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[Editorial] Taking urgent action on health inequities

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The 2010 Marmot Review Fair Society, Healthy Lives was regarded as one of the top three major UK public health achievements of the 21st century in a Royal Society for Public Health survey. The report established a political imperative to reduce health inequalities and address the social determinants of health. To coincide with the 10-year anniversary of the report, a follow-up review—Health Equity in England: The Marmot Review 10 Years On—was released on Feb 25, 2020. This new report, built on updated evidence, explores the outcomes of addressing health inequalities and social determinants of health in England over the past decade.

[Editorial] Support for caregivers in the USA

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The contest to secure the Democratic party nomination for President of the USA has brought health care to the forefront of public discourse, with much of the discussion dominated by the merits of Medicare for All, a comprehensive single-payer national health-care programme. The questions raised in this debate have brought a welcome focus on specific policy options for addressing the country's myriad health-care challenges. But largely missing has been the issue of social care, particularly the role of the country's estimated 17·7 million informal caregivers.

[Editorial] Rare diseases need sustainable options

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Feb 29 marks Rare Disease Day, an opportunity to reflect on the lives of the estimated 400 million people globally who are affected by one of 6000–8000 rare diseases, most of them genetic. These diseases were long neglected, but large international initiatives such as EURORDIS and Rare As One have been set up to represent patients’ voices, highlight the disease burden (including psychological aspects) on patients and their families, share data and knowledge, promote collaboration, and fund research into the causes of rare diseases and novel therapeutics.

[Comment] The Lancet–SIGHT Commission on peaceful societies through health and gender equality

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In 2015, world leaders adopted the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs) with a vision for more peaceful and inclusive societies. However, the UN Secretary-General has warned that conflict and instability in many parts of the world are impeding progress towards these goals, including SDG3 on health and SDG5 on gender equality.1 This lack of progress could create inequality, exclusion, and injustice, contributing to instability and conflict.2 Solutions that harness the potential of health and gender equality are needed to reduce violent conflict and promote stability.

[Comment] Offline: The pretensions of global health elites

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A small group within the global health community—a group whose members I have been asked not to name—assembled at Wilton Park in the UK earlier this month to discuss the idea of “Healthy Societies for Healthy Populations”. The aura of Wilton Park is beguiling. Situated about 50 miles south of London, and surrounded by little but a disparate collection of wandering sheep in desolate grounds, Wilton Park is an executive agency of the UK's Foreign and Commonwealth Office. The venue is commonly used for defence and security gatherings.

[World Report] Medicare for All scrutinised in Democratic primaries

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On March 3, 14 states will pick their nominees for the US presidential election. The feasability of a single payer insurance plan is a key issue. Susan Jaffe reports from Washington, DC.

[World Report] Indian pharma threatened by COVID-19 shutdowns in China

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As factories in China are closed, India is working to maintain supplies of active pharmaceutical ingredients. Patralekha Chatterjee reports from New Delhi.

[World Report] How to fight an infodemic

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WHO's newly launched platform aims to combat misinformation around COVID-19. John Zarocostas reports from Geneva.

[Perspectives] Making sense

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As a surgeon I knew a lot about relatively little. Surgery was what I read about, thought about, practised, and learned. After finishing my specialist training, I changed direction and became a general practitioner (GP). My colleagues couldn’t understand it. But becoming a GP was a fascinating challenge. As a family doctor, I had to know a little about a lot. I couldn’t possibly have a deep knowledge of any of the branches of medicine my specialist colleagues lived in—or certainly not more than one or two.

[Perspectives] Subtle provocation

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Alice (Emily Beecham) is a talented scientist who breeds genetically engineered plants in director Jessica Hausner's film Little Joe. A workaholic, she finds it a challenge to make time for her teenage son Joe (Kit Connor), for whom she is a single mother. Alice's team is working on a new project: it's an otherworldly flower with spiky blood red petals. Given enough care and attention, it's been engineered to release a scent that stimulates the release of oxytocin in the brain. Or, as Alice puts it, it's “the first, mood-lifting, antidepressant, happy plant, that's fit for market.”

