As world leaders gather for the 2022 United Nations Climate Change Conference (COP27) in Sharm el-Sheikh, it’s time to centre the voices of communities whose health, wellbeing and futures have been shattered, ensuring they are at the heart of national climate action plans and debate.

Global heating has sparked the worst health and humanitarian catastrophe in history. Communities experiencing marginalisation as a legacy of historic power structures now face the twin threats of rapid environmental change and a fast-growing burden of non-communicable diseases (NCDs), already the biggest killer of people globally. Rates of injury, cardiovascular and acute and chronic kidney diseases, respiratory illness, and mental health conditions are rising along with temperatures.[1][2]

The impact of climate change is supercharged by the unhealthy and unsustainable environments in which people grow, play, live, learn, travel, and work. The global food system, for example, promotes the consumption of diets high in fats, sugars, and salt and low in diversity, fuelling a pandemic of diabetes, cardiovascular diseases, malnutrition and other NCDs.[3][4] It also plays a significant role in environmental degradation and biodiversity loss, through greenhouse gas emissions, unsustainable water extraction and deforestation.

Unregulated burning of plastic waste - often near communities experiencing poverty who have no option to move - releases harmful chemicals such as Dioxin, exacerbating climate change, polluting the environment, and leading to chronic lung disease, heart disease and cancers. Meanwhile, rising sea levels are increasing the salinity of drinking water in some coastal areas, which may be associated with increased blood pressure, progressive kidney disease and gestational hypertension in pregnant women. And these are just a few examples.

The George Institute for Global Health calls on governments at COP27 to commit to:

1. Centre the voices of communities most affected by the climate crisis in setting policy agendas and allocating resources for mitigation and adaptation measures, prioritising health equity

• Ensure that the Traditional Knowledges of First Nations and Tribal peoples, and the voices of other communities experiencing marginalisation are heard
• Focus on women, girls and other groups who experience the impacts of the climate crisis disproportionately
• Establish mechanisms to ensure the meaningful participation and inclusion of civil society in climate-related policymaking

2. Build effective, equitable and sustainable primary health care systems to reduce and respond to the twin threats of the climate crisis and growing burden of NCDs

• Strengthen the provision of mental health support and other primary health care services to improve psychological resilience and adaptation skills in the wake of environmental damage
• Develop robust digital platforms to monitor and evaluate NCDs and climate threats and generate high-quality data to support decision making
• Reduce the contribution of the health care sector to environmental degradation by researching and implementing low-emission primary health care solutions

3. Challenge commercial actors and rapidly transition away from harmful systems, practices, and commodities, including the use of fossil fuels, to secure co-benefits for the health of people and planet

• Adopt regulatory and fiscal measures to facilitate and promote the production and consumption of low-emission, diverse and healthy food options
• Regulate the burning of plastic waste, improve waste management systems, and hold stakeholders to account for collecting and controlling the waste they create
• Identify alternative water sources for coastal communities vulnerable to rising drinking water salinity; for example, through rainwater harvesting and reverse osmosis

You can learn more about The George Institute’s work to accelerate evidence-informed action on planetary health here.

We were recently awarded funding to establish a NIHR Global Health Research Centre for Non-communicable Diseases and Environmental Change, a partnership between The George Institute for Global Health India and Imperial College London.

We are co-leading the COP2 (Care of People x Planet), Southeast Asia and Western Pacific Regional Hub, a growing community of companies, governments, organisations, and institutions focused on strengthening the human operating systems needed to address climate change.

The George Institute is proud to join the call for a global, fossil fuel non-proliferation treaty and is a signatory of the Global Climate & Health Alliance COP27 Health Community Recommendations.

[1]Climate change may be causing chronic kidney disease by triggering dehydration and heat stress (2016) The George Institute for Global Health. Available at: https://www.georgeinstitute.org/media-releases/climate-change-may-be-causing-chronic-kidney-disease-by-triggering-dehydration-and

[2] Why Mental Health is a priority for action on climate change. World Health Organization (2022) Available at: https://www.who.int/news/item/03-06-2022-why-mental-health-is-a-priority-for-action-on-climate-change.  

[3] Diet and food systems for Health, Climate and Planet (2021) Health Climate Network. Available at: https://epha.org/wp-content/uploads/2021/07/hcn-briefing-1-diet-and-food-systems-final.pdf. 

[4] Centre of Research excellence: Healthy Food, healthy planet, healthy people (2022) The George Institute for Global Health. Available at: https://www.georgeinstitute.org/projects/centre-of-research-excellence-healthy-food-healthy-planet-healthy-people. 

A new study analysing sugar content in Australian beverages shows that a voluntary industry pledge to reduce sugar had little or no impact on companies actually doing so. Decreases were larger among those companies that had not signed the pledge than those that had.

