Health: a complex and intertwined problem

Abstract

This issue of the MJA covers a wide spectrum of topics, ranging from nuclear war — possibly the biggest potential threat to human health — through to articles on a variety of topics of practical clinical relevance.

Beginning with an editorial on nuclear war,¹ this multijournal, international editorial is targeted to support work being undertaken at the World Health Assembly to lobby for the re-establishment of a mandate at the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.

This editorial follows on from one published in 2023 from the same group of international authors, including from this journal.² That editorial called for a range of actions, including a verifiable, timebound agreement to eliminate nuclear arsenals. The lack of progress on these aims makes this current editorial even more important.

Medical professionals have a unique authority to advocate on the dangers of nuclear war and the editorial reinforces that: “Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations comprehensive study on the effects of nuclear war”. The urgency and rationale for these calls are clear. As this new editorial states, there is “compelling evidence of the catastrophic humanitarian consequences of nuclear war, its severe global climatic and famine consequences, and the impossibility of any effective humanitarian response”. We will continue to advocate with colleagues internationally on this threat.

Turning to articles of immediate clinical importance, especially as we head into the southern hemisphere winter, this issue includes a highly topical pair of articles on respiratory syncytial virus (RSV) infection — a disease that predominantly affects infants, the most vulnerable in our community.

The first, a research letter by Bloomfield and colleagues,³ reports exciting new information on the effect of nirsevimab immunisation of infants on RSV-associated hospitalisations from Western Australia in 2024. This research letter describes outcomes after the approval of nirsevimab in November 2023 in Australia and then a commitment by the WA government to an age-inclusive universal nirsevimab program. The research letter reports that “immunising 71% of infants prior to and during the RSV season was associated with 57% fewer admissions [from RSV]”. These are important initial results. Implementation and monitoring are ongoing on a national level; these results will be important for future programmatic planning. The second article, a narrative review by Barnett and colleagues,⁴ describes the current state of RSV preventives for children and outlines the logistical and other considerations for future immunisation programs.

Finally, the MJA has an ongoing interest in publishing on climate and health and the last article I’ll highlight from this issue is a perspective by Bone and colleagues⁵ on the role of fans in protection from heat-related illnesses. As the authors note, air conditioning has been widely adopted and is currently the leading cooling strategy used globally. But access to air conditioning is neither universally distributed nor used for a variety of reasons, including cost, leading to inequity in its actual utility. The authors acknowledge the intuitive appeal of air conditioning, especially in large public facilities (such as the one where I am writing this article). They discuss, however, the case for doctors and the wider public to better understand the rationale for the use of fans instead. As the climate changes and warms, equitable approaches to addressing the prevention and treatment of heat-related illnesses are increasingly critical.

As all these articles highlight, health, or the lack of it, is rarely a simple clinical issue. Solutions are not individual but often complex and intertwined. Effective health measures require whole-of-system approaches — financial, social and political.