Universal Health Coverage (UHC) is defined by WHO and the World Bank as when “all people receive the health services they need without suffering financial hardship when paying for them”. UHC is central to the UN Sustainable Development Goals (SDGs), adopted in September, 2015, with a specified target in SDG 3—ensure healthy lives and promote wellbeing for all at all ages. The SDGs are interconnected but good health underlies them all. UHC has been acknowledged by the World Bank, WHO, the G7, and multiple governments as fundamental for realising the goal of sustainable development.
On this year's Human Rights Day, Dec 10, current events in the USA suggest that a key human right is being dangerously disregarded. Access to water is an indispensable part of life, health, and dignity. In 2010, the UN General Assembly recognised the human right to safe and clean drinking water and sanitation; the US has yet to agree and ratify this view.
The global prevalence of food allergies has steadily increased over the past two decades, according to a new report, Finding a Path to Safety in Food Allergy, released by the National Academies of Sciences on Nov 30. The comprehensive report assessed and defined the current landscape of food allergy in the USA, and outlined six courses of action—including expanding research, improving public policies, and increasing education of health-care providers—aimed at improving the quality of life of people with food allergies.
That women and men have different physiology, experiences of illness, and health-care outcomes is well established.1 From the benefits of aspirin for prevention of cardiovascular events2 to the effects of sleep medication,3 sex differences in health outcomes, and in the most appropriate health-care interventions, matter to doctors and patients. Despite this knowledge, a historical bias towards homogeneous male populations in biomedical research has often left the variable of sex under-addressed or unexplored entirely.
Sex and gender are basic variables in preclinical and clinical scientific research.1–4 Data show that physiology differs between male and female humans and animals beyond reproductive function to encompass all systems, including differences in cardiovascular, respiratory, musculoskeletal, immunological, gastrointestinal, neurological, and renal function.5–7 Failure to account for sex and gender may result in the inability to reproduce scientific findings, and often translates into less than adequate care of, or even harm to, men and women.
Yassin al-Haj Saleh's image flickered onto the screen in Mary Dodge Hall at the American University of Beirut (AUB) in Lebanon last week. Yassin is a Syrian doctor and writer, now living in Turkey. He spent 16 years in prison (from 1980 to 1996) for actively promoting democracy under the rule of President Hafez al-Assad. A medical student when he was arrested, Yassin finished his studies after being released and qualified as a doctor in 2000. He was speaking at the first meeting of the Lancet–AUB Commission on Syria: Health in Conflict.
A local government scheme to provide better primary care coverage in India's capital territory is proving popular with residents, but not central government. Dinesh C Sharma reports from Delhi.
Several campaigns and initiatives are underway in Europe and the USA by doctors hoping to improve services and care for patients with chronic pain. Tatum Anderson reports.
At the beginning of Paul Kalanithi's memoir, When Breath Becomes Air, he appears to be a doctor at work, scrolling through CT scan images on a hospital computer: “the diagnosis was obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated”. The story takes an unexpected turn when he adds, “This scan was different: it was my own”. 15 months before the end of his neurosurgery residency, Kalanithi was diagnosed with lung cancer. He died less than 2 years later.
Psychiatrist Peter Kramer found fame in 1993 with the publication of Listening to Prozac. At a time when Prozac (fluoxetine) was as much a cultural as medical phenomenon, the book documents and explores Kramer's experience of prescribing antidepressants to his patients. Provocatively, Kramer observed that these medications leave some patients apparently improved, or “better than well”. Listening to Prozac spent 4 months on The New York Times bestseller list, earning Kramer the moniker “Dr Prozac”.
Probably the biggest take away from Siddhartha Mukherjee's The Gene: An Intimate History is that we might all have made a greater impact on the world had we failed more exams. As Mukherjee describes in this follow-up to his Pulitzer Prize-winning Emperor of All Maladies, Charles Darwin left Edinburgh medical school unable to stomach the blood and screaming, tutors of Sir Ronald Fisher, the forefather of statistical genetics, were sorely disappointed in his abilities, and John Gurdon, who later won a Nobel Prize in Physiology or Medicine, once came 250th out of a class of 250 in a biology exam at Eton College.
