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  • With the availability of vaccines screen and treat approache

    2019-04-30

    With the availability of vaccines, screen-and-treat approaches, and effective drugs to treat hepatitis C virus, , and HIV infections, the question is no longer limited to what to do but now extends to how to implement. The expanding focus from basic research, drug development, and clinical trials that are historically concentrated in high-income countries, to basic, translational, and implementation science done in collaboration with centres in endemic areas, has the potential to both reduce the burden of infection-related cancers and shed light on presently unknown pathways in carcinogenesis.
    In , Ahmad Hosseinpoor and colleagues provide a status report on global disparities in rates of immunisation with three doses of diphtheria–tetanus–pertussis (DTP3) vaccine in children of different socioeconomic status (measured by quintiles of estimated physical assets). As in previous similar studies, there were large and significant disparities between children from the richest and poorest households. As sufficient comparable household surveys became widely available for cross-country trend analysis at the turn of the century, data for immunisation and other health indicators have consistently pointed in the same, disheartening direction. These inequities are not declining through time.
    Although no systematic causal review has yet been done, the evidence of a relation between democracy and health is increasingly convincing. In , Hannah Pieters and colleagues report a an innovatively designed study and a novel application of the synthetic control method to investigate the issue of democracy and infant mortality. They investigated whether political transition into democracy that had lasted for at least 10 years affected child mortality, as a proxy for health. Among 24 countries with good counterfactuals, changes in 15 were not significant but nine (38%) showed significant reductions in infant mortality after democratisation. Among these nine countries the average Fulvestrant was 13%. Interestingly, the effect increased over time, suggesting that there is an induction period for change while services and organisation are improved. Of note was that the benefits of democratisation increased with increasing child mortality before political change. The design innovation came from the units of observation, which in this case were countries that had transitioned from regimes with restricted freedom to democracies. Thus by studying ‘incident’ cases (change in status), the authors avoided selection bias and temporal ambiguity, which strengthens the case for the causal relation between democracy and health. These issues were seen in previous studies (including our own) that have used ‘prevalent’ cases (current regime) and one study that did a cross-sectional time-series analysis to compare situations after versus before democratisation. If democracy is good for health, it must be questioned whether deepening democracy would improve health further. We believe there is clear room for improvement in democracy and health by taking into account the distribution of power in populations. In most populations, men have more power than women. This gender order means that men generally enjoy patriarchal dividends in wages (division of labour), power (political and corporate), and cathexis (investment of mental or emotional energy). In this arena, the notion of empowerment is necessary because it involves bringing to the foreground the value of autonomy and embracing the ultimate goal of gender equality policies. Thus, an empowered individual is recognised not so much as being entitled to wellbeing, but rather as an agent with his or her own skills, values, judgements, and priorities that he or she may use to achieve wellbeing. Empowerment also involves accepting the need for public policies aimed at building political communities where all citizens participate in designing the social framework and fabric.