Myths and stigma about ADHD contribute to poorer mental health for those affected


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David Coghill, The University of Melbourne; Alison Poulton, University of Sydney; Louise Brown, Curtin University, and Mark Bellgrove, Monash UniversityAround one in 30 Australians (or 3.4% of the population) have attention-deficit hyperactivity disorder (ADHD). Yet it remains a poorly understood and highly stigmatised disorder.

Our new paper, which reviews the research on community attitudes about ADHD, found misconceptions are common and affect the way people with ADHD are treated and see themselves.

Stigma is an underestimated risk factor for other negative outcomes in ADHD, including the development of additional mental health disorders such as anxiety, depression, alcohol and substance abuse, and eating disorders.

Stigma is also likely to contribute to the increased risk of suicide, with people with ADHD three times more likely than the rest of the population to take their own life.

Early recognition and treatment of ADHD significantly improves the physical, mental and social outcomes of people with the condition who, like everyone else, deserve to live full and rewarding lives.

No, ADHD isn’t caused by too much TV

Our review of the research found many people erroneously attribute ADHD symptoms – particularly in children – to exposure to TV or the internet, lack of parental affection, or being from a broken home.




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Rather, ADHD is a complex disorder that results from inherited, genetically determined differences in the way the brain develops.

People with ADHD have persistent patterns of hyperactive, impulsive and inattentive behaviour that are out of step with the rest of their development. This can affect their ability to function and participate in activities at home, at school or work, and in the broader community.

Boy looks at computer screen with hand in hair, thinking.
ADHD can affect your ability to concentrate.
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There are clear criteria for diagnosing ADHD, and a diagnosis should only be made by a specialist clinician following a comprehensive medical, developmental and mental health review.

No, ADHD isn’t routinely overdiagnosed

Our review of the research found three-quarters of Australian study participants believe the disorder is overdiagnosed.

Based on the international research, an estimated 850,000 Australians are living with ADHD.

Yet current rates of diagnosis are much lower than this, particularly in adults where fewer than one in ten have received a diagnosis.

There is also widespread scepticism in the community about the use of medicines to treat ADHD.

Medication is only one part of the management of ADHD which should always include educational, psychological and social support.

Clinical evidence does, however, support the use of prescription medications as a key part of the treatment for ADHD. And there is evidence to show these medications are seen as helpful by those who take them.




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My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?


Although rates of medication treatment have increased over the years, less than one-third of Australian children with ADHD and fewer than one in ten adults with the condition are currently receiving medication. This is much lower than expected, based on international guidelines.

How this stigma feels

People with ADHD can struggle with day-to-day things other people find easy, with little understanding and acknowledgement from others.

Typical examples include butting in to others’ conversations and activities, leaving tasks half done, being forgetful, losing things, and not being able to follow instructions.

The response to these behaviours from family, teachers and friends is often negative, critical and relentless. They’re constantly reminded of just how much they struggle with the day-to-day things most people find easy.

Teenage boy in a hoodie stands against a wall, looking down
People with ADHD know they’re being judged.
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Our review found young people are particularly affected by this judgement and stigma. They’re aware they’re viewed by others in a negative light because of their ADHD and they commonly feel different, devalued, embarrassed, unconfident, inadequate, or incompetent.

Some respond to this constant criticism by acting out with disruptive and delinquent behaviours, which of course usually just escalates the situation.

Stigma can be a barrier to treatment

The perception and experience of stigma can influence whether a parent decides to have their child assessed for ADHD, and can leave parents underestimating the risks associated with untreated ADHD.

The confusion about what parents should believe can also affect their ability to make informed decisions about the diagnosis and treatment of their child. This is concerning because parents play a vital role in ensuring health professionals properly recognise and support their child’s health needs.

When diagnosis is delayed until adulthood, people with ADHD are four times more likely to die early than the rest of the population. This not only reflects the increased risk of suicide, but also an increase in serious accidents which arise due to impulsive behaviours.




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ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed


When we treat people with ADHD, many of these problems dramatically improve. It’s not uncommon for someone who has recently started on treatment to say, “wow, I didn’t know life was meant to be like this”.

Treatment also improves the physical, mental and social well-being for children and adults with the disorder.


If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or visit Headspace.The Conversation

David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne; Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney; Louise Brown, PhD candidate, Curtin University, and Mark Bellgrove, Professor in Cognitive Neuroscience, Director of Research, Turner Institute for Brain and Mental Health; President Australian ADHD Professionals Association (AADPA, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Global herd immunity remains out of reach because of inequitable vaccine distribution – 99% of people in poor countries are unvaccinated


A COVID-19 field hospital in Santo Andre, Brazil. The pandemic has killed over 503,000 people in Brazil; just 11% of the population is fully vaccinated.
Mario Tama/Getty Images

Maria De Jesus, American University School of International ServiceIn the race between infection and injection, injection has lost.

Public health experts estimate that approximately 70% of the world’s 7.9 billion people must be fully vaccinated to end the COVID-19 pandemic. As of June 21, 2021, 10.04% of the global population had been fully vaccinated, nearly all of them in rich countries.

Only 0.9% of people in low-income countries have received at least one dose.

I am a scholar of global health who specializes in health care inequities. Using a data set on vaccine distribution compiled by the Global Health Innovation Center’s Launch and Scale Speedometer at Duke University in the United States, I analyzed what the global vaccine access gap means for the world.

