When neurologist Reisa Sperling stepped up to receive her lifetime achievement award at an international Alzheimer’s conference last December, she was more excited about the future than about celebrating the past.
What thrilled Sperling, who won the award for her work on clinical trials of Alzheimer’s treatments, was a sense of hope, which has been conspicuously missing from research into the disease for many years. Most other attendees felt the same.
Just a few months before the meeting, researchers had announced that an antibody drug called lecanemab clearly lowered the amount of amyloid protein plaques — a tell-tale sign of the disease — in the brains of participants in a clinical trial, and slowed their cognitive decline.
A recent ground-breaking series of reports in the science journal The Lancet unpacks what commercial determinants of health are, and how they affect public health. It uses a new, broader definition of the determinants:
the systems, practices and pathways through which commercial actors drive health and equity.
Some commercial entities contribute positively to health and society. However, research shows that some commercial products and practices are directly linked to avoidable ill health, planetary damage, and social and health inequity. Large transnational corporations are especially to blame.
Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.
Jyotsna Singh of the People’s Health Movement talks about the recent Executive Board meeting of the World Health Organization. She talks about what happens during such meetings and the major issues on the table at the WHO. This is a key moment for the future of global health care as amendments to the International Health Regulations and the Pandemic Treaty are being discussed. Jyotsna describes the concerns raised by countries of the Global South and the ways in which the pandemic has influenced these discussions.
Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.
We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes.
We report an empirical analysis of the use of imagery by the key actors in global health who set policy and strategy, and we provide a comprehensive overview, particularly related to images used in reports on vaccination and antimicrobial resistance. The narrative currently depicted in imagery is one of power imbalances, depicting women and children from low-income and middle-income countries (LMICs) with less dignity, respect, and power than those from high-income countries. The absence of any evidence of consent for using intrusive and out-of-context images, particularly of children in LMICs, is concerning. The framework we have developed provides a platform for global health actors to redefine their intentions and recommission appropriate images that are relevant to the topic, respect the integrity of all individuals depicted, are accompanied by evidence of consent, and are equitable in representation. Adhering to these standards will help to avoid inherent biases that lead to insensitive content and misrepresentation, stigmatisation, and racial stereotyping.
Natalie Rhodes, PhD candidate at University of Leeds, and People’s Health Movement, along with Remco van de Pas, researcher at the Centre for Planetary Health Policy, and People’s Health Movement discuss in detail about the implications of the newly established World Bank fund for Pandemic Prevention, Preparedness and Response and the Bank’s other policies pertaining to public health.
In The Lancet Global Health, the Global Burden of Disease Study (GBD) 2019 Indonesia Collaborators report on 30 years of disease burden and risk factors in Indonesia, expanding their analysis to a more granular subnational level.
Given the ongoing challenges of obtaining comparable subnational data, the GBD data provides enlightening evidence for decision makers at the subnational level for future programmatic planning and policy strategies specific to their local health issues. These findings will ultimately help narrow down the inequality gaps at regional levels. This paper is perfectly timed to captured and illustrate the health status in Indonesia before and after the launch of the universal health coverage (UHC) programme Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) in 2014. The BPJS has now covered more than 75% of the Indonesian population.
Although excellent programmatic interventions and policies have significantly reduced the disease burden in the past three decades, communicable diseases remain the main source of disability-adjusted life-years (DALYs) in Indonesia, along with the rising burden of non-communicable diseases (NCDs) such as diabetes. Diabetes has become one of the main priorities of the national government as programmatic research and efforts towards prevention, early detection, and treatment of diabetes are increasing. Apart from poor quality of life, health-care costs related to diabetes complications are high, with diabetic retinopathy accounting for nearly 2% of the total national state budget, and are estimated to triple by 2025.
[NEW DELHI] Antibiotic-resistant strains of Salmonella Typhi, the typhoid bacteria, have spread from South Asia to other countries nearly 200 times since 1990, new research suggests.
Every year, an estimated 11 to 20 million people suffer from typhoid and 128,000 to 161,000 victims die from the disease, says the World Health Organization (WHO). Typhoid spreads through water contaminated by an infected person’s faeces. Its symptoms include prolonged fever, nausea, rashes, headache and diarrhoea or constipation.
“S. Typhi can only infect humans, and by studying how closely related bacteria found in different places are, we discovered that typhoid had spread from South Asia, the home of typhoid, to many parts of the world many times,” says Gagandeep Kang, co-author of the study and professor at the Wellcome Trust Research Laboratory in the Division of Gastrointestinal Sciences at the Christian Medical College, Vellore, India.
Summary Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades.