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Summary

The MJA–Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement.
Our special report in 2020 focused on the unprecedented and catastrophic 2019–20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators.
We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians’ wellbeing in multiple and complex ways.
In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID‐19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.

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1 Macquarie University, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Institute for Global Health, University College London, London, UK
4 Queensland University of Technology, Brisbane, QLD
5 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
6 University Centre for Rural Health, University of Sydney, Sydney, NSW
7 University Centre for Rural Health, University of Sydney, Lismore, NSW
8 Monash University, Melbourne, VIC
9 Integrated Sustainability Analysis, University of Sydney, Sydney, NSW
10 University of Melbourne, Parkville, VIC
11 Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, NSW
12 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
13 UCL Energy Institute, University College London, London, UK
14 Monash Sustainable Development Institute, Monash University, Melbourne, VIC

Correspondence: paul.beggs@mq.edu.au

Acknowledgements:

We thank Katie Quail for assistance with indicator 1.2 Indigenous health and climate change. We thank Robert Fawcett, John Nairn (retired), Elizabeth Ebert and Bronwyn Brown (all from the Australian Bureau of Meteorology) for indicators 1.3 Health effects of heatwaves and 2.4 Climate information services for health. We thank Nathan Morris for assistance with the analysis for indicator 1.4 Heat impact on physical and sporting activities. We thank Tord Kjellstrom and Matthias Otto for providing the results for indicator 1.5 Change in labour capacity. The Bushfires indicator was generated with support from NASA Applied Sciences Program (grant no. 80NSSC21K0507) and we thank Yang Liu, Bryan Vu and Liuhua Shi (all from Emory University) for the Australian data used for this indicator (1.7), and Nicolas Borchers Arriagada (Menzies Institute for Medical Research, University of Tasmania) for assistance with analysis. Shouro Dasgupta conducted the sea level rise‐related data analysis for indicator 1.9 Migration, displacement, and environmental change. He is an author on the Lancet Countdown global report, and contributor to the sea level rise indicator. The global version of this indicator was developed in collaboration also with Ilan Kelman and Sonja Ayeb‐Karlsson. We thank Kerry Nice (University of Melbourne) who worked on indicator 2.6 Urban green space. The assistance of Zahra Borghei Ghomi (Macquarie University) in compiling the data for indicators 3.1 Carbon intensity of the energy system, 3.2 Coal phase‐out, 3.3 Zero carbon emission electricity, and 3.4 Clean household energy is acknowledged. We thank Marco Springman from the Lancet Countdown for providing the results for indicator 3.9 Diet and health co‐benefits. We thank Maddie Heenan for searching and data compilation for indicator 5.3 Government engagement in health and climate change in Australia. We thank the NHMRC for providing the data for indicator 5.4 Health and climate change research funding.

Competing interests:

No relevant disclosures.

1. Arjmand H‐A, Seabrook E, Bakker D, Rickard N. Mental health consequences of adversity in Australia: national bushfires associated with increased depressive symptoms, while COVID‐19 pandemic associated with increased symptoms of anxiety. Front Psychol 2021; 12: 635158.
2. Batterham PJ, Calear AL, McCallum SM, et al. Trajectories of depression and anxiety symptoms during the COVID‐19 pandemic in a representative Australian adult cohort. Med J Aust 2021; 214: 462–468. https://www.mja.com.au/journal/2021/214/10/trajectories‐depression‐and‐anxiety‐symptoms‐during‐covid‐19‐pandemic
3. Farugia TL, Cuni‐Lopez C, White AR. Potential impacts of extreme heat and bushfires on dementia. J Alzheimers Dis 2021; 79: 969–978.
4. Royal Commission into National Natural Disaster Arrangements. Report. Canberra: Commonwealth of Australia, 2020. https://naturaldisaster.royalcommission.gov.au/publications/royal‐commission‐national‐natural‐disaster‐arrangements‐report (viewed Sept 2021).
5. Zhang Y, Beggs PJ, Bambrick H, et al. The MJA‐Lancet Countdown on health and climate change: Australian policy inaction threatens lives. Med J Aust 2018; 209: 474.e1‐474.e21. https://www.mja.com.au/journal/2018/209/11/mja‐lancet‐countdown‐health‐and‐climate‐change‐australian‐policy‐inaction
6. Beggs PJ, Zhang Y, Bambrick H, et al. The 2019 report of the MJA‐Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust 2019; 211: 490–491.e21. https://www.mja.com.au/journal/2019/211/11/2019‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐turbulent‐year‐mixed
7. Zhang Y, Beggs PJ, McGushin A, et al. The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia’s “Black Summer”. Med J Aust 2020; 213: 492.e2–492.e10. https://www.mja.com.au/journal/2020/213/11/2020‐special‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐lessons
8. Crowley K. Fighting the future: the politics of climate policy failure in Australia (2015–2020). WIREs Clim Change 2021; 12: e725.
9. Sachs J, Kroll C, Lafortune G, Fuller G, Woelm F. Sustainable Development Report 2021: The decade of action for the Sustainable Development Goals. Cambridge: Cambridge University Press, 2021. https://s3.amazonaws.com/sustainabledevelopment.report/2021/2021‐sustainable‐development‐report.pdf (viewed Sept 2021).
10. Australian Government Department of Industry, Science, Energy and Resources. International climate change commitments. https://www.industry.gov.au/policies‐and‐initiatives/australias‐climate‐change‐strategies/international‐climate‐change‐commitments (viewed July 2021).
11. Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 2021; https://doi.org/10.1016/S0140‐6736(21)01787‐6.
12. Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021; 397: 129–170.
13. Lancet Countdown on Health and Climate Change. Explore our data: 1.1.1 Vulnerability to extremes of heat. https://www.lancetcountdown.org/data‐platform/climate‐change‐impacts‐exposures‐and‐vulnerability/1‐1‐health‐and‐heat/1‐1‐1‐heat‐vulnerability (viewed Jul 2021).
14. Green D, King U, Morrison J. Disproportionate burdens: the multidimensional impacts of climate change on the health of Indigenous Australians. Med J Aust 2009; 190: 4–5. https://www.mja.com.au/journal/2009/190/1/disproportionate‐burdens‐multidimensional‐impacts‐climate‐change‐health
15. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework: 2020 summary report (Cat. No. IHPF 2). Canberra: AIHW, 2020. https://www.indigenoushpf.gov.au/ (viewed Sept 2021).
16. Campbell S, Remenyi TA, White CJ, Johnston FH. Heatwave and health impact research: a global review. Health Place 2018; 53: 210–218.
17. Watson KE, Gardiner KM, Singleton JA. The impact of extreme heat events on hospital presentations to the Royal Hobart Hospital. J Public Health (Oxf) 2020; 42: 333–339.
18. Nairn J, Fawcett R. Defining heatwaves: heatwave defined as a heat‐impact event servicing all community and business sectors in Australia (CAWCR Technical Report No. 060). CSIRO and Australian Government Bureau of Meteorology, 2013. https://www.cawcr.gov.au/technical‐reports/CTR_060.pdf (viewed May 2021).
19. Nairn JR, Fawcett RJB. The excess heat factor: a metric for heatwave intensity and its use in classifying heatwave severity. Int J Environ Res Public Health 2015; 12: 227–253.
20. Australian Government Bureau of Meteorology. Heatwave assessment and forecast. http://www.bom.gov.au/metadata/catalogue/19115/ANZCW0503900601 (viewed July 2021).
21. Jay O, Broderick C, Smallcombe J. Extreme heat policy. Melbourne: Sports Medicine Australia, 2021. https://sma.org.au/sma‐site‐content/uploads/2021/02/SMA‐Extreme‐Heat‐Policy‐2021‐Final.pdf (viewed Sept 2021).
22. Chen K, Vicedo‐Cabrera AM, Dubrow R. Projections of ambient temperature‐ and air pollution‐related mortality burden under combined climate change and population aging scenarios: a review. Curr Environ Health Rep 2020; 7: 243–255.
23. Johnston FH. Bushfires and human health in a changing environment. Aust Fam Physician 2009; 38: 720–724.
24. Williamson GJ, Prior LD, Jolly WM, et al. Measurement of inter‐ and intra‐annual variability of landscape fire activity at a continental scale: the Australian case. Environ Res Lett 2016; 11: 035003.
25. Abram NJ, Henley BJ, Gupta AS, et al. Connections of climate change and variability to large and extreme forest fires in southeast Australia. Commun Earth Environ 2021; 2: 8.
26. March A, Riddell G, de Moraes LN, et al. Urban planning capabilities for bushfire: treatment categories and scenario testing. Aust J Emerg Manag 2020; 35: 32–40.
27. McMartin DW, Sammel AJ, Arbuthnott K. Community response and engagement during extreme water events in Saskatchewan, Canada and Queensland, Australia. Environ Manag 2018; 61: 34–45.
28. Raikes J, Smith TF, Baldwin C, Henstra D. Linking disaster risk reduction and human development. Clim Risk Manag 2021; 32: 100291.
29. Internal Displacement Monitoring Centre. Displacement data. https://www.internal‐displacement.org/ (viewed May 2021).
30. Internal Displacement Monitoring Centre. Internal displacement 2020: mid‐year update. Geneva: IDMC, 2020. https://www.internal‐displacement.org/publications/internal‐displacement‐2020‐mid‐year‐update (viewed May 2021).
31. Dannenberg AL, Frumkin H, Hess JJ, Ebi KL. Managed retreat as a strategy for climate change adaptation in small communities: public health implications. Clim Change 2019; 153: 1–14.
32. McMichael C. Human mobility, climate change, and health: unpacking the connections. Lancet Planet Health 2020; 4: e217–e218.
33. Duncombe J, Clements A, Davis J, et al. Spatiotemporal patterns of Aedes aegypti populations in Cairns, Australia: assessing drivers of dengue transmission. Trop Med Int Health 2013; 18: 839–849.
34. Stratton MD, Ehrlich HY, Mor SM, Naumova EN. A comparative analysis of three vector‐borne diseases across Australia using seasonal and meteorological models. Sci Rep 2017; 7: 40186.
35. Climate and Health Alliance. Framework for a national strategy on climate, health and well‐being for Australia. Melbourne: CAHA, 2017. https://www.caha.org.au/national_strategy_framework_launch (viewed May 2021).
36. Australian Capital Territory Government. ACT climate change strategy 2019–25. Canberra: ACT Government, 2019. https://www.environment.act.gov.au/__data/assets/pdf_file/0003/1414641/ACT‐Climate‐Change‐Strategy‐2019‐2025.pdf/_recache (viewed May 2021).
