World cancer burden to hit poorest nations hardest

The funding model for cancer care and research is “broken” – with poorer nations hardest-hit, a University of Strathclyde-based expert has warned.

Professor Peter Boyle, Director of the University of Strathclyde Institute of Global Public Health at iPRI, called on the private medical and pharmaceutical industries to work more closely with governments and the public sector to enable them to cope with the growing international cancer burden.

Prof Boyle, lead author on the recentlypublished “State of Oncology 2013” report, told how cancer diagnosis and death rates were rising across the world, while access to care was inconsistent between nations. Speaking at the European Cancer Congress in Amsterdam, he added: “It is bad to have cancer, and worse to have cancer if you are poor.

“Many parts of the world are already unable to cope with the current situation and are totally unprepared for the future growth of the cancer problem.” Prof Boyle called for a private-public fund to help poorer countries manage, citing 2009 estimates by the Economist Intelligence Unit that it would cost $217 billion a year to bring cancer diagnosis, care and treatment in poor countries up to the standards of wealthy nations.

He said: “There’s no single source of philanthropy, there’s no government, there’s no company, there’s no single institution that can afford that sort of investment. “The current model of financing is broke. We need to fix it. We need radical solutions.”

Cancer will claim more than 13.2 million lives by 2030 – almost double the number in 2008 – the International Agency for Research on Cancer has estimated, with most deaths in low and middle income countries. Prof Boyle warned of “devastating damage to entire families and communities” in poorer nations, which have limited access to equipment, expertise and medicines.

The report predicted global cancer cases would reach 26.4 million a year by 2030, in large part due to the impact of expanding and ageing populations in populous countries such as India, China and Nigeria, along with changing lifestyles. Prof Boyle said: “It is impossible to avoid the conclusion that there is a need for a major public-private partnership, involving a number of sources from different areas, to make the necessary progress with the briefest delay.”

This partnership would require the backing of drug firms, as well as manufacturers of diagnostic and treatment technology, including scanning and radiotherapy equipment, Prof Boyle added. He cited the Global Fund to Fight AIDS, Tuberculosis and Malaria – set up in 2002 and funded mainly by OECD governments – as an example of how such a fund could operate successfully.

However, he cautioned that while the Global Fund was seeking $15 billion in financing over the coming three years, the amount of investment required to have all cancer patients world-wide brought up to the same standard of care would require between one and two orders of magnitude greater investment.

US NIH approves high-priority research for BRAIN initiative

US National Institutes of Health (NIH) Director Francis S. Collins, M.D., Ph.D., has approved initial areas of high-priority brain research to guide US$40 million of NIH fiscal year 2014 funding within the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative.

The initiative aims to accelerate work on technologies that give a dynamic picture of how individual cells and complex neural circuits interact. The ultimate goal is to enhance understanding of the brain and improve prevention, diagnosis and treatment of brain diseases. The initiative was announced in April by US President Barack Obama.

He called for a total of $110 million in the 2014 fiscal year budget to support the effort, of which $40 million is expected to be allocated by NIH. “The time is right to exploit recent advances in neuroscience research and technologies to advance our understanding of the brain’s functions and processes and what causes them to go wrong in disease,” said Dr Collins. “The BRAIN Working Group has been on a fast track to identify key areas of research for funding.

This group of visionary neuroscientists has provided an excellent set of recommendations, and I am eager to move these areas forward.” NIH’s fiscal 2014 investment will focus on nine areas of research. The vision for the initiative is to combine these areas of research into a coherent, integrated science of cells, circuits, brain and behaviour.

- Generate a census of brain cell types l Create structural maps of the brain
- Develop new, large-scale neural network recording capabilities
- Develop a suite of tools for neural circuit manipulation
- Link neuronal activity to behaviour
- Integrate theory, modelling, statistics and computation with neuroscience experiments
- Delineate mechanisms underlying human brain imaging technologies
- Create mechanisms to enable collection of human data for scientific research
- Disseminate knowledge and training

Global child mortality rate on positive trend

In 2012, approximately 6.6 million children worldwide – 18 000 children per day – died before reaching their fifth birthday, according to a new report released today by UNICEF, the World Health Organization (WHO), the World Bank Group and the United Nations Department of Economic and Social Affairs/Population Division.

This is roughly half the number of underfives who died in 1990, when more than 12 million children died. “This trend is a positive one. Millions of lives have been saved,” said Anthony Lake, UNICEF Executive Director.

“And we can do still better. Most of these deaths can be prevented, using simple steps that many countries have already put in place – what we need is a greater sense of urgency.” The leading causes of death among children aged less than five years include pneumonia, prematurity, birth asphyxia, diarrhoea and malaria.

Globally, about 45% of under-five deaths are linked to undernutrition. About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria, and Pakistan. India (22%) and Nigeria (13%) together account for more than one-third of all deaths of children under the age of five.

Newborn children are at particularly high risk

“Care for mother and baby in the first 24 hours of any child’s life is critical for the health and wellbeing of both,” says Dr Margaret Chan, Director-General at WHO. “Up to half of all newborn deaths occur within the first day.”

