What is Defined Daily Dose?

Introduction

The defined daily dose (DDD) is a statistical measure of drug consumption, defined by the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology (WHOCC).

It is defined in combination with the ATC Code drug classification system for grouping related drugs. The DDD enables comparison of drug usage between different drugs in the same group or between different health care environments, or to look at trends in drug utilisation over time. The DDD is not to be confused with the therapeutic dose or prescribed daily dose (PDD), or recorded daily dose (RDD), and will often be different to the dose actually prescribed by a physician for an individual person.

The WHO’s definition is: “The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.” The Defined Daily Dose was first developed in the late 1970s.

Assignment

Before a DDD is assigned by the WHOCC, it must have an ATC Code and be approved for sale in at least one country. The DDD is calculated for a 70kg adult, except if this drug is only ever used in children. The dose is based on recommendations for treatment rather than prevention, except if prevention is the main indication. Generally there is only one DDD for all formulations of a drug, however exceptions are made if some formulations are typically used in significantly different strengths (e.g. antibiotic injection in a hospital vs tablets in the community). The DDD of combination tablets (containing more than one drug) is more complex, most taking into account a “unit dose”, though combination tablets used for high blood pressure take the number of doses per day into account.

The formula for determining the dose is:

  • If there is a single recommended maintenance dose in the literature, this is preferred.
  • :If there are a range of recommended maintenance doses then
    • If the literature recommends generally increasing from initial to maximum dose provided it is tolerated, pick the maximum dose.
    • If the literature recommends only increasing from an initial dose if not sufficiently effective, pick the minimum dose.
    • If there is no guidance then pick the mid point between the dose range extremes.

The DDD of a drug is reviewed after three years. Ad hoc requests for change may be made but are discouraged and generally not permitted unless the main indication for the drug has changed or the average dose used has changed by more than 50%.

Limitations

The DDD is generally the same for all formulations of a drug, even if some (e.g. flavoured syrup) are designed with children in mind. Some types of drug are not assigned a DDD, for example: medicines applied to the skin, anaesthetics and vaccines. Because the DDD is a calculated value, it is sometimes a “dose” not actually ever prescribed (e.g. a midpoint of two prescribed tablet strengths may not be equal to or be a multiple of any available tablet). Different people may in practice be prescribed higher or lower doses than the DDD, for instance in children, people with liver or kidney impairment, patients with a combination therapy, or due to differences in drug metabolism between individuals or ethnicities (genetic polymorphism).

Although designed primarily for drug utilisation research, data using the DDD can only give a “rough estimate” compared with actually collecting statistics on drug use in practice. The DDD is often use for long term research and analysis of drug utilisation trends over time, so changes to the DDD are avoided if possible, whereas changes in the actual daily dose prescribed for a population may often occur. For example, the Recorded Daily Dose (RDD) of simvastatin in Canada in 1997 was only 8% different to the DDD, but by 2006 it was 67% different. In 2009, the DDD of several statins were updated, with simvastatin changing from 15mg to 30mg.

The DDD is based on the maintenance dose, but in practice patients in a population will be on a mix of initial and maintenance doses.

Use and Misuse

The DDD can be used as the basis for calculating various indicators of drug utilisation. The indicator DDD per 1000 inhabitants per day can suggest what portion of a population are regularly using a drug or class of drugs. The indicator DDD per 100 bed days estimates on average how many inpatients are given a drug every day in hospital. The indicator DDDs per inhabitant per year can be used for drugs normally prescribed for short treatment duration (e.g. antibiotics) to indicate the average number of days in a year a person may take that treatment. The extent to which estimates using DDD reflect actual clinical practice depends on how close the DDD is to the typical prescribed dose in that country or setting and at that point in history.

Because the primary purpose of the ATC/DDD system is drug consumption measurement, the WHO recommend caution when considering its use for cost analysis: “DDDs, if used with caution can be used to compare, for example, the costs of two formulations of the same drug.” So, the cost per DDD of an extended-release tablet taken once a day compared with a standard tablet taken twice a day, may indicate the extended-release tablet costs much more to treat the same condition.

In contrast, using DDD to compare the cost of different drugs or drug groups is “usually not valid” according to the WHO. They recommend that “DDDs are not suitable for comparing drugs for specific, detailed pricing, reimbursement and cost-containment decisions”. The DDD may not necessarily compare well with the actual PDD, and two drugs in the same ATC group may not be equally effective at their DDD.

For example, an analysis of statin use in the Ontario Drug Benefit Programme, 2006-2007. The average cost per DDD of rosuvastatin was 21% more expensive than atorvastatin ($1.14 compared to $0.94), which would suggest the shift at the time from prescribing atorvastatin to prescribing rosuvastatin would result in increased costs to the healthcare budget. Both had a DDD at that time of 10mg, but 10mg was not the only dose prescribed. For example, atorvastatin once daily at 10mg, 20mg, 40mg and 80mg was prescribed 45%, 36%, 16% and 3% of the time respectively. If one compared cost per unit (daily tablet) then rosuvastatin was instead 24% cheaper than atorvastatin ($1.44 vs $1.90), and if one compares cost per RDD (recorded daily dose) then rosuvastatin was 26% cheaper than atorvastatin ($1.43 vs $1.93). An erroneous conclusion of a healthcare budget cost increase arises in this case from using cost per DDD. At the time, the RDD of rosuvastatin was similar to its DDD (12.6 mg vs 10mg), but the RDD of atorvastatin was twice its DDD (20.6 mg vs 10mg). The DDD of atorvastatin was revised in 2009 to 20mg.

The Canadian Patented Medicine Prices Review Board analysed the use of DDD for drug utilisation and cost analysis and offered recommendations. They particularly concentrated on the problems that occur when the RDD observed in the population deviates more than minimally from the DDD. They conclude that the DDD methodology “should generally not be used to interpret Canadian drug utilisation; should generally not be applied in cost analyses; and should generally not be applied in policy decisions”. The Board recommend that provided the agreement between DDD and RDD is known and minimal, then a cost per DDD “can provide a rough idea of the treatment cost” but “caution should still be used, as misinterpretation of the results based on the DDD methodology may still occur”. If the agreement between DDD and RDD is unknown or a significant disagreement is known, then the DDD methodology “should not be used in cost analyses”. In all cases, the Board state “The DDD methodology should not be used in guiding policy decisions regarding reimbursement, therapeutic substitution and other pricing decisions”.

Example

If the DDD for a certain drug is given, the number of DDDs used by an individual patient or (more commonly) by a collective of patients is as follows.

Drug usage (in DDDs) = (Items issued x Amount of drug per item) divided by DDD.

For example, the analgesic (pain reliever) paracetamol has a DDD of 3 g, which means that an average patient who takes paracetamol for its main indication, which is pain relief, uses 3 grams per day. This is equivalent to six standard tablets of 500 mg each. If a patient consumes 24 such tablets (12 g of paracetamol in total) over a certain span of time, this equals a consumption of four DDDs.

Drug usage in DDDs = (24 (items) x 500 (mg/item)) divided by 3000 mg = 4

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Defined_daily_dose >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Anatomical Therapeutic Chemical Classification System?

Introduction

The Anatomical Therapeutic Chemical (ATC) Classification System is a drug classification system that classifies the active ingredients of drugs according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties.

Its purpose is an aid to monitor drug use and for research to improve quality medication use. It does not imply drug recommendation or efficacy. It is controlled by the World Health Organisation Collaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.

Brief History

The ATC system is based on the earlier Anatomical Classification System, which is intended as a tool for the pharmaceutical industry to classify pharmaceutical products (as opposed to their active ingredients). This system, confusingly also called ATC, was initiated in 1971 by the European Pharmaceutical Market Research Association (EphMRA) and is being maintained by the EphMRA and Intellus. Its codes are organised into four levels. The WHO’s system, having five levels, is an extension and modification of the EphMRA’s. It was first published in 1976.

Coding System

This pharmaceutical coding system divides drugs into different groups according to the organ or system on which they act, their therapeutic intent or nature, and the drug’s chemical characteristics. Different brands share the same code if they have the same active substance and indications. Each bottom-level ATC code stands for a pharmaceutically used substance, or a combination of substances, in a single indication (or use). This means that one drug can have more than one code, for example acetylsalicylic acid (aspirin) has A01AD05 (WHO) as a drug for local oral treatment, B01AC06 (WHO) as a platelet inhibitor, and N02BA01 (WHO) as an analgesic and antipyretic; as well as one code can represent more than one active ingredient, for example C09BB04 (WHO) is the combination of perindopril with amlodipine, two active ingredients that have their own codes (C09AA04 (WHO) and C08CA01 (WHO) respectively) when prescribed alone.

The ATC classification system is a strict hierarchy, meaning that each code necessarily has one and only one parent code, except for the 14 codes at the topmost level which have no parents. The codes are semantic identifiers, meaning they depict information by themselves beyond serving as identifiers (namely, the codes depict themselves the complete lineage of parenthood). As of 07 May 2020, there are 6,331 codes in ATC; the table below gives the count per level.

ATC LevelCodesDifferent Names/Pharmaceuticals
11414
29494
3267262
4889819
550674363

Classification

In this system, drugs are classified into groups at five different levels.

First Level

The first level of the code indicates the anatomical main group and consists of one letter. There are 14 main groups:

CodeContents
AAlimentary tract and metabolism
BBlood and blood forming organs
CCardiovascular system
DDermatologicals
GGenito-urinary system and sex hormones
HSystemic hormonal preparations, excluding se hormones and insulins
JAnti-infectives for systemic use
LAntineoplastic and immunomodulating agents
MMusculo-skeletal system
NNervous system
PAntiparasitic products, insecticides, and repellents
RRespiratory system
SSensory organs
VVarious

Second Level

The second level of the code indicates the therapeutic subgroup and consists of two digits.

  • Example: C03 Diuretics.

Third Level

The third level of the code indicates the therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03C High-ceiling diuretics.

Fourth Level

The fourth level of the code indicates the chemical/therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03CA Sulfonamides.

Fifth Level

The fifth level of the code indicates the chemical substance and consists of two digits.

  • Example: C03CA01 furosemide.

Other ATC Classification Systems

ATCvet

The Anatomical Therapeutic Chemical Classification System for veterinary medicinal products (ATCvet) is used to classify veterinary drugs. ATCvet codes can be created by placing the letter Q in front of the ATC code of most human medications.

  • For example, furosemide for veterinary use has the code QC03CA01.

Some codes are used exclusively for veterinary drugs, such as QI Immunologicals, QJ51 Antibacterials for intramammary use or QN05AX90 amperozide.

Herbal ATC (HATC)

The Herbal ATC system (HATC) is an ATC classification of herbal substances; it differs from the regular ATC system by using 4 digits instead of 2 at the 5th level group.

The herbal classification is not adopted by WHO. The Uppsala Monitoring Centre is responsible for the Herbal ATC classification, and it is part of the WHODrug Global portfolio available by subscription.

Defined Daily Dose

The ATC system also includes defined daily doses (DDDs) for many drugs. This is a measurement of drug consumption based on the usual daily dose for a given drug. According to the definition, “[t]he DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.”

Adaptations and Updates

National issues of the ATC classification, such as the German Anatomisch-therapeutisch-chemische Klassifikation mit Tagesdosen, may include additional codes and DDDs not present in the WHO version.

ATC follows guidelines in creating new codes for newly approved drugs. An application is submitted to WHO for ATC classification and DDD assignment. A preliminary or temporary code is assigned and published on the website and in the WHO Drug Information for comment or objection. New ATC/DDD codes are discussed at the semi-annual Working Group meeting. If accepted it becomes a final decision and published semi-annually on the website and WHO Drug Information and implemented in the annual print/on-line ACT/DDD Index on 01 January.

Changes to existing ATC/DDD follow a similar process to become temporary codes and if accepted become a final decision as ATC/DDD alterations. ATC and DDD alterations are only valid and implemented in the coming annual updates; the original codes must continue until the end of the year.

An updated version of the complete on-line/print ATC index with DDDs is published annually on 01 January.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Pan American Health Organisation?

Introduction

The Pan American Health Organisation (PAHO) is an international public health agency working to improve the health and living standards of the people of the Americas.

It is part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organisation (WHO) and as the health organisation of the Inter-American System. It is known in Latin America as the OPS or OPAS (Spanish: Organización Panamericana de la Salud; Portuguese: Organização Pan-Americana da Saúde).

Brief History

The organisation was founded in December 1902. It was originally called the Pan-American Sanitary Bureau.  In 1949, PAHO and WHO signed an agreement making PAHO the American Regional Office (AMRO) of WHO. Today the usual phrasing is “Regional Office for the Americas”. The first hemisphere-wide effort to eradicate smallpox was made in 1950 by the PAHO. The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.

Background

PAHO has scientific and technical expertise at its headquarters, in its 27 country offices, and its three Pan American centres, all working with the countries of the Americas in dealing with priority health issues. The health authorities of PAHO’s Member States set PAHO’s technical and administrative policies through its Governing Bodies. The PAHO Member States include all 35 countries in the Americas; Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are the Participating States, and Portugal and Spain are the Observer States.

The Organization’s essential mission is to strengthen national and local health systems and improve the health of the peoples of the Americas, in collaboration with Ministries of Health, other government and international agencies, non-governmental organisations (NGO), universities, social security agencies, community groups, and many others.

PAHO promotes universal health coverage and universal access to health and strengthening of health systems based on primary health care strategies. It assists countries in fighting infectious diseases such as malaria, cholera, dengue, HIV and tuberculosis as well as the region’s growing epidemic of noncommunicable diseases such as cardiovascular disease, cancer and diabetes. PAHO engages in technical cooperation with ministries of health and facilitates coordination with other sectors to promote health in all policies. PAHO also promotes the use of research evidence to inform health care decisions and policymaking through the implementation of knowledge translation strategies such as the Evidence-Informed Policy Network – EVIPNet Evipnet. Through the Elimination Initiative, it targets HIV/AIDS.

In its efforts to improve health, PAHO targets the most vulnerable groups including mothers and children, workers, the poor, the elderly, and refugees, and displaced persons. It focuses on issues related to equity for those who lack access to health, and on a Pan American approach, encouraging countries to work together on common issues and build lasting capacities.

Specific initiatives spearheaded by PAHO include the Expanded Programme on Immunisation, which played a major role in the elimination of smallpox and polio from the Americas; the Tobacco-free Americas initiative; the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola; the Salt Smart Consortium; the Pan American Network for Drug Regulatory Harmonization; and a blood safety initiative that seeks to improve blood safety and efficiency by helping countries reach 100% blood supplies from unpaid voluntary donors.

A major priority for the Americas is cutting infant mortality, and PAHO is mobilising new political, institutional, and financial resources to prevent an additional 25,000 infant deaths every year through the application of the Integrated Management of Childhood Illness strategy, a simple and practical approach in which primary health care workers are taught a complete process to evaluate the health status of children brought to a health post or clinic. They learn to recognise signs of disease and evaluate and treat them. They learn to give parents information on how to prevent disease in the home. If they see danger signs indicating the infant could die, they are taught to treat the child immediately or take him or her to a hospital.

Improvement of drinking water supplies, adequate sanitation, and increased access to health care for the poor are still top priorities for PAHO, with a focus on equity. The Organisation is intensifying its efforts to have countries know the true state of health of their populations and where the inequalities lie. Programme efforts focus on correcting inequality, taking into account decentralisation and change of state functions, on showing that health has a role to play in the success of other sectors, and on how attention to health affects positively other aspects of human development. Advocacy in this area is also directed to reducing pernicious gender inequity, which reflects in some health problems of women.

The Pan American approach is a part of PAHO history and the spirit of Panamericanism continues to stimulate technical cooperation among countries in health. PAHO has helped countries work together toward common goals, and to initiate multi-country health ventures in Central America, the Caribbean, the Andean Region, and the Southern Cone. Experience has shown practical benefits such as the solidarity that helped Central America after hurricane Mitch, and there are numerous other examples. Health collaboration found expression at the highest political level when American heads of state in their Summit in Santiago accepted a health initiative called “Health Technology Linking the Americas.”

The countries of Latin America and the Caribbean joined together over 20 years ago to buy vaccines through a revolving fund, bringing them tangible benefits and helping advance PAHO’s efforts to eliminate or control vaccine-preventable diseases. These are among the Organisation’s most notable successes, starting with the eradication of smallpox from the Americas in 1973; a triumph followed five years later by global eradication of the dreaded disease.

A major effort committing the Americas to embark on polio eradication in 1985 succeeded in September 1994, when a distinguished International Commission declared the Americas officially polio-free. The last case of polio in the Americas was identified on August 23, 1991, in a young boy named Luis Fermín Tenorio Cortez, in Junín, Peru. Since then, despite intensive surveillance, no cases of polio have been detected anywhere in the Americas, and the WHO is now working toward the goal of eradicating polio globally. PAHO assists the countries in mobilising the necessary resources to provide immunisation and treatment services for all vaccine-preventable diseases. PAHO is close to accomplishing the goal of eliminating measles from this hemisphere and is pressing on with the introduction of new vaccines that are currently available, such as Haemophilus influenzae B. to reduce meningitis and respiratory infections. PAHO works to reduce the toll of death and illness from diarrheal diseases, including cholera, through case management and oral rehydration therapy to prevent deaths from dehydration, and to provide adequate diagnosis and treatment of acute respiratory infections, thus saving the lives of hundreds of thousands of children each year.

PAHO disseminates scientific and technical information through its publications program, its Internet site, and a network of academic libraries, documentation centres, and local health care libraries.

