69th World Health Assembly – A new era for health development


An ambitious new era for health development

 




Director-General of the World Health Organization, Dr Margaret Chan’s speech at the opening of the 69th World Health Assembly in Geneva on 23 May, is clearly pertinent to the current state of worldwide health. It deserves publishing it in full. She puts into context what remarkable feats have been achieved and warns of the challenges we face. What’s abundantly clear, is that all countries, now more than ever, need to work collectively to protect all people from the threat of pandemic disease and other health disasters. As she says, ‘we have entered an ambitious new era for health development … and we have a solid foundation of success to build on.’

Mister President, Excellencies, honourable ministers, ambassadors, distinguished delegates, colleagues, ladies and gentlemen, Public health constantly struggles to hold infectious diseases at bay, to change lifestyle behaviours, and to find enough money to do these and many other jobs.

But sometimes we need to step back and celebrate.

Commitment to the Millennium Development Goals brought focus, energy, creative innovation, and above all money to bear on some of the biggest health challenges that marred the start of this century.

We can celebrate the 19,000 fewer children dying every day, the 44% drop in maternal mortality, and the 85% of tuberculosis cases that are successfully cured.

Africa in particular can celebrate the 60% decline in malaria mortality, especially since the African Leaders Malaria Alliance, supported by partners, did so much to make this happen.

We can celebrate the fastest scale-up of a life-saving treatment in history. More than 15 million people living with HIV are now receiving antiretroviral therapy, up from just 690,000 in 2000.

A culture of measurement and accountability evolved to make aid more effective. Greater transparency brought the voice of civil society to bear in holding governments and donors accountable for their promises.

The profile of health changed, from a drain on resources to an investment that builds stable, prosperous, and equitable societies.

Everyone in this room can be proud of these achievements.

You have saved many millions of lives. Your strategic and technical innovations have left us well-prepared to set our sights even higher. You deserve an applause.

Ladies and gentlemen,
In an interconnected world characterized by profound mobility of people and goods, few threats to health are local anymore.

Air pollution is a transboundary hazard that affects the global atmosphere and contributes to climate change.

Drug-resistant pathogens, including the growing number of “superbugs”, travel well internationally in people, animals, and food.

The marketing of unhealthy foods andbeverages, especially to children, is now a global phenomenon.

Safeguarding the quality of pharmaceutical products has become much harder, with complex manufacturing procedures and supply chains spanning multiple companies and countries.

Ensuring the quality of the food supply is also much harder when a single meal can contain ingredients from all around the world, including some potentially contaminated with exotic pathogens.

The refugee crisis in Europe taught the world that armed conflicts in faraway places will not stay remote.

The Ebola outbreak in 3 small countries paralyzed the world with fear and travel constraints.

Last year, a business traveller returning home to the Republic of Korea, infected with the MERS coronavirus, disrupted the country’s economy as well as its health system.

The rapidly evolving outbreak of Zika warns us that an old disease that slumbered for 6 decades in Africa and Asia can suddenly wake up on a new continent to cause a global health emergency.

This year’s appearance of urban yellow fever in Africa, now confirmed in the capital cities of Angola and the Democratic Republic of Congo, is yet another serious event with potential for further international spread.

Ladies and gentlemen,
For infectious diseases, you cannot trust the past when planning for the future.

Changes in the way humanity inhabits the planet have given the volatile microbial world multiple new opportunities to exploit. There will always be surprises.

The possibility that a mosquito bite during pregnancy could be linked to severe brain abnormalities in newborns alarmed the public and astonished scientists.

Confirmation of a causal link between infection and microcephaly has transformed the profile of Zika from a mild disease to a devastating diagnosis for pregnant women and a significant threat to global health.

Outbreaks that become emergencies always reveal specific weaknesses in affected countries and illuminate the fault lines in our collective preparedness.

For Ebola, it was the absence of even the most basic infrastructures and capacities for surveillance, diagnosis, infection control, and clinical care, unaided by any vaccines or specific treatments.

For Zika, we are again taken by surprise, with no vaccines and no reliable and widely available diagnostic tests. To protect women of childbearing age, all we can offer is advice. Avoid mosquito bites. Delay pregnancy. Do not travel to areas with ongoing transmission.

Zika reveals an extreme consequence of the failure to provide universal access to sexual and family planning services. Latin America and the Caribbean have the highest proportion of unintended pregnancies anywhere in the world.

