Europe’s health systems are facing a perfect storm of challenges, with a post-COVID budget crunch, ageing population and health workforce crisis threatening long-term stability.

BAD HOFGASTEIN, Austria – European health systems, among the best-funded and most equitable in the world, face a barrage of threats to their long-term stability, highlighting the difficulty of achieving and maintaining universal health coverage even in the world’s wealthiest regions.

Experts and political leaders from across the World Health Organization’s (WHO) European region are gathered at the annual European Health Forum meeting in the idyllic resort town of Bad Hofgastein, Austria, this week to debate how to navigate Europe through the labyrinth of threats to the universal health care enjoyed by most of its citizens.

A rapidly ageing population, growing healthcare worker shortages, underinvestment in health systems and external shocks such as climate change and inflation driven by the Russian invasion of Ukraine are putting Europe’s healthcare systems through a battery of stress tests as the bloc looks to move on from the COVID-19 pandemic.

The threats faced by health systems of the European Union are shared across the WHO European region, which includes non-EU Scandinavian countries, Switzerland, the United Kingdom, Turkey, Russia and former Soviet Republics.

“The time is ticking on climate, the time is ticking on demographics, and on sustainability in economic terms,” said Sandra Gallina, Director General for Health and Food Safety at the European Commission. “We are talking about very sophisticated [health] systems … now we need to somehow make them sustainable.”

Post-COVID budget crunch threatens health systems

Christopher Fearne, Malta’s Deputy Prime Minister and Health Minister, was the President of the 73rd World Health Assembly.

The European Union is moving on from the COVID era, but the end of crisis legislation is threatening to create a new set of crises of its own.

During the COVID-19 emergency, EU countries were granted the flexibility to spend beyond the 3.5% annual budget spending deficit mandated by the bloc, allowing countries with strong and weak healthcare systems alike to spend as they saw fit to respond to the virus.

That leniency is set to end on December 31, 2023, and as governments face massive cuts to overall public spending, health is likely to be one of the first items on the chopping block.

“Coupled with inflation and shrinking economies, governments have much less to spend and will have much less leeway with the budgets than they have now,” said Christopher Fearne, deputy prime minister of Malta and Europe’s longest-serving health minister. “The biggest victim of all of this could very well be health.”

Fearne is one of many European Union health ministers who will need to cut back on health spending if the bloc’s rigid budgetary rules are put back in place come January.

“The budgets member states will present to the [EU] Commission in October of this year are already starting to reflect this,” said Fearne. “Government spending will have to come down drastically, and of course, health is going to be one of the spheres which will be impacted.”

But Fearne and his fellow ministers argue there is a clear solution: count health as an investment, not a cost against national budgets.

“We need to look at this question of whether health spending should be reflected in the national budgets – at the moment, it is,” said Fearne. “This means next year governments are going to be very, very, very, very tight with spending.”

Government budget cuts are poised to deliver a shock to the health sector, which is already grappling with the new costs of climate change and the ongoing cost-of-living crisis. Efforts to decarbonize national health systems are also likely to be deprioritized as governments triage increasingly scarce funding.

Health experts warn that the cuts could have a devastating impact on the quality of care for Europeans. Longer wait times, reduced access to services, and a decline in the quality of care are all likely consequences of the cuts.

If public spending on health across the bloc falls, Fearne warned, the door will be left open for private industry to step into the vacuum in Europe’s health sector, with unpredictable results.

The EU health budget passed in 2021 earmarked a record €5.4 billion for spending on health – 11 times the amount apportioned in the previous budget for the 2014-2020 period.

Budgets still consider health a cost, not an investment

Sandra Gallina is the Director General for Health and Food Safety at the European Commission.

In principle, European Commission officials such as Gallina agree with the notion of health as an investment.

“People started to believe a bit more in the words ‘investing in health’: that health is not a cost, but is an investment,” Gallina said, discussing the evolving attitudes of EU officials during the COVID-19 crisis. “Now, not all believe in it, but I believe that [among] a fair share of the actors around me, meaning the people that in the end decide … there was a paradigm shift.”

However, Gallina was more measured in her response to concerns about the pressure on the budget of smaller EU member states raised by Fearne on Wednesday, clarifying that “no promises” could be made that health might be exempted from the budget crunch.

“Budget discipline is budget discipline,” Gallina said. “The only gloomy part I have in my toolbox is that I need to find sustainability soon, meaning economic viability which is good for the budgets of member states.”

Gallina added that Europe needs to find a way to balance the need for financial sustainability with maintaining the high-quality public health system that is, and should remain, a key pillar of the EU’s identity. She held up the heavily privatized healthcare system in the United States, which she had just visited after attending the United Nations General Assembly in New York City last week, as an example of what she does not want for Europe.

“Europe is a good place and we need to protect it,” she said. “We need to not let it erode and arrive at a different reality which is not Europe.”

