The lived experience of many South Australians reveals racism continues to harm individuals and affect the life opportunities of our next generations. There are numerous instruments at national and state level aimed at addressing discrimination. However, whilst effective laws are critical foundational tools to address inequality, we know that laws alone are not enough.

South Australia (SA) is the first Australian state to develop and launch a public sector Anti-Racism Strategy. It is informed by research and extensive consultation with Aboriginal and Culturally and Linguistically Diverse people with lived experience of racism. The strategy centres racism as a determinant of health and wellbeing, recognising the significant negative physical and mental health impacts and intergenerational trauma it can cause.

The strategy demonstrates our commitment to listening and learning from one of the oldest civilisations on Earth, as we develop a workforce that is culturally capable and accountable. It complements the State Government and SA public sector’s ongoing work to remove racial inequality and promote inclusion within the public sector workforce, including the establishment of the First Nations Voice to Parliament, Closing the Gap, the South Australian Multicultural Charter, and agency-level plans and actions on reconciliation and inclusion.

From conception of the Strategy to Cabinet Approval and launch, the anti-racism journey in South Australia has been an exercise in building evidence, advocacy, and partnership from which many lessons can be learnt.

Applying a public health lens to the issue of racism has allowed the public discourse and policy creation on the issue to take on new depth and breadth. The result of which is a unique partnership between two State government agencies with distinct mandates, Preventive Health SA, and the Office of the Commissioner for Public Sector Employment (OCPSE). This partnership has seen the leveraging of respective strengths, with OCPSE acting as lead agency responsible for implementation, supported by Preventive Health SA’s specialist capability in population level data and analysis.

As the largest employer in South Australia, the public sector is uniquely placed to set the standard for tackling racism in all its forms government, and in the community at large.

What is the problem/issue that requires public health action? [Context and aim]
Salmonella Typhimurium is a zoonotic pathogen that causes gastroenteritis. It is transmitted primarily via contaminated food. In March 2024, the Western Australian Department of Health was alerted to a growing cluster of Salmonella cases in Perth.
What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]
An outbreak investigation comprising epidemiological, laboratory and environmental findings ensued.
There were 182 possible cases identified via notifications from laboratories, general practice and hospitals. Interviews about demographics, symptoms and food histories were conducted for 169 cases, which identified 144 outbreak cases linked to a single food venue.
S. Typhimurium multiple-locus-variable number tandem repeats analysis (MLVA) types 03-14-06-11-523, 03-14-06-12-523 and 03-14-07-12-523 were identified in the stool samples of 74% (107/144) of outbreak cases, while 26% (37/144) of cases were defined by their clinical and epidemiological links. These MLVA types had not previously been identified in WA.
All 144 outbreak cases had symptoms consistent with salmonellosis, including 33 people who were hospitalised. 140 cases reported consuming banh mi from the food venue 5-140 hours (median 30 hours) prior to symptom onset. The banh mi contained pork, chicken, or tofu, with raw-egg mayonnaise as a common ingredient.
An inspection was conducted at the food venue. A swab from the food processor confirmed contamination with S. Typhimurium. Whole genome sequencing linked this isolate to the outbreak cases. The food processor had been used to produce mayonnaise, liver pâté, and shredded tofu used in banh mi. The inspection identified substandard cleaning of the food processor and inadequate cooking temperature of raw liver products.
How has this been used in practice? [Translational outcomes]
This is the largest known Salmonella outbreak associated with banh mi in WA. Early control measures were implemented, including immediate cessation of use of raw-egg mayonnaise, disinfection of the contaminated food processor, and disposal of affected ingredients. Case ascertainment continued until eight weeks post outbreak identification There were no further infections following the implementation of the control measures.
What actions should we take in the future to address the problem/issue? [Future actions]
This outbreak demonstrated that multi-agency surveillance and response activities are key to the detection and containment of serious food-borne outbreaks. Furthermore, banh mi has been frequently implicated in food-borne outbreaks. Consideration to the use of safer raw ingredients, and attention to food safety standards is advised.

