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Women live longer than men, however, despite this, women experience poorer health outcomes including higher rates of morbidity and disability.2 This disparity has been attributed to, at least in part, societal gender inequalities such as the employment and pay gap, making women more likely to have a lower socioeconomic status than men.2 Lower socioeconomic status (SES) and lower educational attainment have been linked to oppression3,4 and poor physical health.5 In Australia, women are more likely than men to be assaulted by an intimate partner. Between 2014 and 2015, 2,800 women and 560 men were hospitalised following an assault by a partner or spouse.6 One woman per week and one man per month were murdered by a current or former partner between 2013 and 2015.6 In addition to physical violence, sexual abuse against women is more prevalent than it is against men.7 These inequities may be a modern manifestation of the historical imbalance of power between the sexes.8Sexual abuse is an ongoing public health issue, highlighted in recent years by the #MeToo movement, where women shared their stories of sexual assault and advocated for change.9 Statistics from the domestic violence advocacy body White Ribbon Australia reveal that one in every five Australian women have experienced sexual abuse and 85% of women have been sexually harassed.10 Violence and sexual abuse have clear physical and psychological health impacts on women, contributing to women's general disadvantage and often their lower SES and homelessness.11 The employment and pay gap contribute significantly to the disadvantage experienced by women.

Addresses the obligations of countries to implement a human rights-based approach to public health. Observes how this is incorporated in some countries, but alerts to the growing threat to human rights-based public health as a result of the rise of far-right populism and neoliberalism across the Westernised world. Advocates a movement towards healthcare that is grounded in human rights, ending socioeconomic inequality and inequity, and holding governments accountable for the capitalist systems that impinge on human rights. Looks particularly at the situation in Australia. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Addresses the ecological and public health impacts of plastics waste in the environment and of both macro and microplastic plastic pollution, particularly in the ocean. Emphasises the types of action necessary to respond to this plastics pandemic. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Climate disruption and its consequences are an emerging public health crisis. While much emphasis is placed on adaptation and mitigation, there is no long‐term plan to support those who face environmental displacement. Continued increase in greenhouse gas (GHG) emissions will result in perpetual rise in global mean temperatures. Global precipitation will increase with significant geographical variation; some locations experiencing much more precipitation and others experiencing far less. Increased global temperatures are likely to bring with them continued thinning of the Arctic and Antarctic sea ice. Global ocean temperatures increase in all predictive models; deep ocean warming is associated with sea‐level rise. It is strongly anticipated that there will be increased frequency and severity of hurricanes and cyclones.These changes in climate are likely to bring about a number of adverse events for humans, including food insecurity, drought and coincident degradation of drinking water, increased infectious diseases and increased vector‐borne diseases. Droughts are predicted to leave 700–1,500 million people short of water. Rising sea levels and storm surges are potentially catastrophic for low‐lying land masses, particularly the Pacific Islands; Kiribati and Tuvalu are predicted to be uninhabitable by 2050. As vital resources such as food and drinking water increase in scarcity,8 it is not inconceivable that conflict may ensue. These are all some of the most imminent reasons populations may become displaced owing to climate disruption.

The reduced prevalence of insulin resistance and type 2 diabetes in countries with endemic parasitic worm infections suggests a protective role for worms against metabolic disorders, however clinical evidence has been non-existent. This 2-year randomised, double-blinded clinical trial in Australia of hookworm infection in 40 male and female adults at risk of type 2 diabetes assessed the safety and potential metabolic benefits of treatment with either 20 ( n  = 14) or 40 ( n  = 13) Necator americanus larvae (L3) or Placebo ( n  = 13) (Registration ACTRN12617000818336). Primary outcome was safety defined by adverse events and completion rate. Homoeostatic model assessment of insulin resistance, fasting blood glucose and body mass were key secondary outcomes. Adverse events were more frequent in hookworm-treated participants, where 44% experienced expected gastrointestinal symptoms, but completion rates were comparable to Placebo. Fasting glucose and insulin resistance were lowered in both hookworm-treated groups at 1 year, and body mass was reduced after L3-20 treatment at 2 years. This study suggests hookworm infection is safe in people at risk of type 2 diabetes and associated with improved insulin resistance, warranting further exploration of the benefits of hookworms on metabolic health. A beneficial effect of parasitic worms on metabolic health has been postulated based on epidemiological and animal studies. Here, the authors show in a phase I clinical trial that treatment of people at risk of type 2 diabetes with hookworms is safe and may improve key measures of metabolic health.

Correspondence to Dr Gideon Meyerowitz-Katz; gideon.meyerowitzkatz@health.nsw.gov.au Summary box Restrictive non-pharmaceutical interventions against COVID-19 (known as ‘lockdowns’) are associated with health harms However, it is challenging to determine whether lockdowns have caused the harms or whether these harms are a direct consequence of the underlying health disaster of the pandemic Careful analysis of excess mortality suggests that lockdowns are not associated with large numbers of deaths in places that avoided large COVID-19 epidemics (eg, Australia, New Zealand) This evidence must be weighed against the very severe harms caused by COVID-19 itself, as seen for example in Brazil and India It is unlikely that government interventions have been worse than the pandemic itself in most situations using data collected to date Introduction During the pandemic, there has been ongoing and contentious debate around the impact of restrictive government measures to contain SARS-CoV-2 outbreaks, often termed ‘lockdowns’. A much stronger claim that has still persistently appeared in the media as well as peer-reviewed research concerns only health effects: that there has been a large toll of death and disease attributable directly to government action against COVID-19, a toll larger than that of COVID-19 itself.1 2 The tagline for this claim is that “the cure is worse than the disease”.3 Here, we consider the claim that lockdowns cause more health harms than COVID-19 by examining their impacts on mortality, routine health services, global health programmes and suicide and mental health. [...]the World Mortality Dataset appears to show that countries with concerted COVID-19 restrictions have had fewer deaths than in previous years, with the authors estimating that lockdowns may reduce annual mortality by 3–6% from eliminating influenza transmission alone.5 This finding is supported by data from Peru showing that lockdowns are likely to reduce death risks from common sources such as automobile accidents in the short term, resulting in a reduction in the immediate mortality burden when implemented.6 The high excess mortality in countries with few restrictions, or less voluntary behaviour change, may not be surprising given the high infectiousness and fatality rate of COVID-19.7–9 For example, in Manaus, Brazil, COVID-19 spread was largely unmitigated and as of 15 March 2021 more than 10% of the entire population aged over 85 years had died of COVID-19.10 Similarly, the USA did not impose highly restrictive sets of non-pharmaceutical interventions to contain the spread of SARS-CoV-2 in autumn and winter 2020, and COVID-19 became the leading cause of death in the USA for several months in late 2020 and early 2021. [...]one study found that there was an increase in out-of-hospital cardiac arrests in England associated with the first wave of COVID-19, but it could not identify whether this was a result of government action or a consequence of SARS-CoV-2 infections.17 Another study found that missed cancer screenings in the UK could be associated with a very large increase in cancer deaths, but argued that these missed screenings could be attributed to healthcare staff being reallocated to care for patients with COVID-19 during epidemic peaks or due to government action causing patients to avoid care.18 It may be that lockdowns tend to disincentivise people from going to routine screenings, but so will overwhelmed health services or a high perceived risk of infection at health facilities; equally, there is a plausible impact on health and well-being directly caused by lockdowns.

Global warming owing to greenhouse gas (GHG) emissions is irrefutable. This has clear effects on human health. The effects of global warming and climate disruption are only two of a series of issues facing Pacific Island nations. Increasing GHGs and planetary temperatures, rising sea levels and extreme weather events are potentially catastrophic for these low‐lying Islands. Despite their predicament, the nations of the Pacific are taking action to mitigate their risks and prepare for what they must do to survive physically and culturally.The speed of climate change is accelerating and with it the likelihood of ‘climate refugeeism’ is increasing. Climate change has a wide‐reaching impact on human health; both directly – for example, from injuries caused by adverse weather events – and indirectly, from issues including changing disease profiles, effects on agriculture and flow‐on socioeconomic impacts. These effects all combine to force emigration and pressure other countries.Because of proximity and existing networks, Australia, New Zealand and the United States are key migration destinations.The Paris Declaration focuses on displacement due to climate change but does not discuss voluntary migration as a method for reducing future refugeeism. Climate disruption may result in people feeling forced to flee, while others may decide to voluntarily migrate. There is no agreed distinction between forced displacement and voluntary migration.

Background Abdominal obesity and presence of the metabolic syndrome (MetS) significantly increase the risk of developing diseases such as Type 2 diabetes mellitus (T2DM) with escalating emergence of MetS and T2DM constituting a significant public health crisis worldwide. Lower prevalence of inflammatory and metabolic diseases such as T2DM in countries with higher incidences of helminth infections suggested a potential role for these parasites in the prevention and management of certain diseases. Recent studies confirmed the potential protective nature of helminth infection against MetS and T2DM via immunomodulation or, potentially, alteration of the intestinal microbiota. This Phase 1b safety and tolerability trial aims to assess the effect of inoculation with helminths on physical and metabolic parameters, immune responses, and the microbiome in otherwise healthy women and men. Methods Participants eligible for inclusion are adults aged 18–50 with central obesity and a minimum of one additional feature of MetS recruited from the local community with a recruitment target of 54. In a randomised, double-blind, placebo-controlled design, three groups will receive either 20 or 40 stage three larvae of the human hookworm Necator americanus or a placebo. Eligible participants will provide blood and faecal samples at their baseline and 6-monthly assessment visits for a total of 24 months with an optional extension to 36 months. During each scheduled visit, participants will also undergo a full physical examination and complete diet (PREDIMED), physical activity, and patient health (PHQ-9) questionnaires. Outcome measurements include tolerability and safety of infection with Necator americanus , changes in metabolic and immunological parameters, and changes in the composition of the faecal microbiome. Discussion Rising cost of healthcare associated with obesity-induced metabolic diseases urgently calls for new approaches in disease prevention. Findings from this trial will provide valuable information regarding the potential mechanisms by which hookworms, potentially via alterations in the microbiota, may positively influence metabolic health. Trial registration The protocol was registered on ANZCTR.org.au on 05 June 2017 with identifier ACTRN12617000818336 . Alternatively, a Google search using the above trial registration number will yield a direct link to the trial protocol within the ANZCTR website.

The prevalence of hepatitis C virus (HCV) in correctional facilities in Australia among people who inject drugs is 60%, with disproportionate effects observed in Aboriginal and Torres Strait Islander people. Following the micro‐elimination of HCV in a Queensland correctional facility (QCF), newly acquired cases began to increase in mid‐2019. Here we discuss the public health response to increasing HCV in a QCF. Enhanced surveillance was performed to obtain contextual outbreak data on risk factors including injecting drug use, sharing of personal hygiene equipment and do‐it‐yourself‐tattooing. In the sixteen months, there were 250 notifications of new and re‐infected HCV infections in prisoners in the QCF. Qualitative data revealed the leading factor in transmission to be injecting drug use. Drivers for increased HCV transmission in correctional facilities include boredom, waiting lists for opioid substitution programs, changes in injecting behaviours and sharing of injecting paraphernalia. Point‐of‐care testing combined with education and the development of a needle and syringe program may be promising ways forward for managing HCV in correctional facilities. Correctional facilities are key locations to target sexually transmitted infection (STI) and blood‐borne virus (BBV) testing and treatment as well as health promotion to improve the health of inmates and the communities they return to.

Provides a critical overview of the leading treatment options under investigation as of Aug 2020 for COVID-19, including anti-malarials, antivirals, antiretrovirals, monoclonal antibodies, corticosteroids and anti-inflammatory drugs, and ivermectin. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.