As the Tokyo Games begin, the stakes could not be higher for Japan — and the Olympics themselves

Originally published on theconversation.com

Martin Meissner/AP

History shows there nothing in sport quite like an Olympics. Equally, there is nothing in Olympic history quite like what is happening now in Tokyo at the most expensive — and likely the most fraught — summer games of all time.

When Tokyo bid for the games a decade ago, many of the political elite saw the Olympics as a way to promote Japan 2.0. The games would reinvigorate a country beset by nuclear and natural disasters, economic stagnation and geopolitical concerns about China’s rise.

Japan’s leaders were part of its post-second world war generation. They witnessed the benefits in hosting the 1964 Tokyo Games, and thought the same could happen in 2020.

But COVID-19 has seen the anticipation and feel-good factor of the Olympics replaced by anxiety and fear. The city’s stadiums and train lines are empty, as are its coffers, with the lack of ticket sales and tourism income.

Any diplomatic or soft power advantage Japan might have sought over China will be offset by the fact the next Olympics to be held in front of cheering crowds will likely be the 2022 Winter Games in Beijing.

The most expensive Summer Games on record

Now that attention is about to shift to the spectacle of the opening ceremony and athletic competitions, it’s worth keeping in mind the enormous cost of these games to the Japanese public.

When it won the bid for the games in 2013, Tokyo said they would cost US$7.3 billion (A$9.9 billion). In 2019, a report by Japan’s national auditor said the costs would be nearly twice that amount.

Then, in December 2020, the organisers admitted the official spend would be closer to US$15.4 billion (A$20.9 billion) after factoring in the costs of the COVID postponement. Government audits over the past several years suggest the true cost, however, will actually be US$25 billion (A$33.9 billion).



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Most expensive, greatest gender parity, most sports: Tokyo Olympics by the numbers

Egregious cost overruns have been a feature of most Olympics, but as COVID-related precautions continue to bloat its budget, Tokyo has already surpassed the London games of 2012 as the most expensive summer games on record, according to one study. It is the one gold medal the International Olympic Committee did not want to award.

Under the terms of the host city contract between the Tokyo Organising Committee and the IOC, the costs of hosting the games and underwriting all associated contingencies — including their abandonment, which is still a possibility — lie with the hosts.

This diversion of resources — both in terms of money and healthcare personnel — has annoyed the Japanese public. And yet, the oft-quoted polls suggesting three-quarters of the Japanese public do not want the games to take place should not be taken as anti-sport in sentiment.

In a new survey, only 21% of Japanese respondents said they believe the games can be held safely.
Hiro Komae/AP

Indeed, well-attended sports events continue to take place in Japan despite various states of emergency, rising COVID infections and sluggish vaccination rates. The polls on the Olympics are an expression of understandable unease among the Japanese public about hosting a global sporting event during a global pandemic and the considerable costs they’ve had to bear.

Unease over the costs is not unusual for Olympic hosts. In the past, this has been quickly tempered by the games themselves. The atmosphere invokes a national pride as the host nation’s best athletes compete against the world and the host city gets to show off its iconic landmarks and newly minted sporting and urban infrastructure.

The tangible benefits promised to the hosts are then realised in the millions spent by visitors on hotels, restaurants, bars and most importantly tickets.

Ticketing is one of the few areas of economic value in an Olympics that the IOC leaves exclusively to the host to exploit. With no tourists or spectators permitted for the Tokyo Games, the organisers will miss out on an estimated US$800 million (A$1.08 billion) in revenue.

Most events at the games will be held in empty stadiums and arenas.
Keita Iijima/AP

Reputational damage to the IOC

The impact of COVID, of course, could not be helped by the IOC. But the IOC has not helped itself in how it has managed the postponed games. Its adamant insistence that the Olympics go ahead has been seen as arrogant and unsympathetic to Tokyo. The host city contract and insurance policies may mitigate any economic risks to the IOC of pressing ahead, but neither will do much to repair the reputational damage.

Public disquiet over the games has already led Toyota, one of the Olympics’ most important global sponsors, to cancel its Olympic television advertising and decide against sending its executives to the opening ceremony.

Its stance may have a domino effect and see other corporate sponsors follow suit. Approximately 60 Japanese companies have paid a record US$3 billion (A$4.08 billion) to sponsor the games. This had to be topped up by another US$200 million (A$272 million) to extend contracts after the Olympics were postponed. Goodwill among such sponsors towards the IOC is running low.

The vast bulk of the revenue generated by the IOC is not from sponsorship, but television broadcasting deals. In the last Olympic cycle (2013-16), broadcasting rights raised four times more in revenue (US$4.1 billion or A$5.6 billion) than the IOC’s official sponsorship program.

The importance of the broadcasters, especially the US television networks, is reflected by the fact that in making the decision to postpone the games, little to no consideration was given to the option of spreading it out over a longer period of time. This would have provided scheduling flexibility to allow for COVID-related spikes (like the one Japan is currently experiencing).



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But this has not happened. The games are only viable (financially) if they fit a tight window dictated by the US networks. And given the fact crowds have now been banned at most events in Tokyo, this means the games will now almost exclusively be a made-for-TV event.

The main bulk of those allowed to attend events will be members of the IOC executive elite. The image of such executives looking down on competing athletes may reinforce the view that, while the predominately amateur participants have had to endure disruptions to their lives and training schedules and isolate for weeks in order to get to the Olympics, the IOC elite lives in a permanent bubble.

Moreover, as the number of COVID infections among athletes and officials increases, the risks and responsibilities that the IOC has assumed in pushing ahead with the games become more onerous.

Getting athletes to sign waivers may absolve the IOC from its narrow legal responsibility to ensure the health and safety of athletes, but not its moral obligations.

Where does the Olympic movement go from here?

In the longer term, the legacy of the Tokyo games may be quite complex for the IOC. International sports federations will surely have to rethink whether it is wise to rely so heavily on the redistribution of revenue generated by one event every four years and controlled by one dominant, highly political entity – the IOC.

As for future games — even for Brisbane in 2032 — who knows what impact climate change will have on a country’s capacity or willingness to host an event that is responsible for large amounts of carbon emissions through air travel, energy use and construction.



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Leaner, cost-effective, practical: how the 2032 Brisbane Games could save the Olympics

As the games begin, the spotlight rightly focuses on the diverse array of talented athletes from around the globe. For many of us, our love of sport began by watching an Olympics. As a 10-year-old, I sat transfixed when John Treacy of Ireland won silver in the marathon at the 1984 Los Angeles games. As he entered the final straight, the local commentator listed Irish medallists of the past. I still know them by heart.

But if the Tokyo games have made clear, the IOC’s slogan of “Citius, Altius, Fortius” is no longer as potent as it once was. For future hosts, there might be an alternative version to reflect the rather more circumspect view of the IOC and its games – “caveat emptor”, or buyer beware.

Jack Anderson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Grattan on Friday: Morrison wrong to try to influence advice from expert immunisation group

Originally published on theconversation.com

Scott Morrison this week more or less trashed Australia’s top advisory body on immunisation, in remarks that were at best ill-judged and at worst alarming.

On Wednesday Morrison told a news conference he (or the government) made a “constant appeal” to the Australian Technical Advisory Group on Immunisation (ATAGI) to review its advice on AstraZeneca according to the balance of risk.

On Thursday he said on radio: “I’ve just simply said balance of risk is changing, guys, so how is that impacting on your advice, and it’s time to think about that”.

The “guys” (and girls) on ATAGI are obviously as aware as anyone of the changing risk profile as cases increase.

Indeed ATAGI has already altered its advice on AstraZeneca in light of the Sydney outbreak. On July 13 it said where there was an outbreak and the Pfizer supply was constrained, people under 60 without immediate access to Pfizer should “reassess the benefits to them and their contacts from being vaccinated with COVID-19 Vaccine AstraZeneca, versus the rare risk of a serious side effect”.

ATAGI, whose members have qualifications in immunisation and infectious diseases, is charged with advising the health minister on immunisation issues.

There’s no doubt its advice on AstraZeneca has been very cautious. It threw a spanner in the vaccination works when it said that Pfizer (of which Australia doesn’t yet have enough) was preferred for those under 50, and then raised the age to under 60.

This was based on the very small risk of blood clots, which are more likely to occur in younger people. Two more recent deaths associating AZ and clots were announced by the Therapeutic Goods Administration on Thursday – the people were in their 40s.

Whether ATAGI is right or wrong in its caution is disputed.



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But it is not the only expert source in Australia taking this position. A paper by the Kirby Institute’s Raina MacIntyre and other authors published in this month’s issue of the international journal Vaccine reported their “risk-benefit analysis for Australians aged 18–59”, comparing the risk of AZ vaccination with the risk of COVID infection.

The authors concluded: “In Australia, the potential risks of the AZD1222 vaccine in younger adults, who are at low risk of dying from COVID-19, may outweigh the benefits”.

The article also said: “The latest policy decision to avoid use of this vaccine in adults < 60 years in Australia is entirely consistent with past vaccine risk–benefit policy decisions when rare but serious adverse events were identified”.

The authors say their analysis, done after the death of a 48-year-old woman, was “shared with senior health officials in Australia on April 8, 2021”. That was the same day ATAGI advised against AZ for under 50s, with the government announcing this at a hastily-called night news conference.

It’s up to the government whether it accepts whatever ATAGI says – as ATAGI’s remit indicates, it only “advises”.

Certainly we know ATAGI’s advice (and the debate it prompted) contributed to vaccine hesitancy including among those for whom AZ is most appropriate – older people – and this is very unfortunate.

It would be legitimate – if difficult and some would say irresponsible – for Morrison at any point to say he thought ATAGI wrong, that other advisers were telling him something else, and so the government rejected ATAGI’s advice.

But what he – a leader with his back against the wall because of the Pfizer shortage and the rollout shambles – should not do is try to lean on a supposedly independent expert group to change its advice.

The PM’s aim seemed obvious. If ATAGI was pliable, he could say, “this is the new health advice – everyone should follow it”. He would have the best of all worlds.

Or perhaps not. If and when ATAGI changes its advice from now on – even if the PM’s view has nothing to do with that change – will it have the same credibility? Won’t many people, already suspicious and cynical, think: that’s just ATAGI giving into political pressure?

If the perception of ATAGI’s independence is going to be undermined, the usefulness of the body – whatever it says – becomes questionable.

At his Thursday news conference, Morrison tried to re-spin his pressure on ATAGI. He completely respected its advice, he said. “That’s why we’ve followed the advice of ATAGI. It’s my job as prime minister not just to simply accept advice uncritically. Whether it’s sitting in cabinet meetings or in other forums, of course I challenge the advice that I receive. I ask questions. I drill into it. You would expect me to do that. I think Australians would not expect me to just take this advice simply on the face of it.”

Actually, on numerous occasions, the government has made a virtue of just accepting health advice without question.

In the Australian Financial Review two economists, Ashley Craig and Matthew Lilley, have criticised ATAGI for not building into its recommendations social benefits versus risks.

They write: “ask yourself whether ATAGI made the right call by refusing to properly account for social benefits in its advice, which encouraged millions of Australians to delay vaccination”.

“It is not too late to change this message. With millions stuck in lockdowns, ATAGI could instead be emphasising how accelerating vaccinations will make society better off.”

This, however, seems wrong-headed. ATAGI is a narrow, specialist vaccination advisory body. You wouldn’t ask Treasury to assess the effectiveness of Pfizer against AstraZeneca. ATAGI’s advice is part of a wider picture, which government has the job of bringing together into one frame.

The ATAGI episode is just the latest chapter in the evolving story of the role of health experts in this pandemic.

Early on, their status was substantially unquestioned. Morrison and other leaders constantly referred and deferred to them.

But then health officials especially at state level became controversial figures, accused of being political.

Although the federal bureaucrats have not been targets in the same way as state officials, there has been a growing perception their advice is influenced by the political needs of their masters.

This makes it all the more important that independent advisory groups like ATAGI are not perceived as having a political tinge.

As Morrison struggled with what he was saying, or not saying, about ATAGI, on Thursday he did what he hates doing, to get the media off his back on another front.



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He had been under pressure for earlier refusing to say “sorry” for the rollout problems – he’d resisted the word, preferring to say he took responsibility.

But at Thursday’s news conference he said: “I’m certainly sorry that we haven’t been able to achieve the marks that we had hoped for at the beginning of this year. Of course I am.”

He had decided, or been persuaded, that the “sorry” question wouldn’t go away without being dealt with. It might be harder to put the ATAGI questions to rest.

Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

The sunlight that powers solar panels also damages them. ‘Gallium doping’ is providing a solution

Originally published on theconversation.com

Shutterstock

Solar power is already the cheapest form of electricity generation, and its cost will continue to fall as more improvements emerge in the technology and its global production. Now, new research is exploring what could be another major turning point in solar cell manufacturing.

In Australia, more than two million rooftops have solar panels (the most per capita in the world). The main material used in panels is silicon. Silicon makes up most of an individual solar cell’s components required to convert sunlight into power. But some other elements are also required.

Research from our group at the University of New South Wales’s School of Photovoltaics and Renewable Energy Engineering shows that adding gallium to the cell’s silicon can lead to very stable solar panels which are much less susceptible to degrading over their lifetime.

This is the long-term goal for the next generation of solar panels: for them to produce more power over their lifespan, which means the electricity produced by the system will be cheaper in the long run.

As gallium is used more and more to achieve this, our findings provide robust data that could allow manufacturers to make decisions that will ultimately have a global impact.

The process of ‘doping’ solar cells

A solar cell converts sunlight into electricity by using the energy from sunlight to “break away” negative charges, or electrons, in the silicon. The electrons are then collected as electricity.

However, shining light on a plain piece of silicon doesn’t generate electricity, as the electrons that are released from the light do not all flow in the same direction. To make the electricity flow in one direction, we need to create an electric field.



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In silicon solar cells — the kind currently producing power for millions of Australian homes — this is done by adding different impurity atoms to the silicon, to create a region that has more negative charges than normal silicon (n-type silicon) and a region that has fewer negative charges (p-type silicon).

When we put the two parts of silicon together, we form what is called a “p-n junction”. This allows the solar cell to operate. And the adding of impurity atoms into silicon is called “doping”.

An unfortunate side effect of sunlight

The most commonly used atom to form the p-type part of the silicon, with less negative charge than plain silicon, is boron.

Boron is a great atom to use as it has the exact number of electrons needed for the task. It can also be distributed very uniformly through the silicon during the production of the high-purity crystals required for solar cells.

But in a cruel twist, shining light on boron-filled silicon can make the quality of the silicon degrade. This is often referred to as “light-induced degradation” and has been a hot topic in solar research over the past decade.

The reason for this degradation is relatively well understood: when we make the pure silicon material, we have to purposefully add some impurities such as boron to generate the electric field that drives the electricity. However, other unwanted atoms are also incorporated into the silicon as a result.

One of these atoms is oxygen, which is incorporated into the silicon from the crucible — the big hot pot in which the silicon is refined.

When light shines on silicon that contains both boron and oxygen, they bond together, causing a defect that can trap electricity and reduce the amount of power generated by the solar panel.

Unfortunately, this means the sunlight that powers solar panels also damages them over their lifetime. An element called gallium looks like it could be the solution to this problem.

A smarter approach

Boron isn’t the only element we can use to make p-type silicon. A quick perusal of the periodic table shows a whole column of elements that have one less negative charge than silicon.

Adding one of these atoms to silicon upsets the balance between the negative and positive charge, which is needed to make our electric field. Of these atoms, the most suitable is gallium.

Gallium is a very suitable element to make p-type silicon. In fact, multiple studies have shown it doesn’t bond together with oxygen to cause degradation. So, you may be wondering, why we haven’t been using gallium all along?

Well, the reason we have been stuck using boron instead of gallium over the past 20 years is that the process of doping silicon with gallium was locked under a patent. This prevented manufacturers using this approach.

Gallium-doped silicon heterojunction solar cell.
Robert Underwood/UNSW

But these patents finally expired in May 2020. Since then, the industry has rapidly shifted from boron to gallium to make p-type silicon.

In fact, at the start of 2021, leading photovoltaic manufacturer Hanwha Q Cells estimated about 80% of all solar panels manufactured in 2021 used gallium doping rather than boron — a massive transition in such a short time!

Does gallium really boost solar panel stability?

We investigated whether solar cells made with gallium-doped silicon really are more stable than solar cells made with boron-doped silicon.

To find out, we made solar cells using a “silicon heterojunction” design, which is the approach that has led to the highest efficiency silicon solar cells to date. This work was done in collaboration with Hevel Solar in Russia.

We measured the voltage of both boron-doped and gallium-doped solar cells during a light-soaking test for 300,000 seconds. The boron-doped solar cell underwent significant degradation due to the boron bonding with oxygen.

Meanwhile, the gallium-doped solar cell had a much higher voltage. Our result also demonstrated that p-type silicon made using gallium is very stable and could help unlock savings for this type of solar cell.

To think it might be possible for manufacturers to work at scale with gallium, producing solar cells that are both more stable and potentially cheaper, is a hugely exciting prospect.

The best part is our findings could have a direct impact on industry. And cheaper solar electricity for our homes means a brighter future for our planet, too.



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Matthew Wright receives funding from Australian Renewable Energy Agency (RND005).

Brett Hallam receives funding from the Australian Renewable Energy Agency.

Bruno Vicari Stefani receives funding from Australian Renewable Energy Agency (RND005).

Japan signals a ‘sense of crisis’ over Taiwan — this is why it is worried about China’s military aims

Originally published on theconversation.com
A joint drill between Japan’s Ground Self-Defence Force, the U.S. Marine Corps and the French army in Japan this year. KYDPL KYODO/AP

In recent weeks, Japan has signalled a significant foreign policy shift that could have implications for security in the Asia-Pacific region.

Japan’s latest defence white paper, released last week, has for the first time made direct reference to the importance of Taiwan when it comes to peace and security in the region.

Noting an uptick in cross-strait tensions as a result of China’s “intensified military activities around Taiwan”, the document warns that Tokyo will “pay close attention to the situation with a sense of crisis.”

This follows even firmer language from Deputy Prime Minister Taro Aso, who said earlier this month that Japan “would have to defend Taiwan” alongside the United States if it was invaded by China. He later retracted the statement.

China reacted with predictable fury to the statements, both through official channels and its more bellicose media outlets.

Foreign Affairs Ministry spokesman Zhao Lijian decried the white paper as “extremely wrong and irresponsible”. Meanwhile, the Global Times newspaper claimed Japan “will lose badly” if it comes to Taiwan’s aid.

And a more incendiary video appeared on a military commentary channel advocating a nuclear response to any Japanese intervention, before being deleted.

Why Taiwan is a regional flashpoint

The unresolved status of Taiwan has long been considered a potentially dangerous flashpoint in the Asia-Pacific region. As US power has waned and China has become increasingly dominant in recent years, the issue has returned to the fore.

Beijing has never given up on its ultimate aspiration to reclaim what it dubs a “renegade province of China”. In 2005, it passed an “anti-secession law” declaring any attempt by Taipei to translate its de facto sovereignty into formal “independence” would be met by force.



Read more:
China does not want war, at least not yet. It’s playing the long game

Chinese President Xi Jinping has been particularly adamant in his desire to achieve “national reunification”, as he expressed, in colourful language, during the centenary celebration of the Chinese Communist Party in early July.

Having viewed Hong Kong’s unhappy return to the “motherland” in recent years, however, the people of Taiwan have resolved in the words of Foreign Minister Joseph Wu to “defend ourselves to the very last day”, should a Chinese attack actually materialise.

The ruling Democratic Progressive Party in Taipei has been buoyed by the increasing support of the Biden administration, though the US has sought to avoid possible military confrontation with China and stopped short of backing any move toward formal “independence”.

Why Japan is worried

This is where Japan enters the picture. Traditionally, Tokyo has been cautious in offering overt support to Taiwan due to the diplomatic sensitivities with Beijing, a major trading partner.

But for Tokyo, Taiwan’s predicament is indicative of the challenges that a more powerful and assertive China poses to Japan’s own security and to regional stability more widely. This has been heightened by the inexorable shift in the Asia-Pacific balance of power in China’s favour.



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Not only is Japan now more supportive of Taiwan as a fellow democracy, it fears for its own strategic vulnerability should China occupy Taiwan.

This is because Taiwan sits at a crucial strategic chokepoint for naval forces in the western Pacific — the so-called “first island chain” stretching from Japan in the north to the Philippines in the south.

Taiwan is just 100 kilometres from the closest island in Japan’s Ryukyu archipelago, meaning that without Taiwan as a friendly neighbour, Japan’s southern strategic flank would become extremely exposed.

How Japan is stepping up

This has led Japan to adopt a more robust stance in regional security matters, particularly under the leadership of former Prime Minister Shinzo Abe.

In 2015, for instance, Japan passed a controversial “peace and security” law that allowed it to engage in “collective self defence” with allies and strategic partners, providing the opportunity to contribute more meaningfully in any crisis scenario.

Japan has also increased its defence budget (it rose by 0.5% to 5.34 trillion yen or A$66.4 billion this year). And it has emphasised its new military capabilities, such as the retrofit of its helicopter destroyers into de facto aircraft carriers, the creation of an amphibious assault force, and the acquisition of stand-off or strike missiles.

Tokyo has also assumed the mantle of a more vocal regional leader in terms of its diplomacy. This is exemplified by its “Free and Open Indo-Pacific” vision for regional order, which emphasises the promotion of the rule of law, pursuit of economic prosperity and a commitment to peace and stability.

One of the most significant aspects of this “vision” has been the strengthening of bilateral strategic partnerships with countries such as Australia and India. Alongside the US, these countries form the “Quad”, a loose coalition seeking to counteract increasing Chinese dominance of the region.



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Australia would be wise not to pound ‘war drums’ over Taiwan with so much at stake

Is a conflict between Japan and China likely?

Japan is also concerned about increasingly assertive moves by China to expand its maritime reach and exert more pressure on Japan’s Senkaku islands, which are claimed by Beijing (as well as Taiwan) as the Diaoyu islands.

To wit, Japan’s defence white paper notes the sharp increase in the number of Chinese Coast Guard vessels that have entered Japanese territorial waters since 2019, denouncing Chinese “attempts to unilaterally change the status quo by coercion”. Moreover, the Chinese Coast Guard is now empowered to use force against foreign vessels under a new law passed this year.

A Chinese Coast Guard vessel sails near disputed Japanese islands in the East China Sea.
11th Regional Coast Guard/AP

Seeing Taiwan’s plight as part of a larger pattern of Chinese assertiveness is surely a motivator behind Tokyo’s new declaration of interest in the Taiwan issue.

Nevertheless, it is important to underline that Japan is in no sense legally obligated to provide military assistance in a potential conflict over Taiwan. There are still strict legislative restraints on the use of force firmly in place.

Rather, the defence white paper should be viewed as a strong indication that Japan believes it cannot afford to idly stand by as the Asia-Pacific security environment continues to deteriorate. It is therefore assuming greater responsibility to maintain a rules-based order that it believes will provide stability and prosperity for this dynamic region.

Thomas Wilkins receives funding from Japan Institute of International Affairs think-tank in Tokyo – the views expressed here are those of the author and do not necessarily reflect the policy or position of The Japan Institute of International Affairs.

How did I catch a cold in lockdown?

Originally published on theconversation.com

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More than half of Australia is in lockdown in an effort to stem the current Delta strain COVID outbreak, with vast numbers of us steering clear of workplaces, school, retail shops, public transport and other busy places.

If, despite all that, you or your children have developed a sniffle, tested negative for COVID and been forced to conclude it’s just a common cold, don’t worry — you’re not alone.

It’s still reasonably easy to catch a cold even during lockdown. The good news is there’s plenty you can do to greatly reduce the risk.

We cannot avoid germs altogether

The air is much more contaminated than many of us would like to believe. So even if we are isolating from humans, we are still breathing in germs all the time.

Most of them don’t make us sick, thanks to our incredible immune system, but sometimes viruses do sneak past our defences. There have even been outbreaks of the common cold on Antarctic bases after 17 weeks of complete isolation.

Pathogens are part of life, and indeed part of us. We carry around pathogens all the time, including on our skin and up our noses. Most of the time we live in harmony with them.

However, even though our skin and noses are well designed to stop serious pathogens from entering our body, if there’s a breakdown in a barrier — for example, from picking our nose — that can give them a way to get in. In fact, the commonest ways viruses enter our bodies are through our mouth, nose and eyes, which is why we are always being reminded not to touch our faces.

You are still out and about

It’s worth remembering that even during lockdown, many of us still have to go out — for exercise, essential shopping, to seek medical care or for work or compassionate care reasons. So even if you feel locked away and like you’ve not seen friends or family in eons, you have still been out and about.

You can pick up one of the 200 or more viruses that cause what we call the common cold by simply touching a shop counter when you pick up essential groceries, then rubbing the germ into your eye.

Perhaps you pushed a child on the swings and then touched your nose or mouth. A child might have picked up a cold at the playground and brought it home.

Rubbing your eye is a one way to transfer a germ from your hand to your body.
Shutterstock

Viruses that cause the common cold include rhinovirus (which can be airborne and can survive for hours on surfaces under certain conditions). Another virus that causes colds is adenovirus, which can be airborne and has been detected on surfaces.

Once you have actually picked up a cold virus, it may take days before you actually get sick — this is what we call the incubation period, meaning the time between infection with the pathogen, and the onset of symptoms.

Cold viruses can incubate for many days, so it’s possible that even though you or your household members are getting a sniffle now, it was a germ picked up some time ago that has just been biding its time.

And remember: not all “coughs and colds” are actually caused by a virus. For example, whooping cough seems very much like “just a cold” when you first get sick with it. Whooping cough is actually caused by a bacterium, and can survive up to 42 days before it declares itself. For example, my son managed to “catch” whooping cough more than two weeks into lockdown last year. It’s highly likely he picked it up from another child at school before lockdown began, but only developed the cough a fortnight later. Incidentally, he was fully vaccinated as a baby.

Washing hands and wearing masks

What all this shows is that many of us are not as great at washing our hands as we would like to think. Even surgeons, who know how to scrub exceptionally well, still sometimes pass on infections to patients. Viruses are just excellent at surviving and getting past our defences.

So if you’d like to reduce your chances of getting a cold during lockdown — and goodness knows it’s the last thing you need when you’ve got so much else on your plate — remember the basics.

Wash hands often, don’t share utensils, avoid touching your nose, mouth and eyes, wear a mask when you leave the house, and try not to get too close to any other household members who may be coughing and sneezing.

Natasha Yates is a member of RACGP.

We’re paying companies millions to roll out COVID vaccines. But we’re not getting enough bang for our buck

Originally published on theconversation.com

from www.shutterstock.com

How we roll out vaccines is recognised as more important to the success of vaccination programs than how well a vaccine works. And the “last mile” of distribution to get vaccine into people’s arms is the most difficult.

The Morrison government, confronted with a public service ill-prepared for big challenges and with no expertise in rolling out vaccines nationally, has contracted out many aspects of the COVID vaccine rollout to a range of for-profit companies. These include strategies and planning, vaccine distribution, delivery of vaccination programs in aged care, and systems meant to monitor these activities.

To date, vaccine rollout efforts have been clearly inadequate. Government planning has not involved all the possible players and there was no attempt to involve the states and territories in a concerted national effort. Companies have been contracted to give overlapping advice and to provide services where that expertise already exists.

The lack of transparency about how some of these contracts were awarded is also an issue, along with whether the expenditure of taxpayers’ dollars is delivering value and the needed outcomes.

Calling in the consultants

From late 2020, the federal government engaged a raft of consultancies to provide advice on the vaccine rollout. Companies PwC and Accenture were contracted as lead consultants.

PwC was described as a “program delivery partner”. It was engaged to oversee “the operation, and coordinate activities of several actors working on specific functional areas, including — for instance — logistics partners DHL and Linfox”. In other words, PwC was contracted to oversee other contractors.

Accenture was engaged as the primary digital and data contractor to develop a software solution to track and monitor vaccine doses. This included receipt of vaccines by health services, vaccination of patients and monitoring adverse reactions. It received at least A$7.8 million for this work. It is not known if any of these products were delivered or are in use.



Read more:
Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?

McKinsey received a two-month contract worth A$3 million to work with the health department on vaccine issues; EY was contracted for A$557,000 last November to deliver a “2020 Influenza Evaluation and Covid Vaccine System Readiness Review”. Later there was a A$1 million contract to assess vaccine system readiness and provide advice on on-shore manufacturing.

Despite all this “expert” — and expensive — advice, the vaccination rollout has become a shambles and is far behind schedule. So the military (Lieutenant General John Frewen) has been called in to take “operational control of the rollout and the messaging around the rollout”.

Let’s look at distribution and logistics

Last December health minister Greg Hunt announced the government had signed contracts with DHL and Linfox for vaccine distribution and logistics.

The value of the contracts remains undisclosed. However, the 2021-22 federal budget provides almost A$234 million for vaccine distribution, cold storage and purchase of consumables.



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The decision for these companies to be involved in vaccine distribution shocked many in the pharmaceutical supply industry. The government already has a well-established mechanism to supply pharmaceutical products to the most remote areas. It already does this via pharmacies and other outlets as part of the community service obligation funded under the Community Pharmacy Agreement.

This supply network, for which the government pays A$200 million per year, involves a small number of pharmaceutical wholesalers with decades of experience in delivering to pharmacies. In remote areas, the network also delivers to medical services and doctors’ offices. It’s the same network used every year to deliver flu vaccines.

Pharmaceutical wholesalers offered their expertise. But the government did not approach them to undertake this work. The federal government also ignored the capabilities of state hospital systems, which routinely deliver time-sensitive items such as radioisotopes and blood products.



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More contracts, this time for vaccination programs

The federal government took on responsibility for vaccinating people in aged and disability care, and GP respiratory clinics. It has contracts totalling A$155.9 million with Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS to deliver these services.

Despite the fact these companies were selected in January, planning has been abysmal.

Only now have most residents in aged care facilities been fully vaccinated. Meanwhile many workers in these facilities and people receiving and delivering care in the community are yet to receive a jab.

The health department has not made these contracts public, citing “commercial-in-confidence” issues. There has been confusion about what the contracts covered and concern the firms involved are significant Liberal Party donors.

There have been widespread logistical problems with juggling vaccine deliveries, having the workforce available to do vaccinations, and demand. Poor planning has led to cancelled vaccinations in aged care and thousands of doses thrown away in one clinic after problems with temperature-controlled storage.



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Where to next?

The key task now is to get all Australians vaccinated.

This will require a competent, reliable and integrated system operating at full efficiency. Those aspects of the system that are the responsibility of the federal government (or its contractors) must be better coordinated with the efforts of the states and territories, GPs and others involved in the vaccination rollout. That should be a key responsibility of Lieutenant General Frewen.

The effort to get more Australians vaccinated requires the public having trust in the system that will get us there and the communications that accompany that.

We have no way of knowing what advice the government has received and indeed, whether that advice was implemented. For-profit companies have been contracted to perform vital services, but we do not know at what cost to taxpayers and whether key performance indicators are being met — or even if they exist.

Openness and transparency are the pillars on which trust in government is built. Currently they are sadly lacking.

Lesley Russell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

The Lambda variant: is it more infectious, and can it escape vaccines? A virologist explains

Originally published on theconversation.com
The Lambda variant accounts for almost all new cases in Peru, which has the world’s highest COVID death toll per capita. Rodrigo Abd/AP/AAP

The Lambda coronavirus variant was first reported in Peru in December 2020, according to the World Health Organization (WHO).

It then spread to multiple countries in South America, where it currently accounts for over 20% of detected variants.

One case of Lambda was recorded in hotel quarantine in New South Wales in April.

Lambda has now been detected in more than 20 countries around the globe.

The European Centre for Disease Prevention and Control has designated Lambda a “variant under monitoring”, and Public Health England regards it as a “variant under investigation”.

In June this year, the WHO designated it a “variant of interest”. This is due to mutations thought to affect the virus’ characteristics, such as how easily it’s transmitted. Though it’s not yet concerning enough for the WHO to deem it a “variant of concern”, such as Alpha or Delta.

Epidemiological evidence is still mounting as to the exact threat Lamda poses. So, at this stage more research is required to say for certain how its mutations impact transmission, its ability to evade protection from vaccines, and the severity of disease.

Preliminary evidence suggests Lambda has an easier time infecting our cells and is a bit better at dodging our immune systems. But vaccines should still do a good job against it.

Is Lambda more infectious? And can it escape vaccines?

Mutations affecting the spike protein of the SARS-CoV-2 virus can increase infectivity, which is the ability of the virus to infect cells.

What’s more, as many of the coronavirus vaccines currently available or in development are based on the spike protein, changes to the spike protein in new variants can impact vaccine effectiveness

Lambda contains multiple mutations to the spike protein.

One mutation (F490S) has already been associated with reduced susceptibility to antibodies generated in patients who had recovered from COVID. This means antibodies generated from being infected with the original Wuhan strain of COVID aren’t quite as effective at neutralising Lambda.

Another Lambda mutation (L452Q) is at the same position in the spike protein as a previously studied mutation found in the Delta variant (L452R). This mutation in Delta not only increases the ability of the virus to infect cells, but also promotes immune escape meaning the antibodies vaccines generate are less likely to recognise it.

Both mutations F490S and L452Q are in the “receptor binding domain”, which is the part of the spike protein that attaches to our cells.



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Preliminary data on the Lambda spike protein suggests it has increased infectivity, meaning it’s more easily able to infect cells than the original Wuhan virus and the Alpha and Gamma variants. These early studies also suggest antibodies generated in people receiving the CoronaVac vaccine (developed by Chinese biotech Sinovac) were less potent at neutralising the spike protein of Lambda than they were the Wuhan, Alpha or Gamma variants.

It’s worth noting infectivity is not the same as being more infectious between people. There’s not enough evidence yet that Lambda is definitely more infectious, but the mutations it has suggest it’s possible.

A separate small study, also yet to be reviewed by the scientific community, suggests the L452Q mutation in the Lambda spike protein is responsible for its increased ability to infect cells. Like the L452R mutation in the Delta variant, this study suggests the L452Q mutation means Lambda may bind more easily to the “ACE2 receptor”, which is the gateway for SARS-CoV-2 to enter our cells.

This preliminary study suggests Lambda’s spike protein mutations reduce the ability of antibodies generated by both Pfizer and Moderna’s vaccines to neutralise the virus. Also, one mutation was shown to resist neutralisation by antibodies from antibody therapy to some extent.



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However, these reductions were moderate. Also, neutralising antibodies are only one part of a protective immune response elicited by vaccination. Therefore, these studies conclude currently approved vaccines and antibody therapies can still protect against disease caused by Lambda.

Is it more severe?

A risk assessment released by Public Health England in July concedes there’s not yet enough information on Lambda to know whether infection increases the risk of severe disease.

The risk assessment also recommends ongoing surveillance in countries where both Lambda and Delta are present be implemented as a priority. The aim would be to find out whether Lambda is capable of out-competing Delta.

With ongoing high levels of transmission of the coronavirus, there’s a continued risk of new variants emerging. The Lambda variant again highlights the risk of these mutations increasing the ability of SARS-CoV-2 to infect cells or disrupt existing vaccines and antibody drugs.

The WHO will continue to study Lambda to determine whether it has the potential to become an emerging risk to global public health and a variant of concern.

Adam Taylor receives funding from the Australian National Health and Medical Research Council.

‘Die of cold or die of stress?’: Social housing is frequently colder than global health guidelines

Originally published on theconversation.com

Shutterstock

As you huddle inside this winter – possibly as part of a pandemic lockdown – you might be noticing the “thermal performance” of your home. In other words, does your home maintain a comfortable temperature inside, despite cold conditions outside?

If you’re a social housing tenant in New South Wales, the answer may well be no. Our new research examined the relationship between energy consumption and thermal performance in 42 social housing dwellings. We found many homes operated outside the healthy temperature recommendations of the World Health Organisation (WHO) for substantial periods, particularly during winter.

Our research also found many social housing tenants were effectively being forced to choose between keeping their home at a healthy temperature through cooling and heating, and keeping their energy bills manageable. As one tenant told us:

I put the heater on the other night for 20 minutes — it didn’t do much. But the whole time it was on I was freaking about the cost. No good — die of cold or die of stress, take your pick.

Social housing in NSW is often colder than WHO standards.
Shutterstock

The dangers of energy inefficiency

Social housing often brings together low-income households and poor quality building stock.

In Australia, more than one million people live in housing in poor condition – 100,000 of them in very poor or derelict housing.

Yet, little is known about the internal temperatures in social housing, or how tenants experience seasonal temperature change. Our research represents one step to address this knowledge gap.

Exposure to temperatures that are too high or too low has been linked to an increased risk of cardiovascular and respiratory illnesses and other conditions, which can lead to death.

Energy inefficient homes are blamed in part for higher winter death rates in Australia than other much colder nations, such as Sweden. Conversely, research has shown the health benefits of retrofitting housing to improve winter warmth.

