Cancer kills nearly 9 mln every year - World Health Organization

Oncological diseases kill about 8.8 million people around the world every year, the World Health Organization said on its website on Saturday. According to the news release timed for World Cancer Day, observed on February 4, as a rule cancer is identified at late stages.

"New WHO figures released this week indicate that each year 8.8 million people die from cancer, mostly in low-and middle-income countries. One problem is that many cancer cases are diagnosed too late," the release says.

World Health Organization specialists pay special attention to early diagnosis of cancer, because most oncological diseases are curable, if identified at early stages. Under WHO criteria cancer is regarded curable if the patient lives for more than five years after the disease has been identified. High mortality rates are usually observed among third and fourth degree cancer patients.

"By taking the steps to implement WHO’s new guidance, healthcare planners can improve early diagnosis of cancer and ensure prompt treatment, especially for breast, cervical, and colorectal cancers. This will result in more people surviving cancer. It will also be less expensive to treat and cure cancer patients," says Dr. Etienne Krug, Director of WHO’s Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention.

Situation in Russia
Russian Health Minister Veronika Skvortsova has said Russia has shown a considerable improvement in terms of early cancer diagnosis and one-and five-year life expectancy among cancer patients over the past few years.

"The identification of cancer at early stages has shown noticeable improvement. More than 57% of oncological diseases in Russia are exposed at early stages," Skvortsova said.

The Health Ministry has developed new rules of comprehensive medical examination, which may take effect next year. Patients of certain age groups will enjoy the benefits of oncological screening programs.

A federal anti-cancer program is being drafted. The Russian Health Ministry’s leading outsourced cancer specialist, Mikhail Davydov, says the program will be presented at an oncological conference in Bashkortostan’s capital Ufa next summer. In fact, it will consist of individual sub-programs each region will devise for itself.

Cancer is Russia’s number two killer disease, accounting for about 14-15% of all deaths in the country, Skvortsova said.



WHO develops guide to early cancer diagnosis

The World Health Organisation (WHO) says it has developed a guide to effectively address all barriers to early diagnosis of cancer.

In a message released in Commemoration of the 2017 World Cancer Day, on Saturday, WHO called for improved access to treatment of cancer.

The message read: “In anticipation of World Cancer Day, WHO has developed a Guide to Cancer Early Diagnosis, to help effectively address barriers to early cancer diagnosis.

“The guide aims to help policy-makers, programme managers and cancer advocates develop or strengthen programmes that improve early diagnosis and access to treatment.

“The consequences are more people surviving cancer, less morbidity and lower costs from treatment.”

WHO said it had provided guidance on how to address the cancer challenge through comprehensive cancer control, founded on global coordination and strong health systems.

The UN health agency added that it had helped lead engagement of partner UN agencies and entities, such as the UN Joint Global Programme on Cervical Cancer Prevention and Control.

According to WHO, collaboration is critical to producing a stronger response against the disease that needlessly claims the lives of millions around the world each year.

“New WHO figures released this week indicate that cancer deaths continue to increase.

“In 2015, 8.8 million people died from cancer, mostly in low- and middle-income countries,” it said.

WHO emphasised that globally, common challenges to cancer control are delays in cancer diagnosis and inaccessible treatment.

“Even in countries with strong health systems and services, many cancer cases are diagnosed at a late-stage, when they are harder to treat successfully.

“On World Cancer Day, WHO acknowledges the role of all stakeholders to strengthen coordination and health systems in cancer control, working toward a future of healthy lives for all,” it stated.

The News Agency of Nigeria (NAN) reports that the World Cancer Day, organised by the Union for International Cancer Control and celebrated each year on Feb. 4, is an opportunity to rally the international community to end the injustice of preventable suffering from cancer.

NAN also reported that the theme of World Cancer Day 2017 is ‘We can, I can.’


Is Gates Foundation, WHO’s Biggest Private Funder, Ineligible To Join WHO?