The lives of most of these babies could be saved if they had access to some basic healthcare services. These include skilled care during and after childbirth; inexpensive medicines such as antibiotics; and practices such as skin-to-skin contact between mothers and their newborn babies and exclusive breastfeeding for the first six months of life.

Progress, challenges

While the global average annual rate of reduction in under-five mortality accelerated from 1.2% a year for the period 1990-1995 to 3.9% for 2005-2012, it remains insufficient to reach Millennium Development Goal 4 which aims to reduce the underfive mortality rate by two-thirds between 1990 and 2015.

“Continued investments by countries to strengthen health systems are essential to ensure that all mothers and children can get the affordable, quality care they need to live healthy, productive lives,” said Keith Hansen, Acting Vice President of Human Development at the World Bank Group. Sub-Saharan Africa, in particular, faces significant challenges as the region with the highest child mortality rates in the world.

With a rate of 98 deaths per 1000 live births, a child born in sub- Saharan Africa faces more than 16 times the risk of dying before his or her fifth birthday than a child born in a high-income country. However, sub-Saharan Africa has shown remarkable acceleration in its progress, with the annual rate of reduction in deaths increasing from 0.8% in 1990 -1995 to 4.1% in 2005-2012. This is the result of sound government policies, prioritized investments and actions to address the key causes of child mortality and reach even the most difficult to reach populations.

Global and national action to improve child health

Both globally and in countries, a series of initiatives are in place aimed at improving access to maternal and child health care, inspired by the United Nations Secretary-General’s widely endorsed Global Strategy for Women’s and Children’s Health which aims to save 16 million lives by 2015 through a “continuum of care” approach. As part of this strategy, focus on specific areas is given through:

- A Global Vaccine Action Plan that is working towards universal access to immunization by 2020. Vaccination against preventable diseases is one of most effective country-driven and globally-supported actions, as it currently averts an estimated two to three million deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles. In 2012, an estimated 83% (111 million) of infants worldwide were vaccinated with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine.

- Some 176 countries have signed on to A Promise Renewed – the call to action spearheaded by the Governments of Ethiopia, India and the United States, together with UNICEF in a global effort to stop children from dying of causes that are easily prevented.

- The United Nations Commission on Life-Saving Commodities for Women and Children is helping countries improve access to priority medicines such as basic antibiotics and oral rehydration salts.

- Earlier this year, WHO and UNICEF joined other partners in establishing a new Global Action Plan for Pneumonia and Diarrhoea which aims to end preventable child deaths from these two major killers of under-fives by 2025. The plan promotes practices known to protect children from disease, such as creating a healthy home environment, and measures to ensure that every child has access to proven and appropriate preventive and treatment measures.

- Similarly, partners are working on Every Newborn: a global action plan to end preventable deaths. The aim is to launch this global newborn action plan in May 2014 and provide strategic directions to prevent and manage the most common causes of newborn mortality, which account for around 44% of all under- five mortality.

- UNICEF, WHO and the World Bank Group all support the Scaling Up Nutrition (SUN) global movement in its efforts to collaborate with countries to implement programmes to address poor nutrition at scale with a core focus on empowering women.

GAVI on track to meet ambitious immunisation goals

The GAVI Alliance is on track to meet its ambitious targets of supporting developing countries to immunise an additional quarter of a billion children by 2015, and preventing nearly four million deaths in the process. That’s the conclusion of the Mid-Term Review report, a comprehensive and transparent assessment published 20 October this year aimed at examining the progress GAVI has made midway through its current strategic period from 2011 to 2015, and the challenges it faces in meeting its commitments to developing countries and to donors.

Dagfinn Høybråten, Chair of the GAVI Alliance Board, said: “GAVI is reaching record numbers of children with life-saving vaccines, just over two years after our successful pledging conference and midway through our current strategy period. “More countries than ever are introducing new vaccines, resulting in more deaths averted and improved health and wellbeing for millions of people.”

In addition to reaching its goal of helping developing countries immunise 243 million children between 2011 and 2015, GAVI is also on target to help avert nearly four million future deaths during the same period. The report also found that the historic gap in access to immunisation between low- and high-income countries is starting to close. In the Kilifi district of Kenya, for example, the number of hospital admissions of children with pneumococcal disease from vaccine serotypes fell from 38 to zero within less than three years of the introduction of pneumococcal vaccine.

Such accounts have been captured in a series of impact stories that are being published on the GAVI website alongside the report. These show the extraordinary efforts of implementing countries and Alliance members to ensure vaccines reach the children who need them, wherever they live. Together, the report and the impact stories, come mid-way through GAVI’s funding cycle, following its first ever pledging conference in London, in 2011, where GAVI raised additional funding to enable it to commit a total of US$7.4 billion towards its mission.

GAVI has four strategic goals: These goals include: accelerating the uptake and use of under-used and new vaccines; strengthening health systems to improve immunisation coverage; improving long-term predictability and stability of immunisation financing; and helping to improve vaccine market conditions for developing countries.

