Editorial

558 www.thelancet.com Vol 384 August 16, 2014

For the IMM report on disability rights see http://www.hrc.co.nz/

disabled-people/convention-on-the-rights-of-persons-

with-disabilities/making-disability-rights-real/making-disability-rights-real-

2012-2014-report/

For New Zealand’s Disability Action Plan 2014–18 see http://

www.odi.govt.nz/what-we-do/ministerial-committee-on-

disability-issues/ disability-action-plan/2014-2018/index.html

Globally, about 650 million people live with disabilities, including intellectual or learning disabilities, and the 80% of disabled people who live in low-income countries often have little or no access to essential health services. Health disparities are also stubbornly evident in high-income countries, and in New Zealand, for example, aff ect disabled people of Maori and Pacifi c Island ethnicity. Making disability rights real, a report aiming to address the situation of people living with disabilities in New Zealand, was published on Aug 7 by the Independent Monitoring Mechanism (IMM) of the UN Convention on the Rights of Persons with Disabilities, part of the independent monitoring process for countries that have ratifi ed the Convention.

In New Zealand, women with intellectual disability die an average of 23 years before other women, whereas the life expectancy of men with intellectual disability is curtailed by 18 years on average. To tackle such serious disability-related issues, the IMM report stresses fi ve key areas that require attention—to ensure regular collection of robust

and timely data across a range of sectors; to recognise the right to access the physical environment and services; to build a people-driven system; to prevent abuse of disabled people in all environments; and to ensure that disabled children realise their educational rights. The report also highlights the need to close serious health outcome gaps, which particularly aff ect people with learning or intellectual disabilities.

The seriousness of New Zealand’s intent to address the health and wellbeing of people with disabilities is evident from the scope of the IMM report. The country’s Disability Action Plan 2014–18, which was released in May of this year, details its priorities in transforming systems for protection and support of people with disabilities. It is essential that disabled people and their organisations are actively involved in fi nding solutions to improve health, wellbeing, and life expectancy. At the end of the 2014–18 period, evaluation of New Zealand’s Disability Action Plan by and on behalf of people with disabilities will be key to its success. The Lancet

There is no single solution to the rapidly progressing problem of antibacterial resistance. Although various strategies are being implemented worldwide, between 2000 and 2010 consumption of antibiotics increased by 36%. Discovery of new antibiotics is a necessary but not suffi cient solution because of the high cost and lengthy timelines. Thus, action to control prescription practices should be a key feature of intervention strategies.

In 1998, the UK Department of Health reported that 80% of antimicrobial prescriptions for patients took place in the community and so recommended cessation of prescriptions for simple coughs and colds. In 2010, the Health Protection Agency (now Public Health England) expanded this guidance in a report detailing which antibiotics should be prescribed by doctors per condition and when. Prescription for acute respiratory infections, such as sore throat, was to be avoided. Unfortunately, data published earlier this month for 3·8 million patients in 537 general practices in the UK showed that the proportion of patients prescribed antibiotics for coughs and colds had risen from 35·5% in 1995 to 50·8% in

2011. But it is possible to change prescribing practice: in 2001, France started a national campaign to reduce use of antibiotics and by 2007 prescriptions had decreased by 26%. The benefi ts of sharing experience between policy makers and countries is considerable.

Inappropriate prescription is a greater problem in countries undergoing rapid economic expansion. In Bangladesh, China, and Thailand antibiotics are repeatedly indicated for self-limiting diarrhoeal infections and in India for viral dengue fever. In such countries where antibiotics were previously inaccessible and unaff ordable, over-the-counter and incentive-driven prescriptions have elevated antibiotic consumption. In low-income countries, antibiotics are given as a substitute for provision of clean water and safe waste disposal.

Surveillance of antibiotic resistance and consumption is globally weak or non-existent. However, before bacteria win the battle and currently treatable infections become fatal, prescribers, patients, policy makers, and governments need to take responsibility to ensure that antibiotics are used far more rationally. The Lancet

Priorities for people with disabilities in New Zealand

Prescribing antibiotics: a battle of resistance

For more on global antibiotic consumption see Articles

Lancet Infect Dis 2014; 14: 742–50

For the UK Department of Health’s report see http://

antibiotic-action.com/wp-content/uploads/2011/07/Standing-

Medical-Advisory-Committee-The-path-of-least-resistance-1998.pdf

For the Health Protection Agency report see http://www.

hpa.org.uk/webc/hpawebfi le/hpaweb_c/1279888711402

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