On the eve of the September UN Climate Action Summit, young women and men around the world mobilized by the millions and told global leaders: “You are failing us”.

They are right.

Global emissions are increasing.  Temperatures are rising.  The consequences for oceans, forests, weather patterns, biodiversity, food production, water, jobs and, ultimately, lives, are already dire — and set to get much worse.

Secretary General Antonio Guterres speaks at the opening ceremony of the 2019 Climate Action Summit.

The science is undeniable.  But in many places, people don’t need a chart or graph to understand the climate crisis.  They can simply look out the window.

Climate chaos is playing out in real time from California to the Caribbean, and from Africa to the Arctic and beyond.  Those who contributed least to the problem are suffering the most.

I have seen it with my own eyes from cyclone-battered Mozambique to the hurricane-devastated Bahamas to the rising seas of the South Pacific.

I called the Climate Action Summit to serve as a springboard to set us on the right path ahead of crucial 2020 deadlines established by the Paris Agreement on climate change.  And many leaders — from many countries and sectors — stepped up.

A broad coalition — not just governments and youth, but businesses, cities, investors and civil society — came together to move in the direction our world so desperately needs to avert climate catastrophe.

More than seventy countries committed to net zero carbon emissions by 2050, even if major emitters have not yet done so.  More than 100 cities did the same, including several of the world’s largest.

At least seventy countries announced their intention to boost their national plans under the Paris agreement by 2020.

Small Island States together committed to achieve carbon neutrality and to move to 100 per cent renewable energy by 2030.

Countries from Pakistan to Guatemala, Colombia to Nigeria, New Zealand to Barbados vowed to plant more than 11 billion trees.

More than 100 leaders in the private sector committed to accelerating their move into the green economy.

A group of the world’s largest asset-owners — responsible for directing more than $2 trillion — pledged to move to carbon-neutral investment portfolios by 2050.

This is in addition to a recent call by asset managers representing nearly half the world’s invested capital – some $34 trillion – for global leaders to put a meaningful price on carbon and phase out fossil fuel subsidies and thermal coal power worldwide.

The International Development Finance Club pledged to mobilize $1 trillion in clean energy funding by 2025 in 20 least developed countries.

One-third of the global banking sector signed up to align their businesses with the Paris agreement objectives and Sustainable Development Goals.

The Summit also showcased ways in which cities and global industries like shipping can achieve major reductions in emissions.  Initiatives to protect forests and safeguard water supplies were also highlighted.

These steps are all important — but they are not sufficient.

From the beginning, the Summit was designed to jolt the world and accelerate action on a wider scale.  It also served as a global stage for hard truths and to shine a light on those who are leading and those who are not.  Deniers or major emitters have nowhere to hide.

I will continue to encourage them to do much more at home and drive green economic solutions around the world.

Our planet needs action on a truly planetary scale.  That cannot be achieved overnight, and it cannot happen without the full engagement of those contributing most to the crisis.

If our world is to avoid the climate cliff, far more is needed to heed the call of science and cut greenhouse emissions by 45 percent by 2030; reach carbon neutrality by 2050; and limit temperature rise to 1.5 degrees by the end of the century.  That’s how we can secure the future of our world.

Too many countries still seem to be addicted to coal – even though cheaper, greener options are available already.  We need much more progress on carbon pricing, ensuring no new coal plants by 2020, and ending trillions of dollars in giveaways of hard-earned taxpayers’ money to a dying fossil fuel industry to boost hurricanes, spread tropical diseases, and heighten conflict.

At the same time, developed countries must fulfill their commitment to provide $100 billion a year from public and private sources by 2020 for mitigation and adaptation in developing countries.

And I will make sure that the commitments that countries, the private sector and local authorities have made are accounted for — starting in December at the UN Climate conference in Santiago, Chile. The UN is united in support of realizing these initiatives.

Climate change is the defining issue of our time.

Science tells us that on our current path, we face at least 3 degrees Celsius of global heating by the end of the century.  I will not be there, but my granddaughters will.

I refuse to be an accomplice in the destruction of their one and only home.

Young people, the UN – and a growing number of leaders from business, finance, government, and civil society – in short, many of us – are mobilizing and acting.

But we need many others to take climate action if we are to succeed.

We have a long way to go. But the movement has begun.

_________________________________________

António Guterres is Secretary-General of the United Nations.

 

This article appears as part of the Health Policy Watch partnership with Covering Climate Now, a global collaboration of more than 300 news outlets to strengthen coverage of the climate story.  

 

Image Credits: UN Photo/Ariana Lindquist.

Bad Hofgastein, Austria – Malta is working with Italy and 8 other European countries to lay the groundwork for a formal European Union framework in which members could voluntarily share information about medicines prices, in order to advance more coherent pricing policies in regional markets, Malta’s Deputy Prime Minister and Health Minister said on Wednesday.

The 10 countries of the so-called “Valletta Group” are among the first worldwide to band together on practical steps to implement the aims of the landmark World Health Assembly resolution approved in May, calling for greater price transparency in medicines markets.

Christopher Fearne, Malta’s Deputy Prime Minister and Health Minister, said he expects Croatia, another member of the Valletta Group, to put the issue on the agenda of the European Employment, Social Policy, Health and Consumer Affairs Council [EPSCO] sometime next year, after it assumes the EU presidency.

Fearne spoke to Health Policy Watch following Wednesday’s opening session of the 2019 European Health Forum – Gastein, where he delivered a keynote address at this year’s opening session. Under the banner “a healthy dose of disruption” the Forum is focusing on new policies, digital technologies, research and advocacy, which have the potential to positively transform health systems.

“What we would like to do is to bring this on the agenda of the European Health Council [EPSCO] next year,” Fearne said.

Christopher Fearne, Malta’s Deputy Prime Minister and Health Minister

The Valletta Group process is being followed closely both by countries outside of Europe as well as by civil society advocates, to see if the group can formulate a model for practical implementation of the ambitious WHA resolution that others could follow.

Fearne said that the first step for the Valletta group would likely be an agreement to confidentially share information on the prices that they pay for medicines and other health products, so as to begin building trust towards collective negotiations on regional prices for bulk purchases.

Malta hosted a ministerial meeting of the Valletta Group in July, which mandated a group of technical experts to come back to the ministers with a firm proposal for moving ahead on a collaborative framework for price information-sharing, which could also be advanced before the European Health Council.

The group is named after a 2017 Valletta Declaration, in which the countries first agreed to work together to leverage reduced drug prices from industry.  Representing some 160 million citizens, the group of ten countries also includes Ireland, Portugal, Spain, Cyprus, Greece, Slovenia, and Romania, along with Malta, Croatia and Italy.

Italy, the lead sponsor of the WHA resolution, recently enacted its own national legislation stipulating that prices must be disclosed for any new bulk purchases of medicine made.

But Fearne stressed that a European legal framework is needed to empower countries to buck the non-disclosure agreements that are the standard of practice now, and which critics say have led to large disparities in prices paid for the same drug in neighbouring European countries.

“One country is paying 15 000 Euros and another country can’t pay 100 000 Euros. Why can’t we all buy it at 15 000?  The company is still making money,” he said, adding that he was referring to a specific drug that Malta procures, but he could not cite the name due to the NDAs that are currently in place.

“The pharmaceutical companies, when they enter into agreements for procuring medicine, specifically state that you are not at liberty to publicize the price,” he added.

“They usually release the medicines first in countries where there is a high GDP, and so when they [publicly] reference the price, they are referencing the high end of the European market.”

The Valletta Group ministers are due to meet soon again in Rome, to consider the proposals of the technical group, and see if they can form a unified position to submit to the Health Council [EPSCO].

Fearne said that in his opinion, “the next step is to agree between us to share prices between us confidentially, not publicly.  That will enable us to start trusting each other, when we come together to negotiate jointly. So in our case, instead of having a market of half a million, the Valletta Group is made up of 163 million; if we negotiate collectively then we have a stronger bargaining power.

”But because we have always been told that we get the best prices, amongst us there are people who don’t believe that negotiating jointly is going to be beneficial. The only way to break this is to make prices known, and then we will realize the inevitable truth that most of us are paying very high prices.  Breaking this secrecy will allow member states to build trust and then will be able to negotiate jointly.”

Tobacco Control Research Group Receives European Health Leadership Award

In other events at the Gastein Forum, the Tobacco Control Research Group (TCRG) of the University of Bath, United Kingdom, was awarded a first-ever €10,000 European Health Leadership Award (EHLA).

This was the first year for the prize, sponsored by the Austrian Federal Ministry of Labour, Social Affairs, Health and Consumer Protection. A press release said the award was launched to “shine the spotlight on disruptive thinkers who are leading efforts to improve health outcomes across the EU.

TCRG, founded in 2007, was awarded the prize due to its global leadership in tobacco control research that leads to policy action, the Gastein Forum’s organizers said in a press release. The group’s Tobacco Tactics data base has exposed controversial tactics of the tobacco industry, including industry-supported tobacco smuggling to avoid taxes levied on the health-harmful product. The smuggling practices were the focus of two studies published in the BMJ journal, Tobacco Control, over the past year.

Bloomberg Philanthropies has made the Tobacco Control Research Group one of the leaders of an all-new $20 million global tobacco industry watchdog which aims to counter the negative influences of the tobacco industry on public health. The global partnership aims in particular to highlight tobacco industry activity across low- and middle-income countries.

(left-right) TCRG Director Anna Gilmore and Christopher Fearne

“Tobacco use is one of the most severe risk factors for non-communicable diseases – one of the biggest global health problems to date. The TCRG has made it their mandate to disrupt one of the most lucrative global industries by monitoring and investigating the industry’s influence on health behaviour and critically examining their public intention of reducing harm from tobacco,” said Anna Gilmore, TCRG director in a press release, “We are thrilled to be the proud recipients of the EHFG´s first European Health Leadership Award”.

The TCRG was chosen from six shortlisted candidates all of which were said to have  demonstrated unique and innovative ideas to challenge the status-quo of health in Europe.

Image Credits: European Health Forum Gastein, European Health Forum Gastein, European Health Forum Gastein.

Some 70% of all health needs can be addressed through primary health care systems based in local communities, and yet the bulk of the US $7.5 trillion spent on health each year goes towards funding care in secondary and tertiary hospital care, which people reach only after they are already very ill, leading to higher costs for governments and households.

This was a key message of World Health Organization Deputy Director General Zsuzsanna Jakab in an address Tuesday evening at the Graduate Institute of Geneva, where she spoke about the challenges facing health policymakers in making last week’s landmark UN Declaration on Universal Health Coverage (UHC) a reality.

“To many countries spend large parts of their health budget on managing diseases in hospitals -where the costs are higher and the outcomes can be worse – instead of preventing them at the primary health care level,” Jakab said.

More than half of the world’s population cannot access quality, affordable healthcare, through primary health care systems, and this is particularly true for preventive services, she said.

But by the time people reach a hospital, they require more expensive and intensive care, she pointed out. Catastrophic health expenses have pushed over 100 million people into extreme poverty, keeping both individuals and whole economies from thriving.

Last week’s landmark UHC declaration called on countries to increase primary health care spending by 1% of their GDP.

This additional investment is “not just a moral imperative, it’s an economic imperative,” Jakab said, “We must make a crucial shift – from a focus on treating the sick to a focus on protecting the healthy.“

She was sounding a battle cry that is sure to be echoed repeatedly over the coming months and years, as WHO seeks to convince member states as well as donors to finance the billions of dollars in spending annually that health economists say would be needed to attain the ambitious UHC goals.

1% Increase In Primary Health Care Financing, 60 Million Lives Saved

A 1% GDP increase in spending would infuse approximately US $200 billion a year into primary health services, which WHO estimates would contribute to saving over 60 million lives and addressing the shortfall of 18 million additional health workers needed to achieve UHC by 2030.

WHO Deputy-Director General, Zsuzsanna Jakab, said health financing for primary care is crucial to the long-term sustainability of health systems, so as to prevent non-communicable diseases (NCDs) such as cancer, cardiovascular and respiratory disease, and mental health disorders from occurring in the first place. These NCDs have become the leading causes of death around the world.

“With ageing populations and the rising tide of diseases that need long-term care, no country can afford simply to treat the people who turn up in its hospitals and clinics,” Jakab pointed out.

Countries that strengthen health spending on preventative and health promotions services, delivered through a primary health care platform, will “not only save lives, they will save money.” The same platform can also be used for integrating “siloed” global health funding from disease-focused programs, “making that money work harder.”

Investing in Innovative Global Health Solutions

Jakab’s reflections on Universal Health Coverage were made at the awards ceremony of the 2019 “Advancing Development Goals” Geneva Challenge, where five teams of young global health practitioners from five continents were awarded cash prizes ranging from CHF 2500 – 10000 for innovative health projects on research, policy and practice.

ReMedic – an integrative solution turning medicines’ excess into access – the brainchild of Asia’s team, won the first place prize of CHF 10000. The projects, selected and ranked by a panel of judges, all targeted key issues raised in the discussions around UHC, including: care for aging populations, access to essential medicines and safe water, and addressing the burden of non-communicable mental health disorders. The runner-ups were:

  • North America/Oceania: PEACE – Program for Elderly Adults with Cohabitation and Enrichment
  • Europe: RapidCare – strengthening health systems in an urbanizing world
  • Africa: Rural Water Filtration Kit – improving global health through safe drinking water
  • South America: Project Wanöpo – Improving mental health

An additional special prize, co-sponsored by the United Nations’ Sustainable Development Solutions Network, was granted to the project “Renewable Energy as the Game Changer in Rural Health Crisis: Bringing Advancement in Community-Based Healthcare Facilities in Remote Rural Areas of Indonesia”.

The contest was hosted by the Global Health Centre at the Graduate Institute in Geneva. Established and sponsored by the late Kofi Annan and Ambassador Jenö Staehelin, the contest aims to identify innovative and pragmatic graduate student projects that address key international issues. This year’s theme was identifying solutions to address issues in global health tied to social and economic development.

 

Image Credits: Ilona Kickbusch/Twitter.

Life expectancy increased to a historic peak of 68 years for men and 78 years for women in the Russian Federation in 2018 thanks in part to stringent alcohol regulations. A new study published by the World Health Organization’s European Regional Office found that alcohol regulations in the country reduced consumption by more than 40% and could be linked to declines seen in deaths from alcohol-related disorders, homicides, and transport accidents between 2003 to 2018.

“These results show that measures such as the introduction of monitoring systems, price increases and limited alcohol availability, work to save lives and health system costs”, said Carina Ferreira-Borges, from the Alcohol and Illicit Drugs programme at WHO Europe said in a press release.

During “Russia’s mortality crisis” of the 1990s and early 2000s, one out of every two young men died prematurely due to alcohol. The Russian Federation made key moves to regulate alcohol production and consumption between the early 1990s to 2011. The most effective reforms began in 2005/06, after reforms attempting to reduce the proportion of unrecorded or “illegal” alcohol were introduced. Individual behavior was targeted beginning in 2009, when Russia began implementing its first national strategy focused on reducing the harmful use of alcohol and alcohol dependence, which included strategies such as raising taxes on alcohol, introducing alcohol-free public spaces, and real-time tracking of alcohol production and sales.

As a result, alcohol poisoning mortality has dropped by 73% in men and 78% in women, morbidity from alcohol related psychosis has dropped by 64%, and mortality from alcohol-related liver diseases has decreased by 22% in men and 24% in women between 2003 to 2018. However, the report was unable to clearly measure the effect of alcohol regulations on the incidence of alcohol-related cancers, as cancer takes decades to develop and gains will only be seen years down the line if regulation continues.

Deaths attributable to alcohol-linked causes such as heart disease, traffic accidents, suicides and homicides also dropped between 2003 and 2017, with mortality due to heart disease and transport accidents slashed in half, and suicide and homicide deaths dropping by around 60% and 80% respectively.

While the report notes that other factors such as abrupt economic changes, malnutrition, smoking, and a deterioration of social services may have helped lead to the sharp decline in life expectancy observed in the early 1990s, alcohol regulation, or the lack thereof, has played a key role in the dramatic health changes in the Russian population.

Notably, the authors found that growth in life-expectancy flattened in 2015, when major alcohol regulations were temporarily discarded. Since 2016, Russian policy-makers have attempted to mainstream alcohol control into many health and development policies, recognizing its role as a key risk factor for a variety of poor health and socioeconomic outcomes.

Still, the analysis shows that alcohol consumption has stagnated at about 11-12 litres of pure ethanol per person per year, which remains one of the highest consumption levels worldwide. Tackling individual drinking behaviors remains a key challenge in the future.

Image Credits: Alcohol Policy Impact Case Study/WHO EURO.

Norway pledged to scale up their investments to NOK 2.020 billion (over US $220 million) to The Global Fund to Fight AIDS, Tuberculosis and Malaria over the next three years.

Norway joins other European donors such as Spain, Luxembourg, Ireland, Portugal, the United Kingdom, Switzerland, the European Commission, Germany, and Italy, who have stepped up their pledges ahead of the Global Fund’s Sixth Replenishment pledging conference next week, which will be hosted by French President Emmanuel Macron in Lyon.

“We must end the epidemics of HIV/AIDS, malaria and tuberculosis in our lifetimes. To this end, Norway will increase its contribution to the Global Fund to two billion twenty million Norwegian kroner by 2023,” Norway’s Prime Minister, Erna Solberg, said in a press release.

(left-right) ED of The Global Fund, Peter Sands; Norway’s PM, Erna Solberg

The commitment was announced at the Global Citizen festival in New York this past weekend.

The move was praised by Peter Sands, executive director of The Global Fund, who said, “Through global solidarity and effective partnerships like Norway’s, we will save millions of lives.” Norway is the 11th largest public donor to the Global Fund and gives the most on a per capita basis.

Norway, Ghana and Germany, initiated a project to bring together 12 agencies, including The Global Fund, to accelerate work towards the 2030 Sustainable Development Goal for “Good Health and Well-being.” This initiative was launched just last week at the 74th United Nations General Assembly.

The Global Fund has set a target for raising at least US$14 billion for the next three years, which will be used to fund its mission to “end the epidemics of HIV, tuberculosis and malaria.” As the Fund’s Sixth Replenishment pledging conference draws closer, stakeholders cautiously wait for the United States, which contributes about a third of the Fund’s budget, to announce whether they will be increasing their contributions like other donors.

So far, the Global Fund claims its partnership has saved over 32 million lives, and expanded access to key preventative services and treatments for HIV, Tuberculosis, and Malaria.

The Fund estimates that a successful Sixth Replenishment will go towards saving 16 million lives, slashing the mortality rate from HIV, TB, and malaria in half, and building stronger health systems by 2023. In addition, every US dollar invested in the Global Fund will have a return in broader economic gains of US$19.

 

The 2019 European Health Forum (Gastein) opens Wednesday under this year’s theme: “A Healthy Dose of Disruption.” The three-day Forum will explore ways in which Europe can transform health systems into levers of good health and well-being, guided by the aspirations of the recent UN declaration on Universal Health Coverage. Since its foundation in 1998, the Gastein conference has become a key annual event for the European region, bringing together, politicians, health policy decision-makers, civil society, and experts in the field of public health and healthcare. Francesca Colombo, head of the health division at the Organisation for Economic Co-Operation and Development (OECD) and a member of the Gastein Advisory Committee, explored with Health Policy Watch some of the key challenges that Europe faces, which the conference is tackling.

Francesca Colombo (Photo: OECD/Andrew Wheeler)

Health Policy Watch:  What are the biggest challenges Europe’s health systems will face in the upcoming years, and how well are they prepared to respond?

Francesca Colombo: Health challenges should be looked at within the broader context of mega trends affecting societies. Aging brings more demands for health care due to the growing number of people living with chronic conditions – requiring greater focus on prevention and primary health care. The number of retired people is rising rapidly, at the same time the working age population is shrinking – putting pressure on economic growth and on public spending on health, and long-term care in the coming years and decades.

New medical technologies add pressure to health spending, while health systems lag being other sectors in gains that could be obtained from leveraging digital data.  And there are rising levels of inequalities. Younger cohorts will not have all the benefits and opportunities as older cohorts, as younger people are no longer getting richer [than the previous generation]. There is generally less support for redistribution of resources in our society, with more tensions across generations.

We also have specific public health challenges, such as growing antimicrobial resistance and risk factors such as obesity – rates of adult obesity in OECD countries have increased over time and are now at 24%.

So, we see a complex environment for health systems. The challenge for the future is therefore to rethink the sustainability of the health system in this context, while placing people and patients much more prominently at the centre of health systems. There is a need to tackle the significant waste in the way we use resources – according to our work, 20% of health spending across OECD countries could be wasteful. We also need to invest more in public health. Fundamentally, health is about improving the health and well-being of individuals. And yet the health systems today are still focused on treating episodes of ill health. We measure what services are delivered and how much we are providing, rather than whether we are making a real difference to the lives and well-being of individuals. This must change.

HP-Watch: You mentioned that the ageing of Europe’s population puts pressure on economies, as well as healthcare systems. And indeed, the proportion of people age 65 or over is projected to increase from about 19.8% in 2018 to 29.1% by 2060. But aren’t there also opportunities that can be seized by health systems and the private sector in light of changing demographics?

Colombo: Ageing creates some economic challenges because there are fewer younger people to support a larger cohort of older people, who are retired.  Across the OECD, the median age of the population is projected to increase from 40 years today to 45 years in the mid-2050s, and the ratio of older people aged 65 and over to people of working age (15-64) is projected to rise from 1 in 4 in 2018 to 2 in 5 in 2050.

But if you can ensure that people remain healthy for longer and are able to work longer, this is not only good for people themselves, but they are also able to participate for longer in labour markets thereby easing this economic challenge. Evidence shows a strong relationship between ageing healthily and being able to work longer, with knock-on effect in terms of per capita contributions to GDP and growth. This also mitigates the growing cost of health and social care.  So, delaying the need for health and long-term care creates economic opportunities.

Healthy ageing requires addressing people’s health while they are still young – for example through strong prevention policies as well as addressing inequalities. Ageing experiences are very diverse, with some people being more fortunate than others. At all ages, people in bad health work less and earn less. And as inequalities across society grow – so is the risk that the chances of living a good life in old age will be unequally distributed. Presently, the average income of the richest 10% of the population is about nine times greater than that of the poorest 10% across the OECD, up from seven times greater 25 years ago.

Policies that look across the life course and consider the unequal experiences that individuals live throughout their lives will help to ensure that individuals can prolong being active and continue to participate in labour markets and in societies.

HP-Watch: The theme of Gastein this year is: “A healthy dose of disruption? Transformative change for health and societal well-being”. This echoes the 1948 WHO constitution, which described health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet many people still perceive well-being as more of a luxury than a necessary – what’s your take?

Colombo: I am not sure that I would agree that well-being is regarded as a luxury. There has been recent focus to look beyond GDP [gross domestic product], to measure more holistically societal progress from the perspective of well-being – is life getting better for individuals? Are individuals able to live a good quality of life?

If you take a well-being perspective, inevitably you need to place health within a broader context of issues that matter to people. This includes housing conditions, income and wealth, environmental quality, social connection and inclusion, level of education and skills, as well as health. These are not luxuries; they are all issues that are relevant at any stage of development of a country and for individuals from different socioeconomic status. We must therefore take a broader approach, which includes different dimensions of well-being as a means of understanding what progress is being made.

HP-Watch: How can you convince health systems to invest in well-being?  Do you have examples of best practice in Europe that you would like to cite?

Colombo: A first thing is to consider health in a broader context, as mentioned earlier. There is a two-way relationship between health and wider social and economic development. Not only do poor people tend to have worse health outcomes, but also if individuals have poor health, this damages their economic prospects throughout their life and adversely affects economic growth. Looking at these two-way relationships makes you realise how important it is to invest in wider determinants of health – including the environment, housing, the workplace, and lifestyles; and, at the same time, how health can contribute to more robust institutions and economic prospects. It is by focusing on these two-way relationships that we can make the wider case for talking about health and well-being. Unfortunately, public health and prevention budgets are often the first thing that is cut during times of fiscal constraints, despite that recognition.

Second, it is important to measure better both health and well-being – see for example the OECD Better Life Initiative and the work programme on Measuring Well-Being and Progress. Several countries have already taken steps to measure improvements in well-being. Belgium has developed its own sustainable development indicators. Italy has measures of equitable and sustainable well-being.  Sweden has developed new measures of well-being policy.  Outside of Europe, New Zealand has developed its Living Standards Framework.

Third, it is important to address better areas where we are doing poorly and keep pushing for action on key elements of health that are important for people’s well-being. For example, France has placed addressing inequalities at the core of their G7 presidency, as a challenge that spans all sectors of the economy including health.  The United Kingdom has led efforts to tackle poor mental health, which damages individuals’ health but also their labour market outcomes.

HP-Watch: Digital transformation is another one of the key topics at this year’s European Health Forum Gastein. What role do you think will the digital revolution in healthcare play in providing better care to people, including for older people? 

Colombo: If you look at other sectors of the economy, such as the banking sector, digitalisation has completely transformed the way you do business. Customer service has been enhanced, for example you can do all your banking online. Businesses must deliver better customer service to remain competitive. Health, however, lags behind other sectors in implementing broader transformations that leverage data and digital solutions. Among many other industries, the health sector is among the least likely where jobs are likely to be significantly automated.

There are several reasons for this. For a start, health labour markets are rigid. Many health workers are poorly equipped to take advantage of digital data and tools.  Between one-third and two-thirds of all health professionals report gaps in knowledge and skills needed for a safe and effective use of digital tools. Second, health data are personal and sensitive. Privacy concerns and fears that the protections that the governments have in place might not be enough are other reasons that prevent the leveraging of this data in health systems.

And yet pooling health data together would create massive opportunities for improving clinical care, research and development of new treatments. It can encourage new solutions and ways of working that make health systems more efficient and coordinated, for example reducing errors and cutting repeat tests.

Digitalisation can also help doctors do their job better. Health remains a very labour-intensive sector, and fears that digitalization will significantly reduce jobs in the sector may be overestimated. That said, certain jobs like radiologists might disappear and others significantly change. Digital solutions can help doctors and nurses do tasks more accurately and faster, helping to optimize health service delivery.

HP-Watch: And finally, besides the opportunity to step back and discuss all of these critical topics, what makes the European Health Forum (Gastein) stand out from other health-themed conferences in Europe?

Colombo: The forum brings together a wide range of health stakeholders, with a great mix of participants from NGOs, public and private sector, researchers and young people. The fantastic mountain settings and cosy atmosphere encourage open discussions. The Forum organisers make constant efforts to develop innovative methods and tools to organize and run the discussions.

 

Image Credits: Photo: OECD/Andrew Wheeler, Eurostat, OECD (2017), How's Life? 2017: Measuring Well-being., EHF (Gastein).

Antimicrobial resistance (AMR) is emerging fast in livestock in the developing world, with northeast India and northern China among the most worrisome “hotspots”, says a first-ever study mapping AMR in low and middle-income countries, published this week in Science. Parts of Turkey, Kenya, Brazil, Egypt, Vietnam and South Africa were also noted as areas of high concern.

Chickens roam freely outside of a family-owned farm in Kitwe, Zambia.

Kenya, Morocco, Uruguay, southern Brazil, central India, and southern China also were noted as areas where resistance is starting to emerge.  There was uncertainty about trends in the Andes, the Amazon region, West and Central Africa, the Tibetan plateau, Myanmar, and Indonesia, the authors noted. And data was contradictory for Ethiopia, Thailand, Chhattisgarh (India), and Rio Grande do Sul (Brazil).

The study found that in the low and lower-middle income countries reviewed (LMICs), levels of resistance for the most common classes of antibiotics important to human health were approaching or even exceeding levels of AMR found in Europe and the United States, which have been using antibiotics in livestock production since the 1950s.

The authors recommended that governments of the lower-middle income countries where resistance is rising, together with high-income countries that help drive the global market for meat, work together to reduce the threat of rising AMR.

The study pointed out that industrial livestock production, which has also been linked to driving climate change, consumes some 73% of all antimicrobials produced annually. Governments of countries at risk could take “immediate action” in regulating antibiotic use, and adopting biosafety practices more common in high income countries, the authors said.

Geographic distribution of antimicrobial resistance in LIMCs. P50 measures the proportion of antimicrobial compounds with resistance higher than 50%.

The studied identified and reviewed 901 point prevalence surveys of AMR resistance in low- and middle- income country livestock settings for the common indicator pathogens: Escherichia coli, Campylobacter spp., nontyphoidal Salmonella spp., and Staphylococcus aureus.

It found that from 2000 to 2018, the proportion of pathogens displaying resistance to common anti-microbial agents greater than 50% increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs, while plateauing between 0.12 and 0.23 in cattle.

Alarmingly, resistance rates ranged from as high as 40-80% to first-line antibiotics such as penicillin in parts of Asia to ~18-40% in “drugs of last resort,” or the most potent antibiotics such as colistin, in the Americas and Asia.

The authors stressed that high-income countries in Europe and North America that are driving meat demand need to to support the “transition to sustainable animal production” in LMICs. They note that many developed countries that have strict regulations on domestic agricultural antibiotic use still import meat produced in countries with more lax laws.

“We [high-income countries] are largely responsible for this global problem we’ve created,” said Thomas Van Boeckel, a co-author of the study and epidemiologist at the Swiss Federal Institute of Technology in Zurich, to Nature News. “If we want to help ourselves, we should help others.”

The US, the 28 countries of the European Union, China, Brazil, and India all rank among either the top ten meat importers and/or exporters according to the Food and Agricultural Organization (FAO) of the United Nations.

For quite some time, scientists have expressed uncertainty about whether AMR levels could be lower in low and middle income countries due to more limited access to veterinary antimicrobials and less meat consumption overall. But the study’s findings seem to indicate that AMR in LMIC settings is also exacerbated by lower surveillance and less restrictive veterinary regulations that may be common to such settings.

Using geo-spatial mapping and analytic techniques, the authors collated data from a range of smaller studies to analyze risks of antimicrobial resistance on a global scale. They note that data is still limited, particularly for the Americas, which hosts some major meat exporters, so it is difficult to draw definitive conclusions about that region as well as about large parts of Africa.

Image Credits: S. Jetha/Science, Science/resistancebank.org.

Greta Thunberg, young climate activist, visits the “Pollution Pods” with Dr. Maria Neira, director of Public Health at the WHO. The “Pollution Pods” allows visitors to experience simulated air pollution levels in different cities around the world, bringing attention to the connection between climate change, air pollution, and respiratory health.

 

NEW YORK CITY – Globally, governments are spending nearly $US 300 billion in price supports and other pre-tax subsidies for fossil fuels – which are costing national governments a whopping $US 2.7 trillion in health costs from air pollution-related mortality, disease and lost productivity—not to mention fueling climate change.

As just one stunning example of these so-called “perverse subsidies”, India spends some US$ 7 billion a year on price supports for coal, diesel and kerosene, which cost the country about 20 times more, or an estimated $US 140.7 billion, in health costs from air pollution-related deaths and disease.  Even in the European Union and the United States, fossil fuel subsidies worth over US$ 2 billion cost people and economies in those countries some US$ 200 billion, the analysis found.

