Global leaders to promote health to achieve Sustainable Development Goals

At a meeting of 9th Global conference on health promotion on 21 November last year, the leaders from governments and United Nations organizations, city chiefs and health experts from around the world made two landmark commitments to promote public health and eradicate poverty.

The conference, co-organized by the World Health Organization (WHO) and the National Health and Family Planning Commission of the People’s Republic of China in Shanghai, agreed:

  • The Shanghai Declaration on Health Promotion, which commits to make bold political choices for health, stressing the links between health and wellbeing and the United Nations 2030 Agenda for Sustainable Development and its Sustainable Development Goals.
  • The Shanghai Healthy Cities Mayors’ Consensus, which contains a commitment by more than 100 mayors to advance health through improved management of urban environments. WHO Director-General Dr Margaret Chan says underpinning these commitments is the need for government action that protects people from health risks, provides access to healthy choices and spreads awareness of how to be and stay healthy. Dr Chan adds: “Legislative and fiscal measures are among the most effective interventions that governments – national and city – can take to promote the health of their citizens, from tobacco control and taxing sugary drinks to ensuring people can breathe clean air, bike home safely and walk to school or work without fear of violence.”

The Declaration:
The Declaration highlights the need for people to be able to control their own health – to be in a position to make healthy lifestyle choices. Noting the need for political action across many different sectors and regions, it highlights the role of good governance and health literacy in improving health, as well as the critical role played by city authorities and communities.

Governance-related commitments include protecting health through public policies, strengthening legislation, regulation and taxation of unhealthy commodities and implementing fiscal policies to enable new investments in health and wellbeing. The Declaration also stresses the importance of worldwide monitor Update from around the globe universal health coverage, and the need to better address cross-border health issues.

Health literacy pledges include the development of national and local strategies to improve citizens’ awareness of how to live healthy lives, and increasing citizens’ ability to control their own health and its determinants by harnessing the power of digital technology. The Declaration also commits to ensure that environments support healthy consumer choices, for example through pricing policies, transparent information and clear labelling.

The Declaration emphasizes the need for healthy urban policies that promote social inclusion, issues that are further strengthened in the Mayors’ Consensus.

Mayors’ Consensus:
Cities are already home to over 50% of the world’s population, and this is expected to increase to twothirds by 2030, making them a particularly important focus. The Mayors’ Consensus listed 10 action areas that municipal leaders attending the Conference will integrate into their cities’ plans to implement the United Nations 2030 Agenda for Sustainable Development. Key areas include addressing pollution, gender-based violence, child development and making cities smoke-free.

The mayors agreed to integrate health as a core consideration in all city policies; to promote community engagement through multiple platforms, including schools, workplaces and modern technology, to advance health; and reorient municipal health and social services towards equity and universal health coverage.


Around 6 million children die each year despite progress in reducing child deaths

Estimates for 2015 suggest that 5.9 million children worldwide died before reaching the age of five, including 2.7 million newborns. Globally, four million (4.02 million) fewer child deaths occurred in 2015 than in 2000, mainly thanks to reductions in deaths from pneumonia, diarrhoea, death during birth, malaria and measles. However, progress on reducing newborn deaths (in the first 28 days) has been slower meaning that as a whole the world failed to reach the Millennium Development Goal (MDG) target of reducing child deaths by two-thirds between 1990 and 2015.

The study, published in The Lancet, provides the most up-to-date figures for deaths of children under five years old and includes data for all 194 countries that are World Health Organisation states. The 2015 figures highlight the inequality in child deaths around the world with the national rates of child death ranging from 1.9 to 155.1 deaths per 1000 births, and 60.4% (3.6 million) of all deaths occurring in 10 countries.