As the World Health Organization Board prepares to consider candidate institutions to be admitted into official relations with the UN agency, some health and public interest groups are raising alarm at what they see as a seeming lack of safeguard against conflicts of interest. Particular concern has been raised over admitting the Bill & Melinda Gates Foundation as an observer because of the Foundation trust’s investments in business ventures such as Coca-Cola, which they see as contrary to health goals. But the Gates Foundation, which is the biggest private donor of the WHO, said the trust is a separate entity from the foundation, and refutes any conflicts of interest.

The WHO Executive Board, meeting from 23 January to 1 February, is expected to consider [pdf] the following candidates: the Bill & Melinda Gates Foundation, Grand Challenges Canada, International Rescue Committee, Knowledge Ecology International and The Fred Hollows Foundation for admission into official relations with WHO.

In May 2016, the WHO adopted a Framework of Engagement with Non-State Actors (FENSA), which is aimed at reducing the risk of conflicts. Non-state actors are non-government organisations, private sector entities, philanthropic foundations, and academic institutions.

A number of public interest, health, and citizens’ groups sent a letter [pdf] to the Executive Board calling the attention of the Board to the weakness of conflict of interest safeguards to protect WHO from influence of industry.

In the letter, the groups detail the example of the Gates Foundation, which is seeking to be admitted as an external actor in “official relations” with the WHO and as a non-voting member of the World Health Assembly. The Gates Foundation is the largest non-governmental donor of the WHO.

According to the letter, citing the United States Government’s Securities and Exchange Commission, “the Bill and Melinda Gates Foundation Trust endowment—the source of revenue for the Foundation—is heavily invested in many of the food, alcohol, and physical inactivity related consumer products that cause or treat the current crisis of preventable heart disease, stroke, cancer, and diabetes.”

In particular, “Gates Foundation Trust direct investments include: Coca-Cola regional company that operates in the Americas south of the U.S. ($466 million), Walmart ($837 million), the largest food retailer in the U.S. and a leading retailer of pharmaceutical drugs and alcoholic beverages, Walgreen-Boots Alliance ($280 million), a large multinational pharmaceutical drug retailer, and two of the world’s largest TV companies (screen-time): Group Televisa ($433 million) and Liberty Global PLC ($221 million),” the letter said.

The signatories belong to institutions such as Alcohol Justice (USA), Baby Milk Action (United Kingdom), Centre for Health Science and Law (Canada), FIAN International (Germany), Foundation for Alcohol Research and Education (Australia), Health Innovation in Practice (Switzerland), International Baby Food Action Network (Brazil) People’s Health Movement (Global), and World Public Health Nutrition Association (United Kingdom).

The letter notes that what they see as conflicts of interest are not acknowledged in the WHO budget’s financial contributor database, and only partially noted in the WHO’s Register of Non-State Actors.

The signatories called for member states to fund the WHO more adequately so it does not have to rely on funding from major investors in food, drug, and alcohol companies, and compromises the independence of the WHO.

They asked the Executive Board this week to “defer the decision to accept the Gates Foundation and any other new and legacy applicants for Official Relations status for which there has been no conflict of interest safeguard review on the record for consideration” by member states of the EB.

Gates Foundation Clarifies Independence

Meanwhile, according to Chris Elias, president of Global Development at the Gates Foundation, “The Gates Foundation provides the World Health Organization with funding to help it achieve global health goals that have been approved by its member states. These include global polio eradication and ending preventable child deaths. Formalizing our relationship with WHO under the framework that it has adopted for working with NGOs creates clear norms and guidelines for our ongoing support.”

“In this and all our work, the foundation operates as a separate entity from the Bill & Melinda Gates Foundation Trust,” he told Intellectual Property Watch in an email.

“Foundation staff have no influence on the trust’s investment decisions and no visibility into its investment strategies or holdings, other than through what is publicly available. This two-entity structure ensures that the foundation’s work remains independent from the trust’s investments, and focused solely on fulfilling our mission to improve quality of life for the world’s poorest,” he said.