The Organisation provides technical collaboration in a variety of specialised public health fields and organises emergency preparedness and disaster relief coordination. It supports efforts to strengthen national health systems, develop national health research systems, control malaria, Chagas’ disease, urban rabies, leprosy, and other diseases that affect the people of the Americas. PAHO collaborates with governments, other agencies, and private groups to address major nutritional problems including protein-energy malnutrition, and is now working to eliminate iodine and vitamin A deficiencies.

It engages in and facilitates health promotion to help countries deal with health problems typical of development and urbanisation, especially non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, accidents, smoking, addiction to drugs and alcohol, and injuries among others. Beyond health promotion, PAHO also addresses health systems and quality of care issues in support of national efforts to respond to the NCD pandemic.

The Organisation also executes projects for other United Nations agencies, for international organisations such as the World Bank and Inter-American Development Bank, for official development cooperation agencies of various governments, and for philanthropic foundations.

PAHO strengthens the health sector capacity in the countries to advance their priority programmes through intersectoral action, promoting an integrated approach to health problems. It also works to improve women’s health, promoting the greater integration of women in society, as well as awareness of their importance as both recipients and providers of health services.

PAHO trains health workers at all levels, through fellowships, courses and seminars, and the strengthening of national training institutions. It leads to the use of advanced communications technologies for information, health promotion, and education, working with journalists in many countries.

The Organisation recognises the role of the private sector in the delivery of services and fosters dialogue and partnerships with the Ministries of Health. In addition to its core budget financed by quota contributions from its Member Governments, PAHO also seeks outside funding to help implement special programmes and initiatives in response to vital health needs. Voluntary tax-deductible contributions for PAHO health and education projects in the Americas may be made to the PAHO Foundation.

Headquarters Building

In March 1960, President Eisenhower signed into law a bill passed by the US Congress authorising the US government to purchase and donate a lot for the PAHO headquarters in Washington, D.C. At the meeting of its Executive Committee in April 1960, the PAHO decided to accept the USG’s offer and set forth parameters for proceeding with the project of a new headquarters building. PAHO decided to use an international open competition as the means of selecting an architect for the project, following the recent successful model of other international organisations (most notably the United Nations New York headquarters inaugurated in 1952, and the UNESCO Paris headquarters in 1953 – both resulting in landmark designs of modernist architecture). PAHO framed the competition based on standards developed by the International Union of Architects and determined that the competition should be open to architects from all countries of the Americas. The vision was that “the new building should be a monument to international health cooperation.”

Following a review of 58 entries, the PAHO in October 1961 declared Uruguayan architect Román Fresnedo Siri the winner of its competition. At the ceremony announcing him as a winner, the organization’s Director Abraham Horwitz said “this beautiful building will become a monument to the ideal of better health for the peoples of the Americas.” He described the winning design as one of “both grace and utility,” and said, “it reflects the high ideals of the Pan-American spirit in an age when we must move ahead to build a better future for our peoples.”

The building was designed in a modernist style by Fresnedo Siri in part as a tribute to Le Corbusier, a key influence on Fresnedo Siri’s work. Constructed in 1965, the exterior features 29 round bronze seals of the founding nations of the Pan American Health Organisation set in black stone. Each medallion is 2.5 feet (0.76 m) in diameter and were designed by American sculptor Michael Lantz. They were originally meant to be carved in granite. The east side of the south façade (left to right) seals are for: France, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, the Netherlands, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United Kingdom, United States, Uruguay, and Venezuela. The west side of the south façade seals are for: Argentina, Barbados, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, and El Salvador. In 1993 the seals were surveyed by the Smithsonian Institution’s Save Outdoor Sculpture! program and were described as needing conservation treatment.

The building is situated on a triangular lot of just over one acre nestled between Virginia Avenue, E Street, and 23rd Street, Northwest, in the Foggy Bottom neighbourhood of Washington. Constructed of reinforced concrete over a steel frame with an exterior of glass and marble, the building is one of Washington’s most recognised examples of mid-century modern architecture. The building is divided into two distinct volumes: a gracefully curved ten-story building that hosts the organization’s main offices, and an adjoining four-story cylindrical annex that serves as the congress hall for formal assemblies of the PAHO member state delegates, as well as other meetings and events. It is surrounded by George Washington University to the north and east, the Columbia Plaza office/residential complex to the west, and the State Department to the south across the E street expressway underpass.

The main building features soaring white vertical columnar ribs evenly separating dark vertical columns of glass. There are no horizontal lines to compete with the vertical symmetry; the building’s vertical ribs disappear along “blind gables” into an invisible roofline. In the formalism and attention to symmetry, Fresnedo Siri said he was trying to stay true to the “classic spirit of the city of Washington.” The interplay of light and dark is accentuated by the use of white American marble, black Mexican granite, and dark gray glass. The building’s slender, windowless west and east sides are clad in white marble, while the black granite frames all the ground floor elements, including the entry portico, the hidden downward ramp to an underground garage, and the reflecting pool and garden elements.

Fresnedo Siri placed the main building on 20 rounded pilotis (columns) that lift it a full story above ground level. He employed this signature element of mid-century modernist design to maximise the open pedestrian plaza space on the relatively small and unusually shaped lot while enhancing visual transparency and flow. He added reflecting pools with fountains at the base of each building – his vision was that the cylindrical congress hall, in particular, would appear to be “emerging from the water.” The thin vertical streams spurting up from the fountains would echo the symmetry of the columns and vertical ribbing of the main building. A row of 42 flag poles (representing each PAHO member state) reinforces still further the building’s dancing array of vertical symmetries, while also gracefully delineating the Northeastern edge of the property site. Unfortunately, the reflecting pools years later were eliminated, filled in and replaced by garden plots.

Fresnedo Siri purposefully placed the convex side of the curved main office building to the north, smoothly integrating it into the urban streetscape of similarly sized office, university and residential buildings. This allowed the concave side of the building to face the open side of the lot, gently cradling the congress hall annex while framing the contours of the small but appealing pedestrian plaza area that flows toward the site’s open southern side.

The cylindrical annex’s around the central congress hall are about 92 feet (28 m) in diameter and seat up to 300 people. The single open space soars upward, filling the top three levels of the building. Fresnedo Siri designed a dramatic spider web-like steel structure to support the building, allowing the entire interior space to be free of any supporting columns. The resulting internal space, naturally lit by windows throughout the cylinder’s full 360 degrees, achieves an impressive sense of openness and purity of design. The cylindrical building is encased on the outside by a lattice-like grill of diamond-shaped hexagons composed of white marble, quartz and Portland cement. The recessed ground floor space of the cylinder is encased in the same Mexican black granite used for all the site’s ground-level elements, creating a striking contrast with the white honeycomb grill of the upper levels it supports.

After studying the main diplomatic congress halls at the UN, State Department, the OAS and elsewhere, Fresnedo Siri devised a “floating seat” solution for the chairs in the PAHO’s hall. The seats are all anchored to the floor in the rear to curved latitudinal support elements running behind each row (and serving as hidden conduits for the simultaneous translation cabling), achieving what he described as “a great functional and aesthetic purity.” All of the furnishings for the main halls and meeting rooms were designed under his specifications by Knoll Associates, a leading New York-based producer of modernist furniture including landmark designs of the era like the Saarinen womb chair and Mies Van de Rohe’s Barcelona chair. Fresnedo Siri designed the magisterial backdrop to the presidium of the Congress hall, using vertical slats of six different kinds of wood including Honduran mahogany, Brazilian jacaranda, American walnut and oak, arranged in his words “to accentuate the dimension of the space and the importance of the function it served.” Fresnedo Siri also designed the central chandelier of the Congress hall, calling the piece “a sculpture in light.” Measuring 20 feet in diameter and weighing 16,000 pounds (7,300 kg), it consisted of 3000 long rectangular pieces of Lucite, the translucent acrylic resin invented by Dupont in the 1930s for industrial and military uses then enjoying an early-60’s boom as a “space age” material for vanguard furniture and art.

What is the World Health Organisation Collaborating Centre?

Introduction

World Health Organisation collaborating centres are institutions that work with the World Health Organisation (WHO) in disciplines such as occupational health, food safety, and communicable disease prevention.

Overview

There are over 700 such centres across 80 countries. Collaborating centres may be research institutes, parts of universities, or academies. The participating institutions partner with WHO to perform research, provide training, or offer other services in furthering the WHO health agenda. These partners are designated by the WHO director-general as a part of a collaborative network. By using networks of established organisations, WHO is able to strengthen the scientific validity of its work and lower the costs of research.

Centres Worldwide

The WHO has established networks related to a variety of health topics. For example, WHO has put in place centres focused on organ transplants, hearing loss prevention, hepatitis, leprosy, medical ethics, and maternal health. To move the work forward, WHO has numerous designated centres in each inhabited continent. The network of centres for reference and research on influenza draws upon resources from Japan, the United States, the United Kingdom, and Australia. The network of WHO collaborating centres in occupational health is chaired by Dr. John Howard, director of the US National Institute for Occupational Safety and Health, and contains more than 60 designated organisations from across the globe.

The WHO Collaborating Centre on Global Governance of Antimicrobial Resistance has been working on the Coronavirus disease 2019 and is directed by Steven Hoffman.

What is the WHO Assessment Instrument for Mental Health Systems?

Introduction

The World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) is a new WHO tool for collecting essential information on the mental health system of a country or region.

Purpose

The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change.

What is WHO-AIMS?

WHO-AIMS is a WHO tool for collecting essential information on the mental health system of a country or region. The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change.

For the purpose of WHO-AIMS, a mental health system is defined as all the activities whose primary purpose is to promote, restore or maintain mental health. WHO-AIMS is primarily intended for assessing mental health systems in low and middle income countries, but is also a valuable assessment tool for high resource countries.

Note: Great care has been taken to ensure the reliability of the data presented in the WHO-AIMS country reports. Data for WHO-AIMS are collected by a team led by a focal point within the country and are, in most cases, approved by the Ministry of Health. However, since WHO is not directly responsible for the data collection, WHO cannot independently verify the accuracy of any of the data presented in these reports.

WHO-AIMS Instrument, Version 2.2

You can find country reports, sub-regional reports, and other reports here (Pan American Health Organisation (PAHO) site).

What is the Mental Health Gap Action Programme (mhGAP)?

Introduction

The World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.

Background

Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.

As such, the programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives – even where resources are scarce.

The following overview is from the WHO ‘mhGAP Mental Health Gap Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders’ published on 01 January 2008:

Mental, neurological and substance use disorders are highly prevalent and burdensome globally. The gap between what is urgently needed and what is available to reduce the burden is still very wide.

WHO recognizes the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge. mhGAP is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The priority conditions addressed by mhGAP are: depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children. The mhGAP package consists of interventions for prevention and management for each of these priority conditions.

Successful scaling up is the joint responsibility of governments, health professionals, civil society, communities, and families, with support from the international community. The essence of mhGAP is building partnerships for collective action. A commitment is needed from all partners to respond to this urgent public health need and the time to act is now!

References/Further Reading

WHO mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders (WHO site; published 01 January 2008).

Outline of the Mental Health Gap Action Programme (mhGAP) (WHO site).

Clinical Review: WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A Systematic Review of Evidence from Low and Middle-Income Countries (BMJ Journals: Evidence-Based Mental Health).

What is the WHO Model List of Essential Medicines?

Introduction

The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organisation (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.

The list is frequently used by countries to help develop their own local lists of essential medicines. As of 2016, more than 155 countries have created national lists of essential medicines based on the WHO’s model list. This includes countries in both the developed and developing world.

40 years of the WHO Model List of Essential Medicines was celebrated in 2017.

The list is divided into core items and complementary items. The core items are deemed to be the most cost-effective options for key health problems and are usable with little additional health care resources. The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost–benefit ratio. About 25% of items are in the complementary list. Some medications are listed as both core and complementary. While most medications on the list are available as generic products, being under patent does not preclude inclusion.

The first list was published in 1977 and included 208 medications. The WHO updates the list every two years. The 14th list was published in 2005 and contained 306 medications. In 2015, the 19th edition of the list was published and contains around 410 medications. The 20th edition was published in 2017, and contains 433 medications. The 21st list was published in 2019 and contains 460 medications. The 22nd list was published in 2021 and contains 479 medications. Various national lists contain between 334 and 580 medications.

A separate list for children up to 12 years of age, known as the WHO Model List of Essential Medicines for Children (EMLc), was created in 2007 and is in its 8th edition. It was created to make sure that the needs of children were systematically considered such as availability of proper formulations. Everything in the children’s list is also included in the main list. The list and notes are based on the 19th to 22nd edition of the main list. An α indicates a medicine is only on the complementary list. Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists.

Anaesthetics, Preoperative Medicines and Medical Gases

  • General anaesthetics and oxygen:
    • Inhalational medicines.
      • Halothane.
      • Isoflurane.
      • Nitrous oxide.
      • Oxygen.
    • Injectable medicines.
      • Ketamine.
      • Propofol.
  • Local anaesthetics:
    • Bupivacaine.
    • Lidocaine.
    • Lidocaine/epinephrine (lidocaine + epinephrine).
    • Ephedrineα.
  • Preoperative medication and sedation for short-term procedures:
    • Atropine
    • Midazolam
    • Morphine
  • Medical gases:
    • Oxygen.

Medicines for Pain and Palliative Care

  • Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs):
    • Acetylsalicylic acid (aspirin).
    • Ibuprofen.
    • Paracetamol.
  • Opioid analgesics:
    • Codeine.
    • Fentanyl.
    • Morphine.
    • Methadoneα.
  • Medicines for other common symptoms in palliative care:
    • Amitriptyline.
    • Cyclizine.
    • Dexamethasone.
    • Diazepam.
    • Docusate sodium.
    • Fluoxetine.
    • Haloperidol.
    • Hyoscine butylbromide.
    • Hyoscine hydrobromide.
    • Lactulose.
    • Loperamide.
    • Metoclopramide.
    • Midazolam.
    • Ondansetron.
    • Senna.

Antiallergics and Medicines used in Anaphylaxis

  • Dexamethasone.
  • Epinephrine (adrenaline).
  • Hydrocortisone.
  • Loratadine.
  • Prednisolone.

Antidotes and Other Substances used in Poisonings

  • Non-specific:
    • Charcoal, activated.
  • Specific.
    • Acetylcysteine.
    • Atropine.
    • Calcium gluconate.
    • Methylthioninium chloride (methylene blue).
    • Naloxone.
    • Penicillamine.
    • Prussian blue.
    • Sodium nitrite.
    • Sodium thiosulfate.
    • Deferoxamineα.
    • Dimercaprolα.
    • Fomepizoleα.
    • Sodium calcium edetateα.
    • Succimerα.

