The George Institute, together with public health and consumer organisations, are calling for the Australian Government to prioritise the health of Australians and New Zealanders as they consider reforms to our food regulatory system

The George Institute has considerable concerns with the Draft Regulatory Impact Statement as it fails to recognise and address the key issue consistently raised by public health organisations – that our food regulatory system does not meet its primary goal of protecting public health, particularly long-term health and preventable diet-related disease.

The system requires reform, but this must be done in a way that supports the health and wellbeing of the community. Unfortunately, the proposals within this Draft Regulatory Impact Statement would seriously undermine future efforts at protecting public health.

The George Institute strongly recommends that the Review acknowledge the cost of inaction on diet-related disease and put public health measures first. This priority will help ensure that our food regulatory system is equipped to effectively protect the community, prevent diet-related disease and promote a resilient and productive population into the future.

With a growing global population and increasing urbanisation, cities are facing huge pressures in terms of population density, transport, air quality, access to opportunities for physical activity, and climate change. We urgently need to adopt policies that address these issues and the threats to safety and health the present. 

The Stockholm Declaration signed at the 2020 Global Ministerial Conference on Road Safety states that global leaders have a shared responsibility to protect road users from crash forces beyond the limits of human injury tolerance. This requires a focus on safe speeds, including: 

• ZERO SPEEDING: use of effective speed management approaches, and
• 30 KM/H: mandating a 30 km/h speed limit in urban areas to prevent serious injuries and deaths to vulnerable road users when human errors occur.

The benefits of lower urban speed limits go well beyond saving lives and reducing injuries from road traffic collisions. This policy brief outlines six compelling co-benefits which support progress towards the Sustainable Development Goals (SDGs). There is growing evidence of the link between lowered urban speed limits and:

• The prevention of road traffic injuries, notably to pedestrians and cyclists (SDG targets 3.6, 11.2)
• The promotion of physical activity through more active transport (walking or cycling) and the prevention of non-communicable diseases (NCDs) as a result (SDG target 3.4)
• The improvement of air quality and a reduction in related short- and long-term health issues as a result, while also addressing a major contributor to climate change (SDG targets 3.9, 11.6, 13.2) 
• Increased social connectivity and access to goods and services (SDG target 10.2)
• Enhanced equity, as a result of focusing on the safety and health concerns of the most vulnerable in our communities, and 
• Economic gains for businesses and governments. 

POLICY RECOMMENDATIONS

In addition to setting and enforcing urban speed limits of 30 km/h or less, policymakers should consider implementing: 

• National policies that prioritise walking and cycling;
• National policies that invest in and promote public transport as an alternative to private vehicles; 
• National and sub-national policies that encourage planning of liveable urban spaces;
• Education programmes and social marketing to increase public demand for safer speeds;
• Monitoring and evaluation of the impact of walking and cycling policies.

Read the full policy paper here (PDF 949 KB)

The COVID-19 pandemic has caused significant morbidity and mortality globally, across multiple waves. The recent situation in India has been grim. Evidence suggests that the spread of the virus can be mitigated through physical distancing, non-pharmaceutical interventions like use of face masks / shields and maintaining hand hygiene, and in advanced cases of morbidity, therapeutics.

The risk of outbreaks and disruption to societal and economic activity likely remains until effective vaccines are administered to prevent hospitalisation and limit infection. Emerging evidence also suggests that even a single dose of some COVID vaccines reduces infection rates across population groups. Therefore, it is essential to ensure equitable access to vaccines within and across all nations.

Several novel vaccines were developed in rapid response to the urgent need for a long-term solution to curb the spread of COVID 19 infection. Some COVID-19 vaccines have now been authorised or approved for human use, with some in the late stages of clinical development. The speedy rollout of vaccines is essential for complete economic reopening and recovery across the country.  The Government of India’s CoWIN portal reported in the last week of April that 150 million doses of vaccine have been administered with 25 million individuals having received both the doses.

Vaccine hesitancy has been reported anecdotally, although the prevalence of this phenomenon remains to be rigorously studied in India, particularly as the second wave mounts. India is phasing this summer into opening vaccines to all adult populations of age group 18 years and above, and vaccine acceptance will be critical. 

The Rapid Evidence Synthesis team at the George Institute for Global Health and the Knowledge Management Division (KMD) of the National Health Systems Resource Centre (NHSRC) have collaborated to identify evidence on the determinants of vaccine acceptance and hesitancy, interventions that can promote vaccine acceptance, and also review relevant literature that contextualises this evidence in light of the ongoing pandemic crisis in India. 

