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The debate on how Britain's National Health Service should be financed shows no sign of letting up.
In theory at least, the expansion of health minister Jeremy Hunt’s role— albeit met with much scepticism — was one coherent moment in an otherwise shambolic government reshuffle this week. He now takes on the portfolio for social care as well as healthcare, a nod towards the need to link these functions in an ageing society, a problem faced by health services around the world. The number of people over 85 in the UK alone is set to rise by two-thirds between 2010 and 2030.
In practice, for all the talk of the NHS as world class during its 70th anniversary year, the resources available are falling behind health systems in many other countries, with spending increases below GDP growth and demand increasing. Better social care — without which hospital beds are blocked — is still more hampered by local authority funding cuts.
There is a fresh debate about the need for ringfenced taxes earmarked for health, while some argue the NHS — set up in 1948 with a firm focus on fighting infectious disease — needs fundamental change.
The FT argues, however, that while there is always a case for greater efficiency, the case for extra funding is “indisputable”.
Child mortality The US has more child deaths than other developed countries despite spending more per capita on their health. Cases have dropped everywhere since the 1960s but the US has lagged behind its peers since the 1980s. From 2000 to 2010, American children aged 15-19 were 82 times more likely to die from gun homicide than in other countries. Doctors in Chicago are taking lessons from Cuba's health system. (Health Affairs, Kaiser)
We spoke to Helen Clark, former New Zealand prime minister, ex-chair of the UN Development Group and a member of the Global Commission on Drug Policy, about its new report: The World Drug Perception Problem. Recommendations include shifts in language such as “people who use drugs” instead of “abusers” and “person with drug dependence” instead of “addict”.
What is the key message from the report and how does it differ from other efforts?
Previous reports have concentrated on decriminalisation and regulation. This report, however, directly addresses the perception issues of the “drug problem” and looks at the language we use about people who use drugs. A narrative has developed which makes it very difficult for policymakers to be brave enough to address the issue, based on the evidence of what works.
What is the World Health Organization position?
There can be a huge difference between what the specialised agencies and other organisations in the UN believe and work for, and what the member states’ attitudes might be. From the WHO we expect an evidence-based approach to health issues and I would expect the same from them on drug policy. Two of the commissioners — Ruth Dreifuss [chair and former president of Switzerland] and Michel Kazatchkine [former executive director of the Global Fund to Fight Aids, TB and Malaria] went to see Tedros Adhanom [the new WHO chief] very early in his tenure and got a very good reception.
What are you hoping to see at the big UN drugs meeting in 2019?
An opportunity to advocate for an evidence-based approach. There are so many prominent figures around the world now saying — loudly — that the “war on drugs” has failed. The 10-year action plan approved in 2009 will be examined at next year's meeting. Any credible independent evaluation will say that it has failed as a strategy. If you can get a clear focus on that failure, then you have a chance to move the debate on to what will work. If not, you carry on with the criminalisation, the incarceration and frankly, in the countries that do little else, a lot of people dying. My motivation is harm reduction: how can we stop people dying from the unsafe use of drugs?
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Health leadership Germany is becoming a leading voice in global health, as shown by its new international centre to fight antimicrobial resistance and by its influential annual World Health Summit. Its spending on development assistance for health is still far behind the US and the UK but has surpassed Japan, France and Canada. Bill Gates used a special edition of Time magazine to talk about health leadership, emphasising that philanthropy could only ever complement the role of government. (Science, Time)
Pollution peril The UN and WHO are combining forces to fight the environmental health risks that kill 12.6m people a year, focusing on air quality, climate, water quality and waste and chemicals. Regional authorities are issuing more pollution alerts, but unless backed up with action they have little effect. The Pulitzer Center brings together its pollution reporting in a new ebook. (UN, Lancet, Pulitzer Center)
Crash warning Road traffic injuries are the single largest cause of mortality and long-term disability among people aged 15-29, according to a new report. Cutting traffic deaths and injuries by half could add up to 22 per cent to GDP per capita over 24 years in select countries. (World Bank)
Flu worries The prospect of large influenza outbreaks aroused much excitement in the US and the UK on the 100th anniversary of the great pandemic of 1918. Many fear authorities would not be able to cope with such an outbreak: the US, for example, keeps in stock just a few days’ supply of life-saving drugs, almost all of which are made in Asia. (NYT, New Statesman)
Dementia drug blow The difficulty of finding drugs to treat Alzheimer's and Parkinson's diseases was underlined by Pfizer's withdrawal from research. One critic said the company seem to have “devoted more effort to financial engineering than biomedical engineering”. Another promising Alzheimer's drug — Lundbeck's idalopirdine — had a setback in trials but other companies remain optimistic. (Bloomberg, LA Times, Guardian)
China breakthrough Chi-Med — backed by Li Ka-shing, Hong Kong’s richest man — is on the brink of becoming the first Chinese company to get US approval for a new cancer drug. India, meanwhile, is set to blacklist several Chinese companies for supplying poor-quality materials to Indian drugmakers. (NYT, Healthworld)
Food safety The US Food and Drug Administration announced “the biggest overhaul in our nation's food safety laws in more than 70 years” while a top US trade official urged Britain to move away from strict EU food production rules: “To the degree that some of the sanitary and phytosanitary burdens are removed, or changed, there is much greater opportunity for trade between the UK and US.” (CNN, FT)
Action on addiction In a rare example of investors pressuring a company on public health issues, two groups are urging Apple to address concerns over smartphone addiction. They argue that mental health concerns could lead to a regulatory backlash and hit Apple's financial performance. (WSJ)
Ageing and bioethics The rapid advancement of research on ageing is outpacing ethical issues around prolonging life and the consequences for health, society and the economy. A new series of guidelines for researchers and policymakers aims to fill this gap. (Nuffield Council on Bioethics)
Future of IVF More radical treatments are on the horizon for cases of infertility in which sperm or eggs are absent or too low in quality for today’s IVF techniques to work. Growing a foetus from conception in a synthetic womb could soon become the stuff of real life rather than science fiction. (FT 50 Ideas to Change the World)
The sympathy market where sickness is on sale Online donation sites in the US are booming as patients with little or no health insurance turn to strangers to help pay medical costs in the only developed country without universal healthcare coverage. The US government said it would allow states to impose work requirements on beneficiaries of Medicaid, the health programme for the poor. (FT)
Best from the Journals
TB on political agenda The first ever UN high-level meeting on tuberculosis takes place this year. Progress in eliminating the world's top infectious disease killer has stalled, thanks to under-investment in R&D, ineffective prevention and a lack of political will. Poorer countries face high cost of treatment, social stigma and lack of care facilities. WHO chief Tedros Adhanom is facing criticism for choosing a little-known Russian official to run the WHO TB programme, using a fast-track process, shortly after meeting Vladimir Putin. (The Lancet, Politico)
The female advantage Women live longer than men even during severe famines and epidemics, suggesting that female advantage has a fundamental biological root. (PNAS)
The sensor in your gut Human trials have taken place of an ingestible electronic capsule that can sense oxygen, hydrogen and carbon dioxide in the gut. The capsules could offer insights into the effects of diet and medical supplements or act as monitoring tools to develop individualised diets. (Nature)
Social networks and health Awareness is growing that social networks can play a part in delivering healthcare. Chronic disease management and the promotion of healthy behaviour are the best examples. The Canadian government is testing AI-supported technology that can identify people at risk of suicide by their social media posts. (NEJM Catalyst, MobiHealthNews)
Comics can save lives Comics and cartoons have often been used for public health messaging — as shown in the Wellcome Collection's exhibition — but are now being used for teaching and to disseminate research. Lissa, a new graphic novel, explores the dilemmas faced by clinicians and patients experiencing illness and living in poor or conflict-torn communities. (The Lancet, University of Toronto press)
Podcast of the week
The story of slimming How a popular postwar magazine began the craze that helped create the diet culture that lasts to this day. (The Conversation, 17m)
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Language and health As we report above, the words referring to people who use drugs have a big impact on how they view themselves and how they are viewed by others. A separate row is raging in the US over the effects of “verbal hygiene” — changing language to suit socially conservative tastes — such as the use of “unborn child” instead of “foetus”. Are researchers over-reacting or are they correct to reject such approaches?