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Indigenous health and environmental risk factors: An Australian problem with global analogues?

Global Health Action

April 2014
7(1):23766

DOI:10.3402/gha.v7.23766

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PubMed

License
CC BY 4.0

Authors:

Peter Sly

University of Queensland

Indigenous people experience poorer health than non-Indigenous people, and this well-described inequality has been observed in many countries. The contribution of different risk factors to the health 'gap' has understandably focussed on those factors for which there are sufficient data. However, this has precluded environmental risk factors - those present in air, water, food, and soil - due to a lack of data describing exposures and outcomes. These risk factors are demonstrably important at the global scale, as highlighted by the 2010 Global Burden of Disease study. Here, we describe how a greater focus on environmental risk factors is required in order to define their role in the Indigenous health gap. We use the Australian context as a case study of an issue we feel has global analogues and relevance. Suggestions for how and why this situation should be remedied are presented and discussed.

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SHORT COMMUNICATION

Indigenous health and environmental risk factors:

an Australian problem with global analogues?

Luke D. Knibbs

* and Peter D. Sly

School of Population Health, The University of Queensland, Brisbane, Australia;

Children’s Health

and Environment Program, The University of Queensland, Brisbane, Australia

Indigenous people experience poorer health than non-Indigenous people, and this well-described inequality

has been observed in many countries. The contribution of different risk factors to the health ‘gap’ has

understandably focussed on those factors for which there are sufficient data. However, this has precluded

environmental risk factors  those present in air, water, food, and soil  due to a lack of data describing

exposures and outcomes. These risk factors are demonstrably important at the global scale, as highlighted by

the 2010 Global Burden of Disease study. Here, we describe how a greater focus on environmental risk factors

is required in order to define their role in the Indigenous health gap. We use the Australian context as a case

study of an issue we feel has global analogues and relevance. Suggestions for how and why this situation

should be remedied are presented and discussed.

Keywords: environmental health; Indigenous peoples; Australia; health; environment

*Correspondence to: Luke D. Knibbs, Public Health Building, School of Population Health, The University

of Queensland, Herston Rd., Herston, Brisbane, QLD 4006, Australia, Email: l.knibbs@uq.edu.au

Received: 7 January 2014; Revised: 19 March 2014; Accepted: 3 April 2014; Published: 29 April 2014

ccess to clean air, soil, water, and food in a

sustainable way is a fundamental tenet of human

health. Without provision of these basic ame-

nities, disease and inequality can manifest and perpetuate

unchecked. This is hardly a novel proposition  Hippo-

crates and a procession of others since then have re-

minded us that when these critical foundations of health

are compromised, the consequences for society can be

profound. Yet in 2013, the world confronted the stark

reality of a sizeable proportion of its population having

no or infrequent access to clean water and sanitation,

breathing air with potentially dangerous levels of vehicle

and industrial emissions, and eating food contaminated

by chemicals. Lead poisoning  recognised since Hippo-

crates’ time  continues to exact its toll on vulnerable

children living in Africa (1). The visibility of environ-

mental degradation and its consequences for human

health have never been greater.

Many of the Millennium Development Goals (MDGs)

target problems with environmental causes. The ecologi-

cal nexus between humans and the physical environment

is one of the pillars on which our health and wellbeing

rests. It is therefore unsurprising that indoor and outdoor

air pollution feature in the top 10 risk factors in the

global burden of disease, while lead, poor sanitation, and

water quality are all present in the top 30 (2). However,

some populations are more susceptible to these risk

factors than others (3).

Indigenous peoples worldwide bear a disproportionate

share of the burden of disease. The reasons for this are

complex, but marginalisation following colonisation of

their traditional homelands are recurring themes that

have initiated a legacy of inequity and disadvantage that

is unfortunately pronounced among the near 400 million

Indigenous people worldwide today (4).

Indigenous Australians (Aboriginal and Torres Strait

Islander peoples) experience a markedly greater dis-

ease burden compared with non-Indigenous Australians,

and newborn Indigenous Australians are expected to

live a decade less than their non-Indigenous counter-

parts (5). The health ‘gap’ is largely attributable to non-

communicable diseases (NCDs), about half of which

can be explained by established risk factors including

tobacco and alcohol use, obesity, physical inactivity,

and inadequate fruit and vegetable intake (6). Efforts

to quantify the extent to which other factors  such as

those in the environment  contribute to the burden of

disease and health gap have been hampered by a lack

of data describing exposures and outcomes among the

Indigenous population (6).

‘Environmental’ risk factors are often an ambigu-

ous concept, as the malleable definition of environment

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Citation: Glob Health Action 2014, 7 : 23766 - http://dx.doi.org/10.3402/gha.v7.23766

(page number not for citation purpose)

can take on vastly different meanings depending on the

context. The more traditional and narrower scientific

definition encompasses biological, chemical, and physical

agents encountered in the natural and built environment

that are capable of causing harm. Conversely, environ-

mental risk factors can be taken to represent anything a

person encounters in his/her life that is not genetic,

whether physical, social, behavioural, economic, cultural,

or any combination of these (7). While the latter definition

is valid, there is a lot we do not know about the traditional

environmental risk factors on Indigenous people’s health,

let alone their complex interactions with other risk factors.

Improved understanding of the environmental risk

factors experienced by Indigenous Australians will better

define their role in cardiovascular, endocrine and neuro-

developmental disease, and cancer, all of which can have

environmental aetiology and are substantial contributors

to the disease burden. The issue currently faced is how to

understand the true nature of environmental risks to

Indigenous Australians, which are demonstrably impor-

tant at a worldwide scale. It is also a case study relevant

to other Indigenous communities globally.

The Australian context

Ambient and indoor air pollution

Air pollution describes the complex mixture of gaseous

and particulate contaminants in the atmosphere. There

is a small body of evidence that shows that the effects

of ambient PM

(particles B10 mm) from bushfires on

respiratory and cardiovascular illnesses are greater in

Indigenous people compared with non-Indigenous people

(8). Similarly, pregnant Indigenous women may be at

greater risk of pre-eclampsia due to ambient traffic-

related air pollution than non-Indigenous women (9).

Exposure to second-hand smoke indoors places Indige-

nous children at higher risk of developing otitis media

(10).

Asbestos

Asbestos is a naturally occurring fibrous mineral that was

found in many domestic, commercial, and industrial

applications throughout the 20th century. Inhalation of

asbestos fibres is the overwhelming risk factor for malig-

nant mesothelioma, an aggressive and fatal cancer, as well

as lung cancer and asbestosis. Australia has one of the

world’s highest incidences of malignant mesothelioma.

Indigenous people in historic asbestos mining regions had

the world’s second-highest crude incidence rate of malig-

nant mesothelioma (250 per million person-years) in the

1990s  about 10 times the national rate (11, 12).

Weather and climate

Weather, especially temperature and rainfall, can exert

many direct and indirect effects on health. Heat waves

and cool spells can cause fatal hyper- and hypothermia,

respectively, while severe weather and flooding can pose

an immediate threat through injury or drowning. More

expansive are their many indirect effects on health via

vector- and water-borne infections, crop yields, and

population displacement (13).

In the tropical Kimberley area of northern Western

Australia, a marked increase in the proportion of very

low birth weight (B1,500 g) Indigenous babies was

observed in the ‘wet’ season (January to June) compared

to the ‘dry’ season (14). Many infectious diseases exhibit a

strong seasonality, especially in tropical locations, but

the specific effects on Indigenous Australians are not

well-documented. The role of weather and climate on

Indigenous health is poorly defined, and this lack of

information becomes starker when the prevailing back-

drop of climate change is considered.

Contaminated water and land

Remote Indigenous communities can be particularly

susceptible to water contamination. Stagnant water can

promote mosquito breeding and facilitate transmission of

vector-borne diseases. Insufficient access to clean water

and sewerage systems remain contributing factors to

skin, eye, and diarrhoeal illnesses among Indigenous

communities, especially children (15, 16).

Mining conducted near Indigenous land can leave a

legacy of copper sulphide contamination causing substan-

tial impacts on ecosystems with cultural and environmen-

tal significance. Australia’s vast deposits of uranium have

been mined in rural areas located on or near traditional

Indigenous lands. Some traditional foods (freshwater

mussels, turtles, and fish) are strong bio-accumulators

of ionising radiation from mining waste (17). Nuclear

weapons tested during the post World War II period in the

vicinity of Indigenous communities resulted in the pre-

sence of residual radionuclides for several decades. How-

ever, the effects of radioactivity on the health of Indigenous

peoples are unknown.

Indigenous children in mining communities have been

shown to be at greater risk of abnormally high levels of

lead in blood compared to their non-Indigenous counter-

parts, which was attributed to poorly maintained housing

and bare soil (18). Iron deficiency due to poor diet may

also promote lead uptake.

Cadmium has detrimental renal effects, and it is present

in several traditional Indigenous sea foods such as turtle,

dugong, and clams. The high prevalence of diabetes among

Indigenous people coupled with dietary exposure to

cadmium can exacerbate diabetic nephropathy (19).

What we do and do not know

There is scarce information on the association between

environmental risk factors and Indigenous peoples’

health in Australia. Most of the very limited work has

Luke D. Knibbs and Peter D. Sly

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Citation: Glob Health Action 2014, 7 : 23766 - http://dx.doi.org/10.3402/gha.v7.23766

quantified environmental exposures without linking these

to health outcomes. This is concerning given the role of

environmental risk factors in many of the communicable,

and especially non-communicable, diseases that contri-

bute to the Indigenous disease burden (4). There is also a

pronounced lack of information on gradients of exposure

and health effects across urban, rural, and remote areas,

which is a crucial distinction as most Indigenous people

do not live in cities.

We know that environmental risk factors are important

globally, and we know only half of the Indigenous health

gap can be attributed to non-environmental risks. We

suspect that Indigenous people may be more susceptible

to the health effects of some environmental risk factors.

But we do not know how much disease they cause. It is

important not to over- or understate the effects these risk

factors may have, because there is simply too little

information for unequivocal conclusions to be drawn.

What we can do about it

We need to better understand how an Indigenous

Australian’s health can potentiate the extent to which

they are susceptible to environmental risk factors, and

what role social determinants of health play in establish-

ing this relationship. Properly delineating the role of

environmental risk factors will enable their inclusion and

relative place in the spectrum of contributors to Indigen-

ous disease to be determined. A deeper understanding is

the first step towards prioritising research, policy, and

interventions. The well-described tools at our disposal,

such as health impact assessment and comparative risk

assessment, have much to offer in achieving this (20).

Understanding the source and control of all relevant

environmental risk factors will mean they can be more

effectively targeted and prioritised.

Global relevance

Australia is a highly developed country that performs

admirably on most measures of human and economic

development. Yet, its record on Indigenous health leaves

much to be desired. This is reflected in our lacklustre

understanding of environmental contributors to the In-

digenous disease burden. If a country such as Australia

that is rich in human and natural resources struggles to

make inroads on this issue, it does not bode well for more

poorly resourced settings where the burden is likely to be

the greatest (3). The Australian Indigenous people makes

up for less than 0.2% of the world’s Indigenous population,

but the issues faced in defining the role of environmental

risk factors are symptomatic of a wider global problem.

Adverse health effects due to environmental risk factors

have been described in numerous Indigenous populations

around the world (2125). Notwithstanding methodolo-

gical differences and limitations, there is a modest but

accumulating body of evidence about these risks and how

they compare with those in non-Indigenous people. This

provides a good foundation on which to build the more

extensive studies required to address the issue.

