The international community can best support countries to implement progressive universal health coverage by financing population, policy, and implementation research, such as on the mechanics of ...designing and implementing evolution of the benefits package as the resource envelope for public finance grows. Antimicrobials based on a new mechanism of action Combined diarrhoea vaccine (rotavirus, enterotoxigenic Escherichia coli, typhoid, and shigella); protein-based universal pneumococcal vaccine; respiratory syncytial virus vaccine; hepatitis C vaccine ..
Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human ...development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.
Towards a common definition of global health Koplan, Jeffrey P, Prof; Bond, T Christopher, PhD; Merson, Michael H, Prof ...
The Lancet (British edition),
06/2009, Letnik:
373, Številka:
9679
Journal Article
Recenzirano
Odprti dostop
A steady evolution of philosophy, attitude, and practice has led to the increased use of the term global health. ... on the basis of this analysis, we offer the following definition: global health is ...an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.
Assuring health coverage for all in India Patel, Vikram, Prof; Parikh, Rachana, MPH; Nandraj, Sunil, MA ...
The Lancet (British edition),
12/2015, Letnik:
386, Številka:
10011
Journal Article
Recenzirano
Summary Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. ...Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022—a fitting way to mark the 75th year of India's independence.
To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has ...to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020.
Summary Background India has the highest burden of acute coronary syndromes in the world, yet little is known about the treatments and outcomes of these diseases. We aimed to document the ...characteristics, treatments, and outcomes of patients with acute coronary syndromes who were admitted to hospitals in India. Methods We did a prospective registry study in 89 centres from 10 regions and 50 cities in India. Eligible patients had suspected acute myocardial infarction with definite electrocardiograph changes (whether elevated ST STEMI or non-STEMI or unstable angina), or had suspected myocardial infarction without ECG changes but with prior evidence of ischaemic heart disease. We recorded a range of clinical outcomes, and all-cause mortality at 30 days. Findings We enrolled 20 937 patients. Of the 20 468 patients who were given a definite diagnosis, 12 405 (60·6%) had STEMI. The mean age of these patients was 57·5 (SD 12·1) years; patients with STEMI were younger (56·3 12·1 years) than were those with non-STEMI or unstable angina (59·3 11·8 years). Most patients were from lower middle 10 737 (52·5%) and poor 3999 (19·6%) social classes. The median time from symptoms to hospital was 360 (IQR 123–1317) min, with 50 (25–68) min from hospital to thrombolysis. 6226 (30·4%) patients had diabetes; 7720 (37·7%) had hypertension; and 8242 (40·2%) were smokers. Treatments for STEMI differed from those for non-STEMI or unstable angina. More patients with STEMI than with non-STEMI were given anti-platelet drugs (98·2% vs 97·4%); angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) (60·5% vs 51·2%); and percutaneous coronary interventions (8·0% vs 6·7%, p<0·0001 for all comparisons). Thrombolytics (96·3% streptokinase) were used for 58·5% of patients with STEMI. Conversely, fewer patients with STEMI than those with non-STEMI or unstable angina were given β blockers (57·5% vs 61·9%); lipid-lowering drugs (50·8% vs 53·9%); and coronary bypass graft surgery (1·9% vs 4·4%, p<0·0001 for all comparisons). The 30-day outcomes for patients with STEMI were death (8·6%), reinfarction (2·3%), and stroke (0·7%). Outcomes for those with non-STEMI or unstable angina were better: death (3·7%), reinfarction (1·2%), and stroke (0·3%, p<0·0001 for all comparisons). Use of key treatments also differed by socioeconomic status: more rich patients than poor patients were given thrombolytics (60·6% vs 52·3%), β blockers (58·8% vs 49·6%), lipid-lowering drugs (61·2% vs 36·0%), ACE inhibitors or ARB (63·2% vs 54·1%), percutaneous coronary intervention (15·3% vs 2·0%), and coronary artery bypass graft surgery (7·5% vs 0·7%, p<0·0001 for all comparisons). Mortality was higher for poor patients than for rich patients (8·2% vs 5·5%, p<0·0001). Adjustment for treatments (but not risk factors and baseline characteristics) eliminated this difference in mortality. Interpretation Patients in India who have acute coronary syndromes have a higher rate of STEMI than do patients in developed countries. Since most of these patients were poor, less likely to get evidence-based treatments, and had greater 30-day mortality, reduction of delays in access to hospital and provision of affordable treatments could reduce morbidity and mortality. Funding Division of Clinical Trials, St John's Research Institute, Bangalore, India; Population Health Research Institute (PHRI), McMaster University, Canada; Sanofi-Aventis India.
The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader ...contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Major findings Worldwide, 2420 medical schools, 467 schools or departments of public health, and an indeterminate number of postsecondary nursing educational institutions train about 1 million new doctors, nurses, midwives, and public health professionals every year.
Chronic diseases and injuries in India Patel, Vikram, Prof; Chatterji, Somnath, MD; Chisholm, Dan, PhD ...
The Lancet (British edition),
2011, Letnik:
377, Številka:
9763
Journal Article
Recenzirano
Summary Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced ...increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved.
Summary The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable ...morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
Summary The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the sale (legal and illegal) ...of tobacco products. A tobacco-free world by 2040, where less than 5% of the world's adult population use tobacco, is socially desirable, technically feasible, and could become politically practical. Three possible ways forward exist: so-called business-as-usual, with most countries steadily implementing the WHO Framework Convention on Tobacco Control (FCTC) provisions; accelerated implementation of the FCTC by all countries; and a so-called turbo-charged approach that complements FCTC actions with strengthened UN leadership, full engagement of all sectors, and increased investment in tobacco control. Only the turbo-charged approach will achieve a tobacco-free world by 2040 where tobacco is out of sight, out of mind, and out of fashion—yet not prohibited. The first and most urgent priority is the inclusion of an ambitious tobacco target in the post-2015 sustainable development health goal. The second priority is accelerated implementation of the FCTC policies in all countries, with full engagement from all sectors including the private sector—from workplaces to pharmacies—and with increased national and global investment. The third priority is an amendment of the FCTC to include an ambitious global tobacco reduction goal. The fourth priority is a UN high-level meeting on tobacco use to galvanise global action towards the 2040 tobacco-free world goal on the basis of new strategies, new resources, and new players. Decisive and strategic action on this bold vision will prevent hundreds of millions of unnecessary deaths during the remainder of this century and safeguard future generations from the ravages of tobacco use.
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