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HOUSING, FUEL POVERTY AND HEALTH: A PAN-EUROPEAN ANALYSIS Jonathan Healy Ashgate Publishing 2004, 249 pp, US$99.95 ISBN 0 7546 4218 6This is a very important book. Housing is a basic human right, embedded in the Universal Declaration of Human Rights (UN 1948), and in major international human rights treaties such as the International Covenant on Economic, Social and Cultural Rights (UN 1966). More recently, the Ottawa Charter blueprint for health promotion identified the prerequisites for health as being peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity (WHO 1986). It is against this backdrop of international law and governance that the author tells the story of inequity in a basic necessity for health: adequate housing.The book embraces primarily housing-related, structural, and material determinants of health, but contextualises the observations within cultural and social policy considerations; describing how these upstream conditions shape (beneficially or otherwise), housing related matters and subsequently, health. Specifically, using a comparative framework, it sets out to examine, for Europe, the relationship between domestic energy efficiency, fuel poverty and related health impacts. The Republic of Ireland is used as a specific country context case study on the premise that it has high rates of fuel poverty, excess winter mortality, energy inefficient housing, high domestic energy consumption, and greater environmental emissions. While the introductory chapter rationalises the approach taken throughout the book, no explicit working definition is given for fuel poverty. Just as food poverty encompasses a number of domains including nutritional, social and health connotations, it would have been useful to make clear, upfront, the constituents of fuel poverty. Following from this, the book would benefit from a conceptual framework at the beginning, providing a heuristic device from which to consider the various ways fuel poverty and related socio-environmental factors affect health.The book makes excellent use of existing dataseis from a diversity of sources to illustrate systematic inequalities in key components of housing related socio-environmental determinants of health, both between countries and within countries. Chapters two to nine explore the empirical data, demonstrating marked gradients across Europe in housing conditions, levels of deprivation, affordability and general satisfaction with housing. The book highlights data limitations within the European countries, but is not unduly constrained by them. A key message from the book is the usefulness and necessity for harmonisation of public health related data and development of multilevel surveillance systems. In Chapter three, a new approach to measuring fuel poverty (and hence its definition) provides the mechanism by which to quantify and demonstrate the severity of fuel poverty within Europe. In an economically rich country such as Ireland, a remarkable 17% of households were found to be fuel poor.The final results chapter combines the various risk factors, explored until now in singular fashion, and assesses their impact on seasonal mortality, specifically excess winter mortality. It is hard to imagine that the inhabitants of Portugal - a country which provokes images of hot summers and unexceptional winters - experience the highest seasonal variation in mortality across the EU, with a winter increase of 28%. However, using a collection of datasets from 1988-97, Healy demonstrates that relative excess winter mortality is highest in southern Europe, Ireland and the UK. …

Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis.Australia has a high prevalence of asthma. Respiratory-related encounters in general practice, including acute and chronic respiratory illness and influenza immunisations, account for 20.6% of general practice activity. Lung cancer is a rare disease in general practice. Tuberculosis is uncommon and most often found in people born outside of Australia. Aboriginal and Torres Strait Islanders have higher rates of asthma, smoking and tuberculosis.Access to care is positively influenced by substantial public funding underpinning both the private and public sectors through Medicare. Access to general practice care is negatively influenced by workforce shortages, the ongoing demands of acute care, and the incremental way in which system redesign is occurring in general practice.Most general practice operates from privately-owned rooms. The Australian Government requires general practice facilities to be accredited against certain standards in order for the practice to receive income from a number of government programs. These standards require GPs to have ready access to spirometry, but do not require every practice to have a spirometer.The initial assessment and management of acute respiratory illnesses currently seen in primary health care settings will continue, but for this to occur the sector may have to adapt traditional workforce roles because of workforce shortages. In the longer term, climate change and migration patterns may result in changes in the epidemiology of regions and populations. The health system will continue to reform incrementally in order to deliver improved chronic disease care, including care of people with asthma and COPD. The incoming Labor Government's National Primary Health Care Strategy provides the high level policy opportunity to drive reform.Australia's complex primary health care system is incrementally changing from one of exclusive acute- and episodic-care orientation in both the public and private sectors to a system that delivers effective anticipatory chronic disease care as well. From a national policy perspective, asthma has received most attention. COPD and possibly other respiratory diseases may now receive focus.

Climate change is likely to have an effect on global food production but to examine effects on food and nutrition security, an appreciation of the dimensions of food security is required. The 1996 World Food Summit defined food security as ‘when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active healthy life’. Thus food security is largely multi-factorial and defined by context. Australia and New Zealand both have substantial agricultural profiles and there is a significant production in meat and livestock, dairy and grains from the region. Both countries are islands, surrounded by oceans with extensive fisheries, bearing in mind that the local ecology will reflect the type of fish that are available. Meeting dietary needs and food preferences in this context would mean taking into account the health profiles of the population and how these relate to the food that is available now and in the future. Layering in the effects of climate change means that the high prevalence of lifestyle related disease (obesity, heart disease, diabetes) and the vulnerability of at risk groups, particularly in remote communities in Australia, will require additional consideration. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Tapsell, L. C., Probst, Y., Lawrence, M., Friel, S., Flood, V. M., McMahon, A. & Butler, R. (2011). Food and nutrition security in the Australia-New Zealand region: impact of climate change. World Review of Nutrition and Dietetics, 102 192-200. Authors Linda Tapsell, Yasmine Probst, Mark Lawrence, Sharon Friel, Victoria Flood, Anne McMahon, and Rosalind Butler This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/3554 Food and nutrition security Food and nutrition security in the Australia-New Zealand region: impact of climate change Linda C Tapsell, Yasmine Probst, Mark Lawrence, Sharon Friel, Victoria Flood, Anne McMahon, Rosalind Butler 1 1 University of Wollongong, Wollongong NSW Australia Australian National University, Canberra ACT Australia 3 Deakin University, Australia, Burwood VIC Australia * Corresponding author: Smart Foods Centre, University of Wollongong, Wollongong NSW 2522 Australia. P: +612 4221 3152, F: +612 4221 4844, E: ltapsell@uow.edu.au Food and nutrition security

The observational evidence of the impacts of climate conditions on human health is accumulating. A variety of direct, indirect, and systemically mediated health effects have been identified. Excessive daily heat exposures create direct effects, such as heat stroke (and possibly death), reduce work productivity, and interfere with daily household activities. Extreme weather events, including storms, floods, and droughts, create direct injury risks and follow-on outbreaks of infectious diseases, lack of nutrition, and mental stress. Climate change will increase these direct health effects. Indirect effects include malnutrition and under-nutrition due to failing local agriculture, spread of vector-borne diseases and other infectious diseases, and mental health and other problems caused by forced migration from affected homes and workplaces. Examples of systemically mediated impacts on population health include famine, conflicts, and the consequences of large-scale adverse economic effects due to reduced human and environmental productivity. This article highlights links between climate change and non-communicable health problems, a major concern for global health beyond 2015.Detailed regional analysis of climate conditions clearly shows increasing temperatures in many parts of the world. Climate modelling indicates that by the year 2100 the global average temperature may have increased by 34°C unless fundamental reductions in current global trends for greenhouse gas emissions are achieved. Given other unforeseeable environmental, social, demographic, and geopolitical changes that may occur in a plus-4-degree world, that scenario may comprise a largely uninhabitable world for millions of people and great social and military tensions.It is imperative that we identify actions and strategies that are effective in reducing these increasingly likely threats to health and well-being. The fundamental preventive strategy is, of course, climate change mitigation by significantly reducing global greenhouse gas emissions, especially long-acting carbon dioxide (CO(2)), and by increasing the uptake of CO(2) at the earth's surface. This involves urgent shifts in energy production from fossil fuels to renewable energy sources, energy conservation in building design and urban planning, and reduced waste of energy for transport, building heating/cooling, and agriculture. It would also involve shifts in agricultural production and food systems to reduce energy and water use particularly in meat production. There is also potential for prevention via mitigation, adaptation, or resilience building actions, but for the large populations in tropical countries, mitigation of climate change is required to achieve health protection solutions that will last.