37. Government of South Australia. State Public Health Plan 2019–2024. Adelaide: SA Health, 2018. https://www.sahealth.sa.gov.au/wps/wcm/connect/d18380e5‐6792‐4cdd‐a193‐08d80fd47df4/FINAL+State+public+Health+Plan+2019‐2024.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE‐d18380e5‐6792‐4cdd‐a193‐08d80fd47df4‐nK5wa‐k (viewed Sept 2021).
38. Weeramanthri TS, Joyce S, Bowman F, et al. Climate Health WA Inquiry: final report. Perth: WA Department of Health, 2020. https://ww2.health.wa.gov.au/Improving‐WA‐Health/Climate‐health‐inquiry (viewed Sept 2021).
39. Tasmanian Government Department of Health. Tasmanian climate change and health roundtable: final report. Hobart: Department of Health, 2020. https://www.health.tas.gov.au/__data/assets/pdf_file/0009/408429/Tasmanian_Climate_Change_and_Health_Roundtable_‐_Final_Report_June_2020.pdf (viewed May 2021).
40. Rice M, Weisbrot E, Bradshaw S, et al. Game, set, match: calling time on climate inaction. Sydney: Climate Council, 2021. https://www.climatecouncil.org.au/wp‐content/uploads/2021/02/Game‐Set‐Match‐Calling‐Time‐on‐Climate‐Inaction‐Climate‐Council‐Sports‐Report‐1.pdf (viewed Sept 2021).
41. Bambrick H, Charlesworth K, Bradshaw S, Baxter T. Kicking the gas habit: how gas is harming our health. Sydney: Climate Council, 2021. https://www.climatecouncil.org.au/wp‐content/uploads/2021/05/Kicking‐the‐Gas‐Habit‐How‐Gas‐is‐Harming‐our‐Health.pdf (viewed Sept 2021).
42. Garnaut R. The Garnaut climate change review: final report. Cambridge: Cambridge University Press, 2008.
43. CSIRO, Bureau of Meteorology. State of the climate 2020. Commonwealth of Australia, 2020. https://www.csiro.au/en/Showcase/state‐of‐the‐climate (viewed May 2021).
44. City of Sydney. Climate emergency response. Sydney: City of Sydney, 2019. https://www.cityofsydney.nsw.gov.au/strategies‐action‐plans/climate‐emergency‐response (viewed May 2021).
45. City of Sydney. Sustainable Sydney 2030: community strategic plan 2017–2021. Sydney: City of Sydney, 2017. https://www.cityofsydney.nsw.gov.au/strategies‐action‐plans/community‐strategic‐plan (viewed May 2021).
46. City of Melbourne. Climate change adaptation strategy refresh 2017. Melbourne: City of Melbourne, 2017. https://www.melbourne.vic.gov.au/about‐council/vision‐goals/eco‐city/Pages/climate‐change‐adaptation‐strategy.aspx (viewed May 2021).
47. City of Hobart. Sustainable Hobart action plan: towards a zero emissions Hobart, 2020‐2025. Hobart: City of Hobart, 2020. https://www.hobartcity.com.au/files/assets/public/strategies‐and‐plans/sustainable‐hobart‐action‐plan‐2020‐2025.pdf (viewed May 2021).
48. Government of South Australia: Department of Planning, Transport and Infrastructure. The 30‐year plan for Greater Adelaide: 2017 update. Adelaide: DPTI, 2017. https://livingadelaide.sa.gov.au/__data/assets/pdf_file/0003/319809/The_30‐Year_Plan_for_Greater_Adelaide.pdf (viewed May 2021).
49. City of Darwin. Climate change action plan 2011–2020. Darwin: Darwin City Council, 2011.
50. Brisbane City Council. Brisbane. Clean, green, sustainable: 2017–2031. Brisbane: Brisbane City Council, 2017.
51. City of Perth. Towards an energy resilient city: strategic directions paper. Perth: City of Perth, 2014.
52. Bannister T, Ebert EE, Silver J, et al. A pilot forecasting system for epidemic thunderstorm asthma in southeastern Australia. Bull Am Meteorol Soc 2021; 102: E399–E420.
53. World Health Organization. International Health Regulations (2005). 3rd ed. Geneva: WHO, 2016.
54. Wong MCS, Huang J, Wong SH, Yuen‐Chun Teoh J. The potential effectiveness of the WHO International Health Regulations capacity requirements on control of the COVID‐19 pandemic: a cross‐sectional study of 114 countries. J R Soc Med 2021; 114: 121–131.
55. Kriegler FL, Malila WA, Nalekpa RF, Richardson W. Preprocessing transformations and their effects on multispectral recognition. Proceedings of the Sixth International Symposium on Remote Sensing of Environment 1969; II: 97.
56. Wolch JR, Byrne J, Newell JP. Urban green space, public health, and environmental justice: the challenge of making cities ‘just green enough’. Landsc Urban Plan 2014; 125: 234–244.
57. Markevych I, Schoierer J, Hartig T, et al. Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res 2017; 158: 301–317.
58. Fong KC, Hart JE, James P. A review of epidemiologic studies on greenness and health: updated literature through 2017. Curr Environ Health Rep 2018; 5: 77–87.
59. Murphy K, Morton A. Morrison government flags $540m for hydrogen and carbon capture ahead of Biden summit. The Guardian 2021; 21 Apr. https://www.theguardian.com/environment/2021/apr/21/morrison‐government‐flags‐540m‐for‐hydrogen‐and‐carbon‐capture‐ahead‐of‐biden‐summit (viewed July 2021).
60. International Energy Agency. Indicators for CO2 emissions (edition 2020). Paris: IEA, 2020. https://www.oecd‐ilibrary.org/energy/data/iea‐co2‐emissions‐from‐fuel‐combustion‐statistics/indicators‐for‐co2‐emissions‐edition‐2020_8d2fb5d7‐en (viewed Mar 2021).
61. International Energy Agency. Global energy review 2021. Paris: IEA, 2021. https://www.iea.org/reports/global‐energy‐review‐2021 (viewed May 2021).
62. International Energy Agency. Coal information: statistics report. https://www.iea.org/reports/coal‐information‐overview (viewed Sept 2021).
63. International Energy Agency. Key world energy statistics 2020. https://www.iea.org/reports/key‐world‐energy‐statistics‐2020 (viewed Mar 2021).
64. International Energy Agency. Coal 2020: analysis and forecast to 2025. https://www.iea.org/reports/coal‐2020 (viewed Mar 2021).
65. International Energy Agency. Coal information: overview. https://www.iea.org/reports/coal‐information‐overview (viewed Mar 2021).
66. International Energy Agency. World energy balances: overview. https://www.iea.org/reports/world‐energy‐balances‐overview (viewed Sept 2021).
67. Australian Government Department of Industry, Science, Energy and Resources. Australian energy statistics, Table O: Electricity generation by fuel type 2018–19 and 2019. Canberra: DISER, 2020. https://www.energy.gov.au/publications/australian‐energy‐statistics‐table‐o‐electricity‐generation‐fuel‐type‐2018‐19‐and‐2019 (viewed May 2021).
68. Clean Energy Council. Clean energy Australia: report 2021. Melbourne: CEC, 2021. https://www.cleanenergycouncil.org.au/resources/resources‐hub/clean‐energy‐australia‐report (viewed Sept 2021).
69. Clean Energy Council. Renewable energy target. https://www.cleanenergycouncil.org.au/advocacy‐initiatives/renewable‐energy‐target (viewed Mar 2021).
70. Clean Energy Regulator. Postcode data for small‐scale installations. http://www.cleanenergyregulator.gov.au/RET/Forms‐and‐resources/Postcode‐data‐for‐small‐scale‐installations#Smallscale‐installations‐by‐installation‐year (viewed Jul 2019).
71. Clean Energy Council. Solar. https://www.cleanenergycouncil.org.au/resources/technologies/solar‐energy#:~:text=The%20growth%20of%20solar,the%20third%2Dhighest%20number%20ever (viewed May 2021).
72. Mazengarb M. Rooftop solar’s stunning surge to new records, as Australia installs reach 2.5 million. Renew Economy 2020; 3 Aug. https://reneweconomy.com.au/rooftop‐solars‐stunning‐surge‐to‐new‐records‐as‐australia‐installs‐reach‐2‐5‐million‐55528/ (viewed May 2021).
73. Australian Government Department of Industry, Science, Energy and Resources. Regional and Remote Communities Reliability Fund. https://www.energy.gov.au/government‐priorities/energy‐programs/regional‐and‐remote‐communities‐reliability‐fund (viewed May 2021).
