Publications by authors named "Celia McMichael"

21 Publications

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A review of estimating population exposure to sea-level rise and the relevance for migration.

Environ Res Lett 2020 Dec 27;15(12):123005. Epub 2020 Nov 27.

Corresponding author: University College London (UCL), United Kingdom.

This review analyses global or near-global estimates of population exposure to sea-level rise (SLR) and related hazards, followed by critically examining subsequent estimates of population migration due to this exposure. Our review identified 33 publications that provide global or near-global estimates of population exposure to SLR and associated hazards. They fall into three main categories of exposure, based on definitions in the publications: (i) the population impacted by specified levels of SLR; (ii) the number of people living in floodplains that are subject to coastal flood events with a specific return period; and (iii) the population living in low-elevation coastal zones. Twenty of these 33 publications discuss connections between population migration and SLR. In our analysis of the exposure and migration data, we consider datasets, analytical methods, and the challenges of estimating exposure to SLR followed by potential human migration. We underscore the complex connections among SLR, exposure to its impacts, and migration. Human mobility to and from coastal areas is shaped by diverse socioeconomic, demographic, institutional, and political factors; there may be 'trapped' populations as well as those who prefer not to move for social, cultural, and political reasons; and migration can be delayed or forestalled through other adaptive measures. While global estimates of exposed and potentially migrating populations highlight the significant threats of SLR for populations living in low-lying areas at or near coastlines, further research is needed to understand the interactions among localised SLR and related hazards, social and political contexts, adaptation possibilities, and potential migration and (im)mobility decision-making.
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http://dx.doi.org/10.1088/1748-9326/abb398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208600PMC
December 2020

Planned Relocation and Health: A Case Study from Fiji.

Int J Environ Res Public Health 2021 04 20;18(8). Epub 2021 Apr 20.

Pacific Centre for Environment and Sustainable Development (PACE-SD), Marine Campus, University of the South Pacific, Suva, Fiji.

In Fiji, low-lying coastal villages are beginning to retreat and relocate in response to coastal erosion, flooding and saltwater intrusion. Planned relocation is considered a last resort as a form of adaptation to the impacts of climatic and environmental change. The health impacts of planned relocation are poorly understood. This paper draws on data from multi-year research with residents of the iTaukei (Indigenous) Fijian village of Vunidogoloa. We used qualitative research methods to examine experiences of planned relocation, including residents' accounts of their health and quality of life. In-depth interviews and group discussions were conducted with villagers living in a site of relocation, at four points in time (2015, 2016, 2019, and 2020). Twenty-seven people in Vunidogoloa, Fiji, participated in in-depth interviews, several on more than one occasion. Six group discussions with between eight to twelve participants were also conducted. Qualitative analytic software (NVivo) was used to analyse interview transcripts and identify themes. Villagers report both health benefits and challenges following planned relocation. Key facilitators for good health include movement away from some environmental risks to health, adequate drinking water and sanitation, food security including through farms and kitchen gardens, livelihood opportunities, improved access to schools and health services, and appropriate housing design. However, residents also refer to unanticipated risks to health including increased consumption of packaged goods and alcohol, disruptions to social structures and traditional values, and disrupted place attachment following movement away from a coastal site of belonging with consequences for mental wellbeing. Therefore, planned relocation has altered the social determinants of health in complex ways, bringing both health opportunities and risks. These results highlight the need for context-specific planning and adaptation programs that include meaningful involvement of community members in ongoing decision making, and call for an understanding of diverse social determinants of health that emerge and evolve in contexts of planned relocation.
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http://dx.doi.org/10.3390/ijerph18084355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072796PMC
April 2021

A Meta-Synthesis of Policy Recommendations Regarding Human Mobility in the Context of Climate Change.

Int J Environ Res Public Health 2020 12 14;17(24). Epub 2020 Dec 14.

Heidelberg Institute of Global Health, Universitaetsklinikum Heidelberg, 69120 Heidelberg, Germany.

Changing mobility patterns combined with changes in the climate present challenges and opportunities for global health, requiring effective, relevant, and humane policy responses. This study used data from a systematic literature review that examined the intersection between climate change, migration, and health. The study aimed to synthesize policy recommendations in the peer-reviewed literature, regarding this type of environmental migration with respect to health, to strengthen the evidence-base. Systematic searches were conducted in four academic databases (PubMed, Ovid Medline, Global Health and Scopus) and Google Scholar for empirical studies published between 1990-2020 that used any study design to investigate migration and health in the context of climate change. Studies underwent a two-stage protocol-based screening process and eligible studies were appraised for quality using a standardized mixed-methods tool. From the initial 2425 hits, 68 articles were appraised for quality and included in the synthesis. Among the policy recommendations, six themes were discernible: (1) avoid the universal promotion of migration as an adaptive response to climate risk; (2) preserve cultural and social ties of mobile populations; (3) enable the participation of migrants in decision-making in sites of relocation and resettlement; (4) strengthen health systems and reduce barriers for migrant access to health care; (5) support and promote optimization of social determinants of migrant health; (6) integrate health into loss and damage assessments related to climate change, and consider immobile and trapped populations. The results call for transformative policies that support the health and wellbeing of people engaging in or affected by mobility responses, including those whose migration decisions and experiences are influenced by climate change, and to establish and develop inclusive migrant healthcare.
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http://dx.doi.org/10.3390/ijerph17249342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764877PMC
December 2020

Human mobility, climate change, and health: unpacking the connections.

Authors:
Celia McMichael

Lancet Planet Health 2020 06;4(6):e217-e218

School of Geography, University of Melbourne, Carlton, VIC 3053, Australia. Electronic address:

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http://dx.doi.org/10.1016/S2542-5196(20)30125-XDOI Listing
June 2020

The political economy of restricting marketing to address the double burden of malnutrition: two case studies from Fiji.

Public Health Nutr 2021 02 17;24(2):354-363. Epub 2020 Jun 17.

School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.

Objective: To draw lessons from Fiji regarding the challenges and opportunities for policy initiatives to restrict (i) food marketing to children and (ii) marketing of breast milk substitutes, to inform policy for the double burden of malnutrition.

Design: Qualitative political economy analysis of two policy case studies.

Setting: Fiji.

Participants: Eleven key informants from relevant sectors, representing public health, economic and consumer interests.

Results: This study used two policy initiatives as case studies to examine factors influencing decision-making: Marketing Controls (Foods for Infants and Young Children) Regulations 2010, amended in 2016 to remove guidelines and restrictions on marketing in the form of labelling, and the draft Advertising and Promotion of Unhealthy Foods and Non-Alcoholic Beverages to Children Regulation developed in 2014 but awaiting review by the Solicitor General's Office. Factors identified included: a policy paradigm in which regulation of business activity contradicts economic policy goals; limited perception by key policy actors of links between nutrition and marketing of breast milk substitutes, foods and beverages; and a power imbalance between industry and public health stakeholders in policymaking. Regulation of marketing for health purposes sits within the health sector's interest but not its legislative remit, while within the economic sector's remit but not interest. Opportunities to strengthen restrictions on marketing to improve nutrition and health include reframing the policy issue, strategic advocacy and community engagement.

Conclusions: Restricting marketing should be recognised by public health actors as a public health and an industry policy issue, to support strategic engagement with economic policy actors.
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http://dx.doi.org/10.1017/S1368980020000440DOI Listing
February 2021

Children's perspectives on water, sanitation and hygiene in schools: A case-study from the Philippines.

Health Place 2020 03 1;62:102290. Epub 2020 Feb 1.

School of Psychology & Public Health, La Trobe University, VIC, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.healthplace.2020.102290DOI Listing
March 2020

The Impact of a School-Based Water, Sanitation and Hygiene Intervention on Knowledge, Practices, and Diarrhoea Rates in the Philippines.

Int J Environ Res Public Health 2019 10 23;16(21). Epub 2019 Oct 23.

Philippine Red Cross, Manila 1515, Philippines.

A school-based water, sanitation, and hygiene (WASH) intervention in the Philippines was evaluated. Students and households from four schools that received the WASH intervention (intervention schools) were compared with four schools that had not (comparison schools). Knowledge of critical handwashing times was high across all schools, but higher in intervention schools. Students reported higher rates of handwashing after toilet use (92% vs. 87%; RR = 1.06; = 0.003) and handwashing with soap (83% vs. 60%; RR = 1.4; < 0.001) in intervention versus comparison schools. In intervention schools, 89% of students were directly observed to handwash after toilet use versus 31% in comparison schools (RR = 2.84; < 0.0001). Observed differences in handwashing with soap after toilet use were particularly marked (65% vs. 10%; RR = 6.5; < 0.0001). Reported use of school toilets to defecate (as opposed to use of toilet elsewhere or open defecation) was higher among intervention versus comparison schools (90% vs. 63%; RR = 1.4; < 0.001). Multilevel modelling indicated that students from intervention schools reported a 10-fold reduction in odds ( < 0.001) of school absence due to diarrhoea. In addition to school-based findings, self-reported handwashing at critical times was found to be higher among household members of students from intervention schools. This school-based WASH program appeared to increase knowledge and hygiene behaviours of school students, reduce absences due to diarrhoea, and increase handwashing at critical times among household members.
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http://dx.doi.org/10.3390/ijerph16214056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861971PMC
October 2019

Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact.

