Editorial
1995, Worldsat International and J Knighton/ Science Photo Library
The African CDC and WHO AFRO
For more on the African CDC see http://www.cdc.gov/media/ releases/2015/p0413-africanunion.html
Last week, the USA and the African Union (AU) signed a Memorandum of Cooperation to support the establishment of a new African Centres for Disease Control and Prevention (CDC) this year. An African CDC Surveillance and Response Unit will be set up in Addis Ababa, Ethiopia, including an Emergency Operations Centre to provide technical expertise and response coordination during large outbreaks. Regional Collaborating Centres in the five AU geographic regions are also planned. The US CDC will provide expertise and advice along with fellowships for African epidemiologists to help to staff the centres. If the African CDC develops into a strong organisation, it should help bolster disease surveillance and response on the continent. However, it needs to work with existing health agencies in Africa, especially WHO’s Regional Office for Africa (AFRO), to ensure a coordinated, comprehensive response to health challenges in the region. Surprisingly, the releases by the USA and the AU about the African CDC do not mention WHO or AFRO. This omission could signal their lack of confidence in WHO and AFRO following
perceived failures in the west African Ebola outbreak. But this is not the time to disengage with either. WHO needs continued investment from countries, including the USA, to respond effectively to global health threats. According to some critics, underfunding severely compromised the agency’s ability to respond in the Ebola outbreak. In January, WHO AFRO appointed a new leader, Matshidiso Moeti, for a 5-year term. Moeti was an internal candidate who was well-respected. In her speech to WHO’s Executive Board in Geneva during her appointment, Moeti said: “building a responsive and results-driven WHO Secretariat in Africa will be central to my term as the Regional Director”. To help to realise this vision, Moeti is establishing an Independent Advisory Group of 12–15 members (the Editor of The Lancet is a member) to give her strategic and policy advice during the first 12 months of her mandate. These are promising signs that WHO AFRO is looking to evolve into a stronger and more effective organisation. It now needs support, not side-stepping, to achieve its goals. The Lancet
Alex Mares-Manton/Asia Images/Corbis
Cognitive ageing: wisdom in the bigger picture
For the Institute of Medicine report, Cognitive Aging, Process in Understanding and Opportunities for Action see http://www.nap.edu/ catalog/21693/cognitive-agingprogress-in-understanding-andopportunities-for-action
1592
The Institute of Medicine (IOM) recently published its first recommendations on cognitive ageing, in response to the needs of an ageing population that increasingly turns to health professionals for help with the effects of growing older on their daily lives and health choices. Cognitive ageing is not a disease, but a natural part of growing up and getting older that starts in utero and continues until death. Cognition describes memory, attention, and processing, and encompasses wisdom, learning, and understanding. Although changes in memory and decision making can be alarming for patients and their families, older adults report greater levels of happiness than younger people, and knowledge can increase into very old age. Cognitive ageing is difficult to define, hard to measure, and impossible to predict. Mental processes are not neatly located in discrete brain structures. Cognition varies from person to person and within the same person from day to day. Tests used to measure aspects of cognition are influenced by factors that affect ageing itself, such as education, cultural context, or acute illness.
