrell Denis Spelman Alicia J Spittle Geoffrey K Spurling Preeyaporn Srasuebkul Ingrid Stacey Andrew Staib Julia Steinberg Alexandre S Stephens Michele Sterling Mark Stevenson Adam Stewart Rob Stirling Martin R Stockler Nigel P Stocks Simone I Strasser Edward Strivens Bronwyn Gwenneth Ann Stuckey Elizabeth Ann Sturgiss Wei‐May Su Takemi Sugiyama Ahna Ballonoff Suleiman Clair Sullivan Anastasia S Suraev Tatiana Surzhina Georgina Sutherland Tom Sutherland Aaron L Sverdlov Arianne Sweeting Prue Talbot Nicholas J Talley Natassia Pinpin Tan Patrick Tansley Avelina Tarrago Amanda Taylor Adam G Testro Hiran Thabrew Mark AB Thomas Alexander Thompson Kelly Thompson Tilda Nell Thomson Karen Thorpe Matthew Tieu Kaylie Toll Shidan Tosif Stephen Craig Trumble Haitham Tuffafa Thomas Turnbull Stuart Turville Bep Uink Patricia C Valery Kees van Gool Leesa Van Niekerk Alicia Veasey Mark George Knox Veitch Rebecca Louise Venchiarutti Bala Venkatesh Deborah Verran Karin Verspoor Elmer V Villanueva Renuka Visvanathan Beverley Vollenhoven Amy Von Huben Kylie Vuong Zoe Wainer Dennis Walker Robert J Walker Richard Walton Michael B Ward Peter A B Wark David D Warrell Chelsea J Watego David I Watson Jared Watts Cora Weber‐Pillwax Peter Wein Barbara Weinstein Heidi Welberry Cameron Wells Aliza Werner‐Seidler Robb Wesselingh Juanita L Westbury Seth Westhead Melissa Anne Wheeler Sara Whitburn Cassandra White Christopher P White Jenni White Julian White Kate White David C Whiteman Alan John Wigg Kay A Wilhelm Garry J Wilkes Chris S Wilkinson Dominic J C Wilkinson Louise Wilkinson Carmel Williams Craig Williams Crystal Williams Megan Williams Robyn Williams Andrew Wilson Leon Winata Ingrid Winship Sarah Wise Gary A Wittert Vincent Wing Ming Wong Anna Wood Michael C Woodward AM Paul Worley Melina Gattellari Worthington Michael Wright Ian Wronski Rosemary Wyber Elizabeth J Wylie Jessica Yang Mark W Yates Margaret R Zacharin Ehud Zamir Christopher Zeitz Yuejen Zhao Nicholas A Zwar

Virginia Barbour

Decades of public health research have taught us that childhood and adolescence are a critical window for investing in the health of populations. Simply put, ensuring young people have a safe and healthy start to life pays dividends across the life course for individuals, their families, and communities. Despite this knowledge, Australia's children and adolescents continue to face enormous threats to their lifelong health and wellbeing. From growing inequality and declining standards of living to the climate crisis and environmental degradation, to conflict, violence and growing mistrust in our institutions and political processes, it is young people who will bear the greatest burden of the most pressing social and economic challenges of our time. Given the central role that the health sector has in responding to and meeting these challenges, this issue of the MJA is dedicated to child and adolescent health. The Future Healthy Countdown 2030 aims to drive systemic changes to Australia's policy environments to improve the health and wellbeing of young people and future generations. The second annual series of Countdown articles appears in a supplement to this issue of the MJA (https://www.mja.com.au/journal/2024/221/10/supplement). Building on the breadth of existing work by advocates and experts, the capstone article in the supplement, by Lycett and colleagues (https://doi.org/10.5694/mja2.52494), reports on development of eight policy actions that are most likely to substantially improve health and wellbeing for children and young people by 2030. The authors recommend that Australia: establish a federal Future Generations Commission; address poverty and material deprivation in the first 2000 days of life; expand access to maternal and child health and development home visiting services; implement a dedicated funding model for Aboriginal and Torres Strait Islander community‐controlled early years services; properly fund public schools; protect children from the marketing of unhealthy and harmful products; lower the voting age to 16 years; and immediately end all new fossil fuel projects. In recognition of the fact that young people are experts on their own lives and needs, five subsequent articles in the supplement take a deep dive into the importance of young peoples’ meaningful participation in decision‐making initiatives, both within and beyond the health sector, to support their health and wellbeing. The tendency of adults to make decisions about young people without genuine consideration of their views and preferences is highlighted by the current debate about social media and the merits of age‐based restrictions. The relative harms and benefits of social media for the mental health and wellbeing of children and adolescents, including appropriate policy responses, is a valid and important issue. Yet too often, public and political discourse reduces nuanced and at times conflicting evidence to black‐and‐white judgements. In a perspective article, Christensen and colleagues (https://doi.org/10.5694/mja2.52503) thoughtfully examine the potential relationships between social media use and self‐harm and suicide among young people. They conclude that the evidence for a causal relationship is weak, that “restricting social media may have harmful effects”, and they make recommendations for better understanding and addressing this problem. Two further articles in this issue of the MJA spotlight youth mental health. Watkeys and colleagues (https://doi.org/10.5694/mja2.52498) report findings from New South Wales that 26.9% of children had used Medicare‐subsidised mental health services before their 15th birthday, with evidence of inequities in access to care relating to socio‐economic status and geography. Judd and colleagues (https://doi.org/10.5694/mja2.52489) indicate that 3.2% of adolescents in South Australia were hospitalised with mental health‐related diagnoses between the age of 12 and 17 years. This differed markedly according to their level of contact with the child protection system earlier in their life (0–11 years of age), with around 45% of mental health‐related hospitalisations of 12–17‐year‐olds being people who had had previous contact with child protection services. This emphasises the likely importance of adopting trauma‐informed approaches for young people who are admitted to hospital with mental health conditions. Moving on from mental health, this issue includes insightful work on a wide range of topics, including on an Aboriginal and Torres Strait Islander adolescent model of primary health care (https://doi.org/10.5694/mja2.52484), the changing prevalence of cerebral palsy in Australia (https://doi.org/10.5694/mja2.52487), safeguarding the wellbeing of transgender youth (https://doi.org/10.5694/mja2.52504), and clinical trials for paediatric brain cancer (https://doi.org/10.5694/mja2.52506). We hope you enjoy reading this theme issue as much as we enjoyed curating it.

Elizabeth Zuccala · Michael Skilton

In rock climbing, the crux is the hardest section, or sections, of a particular climbing route. To solve a crux, the climber must draw on their skill and expertise, problem‐solving abilities, perseverance and teamwork, before being able to send it — solve the crux and complete the route. This issue of the MJA covers a broad range of subjects that could be considered some of the most critical challenges in modern health and health care. Over the past 55 years, the proportion of people in Australia who die from cardiovascular diseases has halved (https://www.abs.gov.au/statistics/health/causes‐death/changing‐patterns‐mortality‐australia/latest‐release). Nonetheless, cardiovascular diseases remain a leading cause of death and morbidity. In this issue of the MJA, Figtree and colleagues (https://doi.org/10.5694/mja2.52482) describe the Cardiovascular Health Leadership Research Forum. Established in 2022, this initiative unites governments, health service providers, and the research workforce to tackle major cardiovascular health challenges. By accelerating the implementation of new preventive and therapeutic strategies, it seeks to enhance patient outcomes and produce economic benefits. On a broader scale, Jackson (https://doi.org/10.5694/mja2.52476) discusses the National Health Reform Agreement, and the challenges it faces to remain fit‐for‐purpose for maintaining a high quality equitable health system. Seven policy barriers are identified that have long undermined health system reform, and will need to be addressed for the next agreement to be successful. Four further articles discuss key aspects of modern socially responsible health care. Rodda and colleagues (https://doi.org/10.5694/mja2.52471) review current approaches to identifying and managing gambling disorder. Formerly known as pathological gambling, gambling disorder is now classified as a behavioural addiction. Gambling disorder affects only 1% of the population; however, gambling is pervasive in Australian culture with significant costs. Approximately three‐quarters of the Australian adult population spent money on gambling in 2022, with total losses of $20–25 billion per year (https://www.aihw.gov.au/reports/australias‐welfare/gambling). This does not account for the further social costs of gambling, which are extensive. Of those Australian adults who gamble, almost half are classified as being at risk of harm, with the highest rates in young people and men. The evidence base outlined by Rodda and colleagues provides best practices for identifying gambling disorder and risk thereof, and subsequent treatment. Slape and colleagues (https://doi.org/10.5694/mja2.52475) provide a perspective on the establishment of a First Nations custodial dermatology service. This First Nations‐led service, established in New South Wales and now extended to the Northern Territory, reflects a commitment to ethical and socially responsible health care services through timely and high quality health care that is culturally safe and meets the complex health care needs of incarcerated people. More broadly, the foundational principles of this service highlight the promise of First Nations‐led specialty care within the prison system. In their research letter, Nolan and colleagues (https://doi.org/10.5694/mja2.52471) used deidentified dispensing data from the Pharmaceutical Benefits Scheme (PBS) to demonstrate that about one in five PBS‐subsidised testosterone prescriptions are for trans individuals, despite there being no specific PBS indication for gender affirmation. In younger people, this figure is as high as four in five. They argue that a specific PBS authority indication for “gender affirmation” would facilitate equitable access and improve quality of care for trans people. Finally, Fry and colleagues’ medical education article (https://doi.org/10.5694/mja2.52481), which, in their words, “is intended to serve as a beginner's introduction to the environmental footprinting techniques that can be applied to uncover health care's environmental impacts”, with a clear focus on greenhouse gas emissions. They identify five key areas for action, including improving health care environmental footprinting literacy and incorporating environmental footprinting into existing frameworks for quality improvement, procurement and health system performance. These are practical recommendations that have implications for individual health care worker practices, but also, perhaps more importantly, for system change guided by health and medical leadership and management. These are some of the most challenging aspects of modern health and health care. Much like climbers working through a crux, these challenges will require the collective efforts of the medical and health care community to achieve the best outcomes for patients and the broader community.

Michael Skilton

This issue of the MJA has a range of articles that examine various aspects of the Australian health system, and which then reflect on the lessons that can be drawn.

Virginia Barbour

Women's health is an essential aspect of global public health that is not only crucial for the individuals affected but also has far‐reaching implications for family dynamics, community cohesion, and overall economic stability. While, globally, complications during pregnancy and childbirth remain a leading cause of morbidity and mortality among women of reproductive age, women's health encompasses broad areas of health and wellbeing including non‐communicable diseases (NCDs), mental health, and gender‐based violence. In these areas important health disparities exist among women and between genders at local, national and global levels. Tackling these health gaps requires an appreciation of their historical, social, environmental and economic roots. This issue of the MJA is dedicated to women's health. Ramson and colleagues (https://doi.org/10.5694/mja2.52452) set the scene with a discussion on the opportunities afforded by maternal care contexts for addressing NCDs. Low‐ and middle‐income countries struggle with a mix of NCDs and other health challenges, with evidence indicating that women in these regions experience higher rates of multimorbidity compared with men. The authors explain that a life course approach to women's health, with a focus on addressing NCDs early, can improve maternal and child health outcomes, necessitating enhancements in sexual, reproductive, maternal, newborn and child health services. They propose that policy recommendations should include establishing standardised definitions for NCDs to improve data collection, focusing on primary prevention strategies, integrating care services, addressing inequalities, and providing global guidelines for the management of NCDs in maternity care. A noteworthy area of concern in Australian women's health is equitable access to contraception and family planning services, which is a particular challenge in rural and remote areas where health care services may be limited (https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_2_‐_Enhancing_access_to_contraceptives). Research by Perkins and colleagues (https://doi.org/10.5694/mja2.52438) explored general practitioners’ views on postpartum contraception counselling and provision during postnatal checks. Three themes were generated: preferences for counselling timing, the provision of long‐acting reversible contraception (LARC), and opportunities for improving postpartum care. Participants expressed a desire to discuss contraception but had differing opinions on the timing of these discussions, often feeling that postpartum checks were not the ideal moment. While most recommended intrauterine devices (IUDs) and implants as preferred contraceptives, barriers such as long waiting times and insufficient training for IUD insertion limited their provision. Recommendations for improving postpartum contraception care included enhanced training opportunities, financial incentives for general practitioners, and multidisciplinary collaboration among health care professionals. A research article by Grzeskowiak and colleagues (https://doi.org/10.5694/mja2.52451) analysed the dispensing patterns of category X medications among women aged 15–49 years in Australia from 2008 to 2021 and their concurrent use of hormonal LARC and other contraceptives. LARC overlap with category X medications was only present for 13.2% of study participants, highlighting insufficient usage of effective contraceptive methods. The authors argue that strategies are required to enhance the uptake of LARCs among women using category X medications, including addressing barriers to LARC access, education on contraceptive options, and ongoing monitoring of contraceptive practices. Gender‐based violence is an ongoing societal challenge in Australia, with one in six Australian women experiencing physical or sexual violence since the age of 15 years (https://www.abs.gov.au/statistics/people/crime‐and‐justice/personal‐safety‐australia/2021‐22). In a research article, Galrao and colleagues (https://doi.org/10.5694/mja2.52436) aimed to determine the prevalence of intimate partner violence and reproductive coercion through standardised data collection in Australia. A cross‐sectional study was conducted with female clients aged 16 years and older attending a Perth sexual health clinic from March 2019 to March 2020, involving demographic data extraction and screening questionnaires. In this study, 2623 clients participated, with 17.3% reporting having experienced intimate partner violence (16.3%) or reproductive coercion (5.3%). The study revealed higher rates of both forms of abuse among specific demographics, including Australian‐born women and those with female partners, emphasising that clinicians should be open‐minded when assessing risk of abuse in order to identify and support affected individuals. In summary, women's health issues are influenced by various factors, both globally and within Australia. As we strive for gender equality and health equity, understanding the unique needs of women and the barriers many face is crucial in developing effective interventions and policies. There is a need for commitment from all stakeholders, including governments, health care providers, and communities, to advance women's health as a shared priority.

Francis Geronimo

The MJA aims to prioritise studies that will “advance knowledge or practice with respect to medical problems of significance for Australia”. This is particularly inclusive of studies that not only have the potential to affect clinical practice, but also to help set, inform and improve our national health and social policies. In this issue of the MJA, we showcase several studies that have and will continue to inform national policy, help us understand how evidence can be used to best effect in the health policy process, and remind us of how and what is being done about other important national policy priorities. Australia's journey in regulating vaping, a relatively recent yet significant public health threat, especially to younger people, has taken a positive turn this year. The Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Act 2024 took effect in July 2024 and significant more regulation to access, packaging, and formulations of vapes was introduced nationally (https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/bd/bd2324a/24bd061a). These changes are internationally recognised as bold attempts at curbing vaping among younger people and have been influenced by an enormous body of work and advocacy. It is work such as Jenkins and colleagues’ (https://doi.org/10.5694/mja2.52423) in this issue, which identified a synthetic nicotine analogue (6‐methylnicotine) in “non‐nicotine” vapes and accompanying inconsistent chemical reporting, that are the pillars of evidence required to inform our national legislative journey. As noted by Larcombe and Hunter (https://doi.org/10.5694/mja2.52422) in an accompanying editorial, loopholes in legislation will continue to be used by vape manufacturers and our regulatory bodies must keep up, or ideally get in front of their attempts at circumventing them using evidence like that presented by Jenkins and colleagues. This issue of the MJA also includes a compendium piece for readers of modelled economic evaluations by Chen and colleagues (https://doi.org/10.5694/mja2.52409). Economic evaluations are ubiquitous and critical to how Australia makes decisions about medicines, devices, and other health care services (https://www.sciencedirect.com/science/article/pii/S221210992030666X), yet not always clearly accessible to non‐health economist readers. Chen et al remind us that with more complex questions, interventions, heterogenous populations, and luckily more computational power, more sophisticated model‐based economic evaluations are required, unavoidable, and our understanding of them must evolve. Using two recent MJA studies as examples (https://doi.org/10.5694/mja2.51825, https://doi.org/10.5694/mja2.51860), Chen et al describe how model‐based evaluations compare to study‐based evaluation, major modelling choices with powerful visual representations of these models and advice on what to look out for when determining model robustness. In Engel and Mihalopoulos’ perspective (https://doi.org/10.5694/mja2.52414), we read about loneliness and its economic impact, an area of increasing national recognition and evolving health and social policies. Loneliness, affecting almost one‐third of adults over 60 years of age and two‐thirds of older adults living in residential care, needs cost‐effective national strategies. Although a bidirectional relationship between loneliness and chronic health problems is not surprising, the magnitude of its potential health effects (eg, 26% higher risk of death), and the increasingly obvious impact that it has on our health system ($2.7 billion annually) that Engel and Mihalopoulos cite is alarming. However, it is not all doom and gloom. Engel and Mihalopoulos suggest that research has identified some critical elements of successful loneliness intervention strategies, including holistic community‐based and ‐led health and social care, and several promising intervention types. Interestingly, one such proposed strategy to address loneliness is “social prescribing”, which Yadav and colleagues’ (https://doi.org/10.5694/mja2.52413) letter to the editor introduces as the “core business” of Aboriginal and Torres Strait Islander community‐controlled health organisations. Yadav et al's call to action that we should learn more from Indigenous models of social prescribing could not have come at a more pertinent time.

Maria Inacio

This issue of the MJA presents a broad mix of content. All of the articles warrant in‐depth discussion, both in the pages of the Journal and in other forums. Three articles in particular highlight the ongoing need, and means by which, to address non‐communicable diseases. Schutte and colleagues (https://doi.org/10.5694/mja2.52373) describe a roadmap to achieve 70% blood pressure control in Australia by 2030, under the auspices of the National Hypertension Taskforce of Australia (https://www.hypertension.org.au/the‐national‐hypertension‐taskforce/). Blood pressure is one of the leading causes of morbidity and premature mortality in Australia. Currently, blood pressure is effectively controlled (blood pressure<140/90mmHg) in only 32% of people with hypertension in Australia, an underwhelming figure compared with those of other countries with a high income economy. In response, the Taskforce has set a goal of achieving a world‐best 70% blood pressure control by 2030. They propose to achieve this through a model whereby 90% of cases are diagnosed, 90% of those diagnosed receive treatment, and 90% of those treated meet blood pressure targets; actioned through three pillars focusing on prevention, screening and detection, and effective treatment. The target and timeline are ambitious, but unbridled ambition is not unwarranted when dealing with one of Australia's greatest current health challenges. A key risk factor for hypertension is obesity; however, the health implications of obesity extend beyond the individual. There is growing awareness that maternal obesity is not only associated with higher risk of complications of pregnancy, including diabetes of pregnancy and preeclampsia, but also potentially of longer term cardiometabolic health consequences for the offspring. Within this context, the findings of Baker and colleagues (https://doi.org/10.5694/mja2.52387) reported in this issue become more concerning. They sought to map the changing prevalence of maternal obesity in Victoria over the decade from 2010 to 2019 and found that the proportion of births to women with obesity increased, while the proportion of births to women with a healthy weight decreased. These patterns were present in metropolitan areas, but were most pronounced in regional areas. This is consistent with the increase in population prevalence of obesity over the same time period and is concerning for the broader implications for the health of women and children. Combating the increasing rates of obesity within the Australian population, including maternal obesity, is a key goal of the National Obesity Strategy 2022–2032 (https://www.health.gov.au/resources/publications/national‐obesity‐strategy‐2022‐2032). As with the hypertension roadmap, success in achieving meaningful reductions to the burden of this disease will be difficult but are of the highest priority. The prevention of hypertension and obesity are both complicated by their complex multifactorial aetiologies. While addressing diseases caused by a single causal agent should be more straightforward, the history of industrial lung diseases indicates that they too are complicated. In a lessons from practice article, Thiruvarudchelvan and colleagues (https://doi.org/10.5694/mja2.52371) document a case of asbestosis in an Australian brake mechanic. In Australia, asbestosis and mesothelioma are best known within the context of workplace exposure, particularly within the mining and construction industries. Asbestos‐lined brake pads were phased out, with the final units being installed in 2003, as part of a broad prohibition of importation and sale of all asbestos‐containing products. As the authors note, asbestosis is rare in brake mechanics, owing in part to the physical nature of the asbestos used. Indeed, they believe this may be the first documented case in Australia and note that the latency between exposure and clinical presentation is consistent with a large epidemiological study from Denmark (https://doi.org/10.1136/thoraxjnl‐2020‐215041). This serves as a reminder that continued vigilance is also required in the ongoing battle against environmental exposures, including those in the workplace, which have a nasty habit of re‐emerging. Case in point being the recent evidence of silicosis in people working with engineered stone (https://doi.org/10.5694/mja16.00257), and the subsequent banning of such products in Australia, which came into effect in July 2024. While this is timely, it nonetheless comes almost a century after landmark industrial law reforms were enacted in the United States after 500–1000 workers died of silicosis in the worst industrial disaster in their nation's history (https://www.assp.org/docs/default‐source/psj‐articles/vpspencer_0223.pdf). Currently, over 20 years after asbestos was banned in Australia, approximately 4000 people per year still die from asbestos‐related diseases; the legacy of the extensive use of asbestos in the 20th century. A legacy that continues to evolve, with latent disease from rarer forms of exposure, such as that described in this issue, and in new and perhaps unforeseen ways, such as the recent widespread community concerns of asbestos‐contaminated mulch in parklands and beyond. These burdens of disease are largely beyond an individual's control. As such they warrant, and rely on, the ongoing action of government and leadership from health care authorities to seek to address their impact. The health of our population remains dependent upon it.

Michael Skilton