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Global Trends by Martin Khor

Monday 2 June 2014
 
State of the world’s health

The pulse of the state of health in the world was taken at the recent World Health Assembly which promoted universal health coverage and pledged to act on antibiotic resistance and on several diseases.

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The premier international conference on public health policy is the World Health Assembly (WHA), organised by the World Health Organisation (WHO), which attracts Ministers of Health and other top health officials as well as NGOs to Geneva every year.

This is where the latest trends in public health problems are presented and debated on, and action plans for solutions are adopted.

This year’s Assembly, which closed on 24 May, had 3,500 participants and saw a record number of issues debated and resolutions adopted.

One of the key buzz words during the Assembly was “universal health coverage” (UHC). This is being promoted by the WHO and several governments to be one of the goals for the United Nations’ post-2015 Development Agenda.

There is no precise definition for the term, but it is widely taken to mean that everyone, including the poor, should have access to medical treatment and other health services.

Inability to pay should not prevent someone from being “covered” by the health system, and  people should not become financially burdened by having to pay, or to pay so much, to get treatment.

The UHC concept is a great one, similar to the “health for all by the year 2000” slogan that the WHO adopted in the 1980s as its umbrella goal.  It resonates with or is even rooted in the “right to health”, which is one of the human rights recognised by the UN.  

UHC was the centre of discussion at the panel session on the post-2015 Development Agenda half way through the WHA.  WHO Director General Margaret Chan stated that there are various ways to finance and achieve UHC and it is for each country to choose its own model.

If UHC is adopted, it will be a big step forward towards equity (another term much used at the Assembly) in the health system. How to make it happen, especially the method to finance it, will be a key question.

In a resolution on health in the post-2015 development agenda, the Assembly proposed priority for the health of the new-born, non-communicable diseases, mental health, neglected tropical diseases and completion of existing health Millennium Development Goals.

It also stressed the importance of universal health coverage and the need to strengthen health systems.

The Assembly also adopted a resolution on antibiotic resistance after many delegates expressed their concerns that the bacteria’s growing resistance to medicines was making it difficult to treat many diseases.

The WHO had recently issued a report showing increasing prevalence of resistance in many diseases including TB, pneumonia, diarrhoea, malaria, skin diseases, and gonorrhoea.  It warned of a post-antibiotic era, where drugs will no longer be able to cure infectious diseases. 

The resolution urges governments to strengthen the proper use and management of drugs, support research to extend the lifespan of existing drugs, and to develop new antibiotics and diagnostic technologies.
 
The WHO was asked to develop a draft global action plan within a year to combat antimicrobial resistance, that includes rational drug use, better surveillance, access to medicines and discovery of new drugs. 
 

The Assembly adopted the first-ever global plan to end preventable deaths of newly born babies and stillbirths by 2035, and called for all countries to aim for fewer than 10 newborn deaths per 1000 live births and less than 10 stillbirths per 1000 total births by 2035.
 
Every year almost 3 million babies die in the first month of life and 2.6 million babies are stillborn (they die in the last 3 months of pregnancy or during childbirth).  Most of these deaths could be prevented. 

The Plan’s goals will require every country to invest in high-quality care before, during and after childbirth for every pregnant woman and newborn.
 
The Assembly also approved the WHO’s strategy to help countries improve access to essential medicines.  Key principles include selecting a limited range of medicines using best evidence, efficient procurement, affordable prices, effective distribution systems, and rational use.  

Another new global strategy was adopted for TB, aimed at ending the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% by 2035. 

TB remains a deadly disease.  In 2012, 8.6 million people fell ill with TB, 1.3 million died from it and 450 000 people developed multidrug-resistant TB.

Non-communicable diseases, including those caused by diet, were also discussed.  At her opening speech, Dr Chan highlighted the increase in childhood obesity, especially in developing countries and announced a Commission on Ending Childhood Obesity.

The health plight of the poor in middle-income countries was also a theme at the Assembly. 

Dr Chan highlighted that 70% of the world’s poor live in middle-income countries and asked if there will be polices to ensure benefits are fairly shared, or else the world will see “a growing number of rich countries full of poor people.”

But it is not only domestic policy that affects the poor.  A side-event by health NGOs focused on how the middle income countries were being left out of schemes such as supply of free medicines or the relaxation of patent rules to help the poor, as these are often reserved for low-income countries. 

However most of the poor people in the world live in middle-income countries, some of which have large populations.

Some developing countries voiced frustration on how they are being picked upon by the United States for having patent laws that prioritise making medicines affordable to the public.

Dr Chan in another speech also criticised free trade agreements that enable tobacco companies to challenge measures taken by governments to curb cigarette sales.

Other issues the WHA discussed include  autism, psoriasis, an action plan for disabilities, palliative care, financing for research and development for diseases that affect developing countries, strengthening of medicines regulations, and assessment of health technologies.

 


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