Global Health Series

The relationship between academe and industry is explored in this collection of papers. Important questions are raised about biotechnology and research, biotechnology and new companies arising from academia, and industry-sponsored clinical research.

A three-part Series assesses the global public-health toll and policy implications of drug addiction. The first paper summarises data for the prevalence and consequences of problem use of amphetamines, cannabis, cocaine, and opioids. In high-income countries, illicit drug use contributes less to the burden of disease than tobacco, but a substantial proportion of that burden is due to alcohol. Intelligent policy responses to drug problems need better prevalence data for different types of illicit drug use and the harms that their use causes globally. This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas. The second paper reviews existing drug policies and highlights the need for greater reliance on scientific evidence-based policy making. The final paper examines the value of international drug conventions in protecting public health.

Many young people today are living with HIV/AIDS or depression—the leading causes of disease burden for adolescents worldwide. However, hazardous alcohol use now accounts for 86% of the 8·6 million substance related deaths of 15–29–year-olds globally. The Lancet Series on Adolescent Health brings together experts from the Institute of Child Health, London, UK, Kings College London, UK, and the Royal Childrens Hospital, Melbourne, Australia, to highlight the gaps in health services to adolescents and to draw up an action plan for improved health services for this population worldwide.

In 2007, The Lancet published its first adolescent health series, which highlighted particular areas of attention, such as sexual and reproductive health, mental health, and substance misuse. Today's 1.8 billion adolescents are more exposed to harmful alcohol consumption, sexually transmitted diseases, and other risks than in the past, and face other new challenges such as social media. The Lancet's second Series on Adolescent Health, launched to coincide with the 45th Session of the United Nations Commission on Population and Development, argues that it is now time to put the young person, not the specific issue, centre stage. Four papers analyse the role of adolescence as a foundation for future health, the social determinants of adolescent health, the potential of the worldwide application of prevention science, and the current availability of data on 25 suggested core indicators in all countries.

The 2016 Lancet Early Childhood Development Series highlights early childhood development at a time when it has been universally endorsed in the 2030 Sustainable Development Goals. This Series considers new scientific evidence for interventions, building on the findings and recommendations of previous Lancet Series on child development (2007, 2011), and proposes pathways for implementation of early childhood development at scale. The Series emphasises 'nurturing care', especially of children below three years of age, and multi-sectoral interventions starting with health, which can have wide reach to families and young children through health and nutrition.

As the burden of cancer continues to increase, a major concern in high-income countries is how to sustain affordable health care to cope with these rising patient numbers and with the increasing costs of service provision. In September, 2011, The Lancet Oncology published a Commission outlining the challenges of delivering affordable cancer care in high-income countries. Here, we re-visit the topic 3 years on, and ask what, if any, progress has been made. This Series of three papers identifies the key drivers of health-care cost in high-income countries, offers debate and recommendation for their reduction, and pragmatically discusses what changes can be implemented across health-care systems in order to deliver affordable, efficient cancer care in the years of increased burden to come.

Sub-Saharan Africa faces a major public-health challenge from non-communicable diseases. Although infectious diseases continue to afflict Africa, the proportion of the overall disease burden in sub-Saharan Africa attributable to cancer is rising, and the region is predicted to have a greater than 85% increase in cancer burden by 2030. This Series of seven papers focuses on cancer control in Africa, outlining the current situation, detailing barriers to care, and presenting ideas to advance cancer care and control in the region.

This Series on Ageing highlights a neglected area in the health sector and in social and economic-policy development. The six papers address issues related to mortality, morbidity and disability, wellbeing, and potential health-system responses. The Series provides a much-needed synthesis of the evidence, and suggests possible strategies to address the health and wellbeing of older adults. Scope for improving health of older adults is underlined in the Series papers by Martin Prince and Somnath Chatterji and their respective colleagues. Interventions that are targeted towards older people, including health promotion, disease prevention, and the entire range of care provision, from primary to palliative care, hold the promise of keeping older adults in good health for longer.

The adverse effects of alcohol consumption on population health are underestimated; a three-part Series, under the guidance of Robert Beaglehole, emeritus professor at the University of Auckland, highlights how one in 25 deaths worldwide are attributable to alcohol, and calls for a global framework convention to reduce alcohol harm similar to the global convention on tobacco control.

30 years on, what is the relevance of the Alma-Ata Declaration in 2008? In short, primary health care is now offering global health a lifeline. Progress towards the Millenium Development Goals (MDGs) has stalled. Weak health systems have restricted the success of efforts to improve maternal, newborn, and child health, and to reduce the disease burden from malaria and tuberculosis. New epidemics of chronic disease threaten to reverse what small gains have been achieved. To get back on track, and to meet the MDGs by 2015, countries need to strengthen their health systems through the implementation of effective primary health care.

