Policy

Health policy and practice

The George Institute for Global Health draws on our latest evidence to produce statements, recommendations, and reports to inform policy, guidelines, and practices across the world. We engage with key decision makers to enact real change in health policy and practice where it is needed most.

who-consultation-kids-marketing

Submission to WHO Consultation on policy guideline to protect children from the harmful impact of food marketing

The George Institute for Global Health is pleased to contribute to the public consultation on the World Health Organization (WHO) draft guideline on policies to protect children from the harmful impact of food marketing.

Across the globe, marketing of unhealthy products to children is a powerful tool used by food manufacturers to increase unhealthy food consumption, alter preferences, stimulate purchase requests, and ultimately adversely impact human health. Marketing limits the uptake of healthy and sustainable diets and is associated with increased rates of diet-related non-communicable diseases (NCDs), including overweight and obesity, dental caries, diabetes, and some cancers. Based on this work and the broader evidence base, we strongly recommend that the marketing of unhealthy products to children is restricted to ensure the healthiest start in life, particularly among communities experiencing greatest vulnerability.

In our response, we share recommendations to improve the overall clarity and support implementation of the Guideline. Moreover, we highlight missing data and context and setting specific issues that have not yet been captured.

This submission was prepared by members of the Food Policy and Impact and Engagement Team, in addition to a complementary, joint submission that was co-developed with the NCD Alliance, NCD Child, World Cancer Research Fund International and the World Obesity Federation.

We congratulate the WHO on the development of the Guideline and stand ready to collaborate to address research gaps and considerations identified by the WHO.

Submission-WHO-NCDs

Submission to the WHO consultation on the global action plan for the prevention and control of NCDs 2013-2030

The George Institute appreciated the opportunity to provide feedback on the updated Appendix 3 of WHO’s Global action plan for the prevention and control of noncommunicable diseases (NCDs) 2013–2030 and commends WHO for its efforts to revise it in light of advancing scientific knowledge.

The George Institute for Global Health contributed two submissions to the call:

We strongly support the overall approach and the intention to assist countries selecting a combination of these interventions to define locally tailored packages of interventions to accelerate ongoing national NCD responses. The George Institute, however, believes there are several ways Appendix 3 could be improved to achieve NCD Targets by 2025, as well as facilitate the realisation of Sustainable Development Goals (SDG) Target 3.4.

To ensure its objectives and ambitions are realised, we have made several comments and reflections as summarised below:

  • Appendix 3 should highlight the importance of equity considerations, and the need to consider the impacts of interventions on communities experiencing marginalisation because of historic power imbalances.
  • A sex and gender lens should be applied to the updated Appendix 3, reflecting the latest scientific evidence on the differential impact of NCD risk factors for women and men.
  • Appendix 3 would be strengthened with further guidance on how to combine packages of interventions where there are synergies in cost and outcomes.
  • It is important to name Appendix 3 and retain the concept of NCD ‘best buys’.
  • More information on the methodology of this update, the use of healthy-life year (HLY) unit, how cost-effectiveness was measured for interventions that include several components, and clarification on methodological limitations.
  • Appendix 3 should be more consistent across sections, especially in detailing the overarching/enabling actions and outlining non-financial considerations across risk factor sections.
  • Appendix 3 should be as clear and precise as possible with the description of interventions.
  • The consultation and updating processes need to be strengthened.
  • Appendix 3 needs to reflect the evolving NCD agenda.
Child Drowning

Childhood drowning - Stopping a silent epidemic

Drowning, particularly among children, is a largely invisible health crisis in low- and middle-income countries that has only recently begun to receive the attention it demands. Between 2016-20, researchers from The George Institute for Global Health examined the health burden stemming from drownings in parts of Bangladesh, India and Vietnam. The Institute’s ground-breaking research across the three countries revealed critical insights, raised awareness and offered policy makers and local communities evidence-based tools to help stop the silent epidemic.

planetary health

The George Institute and partners call for recognition of unheard voices at the UN Food Systems Summit

The George Institute for Global Health has partnered with the Walgett Aboriginal Medical Service and Dharriwaa Elders Group, and the Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, to call for Traditional Knowledges and First Nations and Pacific Island priorities to be recognised at the UN Food Systems Summit, which will be held in New York in September. The Summit aims to launch bold new actions to deliver progress on the Sustainable Development Goals, each of which relies to some degree on healthier, more sustainable and equitable food systems. It calls on people everywhere to ‘work together to transform the way the world produces, consumes and thinks about food’.

