The importance of relationships between people and the environment, the latest alarming news from the United States including the push for “medical freedom”, and an update on childhood asthma are among topics covered in The Health Wrap below.
The column also takes a deep dive into climate and health news, as election scorecards examine the major parties’ performance, and brings some good news from Bottle Bend Reserve on Kureinji and Barkindji Country.
The quotable?
Professor Timothy Caulfield, from the University Alberta, said the medical freedom movement has grown around distrust in healthcare and scientific institutions, driven largely by the spread of misinformation, including about vaccines.”
Lesley Russell writes:
These are disturbing times as we watch what is happening in the United States and brace ourselves for Australian impacts – some of which have already arrived.
The “Trump effect” has inserted itself into the Australian election campaign, in ways both obvious and subtle. Thank goodness for universal voting, the Australian Electoral Commission, and a judicial system independent of politics.
There is great pleasure to be found at these times in nature (although maybe those Australians in northern New South Wales and Queensland who are currently experiencing severe flooding might have second thoughts about that).
We know that spending time in nature is good for us physically and mentally. And research shows that people who are more connected with nature are generally happier in life and more likely to report feeling their lives are worthwhile.
Not surprisingly, people with strong connections to nature are more likely to have pro-environmental behaviours.
At a time of devastating environmental threats, it is critical to develop stronger, mutually supportive relationships between people and the environment.
The “third candidate”
It is very hard to talk about what is happening in the Australian election campaign without referencing how Trump 2.0 will impact the new government (of whatever composition) and what it means for our everyday lives and plans to travel or work in the United States.
Trump also means huge disruptions and re-alignments in foreign policy and trade – with likely direct and indirect impacts on health both here and for our Pacific and Southeast Asian neighbours.
Here are some recent Croakey articles:
- How safe are health agencies in Australia from a Trump-style assault?
- As global trade war launches, a call for national leadership to drive decarbonisation of our health system
- Coalition’s plans for public health service cuts are a health threat, experts warn
- As Australia votes, don’t lose sight of the Trump Administration’s assaults on health
- In the shadow of Trump
- Chaos under Trump: on tariffs, health and inequities
- Recent editions of The Zap and ICYMI have also covered these issues.
You can bookmark this link to follow Croakey’s ongoing coverage of the Trump Administration.
As I wrote in my article, In the shadow of Trump, the real shocker has been the extent to which Opposition Leader Peter Dutton has been willing to imitate Trump’s agenda, something that appeals to only a small minority of Australian voters.
And since I wrote that article things have not improved, with Dutton evading a response to Senator Jacinta Nampijinpa Price’s provocative statement echoing Trump’s rhetoric.
AFR journalist Phil Coorey calls Trump “the third candidate” in the elections, and it is certainly true that every day political leaders must compete with Trump and his Administration for media attention and respond to Trump’s chaotic, ever-changing policy announcements.
Trump has managed to define (or redefine) the terms of Canada’s upcoming federal election. The governing Liberals, once projected to be headed for defeat, now have a six-point lead over the Conservatives.
However, the situation is somewhat different to Australia in that Trump wants Canada as the 51st state, is driving border and immigration reforms and has imposed 25 percent tariffs.
And perhaps I should add that new Prime Minister Mark Carney is doing a sterling job of standing up to Trump.
Political journalist George Megalogenis sees Trump as “the wildcard that can swing the [election] contest in either direction” but I think that cost-of-living issues are what concern most voters, of all ages, and will drive where they send their votes rather than overt concerns about Trumpism in Australia.
See also these articles:
- The Conversation: Donald Trump has gatecrashed the federal election. It’s creating huge challenges for Australia’s next government
- US Council on Foreign Relations: Australia’s Upcoming Elections and the Trump Factor
- The Guardian: Like it or not, Donald Trump is now embedded in Australian politics. Both sides are struggling to deal with it
- Inside Story: Be careful what he wishes for.