Anticonvulsants/Antiepileptics

Anti-Infective Medicines

  • Anthelminthics:
    • Intestinal anthelminthics.
      • Albendazole.
      • Ivermectin.
      • Levamisole.
      • Mebendazole.
      • Niclosamide.
      • Praziquantel.
      • Pyrantel.
    • Antifilarials.
      • Albendazole.
      • Diethylcarbamazine.
      • Ivermectin.
    • Antischistosomals and other antinematode medicines.
      • Praziquantel.
      • Triclabendazole.
      • Oxamniquineα.
    • Cysticidal medicines.
      • Albendazoleα.
      • Mebendazoleα.
      • Praziquantelα.
  • Antibacterials:
    • Access group antibiotics.
      • Amikacin
      • Amoxicillin.
      • Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid).
      • Ampicillin.
      • Benzathine benzylpenicillin.
      • Benzylpenicillin.
      • Cefalexin.
      • Cefazolin.
      • Chloramphenicol.
      • Clindamycin.
      • Cloxacillin.
      • Doxycycline.
      • Gentamicin.
      • Metronidazole.
      • Nitrofurantoin.
      • Phenoxymethylpenicillin (penicillin V).
      • Procaine benzylpenicillin.
      • Spectinomycin.
      • Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim).
      • Trimethoprim.
    • Watch group antibiotics.
      • Azithromycin.
      • Cefixime.
      • Cefotaxime.
      • Ceftriaxone.
      • Cefuroxime.
      • Ciprofloxacin.
      • Clarithromycin.
      • Piperacillin/tazobactam (piperacillin + tazobactam).
      • Vancomycin.
      • Ceftazidimeα.
      • Meropenemα.
      • Vancomycinα.
    • Reserve group antibiotics.
      • Cefiderocolα.
      • Ceftazidime/avibactam (ceftazidime + avibactam)α.
      • Colistinα.
      • Fosfomycinα.
      • Linezolidα.
      • Meropenem/vaborbactam (meropenem + vaborbactam)α.
      • Plazomicinα.
      • Polymyxin Bα.
    • Antileprosy medicines.
      • Clofazimine.
      • Dapsone.
      • Rifampicin.
    • Antituberculosis medicines.
      • Ethambutol.
      • Ethambutol/isoniazid/pyrazinamide/rifampicin (ethambutol + isoniazid + pyrazinamide + rifampicin).
      • Ethambutol/isoniazid/rifampicin (ethambutol + isoniazid + rifampicin).
      • Isoniazid.
      • Isoniazid/pyrazinamide/rifampicin (isoniazid + pyrazinamide + rifampicin).
      • Isoniazid/rifampicin (isoniazid + rifampicin).
      • Isoniazid/rifapentine (isoniazid + rifapentine).
      • Moxifloxacin.
      • Pyrazinamide.
      • Rifabutin.
      • Rifampicin.
      • Rifapentine.
      • Amikacinα.
      • Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)α.
      • Bedaquilineα.
      • Clofazimineα.
      • Cycloserineα.
      • Delamanidα.
      • Ethionamideα.
      • Levofloxacinα.
      • Linezolidα.
      • Meropenemα.
      • Moxifloxacinα.
      • P-aminosalicylic acidα.
      • Streptomycinα.
  • Antifungal medicines.
    • Amphotericin B.
    • Clotrimazole.
    • Fluconazole.
    • Flucytosine.
    • Griseofulvin.
    • Itraconazole.
    • Nystatin.
    • Voriconazole.
    • Micafunginα.
    • Potassium iodideα.
  • Antiviral medicines
    • Antiherpes medicines.
      • Aciclovir.
    • Antiretrovirals.
    • Nucleoside/nucleotide reverse transcriptase inhibitors.
      • Abacavir.
      • Lamivudine.
      • Tenofovir disoproxil fumarate.
      • Zidovudine.
    • Non-nucleoside reverse transcriptase inhibitors.
      • Efavirenz.
      • [[Nevirapine].
    • Protease inhibitors.
      • Atazanavir/ritonavir (atazanavir + ritonavir).
      • Darunavir.
      • Lopinavir/ritonavir (lopinavir + ritonavir).
      • Ritonavir.
    • Integrase inhibitors.
      • Dolutegravir.
      • Raltegravir.
    • Fixed-dose combinations of antiretroviral medicines.
      • Abacavir/lamivudine (abacavir + lamivudine).
      • Dolutegravir/lamivudine/tenofovir (dolutegravir + lamivudine + tenofovir.
      • Efavirenz/emtricitabine/tenofovir.
      • Efavirenz/lamivudine/tenofovir (efavirenz + lamivudine + tenofovir).
      • Emtricitabine/tenofovir (emtricitabine + tenofovir).
      • Lamivudine/zidovudine (lamivudine + zidovudine).
    • Medicines for prevention of HIV-related opportunistic infections.
      • Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim (isoniazid + pyridoxine + sulfamethoxazole + trimethoprim).
    • Other antivirals.
      • Ribavirin.
      • Valganciclovir.
      • Oseltamivirα.
      • Valganciclovirα.
    • Antihepatitis medicines.
    • Medicines for hepatitis B.
    • Nucleoside/Nucleotide reverse transcriptase inhibitors.
      • Entecavir.
      • Tenofovir disoproxil fumarate.
    • Medicines for hepatitis C.
    • Pangenotypic direct-acting antiviral combinations
      • Daclatasvir.
      • Daclatasvir/sofosbuvir (daclatasvir + sofosbuvir).
      • Glecaprevir/pibrentasvir (glecaprevir + pibrentasvir).
      • Sofosbuvir.
      • Sofosbuvir/velpatasvir (sofosbuvir + velpatasvir).
    • Non-pangenotypic direct-acting antiviral combinations
      • Dasabuvir.
      • Ledipasvir/sofosbuvir (ledipasvir + sofosbuvir).
      • Ombitasvir/paritaprevir/ritonavir (ombitasvir + paritaprevir + ritonavir).
    • Other antivirals for hepatitis C.
      • Ribavirin.
      • Pegylated interferon-alpha-2a or pegylated interferon-alpha-2bα.
  • Antiprotozoal medicines:
    • Antiamoebic and antigiardiasis medicines
      • Diloxanide.
      • Metronidazole.
    • Antileishmaniasis medicines
      • Amphotericin B.
      • Miltefosine.
      • Paromomycin.
      • Sodium stibogluconate or meglumine antimoniate.
    • Antimalarial medicines.
    • For curative treatment.
      • Amodiaquine.
      • Artemether.
      • Artemether/lumefantrine (artemether + lumefantrine).
      • Artesunate.
      • Artesunate/amodiaquine (artesunate + amodiaquine).
      • Artesunate/mefloquine (artesunate + mefloquine).
      • Artesunate/pyronaridine tetraphosphate (artesunate + pyronaridine tetraphosphate).
      • Chloroquine.
      • Dihydroartemisinin/piperaquine phosphate (dihydroartemisinin + piperaquine phosphate).
      • Doxycycline.
      • Mefloquine.
      • Primaquine.
      • Quinine.
      • Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine).
    • For chemoprevention.
      • Amodiaquine + sulfadoxine/pyrimethamine (Co-packaged).
      • Chloroquine.
      • Doxycycline.
      • Mefloquine.
      • Proguanil.
      • Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine).
    • Antipneumocystosis and antitoxoplasmosis medicines.
      • Pyrimethamine.
      • Sulfadiazine.
      • Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim).
      • Pentamidineα.
    • Antitrypanosomal medicines.
    • African trypanosomiasis.
      • Fexinidazole.
    • Medicines for the treatment of 1st stage African trypanosomiasis.
      • Pentamidine.
      • Suramin sodium.
    • Medicines for the treatment of 2nd stage African trypanosomiasis.
      • Eflornithine.
      • Melarsoprol.
      • Nifurtimox.
      • Melarsoprolα.
    • American trypanosomiasis.
      • Benznidazole.
      • Nifurtimox.
  • Medicines for ectoparasitic infections.
    • Ivermectin.

Antimigraine Medicines

  • For treatment of acute attack:
    • Acetylsalicylic acid (aspirin).
    • Ibuprofen.
    • Paracetamol (acetaminophen).
    • Sumatriptan.
  • For prophylaxis:
    • Propranolol.

Immunomodulators and Antineoplastics

  • Immunomodulators for non-malignant disease:
    • Adalimumabα.
    • Azathioprineα.
    • Ciclosporinα.
    • Tacrolimusα.
  • Antineoplastics and supportive medicines:
    • Cytotoxic medicines.
      • Arsenic trioxideα.
      • Asparaginaseα.
      • Bendamustineα.
      • Bleomycinα.
      • Calcium folinateα.
      • Capecitabineα.
      • Carboplatinα.
      • Chlorambucilα.
      • Cisplatinα.
      • Cyclophosphamideα.
      • Cytarabineα.
      • Dacarbazineα.
      • Dactinomycinα.
      • Daunorubicinα.
      • Docetaxelα.
      • Doxorubicinα.
      • Etoposideα.
      • Fludarabineα.
      • Fluorouracilα.
      • Gemcitabineα.
      • Hydroxycarbamideα.
      • Ifosfamideα.
      • Irinotecanα.
      • Melphalanα.
      • Mercaptopurineα.
      • Methotrexateα.
      • Oxaliplatinα.
      • Paclitaxelα.
      • Pegaspargaseα.
      • Procarbazineα.
      • Realgar Indigo naturalis formulationα.
      • Tioguanineα.
      • Vinblastineα.
      • Vincristineα.
      • Vinorelbineα.
    • Targeted therapies.
      • All-trans retinoic acid (tretinoin) (ATRA)α.
      • Bortezomibα.
      • Dasatinibα.
      • Erlotinibα.
      • Everolimusα.
      • Ibrutinibα.
      • Imatinibα.
      • Nilotinibα.
      • Rituximabα.
      • Trastuzumabα.
    • Immunomodulators.
      • Filgrastimα.
      • Lenalidomideα.
      • Nivolumabα.
      • Thalidomideα.
    • Hormones and antihormones.
      • Abirateroneα.
      • Anastrozoleα.
      • Bicalutamideα.
      • Dexamethasoneα.
      • Hydrocortisoneα.
      • Leuprorelinα.
      • Methylprednisoloneα.
      • Prednisoloneα.
      • Tamoxifenα.
    • Supportive medicines.
      • Allopurinolα.
      • Mesnaα.
      • Rasburicaseα.
      • Zoledronic acidα.

Antiparkinsonism Medicines

  • Biperiden.
  • Levodopa/carbidopa (levodopa + carbidopa).

Medicines Affecting the Blood

  • Antianaemia medicines:
    • Ferrous salt.
    • Ferrous salt/folic acid (ferrous salt + folic acid).
    • Folic acid.
    • Hydroxocobalamin.
    • Erythropoiesis-stimulating agentsα.
  • Medicines affecting coagulation:
    • Dabigatran.
    • Enoxaparin.
    • Heparin sodium.
    • Phytomenadione.
    • Protamine sulfate.
    • Tranexamic acid.
    • Warfarin.
    • Desmopressinα.
    • Heparin sodiumα.
    • Protamine sulfateα.
    • Warfarinα.
  • Other medicines for haemoglobinopathies:
    • Deferoxamineα.
    • Hydroxycarbamideα.

Blood Products of Human Origin and Plasma Substitutes

  • Blood and blood components:
    • Fresh frozen plasma.
    • Platelets.
    • Red blood cells.
    • Whole blood.
  • Plasma-derived medicines:
    • Human immunoglobulins.
      • Rho(D) immune globulin (anti-D immunoglobulin).
      • Anti-rabies immunoglobulin.
      • Anti-tetanus immunoglobulin.
      • Normal immunoglobulinα.
    • Blood coagulation factors.
      • Coagulation factor VIIIα.
      • Coagulation factor IXα.
    • Plasma substitutes.
      • Dextran 70.

