Last year, The Lancet published a series of papers on the neglected topic of global mental health, with a focus on low-income and middle-income countries. In today’s issue, and to coincide with World Mental Health Day, the series authors take stock of developments since the series was published. One of the key elements to have come out of the series is the launch of the Movement for Global Mental Health—an officeless, budgetless conglomeration of individuals and organisations with a concern for expanding mental health services and tackling the stigma that shrouds mental illnesses in many countries. Anyone who shares these principles can join the movement, so do take a look at the website.

Since another key tenet of the series was to take a strictly evidence-based approach to scaling up mental health services, The Lancet is now calling for research papers, the best of which will be published in a special issue next year. To submit a paper, the deadline for which is April 2, 2009, click here.

Zoë Mullan

An adviser to Barack Obama discussed the Democratic presidential contender’s health plan this morning in a webcast produced by the Henry J Kaiser Family Foundation (a McCain adviser will be interviewed on Oct 16).

David Cutler, professor of Applied Economics at Harvard, warned that if present trends continue, US federal tax revenues will be spent entirely on Social Security and Medicare— the retirement and medical programmes for the elderly and people with certain chronic conditions.

Cutler estimated that Obama’s plan would cost the federal government US$50 billion to $65 billion annually, to be paid for largely by ending tax cuts President Bush enacted for individuals with annual incomes of $250 000 or more. All in all, a typical family of four would save about $2500 per year in medical costs under the plan, or roughly 8% of what it costs to cover that family today. At the same time, an Obama administration would lower medical costs by enlarging risk pools, and through investments in areas such as health-care infrastructure, public health, and preventive care. Doctors would be rewarded for good outcomes, and Medicare would offer incentive payments for activities such as following up with patients who miss appointments, electronic doctor-patient communication, and investing in information technology (IT). Read the rest of this entry »

Today is the International Day for Disaster Reduction. Under the auspices of the UN, the event marks the launch of an annual campaign to foster awareness and bring about change in the way countries respond to natural disasters. And the world has seen its fair share this year: cyclone Nargis, which left hundreds of thousands dead, injured, or homeless in Burma; the massive and devastating earthquake in Sichuan province, China; a series of hurricanes that has left Haiti in a state of dire emergency. Climate change is exacerbating these yearly catastrophes, and, as Ban Ki-Moon has said, it is time that strategies to reduce their impact became “a key plank” in nations’ efforts towards reaching the Millennium Development Goals. 

This year’s campaign focuses on making hospitals safe from disaster. An obvious concept, perhaps, but one that is all too often overlooked. Campaign organisers make the economic case for making hospitals and health facilities disaster-safe, either when designing them from scratch or by retro-fitting existing buildings. Hopefully by seeing the issue from a cost-effectiveness angle, thrifty governments can be persuaded to take it more seriously.

Zoë Mullan

I just wanted to draw your eyes towards the “We recommend” spot this week, which highlights the new five-year global health strategy published by the UK government. Launched last week in collaboration with The Lancet and the London School of Hygiene and Tropical Medicine, the document is something of a first in that it addresses the challenges of global health from a cross-departmental perspective, including those of security, development, and trade.

It identifies five areas for action: health security, strong and fair systems for health, more effective international health organisations, freer and fairer trade, and strengthening the way we develop and use evidence to improve policy and practice. It then lays out a plan for tackling them. The strategy will be reassessed in 2013.

Zoë Mullan

The following will appear in the Oct 4 issue of The Lancet:

Industry transparency Starting in 2009, Eli Lilly will disclose payments to doctors who speak or advise on behalf of the company. Merck followed with an announcement of similar plans. The statements come at a time of continuing debate in the US Congress about the Physician Payments Sunshine Act, which would require disclosure of such details.

Open drug discovery In an effort to accelerate drug discovery for tuberculosis, the Indian Council of Scientific and Industrial Research has launched the Open Source Drug Discovery programme. The Indian Government has committed US$38 million to the programme, which aims to foster collaboration between researchers by making all discoveries open access. New drugs will become generic immediately, allowing pharmaceutical companies to jointly bring the drugs to the market and maintain competitive prices.

US Mental Health Bill The US Congress has passed a bill that will force private health insurers to provide the same benefits for mental illness as they do for physical ailments. The legislation has firm support in the House, the Senate, and the medical community but there is growing debate about how to fund the changes, which will cost the federal government an estimated US$3·4 billion over 10 years.

Cholera outbreak 291 people have died from cholera on the island of West Papua, Indonesia, since April this year, prompting fears of a major epidemic. Distrust of outside groups and the military in the affected tribal population could hinder any response to the potential crisis, say observers.

Under the skin Lenalidomide, which is licensed in the USA for the treatment of multiple myeloma and anaemia associated with myelodysplastic syn-dromes, has been included by the US Food and Drug Administration in a list of drugs with potential safety issues. Serious skin disorders such as Stevens-Johnson syndrome have been reported in some patients taking lenalidomide, and doctors are urged to be alert for rare but serious skin reactions. Read the rest of this entry »

Not that they expect to generate much response, but reproductive-health advocates are calling on the US presidential candidates to discuss the thorny issues of global family planning and women’s human rights during  a series of televised debates that began Sept 26. “I submit that if we truly want to regain international credibility and legitimacy, the US must become a collaborator with our global neighbors on a variety of issues”, writes Serra Sippel, executive director of the Center for Health and Gender Equity. “Why not start with the global crisis women face throughout the world regarding fundamental sexual and reproductive health rights.”

She points out that women havemore than half of HIV infections in some regions. In addition, 200 million women yearly have unmet need for contraceptive services and there are 80 million unintended pregnancies each year, 60% of which end in abortion. Half a million women die each year from pregnancy related complications and 68000 die from unsafe abortions.

Despite these grime statistics and widespread acknowledgement of the need to address both gender equity and the effects of demographics on development, the issue has not been a hot topic on the campaign trail, to say the least. Even development groups haven’t pushed the issue in recommendations on foreign assistance reform aimed at the next president, Sippel said.  Read the rest of this entry »

The US banking and economic crisis has taken centre stage. Many Americans are worried about whether they’ll be able to get a car loan next year, much less pay for health care.

But they have good reason to worry about the latter. There was some stark news this week from the Henry J Kaiser Family Foundation, which tracks the cost of employer-paid health coverage. That’s the bedrock of the American health-delivery system, which more than 160 million Americans getting their insurance through their workplace or a family member’s workplace.

The hard facts: private health coverage for the average family of four now costs US$12 680 per year. Workers’ share of that staggering costs is $3354, which Kaiser described as only a “modest” rise of 5% from last year.

It’s true, a 5% rise in premiums is relatively small compared to the double-digit rises in some years over the last decade. But the figure is more than double what workers paid in premiums in 1999. Over the same time period, wages are up 34% and inflation 29%.

Kaiser’s data shows that it’s not just consumers who are clamoring for some cost relief in the health system. Employers are buckling under the weight of rising costs, leading more and more of them to opt for high-deductible insurance plans that let them limit their financial liability when it comes to workers’ health care. Read the rest of this entry »

Last Friday’s Washington Post had a very interesting article about the current popularity of global health studies among college students. 16% of US colleges now offer majors or minors in public health. That’s a pretty far cry from the rather traditional, plain-vanilla offerings that undergraduates flocked to in my day–literature, history, and, of course, the eternally popular accounting and business (though an American, at least, might wonder whether enthusiasm for these subjects may have waned a wee bit in the last few days. I was going to add some links here, but you can find a mind-boggling number of background pieces by Googling “$700 billion”). Very intriguing that interest in public health is taking hold earlier than medical or graduate school.

Faith McLellan

Click below to see an announcement from the Carso Health Institute.

Carso Awards

The following will appear in the Sept 27 issue of The Lancet:

China’s milk scandal More than 54 000 children have been taken ill in China after drinking milk made from powder contaminated with melamine. Four children have died, and 13 000 are in hospital, most presenting with kidney stones. This scare is the latest in a string of scandals arising from  tainted food products in China.

Generic roadblock The US Food and Drug Administration (FDA) has moved to block the import of more than 30 drugs, including antiretrovirals, produced in two plants in India by the generic manufacturer Ranbaxy. The FDA cited concerns about manufacturing prac-tices, but emphasised that there was no evidence of harm having been caused to patients by drugs from Ranbaxy.

Multiple sclerosis The number of people worldwide with multiple sclerosis could be many more than the estimated 1·3 million, according to a new study by the Multiple Sclerosis International Federation and WHO. Many people with this disease are unaccounted for, especially in developing countries, where specialist equipment for diagnosis is scarce.

Australian HIV/AIDS spike Australia’s mining boom might be causing an alarming rise in the incidence of HIV/AIDS in the country. A 68% increase in infections in heterosexual men over the past 3 years has been linked to wealthy miners and businessmen visiting southeast Asia and having unprotected sex. The Government is working with mining companies to implement education programmes for workers. Read the rest of this entry »