EHFG President Clemens Marten Auer warned Europe’s health systems face an existential threat from artificial intelligence.

BAD HOFGASTEIN, Austria — Artificial intelligence poses an “existential” threat to Europe’s health and social security systems through its potential to “completely replace” human work and eliminate the income tax funding base on which they depend, a leading health policy figure has warned.

Clemens Marten Auer, president of the European Health Forum Gastein, used the opening of the summit’s 28th edition in Austria’s Tauren mountains to sound the alarm that AI automation could hollow out the tax revenues that underpin Europe’s postwar welfare systems.

“AI will drastically change, even obliterate, the very foundations of the social contract as we know it today,” Auer said, arguing that the tax base funding Europe’s social provisions requires “total reformation” to preempt the coming transformation of the labour force and collapse of tax revenue.

“AI will transform societies, but may also devalue human labour, deepening inequality and creating instability,” Auer said. “The sustainability of solidarity systems is threatened at its core by this development and cannot be rendered future-proof unless the basis for funding of these systems changes.”

Europe’s social contract—the postwar consensus guaranteeing health, housing and education funded through employment-based taxation—is under attack from all sides as stagnating economic growth and ageing populations collide with budgets strained by war, climate change and digitalisation.

Demographics lead the assault. The EU’s active workforce is projected to shrink by 2 million by 2040, pushing the ratio of workers to pensioners from 3:1 to 2:1 as medical advances extend life expectancy and healthcare costs. Fewer workers mean less tax revenue even as spending on an ageing population rises.

“Society is changing in a positive way. We have lots of technological changes, new drugs, we can treat more diseases,” said Slovenia’s health minister Valentina Prevolnik Rupel. “In developed countries, the number of citizens does not really grow—what grows is the life expectancy. All this is positive, but it brings changes in demand, and needs are growing.”

Those same trends are pushing Europe’s medical workforce to the limit with a projected shortage of 4 million staff by 2030, despite increasing the import of foreign nurses by 67% and doctors by 54% over the last decade, according to WHO figures.

“If we keep the social contributions or the funding unchanged, and on the other hand, we see that the needs are increasing, we have some discrepancies that cause issues in trust,” she said.

‘Learn to speak Russian’

NATO Secretary-General Mark Rutte warned in July that nations face a choice between welfare system spending and defence.

Geopolitical tensions on European borders have intensified competition for scarce funds. Russia’s four-year full-scale invasion of Ukraine has forced a fundamental rethink of EU defence budgets, which stalled in a holding pattern around 2% of GDP in recent decades.

Nato allies are now pushing for member states to reach 5% of GDP in defence spending. The EU has already relaxed budget rules to allow member states to boost defence output, driving a 19% increase in defence spending across the bloc last year.

“If you do not do this, if you would not go to the 5%, including the 3.5% core defence spending, you could still have the National Health Service…the pension system, etc.,” Nato secretary-general Mark Rutte said ahead of a summit in The Hague in June. “But you’d better learn to speak Russian.”

“Sounds a little cynical,” Auer quipped, “but he said it.”

The landmark Draghi report on European competitiveness, released last month, estimates that investment in decarbonisation, defence, economic independence and digitalisation will require an additional 5% of GDP to keep pace with global powers in the US and China, a daunting figure given the bloc’s minimal economic growth and correspondingly stagnant government revenues.

“It’s high time to wake up and to start reflecting these political developments for our sector,” Auer continued. “All these developments will have a massive impact on how we finance, how we organise the level of and the access to health services.”

The 5% calculation in the Draghi report does not include health or pensions, which are largely absent from the document that charts the EU’s growth roadmap and investment priorities. Health and welfare budgets will have to compete for what’s left.

“You need additional money for the investment in infrastructure, that’s the fact. Through social contributions, we just fund the [social] programs,” Prevolnik Rupel said, noting that Slovenia has spent more in the last two years on health than in the previous decade combined to meet rising demand.

“That’s investments in the infrastructure—they are needed because the technological events are so fast,” she explained. “We need new equipment, we need new buildings, we need new spaces, because the protocols of how the patient travels through the systems change.”

Steam engine or hot air? 

The financial pressures on European welfare systems from demographic ageing, geopolitical instability and climate change are clear, as is the looming crisis in health worker shortages. The apocalyptic impact of AI that Auer outlined, however, remains far less certain.

In an essay accompanying his opening remarks, Auer compared AI’s potential to automate work processes to “the invention of the steam engine…and the First Industrial Revolution” in transformative power.

He cited Sam Altman, OpenAI’s chief executive, who predicted ChatGPT “will soon be more powerful than any person who has ever lived,” and Eric Schmidt, Google’s former chief executive, who forecast AI will reach 80 to 90% of top expert skills in mathematics, law, science and programming by 2033. Schmidt maintains one of the largest private AI investment portfolios worth billions of dollars.

Yet nearly all predictions of AI’s looming takeover come from inside the industry itself, where executives and investors have substantial financial stakes in the technology’s success. A significant decline in AI’s perceived value would cost companies like OpenAI hundreds of billions in valuation, and industry figures personally many billions of dollars.

The optimistic industry narrative has fuelled historic valuations despite record cash burn. The AI industry’s leading companies—Google, Meta, Microsoft, OpenAI, Amazon and Tesla—have spent a combined $560bn on capital expenditure since 2024 and generated just $35bn in return, netting $525bn in combined losses.

Despite the losses, OpenAI reached a $500bn valuation on Thursday, cementing its place as the world’s most valuable start-up.

The lack of profitability has contributed to growing concerns that the AI market might be a bubble, potentially undercutting its perceived revolutionary potential—and threat to solidarity systems in Europe.

AI’s capacity to “completely replace human work,” as Auer wrote, echoing warnings from other AI industry figures such as Anthropic’s Dario Amodei, has scarcely materialised.

A Yale University study published on Thursday found that US labour market metrics show “the broader labour market has not experienced a discernible disruption since ChatGPT’s release 33 months ago, undercutting fears that AI automation is currently eroding the demand for cognitive labour across the economy.”

Meanwhile, AI advancement has stalled as models hit walls in processing power, energy infrastructure, compute capacity and diminishing returns, all while companies have yet to identify profitable use cases for the technology.

A Massachusetts Institute of Technology report in August found that 95% of companies experimenting with AI are not making money from it, despite widespread promises from corporate leaders about efficiency gains.

Large language model technology is currently built on burning cash and the environment. Data centres consume more energy annually than all but 16 of the world’s 192 nations, with consumption set to double by 2030.

Global AI demand for water to cool servers and microchips is projected to require a supply equal to the total annual water withdrawal of countries like Denmark by 2027.

Continuing AI scaling and power-hungry data centres are eating into gains from green energy sources such as solar and wind, forcing gas, oil and coal plants back online to meet demand as air, noise and environmental pollution from digital waste threaten the health of nearby communities.

AI leaders including Altman have acknowledged that an energy breakthrough, likely from nuclear fusion, will be required if AI is to continue scaling. Google and Microsoft have started investing in nuclear technology, but a scalable breakthrough in the field is still a long way off.

“Naturally, historic predictions are difficult, especially when it comes to developments and employment in the labour market,” Auer acknowledged. “I do not want to oversimplify the issue here.”

AI’s healthcare promise 

If AI does fulfil its transformative potential, healthcare is seen as one of the most promising frontiers. Yet here too, the gap between promise and reality remains wide.

Nearly two-thirds of physicians surveyed in the United States reported using AI in 2024, a jump to 78% from 38% the previous year, according to a study by the American Medical Association. The usage, however, was primarily for administrative tasks such as documentation of billing codes, medical charts, visit notes, discharge instructions and translation services rather than medical or scientific breakthroughs.

