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Health and wealth in the Americas
Editorial
Science Photo Library
UK to develop a national strategy for liver disease
For the National Plan for Liver Services UK 2009 see http:// www.basl.org.uk/media/uploads/ National_Liver_Plan_2009.pdf For The British Liver Trust see http://www. britishlivertrust.org.uk
On Oct 20, the UK Government announced it will appoint a new Clinical Director to lead the development and implementation of a national strategy for liver disease. In the UK, liver disease is the fifth largest cause of death after cardiovascular, cancer, stroke, and respiratory diseases. Over the past 30 years mortality from liver disease in young and middle-aged people has increased at least six times, with liver admissions and deaths both rising at 8–10% a year. By 2012, the UK is expected to have the highest liver disease death rates in Europe, and without action to tackle the disease, it could overtake stroke and coronary heart disease as a leading cause of death within the next 10–20 years. Coupled with the substantial burden of morbidity and huge economic cost from liver-related illnesses, a strategy is urgently needed. There are at least 100 different types of liver disease. The three major causes are alcohol consumption, viral transmission, and obesity. The new appointee should have an excellent track record of managing patients with liver disease, and be credible and determined in making
the case across government departments for the changes needed to reduce incidence and mortality, including action on prevention, especially the harmful effects of alcohol, and earlier diagnosis and treatment. He or she will need to raise the currently low political priority and status of liver patients, perhaps as a result of the perception of liver disease as largely being a lifestyle condition. The strategy has to encompass the needs of a very diverse and increasing number of patients, both those with liver disease and those at risk in the future. It needs to secure the support of all stakeholders, including specialist clinicians, patient groups, and the NHS as a whole. A national strategy approach has worked in other disease areas in the UK—the substantial improvements in age-standardised mortality in heart disease and cancer can at least in part be attributed to the national service frameworks and dedicated funding to support NHS interventions in these diseases. Such an approach now has the potential to halt the rising burden of liver disease in the UK. ■ The Lancet
PAHO
Health and wealth in the Americas
For Health Situation in the Americas: Basic Indicators 2009 see http://new.paho.org/hq/ index.php?option=com_content& task=view&id=1878&Itemid=229 For The Lancet’s Series on chronic diseases see http://www.thelancet.com/ series/chronic-diseases
1474
Four out of five deaths from chronic diseases occur in low-income and middle-income countries. Thanks to a concerted effort by several global health organisations, led by WHO, awareness about the impact of chronic diseases in developing countries has been growing over the past 5 years. People in these countries tend to develop chronic diseases at younger working ages and therefore they can, and do, push individuals and households into poverty. But poverty and income inequality can also be a driver of premature mortality from chronic diseases, according to a new report by the Pan American Health Organization (PAHO)—Health Situation in the Americas: Basic Indicators 2009. In their report, PAHO highlight the relation between poverty and income inequality and cerebrovascular diseases, a leading cause of mortality and morbidity in the Americas. Mortality due to cerebrovascular diseases is four times greater in Latin America and the Caribbean than in North America. And a large proportion of deaths from cerebrovascular diseases (90 000 of 400 000 deaths) occur prematurely, in people younger
than 65 years. The report shows that the wealthier people are, the more likely they are to delay death from cerebrovascular diseases to ages older than 65 years. 30% of the premature deaths from cerebrovascular diseases are in the poorest 20% of the population of the Americas, whereas only 13% of those premature deaths are concentrated in its richest 20%. Chronic diseases are increasingly taking their toll on populations in low-income and middle-income countries. The Lancet’s 2007 Series on chronic diseases showed that scientific and public health interventions, such as tobacco control and treatment with drugs to lower blood pressure and cholesterol, can substantially avert mortality from these diseases. Now the data from PAHO suggest that poverty-reduction strategies and policies that reduce income inequalities could also become part of the package of interventions to tackle chronic diseases. As global action on chronic diseases continues to gather momentum, this interesting possibility should be explored for chronic diseases other than cerebrovascular disease and beyond the Americas. ■ The Lancet www.thelancet.com Vol 374 October 31, 2009
Science Photo Library
UK to develop a national strategy for liver disease
For the National Plan for Liver Services UK 2009 see http:// www.basl.org.uk/media/uploads/ National_Liver_Plan_2009.pdf For The British Liver Trust see http://www. britishlivertrust.org.uk
On Oct 20, the UK Government announced it will appoint a new Clinical Director to lead the development and implementation of a national strategy for liver disease. In the UK, liver disease is the fifth largest cause of death after cardiovascular, cancer, stroke, and respiratory diseases. Over the past 30 years mortality from liver disease in young and middle-aged people has increased at least six times, with liver admissions and deaths both rising at 8–10% a year. By 2012, the UK is expected to have the highest liver disease death rates in Europe, and without action to tackle the disease, it could overtake stroke and coronary heart disease as a leading cause of death within the next 10–20 years. Coupled with the substantial burden of morbidity and huge economic cost from liver-related illnesses, a strategy is urgently needed. There are at least 100 different types of liver disease. The three major causes are alcohol consumption, viral transmission, and obesity. The new appointee should have an excellent track record of managing patients with liver disease, and be credible and determined in making
the case across government departments for the changes needed to reduce incidence and mortality, including action on prevention, especially the harmful effects of alcohol, and earlier diagnosis and treatment. He or she will need to raise the currently low political priority and status of liver patients, perhaps as a result of the perception of liver disease as largely being a lifestyle condition. The strategy has to encompass the needs of a very diverse and increasing number of patients, both those with liver disease and those at risk in the future. It needs to secure the support of all stakeholders, including specialist clinicians, patient groups, and the NHS as a whole. A national strategy approach has worked in other disease areas in the UK—the substantial improvements in age-standardised mortality in heart disease and cancer can at least in part be attributed to the national service frameworks and dedicated funding to support NHS interventions in these diseases. Such an approach now has the potential to halt the rising burden of liver disease in the UK. ■ The Lancet
PAHO
Health and wealth in the Americas
For Health Situation in the Americas: Basic Indicators 2009 see http://new.paho.org/hq/ index.php?option=com_content& task=view&id=1878&Itemid=229 For The Lancet’s Series on chronic diseases see http://www.thelancet.com/ series/chronic-diseases
1474
Four out of five deaths from chronic diseases occur in low-income and middle-income countries. Thanks to a concerted effort by several global health organisations, led by WHO, awareness about the impact of chronic diseases in developing countries has been growing over the past 5 years. People in these countries tend to develop chronic diseases at younger working ages and therefore they can, and do, push individuals and households into poverty. But poverty and income inequality can also be a driver of premature mortality from chronic diseases, according to a new report by the Pan American Health Organization (PAHO)—Health Situation in the Americas: Basic Indicators 2009. In their report, PAHO highlight the relation between poverty and income inequality and cerebrovascular diseases, a leading cause of mortality and morbidity in the Americas. Mortality due to cerebrovascular diseases is four times greater in Latin America and the Caribbean than in North America. And a large proportion of deaths from cerebrovascular diseases (90 000 of 400 000 deaths) occur prematurely, in people younger
than 65 years. The report shows that the wealthier people are, the more likely they are to delay death from cerebrovascular diseases to ages older than 65 years. 30% of the premature deaths from cerebrovascular diseases are in the poorest 20% of the population of the Americas, whereas only 13% of those premature deaths are concentrated in its richest 20%. Chronic diseases are increasingly taking their toll on populations in low-income and middle-income countries. The Lancet’s 2007 Series on chronic diseases showed that scientific and public health interventions, such as tobacco control and treatment with drugs to lower blood pressure and cholesterol, can substantially avert mortality from these diseases. Now the data from PAHO suggest that poverty-reduction strategies and policies that reduce income inequalities could also become part of the package of interventions to tackle chronic diseases. As global action on chronic diseases continues to gather momentum, this interesting possibility should be explored for chronic diseases other than cerebrovascular disease and beyond the Americas. ■ The Lancet www.thelancet.com Vol 374 October 31, 2009