The data is part of a new paper released Thursday by the New York-based global health organization Vital Strategies and the Geneva-based NCD Alliance. The brief, Fueling an Unhealthy Future, lines up national expenditures on expenditures for the most health-harmful fossil fuels against the costs to economies and health systems incurred on the other end – in terms of air pollution’s health impacts.

A student wears a mask to protect him from the smoke that blankets the city of Palangka Raya, Central Kalimantan.

While comparisons of global fossil fuel subsidies and associated global health costs have been made in the past by the International Monetary Fund, among others, this new analysis, the pre-release of a larger technical report, brings the issue down to the level of impacts at country level. By comparing fuel subsidies directly with health costs associated with air pollution, as well as with health system budgets, it casts into sharp relief the level of losses countries and societies incur.

The study also limits the analysis very conservatively to direct subsidies provided by governments to the most health-harmful fossil fuels – such as coal, kerosene and diesel/gasoline – excluding liquified petroleum gas (LPG) which is regarded by many health advocates as an important “transition fuel” for poor households’ energy needs in low and middle-income countries.

The result is a granular, country-by- country comparison that starkly portrays the out-sized health costs associated with policies that artificially reduce fossil fuel prices, encouraging their use.  This sheds a new perspective on what one of the lead authors of the report, Nandita Murukutla, describes as the “perverse incentives” of fossil fuel subsidies.

Murukutla spoke at a Vital Talks side event Thursday on the margins of this year’s 74th United Nations General Assembly – where global leaders this week announced a new round of commitments to climate action, as well as approving a landmark declaration on achieving worldwide Universal Health Coverage by 2030.

In low- and lower-middle income countries such as India, China and Russia – the estimated health costs attributable to fossil fuel subsidies also are more than five times the entire national government health expenditure, she pointed out.

“We are incentivizing unhealthy industries that will sicken millions and cost trillions,” said Murukutla. “We call these incentives perverse because they go against health and wellbeing. We cannot be incentivizing these industries and then bearing the health costs. We are calling for more policy coherence.”

WHO estimates that some 7 million people a year die from air pollution related risks – and most of those deaths are attributable to noncommunicable diseases (NCDs), including heart attack, stroke, lung cancer and respiratory diseases.

At the same time, NCDs now comprise the lion’s share of the global disease burden – responsible for some 71% of premature deaths and diseases.

NCDs are also the elephant in the room when it comes to financing universal health coverage.  The challenge is huge for low- and middle-income governments that are struggling to cover the very basics such as maternal and child care and immunizations – and it is also affecting more affluent countries that face rising costs from expensive cancer and cardiovascular treatment procedures.

Health Taxes on Sugary Drinks, Tobacco, Alcohol

Faced with such a funding gap, global health leaders have recently begun to express much stronger backing for so-called “sin taxes”, also called “health taxes”, that can be applied to sugary drinks, tobacco and alcohol to both reduce consumption and raise revenues for health systems. These are taxes that civil society groups such as the NCD Alliance and Vital Strategies have long championing already for some years as effective strategies in shaping consumer demands and preventing NCDs

An article Wednesday in The Financial Times, co-authored by the heads of the The Global Fund, Gavi, The Vaccine Alliance, and the World Bank’s Global Financing Facility, said that taxing products harmful to health such as tobacco, alcohol or highly-sugared drinks, could be a potentially “valuable contribution” to achieving UHC.

“They have the double benefit of suppressing the consumption of harmful products and providing incremental government revenues,” said the op-ed, by Peter Sands, Muhammad Ali Pate and Seth Berkley, whose agencies together provide about US$10 billion in health aid to the world’s poorest countries and communities.

WHO’s leadership is also getting on the alcohol-tobacco-sugary drinks bandwagon:

“Increasing taxes on alcohol, tobacco and sugary drinks can help improve health while improving health systems,” declared WHO’s Director General Tedros Adhanom Ghebreyesus, in a brief appearance at Thursday’s Vital Talks side event.

However, none of the big agency heads have spoken out in the same way about fuel subsidies. For health advocates, confronting the ways in which fossil fuel subsidies are also fueling deaths and disease is still a relatively new, and edgy topic – which has generally been regarded as a topic of the climate sector.

However, even if this year’s Climate Summit failed to see the level of dramatic new country commitments that advocates say are needed to limit global warming to 1.5 C, it has seen a paradigm shift where climate change is being framed in the context of a much broader range of issues. These include air pollution, foods and biodiversity, oceans’ health and sea level-rise, where climate-related health impacts are being examined through a lens of greater complexity – and linkages more widely acknowledged.

Another new report, Burning Problems, Inspiring Solutions, released last week by the NCD Alliance and the International Institute for Sustainable Development (IISD) calls on governments to fight air pollution from fossil fuels with some of the same strategies that have been used in the past to fight the tobacco industry.

Advocates from the two sectors, tobacco and air pollution, have much to learn from each other, said NCD Alliance Policy and Advocacy director Nina Renshaw, a co-author of the report.  “So why not draw lessons from the action against tobacco smoking to regulate fossil fuels?” she asks.

The report cites case studies of action on tobacco control, and points to lessons for health advocates regarding strategies to:

  • Name and address fossil fuels as a root cause of air pollution-related health issues;
  • Promote subsidy reform, taxation and regulatory measures to curb fossil fuels’ production and use;
  • Define fair transition plans away from unhealthy commodities – recognizing that there are consumers and industry workers dependent on oil, gas and coal.

In the health arena, however, the air pollution-fossil fuel-health nexus remains an more edgy one – more so even than taxes on sugary drinks, alcohol, and tobacco.  And even proponents acknowledge that raising taxes or reducing longstanding subsidies can encounter significant resistance in the halls of government as well as from industry and consumers who can perceive measures as limiting personal choice and freedoms.

For now, despite the mounting evidence around climate, air pollution and health linkages, mainstream NCD prevention strategies remain overwhelmingly focused on personal management strategies, such as reducing salt reduction for hypertension management and less sugar intake for diabetes control.

Asked what steps could be taken to advance the health arguments for reducing fuel subsidies to a more central place on policymakers’ agendas, Kelly Henning of Bloomberg Philanthropies’ Public Health programme, noted that the philanthropy funds work on both issues, and yet connecting the dots remains a challenge. “It’s going to be quite difficult,” she acknowledged. “I don’t think we have quite figured that all out.”

(left-right) Nandita Murukutla, VP, Vital Strategies; Douglas Webb, Team Leader, Health and Development at UNDP; Dr. Kelly Henning, Lead of Global Health Programs, Bloomberg Philanthropies; José Luis Castro, President and CEO, Vital Strategies; Her Royal Highness Princess Dina Mired of Jordan, President of the Union for International Cancer Control; Nina Renshaw, Director of Policy and Advocacy, NCD Alliance.

 

 

This story was published as part of Covering Climate Now, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story, co-founded by The Nation and Columbia Journalism Review.

Image Credits: Aulia Erlangga/CIFOR , Vital Strategies, E Fletcher/HP-Watch.

NEW YORK CITY – Evidence-based decision-making and tapping into local potential are keys to achieving the goals set in the Universal Health Coverage (UHC) declaration, said a panel convened today on the sidelines of the 74th United Nations General Assembly.

The Government of Georgia, whose Permanent Mission to the UN co-sponsored the panel, helped lead key intergovernmental meetings during drafting of the landmark UHC declaration adopted on Monday. Health Systems Global and the Alliance for Health Policy and Systems Research, a collaboration hosted by the World Health Organization, co-hosted the event.

“Without evidence-driven decision making… it will be impossible to obtain the Universal Health Coverage goals,” said Dr. Mariam Jashi, chair of the Education, Science and Culture Committee, Parliament of Georgia.

(left-right) Lola Adedokun, Director of Programs at the Doris Duke Charitable Foundation; Executive Director of NHSRC, Ranjani R. Ved; Director of Health Systems Program at JHSPH, Sara Bennett; Chair of ESC Committee, Parliament of Georgia, Mariam Jashi; Counselor to the Permanent Mission of Georgia to the UN, Tamar Tchelidze; Associate Director of Health Section, Programmes Division at UNICEF, Stefan Swartling Peterson.

The goal in drafting the UHC declaration was “to be prescriptive to the government,” said Tamar Tchelidze, Counselor on Health and Social Issues at the Permanent Mission of Georgia to the UN in New York. Tchelidze emphasized that the drafting team wanted governments to use the statements in the declaration to guide multisectoral engagement within countries, involving stakeholders that were most important to local governments.

Along the same theme, panelists pointed out that addressing shortcomings in policy-relevant research is a responsibility of multilaterals, civil society, and academia, which fund and conduct much of the research that government needs and uses.

Research should aim to inform policy-making more directly, said panelists. And in particular, global health researchers should focus on gathering just enough data to “prove a point,” said Lola Adedokun, Director of the African Health Initiative at the Doris Duke Charitable Foundation.

Adedokun said that the academic mandate to publish can otherwise meander into areas that are not relevant to countries, imposing burdens on data collectors, who are often community health workers that must still carry out routine, primary care duties.

At the same time, local research capacities should be leveraged, said Dr. Stefan Swartling Peterson, associate director of the Health Section, Programme Division at UNICEF.

“Country programs come to UNICEF and ask, ‘We don’t know this, and we don’t know that,’ and I always ask, ‘Who is your local academic partner? And that always throws them off,’ notes Peterson. He says that all stakeholders should build strong partnerships with local academic partners because “safari researchers,” who run short-term research programs, do not “have the same swaying power” as local research institutions do.

He noted that, although the World Health Organization’s plan for UHC does include calls to strengthen human resources for health, discussions focus mostly on the shortage of healthcare workers rather than healthcare researchers.

In communicating research findings to policy makers, the panel highlighted the roles of journalists, civil society, and government champions, who create spaces for knowledge exchange to happen.

“People’s movements are really the key to social accountability,” said Dr. Ranjani R. Ved, executive director of the National Health Systems Resource Centre (NHSRC), a technical agency within India’s Ministry of Health.

Yet at the same time, higher-level “knowledge brokers” are required to help shift the paradigm away from traditional research models that emphasize publication for its own sake, towards more open forum spaces for policy-makers, practitioners, and researchers to discuss lessons learned.

Citing other panelists, Dr. Sara Bennett, director of the Health Systems Program at John’s Hopkins Bloomberg School of Public Health, said that there is a need for countries to institutionalize organizations that “bridge research and policy,” and dedicate funding towards that space.

In response to a query by Health Policy Watch regarding where such investments should be focused, Bennett said, “I’m not quite sure that we have the formula right for how these organizations work yet, but certainly we need to think more about the go-between space [between research and policy]. How do we connect these worlds?”

Image Credits: Health Systems Global.