Loneliness among older people: a new epidemic

A weekly phone call or visit from a volunteer are among the solutions to help ease the loneliness epidemic affecting 1.2 million older people in England, according to campaigners.

Age UK, says that 1.2 million older people are chronically lonely and that this has an adverse impact on mental health, and the challenge will increase as our population ages. In the next 20 years, England’s over-85 population is set to rise from nearly
1.3 million people to just under 2.8 million.

Caroline Abrahams, Age UK charity director says: “Loneliness can have an impact on older people’s health and wellbeing. And this is particularly true when it comes to mental health, with older people’s depression often brought on by, or exacerbated by loneliness.”

NHS figures reveal that depression affects around
22% of men and 28% of women aged over 65 in England, but, according to the Royal College of Psychiatrists,
85% of older people with depression receive no NHS help at all. The spotlight on older people initiative – a group of nine older people’s organisations led by the Jo Cox Commission on Loneliness – says that more than half the users of over-50s social networking site Gransnet who say they are lonely have never discussed loneliness with anyone.

But solutions do exist, says Abrahams: “There is no quick fix or single policy solution to eradicate loneliness but there are reasons to hope that we can change things for the better.” An Age UK and Campaign to End Loneliness 2015 report, Promising Approaches to Reducing Loneliness and Isolation in Later Life, reveals good practice. For example, it says interventions involving help with transport or technology “can be the glue that keeps people active and engaged”.

The report highlights successes such as face-to-face or telephone befriending projects, including the Royal Voluntary Service’s Dorset Befriending Service, offering home visits to older people. The project began after a local GP’s concerns that older patients would visit the doctor primarily because they were isolated. Another initiative, The Silver Line, is a 24-hour, free helpline for information and companionship. In addition, British Red Cross community connectors are volunteers who identify and attend local activities with lonely older people.

The Campaign to End Loneliness is developing a national initiative to tackle loneliness through community collaboration. Laura Alcock-Ferguson, the campaign’s director, adds: “At a local level across the UK, health authorities should be developing clear plans to reduce loneliness and social isolation in their local areas.”

Dr Amanda Thompsell, chair of the old age psychiatry faculty at the Royal College of Psychiatrists, says organisations developing support projects must also include older people and carers as well as psychiatrists, GPs, and the social care sector. Thompsell suggests awareness of loneliness could also be incorporated into the school curriculum: “Inter-generational contact has been shown to be particularly effective in combating loneliness and we often forget how much children can learn from older people.”

Ignoring the challenge is not an option, as Thompsell says: “Failure to tackle loneliness will lead to more pressure on services which are already overwhelmed.”

Roy Warman: ‘I met the daughter I never had through a telephone befriending service. It changed my life’

Warman credits Age UK with helping to turn his life around Photograph: Amanda Searle

Roy Warman’s wife, Phyllis, died in January 2015. Buoyed by well-wishers in the first few weeks of bereavement, the visits and telephone calls gradually dwindled, and he felt increasingly alone. Many of his friends have passed away, he does not have any family nearby and the couple never had children. He explains: “The longer it goes without speaking to someone, the harder it gets.” He describes loneliness as “one of the hardest things that you will encounter in life”, likening feeling low to “living in a void”.

The 84-year-old from Wiltshire spotted information about Age UK in a local magazine a few months after Phyllis’s death. He got in touch and was referred to an Age UK telephone befriending service that matches older people with like-minded volunteers for friendship or phone calls.

He recalls the first time he spoke to a companion on the phone: “It opened a new door. It was so nice to think that someone might listen … a voice at the other end who could sympathise.” Today he has weekly phone calls with a volunteer he describes as “like the daughter I never had” and he also has regular visits from another volunteer as part of Age UK’s face-to-face befriending scheme.

The impact has been extraordinary, says Warman, describing the experience of support as “like being in a desert and coming across an oasis”. He has joined a singing group and developed his IT skills: “I think it partly affected my decision to join a local choir. And Age UK introduced me to the tablet, it’s like a giant library.” Crucially, he senses his self-confidence has returned: “I feel good about myself and feel able to cope now.” SS

Loneliness among older people: a new epidemic

Obesity epidemic in Latin America is "frightening", says UN report

More than two thirds of people living in Mexico, Chile and Ecuador are overweight or obese, costing their economies tens of billions of dollars every year, driving rates of disease and straining health services, according to a new UN report.

While the number of hungry people in Latin America and the Caribbean has halved in the last 25 years, the region is now struggling to combat an obesity epidemic.

Changing diets, including more processed food that are high in salt, sugar and fat, along with more sedentary lifestyles have triggered a rising tide of obesity, experts say.

“The implications for the future of countries are frightening … undernutrition is declining, but overnutrition is expected to become the largest social and economic burden in the region,” the UN World Food Programme (WFP) said in a statement.

The report by the WFP and the UN’s Economic Commission for Latin America and the Caribbean (ECLAC), said over the next six decades people being overweight and obese would cost Mexico an estimated $ 13bn a year, Ecuador $ 3bn and Chile $ 1bn.

Undernutrition, when people do not get enough food, and obesity – itself a form of malnutrition – are two sides of the same coin, and together they inflict a so-called “double burden” of disease on people and economies, the report said.

Undernutrition impairs child growth and brain development, while obesity can led to type 2 diabetes, cancer and heart disease.

“We now witness a worrying trend among vulnerable communities with cases of undernourishment and overweight simultaneously within the same families,” said Miguel Barreto, WFP’s regional director said in a statement.

“Both undernourishment and overweight represent a serious burden for the health of those families, that eventually translates into losses in productivity, and in pressure on the health and education systems in the country where they live.”

According to the World Health Organisation, obesity is an epidemic worldwide, killing 2.8 million adults every year, and obesity-related conditions now cause more deaths than hunger.

In Latin America, obesity is increasingly affecting the region’s poor, particularly women.

In Mexico, a country that faces one of the world’s most acute obesity crisis, 74% of women are obese or overweight compared with 70% of men, the report said.

The report urged food companies to play a greater role in combating obesity.

“The food industry has the opportunity to ensure the production, availability and accessibility of healthier food products,” it said.

Governments should also do more to promote exercise and health eating and place greater controls on food labelling.

The report noted Chile’s efforts to combat obesity, including an 18% tax on sugary drinks introduced in 2014 – one of the world’s highest – along with laws that restrict the advertising of unhealthy foods targeting children.

In 2014, Mexico also introduced a 10% tax on fizzy drinks, and 2016 research by the British Medical Journal found that the sugar tax led to as much as a 12% reduction in sales during the first year it was implemented.

Obesity epidemic in Latin America is "frightening", says UN report

Italy experiencing measles epidemic after fall-off in vaccinations

Italy has announced that it is experiencing a measles epidemic following a fall-off in vaccinations, as the United States issued a warning to visitors about the outbreak of the potentially fatal disease.

