Climate change is impacting food security, productivity and social and economic inequalities, writes Adjunct Associate Professor Lesley Russell in her latest column.
The Health Wrap also looks at what can be learnt from the Biden Administration’s National Strategy on Hunger, Nutrition and Health, pandemic communications and the “unicorns” yet to be infected with the SARS-CoV-2 virus. Also, the giant puppet of a 10-year-old Syrian refugee girl carries a hopeful message.
Lesley Russell writes:
A lesson learned the hard way from the pandemic is about the importance of effective communications in building public trust and ensuring appropriate behaviours, including getting vaccinated.
A recent paper in Science Advance presents a fascinating analysis of how the battle to present the public with best-science guidance, crucial in any health-related crisis, was lost – at least on Facebook – very early in the COVID-19 pandemic, before vaccines arrived.
The research (conducted using Facebook data from December 2019 to August 2020) shows that the anti-science communities dominated the conversations about the new virus well before the official announcement of the COVID-19 pandemic, with little input from pro-science communities. Neutral communities (the paper uses parents as an example) were consequently highly exposed to anti-science content.
Modelling suggests that if pro-science communities increased their connections to other communities, it would have a positive impact – an incentive for scientists and clinicians to keep speaking out on social media platforms.
For more on this topic, there’s an analysis of the role of social media dynamics in the public exchange of information between scientists (experts), government (policy-makers), mass media (journalists), and citizens (non-experts) during the first four months after the COVID-19 outbreak in the Netherlands here.
Too many scientists, clinicians and public health experts have been deterred from speaking out publicly after being trolled and threatened on social media. In October 2021, a Nature editorial highlighted the need for protection from harassment (and worse) for scientists who speak out on the pandemic.
Unicorns, superdodgers and asymptomatic spreaders
By July this year it was estimated that almost one in every two Australians had been infected with the SARS-CoV-2 virus – that figure is almost certainly higher now. Those people who have somehow avoided getting infected are increasingly regarded as unicorns.
I’m in that category, but I keep wondering if my luck will last. Or is there is something special about my immune system (apart from the antibodies from five vaccine jabs – I got the new Moderna bivalent vaccine shot on my recent trip to Colorado) that makes me a “superdodger”?
Scientists at the University of California in San Francisco have found a genetic mutation in the HLA gene that doesn’t prevent the virus from infecting cells but does prevent a person from having COVID-19 symptoms.
People with this mutation test positive but are completely asymptomatic. There is a preliminary report of this work here.
It has long been suspected that infected persons who remain asymptomatic play a significant role in the ongoing pandemic, but their relative numbers and effect have been uncertain. Asymptomatic persons seem to account for approximately 40 to 45 percent of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days.
That’s one reason why public health surveillance measures such as monitoring sewage sludge are so useful.
And, as Croakey‘s Alison Barrett pointed out to me, it appears that the number of asymptomatic cases has not increased with the advent of vaccines (the above 40 to 45 percent figure is from 2020; in the UK in June 2022, 37 to 40 percent of people were asymptomatic).
This explanation does not cover people like me, who have never tested positive, despite known exposure to the SARS-CoV-2 virus. It could just be luck (after all, I have a doctor friend who avoided getting infected for over two years – until he took a trip to England). But it might be genetics. Scientists have discovered that nasal cells from some human donors are resistant to infection with the virus.
There’s also the possibility that previous infection with other types of coronaviruses results in cross-reactive immunity, where our immune system may recognise SARS-CoV-2 as being similar to a recent virus and launch an immune response. There are seven coronaviruses that infect humans: four that cause the common cold, and one each that cause SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and COVID-19.
Again, I’m pretty certain that’s not me. So I continue to take precautions, wear a mask, be grateful for good health, and hope my luck holds.
COVID diabetes risks
A number of studies have indicated an increased risk of developing diabetes after coronavirus infection. Results suggest people who have had COVID-19 are between 31 percent and 166 percent more likely to later develop diabetes, compared to people who have not had the virus.
These studies need careful examination. For example, a large US study of 200,000 people in the Veterans Affairs healthcare system found that people who had even a mild case of COVID-19 were about 40 percent more likely to develop type 2 diabetes up to a year later.
The chance of developing diabetes rose with increasing severity of COVID-19. People who were hospitalised or admitted to intensive care had roughly triple the risk compared with control individuals who did not have COVID-19.
However, the veterans in the study were mostly older, white men, many of whom had elevated blood pressure and were overweight, putting them at high risk of developing diabetes under any circumstances.
Researchers have long theorised that viral infections enhance or elicit autoimmune disorders such as type 1 diabetes.
Now three new reports, from Norway, the United States, and an international study, indicate an increased risk of type 1 diabetes after COVID-19 in children. The risk is low, although statistically significant, but with large numbers of children and youth infected, the numbers quickly add up.
Several studies have shown that SARS-CoV-2 can attack the beta cells in the pancreas that produce insulin, which could lead to development of type 1 diabetes. Inflammation caused by the virus may also lead to exacerbation of already-existing autoimmunity.
Most experts in the area remain cautious about a direct association between COVID-19 and new-onset diabetes in adults and children, and more research is needed. But if these findings hold, the pandemic could potentially lead to a large number of people with diabetes, with severe consequences for the patients and the healthcare system.
Hunger, nutrition and climate change
Economists in Australia are worrying about inflation, the stock market, the decisions of the Reserve Bank, and the impact on housing prices, but for many people, the rising cost of living is hitting hard in an important area – the affordability of fresh and nutritious foods.
Last week the Australian media reported that Australians are now paying nearly 20 percent more for fruit and vegetables than this time last year. This is due to a combination of factors that include: rising inflation and energy prices, the impact of COVID-19 on employment, and natural disasters like floods in food-producing regions.
The Australian Bureau of Statistics (ABS) has recently started reporting a monthly Consumer Price Index (CPI) Indicator that is a useful tool for tracking the impact of the economy on the budgets of Australian families.
A recent ABS release shows that food and non-alcoholic beverages inflation increased to 9.3 percent in the 12 months to August, with prices rising across most food categories. The biggest increase was 18.6 percent for fruit and vegetables. (As an aside, this same release shows no increase in the costs of the health category over the past year).
While everyone knows that fruit and vegetables are an essential part of a healthy diet, ABS data show that knowledge is poorly transformed into action. Only 6.1 percent of adults and 8.5 percent of children eat the recommended amounts of fruit and vegetables.
There is little Australian information about the extent to which the consumption of fruit and vegetables is linked to socio-economic status. Some research suggests that poor vegetable eating experiences in childhood tend to carry through to lifetime habits. This, combined with a surprising lack of knowledge about seasonal patterns and how to select and prepare different varieties, results in continued generational legacies of poor eating.
Still, cost is clearly a barrier to efforts to improve nutrition generally. In particular, Australians living in remote communities must pay staggering amounts of money for fresh foods, as highlighted by the 2020 parliamentary report on food pricing and food security in remote Indigenous communities.
Back in 2015 the Climate Council warned that the price, quality and seasonality of Australia’s food supply was increasingly affected by climate change.
Even earlier, in 2010, Professor Sharon Friel discussed how food security in 21st century Australia and internationally requires the focus of food policy to evolve from seeking to increase the amount of food available for consumption to also consider wider public health and environmental consequences.
She looked at how the reduction of greenhouse gas emissions from the agricultural sector can both improve food security and reduce the levels of chronic diseases such as cardiovascular diseases and some cancers.
The 2019 IPCC report, Climate Change and Land, has a chapter on food security and climate change.
The previous Morrison Government consistently resiled from anything to do with reducing the impacts of climate change on health and also made little or no effort to improve nutrition during their tenure. There are hopes that the Albanese Government will do more.
In May 2022 Dr Rachel Carey and Dr Maureen Murphy from the University of Melbourne urged the newly elected Labor Government to put tackling food insecurity high on its ‘to do’ list. They provided a roadmap for addressing the problem and pushed for a Minister for Food.
Food insecurity is generally addressed through charitable food relief, but this is a bandaid solution that undermines recipients’ dignity.
In its January 2022 budget submission, Nutrition Australia outlined the health and economic benefits that a behavioural change program to increase vegetable consumption by one serve per day could deliver.
Perhaps the Albanese Government could look to the recent efforts of the Biden Administration, which has just announced a National Strategy on Hunger, Nutrition and Health with more than US$8 billion committed to this effort. A report has been developed that outlines how the various federal departments should work together to implement the strategy.
At the first conference held on this topic in 50 years President Biden committed to ending hunger and reducing diet-related diseases in the United States by 2030.
