President Trump addresses the United Nations on September 19 2017 © Reuters

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Donald Trump’s speech this week at the United Nations, and the riposte from North Korea, placed more emphasis on death than health. But there was some good news for those focused more on human improvement than destruction.

President Trump name-checked US-led funders of global health programmes, notably Pepfar for HIV and PMI for malaria, although he showed little warmth towards UN institutions. Meanwhile, USAID will probably be placed under the tighter direct control of the State Department.

Michael Bloomberg tried to revive and update the annual Clinton Global Initiative, which brought together private and public sector organisations but folded following last year’s presidential election campaign.

Bill Gates sought to emphasise the progress in human health and development over the past two decades in his first annual Goalkeepers report, although he admitted he gave himself only a C+.

As the International Health Policies newsletter highlighted, a more original if complex ranking has just been published in the Lancet, which offers plenty of provocative thoughts on progress towards the UN’s health-related sustainable development goals. And the winner is . . . Singapore. Other countries, including Rwanda, do not perform so well. North Korea, incidentally, is only just behind India.


Three questions

Awa Marie Coll-Seck, Senegal’s minister for women, former health minister and member of the Lancet Commission on the future of health in sub-Saharan Africa.

What is the most important aspect of your report?

This a list of things to do by Africans. It is not theoretical but draws on practical examples. We have made lots of advances but we need to invest in universal health coverage that is people-centred: it’s not just about finances but about medical staff. We need to tackle not just treatment but promotion and prevention.

Should African governments do more?

Absolutely. It’s important to say that countries themselves have to put in more money. But we need the private sector and the community too. Africans should learn from other Africans, recognising other countries with the same problems. They should work together on issues such as procurement.

Can we talk about “African” health?

Yes — in sub-Saharan Africa. The indicators are the worst. Prevention and treatment are really below international levels: for child and maternal mortality, for access to family planning and so on. There is the unfinished agenda of tropical disease, plus modern diseases. A European who came to live in Africa would face the same problems as Africans: it’s linked to the environment, the economy and the social conditions.


Chartwatch

Synthetic opioids have become the star performers in China’s pharmaceutical market — the second largest in the world — as a rise in cancer drives demand for painkillers. The legacy of the 19th century opioid epidemic meant until recently that doctors were reluctant to prescribe the drugs because of their association with addiction. In the US, the epidemic is killing 91 people a day and costing companies $18bn a year. (FT)


News round-up

Antibiotic warning The WHO reported a serious lack of antibiotics to combat antimicrobial resistance. It identified 51 new products in development for priority pathogens but classified only eight as innovative treatments that would add value to the current range of drugs. (WHO)

Cholera crises More than 500 people have died in the outbreak that has hit 10 urban centres in Congo; a vaccination campaign is targeting northern Nigeria as the disease spreads in camps for those displaced by the conflict with Boko Haram militants; and in Yemen the number of infections passed 700,000. The WHO plans a global war on the disease. (Reuters, NYT)

World hunger A UN report says hunger is on the rise after declining for more than a decade and now affects 11 per cent of the global population. The number of undernourished has risen to 815m in 2016 from 777m in 2015. Western food companies are targeting developing nations, contributing to obesity and health problems. (United Nations, NYT)

Monitoring NCDs The World Health Organization said progress on non-communicable diseases was falling short of UN targets to cut premature NCD deaths by a third by 2030. The diseases — mainly cardiovascular and chronic respiratory problems, cancers and diabetes — are the world’s biggest killers. (WHO)

HIV drug deal A new pricing agreement backed by the Gates Foundation will make a generic HIV pill available to public sector buyers in poorer countries for around $75 per person per year. (Reuters, UNAids)

US healthcare battle The Republicans next week will make one final attempt to kill President Obama’s signature reforms. The ‘mean-spirited’ proposals include ending Medicaid expansion and insurance subsidies, as well as a massive cut in federal spending on health. Here’s a summary of winners and losers. (WSJ, Stat) 

US aid cuts bite Marie Stopes International, the family planning organisation, said it was closing or cutting back programmes in Madagascar and Zimbabwe after the Trump administration reinstated its policy of blocking federal funding for NGOs overseas that “perform or actively promote abortion”. (CBC)

Zika uncertainty Seth Berkley of Gavi, the Vaccine Alliance, said uncertainties around Zika were hampering the development of vaccines. He called for more research into its epidemiology and incentives to stimulate companies if the market failed to provide a vaccine. New maps show US mosquito hotspots. (Stat, Lancet, Cidrap)

App for addiction The US Food and Drug Administration has for the first time sanctioned an app for substance misuse. Reset provides a form of cognitive behavioural therapy to complement treatment from clinicians. (Pharmaceutical Journal)

Tobacco strategies Spurred by the FDA clampdown on nicotine, big tobacco is racing to offset shrinking cigarette sales with other products. A study suggests budget brands are associated with increased child deaths. UK public health campaigns are embracing ecigarettes for the first time as a better alternative to smoking. The WHO examines tobacco control measures across Europe. (FT, JAMA, BBC, WHO)

Decoding our genes China is racing the US to decode the genetic make-up of its citizens. Uncovering the causes of diseases such as cancer can lead to individually tailored medicines and massive reductions in public healthcare costs. (WSJ)

CFS debate Trials of Lightning Process therapy suggest it could be useful against chronic fatigue syndrome/myalgic encephalitis in children. Campaign groups disagree. Nice, the UK regulator, is revising its guidelines for treatment. Unrest, a new documentary, is gaining plaudits for highlighting the suffering of those affected. (Archives of Disease in Childhood, BBC, Nice, Unrest)

Death British-style A data-rich look at how death in Britain has changed over the past 100 years, from measles mortalities to war, traffic and dementia. (The Guardian)

Depression warning A UK government-funded study revealed one in four girls aged 14 was depressed with those from poorer families the most affected. Out of the Woods, a new book, tackles depression and anxiety in adults in the form of a beautifully illustrated graphic novel. (Centre for Longitudinal Studies, Out of the Woods)


Best from the journals

Fighting counterfeits Fake malaria drugs are hampering efforts to control the disease in Africa. Counterfeit or substandard drugs account for 10 per cent of the world’s pharmaceutical market but in Africa the proportion is about 30 per cent. (Lancet Infectious Diseases)

Disease in crisis zones Non-communicable diseases are the primary source of illness and death across the world but prevention is doubly difficult in crisis situations. Here are ten factors to guide humanitarian interventions. (Conflict and Health)

India child deaths India has avoided about 1m child deaths since 2005, but this could have been about 3m if national progress matched that of some states. There has been progress on pneumonia, diarrhoea and measles but increases in deaths of children born prematurely or with a low birth weight in rural and poorer areas. (Lancet)

Cutting cardiovascular risk A 17-nation study shows the benefits of physical activity in preventing cardiovascular disease in rich and poor countries alike. One in 12 deaths and one in 20 cases of CVD could be prevented with 150 minutes of activity a week. (Lancet)

US health inequality American adults are getting healthier but there are substantial differences when filtered by race, education and income. (JAMA)

Editing embryos UK scientists have for the first time used new genome editing technology to change the development of early stage embryos. The discovery proves DNA editing can pin down the previously elusive genetic processes involved. (Nature, FT).

Gender stereotypes Health risks that could lead to abuse and suicide need to be tackled before teenage years when gender stereotypes take hold, says the 15-country Global Adolescent Study. The 10-14 age group is the most significant period for physical, emotional, social and cognitive changes. (Journal of Adolescent Health)


Podcast of the week

A discussion of trends in the Lancet’s annual Global Burden of Disease with case studies from Ethiopia, Nepal and Peru. (Lancet audio, 29m) 


In case you missed it

Previous edition Boardroom commitment key to healthier workforce

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Final thought

Compared with what? A reminder of the power of the food industry and the way it can sometimes distort research, combining findings of studies that differ in important ways and yielding meaningless conclusions. (JAMA)

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