WHO Global Strategy Research Articles

Estonia: Problems created by border-trade for applying high-tax alcohol policy

Abstract In early 2000s, Estonia had one of the highest levels of alcohol consumption globally. In 2008, the average salary could buy 62 litres of strong spirits, compared with 28 litres in 2000; the increase of affordability was one of the highest in the EU. Since then, alcohol consumption per capita has been reduced by a third, which has also led to a reduction in related problems: mortality from alcohol-related illnesses has fallen by 40%. This was achieved with the progressive adoption of measures that rely heavily, but not exclusively, on increasing excise taxes. In 2014 a comprehensive alcohol policy document was adopted, paving the way to the measures in all 10 areas of WHO global strategy to reduce harmful use of alcohol. Since then Estonia has launched treatment programme and awareness campaigns, restricted advertising and the exposure of alcohol in the public sphere. By 2017, the over-exploitation of the tax-based measures backfired. The twofold alcohol price difference between Estonia and Latvia, resulting from doubling the excise tax for beer and raising significantly those for other alcoholic beverages, caused an unintended increase in cross-border trade between the two countries. This, in turn, caused a new wave of public discussion around pricing policies, and a loss of popular support for tax increases. As a first step to address the problem, the government halved the tax increase planned for February 2018, thus increasing beer tax by 9% and spirits tax by 5%. Tax increases scheduled for 2019 and 2020 were cancelled, and taxes on spirits, beer and cider were cut by 25% instead. This resulted in Latvia decreasing their spirits taxes by 15% in turn. This development forces health promoters to seek new ways to reduce harm to public health and win back support to healthy policy choices.

Will alcohol harm get the global response it deserves?

For the first time since the endorsement in 2010 of the WHO global strategy to reduce harmful use of alcohol,1 alcohol had a place on the World Health Assembly (WHA) agenda. At the 2019 WHA, it was agreed that the WHO Director-General will report on “the implementation of WHO's global strategy to reduce the harmful use of alcohol during the first decade since its endorsement, and the way forward” to the WHA in 2020.2 This move comes after several years of civil society and some member states working cooperatively to raise the profile of alcohol at the WHA.

Planetary health: from concept to decisive action

Planetary health: from concept to decisive action

Leprosy in the post-elimination phase: so near and yet so far

Leprosy is a chronic infectious disease affecting primarily the skin and peripheral nerves. WHO multi-drug therapy launched in 1982 revolutionized the treatment of this old age scourge, paving the way for leprosy elimination at global and national level. The global prevalence came down from over 5 million cases in the 1980s to less than 200,000 at the end of 2016. At present, India, Brazil and Indonesia are the top three countries with maximum leprosy load. The Indian national leprosy programme achieved the prevalence rate of less than 1/10,000 in the year 2005 but even after decade of attaining the WHO elimination target, India still contributes over 50% of the cases to the global leprosy burden leading the pack. Despite achieving the elimination target, the incidence of the disease has not come down as new cases continue to be reported or have plateaued worldwide. Adding to the boil is the persistence of social disparity and shadow of discriminatory laws in the statute books of many countries. Although significant success has been achieved in leprosy control over the years, but as the old adage goes, 'the last lap is the hardest and requires special efforts'. WHO global leprosy strategy 2016-2020 has a vision to achieve "the three zeros": zero disease, zero disability and zero discrimination. The present review focuses on the global and national leprosy scenario, changes made in the leprosy programme in the post-elimination phase and its consequences particularly in India, new scientific advances/insights and global and national strategies to deal with the hurdles in the road towards a "leprosy free world".

J-105 Novel antiviral targets for HBV elimination

Chronic hepatitis B virus (CHB) infection continues to be a major global public health issue despite the availability of effective HBV vaccines. Approximately 257 million people worldwide are infected with CHB and complications from HBV are now a leading cause of morbidity and mortality. The number of deaths from CHB now exceed >1 million per year. In 2016, the WHO Global health sector strategy on viral hepatitis, announced new goals to achieve a 90% reduction in new cases of HBV and hepatitis C (HCV) and a 65% reduction in mortality due to HBV and HCV by 2030. To achieve the ambitious HBV targets, significant progress is needed in several key intervention areas along the continuum of HBV care including (1) improved access to HBV vaccination and drugs for the prevention of mother to child transmission; (2) more rapid and affordable diagnostics for improved screening and detection of HBV; and (3) innovative therapeutics that can result in HBV cure. Current recommended therapies for CHB include either pegylated interferon-alpha which stimulates innate immune responses against HBV or oral nucleoside reverse transcriptase inhibitor (NUC) therapies which block the maturation of HBV genome into its infectious form and thus release of infectious virus containing HBV DNA. While both therapies effectively suppress HBV DNA, they rarely result in complete loss of HBsAg, which is needed to achieve functional cure, a serological state associated with a higher remission rate after treatment cessation, and lower rates of cirrhosis and hepatocellular carcinoma. Sterilizing cure is unlikely to be achievable at the current time because of the persistence of the active transcriptional template of HBV covalently closed circular DNA (cccDNA). Recently there have been promising advances in the treatment of HBV that could potentially achieve widespread functional cure and bring us closer to achieving the ambitious WHO goals of HBV elimination. These include the development of novel therapeutics that target various stages of the HBV lifecycle (eg, HBV entry, viral replication, HBV cccDNA production, and viral protein expression) and immunotherapeutic agents, as well as innovative treatment approaches with existing HBV therapies that seek to maximize the possibility of functional cure. This goal of this talk us to provide a comprehensive overview of these new developments in HBV therapeutics, covering the following key areas: (1) current goals of treatment, and definitions of HBV “cure”; (3) the HBV life cycle, antiviral targets and investigational agents currently being developed that target virus including inhibition of viral entry, HBV surface antigen production and elimination or silencing of cccDNA; and (4) the use of novel surrogate markers (ie, quantitative HBsAg) to assess treatment response in clinical trials.

Prevalence and related factors of Active and Healthy Ageing in Europe according to two models: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE).

BackgroundActive and Healthy Ageing (AHA) is the process of optimizing opportunities related to health, participation, and safety in order to improve quality of life. The approach most often used to measure AHA is Rowe and Kahn’s Satisfactory Ageing model. Nonetheless, this model has limitations. One of the strategic objectives of the WHO Global Strategy and Action Plan (2016) is to improve Healthy Ageing measurement. Our objectives were to compare two models of assessing AHA and further compare the results by country and sociodemographic variables.MethodsThis was a cross-sectional, observational analysis of a representative sample of the general population aged 50 years and older in Europe. The data analysed were obtained by the Study of Health, Ageing and Retirement in Europe (SHARE). The dependent variable was AHA and its dimensions, measured using the Rowe and Kahn AHA model (AHA-B) and the authors’ model based on the WHO definition (AHA-BPS). A descriptive analysis and multivariate models of binary logistical regression were developed.ResultsThe sample consisted of 52,641 participants (mean age 65.24 years [SD = 10.18; Range = 50–104], 53.2% women). Healthy Ageing prevalence in the AHA-B model was 23.5% (95%CI = 23.1%-23.9%). In the AHA-BPS model, this prevalence was 38.9%. In both models, significant variations were observed between countries, and were distributed along a north-western to south-eastern gradient. The sociodemographic variables associated with the absence of AHA were advanced age, female sex, death of spouse, low educational level, lack of employment, and low financial status. Comparing the two models, the strength of association between absence of AHA and advanced age (85 years and older) was four times greater in the AHA-B model.ConclusionsOur results showing differences between these two models provide evidence that the AHA-BPS model does not penalize older age and is more likely to characterize AHA from a health promotion perspective.

The hepatitis B epidemic and the urgent need for cure preparedness.

More than 250 million people worldwide are chronically infected with the hepatitis B virus (HBV). In this Comment, members of the International Coalition to Eliminate HBV appraise the current policy environment and the need for appropriate cure research and preparedness to complement the WHO global elimination strategy, the HBV vaccine and the well-tolerated but poorly accessed therapy.

Epidemiological trends and risk factors associated with dengue disease in Pakistan (1980\u20132014): a systematic literature search and analysis

BackgroundDengue is becoming more common in Pakistan with its alarming spreading rate. A historical review needs to be carried out to find the root causes of dengue dynamics, the factors responsible for its spread and lastly to formulate future strategies for its control.MethodsWe searched (January, 2015) all the published literature between 1980 and 2014 to determine spread/burden of dengue disease in Pakistan.ResultsA total of 81 reports were identified, showing high numbers of dengue cases in 2010, 2011, and 2013. The tendency of dengue to occur in younger than in older age groups was evident throughout the survey period and all four serotypes were recorded, with DENV1 the least common. Most dengue hemorrhagic fever (DHF) cases fell in the 20–45 years age range. High frequencies tended to be observed first in the Southern coastal region characterized by mild winters and humid warm summers and then the disease progressed towards the lowland areas of the Indus plain with cool winters, hot summers and monsoon rainfall. Based on this survey, new risk maps and infection estimates were identified reflecting public health burden imposed by dengue at the national level.ConclusionsOur study showed that dengue is common in the three provinces of Pakistan, i.e., Khyber Pakhtunkhwa (KP), Punjab and Sindh. Based on the literature review as well as on our study analysis the current expansion of dengue seems multifactorial and may include climate change, virus evolution, and societal factors such as rapid urbanization, population growth and development, socioeconomic factors, as well as global travel and trade. Due to inadequate remedial strategies, effective vector control measures are essential to target the dengue vector mosquito where high levels of human-vector contact occur. The known social, economic, and disease burden of dengue is alarming globally and it is evident that the wider impact of this disease is grossly underestimated. An international multi-sectoral response, outlined in the WHO Global Strategy for Dengue Prevention and Control, 2012–2020, is now essential to reduce the significant influence of this disease in Dengue endemic areas. Overall gaps were identified in knowledge around seroprevalence, dengue incidence, vector control, genotype evolution and age-stratified serotype circulation.

Finnish NGOs promoting health equity in the context of welfare economy.

Health inequality is a national challenge in Finland. The WHO global strategy of Health for All implies that all people should have an equal opportunity to develop and maintain their health through fair and just access to health resources. This article examines the role of Finnish Non-Governmental Organizations (NGO) in strengthening the health equity. The article presents the strategy and specific criteria constructed by the NGOs to promote health equity in society. The health equity criteria and welfare economy strategy are combined to a framework which NGOs can utilize in their work to promote health equity. The welfare economy strategy describes the important issues that NGOs have to address when working towards a specific societal goal, in this case equity. The health equity criteria in turn are an instrument for the practical implementation of the preconditions of equity.

Values and principles of person-centered integrated care: a systematic literature review (SIG meeting)

Introduction: In recent years many knowledge about integrated health services has been developed. So far research has focused on operational themes and interventions on the one side, which help decision makers in practice. On the other hand, a number of studies about generic elements of person-centered and integrated care have been published, resulting in valuable conceptual models and frameworks [1-9]. A third area of research is how to measure integrated care. However, if we want to further develop the person-centered integrated approach to improve the quality of services for civilians, a better understanding of the essence of integrated care and it’s underlying values is necessary. Shared values and principles can help to concretely identify what integrated care really is about and what integrated care thinking stands for [10,11]. Therefore, IFIC and Vilans have initiated a Special Interest Group (SIG) on values and principles of integrated care. The aim of the SIG is to develop a valuable and workable set of values and principles for person-centered integrated care. Within this context, a systematic literature review on value and principles of person-centered integrated care is carried out as a starting point. We propose a session with two objectives: A SIG-meeting with exchange of experiences A presentation and discussion about the first deliverable: the systematic literature review Theory/Methods: A systematic literature review of scientific and grey literature was conducted. Two researchers independently screened the initial results by title and abstract. Differences in interpretation were resolved by consensus. Each full text paper was independently assessed by two researchers on the criteria for inclusion. In each included article, values and principles of person-centered integrated care were identified and coded independently by two researchers. The codes were discussed in the research team. 3) Preliminary results 732 records were identified through the systematic search. After removing duplicates 396 articles remained, of which 48 were assessed for eligibility after the screening of titles and abstracts. 23 articles (48%) contained values and principles of person-centered integrated care and were coded. Currently (Dec 2016) an expert panel, mostly members of IFIC and Vilans’ SIG on Values of Integrated Care, is reflecting on the search results. Additional articles suggested by experts, are being added to the database the coming months (before ICIC2017). The experts have a range of backgrounds, including health and social care, and practice and academia. Conclusion & Discussion: A large amount of literature about integrated care is available, but less about the underlying values and principles. Preliminary results show that in the selected articles values and principles are present, which partly support the set of Ferrer and Goodwin [12]. At this moment the international expert panel is reviewing the search results, more definite results can be discussed in spring nest year. Lessons learned: Only limited literature has a focus on this level of abstraction (values and principles). The perspective appears to be quite new which is interesting a SIG topic. Limitations: Because the limited amount of literature, available conceptual models were analysed to derive values and principles. The quality of this process asks for skilled researchers; to enhance quality, all articles were independently assessed by two researchers. Suggestions for future research: To further develop the set of values and principles, a multi-perspective Delphi Study will be carried out. Multiple (SIG) experts with different backgrounds (clients, caregivers, developers, researchers) will be involved. The results of the Delphi Study will also be shared in the SIG.

An Integrated Care Charter - Correcting the Organisational Focus Paradox by Empowering the Citizen

An introduction: (comprising background and problem statement) Integrated care is in principle a ‘no contest’ goal – no-one can argue against it. Vertical integration seeks to link secondary care, primary care, and community care, while Horizontal integration seeks to link separate streams of clinical and related activity for persons with multiple conditions, drawing formal, family and societal care into a cohesive patient-focused pattern of care delivery and support. However, the real test of achievement is whether the patient feels care is integrated. Description of policy context and objective: Many organisations are focussing on addressing the organisational challenges, including the World Health Organisation’s WHO global strategy on people-centred and integrated health services, the WHO Regional Office for Europe with its programme Towards people-centred health systems: an innovative approach for better health systems International, the Foundation for Integrated Care’s activities, and the EU Project Integrate and its Conceptual Framework for Integrated care. These all focus on organisations, systems, and governance, which are clearly key determinants of care integration. But while these documents emphasise the importance of putting the patient at the centre (and also family and informal carers), they do not do this practically. There is something missing, and that is the provision of a person-centric definition of integrated care, and the person’s means of recognising and measuring it. Targeted population: Citizens for whom integrated care is appropriate; organisations seeking to deliver integrated care. Highlights: (innovation, Impact and outcomes) The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project has to some degree started on this route by seeking to devise standardised measures of health and functioning of a person in a holistic sense, but this is still largely based on physiological assessment. Several studies have looked at system-based measures of integration, but the citizen is not directly involved. The Policy Innovation Research Institute (2014) devised a recipient-based survey tool. However, what is missing is a proactive tool. Citizen’s Charters and Customer Charters set standards by which the citizen could assess in lay terms whether a service met specified standards, in terms and measures meaningful to the lay citizen. Not least in the English NHS the Patient’s Charter has become an established concept. Such measures inform the citizen as to what they can reasonably expect, empower the citizen (or their advocates) to assess the quality of the service they are receiving, and provide a performance monitor for the organisation. In all the discussion and debate about organisational structures and processes, and changes to them to facilitate integrated care, it is paradoxical that there has been no focus on empowering citizens to identify, measure, or argue for integrated care, not least in their own personal situation. Comments on transferability: The concept is widely transferable, framed in local terms. Conclusions: (comprising key findings, discussion and lessons learned) The presentation will show how this might be achieved by producing the mirror image of organisational tools including those listed above, giving the patient expectations and a means of assessment.

The Role of Fruit and Vegetable Concentrates in Alleviating the Growing Burden of Cardiovascular Diseases in USA: Evidence from a Simulation Study

BackgroundPromoting fruit and vegetable consumption has been one of the key points in WHO's Global Strategy on Diet, Physical Activity and Health. The recommendation for fruit and vegetable (FV) consumption, as set by the panel of WHO/FAO experts, is 400gr/day minimum, however different studies show that the majority of individuals do not comply to the suggested intake levels. One of the measure proposed to help individuals improve their intake of FV is the adoption of FV concentrates, which contain a well‐balanced mixture of bioactive compounds. The aim of this study was to collect and analyze scientific material on FV concentrates and their effectiveness in mitigating important risk factors for selected Noncommunicable diseases (NCDs). Findings about the FV effectiveness are illustrated through a simulation exercise, which shows a potential relief in public health burden in terms of reduction of cases of NCDs and their respective economic cost.MethodsRelevant articles about the FV concentrates were collected and analyzed in terms of their impact on measurable physiological outcomes (total cholesterol, low‐density lipoprotein, plasmatic homocysteine, systolic blood pressure, body mass index and tumour necrosis factor alpha), widely accepted in literature as risk factors for cardiovascular NCDs. Literature review results provided input for Markov chain simulation model. The model provides a simulation, using USA population projections, of potential reduction in morbidity and direct public health cost associated with different FV concentrates supplementation regimes.ResultsThe literature review has revealed a significant research gap about the effect of FV supplementation on NCDs. Building upon the (modest) evidence documented in literature, we show that FV concentrates have important potential in lowering NCD burden. A combined FV concentrate, such as Juice plus, appears to yield a significant gain in terms of lowering the risk of CHD in general population. Artichoke leaf juice concentrate and cherry juice concentrate produce non‐negligible effects in lowering the risk of stroke in vulnerable population (individuals with metabolic syndrome and hypertension). We found less evidence for heart failure, though the literature suggests effectiveness of fruit and vegetable juice.ConclusionIn conclusion, FV concentrates appear to play a non‐negligible role in prevention of cardiovascular diseases in healthy and vulnerable populations, and this is particularly relevant because of the increasing tendency to consume less fresh fruit and vegetables. Despite the documented potential benefits, FV supplements are still poorly debated in scientific research: high quality and long‐term studies are necessary to understand their effect on human well‐being and their potential for health care system.

Harmful Use of Alcohol: A Shadow over Sub-Saharan Africa in Need of Workable Solutions.

Alcohol consumption and alcohol-attributable burden of disease in Africa are expected to rise in the near future, yet. increasing alcohol-related harm receives little attention from policymakers and from the population in general. Even where new legislation is proposed it is rarely enacted into law. Being at the center of social and cultural activities in many countries, alcohol’s negative role in society and contribution to countries’ burden of disease are rarely questioned. After the momentum created by the adoption in 2010 of the WHO Global Strategy and the WHO Regional Strategy (for Africa) to Reduce the Harmful Use of Alcohol, and the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases, in 2013, little seems to have been done to address the increasing use of alcohol, its associated burden and the new challenges that derive from the growing influence of the alcohol industry in Africa. In this review, we argue that to have a positive impact on the health of African populations, action addressing specific features of alcohol policy in the continent is needed, namely focusing on particularities linked to alcohol availability, like unrecorded and illicit production, outlet licensing, the expansion of formal production, marketing initiatives and taxation policies.

Is elimination of HCV possible in a country with low diagnostic rate and moderate HCV prevalence?: The case of Greece.

