Wellbeing of Australians : carer health and wellbeing

This Report concerns the subjective wellbeing of carers in Australia. It is the product of a partnership between Carers Australia, Australian Unity, and Deakin University. All three partners were involved in all stages of the project as planning the logistics, designing the questionnaire and composing the report. Data analysis was undertaken by Deakin University while the logistics of questionnaire mailout was managed by Australian Unity and Carers Australia. The actual mailing took place from each of the state/territory Carers Associations, who used their own databases to print and affix the addresses of their members to the envelopes. Three major outcome measures have been used. The first is the Personal Wellbeing Index, which is our standard measure of wellbeing. The Index score is the average level of satisfaction across seven aspects of personal life – health, personal relationships, safety, standard of living, achieving in life, community connectedness, and future security. The other two outcome measures are sub-scales taken from the Depression, Anxiety, and Stress Scale (Lovibond and Lovibond, 1995). This is a very well regarded scale and the sub-scales of Depression and Stress have been used for this study. A total of 10,939 questionnaires were distributed and 4,107 were returned in time for processing. This constitutes a 37.6% response rate.

Nutrition, health and related claims

The article deals with food regulations controlling the use of nutrition, health and related claims in Australia and New Zealand. It relates how such regulation of claims are managed in several ways. Examples are the Code of Practice on Nutrient Claims, vitamin and mineral claims, claims about electrolyte drinks and sports food and the Australia New Zealand Food Standards Code.

Knowledge synthesis, translation and exchange in public health and health promotion: the role of a Cochrane review group

The Cochrane Collaboration is an international non-profit organisation that aims to produce high quality systematic reviews of the effectiveness of health interventions. This work is conducted by 51 Review Groups that span a  range of topics (e.g. pregnancy and childbirth, HIV/AIDS). The role of Fields within the Collaboration has been to actively engage relevant stakeholders internationally to improve the quality and relevance of reviews. Since the inception in 1996 of the Cochrane Public Health and Health Promotion Field, the Cochrane Collaboration has begun to embrace reviews related to public health and health promotion and is adapting to the changing needs of end-users. The introduction of a Cochrane health promotion and public health review group will help ensure that reviews will be oriented towards building evidence for equity and reducing inequalities and best meet the needs of decision-makers, practitioners and consumers. Our role as a Field has led to us working with a range of partners including reviewers,  researchers, practitioners and consumers. Knowledge synthesis, translation and exchange (KST&E) has emerged as an issue in need of further  exploration for practice to influence decision-makers and for policy to  influence practitioners. 2007 will be an exciting year for evidence-informed Health Promotion and Public Health (HPPH) both within the Cochrane Collaboration and for our partners in policy, practice and research.

Overweight and obesity from childhood to adulthood: a follow-up of participants in the 1985 Australian Schools Health and Fitness Survey

Objective: To examine overweight and obesity in Australian children followed through to adulthood.

Design and participants: A cohort study of 8498 children aged 7–15 years who participated in the 1985 Australian Schools Health and Fitness Survey; of these, 2208 men and 2363 women completed a follow-up questionnaire at age 24–34 years in 2001–2005.

Main outcome measures: Height and weight were measured in 1985, and self-reported at follow-up. The accuracy of self-reported data was checked in 1185 participants. Overweight and obesity in childhood were defined according to international standard definitions for body mass index (BMI), and, in adulthood, as a BMI of 25–29.9 and ≥ 30 kg/m2, respectively, after correcting for self-report error.

Results: In those with baseline and follow-up data, the prevalence of overweight and obesity in childhood was 8.3% and 1.5% in boys and 9.7% and 1.4% in girls, respectively. At follow-up, the prevalence was 40.1% and 13.0% in men and 19.7% and 11.7% in women. The relative risk (RR) of becoming an obese adult was significantly greater for those who had been obese as children compared with those who had been a healthy weight (RR = 4.7; 95% CI, 3.0–7.2 for boys and RR = 9.2; 95% CI, 6.9–12.3 for girls). The proportion of adult obesity attributable to childhood obesity was 6.4% in males and 12.6% in females.

Conclusion: Obesity in childhood was strongly predictive of obesity in early adulthood, but most obese young adults were a healthy weight as children.

Workplace change & the care of the self : health and wellbeing as a professional duty of care?

This paper examines the ways in which transformations in the organisation and practice of teacher’s work have witnessed large numbers of teachers being seen, and seeing themselves, as stressed. These understandings of teacher stress have provoked a number of strategies designed to encourage individuals to take care of themselves – and to take care of themselves in ways that will make schools more effective.

Train without strain : health and amateur athletes

An exercise in historical sociology, this paper investigates the association between training and health made by amateur athletes between about 1860 and WWI. It examines the idea that while exercise benefited a person’s health and well-being, excessive exertion caused potentially life-threatening ‘strain’. The paper sets out the interpretation of contemporary scientific knowledge about the body–which the author terms the ‘physiology of strain’–that underpinned the advice given to those undergoing a training program for amateur competition. The point is made that the imputed effects of exercise on health were deduced from this scientific knowledge; it did not derive from bio-medical investigations specifically addressing these issues. Amateur athletes included people drawn from the professionally educated elite and medical practitioners figured significantly among them. Using insights from Bourdieu and Foucault, it is argued that their social power and professional connections served to legitimate their interpretation of the physiological effects of exercise (denying the value of the training practices of working class professional athletes) and cemented the physiology of strain as a ‘factual’ statement about exercise and health until well into the twentieth century. The data for the paper comes from training manuals, medical journals and other contemporary publications.

Ethnic aged discrimination and disparities in health and social care : a question of social justice

Older overseas-born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a 'special needs' group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian-born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult.

Health and mortality consequences of abdominal obesity : evidence from the AusDiab study

Objective: To provide an estimate of the morbidity and mortality resulting from abdominal overweight and obesity in the Australian population.

Design and setting: Prospective, national, population-based study (the Australian Diabetes, Obesity and Lifestyle [AusDiab] study).

Participants: 6072 men and women aged ≥ 25 years at study entry between May 1999 and December 2000, and aged ≤ 75 years, not pregnant and for whom there were waist circumference data at the follow-up survey between June 2004 and December 2005.

Main outcome measures: Incident health outcomes (type 2 diabetes, hypertension, dyslipidaemia, the metabolic syndrome and cardiovascular diseases) at 5 years and mortality at 8 years. Comparison of outcome measures between those classified as abdominally overweight or obese and those with a normal waist circumference at baseline, and across quintiles of waist circumference, and (for mortality only) waist-to-hip ratio.

Results: Abdominal obesity was associated with odds ratios of between 2 and 5 for incident type 2 diabetes, dyslipidaemia, hypertension and the metabolic syndrome. The risk of myocardial infarction among obese participants was similarly increased in men (hazard ratio [HR], 2.75; 95% CI, 1.08–7.03), but not women (HR, 1.43; 95% CI, 0.37–5.50). Abdominal obesity-related population attributable fractions for these outcomes ranged from 13% to 47%, and were highest for type 2 diabetes. No significant associations were observed between all-cause mortality and increasing quintiles of abdominal obesity.

Conclusions: Our findings confirm that abdominal obesity confers a considerably heightened risk for type 2 diabetes, the metabolic syndrome (as well as its components) and cardiovascular disease, and they provide important information that enables a more precise estimate of the burden of disease attributable to obesity in Australia.