Alexandra Macmillan

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• MBChB, MPH (Hons), PhD
• Professor at University of Otago

The shortage of social housing is a crucial element of the UK housing crisis. In England, social rented housing provision significantly relies on market homes construction, with detrimental impacts on residents and the environment. Moratoria are often cited in the degrowth literature as policy tools supporting strategies to break free from growth-d...

The shortage of social housing is a crucial element of the UK housing crisis. In England, social rented housing provision significantly relies on market homes construction, with detrimental impacts on residents and the environment. Moratoria are often cited in the degrowth literature as policy tools supporting strategies to break free from growth-d...

Aotearoa New Zealand is changing. The relationship between the inequities iwi Māori face and centuries of colonisation is clear. The need to address these inequities and the embedded colonial thinking that reinforces them in our society is more widely accepted. Nowhere is this need for change more acute than in education. The challenge of embedding...

The shortage of social housing is a crucial element of the UK housing crisis. In England, social housing provision significantly relies on market homes construction, with detrimental impacts on residents and the environment. Moratoria are often cited in the degrowth literature as policy tools to break free from growth-driven mechanisms and achieve...

The provision of good quality social housing is crucial to address disparities in cities. However, the supply of social homes in London is threatened by numerous political, economic, environmental, and social pressures. Interacting, these pressures generate a complexity hard to navigate, leading to interventions that reinforce rather than alleviate...

Introduction Climate change-related flooding and sea-level rise have important direct and indirect health effects. In order to support health and equity, adaptation responses require collaborative, transdisciplinary learning and consensus-building, across a wide range of local-level stakeholders. We aimed to co-develop a shared understanding of the...

Transport-related health risks often disproportionately affect disadvantaged social groups, but whether transport interventions help achieve health equity is unclear. We investigated whether the effects of transport interventions differ by ethnicity or socio-economic position. The review included empirical (n = 10) and modelling studies (n = 23) th...

Planetary health has an important role to play in guiding humanity towards a healthy, equitable, and sustainable future. However, given planetary health's dominant colonial and capitalist underpinning ideologies, it risks reinscribing the same exploitative power dynamics that are fundamental drivers of global ecological collapse. In this Personal V...

Background: Climate change is already affecting Aotearoa New Zealand (Aotearoa-NZ). The public health effects are varied and complex, and rural primary care staff will be at the front line of effects and responses. However, little is known about their understanding and experience. Objectives: To determine understanding, experiences and preparedn...

Aotearoa is changing. The relationship between the inequities Iwi Māori face and centuries of colonisation is clear. The need to address these inequities and the embedded colonial thinking that reinforces them in our society is more widely accepted. Nowhere is this need for change more acute than in education. The challenge of embedding bicultural...

We aim to understand how a streetscape intervention, Te Ara Mua- Future Streets, designed to improve the ease and safety of active modes, influenced perceptions of neighbourhood safety and security in Māngere, New Zealand. In this controlled intervention study, survey, focus group and in-depth interview data on neighbourhood perceptions were gather...

Introduction Policies to mitigate climate change are essential. The objective of this paper was to estimate the impact of greenhouse gas (GHG) food taxes and assess whether such a tax could also have health benefits and reduce ethnic inequalities in health in Aotearoa NZ. Methods We undertook a systemised review on GHG food taxes to inform four ta...

Climate change belongs in a new category of global environmental health problems. It is not just that the impacts are widely distributed: climate change is a result of unbalanced global systems. It is one of the modern threats to a ‘safe operating space’ for the planet. The effects on health occur directly, such as increased heat waves; through pre...

Despite the importance of a transition from car use to more active and public transport and an adequate knowledge base for taking action, the pace and scale of change globally has been inadequate to protect health, particularly from the effects of climate change. While the active transport research agenda has rightly broadened beyond behaviour chan...

In settler countries, attention is now extending to the wellbeing benefits of recognising and promoting the Indigenous cultural identity of neighbourhoods as a contributing factor to more equitable and healthier communities. Re-indigenisation efforts to (re)implement cultural factors into urban design can be challenging and ineffective without the...

This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as...

Climate change mitigation policies can either facilitate or hinder progress towards health equity, and can have particular implications for Indigenous health. We sought to summarize current knowledge about the potential impacts (co-benefits and co-harms) of climate mitigation policies and interventions on Indigenous health. Using a Kaupapa Māori th...

The transport system influences everyone’s wellbeing on a daily basis. These impacts are both positive and negative and are borne directly and indirectly at a range of spatial and temporal scales and across different groups in society. Furthermore, they are often distributed unfairly and the people who are least able to use transport networks frequ...

