The Health Wrap takes us from a beautiful walking track on the south coast of New South Wales, to ‘climate hushing’ in the United States election, and the “grave injustice” being perpetrated on small island states in this era of rising heat and sea levels.
As Fiji co-hosted the Pre-COP meeting, global health leaders were sounding an alarm about the country’s HIV/AIDS crisis, calling for a harm reduction response, including needle exchange programs.
Also covered are low breast cancer screening rates, mixed progress on preventing cardiovascular disease, and a new study scrutinising how the pharmaceutical industry and the pharmacy sector influence Aboriginal and Torres Strait Islander Peoples’ health and wellbeing.
The quotable?
While some medicines sector initiatives show potential, particularly when driven by Aboriginal leadership and grounded in community control, concerns about tokenistic engagement, structural constraints, conflicts of interest and profit-driven models and the political influence of medicines sector actors can undermine Aboriginal and Torres Strait Islander health priorities and may generate unintended health inequities.”
Lesley Russell writes:
Early spring in coastal New South Wales is starting to look a lot like summer. That may seem wonderful – great for hiking, time at the beach, and gardening. But it also hints at what El Niño may have in store for summer, and the escalating impacts of the wider climate crisis.
Last week we spent a few days at Malua Bay on the NSW south coast and greatly enjoyed hiking a significant part of the Munjip Trail, which runs from Batehaven to Moruya.
It’s a trail, along cliffs and beaches and through forests and seaside towns, that is beautifully cared for. There is also thoughtful acknowledgement of the Indigenous custodians of this land and sea.
The trail follows an ancient saltwater songline that connects people, places, and trade routes along the NSW south coast. For the local Walbunja people, “Munjip” means “walking together, let’s go” in the Dhurga language.
Local artists have contributed murals and artwork along the trail and there are excellent information boards. More information about the trail is here and here.
What’s ahead this Australian summer?
The CSIRO has Australia bracing for a severe, near-record Super El Niño event throughout the 2026–27 summer, with significantly hotter temperatures, heightened heatwave risks, and elevated bushfire dangers across much of the country.
The impact of climate change on health is a familiar topic for Croakey readers who understand the urgent need for action, nationally, with vulnerable Pacific Island nations, and around the globe.
Australia has a National Health and Climate Strategy (although this has not been fully funded). We are now halfway through its five-year implementation. What has been achieved? And is progress proceeding at an appropriate pace?
The 2025 implementation progress report (released in May this year) is here.
Make sure you read this recent article – Health services are facing a killer El Niño without enough support – by my Croakey colleague Marie McInerney.
She provides further information on what has not been done to provide a National Health Adaption Plan (promised for the end of 2024) and guidance for health organisations on climate risk assessment and adaption planning.
Global updates
A report by the Climate Impact Lab at the University of Chicago estimates that some 450,000 people worldwide could die by February as a result of hotter weather caused by the record-breaking El Niño.
Most of these deaths will be in the southern hemisphere, where the El Niño effects coincide with spring and summer. But the impact is expected to persist into the northern hemisphere’s spring, so there will be another wave of deaths there after February.
A similar study estimated that the June heatwave in Europe killed 20,000 people. So far, 35,000 extra deaths in Europe attributable to the heat have been reported over a longer period of the summer.
The University of Chicago study looked only at heat-related deaths. El Niño will also influence wildfires, infectious diseases and flooding.
Meanwhile, climate change is an increasing issue for small Island developing states. This week Australia, Fiji and Tuvalu hosted the Pre-COP meeting, ahead of COP31 in Antalya, Türkiye next month.
The focus for Pre-COP was keeping 1.5°C within reach, accelerating the clean energy transition, elevating the ocean-climate nexus and unlocking finance for vulnerable countries.
As I write this, media reports are critical of Australia’s ability to get the developed nations to this meeting. Only two leaders from nations beyond the Pacific are attending.
Prime Minister Anthony Albanese represented Australia, but New Zealand’s Prime Minister, Christopher Luxon, did not attend as their Government is currently in caretaker mode ahead of the 7 November election.
Former Prime Ministers Julia Gillard and Jacinda Ardern were there. Gillard, in her role as the Chair of the UK Wellcome Trust, spoke about the results of a Wellcome survey showing the impact of extreme heat on the health of pregnant women and newborn babies.
Croakey contributor Isabelle Zhu-Maguire is attending these meetings and will report on them for Croakey.
Ahead of this meeting, The Lancet released the ‘2025 small island developing states report of the Lancet Countdown on health and climate change: building resilience in the face of rising heat’.
The accompanying editorial states: “Small island developing states (SIDS) are among the countries most heavily affected by anthropogenic climate change, but with little sway in global politics and producing less than one percent of global emissions, they find themselves at the mercy of larger and more powerful geographical territories and corporations.”
It concludes that: “Morally, a grave injustice is being done to the health of people in SIDS. If high-income countries only truly commit to lasting action when their nations suffer serious climate events, it will be too late for SIDS, who are the first to be impacted by a dangerously changing planet.”
‘Climate hushing’ and the US election
It’s impossible to escape the fact that important elections are looming in the United States. There’s a lot at stake.
But sadly climate change and its consequences are barely on the radar of campaigning politicians and voters.
The US has just come through its hottest summer on record, almost 60 percent of the lower 48 states are in drought and the powerful El Niño climate pattern brewing in the Pacific Ocean is already influencing extreme weather expected for the northern winter.
But Trump and his Administration are ignoring this. Trump calls climate change “a hoax” and right wing populists are taking aim at climate policies as a liberal elitist project that hurts working-class people.
The Trump Administration is working to eliminate the National Oceanic and Atmospheric Administration (NOAA) research office, the primary scientific arm that studies events like El Niño. NOAA has lost more than 2,000 staff since Trump began his second term.
The Natural Resources Defense Council White House Watch tracks the Trump attacks on the environment, climate and health: it lists at least 560 taken or proposed actions.
As an issue for voters, climate change does not rank high (although related issues like costs of energy do).
Polling from the Yale Program on Climate Change Communication shows that roughly 35 percent of registered voters consider global warming “very important” for the 2026 midterms, while broader tracking indicates around two-thirds of Americans remain worried about the climate crisis.
The Covering Climate Now collaboration’s 89 Percent Project is a year-long global journalistic effort to explore a pivotal but little-known fact about climate change – that the overwhelming majority of the world’s people want governments to take stronger action. “But that fact is not reflected in our news coverage, which helps explain why the 89 percent don’t know that they are the global majority,” says the collaboration.
In response to the stance of Trump and Republicans, Democrats are changing how they talk about climate change, shifting the focus to energy affordability in a move now referred to a “climate hushing”.
Climate hawks, progressive groups like the Sierra Club, and California Governor Gavin Newsom all criticise the quiet approach, arguing that muting the crisis demobilises the progressive base.
But, as a column in The Michigan Daily states: “The reality is that affordability is mutually linked with climate change and pollution. In the 2026 midterm elections, surging support [for Democrats] does not have to come at the expense of strong environmental and emissions policy.
“In fact, over both immediate and distant time horizons, ingraining a strong environmental agenda is a necessary cornerstone to this movement, if the Democratic party is willing to make the leap.”
This month the US Supreme Court convenes for a new session and one of the first cases it will hear is centred on whether Big Oil should pay for climate change. he city of Boulder, Colorado, is hoping its novel lawsuit will be the environmental equivalent of the landmark litigation that produced billions in damages and settlements against Big Tobacco and opioid makers. You can read more here.
Food and Drug Administration update
Will Trump’s nominee to head FDA get congressional approval? The Senate Health, Education, Labor and Pensions (HELP) Committee held a confirmation hearing on 24 September for the nomination of Dr Heidi Overton, Trump’s nominee to be the Commissioner of the US Food & Drug Administration (FDA).
