Pregnant women wait to be examined at a hospital in Agartala, India © Reuters

Each year brings advances in science and progress in fighting deadly diseases, but one indicator is proving much more difficult to shift: health inequality.

The World Health Organization's annual snapshot of global health published this week breaks indicators down by sex for the first time, shining a light on some glaring discrepancies.

Men for example are much more likely to die from preventable diseases, suffer road accidents and commit suicide. Women on the other hand outlive men everywhere, particularly in wealthier countries with better access to maternal health services.

Deaths from maternal causes highlight another huge rift: the gap between rich and poor. One in 3,300 women in richer countries is a victim, compared with one in 41 in low-income countries. Deaths from caesarean sections are 100 times higher in poorer countries and overall life expectancy is 18 years lower. One child in every 14 will die before their fifth birthday. 

Solutions include better access to services through universal healthcare; more control for women over their sexual and maternal health; and better data collection. But as the WHO acknowledges, much of this is beyond the remit of traditional health ministries. Without multisectoral approaches and the political will to tackle underlying gender and socio-economic inequalities, the struggle will remain an uphill one.

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Three questions

Bill Gates, co-chair of the Bill & Melinda Gates Foundation


What’s your assessment of your philanthropy?
Our deep areas of expertise are health and agriculture. Our initial focus was global health and US education. In global health, overall we’ve done a great job, we feel more impact than we expected. [In education] your challenge is always scaling up.


Are you increasingly focused on activities outside the foundation?
The only substantial thing outside is energy-related innovation, to provide cheap energy and avoid climate change. Because it relates to private companies — with energy storage and generation — it’s done with private investment. In scale, it’s not meaningful. Our philanthropic work is $5bn a year.


How would you describe your own leadership style?
I have definitely mellowed since the days at Microsoft when I didn’t believe in taking off weekends or going on vacation. I think having a family really helped with that. But I am still just as passionate about my work, and the underlying principles of the way I think about leading an organisation are the same.


Read the full interview here


Chartwatch

Air pollution alert The world's fifth highest risk factor for mortality reduces average life expectancy by almost as much as tobacco, according to a new report. London is preparing to open its ultra low emission zone, which aims to cut toxic air by up to 45 per cent. Here's a summary of what it does to our bodies. (State of Global Air, Evening Standard, BBC) 


News round-up

Mozambique suffering Cholera is spreading fast in the aftermath of Cyclone Idai which has displaced some 2m people in Mozambique. Health workers hope a vaccination campaign will stem the tide but fear the emergence of other diseases such as malaria. (New York Times)

Africa’s burden Diseases cost Africa $2.4tn a year in lost productivity. Some 37 per cent of these losses are due to non-communicable diseases, which have now overtaken the share of infectious ones such as Aids, TB and malaria. (WHO)


Water woes One in four of the world's healthcare facilities lacks basic water supplies and one in five has no basic sanitation, according to a Unicef/WHO report. As well as endangering patients, the situation also encourages the spread of anti-microbial resistance. (Unicef)

Food insecurity More than 113m people across 53 countries faced “acute hunger” in 2018 with Africa the worst hit, creating problems such as stunting and wasting. The main drivers were conflict, climate shocks and economic turbulence. Disease outbreaks in countries such as Yemen and DRC are expected to make the situation worse. (FSIN)

Honouring health workers There were almost 1,000 attacks on health facilities and workers last year, killing more than 150 and injuring more than 700, according to new data presented to the UN Security Council. Syria was the worst hit. World Health Worker Week highlighted the problems they faced around the globe. (Global Health Now)

Unhealthy advertising Sports are usually seen as a driver of public health but many have become closely linked with harmful products. Policymakers need to become more aware of these links and the industry needs to embrace a socially responsible approach to commercial sponsorship and advertising. (WHO Bulletin)

Smoke signals The debate around the pros and cons of ecigarettes continues apace. In the US, officials are investigating the risk of seizures while a new poll says Americans believe they are more harmful than regular cigarettes. A UK study finds they do not “normalise” smoking among teens. Heart deaths have dropped by almost two-thirds since the UK's public smoking ban. (FT, CNN, Tobacco Control, Times)

Fighting antivaxxers Mobilising youth to fight back against the anti-vaccination movement is crucial to stop the resurgence of diseases like measles. A new study examines the degree of vaccine hesitancy in the UK. Some outbreaks have been linked to a religious festival in Ukraine known as “the Hasidic Burning Man”. (Project Syndicate, CNN, Science, NYT)

Trump back on Obamacare The US president is gearing up to make healthcare a key focus of the 2020 elections, despite misgivings from fellow Republicans. Jama has a new series on US healthcare policy and this Kaiser dashboard shows the system’s comparative performance. Nearly half of Americans fear bankruptcy in case of a health emergency. (FT, Jama, Peterson-Kaiser, New York Times)

Angst over asbestos Campaigners in the UK, US, Italy, Australia and New Zealand have been asking questions about the link between asbestos water pipes and disease. The WHO says there is no cause for concern but some scientists point to the power of industry lobbying and question research carried out on hamsters and rats. (FT)


Brexit and UK tech Investors are piling into science and tech companies based in Cambridge, which together with London and Oxford forms part of the UK's “golden triangle” for research. Here's our recent video on the city's “Nobel Prize factory”. Scientists warned however that Brexit had already begun to severely weaken the UK's influence. It is also affecting the nation's mental health. (FT, Science, Guardian)


Best from the journals

Bad diets riskier than smoking One in five global deaths are associated with a poor diet, thanks to its contribution to cardiovascular disease, cancers and diabetes. Key causes are too much salt and not enough whole grains or fruits. Uzbekistan has the highest rate of diet-related deaths and Israel the lowest. (The Lancet) 

HPV hopes Tests involving routine HPV vaccination of girls in Scotland hold out hopes for dramatic reductions in cervical cancer. Cervical carcinoma is the fourth most common cancer in women and a major global cause of death and illness. (BMJ)

Alcohol and stroke A large Chinese study seems to debunk the theory that the odd drink can help safeguard against stroke. (The Lancet)

Ageism and health The first study to examine links between ageism and health highlighted the need to adopt public policy to the needs of a rapidly ageing population. (The Lancet)

Machine learning Embedding machine learning in medicine could reduce human error but beware the adage: garbage in, garbage out. (NEJM) 


Podcast of the week

Pain in the brain Why do individuals feel pain in different ways? Irene Tracey, a professor of anaesthetic science — also known as the “Queen of Pain” — discusses how it is processed by the brain. (The Life Scientific, BBC)


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Previous edition: Sackler saga; health inequality; Ebola strikes again

Measles vaccination: A matter of confidence and commitment (PLOS Medicine)

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Final thought

Female sexual health From schoolgirls protesting against period poverty to the #MeToo movement, woman's sexuality is slowly being destigmatised. The shift is also driving a new industry. (FT)

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