The tragedy of the Fukushima nuclear accident is still present in our minds. On March 11, 2011, a tsunami caused by an earthquake not far from the eastern coast of Japan triggered 15 m high waves that crashed into the Fukushima Daiichi nuclear power station causing multiple meltdowns. Nearly 19 000 people were killed or left missing, and some 170 000 lost their homes and livelihoods. More than 5 years have passed since that day and the consequences for the health of people who lived in the area and were exposed to radiation remain substantial, as described in the Lancet Series Japan: from Hiroshima and Nagasaki to Fukushima in 2015.
In a memoir of her exploits in World War 2, the redoubtable Nancy Wake, a straight-talking New Zealander famed for her work with the French Resistance, recalled being screened by a British psychiatrist for service as a secret agent. Among his methods was the Rorschach projective test, which required her to state what she saw in a series of ambiguous shapes made from inkblots. After declaring that they looked like inkblots, “I told him he should be doing something more constructive instead of wasting his time and mine”.
In the 17th century, Britain's most respected physician, Thomas Sydenham, was a strong advocate of opium from poppies for treating coughs and, especially, dysentery and diarrhoea: “Among the remedies which it has pleased Almighty God to give man to relieve his sufferings, none is so universal and efficacious as opium.” In the 18th century, opium in dilute form was prescribed for children, mainly to keep them quiet, despite the fact that it caused many deaths. Governments treated opium as a medicine and did not tax it, unlike alcohol.
At the UK premiere of Ken Loach's latest film, I, Daniel Blake, a group of people with disabilities and their supporters gathered to protest against the benefits system, asserting that “we are Daniel Blake every single day”. Loach and the film's lead actors, along with Labour Party leader Jeremy Corbyn, later stopped to greet the protestors. Photos were taken against the backdrop of a series of placards, some of which displayed official Department of Work and Pensions statistics: in 2011–14, 7200 recipients of Employment and Support Allowance allocated to a “work-related activity” group, and therefore potentially fit for work in the immediate future, had died.
Walking into this show, after a ramble through Cambridge's grey and muted-yellow lanes, you enter an Aladdin's cave of dazzling colour. At first you perceive only the gold, emanating from the wafer-thin gold leaf that was hammered onto the illuminated manuscripts on display, and from the gold specks brushed onto them in a liquid medium. An exalting and exultant golden light leaps out of the suns, stars, haloes, and gilt letters depicted on these parchments, to form a single blinding band that encircles the exhibition galleries.
Leader in Greek psychiatry. He was born in Kalabaka, Greece, on Feb 18, 1928, and died of respiratory failure in Athens, Greece, on Oct 29, 2016, aged 88 years.
The Article by Ian Anderson and colleagues1 (July 9, p 131) on the health and social aspects of tribal people is both astounding and instigative. However, the indicators are grouped together under a single classification, wherein the individual positions of each tribe remain hidden. Such classifications have a sluggish effect on development. To cite here the case in India, 705 tribal groups are classified as Scheduled Tribes.2 Although the impetus on tribal development is very clear in every 5-year plan period, the health and social conditions of Scheduled Tribes remain regressive even after 69 years of independence of India.
In a recent Lancet Article, Ian Anderson and colleagues1 recommended that governments develop national policies with sustainable health targets focused on health service delivery, access, and Indigenous data systems. Smart policy and practice decisions can be informed by research evidence about what works; however, Indigenous people worldwide have expressed concerns that much research has been done already, without corresponding improvements in their health.2
Janya McCalman and colleagues quite rightly highlighted the importance of intervention research in developing a fully mature national research agenda for Indigenous and tribal communities, a gap that was also described by Sanson-Fisher and colleagues1 in 2006. However, we stress that descriptive statistics are equally vital to the identification of policy priorities and key to long-term monitoring and assessment of policy. Similarly, although the scope of our study2 did not allow for disaggregation of data at the tribal level, we agree with Kalyan Saha and colleagues that this is necessary to ensure that Indigenous policy development takes into account sub-national variation.