Wednesday, April 27, 2022

Researchers scour Twitter to analyze public attitudes about COVID-19 vaccinations

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS CHICAGO

A new study from the University of Illinois Chicago examines key themes and topics from almost three million COVID-19 vaccine-related tweets posted by individuals and explores the trends and variations in public opinions and sentiments about vaccines and vaccination programs.

Covering four months of the pandemic, Jan. 1 to April 30, 2021, the researchers used topic modeling to explore the themes and topics underlying the tweets, and used sentiment analysis to compute sentiment scores and examine weekly trends. Their findings can be found in the journal JMIR Infodemiology.

“Our study is uniquely positioned and differs from many other similar studies, as we capture and use the tweets made by the general public, excluding those made by news outlets and other organizations,” said the study’s lead author Ranganathan Chandrasekaran, professor of information and decision sciences in the College of Business Administration and professor of biomedical and health information sciences in the College of Applied Health Sciences. “We have identified changes in public attitudes towards vaccination, key concerns about vaccination, reasons behind vaccine hesitancy and poor uptake of vaccines by certain groups.”

Some of the key findings include:

  • The most-tweeted topic about COVID-19 vaccination was related to vaccination policy, specifically, whether vaccines needed to be mandated or optional (13.94%), followed by vaccine hesitancy (12.63%) and post-vaccination symptoms and effects (10.44%).
  • The proportion of positive or overly positive tweets was always greater than that of negative or overly negative tweets in all of the weeks examined. Overall, 41.62% of the tweets had a positive sentiment, 31.16% had a negative sentiment and 27.22% had neutral sentiment scores.
  • A large proportion of tweets about post-vaccination symptoms and side effects (40-45%) and those about conspiracy/hoax (35-45%) had negative or overly negative sentiments in all weeks of the examination. In contrast, greater proportions of tweets about vaccination disclosure (35-40%), vaccine efficacy (45-55%), clinical trials and approvals (30-40%), vaccine affordability (30-35%), vaccine regulation (30-35%), travel (35-45%), opinion leaders and endorsement (30-50%), and gratitude to health care workers (30-45%) carried positive or overly positive sentiments throughout the 16-week period of research.

The researchers’ qualitative analysis provided some preliminary insights into the reasons behind vaccine hesitancy, such as the shorter duration of the vaccine development cycle, concerns about the effectiveness of the vaccine in controlling the virus and its variants, and general mistrust of the pharmaceutical and medical industries and governments.

This type of research based on social media data can provide rich insights for policymakers and health officials to frame appropriate policies and programs for COVID-19 vaccination and accelerate vaccine uptake by the general public, according to the researchers.

Co-authors of the study are Rashi Desai, Harsh Shah and Vivek Kumar of UIC, and Evangelos Moustakas of Middlesex University.

The work was partly funded by the UIC College of Business Administration’s Summer Research Grant Program.


New study shows fewer people die from covid-19 in better vaccinated communities

Deaths more than 80% lower in communities with high vaccination coverage

Peer-Reviewed Publication

BMJ

A large US study published by The BMJ today finds that fewer people die from covid-19 in better vaccinated communities.

The findings, based on data across 2,558 counties in 48 US states, show that counties with high vaccine coverage had a more than 80% reduction in death rates compared with largely unvaccinated counties.

This large benefit complements the growing body of evidence indicating individual level benefits of covid-19 vaccination. A linked editorial also proposes that encouraging people to keep up to date with vaccination saves lives.

As of 11 April 2022, more than 11 billion covid-19 vaccine doses have been administered globally and the World Health Organization’s target is to vaccinate 70% of the world’s population by mid-2022.

Yet while previous vaccine studies have shown benefits at the individual level, the wider population level impact of scaling up covid-19 vaccination remains largely unknown.

To address this, researchers at the US Centers for Disease Control and Prevention (CDC) set out to estimate how increasing county coverage of vaccines affected population level mortality and incidence of covid-19.

Their findings are based on more than 30 million cases of covid-19 and over 400,000 deaths linked to covid-19 across 2558 counties, which were reported during the second year of the pandemic, between December 2020 and December 2021.

They measured effectiveness by comparing reported covid-19 incidence and mortality rates in counties with very low (0-9%), low (10-39%), medium (40-69%), and high (70% or more) vaccination coverage - defined as the percentage of adults (aged 18 and over) who had received at least one dose of a covid-19 vaccine.

After taking account of potentially influential factors, the researchers found that increased vaccination coverage in counties was associated with reduced levels of covid-19 related mortality and cases.

For example, during the first half of 2021, when the alpha variant of coronavirus was dominant, the covid-19 mortality rate was reduced by 60%, 75%, and 81% in counties with low, medium, and high vaccination coverage, respectively, compared with counties that had very low coverage.

The corresponding figures for the reduction in cases were 57%, 70%, and 80%.

Similar reductions in mortality were also seen during the second half of 2021 when the delta variant became dominant in the US, although with smaller effects on case levels.

This is an observational study, so can’t establish cause and the researchers say several limitations should be considered when interpreting these data. For example, additional markers of severe disease, such as hospital admissions, were not explored and they did not control for factors such as rules on wearing a face mask masking and physical distancing at the time, which may have affected their results.

Nevertheless, they point out that results were similar after further sensitivity analyses, suggesting that they withstand scrutiny. And they say: “Future research may benefit from evaluating macroeconomic effects of improving population health, such as changes in employment rates and gross domestic product resulting from reopening society.”

This study adds to the evidence that vaccination can prevent infection and illness on a large scale, writes Professor Christopher Dye at the University of Oxford in a linked editorial.

“The findings of this study also make clear that many more lives could have been saved, and will be saved, by encouraging people to keep up to date with vaccination in the face of waning immunity and new coronavirus variants and by achieving even higher population coverage,” he adds.

“How many lives is a matter for others to explore. Meanwhile, this new study is another confidence booster for covid-19 vaccines,” he concludes.
[Ends]

Loneliness leads to higher risk of future unemployment, study finds

Experiencing loneliness appears to lead to a higher risk of future unemployment, according to new research.

Peer-Reviewed Publication

UNIVERSITY OF EXETER

Experiencing loneliness appears to lead to a higher risk of future unemployment, according to new research.

Previous research has established that being unemployed can cause loneliness, however the new study from the University of Exeter is the first to directly explore whether the opposite also applies across the working age population. Published in BMC Public Health, the study found that people who reported “feeling lonely often” were significantly more likely to encounter unemployment later. Their analysis also confirmed previous findings that the reverse is true – people who were unemployed were more likely to experience loneliness later.

Lead author Nia Morrish, of the University of Exeter, said: “Given the persisting and potentially scarring effects of both loneliness and unemployment on health and the economy, prevention of both experiences is key. Decreased loneliness could mitigate unemployment, and employment abate loneliness, which may in turn relate positively to other factors including health and quality of life. Thus, particular attention should be paid to loneliness with additional support from employers and government to improve health and wellbeing. Our research was largely conducted pre-pandemic, however we suspect this issue may be even more pressing, with more people working from home and potentially experiencing isolation because of anxieties around covid.”

The research analysed largely pre-pandemic data from more than 15,000 people in the Understanding Society Household Longitudinal Study. The team analysed responses from the participants during 2017-2019, then from 2018-2020, controlling for factors including age, gender, ethnicity, education, marital status, household composition, number of own children in household and region.

Senior author Professor Antonieta Medina-Lara said: “Loneliness is an incredibly important societal problem, which is often thought about in terms of the impact on mental health and wellbeing only.  Our findings indicate that there may also be wider implications, which could have negative impacts for individuals and the economy. We need to explore this further, and it could lay the foundations for employers or policy makers to tackle loneliness with a view to keeping more people in work.”

Paper co-author Dr Ruben Mujica-Mota, Associate Professor of Health Economics in the University of Leeds’ School of Medicine, said: “While previous research has shown that unemployment can cause loneliness, ours is the first study to identify that lonely people of any working age are at greater risk of becoming unemployed. Our findings show that these two issues can interact and create a self-fulfilling, negative cycle. There is a need for greater recognition of the wider societal impacts of loneliness in the working age population.”

The paper is entitled ‘Understanding the effect of loneliness on unemployment: propensity score matching’, published in BMC Public Health. The research involved collaboration with Leeds University.

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Talk therapy may alleviate depression and improve quality of life for people with dementia

Peer-Reviewed Publication

UNIVERSITY COLLEGE LONDON

Feelings of anxiety and depression are common in people living with dementia and mild cognitive impairment, but the best way to treat these symptoms is currently unknown, as medicines often used to treat these symptoms may not be effective for people with dementia and may cause side effects.

The findings of the new and updated Cochrane Review paper are important because it is the first review showing that psychological interventions (talking therapies) are effective and worthwhile in the context of ineffective drugs for depression in dementia. The review also shows they may provide additional benefit in terms of improving patient quality of life and everyday function.

The researchers are calling for clinical guidelines for dementia to be revised to recommend psychological therapies and specifically Cognitive Behavioural Therapy (CBT).

Lead author Dr Vasiliki Orgeta (Associate Professor at UCL Psychiatry) said: “We currently have no standard treatments for depression for people with dementia, as antidepressants do not work for them. Yet, despite the lack of supporting evidence, they are still prescribed for many people living with dementia, which is an important problem given that more and more evidence is accumulating suggesting that not only they do not improve symptoms, but they may increase risk of mortality.”

“Previous evidence into the clinical effectiveness of psychological treatments has been limited. Reporting on the most up to date evidence, we found that these treatments, and specifically those focusing around supporting people with dementia to use strategies to reduce distress and improve wellbeing, are effective in reducing symptoms of depression.”

People with dementia are twice as likely as other people their age to be diagnosed with a major depressive disorder. Studies have estimated that 16% of people with dementia experience depression, but this may be as high as 40%, so there is a great need for effective treatments. Depression and anxiety can also increase the severity of the neurological impairment itself, thus reducing independence and increasing the risk of entering long-term care.

Dr Orgeta added: “Our findings break the stigma that psychological treatments are not worthwhile for people living with cognitive impairment and dementia, and show that we need to invest in more research in this area and work towards increasing access to psychological services for people with dementia across the globe. We want people who experience cognitive impairment and dementia to have the same access to mental health treatments as everyone else.”

The paper, published by the Cochrane Library as part of their database of systematic reviews, incorporated evidence from 29 trials of psychological treatments for people with dementia or mild cognitive impairment, including close to 2,600 study participants in total.

The psychological interventions varied somewhat, including CBT and supportive and counselling interventions, but were generally aimed at supporting wellbeing, reducing distress, and improving coping.

The review shows that psychological treatments for people with dementia may improve not only depressive symptoms but several other outcomes, such as quality of life and the ability to carry out everyday activities. Although more research is needed, the study found that these treatments may also improve depression remission. The authors say the potential of improving many outcomes with one psychological intervention may be highly cost-effective and could be key to improving quality of life and wellbeing for people with dementia.

The authors judged the evidence to be of moderate quality overall; this means it is of high enough quality to warrant clinical recommendations to support the use of psychological therapies. They say that larger studies are needed, as they may be able to identify a more substantial effect.

Co-author Dr Phuong Leung (UCL Psychiatry) said: “There is now good enough quality evidence to support the use of psychological treatments for people with dementia, rather than prescribing medications, and without the risk of drug side effects. What we need now is more clinicians opting for talk therapies for their patients and commitment to funding further high-quality research in this area.”

Dr Orgeta added: “Pharmacological treatments in dementia have been prioritised in trials for many years, as a result they benefit from more investment, so it will be important to invest more in studying psychological treatments. There is a need for novel treatments, specifically developed alongside people with dementia, their families, and those contributing to their care.”

The review was conducted by researchers from UCL, University of Nottingham, Universidad de Jaén, and Salford Royal NHS Foundation Trust, and was supported by the National Institute for Health Research.

Language that belittles or blames patients is overdue for change

Working to change medical language is not for political correctness, but to improve shared-decision making, say experts

Peer-Reviewed Publication

BMJ

Medical language that casts doubt, belittles, or blames patients for their health problems continues to be commonly used in everyday clinical practice, but is outdated and overdue for change, argue experts in The BMJ today.

Caitríona Cox and Zoë Fritz at the University of Cambridge draw on existing research to describe how such language, while often taken for granted, can insidiously affect the therapeutic relationship by altering the attitudes of both patients and physicians. They suggest how it could be changed to foster a relationship focused on shared understanding and collective goals.

Language that belittles patients includes the widely used term “presenting complaint” rather than referring to a patient’s reason for engaging with healthcare, they write. Similarly, use of words such as “denies” and “claims” when reporting a patient’s account of their symptoms or experiences, suggests a refusal to admit the truth, and can hint at untrustworthiness. 

Other frequently used language renders the patient as passive or childlike, while emphasising the doctor’s position of power, they add. For example, doctors “take” a history, or “send” patients home.

The terms “compliance” and “non-compliance” (in relation to taking medication) are also authoritarian, and they suggest that doctors should focus on changing their language to instead focus on reasons why patients might not be taking prescribed medications, promoting a more collaborative doctor-patient relationship.

Patients too have objected: “Being described as ‘non-compliant’ is awful and does not reflect the fact that everyone is doing their best.”

Language that implicitly places the blame on patients for poor outcomes is also problematic, argue Cox and Fritz. For instance, the term “poorly controlled” in conditions such as diabetes or epilepsy can be stigmatising and make patients feel judged, while “treatment failure” suggests that the patient is the cause of the failure, rather than the limitations of the treatment or the doctor.

Research shows that specific word choices and phrases not only affect how patients view their health and illness but also influence doctors’ attitudes towards patients and the care and treatments offered, they explain.

For example, a study of neutral language with language implying patient responsibility (not tolerating oxygen mask v refuses oxygen mask), showed that the non-neutral term was associated with negative attitudes towards the patient and less prescribing of analgesic medication.

The authors note that using the right language “is not a matter of political correctness; it affects the core of our interactions” and say research is now needed to explore the impact that such language could have on patient outcomes.

Much of the language highlighted here is deeply ingrained in medical practice and is used unthinkingly by clinicians, they write. Clinicians should consider how their language affects attitudes and choose language that facilitates trust, balances power, and supports shared decision making.

[Ends]

2 out of 3 women with depression or anxiety say they’ve reached their “breaking point,” yet more than half wait a year before seeking treatment


Six in 10 of the women surveyed with depression or anxiety diagnosis say they have been ignored or dismissed by family, friends, and/or partners about their mental health concerns


Reports and Proceedings

GENESIGHT

News Package 

VIDEO: A NEW NATIONAL SURVEY, THE GENESIGHT MENTAL HEALTH MONITOR, FOUND THAT WHEN FEELING OVERWHELMED, WOMEN SAY THEY “JUST NEED TO TAKE A BREAK,” WITH NEARLY A THIRD BELIEVING THEY JUST NEED TO TRY HARDER. TWO THIRDS OF WOMEN WITH DEPRESSION AND ANXIETY SAY THEY ARE REACHING A BREAKING POINT WITH REGARD TO THEIR MENTAL HEALTH, YET MANY ARE WAITING A YEAR OR MORE TO SEEK TREATMENT — IF THEY EVER DO. THIS BREAKING POINT CAN INCLUDE A NEGATIVE IMPACT OR A SIGNIFICANT STRAIN ON ANYTHING FROM SOCIAL LIFE OR CARING FOR LOVED ONES AT HOME TO PROFESSIONAL WORK. FOUR OUT OF 10 WOMEN NOT DIAGNOSED WITH DEPRESSION OR ANXIETY ALSO SAY THEY HAVE REACHED OR ARE REACHING THIS POINT. view more 

CREDIT: GENESIGHT MENTAL HEALTH MONITOR

Two out of three women diagnosed with depression or anxiety say they have reached or are approaching their breaking point regarding their mental health, according to the GeneSight® Mental Health Monitor, a new nationwide survey from Myriad Genetics, Inc. (NASDAQ: MYGN). 

This breaking point can include a negative impact or a significant strain on anything from social life to caring for loved ones at home to professional obligations. Four out of 10 women without a diagnosis of depression or anxiety say they have reached or are reaching this point. 

When feeling overwhelmed, nearly three in four (72%) of women say they "just need to take a break,” with 31% believing “I need to try harder.” Only 13% said they thought “I should see a doctor” when feeling overwhelmed. 

“Women often feel pressure to ‘hold it all together’ and not admit when they are struggling,” says Dr. Betty Jo “BJ” Fancher, a family medicine and psychiatric physician assistant with a doctorate of medical science and a masters in psychopharmacology. “Yet, if you are sobbing on the floor of your shower, throwing things in anger or repeatedly screaming into a pillow, these are signals that you have crossed a line and should see a healthcare provider about your mental health.” 

Delaying mental health treatment is common among the women surveyed. In fact, more than half (51%) of women diagnosed with anxiety and/or depression waited at least one year before seeking treatment – or never sought treatment at all.

“The GeneSight Mental Health Monitor found that women are waiting more than a year – longer than a pregnancy – to get the mental health treatment they need,” noted Rachael Earls, PhD, a medical science liaison with Myriad Genetics, makers of the GeneSight test. “Pregnant women don’t go a year without pre-natal care to protect their or their baby’s health. Why live with a mental health condition that can impact every aspect of your life until you reach a breaking point?” 

According to the survey, the top reasons women diagnosed with depression or anxiety delayed treatment are:

  • “I thought it was ‘just a phase’ or that I could get over it on my own” (60%) 
  • “I didn’t want anyone to know I was struggling” (50%)
  • “I didn’t want to take medication” (31%)
  • “I couldn’t afford treatment” (26%)
  • “I didn’t have health insurance” (19%)
  • “I didn’t have time to seek treatment” (18%)

Will my concerns be validated or ignored?

The reluctance by some women to seek treatment may be rooted in how their mental health concerns have been received by family and friends.

Six in 10 of the women surveyed with depression or anxiety diagnosis say they have been ignored or dismissed by family, friends, and/or partners about their mental health concerns. Less than half of women (44%) say they talk to friends or family to relieve stress and anxiety.

“I have friends who won’t talk to their parents about how they are struggling because they are afraid of their parents’ reaction,” says Ansley, daughter of Dr. Fancher and a senior at the University of Georgia, who has been diagnosed with depression, anxiety and ADHD. “Therapy has helped me, so I know the benefits of talking to someone about your mental health. When friends or classmates say they are suffering with depression or anxiety, I encourage them to reach out to someone and get the help they need.”

Despite available treatment options, fewer than two in 10 women believe they will ever be free from anxiety or depression symptoms. 

CAPTION

Ansley Fancher can relate to the two thirds of women polled in the new GeneSight Mental Health Monitor nationwide survey who say they are at or near their breaking point. After trying to manage her depression and anxiety on her own, she began therapy and took the GeneSight test, which helped inform her clinician’s medication treatment decision. She is now studying to become a psychologist to help others with mental health needs.

CREDIT

GeneSight Mental Health Monitor


Getting personalized treatment

Six in 10 women diagnosed with depression or anxiety agree that taking a prescription medication was the most helpful step in treating their anxiety or depression symptoms, more than any other action or treatment option offered in the survey, including therapy.

Only about 30% of women who have been prescribed psychiatric medication are aware of genetic testing that may help their physicians with prescribing decisions – and only 8% of these respondents have had genetic testing. Yet, 67% of diagnosed women whose doctor did not use genetic testing said they wish their doctor had told them about and/or offered a genetic test that could provide information about how their genes may affect medication outcomes.

Dr. Fancher orders the GeneSight test to get personalized genetic information about her patients that helps her understand how they may metabolize or respond to certain medications commonly used to treat depression, anxiety, ADHD and other mental health conditions. 

“Having the genetic information from the GeneSight test at my fingertips to help inform my medication selection makes me a better provider,” said Dr. Fancher. 

Ansley’s mental health provider also uses the GeneSight test. “She made adjustments based on my results, and I am happy to say that everything is working really well,” said Ansley. 

For more information on how genetic testing can help inform clinicians on treatment of depression, anxiety, ADHD, and other psychiatric conditions, please visit GeneSight.com. To download graphics, a multimedia video and other information regarding the survey, please visit GeneSight.com/Mental-Health-Monitor.

CAPTION

Mental health clinician BJ Fancher, DMSc, helped her own daughter, Ansley, find a clinician to treat her anxiety. Now, both are trying to encourage women to be more open about their mental health issues and more receptive to seeking treatment.

CREDIT

GeneSight Mental Health Monitor



About the GeneSight® Mental Health Monitor
The GeneSight Mental Health Monitor is a nationwide survey of U.S. adults conducted online by ACUPOLL Precision Research, Inc. from Feb. 25 – March 11, 2022, among a statistically representative sample (n=1000) of adults age 18+. The survey included a representative sample of women diagnosed with depression and anxiety. The margin of error in survey results for the total base population at a 95% confidence interval is +/- 3%.

About the GeneSight Test
The GeneSight Psychotropic test from Myriad Genetics is the category-leading pharmacogenomic test for 64 medications commonly prescribed for depression, anxiety, ADHD, and other psychiatric conditions. The GeneSight test can help inform clinicians about how a patient’s genes may impact how they metabolize and/or respond to certain psychiatric medications. It has been given to more than 1.5 million patients by tens of thousands of clinicians to provide genetic information that is unique to each patient. The GeneSight test supplements other information considered by a clinician as part of a comprehensive medical assessment. Learn more at GeneSight.com.

About Myriad Genetics
Myriad Genetics is a leading genetic testing and precision medicine company dedicated to advancing health and well-being for all. Myriad discovers and commercializes genetic tests that determine the risk of developing disease, assess the risk of disease progression, and guide treatment decisions across medical specialties where critical genetic insights can significantly improve patient care and lower healthcare costs. Fast Company named Myriad among the World’s Most Innovative Companies for 2022. For more information, visit www.myriad.com.

Myriad, the Myriad logo, BRACAnalysis, BRACAnalysis CDx, Colaris, Colaris AP, MyRisk, Myriad MyRisk, MyRisk Hereditary Cancer, MyChoice CDx, Prequel, Prequel with Amplify, Amplify, Foresight, Precise, FirstGene, Health.Illuminated., RiskScore, Prolaris, GeneSight, and EndoPredict are trademarks or registered trademarks of Myriad Genetics, Inc. or its wholly owned subsidiaries in the United States and foreign countries.

THE LANCET: Global child and adolescent health targets in jeopardy without urgent, comprehensive reform, experts warn


Peer-Reviewed Publication

THE LANCET

LONG READ

Peer-reviewed/ Review, Analysis, and Opinion/ People

  • With 8.6 million deaths reported globally among stillbirths, children, and adolescents up to 20 years of age in 2019, achieving targets to reduce child and adolescent mortality by 2030 remains a global challenge.
  • Economic inequality continues to drive disparities in health outcomes, with children who face early life poverty being at least twice as likely to experience detrimental health outcomes compared to children at the top of the wealth spectrum.
  • COVID-19 has worsened global inequalities and threatens to reverse recent gains made to improve maternal, child, and adolescent health as children and families face interrupted health and social services and economic strain.
  • A new Lancet Series provides abundant scientific evidence to support a holistic agenda for children and adolescents that spans maternal, newborn, child, and adolescent health, offering comprehensive social and health support from preconception through age 20. 

Despite recent progress, the world is at risk of failing to meet child and adolescent health targets, with more than 8.6 million deaths among children and adolescents (aged 0-20 years) recorded in 2019. Comprehensive, coordinated care that begins at preconception and lasts through adulthood is urgently needed to reduce childhood mortality and improve child and adolescent health, according to a new Series published in The Lancet.

The authors of the Lancet Series on optimising child and adolescent health and development call on global leaders and policymakers to replace current approaches to child and adolescent health, which are often fragmented by age groups or specific health conditions, to offer comprehensive care that spans nutrition, preventive health, education, economic, and community support across age groups from preconception through age 20.

The new collection of papers also highlights how the COVID-19 pandemic has disrupted health and education services as well economies and social systems, putting recent progress toward achieving the United Nations’ Sustainable Development Goals (SDGs) [1] in jeopardy and increasing children’s vulnerability to violence, abuse, and mental health conditions.

“The challenges faced in responding to the needs of children and families during the COVID-19 pandemic should serve as a wake-up call to the global community, underlining the urgent need to transform the child and adolescent health agenda on a global scale,” says Series coordinator and author Dr Zulfiqar Bhutta from The Hospital for Sick Children (SickKids) Centre for Global Child Health, Toronto (Canada) and the Aga Khan University, Karachi (Pakistan). [2]

Bhutta adds, “We have less than eight years to meet the UN’s Sustainable Development Goals, and many child and adolescent health targets are off track. A holistic approach that supports children and their families from before birth through early adulthood is urgently needed to bring us back in line, building a foundation that will last a lifetime and improve health outcomes, economies, and society.” [2]

A holistic approach to child and adolescent health from preconception through age 20

The probability of mortality in the first five years of life is a commonly used indicator of human capital [3] and country progress. However, this indicator only provides a narrow view of child health and development.

Instead, Series authors considered conditions of survival, growth, disability, and education across different world regions and their effects on crucial life stages from the third trimester of pregnancy to 20 years of age. In this age range, there were 8.6 million deaths in 2019. Of these deaths, 1.9 million (23 %) were stillbirths and 2.4 million (28%) were neonatal deaths. Additionally, 2.75 million (32%) children died between one month and five years of age. Among older children and adolescent deaths, 506,000 (6%) occurred among five-to-nine-year-olds, 368,000 (4%) deaths occurred among 10–14-year-olds, and 595,000 (7%) deaths occurred among 15–19-year-olds.

“By looking at mortality and nutrition from the third trimester of pregnancy until age 20, we can have a more complete understanding of child and adolescent health. Our analysis clearly indicates that the first two years of life are crucial indicators of future health, but that age range is only one piece of the puzzle,” says study author Professor Robert Black from the Johns Hopkins Bloomberg School of Public Health, Baltimore (USA).

“Interventions such as improved nutrition during pregnancy and infanthood work in tandem with education and social support networks that reach children and families across a broad range of interventions, from offering mothers’ care during pregnancy to providing mental health and reproductive health services to adolescents,” adds study author Tyler Vaivada from the Centre for Global Child Health, Toronto (Canada).

Strong health and social systems must come together to support all children

Preconception, pregnancy, and infant interventions that address child survival and nutrition have a strong influence on weight, height, and development, and serve as key indicators of future health, nutrition, education level, and intelligence quotients – if they are delivered at high level of quality.

However, these interventions must be scaled up and continued through early childhood and adolescence via school-based and community delivery platforms, where children and families can have consistent access to immunisations and screening programmes to address often neglected areas of child health such as anaemia, vision, dental conditions, non-communicable diseases, neglected tropical diseases, and mental health conditions (including anxiety and depression).

Building on this analysis, the Series authors point out that to maximize children’s health, strong health systems need to partner with equally effective social systems such as schools, communities, families, and digital platforms that offer promotive, preventive, and curative services relevant to a child’s life stage.

“Although scaling up high quality health facility-based interventions in children younger than five years will have the greatest effect on reducing child mortality rates, we also have to engage with families to boost children’s development and think beyond the clinic to schools and communities to reach older children whose health needs have been relatively neglected,” says Dr Margaret Kruk from the Harvard Chan School of Public Health, Boston (USA).

The authors also point out the growing challenges older children and adolescents face because of the COVID-19 pandemic, including the lack of social support and the mental health effects such as feelings of isolation, loneliness, and anxiety.

“The COVID-19 pandemic showed us the devastating effects that gaps in care and education can have on children. Health and social systems must be better equipped to work together to address the emerging needs of children and families as part of the effort to rebuild equitable and resilient services,” says Professor Maureen Black from RTI International and the University of Maryland, Baltimore (USA).

Overcoming long-term effects of early life poverty

An analysis of data from 95 national surveys in low and middle income countries (LMICs) [4] confirms that vast economic inequalities persist both between and within countries, with strong connections between early-life poverty and health, nutrition, and cognitive development of children and adolescents.

Of the countries included in the analysis, children at the lowest end of the wealth spectrum had at least double the risk of detrimental health outcomes linked to early life poverty, such as childhood mortality, stunting, development delays, teenage motherhood, and incomplete primary school compared to children at the top of the wealth spectrum. Furthermore, the magnitude of inequality in child mortality, nutrition, and development was positively associated with the degree of economic inequality.

The authors also analysed data from six long-running birth cohorts in LMICs [5] to observe specific effects of early life poverty. The most striking differences were observed in intelligence quotients examined in two different cohorts from Pelotas, Brazil, where children and adolescents at the top of the wealth scale scored 20 points higher compared to children at the bottom of the scale. These disparities were also observed in children younger than five years of age, indicating that while overall differences in access to school likely played a role in cognition scores, environmental factors linked to poverty from early childhood (such as nutrition, childhood illness, and living in a conflict zone) have a large impact starting in gestation and continuing throughout childhood and adolescence.

“The COVID-19 pandemic has exacerbated the factors that already drive early-life poverty,” says, Dr Cesar Victora from Pelotas University (Brazil). “However, as pandemic recovery programmes are developed, policymakers have an unprecedented opportunity to strengthen existing anti-poverty policies and create new, multisectoral programmes that will work with health and nutrition interventions to offset the pandemic’s impact on women and children.”

Placing children and adolescents at the centre of the global policy agenda

The long-term impact of the COVID-19 pandemic on children and families is not yet fully known. However, evidence suggests that disruptions caused by the pandemic, particularly in children’s access to preventive health services and education, are likely to result in excess mortality and morbidity for infants, children, and adolescents – undermining hard-fought gains in recent years.

Writing in a linked Comment, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Catherine Russell, Executive Director of UNICEF (who were not involved in the Series), say, “At this especially perilous moment in history, with conflict and fragility around the world, all countries need to prioritise child and adolescent health, and tailor health and multisectoral programmes to meet their needs and risk factors. This is the time for governments, donors, and institutions to come together not only to end the pandemic, but also to prevent future ones, fix long-standing structural deficiencies in fragile health systems including strengthening the health workforce, and address the social and environmental determinants of health that put children at risk. It is time for solidarity to triumph over politics, for the sake of our children and future generations. Failure to do so could result in close to 21 million children and adolescents aged 5–24 years and 43 million children under-five years dying before 2030. This prospect is unconscionable and unnecessary, because as seen in this Lancet Series, stakeholders know what needs to be done so that every child, everywhere, can survive and thrive.”

Dr Richard Horton, Editor-in-Chief for The Lancet, adds, “The most extraordinary success story in global health’s recent history has been the rapid decline in deaths of children younger than 5 years…[But] the frightening truth is that despite all the lives saved, millions of children are still dying of preventable causes. Those who survive remain unable to reach their full potential…[We] need political commitment. We need the leaders of multilateral agencies, governments, and civil society to step up to the challenges this Series lays out and the opportunities it describes.”

NOTES TO EDITORS

A full list of funders, authors, and institutions is available in the papers.

[1] United Nations Sustainable Development Goals: https://sdgs.un.org/goals
[2] Quote direct from author and cannot be found in the text of the Article.
[3] The World Bank’s Human Capital Project uses the Human Capital Index, which includes measures of mortality, growth, and education, to assess how countries invest in the capabilities and economic potential of citizens. https://www.worldbank.org/en/publication/human-capital
[4] These countries included 28 (90%) of 31 low-income countries, 37 (79%) of 49 lower-middle-income countries, and 30 (50%) of 60 upper-middle-income countries.
[5] The six cohorts included populations from Cebu, Philippines; Delhi, India; Guatemala City, Guatemala; Pelotas, Brazil (1982 birth cohort and 1993 birth cohort); and Soweto, South Africa

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