Measures to make an existing home more energy efficient include:

insulating the ceiling, and potentially the walls and underfloor
sealing gaps and draught-proofing
installing ceiling fans
improving the efficiency of heating and cooling systems
installing efficient hot water systems
improving windows with shading, heavy curtains or double glazing.



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Insulation helps make a home more energy efficient.
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Our findings

Social housing is provided by government, not-for-profit or private organisations, to tenants who are often vulnerable and marginalised.

We examined the thermal performance of 42 social housing properties in NSW between March 2017 and September 2019. Our study included energy audits monitoring of electrical energy and indoor conditions, and interviews with tenants.

We found substantial under-heating in many of the properties. According to the WHO, the minimum temperature for healthy homes is 18℃. But one-quarter of properties recorded winter temperatures below this for more than 80% of winter. More than half were below 18℃ for more than half of winter.

The problem of overheating in summer was less widespread, but still a significant issue in some homes.

Some households consumed higher-than-average levels of energy despite their low incomes (even after correcting for family size and location) while others used far less than average.

High household energy use was predominately associated with air conditioning use in hot summer climates. In most of these cases, tenants had installed window air-conditioning units with extremely low energy efficiency.

Tenants regularly reported having to forgo thermal comfort to manage their energy bills. To keep power bills down, they also spoke of relinquishing essentials such as daily showers, cooked dinners, night lighting and watching television.



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Social housing tenants often forgo life’s essentials to save on electricity bills.
Shutterstock

What can be done?

The homes in our study subsequently received energy efficiency upgrades, funded by the housing provider and the NSW government. The social housing sector, while operating on tight budgets, is an innovator when it comes to retrofitting existing buildings.

In Australia, social housing upgrade programs typically focus on improving heating, cooling and hot water systems, and in some cases adding solar. This is largely because such upgrades are simple and rooftop solar costs are falling.

However, energy efficiency experts generally say improvements to the building fabric, such as installing insulation and sealing draughts, should be carried out before services to the home are upgraded.

This approach generally requires on-ground assessment of each property and can be difficult and costly to roll out on a large scale. This is a major challenge for housing providers with constrained budgets, and who are often under pressure to deliver new housing.

But building fabric upgrades are long-lasting, don’t increase maintenance costs and deliver benefits regardless of a tenant’s heating and cooling practices.

One social housing tenant told us of the benefits of such upgrades:

[Before the upgrade] I’d have my heater on, say, from half past four of an afternoon ‘til half past eleven, you just would not turn it off. [Since the upgrade] I turn it on at half past four, it’s coming off at about seven o’clock and I don’t need to turn it back on.

While our study involved a small sample size, it provided new empirical evidence of the need for substantial new investment to continue to upgrade the energy performance of our social housing stock. Such upgrades will help reduce energy costs for tenants and enhance their health and well-being.

It would also reduce greenhouse gas emissions, increase resilience to climate change and provide jobs and economic stimulus during the pandemic and beyond.

This story is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay Foundation. Read the rest of the stories here.

Funding for this work was provided by the Cooperative Research Centre for Low Carbon Living and the New South Wales Office of Environment and Heritage

Paul Cooper receives funding from the Australian Research Councili.

Federico Tartarini, Gordon Waitt, Michael Tibbs, and Theresa Harada do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

7 tips for making masks work in the classroom

Originally published on theconversation.com

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With more infectious variants of the COVID-19 virus emerging, teachers and students have been required to wear masks in high school classrooms. It was mandatory in Greater Sydney and all of Victoria before the recent switch to remote learning under lockdowns. Mask wearing has also been compulsory in schools overseas, including parts of the US, Canada and Malaysia.

The new variants appear to have increased infection risks for younger people, and most Australians are not yet fully vaccinated. Until that time, masks may well be one of our best tools to allow a return to face-to-face schooling.



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However, having to wear masks in the classroom may create challenges for teachers and students. Mask-wearing can have negative impacts on all students, although the issues can be greater for students from minority cultures and those with chronic health or disability barriers.

Education is primarily a communication and relational activity. Masks not only hinder the visual communication tools we rely on but can also muffle speech, create discomfort and be psychologically unsettling for some. The word mask is thought to come from the Medieval Latin masca, meaning spectre or nightmare.

Most of the barriers to wearing masks can be overcome. By harnessing the benefits of embracing the mask, classrooms can adapt and thrive during the pandemic. Adopting recommended practices for using masks in the classroom will benefit all students.



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Use masks properly

Openly and regularly discuss mask use with all students. Teach and practise mask etiquette so students understand the need to avoid touching the mask and to touch only the edges if they need to adjust their mask. They may need to do this to maximise comfort and to ensure the mouth and nose are properly covered, protecting the wearer and those around them.

Encourage students to use hand sanitiser, especially after touching the mask.

Remind students to clean reusable masks every day and to dispose of single-use masks.

Encouraging students to use hand sanitiser adds to the protection masks provide.
Shutterstock



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Exaggerate body language and facial expressions

Young people take many visual cues from the mouth of the speaker, while adults take more visual cues from the eyes. When wearing masks covering the lower half of the face, teachers and students will naturally become more aware of upper face expressions.

Exaggeration is helpful to communicate clearly while wearing a mask. Teachers should continue to use natural facial expressions like smiling, such as the “Duchenne smile”, but exaggerate eye gestures and eyebrow movements to aid communication. The face has 42 individual muscles. We should use them all.

Play with facial expressions when using masks and have students read social cues from the eye movements they can see. Make the development of social and emotional intelligence a game of exploration to promote an understanding of psychology and how we react to others. This is merging science and the arts.

Teachers can and should use their whole body to communicate. For example, the teacher can shrug their shoulders when asking a question, or shake or nod their head to communicate a point of view. Exaggerated hand gestures and being near to the students are other helpful strategies.

Wearing a mask means we have to express more with our eyes and body language.
Shutterstock



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Use your voice

Although the mask covers the mouth, teachers can generally still be heard through the cloth. The key here is again a form of exaggeration as well as proximity to the student. Teachers can stay close to their listeners, speak more slowly, articulate all sounds clearly and increase volume.

However, teachers must balance vocal volume with projecting the voice. Teachers can practise diaphragmatic breathing to help avoid vocal straining.

Where possible, try to rely less on talking for teaching. Use PowerPoint and written communication. Keep language simple and straightforward.

