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Securing a fairer deal for children
Editorial
Cordelia Molloy/Science Photo Library
Strong stewardship to fight antimicrobial resistance
See Comment page 1699 See Articles page 1743
For the guideline Implementing an Antibiotic Stewardship Program see http://cid. oxfordjournals.org/content/ early/2016/04/11/cid.ciw118. abstract For the Lancet Series on antimicrobials see http://www. thelancet.com/series/ antimicrobials-access-andsustainable-effectiveness
Antibiotics have undoubtedly revolutionised medicine. However, widespread use of antimicrobial drugs in medicine and agriculture has spurred the evolution of pan-resistant bacterial strains. With few new antibiotics in the development pipeline, the threat to public health of antimicrobial resistance is all too real. Strong stewardship policies are urgently needed to stem inappropriate prescribing and use of antibiotics. On April 13, the Infectious Diseases Society of America and the Society for Health Care Epidemiology of America released a new guideline: Implementing an Antibiotic Stewardship Program, with 27 recommendations that cover a broad range of antibiotic stewardship interventions. Among the recommendations are use of preauthorisation for antibiotic prescribing, restriction of use of antibiotics with high risk of Clostridium difficile infection, and strategies for specific health-care settings (such as nursing homes) to reduce unnecessary or inappropriate antibiotic use. Of note, although these recommendations can be used across a range of clinical settings, the authors highlight the lack evidence for
effective antibiotic stewardship interventions, and call for increased research to determine how to best achieve large-scale implementation of these measures. In today’s Lancet, Michael Hallsworth and colleagues report outcomes of a randomised controlled trial in general practice surgeries in England with high rates of antibiotic prescribing. Social norm feedback—provided as a letter from the Chief Medical Officer—reduced the number of antibiotics prescribed by doctors in the intervention group over the following 6 months. Although successful, Timothy Lawes reminds readers that many behavioural interventions are context dependent, and region-specific strategies will need to be implemented. In a Lancet Series on antimicrobials, Osman Dar and colleagues propose a policy framework to preserve effectiveness of antimicrobials, which includes fostering responsible use and implementing a robust surveillance and monitoring system. Now that the urgent need to combat antimicrobial resistance is finally on the global agenda, antibiotic stewardship policies must be grounded in a robust evidence base. The Lancet
Michael Biach/Demotix/Corbis
Securing a fairer deal for children
For the UNICEF report see http://www.unicef.org.uk/ Documents/Campaignsdocuments/RC13-ENG-FINAL. pdf
1694
As American philosopher John Rawls noted in A Theory of Justice, “The natural distribution is neither just nor unjust; nor is it unjust that persons are born into society at some particular position. These are simply natural facts. What is just and unjust is the way that institutions deal with these facts.” This principle underlies a new report by UNICEF released last week, which assesses how well countries are looking after the wellbeing of their most disadvantaged children—a measure of a nation’s fairness. The report presents an overview of inequalities in child wellbeing in 41 countries from the European Union and the Organisation for Economic Co-operation and Development. It ranks countries in so-called bottom-end inequality—the gap between children at the bottom and those in the middle—in four areas: income, education, health, and life satisfaction. Health was measured by children’s daily self-reported health symptoms—eg, headache, stomach ache, backache, or feeling low or nervous. The smallest relative health gaps were found in Austria, Germany, and Switzerland. The
largest gaps were found in Israel, Turkey, and Poland. No country made clear progress in reducing inequalities in child health from 2002–14. Furthermore, the gap actually increased in 25 countries, with large increases in Ireland, Malta, Poland, and Slovenia. Interestingly, the report also assessed income inequality and social transfers (ie, taxes and benefits) in Europe. It shows that income inequality is higher before transfers than after them in every country. It should be an alert for any government thinking about cuts to benefit levels: child poverty will increase. To address the gaps, the report’s recommendations include protecting the incomes of households with the poorest children, promoting and supporting healthy lifestyles for all children, and placing equity at the heart of child wellbeing agendas. Indeed, the fact that children fall less far behind in some countries than others shows that large gaps are not inevitable. Creating fairer societies for children is achievable with targeted policies. It is time for governments to deal with these facts. The Lancet www.thelancet.com Vol 387 April 23, 2016
Cordelia Molloy/Science Photo Library
Strong stewardship to fight antimicrobial resistance
See Comment page 1699 See Articles page 1743
For the guideline Implementing an Antibiotic Stewardship Program see http://cid. oxfordjournals.org/content/ early/2016/04/11/cid.ciw118. abstract For the Lancet Series on antimicrobials see http://www. thelancet.com/series/ antimicrobials-access-andsustainable-effectiveness
Antibiotics have undoubtedly revolutionised medicine. However, widespread use of antimicrobial drugs in medicine and agriculture has spurred the evolution of pan-resistant bacterial strains. With few new antibiotics in the development pipeline, the threat to public health of antimicrobial resistance is all too real. Strong stewardship policies are urgently needed to stem inappropriate prescribing and use of antibiotics. On April 13, the Infectious Diseases Society of America and the Society for Health Care Epidemiology of America released a new guideline: Implementing an Antibiotic Stewardship Program, with 27 recommendations that cover a broad range of antibiotic stewardship interventions. Among the recommendations are use of preauthorisation for antibiotic prescribing, restriction of use of antibiotics with high risk of Clostridium difficile infection, and strategies for specific health-care settings (such as nursing homes) to reduce unnecessary or inappropriate antibiotic use. Of note, although these recommendations can be used across a range of clinical settings, the authors highlight the lack evidence for
effective antibiotic stewardship interventions, and call for increased research to determine how to best achieve large-scale implementation of these measures. In today’s Lancet, Michael Hallsworth and colleagues report outcomes of a randomised controlled trial in general practice surgeries in England with high rates of antibiotic prescribing. Social norm feedback—provided as a letter from the Chief Medical Officer—reduced the number of antibiotics prescribed by doctors in the intervention group over the following 6 months. Although successful, Timothy Lawes reminds readers that many behavioural interventions are context dependent, and region-specific strategies will need to be implemented. In a Lancet Series on antimicrobials, Osman Dar and colleagues propose a policy framework to preserve effectiveness of antimicrobials, which includes fostering responsible use and implementing a robust surveillance and monitoring system. Now that the urgent need to combat antimicrobial resistance is finally on the global agenda, antibiotic stewardship policies must be grounded in a robust evidence base. The Lancet
Michael Biach/Demotix/Corbis
Securing a fairer deal for children
For the UNICEF report see http://www.unicef.org.uk/ Documents/Campaignsdocuments/RC13-ENG-FINAL. pdf
1694
As American philosopher John Rawls noted in A Theory of Justice, “The natural distribution is neither just nor unjust; nor is it unjust that persons are born into society at some particular position. These are simply natural facts. What is just and unjust is the way that institutions deal with these facts.” This principle underlies a new report by UNICEF released last week, which assesses how well countries are looking after the wellbeing of their most disadvantaged children—a measure of a nation’s fairness. The report presents an overview of inequalities in child wellbeing in 41 countries from the European Union and the Organisation for Economic Co-operation and Development. It ranks countries in so-called bottom-end inequality—the gap between children at the bottom and those in the middle—in four areas: income, education, health, and life satisfaction. Health was measured by children’s daily self-reported health symptoms—eg, headache, stomach ache, backache, or feeling low or nervous. The smallest relative health gaps were found in Austria, Germany, and Switzerland. The
largest gaps were found in Israel, Turkey, and Poland. No country made clear progress in reducing inequalities in child health from 2002–14. Furthermore, the gap actually increased in 25 countries, with large increases in Ireland, Malta, Poland, and Slovenia. Interestingly, the report also assessed income inequality and social transfers (ie, taxes and benefits) in Europe. It shows that income inequality is higher before transfers than after them in every country. It should be an alert for any government thinking about cuts to benefit levels: child poverty will increase. To address the gaps, the report’s recommendations include protecting the incomes of households with the poorest children, promoting and supporting healthy lifestyles for all children, and placing equity at the heart of child wellbeing agendas. Indeed, the fact that children fall less far behind in some countries than others shows that large gaps are not inevitable. Creating fairer societies for children is achievable with targeted policies. It is time for governments to deal with these facts. The Lancet www.thelancet.com Vol 387 April 23, 2016