Online First articles may not be available until 09:00 (UK time) Friday.
Press releases Saturday 2 July 2005
Please remember to credit the BMJ
as source when publicising an article and to tell your readers that they can
read its full text on the journal's web site (http://bmj.com).
(1) SURGEON CHALLENGES TONY BLAIR TO "TAKE A LEAD" ON AFRICA'S HEALTH NEEDS
(2) WE MUST ACT NOW TO STOP MEDICAL BRAIN DRAIN
(3) GLOBALISATION IS HARMING CHILDREN'S MENTAL HEALTH
(4) DO YOUNG PEOPLE IN BRITAIN GET ENOUGH SUNLIGHT?
(1) SURGEON CHALLENGES TONY BLAIR TO "TAKE A LEAD" ON AFRICA'S HEALTH NEEDS
(Open letter to Tony Blair
on publication of the report of the Commission for Africa)
http://bmj.com/cgi/content/full/331/7507/46
As world leaders prepare to discuss Africa at the G8 summit, a British surgeon working in Malawi argues that conditions in many healthcare institutions are getting worse not better, and challenges Tony Blair to "take a lead" on the continent's health needs.
In an open letter published in this week's BMJ, Professor Chris Lavy congratulates the British Prime Minister on the Commission for Africa report, but also points out some important omissions.
For instance, he is disappointed not to see anything on the escalating road traffic injuries in Africa. The World Health Organization estimates that around 200,000 people a year, or 500 a day, are killed on African roads, yet the report suggests that the key to development is increased, cheap transport. Can you imagine what it would do to road deaths, he asks?
He also highlights the lack of basic surgery for the hundreds and thousands of children with a physical disability that prevents them from walking, or walking properly.
Conditions in healthcare institutions in many African countries are getting worse not better because those who make policy and govern funding do not use the local health services; they go abroad, he says. Changing this would improve African health services dramatically overnight, he argues.
Although standards of health care are dropping, some encouraging exceptions to the general rule keep us going, he adds. Locally driven schemes that provide surgical training are helping to save lives and are far more appropriate than scholarships to the West. Projects like these bring results but need the support of G8 countries.
He agrees that overseas aid can be useful if it is well thought out, but aid gaffes help no-one. For example, two new district hospitals are being built in Malawi, but there are no surgeons or other staff to run them.
He ends with a challenge, asking the prime minister to "take a lead" and give 1% of the UK's national income to development aid.
Could we in medicine also take a lead and expand our global outlook? he adds. Could we look closely at the ethics of research that only benefits rich minorities? Could we look at strengthening medical training in Africa, rather than training African doctors in the UK? Could the NHS encourage UK doctors to spend time in Africa?
This would need approval, but would show solidarity with our colleagues in Africa, he concludes.
Contact:
Professor Chris Lavy, Department
of Surgery, College of Medicine, Malawi, Africa
Email: lavy@malawi.net
(2) WE MUST ACT NOW TO STOP MEDICAL BRAIN DRAIN
(Managing medical migration
from poor countries)
http://bmj.com/cgi/content/full/331/7507/43
(Editorial: Stopping Africa's
medical brain drain)
http://bmj.com/cgi/content/full/331/7507/2
Migration of health workers from poorer to richer nations is unlikely to stop, but we can and must put policies in place to minimise the damage it causes, says a doctor in this week's BMJ.
Many developed countries have insufficient health workers to meet their needs, yet recruiting from developing countries is damaging, writes Omar Ahmad from the University of Ghana. For instance, in Ghana over 60% of all doctors trained locally in the 1980s had emigrated by 1999. In 2000 alone, it lost nearly 3,000 nurses compared with 387 in 1999.
Fortunately, concern about the harmful effects of indiscriminate poaching is growing. But the right of the individual health worker to emigrate has to be balanced against the consequences of such migration on the welfare of the larger society, he says
The adoption of a code of ethical recruitment by the UK Department of Health and Commonwealth countries are notable (albeit feeble) attempts at minimising the damage. But the problem is global and therefore requires a global solution.
Better data on the movement of health workers are needed to develop an international framework for the management of skills migration. Setting up such a framework will be complicated, but prompt action is essential for everyone's health, he concludes.
The rich countries of the North must stop looting doctors and nurses from developing countries, argues James Johnson, Chairman of the British Medical Association, in an editorial.
