Special meeting in a special time
As the Executive Board of the World Health Organization meets in Geneva, Switzerland these days to discuss the future of WHO and its work until 2023, we have a unique opportunity to reflect about the state of global health and the organization’s role in promoting wellbeing among the people of the world.
WHO is drafting a new General Program of Work, to be adopted by the World Health Assembly in May 2018. Under the new leadership of Dr Tedros the organization is looking to find compelling answers to the dire state of global health. The tsunami of Non-communicable diseases is gathering ever more strength, threatening to ruin communities, progress made and countries’ health systems. At the same time, communicable diseases are still wreaking havoc. Other threats to health are rising, such as anti-microbial resistance. WHO itself is grappling with an organizational reform, funding shortages and scarce resources for global public health and a blow to its credibility during the Ebola epidemic. The rise of commercial determinants of health further aggravates the already massive challenges. With a corporate consumption complex that ruthlessly pursues profits and imperils health and sustainable development aggressively lobbying and scheming to avert regulations, WHO is coming under even more pressure, on global, regional and country levels.
That’s the context of the conversations about WHO’s proposed General Program of Work.. In his The Lancet comment, Richard Horton wrote:
This document represents WHO’s promise to the world. In many ways, it conveys urgency and ambition.
The agency’s mission is to promote health, keep the world safe, and serve the vulnerable.”
It’s about people’s lives
What WHO member states decide in coming days, weeks and months matters. The stakes are high. They are high for WHO itself. As Richard Horton writes: “WHO cannot afford to fail again.” And the stakes are high for people around the world. In the era of sustainable development, will people – especially those most at risk of being left behind – see improvements in health and well-being?
As New Zealand just said during the morning session of the Speciall Session fo the Executive Board:
New Zealand delivers so far the best zingers at #EBSS4 discussions of #GPW13. In setting the scene: “What is the most important thing in the world? It is the people. It is the people. It is the people.” In concluding: “We’re all in the same canoe. It’s time to start paddling.” pic.twitter.com/2oY76tLvtx
— IOGT International (@IOGTInt) November 22, 2017
The WHO (and Global Health) we want
What WHO should do to be in the best position to deliver for the people of the world, can be summarized in seven core messages. I think that if WHO can take care of these points and implement them into its future work, it will be substantially better placed to help achieve the SDGs and to deliver for the people of the world.
1. Better align the GPW13 with the WHO constitution
Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity,” stipulates the WHO constitution.
Nevertheless, the draft GPW13 seems to address mainly physical health and health emergencies. To a much lower degree are mental and especially social well-being being addressed.
This should be changed and both mental and social well-being should be covered more substantially in WHO’s future work.
Why does it matter?
Mental health and substance abuse are included in the Sustainable Development Agenda. This inclusion is likely to have a positive impact on communities and countries where millions of people will receive much needed help, as mental ill-health is a long-neglected problem. No country in the world can claim that its services are reaching all those in need, with the most appropriate interventions, provided with adequate social protection, and delivered in ways that promote social inclusion, recovery and social well-being.
But countries can and must do more and WHO should lead the way. A comprehensive life-course approach to mental health – from promotion and prevention to treatment, rehabilitation, care and recovery – promises to significantly make lives better for millions of people. Anchoring such an approach in WHO’s General Program of Work means that co-morbidities can be better taken care of and that scarce human resources can be used more efficiently and closer to affected communities. Above all, it helps normalize the management of mental disorders and reduce the stigma and discrimination that have isolated people with these disorders since ancient times, leaving them helpless and hopeless. Evidence shows that making the promotion of mental health and the prevention of disorders is a realistic and entirely feasible objective – and helps boosting social wellbeing.
2. Make alcohol the priority it needs to be
Given the global burden of alcohol, there is an urgent need to address alcohol harm in accordance with its impact on people, families, communities and societies worldwide. WHO should thus more adequately address alcohol harm in its 13th General Programme of Work – in terms of political attention, allocated funding and technical support provided to countries.
Why does it matter?
Given the evidence of alcohol’s pervasive harm, WHO is well advised to better prioritize efforts to prevent and reduce alcohol-related harm – especially through the three best buys. This work needs to be better resourced, corresponding to the global health and sustainable development burden that alcohol is.
