Lessons from the sixty-eighth World Health Assembly
Guest blog by Dr. C. Ruth Wilson, a Professor in the Department of Family Medicine, a practising family physician, and the president of the WONCA North American region.
The World Health Assembly, which is the governing body of the World Health Organization (WHO), met in Geneva from May 18th to 26th. I had the privilege of attending this annual event as a representative of the world organization of family doctors, WONCA. Geneva is an inspiring setting for the yearly meeting of delegations from member states around the world. The deliberations are held at the United Nations building, the Palais des Nations. Just across the street is the headquarters of the ICRC (the Red Cross). Switzerland’s centuries-old commitment to neutrality and its fostering of humanitarian agencies make it a natural home for this gathering.
Two major issues dominated the agenda. The first was the performance of the WHO in the face of the recent Ebola crisis. More than 11,000 people, including 500 health care workers, died in this epidemic, which is still infecting people in Sierra Leone and Guinea, although Liberia has now been declared free of the deadly virus. Director General Margaret Chan admitted that the WHO had been underprepared and not well organized to respond to this emergency situation. She announced the establishment of a $100 million contingency fund, the management of which is to report directly to her, to try to prepare the WHO to respond to crises more effectively. She is also proposing establishing a Global Emergency Workforce. I heard Angela Merkel, Chancellor of Germany, criticize the WHO and pledge the financial support of the G7 countries to help countries improve their health infrastructure.
The second major issue at the World Health Assembly was the ongoing work in developing what are termed Sustainable Development Goals. The United Nations has been working towards Millennium Development Goals, which are due to expire at the end of 2015; these goals focussed on low and middle income countries. The new Sustainable Development Goals are for all countries, and in draft form consist of 17 goals with 169 indicators. Although many of the goals address the broad determinants of health (for example, there is a goal to end poverty), there is only one health goal. Most of the discussion focused on how the success of the goal of “ensuring healthy lives and promoting wellbeing for all at all ages” would be measured, on the principle that what is not measured is not managed or funded. Although there are many indicators suggested to measure so-called vertical programs (rates of polio or malaria, for example), there is no horizontal indicator measuring the strength of primary care systems in the countries of the world. There is good evidence that countries with stronger primary care systems have better health outcomes at lower costs. An emphasis on disease-specific, donor-driven priorities is not the best way to improve the health of populations. Given that the Ebola crisis is considered to be partly due to weak infrastructure in the health care systems of affected countries, it is surprising to me that more attention is not paid to primary care systems. Our family doctor delegation remains particularly concerned about this issue, and we made this point in formal and informal interventions.
Personally, I was inspired to see thousands of committed and capable individuals representing non-governmental organizations as well as national delegations, gathered in Geneva, using their best efforts to improve the health of all people in the world. I learned a great deal myself. I learned that Cuba sent 265 health workers to West Africa to combat Ebola. I learned that Ghana, which once had 180,000 cases of guinea worm, was certified free of this disease in January. I learned that soon the proportion of the world’s population over 65 will exceed the proportion who are children. I learned AIDS reached a tipping point last year, when the number of people newly receiving antiretroviral therapy surpassed the number of new infections. Sadly, AIDS remains the second leading cause of death for women in Mozambique. I learned that the WHO estimates that antimicrobial resistance is responsible for 25000 deaths per year across the European Union. I learned that in some countries suicide attempts are considered criminal, so that patients discharged from hospital are immediately detained by police. I learned of the commitment of many states and organizations to tackle issues such as dementia, violence, and the effects on health of climate change. The emphasis on chronic disease around the world is also increasing; as Dr. Margaret Chan pointed out last year, “hunger persisted, but the world as a whole got fat.”
In spite of the criticisms of the WHO, whether these are about the handling of emergencies or the slow progress on primary health care systems, it is nevertheless a sign of hope that the countries of the world come together in this annual assembly to address seriously how the health of the people of the world can be protected, maintained and advanced.
Dr. C. Ruth Wilson MD CCFP FCFP
Dean Reznick would like to express his thanks to Dr. Wilson for the creation of this post and welcomes comments below on the 68th World Health Assembly.