Progress since 2000 has largely been due to reductions in the rates of deaths from pneumonia, diarrhoea, malaria, measles and deaths during birth – each reduced by more than 30% worldwide between 2000 and 2015. However, some of these still remain leading causes of deaths. Globally in 2015, the leading causes of death for children under five years old were complications due to premature birth (17.8%, 1.1 million deaths), pneumonia (15.5%, 0.9 million deaths) and death during birth (11.6%, 0.7 million deaths). Countries with the highest rates of child death (100 or more deaths per 1000 births) include Angola, Central African Republic, Chad, Mali, Nigeria, Sierra Leone and Somalia. In these countries pneumonia, malaria and diarrhoea were the leading causes of death, so to improve survival in these regions the researchers recommended improving the uptake of breastfeeding, providing vaccines for pneumonia, malaria and diarrhoea, and improving water and sanitation.

In comparison, for countries with the lowest rate of child death (less than 10 deaths per 1000 births) which include the Russian Federation and the United States of America, the leading causes of death include congenital abnormalities, complications due to premature birth and injuries. Improved detection and surgery for congenital abnormalities, better medical care during pregnancy and childbirth, and more research on effectiveness of injury interventions could help improve survival in these countries.

Although the number of newborn deaths was reduced from 3.9 million in 2000 to 2.7 million in 2015, progress has been slower than the improvements in survival for one month to five year olds. This resulted in the proportion of newborn deaths increasing from 39.3% in 2000 to 45.1% in 2015. If newborn deaths had reduced at the same rate as that of children aged between one month and five years old the MDG target to reduce child deaths by two-thirds between 1990 to 2015 might have been reached. “Child survival has improved substantially since the Millennium Development Goals were set even though the target to reduce child deaths by two-thirds was not achieved,” says Dr Li Liu, lead author, Johns Hopkins Bloomberg School of Public Health, USA. “The problem is that this progress is uneven across all countries, meaning a high child death rate persists in many countries. Substantial progress is needed for countries in sub-Saharan Africa and Southern Asia to achieve the child survival target of the Sustainable Development Goals.”

Writing in a linked Comment, Professor Peter Byass, Umeå Centre for Global Health Research says “Undoubtedly child mortality is falling, and the world should be proud of this progress,” but he adds “… Of the estimated six million under- 5 child deaths in 2015, only a small proportion were adequately documented at the individual level, with particularly low proportions evident in low-income and middle-income countries, where most childhood deaths occur… That six million under-5 children continue to die every year in our 21st century world is unacceptable, but even worse is that we seem collectively unable to count, and hence be accountable for, most of those individual deaths.”

Study finds number of people with high BP up in poor countries, down in rich countries

In the past 40 years, there has been a large increase in the number of people living with high blood pressure worldwide because of population growth and ageing – rising from 594 million in 1975 to over 1.1 billion in 2015.

The largest rise in the prevalence of adults with high blood pressure has been in low- and middle-income countries (LMICs) in south Asia (eg. Bangladesh and Nepal) and sub-Saharan Africa (eg. Ethiopia and Malawi). But high-income countries (eg. Australia, Canada, Germany, Sweden, and Japan) have made impressive reductions in the prevalence of adults with high blood pressure, according to the most comprehensive analysis of worldwide trends in blood pressure to date, published in The Lancet.

The study shows mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these regions had larger uncertainty than in high-income regions.

The study also found that men had higher blood pressure than women in most world regions in 2015.

Both elevated systolic (higher than 140 mmHg) and diastolic (higher than 90mmHg) blood pressure can be used to make a diagnosis of high blood pressure. Recent research suggests that the risk of death from ischemic heart disease and stroke doubles with every 20 mmHg systolic or 10 mmHg diastolic increase in middle and older ages.

Over the past four decades, the highest average blood pressure levels have shifted from high-income western countries (eg. Norway, Germany, Belgium, France) and Asia-Pacific countries (eg. Japan) to LMICs in sub-Saharan Africa, South Asia, and some Pacific island countries. High blood pressure remains a serious health problem in central and eastern Europe (eg. Slovenia, Lithuania).