Dr Hans Kluge, director of the World Health Organization’s European Region, warned that the historic rise in economic inequality amid record profits for private corporations is undermining the resilience of health systems in Europe and around the world.

“We have never seen that extreme poverty and extreme wealth have risen simultaneously and sharply,” said Kluge. “We see giant corporations paying almost no, or few taxes, having unimaginable benefits, while for the first time in recent history, we have more and more children going to bed in the evening with a hungry stomach in the richest countries in our region.”

“Our region is not the disaster-resilient region it used to be,” he said.

Europe’s health workforce crisis: a ‘ticking time bomb’ 

Despite having more doctors, nurses, and primary care workers than ever before, Europe faces a paradox: the shortage of health workers is growing, is larger than it has been in decades, and is still worsening.

Today, the World Health Organization’s 53-member European region is short an estimated 1.8 million health workers. That number is expected to climb to 4 million by 2030 if nothing is done to correct its course.

“The number one problem is the health worker crisis we have here in Europe because there is no health without the health workforce,” said Kluge. “We are facing a ticking time bomb.”

The COVID-19 pandemic exposed and exacerbated the deep-rooted problems facing Europe’s health workforce. Burnout, low pay, and dangerous working conditions are driving healthcare workers away from hospitals across the continent in droves.

Around 40% of healthcare workers are grappling with depression and anxiety, while 70% report feeling burned out, according to the ‘Time to Act’ WHO Europe report published last year.

Attrition rates among health workers are climbing, and as they do, more stress is placed on those who stay.

“Some steps have been taken, but not enough has been done,” said Alvaro Cerame, chairperson for the Medical Workforce Committee of the European Junior Doctors Association. “We need to be a political priority.”

Nearly 50,000 European health workers lost their lives to COVID-19. Those who survived the pandemic continue to struggle through high burdens from mental health, physical exhaustion, and the death of colleagues — from COVID or suicide — which make remaining on the frontlines unbearable for many.

“Let’s remember these are the brave souls who saved society on the frontline of the pandemic,” said Kluge. “The health providers I meet, they love what they do.”

“It is not a job, It’s a vocation,” he said. “The people leaving the workforce simply have no choice, and the despair I see is — truly, as a medical doctor myself — really heartbreaking.”

UK health worker strikes are a warning shot

Strikes across the UK’s National Health Service have resulted in over one million cancelled medical appointments to date.

Subpar pay and hazardous working conditions have sparked healthcare worker strikes across Europe. The ongoing strikes in the United Kingdom, which have snowballed into an uncontrollable crisis that just passed the bleak milestone of one million cancelled medical appointments, are a warning to other European countries of the consequences of neglecting their health workforce.

“There are strikes that then create huge issues, but it is not the moment of the strike that is important — it’s the long-term vision of where you get the staff and how we deal with staff shortages,” said Gallina. “We need to be better at planning and forecasting needs for the workforce.”

Europe’s doctors are also ageing out of work at an alarming rate, and the continent is not churning out enough new doctors to replace them. On average, 30% of doctors in Europe are over 55, and in 13 countries, at least 40% of doctors are over 55 and will retire within the next decade. Italy has the oldest medical workforce in Europe, with nearly 60% of doctors over the age of 55.

If more people in the health workforce today leave, the gap will grow into a gulf, with potentially disastrous consequences for healthcare quality and access.

“We need first to focus on retaining the health workers we already have because it takes a long time to produce more,” said Kluge. “So let’s retain and motivate the people we have by improving their working conditions and making the profession more attractive.”

Europe’s Aging Population: A Challenge for Healthcare

Percentage of medical doctors in WHO European region countries aged 55 and older, 2020 or latest.

Beyond Europe’s ageing doctors lies a more fundamental problem: a rapidly ageing population. As people live longer, they are more likely to develop chronic diseases, which can put a strain on healthcare resources.

The demographic shift has already prompted many European countries, including France, to raise the retirement age in order to correct budgetary imbalances that emerge when too few working people support a system of socialized healthcare and pension benefits.

While Europe’s demographic evolution towards an older society is inevitable, the solution over the long term, experts say, must be to reduce the pressure created by avoidable demands on the healthcare system in the first place. That means ensuring that more people enjoy more “healthy life years” through middle age and as they grow older.

This can be achieved through promoting health literacy and proactively combating avoidable health problems like obesity through education and awareness-raising, as well as tax, environment, and food policies that enable healthier choices and lifestyles.

“Expecting to turn a big tanker of more than 500 million people fast is not fair,” said Gallina. “[But] where we want to arrive is a future that is sustainable for everybody, where is no inequality within countries or within member states.”

Image Credits: EHFG, Chris Marchmant.

Pedestrians in Bangladesh cover their faces to keep from breathing in dust and smog.

