Each fortnight, we will highlight hot policy topics, blogs or publications related to public health in Aotearoa. Our aim will be to summarise the issues and stimulate debate and facilitate sharing of viewpoints from across the wide and diverse public health spectrum. Comment welcomed!
We particularly welcome contributions from our public health student members. Around 500 words, please. Editor's reserve the right to balance content across different policy spots!
To suggest topics for inclusion, or to respond to the issues raised, please contact leonie@pha.org.nz
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Policy Debate:
Syndemics: Climate change, malnutrition and food insecurity
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Is it time to change the narrative on Genetic Modification in New Zealand?
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The idea of syndemics – or synergies of co-occurring epidemics - investigates synergistic, harmful interactions between different drivers of particular health conditions, especially under circumstances of structural and political adversity. One example is the synergy between intensive factory farming, and the emergence of animal or bird viruses re-combining and jumping species in the emergence of human epidemics. These overlap with and intensify the impacts of climate change and food insecurity on public health. Another example is the links between food insecurity, poverty, malnutrition and obesity as highlighted by Boyd Swinburn and co-writers in a Lancet-commissioned article in 2019. In it, they reported that: “In the near future, the health effects of climate change will considerably compound these health challenges…..These three pandemics—obesity, under-nutrition, and climate change…will create a Global Syndemic which represents the paramount health challenge for humans, the environment, and our planet in the 21st century”
Now, into the global COVID-19 pandemic, and in a world that operates with an already stressed food security system, further vulnerabilities to food insecurity, malnutrition and obesity imposed by the COVID-19 pandemic are expected and likely to magnify disparities in healthy living behaviours, perpetuating a viscous synergy of complex yet preventable nutrition conditions that contribute to the development of diet-related Non Communicable Diseases.
Public health policy must take a wide, holistic approach to tackle emerging syndemics. A combined syndemics/health and human rights approach offers a principled, evidence-based foundation for strategic collaboration between clinicians, public health professionals, policy makers, civil society actors, and other stakeholders who are committed to tackling health inequities by working to advance structural and political change.
Time to change the narrative on Genetic Modification in New Zealand?
The world will need to feed an estimated population more than 9 billion by 2050 with diminishing natural resources, and whilst ensuring the health of people and the planet.
One of the most serious challenges we're facing in a world of climate change and increasing population is growing enough food. Pretty much all the arable land on Earth is already being used, so the key is going to involve increasing crop yields.
That, along with adding features such as drought tolerance, is something RNA manipulation can allow. Researchers at the University of Chicago and Guizhou University recently announced the results of field tests where both rice and potato plants increased their yield by a stunning 50%, and grew longer root systems capable of increased drought resistance. The plants demonstrated increased rates of photosynthesis as well. Read more.
Genetic modification (GM) of crops and climate change are arguably two of today's most challenging science communication issues. Increasingly, these two issues are connected in messages proposing GM as a viable option for ensuring global food security threatened by climate change. Genetic modification of crops provides a methodology for the agricultural improvements needed to deliver global food security – whether by increasing the ranges suitable for crop growth by increasing drought or salt tolerance, or by increasing yields or nutrients. However, public opposition to GM food is great - bringing with it images of “Frankenfoods”, of Big Food and Big Agri engineering sterile F1 hybrid seeds, and herbicide linked environmental damage.
Te Ao Māori and GM: Interest in whakapapa in New Zealand arises directly from controversy over the genetic modification of plants and animals. In New Zealand, concerns expressed by the public in general and by Māori in particular led to the establishment in 2000 of a royal commission to inquire into genetic modification and its place in New Zealand society. More recently, a pilot study identified that while Māori informants were not categorically opposed to new and emerging gene editing technologies, they suggest a dynamic approach to regulation is required where specific uses or types of uses are approved on a case by case basis.
World-wide, checks and balances exist such as the Cartagena Protocol on Biosafety to the Convention on Biological Diversity, which is the only international environmental agreement that is concerned exclusively with the transboundary movement (i.e. trade) of products of modern biotechnology that are living modified organisms. The New Zealand biotechnology policy regulatory framework, which consists of the Hazardous Substances and New Organisms (HSNO) Act and the Environmental Risk Management Authority (ERMA) have very conservative settings – and the New Zealand population appears still conflicted about the risks and benefits of GM.