Slovenia’s experience illustrates the challenge facing health systems. The government issued an open call for AI healthcare proposals and received 52 potential solutions for a country of just 2 million people.

“It’s like a flood of artificial intelligence applications, and we have to decide which ones to take on—and it’s very difficult because we don’t know,” Prevolnik Rupel said. “We don’t have enough evidence yet on which solutions work and which don’t.”

The government decided to pilot the most promising submission, an artificial intelligence program for scheduling healthcare workers’ shifts. Like the administrative applications in the AMA survey, the use case was organizational rather than medical, as doctors remain wary of trusting AI with decisions that could impact patients.

“Because it was an artificial intelligence, a logical program, it was more fair than when it was a nurse who would say, you do this,” she said. “Everybody was happy, and the level of satisfaction increased, and actually, the absenteeism among the healthcare workers fell in that hospital.”

The proliferation of untested AI applications has raised questions about how to regulate the technology safely. But experts say existing regulatory frameworks can be adapted rather than reinvented.

“When we started regulating medicines, 70 years ago more or less in the European Union, it was one of the first success stories,” said Natasha Azopardi-Muscat, division lead for WHO’s Europe office.

“We said medicines have to meet certain criteria: quality, safety, efficacy. And then we went further. We said that they have to be better than the alternative,” Azopardi-Muscat explained. “We can use the same [standards] for AI… We need to have a very clear system of evaluation.”

Despite the gap between AI predictions and current reality, Auer argued that political leaders are ceding crucial decisions about society’s future to private investors.

“If the automation stimulated by AI leads to a broad reduction of costs, meaning labour costs, meaning a significant loss of jobs,” he said, decisions about “how much capital to invest in development are made by financial investors, and not in parliaments or cabinet tables of governance.”

“The political call of the economic elites to strengthen Europe’s innovative power as forcefully as possible will come to nothing if at the same time we ignore the political concerns that innovations of the tech industry have the potential to dehumanize economic activity and weaken human labour,” he said.

“We must discuss and politically initiate steps to protect the solidarity systems in the long term and ensure the social and economic participation of as many segments of the population as possible.”

Image Credits: CC.

In April 2024, the Israeli Defence Force bombed Al Shifa Hospital, the largest hospital in Gaza.

All attacks on hospitals should be banned and the exceptions in international humanitarian law (IHL) that enable aggressors to justify bombing hospitals – by, for example, claiming that they are shielding combatants – should be removed.

Professor Neve Gordon, professor of international law at Queen Mary University in London, made this argument at a recent seminar hosted by the Geneva Graduate Institute’s Global Health Centre  and the International Geneva Global Health Platform. Queen Mary University, Médecins Sans Frontières (MSF) and the Graduate Institute’s Center on Conflict, Development & Peacebuilding co-hosted the event.

According to IHL, hospitals are protected from attack unless they are being used to “commit acts harmful to the enemy”, including shielding combatants and weapons.

But, said Gordon, this exception has now become the law, particularly in Gaza where “shielding has become a tool of genocide”.

The Israeli government claims that there are “hundreds of kilometres of tunnels under the Gaza Strip, and these tunnels are legitimate military targets, so anything above the target can be interpreted as a shield to the target”, said Gordon.

“Israel has targeted [hundreds] of medical units in the Gaza Strip, and each time it has claimed that these hospitals shielded something that belongs to Hamas,” he added.

“The vast majority of these claims are fabrications…. what you can see is how the law is being deployed by Israel, through the shielding argument, to defend and protect genocide,” he added.

“Anyone can decide what is proportional and what is not. Today, you kill two civilians for a soldier. Tomorrow, you kill 100 civilians for a soldier. And who can argue that that is not an adequate interpretation?” Gordon asked.

 “Part of the problem is the law. Let’s say there’s evidence of 10 combatants in a hospital. I say:” So what? We do not attack the hospital full stop. Wait till they come out, and you attack them.”

Massive increase in state attacks on hospitals

There has been a massive increase in attacks on health facilities, particularly by states.

Maarten van der Heijden, Global Health Centre research fellow,  showed that states were responsible for the majority of attacks on hospitals between 2016 and 2024, according  to the the Epidemic of Violence Report 2024 produced by the Safeguarding Health in Conflict Coalition.

There has also been a 1,000% increase in attacks on hospitals by states during this time.

“Attacks on healthcare are becoming part of the scorched-earth tactic, where you make a place unlivable,” said van der Heijden. 

After an Israeli attack on Nasser Hospital in August, the government of Prime Minister Benjamin Netanyahu used “multiple arguments” to justify the attack, based on denial, deflection and justification, he said.

“Netanyahu said it was a mistake. The military claimed that there was a [Hamas] camera. And then later, … they published a picture of six Hamas fighters that were attacked,” he said, adding that there was no clarity about how the Israeli military had assessed that the hospital was a legitimate target.

Deciding whether a hospital is a legitimate target requires a “complex analysis”, he added. “During a conflict, as we see right now in Myanmar, in Gaza, in Sudan, it is impossible to assess whether these attacks are actually legitimate or not.”

Lack of compliance

Professor Esperanza Martinez, head of Health and Human Security at the Australian National University’s law college, argued there was not an absence of legal frameworks but rather “an absence of compliance.”

“In 2024, there were more than 1,000 incidents directly targeting health facilities, hospitals primarily, and more than 80% of the attacks were committed by states,” said Martinez.

“So what we do have really here is a situation of widespread violations, impunity or lack of compliance and very limited enforcement.”

Professor Gloria Gaggioli, Vice-Dean for Research at the University of Geneva’s Law Faculty, agreed that IHL is sufficient and that exceptions to hospital attacks are important.

“Is the exception the problem? I don’t think so, because imagine a situation where we would say all attacks on hospitals are prohibited, and it’s a crime. What would be the result? The result would be that the enemy would have an incentive to use hospitals for military purposes,” said Gaggioli.

Moderator Ellen Rosskam with panellists Neve Gordon, Gloria Gaggioli and Tarak Bach-Baouab, with Esperanza Martinez on screen.

Plea from the field

“IHL doesn’t work,” said MSF’s Tarak Bach-Baouab. “We have the lives of our patients, the lives of our staff in our hands, and we have to have an environment where all the rules are well understood by all the players, and in which we can continue to operate.

“We have a larger problem than compliance. The law is actually used to justify attacks on health care, and the onus today is put on practitioners like ourselves, working in hospitals in conflict zones, to prove that the hospital is not used for a military purpose, or is not used as a shield,” added Bach-Baouab, who heads advocacy for MSF’s Operations Management Team.

“It used to be that the military contemplating attacking a hospital needed to go through almost a checklist before being able to attack. Today, the onus of proof has been turned on its head, and I think this is a major problem we are facing as humanitarians in conflict zones.”

He called for mobilisation by medical associations across the globe against these attacks and in support of the implementation of resolutions such as Resolution 2286 on the protection of health care, which was passed almost 10 years ago.

He also challenged the Swiss government, as the host of the Geneva Convention adopted at the end of the Second World War, to step up as guardians of IHL and push for “stronger uptake of these rules”.

How many civilians is it acceptable to kill in pursuit of a military target, Bach-Baouab concluded? 

MSF’s health facility in Al Shifa Hospital compound was severely damaged in the attack on the hospital in April 2024.

A complete recording of the event is available at the GHC You Tube Channel. 

Image Credits: Olga Cherevko/ OCHA, MSF, Safeguarding Health in Conflict Coalition.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals

Vaccinations have saved the lives of an estimated 17 million people between 2021 and 2024 – but global immunisation programmes face several challenges, according to an assessment by the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunisation.

Dr Kate O’Brien, WHO director of Immunisation, Vaccines and Biologicals, acknowledged the “deep commitment of countries and communities around the world to vaccination” at a media briefing on Tuesday following SAGE’s biannual meeting. 