Authors:
Celia McMichael

Int J Environ Res Public Health 2019 01 28;16(3). Epub 2019 Jan 28.

School of Geography, The University of Melbourne, Carlton 3053, Australia.

Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students' households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported 'output' and/or 'exposure' of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.
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http://dx.doi.org/10.3390/ijerph16030359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388361PMC
January 2019

Human mobility and health in a warming world.

J Travel Med 2019 Jan;26(1)

Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.

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http://dx.doi.org/10.1093/jtm/tay160DOI Listing
January 2019

The health impacts of climate-related migration.

BMC Med 2017 12 11;16(1). Epub 2017 Dec 11.

The School of Geography, The University of Melbourne, Parkville, VIC, 3010, Australia.

Background: Changes in climate, in conjunction with other drivers of mobility, shape human migration. While there is an increasing focus on the adaptive potential of migration, the health impacts of climate-related migration, including planned relocation and forced displacement, have not been thoroughly examined. The Intergovernmental Panel on Climate Change stated that migration is currently, and will increasingly be, influenced by environmental degradation and climate change, and that it needs to be addressed in a focused and coordinated manner.

Discussion: This paper examines the links between climate change, migration, and health, considering diverse migration responses, including immobility, forced displacement and planned migration, as well as the associated health risks and opportunities in different contexts. Using case studies, the paper illustrates strategies to reduce the health risks associated with climate change-related migration.

Conclusion: While there is an increasing body of research examining the climate change-migration nexus, a dual approach is now required. This approach must include debate and further research regarding the health consequences and responses associated with climate migration as well as immediate strengthening of health systems to make them both climate resilient and migrant inclusive.
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http://dx.doi.org/10.1186/s12916-017-0981-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753535PMC
December 2017

Toilet Talk: Eliminating Open Defecation and Improved Sanitation in Nepal.

Authors:
Celia McMichael

Med Anthropol 2018 May-Jun;37(4):294-310. Epub 2017 Sep 25.

a School of Geography, University of Melbourne , Carlton , Victoria , Australia.

Globally, 2.4 billion people lack adequate sanitation, and open defecation remains common. In this article, I present the qualitative findings from an evaluation of a water, sanitation, and hygiene intervention in remote, mid-West Nepal. The evaluation, conducted in 2014, involved villagers from eight wards in Kotgaun Village Development Committee. Drawing on the concept of the "toilet tripod," I argue as follows: multi-scalar political will provide an important foundation for construction and sustained use of toilets, proximate social pressures contributed significantly to toilet adoption and efforts to eliminate open defecation, and water insecurity constrained improved sanitation and hygiene.
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http://dx.doi.org/10.1080/01459740.2017.1371150DOI Listing
December 2018

Health equity and migrants in the Greater Mekong Subregion.

Glob Health Action 2017 ;10(1):1271594

b Australian National University, School of Regulation and Global Governance (RegNet) , Canberra , Australia.

Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries.

Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants.

Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers - and irregular migrants in particular - face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services.

Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems.
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http://dx.doi.org/10.1080/16549716.2017.1271594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328359PMC
September 2018

Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal.

Soc Sci Med 2016 08 29;163:28-36. Epub 2016 Jun 29.

La Trobe University, School of Psychology & Public Health, Franklin Street (City) Campus, 215 Franklin Street, Melbourne, VIC, 3000, Australia. Electronic address:

Behaviour change is central to the prevention of many population health problems, yet it is typically difficult to initiate and sustain. This paper reports on an evaluation of a water, sanitation and hygiene (WASH) intervention in mid-western Nepal, with particular focus on the drivers and barriers for handwashing with soap/ash and elimination of open defecation. The research was conducted during October-November 2014, two and half years following the intervention's end-point. Qualitative data were collected from the target community (n = 112) via group discussions, interviews and drawings/stories of 'most significant change'. Households' handwashing/water facilities and toilets were observed. Analysis was informed by a model that highlights environmental, psychosocial and technological factors that shape hygiene behaviours across multiple levels, from the habitual to the structural (Dreibelbis et al. 2013). Findings indicate the intervention has supported development of new norms around hygiene behaviours. Key drivers of sustained hygiene behaviour were habit formation, emotional drivers (e.g. disgust, affiliation), and collective action and civic pride; key constraints included water scarcity and socio-economic disadvantage. Identifying and responding to the drivers and constraints of hygiene behaviour change in specific contexts is critical to sustained behaviour change and population health impact.
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http://dx.doi.org/10.1016/j.socscimed.2016.06.051DOI Listing
August 2016

Early motherhood: a qualitative study exploring the experiences of African Australian teenage mothers in greater Melbourne, Australia.

