Lancet

In the far future, when the human species is extinct and every ruin has long since crumbled, the last remaining sign of our civilisations might well be a distinct layer of plastics in the geological strata. The Anthropocene can be defined by plastic: cheap, convenient, incredibly durable, and endlessly adaptable, it is a wonder material. There is much good that comes from plastic. 21st century medicine would be unimaginable without it: from intravenous tubes to gowns; syringes to catheters. Plastics have become integral to modern life.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 Causes of Death Collaborators analysed cause-specific mortality and years of life lost for 288 causes by age and sex across 204 countries and territories from 1990 to 2021.1 Compared with previous GBD studies, their analysis included both COVID-19 and a novel indicator, other pandemic-related mortality (OPRM), and the effect of each on life expectancy.1 Overall, life expectancy increased by 6·2 years from 1990 to 2021.1 The gradual increase was followed by a global shock.

The latest round of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has landed, delayed due to the COVID-19 pandemic but now including COVID-19 in its estimations. One can think of burden of disease studies, and GBD in particular, as having three overarching goals: to estimate the present burden (ie, the disability-adjusted life years [DALYs] by sex and age in every country, for the current year—2021 in this round of GBD) and in the recent past;1 to attribute the DALY burden by 88 risk factors that contributed to it (eg, smoking and indoor air pollution);2 and to forecast what the DALY burden might be in the future under business-as-usual and various scenarios.

In their study published in The Lancet, the GBD 2021 Forecasting Collaborators1 assessed cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) from 2022 to 2050 for 204 countries and territories under five scenarios—a reference scenario (the most likely future, based on historical trends) and alternative scenarios in which certain risk factors are eliminated by 2050 (Safer Environment scenario, Improved Childhood Nutrition and Vaccination scenario, Improved Behavioural and Metabolic Risks scenario, and a combination of these three scenarios).

The science of global health offers reasons for great confidence about the future for human wellbeing. Implementation of the RTS,S/AS01 malaria vaccine into routine immunisation programmes is predicted to have a significant impact on child mortality. Studies suggest that hospital admissions among children with severe malaria will be cut by up to a third. A second malaria vaccine, R21/Matrix-M, is already licensed in several African countries. It has even higher protective efficacy: over 75%. Mother-to-child transmission of HIV is on the verge of being eliminated.

A key driver of advances in childhood survival over the past half-century, the EPI faces fresh challenges in protecting the most vulnerable. Udani Samarasekera reports.

Opposition parties promise to increase health spending, while the ruling National Democratic Alliance plans to continue existing policies. Dinesh C Sharma reports.

When Miriam Mutebi, the first female breast cancer surgeon in Kenya, jokes that she is “a breast cancer surgeon by day, and a health systems researcher by night”, it is only part jest—her workload is intense. Mutebi, who received the 2023 Global Health Catalyst Distinguished Leadership (LMIC) Award, is a breast surgical oncologist, health systems researcher, and Assistant Professor in the Department of Surgery at the Aga Khan University in Nairobi, Kenya, among many other roles. A passionate advocate for an inclusive, gender transformative approach in the treatment of breast cancer across Africa, she is a co-founder of the Pan African Women's Association of Surgeons (PAWAS) and the President of the African Organization for Research and Training in Cancer (AORTIC), where she is focused on advancing research and training and “enabling patients and community groups to be peer level partners to the African oncology research community”.

When I say eating disorders, what kind of person springs to mind? Probably not former international rugby union referee Nigel Owens, Olympic medallist Marilyn Okoro, comedian Dave Chawner, or public health professional Bayadir Mohamed-Osman. These are among the people who have contributed to Eating Disorders Don’t Discriminate: Stories of Illness, Hope and Recovery from Diverse Voices, co-edited by mental health doctor Chukwuemeka (Chuks) Nwuba and lived-experience advocate Bailey Spinn. The 31 personal essays in the book describe the multifaceted, unique experiences of individuals on their eating disorder recovery journeys.

In 1973, The Lancet's editors published an unlikely piece on “fingerprints and palmistry”. An image set out “ancient names for palmar creases and areas”. Perhaps more surprising was the distinction of its eminent author: Lionel Penrose, for many years Galton Professor at University College London (UCL) in London, UK. But what did fingerprints, palmistry, and hands have to do with his mathematical, genetic, and psychiatric expertise? Penrose would not have thought this question as peculiar as it sounds.

Infectious disease specialist and influential HIV/AIDS researcher. Born on July 17, 1934, in Paris, France, he died of heart failure on Feb 19, 2024, in Evanston, IL, USA, aged 89 years.

Chikungunya, a neglected viral disease transmitted by Aedes mosquitoes, which also carry dengue and yellow fever, has been identified in more than 110 countries across Asia, Africa, Europe, and the Americas.1 Although chikungunya typically results in low mortality, the disease can lead to prolonged illness and, in rare instances, complications, such as neurological disorders, eye inflammation, and heart issues.2 No specific treatment or vaccine is available, making prevention and symptomatic treatment the primary management strategies.

Sustainable immunisation financing is a global health issue of utmost concern that requires serious political attention and commitment from all countries. However, the efforts that many low-income and middle-income countries (LMICs), with persistently underfunded immunisation systems, are making to institute policy reforms that can stimulate more domestic immunisation financing are alarmingly passive. The COVID-19 pandemic exposed the gross level of unpreparedness of many countries to meet the needs of their people during external shocks (eg, unprecedented health emergencies), thus underscoring the importance of adequately funded and self-reliant health systems.

Urbanisation creates novel interfaces that facilitate cross-species transmission of emerging infectious diseases. Outwardly, so-called city encroachment into natural areas creates periurban interfaces between people, livestock, and wildlife. Inwards, companion animals are fully integrated into urban life, creating so-called animal encroachment into dwellings and novel human–animal interfaces, with the potential for complex urban multi-species transmission networks.

In the face of escalating biodiversity loss, the imperative role of comprehensive research and conservation strategies has never been more pressing. The National Biodiversity Future Centre (NBFC) in Italy stands at the forefront of tackling biodiversity loss, pioneering innovative approaches within the Mediterranean's biodiversity hotspot. In this Correspondence, we aim to highlight the pressing need for synchronised efforts in protecting our planet's biological wealth, which is fundamental to sustaining life as we know it.

We read the study published by Siow Ming Lee and colleagues1 with great interest. The authors concluded that atezolizumab monotherapy was associated with better outcomes for patients deemed ineligible for platinum-based chemotherapy. However, the study raised two substantial concerns regarding the heterogeneity of the study population and the single-agent treatment of the control group.

We read with great interest Siow Ming Lee and colleagues’1 study on the efficacy and safety of atezolizumab in patients with non-small-cell lung cancer. The research commendably addresses a broader demographic of lung cancer patients who are less commonly included in clinical trials compared with patients who have solid organ tumours.2 But an unmistakable concern arises: the grave under-representation of Black patients.

We read with interest the Correspondence from Jonathan Douxfils and colleagues regarding an increased risk of neoplasm with the neurokinin 3 receptor antagonist fezolinetant.1 However, important considerations warrant clarification.

We read the Correspondence by Genevieve Neal-Perry and colleagues on our analysis reporting an increased risk of neoplasm with the neurokinin 3 receptor antagonist fezolinetant. Their conclusion is in line with the US Food and Drug Administration (FDA) Clinical Review suggesting that the incidence rate of malignancy treatment emergent adverse events is within the normal background rate of cancer. However, the FDA document states that the background incidence rate of cancer for the age group 50–59 years is 0·56%.

Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP.