From November 30 to December 12, the Twenty-eighth session of the Conference of the Parties (COP28) in Dubai brought together leaders from around the world to discuss how to limit global temperature rises and adapt to the impacts of climate change. The George Institute for Global Health was among 1,900 health representatives, and called for leaders to centre the voices of communities whose health, well-being and futures have been most impacted, ensuring they are at the heart of national climate action plans and debate.

The inaugural Health Day was a significant milestone, spotlighting the critical connection between climate change and human health, a topic neglected in the past 28 years of COPs. Alongside this event, various high-level gatherings, a two-week World Health Organization (WHO) Health Pavilion, and health installations underscored the urgency of addressing the climate crisis to protect human lives. The engagement of over 50 health ministers in the Climate-Health Ministerial and endorsements from 140+ countries for the United Arab Emirates (UAE) Declaration on Climate and Health showed promise. Many delegates related stories of significant impacts on health arising from the impacts of global warming. The Director General of the WHO, Dr Tedros Adhanom Ghebreyesus, highlighted in several forums that more than 7 million people die every year due to air pollution from the burning of fossil fuels. It was noted that public health gains achieved in the 20th century are being reversed by climate change, with increased incidence of infectious diseases such as malaria and dengue fever of particular concern. While some delegates spoke about the interactions with non-communicable diseases and injuries (NCDIs), it was clear that more work needs to be done to highlight the implications of global heating in this area.

It’s imperative that the commitments made in the Declaration on Climate and Health are translated into action, ensuring sustained attention to Health Day in future COPs and mainstreaming health as pivotal for ambitious climate action in COP and other policy-making spaces, including the forthcoming World Health Assembly in 2024. Although the Declaration acknowledged the link between healthy populations and climate resilience across sectors like food, water, housing, and energy, overall COP28 outcomes fell short. Some high-income countries hesitated to recognise their primary responsibility in reducing emissions and failed to commit to financially support adaptation and mitigate loss and damage in the most impacted regions. One of the positive outcomes of Health Day was the collaborations that are emerging. For example, US $1 billion in funding was announced to kickstart implementation of the health declaration, with contributions from development banks, climate funds and large philanthropic organisations. The WHO in partnership with others has developed a set of financing principles for climate and health initiatives to help support implementation. While the funding is still small relative to the need, it indicates that there is an increasing understanding of the links between climate and health which can be built on in future. In addition, the Australian Government launched its first National Health and Climate Strategy, which highlights the importance of investing in research to improve the evidence base for responses to climate change. We hope to see this translate into funding for implementation.

Encouragingly, the UAE Declaration on Climate and Health emphasises the importance of strengthening health systems to anticipate and implement adaptation measures against climate-sensitive health risks (such as climate-health information services, surveillance, and early warning and response systems). However, we need a more robust emphasis on developing climate risk and vulnerability assessments for high-risk communities and leveraging digital platforms to generate high-quality data for decision-making. Strengthening primary health care services is also crucial, given their role as the primary point of access for many communities, and ability to provide essential mental health support—a critical response to the significant health impacts of the climate crisis.

COP28 celebrated key accomplishments, notably being termed the most 'Inclusive COP.' It introduced the People's Plenary, providing civil society with a formal platform to voice expectations. There were dedicated days focused on the experience of climate impacts by Indigenous peoples and women, and their respective roles in driving community-led climate action. The inclusion of diverse constituencies is a welcome development, but it was noted during discussions that there are still too few of these constituencies represented in the formal negotiations. The first Youth Stocktake offered a comprehensive analysis of youth involvement in climate diplomacy, serving as a blueprint for enhancing their participation in future COPs. Additionally, a $220 million funding package for Africa aimed at improving youth health and an upcoming dialogue in 2024 on the impacts of climate change on children and youth indicated progress in engaging communities in policymaking. These initiatives should set a precedent and be expanded to support other groups experiencing marginalisation, including Indigenous communities.

