Impacts of extreme weather on the health and well-being of people who are homeless.

This letter responds to the article by Cusack et al., 'Extreme weather-related health needs of people who are homeless' (Australian Journal of Primary Health, 2013, 19(3), 250-255), which addressed the impacts of extreme weather on the health of the homeless population in inner city Adelaide. We compare the findings of Cusack et al. to our own original research, based on interviews with service providers to the homeless in urban and rural Victoria. We further place this issue in the broader context of climate change, which is crucial given the expected increase in extreme weather events and associated health impacts.

Health risks from indoor gas appliances.

BACKGROUND: Cooking and heating with gas is common in Australian homes and is a risk factor for several important health problems; however, there is little awareness of these risks among doctors or the public. Gas stove use is estimated to cause 12% of childhood asthma in Australia. OBJECTIVE: The aim of this article is to help general practitioners identify when gas combustion products such as nitrogen dioxide might be contributing to asthma in children and adults and to alert them to the risks of carbon monoxide (CO) poisoning, which can be hard to diagnose. DISCUSSION: There are excellent alternatives to the use of gas in domestic appliances and some simple behavioural changes that can reduce exposure in situations where appliances cannot yet be removed. CO poisoning can be insidious. Mild exposure can cause headache, nausea, vomiting, dizziness, malaise and confusion, so it can be mistaken for common conditions such as influenza or gastroenteritis. The COMA mnemonic is clinically useful. Increased awareness of these issues can provide patients with safer and healthier living environments.

Breast and cervical cancer in indigenous women-overcoming barriers to early detection.

BACKGROUND: Aboriginal and Torres Strait Islander women have a higher incidence of cervical cancer and poorer outcomes for breast and cervical cancer than nonindigenous women. This article reports on a project that aimed to implement and evaluate strategies to improve general practitioner early detection of breast and cervical cancer in this group. METHODS: In three sites a female indigenous worker and female GP developed and implemented local plans aimed to improve service coordination and access, GP knowledge, recall systems, and health promotion. Evaluation included analysis of qualitative and quantitative data from project reports and surveys. RESULTS: Project officers and partners identified collaboration between service providers, community participation in planning and delivery, an indigenous health worker raising awareness in both the women and GPs, and a female GP providing a holistic service as important factors in project success. Increased cervical screening was documented in one site and a trend toward increased breast and cervical screening in another. DISCUSSION: Partnerships involving community members planning and implementing evidence based strategies may improve participation of Aboriginal and Torres Strait Islander women in breast and cervical cancer screening.

Blood lead levels in the adult Victorian population: results from the Victorian Health Monitor.

OBJECTIVE: To estimate blood lead levels (BLLs) in the adult Victorian population and compare the distribution of BLLs with the current national reference level to better inform public health prevention and management of lead toxicity. METHODS: Population-based cross-sectional health measurement survey of 50 randomly selected Census Collection Districts (CDs) throughout Victoria. The Victorian Health Monitor (VHM) was conducted over 12 months from May 2009 to April 2010. One eligible person (aged 18-75 years) from each household selected within each CD was randomly selected to participate. Persons with an intellectual disability and pregnant women were excluded from the sampling frame. BLLs were obtained from 3,622 of the 3,653 (99%) VHM participants. RESULTS: The geometric mean and median BLLs from the adult sample were 0.070 µmol/L (95%CI, 0.068-0.073) and 0.05 µmol/L (range: 0.05 to 1.22 µmol/L), respectively. Elevated BLLs (≥0.483 µmol/L or ≥10 µg/dL) were identified in 19 participants (0.7%; 95%CI, 0.3-1.6). Additionally, 86 participants (1.8%; 95%CI, 1.3-2.4) were identified with BLLs between 0.242 and <0.483 µmol/L (5 to <10 µg/dL). The geometric mean BLL was significantly higher for males, compared with females (0.077 µmol/L vs 0.064 µmol/L; p<0.001). BLLs increased significantly with age for both sexes. CONCLUSIONS: The first population estimates of BLLs in Victorian adults indicate the average adult BLL to be well below the current national reference level. However, some groups of the population have BLLs at which adverse effects may occur. Implications : The results provide baseline estimates for future population health surveillance and comparison with studies of at-risk groups.

Air quality and chronic disease: why action on climate change is also good for health.

There is increasing evidence that air pollution contributes to the burden of chronic disease and premature mortality, particularly from cardiovascular and respiratory causes. Action now urgently required to mitigate climate change has the potential co-benefit of improving air quality and reducing the chronic disease burden. Fossil fuel combustion, primarily from motor vehicles and energy generation, is a major contributor to anthropogenic climate change and air pollution-related health conditions. Action to reduce greenhouse gas emissions by improving energy efficiency, departing from carbon-intensive energy generation, facilitating mass transit and active transport options, also has the potential for significant public health benefits.