Facing up to the world’s critical health crises

By Martin Khor (Executive Director, South Centre)

The recent World Health Assembly discussed the manifold global health crises that the world is unprepared for, and adopted resolutions to act on many issues.

(The article has been published and circualted by Third World Network. A shorter version of this article was first published in The Star, Malaysia on 6 June 2016.)

The global health situation is facing many critical challenges, and multiple actions must be taken urgently to prevent crises from boiling over.

This is the impression one gets from this year’s World Health Assembly held in Geneva on 23-28 May.

The WHA is the world’s prime public health event.  This year 3,500 delegates from 194 countries took part, including Health Ministers of most countries.   The one-week session provided a snapshot of the major medical problems and the actions being taken or proposed to deal with them.

In her opening speech, World Health Organisation Director-General Dr. Margaret Chan gave an overview of what went right and what is missing on the global health front.

First, the good news – 19 000 fewer children dying every day, 44% drop in maternal mortality, 85% of tuberculosis cases that are successfully cured, and  the fastest scale-up of a life-saving treatment in history, with over 15 million people living with HIV now receiving therapy, up from just 690 000 in 2000.

Aid for health became more effective.  Health is now seen as an investment for stable and equitable societies, not just a drain on resources.

Then Dr. Chan described how health has evolved from a local to a globalised problem, with air pollution becoming a transboundary health hazard also causing climate change, and drug-resistant pathogens being spread through travel and food trade. 

The recent Ebola and Zika outbreaks showed how global health emergencies can quickly develop. There is a dramatic resurgence of emerging and re-emerging infectious diseases, which the world is not prepared to cope with.

Dr Chan gave three examples of the global health landscape being shaped by slow-motion disasters: climate change, antimicrobial resistance, and the rise of chronic non-communicable diseases as the leading killers worldwide.

These are man-made disasters created by policies that place economic interests above health and environmental concerns. Fossil fuels power economies, medicines for treating chronic conditions are more profitable than a short course of antibiotics, and highly processed foods gain a bigger market than fresh fruits and vegetables.

Unchecked, these slow-motion disasters will eventually reach a tipping point where the harm done is irreversible.  For antimicrobial resistance, “we are on the verge of a post-antibiotic era in which common infectious diseases will once again kill.”

On moving ahead, Dr. Chan pinpointed universal health coverage as the target that underpins all others in the health aspect of the Sustainable Development Goals. It is the ultimate expression of fairness that leaves no one behind, and can meet people’s expectations for comprehensive care.

The Director-General’s speech provided a framework for the many discussions and resolutions that followed.

The Assembly agreed that the WHO set up a new Health Emergencies Programme to enable it to deal operationally better with disease outbreaks and humanitarian emergencies.  It aims to enable WHO to lead in providing rapid, predictable, and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or conflicts.

On antimicrobial resistance, many countries reported on actions they have taken in light of the Global Action Plan adopted at the World Health Assembly in 2015.  Several developing countries requested for funds and technology such as laboratory equipment to diagnose resistant strains of pathogens, to help them meet the deadline of making national action plans by 2017.

The WHO produced a new paper on options to set up a global stewardship framework to support the development, control and appropriate use of new antimicrobial medicines and diagnostic tools, and also gave a report on the past year’s actions.

The Secretariat has made quite a lot of progress, but action on the ground is still slow.  For example, in the Asia-Pacific region only six countries have completed their national plans and another five have plans are being developed.

At the end of the discussion, the WHO’s assistant Director-General Keiji Fukuda said the next year would focus on three elements:  make progress on the Global Action Plan, further develop the global stewardship framework, and involve political leaders in the issue through a heads of states meeting in the United Nations headquarters in New York in September.

There were two issues on childhood nutrition that highlighted the need to put health concerns above corporate interests. The first was childhood and adolescent obesity.  In 2014, an estimated 41 million children under 5 years were affected by overweight or obesity, and 48% of them lived in Asia and 25% in Africa.

The marketing of unhealthy foods to children was identified by the WHO Commission on Ending Childhood Obesity as a major factor in the increase in childhood obesity.

The Commission recommended the promotion of intake of healthy foods and to reduce the intake of unhealthy foods and sugar-sweetened beverages by children and adolescents. It proposed effective taxation on sugar-sweetened beverages and curbing the marketing of unhealthy foods.

The World Health Assembly welcomed the Commission’s six recommendations and called on the WHO Secretariat to develop an implementation plan to guide further action and also recommended Member States to develop national responses to end childhood and adolescent obesity.

On the second issue, the Assembly welcomed the WHO guidance on ending the inappropriate promotion of foods for infants and young children.  According to the guidelines, to support breastfeeding, the marketing of “follow-up formula” and “growing-up milks” – targeted for babies aged 6 months to 3 years – should be regulated in the same manner as infant formula for 0 to 6-month-olds.

The WHO guidance also indicates that foods for infants and young children should be promoted only if they meet standards for composition, safety, quality and nutrient levels and are in line with national dietary guidelines.  It also recommends that health professionals do not accept gifts or free samples from companies marketing these foods and that companies do not sponsor meetings of health professionals.

On another issue, access to medicines and vaccines, the WHA agreed on measures to address the global shortage of medicines and vaccines, including monitoring supply and demand, improving procurement systems and improving affordability through voluntary or compulsory licensing of high-priced medicines.

An interesting and well-attended side event was organised by India on behalf of the BRICS countries (Brazil, Russia, India, China and South Africa) on the effects of free trade agreements on access to medicines.

After remarks from the health ministers of the BRICS countries, the main speaker, American law professor Frederick Abbot, gave reasons why the Trans Pacific Partnership Agreement (TPPA) goes beyond the WTO’s intellectual property standards and would make it much more difficult for the TPPA members to have access to affordable medicines.

His warning was complemented by the head of UNAIDS Michel Sidete who estimated that the US$2 billion annually now spent to treat 15 million AIDS patients could jump to US$150 billion if there were no generic drugs and patients had to use originator drugs at US$10,000 a person a year.  South Africa’s heath minister agreed that patents pose a barrier to access to medicines.

Air pollution was one of the environmental issues highlighted. Every year, 8 million deaths are attributed to air pollution – 4.3 million to indoor and 3.7 million to outdoor air pollution.

The Assembly welcomed a new WHO road map to respond to air pollution’s health effects. This outlines actions to be taken in the period 2016 - 2019: expand knowledge on the health impacts of air pollution and effective policies to address it; enhance systems to monitor and report on the SDG’s air pollution-related targets;  leverage health sector leadership and coordinated action to raise awareness of air pollution; and enhance capacity to address air pollution’s health effects through training, guidelines and national action plans.
 
Chemicals also need to be soundly managed, since 1.3 million deaths worldwide are caused by exposure to chemicals such as lead and pesticides. The World Health Assembly committed to ensure chemicals are used and produced in ways that minimize adverse health and environmental effects by 2020.

Agreed actions include countries cooperating by the transfer of expertise, technologies and scientific data, and exchanging good practices to manage chemicals and waste. The WHO will develop a road map with actions to meet the 2020 goal and the associated SDG targets.
 
A controversial issue that has taken two years of negotiations was how the WHO should relate to non-state actors.  The World Health Assembly finally adopted the WHO Framework of Engagement with Non-State Actors (FENSA), which provides the WHO with policies and procedures on engaging with NGOs, private sector entities, philanthropic foundations and academic institutions.

On one hand, there is the aim to strengthen WHO’s engagement with the non-state stakeholders.  On the other hand, there is the need for the WHO to avoid conflicts of interest that may arise when corporations and their foundations, associations and lobbies wield large and undue influence if they are allowed to get too close to the WHO.  Whether the adopted FENSA strikes the right balance will be seen in future years.

The Sustainable Development Goals (SDGs) is a very topical issue and the Assembly agreed on steps to pursue the health-related Goals.

There was agreement to prioritize universal health coverage; to work with actors outside the health sector to address the social, economic and environmental causes of health problems, including antimicrobial resistance; to expand efforts to address poor maternal and child health and infectious diseases in developing countries; and to put a greater focus on equity within and between countries, leaving no-one behind.

The WHO is requested to take steps to ensure it has the resources it needs to achieve the SDGs and to work with countries to strengthen their ability to monitor progress towards the goals.

The WHA also adopted many other resolutions, including on International Health Regulations, tobacco control, road traffic deaths and injuries; HIV, viral hepatitis and sexually transmitted infections; Mycetoma; Integrated health services; Health Workforce; Global plan of action on violence; and prevention and control of noncommunicable diseases; Global Strategy for Women’s, Children’s and Adolescents’ Health;  and healthy ageing.

* The full article was published and circulated by Third World Network. A shorter version of this article was first published in The Star, Malaysia on 6 June 2016.

Photo: WHO/L. Cipriani