Preventable Child Deaths Contribute to Global Mortality Levels

The health and mortality transition continues to move in the direction of people dying at older ages from degenerative diseases (albeit with some of these having roots in infectious diseases). But a new report in The Lancet by researchers at The Johns Hopkins University reminds us that children are still dying in large numbers and most of these deaths are preventable. BBC News covers the story.

The team from Johns Hopkins Bloomberg School of Public Health looked at data from a range of sources, including household surveys and registration systems for 193 countries. Mathematical modelling was used where data was incomplete.
They found child deaths had fallen by two million (26%) since 2000, and there have been significant reductions in leading causes of death including diarrhoea and measles - as well as pneumonia.
But they say there are still significant challenges.
They found two-thirds of the 7.6m children who died before their fifth birthday did so due to infectious causes - and pneumonia was found to be the leading cause of death. 
Five countries (India, Nigeria, Pakistan, Democratic Republic of Congo and China) accounted for almost half (3.75m) of deaths in children under five.

Of course, two of those five are in sub-Saharan Africa, where half of child deaths occurred, two-thirds (2.6m) of which were due to infectious causes, including malaria and AIDS. Preventing these child deaths may encourage couples to have fewer children, although that results is by means assured. Thus, we need to work to prevent these deaths at the same time that we work to provide the motivation and means for couples to limit fertility.

Infections Are an Important Source of Cancer

It is convenient to divide causes of death into communicable/infectious disease and degenerative diseases. In general, communicable disease kills younger people more than older people, whereas degenerative diseases are the kinds of things that kill older people. Researchers are increasingly discovering, however, that certain kinds of infectious diseases are actually the cause of certain kinds of cancer. If one doesn't kill you, the other might. A new study published in The Lancet Oncology by a French research team, and reported in places such HuffingtonPost, estimates that 2 million cancers each year in the world are caused by infections, especially human papillomavirus (HPV), hepatitis B and C, or Helicobacter pylori.

For men in particular, 80 percent of the infection-related cancers were liver and gastric cancers. In women, about half of the infection-related cancers were cervical cancer, according to the study.
"Application of existing public health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on the future burden of cancer worldwide," the researchers wrote in the study.

Especially striking, though, is that infections are a much more important source of cancer in developing countries than in developed countries.

This fraction was higher in less developed countries (22·9%) than in more developed countries (7·4%), and varied from 3·3% in Australia and New Zealand to 32·7% in sub-Saharan Africa.

And equally striking is that around 30% of infection-attributable cases occur in people younger than 50 years. If you put these findings together you can see that the populations in the world that are already most susceptible to infections--younger people in developing countries--are those most susceptible to having an infection lead to cancer. 

FDA Panel Urges Approval of Drug that Prevents HIV Infection

Truvada is a medication that, if taken every day, can prevent a person from contracting HIV. This can be very important for people in high-risk situations, such as gay and bisexual men and heterosexual couples with one HIV-positive partner. The Associated Press reported today that an expert panel appointed by the US Food and Drug Administration has recommended that it be approved for sale. You might assume that this news would be widely welcomed since it would seem to offer a new opportunity to reduce HIV infections and possible death from AIDS. However, there are counter-arguments:

During the meeting's public comment period, FDA panelists heard from more than two dozen doctors, nurses and patients who said patients would not take the drug as recommended — every day, in addition to using condoms.
"Truvada needs to be taken every day, 100 percent of the time, and my experience as a registered nurse tells me that won't happen," Karen Haughey told the panel. "In my eight years, not one patient that I've cared for has been 100 percent adherent."
Other speakers worried that wide scale use of Truvada would divert limited funding from more cost-effective options. Truvada sells for about $900 a month, or just under $11,000 per year. The AIDS Healthcare Foundation, which opposes approval of Truvada, estimates that 20 HIV-positive patients could be treated for the cost of treating one patient with preventive Truvada.
"Truvada for prevention will squeeze already-constrained health care resources that can be better spent on cheaper and more effective prevention therapies," the group states in a petition to the FDA.

If the drug is approved as expected, it may simply become a boutique drug, rather than a real breakthrough. It is the latter, of course, that would be very nice, but every little bit helps. After all, 

An estimated 1.2 million Americans have HIV, which develops into AIDS unless treated with antiviral drugs. AIDS causes the body's immune system to breakdown, leading to infections which are eventually fatal. Gay and bisexual men account for the majority of cases — nearly two-thirds.
The number of new HIV infections in the U.S. has held steady for 15 years at about 50,000 per year. But with no vaccine in sight and an estimated 240,000 HIV carriers unaware of their status, doctors and patients say new methods are needed to fight the spread of the virus.

Garbage Threatens Sea Life

About 70 percent of the earth's surface is covered by ocean water, and we use it routinely as our place of refuse (not refuge, but refuse). In a relatively short span of time, this habit is coming back to bite us. Scientists at the Scripps Institute of Oceanography here in San Diego have just published results of their latest estimates of garbage in the Northwest Pacific ocean. The story was covered locally by the San Diego Union-Tribune (front page above the fold, no less) and internationally by BBC News.

The quantity of small plastic fragments floating in the north-east Pacific Ocean has increased a hundred fold over the past 40 years.
Scientists from the Scripps Institution of Oceanography documented the big rise when they trawled the waters off California.
They were able to compare their plastic "catch" with previous data for the region.
The group reports its findings in the journal Biology Letters.Researchers analyzed plastic particles reported or collected by various sources since 1972 and discovered not only a sharp growth of the “plastisphere” but also that a common insect, the sea skater, is increasingly laying eggs on the artificial flotsam. That has allowed sea skaters to boost egg densities in the North Pacific Subtropical Gyre, a phenomenon that hasn’t been documented until now among invertebrates using plastics in the open ocean.

While it is not yet entirely clear what all of this means for sea life, the consensus is that it isn't good. It is already the case that fish caught in the region have been found to have ingested plastic, and the increasing insect population is not likely to be beneficial to sea life, either. Given the worldwide reliance on fish and other sea life as a source of food (and other key products), it seems likely that our sea-borne garbage is lowering our long-term sustainability, especially in the face of continued global population growth and the demand for higher standards of living.

Can More Than 7 Billion People be Sustained?

In a nice coincidence of timing with the PERN cyberseminar on population and sustainability, I have been asked to write an essay for the ABC-CLIO/Greenwood Press World Geography database. The question posed is this: "Is a world population of over 7 billion sustainable?" If you've read my chapter on Population and the Environment, you'll know my answer to that question. My general position is that a population of more than seven billion people is only sustainable if we are willing to accept either continued gross inequality in standards of living around the globe, or if everyone is willing to accept a lower standard of living. I do not believe that the earth has enough resources for more than seven billion people to live sustainably like Americans or Europeans. 

So far, none of the people posting comments on the PERN cyberseminar have disagreed with this perspective. Keep in mind that I don't like to have this view of the world. I would very much like for every one of the 9-10 billion likely alive at mid-century to live sustainably at the current level of Americans an Europeans. However, all of the available evidence suggests that to do so will require a miracle...and in the meantime there is a continual push in the rich countries to somehow raise our standard of living even higher.