FT Health: The burden of depression

Depression affects more than 300m people worldwide and the number suffering has risen by nearly a fifth over the past decade, according to new estimates from the World Health Organization.

The condition has been chosen as the focus of World Health Day, which highlights the low levels of support and scant government investment to tackle the problem in richer as well as poorer countries.

The data suggest depression is the largest single contributor to global disability. It is responsible for 7.5 per cent of all years lived with disability (with the greatest burden in Africa), and is the major contributor to the 800,000 suicides each year. Anxiety disorders add an additional 3.4 per cent disability years.

Yet there is dispute over the figures. Some calculations put the overall burden of mental illness much higher still, while the poor quality of treatment and surveillance and over medicating make it difficult to generate reliable numbers. The 18 per cent growth in depression in 2005-15 is largely based on the overall growth of the world's population.

What seems clear is that improved early identification, training and support could help substantially and workplaces can play a substantial role. That is why the FT is seeking to collect better information and identify the impact of employers’ interventions through its health at work initiative.

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Three questions

Stephen O’Brien, UN under-secretary-general for humanitarian affairs and emergency relief co-ordinator, on its appeal against famine.

How big are the risks in Africa? 

We have a potential famine in Yemen, Somalia and Nigeria, and already 100,000 people affected in South Sudan. Between malnutrition and death there is always disease. Where you have conflict, food insecurity and low resilience, you get cholera, malaria, kala-azar, measles. Everybody feels very conscious of the lessons learned in Somalia in 2010-11, when 260,000 people died. Very sadly, half were dead by the time the famine was declared. We have alerted the world to save millions of lives. It’s important to call it early when you first see the evidence, rather than wait for the proof on TV screens to mobilise resources.

What are the causes?

Conflict is present in all four countries, and there are access challenges, continuing political failures, and exacerbation due to climate effects, including El Niño. This has resulted in back-to-back seasons with a lack of rain, with no way to plant and harvest and no opportunity for recovery or development of resilience. Conflict is a major, man-made, preventable source. We need political dialogue, but pending that, we all have a job to do to alleviate human suffering. There are 20m lives at risk. Humanitarians have been present in these countries saving millions of lives, but with this combination of circumstance, we need to scale up our response now to avert further catastrophe.

What is different about your response this time?

We sounded the alarm very early to alleviate and prevent the worst suffering and build more resilient communities. Our co-ordinated response means we will get the best return on our funds to save lives quickly. We are focusing on water and sanitation and health as well as malnutrition and food. There is a new way of working horizontally across the United Nations to make sure we are accountable, meeting needs and helping vulnerable communities withstand future shocks even as they recover from past ones. We are using cash transfers so people can make their own choices. They are very efficient where there is access to functioning markets.

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Chartwatch

Child deaths fall Global child mortality rates are dropping but the gap between the lowest and highest ranked countries is rising. Deaths fell from 14.2m in 1990 to 7.3m in 2015 with poorer nations accounting for almost 75 per cent. Most common causes include premature birth complications, lower respiratory tract infections and swelling of the brain. (NEJM, NPR)

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News round-up

US aid cuts President Donald Trump’s decision to pull the US contribution of $32m from the United Nations Population Fund — provider of maternal and childcare services and the world's largest distributor of contraceptives — was widely attacked. The administration said the agency assisted “coercive abortion or involuntary sterilisation” in China. (Humanosphere, UN Dispatch)

Health workers under pressure In World Health Worker Week we remember those medical staff working in extreme circumstances, from doctors dealing with chemical attacks in Syria to the ambulance drivers of Karachi. (WHO, Guardian/Mosaic)

Zika dangers The virus is more dangerous for pregnant women than previously thought, according to new research that shows one in 10 pregnancies with an infection results in birth defects. EU authorities are working with their counterparts to better map the spread of the disease. (Washington Post, CDC, ECDC) 

US regulation Scott Gottlieb, President Trump's pick to lead the Food and Drug Administration, reassured senators he would maintain its “gold standard” for drug safety and said his priorities were the opioid crisis and speeding the approval of generic medicines. Attempts to resuscitate the president's healthcare proposals continue. (Stat, BioPharma Dive, NYT) 

