Anthony J McMichael

Australian National University, Canberra, Australian Capital Territory, Australia

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Publications (222)1817.24 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is increasing understanding, globally, that climate change will have profound and mostly harmful effects on human health. This authoritative book brings together international experts to describe both direct (such as heat waves) and indirect (such as vector-borne disease incidence) impacts of climate change, set in a broad, international, economic, political and environmental context. This unique book also expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and conflict. This lively yet scholarly resource explores these issues fully, linking them to health in urban and rural settings in developed and developing countries. The book finishes with a practical discussion of action that health professionals can yet take.
    1st edited by Colin D Butler, 09/2014; CABI., ISBN: 9781780642659
  • Anthony J McMichael
    The Medical journal of Australia. 05/2014; 200(9):507-8.
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    ABSTRACT: Immunisation with a T-cell dependent antigen has been promoted as a reliable and sensitive tool for assessing the influence of putative immunotoxic exposures or agents on immune function. Keyhole limpet haemocyanin (KLH) is a very large, copper-containing protein molecule derived from the haemolymph of the inedible mollusc, Megathura crenulata. KLH is a highly immunogenic T-cell dependent antigen that is used increasingly in immunotoxicological studies, particularly in those involving animals. This report systematically reviews the human clinical studies that have used trans-cutaneous KLH immunisation for assessment of the influence of various physiological and disease states and exposures on immune function over the last twenty years (1994 – 2013). These studies varied in their immunisation protocols, formulation of KLH, dose, site and route of administration and immunoassay platforms developed to assess KLH-specific responses. KLH immunisation has been well tolerated with only mild to moderate adverse effects reported. Though very promising as a model antigen candidate in immunotoxicology research, more work on standardising immunisation and immunoassay protocols is required.
    British Journal of Clinical Pharmacology 05/2014; · 3.58 Impact Factor
  • Victoria Ng, Keith Dear, David Harley, Anthony McMichael
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    ABSTRACT: Abstract Background: Ross River virus (RRV) disease is the most widespread mosquito-borne disease in Australia. The disease is maintained in enzootic cycles between mosquitoes and reservoir hosts. During outbreaks and in endemic regions, RRV transmission can be sustained between vectors and reservoir hosts in zoonotic cycles with spillover to humans. Symptoms include arthritis, rash, fever and fatigue and can persist for several months. The prevalence and associated morbidity make this disease a medically and economically important mosquito-borne disease in Australia. Methods: Climate, environment, and RRV vector and reservoir host information were used to develop predictive models in four regions in NSW over a 13-year period (1991-2004). Polynomial distributed lag (PDL) models were used to explore long-term influences of up to 2 years ago that could be related to RRV activity. Results: Each regional model consisted of a unique combination of predictors for RRV disease highlighting the differences in the disease ecology and epidemiology in New South Wales (NSW). Events up to 2 years before were found to influence RRV activity. The shorter-term associations may reflect conditions that promote virus amplification in RRV vectors whereas long-term associations may reflect RRV reservoir host breeding and herd immunity. The models indicate an association between host populations and RRV disease, lagged by 24 months, suggesting two or more generations of susceptible juveniles may be necessary for an outbreak. Model sensitivities ranged from 60.4% to 73.1%, and model specificities ranged from 57.9% to 90.7%. This was the first study to include reservoir host data into statistical RRV models; the inclusion of host parameters was found to improve model fit significantly. Conclusion: The research presents the novel use of a combination of climate, environment, and RRV vector and reservoir host information in statistical predictive models. The models have potential for public health decision-making.
    Vector borne and zoonotic diseases (Larchmont, N.Y.) 04/2014; · 2.61 Impact Factor
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    Bianca Brijnath, Colin D Butler, Anthony J McMichael
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    ABSTRACT: In 2008 the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) commissioned ten think-tanks to work on disease-specific and thematic reference groups to identify top research priorities that would advance the research agenda on infectious diseases of poverty, thus contributing to improvements in human health. The first of the thematic reference group reports - on environment, agriculture and infectious diseases of poverty - was recently released. In this article we review, from an insider perspective, the strengths and weaknesses of this thematic reference group report and highlight key messages for policy-makers, funders and researchers.