Objective: The aim of the present qualitative study was to add to our understanding of the perceptions of mental health and service access among Bangladeshi migrants living in Australia to develop effective and culturally acceptable services that will enhance equity in healthcare.
Design, setting and Participants: In 2024, qualitative In-depth interviews were conducted with Bangladeshi migrants living in Australia. A subset of Bangladeshi migrants who participated in a quantitative survey and consented to qualitative interviews was used to recruit participants. A stratified purposeful sampling technique was used to identify ten respondents (5 men and 5 women; aged 27-44 years), balancing gender, visa, location and levels of psychological distress. A thematic analysis was performed.
Results: The challenges faced by Bangladeshi migrants in accessing and utilizing mental health services in Australia were organized into seven overarching categories: Firstly, participants lacked knowledge of mental health services and were unsure of where to seek support. Secondly, stigma surrounding mental health issues was a significant barrier, with participants fearing negative treatment from their community. Financial constraints, including out-of-pocket costs, were also a concern. Additionally, some participants believed that their religious faith restricted them from disclosing personal issues to outsider counsellors, while others thought that religious practices were sufficient for maintaining wellbeing. Further barriers included a lack of awareness about existing mental health services due to insufficient publicity through appropriate media channels. Communication difficulties with non-Bangladeshi service providers also prevented participants from seeking help. Finally, cultural issues and fears of breaking confidentiality were significant concerns.
Conclusion: The study's findings have important implications for future research and policy development: Culturally sensitive interventions, targeted public health campaigns about services, mental health literacy, strategies to reduce out-of-pocket costs and increase affordability of mental health services are needed to improve access to mental health care for Bangladeshi migrants in Australia.

Refugees and Humanitarian entrants have unique experiences which may impact their health and wellbeing. However, there is limited data on health outcomes in this population. Using linked data to identify refugee and humanitarian entrants in health datasets provides a better picture of the health of this vulnerable and diverse population.
The settlement database, which contains visa information for all permanent migrants who arrived in Australia from 2000, was linked to health datasets via the Australian Bureau of Statistics (ABS) Person Level Integrated Data Asset (PLIDA) and a novel linked data set created by the AIHW.
Extensive analyses of these data identified particular health issues and disparities in the refugee and humanitarian entrant population in comparison with other permanent migrants and the rest of the Australian population.
After adjusting for age, humanitarian entrants had 80% higher rates of self-reported diabetes and kidney disease. Humanitarian entrants were 2.4 times more likely to die from accidental drowning and 1.5 times more likely to die from liver cancer. Humanitarian entrants have higher rates of emergency department (ED) presentations compared with other permanent migrants and are more likely to arrive at an ED via ambulance.
The information garnered from these linked data analyses is vital to help inform health service planning and settlement policies to support targeted interventions. For example, the identification of high levels of kidney disease and diabetes in this population could help raise clinicians’ and policy makers’ awareness of these issues and help inform potential responses. Additionally, the findings support considering certain health promotion and early intervention strategies ranging from water awareness and swimming lessons to translation services for ambulance officers and ambulance dispatchers.
Further research into subgroups within this population such as country of origin, ethnicity or time spent in Australia could further support understanding of the drivers of health outcomes in this diverse population and help target service planning and policy.

Context and aim
Despite strengthening health systems for non-communicable diseases (NCDs) in South Asia (SA), low healthcare utilization (HCU) and unequal access remain challenges. A systematic review was conducted to explore factors affecting HCU for major NCDs (Cardiovascular disease, Diabetes, Chronic Obstructive Pulmonary Disease) in SA. This study examined both service availability (supply-side) and patients' willingness and ability to use them (demand-side). Additionally, this systematic review investigated the overall prevalence of HCU and the distribution between public and private healthcare systems.
Methods and analysis/research findings
This review included English language studies published between 2016 and August 31st, 2023, identified through a systematic search of Pubmed, CINAHL Ultimate, Scopus, and Web of Science databases. This study employed a combination of Joanna Briggs Institute's convergent integrated approach, framework synthesis, and 'synthesis without meta-analysis' (SWiM) to synthesize the evidence.
A total of 8,297 articles were identified, of which 81 met the inclusion criteria. Findings showed that the top three frequently reported supply-side determinants of HCU were wait times, quality of patient engagement with healthcare providers, and direct costs related to healthcare visits. Financial limitations, healthcare center proximity, and educational qualification emerged as the top three frequently reported demand-side determinants of HCU among patients with NCDs. Across SA countries, public health facilities showed HCU prevalence between 6.9% and 69.0%, while private facilities ranged from 21.6% to 87.5%.
Translational outcomes
By examining patients' experiences, views, and beliefs, we gained valuable insights into healthcare utilization for NCDs and strategies to promote it in the future.
Future actions
This review highlights the need for further research on HCU for NCDs in SA. This systematic review provides a foundation for researchers and policymakers to develop intervention strategies that strengthen healthcare systems for NCDs in SA.

Importance: Women are being diagnosed with attention deficit hyperactivity disorder at an increasing rate and are likely to be prescribed dexamphetamine as a treatment method in Australia. This indicates the potential for unplanned pregnancies to be exposed to dexamphetamine. It is vital to understand trends associated with dexamphetamine exposure during pregnancy so that potential risks may be evaluated and appropriate at-risk groups identified.
Objective: To examine trends and patterns in dexamphetamine use during pregnancy.
Design, Setting, and Participants: A population-based retrospective cohort study of Western Australian women who gave birth between 2003-2018. These women were dispensed dexamphetamine or lisdexamphetamine during their pregnancies.
Main outcomes: Prevalence of exposure to dexamphetamine during pregnancy was analysed by trimester, remoteness of the women and maternal age were analysed by time-trend analysis using the Joinpoint Regression Program, version 5.0.2 – May 2023.
Results: Overall, there has been an increase in the prevalence of dexamphetamine exposure during pregnancy, with a significant increase from 2003 to 2007. This trend can also be seen in each trimester. Age categories saw differing trends, with those with a maternal age of 25 years and under seeing a decrease in pregnancy exposure from 2007 to 2018, whilst the other age groups had an increase. Levels of remoteness also had differing trends, with those who live in rural settings showing an increase in dexamphetamine exposure during pregnancy from 2003 to 2007 followed by a reduction until 2010 and then an increase until 2018. Those who live in an urban dwelling have had an increase in the prevalence of dexamphetamine exposure during pregnancy, particularly between 2003-2011.
Conclusion and relevance: The overall increase in the prevalence of dexamphetamine exposure during pregnancy indicates a need to further investigate the safety of this medication during pregnancy. The differing trends seen in remoteness and maternal age indicate unique differences that require further research to determine if these groups have a potential for differing risks.

Abstract
Background: Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational transmission of preterm birth showed inconsistency in effect size and direction.
Objective: This systematic review and meta-analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational transmission of preterm births.
Search strategy: We searched MEDLINE, Embase, and Maternity and Infant Care databases, from the inception of each database to 04/04/2024.
Selection criteria: Eligibility criteria included studies that reported on women who had given birth and had recorded information about family history of preterm birth in one or both of the child’s biological parents.
Data collection and analysis: Data were extracted by two independent reviewers. A random-effects model was used to compute pooled estimates using odds ratios.
Main results: Sixteen eligible studies with a total of 2,271,612 mothers were included. The findings indicated a 1.44 (OR=1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR=1.53, 95%CI=1.24, 1.87), and having a partner born preterm (OR=1.12, 95%CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.
Conclusion: The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. It is important that countries integrate screening of family history of preterm into routine prenatal care. Closer follow-up and monitoring should be prioritized for pregnant women with a positive family history of preterm birth.