There has been no review of gene technologies in New Zealand since the Royal Commission on Genetic Modification held in 2001 and the subsequent amendments to the Hazardous Substances and New Organisms Act (1996). However, an expert panel set up by Royal Society Te Apārangito (2019) considered the implications of new technologies that allow much more controlled and precise ‘editing’ of genes. It concluded that an overhaul of the regulations and an urgent need for wide discussion and debate about gene editing within and across all New Zealand communities is needed.
Cross-talk between scientists and society based on reliable scientific knowledge is urgently needed, as is appropriate legislation. A positive outcome from COVID-19 has been the re-connection between, and trust in, public health scientists, the wider public and politicians. The lessons of trustworthy and skilled communication to address fears of new situations and technologies could be adapted to help us with the syndemics of climate change, population growth, food insecurity and environmental degradation.
References
Cole, M. B., Augustin, M. A., Robertson, M. J., & Manners, J. M. (2018). The science of food security. Science of Food, 2(1), 1-8.
Hope, J. (2001). The New Zealand Royal Commission on Genetic modification. Environmental and Planning Law Journal, 18(5), 441-444.
Hudson, M., Mead, A. T. P., Chagné, D., Roskruge, N., Morrison, S., Wilcox, P. L., & Allan, A. C. (2019). Indigenous perspectives and gene editing in Aotearoa New Zealand. Frontiers in bioengineering and biotechnology, 7, 70.
Huizar, M. I., Arena, R., & Laddu, D. R. (2021). The global food syndemic: The impact of food insecurity, Malnutrition and obesity on the healthspan amid the COVID-19 pandemic. Progress in cardiovascular diseases, 64, 105. Read it here
Roberts, M., Haami, B., Benton, R., Satterfield, T., Finucane, M. L., Henare, M., & Henare, M. (2004). Whakapapa as a Māori mental construct: Some implications for the debate over genetic modification of organisms. The Contemporary Pacific, 1-28.
Swinburn, B. A., Kraak, V. I., Allender, S., Atkins, V. J., Baker, P. I., Bogard, J. R., ... & Dietz, W. H. (2019). The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. The lancet, 393(10173), 791-846. Read it here.
Tyczewska A, Woźniak E, Gracz J, Kuczyński J, Twardowski T. (2018) Towards food security: current state and future prospects of agrobiotechnology. Trends in biotechnology. Dec 1;36(12):1219-29.
Wright, J., & Kurian, P. (2010). Ecological modernization versus sustainable development: The case of genetic modification regulation in New Zealand. Sustainable Development, 18(6), 398-412.
Yu, Q., Liu, S., Yu, L. et al. RNA demethylation increases the yield and biomass of rice and potato plants in field trials. Nat Biotechnol (2021). ttps://doi.org/10.1038/s41587-021-00982-9
Dr Leonie Walker
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Health disparities are the end products of a variety of complex factors including, but not limited to the social determinants of health: poverty, transportation, access to healthcare, employment, etc. Additionally, they are also impacted by biological (our genes and family history), social (our culture and networks) and environmental (our physical surroundings) factors. Lastly, health disparities are impacted by individual health behaviors and lifestyles.
One area that rarely grabs attention is the relatively poorer health for men: with lower life expectancy a prime indicator. Research consistently shows that fewer men ago to a regular doctor or health provider, let alone had access to any type of screenings. Raising awareness of prostate cancer - the most commonly diagnosed cancer in men in New Zealand. Finding it early can save lives but not all prostate cancer needs to be treated.
Recent research shows significant ethnic disparities in Prostate Cancer screening rates in the Northern region of New Zealand. Māori men, regardless of other demographic factors, were disproportionately affected. The difference in the rates of screening by ethnicity had influenced the incidence and clinical significance of the diagnosed cancers.
Matti, B., Lyndon, M., & Zargar‐Shoshtari, K. (2020). Ethnic and socio‐economic disparities in prostate cancer screening: lessons from New Zealand. BJU international.
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