Expanding access to medicines, preparing for epidemics, earning public trust, and realising the climate crisis is in fact a health crisis – are we ready for the next decade? The WHO is adamant we need to address global health challenges urgently.
“Developed with input from our experts around the world, this list reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “This puts lives, livelihoods, and economies in jeopardy. None of these issues are simple to address, but they are within reach.”
Dr Tedros said public health is a political choice and countries need to realise that health is an investment in the future. “A virus can be deadlier than a terrorist attack, and a pandemic could bring economies and nations to their knees.
“The challenges in this list demand a response from more than just the health sector. We face shared threats and we have a shared responsibility to act. With the deadline for the 2030 Sustainable Development Goals quickly approaching, the United Nations General Assembly has underscored that the next 10 years must be the ‘decade of action’.
“This means advocating for national funding to address gaps in health systems and health infrastructure,” said Dr Tedros. “Investing now will save lives – and money – later. The cost of doing nothing is one we cannot afford. Governments, communities, and international agencies must work together to achieve these critical goals. There are no shortcuts to a healthier world. 2030 is fast approaching, and we must hold our leaders accountable for their commitments.”
1. ELEVATING HEALTH IN THE CLIMATE DEBATE
The climate crisis is a health crisis. Air pollution kills an estimated seven million people every year, while climate change causes more extreme weather events, exacerbates malnutrition and fuels the spread of infectious diseases such as malaria. The same emissions that cause global warming are responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease. Leaders in both the public and private sectors must work together to clean up our air and mitigate the health impacts of climate change.
2. DELIVERING HEALTH IN CONFLICT AND CRISIS
In 2019, most disease outbreaks requiring the highest level of WHO response occurred in countries with protracted conflict. We also saw the continuation of a disturbing trend in which health workers and facilities are targeted. WHO recorded 978 attacks on health care in 11 countries last year, with 193 deaths. At the same time, conflict is forcing record numbers of people out of their own homes, leaving tens of millions of people with little access to health care, sometimes for years.
3. MAKING HEALTHCARE FAIRER
Persistent and growing socio-economic gaps result in major discrepancies in the quality of people’s health. There’s not only an 18-year difference in life expectancy between rich and poor countries, but also a marked gap within countries and even within cities. Meanwhile, the global rise in noncommunicable diseases, such as cancer, chronic respiratory disease and diabetes, has a disproportionately large burden in low and middle-income countries and can quickly drain the resources of poorer households.
4. EXPANDING ACCESS TO MEDICINES
About one-third of the world’s people lack access to medicines, vaccines, diagnostic tools, and other essential health products. Low access to quality health products threatens health and lives, which can both endanger patients and fuel drug resistance. Medicines and other health products are the second-largest expenditure for most health systems (after health workers) and the largest component of private health expenditure in low- and middle-income countries.
5. STOPPING INFECTIOUS DISEASES
Infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases, and sexually transmitted infections will kill an estimated four million people in 2020, most of them poor. Meanwhile, vaccine-preventable diseases continue to kill, such as measles, which took 140 000 lives in 2019, many of them children. Although polio has been driven to the brink of eradication, there were 156 cases of wild poliovirus last year, the most since 2014.
The root causes are insufficient levels of financing and the weakness of health systems in endemic countries, coupled with a lack of commitment from wealthy countries.
6. PREPARING FOR EPIDEMICS
Every year, the world spends far more responding to disease outbreaks, natural disasters, and other health emergencies than it does preparing for and preventing them. A pandemic of a new, highly infectious, airborne virus – most likely a strain of influenza – to which most people lack immunity is inevitable. It is not a matter of if another pandemic will strike, but when, and when it strikes it will spread fast, potentially threatening millions of lives. Meanwhile, vector-borne diseases like dengue, malaria, Zika, chikungunya, and yellow fever are spreading as mosquito populations move into new areas, fanned by climate change.
7. PROTECTING PEOPLE FROM DANGEROUS PRODUCTS
Lack of food, unsafe food, and unhealthy diets are responsible for almost one-third of today’s global disease burden. Hunger and food insecurity continue to plague millions, with food shortages being perniciously exploited as weapons of war. At the same time, as people consume foods and drinks high in sugar, saturated fat, trans fat, and salt, overweight, obesity, and diet-related diseases are on the rise globally. Meanwhile, tobacco use is declining in a few but rising in most countries, and evidence is building about the health risks of e-cigarettes.
8. INVESTING IN THE PEOPLE WHO DEFEND OUR HEALTH
Chronic under-investment in the education and employment of health workers, coupled with a failure to ensure decent pay, has led to health worker shortages all over the world. This jeopardises health and social care services and sustainable health systems. The world will need 18 million additional health workers by 2030, primarily in low- and middle-income countries, including nine million nurses and midwives.
9. KEEPING ADOLESCENTS SAFE
More than one million adolescents aged 10-19 years die every year. The leading causes of death in this age group are road injury, HIV, suicide, lower respiratory infections, and interpersonal violence. Harmful use of alcohol, tobacco and drug use, lack of physical activity, unprotected sex, and previous exposure to child maltreatment all increase the risks for these causes of death.
10. EARNING PUBLIC TRUST
Trust helps to shape whether patients are likely to rely on health services and follow a health worker’s advice – around vaccinations, taking medicines or using condoms. Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions. The anti-vaccination movement has been a significant factor in the rise of deaths in preventable diseases.
11. HARNESSING NEW TECHNOLOGIES
New technologies are revolutionising our ability to prevent, diagnose, and treat many diseases. Genome editing, synthetic biology and digital health technologies such as artificial intelligence can solve many problems, but also raise new questions and challenges for monitoring and regulation. Without a deeper understanding of their ethical and social implications, these new technologies, which include the capacity to create new organisms, could harm the people they are intended to help.
12. PROTECTING THE MEDICINES THAT PROTECT US
Anti-microbial resistance (AMR) threatens to send modern medicine back decades to the pre-antibiotic era, when even routine surgeries were hazardous. The rise of AMR stems from myriad factors that have come together to create a terrifying brew, including unregulated prescription and use of antibiotics, lack of access to quality and affordable medicines, and lack of clean water, sanitation, hygiene, and infection prevention and control.
13. KEEPING HEALTH CARE CLEAN
Roughly one in four health facilities globally lack basic water services. Water, sanitation and hygiene (WASH) services are critical to a functioning health system. The lack of these basics in health facilities leads to poor-quality care and an increased chance of infection for patients and health workers. All of this is happening against a backdrop of billions of people around the world living in communities without safe water to drink or adequate sanitation services – both of which are major drivers of disease.