CNS: 2012

Tribute to Braveheart

As her violent demise stuns us into silence, and as we hang our head in shame, it also awakens our dead instincts into a quiet but determined uprising, demanding what should have been rightfully ours—a respectable place in society where the dignity of women is not violated day in and day out. We do not want lip sympathy from our impotent leaders, but concrete actions. What happened with the doughty woman (and continues to happen to scores of women every day in some part of the country or the other) must end once for all.

[हिंदी] Gender-sensitive judiciary and police administration, stronger laws, faster legal process to give judgement within six months, protection and social support for those sexually violated, were among some of the key demands getting the mandate of key discussants at the open forum on 'what needs to change in our laws in cases of sexual violence' organized at Ambedkar Mahasabha, opposite Lucknow Vidhan Sabha, by Humsafar - Support Centre for Women, National Alliance of People's Movements (NAPM), Asha Parivar, Lok Rajniti Manch and Socialist Party.

It is said that women who are addicted to cigarettes and other tobacco products are at increased health risks by reason of their biology. Since women biologically conceive and produce children, a coating of tar on their lungs, poisoning due to carbon monoxide or arsenic, or the chemicals that go into the making of a cigarette or a bidi, are more dangerous for them than for men. Pregnant women, who smoke, pass the carbon monoxide in their own blood directly into their unborn babies. Mothers who breastfeed their babies directly pass the nicotine and carbon monoxide to their suckling infants.

[हिंदी] The indefinite fast and demonstration in support of demands of farmers-labourers organized by Socialist Party jointly with National Alliance of People's Movements (NAPM), Lok Rajniti Manch, Hind Mazdoor Sabha, Rihai Manch, Special Teachers and Guardians Association, entered its fourth day today. Two social activists are on an indefinite fast: Dr Sandeep Pandey, Magsaysay Awardee and Vice President of Socialist Party; and Anil Mishra, social activist.

Photo credit: Rajeev Yadav

[हिंदी] Noted social activist and Magsaysay Awardee Dr Sandeep Pandey began an indefinite fast in support of demands of farmers and labourers of unorganized sector and underprivileged children on Sunday, 23rd December 2012 in Lucknow opposite Vidhan Sabha. One of the key demands is: Rs 440 daily minimum wage for labourers of unorganized sector. In last 20 years, although the wage of service class has gone up by twenty times, the wage of labourers of unorganized sector has hardly risen by three times. Just like the labourer is unable to get reasonable wage, the farmers too are unable to get the minimum support price for their crop.

A consultation, to draft a policy to correct the trend of declining sex ratio for the Indian state of Uttar Pradesh was organized by ActionAid and Saajhi Duniya. UP has a dismal sex ratio of 908 and a child sex ratio of 899, which is even worse than the corresponding national average of 940 and 914 respectively. "In UP the child sex ratio is continuously declining. There is a 17 point fall in the child sex ratio in the decade 2001-2011," said Professor (Dr) Roop Rekha Verma from Saajhi Duniya, who is also the former Vice Chancellor of Lucknow University. The main driver is undoubtedly deeply entrenched gender-based inequalities, and obvious culprit seem to be the healthcare personnel who perform sex selective abortions, in gross violation of the Pre conception and Pre Natal Diagnostic Techniques (Prohibition of Sex selection) Act (PCPNDT Act), and yet remain scot-free.

Tuberculosis (TB) is a leading killer of children, particularly in resource-poor settings, though the true size of the problem is unknown. Estimates of the number of children who contract TB annually range from 300,000 up to 1 million; more than 60,000 die each year but many deaths go unreported, especially in high-burden TB countries. Yet the the current TB drug regimens to treat them are inadequate. In 2010, the World Health Organization (WHO) revised its recommended dosages for first-line pediatric TB drugs. However, till today there are no TB drugs for children in the correct dosage forms. With a view to reshape market forces, and catalyze development to improve treatment and reduce mortality among children with TB, UNITAID has provided the Global Alliance for TB Drug Development (TB Alliance) a three-year grant to accelerate the availability of properly formulated pediatric TB regimens.