The treatment of hepatitis C (HCV) with interferon (IFN)-free direct-acting antivirals (DAAs) is anticipated to change the future burden of disease. The aim of this study is to quantify the impact of IFN-free DAAs on HCV-related morbidity and mortality in Greece under different scenarios concerning treatment coverage and primary prevention, including the proposed by World Health Organization Global Hepatitis Strategy. A previously described model was used to project the future disease burden up to 2030 under scenarios, which includes treatment based on the combination of pegylated-IFN with ribavirin (base case) and scenarios using DAAs therapies. Under the base case scenario, an increase in HCV-related morbidity and mortality is predicted in Greece (mortality in 2030: +23.6% compared with 2015). If DAAs are used with the same treatment coverage, the number of hepatocellular carcinoma cases and of liver related deaths are predicted to be lower by 4-7% compared with 2015. Under increased treatment coverage (from 2000 treated/year to approximately 5000/year in 2015-2020 and 2500/year subsequently), morbidity and mortality will decrease by 43-53% in 2030 compared with 2015. To achieve the WHO Global Hepatitis Strategy goals, a total number of 86 500 chronic hepatitis C patients will have to be treated during 2015-2030. Elimination of HCV in Greece by 2030 necessitates great improvements in primary prevention, implementation of large screening programs and high treatment coverage.

IntegraSarea: Building up a Network for Integration in the Basque Country

Introduction : The Basque Country has been implementing integrating care policies since 2010 [1]. One of the cornerstones of this strategy has been the launch of 13 Integrated Health Care Organisations (IHOs) to integrate under the same structure Primary and Secondary Care Services [2]. However, structural integration does not deliver better care by its own. Each of the IHOs has had its own experience in integration/”IHOrmation” (ranging from 2010 to 2016) and best practices have not been systematically shared among them. In fact, merging structures could have the opposite desired effect if not followed by a cultural change among health professionals from both levels of care. IntegraSarea (Network for Integration in Basque) was launched in June 2015 with the aim to facilitate cultural change and uses a collaborative methodology to do so. It should be highlighted that professionals, managers and patients from all Integrated Care Organisations are invited to agree on a set of actions that at the end of the project will be incorporated in the integration narrative of the Basque Country. The objective is to combine a traditional top-down approach (the creation of the network is a priority set by the Governing Body of the Health System) together with a bottom-up approach (the actions to be implemented will be agreed by the people who work at the IHO´s) so that all actors at macro, meso and micro level take ownership of the project. Aims : The aim of IntegraSarea is that IHOs share and agree on their best practices and create a common narrative of integration that is shared by everyone. The idea behind this goal is: (i) to foster integration instead of competition between IHOs, (ii) homogenize best practices and certain key aspects of integration so that everyone can benefit, (iii) engage with health professionals and allow them to take ownership of integration policies in the Basque Country and (iv) incorporate the discourse for People and Person Centred Care to the core of the health care system as suggested by WHO [3]. Methodology : Firstly, a literature review to select the most relevant areas of work for integration was conducted and contrasted with relevant actors both internally (Managers of IHOs) and internationally (IFIC and AQuA). The areas that came after this review are: People Centred Care, Social and Care Coordination, Community Health, Model of care for Chronicity and Management. Secondly, one working group per area of work and formed by health professionals from all IHOs has been created and given the task of: (i) co-create a status report of their area of work in the Basque Country, (ii) review the best practices that exist at a local level (iii) agree on a series of actions/practices to scale them up. It should be stated that participants, mostly clinicians and intermediate cadres will play a vital role as agents of change back in their own IHO. Thirdly, in order to overcome the challenge of dissemination among all 35.000 professionals a newsletter is being sent monthly and an online repository in the intranet has been created to allow interaction of professionals from different IHOs. And last but not least, a panel of experts from both inside and outside the Basque Country has been given the mission to guide each workforce throughout the project in order to give technical support when needed. Results : This stage of the project will be completed in June 2016 and preliminary results will be presented in the Conference. In addition to the fulfilment of the deliverables described above a series of evaluation tools linked with integrated care will be used: IEMAC-ARCHO [4], D’Amour Questionnaire [5].

Health literacy in Catalonia: Situation Analysis

Introduction: The World Health Organisation describes health literacy as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literate individuals have skills to keep healthier by themselves and to maintain their quality of life for longer. In ageing societies, where chronic conditions are expected to keep growing while resources will remain stable, health literacy is one of the keys challenges facing community health at the beginning of the XXI century.The Health Plan for Catalonia (HPC) is the indicative instrument and framework for all public programs in the field of the Health Ministry of the Government of Catalonia. The main 2020 goal of the HPC is to increase healthy life expectancy, that is, the proportion of years with a good self-perceived health status. This objective aligns with the purpose of promoting more health literate societies.Methods: During 2014 the health survey for Catalonia (HSC) included the short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HSC is an official survey that provides information on the health status, life styles and the use of health services of Catalonia’s population. 3.642 people aged 15 and over answered the questionnaire. HLS-EU-Q16 is a shortened version of the questionnaire HLS-EU-Q47, developed by the European Health Literacy Project 2009-2012, which was administered in eight different countries. As the longer version, HLS-EU-Q16 assumes a multidimensional concept of health literacy, which helps to identify health literacy profiles of individuals, but also of populations. A descriptive analysis of sociodemographic characteristics, health status and healht service use (% and CI95%) is performed according to the health literacy level of people.Results: Results show that the proportion of people with insufficient health literacy (either problematic or inadequate health literacy levels) is higher among people aged 65 and over, among people who attained primary education or below, and among people who belong to lower social classes. On the other hand, people without sufficient health literacy show worse perception of their health status, declare chronic conditions and have disabilities in a higher proportion than those who have sufficient health literacy levels. Regarding the use of health services, people with problematic or inadequate health literacy levels attend to the GP, consume medicines and go to the emergency department more frequently than people with sufficient health literacy.Discussion: The WHO global strategy on person-centred and integrated health care services establishes empowering and engaging individuals and communities as its first strategic goal. Promotion of health literacy is about providing resources and abilities to empower individuals and comunities but also about adapting health care systems to the needs of people. Results show that some people would face more difficulties than expected if they had to perfom health related activities. On the other hand, health literate people enjoy more autonomy when dealing with activities related to health information. In order to advance towards much more integrated and person-centred health care services, health literacy levels should be taken into account and promotion of health literacy at population, individual and health care serveices is desirable.Conclusion: Several difference arise in health status and health care service use arise according the health literacy level of people. These results are the starting point for designing the strategy on health literacy for Catalonia, which will help to design interventions aimed at strengthening and promoting health literacy, but also person-centred health care services.

Evidence of reducing ethanol content in beverages to reduce harmful use of alcohol

Alcohol use is a major contributor to the burden of gastrointestinal disease. WHO's global strategy to reduce harmful use of alcohol encourages the alcohol industry to contribute to this effort. However, evidence that alcohol producers have contributed to the reduction of harmful use of alcohol is scarce. Reduction of alcoholic strength of beer has been proposed and initiated as one potential way forward. We examine the evidence base for the success of such an initiative. Direct evidence from natural experiments or other controlled studies is scarce. We identified three potential mechanisms for how reduction of alcoholic strength could affect harmful use of alcohol: by current drinkers replacing standard alcoholic beverages with similar beverages of lower alcoholic strength, without increasing the quantity of liquid consumed; by current drinkers switching to no alcohol alternatives for part of the time, thereby reducing their average amount of ethanol consumed; and by initiating alcohol use in current abstainers. The first mechanism seems to be the most promising to potentially reduce harm, but much will depend on actual implementation, and only an independent assessment will be able to identify effects on harmful drinking. The potential of alcoholic strength reduction is independent of initiation by law or by self-initiative of the industry.

Tetravalent Dengue Vaccine: A Review in the Prevention of Dengue Disease.

Tetravalent, live-attenuated, dengue vaccine (Dengvaxia(®); CYD-TDV) is the first vaccine approved for the prevention of dengue disease caused by dengue virus (DENV) serotypes 1-4 in individuals aged 9-45 or 9-60years living in high dengue endemic areas. This narrative review discusses the immunogenicity, protective efficacy, reactogenicity and safety of CYD-TDV in the prevention of dengue disease. In Latin American and Asian phase 3 trials in children and adolescents (n>30,000), the recommended three-dose CYD-TDV regimen was efficacious in preventing virologically-confirmed dengue (VCD) during the period from 28days after the last dose (month 13) tomonth 25, meeting the primary endpoint criteria. Protective efficacy against VCD in the respective individual trials was 60.8 and 56.5% (primary analysis). During the 25-month active surveillance phase, CYD-TDV also provided protective efficacy against VCD, severe dengue, any grade of dengue haemorrhagic fever and VCD-related hospitalization in children aged 9years and older. CYD-TDV was generally well tolerated, with no safety concerns identified after up to 4 years' follow-up (i.e. from post dose 1) in ongoing long-term studies. Based on evidence from the dengue clinical trial program, the WHO SAGE recommended that countries with high dengue endemicity consider introducing CYD-TDV as part of an integrated disease prevention strategy to lower disease burden. Pharmacoeconomic considerations will be pivotal to implementing dengue vaccination prevention strategies in these countries. The availability of a dengue vaccine is considered essential if the 2012 WHO global strategy targets for reducing the burden of dengue disease by 2020 are to be attained. Hence, CYD-TDV represents a major advance for the prevention of dengue disease in high dengue endemic regions.

The threat of antimalarial drug resistance

The battle between man and malaria has continued for thousands of years. Antimalarial drugs are essential weapons to fight the disease, but their efficacy is threatened by drug resistance which continues to emerge creating a major obstacle to malaria control and jeopardizing renewed hopes for elimination. As 2016 is the first year under WHO Global Technical Strategy for Malaria 2016–2030, it is a good time to ponder the progress of both sides and plan for the future.

Testing the hypothesis that treatment can eliminate HIV: a nationwide, population-based study of the Danish HIV epidemic in men who have sex with men

Worldwide, approximately 35 million individuals are infected with HIV; about 25 million of these live in sub-Saharan Africa. WHO proposes using treatment as prevention (TasP) to eliminate HIV. Treatment suppresses viral load, decreasing the probability an individual transmits HIV. The elimination threshold is one new HIV infection per 1000 individuals. Here, we test the hypothesis that TasP can substantially reduce epidemics and eliminate HIV. We estimate the impact of TasP, between 1996 and 2013, on the Danish HIV epidemic in men who have sex with men (MSM), an epidemic UNAIDS has identified as a priority for elimination. We use a CD4-staged Bayesian back-calculation approach to estimate incidence, and the hidden epidemic (the number of HIV-infected undiagnosed MSM). To develop the back-calculation model, we use data from an ongoing nationwide population-based study: the Danish HIV Cohort Study. Incidence, and the hidden epidemic, decreased substantially after treatment was introduced in 1996. By 2013, incidence was close to the elimination threshold: 1·4 (median, 95% Bayesian credible interval [BCI] 0·4-2·1) new HIV infections per 1000 MSM and there were only 617 (264-858) undiagnosed MSM. Decreasing incidence and increasing treatment coverage were highly correlated; a treatment threshold effect was apparent. Our study is the first to show that TasP can substantially reduce a country's HIV epidemic, and bring it close to elimination. However, we have shown the effectiveness of TasP under optimal conditions: very high treatment coverage, and exceptionally high (98%) viral suppression rate. Unless these extremely challenging conditions can be met in sub-Saharan Africa, the WHO's global elimination strategy is unlikely to succeed. National Institute of Allergy and Infectious Diseases.