    Infectious diseases of poverty. 01/2014; 3(1):2.
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    ABSTRACT: The increasing prevalence of immune-related diseases, including multiple sclerosis, may be partly explained by reduced microbial burden during childhood. Within a multi-centre case-control study population, we examined: (i) the co-morbid immune diseases profile of adults with a first clinical diagnosis of central nervous system demyelination (FCD) and (ii) sibship structure in relation to an autoimmune (FCD) and an allergic (asthma) disease. FCD cases (n = 282) were aged 18-59 years; controls (n = 558) were matched on age, sex and region. Measures include: history of doctor-diagnosed asthma; sibling profile (number; dates of birth); and regular childcare attendance. FCD cases did not differ from controls with regard to personal or family history of allergy, but had a greater likelihood of chronic fatigue syndrome [odds ratio (OR) = 3·11; 95% confidence interval (CI) 1·11, 8·71]. Having any younger siblings showed reduced odds of FCD (OR = 0·68; 95% CI: 0·49, 0·95) but not asthma (OR = 1·47; 95% CI: 0·91, 2·38). In contrast, an increasing number of older siblings was associated with reduced risk of asthma (P trend = 0·04) but not FCD (P trend = 0·66). Allergies were not over-represented among people presenting with FCD. Sibship characteristics influence both FCD and asthma risk but the underlying mechanisms differ, possibly due to the timing of the putative 'sibling effect'.
    Clinical & Experimental Immunology 06/2013; 172(3):466-74. · 3.41 Impact Factor
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    ABSTRACT: INTRODUCTION: Lifestyle factors prior to a first clinical demyelinating event (FCD), a disorder often preceding the development of clinically definite multiple sclerosis (MS), have not previously been examined in detail. Past tobacco smoking has been consistently associated with MS. METHODS: This was a multicentre incident case-control study. Cases (n = 282) were aged 18-59 years with an FCD and resident within one of four Australian centres (from latitudes 27°S to 43°S), from 1 November 2003 to 31 December 2006. Controls (n = 558) were matched to cases on age, sex and study region, without CNS demyelination. Exposures measured included current and past tobacco and marijuana, alcohol and beverage use, physical activity patterns, blood pressure and physical anthropometry. RESULTS: A history of smoking ever was associated with FCD risk (AOR 1.89 (95%CL 1.82, 3.52)). Marijuana use was not associated with FCD risk after adjusting for confounders such as smoking ever but the estimates were imprecise because of a low prevalence of use. Alcohol consumption was common and not associated with FCD risk. No case-control differences in blood pressure or physical anthropometry were observed. CONCLUSIONS: Past tobacco smoking was positively associated with a risk of FCD but most other lifestyle factors were not. Prevention efforts against type 2 diabetes and cardiovascular disease by increasing physical activity and reducing obesity are unlikely to alter MS incidence, and more targeted campaigns will be required.
    Multiple Sclerosis 05/2013; · 4.47 Impact Factor
  • Charmian M Bennett, Keith B G Dear, Anthony J McMichael
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    ABSTRACT: Studies in temperate countries have shown that both hot weather in summer and cold weather in winter increase short-term (daily) mortality. The gradual warming, decade on decade, that Australia has experienced since the 1960s, might therefore be expected to have differentially affected mortality in the two seasons, and thus indicate an early impact of climate change on human health. Failure to detect such a signal would challenge the widespread assumption that the effect of weather on mortality implies a similar effect of a change from the present to projected future climate. We examine the ratio of summer to winter deaths against a background of rising average annual temperatures over four decades: the ratio has increased from 0.71 to 0.86 since 1968. The same trend, albeit of varying strength, is evident in all states of Australia, in four age groups (aged 55 years and above) and in both sexes. Analysis of cause-specific mortality suggests that the change has so far been driven more by reduced winter mortality than by increased summer mortality. Furthermore, comparisons of this seasonal mortality ratio calculated in the warmest subsets of seasons in each decade, with that calculated in the coldest seasons, show that particularly warm annual conditions, which mimic the expected temperatures of future climate change, increase the likelihood of higher ratios (approaching 1:1). Overall, our results indicate that gradual climate change, as well as short-term weather variations, affect patterns of mortality.
