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

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. (more…)

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

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. (more…)

Both Presidential candidates’ health-care plans come under scrutiny in the Sept 16 issue of Health Affairs, and both are found to have serious flaws.

Right now, people who receive employer-subsidised health insurance do not have to pay taxes on it. In their analysis of John McCain’s proposals, authors Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz state that this not only lowers each employee’s tax burden; it also strengthens risk pools by including younger, healthier people who take advantage of the tax break to obtain coverage. Under McCain’s plan, employer-subsidised health insurance would be considered income and become subject to federal income taxes. However, families would receive tax rebates of US $2500 to $5000 to offset the cost of those policies. 

On the assumption that, stripped of the tax benefit of employer-based coverage, many people would then buy policies on the open market, the McCain plan would eliminate current restrictions against crossing state lines when shopping for policies. Many states now require insurance companies to cover certain services, such as mammograms, even in their barest-bones policies; under the McCain programme, people in one state could buy a less-expensive policy in another state that required less generous coverage.

All in all, the authors estimate that 20 million of the 160 million Americans now covered through employer health plans would lose that insurance under the McCain plan in its current form. His proposal to deregulate the market ultimately would raise prices for consumers and leave them with fewer protections and more limited coverage. (more…)

The following will apppear in the Sept 20 issue of The Lancet:

Suicide watch Statistics released by the US Department of Veteran Affairs (VA) show that suicide rates in young men who served in the Iraq and Afghanistan wars are increasing. There were 46 suicides per 100 000 veteran men aged 18-29 years who used VA services in 2006 compared with 27 the year before.

Biomedical funding In a new joint initiative, the Wellcome Trust and the Government of India’s Department of Biotechnology will aim to provide postdoctoral funding for Indian biomedical researchers. Many talented researchers are forced to find work outside India and few return, but £80 million over 5 years will provide 40 fellowships for researchers early in their career, 20 for those with intermediate experience, and 15 senior researchers every year.

Antibiotic resistance In the run-up to its annual conference, the UK’s Health Protection Agency has drawn attention to the continued need for new antibiotic development. There are now more options for the effective treatment of gram-positive bacteria, but more work needs to be done on suppressing gram-negative bacteria, says the agency.

New meningitis vaccine African health ministers are set to introduce a new highly promising meningitis vaccine. Designed to stop deadly periodic epidemics and priced at only US$0·40 per dose, the vaccine offers a higher immune response than those currently available. The governments of 25 African countries aim to immunise 300 million children and adults between 2009 and 2015.

Near death experiences The world’s largest study of near death experiences has been launched by the University of Southampton, UK. The AWARE (AWAreness during REsuscitation) study is an international collaboration of scientists and physicians who aim to study the brain and consciousness during cardiac arrest, and to test the validity of out-of-body experiences. A successful pilot was done in hospitals in the UK, and the study will now include the rest of Europe and North America.

Human trafficking The International Organisation for Migration (IOM) and the South African Government are holding several workshops in the country to aid and encourage the media to raise public awareness about human trafficking. The IOM estimates that the global trade of people is now worth between US$7 million and $12 billion each year.

2008 Lasker awards On Sept 13 the 2008 Lasker Awards were announced. The award for clinical medical research went to Akira Endo from Japan, who worked on the first statin. Victor Ambros from the USA has been honoured with the basic medical research award for his discovery of small nuclear RNAs, including microRNAs. (more…)

 Sept 12, 2008, marks the 30th anniversary of the Alma-Ata Declaration -a huge milestone for international health. This week’s issue of The Lancet marks the anniversary with a comprehensive series of articles about what Alma-Ata stood for back in 1978, where we have come in ‘putting the ‘Health’ into Public Health’, and what future priorities are for accessible and equitable health care worldwide. Listen to Alma-Ata series co-ordinator Joy Lawn discuss Alma Ata in a podcast. And take part in our Alma-Ata poll…

The following will be published in the Sept 6 issue of The Lancet:

Macular degeneration Ranibizumab, a sight-saving drug for patients with wet age-related macular degeneration, will become accessible to patients in the UK. In a dose-capping scheme, the National Health Service has agreed to fund the first 14 injections for each eye. The manufacturer will meet any additional costs.

Poverty report The World Bank has assessed that 1·4 billion people in the developing world lived in poverty in 2005; this is substantially more than its 2004 estimate of 985 mil­lion people. The figure is based on a newly drawn poverty line of US$1·25, which for the first time is ad­justed for inflation. Although the global poverty rate has fallen from 50% to 25% over the past 25 years, poor people in sub-Saharan Africa have almost doubled in number, to 380 mil­lion, and still make up half the population.

Fake sick notes on the internet A website is selling notes and medical certificates that purport to be from real doctors at NHS medical centres in any part of the UK. The site advertises the notes at £25 for two, with 48 h delivery. The NHS fraud squad has said that anyone who uses a fraudulent document risks prosecution, but that selling the notes is not illegal.

Post-traumatic stress disorder Since the war in Iraq began, post-traumatic stress disorders have become en­demic, and other stress-related mental illnesses are also com­mon. How­ever, psychiatric services have deteriorated. Baghdad’s Central Paediatric Teaching Hospital has now been funded to open a clinic for chil­dren with psychological disorders.

HIV in New York City 72 in every 100 000 people in New York con­tracted HIV in 2006, more than three times the US average of 23 per 100 000. Since re­searchers used new technology to identify recent infections, and a novel statistical model to estimate inci­dence at a population level, these results cannot be used to assess change over time. However, even a rough estimate of incidence will help to understand and combat the spread of HIV.

(more…)