Above all, the spread of Zika, the resurgence of dengue, and the emerging threat from chikungunya are the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s.

The lesson from yellow fever is especially brutal. The world failed to use an excellent preventive tool to its full strategic advantage.

For more than a decade, WHO has been warning that changes in demography and land use patterns in Africa have created ideal conditions for explosive outbreaks of urban yellow fever. Africa’s urbanization has been rapid and rampant, showing the fastest growth rates anywhere in the world.

Migrants from rural areas, and workers from mining and construction sites, cannow carry the virus into urban areas with powder-keg conditions: dense populations of non-immune people, heavy infestations with mosquitoes exquisitely adapted to urban life, and the flimsy infrastructures that make mosquito control nearly impossible.

The world has had a safe, low-cost, and effective vaccine that confers life-long protection against yellow fever since 1937. That’s nearly 80 years. Yellow fever vaccines should be and must be used more widely to protect people living in endemic countries. Yellow fever is not a mild disease.

Let me give you a stern warning. What we are seeing now looks more and more like a dramatic resurgence of the threat from emerging and re-emerging infectious diseases. The world is not prepared to cope.

High-level assessments of the Ebola response have consistently called for more resilient health systems as a first line of defence. This is also the position taken at the G7 summit being held later this week in Japan.

I welcome the current joint external evaluations that are looking at preparedness and response capacities in several countries. The evaluations need to continue with the utmost urgency, as a tool under WHO authority and coordination.

WHO is the organization with universal legitimacy to implement the International Health Regulations. The evaluations must be accompanied by well-resourced efforts to fill the gaps. Many generous countries have promised to support 76 countries to build IHR core capacities. I urge you to keep this promise.

Given what we face right now, and the next surprises that are sure to come, the item on your agenda with the most sweeping consequences, for a danger that can quickly sweep around the world, is the one on the reform of WHO’s work in health emergency management.

The Secretariat’s report gives you an overview of the design, oversight, implementation plan, and financing requirements of the new health emergencies programme.

Setting this up marks a fundamental change for WHO, in which our traditional technical and normative functions are augmented by operational capacities needed to respond to outbreaks and humanitarian emergencies. Implementation of this change has moved forward quickly.

The programme’s design is aligned with the principles of a single programme, with one clear line of authority, one workforce, one budget, one set of rules and processes, and one set of standard performance metrics.

In March, I established an Independent Oversight and Advisory Committee. This 8-member committee is monitoring the development and performance of the programme. The Committee will report its findings through the Executive Board to the Health Assembly.

I urge you to give this item the serious consideration it deserves. Anything short of full political and financial support for the programme will handicap the WHO response, right now and into the future.

Ladies and gentlemen,
Few health threats are local anymore. And few health threats can be managed by the health sector acting alone.

As the international community enters the era of sustainable development, the global health landscape is being shaped by 3 slow-motion disasters: a changing climate, the failure of more and more mainstay antimicrobials, and the rise of chronic noncommunicable diseases as the leading killers worldwide.

These are not natural disasters. They are man-made disasters created by policies that place economic interests above concerns about the well-being of human lives and the planet that sustains them.

This is the way the world works. The burning of fossil fuels powers economies.

Medicines for treating chronic conditions are more profitable than a short course of antibiotics. Highly processed foods that are cheap, convenient, and tasty gain a bigger market share than fresh fruits and vegetables.

Unchecked, these slow-motion disasters will eventually reach a tipping point where the harm done is irreversible.

This is best documented by the 2° C limit for catastrophic climate change. For antimicrobial resistance, we are on the vergeof a post-antibiotic era in which common infectious diseases will once again kill. If you want to know the future consequences of markets saturated with unhealthy foods and beverages, read the report of the Commission on Ending Childhood Obesity.

The 2030 agenda for sustainable development wants to make sure these and many other disasters are averted. The agenda aims to do nothing less than transform theway the world, and the international systems that govern it, work.

The goals and targets are broad, visionary, and supremely ambitious. They have been criticized by some as utopian, unaffordable, out of touch, and out of reach.

I disagree. The vision inspires optimism and hope, but it is also firmly anchored in the realities of a world that desperately needs to change.

The ambition of the agenda is to tackle the root causes of the world’s many woes, from the degrading misery of poverty to the consequences of terrorism and violence, in an integrated and interactive way.

The agenda puts the people left behind first. We know what this implies.

