Exploring co-benefits of climate change in the context of global health

By Ben Griffiths — Community Engagement Project Manager

Source: Pixabay

Understanding the links between climate change and public health is paramount to comprehending the potential devastation that communities could face and building a foundation for tangible action. Various aspects of climate change have been observed to produce deleterious effects on public health. This article will examine the effects of climate change on public health, the impact of public health interventions on climate change, and the co-benefits to health observed in responses to climate change. 

The impacts of climate change on health are truly plethoric, with dramatic current and projected effects from a variety of climatic and human factors. Below are a few factors that contribute to negative health outcomes:

Air pollution

As one of the leading causes of death and health risk globally, air pollution is a major silent killer. Ambient particulate matter in the atmosphere from fossil fuels and coal has been linked to heart attacks, asthma, stroke, hypertension, lung cancer, and miscarriage amongst other ailments. These millions of annual deaths are inexorably linked to climate change through fossil fuel use, which will continue to escalate and result in further deaths unless full decarbonisation is achieved. Moreover, household air pollution both exacerbates climate change through burning solid fuels and causes millions of deaths annually. Burning solid fuels such as coal, wood, and dung for household use is disproportionately employed in low-income communities that are reliant on this energy source, thus leading to disproportionate negative health implications as well.

Natural disasters

Climate change is causing an increase in the frequency and intensity of natural disasters globally, with dramatic consequences for sentient wellbeing and human health. Natural disasters can have wide-ranging health consequences through disrupting supply chains of medical supplies, death and bodily injury, displacement, infectious diseases, damages to clean water systems, and consequently mental health challenges.

The Asia-Pacific region is particularly subject to risk, with countries such as Vietnam, the Philippines, and Japan facing significant disaster risk, as well as small island developing states like Kiribati facing dramatic sea-level rise. While the Asia-Pacific region faces risk due to being in the tropics and along major fault lines, most regions of the world have begun to experience significant and escalating risks. Dramatic sea-level rise is projected to affect coastal communities globally and different combinations of increasingly regular and severe natural disasters create unique challenges for each region.

The stark reality of the damages caused by natural disasters was brought to where many of us live, work, and study when the devastating bushfires arrived in Australia early in 2020. The fires resulted in at least 33 direct deaths, hundreds of deaths in indirect excess mortality, trauma to firefighters and those directly impacted, biodiversity loss, and reduced air quality. These all present challenges to healthcare systems that will be magnified in future years when Australia faces concurrent disasters that occur more regularly and severely.  A recent report from the Grattan Institute outlines the effects of climate change on public health, with particular focus drawn to the recent bushfires and future steps to be taken.

Photography by fvanrenterghem/Flickr
Heat

Global warming is causing sustained increases in temperatures, which are projected to result in 75% of the world’s population experiencing deadly heat waves by 2100 and some areas of the world becoming uninhabitable for human life. This has the potential to cause global disruption and additional strain on healthcare systems during hotter periods, with potentially existential consequences for sentient life in the long-term.

Sustained heat exposure can result in heat exhaustion, heat stroke, and the exacerbation of existing health problems such as heart failure.

MALNUTRITION

Through increased drought, natural disasters, ocean acidification, soil degradation, pollution, and the spread of infectious diseases, climate change will have a substantial negative effect on agricultural yields and the nutritional value of crops. This leads to malnutrition both from a lack of food availability and decreased quality of the food that does exist.

Once again, low-income nations will be affected disproportionately by food and nutrient scarcity, thus necessitating justice-based approaches to climate change that are cognisant of this inequity.

Co-benefits

These substantial negative health implications of climate change should act as an impetus for action so that they can be avoided through a combination of adaptation and mitigation measures. However, it is also worth noting that many of these climate change interventions result in considerable public health co-benefits that reach communities immediately. This is a much more compelling motivator relative to simply avoiding the damages of climate change, which are often perceived to be conceptually abstract and long-term. It is worth noting that while this article has a health focus, co-benefits of climate action can extend to “increased energy security, job creation, and reductions in poverty and inequality”. Moreover, adaptation efforts that build community resilience for future disasters also improve adaptability to current disasters and health issues.

Policies and initiatives that deliver health co-benefits are wide-ranging, with opportunities emerging across the spectrum of decarbonisation possibilities and industries. Given the plethoric range of policy possibilities that couldn’t easily be summarised in a single article, only a few of these initiatives will be outlined.

Renewable energy transition

Fossil fuel use is the primary means through which climate change manifests, and a transition towards alternative sources of energy is fundamental to mitigating future harm. Beyond merely averting harm, such a transition has the potential to improve human lives and avert needless deaths through resultant improvements in air quality. For example, three million premature deaths by 2040 could be averted with a 7% increase in investment in a “Clean Air Scenario”. Reducing the amount of ambient particulate matter and ozone in the air would result in significant quality of life improvements as the aforementioned negative effects of air pollution are minimised and outdoor spaces become less polluted.

There are also simpler shifts of energy use that can make a profound impact on climate change, public health, and economic development. For example, national programs that transition solid fuel cooking utensils to low-emissions stove technology could save millions of lives and avoid millions of tonnes of greenhouse gas emissions.

Photography by Andreas Gücklhorn/Unsplash
Increased use of active and low emissions transport

Transport represents 21% of overall CO2 emissions, which both necessitates decarbonisation of this sector while presenting opportunities to improve public health. For example, the electrification of transport in addition to increasing public transport use can decrease emissions while increasing air quality. Encouraging increases in active transport methods such as walking and cycling results in greater cardiovascular health, lower overall morbidity, and greater mental health outcomes in addition to the previously mentioned benefits to health and the climate.

Dietary choices

Agriculture represents 26% of overall CO2 emissions, a substantial portion of which is animal agriculture. Industrialised animal agriculture is currently unsustainable, using inefficient levels of water and land, while resulting in substantial methane and CO2 emissions and a number of other negative environmental impacts. Moreover, the greatest sources of environmental degradation—red meat and processed meat—are also the sources of animal agriculture with the most negative health implications. Diets with large amounts of animal agriculture—in particular red and processed meat—are associated with health risks including heart disease, stroke, and higher overall morbidity relative to plant-based diets. This dual benefit to health and the environment merits a shift towards diets with more fruits, vegetables, nuts, seeds, and beans, with the greatest positive impacts associated with an exclusively plant-based diet.

Greening cities

Creating more urban green spaces doesn’t only provide an aesthetic benefit. Increased numbers of trees in cities are a valuable source of carbon sequestration and a shared space that allows a city’s denizens to connect with nature. Beyond these benefits, green spaces also reduce the “urban heat island effect”, provide psychological benefits, and reduce water runoff that is associated with disease spreading, land degradation, and polluted waterways.

Photography by Michael Sotnikov/Flickr

Final remarks

Climate change advocacy often takes the form of justifiably warning about impending devastation and framing climate action through the lens of avoiding or mitigating harm. Reframing the issue through co-benefits discourse may prove to be more effective as it shifts the conversation from advocating sacrifice for the greater good to improving the planet through corresponding improvements to society that we should all want to pursue, irrespective of the looming spectre of climate change.

Personalised Medicine: A new frontier of healthcare?

By Rachel Lim — Community Engagement Officer

For years, physicians have strived to consider the environmental, behavioural and genetic factors that may affect a patient’s health and disease management in order to provide precise and impactful care for each individual. However, it is only recently that we have been able to skyrocket this goal to the next level, with the term ‘personalised medicine’ rising to the forefront. Personalised medicine in the twenty-first century mainly refers to the use of genomics to optimise medical care and outcomes for each individual, enabling physicians to customise patient care in an unprecedented way. This approach has become prominent due to the exponential increase in the availability of genetic sequencing, testing, and data storage, accompanied by an increase in technological innovation and decrease in sequencing costs. This has enabled three major domains in clinical medicine to be accelerated, including the field of pharmacogenomics, genetic predispositions for common diseases, and the identification of rare disease-causing genetic variants.

Pharmacogenomics

Pharmacogenomics refers to the study of how genes modulate drug responses in different individuals. This is because variability of genes within the human population exists due to DNA polymorphisms and epigenetics. This causes changes in protein structure, function, or the amount of protein produced, which inevitably impacts how a person responds to a drug. Thus, if we are able to understand which DNA variants correspond to abnormal production of body proteins, we will be able to identify drug responders and non-responders, avoid adverse reaction events, and optimise drug dosage. 

For example, 40% of metastatic colon cancer patients are unlikely to respond to the typical drugs prescribed for colon cancer such as cetuximab and panitumumab, because these patients have tumours with mutated KRAS genes. Hence, being able to identify patients who are unlikely to respond to these drugs will enable us to save time and increase their rate of survival by immediately prescribing an alternative drug which they are predicted to respond positively to. In particular, this is important in cancer where different individuals have different genetic mutations present in their tumours, and hence targeting an individual patient’s tumours allows us to maximise efficacy and treatment benefit, while limiting the risk of adverse side effects.

Genetic predispositions for common diseases

Certain genetic variants lead to an increase in an individual’s risk of developing a particular disease. Thus, valuable research has been conducted into genetic factors that when combined with other environmental factors, can result in the development of a common disease. For example, type one diabetes occurs due to immune-mediated destruction of insulin-producing beta cells, causing insulin deficiency which results in unattenuated blood glucose levels. Type one diabetes affects over 18 million individuals worldwide and there are on average seven new cases a day in Australia

Source: WebMD

A genetic risk factor that has been identified which confers the highest risk of type one diabetes is having HLA-DQ2 and HLA-DQ8 alleles. It has been hypothesised that these alleles lead to the production of HLA molecules which do not interact properly with the body’s T cells in the thymus, thus allowing for self-reactive T cells to escape into the body’s periphery instead of being eliminated. Hence, if we can sequence a patient’s genome and identify these alleles, we can predict the patient’s risk of developing type one diabetes. With this powerful knowledge, physicians can more easily prescribe preventative measures to avoid the development of this condition. This allows for a shift in emphasis from reaction to prevention, in which we manage the root of the cause, rather than sticking to a Band-Aid solution. This can have a significant effect in reducing the costs generated by the disease burden on society, as well as individual health and economic costs on the patient and their family. Additionally, disease risk can be stratified so that high risk individuals are targeted more efficiently, allowing resources to be better utilised and early or prophylactic treatment to become more available.

Source: KPI Ninja

Identifying rare disease-causing genetic variants

Rare genetic diseases collectively affect 25 million people globally  and hence there is substantial merit in identifying genetic variants that cause these rare diseases. In Australia, a disease is considered rare if it affects less than 5 in 10,000 people. An example of a rare disease is cystic fibrosis (CF), in which the CFTR gene is mutated, subsequently affecting the production or function of the CFTR protein. This has a widespread impact throughout the body, resulting in many debilitating effects including lung disease, failure to thrive, and abnormal electrolyte composition in sweat. In fact, this condition has been recognised by midwives for hundreds of years by tasting the salty sweat on an infant’s brow, with the infamous saying that “an infant that tastes of salt will surely die”. 

Source: Firstcry

Fortunately, we have made leaps and bounds in identifying the genetic cause and consequences of cystic fibrosis, and the median life expectancy of people with CF has increased from a few months in the 1950s to over 40 years of age presently. Scientists have also created cystic fibrosis gene panels to detect the 175 most common genetic variants that cause cystic fibrosis, and this screening test can be performed on infants so that early treatment and management can commence promptly for affected newborns.

Considerations and drawbacks

Despite the many benefits and potential of personalised medicine, there are also several issues and challenges that we need to consider. For instance, infrastructure requirements such as the collection and storage of genomic data are a major hurdle. At the moment, we do not have sufficiently large, secure databases to store such information, nor is there enough funding and research going into this technological challenge. Additionally, there are privacy and ethical issues that arise as the genetic information of an individual is very personal and sensitive material that larger and more powerful organisations might exploit. There are also legal disputes as to who owns the genomic data collected and who is allowed access; questions that we must consider and create laws to govern.

Another major issue is the potential of personalised medicine to exacerbate inequalities. Although the cost of genomic sequencing is decreasing, there are still significant expenses that must go into the collection, sequencing, and interpretation of genomic data. Hence, it is foreseeable that equal access and affordability may not be available initially, which can drive increased disparities between countries and different socioeconomic groups. Considering the substantial benefits of personalised medicine, this may lead to a deepened poverty cycle which may spiral to become inescapable.

Illustration by durantelallera / Shutterstock

Moving forward

Personalised medicine is still a developing approach to clinical medicine that has a bright prospect in the future, despite its issues and challenges. It signifies a momentous change in patient care that aligns with the rise of the Information Age, and places us in a position to employ preventative medicine and improve the quality of life for patients. Moving forward, personalised medicine can be largely enabled by electronic health records, which will allow clinicians and patients to share and integrate relevant genomic information, supporting interdisciplinary care and management. Adequate regulatory frameworks and data management protocols must be established to protect personal rights and secure health data flow.

Additionally, healthcare training in technology, data analysis and genomic interpretation must be prioritised so that healthcare workers are able to understand and communicate this information to patients and the wider public. There is also an accompanying need for an increase in general health literacy so that patients have a greater awareness of their choices and are able to understand and appropriately consent to their desired management plan. Thus, it is through innovation, regulatory frameworks, education and commitment to equal access that personalised medicine will truly thrive and have a profound impact on healthcare globally.

Strive x Cainz public health debate: “decriminalising all drugs is an effective public health policy”

DEBATE – Strive Student Health Initiative x Cainz:

Disclaimer: The writers in this article are competitive debaters, and therefore the views expressed may not necessarily represent their beliefs or the beliefs of any organisations they represent.

1st Affirmative Writer – Henry Sundram, Community Engagement Project Officer

Greetings, my name is Henry Sundram and I’m currently completing my second year of a Bachelor of Arts, majoring in English and History alongside a Diploma in Languages (Indonesian). I joined Strive with the hope of helping advance the collective health of the community, especially the disadvantaged. I enjoy reading, bushwalking and all things cricket!

In recent years, there has been a significant movement to decriminalise all drug usage as a method of effectively advancing public health. We critically differentiate between drug legalisation, which involves government regulation of all drug markets and distribution, and drug decriminalisation, which centres on not prosecuting drug users whilst maintaining the illegality of drug manufacturing and selling. Policies of drug prohibition have failed as public health policies because they have largely failed to reduce drug consumption. By shifting the governmental lens on drug use from one of criminality to that of a health issue, public health outcomes will be improved.

Throughout history, forms of drug consumption have occurred in almost all societies whom “actively seek addictive drugs” for use in religion, medicine or recreation. Given the inherent tendency for drug consumption in societies, drug policies must reflect this reality to have meaningful public health outcomes. Drug prohibition has abjectly failed to reduce drug usage within societies and therefore failed as a public health policy. This failure may be attributed to the disjunct between prohibition’s idealistic aims of total drug elimination and the social realities of ever-present drug usage. Given that demand for drugs will always exist, parallel markets which supply and distribute illicit drugs will also exist, regardless of the efforts of law enforcement which US$100 billion per annum is expended on globally. The motivations behind drug prohibition is to “protect the health and well-being” of citizens. However, in Australia, there was a 55-fold increase in the number of heroin overdoses between 1964 and 1997 after the federal government prohibited the drug, reinforcing the ineffectiveness of prohibition at reducing drug use as a public health outcome.

Given the failures of drug prohibition, we logically turn to supporting the decriminalisation of all drugs as an effective alternative policy for advancing public health. Decriminalisation policies recognise the realities of drug consumption in societies and shift their focus from punitively prosecuting drug users to minimizing drugs’ potential harm. Decriminalisation destigmatises drug addiction as family members and friends are less likely to negatively judge drug users and are more willing to support and assist in their recovery because the user’s actions are no longer criminal. Accompanying this social destigmatisation, not prosecuting drug users enables them to seek medical assistance more openly for addictions without fear of repercussion. This would likely reduce demand for illicit drugs, increasing public health outcomes as dependents recover. In contrast, prohibitive-drug policies, which issue criminal records to drug users, often condemn them to further economic and health deprivation. The possession of a criminal record significantly reduces one’s employment opportunities, increasing the likelihood of poverty which is closely associated with poorer health through increased drug use, reduced access to healthcare services and poorer-quality food.

Ultimately, the irreconcilable failures of drug prohibition as a public health policy leads us to the alternative of total decriminalisation of drugs which will advance public health by encouraging more drug users to seek treatment.

1st Negative Speaker – Melanie Suriarachchi

Melanie is a Bachelor of Commerce student with an interest in public policy, politics and the ever-evolving global markets. In her spare time you can find her delving into her creative side either card-making or baking. 

The rising movement to decriminalise all drug use as a means of drastically improving public health outcomes is best described as idealistic. In order for decriminalisation to be a viable option to address concerns relating to drug use, there are many obstacles that need to be addressed first, which in a perfect world may be easy to address, however, can prove to be tricky in modern day societies. Whilst we understand that drug prohibition may not be the most robust measure to further public health outcomes relating to substance related issues, it provides a certain assurance as a ‘tried and true’ system to control addiction related issues within society.

The affirmative team asserts given the inherent tendency to consume drugs by those ‘actively seek addictive drugs’, drug policies should reflect this reality in order to further health outcomes relating to substance use. Hence, taking into consideration the ‘inherent tendency’ of some individuals to consume drugs, it may be considered a disservice to them to decriminalise drugs, as it provides them greater access to the substances that they may be wanting to avoid, especially in circumstances of rehabilitation. By decriminalising all drugs, it puts those who are going through a rehabilitative phase in great harm as they may not be able to control the environments they encounter, which could possibly lead to relapse and further trauma.

Moreover, to counter the argument addressing the ‘abject failure’ of drug decriminalisation, a 2001 Australian study of 18–29-year-old individuals by the NSW Bureau of Crime Statistics and Research demonstrates that prohibition did work to deter drug use. Of the subjects who had never used cannabis, 29% cited illegality as their reason for not using. 19% of those subjects who had stopped using cannabis stated that illegality of the substance was their reason for ceasing use. However, the most alarming statistic revealed that 91% of those currently using cannabis said that they would increase their usage if it was to be decriminalised.

Whilst decriminalisation may work to destigmatise drug addiction, the affirmative team fails to recognise those individuals who have biological predisposition towards drug addiction, making them more vulnerable to drug abuse. If there are measures such as legal prosecution are not in place, they probability that those individuals start to experiment with drugs is heightened, placing them in greater risk for continued substance abuse. When working to decriminalise all drugs, the health system needs to be prepared to handle the current drug addicts as well as the inundation of new addicts in order to provide fair access to the appropriate resources needed for those experiencing drug addiction, overdoses and withdrawals, as well as supporting family members and friends with a loved one who is suffering from an addiction.

Moreover, using basic economic theory, decriminalising all drugs will ultimately lead to a surge in the supply in drugs within the community, effectively leading to lower prices of such substances which may result in a greater temptation for individuals to experiment.

Fundamentally, whilst drug prohibition may not be the most efficacious system to improve health outcomes related to drug use, it is the system that many countries continue to utilise in order to address such issues. If public health outcomes relating to substance abuse were to be prioritised, the first measure to put in place would be greater access to support for addicts and the family and friends of addicts relating to both physical and mental health. It is foolish to believe decriminalisation would improve health outcomes without placing the ‘middle measures’ in place and trialling those initiatives first.

REference List:

Alcohol and Drug Foundation. (28 April 2021). Decriminalisation vs. Legalisation. https://adf.org.au/talking-about-drugs/law/decriminalisation/decriminalisation-detail/

Weatherburn, D. (2014). The Pros and Cons of Prohibiting Drugs. Journal of Criminology, 47(2), 176–189. https://idhdp.com/media/362647/1408-weatherburn-article.pdf

Drug Free Australia. (n.d.) Arguments Against Drug Legalisation. https://www.drugfree.org.au/images/pdf-files/library/Drug-Free-Australia/Taskforce_Arguments_for_Prohibition.pdf

2nd Affirmative Writer – Ben Smyth, Community Engagement Project Officer

Hi there, my name is Ben Smyth and I’m in my third year of Bachelor of Science, majoring in Psychology and also completing a diploma in Computing. I’ve always enjoyed writing and helping others refine their writing; this ties in with a burgeoning interest in public health. I’m also an executive member of Students for Sensible Drug Policy (SSDP) Unimelb, a student organisation that advocates for harm reduction and evidence-based drug policy reform. When I have the time, I enjoy boxing, singing, listening to podcasts, and playing video games.

The negative team suggests that decriminalizing all drugs will give individuals who “inherently” want to consume drugs greater access to substances they may want to avoid. However, drug use per se is not problematic to public health, but drug dependency is problematic and leads to poorer health outcomes. Legal drugs such as alcohol and caffeine can provide benefits while posing minimal risk to health; it is when addiction develops that the risk of poor health outcomes increases and an intervention is required.

Moreover, the legalization of relatively dangerous drugs such as tobacco and alcohol seems a farce when considering the criminalization of relatively benign drugs such as cannabis. Instead of arbitrarily criminalizing some drugs, all drugs should be decriminalized.

The negative team goes on to argue that due to lack of legal disincentives in decriminalization, addiction-prone individuals may become more vulnerable to drug abuse. However, since decriminalizing all drugs, Portugal has seen reductions in problematic use and drug-related harms. Therefore, apart from merely reduced problematic use, the decriminalization of drugs will help reduce drug-related harms ostensibly due to better access to education and medical care.

The negative team states that due to economic theory, decriminalization will lead to a surge in drug supply. Despite an increase in illicit drug seizures by Australian police forces over the past decade, the availability of drugs has been largely unaffected. There is simply too much demand and too many suppliers for prohibition of drugs to have effects on the market. The prohibition of alcohol in the USA was built on the utopian ideology of a drugless state, but ultimately led to an increase in crime and no meaningful reduction in alcohol use.

The vast majority of individuals who use drugs (legal or otherwise) do so rationally, recreationally, and sensibly. Policies should focus on the minority of users who develop dependence disorders. The real disservice to addicts is not providing them the opportunity to rehabilitate without risk of prosecution. Imagine the difference in public health if all the money now spent on arresting people and judicial processes was instead provided to drug treatment and support services.

REference List:

Buchanan, J. (2017). 72 Misleading Assumptions. Retrieved from Drugs, Human Rights & Harm Reduction: https://julianbuchanan.wordpress.com 

Hughes, C. E., & Stevens, A. (2010). What can we learn from the Portuguese decriminalization of illicit drugs? British Journal of Criminology, 50(3), 999-1022. doi:10.1093/bjc/azq038  

Stafford, J., & Breen, C. (2017). Australian Drug Trends 2016. Findings from the Illicit Drug Reporting System (IDRS). National Drug and Alcohol Research Centre. Sydney: UNSW Australia. Retrieved from https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/national-idrs_2016_finalwith-customs.pdf 

Taylor, S., Buchanan, J., & Ayres, T. (2016). Prohibition, privilege and the drug apartheid: The failure of drug policy reform to address the underlying fallacies of drug prohibition. British Society of Criminology, 16(4), 452-469. doi:10.1177/1748895816633274 

Vumbaca, G. (2016, July). Decriminalisation Is The Only Way To Arrest Australia’s Drug Problem. HuffPost Australia. Retrieved from https://www.huffingtonpost.com.au/gino-vumbaca/decriminalisation-is-the-only-way-to-arrest-australias-drug-pro_a_23013350/ 

 2nd Negative Writer – Vedanth Shah

My name is Vedanth, and I am a first year Commerce student at UniMelb. I am a member of CAINZ and currently hold the role of General Committee. I enjoy reading, playing sports mainly soccer, and have an interest in Economics.

The affirmative side have outlined that drug dependency is the core issue we are faced with, as it can cause health, financial and wellbeing issues. By legalising drugs, we are only providing the broader community with a gun and asking them not to shoot. If you take away the gun, they are deterred from shooting. This is the basis of decriminalising all drugs. If the community doesn’t have easy access to drugs, then it will deter most people from consuming potentially harmful and dangerous drugs. Initially the drugs may not be addicting in nature, but it opens up a gateway to harder, stronger drugs. Under the affirmative sides model, they suggest that decriminalised drugs will be safe and monitored, however, when people look for harder, stronger drugs after getting a feel for the “softer” drugs, they will face the downwards spiraling consequences from consumption of drugs. 