The diverse nature of environmental risk factors re-

quires an equally diverse interdisciplinary approach to

their quantification and control. Researchers, health care

professionals, non-government organisations, and policy-

makers are all in a position to contribute towards redres-

sing the situation. If we are to understand the effect of the

environment on the health of Indigenous people, we first

need to make a clarion call to the people who have the

greatest capacity to undertake this important work.

Acknowledgements

LDK acknowledges an NHMRC Early Career (Australian Public

Health) Fellowship (APP1036620).

Conflict of interest and funding

The authors have not received any funding or beneﬁts from

industry or elsewhere to conduct this study.

References

1. Global Alert and Response (GAR). Nigeria: mass lead poison-

ing from mining activities, Zamfara State  update. Geneva:

World Health Organization [updated 11 November 2011]. Avail-

able from: http://www.who.int/csr/don/2011_11_11/en/ [cited 4

December 2013].

2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-

Rohani H, et al. A comparative risk assessment of burden

of disease and injury attributable to 67 risk factors and risk

factor clusters in 21 regions, 19902010: a systematic analysis

for the Global Burden of Disease Study 2010. Lancet 2012; 380:

2224 60.

3. Smith KR. Environmental health  for the rich or for all? Bull

World Health Organ 2000; 78: 1156 7.

4. Gracey M, King M. Indigenous health part 1: determinants and

disease patterns. Lancet 2009; 374: 65 75.

5. Australian Institute of Health and Welfare. Life expectancy

and mortality of Aboriginal and Torres Strait Islander people.

Canberra: Australian Institute of Health and Welfare [updated 5

May 2011]. Available from: http://www.aihw.gov.au/publication-

detail/?id10737418927 [cited 16 December 2013].

6. Vos T, Barker B, Begg S, Stanley L, Lopez AD. Burden of

disease and injury in Aboriginal and Torres Strait Islander

peoples: the Indigenous health gap. Int J Epidemiol 2009; 38:

4707.

7. Norman RE, Carpenter DO, Scott J, Brune MN, Sly PD.

Environmental exposures: an underrecognized contribution to

noncommunicable diseases. Rev Environ Health 2013; 28:

59 65.

8. Johnston FH, Bailie RS, Pilotto LS, Hanigan IC. Ambient

biomass smoke and cardio-respiratory hospital admissions in

Darwin, Australia. BMC Public Health 2007; 7: 240.

9. Pereira G, Haggar F, Shand AW, Bower C, Cook A, Nassar

N. Association between pre-eclampsia and locally derived

trafﬁc-related air pollution: a retrospective cohort study.

J Epidemiol Community Health 2013; 67: 14752.

10. Jacoby PA, Coates HL, Arumugaswamy A, Elsbury D, Stokes

A, Monck R, et al. The effect of passive smoking on the risk of

Indigenous health and environmental risk factors

Citation: Glob Health Action 2014, 7: 23766 - http://dx.doi.org/10.3402/gha.v7.23766 3

(page number not for citation purpose)

otitis media in Aboriginal and non-Aboriginal children in the

Kalgoorlie-Boulder region of Western Australia. Med J Aust

2008; 188: 599603.

11. Leigh J, Driscoll T. Malignant mesothelioma in Australia,

1945 2002. Int J Occup Environ Health 2003; 9: 206 17.

12. Musk AW, de Klerk NH, Eccles JL, Hansen J, Shilkin K.

Malignant mesothelioma in Pilbara Aborigines. Aust J Public

Health 1995; 19: 520 2.

13. McMichael AJ, Woodruff RE, Hales S. Climate change and

human health: present and future risks. Lancet 2006; 367:

85969.

14. Rousham EK, Gracey M. Seasonality of low birthweight in

Indigenous Australians: an increase in pre-term birth of

intrauterine growth retardation? Aust N Z J Public Health

1998; 22: 66972.

