GENEVA, May 13 (Xinhua) -- The World Health Organization (WHO) released on Wednesday its World Health Statistics 2015 report to assess the progress made towards meeting health-related objectives in 194 countries around the world.

Data on mortality and health system indicators including life expectancy, illnesses and deaths from diseases, as well as statistics on health services and financial investment, unveil a mixed picture as the 2015 UN Millennium Development Goals (MDGs) deadline approaches.

"We have seen incredible progress in the last 25 years, particularly in HIV, malaria and tuberculosis" said WHO Health Statistics and Information Systems director Ties Boerma, adding that "many issues still need to be addressed."

WHO figures indicate that although few global targets have been met, a number of objectives show positive trends and are on track of being realized.

Regional disparities also highlight the varied situation across the world: the Americas, Europe and the Western Pacific have reported substantial progress across most health-related sectors since 1990, while the Eastern Mediterranean and Africa have reported only limited progress.

Recent development in countries such as China, which has "significantly contributed to global achievements" according to Boerma, has been decisive in improving the systemic outlook.

Figures show that China has met most of the MDG targets, including reducing the under-five mortality rate (by 76 percent), achieving a measles immunization rate among 1 year olds of 99 percent and reducing the tuberculosis mortality rate by 84 percent, amongst other achievements.

Amid a mixed global picture and despite health figures falling short of targets set in 2000, progress in global child survival is considered to be one of the greatest success stories of international development, as the mortality rate of children under five has almost halved since 1990.

Global trends of HIV, malaria and tuberculosis have also been reversed, meeting targets to turn around the epidemics by 2015 -- 2.1 million HIV infections were reported in 2013, compared to 3.4 million in 2001.

Similarly, the number of malaria cases is estimated to have fallen from 227 million in 2000 to 198 million in 2013.

The global life expectancy at birth for both sexes was 71 years in 2013 (compared to 64 in 1990), the lowest being in the African Region (58) and the highest in the Region of the Americas (77)

Come September, countries will draw up new global targets to be reached by 2030, so as to finish the MDG agenda and address emerging problems such as non-communicable diseases, which account for two-thirds of global deaths, as well as other socio-environmental factors which are affecting the global population.

source: http://www.shanghaidaily.com

13 MAY 2015 | GENEVA - 2015 is the final year for the United Nations Millennium Development Goals (MDGs) – goals set by governments in 2000 to guide global efforts to end poverty. This year's "World Health Statistics" – published today by WHO – assesses progress towards the health-related goals in each of the 194 countries for which data are available. The results are mixed.

By the end of this year if current trends continue, the world will have met global targets for turning around the epidemics of HIV, malaria and tuberculosis and increasing access to safe drinking water. It will also have made substantial progress in reducing child undernutrition, maternal and child deaths, and increasing access to basic sanitation.

"The MDGs have been good for public health. They have focused political attention and generated badly needed funds for many important public health challenges," says Dr Margaret Chan, Director-General of WHO. "While progress has been very encouraging, there are still wide gaps between and within countries. Today's report underscores the need to sustain efforts to ensure the world's most vulnerable people have access to health services."

Child deaths halved, but won't reach target

Progress in child survival worldwide is one of the greatest success stories of international development. Since 1990, child deaths have almost halved – falling from an estimated 90 deaths per 1000 live births to 46 deaths per 1000 live births in 2013.

Despite great advances, this is not enough to reach the goal of reducing the death rate by two-thirds. Less than one third of all countries have achieved or are on track to meet this target by the end of this year. The top killers of children aged less than 5 years are now: preterm birth complications, pneumonia, birth asphyxia and diarrhoea.

Saving more mothers

The number of women who died due to complications during pregnancy and childbirth has almost halved between 1990 and 2013. This rate of decrease won't be enough to achieve the targeted reduction of 75% by the end of this year.

The maternal mortality ratio has fallen in every region. However, 13 countries with some of the world's highest rates have made little progress in reducing these largely preventable deaths.

In the WHO African Region, 1 in 4 women who wants to prevent or delay childbearing does not have access to contraceptives, and only 1 in 2 women gives birth with the support of a skilled birth attendant. Less than two-thirds (64%) of women worldwide receive the recommended minimum of 4 antenatal care visits during pregnancy.

