Alastair Campbell

  Olumide Ogundeji

It has no respect for wealth, race, gender, social status or location, from top government officials to the unemployed youth next door.

According to the World Health Organisation, depression leads the causes of disability (measured by years lost due to disability) and is predicted to move from fourth to second place in contributing to the global burden of disease. Within the UK, whether in Downing Street or Camden Street no one has an absolute barrier to this condition.

Most of us know someone or have friends or family, who suffer from depression, yet we rarely speak about it, creating a false impression that the less we talk about it the safer we are from acquiring it.

With the current increasing interest in global health, not only by individuals in health sciences but across many diverse fields including economics, law and behavioural sciences, it is only prudent that we discuss depression, its symptoms and challenges.

The language
Explaining the condition at the UCL symposium, Tackling Depression: The Most Common Global Illness, on 29 May, Professor Michael King expressed the fact that although depression “can be described and differentiated from sadness, the boundaries may not always be clear”.

It is represented by a “persistently low mood, loss or little interest or pleasure in doing things, sometimes feelings of guilt and loss of self esteem”. Other more noticeable symptoms may include sleep disturbance, poor concentration, a feeling of little or no energy; however, this list is in no way exhaustive. Over time, these symptoms affect and impair an individual’s ability to perform day-to-day activities.

Professor King went on to emphasise that the present public understanding of depression is somewhat obscured to the extent that some of the most significant challenges that people with depression and their families face are based on public perception of the condition and stigmata associated with it.

Accepting the diagnosis is often an initial but major obstacle; some individuals avoid seeking help for the fear of being labelled with depression.

The wealth of a nation
On a global scale, the increase in the wealth of nations in terms of the GDP (gross domestic product) per capita has not shown to cause an increase in the measurement of happiness or a decrease in the levels of depression.

Rather, the findings from some studies highlight possible connection between modern lifestyle changes and an increase in the incidence of depression. Some academic professionals have expressed the view that the increase in our awareness and ability to identify depression has seemingly contributed to a perceived rise in incidence; this view was equally shared by the panel.

Contributing to the discussion, Sushrut Jadhav mentioned that in one of the less affluent countries during 1970s, researchers had difficulty finding exact translations for the word “depression”; though the people had expressions for some of the symptoms of depression, they did not constitute a condition like in the more affluent countries.

The extent to which this is documented and proven varies between cultures and races. With the increasing globalisation and wealth of most countries, this variation has become less evident. Has globalisation helped to improve the “language” of depression or condition known as depression or both?

The art
The association between creativity and depression continues to draw attention not just from the media, but from within academic circles as more studies and research are published.

Some of the greatest poets, painters, musicians, sculptors, composers and writers had some degree of depression or other mental health conditions. Most documented that they find inspiration in the depth of their symptoms of depression, while others completed their famous works while they were institutionalised.

One common observation is that their creativity was usually associated with their personal experience of depression.

Tony Blair’s former director of communications Alastair Campbell was one of the panellists and described his personal experience of depression as a “state of being dead and alive at the same time”. As a writer and speaker, he regularly reflects on this past experience.

No doubt the disease burden of depression is increasing, but how do we relate the increasing global burden from depression and relatively few, but important, contributions from people who have suffered from it?

Some surveys have been performed both in the US and UK to ascertain the attitude of employers to the disclosure of depression among prospective employees. It is hoped that the resilience of overcoming depression will prevail over the stigmata of this condition.

Community care
Focusing on care of people in the community, Fiona Butler talked about the key role of general practitioners (GPs) in being the first point of contact for people with depression.

She expressed the fact that one in three consultations by GPs have a psychological component, with depression being the commonest one; and more than 95% of treatment is carried out in the community (primary care). The importance of developing an integrated care model that is linked with an individual’s social care cannot be over-emphasised.

Finally, she stated the need for health authorities and politicians to sustain and improve resources available for depression and mental health as whole.

It is clear that to tackle the growing burden of depression, we need to have a clearer understanding of depression, overcome the stigma, acknowledge the creativity that it can inspire and channel more local and national resources to have a global impact upon it.

Jessica Lowrie, UCL Communications & Marketing intern.

By 2030, globally, three in five people will live in cities. Despite the perception that city living provides an ‘urban advantage’ over those who live in rural areas, those who live in poor urban areas can often have worse health outcomes than wealthier city residents, but also in comparison to rural dwellers.

Urban and economic growth will not automatically create an ‘urban advantage’ – public policy is needed to maintain and improve conditions to allow for such an advantage to exist.

Healthy cities
This concept was the foundation for an event held by the UCL-Lancet Commission on 30 May to launch their high-profile report on Healthy Cities, published on the same day.

The report was the second from the UCL-Lancet Commission, recognising the valued commitment from both organisations to UCL’s Grand Challenges (Global Health, Sustainable Cities, Intercultural Interaction and Human Wellbeing).

The well-organised and insightful event began with introductions from Professor David Price (UCL Vice-Provost – Research) and Professor Richard Horton (Editor, the Lancet).

Professor Yvonne Rydin (UCL Bartlett School of Planning), lead author of the report, then embarked on a comprehensive overview of the report and its main findings.

Professor Rydin explained that the report aimed “to understand how better health outcomes can be delivered through interventions in urban environments in cities across the world”.

Certain components of a healthy city seem obvious: good water and sanitation infrastructures, clean air, uncontaminated land, safe homes, opportunities for safe and active mobility and effective green infrastructure.

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The latest book in the Amnesty International Global Ethics Series, published by Norton is The Human Right to Health, written by Professor Jonathan Wolff (UCL Philosophy).

On Tuesday 27 March, Amnesty International hosted a panel discussion to launch this new publication. The panel consisted of Jonathan Wolff, Mike Rowson (UCL Centre for International Health and Development) and Widney Brown (Amnesty International), and was chaired by Steve Crawshaw (Amnesty International).

Panel Discussion
Professor Wolff began by admitting that because of his philosophical roots he was a relatively recent convert to the concept of the human right to health. Despite this, his book defends the concept against multiple criticisms.

The first criticism to be discussed relates to the phrasing of “the right to the highest attainable standard of health” (United Nations).

Three routes of criticism seem to emanate from this statement, firstly, how is attainability measured – globally, nationally or regionally could give very different standards. Secondly, this seems an unreal expectation and thirdly, if this right exists – who is accountable for providing it.

A further point raised was the fact that health itself did not need to be a human right – it could be considered simply a culmination of other human rights.

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TB research has changed over the past 10 years. Growing collaborations have led to huge advancements in testing and treatment for a disease that kills every 20 seconds.

But this progress is threatened by reduced financing of health programmes by the Global Fund, which accounts for two-thirds of global TB funding, leaving money only for ‘essentials’.

“Lives are on the line,” said Simon Logan, a policy advisor from the All Party Parliamentary Group on Global Tuberculosis, who is now urging the public to engage in dialogue about the potential impact that Global Fund restrictions will have on the disease.

The challenge of TB
World TB Day, held on 24 March, marks 130 years since Robert Koch discovered the bacteria responsible for the disease. The ‘UCL ‘Local and global’ TB conference last week coincided with a TB supplement in the Journal of Infectious Diseases – this year, the focus is paediatric TB. There are major challenges to tackling the disease and many are particular to children. These include under-reporting of cases, diagnostic difficulties and the need for better quality drugs.

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