Climate change, health and election scorecards
We are not hearing much about climate change in this election campaign: the proposals put forward on energy, coal, nuclear, gas, batteries and fuel costs are being framed as cost-of-living rather environmental issues.
Yet climate change (and related issues of health health and equity) is top of mind for young voters aged 18 to 24 years – many of these are first time voters whose support is up for grabs. In a Roy Morgan poll, “global warming and climate change” ranks fourth among top voter issues (although it’s disturbing to see this down nine percentage points since the 2022 election).
This is also an issue that Croakey has been exploring, but I think it is so important that it’s worth adding to your reading on the topic.
There was little in the Federal Budget to address Australia’s environmental crises, conservation and climate change, and the overall environment spend is best described as inadequate given the scale of the challenges.
However, it was good to see more than $70 million in the Budget for seawall structures and waste infrastructure to help boost climate resistance in the Torres Strait.
The increasing number of extreme weather events – heatwaves, bushfires, floods – around Australia should serve to remind us that us that global warming is having dire impacts and given the Trump Administrations anti-climate actions, it behoves Australia to step up as an international leader in this area.
And now the Bureau of Meteorology is predicting one of Australia’s warmest winters on record.
Yet the Climate Action Tracker rates Australia’s climate targets, policies and climate finance as “insufficient”. Election scorecards by the Climate and Health Alliance and the Public Health Association of Australia also present a disappointing response by the major parties.
A recent Editor’s Choice article in The Medical Journal of Australia says this: “Increasingly, the association between a changing climate and the effects on human health [is] becoming clearer and more urgent… as every year passes, the importance of action becomes even necessary, and the time frame for action is shortening”.
The MJA-Lancet countdown on health and climate change in Australia, which was established in 2017, has produced a series of annual national assessments. The 2024 report is here.
Environmental factors like air pollution and heat are major contributors to areas that are classified as Sydney’s “sickest suburbs”. The impact is greatest in areas with economic disparities.
The World Health Organization describes climate change as a “fundamental threat to human health”, stating that “it threatens the essential ingredients of good health — clean air, safe drinking water, nutritious food supply and safe shelter — and has the potential to undermine decades of progress in global health”.
Already in Australia, scientists say they are beginning to see the impact of global warming on people’s overall health.
They predict an increase in gastro-intestinal diseases and mosquito-borne diseases, more heat stroke cases, extended periods for seasonal allergies, and increased mental stress.
Just a few examples show what is happening. In 2024 gastro cases reached a 20-year high; transmission intensity of the most prevalent mosquito-borne infectious disease in Australia, Ross River virus, is increasing; pollen seasons are becoming longer; more than half of those who experienced climate-related disasters report moderate to high levels of impact on their mental health.
Recent research shows that one-quarter of young Australians are very or extremely concerned about climate change, and that these concerns are associated with higher psychological distress and a negative outlook on the future.
Last week a young protester interrupted a major mental health funding announcement by the Prime Minister to make the case that climate change is impacting young people’s mental health.
Australia’s National Health and Climate Strategy was released in December 2023, followed by an Implementation Plan in September 2024. A Climate and Health Expert Advisory Group was established in July 2024.
As far as I can determine the only funding for the implementation of this Strategy is $11 million in NHMRC research funding which was announced in March 2024, with applications to close in May 2024.
Some of the results of this Targeted Call for Research were announced in a media release from Assistant Minister for Health and Aged Care, Ged Kearney, in January 2025.
The 2023–24 Federal Budget allocated $27.4 million over 2 years to deliver Australia’s first National Climate Risk Assessment and National Adaptation Plan. A First Pass Risk Assessment Report was released in 2024.
The National Adaptation Plan will not be finalised until the Second Pass Risk Assessment Report is completed.
The Public Health Association of Australia has climate action as a key election policy. You can read the supporting paper here, and see their report card ranking the major parties on climate.
Recent Croakey articles on this topic:
- As our planet heats, politicians are leaving climate and health out in the cold
- The next Federal Government has some big health matters to address
- An open letter to federal election candidates on the importance of clean air
- Climate change, health and the federal election: what’s at stake?
A report on last night’s #CroakeyLIVE on #ClimateHealthMatters, supported by a grant from the Local and Independent News Association, will be published at Croakey tomorrow.
Medical freedom – the new political rallying cry
Late last year The New York Times published a story about how “health freedom” or “medical freedom” has become a rallying cry in the United States.
Since then, this approach has been boosted by the appointment of Robert F Kennedy Jr as the Secretary for Health and Human Services.
The medical freedom movement represents people with a broad range of positions. It’s increasingly populated by people who not only oppose government health regulations (in areas like food safety and pharmaceutical approvals) but are resistant to proven public health measures like vaccinations.
Increasingly these are seen as “un-American”.
Make America Great Again (MAGA) overlaps with Make America Healthy Again (MAHA) as a politically right-wing cry for individual freedoms and choice.
An interesting article in the Washington Post looks at the so-called “MAHA Moms”. Although not a uniform group, they share common beliefs that conventional wisdom on health is often wrong. This is fuelled by the proliferation of communities that replace advice from experts.
Telling these women they are victims of conspiracy theories is unhelpful, because they often take pride in doing their own research and have large networks who back up their thinking.
Experts talked about the threat this poses to public health in an article in MedPage Today.
Professor Timothy Caulfield, from the University Alberta, said the medical freedom movement has grown around distrust in healthcare and scientific institutions, driven largely by the spread of misinformation, including about vaccines.
“In the past, you didn’t hear anti-vax rhetoric be such an explicit part of political platforms,” Caulfield said.
Now it has become a “political identity [and] there’s this basket of beliefs that go with it including more access to supplements, access to unproven stem cell therapies, not being required to use other kinds of public health measures.”
The situation is complicated when Kennedy argues – rightly – that the American government must do more to keep people healthy and prevent chronic diseases and then – wrongly and dangerously – pushes for research to link autism to vaccines, looks to ban fluoride in water supplies and praises two anti-vax Texas doctors who “healed” children with measles with unconventional and unapproved treatments.
When it comes to Make America Healthy Again, Kennedy seems unable to recognise the strong links between infectious diseases, cancers, dementias and chronic conditions like obesity and diabetes.
His adoption of crazy, non-scientific beliefs undermines any value in his policy commitments to better health.
His commitment is to his own weird ideologies rather than to an evidence-based approach reflecting population needs.
As just one example, the CDC’s Division of Population Health has been eliminated. The Division was focused on promoting health and preventing chronic diseases, addressing the social determinants of health and funding Prevention Research Centers. The CDC Office on Smoking and Health was also eliminated.
If you are an admirer of the work of American molecular biologist, nutritionist, and public health advocate, Professor Marion Nestle, then you will appreciate this article in The New York Times about how she is struggling to reconcile the good point of Kennedy’s approach to health with the non-scientific nonsense.
An article in The Wall Street Journal recently suggested that American patients trust social media influencers more than their doctors when it comes to health advice.
Dr Steve Robson, former head of the Australian Medical Association, looked at this issue from an Australian perspective in an article in The Australian.
He says many Australian doctors sense pressure on their therapeutic relationships as social media and other online sources disrupt the traditional models of care.
He quotes one Melbourne doctor as saying, “There’s absolutely no question that what influences patients’ decisions is, increasingly, coming not from the medical space but from the celebrity space, [on social media].”
Another doctor fears that social media algorithms are driving people towards the more controversial or more fringe thinking in any particular area.
The pervasiveness and international reach of social media means that it’s very easy for crazy American ideas to be picked up and promulgated in Australia.
A paper by Australian researchers from Deakin University, published last month in Health Promotion International, proposed taking a public health approach to social media-based misinformation that includes primary, secondary and tertiary prevention to address immediate impacts, long-term consequences, and root causes of misinformation.
Nepotism in medicine
American schools, colleges and universities – and many other institutions and businesses – are caught up in a dreadful brouhaha with the Trump Administration over Diversity, Equity and Integration (DEI) issues.
The Trump Administration is looking to apply the new policies against DEI to international research bodies and universities as a condition of receiving US research funding.
These policies will have severe consequences for diversity among medical school students and education and health experts warn that, ultimately, this could harm patient care.
American research shows that a higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people.
And doctors from minority populations are more likely to build their careers in medically under-served communities.
In Australia many Aboriginal and Torres Strait Islander medical students are motivated to pursue a career in medicine to improve health outcomes for their communities. The increasing number of Indigenous doctors also helps improve the cultural responsiveness of healthcare services.
But there’s another form of selection going on in medical schools around the world that is rarely discussed.
Students admitted to medical school do not represent the socio-demographic proportions of the average population: children of parents with an academic background are highly over-represented, and in particular those with parents who are medical doctors are a very large group.
This has been revealed in studies from Germany, the United States, and Denmark. I found an unreferenced statement in a published paper that 57 percent of applicants to medical schools in Australia had parents with a medical background, but that can’t possibly be correct (I hope it’s not correct!)
These findings mean that students from less well-off backgrounds are further disadvantaged.
Moreover, a US study found that medical students who reported having a physician parent or grandparent were less likely to report intentions to practise among the underserved or work in primary care.
A opinion piece published in MedPage Today recently asked “Where is the outrage against nepotism in medicine?”. It makes the case that if opposition to DEI is about ensuring standards are met, the same should apply to “legacy” admissions.
This is definitely a question for American medical schools – I hope it is not a question for Australian medical schools.
By the way: I have recently tuned in to watch the TV medical series called The Pitt, which has been much analysed and mostly praised.
One of the medical students in the series is struggling with the issues that come with being a “legacy admission” and having your parent show up to check on how you are performing.
The situation is further complicated because the fearsome specialist doctor mother and the nervous, not very committed daughter are Persons of Colour.
Shingles and dementia
There was some very good news in the recent media around research showing that the vaccine against shingles appears to help protect against dementia.
Vaccine manufacturer GSK has been conducting a very large study in the United Kingdom, using the health data of more than 1.4 million older adults,
This is a unique set of information because a tweak in the UK’s shingles immunisation program means there is effectively a naturally randomised trial already taking place.
This is how it happened: When the UK national vaccine program expanded in 2023, 65-year-olds upwards became eligible for the Shingrix vaccine (previously only people aged 70 and over were eligible). However, those aged 66 and over at the time of the expansion must wait until they turn 70 to be eligible.
This means two large patient groups have been randomly assigned to a distinct vaccination status.
Now some of this research has been published in Nature and has produced some very encouraging results.
This aligns with the results of a 2024 study conducted in the United States which compared the health records of Americans who received the Zostavax shingles vaccine with those who received the Shingrix shingles vaccine when the use of Zostavax was discontinued in 2017 because of waning efficacy in protecting against shingles.
They found that Shingrix is more effective at preventing shingles and was associated with a significant reduction in dementia risk and 17 percent more time before a diagnosis.
Researchers in this area see two main potential biological mechanisms that link the shingles vaccine with reduced dementia risk.
First, the shingles vaccines reduce the risk of reactivations of the varicella-zoster virus, which are associated with increased dementia risk, probably because of the resulting inflammation.
Second, the vaccine itself may have a broader effect in activating the immune system, which may be beneficial to delaying or preventing dementia.
An article published in The Sydney Morning Herald just after the publication of the United Kingdom results reveals that the same team has similar data from Australia, uploaded online but not yet peer reviewed, that shows a two percent reduction in risk of dementia from shingles vaccinations.
How sad then that Grattan Institute research (published here in Croakey) has shown that the uptake of shingles vaccines across Australia is troublingly low, with less than half of people in their 70s protected. And the rates for some communities are much lower.
