Tedros Adhanom Ghebreyesus

Beating NCDs can help deliver universal health coverage

1 United Nations Development Programme, Human Development Report 2016: Human Development for Everyone. 2016. http://hdr.undp.org/sites/ default/files/2016_human_development_report.pdf (accessed May 30, 2017). 2 Ikeda N, Saito E, Kondo N, et al. What has made the population of Japan healthy? Lancet 2011; 378: 1094–105. 3 Japan Statistics Bureau, Ministry of Internal Affairs and Communications. Japan statistical year book 2017. Population and Households. http://www. stat.go.jp/english/data/nenkan/66nenkan/1431-02.htm (accessed May 30, 2017). 4 Nomura S, Sakomoto H, Glenn S, et al. Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015. Lancet 2017; published online July 19. http://dx.doi.org/10.1016/S0140-6736(17)31544-1. 5 Sugisawa H, Harada K, Sugihara Y, et al. Socioeconomic status and self-rated health of Japanese people, based on age, cohort, and period. Popul Health Metr 2016; 14: 27. 6 Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z. Economic recession and health inequalities in Japan: analysis with a national sample, 1986–2001. J Epidemiol Community Health 2008; 62: 869–75. 7 Hiyoshi A, Fukuda Y, Shipley M, Brunner E. Health inequalities in Japan: The role of material, psychosocial, social relational and behavioral factors. Soc Sci Med 2014; 104: 201–09. 8 Fukuda Y, Nakao H, Yahata Y, Imai H. Are health inequalities increasing in Japan? The trends of 1955 to 2000. Biosci Trends 2007; 1: 38–42. 9 Crombie I, Irvine L, Elliott L, Wallace H. Closing the health inequalities gap: an international perspective. Copenhagen 2005. WHO Regional Office for Europe. 10 Marmot M, Allen J. Social determinants of health equity. Am J Public Health 2014: 104 (suppl 4): S517–19. 11 Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status and health: complexities, ongoing challenges and research opportunities. Ann N Y Acad Sci 2010; 1186: 69–101. 12 Fone DL, Farewell DM, White J, et al. Socioeconomic patterning of excess alcohol consumption and binge drinking: a cross-sectional study of multilevel associations with neighbourhood deprivation. BMJ Open 2013; 3: e002337. 13 Nagassar RP, Rawlins JM, Sampson NR, et al. The prevalence of domestic violence within different socio-economic classes in Central Trinidad. West Indian Med J 2010; 59: 20–25 14 Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci 2012; 1248: 107–23.

Malaria: efforts starting to show widespread results.

informed advocacy SIR — Your Editorial ‘Time to take control’ (Nature 451, 1030; 2008) seems to downplay the current importance of advocacy for maintaining funds in the fight against malaria. But funding for all elements of malaria programmes — from research and development, design, implementation and commodities, to monitoring and evaluation — is essential to success. Results don’t happen without dedicated and predictable financial resources and, although commitments have increased, we still have a long way to go. A recent study by McKinsey (see http://tinyurl.com/52aoda) estimates that an investment of some US

Will you support a patient-centred R&D agreement?—Response from Tedros Adhanom Ghebreyesus

2.2 billion a year for five years is needed to achieve full coverage of prevention and treatment measures in just 30 of the hardest-hit African countries where malaria is endemic, addressing 90% of current malaria deaths. Without continued pressure on donors to keep up their commitments, there is no guarantee that additional funding will ever materialize. Also, advocacy is critical for ensuring that malaria efforts reach the communities most in need. On-the-ground efforts to engage national health leaders, navigate bureaucracies and encourage effective implementation of sound public-health policies are crucial. Without them, life-saving drugs, bed nets and insecticides will sit and spoil in warehouses. Generating and supporting participation and commitment on the spot is essential to the success of any programme. The Editorial highlights one of the most extreme situations where informed advocacy is needed. In the Democratic Republic of the Congo, the first step in addressing the extremely high burden of malaria is fervent advocacy to increase investment in malaria programmes in challenging regions. Without that advocacy, government and donors will continue to avoid investment, and there will be no progress to measure. Matthew Lynch Global Program on Malaria, Center for Communication Programs, Johns Hopkins University, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA

All roads lead to universal health coverage

www.thelancet.com/lancetgh Published online January 18, 2017 http://dx.doi.org/10.1016/S2214-109X(17)30027-X 1 4 WHO. Consultative Expert Working Group on Research and Development: Financing and Coordination. Research and development to meet health needs in developing countries: strengthening global fi nancing and coordination. http://www.who.int/phi/CEWG_ Report_5_April_2012.pdf (accessed Jan 12, 2017). 5 United Nations Secretary General’s High Level Panel on Access to Medicines. Report of the United Nations Secretary General’s High Level Panel on Access to Medicines: promoting innovation and access to health technologies. http://www.unsgaccessmeds.org/fi nal-report/ (accessed Jan 12, 2017). 6 Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. 7 WHO. Cholera vaccine supply set to double, easing global shortage. http://www.who.int/ cholera/vaccines/double/en/ (accessed Jan 12, 2017). 8 WHO. The WHO Strategy on Research for Health, 2012. http://www.who.int/phi/WHO_ Strategy_on_research_for_health.pdf?ua=1 (accessed Jan 12, 2017). Will you support a patient-centred R&D agreement?—Response from Tedros Adhanom Ghebreyesus