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UK leads a global effort to tackle hunger and malnutrition
Editorial
Corbis
Mexico: celebrating universal health coverage
Published Online August 16, 2012 http:/dx.doi.org/10.1016/ S0140-6736(12)61342-7 See Online/Health Policy http://dx.doi.org/10.1016/ S0140-6736(12)61068-X
For the Health system reform in Mexico Series see http://www. thelancet.com/series/healthsystem-reform-in-mexico
Earlier this year, Mexico reached a truly immense landmark in its pioneering journey of health reform: achieving universal health coverage (UHC) for its 100 million citizens. This remarkable feat has been realised in less than a decade, and is detailed in a Lancet Health Policy paper published online on Aug 16—an update on The Lancet’s 2006 Series on Mexico’s early experiences of health reform. Central to Mexico’s progress is an ideological shift: health insurance is no longer seen as an employment benefit, but a right of citizenship. The outcome? 52 million previously uninsured Mexicans now have state-protected health cover via the public insurance system and instrument of Mexico’s health reform, Seguro Popular. It would be naive to assume that achieving UHC is the final destination in Mexico’s journey of health reform. Despite many crucial new changes in the way Mexico organises its health services—such as the investment in disease prevention through public health programmes (the ban on tobacco use in public places being a good
example), and encouraging signs of access to the latest drugs in clinical medicine (such as the availability of trastuzumab for breast cancer treatment)—large challenges lie ahead. The threat of a rise in the burden of non-communicable diseases looms large. There are also important lessons for other low-income and middle-income countries who share Mexico’s quest for UHC, notably the positioning of health reform within a legal framework to secure protection from future political interference. And, crucially, Mexico has showed how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development. UHC in other regions will be explored further in a themed issue of The Lancet on Sept 8. And let us not forget Mexico’s northern neighbour, where President Barack Obama is seeking to drive through the most radical reforms in the history of US health care. But for now, let us celebrate success, and hope for a sustained Mexican wave of UHC worldwide. The Lancet
Max Nash/PA Wire/Press Association Images
UK leads a global effort to tackle hunger and malnutrition
See World Report page 637
For more on the DFID Hunger summit see http://www.dfid. gov.uk/News/Latest-news/2012/ Hunger-event-news-story/ For the Sahel hunger crisis see http://www.bbc.co.uk/news/ world-africa-19074859 For the paper on stunting and underweight see Articles Lancet 2012; published online July 5. http://www.thelancet.com/ journals/lancet/article/ PIIS0140-6736 (12)60647-3/fulltext
622
A World Report in The Lancet this week highlights the food and malnutrition crisis in Yemen. Elsewhere, leading charities have warned that more than 1 million children in the Sahel region of west Africa are at risk of severe malnutrition. It was timely, therefore, that on the back of the euphoria of the London Olympics, the UK’s Prime Minister, David Cameron, co-hosted a global hunger summit with the Vice President of Brazil, Michel Temer, to kickstart efforts to tackle undernutrition in children. Malnutrition is a neglected area globally. A study published in The Lancet last month showed that, in low-income and middle-income countries in 2011, 314 million children younger than 5 years were stunted and 258 million were underweight. As well as a global commitment to reduce child malnutrition by the Rio Olympics in 2016, measures announced at the summit included investment in drought-resistant and vitaminenriched crops; a collaboration with Unilever, Syngenta, and GlaxoSmithKline to make nutritious food available to the poorest communities; and use of technology innovations to improve accountability across countries.
Tackling malnutrition globally has been unacceptably slow. To date, donor approaches have focused mainly on agricultural issues and have not placed enough emphasis on human nutrition, especially during pregnancy and the first 2 years of life—a crucial period in a child’s development. Key interventions such as improving diets of women before and during pregnancy, breastfeeding, complementary feeding, and fortification of foods for this high-risk period have not been sufficiently scaled up. Unfortunately, the summit’s emphasis on technical fixes and partnering with the private sector might fall short unless it focuses on the needs of vulnerable groups. The determinants of malnutrition—inequity, women’s nutrition and empowerment, food distribution and pricing systems, conflict and emergencies, and climate change—need addressing. Next year, The Lancet will publish a Series on maternal and child nutrition which will cover these and other issues, and hopefully pave the way towards integration of agriculture, nutrition, and food security so that the global malnutrition problem can be tackled head on. The Lancet www.thelancet.com Vol 380 August 18, 2012
Corbis
Mexico: celebrating universal health coverage
Published Online August 16, 2012 http:/dx.doi.org/10.1016/ S0140-6736(12)61342-7 See Online/Health Policy http://dx.doi.org/10.1016/ S0140-6736(12)61068-X
For the Health system reform in Mexico Series see http://www. thelancet.com/series/healthsystem-reform-in-mexico
Earlier this year, Mexico reached a truly immense landmark in its pioneering journey of health reform: achieving universal health coverage (UHC) for its 100 million citizens. This remarkable feat has been realised in less than a decade, and is detailed in a Lancet Health Policy paper published online on Aug 16—an update on The Lancet’s 2006 Series on Mexico’s early experiences of health reform. Central to Mexico’s progress is an ideological shift: health insurance is no longer seen as an employment benefit, but a right of citizenship. The outcome? 52 million previously uninsured Mexicans now have state-protected health cover via the public insurance system and instrument of Mexico’s health reform, Seguro Popular. It would be naive to assume that achieving UHC is the final destination in Mexico’s journey of health reform. Despite many crucial new changes in the way Mexico organises its health services—such as the investment in disease prevention through public health programmes (the ban on tobacco use in public places being a good
example), and encouraging signs of access to the latest drugs in clinical medicine (such as the availability of trastuzumab for breast cancer treatment)—large challenges lie ahead. The threat of a rise in the burden of non-communicable diseases looms large. There are also important lessons for other low-income and middle-income countries who share Mexico’s quest for UHC, notably the positioning of health reform within a legal framework to secure protection from future political interference. And, crucially, Mexico has showed how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development. UHC in other regions will be explored further in a themed issue of The Lancet on Sept 8. And let us not forget Mexico’s northern neighbour, where President Barack Obama is seeking to drive through the most radical reforms in the history of US health care. But for now, let us celebrate success, and hope for a sustained Mexican wave of UHC worldwide. The Lancet
Max Nash/PA Wire/Press Association Images
UK leads a global effort to tackle hunger and malnutrition
See World Report page 637
For more on the DFID Hunger summit see http://www.dfid. gov.uk/News/Latest-news/2012/ Hunger-event-news-story/ For the Sahel hunger crisis see http://www.bbc.co.uk/news/ world-africa-19074859 For the paper on stunting and underweight see Articles Lancet 2012; published online July 5. http://www.thelancet.com/ journals/lancet/article/ PIIS0140-6736 (12)60647-3/fulltext
622
A World Report in The Lancet this week highlights the food and malnutrition crisis in Yemen. Elsewhere, leading charities have warned that more than 1 million children in the Sahel region of west Africa are at risk of severe malnutrition. It was timely, therefore, that on the back of the euphoria of the London Olympics, the UK’s Prime Minister, David Cameron, co-hosted a global hunger summit with the Vice President of Brazil, Michel Temer, to kickstart efforts to tackle undernutrition in children. Malnutrition is a neglected area globally. A study published in The Lancet last month showed that, in low-income and middle-income countries in 2011, 314 million children younger than 5 years were stunted and 258 million were underweight. As well as a global commitment to reduce child malnutrition by the Rio Olympics in 2016, measures announced at the summit included investment in drought-resistant and vitaminenriched crops; a collaboration with Unilever, Syngenta, and GlaxoSmithKline to make nutritious food available to the poorest communities; and use of technology innovations to improve accountability across countries.
Tackling malnutrition globally has been unacceptably slow. To date, donor approaches have focused mainly on agricultural issues and have not placed enough emphasis on human nutrition, especially during pregnancy and the first 2 years of life—a crucial period in a child’s development. Key interventions such as improving diets of women before and during pregnancy, breastfeeding, complementary feeding, and fortification of foods for this high-risk period have not been sufficiently scaled up. Unfortunately, the summit’s emphasis on technical fixes and partnering with the private sector might fall short unless it focuses on the needs of vulnerable groups. The determinants of malnutrition—inequity, women’s nutrition and empowerment, food distribution and pricing systems, conflict and emergencies, and climate change—need addressing. Next year, The Lancet will publish a Series on maternal and child nutrition which will cover these and other issues, and hopefully pave the way towards integration of agriculture, nutrition, and food security so that the global malnutrition problem can be tackled head on. The Lancet www.thelancet.com Vol 380 August 18, 2012