Even as the Delhi gang rape victim—a 23-year-old paramedical student--who was gang raped, tortured and thrown out from inside a moving bus on the night of 18th December, 2012--- lies in a critical condition on a ventilator support system and battles for her life at the Safdarjung hospital:
- TV channels vie with each other in crying hoarse over the condemnable incident;
- Member of Parliament Jaya Bachchan sheds tears in the Rajya Sabha for the girl;

In 2004, when the International Union Against Tuberculosis and Lung Disease (The Union) launched the Programme of Integrated HIV Care for TB Patients Living with HIV/AIDS (IHC), TB was already a leading killer of people with HIV, but antiretroviral treatment (ART) had just started to become available through the public health system in sub-Saharan Africa. The implementation of coordinated care was therefore in its infancy, and the opportunities for and challenges of treating the ‘two diseases, one patient’ within one health system were still being explored.

The Global Stop-TB eForum facilitated by Citizen News Service - CNS looked back at its archives to enlist key issues raised related to tuberculosis (TB) and online consultations it hosted in the year 2012. Over 1600 members from over 40 countries were part of this online information exchange with over 200 of them having their say in form of commentaries, in-depth articles, case studies, or other input.

During the last three decades, the World Health Assembly (WHA) agreed upon two interventions, which can have far reaching and lasting impacts on global health, if implemented (and not merely endorsed) in their true spirit and letter by the member states. The first one is The International Code of Marketing of Breastmilk Substitutes (The Code), which is an international public health recommendation to regulate the marketing of breastmilk substitutes.

This is one of the main findings of the Global Burden of Disease Study 2010 (GBD 2010) - a collaborative project conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to quantify the trends in the world’s health problems. The report will be formally released at the Royal Society in London on Dec. 14 and published in The Lancet, which has dedicated an entire triple issue to this massive systematic scientific study which was conducted by 486 authors from 50 countries, including 26 low- and middle-income countries.

Globally, nearly 7 million children under the age of 5 years die every year--two thirds of them before celebrating even their first birthday. Most of these deaths are due to preventable causes like pneumonia, diarrhea and new born respiratory infections and one third of all the under 5 deaths are related to maternal and child under nutrition. A simple intervention comprising early initiation (within the first hour of birth) of breastfeeding, that is continued exclusively for the first six months of life, and later supplemented by complementary feeding, can reduce neonatal mortality by as much as 20%. Yet more than 60% of the world’s infants are deprived of exclusive breastfeeding.

….to protect every feeding mother and her infant from man-made milk as babies need only the Mom-made one. This was the theme of the 1st World breastfeeding Conference 2012 which was hosted jointly in Delhi by the Breastfeeding Promotion Network of India (BPNI), International Baby Food Action Network (IBFAN), and World Alliance for Breastfeeding Action (WABA), in partnership with the Ministry of Women and Child Development, and the Ministry of Health and Family Welfare.

"Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths," is the theme for World AIDS Days between 2011 and 2015, in line with a new global vision being spearheaded by UNAIDS. Whether all countries, regardless of the size of their epidemic and level of development, will achieve this target is another issue all together. However, countries around the world are trying to work out ways of achieving the UNAIDS vision.

To increase issue-focussed reporting on tuberculosis, HIV and lung health in lead up to, during and post 43rd Union World Conference on Lung Health in Kuala Lumpur, Malaysia, the Citizen News Service - CNS was engaged in a range of communication initiatives around this event. Voices of affected communities were in the centre of what CNS did around this conference.

A lot has been bloated about Gujarat’s outstanding economic performance during Narendra Modi’s Chief Minister-ship. Many educated people believe in it too. By looking at the growth of the Net Domestic Product in the past five years, I show that this is a myth rather than reality. Several other states like Bihar, Haryana, Andhra Pradesh and Maharashtra have performed better than Gujarat. By looking at the whole picture, Gujarat’s performance on economic growth relative to other states can only be labeled as above-average. It cannot be called outstanding or spectacular by any yardstick.

As the rich countries are still recovering from the economic depression, health financing is surely one of the casualties. Everyone rightly wants most value for every penny spent and tuberculosis care and control is one of the smart investments countries can make when purse strings tighten. That is why perhaps the Stop TB Partnership has come up with an Operational Strategy for next three years (2013-2015) on how to implement the Global Plan to Stop TB by 2015 end with given human and financial resources.

Dr Manoon Leechawengwong, is the chairman of the Drug Resistant TB Research Fund at Thailand's Siriraj Foundation and is also the Immediate Past President of Thai AIDS Society-- His foundation is under the patronage of the King’s sister--The Royal Highness Princess Galyani Vadhana Krom Luang Naradhiwas Rajanagarindra. He recently spoke to Citizen News Service (CNS) in Bangkok about the rising problem of multidrug-resistant TB (MDR-TB) in Thailand.

