As far as alcohol studies go, The Lancet’s analysis of almost thirty years of global trends makes for sober reading.
Between 1990 and 2017, total consumption rose by 70 per cent, with the average per person rising from 5.9 litres a year to 6.5l. This is forecast to hit 7.6l by 2030, by which time half of all adults will be drinkers and almost a quarter will binge drink at least once a month. Needless to say, WHO targets to cut harmful use by 10 per cent by 2025 are likely to be missed.
Alcohol poses a unique health risk because of its association with a wide range of illnesses, disabilities and injuries. It has wider societal effects too: a separate study showed one in five people in England had been harmed by others' drinking.
Increases in low-and middle-income countries such as India and Vietnam are outweighing declines in richer areas such as Europe. Alcohol use tends to increase as populations get richer, but many of these countries do not yet have policies in place to mitigate harms to health.
Public messaging can also lack clarity. Several studies have reported that the occasional drink could be beneficial to health, but another recent Lancet analysis suggested that there were no health benefits from any level of alcohol consumption.
Policymakers also have to fight off pressure from powerful lobbying. Public Health England was recently criticised for its partnership with an industry-funded charity while the WHO felt moved to tell staff not to engage with the alcohol industry on matters of policy.
In the words of one expert cited by the British Medical Journal: “Supporting evidence-based policies outside high-income countries, despite anticipated strong industry resistance, will be a key task for public health advocates in the coming decades.”
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Sigrid Kaag, minister for foreign trade and development co-operation, the Netherlands
What needs to be done to reach universal health coverage?
We support human capital — in education and health — as the mainstays of a healthy and productive life. But donor and local funding is not enough. We have to supplement it with digital technology to make it cheaper and to mobilise the private sector to close the gap. At the moment, competing rival companies would be a luxury in many countries. Once we achieve access for all, then we can consider competition, regulation and legislation.
What explains your interest in mental health?
I grew up at a time when if your parents had a mental health issue — like my father — it was not spoken about. I’m always struck by how people are bereft and yet on top of mental health problems they are not supported or recognised. In the Middle East, I saw many cases where psychosocial support for those fleeing conflict was an afterthought. People in Syria have suffered so much trauma, it’s almost impossible to understand how they can survive. My duty is to bring it into the mainstream.
What are your other priorities?
We are preparing covenants on responsible business conduct for 13 sectors on the relationships between producers, consumers, labour and non-profits around issues such as the living wage, environmental respect, abuse and exploitation, gender — a human rights approach. We expect high standards from companies operating in the Netherlands. We will consider binding legislation if necessary. I’m also committed to my predecessor’s support for sexual and reproductive health and #shedecides.
Snakebite strategy Snakebite envenoming affects up to 2.7m people each year and kills up to 138,000, predominantly in tropical and subtropical countries. Children suffer the most because of their smaller body-mass. The WHO's new strategy aims to halve the number of deaths and cases of disability by 2030. (WHO)
Polio endgame A “global milestone” in the fight against polio occurred this week when Zimbabwe and Mongolia became the final countries to vaccinate children against polio. The wild form of the highly contagious disease is now only endemic in Afghanistan, Nigeria and Pakistan. (Gavi)
WHO update A midterm review of the World Health Organization's 2018-2019 programme assessed progress on its “triple-billion” targets: a billion more people with universal health coverage; a billion more better protected from health emergencies; and a billion more with better health and wellbeing. The organisation last year investigated 481 emergencies and potential emergencies in 141 countries. (WHO)
The $2m drug Zolgensma, Novartis' new gene therapy treatment for a muscle-wasting disease in babies, could go on sale at $2m, reigniting the debate about drug pricing. Pharma companies will have to show the list price of any medicine over $35 on US TV ads from this summer. Here's a look at the politics of US prescription drugs. (WSJ, FT, Kaiser)
Road safety Road traffic incidents — which kill around 3,700 people a day — are the world's leading cause of death for children and young adults and disproportionately affect poorer countries. The UN aims to halve deaths and injuries by 2020, but despite effective measures in richer countries, an analysis of data from China underlined the difficulty of the task. (WHO, The Lancet)
Zoonotic diseases A US report ranked the top threats from zoonotic diseases — illnesses that can spread from animal to human. (CDC)
Midwives lauded International Day of the Midwife celebrated the role of the workers who, when qualified to international standards, can provide 87 per cent of the services needed for mothers and babies and are vital in reducing stillbirths and deaths from birthing complications, illustrated by these examples from Lebanon, Bangladesh, and Afghanistan. (WHO, MSF, Figo, UNFPA)
Football firsts FC Not Alone is a UK project using football to encourage men to open up about mental health problems. A new study aims to map the health challenges for professional players. (FC Not Alone, YouTube clip, Drake Foundation)
Mapping mental health An analysis of data from doctors shows the gulf between London and the rest of England when it comes to reported mental health problems and resources to treat them. The “most depressed” areas are all in the north and the Midlands. Brinnington in Greater Manchester comes off worst and a plush part of Westminster the best. (The Guardian)
Noise nightmares Sound-related health problems can contribute to heart disease and high blood pressure as well as problems arising from sleeplessness. Scientists have the knowledge to make the world less noisy but policymakers have been slow to act. (New Yorker)
Organ printing The concept of 3D-printed organs took a tiny step forward with the creation by Israeli scientists of a miniature “living” heart. The use of the patient’s own tissue as the “ink” minimises the chances of rejection. (FT)
Chips in space Human cells on tiny chips are being launched into space to analyse the effects of microgravity, which accelerates some of the mechanisms that cause disease. Osteoporosis for example takes decades to develop, but can be modelled in space in a very short time. (Stat)
A history of empathy The importance of empathy when treating the sick was common in ancient cultures but gave way to a — sometimes crude — paternalism, nicely illustrated in this film clip from the 1950s. Its importance is now recognised by studies that show the positive effect on outcomes. (The Conversation, YouTube)
Best from the journals
Drugs defeating disease Mass drug administration or “preventive chemotherapy” has been successful in fighting a range of neglected tropical diseases afflicting the poor in Africa, Asia and Latin America since it was first proposed in the early 2000s. These interventions now reach more than a billion people a year. (NEJM)
Climate change and health The cost to the global economy of curbing carbon emissions may sound expensive — but not if the health benefits from cleaner air are factored in. Air pollution hurts the poorest the most. (Nature Communications, UN Environment Program)
Cancer concerns The number of people needing chemotherapy for cancer will rise by more than 50 per cent by 2040, raising fears of shortages of specialist drugs and physicians, especially in poorer countries. British MPs hit out at failings in screening programmes. (The Lancet Oncology, UK parliament)
Power of Coke A new study suggests Coca-Cola had contract mechanisms in place to “quash” findings from some of the health research it funded in North American universities. This included retaining the right to review research and control its publication or to terminate studies at will. Some public health experts suggest the food and nutrition industry is copying tactics from tobacco companies. (Journal of Public Health Policy, The Conversation)
Rural obesity A large global study showed — contrary to common perceptions — that obesity was rising faster in rural areas than in cities. Suggested causes include lower education and income levels, higher prices for healthy foods and fewer recreational opportunities. In England, obesity-related hospital admissions rose 15 per cent on the previous year. (Nature, Guardian)
Bug busting A 15-year-old girl with cystic fibrosis was successfully treated with genetically-modified phages — viruses that infect and kill bacteria — giving hope to the idea that they could be used as antibiotics. (Nature, BBC)
Master stroke Animal-like robots can have a positive effect on the health and wellbeing of elderly residents in care homes. The “robopets” provide comfort and reduce agitation as well as stimulating conversation and social interaction. (International Journal of Older People Nursing)
Podcast of the week
Brits and sex A UK survey has been documenting sexual attitudes and lifestyles for 30 years. Kaye Wellings, Professor of Sexual and Reproductive Health at the London School of Hygiene and Tropical Medicine, discusses the latest findings showing declines in sexual frequency among married couples. (BMJ Talk Medicine)
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Dying matters A UK campaign is aiming to encourage conversations around death. “Not knowing what may happen to a loved one as they die can exacerbate fears at the hardest times of our life. It may also mean that people struggle to think clearly about how best to fulfil the wishes of a dying family member or friend, let alone know what to ask doctors and nurses.”
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