The world is facing multiple health challenges now a days.
These range from outbreaks of vaccine-preventable diseases like measles and
diphtheria, increasing reports of drug-resistant pathogens, growing rates of
obesity and physical inactivity to the health impacts of environmental
pollution and climate change and multiple humanitarian crises.
To address all these the World Health Organization’s new
5-year strategic plan. This plan focuses on a triple billion target:
ensuring 1 billion more people benefit from access to universal health
coverage, 1 billion more people are protected from health emergencies and 1
billion more people enjoy better health and well-being. Reaching this goal will
require addressing the threats to health from a variety of angles.
Air pollution and climate change
Nine out of ten people breathe
polluted air every day. In 2019, air pollution is
considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate
respiratory and circulatory systems, damaging the lungs, heart and brain,
killing 7 million people prematurely every year from diseases such as cancer,
stroke, heart and lung disease. Around 90% of these deaths are in low- and
middle-income countries, with high volumes of emissions from industry,
transport and agriculture, as well as dirty cook stoves and fuels in
homes.
The primary cause of air pollution (burning fossil fuels)
is also a major contributor to climate change, which
impacts people’s health in different ways. Between 2030 and 2050, climate
change is expected to cause 250 000 additional deaths per year, from
malnutrition, malaria, diarrhea and heat stress.
Non Communicable
diseases
Non Communicable diseases, such as diabetes, cancer and
heart disease, are collectively responsible for over 70% of all deaths
worldwide, or 41 million people. This includes 15 million people dying
prematurely, aged between 30 and 69.
Over 85% of these premature deaths are in low- and
middle-income countries. The rise of these diseases has been driven by five
major risk factors: tobacco use, physical inactivity, the harmful use of
alcohol, unhealthy diets and air pollution. These risk factors also exacerbate
mental health issues, that may originate from an early age: half of all mental
illness begins by the age of 14, but most cases go undetected and untreated –
suicide is the second leading cause of death among 15-19 year-olds.
Among many things, this year WHO will work with
governments to help them meet the global target of reducing physical inactivity by 15% by 2030 – through such actions as
implementing the ACTIVE policy toolkit to help get more people being active
every day.
Global influenza
pandemic
The world will face another influenza pandemic –
the only thing we don’t know is when it will hit and how severe it will be.
Global defenses are only as effective as the weakest link in any country’s health
emergency preparedness and response system. WHO is constantly monitoring
the circulation of influenza viruses to detect potential pandemic strains: 153
institutions in 114 countries are involved in global surveillance and response.
Every year, WHO recommends which strains, should be
included in the flu vaccine to protect people from seasonal flu. In the event
that a new flu strain develops pandemic potential, WHO has set up a unique partnership with
all the major players to ensure effective and equitable access to diagnostics,
vaccines and antiviral (treatments), especially in developing countries.
Fragile and
vulnerable settings
More than 1.6 billion people (22% of the global
population) live in places where protracted crises (through a combination of
challenges such as drought, famine, conflict, and population displacement) and
weak health services leave them without access to basic care.
Fragile settings exist in almost all regions of the
world, and these are where half of the key targets in the sustainable
development goals, including on child and maternal health, remains unmet.
WHO will continue to work in these countries to
strengthen health systems so that they are better prepared to detect and
respond to outbreaks, as well as able to deliver high quality health services,
including immunization.
Antimicrobial
resistance
The development of antibiotics, antiviral and
antimalarials are some of modern medicine’s greatest successes. Now, time with
these drugs is running out. Antimicrobial resistance – the ability of bacteria,
parasites, viruses and fungi to resist these medicines – threatens to send us
back to a time when we were unable to easily treat infections such as
pneumonia, tuberculosis, gonorrhea, and salmonellosis. The inability to prevent
infections could seriously compromise surgery and procedures such as
chemotherapy.
Resistance to tuberculosis drugs is a formidable obstacle to fighting a
disease that causes around 10 million people to fall ill, and 1.6 million to
die, every year. In 2017, around 600 000 cases of tuberculosis were resistant
to rifampicin – the most effective first-line drug – and 82% of these people
had multidrug-resistant tuberculosis.
