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Poor health outcomes in Native Americans and Alaska Natives
Editorial
Karen Kasmauski/Corbis
Poor health outcomes in Native Americans and Alaska Natives
For the CDC reports published by the American Journal of Public Health see http://ajph. aphapublications.org/toc/ ajph/o/o
A series of reports by the US Centers for Disease Control and Prevention (CDC) published on April 22, highlighted worrying health statistics in Native American and Alaska Native populations compared with white people. The all-cause death rate from 1999 to 2009 was 46% higher for Native Americans and Alaska Natives. Risk factors for cancers and heart disease, such as obesity, smoking, and hypertension were substantially higher in Native Americans and Alaska Natives, as were prevalence and death rates from cancer, particularly for lung, kidney, colorectal, cervical, and prostate cancers. Similarly, infectious diseases such as pneumonia, influenza, and tuberculosis, and chronic diseases (such as chronic liver disease and diabetes) caused significantly more deaths in Native Americans and Alaska Natives. An extremely worrying statistic is that the death rate from suicide was nearly 50% higher in Native Americans and Alaska Natives than in white people. The Indian Health Service (IHS; an agency of the US Department of Health and Human Services that provides
health care to Native Americans and Alaskan Natives) has been chronically underfunded, which might have contributed to the health problems described in these reports. However, working with these communities, the IHS can help patients to understand and take advantage of new coverage under the Affordable Care Act that will increase their access to quality health care. Enhanced social support within communities could also help to lower the risk of suicide. However, the onus of health improvements cannot rest on the shoulders of these communities alone. Public health interventions such as improved sanitation, effective tobacco-cessation counselling, regulation of alcohol outlet densities, access to culturally appropriate health services, cancer screening programmes and outreach for geographically isolated communities, and education about diet and physical activity, could all help to reduce excess mortality rates. Funding for such interventions and Indian health services should increase as a matter of urgency. n The Lancet
Faisal Nasser/Reuters
Political commitment to MERS-CoV in Saudi Arabia
Abdullah Al Rabeeah
For the International Diabetes Federation Diabetes Altas 2013 see http://www.idf.org/sites/ default/files/EN_6E_Atlas_ Full_0.pdf
1522
On April 27, Saudi Arabia reported 16 new cases of infection by the Middle East respiratory syndrome coronavirus (MERS-CoV). Worldwide, from September, 2012, to April 26, 2014, WHO has reported 261 laboratory-confirmed infections, including 93 deaths. According to Nick Phin of Public Health England, and academics involved in the Global Centre for Mass Gatherings Medicine, the recent apparent rise in MERS-CoV infections in Saudi Arabia could have resulted from various factors, including seasonality, increased proactive screening, and poor infection control measures. The rising death toll from MERS-CoV has increased public concern about the spread of the disease and, on occasion, criticism of the Saudi Ministry of Health for its handling of the MERS outbreak. Therefore, the removal of former Health Minister Abdullah Al Rabeeah from his post on April 21, without any detailed explanation, caused speculation about the reasons for Al Rabeeah’s departure and its implications for health in Saudi Arabia. According to the Saudi Ministry of Health, Al Rabeeah has been “discharged from his current position and
appointed as an adviser at the Royal Court (Diwan) at a rank of minister. The Labour Minister—Adel Fakieh— will replace him as Minister for both Labour and Health. As yet unconfirmed, an explanation suggested to The Lancet is that Abdullah Al Rabeeah will devote more time to health reform in the country. If this role is confirmed, Al Rabeeah could consider diabetes a priority for the country’s health reform—according to the International Diabetes Federation Diabetes Atlas 2013, the prevalence of diabetes in Saudi Arabia has increased dramatically to 24%, the highest in the Middle East. For all countries facing emerging infectious diseases, there needs to be clear, honest, and timely communication between the government and its health departments and the public. For Saudi Arabia, the government can allay fears by explaining the reasons for Al Rabeeah’s transfer, and any implications for ongoing management of MERS-CoV. The challenges of public health security in Saudi Arabia, particularly mass gatherings like the Hajj, demand the attention of a fulltime Health Minister. n The Lancet www.thelancet.com Vol 383 May 3, 2014