74. United States Environmental Protection Agency. Integrated science assessment (ISA) for particulate matter (Final Report, Dec 2019). EPA/600/R‐19/188. Washington, DC: USEPA, 2019.
75. Hanigan IC, Johnston FH, Morgan GG. Vegetation fire smoke, indigenous status and cardio‐respiratory hospital admissions in Darwin, Australia, 1996–2005: a time‐series study. Environ Health 2008; 7: 42.
76. Johnston FH, Hanigan IC, Henderson S, Morgan GG. Evaluation of interventions to reduce air pollution from biomass smoke on mortality in Launceston, Australia: retrospective analysis of daily mortality, 1994–2007. BMJ 2013; 346: e8446.
77. Hanigan IC, Broome RA, Chaston TB, et al. Avoidable mortality attributable to anthropogenic fine particulate matter (PM2.5) in Australia. Int J Environ Res Public Health 2021; 18: 254.
78. Broome RA, Powell J, Cope ME, Morgan GG. The mortality effect of PM2.5 sources in the Greater Metropolitan Region of Sydney, Australia. Environ Int 2020; 137: 105429.
79. Australian Government Department of Industry, Science, Energy and Resources. Australian energy statistics 2020 update published. https://www.energy.gov.au/news‐media/news/australia‐energy‐statistics‐2020‐update‐published (viewed May 2021).
80. ClimateWorks Australia. Moving to zero: accelerating the transition to zero‐emissions transport. Melbourne: ClimateWorks Australia, 2020.
81. Australian Government Department of Industry, Science, Energy and Resources. Australian energy update 2020. Canberra: DISER, 2020. https://www.energy.gov.au/publications/australian‐energy‐update‐2020 (viewed Oct 2020).
82. Budget Direct. Electric car sales 2020. https://www.budgetdirect.com.au/car‐insurance/research/electric‐car‐sales‐australia.html (viewed Mar 2021).
83. Electric Vehicle Council. State of electric vehicles: August 2020. Sydney: Electric Vehicle Council, 2020. https://electricvehiclecouncil.com.au/reports/state‐of‐electric‐vehicles‐2020/ (viewed Sept 2021).
84. Climate Change Commission. Ināia tonu nei: a low emissions future for Aotearoa. Advice to the New Zealand Government on its first three emissions budgets and direction for its emissions reduction plan 2022–2025. Wellington: New Zealand Government, 2021.
85. Hamilton I, Kennard H, McGushin A, et al. The public health implications of the Paris Agreement: a modelling study. Lancet Planet Health 2021; 5: e74–e83.
86. Goel R, Goodman A, Aldred R, et al. Cycling behaviour in 17 countries across 6 continents: levels of cycling, who cycles, for what purpose, and how far? Transport Rev 2021; https://doi.org/10.1080/01441647.2021.1915898.
87. Australian Government: Department of Industry, Science, Energy and Resources. National greenhouse gas inventory – Paris Agreement inventory. https://ageis.climatechange.gov.au (viewed Mar 2021).
88. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27–e35.
89. Malik A, Padget M, Carter S, et al. Environmental impacts of Australia’s largest health system. Resour Conserv Recycl 2021; 169: 105556.
90. Lenzen M, Malik A, Li M, et al. The environmental footprint of health care: a global assessment. Lancet Planet Health 2020; 4: e271–e279.
91. Pichler P‐P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14: 064004.
92. Hepburn C, O’Callaghan B, Stern N, et al. Will COVID‐19 fiscal recovery packages accelerate or retard progress on climate change? Oxf Rev Econ Policy 2020; 36 Suppl 1: S359–S381.
93. Conti S, Meli P, Minelli G, et al. Epidemiologic study of mortality during the Summer 2003 heat wave in Italy. Environ Res 2005; 98: 390–399.
94. Semenza JC, Rubin CH, Falter KH, et al. Heat‐related deaths during the July 1995 heat wave in Chicago. N Engl J Med 1996; 335: 84–90.
95. Herbst J, Mason K, Byard RW, et al. Heat‐related deaths in Adelaide, South Australia: review of the literature and case findings – an Australian perspective. J Forensic Leg Med 2014; 22: 73–78.
96. Australian Bureau of Statistics. 3222.0 ‐ Population Projections. Canberra: ABS, 2008. https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3222.0Main+Features12006%20to%202101?OpenDocument (viewed July 2021).
97. Office of Best Practice Regulation, Department of the Prime Minister and Cabinet. Best practice regulation guidance note: value of statistical life. Canberra: Office of Best Practice Regulation, 2014.
98. Australian Energy Regulator. State of the energy market 2020. Melbourne: AER, 2020. https://www.aer.gov.au/publications/state‐of‐the‐energy‐market‐reports/state‐of‐the‐energy‐market‐2020 (viewed May 2021).
99. Australian Energy Market Operator. Generation information. http://aemo.com.au/Electricity/National‐Electricity‐Market‐NEM/Planning‐and‐forecasting/Generation‐information (viewed Apr 2021).
100. Australian Bureau of Statistics. Employment in renewable energy activities, Australia: 2018–19 financial year. Canberra: ABS, 2020. https://www.abs.gov.au/statistics/labour/employment‐and‐unemployment/employment‐renewable‐energy‐activities‐australia/latest‐release (viewed May 2021).
101. Australian Bureau of Statistics. Australian industry: 2018–19 financial year. Canberra: ABS, 2020. https://www.abs.gov.au/statistics/industry/industry‐overview/australian‐industry/2018‐19 (viewed May 2021).
102. Fossil Free. 1200+ divestment commitments. https://gofossilfree.org/divestment/commitments/ (viewed Apr 2021).
103. Clean Energy Regulator. Australian carbon credit units. Canberra: CER, 2020. http://www.cleanenergyregulator.gov.au/OSR/ANREU/types‐of‐emissions‐units/australian‐carbon‐credit‐units (viewed July 2021).
104. Australian Government. Excise ‐ Table 4: Fuel tax credits scheme – claims paid, by broad and fine industry, 2006–07 to 2019–20 financial years. Canberra: Australian Government, 2021. https://data.gov.au/data/dataset/taxation‐statistics‐2018‐19/resource/4b2139a1‐395b‐47e4‐83bb‐f1de7fb0ed8b?inner_span=True (viewed July 2021).
105. The Australia Institute. Australian fossil fuel subsidies hit $10.3 billion in 2020‐21 [media release]. 26 Apr 2021. https://australiainstitute.org.au/post/australian‐fossil‐fuel‐subsidies‐hit‐10‐3‐billion‐in‐2020‐21/ (viewed July 2021).
106. Organisation for Economic Co‐operation and Development. OECD.Stat. Fossil fuel support ‐ AUS. https://stats.oecd.org/Index.aspx?DataSetCode=FFS_AUS (viewed Mar 2021).
107. World Bank. Carbon pricing dashboard. https://carbonpricingdashboard.worldbank.org/ (viewed Mar 2021).
108. Market Forces. How your tax dollars subsidise fossil fuels. https://www.marketforces.org.au/campaigns/ffs/tax‐based‐subsidies/ (viewed Mar 2021).
109. Australian Government Department of Health. Bushfire smoke and health: summary of the current evidence. Canberra: Department of Health, 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A12B57E41EC9F326CA257BF0001F9E7D/$File/Bushfire‐smoke‐health‐Summary‐current‐evidence.pdf (viewed May 2021).
110. Commonwealth of Australia. Disaster and emergency management for environmental health practitioners. Canberra: Commonwealth of Australia, 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A12B57E41EC9F326CA257BF0001F9E7D/$File/Disaster_and_Emergency_Management_for_EHPs.pdf (viewed May 2021).
111. National Health and Medical Research Council. NHMRC Special Initiative in Human Health and Environmental Change. Canberra: NHMRC, 2021. https://www.nhmrc.gov.au/funding/find‐funding/nhmrc‐special‐initiative‐human‐health‐and‐environmental‐change (viewed May 2021).