Air pollution causes seven million premature deaths every year – yet a minuscule 1% of international development funding ($17.3 billion) and 2% of international public climate finance ($11.6 billion) was allocated to reducing it between 2015 and 2021.

This is according to the Clean Air Fund’s (CAF) report on global air quality funding released on Thursday.

The funders included are multilateral development banks such as the World Bank, bilateral development agencies and governments that fund low- and middle-income countries via loans and grants. 

During the same period, development funders committed almost three times as much money ($47.4 billion) to fossil fuel-prolonging projects, primarily oil and gas extraction and production, according to the report.

More positively, funding for fossil fuel-prolonging projects declined over time and by  2021, outdoor air quality funding ($2.3 billion) exceeded investments in fossil fuel-prolonging projects ($1.5 billion) for the first time. 

Transport

Funding for climate and air pollution leaned heavily towards transport projects, accounting for almost half the outdoor air quality funding ($6.5 billion). These include investments in cleaner fuels, electric and hybrid vehicles, public transport and railways.

Outdoor air quality funding peaked in 2019 mainly due to a large railway project in the Philippines aimed at alleviating serious traffic congestion and mitigating air pollution. It plunged by 65% in 2020, likely because of the COVID-19 pandemic, then rose 37% in 2021.

Co-benefits

“While the pool of funding that is explicitly working to improve outdoor air quality is limited, there is a larger bucket of international development finance which delivers outdoor air quality improvements as a co-benefit of the investment,” according to the report.

This “bucket” is substantial in comparison to the small cup of financing purely for air pollution, amounting to $101 billion or 4% of total international development funding committed in the period.

While CAF welcomed this spending, it added that “an explicit focus on the air quality aspects would make for better-designed projects that deliver stronger returns on the investment.”

Money monopolised

The money doesn’t always go where it is needed most. A staggering 86% of funds for outdoor air quality improvement went to five countries: China (37%), Philippines (20%), Bangladesh (17%), Mongolia (6%) and Pakistan (6%). 

India and Nepal have the highest population-weighted exposure to air pollution  (PM2.5), yet they each received less than 1% of the total. 

Meanwhile, Africa received 5% although five of the top 10 countries with the highest average PM2.5 exposure are on the continent.

The Beijing-Tianjin-Hebei Air Quality Improvement Program received the lion’s share of funding.

At a city level, China’s Beijing (27%), Bangladesh’s Dhaka (9%) and Mongolia’s Ulaanbaatar (6%) received the biggest allocations – despite Delhi, Kokkata and Kano being the worst polluted cities.

Lack of monitoring

The report is concerned about the lack of both modelling and monitoring. At least one billion people live in countries where their governments don’t monitor air quality, Meanwhile, in sub-Saharan Africa research shows one monitor per 28 million people.

“Monitoring local air quality benefits – particularly in relation to health – can help to deliver a more comprehensive understanding of the effects of global climate interventions, allowing for more informed decision-making and resource prioritisation,” the report argues.

Ways to pay

Some 92% of funds to prevent outdoor air pollution were in the form of loans. Multilateral development finance institutions (DFIs) provided slightly over half the funding (51%), followed by bilateral DFIs (37%), then governments (7%).

However, the report recommends making “fuller use of the diverse financial toolbox” to “expand the capital base available for cleaning our air.”

It offers a number of suggestions. For multilateral development banks (MDBs), it suggests initiatives such as partnering with private and public investors to expand investment in clean air projects and provide debt capital to local financial institutions through on-lending structures.

For donor countries, the report proposes substantially increasing the outdoor air quality funding by making more grant and concessional finance available, and “recalibrating investment strategies to ensure key sectors such as agriculture and waste are not left behind.”

Image Credits: Rashed Shumon.

WHO Director-General Dr Tedros Adhanom Ghebreyesus 

Cholera cases doubled last year in comparison to 2021, and preliminary data suggests that 2023 is likely to be even worse, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

“So far 28 countries have reported cases this year, compared with 16 during the same period last year,” said Tedros.

Ethiopia, Haiti, Iraq and Sudan have “the most concerning outbreaks”, he added, but noted that “significant progress has been made in countries in southern Africa, including Malawi, Mozambique and Zimbabwe” but these countries remain at risk as the rainy season approaches.

Last week, the WHO released its 2022 cholera report, noting that there had been 472 697 reported cases in 44 countries, in comparison to 223 370 cases in 35 countries in 2021.

“The geographical pattern of outbreaks also changed, as countries that had not reported cholera in many years, including Lebanon and the Syrian Arab Republic, reported large outbreaks in 2022,” according to the report.

It also noted that seven countries reported very large outbreaks of over 10,000 cases – Afghanistan, Cameroon, Democratic Republic of the Congo (DRC), Malawi, Nigeria, Somalia, and Syria.

Tedros said that the “worst affected countries and communities are poor, without access to safe drinking water or toilets” and faced shortages of oral cholera vaccines and overstretched health workers.