“High blood pressure is the leading risk factor for stroke and heart disease, and kills around 7.5 million people worldwide every year. Most of these deaths are experienced in the developing world,” explains lead author Professor Majid Ezzati from Imperial College London.

“Taken globally, high blood pressure is no longer a problem of the Western world or wealthy countries. It is a problem of the world’s poorest countries and people. Our results show that substantial reductions in blood pressure and prevalence are possible, as seen in highincome countries over the past 40 years. They also reveal that WHO’s target of reducing the prevalence of high blood pressure by 25% by 2025 is unlikely to be achieved without effective policies that allow the poorest countries and people to have healthier diets – particularly reducing salt intake and making fruit and vegetables affordable – as well as improving detection and treatment with blood pressure lowering drugs.”

The findings come from a comprehensive new analysis of global, regional, and national trends in adult blood pressure between 1975 and 2015. This includes trends in average systolic (the maximum pressure the heart exerts while beating) and diastolic blood pressure (amount of pressure in the arteries between beats), as well as prevalence of high blood pressure. The Non-Communicable Disease (NCD) Risk Factor Collaboration pooled data from 1479 population-based studies totalling 19.1 million men and women aged 18 years or older from 200 countries (covering more than 97% of the world’s adult population in 2015).

  • doi: 10.1016/S0140-6736(16)31919-5

Malaria vaccine funding ensures roll out of pilot vaccination project

The world’s first malaria vaccine will be rolled out in pilot projects in sub-Saharan Africa in 2018 after funding was secured for the initial phase of the programme and vaccinations, WHO confirmed.

The vaccine, known as RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children.

“The pilot deployment of this first-generation vaccine marks a milestone in the fight against malaria,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “These pilot projects will provide the evidence we need from real-life settings to make informed decisions on whether to deploy the vaccine on a wide scale.”

The Global Fund to Fight AIDS, Tuberculosis and Malaria in November approved US$15 million for the malaria vaccine pilots, assuring full funding for the first phase of the programme. Earlier this year, Gavi, the Vaccine Alliance and UNITAID announced commitments of up to $27.5 million and $9.6 million, respectively, for the first four years of the vaccine programme.

RTS,S was developed through a partnership between GlaxoSmithKline and the PATH Malaria Vaccine Initiative (MVI), with support from the Bill & Melinda Gates Foundation and from a network of African research centres. “These pilots are critical to determine whether this vaccine can be rolled out more broadly, adding an important new tool to the proven interventions we already have in the fight against malaria. The Global Fund’s commitment marks the beginning of a historic partnership between Gavi, the Global Fund and UNITAID, bringing together three of the world’s biggest health financing institutions to tackle one of the leading killers of children,” Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

RTS,S is the first malaria vaccine to successfully complete pivotal Phase 3 testing. The Phase 3 trial enrolled more than 15,000 infants and young children in 7 countries in sub-Saharan Africa. Countries that participated in the Phase 3 clinical trials will be prioritized for inclusion in the WHO pilot programme.

Initiative launched to track progress on health and climate change

The Lancet Countdown: Tracking Progress on Health and Climate Change was launched in November at the COP22 climate talks taking place in Morocco. An international, multi-disciplinary research initiative, it brings together leading experts to track and analyse the impacts of climate change on public health.

The Lancet Countdown will report annually in The Lancet. With input from 48 leading experts from across the world, some 16 institutions are academic partners of the initiative, including University College London, Tsinghua University and the Centre for Climate & Security among others. The Lancet Countdown is engaged in a special collaboration with the World Health Organization (WHO) and the World Meteorological Organisation (WMO) to promote synergies, collaborate on data sources, and ensure strong engagement with Ministries of Health.

With the aim of ensuring the case for action on health and climate change is more widely evidenced and understood, the Lancet Countdown will inform decision-making and drive an accelerated policy response to climate change. It will complement other initiatives, such as the Intergovernmental Panel on Climate Change and its achievements for climate science.

