Article by Lalita Panicker, Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi
Billed as the world’s most comprehensive collection of statistics on the topic, the Health Inequality Data Repository allows users to compare how people of differing incomes, ages, genders and rural-versus-urban settings compare on more than 2,000 measures of health, ranging from access to key health services to child mortality rates – and even upload and analyse their own data. www.npr.org/sections/goatsandsoda/2023/04/21/1171245878/how-do-you-get-equal-health-care-for-all-a-huge-new-database-holds-clues?
“It’s critical for us to look at various dimensions of inequality … to truly understand who’s being left behind in different contexts,” said Erin Kenney, acting director of the World Health Organization (WHO)’s Department of Gender, Diversity Equity and Human Rights.
She was speaking at a press conference to demonstrate how the new database works. Here are three takeaways from that event.
The new WHO database is unquestionably extensive, featuring 11 million data points pulled from 15 global statistics sources. Yet health officials at the press conference mainly stressed how much information was still missing from it.
This is partly due to gaps in the collection of health statistics more generally. “Nine out of 10 deaths in Africa are not reported,” noted Samira Asma, WHO’s assistant director general in charge of data analytics.
Data collectors are especially likely to miss people who belong to vulnerable groups, said Francesca Perucci, assistant director of the United Nations’ Statistical Division. “For example,” she said, “a survey of national statistical offices found that 39% could not adequately collect data on migrants, 27% had difficulties collecting data on older persons and 27% had challenges with data on persons with disabilities.”
When health statistics are available, they are often still not broken out by all the relevant sub-categories. That’s a problem because statistics that average out measures of well-being can paint a misleading picture – hiding pockets of extreme suffering.
The result: Even within the new database, while most of the statistics are broken out by gender, only about 20% can be broken out by age or place of residence, around 15% by either education or wealth – to cite just a few examples.
Asma also warned that, as useful as the new database could prove, there’s the danger that “a data repository alone can also be a trap – a safe deposit box when data is deposited but not used.”
The point of the database, she and other officials stressed, is not merely to track the extent of health inequality across countries but to galvanize efforts to address it.
“It helps us in creating accountability on the promise to leave no one behind,” said Oscar Mujica, an adviser on health equity with the Pan American Health Organization.
Every country made that promise as part of a list of global goals adopted for the year 2030, Mujica noted. And yet, he said even though hundreds of specific statistical targets were set to ensure those broader goals were met “not a single one” actually measures progress on health inequality.
Now, “we can do that with the data that are available,” from the new database, he said. “Even with the gaps in the data, we can start creating accountability on that promise. We are running out of excuses to remain equity blind when assessing a particular population’s health situation.”
WHO officials noted that the database can also illustrate that progress is possible.
For instance, it indicates that over the last decade low- and middle-income countries have actually substantially reduced inequality when it comes to women, new-borns and children’s access to health services. At the outset only 49% of those in the lowest income group had good health coverage compared to 68% in the highest income group – a 19 point difference. Now, that gap has been cut almost in half, with 62% of the lowest income group having health coverage compared to 73% of the wealthiest – an 11 point difference.
The data also helps make the case for prioritizing further efforts to expand access. For instance, if these same countries were to completely close the rich-poor gap when it comes to child mortality, 1.8 million children’s lives would be saved. /////
As a growing number of overweight Americans clamour for Ozempic and Wegovy — drugs touted by celebrities and on TikTok to pare pounds — an even more powerful obesity medicine is poised to upend treatment. apnews.com/article/mounjaro-wegovy-ozempic-obesity-weight-loss-bd0e037cc5981513487260d40636752a
Tirzepatide, an Eli Lilly and Co. drug approved to treat type 2 diabetes under the brand name Mounjaro, helped people with the disease who were overweight or had obesity lose up to 16% of their body weight, or more than 34 pounds, over nearly 17 months, the company said last Thursday.
The late-stage study of the drug for weight loss adds to earlier evidence that similar participants without diabetes lost up to 22% of their body weight over that period with weekly injections of the drug. For a typical patient on the highest dose, that meant shedding more than 50 pounds.
Having diabetes makes it notoriously difficult to lose weight, said Dr Nadia Ahmad, Lilly’s medical director of obesity clinical development, which means the recent results are especially significant. “We have not seen this degree of weight reduction,” she said.
