I remember as a medical student how averse to mobile phones the hospital environment was, particularly around patients on cardiac monitors, and even in hospital corridors. Thankfully, most hospitals are more sensible in their approach these days; allowing relatives and patients to use their phones in most hospital areas at a time when communication is very important to them.

Most of the fear around health risks posed by mobile phones has focussed on cancer. A major review of existing studies showed that mobile phone use led to “no increased risk within approximately 10 years of use for any tumor of the brain or any other head tumor”. This data is particularly strong for fast-growing tumors (e.g. malignant glioma). On the other hand, for slow-growing tumors (e.g. meningioma and acoustic neuroma), the observation periods of mobile phone use within studies have been too short. Similarly, a case-control study published this year in the BMJ showed no association between risk of early childhood cancers and maternal exposure to mobile phone base stations during pregnancy.

It turns out that mobile phones are of great interest to medical researchers: 2602 hits in Pubmed to-date with 160 review articles. For over 10 years, the potential of telemedicine and mobile phones as a force for good in healthcare has been explored. The benefits of mobile phone usage in disease management programmes have been found across many diseases, from reducing frequency and duration of heart failure hospitalisations and self-monitoring of glucose in diabetes to obesity and hypertension.

A systematic review titled, “Healthcare via cell phones identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. “Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy, …….with implications for both patients and providers.”

As bluetooth technology improves to allow remote assessment of patients, particularly in blood pressure monitoring, it seems that mobile phones may represent one of those rare technological advances that can also be useful in low resource settings. The Lancet Online published the results of a randomised controlled trial from Kenya today showing that mobile phone communication between health-care workers and patients starting antiretroviral therapy improves adherence to therapy. 538 clinic patients starting antiretrovirals were randomised to either receive weekly SMS messages from a clinic nurse or to standard care with impressive NNTs. To achieve greater than 95% adherence, only 9 patients needed to receive SMS messages, and to achieve suppression of the viral load of HIV only 11 patients needed to get SMS reminders. The (SMS) message is very clear. Health professionals have to stay afloat of technology and use all available tools to improve healthcare outcomes, maybe even more so in resource-poor settings.

The horrors of the recent earthquake in Haiti have dominated the news media worldwide, making the UN label it as the “worst disaster it has ever faced”. Obama has enlisted the help of his two immediate Presidential predecessors (Bush and Clinton) to tackle this tragedy. Given George W Bush’s success in global conflict creation and resolution, I am not sure why President Obama felt that he was the best man to deal with such a humanitarian catastrophe. Estimates of the number of deaths in Haiti are around 200 000 at this point and the human toll in terms of future ill health and further deaths is likely to be much more. A massive, international fundraising and humanitarian mission is being mobilised to try to help what was already a troubled state, but is now literally a state of emergency.

It got me thinking about the scale of other public health emergencies that the world has recently faced. Ten years ago, at the turn of the millennium, the UN first recognised that a disease could be a threat to human security with respect to HIV/AIDS. A vicious circle connects ill health, poverty and lack of development, and there is no doubt that the global scale of HIV/AIDS and several other diseases such has coronary heart disease causes a massive burden that threatens the security of whole populations. UNAIDS, the UN’s only organisation devoted to a specific disease, was founded in 1996. Whether or not you agree with the prioritisation of one disease over another, this move by the UN definitely increased the profile of the disease in political, health and wider spheres, in a way that had not been seen before. AIDS is the fourth leading cause of death world-wide (2.9 million deaths per year) and the leading cause in Africa. The top three causes of death globally are ischaemic heart disease (7.2 million deaths), stroke (5.5 million) and lower respiratory diseases (3.9 million).

5 years ago, the South Asian tsunami resulted in “more than 150,000 people dead, tens of thousands of people missing, thousands of miles of destroyed coastline, and loss of livelihood for millions of distraught survivors”. The humanitarian responses to the tsunami in the short and long-term will hopefully give our leaders lessons in how best to deal with the terrible situation in Haiti. There were concerns regarding better data collection in the humanitarian disaster setting and whether the funds raised by the relief effort were: (a) reaching the desired targets, and (b) being spent on long-term as well as short-term healthcare provisions. These concerns are there with respect to the Haitian earthquake as well, making some people very sceptical of fundraising by the many charities that are now clamouring to support Haiti’s crumbled infrastructure.

Conflict and civil war are the other massive killers of our time. For example, in Darfur 1.3 million people were displaced from their homes and least 30,000 people were killed. The Iraq war is estimated to have killed 100 000 civilians. It is very difficult to get similar figures for the conflict in Afghanistan.

This quick comparison leads to two conclusions. Firstly, the devil is in the detail. We have to pay attention to the numbers to get an idea of scale of tragedy, especially in the weeks and months following such disasters. Better data and surveillance is always required. Secondly, although development assistance for improving health in countries of low and middle income has greatly increased in the past 20 years, the scale of the response often does not match the scale of the tragedy. The gap between the scale of the problem and the response cannot be better illustrated by the case of swine flu, and the hunt for the culprit has already begun.

South Africa, with a population of 50 million, has nearly 6 million people infected with HIV — more than any other country in the world. AIDS-related diseases kill nearly 1,000 South Africans every day.

Antiretroviral therapy (ART) has been available since the late 1980s, but even in 2009, ART is not available to many people with HIV/AIDS in poorer countries. Since the beginning of the epidemic, South Africa has been the hotbed for political activism and human rights campaigns to address the massive inequalities in AIDS management in the developing world. For example, the Treatment Action Campaign (TAC), led by Zackie Achmat, successfully sued the Ministry of Health in South Africa in 2002 to ensure access to ART for HIV-infected pregnant mothers, so that mother-to-child transmission was reduced. The TAC even took Merck and other pharma companies to court to force them to make their patents available to generic drug-producing companies so that cheaper antiretroviral drugs could be available in South Africa. This type of action massively forced the price of ART down in the last decade, and meant that generic companies are the main suppliers of ART in this country, and across Africa.

In the past, the relationship between politicians and the public health community of South Africa, particularly relating to HIV/AIDS, has been confrontational at worst, and lukewarm at best. Past President, Thabo Mbeki, famously denied the association between HIV and AIDS and instead focused mainly on poverty as a powerful co-factor in AIDS diagnosis. His successor, the current President Jacob Zuma, went on trial in 2006 for allegedly raping an HIV-positive woman. He earned wide criticism and incredulity when he admitted that he had unprotected sex and stated his belief that showering after sex would prevent HIV transmission. We do not need a clearer illustration of what happens when ill-informed politics and lay beliefs inform health policy and practice, instead of science and evidence. More than 330,000 lives were lost to HIV/AIDS in South Africa from 2000 and 2005, due to the policies of the South African government. In the UK and most countries of the world, we have similar instances of ill-informed health policy based on beliefs or poorly interpreted evidence, which have led to negative impact on health. For example, the Lancet publication of a case series of only 12 patients with autism led to greatly reduced uptake of the MMR vaccine in the UK with far-reaching consequences, even though the research was discredited years later.

Thankfully, a new era is being heralded in South Africa with a huge shift in direction in terms of HIV/AIDS policy. This week’s Lancet describes President Zuma’s change of heart, leading his country with the slogan, “I am responsible, we are responsible, South Africa is taking responsibility”. Unsurprisingly, the story has not received much coverage in the world press, but the message is clear. Good health policy must rest on good evidence and government action to the contrary is irresponsible and often bad for the health of the population.