Sarah Steele

Introduction: 'dying for gold': the effects of mineral miningon HIV, tuberculosis, silicosis, and occupational diseases in southern Africa.

This article begins a special series, a roundtable discussion on mining activity and health, edited by David Stuckler, Sarah Steele, Mark Lurie, and Sanjay Basu. Mineral mining is among the worlds most hazardous occupations. It is especially dangerous in southern Africa, where mining activity is a leading cause of HIV and tuberculosis epidemics. Inside mines, silica dust exposure causes long-term pulmonary damage. Living conditions are often substandard; poorly ventilated living quarters facilitate tuberculosis and airborne disease spread, and high rates of alcohol and tobacco use compromise immune responses. Family segregation, a legacy of apartheids migrational labor system, increases the likelihood of risky sexual activity. Sex trafficking in women increases risks of HIV and other sexually transmitted diseases, and labor trafficking in men through poorly regulated labor brokering impedes access to health care. Labor migration spreads mining hazards to rural, labor-supplying communities. Cross-border care is often inadequate or nonexistent, contributing to significantly greater rates of extensive and multi-drug resistance in miners, ex-miners, their families, and communities. Miners in high-income countries, working for the same transnational companies, do not experience elevated rates of death and disability. Cost-effective interventions can reduce HIV incidence through social housing, curb trafficking of high-risk groups, stop tuberculosis spread through screening and detection, and reduce drug resistance by standardizing cross-border care. Urgent action is needed to respond to minings staggering, yet avoidable disease toll in sub-Saharan Africa.

The Immigration Bill: Extending charging regimes and scapegoating the vulnerable will pose risks to public health

Politicians, claim these measures are necessary to cut costs of ‘health tourism’ and ‘abuse’ by illegal immigrants, and to further the Government’s push to reduce net migration overall. Such claims are despite evidence that the UK is a net beneficiary of health tourism 3 and that, while immigrants account

National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

BACKGROUND Sex workers are disproportionately affected by HIV compared with the general population. Most studies of HIV risk among sex workers have focused on individual-level risk factors, with few studies assessing potential structural determinants of HIV risk. In this Article, we examine whether criminal laws around sex work are associated with HIV prevalence among female sex workers. METHOD We estimate cross-sectional, ecological regression models with data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation from the US State Departments Country Reports on Human Rights Practices and country-specific legal documents; the rule of law and gross-domestic product per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injecting drug use among sex workers. Although data from two countries include male sex workers, the numbers are so small that the findings here essentially pertain to prevalence in female sex workers. FINDINGS Countries that have legalised some aspects of sex work (n=17) have significantly lower HIV prevalence among sex workers than countries that criminalise all aspects of sex work (n=10; β=-2·09, 95% CI -0·80 to -3·37; p=0·003), even after controlling for the level of economic development (β=-1·86; p=0·038) and the proportion of sex workers who are injecting drug users (-1·93; p=0·026). We found that the relation between sex work policy and HIV among sex workers might be partly moderated by the effectiveness and fairness of enforcement, suggesting legalisation of some aspects of sex work could reduce HIV among sex workers to the greatest extent in countries where enforcement is fair and effective. INTERPRETATION Our findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair. FUNDING European Centre for Disease Prevention and Control.

Human Trafficking, Labor Brokering, and Mining in Southern Africa: Responding to a Decentralized and Hidden Public Health Disaster:

Many southern African economies are dependent on the extractive industries. These industries rely on low-cost labor, often supplied by migrants, typically acquired through labor brokers. Very little attention has so far been paid to trafficking of men into extractive industries or its connection with trafficked women in the regions mining hubs. Recent reports suggest that labor-brokering practices foster human trafficking, both by exposing migrant men to lack of pay and exploitative conditions and by creating male migratory patterns that generate demand for sex workers and associated trafficking of women and girls. While trafficking in persons violates human rights, and thus remains a priority issue globally, there is little or no evidence of an effective political response to mine-related trafficking in southern Africa. This article concludes with recommendations for legal and policy interventions, as well as an enhanced public health response, which if implemented would help reduce human trafficking toward mining sites.

Ethical, legal and professional issues arising from social media coverage by UK Helicopter Emergency Medical Services

Objective Social media (SoMe) are gaining increasing acceptance among, and use by, healthcare service deliverers and workers. UK Helicopter Emergency Medical Services (HEMS) use SoMe to deliver service information and to fundraise, among other purposes. This article examines UK HEMS use of SoMe between January and February 2014 to determine the extent of adoption and to highlight trends in use. Methods The database of the Association of Air Ambulances, crosschecked with UK Emergency Aviation, was used to identify flying, charitable UK HEMS. This search identified 28 UK HEMS, of which 24 services met the criteria for selection for review. Using information harvested from the public domain, we then systematically documented SoMe use by the services. Results SoMe use by UK HEMS is extensive but not uniform. All selected UK HEMS maintained websites with blogs, as well as Facebook, Twitter, Wikipedia and JustGiving profiles, with the majority of services using Ebay for Charity, LinkedIn and YouTube. Some HEMS also held a presence on Pinterest, Google+, Instagram and Flickr, with a minority of services maintaining their own Rich Site Summary (RSS) feed. Conclusions The SoMe adopted, while varied, allowed for increased, and different forms of, information delivery by HEMS to the public, often in real time. Such use, though, risks breaching patient confidentiality and data protection requirements, especially when information is viewed cumulatively across platforms. There is an urgent need for the continued development of guidance in this unique setting to protect patients while UK HEMS promote and fundraise for their charitable activities.

Risks of the unregulated market in human breast milk

Urgent need for regulation

More than just a famous face: exploring the rise of the celebrity expert-advocate through anti-trafficking action by the Demi and Ashton Foundation

While the criminological literatures explore celebrity trials and investigations, the celebrity’s placement as an actor in criminal justice processes – and as an authoritative voice on crime – remains less investigated. With celebrity activism and testimony increasing around issues like human and child trafficking, this article contemplates the celebrity as an ‘expert-advocate’ who reinforces the state’s ability to regulate, especially in light of ongoing challenges to its sovereignty, such as trafficking. Through the Demi and Ashton (DNA) Foundation’s ‘Real Men’ and Customs and Border Protection campaigns, we note that celebrities are no longer just ‘public faces’, but also members of a ‘firm’ working with the state to recreate the illusion of state sovereignty, bolstering borders and divides. We call for further research into celebrities as influential agents in the criminal justice system.

More than a lucrative liquid: the risks for adult consumers of human breast milk bought from the online market

Sarah Steele, Jens Foell, Jeanine Martyn and Andreas Freitag Global Health, Policy and Innovation Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK Richford Gate Medical Practice, Richford Street, London W67HY, UK Lifespan, 167 Point Street, Providence, Rhode Island 02903, USA National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK Corresponding author: Sarah Steele. Email: s.steele@qmul.ac.uk

Tougher charging regime for “overseas” patients

Migrants with mental health needs will be hit hardest

A guide to private prescribing

Under what circumstances can healthcare professionals issue a private prescription? This article explores the various options.