BMC Public Health 2015 Sep 10;15:873. Epub 2015 Sep 10.

School of Social Sciences and Communications, Faculty of Humanities and Social Sciences, La Trobe University, Bundoora, Victoria, Australia.

Background: Motherhood is a significant and important aspect of life for many women around the globe. For women in communities where motherhood is highly desired, motherhood is considered crucial to the woman's identity. Teenage motherhood, occurring at a critical developmental stage of teenagers' lives, has been identified as having adverse social and health consequences. This research aimed to solicit the lived experiences of African Australian young refugee women who have experienced early motherhood in Australia.

Methods: This qualitative research used in-depth interviews. The research methods and analysis were informed by intersectionality theory, phenomenology and a cultural competency framework. Sixteen African born refugee young women who had experienced teenage pregnancy and early motherhood in Greater Melbourne, Australia took part in this research. Interviews were audio recorded, transcribed and data analysed using thematic content analysis. Ethics approval for this research was granted by Victoria University Human Research Ethics committee.

Results: Motherhood brings increased responsibilities, social recognition, and a sense of purpose for young mothers. Despite the positive aspects of motherhood, participants faced challenges that affected their lives. Most often, the challenges included coping with increased responsibilities following the birth of the baby, managing the competing demands of schooling, work and taking care of a baby in a site of settlement. The young mothers indicated they received good support from their mothers, siblings and close friends, but rarely from the father of their baby and the wider community. Participants felt that teenage mothers are frowned upon by their wider ethnic communities, which left them with feelings of shame and embarrassment, despite the personal perceived benefits of achieving motherhood.

Conclusions: We propose that service providers and policy makers support the role of the young mothers' own mother, sisters, their grandmothers and aunts following early motherhood. Such support from significant females will help facilitate young mothers' re-engagement with education, work and other aspects of life. For young migrant mothers, this is particularly important in order to facilitate settlement in a new country and reduce the risk of subsequent mistimed pregnancies. Service providers need to expand their knowledge and awareness of the specific needs of refugee teen mothers living in 'new settings'.
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http://dx.doi.org/10.1186/s12889-015-2215-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566485PMC
September 2015

The persistence of predictors of wellbeing among refugee youth eight years after resettlement in Melbourne, Australia.

Soc Sci Med 2015 Oct 14;142:163-8. Epub 2015 Aug 14.

School of Social Sciences, La Trobe University, Bundoora, Victoria 3086, Australia. Electronic address:

This short report assesses the predictors of subjective health and happiness among a cohort of refugee youth over their first eight years in Australia. Five waves of data collection were conducted between 2004 (n = 120) and 2012-13 (n = 51) using mixed methods. Previous schooling, self-esteem, moving house in the previous year, a supportive social environment, stronger ethnic identity and perceived discrimination were significant predictors of wellbeing after adjusting for demographic and pre-migration factors. When compared with a previous analysis of this cohort over their first three years of settlement, experiences of social exclusion still have a significant impact on wellbeing eight years after arriving in Australia. This study contributes to mounting evidence in support of policies that discourage discrimination and promote social inclusion and cultural diversity and which underpin the wellbeing of resettled refugee youth.
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http://dx.doi.org/10.1016/j.socscimed.2015.08.017DOI Listing
October 2015

Climate change-related migration and infectious disease.

Authors:
Celia McMichael

Virulence 2015 7;6(6):548-53. Epub 2015 Jul 7.

a School of Humanities & Social Sciences; La Trobe University ; Melbourne , Australia.

Anthropogenic climate change will have significant impacts on both human migration and population health, including infectious disease. It will amplify and alter migration pathways, and will contribute to the changing ecology and transmission dynamics of infectious disease. However there has been limited consideration of the intersections between migration and health in the context of a changing climate. This article argues that climate-change related migration - in conjunction with other drivers of migration - will contribute to changing profiles of infectious disease. It considers infectious disease risks for different climate-related migration pathways, including: forced displacement, slow-onset migration particularly to urban-poor areas, planned resettlement, and labor migration associated with climate change adaptation initiatives. Migration can reduce vulnerability to climate change, but it is critical to better understand and respond to health impacts - including infectious diseases - for migrant populations and host communities.
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http://dx.doi.org/10.1080/21505594.2015.1021539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720222PMC
June 2016

An ill wind? Climate change, migration, and health.

Environ Health Perspect 2012 May 20;120(5):646-54. Epub 2012 Jan 20.

School of Social Sciences, La Trobe University, Melbourne, Australia.

Background: Climate change is projected to cause substantial increases in population movement in coming decades. Previous research has considered the likely causal influences and magnitude of such movements and the risks to national and international security. There has been little research on the consequences of climate-related migration and the health of people who move.

Objectives: In this review, we explore the role that health impacts of climate change may play in population movements and then examine the health implications of three types of movements likely to be induced by climate change: forcible displacement by climate impacts, resettlement schemes, and migration as an adaptive response.

Methods: This risk assessment draws on research into the health of refugees, migrants, and people in resettlement schemes as analogs of the likely health consequences of climate-related migration. Some account is taken of the possible modulation of those health risks by climate change.

Discussion: Climate-change-related migration is likely to result in adverse health outcomes, both for displaced and for host populations, particularly in situations of forced migration. However, where migration and other mobility are used as adaptive strategies, health risks are likely to be minimized, and in some cases there will be health gains.

Conclusions: Purposeful and timely policy interventions can facilitate the mobility of people, enhance well-being, and maximize social and economic development in both places of origin and places of destination. Nevertheless, the anticipated occurrence of substantial relocation of groups and communities will underscore the fundamental seriousness of human-induced climate change.
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http://dx.doi.org/10.1289/ehp.1104375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346786PMC
May 2012

Narratives of sexual health risk and protection amongst young people from refugee backgrounds in Melbourne, Australia.

Cult Health Sex 2010 Apr;12(3):263-77

La Trobe Refugee Research Centre, School of Social Sciences, La Trobe University, Victoria, Australia.

Young people with refugee backgrounds face many challenges when making their lives in a resettlement country and their sexual and reproductive health needs are often overlooked. This paper reports on sexual health literacy amongst recently arrived young refugees settling in Melbourne, Australia. Qualitative methods were used to explore how resettled youth access, interpret and implement sexual health information, with a particular focus on how social contexts shape attitudes and understandings. Focus group discussions and in-depth interviews were conducted with 142 participants aged between 16 and 25 years. Findings reveal that while young people had some knowledge of HIV and AIDS, knowledge of other STIs was limited. Importantly, narratives about risk and protection were informed by concerns for maintenance of social wellbeing. Sexual health promotion should be an explicit component of early resettlement services for youth with refugee backgrounds and strategies need to take account of the pre-migration and resettlement contexts.
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http://dx.doi.org/10.1080/13691050903359265DOI Listing
April 2010

Evidence-based public health: what does it offer developing countries?

J Public Health (Oxf) 2005 Jun 8;27(2):215-21. Epub 2005 Apr 8.

School of Public Health, Faculty of Health Sciences, La Trobe University, VIC 3086, Australia.

The global burden of disease and illness is primarily situated in developing countries. As developing countries have limited resources, it is particularly important to invest in public health and health promotion strategies that are effective. Systematic reviews are central to evidence-based public health and health promotion practice and policy. This paper discusses issues surrounding the relevance of evidence-based public health and systematic reviews to the health of developing countries. It argues that there is a lack of systematic reviews relevant to the health priorities of developing countries; many interventions reviewed can not be implemented in resource-poor situations; and, a limited amount of primary research is conducted in developing countries. The paper further argues that improvements in public health are determined not only by effective health services and interventions, but through an approach that includes other sectors and influences broader structural and systematic barriers to health. Given the social complexity of human development, and the inter-sections amongst different development goals, there is no question that gains in developing country public health are unlikely to emerge from systematic reviews alone, but will require decisions about inter-sectoral collaboration and social policy initiatives. Nonetheless, evidence around intervention effectiveness has an important role to play in addressing health priorities in developing countries and resource-poor areas. The public health evidence base urgently needs strengthening, with dedicated effort towards increasing the relevance of primary evidence and systematic reviews.
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http://dx.doi.org/10.1093/pubmed/fdi024DOI Listing
June 2005