MJA
MJA

    Sexual and reproductive health and rights in Australia: we have much to celebrate but must not be complacent

    Catriona Melville and Bonney Corbin
    Med J Aust || doi: 10.5694/mja2.52194
    Published online: 29 January 2024

    In a world where sexual and reproductive injustice continues, Australia has been quietly making changes for the better. Australian sexual and reproductive health law reforms have been prodigious in recent years: we have seen more changes in the past six years than in the previous 60. Alongside Australia's progression, however, sexual and reproductive rights have been considerably eroded in other countries. How does the global context of reproductive rights affect Australia? And how can we protect not only our hard‐fought liberties but also ensure they are equitable and clinically fit for purpose?

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      Socio‐economic status and access to fluoridated water in Queensland: an ecological data linkage study

      Christopher T Sexton, Diep H Ha, Thu Le, Ratilal Lalloo, Pauline Ford, Loc G Do and Nicole Stormon
      Med J Aust || doi: 10.5694/mja2.52196
      Published online: 22 January 2024

      Abstract

      Objectives: To investigate the relationship between access to fluoridated drinking water and area‐level socio‐economic status in Queensland.

      Study design: Ecological, geospatial data linkage study.

      Setting: Queensland, by statistical area level 2 (SA2), 2021.

      Main outcome measures: Proportion of SA2s and of residents with access to fluoridated drinking water (natural or supplemented); relationship at SA2 level between access to fluoridated water and socio‐economic status (Index of Relative Socio‐economic Advantage and Disadvantage, IRSAD; Index of Economic Resources, IER).

      Results: In 2021, an estimated 4 050 168 people (79.4% of the population) and 397 SA2 regions (72.7%) in Queensland had access to fluoridated water. Access was concentrated in the southeastern corner of the state. After adjusting for SA2 population, log area, and population density, the likelihood of access to fluoridated drinking water almost doubled for each 100‐rank increase in IRSAD (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.59–2.36) or IER (aOR, 1.77; 95% CI, 1.50–2.11).

      Conclusions: The 2012 decision to devolve responsibility for water fluoridation decisions and funding from the Queensland government to local councils means that residents in lower socio‐economic areas are less likely to have access to fluoridated water than those in more advantaged areas, exacerbating their already greater risk of dental disease. Queensland water fluoridation policy should be revised so that all residents can benefit from this evidence‐based public health intervention for reducing the prevalence of dental caries.

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      • 1 The University of Queensland, Brisbane, QLD
      • 2 Metro North Hospital and Health Service, Queensland Health, Brisbane, QLD


      Correspondence: c.sexton@uq.edu.au
      Acknowledgements: 

      We acknowledge Queensland Health for providing access to the water fluoridation data for this article.

      Competing interests:

      No relevant disclosures.

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        The Australian Government's new vaping policy should be part of a larger plan towards a tobacco endgame

        Samantha Howe, Driss Ait Ouakrim, Tony Blakely and Coral E Gartner
        Med J Aust || doi: 10.5694/mja2.52197
        Published online: 22 January 2024

        The Australian Minister for Health and Aged Care, Mark Butler, made a strong push to address the growing problem of youth vaping in his speech at the National Press Club in May 2023.1 While new approaches to controlling youth vaping are urgently needed, it is critical that policy reforms to end the tobacco cigarette epidemic are also pursued with equal vigour — otherwise we risk shifting people currently using vapes to tobacco smoking. In this article, we argue that Australia should leverage its strong vaping regulation to commit in parallel to an ambitious commercial tobacco endgame to rapidly minimise smoking.