Introduction: There is increasing attention to microplastics (MPs; plastic particles less than 5 mm in diameter) and nanoplastics (NPs; even smaller plastic particles less than 1 µm in diameter) in the environment due to their potential impact on human health. MPs and NPs are detected in the air, ocean, soil, and sediment. In addition, detection of these MPs and NPs in human tissues such as lung, blood, and placenta highlights the urgency of analyzing health risks to humans. However, environmental MPs and NPs exhibit diverse physicochemical properties (size, shape, surface oxidation due to waves and UV radiation). In contrast, laboratory studies often employ uniform MPs and NPs ignoring their complex characteristics in the environment. Since the hazard and kinetics of MPs and NPs are influenced by their physicochemical properties, it is necessary to consider actual environmental conditions in risk analysis. Nonetheless, standardized MPs and NPs samples suitable for such studies are lacking worldwide. Therefore, this study aims to establish libraries of MPs and NPs reflecting their complex environmental characteristics, facilitating integrated safety assessments. This study introduces an overview of the libraries, focusing on the characteristics of Micro- and Nano- Polypropylene (PS), including their safety aspects.
Methods: To produce smaller particles (less than 1 µm), we utilized PS and employed a previously published precipitation-based method. Additionally, Surface-oxidized MPs and NPs were generated through irradiation with vacuum UV light at 172 nm under air to simulate environmental conditions. Utilizing generated MPs and NPs, we tested safety assessments.
Results and Discussion:
We established MPs and NPs of PS considering several size, shape (sphere and fragment) and surface oxidation. Utilizing these MPs and NPs libraries, we examined cytotoxicity test. As a result, surface oxidated MPs and NPs exhibit more cytotoxic than non-surface oxidated MPs and NPs. In this study, we established MPs and NPs libraries reflecting their physicochemical properties in the environment. In the future, we plan to further enlarge the MPs and NPs libraries and accumulate safety assessments. These libraries are available for distribution upon request through future collaboration. Please direct all questions regarding these libraries to Yuya Haga (haga-y@phs.osaka-u.ac.jp).

What is the problem/issue that requires public health action?

In Australia, 27,000+ women have a hysterectomy for benign conditions each year. While there are benefits, most studies indicate that women who have a hysterectomy before 40 years can suffer long-term detrimental health effects. Our recent study of over 660,000 women showed hysterectomy with ovarian conservation before 35 years was associated with 50% higher mortality rates from causes other than cancer or cardiovascular disease, increasing to 158% when the ovaries were also removed. The reasons for these increases are unclear but may relate to the socioeconomic/health characteristics of younger women who have hysterectomies.

Our study aims to characterise Australian women who have a hysterectomy <40, to assess how the pre-existing health and gynaecological conditions in this group differ from other women.

What do we know, and how has this finding been derived?

Our large study includes all women from New South Wales and Victoria who had a hysterectomy surgery <40 years from 2002-2022 (n≈10,000), and an age-matched comparison group. We used data-linkage to obtain procedures/diagnoses/treatments from state/national health records. Our study investigates associations with health/gynaecological conditions such as endometriosis, fibroids, alcohol dependency, anxiety, depression, severe mental illness, intellectual disability, diabetes, chronic pain, as well as indicators of socio-economic disadvantage.

While analyses are still in progress, we look forward to sharing our detailed findings at the Australian Public Health Conference.

How has this been used in practice?

Our study will identify vulnerable groups of women for whom there have been disparities of care related to gynaecological surgeries. This may have clinical relevance and provide areas for further investigation.

What actions should we take in the future to address the problem/issue?

Understanding disparities/differences for women who have a hysterectomy <40 years will help target interventions to improve health outcomes for these women.

Context and aim
Non-communicable diseases (NCDs) are prominent public health challenges globally. Little is known about the unmet healthcare needs among those with NCDs. This research examined the factors associated with unmet health services needs among people with chronic diseases in China.

Methods and analysis
In this population-based, panel data analysis, we used data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020. The sample of this study included 8,106 adults aged 45 years and older, with more than one type of NCDs who had completed follow-up for the 2013, 2015 and 2020 waves. Unmet healthcare needs were measured by the question “In the past year, did a doctor suggest that you needed inpatient care, but you did not get hospitalised?” Answers to this question were coded as a binary variable (0 =no, 1 =yes). The factors associated with unmet needs were assessed using mixed-effects logistic regression models.

Research findings
The prevalence of unmet healthcare needs in China was increased from 7.4% to 12.6% from 2013 to 2020. Adjusting for socioeconomic, behavioral factors, as well as area of residence, people having more than three types of NCDs (95%CI: 2.09, 2.83), who were satisfied with their lives (95%CI: 0.54, 0.70), and people with poorer self-rated health status ( 95%CI: 3.18, 4.90) were more likely to have unmet healthcare needs.

Transitional outcome and future actions
The findings from this research suggested targeted interventions to support people at higher risk of unmet healthcare needs. For example, healthcare providers can prioritise patients with multiple NCDs and low life satisfaction for more comprehensive care and follow-up. Additionally, public health campaigns can focus on improving life satisfaction and overall well-being as part of a holistic approach to managing NCDs.