Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. WHO Africa to Decide on New Regional Director Process Following Shock Death of Candidate 13/01/2025 Kerry Cullinan Dr Faustine Ndugulile (centre) flanked by outgoing WHO Africa The World Health Organization’s (WHO) Africa regional committee meets on Tuesday (14 January) to decide on the process for nominating a new regional director following the shock death of Dr Faustine Ndugulile. Ndugulile was elected regional director at the WHO Africa regional conference in the Republic of Congo last August. His appointment was due to be ratified by the WHO’s Executive Board meeting next month, but he died in India in late November while undergoing medical treatment for an undisclosed condition. The sole focus of Tuesday’s special virtual meeting of the WHO Africa region is to work out how the next regional director, who serves for five years, should be chosen. Ndugulile secured 25 of the 46 votes at the August conference, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). There are 47 member states in the WHO Africa region as seven North African countries that are predominantly Muslim are part of the WHO Eastern Mediterranean Region. The regional meeting needs to decide whether it will re-open nominations for the position, hold new elections based on the three remaining candidates or simply choose the runner-up as the next regional director. According to the WHO’s Constitution, regional committees “shall adopt their own rules of procedure (Article 49)”. Meanwhile, Article 52 stipulates: “The head of the regional office shall be the Regional Director appointed by the Board in agreement with the regional committee.” “Both the Regional Committee and the Executive Board have a role in the process. The Regional Committee nominates a candidate, and the Executive Board appoints the Regional Director. The Regional Committee and Executive Board are each responsible for their own part in the process,” according to a WHO spokesperson. However, the WHO did comment on questions related to the likely process or whether the incumbent, Dr Matshidiso Moeti, will remain in the position until the new candidate is appointed. Moeti has served two terms (10 years) as regional director and is not eligible for re-election. The remaining three candidates have all worked for the WHO in various capacities. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but has also worked for WHO Africa. Sambo is the WHO Representative to The Democratic Republic of the Congo. Pakistan’s New Commitment to End Hepatitis Needs a People-Centered Approach 11/01/2025 Nida Ali A healthworker in Pakistan tests a man for hepatitis C. Picture a young woman in rural Sindh in Pakistan, fatigued from years of battling an undiagnosed illness, unable to care for her children or fulfill her potential. But a simple diagnostic test and a 12-week treatment for hepatitis C could transform and save her life. This story is no longer a distant dream. With the government’s recent pledge of $250 million to eliminate hepatitis, Pakistan is poised to turn its staggering hepatitis burden into a model of success. However, for this vision to materialize, there is an urgent need to tackle systemic barriers and adopt a person-centered approach to testing and care that addresses the challenges faced by diverse segments of society. The Scope of the Problem Pakistan bears an astounding hepatitis burden, with 10 million people affected by hepatitis C (world’s largest population of people living with hepatitis C infections) and four million living with hepatitis B. These diseases silently claim lives, contributing to liver cancer and liver failure at alarming rates. Every 20 minutes, a Pakistani dies of hepatitis C-related complications. Hepatitis elimination, as stated in the WHO’s Global Health Sector Strategy, is achievable but requires significant interventions. As a populous country with a large disease burden, Pakistan is positioned to play a flagship role in regional elimination efforts. Success here would not only save millions of lives but also demonstrate the feasibility of hepatitis elimination in resource limited settings. Barriers to Hepatitis Testing in Pakistan Despite progress, multiple structural, systemic, and person-level barriers impede the path to hepatitis elimination. Pakistan’s hepatitis response is hindered by significant structural and policy gaps. The underfunding of national programs leaves hepatitis testing and treatment services unable to meet demand. Centralized testing policies prioritize urban tertiary care facilities, neglecting the needs of rural communities. Programs heavily rely on unpredictable funding streams. Compounding this is a widespread stigma affecting both patients and healthcare providers, particularly in marginalized communities. The healthcare system struggles with limited resources and a shortage of trained personnel, especially in rural and underserved regions. Diagnostic facilities are inadequate, and weak surveillance systems result in data gaps that hinder evidence-based decision-making. Missed opportunities for integration with other health services, such as tuberculosis and HIV programs, further exacerbate inefficiencies in hepatitis care delivery. At the individual level, patients face significant barriers to accessing care. Testing and treatment costs remain prohibitive for many, particularly for advanced diagnostics like virologic testing. A lack of awareness about hepatitis symptoms and risks discourages individuals from seeking care. Additionally, the high costs and logistical challenges of traveling to centralized healthcare facilities make it even harder for rural populations to access timely diagnosis and treatment. Person-centered way forward A man is vaccinated against hepatitis in his community. To address these barriers and make the new national hepatitis elimination program effective, Pakistan must embrace person-centered care using the recently released operational guide from the World Health Organization (WHO). This approach prioritizes the needs, preferences, and circumstances of individuals at every stage of care. Below are seven key strategies to operationalize this vision. Decentralizing testing and treatment services is essential to improving access, particularly for rural and underserved populations. Integrating these services into primary and community healthcare centers will allow individuals to access care closer to home. Expanding point-of-care testing in remote areas can provide rapid diagnosis and significantly reduce turnaround times for results. Additionally, deploying mobile clinics to underserved regions can bridge critical gaps in care delivery, ensuring that even the most marginalized populations receive timely testing and treatment. The national programme must ensure financial accessibility by subsidizing diagnostic costs, particularly for virologic testing which remains prohibitively expensive for many. Securing funding from donors and international organizations can help sustain affordable diagnostic tools and treatment options, ensuring financial protection for vulnerable populations. Strengthening healthcare systems is crucial for delivering person-centered care. Training healthcare providers to offer respectful and stigma-free services is a vital first step. Supply chains must be strengthened to ensure the consistent availability of affordable diagnostic kits and treatment regimens. Furthermore, leveraging technology such as telemedicine can enhance access to care and enable real-time tracking of hepatitis cases, improving overall system efficiency. Engaging communities is critical to overcoming barriers such as stigma and lack of awareness. Partnerships with local leaders, NGOs, and civil society organizations can help raise awareness and encourage testing. Culturally sensitive public awareness campaigns are also needed to address misconceptions, improve risk perception, and promote the uptake of testing and treatment services. Differentiated service delivery models with care tailored to individual needs can improve outcomes and reduce the strain on healthcare systems. Uncomplicated cases can be treated at primary care levels, while complex cases are referred to tertiary care centers. Targeted “micro-elimination” strategies in high-prevalence areas can focus on specific populations, enabling efficient and localized hepatitis elimination efforts. A robust surveillance system is vital for identifying disease hotspots and monitoring progress. Establishing hierarchical systems and using digital tools for data collection and visualization can support evidence-based decision-making, ensuring resources are directed where they are most needed. Finally, integrating hepatitis testing into existing health services can maximize resources and increase reach. Combining testing with HIV, tuberculosis, and maternal health services can streamline care delivery, while including hepatitis testing in routine health checkups and immunization drives ensures greater coverage and early diagnosis. Call to Action By addressing the hepatitis crisis, Pakistan can become a model for other nations in South Asia and beyond. Its large-scale elimination efforts, if successful, could inspire global confidence in the feasibility of achieving the WHO’s 2030 targets. The recent funding pledge by the Prime Minister reflects strong political will, but sustained commitment by all provinces is needed to translate plans into action. Hepatitis elimination in Pakistan is feasible, but it requires a paradigm shift toward person-centered care, equitable resource allocation, and strong political commitment. As WHO highlights in its new operational guide, hepatitis elimination is not just a health goal but a step toward social equity and justice. Dr Nida Ali is a Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a program of the Task Force for Global Health. The Coalition pursues worldwide elimination of viral hepatitis by strengthening local capacity and bringing together global partners to share knowledge and experiences related to prevention, testing and treatment. Image Credits: Nida Ali. In 2024, Annual Global Temperatures Exceed 1.5ºC For First Time 10/01/2025 Kerry Cullinan Last year was the hottest on record, bringing a range of natural disasters including fires and floods. Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement. Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder. “Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday. “These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change. About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’. Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record. The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with record highs across nearly one third (27%) of the extra-polar ocean. Globally, the monthly average SST reached a new record in March of 21.07°C. Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean. In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea. The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April. In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year. Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans. The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024. Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030. However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. Human-induced heat Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface. Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report. Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”, according to the report. “Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo. “Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW) “These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.” Image Credits: Unsplash, C3S/ECMWF. Air Pollution Robs Indian Farmworkers of their Health and Livelihoods 09/01/2025 Sanket Jain Indian farmworker Balaso Salokhe can no longer work because of severe asthma YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. “In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened. Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition. So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden. Asthma triggers Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found. Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023. Lack of rural air pollution warnings “Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas. India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring. Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However, burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found. Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. Burning the residue from crops such as sugarcane is driving air pollution in rural India. Breathlessness “During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution. Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. “Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital. His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. Limited research Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain. “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added. “More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.” A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. “The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. Lack of affordable solutions Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. “I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said. Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. “We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.” She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks. With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. Image Credits: Sanket Jain. Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Africa to Decide on New Regional Director Process Following Shock Death of Candidate 13/01/2025 Kerry Cullinan Dr Faustine Ndugulile (centre) flanked by outgoing WHO Africa The World Health Organization’s (WHO) Africa regional committee meets on Tuesday (14 January) to decide on the process for nominating a new regional director following the shock death of Dr Faustine Ndugulile. Ndugulile was elected regional director at the WHO Africa regional conference in the Republic of Congo last August. His appointment was due to be ratified by the WHO’s Executive Board meeting next month, but he died in India in late November while undergoing medical treatment for an undisclosed condition. The sole focus of Tuesday’s special virtual meeting of the WHO Africa region is to work out how the next regional director, who serves for five years, should be chosen. Ndugulile secured 25 of the 46 votes at the August conference, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). There are 47 member states in the WHO Africa region as seven North African countries that are predominantly Muslim are part of the WHO Eastern Mediterranean Region. The regional meeting needs to decide whether it will re-open nominations for the position, hold new elections based on the three remaining candidates or simply choose the runner-up as the next regional director. According to the WHO’s Constitution, regional committees “shall adopt their own rules of procedure (Article 49)”. Meanwhile, Article 52 stipulates: “The head of the regional office shall be the Regional Director appointed by the Board in agreement with the regional committee.” “Both the Regional Committee and the Executive Board have a role in the process. The Regional Committee nominates a candidate, and the Executive Board appoints the Regional Director. The Regional Committee and Executive Board are each responsible for their own part in the process,” according to a WHO spokesperson. However, the WHO did comment on questions related to the likely process or whether the incumbent, Dr Matshidiso Moeti, will remain in the position until the new candidate is appointed. Moeti has served two terms (10 years) as regional director and is not eligible for re-election. The remaining three candidates have all worked for the WHO in various capacities. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but has also worked for WHO Africa. Sambo is the WHO Representative to The Democratic Republic of the Congo. Pakistan’s New Commitment to End Hepatitis Needs a People-Centered Approach 11/01/2025 Nida Ali A healthworker in Pakistan tests a man for hepatitis C. Picture a young woman in rural Sindh in Pakistan, fatigued from years of battling an undiagnosed illness, unable to care for her children or fulfill her potential. But a simple diagnostic test and a 12-week treatment for hepatitis C could transform and save her life. This story is no longer a distant dream. With the government’s recent pledge of $250 million to eliminate hepatitis, Pakistan is poised to turn its staggering hepatitis burden into a model of success. However, for this vision to materialize, there is an urgent need to tackle systemic barriers and adopt a person-centered approach to testing and care that addresses the challenges faced by diverse segments of society. The Scope of the Problem Pakistan bears an astounding hepatitis burden, with 10 million people affected by hepatitis C (world’s largest population of people living with hepatitis C infections) and four million living with hepatitis B. These diseases silently claim lives, contributing to liver cancer and liver failure at alarming rates. Every 20 minutes, a Pakistani dies of hepatitis C-related complications. Hepatitis elimination, as stated in the WHO’s Global Health Sector Strategy, is achievable but requires significant interventions. As a populous country with a large disease burden, Pakistan is positioned to play a flagship role in regional elimination efforts. Success here would not only save millions of lives but also demonstrate the feasibility of hepatitis elimination in resource limited settings. Barriers to Hepatitis Testing in Pakistan Despite progress, multiple structural, systemic, and person-level barriers impede the path to hepatitis elimination. Pakistan’s hepatitis response is hindered by significant structural and policy gaps. The underfunding of national programs leaves hepatitis testing and treatment services unable to meet demand. Centralized testing policies prioritize urban tertiary care facilities, neglecting the needs of rural communities. Programs heavily rely on unpredictable funding streams. Compounding this is a widespread stigma affecting both patients and healthcare providers, particularly in marginalized communities. The healthcare system struggles with limited resources and a shortage of trained personnel, especially in rural and underserved regions. Diagnostic facilities are inadequate, and weak surveillance systems result in data gaps that hinder evidence-based decision-making. Missed opportunities for integration with other health services, such as tuberculosis and HIV programs, further exacerbate inefficiencies in hepatitis care delivery. At the individual level, patients face significant barriers to accessing care. Testing and treatment costs remain prohibitive for many, particularly for advanced diagnostics like virologic testing. A lack of awareness about hepatitis symptoms and risks discourages individuals from seeking care. Additionally, the high costs and logistical challenges of traveling to centralized healthcare facilities make it even harder for rural populations to access timely diagnosis and treatment. Person-centered way forward A man is vaccinated against hepatitis in his community. To address these barriers and make the new national hepatitis elimination program effective, Pakistan must embrace person-centered care using the recently released operational guide from the World Health Organization (WHO). This approach prioritizes the needs, preferences, and circumstances of individuals at every stage of care. Below are seven key strategies to operationalize this vision. Decentralizing testing and treatment services is essential to improving access, particularly for rural and underserved populations. Integrating these services into primary and community healthcare centers will allow individuals to access care closer to home. Expanding point-of-care testing in remote areas can provide rapid diagnosis and significantly reduce turnaround times for results. Additionally, deploying mobile clinics to underserved regions can bridge critical gaps in care delivery, ensuring that even the most marginalized populations receive timely testing and treatment. The national programme must ensure financial accessibility by subsidizing diagnostic costs, particularly for virologic testing which remains prohibitively expensive for many. Securing funding from donors and international organizations can help sustain affordable diagnostic tools and treatment options, ensuring financial protection for vulnerable populations. Strengthening healthcare systems is crucial for delivering person-centered care. Training healthcare providers to offer respectful and stigma-free services is a vital first step. Supply chains must be strengthened to ensure the consistent availability of affordable diagnostic kits and treatment regimens. Furthermore, leveraging technology such as telemedicine can enhance access to care and enable real-time tracking of hepatitis cases, improving overall system efficiency. Engaging communities is critical to overcoming barriers such as stigma and lack of awareness. Partnerships with local leaders, NGOs, and civil society organizations can help raise awareness and encourage testing. Culturally sensitive public awareness campaigns are also needed to address misconceptions, improve risk perception, and promote the uptake of testing and treatment services. Differentiated service delivery models with care tailored to individual needs can improve outcomes and reduce the strain on healthcare systems. Uncomplicated cases can be treated at primary care levels, while complex cases are referred to tertiary care centers. Targeted “micro-elimination” strategies in high-prevalence areas can focus on specific