Search

Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods. Furthermore, as public health researchers, we often discuss the CDOH using sweeping terms such as private sector, industry, or business that lump together diverse entities whose only shared characteristic is their engagement in commerce. The absence of clear frameworks for differentiating among commercial entities, and for understanding how they might promote or harm health, hinders the governance of commercial interests in public health. Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them. In this paper, which is the second of three papers in a Series on commercial determinants of health, we develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency. The framework that we develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes. We discuss possible applications for decision making about engagement; managing and mitigating conflicts of interest; investment and divestment; monitoring; and further research on the CDOH. Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition. [ABSTRACT FROM AUTHOR]

The article reports on the call for papers about the state of medical care and health in China, which will be featured in the weekly issue dedicated to health care and research in China that will start in October 2016.

Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Clinical and preclinical studies have shown that there are sex-based differences at the genetic, cellular, biochemical, and physiological levels. Despite this, numerous studies have shown poor levels of inclusion of female populations into medical research. These disparities in sex inclusion in research are further complicated by the absence of sufficient reporting and analysis by sex of study populations. Disparities in the inclusion of the sexes in medical research substantially reduce the utility of the results of such research for the entire population. The absence of sex-related reporting are problematical for the translation of research from the preclinical to clinical and applied health settings. Large-scale studies are needed to identify the extent of sex-related reporting and where disparities are more prevalent. In addition, while several studies have shown the dearth of female researchers in science, few have evaluated whether a scarcity of women in science might be related to disparities in sex inclusion and reporting. We aimed to do a cross-disciplinary analysis of the degree of sex-related reporting across the health sciences-from biomedical, to clinical, and public health research-and the role of author gender in sex-related reporting.Methods: This bibliometric analysis analysed sex-related reporting in medical research examining more than 11·5 million papers indexed in Web of Science and PubMed between 1980 and 2016 and using sex-related Medical Subject Headings as a proxy for sex reporting. For papers that were published between 2008 and 2016 and could be matched with PubMed, we assigned a gender to first and last authors on the basis of their names, according to our gender assignment algorithm. We removed papers for which we could not determine the gender of either the first or last author. We grouped papers into three disciplinary categories (biomedical research, clinical medicine, and public health). We used descriptive statistics and regression analyses (controlling for the number of authors and representation of women in specific diseases, countries, continents, year, and specialty areas) to study associations between the gender of the authors and sex-related reporting.Findings: Between Jan 1, 1980, and Dec 31, 2016, sex-related reporting increased from 59% to 67% in clinical medicine and from 36% to 69% in public health research. But for biomedical research, sex remains largely under-reported (31% in 2016). Papers with female first and last authors had an increased probability of reporting sex, with an odds ratio of 1·26 (95% CI 1·24 to 1·27), and sex-related reporting was associated with publications in journals with low journal impact factors. For publications in 2016, sex-related reporting of both male and female is associated with a reduction of -0·51 (95% CI -0·54 to -0·47) in journal impact factors.Interpretation: Gender disparities in the scientific workforce and scarcity of policies on sex-related reporting at the journal and institutional level could inhibit effective research translation from bench to clinical studies. Diversification in the scientific workforce and in the research populations-from cell lines, to rodents, to humans-is essential to produce the most rigorous and effective medical research.Funding: Canada Research Chairs. [ABSTRACT FROM AUTHOR]

Implementation research is important in global health because it addresses the challenges of the know-do gap in real-world settings and the practicalities of achieving national and global health goals. Implementation research is an integrated concept that links research and practice to accelerate the development and delivery of public health approaches. Implementation research involves the creation and application of knowledge to improve the implementation of health policies, programmes, and practices. This type of research uses multiple disciplines and methods and emphasises partnerships between community members, implementers, researchers, and policy makers. Implementation research focuses on practical approaches to improve implementation and to enhance equity, efficiency, scale-up, and sustainability, and ultimately to improve people's health. There is growing interest in the principles of implementation research and a range of perspectives on its purposes and appropriate methods. However, limited efforts have been made to systematically document and review learning from the practice of implementation research across different countries and technical areas. Drawing on an expert review process, this Health Policy paper presents purposively selected case studies to illustrate the essential characteristics of implementation research and its application in low-income and middle-income countries. The case studies are organised into four categories related to the purposes of using implementation research, including improving people's health, informing policy design and implementation, strengthening health service delivery, and empowering communities and beneficiaries. Each of the case studies addresses implementation problems, involves partnerships to co-create solutions, uses tacit knowledge and research, and is based on a shared commitment towards improving health outcomes. The case studies reveal the complex adaptive nature of health systems, emphasise the importance of understanding context, and highlight the role of multidisciplinary, rigorous, and adaptive processes that allow for course correction to ensure interventions have an impact. This Health Policy paper is part of a call to action to increase the use of implementation research in global health, build the field of implementation research inclusive of research utilisation efforts, and accelerate efforts to bridge the gap between research, policy, and practice to improve health outcomes. [ABSTRACT FROM AUTHOR]

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. The paper also quantifies the availability of a minimal essential set of information in large armed conflict and natural disaster crises since 2010: we show that information was available and timely only in a small minority of cases. On the basis of this observation, we propose an agenda for methodological research and steps required to improve on the current use of available methods. This proposition includes setting up a dedicated interagency service for public health information and epidemiology in crises. [ABSTRACT FROM AUTHOR]

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable. [ABSTRACT FROM AUTHOR]

Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future. [ABSTRACT FROM AUTHOR]

The authors discuss the results of the paper of the year 2008 award presented by the journal. They believe the choices show that the medical community values well-designed studies which have the ability to change practice and benefit large populations. They explain that the choices show that public health and global health matter. They comment on the contributions to understanding treatment of common health problems.

The preceding papers in this Series have outlined how underuse and overuse of health-care services occur within a complex system of health-care production, with a multiplicity of causes. Because poor care is ubiquitous and has considerable consequences for the health and wellbeing of billions of people around the world, remedying this problem is a morally and politically urgent task. Universal health coverage is a key step towards achieving the right care. Therefore, full consideration of potential levers of change must include an upstream perspective-ie, an understanding of the system-level factors that drive overuse and underuse, as well as the various incentives at work during a clinical encounter. One example of a system-level factor is the allocation of resources (eg, hospital beds and clinicians) to meet the needs of a local population to minimise underuse or overuse. Another example is priority setting using tools such as health technology assessment to guide the optimum diffusion of safe, effective, and cost-effective health-care services. In this Series paper we investigate a range of levers for eliminating medical underuse and overuse. Some levers could operate effectively (and be politically viable) across many different health and political systems (eg, increase patient activation with decision support) whereas other levers must be tailored to local contexts (eg, basing coverage decisions on a particular cost-effectiveness ratio). Ideally, policies must move beyond the purely incremental; that is, policies that merely tinker at the policy edges after underuse or overuse arises. In this regard, efforts to increase public awareness, mobilisation, and empowerment hold promise as universal methods to reset all other contexts and thereby enhance all other efforts to promote the right care. [ABSTRACT FROM AUTHOR]

The article reviews the the journal "The Lancet Planetary Health."

Public security and law enforcement have a crucial but often largely unacknowledged role in protecting and promoting public health. Although the security sector is a key partner in many specific public health programmes, its identity as an important part of the public health endeavour is rarely recognised. This absence of recognition has resulted in a generally inadequate approach to research and investigation of ways in which law enforcement, especially police at both operational and strategic levels, can be effectively engaged to actively promote and protect public health as part of a broader multisectoral public health effort. However, the challenge remains to engage police to consider their role as one that serves a public health function. The challenge consists of overcoming the continuous and competitive demand for police to do so-called policing, rather than serve a broader public health function-often derogatively referred to as social work. This Series paper explores the intersect between law enforcement and public health at the global and local levels and argues that public health is an integral aspect of public safety and security. Recognition of this role of public health is the first step towards encouraging a joined-up approach to dealing with entrenched social, security, and health issues. [ABSTRACT FROM AUTHOR]

Many countries show a growing willingness to use militaries in support of global health efforts. This Series paper summarises the varied roles, responsibilities, and approaches of militaries in global health, drawing on examples and case studies across peacetime, conflict, and disaster response environments. Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines-both within and outside militaries-for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health. [ABSTRACT FROM AUTHOR]

Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease.Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre.Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75-0·94; ptrend=0·0004), total mortality (0·83, 0·72-0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72-1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58-1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67-0·90; ptrend=0·0001), and stroke (0·66, 0·53-0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71-1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82-0·99; ptrend=0·0529) and yogurt (0·86, 0·75-0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76-1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90-1·33; ptrend=0·4113).Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort.Funding: Full funding sources are listed at the end of the paper (see Acknowledgments). [ABSTRACT FROM AUTHOR]

The article comments on British Secretary of State for Health Andrew Lansley's White Paper "Healthy Lives, Healthy People: Our Strategy for Public Health in England." It points out the failure of Lansley to support the paper's list of promises with credible policies. Particular focus is given to the British government's new approach to public health, along with the Public Health Responsibility Deal. It contends that the funds pledged to public health will not be enough to deal with the diverse problems facing the sector.

Comments on a series of three papers starting in "The Lancet" that will explore the gap between research and clinical practice. The topic of quality of care in a study by Richard Grol and Jeremy Grimshaw; The concept of evidence-based primary care medicine in the second paper; The study of problems in health-care policy in the third paper by Maynard.

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings. [ABSTRACT FROM AUTHOR]

Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research. [ABSTRACT FROM AUTHOR]

In this Series paper, we examine how mass incarceration shapes inequality in health. The USA is the world leader in incarceration, which disproportionately affects black populations. Nearly one in three black men will ever be imprisoned, and nearly half of black women currently have a family member or extended family member who is in prison. However, until recently the public health implications of mass incarceration were unclear. Most research in this area has focused on the health of current and former inmates, with findings suggesting that incarceration could produce some short-term improvements in physical health during imprisonment but has profoundly harmful effects on physical and mental health after release. The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs. [ABSTRACT FROM AUTHOR]

This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up. [ABSTRACT FROM AUTHOR]

Background: Road traffic impacts human health through air pollution and road safety issues. Low emission zones (LEZs) and congestion charging zones (CCZs) have therefore been implemented in several cities globally. We systematically reviewed the evidence on the effects of these pollution or congestion reduction schemes on specific physical health outcomes associated with air pollution or traffic exposure.Methods: We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and TRID databases from database inception to Feb 22, 2022, using search terms such as "low emission/congestion charge/zone" and "cardiovascular/respiratory/injury". Searches were limited to English-language records. We included studies that evaluated the effect of a LEZ or CCZ on air pollution-related outcomes (ie, cardiovascular disease, respiratory disease, birth outcomes, dementia, lung cancer, diabetes) or road traffic injuries, using longitudinal study designs. We excluded studies without empirical health data. Two authors independently assessed papers for inclusion. Results were narratively synthesised and summarised using harvest plots. Risk of bias was assessed using the Graphic Appraisal Tool for Epidemiological studies for correlation studies. This systematic review was registered with PROSPERO, number CRD42022311453.Findings: Of 2068 post-deduplication records screened, fifteen studies were included, with two further studies included from references of eligible studies. Nine (53%) of 17 studies assessed LEZs in London, Milan, Tokyo, and several German cities, seven (41%) assessed the London CCZ, and one (6%) assessed the Stockholm CCZ. Each predefined health outcome was considered by at least one study. Six (75%) of eight LEZ studies considering pollution-related outcomes identified reductions in at least one outcome, with all five on cardiovascular disease identifying reductions for at least one disease subcategory. Of seven London CCZ studies, six (86%) reported clear reductions in total or car injuries, although one (14%) reported increases for cyclist or motorcyclist injuries and one (14%) for serious or fatal injuries.Interpretation: Although inter-study heterogeneity exists, current evidence suggests that LEZs reduce some air pollution-related health outcomes. CCZ evidence is mainly limited to London but suggests that they reduce overall road traffic injuries.Funding: National Institute for Health and Care Research (NIHR) School for Public Health Research, NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, MRC Centre for Environment and Health. [ABSTRACT FROM AUTHOR]

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs. [ABSTRACT FROM AUTHOR]

Background: The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.Methods: Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality.Findings: Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.Interpretation: In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases.Funding: None. [ABSTRACT FROM AUTHOR]

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor. [ABSTRACT FROM AUTHOR]

National science and medical academies across the world serve a range of roles and functions. In particular, the benefits of an independent academy tasked with the provision of formal advice are compelling. For nearly half a century, the Institute of Medicine (IOM) has served the USA and the world by providing independent, authoritative advice on issues related to health and medicine. Its influence reaches deep into the health and policy worlds. This paper provides insight into the principles, processes, and governance that confer unique credibility to IOM advice. The IOM can serve as a useful model for other academies to consider for strengthening their work or when other countries contemplate the creation of a new academy. [ABSTRACT FROM AUTHOR]

The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved. [ABSTRACT FROM AUTHOR]

Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues--infectious diseases and chemical, radiation, and environmental hazards--that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events. [ABSTRACT FROM AUTHOR]

The first in a series of papers on health in the occupied Palestinian territory is presented. The demographic characteristics, health status, and health services of the Palestinian population living in Israeli-occupied Palestinian territory are described. The public-health and health-service response to health problems is examined. Health status is described using subjective measures in addition to conventional indicators. The relevance of the indicators and analytical framework for the assessment of health in populations living in continuous war conditions is also discussed. INSET: Panel: A brief history of the occupied Palestinian territory.

The article presents the final paper in a series on the links between international trade, trade liberalization, globalization, and health. The article outlines three major issues relating to establishing evidence of the implications of linkages between trade and health, building capacity for analysis of these links and ensuring that the health community has a voice in trade negotiations and decisions. An agenda for action by various health organizations such as the World Health Organization, the World Trade Organization, the World Bank and International Monetary Fund, among others, is also outlined.

The Indonesia National Task Force for the Acceleration of COVID-19 Mitigation has developed an integrated monitoring system to measure community compliance with the health protocol Bersatu Lawan COVID-19. The current study aims to evaluate compliance with the health protocol in Indonesia through the Bersatu Lawan COVID-19 digital mobile application. Data was collected from the National Task Force between Oct 1, 2020, and May 2, 2021. A total of 437 093 front-line public order forces (eg, police and the military) and Behavioural Change Ambassadors reported real-time community compliance on mask wearing and physical distance keeping at public places such as markets, malls, schools, offices, and worship places. Individuals who did not comply were reprimanded and educated. As of May 2, 2021, more than 165 million reports were gathered, with 469 million people were monitored in 514 districts or cities across 34 provinces in Indonesia. The overall national figures show a compliance of 322 736 010 (85·9%) of 375 711 304 people in mask wearing, and of 315 973 207 (84·1%) of 375 711 304 people in keeping physical distance, as a cumulative estimate. The results showed the variation of compliance rates among districts and cities in provinces. An analysis of data gathered in the week of April 26 to May 2, 2021, showed that mask wearing compliance was low (defined as observed by less than 75% of people) in 103 (29·6%) of 348 districts and cities across Indonesia, and that physical distance compliance was low in 99 (28·4%) of 348 districts and cities. The temporal pattern analysis estimated that compliance decreased in November and December, 2020 (before the peak of the second wave of the pandemic), and that it increased between January and May, 2021 (during and after the second wave). 321 million people were reprimanded and educated on the importance of adherence to the health protocol. This paper discusses an example of the use of the Bersatu Lawan COVID-19 application in Indonesia, the most populous country in southeast Asia. We report the first time that an application for digital health, introduced nationally, produced data that could be analysed on a real-time basis, thus enabling central and local government to strengthen enforcement of the health protocol to stop the potential transmission of COVID-19 in public places. No funding to declare. [ABSTRACT FROM AUTHOR]

To this end, we are producing a series of academic papers to centre the complex challenges of racism and xenophobia in the health discourse. Https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020 May 7, 2020, 3 BBC Rio violence: Police killings reach record high in 2019. https://www.bbc.com/news/world-latin-america-51220364 Jan 23, 2020, 4 JK Stockman, H Hayashi, JC Campbell, Intimate partner violence and its health impact on ethnic minority women [corrected]. Http://theconversation.com/anti-asian-racism-during-coronavirus-how-the-language-of-disease-produces-hate-and-violence-134496 March 31, 2020, 7 United Nations COVID-19: UN counters pandemic-related hate and xenophobia. [Extracted from the article]

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system marred by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances. [ABSTRACT FROM AUTHOR]

Summary Background Valid information about cause-specific child mortality and morbidity is an essential foundation for national and international health policy. We undertook a systematic review to investigate the geographical dispersion of and time trends in publication for policy-relevant information about children's health and to assess associations between the availability of reliable data and poverty. Methods We identified data available on Jan 1, 2001, and published since 1980, for the major causes of morbidity and mortality in young children. Studies with relevant data were assessed against a set of inclusion criteria to identify those likely to provide unbiased estimates of the burden of childhood disease in the community. Findings Only 308 information units from more than 17 000 papers identified were regarded as possible unbiased sources for estimates of childhood disease burden. The geographical distribution of these information units revealed a pattern of small well-researched populations surrounded by large areas with little available information. No reliable population-based data were identified from many of the world's poorest countries, which account for about a third of all deaths of children worldwide. The number of new studies diminished over the last 10 years investigated. Interpretation The number of population-based studies yielding estimates of burden of childhood disease from less developed countries was low. The decreasing trend over time suggests reductions in research investment in this sphere. Data are especially sparse from the world's least developed countries with the highest child mortality. Guidelines are needed for the conduct of burden-of-disease studies together with an international research policy that gives increased emphasis to global equity and coverage so that knowledge can be generated from all regions of the world. [ABSTRACT FROM AUTHOR]

Public nutrition is a broad-based, problem-solving approach to addressing malnutrition in complex emergencies that combines analysis of nutritional risk and vulnerability with action-oriented strategies, including policies, programmes, and capacity development. This paper focuses on six broad areas: nutritional assessment, distribution of a general food ration, prevention and treatment of moderate malnutrition, treatment of severe malnutrition in children and adults, prevention and treatment of micronutrient deficiency diseases, and nutritional support for at-risk groups, including infants, pregnant and lactating women, elderly people, and people living with HIV. Learning and documenting good practice from previous emergencies, the promotion of good practice in current emergencies, and adherence to international standards and guidelines have contributed to establishing the field of public nutrition. However, many practical challenges reduce the effectiveness of nutritional interventions in complex emergencies, and important research and programmatic questions remain. [ABSTRACT FROM AUTHOR]

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Exploration of moral values as they impact public health policies; Use of ethics and moral values to mobilise support for global health initiatives; Presentation of four schools of moral thought used to justify health programmes; Humanitarianism, utilitarianism, equity and rights; Definition of each school of morality; Influence that the selection of information has on ethical assessments of programmes; Different ways that moral values can support global health initiatives.

Health care providers, hospital administrators, and politicians face competing challenges to reduce clinical errors, control expenditure, increase access and throughput, and improve quality of care. The safe management of the acutely ill inpatient presents particular difficulties. In the first of five Lancet articles on this topic we discuss patients' safety in the acute hospital. We also present a framework in which responsibility for improvement and better integration of care can be considered at the level of patient, local environment, hospital, and health care system; and the other four papers in the series will examine in greater detail methods for measuring, monitoring, and improving inpatient safety. [ABSTRACT FROM AUTHOR]

This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them. [ABSTRACT FROM AUTHOR]

Summary: Background: HIV-1 prevalence typically rises more rapidly at young ages in women than in men in sub-Saharan Africa. Greater susceptibility to infection on exposure in women is believed to be a contributory factor as is greater exposure to previously infected sexual partners of the opposite sex. We investigated the latter hypothesis using data from a field study in rural Manicaland, Zimbabwe. Methods: Quantitative data on onset and degree of sexual activity, numbers of partners, concurrent partnerships, condom use, and partner characteristics were used in conjunction with epidemiological data on age and sex specific prevalence of HIV infection to do statistical analyses of association between key variables. Mathematical models and qualitative data were used to aid analysis and interpretation. Findings: Older age of sexual partner was associated with increased risk of HIV-1 infection in men (odds ratio 1.13 [95% CI 1.02-1.25]) and women (1.04 [1.01-1.07]). Young women form partnerships with men 5-10 years older than themselves, whereas young men have relationships with women of a similar age or slightly younger. Greater number of lifetime partners is also associated with increased risk of HIV (1.03 [1.00-1.05]). Young men report more partners than do women but infrequent coital acts and greater use of condoms. These behaviour patterns are underpinned by cultural factors including the expectation that women should marry earlier than men. A strong gender effect remains after factors that affect exposure to infected partners are controlled for (6.04 [1.49-24.47]). Interpretation: The substantial age difference between female and male sexual partners in Manicaland is the major behavioural determinant of the more rapid rise in HIV prevalence in young women than in men. Theoretical studies have suggested that this difference is an important determinant of observed epidemiological patterns but the study reported in this paper provides clear empirical evidence... [ABSTRACT FROM AUTHOR]

Interviews Nkosazana Zuma, South African minister of health. The controversy which surrounds her, especially regarding her method of implementation and lack of planning and costing; Her medical training at Bristol University in the United Kingdom; Her background with the African National Congress (ANC). INSETS: White Paper for the transformation of the health system in...;Recent legislation;The HIV/AIDS epidemic and Virodene.

The article comments on the paper "Tuberculosis prevalence in China, 1990-2010: a longitudinal analysis of national survey data" by L. Wang and colleagues. Topics discussed include the contribution of China to the tuberculosis pandemic, the feasibility of tuberculosis prevalence surveys in China in the largest countries, and the effectiveness of the World Health Organization (WHO)-recommended tuberculosis control strategy in China.

The authors contend that the proposed changes by the British government to the National Health Service (NHS) can further damage the service. They examine some of the reforms suggested as stated in the White Paper "Equity and Excellence: Liberating the NHS," including simplifying and de-layering the number of NHS organisations which indicates replacing primary care trusts (PCT) and strategic health authorities. They also assert that the proposals are steps toward privatisation that risk undermining the equity and efficiency objectives of the NHS.

Analyzes public health policy in Great Britain as of January 29, 2005. Contents of the White Paper on public health entitled "Choosing health: making healthy choices easier," from the Department of Health for England; Importance of developing a philosophical basis for public health policy; Discussion of balancing the influence of government and individual responsibility for public health; Focus of British public health policy on the provision of information to inspire changes in unhealthy behaviors; Critique of the research process by which public health policy effectiveness is tested.

Presents a commentary on the lessons of MMR and a partial retraction of an interpretation from a paper published in February 1998 by Andrew Wakefield and colleagues; Wakefield on one other co-author who have not signed the retraction statement as yet; Original report in which the authors did not prove an association between measles, mumps and rubella vaccine and a newly described syndrome of bowel disease and autism; Suggestion by Wakefield that the MMR vaccine should be split into its component parts which triggered a collapse in confidence in the MMR vaccination programme; Autism research from Leo Kanner which helped prompt the UK Government into funding new research; Expectation of some results of that research this spring; Questions on the research of Wakefield and colleagues and a call for the government to step in; Lack of valid safety data on the vaccine; Need for public-health officials to answer questions from the public; Thoughts on the publishing of controversial new ideas.

Raises the question of whether disease prevention initiatives in the United Kingdom are effective. Role of the National Health Service (NHS) and the Health Development Agency; Hindrances, including conflicts of interest between medicine and public health; Implementation of the White Paper 'Our Healthier Nation,' which seems to have lost impetus; Complexity in the process of promoting healthy lifestyle choices; Relation between evidence and public-health policy; Recommendations to improve prevention efforts.

The article offers brief profile of Qimin Zhan, president of Peking University Health Science Centre (PUHSC). Topics discussed include his role in driving medical research for better health in China, launch of Healthy China 2030, which includes a national programme to develop several world-class universities, and his involvement as co-author of a seminal paper about the tumour suppressor p53 and its role in cell cycle control.

The article comments on the proposed Sustainable Development Goals (SDG) for the post-2015 period. Topics discussed include a paper by Ole Norheim and colleagues which proposes to avoid 40% of premature deaths in each country, the factors to be considered in deliberations on the SDG health goal and targets, and a partnership that has been established to accelerate the achievement of MDGs pertaining to maternal, neonatal, and child health.

The article introduces papers on evolutionary public health within the issue on topics including use of evolutionary theory to design public health interventions; evolutionary perspective of human reproduction; and interaction of human behaviour and microbes to shape physiology and metabolism.

The article highlights the author's views on the funding issues surrounding the proposed National Care Service (NCS) in Great Britain. It offers information on the plan for NCS, based on the Green Paper issued by Health Secretary Andy Burnham on July 14, 2009. It cites the recommendations penned by Burnham in the Green Paper for the financial support for NCS. The author reflects on the issue of funding NCS through taxation, like the National Health Service (NHS).

The authors express their opinion that the best way to eliminate inequalities in coronary disease is to eliminate coronary disease. They refer to a paper by Kika Kivimäki and colleagues which examines best-practice interventions for smoking, cholesterol, blood pressure, and diabetes. They explain how Kivimäki's study shows that addressing the risk factors for coronary disease could eliminate absolute inequalities.

The article reports that the government in Great Britain is sending mixed signals about its commitment to reducing obesity and improving public health. The position "minister for fitness" was created and is being filled by public health minister Caroline Flint. Local government is finding its own health initiatives left without funding due to budget cutbacks imposed by Parliament. Many local health authorities are finding themselves in the same situation as Hillingdon primary care trust. Creating an obesity plan under the auspices of the Choosing Health white paper, Hillingdon apportioned £767,000 in funding. Now they are being pressed for money and have had to abandon their plans. Obesity-related costs amount to £6.6 million in the area served by Hililngdon.