The affirmative side also brought up the example of Portugal decriminalising drugs, however this is only part true. Drugs are not freely available, nor can they be freely sold, instead the only difference in Portugal is that the offence for possession of a narcotic substance has been changed from a criminal to a civil offence, and under this legal framework citizens can still be fined for possession.

The relaxation of the law in Portugal may seem a minor change but had large significant impacts on Portugal’s economy and productivity. The relaxation of the law in 2011, resulted in a 1.7% fall in GDP in 2011, and a further 4.1% fall in GDP in 2012. This fall in GDP is no consequence, in fact many experts believe the laziness of citizens due to higher drug consumption, after the immediate relaxation of drug laws, resulted in a fall in labour productivity, and hurt the countries GDP.

By continuing with the current status quo, we avoid the large health, wellbeing and economic issues that may arise from the legalisation of drugs. Less people will have access to a potential self-destructing weapon, which by all means will keep the broader community safer and happier.

REference List:

Ceicdata.com. 2021. Portugal Labour Productivity Growth, 1996 – 2021 Data. [online] Available at: <https://www.ceicdata.com/en/indicator/portugal/labour-productivity-growth#:~:text=Portugal%20Labour%20Productivity%20dropped%20by,2020%2C%20averaging%20at%200.96%20%25.&text=The%20country’s%20Labour%20Force%20Participation,to%2058.70%20%25%20in%20Dec%202020.>. 

Drugfoundation.org.nz. 2021. Mythbusters: Drugs are legal in Portugal. [online] Available at: <https://www.drugfoundation.org.nz/matters-of-substance/may-2013/drugs-are-legal-portugal/>. 

En.wikipedia.org. 2021. Arguments for and against drug prohibition – Wikipedia. [online] Available at: <https://en.wikipedia.org/wiki/Arguments_for_and_against_drug_prohibition>. 

Laqueur, Hannah. “Uses and Abuses of Drug Decriminalization in Portugal.” Law & Social Inquiry, vol. 40, no. 3, 2015, pp. 746–781., www.jstor.org/stable/24545832.

3rd Affirmative Writer – Sonia Truong, Design Officer

My name is Sonia Truong and I am a first-year Bachelor of Biomedicine student at the University of Melbourne. I am interested in public health issues related to climate change and planetary health.

The affirmative team would like to begin by reminding the negative team that the debate thus far has concerned decriminalisation, not legalisation, which may rectify any misconceptions from the negative team regarding Portugal’s current drug policy. In the context of decriminalisation as an effective public health policy, one of the negative team’s own sources states that “Portugal stands as a global leader of evidence-based policy grounded on the principle of harm reduction”. We agree with their source that the decriminalisation of drugs demonstrably improves health outcomes and results in reduced drug use, addiction, overdoses, and HIV infections. This contrasts with the baseless and unevidenced “gateway drug” assertions reminiscent of doomed-to-fail 1930’s prohibitionists.

We would also like to correct the negative team by clarifying that Portugal’s drug decriminalisation occurred in 2001, not 2011, and that the entire continent was in recession during 2011. Is the negative team claiming that the 2001 decriminalisation of drugs caused a recession in Greece with a near decade-long delay? It seems much more coherent to suggest that the Eurozone debt crisis which impacted the entire continent is more responsible for Portugese economic woes than harmful stereotypes regarding people who use drugs. Nevertheless, this is a non-sequitur that distracts from the significant public health gains resulting from this public health policy.

If the negative team truly wishes to address the risks posed to individuals vulnerable to drug misuse, they may like to consider the serious harms inflicted on these individuals under the current punitive system: the stigma of a criminal record, denial of employment and housing, and the trauma associated with arrest and incarceration, all of which are inextricably linked to poorer health outcomes. Compared with the approach of drug decriminalisation, which approach sounds more pragmatic and humane?

This public health policy does not lend itself to simplistic and shallow analogies of “giving someone a gun and asking them not to shoot.” The regime of drug prohibition undermines the efforts of individuals to seek treatment for their drug use, not only because of stigma associated with drug use but because of legitimate fear of criminalisation. How is the negative team proposing that people who use drugs seek help when they are at risk of prosecution for doing so? Rather than spending exorbitant sums of money on law enforcement and wilfully depriving people with health issues of the help they need, resources could be redirected to provide earlier intervention and appropriate treatment and medical services to people with drug use problems. In the interest of public health, drug decriminalisation is a step in the right direction—and one that is long-overdue.

3rd Negative Writer – Vickram Mehtaanii

Vickram is a third year Bachelor of Commerce student majoring in Accounting and Management. In his spare time, Vickram can be found in the gym, trying his hand in the kitchen or watching football (soccer).

The negative team is well aware of the difference between legalisation and decriminalisation and understands that the debate concerns decriminalisation of all drugs, which is why we stand firm with our views. Drug decriminalisation is not the answer and will never be, at least not in the interest of public health. We understand that so long an act is considered a crime, most people will tend to stay away from “committing the crime”. We do not understand why the affirmative team has drifted away from the main topic and given so much importance to Portugal’s economic woes. If the affirmative and negative team both want an effective public health policy where less people consume drugs, less people get addicted to drugs, and less people overdose on drugs, then it is necessary that the consumption is considered a crime, as it always has been. Importance needs to be given to prevention than thinking of the cure first.

We understand that it is necessary to protect the welfare of those vulnerable to drug misuse, however, we also understand that we need to look after the health of all and therefore, consumption of drugs needs to be considered a crime. Otherwise, drugs would be much more easily available, which would then lead to a lot more people consuming drugs who have so far chosen not to as it is considered a “crime”. The same people who have resisted the consumption of drugs would be keen to explore what it is like to consume drugs, if it would not be a crime anymore. It is basic common sense: more people consuming drugs would lead to higher chances of drug misuse, addiction, and overdose. This would have a significant impact on those around them, including their family and friends, who would be affected both mentally and physically by the abusers. Moreover, this would have an impact on the future offspring as well as they may have some kind of disability from birth. Furthermore, the larger number of people addicted to drugs would lead to a higher crime rate, as a lot of addicts would indulge in criminal activities to purchase drugs. Surely, those who really are worried about their criminal record, employment and housing, trauma associated with arrest and incarceration would choose to not consume drugs. The point stands, prevention is better than cure.

