World Health Assembly addresses major gaps and concerns in public health

Global Strategy for Women’s, Children’s and Adolescents’ Health

Delegates emphasized the importance of taking forward the implementation of Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). The resolution adopted called on the WHO Secretariat to provide technical support to Member States in updating and implementing their national plans and to report regularly to the World Health Assembly on progress towards the health of women, children and adolescents. The strategy sets out a very ambitious goal, namely, to ensure that every woman, child and adolescent, in any setting, anywhere in the world, is able to both survive and thrive by 2030. The document, including its new operational framework, envisions country ownership and strengthened accountability on the part of national authorities at all levels. It was underscored that the monitoring of national progress is hardly possible without the collection of high-quality detailed data and the appropriate capacity for its analysis.

Childhood overweight and obesity drew a lot of attention from the delegates as undeniable risk factors that require early intervention so as to promote the life chances of all children. In many countries childhood obesity has reached alarming proportions, paving the way for the development of diseases later in life. Many delegates – and they were strongly supported here by the civil-society groups – agreed that Governments should endorse the new WHO Guidance to end the inappropriate promotion of commercially produced foods and beverages targeted towards infants and young children. The implementation plans for the comprehensive, integrated package of policy actions recommended in the report of the Commission on Ending Childhood Obesity should be developed at the national level without a delay.

Healthy ageing today and tomorrow

Delegates also approved a resolution on the Global Strategy and Action Plan on Ageing and Health 2016-2020. While countries vary in the timing and speed of the ageing process, the proportion of older persons – namely, the population aged 60 years and over – is growing in all regions and in the large majority of countries. It is estimated that by 2050 the proportion of older persons will rise to 22 per cent in both the more-developed and the less-developed regions. The share of the “oldest old” (those aged 80 and over) is also rising within the group of older adults, creating additional needs.

In itself, ageing is a manifestation of human progress and tremendous achievement; the increase in longevity, particularly if it is coupled with ability to stay healthy well into “oldest-old” age, signifies impressive breakthroughs of modern medicine, including the use of more effective methods in geriatrics and gerontology. The growing share of older persons without a doubt presents numerous opportunities to societies – from using the experiences and skills of older workers at the marketplace to helping families to cope with raising children and grandchildren. But ageing is also a major societal challenge in terms of the additional demand it puts on health-care systems and long-term care at an age when disability or disease are difficult to avoid. In the light of the existing demographic trends, policy makers in all countries have to find answers to such fundamental questions concerning the opportunities and challenges found in ageing societies. Good health in old age reflects a combination of factors, but many chronic conditions can be prevented by healthy behaviors across the life-course. The WHO encourages countries to elaborate and support coherent action on healthy ageing, to develop age-friendly environments and make sure that health policies are inclusive and older persons are not left behind.

Universal health coverage

Achieving universal health coverage and access to quality health care when needed is seen by WHO as a pivotal goal in the context of promoting physical and mental health and well-being and extending life expectancy. Resilient national health systems, which are based on strong primary care, provide essential support on this road and are widely regarded as the best defense that countries can establish against outbreaks of infectious diseases such as Ebola and Zika, as well the burgeoning burden and costs of non-communicable diseases such as cancer and diabetes. Universal health coverage is equitable and in many ways cost-effective. Many delegations expressed a strong commitment to such coverage, noting that it is inclusive, feasible and measurable. At the same time the discussions revealed that the gap in universal health coverage, taking into consideration the existing circumstances on the ground, cannot be covered overnight, and in the case of low-income countries may require decades. There is a need to expedite the quest for the more effective use of private-sector instruments as an important addition to national health-care system, making them more inclusive, without diminishing the importance of the public provision. As noted by WHO Director-General Dr. Margaret Chen in her statement to WHA, universal health coverage goes beyond purely medical aspects – it is “good for health and good for the cohesion and stability of societies”.

Having discussed access to medicines and vaccines, the WHA agreed on a package of measures to address the global shortage of medicines and vaccines, including monitoring supply and demand, making improvements in procurement systems as well as improving affordability through voluntary or compulsory licensing of high-priced medicines.

