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From Sydney to Denmark on a bike, a challenge to Bill Gates, and transforming primary care

Some recent public health news…

A challenge to Bill Gates

The University of Sydney’s Professor Simon Chapman has taken on two of the world’s richest men, arguing that it is inappropriate for Bill Gates to have joined in a health initiative with Mexico’s Carlos Slim Helú because of the latter’s work in the tobacco industry.

Earlier this year, the two men jointly announced that they would each contribute US$50 million to a health project in central America.

Writing in The Lancet (register to read full article), Chapman says that Slim funds other health programs in Latin America, but also holds long-standing majority ownership of the Mexican tobacco company Cigatam which has since 2007 been 80% owned by Philip Morris. He also is a non-executive director of Philip Morris International, the world’s largest tobacco company.

Chapman notes that Gates has recently begun to fund tobacco-control projects in low-income and middle-income nations. In April this year, the Bill & Melinda Gates Foundation withdrew a grant of $5·2 million to Canada’s International Development Research Centre (IDRC), after it emerged that the IDRC’s chair, Barbara McDougall, was a very recent board member of Imperial Tobacco Canada.

“Gates’ decision just 2 months later to partner with Slim is plainly inconsistent,” writes Chapman. “He apparently did not know of McDougall’s appointment when he funded the IDRC. He might well not have known about Slim’s tobacco connections when he joined with him in the Latam project. He must know now. His subsequent actions with IDRC were an outstanding example of principled philanthropy. Let us hope he makes the same call again.”

***

Why is Sydney so slack about cycling?

Compared to most other Australian capital cities, Sydney lags behind in using cycling as a transport option, according to a new NSW Parliamentary briefing paper that is well worth a read, Cycling and Transport Policy in NSW.

The paper includes plenty of policy suggestions for increasing cycling, for the sake of environmental and human health.

Some snippets:

• In 2006, of all Australian capital cities, Sydney had the lowest percentage of trips to work by bike and the lowest percentage of the population who were regular cyclists.

• Melbourne has: twice the amount of journey-to-work cycling; three times the rate of growth in cycling; proportionally more cycling for commuting purposes; better cycling advocacy; and spends roughly three times more per capita on cycling.

• Commuter cycling is much higher in some European countries than in Australia: for example, an average of 27%, 19% and 10% respectively of commuters in Holland, Denmark and Germany cycle to work. In contrast, only 0.7% of commuters in Sydney cycle to work.

• Much of this can be explained by significant differences in expenditure on cycling, cycle-friendly policies and infrastructure, and higher government commitment to cycling. Sydney has lower levels of cycling than San Francisco, arguably a city of comparable topography.

• With roughly double the amount of investment per capita, San Francisco has demonstrated that cycling levels can be increased with an appropriate mix of investment, government commitment and policy options.

***

Only in Denmark

They are so sensible, those Danes.

Rather than crack down on cyclists who don’t park in the bike racks provided, the City of Copenhagan has employed “bicycle butlers” to move illegally parked bicycles to the racks. They then oil your chain, pump your tires and leave a little note asking you to kindly use the racks in the future.

Apparently the initiative is working well. When the project started in April they were moving around 150 bicycles a day. Today that number has dropped to between 30 and 50.

Mmm, perhaps we need more carrots, less sticks in health and social policies generally.

***

Transforming primary care?

An interesting NPR report on the movement to medical homes in the US. What a novel concept – redesigning primary care around population health needs!  It’s worth a read (or listen).

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