A global health crisis

Supply is not the main reason some countries are able to vaccinate their populations while others experience severe disease outbreaks – distribution is.

Many rich countries pursued a strategy of overbuying COVID-19 vaccine doses in advance. My analyses demonstrate that the U.S., for example, has procured 1.2 billion COVID-19 vaccine doses, or 3.7 doses per person. Canada has ordered 381 million doses; every Canadian could be vaccinated five times over with the two doses needed.

Overall, countries representing just one-seventh of the world’s population had reserved more than half of all vaccines available by June 2021. That has made it very difficult for the remaining countries to procure doses, either directly or through COVAX, the global initiative created to enable low- to middle-income countries equitable access to COVID-19 vaccines.

Benin, for example, has obtained about 203,000 doses of China’s Sinovac vaccine – enough to fully vaccinate 1% of its population. Honduras, relying mainly on AstraZeneca, has procured approximately 1.4 million doses. That will fully vaccinate 7% of its population. In these “vaccine deserts,” even front-line health workers aren’t yet inoculated.

Haiti has received about 461,500 COVID-19 vaccine doses by donations and is grappling with a serious outbreak.

Even COVAX’s goal – for lower-income countries to “receive enough doses to vaccinate up to 20% of their population” – would not get COVID-19 transmission under control in those places.

The cost of not cooperating

Last year, researchers at Northeastern University modeled two vaccine rollout strategies. Their numerical simulations found that 61% of deaths worldwide would have been averted if countries cooperated to implement an equitable global vaccine distribution plan, compared with only 33% if high-income countries got the vaccines first.

Put briefly, when countries cooperate, COVID-19 deaths drop by approximately in half.

Vaccine access is inequitable within countries, too – especially in countries where severe inequality already exists.

In Latin America, for example, a disproportionate number of the tiny minority of people who’ve been vaccinated are elites: political leaders, business tycoons and those with the means to travel abroad to get vaccinated. This entrenches wider health and social inequities.

The result, for now, is two separate and unequal societies in which only the wealthy are protected from a devastating disease that continues to ravage those who are not able to access the vaccine.

A repeat of AIDS missteps?

This is a familiar story from the HIV era.

In the 1990s, the development of effective antiretroviral drugs for HIV/AIDS saved millions of lives in high-income countries. However, about 90% of the global poor who were living with HIV had no access to these lifesaving drugs.

Concerned about undercutting their markets in high-income countries, the pharmaceutical companies that produced antiretrovirals, such as Burroughs Wellcome, adopted internationally consistent prices. Azidothymidine, the first drug to fight HIV, cost about US$8,000 a year – over $19,000 in today’s dollars.

That effectively placed effective HIV/AIDS drugs out of reach for people in poor nations – including countries in sub-Saharan Africa, the epidemic’s epicenter. By the year 2000, 22 million people in sub-Saharan Africa were living with HIV, and AIDS was the region’s leading cause of death.

The crisis over inequitable access to AIDS treatment began dominating international news headlines, and the rich world’s obligation to respond became too great to ignore.

“History will surely judge us harshly if we do not respond with all the energy and resources that we can bring to bear in the fight against HIV/AIDS,” said South African President Nelson Mandela in 2004.

A girl with sores on her face and a red bow in her hair bows her head in prayer; pill bottles are seen in the foreground
A 9-year-old girl in Johannesburg, South Africa, prays before taking her twice-daily HIV medications in 2002.
Per-Anders Pettersson/Getty Images

Pharmaceutical companies began donating antiretrovirals to countries in need and allowing local businesses to manufacture generic versions, providing bulk, low-cost access for highly affected poor countries. New global institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria were created to finance health programs in poor countries.

Pressured by grassroots activism, the United States and other high-income countries also spent billions of dollars to research, develop and distribute affordable HIV treatments worldwide.

A dose of global cooperation

It took over a decade after the development of antiretrovirals, and millions of unnecessary deaths, for rich countries to make those lifesaving medicines universally available.

Fifteen months into the current pandemic, wealthy, highly vaccinated countries are starting to assume some responsibility for boosting global vaccination rates.

Leaders of the United States, Canada, United Kingdom, European Union and Japan recently pledged to donate a total of 1 billion COVID-19 vaccine doses to poorer countries.

It is not yet clear how their plan to “vaccinate the world” by the end of 2022 will be implemented and whether recipient countries will receive enough doses to fully vaccinate enough people to control viral spread. And the late 2022 goal will not save people in the developing world who are dying of COVID-19 in record numbers now, from Brazil to India.

The HIV/AIDS epidemic shows that ending the coronavirus pandemic will require, first, prioritizing access to COVID-19 vaccines on the global political agenda. Then wealthy nations will need to work with other countries to build their vaccine manufacturing infrastructure, scaling up production worldwide.

Finally, poorer countries need more money to fund their public health systems and purchase vaccines. Wealthy countries and groups like the G-7 can provide that funding.

These actions benefit rich countries, too. As long as the world has unvaccinated populations, COVID-19 will continue to spread and mutate. Additional variants will emerge.

As a May 2021 UNICEF statement put it: “In our interdependent world no one is safe until everyone is safe.”

