Editorial

508 www.thelancet.com Vol 381 February 16, 2013

For The burden of liver disease in Europe: a review of available

epidemiological data see http://dx.doi.org/10.1016/j.

jhep.2012.12.005

For the Canadian study see http://onlinelibrary.wiley.com/

doi/10.1111/add.12139/abstract

About 29 million people in the European Union have chronic liver disease according to The burden of liver disease in Europe: A review of available epidemiological data, published recently in the Journal of Hepatology. Alcohol consumption, viral hepatitis B and C, and metabolic syndromes linked to overweight and obesity are reported to be leading causes of liver cirrhosis and primary liver tumours.

Liver cirrhosis is responsible for around 170 000 deaths in Europe annually, with wide variations between countries—ranging from about one per 100 000 Greek women to 103 per 100 000 Hungarian men dying each year. About 90% of individuals in Europe infected by viral hepatitis are not aware of their status, which is of great concern: chronic hepatitis B aff ects 0·5–0·7% of the European population, and the prevalence of chronic hepatitis C was 0·13–3·26% in the past decade. Moreover, the prevalence of non-alcoholic fatty liver disease is 2–44% in the European population. In terms of alcohol consumption, Europe is the region of the world

where the heaviest drinking occurs; in some European countries, the mortality rate from alcohol-related liver diseases is as high as 47 per 100 000 inhabitants. A recent study done in Canada showed that a rise in alcohol prices of 10% was associated with a reduction in alcohol-related deaths by almost 32%, which could provide impetus for alcohol-control policies in Europe.

The substantial burden of liver disease-associated mortality in Europe means that governments and health-care providers must tackle liver disease in a much more proactive fashion—taking a cue from diseases such as breast cancer. A higher public health priority and use of non-invasive tests to screen for early stages of fi brosis are required. There is an urgent need to implement prevention programmes, and research will be needed to develop novel treatments to address the problem. The meeting at the European Parliament on the burden of liver disease in Europe on Feb 20 in Brussels should be a fi rst step towards greater care for the health of Europe’s livers. The Lancet

Liver disease in Europe

It would be easy to assume that the worldwide economic crisis had signalled the death knell for global health funding. But, according to the latest report on global health expenditure from the Institute for Health Metrics and Evaluation (IHME), the picture is not so gloomy. So how does the good news weigh up against the bad?

The good news. Development assistance for health from government aid agencies, multilateral donors, private foundations, and charities seems to have held steady from 2010 to 2012. After reaching a historic high of US$28·2 billion in 2010, development assistance for health dropped in 2011 and recovered in 2012, largely thanks to increases in spending from the GAVI Alliance and UNICEF. Additionally, donations from the UK and Australia increased from 2011 to 2012. And money for HIV/AIDS, tuberculosis, and maternal, newborn, and child health continued to increase through 2010.

The bad news. Global health funding is still fl at-lining. From 2011 to 2012, overall health spending from government aid agencies decreased by 4·4%. Development assistance for health from the USA, the largest donor,

dropped by 3·3%, from Germany it decreased by 9·1%, and France by 13%. Development health assistance for health sector support, non-communicable disease, and malaria fell slightly from 2009 to 2010.

Furthermore, the report noted a disconnect between donor priorities and global health needs. IHME combined their funding estimates with the new fi ndings from the Global Burden of Disease Study 2010 to compare the amount of development assistance a country receives with its disease burden. The analysis showed that of the top 20 countries with the highest all-cause disability adjusted life-years, only 12 are among the top 20 recipients of development health assistance.

Some nations, such as Germany, are weathering the economic storm better than others, so their decreases in global health spending are hard to justify. Overall, however, the international community is holding steady on its promises to improve the health of poorer nations. But donors must use the latest IHME data to set priorities, and make sure that funds go to those most in need. The Lancet

Highs and lows in global health funding

For the IHME report see http://www.healthmetrics

andevaluation.org/sites/default/fi les/policy_report/2011/

FGH_2012_full_report_medium_resolution_IHME.pdf

For more on the Global Burden of Disease Study 2010 see

Lancet 2010: 380; 2053-2260

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This online publication has been corrected. The corrected version fi rst appeared at thelancet.com

on March 29, 2013