Measures of uncertainty should be taken into account when estimating progress towards Millennium Development Goal 4 (to reduce the mortality rate of children under 5 years by two thirds from the 1990 level by 2015) in order to give more accurate assessments of countries’ progress, according to a study published in this week’s PLOS Medicine.
Leontine Alkema and Jin Rou New from the National University of Singapore used a statistical method called bootstrapping to calculate uncertainty intervals for the estimates of mortality rates in children aged under 5 years and the yearly reduction in these rates for 174 countries.
Factoring in uncertainty is necessary because many poor countries do not have well-functioning vital registration systems to record the number of child deaths. When analysing trends in under-5 mortality rates, researchers typically focus on the “best” estimates, but this practice can lead to misleading results and comparisons when such estimates are highly uncertain.
The authors found that in 86 high child mortality countries (with more than 40 deaths per 1,000 live births in 1990), there was much uncertainty about the levels and trends, especially more recently because of the limited availability of data. In 2011, the median width of the uncertainty intervals of the child mortality rates, relative to their level, was 48% among the high mortality countries compared with 19% in 1990. Furthermore, for 8 countries, the uncertainty level was high enough to not exclude the possibility that no progress had been made in reducing child mortality, whereas for 13 countries, progress is likely to have exceeded the Millennium Development Goal 4 target of a 4.4% annual rate of reduction since 1990.
Taxes on soft drinks and foods high in saturated fats and subsidies for fruit and vegetables could lead to beneficial dietary changes and potentially improve health, according to a study by experts from New Zealand published in this week’s PLOS Medicine.
Helen Eyles and colleagues from the University of Auckland and the University of Otago (Wellington) reached these conclusions by reviewing all relevant modelling studies that investigated the association between food pricing strategies, food consumption and chronic diseases (often referred to as non-communicable diseases, which includes conditions such as cardiovascular disease and diabetes).
In their combined analysis of 32 studies (all from high-income countries from the Organisation for Economic Co-operation and Development), the authors’ model predicted a 0.02% fall in energy intake from saturated fat for each 1% price increase. Likewise, a 10% increase in the price of soft drinks could decrease consumption by 1% to as much as 24%.
In contrast, the authors found that a 10% decrease in the price of fruits and vegetables could increase consumption by between 2% to 8%. However, the authors found evidence to suggest that such a subsidy might result in compensatory purchasing with people buying less of other healthy products, such as fish, or more of less healthy products (e.g. sugar), which may not be beneficial to health overall.
The authors also found that studies that compared food pricing strategies by socio-economic group estimated improved health outcomes for those on lower incomes, which may be relatively greater than for those on higher incomes. This suggests that food pricing strategies also have the potential to reduce inequalities.
Outbreaks of infectious diseases, such as swine flu (H1N1) threaten global health and should be considered by funding agencies and humanitarian organizations as development issues rather than emergency situations, requiring long-term support and investment, according to US experts writing in this week’s PLOS Medicine.
The authors from several US institutions, led by Tiffany Bogich from Princeton University, reached these conclusions by reviewing nearly 400 serious international public health events. They found that the disruption to, or lack of, public health infrastructure was the major driving factor of infectious disease outbreaks, contributing 40% overall. In contrast, other main driving factors, such as climate and weather and war and famine had a much lesser role, each contributing less that 10% to infectious disease outbreaks.
Based on these findings, the authors argue that there is a mismatch between the drivers of infectious disease outbreaks and current trends in public health spending as shown by the current donor trend of favoring disease-specific global health programs. The authors argue that this mismatch may be at the cost of strengthening public health infrastructure and development in the long term.
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