The Italian health ministry said on Wednesday there had been almost 1,500 registered cases of measles so far this year against some 840 in all of 2016 and some 250 in 2015.

“Italy and Romania have an epidemic at the moment,” said Walter Ricciardi, president of the Higher Health Institute, adding that he understood why the US Centers for Disease Control and Prevention issued an advisory this week.

Ricciardi told Radio 24 that unlike in Italy, the United States had launched a large campaign to convince parents to vaccinate their children.

The Higher Health Institute says only around 85% of two-year-olds are being vaccinated against measles at present, well below the 95% threshold recommended by the World Health Organisation to block the illness.

The centre-left government has accused the anti-establishment Five Star Movement (M5S) of spreading concern among parents by questioning the safety of some vaccines and by loudly denouncing efforts to make vaccinations mandatory.

“Vaccinations have played a vital role in eradicating terrible illnesses … but nonetheless, they bring a risk associated with side-effects,” the M5S founder Beppe Grillo wrote in 2015, saying mandatory vaccination represented a gift for multinational pharmaceutical firms.

A leading M5S politician, Andrea Cecconi, suggested last month that the jump in measles cases might be part of a natural cycle for the illness rather than a preventable epidemic.

Renewed concern over measles came amid fury among doctors over a programme on the state broadcaster RAI that highlighted the possible side-effects of the human papillomavirus (HPV) vaccine, which protects against cervical cancer.

The M5S defended the report, but health officials accused RAI of being unnecessarily alarmist.

“It is very serious that a TV programme, which is supposed to be at the service of citizens, spreads fear by telling lies and giving credence to the anti-vaccine lobby,” said Giuseppe Mele, chairman of the Italian Society of Paediatricians.

Italy experiencing measles epidemic after fall-off in vaccinations

Is the US facing an epidemic of "deaths of despair"? These researchers say yes

In 2015, the Princeton economists Anne Case and Angus Deaton’s groundbreaking paper in the National Academy of Science’s magazine reported that mortality rates among a section of Americans were suddenly surging – something unheard of in previous decades. Mortality was only rising in a certain group: middle-aged non-Hispanic whites without a college degree.

Case and Deaton have returned with a new paper published last week by the Brookings Institute. It paints a grim picture of two Americas, in which one has recovered from the 2008 economic crisis and the other hasn’t. The latter, once called “blue-collar aristocrats”, consists of families who were previously able to get by with jobs not requiring college degrees. The disappearance of those jobs has been accompanied by an alarming rate of suicides, overdoses, and diseases caused by drugs and alcohol.

Case and Deaton call these “deaths of despair” – and argue they have recently reached disturbing levels. While opioids account for many of the deaths, drug abuse may only be a symptom of a larger, unseen epidemic of despair.

Dr Anne Case answered questions over email.

Could you briefly describe your original research and what this new follow-up paper adds to it?

Our 2015 paper documented a set of facts: that after a century of almost uninterrupted progress on mortality, US white non-Hispanics (WNH) in midlife were experiencing a sustained period in which mortality rates stopped falling and rose instead. This stands in contrast to the continued declines in midlife mortality in other rich countries, and to progress being made in the US by black non-Hispanics, and Hispanics, who are on average poorer than whites.

Our 2015 paper highlighted the role played by suicide, alcohol-related liver mortality, and accidental drug overdoses in pushing mortality rates higher for WNH Americans. Our latest paper allowed us to take a deeper dive, looking at mortality and morbidity in much broader perspective. We found the mortality increases are in sync with the distress midlife WNHs face in many dimensions: poorer health and mental health, social isolation, obesity, marriage (or lack of marriage), poorer labor market opportunities, and weaker attachment to the labor market.

Two additional findings stand out: using these outcomes as measures of wellbeing, there appear to be two Americas: one for people who got a four-year college degree, and one for people who didn’t. In addition, these poorer outcomes for those without a college degree become more and more pronounced the later in the 20th century.

You use the term “deaths of despair”. I’m wondering how you would define “despair” in this context?

We think of drug, alcohol and suicide deaths. In a sense, they are all suicide – either carried out quickly (for example, with a gun) or slowly, with drugs and alcohol.

How do you see religion and marriage as factors in the rise of mortality rates among WNH Americans?

There hasn’t been a decline in religion, but it appears there has been a change in the type of churches to which people report an affiliation. “Legacy” churches (eg Catholic, mainline Protestant) have given way to “seeking” churches, in which there is less structure.

I’m not sure traditional ideas of marriage have changed, but later-born birth cohorts of WNH without a college degree are substantially less likely to get married, or stay married. To be concrete, almost three-quarters of WNH men and women with less than a BA born in 1950 were married when observed at age 30; that fell to two-thirds for the cohort born in 1960 seen at age 30; and to half for the cohort born in 1980.

Scholars in sociology tell us this is closely connected to the fact that men in later-born cohorts can’t marry if they don’t have “a good job”. Those jobs – jobs with on-the-job training, jobs with benefits, jobs where, if you work hard, you can expect to move up – are harder and harder to come by now. While marriage rates fell, rates of cohabitation rose. However, unlike what one sees in many European countries, these cohabitations are fragile in the US. Taken together, this leaves less structure (in religion, in jobs, in marriage). If things go well, this is fine, but if things go poorly, this can lead to suicide.

You write that the recent decline in incomes does not completely explain the rise in “deaths of despair” among white non-Hispanics without a college degree; they also face a “cumulative disadvantage” over the course of their lives. How do you explain this?

Current household income per person doesn’t explain why those without a BA have rising mortality rates. For both those with and without a college degree, incomes rose in the 1990s and fell with the great recession. But those with a BA saw mortality rates fall throughout this period, while those without a BA saw mortality rates rise throughout.

We are working with a model of “cumulative disadvantage” to help us make sense of the rise in despair. You can think of everyone born in a given year (say, 1960 or 1970) as being handed a weight that they have to carry with them. The heavier the weight, the harder it is to carry, and the longer you carry it, the worse things become. That weight may be the kinds of jobs a person can get with a high school degree (measured in wages and opportunities for advancement), and it appears that weight is heavier for each successive birth cohort. The quality of the labor market may affect whether a person marries, and the stability of their personal lives, and whether they risk their health at work.

What current policies, if enacted, could prolong or deepen or halt the epidemic?

Addiction and mental health programs are essential. Working to stop the over-prescription of opioids is essential. Policies that make available educational opportunities for people who don’t want a college degree – that allow people to develop the skills that will be rewarded in the 21st-century economy – would make a big difference.

You suggest that Europeans don’t see the same rise in death rates due in part to a stronger social safety net. Could you see an argument for such a social safety net in America?

This might be more difficult than it sounds. Americans like to think of themselves as individuals who can look after themselves and their families, and expect the same of their neighbors. A stronger safety net may not be politically feasible. The difference between a “helping hand” and a “handout” may be in the eye of the beholder.

• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
  

Is the US facing an epidemic of "deaths of despair"? These researchers say yes

Epidemic of untreatable back and neck pain costs billions, study finds

Low back and neck pain is an increasingly widespread and expensive condition worldwide, costing the US alone $ 88bn a year – the third highest bill for any health condition – despite evidence most treatments do not work.

Millions of people worldwide suffer from low back and neck pain, most of it unexplained, although some professionals think it may be worsened by sitting at desks all day, carrying bags and general bad posture. Episodes of acute pain are very common, but experts say that medical investigations only make things worse and the best cure is often to take painkillers, exercise gently and wait for the pain to pass.

The rising bill for treatment in the US has been uncovered in a new study by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, which looked at public and private spending on all diseases in 2013. Diabetes was in first place on $ 101.4bn and heart disease was second with $ 88.1bn. But neck and lower back pain treatment costs were close behind, at $ 87.6bn. The team split cancer into 29 separate conditions, which meant that none of them made the top 20, although combined the costs of treatment came to $ 115bn.

The most remarkable thing, said Joseph Dieleman, lead author of the paper published in the Journal of the American Medical Association, was the increase in treatment costs for lower back and neck pain, running at 6.5% a year against 3.5% overall. “In absolute terms, there was an increase from $ 30bn in 1996 to $ 88bn in 2013,” he told the Guardian.

The numbers of people suffering low back and neck pain in the US had not changed much, he said, but the spending had soared. Three things were driving the rise, said Dielman: individuals with pain going more often to outpatients’ clinics, increases in the costs and quantity of treatments given to people admitted to hospital, and a larger older population.

Surprised by what they found, Dieleman and his colleagues now plan to do similar work looking at the costs of treatment of low back and neck pain and other diseases in England, Norway and Switzerland.

What they already know is that low back and neck pain is a huge worldwide problem. The latest Global Burden of Disease (GBD) study, also produced by the IHME and published by the Lancet, showed it was “the leading global cause of disability in 2015 in most countries”. In the UK, a third of all long-term sickness absence from work, and nearly a fifth of any sick leave, is caused by musculoskeletal disorders, which is mostly lower back and neck pain, according to the Work Foundation.

“It’s about 30% of GP consultations,” said Karen Steadman, health, wellbeing and work lead at the foundation. A lot of patients have other health complaints at the same time – so-called co-morbidities. “About a third have co-morbid depression,” she said.

Dr Andrea Furlan, a co-ordinating editor of Cochrane Back and Neck – one of the collaborating groups of scientists who assess the worldwide evidence for which treatments work – said back or neck pain affect maybe eight out of 10 people at some point. “Almost everybody in the world will have some kind of back pain in their life,” she said.

Acute lower back or neck pain, which can last for a few days up to a couple of months, can be extremely debilitating, she said. Furlan knows this, as quite apart from being based at the Institute for Work and Health in Toronto, Canada, she has experienced it herself. “It was so painful I had to lie on the floor,” she said. “I was sure I had ruptured a disc or ligament.”

But she also knew she should not get it investigated. “The first thing you have to remember is don’t x-ray, don’t MRI and don’t CT scan – no investigation. I was desperate to have one

“Thank goodness I didn’t [get it investigated] because that’s where things go wrong. I’m 47 years old. When you do an investigation, there is a chance you are going to find something wrong in the spine. Then somebody will want to intervene.”

Injections, electrical nerve stimulation, opioid drugs and a whole host of other interventions are not recommended for lower back and neck pain. The Cochrane group have found no evidence in favour of using these or many other interventions; in the UK, guidance from the National Institute for Health and Care Excellence advises healthcare staff not to offer them.

There are people who will be “red flagged” for investigation because of their age, a fever or other issues, but most people will be advised to keep working, keep moving, keep exercising and taking painkillers and wait to get better. “Rest for acute back pain is the worst thing you can do,” said Furlan. After three weeks, her own pain was gone.

It is important to try to prevent acute pain from becoming chronic pain – the sort that does not permanently go away. Treatment can make things worse, but there is also a mental health element to much chronic pain. Those at risk of developing chronic pain are “yellow flagged”, said Furlan, and risk factors include depression and a lack of social or workplace support. Those with chronic pain will need interventions, which may include professional physiotherapy but also relaxation exercises, meditation and mindfulness.

The epidemic of lower back and neck pain is not surprising, said Furlan. “The spine is a part of the body that is so fragile. People have no idea,” she said. “It is unbelievable what the spine does.” It is also supporting increased weight and changed posture in the many people who have become obese in recent years – plus carrying heavy bags around and tension in neck muscles as people work at computers does not help.

Ending the epidemic, however, is going to be hard.

Epidemic of untreatable back and neck pain costs billions, study finds

Thyroid Dysfunctions & The Obesity Epidemic: Is Your Weight Loss Canary Suffering?

There’s no doubt that thyroid disease is on the rise. Now the question is why?

The reason your weight loss attempts might not be working is because your weight loss canary might be suffering…let me explain.

From the research, I have reviewed and the patients I have seen over the last 10 years, it’s clear to me that the thyroid gland is your body’s own yellow canary. It’s sensitive to many different influences—your diet, your lifestyle, and the world around you. And all these influences can affect how well your thyroid functions.

Remember how miners used to detect toxic methane gas and carbon monoxide? They sent bright yellow canaries into the mines. Canaries are highly sensitive to these gasses—so much so that they die when exposed to them. Their deaths served as a warning system for miners so they do not enter and become exposed to poisonous air.

So, it’s not surprising that as we eat more toxic foods and are increasingly exposed to pollution, petrochemical and industrial wastes, and heavy metals that thyroid problems have also skyrocketed. In fact, more than 20 percent of women and 10 percent of men in the United States have thyroid dysfunctions—and half of them don’t even know it (1, 2)!

But exactly how does your environment affect your thyroid?

We now have substantial research to demonstrate that environmental chemicals have a direct impact on the thyroid gland. It’s clear that PCBs and other industrial petrochemical toxins can lower thyroid function, as well as other pollutants such as chlorine, fluoride, and bromide.

Since the thyroid produces hormones that manage your metabolism, anything that affects your thyroid will ultimately affect your metabolism. In fact, there’s evidence that toxins boost the excretion of thyroid hormones, leaving you with less of this hormone to control your metabolism—and a decreased ability to burn fat.

The truth is, your thyroid plays a huge role in weight control, and in determining your metabolic rate.

The question is not if, but how much is today’s obesity epidemic linked to the harmful effects of environmental toxins on metabolism.

I’ve seen so many patients struggle with their weight, only to have the pounds melt off when we addressed their thyroid problems.

True, not everyone’s weight problems are caused by thyroid dysfunction—but if you’re overweight, you should consider the connection. That’s why the best medical doctors always check their patients’ thyroid functions and will consider all the possible causes of subtle thyroid imbalance, including toxins, food allergies, nutritional deficiencies, and stress.

Now let’s talk about some of those other factors.

For example, food allergies, like sensitivities to gluten and other foods, also negatively affect thyroid function—and are frequently undiagnosed. Likewise, deficiencies in nutrients important to good thyroid function—like selenium, zinc, omega-3 fatty acids. and iodine and tyrosine—can also trigger thyroid problems.

With all these factors that can affect your thyroid, it’s clear that we need a new approach to the diagnosis and treatment of thyroid disease. Many doctors can miss the subtle signs of thyroid problems, and conventional medicine often treats low thyroid function with inadequate, one-size-fits-all drugs like Synthroid.

However, thyroid dysfunction requires a more personalized, integrative approach—one that you can help control by becoming an active partner in your care. First, keep an eye out for the symptoms of a low thyroid function, including (3):

• fatigue


• sluggishness


• trouble getting up in the morning


• depression


• dry skin


• dry hair


• constipation


• fluid retention


• menstrual problems and PMS


• hair loss


• cracked or chipping fingernails


• low sex drive


• weight gain


• muscle aches


• cramps

Yes, a lot of those symptoms are common and vague—which is one reason why thyroid dysfunction often goes undetected. But if you notice any of these signs, bring them to your doctor’s attention, and ask him or her to test your thyroid function.

If you are diagnosed with low thyroid function, the following steps recommended:

1. Eliminate the causes of thyroid problems, like toxins, food allergies, and nutritional deficiencies.


2. Exercise


3. Eat foods that provide nutritional support to your thyroid—and avoid those that don’t.


4. Use supplements that protect your thyroid, such as vitamins A and D, selenium, zinc and fish oil.


5. Work with your doctor to choose the right thyroid proto

Remember, thyroid hormone is the master metabolism hormone. If your thyroid is out of balance, your metabolism is out of balance, too.

Do you have a dysfunctional thyroid?

Know that the problem can be fixed. By following the program here you can get your thyroid working properly, keep your weight under control and start feeling better today.
1. The Truth About Low Thyroid: Stories of Hope and Healing for Those Suffering with Hashimoto’s Low Thyroid Disease – August 30, 2016 Dr. Joshua J. Redd
2. Why Do I Still Have Thyroid Symptoms? when My Lab Tests Are Normal: a Revolutionary Breakthrough in Understanding Hashimoto’s Disease and Hypothyroidism, 1st Edition, Dr. Datis Kharrazian
3. http://www.health.com/health/gallery/0,,20723100,00.html

Thyroid Dysfunctions & The Obesity Epidemic: Is Your Weight Loss Canary Suffering?

The obesity epidemic is an economic issue

It is estimated that today’s obesity epidemic costs the global economy about $ 2tn (£1.6tn) or some 3% of GDP. For individuals, deciding what to eat is a jealously guarded privilege, but for economists obesity is not really about people exercising free-market choice. Instead it is a market failure.

The causes of the epidemic are complex, spanning the social sciences to biology and technology. Consider, for example, the shift towards urbanisation and car transport. By reducing many people’s daily physical activity, these are estimated together to reduce individuals’ need for food by 300 calories a day. So how much less food should the car driver eat to compensate? About one biscuit less a day – a trivial change that only goes to illustrate that few of us really understand the energy needs of our bodies.

In market terms, making a rational choice at the dining table requires people to know how much energy they need and how much they are getting – yet neither of these is known. As any one who has ever tried to lose weight knows, in these matters talk is cheap and advice is unreliable. At various times sugar, protein, fat, starch, fast food, home cooking and snacks have all been held to be responsible for the obesity epidemic.

Back in the 1950s, the dominant theory was that eating fat was responsible for making you obese – and by sating appetite, sugar could help to reduce weight gain.

However, food companies prefer to deflect rhetoric about poor diet being the primary cause of obesity, and instead promote messages focused on exercise and other factors – a phenomenon termed “leanwashing”.

Nonetheless, the political spotlight is now on sugar, with “environmental” changes proposed to reduce the appeal of sugary foods, such as warning labels and nutritional information panels. There’s serious talk of taxing them, in the way that tobacco has been. None of this is supported by any real evidence, but certainly new taxes are always popular with governments. (It’s pretty obvious, after all, that there are plenty of thin children who enjoy sugary foods, and plenty of overweight people whose tastes lie elsewhere.)

Prof Kevin Fenton, national director for health and wellbeing at Public Health England, says there are “practical solutions”, by which he means a de-sugaring of foods such as cakes, biscuits and puddings. But these foods are not sugary by accident – they are sugary because that’s what we like about them. It’s like salted crisps having salt removed … but yes, the health industry has pushed that one too.

Solutions based on labelling of foods by calorific content to improve consumer choices belie both human psychology and the complexity of the body’s digestive mechanisms. As a result, it is futile leaving a solution to the food and drink industry, or on relying on “education” to correct consumer behaviour.

However, consumer choices are being skewed by government actions, such as massive programmes of agricultural support that actually favour fast foods over healthy eating. Billions of dollars go towards subsidising junk foods, through farm subsidies for producing ingredients such as soya and high-glucose corn syrup.

Obesity affects poor households far more than their richer neighbours – and the cost of eating healthily is a very practical reason why.

And, as the US economist Richard McKenzie has pointed out, much of the rise of obesity is precisely a consequence of free-market economics. For example, fast food has become cheaper, in part because of mechanisation and in part because the workers producing it are paid less and less. At the same time, the economic forces that propelled 1960s women away from the kitchen and into jobs also propelled families towards processed foodstuffs and eating out … or just snacking.

When markets go wrong, governments need to step in. Agricultural support should be switched away from junk foods and towards producing healthy ones. The low wages and poor training that fast-food outlets rely on should be made a thing of the past, and tax incentives (such as zero VAT) should support the labour-intensive production of “real food” in cafes and restaurants.

Market corrections, rather than punitive moves aimed at individuals, are the only way to tackle what has become, in economic as well as in social terms, a very real crisis.

Martin Cohen is editor of the Philosopher. His recent book, Paradigm Shift (Imprint 2015), discusses ‘how expert opinions keep changing’

The obesity epidemic is an economic issue

Every tobacco death is an avoidable tragedy. The epidemic must stop here | Margaret Chan

Tobacco use, the leading cause of death from non-communicable diseases such as heart and lung disorders and cancer, claims about 6m lives a year. On Monday, countries will gather in Delhi, India, for the seventh conference of the parties to the World Health Organisation framework convention on tobacco control, a treaty that has sparked global action to stem the epidemic.

