The International Baby Food Action Network (IBFAN) says breastmilk contains protective agents and helps children develop a strong immune system. Breastfeeding can mitigate the effects of chemical exposure in the womb, whereas formula feeding does not afford any protection or mitigation.

The IBFAN statement also says formula feeding and industrial baby foods contribute significantly to environmental pollution.

Joy Heads, an experienced midwife and International Board Certified Lactation Consultant in Sydney, gives an overview of the new statement below.

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A useful source of information on breastfeeding and chemical residues

Joy Heads writes:

The reality of the presence of environmental chemicals has been on the world’s radar since the release of Rachel Carson’s book Silent Spring in 1962.

Today it is accepted that every human body contains many man-made chemicals that can cause harm. Human milk has a high proportion of fat and therefore fat soluble contaminants, including dioxins, can be very easily measured.

Expressed breastmilk used to be included in the Australian Basket Market Survey, now called Australian Total Diet Study (ATDS), because it was easy to collect from consenting women in postnatal wards.

Over the last few decades scare tactics have emerged, warning women about the perceived danger of breastfeeding.  I clearly remember one front page headline in a Sydney Sunday paper in the mid 70’s screaming: “DDT’s in breastmilk: mothers poisoning their babies.”

The press coverage of Florence William’s 2012 book: “Breasts: A Natural and Unnatural History”, which covers her investigations into the issue, did little to allay these fears.

It is therefore heartening that the International Baby Food Action Network (IBFAN) has just released “IBFAN Statement on Infant and Young Child Feeding and Chemical Residues” (2013), which presents objective and independent information for parents, carers and health professionals.

The main author of the paper is well respected Dr Adriano Cattaneo, Consultant Epidemiologist and Co-ordinator of the Unit for Health Services Research and International Health, Institute of Child Health “IRCCS Burlo Garofolo”, Trieste, Italy, a WHO Collaborating Centre for Maternal and Child Health. Dr Catteano was an Expert Reviewer on the 2012 NHMRC Infant Feeding Guidelines.

This evidence-based, well referenced statement goes beyond the issue of possible residues in human milk to include that of contaminants in infant formula including in the unnecessary, but cleverly marketed, follow-on formulas, baby foods, feeding bottles and teats.

The paper also emphasises the potential harm of chemical exposure during pregnancy at a time when tissues and organs are growing rapidly. It reinforces the fact that there is now far greater understanding of the beneficial effects of breastfeeding and its role in developing immune protection and mitigating the harmful effects of chemical exposure in the womb.

Conversely, formula feeding does not afford any protection to babies at all. The ecological footprint and consequence of increasing rates of formula feeding is also addressed.

The document lists 10 Key Points and Key IBFAN Messages, which includes the statement that “pregnant and breastfeeding mothers have the right to receive full and unbiased information”.

IBFAN endorses international health regulations to protect, promote and support breastfeeding – because the benefits outweigh any possible harm -“except in the case of industrial disasters and of exceedingly high residues after industrial disasters”.

Contained within the paper is a Call for Action, urging decision-makers and industry across the globe to implement the Stockholm Convention on Persistent Organic Pollutants (POPs).

The Appendix is an excellent reference and carries an analysis of 13 chemical residues or families of chemical residues. IBFAN have considered only substances “for which there is ample literature and that are a target for important policies and regulations worldwide.”

This paper provides strong evidence that the continuing fight for a healthy global environment, with minimum toxins, is a challenging one considering industry redistribution and weak environmental regulations.

• Joy Heads OAM is a midwife and has been an International Board Certified Lactation Consultant since 1986. In 2009, she was awarded the designation of Fellow of the International Lactation Consultants Association (ILCA™). She is currently on the Board of Directors of ILCA, and co-wrote the chapter on “Breast Pathology” for the ILCA’s Core Curriculum for Lactation Consultants. Editors: Mannel B, Martens P J, Walker M. (3nd ed) Jones & Bartlett. MA. USA. 2013.

In 2006 she was awarded the Order of Australian Medal for service to nursing and midwifery as a specialist lactation consultant and to health professional and parent education. Joy was the Clinical Nurse Consultant (Lactation) at the Royal Hospital for Women, Sydney for many years until she retired from paid work in late 2010.

Yes, suggests Dr Melissa Stoneham of the Public Health Advocacy Institute WA (PHAIWA). In the latest edition of JournalWatch, she reviews a recent study investigating the impact of such a scheme in Montreal.

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On your bike!! Why we need more bike share schemes

Melissa Stoneham writes:

Brisbane has one….Melbourne has one…Barcelona has one…..London has one…New York is getting one….

Bike share schemes are popping up all around the globe. In fact, if you visit this site you can actually locate any bike share scheme in the world.

Bike ownership is increasing in Australia, with half (50%) of all Australian households having at least one working bicycle kept at their home. With this in mind, it is timely to consider how to better advocate for more bike share schemes in Australia.

The health benefits of riding a bike are obvious, and they seem to outweigh the risks of other metropolitan hazards such as collisions, pollution and road rage.

Recent data models on cycling in the Netherlands and Barcelona concluded that the benefits from the physical activity of cycling outweigh the combined hazards of traffic accidents and inhaling toxins.

Bike share schemes not only reduce congestion, but make it easier to access a bike in the city.

Interestingly the City of Melbourne is currently trialling free helmets with their bikes to overcome the barrier of “bringing your own helmet” or “hiring one at a local shop”.

To get a better handle on the potential public health benefits of bike-share systems, a group of Canadian researchers led by Daniel Fuller recently evaluated the ridership effects of Montreal’s bike share program, BIXI.

In the March 2013 issue of the American Journal of Public Health, Fuller and colleagues report that if you build a scheme, the riders will come.

BIXI is an acronym that stands for BIcycle-taXI.  The scheme was launched in May 2009 and by 2011, it was the largest bike share scheme in North America.

Fuller and colleagues state the scheme increases accessibility to cycling by making available at low cost, 5050 bicycles throughout 450 bicycle docking stations located in Montreal’s central and more urbanised neighbourhoods. Bicycles are available for hire hourly (the first 30 mins are free), daily, monthly and for an entire season.

The authors tracked rates of cycling in the city at three points in the BIXI timeline. These included at the launch in May-June 2009, after its first season in late 2009, and after its second season in late 2010. A self-report phone survey of approximately 700 inner city residents was conducted seeking information about their cycling activity. Data were collected on total bike riding (commute-related and recreational) in the previous week, noting whether or not a person had cycled for at least 10 minutes.

The authors controlled for seasonality and found that exposure to a BIXI station was associated with a significant increase in the likelihood of bike riding.

After the first season of BIXI there was a slight positive trend, but nothing measurable. However, by the end of the second season, Montreal’s residents who lived near a bike-share docking station were much more likely to be users of the scheme and and more likely to report using BIXI for recreational cycling than for utilitarian (eg getting to work) cycling.

A number of limitations were acknowledged, including the inability to include mobile phones in the self report survey, potentially excluding larger number of younger respondents, media campaigns promoting cycling and physical activity and some minor infrastructure additions and expansions to the city’s bike scheme.

Despite all these factors, this study still indicated that the BIXI public bicycle share program in Montreal was associated with greater likelihood of cycling after the second season of implementation for respondents exposed to the BIXI program. The study adds to the growing consensus that built environment interventions can result in population-level behaviour change.

Around the world, share bike schemes bring convenience and less congestion to city streets, while introducing people to the joys and health benefits of cycling.

We have the right to the same opportunities in Australia, and should continue to advocate for such schemes – but the question for us here in Australia is: should bike scheme riders be exempt from wearing helmets?

I will just push those worms back into the can and leave that discussion for another day.

• Dr Melissa Stoneham is Deputy Director, Public Health Advocacy Institute WA

• Impact Evaluation of a Public Bicycle Share Program on Cycling: A Case Example of BIXI in Montreal, Quebec. Daniel Fuller, Lise Gauvin,  Yan Kestens, Mark Daniel, Michel Fournier, Patrick Morency and Louis Drouin. American Journal of Public Health. Vol 103; Issue 3; Pages e85-e92.

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About JournalWatch

The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.

The Journals reviewed include:

• Australian & New Zealand Journal of Public Health (ANZJPH)
• Journal of Public Health Policy (JPHP)
• Health Promotion Journal of Australia (HPJA)
• Medical Journal of Australia (MJA)
• The Lancet
• Journal for Water Sanitation and Hygiene Development
• Tobacco Control (TC)
• American Journal of Public Health (AMJPH)
• Health Promotion International (HPI)
• American Journal of Preventive Medicine (AJPM).

These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe to Journal Watch go to http://www.phaiwa.org.au/index.php/other-projects-mainmenu-146/journalwatch

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PHAIWA is an independent public health voice based within Curtin University, with a range of funding partners. The Institute aims to raise the public profile and understanding of public health, develop local networks and create a statewide umbrella organisation capable of influencing public health policy and political agendas. Visit our website at www.phaiwa.org.au

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Previous JournalWatch articles:

• On big food, unhealthy partnerships and the health benefits of regulation

• Investigating the health costs of car commuting

• Time for another Sid the Seagull?

• Tackling the unhealthy food supply in disadvantaged communities

• Smoking at the movies, a global public health concern

• Sports clubs are winners when alcohol sponsorship is dropped

• Call for more research and planning to deal with public health challenges of mega events

• Environmental factors that promote cycling

• A focus on the corporate practices that contribute to poor health

• How much healthy food is sold at fast food restaurants?

• Why the world needs a dengue day

• Germany’s role in undermining tobacco control

In a recent article on The Conversation Robert Nelson argues we are all morally culpable for unsustainable urban sprawl. He goes on to suggest we fix this by taking advantage of opportunities for higher density development in sparsely populated inner suburbs.

But his argument is based on a false opposition: mounting evidence shows that high density development in inner areas performs very poorly in terms of resource consumption and greenhouse emissions. The idea that outer suburbs are inherently less sustainable than inner ones doesn’t bear scrutiny.

The key question is not where we accommodate growth; it’s our slavish pursuit of growth itself.

Urban accumulation

The metro fringe is expected to accommodate 40% of our national population increase in the next 15 or so years. Australia has for some time been experiencing record population growth, cheered on by business lobbies, and rationalised by the expertise they buy. Not all of it is corporate conception, or undesirable: the fertility spike and commitment to a humane migration program are also contributors.

The urban sustainability crisis betrays not bad consumption patterns but the awesome success of accumulation. Our cities express the ceaseless economic expansion imperative and its politico-cultural expression, which Clive Hamilton has memorably described as the “growth fetish”.

We have sprawl in every possible physical form – from low density suburbia to the vertical sprawl produced by market driven compaction. It is a fallacy to describe the latter as sustainable.

The existing urban footprint simply cannot absorb the human increase. It is a physical, social and political impossibility. And the underlying imperative of accumulation will drive excessive urban expansion in its various forms.

Risky business

The physical form of cities and suburbs has little influence on overproduction and its social and ecological consequences.

We are, as Nelson correctly implies, in the tightening grip of a species crisis. As the German sociologist Ulrich Beck describes it, we live in a World at Risk – from climate warming, resource depletion, economic default, and social breakdown. The ecological crisis may be the gravest of these as it appears to be moving with wild speed and threatens to upend the planetary order entirely. But it cannot be divorced from the other calamities which all derive from a human modernity that, as Beck states, is devouring itself.

The looming human catastrophe is not a moral crisis or a consequence of ethical failure. It is the product of a political economy that has defined, if not always exclusively, the process of modernisation through the past five or so centuries. The long haul of capitalist accumulation has brought us to the abyss of species threat.

It is wrong to explain this historical process in moral terms. This merely distracts attention from the role of capitalism as a driver of growth. As the philosopher Slavoj Žižek put it recently, “The point of emphasising morality is to prevent the critique of capitalism”.

Capitalism is a force for ceaseless accumulation driven by valorisation (value creating value). It is hard-wired to expansion, and can never be reconceived or reformed as a “steady state” economic order. It expands or it dies.

And therein lays its marvellous, terrifying power. It is a human order set in epic contest with the natural order, scaling ever upwards the heights of risk. One day it will reach the precipice of possibility and a structural transformation will ensue. Humanity will survive this, as it has all other historical transformations, but we do not know what new social dispensation will be possible in its wake.

Weathering the storm

It is simply impossible to dramatically change the urban form in the timescales of looming climate and resource emergencies. Absent war or massive calamity, cities resist sudden change. We cannot design our way out of a crisis generated by the underlying political economy that has driven modernisation for centuries.

However, good planning and design are vital to the project of making our cities as safe and resilient as possible. Elsewhere I have urged us to reconceive cities as lifeboats that will carry an increasingly urbanised humanity through the storms that lie inevitably in our path.

It is only fair that we break from our long habit of malign neglect and cut the outer suburbs an appropriate share of national resources. The investment should be in a massive suburban overhaul to realise the latent environmental potential of the low density form. In quest for resilience, households should be assisted towards self-sufficiency in water, energy and food production.

Paul Mees’ important Australian book, Transport for Suburbia, shows decisively that good public transport is possible in the low density form. We must lament the intellectual and political idiocy that has convinced us that it cannot be made to work in the suburbs.

The outer suburbs simply aren’t the source of our mounting environmental problems. And neither is social delinquency a helpful way of thinking about what is a long run failing of the market economy. We have to prepare the lifeboats for what lies ahead.

This article was originally published on The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons licence.

The sort of magical thinking displayed by the Government in its response to the Productivity Commission’s recent inquiry into barriers to climate change adaptation is alarming, she says, given that we are on course to reach catastrophic conditions within 60 years.

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Climate change adaptation: a mismanaged delusion

Fiona Armstrong writes:

The Productivity Commission was tasked last year to conduct an Inquiry into Barriers to Climate Change Adaptation. The Inquiry received 168 submissions, a small number of which highlighted the importance of health protection through effective adaptation, amid concerns this was being overlooked in Australia’s adaptation responses.

The PC Inquiry report was sent to the government in September 2012. The Inquiry report and the federal government’s response to this report were released on 14 March 2013.

While action to mitigate climate change (i.e. cut emissions) should be a central priority, the unavoidable impacts from past failures to mitigate now demand effective adaptation to minimise harm.

The Inquiry into barriers to climate change adaptation has however failed to highlight the importance of effective mitigation in limiting the need for adaptation.

And while there is some recognition of the need to prepare for and respond to the risks posed to human health, acknowledgement of one of the greatest challenges to effective climate policy is lacking – that of limited public understanding of the risks from climate change.

In receiving and responding to the report, the federal government too has missed an opportunity to highlight this core challenge of both adaptation and mitigation: that you can’t adapt to something you don’t accept as real i.e. the lack of understanding and acceptance of climate change in the wider community is our greatest barrier to doing anything about it.

To its credit, the Government has pointed to this, rather quaintly suggesting that the Productivity Commission’s “insight into the potential barriers in the uptake of climate change adaptation measures – in particular cognitive barriers”… “may need further development”.

Well, yes.

But instead of demonstrating leadership by proposing to address this and other barriers, the response from the federal government is a masterful display of shifting responsibility to the states – along with the community – seen in their assertions that “local initiative and private responsibility will be at the forefront of climate change adaptation in Australia”.

Is this, in other words: “you’re on your own, Australia”?

Given the Government’s stated commitment to “ensure Australia is resilient in the face of the changes in the climate” through “taking action to avoid dangerous levels of climate change” this is somewhat paradoxical, not to mention unrealistic, as is asserting that “governments, businesses and households can all act to manage the risks associated with climate change”.

But will they, without policy to guide them to do so?

No such commitment or ability to manage risks seems likely to be realised, given the current trajectory of global emissions growth. Australia’s position of pretending we can adapt to climate change while tripling coal exports is a good example of the delusion that is gripping policymakers worldwide.

Confounded by the protestations of a public who are also unwilling to accept the evidence (and who, like policymakers, are captured by the influence of corporations with a vested interest in the status quo), Australian politicians and policymakers have retreated into the refuge of semantics and spin – all of which betrays a kind of magical thinking that if we talk about doing something, it will all somehow be ok.

There are two main points to be made here: one that is a delusion to think we can adapt to climate change if we continue to fail to implement strategies to dramatically reduce emissions in a very short time frame. Climate scientist Hans Schellnhuber isn’t optimistic about humanity’s chances of adapting to a four-degree global average temperature rise – suggesting it would be “extremely unlikely that we wouldn’t have mass death at four degrees”.

This is a scenario we are currently right on course to reach in about 60 years – about the time my teenage daughters might have expected to be become grandparents. If we don’t avoid two degrees (and the accompanying possibility of non-linear changes in the global climate system), that expectation may finish with my generation.

The other point is that made above: that you can’t ‘adapt’ to accommodate a risk you don’t accept, aren’t aware of, or if you don’t comprehend the scale and urgency of the threat.

Therefore fiddling with existing policies around energy efficiency, (or as the Government proposes, at the behest of the Business Council of Australia) to reform regulations that “impose unnecessary costs or inhibit competition or flexibility” (aka obliging businesses to clean up the costs of environmental harm), isn’t really going to cut it in terms of helping Australians adapt to climate change.

In a further display of mixed messages, the Government simultaneously asserts that public policy is needed to facilitate effective adaptation while arguing that recent moves to ‘streamline’ (aka remove) climate policies would assist effective adaptation.

A number of submissions to the PC Inquiry exhorted the Commission to ensure the health system was supported to respond to climate change and noted that there were serious gaps in the knowledge base of the sector in general, including among many health professionals about the risks posed, thereby limiting their ability to prepare and respond effectively.

The Climate and Health Alliance was blunt, asserting: “one of the key strategies for protecting health from climate change must be to enhance awareness of climate change and health among health and medical practitioners. This requires leadership from the instruments of government i.e. the public service in developing policies and programs to address this.”

Recent health and medical literature on climate risk preparedness and public health points to the importance of local communities being in the driving seat’ of prevention and recovery – but that “community knowledge deficits” pose serious obstacles to this occurring.

The authors of a 2013 paper on the topic conclude that supporting communities to develop better knowledge about climate risk is one of community health’s “most complex social justice tasks of the twenty-first century”.

However, the government’s response to the PC report in relation to health (which does note the importance of health sector preparedness) is to be completely silent on the topic.

Not. One. Word.

The proposals to shift responsibility to the states (already bearing a huge burden in meeting the costs of increasingly frequent disasters associated with extreme weather) don’t inspire confidence about the national government’s willingness to show leadership or assist the community in facing, and then managing these risks.

Recommendations to commission a (necessary) independent public review of disaster prevention and recovery arrangements are ‘noted’ – but no commitments are made.

It’s no wonder the government chose to respond to this report at the end of a stormy political week. Getting their response out ‘after dark’ would seem the best way to avoid scrutiny of this manifestly inadequate reaction to one of our most pressing public policy challenges.

The brevity of the government’s response and its flimsy relationship with the truth of the matter when it comes to climate risk doesn’t come as a surprise – we’re becoming increasingly inured to politicians, particularly those in Australia, operating in some kind of ‘post-truth’, invented reality, where facts don’t matter.

But when we are talking about an issue of health protection, on which a national government (with responsibilities as a global leader) is willing to play ‘pretend’, we should be very worried – and willing to say so.

• Fiona Armstrong is the Convenor of the Climate and Health Alliance www.caha.org.au which is leading the work of a new network of health groups in advocating for alternatives to coal and coal seam gas. She tweets for CAHA at @healthy_climate.

During the four years over which the Australian Dietary Guidelines were drafted, attacks on the contents came from many quarters. There are many vested interests so these attacks were not unexpected. The most effective means of countering such attacks is to base guidelines firmly on evidence.

The Guidelines were based on examination of around 55,000 individual pieces of evidence and were assisted by advanced modelling. This modelling was undertaken so that the guidelines could talk about foods, rather than ingredients, and therefore were more understandable to readers seeking guidance – clearer and more practical that previous versions.

For the first time for NHMRC’s public health guidelines, we used an approach analogous to that used for clinical guidelines. That is, we considered around 55,000 pieces of evidence and inclusion/exclusion criteria were applied. Data was extracted from the included studies and assessed, with the body of evidence for each research question graded as excellent, good, satisfactory or poor according to rigorous systematic literature review methodology and standard NHMRC protocols. Criteria were then used to make recommendations based on this body of evidence (for example, , there being at least 5 confirming independent pieces of quality evidence, and the studies focussing on foods, not nutrients ). This rigour was the bulwark of our defence against the vested interests, who tend to rely on one or two favoured pieces of evidence.

The guidelines are aimed at health professionals such as general practitioners and dieticians and therefore the issue of social equity was covered with this audience in mind. While there is a relevant appendix, the ‘practical considerations’ and ‘practice guide’ sections of each main Guideline chapter cover considerations for particular groups (e.g. lower socioeconomic status) where relevant. Most importantly, development of the underlying advice took social equity considerations into account, for example in the modelling of dietary patterns and the range of foods depicted on, and flexibility of, the ‘Food Plate’.

As far as the environmental impact of food choices was concerned, we were certainly aware of its importance and that patients and clients increasingly approach their health professionals with a concern about the environmental impact of their choice of food.
Early attempts to include recommendations on the sustainability of food choices were questioned by the Council of NHMRC as lacking a level of evidence rigour comparable to that of the main Guidelines as described above. Other government agencies pointed out that specifically Australian evidence was often lacking, with farming practices here differing markedly to those in Europe and the US where most evidence is from. Secondly, there are many factors that influence environmental sustainability (such as emissions, water use, soil degradation, energy use, storage and transport), but many studies tended to concentrate on a subset of these factors, making it hard to draw rigorously evidence-based overall conclusions. In short, the state of the Australian evidence and the complexity of issues outside the health arena were such that more work is needed in order to provide recommendations at a comparable level of evidence as for the main dietary advice.

So, more work is needed. For this reason, I have asked my staff to continue liaising with the other government agencies on the current status of evidence on dietary choices and the environment, agreed definitions of key aspects, and practical strategies and approaches for Australians. I am very hopeful that this can yield similar strongly evidence based advice in the future. As we have learnt in the last three years, resisting the claims of vested interests is best based on the most rigorous evidence available.

Meanwhile, as the new Australian Dietary Guidelines state, not eating too much, not wasting food, eating a wide range of nutritious foods from the five food groups and limiting our intake of the foods mentioned in Guideline 3 can contribute to limiting our environmental impact.

The Dietary Guidelines are supported by the Eat for Health website. On this website, the sections on companion resources, food essentials, eating well and the eat for health calculators all contain material that may be of interest to Croakey readers.

Today the NHMRC finally launched the new Australian Dietary Guidelines and Infant Feeding Guidelines (available here with masses of supporting material).

The aim of this post (thrown together in a hurry) is to quickly link you into some of the relevant documents and the summary below of responses to date (including concerns from public health experts that the guidelines have failed to address environmental and equity concerns).

New dietary guidelines – evidence for healthy choices more certain

At The Conversation, Professor Warwick Anderson, CEO of the NHMRC, acknowledges that the recommendations will be hotly contested, and cautions:

“…the community needs always to think about the possibility of vested interests influencing the debate about what is healthy and what is not, and of the potential influence of sponsors of nutrition research findings, just as we have become more aware of and vigilant about conflict of interest in pharmaceutical research and clinical trials.”

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Responses from various experts at The Conversation

Tim Crowe, Associate Professor in Nutrition at Deakin University, notes that the revised guidelines have a greater focus on foods and food groups rather than nutrients and says this is a good step forward.

Gary Sacks, Research Fellow, Deakin Population Health at Deakin University, is disappointed the guidelines do not adequately consider the environmental sustainability of the food supply chain, a topic he believes should have been integrated throughout the document rather than being sidelined to a discussion in an appendix. He says:

“It is clear that, in putting together the new version of the guidelines, major public health and environmental compromises were made to take into account the profit-seeking interests of the food industry. This is a similar situation to another key government strategic policy document, the National Food Plan (released in 2012), that also does not adequately address nutrition, health and environmental considerations. It is a travesty that the private sector has such strong influence over government policy decisions, and they should have a much more limited role in the policy development process.”

Professor Clare Collins, NHMRC CDF Research Fellow; Co-Director, Priority Research Centre in Physical Activity and Nutrition, says the guidelines “provide a comprehensive source of information about what to eat to improve health. Each chapter sets out the specific guidelines, the research evidence underpinning it and how to implement the guidelines in practical ways.”

Professor Peter Clifton, Laboratory head, Nutritional Interventions, Baker IDI Heart and Diabetes Institute, has several criticisms of the guidelines, including that he says they overstate the benefits of dairy and encourage men to eat too much of grain foods.

Also at The Conversation is analysis of the new Infant Feeding Guidelines.

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Stronger evidence

At her blog, dietitian Emma Stirling says the evidence base has strengthened for:

• The association between the consumption of sugar sweetened drinks and the risk of excessive weight gain in both children and adults
• The health benefits of breastfeeding
• The association between the consumption of milk and decreased risk of heart disease and some cancers
• The association between the consumption of fruit and decreased risk of heart disease
• The association between the consumption of non-starchy vegetables and decreased risk of some cancers
• The association between the consumption of wholegrain cereals and decreased risk of heart disease and excessive weight gain.

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Edited statement from the Public Health Association of Australia

The PHAA has welcomed the Australian Dietary Guidelines (ADG) the Australian Guide to Better Eating (AGBE), and the Infant Feeding Guidelines.

Associate Professor Heather Yeatman, President of the PHAA, said the ADG were important as “the public needs to know this is the place to go for good, authoritative dietary advice”.
She said:

” The challenge for many Australians is that there are so many myths, confusing pieces of advice and falsehoods perpetuated by so-called gurus.  The work of the NHMRC is strongly evidence based and can be relied on by health, medical and education professionals and everyone in the community.

The PHAA is pleased that the guidelines focus on the types of food to eat for health rather than specific nutrients, and the messages are very clear about avoiding added sugars.  In the new ADGs there is a clear distinction between added sugar (such as found in carbonated soft drink) and sugars eaten as part of the whole food such as in an apple.”

However, the PHAA’s CEO Michael Moore was disappointed by the lack of attention to enviornmental concerns. He said:

“The PHAA has argued in a series of submissions that protecting the environment should form a key part of the Dietary Guidelines.

It is a missed opportunity that this aspect of the advice was not taken more seriously.  Food, health and the environment form an integrated system.  It is appropriate and imperative to let people know how to eat to protect the future environment as well as their health.  Our food choices impact on the environment which needs to be a key consideration of dietary advice in Australia, as it is in other countries.  If we destroy the environment that sustains our food supply we will not be in a position to produce good nutritious food and such advice will become redundant.”

He said another area where the ADGs fall short is consideration of social equity, the cost of food and the consequential limitation on choices.

He said: “Food security is a critical factor in a healthy diet.  It seems pointless to provide advice on how people should be eating and feeding their families if they cannot afford it.”

Associate Professor Yeatman said the breastfeeding advice was based on solid evidence but that the real challenge is supporting mothers to continue to breast feed.  More than 90% of Australian women start breastfeeding, but rates at 6 months fall far short of NHMRC targets.

She said: “We need to arrest the dramatic drop-off in the breastfeeding rates so mothers can sustain it up to 6 months of age and beyond.  The ‘baby friendly hospital’ environment supports commencement of breast feeding.  More research is needed into how to support breastfeeding when mum returns home and perhaps back to work.  There is also a key role for health workers to strengthen their advocacy of the benefits of breastfeeding.”

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Statement from the Heart Foundation

The importance of ‘good fats’ has finally been recognised in Australia’s number one nutrition guideline, the National Heart Foundation of Australia said today.

The National Health and Medical Research Council (NHMRC) today released the 2013 revision of the Australian Dietary Guidelines, which now distinguishes between ‘good’ fats (polyunsaturated and monounsaturated fats) and ‘bad’ fats (saturated and trans fats).

National CEO of the Heart Foundation, Dr Lyn Roberts, welcomed the move away from ‘low fat’ messaging, which she said was a significant change from the previous 2003 guidelines that advised Australians to choose low fat foods.

“Australians have been getting the wrong messages for years – we should certainly be reducing bad fats, but it’s important to replace them with good fats. People should not cut all fats from their diet,” Dr Roberts said.

“Australians are now advised to replace high fat foods which contain predominantly saturated fats such as butter, cream, coconut and palm oil with foods that contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/pastes and avocado.

“It’s good to eat some healthier fats and oils such as canola and olive oil, nuts and fish, as they provide essential nutrients for heart health and protect against heart disease.

“Eating too much saturated fat increases the risk of heart disease and we know Aussies are still eating too much of this bad fat. Too much saturated fat contributes to the build up of fatty material, called plaque, on the inside of your blood vessels, clogging your arteries,” she said.

Heart disease is responsible for around 22,000 deaths every year – the number one killer of Australian men and women.

“The Heart Foundation has been advocating for the distinction between ‘good’ fats and ‘bad’ fats and the importance healthier fats have for heart health, so it’s pleasing to see this reflected in the final guidelines,” she said.

“We have an obesity crisis in Australia and the new guidelines will help Australians to understand nutrition and put them on the path to healthier eating.

“The science and evidence around food has been tried and tested to ensure quality evidence underpins our work and after this review the advice hasn’t changed much. Fad diets will come and go, but we still recommend that to maintain good health people should eat a mix of nutritious foods, avoid overeating and limit their intake of saturated fats, added sugars and salt.”