While vaccination coverage has largely rebounded to pre-pandemic levels, “backsliding in Gavi-ineligible middle-income countries, and an increasing number of people living in fragile and conflict settings, threaten the global gains”, according to the WHO.

Immunisation programmes are being tested by “geopolitical instability”, constrained global and national budgets, and “shifting health architectures”.

In addition, “the information and trust crisis threatens vaccine confidence and uptake”, WHO noted.

However, O’Brien stressed that “the vast majority of parents are strongly supportive of vaccines”. 

“The rollout of malaria vaccine on the African continent, one of the fastest rollouts that we’ve seen, is a testament to the impact of vaccines, and the deep desire for people to protect their children to family members from infectious diseases that are otherwise a daily occurrence,” she said.

Four malaria vaccine doses affirmed as ‘optimal’

Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG)

SAGE confirmed that four doses of the malaria vaccine, known as RTS,S/AS01, provide optimal protection over three doses in preventing the rebound of severe malaria.

This decision was informed by a four-year study, which included children under five years of age, conducted in Ghana, Kenya and Malawi, where the vaccine is being rolled out as part of the routine childhood immunisation programmes.

“The fourth dose reduced severe malaria by 54%, with a 30% incremental effectiveness, above that provided by three doses,” said Harvard Professor Dyann Wirth, chair of the Malaria Policy Advisory Group (MPAG).

“The cumulative effectiveness of the four doses in reducing cerebral malaria, one of the most severe and deadly manifestations, was 74%,” added Wirth. In comparison, three doses reduced cerebral malaria by 48%.

“While three doses provide safe and effective protection against clinical malaria and severe disease, the incremental effectiveness of the fourth dose against severe disease was substantial,” she added.

SAGE chair Dr Hanna Nohynek

SAGE chair Dr Hanna Nohynek said at least 20 countries were using or considering the malaria vaccine, and SAGE recommends aligning the vaccines with other childhood vaccinations where possible.

SAGE “supported the expanded use of the novel oral poliovirus vaccine (OPV) to reduce vaccine-derived polio virus transmission in select geographies with persistent transmission of this particular virus”, said Nohynek.

It also recommended the use of “fractional doses of Sabin-based inactivated poliovirus vaccines (IPV)”.

Dr Joachim Hombach, SAGE’s executive secretary, highlighted the importance of countries “establishing programmes to support trust in vaccines, the safety of vaccines and the impact that they have, as they are “one of the most cost-effective health interventions”.

Hombach stressed that SAGE is an independent group of experts that base their decision on scientific evidence not politics.

Dr Joachim Hombach, SAGE’s executive secretary

O’Brien stressed that “the economic return on investment of vaccines is probably one of the highest available”.

Over the past 50 years, vaccines have saved approximately 154 million lives – and the measles vaccine is responsible for saving around 60% of these deaths, she noted.

US vaccine decision

The US recently decided to recommend two separate vaccinations for children – a combined one for measles, mumps and rubella (MMR), and another for varicella (chicken pox) – instead of a combined MMRV vaccine for all four conditions.

O’Brien said there were a range of vaccines available for the four common childhood infections, and that clinical trials have been done to assess the safety and the performance of the vaccines when they’re put together in a combination.

“Combination vaccines have a lot of benefits to them, especially from the perspective of the child, as it’s fewer injections, and  fewer number of visits to the healthcare provider,” said O’Brien.

“It’s well known that the measles, mumps, rubella and varicella (MMRV) combination vaccine does have a higher risk of fevers following the vaccine than when the varicella vaccine is given separately,” she added, and that these fevers could result in “febrile seizures”.

“A number of different countries constrain the recommendation for use of that combination vaccine to those kids who are older,” she said, but stressed that the MMR vaccine is “very safe”.

As measles and rubella have “significant health risks”, the WHO recommends that countries vaccinate against these two illnesses and this is using given in a combination vacine, she added.

SAGE also reported a decline in reported COVID-19 cases and deaths in the past year, along with low annual vaccination uptake “mainly limited to high-income countries in the WHO regions of Europe, the Americas and the Western Pacific in 2024”.

Variant-adapted COVID-19 vaccines show “moderate” effectiveness in preventing COVID-19 cases and hospitalizations, though protection wanes by six months, said SAGE.

“SAGE recommended an updated review of the evidence on the effectiveness of COVID-19 vaccines during the Omicron period, with a focus on the effect of vaccination in pregnancy on birth outcomes and infant COVID-19 to reassess the validity of recommendation on vaccination during pregnancy, in the current epidemiological context,” said the body.

SAGE also noted that there are 16 candidate tuberculosis vaccines in clinical development, five of which are in phase 3 trials. One, known as M72/ASO1E, could be licenced as early as 2028, depending on trial results.

Chhattisgarh health workers on strike

CHHATTISGARH, India — Nearly 16,000 staff employed under India’s National Health Mission (NHM) have been on an indefinite strike since 8 August. In early September, the dispute escalated dramatically when the state government dismissed 25 union leaders, prompting the mass resignation of  more than 14,000 health workers.

The mass resignations have raised alarm about the stability of healthcare in Chhattisgarh, a heavily forested, predominantly rural state that is home to 32 million people.

While clinics and outreach programs are still functioning in some areas, experts warn that if the strike persists, immunisation, maternal health services, and disease control programs could face severe disruption, leaving patients in remote tribal districts without access to even the most basic care.

“We were called COVID warriors during the pandemic. We reached villages no one else could,” said a health worker from Raipur, speaking on condition of anonymity. “But what are we getting in return?”

At the centre of the standoff are demands for permanent contracts, pay parity with regular staff, and improved benefits. Union leaders say the dispute in Chhattisgarh is not an isolated battle, but a symptom of deeper structural problems in India’s health system – problems that resonate globally.

Demands behind the strike

Health workers under NHM, the country’s flagship public health program launched in 2005, are technically “contractual staff.”  They receive lower pay, fewer benefits, and no job security compared to state-employed counterparts, despite often performing identical roles.

“We have 10 demands, and our top priority is regularisation or at least grade pay equal to permanent health workers,” said Hemant Kumar Sinha, leader of the trade union, Chhattisgarh Pradesh NHM Karamchari Sangh, in an interview with The Indian Express.

Other demands include the creation of a dedicated public health cadre, annual performance evaluations, a 27% salary hike, cashless medical insurance worth at least one million rupees (around $12,000), and expanded leave and medical benefits. 

In mid-August, the executive body of the State Health Committee accepted four of the 10 demands raised by contractual NHM employees, but trade union leaders insist that all their demands must be accepted and implemented.

Chhattisgarh health workers say they deliver services in hard-to-reach villages that permanent workers do not service, yet have no job security or pay parity.

Precarious national workforce

The unrest in Chhattisgarh highlights a paradox: India has rapidly expanded its health workforce in recent years, but much of this growth rests on insecure contracts.

Between 2021 and 2024, more than 1.2 million professionals – including medical officers, specialists, nurses and public health managers – have been inducted nationwide under NHM, according to official data. 

The number of community health officers alone rose from 90,740 in 2021–22 financial year to more than 138,000 by 2023–24.

“Yet we continue to work without security or parity,” Sinha said. “Our services are treated as dispensable, even though the system cannot function without us.”

Similar grievances have flared across India. Earlier this year, NHM staff in Maharashtra staged protests after going without pay for three months. Workers in Bihar, Uttar Pradesh and Madhya Pradesh have launched strikes over delayed wages in the last few years , lack of insurance coverage, and stalled promises of regularisation.

Health policy analysts warn that the over-reliance on contractual staff is not just a labour issue but a systemic risk.

“Primary health care in India is essentially running on precarious contracts,” Ankita Verma, a Delhi-based public health researcher told Health Policy Watch. “When those workers withdraw, the entire rural delivery chain collapses.”

The situation is particularly critical in Chhattisgarh, where tribal populations in remote forested areas depend almost entirely on NHM workers for services ranging from maternal health to malaria control. Prolonged disruptions, experts say, could roll back years of progress in child immunisation and communicable disease surveillance.

Chhattisgarh health workers are sticking to their 10 demands.

Global temporary worker crisis

The crisis in Chhattisgarh is not unique. Around the world, governments have leaned on temporary or flexible contracts to stretch health budgets and scale up ambitious programs, often with similar results.

In Kenya, nurses employed under the Universal Health Coverage (UHC) programme in coastal counties have staged repeated strikes over short-term contracts, unpaid allowances, and lack of permanent status. 

Workers in the Kenyan towns of Mombasa, Kilifi, Kwale, Lamu, Tana River, and Taita Taveta demanded conversion to permanent and pensionable terms, arguing that constant uncertainty undermines service delivery.

In Nigeria, doctors in public hospitals walked out in September 2025 over unpaid salaries, wage arrears, and insecure postings. The strikes disrupted services in Abuja and other cities, adding pressure to an already strained system.

Labour analysts say these parallel struggles expose a global fault line. “The pandemic briefly highlighted the indispensability of frontline health workers,” said a global labour rights advocate while talking to Health Policy Watch. “But once the emergency faded, many governments reverted to treating them as expendable.”

Health toll mounts

For now, the standoff shows little sign of resolution. Health workers say they will not return to work unless their demands are met, while the government has so far doubled down by dismissing union members.

But the human toll is mounting. If the condition persists in the districts, people  may have to walk miles to private clinics and pay for services. Pregnant women in rural areas have to be referred to distant hospitals, often beyond their means to reach.

The state, in the centre-east of India, has a tropical climate that is one of the most climate-vulnerable states, experiencing extreme weather events,  including floods, heatwaves and droughts, according to the India’s Ministry of Health and Social Welfare. 

“Chhattisgarh is a state with the highest mines and mineral-based industries and air pollution is one of the biggest threats to the health of the population,” according to the Ministry. Heavy metal contamination of the soil is also a problem.

Malaria and dengue are prevalent in the hilly north and south, while other zoonotic diseases are increasing due to climate change.

Health advocates warn that if the strike drags on, Chhattisgarh could see rising maternal and infant mortality rates, surges in preventable diseases, and widening inequities in care.

“This isn’t just about wages,” said Verma, the Delhi-based public health researcher Verma. “It’s about the sustainability of India’s healthcare model.”

Test case for India 

The crisis poses a test not just for Chhattisgarh but for India’s approach to public health delivery. Can the country sustain an expanding workforce without offering stability and parity? Or will repeated cycles of protest and disruption continue to erode public confidence?

Globally, the lessons from Chhattisgarh may be equally pressing. As governments grapple with growing health burdens, many have opted for contract-heavy models that prioritise flexibility and cost-saving. But the fragility of such systems becomes apparent the moment workers walk away.

For the health worker from Raipur, the issue is less abstract. “We don’t want to abandon our patients,” she said. “But if the government treats us as disposable, how long can we keep going?”

Image Credits: Chhattisgarh Pradesh NHM Karamchari Sangh.

A happy homeowner with her cleaner cooking stove.

NAIROBI, Kenya – The morning light filters into Alice Siamanta’s home in Nalepo on the outskirts of Nairobi. Her kitchen walls are clean, her pots shine, and free of soot. Her children are busy doing their homework, seated near her. 

The house is quiet. There is no coughing. Siamanta cooks on a stove purchased through her savings in a women’s savings group.

“I never believed cooking could be this easy,” she says, smiling while lifting a pot of simmering beans. “No more tears in my eyes, no black smoke.”

In a neighbouring tin-roofed home in Nalepo, 36-year-old Mary Nasieku used to crouch over a three-stone fire. Smoke curling around her, stinging her eyes as she fanned the flames beneath a pot of maize and beans. The acrid haze clung to her hair, her clothes, and her lungs. 

“My mother cooked like this, my grandmother too,” she said. “We never thought the smoke could kill us.”

Millions of Kenyans are still trapped in smoky kitchens where poverty and tradition keep families tied to firewood. But it comes at a cost: the hidden danger of household air pollution is a silent, daily assault on their health.

Deadly indoor pollution

Indoor air pollution is a global killer. ­It is one of the world’s least discussed but deadliest health risks. According to the World Health Organization (WHO), it causes 3.2 million premature deaths every year, mainly from pneumonia, chronic obstructive pulmonary disease (COPD), heart disease, and lung cancer. Some  3.2 million people die every year from exposure to household smoke, including over 237,000 children under five.

In Kenya, research based on the Global Burden of Disease (GBD) study estimates that around 23,000 people die annually from household air pollution, making it the eighth leading cause of premature death nationally.

This is more than outdoor air pollution. The youngest are most vulnerable: pneumonia remains the leading killer of children under five.

The culprit is familiar: household use of solid fuels such as wood, charcoal, dung, and crop residues, burned in open fires or inefficient stoves. 

A three-stone kitchen in Kenya

In Kenya, about 70% of households still cook with these fuels, according to World Bank data.

In rural and peri-urban communities like Kibiko and Nalepo, kitchens are often poorly ventilated. The smoke levels inside can reach 10 times higher than the WHO’s recommended safe limits for fine particulate matter (PM2.5). 

Kajiado County records respiratory diseases as among the top outpatient cases, according to Kenya’s Ministry of Health.. 

Kenya Medical Research Institute (KEMRI) scientists have linked prolonged smoke exposure to heightened risks of acute respiratory infections in children and chronic respiratory disease in adults. 

Wesley Mochama, a nurse at Oletepes Health Centre, sees the toll daily: “Children come in with persistent coughs and wheezing. Mothers suffer from headaches and burning eyes. Almost every time, the root cause is the same – smoky kitchens.”

Women and children worst affected

Indoor air pollution is not an equal-opportunity killer. Women and children bear the heaviest burden. Women like Nasieku spend long hours each day tending fires in kitchens that double as smoke chambers. 

Children, often strapped to their mothers’ backs or playing nearby, breathe in the same toxic air. Studies show children under five are at the highest risk of pneumonia from indoor smoke. The economic burden is also gendered. Women lose time collecting fuel, and families spend money on hospital visits that could have been prevented.  

The energy poverty trapping women in smoky kitchens also perpetuates cycles of poor health, missed school days for children, and lost productivity for families.

Smoke and soot from the three-stone cooking stove affect the health of residents.

Despite the risks, a slow transformation is underway in Nalepo and Kibiko.  A handful of households have shifted from three-stone fires to clean cooking stoves, a simple innovation that burns fuel more efficiently and produces far less smoke.

The difference is visible. Kitchens once blackened by soot now have clearer walls, mothers no longer cook with streaming eyes, and children cough less. Families are also saving money on firewood. Yet adoption remains stubbornly low.                       

The barriers are complex: affordability, durability concerns, and cultural habits. For stable foods like ugali and githeri, many believe only a three-stone fire achieves the right taste and consistency.

Solutions are within reach

According to the Ministry of Energy’s Bioenergy Strategy (2021–2027), only a small percentage of rural households have transitioned to modern cooking solutions. 

The government’s goal is to reach universal access to clean cooking by 2030, but progress is slow, hampered by cost, infrastructure gaps, and cultural resistance.

Kenya’s Ministry of Energy and Petroleum launched the National LPG Expansion Programme, known as the Mwananchi Gas Project, aiming to give free 6 kg gas cylinders and burners to low-income families, a bold recognition that clean cooking is both a health and energy imperative. 

Schools are also being transitioned from firewood to LPG, reducing deforestation and protecting health.

The government’s Last Mile Connectivity Project, backed by the African Development Bank, is delivering over 150,000 new rural electricity connections in 45 counties.

Within it, the Kenya Electric Cooking Market Development Initiative (KEMDI) aims to expand Electric Cooking from 49,000 to 500,000 users in three years, subsidising electric pressure cookers and induction stoves. 

Kenya Power is piloting 47,000 subsidised cookers in Kiambu, Machakos, and Kajiado — cutting household reliance on biomass.

Complementing this, the Green Entrepreneurship and Empowerment Program (GEEP) supports youth-led enterprises in clean energy, focusing on solar lights and improved cooking stoves.

Last-mile entrepreneurship

The Naserian Women Group’s last mile entrepreneurs promote cleaner stoves to their communities.

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) Kenya is a central player in the country’s clean cooking transition, aligning its work with the Kenya National Cooking Transition Strategy (KNCTS), which targets universal access by 2028. Beyond simply distributing stoves, GIZ is strengthening the ecosystem needed to sustain long-term adoption.

“We are not only distributing stoves but building a clean cooking sector, strengthening supply chains, financing, and awareness. Clean cooking is about dignity, climate resilience, and creating jobs,” says Venice Makori of GIZ Kenya.

GIZ has also flagged last-mile entrepreneurship projects, training women and youth to become clean energy champions and distributors in their villages. These initiatives are supported by innovative financing tools, including results-based financing (RBF), carbon credit schemes, and partnerships with county governments.

“Last-mile entrepreneurs are the backbone of the clean cooking transition,” says Ezekiel Moseri, a clean cooking expert at GIZ.

“They are the ones who reach the villages, explain how the stoves work, and build trust with households. Without them, even the best technology will remain in shops in Nairobi. 

“We are investing in women and youth at the community level, helping them become distributors and technicians, so that clean stoves are not just available, but truly accessible.” 

At the policy level, GIZ provides technical advice to the Ministry of Energy and supports Kenya’s participation in global climate initiatives. 

“Clean cooking is not just about health – it’s about livelihoods, dignity, and climate resilience,” Moseri says.

Subsidies and microfinance

Officials from the Ministry of Energy and GIZ officials launching trucks and tuktuks to support the clean cooking project.

According to experts from the Ministry of Energy and GIZ Kenya, other solutions include subsidies and microfinance, facilitated through Savings and Credit Cooperative Organisations and women’s groups. 

These financing options can make stoves accessible through pay-as-you-go models, loans, or community savings groups.

Some of the pathways to clean cooking in Kenya include cultural adaptation to provide stove designs that align with traditional cooking.

Community-led education, especially through community health workers, can also raise awareness of smoke-related risks, improve trust, and increase people’s willingness to adopt clean stoves.

The government of Kenya could integrate clean cooking into national health and energy priorities to reduce disease burden and support global Sustainable Development Goals (SDGs) relating to health, gender equity, clean energy and climate action.

The government could also offer subsidies and tax incentives to lower household barriers.

Finally, donor-driven models involving results-based financing, carbon credits, and last-mile entrepreneurship could make clean stoves affordable, strengthen supply chains, and support sustainability.

‘Smoke doesn’t have to be part of our lives’

The clean cooking projects stove still uses firewood, but it lasts longer and smoke is channelled out of the house.

This is not just a local crisis; it is a global one. The women of Kibiko and Nalepo in Kenya represent millions worldwide who continue to cook in smoky kitchens. 

Naomi Parpai, 38, a mother of six in Kibiko who has been using a three-stone fire, says it has been affecting her.

“Every day, I cough. My chest feels heavy. I thought it was just dust. Then I learnt it’s the smoke. But what choice do I have? We use what we can find: wood, sometimes maize cobs.”

Her 12-year-old son can’t do homework because the smoke burns his eyes. Sometimes it forces him outside, even when it is raining.

Parpai’s neighbour, Beatrice Mpeti, says her last born child was infected with pneumonia. She now feels helpless.

Back in Nalepo, Nasieku reflected: “The smoke has always been part of our lives. But maybe it doesn’t have to be.”

Nasieku’s neighbour told her how she was able to buy an improved cookstove through a local women’s savings group. It was a basic model — a rocket stove — priced at KES 2,500, paid in three monthly installments.

“Her kitchen has no black soot anymore,” Nasieku observes. “She said her firewood now lasts twice as long.”

Encouraged, Nasieku joined the Naserian Women Group, a community-based organization that partners with GIZ Kenya and the Clean Cooking Alliance to distribute affordable stoves and make briquettes from farm waste. 

Through a pay-as-you-go model, Nasieku also received her own improved stove within weeks.

“It felt strange at first. But my eyes don’t sting any more, and my children stopped coughing at night,” she says. “I use half the firewood now, and spend less time gathering it,” she said.

Health and energy goals

Since Alice Siamanta started cooking with gas, her house is smoke-free and her children have stopped coughing.

Change is possible. You can see it in homes where clean stoves have been adopted, healthier families, brighter kitchens, and empowered women. But for that change to reach everyone, it will take sustained effort, affordable access, and the belief that no meal should come at the cost of someone’s lungs. 

The smoke may be an old companion in these kitchens, but the community is ready to leave it behind. The question is whether the rest of us policymakers, innovators, donors, and citizens will help clear the air.

Siamanta’s children, doing homework beside her smoke-free stove, represent a brighter future. The battle against household air pollution is about more than clean kitchens. It’s about health, dignity, gender equality, and climate resilience.

The clean cooking stove isn’t just a metal object — it’s a tool of empowerment, a health intervention, and an economic equaliser. Women save time, protect their health, and gain control over household energy decisions.

But for this transformation to reach everyone, barriers like cost, credit access, and cultural beliefs must be addressed systematically.

Global struggle 

Kenya isn’t alone in tackling smoky kitchens. In Ethiopia, a World Bank–backed program has supplied improved stoves to more than 10 million households.

Rwanda integrates clean cooking into its climate adaptation financing, linking every stoke to carbon accountability (Climate and Clean Air Coalition, 2021) 

Meanwhile, India’s Ujjwala Scheme distributed free LPG connections to over 80 million rural households, although many still struggle to afford refill costs.

In Kenya, tackling indoor air pollution aligns with national health goals, environmental sustainability, and gender equity. For the world, it contributes to climate commitments and the SDGs. It is also a question of justice. Why should women pay with their lungs to put food on the table?

But Kenya’s path to clean cooking needs stronger political will, better financing options, public-private partnerships, and grassroots innovation. Local women’s groups like Naserian are already leading the way by making fuel briquettes, promoting clean stoves, and organising group purchases of these stoves.

This story was produced as part of a collaboration between Health Policy Watch and the KEMRI Health Journalism Programme.

Image Credits: Ezekiel Moseri/ GIZ.

China’s Ambassador to Nigeria, Yu Dunhai, announcing the deal.

A deal with China will enable Nigeria to join Egypt and South Africa as a producer of insulin, the drug that is essential to control diabetes.

Diabetes is increasing exponentially on the continent, and is projected to affect almost 60 million people by 2050 – a massive increase from the 2.5 million estimated cases in 2000.

The memorandum of understanding between Nigeria’s National Biotechnology Research and Development Agency (NBRDA) and Shanghai Haiqi Industrial Company Limited of China was announced last week.

“Chinese companies are in talks with Nigeria to build Africa’s first local insulin production facility, potentially ending Nigeria’s reliance on imported insulin and positioning it as a hub for African biotechnology,” Chinese Ambassador to Nigeria Yu Dunhai said.