Reversing the spread of HIV

The world has begun to reverse the spread of HIV, with new infections reported in 2013 of 2.1 million people, down from 3.4 million in 2001.

The revised target of achieving universal access to treatment for HIV will be more challenging as WHO's recommendations have resulted in much higher numbers of people needing treatment. At current trends, the world will exceed the target of placing 15 million people in low- and middle-income countries on antiretroviral therapy (ARTs) in 2015. By the end of 2013, almost 13 million people received ARTs globally. Of these, 11.7 million lived in low- and middle-income countries, representing 37% of people living with HIV in those countries.

Increasing access to safe drinking water and sanitation

While the global target for increasing access to safe drinking water was met in 2010, the WHO African and Eastern Mediterranean Regions fall far short, particularly for poor people and those living in rural areas.

The world is unlikely to meet the MDG target on access to basic sanitation. Around 1 billion people have no access to basic sanitation and are forced to defecate in open spaces such as fields and near water sources. Lack of sanitation facilities puts these people at high risk of diarrhoeal diseases (including cholera), trachoma and hepatitis.

Beyond 2015

In September, countries will decide on new and ambitious global goals for 2030 at the United Nations General Assembly in New York. In addition to finishing the MDG agenda, the post-2015 agenda needs to tackle emerging challenges including the growing impact of noncommunicable diseases, like diabetes and heart disease, and the changing social and environmental determinants that affect health.

The draft post-2015 agenda proposes 17 goals, including an overarching health goal to "ensure healthy lives and promote well-being for all at all ages".

Key facts from World Health Statistics 2015

• Life expectancy at birth has increased 6 years for both men and women since 1990.
• Two-thirds of deaths worldwide are due to noncommunicable diseases.
• In some countries, more than one-third of births are delivered by caesarean section.
• In low- and middle-income countries, only two-thirds of pregnant women with HIV receive antiretrovirals to prevent transmission to their baby.
• Over one-third of adult men smoke tobacco.
• Only 1 in 3 African children with suspected pneumonia receives antibiotics.
• 15% of women worldwide are obese.
• The median age of people living in low-income countries is 20 years, while it is 40 years in high-income countries.
• One quarter of men have raised blood pressure.
• In some countries, less than 5% of total government expenditure is on health.

About WHO statistics

Published every year since 2005 by WHO, World Health Statistics is the definitive source of information on the health of the world's people. It contains data from 194 countries on a range of mortality, disease and health system indicators including life expectancy, illnesses and deaths from key diseases, health services and treatments, financial investment in health, as well as risk factors and behaviours that affect health.

source: http://www.who.int/

The Ebola virus outbreak in West Africa has not just illustrated the absence of political commitment towards public health, but it has also initiated discussions on the security of global health. A group comprising of leading practitioners of health have now presented their thoughts on the impact of this epidemic in several essays published in The Lancet. In this essay, Different perspectives have been critically looked at on what the Ebola outbreak has got to teach us. In areas like health care access for individuals, the epidemic can increase political commitment for improving healthy security and how other related issues like antimicrobial resistance are relevant to the security of health have been investigated.

Professor of Infectious Disease Epidemiology at London School of Tropical Medicine and Hygiene, London, UK and lead author of the review, David L.Heymann has described health security as being essentially the protection from various threats to health.

The professor said that throughout history, the approach to threats like the Ebola epidemic has been focused on rapid response and rapid detection of these outbreaks. According to him, this approach has overtime become the commonly understood concept of healthy security for several centuries. But, the Ebola crisis has highlighted a second and equally crucial aspect of global health security that is not considered and that is making accessibility to health products and services more accessible at a personal level around the globe. He also said that this should be better recognized as an integral part in the scope of global health security.

One of the essays also made a suggestion that global healthy security has remained politically neglected for over a decade through the lesser importance given by the WHO and the legal noncompliance by certain countries.

source: http://www.dispatchtimes.com/

A year after its launch on Jan. 1, 2014, the Social Security Organizing Body (BPJS), which provides health care and insurance schemes for Indonesians, has posted a Rp 1.93 trillion ($148.22 million) deficit as claims exceeded premium income.

The health insurance agency generated Rp 40.72 trillion in premium revenue last year from its customers, which include employers, employees, workers of the informal sector and government officials.

Meanwhile, claims from customers — which include spending on curative health care, and rehabilitative in-patient care, preventive services like shots and screening tests — stood at Rp 42.65 trillion.