Health in 2030 Agenda

Universal health coverage as a goal and policy approach is closely connected with the issue of health as addressed in the 2030 Agenda for Sustainable Development. The Sustainable Development Goals (SDGs), in the words of the Declaration, are “integrated and indivisible, global in nature and universally applicable” ¹ . Unlike their predecessor, the Millennium Development Goals (MDGs), the SDGs are intended for all countries, not just for developing countries. One of the critical dimensions of the SDGs is their emphasis on interlinkages, and they are designed to be cross-cutting. As noted in the Report of the Secretariat submitted to the WHA, several health targets in the SDGs follow on from “the unfinished agenda” of the MDGs, while many other health targets are derived from WHA resolutions and related action plans. “At the same time, it is important to recognize the breadth of the new Agenda: it does not only see health as a goal in itself; it also views health and its determinants as influencing, and being influenced by, other goals and targets as an integral part of sustainable development” ² .

Delegates agreed that strengthening national health systems is key to progress towards universal health coverage, which in its turn is crucial for achieving the health-related Sustainable Development Goals. The links between climate change and health, including those related to the spread of vector-borne diseases, were also noted. The discussions, as well as the resolutions adopted, highlighted the need to improve a range of essential public-health functions: investing adequate, sustainable resources in the strengthening of health systems; enhancing the education, recruitment and retention of health workers; tackling the social, environmental and economic determinants of health; and improving the monitoring and analysis of health outcomes.

The health-related targets are concentrated in, but not limited to, Goal 3: “Ensure healthy lives and promote well-being for all at all ages.” They include a target of achieving universal health coverage, including financial-risk protection, access to quality essential health-care services and access to safe, effective, high-quality and affordable essential medicines and vaccines for all. Of course, the achievement of this Goal, as well as other SDGs, implies progressive realization – countries need to take into consideration the availability of domestic and other resources and move forward at their own pace.

Health and the environment

Improving the quality of the air we all breathe is one of the preoccupations of the WHO. Indoor and outdoor air pollution are among the leading avoidable causes of disease and death globally. Air pollution does not respect national boundaries and interventions to address it often require urgent action, not only domestically, but also internationally. The 69^th World Health Assembly considered and adopted a road map for an enhanced global response to the adverse effects of air pollution. In order to make monitoring specific, the adopted reporting framework has indicators and objectives to track progress.

Measures to prevent air pollution fit well within the package of measures considered in conjunction with the implementation of the Paris Agreement adopted at the Conference of the Parties to the UN Framework Convention on Climate Change adopted in December 2015. There are obvious opportunities for synergy in this context. Drastic reversal of the current trend in the generation of gases affecting climate change, envisioned by the Paris Agreement, depends to a large extent on the implementation of a series of policies aimed at mitigating climate change, including clean combustion technologies and demand management mechanisms.

Many of those policies also reduce health-damaging air pollutants (such as black carbon) that directly affect human health and climate. The adopted road map “identifies and harnesses opportunities for synergies and efficiencies linked to those policies that focus on reducing climate change and on monitoring progress with the relevant Sustainable Development Goals”. ³ One of the beneficial impacts of the policies aimed at climate change mitigation is that the allocation of resources in this case will have a dual purpose, and will also serve to improve air quality and prevent millions of deaths associated with air pollution. As observed by the drafters of the above mentioned report of the WHO Secretariat, “the increase in public awareness stimulates the demand for policies that reduce air pollution, prevent diseases and improve health and well-being… To obtain such efficiency gains, it is crucial to identify co-benefits from different measures that are outlined in the road map – to health and air pollution, and to climate change and sustainable development.” ⁴

The implementation of the measures outlined in the above road map requires effective interactions with relevant stakeholders, including those in the private sector. Collaborating with civil-society organizations (CSOs) has numerous potential benefits as CSOs could provide independent monitoring and accountability in assessing and accelerating progress on the indicators outlined in the road map. Those joint efforts are also essential in prioritizing good-practice sharing for effective multispectral collaboration, not only in fighting air pollution, but also with regard to the role of the health sector in the sound management of chemicals – one of the priority areas for discussion at the next WHA in 2017.