However, The George Institute’s report highlights the challenges First Nations and Pacific Island communities face in engaging with the Summit, including a lack of consideration of Traditional Knowledges or what different paradigms of health and food and water systems mean for different cultures.

“Addressing food and water insecurity in Australia demands a considered response that privileges an Aboriginal paradigm of health and culture, including the continued connection between people and Country that has existed over many thousands of years and local Aboriginal community-led solutions crying out for investment and growth,” said Wendy Spencer, Manager of the Dharriwaa Elders Group, an Aboriginal community group operating in Walgett NSW for over 20 years, and Christine Corby, OAM, the Chief Executive Officer of Walgett Aboriginal Medical Service, an Aboriginal Community Controlled Health Organisaiton (ACCHO) operating since June 1986.

'Whose paradigm counts? An Australia-Pacific perspective on unheard voices in food and water systems’ reflects community-identified challenges and priorities in Walgett NSW Australia and the Pacific Islands, and explores the health, environmental and equity impacts of food and water systems in these contexts. Two case studies were submitted with the report, which highlight specific issues around climate change preparedness, systemic racism, threatened natural resources, under-resourcing of public health priorities, the burden of non-communicable diseases (NCDs) and gender inequalities. The case studies also showcase community-led solutions to food and water insecurity in the context of the COVID-19 pandemic.

“The COVID-19 pandemic in our region has threatened our livelihood, compounded poverty, and insecurity within social and health inequities. Many villagers have now invested in social capital (solesolvevaki) through locally-driven development projects to address these issues,” said Gade Waqa, Head of Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University. 

The submission to the Summit – which is part of The George Institute’s ‘Triple P’ advocacy initiative focusing on preventing NCDs, protecting the planet and promoting equity – reflects on how this and future summits can be better governed and designed to support the inclusion of Traditional Knowledges, community priorities and voices that continue to go unheard (see recommendations below).

“We need to ensure Aboriginal and Torres Strait Islander Knowledges of cultural practices and the successful management of our lands are not only acknowledged and respected, but considered by global governments. One-off consultations that do not reflect the voices of all First Nations people will fail to deliver effective solutions for real change to our food and water security,” said Dr Julieann Coombes, Research Fellow, Aboriginal & Torres Strait Islander Health Program, The George Institute for Global Health.

The UN Food Systems Summit has been criticised for its failure to meaningfully engage Indigenous and Tribal communities around the world; its links with multi-national agribusiness firms; and a lack of governance transparency. These concerns have led some civil society organisations to boycott the Summit and organise counter events, with a focus on small-scale producers and solutions such as food sovereignty and agroecology.

“The UN Food Summit should provide an important opportunity to transition towards fairer food systems,” said Jacqui Webster, Professor of Food Policy at The George Institute. “By working with communities to understand barriers and opportunities, we can support local partners to strengthen implementation of policies that improve diets. In this way we can prevent NCDs, protect the planet and promote equity.”

Report recommendations

Based on consultations with key stakeholders, information from case studies included within the report and our research and advocacy expertise, we believe:

Organisers of multilateral summits should:

• Ensure First Nations voices are represented at all levels and in all aspects of governance structures from the earliest stages of summit conception.

• Recognise the diversity of global Traditional Knowledges and unheard voices and embed flexibility in engagement mechanisms to ensure these are captured.

• Ensure discussions of food systems include consideration of water systems as a default.

Health systems should:

• Recognise climate change and its impacts on human health in policy and practice and take responsibility for reducing their own climate footprint.

Governments should:

• Design food policy through a process of community-led policy development that recognises Traditional Knowledges and includes engagement with community leaders and Elders, and shared planning and decision making.

• Adopt a systems approach to developing policy, recognising the relationships and reciprocal links between food and water systems, the burden of non-communicable disease, climate change and equity.

• Support consumer demand for sustainable, fresh and healthy foods, and implement policies to ensure these foods are easily accessible, available and affordable over the long term.