Sugar content in non-alcoholic drinks has gone down by a mere 17 percent over the last five years, despite ample evidence on the health harms associated with eating too much of it. Much of this is driven by the introduction of new low to zero-sugar drinks in the market, rather than companies’ commitment to a non-binding promise.

The paper, co-authored by researchers at The George Institute for Global Health, has been published in the journal Public Health Nutrition.

“Our analysis shows that voluntary initiatives haven’t gone far enough to be able to tangibly reduce sugar content of drinks to the desired extent. The time has come for Australia to consider whether fiscal measures would be appropriate, particularly considering the positive impact the so-called sugar taxes have had in reducing sugar intake in many countries across the globe.,” says lead author Dr Ana-Catarina Pinho-Gomes, Honorary Research Fellow at The George Institute UK.

In Australia, a quarter of children and adolescents and over two thirds of adults are living with overweight or obesity. Poorer households, regional populations and First Nations people, bear most of this burden. Evidence suggests this may be partially explained by excessive sugar intake.

The WHO recommends that people eat no more than 13 teaspoons of free sugars a day to prevent unhealthy weight gain. Free sugars include sugars such as glucose, fructose and table sugar that are added to foods, and sugars naturally present in honey, syrups, fruit juices and concentrates. The average Australian is eating 14 teaspoons a day, with adolescents and young adults consuming far more. More than half of free sugars in the Australian diet derive from beverages including soft drinks, sports and energy drinks, and juices.

This study analysed an average of 1,500 such non-alcoholic beverages sourced from the FoodSwitch database. FoodSwitch is a smartphone app developed by The George Institute that collects and analyses data from packaged food labels. It allows consumers to make better food choices by providing nutrition information on a scanned product and suggesting healthier alternatives to 'switch' to.

The analysis also found that sugar content in sugar sweetened beverages (SSBs) dropped by only 10 percent during the study period - an even smaller reduction than in the non-alcoholic beverages category overall. This could be explained by the introduction of new products with low or no-sugar rather than reformulation of older products to reduce their sugar content.

“There is an inherent conflict between public health and the industry’s profit objective. If we are to curb excessive sugar consumption from soft drinks, we need to move beyond ineffective industry pledges and legislate a tax on SSBs as more than 54 other countries have done,” says co-author Dr Alexandra Jones, Senior Research Fellow at The George Institute.

There is mounting evidence to support the benefits of SSB taxation. A recent systematic review of countries including Mexico, Portugal and the UK, found that taxing SSBs and the resultant price increase brought down demand and consumption considerably.

“The benefits of such taxes are fourfold - they introduce a price signal to consumers that a product is unhealthy; they create disincentives to buy them; they provide profit incentives for manufacturers to reduce sugar content; and they generate revenue that governments can reinvest in public health,” adds Dr Jones.

Modelling by the Australian Medical Association in 2021 suggests that a tax on selected SSBs can reduce sugar consumption from soft drinks a great deal. Earlier studies have shown how this could reduce obesity among men and women over a lifetime.

The WHO supports a taxation of SSBs as a ‘best buy’ policy to reduce sugar intake. Complementary measures like introducing pack size limits, improving information on added sugars on food labels, and setting mandatory targets on sugar content in SSBs, are other important ways to cut sugar intake and, hence, improve population health.

We are delighted to announce that Professor Otavio Berwanger has been appointed Executive Director of The George Institute for Global Health and Chair in Public Health at Imperial College London.

Professor Berwanger will lead The George Institute’s work in partnership with Imperial College London, with its core focus on health systems science, multimorbidity, women’s health, large-scale clinical trials and planetary health. He will also build on his personal research interests in exploring innovative clinical trial models, as well as the conduct of efficient implementation science studies.

“I am honoured to be coming on board as the Executive Director to champion the exciting and unique partnership between two world-class centres of scientific excellence. This partnership will enable us to conduct large-scale, transformative research initiatives that truly address the greatest challenges in health globally”, said Professor Berwanger.

Professor Robyn Norton, Principal Director of The George Institute for Global Health who has been Acting in the Executive Director position said: 

“We have no doubt that in partnership with the UK team and Institute colleagues across all our offices, as well as with colleagues at Imperial College London, Otavio will accelerate the growth and impact of our work in the UK, Latin America and globally and make significant contributions towards our mission to improve the health of millions of people worldwide, especially disadvantaged populations.”

