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“Failure to invest in mental health as a matter of urgency will have health, social and economic costs on a scale that we have rarely seen before.” That's the verdict of the World Health Organization in its new Mental Health Atlas.
The report shows huge inequality of provision between rich and poor countries. Spending in Europe is 20 times higher per capita than in Africa and South-East Asia, and the average number of mental health workers per 100,000 population ranges from less than 1 in poorer regions to 72 in richer areas.
But problems are not confined to poorer countries. A separate WHO report is highly critical of European mental health institutions. It said many “violated the fundamental rights of people with psychosocial and intellectual disabilities, including their legal capacity, autonomy, dignity, liberty and security of person, physical and mental integrity and freedom from torture and ill-treatment and from exploitation, violence and abuse”.
Media interest in mental health usually spikes with news of a public figure suffering or overcoming adversity, but the problem is much more widespread. New data this week showed suicide rising across the US while in the UK, doctors said 40 per cent of their patient consultations now concerned mental health problems.
As with most severe illnesses, the economic case for prevention is strong: The WHO estimates that every $1 invested in treatment for common problems such as depression and anxiety leads to a return of $4 in better health and ability to work. (WHO, ABC News, Independent, CDC, Pulse)
What problem are you trying to solve?
Three billion citizens live in rural areas in emerging markets. They lack access to healthcare commodities, affordable agriculture inputs without middlemen and clean energy products. We began thinking how we could bridge the “last mile” gap between urban and rural areas, which often have no roads, no fibre-optics and suffer other telecoms problems. There is a lack of trust between people in the value chain, and many are not accustomed to poring over spreadsheets. We set out to create a technology platform to address these issues.
What is your solution?
We have built a platform on the cloud, using mobile, machine learning and social nudging. We put an app in the hands of the local health worker: they don’t make errors as they do on paper records. It aggregates the results to show demand for products like vaccines, and helps with forecasting and replenishment. It searches for the best phone network, toggles to encrypted SMS or stores the data until their device finds a signal. It really simplifies the user experience.
What has been the impact?
In India we have reduced the time for vaccine deliveries, cut the buffer stock required, the waste, handling costs and cold chain equipment required. We’re working in 27 countries on healthcare and now looking to expand horizontally into agricultural products, energy and regular commerce, including the “uberisation” of rural freight, from consumer goods to industrial products.
Syphilis shoots up England has followed the US in reporting a rise in syphilis and gonorrhoea. Experts are particularly worried about the emergence of “super gonorrhoea,” a strain resistant to routine drug treatment. Some blame cuts in public health services. (Men's Health, Public Health England, BBC)
Sugar skirmishes The failure of a WHO commission to recommend taxing sugary drinks, because of disagreements revealed in an FT interview with Ilona Kickbusch, angered campaigners. WHO chief Tedros Adnaom Ghebreyesus reiterated his backing for such taxation: “WHO stands firm on #SodaTax . . . Taxing sugary drinks is an effective way to reduce sugar consumption and decrease the risk of diabetes and obesity.” (Washington Post, FT Health, Twitter)
Global gag report A study examines 24 years of the US "Mexico City Policy" aka the "global gag rule" that prevents NGOs with US foreign aid from using their own funds for abortion services or campaigning for liberalisation. UK campaigners failed to persuade the country's highest court to declare Northern Ireland’s strict abortion laws incompatible with human rights legislation. (Centre for Health and Gender Equity, FT)
Spelling out Brexit fears As fears grew of post-Brexit shortages of drugs and medical devices, pharma companies demanded a “mutual recognition agreement” under which safety inspections and certification in the UK would continue to be recognised in Europe, and vice versa. Campaigners summarised their areas of concern: Budget, Research, Employment, X-border healthcare, Innovation, Trials. (FT, Bloomberg, Healthier in the EU)
Environment and health World Environment Day campaigners reminded us that 1.7m deaths of children under 5 years old each year were linked to the environment. A study said four per cent of all premature deaths in a small European city could be prevented if petrol and diesel-powered vehicles were removed. A UK report said the health cost from cars and vans was £6bn a year, with almost 90% due to diesel vehicles. (WHO, Lund University Video, Clean Air Day)
Exercise drive The WHO's new campaign targeted the one in five adults and four out of five adolescents who do not have enough physical activity. This inactivity is estimated to cost £54bn in direct healthcare costs each year and an additional $14bn in lost productivity. (WHO)
Fear and reality We worry about cancer 10 times more than we worry about heart disease, but both diseases kill roughly the same number of people. This animation captures what illnesses we worry about versus themes in the media versus actual causes of death in the US. (The Visual Capitalist)
US health inequality This short film discusses the history of the US Medicaid system and why it Is worse to be sick in some states than others. (Vox video/YouTube, 11m)
War on drugs A campaign group says legalising cannabis could earn the UK £3.5bn a year and responsibility for drug policy should move to the Departments of Health and International Development and a Cannabis Regulatory Authority introduced. In New York, beermats in bars are carrying warnings about Fentanyl being mixed in with cocaine. (Health Poverty Action, New York Health)
Period povertyThe fight against “period poverty” is gaining ground as a public health concern, helped by such high-profile supporters as The Duchess of Sussex (aka Meghan Markle.) The campaign got a boost this week — a badge from the Girl Guides encouraging girls to talk openly about periods and pledge support to make products accessible for anyone who needs them. (Big Issue, Telegraph, Girl Guides)
Best from the Journals
Global health and the private sector “The World Health Assembly is under attack . . . by a private sector that seeks to exploit the growing calls for more partnerships in global health,” says a comment piece in The Lancet. It also says that pharma is “slowly colonising global health in the same way it has colonised clinical medicine”. (The Lancet)
Cancer burden There are large disparities between countries in cancer incidence, deaths, and associated disability. In 2016 there were 17.2m cancer cases and 8.9m deaths, a jump of 28 per cent from 2006, with the largest rises in least-developed countries. Read the FT special report: Combating cancer. (JAMA, FT)
Avoiding chemotherapy The largest ever study of breast cancer treatment showed many women could avoid the pain of chemotherapy and side-effects such as nausea, hair loss and anaemia. Oncologists instead could deploy hormone therapy, a far milder form of treatment. (NEJM)
Medical data Maintaining large databases that comply with new European regulations will be complicated. One strategy might be to make all data the patient’s by default, and store only what is absolutely necessary. A survey showed participants in clinical trials believed the benefits of data sharing outweighed the negatives. (NEJM)
Work stress The first large-scale study on the subject shows a higher risk of early death from work stress for men suffering from coronary heart disease, stroke, or diabetes. Systematic screening, job redesign, cuts in working hours and retirement on health grounds could all help. (The Lancet)
Education and myopia Too much time in the classroom causes short sight, new research shows. Children need sustained exposure to daylight for their eyes to develop properly. (BMJ)
Podcast of the week
The economics of vaccines Developing a vaccine has always been a very slow and expensive process, taking up to 20 years and more than half a billion dollars. But new public-private partnerships could fill this gap between science and commerce. (NPR, 9m)
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The Apple paradox Should we welcome new programmes to limit the amount of time people spend glued to their iPhones? Or, like Frankenstein and his monster, are tech companies just frantically trying — and failing — to solve a problem of their own creation? (Wired)