    International Journal of Biometeorology 04/2013; · 2.59 Impact Factor
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    ABSTRACT: Inconsistent evidence exists regarding the association between work-related factors and risk of multiple sclerosis (MS). We examined the association between occupational exposures and risk of a first clinical diagnosis of central nervous system demyelination (FCD), which is strongly associated with progression to MS, in a matched case-control study of 276 FCD cases and 538 controls conducted in Australia (2003-2006). Using a personal residence and work calendar, information on occupational history and exposure to chemicals and animals was collected through face-to-face interviews. Few case-control differences were noted. Fewer cases had worked as professionals (≥6 years) than controls (adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI): 0.37, 0.96). After further adjustment for number of children, cases were more likely to have ever been exposed to livestock than controls (AOR = 1.54, 95% CI: 1.03, 2.29). Among women, there was an increase in FCD risk associated with 10 or more years of exposure to livestock (AOR = 2.78, 95% CI: 1.22, 6.33) or 6 or more years of farming (AOR = 2.00, 95% CI: 1.23, 3.25; also adjusted for number of children). Similar findings were not evident among men. Thus, farming and exposure to livestock may be important factors in the development of FCD among women, with this finding further revealed after the confounding effect of parity or number of children is considered.
    American journal of epidemiology 04/2013; · 5.59 Impact Factor
  • Anthony J McMichael
    New England Journal of Medicine 04/2013; 368(14):1335-43. · 51.66 Impact Factor
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    ABSTRACT: Observational studies suggest that people with a high serum 25-hydroxyvitamin D (25(OH)D) concentration may have reduced risk of chronic diseases such as osteoporosis, multiple sclerosis, type 1 diabetes, cardiovascular disease, and some cancers. The AusD Study (A Quantitative Assessment of Solar UV Exposure for Vitamin D Synthesis in Australian Adults) was conducted to clarify the relationships between ultraviolet (UV) radiation exposure, dietary intake of vitamin D, and serum 25(OH)D concentration among Australian adults residing in Townsville (19.3°S), Brisbane (27.5°S), Canberra (35.3°S), and Hobart (42.8°S). Participants aged 18-75 years were recruited from the Australian Electoral Roll between 2009 and 2010. Measurements were made of height, weight, waist:hip ratio, skin, hair, and eye color, blood pressure, and grip strength. Participants completed a questionnaire on sun exposure and vitamin D intake, together with 10 days of personal UV dosimetry and an associated sun-exposure and physical-activity diary that was temporally linked to a blood test for measurement of 25(OH)D concentration. Ambient solar UV radiation was also monitored at all study sites. We collected comprehensive, high-quality data from 1,002 participants (459 males, 543 females) assessed simultaneously across a range of latitudes and through all seasons. Here we describe the scientific and methodological issues considered in designing the AusD Study.
    American journal of epidemiology 03/2013; · 5.59 Impact Factor
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    ABSTRACT: Vitamin D deficiency is common and implicated in risk of several human diseases. Evidence on the relative quantitative contribution of environmental, genetic and phenotypic factors to vitamin D status (assessed by the serum concentration of 25-hydroxyvitamin D, 25(OH)D) in free-living populations is sparse. We conducted a cross-sectional study of 494 Caucasian adults aged 18-61 years, randomly selected from the Australian Electoral Roll according to groups defined by age, sex and region (spanning 27°-43°South). Data collected included personal characteristics, sun exposure behaviour, biomarkers of skin type and past sun exposure, serum 25(OH)D concentration and candidate single nucleotide polymorphisms. Ambient ultraviolet radiation (UVR) levels in the month six weeks before blood sampling best predicted vitamin D status. Serum 25(OH)D concentration increased by 10nmol/L as reported time in the sun doubled. Overall, 54% of the variation in serum 25(OH)D concentration could be accounted for: 36% of the variation was explained by sun exposure-related factors; 14% by genetic factors (including epistasis) and 3.5% by direct measures of skin phenotype. Novel findings from this study are demonstration of gene epistasis, and quantification of the relative contribution of a wide range of environmental, constitutional and genetic factors to vitamin D status. Ambient UVR levels and time in the sun were of prime importance but it is nonetheless important to include the contribution of genetic factors when considering sun exposure effects.