Karen Kasmauski/Corbis
Poor health outcomes in Native Americans and Alaska Natives
For the CDC reports published by the American Journal of Public Health see http://ajph. aphapublications.org/toc/ ajph/o/o
A series of reports by the US Centers for Disease Control and Prevention (CDC) published on April 22, highlighted worrying health statistics in Native American and Alaska Native populations compared with white people. The all-cause death rate from 1999 to 2009 was 46% higher for Native Americans and Alaska Natives. Risk factors for cancers and heart disease, such as obesity, smoking, and hypertension were substantially higher in Native Americans and Alaska Natives, as were prevalence and death rates from cancer, particularly for lung, kidney, colorectal, cervical, and prostate cancers. Similarly, infectious diseases such as pneumonia, influenza, and tuberculosis, and chronic diseases (such as chronic liver disease and diabetes) caused significantly more deaths in Native Americans and Alaska Natives. An extremely worrying statistic is that the death rate from suicide was nearly 50% higher in Native Americans and Alaska Natives than in white people. The Indian Health Service (IHS; an agency of the US Department of Health and Human Services that provides
health care to Native Americans and Alaskan Natives) has been chronically underfunded, which might have contributed to the health problems described in these reports. However, working with these communities, the IHS can help patients to understand and take advantage of new coverage under the Affordable Care Act that will increase their access to quality health care. Enhanced social support within communities could also help to lower the risk of suicide. However, the onus of health improvements cannot rest on the shoulders of these communities alone. Public health interventions such as improved sanitation, effective tobacco-cessation counselling, regulation of alcohol outlet densities, access to culturally appropriate health services, cancer screening programmes and outreach for geographically isolated communities, and education about diet and physical activity, could all help to reduce excess mortality rates. Funding for such interventions and Indian health services should increase as a matter of urgency. n The Lancet
Faisal Nasser/Reuters
Political commitment to MERS-CoV in Saudi Arabia
Abdullah Al Rabeeah
For the International Diabetes Federation Diabetes Altas 2013 see http://www.idf.org/sites/ default/files/EN_6E_Atlas_ Full_0.pdf
1522
On April 27, Saudi Arabia reported 16 new cases of infection by the Middle East respiratory syndrome coronavirus (MERS-CoV). Worldwide, from September, 2012, to April 26, 2014, WHO has reported 261 laboratory-confirmed infections, including 93 deaths. According to Nick Phin of Public Health England, and academics involved in the Global Centre for Mass Gatherings Medicine, the recent apparent rise in MERS-CoV infections in Saudi Arabia could have resulted from various factors, including seasonality, increased proactive screening, and poor infection control measures. The rising death toll from MERS-CoV has increased public concern about the spread of the disease and, on occasion, criticism of the Saudi Ministry of Health for its handling of the MERS outbreak. Therefore, the removal of former Health Minister Abdullah Al Rabeeah from his post on April 21, without any detailed explanation, caused speculation about the reasons for Al Rabeeah’s departure and its implications for health in Saudi Arabia. According to the Saudi Ministry of Health, Al Rabeeah has been “discharged from his current position and
appointed as an adviser at the Royal Court (Diwan) at a rank of minister. The Labour Minister—Adel Fakieh— will replace him as Minister for both Labour and Health. As yet unconfirmed, an explanation suggested to The Lancet is that Abdullah Al Rabeeah will devote more time to health reform in the country. If this role is confirmed, Al Rabeeah could consider diabetes a priority for the country’s health reform—according to the International Diabetes Federation Diabetes Atlas 2013, the prevalence of diabetes in Saudi Arabia has increased dramatically to 24%, the highest in the Middle East. For all countries facing emerging infectious diseases, there needs to be clear, honest, and timely communication between the government and its health departments and the public. For Saudi Arabia, the government can allay fears by explaining the reasons for Al Rabeeah’s transfer, and any implications for ongoing management of MERS-CoV. The challenges of public health security in Saudi Arabia, particularly mass gatherings like the Hajj, demand the attention of a fulltime Health Minister. n The Lancet www.thelancet.com Vol 383 May 3, 2014