Patricia Espinosa, Executive Secretary, UN Framework Convention on Climate Change, said: “The health impacts of climate change are already being felt and effecting some of the most vulnerable on our planet. No one is immune or out of reach. Climate action, spearheaded by governments and supported by business, cities, investors and citizens – including health care professionals – goes handin- hand with delivering a better quality of life in its own right and as a key pillar of the Sustainable Development Goals.”

The interrelation of climate change and public health is becoming increasingly clear. The Lancet Countdown builds on the findings of the 2015 Lancet Commission on Health and Climate Change, which concluded that climate change posed both a “potentially catastrophic risk to human health”, while conversely being “the greatest global health opportunity of the 21st century” if the right steps are taken.

Dr Richard Horton, Editor-in-Chief of The Lancet said: “One challenge of the ongoing global climate crisis is to convey the urgency of our collective predicament and the need for decisive action. The Lancet Countdown on Health and Climate Change is being launched to amass the evidence needed to hold policy makers accountable for their promises and commitments. The research community can make an important contribution to heightening political awareness and accelerating progress to a healthier, low-carbon world. These are the goals of our Countdown on Health and Climate Change.”

A broader evidence base on interrelated health and climate change trends will notably help demonstrate clear co-benefits of action. An estimated 18,000 people die every day due to air pollution exposure, making it the world’s largest single environmental health risk. The World Bank in turn estimates it costs the global economy US$225 billion a year in related lost labour income. CO2 and other greenhouse gasses from road transport and fossil fuel energy generation responsible for the bulk of air pollution in the first place, are also a leading cause of climate change. Health and economic cobenefits from addressing climate change – be it mitigation or adaptation – only add to the impetus for action, given that changes to climate take longer to be felt.

The Lancet Countdown comes at a crucial time for international cooperation and national action on climate change, following ratification of the Paris Agreement and the announcement of the 2030 global Sustainable Development Goals (SDGs). As part of this transition, healthcare professionals, governments and countries will have to shift from an understanding of climate change solely as a threat, to one which embraces the response to climate change as an opportunity for human health and wellbeing. The Lancet Countdown is aligned with the SGD process in working to ensure the health challenge posed by climate change is resolved by 2030.

First living-donor uterine transplants performed in US

Baylor University Medical Center at Dallas has performed the first four living-donor uterine transplants ever done in the US.

The medical centre issued a statement saying: After two years of preparation, careful review of all 16 previous uterine transplants performed in the world, and thoughtful discussion of the ethical and resource considerations – we entered a new space. Under IRB (Institutional Review Board) approval, we performed the first four living-donor uterine transplants ever done in the U.S. Alongside our team during all four surgeries in Dallas was a Swedish surgical team, widely considered the world’s experts in uterine transplant as five births have resulted from transplants they have performed. We performed the surgeries between September 14 and 22, making modifications along the way to discover potential improvements to the protocols.

“During the past three weeks since the first surgery, we performed routine follow-up testing as part of the trial protocol on all four patients. In three patients, we determined after several tests the transplanted organs were not receiving viable blood flow and the uteri were removed. Those patients are now doing well and will soon be back to normal activity.

“The fourth patient’s follow-up tests currently indicate a much different result. Her tests are showing good blood flow to the uterus. There are also no signs of rejection or infection at this time. We are cautiously optimistic that she could ultimately become the first uterine transplant recipient in the U.S. to make it to the milestone of uterine functionality.”

Both the Baylor University Medical Center surgical team and the Swedish surgical team reviewed the three cases that resulted in explantation, and they believe the valuable learnings from the cases will result in recommendations to change the current protocols in operative and post-operative management of uterine transplant patients with specific attention to the thickness of the uterine veins.

“We are committed to sharing all of our learnings in this research with the scientific community and the world, as it is the best way to honor our patients – donors and recipients – and our colleagues’ work in helping find a solution to uterine-factor infertility,” the medical center said.


Date of upload: 17th Jan 2017

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