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Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
Getting to zero
Since 1988, the 1st of December has been observed as World AIDS Day. The theme for 2013, as for the last two years, is ‘Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths’ with a specific focus on prevention and treatment services for those aged 10e19 years. The WHO has indicated that the day will be marked by the publication of new guidance for HIV testing and counselling and care for adolescents living with HIV. At time of writing this editorial, we had not seen this new guidance, but it is to be hoped that it is well received by individual countries and the international HIV/AIDs aid agencies. Taking a focus on young people is in line with the general tenor of the Global Health Sector Strategy on HIV/AIDS 2011e20151 with its four strategic directions, each of which has a series of core elements that characterize action(s). The four strategic directions are: 1. optimize HIV prevention, diagnosis, treatment and care outcomes; 2. leverage of broader health outcomes through HIV response; 3. build strong and sustainable systems; and 4. reduce vulnerability and remove structural barriers to accessing services. Against this background it is not hard to see why the focus on youth has been selected for World AIDS Day in 2013. In this issue of Public Health, we are publishing two studies which we believe have a direct bearing on these strategic directions and some of the core elements. The first is a review article, from a joint team from the London School of Hygiene and Tropical Medicine and Mahidol University in Bangkok, which reviews the available research evidence on the impact that HIV and TB programmes have had on strengthening health systems in south-east Asia (WHO strategic direction 3).2 Whilst the evidence is sparse, there are encouraging signs that there can be positive impacts. However, that is not the whole story, as the reviewers considered that any negative consequences of programmes on health systems need to be explored more robustly. They also concluded that much of the research was limited as only service delivery was being explored and not all the elements contributing to local health system(s). As if to illustrate this latter point, the second study
is a research paper from a joint Sino-American team reviewing the delivery of voluntary HIV counselling and care services in three Chinese cities.3 The authors conclude that whilst the services were adequate, they were hampered by a lack of an effective referral mechanism to facilitate easy access to the services. Clearly, there is work still to be done to deliver WHO strategic direction 1. Earlier in 2013 the WHO, as part of the overall support that the agency is offering to the many member states that adopted the global health sector strategy, published a new Guide to conducting programme reviews for the health sector response to HIV/AIDS.4 This guidance provides an approach to looking at the design of HIV programmes and how these programmes can be made more efficient in delivering change. It is aimed at national programmes, though the principles can be applied at other levels of programme implementation and delivery. Perhaps most importantly, the guidance sets out approaches to programme reviews that address the concerns raised in the paper by Conseil et al.2 in reminding reviewers of the importance of looking beyond pure service delivery models to include the other five factors of health systems described in WHO strategic direction 3, namely: human resources; monitoring and evaluation and information systems; financing for health and social protection; access to medicines, diagnostics and other consumables; and leadership, governance and strategic planning.4 We hope that over the next few years we will be asked to consider for publication more papers that explore the impact of HIV/AIDs programmes on strengthening all aspects of comprehensive health systems. As we approach World AIDS Day, let us not forget the other types of ‘zero’ that one needs to consider in relation to HIV/ AIDs. Folch et al. (2003)5 have argued that global action to address HIV/AIDs cannot morally be played as a ‘zero-sum game’: the phrase used in Game Theory to suggest that in a world of finite resources, there will be winners and losers. They argue that e in the context of infectious disease control in developing and emerging economies e the aim should be to play a ‘non-zero-sum game’ where all players/actors achieve a winewin from addressing HIV/AIDs, TB and Malaria. From a macroeconomic perspective this has significant appeal, but there will always remain the risk that such approaches will continue to focus on the consequences and not move truly ‘upstream’ and address the root causes. To do that, we need to
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start addressing the social, economic and political determinants of health and of HIV/AIDs as an avoidable cause of ill-health and death. So, at risk of stating the obvious, getting to zero poverty is critical for global health and well-being.
Competing interests
testing services in three cities in China, 2009. Public Health 2013;127:1074e81. 4. World Health Organisation. Guide to conducting programme reviews for the health sector response to HIV/AIDS. Geneva: WHO. Available at: http://www.who.int/hiv/pub/toolkits/hivresponse-guide/en/index.html; 2013 (last accessed 6 November 2013). 5. Folch E, Hernandez I, Barragan M, Franco-Paredes C. Infectious diseases, non-zero-sum thinking, and the developing world. Am J Med Sci 2003;326:66e72.
Fiona Sim is chair of RSPH.
references
1. World Health Organisation. Global health sector strategy on HIV/ AIDS 2011e2015. Geneva: WHO. Available at: http://www.who. int/hiv/pub/hiv_strategy/en/index.html; 2011 (last accessed 6 November 2013). 2. Conseil Alexandra, Mounier-Jack Sandra, Rudge James, Coker Richard. Assessing the effects of HIV/AIDS and TB disease control programmes on health systems in low- and middle-income of Southeast Asia: a semi-systematic review of the literature. Public Health 2013;127:1063e73. 3. Ma W, Ye S, Xiao Y, Jin C, Li Y, Zhao L, Cai Y, Liu B, Detels R. Rapid operation assessment of voluntary HIV counselling and
P. Mackie F. Sim The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, UK E-mail address: [email protected] (P. Mackie) Available online 22 November 2013 0033-3506/$ e see front matter ª 2013 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. http://dx.doi.org/10.1016/j.puhe.2013.11.002
In this issue As the winter begins to bite in northern Europe, we turn our attention to some warmer countries for many of the papers in this December issue of the journal. China provides us with three papers considering HIV/AIDs and TB control programmes, HIV counselling services, and trends in obesity amongst preschool, rural children. Obesity is also a concern for a paper from Malaysia, which asks if it is an unavoidable consequence of development, and from the two UK studies exploring adult obesity in a mainly rural area and measuring childhood obesity. Sticking to the nations of south-east Asia, we also have studies considering amoebiasis prevention amongst Taiwan immigrants and screening for substance misuse in Thailand. European authors have contributed papers relating to self-reported health in Spain and from the UK, a paper on adverse reactions to a vaccination programmes and two papers that consider very different aspects of mental public health: the views of artists’ on participatory arts programmes for mental health service users, and the mental health of parents with intellectual deficits. Finally, we have a paper which describes variations in US traffic safety policy environments and motor vehicle fatalities in the 32 years to 2012. As always, we believe that there is something for everyone in the issue: so ‘Happy Holiday’ reading!
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
Getting to zero
Since 1988, the 1st of December has been observed as World AIDS Day. The theme for 2013, as for the last two years, is ‘Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths’ with a specific focus on prevention and treatment services for those aged 10e19 years. The WHO has indicated that the day will be marked by the publication of new guidance for HIV testing and counselling and care for adolescents living with HIV. At time of writing this editorial, we had not seen this new guidance, but it is to be hoped that it is well received by individual countries and the international HIV/AIDs aid agencies. Taking a focus on young people is in line with the general tenor of the Global Health Sector Strategy on HIV/AIDS 2011e20151 with its four strategic directions, each of which has a series of core elements that characterize action(s). The four strategic directions are: 1. optimize HIV prevention, diagnosis, treatment and care outcomes; 2. leverage of broader health outcomes through HIV response; 3. build strong and sustainable systems; and 4. reduce vulnerability and remove structural barriers to accessing services. Against this background it is not hard to see why the focus on youth has been selected for World AIDS Day in 2013. In this issue of Public Health, we are publishing two studies which we believe have a direct bearing on these strategic directions and some of the core elements. The first is a review article, from a joint team from the London School of Hygiene and Tropical Medicine and Mahidol University in Bangkok, which reviews the available research evidence on the impact that HIV and TB programmes have had on strengthening health systems in south-east Asia (WHO strategic direction 3).2 Whilst the evidence is sparse, there are encouraging signs that there can be positive impacts. However, that is not the whole story, as the reviewers considered that any negative consequences of programmes on health systems need to be explored more robustly. They also concluded that much of the research was limited as only service delivery was being explored and not all the elements contributing to local health system(s). As if to illustrate this latter point, the second study
