A nurse inspects a pregnant woman outside a ward at a maternity hospital renovated by Royal Dutch Shell in Obio district in Nigeria's oil city of Port Harcourt...A nurse inspects a pregnant woman outside a ward at a maternity hospital renovated by Royal Dutch Shell in Obio district in Nigeria's oil city of Port Harcourt March 24, 2011. REUTERS/Akintunde Akinleye (NIGERIA - Tags: HEALTH)
A nurse inspects a pregnant women at a maternity hospital in Port Harcourt, Nigeria © Reuters

Demographers and family-planning experts are preparing for a golden anniversary this year, as they mark progress since the creation in 1969 of UNFPA, the United Nations’ population fund, and twenty-five years since the International Conference on Population and Development in Cairo.

Birth rates around the world have slowed in the past 50 years, driven largely by economic and social development: as child mortality rates fall, education opportunities increase and women gain greater rights, the desire for fewer children normally follows.

But, to quote the title of UNFPA’s latest annual report, there remains significant “unfinished business”. While forced sterilisation and other state-imposed methods of imposing birth control have faded, other practices which violate human rights and negate women’s choices — from childhood marriage to female genital mutilation — remain too widespread.

Inequalities, traditions and parts of the world where development has been much slower mean that there are over 200m women each year who say they want but have no access to modern contraceptive methods — 37 per cent in least developed countries, according to the latest estimates, where the number of children per woman remains 3.9 compared to 2.5 globally.

While general fears about overpopulation are less pronounced than in the 1960s, specific concerns about environmental pressures and the growing burden of humanity on global warming are more pressing than ever.

As Natalia Kanem, head of UNFPA, says: “Since Cairo we have got away from population being about numbers, to it being about people, development, women and girls. But we cannot shy away from saying that we still have to be vigilant to protect the progress women have made.”

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Three questions

Henrietta Fore is executive editor at Unicef, the UN agency for children, which has just published a report on the poor state of water supplies and sanitation in healthcare centres.

How serious is the problem?

It's serious any time you can’t trust a healthcare facility not to make you more unwell. Imagine giving birth or taking your ill child to a facility where the doctors can’t even wash their hands or dispose of medical waste?

Healthcare facilities are also ground zero for drug-resistant pathogens. When health workers can’t wash their hands, or when they use dirty medical equipment, they risk spreading these resistant germs to other patients. Likewise, when you have poor sanitation in healthcare facilities, you run the risk of exposing more of the population to these resistant germs and antibiotics through contaminated wastewater, both of which contribute to resistance.

Is this just about resources or a lack of political will?

It’s both. Many countries are crippled by dated facilities, lack of trained staff and poor water and sanitation infrastructure. So obviously, resources are critical, but resources require political will. This is why efforts at the upcoming World Health Assembly to encourage governments to prioritise water and sanitation in health facilities around the world are crucial.

What has been Unicef’s most important achievement in global health?

More women are having healthier pregnancies and delivering healthier babies. We are the world’s largest procurer of vaccines for children and thanks largely to vaccines, smallpox has been eradicated, polio is on the verge of eradication, and tetanus has been eliminated in more than 45 countries. What we are most proud of is the big picture: we have been able to get under-five mortality from 12.6m deaths annually down to 5.4m in under three decades, even as the number of births worldwide has soared. Along with vaccines, interventions to treat diarrhoea and pneumonia and save newborn babies are paying off. 


Health spending Two reports illustrated individuals' global spending on health. World Bank data (graphic above) showed considerable variation in out-of-pocket expenditure while World Health Organization analysis showed the level of unmet need and financial hardship across Europe. 

News round-up

Taxing for health The Task Force on Fiscal Policy for Health urged governments to increase taxes on tobacco, alcohol and sugary drinks. Raising the prices of these products by 50 per cent could prevent more than 50m premature deaths over the next 50 years. The UK's “sugar tax” has raised £240m in its first year to spend on anti-obesity initiatives. (Bloomberg, UK Treasury)

Measles measures New York's mayor declared a health emergency and ordered vaccinations in parts of the city struck by measles. Misinformation is rife. Compulsory vaccination in the US is rare but there is a precedent — from 1905. (New York Times, Stat)

Antibiotic resistance The increasing availability of antibiotics — illustrated here in a poor Kenyan community — has a downside: they are losing their ability to kill the germs they were meant to destroy. In the west, telemedicine seems to be driving prescription use for children. Outbreaks of “superbugs” such as Candida auris are largely hidden from public view. (NYT, Washington Post, Vox, Stat)

Antibiotic access Another downside to the overuse of antibiotics is that many patients do not get the drugs they need. Most of the world's annual 5.7m antibiotic-treatable deaths are in poorer countries. Government and industry need to work together to develop new antimicrobials. A new paper argues for economic incentives to encourage development, decoupling profits from volumes sold. (CDDEP, Stat, Science)

Drug price debate US drug prices are becoming a hot election topic, with particular ire aimed at pharmacy benefit managers, the medicine middlemen. Here's an interview with Alex Azar, the US health secretary. The problem is a global one: campaigners want action from the UN. (FT, Stat, Oxfam)

Cholera clues A strain of cholera extracted from a soldier who fought in the first world war is helping scientists understand how the disease — deemed a global threat by the WHO — can spread. Outbreaks are being fought in Yemen and Mozambique. (Reuters, Al Jazeera, ReliefWeb)

Lasting effects of hunger Hunger during childhood can have devastating physical and psychological consequences. Food banks are popping up in richer countries such as the UK alongside diseases such as rickets. (Mosaic)

Where there isn't smoke . . . Regulators are finding it tough to control smokeless tobacco products such as snuff which contain high levels of nicotine and other toxic chemicals. US senators attacked Juul, the dominant e-cigarette company, over a deal with tobacco giant Altria. (The Conversation, CNN)

Booze ban The World Health Organization told its staff not to collaborate with the alcohol industry when developing policy and warned governments to be wary of such risks. (BMJ)

Stressed workers UK workplaces are experiencing a rise in stress linked to poor management. Workers are taking fewer sick days but often work while they are ill. Mind, the mental health charity, has issued advice to British MPs under pressure over Brexit. (CIPD, Politics Home)

Best from the journals

Asthma alert More than one in ten cases of childhood asthma can be linked to traffic-related air pollution. South Korea (31 per cent) is the worst affected and of the ten cities with the highest proportion of cases, eight were in China. (The Lancet Planetary Health)

Mental healthcare Digital technology has great promise to support non-specialists such as community health workers in poorer countries in delivering mental health services. (Harvard Review of Psychiatry)

'Arab world ignored' The Arab world has suffered the brunt of the world's worst conflicts over the past decades but the global health community has failed to adequately address its suffering. The only exclusive body for the region is the WHO's Regional Office for the Eastern Mediterranean. (The Lancet)

UK health spending An ingenious graphic illustrates the cash flows for health and social care in the UK. The total of £208bn comes from two main sources: public (£157.6bn) and private (£44.9bn). (BMJ)

Screens and teens A large-scale study said there was little clear-cut evidence that screen time — even at bedtime — decreased adolescent wellbeing. (Psychological Science)

Turbocharging the memory Electrical stimulation of the human brain can produce a striking improvement in the short-term memory of the elderly, with people in their 60s showing memory functions equivalent to volunteers 40 years younger. (Nature Neuroscience, FT)

Surgery and opioids Pain management after surgery has been a major contributor to the opioids crisis. Global prescriptions more than doubled between 2001 and 2013. Possible solutions include specialist pain clinics, drug monitoring policies, improved prescribing, and new pain management methods. (The Lancet)

Acid tests Psychedelics and related compounds such as LSD, psilocybin, cannabis, and ketamine could be used in psychiatric treatment but their varying effects means more clinical research is needed. (BMJ)

Biology: the final frontier Prolonged space flight causes significant changes to the human body, according to a Nasa-sponsored study that compared the biology of astronaut Scott Kelly with that of his identical twin brother. Factors specific to space flight include the microgravity environment and higher radiation exposure than on Earth. (Science, FT) 

Podcast of the week

“No safe limits for alcohol” New research seems to kill the idea that occasional drinking of alcohol can have medical benefits. Should it be subject to the same treatment as tobacco? (Lancet, 12m)

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Final thought

It’s not just fake news on social media we need to worry about — the #selfcare phenomenonca could be even more dangerous. (Telegraph)

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