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Public health
Weight Loss Medication Marketing and First Nations People: Disease Awareness or Corporate Profit?
The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has driven off-label prescriptions and supply shortages, raising equity concerns for First Nations peoples disproportionately affected by diabetes. Pharmaceutical companies have simultaneously accelerated their marketing through disease-awareness campaigns, sponsored events and telehealth models, with many campaigns prominently featuring women of colour, including First Nations women. In this perspective article, we argue, from a commercial determinants of health perspective, that pharmaceutical companies often influence perceptions of body image, medicines policy and prescribing without addressing the systemic conditions driving First Nations health inequity. We urge clinicians and policymakers to ensure decisions remain free from commercial influence.
Troy Walker, Simone Sherriff, Jennifer Browne
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Objectives To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Study Type Retrospective observational cohort study. Setting Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Participants Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Main Outcome Measures Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. Results There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33years (standard deviation [SD], 7.4years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426–$34,544). Conclusion Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons.
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
Interpreting Australian Stillbirth Rate Trends: Implications for Surveillance and Continuous Quality Improvement
Reports of rising stillbirth rates in Australia have generated concern among affected parents and other stakeholders. Review of the national data suggests that much of the rise is being driven by an increase in terminations of pregnancy after 20 weeks' gestation. This increase coincides with legislative changes expanding access to terminations beyond 20 weeks. Alongside publishing stillbirth rates according to the legal definition (stillbirths from 20 weeks' gestation including terminations of pregnancy), national reporting bodies should routinely publish stillbirth rates among births from 28 weeks' gestation excluding terminations of pregnancy as the latter is most relevant to Australia's current stillbirth prevention initiatives.
Aleena M. Wojcieszek, Kirstine Sketcher-Baker, Christine Andrews, Michael Coory, Imogen Kettle, Melissa Malivoire, David Ellwood, Vicki Flenady
Impact of the 2025 New South Wales Respiratory Syncytial Virus Prevention Program on Infant Notifications and Hospitalisations: A Population-Based Analysis
The 2025 NSW RSV Prevention Program, which achieved an estimated coverage of 63% maternal vaccination and 18% for infant immunisation, led to more than 40% reduction in RSV notifications and hospitalisations among infants aged younger than 6months.
Janaki Amin, Sally L. Ellis, Christopher Lambeth, Jessica Gugusheff, Christine Selvey
The Oral Health and Well-Being Experiences of Indigenous South Australians: A Qualitative Study
Objectives To explore the perceptions of Indigenous South Australian adults regarding their oral and general health, social and emotional well-being and dental care experiences. Study Design Qualitative study; interviews with Indigenous South Australian adults involved in a non-randomised implementation and service-delivery project evaluating provision of culturally safe, comprehensive dental care. Study governance was provided by an Indigenous Oral Health Unit Reference Group with Indigenous leadership to centre cultural authority and cultural safety across all study dimensions. Participants Setting Semi-structured interviews were conducted with 136 Indigenous South Australian participants at a location of their choosing (e.g., their home, a community centre, a research facility), which were held at baseline (1 July 2022–15 December 2023) and 12-month follow-up (1 March 2024–31 March 2025). Intervention The overarching study consisted of a pre–post assessment of oral health embedded in routine dental care with oral epidemiological examinations and assessment of systemic health biomarkers (blood glucose, inflammation, cholesterol, kidney function). This was followed by semi-structured interviews at 12-month follow-up. Main Outcome Measure Qualitative outcomes—participant experiences, understandings and recommendations around supporting oral health, social and emotional well-being and culturally safe dental care for Indigenous South Australians. Results Reflexive thematic analysis was used to analyse interview data, from which five themes were developed. Participants described the importance of oral health for overall health, aesthetic and functional impacts and judgement and discrimination related to poor oral health, all of which were linked to social and emotional well-being. Culturally safe care that includes oral health assessments alongside assessments of biomarkers for systemic health were suggested to promote self-confidence, reduce feelings of shame and empower communities. Conclusion This study highlights the need to incorporate holistic approaches in promoting Indigenous oral and systemic health and in supporting social and emotional well-being. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12626000046303; retrospectively registered)
Ria Aiyar, Sonia Nath, Joanne Hedges, Gina L. Guzzo, Kostas Kapellas, Alexander Pham, Emma Flanagan, Tiyanna-Marie Mastrosavas, Ebony Wallace, Lisa M. Jamieson
Paracetamol in Pregnancy: Uncertain Evidence, Certain Consequences
Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a ‘big factor’ in autism, citing a systematic review based solely on observational studies. The review's selective reporting, methodological flaws (including applying an environmental health rather than evidence-based medicine framework) and lack of causal evidence provided weak justifications for its conclusions and have fuelled public confusion about paracetamol safety in pregnancy. This article critically appraises the review and examines how scientific uncertainty can be manipulated and amplified within broader public health domains.
