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Healthy migration needs a long-term plan
Editorial
Star Shooter/Mediapunch/Corbis
Promising the moon
For Cancer MoonShot 2020 see http://www. cancermoonshot2020.org/ For the 2013 Lancet Series The Cancer Wars see http:// www.thelancet.com/series/thecancer-wars
In his last State of the Union speech on Jan 12, 2016, President Barack Obama endorsed what Vice President Joe Biden has called our generation’s “moonshot”—a renewed commitment to end cancer. Evoking the sentiment of the “spirit of discovery” and the imagery of American space exploration, Obama symbolically appointed Biden as the head of “ground control” in this mission for the remainder of the Administration’s term. Taking up this mantle, Biden, whose son died from brain cancer earlier in October, 2015, visited Penn Medicine’s Abramson Cancer Center in Philadelphia on Jan 14, and laid out an ambitious yet nebulous plan to accelerate research in the pursuit of curing cancer. Obama is expected to issue an executive order that directs all relevant federal agencies and departments to work with Biden on the initiative, although it is not clear in what form his direction will take beyond engaging stakeholders and starting communications. It will, however, involve a substantial degree of diplomacy and political finesse. As Biden suggested, one of the primary impediments to scientific breakthroughs is “cancer
politics” and restricting access to data and information among biotechnology companies and researchers. This situation might be improving with some propitious datasharing developments, such as the recent formation of the National Immunotherapy Coalition, slated to bring together academia, pharma, biotech, and other industries in its immunotherapy-focused Cancer MoonShot 2020. But campaigns such as the moonshot present a substantial risk. At once they are both grandiose and overly simplistic, much like the “war on cancer”. A 2013 Lancet Series called for a rethinking of the metaphor, pointing to the limitations of conceptualising research efforts in such a way. In addition to looking for breakthroughs, there must also be a more comprehensive focus that considers all the factors that can boost cancer advances, including greater attention to prevention, strengthening healthcare systems, and addressing inequalities that contribute to poor outcomes. Without using an integrative approach to target cancer, the moonshot has the same limitations as the war on cancer—a strategy promising the moon with no way to deliver. The Lancet
Leonhard Foeger/Reuters/Corbis
Healthy migration needs a long-term plan
See Comment page 319
For the UNDESA report Trends in International Migrant Stock: The 2015 Revision see http:// www.un.org/en/development/ desa/population/migration/ data/estimates2/estimates15. shtml
312
“It occurred to me that no matter where I lived, geography could not save me”, wrote Isabel Wilkerson in The Warmth of Other Suns, recounting stories of black Americans migrating north in the twentieth century. Today, these same words could be used by international migrants who have relocated either by choice or as refugees, many of whom have inadequate access to health care. According to new data from the UN Department of Economic and Social Affairs, globally, in 2015, 244 million people were international migrants— persons living in a country other than where they were born—an increase of 41% since 2000. The largest increase in the past 15 years has been in Asia, with an addition of 26 million migrants, followed by Europe (20 million) and North America (14 million). In recent years, policy makers have placed emphasis on meeting the health-care needs of a growing, ageing global population. However, these efforts have failed to address the additional strains placed on regional health-care systems that are associated with global population shifts.
Refugees who have fled conflict zones in Syria and elsewhere represent a particularly vulnerable population who have unique health-care needs, including acute mental health problems, malnutrition, and traumaassociated injuries. Although dealing with these immediate challenges is urgent, provision of long-term health care is essential to sustainable relocation. Many displaced individuals are marginalised in host countries and face additional barriers to accessing routine healthcare services. In today’s Lancet, Etienne Langlois and colleagues highlight these difficulties and call for better access to health-care systems, and strengthening the resilience of these systems to meet the specific needs of displaced populations. The International Organization of Migration DirectorGeneral William Lacy Swing has declared that “now is the time for safe, secure and legal migration throughout the world”. Unrestricted and continuing access to healthcare services is fundamental to ensuring the safety and security of all migrant populations. The Lancet www.thelancet.com Vol 387 January 23, 2016
Star Shooter/Mediapunch/Corbis
Promising the moon
For Cancer MoonShot 2020 see http://www. cancermoonshot2020.org/ For the 2013 Lancet Series The Cancer Wars see http:// www.thelancet.com/series/thecancer-wars
In his last State of the Union speech on Jan 12, 2016, President Barack Obama endorsed what Vice President Joe Biden has called our generation’s “moonshot”—a renewed commitment to end cancer. Evoking the sentiment of the “spirit of discovery” and the imagery of American space exploration, Obama symbolically appointed Biden as the head of “ground control” in this mission for the remainder of the Administration’s term. Taking up this mantle, Biden, whose son died from brain cancer earlier in October, 2015, visited Penn Medicine’s Abramson Cancer Center in Philadelphia on Jan 14, and laid out an ambitious yet nebulous plan to accelerate research in the pursuit of curing cancer. Obama is expected to issue an executive order that directs all relevant federal agencies and departments to work with Biden on the initiative, although it is not clear in what form his direction will take beyond engaging stakeholders and starting communications. It will, however, involve a substantial degree of diplomacy and political finesse. As Biden suggested, one of the primary impediments to scientific breakthroughs is “cancer
politics” and restricting access to data and information among biotechnology companies and researchers. This situation might be improving with some propitious datasharing developments, such as the recent formation of the National Immunotherapy Coalition, slated to bring together academia, pharma, biotech, and other industries in its immunotherapy-focused Cancer MoonShot 2020. But campaigns such as the moonshot present a substantial risk. At once they are both grandiose and overly simplistic, much like the “war on cancer”. A 2013 Lancet Series called for a rethinking of the metaphor, pointing to the limitations of conceptualising research efforts in such a way. In addition to looking for breakthroughs, there must also be a more comprehensive focus that considers all the factors that can boost cancer advances, including greater attention to prevention, strengthening healthcare systems, and addressing inequalities that contribute to poor outcomes. Without using an integrative approach to target cancer, the moonshot has the same limitations as the war on cancer—a strategy promising the moon with no way to deliver. The Lancet
Leonhard Foeger/Reuters/Corbis
Healthy migration needs a long-term plan
See Comment page 319
For the UNDESA report Trends in International Migrant Stock: The 2015 Revision see http:// www.un.org/en/development/ desa/population/migration/ data/estimates2/estimates15. shtml
312
“It occurred to me that no matter where I lived, geography could not save me”, wrote Isabel Wilkerson in The Warmth of Other Suns, recounting stories of black Americans migrating north in the twentieth century. Today, these same words could be used by international migrants who have relocated either by choice or as refugees, many of whom have inadequate access to health care. According to new data from the UN Department of Economic and Social Affairs, globally, in 2015, 244 million people were international migrants— persons living in a country other than where they were born—an increase of 41% since 2000. The largest increase in the past 15 years has been in Asia, with an addition of 26 million migrants, followed by Europe (20 million) and North America (14 million). In recent years, policy makers have placed emphasis on meeting the health-care needs of a growing, ageing global population. However, these efforts have failed to address the additional strains placed on regional health-care systems that are associated with global population shifts.
Refugees who have fled conflict zones in Syria and elsewhere represent a particularly vulnerable population who have unique health-care needs, including acute mental health problems, malnutrition, and traumaassociated injuries. Although dealing with these immediate challenges is urgent, provision of long-term health care is essential to sustainable relocation. Many displaced individuals are marginalised in host countries and face additional barriers to accessing routine healthcare services. In today’s Lancet, Etienne Langlois and colleagues highlight these difficulties and call for better access to health-care systems, and strengthening the resilience of these systems to meet the specific needs of displaced populations. The International Organization of Migration DirectorGeneral William Lacy Swing has declared that “now is the time for safe, secure and legal migration throughout the world”. Unrestricted and continuing access to healthcare services is fundamental to ensuring the safety and security of all migrant populations. The Lancet www.thelancet.com Vol 387 January 23, 2016