Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020.

BACKGROUND: In response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020. METHODS: We replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide. RESULTS: Identical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries. CONCLUSIONS: Considerable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

The plastic health map: A systematic evidence map of human health studies on plastic-associated chemicals.

BACKGROUND: The global production and use of plastic materials has increased dramatically since the 1960s and there is increasing evidence of human health impacts related to exposure to plastic-associated chemicals. There is, however, no comprehensive, regulatory, post-market monitoring for human health effects of plastic-associated chemicals or particles and it is unclear how many of these have been investigated for effects in humans, and therefore what the knowledge gaps are. OBJECTIVE: To create a systematic evidence map of peer-reviewed human studies investigating the potential effects of exposure to plastic-associated particles/chemicals on health to identify research gaps and provide recommendations for future research and regulation policy. METHODS: Medline and Embase databases were used to identify peer-reviewed primary human studies published in English from Jan 1960 - Jan 2022 that investigated relationships between exposures to included plastic-associated particles/chemicals measured and detected in bio-samples and human health outcomes. Plastic-associated particles/chemicals included are: micro and nanoplastics, due to their widespread occurrence and potential for human exposure; polymers, the main building blocks of plastic; plasticizers and flame retardants, the two most common types of plastic additives with the highest concentration ranges in plastic materials; and bisphenols and per- or polyfluoroalkyl substances, two chemical classes of known health concern that are common in plastics. We extracted metadata on the population and study characteristics (country, intergenerational, sex, age, general/special exposure risk status, study design), exposure (plastic-associated particle/chemical, multiple exposures), and health outcome measures (biochemical, physiological, and/or clinical), from which we produced the interactive database 'Plastic Health Map' and a narrative summary. RESULTS: We identified 100,949 unique articles, of which 3,587 met our inclusion criteria and were used to create a systematic evidence map. The Plastic Health Map with extracted metadata from included studies are freely available at https://osf.io/fhw7d/ and summary tables, plots and overall observations are included in this report. CONCLUSIONS: We present the first evidence map compiling human health research on a wide range of plastic-associated chemicals from several different chemical classes, in order to provide stakeholders, including researchers, regulators, and concerned individuals, with an efficient way to access published literature on the matter and determine knowledge gaps. We also provide examples of data clusters to facilitate systematic reviews and research gaps to help direct future research efforts. Extensive gaps are identified in the breadth of populations, exposures and outcomes addressed in studies of potential human health effects of plastic-associated chemicals. No studies of the human health effects of micro and/or nanoplastics were found, and no studies were found for 26/1,202 additives included in our search that are of known hazard concern and confirmed to be in active production. Few studies have addressed recent "substitution" chemicals for restricted additives such as organophosphate flame retardants, phthalate substitutes, and bisphenol analogues. We call for a paradigm shift in chemical regulation whereby new plastic chemicals are rigorously tested for safety before being introduced in consumer products, with ongoing post-introduction biomonitoring of their levels in humans and health effects throughout individuals' life span, including in old age and across generations.

Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018.

Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007-2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.

Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups.

Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.

Predicting general practitioner utilisation at a small area level across Western Australia.

Equitable delivery of GP services is a key goal in universal healthcare systems. In Australia, information to evaluate equitable delivery is limited, especially at finer geographic scales, leaving an information void that needs to be filled to inform, prioritise and target interventions. To fill this void, GP utilisation was estimated by combining responses on GP utilisation from a national survey differentiated by demographic and area-based socioeconomic and remoteness characteristics with similar characteristics represented geographically at a fine scale. These estimates were then compared to actual GP utilisation to evaluate their predictive reliability. Comparable estimates were found in the greater metropolitan area, with 76% of areas having estimated GP utilisation within ±10% of actual utilisation. Larger discrepancies were found as areas became remoter, with 84% of areas reporting estimated utilisation that was higher than actual utilisation. Comparing the geographic differences between estimated and actual utilisation allowed us to examine the reliability of our methodology. Given the identified limitations, a proxy for GP utilisation at a small area level can be created, a dataset that is not currently published at this geography. This approach has the potential to be applied Australia-wide, providing another valuable tool to evaluate the equitable delivery of primary health care nationally.

Linked data systems for injury surveillance and targeted prevention planning: Identifying geographical differences in injury in Western Australia, 2009-2012.

ISSUE ADDRESSED: Injuries are a leading preventable cause of disease burden in Australia. Understanding how injuries vary by geographical location is important to guide health promotion planning. Therefore, the geographical and temporal distribution of injury across Western Australia from 2009 to 2012 is explored. METHODS: Three Western Australian health datasets were linked and the expected number of injury cases per postcode calculated. A Standardised Injury Ratio was calculated by comparing the observed and expected number of injury cases. Priority areas and associated injury mechanisms were identified by postcode based on injury rates and temporal trends. RESULTS: Injury levels varied across health region, health district and postcode. All nonmetropolitan regions had at least one health district classified as High or Medium-High priority. In contrast, neither metropolitan health region had health districts in these categories. Adopting the finer postcode level of analysis showed localised injury priority areas, even within health districts not classified as High or Medium-High injury areas. Postcodes classified as High or Medium-High injury priority were located alongside those with lower priority categories. CONCLUSION: Injury prevention priority areas had consistent trends both geographically and over time. Finer scale analysis can provide public health policy makers with more robust information to plan, evaluate and support a range of injury prevention programs. SO WHAT?: The use of linked data systems and spatial analysis can assist health promotion decision-makers and practitioners by demonstrating area-based differences in injury prevention allowing effective targeting of limited resources to populations at the highest risk of injury.

Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence.

BACKGROUND: Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum - namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. METHODS: An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. RESULTS: We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. CONCLUSIONS: In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.

Regional engagement and spatial modelling for natural resource management planning.

Changing unsustainable natural resource use in agricultural landscapes is a complex social-ecological challenge that cannot be addressed through traditional reductionist science. More holistic and inclusive (or transdisciplinary) processes are needed. This paper describes a transdisciplinary project for natural resource management planning in two regions (Eyre Peninsula and South Australian Murray-Darling Basin) of southern Australia. With regional staff, we reviewed previous planning to gain an understanding of the processes used and to identify possible improvement in plan development and its operation. We then used an envisioning process to develop a value-rich narrative of regional aspirations to assist stakeholder engagement and inform the development of a land use management option assessment tool called the landscape futures analysis tool (LFAT). Finally, we undertook an assessment of the effectiveness of the process through semi-structured stakeholder interviews. The planning process review highlighted the opinion that the regional plans were not well informed by available science, that they lacked flexibility, and were only intermittently used after publication. The envisioning process identified shared values-generally described as a trust, language that is easily understood, wise use of resources, collaboration and inclusiveness. LFAT was designed to bring the best available science together in a form that would have use in planning, during community consultation and in assessing regional management operations. The LFAT provided spatially detailed but simple models of agricultural yields and incomes, plant biodiversity, weed distribution, and carbon sequestration associated with future combinations of climate, commodity and carbon prices, and costs of production. Stakeholders were impressed by the presentation and demonstration results of the software. While there was anecdotal evidence that the project provided learning opportunities and increased understanding of potential land use change associated with management options under global change, the direct evidence of influence in the updated regional plan was limited. This project had elements required for success in transdisciplinary research, but penetration seems limited. Contributing factors appear to be a complexity of climate effects with economic uncertainty, lack of having the project embedded in the plan revision process, limited continuity and capacity of end users and limited after project support and promotion. Strategies are required to minimise the controlling influence that these limitations can have.