[The Conversation’s most important politics headlines, in our Politics Weekly newsletter.]The Conversation

Maria De Jesus, Associate Professor and Research Fellow at the Center on Health, Risk, and Society, American University School of International Service

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As India’s COVID crisis worsens, leaders play the blame game while the poor suffer once again


Sujeet Kumar, Jawaharlal Nehru University India is witnessing a sharp spike in COVID-19 cases after months of declining numbers had given the country hope it had made it through the worst of the pandemic relatively unscathed.

On March 1, India recorded just 12,286 new cases, but since early April this figure has skyrocketed to over 100,000 every day. Earlier this week, it hit a record of 168,912 cases in a day — the highest in the world.

As the health crisis escalates, the poor are once again fearing a return to lockdown and economic hardship. Migrants have started fleeing from cities to their home villages in order to avoid the pain and trauma they went through a year ago when Prime Minister Narendra Modi enacted a nationwide lockdown. Many cities, including Mumbai and Delhi, have already announced nightly curfews.




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For now, the Indian government has just asked the states to focus on “stringent containment and public health measures”, including testing, tracing and inoculations. Modi has also appealed to people to get vaccinated during a four-day “Tika Utsav” (special vaccination drive), which began on Sunday.

However, the situation remains grim. Even though India is one of the world’s biggest coronavirus vaccine manufacturers, some states are experiencing vaccine shortages. At the same time, experts fear a lack of social distancing and new variants of the virus are causing infections to potentially spiral out of control.

How the poor suffered during last year’s lockdown

When COVID-19 first appeared in India last year, the Modi government was quick to bring the country together.

In a speech to the nation last March, he announced a 21-day nationwide lockdown of 1.3 billion people with only four hours’ notice. All means of transportation were suspended. The rich and affluent started hoarding food and medicines, while the poor worried about their livelihoods.

A mass migration ensued as hundreds of millions of migrant workers headed from the major cities back to their home villages on foot. This was the most visible face of the humanitarian crisis. Others, however, suffered out of the public eye, such as the street vendors, waste pickers, domestic maids and shopkeepers in slums, who were all forced to stop working.

Migrant laborers wait for buses during last year's lockdown.
Migrant laborers wait for buses to transport them to their hometowns following last year’s lockdown.
AP

As part of a study last year, I helped conduct a series of six rounds of telephone surveys in 20 diverse slums in the city of Patna, the capital of the northeastern Bihar state from July to November.

Nearly all slum residents we spoke with — except the rare few with protected formal sector jobs — were cut off suddenly from their sources of income after the lockdown was announced. And more than 80% of slum households in Patna lost their entire primary source of income.




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Economic recovery since the lockdown has also been slow. By mid-November, one-third of respondents had still not fully recovered their pre-pandemic incomes. Many had been hired back at their old jobs on a part-time basis or at a fraction of their former pay. Many jobs simply disappeared.

The poor survived by cutting back on their food, borrowing money and helping each other.

Given these struggles, there is now a sense of anxiety in these slum communities and a mistrust of the government, especially Modi. Says Ajay, 35, a street vendor who lives in the Kankarbagh slum,

The government finds it is easy to lock us down but not to provide financial and livelihood support. PM is busy campaigning for an election where thousands of people come without masks and are violating social distancing norms.

The government’s failed leadership

Undoubtedly, Modi still remains popular among most ordinary people. When he says something, India listens carefully. It worked well last year, and his appeal compelled people to wear masks and maintain social distancing, helping to flatten the curve and limit the loss of lives.

However, making public speeches will not be enough during this second wave. The prime minister needs to be seen adhering to these practices in his own daily life, but this is not happening on the ground.

In the ongoing elections in West Bengal, Assam, Kerala and Tamil Nadu, as well as the election in Bihar last year, Modi and other party leaders have addressed several rallies without paying much attention to COVID restrictions. Modi himself has addressed more than 20 rallies attended by thousands of unmasked people.

When leaders are seen addressing mass gathering without masks and social distancing, the public will not only assume everything is normal, they will lose their fear of COVID.

Modi has also insisted he would not politicise the pandemic, but he has done exactly that. In states like Maharashtra, Punjab and Chhattisgarh, which are facing a spike in cases, Modi’s party is pointing the finger at the state leaders, who come from opposing parties. The states, meanwhile, are blaming Modi’s government for failed leadership.




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Another concern is the Modi government’s decision to allow a major festival, Kumbh Mela, to take place in Uttrakhand state, which is ruled by his party, the BJP. Several million people gathered at the Ganges River for an auspicious bathing day this week, flouting social distancing practices.

Uttrakhand’s chief minister said the “faith of devotees will overcome the fear of COVID-19”, at a time when infections are skyrocketing.

Millions take part in Hindu festival.
Devotees take holy dips in the Ganges during the Hindu festival, Kumbh Mela.
DIVYAKANT SOLANKI/EPA

Who will help the poor?

As the numbers of COVID-19 cases are rising every day, the fear of a return to lockdown is ever-present, haunting the poor. Many have yet to recover from their previous debts, and COVID-19 is now threatening their livelihoods again.

Last year, several not-for-profit, grassroots organisations came forward to help the migrants and urban poor dwellers, but this is going to be more challenging this year.

Not only have their funds been depleted, but recent changes brought by the government have stopped the flow of foreign aid money to many organisations. Amnesty International announced in September it would halt its operations in India after its bank accounts had been frozen.