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Editorials

Towards risk‐stratified population breast cancer screening: more than mammographic density

John L Hopper and Tuong Linh Nguyen

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51268
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Environment and public health

Information science

Powerful new automated tools are being developed to identify the women most likely to have an existing or future cancer

The article by Noguchi and colleagues in this issue of the MJA1 is timely and motivated by an important aim: to improve breast screening for both women and its funders. The authors conducted a comprehensive analysis of routinely collected data for all screening mammograms by BreastScreen WA over the ten years from July 2007. Although they studied screening episodes rather than individual women, they found evidence that key performance indicators — screen‐detected and interval cancer rates — differed by age, family history, hormone replacement therapy use, benign breast disease, and breast density. Importantly, the strengths of the relationships between some factors and performance varied by age group.1

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC

Correspondence: j.hopper@unimelb.edu.au

Acknowledgements:

We acknowledge the generous support for our work in this area over many years from the National Breast Cancer Foundation, the Cancer Council Victoria, Cancer Australia, the National Health and Medical Research Council, and the National Institutes of Health (USA).

Competing interests:

No relevant disclosures.

1. Noguchi N, Marinovich ML, Wylie EJ, et al. Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening. Med J Aust 2021; 215: 359–365.
2. Allweis TM, Hermann N, Bernstein‐Molho R, Guindy M. Personalized screening for breast cancer: rationale, present practices, and future directions. Ann Surg Oncol 2021; 28: 4306–4317.
3. Eklund M, Broglio K, Yau C, Connor JT, et al. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. JNCI Cancer Spectr 2018; 2: pky067.
4. Hopper JL, Nguyen TL, Schmidt DF, et al. Going beyond conventional mammographic density to discover novel mammogram‐based predictors of breast cancer risk. J Clin Med 2020; 9: 627.
5. Boyd NF, Guo H, Martin LJ, Sun L, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 3563: 227–236.
6. Cappello NM, Richetelli D, Lee CI. The impact of breast density reporting laws on women’s awareness of density‐associated risks and conversations regarding supplemental screening with providers. J Am Coll Radiol 2019; 16: 139–146.
7. Nguyen TL, Aung YK, Evans CF, et al. Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk. Int J Epidemiol 2017; 46: 652–661.
8. Schmidt DF, Makalic E, Goudey B, et al. Cirrus: an automated mammography‐based measure of breast cancer risk based on textural features. JNCI Cancer Spectr 2018; 2: pky057.
9. Nguyen TL, Schmidt DF, Makalic E, et al. Novel mammogram‐based measures improve breast cancer risk prediction beyond an established mammographic density measure. Int J Cancer 2021; 148: 2193–2202.
10. Hopper JL. Genetics for population and public health. Int J Epidemiol 2017; 46: 8–11.
11. Freeman K, Geppert J, Stinton C, et al. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021; 374: n1872.

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Editorials

Abortion care in the 21st century

Caroline M Costa and Kirsten I Black

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51274
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

General medicine

Identifying inequity of access and assessing the effectiveness of interventions is difficult without systematic abortion data collection

The past two decades have seen major changes in both abortion law and abortion provision across Australia. Safe legal abortion is now available to all Australian women, and is accessible to many. Decriminalisation in all states and territories and legislated safety zones around abortion services have led to wider discussion of abortion in Australian society and softening of the attached stigma.1

1 The Cairns Institute, James Cook University, Cairns, QLD
2 The University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW

Correspondence: caroline.decosta@jcu.edu.au

Competing interests:

No relevant disclosures.

1. Miller E, Baird B. Abortion is no longer a crime in Australia. But legal hurdles to access remain. The Conversation (Australia), 4 Mar 2021. https://theconversation.com/abortion‐is‐no‐longer‐a‐crime‐in‐australia‐but‐legal‐hurdles‐to‐access‐remain‐156215 (viewed Aug 2021).
2. de Costa CM, Russell DB, de Costa NR, et al. Early medical abortion in Cairns, Queensland: July 2006 – April 2007. Med J Aust 2007; 187: 171–173. https://www.mja.com.au/journal/2007/187/3/early‐medical‐abortion‐cairns‐queensland‐july‐2006‐april‐2007
3. Goldstone P, Michelson J, Williamson E. Early medical abortion using low‐dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197: 282–286. https://www.mja.com.au/journal/2012/197/5/early‐medical‐abortion‐using‐low‐dose‐mifepristone‐followed‐buccal‐misoprostol
4. NPS MedicineWise. Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for medical termination of pregnancy of up to 49 days’ gestation. Aug 2013. https://www.nps.org.au/radar/articles/mifepristone‐mifepristone‐linepharma‐followed‐by‐misoprostol‐gy‐miso‐for‐medical‐termination‐of‐pregnancy‐of‐up‐to‐49‐days‐gestation#r39 (viewed Sept 2021).
5. Wellings K, Palmer MJ, Geary RS, et al. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study. Lancet 2016; 388: 586–595.
6. Centers for Disease Control and Prevention. Reproductive health: CDCs abortion surveillance system FAQs. Updated Nov 2020. https://www.cdc.gov/reproductivehealth/Data_Stats/Abortion.htm (viewed Sept 2021).
7. Keogh LA, Gurrin LC, Moore P. Estimating the Australian abortion rate from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215: 375–376.
8. Subasinghe AK, McGeechan K, Moulton JE, et al. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215: 366–370.
9. de Costa CM, Black KI, Russell DB. Medical abortion: it is time to lift restrictions. Med J Aust 2019; 211: 428–428.e1. https://www.mja.com.au/journal/2019/210/6/medical‐abortion‐it‐time‐lift‐restrictions.
10. Shankar M, Black KI, Goldstone P, et al. Access, equity and costs of induced abortion services in Australia: a cross‐sectional study. Aust N Z J Public Health 2017; 41: 309–314.
11. Australian Department of Health. National Women’s Health Strategy 2020–2030. https://www.health.gov.au/resources/publications/national‐womens‐health‐strategy‐2020‐2030 (viewed Aug 2021).

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Editorials

Self‐collection for HPV screening: a game changer in the elimination of cervical cancer

Karen Canfell, Megan A Smith and Deborah J Bateson

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51262
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Environment and public health

Self‐collection will facilitate new community‐led, co‐designed delivery models that could greatly increase the acceptability and uptake of screening

In December 2017, the Australian National Cervical Screening Program (NCSP) underwent a major renewal, transitioning from two‐yearly cytology screening for people with a cervix (“women”) aged 18‒20 to 69 years, to five‐yearly primary human papillomavirus (HPV) screening for women aged 25‒74 years. The NCSP renewal was driven by accumulated international evidence for the very high effectiveness of primary HPV screening for predicting current and future risk of pre‐cancerous lesions and invasive cancer.1 It was also prompted by the Australian HPV vaccination program that commenced in 2007, which has resulted in rapid population‐level reductions in the incidence of pre‐cancerous lesions in young women.2

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1 The Daffodil Centre at the University of Sydney (Cancer Council NSW/University of Sydney), Sydney, NSW
2 Family Planning New South Wales, Sydney, NSW
3 The University of Sydney, Sydney, NSW

Correspondence: karen.canfell@nswcc.org.au

Acknowledgements:

Karen Canfell receives salary support from the National Health and Medical Research Council (NHMRC; APP1194679). Megan Smith receives salary support from the NHMRC (APP1159491) and the Cancer Institute NSW (ECF181561).

Competing interests:

Karen Canfell is co‐principal investigator in an unrelated investigator‐initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), conducted and funded by the VCS Foundation, a Victorian government‐funded health promotion charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Systems USA. Neither Karen Canfell nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry for this trial or any other project.

1. Ronco G, Dillner J, Elfström KM, et al; International HPV screening working group. Efficacy of HPV‐based screening for prevention of invasive cervical cancer: follow‐up of four European randomised controlled trials. Lancet 2014; 383: 524–532.
2. Australian Institute of Health and Welfare. Cervical screening in Australia 2019 (Cat. no. CAN 124). May 2019. https://www.aihw.gov.au/reports/cancer‐screening/cervical‐screening‐in‐australia‐2019/summary 2019 (viewed Aug 2021).
3. Lew JB, Simms KT, Smith MA, et al. Primary HPV testing versus cytology‐based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program. Lancet Public Health 2017; 2: e96–e107.
4. Creagh NS, Zammit C, Brotherton JML, et al. Self‐collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. Med J Aust 2021; 215: 354–358.
5. Medical Services Advisory Committee. MSAC outcomes application no. 1276. Renewal of the National Cervical Screening Program. Apr 2014. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/D924E2F768B13C4BCA25801000123B9E/$File/1276%20‐%20Final%20MSAC%20PSD%20‐%20NCSP%20Renewal.pdf (viewed Aug 2021).
6. Arbyn M, Smith SB, Temin S, et al; Collaboration on Self‐Sampling and HPV Testing. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta‐analyses. BMJ 2018; 363: k4823.
7. Smith MA, Hall MT, Saville M, et al. Could HPV testing on self‐collected samples be routinely used in an organized cervical screening program? A modeled analysis. Cancer Epidemiol Biomarkers Prev 2021; 30: 268–77.
8. Medical Services Advisory Committee. MSAC application no. 1664 (public summary document). Apr 2021. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/69F7A5B132EA653ECA258646001B5CD5/$File/1664%20Final%20PSD%20‐%20Mar‐Apr%202021.pdf (viewed Aug 2021).
9. Davies‐Oliveira JC, Smith MA, Grover S, et al. Eliminating cervical cancer: progress and challenges for high‐income countries. J Clin Oncol (R Coll Radiol) 2021; 33: 550–559.
10. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
11. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem (Report no. 9789240014107). Nov 2020. https://www.who.int/publications/i/item/9789240014107 (viewed Aug 2021).
12. Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health 2019; 4: e19–e27.
13. NHMRC Centre of Research Excellence in Cervical Cancer Control. Cervical cancer elimination progress report: Australia’s progress towards the elimination of cervical cancer as a public health problem. Mar 2021. https://www.cervicalcancercontrol.org.au/wp‐content/uploads/2021/03/2021‐C4‐CRE‐Elim‐Report.pdf (viewed Aug 2021).
14. Whop LJ, Smith MA, Butler TL, et al. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144: 106314.

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Editorials

Treatment of alcohol problems: current status and future directions

Paul S Haber, Benjamin C Riordan and Kirsten C Morley

Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51265
Published online: 4 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Substance-related disorders

Scaling up the treatment of alcohol problems will lead to considerable health benefit across the nation

Alcohol is Australia’s most widely used drug, consumed by nearly 80% of the adult population.1 We lack recent prevalence data for alcohol use disorder in Australia but previous estimates vary from about 800 0002 to over a million.3 With such large numbers, it is quite a paradox that we are not better equipped to manage those who develop problems related to its use.

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1 Central Clinical School, University of Sydney, Sydney, NSW
2 Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW
3 Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
4 Centre for Alcohol Policy Research, Melbourne, VIC

Correspondence: paul.haber@sydney.edu.au

Competing interests:

Paul Haber has been funded by the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney to undertake clinical trials of cannabinoid treatment for alcohol withdrawal syndrome; has served on industry advisory boards for Indivior, AbbVie and Gilead; and has been an investigator on clinical trials supported by Camurus. He has also served on international and Australian advisory boards for Lundbeck in relation to nalmefene (2013–2015 and 2014, respectively).

1. Australian Institute of Health Welfare. Alcohol, tobacco and other drugs in Australia. Canberra: AIHW, 2021. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/about (viewed Aug 2021).
2. Teesson M, Hall W, Slade T, et al. Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Addiction 2010; 105: 2085–2094.
3. Mewton L, Slade T, McBride O, et al. An evaluation of the proposed DSM‐5 alcohol use disorder criteria using Australian national data. Addiction 2011; 106: 941–950.
4. Lensvelt E, Gilmore W, Liang W, et al. Estimated alcohol‐attributable deaths and hospitalisations in Australia, 2004 to 2015. National Alcohol Indicators, Bulletin 16. Perth: National Drug Research Institute, Curtin University, 2018. https://ndri.curtin.edu.au/ndri/media/documents/naip/naip016.pdf (viewed Aug 2021).
5. Gao C, Ogeil R, Lloyd B. Alcohol’s burden of disease in Australia. Canberra: FARE and VicHealth in collaboration with Turning Point, 2014. https://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/alcohol%20misuse/Alcohols-burden-of-disease-in-Australia.ashx (viewed Aug 2021).
6. Haber P, Riordan B. The guidelines for the treatment of alcohol problems. Sydney: University of Sydney, 2021. https://alcoholtreatmentguidelines.com.au/ (viewed Aug 2021).
7. Haber PS, Riordan BC, Winter DT, et al. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 (7 Suppl): S1–S32.
8. Connor JP, Haber PS, Hall WD. Alcohol use disorders. Lancet 2016; 387: 988–998.
9. Chapman C, Slade T, Hunt C, Teesson M. Delay to first treatment contact for alcohol use disorder. Drug Alcohol Depend 2015; 147: 116–121.
10. Morley KC, Logge W, Pearson SA, et al. National trends in alcohol pharmacotherapy: findings from an Australian claims database. Drug Alcohol Depend 2016; 166: 254–257.
11. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 (Cat. No. BOD 22). Canberra: AIHW, 2019. https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true (viewed Aug 2021).

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Perspectives

Screening for post‐stroke depression: who, when and how?

Katherine Sewell, Tamara Tse, Geoffrey A Donnan and Leeanne M Carey

Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51256
Published online: 4 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

General medicine

Mental disorders

What Australia can learn from overseas guidelines

Depression is a common sequela of stroke, with about 30% of stroke survivors developing depression.1 The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‐5) recognises post‐stroke depression within the category “Depressive disorder due to another medical condition”.2 Post‐stroke depression significantly hinders patients’ ability to participate in rehabilitation and is associated with poor health outcomes. Despite its high prevalence and negative impact, post‐stroke depression is vastly underdiagnosed.3 One estimate suggested that only 5% of stroke survivors are diagnosed with and treated for depression in routine clinical practice.4 Diagnosis of depression can be challenging in stroke survivors, especially in those who have residual communication and cognitive impairments.

1 La Trobe University, Melbourne, VIC
2 Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
3 St Vincent's Hospital, Melbourne, VIC
4 Melbourne Brain Centre at The Royal Melbourne Hospital, Melbourne, VIC

Correspondence: katherine.sewell@florey.edu.au

Acknowledgements:

Katherine Sewell is the recipient of a La Trobe University postgraduate scholarship for undertaking a PhD, which supported her during the writing of this article.

Competing interests:

No relevant disclosures.

1. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta‐analysis of observational studies. Int J Stroke 2014; 9: 1017–1025.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: APA Publishing, 2013.
3. Medeiros GC, Roy D, Kontos N, Beach SR. Post‐stroke depression: a 2020 updated review. Gen Hosp Psychiatry 2020; 66: 70–80.
4. Swartz RH, Bayley M, Lanctôt KL, et al. Post‐stroke depression, obstructive sleep apnea, and cognitive impairment: rationale for, and barriers to, routine screening. Int J Stroke 2016; 11: 509–518.
5. Ayerbe L, Ayis S, Crichton S, et al. The natural history of depression up to 15 years after stroke: the South London Stroke Register. Stroke 2013; 44: 1105–1010.
6. Towfighi A, Ovbiagele B, El Husseini N, et al. Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2017; 48: e30–e43.
7. Stroke Foundation. Clinical guidelines for stroke management. Melbourne: Stroke Foundation, 2021. https://informme.org.au/en/Guidelines/Clinical‐Guidelines‐for‐Stroke‐Management (viewed Aug 2021).
8. Gilbody S, Sheldon T, House A. Screening and case‐finding instruments for depression: a meta‐analysis. CMAJ 2008; 178: 997–1003.
9. Lynch EA, Mackintosh S, Luker JA, Hillier SL. Access to rehabilitation for patients with stroke in Australia. Med J Aust 2019; 210: 21–26. https://www.mja.com.au/journal/2019/210/1/access‐rehabilitation‐patients‐stroke‐australia
10. Stroke Foundation. National Stroke Audit: rehabilitation services report 2020. Melbourne: Stroke Foundation, 2016. https://informme.org.au/stroke‐data/Rehabilitation‐audits (viewed Aug 2021).
11. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50: e344–e418.
12. Heart and Stroke Foundation of Canada. Canadian stroke best practices. Mood, cognition and fatigue following stroke: post stroke depression. www.strokebestpractices.ca/recommendations/mood‐cognition‐and‐fatigue‐following‐stroke/post‐stroke‐depression (viewed Aug 2021).
13. Royal College of Physicians. National clinical guideline for stroke. 5th ed. London: RCP, 2016. www.rcplondon.ac.uk/guidelines‐policy/stroke‐guidelines (viewed Aug 2021).
14. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th ed. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed Aug 2021).
15. Colquhoun DM, Bunker SJ, Clarke DM, et al. Screening, referral and treatment for depression in patients with coronary heart disease. Med J Aust 2013; 198: 483–484. https://www.mja.com.au/journal/2013/198/9/screening‐referral‐and‐treatment‐depression‐patients‐coronary‐heart‐disease