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        • 1 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
        • 2 School of Public Health, University of Queensland, Brisbane, QLD


        Correspondence: howe.s@unimelb.edu.au


        Open access:

        Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

        Competing interests:

        Coral Gartner is currently funded by the National Health and Medical Research Council (GNT1198301) towards the Centre for Research Excellence on Achieving the Tobacco Endgame (2020–2025). She also receives funding from an Australian Research Council Fellowship (FT220100186) to develop new regulatory options to minimise the legal and illegal tobacco markets (2023–2026). Tony Blakely and Ait Ouakrim were contracted by the Aotearoa NZ Health Ministry (2021–2022) to undertake modelling of the Smokefree Aotearoa 2025 Action Plan.

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          Providing Australian children and adolescents with equitable access to new and emerging therapies through clinical trials: a call to action

          Michelle S Lorentzos, David Metz, Andrew S Moore, Laura K Fawcett, Paula Bray, Lani Attwood, Craig F Munns and Andrew Davidson
          Med J Aust || doi: 10.5694/mja2.52191
          Published online: 15 January 2024

          Opportunities for children to benefit from novel therapies have increased substantially over the past decade. Change is needed to maximise these opportunities, particularly in the paediatric trial environment. Investment and a coordinated national approach are needed to prevent Australian children falling behind their international peers. There is international recognition that collaborative approaches and strategic investment in paediatric clinical trials reap benefits in terms of access to clinical trials and new therapies. This article exemplifies a multi‐state collaboration and presents a united call to action to prioritise paediatric clinical trials, by strategically investing in effective governance and infrastructure, and a shift in culture that embeds clinical trials in the core business of paediatric health care and academic institutions.

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          • 1 Kids Research, Sydney Children's Hospitals Network, Sydney, NSW
          • 2 University of Sydney, Sydney, NSW
          • 3 Monash Children's Clinical Trial Centre, Monash Children's Hospital, Melbourne, VIC
          • 4 Monash University, Melbourne, VIC
          • 5 Child Health Research Centre, University of Queensland, Brisbane, QLD
          • 6 Queensland Children's Hospital, Brisbane, QLD
          • 7 University of New South Wales, Sydney, NSW
          • 8 Sydney Children's Hospitals Network, Sydney, NSW
          • 9 Royal Children's Hospital, Melbourne, VIC
          • 10 Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, VIC



          Open access:

          Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.
           

          Competing interests:

          The Murdoch Children's Research Institute and Sydney Children's Hospitals Network have received funding from Roche to aid in building capacity for gene therapy in Australia. All authors’ hospitals and/or institutions are active sites for pharmaceutical company‐sponsored clinical trials and receive enrolment‐based reimbursement on a trial‐by‐trial basis, but do not receive direct funding for clinical trials capacity or capability building unless stated above.

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          • 35. Ward RM, Benjamin DK Jr, Davis JM, et al. The need for pediatric drug development. J Pediatr 2018; 192: 13‐21.
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          • 37. Bhatnagar M, Sheehan S, Sharma I, et al. Prospect of direct benefit in pediatric trials: practical challenges and potential solutions. Pediatrics 2021; 147: e2020049602.
          • 38. Liu Q, Ahadpour M, Rocca M, Huang SM. Clinical pharmacology regulatory sciences in drug development and precision medicine: current status and emerging trends. AAPS J 2021; 23: 54.
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            Rationale and plan for a focus on First Nations urban health research in Australia

            Janet Stajic, Adrian Carson and James Ward
            Med J Aust || doi: 10.5694/mja2.52181
            Published online: 15 January 2024

            Urbanisation is a global phenomenon. The World Health Organization reported in 2015 that 55% of the global population lived in cities and is predicting this to increase to 68% by 2050.1 First Nations peoples globally are disproportionately affected by urbanisation, with major drivers being climate change, deforestation and increased pressures created by globalisation. Despite this, there is limited research to address urbanisation and its impact on human health and wellbeing. Similarly, there is an urgent need for a focus on improving health and wellbeing outcomes for urban First Nations peoples in Australia given the rapid urbanisation of First Nations people.

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            • 1 UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
            • 2 Institute for Urban Indigenous Health, Brisbane, QLD


            Correspondence: j.stajic@uq.edu.au


            Open access:

            Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.

            Acknowledgements: 

            The UQ Poche Centre for Indigenous Health is generously supported by philanthropists Greg Poche AO and Kay Van Norton Poche. We acknowledge Dr Anton Clifford‐Motopi of the UQ Poche Centre for undertaking yarning sessions with members of the Research Alliance for Urban Community‐Controlled Health Services and analysis to inform and develop its research priorities.

            Competing interests:

            No relevant disclosures.

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              The burden of occupational injury attributable to high temperatures in Australia, 2014–19: a retrospective observational study

              Blesson M Varghese, Alana Hansen, Nick Mann, Jingwen Liu, Ying Zhang, Tim R Driscoll, Geoffrey G Morgan, Keith Dear, Anthony Capon, Michelle Gourley, Vanessa Prescott, Vergil Dolar and Peng Bi
              Med J Aust 2023; 219 (11): . || doi: 10.5694/mja2.52171
              Published online: 11 December 2023

              Abstract

              Objectives: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat‐attributable occupational injury in Australia.

              Study design, setting: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014–19, based on Safe Work Australia (work‐related traumatic injury fatalities and workers’ compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta‐analysis of climate zone‐specific risk data.

              Main outcome measure: Burden of heat‐attributable occupational injuries as disability‐adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen–Geiger climate zone, and by state and territory.

              Results: During 2014–19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury‐related DALYs were attributable to heat (2.3% of occupational injury‐related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat‐attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat‐attributable occupational injury‐related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%).

              Conclusion: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry‐based policies are needed to safeguard workplace health and safety, particularly in heat‐exposed industries, such as agriculture, transport, and construction.

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              • 1 The University of Adelaide, Adelaide, SA
              • 2 Australian Institute of Health and Welfare, Canberra, ACT
              • 3 The University of Sydney, Sydney, NSW
              • 4 Centre for Rural Health, the University of Sydney, Lismore, NSW
              • 5 Monash Sustainable Development Institute, Monash University, Melbourne, VIC


              Correspondence: peng.bi@adelaide.edu.au


              Open access:

              Open access publishing facilitated by The University of Adelaide, as part of the Wiley ‐ The University of Adelaide agreement via the Council of Australian University Librarians.

              Acknowledgements: 

              This investigation was funded by the Australian Research Council with a Discovery Project grant (DP200102571) to Peng Bi. We gratefully acknowledge the Australian Institute of Health and Welfare for providing YLD estimates and supplying the disability weights and life tables produced by the Global Burden of Disease study, for providing methodological input, and for their assistance and guidance throughout the project. We acknowledge Safe Work Australia for providing deaths data for calculating YLLs and workers’ compensation claims data for calculating YLDs. We thank Syeda Hira Fatima and Matthew Borg (University of Adelaide) for their assistance with data analysis.

              Competing interests:

              No relevant disclosures.

