tag:theconversation.com,2011:/global/topics/lancet-11648/articlesLancet – The Conversation2022-11-10T13:41:45Ztag:theconversation.com,2011:article/1930772022-11-10T13:41:45Z2022-11-10T13:41:45Z8 billion people: Four ways climate change and population growth combine to threaten public health, with global consequences<figure><img src="https://images.theconversation.com/files/494155/original/file-20221108-12-bg01z4.jpg?ixlib=rb-1.1.0&rect=522%2C226%2C3071%2C2166&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infectious diseases like COVID-19 top the list of health concerns.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-elderly-man-a-resident-of-the-sprawling-township-of-news-photo/1211082728">Marco Longari/AFP via Getty Images</a></span></figcaption></figure><p><em><a href="https://theconversation.com/ocho-mil-millones-de-personas-asi-amenazan-a-la-salud-publica-el-cambio-climatico-y-la-superpoblacion-194421">Leer in español</a></em></p>
<p>There are questions that worry me profoundly as a population- and environmental-health scientist. </p>
<p>Will we have enough food for a growing global population? How will we take care of more people in the next pandemic? What will heat do to millions with hypertension? Will countries wage water wars because of increasing droughts? </p>
<p>These risks all have three things in common: health, climate change and a growing population that the United Nations determined <a href="https://www.un.org/en/desa/world-population-reach-8-billion-15-november-2022">passed 8 billion</a> people in November 2022 – double the population of just 48 years ago.</p>
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<p>In my <a href="https://www.health.pitt.edu/people/ant-2">40-year career</a>, first working in the Amazon rainforest and the Centers for Disease Control and Prevention, and then in academia, I have encountered many public health threats, but none so intransigent and pervasive as climate change. </p>
<p>Of the multitude of climate-related adverse health effects, the following four represent the greatest public health concerns for a growing population.</p>
<h2>Infectious diseases</h2>
<p>Researchers have found that <a href="https://theconversation.com/58-of-human-infectious-diseases-can-be-worsened-by-climate-change-we-scoured-77-000-studies-to-map-the-pathways-188256">over half of all human infectious diseases</a> can be worsened by climate change.</p>
<p>Flooding, for example, can affect water quality and the habitats where dangerous bacteria and vectors like mosquitoes can breed and transmit infectious diseases to people.</p>
<p>Dengue, a painful mosquito-borne viral disease that sickens <a href="https://www.cdc.gov/dengue/about/index.html">about 100 million</a> people a year, becomes more common in warm, wet environments. Its R0, or basic reproduction number – a gauge of how quickly it spreads – <a href="https://doi.org/10.1016/S0140-6736(22)01540-9">increased by about 12%</a> from the 1950s to the average in 2012-2021, according to the 2022 Lancet Countdown report. Malaria’s season expanded by 31% in highland areas of Latin America and nearly 14% in Africa’s highlands as temperatures rose over the same period.</p>
<figure class="align-center ">
<img alt="Rows of beds, some covered with mosquito nets, fill a warehouse-like space. Doctors visit with some of the patients." src="https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493916/original/file-20221107-19-5r15ur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Patients rest in a makeshift dengue ward at a hospital during a severe outbreak in Pakistan in 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/patients-take-rest-on-beds-arranged-inside-a-makeshift-news-photo/1235932771">Arif Ali/AFP via Getty Images</a></span>
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<p>Flooding can also spread waterborne organisms that cause <a href="https://doi.org/10.1186/s12879-020-04961-4">hepatitis</a> and <a href="https://doi.org/10.1136/bmj.39503.700903.DB">diarrheal diseases</a>, such as cholera, particularly when large numbers of people are displaced by disasters and living in areas with poor water quality for drinking or washing. </p>
<p><a href="https://doi.org/10.1371/currents.dis.7a2cee9e980f91ad7697b570bcc4b004">Droughts</a>, too, can degrade drinking water quality. As a result, more rodent populations enter into human communities in search of food, increasing the <a href="https://doi.org/10.3390/pathogens11010015">potential to spread hantavirus</a>.</p>
<h2>Extreme heat</h2>
<p>Another serious health risk is rising temperatures. </p>
<p>Excessive heat can <a href="https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health">exacerbate existing health problems</a>, such as <a href="https://doi.org/10.1111/all.14177">cardiovascular</a> and respiratory diseases. And when heat stress becomes <a href="https://www.cdc.gov/niosh/topics/heatstress/heatrelillness.html">heat stroke</a>, it can <a href="https://www.mayoclinic.org/diseases-conditions/heat-stroke/symptoms-causes/syc-20353581">damage the heart, brain and kidneys</a> and become lethal.</p>
<p>Today, about 30% of the global population is exposed to potentially deadly heat stress each year. The Intergovernmental Panel on Climate Change estimates that percentage will rise <a href="https://www.ipcc.ch/report/ar6/wg2/about/frequently-asked-questions/keyfaq3/">to at least 48% and as high as 76%</a> by the end of this century.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=477&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=477&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=477&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=599&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=599&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493119/original/file-20221102-24-un18ln.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=599&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Where climate change affects human health.</span>
<span class="attribution"><span class="source">Centers for Disease Control and Prevention</span></span>
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<p>In addition to lives lost, heat exposure was projected to have resulted in <a href="https://www.thelancet.com/infographics-do/climate-countdown-2022">470 billion potential work hours lost</a> globally in 2021, with associated income losses totaling up to US$669 billion. As populations grow and heat rises, more people will be relying on air conditioning powered by fossil fuels, which <a href="https://www.iea.org/news/air-conditioning-use-emerges-as-one-of-the-key-drivers-of-global-electricity-demand-growth">further contributes to climate change</a>.</p>
<h2>Food and water security</h2>
<p>Heat also affects food and water security for a growing population.</p>
<p>The Lancet review found that high temperatures in 2021 <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01540-9/fulltext">shortened the growing season</a> by about 9.3 days on average for corn, or maize, and six days for wheat compared with the 1981-2020 average. Warming oceans, meanwhile, can kill shellfish and shift <a href="https://doi.org/10.1111/gcb.14512">fisheries that coastal communities rely on</a>. Heat waves in 2020 alone resulted in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01540-9/fulltext">98 million more</a> people facing food insecurity compared with the 1981-2010 average.</p>
<figure class="align-center ">
<img alt="A woman standing in a field examines a stalk of sorghum" src="https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493915/original/file-20221107-21-i2g9p0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A farmer in Zimbabwe switched to sorghum, a grain crop that can thrive in dry conditions, as drought withered other crops in 2019.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/angeline-kadiki-an-elderly-who-is-a-sorghum-farmer-inspects-news-photo/1130994283">Jekesai Njikizana/AFP via Getty Images</a></span>
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</figure>
<p>Rising temperatures also affect fresh water supplies through evaporation and by shrinking <a href="https://e360.yale.edu/features/andes-meltdown-new-insights-into-rapidly-retreating-glaciers">mountain glaciers</a> and <a href="https://www.ioes.ucla.edu/project/climate-change-sierra-nevada/">snowpack</a> that historically have kept water flowing through the summer months.</p>
<p>Water scarcity and drought have the potential to displace almost <a href="https://unstats.un.org/sdgs/report/2022/goal-13/">700 million people by 2030</a>, according to U.N. estimates. Combined with population growth and growing energy needs, they can also fuel geopolitical conflicts as countries face food shortages and compete for water.</p>
<h2>Poor air quality</h2>
<p>Air pollution can be <a href="https://theconversation.com/extreme-heat-air-pollution-can-be-deadly-with-the-health-risk-together-worse-than-either-alone-187422">exacerbated by the drivers of climate change</a>. Hot weather and the same fossil fuel gases warming the planet <a href="https://www.lung.org/clean-air/climate-change/climate-change-air-pollution">contribute to ground-level ozone</a>, a key component of smog. That can exacerbate allergies, asthma and other respiratory problems, as well as cardiovascular disease. </p>
<p>Wildfires fueled by hot, dry landscapes <a href="https://doi.org/10.1126/sciadv.abi9386">add to the air pollution health risk</a>. Wildfire smoke is laden with tiny particles that can travel deep into the lungs, <a href="https://www.epa.gov/wildfire-smoke-course/why-wildfire-smoke-health-concern">causing heart and respiratory problems</a>. </p>
<figure class="align-center ">
<img alt="Three school girls with backpacks walk through smog along a road while covering their mouths with handkerchiefs." src="https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493917/original/file-20221107-25-5gvhig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smog in New Delhi, India, is an ongoing problem. It got so bad in 2017 that the city temporarily closed its primary schools.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/indian-schoolchildren-cover-their-faces-as-they-walk-to-news-photo/871511920">Sajjad Hussain/AFP via Getty Images</a></span>
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</figure>
<h2>What can we do about it?</h2>
<p>Many groups and medical experts are working to counter this cascade of negative climate consequences on human health.</p>
<p>The U.S. National Academy of Medicine has embarked on an ambitious <a href="https://nam.edu/programs/climate-change-and-human-health/">grand challenge in climate change, human health, and equity</a> to ramp up research. At many academic institutions, including the University of Pittsburgh’s School of Public Health, where I am dean, climate and health are being embedded in research, teaching and service.</p>
<p>Addressing the health burden on low- and middle-income countries is pivotal. Often, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK525226/">most vulnerable</a> people in these countries <a href="https://sdgs.un.org/goals/goal13">face the greatest harms from climate change</a> without having the resources to protect their health and environment. Population growth can <a href="https://doi.org/10.1289/EHP10384">deepen these iniquities</a>. </p>
<p><a href="https://www.paho.org/en/news/19-8-2022-eu-and-paho-supporting-nine-caribbean-countries-integration-health-national">Adaptation assessments</a> can help high-risk countries prepare for the effects of climate change. Development groups are also leading projects to <a href="https://www.cgiar.org/">expand the cultivation of crops</a> that can thrive in dry conditions. The <a href="https://www.paho.org/en">Pan American Health Organization</a>, which focuses on the Caribbean, is an example of how countries are working to reduce communicable diseases and advance regional capacity to counter the impact of climate change.</p>
<p>Ultimately, reducing the health risks will require <a href="https://www.unep.org/resources/emissions-gap-report-2022">reducing the greenhouse gas emissions</a> that are driving climate change. </p>
<p>Countries worldwide <a href="https://unfccc.int/process/the-convention/history-of-the-convention#Essential-background">committed in 1992</a> to reduce greenhouse gas emissions. Thirty years later, global emissions are <a href="https://www.unep.org/events/publication-launch/emissions-gap-report-2022">only beginning to flatten</a>, and communities around the world are increasingly suffering extreme heat waves and devastating floods and droughts.</p>
<p>The <a href="https://unfccc.int/event/cop-27">U.N. climate change talks</a>, which in my view aren’t focusing enough on health, can help bring attention to key climate impacts that harm health. As U.N. Secretary-General António Guterres noted: While we celebrate our advances, “at the same time, it is a reminder of our shared responsibility to care for our planet and a moment to reflect on where we still fall short of our commitments to one another.”</p>
<p><em>Samantha Totoni, a Ph.D. candidate at the University of Pittsburgh School of Public Health, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/193077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maureen Lichtveld does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The human population has doubled in 48 years, and worsening climate change has left the world facing serious health risks, from infectious diseases to hunger and heat stress.Maureen Lichtveld, Dean of the School of Public Health, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/678662016-11-01T23:32:46Z2016-11-01T23:32:46ZWomen’s cancers: curable for the rich, often a death sentence for the poor<p>Every minute, a woman dies of breast cancer. Every two minutes, a woman dies of cervical cancer. Perhaps you know <a href="http://gco.iarc.fr/today/fact-sheets-cancers?cancer=29&type=0&sex=0">these statistics</a>, and perhaps these cancers have directly affected you, or someone you love. </p>
<p>Each year 2.7 million women will be diagnosed with cancers of the breast, cervix, endometrium, or ovaries, and more than a million of them will die from these cancers. </p>
<p>Did you know that most of those women live in developing countries? </p>
<p>A woman diagnosed with breast cancer in most high-income countries is <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival#heading-Zero3">very likely to survive</a>. The opposite is true for the hundreds of thousands of women facing the same diagnosis in poor countries. Survival should not be a fluke of geography. </p>
<p>A woman’s agency – that is, her ability to seek and receive an accurate diagnosis and care early in the course of disease – can be the difference between life and death. Pervasive myths regarding cancer as a death sentence, and the stigma that accompanies a diagnosis of breast or gynaecological cancer only make these barriers harder to overcome. </p>
<h2>Rich and poor</h2>
<p>In the case of cervical cancer, 85% of women diagnosed, and 87% of those who die are from poorer countries. Cervical cancer is almost entirely preventable via <a href="http://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html">HPV vaccination for girls</a> and cervical screening, with treatment of pre-cancererous growths. None of this requires an oncologist or high-level cancer centre. </p>
<p>These cost-effective interventions can save millions of lives, if made affordable. Many low-income countries are <a href="http://www.gavi.org/support/apply/countries-eligible-for-support/">eligible for lower-cost HPV vaccines</a> through <a href="http://www.gavi.org/library/news/press-releases/2013/hpv-price-announcement/">Gavi, the Vaccine Alliance</a>, but many women with a high risk of death from cervical cancer live in <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/abstract">countries deemed too wealthy</a> for this special access, while other countries risk losing the vaccine upon “graduation”. In other words, developing countries can effectively be disadvantaged by virtue of their economic success. </p>
<h2>Bridging the gap</h2>
<p>In a <a href="http://www.thelancet.com/series/womens-cancers">series in The Lancet medical journal</a>, we highlight the gross inequities in access to prevention, early detection, and treatment for these two common cancers. We review what type of interventions could close this divide, including HPV vaccination and screen-and-treat approaches for cervical cancer prevention. </p>
<p>For breast cancer, key interventions include improving a woman’s access to early diagnosis. Increased public awareness, timely access to diagnostic imaging and a biopsy for accurate diagnosis, and improved access to surgery can make a world of difference. </p>
<p>For the majority of women whose breast cancers are “hormone positive”, the addition of an estrogen-blocking drug such as tamoxifen (which is generic, inexpensive and widely available with low rates of serious toxicity) can greatly improve survival. </p>
<p>There are challenges in taking these interventions to scale, beyond issues of cost. For example, there continues to be <a href="http://www.hpv.org.nz/hpv-vaccine/hpv-vaccine-myth-vs-facts">widespread misinformation</a> regarding the safety as well as the effectiveness of the HPV vaccine, a problem we must urgently overcome to increase coverage globally. </p>
<p>There are pragmatic approaches that can be taken to meet these challenges. Task-sharing – for example, where a nurse receives additional training to perform a visual inspection of the cervix with acetic acid – can greatly improve access to this life-saving intervention, particularly where gynaecologists or other trained physicians are scarce. </p>
<p>Zambia has been <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122169">successful in this approach</a>, which also includes taking digital photographs of the cervix for quality assurance by a remote gynaecologist </p>
<p>Telemedicine can also help bridge the gap, for example when community health workers use smartphones to encourage women to attend the clinic if they have a suspicious breast lump. Nurses can also use smartphones for digital photos as well as data-tracking and follow-up communication between physician and patient.</p>
<h2>A question of funding</h2>
<p>There is stark lack of global funding for cancer, in spite of the fact that cancer <a href="http://www.who.int/gho/en/">kills more people</a>, in fact twice as many, than HIV/AIDS, malaria, and tuberculosis combined.</p>
<p>Breast and cervical cancer alone account for half a million more deaths – mostly of women in the prime of their lives – than the number of women who die from <a href="http://www.unfpa.org/maternal-health">complications of pregnancy or childbirth</a>.</p>
<p>Any time a woman dies in childbirth, it is a tragedy. But equally tragic is a woman who survives her pregnancy, only to succumb to breast cancer when her child is not yet five. But where is the cry for global investments? Where is the fund for women’s cancer in the developing world?</p>
<p>The case must also be made for leverage existing resources, for example by providing breast health education and cervical screening at reproductive health clinics. Women who are living with HIV are four to five times more likely to develop cervical cancer. This is why UNAIDS and the WHO <a href="http://www.unaids.org/en/resources/documents/2016/HPV-HIV-cervical-cancer">recommend</a> combining HIV services with cervical cancer education, screening and treatment, in settings where HIV prevalence is high.</p>
<p>That said, the total funding for all <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">non-communicable diseases</a> is a mere fraction of what is required, and each day millions of families face catastrophic expenditures, which come from largely out-of-pocket sources. </p>
<p>A 2015 report from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539728/">eight ASEAN countries</a> found that one year after a cancer diagnosis, 48% experienced financial catastrophe, 29% of adults had died, and just 23% were alive with no financial catastrophe. </p>
<p>Investments must be made now, including direct international assistance for health, as well as increased expenditures from national governments. Countries moving towards universal health coverage must expand beyond traditional packages that focus exclusively on infectious diseases and mother-and-child health to incorporate services for breast and cervical cancer.</p>
<h2>The threat to development</h2>
<p>Women’s cancers are a major threat to development. It is imperative that we work together, across disciplines, and recognise the role of other partners, including in the UN system, academia, civil society, and the private sector in advocating for women’s health and rights. </p>
<p>Gender equality has its own goal in the United Nations’ <a href="http://www.un.org/sustainabledevelopment/development-agenda/">Sustainable Development Agenda for 2030</a>, and thus presents a critical opportunity for advocates and activists in the gender equality, sexual and reproductive health and rights, and cancer associations and communities to link forces with other women’s advocates to drive greater investment in fighting cancer. </p>
<p>The “life course” approach raised in the UN programme, <a href="http://www.everywomaneverychild.org/">Every Woman Every Child</a>, is essential to improve the health of women and girls. And caring for people throughout their life course also involves screening for, and treating, women’s cancers. </p>
<p>The good news about women’s cancers is that they are often preventable and treatable. Our greatest challenge now is to make sure that is the case for all women, not just those who are lucky enough to be born in the wealthiest parts of the world. </p>
<p><em>This article was co-authored by Rengaswamy Sankaranarayanan from the International Agency for Research on Cancer. He receives funding from the Bill and Melinda Gates Foundation; the US National Cancer Institute and the Association for International Cancer Research.</em></p><img src="https://counter.theconversation.com/content/67866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ophira Ginsburg receives funding from Grand Challenges Canada.</span></em></p><p class="fine-print"><em><span>Lynette Denny has received funding from Glaxosmith Kilne, Merck and Roche</span></em></p><p class="fine-print"><em><span>Lesong Conteh and Richard Sullivan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Of women who die from cervical cancer, 87% live in poor countries.Ophira Ginsburg, Associate Professor, Women’s College Hospital and Research Institute, University of TorontoLesong Conteh, Senior Lecturer in Health Economics, Imperial College LondonLynette Denny, Chair and Professor of Obstetrics & Gynaecology, University of Cape TownRichard Sullivan, Director, Institute of Cancer Policy, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/631822016-07-29T02:18:02Z2016-07-29T02:18:02ZBeing transgender is not a mental illness, and the WHO should acknowledge this<figure><img src="https://images.theconversation.com/files/132434/original/image-20160729-12082-xdth3v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pathology lies in society discriminating against transgender people, not in transgender people themselves.