The George Institute for Global Health has made a submission to the Australian Government’s Department of Health Public Consultation on the Healthy Food Partnership Voluntary Industry Best Practice Guide for Serving Sizes. The submission argues that the guidelines in their current form are not ‘best practice’ as they lack many important features that help to ensure they’re effective, such as:

• clear timeframes for implementation;
• plans for independent and transparent reporting on the uptake of the serving size guidelines; and
• details of monitoring and evaluation initiatives to assess the impact of the serving size guidelines on the food supply and on Australian diets.

Daisy Coyle, Dietitian and Research Fellow at The George Institute, said while setting portion and serving size goals may help reduce rates of diet-related diseases, they need to be properly developed and implemented to result in any meaningful change.

“We agree with colleagues at the Cancer Council and Heart Foundation that portion guidance and serving size goals are good for public health, but more work is needed to encourage food companies to reduce the size of their products,” she said.

“Our research on how the Government’s previous Food and Health Dialogue initiative performed, and our modelling work on the likely impact of its successor, the Healthy Food Partnership, indicate it’s unlikely these serving size goals will have a significant impact. This is concerning given many of the so-called discretionary foods included in the portion size guidelines are not subject to the government’s reformulation targets despite being high contributors to total sodium, added sugar and saturated fat intakes,” Daisy added. “Also, these guidelines are voluntary, which further limits their potential to significantly improve the health of Australians.”

While having national portion guidance and serving size goals is important for public health, The George Institute submission raises concerns that the proposed serving size guidelines  will not reduce intakes of excess kilojoules, sodium, added sugars and saturated fat enough to ease the burden of diet-related disease in Australia.

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.

The George Institute for Global Health made a submission to the inquiry on definitions of meat and other animal products by the Senate Rural and Regional Affairs and Transport Legislation Committee. Our submission made several observations and recommendations to the committee, noting that in Australia over recent decades, the consumption of meat has decreased and meat alternatives have increased, such as plant-based and synthetic protein products.

The George Institute believes more research should be undertaken to better understand the impact of product labelling by manufactured plant-based or synthetic protein brands on sales of meat products. We support the continued use of meat-based descriptors for plant-based or synthetic protein products, and recommend regulatory improvements including a requirement that meat-based descriptors can only be used if the label also clearly states that it is a meat-free product.

We understand manufactured plant-based or synthetic protein products may have immediate and long-term social and economic impacts on primary industries, such as livestock producers and individuals across regional, rural and remote areas. We believe there is opportunity for primary industries to increase farming and agriculture practices towards ingredients found in plant-based meat alternatives to reduce reliance on imported ingredients.

Research by The George Institute shows heavily manufactured protein products can be high in sodium. These products are also ultra-processed, potentially linking them to higher rates of obesity, high blood pressure and heart disease. However, The George Institute notes there is little research into the specific links between manufactured protein products and health outcomes. On the other hand, meat products continued to be consumed in excess in Australia. Reducing population intakes of meat, in particular processed meat, is important for improving the health of Australians. These manufactured plant-based or synthetic protein products can provide variety and nutritional support for people who follow a vegetarian or vegan diet or those looking to reduce their meat intake for health, environmental, ethical or financial reasons.

We believe placement of manufactured plant-based or synthetic protein products in retail settings, such as supermarkets, could also have an impact on the Australian meat category brand investment. We recommend that the placement of these products in the retail environment should be considered as a factor when setting policies around these products.

The George Institute believes the impact of meat on planetary health should be considered within this inquiry due to the major contribution of meat consumption to global warming. The George Institute’s FoodSwitch app, a mobile app that provides simple nutrition information on a scanned product and suggesting healthier alternatives to 'switch' to, now includes a ‘Planetary Heath Rating’. This rating reveals the greenhouse gas emissions of different categories of foods and beverages in an easy-to-interpret ‘star rating’ (based on the current Health Star Rating System). This information will further empower consumers to make better choices when they shop.

The George Institute for Global Health responded to the draft recommendations from the Primary Health Reform Steering Group on the Australian Government’s Primary Health Care 10 Year Plan.