    The Journal of steroid biochemistry and molecular biology 02/2013; · 3.98 Impact Factor
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    ABSTRACT: Energy use is central to human society and provides many health benefits. But each source of energy entails some health risks. This article reviews the health impacts of each major source of energy, focusing on those with major implications for the burden of disease globally. The biggest health impacts accrue to the harvesting and burning of solid fuels, coal and biomass, mainly in the form of occupational health risks and household and general ambient air pollution. Lack of access to clean fuels and electricity in the world's poor households is a particularly serious risk for health. Although energy efficiency brings many benefits, it also entails some health risks, as do renewable energy systems, if not managed carefully. We do not review health impacts of climate change itself, which are due mostly to climate-altering pollutants from energy systems, but do discuss the potential for achieving near-term health cobenefits by reducing certain climate-related emissions. Expected final online publication date for the Annual Review of Public Health Volume 34 is March 17, 2013. Please see for revised estimates.
    Annual Review of Public Health 01/2013; · 3.27 Impact Factor
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    ABSTRACT: Changes in climatic conditions and increases in weather variability affect human health directly and indirectly, including through agricultural changes and urban warming. Adaptation to climate change is receiving increasing attention, given, now, the inevitability of further climate change and its diverse impacts. However, with increased international funding for adaptation comes challenges such as ensuring supportive national policy environments for developing and implementing effective adaptation activities. Adaptation at community and population levels is underpinned by governance processes, such as the nature by which decisions are taken and implemented by government, community and private organizations. Thus an understanding of the policy context is necessary to identify the factors that enable or inhibit adaptation policy and programmes. This article examines to what degree there exist enabling factors to support the development of adaptation policy and activities, with relevance to the health sector. Results of a policy analysis are presented, which used stakeholder participation to investigate the context in which adaptation decisions were made within organizations across different sectors in Cambodia. Five factors were identified as critical components of the governance environment: (1) policy development processes; (2) the existence of a political recognition of climate change and (3–5) the organizational barriers relating to coordination, funding and lack of information. Without achieving a supportive policy environment, future adaptation actions are likely to have limited effect.
    Climate and Development 01/2013; 5(4). · 1.21 Impact Factor
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    Rosemary A McFarlane, Adrian C Sleigh, Anthony J McMichael
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    ABSTRACT: A more rigorous and nuanced understanding of land-use change (LUC) as a driver of emerging infectious disease (EID) is required. Here we examine post hunter-gatherer LUC as a driver of infectious disease in one biogeographical region with a compressed and documented history-continental Australia. We do this by examining land-use and native vegetation change (LUCC) associations with infectious disease emergence identified through a systematic (1973-2010) and historical (1788-1973) review of infectious disease literature of humans and animals. We find that 22% (20) of the systematically reviewed EIDs are associated with LUCC, most frequently where natural landscapes have been removed or replaced with agriculture, plantations, livestock or urban development. Historical clustering of vector-borne, zoonotic and environmental disease emergence also follows major periods of extensive land clearing. These advanced stages of LUCC are accompanied by changes in the distribution and density of hosts and vectors, at varying scales and chronology. This review of infectious disease emergence in one continent provides valuable insight into the association between accelerated global LUC and concurrent accelerated infectious disease emergence.
