Corporate influence linked to slow implementation of public health policies globally

Peer-Reviewed Publication

KAROLINSKA INSTITUTET

Implementation of WHO’s recommended public health policies on alcohol, unhealthy foods and tobacco has been slow globally, according to a study led by researchers at Karolinska Institutet and the London School of Hygiene & Tropical Medicine, published in the journal The Lancet Global Health. The study found particularly low implementation in poor, less democratic countries and where corporations had more influence for example through corruption and political favoritism.

In 2013, the World Health Organization’s 194 member states endorsed a list of so-called ‘Best Buy’ policies to combat non-communicable diseases (NCDs), such as heart disease, cancer, diabetes and chronic lung disease.

The list includes 19 interventions targeted at preventing, monitoring and treating NCDs, with a particular focus on harmful products such as tobacco, alcohol and unhealthy foods. These policies could play a vital role in achieving the United Nations’ Sustainable Development Goal target of cutting premature NCD mortality by a third between 2015 and 2030.

In the study, the researchers examined to what extent WHO member states had implemented the policies and analyzed if national level indicators correlated with the degree of implementation. The analysis is based on three so-called NCD progress monitor reports, where the degree of implementation of NCD policies is reported, as well as a framework of national indicators developed by the study authors.

The researchers note that on average, only a third of the public health policies had been fully implemented in 2020. When awarding a half-point for partially implemented policies, the average implementation score was 47 percent in 2020, up from 45.9 percent in 2017 and 39.0 percent in 2015.

Low scores for alcohol, junk food and tobacco measures

Implementation was lowest for policies targeting alcohol, unhealthy foods and tobacco. For example, around two-thirds of countries had not implemented WHO recommended restrictions on marketing of unhealthy food to children in 2020. Implementation of measures targeting alcohol use, including restrictions on sales and advertising, even eased between 2015 and 2020, while for measures targeting tobacco, it improved somewhat. The most widely implemented interventions were clinical guidelines and national action plans and targets to combat NCDs.

“Our study found slow overall implementation of WHO’s recommended NCD policies, especially when it comes to measures targeted at risk factors such as smoking, alcohol and unhealthy foods,” says corresponding author Hampus Holmer, researcher at the Department of Global Public Health, Karolinska Institutet, who conducted the study in collaboration with Luke Allen, research fellow at the London School of Hygiene & Tropical Medicine, U.K., and Professor Simon Wigley at Bilkent University, Turkey.

“This is worrying since non-communicable disease is already the most common cause of death, including premature death, in the world today. Several of these diseases are also linked to an increased risk of dying of infectious diseases such as COVID-19 or tuberculosis,” Hampus Holmer adds.

Progress was especially slow in low-income countries and countries with less democracy. At the bottom of the list are three countries in West Africa—Equatorial Guinea, Guinea-Bissau and Sierra Leone—with one to two partially implemented policies. Norway and Turkey are at the top of the list with 90 percent fully or partially implemented measures.

Correlation with corporate influence

The researchers found that the positive relationship between democracy on implementation was cancelled out in countries with above-average levels of corporate influence. Corporate influence was measured using an existing index with 25 metrics of corporate power, including corruption, bribery, government official favoritism, foreign investments and foreign contributions to political campaigns. Lobbying was not part of the assessment due to a lack of reliable data for many countries, which is a limitation of the study.

“Our analysis shows that corporate political influence is associated with the degree of implementation – the more influence corporations had, the lower the degree of implementation of preventive public health measures,” says Luke Allen, the first author of the study. “While we cannot establish causality, our findings indicate that more work is needed to support particularly low-income countries in introducing effective NCD policies, especially around commercial determinants.”

The researchers also found a significant positive correlation between the proportion of deaths due to NCDs and policy implementation, suggesting that policymakers are more prone to act as the burden of NCDs grows. However, delayed action could be problematic as the impact of prevention may take years to have its full effect.