3. Design a coherent approach to cross-cutting risk factors common to all three strategic priorities
The three strategic priorities – health coverage, health emergencies and health priorities – are powerful frames for WHO’s future work. But on closer examination, they seem to remain silos in the GPW13. Bridging these silos, better linking them and thus unlocking synergies between and among them should be done in three ways:
- Identifying cross-cutting risk factors, like alcohol harm, that are common to all three strategic priorities;
- Integrating cost-effective and evidence-based responses to these risk factors within the framework of each strategic priority;
- Empowering governments and local communities to address these risk factors, whenever possible with the support of civil society.
Why does it matter?
Addressing common risk factors across silos is key to unlocking synergies and to avoiding working in silos. Even health emergencies do have root causes and social determinants that shape community resilience or vulnerability. Therefore it is vital to identify and consequently address these common risk factors.
4. Strengthen prevention and health promotion as corner stones of global health
Prevention and health promotion as corner stones of global health and as fundamental tools to achieve healthier lives should be key focus of the 13th General Program of Work. Evidence-based prevention strategies working with families, schools and communities have the potential to ensure that children and young people, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age.
WHO should finally transition to being a true health organization, not only a disease agency. Setting the norms and helping governments adopt policies that shape environments for people to lead both long as well as healthy lives should be WHO’s primary endeavor.
Why does it matter?
Effective and evidence-based prevention and health promotion contribute significantly to the positive engagement of children, young people and adults with their families, schools, workplaces and communities. That makes prevention and health promotion an important tool across all three strategic priorities as they help foster community resilience, ease the burden on health systems and governments’ social welfare spending in general and promote health and well-being, including health literacy. Prevention and health promotion are crucial tools to help foster healthier environments and more years lived in physical and mental well-being.
5. Develop WHO’s role in providing technical support to countries for domestic resource mobilization for health
Developing WHO’s role in providing technical support to countries for domestic resource mobilization for health is an important function for the future of WHO itself, and for the future of global health.
I think it’s great that WHO is highlighting the need for investment in health throughout the draft 13th General Program of Work. But I also note the absence of systematically outlining innovative methods for domestic resource mobilization and WHO’s role in support of countries.
Why does it matter?
Innovative methods for raising new domestic resources enable a greater flow of funds into the health sector – which affects all three strategic priorities positively. Innovative methods include options for broadening the general tax base as well as levies on specific consumption goods or sectors that are risk factors for and determinants of health. For example, alcohol taxation has huge potential to help achieve a large number of SDGs.
6. Better address the health needs of adolescents
The health needs of adolescents in the 13th General Program of Work should be better covered. As evidence shows, adolescence is a period that needs special attention from a health perspective.
Why does it matter?
All three strategic priorities are either benefiting from improvements in adolescent health or will be jeopardized by deteriorating health among adolescents. For example with regard to “one billion lives improved”, I think there should be a concrete target for adolescent health in the first priority area “Women, children and adolescent health”. Right now, there is none.
7. More clearly outline the response to commercial determinants of health
As I wrote above, the emergence of a ruthless corporate consumption complex and they way their unethical business practices determine health is a major challenge and threat to WHO’s core mission. Therefore, it is important that GPW13 more clearly outlines how WHO is responding to commercial determinants of health in the years to come. The track record of unethical (and health harmful) business practices employed by the alcohol and tobacco industries is very long.
Why does it matter?
The rise of NCDs is a consequence of health-harmful industries that currently prioritize profits over public health. Health outcomes are determined by the influence of corporate activities on the social environment in which people live and work: namely the availability, cultural desirability, and prices of unhealthy products.
Crucially, the GPW needs to ensure that WHO can stay true to its constitutional mandate and protect its most valuable asset: its independence, integrity and leadership in setting norms for global and public health and the promotion of well-being for all at all ages. WHO needs to put strong, robust safeguards against conflicts of interest in place and combine these measures with vigilance in monitoring private sector actors, their front groups and lobbying arms to protect WHO and its norm setting mission as well as decision-making processes from undue influence.
Towards an era of global health and sustainable development
We are standing on the doorsteps of a new era. But there’s a real threat that the door will hit us in the face as we attempt to walk through it. The decisions that governments and the WHO Secretariat, regions and country offices under the leadership of Dr Tedros are making, including with the General Program of Work, can either propel us into the era of wellbeing and sustainable human development for all. Or they can leave us stuck where we are right now, in a world where corporations make profits from destroying the health of people and planet. What will it be? And will they truly put peoples’ lives first?
Richard Horton: WHO—a roadmap to renewal?, in: The Lancet, November 18, 2017