Researchers should:

• Monitor the effectiveness of policies that aim to improve food and water systems and develop the evidence base on the impacts of implementation on equity, climate change and the disease burden.

fatty_food
Women's health brainstorm

Responding to UK DHSC’s Women’s Health Strategy Call for Evidence

In March 2021, the UK Government’s Department of Health and Social Care called for evidence to inform the development of the government’s first Women’s Health Strategy. In collaboration with Imperial College London, The George Institute for Global Health contributed two submissions to the call:

  1. The first focused on non-communicable diseases (NCDs), the leading causes of death and disability for women in the UK, and stressed the critical role that sex and gender research has in improving how we understand women’s health and disease
  2. The second centred around female-specific health issues, including female sexual and reproductive health, maternal mental and physical health and the intersection with NCDs, and  gynaecological cancers.

A joint summary of the two submissions is provided below.

 

Summary

  • Women’s health must be considered as a continuum across the life course, spanning adolescence, the reproductive years, menopause and later life. Factors arising at any stage of a woman’s life can impact on future health.
  • Empowering a woman with the information to plan her life and spend it in the best possible health is within reach, if evidence-based, gender-sensitive strategies and interventions can be brought into routine practice.

 

  • Four of the five leading causes of death for women in the UK are NCDs, including dementia, acute coronary syndromes, cerebrovascular diseases and chronic lower respiratory diseases.
  • How women and men develop and experience disease can differ significantly, including how they are managed within the health system.
  • However, recognition of these differences is not routinely reflected in policies, clinical guidelines or practice, nor in the training of those involved with the provision of healthcare.
  • Women, and especially pregnant women, continue to be under-represented as participants in research and the disaggregation of analyses by sex and/or gender to reveal health patterns in women and men separately is not yet routine.
  • As a result, there are numerous examples where, compared to men, women are more likely to experience non-evidence-based treatments and have worse health outcomes than would be expected if care were equitable between genders.
  • The disaggregation of health data by sex and gender should be prioritised, where possible and appropriate.

 

  • Unintended pregnancies make up 45% of all pregnancies in England, with nearly 60% of these ending in abortions, and up to half of unintended pregnancies are due to incorrect or inconsistent use of contraception. Equitable access to reliable post-birth contraception for all women in England is needed.
  • Pregnancy-related conditions like pre-eclampsia and gestational diabetes are under-researched but are associated with an increased risk of adverse pregnancy outcomes (e.g. stillbirth and birth trauma) and can reveal those women who are at greater risk of developing these conditions later in life.
  • Research into the integration of NCD prevention and treatment into routine reproductive, maternal, child and adolescent NHS services should be prioritised and resourced.
  • The safety of treatments in pregnancy must be improved through increasing the involvement of women, including women of reproductive age and pregnant women, in clinical trials.
  • Data collected as part of women’s routine care should be used to support maternity service improvement, improve maternal safety and involve pregnant women in clinical trials.

 

  • Deficits in data and understanding of women’s health are evident across all areas of medicine and public services. Although currently a source of inequity, these also represent readily realisable opportunities for action through innovations in policy and practice.
  • Data from clinical research and national datasets could be of even greater utility in delivering national priorities for women’s health if they are designed to provide information specific to women’s health across the life course and made more accessible for research and service improvements.
  • Improvements in women’s’ health will substantially benefit wider society through multiple routes. Women represent 51% of the population, provide 70% of unremunerated caring activities, and represent 99% of the routes of transmission of the early developmental determinants of health and disease to the next generation. In addition, women live on average 5 years longer than men.
CEDAW

Submission to Australian Parliament's Human Rights Sub-Committee on women and girls in the Pacific

The George Institute for Global Health and The Australian Human Rights Institute have jointly prepared a submission to assist the Australian Parliament's Human Rights Sub-Committee prior to its upcoming public hearing for the inquiry into women and girls in the Pacific.

This submission relates to our recent work on the implementation of women’s health rights in the Pacific. This work seeks to improve the health of women and girls worldwide, including in the Pacific, through the development of the United Nations Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Implementation Map on Women’s Health. The Map is a unique tool that measures government responses to CEDAW recommendations on women’s health across 30 countries in the Asia-Pacific region.

It is a collaboration between the George Institute for Global Health and the Australian Human Rights Institute and is led by Dr Janani Shanthosh.

 

Triangular road sign with damage. Depicting child with ball and car

Six reasons why: Compelling co-benefits of lowering speed on our streets

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)

Falls

Preventing and managing falls across the life course

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.