Drug resistance is driven by the overuse of
antimicrobials in people, but also in animals, especially those used for food
production, as well as in the environment. WHO is working with these sectors to
implement a global action plan to tackle antimicrobial resistance by increasing
awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.
Ebola and other
high-threat pathogens
In 2018, the Democratic
Republic of the Congo saw two separate Ebola outbreaks, both of which spread to
cities of more than 1 million people. One of the affected provinces is
also in an active conflict zone.
This shows that the context
in which an epidemic of a high-threat pathogen like Ebola erupts is critical
– what happened in rural outbreaks in the past doesn’t always apply to
densely populated urban areas or conflict-affected areas.
At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.
At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.
WHO’s R&D Blueprint identifies diseases and pathogens that
have potential to cause a public health emergency but lack effective treatments
and vaccines. This watchlist for priority research and development includes
Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory
syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
and disease X, which represents the need to prepare for an unknown pathogen
that could cause a serious epidemic.
Weak primary health
care
Primary health care is usually the first point of contact
people have with their health care system, and ideally should provide
comprehensive, affordable, community-based care throughout life.
Primary health care can meet the majority of a person’s
health needs of the course of their life. Health systems with strong primary
health care are needed to achieve universal health coverage.
Yet many countries do not have adequate primary health
care facilities. This neglect may be a lack of resources in low- or
middle-income countries, but possibly also a focus in the past few decades on
single disease programmes. In October 2018, WHO co-hosted a major
global conference in Astana, Kazakhstan at
which all countries committed to renew the commitment to primary health care
made in the Alma-Ata declaration in 1978.
In 2019, WHO will work with partners to revitalize and
strengthen primary health care in countries, and follow up on specific
commitments made by in the Astana
Declaration.
Vaccine hesitancy
Vaccine hesitancy – the
reluctance or refusal to vaccinate despite the availability of vaccines –
threatens to reverse progress made in tackling vaccine-preventable
diseases. Vaccination is one of the most cost-effective ways
of avoiding disease – it currently prevents 2-3 million deaths a year, and a
further 1.5 million could be avoided if global coverage of vaccinations
improved.
Measles, for example, has
seen a 30% increase in cases globally. The reasons for this rise are complex,
and not all of these cases are due to vaccine hesitancy. However, some
countries that were close to eliminating the disease have seen a
resurgence.
The reasons why people
choose not to vaccinate are complex; a vaccines advisory group to WHO identified
complacency, inconvenience in accessing vaccines, and lack of confidence are
key reasons underlying hesitancy. Health workers, especially those in
communities, remain the most trusted advisor and influencer of vaccination
decisions, and they must be supported to provide trusted, credible information
on vaccines.
In 2019, WHO will ramp up
work to eliminate cervical cancer worldwide by
increasing coverage of the HPV vaccine, among other interventions. 2019 may
also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30
cases were reported in both countries. WHO and partners are committed to
supporting these countries to vaccinate every last child to eradicate this
crippling disease for good.
Dengue
Dengue, a mosquito-borne disease that causes flu-like
symptoms and can be lethal and kill up to 20% of those with severe dengue, has
been a growing threat for decades.
A high number of cases occur in the rainy seasons of
countries such as Bangladesh and India. Now, its season in these countries is
lengthening significantly (in 2018, Bangladesh saw the highest number of deaths
in almost two decades), and the disease is spreading to less tropical and more
temperate countries such as Nepal, that have not traditionally seen the
disease.
An estimated 40% of the world is at risk of dengue fever,
and there are around 390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.
HIV
The progress
made against HIV has been enormous in terms of getting
people tested, providing them with antiretrovirals (22 million are on
treatment), and providing access to preventive measures such as a pre-exposure
prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to
prevent infection).
However, the epidemic continues to rage with nearly a million people every year
dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million
people have acquired the infection, and about 35 million people have died.
Today, around 37 million worldwide live with HIV. Reaching people like sex
workers, people in prison, men who have sex with men, or transgender people is
hugely challenging. Often these groups are excluded from health services. A
group increasingly affected by HIV are young girls and women (aged 15–24), who
are particularly at high risk and account for 1 in 4 HIV infections in
sub-Saharan Africa despite being only 10% of the population.
