Facing Up to the World’s Health Crises

Martin Khor

The global health situation is facing many critical challenges, and urgent action is needed to prevent crises from boiling over. This is the impression one gets from this year’s World Health Assembly (WHA) in Geneva last week.

The WHA is the world’s prime public health event, attended by 3,500 delegates, including Health Ministers from most of the 194 countries.

In her opening speech, World Health Organisation director-general Dr Margaret Chan gave an overview of what went right and what is missing in global health.

First the good news: 19,000 fewer children dying every day, a 44% drop in maternal mortality, the 85% cure rate for tuberculosis, and 15 million people living with HIV now receiving therapy, up from just 690,000 in 2000.

Then Chan described how health has become a globalised problem, with air pollution becoming a transboundary health hazard, 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. The world is not prepared to cope with the dramatic resurgence of emerging and re-emerging infectious diseases.

Chan said the global health landscape is being shaped by three slow-motion disasters: climate change, antimicrobial resistance and the rise of chronic non-communicable diseases.

She described these as man-made disasters created by policies that place economic interests above health and environmental concerns.

Unchecked, these disasters will 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, Chan pinpointed universal health coverage as the target that underpins all others in the health-related Sustainable Development Goals.

The assembly agreed that the WHO set up a new Health Emergencies Programme to enable it to give rapid support to countries and communities to prepare for, face or recover from emergencies caused by health hazards including disease outbreaks, disasters and conflicts.

On anti-microbial resistance, many developing countries stressed the importance of funds and technology to help them develop national action plans by 2017.

The WHO produced a 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.

Another paper showed the secretariat has made quite a lot of progress, but action on the ground seems to be slow. For example, in the two Asia-Pacific regions, only six countries have completed their national plans and another five have plans being developed.

WHO’s Keiji Fukuda said the next steps were to make progress on the global action plan adopted in 2015, further develop the global stewardship framework and involve political leaders on the issue.

Two issues on childhood nutrition 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 five years were affected by overweight or obesity.

The marketing of unhealthy foods to children was identified by the WHO Commission on ending childhood obesity as a major problem. It proposed actions to reduce the intake of unhealthy foods and sugar-sweetened beverages, including imposing taxes on sugar-sweetened beverages and curbing the marketing of unhealthy foods.

The WHA called on the WHO to develop an implementation plan and urged governments to develop national policies.

On the second issue, the WHA welcomed WHO’s guidance on ending the inappropriate promotion of foods for infants and young children. The marketing of “follow-up formula” and “growing-up milks” – targeted for babies aged six months to three years – should be as strictly regulated as infant formula.

Foods for infants and young children should be promoted only if they meet strict standards, and doctors should not accept gifts or free samples from companies.

On access to medicines and vaccines, the WHA agreed on measures to address the global shortage of medicines and vaccines, including by improving affordability through voluntary or compulsory licensing of high-priced medicines.

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

South Africa’s health minister stated that patents pose a barrier to access to medicines.

The main speaker, American law professor Frederick Abbot, gave reasons why the Trans-Pacific Partnership Agreement would create new difficulties for members to have access to affordable medicines.

His warning was complemented by the head of UNAIDS Michel Sidete, who estimated that the US$2bil (RM8.18bil) annually now spent to treat 15 million AIDS patients could jump to US$150bil (RM613bil) if there were no generic drugs and patients had to use originator drugs at US$10,000 (RM40,875) a person a year.

Two environment-related health issues were discussed. Air pollution accounts for eight million deaths worldwide annually – 4.3 million due to indoor and 3.7 million to outdoor air pollution. The assembly welcomed a new WHO road map for actions in 2016-19 to tackle the health effects of air pollution.

Another 1.3 million deaths worldwide are caused by exposure to chemicals such as lead and pesticides.

The WHA committed to ensure chemicals are used and produced in ways that minimise adverse health and environmental effects by 2020, with the WHO asked to develop a road map.

A controversial issue is how the WHO should relate to “non-state actors”. After two years of negotiations, the WHA adopted the Framework of Engagement with Non-State Actors (FENSA), which provides the WHO with policies and procedures on engaging with non-governmental organisations, private sector entities, philanthropic foundations and academic institutions.

On one hand there is the aim to strengthen WHO’s engagement with organisations; on the other hand is the need for WHO to avoid conflicts of interest that may arise when corporations and their foundations and associations wield large and undue influence if they are allowed to get too close to WHO.

Whether the adopted FENSA strikes the right balance will be seen in future years.

Originally published in The Star.

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