In contrast to previous conferences, COP28 also prioritised mostly plant-based catering and starting food emissions labelling on certain products, which is a positive development after concerns raised by Coca Cola’s sponsorship of COP27, also described as a “de-facto sponsor of the obesity epidemic causing diabetes and other NCDs”. Our innovative ecoSwitch app aims to support consumers in making healthy and more sustainable choices, using data on the greenhouse gas emissions associated with a product’s ingredients - a key driver of global heating– to assign a planetary health rating and suggest alternative products with a lower environmental impact. Yet notable increase in meat and dairy lobbyists, tripling compared to the previous year to a total of 340, alongside the continued substantial presence of at least 2,456 lobbyists from the fossil fuel industry, remains raises concerns about the potential for undue influence on the outcomes of COP.

The outcomes of the Global Stocktake rightly recognised the substantial contributions of various non-governmental stakeholders toward limiting global warming to 1.5°C. The George Institute in its new capacity as an Official Observer to the UN Framework Convention on Climate Change (UNFCCC) looks forward to engaging even more substantively with the COP in future. Through our emerging Planetary Health Initiative, we will continue to enhance knowledge on and address knowledge gaps in adaptation and availability of information on climate change impacts, including for monitoring and progress –.

Further information:

1. Read Veronica Le Nevez' insights on the COP28 Outcome's inaugural global stocktake, accessible here.
2. Explore the latest Health Policy Watch article titled ‘From Australia to Bangladesh and Beyond: Mobilizing Local Communities Is Key to Breaking Down Climate and Health Silos’, authored by Chhavi Bhandari, Emma Feeny, and Kez Bennett Brook.
3. Discover The George Institute's COP priorities, including our Conference delegation.
4. Explore our Planetary Health Brochure, summarising our initiatives and dedication to advancing evidence-informed action to improve planetary health.

2023 has been another significant and pivotal year for The George Institute for Global Health. Our team has continued to deliver ground-breaking research across our strategic pillars of better care, better treatments and healthier societies. We’ve forged new research partnerships and welcomed new leadership across our offices.

As we look forward to new milestones and achievements in 2024, let's take a look at the stories that captured our readers' attention this year!

Are plant-based meats really better for us than the real thing?

Research led by Maria Shahid found that despite the growing popularity of plant-based meat substitutes, there is very little evidence of the actual health impact of these products.

The team concluded that until more is known about the health impacts of plant-based meat analogues and there are recommendations on how to include them as part of a healthy balanced diet, it's best to eat them in moderation.

Destination for Safety 2024 revealed as Delhi

We were excited to announce that Safety 2024 - the 15th World Conference on Injury Prevention and Safety Promotion - is to be held in Delhi, hosted by The George Institute India.

The theme for Safety 2024 - Emerging Challenges in Injury Prevention: transformation and resilience for a safer world - reflects these aims with a “co-design” and “co-benefit” agenda, encouraging researchers and practitioners to look beyond just injury or violence prevention to inclusive and broader actions which can affect health such as air quality and climate change.

Why is Mongolia the stroke capital of the world and what can be done?

Research in collaboration with the Institute of Medical Sciences in Mongolia found the burden of stroke in Mongolia affects a much younger population compared to high-income countries (HICs). Stroke in Mongolia occur at a mean age of 60 years, which is at least 10 years earlier than the average age in HICs.

Apart from highlighting the age disadvantage, the study also revealed that the incidence of haemorrhagic stroke, which is caused by bleeding into the brain from a ruptured blood vessel. In Mongolia, the incidence of haemorrhagic stroke is several-fold higher than anywhere elsewhere in the world.

New study shows common blood pressure meds under-used for migraine

The first known large-scale review of international studies on the positive effect of blood pressure (BP) medicines across all classes in preventing migraine showed that these common drugs could be used much more widely, at a lower cost, than is the case with current practice.

Results indicated that not all BP medications are equally effective in preventing migraine. The George Institute will soon publish a further review to give more insight into which of the various mechanisms are most effective.

Food industry failing to meet Government’s Health Star Rating targets

In November - a new report found that Australia’s food industry is failing to meet the already low targets for displaying Health Star Ratings (HSRs) on product packaging by a significant margin.

