Estimating the burden of disease attributable to smoking in South Africa in 2000

Objectives To quantify the burden of disease attributable to smoking in South Africa for 2000. Design The absolute difference between observed lung cancer death rate and the level in non-smokers, adjusted for occupational and indoor exposure to lung carcinogens, was used to estimate the proportion of lung cancer deaths attributable to smoking and the smoking impact ratio (SIR). The SIR was substituted for smoking prevalence in the attributable fraction formula for chronic obstructive pulmonary disease (COPD) and cancers to allow for the long lag between exposure and outcome. Assuming a shorter lag between exposure and disease, the current prevalence of smoking was used to estimate the population-attributable fractions (PAF) for the other outcomes. Relative risks (RR) from the American Cancer Society cancer prevention study (CPS-II) were used to calculate PAF. Setting South Africa. Outcome measures Deaths and disability-adjusted life years (DALYs) due to lung and other cancers, COPD, cardiovascular conditions, respiratory tuberculosis, and other respiratory and medical conditions. Results Smoking caused between 41 632 and 46 656 deaths in South Africa, accounting for 8.0 - 9.0% of deaths and 3.7 - 4.3% of DALYs in 2000. Smoking ranked third (after unsafe sex/sexually transmitted disease and high blood pressure) in terms of mortality among 17 risk factors evaluated. Three times as many males as females died from smoking. Lung cancer had the largest attributable fraction due to smoking. However, cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking. Conclusion Cigarette smoking accounts for a large burden of preventable disease in South Africa. While the government has taken bold legislative action to discourage tobacco use since 1994, it still remains a major public health priority.

Estimating the burden of disease attributable to physical inactivity in South Africa in 2000

Objectives. To quantify the burden of disease attributable to physical inactivity in persons 15 years or older, by age group and sex, in South Africa for 2000. Design. The global comparative risk assessment (CRA) methodology of the World Health Organization was followed to estimate the disease burden attributable to physical inactivity. Levels of physical activity for South Africa were obtained from the World Health Survey 2003. A theoretical minimum risk exposure of zero, associated outcomes, relative risks, and revised burden of disease estimates were used to calculate population-attributable fractions and the burden attributed to physical inactivity. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Adults ≥ 15 years. Outcome measures. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, breast cancer, colon cancer, and type 2 diabetes mellitus. Results. Overall in adults ≥ 15 years in 2000, 30% of ischaemic heart disease, 27% of colon cancer, 22% of ischaemic stroke, 20% of type 2 diabetes, and 17% of breast cancer were attributable to physical inactivity. Physical inactivity was estimated to have caused 17 037 (95% uncertainty interval 11 394 - 20 407), or 3.3% (95% uncertainty interval 2.2 - 3.9%) of all deaths in 2000, and 176 252 (95% uncertainty interval 133 733 - 203 628) DALYs, or 1.1% (95% uncertainty interval 0.8 - 1.3%) of all DALYs in 2000. Conclusions. Compared with other regions and the global average, South African adults have a particularly high prevalence of physical inactivity. In terms of attributable deaths, physical inactivity ranked 9th compared with other risk factors, and 12th in terms of DALYs. There is a clear need to assess why South Africans are particularly inactive, and to ensure that physical activity/inactivity is addressed as a national health priority.

Communicating consequences with costs: A commentary on Corso et al's cost of injury

Estimating the economic burden of injuries is important for setting priorities, allocating scarce health resources and planning cost-effective prevention activities. As a metric of burden, costs account for multiple injury consequences—death, severity, disability, body region, nature of injury—in a single unit of measurement. In a 1989 landmark report to the US Congress, Rice et al1 estimated the lifetime costs of injuries in the USA in 1985. By 2000, the epidemiology and burden of injuries had changed enough that the US Congress mandated an update, resulting in a book on the incidence and economic burden of injury in the USA.2 To make these findings more accessible to the larger realm of scientists and practitioners and to provide a template for conducting the same economic burden analyses in other countries and settings, a summary3 was published in Injury Prevention. Corso et al reported that, between 1985 and 2000, injury rates declined roughly 15%. The estimated lifetime cost of these injuries declined 20%, totalling US$406 billion, including US$80 billion in medical costs and US$326 billion in lost productivity. While incidence reflects problem size, the relative burden of injury is better expressed using costs.

Counting the cost of fast fashion

There’s a polyester mullet skirt gracing a derrière near you. It’s short at the front, long at the back, and it’s also known as the hi-lo skirt. Like fads that preceded it, the mullet skirt has a short fashion life, and although it will remain potentially wearable for years, it’s likely to soon be heading to the charity shop or to landfill...

Predicting the cost of eradication for 41 Class 1 declared weeds in Queensland

The feasibility of state-wide eradication of 41 invasive plant taxa currently listed as ‘Class 1 declared pests’ under the Queensland Land Protection (Pest and Stock Route Management) Act 2002 was assessed using the predictive model ‘WeedSearch’. Results indicated that all but one species (Alternanthera philoxeroides) could be eradicated, provided sufficient funding and labour were available. Slightly less than one quarter (24.4%) (n = 10) of Class 1 weed taxa could be eradicated for less than $100 000 per taxon. An additional 43.9% (n = 18) could be eradicated for between $100 000 and $1M per taxon. Hence, 68.3% of Class 1 weed taxa (n = 28) could be eradicated for less than $1M per taxon. Eradication of 29.3% (n = 12) is predicted to cost more than $1M per taxon. Comparison of these WeedSearch outputs with either empirical analysis or results from a previous application of the model suggests that these costs may, in fact, be underestimates. Considering the likelihood that each weed will cost the state many millions of dollars in long-term losses (e.g. losses to primary production, environmental impacts and control costs), eradication seems a wise investment. Even where predicted costs are over $1M, eradication can still offer highly favourable benefit:cost ratios. The total (cumulative) cost of eradication of all 41 weed taxa is substantial; for all taxa, the estimated cost of eradication in the first year alone is $8 618 000. This study provides important information for policy makers, who must decide where to invest public funding.