GSK reshuffle Emma Walmsley at GlaxoSmithKline became the first female boss of a big pharma company. Her initial challenges include strengthening revenues, revamping R&D, winning over investors as a first-time CEO and dealing with Brexit. (FT)

Stem cells A new website of 3D stem cell images could improve understanding of diseases including cancer by revealing unexpected aspects of cellular structure. Rick Horwitz of the Allen Institute for Cell Science, said: “You can’t predict the outcome of a football game if you know stats on all the players but have never watched a game.” (Allen Institute, Science)

DIY genetics test US regulators gave the green light to 23andMe’s Personal Genome Service, which allows a patient to test their DNA at home to see if they are at risk from diseases such as Alzheimer's. Customers pay $199 for a test kit and return a saliva sample by mail before receiving a report six weeks later. (FT)

Reinventing the hospital Technological advances will not just change the way healthcare is carried out but will also fundamentally alter the relationship between patient and doctor. Basic diagnostics can be carried out and monitored in the home, leaving the hospital to operate more like a cross between an airport and a swish hotel. (The Economist)

UK care crisis A parliamentary report condemned the “short-sighted” nature of successive governments in financing health and social care. Cuts to local authority spending and this week’s rise in the national living wage is making the situation more acute. (Lords Select Committee, FT)

Student stress Anxiety and depression among school children is a rising concern among health professionals. One US school is adding breathing exercises to the curriculum, as well as studying how tension affects the brain, putting new limits on homework and abolishing class rankings. (NYT)

A defibrillator with your decaf Every minute lost during a heart attack cuts the chances of survival by 7-10 per cent, so putting defibrillators in public places makes perfect sense — but where? New research recommends easy to remember locations such as coffee shops and banks, but delivery by drone may also soon be an option. (PLOS blog)

The Mongolian way of death Despite its lowly economic status, Mongolia has a remarkably successful palliative care programme. Increased availability of morphine, enlightened lawmaking and innovative teaching have even helped the country outperform its far larger neighbours Russia and China. (Mosaic)

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Best from the journals

Smoking gun Despite the success of the Framework Convention for Tobacco Control, smoking still causes 10 per cent of global deaths and heaps long-term burdens on stretched health systems. More aggressively enforced tobacco controls are needed, especially where smoking rates are still relatively low. (The Lancet)

Coca-Cola controversy The US drinks giant persuaded journalists that exercise was more important than cutting sugar consumption in the fight against obesity, new research alleges. The company funded conferences at a US university in an attempt to create favourable press coverage of sugar sweetened drinks, documents suggest. (BMJ) 

US health inequality Life expectancy of the wealthiest Americans now exceeds that of the poorest by 10—15 years. The poor have less access to care and those that do have insurance have experienced rising premiums. Meanwhile, the share of resources devoted to care of the wealthy has risen. (Lancet)

Resetting the body clock Sleeping habits, eating patterns and diet may upset body clocks and contribute to problems such as obesity or diabetes. Researchers looking at solutions such as improved sleep and restricted eating times have developed a mobile phone app to collect further data. (Jama)

Tackling lung disease Respiratory illness is one of the UK's leading killers and costs the country almost £10bn in direct healthcare costs, but unlike with heart disease, cancer or mental health, there is no strategic clinical network to address the problem. (BMJ blog)

Betting on gambling treatment Pathological gambling should be treated like any other addiction, says a BMJ paper. Despite wider costs to society such as gambling-related crime and mental illness there is no national agreement on NHS involvement. (BMJ)

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Podcast of the week

Mental health A discussion on global mental health treatments, their delivery and barriers preventing patients from accessing these services. (Nature)

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In case you missed it

Health financing New World Health Organization guide for improving national health systems.

FT Health Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6

Latest news www.ft.com/health and @FT_Health.

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Final thought

Answer: bad skin conditions. Researchers argue that the frequent depiction of movie villains with disfigured features “may foster a tendency toward prejudice in our society directed at those with skin disease.” Is it time film directors took more care when choosing their Face of Evil? (Stat, JAMA Dermatology)