However, two other African countries are already making insulin. Egypt’s EVA Pharma began producing insulin in 2024 in partnership with Eli Lilly, which supplied the active pharmaceutical ingredients (API) at reduced cost alongside free technology transfer. 

This has enabled EVA Pharma to formulate, fill and finish insulin vials and cartridges aimed at low- and middle income countries (LMICs).  

The local insulin, called glargine, received regulatory approval from the Egyptian Drug Authority in December 2024.

“Less than two years after the initial announcement, EVA Pharma has completed a new biologics manufacturing facility, finalized insulin formulations and stability testing processes, engaged with the local regulatory authorities to obtain approval of the insulin glargine injection, and released the first batch of the locally manufactured insulin drug product,” the company announced at the time. 

Meanwhile, the South African generic company Aspen signed a deal with Danish company Novo Nordisk to fill-and-finish insulin vials, although details of the deal are not public.

However, Novo Nordisk and Sanofi are facing investigation in South Africa after the for anti-competitive activity in the insulin pen market. This follows the refusal of Novo Nordisk, Sanofi and Eli Lily, which produce 90% of insulin pens on the continent, to tender to supply the South African government with insulin pens. 

 

Recruiting semi-nomadic people from West Pokot, Kenya, in a clinical trial meant those running the trial needed to know where to find them when they went in search of water and grazing for their animals.

Engaging people from a nomadic community in rural Kenya in a clinical trial involved employing community mobilisers on motorbikes and understanding seasonal and cultural practices.

Geographic touchpoints such as waterholes and schools were mapped as places to find trial participants as they searched for grazing and water for their cattle and goats.

This was a lot of work, but for Luke Kanyangareng, a nurse based in rural West Pokot, adjacent to the Ugandan border, the community is the main stakeholder in clinical trials.

“Clinical trials are about getting a solution to their health problems, so we need to recruit and keep rural patients in the trial,” said Kanyangareng, who recently won an international award for his role as a patient advocate.

“Understanding their life setup is also very important, because when you are doing recruitment, you should know where this patient is coming from, and where you expect to find this patient at different seasons of the year.” 

Kanyangareng was addressing a September 16 webinar on patient and community engagement in clinical trials.  The webinar, hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  was the first such event in a series of four, comprising this year’s African Regulatory Conference.  The online conference focused on advancing the clinical research ecosystem continues this autumn until 25 November. 

‘Not optional’

Dr Tariro Makadzange

Dr Tariro Makadzange, the CEO of the Africa Clinical Research Network, described community engagement in clinical trials as “fundamental not optional”. 

“Africa has not been a key player in clinical trials. We currently only participate in 3% of global trials, and yet, we’re 18% of the global population,” said Makadzange.

The Africa Centres for Disease Control and Prevention (Africa CDC) is trying to improve this statistic, according to Dr Mosoka Fallah, acting director of the body’s Science and Innovation Directorate.

“Africa is very vulnerable to disease outbreaks due to the fact that our research and development (R&D) capacity is very limited,” said Fallah. “We have developed a clinical trial R&D blueprint, working along with many other partners.”

Dr Janet Byaruhanga, from the African Union’s development agency, AUDA-Nepad, spearheads a programme aimed at ensuring the continent can produce certain priority medical products by 2050???

“The Pharmaceutical Manufacturing Plan for Africa is the blueprint for advancing local capabilities on the continent to produce medicines for the diseases of concern,” said Byaruhanga.

“We have prioritised a list of 24 medical products that we want the continent to be self-reliant in producing,” she added, engaging in a product-by-product approach.

Producing paediatric Praziquantel to treat schistosomiasis and medicines to address post-partum bleeding in women after birth are some of the priorities.

“We support the member states and the regional economic communities to create an enabling environment for the manufacture of these producta, and provide advisory services to industry.

“It will be very important for us to ensure that our community health care programme is linked with the local manufacturing programme to engage communities,” she added.

‘People First’ approach

Joy Malongo is the access manager at Drugs for Neglected Diseases Initiative (DNDi), the non-profit organisation that develops affordable treatments for neglected tropical diseases (NTDs), particularly for marginalised communities. 

DNDi’s approach involves “systemic community engagement” across all R&D phases, guided by a “people first” approach, said Malongo.

“Patient and community engagement helps identify and respond to barriers faced by marginalised groups, encourages a team approach that reduces disparities in access and outcomes, and empowers communities to advocate for their health rights.”

Norest Beta, the coordinator of clinical trials and community engagement at Africa Clinical Research Network, says communities need time to “understand, process and accept” clinical research. 

“Rather than rush engagement, we need to give them time to ask questions, question the research agenda, and hold us accountable,” said Beta.

But, as Waila Mukulu from Science for Africa Foundation says, theer often isn’t the budget to engage with communities.

“When there’s a need to cut down on the budget, community engagement activities are usually the first ones to go because there’s a feeling that the interest is the science,” said Makulu.

“We really emphasize to our researchers that it is important to ensure that we are actually meeting the needs of the African continent in whatever we are doing, and you will only be able to do this if you engage communities meaningfully and ensure that any research that we are conducting, is actually a reflection of their needs and priorities.”

Early engagement

Dr Huwaida Bulhan, scientific operations lead at Roche, said that patient and community engagement is” embedded throughout the clinical journey” at her company.

“We’re really engaged with patients and patient advocacy groups right from the study design stage,” said Bulhan, who also represented the IFPMA at the webinar.

“They advise us on endpoints that actually matter to patients”, said Bulhan, including how to make trial procedures less burdensome, especially for under-represented groups like women and young people. 

“Decentralised trials, hybrid trial models, and digital tools have worked very well in sub-Saharan Africa, with practical support like transport, care conditions and flexible scheduling for patients,” she added.

Dr Huwaida Bulhan

“We work very closely with local patient organisations, healthcare providers and community leaders, and these trusted networks help us understand the cultural context, how to reduce stigma, and how to create the right engagement strategies that resonate with people where they are.”

Roche also invests in health literacy for patients and healthcare providers to demystify clinical trials.

“We look at community engagement as a long-term commitment that does not stop when the trial ends,” Bulhan stressed.

“We share trial results with participants and communities where we’re able to do so. We also work to ensure that patients can access the innovations that emerge from this research. 

“The research is not effective if it’s not actually reaching the patients who need them,” added Bulhan.

“It really is about moving from that transactional relationship that a lot of people have in mind when they think of private industry, to a long term partnership that is rooted in trust and shared benefit.

“Patient and community engagement is what transforms clinical research from being about data collection to being about people, and when we do it well, then everyone benefits. Patients feel respected and communities see the lasting value of everything that we do.”

The IFPMA is hosting a four-part Africa Regulatory Conference webinar series from September to November 2025 that is open to all who are interested. The next webinar, on 2 October, deals with underrepresented populations in clinical trials.

Image Credits: UNFPA.

WHO Headquarters in Geneva where planned staff cuts are the focus of significant unrest.

Staff unrest at the World Health Organization’s Geneva headquarters reached a new milestone this week, as the WHO Staff Association (HQSA) adopted three resolutions challenging the fairness and legitimacy of the Organization’s ongoing restructuring process, which has already led to post abolitions, reassignments, and widespread anxiety.

In two meetings, Monday and Friday, attended by some 800 members of Geneva’s WHO staff, members expressed a vote of “no confidence” in the downsizing process, endorsing demands for greater transparency.  Key components of the demands call upon WHO senior management to:

  • Disclose all criteria and decision-making logic used in departmental staff cuts, including pre- and post department structures;
  • Freeze abolitions and recruitments tied to the restructuring pending independent review;
  • Launch an independent review within four weeks with meaningful staff participation; 
  • Issue a savings and impact statement showing what has been cut, what has been protected, and where further efficiencies are expected.
  • Report corrective actions not just to staff but also to Member States.

WHO is in the process of eliminating some 600 jobs at its Geneva headquarters, where nearly  2,800 people were employed as of June 2025, as part of a restructuring triggered by the withdrawal of United States funding for the global health agency in January. The withdrawal of the US, WHO’s largest donor, has left a massive $1.7 billion hole in the upcoming 2026-2027 budget cycle. WHO’s worldwide workforce is set to be trimmed by about  20% down to 7,525 staff from 9,463 as of December 2024.

Vote of No Confidence

The Friday meeting of the “Extraordinary General Assembly” (EGA) carried a motion of no confidence in the prioritization exercise and review process (ARC) of the cutbacks, citing widespread reports from staff, HR insiders, and even some directors that the process was “fundamentally unfair and flawed,” with evidence of both of inconsistencies as well as allegations that the abolition of posts, in some cases, was used as a retaliatory measure against staff who had previously acted as whistleblowers. 

The final text  sidestepped criticism of elected Staff Association representatives themselves, who have also come under fire for allegedly failing to defend staff interests more assertively throughout the restructuring process, which began at staff level in June.  

Freeze on Abolitions and Recruitment

Another measure approved called on the WHO administration to temporarily freeze further post abolitions/discontinuations and new recruitments directly linked to the prioritization exercise “until completion of an independent review” within four weeks time. Supporters argued this measure was essential to prevent further damage before an independent review could be conducted, overriding concerns by some critics that freezing action indefinitely could worsen WHO’s financial crisis and obstruct urgent recruitment.

Independent Review

Finally, the Staff Association called upon WHO management to urgently establish an independent review of the process and its outcomes, with direct engagement of staff, to document issues of concern and present proposed corrective actions to staff, administration and Member States.

The resolution calls for a tight, four-week deadline for  the review, which could be conducted by an external body such as the International Labour Organization, which maintains a judicial process for individual staff-administration disputes, or  by an internal panel with staff-elected members, insiders suggested.

A fourth resolution, which would have authorized collective legal action challenging the restructuring, was deferred due to the fact that collective staff appeals have limited standing before the ILO Administrative Tribunal, whose purview mainly involves the review of individual staff-management disputes. 

Broader Implications

Together, the Assembly resolutions have poised  the Staff Association to play a more assertive role in the WHO downsizing process.  However,  it remains to be seen how WHO’s senior management might respond to demands by the group, which has never gone on strike and typically remained in the shadows of major WHO management moves.  Health Policy Watch could not reach a WHO spokesperson by the time of publication.  

For WHO, already facing a US$1.7 billion budget shortfall after the withdrawal of major donor funding, the challenge is acute. Leadership must balance cost-cutting imperatives with credibility, fairness, and staff morale. Headquartered in Geneva, WHO’s staff there is in the eye of the storm. 

A Call for Deeper Reform

Speaking to Health Policy Watch on condition of anonymity, staff members stressed that the criticism over the downsizing goes beyond budgetary pressures.

The process has exposed patterns of favoritism that risk creating an opaque, top-heavy structure that sacrifices more vulnerable junior and temporary staff disproportionately.

The process has also exposed structural gaps in WHO’s internal justice system and the absence of a truly independent mechanism to hold senior leadership accountable. 

“Moving forward, real accountability requires strengthening the internal justice system, with clear protections against retaliation for staff who speak out,” one staff member said. “This is not just an HR quarrel—it is a governance crisis,” echoed another staff member.

 “WHO staff are international civil servants, bound by an oath to act solely in the Organization’s interest, and management is bound to transparent, rule-based administration confirmed by the Executive Board. 

“When prioritization and realignment sever core public health functions without clear criteria; when decision review files, organigrams, and rationales are withheld; when decisions are perceived to be personalized rather than principled, the problem isn’t morale—it’s legality and legitimacy.”

Said another: “By adopting these resolutions, staff have sent a unified signal: austerity cannot override fairness, transparency, and due process. For an organization tasked with setting global standards, staff reminded management that those standards must begin at home.

“The coming four weeks will be decisive. If leadership implements the freeze, commissions a credible independent review, and engages staff meaningfully, trust may be restored. If not, the Organization risks deepening mistrust — with consequences not just for staff morale, but for the credibility of WHO’s governance itself.”

Image Credits: WHO .

Panelists  Nick Banatvala, Sean Maguire, Barbara Hoffmann, and Kjeld Hansen at the Lung Health Matters side event.

NEW YORK – Although chronic respiratory diseases (CRDs) are the third leading cause of death globally, there remains a ‘mismatch’ between impact and action, said a group of global health leaders and experts on the sidelines of the 80th UN General Assembly.

“There is a mismatch between the disease [impact] from CRD and the action against it. CRD lags behind in awareness and attention, and so far, we don’t have any specific targets,” said Barbara Hoffmann, Chair of the European Respiratory Society (ERS) Advocacy Council, at the event Wednesday, Lung Health Matters – Accelerating Progress towards UN NCD targets.”  

The high-level side event, sponsored by the Permanent Mission of Malaysia and the Government of Romania, focused on the enormous societal costs of CRDs and their main risk factors, and actions that can be taken to prioritize lung health and preventative measures, through political commitment, resource mobilization, and greater integration of lung health issues into environmental policies. 

Some of the most common CRDs are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.

“Lung health is absolutely essential to personal well being. It’s essential for our economies and for our ability to thrive as societies,” said Hoffmann.  In the WHO European Region, which includes some 53 nations extending from the British Isles to Central Asia and Russia, CRDs are the sixth leading cause of death.

Unveiling the Political Declaration on NCDs 

The event came on the eve of the Fourth UN High-Level Meeting on Noncommunicable Diseases (NCDs), where the United States blocked the consensus approval of a new Political Declaration for the Prevention and Control of NCDs, despite overwhelming approval by almost all other UN member states. The  declaration will now be brought for a vote in the UN General Assembly in October. See related story:

BREAKING: UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus

Taking the long view, the lung health experts who gathered also noted the ‘missed opportunities’ within the declaration, especially in regards to respiratory health and air pollution. 

“While there are things to celebrate in the declaration, there’s also actually quite a lot of missed opportunities in that document. It’s not as strong as it could be, or it should be, around the challenges that air pollution presents to health and in particular, particular to respiratory health,” said Sean Maguire, Executive Director of Strategic Partnerships of the Clean Air Fund. 

In particular, Maguire called out the absence in the declaration of any reference to fossil fuels as a leading air pollution source. Nearly one-half of all deaths from COPD and 19% of deaths from lung cancer are attributable to air pollution exposures,  according to the latest Global Burden of Disease data from the Seattle-based Institute of Health Metrics and Evaluation. 

Deaths from lung diseases attributable to environmental risks (including but not only air pollution) as compared to behavioural and metabolic risks.

“Burning fossil fuels is really at the heart of what causes so much air pollution. So unless we’re honest about the challenges, we’re not going to succeed. We’re not going to meet our SDG targets, and we’re not going to reduce the health work of air pollution.” 

Lack of Defined Targets for CRDs Despite Being Preventable and Manageable 

Barbara Hoffmann speaking on results from the WHO Europe-ERS Report into CRDs in the WHO European Region

In addition, unlike other major NCDs, CRDs lack robust global targets, both in the new political declaration as well as in WHO global action plans, which are essential to supporting country prioritization, measuring progress, and benchmarking. This includes the recent landmark resolution, “Promoting and prioritizing an integrated lung health approach,” which was formally adopted at the 78th World Health Assembly this past May.

The lack of defined targets for CRDs also means that governments may not assign it sufficient priority in national health planning. 