Around the world, the frequency and intensity of droughts is increasing as a result of global climate change, with important consequences for the growth and survival of agricultural and native plant species. Understanding how plants respond to water stress is thus crucial for predicting the impacts of climate change on the crop productivity and ecosystem functioning. In contrast to the large number of studies assessing drought impacts on photosynthesis, relatively little attention has been devoted to understanding how mitochondrial respiratory metabolism is altered under water stress conditions.This review provides an overview of the impacts of water stress on mitochondrial respiration (R), combining studies at the whole-plant, individual organ, cellular and organelle levels. To establish whether there are clear patterns in the response of in vivo R to water stress, a wide range of root, leaf and whole-plant studies are reviewed. It is shown that water stress almost always inhibits R in actively growing roots and whole plants. However, in fully expanded, mature leaves the response is more variable, with water stress reducing R in near two-thirds of reported studies, with most of the remainder showing no change. Only a few studies reported increases in leaf R under severe water stress conditions. The mechanisms responsible for these variable responses are discussed. Importantly, the fact is highlighted that irrespective of whether drought increases or decreases respiration, overall the changes in R are minor compared with the large decreases in photosynthetic carbon gain in response to drought. Based on recent work highlighting the link between chloroplast and mitochondrial functions in leaves, we propose a model by which mitochondrial R enables survival and rapid recovery of productivity under water stress conditions. Finally, the effects of water stress on mitochondrial function, protein abundance and overall metabolism are reviewed.

Resilin is a member of a family of elastic proteins that includes elastin, as well as gluten, gliadin, abductin and spider silks. Resilin is found in specialized regions of the cuticle of most insects, providing low stiffness, high strain and efficient energy storage; it is best known for its roles in insect flight and the remarkable jumping ability of fleas and spittle bugs. Previously, the Drosophila melanogaster CG15920 gene was tentatively identified as one encoding a resilin-like protein (pro-resilin). Here we report the cloning and expression of the first exon of the Drosophila CG15920 gene as a soluble protein in Escherichia coli. We show that this recombinant protein can be cast into a rubber-like biomaterial by rapid photochemical crosslinking. This observation validates the role of the putative elastic repeat motif in resilin function. The resilience (recovery after deformation) of crosslinked recombinant resilin was found to exceed that of unfilled synthetic polybutadiene, a high resilience rubber. We believe that our work will greatly facilitate structural investigations into the functional properties of resilin and shed light on more general aspects of the structure of elastomeric proteins. In addition, the ability to rapidly cast samples of this biomaterial may enable its use in situ for both industrial and biomedical applications.

SummaryBackground  How climate variability affects the transmission of infectious diseases at a regional level remains unclear. We assess the impact of climate variation on the Ross River virus (RRv) transmission in the Townsville region, Queensland, north‐east Australia.Methods  We obtained population‐based information on monthly variations in RRv cases, climatic factors, sea level, and population growth between 1985 and 1996. Cross‐correlations were computed for a series of associations between climate variables (rainfall, maximum temperature, minimum temperature, relative humidity and high tide) and the monthly incidence of RRv disease over a range of time lags. We assessed the impact of climate variability on RRv transmission using the seasonal auto‐regressive integrated moving average (SARIMA) model.Results  There were significant correlations of the monthly incidence of RRv to rainfall, maximum temperature, minimum temperature and relative humidity, all at a lag of 2 months, and high tide in the current month. The results of SARIMA models show that monthly average rainfall (β = 0.0007, P = 0.01) and high tide (β = 0.0089, P = 0.04) were significantly associated with RRv transmission and maximum temperature was also marginally significantly associated with monthly incidence of RRv (β = 0.0412, P = 0.07), although relative humidity did not seem to have played an important role in the Townsville region.Conclusions  Rainfall, high tide and maximum temperature were likely to be key determinants of RRv transmission in the Townsville region.

The human immune system is an interface across which many climate change sensitive exposures can affect health outcomes. Gaining an understanding of the range of potential effects that climate change could have on immune function will be of considerable importance, particularly for child health, but has, as yet, received minimal research attention. We postulate several mechanisms whereby climate change sensitive exposures and conditions will subtly impair aspects of the human immune response, thereby altering the distribution of vulnerability within populations—particularly for children—to infection and disease. Key climate change-sensitive pathways include under-nutrition, psychological stress and exposure to ambient ultraviolet radiation, with effects on susceptibility to infection, allergy and autoimmune diseases. Other climate change sensitive exposures may also be important and interact, either additively or synergistically, to alter health risks. Conducting directed research in this area is imperative as the potential public health implications of climate change-induced weakening of the immune system at both individual and population levels are profound. This is particularly relevant for the already vulnerable children of the developing world, who will bear a disproportionate burden of future adverse environmental and geopolitical consequences of climate change.

Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally.A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO).The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I2 = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I2 = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income.High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention.Australian Research Council Discovery Program.