              • 1. Varghese BM, Barnett AG, Hansen AL, et al. The effects of ambient temperatures on the risk of work‐related injuries and illnesses: evidence from Adelaide, Australia 2003–2013. Environ Res 2018; 170: 101‐109.
              • 2. Varghese BM, Barnett AG, Hansen AL, et al. Geographical variation in risk of work‐related injuries and illnesses associated with ambient temperatures: a multi‐city case‐crossover study in Australia, 2005–2016. Sci Total Environ 2019; 687: 898‐906.
              • 3. Varghese BM, Barnett AG, Hansen AL, et al. Characterising the impact of heatwaves on work‐related injuries and illnesses in three Australian cities using a standard heatwave definition: Excess Heat Factor (EHF). J Expo Sci Environ Epidemiol 2019; 29: 821‐830.
              • 4. Xiang J, Hansen A, Pisaniello D, Bi P. Extreme heat and occupational heat illnesses in South Australia, 2001–2010. Occup Environ Med 2015; 72: 580‐586.
              • 5. Varghese B, Hansen A, Bi P, Pisaniello D. Are workers at risk of occupational injuries due to heat exposure? A comprehensive literature review. Saf Sci 2018; 110: 380‐392.
              • 6. 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; 398: 1619‐1662.
              • 7. Martínez‐Solanas È, López‐Ruiz M, Wellenius GA, et al. Evaluation of the impact of ambient temperatures on occupational injuries in Spain. Environ Health Perspect 2018; 126: 067002.
              • 8. Concha‐Barrientos M, Nelson DI, Fingerhut M, et al. The global burden due to occupational injury. Am J Ind Med 2005; 48: 470‐481.
              • 9. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018 (cat. no. BOD 29). 24 Nov 2021. https://www.aihw.gov.au/reports/burden‐of‐disease/abds‐impact‐and‐causes‐of‐illness‐and‐death‐in‐aus/summary (viewed Jan 2023).
              • 10. Beck HE, Zimmermann NE, McVicar TR, et al. Present and future Koppen–Geiger climate classification maps at 1‐km resolution. Sci Data 2018; 5: 180214.
              • 11. Safe Work Australia. Work‐related traumatic injury fatalities time series. Updated 14 Nov 2022. https://www.safeworkaustralia.gov.au/doc/work‐related‐traumatic‐injury‐fatality‐time‐series (viewed Jan 2023).
              • 12. Safe Work Australia. National dataset for compensation‐based statistics 3rd edition (revision 1). 20 Mar 2020. https://www.safeworkaustralia.gov.au/doc/national‐dataset‐compensation‐based‐statistics‐3rd‐edition‐revision‐1 (viewed Jan 2023).
              • 13. Australian Institute of Health and Welfare. National Hospitals Data Collection. Updated 3 June 2022. https://www.aihw.gov.au/about‐our‐data/our‐data‐collections/national‐hospitals‐data‐collection (viewed Jan 2023).
              • 14. Queensland Government. SILO: Australian climate data from 1889 to yesterday. 2023. https://www.longpaddock.qld.gov.au/silo (viewed Jan 2023).
              • 15. Stone G, Dalla Pozza R, Carter J, McKeon G. Long Paddock: climate risk and grazing information for Australian rangelands and grazing communities. Rangeland Journal 2019; 41: 225‐232.
              • 16. Australian Bureau of Statistics. Australian Statistical Geography Standard (AGCS). Vol. 1: main structure and greater capital city statistical areas, July 2016 (1270.0.55.001). 12 July 2016. https://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.001 (viewed Feb 2022).
              • 17. Australian Bureau of Statistics. 2016 Census: counting persons, place of usual residence (MB) by Main Statistical Area Structure (Main ASGS) (UR) by LFSP Labour Force Status [Census TableBuilder]. 8 Nov 2021. https://www.abs.gov.au/statistics/microdata‐tablebuilder/tablebuilder (viewed Nov 2021).
              • 18. Liu J, Hansen A, Varghese BM, et al. Estimating the burden of disease attributable to high ambient temperature across climate zones: methodological framework with a case study. Int J Epidemiol 2023; 52: 783‐795.
              • 19. Burkart KG, Brauer M, Aravkin AY, et al. Estimating the cause‐specific relative risks of non‐optimal temperature on daily mortality: a two‐part modelling approach applied to the Global Burden of Disease Study. Lancet 2021; 398: 685‐697.
              • 20. Tobías A, Hashizume M, Honda Y, et al. Geographical variations of the minimum mortality temperature at a global scale: a multicountry study. Environ Epidemiol 2021; 5: e169.
              • 21. Fatima SH, Rothmore P, Giles LC, et al. Extreme heat and occupational injuries in different climate zones: a systematic review and meta‐analysis of epidemiological evidence. Environ Int 2021; 148: 106384.
              • 22. Dally M, Butler‐Dawson J, Sorensen CJ, et al. Wet bulb globe temperature and recorded occupational injury rates among sugarcane harvesters in southwest Guatemala. Int J Environ Res Public Health 2020; 17: 8195.
              • 23. Marinaccio A, Scortichini M, Gariazzo C, et al; BEEP Collaborative Group. Nationwide epidemiological study for estimating the effect of extreme outdoor temperature on occupational injuries in Italy. Environ Int 2019; 133: 105176.
              • 24. Intergovernmental Panel on Climate Change. Climate change 2022. Impacts, adaptation and vulnerability. Summary for policymakers. 2022. https://www.ipcc.ch/report/ar6/wg2 (viewed Mar 2022).
              • 25. Beggs PJ, Zhang Y, McGushin A, et al. The 2021 report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust 2021; 215: 390‐392. https://www.mja.com.au/journal/2021/215/9/2021‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐australia
              • 26. Shaffer RM, Sellers SP, Baker MG, et al. Improving and expanding estimates of the global burden of disease due to environmental health risk factors. Environ Health Perspect 2019; 127: 105001.
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                Planetary health: a new standard for medical education

