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Indigenous health in Australia: unacceptable differences remain
Editorial
Corbis
Banking on the BRICS for health?
For The Lancet Series on Health in Europe see http://www. thelancet.com/series/health-ineurope For more on chronic kidney disease in China see Articles Lancet 2012; 379: 815 For more on health in South Africa see Series Lancet 2012; 380: 2029 For The Lancet’s 2011 Series on India see http://www.thelancet. com/series/india-towardsuniversal-health-coverage
Leaders of the BRICS (Brazil, Russia, India, China, and South Africa) nations met in Durban, South Africa, last week (March 26–27), for their fifth annual Summit, and made an intriguing decision: to establish between them a new development bank. The bank would mobilise resources for infrastructure and sustainable development projects in BRICS and other emerging economies and could one day rival the World Bank and International Monetary Fund. However, the BRICS leaders could not reach an agreement over the bank’s size and infrastructure at the Summit. Some observers have since speculated that it could take years to negotiate contributions from the countries, the location of the headquarters, and the appointment of a leader for this first BRICS institution. But there are additional issues. A true development bank should support health as well as infrastructure. However, in the final communiqué from the Summit, health issues were notably absent. Furthermore, there was no mention of the Delhi communiqué, agreed by the BRICS health ministers in January, which identified several priority areas for the nations, including
non-communicable diseases, mental disorders, multidrug-resistant tuberculosis, malaria, and HIV/AIDS. This omission is disappointing considering the huge health challenges these emerging economies face. As The Lancet’s Series on Health in Europe showed, life expectancy in Russia is shockingly low when compared with countries in western Europe, largely because of high levels of alcohol and tobacco use. China’s number one health threat is now non-communicable diseases; the country has the highest prevalence of chronic kidney disease and diabetes in the world. South Africa, meanwhile, has so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental disorders; injury and violence; and high burdens of maternal, neonatal, and child illness and deaths. And, in our 2011 Series, we noted that “a failing health system is perhaps India’s greatest predicament of all”. These issues are hard to ignore, especially as they represent threats to both the health and economies of these nations. If a BRICS development bank does emerge, a focus on improving population health could be its wisest investment. The Lancet
Corbis
Indigenous health in Australia: unacceptable differences remain
This online publication has been corrected. The corrected version first appeared at thelancet.com on April 26, 2013
For the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland see http://www.aihw.gov.au/ WorkArea/DownloadAsset. aspx?id=60129542792
1158
The Australian Institute of Health and Welfare released the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland on March 25. The report draws attention to the many disparities between the Aboriginal and Torres Strait Islander (Indigenous) and the non-Indigenous populations of Queensland, Australia, in terms of health status and outcomes; determinants of health; and health system performance. Additionally, the data for Queensland are compared with those nationally. By June 30, 2011, 4·2% of Queensland’s population were Indigenous. In 2009, 52% of the Indigenous and 16% of the non-Indigenous women in Queensland smoked during pregnancy. Incidences of lung and cervical cancers in 2004–08 were 1·7 and 3·4 times higher, respectively, in the Indigenous population than in the non-Indigenous population. Between July, 2008, and June, 2010, the rates of hospital admissions for cancer were lower for the Indigenous population. The incidence of end-stage renal disease was higher in the Indigenous population in 2008–10, with the greatest
(14·4 times) difference in the age group 45–54 years. From 2006 to 2010, the mortality rates from chronic illnesses, including cancer, diabetes, and circulatory, respiratory, and kidney diseases, were higher in the Indigenous population—eg, 7·8 times for diabetes. In 2006, 46% of the Indigenous population were in the most disadvantaged quintile of socioeconomic status compared with 19% of the non-Indigenous population. The good news is that some improvements have occurred in Queensland. From 2001 to 2010, the rate of avoidable deaths fell by 32% in the Indigenous population. Also, the infant mortality rate decreased by 41%, with a reduction of 71% in the disparity between the Indigenous and non-Indigenous populations. Although the ill treatment of the Indigenous Australians will not be forgotten, the Government of Australia needs to respond to the findings of its report and find ways to improve the circumstances, health, and welfare of this population so that they are on a par with those of the non-Indigenous population. The Lancet www.thelancet.com Vol 381 April 6, 2013
Corbis
Banking on the BRICS for health?