Other Candidates

Grand Challenges Canada is funded by the government of Canada and fund innovators in low- and middle-income countries and Canada.

The United States-based International Rescue Committee specialises in relief during humanitarian crisis.

The Fred Hollows Foundation based in Australia works to restore sight to people in developing countries.

US-based Knowledge Ecology International has a focus on social justice.

Draft Decision Calls for Postponing Review of Some, Dropping Others

The draft decision to the agenda item on non-state actors calls for the Board to approve maintaining official relations with 58 non-state actors whose names are listed in Annex 2 of the document. This includes the Drugs for Neglected Diseases initiative, International Baby Food Action Network, International Federation on Ageing, Medicines Patent Pool, Médecins Sans Frontières (MSF, Doctors Without Borders), and the International Society for Biomedical Research on Alcoholism.

The draft decision also asks to defer the review of relations with a number of non-state actors until the 142nd session of the EB in January 2018. The list includes the European Generic Medicines Association, the International Union for Health Promotion and Education, and the World Federation of the Deaf.

Among the institutions with which the WHO suggested discontinued relations are the Inter-African Committee on Traditional Practices affecting the Health of Women and Children, the International Centre for Trade and Sustainable Development, and the World Association for Sexual Health.


3 Left in Running to Lead World Health Organization

The list of candidates to become director-general of the World Health Organization was whittled to three Wednesday, with a final choice due in May.

The U.N. agency said those left in the running were Ethiopian Foreign Minister Tedros Adhanom Ghebreyesus; medical doctor David Nabarro, who served as U.N. envoy on Ebola; and Sania Nishtar, the Pakistani founder of a health think tank, Heartfelt, who served one year as a federal minister.

The next WHO chief will replace Margaret Chan, who took over its reins 10 years ago and came under fire for the agency's sluggish reaction to the Ebola epidemic, which spread across West Africa, one of the world's poorest regions, and killed of thousands of people. Chan's second five-year term ends June 30.

The final choice is to be made by the World Health Assembly, the annual ministerial gathering of WHO's 194 member states, held May 22-31.

Some public health policy experts called for a leader with political experience to revive the WHO's international standing and bring in funding for flagship programs.

"International organizations like WHO have lost lots of luster," Lawrence Gostin, professor of global health law at Georgetown University Law School, told Reuters. "WHO was wounded very badly with Ebola, and now even its new emergencies program is underfunded. It should be easy to fund. That is why somebody who has a lot of political stature has to direct it."


A guide to the selection of the new head of the World Health Organization

The process of choosing the next director-general of the World Health Organization starts in earnest this week. While the final selection won’t be made until May, the current field of six will shrink to five, then no more than three before the week is out.

If you haven’t been paying much attention up until now, you’re not alone. With Brexit and the US election, this campaign has been getting little attention.

So let’s explore the three Ps — the people, the process, and the predictions.

Who wants to lead the WHO?

Four Europeans, one African, and one South Asian are vying to succeed Dr. Margaret Chan, whose second term as WHO director-general ends on June 30. (Directors-general can only serve two five-year terms. Chan, who was nominated by China, served a little longer because her predecessor, J.W. Lee of South Korea, died before his term ended.)

All but one of this year’s candidates is a medical doctor. Four have served as health minister for their respective countries and two of those four have also served as foreign minister. Two have had extensive WHO experience. Most have done work for global institutions — the United Nations, the World Bank, UNICEF, or prominent players in the global health sector such as Roll Back Malaria and Gavi, the Vaccine Alliance.