 

Almost a year ago, in the face of a huge shortage of oral cholera vaccines, the WHO recommended that people be given a single dose instead of the usual two doses 

The standard preventive approach to cholera is two-dose vaccination with the second dose administered within six months of the first. The immunity of a fully vaccinated person against cholera lasts for three years. While single doses have been used effectively in previous outbreaks,  there is limited evidence on how long protection lasts. The global shortage is projected to last until 2025.

“WHO is providing essential supplies, and coordinating the on-the-ground response with partners, supporting countries to detect, prevent and treat cholera and informing people how to protect themselves,” said Tedros. 

“To support this work, we have appealed for $160 million, and we have released over $16 million from the WHO contingency fund for emergencies. But the real solution to cholera lies in ensuring everyone has access to safe water and sanitation, which is an internationally recognised human right.”

Dr Mike Ryan, WHO’s head of health emergencies, added that cholera outbreaks were sensitive to climatic variability and climatic change, while conflict and resultant displacement of people were driving cases.

Rise in COVID-19 cases

The WHO also expressed concern about the rise in COVID-19 cases, particularly in Europe and the Americas.

“Among the relatively few countries that report them, both hospitalisations and ICU admissions have increased in the past 28 days, particularly in the Americas and Europe,” said Tedros. 

He added that vaccination levels among the most at-risk groups was “worryingly low”, with only a third of people having received a booster shot.

Dr Maria van Kerkhove, WHO’s technical lead on COVID-19, stressed that the vaccines currently available worked on the new variants.

More resources for cervical cancer

Professor Groesbeck Parham

The WHO’s Expert Group on Cervical Cancer Elimination met this week to review progress and advise on the future direction or the initiative.

Addressing the press conference, co-chair Professor Groesbeck Parham, said the group had resolved that there should be a “heavy emphasis on country-specific support for the implementation of the three pillars”, namely HPV vaccination of young girls, cervical cancer screening of adult women, and treatment of women who were found to have pre-cancer or invasive cancer during screening.

“There should be fewer guidelines from WHO but more resources that focus on supporting field workers in the countries that have the highest burden of disease,” said Parham.

The group also felt that all three pillars should be “implemented collectively” and that  “information hubs need to be created that facilitate countries sharing their successes.”

“Rwanda has had great success in vaccinating greater than 90% of their young girls,” he added.

In Ireland, students launched a campaign entitled ‘Not around us’ to promote smoke-free environments in schools.

WHO has stepped up its counteroffensive against tobacco companies that market cigarettes and other tobacco products to teens – with the release of a new set of guidance for school-based anti-smoking policies. 

The guidance, “Freedom from Tobacco and Nicotine: Guide for Schools,” and “Nicotine- and Tobacco-free School Implementation Toolkit”, aims to support school policies banning smoking, vaping and other forms of tobacco use. 

Nearly nine out of 10 smokers begin the habit by the age of 18 – meaning that schools need to be on the frontlines of tobacco control efforts aimed at the next generation. 

“Whether sitting in class, playing games outside or waiting at the school bus stop, we must protect young people from deadly second-hand smoke and toxic e-cigarette emissions as well as ads promoting these products,” said Dr Ruediger Krech, Director of Health Promotion, WHO in a press release describe the new school guidance.

Tobacco epidemic a key concern for youths

The dark shaded areas represent the proportional risk of tobacco use as a factor in key noncommunicable diseases, including heart disease (IHD), stroke, lung disease, cancers (lung, lip, stomach, colorectal) and diabetes.

About 1.8 billion people, or nearly 25% of the world’s population, are between the ages of 18-24.  And more than 80% of these young people live in developing countries, many of which lack strict regulations on tobacco advertising and marketing.  

But the problem of youth-focused marketing of tobacco products extends across nations at all levels of development – as the marketing of vape sticks, e-cigarettes and other tobacco products has shifted to a flourishing online trade. The multi-billion-dollar tobacco industry also has been increasingly active marketing nicotine products, such as e-cigarettes, that resemble youth-appealing characters, school suppliers, toys, and drinks, WHO notes. 

Globally, tobacco is one of the largest risks to health, and for the development noncommunicable diseases; as a result tobacco kills about 8 million people across the globe every year – or more than one person every four seconds. 

“Keeping schools tobacco and nicotine free can help prevent this,” said the WHO in a Twitter post announcing the new guidance, issued just this week.

What’s in the guide? 

Example of a school-based arts and craft project In Krygyzstan promoting anit-tobacco education.

The guide and toolkit offer a step-by-step manual towards creating nicotine- and tobacco-free school campuses by offering advice on policy design; implementation and enforcement; education and awareness-raising campaigns; and smoking cessation programmes. The toolkit and guide highlight four key strategies for schools to adopt and promote: 

  • Banning nicotine and tobacco products on school campuses;
  • Prohibiting the sale and/or distribution of nicotine and tobacco products in school neighborhoods;
  • Banning direct and indirect ads and promotion of nicotine and tobacco products in school neighborhoods; 
  • Refusing offers of sponsorship or engagement with tobacco and nicotine industries. 