The treaty is already one of the most widely embraced in UN history. One of my proudest accomplishments at the helm of the World Health Organisation has been rallying global efforts to drive down tobacco use. I’m pleased to say that, following the adoption of the agreement, governments around the world have taken decisive steps not only to reduce tobacco use, but also to stand up to the multinational tobacco companies standing in the way of global progress.

The tide of tobacco use is beginning to turn. After decades of Big Tobacco targeting low- and middle-income countries and years of steadily increasing sales, tobacco sales show signs of dropping.Countries are passing stronger laws to reduce demand for tobacco products not envisioned even a few years ago, and tobacco companies are losing the legal challenges they mount against these measures. From Uruguay to Australia, countries large and small have stood up to the tobacco industry by implementing plain packaging and large pictorial health warning labels. Where tobacco companies have tried to threaten and bully nations, governments have responded with firm measures to protect public health.

However, amid these clear signs of progress, the tobacco industry has made it absolutely clear that it has no intention of abandoning a business model that depends on enticing millions of new users – especially young people – to its deadly products.

The impetus of the global movement to reduce tobacco use should not be lost. More than ever, decisive action is needed. Now is the time for countries to build on the momentum established and protect their citizens. By raising tax on tobacco products, requiring graphic warning labels, conducting hard hitting mass media campaigns and banning tobacco industry advertising and marketing, countries can improve the health of their citizens, reduce healthcare costs and prevent the tobacco industry from addicting another generation of children.

Illicit trade in tobacco threatens the progress governments make in tobacco control by making cheap and unregulated products available. I am pleased to note that governments are increasingly taking action and becoming parties to the new international treaty to eliminate illicit trade in tobacco products.

I urge global leaders convening in India to see this as an opportunity to bend the course of public health history

We need to work together, as allies in global health, to fight to protect people from the dangers of tobacco. I recently appointed Michael Bloomberg as WHO global ambassador for non-communicable diseases because of his track record in tobacco control, which includes more than 10 years of support for low- and middle-income countries. Advocates like him, and many others who champion tobacco control, stand with the WHO to support governments in this fight.

I am also heartened by progress on standardised or “plain” packaging – a measure introduced by the treaty and pioneered in Australia, where smoking rates have now fallen to record lows. The early evidence from Australia shows that plain packaging, as part of a comprehensive approach to tobacco control, is diminishing the appeal of tobacco products, increasing the effectiveness of health warnings and reducing the ability of the pack to mislead. France and the UK have begun implementing plain packaging laws, and New Zealand and Hungary have recently passed legislation. Many other countries are close behind.

We have made great strides, but we have so much more to do. Tobacco use remains one of the most vexing challenges we face in the global health arena.

I urge global leaders convening in India to see this moment as an opportunity to bend the course of public health history and commit to returning home with a renewed dedication to fully implement the WHO framework convention. To make the event effective, it is vital that governments recognise the inherent conflict between public health and the interests of the tobacco industry. Representatives from the latter should be completely excluded from government delegations.

Every death from tobacco is an avoidable tragedy. It is our task to reverse the tide, effecting an irreversible decline in the number of such deaths.

We need history to show us that the turning point in the tobacco epidemic is now. We know what to do and we know how to do it. We now need to ensure that every country moves forward and no one is left behind. Future generations depend on us.

Every tobacco death is an avoidable tragedy. The epidemic must stop here | Margaret Chan

Staggering New Data Shows Serious Depression Epidemic in America

This month, Mental Health America (MHA) shared some staggering new numbers related to depression in America.  In 2014, the nation’s community-based nonprofit leader in mental health support, recovery and advocacy began screening people for mental health issues using their online, scientifically-based mental health screening tools.

To this date, 1.7 million people took advantage of the screening opportunity.

Most noteworthy, the results of Mental Health America’s screening programs shed a light on the current depression epidemic in America and serve as a wake-up call to the country.

Depression in America

The depression screen is one of nine mental health screens provided online by Mental Health America.

Especially relevant results found by MHA’s depression screening:

• About 1,400 people screen for depression every day.

• Sixty-six percent of screeners are under 25; 32 percent are under 18.

• Fifty-nine percent report to having serious depression.

• The youngest screeners have the highest scores compared to any other age group — 37 percent of 11-17 year olds score in the range for severe depression.

• Thirty-two percent of all screeners report they have significant thoughts of suicide or self-harm.

• Among screeners who self-identify as youth and lesbian, gay, bisexual, and transgender, 41 percent score for severe depression.

After review, Mental Health America’s president and CEO, Paul Gionfriddo, emphasized the importance of these recent findings on depression in America.

“The sheer volume of individuals seeking mental health screening and supports is astonishing.  But when you couple this volume with these facts — that the depression screening tool is the most common screening tool they use; that most depression screeners are young; that two in every five depression screeners have severe depression; and that the majority of people coming to our screening program have never been diagnosed with a mental health condition — this is a national wake-up call.”

Mental Health Screening Programs

Mental Health America’s screening programs include anonymous, scientifically-based screens for depression, post-traumatic stress disorder (PTSD), bipolar disorder, anxiety, early psychosis, alcohol and substance use, a parent and youth screen, and a work health survey.

Furthermore, after an individual completes their screening, they receive immediate results, education, resources and linkage to MHA affiliates. Along with the results of their screens, the participants provide MHA with valuable demographic and survey responses that allow the organization to further support their mental health policy and education efforts.

Mr. Gionfriddo adds the need for improvement in mental health services.

“We must demand better mental health services — practitioners, employers, and educators need to offer mental health screening to all children and adults and policy makers must pass meaningful mental health reform legislation that emphasizes earlier detection and integrated services for recovery.”

Plans for the Future

MHA plans to launch a new “Screening-to-Supports,” (or S2S) initiative in the next year.  This new initiative will include informational and educational resources.  Plus, people will benefit from receiving referrals to services and supports.

In addition, people will monitor their mental health with do-it-yourself tools.  And engagement with others who are experiencing similar conditions is included in the S2S initiative.

Gionfriddo concluded as follows.

“S2S will use digital and other resources to help people in need onto pathways to recovery.  The reason is simple — because this is what 1.7 million screeners have asked from us. They want help, and we want to respond. This officially may be Mental Illness Awareness Week, but for us and for so many Americans, every day is Mental Health Day.  We need to address mental illness in this country Before Stage 4.”

Mental Health Screening Tools

In conclusion, one of the quickest and easiest ways to determine whether you are experiencing symptoms of a mental health condition is to use the mental health screening tools provided by Mental Health America.

Mental health conditions, like depression or anxiety, are real — they’re common and treatable. However, recovery is also possible.

Finally, following a screening, information, resources and tools are provided for you.  In addition, you can also discuss the screening results with your doctor or healthcare provider.