The 2023 State of the Food Supply Report also highlighted how the food industry is preferentially applying HSRs to healthier categories and avoiding showing star ratings on the packaging of low-rating, less healthy items. With HSRs still missing on more than half of all products, consumers are being denied the chance to use this information.

Early Career Fellowship

1. Developing and testing An intervention to promote psYchological wellbeing Among Scheduled TRibe communities in Andhra Pradesh. (DAYARA)

The Scheduled Tribes (constitutional term for tribal communities in India) make up about 8% of the nation’s population. Scheduled Tribe (ST) communities fall below the national average in most socio-economic indicators. There is limited research on the mental health status and needs for ST population. In a previous study done in the same area, about 5% of adult population screened positive for anxiety and depression. Improved psychological wellbeing and promotion of mental health can prevent mental morbidity.

Through this study, Dr Ankita Mukherjee aims to co-create and test feasibility and acceptability of a culturally appropriate peer-led, mental health promotion intervention, for ST communities in Eluru district of Andhra Pradesh. The intervention will use 3 strategies to improve psychological wellbeing (1) competency enhancement (2) arts and culture-based strategies (3) empowering communities to access social entitlements. Peers (Community Champions) will deliver the intervention. A local Expert Advisory Group will advise on design and delivery of the intervention components.

Senior Fellowship

2. PATANG: Promoting community Action for health – a co-produced, Technology-enabled platform to Achieve National Goals

Prior work and scoping done by Dr Devaki Nambiar suggests that six states in particular have evolved Community Action in Health (CAH) exemplars, i.e., Tamil Nadu, Chhattisgarh, Jharkhand, Gujarat, Maharashtra, and Kerala. However, the methods used to evaluate and understand how such initiatives are formed and their impacts are diverse. The scalability, sustainability and cost of these initiatives are also under-studied. Consequently, there is limited knowledge on whether/how to adopt or adapt successful initiatives across contexts or at scale in India, even as in May of 2024, a World Health Assembly resolution on Social Participation for Health is to be tabled.

In this study, Dr Nambiar proposes to co-produce and evaluate PATANG, a co-produced technology-enabled learning platform for CAH, where government and civil society actors may share experience and evidence related to CAH, network and interact with others to adapt and scale up CAH and access practical tools to design and evaluate CAH initiatives.

Four researchers from The George Institute have secured Investigator Grants from the National
Health and Medical Research Council (NHMRC) to help tackle some of biggest causes of death and
disease in Australia and globally.
 

Reviewing gaps in Australian food policy to address diet-linked disease

Unhealthy diets are linked to heart disease, type 2 diabetes, obesity, poor mental health and certain cancers; global growth of these conditions coincides with significant changes in the world’s food supply, particularly the substantial increase in consumption of ultra-processed foods. Ultra-processed foods account for nearly two-thirds (61%) of total energy intake in the average Australian diet – with the highest being in the lowest socioeconomic groups - and are a major public health concern.

There is growing recognition of the need to consider the level of processing, not just the nutrient content alone, when evaluating the overall quality of a food. Globally, decision makers are embracing the NOVA classification system, which groups food products based on how much processing they have been through, when developing nutrition policies to tackle unhealthy diets.
Over the next five years, Dr Daisy Coyle’s research aims to enhance understanding of how food policy can effectively tackle the escalating problem of ultra-processed foods in Australian diets.  The work will evaluate the extent to which Australia’s existing policies and guidelines allow for ultra-processing of foods in comparison with global guidelines and identify how local policies can be improved to improve the health and wellbeing of Australians.
 

Optimising existing safety tech to reduce global road harms

Road traffic injuries kill more than one million people and harm 50 million more every year around the world - despite well-established effective protective measures such as vehicle restraints (seat belts and child restraints), and helmets and protective clothing (for motorcyclists). There is immense scope to reduce this massive burden by ensuring the most appropriate existing safety systems are installed and used correctly. 

There are gaps in understanding of the behavioural influences on how safety systems are being used, and how best to encourage optimal use among road users in low-, middle- and high-income countries. Closing these gaps and delivering scalable interventions are among the greatest challenges in road safety globally.

