Croakey is closed for summer holidays and will resume publishing in the week of 15 January 2024. In the meantime, we are re-publishing some of our top articles from 2023.
This article was first published on Tuesday, August 8, 2023
Adjunct Associate Professor Lesley Russell is writing from the United States, where climate-related events – fires, flooding and extreme heat – are THE topic of conversation, even as conservative groups develop their plans to stop climate action.
Also featured in this latest column are threats to a United States program that aims to eliminate HIV transmission globally, the latest on long COVID, concerns about lead exposure in children, and Sesame Street’s foray into health promotion.
The quotable?
What is Australia doing to address the fearful possibilities this summer might bring?”
Lesley Russell writes:
The next few editions of The Health Wrap are coming to you from our Colorado mountain home, so please excuse the predominance of American news and views.
We are enjoying lots of hiking, beautiful wildflowers, and some spectacular afternoon thunderstorms (why you need to be off the top of the mountain by early afternoon). This is the early morning view from my ‘office’ – always inspiring.
Fortunately, this part of the United States has escaped the heat dome, the wildfires and the flooding that have been so widespread in Northern America and Europe this (northern hemisphere) summer. But it is THE topic of conversation and dominates the news reports.
The media here is also full of reports about Trump, other potential GOP presidential candidates, and the chances that President Biden and Vice President Harris will be re-elected in November 2024 (yes, the elections are more than 450 days away and these issues will fill the news feeds from now on).
It will be fascinating to see if the country’s experiences this summer drives changes in public opinions about the climate change crisis and the need for national policies to address this.
American views of the current climate crisis
If you are into American history, politics and views, then Letters from an American, by Professor Heather Cox Richardson, is a daily must-read.
On July 26 she posted a great summary of the climate change issues from the US perspective.
The United States has broken more than 2,000 high temperature records in the past month and last week the ocean water off the tip of Florida reached temperatures over 100 degrees Fahrenheit (37.8 Celsius), the same temperature as an average hot tub.
The Coral Restoration Foundation says the historically high water temperatures are creating “a severe and urgent crisis”. In some reefs they have found 100 percent coral mortality.
Hundreds of wildfires are currently burning across the United States. Across Canada, more than 25 million acres have burned and most of Canada’s fire season is still ahead.
As I write a massive fire burning in the Mojave National Preserve in California and Nevada is creating “fire tornados” (a vortex of flames and smoke that forms when intense heat and turbulent winds combine, creating a spinning column of fire). Habitat losses will change this desert permanently as pinyon pines, junipers and Joshua trees burn.
As Cox Richardson notes, a new study from World Weather Attribution finds that the heatwaves experienced across the Northern hemisphere would have been “virtually impossible” without human-induced climate change.
Yet here in the United States, conservative groups have crafted a plan they expect Republican presidential candidates to endorse that calls – among a raft of policies most of us would view as destructive – for demolishing the federal government’s efforts to counter climate change.
The 920-page plan, called Project 2025, would go far beyond past Republican efforts to slash environmental agencies’ budgets, oust “deep state” employees (ie those who stick to the scientific evidence) and undo the Biden Administration’s initiatives.
It’s designed to be a road map for the first 180 days of the next Republican administration.
Here’s what the director of the program said: “Project 2025 is not a white paper. We are not tinkering at the edges. We are writing a battle plan, and we are marshalling our forces. Never before has the whole conservative movement banded together to systematically prepare to take power day one and deconstruct the administrative state.”
Americans’ views on climate change and the importance of addressing it are increasingly partisan. In a poll released this week, a majority of Republicans say climate change is not having much or any impact on their communities (61 percent), and significant percentages say that it won’t have a serious impact at all (43 percent) or that it’s a “minor” threat (37 percent).
Meanwhile the Biden Administration has announced action (and US$50 billion) to protect communities from extreme heat fuelled by the climate crisis.
What is Australia doing to address the fearful possibilities this summer might bring?
As outlined in an article in The Guardian, many Australian experts feel deep sadness – and resentment – while dreading what lies ahead.
The rules for hiking in summer – especially at high altitudes – and the consequences of ignoring them should be well known. But this summer in the United States has highlighted just how foolish some people can be.
Tourists have flocked to Death Valley and other national parks to experience the triple digit heatwave temperatures; at least seven have died and many others have suffered heat stroke.