The candidates are:

  • Tedros Adhanom Ghebreyesus, 51, from Ethiopia. Tedros (he goes by his first name), who was until recently foreign affairs minister, and health minister earlier in his career, is the only non-physician; he has a PhD in community health.
  • Dr. Flavia Bustreo, 55, from Italy. Bustreo is WHO’s assistant director-general for family, women’s, and children’s health (on leave while she campaigns). She has also worked at UNICEF and the World Bank.
  • Dr. Philippe Douste-Blazy, 64, of France. A former health and foreign affairs minister, he founded UNITAID, which works to prevent, diagnose, and treat HIV.
  • Dr. David Nabarro, 67, of Britain. Nabarro has spent much of his career at the WHO and then the UN. He is currently the special adviser to the UN secretary general on sustainable development and climate change.
  • Dr. Sania Nishtar, 53, of Pakistan. A former health minister, Nishtar has extensive experience both nationally and internationally in the civil society sector.
  • Dr. Miklós Szócska, 56, from Hungary. Szócska is a former health minister, and a professor in the Health Services Management Training Centre, at Semmelweis University in Budapest.

How does this election work?

The first few steps in this process are taken by the WHO’s executive board, which holds its annual meeting in Geneva this week. It is composed of representatives from 34 countries who are elected to serve on the board for three-year terms.

The United States currently has a seat on the executive board, held by Dr. Tom Frieden, who until Friday was director of the Centers for Disease Control and Prevention. He was not asked to stay on by the incoming Trump administration.

The US government has not made public who it is backing in this race and Frieden will not say for whom he’s been instructed to vote. “That is confidential,” he told STAT in an email.

Voting throughout this process will be done by secret ballot, a decision some observers have criticized.

On Tuesday, the executive board will vote to select a short list of five candidates who will be interviewed Wednesday. The interviews — one hour per candidate — will be held behind closed doors. Canada and Colombia have put forward a motion to make the interviews public, but it was not accepted.

After the interviews, executive board members will pare the list of candidates down to no more than three. The finalists will continue to campaign until the World Health Assembly — the WHO’s annual general meeting — in May, when the 194 member states will elect Chan’s successor. He or she will take office July 1.

Anyone want to place a bet?

If you’re tempted, you may not find someone to take it.

“I do think the outcome is going to be unpredictable,” Suerie Moon, director of research at the global health center of the Graduate Institute of International and Development Studies in Geneva, told STAT. “Everybody has their hunch. But I haven’t spoken to a single person who thinks they know or will admit that they know.”

Many observers are skeptical that Szócska will make it to the interview stage. His CV is thinner than those of his rivals.

After that, it becomes much harder to forecast. Voting for a position like this involves backroom diplomacy and often, frankly, horse-trading — things that are impossible to track with secret ballots and when few if any countries openly declare their preference.

Another factor adds to the opacity: When voting on the final three, board members will have three votes apiece. The system may have been devised to try to ensure that the three strongest candidates go forward to the final round, but observers are not so sure things will work that way.

Some countries may choose to cast one vote for the person they hope will win, and use the other two to strengthen his or her chances by supporting weaker candidates to knock out their favorite’s strongest rivals. Or the executive board as a body might favor a candidate, and nominate that person plus two weaker candidates — putting its thumb on the scale, essentially.

Who would be best for WHO may not be top of mind. “I would be highly skeptical that that is the driving force behind voting decisions,” said Moon. “I think countries will vote based on strategic calculations.”

While the outcome is uncertain, there are a few tea leaves in the bottom of the cup.

For a while, the word in international circles was that it was Africa’s turn; an African has never led the WHO. And though a number of potential African candidates tested the waters early on, only one emerged. Early last year, the African Union said all African countries were supporting Tedros. That would make a 54-country bloc for him if he makes it to the final three. But only eight African Union countries are on the executive board. And rumors have swirled for months that France has pried away some African support for Douste-Blazy, for whom France has been campaigning hard.

Having four candidates from Europe doesn’t help any of them, as it likely splits what might otherwise might have been a significant bloc. Likewise, Britain’s departure from the European Union may cost Nabarro — who on experience alone would appear to be one of the strongest candidates. “I imagine that Brexit isn’t helping David Nabarro,” Moon said.

It’s also not clear, given the appetite for change manifested in the Brexit vote and the US election, whether being a WHO insider is an advantage at this point. That said, Moon noted that none of the five expected to go through to the interview round could be seen as a true outsider.

She wouldn’t make a prediction on who will win this race — or even who will be in the final three. But Dr. Ashish Jha, director of the Harvard Global Health Institute, said he thought Douste-Blazy, Tedros, and either Nishtar or Bustreo would be the candidates who make it through to the final voting round.

Watch this space.


Here’s how the next director-general can rebuild the World Health Organization

Nearly nine months have passed since the last Ebola patient was declared free of the disease in West Africa. Yet one body — the World Health Organization — is still ailing, stung by criticism that it responded slowly to that local and global emergency.

Despite encouraging signs that it learned valuable lessons from the Ebola outbreak, faith in the WHO hasn’t yet fully returned. The organization has been chronically underfunded for years, and its outdated structure has resisted reform over many decades. This has led to a vicious spiral of underachievement.

The WHO needs to lead on global health — and its member states must allow it to do so. But its problems are undermining its position as the global leader responsible for moving the world toward a better, healthier future.

This week, the WHO will announce the finalists for the director-general post. He or she will take over its public health, strategic, and political leadership on July 1, 2017. This offers the organization a real chance to resolve these issues and return to working effectively toward improving global health.

My foundation, Wellcome, which often partners with the WHO on research and advocacy for our shared interests, such as tackling drug-resistant infection worldwide and vaccine development, won’t be endorsing any of the candidates. But we will be looking carefully at their platforms.

Here are several qualities we believe the new director-general needs to have, along with several actions the WHO should take to recapture the world’s confidence.

First and foremost, the WHO needs more effective political leadership to regain trust. It is the only organization charged exclusively with speaking for public health and for health care workers around the world, with a mandate that trumps the interests of individual countries. At a time when health budgets around the world are under increasing pressure, the new director-general must strengthen the case for investing in improving health outcomes.

That includes encouraging greater investment in stronger national health systems and epidemic preparedness, and being fearless in calling out countries that fail to take action where it is needed. Movement in this direction has begun, notably the joint evaluation exercise on epidemics, support for universal health coverage, and the naming and shaming of countries not meeting air pollution standards. But the new director-general must go further.

The WHO must also strengthen its unique role in alerting the world to health emergencies and coordinating the responses to them. While the WHO’s new emergencies team has shown that it can mobilize resources and action at a pace unprecedented in the organization’s history, the new director-general needs to convince national leaders that the world doesn’t yet have the capability to respond to cross-border emergencies. He or she must also make sure the WHO clearly sees the gaps that exist and the steps needed to close them.

The new director-general should also be fearless in calling out global health risks, such as the growth of artemisinin-resistant malaria in Southeast Asia, particularly where national and regional authorities are not doing enough to combat such threats.

The next director-general can expect greater pressure on the WHO to ensure access to health care, drugs, and services at prices that countries and citizens can afford. He or she is also likely to see new arguments about access to innovative therapies as medicines become more personalized and expensive. The WHO should lead the fight for access to innovative health care for all.

Clear, decisive leadership on all of the above will go a long way to restoring confidence in the WHO — a vital prerequisite to attracting the financial support the organization so desperately needs. Other essential steps to rebuilding trust should include an ambitious internal reform program that simplifies the WHO’s complex governance structures, and challenging poor-performing offices at the national, regional, and global levels. Key to that would be ensuring that staff are selected for posts based on their competence, not their politics.

To fully ensure that the WHO has sufficient funds for its mission, the new director-general will need to work effectively with the increasingly mixed economy of health care funders and providers. We’ve already seen encouraging signs of this in the research and development blueprint for epidemics, where Wellcome is working with the United Kingdom’s Department for International Development, the Gates Foundation, and other global funders to improve the research pipeline for epidemic disease risks. In exchange, all of WHO’s funders must be transparent about their expectations and be held accountable for their activities.