Funding was provided by the National Institutes for Health Research, the Swedish Research Council, the Fulbright Commission, and the Swedish Society of Medicine. No conflicts of interest were reported.

Publication: “Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.” Luke N Allen, Simon Wigley, Hampus Holmer, The Lancet Global Health, online Oct. 19, 2021, doi: 10.1016/PIIS2214-109X(21)00359-4

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JOURNAL

The Lancet Global Health

DOI

10.1016/PIIS2214-109X(21)00359-4 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

“Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries"

ARTICLE PUBLICATION DATE

19-Oct-2021

Europeans want climate action but show little appetite for radical lifestyle change -– new polling

Reports and Proceedings

UNIVERSITY OF CAMBRIDGE

Europeans want urgent action on climate change but remain committed meat-eaters and question policy proposals such as banning the sale of new petrol vehicles after 2030, according to a new poll from the YouGov-Cambridge Centre for Public Opinion Research that surveyed environmental attitudes in seven European countries, including the UK.

The results – part of a collaboration with Cambridge Zero, the University’s climate initiative – also found that as the UK prepares to host crucial climate talks in Glasgow next month, barely a third of British adults have noticed that the event is taking place.

According to polling conducted last week, just 31% of British adults have read or heard much about COP26 so far, compared with 63% answering to the contrary – either “not very much” or “nothing at all”. These numbers have also barely changed in two months.

When the same question was asked as part of the main, international fieldwork in August, results showed a slightly larger difference of 28% versus 67%. Predictably, the other populations showed even less impact, such as 17% versus 75% in France, 9% versus 84% in Sweden and 7% versus 83% in Germany.

However, the poll indicates that while survey participants may not be following COP26, a significant majority of the 9,000 people polled across the UK, Germany, France, Denmark, Sweden, Spain and Italy strongly support many of the aims of the talks, at least in principle.

Dr Emily Shuckburgh OBE, Director of Cambridge Zero, said:
“As the impacts of climate change are starting to be felt everywhere, COP26 should be seen as a vital summit where the world must deliver immediate and meaningful climate action. But the bad news is that most people have still barely noticed that the world leaders who can actually take the actions needed will be in our own backyard.”

Dr Joel Rogers de Waal, Academic Director of YouGov, said:
“The good news for COP26 organisers is that in every country surveyed, the vast majority are on board with the programme, at least in principle. In each national sample, most agreed that climate change is a genuine phenomenon and a considerable concern, and rejected the idea that its seriousness is being exaggerated.”

Beyond overall terms of debate, however, the same findings also indicate both strong support for certain environmental agendas – the polling showed widespread enthusiasm for “rewilding”, with 70% support in Britain and 79% in Spain for programmes to restore parts of the country to their natural state – and some obvious challenges.

However, when it comes to making lifestyle changes, participants were less enthusiastic. Despite the clear environmental benefits of eating less meat, all seven countries showed majorities who eat meat at least several times a week. Within the meat-eating section of respondents, only a small proportion claimed to have reduced their meat consumption over the past 12 months, and of those, generally around half or under had done so for environmental reasons.

Attitudes towards environmental action at the policy level are a mixed bag. In nearly every country, large portions support the policy of greatly expanding government investment in renewable energy, such as solar, wind and tidal power, including majorities or pluralities in Britain (66%), Germany (52%), Denmark (65%), Sweden (47%), Spain (74%) and Italy (69%). Only France was an outlier in this respect, where just 24% said the same.

But in other areas, public support is tentative and variable, such as bans on the sale of petrol or diesel cars and vans, or a frequent flyer tax.

Poll results also give a sense of public attitudes towards the new environmental activism. Additional polling for the project at the start of September asked British voters two questions regarding Extinction Rebellion – one about methods, the other about message. On the former, a 53% majority said the methods used by the protest group generally go too far, compared with only 10% saying they got the balance about right and 7% saying they didn’t go far enough. On the latter, however, only 38% thought the environmental warnings of Extinction Rebellion generally overstate the situation, next to a combined 41% saying that they describe the situation about right (32%) or even understate it (9%).

