Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Qualitative Assessment of Environmental Health Risk Perceptions and Community Challenges in a Puerto Rican Community: Change and Continuity in Response to Hurricanes Irma and María.

Culebra, a geographically isolated island located 17 miles from the eastern coast of Puerto Rico's main island, suffers from an amalgam of significant environmental health risk and associated social determinants of health that are affecting the community. In 2017, two major Hurricanes (Irma and María) impacted Culebra, resulting in an increase of preexisting environmental health risk. The present study's primary aim was to explore community attitudes, beliefs, and perceptions of environmental health risk, and to describe the social priorities of Culebrenses in relation to these risks and challenges. Semi-structured interview guide and Rapid Qualitative Inquiry (RQI) focused on topics of environmental health risk was followed. Qualitative focus groups and individual interviews were conducted among community members in Culebra before and shortly after Hurricanes Irma and María affected the island. Environmental health factors identified included: presence of mosquitoes, trash disposal, water quality and tourism. Additionally, a strong sentiment of island pride was found potentially generating a sense of community that could facilitate solutions to the existing environmental health challenges. Preexisting environmental health risk magnified after the pass of Hurricanes Irma and María. Sustainable and community engagement approaches are needed to develop strategies that can assist in the mitigation and resolution of the identified environmental health risk and challenges, including factors associated with threats such as disasters and pollution.

Relatório luz da Agenda 2030 de desenvolvimento sustentável: síntese III / Relatório Luz / Spotlight report on the 2030 sustainable development agenda: synthesis III Brazil

O Grupo de Trabalho da Sociedade Civil para a Agenda 2030, GTSC A2030, foi formalizado em setembro de 2014 e é resultado do encontro entre organizações não governamentais, movimentos sociais, fóruns e fundações brasileiras durante o seguimento das negociações da Agenda pós-2015. Desde então, atua na difusão, promoção e monitoramento da Agenda 2030, assim como da Agenda de Ação de Adis Abeba, em âmbito local, nacional e internacional.

This summary version of the Civil Society Spotlight Report indicates the magnitude of Brazil's challenges, whose policies to promote equality, and access to social and environmental justice have been losing status, budget, or have been simply eliminated in the last six months. It shows a rapid dismantling of strategic programs to achieve the Sustainable Development Goals, permeated by scandals in the three levels of power, fuelled by ultra-liberal, elitist, and ineffective policies that deepen the social-economic crisis which, in turn, is used to justify environmental degradation and social aggression. The federal government ignores laws and evidence, insisting on simplistic and misguided solutions to complex challenges, including by reorienting the foreign policy to the point of alienating historic geopolitical allies. The data presented here is from official sources, revealing a trend toward increasing inequalities and violence, which, if not reversed, will make Brazil an unsustainable country by 2030.

[Policies of zoonosis in Colombia: from health Code to environmental health]. / Políticas de zoonosis en Colombia: del Código Sanitario a la salud ambiental.

OBJECTIVE: To analyze public policies of zoonosis in Colombia, in the period of 1975 to 2014, as State responses. METHODOLOGY: Used the policy cycle analysis approach or sequential approach. This analysis was carried out by means of the following aspects: content, processes, actors, and vertical and horizontal relationships between policies. RESULTS: Zoonosis policies were very different in scope, contents and forms, and results are part of a history of successes and failures, who have only managed to partially transform the general and regional overview of the zoonosis. CONCLUSIONS: The implementation of decisions that have operational scope is relatively slow and scattered in areas of zoonosis in the country. A major achievement has been the shift from policies that are individualized to the great policy of health environmental-PISA.

OBJETIVO: Analizar las políticas públicas de zoonosis en Colombia, en el período de 1975 a 2014, como respuestas estatales. METODOLOGÍA: Se utilizó el enfoque de análisis de ciclo de política o enfoque secuencial. Este análisis se llevó a cabo por medio de los siguientes aspectos: contenidos, procesos, actores y relaciones verticales y horizontales entre las políticas. RESULTADOS: Las políticas de zoonosis son muy diversas en su alcance, contenidos y formas, y hacen parte de una historia de éxitos y fracasos, que sólo han logrado transformar de manera parcial el panorama general y regional de las zoonosis. CONCLUSIONES: La implementación de las decisiones que tienen alcance operacional es relativamente lenta y dispersa en las zonas de zoonosis del país. Ha sido un logro importante el viraje desde las políticas individualizadas a la gran política de salud ambiental-PISA.

