Good news from the Americas
Good news from the Americas illuminated the global health scene in September. As the Ministers of Health from the western hemisphere gathered in Washington, DC, USA, for PAHO\'s 55th Directing Council, a series of announcements confirmed the New World\'s role as a pioneer of sorts in disease prevention and control. Repeating the pattern that began with smallpox in 1971, polio in 1994, and rubella in 2015, the region of the Americas was declared the first in the world to be free of endemic measles on Sept 27. This feat was achieved through 14 years of unrelenting efforts to reach the farthest pockets of unvaccinated populations and document the end of transmission of a virus that still caused over 110 000 deaths worldwide in 2014, mostly in children under 5 years of age. It is a laudable achievement and a testament to the success of yearly national immunisation campaigns and efforts to educate the populations of the region on the innocuity and efficacy of vaccines. The confidence in this essential global health tool in the countries of the Americas is highlighted in a recent published in , which shows that countries of the region reported low levels of scepticism on the dimensions surveyed, including the importance of cyclic gmp and the safety and effectiveness of vaccines. The fact that other countries or regions do not show the same confidence, and the related impact on vaccination coverage, underscore the fragility of the elimination status and the importance of persistently promoting the value of vaccines at the global level.
Achievements such as these educate us on the feasibility of reaching elimination goals. They perhaps also provide additional thrust for efforts towards harder to reach, more uncertain milestones. The Ministers of Health concluded their gathering at PAHO with a set of agreements on the prevention, control, and elimination of diseases in the Americas, including a for malaria elimination with ambitious goals for the next 4 years. Elimination, if reached, would be a first step in a major global health quest: the eradication of malaria, a disease that currently threatens half of the world\'s population, and in 2015 killed almost 500 000 people worldwide. Perhaps the Americas can show us once again how it is done.
Based on current trends, smoking is predicted to cause 1 billion deaths in the 21st century. Nevertheless, there are signs of hope. Although the number of smokers has increased worldwide due to population growth, daily smoking prevalence among men fell from 41% in 1980 to 31% in 2012, and from 11% to 6% in women in the same time. 52 years since the first US Surgeon General\'s report on smoking and health, the academic and policy debate is increasingly about the most efficient strategies for the tobacco endgame and a world where less than 5% of the adult population use tobacco. The tobacco epidemic is moving from high-income countries to low-income and middle-income countries (LMICs). To achieve global tobacco use prevalence of less than 5%, a sustained focus in these countries is required. Tobacco deaths are declining in high-income countries; by 2030, 6·8 million of the projected 8·3 million annual global tobacco deaths will be in LMICs, where tobacco deaths are expected to double between 2002 and 2030. The tobacco industry needs to keep recruiting young smokers to replace these smokers who are dying. In , Bo Xi and colleagues describe tobacco use and secondhand smoke exposure in young adolescents in 68 LMICs. Monitoring of progress by use of surveys such as the Global School-based Health Survey (GSHS) and the Global Tobacco Youth Survey (GYTS) is essential to understand whether current policies are working, especially in LMICs where data are more limited. Unfortunately, Xi and colleagues cannot neatly compare their new global and regional estimates for LMICs with earlier published estimates due to their use of different countries, different age groups, and different questions. The results are more useful at a national level, where data can be used to improve national policy. As with much tobacco use data, the results demonstrate enormous variation between countries, even within the same region. These differences can provide important lessons about tobacco control success and failure. For example, Xi and colleagues highlight the very high adolescent smoking prevalence and prevalence of exposure to secondhand smoke in the small Pacific island nation of Kiribati. However, national data can hide variations in smoking prevalence within countries due to important social determinants such as education levels, wealth, and gender. Research about these subnational differences in smoking in LMICs is also important to inform policy.