The tools and guidance were developed and tested in collaboration with countries that have successfully implemented tobacco and nicotine-free campus policies. Those include: India, Indonesia, Ireland, Morocco, Qatar, Syria, Kyrgyzstan, Saudi Arabia, and Ukraine. 

Samples of nicotine and tobacco-free signage to promote non-smoking school environments.

Release coincides with USD Food and Drug Administration’s warning to online retailers 

Nicotine and tobacco-free campus policies also support healthier lifestyles and waste management, reducing cigarette litter and protecting non-smoking youth from toxic chemicals in second-hand smoke, WHO said. 

The release of the WHO publications coincides with a stiff warning issued recently by the U.S. Food and Drug Administration to 15 online retailers for selling and/or distributing tobacco products that are specifically packaged to appeal to young people. 

“The design of these products is a shamelessly egregious attempt to target kids,” states Brian King, director of FDA’s Center for Tobacco Products, in the notice, issued August 15.

Image Credits: WHO , Institute for Health Metrics and Evaluation (IHME), WHO, WHO/Nicotine and Tobacco Free Schools.

South African President Cyril Ramaphosa visits Aspen Pharmacare manufacturing facility in Gqeberha.

A new deal between Danish company Novo Nordisk and South African generic manufacturer Aspen will massively expand the supply of insulin in sub-Saharan Africa and also transfer the production rights and technology to the African company.

The deal will more than double Novo Nordisk’s production within just one year.  Currently, the pharma company’s insulin products reach 500,000 people living with diabetes in sub-Saharan Africa.  Through the partnership, expanded production will be able to meet the insulin needs of 1.1 million people across the continent by 2024. 

By 2026, the two companies will be able to meet the insulin needs of 4,1 million people living with type 1 and type 2 diabetes across the African continent.

According to the agreement, Novo Nordisk has a minimum purchase obligation from Aspen of €195.5 million for the period 2024-2028.  

“The human insulin will be distributed at low cost to health authorities and non-governmental organisations through government tenders as part of Novo Nordisk’s sustainable business integrated model, iCARE. With iCARE, Novo Nordisk will guarantee a ceiling price of human insulin at $3 per vial,” according to a media release from the company.

“The expanded commitment supports the African Union’s Pharmaceutical Manufacturing Plan for Africa. The collaboration between the partnership allows for local production, storage, and distribution of human insulin in vials in the African continent and means more equitable access to lifesaving care to people with diabetes,” the company added.

Intense engagement with industry based on the Global Diabetes Compact 

The deal was announced jointly by the pharma companies and the World Health Organization (WHO) on the sidelines of a series of high level health-related meetings at the United Nations General Assembly in New York last week. 

The past two years have seen a period of intense WHO engagement with pharma leaders to rev up insulin production following the launch of a WHO Global Diabetes Compact two years ago. 

In 2021, WHO estimated that half of the 63 million people living with Type 2 diabetes could not afford or access insulin, which controls their blood glucose levels. Around 90% of the insulin market is controlled by just three pharma companies: Novo Nordisk, Eli Lilly, and Sanofi.

“Diabetes is on the rise in low- and middle-income countries, but access to insulin has not kept pace with the growing disease burden,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, addressing an event in New York where the deal with announced. 

“Currently, 24 million adults are living with diabetes in Africa, and that figure is projected to more than double to 55 million by 2045.”

Bente Mikkelson, WHO’s director of the Department of Noncommunicable Diseases, added: “The unmet need for insulin is a stark reminder of the health inequalities that persist in our world today.

“Manufacturers have a pivotal role to play in filling this critical gap, not just with their products but also with their commitment to affordability, accessibility, and sustainable production. This event marks a significant milestone in our collective work to make diabetes treatment and care accessible to those who need it the most, in Africa and around the world,” Mikkelsen said.

“It underscores the power of dialogue and collaboration, where governments, international organisations, and private sector entities come together for a common cause – the cause of humanity.  Together through the Global Diabetes Compact, and with unwavering determination, we’ll script a healthier future for millions in Africa and beyond.”

The Novo Nordisk deal follows on the heels of a partnership announced in May by another leading insulin producer, Eli Lilly with Egypt’s Eva Pharma. As part of the deal, Eva will produce another 1 million “fill and finish” doses of Eli Lilly’s insulin products a year by 2030.

Enabling more local insulin production by Africa

Welcoming the Novo Nordisk partnership with Aspen, South Africa’s Minister of Trade and Industry Ebrahim Patel said that it “will enable the local production of human insulin in South Africa through the conversion of insulin into finished dose vials.”

“This is an excellent first step that we hope will pave the way for both licensing and additional manufacturing opportunities, in areas such as sterile cartridge production and the production of high-demand and the new classes of drugs, such as the glucagon-like peptide-1 (GLP-1), which is largely inaccessible at present to African patients,” Patel said.

The production of insulin will utilise Aspen’s sterile infrastructure in the city of Gqeberha in South Africa, using some of the infrastructure introduced for Aspen’s ill-fated COVID-19 vaccine manufacture.

“We firmly believe that access to quality healthcare is a fundamental human right,” said Katrine DiBona, corporate vice president for Global Public Affairs and Sustainability at Novo Nordisk. 

“We are committed to providing affordable human insulin to ensure access to quality treatments for even more people with diabetes in the African continent. At the same time, it is equally important for us that we are doing it in a sustainable way by focusing on local production.”

World leaders met at a summit last week to discuss how to accelerate progress to achieving the SDG goals by 2030.

At the Sustainable Development Goals Summit last week, world leaders discussed the many ways in which progress toward the Sustainable Development Goals (SDGs) has slowed, stopped, and in some cases retreated. Halfway to the 2030 deadline, half of the 140 targets are off-track and a third are at or below their 2015 baselines. We must reverse this trend.

Achieving the SDGs is even more critical than in 2015, as the world faces unprecedented shocks. The COVID-19 pandemic has taken almost seven million lives and done incalculable damage to health systems. Climate change threatens billions of livelihoods through extreme weather, rising seas, and changing ecosystems. Global conflict is resurgent, and economic inequality and instability are widespread. 

A worrying increase in maternal deaths after decades of improvement is just one example of how easily progress can be reversed, and our public health networks and infrastructure cannot begin to meet the need.

In short, it is a time for reckoning and for action. A time to acknowledge that achieving the SDGs is not the responsibility of governments and philanthropists alone. We need everyone at the table, from grassroots civil society to academia, the private sector and multilateral finance and banking institutions, if we are going to accelerate progress on the SDGs. 

Unprecedented cooperation

But there are lessons to be learnt in every crisis. On that front, at least, the global public health community is ahead of the curve, with the interrelated crises we face eliciting unprecedented levels of cooperation and data-sharing among public and private, global and local actors. 

This period of deterioration in health services and quality of life for so many has also been one of the most productive periods in research in recent memory. That is especially true when it comes to the complexities of multinational programs and the cascading, multiplicative effects of crisis. 

The need for cooperation is the broadest and most common theme to address at this mid-point in our shared work toward the SDGs. What the last seven years have shown us is that government and philanthropy alone lack the tools, resources and insight needed to achieve change on this scale. While both are indispensable, their efforts must be tightly linked to those of global financial institutions, civil society in every nation, and – perhaps most vitally – local organizations that understand how best to reach and support the most vulnerable members of their communities.  

The flip side of that need for cooperation involves industries that are actively hampering progress toward SDGs. For-profit industries that harm health and the environment can’t be part of the solution as long as they are part of the problem. 

Tobacco offers a clear example; with SDG 3 dependent on reducing rates of smoking, tobacco companies have simply shifted focus away from well-regulated markets to target young people and markets in developing regions. Limiting their access, disinvesting from their companies, and cutting them out of global conversations are just as important as paying for preventive care or addressing the shortage of health care workers.

Reimagining our solutions

The UN has identified 12 high-impact initiatives to boost SDG progress, and these will be a key part of discussions around the summit. Bringing these initiatives from discussion to action will require concerted collaboration and innovative partnerships.

Here are four of the initiatives that illustrate the value of partnerships, how progress or setbacks in one goal inevitably affect the others, and the critical role public health plays across the SDGs.

Scaling up long-term, affordable financing for the SDGs

The best plans and goals are pointless if countries don’t have the means to implement them. In July, UNDP published a policy brief arguing that in many low- and middle-income countries, the debt burden is draining resources that should be invested in achieving the SDGs. In 2022, 25 countries spent more than 20% of government revenues on external debt service; the average low-income country spends 2.3 times more on interest than on social assistance. 

The authors propose adding “debt pauses” to the international financial architecture to give developing economies room to grow—and recover from shocks such as COVID-19—while also improving people’s lives.

Bringing international finance institutions to the table is one example of a potential partnership that could boost progress on SDGs, especially the first one: “End poverty in all its forms everywhere.” And ending poverty is key to progress across the SDGs.

Food systems transformation 

World hunger has increased in recent years, with an estimated 9.2% of the world’s population in a state of chronic hunger in 2022. At the same time, the international development community has been slow to look beyond hunger to malnutrition and food insecurity in all of its forms. 

The high-impact initiative on food systems transformation recognizes that we need to change our food systems, so they provide healthy, nutritious food for all, in line with SDG 2, which seeks to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

At Vital Strategies, our Food Policy Program has been supporting our civil society partners in sounding the alarm about the health risks of ultra-processed foods high in salt, fat and sugar that international corporations market mercilessly—including to children—despite the proven health risks. 