Obviously, a better policy needs to be brought in place where those individuals who would like to seek treatment for their drug use get proper help, instead of straight off being treated as criminals. However, decriminalisation of consumption of drugs is NOT the answer to that. The negative team understands that the “cure” side of the public health policy needs to be looked into, but remains firm on the “prevention” side. Therefore, in the interest of public health, the negative team holds ground for criminalising the consumption of all drugs.


Affirmative Team Editor – Ben Griffiths, Community Engagement Project Manager

My name is Ben Griffiths and I’m currently a 4th year Bachelor of Commerce (Economics) and Diploma in Languages (French) student at the University of Melbourne. I’m passionate about policy, public health, climate change, international collaboration, and finding ways to combine these interests to make a tangible impact. In my spare time I like to play guitar, learn more about the world, hang out with friends, and write articles. You can find more of my current and previous writing at Cainz, ESSA Unimelb, Melbourne Microfinance Initiative, LSE International Development Review, and Strive Student Health Initiative.

Negative Team Editor – Emily Hartley

Hi everyone! My name is Emily and I am a current penultimate year student studying Bachelor of Commerce with majors in Finance and Economics. As a digest writer at CAINZ, I am able to tie together my childhood passion for writing and the qualitative and quantitative aspects of finance and economics. I am excited to deliver to you a range of articles throughout my time as a writer.

HIV/AIDS epidemics in developed nations: Evaluating mitigation strategies

By Stella Liu, Community Engagement Director

The human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic has wreaked havoc on humans for decades. HIV has claimed 33 million lives since it was first identified, with an estimated 38 million people currently living with the disease. Although developing countries within central Europe, central Asia, the Pacific, the Middle East and North Africa account for 95% of new HIV infections, HIV/AIDS persists within key populations in developed nations, including men who have sex with men (MSM), injection drug users (IDUs), commercial sex workers (CSWs) or clients of CSWs. HIV/AIDS distribution amongst populations in developed countries indicates persisting socioeconomic disadvantage. 

Increases in HIV virulence can only be prevented by targeting high-risk CSWs, and addressing characteristics underpinning treatment non-compliance. Health systems in developed nations cannot solely rely on free universal healthcare and advanced biomedicine. The ongoing AIDS epidemics and the resulting health burden on developed nations can only be resolved by socioeconomic development, health policy initiatives targeting high-risk groups, and improving ease of access for lower socioeconomic status (SES) populations.

Socioeconomic Status (SES)

Given that HIV/AIDS epidemics in developed nations originated from resource-poorAfrican countries, the impact of poor SES on HIV infection risk must be understood. Intriguingly, initial HIV epidemics in sub-Saharan Africa predominantly affected high-income well-educated individuals. By the early 2000s however, HIV infection predominantly occurred within poorer low-education populations. This demographic shift was due to behavioural changes within highly educated and wealthy gay communities, although poorer, less-educated communities have not undertaken similar changes. Distribution of HIV in developed nations is heterogeneous, with concentrated HIV epidemics in impoverished urban areas. In such regions within the US, HIV prevalence reaches as high as 5%, well above the national average. 

There are similar concerns regarding HIV prevalence among low SES groups in Australia, primarily gay and other homosexually active men, Aboriginal and Torres Strait Islander people, people who inject drugs, people in custodial settings, sex workers, and people from culturally and linguistically diverse (CALD) backgrounds. Socioeconomic disadvantage leads to risky health practices such as substance use and reduced condom use which amplifies HIV infection risk. As such, HIV prevalence is characterised by key indicators of SES: education, annual household income, poverty level, employment, and homeless-status. 
Hopelessness is a major contributor to HIV-risky behaviour among all at-risk groups aside from MSM. Substance abuse and unprotected sex is concerningly high among low SES individuals who exhibit a lack of hope for future improvements. Education is universally protective for all areas of SES as it mitigates hopelessness by increasing economic opportunity. As such, education improvements for low SES individuals has the potential to reduce HIV prevalence in developed countries. Ultimately, health systems must look beyond a biomedical understanding of HIV infection and resolve the socioeconomic determinants of HIV/AIDS epidemics.

Commercial Sex Workers (CSW)

Healthcare systems must shift their focus to CSWs, a low SES population at high risk of HIV.  HIV is transferred in blood, semen, rectal and vaginal fluids, and breastmilk. Thus, infection predominantly occurs in sexually active individuals. Increased rates of HIV transmission among CSW populations concerningly favours HIV virulence, as this allows the virus to frequently mutate, leading to more virulent strains. For CSWs and clients of CSWs who have multiple sexual partners, rapid HIV replication provides selective pressure that favours higher infectability and increased survivability. Thus, host survival becomes insignificant for the survival of HIV and accordingly, more virulent HIV strains quickly incapacitate the host immune system and AIDS progression occurs quicker

In developed countries, low SES individuals facing economic insecurity engage in ‘survival sex’; high-risk sexual behaviour with multiple partners, possibly without condom use, to meet basic financial needs. However, whilst CSWs generally have a higher HIV infection risk, legal brothel sex workers, unlike illegal street workers, are able to mitigate these risks through behaviour changes. Women working in brothels generally support and care for one another, and the business’ management can establish a safe client atmosphere with consistent condom use. For street CSWs however, it is up to the sex worker themselves to demand condom use. Faced with physical threat and coersion from clients, absence of legal protection, social isolation, and no community support, practicing safe sex easily becomes challenging. Social pressure from clients and challenging economic situations push street CSWs to believe that the cost of demanding condom use is greater than any health benefits.

Disappointingly, Australia’s sex industry predominantly consists of migrants from Thailand, China, or South Korea who’s working rights are compromised an uncertain immigration status or language barriers. Thus, they resort to street sex work rather than legal and safer brothel work. The lifestyle of street workers is an additional indicator of low SES, as they report higher levels of drug, alcohol, and cigarette use than brothel workers. With sharing needles and drug paraphernalia further contributing to the HIV risk of-street CSWs, it is clear why HIV/AIDS remains prevalent among this low SES group. 
Public health systems need to address systemic issues that influence this evolution. Other indicators of low SES – primarily homelessness and heavy drug use –  are seen in high-risk CSWs. Given that street CSWs face a lifestyle of irregularity, instability, and social isolation, maintaining the requirements for brothel employment can be difficult, even with the relevant working rights. Thus, education is necessary to change these behaviours and improve the economic opportunities for high-risk CSWs.

