NHS at 70 – if original ideals are to be sustained then we need honesty on its running costs

The London School of Hygiene & Tropical Medicine’s (LSHTM) clinical research teams are active in dozens of countries, with field teams moving around by canoe in the Pacific Islands, by seaplane off the coast of Guinea Bissau and in modified off-road vehicles on the rocky terrain around Mount Kilimanjaro.

Between 80-90% of healthcare worldwide is delivered by nurses and midwives. Doctors and surgeons give & prescribe groundbreaking treatment, but without the care and follow through of the nurses those patients will not survive. Nurses are one of the most important factors for global health and achieving the Sustainable Development Goals, so it’s imperative they have the skills to work effectively wherever they are in the world.

Currently 700,000 people die of resistant infections every year with experts estimating this number to increase to 10 million by 2050 if we do not slow down the rise of resistance.  Consequently, hundreds of millions of pounds (e.g. the Fleming Fund, the Wellcome Trust, and Nesta’s Longitude Prize) are being invested to solve this superbug crisis.

The UK Public Health Rapid Support Team (UK-PHRST) is a group of public health experts, scientists, academics and clinicians ready to support countries around the world responding to disease outbreaks. The UK-PHRST is partnership between the London School of Hygiene & Tropical Medicine and Public Health England, with University of Oxford and King’s College London as academic partners.

TB killed 1.7 million people in 2016 – about three a minute – and it shows few signs of slowing, despite the availability of the BCG vaccine and a generally effective drug regimen. The problem of TB eradication is simple: as long as poverty continues to flourish, so will TB.

The West African Ebola outbreak of 2014-16 was a terrifying, murderous rampage that ticked almost every box on the ‘bad’ column, yet surprisingly enough, it ticked some ‘good’ boxes, too. It taught the world how truly interconnected our health is and that we must do a better job in protecting health globally so that we can better protect health locally.

Malaria spreads with dizzying efficiency. In infectious disease theory, the R0 describes how many people someone with a disease will infect: more than one and the disease will spread, fewer than one and it will die out. The R0 of the Ebola virus during the 2015 outbreak in West Africa was estimated to be between two and three. Estimates for the R0 of malaria in Africa vary from fewer than one to more than 3000.

Multi drug-resistant TB is now found in almost all countries around the world. Even worse, incurable TB with resistance to all the locally available drugs has been reported in several countries, including countries with a high burden of disease such as India and South Africa. Complete resistance to the cocktail of antibiotics used to treat TB is an alarming and realistic prospect. What can be done?

The cramped Rohingya refugee camps in Bangladesh are the perfect environment for the transmission of respiratory infections such as diphtheria. It’s no surprise that the disease, which can cause airway obstruction, damage the heart and sometimes cause death, has been sweeping through these camps for a few months now.