These cheap, unhealthy products have made it more difficult for people to consume nutritious, traditional diets. The ubiquitous nature of ultra-processed foods exposes billions of people to a higher risk of noncommunicable diseases, including type 2 diabetes, heart disease, stroke and cancer.

Poor nutrition is responsible for 11 million deaths from NCDs annually, killing more people than tobacco. Our Food Policy team has supported civil society partners in Barbados, Brazil, Colombia, Jamaica and South Africa to work toward proven healthy food policies such as taxes on sugary drinks and front-of-package warning labels on ultra-processed products. These policies are just one component of the food systems transformation that has to happen—but a critical one.

Unlocking the data dividend for the SDGs

Regardless of the issue, “data is the fuel that powers progress across all the SDGs,” and investments in data return an average “dividend” of $32 for every $1 invested. Data is especially important in health. We simply cannot address pressing health challenges without the data to guide us. That is why strengthening data collection and shoring up national civil registration and vital statistics systems is an integral part of Vital Strategies’ work. 

Vital Strategies is proud to be a leader in this kind of big-picture, cross-sector collaborative thinking. We partner and work with governments to expand the use of data to identify problems and potential solutions, particularly concerning equity. 

During the COVID-19 pandemic, Vital’s Data for Health team partnered with 13 countries in rapid mortality surveillance—a way to track the true human toll of the pandemic by comparing recent mortality rates to historic averages. These are the kinds of partnerships that drive real progress, but we need the political leadership and investment to make them happen. 

We also need to invest in gender-based statistics so that government stakeholders can rely on applicable data to build policies and programs that will close gender equity gaps. By applying a gender lens to data collection and analysis, we can address a broad range of gender-sensitive policy issues, such as ensuring that all girls are registered at birth, reducing barriers to reproductive health care and treatment, and preventing gender-based violence. 

In Brazil, for example, Vital Strategies’ research uncovered a hidden epidemic of femicide and domestic violence. By selecting mortality data for which the cause of death was unknown, investigators were able to attribute many of these deaths to gender-based violence. We spotlighted other examples of using data to address violence against women at a VitalTalks event in May, “Can Data End Gender-Based Violence?”  

Pulling together

In a special SDG report released in July, UN Secretary-General António Guterres issued a stark warning: “Unless we act now, the 2030 Agenda could become an epitaph for a world that might have been.” 

Affordable financing and debt restructuring—as described in the SDG Stimulus—top his list of critical actions, along with reforming “our outdated, dysfunctional and unfair international financial architecture.” But the U.N., governments and donors can’t go it alone. 

At the halfway point to 2030 and the SDG deadline, we all need to pull together. Without active participation by all stakeholders, the SDGs will fail. I wish the forecast were brighter. But it is clear. Clear that our current actions are falling short, and this is a critical moment if we are to make the world the safe, healthy, prosperous place that I know it can be, for everyone.

José Luis Castro is the President and CEO of Vital Strategies, where he has led a rapid expansion of Vital Strategies’ portfolio to tackle the world’s most difficult health challenges, primarily in low- and middle-income countries. The organization now works in 73 countries and has touched the lives of more than 2 billion people.

Image Credits: Cia Pak/ United Nations, Vital Strategies.

Indoor air pollution
Indoor air quality experts gathered in Bern, Switzerland, to discuss how to improve air quality in European schools, homes, offices, and healthcare facilities.

After the COVID-19 pandemic and social distancing in indoor spaces raised awareness of the risks of infection in closed spaces and super-spreader events, scientists concerned about human exposure to other indoor contaminants and strategies to reduce risks are hopeful that the time has come for more action.

BERN, Switzerland – A dearth of data and low public awareness of the presence of pollutants in the indoor air we breathe are the greatest impediments towards making spaces more healthy, experts said at the first World Health Organization/Europe Indoor Air Conference.

The conference on Wednesday 20 September, was the first-ever WHO event focusing on the wide range of indoor air pollutants that can affect the health of people in modern homes and buildings. It was co-hosted by WHO’s European Region, the Swiss government and the Geneva Health Forum. 

The conference went beyond long-discussed issues of indoor air pollution from coal and biomass heating and cooking systems, which are a major issue in many low and middle-income countries, including parts of WHO’s 53-country European Region.

Overlooked for too long

“This is not a new issue or a new concern. But the pandemic, with its devastating toll, has raised the issue of indoor air quality higher on health and environmental agendas than ever before,” Kluge told the conference.

“Indoor air quality has been overlooked for far too long,” said Hans Kluge, WHO’s regional director, speaking at the conference via video link from Copenhagen.

