H5N1

Launch of the Phase 3 strategic response plan against the Ebola outbreak in North Kivu and Ituri

Via digitalcongo.net: Launch of the Phase 3 strategic response plan against the Ebola outbreak in North Kivu and Ituri. The Google translation:

Health Minister Oly Ilunga proceeded on Wednesday, February 13, in Kinshasa, at the launch ceremony of the strategic response plan phase 3 to combat the Ebola virus epidemic (SRP 3), which is rife in the provinces of North Kivu and Ituri.  

How to find ways and means to mobilize the necessary funds for the next six months? This was the focus of an interview between international donors, UN agencies and non-governmental organizations. This project aims to stop the spread of the virus and stop the spread of the disease in other DRC risk provinces and neighboring countries.  

For his part, the Minister of Health, Oly Ilunga, stressed that the DRC needs more than 147 million dollars to continue to face this epidemic, before adding that this epidemic has already affected 823 people including 517 death on 12 February 2019. 

For his part, the acting representative of the WHO / DRC, Dr Deo Nshimirimana, welcomed the availability of donors for the adequate financial support in the Emergency Contingency Fund, starting in August 2018. 

He also recalled that this initial funding from the WHO Contingency Fund, already injected into ongoing operations, is at an extremely low level and requires urgent replenishment. 

"The financial means are among the major challenges on the ground to fight against this disease," he said Dr. Deo Nshimirimana.

Patient attendance decreases with the new modalities of free healthcare in Butembo

Via Radio Moto Butembo-Beni: Patient attendance decreases with the new modalities of free healthcare in Butembo. The Google translation:

After the new modalities of free healthcare, the attendance of patients has significantly decreased in health facilities. Declaration of Finance KAMASUA administrator health manager in health zone of Katwa. He said it in an interview with RMBB this Saturday 09 February 2019.  

"With regard to the contract amendment since January 16th, the movement of patients has become irregular within the structure, because there are certain diseases that have been discarded, and then there may have been a lot of conditions for care," said the health manager administrator in Katwa Health Zone. 

He took the opportunity to call those who frequent the health facilities calm in case of the presence of the police in these structures. 

"This is true, it's something that may be normal, but I'll ask that the patient be calm and appeased about the situation that happens to him, and when someone is told is suspicious, it is not the end of the world. A suspect is this one now where we will investigate to see if he is really sick of Ebola," he added.  

Recall that since Wednesday, January 16, 2019, we have reduced the package of the service covered by free care in health areas concerned.

Malnutrition, obesity and climate change threaten our future, warns report

The Tyee has published my article Malnutrition, Obesity and Climate Change Threaten Our Future, Warns Report. Excerpt:

Having dropped one bombshell report this month warning that our food choices are destroying the world, the British medical journal The Lancet has now dropped a second that says we’re now in a perfect storm of undernutrition, obesity and climate change.  

The Lancet calls it the “Global Syndemic.” The report’s authors say we’re facing three pandemics — undernutrition, obesity and climate change — that are interacting to form a “synergy of epidemics,” or syndemic, and it’s a global problem. 

Here’s how it works. Undernourished children in low-income and middle-income countries suffer from stunting, which makes them smaller than well-nourished children. But it also makes them more susceptible to obesity (which affects kids and adults in high-income countries even more). By 2015, obesity was affecting two billion people around the world. They’ve been set up to die of cardiovascular diseases, Type 2 diabetes and some cancers.  

The report says, “Economic losses attributable to undernutrition are equivalent to 11 per cent of the GDP in Africa and Asia, or approximately $3.5 trillion annually.” As we add another billion undernourished people by 2030, those losses will worsen.

When the gig economy become a public health issue

An opinion piece in The Globe and Mail: When the gig economy become a public health issue. This is not news to anyone who follows the social determinants of health, but it may be a shock to some the Globe's more affluent readers. Excerpt and then a comment:

Another day, another dollar, right? Not exciting maybe, maybe not that fun either, but at least predictable. 

Having a job that provides a paycheque at regular intervals is a source of comfort, while not having one is a source of stress. Today, an increasing number of workers get that dollar some days but for one reason or another, some days they do not. As a result, they may be more or less employed, but stressed all at the same time. Income instability is becoming the reality for many, and with that instability comes worry and strain – and maybe health consequences as well. 

There is indeed evidence to suggest that income volatility is hazardous to your health. A new study published in the journal Circulation had researchers tracking data for nearly 4,000 individuals in the United States starting from the age of 23 through to 35. Looking at income levels five times over that span, they also monitored individuals’ medical records during the same period. 

Their findings showed that individuals with the biggest fluctuations in personal income had nearly twice the risk of death and more than twice the risk of heart problems such as strokes and cardiac arrest as compared with those with more stable incomes. Their conclusion: The trend toward fluctuating incomes poses a threat to public health.

See also my review of Dying for a Paycheck, an excellent book on the stress involved even in regular employment.

Chronic life-saving medicines in short supply in Sudan

Via Radio Dabanga: Chronic life-saving medicines in short supply in Sudan.

The former head of the Private Pharmacies Association, Dr Nasri Morgos, has reported a scarcity of medicines in Sudan. The ongoing shortage of foreign currency in the country means that especially life-saving chronic medicines and permanent eye drops are running short. 

For the few medicines still available, Dr Morgos predicted further prices rises of about 400 per cent and predicted “a disaster” in the near future. 

“The situation will be catastrophic,” he said. “The current prices of medicines are expensive anyhow”, he said, and reported that Sudan is currently experiencing a 200 per cent increase which he predicts will rise still further to 400 per cent, “which would be considered a major disaster”. 

He attributed the lack of medicines to pharmacies halting importation and sales due the rise in price of the Dollar.  

Dr Morgos told Radio Dabanga that patients with heart disease, kidney failure, and asthma have complained that they do not receive medication and that they are forced to depend on their relatives abroad to provide medicines. 

Pharmacists stop imports  

As reported previously by Radio Dabanga, over the past few months, as the value of the Sudanese Pound has dropped steadily against the US Dollar, pharmaceutical companies have reportedly imported less to no medicines which has led to a scarcity of a number of medicines.  

The Central Bank of Sudan and Market Makers Committee have identified the price of the import of medicines to stand at SDG 47.5 per Dollar for medicine importers.  

Meanwhile the Sudanese board of medicines and toxins has instructed pharmaceutical companies to sell all medicines in the stores at the minimum price.  

In August 2018, people in Sudan complained about the lack and high prices of lifesaving medicines to treat chronic conditions such as blood pressure and diabetes, as well as medicines related to epilepsy and other neurological and psychological conditions.

US: A disaster for American healthcare

Via The New York Times: Texas Judge Strikes Down Obama’s Affordable Care Act as Unconstitutional. Excerpt, and then a response to the decision:

WASHINGTON — A federal judge in Texas struck down the entire Affordable Care Act on Friday on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. 

The ruling was over a lawsuit filed this year by a group of Republican governors and state attorneys general. A group of intervening states led by Democrats promised to appeal the decision, which will most likely not have any immediate effect. But it will almost certainly make its way to the Supreme Court, threatening the survival of the landmark health law and, with it, health coverage for millions of Americans, protections for people with pre-existing conditions and much more. 

In his ruling, Judge Reed O’Connor of the Federal District Court in Fort Worth said that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.”  

Accordingly, Judge O’Connor, a George W. Bush appointee, said that “the individual mandate is unconstitutional” and the remaining provisions of the Affordable Care Act are invalid.  

At issue was whether the health law’s insurance mandate still compelled people to buy coverage after Congress reduced the penalty to zero dollars as part of the tax overhaul that President Trump signed last December.  

When the Supreme Court upheld the mandate as constitutional in 2012, it was based on Congress’s taxing power. Congress, the court said, could legally impose a tax penalty on people who do not have health insurance.  

But in the new case, the plaintiffs, led by Texas, argued that with the penalty zeroed out, the individual mandate had become unconstitutional — and that the rest of the law could not be severed from it. 

The Justice Department’s response to the case was highly unusual: though it disagreed with the plaintiffs that the entire law should be struck down, it declined this year to defend not just the individual mandate, but the law’s provisions that protect people with pre-existing conditions. That prompted a coalition of 16 states and the District of Columbia, led by California, to intervene and defend the law. 

On Friday night, a spokeswoman for Xavier Becerra, the California attorney general, said California and the other defendant states would challenge the ruling with an appeal in the United States Court of Appeals for the Fifth Circuit in New Orleans.

The American Medical Association has published this response:

CHICAGO – The American Medical Association (AMA) released the following statement after the federal district court in the Northern District of Texas sided with the plaintiff, striking down popular key provisions of the Affordable Care Act (ACA).

“Today’s decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans,” said AMA president Barbara L. McAneny, M.D. “It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction.”

The AMA will work with patient and other health stakeholder groups in pursuing an appeal and reversal of this unfortunate decision at the district court level.

The AMA led an amicus brief in June that urged the court to reject the challenge. Additional organizations joined the AMA in filing the amicus brief, including the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. Download or view the amicus brief.

Ebola vaccine is having ‘major impact’ but Congo outbreak may still explode (for lack of funding)

Via Science, Jon Cohen writes a good summary of the situation, but buries the lede: Money for the Ebola response will run out next month. Ebola vaccine is having ‘major impact’ but Congo outbreak may still explode. Excerpt, with my bolding:

As an Ebola outbreak in a conflict-plagued region of the Democratic Republic of the Congo (DRC) continues to spread after 4 months, there’s a glimmer of hope: An experimental Ebola vaccine appears to be helping the communities it reaches. More than 40,000 people have received the vaccine, by far the largest use of it since a trial in 2015 showed it worked well. The vaccine’s effectiveness in this outbreak has not been formally assessed. But Peter Salama, who heads the Ebola response for the World Health Organization (WHO) in Geneva, Switzerland, says, “I think it’s having a major impact.” 

WHO, which works in concert with the DRC’s Ministry of Public Health, can’t distribute the vaccine as widely as it would like, however, because of limited supplies, Salama notes. And the obvious targets for vaccination—people who have had contact with cases—have been difficult to identify and reach because of the ongoing conflict; a small number of front-line health care workers have even been caught in the crossfire.  

So far the outbreak has tallied some 500 cases, about half of whom have died, according to the DRC’s Ministry of Public Health. It spans a region of the DRC’s northeast that abuts four other countries, and Salama and many others worry about the deadly virus jumping a border, which would require separate response teams and boost the potential for wider spread by infecting people with increased transportation options. 

Without more financial and personnel support from wealthy countries, the situation could explode into a long-running calamity similar to the Ebola epidemic that devastated three West African countries from 2014 to 2016, warns an editorial published last month in The New England Journal of Medicine (NEJM). A consensus statement from 25 public health and policy experts published the same week in The Journal of the American Medical Association calls the outbreak “exceptionally” dangerous. 

The editorials urge the U.S. government to change a policy that prevents its Centers for Disease Control and Prevention (CDC) from sending staff to the region because of security concerns. And many are calling for a WHO-established review committee to designate the outbreak a Public Health Emergency of International Concern, which could drive more countries to contribute to the response; in October, the panel said the designation wasn’t yet necessary. 

Although the toll so far is much smaller than the West African epidemic’s 28,000 cases and 11,000 deaths, it’s now the second largest Ebola outbreak ever documented, and one of the longest running. The outbreak has hit mothers and their young children especially hard, because many sought care for malaria at health centers that unknowingly have Ebola cases. Women have made up 62% of all cases, and 24% were children under age 15. Only about 50% of new infections are in people previously identified as having been in contact with a case, which underscores how the violence has interfered with contact tracing. 

Salama says funding for the response in the DRC has been ample so far, but will run out in January 2019. Programs to support readiness and preparedness efforts in nine neighboring countries need another $45 million, he says. He’s particularly worried about Uganda, Burundi, Rwanda, and South Sudan, all bordering the DRC. “If there is a case, as is very likely in surrounding countries, we want to pick up that first one so we can have a very robust response,” Salama says.  

He adds that the front-line responders from the DRC, WHO’s 300 staffers on the ground, and personnel from nongovernmental organizations such as Doctors Without Borders and ALIMA are “frankly exhausted” from working long days in a conflict zone. “Where can we keep finding these brave people who are expert in viral hemorrhagic fever and know how to operate in a conflict-affected area?” he asks.

The impact of air pollution on deaths, disease burden, and life expectancy across the states of India

Via The Lancet Planetary Health: The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017. The summary:

Background 

Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. 

Methods 

We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years.

We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure–response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. 

Findings 

The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0–112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. 

The proportion of population using solid fuels in India was 55·5% (54·8–56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09–1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55–0·79) from ambient particulate matter pollution and 0·48 million (0·39–0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. 

India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. 

We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6–1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. 

Interpretation 

India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state.

WHO: Health benefits far outweigh the costs of meeting climate change goals

A news release from WHO: Health benefits far outweigh the costs of meeting climate change goals. Excerpt:

Meeting the goals of the Paris Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone. The latest estimates from leading experts also indicate that the value of health gains from climate action would be approximately double the cost of mitigation policies at global level, and the benefit-to-cost ratio is even higher in countries such as China and India.  

A WHO report launched today at the United Nations Climate Change Conference (COP24) in Katowice, Poland highlights why health considerations are critical to the advancement of climate action and outlines key recommendations for policy makers.  

Exposure to air pollution causes 7 million deaths worldwide every year and costs an estimated US$ 5.11 trillion in welfare losses globally. In the 15 countries that emit the most greenhouse gas emissions, the health impacts of air pollution are estimated to cost more than 4% of their GDP. Actions to meet the Paris goals would cost around 1% of global GDP. 

“The Paris Agreement is potentially the strongest health agreement of this century,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “The evidence is clear that climate change is already having a serious impact on human lives and health. It threatens the basic elements we all need for good health - clean air, safe drinking water, nutritious food supply and safe shelter - and will undermine decades of progress in global health. We can’t afford to delay action any further.”  

The same human activities that are destabilizing the Earth’s climate also contribute directly to poor health. The main driver of climate change is fossil fuel combustion which is also a major contributor to air pollution. “The true cost of climate change is felt in our hospitals and in our lungs. The health burden of polluting energy sources is now so high, that moving to cleaner and more sustainable choices for energy supply, transport and food systems effectively pays for itself,” says Dr Maria Neira, WHO Director of Public Health, Environmental and Social Determinants of Health. “When health is taken into account, climate change mitigation is an opportunity, not a cost.” 

Switching to low-carbon energy sources will not only improve air quality but provide additional opportunities for immediate health benefits. For example, introducing active transport options such as cycling will help increase physical activity that can help prevent diseases like diabetes, cancer and heart disease.  

WHO’s COP-24 Special Report: health and climate change provides recommendations for governments on how to maximize the health benefits of tackling climate change and avoid the worst health impacts of this global challenge.  

It describes how countries around the world are now taking action to protect lives from the impacts of climate change – but that the scale of support remains woefully inadequate, particularly for the small island developing states, and least developed countries. Only approximately 0.5% of multilateral climate funds dispersed for climate change adaptation have been allocated to health projects.

Belluz: What the dip in US life expectancy is really about: Inequality

In Vox.com, Julia Belluz has a must-read report: What the dip in US life expectancy is really about: inequality. Click or tap through for the full article with excellent links, tables, and graphs. Excerpt:

Living in the US increasingly looks like a health risk. Average life expectancy in the country dropped for the third year in a row, according to recent data from the Centers for Disease Control and Prevention. That’s the longest downturn since the Spanish flu wiped out more than 50 million people a century ago. 

The grim trend stems from a toxic mixture of more drug- and alcohol-related deaths and more suicide in many parts of the country. And it puts Americans at a higher risk of early death compared to their counterparts in other wealthy countries. 

But what’s often lost in the conversation about the uptick in mortality in the US is that this trend isn’t affecting all Americans. In fact, there’s one group in the US that’s actually doing better than ever: the rich. While poor and middle-class Americans are dying earlier, the wealthiest among us are enjoying unprecedented longevity. 

So when we talk about life expectancy slipping, what we should also talk about is the growing problem of health inequality in America. And it’s an increasingly urgent discussion, health researchers are warning, because of policy changes on the horizon that are poised to make the mortality gap even wider. 

Some of these policies will hamper access to medical care (such as rescinding funding for CHIP, the health insurance program for low-income children) but others that aren’t even directly related to health care, like tax cuts, may have even more insidious effects on the American mortality gap. 

America’s alarming life expectancy gap 

The rich have long enjoyed more longevity than the poor, but the gap in life expectancy has been widening in the US over the past few decades, along with other types of social and income inequality.  

The CDC’s Division of Vital Statistics, which tracks mortality in the US, uses death certificates as the data source and doesn’t collect family income data. But we do have good data on the mortality gap and income from a study published in JAMA in 2016. 

A group of researchers, led by Stanford University economist Raj Chetty, analyzed income data for the US population from 1.4 billion tax records between 1999 and 2014. They then compared it with mortality data from Social Security Administration death records. They found that, from 2001 to 2014, the richest Americans gained about five years of longevity, while life expectancy for the poor didn’t budge.