The Lancet publishes a new Series about US health and health care, which highlights how widening gaps of income inequality are driving increases in health inequity. Other contributory factors, including mass incarceration and structural racism, are evaluated, as is the impact of the Affordable Care Act. The Series warns of a 21st century health-poverty trap unless new interventions are implemented.

This Series examines the access and sustainable effectiveness of antimicrobials. The first two papers provide an insight into the mechanisms and drivers of antimicrobial resistance, its disease burden, and the potential effect of vaccines in restricting the need for antibiotics. The last three papers in the Series examine access and sustainability of antimicrobials at a more geographical level: reviewing access in low-income and middle-income countries; considering different policy domains and their effectiveness at national and regional levels to combat resistance; and identifying gaps in the current global effort to improve international collaboration and achieve key policy goals.

In the past few decades, the Arab region as a whole has made significant strides forward in health development and in improving the overall health and life expectancy of populations. However, the region also faces tremendous health challenges. A new Lancet Series focuses on priority health issues in the Arab world, based on evidence interpreted mainly by scholars from the region, and adopts a multidisciplinary approach that includes medical, public health, social, and political perspectives.

Bacterial meningitis is a devastating disease that is associated with substantial mortality and morbidity. Major causative bacteria are Streptococcus pneumoniae and Neisseria meningitis, with case-fatality rates of 30% and 7% in higher-income countries. In resource-poor settings, fatality rates can be as high as 50%. Neurological sequelae, including hearing loss, developmental disorders, and neuropsychological impairment are reported to occur in up to half of survivors of bacterial meningitis. Although routine vaccination against the three most common causative bacteria had considerable impact on the occurrence of bacterial meningitis, there are an estimated 1·2 million cases each year worldwide resulting in 180,000 deaths among children aged 1–59 months in 2010.

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. Improvements in the survival of infants and children under 5 years of age, life expectancy, immunisation coverage, and tuberculosis control in Bangladesh are part of a remarkable success story for health in the South Asian country. This is despite low spending on health care, a weak health system, and widespread poverty. But the nation still faces considerable problems, including deep poverty and malnutrition, and this is being exacerbated by an evolving set of 21st-century challenges. The six-part Series takes a comprehensive look at one of the "great mysteries of global health", investigating a story not only of "unusual success" but also the challenges that lie ahead as Bangladesh moves towards universal health coverage.

Brazil has made significant improvements in maternal and child health, emergency care, and in reducing the burden of infectious diseases. But the news is not all good. The country continues to have a burden of injury mortality that is different from other countries due to the large number of murders, especially using firearms. Obesity levels are increasing and caesarean section rates are the highest in the world.

With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe. The two papers in this Series will describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.

Is bullying part of a 'normal' childhood? Or is it a damaging behaviour that health professionals can and should try to prevent? This Series looks at the nature and mental health consequences of bullying, and highlights ways in which clinicians and researchers might address the problem.

The Lancet’s Series on Canada, the first-ever for the journal, examines the country’s system of universal health coverage and its global role in health, including Canada’s legacy, challenges, and future path on issues such as access to health care, gender equality, global health diplomacy, and Indigenous peoples’ health. Led by authors from across the country’s diverse ethnocultural, linguistic, and geographic landscape, the Series sets the stage for accelerated Canadian leadership on health at home and abroad, as Canada marks 150 years since confederation and assumes the G7 presidency for 2018. Commentaries by leaders in Indigenous health and foreign aid assistance, and by Prime Minister Justin Trudeau and Minister Jane Philpott, show Canada to be poised for more action, more financial investment, and bolder leadership on health for the world.

In this five-part Series on cancer control in small island nations in The Lancet Oncology, the Series authors highlight the current state of cancer control in the Pacific and Caribbean islands. These island nations all face similar challenges of a growing cancer burden, inadequate cancer surveillance, geographically isolated small populations, vulnerable ecological and economic situations, insufficient resources, poor access to screening and treatment, and overburdened health-care systems. The authors discuss the specific challenges relevant to each of these regions, and provide several examples of promising innovative strategies to improve all aspects of the cancer care continuum that are emerging in some areas. The Series papers emphasise the crucial role of collaborative approaches—including through funding and investment opportunities with more developed countries—to create comprehensive cancer control programmes to improve cancer planning, prevention, and treatment in these under-resourced small island nations.

In this five-part Series on cancer disparities in indigenous populations in Polynesia, Australia, North America, and Africa in The Lancet Oncology, the Series authors highlight the scarcity of cancer burden data for Indigenous peoples and the unique genetic, environmental, and lifestyle factors that influence this burden. Gabi U Dachs and colleagues and Joan Cunningham and colleagues report risk factors that differ between ethnicities and disparities in measures of health in Australia, New Zealand, Hawaii, and other Pacific islands. Jeppe T Friborg and colleagues summarise the current knowledge on cancer epidemiology in Inuit populations. D Max Parkin and colleagues highlight areas where better surveillance and monitoring are needed to improve cancer control in Africa and Freddy Sitas and colleagues assess cancer risk factors and their importance in Africa.

The Cancer in Peru Series is a detailed examination of the cancer burden and control measures taken in Peru.

This Series of five papers in The Lancet Oncology explores cancer survivorship programmes in US healthcare systems.

Reductions in child mortality in high-income settings have been substantial over recent decades, although variations remain between and within countries. A three-part Series outlines the epidemiology of child mortality and a standardised approach to child death reviews in high-income countries. The Series authors delineate patterns of child mortality at different ages into five broad categories (perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths), and describe contributory factors across four broad domains—biological and psychological factors, the physical environment, the social environment, and service delivery. In a Comment, the conclusions of these three reports are reviewed, and practical recommendations on strategies are proposed in three key areas: perinatal causes, notably preterm birth; acquired natural causes, such as sepsis or acute respiratory problems; and external causes, including road traffic fatalities.

Few topics are more emotive than child maltreatment. "Children, the most precious and vulnerable members of our societies, deserve closer attention to their care and education and better protection against abuse", states a Comment introducing the Series.

More than 10 million children die each year, most from preventable causes and almost all in poor countries. Six countries account for 50% of worldwide deaths in children younger than 5 years, and 42 countries for 90%. The causes of death differ substantially from one country to another, highlighting the need to expand understanding of child health epidemiology at a country level rather than in geopolitical regions.

The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea. The first paper assesses the global burden of these two illnesses, comparing and contrasting them, and includes new estimates of severe disease and updated mortality estimates for 2011. Findings from the second paper show that a set of highly cost-effective interventions can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. Furthermore, the paper estimates what the cost of scale up will be. The third paper presents the results of consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward. The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025.

China and India, which together contain 37% of the world’s population, are both undergoing rapid social change. Because mental disorders account for a high proportion of morbidity, detailed knowledge of the mental health status of the populations in these two countries and the evidence-base regarding the treatment of those disorders are of paramount concern. The China-India Mental Health Alliance comprises experts from both countries and elsewhere who have worked to produce a collection of systematic reviews based on extensive literature searches of both international and national databases. It is hoped that this series will encourage further collaboration between Chinese and Indian mental health research communities to address shared concerns.

Diabetes has become a major public health crisis in China, with an annual projected cost of 360 billion RMB (almost 60 billion USD) by 2030. Recent health system reforms have resulted in remarkable successes in other areas of medicine in China, but efforts to address diabetes and other non-communicable diseases lag behind. In addition to affecting the growing elderly population, type 2 diabetes increasingly affects young people, with the combined effect being enormous tolls on productivity and health-care systems. This Series in The Lancet Diabetes & Endocrinology examines the unique aspects of the diabetes epidemic in China and outlines potential public health strategies—such as targeted screening, improved prevention and access to care, and community support—that could help to manage diabetes in China as the health system continues to evolve.

"China can produce and harness knowledge, create innovative approaches, and implement at large-scale effective solutions for both its own people as well as the world community."

The reduction of chronic disease is not a Millennium Development Goal (MDG). While the political fashions have embraced some diseases—HIV/AIDS, malaria, and tuberculosis, in particular—many other common conditions remain marginal to the mainstream of global action on health. Chronic diseases are among these neglected conditions.

Chronic diseases, principally cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, are leading causes of death and disability but are grossly neglected on the global-health agenda.

In September 2011, the UN will hold its first High-level Meeting of the General Assembly on chronic non-communicable diseases. The Lancet's Series of papers is our contribution to preparations for the September meeting. These papers cover a range of diseases - cardiovascular, diabetes, cancer, and chronic obstructive respiratory diseases - and present strategies for substantial health gains, monitoring, and scaling up of interventions. We also highlight earlier Lancet Series and provide links through to all of the relevant content.

The UN's emergency relief coordinator on disaster reduction, Jan Egeland, is frustrated by the lack of attention given to natural disasters by the international community. For example, by comparison with the response to appeals over the complex emergency in Darfur, western Sudan, an appeal for money to tackle Africa's plague of locusts was a failure.

This Lancet Series, which reviews progress since the seminal 2007 series Who counts, describes the growing momentum for civil registration and vital statistics (CRVS) systems in countries and in the global health and development community more broadly, stimulated by the need to monitor progress and accountability for the Sustainable Development Goals post 2015 era.  The four papers summarise the need for better empirical data on births and deaths, describe bottlenecks to progress and how they are being overcome, and identify drivers for change and opportunities to sustain progress. They show,  using a composite metric, evidence of some progress in vital statistics systems, identify the interventions that work to strengthen CRVS systems and the organizational, political and leadership ingredients for success.  

The burden of dengue is large and growing; expanding for decades it now affects more than 120 countries. Uncertainty in burden estimates, however, challenges policy makers’ ability to set priorities, allocate resources, and plan for interventions.

Diabetes is increasingly recognised as an important health issue in humanitarian contexts worldwide. This two-paper Series from The Lancet Diabetes & Endocrinology provides a detailed account of the current burden of diabetes, the use of diabetes services, and contextual and operational challenges related to the provision of diabetes care in humanitarian crises in low-income and middle-income settings.

At a time when a number of biological agents have gone or are soon to become off-patent, and with a market fuelled by escalating drug prices, the issue of drug safety has never been more paramount.

The drug use landscape is dynamic and changing. Changes in public attitudes and laws towards drug use have occurred in an increasing number of countries. Global drug production and consumption are increasing as are the risks and harms to health, while new substances continue to emerge. This Series focuses on opioids, cannabinoids, stimulants, and new psychoactive substances. The Series authors review the evidence on the epidemiology of drug use and related harms and interventions (treatment and policies) to address them. They highlight issues that are likely to become increasingly important in the next decade.

Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development.

Four years after The Lancet published a first Series on early child development, the challenge of supporting 200 million children under five years to reach their developmental potential remains. A new Series of two papers and a Comment now documents progress worldwide. The Series aims to identify gaps in implementation and coverage of interventions, calculate the economic costs of missed investment in early learning programmes, and present new evidence on the causes and effects of developmental inequities in early childhood.

Emerging and re-emerging respiratory tract infections and the growing problem of antimicrobial resistance challenge diagnostic, treatment, prevention, and control strategies. Respiratory tract infections with epidemic and pandemic potential have plagued people since the dawn of human history. Comprehensive assessments of the global burden of disease show that respiratory tract infections are some of the commonest causes of morbidity and mortality worldwide, imposing a huge burden on health services. Several epidemics of new viral respiratory tract infections, most of which emerged from interactions between people and animals, have occurred in the past century.

Whilst death is inevitable, cultural and religious aspects make end-of-life experiences affect the dying, their carers, and health-care professionals in different ways. This series of Viewpoints explores many contrasting end-of-life perspectives.

The current debate about the impact of human beings on our planet—especially with respect to climate change—is one of the most important issues of our time.

The September 28-Oct 5, 2012, issue of The Lancet focuses on epilepsy, and—together with content in The Lancet Neurology and The Lancet Oncology—aims to highlight the challenges and achievements in the global campaign against this neurological disorder. Epilepsy is a costly and complex public health problem; given the prevalence of epilepsy globally, an Editorial in The Lancet calls for epilepsy to be included as a priority on the public health agenda, concluding "it is time for all governments to take epilepsy more seriously".

In a Comment, Anthony Lake, Executive Director of UNICEF, writes "For decades, many have believed that reaching the remote, the poorest and most-in-need children is a moral imperative ... however, it has often been considered by policymakers as too costly, time-consuming and difficult to pursue with the limited purses of international aid and public finance."

The Lancet Series on Europe provides a comprehensive examination of some of the most important issues affecting the health of people in Europe today. Seven Series papers, led by Professor Martin McKee of the London School of Hygiene & Tropical Medicine, cover a diverse range of subjects, from how the financial crisis is affecting health in Europe, to whether children's health services are keeping pace with the changing landscape of child health. In recent years, the 53 countries that make up WHO's European Region have undergone turbulent political changes that have left an indelible mark on the health of their populations, including a striking east-west divide.

Following The Lancet Neonatal Survival Series in 2005, this Every Newborn Series presents the clearest picture so far of the ongoing slow progress in newborn survival, provides new focus beyond survival, and combines research and reality in countries to set target for post-2015 to ensure that every newborn has a healthy start in life. Every year, 2·9 million newborn babies die from largely preventable causes, and 2·6 million more are stillborn.

Primary care is the subject of more charters, declarations, manifestos, and principles than any other medical discipline, except perhaps its similarly plagued cousin, public health. Yet this efflux of ruminations from worthy experts and respected bureaucracies has contributed hardly anything to the daily practice of family medicine.

The field of evolutionary medicine has grown in recent years, but can the principles of evolutionary theory be applied to public health to shape more effective interventions and improve lives? This Series introduces the new area of evolutionary public health—a holistic framework to consider the physical and behavioural decisions individuals make in light of energy allocation and maximising reproductive success. The Series also considers the perspective of evolution in human reproduction as well as the interaction between human behaviour and microbes that shapes our physiology and metabolism.