GAVI Alliance

WHO calls for phase out of mercury thermometers by 2020

The World Health Organization (WHO) and Health Care without Harm organisation have joined forces to launch a new initiative to get mercury removed from all medical measuring devices by 2020.

The initiative ‘Mercury-Free Healthcare by 2020’, launched 11 October 2013 to mark the signing of the Minamata Convention on Mercury, calls for the phase out of mercury fever thermometers and blood pressure devices containing mercury. This will be done by ending the manufacture, import and export of these devices and by supporting the deployment of accurate, affordable, and safer non-mercury alternatives.

Mercury and its various compounds are of global public health concern and have a range of serious health impacts including brain and neurological damage especially among the young. Others include kidney damage and damage to the digestive system.

While the Minamata Convention allows countries to continue to use mercury in medical measuring devices until 2030 under certain special circumstances, WHO and the nongovernmental organization Health Care without Harm believe that the potential negative health consequences from mercury are so great that all should strive to meet the main target date of 2020 set out in the Convention. “With the signing of the Minamata Convention on Mercury we will be going a long way in protecting the world forever from the devastating health consequences from mercury,” says WHO Director-General Dr Margaret Chan.

“Mercury is one of the top ten chemicals of major public health concern and is a substance which disperses into and remains in ecosystems for generations, causing severe ill health and intellectual impairment to exposed populations.”

The Convention provides a blueprint for country action to eliminate the most harmful forms of mercury use, reduce mercury emissions from industry, promote mercury free methods, protect children and women of childbearing age from mercury exposure, and take steps to improve workers health and well-being.

Mercury-Free Healthcare

Health of older women in developed countries improves

Measures taken in developed countries to reduce noncommunicable diseases – the leading causes of death globally – have improved the life expectancy of women aged 50 years and older over the last 20 to 30 years. But, according to a study published in the Bulletin of the World Health Organization 2 September 2013, the gap in life expectancy between such women in rich and poor countries is growing.

The WHO study, one of a collection of articles in a special issue of the journal devoted to women’s health beyond reproduction, found that the leading causes of death of women aged 50 years and older worldwide are cardiovascular disease (heart disease and stroke) and cancers, but that in developing countries these deaths occur at earlier ages than in the economically advanced world.

The study is one of the first to analyse the causes of death of women aged 50 years and older from a wide range of countries. Its findings suggest that prevention, detection and treatment of noncommunicable diseases are currently inadequate in many countries.

“Given the substantial reduction in maternal mortality and the increase in the number of older women over the last 10 years, health systems in low- and middleincome countries must adjust accordingly, otherwise this trend will continue to increase,” said Dr John Beard, director of the World Health Organization’s (WHO) Department of Ageing and Life Course and one of the authors of the study.

“Changing women’s exposures at earlier stages of their lives, particularly in relation to sexual health, tobacco and harmful use of alcohol, is essential to reversing the epidemic of chronic diseases,” Dr Beard said. There are known and cost-effective ways to address these common noncommunicable diseases, including prevention, early diagnosis and management of high blood pressure, obesity and high cholesterol and screening and treatment for cancers.

“The best way to address these conditions in low- and middle-income countries is to build on the existing healthcare services, so that they can be detected early and managed with effective treatment,” he said.

“So, for example, maternal healthcare services can provide proper detection and management of gestational diabetes to help prevent mothers from becoming overweight or diabetic later in life.”

Developed countries have taken measures to address these conditions over the last 20 to 30 years and the results show. According to the WHO study, fewer women aged 50 years and older in these countries are dying from heart disease, stroke and diabetes than 30 years ago and these health improvements contributed most to increasing women’s life expectancy at the age of 50. At 50 years, women in Germany and Japan gained 3.5 years in life expectancy – thanks to improvements in these health areas – and can today expect to live to 84 and 88 years respectively. In France, the United Kingdom and Chile, the life expectancy of 50-year-old women increased by about 2.5 years to 36.7, 34.4 and 34.3 years, so that they can expect to live to 83 or 84 years thanks to improvements in these health areas, the study showed.

Meanwhile, in Mexico and the Russian Federation, the life expectancy of 50-yearold women increased more slowly, by 2.4 and 1.2 years, so they can expect to live to the age of 80 and 78 years, it showed. While breast cancer incidence increased overall during the same 30-year period, there were fewer breast and cervical cancer deaths among women aged 50 years and older due to the provision of early diagnosis and timely treatment.

Between 1970 and 2010, female deaths in this age group from cardiovascular disease and diabetes fell on average by 66% in 11 affluent countries: Chile, France, Germany, Greece, Japan, New Zealand, Mexico, Poland, the Russian Federation, the United Kingdom and the United States of America, the study showed. WHO’s 194 Member States agreed on a global action plan for the prevention and control of noncommunicable diseases (NCD) at the World Health Assembly in May.

The plan proposes measures that countries can take to address these diseases over the next seven years. l The complete contents of the journal, since 1948, is available free at:


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