Pesticide-handling practices: The case of coffee growers in Papua New Guinea

Pesticide mismanagement potentially has high risks for farmers, households living in the community and the environment. In Papua New Guinea where farming is the primary occupation, there is evidence of dangerous herbicide application methods being used by coffee growers. Using original survey data for coffee smallholders from four provinces, we assess the factors driving farmers' use of personal protective equipment when preparing and applying herbicides, and farmers' disposal of agro-chemical containers. We control for households' demographic variables and measure the impact of farmers' training in pest and disease management. We use the special regressor method to estimate binary choice models featuring an endogenous binary regressor (training). Our results show that human capital (education) and training are important drivers of farmers' pesticide-handling practices, with marginal effects estimated at 10 and 22 per cent, respectively

The association between built environment features and physical activity in the Australian context: A synthesis of the literature

Background: There is growing evidence indicating that the built environment is a determinant of physical activity. However, despite the well-established health benefits of physical activity this is rarely considered in urban planning. We summarised recent Australian evidence for the association built environment-physical activity among adults. This summary aims to inform policy makers who advocate for the consideration of health in urban planning. Methods: A combination of built environment and physical activity terms were used to systematically identify relevant peer reviewed and grey literature. Results: A total of 23 studies were included, providing 139 tests of associations between specific built environment features and physical activity. Of the total, 84 relationships using objective measures of built environment attributes were evaluated, whereas 55 relationships using self-reported measures were evaluated. Our results indicate that walkable neighbourhoods with a wide range of local destinations to go to, as well as a diverse use of land, encourage physical activity among their residents. Conclusions: This research provides a summary of recent Australian evidence on built environments that are most favourable for physical activity. Features of walkability and availability of destinations within walking distance should be accounted for in the development or redevelopment of urban areas. Our findings emphasise the importance of urban planning for health via its impact on population levels of physical activity

The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia

Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments

A rapid review of evidence: The effects of urban form on health: costs and benefits

Within the Australian context, there is sufficient evidence that increased walking and cycling have positive monetary health-related benefits. Each additional kilometre walked has been estimated to result in health-related benefits that range in value from $1.04 to$2.08. Each additional kilometre cycled results in health-related benefits that range in value from less than $0.02 to$1.12. There is compelling Australian evidence linking attributes of the urban form with physical activity among adults. There is insufficient evidence to draw conclusions for children and adolescents. Attributes of the urban form that increase physical activity among adults are the number of destinations within walking or cycling distance, greater diversity in land use, shorter distance to transit, and neighbourhood walkability. Broadly, the literature suggests that if people are to walk and cycle, they need destinations within walking or cycling distance. Economic outcomes were found to be greatest for increasing destinations within the neighbourhood, which are associated with health-related benefits worth an average $14.65 per adult annually (range$0.42 to $42.50), depending on the destination and context. The economic value of increasing neighbourhood walkability was found to be worth an average$1.62 per adult annually (range $0.11 to$15.73). The health-related economic benefits of changes in urban form are modest at an individual level, but when multiplied for whole populations, these figures are significant

The impact on productivity of a hypothetical tax on sugar-sweetened beverages

Objectives To quantify the potential impact of an additional 20% tax on sugar-sweetened beverages (SSBs) on productivity in Australia. Methods We used a multi-state lifetable Markov model to examine the potential impact of an additional 20% tax on SSBs on total lifetime productivity in the paid and unpaid sectors of the economy. The study population consisted of Australians aged 20 years or older in 2010, whose health and other relevant outcomes were modelled over their remaining lifetime. Results The SSBs tax was estimated to reduce the number of people with obesity by 1.96% of the entire population (437,000 fewer persons with obesity), and reduce the number of employees with obesity by 317,000 persons. These effects translated into productivity gains in the paid sector of AU$751 million for the working-age population (95$565 million to AU$954 million), using the human capital approach. In the unpaid sector, the potential productivity gains amounted to AU$1172 million (AU$929 million to AU$1435 million) using the replacement cost method. These productivity benefits are in addition to the health benefits of 35,000 life years gained and a reduction in healthcare costs of AU$425 million. Conclusions An additional 20% tax on SSBs not only improves health outcomes and reduces healthcare costs, but provides productivity gains in both the paid and unpaid sectors of the economy

The impact on productivity of a hypothetical tax on sugar-sweetened beverages

Objectives To quantify the potential impact of an additional 20% tax on sugar-sweetened beverages (SSBs) on productivity in Australia. Methods We used a multi-state lifetable Markov model to examine the potential impact of an additional 20% tax on SSBs on total lifetime productivity in the paid and unpaid sectors of the economy. The study population consisted of Australians aged 20 years or older in 2010, whose health and other relevant outcomes were modelled over their remaining lifetime. Results The SSBs tax was estimated to reduce the number of people with obesity by 1.96% of the entire population (437,000 fewer persons with obesity), and reduce the number of employees with obesity by 317,000 persons. These effects translated into productivity gains in the paid sector of AU$751 million for the working-age population (95$565 million to AU$954 million), using the human capital approach. In the unpaid sector, the potential productivity gains amounted to AU$1172 million (AU$929 million to AU$1435 million) using the replacement cost method. These productivity benefits are in addition to the health benefits of 35,000 life years gained and a reduction in healthcare costs of AU$425 million. Conclusions An additional 20% tax on SSBs not only improves health outcomes and reduces healthcare costs, but provides productivity gains in both the paid and unpaid sectors of the economy

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: A systematic review of economic evaluations

Background: Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low-and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods: In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond's checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results: From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions: This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Populati

Transport-related walking among young adults: When and why?

Background: The existing smartphones' technology allows for the objective measurement of a person's movements at a fine-grained level of geographic and temporal detail, and in doing so, it mitigates the issues associated with self-report biases and lack of spatial details. This study proposes and evaluates the advantages of using a smartphone app for collecting accurate, fine-grained, and objective data on people's transport-related walking. Methods: A sample of 142 participants (mostly young adults) was recruited in a large Australian university, for whom the app recorded all their travel activities over two weekdays during August-September 2014. We identified eight main activity nodes which operate as transport-related walking generators. We explored the participants' transport-related walking patterns around and between these activity nodes through the use of di-graphs to better understand patterns of incidental physical activity and opportunities for intervention to increase incidental walking. Results: We found that the educational node - in other samples may be represented by the workplace - is as important as the residential node for generating walking trips. We also found that the likelihood of transport-related walking trips is larger during the daytime, whereas at night time walking trips tend to be longer. We also showed that patterns of transport-related walking relate to the presence of 'chaining' trips in the afternoon period. Conclusions: The findings of this study show how the proposed data collection and analytic approach can inform urban design to enhance walkability at locations that are likely to generate walking trips. This study's insights can help to shape public education and awareness campaigns that aim to encourage walking trips throughout the day by suggesting locations and times of the day when engaging in these forms of exercise is easiest and least intrusive

A systematic review of economic analyses of active transport interventions that include physical activity benefits

Physical inactivity is one of the leading causes for the growing prevalence of non-communicable diseases worldwide and there is a need for more evidence on the effectiveness and cost-effectiveness of interventions that aim to increase physical activity at the population level. This study aimed to update a systematic review published in 2008 by searching peer-reviewed and unpublished literature of economic evaluations of transport interventions that incorporate the health related effects of physical activity. Our analysis of methods for the inclusion of physical activity related health effects into transport appraisal over time demonstrates that methodological progress has been made. Thirty-six studies were included, reflecting an increasing recognition of the importance of incorporating these health effects into transport appraisal. However, significant methodological challenges in the incorporation of wider health benefits into transport appraisal still exist. The inclusion of physical activity related health effects is currently limited by paucity of evidence on morbidity effects and of more rigorous evidence on the effectiveness of interventions. Significant scope exists for better quality and more transparent reporting. A more consistent approach to the inclusion of benefits and disbenefits would reinforce the synergies between the health, environmental, transport and other sectors. From a transport sector perspective the inclusion of physical activity related health benefits positively impacts cost effectiveness, with the potential to contribute to a more efficient allocation of scarce resources based on a more comprehensive range of merits. From a public health perspective the inclusion of physical activity related health benefits may result in the funding of more interventions that promote active transport, with the potential to improve population levels of physical activity and to reduce prevalence of physical activity related diseases

Shifting car travel to active modes to improve population health and achieve transport goals: A simulation study

Introduction: Being physically active has multiple health benefits and contributes to the reduction of co-morbidities and mortality from chronic diseases. Active transport (walking and cycling) contributes to population health by enabling physical activity. We developed a simulation model to measure health impacts of transport scenarios for Melbourne, Australia. Our aim was to demonstrate active transport health impacts and support the materialization of policies for healthy cities and people. The model measures health impacts of increased physical activity from replacing short car trips for any purpose or for commuting under 5 km by walking and cycling. Methods: We developed a micro-simulation model of physical activity and disease risk in combination with the well-established proportional multi-state life table model. We quantified life course health including health adjusted-life years, life years, new cases of diseases prevented, and deaths prevented for 14 chronic diseases associated with physical inactivity for the adult population of people from Melbourne, Australia in 2017. Results: Over the life course of the Melbourne adult population of 3.6 million people in 2017, gains in health-adjusted life years ranged from 5,100 (95% Uncertainty Interval (UI) 3,700 to 6,500) for the scenario replacing commute trips by car under 1 km with walking up to 738,800 (95% UI 546,000 to 935,000) when replacing car trips under 2 km with walking and between 2 km and 5 km with cycling. We also estimated benefits in terms of reductions of new cases of diseases and deaths prevented, with the greatest gains for ischemic heart disease, stroke, Alzheimer's and other dementias and type 2 diabetes. Conclusions: We found that shifting car travel to active modes would accrue important health benefits for the 2017 Melbourne population. Our results support policies and strategies for sustainable transport planning to contribute to reduce the burden from chronic diseases and environmental impact of car-oriented cities