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/taedc/17793410742/in/photolist-t7kT6Q-8pjv3k-cVJ9uj-saxCDw-f1y96p-cVJ9JG-9WPhBL-f1y9be-fndYDz-9Svn7g-cVJdh3-9SygtC-fndTux-9SyeCC-9SvogM-f1Nqh1-6S4uQR-9Svm5V-9Syi9C-f1Nqks-uDc4So-f3Gben-fntaYW-9WP8ZU-8pnAG9-9WLRpP-9WPFf5-cVJ9eC-fntcpG-f1y97x-vpHikj-cVJdLw-pvyekw-dWdb3z-f1y9ok-fndTh4-f1NqwW-oQfyYM-8hTY61-9Svrjc-dWizSU-f1Nqw9-fnt5YS-dWddUR-8nzner-9SvoWK-pvyf1u-avnGE5-8hTY6N-a2CRz6">Ted Eytan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The World Health Organisation (WHO) has announced it may <a href="http://www.nytimes.com/2016/07/27/health/who-transgender-medical-disorder.html?_r=0">no longer classify</a> being transgender as a disorder in the revised version of its International Classification of Diseases (ICD), due for release in 2018. </p>
<p>The ICD is a diagnostic tool used across much of the world to diagnose health issues, including mental illness.</p>
<p>A study published this week in the <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30165-1/fulltext">Lancet medical journal</a> has lent support to this move. Echoing previous research, the study found poor mental health among transgender people is primarily the product of social stigma and violence. This counters the view that being transgender is itself pathological. </p>
<h2>History of diagnostic criteria</h2>
<p>Historically, it has been assumed that the sex we are assigned at birth determines our gender. Primarily on the basis of visual inspection of genitalia, people are considered male if they have a penis and female if they have a vagina. Respectively, people are expected to experience themselves as such. </p>
<p>For transgender people, these assumptive classifications are incorrect. Yet the belief that sex determines gender has remained, despite evidence to the contrary. </p>
<p>This is evident in the treatment of transgender people as disordered, as in the case of the ICD. This designation is a product of social values and norms, not of any evidence that transgender people are inherently disordered.</p>
<p>Calls to remove being transgender from the ICD reflect growing recognition of the rights of transgender people. In 2013, this was recognised in changes to the <a href="http://www.apa.org/monitor/2013/04/transgender.aspx">American Psychiatric Association’s fifth edition</a> of the Diagnostic and Statistical Manual (DSM). </p>
<p>The previous edition of the DSM included the diagnosis of gender identity disorder, which treated being transgender as a disorder. The DSM5 classifies being transgender under the diagnosis of gender dysphoria. The ICD’s proposed revised terms include gender incongruence or gender discordance. </p>
<p>Those involved in introducing new terminology to the DSM suggested the focus on dysphoria reflects the impact of social norms on transgender people, rather than being indicative of a disorder. As such, <a href="http://www.huffingtonpost.com/2013/06/04/gender-dysphoria-dsm-5_n_3385287.html">the diagnosis is limited</a> to the time in which the person is experiencing distress about their gender. </p>
<h2>Arguments for and against</h2>
<p>The DSM5 (and likely the ICD) retain mention of transgender people due to the apparent <a href="http://www.huffingtonpost.com/chase-strangio/gender-identity-disorder-dsm_b_2247081.html">necessity of a diagnosis</a> when accessing services covered by medical insurance or public health funds. Insurers, it is suggested, are unlikely to pay if there is not a diagnosed issue requiring treatment. </p>
<p>But the Standards of Care of the <a href="http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=4655">World Professional Association for Transgender Health</a> recognise that some transgender people do not experience significant distress and should not need to do so in order to access services. </p>
<p>Transgender people have <a href="http://www.stp2012.info/old/en/news">long opposed diagnoses</a> being applied to their lives, even if to warrant access to services. Many have argued these pathologise transgender people’s lives, allow for gatekeeping of access to services and place unnecessary barriers to accessing them. </p>
<p>In terms of pathologisation, <a href="http://juliaserano.blogspot.com.au/2015/07/the-real-autogynephilia-deniers.html#more">it has been argued that</a> retaining diagnostic categories, even if not framed in terms of a disorder, may be used negatively by those opposing rights of transgender people. </p>
<p>In terms of gatekeeping, focusing on a particular description of what counts as transgender may encourage some to present a scripted account of their experiences in order to justify support. This could mean <a href="http://www.damienriggs.com/blog/wp-content/uploads/2013/09/Trans-Men-Disability.pdf">actual mental health issues</a> requiring attention are overlooked or minimised.</p>
<p>And in terms of barriers, services for transgender people are relatively limited in most countries – certainly so in Australia. Requiring a diagnosis means that before accessing specialist services such as endocrinologists or surgeons, transgender people must first attend appointments with mental health professionals. </p>
<p>Given the demand for mental health professionals, wait times can be long. <a href="http://tvo.org/article/current-affairs/shared-values/why-surgery-wait-times-put-transgender-people-at-risk-of-suicide">Research suggests</a> that people can be particularly vulnerable during the period between first disclosure of being transgender and accessing services. Long wait times extend this unnecessarily. </p>
<h2>Alternative approaches</h2>
<p>Some transgender people may certainly experience mental health concerns, as may any person. GP referral to a mental health professional currently provides a clear pathway to services. </p>
<p>Transgender people who do not require support for mental health, but who wish to access support for hormones or surgery, could be referred directly to specialists rather than via a mental health professional assessment. </p>
<p>This would require upskilling GPs so they are able to provide appropriate referral and initial support. Some transgender people may of course wish to access support from a mental health professional, but this would be at their discretion, not as a requirement for a diagnosis. </p>
<p>As when a person is pregnant, the pregnancy is not a diagnosis but a confirmation of fact, and services are provided accordingly. While the ICD <a href="http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z30-Z39/Z34-">includes a code for professionals</a> who supervise a pregnancy, this is not <em>per se</em> a diagnosis. </p>
<p>A person who has received no care throughout their pregnancy can still walk into a hospital when in labour and receive services covered by health insurers or public funds. </p>
<p>Similarly, and as an <a href="http://www.icath.org">informed consent model</a> would advocate, transgender people are well versed in the facts of their lives and should be able to present for specialist services with a GP referral. </p>
<p>This would not prohibit transgender people also accessing mental health services. Treating mental health assessment (when needed) as separate from referrals for specialist services would help reduce gatekeeping and wait times. </p>
<p>Changes to the ICD, like the DSM, would be welcomed, as is research that continues to demonstrate the impact of social stigma. However, transgender people have long made these points, and we must acknowledge their rights to self-determination and timely access to services.</p><img src="https://counter.theconversation.com/content/63182/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damien Riggs receives funding from the Australian Research Council. </span></em></p>Poor mental health in transgender people is primarily the product of social stigma and violence. This counters the view that being transgender is itself pathological.Damien Riggs, Associate Professor in Social Work, Australian Research Council Future Fellow, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/476162015-09-21T10:00:05Z2015-09-21T10:00:05ZLiving longer, sicker lives? Make lifestyle changes to remain healthier in old age<figure><img src="https://images.theconversation.com/files/95374/original/image-20150918-17676-1hyi65o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fighting fit.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-181671983/stock-photo-elderly-person-practicing-a-sport.html?src=hQii59zazhAJcrlSpf4HSQ-2-72">Exercise by Shutterstock</a></span></figcaption></figure><p>Life expectancy across the world is growing, but the number of those extra years in which we’re healthy is not rising at the same rate. This adds to the demographic time-bomb of a greater number of older people suffering from ill-health. Yet, according to the Global Burden of Disease study <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961340-X/abstract">published in the Lancet</a>, of the top ten health risks most are lifestyle-related and within our power to change.</p>
<p>Between 1990 and 2013, life expectancy in the UK increased by 6.2 years for men to 79.1 years, and by 4.4 years for women to 82.8 years. However, the amount of this gain expected to be lived in good health increased by only 4.7 years for men and 3.3 years for women. </p>
<p>While a similar improving trend was observed in most countries across the globe, in dozens of countries including Belarus, Belize, Gabon, Guyana, Paraguay, Syria and all of southern Sub-Saharan Africa, healthy life expectancy was lower in 2013 than in 1990. Interestingly, this is also the first time that improvements to healthy life expectancy in the developing world (5.4 years for men and 6.4 years for women) are greater than those in the developed world (3.9 years for men and 2.8 years for women).</p>
<h2>Chronic disease and disability</h2>
<p>A surprising fact is that, nowadays, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960692-4/abstract">fewer than 4% of people are completely free of any health problem</a>, with more people living with chronic and under-reported illnesses. The number of years lived with disability have increased in almost every country, attributable to the growth of chronic diseases such as cardiovascular and respiratory diseases, cancer, back pain, mental health disorders, dementia, road injuries, HIV/AIDS and malaria. This has also increased the demand for care.</p>
<p>A comparison of years of life lost between regions of the UK, <a href="https://stats.oecd.org/glossary/detail.asp?ID=6805">the EU15 group of countries</a>, plus Australia, Canada, Norway and the US, shows that England’s worst affected region – the north-west (with north-east England close behind) – is similar to Scotland, Northern Ireland and the US. The East Midlands is the UK average, equivalent to France, Canada and Germany, while better-off regions such as the south-west, south-east and London are closer to Spain, Australia and Norway.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95022/original/image-20150916-11977-nzwltr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rates of years of life lost (YLLs) for both sexes combined in the nine English regions, Scotland, Northern Ireland, Wales, the EU15 countries, Australia, Canada, Norway and the US (2013).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00195-6">Newton et al\The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Factors within our control</h2>
<p>We could live longer and healthier if we tackled the main health risks that affect us. Globally, the leading ten risks are smoking, obesity, high blood pressure, diabetes, alcohol use, high cholesterol, kidney disease, low physical activity, diets <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low in fruits and vegetables</a> and drug use. These are drawn from 79 biological, behavioural, environmental and occupational factors.</p>
<p>The list is similar in the UK, with smoking, high blood pressure, obesity at the top and <a href="https://theconversation.com/top-five-things-you-can-do-to-keep-your-heart-healthy-34950">low physical activity also ranking highly</a>, comparable to <a href="http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2815%2900128-2/abstract">Australasia, Ireland and the US</a>. Among developed countries there is some variation: alcohol use is a bigger problem in Belgium, Denmark, Finland and South Korea, while smoking is less of a problem in Finland, Israel and Singapore, for example.</p>
<p>The same is true <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2900195-6/abstract">within the UK</a>, where Wales scored worse in physical activity but better in blood pressure, or where drug use was a greater problem in the south-west, south-east and the east of England than elsewhere. As the chart below shows, of metabolic (biological), environmental, or behavioural (lifestyle) factors affecting health, it is lifestyle factors that carry the most weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95031/original/image-20150916-6299-h3p1rc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=468&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Proportion of disability-adjusted life years lost in 2013 attributable to behavioural, environmental and metabolic risks and where they overlap (marked by ∩).</span>
<span class="attribution"><a class="source" href="http://dx.doi.org/10.1016/S0140-6736(15)00128-2">GBD 2013 Risk Factors Collaborators/The Lancet</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>The future</h2>
<p>We are now entering an era when fighting for funding to tackle a single disease in isolation is no longer effective. Health problems <a href="http://pediatrics.aappublications.org/content/88/3/519.abstract">tend to cluster from childhood to adulthood</a> and then <a href="http://spcare.bmj.com/content/5/Suppl_1/A6.1.abstract">around the end of life</a>. They also share both biological and environmental risks. </p>
<p>The main risk factors leading to chronic diseases such as high blood pressure, obesity, smoking and heavy alcohol consumption might result from <a href="http://www.jsad.com/doi/abs/10.15288/jsa.2001.62.773">family problems</a>, <a href="http://bmjopen.bmj.com/content/5/5/e006588.long">social inequality</a> or poverty, beliefs or <a href="http://psycnet.apa.org/journals/hea/21/3/279/">customs</a> of particular subcultures, <a href="http://www.bmj.com/content/350/bmj.h1565.long">selfish business models</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861792/">bullying</a> or violence, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.82.6.816">poor education (awareness)</a>, depressive mood and even <a href="https://theconversation.com/being-too-hot-or-too-cold-can-worsen-health-conditions-27086">the changeable weather</a>.</p>
<p>Current prevention and interventions programmes and social and health policies aimed at reducing the leading risks might have limited effects. Instead, we should focus on the context and mechanism of actions of these risks. We, therefore, need to restructure human society in each country, with systematic examination and improvements in every aspect of human life including <a href="http://www.healthpolicyjrnl.com/article/S0168-8510%2815%2900221-3/abstract">politics</a>, the occupational (for example, more healthcare and less business; <a href="http://www.theguardian.com/commentisfree/2013/sep/18/shorter-working-week-fairer-economy">shorter working hours</a> with lower unemployment rates), the built environment (including <a href="http://www.ingentaconnect.com/content/hsp/jbsav/2015/00000004/00000001/art00012">housing and neighbourhoods renewal</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20191/epdf">the transport system</a>, etc), <a href="http://link.springer.com/article/10.1007%2Fs10964-010-9584-8">consistent culture, education and parenting</a>, <a href="http://www.tandfonline.com/doi/full/10.3109/11038128.2015.1085596">hobbies</a> and so on. This is the grand challenge that faces us in the next decade.</p><img src="https://counter.theconversation.com/content/47616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivy Shiue (Scthiue) does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A global health and disease study shows we’re living longer, but spending more years in poor health. But there are some things within our power to change.Ivy Shiue (Scthiue), Senior research associate, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/295722014-07-24T04:44:16Z2014-07-24T04:44:16ZPut down the paracetamol, it’s just a placebo for low back pain<figure><img src="https://images.theconversation.com/files/54741/original/xy4dhrr6-1406170330.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Up to 90% of the population will experience lower back pain over their life time; around 25% will have it on any given day.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/yamagatacamille/5240315494">Flickr: Christian Bucad</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>People with lower back pain are usually told to take some paracetamol for relief. But <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/abstract">research published today</a> shows that this almost universal advice is misguided.</p>
<p>Up to 90% of the population will experience lower back pain over their life time; around 25% will have it on any given day. </p>
<p>“Non-specific low back pain” - so called because it’s not caused by a serious condition, such as a fracture, cancer or infection - accounts for around 95% of all cases. It includes people with so-called slipped discs, spinal misalignment, facet joint problems, spinal instability and, in some cases, back pain radiating into the leg.</p>
<p>In <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/abstract">research published in The Lancet today</a>, we show that paracetamol doesn’t speed recovery, or reduce pain for people with lower back pain any more than a placebo does. Our results raise questions about the value of pain medications for managing low back pain.</p>
<h2>What we did</h2>
<p>Paracetamol is universally recommended in treatment guidelines for treating non-specific low back pain. But this recommendation isn’t actually based on direct evidence of benefit; it’s just been compared to other medicines and is preferred because it’s a safe pain killer with few, if any, side effects. And because it was assumed to help.</p>
<p>In a study involving 1,643 people with lower back pain, we directly tested paracetamol against placebo and also compared two ways of taking it - regularly and intermittently. Many people do the latter, following advice of taking paracetamol “as needed”. We thought they would need to take it regularly to benefit. </p>
<p>All our subjects took their respective medicine for up to four weeks. And all of them were also given general advice and reassured that they would recover. </p>
<p>We followed them all up for three months, and found both methods of taking paracetamol (regularly and intermittently) were completely ineffective. What’s more, we found that people did just as well taking a sugar pill (our placebo) as taking paracetamol for lower back pain.</p>
<p>It’s clearly time to reconsider the recommendation for taking this drug and more generally, the contribution of pain-relief medicines in helping people manage acute lower back pain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54731/original/5c22f738-1406169488.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Paracetamol is universally suggested in treatment guidelines for treating non-specific lower back pain, but there is no direct evidence to support this recommendation.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/arleach84/7727106004/in/photostream/">Flickr: Leach84</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
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<h2>What this means</h2>
<p>So, what do our results mean for managing lower back pain, and what, if anything, should people do instead of taking paracetamol?</p>
<p>First, if you haven’t started any treatment and are deciding what to do about about your lower back pain, our study shows paracetamol will neither help you recover quicker or dull your pain. So, there’s no point in taking it and no justification for your doctor to recommend it. </p>
<p>Second, if you are taking paracetamol for acute lower back pain and feel it’s helping, you should continue to take it. But if your pain doesn’t improve after a week or two, we suggest you see a doctor about it.</p>
<p>What our results don’t suggest is that it’s better to take other pain killers instead of paracetamol. It’s important to remember that the purpose of taking pain-relief medicine for lower back pain is so people can stay as active as possible. If you take very strong pain medication, it can make you sleepy and drowsy, and it could limit what you’re able to do.</p>
<h2>You will recover</h2>
<p>What’s more, we actually have a very poor understanding of the benefits and harms of most of the pain medicines commonly used for acute back pain. </p>
<p>Two key examples are non-steroidal anti-inflammatory drugs and opioid analgesics. We simply don’t have large, well-conducted trials (like our study) that have tested these medicines so people with lower back pain and their doctors can make informed decisions about the balance of benefits and harms. </p>
<p>It’s not all bad news though. People with low back pain are usually told to maintain normal activity as much as possible, avoid bed rest and reassured that they’re likely to recover. And that’s exactly what happened in our study. </p>
<p>We provided this advice and reassurance to all our subjects and the vast majority of them recovered relatively quickly (about half recovered within two and a half weeks). These key messages need to be reinforced.</p>
<p>So, don’t be concerned if your doctor doesn’t prescribe medication for your back pain. It’s best to focus on the advice you’re given rather than a script for medication.</p><img src="https://counter.theconversation.com/content/29572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams received funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Jane Latimer receives funding from The Australian Research Council (ARC) and The National Health and Medical Research Council (NHMRC). Industry partner GSK provided part funding for the paracetamol study.</span></em></p>People with lower back pain are usually told to take some paracetamol for relief. But research published today shows that this almost universal advice is misguided. Up to 90% of the population will experience…Christopher Williams, Research Fellow at Hunter Medical Research Institute &, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.