EcoHealth and the Determinants of Health: Perspectives of a Small Subset of Canadian Academics in the EcoHealth Community.

EcoHealth is an emerging field that examines the complex relationships among humans, animals, and the environment, and how these relationships affect the health of each of these domains. The different types of determinants of health greatly influence human health and well-being. Therefore, EcoHealth's ability to improve human, animal, and environmental health and well-being is, in part, influenced by its ability to acknowledge and integrate the determinants of health. However, our previous research demonstrates that the academic EcoHealth literature had a low, uneven engagement with the determinants of health. Accordingly, to make sense of this gap, our research aim is to better understand the views of a small subset of the Canadian EcoHealth community about EcoHealth and the determinants of health relative to EcoHealth. We used a qualitative research design involving seven semi-structured interviews, which were analyzed using thematic analysis. Our findings suggest a tension across themes and a lack of conceptual engagement with the determinants of health. As we consider a future with rapid, unsustainable changes, we expect the identification and integration of the different types of determinants of health within EcoHealth to be imperative for EcoHealth to attain its goal of improving the health and well-being of humans, animals, and the environment.

Children's Environmental Health in Thailand: Past, Present, and Future.

BACKGROUND: There is increasing evidence of a link between environmental pollution and preventable diseases in developing countries, including Thailand. Economic development has generated several types of pollution that can affect population health. While these environmental health effects can be observed throughout life, pregnant women and children represent particularly vulnerable and sensitive groups. METHODS: The published epidemiological literature investigating environmental chemical exposure in Thai children was reviewed, highlighting those that investigated associations between exposure and subsequent health outcomes. RESULTS: The majority of the Thai epidemiological studies on environmental health in children were cross-sectional in design, with some demonstrating associations between exposure and outcome. The three main types of chemical exposure in Thai children were pesticides, heavy metals, and air pollution, which resulted from agricultural activities in countryside areas, industrial zones (both registered and unregistered establishments), mining, and traffic in inner cities. Major health outcomes included detrimental effects on cognitive function and cancer risk. Pesticide exposure was focused on, but not limited to, agricultural areas. The success of the Thai environmental policy to introduce lead-free petrol can be demonstrated by the decline of mean blood lead levels in children, particularly in urban areas. However, unregistered lead-related factories and smelters act as hidden sources. In addition, there is increasing concern, but little acknowledgement, about the effects of chronic arsenic exposure related to mining. Lastly, air pollution remains a problem in both dense city populations due to traffic and in rural areas due to contamination of indoor air and house dust with heavy metals, endotoxins and other allergens. CONCLUSIONS: The increasing number of published articles demonstrates an improved awareness of children's environmental health in Thailand. Chemical hazards, including the improper use of pesticides, environmental contamination with heavy metals (lead and arsenic), and air pollution in inner cities and indoor air, continue to be growing issues.

Health assessment of future PM2.5 exposures from indoor, outdoor, and secondhand tobacco smoke concentrations under alternative policy pathways in Ulaanbaatar, Mongolia.

INTRODUCTION: Winter air pollution in Ulaanbaatar, Mongolia is among the worst in the world. The health impacts of policy decisions affecting air pollution exposures in Ulaanbaatar were modeled and evaluated under business as usual and two more-strict alternative emissions pathways through 2024. Previous studies have relied on either outdoor or indoor concentrations to assesses the health risks of air pollution, but the burden is really a function of total exposure. This study combined projections of indoor and outdoor concentrations of PM2.5 with population time-activity estimates to develop trajectories of total age-specific PM2.5 exposure for the Ulaanbaatar population. Indoor PM2.5 contributions from secondhand tobacco smoke (SHS) were estimated in order to fill out total exposures, and changes in population and background disease were modeled. The health impacts were derived using integrated exposure-response curves from the Global Burden of Disease Study. RESULTS: Annual average population-weighted PM2.5 exposures at baseline (2014) were estimated at 59 µg/m3. These were dominated by exposures occurring indoors, influenced considerably by infiltrated outdoor pollution. Under current control policies, exposures increased slightly to 60 µg/m3 by 2024; under moderate emissions reductions and under a switch to clean technologies, exposures were reduced from baseline levels by 45% and 80%, respectively. The moderate improvement pathway decreased per capita annual disability-adjusted life year (DALY) and death burdens by approximately 40%. A switch to clean fuels decreased per capita annual DALY and death burdens by about 85% by 2024 with the relative SHS contribution increasing substantially. CONCLUSION: This study demonstrates a way to combine estimated changes in total exposure, background disease and population levels, and exposure-response functions to project the health impacts of alternative policy pathways. The resulting burden analysis highlights the need for aggressive action, including the elimination of residential coal burning and the reduction of current smoking rates.