Estimating the duration and cost of weed eradication programmes

Two prerequisites for realistically embarking upon an eradication programme are that cost-benefit analysis favours this strategy over other management options and that sufficient resources are available to carry the programme through to completion. These are not independent criteria, but it is our view that too little attention has been paid to estimating the investment required to complete weed eradication programmes. We deal with this problem by using a two-pronged approach: 1) developing a stochastic dynamic model that provides an estimation of programme duration; and 2) estimating the inputs required to delimit a weed incursion and to prevent weed reproduction over a sufficiently long period to allow extirpation of all infestations. The model is built upon relationships that capture the time-related detection of new infested areas, rates of progression of infestations from the active to the monitoring stage, rates of reversion of infestations from the monitoring to active stage, and the frequency distribution of time since last detection for all infestations. This approach is applied to the branched broomrape (Orobanche ramosa) eradication programme currently underway in South Australia. This programme commenced in 1999 and currently 7450 ha are known to be infested with the weed. To date none of the infestations have been eradicated. Given recent (2008) levels of investment and current eradication methods, model predictions are that it would take, on average, an additional 73 years to eradicate this weed at an average additional cost (NPV) of $AU67.9m. When the model was run for circumstances in 2003 and 2006, the average programme duration and total cost (NPV) were predicted to be 159 and 94 years, and $AU91.3m and $AU72.3m, respectively. The reduction in estimated programme length and cost may represent progress towards the eradication objective, although eradication of this species still remains a long term prospect.

Prevalence and potential fitness cost of weak phosphine resistance in Tribolium castaneum (Herbst) in eastern Australia

The prevalence of resistance to phosphine in the rust-red flour beetle, Tribolium castaneum, from eastern Australia was investigated, as well as the potential fitness cost of this type of resistance. Discriminating dose tests on 115 population samples collected from farms from 2006 to 2010 showed that populations containing insects with the weakly resistant phenotype are common in eastern Australia (65.2 of samples), although the frequency of resistant phenotypes within samples was typically low (median of 2.3). The population cage approach was used to investigate the possibility that carrying the alleles for weak resistance incurs a fitness cost. Hybridized populations were initiated using a resistant strain and either of two different susceptible strains. There was no evidence of a fitness cost based on the frequency of susceptible phenotypes in hybridized populations that were reared for seven generations without exposure to phosphine. This suggests that resistant alleles will tend to persist in field populations that have undergone selection even if selection pressure is removed. The prevalence of resistance is a warning that this species has been subject to considerable selection pressure and that effective resistance management practices are needed to address this problem. The resistance prevalence data also provide a basis against which to measure management success.

Developing standardized methods to assess cost of healthy and unhealthy (current) diets in Australia

Unhealthy diets contribute at least 14% to Australia's disease burden and are driven by ‘obesogenic’ food environments. Compliance with dietary recommendations is particularly poor amongst disadvantaged populations including low socioeconomic groups, those living in rural/remote areas and Aboriginal and Torres Strait Islanders. The perception that healthy foods are expensive is a key barrier to healthy choices and a major determinant of diet-related health inequities. Available state/regional/local data (limited and non-comparable) suggests that, despite basic healthy foods not incurring GST, the cost of healthy food is higher and has increased more rapidly than unhealthy food over the last 15 years in Australia. However, there were no nationally standardised tools or protocols to benchmark, compare or monitor food prices and affordability in Australia. Globally, we are leading work to develop and test approaches to assess the price differential of healthy and less-healthy (current) diets under the food price module of the International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS). This presentation describes contextualization of the INFORMAS approach to develop standardised Australian tools, survey protocols and data collection and analysis systems. The ‘healthy diet basket’ was based on the Australian Foundation Diet, 1 The ‘current diet basket’ and specific items included in each basket, were based on recent national dietary survey data.2 Data collection methods were piloted. The final tools and protocols were then applied to measure the price and affordability of healthy and less healthy (current) diets of different household groups in diverse communities across the nation. We have compared results for different geographical locations/population subgroups in Australia and assessed these against international INFORMAS benchmarks. The results inform the development of policy and practice, including those relevant to mooted changes to the GST base, to promote nutrition and healthy weight and prevent chronic disease in Australia.

Scheduling tools to reduce the cost of cane railway transport

Cane railway systems provide empty bins for harvesters to fill and full bins of cane for the factory to process. These operations need to be conducted in a timely fashion to minimise delays to harvesters and the factory and to minimise the cut-to-crush delay, while also minimising the cost of providing this service. A range of tools has been provided over the years to assist in this process. This paper reviews the objectives of the cane transport system and the tools available to achieve those objectives. The facilities within these tools to assist in the control of costs are highlighted.

Understanding the ex-ante cost of liquidity in the limit order book: A note

This paper estimates a new measure of liquidity costs in a market driven by orders. It represents thecost of simultaneously buying and selling a given amount of shares, and it is given by a single measure of ex-ante liquidity that aggregates all available information in the limit order book for a given number of shares. The cost of liquidity is an increasing function relating bid-ask spreads with the amounts available for trading. This measure completely characterizes the cost of liquidity of any given asset. It does not suffer from the usual ambiguities related to either the bid-ask spread or depth when they are considered separately. On the contrary, with a single measure, we are able to capture all dimensions of liquidity costs on ex-ante basis.

Economic Assessment of Forest Ecosystem Services Losses: Cost of Policy Inaction

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