R&D market failures punish the poor. User fees punish the poor. User fees discourage people from seeking care until a condition is severe and far more difficult and costly to manage. Diabetes is a prime example. User fees waste resources as well as human lives.

The agenda is indeed broad, but so are the social, economic, and environmental determinants of health. The advantage of addressing these broad determinants is wellreflected in the operational framework for implementing the Global strategy for women’s, children’s and adolescents’ health.

Health holds a prominent and central place that benefits the entire agenda. In the final analysis, the ultimate objective of all development activities, whether concerning the design of urban environments or the provision of modern energy to rural areas, is to sustain human lives in good health.

In an interactive agenda, the broad determinants of health, coupled with methodologies that let us track progress with confidence, make improvements in health a reliable marker of overall progress.

Member States have approved roadmaps of strategic actions for taking forward work on individual health targets. Nearly all these strategies and plans map out priority R&D innovations that will boost the prospects of reaching ambitious goals.

Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, peoplecentred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people’s expectations for comprehensive care that does not drive them below the poverty line.

And we have other resources to tap. The Women Deliver conference, held last week in Copenhagen, provides evidence of the energy unleashed when women are freed from the constraints of violence, discrimination, and unintended pregnancies.

It also falls to the health sector to show some principled ethical backbone in a world that, for all practical appearances, has lost its moral compass. We must express outrage at the recent bombings of hospitals and refugee camps in Syria and Yemen, the use of rape and starvation as weapons of war, and the killing of innocent civilians in the pursuit of terrorist goals.

Ladies and gentlemen,
We need to celebrate not only the wealth of achievements and lessons learned during the MDG era, but also every victory that permanently eliminates a health threat.

Earlier this month, WHO declared that India has eliminated yaws from its vast population. Last year, human cases of sleeping sickness reached the lowest level seen since data collection began 75 years ago. This year, only 2 cases of guinea worm disease have been detected, both in Chad.

After Cuba was validated as the first country in the world to eliminate mother-to-child transmission of HIV and syphilis, a second wave of countries will be considered by the global validation committee this week.

Polio eradication has never been so close to the finish line, with Africa now free of wild poliovirus for nearly 2 years.

During the short span of 2 weeks in April, 155 countries successfully switched from trivalent to bivalent oral polio vaccine, marking the largest coordinated vaccine withdrawal in history. I thank you and your country teams for this marvellous feat. This is another milestone towards a world permanently free of a crippling disease.

We have victories on other fronts. More countries are exercising their legal right to mandate plain packaging for tobacco products, with the UK being the latest on the list. One tobacco giant has decided not to appeal, adding to the victory.

These are critical victories. No country can hope to bring down the burden of noncommunicable diseases in the absence of strong legislation for tobacco control in line with the WHO Framework Convention on Tobacco Control.

World leaders are fully aware of the major challenges affecting health in general and this Organization in particular.

Many recent meetings have focused on the crisis caused by antimicrobial resistance. I thank Member States for taking this crisis so seriously, including the pressing need for incentives to get new products into the pipeline.

World leaders are concerned about the world drug problem and the need to broaden and balance the response by adopting a public health approach.

They are concerned about a humanitarian system that is overwhelmed and badly needs reform. This concern is reflected in the first-ever World Humanitarian Summit being held this week in Istanbul.

They are concerned about the costs, to economies as well as to health, incurred by noncommunicable diseases. Thanks to last year’s successful event in Paris, the world now has a climate treaty.

I thank Member States for recognizing the critical importance of strengthening health systems and embracing the vision of universal health coverage. You have approved many resolutions that contribute to this end. We are well-poised to implement the SDGs.

You are also on the verge of delivering a solid framework for engagement with non-state actors that will mainstream a major area of reform.

This Health Assembly, with its recordbreaking number of agenda items and participants, tells me how much you expect from WHO.

We have entered an ambitious new era for health development. We have a solid foundation of success to build on.

WHO, together with its multiple partners, is poised to save many more millions of lives. I ask you to remember this purpose as we go through an agenda that can mean so much for the future.

Thank you.


How the World Health Assembly works


WHO was established 68 years ago to promote health and ease the burden of disease worldwide. The Organization takes direction for its goals and priorities from the 194 Member States it is designed to serve. Each year, senior health officials from Member States come to Geneva to participate in the World Health Assembly. It is at the Health Assembly that WHO’s work is reviewed, new goals are set, and new tasks assigned.

The Sixty-ninth World Health Assembly this year has a long and complex list of health challenges and responses to review.

The process at the annual World Health Assembly
At the Health Assembly 2 main types of meetings are held, each with a different purpose: l

  • Committees meet to debate technical and health matters (Committee A), and financial and management issues (Committee B), and approve the texts of resolutions, which are then submitted to the plenary meeting.
  • Plenary is the meeting of all delegates to the World Health Assembly. The Health Assembly meets in plenary several times in order to listen to reports and adopt the resolutions transmitted by the committees. The Director-General and Member States also address the delegates at the plenary.

In addition, technical briefings are organized separately on specific public health topics to present new developments in the area, provide a forum for debate and to allow for information sharing.


New Health Emergencies Programme

WHO Member States agreed to one of the most profound transformations in the Organization’s history, establishing a new Health Emergencies Programme. The programme adds operational capabilities for outbreaks and humanitarian emergencies to complement its traditional technical and normative roles.

The new programme is designed to deliver rapid, predictable, and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or conflicts.

WHO will provide leadership within the context of the International Health Regulations and health, in relation to the broader humanitarian and disastermanagement system. As health cluster lead, it will draw on the respective strengths and expertise of a wide range of partners and Member States.

In order to fulfil these new responsibilities, delegates agreed a budget of US$494 million for the Programme for 2016-2017. This is an increase of US$160 million to the existing Programme Budget for WHO’s work in emergencies.


 

Resolutions on air pollution, childhood obesity among decisions adopted at WHA

 

Delegates at the World Health Assembly agreed resolutions and decisions on air pollution, chemicals, the health workforce, childhood obesity, violence and noncommunicable diseases. They also agreed to implement two new health strategies that are closely aligned with the Sustainable Development Goals. One relates to women’s children’s and adolescents’ health; the other to healthy ageing. In summary:

Air pollution
Delegates welcomed a new road map for responding to the adverse health effects of air pollution. Every year, 4.3 million deaths occur from exposure to indoor air pollution and 3.7 million deaths are attributable to outdoor air pollution. The road map outlines actions to be taken between 2016 and 2019, and is organized into four categories.

It sets out to expand the knowledge base, by building and disseminating global evidence and knowledge impacts of air pollution of health and the effectiveness of interventions and policies to address it. The road map also aims to enhance systems to monitor and report on health trends and progress towards the air pollution-related targets of the Sustainable Development Goals. It focuses on leveraging health sector leadership and coordinated action at all levels – local, national, regional and global – to raise awareness of air pollution. Lastly, it will enhance the health sector’s capacity to address the adverse health effects from air pollution through training, guidelines and national action plans.

Chemicals
The Health Assembly also approved a resolution on the health sector’s role in the sound management of chemicals. Chemicals contribute significantly to the global economy, living standards and health, but poor management also contributes significantly to the global burden of disease and death, particularly in developing countries. Worldwide, 1.3 million lives are lost every year due to exposures to chemicals, such as lead and pesticides.

Delegates reconfirmed their commitment to ensuring chemicals are used and produced in ways that minimize significant adverse effects on human health and the environment by 2020. The resolution urges Member States to strengthen international cooperation, through transferring expertise, technologies and scientific data, as well as exchanging good practices to manage chemicals and waste.

The resolution asks the WHO Secretariat to develop and to present to the Seventieth World Health Assembly a road map outlining concrete actions to enhance the health sector engagement towards meeting the 2020 goal and associated targets of the 2030 Agenda for Sustainable Development. It also requests the Secretariat to develop a report on the impacts of waste on health and actions the health sector could take to protect it.

Health Workforce
Delegates agreed today to adopt the Global Strategy on Human Resources for Health: Workforce 2030, which aims to accelerate progress towards universal health coverage and the achievement of the Sustainable Development Goals (SDGs) by ensuring equitable access to health workers in every country. Today’s resolution calls on countries to take steps to strengthen theirhealth workforces, including actively forecasting gaps between needs for and supply of health workers, collecting and reporting better data, and ensuring adequate funding for the health workforce.

Population growth, ageing societies, and changing disease patterns are expected to drive greater demand for welltrained health workers in the next 15 years. The global economy is projected to create around 40 million new health sector jobs by 2030; mostly in middleand high-income countries. But despite that anticipated growth, there will be a projected shortage of 18 million health workers needed to achieve the SDGs in low- and lower-middle income countries, fuelled in part by labour mobility, both within and between nations.

Ending Childhood Obesity
Delegates considered the report of the Commission on Ending Childhood Obesity which sets out the approaches and combinations of interventions that are likely to be most effective in tackling childhood and adolescent obesity in different contexts around the world. In 2014, an estimated 41 million children under 5 years of age were affected by overweight or obesity, and 48% of these lived in Asia and 25% in Africa. Under-nutrition in early childhood places children at an especially high risk of developing obesity later in life when food and physical activity patterns change.

Member States welcomed the six recommendations detailed in the Commission’s report. These include strategies to tackle environmental norms that foster obesity, reduce the risk of obesity through the life-course and treat children who are already obese to improve their current and future health. The Health Assembly calls on the WHO Secretariat to develop an implementation plan to guide further action, in consultation with Member States, and invited stakeholders to work towards implementation of the actions. The Assembly also recommended Member States develop national responses to end childhood and adolescent obesity, in line with the report’s recommendations.

Global plan of action on violence
Delegates agreed a resolution on the WHO global plan of action on violence. Non-fatal acts of violence take a particular toll on women and children. One-in-four children has been physically abused; one-in-five girls has been sexually abused; and one-in-three women has experienced physical and/or sexual intimate partner violence at some point in her lifetime.

The plan is designed to help countries strengthen action to address interpersonal violence, in particular violence against women and girls, and children. The resolution encourages countries to strengthen the role of the health system in responding to violence. It invites partners to take steps to accomplish the plan¹s four strategic directions: strengthen health system leadership and governance; enhance health service delivery and the capacity of health workers and providers to respond to the needs of people who have experienced violence; boost programming to prevent interpersonal violence; and improve information and evidence.

Prevention and control of noncommunicable diseases
Member States reviewed the progress made by countries in addressing noncommunicable diseases (NCDs), including heart and lung diseases, cancers and diabetes, since the first UN High-level Meeting on NCDs in 2011.

There has been a significant increase in the number of countries with a national multisectoral NCD action plan (from 18% of countries in 2010 to 37% in 2015) and a NCD department within national ministries of health (from 53% to 66%). Globally, the probability of dying between the ages of 30 and 70 from a major NCD has dropped slightly, as well as alcohol per capita consumption, and the prevalence of raised blood pressure. However, significant global increases are witnessed in the prevalence of obesity and overweight.

In preparation for the third UN Highlevel Meeting on NCDs in 2018, Member States requested WHO update a set of very cost-effective and affordable NCD interventions that can be implemented by all Member States, as well as to develop an approach to register and publish contributions of the private sector to achieving global NCD targets.

Global Strategy for Women’s, Children’s and Adolescents’ Health
Delegates committed to take forward the implementation of Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030).

The strategy sets out to ensure every woman, child and adolescent, in any setting, anywhere in the world, is able to both survive and thrive by 2030. The strategy, and the new operational framework, place a strong emphasis on country leadership. They highlight the need to strengthen accountability at all levels through monitoring national progress and increasing capacity to collect and analyse data. They underscore the importance of developing a sustainable evidenceinformed health financing strategy, as well as strengthening health systems and building partnerships with a wide range of actors across different sectors.

Today’s resolution calls 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 women’s, children’s and adolescents’ health. It also requests the Secretariat to continue to collaborate with other UN agencies and partners to advocate and leverage assistance so that national plans can be implemented.

Global strategy on ageing and health
Delegates also approved a resolution on the global strategy and action plan on ageing and health 2016-2020. In May 2014 the World Health Assembly asked the Director- General to develop a comprehensive global strategy and plan of action, to address the world’s rapidly ageing populations.

The proportion of the world’s population aged 60 years or over is predicted to double between 2000 and 2050, rising to 22%. A WHO report released in October 2015 revealed little evidence that older people today are experiencing better health than their parents did at the same age. Moreover, good health in older age is unequally distributed, both within and between countries. Most health problems are linked to chronic conditions, particularly noncommunicable diseases that can be prevented or delayed by healthy behaviours across the life-course.

The aim of the strategy is for every country to commit to action on healthy ageing. It calls for the development of age-friendly environments and the alignment of health systems to the needs of older populations. It envisages the development of sustainable and equitable systems of long-term care, and improved measurement, monitoring and research. It emphasizes equity and human rights, including the important role of involving older adults in all decisions that concern them.

 

Date of upload: 13th July 2016

                                  
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