One NGO volunteer, Prabhakar, who works with slum dwellers in Patna, told us,

if the government is going to announce the complete lockdown like last year, many people will run out of food, as parent NGOs have stopped sponsoring the small organisations which work with the slum dwellers.

This is the time for Modi to show decisive leadership in not only controlling the surge of the virus, but also providing financial assistance to millions of urban poor and helping them reach their home villages with their dignity intact. This is what is needed to instill trust in the prime minister again.


Binod Kumar, a senior project officer in the Entrepreneurship Development Institute of India, contributed to this article.The Conversation

Sujeet Kumar, Senior Research Fellow, Centre for the Study of Law and Governance, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Poor ventilation may be adding to nursing homes’ COVID-19 risks


Geoff Hanmer and Bruce Milthorpe, University of Technology Sydney

Over 2,000 active cases of COVID-19 and 245 resident deaths as of August 19 have been linked to aged care homes in Victoria, spread across over 120 facilities. The St Basil’s cluster alone now involves 191 cases. In New South Wales, 37 residents were infected at Newmarch House, leading to 17 deaths.

Why are so many aged care residents and staff becoming infected with COVID-19? New research suggests poor ventilation may be one of the factors. RMIT researchers are finding levels of carbon dioxide in some nursing homes that are more than three times the recommended level, which points to poor ventilation.

An examination of the design of Newmarch in Sydney and St Basil’s in Melbourne shows residents’ rooms are arranged on both sides of a wide central corridor.

The corridors need to be wide enough for beds to be wheeled in and out of rooms, but this means they enclose a large volume of air. Windows in the residents’ rooms only indirectly ventilate this large interior space. In addition, the wide corridors encourage socialising.

If the windows to residents’ rooms are shut or nearly shut in winter, these buildings are likely to have very low levels of ventilation, which may contribute to the spread of COVID-19. If anyone in the building is infected, the risk of cross-infection may be significant even if personal protective equipment protocols are followed and surfaces are cleaned regularly.

Why does ventilation matter?

Scientists now suspect the virus that causes COVID-19 can be transmitted as an aerosol as well as by droplets. Airborne transmission means poor ventilation is likely to contribute to infections.

A recent article in the journal Nature outlines the state of research:

Converging lines of evidence indicate that SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic, can pass from person to person in tiny droplets called aerosols that waft through the air and accumulate over time. After months of debate about whether people can transmit the virus through exhaled air, there is growing concern among scientists about this transmission route.




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Under the National Construction Code (NCC), a building can be either “naturally ventilated” or “mechanically ventilated”.

Natural ventilation requires only that ventilation openings, usually the openable portion of windows, must achieve a set percentage of the floor area. It does not require windows to be open, or even mandate the minimum openable area, or any other measures that would ensure effective ventilation. Air quality tests are not required before or after occupation for a naturally ventilated building.

Nearly all aged care homes are designed to be naturally ventilated with openable windows to each room. In winter most windows are shut to keep residents warm and reduce drafts. This reduces heating costs, so operators have a possible incentive to keep ventilation rates down.

From inspection, many areas of typical nursing homes, including corridors and large common spaces, are not directly ventilated or are very poorly ventilated. The odour sometimes associated with nursing homes, which is a concern for residents and their visitors, is probably linked to poor ventilation.

Carbon dioxide levels sound a warning

Carbon dioxide levels in a building are a close proxy for the effectiveness of ventilation because people breathe out CO₂. The National Construction Code mandates CO₂ levels of less than 850 parts per million (ppm) in the air inside a building averaged over eight hours. A well-ventilated room will be 800ppm or less – 600ppm is regarded as a best practice target. Outside air is just over 400ppm

An RMIT team led by Professor Priya Rajagopalan is researching air quality in Victorian aged care homes. He has provided preliminary data showing peaks of up to 2,000ppm in common areas of some aged care homes.

This figure indicates very poor ventilation. It’s more than twice the maximum permitted by the building code and more than three times the level of best practice.

Research from Europe also indicates ventilation in aged care homes is poor.

Good ventilation has been associated with reduced transmission of pathogens. In 2019, researchers in Taiwan linked a tuberculosis outbreak at a Taipei University with internal CO₂ levels of 3,000ppm. Improving ventilation to reduce CO₂ to 600ppm stopped the outbreak.




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What can homes do to improve ventilation?

Nursing home operators can take simple steps to achieve adequate ventilation. An air quality detector that can reliably measure CO₂ levels costs about A$200.

If levels in an area are significantly above 600ppm over five to ten minutes, there would be a strong case to improve ventilation. At levels over 1,000ppm the need to improve ventilation would be urgent.

Most nursing homes are heated by reverse-cycle split-system air conditioners or warm air heating systems. The vast majority of these units do not introduce fresh air into the spaces they serve.

The first step should be to open windows as much as possible – even though this may make maintaining a comfortable temperature more difficult.




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Creating a flow of warmed and filtered fresh air from central corridor spaces into rooms and out through windows would be ideal, but would probably require investment in mechanical ventilation.

Temporary solutions could include:

  1. industrial heating fans and flexible ventilation duct from an open window discharging into the central corridor spaces

  2. radiant heaters in rooms, instead of recirculating heat pump air conditioners, and windows opened far enough to lower CO₂ levels consistently below 850ppm in rooms and corridors.

The same type of advice applies to any naturally ventilated buildings, including schools, restaurants, pubs, clubs and small shops. The operators of these venues should ensure ventilation is good and be aware that many air-conditioning and heating units do not introduce fresh air.