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Perspectives

Reforming our health care system: time to rip off the band‐aid?

Claire L Jackson and Diana O’Halloran

Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51261
Published online: 4 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

The health reform imperative is clear; it now requires national courage and leadership to implement it

While Australia has traditionally delivered some of the best health care outcomes in the world,1 there are increasing signs that our strained health care system is pushing the stress performance curve into the red. Benchmarks of hospital activity demonstrate ongoing difficulty;2 Local Hospital Networks scramble to meet demand despite annual federal government funding increases of 6.5%; and the grey literature attests to the unfolding human impact behind the figures.3 Patients deteriorate waiting for specialist assessment,4 and junior doctors find themselves trapped in increasingly overstretched, dysfunctional work environments. The much‐reviewed experience of Yumiko Kadota is not an isolated incident, with similar experiences documented regularly by doctors‐in‐training nationwide.5

1 University of Queensland, Brisbane, QLD
2 MRI‐UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, QLD
3 University of Western Sydney, Sydney, NSW

Correspondence: c.jackson@uq.edu.au

Competing interests:

No relevant disclosures.

1. Commonwealth Fund. Mirror, mirror: comparing health systems across countries. https://www.commonwealthfund.org/series/mirror‐mirror‐comparing‐health‐systems‐across‐countries (viewed Aug 2021).
2. Judkins S, Bonning J, Skinner C. Emergency Physicians call for whole‐of‐system reform. InSight+ 2021; 14 June. https://insightplus.mja.com.au/2021/21/emergency‐physicians‐call‐for‐whole‐of‐system‐reform/ (viewed July 2021).
3. Sakkal P. “People are dying in ambulances”: health ministers say nation gripped by health crisis, call for NDIS fix. Sydney Morning Herald 2021; 16 May. https://www.smh.com.au/healthcare/people‐are‐dying‐in‐ambulances‐health‐ministers‐say‐nation‐gripped‐by‐health‐crisis‐call‐for‐ndis‐fix‐20210514‐p57rx7.html#comments (viewed July 2021).
4. Naiker U, FitzGerald G, Dulhunty JM, Rosemann M. Time to wait: a systematic review of strategies that affect out‐patient waiting times. Aust Health Rev 2018; 42: 286–293.
5. Medical Board of Australia; Ahpra. Medical Training Survey 2020: report for the Royal Australian and New Zealand College of Ophthalmologists. https://www.medicaltrainingsurvey.gov.au/Download/2020/2020%20MTS%20Report%20for%20RANZCO.pdf (viewed July 2021).
6. Consumers Health Forum of Australia; George Institute for Global Health; University of Queensland. Snakes and ladders: the journey to primary care integration. CHF, 2018. https://chf.org.au/publications/snakes‐ladders‐journey‐primary‐care‐integration (viewed July 2021).
7. Department of Health, Australian Government. Draft recommendations: discussion paper to inform the development of the Primary Health Reform Steering Group recommendations on the Australian Government’s Primary Health Care 10 Year Plan. https://www.health.gov.au/resources/publications/draft‐recommendations‐from‐the‐primary‐health‐reform‐steering‐group (viewed Sept 2021).
8. New Zealand Ministry of Health. Better, sooner, more convenient health care in the community. Wellington: Ministry of Health, 2011. https://www.health.govt.nz/publication/better‐sooner‐more‐convenient‐health‐care‐community (viewed July 2021).
9. Brawley T. Oregon’s CCO approach is a model for reduced health care spending, study finds. OHSU, 2017. https://news.ohsu.edu/2017/03/07/oregons‐cco‐approach‐is‐a‐model‐for‐reduced‐health‐care‐spending‐study‐finds (viewed July 2021).
10. NSW Health. NSW Health submission to the Inquiry into Chronic Disease Prevention and Management in Primary Health Care [Submission No. 152]. https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health/Chronic_Disease/Submissions (viewed July 2021).
11. Cheung NW, Crampton M, Nesire V, et al. Model for integrated care for chronic disease in the Australian context: Western Sydney Integrated Care Program. Aust Health Rev 2019; 43: 565–571.
12. Meyerowitz‐Katz G, Bramwell S, Jayaballa R, et al. Effectiveness of joint specialist case conferences for building general practice capacity to enhance diabetes care: a pilot study in Western Australia. J Integr Care 2018; 26: 199–210.
13. Benson H, Lucas C, Benrimoj SI, et al. Pharmacists in general practice: recommendations resulting from team‐based collaborative care. Aust J Prim Health 2018; 24: 448–454.
14. Correll P, Feyer AM, Phan PT, et al. Lumos: a state wide linkage programme in Australia integrating general practice data to guide system design. Integrated Healthcare Journal 2021; 3: e000074.
15. Australian Digital Health Agency, Australian Government. Innovation Challenge winner: CareMonitor. https://www.digitalhealth.gov.au/newsroom/innovation/innovation‐challenge‐winner‐caremonitor (viewed July 2021).
16. Council on Federal Financial Relations. Addendum to National Health Reform Agreement 2020–2025. https://www.federalfinancialrelations.gov.au/content/npa/health/other/NHRA_2020‐25_Addendum_consolidated.pdf (viewed Aug 2021).

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Research

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children

Jane Oliver, Shidan Tosif, Lai‐yang Lee, Anna‐Maria Costa, Chelsea Bartel, Katherine Last, Vanessa Clifford, Andrew Daley, Nicole Allard, Catherine Orr, Ashley Nind, Karyn Alexander, Niamh Meagher, Michelle Sait, Susan A Ballard, Eloise Williams, Katherine Bond, Deborah A Williamson, Nigel W Crawford and Katherine B Gibney

Med J Aust 2021; 215 (6): . || doi: 10.5694/mja2.51188
Published online: 20 September 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

General medicine

Environment and public health

Pediatric medicine

Abstract

Objective: To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice.

Design: Prospective multicentre diagnostic validation study.

Setting: Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020.

Participants: 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing.

Main outcome measures: Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type.

Results: SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%).

Conclusion: In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.