What is happening with childhood asthma?
Asthma is a major reason for hospitalisations in childhood in both the United States and Australia.
Now comes news that in the US, the incidence of asthma in children has been declining since 2010, along with the number of visits to Emergency Departments and the number of children admitted to hospital for this condition (the original publication is here).
Interestingly, there is evidence that childhood asthma diagnoses declined during the COVID-19 pandemic (a similar result has been found in Japan).
Also, there were large reductions in asthma exacerbations and asthma-related use of emergency services that were attributed to better asthma management rather than restrictions on access to healthcare services.
I went looking for Australian data. There are some statistics here, although some data are quite old. There does not appear to be any decline in either prevalence matching that seen in the US, but hospitalisation rates have declined over the past decade (see this report from the Australia Institute of Health and Welfare, updated November 2024, but some of the data are considerably older).
A 2024 paper highlights concerns with the way childhood asthma is managed in Australia. It cites a 2023 study (of a small number of hospitals) showing that readmission rates for childhood asthma have increased.
It attributes this to poor management: 31 percent of children with asthma did not have an action plan, and the researchers’ analysis revealed poor prescribing patterns,
A Perspectives article published in The Medical Journal of Australia in 2023 is headed ‘Sleepwalking towards more harm from asthma’. The authors find that suboptimal asthma control is prevalent in Australia.
“Current models of care are failing people with asthma, resulting in management that does not align with the evidence clearly articulated in guidelines,” they report.
In case you missed it
There’s always a raft of interesting studies that I never quite find time to analyse in detail. Here are just two you might have missed.
Irritability and social media use
These days, when you see an article headed “Is social media making adults grumpy” – you have to read it!
This is a summary of a paper recently published in JAMA that reports a study of 42,500 American adults which found that frequent users of social media experienced increased levels of irritability, above and beyond that explained by depression or anxiety.
A dose-response pattern was particularly apparent when frequency of posting (ie, active rather than passive engagement) was considered, although the particular pattern and magnitude varied by platform.
Routine eye scans could provide early disease detection
A study led by researchers at the Walter and Eliza Hall Institute has used artificial intelligence technology to analyse over 50,000 eyes and produce detailed maps of the retina to better understand how retinal differences link to various diseases.
It seems that retinal thickness (a marker for the health of the retina, which is intimately connected to the central nervous system) could be used in the early detection of diseases like Type 2 diabetes, dementia and multiple sclerosis.
Good news in Indigenous health
Many years ago, when I was working as a political advisor on health to Julia Gillard, I worked up a proposal for swimming pools in remote Indigenous communities, arguing that pools could provide a focus for physical activity, making sure children knew how to swim and about water safety, and for learning about public health.
My proposal never went anywhere.
So how exciting to read an article in The Sydney Morning Herald highlighting how swimming pools in some of Western Australia’s remote communities have changed lives and improved mental and physical health.
Ear, nose, throat and skin infections have dropped and as a result so has the use of antibiotics. And the No Pool No School policy has boosted school attendances.
The best of Croakey
Another must-read from Dr Louis Peachey:
A good news story
I started this column with some thoughts about how nature can revive us in worrying times. To end this edition of The Health Wrap, here’s a good news story about how humans have revived nature.
Bottle Bend Reserve, which is located on the New South Wales side of the Murray River, on Kureinji and Barkindji Country, was hit hard by the millennium drought.
But regular water flows and hard work by the local community have rejuvenated the ecosystem, which can now support threatened species such as black box trees, curlew sandpipers, the southern bell frog, and golden perch.
Next steps
There will be a hiatus of several weeks for The Health Wrap. I’m off again on my hiking travels – this time to the Atlas Mountains in Morocco and then, via Madrid, to more hiking in Malta.
You can follow my adventures on Bluesky @lrussellwolpe.bsky.social.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here. And see The Hiking Wrap.