These deaths provide a glimpse of how climate change is reshaping the environment within some of America’s most popular parks, and of the risks that hikers encounter on increasingly hot and dry trails.
I found this interesting article in The New York Times about how Grand Canyon National Park Rangers are working proactively to prevent heat-related deaths and rescues.
It isn’t just a matter of staying hydrated – it’s also about keeping up the salt balance. They are pioneering an approach of providing salty snacks, using aggressive messaging, and outreach to prevent disaster on the trails.
Long reach of US abortion policies
Last month saw the 12th International AIDS Society Conference on HIV Science in Brisbane, and Australia was celebrated for its success in dramatically reducing HIV transmission (I wrote about this in the previous edition of The Health Wrap).
But now we learn that the lifesaving United States President’s Emergency Plan for AIDS Relief (PEPFAR), which was set up by President George W Bush in 2003 and which has the goal of eliminating HIV transmission by 2030, is under threat from Republicans in the US Congress.
They are citing allegations that the program’s funding is being used to indirectly support abortions – claims that health advocates, Democrats and PEPFAR officials say are baseless.
It is estimated that PEPFAR, which works in over 50 countries globally, has saved over 20 million lives, prevented transmission to 5.5 million babies, and enabled countries to surpass UNAIDS’ 90-90-90 treatment targets.
PEPFAR has also played an important role in addressing other global health challenges, including the COVID-19 pandemic, and expanding care to marginalised groups such as young women and displaced persons.
Abortion concerns were first raised in a report from the conservative Heritage Foundation in May.
US funding for the program will expire on September 30. Congressional lawmakers have spent months wrangling over whether Congress will reauthorise the program for five years, for one year or not at all — a decision that experts warn would have both practical and symbolic consequences.
“What’s changed is the Biden Administration’s radical insistence on ramming abortion into our foreign policy in an aggressive manner that we’ve never seen before,” stated Travis Weber of the Family Research Council, as he called for more anti-abortion controls on PEPFAR.
The United States is the largest donor to PEPFAR; it has provided over US$100 billion since 2003.
Funding for FY 2023 is US$6.9 billion – this includes US$4.8 billion for bilateral HIV efforts and US $2.05 billion for multilateral efforts ($50 million for UNAIDS and $2.0 billion for the Global Fund).
In most countries PEPFAR operates within a broader landscape of global funding for HIV/AIDS, which includes partner country governments, other donor governments, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund), the World Bank, and other multilateral institutions.
“If PEPFAR doesn’t get reauthorised, the program can continue — but it could send some pretty chilling messages to people in the field who depend on PEPFAR for life support,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.
As far as I can determine, Australia’s international contributions to tackling HIV/AIDS are made through the Global Fund to Fights AIDS, Tuberculosis and Malaria (the Global Fund).
Last September the Albanese Government pledged AU$266 million to the Global Fund, a 10 percent increase from Australia’s 2019 pledge of $242 million.
More on long COVID
The Biden Administration has announced it will establish a new Office of Long COVID Research and Practice under the Department of Health and Human Services (HHS). The office “is charged with on-going coordination of the whole-of-government response to the longer-term effects of COVID-19,” according to a HHS news release.
You can read more about the new office here.
The HHS also announced that the National Institutes of Health (NIH) is launching long COVID clinical trials through the RECOVER Initiative, which seeks to understand, treat and prevent long COVID. The new clinical trials will explore possible treatments for extreme fatigue, sleep disturbances, changes in body function and cognitive dysfunction.
It is estimated that somewhere between 7.7 million and 23 million Americans have long COVID.
There have been complaints that the Biden Administration has been slow to implement these measures. The coordinating office for long COVID was promised in April 2022, and there are reports that it currently has funding for only two full-time staff.
To date the NIH has poured US$1 billion into Long COVID research with little to show for it. Instead of a focus on clinical trials, the NIH has spent the majority of the funds allocated for long COVID on broader, observational research that won’t directly bring relief to patients.
A recent editorial in The Lancet discusses the dismal state of clinical research relative to the substantial burden of long COVID and states that the number and pace of clinical trials to tackle Long COVID are “vastly insufficient”.
Once again, I ask – what is Australia doing to address long COVID research, treatment and care? Who within the Department of Health and Ageing (DoHA) has responsibility for this?
A report, Sick and tired: Casting a long shadow from the House Standing Committee on Health, Aged Care and Sport (released in April), recommended the Australian Government establish a nationally coordinated research program, led by DoHA, to coordinate and fund COVID-19 and long COVID research. That has yet to be done.
If you google “getting help for long COVID in Australia” you get a two-page document from the federal DoHA that suggests: “If you have ongoing symptoms after COVID-19 diagnosis, schedule regular appointments with your GP to discuss how best to manage them. Your GP will be able to assess your symptoms and, if needed, provide referrals to medical specialists, allied health professionals and/or multidisciplinary clinics.” (No advice offered about how to get these appointments and afford the out-of-pocket costs.)
It is good to note, as per a recent Croakey article, that the Centre for Culture, Ethnicity and Health in Victoria has created a website to help people with long COVID that is specifically targeted at people whose first language is not English.
The $50 million funding from the Medical Research Future Fund (MRFF) that was announced for long COVID research at the time the parliamentary report was released is supposed to become available for distribution this month. But this does not appear on the lists of current and forecast MRFF grant opportunities.
Lead exposure and children’s learning
A paper from Center for Global Development estimates that over a fifth of the gap in learning outcomes between rich and poor countries is explained by elevated blood lead levels in low-income countries.
The paper’s lead author, in an interview with the Financial Times, said that children who have high levels of lead in their blood can have much lower IQ scores and test results than their healthier counterparts. “Lead poisoning is invisible — it has a huge impact on learning and productivity.”
Around half of children in low income countries have elevated blood lead levels, and of all children around the world, up to one in three suffers from lead poisoning.
In a draft assessment issues earlier this year, the US Environmental Protection Agency describes the causal relationships between lead exposure and reduced cognitive functions, hyperactivity, cardiovascular health and development in children, as well as character traits such as aggression.
A review, published just this week in PLOS Global Public Health, identifies “significant relationships between lead and damaging patterns of behaviour” (including criminal behaviour), even when lead blood concentrations were very low.
“The evidence we found points in the direction of lead exposure being associated with biological effects in children that have long-term behavioural consequences,” said the lead author.
The first description of “paediatric plumbism” (lead toxicity in children) came at the end of the 19th century from two Australian doctors, JL Gibson and J Turner, who were the first to publish the connection with the lead content of house paint.
But it was not until the 1960s that Australia legislated the lead content of domestic pants and leaded petrol was not banned until 2002. (You can read some history of this work here.)
However, the Australian population, especially children, continues to be exposed to harmful levels of lead. This is especially so in Mt Isa, Port Pirie and Broken Hill, cities where nonferrous lead is mined and smelted.
An article published in The Guardian in 2021 found that lead levels among children in Port Pirie were spiking: in 2020, 74.8 percent of children tested had a blood-lead result higher than 5 micrograms per decilitre and some children had results equal to or exceeding 20 micrograms per decilitre.
The National Health and Medical Research Council (NHMRC) considers any reading above 5 micrograms per decilitre as above the average “background” exposure among the general population, with unborn babies, infants and children the most vulnerable. The World Health Organization says there is no safe level of lead exposure.
A study reported in 2018 found that over 75 percent of Aboriginal children in Broken Hill had unsafe blood lead levels. Worse, the average blood lead levels of Aboriginal children was almost double that of all other children in Broken Hill (8.7 g/dL versus 4.6g/dL).
The 2022 Lead Report from the Far West Local Health District shows that while blood lead levels have improved for Aboriginal children, the underlying trend is that population blood lead levels have plateaued, with no significant change since 2012.
In 2022 an estimated 306 (39 percent) of Broken Hill children aged one to five years had blood lead levels above the notification level of ≥5 micrograms per decilitre.
The best of Croakey
Read the article by Charles Maskell-Knight: An analysis of consultancy use by the Department of Health and Aged Care 
Read the article by Jennifer Doggett: Amid growing scrutiny of consultancies, what are the implications for health and health policy?
The good news story
At the recent Aspen Ideas Festival, well-known health journalist Julie Rovner hosted a wonderful and unique panel where three former HHS Secretaries talked frankly about what it is like to have that job.
Take the time to listen to them, you can access the recording here.
I especially liked the story from Kathleen Sebelius (who was Secretary when I worked at HHS during the Obama Administration) about a highlight of her tenure: recording a public service message with Sesame Street characters to teach young children how to sneeze in public. (You can access the YouTube video of this PSA here.)
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
