Most of 3000 adolescent deaths a day are preventable

More than 3000 adolescents die every day, totalling 1.2 million deaths a year, from largely preventable causes, according to a new report from the World Health Organization (WHO) and partners. In 2015, more than two-thirds of these deaths occurred in low- and middle-income countries in Africa and South-East Asia. Road traffic injuries, lower respiratory infections and suicide are the biggest causes of death among adolescents.

Most of these deaths can be prevented with good health services, education and social support. But in many cases, adolescents who suffer from mental health disorders, substance abuse or poor nutrition cannot obtain critical prevention and care services – either because the services do not exist, or because they do not know about them.

In addition, many behaviours that impact health later in life, such as physical inactivity, poor diet, and risky sexual behaviours, begin in adolescence.

“Adolescents have been entirely absent from national health plans for decades,” says Dr Flavia Bustreo, Assistant Director- General, WHO. “Relatively small investments focused on adolescents now will not only result in healthy and empowered adults who thrive and contribute positively to their communities, but it will also result in healthier future generations, yielding enormous returns.”

Data in the report, Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation, reveal stark differences in causes of death when separating the adolescent group by age (younger adolescents aged 10-14 years and older ones aged 15- 19) and by sex. The report also includes the range of interventions – from seat-belt laws to comprehensive sexuality education – that countries can take to improve their health and well-being and dramatically cut unnecessary deaths.

Road injuries
In 2015, road injuries were the leading cause of adolescent death among 10 to 19-year-olds, resulting in approximately 115,000 adolescent deaths. Older adolescent boys aged 15 to 19 years experienced the greatest burden. Most young people killed in road crashes are vulnerable road users such as pedestrians, cyclists and motorcyclists.

However, differences between regions are stark. Looking only at low- and middleincome countries in Africa, communicable diseases such as HIV/AIDS, lower respiratory infections, meningitis and diarrhoeal diseases are bigger causes of death among adolescents than road injuries.

Lower respiratory infections and pregnancy complications
The picture for girls differs greatly. The leading cause of death for younger adolescent girls aged 10-14 years are lower respiratory infections, such as pneumonia – often a result of indoor air pollution from cooking with dirty fuels. Pregnancy complications, such as haemorrhage, sepsis, obstructed labour and complications from unsafe abortions, are the top cause of death among 15 to 19-year-old girls.

Self-harm and suicide
Suicide and accidental death from selfharm were the third cause of adolescent mortality in 2015, resulting in an estimated 67,000 deaths. Self-harm largely occurs among older adolescents, and globally it is the second leading cause of death for older adolescent girls. It is the leading or second cause of adolescent death in Europe and South-East Asia.

Vulnerable population
Adolescent health needs intensify in humanitarian and fragile settings. Young people often take on adult responsibilities, including caring for siblings or working, and may be compelled to drop out of school, marry early or engage in transactional sex to meet their basic survival needs. As a result, they suffer malnutrition, unintentional injuries, pregnancies, diarrhoeal diseases, sexual violence, sexually-transmitted diseases and mental health issues.

Interventions
“Improving the way health systems serve adolescents is just one part of improving their health,” says Dr Anthony Costello, Director, Maternal, Newborn, Child and Adolescent Health, WHO. “Parents, families and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.”

The AA-HA! Guidance recommends interventions across sectors, including comprehensive sexuality education in schools; higher age limits for alcohol consumption; mandating seat-belts and helmets through laws; reducing access to and misuse of firearms; reducing indoor air pollution through cleaner cooking fuels; and increasing access to safe water, sanitation and hygiene. It also provides detailed explanations of how countries can deliver these interventions with adolescent health programmes.


Hospitals treated as targets by parties to conflict – UN chief

Parties to conflict are treating hospitals and clinics as targets, rather than respecting them as sanctuaries, United Nations Secretary- General António Guterres warned in May at a Security Council debate on the protection of civilians in armed violence.

“Despite our efforts, civilians continue to bear the brunt of conflict around the world,” Guterres told the 15-member body, stressing that attacks on medical staff and facilities continue in conflict zones. Alongside him were Christine Beerli, Vice-President of the International Committee of the Red Cross (ICRC) and Bruno Stagno Ugarte, Deputy Executive Director for Advocacy of Human Rights Watch.

The UN chief recalled that last year, the Council took specific action to improve the protection of medical care during conflict, by adopting Resolution 2286, which, among others, urged ‘States and all parties to armed conflict to develop effective measures to prevent and address acts of violence, attacks and threats against medical personnel and humanitarian personnel exclusively engaged in medical duties.

In August, his predecessor submitted recommendations for the swift implementation of this resolution.

“But on the ground, little has changed,” Guterres warned, citing statistics from the World Health Organization showing that attacks on medical care took place in at least 20 countries affected by conflict in 2016.

In Syria, Physicians for Human Rights has documented more than 400 attacks on medical facilities since the conflict began. More than 800 medical staff have been killed, and more than half of all medical facilities are closed or are only partially functioning, with two-thirds of specialized medical personnel having fled the country.

In Yemen, just a few months after the adoption of resolution 2286, 15 people including three medical staff were reported killed when a hospital was hit in an airstrike.

In Afghanistan, the number of reported attacks against health facilities and personnel almost doubled in 2016 compared with 2015.

In South Sudan, after years of attacks, less than 50% of medical facilities are functional in areas affected by conflict.

“These attacks are evidence of a broader trend: parties to conflict are treating hospitals and health clinics as targets, rather than respecting them as sanctuaries,” Guterres said.

He went on to highlight the three main protection priorities; ensure greater respect for international humanitarian and human rights law; stepping up the protection of humanitarian and medical missions, by implementing his predecessor’s recommendations on Security Council resolution 2286 (2016); and preventing forced displacement and finding durable solutions for refugees and internally displaced people.

On the third point, he stressed the need to address the root causes of conflicts that are driving displacement, by investing in inclusive and sustainable development, promoting all human rights and the rule of law, strengthening governance and institutions, and enhancing mediation capacity, from communities to national governments.

“Preventing and ending conflict is my first priority,” he declared. “I call on you all to make it yours, for the sake of the millions of civilians who are suffering around the world.”


Major research funders to implement WHO standards on reporting clinical trial results

Some of the world’s largest funders of medical research and international non-governmental organizations have agreed on new standards that will require all clinical trials they fund or support to be registered and the results disclosed publicly.

In a joint statement in May, the Indian Council of Medical Research, the Norwegian Research Council, the UK Medical Research Council, Médecins Sans Frontières and Epicentre (its research arm), PATH, the Coalition for Epidemic Preparedness Innovations (CEPI), Institut Pasteur, the Bill & Melinda Gates Foundation, and the Wellcome Trust agreed to develop and implement policies within the next 12 months that require all trials they fund, co-fund, sponsor or support to be registered in a publicly-available registry. They also agreed that all results would be disclosed within specified timeframes on the registry and/or by publication in a scientific journal.

Currently, about 50% of clinical trials go unreported, according to several studies, often because the results are negative. These unreported trial results leave an incomplete and potentially misleading picture of the risks and benefits of vaccines, drugs and medical devices, and can lead to use of suboptimal or even harmful products.

“Research funders are making a strong statement that there will be no more excuses on why some clinical trials remain unreported long after they have completed,” said Dr Marie-Paule Kieny, Assistant Director-General for Health Systems and Innovation at WHO.

The signatories to the statement also agreed to monitor compliance with registration requirements and to endorse the development of systems to monitor results reporting.

“We need timely clinical trial results to inform clinical care practices as well as make decisions about allocation of resources for future research,” said Dr Soumya Swaminathan, Director-General of the Indian Council of Medical Research. “We welcome the agreement of international standards for reporting timeframes that everyone can work towards.”

In 2015 WHO published its position on public disclosure of results from clinical trials, which defines timeframes within which results should be reported, and calls for older unpublished trials to be reported. That position builds on the World Medical Association’s Declaration of Helsinki in 2013. Today’s agreement by some of the world’s major research funders and international NGOs will mean the ethical principles described in both statements will now be enforced in thousands of trials every year.

Dr Trevor Mundel, President, Global Health, Bill & Melinda Gates Foundation, said: “It’s a 21st-century best practice – and an essential part of the social contract that underlies medical research – that clinical trial data should be made publicly available less than one year after a clinical trial’s completion. We strongly support WHO’s effort to establish a global standard for reporting data within this timeframe, which is a practice we require of our grantees as well.”

“Requiring summary results of clinical trials to be made freely available through open access registries within 12 months of study completion is good for both science and society,” said Dr Jeremy Farrar, Director of the Wellcome Trust. “Not only will this help ensure that these research findings are more discoverable, but it will also reduce reporting biases, which currently favour publication of trials which have a positive outcome.”

Most of these trials and their results will be accessible via WHO’s International Clinical Trials Registry Platform, a unique global database of clinical trials that compiles data from 17 registries around the world, including the United States of America’s ClinicalTrials.gov, the European Union’s Clinical Trials Register, the Chinese and Indian Clinical Trial Registries and many others.

Dr Micaela Serafini, Medical Director, Médecins Sans Frontières, said: “Timely reporting of all clinical trial results is of upmost importance to MSF allowing fully informed decisions when it comes to health strategies, treatments and diagnostics. We fully support this move towards increased transparency and accountability in clinical research.”

WHO International Clinical Trials Registry Platform
www.who.int/ictrp


Life expectancy set to increase in developed nations, potentially surpassing 90 years in some countries

Life expectancies in developed countries are projected to continue increasing, with women’s life expectancy potentially surpassing 90 years old in South Korea by 2030, according to a study published in The Lancet.

The study predicts life expectancy is likely to be highest in South Korea (90.8 years old), France (88.6 years old) and Japan (88.4 years old) for women, and in South Korea (84.1 years old), Australia (84.0 years old) and Switzerland (84.0 years old) for men.

The researchers advise that increasing life expectancies will have major implications for health and social services that will need to adapt and will require policies to support healthy ageing, increase investment in health and social care, and possibly changes to retirement age.

“As recently as the turn of the century, many researchers believed that life expectancy would never surpass 90 years,” said lead author Professor Majid Ezzati, Imperial College London, UK. “Our predictions of increasing lifespans highlight our public health and healthcare successes. However, it is important that policies to support the growing older population are in place. In particular, we will need to both strengthen our health and social care systems and to establish alternative models of care such as technology-assisted home care.”

In the study, researchers used a statistical technique used in weather forecasting to determine their projections and how certain they are. They developed 21 models to predict life expectancy in 35 developed countries – unlike most life expectancy projections which are based on a single model – and combined the results from these models based on how well they performed. All the predictions in the study come with a range of uncertainty. For instance, there is a 90% probability that life expectancy for South Korean women in 2030 will be higher than 86.7 years, and a 57% probability that it will be higher than 90 years.

Although life expectancy is predicted to increase across all 35 countries, the extent of the increase varies by country. Comparing 2030 and 2010 life expectancies, female life expectancy is projected to increase most in South Korea, Slovenia and Portugal (6.6, 4.7 and 4.4 years, respectively). While for men life expectancy will increase most in Hungary, South Korea and Slovenia (7.5, 7.0 and 6.4 years).

Life expectancy is predicted to increase least in Macedonia, Bulgaria, Japan and the USA (1.4, 1.5, 1.8 and 2.1 years) for women, and in Macedonia, Greece and Sweden and the USA (2.4, 2.7, 3.0 and 3.0 years) for men.

The USA is predicted to see relatively small improvements in life expectancy (from 81.2 for in 2010 to 83.3 in 2030 for women and 76.5 to 79.5 for men). US life expectancy is already lower than most other high-income countries, and is expected to fall further behind in 2030, potentially as a result of its large inequalities, absence of universal health insurance and of the country having the highest homicide rate, body mass index (BMI) and death rates for children and mothers of all high-income countries.

Conversely, South Korea’s projected gains may be the result of continued improvements in economic status which has improved nutrition for children, access to healthcare and medical technology across the whole population. This has resulted in fewer deaths from infections and better prevention and treatment for chronic diseases, in a way that is more equitable than some Western countries.

As well as calculating life expectancy at birth in 2030, the researchers projected how long those aged 65 years were likely to live in 2030. They found that women were likely to live an additional 24 years in 11 of the 35 countries, and that 65-year old men were likely to an additional 20 years in 22 countries – illustrating that older populations are likely to continue growing across the developed world.

With an ageing population it will be important to help people to age healthily and ease the impact of an ageing population on health systems through programmes that support healthy lifestyles and detect and treat diseases early. Providing assistive technology could also help older people remain in their homes by compensating for loss of mobility and senses, while building communities that are more accessible and providing good transportation services could help older people access amenities while staying in their community for longer.

The social implications of this change will also likely require changes to pensions and retirement, with further payments of social security and pensions needed to support those living longer. As a result, the researchers propose changes to working practice through changing retirement age or creating schemes that allow a gradual transition to retirement.

“Dealing with an ageing population will require a combination of strengthening and positioning our health and social care systems and our societies as a whole, so as to ensure that people age healthily, continue to contribute to society for longer, and receive appropriate pension and care once they age.” said Professor Ezzati.

 

 

Date of upload: 19th Jul 2017

                                  
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