Professor Berwanger joins us from the Academic Research Organization (ARO) of the Albert Einstein Israelite Hospital in São Paulo, Brazil, where he was Director. An esteemed cardiologist and clinical trialist, Professor Berwanger has extensive research and managerial experience and has led large-scale, randomised clinical trials nationally and internationally across countries including Brazil, Australia, New Zealand, Canada, China, Chile, Argentina, Peru and Colombia. Trials led by Professor Berwanger were published in high-impact journals such as the New England Journal of Medicine, Lancet, JAMA and BMJ.

Professor Deborah Ashby, Director of the School of Public Health, Imperial College London, said:

“We are thrilled with Professor Berwanger’s appointment. His international research collaborations and ambitions add to the dynamic and wide-reaching research and policy activity across the School of Public Health. We are looking forward to working closely together and continuing our close collaboration with The George Institute to drive health innovation.”

The George Institute for Global Health, UK embarked on a long-term partnership with Imperial College London in early 2022, building on a successful initial collaboration started in 2020. This relationship is being celebrated with a launch event on November 22nd during which presentations will showcase current and planned research, key experts will consider the future of global health, and Professor Berwanger will outline his vision for our work together.

“Professor Berwanger’s appointment is a celebratory moment in our partnership, as he will help us build on the robust foundations of our research and engagement to drive global health change through recruitment of several new professorial-level positions and expansion of the team’s research, training, leadership and funding opportunities”, said Professor Jonathan Weber, Dean of the Faculty of Medicine, Imperial College London.

Welcome, Otavio!

Prof Craig Anderson, Director of the Global Brain Health Program at The George Institute, has been elected Vice President of the World Stroke Organisation (WSO). Spanning ever global region, WSO is the only international body solely focused on stroke. It represents over 55,000 stroke specialists in clinical, research and community settings.

Prof Anderson is also past President of the Asia Pacific Stroke Organisation and the Stroke Society of Australasia. He has published widely on the clinical and epidemiological aspects of stroke, cardiovascular disease and aged care, and has led several large-scale trials that have had a major influence on clinical practice guidelines for stroke treatment and prevention.

He has recently been awarded MRFF funding for his research project to develop a better tool to predict and guide treatments for people who suffer stroke due to spontaneous bleeding in the brain. This affects several thousand people in Australia each year.

Ahead of World Stroke Day we speak to Prof Anderson about his new position and how brain health can be prioritised as an urgent public health issue the world over.

Congratulations on being elected as World Stroke Organization Vice President. What does the role entail?

I am honoured to have been elected to the Board of WSO. I will work with the President and President-elect, and other members of the Executive team of the Board of WSO.  In our leadership roles, we will guide future development of the organisation and foster its mission in reducing the global burden of stroke through research, advocacy, education, training, and promotion of prevention strategies, effective health care delivery, and the generation of reliable evidence upon which policy recommendations can be made.  There is much to be done but I am very excited and totally committed to working with such a passionate, skilled and cohesive group of people at WSO.

We're marking World Stroke Day this week and the focus is on symptom awareness. What needs to be done to improve public knowledge and awareness about stroke to help reduce disability and save lives?

Despite significant advances being made in awareness of stroke in the community, there are still many gaps in knowledge related to effective risk factor management such as the detection and control of elevated blood pressure, and in seeking rapid assessment and diagnosis in the event of symptoms of acute stroke.  There are many segments of the community who still consider a stroke as part of a heart attack or that symptoms will just 'pass off with time'.  The acronym FAST -'Face', 'Arm', 'Speech', and 'Transfer', is simple and effective messaging but we still need to work more broadly across the community to ensure more people receive highly time-dependent treatments and know that stroke can be prevented.  Statistics indicate reductions in stroke incidence in older age, which is reassuring, but that it is increasing in young and middle aged people, which is worrisome.

The George has recently started a big program of work on Brain Health. What issues is this hoping to address?

The program takes a life-course approach to finding and implementing effective strategies for people to maintain healthy brains. In order to avoid the major diseases of stroke and dementia, we need to examine how to implement effective lifestyles related to diet, exercise, sleep, education and social engagement, at all stages of life.  For those who are at risk of stroke and dementia, or suffer from these terrible conditions, we need to ensure that their recovery and quality of life is as successful as possible.

The burden of stroke, dementia and other issues related to brain health is increasing world over. How can brain health be prioritised as an urgent public health concern?

I think there is an increasing awareness of the importance of brain health from the stories and research we are seeing in relation to the consequences of head injuries among young sportspersons.  We need to make people more aware of brain health as part of everyday activities, starting in schools, continuing into the workplace and community, and among primary health care providers as part of health maintenance as well as direct health care delivery. It is not an easy task but it is possible with a clear plan, patience, multi-stakeholder engagement, and commitment.  Governments are increasingly aware of the economic advantages to countries of a healthy population, and brain health is a critical component of that.