“The most powerful protest movements are those that ultimately manage to inspire and co-opt the wider population, creating a sense of social momentum that becomes impossible for the political centre to ignore,” said de Waal. “By contrast, acts of civic vandalism that specifically target the basic necessities of daily life are more likely to do the opposite, since by infuriating the public, they only make it easier for governments to ignore the message behind the action.”

All figures, unless otherwise stated, are from YouGov Plc. Total sample sizes were: Britain= 1767; Germany=2108; France=1035; Denmark=1009; Sweden=1015; Spain=1050; Italy=1000. Fieldwork was undertaken online between 6th – 23rd August, 2021. For each country, the figures have been weighted and are representative of the adult population aged 18+.

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THE LANCET: Urgent action needed to integrate climate change mitigation into COVID-19 recovery plans to address global inequities in health and build a sustainable future

Peer-Reviewed Publication

THE LANCET

NEWS RELEASE 20-OCT-2021

Peer-reviewed/Review

• The Lancet Countdown’s sixth annual report tracks 44 indicators of health impacts that are directly linked to climate change - and shows key trends are getting worse and exacerbating already existing health and social inequities.
• Global leaders have the opportunity to put actions and policies in place that will address these stark inequities, improve health, and deliver economic and environmentally sustainable COVID-19 recovery plans.
• Countries must commit to more ambitious climate plans that incorporate health equity and societal support to ensure a more suitable future for all.  

The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future outlines the growing risks to health and climate. These risks exacerbate the health hazards already faced by many, particularly in communities exposed to food and water insecurity, heatwaves, and the spread of infectious diseases. The authors call for urgent, globally coordinated action to mitigate climate change and build a healthier, sustainable future for all.

• Many current COVID-19 recovery plans are not compatible with the Paris Agreement and will therefore have long-term health implications.
• Despite the detrimental climate effects, the world continues to subsidise fossil fuels. In 2018, 65 out of the 84 countries analysed by Lancet Countdown researchers had net-negative carbon prices equivalent to an overall subsidising of fossil fuels. The median value of the subsidy was US$1 billion, with some countries providing net subsidies to fossil fuels in the tens of billions of dollars each year. The 84 countries surveyed are responsible for around 92% of global CO2 emissions.
• In 2020, adults over 65 were affected by 3.1 billion more days of heatwave exposure than in the 1986–2005 baseline average. Chinese, Indian, American, Japanese, and Indonesian senior citizens were the most affected.
• Climate change and its drivers are creating ideal conditions for infectious disease transmission, potentially undoing decades of progress to control diseases such as dengue fever, chikungunya, Zika, malaria, and cholera.
• Healthcare systems are ill-prepared for current and future climate-induced health shocks. Only 45 (49%) of 91 countries in 2021 reported having carried out a climate change and health vulnerability and adaptation assessment.

The COVID-19 pandemic has demonstrated the need for increased international co-operation in the face of global crises. Politicians must show leadership by moving beyond rhetoric and take action at the upcoming UN Climate Change Conference (COP26), which will start on Sunday 31 October 2021 in Glasgow, Scotland. Carbon emissions must be rapidly reduced to improve health and to provide a more equitable, sustainable future.

 

As countries commit trillions of dollars to restart their economies in the midst of the COVID-19 pandemic, the report urges political leaders and policy makers to use this public spending to reduce inequities. Promoting a green recovery by creating new and green jobs, and safeguarding health, will build healthier populations now and in the future.   

A fossil-fuel driven recovery – which includes large subsidies for oil, gas and coal and limited financial support for clean energy – could potentially meet narrow and near-term economic targets, but may then push the world irrevocably off course and make it impossible to meet the maximum 1.5C of warming as outlined in the Paris Agreement. This has a toll on human health, hardest hitting to those people living in low income countries, whose populations have made the smallest relative contribution to climate change. As governments turn from emergency spending to long term post-pandemic recovery it is vital that more of these funds are spent in ways that reduce climate change, such as promoting jobs in zero-carbon energy, where investment lags behind what is necessary to keep within 1.5C of warming.

The Lancet Countdown report shows that many countries are under-prepared for the health effects of climate change. In a 2021 World Health Organisation survey of health and climate change, only 45 of 91 countries surveyed (49%) say they have a national health and climate change plan or strategy. Only 8 out of those 45 countries in the analysis reported that their assessments of the effects of climate change on their citizens’ health had influenced the allocation of human and financial resources. The survey found 69% of countries in this analysis reported insufficient financing was a barrier to implementing these plans.

“Climate change is here and we’re already seeing it damaging human health across the world,” said Prof Anthony Costello, Executive Director of the Lancet Countdown.   

“As the COVID-19 crisis continues, every country is facing some aspect of the climate crisis too. The 2021 report shows that populations of 134 countries have experienced an increase in exposure to wildfires. Millions of farmers and construction workers could have lost income because on some days it’s just too hot for them to work. Drought is more widespread than ever before. The Lancet Countdown’s report has over 40 indicators and far too many of them are flashing red.   

“But the good news is that the huge efforts countries are making to kick-start their economies after the pandemic can be orientated towards responding to climate change and COVID-19 simultaneously. We have a choice. The recovery from COVID-19 can be a green recovery that puts us on the path of improving human health and reducing inequities, or it can be a business-as-usual recovery that puts us all at risk.” [1]

The Lancet Countdown report represents the consensus of leading researchers from 38 academic institutions and UN agencies. The 44 indicators in the 2021 report expose an unabated rise in the health impacts of climate change: 

• The potential for outbreaks of dengue, chikungunya and Zika is increasing most rapidly in countries with a very high human development index, including European countries. Suitability for malaria infections is increasing in cooler highland areas of countries with a low human development index. Coasts around northern Europe and the US are becoming more conducive to bacteria which produce gastroenteritis, severe wound infections, and sepsis. In resource-limited countries the same dynamic is putting decades of progress towards controlling or eliminating these diseases at risk.
• There are 569.6 million people living less than five metres above current sea levels, who could face rising risks of increased flooding, more intense storms, and soil and water salinification. Many of these people could be forced to permanently leave these areas and migrate further inland.

Maria Romanello, lead author of the Lancet Countdown report, said:

“This is our sixth report tracking progress on health and climate change and unfortunately we are still not seeing the accelerated change we need. At best the trends in emissions, renewable energy and tackling pollution have improved only very slightly. This year we saw people suffering intense heatwaves, deadly floods and wildfires. These are grim warnings that for every day that we delay our response to climate change, the situation gets more critical. 

“Governments are spending trillions of dollars on the recovery from the COVID-19 pandemic. This gives us an opportunity to take a safer, healthier, low carbon path, but we have yet to do so. Less than one dollar in five being spent on the COVID-19 recovery is expected to reduce greenhouse gas emissions and the overall impact is likely to be negative. We are recovering from a health crisis in a way that’s putting our health at risk.  

“It’s time to realise that no one is safe from the effects of climate change. As we recover from COVID-19 we still have the time to take a different path and create a healthier future for us all.” [1]

A Lancet Editorial adds, “The world is watching COP26—widely perceived as the last and best opportunity to reset the path to global net zero carbon emissions by 2050—and public interest in climate change is higher than ever, in part due to global youth activism and engagement…This year’s indicators give a bleak outlook: global inequities are increasing, and the direction of travel is worsening all health outcomes. Health services in low-income and middle-income countries are in particularly urgent need of strengthening…However, the future is not necessarily hopeless…Succumbing to the climate emergency is not inevitable.”

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Key report findings

Just as the world is failing to deliver an equitable supply of COVID-19 vaccines, the data in this report exposes similar inequities in the global response to climate change. In general, it is the countries lowest on the human development index that are often least responsible for rising greenhouse gas emissions and are lagging behind in climate change adaptation and mitigation efforts and in realising the associated health benefits of accelerated decarbonisation.

• In 2020, up to of 19% of the global land surface was affected by extreme drought in any given month, a value that had not exceeded 13% between 1950 and 1999.
• Climate change is driving an increase in the frequency, intensity, and duration of drought events, threatening water security, sanitation, and food productivity, and increasing the risk of wildfires and exposure to pollutants. The five years with the most areas affected by extreme drought have all occurred since 2015. The Horn of Africa, a region impacted by recurrent extreme droughts and food insecurity, was one of the most affected areas in 2020.
• Climate change threatens to accelerate food insecurity, which affected 2 billion people in 2019. Rising temperatures shorten the time in which plants reach maturity, meaning smaller yields and an increased strain on our food systems. Maize has seen a 6% decrease in crop yield potential, wheat a 3% decrease and rice a 1.8% decrease, compared to 1981 – 2010 levels.
• Average sea surface temperature has increased in the territorial waters of nearly 70% (95 out of 136) of coastal countries analysed, compared to 2003-2005. This reflects an increasing threat to their marine food security. Worldwide 3.3 billion people depend on marine food.
• In 2021 the World Health Organisation found just over half of countries that answered to the Health and Climate Change Global Survey (37 out of 70) had a national health and climate change strategy in place, a similar proportion to 2018. Nearly three-quarters of countries surveyed said finances prevented them developing such a strategy, with others citing a lack of skilled people, being restricted by COVID-19 and lacking research and evidence.
• Globally, climate change adaptation funding directed at health systems represents just 0.3% of total climate change adaptation funding.

NOTES TO EDITORS

This study was funded by Wellcome Trust. A full list of researchers and institutions is available in the paper.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

[1] Quote direct from author and cannot be found in the text of the Article.

IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: https://www.thelancet.com/countdown-health-climate

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JOURNAL

The Lancet

DOI

10.1016/S0140-6736(21)01787-6 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future

ARTICLE PUBLICATION DATE

20-Oct-2021

Salmon decline impacted by “squeeze” of combined river and sea stressors

Study traces 40 years of change on Vancouver Island river-to-sea salmon and trout pathway

Peer-Reviewed Publication

SIMON FRASER UNIVERSITY

 

IMAGE: COHO SMOLT. view more 

CREDIT: JULIAN GAN

Researchers from Simon Fraser University’s Salmon Watershed Lab have found that recent declines of Pacific salmon and trout are associated with 40 years of changes in their combined marine and freshwater ecosystems. 

Led by lab researcher Kyle Wilson, the study found that stressors in both environments combine to impact fish resiliency. “It’s not just the ocean that is driving declines,” says Wilson, a former SFU Banting postdoctoral fellow. “The combination of marine and freshwater stressors effectively ‘squeezes’ some salmon populations by lowering survival in both the river and the sea.” 

The study, published today in the journal Global Change Biology, traces declining numbers in five salmon species found in the Keogh River near Port Hardy on Vancouver Island. 

The declines were found to coincide with combinations of stressful environmental changes including fluctuating ocean climate, increases in coastal seals and other competing salmon, warmer water temperatures, and increased watershed logging.

CAPTION

Keogh sampling.

CREDIT

Colin BaileyWilson says the study findings can help inform policies such as the federal government’s recent Pacific Salmon Strategy Initiative (PSSI) which will allocate $647.1 million to a wide variety of conservation and scientific efforts to help recover salmon. 

CAPTION

Morice Steelhead.

CREDIT

Jonathan Moore

The research was carried out by Wilson and SFU biology professor Jonathan Moore, along with lab researchers Colin Bailey and Provincial collaborator Trevor Davies. The study’s research funders include the Habitat Trust Conservation Fund. 

CAPTION

Keogh e-fishing sampling 2020.

CREDIT

Sean Naman

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JOURNAL

Global Change Biology

DOI

10.1111/gcb.15895 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Animals

CAPTION

Keogh Steelhead.

CREDIT

Kyle Wilson

ARTICLE TITLE

Marine and freshwater regime changes impact a community of migratory Pacific salmonids in decline

ARTICLE PUBLICATION DATE

20-Oct-2021

USA

How political partisanship governed in-person schooling during pandemic

Peer-Reviewed Publication

MICHIGAN STATE UNIVERSITY

 

IMAGE: A KEY PREDICTOR OF WHETHER A SCHOOL OFFERED ONLY REMOTE INSTRUCTION WAS THE PROPORTION OF THE COUNTY THAT VOTED DEMOCRATIC IN THE 2016 PRESIDENTIAL ELECTION, THE RESEARCH FOUND. view more 

CREDIT: CREATIVE COMMONS VIA PEXELS

One of the most controversial topics related to the COVID-19 pandemic, in-person schooling, wasn’t necessarily determined by the severity of the virus. New research from Michigan State University reveals how political partisanship influenced schools’ reopening plans amid the global pandemic.

The study, published in the journal Educational Researcher, showed that partisan politics played a large role in local decisions about whether students would attend school in person in the fall of 2020 — a more prominent role than COVID severity, in fact.

“A key predictor of whether a school offered only remote instruction was the proportion of the county that voted Democratic in the 2016 presidential election,” said Sarah Reckhow, associate professor of political science. “Based on public opinion polling in Michigan, partisanship and support for Trump were also strong predictors of the public’s support for offering in-person school.”

In counties that voted heavily Democratic, Reckhow said that the data showed school districts were almost three times as likely to open fully remote in fall 2020. In heavily Republican counties, school districts were nearly 1.8 times more likely to offer in-person instruction. School districts in political battleground counties were in the middle.

The study also found that partisan politics did not play a major role in state-level decisions — governors ordered school closures in spring 2020 and left decisions to districts in the fall of 2020, regardless of partisanship.

The study was co-authored by Matthew Grossmann, director of MSU’s Institute for Public Policy and Social Research and professor of political science; Katharine Strunk, professor of education policy and the Clifford E. Erickson Distinguished Chair in Education; and Meg Turner, project manager for MSU’s Education Policy Innovation Collaborative. The researchers collected and analyzed data on COVID-19 rates, educator unionization, presidential voting records, district demographics, state education policies since the start of the pandemic, local district reopening plans and public opinion on reopening in the politically competitive state of Michigan.

Surprisingly, the study showed that it took quite a bit of time for the policy response on education during the pandemic to become polarized.

In spring of 2020, the response from states was consistent, regardless of the party of their governors. “It wasn’t until fall 2020 that we saw partisan polarization become a key factor in both local district decision making and public opinion,” Reckhow said.

While relying on local constituencies to implement challenging choices may be a simpler option for the federal system, the researchers hope their findings serve as a warning: Partisanship and polarization matter in local decisions, even when the boards making those decisions are officially “nonpartisan” elected officers.

“COVID-19 continues to divide communities and leaving decisions up to local control doesn’t mean that local public health conditions will guide decision making,” Reckhow said. “If state leaders want local officials to be more responsive to local context and conditions than partisan attitudes, then more guidance and direction from the state likely would be required.”

(Note for media: Please include the following link to the study in all online media coverage: https://journals.sagepub.com/doi/10.3102/0013189X211048840)

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JOURNAL

Educational Researcher

DOI

10.3102/0013189X211048840 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

All States Close but Red Districts Reopen: The Politics of In-Person Schooling During the COVID-19 Pandemic

ARTICLE PUBLICATION DATE

24-Sep-2021

Canada should limit use of forceps in childbirth to prevent lifelong injuries to women: Study

Education about the risks needed for both clinicians and mothers, say University of Alberta experts on incontinence

Peer-Reviewed Publication

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

Canada has an alarmingly high rate of forceps use during childbirth and a correspondingly high number of preventable injuries to mothers, according to recently published research from an international team of incontinence experts. 

The researchers call for a reduction in the number of births by forceps in Canada and better education for both clinicians and mothers on how to avoid injury when forceps are required. 

“Often women who have had this type of delivery are completely shell-shocked because they’ve got infection, they’ve got pain, they’ve got a newborn and they had no idea that this was even a possibility,” said co-principal investigator Jane Schulz, professor and chair of obstetrics and gynecology in the Faculty of Medicine & Dentistry.

“Education is needed for both patients and health providers that this is a potential complication,” said Schulz, who is also a urogynecologist with the pelvic floor clinic at the Lois Hole Hospital for Women and the Alberta Women’s Health Foundation Chair in Women’s Health Research.

The injuries can lead to immediate or long-term complications including poor healing, infection, chronic pain, sexual dysfunction, bladder or bowel incontinence and pelvic organ prolapse. 

“These birth injuries sometimes result in conditions which are extremely troublesome in later life,” said co-principal investigator Adrian Wagg, division director of geriatric medicine and scientific director for the AHS Seniors’ Health Strategic Clinical Network.

“This is a call to action for Canadian providers in terms of quality improvement,” said Wagg, who is also Alberta Health Services Endowed Professor of Healthy Ageing and professor of continence sciences at the University of Gothenburg.

The researchers analyzed nearly two million birth records from Canada, Norway, Sweden and Austria, focusing on women who were giving birth for the first time or had a vaginal birth after caesarean section (VBAC). 

Overall, five per cent of the women had third or fourth degree tears to the perineum — the area between the vagina and the anus. Canada and Sweden had the highest rates of injury, and Austria and Norway the lowest.

The injuries were associated with the use of instruments — either a vacuum or forceps — during delivery. About one in four pregnancies was delivered using instruments in both Canada and Norway in 2016, but the researchers found that Canadian women had a much higher rate of injury: 24.3 per cent of the Canadian mothers with forceps deliveries were injured, compared with 6.2 per cent in Norway. 

“We’re not doing well compared to other countries that were chosen based on similar social demographics and health-care services,” Schulz said.

Schulz explained that the forceps can cause either mechanical or neurological trauma to the pelvic floor of the mother. 

“They are kind of like large sugar tongs. You put them on the baby’s head and pull the baby out,” she said. “The blades go around the baby’s head and can potentially tear muscles and ligaments of the pelvic floor or cause damage to the nerves that supply the pelvic floor.”

Norway introduced a perineal protection program in 2004 that has led to a sharp decline in injuries. Physicians, midwives and nurses are taught techniques to prevent perineal damage, such as how to slow down the second stage of delivery when the infant’s head is crowning, how to avoid pushing during crowning and when to perform an episiotomy (a surgical cut to the perineum to prevent tearing). 

“They also have education around how to recognize an injury, repair it, make sure antibiotics are given and then follow up to ensure it has healed,” said Schulz.

Schulz noted that some women are at higher risk of injury during childbirth due to factors such as having a larger baby or a shorter perineum. 

Schulz and Wagg said they intend to work with obstetrical health providers, potentially through groups such as the Society of Obstetricians and Gynaecologists of Canada, to improve education for clinicians and provide better information for new mothers.

“Obstetrical care providers go through a checklist of things at prenatal visits including nutrition, genetic screening options, vaccinations and routine prenatal testing, but this is often something that is not discussed, so patients are unaware,” said Schulz.

“I advocate for women to be fully informed about their options in childbirth and counsel women to avoid forceps if at all possible,” said Wagg. “Caesarean section is the fallback option, although of course we know there are other concerns about the health of the infant (such as immune changes), so it’s important to discuss beforehand.”

In an earlier study, Schulz reported on how the perineal clinic in Edmonton, started in 2011, helps women injured in childbirth. Patients are seen within six weeks of delivery so they can be assessed and treated by a team of physicians, nurses and physiotherapists. A team of researchers and clinicians with diverse specialties including geriatrics, obstetrics and gynecology, and urology continues to look for ways to enhance care for patients with pelvic floor problems. 

Both Wagg and Schulz are members of the Women and Children’s Research Health Institute. The study was funded by the Gothenburg Continence Research Centre, of which Wagg is co-director. 

Wagg noted that one in four Canadian women over the age of 65 has a bladder problem and a quarter of them inaccurately believe it’s normal to be incontinent just because they are getting older — which may prevent them from seeking medical help for what may be the result of an injury. 

“We see this as a real opportunity to improve the quality of care for Canadian women,” he said.

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JOURNAL

Acta Obstetricia Et Gynecologica Scandinavica

DOI

10.1111/aogs.14244 

ARTICLE TITLE

Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden

ARTICLE PUBLICATION DATE

25-Aug-2021

 

Traces of an ancient road in a lake

by Helmholtz Association of German Research Centres

From a raft the team uses a hollow cylinder to punch through the lake bottom thus getting 

sediments with layers. The layers are called warves and preserve traces from historic

 developments and landscape changes, e.g. pollen or ashes. Credit: Achim Brauer/GFZ

Anyone traveling from the German city of Brandenburg via Berlin to Frankfurt an der Oder at the Polish-German border does so along an ancient route that reaches far into Poland. German and Polish researchers have now documented the influence of this East-West connection on the history of the landscape by examining the sediments of Lake Czechowskie in the Bory Tucholskie and also evaluating historical sources. According to the results, three phases of landscape development can be distinguished in the last eight hundred years: from an almost untouched landscape through an intermediate phase lasting several centuries—characterized by alternations between strong settlement activity and the return of nature after wars—to today's cultural landscape.

One of the two main authors, Achim Brauer of the GFZ German Research Centre for Geosciences in Potsdam, says: "Wars had a clear influence, as the Via Marchionis was repeatedly used for troop transports that led to local destruction and devastation. In this study, for the first time, we have shown the impact on the landscape for every war in the region's history. In general, wars have led to greater or lesser devastation ('renaturalization') of the landscape, which has also lasted for varying lengths of time."

At other times, it was political developments that left their mark on the landscape, such as an agrarian reform in 1343, which led, with a certain time lag, to an accelerated "anthropogenization" of the landscape, that is, to clearly visible human influence. In the sediments of Lake Czechowskie this is shown by a strong increase of rye pollen and the decrease of birch and pine pollen.

Because sediments in a lake exhibit annual stratification similar to tree rings, the German-Polish team was able to pinpoint the year from which pollen originated by counting the individual layers ("warves") down to a resolution of five years. According to this, the landscape remained largely untouched by humans until about 1350 AD. Extensive forests and natural grasses dominated. Then followed five turbulent centuries. The expansion of agriculture and the formation of larger towns were favored by a warm climate and politically calm times. However, between 1409 and 1435 there was war between the Teutonic Order and Poland—fields became fallow land, forests expanded again. After peace was concluded, five quiet decades followed again, during which an increase in handicrafts was also evident. Hardwood was cut to obtain building material and potash—thus, birch pollen disappeared from lake sediments, rye again increased massively.

Sediments from the bottom of lakes are often layered. The individual layers, called warves, preserve information from the past and can be "read" like tree rings. By identifying pollen or ashes, landscape evolution, climate and even political events can be traced. Credit: Achim Brauer/GFZ

Huge army campaigns with thousands of riders and foot soldiers, plague epidemics in several waves and some very cold years with crop failures are also documented. Then, from the middle of the 19th century, the influence of agriculture, settlements and economic activity took over to such an extent that one can speak of a predominantly human influence, which continues to this day.

First author Michał Słowiński says that "the most important result is that this development did not take place uniformly. Rather, we see an alternation of phases of rapid development and significant regressions. The reasons for this are complex interactions of socio-economic, political and climatic factors."

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More information: Michał Słowiński et al, The role of Medieval road operation on cultural landscape transformation, Scientific Reports (2021). DOI: 10.1038/s41598-021-00090-3

Journal information: Scientific Reports 

Provided by Helmholtz Association of German Research Centres