Of this figure, Rp 8.34 trillion was paid to 18,437 community health clinics, known as Puskesmas and Rp 34.31 trillion was paid to 1,681 hospitals.

The mismatch between claims and premium revenue means the government has to step in.

"We expect the deficit can be plugged with a government [cash] injection," said Fahmi Idris, chief executive for the BPJS's unversal health care branch known as BPJS Kesehatan.

This year, the agency expects to receive up to Rp 5 trillion in funds from the government, of which Rp 3.46 trillion is expected to be disbursed sometime in the first half of this year, while the remainder will be allocated at the end of 2015.

Through the BPJS, the government subsidizes health premiums for all Indonesians, including citizens working in the informal sector.

The government is still working to get as many health institutions as possible to participate in the program.

The agency had already estimated a potential deficit of up to Rp 1 trillion for the first quarter of 2015, said Riduan, its finance and investment director. Claims from January to March are expected to reach Rp 13 trillion, while the agency receives an average of Rp 4 trillion from premium income per month, he added.

This means premium revenue for the first three months stood at Rp 12 trillion, yielding to a shortfall of Rp 1 trillion.

In addition to seeking financial support from the government, the agency is working to make improvements in its operation that would allow it to generate more revenue and optimize claims.

Its efforts include revising the activation date of insurance cards and raising the amount of premiums.

Starting June this year, new participants will only be able to use the health insurance card two weeks after they register — only slightly longer than the current seven days.

This is done to avoid "free riders" — people who only register when they are sick, or know they would need to pay for health care services in the immediate future.

With regard to the premium, Riduan said the health agency is still reviewing the current figure, although he signaled the possibility of an increase.

The current premium for clients of BPJS Kesehatan's health insurance schemes ranges from Rp 25,500 to Rp 59,500 per month, per person.

"The increase plan will start in 2016, not this year," Riduan said.

He added that the agency still has Rp 400 billion in unpaid premium bills from regional governments who registered their officials last year.

These local administrations first need approval from their legislators to settle budget spending, delaying their premium payments.

Also, more than 2 million registrants from the workers category have yet to pay their premiums.

Riduan said BPJS Kesehatan also plans to cooperate with state lenders to help participants in making their payments, including Bank Rakyat Indonesia, Bank Mandiri and Bank Negara Indonesia.

source: http://thejakartaglobe.beritasatu.com/

It has now been over a year since the Ebola outbreak in West Africa was first reported and it has since gone on to become the deadliest occurrence of the disease since its discovery in 1976, claiming the lives of more than 10,000 people. So what has the outbreak taught us and how prepared are we for the next global health crisis?

What lessons have been learned from Ebola?

We have learned that the initial response to an outbreak must be robust and complete so that the outbreak does not spread from rural areas, where it emerges from an animal source in nature, into neighbouring countries and urban areas.

We have also learned that community engagement is of the utmost importance - helping village elders, paramount chiefs and others understand how the disease is transmitted and how it can be stopped, including emphasis on safe burial practices.

Equally important is contact tracing - and daily monitoring of the temperature of those who are known to have been in contact with a patient - for three weeks, in order to identify those who are potentially infected with Ebola; and surveillance to identify patients and ensure their transport and management in a health facility where infection control is up to standard.

Ebola transmission is amplified if patients are admitted to health facilities where infection control is sub-standard; and where health workers inadvertently become infected and then unintentionally infect their family members, spreading the infection to the community.

Health workers are often infected because it is impossible to diagnose Ebola early - it has signs and symptoms similar to other infections such as malaria - and they are therefore at great risk of infection. It has been shown that the Ebola virus does not cause major outbreaks where health facility infection control is up to standard.

The best means of dealing with an international health crisis is prevention - it has been known, for example, since 1976 that it is sub-standard health facility infection control that permits Ebola to spread, yet sub-standard infection control continues in many facilities. Emphasis must be placed on helping health facilities understand and use infection control measures as part of their routine activities.

The International Health Regulations are international laws that are meant to help prevent the international spread of disease, and they required countries to develop standard core capacity in public health between the years 2007 and 2014, yet many countries did not accomplish this and continue to be at great risk of not detecting and responding to outbreaks early, when their spread can be prevented.

What dangers lie ahead?

There continue to be many infectious disease risks that can spread internationally - some of them are known, others unknown. Those that are known include infections resistant to the medicines used to cure them (antimicrobial resistant infections). Infections such as Dengue, Chikungunya, and cholera all continue to spread throughout the world.

Those that are unknown - they emerge from a source in nature to infect humans - sometimes also have the potential to spread internationally. Sars in 2003 is an example - and others, such as Ebola, re-emerge from time to time. It is impossible to predict when these latter, emerging infections, will emerge or re-emerge, so it is important that all countries develop the public health capacity to detect and respond to infectious diseases when and where they emerge or re-emerge.

The way forward must therefore include stronger government engagement in developing core capacities in public health so that outbreaks can be rapidly identified and contained when and where they occur; and strengthening of global alert and response mechanisms to ensure a rapid and robust response - a safety net when countries are unable to detect and contain outbreaks on their own.

David Heymann is head and senior fellow, Chatham House Centre on Global Health Security, and professor of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.

source: http://www.bbc.com/

More than 2 million participants have fallen behind on National Health Insurance (JKN) premium payments, contributing to the programme's financial difficulties last year.

The Healthcare and Social Security Agency (BPJS Kesehatan), the insurance operator, reported that 2,158,584 people had been late in their premium payments for three to six months.

"Those who are late in their payments are mostly workers who do not receive fixed salaries," BPJS spokesperson Irfan Humaidi told The Jakarta Post recently. "They are people who register when they fall ill, but stop paying once they recover."

There are 1,915,424 participants in this category, while 242,653 long-time members have failed to keep up with premium payments, including those covered by the Jamsostek insurance programme. A further 175 members have become late-payers after retiring from their jobs.

Irfan said that the rate of non-compliant participants had not harmed the agency's finances, since their number accounted for less than two per cent of the current 140 million JKN participants.

Each JKN participant is required to pay premiums of differing sums, starting from Rp 25,500 (US$1.96) per month.

BPJS Kesehatan expects to remain in the red throughout this year, with its claim ratio expected to hover around 100 per cent. The claim ratio is the difference between the hospitals' bills for health services provided and the premiums collected by the agency from participants registered in the programme.

Separately, the National Social Security Board (DJSN), which is tasked with monitoring the programme, said that while the number of late-payers might be relatively small now, BPJS Kesehatan should not ignore these groups of people.

"If non-compliant participants are ignored and there's no punishment, their numbers will swell," DJSN head Chazali Husni Situmorang told the Post.

BPJS Kesehatan should hunt these late-payers, he argued, a simple process since the agency already had their addresses and phone numbers.

"The agency has to have a strategy. For example, the marketing division should call all those who are late in their payments. The agency could also utilize a system to send automated SMS," said Chazali.

Irfan said that the agency had already sent bills via text message.

"Moreover, late-payers receiving treatment at hospitals will receive notification that they haven't paid," he said.

After six months without payment, they are no longer eligible for health treatments, according to Irfan.

The late-payers also have to pay a fine of two per cent of the total premiums before they can resume their membership in the JKN programme.

"The fine is too small. It should be increased incrementally," Chazali said. "If the fine is too small, then its deterrent effect is negligible."

He also suggested that the BPJS Kesehatan require its participants pay premiums once every six months, instead of monthly.

"It would counter late payments. And it doesn't violate the law because the law doesn't stipulate that BPJS Kesehatan must collect premiums every month," said Chazali.

He also suggested that BPJS Kesehatan publish the names of late-payers in local media or government offices to shame them.

Lastly, Chazali said, BPJS Kesehatan could team up with state-owned electricity company PLN and state-owned telecommunications company Telkom to target late-payers.

"When they pay their electricity bills or phone bills, they could be reminded to pay their JKN premiums," he said

source: http://business.asiaone.com

Republican congressional leaders are eager to give President Obama Trade Promotion Authority, or "Fast Track." Proponents argue that Fast Track will break the logjam holding up important international trade agreements like the Trans Pacific Partnership (TPP), which includes countries as diverse as Australia, Canada, Peru and Vietnam.

Fast Track would allow the president to finalize the agreement before sending it to Congress for a straightforward up-or-down vote within a limited time. However, the likelihood of Fast Track resulting in TPP getting a "thumbs up" from Congress is limited by potential differences between the president and the congressional majority on intellectual property rights.

In a recent Wall Street Journal op-ed, Representative Paul Ryan (R-WI) and Senator Ted Cruz (R-TX) asserted that the administration must pursue a number of negotiating objectives, including "beefing up protections for U.S. intellectual property" if it wants Congress to approve the TPP.

It is uncertain the president is as committed to intellectual property as Mr. Ryan and Mr. Cruz hope, especially with respect to patents for medicines. Although the text of the TPP is not yet available to the public, the U.S. Trade Representative, who negotiates in the president's name, insists that "TPP countries have agreed to reflect in the text a shared commitment to the Doha Declaration on TRIPS and Public Health."

The 2001 Doha Declaration was an attempt to limit international trade agreements' commitment to patent rights that were accepted in the World Trade Organization's 1995 Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. It insists that low and middle-income countries should have broad latitude to allow generic drug makers to make copies of patented medicines through a legal mechanism called "compulsory licensing."

The Doha Declaration was an important achievement for well-intentioned advocates for public health, such as Doctors Without Borders (known also by its French acronym MSF), which has just launched an advertising campaign designed to gut patent rights in the TPP. MSF claims – reasonably – that poor countries and nonprofits cannot afford to pay the prices that manufacturers can negotiate with payers in wealthier countries.

Unfortunately, attacking patents is a misguided way to improve access to medicines in low and middle-income. Although it is a counter-intuitive conclusion, strong patent rights are a better way to achieve this goal.

In an international environment of strong patent rights, innovative drug makers would have every incentive to lower prices voluntarily to poor countries. Costs of manufacturing and distribution are a small percentage of prices charged for patented medicines in the United States. The reason the government recognizes patents is so the manufacturer can charge enough to earn a return on investment in research and development.

source: http://www.forbes.com/

In 2012, the FDA warned physicians and medical practices that their supplies of bevacizumab, an expensive drug used in combination with chemotherapy to inhibit tumor growth, might be tainted. It turns out some hospitals were literally giving cancer patients cornstarch instead of anticancer meds: The FDA found that some batches of the counterfeit beyacizumab contained no active pharmaceutical ingredients at all.

Tim Mackey, director of the Global Health Policy Institute, said that even today it's hard to guess exactly how many patients were exposed to the counterfeit bevacizumab; those being treated would have a high mortality rate anyway. "It's kind of like the perfect crime," Mackey said.

Further obscuring the extent of the ersatz drug is the maze of grey market distributors it wound through. Before the counterfeit bevacizumab arrived in the United States, investigators found, it traveled through Turkey, Switzerland, Denmark, the U.K., and Canada.

Despite the scope of this scandal, the security of our medical supply chain hasn't improved much. "It could happen tomorrow and we wouldn't be any more protected," Mackey said.

The process for reporting incidents of counterfeited drugs around the world is severely impaired, a study published today in the American Journal of Tropical Medicine and Hygiene has found. Of 169 countries, 127 reported no counterfeit incidents at all, meaning, Mackey said, that many countries are simply ignoring the problem. Without an accurate picture of the security of the medical supply chain, it's difficult for governments to crack down on drug counterfeiting. The study is the first global-scale assessment of drug counterfeiting.

The study found that counterfeit medicine turned up in a range of settings: from small community pharmacies providing anti-malarial drugs to U.S. clinics providing anticancer treatment. From 2009 to 2011, the study counted 1,799 different types of counterfeited medicine across 1,510 reports of "counterfeit incidents," which encompass a range of situations or quantities of drugs, worldwide. A customs official unearthing multiple counterfeited drugs, for example, would be counted as one incident.

China reported the largest number of counterfeit incidents, followed by Peru, Uzbekistan, Russia, and Ukraine. However, Mackey said, these finding should be taken with a grain of salt: Countries such as China, which has a reputation for counterfeit medicine, might be looking for counterfeit drugs and therefore turn up more, while other countries, such as India, might be ignoring drug security in part to delay having to address it. "The countries and numbers would look really different," with more accurate reporting, Mackey said.

Although the study's data might be limited, it emphasizes the need for a standardized procedure and system for reporting counterfeit medicine worldwide. The majority of counterfeit drugs—about 53 percent—fall under "lifesaving-related drug categories," the study found.

"There's this global drug supply chain, and there's gaps in it," Mackey said. "We really need to make this a global priority."

source: http://www.newrepublic.com/