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The Health Wrap: US gaze on Oz, climate initiatives, presidential budget, COVID-19 horizon scanning & sweet successes

In this fortnight’s edition of The Health Wrap, Dr Lesley Russell ponders the reporting of the Australian bushfire crisis in the US and climate change mitigation strategies in Colorado. 

She examines the fine print in the latest Presidential fiscal budget, looks at what is in the pipeline for COVID-19 management, and reports on public health success in Chile.

Finally, back home, it seems there is good news for the pygmy possum – and not a moment too soon.


Lesley Russell writes:

Right now, I am spending some time at our home in Keystone, Colorado; some skiing and snowshoeing, some work, and lots of attention to politics. So, not surprisingly, there’s a strong US focus in this edition of The Health Wrap.

The bushfire crisis is changing how Americans are seeing and thinking about Australia.

Generally it’s quite hard to get news about Australia in the US, but over the past few months the major media outlets, both print and TV, have done an excellent job of reporting on the Australian bushfires and their consequences.

Recent examples include:

It seems everyone we run into – from friends and family to strangers on the ski lifts – is aware of the destruction, the disruption to people’s lives, the harms to flora and fauna and farming, and the failures of the Morrison Government.

There is real concern and genuine sympathy, and queries about what the government will now do. And, although I acknowledge that generalisations are dangerous, I think that Americans’ perceptions of Australia – as a politically progressive nation with a lot to offer from beautiful beaches to wild bushland, and lots of cute native animals – are changing.

Not everyone we meet is totally into the environment, so they might skip over stories highlighting Australia’s lust for coal, or that Australia leads the world in liquified gas production, but they do get the connection between bushfires, climate change and millions of dead animals (especially koalas) and the continuing damage to the Great Barrier Reef.

I know that some commentators in Australia have spoken out against this article in The New York Times entitled The End of Australia as we know it (it finds that anxiety and trauma is taking hold in a country seen as relaxed and optimistic, postulates that climate change will force Australia to stumble to new ways to live and work, and queries whether local politics is up to managing the changes needed to address climate change).

However, lots of people here in the US have seen it and read it and believe it. People want to know if they should still plan a trip Down Under.

We don’t have answers to most of the questions put to us. But it does seem that our governments must address these issues, or a drop in American tourism will be yet another economic consequence of a really difficult summer.


Climate action in Summit County and local ski resorts

One of the reasons we love this part of the world is the local attention to the environment. From the very beginning our small resort town (Keystone – part of Vail Resorts) has paid attention to preserving the local wetlands and beaver ponds, had a strong recycling program (sadly not always adhered to by visitors), and increasingly used renewable energy.

In 2017, Vail Resorts announced that the company will aggressively pursue an “Epic Promise for a Zero Footprint” with the goals of zero net emissions, zero waste to landfill, and zero net operating impact on forests and habitat by 2030.

Climate change is obvious here. Colorado is already two degrees Fahrenheit warmer than thirty years ago.

Warming temperatures have chipped away at the length of the ski season, invited a beetle invasion that has impacted the lodgepole pine population.

 Less spring melt means less water in the Colorado River. Colorado is the third-most wildfire-prone state in the United States.

Keystone is located in Summit County, which has just over 30,600 permanent residents. Many depend on the ski resorts for their living, others have moved here for the wonderful environment.

So, like Australians, they are wondering about the future and how to mitigate the effects of the climate change global emergency in the face of the Trump Administration’s failures.  

Things are happening here – and they are obvious. Summit County has a Community Climate Action Plan under which the county is committed to drastically reduce greenhouse gas emissions from its buildings, transportation and infrastructure.

This is part of the Compact of Colorado Communities which has existed since 2017.

Last week I read about a group called Protect Our Winters which aims to convert the enthusiasm of athletes (skiers, climbers, runners, paddlers) into climate change advocacy using an ethos they are calling “Imperfect Advocacy”.

They want people who admit their carbon impacts (in my case, all my flights to ski and hike!) but remain dedicated to swaying corporations, elections and policies towards a carbon-neutral future. I really like this idea – progress over perfection or never let the perfect be the enemy of the good!

At the same time a group of US companies involved in the outdoor industry have formed the Climate Action Corps with plans to reduce their carbon footprints.

Pine forest damage caused by the pine beetle near Keystone Colorado

Trump budget hits science and health

On February 10, the White House released President Trump’s fiscal year 2021 budget.

These presidential budgets are often described as aspirational or statements of priorities because (fortunately) they do not become reality unless they are enacted by the Congress. Mostly they are DoA (dead on arrival).

In recent years, lawmakers have largely rejected the Trump administration’s proposed cuts and instead increased major science agency budgets, or at least held them flat.

This year’s budget deserves some attention because, in an election year, there is quite a contrast between what Trump has been promising and what his budget, if implemented, would deliver.

The budget cuts funding for health, science and environment agencies. It proposes a nearly 10 percent cut to Health and Human Services and a 26 percent cut to the Environmental Protection Agency.

It does ask for increases in funding for research on quantum computing and artificial intelligence, areas in which the United States competes with China. Trump also wants to grant NASA a multibillion-dollar boost to help the space agency put astronauts back on the moon.

Science

There are deep cuts to R&D at the major science agencies.

Here is how Science magazine summarised the major cuts (the numbers – given in US$ – reflect the portion of each agency’s budget classified as research, which in most cases is less than its overall budget).

