Health leaders challenge global policy makers on cancer

Global health leaders have put out an urgent call to countries to improve action on cancer services.

At the World Cancer Leaders’ Summit (WCLS) in Kuala Lumpur, Malaysia, on October 1, health leaders from United Nations agencies, the non-profit and private sectors, and academia came together to issue the call.

They asked countries to increase access to, and investment in, cancer services to improve vital early detection, treatment, care, and public health data.

Insisting that the need for global action on cancer was more urgent than ever, the group presented new data from the International Agency for Research on Cancer (IARC) estimating that there will be 18.1 million new cancer cases diagnosed and 9.6 million cancer deaths in 2018.

This means that countries are way off-course to meet the ambitious global target of reducing premature deaths from non-communicable diseases (NCDs), like cancer, 25 per cent by 2025 as agreed by the World Health Organisation in 2013, they said.

Union for International Cancer Control President, Professor Sanchia Aranda, said: “Cancer is not just a health concern, but also a serious threat to development. The growing burden has clear implications for patients, their families, and health systems, but also for the economic growth of a country as a whole.”

UICC President-elect, HRH Princess Dina Mired said: “We know Treatment for All is possible in every country. What we need is strategic national plans and national champions for cancer control to implement these measures.”

CHRIS JOHNSON

[Correspondence] Cautery in medieval surgery: a unique palaeopathological case

Cautery is a fundamental tool in ancient and medieval surgery. According to a aphorism of Hippocrates, the father of medicine, “Those diseases which medicines do not cure, iron cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable”.1 This statement was accepted in Roman medicine and then by the Byzantine and Islamic surgical practices in the Middle Ages.2 Despite this widespread acceptance, the bioarchaeological evidence of the use of cautery is extremely rare.

[Comment] Risk factor policies, morbidity, and mortality in Russia

Mortality rates in Russia decreased for non-communicable diseases and all other major causes of death between 1980 and 2016 according to the Global Burden of Disease (GBD) 2016 Study by the GBD 2016 Russian Collaborators,1 published in The Lancet. As the prevalence of the most important risk factor according to this study—high blood pressure—increased over the past decades,2 these achievements seem to be primarily due to substance control policies, specifically WHO’s so-called best buys,3 which resulted in marked declines in tobacco4 and—more importantly for Russia—alcohol use.

[Health Policy] NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs.

[Editorial] Standing by France’s social contract: Macron’s health reform

On a background of tense negotiations for a workable Brexit deal, President Emmanuel Macron announced a health reform for France, which stands health as a pillar for his 21st century welfare state. Macron’s “health transformation strategy” aims to be the most ambitious reform in 60 years, a “change in paradigm” that puts the patient at the centre of care and focuses on better prevention, care for non-communicable diseases, and translational care.

[Correspondence] Support for UNRWA’s survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy.

Aiming to unlock a kidney mystery

The remaining kidney of a donor often grows in order to compensate for the loss, allowing the donor to live on without complication.

It is somewhat unknown how this occurs, but a new research project aims to unravel the mystery and help people who suffer from reduced kidney function.

Professor Jonathan Gleadle from Flinders University intends to uncover exactly how a remaining kidney grows and increases its output to function at around 80 percent of the capacity of the previous two.

“The remaining kidney in a donor has a natural ability to compensate for the loss of the other, however the key initiators of this response are unknown,” Professor Gleadle said.

“Recent evidence indicates that this growth is in response to an initial sensing mechanism, and there is strong reason to consider microRNAs play a significant role.”

MicroRNAs are specific molecules released from cells under stress that serve as messengers, telling cells how to behave. They are known to play a role in basic cell processes, with the loss or unusual expression of MicroRNAs already associated with several diseases, including diabetes and kidney disease.

“Our team aims to identify the expression of circulating microRNAs using a novel technique which will enable us to investigate hundreds of miRNAs simultaneously after the removal of a kidney.” Prof Gleadle said.

“The ultimate aim of our research is to see new treatments that can trigger healthy kidney growth in diseased patients and remove or delay the need for dialysis and transplants.”

Up to ten percent of the global population suffers from chronic kidney disease, and in Australia, 53 people die from kidney-related disease each day.

It is estimated that the economic cost of treating kidney disease in the decade to 2020 will reach about $12 billion, indicating an urgent need to invest in research to develop new strategies and treatments.