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1 The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
2 The Royal Children’s Hospital, Melbourne, VIC
3 Melbourne Medical School, University of Melbourne, Melbourne, VIC
4 The Royal Women’s Hospital, Melbourne, VIC
5 cohealth, Melbourne, VIC
6 Cirqit Health, Melbourne, VIC
7 The University of Melbourne, Melbourne, VIC
8 Public Health Laboratory, University of Melbourne, Melbourne, VIC
9 Royal Melbourne Hospital, Melbourne, VIC
10 Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, VIC
11 Melbourne Health, Melbourne, VIC
12 Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Children’s Research Institute, Melbourne, VIC

Correspondence: jane.oliver@unimelb.edu.au

Acknowledgements:

Our study was supported by a donation from the Isabel and John Gilbertson Charitable Trust. We acknowledge all participants, and the clinical, administrative and laboratory staff who assisted our study at the Royal Children’s Hospital Melbourne, cohealth, Cirqit Health, the Microbiological Diagnostic Unit Public Health Laboratory, Golden Messenger, the Royal Melbourne Hospital, and the University of Melbourne.

Competing interests:

No relevant disclosures.

1. Public Health Laboratory Network. PHLN guidance on laboratory testing for SARS‐CoV‐2 (the virus that causes COVID‐19), version 1.16. Updated Feb 2021. https://www.health.gov.au/resources/publications/phln-guidance-on-laboratory-testing-for-sars-cov-2-the-virus-that-causes-covid-19 (viewed May 2021).
2. Fernandes LL, Pacheco VB, Borges L, et al. Saliva in the diagnosis of COVID‐19: a review and new research directions. J Dent Res 2020; 99: 1435–1443.
3. Kivelä JM, Jarva H, Lappalainen M, Kurkela S. Saliva‐based testing for diagnosis of SARS‐CoV‐2 infection: a meta‐analysis. J Med Virol 2021; 93: 1256–1258.
4. Khiabani K, Amirzade‐Iranaq MH. Are saliva and deep throat sputum as reliable as common respiratory specimens for SARS‐CoV‐2 detection? A systematic review and meta‐analysis. Am J Infect Control 2021; https://doi.org/10.1016/j.ajic.2021.03.008 [online ahead of print].
5. Buban JM, Villanueva PN, Gregorio GEV. Should RT‐PCR of saliva samples be used for diagnosis of COVID‐19? (Philippine COVID‐19 Living Clinical Practice Guidelines). Updated 15 Mar 2021. https://www.psmid.org/wp-content/uploads/2021/05/SALIVA-RT-PCR-CPG-FINAL_031521_MMA.pdf (viewed May 2021).
6. Tsang NNY, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS‐CoV‐2 RT‐PCR testing: a systematic review and meta‐analysis. Lancet Infect Dis 2021; https://doi.org/10.1016/S1473-3099(21)00146-8 [online ahead of print].
7. Zhu J, Guo J, Xu Y, Chen X. Viral dynamics of SARS‐CoV‐2 in saliva from infected patients. J Infect 2020; 81: e48–e50.
8. Ruggiero A, Sanguinetti M, Gatto A, et al. Diagnosis of COVID‐19 infection in children: less nasopharyngeal swabs, more saliva. Acta Paediatr 2020; 109: 1913–1914.
9. Chong CY, Kam KQ, Li J, et al. Saliva is not a useful diagnostic specimen in children with coronavirus disease 2019 [letter]. Clin Infect Dis 2020; https://doi.org/10.1093/cid/ciaa1376 [online ahead of print].
10. Han MS, Seong MW, Kim N, et al. Viral RNA load in mildly symptomatic and asymptomatic children with COVID‐19, Seoul, South Korea. Emerg Infect Dis 2020; 26: 2497–2499.
11. Yee R, Truong TT, Pannaraj PS, et al. Saliva is a promising alternative specimen for the detection of SARS‐CoV‐2 in children and adults. J Clin Microbiol 2021; 59: e02686–20.
12. Huber M, Schreiber PW, Scheier T, et al. High efficacy of saliva in detecting SARS‐CoV‐2 by RT‐PCR in adults and children. Microorganisms 2021; 9: 642.
13. Fougère Y, Schwob JM, Miauton A, et al. Performance of RT‐PCR on saliva specimens compared to nasopharyngeal swabs for the detection of SARS‐CoV‐2 in children: a prospective comparative clinical trial [preprint]. medRxiv , 1 Mar 2021. https://doi.org/10.1101/2021.02.27.21252571 (viewed May 2021).
14. Felix AC, De Paula AV, Ribeiro AC, et al. Saliva as a reliable sample for COVID‐19 diagnosis in paediatric patients [preprint]. medRxiv , 31 Mar 2021. https://doi.org/10.1101/2021.03.29.21254566 (viewed May 2021).
15. Al Suwaidi H, Senok A, Varghese R, et al. Saliva for molecular detection of SARS‐CoV‐2 in school‐age children. Clin Microbiol Infect 2021; https://doi.org/10.1016/j.cmi.2021.02.009 [online ahead of print].
16. Department of Health and Human Services (Victoria). Assessment and testing criteria for coronavirus (COVID‐19). Updated 9 Apr 2021. https://www.dhhs.vic.gov.au/assessment-and-testing-criteria-coronavirus-covid-19 (viewed May 2021).
17. Department of Health and Human Services (Victoria). Coronavirus (COVID‐19). https://www.dhhs.vic.gov.au/coronavirus (viewed May 2021).
18. Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 2016; 6: e012799.
19. Williams E, Bond K, Zhang B, et al. Saliva as a noninvasive specimen for detection of SARS‐CoV‐2. J Clin Microbiol 2020; 58: e00776–20.
20. Ku CW, Shivani D, Kwan JQT, et al. Validation of self‐collected buccal swab and saliva as a diagnostic tool for COVID‐19. Int J Infect Dis 2021; 104: 255–261.
21. Zimba R, Kulkarni S, Berry A, et al; the CHASING COVID Cohort Study Team. Testing, testing: what SARS‐CoV‐2 testing services do adults in the United States actually want? [preprint]. medRxiv, 18 Sept 2020. https://doi.org/10.1101/2020.09.15.20195180 (viewed May 2021).
22. Communicable Diseases Network Australia. Coronavirus disease 2019 (COVID‐19): CDNA national guidelines for public health units; version 3.1. Updated 4 June 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm (viewed May 2021).
23. Caulley L, Corsten M, Eapen L, et al. Salivary detection of COVID‐19. Ann Intern Med 2021; 174: 131–133.
24. Byrne RL, Kay GA, Kontogianni K, et al. Saliva offers a sensitive, specific and non‐invasive alternative to upper respiratory swabs for SARS‐CoV‐2 diagnosis [pre‐print]. medRxiv, 11 July 2020. https://doi.org/10.1101/2020.07.09.20149534 (viewed May 2021).
25. Landry ML, Criscuolo J, Peaper DR. Challenges in use of saliva for detection of SARS CoV‐2 RNA in symptomatic outpatients. J Clin Virol 2020; 130: 104567.
26. Vogels CBF, Watkins AE, Harden CA, et al. SalivaDirect: a simplified and flexible platform to enhance SARS‐CoV‐2 testing capacity. Med (NY) 2021; 2: 263–280.
27. Ceron JJ, Lamy E, Martinez‐Subiela S,et al. Use of saliva for diagnosis and monitoring the SARS‐CoV‐2: a general perspective. J Clin Med 2020; 9: 1491.

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