populations, enabling efficient and localized hepatitis elimination efforts. A robust surveillance system is vital for identifying disease hotspots and monitoring progress. Establishing hierarchical systems and using digital tools for data collection and visualization can support evidence-based decision-making, ensuring resources are directed where they are most needed. Finally, integrating hepatitis testing into existing health services can maximize resources and increase reach. Combining testing with HIV, tuberculosis, and maternal health services can streamline care delivery, while including hepatitis testing in routine health checkups and immunization drives ensures greater coverage and early diagnosis. Call to Action By addressing the hepatitis crisis, Pakistan can become a model for other nations in South Asia and beyond. Its large-scale elimination efforts, if successful, could inspire global confidence in the feasibility of achieving the WHO’s 2030 targets. The recent funding pledge by the Prime Minister reflects strong political will, but sustained commitment by all provinces is needed to translate plans into action. Hepatitis elimination in Pakistan is feasible, but it requires a paradigm shift toward person-centered care, equitable resource allocation, and strong political commitment. As WHO highlights in its new operational guide, hepatitis elimination is not just a health goal but a step toward social equity and justice. Dr Nida Ali is a Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a program of the Task Force for Global Health. The Coalition pursues worldwide elimination of viral hepatitis by strengthening local capacity and bringing together global partners to share knowledge and experiences related to prevention, testing and treatment. Image Credits: Nida Ali. In 2024, Annual Global Temperatures Exceed 1.5ºC For First Time 10/01/2025 Kerry Cullinan Last year was the hottest on record, bringing a range of natural disasters including fires and floods. Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement. Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder. “Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday. “These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change. About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’. Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record. The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with record highs across nearly one third (27%) of the extra-polar ocean. Globally, the monthly average SST reached a new record in March of 21.07°C. Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean. In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea. The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April. In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year. Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans. The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024. Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030. However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. Human-induced heat Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface. Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report. Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”, according to the report. “Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo. “Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW) “These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.” Image Credits: Unsplash, C3S/ECMWF. Air Pollution Robs Indian Farmworkers of their Health and Livelihoods 09/01/2025 Sanket Jain Indian farmworker Balaso Salokhe can no longer work because of severe asthma YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. “In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened. Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition. So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden. Asthma triggers Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found. Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023. Lack of rural air pollution warnings “Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas. India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring. Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However, burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found. Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. Burning the residue from crops such as sugarcane is driving air pollution in rural India. Breathlessness “During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution. Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. “Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital. His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. Limited research Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain. “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added. “More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.” A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. “The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. Lack of affordable solutions Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. “I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said. Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. “We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.” She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks. With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. Image Credits: Sanket Jain. Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Pakistan’s New Commitment to End Hepatitis Needs a People-Centered Approach 11/01/2025 Nida Ali A healthworker in Pakistan tests a man for hepatitis C. Picture a young woman in rural Sindh in Pakistan, fatigued from years of battling an undiagnosed illness, unable to care for her children or fulfill her potential. But a simple diagnostic test and a 12-week treatment for hepatitis C could transform and save her life. This story is no longer a distant dream. With the government’s recent pledge of $250 million to eliminate hepatitis, Pakistan is poised to turn its staggering hepatitis burden into a model of success. However, for this vision to materialize, there is an urgent need to tackle systemic barriers and adopt a person-centered approach to testing and care that addresses the challenges faced by diverse segments of society. The Scope of the Problem Pakistan bears an astounding hepatitis burden, with 10 million people affected by hepatitis C (world’s largest population of people living with hepatitis C infections) and four million living with hepatitis B. These diseases silently claim lives, contributing to liver cancer and liver failure at alarming rates. Every 20 minutes, a Pakistani dies of hepatitis C-related complications. Hepatitis elimination, as stated in the WHO’s Global Health Sector Strategy, is achievable but requires significant interventions. As a populous country with a large disease burden, Pakistan is positioned to play a flagship role in regional elimination efforts. Success here would not only save millions of lives but also demonstrate the feasibility of hepatitis elimination in resource limited settings. Barriers to Hepatitis Testing in Pakistan Despite progress, multiple structural, systemic, and person-level barriers impede the path to hepatitis elimination. Pakistan’s hepatitis response is hindered by significant structural and policy gaps. The underfunding of national programs leaves hepatitis testing and treatment services unable to meet demand. Centralized testing policies prioritize urban tertiary care facilities, neglecting the needs of rural communities. Programs heavily rely on unpredictable funding streams. Compounding this is a widespread stigma affecting both patients and healthcare providers, particularly in marginalized communities. The healthcare system struggles with limited resources and a shortage of trained personnel, especially in rural and underserved regions. Diagnostic facilities are inadequate, and weak surveillance systems result in data gaps that hinder evidence-based decision-making. Missed opportunities for integration with other health services, such as tuberculosis and HIV programs, further exacerbate inefficiencies in hepatitis care delivery. At the individual level, patients face significant barriers to accessing care. Testing and treatment costs remain prohibitive for many, particularly for advanced diagnostics like virologic testing. A lack of awareness about hepatitis symptoms and risks discourages individuals from seeking care. Additionally, the high costs and logistical challenges of traveling to centralized healthcare facilities make it even harder for rural populations to access timely diagnosis and treatment. Person-centered way forward A man is vaccinated against hepatitis in his community. To address these barriers and make the new national hepatitis elimination program effective, Pakistan must embrace person-centered care using the recently released operational guide from the World Health Organization (WHO). This approach prioritizes the needs, preferences, and circumstances of individuals at every stage of care. Below are seven key strategies to operationalize this vision. Decentralizing testing and treatment services is essential to improving access, particularly for rural and underserved populations. Integrating these services into primary and community healthcare centers will allow individuals to access care closer to home. Expanding point-of-care testing in remote areas can provide rapid diagnosis and significantly reduce turnaround times for results. Additionally, deploying mobile clinics to underserved regions can bridge critical gaps in care delivery, ensuring that even the most marginalized populations receive timely testing and treatment. The national programme must ensure financial accessibility by subsidizing diagnostic costs, particularly for virologic testing which remains prohibitively expensive for many. Securing funding from donors and international organizations can help sustain affordable diagnostic tools and treatment options, ensuring financial protection for vulnerable populations. Strengthening healthcare systems is crucial for delivering person-centered care. Training healthcare providers to offer respectful and stigma-free services is a vital first step. Supply chains must be strengthened to ensure the consistent availability of affordable diagnostic kits and treatment regimens. Furthermore, leveraging technology such as telemedicine can enhance access to care and enable real-time tracking of hepatitis cases, improving overall system efficiency. Engaging communities is critical to overcoming barriers such as stigma and lack of awareness. Partnerships with local leaders, NGOs, and civil society organizations can help raise awareness and encourage testing. Culturally sensitive public awareness campaigns are also needed to address misconceptions, improve risk perception, and promote the uptake of testing and treatment services. Differentiated service delivery models with care tailored to individual needs can improve outcomes and reduce the strain on healthcare systems. Uncomplicated cases can be treated at primary care levels, while complex cases are referred to tertiary care centers. Targeted “micro-elimination” strategies in high-prevalence areas can focus on specific populations, enabling efficient and localized hepatitis elimination efforts. A robust surveillance system is vital for identifying disease hotspots and monitoring progress. Establishing hierarchical systems and using digital tools for data collection and visualization can support evidence-based decision-making, ensuring resources are directed where they are most needed. Finally, integrating hepatitis testing into existing health services can maximize resources and increase reach. Combining testing with HIV, tuberculosis, and maternal health services can streamline care delivery, while including hepatitis testing in routine health checkups and immunization drives ensures greater coverage and early diagnosis. Call to Action By addressing the hepatitis crisis, Pakistan can become a model for other nations in South Asia and beyond. Its large-scale elimination efforts, if successful, could inspire global confidence in the feasibility of achieving the WHO’s 2030 targets. The recent funding pledge by the Prime Minister reflects strong political will, but sustained commitment by all provinces is needed to translate plans into action. Hepatitis elimination in Pakistan is feasible, but it requires a paradigm shift toward person-centered care, equitable resource allocation, and strong political commitment. As WHO highlights in its new operational guide, hepatitis elimination is not just a health goal but a step toward social equity and justice. Dr Nida Ali is a Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a program of the Task Force for Global Health. The Coalition pursues worldwide elimination of viral hepatitis by strengthening local capacity and bringing together global partners to share knowledge and experiences related to prevention, testing and treatment. Image Credits: Nida Ali. In 2024, Annual Global Temperatures Exceed 1.5ºC For First Time 10/01/2025 Kerry Cullinan Last year was the hottest on record, bringing a range of natural disasters including fires and floods. Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement. Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder. “Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday. “These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change. About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’. Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record. The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with record highs across nearly one third (27%) of the extra-polar ocean. Globally, the monthly average SST reached a new record in March of 21.07°C. Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean. In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea. The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April. In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year. Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans. The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024. Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030. However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. Human-induced heat Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface. Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report. Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”, according to the report. “Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo. “Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW) “These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.” Image Credits: Unsplash, C3S/ECMWF. Air Pollution Robs Indian Farmworkers of their Health and Livelihoods 09/01/2025 Sanket Jain Indian farmworker Balaso Salokhe can no longer work because of severe asthma YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. “In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened. Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition. So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden. Asthma triggers Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found. Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023. Lack of rural air pollution warnings “Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas. India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring. Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However, burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found. Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. Burning the residue from crops such as sugarcane is driving air pollution in rural India. Breathlessness “During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution. Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. “Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital. His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. Limited research Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain. “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added. “More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.” A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. “The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. Lack of affordable solutions Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. “I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said. Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. “We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.” She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks. With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. Image Credits: Sanket Jain. Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
In 2024, Annual Global Temperatures Exceed 1.5ºC For First Time 10/01/2025 Kerry Cullinan Last year was the hottest on record, bringing a range of natural disasters including fires and floods. Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement. Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder. “Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday. “These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change. About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’. Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record. The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with record highs across nearly one third (27%) of the extra-polar ocean. Globally, the monthly average SST reached a new record in March of 21.07°C. Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean. In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea. The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April. In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year. Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans. The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024. Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030. However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. Human-induced heat Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface. Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report. Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”, according to the report. “Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo. “Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW) “These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.” Image Credits: Unsplash, C3S/ECMWF. Air Pollution Robs Indian Farmworkers of their Health and Livelihoods 09/01/2025 Sanket Jain Indian farmworker Balaso Salokhe can no longer work because of severe asthma YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. “In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened. Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition. So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden. Asthma triggers Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found. Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023. Lack of rural air pollution warnings “Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas. India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring. Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However, burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found. Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. Burning the residue from crops such as sugarcane is driving air pollution in rural India. Breathlessness “During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution. Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. “Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital. His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. Limited research Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain. “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added. “More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.” A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. “The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. Lack of affordable solutions Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. “I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said. Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. “We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.” She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks. With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. Image Credits: Sanket Jain. Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Air Pollution Robs Indian Farmworkers of their Health and Livelihoods 09/01/2025 Sanket Jain Indian farmworker Balaso Salokhe can no longer work because of severe asthma YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. “In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened. Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition. So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden. Asthma triggers Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found. Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023. Lack of rural air pollution warnings “Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas. India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring. Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However, burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found. Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. Burning the residue from crops such as sugarcane is driving air pollution in rural India. Breathlessness “During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution. Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. “Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital. His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. Limited research Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain. “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added. “More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.” A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. “The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. Lack of affordable solutions Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. “I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said. Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. “We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.” She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks. With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. Image Credits: Sanket Jain. Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Publisher Retracts Controversial COVID-19 Treatment Study 09/01/2025 Kerry Cullinan A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier. The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month). “Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes. The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin. “Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study. Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France. Ethical questions But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month. In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”. There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients. None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it. Author disputes Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported. Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. The corresponding author, Didier Raoult, did not respond to the deadline to address concerns. However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola, Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”. Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19. Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Midwives Are an Overlooked Solution to the Climate Crisis 08/01/2025 Sandra Oyarzo Torres & Ana Gutierrez Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan. In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis. Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked. Minimal infrastructure “As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). “Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.” The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience. A midwife checking a pregnant woman in a rural community clinic in Guatemala. Impact of extreme heat Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage. “Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia. Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. “Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent. Displacement caused by climate disasters adds another layer of inequity. A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.” Midwives are already responding Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change. “Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya. Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively. This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala. A sustainable model of care Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused. “As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.” Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. “Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh. There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes. Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities. An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” Call to action Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed. The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives. The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.” The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future. Sandra Oyarzo Torrez is President of the International Confederation of Midwives Ana Gutierrez is Communications Lead at the International Confederation of Midwives Image Credits: International Confederation of Midwives. Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Sugary Drinks Drive Global Diabetes and Cardiovascular Cases 07/01/2025 Kerry Cullinan Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease. Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week. One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy. They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages. Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries. Biggest increase in sub-Saharan Africa The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region. Colombia, Mexico, and South Africa have been particularly hard hit. Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks. Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. “Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute. ‘Clarion call’ to cut consumption The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”. Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk. There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks. “Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note. However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity. Taxes on sugary drinks South Africans campaign in favour of a tax on sugary drinks in 2017 The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages. Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink: “Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study. “High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.” Image Credits: Heala_SA/Twitter, Kerry Cullinan. China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
China Pioneers Remote Surgeries Using Robots and a Satellite 06/01/2025 Kerry Cullinan Chinese doctors perform remote surgeries on patients thousands of kilometres away. Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news broadcaster. The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder. “The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN. “Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.” The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems. “This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN. China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones. “The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted. However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. “There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.” Image Credits: China Global Television Network (CGTN). Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. 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Amid Ignorance of the Links Between Alcohol and Cancer, US Surgeon General Calls for Updated Warning Labels 06/01/2025 Kerry Cullinan Evidence of the links between alcohol and cancer is “extensive”. Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General. To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week. By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year. Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. At least seven cancers are associated with alcohol There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol. “The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes. Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020). According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption. Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres. But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk. Only 45% of US citizens were aware of the link between alcohol and cancer ‘Extensive evidence’ There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory. First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs. Mitigation of risk In order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”. He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk. Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral. Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General. Posts navigation Older postsNewer posts