Until now, US presidential hopefuls John McCain and Barack Obama have mostly focused on delivering their campaign messages to non-minority voters in the USA. But this week, the two candidates extended campaign promises to Hispanics and African Americans in two sets of key speeches catering to a voting bloc that will help determine who makes it to the White House in November.

On health issues, Democrat Obama—who if elected would be the first African American US president—seemed better prepared than his Republican rival on addressing the disproportionate health risks faced by Hispanics and African Americans when compared with non-minorities.

In both speeches, one before the National Council of La Raza (NCLR) in California and the other at the annual National Association for the Advancement of Colored People (NAACP) convention in Ohio, Obama offered new health-policy initiatives. Speaking at the NCLR conference, Obama promised a 50% tax credit programme for small businesses that provide health insurance to employees, a plan promoted by Obama’s former Democratic rival Senator Hillary Clinton and one that Obama says will help struggling Hispanic families.

At the NAACP event, Obama promised to “end the outrage of one in five African Americans going without the health care they deserve”, and he promised to do it by the end of a first presidential term.

McCain, who also spoke to both minority groups, seemed to overlook these growing health disparities, which include increasing obesity rates and continued difficulty in health-care access.  Read the rest of this entry »

The following will be published in the July 19 issue of The Lancet:

Poor multiple sclerosis care The UK’s Royal College of Physicians and the Multiple Sclerosis Trust have issued a report which shows that the NHS is failing to meet the guidelines for multiple sclerosis care that were issued by the National Institute for Health and Clinical Excellence 5 years ago. The data show inequalities in access to specialised neurological rehabilitation, which is crucial in limiting disability.

Abortion rights Abortion in Brazil will remain a criminal offence except in cases of rape or if a woman’s life is in danger. The government had backed moves to decriminalise abortion. At least a million Brazilian women are believed to have had abortions, despite the possibility of a jail term. Church groups lobbied hard against the proposals, and only four MPs voted in favour.

Indigenous health Health researcher Ian Anderson will chair a National Indi­genous Health Equality Council, which will advise the Australian Govern­ment on its com­mit­ments to indigenous health. The Council is the latest effort to address the high level of child mortality and the 17-year life expectancy gap between indi­genous and non-indigenous Australians.

HIV awareness needed The non-governmental Israel AIDS Task Force (IATF) has reported a substantial increase in HIV infection in young Israelis aged 18–25 years, although the UN estimates that only 4000 people were HIV positive by the end of 2005. IATF has called for the government to invest in raising HIV awareness and to deliver prevention messages effectively to vulnerable populations. Read the rest of this entry »

With wrangling over reauthorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) continuing this week, where do Barack Obama and John McCain stand on the issue? Both candidates have endorsed the legislation. Obama and McCain officially added their names to the list of bill cosponsors on June 18 while the bill was being negotiated in the Senate. Both received large home made gold medallions from HIV/AIDS activists proclaiming the Senators to be “Global AIDS Superheroes”. But, in reality, the candidates have done little to advance the bill’s passage.

Supporters of the bill, which would authorise PEPFAR for an additional 5 years, hoped for final passage before the G8 summit in Japan this week. But after sailing through the House of Representatives on a 308-116 vote in April, the bill was stymied in the Senate by conservative Republicans. Initially, a group of seven Senators, led by Tom Coburn of Oklahoma, opposed loosening restrictions on funding allocations for treatment, were concerned about broadening the programme’s scope, and objected to its US$50 billion price tag. Negotiators made good progress in reaching an agreement but objections persisted this week. Senate Majority Leader Harry Reid, tired of waiting for resolution, made a procedural move on July 9 that could force a vote on the measure in the next few days. Advocates are optimistic the measure will be approved.

PEPFAR rally in Washington, DC

 

Although Obama’s endorsement of the reauthorisation measure was dramatic, it was not his first action on the bill. As a member of the Senate Foreign Relations Committee, Obama added an amendment to the legislation during committee consideration. The provision requires the National Institutes of Health to expedite a federal strategic plan to support research and development of microbicides for developing countries.

Obama’s presidential campaign says the Senator is determined to ensure the US continues to be a global leader in the fight against AIDS. He and his wife Michelle were publicly tested for the virus during a visit to Africa in 2006 in an attempt to reduce stigma associated with the disease.

HIV/AIDS doesn’t seem to be as high a priority for McCain. Last year, when asked by a reporter whether taxpayer subsidised contraceptives should be distributed in Africa to fight HIV, McCain appeared confused. “The upshot was that McCain said he did not know this subject well, did not know his position on it, and relied on the advice of Senator Tom Coburn, a physician and Republican from Oklahoma”, The New York Times reported. Despite the gaffe, McCain’s campaign issued a statement on World AIDS Day in December saying he has “consistently supported the most aggressive global AIDS program in the history of this pandemic, the President’s Emergency Plan for AID Relief (PEPFAR)”. Activists say they hope McCain will continue to be a vocal supporter of the programme, but concerns remain. “He stepped up to the plate on this bill, but his track record on AIDS issues has many shortcomings”, said Health GAP Grassroots Organiser Kaytee Riek. Read the rest of this entry »

Surgical services are a crucial part of any health system, yet very little is known about the volume and availability of such services. In a study published early online in The Lancet, Thomas Weiser and colleagues have estimated that roughly 234 million major surgical procedures are undertaken every year, which equates to one operation for every 25 people.

Examining health analyses from 2004, they noted a large disparity between countries. Middle-expenditure and high-expenditure countries, accounting for 30·2% of the world’s population, provided 73·6% (172·3 million) of operations worldwide in 2004, whereas poor-expenditure countries account for 34·8% of the global population yet undertook only 3·5% (8·1 million) of all surgical procedures in 2004.

The study coincides with a new safety checklist for surgical teams to use in operating theatres, which was launched by WHO as part of their Safe Surgery Saves Lives initiative in a bid to make surgery safer around the world. WHO has stated that “preliminary results [of the checklist] from a thousand patients in eight pilot sites worldwide indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care.”

Hannah Cumber

The following will be published in the July 12 issue of The Lancet:

Gun law The US Supreme Court over­turned a ban on handguns ruling that individuals in the District of Columbia have a constitutional right to bear arms. The American Public Health Association responded to the ruling with a statement that gun violence is a major public-health concern and the risk of suicide, homicide, and unintentional fatalities is greater in homes in which there are guns. The ruling is likely to result in challenges to gun regulations in other US states.

Rapid tuberculosis test Diagnosis of multi­drug-resistant tuberculosis (MDR-TB) will be possible in 2 days, instead of 2–3 months, thanks to a molecular test—the line probe assay—being rolled out in 16 resource-poor countries. UNITAID has provided US$26·1 million and is working with WHO, the Stop TB Partnership, and the Foundation for Innovative New Diagnostics to supply equipment and train laboratory staff. This project will be complemented by $33·7 million from UNITAID to improve the supply of drugs for MDR-TB in 54 countries.

Spanish research Spanish Minister for science and innovation, Cristina Garmendia, announced a new science law to be presented to parliament in 2009, which will help improve the pace of research and development in Spain. The law will promote research by modernising R&D structures, simpli­fying R&D policies, removing barriers to developing R&D, and im­proving cooperation between central govern­ment and autonomous regions.

Organ services Organ-donation and trans­plant services in the UK need re-organisa­tion and committed funding to address the shortage of available organs, according to the House of Lords EU Committee. The Committee rejected proposals to adopt a policy of assumed consent at present, but recommended targeted public awareness and education cam­paigns to encourage donor registra­tion. Read the rest of this entry »

With their campaigns sniping at one another on the military, campaign financing, and Iraq, Barack Obama and John McCain hardly had any time to talk about health care this week. All of the action that could affect the presidential contest happened off the campaign trail.

But some interesting numbers out this week from the Henry J Kaiser Family Foundation, a non-profit group that tracks and researches health-care policy. Kaiser’s latest tracking poll shows that a worsening economy and rising prices are making it even tougher for middle-class Americans to pay for health care, and, not surprisingly, making health care a bigger and bigger issue.

Six in ten adults told Kaiser they were having a “serious problem” with their finances. For many, that means rising food prices and, of course, four-dollar-a-gallon gasoline. But for one in four said their main economic issue is paying their medical or insurance bills.

Political pundits are nearly unanimous; it seems, in their declarations that a faltering economy is bad news for John McCain. With his party in control of the White House for the past 8 years, it’s hard to imagine the Republican senator benefiting from numbers like the ones that showed up in the Kaiser poll.

But there could be a silver lining for McCain. A plurality of adults in the poll-nearly half-said their number-health concern was the effect or rising costs on their own pocket books. That is, not the cost to the economy, or to the employers who buy most coverage. And that result seems to play right into McCain’s strategy for selling his health plan. Read the rest of this entry »

The global shortage of health workers—about 4.3 million according to the 2006 World Health Report—has received much attention, and many countries have now committed to scaling up. But what is the projected result of current strategies to increase the numbers of health workers, and will they have the right effect in the right places?

An analysis in the July issue of the WHO Bulletin suggests some good news and some bad. Using historical data on physician numbers for each country, they project that 12.7 million doctors will be supplied by 2015 globally. They then use two forecasting strategies—one based on needs (the number of physicians required to enable 80% of livebirths to be attended by a skilled health worker) and one based on demands (as determined by economic growth)—to estimate the number actually required worldwide. By the needs-based approach, the predicted requirement was 3.8 million, and by the more conservative demand-based approach it was 10.8 million. In other words, hooray! A surplus!

But not so fast. As could probably have been predicted without the use of fancy equations, the distribution of these physicians was the problem. Depending on the forecasting strategy, 37–45 countries would have less than 80% of the physicians they need by 2015. Most were in Africa, although countries experiencing rapid economic growth such as China were also predicted to suffer.

Despite the gloom, the researchers hope that, by spelling out what type of shortage is expected (ie, needs-based or demand-based), a country’s health workforce policies could be tailored more appropriately. I hope they are right.

Zoë Mullan

I have just hired a cleaner. Two, in fact. They “operate in teams for their own security as well as efficiency”, are “fully insured”, and have “completed a comprehensive training programme”. All well and good (apart from the cost, but I will not go into that…) Consider, then, the conditions in which some domestic workers in the UK find themselves.

A report presented to UK parliament today by Oxfam and Kalayaan-a charity working for the rights of migrant domestic workers in the UK-reveals astonishing levels of human rights abuses. The organisations surveyed more than 300 domestic workers (cleaners, chauffeurs, cooks, etc) who had entered the UK along with the family for whom they had been working abroad. About two-thirds reported that they were not given their own room, not permitted meal breaks, and not allowed to leave the house. 72% suffered psychological abuse, 26% physical abuse, and 10% sexual abuse.

 The UK’s new points-based immigration programme could see immigrant domestic workers’ status changed from that of “worker”, subject to legal employment rights, to “domestic assistant” on a modified business visa. Domestic workers would then be forced to stay with the same employer even if that employer was extremely abusive. Oxfam and Kalayaan are rightly campaigning for this potential change to be scrapped.

Meanwhile, leaders of South America’s trade bloc Mercosur (AKA the Common Market of the South) have condemned as “barbaric” the EU’s new “return directive“, under which immigrants deemed illegal, and who do not leave voluntarily, can be placed in custody for up to 18 months while their deportation is approved by courts. They could then be banned from returning for 5 years.

The UK will not be obliged to comply with this directive since it did not opt in to this aspect of EU community law. In this instance, it made the right decision.

Zoë Mullan

The following will be published in the July 5 issue of The Lancet:

Diabetes deluge The US Centers for Disease Control and Prevention concluded that 23·6 million Americans—nearly 8% of the population—now have diabetes. This number includes about 5·7 million people who have undiagnosed diabetes. Rates of diabetes are highest in African Americans and other minority groups.

Diagnoses of tuberculosis According to experts at the 13th International Congress on Infectious Diseases in Kuala Lumpur, Malaysia, countries with a high incidence and prevalence of tuberculosis do not have the laboratories to make fast diagnoses. Rapid diagnosis is especially important for drug-resistant strains of tuberculosis. Almost all patients with very drug-resistant tuberculosis die because they are incorrectly diagnosed.

UK infant mortality rates Death rates in babies from Pakistani and Caribbean communities, who were born in England and Wales in 2005, were twice as high as the rate in white babies, according to the UK Office for National Statistics. These findings suggest that people from some ethnic communities are not accessing health care effectively.

Malaria and trachoma in Ethiopia The Carter Center has allocated about US$920 million to prevent malaria and trachoma in Amhara state, in Ethiopia. 63% of children aged between 1 year and 9 years are exposed to trachoma in this region, and 6% of adults need eye surgery. A million mosquito nets will be distributed as part of the project. Read the rest of this entry »

So, Zimbabweans must endure another term of Robert Mugabe. Here are some health-related statistics from that beleaguered country:

Life expectancy at birth: 39.7 years (4th lowest in the world)

Infant mortality rate: 50.6 per 1000 livebirths

 Adult HIV prevalence: 24.6% (4th highest in the world)

Proportion of population below poverty line: 68%

Mugabe has now made a triumphal entry at the African Union summit in Sharm el-Sheikh, Egypt. The talk there has turned to Zimbabwe, as delegates weigh up whether to even recognise him as President in light of the risible election process by which he “won”, and are expected to call for him to explore power-sharing negotiations with opposition leader Morgan Tsvangirai.

Let’s hope participants are not distracted from the focus of the summit: meeting the Millennium Development Goals on water and sanitation. As The Lancet discusses in its long leader this week, 9·1% of the global burden of disease could be prevented by improving water, sanitation, and hygiene. Now that is worth talking about.

Zoë Mullan