Based on the new results, which have not yet been published in full, company officials said they will finalize an application to the U.S. Food and Drug Administration (FDA) for fast-track approval to sell tirzepatide for chronic weight management. A decision could come later this year. A company spokeswoman would not confirm whether
the drug would be marketed for weight loss in the U.S. under a different brand name.
If approved for weight loss, tirzepatide could become the most effective drug to date in an arsenal of medications that are transforming the treatment of obesity, which affects more than 4 in 10 American adults and is linked to dozens of diseases that can lead to disability or death.
“If everybody who had obesity in this country lost 20% of their body weight, we would be taking patients off all of these medications for reflux, for diabetes, for hypertension,” said Dr Caroline Apovian, a director of the Centre for Weight Management and Wellness at Brigham and Women’s Hospital. “We would not be sending patients for stent replacement.”
Industry analysts predict that tirzepatide could become one of the top-selling drugs ever, with annual sales topping $50 billion. It is expected to outpace Novo Nordisk’s Ozempic — a diabetes drug used so commonly to shed pounds that comedian Jimmy Kimmel joked about it at the Oscars — and Wegovy, a version of the drug also known as semaglutide approved for weight loss in 2021. Together, those drugs made nearly $10 billion in 2022, with prescriptions continuing to soar, company reports show.
In separate trials, tirzepatide has resulted in greater weight loss than semaglutide, whose users shed about 15% of their body weight over 16 months. A head-to-head trial comparing the two drugs is planned.
Mounjaro was first approved to treat diabetes last year. Since then, thousands of patients have obtained the drug from doctors and telehealth providers who prescribed it “off-label” to help them slim down.
Rather than relying solely on diet, exercise and willpower to reduce weight, tirzepatide and other new drugs target the digestive and chemical pathways that underlie obesity, suppressing appetite and blunting cravings for food.
Though the drugs appear safe, they can cause side effects, some serious. Most common reactions include diarrhoea, nausea, vomiting, constipation and stomach pain. Some users have developed pancreatitis or inflammation of the pancreas, others have had gallbladder problems. Mounjaro’s product description warns that it could cause thyroid tumours, including cancer.
There are other downsides: Versions of semaglutide have been on the market for several years, but the long-term effects of taking drugs that override human metabolism are not yet clear. Early evidence suggests that when people stop taking the medications, they gain the weight back.
Plus, the medications are expensive — and in recent months, hard to get because of intermittent shortages. Wegovy is priced at about $1,300 a month. Mounjaro used for diabetes starts at about $1,000 per month.
Apovian said that only about 20% to 30% of patients with private insurance in her practice find the medications are covered. Some
insurers who previously paid for the drugs are enacting new rules, requiring six months of documented lifestyle changes or a certain amount of weight loss for continued coverage. Medicare is largely prohibited from paying for weight-loss drugs, though there have been efforts by drugmakers and advocates for Congress to change that.
Still, experts say that the striking effects of tirzepatide — along with Ozempic, Wegovy and other drugs — underscore that losing weight is not merely a matter of willpower. Like high blood pressure, which affects about half of U.S. adults and is managed with medication, obesity should be viewed as a chronic disease, not a character flaw, Aronne emphasized.
U.S. health officials on Wednesday approved the first pill made from healthy bacteria found in human waste to fight dangerous gut infections — an easier way of performing so-called faecal transplants.
The new treatment from Seres Therapeutics provides a simpler, rigorously tested version of stool-based procedures that some medical specialists have used for more than a decade to help patients. https://apnews.com/article/fecal-transplant-fda-stool-microbiome-2204e1debaab5d75273025cd0b2a1308 The U S Food and Drug Administration (FDA) cleared the capsules for adults 18 and older who face risks from repeat infections with Clostridium difficile, a bacteria that can cause severe nausea, cramping and diarrhoea.
C. diff is particularly dangerous when it reoccurs, leading to between 15,000 and 30,000 deaths per year. It can be killed with antibiotics but they also destroy good bacteria that live in the gut, leaving it more susceptible to future infections. The new capsules are approved for patients who have already received antibiotic treatment.
More than 10 years ago, some doctors began reporting success with faecal transplants — using stool from a healthy donor — to restore the gut’s healthy balance and prevent reinfections. The FDA approved the first pharmaceutical-grade version of the treatment last year from a rival drugmaker, Ferring Pharmaceuticals. But that company’s product — like most of the original procedures — must be delivered via the rectum.