In comparison, there are five global diabetes targets, three global targets on hypertension control, targets for reducing the burden of several types of cancers and three targets tackling HIV/AIDS, through increased access to prevention, diagnostics, and treatment. 

“These CRDs are largely preventable and manageable, yet no specific targets have been formulated, and the action to prevent and match them remains weak,” she says, citing a recently released WHO European Region report on CRDs, co-developed with the Respiratory Society.  

The report recommends that countries consider adoption of national-level targets for COPD and asthma to ensure advocacy, implementation and progress monitoring at country, regional, and global level.

“There is a need for setting targets and for starting disease surveillance, and we need further actions, national plans, awareness raising and education. CRD is largely preventable and manageable, and we know how to do it, and can do something about it,” said Hoffmann. 

Bringing Lung Health to the Forefront in Malaysia 

Muhammed Radzi Jamuludin, the representative of Malaysia and Ambassador to Cuba

Malaysia is one such country that has been making concerted effort in the fight for better lung health, both locally and globally.

“Lung health must be a shared priority,” said Muhammed Radzi Jamaludin, the representative of Malaysia and Ambassador to Cuba, in his opening remarks. 

He highlighted the recent WHA resolution, “Promoting and prioritizing an integrated lung health approach,” which was co-sponsored by Malaysia, together with 15 other WHO member states, which calls for a comprehensive and forward-looking agenda to strengthen prevention, early diagnosis, treatment and control of lung diseases.

Malaysia has also launched the roadmap for the Lung Health Initiative 2025 – 2030, a holistic plan that covers various aspects of lung health, from prevention to treatment, and including palliative care and research. Other efforts to address lung health issues in the country also included nationwide awareness campaigns, stricter tobacco and vaping regulations, multi-sectoral collaboration to improve air quality, workplace safety, and enhancing screening/early detection.

Air pollution has multiple, cascading health impacts on children.

Jamaludin called on governments for even stronger commitments in order to accelerate progress and achieve UN NCD targets.  

“By firmly placing lung health within the global NCD and sustainable development agenda, we can reduce premature mortality, improve population health and build healthier and more resilient societies.” 

Stronger Governance for Multi-sectoral Action

Nick Banatvala, Head of the Secretariat for the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, also emphasized the need for lung health to be articulated at a national level, especially in development strategies, where multi-sectoral plans can be made. 

“[Lung health] now needs to be well articulated in national health and development strategies. I’m always pushing for development strategies, because that’s where I think we have a big opportunity, because so much of what we’re discussing requires action across a number of different sectors.”

However, this is easier said than done, and as it ‘becomes notoriously difficult to get action’ once other sectors are involved, says Banatvala, using the example of tobacco industry interference. 

The solution lies in stronger governance, he argues. 

“We need to take this political declaration back not to the Minister of Health, because they’ve heard it, but to parliamentarians and say, these are your communities. These are your people. You should be elected or fail to be elected, dependent on whether or not you are sorting out tobacco and air and health services and universal health coverage.” 

Investing in civil society and patient advocacy

Patients, those impacted by CRDs themselves, also need to become more involved in advocacy and policy debates in order to integrate lung health better into the NCD agenda, the experts agreed.

“Some of the best investment is investing in civil society organizations, in grassroots who can make their voice known, to try and get the voice of the patients,” Banatvala said.

Kjeld Hansen, Chair of the European Lung Foundation, spoke about his experiences working and advocating for patients with asthma and other CRDs as a person who himself has lived experience with lung disease. “I understood at that point that if I meet the right people with the right solutions, anything is actually possible,” he said. 

“Civil society actors will come together with the government to help set priorities on different issues. And once you hear it from your constituency, then it’s much harder to strike down the message afterwards. So I would say, bring them into the process.” 

Now the Real Work Begins 

José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases

While final UN approval of the political declaration will now be delayed for a few more weeks, it’s important to focus on the next stages in the process, ”when the resl will begin,” said José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases. 

“What matters now is implementation and advocacy at the national level, turning global commitments into cleaner air, into early diagnosis, into stronger primary care, into treatments for patients, for 650 million people affected by [CRDs].”

Patients impacted by CRDs must be at the heart of this work, “if we are to keep the momentum to ensure that patients see the change,” he emphasized. 

“Let us measure our progress not by the declarations adopted, but by the lives that will be extended and the dignity restored to patients everywhere.”

Image Credits: National Cancer Institute/Unsplash, Raisa Santos, Our World in Data, IHME.

People running
The World Health Organization sees physical activity as a “missed opportunity” in combatting non-communicable diseases.

The statistics are stark. Non-communicable diseases (NCDs), like heart disease, cancer, and diabetes, are responsible for a staggering 75% of non-pandemic deaths worldwide.

This isn’t just a challenge for high-income nations; it’s a crisis that hits low- and middle-income countries the hardest, where 85% of premature NCD deaths occur. It’s clear the traditional approach to healthcare isn’t enough. We need a new strategy, one that empowers individuals and strengthens health systems from the ground up.

This is the promise of self-care, a concept that is now rightfully at the center of the global health conversation. The World Health Organization (WHO) defines self-care as the ability of individuals, families, and communities to promote health, prevent disease, and manage illness. It’s a simple but powerful idea that focuses on empowering people to take an active role in their own health, from managing chronic conditions to getting vaccinated or using digital health tools to monitor blood pressure.

A smarter approach to health

United for Self-Care Coalition team at the sidelines of 80th UNGA.

At first glance, self-care might sound like an individual responsibility, but it’s a powerful public health strategy with benefits that ripple across entire societies. The “Health for All, by All” self-care manifesto launched by the United for Self-Care Coalition on the sidelines of United Nations General Assembly this week champions this very idea, aligning with the new 2025 UN Political Declaration on NCDs. The manifesto argues that by investing in self-care, we can make healthcare more accessible, more efficient, and more equitable.

Consider the potential impact. Self-care interventions can help 150 million more people gain control over their hypertension and help another 150 million more quit tobacco. The numbers aren’t just about saving lives; they’re also about saving healthcare systems from breaking under the strain. By empowering individuals to manage routine health needs, we can free up doctors and nurses to focus on more critical cases. This isn’t bypassing health systems; it’s strengthening them.

And the economic benefits are immense. We’re talking about billions of dollars in annual savings. By 2030, self-care interventions across the board could generate $179 billion in healthcare savings and free up 2.8 billion physician hours per year. In low- and middle-income countries, this could lead to $230 billion in potential gains, fundamentally changing the healthcare landscape.

Our call to action

Self-care isn’t a replacement for professional medical care. It’s an essential partner. It’s about creating a health ecosystem where people have the tools and knowledge to stay healthy, and where healthcare providers can use their expertise most effectively. The manifesto calls on policymakers and Member States to make this a reality by:

  • Providing dedicated investment in self-care infrastructure, including digital health tools, education campaigns, and equitable access to self-care products and tools, with a particular focus on women, youth, marginalized communities, and vulnerable populations.
  • Incentivizing self-care within financing models such as through value-based care, universal coverage schemes, and public-private partnerships.
  • Embedding self-care in health workforce planning allowing care teams to focus their expertise where it’s most needed, while individuals take more control over routine management.
  • Integrating self-care into primary care strategies enabling earlier intervention, better health outcomes, and reduced system strain.
  • Systematically involving patients and people with lived experience in designing, implementing, and evaluating self-care infrastructure, policies, products and tools.

The solutions are ready and realizable. Now is the time to embrace a new approach to global health – one that empowers us all to turn the tide on NCDs, together.

The United for Self-Care Coalition is a global alliance of like-minded organizations dedicated to the common goal: to achieve universal health coverage through codifying self-care as a critical component of the self-care continuum, particularly in the context of managing NCDs.

Image Credits: Gabin Vallet, United for Self-Care Coalition .