However, the Senate has gone home for the summer recess without a vote on her confirmation which appears to the in trouble.
Her testimony raised concerns about her positions on issues such as vaccines, abortion and tobacco regulation. She would not offer an opinion on Trump’s proposal to split the childhood MMR vaccine into separate shots and also declined to say if she would stand up to the President or Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.
More than 2,500 doctors have signed a letter calling out what they said was Overton’s extreme, anti-scientific positions and urging the Senate to reject her nomination.
The letter said: “The FDA requires a commissioner who will put evidence and patient safety ahead of ideology and political pressure.”
It would take just one Republican to sink Overton’s nomination in committee before it reaches the Senate floor, but lawmakers on the committee won’t vote until after the midterm elections.
Make America Healthy Again summit
The Make America Health Again movement held a summit last week featuring Health Secretary Robert F Kennedy Jr, Dr Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid, and Vice President JD Vance.
There were some pretty shocking pronouncements.
Kennedy engaged in doctor-bashing, saying artificial intelligence (AI) is “much better informed than any doctor in the country” and that AI could free Americans from “medical tyranny”.
He also said that he wants to collect Americans’ health and lifestyle data and feed it to AI so it can search for links between vaccines and health outcomes.
Vance utilised the platform to tout his fraud enforcement efforts, claiming – without producing any evidence – that the Administration’s anti-fraud task force has uncovered close to US$250 billion in fraud within Medicaid, Medicare, and the Affordable Care Act (Obamacare) marketplace. He explicitly blamed this systemic theft on undocumented immigrants.
There is a deepening rift between MAHA and Kennedy supporters and the White House, and the summit captured the tension.
Activists criticised Kennedy for accepting corporate sponsors for the summit, including Walmart, the country’s largest seller of “ultra-processed” foods, and some now say he is not doing enough to hold companies accountable and to ban food additives.
Also MAHA leaders have issued an ultimatum to Kennedy and Trump: take mRNA off the market or lose the support of the health freedom movement.
And some better news to conclude this section: A recent survey from the Annenberg Public Policy Center shows most Americans don’t agree with claims that vaccines cause autism.
More than two-thirds of respondents (68 percent) said it’s false to state that childhood vaccines like those against measles, mumps, and rubella (MMR) cause autism; only 13 percent said that vaccines cause autism and 19 percent weren’t sure. These findings are unchanged since 2022.
HIV/AIDS rages in Fiji
Last month Fiji declared a national health emergency as the country faces the fastest-growing HIV epidemic in the world.
Estimates are that there are upward of 9,000 cases, with two-thirds of those cases in people aged 20 to 34. One in 60 adult Fijians are now living with HIV, with a rising number of babies dying from HIV-related complications.
Health experts report that the surge is heavily driven by unsafe needle sharing and injecting crystal methamphetamine (meth).
Estimates from UNAIDS indicate that only about 39 percent of people living with HIV in Fiji know their status, and just 22 precent are currently accessing antiretroviral treatment.
Fiji is now working to rapidly introduce Pre-Exposure Prophylaxis (PrEP) and peer outreach programs and community-led programming, and integrate HIV care into 15 of the 21 primary healthcare facilities across the country.
However, what is missing from the response is the availability of a needle and syringe program as a central part of a harm reduction program. More information is here and here.
Breast cancer screening
Nine Australians die of breast cancer every day. It is the most commonly diagnosed cancer in Australian women and the second leading cause of cancer death for women, following lung cancer.
While research has transformed breast cancer outcomes (the Australian breast cancer death rate has reduced by more than 40 percent over the past 30 years), this cancer remains a significant challenge to individuals and to the healthcare system.
New survey findings from the National Breast Cancer Foundation (NBCF) show a disconnect between public perceptions and the reality of breast cancer.
The survey found that 64 percent of people under-estimated the number of people diagnosed each year, 84 percent under-estimated the likelihood of recurrence and spread, and 51 percent underestimated the number of Australians who die from breast cancer each day.
“When people underestimate the seriousness of breast cancer, they may also underestimate the importance of breast awareness, screening and seeking medical advice about breast changes,” says Dr Cleola Anderiesz, chief executive of the NBCF.
The release of these survey findings coincided with the release of the BreastScreen Australia monitoring report 2026 from the Australian Institute of Health and Welfare.
This shows that in 2023-2024, only 52.4 percent of women aged 50 to 74 years (the target population for the screening program) were screened.
Preliminary data for 2024-2025 show participation in the target age group edging down to 51.6 percent. That means the program is yet to regain the participation levels seen before the COVID-19 pandemic (53 – 54 percent).
Participation declines with rurality and with whether English is spoken at home and is particularly low for Indigenous women (37.5 percent).
While the gap with non-Indigenous women is narrowing, and lower participation could reflect reduced opportunities to screen and under-reporting of participants’ Indigenous status (this is self-reported by women attending BreastScreen), it is concerning because there are poorer breast cancer mortality outcomes among Indigenous women.
Green alternatives in healthcare
A recent article in The Sydney Morning Herald caught my eye: NSW health workers are querying the decision of the Clinical Excellence Commission (the state’s health safety agency ) to ban hospitals from using eco-friendly medical supplies in favour of single-use products that end up in landfill and cost taxpayers millions of dollars each year.
Clinicians are accusing the Clinical Excellence Commission (CEC) of siding with a multibillion-dollar manufacturer of disposable medical devices that would lose money if sustainable products were widely adopted.
The stoush revolves around remanufactured materials, which are formerly single-use items that are reprocessed into new products, including patient transfer mattresses, compression sleeves, tourniquets and blood pressure cuffs.
These have been approved by the Therapeutic Goods Administration (TGA) and are used in every other state and territory.
The CEC has expressed concern about infection control, traceability issues, a risk of expansion into more critical care items, and the potential for the materials to mislead doctors and patients.
It seems that one of the largest (and most profitable) suppliers of medical devices in Australia has lobbied effectively against the recycling company that collects discarded medical products for recycling. This company supplies their recycled products to more than 170 hospitals across Australia and New Zealand.
The TGA is currently developing guidance documents on the therapeutic goods regulatory requirements for reprocessing and remanufacturing of medical devices, presumably in response to this issue.
This does raise the issue of how to ensure that healthcare services, especially hospitals, are as environmentally sustainable as possible.
Back in 2015 I co-authored a paper published in The Medical Journal of Australia that explored this.
My research shows that since then some clinical organisations have worked to develop sustainability guidelines.
See for example:
- Australian Commission on Quality and Safety in Health Care, 2022. A review of sustainable healthcare.
- Australasian College for Emergency Medicine, 2024. Environmental sustainability practices in emergency departments.
- Australian College of Nursing, 2026. Sustainable healthcare in action: Six practice changes that make a difference.
Mixed progress on preventing heart disease
Cardiovascular conditions remain a leading cause of death globally, so prevention and early intervention approaches are key mechanisms to improve health outcomes.
Effect of statins on healthy ageing
The first results from the Statins in Reducing Events in the Elderly (STAREE) trial, conducted by universities across Australia, have just been published.
This is the first randomised controlled trial of statin therapy in an apparently healthy cohort of older adults living independently in the community. It aims to provide the evidence required to determine whether statin therapy should be taken routinely by healthy people aged 70 years and over.
The findings, published in The New England Journal of Medicine, found that daily use of atorvastatin (40 mg) reduces major cardiovascular events by 30 percent in healthy adults aged 70 and older without prior heart disease, diabetes, or dementia. Serious adverse side effects were rare.
Statin therapy did not significantly change overall disability-free survival, meaning it reduced heart attacks and strokes but did not extend survival free of physical disability or dementia.
Promising heart drug fails
The shocking failure of a clinical trial of a drug targeting inflammation has experts questioning whether inflammation really does cause heart disease.
The study called ZEUS looked at how Ziltivekimab (a Novo Nordisk drug) works compared to placebo in people with cardiovascular disease and chronic kidney disease. The trial evaluated the drug versus placebo for reducing the risk of cardiovascular death, non-fatal heart attack or non-fatal stroke.
This drug targets inflammation, which is generally thought to be a cause of atherosclerosis, and these patients had inflammation as measured by the high levels in their blood of a marker of inflammation known as C reactive protein, or CRP. And they had high levels of interleukin-6, or il-6, a chemical that causes inflammation.
The drug did what it was supposed to do. It made il-6 levels plunge and CRP levels fell in concert.
With those indications that inflammation was controlled, it seemed only logical that heart disease complications and cardiovascular death rates would drop, too. But that didn’t happen.
The Novo Nordisk statement about the findings is here.
Now the drug’s failure is raising a troubling question. Is inflammation really a cause or is it just a marker of atherosclerosis?
More on mosquitoes
As a follow-up to the section on mosquito-borne diseases and climate change in the previous edition of The Health Wrap: A review just published from scientists at Monash University examines how climate change is differently affecting mosquito-borne infectious diseases such as malaria and dengue.
And President Trump has just signed an Executive Order directing federal agencies to develop a plan to reduce mosquito (and tick) populations across the District of Columbia by 90 percent by 2028.
It will be interesting to see if Trump follows through on this and how successful his orders will be.
Washington has a long history with malaria-carrying mosquitoes tied to its marshy lowlands in the areas near the National Mall and Tidal Basin. Famous sufferers of malaria included George Washington, Abraham Lincoln, and Ulysses S Grant. You can read more history here.
In case you missed it
Ebola cases continue to rise
The number of confirmed Ebola cases in Democratic Republic of Congo has reached 8,300 across seven provinces, with 4,018 deaths, as the worst epidemic in the country’s history resists containment efforts.
The United Nations reports that a camp housing a centre for Ebola-infected patients was burned last week by soldiers looking for weapons. This forced 19,000 people to flee the camp, meaning a further spread of disease.
Also on this topic: a recent edition of The New England Journal of Medicine had a thoughtful and interesting article titled Grief as a Vector for Disease that highlights how, when public health measures conflict with cultural, relational, and emotional practices surrounding severe illness and death, they may lead to uprisings that increase the risk of infection spread.
Rural areas deprived of research funding
A joint analysis (the first of its kind) of National Health and Medical Research (NHMRC) and Medical Research Future Fund funding shows that institutions headquartered in rural and remote Australia received just 0.5 percent (17 grants totalling $34.7 million) of the almost $6.5 billion that was distributed between 2021-22 and 2024-25.
Note that this funding may not necessarily reflect the actual locations where research is being conducted.
However, as pointed out by Professor Sarah Chalmers, president of Rural Doctors Association of Australia, sustained investment is needed in local research infrastructure and staff so rural and remote institutions can better compete for funding.
“University departments of rural health in places such as Alice Springs, Mount Isa and Broome show the value of having research capability based in rural and remote communities,” she said. “We should be looking at how to build more of that capability across the country.”
Study shows millions of cancers are linked to infections
A paper from the International Agency for Research on Cancer published in The Lancet finds that infections were responsible for 2.3 million new cancer cases in 2024 (12 percent of global cases that year).
Helicobacter pylori (linked to 760,000 cases, predominantly of gastric cancer, with most of these in East Asia) is the leading infectious cause of cancer.
Other significant drivers of infectious cancer were human papillomavirus (HPV) (750,000 cancer cases, predominantly cervical cancer), hepatitis B virus (HBV) (360,000 cases, predominantly liver cancer), Epstein-Barr virus (260,000 cases, predominantly of nasopharyngeal cancer, gastric cancer, and Hodgkin lymphoma), and hepatitis C (HCV) virus (160,000 cases, predominantly liver cancer).
Four of the five leading infectious causes have highly effective prevention measures: vaccinations for hepatitis and HPV, testing and treatment for H. pylori, HBV, HCV, and HIV, and cervical screening programs. You can read more here and here.
Evidence in age of enshittification
How could I not stop to read an article in The Mandarin with this title?
This was a summary of former Chief Scientist Dr Cathy Foley’s survival guide – six questions for policymakers struggling to make sense of the evidence around them.
“The real world rarely presents you with a neat folder marked ‘the evidence’, containing the answer,” she said. “The capability we need is not simply finding information. It is deciding what deserves confidence.”
Here are the six questions she proposes for public servants to use to orient themselves and evaluate evidence:
- What exactly is the claim?
- Where did the evidence come from?
- Is the method fit for the question?
- What does the wider body of evidence say?
- What don’t we know?
- Is this evidence fit for the decision we have to make?
“You can have excellent science answering the wrong policy question. Even scientists don’t always appreciate that,” she said.
And then she added something that will resonate with all political staffers: “And there is another problem. All of this sounds wonderful until a Minister asks for an answer by Friday.”
Sector under scrutiny on Indigenous health
A newly published study from Deakin University, led by Indigenous academics, uses a yarning perspective to look at the systems, practices and pathways through which the pharmaceutical industry and the pharmacy sector may influence Aboriginal and Torres Strait Islander health and wellbeing.
This is a substantial paper with some key findings, including the following:
- Political, economic, and regulatory settings across the medicines supply chain tend to favour commercial interests over the priorities of Aboriginal organisations and communities.
- Indigenous knowledges remain poorly recognised in current medicines policy and western regulatory systems.
- There is a system-level misalignment between pharmacy sector service models and ACCHO sector priorities. Pharmacy Guild policy positions are often at odds with ACCHO priorities, including efforts to embed dispensaries and pharmacists into ACCHO primary health care teams.
- The pharmaceutical industry and the pharmacy sector employ corporate social responsibility practices to engage with Aboriginal and Torres Strait Islander peoples but these are seen by participants as “tokenistic and transactional, operating as a pseudo-benevolent marketing exercises with vague commitments and weak accountability”.
- The political influence of medicines sector actors can undermine Aboriginal and Torres Strait Islander health priorities and may generate unintended health inequities.
The authors conclude: “Our findings reveal how systems and practices within the medicines sector shape access to medicines, Indigenous cultural and intellectual property rights, pharmacy services, and culturally safe care and therefore have the potential to both promote health and to exacerbate inequities.
“While some medicines sector initiatives show potential, particularly when driven by Aboriginal leadership and grounded in community control, concerns about tokenistic engagement, structural constraints, conflicts of interest and profit-driven models and the political influence of medicines sector actors can undermine Aboriginal and Torres Strait Islander health priorities and may generate unintended health inequities.”
[COI statement: I was a participant in this study.]Best of Croakey
Make sure you take time to read Growing healthy together – when medical students swap lecture theatres for community gardens, written by Associate Professor Keith McNaught who is at Curtin Medical School’s Kalgoorlie campus.
McNaught elegantly and passionately makes the case for medical schools to build environmental literacy into clinical training.
Good news
As those of us who live in the Australian Capital Territory and parts of New South Wales and Victoria know, this is bogong moth season.
And there’s reason to be glad that there are so many fluttering around our outside light in the evenings and hiding in the curtains during the day: after a catastrophic decline, the moths are back in great numbers!
After drought struck much of their lowland breeding areas, bogong moth numbers collapsed by more than 99 percent between 2017 and 2019, causing them to be listed as endangered in 2021.
The impact of this was profound. The moths’ migration serves to pollinate native vegetation, as food for birds and mammals (especially the critically endangered mountain pygmy possums), and as a huge transfer of protein and nutrients into the delicate ecosystems of the high country.
News of the recovery of the bogong moths even made The New York Times (read the article here) and First Dog on the Moon in The Guardian did a great picture story (here).
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.
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