The last such food conference, hosted by President Richard Nixon in 1969, was a pivotal moment in American food policy that led to the expansion of food stamps and gave rise to the Women, Infants and Children program that today provides parenting advice, breastfeeding support and food assistance to the mothers of half the babies born each year.
Recent Croakey articles on this issue:
Climate change and environmental equity
The fourth interim report of the Productivity Commission’s Productivity Inquiry (released last week) has found climate change is expected to directly impact some of Australia’s key industries and thus affect productivity growth.
“The physical impacts of climate change stand to be profound and will directly constrain productivity growth in sectors that are important to Australia, including agriculture, fisheries, tourism, and sectors that rely on physical labour in heat-exposed settings.” it said.
While the interim report does not address health (and as far as I can tell the Inquiry is not addressing the impact of the pandemic on productivity) it is easy to see that there will be health-related consequences from failure to address the issues outlined.
In July, the Treasurer Jim Chalmers reported that Treasury would once again begin modelling the impacts of climate change on the economy (work that was ceased under the Morrison Government). Perhaps this work will include the costs of health impacts?
Climate change is exacerbating the social and economic inequalities that already contribute to profound health inequities; this is especially true for Indigenous people living in remote communities.
In the US, the National Academies of Science, Engineering and Medicine recently convened a workshop on Communities, Climate Change and Health Equity. You can read the report of this workshop here.
The report conclusion is applicable in Australia:
Many participants emphasised the importance of addressing the root causes, or the “causes behind the causes,” that are driving the climate crisis as well as the disproportionate impacts of climate change on certain populations and communities. This means that issues across many facets of society – from housing and transportation, to systemic racism and disenfranchisement, to education and job opportunities—will likely be involved in advancing environmental justice and health equity in the face of a changing climate, with a goal of achieving meaningful changes that improve the lives of people throughout society.”
It’s worth noting that the Biden Administration has just unveiled a new office within the Environmental Protection Agency that aims to place environmental justice at the core of the agency’s work.
The new Office of Environmental Justice and External Civil Rights will have hundreds of staff, a Senate-confirmed director, and an annual budget of US$100 million. It will ensure that the wellbeing of marginalised communities is an integral part of federal decision-making on environmental issues, including climate change.’
You can read more about the Office’s work here.
In case you missed it
This paper, published in Health Research Policy and Systems, looks at the lessons from COVID-19 research responses in seven countries: Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the US, to identify examples of achievements and challenges.
In the US the COVID-19 mortality burden was greater for people with intellectual and developmental disabilities than for those without during the first year of the pandemic.
Australia does not collect this data so we have no way of knowing the mortality and morbidity burden from the pandemic for this population.
This paper from the US-based Commonwealth Fund outlines how integrating behavioural health services (mental health and substance misuse services) with primary care can help address the current crisis by expanding access to treatment.
This annual report from the Royal Australian College of General Practitioners is focused this year on the sustainability of general practice.
The report highlights:
Burnout among the profession.
- Unsustainable workload and mounting administrative and regulatory burden impacting on the provision of patient care.
- A declining interest in the profession as a preferred career path and a declining willingness from current GPs to recommend the profession as a career.
- Worsening workforce issues with increasing numbers of GPs intending to retire or cease practicing over the next 10 years.
- Underfunding of general practice and the unsustainability of general practice as a business.
In response, Health Minister Mark Butler has said that fixing the decline of general practice is his top priority.
Potentially avoidable hospitalisations (PAHs) are a proxy measure of effective primary care at a population level. PAHs are higher in rural and disadvantaged areas.
This qualitative study found that patients’ complex health and social circumstance, health service access and unclear care pathways were strong themes associated with rural PAHs.
The Department of Health and Ageing is currently reviewing the Aged Care Quality Standards. Public consultation will be open from 17 October to 25 November. More information is available here.
The best of Croakey
Recent stories at Croakey have highlighted the Government’s decision to shut down NPS MedicineWise:
The good news story
This story has its genesis in tragedy and political upheaval, but I found it uplifting too.
Little Amal is the giant puppet of a 10-year-old Syrian refugee girl. Since July 2021 Amal has travelled over 9,000km across 12 countries representing all children fleeing war, violence and persecution and each with their own story. Little Amal’s urgent message to the world is “Don’t forget about us”.
She has become an international symbol of compassion and of human rights. She carries a message of hope for displaced people everywhere, especially children who have been separated from their families.
You can read more 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.