                Catherine GA Pendrey, Sonia Chanchlani, Laura J Beaton and Diana L Madden
                Med J Aust 2023; 219 (11): . || doi: 10.5694/mja2.52158
                Published online: 11 December 2023

                The Australian Medical Council (AMC) recently released updates to the National Framework for Prevocational (PGY1 and PGY2) Medical Training and the Standards for Assessment and Accreditation of Primary Medical Programs (medical school standards). Together, these cover all medical school programs in Australia and Aotearoa New Zealand and all accredited prevocational training programs in Australia.1,2 In a significant development, the standards recognise the health impacts of climate change, the need for environmentally sustainable health practice,3 and planetary health.4 This welcome and necessary development comes as climate and environmental health indicators deteriorate. All medical education institutions should now integrate planetary health into curricula to ensure the profession is equipped to respond to the unfolding planetary health crisis and realise environmentally sustainable health care.

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                • 1 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
                • 2 Climate and Environmental Medicine Specific Interests Group, Royal Australian College of General Practitioners, Melbourne, VIC
                • 3 Melbourne Medical School, University of Melbourne, Melbourne, VIC
                • 4 Doctors for the Environment Australia, Melbourne, VIC
                • 5 University of Notre Dame Australia, Sydney, NSW
                • 6 Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians, Sydney, NSW



                Open access:

                Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.

                Acknowledgements: 

                We thank all who have contributed to advancing planetary health education and practice in Australia, Aotearoa New Zealand, and globally.

                Competing interests:

                No relevant disclosures.

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                  Disruption of gender‐affirming health care, and COVID‐19 illness, testing, and vaccination among trans Australians during the pandemic: a cross‐sectional survey

                  Sav Zwickl, Tomi Ruggles, Alex FQ Wong, Ariel Ginger, Lachlan M Angus, Kalen Eshin, Teddy Cook and Ada S Cheung
                  Med J Aust || doi: 10.5694/mja2.52169
                  Published online: 11 December 2023

                  Abstract

                  Objectives: To assess rates of disruption of gender‐affirming health care, of coronavirus disease 2019 (COVID‐19) illness, testing, and vaccination, and of discrimination in health care among Australian trans people during the COVID‐19 pandemic.

                  Design, setting: Online cross‐sectional survey (1–31 May 2022); respondents were participants recruited by snowball sampling for TRANSform, an Australian longitudinal survey‐based trans health study, 1 May – 30 June 2020.

                  Participants: People aged 16 years or older, currently living in Australia, and with a gender different to their sex recorded at birth.

                  Main outcome measures: Proportions of respondents who reported disruptions to gender‐affirming health care, COVID‐19 illness, testing, and vaccination, and positive and negative experiences during health care.

                  Results: Of 875 people invited, 516 provided valid survey responses (59%). Their median age was 33 years (interquartile range, 26–45 years); 193 identified as women or trans women (37%), 185 as men or trans men (36%), and 138 as non‐binary (27%). Of 448 respondents receiving gender‐affirming hormone therapy, 230 (49%) reported disruptions to treatment during the pandemic; booked gender‐affirming surgery had been cancelled or postponed for 37 of 85 respondents (44%). Trans‐related discrimination during health care was reported by a larger proportion of participants than in a pre‐pandemic survey (56% v 26%). COVID‐19 was reported by 132 respondents (26%), of whom 49 reported health consequences three months or more after the acute illness (37%; estimated Australian rate: 5–10%). Three or more COVID‐19 vaccine doses were reported by 448 participants (87%; Australian adult rate: 70%).

                  Conclusions: High rates of COVID‐19 vaccination among the trans people we surveyed may reflect the effectiveness of LGBTIQA+ community‐controlled organisation vaccination programs and targeted health promotion. Training health care professionals in inclusive services for trans people could improve access to appropriate health care and reduce discrimination.

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                  • 1 The University of Melbourne, Melbourne, VIC
                  • 2 Austin Health, Melbourne, VIC
                  • 3 La Trobe University, Melbourne, VIC
                  • 4 ACON, Sydney, NSW


                  Correspondence: adac@unimelb.edu.au


                  Open access:

                  Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.


                  Data sharing statement

                  De‐identified participant data are available upon reasonable request to the corresponding author (adac@unimelb.edu.au), provided that the aim of the request is deemed to be of benefit to the trans and gender‐diverse community and has received Austin Health Human Research Ethics Committee approval (as an amendment).

                  Acknowledgements: 

                  We thank the Melbourne Clinical and Translational Sciences (MCATS) research platform staff for the administrative and technical support that facilitated this investigation. Ada Cheung is supported by a National Health and Medical Research Council Investigator Grant (2008956).

                  Competing interests:

                  No relevant disclosures.

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                    Invisible wounds of the Israel–Gaza war in Australia

                    Susan J Rees and Batool Moussa
                    Med J Aust || doi: 10.5694/mja2.52168
                    Published online: 20 November 2023

                    Among the many dire consequences of the Israel–Gaza war that began in October 2023, the impact on the mental health of populations living in multicultural Western countries is significant and should not be overlooked1. The psychosocial reverberations of the conflict are felt in societies throughout the world, embodying unique characteristics of trauma and adding to the complexity of the mental health risk for people living in Western countries. The threat to mental health status is higher for those who have had family members killed, harmed or gone missing, and for those with previous exposure to war, including in Lebanon, Iraq and Syria. The level of stress has been exacerbated by its enduring nature, including systematic oppression, economic hardship, violence, human rights violations and national struggle.2,3

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                    • Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW


                    Correspondence: s.j.rees@unsw.edu.au


                    Open access:

                    Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.

                    Competing interests:

                    No relevant disclosures.

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                      The Lancet Countdown on health and climate change: Australia a world leader in neglecting its responsibilities

                      Paul J Beggs and Ying Zhang
                      Med J Aust || doi: 10.5694/mja2.52152
                      Published online: 20 November 2023

                      Climate is integral to good health and wellbeing, but it can also be a forceful driver of death and disease. Many diseases both here in Australia and globally are climate sensitive — the global magnitude of such diseases was estimated to be 39 503 684 deaths (69.9% of total annual deaths) and 1 530 630 442 disability‐adjusted life years in 2019.1,2 Climate change is the biggest health threat facing humanity.3,4

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                      • 1 Macquarie University, Sydney, NSW
                      • 2 University of Sydney, Sydney, NSW


                      Correspondence: paul.beggs@mq.edu.au
                      Competing interests:

                      No relevant disclosures.

                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
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