Access to Therapies (HAART)

The 1980s North-American AIDS epidemic was a period of uncertainty as healthcare professionals were unable to cure or control the disease. Stigma and rejection surrounding homosexuality, intravenous drug use, poverty, racism, and fear of contagion hindered support for HIV/AIDS prevention and research, leaving affected individuals unable to seek appropriate treatment. Slowly, HIV/AIDS research progressed, and by 1984, the viral cause of AIDS was identified, and laboratory HIV tests became available. 

Although HIV testing is now widely available in developed countries, low SES groups still face difficulties in receiving a diagnosis. Late AIDS diagnosis and healthcare delivery is a significant issue in Australia, with 55% of all cases remaining undiagnosed until progression to AIDS. Unsurprisingly, this mainly affects heterosexual individuals from CALD populations who faced socioeconomic disadvantage. These individuals were typically diagnosed in routine screenings during pregnancy, or following symptoms of AIDS. Healthcare systems in developed countries need to be wary that healthcare remains inaccessible to some populations, and stronger efforts are needed to ensure equitable access for low SES groups. 

The 1990s saw a paradigm shift in the treatment of HIV/AIDS. Highly active antiretroviral therapy (HAART) could reduce viral loading of HIV and increase white blood cell count, transforming it into a chronic disease rather than a death sentence. HAART has the potential to eliminate transmission between sexual partners, serving a dual purpose of treatment and prevention. However, the effectiveness of HAART has been questioned following studies that failed to show a decline in HIV incidence following treatment implementation. The possible connection between reduced HAART compliance within low SES populations and these results must be investigated
In the UK, low SES is strongly associated with HAART non-compliance, with the US showing a similar trend regarding SES and virological and immunological outcomes. More shockingly, in Canada where universal healthcare is provided free of charge, 40% of patients with HIV/AIDS related deaths never accessed treatment. As developed countries are capable of treating HIV/AIDS, it is unacceptable that benefits of medical innovation are not accessed by certain populations. Adverse effects of low SESgo beyond inability to pay for treatment, but rather individuals with knowledge, money, or social connections are disproportionately benefiting from advanced health systems. HAART, despite reducing overall HIV/AIDS deaths, has exacerbated health inequalities for low SES groups. In resource-rich countries, poverty, addiction, depression, and homelessness prevents HIV affected individuals from adhering to HAART medications despite access to health infrastructure, whilst unfavourable attitudes towards healthcare providers further damages health outcomes.

Key Conclusions

HIV infection and transmission are ultimately mitigated by-behavioural interventions. Whilst biomedical advances provide more options for HIV/AIDS prevention and treatment, safer sex and adherence to treatment regimes relies on individuals adopting behavioural and lifestyle changes that maintain health and reduce infection. Developed European countries spend approximately €1 million to treat HIV/AIDS, representative of around 1% of the total healthcare costs of these countries. This is a significant economic burden given the low HIV/AIDS prevalence within these populations, and despite these efforts, AIDS epidemics persist within these developed countries. 
A purely medical approach fails to address the stigma and discrimination, stress, trauma, and lack of social support for marginalised low SES populations which inherently increases their HIV risk. Developed nations must shift resources towards HIV prevention in impoverished urban areas, and provide community level and structural interventions to improve socioeconomic conditions. Programs such as Medicaid in the US and universal healthcare in other nations have reduced HIV/AIDS mortality, and can be built to include interventions specifically targeting lower SES groups with fewer accessible resources. Social services that address drug use behaviour, homelessness and poor education can work in conjunction with healthcare systems that provide treatment options to ultimately reduce and eliminate AIDS epidemics within developed countries. HIV/AIDS continues to be a global public health risk and speaks to the worldwide threat of infectious disease. Only by reconciling the biological understanding of HIV/AIDS with the socioeconomic determinants of infection and transmission, can developed-nations set an example of effective HIV/AIDS prevention.

Global COVID-19 vaccine inequity: Are we moving forward?

BY Kin Peng Soo, Community Engagement Project Office

Disclaimer: Due to the evolving nature of both the pandemic and COVID-19 vaccines, new information may continue to emerge. The following article is therefore accurate as of 20/05/2021.

Source: Getty Images
Introduction

With the development and distribution of multiple COVID-19 vaccines, the end of this pandemic is in sight; at least for wealthy countries. Variations in the rollout of vaccines being dependent on region and wealth has further highlighted the stark global inequities that have plagued the world for generations. Although many resource rich countries can look forward to being completely vaccinated by the end of 2021, many resource poor countries will likely be waiting until 2023. This is the direct result of many factors, including logistical difficulties, vaccine nationalism, and bottlenecks in supply.

Comparison of vaccine technology

An understanding of how the COVID-19 vaccines differ is imperative to grasping the conditions that give rise to logistical inequities. The two main vaccines that are currently being distributed in Australia are the Pfizer/BioNTech mRNA vaccine and the AstraZeneca/Oxford viral vector vaccine. Although they both aim to provide the same results, their approach differs greatly as the Pfizer vaccine is based on entirely new technology whilst AstraZeneca adopts an approach first developed in the 1970s. 

Our body’s immune system has developed over many millennia and is the most effective tool at clearing infections. Vaccines work by delivering the schematics of a virus or bacteria to the immune system so they can prepare for a real attack in advance. The various COVID-19 vaccines differ in the way they deliver these schematics. Pfizer’s mRNA vaccine when injected into the human body introduces instructions on how to make harmless SARS-CoV-2 proteins, which is the virus that causes COVID-19. These instructions, known as mRNA, will then enter some of our own cells which begin to produce the harmless COVID-19 proteins. Our immune system then recognises these COVID-19 proteins, thus priming it for any future attacks from real SARS-CoV-2 viruses. On the other hand, the Oxford/AstraZeneca vaccine uses viral vector technology, whereby a benign virus enters our cells to deliver these schematics for the SARS-CoV-2 proteins. Although the delivery mechanism is very different, the results should be the same in theory.    