  • National Institutes of Health: a cut of 7%, or $2.942 billion, to $36.965 billion
  • National Science Foundation: a cut of 6%, or $424 million, to $6.328 billion
  • Department of Energy’s (DOE’s) Office of Science: a cut of 17%, or $1.164 billion, to $5.760 billion
  • National Aeronautical and Space Administration: a cut of 11%, or $758 million, to $6.261 billion
  • US Department of Agriculture’s Agricultural Research Service: a cut of 12%, or $190 million, to $1.435 billion
  • National Oceanic and Atmospheric Administration: a cut of 31%, or $300 million, to $678 million
  • Environmental Protection Agency science and technology: a cut of 37%, or $174 million, to $318 million

Overall, federal spending on research would drop by 9%, or $13.78 billion, to $142.185 billion.

Health

The budget proposes $1 trillion in cuts to Medicaid (health care for the poor, especially children, and those in aged care)  and the Affordable Care Act (Obamacare) over ten years, with the cuts growing over time.

That amount includes $844 billion in reductions labelled an “allowance for the President’s health reform vision”. While the budget provides almost no explanation for most of the cuts in the allowance, it is clear that this is code for yet another attempt to kill off Obamacare.

The Administration may hope that being vague will let it argue in an election year that it no longer supports policies that would reduce health coverage (especially for issues such as pre-existing conditions), but policy wonks say this argument is hard to credit.

Despite Trump claiming that Medicare is safe, the budget actually wrings some $500 billion in Medicare savings over ten years – with much of this coming from reduced funding to doctors and hospitals.

In addition to the steep cuts to health care coverage, the administration is seeking to “reform” the way food stamps, also known as the Supplemental Nutrition Assistance Program (SNAP), are allocated.

These potential reforms would kick nearly 3.7 million Americans out of the program; slashing nearly $182 billion from SNAP over the next decade. 

The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent. Amid the coronavirus outbreak, funds will be cut for preparedness, infectious diseases and chronic conditions. HHS officials say they want the CDC to focus on its core mission of preventing and controlling infectious diseases and on other emerging public health issues, such as opioid abuse.

Although the budget reduces overall funding for global health,  from $9.1 billion Congress allocated for them in Fiscal Year 2020 to $6 billion for FY 2021, officials carved out an extra $50 million for global health security, which are measures aimed at disease detection and emergencies. However that bump comes at the expense of international HIV/AIDS programs, which is being cut by about $58 million.


Clinical trials for coronavirus drugs and vaccines

Many clinical studies are being conducted around the world to find a treatment for, and a vaccine to prevent, COVID-19, the illness caused by a novel coronavirus that has thus far infected over 75,000 people and killed more than 2,000 people.

In China, it is estimated there are more than 80 such trials underway and the World Health Organization is attempting to bring some order to these to ensure that research is carefully conducted, with strict standards for study parameters, and not wasteful of precious resources.

It is hoped that agreed-on clinical trial protocols could then simultaneously be run by clinicians around the world.

The Chinese Clinical Trial Registry, a database of biomedical studies in China, list trials on existing therapies, experimental procedures – including stem cells procedures and the infusion of plasma from those who have survived the infection – and traditional medicines.

These treatments have varying amounts of evidence backing their efficacy. Some further detail is here.

To date Western scientists have praised cooperative efforts, saying “Improved technology, pressure tested simulated pandemic situations, and stronger relationships that encourage collaboration between organizations and governments during emergency situations have been a bright spot so far in this novel coronavirus outbreak”.

There’s a list of some of the drugs and vaccines in the pipeline being tested outside China here.


Chile tackles sugary drink consumption

A study published last week in the journal PLOS Medicine finds that a landmark law requiring warning labels on unhealthy foods has quickly made a difference in purchases of sodas, bottled water and juices in Chile.

Four years after Chile embraced the world’s most sweeping measures to combat mounting obesity (in 2016, three-quarters of Chilean adults and more than half of children were overweight or obese) a partial verdict on their effectiveness is in: Chileans are drinking a lot fewer sugar-laden beverages.

Consumption of sugar-sweetened drinks dropped nearly 25 percent in the 18 months after Chile adopted a raft of regulations that included advertising restrictions on unhealthy foods, bold front-of-package warning labels and a ban on junk food in schools.

During the same period, there was a five percent increase in purchases of bottled water, diet soft drinks and fruit juices without added sugar.

The far-reaching law includes mandatory package redesigns that erased cartoons from sugary cereal boxes, and television advertising restrictions that banished ads for unhealthy products from the airwaves between 6 am and 10 pm.

study published last year by the journal Public Health Nutrition found that Chilean children were subjected to half as many ads for junk food and sugary drinks a year after the regulations came into effect, as in the months before implementation.

The regulations were championed by then-president Michelle Bachelet, a socialist, and passed by the National Congress despite fierce objections from big multinational food companies. While initially opposed, Chile’s current president, Sebastián Piñera, a conservative billionaire businessman, has left the regulations in place.

Since then, PeruUruguayIsrael have adopted Chilean-style front-of-package labels; Brazil and Mexico are expected to finalise similar labels in the coming months, and a dozen other countries are considering them as well.

I know the cynics will ask if all this has resulted in a decrease in obesity – and the answer is that we don’t yet know, that will take some time.

However, I am optimistic this eventually will be the result, because the Chilean Government is making a major effort to tackle obesity on a number of fronts. You can read more here.


And a good news story

As a counter to the dreadful and sad stories about the havoc and death wrought by the recent bushfires, here is a story to make you smile. It seems the pygmy possum is surviving in the huge burnt tracts of Kosciuszko National Park.  


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.

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