Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Addressing barriers to help-seeking behaviour through M-mental health services : a social marketing perspective

Although seeking help for mental ill-health is beneficial, the majority of persons afflicted do not access available help services. Young adults (16-24 years old) in particular have the highest prevalence of mental health problems and the lowest rate of help-seeking behaviour. Key barriers to help-seeking for young adults, including cost, privacy concerns, inconvenience, access to health professionals and interpersonal interaction, appear to derive from the face-to-face method of service delivery traditionally used to distribute mental health services. Social marketing employs the principle of value exchange, whereby consumers will choose a behaviour in exchange for receiving valued benefits and/or a reduction in key barriers, to achieve behavioural goals for social good. The appropriation of mobile digital technology to deliver self-help mental health services may reduce the current barriers to help seeking, however, extant literature offers no empirical support for this proposition. Our research addresses this gap by examining the perceptions of young adults regarding M-mental health services. Depth interviews were undertaken with 15 young adults (18-24 years old), who had self-reported mild-moderate stress, anxiety or depression. The data were thematically analysed with the assistance of Nvivo. The findings reveal M-mental health services reduce the barriers to accessing face-to-face help services to a large extent. However, they also present their own barriers to help-seeking that must be considered by social marketers, including negligible cost expectations and service efficacy concerns. Overall, this study highlights the potential of M-mental health services to encourage early intervention and help-seeking behaviour as part of a social marketing strategy to address mental illness in young adults.

A stakeholder process evaluation of a social marketing walking intervention targeting children

One quarter of Australian children are overweight or obese (ABS, 2010), putting them at increased risk of physical and psychological health problems (Reilly et al., 2003). Overweight and obesity in childhood tends to persist into adulthood and is associated with premature death and morbidity (Reilly & Kelly, 2011). Increases in Australian children’s weight have coincided with declines in active transportation, such as walking, to school (Salmon et al., 2005). To address this problem, the Victorian Health Promotion Foundation (VicHealth), which is an independent statutory authority which advises government and contributes to promoting good health in Victoria (VicHealth, 2014), developed the Walk to School program. Walk to School aims to encourage primary school children in Victoria to walk to and from school more often. Walking to school is a low cost and effective means of reducing excess weight (Rosenberg et al., 2006) that can be easily integrated into daily routine (Brophy et al., 2011). The purpose of this paper is to present the results of the stakeholder process evaluation of Walk to School 2013, which forms part of a broader outcome evaluation that is currently in field. Although there is an emphasis on outcome evaluation of programs, process evaluation can be equally important in determining program success (Saunders et al., 2005). Further, process evaluation to assess program delivery and utilization is explicitly recommended by two social marketing frameworks (see Lefebvre et al., 1988; Walsh et al., 1993).

Game On: Know Alcohol - Co-creating a tailored alcohol social marketing program

Research demonstrates that education programs are more effective when their target audiences and other key stakeholder groups are involved in the design. The majority of programs continue to be researcher and expert driven. This study extends upon previous research by employing a co-creation research design to offer a consumer driven alternative to education program design. Two co-creation groups involving twenty 14-16 year old Year 10 students who had previously participated in the Game On:Know Alcohol (GOKA) program, which aims to moderate alcohol drinking attitudes and behaviour, were conducted. Analysis revealed that a co-created GOKA program will differ substantially from the researcher and expert driven program that is currently being field tested. Students prefer interactive activities and activities that engage and challenge. Co-creation offers the potential to contest researcher and expert views and may offer to assist in the generation of new insights for the development of education programs.

Competition and its influence on consumer decision making in social marketing

This paper extends the largely conceptual understanding of competition in social marketing by empirically investigating, from a consumer perspective, the nature of competition and its influence on decision making at the individual level. Two phases of qualitative inquiry in Australia, comprising 30 and 20 semi-structured interviews respectively, examined the role of competition in young adults’ decision to adopt and maintain help-seeking for mental ill-health. The findings from thematic analysis suggest that competition operates at both the behavioural and goal level to influence consumers’ decision to perform behaviour and that the types of competition in operation may vary from the adoption to the maintenance of behaviour. The findings are integrated into a framework that social marketers could employ to identify, analyse and address competition.

The impact of Internet marketing capabilities on international network capability, a cross country study comparison between Australia, Chile and Taiwan internationalised SMEs

The Internet has been shown to positively enhance internationalisation for SMEs, but scant empirical testing limits our understanding of the explicit impact of the Internet on firm internationalisation. This paper highlights key areas where the integration of the Internet can be leveraged through Internet-related capabilities within the internationalisation of the firm. Specifically, this study investigates how Internet marketing capabilities play a role in altering international information availability, international strategic orientation, and international business network relationships. This study provides evidence, indicating that these key relationships may vary between countries. To examine these key relationships this study utilises draws from data small and medium sized enterprises (SMEs) in three export intensive markets; Australia (215 international SMEs), Chile (204 international SMEs) and Taiwan (130 international SMEs); and tests a conceptual model through structural equation modelling. Results from the data show the impact of Internet marketing capabilities in positively impacting traditional internationalisation elements, which varies between countries. That is, our findings highlight the international business network relationships in Australia and Taiwan are directly impacted by Internet marketing capabilities, but not in Chile. We offer some insight into why we see variance across comparative exporting countries in how they leverage new technological capabilities for internationalisation and firm performance.

When sex doesn't sell: Using sexualized images of women reduces support for ethical campaigns

Images of scantily clad women are used by advertisers to make products more attractive to men. This ‘‘sex sells’’ approach is increasingly employed to promote ethical causes, most prominently by the animal-rights organization PETA. Yet sexualized images can dehumanize women, leaving an unresolved paradox – is it effective to advertise an ethical cause using unethical means? In Study 1, a sample of Australian male undergraduates (N = 82) viewed PETA advertisements containing either sexualized or non-sexualized images of women. Intentions to support the ethical organization were reduced for those exposed to the sexualized advertising, and this was explained by their dehumanization of the sexualized women, and not by increased arousal. Study 2 used a mixed-gender community sample from the United States (N = 280), replicating this finding and extending it by showing that behaviors helpful to the ethical cause diminished after viewing the sexualized advertisements, which was again mediated by the dehumanization of the women depicted. Alternative explanations relating to the reduced credibility of the sexualized women and their objectification were not supported. When promoting ethical causes, organizations may benefit from using advertising strategies that do not dehumanize women.

The performance advantages for SMEs of product innovation and marketing resource–capability complementarity in emerging economies

This study argues that small and medium-sized enterprises (SMEs) must possess both resources and capabilities at a superior level, and those resources and capabilities must be complementary with one another to achieve superior financial performance. The resources and capabilities of interest are product innovation and marketing. Using data from manufacturing SMEs, the results suggest that product innovation resource–capability complementarity, marketing resource–capability complementarity, and their interaction are positively related to financial performance through product innovation and customer performance. The findings suggest that some SMEs may outperform others not only because they possess a specific individual resource–capability complementarity but also because they create synergy and asset interconnectedness.

The Interview: Schnarking, Knob Jokes and the right to cause gross offence

Discussion of censorship and media freedom in the context of The Interview. A few weeks before the murderous attack by Islamic extremists on the satirical journal Charlie Hebdo, the Hollywood dream factory had its own encounter with would-be censors. The Interview (Evan Goldberg and Seth Rogen, 2014), as everyone with an interest in culture and current affairs cannot fail to be aware of by now, is a comedy in the “grossout” tradition exemplified by commercially successful movies such as Ted (Seth MacFarlane, 2012) and Bridesmaids (Paul Feig, 2011). Their humour is a combination of slapstick, physical comedy, and scatological jokes involving body fluids and the like— hence the “gross”. The best of them have been very funny, as well as bordering on the offensive (see Ted’s scene involving prostitutes, a foul-mouthed teddy bear and the entertainment value of someone taking a dump on the living room floor). They have often been controversial, as in the Farrelly brothers’ Me, Myself and Irene (2000), starring Jim Carrey as a schizophrenic police officer. At their most outrageous they have pushed the boundaries of political correctness to the limit.

'It's Africa. It's Arizona. It's Antarctica. It's Afghanistan. Actually, it's Alberta' : Marketing locations to film producers

This chapter begins by outlining the dynamics of contemporary international film production and the inherent tension between ‘design interest’ and ‘location interest’. A history of the promotion of particular places as filmmaking locations (including Hollywood) is presented, prior to the establishment of the first film commissions. The creation of international associations and their role in professionalization, norm setting and the standardization of offerings and activities, is then described. The chapter concludes with a discussion of commissions’ work, the emergent discourse of ‘film friendliness,’ and the differences between location marketing and other kinds of destination marketing.

Friendship group motives for alcohol consumption: A midstream social marketing approach

Alcohol has been estimated to cost Australia $36 Billion per year, almost double that of all illegal drugs combined. This thesis uncovered seven friendship group-level motives for alcohol consumption, these motives were: Competition, Copying, Commitments, Conformity, Winding down, Play, and Confidence. These motives were then measured and their correlation with self-reported alcohol consumption was assessed. Using these results will allow social marketers to design targeted programmes that achieve meaningful behaviour change that goes beyond merely informing or raising awareness about the dangers of alcohol.

Differential segmentation responses to an alcohol social marketing program

Objective This study seeks establish whether meaningful subgroups exist within a 14-16 year old adolescent population and if these segments respond differently to the Game On: Know Alcohol (GOKA) intervention, a school-based alcohol social marketing program. Methodology This study is part of a larger cluster randomized controlled evaluation of the Game On: Know Alcohol (GOKA) program implemented in 14 schools in 2013/2014. TwoStep cluster analysis was conducted to segment 2114 high school adolescents (14-16 years old) on the basis of 22 demographic, behavioral and psychographic variables. Program effects on knowledge, attitudes, behavioral intentions, social norms, expectancies and refusal self-efficacy of identified segments was subsequently examined. Results Three segments were identified: (1) Abstainers (2) Bingers (3) Moderate Drinkers. Program effects varied significantly across segments. The strongest positive change effects post participation were observed for the Bingers, while mixed effects were evident for Moderate Drinkers and Abstainers. Conclusions These findings provide preliminary empirical evidence supporting application of social marketing segmentation in alcohol education programs. Development of targeted programs that meet the unique needs of each of the three identified segments is indicated to extend the social marketing footprint in alcohol education.