is a research paper from a joint Sino-American team reviewing the delivery of voluntary HIV counselling and care services in three Chinese cities.3 The authors conclude that whilst the services were adequate, they were hampered by a lack of an effective referral mechanism to facilitate easy access to the services. Clearly, there is work still to be done to deliver WHO strategic direction 1. Earlier in 2013 the WHO, as part of the overall support that the agency is offering to the many member states that adopted the global health sector strategy, published a new Guide to conducting programme reviews for the health sector response to HIV/AIDS.4 This guidance provides an approach to looking at the design of HIV programmes and how these programmes can be made more efficient in delivering change. It is aimed at national programmes, though the principles can be applied at other levels of programme implementation and delivery. Perhaps most importantly, the guidance sets out approaches to programme reviews that address the concerns raised in the paper by Conseil et al.2 in reminding reviewers of the importance of looking beyond pure service delivery models to include the other five factors of health systems described in WHO strategic direction 3, namely: human resources; monitoring and evaluation and information systems; financing for health and social protection; access to medicines, diagnostics and other consumables; and leadership, governance and strategic planning.4 We hope that over the next few years we will be asked to consider for publication more papers that explore the impact of HIV/AIDs programmes on strengthening all aspects of comprehensive health systems. As we approach World AIDS Day, let us not forget the other types of ‘zero’ that one needs to consider in relation to HIV/ AIDs. Folch et al. (2003)5 have argued that global action to address HIV/AIDs cannot morally be played as a ‘zero-sum game’: the phrase used in Game Theory to suggest that in a world of finite resources, there will be winners and losers. They argue that e in the context of infectious disease control in developing and emerging economies e the aim should be to play a ‘non-zero-sum game’ where all players/actors achieve a winewin from addressing HIV/AIDs, TB and Malaria. From a macroeconomic perspective this has significant appeal, but there will always remain the risk that such approaches will continue to focus on the consequences and not move truly ‘upstream’ and address the root causes. To do that, we need to
1056
p u b l i c h e a l t h 1 2 7 ( 2 0 1 3 ) 1 0 5 5 e1 0 5 6
start addressing the social, economic and political determinants of health and of HIV/AIDs as an avoidable cause of ill-health and death. So, at risk of stating the obvious, getting to zero poverty is critical for global health and well-being.
Competing interests
testing services in three cities in China, 2009. Public Health 2013;127:1074e81. 4. World Health Organisation. Guide to conducting programme reviews for the health sector response to HIV/AIDS. Geneva: WHO. Available at: http://www.who.int/hiv/pub/toolkits/hivresponse-guide/en/index.html; 2013 (last accessed 6 November 2013). 5. Folch E, Hernandez I, Barragan M, Franco-Paredes C. Infectious diseases, non-zero-sum thinking, and the developing world. Am J Med Sci 2003;326:66e72.
Fiona Sim is chair of RSPH.
references
1. World Health Organisation. Global health sector strategy on HIV/ AIDS 2011e2015. Geneva: WHO. Available at: http://www.who. int/hiv/pub/hiv_strategy/en/index.html; 2011 (last accessed 6 November 2013). 2. Conseil Alexandra, Mounier-Jack Sandra, Rudge James, Coker Richard. Assessing the effects of HIV/AIDS and TB disease control programmes on health systems in low- and middle-income of Southeast Asia: a semi-systematic review of the literature. Public Health 2013;127:1063e73. 3. Ma W, Ye S, Xiao Y, Jin C, Li Y, Zhao L, Cai Y, Liu B, Detels R. Rapid operation assessment of voluntary HIV counselling and
P. Mackie F. Sim The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, UK E-mail address: [email protected] (P. Mackie) Available online 22 November 2013 0033-3506/$ e see front matter ª 2013 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. http://dx.doi.org/10.1016/j.puhe.2013.11.002
In this issue As the winter begins to bite in northern Europe, we turn our attention to some warmer countries for many of the papers in this December issue of the journal. China provides us with three papers considering HIV/AIDs and TB control programmes, HIV counselling services, and trends in obesity amongst preschool, rural children. Obesity is also a concern for a paper from Malaysia, which asks if it is an unavoidable consequence of development, and from the two UK studies exploring adult obesity in a mainly rural area and measuring childhood obesity. Sticking to the nations of south-east Asia, we also have studies considering amoebiasis prevention amongst Taiwan immigrants and screening for substance misuse in Thailand. European authors have contributed papers relating to self-reported health in Spain and from the UK, a paper on adverse reactions to a vaccination programmes and two papers that consider very different aspects of mental public health: the views of artists’ on participatory arts programmes for mental health service users, and the mental health of parents with intellectual deficits. Finally, we have a paper which describes variations in US traffic safety policy environments and motor vehicle fatalities in the 32 years to 2012. As always, we believe that there is something for everyone in the issue: so ‘Happy Holiday’ reading!
