The Lancet
May 09, 2015 Volume 385 Number 9980 p1803-1916 e45-e46
http://www.thelancet.com/journals/lancet/issue/current

.
Editorial
Rural health inequities: data and decisions
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60910-2
70% of the world’s 1.4 billion people who are extremely poor live in rural areas. A new report released on April 27 by the UN International Labour Organisation (ILO), Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries, presents the first global, regional, and national data on the extent and major causes of rural–urban inequities in coverage, and access to health care. 56% of rural residents worldwide are without legal health coverage (defined as protected by legislation or affiliation with a health insurance scheme)—compared with 22% of the urban population.

.
Editorial
Keeping watch on women’s cancers
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60911-4
Cancer is a perennial public health issue. With refined estimates of the global burden of disease (GBD), the picture of cancer has become clearer and has begun to yield crucial new details about where the challenges lie. According to the 2013 GBD study, the cancers that contribute to the most deaths are: lung (1•64 million), stomach (840 000), liver (820 000), colorectal (770 000), and breast (470 000). But other areas of concern emerge when aggregating across types of cancer, such as cancers that specifically affect women.

.
Comment
Global health security now
Richard Horton, Pamela Das
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60909-6
The concept of security as an important dimension of health divides opinions. To invoke the idea of security risks giving permission to more authoritarian-minded governments to use health crises as justification for sometimes extreme curbs on liberty or the political, economic, and social rights of citizens. During the Ebola virus disease outbreak, photographs appeared in news media of police brutally attacking the public for breaching curfews. Invoking arguments of global health security might further encourage this kind of violent response.

.
Comment
Putting science into practice for early child development
Anthony Lake, Margaret Chan
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61680-9
The debate between nature and nurture as determinants of early child development is over. Today, we understand that the two are inextricably linked. The degree of their interdependence—and the impact of this interplay on the developing brains of children—is even greater than we previously imagined.1 This knowledge has tremendous implications for how we design and deliver early child development interventions…

.
Public Policy
Global health security: the wider lessons from the west African Ebola virus disease epidemic
Prof David L Heymann, MD, Lincoln Chen, MD, Prof Keizo Takemi, MA, Prof David P Fidler, BCL, Jordan W Tappero, MD, Mathew J Thomas, MPH, Thomas A Kenyon, MD, Thomas R Frieden, MD, Derek Yach, MBChB, Sania Nishtar, FRCP, Alex Kalache, Prof Piero L Olliaro, MD, Prof Peter Horby, MD, Els Torreele, PhD, Prof Lawrence O Gostin, JD, Margareth Ndomondo-Sigonda, MBA, Prof Daniel Carpenter, PhD, Simon Rushton, PhD, Louis Lillywhite, MSc, Prof Bhimsen Devkota, PhD, Prof Khalid Koser, PhD, Rob Yates, MBA ,Ranu S Dhillon, MD, Ravi P Rannan-Eliya, DPH
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60858-3
Summary
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

.
Public Policy
A retrospective and prospective analysis of the west African Ebola virus disease epidemic: robust national health systems at the foundation and an empowered WHO at the apex
Prof Lawrence O Gostin, JD, Eric A Friedman, JD
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60644-4
Summary
The Ebola virus disease outbreak in west Africa is pivotal for the worldwide health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership suggest the need for innovative reforms. Such reforms would transform the existing worldwide health system architecture into a purposeful, organised system with an empowered, highly capable WHO at its apex and enduring, equitable national health systems at its foundation. It would be designed not only to provide security against epidemic threats, but also to meet everyday health needs, thus realising the right to health. This retrospective and prospective analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilisation, ill defined responsibilities, and insufficient coordination. The scope of the reforms should address failures in the Ebola response, and entrenched weaknesses that enabled the epidemic to reach its heights.

.
Viewpoint
What is a resilient health system? Lessons from Ebola
Margaret E Kruk, Michael Myers, S Tornorlah Varpilah, Bernice T Dahn
Ebola vaccines: keep the clinical trial protocols on the shelf and ready to roll out
David L Heymann, Guenael R Rodier, Michael J Ryan