Correspondence
I declare no competing interests.
Carmen Barroso, on behalf of the Independent Accountability Panel
[email protected] Co-Chair of the IAP, 174 Pacific, Brooklyn, NY 11201, USA 1
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Nordenstedt H, Rosling H. Chasing 60% of maternal deaths in the post-fact era. Lancet 2016; 388: 1864–65. Independent Accountability Panel. 2016: old challenges, new hopes: accountability for the Global Strategy for Women’s, Children’s and Adolescents’ Health. http://iapreport.org/ downloads/IAP_Report_September2016.pdf (accessed Oct 20, 2016).
Setting up childhood obesity policies in Europe I’ve read with interest your editorial (Aug 27, p 841) and the comment of Tim Lobstein and Klim McPherson (Aug 27, p 853) concerning the UK Childhood Obesity Plan.1,2 Like British children, one in three Spanish children are overweight or obese. Similar to the UK, the Spanish Obesity Strategy lacks commitments to which it can be held accountable and relies on voluntary measures and self-regulation by industry, recommendations to schools and health-care workers, and appeals to personal responsibility.3 But the reality is even more disappointing in Spain than in the UK. We lack a nutritional profile model and a food-labelling traffic light system. Contrary to the Ofcom rules, the 2005 Spanish self-regulation www.thelancet.com Vol 388 November 19, 2016
code of food advertising to children4 ignored the nutritional quality of the products advertised. In 2011, despite evidence of the lack of effectiveness of self-regulation and appeals by WHO to protect children from food marketing, the Spanish government issued the Food Safety and Nutrition Act, committing itself again to voluntary regulation.5 The new coregulation code of food advertising not only permits for unhealthy foods to be advertised to children, but applies to children younger than age 12 years in audiovisual and printed media rather than to children up to 15 years, as stated in the law. Similarly, despite the approval of a series of recommendations regarding nutritional criteria for foods and drinks at schools in 2010, most products sold in school vending machines are energy-dense and nutrient-poor.6 It seems that in Spain and the UK, the food industry continues to govern food and obesity policies behind the scenes. I declare no competing interests.
Miguel Ángel Royo-Bordonada
[email protected] National School of Public Health, Health Institute Carlos III, Madrid 28029, Spain 1
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The Lancet. UK Government won’t step up to the plate on childhood obesity. Lancet 2016; 388: 841. Lobstein T, McPherson K. Nothing new in UK’s strategy on childhood obesity. Lancet 2016; 388: 853–54. Neira M, de Onis M. Preventing obesity: a public health priority in Spain. Lancet 2005; 365: 1386. Spanish Food Security and Nutrition Agency. Code of self-regulation of the advertising of food products directed at minors, prevention of obesity and health. March 29, 2005. http:// www.aecosan.msssi.gob.es/AECOSAN/docs/ documentos/nutricion/Codigo_PAOS_2005_ ingles.pdf (accessed Oct 3, 2016). Spanish Government. Law 17/2011, of July 5, on food security and nutrition. Official State Gazette. 2011. https://www.boe.es/diario_ boe/txt.php?id=BOE-A-2011-11604 (accessed Oct 3, 2016; in Spanish). Monroy-Parada DX, Moya MA, Bosqued MJ, López L, Rodríguez-Artalejo F, Royo-Bordonada MA. Vending machines of food and beverages and nutritional profile of their products at schools in Madrid, Spain, 2014–2015. Rev Esp Salud Pública 2016; 90: e1–9.
Revising the ICD: stroke is a brain disease The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was long overdue. The ICD-10 was based on outdated medical knowledge and concepts from the 1980s. Since then, science and practice have changed beyond recognition. The WHO neurology topic advisory group (TAG) for the revision of the ICD-10 was formed in 2009. In the ICD-10, cerebrovascular diseases were inconsistently and confusingly spread over several different chapters. In March, 2011, the Neurology and Circulatory TAGs, with contribution of WHO classification representatives and relevant WHO departments, agreed that in the ICD-11, all types of strokes should form a single block, and that this block should be placed in the nervous system diseases chapter. The decision was based on a transparent process, reflecting the fact that all manifestations of cerebrovascular diseases are related to brain dysfunction,1 stroke being the second leading cause of disability-adjusted life-years (DALYs) globally.2,3 The relationship with dementia and particularly Alzheimer’s disease is becoming clearer. 4 Public health advocacy has a focus on recognition of acute neurological symptoms warranting immediate medical intervention and subsequent commencement of life-saving therapies. The long-term cost of care and rehabilitation is of paramount global importance. The purpose of the ICD-11 is to produce a classification that reflects the advances in knowledge and concepts of the 21st century. On Sept 9, 2016, WHO classification staff unilaterally decided to break their agreed decision made 5 years earlier and move the newly created cerebrovascular block from neurology to circulatory disease. This backward step did not follow the expected
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address the complex issues we face today, we need: strong leadership at all levels, especially in crisis settings; a reassessment of aid eligibility criteria, which currently excludes two-thirds of the world’s poor; and strengthening of national capacities and institutions. Finally, we welcome Nordenstedt and Rosling’s Comment as it is a stark reminder that we all need to hold ourselves accountable—a reminder that is in line with the notion of accountability the IAP itself seeks to foster at the global and national levels.
Published Online October 13, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)31850-5 See Correspondence page 2476
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