The Value of Traditional Ecological Knowledge for the Environmental Health Sciences and Biomedical Research.

BACKGROUND: Traditional Ecological Knowledge (TEK) is a term, relatively new to Western science, that encompasses a subset of traditional knowledge maintained by Indigenous nations about the relationships between people and the natural environment. The term was first shared by tribal elders in the 1980s to help raise awareness of the importance of TEK. TEK has become a construct that Western scientists have increasingly considered for conducting culturally relevant research with Tribal nations. OBJECTIVES: The authors aim to position TEK in relation to other emerging schools of thought, that is, concepts such as the exposome, social determinants of health (SDoH), and citizen science, and to explore TEK's relevance to environmental health research. This article provides examples of successful application of TEK principles in federally funded research when implemented with respect for the underlying cultural context and in partnership with Indigenous communities. DISCUSSION: Rather than treating TEK as an adjunct or element to be quantified or incorporated into Western scientific studies, TEK can instead ground our understanding of the environmental, social, and biomedical determinants of health and improve our understanding of health and disease. This article provides historical and recent examples of how TEK has informed Western scientific research. CONCLUSIONS: This article provides recommendations for researchers and federal funders to ensure respect for the contributions of TEK to research and to ensure equity and self-determination for Tribal nations who participate in research. https://doi.org/10.1289/EHP858.

Unlocking Marine Biotechnology in the Developing World.

Fulfilling the promise of marine biotechnology as a source for environmental and biomedical applications remains challenging. New technologies will be necessary to harness marine biodiversity, and collaboration across government, academic, and private sectors will be crucial to create mechanisms of technology transfer and promote the development of new marine biotechnology companies.

AEDT: A new concept for ecological dynamics in the ever-changing world.

The important concept of equilibrium has always been controversial in ecology, but a new, more general concept, an asymptotic environmentally determined trajectory (AEDT), overcomes many concerns with equilibrium by realistically incorporating long-term climate change while retaining much of the predictive power of a stable equilibrium. A population or ecological community is predicted to approach its AEDT, which is a function of time reflecting environmental history and biology. The AEDT invokes familiar questions and predictions but in a more realistic context in which consideration of past environments and a future changing profoundly due to human influence becomes possible. Strong applications are also predicted in population genetics, evolution, earth sciences, and economics.

A cross-disciplinary approach to global environmental health: the case of contaminated sites.

Cross-disciplinary approaches to Global Environmental Health are essential to address environmental health threats within and beyond national boundaries, taking into account the links among health, environment and socio-economic development. The aim of this study is to present a cross-disciplinary approach where knowledge and findings from environmental epidemiology and social research are integrated in studying environmental health issues, focusing on environmental health inequities, public and environmental health literacy, and international scientific cooperation. In the case of contaminated sites, environmental epidemiology can contribute investigating the multidimensionality of equity for sustainable development practices. These practices entail a better understanding of environmental contamination, health effects pathways and improved capacities of different stakeholders to identify policy options for environmental risk prevention, remediation and management that will foster informed participation in decisions influencing communities. International scientific cooperation frameworks adopting equity principles shared by scientific community, populations and decision-makers may be of valuable support to this task.

The Centrality of Philosophical Anthropology to (a Future) Environmental Ethics.

While environmental ethics has successfully established itself in philosophy, as presently conceived it is still largely irrelevant to grappling the global ecological crisis because, as Alasdair MacIntyre has argued, ethical philosophy itself is in grave disorder. MacIntyre's historically oriented recovery of virtue ethics is defended, but it is argued that even MacIntyre was too constrained by received assumptions to overcome this disorder. As he himself realized, his ideas need to be integrated and defended through philosophical anthropology. However, it is suggested that current defenders of philosophical anthropology have not done it justice. To appreciate its importance it is necessary accept that we are cultural beings in which the core of culture is the conception of what are humans. This is presupposed not only in thought but in social practices and forms of life. This was understood by Aristotle, but modernity has been straightjacketed by the Seventeenth Century scientific revolution and Hobbes' philosophical anthropology, identifying knowledge and with techno-science and eliminating any place for questioning this conception of humans. The only conception of humanity that could successfully challenge and replace Hobbes' philosophical anthropology, it is argued, is Hegel's philosophical anthropology reformulated and developed on naturalistic foundations. This involves subordinating science to a reconceived humanities with a fundamentally different role accorded to ethics, placing it at the center of social life, politics and economics and at the centre of the struggle to transform culture and society to create an ecologically sustainable civilization.