15. Grimwood K, Forbes DA. Acute and persistent diarrhea.

Pediatr Clin North Am 2009; 56: 134361.

16. Bailie RS, Stevens MR, McDonald E, Halpin S, Brewster D,

Robinson G, et al. Skin infection, housing and social circum-

stances in children living in remote Indigenous communities:

testing conceptual and methodological approaches. BMC Public

Health 2005; 5: 128.

17. Johansen MP, Twining JR. Radionuclide concentration ratios in

Australian terrestrial wildlife and livestock: data compilation

and analysis. Radiat Environ Biophys 2010; 49: 60311.

18. Willis FR, Rossi E, Bulsara M, Slattery MJ. The Freemantle

lead study. J Paediatr Child Health 1995; 31: 32631.

19. Haswell-Elkins M, Satarug S, O’Rourke P, Moore M, Ng J,

McGrath V, et al. Striking associations between urinary

cadmium level and albuminuria among Torres Strait Islander

people with diabetes. Environ Res 2008; 106: 379 83.

20. Kjellstrom T, van Kerkhoff L, Bammer G, McMichael T.

Comparative assessment of transport risks  how it can

contribute to health impact assessment of transport policies.

Bull World Health Organ 2003; 81: 4519.

21. Luce D, Bugel I, Goldberg P, Goldberg M, Salomon CV, Billon-

Galland M, et al. Environmental exposure to tremolite and

respiratory Cancer in New Caledonia: a case-control study. Am

J Epidemiol 2000; 151: 25965.

22. Fieten KB, Kromhout H, Heederik D, de Joode B. Pesticide

exposure and respiratory health of indigenous women in Costa

Rica. Am J Epidemiol 2009; 169: 15006.

23. Schei MA, Hessen JO, Smith KR, Bruce N, McCracken J,

Lopez V. Childhood asthma and indoor woodsmoke from

cooking in Guatemala. J Expo Anal Environ Epidemiol 2004;

14: S110 17.

24. Gilbreath S, Kass PH. Adverse birth outcomes associated with

open dumpsites in Alaska Native Villages. Am J Epidemiol

2006; 164: 51828.

25. Bonefeld-Jorgensen EC, Long M, Bossi R, Ayotte P, Asmund

G, Kruger T, et al. Perﬂuorinated compounds are related to

breast cancer risk in Greenlandic Inuit: a case-control study.

Environ Health 2011; 10: 88.

Luke D. Knibbs and Peter D. Sly

(page number not for citation purpose)

Citation: Glob Health Action 2014, 7 : 23766 - http://dx.doi.org/10.3402/gha.v7.23766

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Full-text available

Jan 2021

Introduction Prudent infant nutrition, including exclusive breastfeeding to 6 months, is essential for optimal short-term and long-term health. Quantitative research to date has documented that many Indigenous communities have lower breastfeeding rates than the general population and that this gap in breastfeeding initiation and maintenance may have an important impact on chronic disease risk later in life. However, there are critical knowledge gaps in the literature regarding factors that influence infant feeding decisions. Qualitative research on infant feeding experiences provides a broader understanding of the challenges that Indigenous caregivers encounter, and insights provided by this approach are essential to identify research gaps, community engagement strategies, and programme and policy development. The objective of this review is to summarise the qualitative literature that describes breastfeeding and other infant feeding experiences of Indigenous caregivers. Methods and analysis This scoping review will follow guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the Joanna Briggs Institute and the methodological framework from Arksey and O’Malley. In October 2020, we will conduct an electronic database search using Medline, Embase, The Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO, and Scopus, and will focus on qualitative studies. Publications that have a focus on infant feeding in Canada, the USA, Australia and New Zealand, and the Indigenous caregiver experience from the caregiver perspective, will be included. We will conduct a grey literature search using Indigenous Studies Portal, country-specific browser searches, and known government, association, and community websites/reports. We will map themes and concepts of the publications, including study results and methodologies, to identify research gaps, future directions, challenges and best practices in this topic area. Ethics and dissemination Ethical approval is not required for this review as no unpublished primary data will be included. The results of this review will be shared through peer-reviewed publications and conference presentations. This protocol is registered through the Open Science Framework ( osf.io/4su79 ).

