Martin Khor is the Executive Director of the South Centre.
- The last World Health Assembly (WHA) in Geneva (23-28 May) discussed the manifold global health crises that require urgent attention, and adopted resolutions to act on many issues. We are currently facing many global health related challenges, and as such multiple actions must be taken urgently to prevent these crises from boiling over.
The WHA is the world’s prime public health event and this year 3,500 delegates from 194 countries took part, including Health Ministers of most countries. World Health Organization (WHO) Director-General, Dr. Margaret Chan gave an overview of some of the successes and further work needed on the global health front.
The good news includes 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. As a result, aid for health is now far more effective, and the issue of health has become an investment for stable and equitable societies, not just a drain on resources.
The recent Ebola and Zika outbreaks showed how global health emergencies can develop very quickly. There is a dramatic resurgence of emerging and re-emerging infectious diseases, which the world is currently not prepared to cope with. Dr. Chan gave three examples of the emerging global health emergencies: climate change, antimicrobial resistance, and the rise of chronic-communicable diseases as the leading causes of death worldwide.
Many of the issues addressed are largely anthropogenic, 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 provide longer term profit than fresh fruits and vegetables.
Unchecked, these emergencies will eventually reach a tipping point and become irreversible and as regards 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 highlighted universal health coverage as an essential aspect of the Sustainable Development Goals. It is the ultimate expression of fairness that ensures no one is left behind, and to provide comprehensive care for all.
A question however, was not covered by Dr Chan in her speech; how can some governments- especially in underdeveloped countries, obtain enough funds to finance the idealistic goal of providing healthcare for their citizens?
The Assembly agreed that WHO set up a new Health Emergencies Programme, enabling it to provide rapid, consistent, and comprehensive support to countries and communities facing or recovering from various emergencies, disease outbreaks, disasters or conflicts.
The WHO has produced a new paper to set up a global stewardship framework to support the development, control and appropriate use of new antimicrobial medicines and diagnostic tools to counter the threat of a global increase in antimicrobial resistance. The Secretariat has made quite a lot of progress, but action on the ground is still slow, in the Asia-Pacific region so far, only six countries have completed their national plans and another five have plans that are being developed.
WHO assistant Director-General, Keiji Fukuda said that focus in the upcoming year will include: making progress on the Global Action Plan (established in 2015), further developing the global stewardship framework, and involving political leaders by 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 of these issues was childhood and adolescent obesity. In 2014, an estimated 41 million children under 5 years were affected by being overweight or obese, and 48% of them lived in Asia and 25% in Africa.
The Commission on Ending Childhood Obesity recommended the promotion of healthier foods, reducing the consumption of highly processed foods and sugar-sweetened beverages by children and adolescents. It proposed more effective taxation on sugar-sweetened beverages and curbing the marketing of unhealthy foods.
On the second issue, the Assembly welcomed 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 babies below 6 months.
On 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 these, the main speaker, American law professor Frederick Abbott, spoke about why the Trans Pacific Partnership Agreement (TPPA) could make it very difficult for the TPPA members to have access to affordable medicines.
His warning was complemented by the head of UNAIDS Michel Sidibé who estimated that the annual cost of treating 15 million AIDS patients could increase from US$2 to US$150 billion without the availability of generic drugs, costing about US$10,000 per patient annually.
Air pollution and the use of chemicals were other important environmental issues highlighted by the Assembly. Every year, 8 million deaths are attributed to air pollution – 4.3 million indoor and 3.7 million due to outdoor air pollution. The Assembly has also welcomed a new WHO roadmap to respond to the adverse health effects of increasing air pollution.
Since 1.3 million deaths worldwide are caused by exposure to extremely harmful chemicals, among them lead and various pesticides. WHA would like to ensure that the use and production of chemicals is regulated to minimize adverse health and environmental effects by 2020. Some agreed actions include the transfer of expertise, technologies and scientific data, and exchanging good practices to manage chemicals and waste between cooperating countries. WHO will develop a roadmap to meet the 2020 goals and the associated SDG targets.
A controversial issue that has taken two years of negotiations was how WHO should cooperate with non-state actors. The WHA finally adopted the WHO Framework of Engagement with Non-State Actors (FENSA), which provides WHO with policies and procedures to engage with NGOs, private sector entities, philanthropic foundations and academic institutions.
On the one hand, there is the aim to strengthen WHO’s engagement with non-state stakeholders. On the other hand, there is the need for 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 WHO. Many NGOs and several developing countries are concerned about how this corporate influence is undermining WHO’s public health responsibilities, and that FENSA will worsen rather than reverse this trend.
On the health-related Sustainable Development Goals, the Assembly agreed 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, infectious diseases in developing countries; and to put a greater focus on equity within and between countries.
The WHA also adopted many other resolutions on international health regulations including; tobacco control, road traffic deaths and injuries, HIV, viral hepatitis and sexually transmitted infections, Mycetoma, integrated health services, the health workforce, the Global Plan of Action on Violence, Prevention and Control of Non-communicable Diseases, the Global Strategy for Women’s, Children’s and Adolescents’ Health, and healthy ageing.