What next for environmental health?

AIMS: The aim of the wider research was to explore Health and Wellbeing Boards (HWBs) during their early development stages, with a focus on health inequalities and the role of environmental health (EH). This article presents empirical findings relating to challenges facing the EH profession in the new English public health (PH) system and offers new practical suggestions as to how they might be overcome in relation to educating and training the new generation of EH practitioners (EHPs). METHODS: Four case study HWBs in the Midlands and North of England were followed for 18 months from early 2012. In addition, EHPs and managers from each English region were interviewed. In total, 50 semi-structured interviews were carried out, around 55 h of HWB meetings were observed, and documents associated with HWBs such as strategies and minutes of meetings were collected. Data were analysed thematically, both inductively and deductively, using Atlas.ti. RESULTS: EH is largely invisible in the new PH system due to a variety of internal and external factors, including existing skill sets and practices. There is a new imperative to move away from reliance on statutory functions for funding and to engage with wider PH issues and colleagues, requiring new skills of evaluation and a change in perception from being 'doers' to include a greater role as 'thinkers'. This is being recognised by EHPs and managers, who are seeking ways to adapt to these new expectations. CONCLUSION: Recent changes to the English PH system have led to a period of reflection and the beginnings of adaptation in EH to overcome new challenges. Linked to this is a need for graduate training to prepare new practitioners to think critically, to thrive and become high-level managers of the future, while being technically competent. We suggest a new, enhanced role for Chartered Institute of Environmental Health (CIEH)-accredited universities in securing the future of the profession by supporting new graduates. Specifically, a mentoring scheme could be introduced for the practical training element for new practitioners. This would help to embed criticality and evaluation in practice, provide consistency in training, and overcome the disconnect between academia and practice.

Water insecurity in Canadian Indigenous communities: some inconvenient truths.

INTRODUCTION: Canada has the second highest per capita water consumption in the world. However, little is known about complex socio-economic and cultural dynamics of water insecurities in Indigenous communities and the multiple health consequences. Most studies have concentrated on a simplified interpretation of accessibility, availability and quality issues, including some common water-borne infections as the only health outcomes. Thus, several government initiatives on potable water supply, particularly for remotely located communities, have failed to sustain and promote a healthy lifestyle. The objective was to explore the water insecurity, coping strategies and associated health risks in a small and isolated sub-Arctic Indigenous (Inuit) community in Canada. METHODS: The study was based on a community-based survey (2013) in one of the most remote Inuit communities of Labrador. In-depth, open-ended key informant (KI) interviews (community leader (1), woman (1), nurse (1), teacher (1), and elder (1)) and focus group discussions (FGDs) were conducted with community leaders (5), community members (25), women (5), and high school students (8). Convenience sampling was followed in selection of the subjects for FGDs and approached some KIs. All the water sources (five in April and seven in October) were visited and tested for their physical, chemical and microbiological parameters. The FGDs and KI interviews were audio recorded and transcribed. In the analysis, the data (qualitative and quantitative) were broadly categorized into (a) water sources, access and quality, (b) coping, (c) health risks and (d) challenges to run a public water system. RESULTS: The community did not have any piped water supply. Their regular sources of water consisted of several unmonitored local streams, brooks, and ponds. The public water system was not affordable to the majority of community members who solely depended on government aid. Animal fecal contamination (in natural sources such as streams, brooks, and ponds) and the presence of disinfection by-products (in the public water system) were the major quality issues. Gastro-intestinal infections were the most common disease in the community. Per capita water consumption was less than one-third of the Canadian national average (274 L/day/person), severely compromising personal hygiene and water intake. High-sugar-content beverages were the most common alternative to lack of accessible and affordable potable water, particularly for children. Mental stress due to water insecurity and chronic back and shoulder injuries due to carrying heavy water buckets every day were the commonly encountered adverse health outcomes. CONCLUSIONS: Water insecurity has put the community at risk of multiple serious adverse health outcomes. The scenario is not unique in Canada. There are many remote Indigenous communities facing similar kinds of water insecurity.