In addition, check with students that they can hear and understand. Pay particular attention to children who are deaf or hard of hearing. Speak with them about the situation and take their advice.

Embrace technology

Where possible, use technology such as iPads or IT devices. Choose or make a video clip with subtitles instead of having to speak while wearing a mask. This is particularly important for students who are deaf or hard of hearing.

Use a microphone, carefully placing it near the mouth but not against the mask material.

Don’t panic

Masks do allow enough airflow to breathe comfortably. However, remain vigilant to children who do panic or feel claustrophobic when required to wear a mask. These psychological challenges can be made worse when a child has breathing difficulties such as asthma.

Schedule regular quiet breaks throughout the day – even every hour.

Create a safe space

Staff should try to include a photograph of themselves on their school ID badge, if wearing one. This can help reassure those who feel isolated and uncomfortable when people are wearing masks.

Children with neurological disabilities, such as autism or dyspraxia, will not always have the issues some might expect with wearing a mask. Like all children, they just need to know who we are and why we are all wearing masks.

The most important thing is to communicate. Talk with and listen to students, as the best teachers always do. Let them talk about their masks and take ownership of the situation, and then we can move forward with learning.

Taking the time to talk with individual students and hear what they have to say is most important.
Shutterstock

Following Maslow’s Hierarchy of Needs, children will learn when they know they are safe.

See it as a opportunity to learn

The challenges of mask-wearing can be opportunities. Rather than seeing the mask as a burden, see it as an opportunity to teach and have fun.

Incorporate lessons that look at masks in history, from the earliest Greek plays through to Asian theatre and more recent times. Look at superhero movies, look at politics and public protests. Understand medicine and the use of masks throughout history – why we wear them to keep both ourselves and others healthy.

Explore the inclusive nature of masks and how they can create acceptance and equity. Research has found masks allow children to disassociate from identities and see themselves and others from a more empathetic and accepting perspective.

Many societies where people commonly wore masks prior to COVID, in parts of Asia for example, have thrived. Schools are microcosms of society. The mask is not a barrier to learning. A mask should only be a barrier to the spread of the virus, so mask up and enjoy the masquerade.

Jill Duncan is affiliated with Aussie Deaf Kids, Disability Council NSW, Deafness & Education International.

David Roy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Gender-specific health programmes address important issues, but risk creating new biases

Originally published on theconversation.com

Shutterstock/elenavolf

Gone are the days when health programmes were designed to simply punish or reward people to encourage behaviour change. We now know lasting behaviour change is more complex and nuanced, and this has prompted a proliferation of programmes that attend to factors like motivation, confidence, social support and social determinants of health.

Among such programmes, we’ve observed a trend towards gender-targeted interventions. Examples include programmes for men focusing on rugby fandom as a route to getting them to look after their health, and those for women that concentrate on small, holistic health changes to limit the impact of damaging body ideals.

Health programmes are often tailored for either men or women.
Shutterstock/Nataliia Martseniuk

While biological sex is based on our anatomy and physiology, gender is a socialised identity. Our gendered identities accompany societal expectations of how we should or should not act.

There is no doubt gender shapes how we “do” health — the way we eat, sleep, exercise, connect with others and manage stress. While gender-specific needs are important, a gendered approach may ignore people who identify as neither and it runs the risk of creating new biases.

A case for women-focused health programmes

Women-focused health programmes were arguably developed as an antidote to an overwhelmingly patriarchal society.

The most obvious bias in health research is that much of the data on women’s health has been collected by and from men.

Gendered disadvantages or inequities for women also result from poor representation in leadership positions and unfair norms that place greater expectations on them.

For example, women spend more time than men doing unpaid household work and taking on caring responsibilities. These imbalances trickle down to shape how women spend their time and care for their health.

In response, women-specific research centres have been established in New Zealand and internationally to help close the gap in knowledge regarding women’s health.



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Similarly, organisations like YWCA and Women’s Health Victoria position gendered inequities at the centre of their work and help create a better understanding of how health programmes can effectively support women’s long-term outcomes for behaviour change.

In New Zealand, Shift supports young women to be physically active through a focus on collaboration, fun, building community and leadership. Next Level Health empowers women by using a holistic and weight-neutral approach to behaviour change. This moves the focus away from body weight and defines health more broadly, emphasising well-being, connection to people and place and other behaviours.

As a result, sleep, self-care and stress management become as important as physical activity and nutrition. Such programmes create a more inclusive and relevant vision of health and counteract the body image concerns women often experience due to socialised pressures to attain an “ideal” body.

Men are less likely to seek medical help.
Shutterstock/Chinnapong

‘Tough’ approach to men’s health

Despite a male-dominated health system, men continue to have a higher risk of various health conditions, including coronary heart disease and being overweight.

When it comes to health behaviour programmes, men are notoriously difficult to recruit. This may be due to the fact men are less likely to seek help.

There have been urgent calls for male-specific healthy lifestyle programmes that often use “masculine” male-dominated sports (rugby, football) to entice men to join.

Some, such as Tough Talk, play with stereotypical male traits to encourage men to discuss their health. In parallel with women’s health research, male health research centres are fast becoming commonplace.



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Considering these gender differences, a gendered approach can be justified. Gender equality and health equity are global priorities and such programmes have potential to address them. Playing to peoples’ gendered identities may work for recruitment and effectiveness, too.

Slipping through the cracks

While gendered interventions aim to fill certain gaps, they may actually create new ones, particularly when we consider that many health programmes are funded by nationally competitive grants that often favour projects with potential for greater impact (the biggest slice of the population).

People who identify with the wider group of LGBTQI+ are vulnerable in terms of mental health. This disparity exists because of the greater inequities this community faces.

Some solutions may come from gender-diverse marketing that emphasise gender responsiveness, rather than placing a specific gender at the centre of campaigns.



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Perhaps non-gendered health programmes could create open discussion about how people identify their gender, rather than repeating an inherited gendered story. Admittedly, that might be idealistic for a lifestyle programme.

We’re not arguing against gender-specific programmes. Gender bias in health research is an ongoing issue, among others, that requires targeted action to eliminate harmful inequities.

But we suggest gender responsiveness as a compatible approach for lifestyle programmes, in which gender is embraced but does not drive the programme. A choose-your-own-path approach that allows for diverse identities and autonomy, regardless of gender. Otherwise, the gaps we aim to fill might become gaping holes elsewhere.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.