Prof Gleadle was awarded a $50,000 grant from Kidney Health Australia to progress his research.

HIV rates falling overall – but not for everyone

HIV rates in Australia have dropped overall to a seven-year low, but a concerning increase in infection rates has been observed among heterosexual males and Aboriginal and Torres Strait Islander people.

According to the latest HIV surveillance report released by the Kirby Institute at UNSW, there were 963 new HIV diagnoses in Australia in 2017, representing a 7% decline over five years

The reductions were greatest among gay and bisexual men, with a 15% reduction in the past year alone.
Associate Professor Darryl O’Donnell, CEO of Australian Federation of AIDS Organisations, told doctorportal that “this is some really good news.”

“There have been strong increases in regular HIV testing in this population, along with incredible enthusiasm for the pre-exposure prophylaxis (PrEP) drug, and people taking treatment very early on in their diagnosis. All three things are really helping us get those diagnoses down.”

HIV rates among heterosexual males on the rise

The results of the report are not all good news, however. There was a 10% increase between 2013 and 2017 in HIV diagnoses among heterosexuals, with a 14% increase between 2016 and 2017 alone. In men, the number of diagnoses attributable to heterosexual sex has increased by 19% in the last five years yet has remained relatively stable in women.

Professor O’Donnell said that this data was concerning. “This is a much smaller proportion we’re talking about here – around 20-25% of all diagnoses are among heterosexuals – but we do want to keep an eye on this”

“It’s important for us to understand that not everyone who is a heterosexual is equally at risk for HIV. The sorts of things emerging from the data are that a person who is at relatively low risk in Australia might be at higher risk when they’re travelling overseas if they’re having sex with partners there.”

Another factor behind the rise in HIV among heterosexuals has been the increase in the number of people with HIV coming to Australia from countries with a high prevalence.

“The third category is people who are heterosexual whose partner is at high risk of HIV – maybe their partner is someone who injects drugs, or their partner is from a high risk country”, Professor O’Donnell said.

HIV among Indigenous Australians nearly double the rate of non-Indigenous Australians

HIV diagnoses among Aboriginal and Torres Strait Islander people have also increased in the past five years. In 2017 the notification rate was 1.6 times higher than the Australian‑born, non‑Indigenous population.

“The rate of HIV among Aboriginal and Torres Strait Islander people has been increasing since 2008. This is very concerning, because once HIV is established in these communities, it is much harder to achieve the type of outcomes we see elsewhere”, Professor O’Donnell said.

He added that for this reason, prevention and testing for early diagnosis are key. “We need to be sure that our workforce, including Aboriginal health workers and staff working within Aboriginal medical services, are fully supported to be able to offer HIV screening.”

Return to Grim Reaper-style campaigns not the answer

“We certainly don’t want to go back to the grim reaper. It certainly raised awareness, but also frightened people and made people think that HIV was about someone who wasn’t like them”, Professor O’Donnell said.

The goal of any HIV campaign should not be to make people fear each other, but instead build their understanding of their individual level of potential risk, and encourage them to take positive steps based on that.

“We need awareness and to intensify educational efforts with those most at risk and across the whole community. But we need to do it in a mature way, and work with people as adults who are confident and capable of making sensible choices.”

[Comment] No level of alcohol consumption improves health

By use of methodological enhancements of previous iterations,1 the systematic analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 for 195 countries and territories, 1990–2016,2 is the most comprehensive estimate of the global burden of alcohol use to date. The GBD 2016 Alcohol Collaborators clearly demonstrate the substantial, and larger than previously estimated, contribution of alcohol to death, disability, and ill health, globally. In 2016, alcohol use was the seventh leading risk factor for both deaths and disability-adjusted life-years (DALYs), accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of female deaths and 6·8% (5·8–8·0) of male deaths.

[Correspondence] The future of end-of-life care

Not much in life is certain, but death is an inevitability we all share. Because of advances in modern medicine and increasing life expectancy, population ageing is affecting developed nations, and, increasingly, the developing world. This change brings higher prevalence of chronic diseases and multimorbidity, highlighted in an Editorial (April 28, p 1637)1 as an emerging priority for global health research. Less often discussed are the implications of these global trends for death and dying, which will become more common and more complex.