Vaccine efficacy has been a very contentious issue over the past months with a continued influx of new data regarding each vaccine. We know from research published in the American Journal of Preventive Medicine that an efficacy rate of at least 80% or higher is needed to extinguish an epidemic without additional measures such as social distancing, quarantines, or mask use. The latest data suggests that in the prevention of COVID-19 transmission, Pfizer and AstraZeneca vaccines have efficacies of 95% and 76% respectively. However, due to the research being conducted at wildly different points of the pandemic and under different conditions, these numbers must be taken with a grain of salt. What we do know is that both vaccines are extremely good at preventing severe infections that lead to hospitalisation, intubation, and even death, which are the most important factors in reducing the burden on our health systems.

Logistics

A working vaccine is only the first step in moving past this pandemic as there is little use for a vaccine that cannot be distributed to those who need it. Due to the fragile nature of vaccines, a cold chain is required to maintain its potency. Most vaccines, including AstraZeneca’s, can be stored in fridges between 2-8oC however, the new mRNA technology requires continuous storage at temperatures of -70oC. At these temperatures, the vaccine is only guaranteed to last up to six months. Transporting the vaccine at these temperatures is almost impossible as they are moved in dry ice cooled shipping containers where they only last ten days. To worsen the issue, they are packed in containers of 5000 doses and only survive for five days when stored in standard vaccine freezers found at most vaccination centres. The challenge of distributing these 5000 doses within five days  is compounded by the need to coordinate a second dose within three weeks after the first dose. These logistical issues are difficult to navigate in resource rich countries such as America and Australia and are nigh on impossible for resource poor countries.

Adapted from Yale Medicine

The issue of cold chains is one element of a larger system of inequities between resource rich and poor countries. Most countries will not be able to distribute the Pfizer/BioNTech vaccine and will thus have to turn to more conventional vaccines such as AstraZeneca. Much like the personal protective equipment (PPE) crisis observed at the start of the pandemic, we are seeing immense difficulties in obtaining these critical products. The misuse of money and power derived from panic buying and hoarding continues to put many lives at risk.

Justice, morality, and the benefits of an equitable distribution

“Rich nations representing just 14% of the world’s population had bought up more than half (53%) of all the most promising vaccines”

BBC News

When faced with crisis and adversity, the natural human response is one of greed and selfishness in an effort to protect one’s interests. Vaccine nationalism is yet another example of how resource rich nations continue to serve their own interests at the expense of the resource poor. However, this moral injustice leading to the unnecessary death of thousands will have reciprocal deleterious effects on the rich. After globalisation, the economies of the rich and poor became increasingly intertwined. Indeed, many global supply chains are reliant on the goods and services provided by lower income countries. The longer the delays in vaccine rollout for these countries, the longer these lockdowns will last, thus exacerbating any current supply bottlenecks. COVID-19 is estimated to cost the world economy between $1.8 trillion and $3.8 trillion, with rich countries set to take more than half of this pain. It is therefore in the best interest of all countries to ensure an equitable distribution of vaccines.

The achievement of an equitable distribution is being tackled by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi (The Vaccine Alliance), and the World Health Organisation (WHO) in a co-led initiative known as COVAX. It has currently been able to deliver 38 million doses to 98 countries (source). While this represents a positive start, America alone has been able to deliver 265 million doses (as of 12/05/21). The supply bottleneck of vaccines presents a significant distribution challenge. This can largely be attributed to the intricacies of patent law hampering global production of vaccines. Many countries such as India, China, and the Philippines with large-scale vaccine production capabilities  do not have the rights to manufacture and distribute them to countries in need. In this time of crisis, a mutual agreement needs to be made wherein these capable countries are able to produce vaccines while ensuring patent holders are adequately compensated.

See here for a more in-depth look into the patent law.

In conjunction with these issues, COVAX faces further challenges following the plausible link between the AstraZeneca vaccine and rare blood clots. As more affluent countries scramble to get their hands on more Pfizer vaccines, COVAX — which is heavily reliant on AstraZeneca due to the aforementioned logistical difficulties of delivering Pfizer — is facing further delays in rollout. Several countries involved with COVAX have already decided to suspend the use of AstraZeneca citing possible side effects. This isn’t a reasonable cost-benefit analysis as the risk of patients dying from COVID-19 in many countries heavily outweighs the risk of developing one of these rare blood clots. However, this unfortunate link will remain a roadblock and will likely cost the lives of many.

Along with the moral and economic benefits that equitable vaccine distribution provides, China and Russia are also using their vaccines as a form of diplomacy. China and Russia are filling a gap other rich countries have left during their preoccupation with vaccine nationalism. China has learnt from its failed attempt at PPE diplomacy which was plagued with quality control issues, and is successfully donating their vaccines in a bid to strengthen ties and forge new partnerships. Meanwhile, the US and EU lag behind, only pledging donations to poorer countries and regions recently.

Source: Getty Images

COVID-19 has brought to light the difference in access to quality healthcare between low and high income countries. Epidemics are not uncommon phenomena with many regions and countries being ravaged by them. The difference between COVID-19 and other diseases such as tuberculosis, Ebola, and malaria are that it impacted not only the poorer countries but the more affluent ones as well. If we compare the responses to COVID-19 and tuberculosis — a disease that claimed the lives of 1.4 million people worldwide in 2019 — rich countries were able to source, develop, and mobilise PPE, life saving drugs, and vaccines at unprecedented speeds. Meanwhile tuberculosis — which has a readily available vaccine and treatment regime — consistently appears in the top ten causes of death in low to middle income countries.

Conclusions

The inequitable distribution of resources is a long-standing issue that has been exacerbated by the COVID-19 pandemic. Vaccines have been the latest addition to this growing list of life saving measures that remain out of reach for lower income countries. Richer countries must recognise that altruism is not the only reason to support others during this pandemic as there are tangible economic and political advantages to be gained. Addressing the larger long-standing issues of health access in poorly resourced areas is more challenging and complex, which requires structural changes. This would involve an increase in human, material, and financial support through collaboration in addition to changing the internal environment through education, training, and leadership.