    International Journal of Environmental Research and Public Health 01/2013; 10(7):2699-2719. · 2.00 Impact Factor
  • Kathryn J Bowen, Kristie Ebi, Sharon Friel, Anthony J McMichael
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    ABSTRACT: Background : Addressing climate change and its associated effects is a multi-dimensional and ongoing challenge. This includes recognizing that climate change will affect the health and wellbeing of all populations over short and longer terms, albeit in varied ways and intensities. That recognition has drawn attention to the need to take adaptive actions to lessen adverse impacts over the next few decades from unavoidable climate change, particularly in developing country settings. A range of sectors is responsible for appropriate adaptive policies and measures to address the health risks of climate change, including health services, water and sanitation, trade, agriculture, disaster management, and development. Objectives : To broaden the framing of governance and decision-making processes by using innovative methods and assessments to illustrate the multi-sectoral nature of health-related adaptation to climate change. This is a shift from sector-specific to multi-level systems encompassing sectors and actors, across temporal and spatial scales. Design : A review and synthesis of the current knowledge in the areas of health and climate change adaptation governance and decision-making processes. Results : A novel framework is presented that incorporates social science insights into the formulation and implementation of adaptation activities and policies to lessen the health risks posed by climate change. Conclusion : Clarification of the roles that different sectors, organizations, and individuals occupy in relation to the development of health-related adaptation strategies will facilitate the inclusion of health and wellbeing within multi-sector adaptation policies, thereby strengthening the overall set of responses to minimize the adverse health effects of climate change.
    Global Health Action 01/2013; 6:21820. · 2.06 Impact Factor
  • McFarlane R, Sleigh A, McMichael A
    Int J Environ Res Public Health. 01/2013; 10:1-19.
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    Anthony J McMichael
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    ABSTRACT: During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human health entail changes-often disruptive, sometimes irreversible-in complex system functioning. Understanding the diverse health risks from climate change, and their influence pathways, presents a challenge to environmental health researchers whose prior work has been in a more definable, specific and quantitative milieu. Extension of the research agenda and conceptual framework to assess present and future health risks from climate change may be constrained by three factors: (i) lack of historically-informed understanding of population-health sensitivity to climatic changes; (ii) an instinctual 'epidemiologising' tendency to choose research topics amenable to conventional epidemiological analysis and risk estimation; and (iii) under-confidence in relation to interdisciplinary collaborative scenario-based modeling of future health risks. These constraints must be recognized and remedied. And environmental researchers must argue for heightened public attention to today's macro-environmental threats to present and future population health-emphasising the ecological dimension of these determinants of long-term health that apply to whole populations and communities, not just to individuals and social groupings.
    International Journal of Environmental Research and Public Health 01/2013; 10(11):6096-105. · 2.00 Impact Factor
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    Tord Kjellstrom, Anthony J McMichael
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    ABSTRACT: Background: The observational evidence of the impacts of climate conditions on human health is accumulating. A variety of direct, indirect, and systemically mediated health effects have been identified. Excessive daily heat exposures create direct effects, such as heat stroke (and possibly death), reduce work productivity, and interfere with daily household activities. Extreme weather events, including storms, floods, and droughts, create direct injury risks and follow-on outbreaks of infectious diseases, lack of nutrition, and mental stress. Climate change will increase these direct health effects. Indirect effects include malnutrition and under-nutrition due to failing local agriculture, spread of vector-borne diseases and other infectious diseases, and mental health and other problems caused by forced migration from affected homes and workplaces. Examples of systemically mediated impacts on population health include famine, conflicts, and the consequences of large-scale adverse economic effects due to reduced human and environmental productivity. This article highlights links between climate change and non-communicable health problems, a major concern for global health beyond 2015. Discussion: Detailed regional analysis of climate conditions clearly shows increasing temperatures in many parts of the world. Climate modelling indicates that by the year 2100 the global average temperature may have increased by 34°C unless fundamental reductions in current global trends for greenhouse gas emissions are achieved. Given other unforeseeable environmental, social, demographic, and geopolitical changes that may occur in a plus-4-degree world, that scenario may comprise a largely uninhabitable world for millions of people and great social and military tensions. Conclusion: It is imperative that we identify actions and strategies that are effective in reducing these increasingly likely threats to health and well-being. The fundamental preventive strategy is, of course, climate change mitigation by significantly reducing global greenhouse gas emissions, especially long-acting carbon dioxide (CO2), and by increasing the uptake of CO2 at the earth's surface. This involves urgent shifts in energy production from fossil fuels to renewable energy sources, energy conservation in building design and urban planning, and reduced waste of energy for transport, building heating/cooling, and agriculture. It would also involve shifts in agricultural production and food systems to reduce energy and water use particularly in meat production. There is also potential for prevention via mitigation, adaptation, or resilience building actions, but for the large populations in tropical countries, mitigation of climate change is required to achieve health protection solutions that will last.
    Global Health Action 01/2013; 6:1-9. · 2.06 Impact Factor
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    ABSTRACT: Cities are rapidly increasing in importance as a major factor shaping the Earth system, and therefore, must take corresponding responsibility. With currently over half the world's population, cities are supported by resources originating from primarily rural regions often located around the world far distant from the urban loci of use. The sustainability of a city can no longer be considered in isolation from the sustainability of human and natural resources it uses from proximal or distant regions, or the combined resource use and impacts of cities globally. The world's multiple and complex environmental and social challenges require interconnected solutions and coordinated governance approaches to planetary stewardship. We suggest that a key component of planetary stewardship is a global system of cities that develop sustainable processes and policies in concert with its non-urban areas. The potential for cities to cooperate as a system and with rural connectivity could increase their capacity to effect change and foster stewardship at the planetary scale and also increase their resource security.
    AMBIO A Journal of the Human Environment 10/2012; · 2.30 Impact Factor

Publication Stats

6k Citations
1,817.24 Total Impact Points


  • 2001–2014
    • Australian National University
      • National Centre for Epidemiology & Population Health Research
      Canberra, Australian Capital Territory, Australia
  • 2013
    • University of Melbourne
      Melbourne, Victoria, Australia
    • Umeå University
      Umeå, Västerbotten, Sweden
  • 2012
    • La Trobe University
      • School of Social Sciences and Communications
      Melbourne, Victoria, Australia
  • 2001–2012
    • University of Canberra
      Canberra, Australian Capital Territory, Australia
  • 2009
    • World Health Organization WHO
      • Department of Public Health and Environment (PHE)
      Genève, GE, Switzerland
    • University of Technology Sydney 
      • Centre for Midwifery, Child and Family Health
      Sydney, New South Wales, Australia
  • 1999–2009
    • Queensland University of Technology
      • Institute of Health and Biomedical Innovation
      Brisbane, Queensland, Australia
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia
    • University of Leeds
      Leeds, England, United Kingdom
  • 1990–2009
    • University of Toronto
      • Faculty of Medicine
      Toronto, Ontario, Canada
  • 1988–2009
    • University of Adelaide
      • • Discipline of Psychiatry
      • • School of Medicine
      Tarndarnya, South Australia, Australia
  • 2008
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States
  • 1997–2008
    • London School of Hygiene and Tropical Medicine
      • Faculty of Epidemiology and Population Health
      Londinium, England, United Kingdom
    • Maria Sklodowska Curie Memorial Cancer Centre
      Gleiwitz, Silesian Voivodeship, Poland
  • 2007
    • University of Tasmania
      • Menzies Research Institute
      Newnham, Tasmania, Australia
    • University of Notre Dame
      • Department of Biological Sciences
      Indiana, PA, United States
  • 2005
    • Canberra Institute of Technology
      Canberra, Australian Capital Territory, Australia
    • University of Wisconsin–Madison
      • Center for Sustainability and the Global Environment (SAGE)
      Madison, Wisconsin, United States
    • Ecole Normale Supérieure de Paris
      Lutetia Parisorum, Île-de-France, France
  • 1985–1999
    • The Commonwealth Scientific and Industrial Research Organisation
      Canberra, Australian Capital Territory, Australia
  • 1998
    • Université de Montréal
      Montréal, Quebec, Canada
  • 1996
    • International Agency for Research on Cancer
      Lyons, Rhône-Alpes, France
  • 1994
    • The Whittington Hospital NHS Trust
      Londinium, England, United Kingdom
  • 1989
    • Royal Adelaide Hospital
      Tarndarnya, South Australia, Australia