The UN Food and Agriculture Organization has warned that the hunger and malnutrition crisis is worsening in Sudan. Poor harvests, food price rises, conflict, and increased refugee movements have led to food insecurity for 3·3 million people (a number that is likely to rise). The UN is calling for US$19 million to fund urgent interventions in the country but has only received $7 million so far.
“Water is life”, said UN Secretary-General Ban Ki-moon, at the opening session of the high-level meeting on sanitation and water for all, in Washington, DC, on April 11, 2014. Yet lack of access to safe drinking water, and poor sanitation and hygiene in many parts of the world, often leads to death. The Lancet Series on childhood pneumonia and diarrhoea estimated that in 2011 around 700 000 child deaths occurred from diarrhoeal disease alone. The Millennium Development Goal (MDG) 7c target to halve the proportion of people without sustainable access to safe water by 2015 has been declared on track, yet 768 million people globally are still without access to safe drinking water.
More than 500 million people live in the European Union, but despite being connected on a political level, disparities in health outcomes are widespread. This disparity was exemplified in last week's Lancet when Sheng-Chia Chung and colleagues reported that 30 day mortality after acute myocardial infarction (AMI) was more than a third higher in the UK than in Sweden, even though health spending was similar between the countries.
A WHO report, Tobacco Health Warnings in China: Evidence of Effectiveness and Implications for Action, published on April 8, summarises evidence on the effectiveness of China's written health warnings on tobacco packaging. It concludes that China failed to comply with Article 11 of the WHO Framework Convention on Tobacco Control (FCTC), which defines packaging and labelling of tobacco products. The report calls for policy makers to accelerate the implementation of pictorial warnings in the packaging of tobacco products and public education targets set out in China's National Tobacco Control Plan.
In the past 5 years, doubts have been raised about the therapeutic effectiveness of antidepressants in patients with depressive disorders, because of the small differences in symptom improvement between antidepressants and placebo recorded in randomised controlled trials (RCTs). With the recent debates about lowering of disease thresholds in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and the medicalisation of normal bereavement, this scepticism has increased. For the large group of patients with mild depression, the differences between antidepressants and placebo are not thought to be large enough to be clinically significant—ie, at least three points on the Hamilton Depression Rating Scale, HAMD-17.
The Global Mental Health (GMH) movement has played a pivotal part in bringing to attention the unmet needs of patients with mental disorders, particularly in low-income and middle-income countries. Schizophrenia is of primary concern in view of the high level of associated disability and stigma, and the risk that, without treatment, patients will experience prolonged institutionalisation, neglect, and abuse.
Schizophrenia causes substantial disability and premature mortality, and is one of the top causes of disease burden worldwide. Antipsychotic drugs revolutionised schizophrenia treatment when introduced in the 1950s, and numerous studies have shown that antipsychotics are effective for acute episodes, and as maintenance treatment, with a number needed to treat of 3 to prevent relapse. Evidence has also shown that some drugs could reduce mortality, mainly through a reduction in suicide rates. However, the clinical reality is that many patients stop taking antipsychotics for various reasons: side-effects, absence of benefit, disorganisation, and because they do not perceive they have an illness.
Mental disorders are common, although reported rates differ according to developmental stage. The prevalence of common mental disorders such as depression increases in adolescence, Mental disorder in adolescence increases the risk of later adult disorder, and adults with mental disorder often have their first episode in adolescence. Therefore, adolescence is potentially an important time for mental health interventions to reduce both present and long-term impairment. However, there is little detailed knowledge about the prognosis of common adolescent mental disorders during the transition to adulthood.
In two Series articles in The Lancet, Christopher Bass and colleagues examine fabricated or induced illness in children, and factitious disorders and malingering, respectively, which fall under the umbrella of abnormal illness behaviours. A common theme is the strategic use of illness behaviours in relationships with other individuals, including doctors and other health professionals. Abnormal illness behaviours are inherently social and interpersonal; they have no strategic or communicative function except when someone else can observe and respond to the behaviour.
France, writes Andrew Hussey in The French Intifada (Granta, 2014), is home to the largest Muslim population in Europe—5 million people out of a population of almost 64 million. Many of these migrants, the majority of whom originate from the North African Maghreb (Algeria, Morocco, and Tunisia), live in the banlieues surrounding Paris: “the most literal expression of ‘otherness’—the otherness of exclusion, of the repressed, of the fearful and despised—all kept physically and culturally away from the mainstream of French ‘civilisation’.
After 2 years of radical reform, and with a new president at its helm, the South African Medical Research Council is ready to start hitting its stride. Anna Petherick reports.
Globally, health-care workers experience high rates of violence and abuse in the workplace. More focus should be put on preventing such attacks, say experts. Roxanne Nelson reports.
The UK's National Health Service (NHS) is by almost any measure an extraordinary organisation. In 2012–13 its budget was £105 billion; it employs some 146 000 doctors and sees more than 1 million patients every 36 hours. The British look to the NHS to bring their children into the world, to treat their maladies, and to ease their time of dying. But the NHS is more than just a health service. It's an embodiment of high ideals: that health care should be universally available, and that the costs of this should be shared.
The passing of time can render wondrous what was once commonplace. The everyday can become obscure and the unremarkable mysterious. The Whipple Museum of the History of Science in Cambridge, UK, and London's Wellcome Collection contain many such objects which demonstrate the process. Glass cases and display cabinets are filled with antiquated scientific and medical objects, many of which, to the 21st-century eye, appear to possess curious and unsettling qualities that were wholly unintended by their creators.
Millennium Development Goal (MDG) target 7c aims to halve the proportion of the population without sustainable access to safe drinking water and basic sanitation. With 89% coverage globally and 91% coverage in India in 2011, UN monitoring bodies judge the world to be on track for access to drinking water.
We welcome the report of The Lancet–University of Oslo Commission on Global Governance for Health (Feb 15, p 630) and agree with its diagnosis that the root causes of health inequity are political and power imbalances, which drive an unequal neoliberal globalisation that current global governance institutions are unable or unwilling to address.
In the market economy the goal of participants is to make profits. Notwithstanding the growth of corporate philanthropy and ethical consumption, market economy is, has been, and will be about profit making. Corporate management's responsibility lies in shareholder wealth maximisation. Consumers pay for goods and services that give them the biggest return to their hard-earned money. We certainly can aspire for a softer, more inclusive economic system.
We are pleased that the People's Health Movement welcomes our report of The Lancet–University of Oslo Commission on Global Governance for Health and agrees with its diagnosis. “Bottom-up (health) activism will continue to be an essential strategy for health equity”, which is indeed why the People's Health Movement is so important. We certainly see WHO as the legitimate supranational global health organisation, requiring greater support. But we do not believe that our recommendation for an Independent Scientific Monitoring Panel and a Multi-Stakeholder Platform on Governance for Health (MSPGH) would weaken WHO or serve to multiply multilateral organisations, as suggested.