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For many readers of The Lancet, 2016 will be viewed as a dark year. As highlighted elsewhere in this issue (p 2971), ongoing civil conflict has led to record numbers of displaced people (around 65 million, just under 1% of the world's population). The aftershocks of democratic political revolutions on both sides of the Atlantic still resonate, with no clear path ahead and few grounds for optimism. Yet, by contrast, 2016 has also seen some striking successes in health: polio eradication has come tantalisingly close, with only 34 cases reported this year in three countries; and 30 million people were successfully vaccinated against a raging yellow fever outbreak in DR Congo and Angola, a remarkable effort from the many agencies involved.
In clinical medicine, The Lancet's Commission on Hypertension highlighted an action plan to reduce the enormous burden of cardiovascular disease worldwide, a burden that could largely be prevented through non-pharmacological interventions—including improved diet and more physical activity. In 2017, a Lancet Commission on Dementia will focus on global efforts to bring together the best science to outline realistic and practical actions to reduce the onset and progression of this most profoundly debilitating and poorly understood disease. This is science in action. The challenge is translation. But sometimes the rationality of science can be thwarted.
A year ago, Zika was a little-known virus, yet it undoubtedly became the public health story of 2016. Zika virus may no longer be a Public Health Emergency of International Concern (as of Nov 18), but it remains a public health threat. And it has left a shadow of sadness and fear among millions of women and families exposed to its unpredictable dangers.
The International AIDS Society returned to its spiritual home of Durban, South Africa. It was in Durban in 2000 that the AIDS response went global. But not all those at risk of acquiring HIV have been treated equally. The Lancet's Series on HIV in prison communities sought to break further new ground by throwing light on this highly stigmatised population. Meanwhile, the latest Global Burden of Disease report, published in October, provided a framework for how comprehensive health data can be used in countries to serve as baseline performance measures for stronger and more effective accountability—monitoring, review, and action—within the 2030 Sustainable Development Goal era.
2017 will see The Lancet launch two new journals. The Lancet Planetary Health will be an open-access, online journal, focusing on the health of human civilizations and the ecosystems on which they depend. Its work, led by Editor-in-Chief Raffaella Bosurgi, will be supported by a LancetCommission on Pollution and Health and a research-driven conference led by the Planetary Health Alliance, to be held in April, 2017. The birth of a new discipline is always a cause for excitement in medicine. We plan for The Lancet Planetary Health to become a leading source of reliable science for sustainability and health. The Lancet Child & Adolescent Health, led by Editor-in-Chief Jane Godsland, will build on more than a decade of work at The Lancet to promote the cause of child and newborn survival, ending stillbirths, early child development, and adolescent health. There can be no future for human civilizations without attention to the future of its 1·8 billion young people. The Lancet Child & Adolescent Health will seek to be the trigger for a new social movement for intergenerational equity.
Perhaps the biggest challenge for medicine in 2017 will be making tangible progress towards the goal of Universal Health Coverage (UHC). To that end, WHO will elect a new Director-General in May. His or her task will be to show that WHO can be more than a talking shop for well meaning health advocates and public health scientists. It is not clear that a new Director-General can succeed. WHO may have been eroded beyond the point of recovery. But to demonstrate WHO's continuing value, his or her first priority must be to foster the political environment to accelerate implementation of UHC in countries.
At its best, the health community can offer hope at moments of despair. In 2017, we will discover what a US Presidency led by Donald Trump actually means. Will it be as apocalyptic as some predict? Or will he be a model of business-like pragmatism? As 2016 draws to a close, it is perhaps worth reflecting on the unifying power of health. 2017 is likely to need that kind of optimism more than ever.