FT Health: Foreign aid and the threat to multilateralism

At a time of rising populism and questions over the value of foreign aid, a new analysis suggests Britain’s contributions are largely well spent — especially the share channelled directly by its international development agency.

The Center for Global Development think-tank concludes that nearly four-fifths of the £28bn donated via the British government over eight years was spent well or satisfactorily. It was reviewing 65 individual assessments by the Independent Commission on Aid Impact, a UK watchdog.

While most of the money goes via the Department for International Development, other agencies were less well rated. In particular, spending via the Foreign and Commonwealth Office — which some ministers are keen to have take back direct control of Dfid — performed worst, with some disbursements possibly not even meeting the legal definition of aid.

There is no room for complacency. A previous analysis by CGD highlighted that some other countries — and multilateral institutions — perform better than the UK when considering factors such as efficiency, transparency and fostering institutions. New Zealand and Denmark ranked particularly well, although high quality was offset by a relatively low quantity of aid. The US, which gives generously, scores poorly, notably because much remains “tied” or linked to its own interests.

But as the World Bank heads into new leadership by a man highly critical of multilateralism, and with public opinion febrile, constructive criticism should not trump the benefits aid can bring.

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Chartwatch

Measles cases jump M easles is the “canary in the coal mine” of vaccine-preventable illnesses, asserted WHO and Unicef chiefs, as new data showed a 300 per cent increase in global cases for the first quarter of 2019 compared with last year. Numbers are also rising fast in the US, but at least “patient zero” has been located. (FT graphic, CNN, WHO, CDC, Washington Post)

News round-up

Overcoming vaccine hesitancy As measles spreads, health experts are attempting to boost confidence in vaccines and studying what can be learned from examples such as India's conquering of polio. In the US, Republican lawmakers have rejected Democrat attempts to tighten vaccine laws.

A UK decision to reduce an important childhood vaccine (PCV) from three to two doses could encourage poorer countries to do likewise and save a considerable amount of money. “Life-course” vaccination could save many unnecessary deaths. (CNN, Scientific American, Politico, Telegraph, Stat)

Climate change and disease Diseases spread by mosquitoes and ticks such as Dengue are on the rise as the planet warms. Other factors driving the increase are globalisation, economic development, urbanisation and the changing use of land. (European Congress of Clinical Microbiology and Infectious Diseases, Guardian)

Venezuelan woes deepen Vaccine-preventable diseases such as measles and diphtheria have soared in crisis-stricken Venezuela, adding to pressures on the country's healthcare system as scientists and health professionals flee. In addition, the upsurge in malaria is becoming “uncontrollable”. (CDC, Outbreak News)

Digital health dilemmas The WHO's first guidelines on digital health interventions aim to help policymakers make “informed investments”. Small companies developing apps for physical problems such as diabetes are facing an unexpected dilemma: what do they do if a user uses their app to communicate suicidal thoughts? (WHO, Stat)

Politics of pollution “Governments need to find politically acceptable ways of sharing the pain of radical public health measures,” said the FT, marking the introduction of London's pioneering clean air zone. Air pollution kills up to 40,000 British people each year and is thought to cause 4m new cases of childhood asthma globally. (FT)

The Butterfly effect The Butterfly, a small handheld scanner that links with a smartphone, is being used to bring medical imaging to remote communities in Africa. (NYT)

Of mice and men Tests in mice are useful indicators for physical human problems, such as those involving movement, but less so for diseases of the brain such as Alzheimer's. More generally, studies involving mice alone are too often overhyped. (Stat)

Pregnancy and privacy A parenting and pregnancy company in the UK was fined for selling personal data from millions of new mothers. In the US, fears were raised that data from pregnancy apps could be accessed by a woman's employer. (FT, Washington Post)

Menstrual health Basic necessities for menstruation are still lacking for many women, who use everything from goatskin to cow dung to manage their periods. (Guardian)

Best from the journals

Unhealthy advertising A global study of children’s exposure to TV ads for unhealthy foods and drinks called for greater government regulation. Self-regulation by industry has proved ineffective, it says. The UK's sugar reduction targets could save the NHS £286m over the next ten years, says the first analysis of their cost benefits. (Obesity Reviews, BMJ)

Commerce and health A new BMJ venture aims to analyse commercial influences on health and “to forge a new independence from those who make and sell products, to strengthen trust in how evidence is produced and disseminated, and to drive more rational and safer use of drugs, devices, diagnoses, and data in the public interest”.

Cancer risks A large study using UK Biobank data reaffirms the association between eating too much red and processed meat and increased risks of colorectal cancer. It also confirmed the increased risk from drinking alcohol. (International Journal of Epidemiology)

Statins shock Statins, one of the most commonly prescribed groups of drugs, were only successful in reducing cholesterol to “healthy” levels for half of the patients in a new study, increasing the risk for the other half of cardiovascular disease. (Heart BMJ)

A matter of life and death Scientists restored some brain functions in pigs four hours after the animals were decapitated, a breakthrough that could advance neuroscience but which raises questions about the line between life and death. Hundreds of people have already paid to have their brains frozen and stored after death, in the hope that scientists will eventually be able to revive them. (FT, Nature)

Problem patients Patients who miss hospital appointments cost Britain's NHS about £1bn a year but the problem is a global one: the highest “no-show” rate is In Africa at 43 per cent. A UK hospital is using artificial intelligence to predict which patients are most likely to miss their appointments. (Digital Medicine, BMJ)

Does workplace wellness work? Workplace wellness schemes — offered by 80 per cent of large US employers via an $8bn industry — may help individuals change certain behaviours but do little to improve health overall. (Jama)

Podcast of the week

The Friendship Bench The story of how a Zimbabwean initiative to help treat depression — in a country that had just two psychiatrists for 12m people — is spreading around the world. (Mosaic, 37 min)

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Final thought

Tackling taboos Connect, a new film tackling the problem of mental health and suicide in Scotland, will be shown to the country's parliament next month to raise awareness among politicians. “As Scottish men, we are just not good at speaking about our emotional and mental wellbeing,” said one MSP. “We need to open up a national conversation around male suicide in Scotland, and I believe films like Connect can help to encourage discussions.” (Sunday Times)