Staggering New Data Shows Serious Depression Epidemic in America

Back to sleep: the doctor who helped stem a cot death epidemic

Parenting manuals have a lot to answer for. They brought useful advice and reassurance, true. But along with those came an epidemic that killed tens of thousands of babies. Sudden infant death syndrome – Sids – is always a tragedy, but it is no longer commonplace. It became an epidemic between 1970 and 1991, and, at its peak, babies in some of the world’s richest countries were dying at the rate of one in every 250 live births each year. The rate in the last year for which figures were available in England and Wales only, 2013, is one in every 3,000.

The Back to Sleep campaign, launched in 1991, changed the advice on sleeping position from front to back, and has had a public health benefit comparable to such breakthroughs as the moment Victorian epidemiologist John Snow took the handle off the Soho water pump in 1854 and stopped a cholera outbreak in its tracks.

At the centre of the Sids revolution was Bristol doctor Peter Fleming. He is now semi-retired, but is currently exploring a link between subtle features of the newborn hearing test and arousal mechanisms that might answer the grievous unsolved riddle of why Sids happens.

In 1978 Fleming, who had qualified in Bristol, returned from a job at the Toronto children’s hospital in Canada with funding from the US National Institutes of Health that enabled him to set up his own respiratory lab. He wanted to look in particular at the relationship between breathing and temperature control in infants.

Prof Peter Fleming, whose research in the 1980s was crucial to the reduction of Sids death rates. Photograph: Martin Godwin for the Guardian

Fleming is both very clever – he has a PhD in nonlinear mathematical modelling, AKA chaos theory – and very humane. When he found that Bristol offered no counselling or support for families whose baby had died unexpectedly, he began to offer it himself. He saw the families in the emergency department and later in their homes and told them what was known – and how much was unknown – about what was then still widely called cot death.

“Lots of people still thought that the parents must be at fault in some way if their baby had died. They were made to feel very guilty. I wanted to get support, and information, to these families.”

The progress in public understanding is reflected in the change of terminology. When it was called cot death it was considered primarily a social problem, a parental failure that still carried a hint of the most unnatural of crimes, infanticide. When it became sudden infant death syndrome (or sudden unexplained/unexpected infant death syndrome, SUID), it became a medical problem that was capable of scientific resolution.

Early in the 1970s, a US congressional committee called it “one of the last great unresolved childhood catastrophes” and announced federal funding. Meanwhile, bereaved parents were organising too. In 1971 the Foundation for the Study of Infant Deaths was set up in the UK by a grandmother determined to explain her grandson’s death. (It recently rebranded itself as The Lullaby Trust, because it believed its previous name was too austere and off-putting.) A decade later there was an international federation of similar organisations. In 1984, Fleming, working closely with the trust, set up the Avon infant mortality programme.

“I didn’t look at the sleeping position. But in 1987, with two colleagues, I started a temperature and infection study, and we did include the sleeping position, because scientists in the Netherlands and Australia had no data but they did have a lot of careful observation that made them think it was important.” Far from starting his study in equipoise, with a mind open to every possibility, Fleming only considered the sleeping position question in order to exclude it.

There were no immediately definitive results. “It was incremental. Very few things are ever black and white. It is rarely clear-cut. It is about changing the risk,” Fleming says. This is why the maths matters. “You have to try to understand complexity. You have to see whether a small change can make a difference.”

It helped that, like many of the Bristol families whose experiences were central to Fleming’s research, he came from a working-class family. He grew up in Medway in Kent, where his father worked in the naval dockyard and his mother in the office of a local factory.

For his study, Fleming and his team talked to the bereaved families as soon as possible after the death, to gather information about the baby and the family, what they normally did, what might have been different – all the variables that might have influenced the outcome. He promised the families that they would know the results of his research before it was published: “It’s really important that the people involved feel they own the work. It is a collaborative effort. I want to work with people, not instruct them.”

GPs, midwives and health visitors were all involved. If a GP got a call about a dead or an unresponsive baby, their next call would be to Fleming. “I spent a lot of time with just-bereaved families in council houses. It didn’t bother me, because I was not inclined to see them as different from myself.”

Over the next two years, he and his team gathered data from 70 bereaved families, and from another 140 families whose babies had been born very close to the time of a Sids baby. The control group were identified by asking the health visitor for the details of the two babies next on their list. They were “the babies next door”. “There was 99% collaboration from the families,” Fleming said. “People were very, very positive about wanting to do something.”

The team was confident that their population-based study, with a control group drawn from the same population, at the same time, was as close as possible to achieving the holy grail of true comparability. Yet despite their confidence in the robustness of their data, presenting the preliminary results at the first ever meeting of the International Society for the Prevention and Investigation of Perinatal and Infant Deaths in March 1989 was a nerve-racking moment. Fleming’s findings were received by his knowledgeable audience with incredulity. “They could not accept that something so simple could be so important,” he says.

It was like being asked to believe two impossible things before breakfast. Here was a non-medical intervention that could, for no clear reason, stop babies dying of a syndrome that was also unexplained. But Fleming believed it himself. And when he went back to do a bigger study in Bristol, he found that health professionals who already knew of his findings were advising all new mothers to put their babies on their back to sleep.

Understandably, bereaved families whose babies died after Fleming’s first study believe his results should have been publicised at once. But “Nice [the National Institute for Health and Care Excellence] would have laughed at my research. They want things done properly – randomised control trials and all that sort of thing. It wasn’t enough to convince scientific colleagues, and it certainly wouldn’t meet the standards for any public health campaign,” he says.

Fleming published his paper in the British Medical Journal and went back to do more research. Soon, a New Zealand study [pdf download] produced similar findings. The quest now was for evidence with which to argue for a new public health campaign. Unable to conduct a study with a bigger sample in Bristol because newborns were no longer being put to sleep on their fronts as a result of his first findings, instead Fleming found himself conducting a self-initiated, population-wide observational study of newborn babies sleeping on their backs. As his first study predicted, the number of Sids deaths fell from around one a week to less than one a month, and then to just three a year. While he was in the midst of the long process of getting this study published in the Lancet, another family’s tragedy tipped the whole project into the headlines.

Anne Diamond, whose four-month-old son died in 1991. She spearheaded the Back to Sleep campaign, which led to Sids deaths falling dramatically. Photograph: Karen Robinson for the Observer

In July 1991, Sebastian, the four-month-old son of Anne Diamond – then a household name with a daily TV show – died in his cot. Diamond’s response was to use all her fame and journalistic experience to investigate what people knew about why it had happened. When she met Fleming, and learned of the findings in the Avon and New Zealand studies, she marched on the Department of Health.

She galvanised the health secretary, Viriginia Bottomley, into accepting the need for a strong public health message. In December 1991 the Back to Sleep campaign was launched. Sids deaths in the UK fell instantly, and with astonishing speed. In 1989 there were 1,545 Sids deaths. Now there are barely 200 a year.

The Sids epidemic can be dated from the time it first appeared on death certificates in 1970, until the public health campaign in 1991. In Britain alone, it probably cost 10,000 lives. It is still hard to explain how it happened. The first recorded advice to put babies to sleep on their front is from 1943. Dr Spock changed his advice to recommend front sleeping between the first and second editions of his famous handbook in 1955.

Some studies associate the syndrome with the rise of the parenting expert, others with the industrialisation of baby care that turned it into a round of bottle-feeding and rigid routines. Others point to the fading respect for culture and experience. The only medical evidence for the benefit of front sleeping came from studies of very premature babies who are still put face down; but even they are never now sent home until they can breathe well enough to prosper on their backs. It was a tragic lesson in the danger of taking a small, sick subset of a population and extrapolating a public health message for well babies.

The architectural writer Gillian Darley lost her son Joseph when he was 11 weeks old, during a midday sleep on a cold, murky day in early April nearly 30 years ago. “I was visiting a friend. He was in his moses basket. I don’t remember being told what to do, it was just what everyone did,” she says. “It was received wisdom. The underlying thing is – like those terrible stories of children who disappear on their gap year and whose bodies are never found – the lack of closure. It’s not a constant presence, but if it was possible to say what was the trigger, it would take a whole load off my subconscious.”

Understanding that trigger is no closer. But the risk factors are now well understood: maternal smoking and co-sleeping. No one questions the former. Co-sleeping, however, has become the subject of intense controversy, not least because warnings of the dangers of taking babies into their parents’ beds has led some mothers to choose instead to nurse babies on sofas, where accidents such as suffocation are more likely. Fleming believes the direct risk from co-sleeping is very small, but the Lullaby Trust takes the view that, like advertising, public health cannot do complexity, and so continues to warn against co-sleeping.

Sids was once a curse that struck randomly across classes. Now it hits in wildly disproportionate numbers the poorest, least-educated families. More than 70% of deaths now occur in poor households, and often to young mothers.

Francine Bates, Lullaby’s chief executive, says that justifies sticking to one clear, simple message: don’t smoke, don’t co-sleep.

“It’s fundamentally wrong and preventable that it’s poor babies who are dying now,” she says. “It’s unacceptable. We’ve still got a job of work to do. Behind the statistics, there are still hundreds of babies, and hundreds of devastated families.”

Back to sleep: the doctor who helped stem a cot death epidemic

Think the Aids epidemic is over? Far from it – it could be getting worse | Sarah Boseley

Sixteen years ago, an 11-year-old boy and a judge alerted a shocked world to the terrible reality of Aids in Africa, where hospitals were overflowing with the dying and children were orphaned.

Related: Hope for ‘end of Aids’ is disappearing, experts warn

The international Aids conference, held in 2000 in Durban, KwaZulu-Natal – the world’s worst-hit region – was billed as a scientific meeting. It became a week-long, vibrant, impassioned, singing, dancing, drumming and marching mass rally. Scientific neutrality disappeared as researchers became campaigners too.

The cry was for drugs to save lives. It was too late for Nkosi Johnson, the boy who spoke at the opening ceremony. He died the next year. Judge Edwin Cameron stunned his native South Africa by declaring he was gay and HIV positive, and said it was iniquitous that he could buy drugs from Europe or the US to save his own life while his countrymen and women died in their thousands. Nelson Mandela called on the world to act.

Their calls were heard. Campaigners, in collusion with generic drug makers, brought down the price of a three-drug cocktail to suppress the virus and keep people well, the cost dipping from $ 10,000 a year then to $ 100 (£76) today. Last week the conference was back in Durban, with 17 million people on treatment. But it’s not over. Far from it. There is a real possibility that Aids will re-emerge as the mass killer it was at the turn of this century.

It is a complete crisis. The message of the conference is that there is all this hope – and it is not sustainable

Deenan Pillay, virologist

There are about 38 million people with HIV, so more than 20 million are not yet on treatment. About 2 million more get infected every year. Antiretroviral drugs not only keep people well but also stop them being infectious. The World Health Organisation now advises that anyone with HIV should take drugs as quickly as possible, not just for their health but to protect their sexual partners. In September, South Africa will introduce test and treat.

However, this year’s conference heard disturbing news from researchers at the Wellcome-funded Africa Centre for Population Health in KwaZulu-Natal, which has been trialling test and treat in a population where nearly one in three people have HIV. They found that while most people agreed to be tested by health workers visiting their homes, only half of those who were diagnosed with HIV then went to a clinic to get the treatment that would stop them infecting their partners.

Test and treat

A sugar cane farmer gets tested for HIV by an MSF health worker in Gwegwe on the outskirts of Eshowe, 2014. Photograph: Gianluigi Guercia/AFP/Getty Images

In Eshowe, a town of 14,000 people set among rolling hills and sugar plantations, Médecins Sans Frontières has been pioneering testing by health workers who go door to door. MSF has also opened testing booths next to the butcher’s and by the taxi rank, where working men pass by on payday. They have found the same thing as the researchers in KwaZulu-Natal. They can get high proportions of people tested – but not to the clinic to get the drugs.

“We give them referral letters to the clinic. Then you find they don’t go,” says Babongile Luhlongwane, who walks miles every day on rough tracks with her kit in a backpack to reach those who live in this rural community. “Last Monday I had three men who tested positive. Two went to the clinic. The other said he didn’t have time.”

Dr Carlos Arias leads MSF’s initiative to set up monthly clinics on sugar plantations, testing workers for HIV and delivering medication. He says they see people with Aids who have virtually no immune system left.

Related: Village girls fight scourge of the ‘blessers’ – whose gifts ruin their lives

South African guidelines say people should be treated when their CD4 count – a measure of the strength of their immune system – drops below 500. “We see CD4 counts of less than 100 – CD4s of five or six,” he says. A serious infection would kill them. He tells of one man who arrived with a CD4 of 13 but did nothing about it. Two years later he was tested again and had a CD4 of 8. That means the virus in his body will be rampant and he will be highly infectious to a sexual partner. “HIV prevalence here is enormous,” he says. “In KwaZulu-Natal, among women aged 15 to 29, it is 56.8%.”

The Africa Centre trial in northern KwaZulu-Natal compared what happened in 22 clusters of 1,000 people: half were randomly allocated to test and treat, half told they would be given drugs when their CD4 count dropped below 350 (500 when government guidelines later changed). The trial set up a mobile clinic in each of the 22 clusters.

The trial investigated whether immediate treatment led to a drop in the numbers becoming infected. The answer, to their dismay, was no.

“Disappointingly, we found no difference in the number of new infections between these two randomised sets of clusters,” says Deenan Pillay, director of the Africa Centre and professor of virology at University College London.

Sex in the cities was an issue. People were travelling away from home into Durban and Johannesburg a lot more than expected, and having sex there. But more problematic are the social and cultural mores that have long beset HIV response in Africa. Far fewer men went to the clinics for treatment than women. “It is a hierarchical society. It is about being seen to be positive. There is stigma associated with it,” says Pillay.

He has been working with this community for more than 10 years, he says, and saw the huge change when people stopped dying. “Treatment was first used for people who were very ill and dying – and they lived. Now we talk about people who appear well and look well and you are asking them to medicalise themselves, to go to this government clinic where you have to queue up all day and you see other people you know there.”

An MSF mobile clinic to test people for HIV in Ngudwini, on the outskirts of Eshowe, 2014. Photograph: Gianluigi Guercia/AFP/Getty Images

Pillay thinks more must be done to target the sugar daddies or “blessers” – the older, working men who give gifts and money to impoverished young girls in exchange for sex. About 60% of new cases are women. “It is horrendous. In our setting, a 15-year-old girl today has an 80% chance of being infected in her lifetime,” he says. At antenatal clinics where pregnant women are all tested for HIV, half are positive.

The government has launched a campaign telling young girls not to sleep with older men. But, says Pillay, “the real problem is the men who are not being tested and treated”.

“It is a complete crisis. The message of the conference is that there is all this hope – and it is not sustainable.”

Cost is a huge and growing issue. If test and treat worked, it would slash the bills by preventing new infections. But that assumption now seems premature and funding from donors has dropped for the first time. A report by the Kaiser Family Foundation and UNAids says they gave $ 7.5bn last year, compared with $ 8.6bn in 2014.

The drugs bill is going to rise dramatically, not just because of the increase in infections and the fact that everybody must take antiretroviral therapy for life, but also because resistance is spreading to the basic three-drug combination available in Africa for as little as $ 100 a year. Hospital beds are once more taken up by Aids patients whose treatment has failed. Africa cannot afford the newer drugs available in Europe and the US.

MSF has found resistance levels to the basic combination of 10% in its South Africa projects. There has been worse news in other parts of Africa. A study covering Kenya, Malawi and Mozambique found 30% of people on second-line treatment, which costs at least $ 300, were resistant. The lowest cost of a third-line drug regime – or salvage therapy – in Africa is $ 1,859 a person annually.

“I think we are seeing the tip of the iceberg,” says Dr Vivian Cox of MSF. “A lot of countries are not doing routine viral load monitoring in the first place. They are moving towards it and then you can imagine what they will find.”

Youth focus

Related: Under the shadow of ‘dirty’ HIV, South African children offered a refuge

Nobody at this year’s conference was talking about the end of Aids, as they were only four years ago when the conference was held in Washington DC. Bill Gates expressed real concern. If it is difficult now to treat and prevent HIV infections, he said, the demographic bulge could make things worse.

“If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak,” Gates said. “We have to do an incredible amount to reduce the incidence of the number of people getting the infection. To start writing the story of the end of Aids, new ways of thinking about treatment and prevention are essential.”

A vaccine is still a long way off. Pre-exposure prophylaxis works for the partners of people with HIV in the global north. Taking an antiretroviral drug guards them against infection. But that looks very hard to implement for young women in Africa who barely own their own bodies and could face accusations of either having HIV or being a prostitute.

There are brave attempts to change behaviour and the subservience of women and girls. Actor Charlize Theron is funding projects to educate, help and support young people. MTV’s Staying Alive Foundation is attempting to reach young people through its mass media campaign Shuga, sharing the sexual lives of more affluent young Africans. After two series in Kenya and two in Nigeria, the fifth will be filmed in South Africa.

Surveys carried out in South African schools to determine the issues facing 14- to 20-year-olds before the new series offer a glimpse of the dangers they face. A third of girls said a girl does not have the right to ask a boy to stop kissing her. A quarter of the boys said they had “sexually forced” someone. A fifth of the girls said they were sexually active and most of those had been forced into sexual activity at some point.

Charlize Theron visits a project to create youth ambassadors in KwaZulu-Natal in 2013. Photograph: Justin Barlow/Getty Images/The Global Fund

“The figures point to 86% of sexually active girls experiencing being sexually forced by their boyfriends,” say the researchers. “These figures … reflect a need to understand what is going on within heterosexual relationships and the experience and position of risk within those relationships. It also calls for HIV prevention efforts to help build safe and supportive norms within relationships.”

Of the girls among the 3,000 students surveyed in three provinces over two years, 15% said they had been pregnant – which equates to 70% saying they are sexually active. Nearly half the young people – 46% – said a young couple who went public about one of them becoming HIV positive would be openly judged and 4% thought they would be physically harmed. “This indicates the fear-filled environment South African young people are still growing up in when it comes to HIV,” says the report. “Fear keeps people silent and silence feeds everyone’s risk for HIV and for not getting the care and support they require to address HIV infection.”

Research is showing that Shuga does have an impact on young people’s behaviour. “Where we see behaviour change work really well is when the audience see their own lives reflected in the storylines,” says Georgia Arnold, executive director of the MTV Staying Alive Foundation, who says she wants to get a DVD to every one of the 6 million high school students in South Africa.

“We’ve had a recent World Bank study that was done on … series four in Nigeria. It was a random, cluster study of 5,000 young people and what it proved was that if you watched MTV Shuga you are twice as likely to get tested for HIV.”

The biggest challenge in fighting HIV is stopping people becoming infected. Photograph: Steve Forrest/International Aids Society

Behaviour change could stop the epidemic – although it is not doing so in Europe or the US – and initiatives could help improve young people’s lives. But it is difficult and slow. Aids will be with us for far longer than anybody used to imagine.

Professor Peter Piot, the first head of UNAids and director of the London School of Hygiene & Tropical Medicine, says the biggest challenge is keeping people from being infected. “It is as if we’re rowing in a boat with a big hole and we are just trying to take the water out. We’re in a big crisis with this continuing number of infections and that’s not a matter of just doing a few interventions.

“We will not end HIV as an epidemic just by medical means. People are not robots. Sex happens in a context. It is about power. Southern African girls and young women are infected by men who are much older than themselves. It’s about poverty. It’s also about a culture of machismo. There are also gay men all over the world who are discriminated against and underground, and there’s no way you can prevent infections if something is underground.”

He believes that it was a mistake to foresee the end of the epidemic a few years ago. “I don’t believe the slogan ‘the end of Aids by 2030’ is realistic and it could be counter-productive. It could suggest that it’s fine, it’s all over and we can move to something else. No. Aids is still one of the biggest killers in the world.”

Think the Aids epidemic is over? Far from it – it could be getting worse | Sarah Boseley