For The Lancet Series on Health in Europe see http://www. thelancet.com/series/health-ineurope For more on chronic kidney disease in China see Articles Lancet 2012; 379: 815 For more on health in South Africa see Series Lancet 2012; 380: 2029 For The Lancet’s 2011 Series on India see http://www.thelancet. com/series/india-towardsuniversal-health-coverage
Leaders of the BRICS (Brazil, Russia, India, China, and South Africa) nations met in Durban, South Africa, last week (March 26–27), for their fifth annual Summit, and made an intriguing decision: to establish between them a new development bank. The bank would mobilise resources for infrastructure and sustainable development projects in BRICS and other emerging economies and could one day rival the World Bank and International Monetary Fund. However, the BRICS leaders could not reach an agreement over the bank’s size and infrastructure at the Summit. Some observers have since speculated that it could take years to negotiate contributions from the countries, the location of the headquarters, and the appointment of a leader for this first BRICS institution. But there are additional issues. A true development bank should support health as well as infrastructure. However, in the final communiqué from the Summit, health issues were notably absent. Furthermore, there was no mention of the Delhi communiqué, agreed by the BRICS health ministers in January, which identified several priority areas for the nations, including
non-communicable diseases, mental disorders, multidrug-resistant tuberculosis, malaria, and HIV/AIDS. This omission is disappointing considering the huge health challenges these emerging economies face. As The Lancet’s Series on Health in Europe showed, life expectancy in Russia is shockingly low when compared with countries in western Europe, largely because of high levels of alcohol and tobacco use. China’s number one health threat is now non-communicable diseases; the country has the highest prevalence of chronic kidney disease and diabetes in the world. South Africa, meanwhile, has so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental disorders; injury and violence; and high burdens of maternal, neonatal, and child illness and deaths. And, in our 2011 Series, we noted that “a failing health system is perhaps India’s greatest predicament of all”. These issues are hard to ignore, especially as they represent threats to both the health and economies of these nations. If a BRICS development bank does emerge, a focus on improving population health could be its wisest investment. The Lancet
Corbis
Indigenous health in Australia: unacceptable differences remain
This online publication has been corrected. The corrected version first appeared at thelancet.com on April 26, 2013
For the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland see http://www.aihw.gov.au/ WorkArea/DownloadAsset. aspx?id=60129542792
1158
The Australian Institute of Health and Welfare released the Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Queensland on March 25. The report draws attention to the many disparities between the Aboriginal and Torres Strait Islander (Indigenous) and the non-Indigenous populations of Queensland, Australia, in terms of health status and outcomes; determinants of health; and health system performance. Additionally, the data for Queensland are compared with those nationally. By June 30, 2011, 4·2% of Queensland’s population were Indigenous. In 2009, 52% of the Indigenous and 16% of the non-Indigenous women in Queensland smoked during pregnancy. Incidences of lung and cervical cancers in 2004–08 were 1·7 and 3·4 times higher, respectively, in the Indigenous population than in the non-Indigenous population. Between July, 2008, and June, 2010, the rates of hospital admissions for cancer were lower for the Indigenous population. The incidence of end-stage renal disease was higher in the Indigenous population in 2008–10, with the greatest
(14·4 times) difference in the age group 45–54 years. From 2006 to 2010, the mortality rates from chronic illnesses, including cancer, diabetes, and circulatory, respiratory, and kidney diseases, were higher in the Indigenous population—eg, 7·8 times for diabetes. In 2006, 46% of the Indigenous population were in the most disadvantaged quintile of socioeconomic status compared with 19% of the non-Indigenous population. The good news is that some improvements have occurred in Queensland. From 2001 to 2010, the rate of avoidable deaths fell by 32% in the Indigenous population. Also, the infant mortality rate decreased by 41%, with a reduction of 71% in the disparity between the Indigenous and non-Indigenous populations. Although the ill treatment of the Indigenous Australians will not be forgotten, the Government of Australia needs to respond to the findings of its report and find ways to improve the circumstances, health, and welfare of this population so that they are on a par with those of the non-Indigenous population. The Lancet www.thelancet.com Vol 381 April 6, 2013