The report describes activities for support of cognitive health that are indivisible from other elements of wellbeing—keeping physically and socially active, taking control of cardiovascular risk factors, getting enough sleep—and asks doctors to help patients in taking these steps, and to manage other risk factors for cognitive decline such as medications and delirium. The IOM calls for research into cognitive ageing and increased collaboration between agencies and providers to support people as they get older. Caring for an ageing population is one of the most challenging issues facing health-care planners and practitioners today, but also one of the most exciting. In an era of increasing specialisation, the necessity of managing older patients holistically and in context offers those caring for them a real opportunity to improve the wellbeing of the individual and the community around them. Understanding ageing is a frontier of science and health. Every level of society, everyone involved in health care and health planning, and researchers from all areas of biomedicine can contribute to a world supportive of older people and a future to look forward to. The Lancet www.thelancet.com Vol 385 April 25, 2015
1995, Worldsat International and J Knighton/ Science Photo Library
The African CDC and WHO AFRO
For more on the African CDC see http://www.cdc.gov/media/ releases/2015/p0413-africanunion.html
Last week, the USA and the African Union (AU) signed a Memorandum of Cooperation to support the establishment of a new African Centres for Disease Control and Prevention (CDC) this year. An African CDC Surveillance and Response Unit will be set up in Addis Ababa, Ethiopia, including an Emergency Operations Centre to provide technical expertise and response coordination during large outbreaks. Regional Collaborating Centres in the five AU geographic regions are also planned. The US CDC will provide expertise and advice along with fellowships for African epidemiologists to help to staff the centres. If the African CDC develops into a strong organisation, it should help bolster disease surveillance and response on the continent. However, it needs to work with existing health agencies in Africa, especially WHO’s Regional Office for Africa (AFRO), to ensure a coordinated, comprehensive response to health challenges in the region. Surprisingly, the releases by the USA and the AU about the African CDC do not mention WHO or AFRO. This omission could signal their lack of confidence in WHO and AFRO following
perceived failures in the west African Ebola outbreak. But this is not the time to disengage with either. WHO needs continued investment from countries, including the USA, to respond effectively to global health threats. According to some critics, underfunding severely compromised the agency’s ability to respond in the Ebola outbreak. In January, WHO AFRO appointed a new leader, Matshidiso Moeti, for a 5-year term. Moeti was an internal candidate who was well-respected. In her speech to WHO’s Executive Board in Geneva during her appointment, Moeti said: “building a responsive and results-driven WHO Secretariat in Africa will be central to my term as the Regional Director”. To help to realise this vision, Moeti is establishing an Independent Advisory Group of 12–15 members (the Editor of The Lancet is a member) to give her strategic and policy advice during the first 12 months of her mandate. These are promising signs that WHO AFRO is looking to evolve into a stronger and more effective organisation. It now needs support, not side-stepping, to achieve its goals. The Lancet
Alex Mares-Manton/Asia Images/Corbis
Cognitive ageing: wisdom in the bigger picture
For the Institute of Medicine report, Cognitive Aging, Process in Understanding and Opportunities for Action see http://www.nap.edu/ catalog/21693/cognitive-agingprogress-in-understanding-andopportunities-for-action
1592
The Institute of Medicine (IOM) recently published its first recommendations on cognitive ageing, in response to the needs of an ageing population that increasingly turns to health professionals for help with the effects of growing older on their daily lives and health choices. Cognitive ageing is not a disease, but a natural part of growing up and getting older that starts in utero and continues until death. Cognition describes memory, attention, and processing, and encompasses wisdom, learning, and understanding. Although changes in memory and decision making can be alarming for patients and their families, older adults report greater levels of happiness than younger people, and knowledge can increase into very old age. Cognitive ageing is difficult to define, hard to measure, and impossible to predict. Mental processes are not neatly located in discrete brain structures. Cognition varies from person to person and within the same person from day to day. Tests used to measure aspects of cognition are influenced by factors that affect ageing itself, such as education, cultural context, or acute illness.
The report describes activities for support of cognitive health that are indivisible from other elements of wellbeing—keeping physically and socially active, taking control of cardiovascular risk factors, getting enough sleep—and asks doctors to help patients in taking these steps, and to manage other risk factors for cognitive decline such as medications and delirium. The IOM calls for research into cognitive ageing and increased collaboration between agencies and providers to support people as they get older. Caring for an ageing population is one of the most challenging issues facing health-care planners and practitioners today, but also one of the most exciting. In an era of increasing specialisation, the necessity of managing older patients holistically and in context offers those caring for them a real opportunity to improve the wellbeing of the individual and the community around them. Understanding ageing is a frontier of science and health. Every level of society, everyone involved in health care and health planning, and researchers from all areas of biomedicine can contribute to a world supportive of older people and a future to look forward to. The Lancet www.thelancet.com Vol 385 April 25, 2015