Based on discussions and a scoping brief, this rapid evidence synthesis (RES) addresses the following objectives: 

• What are the determinants of COVID-19 vaccine acceptance and hesitancy?
• What interventions have been shown to improve COVID-19 vaccine acceptance and reduce hesitancy?
• What contextual considerations related to the aforementioned are relevant for India’s COVID scenario?

Policy Implications

• This RES lays out evidence from LMICs, including India, in relation to a (WHO) framework to understand COVID vaccine acceptance and hesitancy. 
• It contextualises evidence – including from pre-prints- to make recommendations (see below).
• It expands the scope of response to vaccine acceptance and hesitancy beyond vaccine communication strategies, which, as evidence suggests, are necessary, but not sufficient. 

Policy Recommendations

Policy makers at national and subnational levels may consider the following key determinants of vaccine acceptance – which likely shape strategies 

• Risk perception and severity of illness
• Gender, occupation, education, income, place of residence, certain occupations and religious beliefs – these tend to be associated with population sub-groups neglected by the health system 
• Vaccine effectiveness, side effects, perceptions of safety (including exposure risks while getting vaccinated), misinformation and affordability 
• Endorsement from health provider and employers 
• Communication and public engagement 
• Most centrally, trust in government and pharmaceutical companies

No evidence was found assessing strategies or interventions. Multipronged strategies were recommended, and include

• At the overall systems level
  • Addressing historic issues and sensitivities, particularly in pockets where vaccine acceptance may be heterogenous
  • Minimisation of vaccine associated costs borne by the public
  • Measures to ensure infection control and reduce infection spread o Increase in availability of human resources and vaccine delivery capacity, including innovations to improve pre-registration access
• Engagement directly with communities by mobilisers and frontline workers, as well as providers sharing knowledge and encouraging vaccination in their personal networks – in the Indian context, this should include support for vaccine registration especially for those with access constraints.
• Clear, consistent and transparent communication regarding service availability, risks, and benefits through general as well as intensive campaigns with
  • Engagement of community leaders, celebrities, as well as health and scientific experts to build awareness, and
  • Tailoring messaging according to health, scientific and general literacy of sub-populations using traditional and social media, as appropriate.

Related People:

• Dr Devaki Nambiar, Program Head – Health Systems and Equity, The George Institute for Global Health
• Sandeep Moola, Research Fellow, The George Institute for Global Health
• Nachiket Gudi, Consultant, The George Institute for Global Health

India successfully averted any significant mortality and morbidity due to COVID-19 in 2020 through institution of several measures. India is now facing the second wave of COVID-19 which has overwhelmed the health system. State governments have revised strategies to deal with the pandemic surge but there is a need for crisis preparedness response on the second wave of COVID-19 in India. The National Health Systems Resource Centre (NHSRC) requested the George Institute for Global Heath for rapid evidence synthesis for the purpose. scanned key issues and developed an evidence informed policy brief which had the following objectives:

1. To understand the magnitude of the second wave of COVID-19 at a national and state level, together with resource requirements,
2. To synthesise evidence on interventions that can flatten the curve” of transmission and contain the spread of COVID-19 infection,
3. To identify strategies and synthesis evidence for rapidly scaling up health systems capacity during COVID-19 surges.

The policy brief is based on synthesis of six public health graded response frameworks, 115 research studies on several aspects, two reviews, and presents one inventory of resources. We also present estimates from one model to inform magnitude and temporality of the pandemic which can inform planning. All rapid evidence synthesis and policy brief development was carried out in 5 days.

Key policy considerations and recommendations are:

1. Estimates on the course of the pandemic as per the IHME model indicates that the second wave of COVID-19 will cause significant mortality and health system crunch in coming weeks to months with peak health systems burdening yet to be achieved in many states. There is an urgent need to rapidly act to prevent transmission and mount crisis response and state-wise estimates are provided. We however recommend using a multi-model approach, with the worst-case scenario being considered for planning and strategy development.  
2. There is an urgent need to “flatten the curve” of transmission and contain the spread of COVID-19 infection by:
   1. Adoption of a graded public health response for movement restriction and scaling it up guided by multi-indicator technical criteria. We recommend the use of Ontario COVID-19 response framework (with suitable state-level adaption, if necessary) which mounts five colour coded grades of responses, based on epidemiological, health system capacity and public systems capacity indicators. A state-level dashboard which captures indicators guiding the graded public health response might be developed to ensure better decision making and build citizen trust in restriction measures. Evidence on different types of restriction measures is presented and other graded public health response frameworks is also presented. 
   2. A multi-component community-based intervention to remove barriers to access and promote mask usage consisting of the following components needs to be invested on and scaled up across India:
      1. Engaging community-based organisations to ensure availability of free surgical masks (free door-to-door distribution of surgical mask would be appropriate strategy after surge is over),
      2. Offering information on mask usage and disposal with videos on tab, brochure in local languages and other community-based platforms,
      3. Endorsement and advocacy by local community leaders – healthcare, social, political and cultural,
      4. Periodic in-person monitoring of mask usage including providing reminders and distribution in public spaces,
      5. Development of protocols for disposal of masks in safe and environment friendly manner.
3. Ensuring health system preparedness for COVID-19 surge:
   1. Urgent investments to ensure scaling up of a crisis health system (for both COVID and non-COVID needs) is required. Evidence on several strategies (shelter hospital /alternate hospital sites; mobile field hospital, Biocontainment patient care units; recovery /rehabilitation units; deployment of hospital ships and planes; escalating ICU/HDU resources in ICU; community care facilities; hospital re-engineering; medical missions) used successfully in other countries for COVID-19 surge is presented. We recommend institution of all modalities, as relevant, considering the magnitude of crisis.
   2. Shortfalls in ventilator requirements, after purchase through routine supply chains and those received through aid, might be met by requesting support from organisations with capacity to manufacture open source ventilators. A resource on ranking of open source ventilator on several parameters is presented. Training for critical-care staff and accessories for ventilators including oxygen delivery need to be addressed.
   3. There is an urgent need to support people with COVID-19 who can undergo home care safely and scale up telemedicine provided by registered medical practitioners. Telemedicine facilities should be linked to transportation and hospital admission facilities such that severe patients can be optimally managed.
   4. The government needs to urgently develop and implement a fair, just and transparent triaging criterion for rationale allocation of beds, oxygen, and other critical care resources in consultation with bioethicists. Evidence on different triaging strategies is presented in the form of an inventory.  

Related people:

• Soumyadeep Bhaumik, Research Fellow, The George Institute for Global Health
• Deepti Beri, Research Officer, The George Institute for Global Health
• Jyoti Tyagi, Research Officer, The George Institute for Global Health
• Rupasvi Dhurjati, Research Assistant, The George Institute for Global Health
• Nachiket Gudi, Consultant, The George Institute for Global Health

Download full report (PDF 530 KB)

The Barisal Drowning Reduction Project – Bhasa is a multi-stakeholder approach to drowning reduction within a sub-region of Bangladesh.

It is estimated that 321,000 drowning deaths occur globally each year. That is a global drowning rate of one person every 80 seconds. More than 90% of drownings occur in low and middle income countries (LMICs). However, little is known about the impact of drowning on communities, both socially and economically. In this document, we report on the findings of a household population-based cross-sectional survey to understand the burden and context of fatal drowning in the Barishal division of Bangladesh. We investigated drowning cases by demographic characteristics and features of the drowning event. We also report on the qualitative findings, which helped us understand the context, beliefs and behaviour that influence water safety practices in the Barishal division.

Read the full project report (PDF 17 MB)

Falls are a growing and under-recognised public health issue. Every year more than 684,000 people die as a result of a fall, and 172 million more are left with short- or long-term disability. The vast majority of these deaths occur in low- and middle-income countries. 

In June 2016, the World Health Organization (WHO) Expert Consultation on Falls Prevention and Management met in Geneva where it agreed to the need for an evidence-informed guide on the prevention and management of falls, which is suitable for practitioners, program managers and decision-makers whose portfolios may affect falls outcomes.

In response, the WHO commissioned researchers from the WHO Collaborating Centre for Injury Prevention and Trauma Care at The George Institute for Global Health and UNSW School of Population Health to conduct a review of high-quality global evidence on falls prevention. The resulting Evidence Synthesis report describes the rapid evidence review process undertaken to identify and quality appraise relevant studies, and assess the level of evidence to support various falls prevention strategies for five key population groups:

1. Children and adolescents

2. People in occupational settings

3. Community dwelling older adults

4. Older people living in residential care facilities

5. Older people receiving care in hospitals 

The Evidence Synthesis report, along with a global end-user survey and extensive input from global falls experts, formed the background to the World Health Organization report, Step Safely: strategies for preventing and managing falls across the life-course, to which the researchers were also major contributors. Step Safely was released on 27 April 2021.     

The George Institute for Global Health is pleased to contribute to the consultation on the draft National Preventive Health Strategy.  The George Institute strongly supports the development and implementation of the Strategy. We believe this Strategy is a meaningful step towards an impactful prevention agenda in Australia that will result in better health outcomes.

We particularly wish to congratulate the Government on its commitment to spend 5% of total health expenditure on prevention by 2030, and the development of a ‘Blueprint for Action’. The George Institute’s recommendations in the submission seek to further strengthen and enhance what is already a thorough and well-prepared document.