Fiona Gore

Global burden of disease in young people aged 10–24 years: a systematic analysis

BACKGROUND Young people aged 10-24 years represent 27% of the worlds population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden. METHODS We used data from WHOs 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups. FINDINGS The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%). INTERPRETATION The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention. FUNDING None.

Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities

Mikkel Oestergaard and colleagues develop annual estimates for neonatal mortality rates and neonatal deaths for 193 countries for 1990 to 2009, and forecasts into the future.

Health of the world's adolescents: a synthesis of internationally comparable data

Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the worlds adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents.

Urban Environmental Health Hazards and Health Equity

This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on “Improving the living environment” prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.

Too much or too little? A review of the conundrum of selenium

Chemical elements such as selenium, fluoride, iron, calcium and magnesium are essential to the human being, although some are toxic when absorbed in high doses. In this paper, the risks associated with insufficient and excessive intake of selenium in the diet are reviewed, focusing on drinking water. Two different approaches are used to derive recommended nutrient intakes (RNI) for adequate nutritional status and guideline values to prevent excessive exposure. The former is based on the daily intake which meets the nutrient requirements of 97.5% of the population. The latter is a value derivation based on an assumed daily per capita consumption at the individual level, a conservative approach used where there is any uncertainty and is related to a negligible risk to health at population level across life stages. There is an increasing need to develop a conceptual framework bringing together aspects of toxicity and essentiality especially for elements apparently exhibiting narrow or overlapping ranges between essentiality and toxicity and to provide guidance on the nature and severity of risks in order to better protect human. While there are a number of frameworks available, these generally only consider food. There is a need to include water, which can be a significant source in some circumstances.

Modeling household solid fuel use towards reporting of the Millennium Development Goal indicator

Household use of solid fuels, such as dung, wood, agricultural residues, charcoal, and coal, is likely to be the largest indoor source of air pollution in developing countries. Combustion of solid fuels in inefficient stoves under poor ventilation conditions can result in large exposure burdens, particularly for women and young children, who spend the major part of their time at home. The importance of this public health and environmental issue is reflected in the inclusion of the percentage of households using solid fuels as an indicator towards the achievement of the Millennium Development Goal (MDG) for environmental sustainability. This article outlines the model used for completing missing country data for household use of solid fuels. Out of a total of 181 country data points reported, data were available for 94 countries. These included estimates from 42 countries where household solid fuel use was previously unknown, largely from the recently conducted World Health Survey. Based on the data available for these countries, using step-wise regression, a model to predict household solid fuel use based on rural population, gross national income (GNI) and geographic regional variables was developed. Thirty-five data points were estimated using this model. In general, household solid fuel use seems to be lower in 2003 than in 2000. Yet, even with increases in economic development and urbanization, drastic reductions in household solid fuel use are unlikely to occur in the absence of targeted programs to promote cleaner fuels.

Environmental threats to children's health - a global problem

Todays children are exposed to a wide range of environmental threats, whose consequences on health and development may appear early in life, throughout their youth and even later, in adulthood. Health problems linked to environmental hazards are multiplying and becoming more visible due to a rapidly changing environment, rapid population growth, overcrowding, fast industrialisation and uncontrolled pollution from many anthropogenic and also natural sources, and as a result of the effects of climate change. A World Health Organization report on the global burden of disease estimated that nearly a quarter of the global disease burden is related to environmental causes. These environmental-mediated diseases cause more than three million deaths in children under five every year. Such a large burden is unacceptable. Both industrialised and developing countries should reinforce their capacities to assess the environmental burden of paediatric diseases and characterise their impact on childrens health. This will enable all responsible sectors to distinguish the main environmental threats affecting childrens health and identify their specific roles in improving childrens environments. Implementing these activities and turning efforts into prevention, education, policy-making and other actions will reduce the burden of disease affecting children globally, therefore contributing towards achieving the Millennium Development Goals (MDGs).

Children's Environmental Health Indicators in Australia

BACKGROUND Adverse environmental exposures in early life increase the risk of chronic disease but do not attract the attention nor receive the public health priority warranted. A safe and healthy environment is essential for childrens health and development, yet absent in many countries. A framework that aids in understanding the link between environmental exposures and adverse health outcomes are environmental health indicators-numerical estimates of hazards and outcomes that can be applied at a population level. The World Health Organization (WHO) has developed a set of childrens environmental health indicators (CEHI) for physical injuries, insect-borne disease, diarrheal diseases, perinatal diseases, and respiratory diseases; however, uptake of steps necessary to apply these indicators across the WHO regions has been incomplete. A first indication of such uptake is the management of data required to measure CEHI. OBJECTIVES The present study was undertaken to determine whether Australia has accurate up-to-date, publicly available, and readily accessible data on each CEHI for indigenous and nonindigenous Australian children. FINDINGS Data were not readily accessible for many of the exposure indicators, and much of the available data were not child specific or were only available for Australias indigenous population. Readily accessible data were available for all but one of the outcome indicators and generally for both indigenous and nonindigenous children. Although Australia regularly collects data on key national indicators of child health, development, and well-being in several domains mostly thought to be of more relevance to Australians and Australian policy makers, these differ substantially from the WHO CEHI. CONCLUSIONS The present study suggests that the majority of these WHO exposure and outcome indicators are relevant and important for monitoring Australian childrens environmental health and establishing public health interventions at a local and national level and collection of appropriate data would inform public health policy in Australia.

Monitoring the inputs required to extend and sustain hygiene promotion: findings from the GLAAS 2013/2014 survey†

There are significant gaps in information about the inputs required to effectively extend and sustain hygiene promotion activities to improve peoples health outcomes through water, sanitation and hygiene (WASH) interventions. We sought to analyse current country and global trends in the use of key inputs required for effective and sustainable implementation of hygiene promotion to help guide hygiene promotion policy and decision‐making after 2015.