By Sean Buchanan
A list of urgent, global health challenges released by the World Health Organisation (WHO) at the beginning of 2020 reflects deep concern that leaders are failing to invest sufficient resources in core health priorities and systems. This, says the Geneva-based UN agency, is putting lives, livelihoods and economies in jeopardy.
Recommending that countries spend one percent of their gross domestic product on primary health care, to give more people access to the quality essential services they need, close to where they live, WHO has identified a series of priorities for the decade, covering a wide range of issues affecting people across the planet.
These include elevating health in the climate debate, delivering health care in situations of conflict and crisis, keeping health care clean, making health care fairer, expanding access to medicines, stopping infectious diseases, preparing for epidemics, and protecting people from dangerous products.
Arguing that the climate crisis is a health crisis, WHO notes that air pollution kills an estimated seven million people every year, while climate change causes more extreme weather events, exacerbates malnutrition and fuels the spread of infectious diseases such as malaria. The same emissions that cause global warming are said to be responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease.
WHO urges leaders in both the public and private sectors to work together to clean up the planet’s air and mitigate the health impacts of climate change. In 2019, over 80 cities in more than 50 countries committed to WHO’s air quality guidelines, agreeing to align their air pollution and climate policies and in 2020 the UN agency will work towards developing a set of policy options for governments to prevent or reduce the health risks of air pollution.
In terms of delivering health care in conflict and crisis, 2019 was the year that disease outbreaks required the highest level of response in countries with protracted conflict. There was also continuation of a disturbing trend in which health workers and facilities were targeted. WHO recorded 978 attacks on health care in 11 countries, with 193 deaths. At the same time, conflict is forcing record numbers of people out of their own homes, leaving tens of millions of people with little access to health care, sometimes for years.
WHO recognises that health is only part of the equation, saying that ultimately what is needed are political solutions to resolve protracted conflicts, stop neglecting the weakest health systems, and protecting health care workers and facilities from attacks.
Meanwhile, an estimated one in four health facilities globally lack the basic water, sanitation and hygiene services which are critical to a functioning health system. This leads to poor-quality care and an increased chance of infection for patients and health workers. All of this is taking place against a backdrop of billions of people around the world living in communities without safe water to drink or adequate sanitation services – both of which are major drivers of disease.
When it comes to the fairness of health care, WHO warns that persistent and growing socio-economic gaps result in major discrepancies in the quality of people’s health – there is not only an 18-year difference in life expectancy between rich and poor countries, but also a marked gap within countries and even within cities.
At the same time, the global rise in noncommunicable diseases, such as cancer, chronic respiratory disease and diabetes, has a disproportionately large burden in low and middle-income countries and can quickly drain the resources of poorer households.
Saying that one of the best ways to reduce inequalities is through primary health care, which addresses the majority of a person’s health needs, WHO is calling for all countries to allocate one percent more of their gross domestic product to primary health care, to give more people access to the quality essential services they need, close to home.
This is closely related to the need to expand access to medicines. About one-third of the world’s people lack access to medicines, vaccines, diagnostic tools and other essential health products. Low access to quality health products threatens health and lives, which can both endanger patients and fuel drug resistance. Medicines and other health products are the second-largest expenditure for most health systems (after health workers) and the largest component of private health expenditure in low- and middle-income countries.
In 2020, WHO says it will sharpen its focus on priority areas for global access, including fighting substandard and falsified medical products, enhancing the capacity of low-income countries to assure the quality of medical products throughout the supply chain, and improving access to diagnosis and treatment for non-communicable diseases, including diabetes.
On the communicable diseases front, it is estimated that infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases and sexually transmitted infections will kill an estimated four million people in 2020, most of them poor. Meanwhile, vaccine-preventable diseases continue to kill, such as measles, which took 140,000 lives in 2019, many of them children, and although polio has been driven to the brink of eradication, there were 156 cases of wild poliovirus last year, the most since 2014.
The root causes are insufficient levels of financing and the weakness of health systems in endemic countries, coupled with a lack of commitment from wealthy countries.
Every year, the world spends far more responding to disease outbreaks, natural disasters and other health emergencies than it does preparing for and preventing them.
According to WHO, a pandemic of a new, highly infectious, airborne virus – most likely a strain of influenza – to which most people lack immunity is inevitable. It warns that is not a matter of if another pandemic will strike, but when, and when it strikes it will spread fast, potentially threatening millions of lives. Vector-borne diseases like dengue, malaria, Zika, chikungunya and yellow fever are spreading as mosquito populations move into new areas, fanned by climate change.
However, it is not just these diseases that poses a threat to health worldwide – lack of food, unsafe food and unhealthy diets are responsible for almost one-third of today’s global disease burden.
Hunger and food insecurity continue to plague millions, with food shortages being perniciously exploited as weapons of war. At the same time, as people consume foods and drinks high in sugar, saturated fat, trans fat and salt, overweight, obesity and diet-related diseases are on the rise globally.
Because of the widespread impact that health issues have on development, WHO Director-General Tedros Adhanom Ghebreyesus said that health security should not be a matter for ministries of health alone and called for more funding to address gaps in health systems, and support for the most vulnerable countries. “There are no shortcuts to a healthier world … and we must hold our leaders accountable for their commitments”.
Comparing health concerns with peace and security, Ghebreyesus pointed out that many countries are willing to invest in protection against terrorist attacks, but not to allocate money to halting the spread of a virus, even though a pandemic may be far more deadly, and more economically damaging.