We believe primary health care should be at the heart of the Australian health system. It needs to be of high value, integrated, equitable and patient-centred. It should be readily available and accessible for people across their life course, responding to acute needs at critical life stages and proactive in the intervening periods to promote health and well-being.

As the report acknowledges, in Australia there is a growing burden on individuals in the health system with chronic conditions, with many conditions largely preventable. The current system is not “fit for purpose” and a business-as-usual approach to primary health care is not an option.

The COVID-19 pandemic has demonstrated the importance of primary health care, and its need to be innovative, agile and better prepared to ensure safe and secure connectivity between individuals, their families and the primary health care workforce. Although the pandemic has exposed many of our health system weaknesses, it has also highlighted extraordinary potential to rapidly address those weaknesses. What previously was thought to be a decades long process has been achieved in months. The momentum gained from such agility must not be lost and we strongly believe this mindset needs to be at the core of the proposed primary health care reforms.

In responding to the recommendations by the Primary Health Reform Steering Group, The George Institute believes there is an opportunity to establish an Australian Primary Health Care Innovation and Translation Institute. This would be similar to the United States Center for Medicare and Medicaid Innovation, which is a government-led innovation initiative that is continuously developing and testing new service delivery models and has a mandate to scale and spread the most promising innovations nationally.

We look forward to the final report to the Minister for Health, Hon Greg Hunt MP, followed by action by the Federal Government

Waste workers include government-employed sanitation workers; privately contracted door-to-door garbage collectors; and waste pickers who work in the informal sector. India has over 5 million sanitation workers. While there are no official data on the number of persons engaged in waste picking in India, it is estimated at up to 1.5 million persons, which is approximately 10 percent of the global waste picker community. A waste picker is “a person or groups of persons informally engaged in collection and recovery of reusable and recyclable solid waste from the source of waste generation - the streets, bins, material recovery facilities, processing and waste disposal facilities for sale to recyclers directly or through intermediaries to earn their livelihood.” Waste pickers in informal employment collect over 80 percent of the total recyclable waste, contributing significantly to savings for the government, and to environmental health. 

Access to health care and good quality health services is severely iniquitous, with marginalised and historically oppressed communities, such as waste pickers, facing numerous impediments to the attainment of health and well-being. Their experiences of health inequity and precarity are shaped by intersectional vulnerabilities, stemming from caste, class, gender, region of origin, mother- tongue, religion, religion, degree of formality of employment, nature of occupational (e.g., picking, sorting, or selling waste) and place and conditions of residence.

Waste pickers are exposed to various occupational hazards, physical, chemical, and biological, and encounter numerous impediments to the attainment of optimal health and well-being, in access to information; strategies for disease prevention, management, and rehabilitation; economic and social security; and opportunities for health promotion and recreation.

The Accountability for Informal Urban Equity Hub (ARISE) at The George Institute for Global Health, India (TGI) engaged in a policy content review, participant-observation, in-depth interviews, focus group discussions, and community meetings with waste workers at the ARISE project sites, and present the following recommendations for policy and research.  

Recommendations for policy

1. Health and well-being interventions need to be tailored to the specific needs of waste pickers, particularly informal workers. 
2. Waste workers need to be recognised as an occupational community engaged in diverse activities related to cleaning, collection, sorting, processing, and sale of discarded materials. 
3. The ability to access services needs to be delinked from specific documentation, and assistance with obtaining documentation needs to be provided to waste workers. 

Recommendations for research

1. The lives, livelihoods, occupational and social security of waste picker communities need to be explored, ideally through participatory research. 
2. The health conditions, occupational hazards, practices for health promotion, disease prevention and management, recreation, and recourse to health care among waste picker communities need to be understood and documented, and effective interventions designed for improvements in their health and well-being.

Contact Josyula K Lakshmi (jlakshmi@georgeinstitute.org.in) or Shrutika Murthy (smurthy@georgeinstitute.org.in) for more details or clarification.

Executive Summary: Snakes are often killed at sight, even if not venomous. Social and cultural connotations, some more negative than others, and fear of snakebite shape our attitudes towards snakes and lead to human snake conflict. But snakes play an important role in our ecosystem and provides us economic and therapeutic benefits. It is high time we now start valuing the importance of snakes in biodiversity to make our societies healthier.

Snakes, as serpent deities are revered in various cultures - as a symbol of fertility, rebirth, afterlife, medicine, healing and prosperity.[1-4] Paradoxically, in communities, they are also considered as a threat to life and livelihood. Ophidiophobia, the fear of the snakes, is one of the most common phobias of animals (affecting 2-3% human population).[5, 6] Snakes are often killed on sight, for fear of snakebite.

Globally, up to 138,000 people die due to snakebite every year with nearly 2.7 million people suffering serious injuries and permanent disabilities.[7] However, about 85-90% of snakes species worldwide are non-venomous.[8] Most snakes are not aggressive in nature, and often bite in defence, or when threatened or provoked.[9] Killing snakes for fear of snakebites is problematic – as decreased snake population is detrimental not only for the environment but also for humans. Snakes serve critical role as predators, as preys, as ecosystem engineers, and provide economic and therapeutic benefits to humans (Figure 1).

Snakes as predators, feed on frogs, insects, rats, mice, and other rodents, helping to keep prey population under control. Snakes are also eaten by other species - thus playing a key role in the food-chain as prey. Skunks, mongooses, wild boars, hawks, snake eagles, falcons, and even some snake-species are Ophiophagus, i.e. species who feed on snakes as their primary diet.[10-12] The king cobra (Ophiophagus hannah), eastern king snake (Lampropeltis getula), black-headed python (Aspidites  melanocephalus), eastern indigo snake (Drymarchon couperi) are some ophiophagus snakes.[13-15] Declining snake population not only effects ophiophagus species, but has effects across many trophic levels. A disrupted ecosystem in the context of climate change, an increased probability of natural disasters has the potential to cause massive loss of life and livelihood.[16-18] The declining population of snakes has been documented globally.[19] 

Snakes as ‘ecosystem-engineers’ facilitate ‘secondary seed dispersal’, thus contributing to reproduction of plants.[20-22] When snakes swallow rodents (who consume seeds), the seeds are expelled through excretion into the environment in an intact manner. As snakes have larger home ranges than rodents, seeds tend to disperse at greater distances from the parent plant.[23] This mechanism supports growth and survival of plant species without struggling for common resources of light, water, and soil nutrients and hence essential for biodiversity and ecological restoration.[24]  

Snakes also play a role in disease prevention and provide benefits to agricultural communities. Rodents are carriers of many zoonotic diseases (like Lyme disease, leptospirosis, leishmaniasis, hantavirus) which affects humans, dogs, cattle, sheep, and other domestic animals.[25-28]. A sudden increase in rodent population might lead to zoonotic diseases outbreaks.[29]. Increase in population of rodents leads to loss of crops.[30] By eating rodents, snakes keep the population of rodents under control, thus preventing zoonotic disease transmission, and contributing to food security.[31] Estimates suggest that nearly 200 million people can be fed by food grains that are destroyed by rodents every year.[30] Offering natural, environmental-friendly, and free service to mitigate against rodents, snakes are truly “farmer’s friends”.[32] 

Snakes are also a source of many medicines. The only proven and effective therapy for snakebite - the snake-anti venom, is also derived from snake venoms.[33] Snake venom is injected into horses and sheep. The animals’ plasma with antibodies against the venom is collected and purified to produce the life-saving, snake anti-venom. [34] Snake venom has therapeutic value beyond anti-venom production. Many drugs derived from snake venoms are used in clinical practice (Table 1). [35-38] However, the therapeutic potential of snake venoms remains unexplored. Venom researchers continue to discover and investigate many more compounds. 

With the effects of climate change now evident, it is time now to start valuing the importance of biodiversity in making our societies healthier. Let’s save the snakes! 

Table 1: Snake venom derived drugs which are approved for clinical use [35-39]
 

Author contributions

Conceptualisation - SB and DB; Writing original draft – DB; Writing- review and editing – SB, DB; Guarantor – SB and DB

Acknowledgement 

The authors acknowledge feedback received from Maarinke van der Meulen and Jagnoor Jagnoor from The George Institute for Global Health.

Publication Note 

The working paper is a part of a deep-thinking report on snakebite. 

Suggested Citation 

Beri D, Bhaumik S. - Snakes, the ecosystem, and us: it’s time we change. The George Institute of Global Health. July 2021. Available online at www.georgeinstitute.org. The article is licensed under CC BY-NC 2.0. 

References  

1. Antoniou, S.A., et al., The rod and the serpent: history's ultimate healing symbol. World J Surg, 2011. 35(1): p. 217-21.
2. Behjati-Ardakani, Z., et al., An Evaluation of the Historical Importance of Fertility and Its Reflection in Ancient Mythology. Journal of reproduction & infertility, 2016. 17(1): p. 2-9.
3. Bird, S.R., "Australian Aborigines". In William M. Clements (ed.), in The Greenwood Encyclopedia of World Folklore and Folklife. 2006 Greenwood Press: Westport, CT. p. 292–299.
4. Mundkur, B., The Roots of Ophidian Symbolism. Journal of the society for Psychological Anthropology, 1978. 6(3): p. 125-158.
5. Ceríaco, L.M., Human attitudes towards herpetofauna: the influence of folklore and negative values on the conservation of amphibians and reptiles in Portugal. J Ethnobiol Ethnomed, 2012. 8(8).
6. Polák J, et al., Faster detection of snake and spider phobia: revisited. Heliyon, 2020. 6(5): p. e03968.
7. World Health Organization, Factsheet: Snakebite envenoming. 2021: p. Cited 15 June 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming.
8. Meyers, S.E. and P. Tadi, Snake Toxicity. [Updated 2021 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021: p. Cited May 27, 2021. Available from: Available from: https://www.ncbi.nlm.nih.gov/books/NBK557565/.
9. Coelho, C.M., et al., Are Humans Prepared to Detect, Fear, and Avoid Snakes? The Mismatch Between Laboratory and Ecological Evidence. Frontiers in psychology, 2019. 10: p. 2094-2094.
10. Animal Hype, What Animals Eat Snakes? (A List Of Snake Predators). 2021(Cited May 31, 2021. Available from: https://animalhype.com/facts/what-animals-eat-snakes/).
11. Dykstra, J., What animals eat snakes? Grunge 2019. Cited May 31, 2021. Available from: https://www.grunge.com/161123/what-animals-eat-snakes/.
12. Zainal Abidin, S.A., et al., Malaysian Cobra Venom: A Potential Source of Anti-Cancer Therapeutic Agents. Toxins, 2019. 11(2): p. 75.
13. Jackson, K., N.J. Kley, and E.L. Brainerd, How snakes eat snakes: the biomechanical challenges of ophiophagy for the California kingsnake, Lampropeltis getula californiae (Serpentes: Colubridae). Zoology (Jena), 2004. 107(3): p. 191-200.
14. McCracken, J., Aspidites melanocephalus - Black-headed Python. Animal Diversity Web, 2020 (Cited May 31, 2021. Available from: https://animaldiversity.org/accounts/Aspidites_melanocephalus/).
15. Oddly cute pets, What Snake Eats Other Snakes? 2019 (Cited May 31, 2021. Available from: https://oddlycutepets.com/what-snake-eats-other-snakes/).
16. World Health Organization, Factsheet: Biodiversity and Health. 2015(Available from: https://www.who.int/news-room/fact-sheets/detail/biodiversity-and-health).
17. Pyšek, P., et al., Scientists' warning on invasive alien species. Biol Rev Camb Philos Soc, 2020. 95(6): p. 1511-1534.
18. Adebayo, O., Loss of Biodiversity: The Burgeoning Threat to Human Health. Annals of Ibadan postgraduate medicine, 2019. 17(1): p. 1-3.
19. Reading, C.J., et al., Are snake populations in widespread decline? Biology letters, 2010. 6(6): p. 777-780.
20. Hämäläinen, A., et al., The ecological significance of secondary seed dispersal by carnivores. 2017. 8(2): p. e01685.
21. Glaser, L.B., Snakes act as 'ecosystem engineers' in seed dispersal. Cornell Chronicle, 2018 (Cited May 21, 2021. Available from: https://news.cornell.edu/stories/2018/02/snakes-act-ecosystem-engineers-seed-dispersal ).
22. Sunyer, P., et al., The ecology of seed dispersal by small rodents: a role for predator and conspecific scents. 2013. 27(6): p. 1313-1321.
23. Hasik, A., Snakes spreading seeds. Ecology for the masses, 2018(Cited May 31, 2021. Available from: https://ecologyforthemasses.com/2018/08/16/snakes-spreading-seeds/).