Dr Julie Brown’s new research will build on ten years of work defining these problems, identifying risk and protective factors and designing prevention measures, to achieve optimal use of safety equipment in the biggest problem areas – restraints for child passengers and for older car occupants; and protective clothing and helmets by motorcyclists. 

Dr Brown will generate fundamental new knowledge about barriers to accurate decision making and behavioural factors for appropriately transitioning to adult seat belts by children aged seven years and over. For older drivers and motorcyclists in Australia and other high-income settings, she will develop and test user-driven behaviour change interventions - a world-first approach. The work will involve partnerships with researchers, governments and industry in rapidly motorising countries to increase uptake of child restraints among young children in China and helmets among motorcyclists in India - two examples of the multi-faceted project.

Dr Brown’s five-year program responds to the need for action globally under United Nations Sustainable Development Goal 3.6 - which calls for a halving of road traffic injuries by 2030 - and the Australian Government’s commitment to work towards zero road traffic injury and fatalities by 2050.
 

Improving population health with SGLT2 inhibitors 

Large clinical trials have demonstrated that a class of medicines called SGLT2 inhibitors, originally developed to treat type 2 diabetes, reduce the risk of cardiovascular disease, delay kidney failure, and extend overall survival in people with heart failure or chronic kidney disease, regardless of whether they have diabetes. 

There is now widespread recognition that optimal uptake of this class of drugs could dramatically reduce the global burden of heart failure and kidney disease, which are among the leading causes of premature death and disability worldwide. 

However, SGLT2 inhibitors remain underused in clinical practice, even in patients who would most benefit. A key reason is the lack of definitive evidence of their effects in specific types of patients, such as those without cardiovascular disease or across different stages of kidney damage. These are questions that cannot be robustly addressed in any individual clinical trial because sample sizes are insufficient.

Dr Brendon Neuen will lead a program to aggregate all the available data from 13 landmark clinical trials of SGLT2 inhibitors, involving over 90,000 patients, allowing the analysis of much larger data sets for different patient sub-groups. 

Dr Neuen will also review data from over 2.7 million people in Australia’s MedicineInsight national primary care database, to better understand real world uptake of SGLT2 inhibitors, variations in their use, and estimate personal and societal level benefits of optimal use of SGLT2 inhibitors. His work will directly inform major international guidelines and implementation strategies for one of the most important cardiometabolic medicines in a generation.

Partnering with Aboriginal Community Controlled Health Services to strengthen health care quality

Internationally recognised for excellence in comprehensive primary health care, the Aboriginal Community Controlled Health Service (ACCHS) sector has been delivering accessible, culturally safe and high-quality care in Australia for over five decades.
 
The National Aboriginal Community Controlled Organisation (NACCHO) and The George Institute are partnering to enhance continuous quality improvement (CQI) support for ACCHSs through the development of novel digital health tools to promote healthy ageing. The project is closely aligned with Close the Gap Priority Reforms and NACCHO strategic priorities.
 
The CQI enhancements will be co-designed following community control principles and result in a suite of clinical decision support apps that incorporate the latest guidelines for management and prevention of chronic conditions. These apps will be interoperable with multiple health record systems to maximise availability to ACCHSs nationally.
 
Prof David Peiris from The George Institute said: “There is good evidence of the benefit of clinical decision support tools in improving health care quality. The challenge is to embed these tools into daily practice so that health professionals and community members can easily access them to make informed health care decisions.”
 
Dr Dawn Casey PSM, Deputy Chief Executive Officer from NACCHO said: “CQI is a critical part of the ACCHO's model of care. It allows services to embed strategies to improve the quality, safety, and efficiency of health care provision. Through this project we have an opportunity to learn from the Aboriginal and Torres Strait Islander health sector’s extensive experience with CQI programs, and to scale up this expertise to enhance the impact of CQI programs.”
 
Once developed, the program will be evaluated to assess its health and economic impacts over three years with the goal of establishing a compelling case for long-term investment by government.