Cardiovascular Medicines

  • Antianginal medicines:
    • Bisoprolol.
    • Glyceryl trinitrate.
    • Isosorbide dinitrate.
    • Verapamil.
  • Antiarrhythmic medicines:
    • Bisoprolol.
    • Digoxin.
    • Epinephrine (adrenaline).
    • Lidocaine.
    • Verapamil.
    • Amiodaroneα.
  • Antihypertensive medicines:
    • Amlodipine.
    • Bisoprolol.
    • Enalapril.
    • Hydralazine.
    • Hydrochlorothiazide.
    • Lisinopril/amlodipine (lisinopril + amlodipine).
    • Lisinopril/hydrochlorothiazide (lisinopril + hydrochlorothiazide).
    • Losartan.
    • Methyldopa.
    • Telmisartan/amlodipine (telmisartan + amlodipine).
    • Telmisartan/hydrochlorothiazide (telmisartan + hydrochlorothiazide).
    • Sodium nitroprussideα.
  • Medicines used in heart failure:
    • Bisoprolol.
    • Digoxin.
    • Enalapril.
    • Furosemide.
    • Hydrochlorothiazide.
    • Losartan.
    • Spironolactone.
    • Dopamineα.
  • Antithrombotic medicines:
    • Anti-platelet medicines.
      • Acetylsalicylic acid (aspirin).
      • Clopidogrel.
    • Thrombolytic medicines.
      • Alteplaseα.
      • Streptokinaseα.
    • Lipid-lowering agents.
      • Simvastatin.

Dermatological Medicines (Topical)

  • Antifungal medicines:
    • Miconazole.
    • Selenium sulfide.
    • Sodium thiosulfate.
    • Terbinafine.
  • Anti-infective medicines:
    • Mupirocin.
    • Potassium permanganate.
    • Silver sulfadiazine.
  • Anti-inflammatory and antipruritic medicines:
    • Betamethasone.
    • Calamine.
    • Hydrocortisone.
  • Medicines affecting skin differentiation and proliferation:
    • Benzoyl peroxide.
    • Calcipotriol.
    • Coal tar.
    • Fluorouracil.
    • Podophyllum resin.
    • Salicylic acid.
    • Urea.
  • Scabicides and pediculicides:
    • Benzyl benzoate.
    • Permethrin.

Diagnostic Agents

  • Ophthalmic medicines:
    • Fluorescein.
    • Tropicamide.
  • Radiocontrast media:
    • Amidotrizoate.
    • Barium sulfate.
    • Iohexol.
    • Barium sulfateα.
    • Meglumine iotroxateα.

Antiseptics and Disinfectants

  • Antiseptics:
    • Chlorhexidine.
    • Ethanol.
    • Povidone iodine.
  • Disinfectants:
    • Alcohol based hand rub.
    • Chlorine base compound.
    • Chloroxylenol.
    • Glutaral.

Diuretics

  • Amiloride.
  • Furosemide.
  • Hydrochlorothiazide.
  • Mannitol.
  • Spironolactone.
  • Hydrochlorothiazideα.
  • Mannitolα.
  • Spironolactoneα.

Gastrointestinal Medicines

  • Pancreatic enzymesα.
  • Antiulcer medicines:
    • Omeprazole.
    • Ranitidine.
  • Antiemetic medicines:
    • Dexamethasone.
    • Metoclopramide.
    • Ondansetron.
    • Aprepitantα.
  • Anti-inflammatory medicines:
    • Sulfasalazine.
    • Hydrocortisoneα.
    • Prednisoloneα.
  • Laxatives:
    • Senna.
  • Medicines used in diarrhoea:
    • Oral rehydration salts + zinc sulfate (Co-packaged).
    • Oral rehydration.
      • Oral rehydration salts.
    • Medicines for diarrhoea.
      • Zinc sulfate.

Medicines for Endocrine Disorders

  • Adrenal hormones and synthetic substitutes:
    • Fludrocortisone.
    • Hydrocortisone.
  • Androgens:
    • Testosteroneα.
  • Estrogens:
    • No listings in this section.
  • Progestogens:
    • Medroxyprogesterone acetate.
  • Medicines for diabetes:
    • Insulins.
      • Insulin injection (soluble).
      • Intermediate-acting insulin.
      • Long-acting insulin analogues.
    • Oral hypoglycaemic agents.
      • Empagliflozin.
      • Gliclazide.
      • Metformin.
      • Metforminα.
    • Medicines for hypoglycaemia.
      • Glucagon.
      • Diazoxideα.
  • Thyroid hormones and antithyroid medicines:
    • Levothyroxine.
    • Potassium iodide.
    • Methimazole.
    • Propylthiouracil.
    • Lugol’s solutionα.
    • Methimazoleα.
    • Potassium iodideα.
    • Propylthiouracilα.

Immunologicals

  • Diagnostic agents:
    • Tuberculin, purified protein derivative (PPD).
  • Sera, immunoglobulins and monoclonal antibodies:
    • Anti-rabies virus monoclonal antibodies.
    • Antivenom immunoglobulin.
    • Diphtheria antitoxin.
    • Equine rabies immunoglobulin.
  • Vaccines:
    • Recommendations for all.
      • BCG vaccine.
      • Diphtheria vaccine.
      • Haemophilus influenzae type b vaccine.
      • Hepatitis B vaccine.
      • Human papilloma virus (HPV) vaccine.
      • Measles vaccine.
      • Pertussis vaccine.
      • Pneumococcal vaccine.
      • Poliomyelitis vaccine.
      • Rotavirus vaccine.
      • Rubella vaccine.
      • Tetanus vaccine.
    • Recommendations for certain regions.
      • Japanese encephalitis vaccine.
      • Tick-borne encephalitis vaccine.
      • Yellow fever vaccine.
      • Recommendations for some high-risk populations.
      • Cholera vaccine.
      • Dengue vaccine.
      • Hepatitis A vaccine.
      • Meningococcal meningitis vaccine.
      • Rabies vaccine.
      • Typhoid vaccine.
    • Recommendations for immunisation programmes with certain characteristics.
      • Influenza vaccine (seasonal).
      • Mumps vaccine.
      • Varicella vaccine.

Muscle Relaxants (Peripherally-Acting) and Cholinesterase Inhibitors

  • Atracurium.
  • Neostigmine.
  • Suxamethonium.
  • Vecuronium.
  • Pyridostigmineα.
  • Vecuroniumα.

Ophthalmological Preparations

  • Anti-infective agents:
    • Aciclovir.
    • Azithromycin.
    • Erythromycin.
    • Gentamicin.
    • Natamycin.
    • Ofloxacin.
    • Tetracycline.
  • Anti-inflammatory agents:
    • Prednisolone.
  • Local anaesthetics:
    • Tetracaine.
  • Miotics and antiglaucoma medicines:
    • Acetazolamide.
    • Latanoprost.
    • Pilocarpine.
    • Timolol.
  • Mydriatics:
    • Atropine.
    • Epinephrine (adrenaline)α.
  • Anti-vascular endothelial growth factor (VEGF):
    • Bevacizumabα.

Medicines for Reproductive Health and Perinatal Care

  • Contraceptives:
    • Oral hormonal contraceptives.
      • Ethinylestradiol/levonorgestrel (ethinylestradiol + levonorgestrel).
      • Ethinylestradiol/norethisterone (ethinylestradiol + norethisterone).
      • Levonorgestrel.
      • Ulipristal.
    • Injectable hormonal contraceptives.
      • Estradiol cypionate/medroxyprogesterone acetate (estradiol cypionate + medroxyprogesterone acetate).
      • Medroxyprogesterone acetate.
      • Norethisterone enantate.
    • Intrauterine devices.
      • IUD with copper.
      • IUD with progestogen.
    • Barrier methods.
      • Condoms.
      • Diaphragms.
    • Implantable contraceptives.
      • Etonogestrel-releasing implant.
      • Levonorgestrel-releasing implant.
    • Intravaginal contraceptives.
      • Ethinylestradiol/etonogestrel (ethinylestradiol + etonogestrel).
      • Progesterone vaginal ring.
  • Ovulation inducers:
    • Clomifeneα.
  • Uterotonics:
    • Carbetocin.
    • Ergometrine.
    • Mifepristone + misoprostol (Co-packaged).
    • Misoprostol.
    • Oxytocin.
  • Antioxytocics (tocolytics):
    • Nifedipine.
  • Medicines administered to the mother:
    • Dexamethasone.
    • Multiple micronutrient supplement.
    • Tranexamic acid.
  • Medicines administered to the neonate:
    • Caffeine citrate.
    • Chlorhexidine.
    • Ibuprofenα.
    • Prostaglandin E1α.
    • Surfactantα.

Peritoneal Dialysis Solution

  • Intraperitoneal dialysis solution (of appropriate composition)α.

Medicines for Mental and Behavioural Disorders

  • Medicines used in psychotic disorders:
  • Medicines used in mood disorders:
    • Medicines used in depressive disorders.
    • Medicines used in bipolar disorders.
      • Carbamazepine.
      • Lithium carbonate.
      • Valproic acid (sodium valproate).
  • Medicines for anxiety disorders:
  • Medicines used for obsessive compulsive disorders:
    • Clomipramine.
  • Medicines for disorders due to psychoactive substance use:
    • Bupropion.
    • Nicotine replacement therapy.
    • Varenicline.
    • Methadoneα.

Medicines Acting on the Respiratory Tract

  • Antiasthmatics and medicines for chronic obstructive pulmonary disease:
    • Budesonide.
    • Budesonide/formoterol (budesonide + formoterol).
    • Epinephrine (adrenaline).
    • Ipratropium bromide.
    • Salbutamol.
    • Tiotropium.

Solutions Correcting Water, Electrolyte and Acid-Base Disturbances

  • Oral:
    • Oral rehydration salts.
    • Potassium chloride.
  • Parenteral:
    • Glucose.
    • Glucose with sodium chloride.
    • Potassium chloride.
    • Sodium chloride.
    • Sodium hydrogen carbonate.
    • Sodium lactate, compound solution.
  • Miscellaneous:
    • Water for injection.

Vitamins and Minerals

  • Ascorbic acid.
  • Calcium.
  • Colecalciferol.
  • Ergocalciferol.
  • Iodine.
  • Multiple micronutrient powder.
  • Nicotinamide.
  • Pyridoxine.
  • Retinol.
  • Riboflavin.
  • Thiamine.
  • Calcium gluconateα.

Ear, Nose and Throat Medicines

  • Acetic acid.
  • Budesonide.
  • Ciprofloxacin.
  • Xylometazoline.

Medicines for Diseases of Joints

  • Medicines used to treat gout:
    • Allopurinol.
  • Disease-modifying agents used in rheumatoid disorders (DMARDs):
    • Chloroquine.
    • Azathioprineα.
    • Hydroxychloroquineα.
    • Methotrexateα.
    • Penicillamineα.
    • Sulfasalazineα.
  • Juvenile joint diseases:
    • Acetylsalicylic acid (aspirin).
  • Dental preparations:
    • Fluoride.
    • Glass ionomer cement.
    • Silver diamine fluoride.

An Overview of Global Mental Health

Introduction

Global mental health is the international perspective on different aspects of mental health. It is ‘the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide’. There is a growing body of criticism of the global mental health movement, and has been widely criticised as a neo-colonial or “missionary” project and as primarily a front for pharmaceutical companies seeking new clients for psychiatric drugs.

In theory, taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of mental health care systems, human resources in mental health, and human rights issues among others.

The overall aim of the field of global mental health is to strengthen mental health all over the world by providing information about the mental health situation in all countries, and identifying mental health care needs in order to develop cost-effective interventions to meet those specific needs.

The Global Burden of Disease

Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD). This is a global measure of so-called disability-adjusted life years (DALY’s) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY’s – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.

Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability related to health conditions.

Mental Health by Country

The following is an outline from selected countries.

Africa

Mental illnesses and mental health disorders are widespread concerns among underdeveloped African countries, yet these issues are largely neglected, as mental health care in Africa is given statistically less attention than it is in other, westernised nations. Rising death tolls due to mental illness demonstrate the imperative need for improved mental health care policies and advances in treatment for Africans suffering from psychological disorders.

Underdeveloped African countries are so visibly troubled by physical illnesses, disease, malnutrition, and contamination that the dilemma of lacking mental health care has not been prioritised, makes it challenging to have a recognised impact on the African population. In 1988 and 1990, two original resolutions were implemented by the World Health Organisation’s (WHO) Member States in Africa. AFR/RC39/R1 and AFR/RC40/R9 attempted to improve the status of mental health care in specific African regions to combat its growing effects on the African people. However, it was found that these new policies had little impact on the status of mental health in Africa, ultimately resulting in an incline in psychological disorders instead of the desired decline, and causing this to seem like an impossible problem to manage.

In Africa, many socio-cultural and biological factors have led to heightened psychological struggles, while also masking their immediate level of importance to the African eye. Increasing rates of unemployment, violence, crime, rape, and disease are often linked to substance abuse, which can cause mental illness rates to inflate. Additionally, physical disease like HIV/AIDS, the Ebola epidemic, and malaria often have lasting psychological effects on victims that go unrecognised in African communities because of their inherent cultural beliefs. Traditional African beliefs have led to the perception of mental illness as being caused by supernatural forces, preventing helpful or rational responses to abnormal behaviour. For example, Ebola received loads of media attention when it became rampant in Africa and eventually spread to the US, however, researchers never really paid attention to its psychological effects on the African brain. Extreme anxiety, struggles with grief, feelings of rejection and incompetence, depression leading to suicide, PTSD, and much more are only some of the noted effects of diseases like Ebola. These epidemics come and go, but their lasting effects on mental health are remaining for years to come, and even ending lives because of the lack of action. There has been some effort to financially fund psychiatric support in countries like Liberia, due to its dramatic mental health crisis after warfare, but not much was benefited. Aside from financial reasons, it is so difficult to enforce mental health interventions and manage mental health in general in underdeveloped countries simply because the individuals living there do not necessarily believe in western psychiatry. It is also important to note that the socio-cultural model of psychology and abnormal behaviour is dependent on factors surrounding cultural differences. This causes mental health abnormalities to remain more hidden due to the culture’s natural behaviour, compared to westernised behaviour and cultural norms.

This relationship between mental and physical illness is an ongoing cycle that has yet to be broken. While many organisations are attempting to solve problems about physical health in Africa, as these problems are clearly visible and recognisable, there is little action taken to confront the underlying mental effects that are left on the victims. It is recognised that many of the mentally ill in Africa search for help from spiritual or religious leaders, however this is widely because many African countries are significantly lacking in mental health professionals in comparison to the rest of the world. In Ethiopia alone, there are “only 10 psychiatrists for the population of 61 million people,” studies have shown. While numbers have definitely changed since this research was done, the lack of psychological professionals throughout African continues with a current average of 1.4 mental health workers per 100,000 people compared to the global statistic of 9.0 professionals per 100,00 people. Additionally, statistics show that the “global annual rate of visits to mental health outpatient facilities is 1,051 per 100,000 population,” while “in Africa the rate is 14 per 100,000” visits. About half of Africa’s countries have some sort of mental health policy, however, these policies are highly disregarded, as Africa’s government spends “less than 1% of the total health budget on mental health”. Specifically in Sierra Leone, about 98.8% of people suffering from mental disorders remain untreated, even after the building of a well below average psychiatric hospital, further demonstrating the need for intervention.

Not only has there been little hands-on action taken to combat mental health issues in Africa, but there has also been little research done on the topic to spread its awareness and prevent deaths. The Lancet Global Health acknowledges that there are well over 1,000 published articles covering physical health in Africa, but there are still less than 50 discussing mental health. And this pressing dilemma of prioritising physical health vs. mental health is only worsening as the continent’s population is substantially growing with research showing that “Between 2000 and 2015 the continent’s population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%”. The number of deaths caused by mental instability is truly competing with those caused by physical diseases: “In 2015, 17.9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18.5 million years lost to disability,”. Mental health and physical health care, while they may seem separate, are very much connected, as these two factors determine life or death for humans. As new challenges surface and old challenges still haven’t been prioritised, Africa’s mental health care policies need significant improvement in order to provide its people with the appropriate health care they deserve, hopefully preventing this problem from expanding.

Australia

A survey conducted by Australian Bureau of Statistics in 2008 regarding adults with manageable to severe neurosis reveals almost half of the population had a mental disorder at some point of their life and one in five people had a sustained disorder in the preceding 12 months. In neurotic disorders, 14% of the population experienced anxiety and comorbidity disorders were next to common mental disorder with vulnerability to substance abuse and relapses. There were distinct gender differences in disposition to mental health illness. Women were found to have high rate of mental health disorders, and Men had higher propensity of risk for substance abuse. The SMHWB survey showed families that had low socioeconomic status and high dysfunctional patterns had a greater proportional risk for mental health disorders. A 2010 survey regarding adults with psychosis revealed 5 persons per 1,000 in the population seeks professional mental health services for psychotic disorders and the most common psychotic disorder was schizophrenia.

Bangladesh

Mental health disorder is considered a major public health concern and it constitutes about 13% of the Global Burden of disease and severe mental health disease may reduce each individual’s life expectancy by about 20%. Low and middle-income countries have a higher burden of mental health disorder as it is not considered as a health problem as other chronic diseases. Being a low-income country, in Bangladesh, mental health issues are highly stigmatised.

A community-based study in the rural area of Bangladesh in 2000-2001 estimated that the burden of mental morbidity was 16.5% among rural people and most were suffering from mainly depression and anxiety and which was one-half and one-third of total cases respectively. Furthermore, the prevalence of mental disorders was higher in women in large families aged 45 years.

Care for mental health in Bangladesh

A study conducted in 2008 stated that only 16% of patients came directly to the Mental Health Practitioner with a mean delay of 10.5 months of the onset of mental illness, which made them more vulnerable in many ways. 22% of patients went for the religious or traditional healer and 12% consulted a rural medical practitioner with the least delay of 2-2.5 weeks.

Canada

According to statistics released by the Centre of Addiction and Mental Health one in five people in Canada experience a mental health or addiction problem. Young people of ages 15 to 25 are particularly found to be vulnerable. Major depression is found to affect 8% and anxiety disorder 12% of the population. Women are 1.5 times more likely to suffer from mood and anxiety disorders. WHO points out that there are distinct gender differences in patterns of mental health and illness. The lack of power and control over their socioeconomic status, gender based violence; low social position and responsibility for the care of others render women vulnerable to mental health risks. Since more women than men seek help regarding a mental health problem, this has led to not only gender stereotyping but also reinforcing social stigma. WHO has found that this stereotyping has led doctors to diagnose depression more often in women than in men even when they display identical symptoms. Often communication between health care providers and women is authoritarian leading to either the under-treatment or over-treatment of these women.

Women’s College Hospital has a program called the “Women’s Mental Health Program” where doctors and nurses help treat and educate women regarding mental health collaboratively, individually, and online by answering questions from the public.

Another Canadian organisation serving mental health needs is the Centre for Addiction and Mental Health (CAMH). CAMH is one of Canada’s largest and most well-known health and addiction facilities, and it has received international recognitions from the Pan American Health Organisation and WHO Collaborating Centre. They do research in areas of addiction and mental health in both men and women. In order to help both men and women, CAMH provides “clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.” CAMH is different from Women’s College Hospital due to its widely known rehab centre for women who have minor addiction issues, to severe ones. This organization provides care for mental health issues by assessments, interventions, residential programs, treatments, and doctor and family support.

Israel

In Israel, a Mental Health Insurance Reform took effect in July 2015, transferring responsibility for the provision of mental health services from the Ministry of Health to the four national health plans. Physical and mental health care were united under one roof; previously they had functioned separately in terms of finance, location, and provider. Under the reform, the health plans developed new services or expanded existing ones to address mental health problems.

United States

According to the WHO in 2004, depression is the leading cause of disability in the United States for individuals ages 15 to 44. Absence from work in the US due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts. In 2004, suicide was the 11th leading cause of death in the United States, third among individuals ages 15-24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high. By way of comparison, a study conducted in Australia during 2006 to 2007 reported that one-third (34.9%) of patients diagnosed with a mental health disorder had presented to medical health services for treatment. The US has a shortage of mental healthcare workers, contributing to the unmet need for treatment. By 2025, the US will need an additional 15,400 psychiatrists and 57,490 psychologists to meet the demand for treatment.

Treatment Gap

It is estimated that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Although many effective interventions for the treatment of mental disorders are known, and awareness of the need for treatment of people with mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called “treatment gap” is estimated to reach between 76-85% for low- and middle-income countries, and 35-50% for high-income countries.

Despite the acknowledged need, for the most part there have not been substantial changes in mental health care delivery during the past years. Main reasons for this problem are public health priorities, lack of a mental health policy and legislation in many countries, a lack of resources – financial and human resources – as well as inefficient resource allocation.

In 2011, the WHO estimated a shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. The annual wage bill to remove this health workforce shortage was estimated at about US$4.4 billion.

Interventions

Information and evidence about cost-effective interventions to provide better mental health care are available. Although most of the research (80%) has been carried out in high-income countries, there is also strong evidence from low- and middle-income countries that pharmacological and psychosocial interventions are effective ways to treat mental disorders, with the strongest evidence for depression, schizophrenia, bipolar disorder and hazardous alcohol use.

Recommendations to strengthen mental health systems around the world have been first mentioned in the WHO’s World Health Report 2001, which focused on mental health:

  • Provide treatment in primary care.
  • Make psychotropic drugs available.
  • Give care in the community.
  • Educate the public.
  • Involve communities, families and consumers.
  • Establish national policies, programs and legislation.
  • Develop human resources.
  • Link with other sectors.
  • Monitor community mental health.
  • Support more research.

Based on the data of 12 countries, assessed by the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the costs of scaling up mental health services by providing a core treatment package for schizophrenia, bipolar affective disorder, depressive episodes and hazardous alcohol use have been estimated. Structural changes in mental health systems according to the WHO recommendations have been taken into account.

For most countries, this model suggests an initial period of investment of US$0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least ten-fold in low-income countries. In those countries, additional financial resources will be needed, while in middle- and high-income countries the main challenge will be the reallocation of resources within the health system to provide better mental health service.

Prevention

Prevention is beginning to appear in mental health strategies, including the 2004 WHO report “Prevention of Mental Disorders”, the 2008 EU “Pact for Mental Health” and the 2011 US National Prevention Strategy. NIMH or the National Institute of Mental Health has over 400 grants.

Stakeholders

World Health Organisation (WHO)

Two of WHO’s core programmes for mental health are WHO MIND (Mental health improvements for Nations Development) and Mental Health Gap Action Programme (mhGAP).

WHO MIND focuses on 5 areas of action to ensure concrete changes in people’s daily lives. These are:

  • Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet).
  • Mental health policy, planning and service development.
  • Mental health human rights and legislation.
  • Mental health as a core part of human development.
  • The QualityRights Project which works to unite and empower people to improve the quality of care and promote human rights in mental health facilities and social care homes.

Mental Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The aim of mhGAP is to build partnerships for collective action and to reinforce the commitment of governments, international organisations and other stakeholders.

The mhGAP Intervention Guide (mhGAP-IG) was launched in October 2010. It is a technical tool for the management of mental, neurological and substance use disorders in non-specialist health settings. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.

Criticism

One of the most prominent critics of the Movement for Global Mental Health has been China Mills, author of the book Decolonising Global Mental Health: The Psychiatrization of the Majority World.

Mills writes that:

This book charts the creeping of psychology and psychiatry across the borders of everyday experience and across geographical borders, as a form of colonialism that comes from within and from outside, swallowed in the form of a pill. It maps an anxious space where socio-economic crises come to be reconfigured as individual crisis – as ‘mental illness’; and how potentially violent interventions come to be seen as ‘essential’ treatment.

Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalisation of the American Psyche. A more constructive approach is offered by Vincenzo Di Nicola whose article on the Global South as an emergent epistemology creates a bridge between critiques of globalisation and the initial gaps and limitations of the Global Mental Health movement.

10 Mental Health Stats

Good mental health is related to mental and psychological well-being. The World Health Organisation’s (WHO’s) work to improve the mental health of individuals and society at large includes the promotion of mental well-being, the prevention of mental disorders, the protection of human rights and the care of people affected by mental disorders.

  1. Mental, neurological and substance use disorders make up 10% of the global burden of disease and 30% of non-fatal disease burden.
  2. Around 1 in 5 of the world’s children and adolescents have a mental disorder.
  3. Depression is one of the leading causes of disability, affecting 264 million people.
  4. About half of mental disorders begin before the age of 14.
  5. Almost 800,000 people die by suicide every year; 1 person dies from suicide every 40 seconds.
    • Suicide is the second leading cause of death in individuals aged 15-29 years.
  6. Around 1 in 9 people in settings affected by conflict have a moderate or severe mental disorder.
  7. People with severe mental disorders die 10 to 20 years earlier than the general population.
  8. Rates of mental health workers vary from below 2 per 100,000 population in low-income countries to over 70 per 100,000 in high-income countries.
  9. Less than half of the 139 countries that have mental health policies and plans report having these aligned with human rights conventions.
  10. The global economy loses about US$ 1 trillion per year in productivity due to depression and anxiety.

Reference

World Health Organisation. (2019) Mental Health. Available from World Wide Web: https://www.who.int/news-room/facts-in-pictures/detail/mental-health. [Accessed: 17 May, 2021].

Elucidating the Epidemiology of Mental Disorders

Research Paper Title

WHO’s work on the epidemiology of mental disorders.

Background

The WHO programme on epidemiology of mental disorders started in the early 1960’s with a series of reviews of knowledge.

These were followed by activities aiming at four main goals:

  • The standardisation of psychiatric diagnosis, classification and statistics;
  • The development of standardised internationally applicable instruments for the assessment of mental patients and of variables relevant to the assessment of mental illness;
  • The conduct of epidemiological studies of mental disorders; and
  • The training relevant to the above goals.

The paper provides a description of the activities undertaken to achieve these goals and stresses the importance and usefulness of the collaboration of individuals, experts and institutions all over the world in this effort.

Reference

Sartorius, N. (2020) WHO’s work on the epidemiology of mental disorders. Social Psychiatry and Psychiatric Epidemiology. 28(4), pp.147-155. doi: 10.1007/BF00797316.