FT Health: D-Day for tuberculosis

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The end of tuberculosis remains an aspiration rather than a reality. That's the sobering message from the World Health Organization’s progress report on the world's deadliest infectious disease.

TB, still essentially a poor person’s illness, killed 1.6m people in 2017 and affected around 10m, the majority clustered in eight countries across Asia and Africa. Drug-resistance is a serious concern, as is the — sometimes disputed — contention that 1.7bn people — almost a quarter of the world’s population — may have a latent infection and are at risk of developing the disease.

Campaigners branded the update a “shameful report card” and demanded renewed efforts from world leaders at next week's special UN meeting, including commitments to diagnose 40m people by 2022, remove discriminatory laws against sufferers, and step up funding.

The proportion of people with TB dying from the disease has fallen to 16% from 23% in 2000, and money for prevention, diagnosis and treatment has more than doubled since 2006. But funding still falls short: The $6.9bn for 2018 is far below the $10.4bn the Stop TB Partnership says is needed.

Lucica Ditiu, Stop TB's executive director, leaves no doubt about the landmark nature of next week’s meeting. “Let’s be very clear — ANY head of state that doesn’t attend #UNHLMTB on 26 Sept is comfortable with his own people, family, friends being sick and killed by airborne TB, which is curable and preventable.” (WHO, UN Dispatch, Global Health Now, NYT, Devex)

Three questions

Mariam Claeson is director of the Global Financing Facility, the World Bank-backed scheme that aims to help governments in poorer countries change how they prioritise and finance the health and nutrition of their people.

How did the GFF come about and how does it differ from other multilateral initiatives?

In 2015 when global leaders looked back at the MDG [Millennium Development Goals] era, they realised many countries had not met their targets for maternal health. Having seen aid flattening out, they were looking for a new instrument that could draw on multiple sources, be truly catalytic and really change the way countries do health financing. They thought the answer to scale and sustainability was a) working with ministers of finance to mobilise domestic resources b) to get more value for the money already spent and c) to grow the whole area while making sure countries allocated towards high-impact interventions.

What is the focus of your efforts?

The focus is across the continuum of care during pregnancy, birth, early years and adolescence because that’s what’s going to give countries their human capital and future growth. We work alongside the private sector: they know about system supply and how to reach the last mile and we take that to scale. We also validate results and check accountability.

Where does the scheme go next?

We have now reached 27 countries and want to expand to 50 but we need $2bn to do this. We can then save up to 35m lives by 2030. Countries like this model because it puts them in the driver’s seat. There is this new recognition that if you invest in people, that’s 30 per cent of your growth. If we can capitalise on that and get investments in poor communities, that's huge. We can create jobs and increase the likelihood that people stay in their communities.

Chartwatch

Child deaths An estimated 6.3m children under 15 died in 2017, mostly of preventable causes. Half of all deaths under five were in sub-Saharan Africa, and another 30 per cent in Southern Asia. Most were due to causes such as complications during birth, pneumonia, diarrhoea, sepsis and malaria. Among those aged between five and 14, injuries — such as drowning and road traffic incidents — were the most common causes. The overall number of under-five deaths has fallen from 12.6m in 1990 to 5.4m. (Unicef, WHO, UN, World Bank)

News round-up

Population and poverty Progress against poverty and disease may be stalling because of the speed of population growth in poorer areas. Watch our discussion with Bill Gates on the dangers posed by Africa doubling in size by 2050. Separately, the UN’s human development index showed improving health, education and incomes across the world, but worrying levels of inequalities between and within countries. (Gates Foundation, FT video, UN)

Costs of dementia The number of people living with dementia is projected to increase from 50m to152m by 2050 while the cost of the disease could rise from $1tn today to $2tn by 2030. Campaigners want 1 per cent of national societal costs of dementia to be spent on research in basic science, care improvements, prevention and risk reduction, drug development and public health. (Alzheimer’s Disease International)

WHO pitches for $14bn The WHO asked donor countries for $14.1bn — a 14 per cent increase — to fund its five-year strategic plan which it said would save up to 30m lives, give an extra 100m years of healthy living to the world’s population and add up to 4 per cent of economic growth in low and middle-income countries by 2023. (WHO)

Anti-vaxxers advance The take-up of MMR vaccines fell for the fourth successive year in England. Problems are even worse in Canada and campaigners there are calling for much more graphic pro-vaccination campaigns. The BBC looks at how a virus — of misinformation — spread around the world. (The Guardian, CBC, BBC Newsnight video)

Health and efficiency Hong Kong and Singapore have the most efficient healthcare in an analysis examining spending per capita and lifespan across more than 50 countries. The US languishes at the bottom of the table alongside Bulgaria. (Bloomberg)

Stubbing out smoking English health authorities launched their annual “Stoptober” anti-smoking campaign with a prediction that the practice would be “eradicated” by 2030. Ecigarettes are suggested as one alternative to smoking. The country has the second-lowest smoking rate after Sweden. (Public Health England, Telegraph)

Pollution and the school run Children are exposed to over 60 per cent of their daily air pollution intake during the school run and while on school premises. A study showed polluted air could affect unborn babies via the placenta, and another showed a possible link between London pollution and dementia. Global health leaders are stepping up action on pollution and other aspects of climate change. (Unicef, Eureka, BMJ Open, Devex)

Cannabis with your Coke? Coca-Cola’s possible move into cannabis drinks is the latest sign of the drug’s move into the mainstream as decriminalisation spreads. The world’s largest beverage group said it was “closely watching” the sector, which uses the non-psychoactive chemical in marijuana for wellness drinks. (FT)

Taboo busting A prominent British politician was praised for disclosing her past mental health problems and ruling out any ambitions to be prime minister. (Guardian)

Scaling up action on snakebite The first international Snakebite Awareness Day focused attention on the 138,000 people killed and 400,000 permanently disabled or disfigured each year after being bitten by venomous snakes. (RSTMH)

Best from the journals

NCD strategies failing Half of all countries look set to miss 2030 WHO targets for cutting premature deaths from cancers, cardiovascular disease, chronic respiratory disease and diabetes. Together these illnesses killed 12.5m 30-70 year-olds in 2016. (The Lancet)

Aspirin not a panacea Although aspirin can help prevent some heart problems, a trio of studies casts doubt on the idea that a small daily dose could prolong life or prevent dementia and disability in otherwise healthy older people. (New England Journal of Medicine)

Diarrhoea dangers New maps showing concentrations of child deaths from diarrheal diseases across Africa provide a guide for targeted interventions into a highly preventable illness, the third leading cause of disease and death in the continent's under-fives, killing 330,000 in 2015. (NEJM)

Treating obesity Almost 37 per cent of US adults are obese, putting them at high risk of chronic diseases, but treatment recommendations are not being implemented efficiently by clinicians. (JAMA)

Podcast of the week

UK Biobank A discussion on the world’s most comprehensive set of human health data, which is providing a vital research resource. We speak to Professor Clare Elwell of University College London; Cathie Sudlow, UK Biobank’s chief scientist; and Clive Cookson, FT science editor. (FT 16m)

FT conference

FT Digital Health Summit USA, New York October 17 Explore the benefits, opportunities and complexities of digital disruption. FT Health readers save 20 per cent with the code FTHealth20. Register here.

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Final thought

Violence as ‘disease’ Treating violent crime as a public health issue, an approach pioneered in Chicago and employed in Boston and Glasgow, is being introduced to London. It combines establishing the underlying causes of violent conduct with new approaches to prevention and co-operation between the police, education system and health service. Could it make a significant difference? Share your thoughts on our usual channels. (BBC, FT)