Introduction A transition from car-dependence in cities, towards public and active transport has potential accessibility, health, and environmental benefits. However, it is critical that this transition does not exacerbate health inequities, but rather proactively plans to address them. A focus on youth who experience disadvantage and health dispar...

Climate change is a major threat to public health worldwide. Conversely, well-designed action to mitigate climate change offers numerous opportunities to improve health and equity. Despite this, comprehensive climate action has not been forthcoming within New Zealand. The media plays an important role in shaping public opinion and support for polic...

The 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) represent a historic global linking of health, equity and environmental sustainability. Accumulated evidence suggests that improving urban neighbourhoods to make them safer and more attractive for walking and cycling can accelerate progress towards the SDGs. Th...

Background: The global food system is driving both the climate crisis and the growing burden of noncommunicable disease. International research has highlighted the climate and health co-benefit opportunity inherent in widespread uptake of plant-based diets. Nevertheless, uncertainty remains as to what constitutes healthy and climate-friendly eatin...

This article is available open access at: https://doi.org/10.1016/S0140-6736(19)32985-X Climate change is a global health emergency and a growing ethical crisis, and well planned climate action brings opportunities to improve health, equity, and human rights. In the face of continued inaction, citizens are turning to civil disobedience to persuad...

Background: EcoHealth and One Health are two major approaches broadly aimed at understanding the links between human, animal, and environment health. There have been increasing calls for convergence between the two. If convergence is desired, greater clarity regarding the underlying theoretical assumptions of both approaches is required. This woul...

Background Efforts to improve health equity should be informed by the best available evidence. However, equity-related research is inconsistently indexed, and uses a variety of terms to describe key concepts, making it difficult to reliably identify all relevant studies. We report the development and validation of a search strategy for studies inve...

The construction of bike lanes in communities is widely seen as an enabler of cycling, which in turn supports positive outcomes for population health, transport systems and the environment. Yet despite the evidence for their benefits, proposals to change roads to include space for cyclists frequently encounter ‘bikelash’, the organised opposition t...

Te Ara Mua - Future Streets is a controlled before-after study of neighbourhood infrastructure changes that aim to make walking and cycling safer and easier and reflect cultural identity in Māngere, Auckland, New Zealand. The project intervention was delivered through an innovative and challenging partnership between the research team and funding/d...

Background: Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neig...

Climate change is affecting New Zealand and the health of New Zealanders as many factors that contribute to our health and well-being are threatened by climate change. Over time, increasing climate change will lead to our health being impacted more severely, and more of us will be affected. Direct effects from climate change include increased expos...

This article explores the phenomenon of ‘bikelash’, or organised community opposition to cycle lanes. Urban residents commonly cite bicycle lanes, a space on the road reserved for cyclists, as the infrastructure most likely to encourage them to cycle. Yet the introduction of cycle lanes is often controversial. This article explores the phenomenon o...

Background Evidence is mounting to suggest a causal relationship between the built environment and people’s physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic...

BACKGROUND: Increasing urban bicycling has established net benefits for human and environmental health. Questions remain about which policies are needed and in what order, to achieve an increase in cycling while avoiding negative consequences. Novel ways of considering cycling policy are needed, bringing together expertise across policy, community...

This is the Royal Society of NZ's expert guidance on climate change and health.

Abstract Background Increasing urban bicycling has established net benefits for human and environmental health. Questions remain about which policies are needed and in what order, to achieve an increase in cycling while avoiding negative consequences. Novel ways of considering cycling policy are needed, bringing together expertise across policy, c...

Background Future Streets is a street redesign intervention study that aims to slow traffic, change driver behaviour and make walking and cycling easier and safer in Mangere, a suburban neighbourhood in Auckland, New Zealand. It is a collaborative project between research team, local community and the city’s transport agency. Community engagement,...

The first edited collection to examine how we can transition to a future of low carbon methods of travel and mobility.

The UK government has an ambitious goal to reduce carbon emissions from the housing stock through energy efficiency improvements. This single policy goal is a strong driver for change in the housing system, but comes with positive and negative “unintended consequences” across a broad range of outcomes for health, equity and environmental sustainabi...

Successfully increasing cycling across a broad range of the population would confer important health benefits, but many potential cyclists are deterred by fears about traffic danger. Media coverage of road traffic crashes may reinforce this perception. As part of a wider effort to model the system dynamics of urban cycling, in this paper we examine...

