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Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined. Because much of the world's population is inadequately nourished and many environmental systems and processes are pushed beyond safe boundaries by food production, a global transformation of the food system is urgently needed. More than 820 million people have insufficient food and many more consume an unhealthy diet that contributes to premature death and morbidity. [...]global food production is the largest pressure caused by humans on Earth, threatening local ecosystems and the stability of the Earth system. With food production causing major global environmental risks, sustainable food production needs to operate within the safe operating space for food systems at all scales on Earth. [...]sustainable food production for about 10 billion people should use no additional land, safeguard existing biodiversity, reduce consumptive water use and manage water responsibly, substantially reduce nitrogen and phosphorus pollution, produce zero carbon dioxide emissions, and cause no further increase in methane and nitrous oxide emissions. Because food systems are a major driver of poor health and environmental degradation, global efforts are urgently needed to collectively transform diets and food production.

Cardiovascular disease, cancer, chronic pulmonary disease, and diabetes are conditions that, to a large extent, do not result directly from infection. The toll from these noncommunicable diseases is the subject of this review in the Global Health series. The United Nations has held only two meetings of heads of state on a health-related issue. The first, in 2001, was on human immunodeficiency virus infection and the acquired immunodeficiency syndrome. The second, in September 2011, was on noncommunicable diseases. Although noncommunicable diseases were ignored during the framing of the Millennium Development Goals in 2000, their leading and growing contribution to preventable deaths and disability across the globe has compelled policymakers to pay attention and initiate action. The United Nations and the World Health Organization (WHO) have called for a 25% reduction by 2025 in mortality from noncommunicable diseases among . . .

The latest estimates and analyses from the Global Burden of Disease Study 2015 (GBD 2015)1-7 provide a vital link between the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) for 2016-30. The GBD 2015 investigators report global and national trends in various health metrics, from 1990 to 2015, and their association with levels of national development measured through a Socio-demographic Index (SDI), and profile epidemiological and health transitions across the world. GBD 2015 also measures progress on specific MDG-related indicators and non-MDG-related indicators that are included in the SDGs.1-7

Several public health experts have questioned a general need for boosters.5 Beyond declining antibody concentrations, proponents of booster doses have cited real-life evidence of protection against breakthrough infections in Israel.6 As clinical trials of booster dose efficacy would be difficult to conduct at this stage of the pandemic, evidence about protection is valuable. The study included recipients of the BNT162b2 vaccine, which delivers a lower antigen dose than Moderna's mRNA-1273 vaccine.7 The US Centers for Disease Control Prevention report from a case-control analysis that the mRNA-1273 vaccine showed a decline in efficacy from 93% to 92%, after 120 days from the completion of vaccination, in contrast to a decline from 91% to 77% for BNT162b2.7 A report on a Kaiser Permanente population indicates that effectiveness of the BNT162b2 vaccine against the delta (B.1.617.2) variant fell to 53% (95% CI 39–64) 4 months after the second dose, although effectiveness against admission to hospital remained high at 93% (84–96) up to 6 months.8 Other reports from Israel and Qatar indicate speedily declining protection.2,3 Although these reports strengthen the case for a booster dose of BNT162b2, there is no evidence yet to suggest that global policies related to other vaccines should be influenced by this experience. [...]dose vaccine effectiveness against admission to hospital and severe disease was similar between males and females, and between individuals aged 40–69 years and at least 70 years; however, for individuals aged 16–39 years, the rate of these severe outcomes was too small for meaningful estimation.

Lesson one: don’t declare success too early

Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022—a fitting way to mark the 75th year of India's independence.

The international community can best support countries to implement progressive universal health coverage by financing population, policy, and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows. Antimicrobials based on a new mechanism of action Combined diarrhoea vaccine (rotavirus, enterotoxigenic Escherichia coli, typhoid, and shigella); protein-based universal pneumococcal vaccine; respiratory syncytial virus vaccine; hepatitis C vaccine ..

Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.

Additionally, more than 70 non-state actors, representing more than 14 000 health-care facilities in 25 countries, have joined the UN Framework Convention on Climate Change (UNFCCC) High Level Climate Champions' Race to Zero, committing to net zero emissions.9 Alongside this progress, under the leadership of the Government of India's G20 Presidency and the Ministry of Health and Family Welfare, G20 governments are discussing a set of high-level principles for health-care climate action grounded in a One Health approach (panel).10 These principles, which were discussed at a G20 co-branded event, led by the Asian Development Bank in April, 2023, provide a framework for developing and financing climate resilient, sustainable, low-carbon health systems and supply chains.10 Many governments have voiced support for the proposed principles and for the urgency of addressing the climate and health nexus. Some initiatives indicate what this could look like at a national level and in front-line services, such as England's National Health Service (NHS) net zero strategies11 and the collaboration between the NHS and the US Department of Health and Human Services to decarbonise the supply chain by aligning procurement requirements.12 Meanwhile, more than 1000 hospitals in the USA have pledged to reduce emissions and build climate resilience,13 and the US National Academy of Medicine has established an Action Collaborative to support efforts to decarbonise the US health-care sector.14 Portugal published a national carbon footprint assessment and action plan for net zero.15 The Netherlands have established a Green Deal on Sustainable Health Care to reduce emissions by 49% by 2030 and achieve carbon neutrality by 2050.16 In May, 2023, France released a Road Map for Sustainability in Health Care that aims to provide credits for energy efficiency, subsidise electric vehicle fleets, and establish a sustainable procurement platform, among other initiatives.17 Importantly, environmentally sustainable health systems are now a major priority for the WHO Regional Office for Europe.18 Efforts are also underway in low-income and middle-income countries (LMICs) to advance low-carbon, climate resilient health development strategies that ensure the path to universal health coverage (UHC) reduces emissions.19 National health ministries in Argentina, Chile, Colombia, Indonesia, Laos, Nepal, and Peru, among others, are initiating efforts to calculate their health-care sectors' climate footprints and set plans for climate resilience and decarbonisation. In India, Chhattisgarh state is using solar energy for all primary health centres and more than 90% of all district hospitals and community health centres.21 And a €48 million grant from the IKEA Foundation to the Indian non-governmental organisation the SELCO Foundation will support the provision of sustainable solar energy to 25 000 health-care facilities in 12 states by 2026, in partnership with the Ministry of Health and Family Welfare.22 Similarly, PowerAfrica, a US Government-led partnership, is working with African governments to deliver reliable, renewable power to 10 000 remote health facilities in sub-Saharan Africa.23 The World Bank is also supporting the electrification of health-care facilities in LMICs with renewable energy.

Migration from rural areas of India contributes to urbanisation and may increase the risk of obesity and diabetes. We tested the hypotheses that rural-to-urban migrants have a higher prevalence of obesity and diabetes than rural nonmigrants, that migrants would have an intermediate prevalence of obesity and diabetes compared with life-long urban and rural dwellers, and that longer time since migration would be associated with a higher prevalence of obesity and of diabetes. The place of origin of people working in factories in north, central, and south India was identified. Migrants of rural origin, their rural dwelling sibs, and those of urban origin together with their urban dwelling sibs were assessed by interview, examination, and fasting blood samples. Obesity, diabetes, and other cardiovascular risk factors were compared. A total of 6,510 participants (42% women) were recruited. Among urban, migrant, and rural men the age- and factory-adjusted percentages classified as obese (body mass index [BMI] >25 kg/m(2)) were 41.9% (95% confidence interval [CI] 39.1-44.7), 37.8% (95% CI 35.0-40.6), and 19.0% (95% CI 17.0-21.0), respectively, and as diabetic were 13.5% (95% CI 11.6-15.4), 14.3% (95% CI 12.2-16.4), and 6.2% (95% CI 5.0-7.4), respectively. Findings for women showed similar patterns. Rural men had lower blood pressure, lipids, and fasting blood glucose than urban and migrant men, whereas no differences were seen in women. Among migrant men, but not women, there was weak evidence for a lower prevalence of both diabetes and obesity among more recent (