The impact of climate-related extreme events on public health workforce and infrastructure – how can we be better prepared?

The Intergovernmental Panel on Climate Change’s fifth assessment report1 states with confidence that human induced climate change is occurring and that temperatures will continue to rise, even if CO2 emissions were to stop forthwith. The report also acknowledges that climate-related extreme events are increasing in frequency, severity and duration; particularly heavy rainfall events, intensification of cyclones, increases in tidal surge and fires. This poses the question: “Are we prepared?” This is question that public health authorities will need to face but, as health systems are increasingly stressed due to limited resources, increased demand and workforce shortages, being prepared becomes even more challenging. Extreme events place an additional burden on health systems already under pressure due to increased demand for health care services, and as public health resources are offset against the demands in the acute care sector. (For the purposes of this paper, public health services refer to those health and related services that seek to prevent disease and promote health.) The impact on often already overstretched public health services may not be recognised, and additional resourcing and support may not follow. As discussed later, recent Australian experiences indicate that the status quo will not be sufficient to both mount a successful public health response to climate-related extreme events and maintain a strong public health infrastructure

A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25–39 year-old males

Objective: To assess the relative cost-effectiveness of various non-television advertising media in encouraging 25–39 year-old male smokers to respond to a cessation-related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. Methods: Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost-effectiveness of each media in isolation and the integrated approach. Results: The online-only campaign phase was substantially more cost-effective than the other phases, including the integrated approach. Conclusions: This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost-effective way of reaching and affecting target audiences. Implications: Online advertising may be a highly cost-effective channel for low-budget tobacco control media campaigns

High folate levels in Aboriginal children after subsidised fruit and vegetables and mandatory folic acid fortification

Objective: To evaluate the impact of a fruit and vegetable (F&V) subsidy program for disadvantaged Aboriginal children in Australia, implemented alongside the introduction of mandatory folic acid fortification of bread-making flour.\ud \ud Methods: A before-and-after evaluation was undertaken of a F&V subsidy program at three Aboriginal community-controlled health services in New South Wales. The program provided a weekly box of subsidised F&V linked to preventive health services and nutrition promotion for families. In this analysis, red blood cell (RBC) folate was assessed together with self-reported dietary intake at baseline and 12 months later in a cohort of 125 children (aged 0-17 years).\ud \ud Results: No children had low RBC folate at baseline or at follow-up; however, 33 children (26%) exceeded the reference range of RBC folate at baseline and 38 children (30%) exceeded the reference range at follow-up. Mean RBC folate levels increased substantially in children at follow-up (mean RBC folate z-score increased +0.55 (95%CI 0.36-0.74). Change in F&V intake (p=0.196) and mean bread intake (p=0.676) were not statistically significant predictors for change in RBC folate levels.\ud \ud Conclusions: RBC folate levels increased among these disadvantaged Aboriginal children following mandatory folic acid fortification and participation in a subsidised F&V program. Even before mandatory folic acid fortification, none of these children had low RBC folate.\ud \ud Implications: The effect on health of mandatory fortification of foods with folate is not clear, hence, ongoing population-based monitoring of folate levels to assess the impact of mandatory folic acid fortification is important