Health and wellbeing have been largely ignored in discussions around climate change targets and action to date. The current public consultation around New Zealand's post-2020 climate target is an opportunity for health professionals to highlight the health implications of climate change. Without urgent global efforts to bring down global GHG (green...

Background The social and financial burden of road traffic injury in New Zealand is high compared with many other developed countries. In addition, the population is affected by chronic diseases such as obesity, diabetes and cardiovascular disease, all of which share physical inactivity as a risk factor. Road safety is currently a major objective o...

Background Designing walking and cycling back into urban communities may be most effective at achieving a sustained shift from car trips to walking and cycling. Such a shift could deliver substantial benefits for mitigating climate change, public health, social and health inequities, and economic resilience. There is a lack of robust evidence about...

Climate change belongs in a new category of global environmental health problems. It is not just that the impacts are widely distributed: climate change is a result of unbalanced global systems. The effects on health occur through direct mechanisms, such as increased heat waves; through pressures on natural systems (reduced crop yields and undernut...

As a major sector contributing to the UK’s greenhouse gas (GHG) emissions, housing is an important focus of Government policies to mitigate climate change. Current policy promotes the application of a variety of energy efficiency measures to a diverse building stock, which will likely lead to a wide range of unintended consequences. We have underta...

Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and been unable to incorporate acknowledged system feedbacks. To compare the effects of policies to increas...

Population dependence on car use has adverse health consequences including road traffic injury, physical inactivity, air pollution and social severance. Widespread car dependence also entrenches lifestyles that require unsustainable levels of energy use. Most transport policies explicitly include goals for public health and sustainability. Transpor...

There is a growing body of research linking urban transport systems to inequities in health. However, there is a lack of research providing evidence of the effect of transport systems on indigenous family wellbeing. We examined the connections between urban transport and the health and wellbeing of Māori, the indigenous people of New Zealand. We pr...

Our current urban context ties access to employment, education, healthcare and connection with friends and family to car ownership which creates social disadvantage. This comes with costs to health and the environment contributing to road traffic injuries, air pollution, physical inactivity and climate change. Reducing car use can have positive imp...

Fecal incontinence is a socially stigmatized condition, and its prevalence in the community has been problematic to quantify because of difficulty with its definition. This study estimates the community prevalence of fecal incontinence in New Zealand by 3 scales of measurement: patient perceptions of a "problem with bowel control," their symptoms,...

To estimate the effects on health, air pollution and greenhouse gas emissions if short trips (≤7 km) were undertaken by bicycle rather than motor car. Existing data sources were used to model effects, in the urban setting in New Zealand, of varying the proportion of vehicle kilometres travelled by bicycle instead of light motor vehicle. Shifting 5%...

Background: Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single-occupant car use and i...

Human-induced climate change is now the central health issue facing humanity. The World Medical Association recently adopted the Declaration of Delhi, committing the medical profession to mitigate and adapt to the effects of climate change. This is new professional territory for many doctors. Even so, the profession has often engaged with issues ou...

New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and...

The likely health effects of climate change make it one of the most pressing global public health issues of our time. Effects range from more intense and frequent cyclones, flooding, and heat waves through to changing infectious disease patterns, food and water insecurity, sea-level rise, and economic and social disruption. The governments of almos...

Fecal incontinence can have a profound effect on quality of life. Its prevalence remains uncertain because of stigma, lack of consistent definition, and dearth of validated measures. This study was designed to develop a valid clinical and epidemiologic questionnaire, building on current literature and expertise. Patients and experts undertook face...

This chapter focuses on the prevalence and incidence rate of faecal incontinence in the general population and specific subgroups, including the elderly and children. Epidemiological definitions are described, and problems with measuring faecal incontinence are discussed. Descriptive studies of prevalence and incidence rates are reviewed, including...

By including traffic fatalities occurring while commuting, as well as in the course of work, the authors make a significant statement recognising the joint responsibility of employers and employees for the trip to work. This is an important step towards reducing such deaths. The location of workplaces relative to where employees live and the times...

A nationwide strategy to control a group B meningococcal disease epidemic in New Zealand using an epidemic strain-specific vaccine (MeNZB ) commenced in 2004. In the absence of randomised controlled trials investigating the efficacy of this particular vaccine, a complement of observational methods are planned to evaluate the post-licensure effectiv...

Although the results of surgery for symptomatic rectocele seem satisfactory initially, there is a trend toward deterioration with time. This study was designed to assess the long-term outcome of Anterior Délorme's operation for rectocele. Questionnaires were sent to all females who had Anterior Délorme's operation performed in Auckland between 1990...