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Previous Croakey articles on the guidelines

• Look beyond the headlines

• Why everyone wants you to eat more – and other problems confronting the dietary guidelines 

• The Australian’s campaign against environmentally friendly eating

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PostScript from Croakey

Is it just me, or are the sample meal plans somewhat Anglo-centric given the diversity of our population and cultures?

The surging prevalence of obesity and calls for more effective measures to counter the convenience food and drink conglomerates were aired at the World Economic Forum, itself attended by chiefs of companies like Coca-Cola and Nestle.

Professor Bull, of Perth, made her main message at Davos a call for society to “recalibrate” urban development.  Society needs to “design in” the opportunities and places for physical activity in travel, at work and schools and in recreation, she says.

“Physical inactivity is a global problem – and is being largely ignored.  Certainly action is disproportionate to its importance and potential gains,” Professor Bull tells Croakey.

“The benefits of regular activity for individuals and society are large – in health (mental, physical and social) and in co-benefits — less traffic, better air quality, social capital and community connectedness, [and] perception of safety.”

“My challenge to the audience at Davos was what industry, civil society and governments should do to scale up implementation.”

*****

Professor Bull, director of the Centre for Built Environment and Health at the University of Western
Australia, also chairs GAPA-Global Advocacy for Physical Activity,  is president-elect of the International Society for Physical Activity and Health and is a WHO advisor on physical activity.

Material on health topics at the WEF can be seen here.

Professor Bull focused on the environment and transport as she says these are the most upstream options and if done well would create the conditions for active communities in towns and cities.

She attended sessions where designers and others spoke on different twists to promoting walking and physical activity.

At another session, developers, construction industry and government leaders spoke on building smart cities of the future – meeting the triple agenda of environment, economy and people.

“Yes there are some good things happening in Australian – from different angles,” she says, citing the  Heart Foundation’s Healthy Spaces and Places policy and Western Australia’s  Liveable Neighbourhood Guidelines -

Obesity pandemic

At Davos, obesity was described as “a global pandemic” which could result in more than half the world’s adults being overweight within 20 years, prompting for more action than merely accusing people of failing to have self-discipline in their diet and physical activity.

Reuters reported that while business leaders agree that obesity drags down economic growth those meeting at Davos could not agree what to do about it.

The WEF estimates a cumulative $47 trillion of output might be lost in the next 20 years a result of non-communicable diseases and mental health problems, with obesity blamed for 44 percent of the diabetes burden and 23 percent of heart disease costs.

Reuters reported that “one look at the list of the strategic partners of the WEF shows how many vested interests are at play – food and drink companies are blamed for feeding the crisis, while drug manufacturers profit from soaring rates of diabetes”.

“We could stop selling ice cream, but people are still going to want to eat ice cream,” said Paul Bulcke, chief executive of food giant Nestle, which has been investing heavily in developing healthier products, including low-fat ice cream.

Fat fight

Last week Coca-Cola, whose chief executive,  Muhtar Kent, was one of the co-chairs  at Davos, launched a commercial on American cable television seeking to highlight the company’s efforts in fighting obesity.

Separately a report to Davos says the spectacular rate of urbanisation poses opportunities and challenges in many countries to build healthier cities.

Changes to the rules of urban design and planning should consider such developments as:

– Mandating pavements and properly protected cycle lanes as an integral part of highway construction in new cities

– Reforming planning policies to create communal space for exercise indoors and outdoors, with the cost borne by property developers.

“Promoting healthier lives remains a puzzle that has not yet been solved,” said the WEF report.

Anti-coal protester Jonathan Moylan has said the main reason for his ANZ sharemarket hoax was his concern about the health impacts of coal mining at Maules Creek. He stressed the impact of the mine on children’s health and on the climate. He also believed that ANZ was investing unethically.

This is a very important message. Doctors for the Environment Australia deals with many cries for help from local communities suffering from coal pollution. In our experience, their plight is often dismissed and they suffer conflict from a seemingly imposed trade-off between health and jobs.

We do not condone breaking the law but Moylan’s message is out and comment is due.

The causal links between coal and ill health are as secure as those between smoking and cancer. Primarily as a result of air pollution, coal causes cardiac, respiratory, and other illnesses and shortens lives, particularly in communities near coalmines and power stations. There are many other toxic and harmful pollutants released into the environment, such as mercury and other heavy metals.

In Australia and other Western countries, we have reduced some of these health impacts. But pollution illness from coal in less-wealthy countries is rampant. For example, a 2012 study by Peking University’s School of Public Health, found 8,572 premature deaths were estimated to have occurred in four major Chinese cities due to air pollution. Most of this arises from coal combustion.

But even in wealthy developed nations, studies on the health costs of coal reveal significant health costs. In the United States, it has been calculated that if health and other environmental costs are included, the cost of electricity would double. Another study found the largest industry contributor to external pollution costs in the US was coal-fired electricity generation.

In 2005 in the US, the cost of pollution from power stations was $62 billion. If the industry was to pay these costs, there would be a stampede to renewable energy.

There is an official facade of silence on government thinking on this matter. How does each member of the two major parties assess this issue? Do they regard it as a reasonable trade-off to try and balance budgets and to keep jobs and growth happening? Do they know and understand the causes and scale of this human damage? Could it be they have never been briefed?

Do their frequent statements on coal being the cheapest fuel indicate that they feel compelled to mislead us? Or perhaps they do not understand externalities – coal is cheap only because the health and environmental costs are not included. Is the power of the fossil fuel industries such that they feel impotent?

The use of fossil fuels for energy has brought overwhelming advantages to many societies during the modern industrial era and prosperity has fostered advances and delivery of health care beyond our dreams. Once the health impacts from the coal mining and energy industries were accepted for the common good. But today there are alternatives: illness and death for the common good are no longer necessary, particularly in the case of exporting coal.

While Jonathan Moylan was most concerned about health impacts on his community – and we agree that many projects in Australia are inadequately assessed in the interests of development – he also raised the international dimension.

Australia has had an unpalatable role in its contribution to world emissions and these human tragedies. A most cogent summary of our role comes from Guy Pearse in an article by Andrew Revkin in the New York Times: Australia is on course to treble its export of coal by 2020. This will exceed ten-fold the expected emission savings from present government (and opposition) policy.

The facts and figures of the Australian role in increasing world emissions have also been detailed by Peter Christoff, Ruth Colagiuri and Emily Morrice and Sonya Duus.

Climate change from greenhouse gas emissions is one of the greatest health issues of the century according to the World Health Organization. The ethics are clear. The burning of coal will change the earth irrevocably and confer human harm for many decades and possibly centuries. This is being done in the name of profit and jobs: even then the positive balance to Australian society is debatable.

We need to hear from our elected representatives why they support subsidies for the coal industry, why they misinform on “cheap coal” and what is stopping them from acknowledging the increasing human toll from their policies. How do some premiers, who are rolling back clean energy development, absolve their consciences on these human issues?

Nor is the medical profession absolved; this is a global public health issue driven by the power of fossil fuel industries. How much has the intense lobbying of government by these industries been countered by visits from their medical leaders?

Australia wants to contribute to international peace and security with its pursuit of a seat on the UN Security Council. Perhaps its desire for a leadership role could be fulfilled in the sphere where every nation waits for the other to move first in case it is disadvantaged. Perhaps the most wealthy and fortunate should put up their hand first.

** David Shearman is Emeritus Professor of Medicine at the University of Adelaide.

This article was originally published on The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons licence. 

The evidence suggests that these sort of extreme events are going to become more common and more devastating as the effects of climate change escalate.

(New Scientist cites a prediction from the Intergovernmental Panel on Climate Change that in south-eastern Australia, the frequency of days when extreme fire danger threatens will increase by up to 25 per cent by 2020, and up to 70 per cent by 2050 – though the report doesn’t give the baseline figures).

Perhaps 2013 will be the year when concerned citizens engaging with social media and other avenues can help to create a more constructive public discussion about climate change – beyond the futile, pathetic political point-scoring and false controversies that are way too common.

Perhaps it will be the year when concerned citizens make headway in holding to account the media, the politicians, and the fossil fuel industry, and in engaging the wider community in effective ways forward.

As health leaders and organisations start work on their election wish lists, perhaps they will prioritise sustainability and action on climate change.

Perhaps they will also become more proactive in countering climate change denialism, which the author George Monbiot described in an article in The Guardian this week, as “almost a national pastime in Australia”.

Monbiot, who said our “terrible weather is a warning of much worse to come”, described the powerful vested interests opposing action on climate change in Australia, as well as noting that Australians now burn, on average, slightly more carbon per capita than the citizens of the United States and more than twice as much as the people of the United Kingdom.

“Taking meaningful action on climate change would require a serious reassessment of the way life is lived there,” he said.

Meanwhile, in the US, which experienced 11 natural disasters in 2012, its warmest year on record, the editors of the MIT Technology Review have published an open letter to President Obama, arguing that addressing climate change must take top priority in the next four years.

They urge the President to be straight with the public about the need to transform the energy system “to avoid the most catastrophic effects of global warming”. They say:

“This is a deeply unpalatable political message. It means immediate spending and economic sacrifice by present-day voters in order to achieve benefits that will be realized decades from now. And it must be done while millions of Americans are still skeptical that global warming is taking place or that it is caused by human activity. But as extensive and exacting analyses over the last decade have shown, we can no longer wait without risking dramatic upheavals in global security and the health and welfare of hundreds of millions of the world’s inhabitants.

… You have the power and the opportunity to lay the groundwork for a new clean-energy policy that will help us avoid the worst consequences of climate change. It is quite possible that if this is not done over the next four years, it will be too late.”

When the smoke finally clears in Australia, perhaps we will contemplate the advice of a senior editor at Time magazine, Bryan Walsh, who wrote in an article titled 2012 was the hottest year in US history. And yes – it’s climate change:

“The problem is that we tend to gawk at these temperature extremes, or at multibillion-dollar storms, then shrug and go back to our daily business. That shouldn’t be an option anymore.”

As New York Mayor Michael Bloomberg said in the wake of Hurricane Sandy, the climate is changing and leaders have a responsibility to act.

And so do we all.

***

Further reading (these links were updated on 10 Jan)

• The World Economic Forum’s report,Global Risks 2013, calling for “climate-smart decision making”, summarised here at Croakey.

• In The Age, journalist Chris Hammer writes that Australia can expect more deaths from natural disasters as the climate becomes more volatile. Those exceptional days that once came every decade or two, will now occur much more often.

• This article at EcoWatch (self-described as a “news service promoting the work of more than 1,000 grassroots environmental organizations, activists and community leaders”)  links to recent reports including:

Turn Down the Heat: Why a 4°C Warmer World Must be Avoided - This report is a snapshot of the latest climate science prepared for the World Bank by the Potsdam Institute for Climate Impact Research (PIK) and Climate Analytics. It states that the world is on a path to a 4 degree Celsius (4°C) warmer world by end of this century and current greenhouse gas emissions pledges will not reduce this by much.

World Meteorological Organization Report - This report states that the amount of greenhouse gases in the atmosphere reached a new record high in 2011. Between 1990 and 2011 there was a 30 percent increase in radiative forcing—the warming effect on our climate—because of carbon dioxide and other heat-trapping long-lived gases.

Emissions Gap Report 2012 - This report from the UN Environment Programme identifies a huge gap between current pledges to cut polluting greenhouse gas emissions for 2020 and the benchmark of 44 gigatonnes that offers a credible pathway to staying below 2°C.

Global Coal Risk Assessment - World Resources Institute analyzes information about proposed new coal-fired plants and other market trends in order to assess potential future risks to the global climate. The report finds that there are 1,199 new coal power plants in the works, totaling more than 1.4 million megawatts of capacity worldwide. That’s four times the capacity of all the coal-fired power plants in the U.S. Seventy-six percent of the coal plants are proposed for India and China, with the U.S. seventh in the world for coal power plants in development.