24. Ruxton, G.D. and H.M. Schaefer, The conservation physiology of seed dispersal. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 2012. 367(1596): p. 1708-1718.
25. Moola, S., et al., Leptospirosis prevalence and risk factors in India: Evidence gap maps. 0(0): p. 00494755211005203.
26. Centers for Disease Control and Prevention, Rodents. 2010: p. Accessed 03 April 2021. Available from: https://www.cdc.gov/rodents/index.html.
27. Himsworth, C.G., et al., Rats, cities, people, and pathogens: a systematic review and narrative synthesis of literature regarding the ecology of rat-associated zoonoses in urban centers. Vector Borne Zoonotic Dis, 2013. 13(6): p. 349-59.
28. Rabiee, M.H., et al., Rodent-borne diseases and their public health importance in Iran. PLoS neglected tropical diseases, 2018. 12(4): p. e0006256-e0006256.
29. Miller, J., A World Without Snakes. In Forestry and Wildlife. 2020 (Cited June 02, 2021. Available from: https://www.aces.edu/blog/topics/forestry-wildlife/a-world-without-snakes/).
30. Singleton, G.R., et al., Impacts of rodent outbreaks on food security in Asia. Wildlife Research, 2010. 37(5): p. 355-359.
31. Jowit, J. and A. Searle, Snake numbers ‘in decline'. The Hindu, 2010 (Cited June 02, 2021. Available from: https://www.thehindu.com/opinion/op-ed/Snake-numbers-lsquoin-decline/article16242431.ece).
32. Save The Snakes, Why Snakes? 2021(Cited May 31, 2021. Available from: https://savethesnakes.org/s/why-snakes/).
33. Ferraz, C.R., et al., Multifunctional Toxins in Snake Venoms and Therapeutic Implications: From Pain to Hemorrhage and Necrosis. 2019. 7(218).
34. World Health Organization, Snakebite envenoming. 2021 (Cited May 31, 2021. Available from: https://www.who.int/snakebites/antivenoms/en/).
35. Bansal AB, Sattar Y, and Jamil RT, Eptifibatide. [Updated 2020 Nov 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021: p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541066/.
36. Bordon, K.d.C.F., et al., From Animal Poisons and Venoms to Medicines: Achievements, Challenges and Perspectives in Drug Discovery. 2020. 11(1132).
37. Mohamed Abd El-Aziz, T., A. Garcia Soares, and J.D. Stockand, Snake Venoms in Drug Discovery: Valuable Therapeutic Tools for Life Saving. Toxins, 2019. 11(10): p. 564.
38. Péterfi, O., et al., Hypotensive Snake Venom Components-A Mini-Review. Molecules (Basel, Switzerland), 2019. 24(15): p. 2778.
39. Takacs, Z. and S. Nathan, Animal Venoms in Medicine, in Encyclopedia of Toxicology (Third Edition), P. Wexler, Editor. 2014, Academic Press: Oxford. p. 252-259.

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.

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.

The George Institute has contributed to the public consultation of Policy Guidance for Menu Labelling in Australia and New Zealand. The consultation was set by Food Standards Australia New Zealand in response to ongoing concerns about inconsistency in national menu labelling regulations. Inconsistency of menu labelling can impact consumers’ ability to select healthier food choices.

The George Institute has previously suggested and continues to recommend the following reforms in menu labelling:

• Extend menu labelling to vending machines.
• Close known loopholes in legibility requirements in some jurisdictions.
• Ensure legislation is sufficiently flexible to accommodate new opportunities created by digital menus, self-service kiosks and online ordering systems, including those operated by third party delivery agents.
• Extend labelling requirements to incorporate interpretive elements such as the Health Star Rating.
• Invest in robust monitoring and evaluation, examining outcomes on both consumer behaviour and food business reformulation.

Improve synergies between menu labelling activities, the Healthy Food Partnership, and the Health Star Rating System to maximise their combined public health impact.