The Trans Pacific Partnership Agreement negotiations and the health of Australians

The Trans Pacific Partnership Agreement has the potential to negatively impact the health of Australians by raising the cost of medicine and limiting the government\u27s ability to regulate tobacco and alcohol, argues this policy brief based on publicly available and recently leaked negotiating documents. Executive summary The purpose of this policy brief is to inform the debate from a health perspective in the final stages of the negotiations on the Trans Pacific Partnership Agreement (TPPA), particularly during meetings of chief negotiators and ministers in February 2014. This policy brief outlines the evidence about the potential health effects on the Australian community of actions related to the TPPA, based on publicly available and recently leaked negotiating documents. The purpose of the TPPA is to enhance each of the countries’ economic development and that this may lead to improved social and health development. However, although there may be positive impacts on the health and wellbeing of Australians resulting from economic growth, there are also many ways in which the TPPA has the potential to have negative impacts on the health of Australians. This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs. Concerning the cost of medicine we focus on how proposed provisions in the TPPA could impact the affordability of medicines through several different routes: by delaying the availability of cheaper generic medicines, by altering the operation of the Pharmaceutical Benefits Scheme (PBS) making it more difficult to keep costs down, and by enabling pharmaceutical companies to sue the government over its pharmaceutical policies. These changes would increase the cost of the PBS for the government and taxpayers. Strategies to compensate for an increase in medication costs include increased cost-sharing, with patients assuming higher co-payments, or funding reallocation from other parts of the healthcare system. Provisions in the TPPA may impact the ability of Government to enforce existing policies and implement new policies that support public health. Australia is internationally recognised for the success of comprehensive strategies to reduce tobacco smoking. And more recently, there are multiple initiatives being proposed to achieve similar success to reduce harmful use of alcohol. We outline several of the many provisions in the TPPA that could affect tobacco and alcohol policies in Australia. Concerning tobacco these include an investor-state dispute settlement mechanism clause in the TPPA would provide more opportunities for tobacco companies to sue the Australian government over strong tobacco control measures. Rules about ‘indirect expropriation’ (i.e. depriving an investor of property, which, if broadly defined, can include intellectual property such as trademarks) and ‘fair and equitable treatment’ provide additional grounds for corporations to argue that their assets are being unfairly affected by government policies and laws. Provisions in the TPPA may impact the Government’s ability to implement effective alcohol control policies such as restrictions on liquor licences, bans or limits on alcohol advertising, and alcohol health warning labels. Concerning alcohol these include provisions in the Technical Barriers to Trade (TBT) Chapter of the TPPA which could limit possibilities for introducing innovative alcohol policies, such as requiring health warning labels. Provisions in the wine and spirits annex to the TBT Chapter may limit the options available to create a fully effective alcohol warnings scheme for wine and spirits. If Australia agrees to an investor-state dispute settlement (ISDS) mechanism applying to Australia, the alcohol industry will have access to a new legal channel to sue the Australian Government over alcohol policy decisions that adversely impact their investments. We conclude that while there is some potential for the TPPA to contribute to economic development, there is also significant risk that the economic gains which the TPPA may represent, as well as the health of the Australian community, will be threatened if certain proposed provisions are adopted for the TPPA. These include increased direct costs in terms of providing health care and increased use of hospitals, higher costs of obtaining pharmaceuticals, indirect costs associated with lost productivity across society, continuing or exacerbating inequalities in society, and worsening the health of Australia’s already vulnerable communities. Authored by: Katie Hirono, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Deborah Gleeson, School of Public Health and Biosciences, La Trobe University Fiona Haigh, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Patrick Harris, Centre for Health Equity Training, Research and Evaluation, University of New South Wale

Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement

Drawing on leaked texts of potential provisions of the proposed Trans-Pacific Partnership Agreement, this health impact assessment found the potential for negative impacts in the cost of medicines, tobacco control policies, alcohol control policies, and food labeling. Overview The Centre for Health Equity Training Research and Evaluation (CHETRE) has been working with a group of Australian academics and non-government organisations interested in the health of the Australian population to carry out a health impact assessment (HIA) on the Trans-Pacific Partnership Agreement (TPP) negotiations. In the absence of official publicly available drafts of the trade agreement, the health impact assessment drew on leaked texts of potential provisions and formulated policy scenarios based on high priority health policies that could be affected by the TPP. The HIA found the potential for negative impacts in each of the four areas under investigation: the cost of medicines; tobacco control policies; alcohol control policies; and food labeling. In each of these areas, the HIA report traces the relevant proposed provisions through to their likely effects on the policy scenarios onto the likely impact on the health of Australians, focusing particularly on vulnerable groups in the Australian community. The report makes a number of recommendations to DFAT regarding the TPP provisions and to the Australian Government regarding the TPP negotiating process

An evaluation of earth banked tanks for slurry storage

End of project reportThis study examines the feasibility of using earth-banked tanks (EBT’s) as an alternative and economical means of winter storage for animal and other farmyard wastes. The study contains a detailed literature review on the subject, the results of a series of laboratory-scale experiments, field studies and a predictive model of the transport process through the soil liner of an earth-banked tank

The Relationship Between Cholesterol Absorption and Intestinal Cholesterol Synthesis in the Diabetic Rat Model

The chylomicron remnant particle is thought to be particularly atherogenic and we have previously shown alterations in post-prandial lipoproteins which could contribute to their atherogenicity. Cholesterol metabolism is disturbed in diabetes, yet the effect of diabetes on intestinal cholesterol synthesis and absorption has rarely been investigated. The aim of this study was to examine cholesterol absorption and intestinal synthesis of cholesterol in the streptozotocin diabetic rat. Twelve diabetic rats were paired with 12 control rats. [14C]-Cholesterol emulsion was administered and the lymph duct was canulated. Lymph was collected for 4 h. At sacrifice blood was taken for plasma lipoprotein measurements. Chylomicrons were prepared from the lymph by ultracentrifugation and [14C]-cholesterol content was determined by liquid scintillation counting. Lymph apolipoprotein B48 was isolated by gradient gel electrophoresis, and quantified by densitometric scanning. Serum triglyceride and cholesterol were greatly elevated in diabetic compared to control animals (260 ± 90 and 9.8 ± 8.0 mg/ml vs. 1.0 ± 0.4 and 0.6 ± 0.3 mg/ml, p < 0.0001 respectively). Lymph chylomicron apo B48 was similar in the two groups. Cholesterol absorption was not significantly different in diabetic compared to control rats but cholesterol synthesis was significantly, higher in the diabetic animals (550 ± 352 vs. 322 ± 113 μg/h p < 0.03). There was a positive correlation between apo B48 and cholesterol absorption (r = 0.70, p < 0.01) in the diabetic rats and control rats (r = 0.71, p < 0.01) but no correlation between apo B48 and cholesterol synthesis in either group. This study demonstrates that cholesterol synthesis was increased in diabetes whereas cholesterol absorption was unaffected suggesting that intestinal cholesterol synthesis made an important contribution to the hypercholesterolaemia seen in the diabetic animals

Lipid coated liquid crystal droplets for the on-chip detection of antimicrobial peptides

We describe a novel biosensor based on phospholipid-coated nematic liquid crystal (LC) droplets and demonstrate the detection of Smp43, a model antimicrobial peptide (AMP) from the venom of North African scorpion Scorpio maurus palmatus. Mono-disperse lipid-coated LC droplets of diameter 16.7 ± 0.2 μm were generated using PDMS microfluidic devices with a flow-focusing configuration and were the target for AMPs. The droplets were trapped in a bespoke microfluidic trap structure and were simultaneously treated with Smp43 at gradient concentrations in six different chambers. The disruption of the lipid monolayer by the Smp43 was detected (<6 μM) at concentrations well within its biologically active range, indicated by a dramatic change in the appearance of the droplets associated with the transition from a typical radial configuration to a bipolar configuration, which is readily observed by polarizing microscopy. This suggests the system has feasibility as a drug-discovery screening tool. Further, compared to previously reported LC droplet biosensors, this LC droplet biosensor with a lipid coating is more biologically relevant and its ease of use in detecting membrane-related biological processes and interactions has the potential for development as a reliable, low-cost and disposable point of care diagnostic tool

Multi-layered collagen-based scaffolds for osteochondral defect repair in rabbits.

INTRODUCTION: Identification of a suitable treatment for osteochondral repair presents a major challenge due to existing limitations and an urgent clinical need remains for an off-the-shelf, low cost, one-step approach. A biomimetic approach, where the biomaterial itself encourages cellular infiltration from the underlying bone marrow and provides physical and chemical cues to direct these cells to regenerate the damaged tissue, provides a potential solution. To meet this need, a multi-layer collagen-based osteochondral defect repair scaffold has been developed in our group. AIM: The objective of this study was to assess the in vivo response to this scaffold and determine its ability to direct regenerative responses in each layer in order to repair osteochondral tissue in a critical-sized defect in a rabbit knee. METHODS: Multi-layer scaffolds, consisting of a bone layer composed of type I collagen (bovine source) and hydroxyapatite (HA), an intermediate layer composed of type I and type II collagen and HA; and a superficial layer composed of type I and type II collagen (porcine source) and hyaluronic acid (HyA), were implanted into critical size (3 × 5 mm) osteochondral defects created in the medial femoral condyle of the knee joint of New Zealand white rabbits and compared to an empty control group. Repair was assessed macroscopically, histologically and using micro-CT analysis at 12 weeks post implantation. RESULTS: Analysis of repair tissue demonstrated an enhanced macroscopic appearance in the multi-layer scaffold group compared to the empty group. In addition, diffuse host cellular infiltration in the scaffold group resulted in tissue regeneration with a zonal organisation, with repair of the subchondral bone, formation of an overlying cartilaginous layer and evidence of an intermediate tidemark. CONCLUSION: These results demonstrate the potential of this biomimetic multi-layered scaffold to support and guide the host reparative response in the treatment of osteochondral defects. STATEMENT OF SIGNIFICANCE: Osteochondral defects, involving cartilage and the underlying subchondral bone, frequently occur in young active patients due to disease or injury. While some treatment options are available, success is limited and patients often eventually require joint replacement. To address this clinical need, a multi-layer collagen-based osteochondral defect repair scaffold designed to direct host-stem cell mediated tissue formation within each region, has been developed in our group. The present study investigates the in vivo response to this scaffold in a critical-sized defect in a rabbit knee. Results shows the scaffolds ability to guide the host reparative response leading to tissue regeneration with a zonal organisation, repair of the subchondral bone, formation of an overlying cartilaginous layer and evidence of an intermediate tidemark

Leisure constraints for adolescents in Cape Town, South Africa: a qualitative study

This study identified leisure constraints, constraints negotiation strategies, and their relative frequencies among 114 high school students from one under-resourced area of South Africa. Through focus group discussions, participants identified intrapersonal, interpersonal, structural, and sociocultural constraints to leisure, suggesting some degree of universality in this previously documented typology. Intrapersonal constraints were mentioned most often. Whereas participants readily identified ways to overcome interpersonal and structural constraints, strategies for overcoming intrapersonal and sociocultural constraints were not mentioned frequently, suggesting a potential need to help adolescents identify and employ these types of strategies.Web of Scienc

Reflecting on Pupil Learning to Promote Social Justice: A Catholic University’s Approach to Assessment

In contrast to current education policies that conceptualize pupil learning largely in terms of standardized exam scores, we offer an alternative view, one that conceives of pupil learning as a source of insight for pupils and teachers alike. Drawing on survey data and a qualitative study of the teacher candidate experience, we explore the following questions: In a teacher education program committed to promoting social justice, embracing an inquiry-into-practice stance, and affirming diversity by meeting the needs of diverse learners, how do teacher candidates assess pupil learning, in particular, how are their assessments influenced by these program themes? Further, how do they respond when dilemmas linked to pupil learning arise? Specifically, we focused on dilemmas two teacher candidates encountered that engendered a sense of “disequilibrium,” a feeling something was not quite right with their teaching. In turn, we consider how they responded”typically taking ownership of dilemmas and modifying their teaching, while occasionally distancing themselves from responsibility for pupil performance. To conclude, we discuss implications for teacher educators, and specifically for Catholic institutions of higher education that prepare teachers for both public and Catholic schools

Reflecting on Pupil Learning to Promote Social Justice: A Catholic University\u27s Approach to Assessment

In contrast to current education policies that conceptualize pupil learning largely in terms of standardized exam scores, we offer an alternative view, one that conceives of pupil learning as a source of insight for pupils and teachers alike. Drawing on survey data and a qualitative study of the teacher candidate experience, we explore the allowing questions: In a teacher education program committed to promoting social justice, embracing an inquiry-into-practice stance, and affirming diversity by meeting the needs of diverse learners, how do teacher candidates assess pupil learning, in particular, how are their assessments influenced by these program themes? Further, how do they respond when dilemmas linked to pupil learning arise? Specifically, we focused on dilemmas two teacher candidates encountered that engendered a sense of disequilibrium,” a feeling something was not quite right with their leaching. In turn; we consider how they responded-typically taking ownership of dilemmas and modifying their teaching, while occasionally distancing themselves from responsibility for pupil performance. To conclude, we discuss implications for teacher educators, and specifically for Catholic institutions of higher education that prepare teachers for both public and Catholic schools