National Snow and Ice Data Center Announcement – This announcement stated that the Arctic sea ice cover was at its lowest level since the satellite record began in 1979.

The review’s consultation paper has already come in for a bucket of criticism at Croakey, especially for its glaring lack of attention to what has been described as the “biggest threat to global public health of the 21st century”.

In the article below, public health advocates warn that research into climate change and health must be a priority, given that we have entered “a period of unprecedented and rapid global environmental change”.

***

An urgent need to prioritise research into health and climate change

Dr Elizabeth Haworth, Dr Brad Farrant and Fiona Armstrong write:

The recent consultation paper from the McKeon strategic review of national health and medical research has been criticised by health professional groups and researchers for overlooking what many consider to be the major threat to health: climate change.

The Climate and Health Alliance, a coalition of health professional groups, health service providers, and health consumers, has expressed serious concerns that the recent review not only failed to prioritise climate change and health, but to mention it at all.

This raises questions about the willingness of the review committee to acknowledge the broader social and environmental determinants of health. It also highlights the shortcomings of the current paradigm of health in considering upstream global drivers of ill health and health risks.

Professor Tony McMichael, one of the world’s leading researchers in climate and health, said the consultation paper from the National Strategic Review of Health and Medical Research in Australia contained a disappointing “but predictable set of recommendations.” It provides a “sobering reminder” of the need to expand “concern, research effort, resources and policy to abate the big and unprecedented systemic threats to population health and survival from human induced climate change and other extraordinary global environmental changes”.

The international medical journal The Lancet identified climate change as ‘the biggest threat to global public health of the 21st century’ in 2009. In September this year, a report commissioned by 20 governments on the human and economic costs of climate change showed that climate change is a direct cause of 400,000 deaths each year, along with 4.5 million deaths annually attributable to urban air pollution and other environmental hazards in carbon-intensive economies. These losses cost the world $1.2 trillion in 2010 alone.

Australians already face serious risks to health from climate change, as documented in the 2011 Australian Government Climate Commission report: The Critical Decade: Climate Change and Health. More heatwaves; increasing frequency and severity of extreme weather events; more infectious diseases; more vector borne diseases; more disease and premature deaths due to air pollutants all adversely impact health. The report also warned of inadequate health service preparation in an already stressed healthcare system.

While the review, chaired by Simon McKeon, has identified the need for funding ongoing public health research, nowhere does the report acknowledge the need for research on health impacts of climate change or the carbon intensive economy.

Climate change threatens natural and built systems that protect and preserve health, ranging from direct infrastructure damage to disruption of social and organisational structures required for community resilience. Weaknesses of existing health and public health systems need to be identified so that they can be strengthened by informed policy.

People’s health around the world is already at serious risk from climate change with less than one degree of global mean temperature rise. Our current emissions path, which shows no sign of abating, is predicted to deliver a four degrees global average temperature rise over the next few decades.

The observed rate of climate change is occurring much faster than predictions, so even this may be exceeded. What is known of human’s physiological ability to adapt to these rapid changes in temperature, which also have implications for food and water security, mass global migration, and social and ecological disruption?

Such a rapid change is unrecorded in human history, and no one can be sure humans will be able to adapt. Given this dramatic gamble, it seems unthinkable that a 21st century society, especially one that considers itself a “clever country”, could undertake a review of its national health and medical priorities and fail to even consider the most profound risk to health. And yet this is what we are seeing.

The Climate and Health Alliance (CAHA) recommends that research on the health impacts of climate change and the health benefits of climate action should be part of a collaborative global health improvement program, aiming to reduce the adverse impacts of climate change and improve adaptive resilience.

This is in line with the roadmap for applied research in The Lancet in 2009, the Australian National Adaptation Research Plan – Human Health of the National Climate Change Research Facility and major public health bodies worldwide.

However, spending on health and medical research with any relationship to climate change by the National Health and Medical Research Council over the last decade was just 0.23% of the total spend. This is completely disproportionate to the risks posed to health.

How can governments find $5 trillion to bail out the financial sector and yet be unable to find funding for critical health priorities like addressing climate change?

Assumptions that rely on a business-as-usual world are ignoring the weight of evidence that we are living in a period of unprecedented and rapid global environmental change.

Australia, as a wealthy and developed country with a large land mass, highly variable climate, existing problems with water supply and drought and a recent history of health problems following catastrophic weather events has both a responsibility and opportunity to act as a leader in the field of climate-health research.

Protection and improvement of the health of the public requires a clear-eyed evaluation of the most serious threats to health supported by a comprehensive interdisciplinary research program. This includes healthcare itself becoming a low carbon industry.

These challenges to health require looking beyond narrow ‘medical’ approaches to health, and giving consideration to broader ‘upstream’ factors. As Professor Tony McMichael points out, lessons from history such as the collapse of the Mayan civilisation, highlight the risks of ignoring warning signs of environmental pressures.

We should not imagine ourselves immune to these risks and must heed the warnings, and invest in the research to help us respond and manage them.

The next phase of the McKeon strategic review is an opportunity to reconsider our national health and medical research priorities, and enable integrated health research to address the ‘biggest threat to global public health of the 21st century’.

• Brad Farrant is a post doctoral researcher at the Telethon Institute for Child Health Research. He is interested in how ecological factors like biodiversity loss, population growth, peak water and climate change will interact to affect children’s development now and in the future.

• Elizabeth Haworth is an epidemiologist and public health researcher and consultant based in Tasmania formerly Senior Clinical Lecturer in Public Health at the University of Oxford.

***

Further reading recommended by Croakey

• The Guardian has a useful portal for climate change news and resources

• This report from The Atlantic, 5 Charts About Climate Change That Should Have You Very, Very Worried, links to recent reports from the World Bank and the US National Research Council warning of the need for urgent action, and includes some sobering infographics, as well as a link to this sobering clip from Grist’s David Roberts. 

Click here to view the embedded video.