The next director-general should also make a greater effort to better develop the WHO’s relationships with civic society and the private sector — every dollar invested by private companies not only reduces the burden on finance ministries and taxpayers, but also delivers innovations and technical advances that can improve health.

While noting the challenges the WHO currently faces, we must not lose sight of its remarkable achievements, from eradicating smallpox to the near-eradication of polio and vastly reducing deaths from malaria. No organization can speak for the improvement of global public health as powerfully as the WHO, and such a role is vital in uncertain and volatile times. At the same time, we mustn’t mince words: Today the WHO is not fulfilling its mission and isn’t adequately funded for it. In its current form, it is failing.

The arrival of a new director-general in a few months offers an opportunity for reform that the WHO must put to good use.


The Briton vying to become the world's most powerful doctor

He was the UN troubleshooter tasked with galvanising the world’s response to the Ebola epidemic and led the fight against cholera in Haiti, just as he did earlier against global pandemic flu. So on paper, David Nabarro may seem the ideal candidate to become the world’s most powerful doctor.

In practice, the Briton faces a stiff contest, with five other candidates also vying to take over from Margaret Chan in May 2017 as head of the World Health Organisation, the troubled UN body much criticised for its slow response to the 2014 Ebola outbreak. The job has always in the past been decided between governments trading political alliances behind closed doors. But this time, with the WHO’s credibility still on the line, Nabarro and his allies think his CV may be the right one.

“I’m actually a doer who delivers,” Nabarro in an interview with the Guardian. “And a doer who is not scared of being accountable at all times. And I think that is known.”

Nabarro, sitting in the London office of the chief medical officer, Prof Dame Sally Davies, has the support of the UK government.Davies says Nabarro is uniquely well-qualified and that will be recognised at a time when the WHO badly needs the best possible leader.

“I think he’s likely to get it because he’s the best candidate, and at the end of the day I’m hopeful that the politics will fall aside and the best person will come through,” she says.

Davies, who has the British seat on the WHO’s executive board, points to an editorial she co-authored with other board members in the Lancet in January, describing the criteria for nomination as DG. They include high-level public health and international health experience, excellent communication, leadership skills and commitment. Quite simply, she says, Nabarro has all of them.

This is not about favouring the UK. “In fact, David might not always do what I would want because he is independent and thoughtful in his own way,” she says. “It is about having a strong leader for the WHO who understands the changing global architecture and the needs of low- and middle-income countries, particularly around two things – emergency response and the SDGs [sustainable development goals] – and can work effectively with ministers and prime ministers.”

Above all, Davies and others are concerned that the reforms of the WHO, in which Nabarro has already been centrally involved, should be implemented to make the institution stronger and fit for purpose as the world’s bulwark against devastating outbreaks of infectious diseases, as well as malnutrition and chronic diseases caused by obesity and changing lifestyles.

The future of the WHO was in question after its failure to spot and close down Ebola early enough in west Africa, which led to a global crisis. All the reports written in the aftermath said that if it were to survive, the organisation needed stronger and more focused leadership in emergencies.

Nabarro led the UN response to bolster the WHO as the envoy of the outgoing UN secretary-general, Ban Ki-moon, and afterwards chaired the advisory committee on reform that Chan set up. A lot of excellent innovations have strengthened the organisation in the past year or two, but it is not yet in good enough shape, he says.

“The new health emergencies programme that we advised on and that’s being implemented, which is a cross-organisation programme with single cadre of staff, single budget, single performance standards, clear lines of responsibility, is being built up,” he says.

“But it also needs to be properly financed – and at the moment it’s not. And so we need to get the money, improve performance, get more money, improve performance more. It’s about a five-year project and I personally would like to be moving more quickly on that because we never know when the next outbreak is going to come. We had a bit of a scare this year with yellow fever and I want to be sure that this is done quickly.”

The WHO needs to be one unified organisation. Ebola exposed the fracture lines between the regions, with Africa failing to communicate with the Geneva HQ. Davies says all staff have to be appointed on merit, not as a political favour to governments, and they must not be advocates for any specific interest.

Nabarro agrees there must be no more fiefdoms. “Part of that is ensuring that all staff are appointed on merit. Part of it is about ensuring they are not just pursuing money for their own interests and part of it is ensuring that they find the organisation something that they believe in and are prepared to work for it as an entire organisation,” he says.

It’s a culture change but it also depends on having enough money, so that WHO staff do not think they have to bargain with governments, organisations or special interest groups to raise it.

The WHO’s finances are a difficult issue. The amount given by governments for general purposes has steadily declined. The coffers have been topped up by voluntary donations from specific governments or organisations, such as the Gates Foundation, that are tied to particular projects. The UK is the third biggest donor, says Davies, and some of the money is for priorities that are agreed with the WHO, but, she says: “I think I would like to see, personally, an increase in the subscription, so that there is less voluntary funding and more that is just routine and under the absolute direction of the DG.”

Nabarro’s solution is for the organisation to become what he calls “catalytic”. It does not have the money to do everything that is needed. There are many health organisations as well as healthcare systems in every country. The WHO can lead and encourage them to do what is needed, like the conductor of an orchestra, rather than doing it itself.

Chan has been was a technocrat, maintaining that her role was to carry out the bidding of member states, while Norwegian former prime minister Gro Harlem Brundtland was criticised when she held the job for telling countries in no uncertain terms what they should do. Nabarro, who once worked for Brundtland when she was DG, diplomatically says he is a bit of each of these leaders but also his own person, able to court consensus on issues such as anti-tobacco treaties while taking tough decisions if necessary in emergencies.

Whether that pleases the voting governments will be seen at the end of January, when the six will be reduced to a shortlist of three, and then in May when the puff of white smoke goes up at the World Health Assembly in Geneva.


Studies find worrying misuse of medicine worldwide

Up to 70 percent of hysterectomies in the United States, a quarter of knee replacements in Spain and more than half the antibiotics prescribed in China are inappropriate, over-used health care, researchers said on Monday.

Experts who carried out a series of studies across the world found that medicine and health care are routinely both over- and under-used, causing avoidable harm and suffering and wasting precious resources.

The studies, commissioned by The Lancet journal and conducted by 27 international specialists, also found rates of Caesarian section deliveries are soaring — often in women who do not need them — while the simple use of steroids to prevent premature births has lagged for 40 years.

“A common tragedy in both wealthy and poor countries is the use of expensive and sometimes ineffective technology while low-cost effective interventions are neglected,” the experts wrote in a statement about their findings.

The World Health Organization estimates that 6.2 million excess C-sections are performed each year — 50 percent of them in Brazil and China alone.

Vikas Saini, one of the lead authors of the study series and president of the U.S. Lown Institute in Boston, said factors driving the global failure to the right level of care include “greed, competing interests and poor information,” which he said combine to create “an ecosystem of poor health care delivery.”

Co-lead researcher Shannon Brownlee added: “Patients and citizens need to understand what’s at stake here if their health systems fail to address these twin problems. In the U.S., we are wasting billions of dollars that should be devoted to improving the nation’s health.”

The study series analyzed the scope, causes and consequences of under-use and over-use of health care around the world. It found that both can occur in the same country, the same organization or health facility, and even afflict the same patient.

The researchers noted that a study in China found 57 percent of patients received inappropriate antibiotics; that inappropriate hysterectomies in the United States range from 16 to 70 percent; and inappropriate total knee replacement rates were 26 percent in Spain and 34 percent in the United States.

Rates of inappropriate hysterectomies were 20 percent in Taiwan and 13 percent in Switzerland, they found.

Under-use leaves patients “vulnerable to avoidable disease and suffering” the researchers said, while over-use causes avoidable harms from tests or treatments at the same time as wasting resources better spent on much-needed services.