Stillbirth prevention is a global health priority and a crucial step towards better maternal and newborn health and wellbeing.1 In 2019, 2 million babies were stillborn, with over three-quarters of these stillbirths occurring in sub-Saharan Africa and south Asia.2 However, progress has been slow, and unless there is a substantial acceleration in progress, the Sustainable Development Goal target 3.2 and Every Newborn Action Plan target of 12 stillbirths per 1000 births will not be met by 2030.3 Slow progress is partly due to the limited emphasis on stillbirth reduction in maternal and child health programmes and a paucity of accurate, complete, and actionable information on stillbirths, particularly in high-burden areas.1, 4
Cancer is emerging worldwide as a significant public health problem and trends indicate that low-income and middle-income countries (LMICs) are going to witness a substantial increase in cancer burden by 2040.1 Surgery plays a vital role in the management of solid tumours, but only 25% of the global population has access to safe, affordable, and timely surgery.2 This disparity is more pronounced in LMICs dealing with high cancer burden and limited resources. Timely access to quality multidisciplinary care is a critical factor determining outcomes. Surgical outcomes are reliant on the experience and skills of the surgeon, and the availability of ancillary support facilities. Cancer surgery outcomes have improved during the past three decades, primarily because of the advancements made in surgery, anaesthesia, surgical technology, perioperative, and critical care domains.34 Operative mortality in patients receiving complex cancer surgeries such as Whipple’s resection and oesophagectomy has reduced drastically.5 However, most of these studies originate from tertiary care cancer centres in high-income countries, and there is little literature available related to cancer surgical outcomes from LMICs.
The ministerial decision on the TRIPS agreement, spurred by the COVID-19 pandemic, was announced in the early morning in Geneva on June 17, almost two days after the expected end of the 12th Ministerial Conference. Although the decision was hailed by the WTO Secretariat and officials from the Global North as an unprecedented result, in practice it falls short of meeting the bare minimum of the world’s needs.
The brain’s immune system includes a network of transport vessels (blue) and its own immune cells made in the bone marrow (green). Credit: Siling Du, Kipnis lab, Washington University in St. Louis
The brain is the body’s sovereign, and receives protection in keeping with its high status. Its cells are long-lived and shelter inside a fearsome fortification called the blood–brain barrier. For a long time, scientists thought that the brain was completely cut off from the chaos of the rest of the body — especially its eager defence system, a mass of immune cells that battle infections and whose actions could threaten a ruler caught in the crossfire.
In the past decade, however, scientists have discovered that the job of protecting the brain isn’t as straightforward as they thought. They’ve learnt that its fortifications have gateways and gaps, and that its borders are bustling with active immune cells.
Summary Global progress towards universal coverage of essential health services, a component of UN Sustainable Development Goal (SDG) 3.8, is measured at the country level using the WHO Service Coverage Index. However, data collection for this crucial metric excludes prisons and youth detention centres, despite the health needs in these settings, chronic underinvestment in custodial health care, and poor health outcomes for people released from custody in most countries. Particularly in countries with high incarceration rates, failure to include custodial settings in calculations of the service coverage index might result in overestimation of progress towards SDG 3.8.1, and mask important health inequalities. In this Viewpoint, we explore how failure to consider custodial settings in calculation of the service coverage index contributes to health inequalities and impedes progress towards SDG 3. We recommend explicitly considering all custodial settings in future estimates of progress towards universal health coverage.
Health-care systems worldwide are fraught with inequalities that have a disproportionate impact on minoritised ethnic and racial groups. These inequalities may lead to reduced access to appropriate health care services, and consequently, poorer health outcomes. Furthermore, research focusing on health outcomes of racial minorities is vastly lacking. In an effort to address the need for research on racial inequality, eClinicalMedicine launched part 1 of an online collection entitled “Racial Inequity in Health” in June 2021.We have now curated part 2 of the collection, which forms part of The Lancet’s strategy to address racial inequity in health care. The papers in this collection highlight racial and ethnic inequality across global healthcare settings, and emphasise that without targeted action, such inequalities are maintained and reinforced. The collection will therefore provide a platform for the dissemination of relevant research on racial disparities in chronic kidney disease (CKD) cardiovascular disease and maternal outcomes, amongst others. This Editorial will discuss several of the papers available in the collection.
In early 2020, we saw the beginning of the COVID-19 ‘pandemic’. The world went into lockdown and even after lockdowns in various countries had been lifted, restrictions continued. Data now shows that lockdowns seemingly had limited, if any, positive impacts on the trajectory of COVID-19 and in 2022 the world – especially the poor – is paying an immense price not least in terms of loss of income, loss of livelihoods, the deterioration of mental and physical health, the eradication of civil liberties, disrupted supply chains and shortages.
Where does creativity come from? According to people such as the US inventor Thomas Edison, our inventiveness surges during an unusual state of mind as we drift into sleep.
New support for this idea comes from a study that finds people gain insight into a tricky maths problem if they are allowed to enter the initial stages of sleep, then woken up.
When people fall asleep they may spend a few minutes in a state called hypnagogia or “N1”, often characterised by vivid dreams – although usually people progress into deep sleep and forget the dreams when they wake.
Latin America is home to about 800 different Indigenous Peoples and Nationalities, the equivalent to 9·8% of its population. The average infant mortality rate in Indigenous children is 60% higher than that in non-Indigenous children.1 In 2018, Ecuador reported that 50·6% of its Indigenous population lived in poverty, compared with 20·9% of the non-Indigenous population.2 Between 2014 and 2017, maternal mortality was 69% higher in Indigenous than in Mestizo women.3 Chronic malnutrition affects one in four Ecuadorian children, and the rate doubles in Indigenous children.4 These figures evidence historical and structural inequalities. Despite discourses of modernisation and development, the old process of colonisation and subjugation of Indigenous Peoples continues. Violent appropriation of territory, forced displacement of peoples and communities, or depredation of their vital spaces for oil and mining are some facets of this domination.