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The US president’s announcement that he would address the March for Life anti-abortion rally on Friday was not only a renunciation of his past “pro-choice” views. It also marks a further trumping of high-level policy by personal belief or political expediency at the expense of evidence — and with global implications.
Domestically, the White House is planning new “conscience” protections for health workers who do not want to perform abortions or other procedures where they have moral objections. A report from Planned Parenthood is highly critical of recent decisions on birth control, STI/HIV services and cancer screenings as well as the “global gag” rule, limiting foreign aid for services offering abortion and hitting countries like Uganda hard.
Yet there are alternative voices — from this weekend's Women’s March to the She Decides movement — more focused on evidence. Unesco recently updated its International Guidance on Sexuality Education, stressing the importance of comprehensive support in schools to reduce the risk of dropout, forced marriage, teenage pregnancy and infection.
Everyone should have a right to their own faith. But as with those who refuse vaccination and raise the risk of infection in others, policymakers need to stand above individuals’ views when the implications jeopardise the health of others.
We spoke to Larry Summers, professor at Harvard and former US Treasury Secretary, who has just been appointed co-chair of Michael Bloomberg's task force on fiscal policy for health and wrote about the topic this week for the FT.
Why did you decide to lead this new commission?
I’ve been concerned about these issues since I oversaw the World Development Report in 1993. I think the under-allocation of resources to global health is as serious as any [problem] in the international system. There are opportunities by promoting these kinds of taxes, developing vaccines, working on drug resistance. This has long been of concern for me. I’ve always felt that tax policy around global health is . . . low-hanging fruit. There is scope for taxes to control tobacco, alcohol and sugar.
Are you disappointed there was not faster adoption of these ideas?
There has been some uptake since the Global Health 2035 report. The global effort to stigmatise and reduce tobacco use has grown and soda taxes have been implemented in Mexico and other developing countries. No one could have conceived in 1972 of where we would be with respect to tobacco. We’re in a similar place for sugar today. There’s too little connection in general between global health and the economic and financial community. The fact that the chairs of the commission are people that finance ministers would naturally relate to will help.
Are you worried about the White House’s turn against global health?
There are grounds for concern. Obviously if you have a more outward-looking, generous-minded US, there are greater prospects for global health. But it would be a shame if people working to make the world a better place became paralysed and focused all their energies on Trump. Plus the National Security Strategy contains a reference to strengthening health systems in the developing world as an important part of protecting our national security and there is much developing countries and US cities can do.
Adapting for ageing The UN projects that by 2050 the number of those aged 80 years and above will triple to 434m. A new index measures how well countries are developing policies to serve their ageing populations. (PNAS)
Attacking AMR An industry report details progress on anti-microbial resistance in research, access, appropriate use and the environment. A sample of 22 companies spent $2bn in R&D in 2016, with 10 antibiotics in late-stage clinical development, 13 clinical bacterial vaccine candidates and 18 AMR-relevant diagnostic products. (AMR Industry Alliance, Devex)
Aid shortage Millions are at risk of starvation this year, yet the lack of funding for the UN's World Food Programme means it can only ever operate as a triage service. Irin, the humanitarian news network, identifies the countries most at risk.
Measles on the march Greece, Italy, Romania and Ukraine are among countries experiencing measles outbreaks, often following anti-vaccination scares. Outbreaks in England have been blamed on the legacy of the MMR scare of the early 2000s. The Northern League and the Five Star Movement, the two main populist parties in Italy, said they would scrap mandatory vaccinations if they won the general election in March. (WHO, Times)
Brexit blowback MPs warned the UK could face a cancer treatment crisis if supplies of radioactive material were hit once the UK leaves Euratom, the EU nuclear regulator. Doctors continue to agitate against Brexit, arguing that medical research is a net beneficiary of EU grants and would suffer without access to EU-powered trials. The debate over Brexit freeing up funds for the NHS has intensified. (Telegraph, BMJ)
Action on NCDs More should be done to tackle non-communicable diseases in adolescents, a group often overlooked in global discussions. A separate report argues an expanded definition of adolescence is essential for framing policies. (Plan International, The Lancet)
Giant genetics collection The US is planning to compile the world's largest genetic library for researchers. The Precision Medicine Initiative began under the Obama administration but, now the cost of genome sequencing has dropped, the National Institutes of Health is ready to enrol a million Americans to contribute to this new pool of data. (Washington Post)
Dementia drugs Some are beginning to question the pharma industry's commitment to finding a drug for Alzheimer's, now Pfizer has withdrawn from research. Others believe the breakthrough will come from smaller and more focused biotech groups as with recent advances in cancer. (FT)
Humanising drug trials UK biotech relies too much on animal testing which offers only “poor approximations of humans”. Because the process remains “patient-free” until clinical trials begin, 40 per cent of new drugs fail when first tried in real patients. (FT)
Supporting innovation Despite its serious contributions to medical R&D, the NHS often struggles to get simple innovations adopted across the network. Possible solutions include rethinking staff roles, overcoming siloed thinking and addressing social issues as major causes of ill health. A shortage of nurses is affecting patient care and threatening lives. (King's Fund, The Conversation)
Dementia and music A report examines the evidence for the use of music in dementia care ahead of a new campaign to improve access to music-based treatments. Recent research suggests parts of the brain associated with musical memory may overlap with those areas relatively spared from Alzheimer's disease. (International Longevity Centre, Utley Foundation video)
Best from the Journals
China's growing role China is poised to fill the gap left by the US slowdown in global health investment. This is the first time a developing nation has switched from recipient to contributor and could herald new models for global health policy. (Health Affairs)
Health omnipresent There is widespread support for action on the social determinants of health and making “health in all policies” the norm, but implementation is patchy and measuring progress is difficult. This report looks at successful examples around the world. (BMJ)
Indigenous languages and global health The world's 370m indigenous people tend to have worse health outcomes than their non-indigenous counterparts, thanks to effects of colonisation, marginalisation and poverty, made worse by language barriers to accessing healthcare. (The Lancet)
War and disease A new study shows how conflict has helped spread HIV in Ukraine — the country with the highest levels of infection in Europe — reinforcing the importance of prevention programmes involving displaced people and those who travel frequently to war-affected regions. (PNAS)
Cancer hopes A new blood test called CancerSEEK has raised hopes of earlier detection of the disease in cancers of the ovary, liver, stomach, pancreas, oesophagus, colorectum, lung or breast. (Science)
Nudge theory and health “Nudge” policies — designed to influence behaviour in a certain direction — are trickier to implement in health environments because of the complex set of stakeholders, conventions and ethical frameworks involved. Penn Medicine Nudge Unit has been trying to put the theory into practice. (NEJM)
Podcast of the week
Device dangers One in 10 American has at least one medical device implanted but these devices are subject to far less scrutiny and regulation than drugs. NPR talks with the author of a new book on the dangers growing within us. (NYT, NPR Fresh Air 36m)
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Are you a very stable genius? All US presidents submit to the public ritual of a health check to assess their fitness for office. But number 45 went one step further — requesting and passing a test on his cognitive faculties. Can you match the president's perfect 30/30? Take the test. (Daily Mirror)