more_vertWeakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed.
Preference: Administration and Health Services
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[Health Policy] Building the case for embedding global health security into universal health coverage: a proposal for a unified health system that includes public health
In the wake of the recent west African Ebola epidemic, there is global consensus on the need for strong health systems; however, agreement is less apparent on effective mechanisms for establishing and maintaining these systems, particularly in resource-constrained settings and in the presence of multiple and sustained stresses (eg, conflict, famine, climate change, and globalisation). The construction of the International Health Regulations (2005) guidelines and the WHO health systems framework, has resulted in the separation of public health functions and health-care services, which are interdependent in actuality and must be integrated to ensure a continuous, unbroken national health system.
[Comment] Implementing sustainable global mental health in a fragmenting world
The Lancet Commission on global mental health and sustainable development1 sets out ambitious recommendations for the transformation of global mental health according to the UN’s wide-ranging Sustainable Development Goals (SDGs) for 2030. The depth of the Commission’s report capture the complex, diverse, and sometimes contradictory positions and perspectives of mental health stakeholders, including the ultimate beneficiaries of the proposed reforms—people with lived experience of mental health problems who may use mental health services, along with their carers and communities.
[Comment] Mental health for all: a global goal
In 2007, The Lancet published a Series on global mental health that sought to transform the way policy makers thought about global health. The Series papers argued that a growing and worldwide burden of mental disorders was a global health crisis. The authors issued an urgent call for action to scale up services for people living with mental health problems and to close a substantial treatment gap, especially in low-income and middle-income countries, where the proportions of people receiving treatment are lowest.
Commissioner appointed for aged care
Australia’s first Aged Care Quality and Safety Commissioner is a former acting head of Northern Territory Health Department.
Aged Care Minister Ken Wyatt has named Janet Anderson as the Commissioner. She will start her role as the sector’s regulator next year.
Mr Wyatt said the appointment marked a significant milestone in the journey towards a better, safer aged care system.
“Highly respected and experienced health sector leader Janet Anderson will oversee establishment of the Commission, as it prepares to start intensified compliance monitoring from 1 January 2019,” he said.
“The new Commission will have a budget of almost $300 million over four years, employing dozens of additional senior compliance officers.”
Ms Anderson was First Assistant Secretary, Health Services, in the Commonwealth Department of Health 2012-2015, and Director, Inter-Government and Funding Strategies in the New South Wales Department of Health 2006-2011.
For the past two years, Ms Anderson has held the positions of Deputy Chief Executive and acting Chief Executive of the Northern Territory Department of Health.
In 2009, she was awarded the Public Service Medal for outstanding work in health policy development and reform.
Ms Anderson was only recently appointed as the new head of ACT Health, but stepped down from the role almost immediately.
She is currently working with the NT Government to implement recommendations from the royal commission into the protection and detention of children in the territory.
Ms Anderson will be assisted by aged care medical expert Associate Professor Michael Murray, who is working as the new interim Chief Clinical Advisor to support key establishment activities.
Associate Professor Murray has a broad range of management, clinical and clinical teaching experience in aged care as the medical director of Continuing Care and head of Geriatric Medicine at Austin Health, Melbourne.
He is also the President of the Board of Directors at the National Ageing Research Institute, Associate Professor at Melbourne University and Adjunct Associate Professor Australian Centre for Evidence Based Aged Care and La Trobe University.
The permanent appointment of a clinical advisor to the Commission will be a matter for the new Commissioner.
The establishment of this agency is in addition to the recently announced royal commission into the aged-care sector.
Life expectancy predictions changing around the world
Australia ranks tenth on a list of global life expectancy by 2040, according to recently published new research.
With the average life expectancy of Australians projected to be 84.1 years, the nation sits high on the table, but it is Spain that is predicted to rise to the top by 2040, overtaking Japan’s long-held first ranking.
The study, first published in Lancet, also shows the United States is set to take a dive in the life expectancy stakes to 64th place, down from 43rd in a 2016 study – the biggest drop of all high-income earning countries.
The US will be passed by China, which will jump 29 places to be 39th on the table.
The average global rise of life expectancy is 4.4 years, while Americans will only live an average 1.1 years longer at 79.8 years of age.
According to the study, People in Spain will live for 85.8 years on average by 2040, while the Japanese will live an average of 85.7 year, followed by Singapore (85.4) and Switzerland (85.2).
The United States will take the biggest drop in ranking of all high-income countries, falling from 43rd in 2016 to 64th by 2040, with an average life expectancy of 79.8.
China will rise 29 places to 39th in the table, to reach a life expectancy level of 81.9 years.
Americans will live only 1.1 years longer on average in 2040 compared to 2016, well below the average global rise of 4.4 years over that same period.
A sharp increase in obesity rates and drug related deaths in the US are the main determining factors in its decline in life expectancy.
Diet, disease, and the standard of healthcare are reported to be the major contributors to each nation’s life expectancy ranking, with the Mediterranean diet helping to propel Spain to the top of the list.
It is also considered a factor neighbouring Portugal’s rise to number five on the list. Portugal has the biggest jump in the top 20, going from 23rd place to number five and adding an average 3.6 years to 84.5.
Researchers found that high blood pressure, high body mass index, high blood sugar, tobacco and alcohol use to be major causes of premature mortalities.
African nation Lesotho has dropped to last place of the 195 countries rated, with a life expectancy of 57.3 years by 2040.
The low ranking of poorer nations points to the inequality in healthcare and sanitation services around the globe.
Lead author of the study, Dr Kyle Foreman of the Institute for Health Metrics and Evaluation noted, however, that the future of the world’s health was not pre-ordained, and there remains a wide range of plausible trajectories.
“Whether we see significant progress or stagnation depends on how well or poorly health systems address key health drivers,” Dr Foreman said.
Top Ten
- Spain (85.8 years)
- Japan (85.7 years)
- Singapore (85.4 years)
- Switzerland (85.2 years)
- Portugal (84.5 years)
- Italy (84.5 years)
- Israel (84.4 years)
- France (84.3 years)
- Luxembourg (84.1 years)
- Australia (84.1 years)
CHRIS JOHNSON
Funds injection to Indigenous health services
Facility upgrades and repairs are taking place to a number of Aboriginal and Torres Strait Islander health services across the nation, following a $2.7 million funding boost from the Federal Government’s Service Maintenance Program.
In total, 25 services across Australia will benefit in this round of upgrades.
Indigenous Health Minister Ken Wyatt said the funds had been allocated to improve the safety and accessibility of services in the Northern Territory, Western Australia, New South Wales, Queensland, Victoria and Tasmania.
“This includes vital support for clinics, accommodation and associated facilities, so staff can continue delivering comprehensive primary health care to First Nations people that is culturally appropriate and best practice,” he said.
“Our Government has given priority to services seeking urgent repairs and maintenance, especially facilities based in remote and very remote areas.”
The Service Maintenance Program – part of the Indigenous Australians’ Health Program (IAHP) – supports the improvement of health outcomes for Aboriginal and Torres Strait Islander people through better access to health services.
“Under the IAHP, we are committed to providing First Nations people with access to quality, comprehensive and culturally appropriate primary health care,” Mr Wyatt said.
The recent Federal Budget allocated $3.9 billion over four years to support Aboriginal and Torres Strait Islander health, an increase of about four per cent per year.
Significant projects in the current upgrade projects include:
- Urgent security and safety upgrades to the Anyinginyi Health Aboriginal Corporation’s Men’s Health Clinic in Tennant Creek to include duress alarms and swipe cards;
- Improving cultural appropriateness, safety and access at the Dhauwurd-Wurrung Portland and District Aboriginal Elderly Citizens Inc. clinic; and
- Extending phlebotomy clean rooms at the Sunrise Health Service Aboriginal Corporation and the Maari Ma Health Aboriginal Corporation to allow immediate testing of children’s lead and iron levels.
[Editorial] The Astana Declaration: the future of primary health care?
Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge. Half the world’s population has no access to the most essential health services. Yet 80–90% of people’s health needs across their lifetime can be provided within a primary health-care framework—from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care. As populations age, and multimorbidity becomes the norm, the role of primary health-care workers becomes ever more important.
[Correspondence] Improve access to quality primary care for patients with anxiety or depression – Authors’ reply
We thank Tony Kendrick for raising the important issue of how few people with anxiety or depression in the UK actually receive any treatment. In high-income countries like the UK, psychological treatment services, such as the Improving Access to Psychological Therapies (IAPT) programme, have an important role in increasing choice and access to evidence-based treatments, alongside strengthening primary care.
[Correspondence] World Restart a Heart initiative: all citizens of the world can save a life
Sudden cardiac arrest is the third leading cause of death in industrialised nations, resulting in more than 700 000 deaths in Europe and the USA annually.1 After cardiac arrest, the brain can survive for 3–5 min, which could be the minimum time that emergency medical services take to arrive. Consequently, the most important way to improve survival is the instigation of early bystander cardiopulmonary resuscitation (CPR).2 Bystander CPR increases survival by two to four times, which is much better than with any other intervention by emergency medical services or hospital staff.