[Perspectives] Sai Subhasree Raghavan: building health solidarity in India

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When Subha Raghavan was growing up in southern India in the 1970s, she witnessed caste discrimination and violence and vowed to “create a more just society” and “give back” to her community and others like it. Raghavan is the Founding President of the non-profit Solidarity and Action Against the HIV Infection in India (SAATHII), which, for 17 years, has worked to increase access to health care, justice, and social welfare for marginalised communities in India. Long-term colleague, Shobana Ramachandran, Senior Manager of Strategic Information and Evaluation at the Elizabeth Glaser Pediatric AIDS Foundation, describes Raghavan as “an extraordinary activist, leader, and collaborator” and says: “Under her charge, SAATHII has become one of the pre-eminent HIV prevention, care, and treatment actors in India, and has gone on not only to serve communities marginalised by their HIV status but also those discriminated against on account of their gender and/or sexuality.”

[Perspectives] Power and perils of prediction in palliative care

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As artificial intelligence (AI) spreads across clinical specialties, its potential to revolutionise health care at the individual and population levels has placed it alongside genomics as one of the frontiers in medicine. The promise that AI could help health systems and clinicians optimise patient care in core domains of diagnosis, prognosis, and treatment drives widespread interest and investment.

[Correspondence] The need for an evidence-based and rational debate on e-cigarettes

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The inaccuracies and misinformation in the Editorial about e-cigarettes1 do a major disservice to evidence-based public health.

[Correspondence] 4 + 4 medical education: a word of caution

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We read with interest the Comment by Chen Wang and colleagues,1 which introduced the new 4 + 4 medical education programme launched in Peking Union Medical College in September, 2018. However, caution must be taken in describing this programme as a success, because medical students have yet to graduate.

[Department of Error] Department of Error

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Silverstein WK, Stroud L, Cleghorn GE, Leis JA. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. Lancet 2020; 395: 734—In this Clinical Picture, the last sentence should have read: “Further, it suggests that the identification of individuals—like our patient—who could be managed by being isolated at home, rather than in hospital, might be an important strategy for containing this outbreak.” This correction has been made to the online version as of Feb 27, 2020, and the printed version is correct.

[Review] Epilepsy in older people

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Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options.

[Editorial] COVID-19: fighting panic with information

Sa, 22/02/2020 - 00:00
As governments and health officials worldwide grapple with the epidemic of severe acute respiratory syndrome coronavirus 2, new developments in the accounting of and response to cases are occurring as part of a swiftly evolving crisis. On Feb 11, 2020, WHO announced an official name for the novel coronavirus disease: coronavirus disease 2019 (COVID-19). After a stabilisation in the number of new cases, on Feb 13, 2020, China reported nearly 15 000 new COVID-19 cases and 242 deaths in a single day in Hubei province.

[Editorial] Childbirth settings in the US

Sa, 22/02/2020 - 00:00
Despite spending more than many comparable countries, the US has the highest incidence of maternal and neonatal mortality and morbidity of any high-resource country, particularly among black and Native American women. A report published by the National Academies of Sciences, Engineering, and Medicine (NASEM) shows that although most US births take place in hospitals, a growing proportion occurs in birth centres or at home. Based on the available data, there is a statistically significant increase in the relative risk of neonatal death in the homebirth setting, but also a consistently lower risk of medical intervention during labour and resulting maternal morbidity.

[Comment] Offline: Facts are not enough

Sa, 22/02/2020 - 00:00
We are in the midst of a struggle. A struggle for the soul of global health. On one side, the intelligent idealists. Those who sincerely believe that by describing the world in ever more refined and precise ways we will advance closer to an elusive truth. A truth that will unlock the extraordinary potential that is global health. The Global Burden of Disease is the divine apotheosis of intelligent idealists. And universal health coverage their Garden of Eden. On the other side of this struggle, the innocent cynics.

[World Report] Locust swarms in east Africa could be “a catastrophe”

Sa, 22/02/2020 - 00:00
The destruction of crops is threatening food security for millions of people. Sharmila Devi reports.