An unregulated and greedy private sector and an inefficient and under- funded public sector in India generously allows its patients to choose between the devil and the deep seas. According to the National Family Health Survey-3, nearly two-thirds of all households (70% in urban and 63% in rural areas) in India generally seek health care from the private medical sector, while only one-third of households use the public medical sector. The most common reason given for not using public sector health care facilities is poor quality of the service, followed by non-availability of a facility nearby, long waiting time, and inconvenient hours of operation. This is a clear indication that India's public health delivery infrastructure fails to protect the interests of vulnerable groups.

Well, perhaps yes. While talking to Citizen News Service - CNS at the 43rd Union World Conference on Lung Health in Kuala Lumpur Mark Harrington, Executive Director of Treatment Action Group (TAG), wondered why we are doing better in responding to HIV, which was discovered only in 1981 and for which there was no effective treatment until 1996, while we are losing the battle against TB which was discovered in 1882 and the first drugs for it came in 1948. He rued the fact that we are falling short of meeting the targets for controlling TB and reducing mortality from TB by 50% by 2015 as compared to 1990.”

A world without asthma is the ultimate vision of the Global Asthma Network (GAN), launched last week at the University of Auckland. The network aims to improve care for people with asthma around the world. Its work will range from research into the causes of asthma to improving access to essential medicines.

(First Published in Deccan Herald)
Anti -TB activists at the recently concluded 43rd Union World Conference on Lung Health held in Kuala Lumpur made strident demands for getting to zero. For a post 2015 (MDG goals) strategy, they demanded zero new infections of TB, zero deaths from TB and zero stigma. At the other end of the scale were the doctors, scientists and academicians, who made very cautious commitments and advocated for the setting of realistic targets for TB control post 2015. The situation raises questions. Is asking for zero an unreasonable demand, especially for a disease such as TB which has been among us for as long as civilisation itself? There’s been very little progress down the years on new prevention and diagnosis tools, and treatment options.

Reaching zero HIV/AIDS deaths depends on addressing TB-HIV co-epidemic

This is a CNS news article in Thai language quoting experts from the International Union Against Tuberculosis and Lung Disease (The Union) that was also broadcasted through FM Radio 102.5 in northern Thailand. This article and radio broadcast transcript is available online here. This was written by Duangkamol Donchaum - CNS who has earlier worked with Health and Development Networks (HDN) and did her Masters from Chiang Mai University, Thailand.

Tuberculosis Control: Are We On Our Way?

Dr Nils E Billo, has been Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) since 1992 when it was a very small organization with just about a dozen staff and consultants, who focused on tuberculosis. During this long stint, spanning over two decades, Dr Billo has been instrumental in helping the Union grow from strength to strength—from a fledging federation to a leading international health organisation, with more than 10,000 members in 152 countries, and some 300 staff and consultants working from Paris and other offices in 11 countries. The Union's mandate has expanded and gone beyond tuberculosis and lung disease to include other public health issues as well, such as child lung health, HIV/AIDS, the pandemic of diseases caused by tobacco use and the rise of non-communicable diseases (NCDs). In this interview, given exclusively to Citizen News Service - CNS at the 43rd Union World Conference on Lung Health, Dr Billo talks about what has changed in the world of TB over this period of twenty years, and the current problems impeding efforts to eradicate this dreaded disease which, despite being curable, takes a huge toll of human lives.

1st December: World AIDS Day
Words of UNAIDS Executive Director Dr Michel Sidibe which I heard first at the Stop TB Partners' Forum in 2009: 'When a virus (HIV) and a bacteria (TB) can work so well together, why can't we?,' still hold true as all countries where TB and HIV co-infection is setting off alarm bells haven't yet fully implemented the TB-HIV collaborative activities as recommended by the WHO. "Countries where the TB epidemic is driven by HIV, such as Zimbabwe and other southern African countries, it is important that ministries of health adopt the 12 point package of collaborative TB HIV activities recommended by WHO" said Dr Riitta Dlodlo, TB-HIV Programme Coordinator, International Union Against Tuberculosis and Lung Disease (The Union) who is also a member of the TB/HIV Working Group of Stop TB Partnership housed in WHO Geneva.