David J. Tunnicliffe, Miranda Cumpston, Debra Kennedy, Margie Danchin, Armando Teixeira-Pinto
Australian Climate Leadership in 2026: COP-Out or Step-Up for Health?
The world is on the brink of tipping points for climate disaster and transformative action. Decisions taken now will shape the health of millions. So, will the Australian Government use its COP31 Presidency of Negotiations to prioritise the health of current and future generations and champion the end of fossil fuels? Despite recent positive shifts in some areas of climate policy, Australia's status as the world's third largest exporter of fossil fuels means strong pressure must be applied from the health professions to maximise political, social and economic progress towards a health-focussed transition to a sustainable society.
Catherine G. A. Pendrey, Angie Bone, Aletha Ward, Francis Nona, Michelle Isles, Paul M. Kelly, Nicholas J. Talley
Fatty Liver Disease in Australia: A Narrative Review on the Epidemiology, Natural History, Prognostication and Management in People With Metabolic Dysfunction
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) or metabolic (dysfunction)-associated steatotic liver disease (MASLD) is the most common and fastest growing cause of chronic liver disease worldwide. There has been a substantial increase in the epidemiological research regarding MASLD/MAFLD originating from Australia since 2020. This narrative review summarises these pivotal epidemiological studies investigating the disease prevalence, natural history, prognostication and management of this condition. The Australian literature demonstrates the prevalence to be between one-third and two-fifths of adults affected, depending on nomenclature, with a heightened risk of cardiovascular disease irrespective of terminology. Current local data support guideline-based disease staging with non-invasive tests of fibrosis and the management continues to centre on diet and lifestyle interventions, with directed therapy on the horizon.
Karl Vaz, Daniel Clayton-Chubb, William W. Kemp, Stuart K. Roberts, Ammar Majeed
Australian Consensus Statement on the Prevention and Management of Frailty Among Community-Dwelling Older Adults: A Modified Delphi Study
Introduction This consensus statement from multidisciplinary experts and consumers across Australia provides comprehensive recommendations on the prevention and management of frailty in community-dwelling older adults. Methods The study uses a modified Delphi design. Phase I involved iterative discussion among six frailty care working groups, based on current evidence and expert opinion, to draft the statements. Phase II involved validation of each statement across two Delphi rounds conducted to determine level of agreement. Main Recommendations A lifelong approach to health promotion for frailty prevention should focus on raising awareness, annual screening (65+ years) and personalised counselling around accessible health behaviours to manage chronic comorbidities. An individualised, balanced, protein-rich diet is likely to be effective in delaying the onset of frailty. Protein–energy malnutrition and nutritional deficiencies should be identified and treated. A nutrition care plan that considers the relaxation of dietary restrictions aligned with goals of care should be planned for older adults with severe frailty. Progressive, individualised and ongoing exercise should be a combination of aerobic and resistance exercise, and balance and functional training tailored to frailty level and supervised by professionals. Social prescribing for older adults should be co-designed with a link worker to support meaningful, accessible and culturally appropriate activities that foster social engagement, with plans customised to the individual's frailty level. A comprehensive, multidisciplinary medication review tailored to the older adult's health status, preferences and frailty degree helps optimise medication use, minimise harm and support functional independence across all stages of frailty. Older adults with severe frailty need a regularly reviewed, personalised care plan, which involves carers in decision-making, supports advance care planning and ensures high-quality end-of-life care. Changes in Management Informed by This Statement The consensus statements introduce an integrated, evidence-informed and consumer-focused framework to guide healthcare professionals in delivering personalised and effective care for community-dwelling older adults living with or at risk of frailty.
Lisa Kouladjian O’Donnell, Marc Sim, Michelle Miller, Peta Dampney, Pazit Levinger, Shannon King, Ruth E. Hubbard, on behalf of the Australian Frailty Network Working Group
Victorian Public Hospitals Go 100% Renewable: Now Let's Replace Gas and Embrace Reusable Equipment
Hayden Burch, Forbes McGain, Scott McAlister
Hearing Justice Through a Stethoscope: Advocacy, Climate Change and Medicine's Upstream Responsibilities
The Intergovernmental Panel on Climate Change (IPCC) acknowledges the existing robust data that show that climate change substantially and negatively affects human health both directly and indirectly, with Indigenous people facing heightened vulnerability. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems that are not taking sufficient steps to reduce the impacts of climate change. This article invites medical professionals to learn from recent climate litigation cases and calls on professionals to listen deeply, act in allyship, and embrace legal and cultural literacy as core to delivering health equity in a changing climate.
Francis Nona, Nina Lansbury, Rowena Maguire, Britta Wigginton
Widening the lens of the social and commercial determinants of health
Alcohol, tobacco, ultra‐processed foods and sugar‐sweetened beverages — these are the types of harmful products that tend to spring to mind when we think about the role of commercial actors and behavioural factors in influencing health. And for good reason. In Australia, for instance, smoking is estimated to kill more than 24 000 people each year.1 Alcohol contributes substantially to a wide range of diseases, including cancer, liver disease, heart disease, and suicide and self‐harm, and overall accounts for around 4% of the nation’s total disease burden.2 Reducing the consumption of sugar via a sugar‐sweetened beverage tax is predicted to substantially reduce the number of cases of type 2 diabetes, heart disease and stroke, while also cutting the prevalence of obesity in children and adolescents.3 Traditionally, scholarship in this area has focused on industries that produce and sell products with obvious health harming impacts. More recently, the understanding of the commercial determinants of health has expanded to encompass the “pathways through which commercial actors drive health and equity”.4 This shift has enabled more deliberate exploration of how many other sectors of the economy can influence health, including gambling, social media, housing and education, to name but a few.5 This issue of the MJA illuminates our evolving understanding of the role that social and commercial factors have on health in Australia. Two articles in this issue address how rising rates of homelessness — which includes sleeping rough, as well as reliance on emergency and temporary accommodation, couch surfing, and substandard housing — demand greater consideration from health policy makers and practitioners. First, Stearn and colleagues6 explain how housing insecurity adversely affects cancer care and outcomes and put forward several possible pathways towards achieving more equitable cancer outcomes for people experiencing homelessness. Second, English and colleagues7 explore the intersection between the worsening climate crisis and homelessness. They outline the evidence on how people experiencing homelessness are more vulnerable than people with secure housing to the health impacts of extreme heat and describe emerging public health responses, including their world first co‐designed mobile cooling hub. Turning to health care, a perspective article by Murphy8 explores the rise in out‐of‐pocket costs for accessing non‐general practitioner specialists. “Doctors have, not unreasonably, had an expectation of earning high incomes, given the training required for each specialty fellow,” Murphy argues. “However, these incomes, and the fees that generate them, have created a number of challenges.” Several possible solutions are discussed, with Murphy concluding “self‐regulation is the simplest option. Given the community and government angst about this issue, specialists would do well to reflect on the impact of their fees on patients … [to] improve patient access and reduce the risk of government intervention”. Other work in this issue of the MJA includes new research by Egger and colleagues9 on trends in adolescent smoking prevalence, which suggests vaping might be slowing Australia’s tobacco control progress. In addition, a narrative review by Cortes‐Ramirez and colleagues10 examines the relatively understudied effects of mining activities on the health of Australians, and a whole of population census data analysis by Gong and colleagues11 characterises the relationship between socio‐economic position and the prevalence of ten leading chronic diseases. Despite our expanding understanding of the social and commercial determinants of health, until very recently the news media industry has attracted little attention from public health scholars.12 Writing in this issue of the MJA, Fredericks and colleagues13 make a case for establishing journalism as a health determinant and for protecting public interest journalism as a public health good. “Our increasingly unreliable and unsafe news and information environment has profound and wide‐ranging implications for the health sector and the health and wellbeing of communities”, they argue. Yet “at the same time, the capacity of public interest journalism has been greatly diminished”. Fredericks and colleagues outline how responses to the spread of health‐related misinformation and disinformation are frequently too narrow in focus. Strategies such as improving science communication or health literacy are important, but on their own will fail to address the complexity and connectivity of the issues at play. Rather, systems approaches are required that recognise the central role of public interest journalism in “hold[ing] to account the commercial and political interests undermining the safety and reliability of news and information systems”. Crucially, the authors highlight how “Indigenous knowledge systems have much to offer to systemic analyses and responses because of their dynamic, adaptive and holistic approaches with the capacity to connect diverse spheres”.
Elizabeth Zuccala
The short term safety of COVID‐19 vaccines in Australia: AusVaxSafety active surveillance, February – August 2021
AusVaxSafety active surveillance affirms the short term safety of Comirnaty and Vaxzevria vaccines in a large population sample
Lucy Deng · Catherine Glover · Michael Dymock · Alexis Pillsbury · Julie A Marsh · Helen E Quinn · Alan Leeb · Patrick Cashman · Thomas L Snelling · Nicholas Wood · Kristine Macartney
Threats and abuse: the price public health campaigners pay
Those of us who spend our time working in public health need a thick skin
Rosemary Stanton PhD(Hon), BSc, APD
Open speeds on Northern Territory roads: not so fast
Road safety should remain a public health priority, not a political issue
David J Read MB BS, FRACS
Social and environmental factors in 10 Aboriginal communities in the Northern Territory: relationship to hospital admission of children
For the full text of this article, please download the PDF.
Estrella Munoz BAppSc, RN, FRCNA · Jennifer R Powers BSc · John D Mathews BSc, MD BS, PhD, FRACP, CPA