In retrospect, 1999 could be seen as the low point for cancer control policy in the UK. In that year, the Eurocare 2 study showed that the survival of patients with cancer was lower in the UK than several other European countries with similar healthcare systems. This finding has since been replicated by much further research—which thankfully also demonstrated continuous improvements in UK survival rates. In the same year, we also learned that cancer survival varies notably between patients living in richer and poorer neighbourhoods of England and Wales. This convinced even the most sceptical members of the academic community (and the most patriotic UK media) that something needed to be done. more…

“Stroke care was woeful,” said Dame Ruth Carnall, former chief executive of NHS London, in her sobering account of efforts to change the system. Less than 1% of patients had thrombolysis, less than 50% were treated in specialist stroke units, and standards were low across a whole range of indicators. Poor care, low standards, and it looked as if it was getting worse. Resource was geographically misplaced too—more strokes occurred in the peripheral population, but the hospitals were central. more…

On welcoming 3300 delegates from 80 countries to the International Quality Forum in London, home of the BMJ, Fiona Godlee (editor in chief, BMJ) asked us to remember the recent marathon trauma at the home of Institute of Healthcare Improvement (IHI) in Boston. All the more poignant as we congregated at Excel, the registration centre for next Sunday’s London marathon. Maureen Bisognano (IHI), in her opening  address, applauded the response of the medical services in Boston and how it highlighted the key attributes of an exemplary health service; reliability, resilience, and empathy. Maureen had some serious questions—when we look at data, are we looking back or are we using the data to predict and prevent problems for the future.  She asked us not to think in terms of  “what’s the matter medicine, but what matters to you.” Medicine tends to focus on efficiency and effectiveness, and we need to think more about empathy. Patient engagement, she said, is the next blockbuster drug. more…

There is something to be said for wearing your heart on your sleeve, and few do it to greater effect than Margaret McCartney, a GP in Glasgow. She exuded frustration as she galvanised a session on public and patient involvement at the Evidence Live conference, in which she explained why she had reached the point of asking, “What are we GPs doing? And who is it for?”

“We are being forced to meet targets and priorities set by the government not by our patients,” she said, and it’s leaving scant time to meet their needs. “Most of them are old, with multimorbidities and they just want our help to get through the next bout of illness.” more…

Essentialist or consequentialist? Patrick Bossuyt (University of Amsterdam) introduced this concept at the “Evidence Live” conference. Thinking about diagnostic testing he suggested that, rather than focus on the nuts and bolts of a diagnostic test (sensitivity, specificity etc), we might also consider the downstream effects. We know there are benefits to accurate diagnostic testing, but there are also potential harms. In this context, he discussed karyotype testing in recurrent miscarriage and how it might alter a couple’s decision on a further pregnancy and may, for example, dissuade them from considering extending their family. Patrick emphasised the need for further research on the consequences of diagnostic testing but, Richard Saitz (Boston University) reminded us during questions, that the consequences will always be confounded by the prior decision.   more…

Qian Li, West China Centre for Rural Health Research & Development, Sichuan University, Chengdu, Sichuan, China.

While we young researchers come from diverse backgrounds and careers, we share a common desire to dedicate ourselves to strengthening the health systems of our countries. I received medical training and I was once a doctor in an urban hospital in western China. It was my childhood dream to be a doctor as I wanted to help people in need.

However, during my practice, I was frustrated when I saw some patients eventually giving up on their treatment because they couldn’t afford the expenses. I also noticed the deteriorating relationship between doctors and patients in my country. In some extreme cases, doctors were even attacked by grieving and frustrated patients. I couldn’t help but ask: why is there such a big difference between my ideals and the reality? Can I make a change? How? more…

The links between the global challenge of non communicable disease (NCD) and what happens to people in the first 1000 days of their lives are not new but are gaining increasing acceptance and attention. They were discussed earlier this month by thousands of those involved in maternal, newborn, and child health at the world congress of the International Federation of Gynaecologists and Obstetricians (FIGO) in Rome.

The Dutch famine of the 1940s is one of the main sources of evidence, and Caroline Fall, professor of international paediatric epidemiology at the University of Southampton, described how men who were in utero during the famine have double the risk of obesity in adult life. She emphasised that we need to understand the underlying processes better before knowing how best to advise women in the affluent world. more…

A standing ovation greeted every paper delivered at one of the sessions I attended at the American Public Health Association annual meeting in San Francisco. I thought the first paper or two were good, but the standing ovations seemed generous to a fault. Then it dawned on me that the session was organised by the physical activity section of APHA and they took their duty to help people avoid being sedentary very seriously indeed. I’m told that the paramilitary wing of the physical activity community stack the chairs away and everyone stands throughout their gatherings! more…

Having the opening day of a major health conference on a Sunday seems slightly unusual to a British or Irish conference goer but thousands gathered in the gorgeous autumn sunshine of California to meet and debate on public health at a crucial time of health and healthcare in the US.

The Annual Meeting of the American Public Health Association (APHA) is the largest gathering of public health professionals in the world and this year’s meeting, the 140th, is being held in San Francisco. Despite the pressures on public sector budgets the number of people attending has held up and around 14,000 are gathering under the theme “Prevention and Wellness Across the Lifespan.”  The effects of inequalities across the lifespan was well illustrated by massive posters inside and outside the conference centre showing some of the enormous differences in life expectancy present in the USA. more…

Introducing the topic of smoking in pregnancy as “an orphan subject in this area” seemed the right choice of words to the handful of people who turned up for the session out of the thousands participating in the congress of the International Federation of Gynecologists and Obstetricians (FIGO) in Rome earlier this month.

WHO is increasingly making the link between early origins of health and non communicable disease (NCD) with tobacco use as a strong common thread, said Dr Edouard Tursan d’Espaignet from the WHO Tobacco Free Initiative. Soon WHO will publish guidelines on the management of tobacco use and secondhand smoke in pregnancy. Smoking is seen as a male concern only in many countries: in China about 60% of men smoke and only 3-4% of women smoke. But the tobacco companies are encouraging smoking among young girls and women using words and images to suggest freedom and independence as well as the more traditional sexy connotations. Data collected in Africa in 2005 showed that some 20% of men and 2% of women smoked, but alarmingly so did 20% of boys and 15% of girls between the ages of 13-15. more…