Flattening the COVID 19 curve in susceptible forest indigenous tribes using SIR model

Preprint

Full-text available

May 2020

Andrio A. Wibowo

COVID 19 is a global threat and globally spreading. The international cooperation involving indigenous peoples and local communities is urgently required in joint prevention to control the epidemic. Currently, many indigenous populations are continuing to face COVID 19. This study is concerned about the dynamic of COVID 19 pandemic among indigenous populations living in the remote Amazon rainforest enclaves. Using the Susceptible Infectious Recovered (SIR) model, the spread of the COVID 19 under 3 intervention scenarios (low, moderate, high) is simulated and predicted in indigenous tribe populations. The SIR model forecasts that without intervention, the epidemic peak may reach within 10 20 days. Nonetheless the peak can be reduced with strict interventions. Under low intervention, the COVID 19 cases are reduced to 73% and 56% of the total populations. While, in the scenario of high intervention, the COVID 19 peaks can be reduced to values ranging from 53% to 15% .To conclude, the simulated interventions tested by SIR model have reduced the pandemic peak and flattened the COVID 19 curve in indigenous populations. Nonetheless, it is mandatory to strengthen all mitigation efforts, reduce exposures, and decrease transmission rate as possible for COVID 19 containment.

Environmental exposures: An underrecognized contribution to noncommunicable diseases

Article

Full-text available

Apr 2013

Abstract Previous attempts to determine the degree to which exposure to environmental factors contribute to noncommunicable diseases (NCDs) have been very conservative and have significantly underestimated the actual contribution of the environment for at least two reasons. Firstly, most previous reports have excluded the contribution of lifestyle behavioral risk factors, but these usually involve significant exposure to environmental chemicals that increase risk of disease. Secondly, early life exposure to chemical contaminants is now clearly associated with an elevated risk of several diseases later in life, but these connections are often difficult to discern. This is especially true for asthma and neurodevelopmental conditions, but there is also a major contribution to the development of obesity and chronic diseases. Most cancers are caused by environmental exposures in genetically susceptible individuals. In addition, new information shows significant associations between cardiovascular diseases and diabetes and exposure to environmental chemicals present in air, food, and water. These relationships likely reflect the combination of epigenetic effects and gene induction. Environmental factors contribute significantly more to NCDs than previous reports have suggested. Prevention needs to shift focus from individual responsibility to societal responsibility and an understanding that effective prevention of NCDs ultimately relies on improved environmental management to reduce exposure to modifiable risks.

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010

Article

Full-text available

Dec 2012
LANCET

Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING Bill & Melinda Gates Foundation.

Perfluorinated compounds are related to breast cancer risk in Greenlandic Inuit: A case control study

Article

Full-text available

Oct 2011
ENVIRON HEALTH-GLOB

Breast cancer (BC) is the most common cancer for women in the western world. From very few cases an extraordinary increase in BC was observed in the Inuit population of Greenland and Canada although still lower than in western populations. Previous data suggest that exposure to persistent organic pollutants (POPs) might contribute to the risk of BC. Rat studies showed that perfluorinated compounds (PFCs) cause significantly increase in mammary fibroadenomas. This study aimed at evaluating the association between serum levels of POPs/PFCs in Greenlandic Inuit BC cases and their controls, and whether the combined POP related effect on nuclear hormone receptors affect BC risk. Thirty-one BC cases and 115 controls were sampled during 2000-2003 from various Greenlandic districts. The serum levels of POPs, PFCs, some metals and the combined serum POP related effect on estrogen- (ER), androgen- (AR) and Ah-receptor (AhR) transactivity were determined. Independent student t-test was used to compare the differences and the odds ratios were estimated by unconditional logistic regression models. We observed for the very first time a significant association between serum PFC levels and the risk of BC. The BC cases also showed a significantly higher concentration of polychlorinated biphenyls at the highest quartile. Also for the combined serum POP induced agonistic AR transactivity significant association to BC risk was found, and cases elicited a higher frequency of samples with significant POP related hormone-like agonistic ER transactivity. The AhR toxic equivalent was lowest in cases. The level of serum POPs, particularly PFCs, might be risk factors in the development of BC in Inuit. Hormone disruption by the combined serum POP related xenoestrogenic and xenoandrogenic activities may contribute to the risk of developing breast cancer in Inuit. Further investigations are needed to document these study conclusions.

Radionuclide concentration ratios in Australian terrestrial wildlife and livestock: Data compilation and analysis

Article

Full-text available

Nov 2010
RADIAT ENVIRON BIOPH

Radionuclide concentrations in Australian terrestrial fauna, including indigenous kangaroos and lizards, as well as introduced sheep and water buffalo, are of interest when considering doses to human receptors and doses to the biota itself. Here, concentration ratio (CR) values for a variety of endemic and introduced Australian animals with a focus on wildlife and livestock inhabiting open rangeland are derived and reported. The CR values are based on U- and Th-series concentration data obtained from previous studies at mining sites and (241)Am and (239/240)Pu data from a former weapons testing site. Soil-to-muscle CR values of key natural-series radionuclides for grazing Australian kangaroo and sheep are one to two orders of magnitude higher than those of grazing cattle in North and South America, and for (210)Po, (230)Th, and (238)U are one to two orders of magnitude higher than the ERICA tool reference values. When comparing paired kangaroo and sheep CR values, results are linearly correlated (r = 0.81) for all tissue types. However, kidney and liver CR values for kangaroo are typically higher than those of sheep, particularly for (210)Pb, and (210)Po, with values in kangaroo liver more than an order of magnitude higher than those in sheep liver. Concentration ratios for organs are typically higher than those for muscle including those for (241)Am and (239/240)Pu in cooked kangaroo and rabbit samples. This study provides CR values for Australian terrestrial wildlife and livestock and suggests higher accumulation rates for select radionuclides in semi-arid Australian conditions compared with those associated with temperate conditions.

Pesticide Exposure and Respiratory Health of Indigenous Women in Costa Rica

Article

Full-text available

Jun 2009

A cross-sectional study was conducted in 2007 to evaluate the relation between pesticide exposure and respiratory health in a population of indigenous women in Costa Rica. Exposed women (n = 69) all worked at plantain plantations. Unexposed women (n = 58) worked at organic banana plantations or other locations without pesticide exposure. Study participants were interviewed using questionnaires to estimate exposure and presence of respiratory symptoms. Spirometry tests were conducted to obtain forced vital capacity and forced expiratory volume in 1 second. Among the exposed, prevalence of wheeze was 20% and of shortness of breath was 36% versus 9% and 26%, respectively, for the unexposed. Prevalence of chronic cough, asthma, and atopic symptoms was similar for exposed and unexposed women. Among nonsmokers (n = 105), reported exposures to the organophosphate insecticides chlorpyrifos (n = 25) and terbufos (n = 38) were strongly associated with wheeze (odd ratio = 6.7, 95% confidence interval: 1.6, 28.0; odds ratio = 5.9, 95% confidence interval: 1.4, 25.6, respectively). For both insecticides, a statistically significant exposure-effect association was found. Multiple organophosphate exposure was common; 81% of exposed women were exposed to both chlorpyrifos and terbufos. Consequently, their effects could not be separated. All findings were based on questionnaire data. No relation between pesticide exposure and ventilatory lung function was found.

Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap

Article

Full-text available

Dec 2008
INT J EPIDEMIOL

Disparities in health status between Aboriginal and Torres Strait Islander peoples and the total Australian population have been documented in a fragmentary manner using disparate health outcome measures. We applied the burden of disease approach to national population health datasets and Indigenous-specific epidemiological studies. The main outcome measure is the Indigenous health gap, i.e. the difference between current rates of Disability-Adjusted Life Years (DALYs) by age, sex and cause for Indigenous Australians and DALY rates if the same level of mortality and disability as in the total Australian population had applied. The Indigenous health gap accounted for 59% of the total burden of disease for Indigenous Australians in 2003 indicating a very large potential for health gain. Non-communicable diseases explained 70% of the health gap. Tobacco (17%), high body mass (16%), physical inactivity (12%), high blood cholesterol (7%) and alcohol (4%) were the main risk factors contributing to the health gap. While the 26% of Indigenous Australians residing in remote areas experienced a disproportionate amount of the health gap (40%) compared with non-remote areas, the majority of the health gap affects residents of non-remote areas. Comprehensive information on the burden of disease for Indigenous Australians is essential for informed health priority setting. This assessment has identified large health gaps which translate into opportunities for large health gains. It provides the empirical base to determine a more equitable and efficient funding of Indigenous health in Australia. The methods are replicable and would benefit priority setting in other countries with great disparities in health experienced by Indigenous peoples or other disadvantaged population groups.

Climate change and human health: present and future risks (vol 367, pg 859, 2006)

Article

Sep 2006

Association between pre-eclampsia and locally derived traffic-related air pollution: A Retrospective Cohort Study

Article

Aug 2012
J EPIDEMIOL COMMUN H

Background Pre-eclampsia is a common complication of pregnancy and is a major cause of fetal–maternal mortality and morbidity. Despite a number of plausible mechanisms by which air pollutants might contribute to this process, few studies have investigated the association between pre-eclampsia and traffic emissions, a major contributor to air pollution in urban areas. Objective The authors investigated the association between traffic-related air pollution and risk of pre-eclampsia in a maternal population in the urban centre of Perth, Western Australia. Method The authors estimated maternal residential exposure to a marker for traffic-related air pollution (nitrogen dioxide, NO2) during pregnancy for 23 452 births using temporally adjusted land-use regression. Logistic regression was used to investigate associations with pre-eclampsia. Results Each IQR increase in levels of traffic-related air pollution in whole pregnancy and third trimester was associated with a 12% (1%–25%) and 30% (7%–58%) increased risk of pre-eclampsia, respectively. The largest effect sizes were observed for women aged younger than 20 years or 40 years or older, aboriginal women and women with pre-existing and gestational diabetes, for whom an IQR increase in traffic-related air pollution in whole pregnancy was associated with a 34% (5%–72%), 35% (0%–82%) and 53% (7%–219%) increase in risk of pre-eclampsia, respectively. Conclusions Elevated exposure to traffic-related air pollution in pregnancy was associated with increased risk of pre-eclampsia. Effect sizes were highest for elevated exposures in third trimester and among younger and older women, aboriginal women and women with diabetes.

Acute and Persistent Diarrhea

Article

Dec 2009

Socially disadvantaged Indigenous infants and children living in western industrialized countries experience high rates of infectious diarrhea, no more so than Aboriginal children from remote and rural regions of Northern Australia. Diarrheal disease, poor nutrition, and intestinal enteropathy reflect household crowding, inadequate water and poor sanitation and hygiene. Acute episodes of watery diarrhea are often best managed by oral glucose-electrolyte solutions with continuation of breastfeeding and early reintroduction of feeding. Selective use of lactose-free milk formula, short-term zinc supplementation and antibiotics may be necessary for ill children with poor nutrition, persistent symptoms, or dysentery. Education, high standards of environmental hygiene, breastfeeding, and immunization with newly licensed rotavirus vaccines are all needed to reduce the unacceptably high burden of diarrheal disease encountered in young children from Indigenous communities.

Indigenous Health Part 1: Determinants and Disease Patterns

Article

Aug 2009
LANCET

The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.