The most important element of the solution is self sufficiency, he writes. For example, the US already employs half of all English speaking doctors in the world, and it wants more. Unless it can be persuaded to think and act differently, it will soak up skilled workforce from every available source, including the UK.
"The African initiative of the G8 countries will fail spectacularly if the richest nations of the world do not allow the poorest to maintain the bare essentials of healthcare provision," he concludes.
Contacts:
Omar Ahmad, School of Public Health,
College of Health Sciences, University of Ghana, Accra, Ghana
Email: oahmad@ug.edu.gh or oahmad@sph.ug.edu.gh
James Johnson, Chairman of Council,
British Medical Association, London, UK
Email: pressoffice@bma.org.uk
(3) GLOBALISATION IS HARMING CHILDREN'S MENTAL HEALTH
(Effect of globalization
on children's mental health)
http://bmj.com/cgi/content/full/331/7507/37
Globalisation is affecting children's mental health by imposing Western child rearing beliefs and psychiatric practice around the world, argues a child psychiatrist in this week's BMJ.
Western culture promotes individualism, competitiveness, and weakens social ties. In contrast, many non-Western cultures encourage values such as duty and responsibility within a close family structure.
While rates of psychological problems, such as crime, anxiety, and unhappiness, have increased sharply among young people in Western societies, the communal ethic of non-Western cultures seems to promote psychiatric wellbeing, says the author.
Exporting these Western ideas to developing countries is not only undermining local ways of solving children's problems, but is masking the real life circumstances (such as poverty and exploitation) those children may face.
Yet child psychiatrists in the West could gain new knowledge from examining childcare practices across the world, he says.
"We must critically re-examine the narrow basis on which current theory and practice has developed. This will help not only other culture's children but also children in the West," he writes.
"Increased knowledge will also make it easier to engage with multi-ethnic communities that have different faith traditions and cultural beliefs from the host society."
Contact:
Sami Timimi, Consultant Child and
Adolescent Psychiatrist, Lincolnshire Partnership NHS Trust, Lincolnshire,
UK
Email: stimimi@talk21.com
(4) DO YOUNG PEOPLE IN BRITAIN GET ENOUGH SUNLIGHT?
(Editorial: Do white British
children and adolescents get enough sunlight?)
http://bmj.com/cgi/content/full/331/7507/3
Some adolescents in Britain do not get enough sunlight to satisfy the body's requirement for vitamin D throughout the year, says a scientist in this week's BMJ. But this doesn't mean that we should abandon skin cancer awareness campaigns.
Fear of skin cancer in the United Kingdom, may have led to children spending less time exposed to sunlight, reducing the opportunities for the production of vitamin D in the skin and resulting in poor bone health. Evidence also shows that sunlight exposure and the resulting synthesis of vitamin D might reduce the risk of certain cancers and, perhaps, multiple sclerosis.
In response, there have been calls for current skin cancer awareness campaigns in the UK to be abandoned. But are such calls justified, asks Professor Brian Diffey, Clinical Director at Newcastle General Hospital?
Adequate sun exposure is not easily defined, but it is thought that a weekly dose of 1 MED (minimal erythema dose - the exposure necessary to result in a just perceptible reddening of the skin) to the face, hands and arms in the spring summer, and autumn is more than adequate to satisfy the body's requirement for vitamin D throughout the year.
If only the face and hands are exposed, then a weekly dose of about 2 MED would be required.
In 1994, Professor Diffey measured the sun exposure of 180 children and adolescents in three regions of England during the spring and summer and found that 98.5% and 91% of children and adolescents, respectively, exceeded a weekly dose of 1 MED. However, only 58% of teenage boys, who generally exposed only their hands and face, exceeded 2 MED.
These findings would certainly account for the fact that the wintertime vitamin D status of almost all teenage girls living in northern Europe is insufficient, he writes. But such evidence is not enough to justify abandoning current awareness campaigns about skin cancer, which are aimed primarily at avoiding excessive exposure.
British children and adolescents need not deliberately spend extended periods in strong sunshine, he explains. Rather, those whose lives are spent almost entirely indoors, in the shade, or in vehicles should take the opportunity during casual everyday activities to walk on the sunny side of the street and, when possible, avoid taking the car.
Contact:
Professor Brian Diffey, Clinical
Director, Newcastle General Hospital, UK
Email: b.l.diffey@ncl.ac.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs DivisionBMA HouseTavistock
SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)