World AIDS Day: 1st December
A new report argues that despite considerable advances in the fight against AIDS, the world is already falling behind pace in the effort to begin ending AIDS. But it doesn't have to be that way - according to the assessment in this report, the top-five critical actions over the coming year could have a tremendous impact. This report, 'Achieving the End: One Year and Counting', released by AVAC: Global Advocacy for HIV Prevention outlines top-five list of critical global priority actions in 2013.

(Based on an exclusive interview Citizen News Service - CNS did with Dr Sirinapha Jittimanee, Public Health Officer, Tuberculosis Bureau, Department of Disease Control, Ministry of Public Health, Thailand)

Thailand is one of the 22 TB high burden countries in the world. According to the WHO Global Tuberculosis Report 2012, Thailand, with a population of 70 million, had about 86,000 TB incident cases and 110,000 TB prevalent cases in past year. Case detection rate for all forms of TB was 76% and treatment success rate was 85% (in 2010).

[Hindi] Well decorated and recognized pulmonary physician Professor (Dr) Rajendra Prasad has joined as the Director of India's prestigious centre for care of tuberculosis and chest diseases - Vallabh Bhai Patel ChestInstitute, Delhi University, Delhi. Professor Prasad has till recently been the Director of Rural Post-Graduate Institute of Medical Sciences in Saifai, UP and is the former Head of the Department of Pulmonary Medicine, King George's Medical University (KGMU) in Lucknow.

Following my return from the 43rd Union World Conference on Lung Health (13-17 November 2012, Kuala Lumpur) one evening I happened to be watching CNN, when suddenly, hooray, TB was the topic of a roundtable discussion. Few tips were given on how TB spreads, few tips were given about the long duration of the treatment and the ‘graduation of TB to MDR-TB’ and yes, a long discussion of how TB enters the US and, yes of course, it was blamed all on the immigrants-- the Mexicans crossing the border, the Eastern Europeans, the Africans, and many other underprivileged and marginalized groups. Isn’t it always the case of someone being blamed for something that someone else is not doing right?

Every morning Aran’s (name changed) father drives him from his home, to the government TB hospital in Bangkok, the capital of Thailand, (which takes one hour to reach) for his multidrug-resistant tuberculosis (MDR-TB) oral medication. Then in the evening Aran takes the injection nearer home at a private clinic which is covered through the Thai government’s universal health scheme or health insurance under which the government pays for the health insurance of all of its citizens, and so Aran does not have to pay out of his pocket at this private clinic.

It seems so. Close to the heels of the WHO Global Tuberculosis Report 2012 releasing some data on childhood tuberculosis for the first time, one plenary at the recently concluded 43rd Union World Conference on Lung Health in Kuala Lumpur was dedicated to ‘Childhood TB: We need to do more’. Childhood TB (CTB) is finally on the public health agenda and children are now being recognized as a vulnerable group in the field of TB. The increase in childhood TB is an indication of the failure of the control of TB epidemic and an indication of household TB dynamics, as well as the emergence of transmitted Multidrug Resistant (MDR) TB. The disease presents itself with high (albeit preventable and treatable) morbidity and mortality in the youngsters. An estimated 490,000 children are falling ill with TB every year and 200 are dying of it every day (the actual numbers would be much more).

Even as we deliberate upon newer strategies for controlling communicable diseases like tuberculosis and non-communicable diseases like diabetes we tend to overlook the tremendous role of an empowered community and a working primary healthcare system in achieving our goal of a healthy society. The recently concluded 43rd Union World Conference On Lung Health re-emphasized the importance of these very pertinent issues. In a country like India, despite well qualified doctors and excellent health policies for its citizens--like the National Rural Health Mission (NRHM) - accessing even basic public health care facilities is a nightmare for most people. Most of an average Indian’s health spending is out of pocket, with the government spending much less on the health of its citizens than they themselves. The malaise of ineptitude pervades everywhere-- whether it is general medical facilities or specialized programmes like maternal/child health, and TB control.

(Based on an interview given to CNS by Dr Anil Kapur, President of World Diabetes Foundation, at the recently concluded 43rd Union World Conference on Lung Health in Kuala Lumpur)

Shockingly, today in 2012, there are 371 million living with diabetes—an increase of around 6 to 7 million since last year. There are another 300 million people in the queue with pre-diabetes. So we are talking about a global health problem that affects about 700 million people on this planet. This number is very soon likely to increase to 550 million people with diabetes and another 400 million with pre diabetes. 20% of the current global burden of the disease is in SE Asia, 36% in Western Pacific, 5% in Africa, and 79% in low and middle income countries. The top ten countries with the highest burden of diabetes are also the most populous countries and 8 of them are in the developing world, making Asia the hub of this huge epidemic.

The association between tuberculosis - TB (a communicable disease) and diabetes (a non-communicable disease) and their synergetic role in causing human suffering has been recognized for centuries but recent studies have undoubtedly established a more direct link between the two. Realizing the gravity of the problem, the WHO issued a policy statement his year, on what needs to be done to address TB-diabetes co-infection. The urgent need to address the comorbidity of these two diseases received serious attention at the recently concluded 43rd Union World Conference on Lung Health in Kuala Lumpur.

Governments to industry: you’re not welcome
The global tobacco treaty negotiations concluded on 17th November 2012 after a week of Big Tobacco’s attempts to derail, distract, and intimidate 175 countries from strengthening lifesaving measures required by the public health treaty. Despite the industry’s underhanded tactics, governments made concrete progress. On the second day of the meetings, the ratifying countries kicked Big Tobacco and its front group representatives out of committee meetings after members of civil society, including Corporate Accountability International, exposed the lobbyists who infiltrated the meetings under the guise of "public badges.” Article 5.3 of the treaty expressly prohibits tobacco industry interference in public health policy, and thus, their presence in the meetings.

As the curtain draws upon the 43rd Union World Conference On Lung Health in Kuala Lumpur, all those involved in health care in some way or the other - TB affected communities, governments, donors, researchers, healthcare professionals, broader civil society, among others - need to deliberate upon this dictum.

A study conducted by the international medical humanitarian organization Médecins Sans Frontières/ Doctors Without Borders (MSF) and presented at the on-going 43rd Union World Conference on Lung Health in Kuala Lumpur, shows that there is an urgent need for better TB tests for children as the current standard TB test fails to detect paediatric TB In 93% cases. The study thus confirms the crisis of undiagnosed TB among children.

Some 100 TB activists marched through the Kuala Lumpur Convention Centre on the afternoon of 14th November 2012, landing at the opening ceremony of the 43rd Union World Conference on Lung Health, just as delegates from over 120 countries were taking their seats in the Plenary Hall. They were an outspoken crowd, demanding more ambitious targets for stopping TB, increased funding to meet those targets and an end to the use of impolite and negative language in the TB community.

The summary report on multidrug-resistant tuberculosis (MDR-TB) services was released during the ongoing Lung Week (12-17 November) and the 43rd Union World Conference on Lung Health in Kuala Lumpur, Malaysia. Citizen News Service – CNS, a partner of the Stop TB Partnership, along with other partners such as National Partnership for TB Care and Control in India, Rural Youth Advocate for Health and Development in Nigeria, National Council of People Living with HIV in India (NCPI+), International Treatment Preparedness Coalition (ITPC) India, Global Health Advocates (GHA), Sneha Foundation Varanasi, Asha Parivar, Vote For Health campaign, National Alliance of People's Movements (NAPM) and the Global Stop-TB eForum had hosted the online consultation and key informant interviews on issues related to multidrug-resistant tuberculosis (MDR-TB).

Advocates are calling for greater attention to the promotion and fulfillment of sexual and reproductive health and rights in the ASEAN region. Just released, “Engaging the ‘New’ ASEAN” highlights the urgency for wide collaboration amongst civil society to assist ASEAN member states to fulfill their commitments. Reducing maternal and child mortality and HIV and improving health outcomes for young people will contribute to the social, economic and environmental sustainability across the region.

Lung Week: 12-17 November
As the world marks the Lung Week, Citizen News Service - CNS' Kakaire Ayub Kirunda speaks to the president of the Uganda Thoracic Society Dr Martin Okot-Nwang who recently retired after several years of service at the country’s national referral hospital in Kampala. Dr Okot – Nwang speaks about the state of lung health in Uganda and resource limited settings.

The International Union Against Tuberculosis and Lung Disease (The Union), the World Health Organization (WHO) and the World Diabetes Foundation in association with the Indian government conducted a pilot project this year screening more than 8,000 tuberculosis patients for diabetes, and over 10,000 diabetes patients per quarter for TB. Fasting blood glucose tests for diabetes measured in TB patients at 7 tertiary hospitals and over 60 primary health care centres across the country showed that 13% of them had high blood sugar levels indicating diabetes, with higher rates in the south than in the north. Interim data from the project was presented to India's Revised National TB Control Programme in September 2012 and resulted in a national policy decision to scale up testing of all TB patients for diabetes in the country.

(Hara Mihalea is a noted Public Health and Tuberculosis Consultant. She is a Greek American and trained as a specialist on adolescent reproductive health. She has worked on all aspects of public health and was one of first groups of people in 1985 that were trained as HIV counsellors at CDC. Then in 1995 she moved to Thailand and has since dedicated her life solely to the cause of TB prevention, care and control. This is based on an interview she granted to CNS onsite at the 43rd Union World Conference on Lung Health in Kula Lumpur.)

World Pneumonia Day, 12th November
Lung Week: 12-17 November
Ms Mary Musoke of Kampala in Uganda is expecting to have her third born child in late March or early April 2013, making the delivery timely for the newborn to get its Pneumococcal Conjugate Vaccine (PCV), which debuts in the Uganda public health system for free. Due to the high disease rates of the killer invasive pneumococcal disease (pneumonia, septicaemia and meningitis), a major cause of illness and death, now Government is set to introduce PCV as part of the routine immunization schedule.

[Hindi]Today government delegates from across the world adopted the illicit trade protocol of the global tobacco treaty – the world’s first public health and corporate accountability treaty - but not without a fight from Big Tobacco. In the lead up to the Seoul negotiations, the World Health Organization, which administers the treaty, deemed the tobacco industry’s interference in these negotiations and the implementation of the treaty as the single greatest threat to its success. But, despite continued pressure tactics from the industry, it is commendable that illicit tobacco trade protocol was adopted on the first day of the negotiations.

Kiran,a healthcare worker
attending to a child with pneumonia

Lung Week is 12-17 November
Despite being preventable and curable, pneumonia is the leading killer of children under 5 years old. In 2011 alone, 1.3 million children died from this preventable and treatable illness, accounting for 18% of child mortality. In 2008, there were an estimated 203,000 deaths due to Haemophilus influenzae type b (Hib) and 541,000 deaths due to Streptococcus pneumoniae (pneumococcus) in children under five. Effective vaccine for pneumonia caused by pneumococcus exists - yet children who are likely to be at a high risk of pneumonia are least likely to get the protection.

Lung Week is 12-17 November

According to the International Union Against Tuberculosis and Lung Disease (The Union), child pneumonia remains a major threat to children under 5 years of age despite the great potential of the pneumococcal vaccine. “Pneumococcal vaccine is an important intervention that is already in use and highly effective in resource-rich settings – and it has great potential in high child-mortality settings too. However, tackling childhood pneumonia is a complex issue that requires a more comprehensive approach than a single vaccine”, said Dr Steve Graham of The Union’s Child Lung Health Division.

New Hope For Protecting Infants Against Malaria

The first complete set of results from an on-going pivotal, large-scale Phase III study of a new malaria vaccine candidate--RTS,S-- in children aged 5 to 17 months and combined data for severe malaria in the first 250 cases from those aged 6 weeks to 17 months were published online in the New England Journal of Medicine. The data confirms that this vaccine candidate reduces both clinical and severe malaria by approximately one-third in African infants (aged 6-12 weeks at first vaccination).

(This story is based upon inputs given by Vedavalli’s daughter Radha to CNS via email)

58 years is no age to die. Yet Radha Rangaswamy’s mother Vedavalli died of tuberculosis (TB) in the last week of October 2012 precisely at that age. Her only fault seemed to be her undaunted faith in the public health system of India (the Government DOTS programme) which proved to be her undoing.

Millions of people around the world struggle to breathe, and more than 10 million die each year due to lung diseases, including tuberculosis, asthma, pneumonia, influenza, lung cancer and chronic obstructive pulmonary disease (COPD). Still lung health is less well recognised as a key health indicator as compared to blood pressure or weight. Lung diseases afflict people in every country and every socioeconomic group, but take the heaviest toll on the poor, the old, the weak and the young. There is a critical need to raise awareness of the importance of lung health and bring it to the top of the public health agenda.

November could be dubbed the “lung health month” this year, with advocates organising World Pneumonia Day on 12 November, World chronic obstructive pulmonary disease (COPD) Day on 14 November and the whole month designated by some groups as Lung Cancer Awareness month. Yet people are largely unaware of their lung health, according to Dr Nils E Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union). “Lung health is as central to health as blood pressure or weight, but most people are unaware of their lungs until something goes wrong”.