People walking into venues might want to turn around and walk out if their nose tells them ventilation is inadequate. We have a highly developed sense of smell for many reasons, and avoiding badly ventilated spaces is one of them.The Conversation

Geoff Hanmer, Adjunct Professor of Architecture and Bruce Milthorpe, Emeritus Professor, Faculty of Science, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Rich and poor don’t recover equally from epidemics. Rebuilding fairly will be a global challenge



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Ilan Noy, Te Herenga Waka — Victoria University of Wellington

Since the Indian Ocean tsunami of 2004, disaster recovery plans are almost always framed with aspirational plans to “build back better”. It’s a fine sentiment – we all want to build better societies and economies. But, as the Cheshire Cat tells Alice when she is lost, where we ought to go depends very much on where we want to get to.

The ambition to build back better therefore needs to be made explicit and transparent as countries slowly re-emerge from their COVID-19 cocoons.

The Asian Development Bank attempted last year to define build-back-better aspirations more precisely and concretely. The bank described four criteria: build back safer, build back faster, build back potential and build back fairer.

The first three are obvious. We clearly want our economies to recover fast, be safer and be more sustainable into the future. It’s the last objective – fairness – that will inevitably be the most challenging long-term goal at both the national and international level.

Economic fallout from the pandemic is already being experienced disproportionately among poorer households, in poorer regions within countries, and in poorer countries in general.




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Some governments are aware of this and are trying to ameliorate this brewing inequality. At the same time, it is seen as politically unpalatable to engage in redistribution during a global crisis. Most governments are opting for broad-brush policies aimed at everyone, lest they appear to be encouraging class warfare and division or, in the case of New Zealand, electioneering.

Banda Aceh, Indonesia, after the 2004 tsunami: the impact of disaster is not felt equally by all.
http://www.shutterstock.com

In fact, politicians’ typical focus on the next election aligns well with the public appetite for a fast recovery. We know that speedier recoveries are more complete, as delays dampen investment and people move away from economically depressed places.

Speed is also linked to safety. As we know from other disasters, this recovery cannot be completed as long as the COVID-19 public health challenge is not resolved.

The failure to invest in safety, in prevention and mitigation, is now most apparent in the United States, which has less than 5% of the global population but a third of COVID-19 confirmed cases. Despite the pressure to “open up” the economy, recovery won’t progress without a lasting solution to the widespread presence of the virus.




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Economic potential also aligns with political aims and is therefore easier to imagine. A build-back-better recovery has to promise sustainable prosperity for all.

The emphasis on job generation in New Zealand’s recent budget was entirely the right primary focus. Employment is of paramount importance to voters, so it has been a logical focus in public stimulus packages everywhere.

Fairness, however, is more difficult to define and more challenging to achieve.

While a rising economic tide doesn’t always lift all boats – as the proponents of growth-at-any-cost sometimes argue – a low tide lifts none. Achieving fairness first depends on achieving the other three goals.

Under-prepared and under-resourced: the hospital ship Comfort arrives in New York during the COVID-19 crisis.
http://www.shutterstock.com

Economic prosperity is a necessary precondition for sustainable poverty reduction, but this virus is apparently selective in its deadliness. Already vulnerable segments of our societies – the elderly, the immuno-compromised and, according to some recent evidence, ethnic minorities – are more at risk. They are also more likely to already be economically disadvantaged.

As a general rule, epidemics lead to more income inequality, as households with lower incomes endure the economic pain more acutely.

This pattern of increased vulnerability to shocks in poorer households is not unique to epidemics, but we expect it to be the case even more this time. In the COVID-19 pandemic, economic devastation has been caused by the lockdown measures imposed and adopted voluntarily, not by the disease itself.

These measures have been more harmful for those on lower wages, those with part-time or temporary jobs, and those who cannot easily work from home.

Many low-wage workers also work in industries that will be experiencing longer-term declines associated with the structural changes generated by the pandemic: the collapse of international tourism, for example, or automation and robotics being used to shorten long and complicated supply chains.




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Defunding the WHO was a calculated decision, not an impromptu tweet


Poorer countries are in the worst position. The lockdowns hit their economies harder, but they do not have the resources for adequate public health measures, nor for assisting those most adversely affected.

In these places, even if the virus itself has not yet hit them much, the downturn will be experienced more deeply and for longer.

Worryingly, the international aid system that most poorer countries partially rely on to deal with disasters is not fit for dealing with pandemics. When all countries are adversely hit at the same time their focus inevitably becomes domestic.

Very few wealthy countries have announced any increases in international aid. If and when they have, the amounts were trivial – regrettably, this includes New Zealand. And the one international institution that should have led the charge, the World Health Organisation, is being defunded and attacked by its largest donor, the US.

Unlike after the 2004 tsunami, international rescue will be very slow to arrive. One would hope most wealthy countries will be able to help their most vulnerable members. But it looks increasingly unlikely this will happen on an international scale between countries.

Without global empathy and better global leadership, the poorest countries and poorest people will only be made poorer by this invisible enemy.The Conversation

Ilan Noy, Professor and Chair in the Economics of Disasters and Climate Change, Te Herenga Waka — Victoria University of Wellington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How Mumbai’s poorest neighbourhood is battling to keep coronavirus at bay



Aerial view of Shivaji Nagar.
Author provided

Ishita Chatterjee, University of Melbourne

Informal settlements are experiencing a greater surge in COVID-19 cases than other urban neighbourhoods in Mumbai, India. Their high density, narrow streets, tight internal spaces, poor access to water and sanitation leave residents highly vulnerable to the spread of coronavirus.

One of Mumbai’s poorest and most underdeveloped neighbourhoods, Shivaji Nagar, is one of three informal settlements I have been studying. More than a month before the Indian government imposed a national lockdown, Shivaji Nagar residents, supported by the NGO Apnalaya, adopted their own measures to counter the pandemic.

Satellite image of Shivaji Nagar and neighbouring areas.
Google Earth

Here, 600,000 people, 11.5% of Mumbai’s informal settlement population, are crowded into an area of 1.37 square kilometres next to Asia’s largest dumping ground. There is one toilet for every 145 people and 60% of residents have to buy water. There is a severe lack of health facilities.

Unsurprisingly, residents’ health suffers. The settlement is a tuberculosis hotspot. Respiratory illness makes COVID-19 even more threatening for residents.

Left: COVID-19 hotspots in Mumbai as of April 14 2020. Right: COVID-19 health facilities in Mumbai as of May 18 2020.
Municipal Corporation of Greater Mumbai, Author provided

By April 13, Shivaji Nagar had 86 COVID-19 cases – an increase of 30 in two days – making it one of Mumbai’s hotspots. As the virus started spreading rapidly, COVID-19 data for individual areas became hard to get. The release of cumulative data for the entire city was much less useful for understanding the growth in cases.

Ward-level data was available until April 25 2020.
Brihanmumbai Municipal Corporation

The lockdown begins

On March 24, the Indian government announced a national lockdown. Barricades were installed on Shivaji Nagar’s main streets to curb people’s movement. TV and radio broadcasts urged residents to stay at home, practise good hygiene and regularly sanitise shared toilets and main streets.

Once the first few COVID-19 cases were detected in Shivaji Nagar, the government shifted patients and their families to isolation facilities outside the settlement. Fever camps were set up in parts of the settlement to screen people with symptoms. While the lockdown allowed essential services to continue, vegetable markets were shut down as cases increased.

After facing a backlash for not considering the impacts on the poor, the government eventually announced a nationwide relief package. Residents could receive free food by producing their ration cards.

Some measures worked while others created new problems. Quarantining people outside the settlement was effective (since home quarantine was not possible), as was setting up fever camps. However, the stigma and fear of being COVID-19-positive stopped many people from coming forward.

The sudden lockdown and market closures left most residents without food, water and medicines. Some 35% of Shivaji Nagar residents didn’t have the ration cards needed to get free food. Enforcing social distancing and stopping people from venturing out of their homes, by beating them, didn’t work either.

NGO fills the gap

The lack of official figures on case numbers and testing rates made it hard to track the spread of the virus in Shivaji Nagar. Volunteers working for Apnalaya kept track on the ground.

As early as the second week of February, before India’s borders closed, Apnalaya had decided to drastically reduce contact between the residents and outsiders. The aim was to minimise residents’ risk of contracting the virus.

Apnalaya enrolled 40-50 volunteers from the neighbourhood to distribute relief supplies instead of bringing in staff. It arranged a year’s health insurance for all volunteers. Elderly and pregnant women were encouraged to stay home and contact the volunteers for help with their daily needs.

Even before the government announced its relief package, Apnalaya was providing food and essentials to residents. Distribution began within the containment zones, but later extended to the entire settlement.

Funds for these activities were raised in several ways: a crowdfunding campaign, an alliance between multiple organisations and collaboration with the government.

A dashboard was used to document, plan and monitor the distribution of relief supplies. As the government’s relief scheme excluded one in three residents, Apnalaya’s door-to-door relief delivery ensured no family was left behind.

Volunteers from the settlement distribute relief.
Apnalaya

Apnalaya’s permanent staff members were now managing everything from outside. The telephone became a medium to reach families who didn’t have a TV or a radio and to monitor the situation. Staff regularly phoned residents to give advice on hygiene and how to get essentials and contact doctors for other ailments.

Not everyone was in their database, but this didn’t matter. The residents played their part too.

Community comes together

As residents, the volunteers were committed to their community even when facing extreme hardships. Relief distribution was particularly tricky in areas where drains had overflowed on streets and foundations built on garbage had slipped. Yet these volunteers reached all residents, knowing they relied on their efforts.

Narrow internal lanes in the settlement.

The community even found a temporary way to deal with the water shortage. Parts of the settlement with piped water shared it with neighbours who previously had to buy water from private suppliers. One supplier, a resident of the settlement, now provided water free of charge.

Lessons from Shivaji Nagar

Shivaji Nagar’s story offers some important lessons. While the government acted pre-emptively, it failed to consider local conditions and needs. Apnalaya filled the gaps.

But the NGO’s reach was limited, too, and the resident volunteers became the missing link. Acting as community leaders, they took stock of the situation on the ground and reported back to the NGO’s office.

Some of the strategies that have worked have been tailored to local conditions and adapted to the evolving crisis. But the shortage of health facilities and lack of data transparency pose a great challenge.

Mumbai’s M East Ward, which includes Shivaji Nagar, now has the highest COVID-19 death rate in Mumbai. At 9.7%, it’s more than double the city’s overall rate. Can Shivaji Nagar withstand the storm?The Conversation

Ishita Chatterjee, PhD Candidate, Informal Urbanism (InfUr-) Hub, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How does poor air quality from bushfire smoke affect our health?


Brian Oliver, University of Technology Sydney

New South Wales and Queensland are in the grip of a devastating bushfire emergency, which has tragically resulted in the loss of homes and lives.

But the smoke produced can affect many more people not immediately impacted by the fires – even people many kilometres from the fire. The smoke haze blanketing parts of NSW and Queensland has seen air quality indicators exceed national standards over recent days.

Studies have shown there is no safe level of air pollution, and as pollution levels increase, so too do the health risks. Air pollution caused nine million premature deaths globally in 2015. In many ways, airborne pollution is like cigarette smoking – causing respiratory disease, heart disease and stroke, lung infections, and even lung cancer.




Read more:
Firestorms and flaming tornadoes: how bushfires create their own ferocious weather systems


However, these are long-term studies looking at what happens over a person’s life with prolonged exposure to air pollution. With bushfire-related air pollution, air quality is reduced for relatively short periods.

But it’s still worth exercising caution if you live in an affected area, particularly if you have an existing health condition that might put you at higher risk.

Air quality standards

The exposure levels will vary widely from the site of the fire to 10 or 50 kilometres away from the source.

The national standard for clean air in Australia is less than 8 micrograms/m³ of ultrafine particles. This is among the lowest in the world, meaning the Australian government wants us to remain one of the least polluted countries there is.

8 micrograms/m³ refers to the weight of the particles in micrograms contained in one cubic meter of air. A typical grain of sand weighs 50 micrograms. When people talk about ultrafine particles the term PM, referring to particulate matter, is often used. The size of PM we worry the most about are the small particles of less than 2.5 micrometres which can penetrate deep into the lungs, called PM2.5.

People with pre-existing medical conditions are at highest risk.
From shutterstock.com

To put this in perspective, Randwick, a coastal suburb in Sydney which was more than 25km from any of the fires yesterday, had PM2.5 readings of around 40 micrograms/m³. Some suburbs which sit more inland had readings of around 50 micrograms/m³. Today, these levels have already reduced to around 20 micrograms/m³ across Sydney.

We’re seeing a similar effect in Queensland. Today’s PM2.5 readings at Cannon Hill, a suburb close to central Brisbane, are 21.5 micrograms/m³, compared with 4.7 micrograms/m³ one month ago.

A number of health alerts were issued for areas across NSW and Queensland earlier this week.

While these numbers may seem alarming compared to the 8 microgram/m³ threshold, the recent air pollution in India’s New Delhi caused by crop burning reached levels of 900 micrograms/m³. So what we’re experiencing here pales in comparison.

Bushfire smoke and our health

However, this doesn’t mean the levels in NSW and Queensland are without danger. Historically, when there are bushfires, emergency department presentations for respiratory and heart conditions increase, showing people with these conditions are most at risk of experiencing adverse health effects.

Preliminary analysis of emergency department data shows hospitals in the mid-north coast of NSW, where fires were at their worst, have had 68 presentations to emergency departments for asthma or breathing problems over the last week. This is almost double the usual number.




Read more:
After the firestorm: the health implications of returning to a bushfire zone


One study looked at the association between exposure to smoke events in Sydney and premature deaths, and found there was a 5% increase in mortality during bushfires from 1994 to 2007.

But it’s important to understand these deaths would have occurred in the people most vulnerable to the effects of smoke, such as people with pre-exsisiting lung and heart conditions, who tend to be older people.

For people who are otherwise healthy, the health risks are much lower.

But as the frequency of bushfires increases, many scientists in the field speculate these health effects may become more of a concern across the population.

How to protect yourself

If you’re in an affected area, it’s best to avoid smoke exposure where possible by staying indoors with the windows and doors closed and the air conditioner turned on.

If you are experiencing any unusual symptoms, such as shortness of breath or chest pain, or just do not feel well, you should speak to your health care professional and in an emergency, go to hospital.




Read more:
How rising temperatures affect our health


Once the fires have been put out, depending upon the region, local weather conditions and the size of the fire, air quality can return to healthy levels within a few days.

In extreme situations, it might take weeks or months to return to normal. But we are fortunate to be living in a country with good air quality most of the time.The Conversation

Brian Oliver, Research Leader in Respiratory cellular and molecular biology at the Woolcock Institute of Medical Research and Senior Lecturer, School of Medical & Molecular Biosciences, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Indians promised benefits of 100 smart cities, but the poor are sidelined again



File 20181216 185261 14z8ner.jpg?ixlib=rb 1.1
Residents of slums like Kamla Nehru Nagar, a kilometre away from Patna Junction, have yet to share in the promised benefits of smart cities.
Sujeet Kumar, Author provided

Sujeet Kumar, Jawaharlal Nehru University

India’s urban population is growing. More than 50% of the country’s population is forecast to be living in cities by 2030. This is a major challenge for government because the country’s cities lack the infrastructure (affordable housing, roads) and basic services (sanitation, water, health care) for existing inhabitants, let alone the influx of people over the next decade.

Globally, one in eight people live in slums where they face issues of durable housing, access to safe drinking water and toilets, and insecure tenure. In India, one in every six city residents lives in a slum.




Read more:
Will India’s experiment with smart cities tackle poverty – or make it worse?


Many Indian children are growing up in very disadvantaged circumstances. These two live in Mahmudi Chak slum next to Rajendra Nagar Railway Junction in Patna.
Sujeet Kumar, Author provided

However, estimates of slum populations differ widely in many Indian cities due to differences in the counting criteria. For example, in cities like Mumbai and Delhi, it’s estimated more than 50% of the population live in slums, but the 2011 Indian Census put the figures at 41.3% and 14.6% respectively.

Launching the national Smart Cities Mission in 2016, Indian Prime Minister Narendra Modi said: “… if anything has the potential to mitigate poverty it is our cities”. He said the mission, which has a target of 100 smart cities, aims to ensure access to basic services for the people. This includes houses for the urban poor.

The program aims to fulfil the aspirations and needs of the citizens through comprehensive development of institutional, physical, social and economic infrastructure. This comprehensive development would also ensure increased public participation, Modi said.

Villagers migrated to the Danapur Block slum after the Ganga river flooded.
Sujeet Kumar, Author provided

Smart city plan has a dark side

In one of the 100 cities selected for the Smart City Mission, Patna (Bihar), I witnessed the flip side of the smart city. Patna, the state capital of Bihar, has a rich history, but 63% of its population lives in slums. And 93% of them are from the historically oppressed “scheduled castes” and “other backward castes” (based on data collected in 42 slums).

Demolished homes at Meena Bazar.
Sujeet Kumar, Author provided

The city administration often demolishes slums without following due process of law in order to seize the land in the name of beautification and development of Patna.

In slums like Meena Bazar (near the famous Nalanda Medical College Hospital) and Amu Kuda Basti (near Patna Airport) people have been living there for generations in houses often partially funded by government housing projects. These have been bulldozed.

Riot police are on hand when slum dwellers’ homes are demolished at Amu Kuda Basti.
Sujeet Kumar, Author provided

The city administration usually makes ad-hoc loudspeaker announcements before bulldozing these settlements. A massive police presence and riot vehicles are on hand in case residents protest the demolitions. They use derogatory language and forcefully enter houses and thrash male members, say women in Amu Kuda Basti.

The government could have given them more time or relocated them elsewhere in the city, rather than just bulldozing their houses, which they had built with hard-earned money, the slum dwellers said.

Residents of slums like Amu Kuda Basti say houses they built with their own hard-earned money are being demolished with little notice.
Sujeet Kumar, Author provided

There is apparently reason to smash these homes. There always is. The usual arguments for demolition include: beautification of the city, construction of a government building or enterprise, extension of the airport, crime locations, governance, illegality, encroachment etc. The state says demolitions of such slums are necessary for the development of the city.




Read more:
Smart or dumb? The real impact of India’s proposal to build 100 smart cities


In 2011, the state proposed a slum policy to relocate slum dwellers who had lived in the city for generations to the outskirts in a plan to develop Patna and make it a smart city, says Kishori Das, an advocate for the rights of slum dwellers for years. Faced with widespread protests, the state deferred the policy, but it is silently applying it on the ground, he said.

Who speaks for the marginalised poor?

These two leaders from Meena Bazar are among 84 community representatives, elected and non-elected, interviewed by the author.
Sujeet Kumar, Author provided

Local and mainstream media are not reporting these demolitions and forced evictions, especially when it happens in non-metro cities like Patna. Civil society and advocacy NGOs also take little notice of these frequent demolitions, probably due to threats to life and, if not, then to co-option by the state. The roles of the ruling party and opposition are also dubious.

Bihar has been ruled by leaders who attracted votes by campaigning on issues of poverty, caste and social justice for the past three decades. In the early 1990s, the prominent leader Lalu Prasad Yadav mobilised the poor and the oppressed caste groups under the umbrella of “Vikas nahin, samman chahiye” (we want dignity, not development). The present chief minister, Nitish Kumar, also known as Sushaasan Babu (good governance man), adopted the slogan “Nyay ke saath vikas” (development with justice).

However, the frequent injustices suffered by the urban poor negate the political commitment. These actions are also in conflict with the motto of the Indian Constitution, which frames justice as a balancing wheel between the haves and have-nots.

Promises of social justice ring hollow for residents of bulldozed communities like Amu Kuda Basti.
Sujeet Kumar, Author provided

These challenges are not limited to one city. In the name of smart and developed cities, the government is not only taking over urban land where millions of the poor have lived for decades but is also acquiring fertile land and violating the constitutional rights of farmers, tribes and other indigenous groups in various cities.

These reports of struggle and forced evictions contradict the statements by Modi when he said smart cities development would strictly follow large-scale public participation in preparing these plans.

Such demolitions reveal a dark side to making Indian cities smart and cast serious doubt on claimed government commitment to the urban poor. These actions hardly live up to the idea of the rights of the poor. It became more challenging when the head of the biggest democracy in the world denounces those who speak up for the poor, oppressed and voiceless as “urban Naxals”.

In the words of Abraham Lincoln, democracy is “government of the people, by the people, for the people”. For India, this means the urban poor need help both from political parties and civil society so that their voice finds expression and their demands and concerns are heard and considered in public policy. The Conversation

Children sleep out in the open in a slum area in Harding Park, Patna.
Sujeet Kumar, Author provided

Sujeet Kumar, Senior Research Fellow, Centre for the Study of Law and Governance, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.