Medicine (RMH) - Theses
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ItemA Recipe for Disaster: Impact of extreme weather on nutrition and metabolic health, with a case study of Aboriginal and Torres Strait Islander communities in Northern Australia( 2019)BACKGROUND: To date, the effects of extreme weather events (EWEs) on specific nutrients within the population’s diet have not been quantified. With climate change projected to increase the severity of extreme weather across the globe, it is necessary to understand how the global nutrient supply has historically responded, and which subpopulations are most at risk. One particular subpopulation of importance is Aboriginal and Torres Strait Islander people, who are already more susceptible to nutritional insult and metabolic syndrome than their non- Indigenous counterparts. While extreme weather is not the primary driving force in poor health outcomes, I hypothesise that it further exacerbates cardiometabolic health burdens globally, and especially among vulnerable populations. METHODS: In my first study, I conducted superposed epoch analysis to calculate the percentage change in nutrient supply during the year of an EWE relative to its five-year window. I composited the results globally and by United Nations designated low-income subgroups. I also reported changes in terms of Recommended Dietary Allowance (RDA) for children aged 1-3 years. In my second study, I constructed a holistic model with data from 104 Aboriginal and Tor- res Strait Islander communities in the Northern Territory from 2010-2015. I used varimax- rotated Principal Component Analysis to extract and condense information from 218 variables for physical environment, census, and climate data. I then conducted MM-estimator regression to model the extreme heat impacts on cardiometabolic-related rates for emergency room, inpatient admission, primary healthcare, and mortality. RESULTS: In the first study, most micronutrient supplies exhibited modest negative percentage change during the year of an EWE, including folate, magnesium, niacin, phosphorus, potassium, thiamin, vitamin B6, vitamin C, and zinc. Effects were magnified among Landlocked Developing Countries, which exhibited significant nutrient supply changes ranging from 1.6 – 8.0% of average supply. The observed nutrient supply deficits were found to be a large percentage (up to 41.5%) of what a healthy child’s average sufficient dietary intake level should be. The most compelling finding of the second study is that holding all else fixed, a unit in- crease in climate PC1 score is associated with a 77.8% change in emergency room rates, 6.7 percentage point increase in inpatient rates, and 9.3 percentage point increase in primary healthcare rates. Thus, a larger cardiometabolic health burden is strongly correlated with communities that experience relatively lower apparent temperature and humidity but greater maximum heatwave severity, e.g. Alice Springs area. CONCLUSION: The EWE effects on nutrient supply are modest in isolation; however, in the context of nutrient needs for healthy child development, the effects observed are substantial. Children are a particularly vulnerable subpopulation of interest, given how certain nutritional deficiencies during gestation and the first five years of life can have irrecoverable consequences for health, growth, and development. In the second study, I found that relative heat – or sudden rises in temperature above that of the recent past – poses the most significant threat to cardiometabolic health among Indigenous communities in northern Australia. Relative heat, rather than absolute heat, should therefore be the focus of public health preparation and response. Both studies echo previous literature in stressing the urgency with which the international community must tackle the issue of nutritional and metabolic health among vulnerable populations, especially because this health landscape is poised to worsen with climate change.