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This report highlights the key findings of the Health and Environment Linkages Initiative, set up by the WHO and UN Environment Programme to identify ways of integrating environment and health considerations into decision-making. The report outlines the ways in which health and environment linkages are usually defined and framed by policymakers, and describes the most common institutional and political barriers they face.

A review of formal impact assessment tools is given, along with a 'menu of options' for good practice application of impact assessment. The report highlights the importance of measuring the impacts of decisions made in terms that can be understood by policymakers. And it offers guidance on how to combine health and environment issues with economic considerations, describing real-world experiences from Jordan, Thailand and Uganda.

In 2005, the World Health Assembly called on WHO member states to tackle their growing rates of cancer by developing rigorous cancer control programmes. To help guide the process, the WHO developed a series of six modules that provide practical advice for programme managers and policy-makers on how to advocate, plan and implement effective cancer control programmes, particularly in developing countries.

Individual modules focus on planning; prevention; early detection; diagnosis and treatment; palliative care; and policy and advocacy. As of May 2008, all but the one on policy and advocacy have been published.

Worldwide, cancer kills more people than HIV/AIDS, malaria and TB put together. In developing countries where chronic diseases are now growing alongside infectious diseases, new strategies need to be developed.

This article outlines how to develop an effective cancer strategy in African countries on the basis of discussions at the recent African Cancer Reform convention. A cancer control plan clearly needs to take into account African countries' financial constraints and the authors outline six key essentials that would offer most health gain for money invested. These are: setting up cancer intelligence units to collect data on cancer incidence; controlling tobacco use; early diagnosis and prevention; offering treatment wherever possible; palliative care when treatment is no longer useful; and training and educating future generations of African oncologists.

Developed countries can offer crucial expertise and experience and collaborate on cancer information networks. Educating local communities about a disease that is relatively new but growing quickly will also be essential to stop it spiralling when many cancers are preventable or treatable when detected early enough.

In 2003, the Gates foundation infused new vigour into global health efforts by declaring that the 21st century's "grand challenges" included developing new vaccines and overcoming drug resistance. This new grand challenges initiative, launched by a collaboration of top global chronic disease experts, identifies priorities in tackling diseases like diabetes and cardiovascular disease, and explains in detail how research should be directed to meet each challenge (a challenge was defined as a critical barrier that if removed would help solve an important health problem).

To distill the range of opinions and priorities, the coordinators sought input from 155 stakeholders from different countries and disciplines. The initiative requires the participation of agencies like the WHO, individual governments, and non-governmental organisations as well as civil society and business if it is to succeed. The authors point out that the Gates initiative was linked to large funding, whereas this project will rely on multiple funding agencies to coordinate on these priorities.

Global health experts have watched with increasing alarm as the waistlines of people in developing countries have started to widen with the adoption of a "Western" lifestyle. Obesity is of such concern because of its heightened risks for other diseases, such as heart disease, cancer, and diabetes.

In developing countries, the number of people with diabetes is set to rise to 228 million by 2030 from 84 million estimated in 2000. The link between obesity and diabetes is so strong because obesity renders individuals unable to properly process glucose — about 90% of type 2 diabetes is due to being overweight. Obesity and diabetes also raise the risk for cardiovascular disease and kidney disease. Diabetic nephropathy was the most common cause of end-stage renal disease in 9 out of 10 Asian countries, say the authors, which could be deadly for countries unable to cope with the health repercussions.

The problem of antibiotic resistance is not easy to solve. In an attempt to tackle the issue, policies are being implemented with some successes. But the successes, however encouraging, will not be enough to stop the spread of resistance, say the authors. Advice to restrict the use of antibiotics so that they are prescribed only when necessary (e.g. not for viral infections just to placate a patient) is useful, say the authors, but, they say, we might need to go further. They make the controversial argument that antibiotic resistance might be stopped only by putting society before the individual, perhaps by banning antibiotic treatment for mild bacterial infections, or using them only for life-threatening illnesses. Everyone has the right to treatment, and acting against the patient's interest is not usually considered ethical. In some situations, however, what is good for an individual patient may not be good for the health of society as a whole, say the authors – drastic problems sometimes necessitate drastic solutions.

At WHO's behest, the Alliance for the Prudent Use of Antibiotics (APUA) undertook a review of 25 key reports on antibiotic resistance to identify areas of consensus in expert recommendations and to suggest ways of translating the advice into action.

The reports were chosen because they were highly cited in medical literature and had input from a wide variety of expert policy groups. The review authors separated their comments into five areas: surveillance; education of patients and providers; prevention; R&D; and antibiotic use in animals.

Education, says the review, needs to happen in medical schools and among the general public. Surveillance of antibiotic resistance occurs but is fragmented – coordinated local surveillance networks could do much to tackle resistance before it spreads. Healthcare institutions need committees to assess antibiotic use data and enforce infection control measures. In terms of use in animals, the review recommends that farmers prevent infection with good hygiene and not just antimicrobials, and calls for the reduced use of antibiotics as growth promoters.

In June 2006, the UN emphasised the crucial role of food and nutrition in mitigating the effects of HIV/AIDS. This briefing paper explains how these issues are intertwined, and analyses why there has been little action in this area so far.

When food is scarce, women tend to get the smallest portion, leading them seek food elsewhere. This might include selling sex for food, putting them at a higher risk of HIV infection. Malnutrition can also weaken the immune system, making it easier to pick up infections but harder to get rid of them.

According to the report, health and food authorities each see it as the other's responsibility to integrate nutrition into HIV programmes. Donors and national policymakers have also been reluctant to support initiatives for integration. The first challenge, says the report, is raising awareness of the UN endorsement to secure action. Donors and governments should work to strengthen links between policies — the responsibility to reduce HIV/AIDS must not rest with the health sector alone. Finally, nutrition indicators should be included in clinical surveillance and reporting.

This briefing paper highlights the challenges in harmonising efforts to provide universal HIV/AIDS care. The 'Three Ones' principles, set in place to make the global fight against HIV/AIDS more efficient, advocate one action framework to coordinate all partners, one national AIDS authority and one country-level monitoring and evaluation system.

But, as the report points out, limited capacity in developing countries and a lack of incentives for donors to revise their practices are barriers to implementing these principles. There are also tensions between national ownership and accountability to donors.

By looking at countries that have been most successful in fighting the disease, such as Botswana and Malawi, the report outlines the keys to improving access to HIV/AIDS care.

Empowering national leadership is vital: what is needed are national HIV/AIDS strategies that have explicit priorities, are evidence-based, and link to other development plans. The multilateral donor community also needs to improve its delivery of technical support.

This risk assessment for Africa, published last year, covers influenza outbreaks in poultry and their significance for human health, human cases of H5N1, vaccine research and development, the role of antivirals during a pandemic, World Health Organization (WHO) support for pandemic preparedness in Africa, and recommended priority actions for African nations. The priority actions are fourfold. First, that African nations collaborate with one another, forming close links between various health sectors. Second, that existing coordinating bodies expand their role to include pandemic influenza. Third, that the surveillance and response systems are improved with the support of the WHO Regional Office. Fourth, that mechanisms be put in place to communicate messages to the public and media.

This clearly written review examines many current questions about using Intermittent Preventive Treatment (IPT) in pregnant women or in infants to reduce the numbers of clinical episodes and deaths due to malaria. Treatment is given at fixed time intervals regardless of whether the person is infected. This means that there is enough time after the drugs have cleared from the body to allow infections to occur and permit a build-up of immunity. The review refers to recent clinical trials on IPT in pregnant women and infants to discuss factors that could affect the outcome of the treatment. These include the intensity of malaria transmission, the choice of drugs, and the use of other prevention measures such as insecticide-treated nets.

 In this report, the World Health Organization (WHO) warns that vigilance is needed to prevent drug-resistant malaria arising from the widescale introduction of artemisin combination therapies (ACTs) for malaria. More than 50 countries have now adopted ACTs, and they must closely monitor the effectiveness of these drugs and check for the emergence of resistance, the report concludes. Patients should receive only WHO-approved high-quality medicines to minimise the risk of resistance emerging, and should be encouraged to complete their treatment courses. The report outlines the WHO's commitment to helping establish stardardised laboratory procedures, and strengthening resistance monitoring networks.

For this report, malaria and HIV/AIDS specialists were consulted on interactions between the two diseases and how having both affects people's health. They said there is still much to learn about the biological and clinical effects that malaria and HIV/AIDS have on each other. But some conclusions are already clear: integrating healthcare services is essential to reducing the burden of both diseases where they are prevalent. Health services providing HIV/AIDS prevention, treatment and care can serve as access points for malaria prevention and control. Likewise, new laboratory capacity to support HIV treatment and monitoring can also be used for malaria diagnosis. More research and debate is needed, however, before formulating new public health policies. 

For this report, malaria and HIV/AIDS specialists were consulted on interactions between the two diseases and how having both affects people's health. They said there is still much to learn about the biological and clinical effects that malaria and HIV/AIDS have on each other. But some conclusions are already clear: integrating healthcare services is essential to reducing the burden of both diseases where they are prevalent. Health services providing HIV/AIDS prevention, treatment and care can serve as access points for malaria prevention and control. Likewise, new laboratory capacity to support HIV treatment and monitoring can also be used for malaria diagnosis. More research and debate is needed, however, before formulating new public health policies. 

The World Health Organization recommends artemisinin combination therapies (ACTs) to treat malaria, but these therapies cost much more than older drugs such as chloroquine. This report by the US Institute of Medicine's Committee on the Economics of Antimalaria Drugs calls for an internationally funded global subsidy of US$300–500 million per year to provide ACTs to everyone needing them. A centralised agency should be set up, the report says, to buy ACTs from recommended producers and re-sell them at substantially lower prices to public and private organisations for distribution. Recipient countries should monitor drug distribution and the emergence of drug-resistant malaria parasites. The report is available free online. 

This article introduces a special collection of contributions by malaria researchers from around the world, including some information first presented at a symposium in Tanzania in 2002. The article is a useful overview of malaria's global impact and our current understanding of mosquito ecology and parasite transmission. It describes new measures needed to combat and eventually eliminate malaria. The full supplement — freely available online, in print or on DVD — features articles on how well artemisinin combination therapies treat malaria and delay the emergence of drug-resistant parasites, how useful insecticide-treated bed nets are, and progress towards a vaccine. It also covers social and economic dimensions of malaria, and how they affect the scaling up and use of existing prevention and control measures.

This article introduces a special collection of contributions by malaria researchers from around the world, including some information first presented at a symposium in Tanzania in 2002. The article is a useful overview of malaria's global impact and our current understanding of mosquito ecology and parasite transmission. It describes new measures needed to combat and eventually eliminate malaria. The full supplement — freely available online, in print or on DVD — features articles on how well artemisinin combination therapies treat malaria and delay the emergence of drug-resistant parasites, how useful insecticide-treated bed nets are, and progress towards a vaccine. It also covers social and economic dimensions of malaria, and how they affect the scaling up and use of existing prevention and control measures.

This article is a call for radically improved communication about the dangers of substandard and fake drugs, particularly in poor countries. This is currently a "vast and underreported problem" that the pharmaceutical industry fails to address, and it should be monitored independently, say the authors. Using examples of fake drug sales in Africa and Asia, they argue that without action, lives will remain at risk, and public confidence in the pharmaceutical industry will be undermined in the long term.

The London School of Hygiene and Tropical Medicine's Gates MalariaIntermittent Presumptive Treatment (IPT) is a recently developed strategy for preventing sickness and death from severe malaria. It involves giving a curative treatment dose of an effective anti-malarial drug at predefined intervals to pregnant women and infants. In this article, Nick White, director of the Wellcome Trust South East Asia Programme in Thailand and Vietnam, and advisor on SciDev.Net's malaria dossier argues that to guide policymakers on promoting and implementing IPT, more information is needed on how it works. White uses some technical terms but expresses clearly his concerns about issues such as how long drugs remain effective after each treatment, as this determines whether IPT can ward off or suppress new infections. He also discusses parasite resistance to drugs currently used in IPT and the rationale for using new antimalarial drugs.

A future malaria vaccine, if licensed, is likely to be far from perfect — it could cost dollars not cents, and might be far less than 100 per cent effective. This article, explores a hypothetical scenario of a new malaria vaccine being only 30–50 per cent effective. It illustrates the hard decisions policymakers will need to make when trying to allocate funds for malaria prevention and control to only the most cost-effective measures. To inform decision-making, research is needed on how different vaccines would affect malaria epidemics and at what cost, as well as to determine a vaccine delivery mechanism. The article is likely to appeal to non-specialist readers more than some other papers in this special supplement.