Background: Although cultural factors play a crucial role in experience of stigma, there is scant review on the impact and importance of culture on stigma of mental illness across Pacific Rim Region. This study aims to investigate: 1) the cultural factors related to stigmatizing beliefs about mental illness in Pacific Rim region, and 2) culture-specific measures and interventions on stigma of mental illness.Methods: A systematic search of papers was conducted in the MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, Cochrane Library and Google scholar through January 2003 to April 2019.Results: Forty-one studies in Pacific Rim region which met the inclusion criteria were included in the study. The rate of stigma of mental illness (e.g., public stigma: from 25.4 to 85.2%) was relatively high in Pacific Rim region. Culture factors (e.g., Collectivism, Confucianism, face concern and familism, religion and supernatural beliefs) contributed to people’s stigmatizing behaviors and attitudes toward persons with mental illness, their relatives and mental health professionals. Certain measurements were developed and employed to assess different type of cultural factors related to stigma of mental illness.Conclusions: Cultural factors play an important role in influencing the rate and performance of stigma of mental illness. Further research on stigma of mental illness and culture-specific interventions to reduce the stigma should be conducted in the Pacific Rim region.

Pathology testing and diagnostic imaging together contribute 9% of healthcare's carbon footprint. Whilst the carbon footprint of pathology testing has been undertaken, to date, the carbon footprint of the four most common imaging modalities is unclear. We performed a prospective life cycle assessment at two Australian university-affiliated health services of five imaging modalities: chest X-ray (CXR), mobile chest X-ray (MCXR), computerised tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). We included scanner electricity use and all consumables and associated waste, including bedding, imaging contrast, and gloves. Analysis was performed using both attributional and consequential life cycle assessment methods. The primary outcome was the greenhouse gas footprint, measured in carbon dioxide equivalent (CO₂e) emissions. Mean CO₂e emissions were 17·5 kg/scan for MRI; 9·2 kg/scan for CT; 0·8 kg/scan for CXR; 0·5 kg/scan for MCXR; and 0·5 kg/scan for US. Emissions from scanners from standby energy were substantial. When expressed as emissions per additional scan (results of consequential analysis) impacts were lower: 1·1 kg/scan for MRI; 1·1 kg/scan for CT; 0·6 kg/scan for CXR; 0·1 kg/scan for MCXR; and 0·1 kg/scan for US, due to emissions from standby power being excluded. Clinicians and administrators can reduce carbon emissions from diagnostic imaging, firstly by reducing the ordering of unnecessary imaging, or by ordering low-impact imaging (X-ray and US) in place of high-impact MRI and CT when clinically appropriate to do so. Secondly, whenever possible, scanners should be turned off to reduce emissions from standby power. Thirdly, ensuring high utilisation rates for scanners both reduces the time they spend in standby, and apportions the impacts of the reduced standby power of a greater number of scans. This therefore reduces the impact on any individual scan, maximising resource efficiency. Healthy Urban Environments (HUE) Collaboratory of the Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise MBG SPHERE. The National Health and Medical Research Council (NHMRC) PhD scholarship

The health impacts of climate are widely recognised, and extensive modelling is available on predicted changes to climate globally. The impact of these changes may affect populations differently depending on a range of factors, including geography, socioeconomics and culture. This study reviewed current evidence on the health risks of climate change for Australian Aboriginal populations and linked Aboriginal demographic data to historical and projected climate data to describe the distribution of climate-related exposures in Aboriginal compared to non-Aboriginal populations in New South Wales (NSW), Australia. The study showed Aboriginal populations were disproportionately exposed to a range of climate extremes in heat, rainfall and drought, and this disproportionate exposure was predicted to increase with climate change over the coming decades. Aboriginal people currently experience higher rates of climate-sensitive health conditions and socioeconomic disadvantages, which will impact their capacity to adapt to climate change. Climate change may also adversely affect cultural practices. These factors will likely impact the health and well-being of Aboriginal people in NSW and inhibit measures to close the gap in health between Aboriginal and non-Aboriginal populations. Climate change, health and equity need to be key considerations in all policies at all levels of government. Effective Aboriginal community engagement is urgently needed to develop and implement climate adaptation responses to improve health and social service preparedness and secure environmental health infrastructure such as drinking water supplies and suitably managed social housing. Further Aboriginal-led research is required to identify the cultural impacts of climate change on health, including adaptive responses based on Aboriginal knowledges.

Objective: To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing. Design: Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis. Setting: Australian healthcare system. Participants: Population of Australia. Outcome measures: We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO ₂ e were estimated using data from our previous study of the carbon footprint of common pathology tests. We distinguished between tests ordered as the primary test and those ordered as an add-on to other tests, as many may be done in conjunction with other tests. We conducted base case (8% being the primary reason for the blood test) and sensitivity (12% primary test) analyses. Results: There were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018–2019 total. From our literature review, 76.5% of Australia’s vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO ₂ e, equivalent to driving ~160 000–230 000 km in a standard passenger car. Conclusions: Unnecessary vitamin D testing contributes to avoidable CO ₂ e emissions and healthcare costs. While the footprint of this example is relatively small, the potential to realise environmental cobenefits by reducing low-value care more broadly is significant.

Solastalgia is a term used to describe the pain and distress experienced by those witnessing their home environments destroyed or changed in unwelcome ways. Solastalgia is expected to become more prominent as climate change worsens and transforms landscapes. This scoping review examines and maps the existing literature on solastalgia in Australia, particularly focusing on Aboriginal and Torres Strait Islander experiences. Four focus questions guided the review to explore how solastalgia is conceptualized, highlight risk and protective factors, and identify strategies for addressing solastalgia. Eighteen papers met the criteria for inclusion. Overall, our results show a minimal evidence base on solastalgia in Australia with an even greater gap in exploring solastalgia from Aboriginal and Torres Strait Islander perspectives. A strong connection to home environments was suggested as both a risk and protective factor for experiencing solastalgia. Aboriginal and Torres Strait Islander peoples are considered at risk due to intimate connections to home environments, and since the invasion, have experienced mental distress resulting from significant, damaging changes to landscapes and home environments. We recommend further exploration of lived experiences of solastalgia across a greater diversity of Australian contexts, particularly amongst Aboriginal and Torres Strait Islander peoples, including a focus on practical implications.

A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists’ perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability–opportunity–motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July−September 2021). Participants’ age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability–opportunity–motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare.