Health: Much achieved but more work needed
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From threats of respiratory infections in newborns to the looming burden of Alzheimer’s in the elderly, it might seem illness and death are winning the battle against humankind.
In fact, people in 2014 will continue to gain ground against disease, living longer and healthier lives than ever. The world’s population has topped 7bn and continues to increase, as the risks of surviving infancy fall and average life expectancy keeps rising.
This year should see continued progress in efforts to tackle infections. Following the success with smallpox in the 1980s, Guinea worm is moving towards its likely status as the second human disease ever to be eradicated. With fresh outbreaks in Syria and Israel, polio will prove more difficult, despite its apparent elimination from India.
The recent dissemination of a vaccine specifically for meningitis A in Africa will swiftly save lives. There will be longer-term benefits from other vaccines distributed more broadly in low-income settings, with donor funding via the Global Alliance for Vaccines and Immunisation. These will protect against rota virus, a cause of often fatal diarrhoeal infections, pneumococcal disease, and HPV, a source of cervical cancer.
Similar funding commitments by donors are spreading life-saving therapies more broadly. The Global Fund to fight Aids, TB and Malaria has been pivotal in helping slow death from those three diseases, aided by new drugs and broader dissemination.
For the 180m people infected with hepatitis C – a cause of cirrhosis and liver cancer – there is far greater hope this year of access to a cure, thanks to effective oral combination treatments.
There has also been progress with treatments for autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and several cancers. Immunotherapy – using the body’s own immune system to tackle cancer – is beginning to take off, and there are breakthroughs in gene therapy.
The sharply falling cost of genetic testing – now as little as $1,000 for the full genome – is finally offering the prospect of significant advances towards personalised, more targeted treatments notably for cancer and some rare diseases.
Yet new pharmaceuticals will only be of limited service in improving health. Without more radical ways to reduce the failure rates, regulatory hurdles and escalating costs of innovation, the high prices of drugs will continue to exclude many of those most affected – whether in low-income countries or among the uninsured or underinsured in the developed world.
Better adherence to existing medicines offers potential to improve outcomes for many patients. Enhanced diagnosis, access to doctors and support are just as important. Prevention is probably the most effective of all – but often has only long-term benefits and has suffered funding restrictions in recent years.
The developing world is lagging behind on efforts to improve maternal and child health to meet the 2015 Millennium Development Goals, but not because medicines are too expensive. Most of the required drugs are cheap generics, but without better facilities, more trained staff and improved pharmacy supply chains, treatments are failing to make a difference.
A focus on more equitable and universal healthcare coverage will continue to gather momentum this year. “Obamacare”, despite continued political resistance and poor implementation so far, offers some prospect of improvements in the US. China, India, Brazil, Ghana, Indonesia, Mexico and other countries are also giving the issue more attention.
There will be more experimentation over transparency, accountability and incentives to reward improved health outcomes. But it risks being undermined in countries such as the UK by a tendency for politicians to berate and scapegoat doctors, and to impose new targets that encourage gamingor manipulating results rather than trying to achieve better outcomes for patients.
Much of the greatest improvement in health outcomes will be the result of factors beyond the control of the medical system: better nutrition and sanitation; reduced road accidents and smoking; and healthier lifestyles.
Mental health and the growing burden of dementia also highlight the need for society to destigmatise and adjust to many long-neglected conditions that will not disappear soon. They must instead trigger a broader debate on how to provide greater social support.
Letter in response to this report: