Promoting the Get Healthy information and coaching service in Australian-Chinese communities: facilitators and barriers

My colleagues Dr Cathy O’Callaghan, An Tran, Nancy Tam, A/Prof Li Ming Wen and I published an article on a pilot telephone health coaching program for Chinese Mandarin and Cantonese-speaking communities, which uses bilingual coaches and translated materials. The study found that:

The bilingual program was culturally and linguistically appropriate and addressed risk factors for chronic conditions. Participants formed positive relationships with bilingual coaches who they preferred to interpreters. They felt the program promoted healthy eating, weight and physical activity. Although Chinese stakeholders had concerns about participants’ ability to goal set, participants said they met their health goals and were committed to the GHS program. Strategies to enhance the program included promoting the bilingual GHS to the communities and stakeholders. Factors to consider beyond language in adapting the program to the Australian Chinese communities include meeting the heterogenous needs of the older population, ensuring community engagement and addressing cultural beliefs and practices.

The aspects of the study that I found interesting were that:

  • translation alone definitely isn’t enough to make a program culturally appropriate and relevant (which we knew but was good to have confirmed)
  • there were a broad range of health beliefs, priorities and attitudes amongst participants, highlighting that even within a relatively narrowly defined population such as this pilot, there is considerable diversity
  • bilingual staff were clearly preferred to interpreters. 

These points are all relevant to other bilingual and culturally targeted health programs. If you have any trouble accessing the article please let me know.

References

O’Callaghan, C., Tran, A., Tam, N., Wen, L. M., & Harris-Roxas. (2021). Promoting the get healthy information and coaching service (GHS) in Australian-Chinese communities: facilitators and barriers. Health Promotion International, daab129. https://doi.org/10.1093/heapro/daab129

We should install air purifiers with HEPA filters in every classroom. It could help with COVID, bushfire smoke and asthma

Saying “open a window to reduce COVID risks” makes sense unless there’s bushfire smoke and poor air quality. 

As NSW ponders how schools can reopen safely after the current COVID lockdown, A/Prof Donna Green and I estimate that a $50 million investment can reduce not only COVID risks but also bushfire smoke and asthma risks as well – and needs to be tackled urgently.

This post first appeared at The Conversation.


The smell of hazard reduction burn smoke in Sydney this week is an unwelcome reminder the bushfire season is almost upon us, and with it, the torment of having to breathe toxic air

Even before the last of the 2019–20 Black Summer smoke dissipated, another deadly reminder of the importance of access to safe air arrived. COVID forced many of us to take a crash course in how to avoid respiratory viruses.

One of the most effective ways to reduce indoor COVID transmission is to open windows. Maximising outdoor air coming inside, known as the air exchange rate, is a good way to reduce transmission risk.

But opening windows during the bushfire season can let toxic smoke in, changing the risk calculation.

Keeping windows closed and re-circulating air through standard aircon systems can cool the air, but doesn’t remove smoke or viruses.

So how can schools reduce exposure to COVID and bushfire smoke simultaneously?

This dilemma has a solution we can implement immediately. We’ve calculated about A$50 million would provide all NSW primary and secondary school classrooms, and other shared spaces within schools, with High-Efficiency Particulate Air (HEPA) grade air purifiers.

This initial outlay pales compared to the roughly A$220 million-a-day cost of Sydney’s lockdown. 

The added benefit of installing air purifiers with HEPA filters is they can help reduce the risk of asthma attacks too.

Air purifiers with HEPA filters can remove over 99% of tiny particles

Most people catch COVID by inhaling it from shared air, and COVID particles often linger in the air in indoor spaces. Simple and relatively cheap air purifiers with HEPA filters have been shown to clear potentially infectious aerosols quickly and effectively

HEPA air purifiers work by mechanical filtration — they force air through a fine mesh which traps particles. Off-the-shelf air purifers with HEPA filters can remove more than 99.97% of all particle sizes down to 0.30-1.0 microns (one millionth of a metre).

This means they can help filter airborne viruses, bacteria, and tiny particles known as “particulate matter” from bushfire or hazard reduction burn smoke. They can’t completely eliminate COVID transmission, but they can help reduce the risk especially when used with other best practices like wearing masks and other public health measures.

This approach isn’t radical. It has already been mandated in New York schools prior to their reopening.

Our calculations

These calculations assume each NSW primary and secondary school student, of which there are approximately 706,000 and 534,000, respectively, are grouped in classes of 25 and 20 pupils, respectively.

Each of these classrooms would require an air purifier designed to work in a standard classroom of approximately 60 square metres. We’ve allowed for each of the 3,100 schools in NSW to have six extra units to include shared spaces such as the library or resource room, staff room and administration area.

Approximately 73,500 units would be needed in NSW. We’ve applied a bulk buy discount of 30% on a currently available, high-quality HEPA air purifier retailing for A$1,000 to arrive at our estimate.

Of course, this doesn’t only affect NSW — schools across the nation would likely benefit from this approach.

Because these units are already available for purchase online and can ship via existing delivery services, the logistics are neither complicated nor expensive. 

Installation of the units can be carried out in minutes, and one of the only concerns is the need to ensure proper PPE when changing the filter. 

Unfortunately, upgrading existing aircon systems in schools by incorporating higher-grade HEPA filters is slow, expensive and not always technically possible. 

In combination with other risk-reduction strategies, air purifiers could be an affordable way to reduce the risk of unmitigated COVID spread between unvaccinated students and staff, and the inevitable spread between, and within, these children’s households.

This approach would buy time until vaccines are approved and rolled out for Australian children. This is unlikely to occur before mid-2022 at the earliest. 

There are multiple other benefits too

An added benefit is that for future years, these air purifiers might be able to reduce asthma attacks triggered by smoke from the inevitable, and increasingly intense, bushfire season. That’s because for many people, asthma can be triggered by the small particles in smoke which, once inhaled, can go into the lungs causing inflammation.

Their tiny size means some of them can enter the blood stream and affect our lungsheart and immune systems.

One in ten Australian children suffer from asthma, so keeping hazard reduction burn and bushfire smoke out of schools is a top priority.

Using HEPA filters will likely result in health savings associated with reduced asthma attacks from avoided smoke inhalation, and a lower burden from COVID cases stemming from school-based transmission. This will place less pressure on NSW’s overwhelmed health system.

It’s hard to comprehend why we haven’t raced to take such an effective no-regrets strategy.

It’s one strategy of many

Installing air purifiers with HEPA filters throughout the entire school system might be one of the most important, and cost effective, ways to improve the health and safety for millions of families in NSW, and around Australia.

We also need to deploy a range of strategies to reduce the risk to school children and staff of exposure to airborne viruses, as well as smoke and other air pollutants.

We know we also need to:

  • promote outdoor sports over indoors
  • stagger outside playground access times
  • move non-essential person-to-person interactions online (for example parent-teacher meetings)
  • perform rigorous daily checks for symptomatic children
  • constantly encourage people with even the most minor symptoms to stay home and get tested
  • mandate masks in schools and on public transport
  • stagger drop off and pick up times where possible.

We hate Covid but we hate it even more when politicians try to police their way out of a public health crisis

It was a real privilege to speak with First Dog on the Moon about how things are going in South Western Sydney during this lockdown, which informed some of this fantastic cartoon.

We hate Covid but we hate it even more when politicians try to police their way out of a public health crisis, by First Dog on the Moon (2021)

More on COVID in South Western Sydney