WHO’s European Region was the first to issue a number of guidelines relating to indoor air pollutants other than cooking smoke. More recently, WHO issued global guidelines for ventilation to reduce virus transmission, including the COVID virus, SARS-CoV2.

Some 150,000 people die in the World Health Organization’s European region each year from exposure to smoky coal and biomass fuels used for cooking and heating, a “shocking” number in and of itself, Kluge said.

But that is only part of the picture, with the health impacts of other indoor air pollutants still unquantified, Kluge added.

“Often there are more pollutants inside than outside,” said David Vernez, professor and head of department at the Center for Primary Care and Public Health at the University of Lausanne in Switzerland, at the conference opening. “We are probably only seeing the tip of the iceberg.”

With Europeans estimated to spend up to 90% of their time indoors, the quality of the air that they breathe within those spaces is vital to their health, Vernez said.

Sources of Indoor Air Pollution

Indoor air pollutants come from a variety of sources, including the buildings themselves, outdoor air and human activities. Radon, asbestos, formaldehyde, and other toxic products are commonly found in homes, offices, and public spaces and can pose a serious risk to human health.

Radon, a radioactive gas found in some soils and rocks, can seep into buildings and cause lung cancer. Asbestos fibers, which can become airborne during building renovations, can also cause lung cancer and other respiratory diseases. Formaldehyde, a chemical used in particleboard and other building materials, can irritate the eyes, nose, and throat, and may also increase the risk of cancer.

Indoor moisture from condensation and humidity in poorly insulated and ventilated bathrooms and kitchens can promote the growth of mould and pathogens that contribute to asthma and other respiratory diseases.

Inadequate air exchanges in crowded spaces or poorly ventilated rooms can also increase carbon dioxide (CO2) levels – with elevated levels potentially reducing cognitive performance, according to recent research. 

Breathing Clean: How Improving Indoor Air Quality Can Save Lives and Boost Productivity

Two million healthy life years lost

The two million healthy life-years lost in EU countries to polluted indoor air every year are comparable to those lost to road traffic accidents.

Pawel Wargocki, associate professor at the International Centre for Indoor Environment and Energy at the Technical University of Denmark, explained that an estimated 2 million healthy life years – a measure of the number of years a person at birth is expected to live in a healthy condition – are lost in the European Union due to indoor air pollution. That is equivalent to annual road traffic injuries.

The economic costs of indoor air pollution are also staggering, totalling about $200 billion every year.

“We need to integrate our activities to improve indoor air with the activities that lead to the improvement of outdoor air quality so that it will have a positive impact on the indoor air quality,” Wargocki said.

Energy efficiency standards can also harm air quality

Sealed windows and an ageing HVAC system in a Stockholm apartment building – a combination that experts now say can lead to health risks from indoor air pollution.

Despite existing guidelines to improve indoor air quality, many buildings lack adequate ventilation. This is especially true of energy-efficient buildings built since the oil crisis in the 1970s, which often have reduced air intake and ventilation systems that remove pollutants and reduce moisture. 

In Switzerland,  Minergie energy efficiency standards require the installation of air exchange systems in new buildings to remove pollutants and reduce moisture. Under these standards, opening windows is optional. 

Roger Waeber, head of the indoor pollutants unit at the Swiss government’s Health Protection Directorate, told Health Policy Watch that corners may be cut when old buildings are renovated.  “Most often the air quality in schools in Switzerland is unacceptable,” he said.

Waeber Authorities granting building permits for renovations in public buildings may often not press for a ventilation plan, Waeber said.

“This is an awareness problem. They shouldn’t provide a permit for a school that doesn’t comply with those standards.” 

Waeber added that other people involved in the construction may forget about ventilation systems as they focus on other design issues. Finally, the municipalities themselves may decide that ventilation systems may be too costly to include in a project, without realising their value for human health.

Certification of indoor air quality needed

Belgian Deputy Prime Minister and Minister of Health and Social Affairs Frank Vandenbrouke addressed the conference via video link.

“It is remarkable to think that this is the first WHO conference (on indoor air pollution)”, WHO Chief Scientist Jeremy Farrar commented at the conference, speaking by video recording from the UN General Assembly in New York. 

“If after the last three years, we do not appreciate the importance of the air we breathe on every part of our lives, then we have really missed an opportunity to move the world forward.”

Farrar emphasised the importance of ethical and social justice considerations in addressing indoor air pollution.  “Whose air is it?” he asked. “What I breathe out will affect you, what I breathe in has come from you.”

In Belgium, Frank Vandenbroucke, deputy prime minister and minister of social affairs and public health, said that recently approved national legislation on indoor air quality has set an agenda for better monitoring, communicating and consulting with stakeholders. 

Vandenbroucke emphasised the need to support scientific research to better understand outdoor and indoor air pollutants. “We need such a knowledge base to define the most efficient regulatory approaches and to use the best existing technologies to reduce the effects of airborne pollutants on our health.”

The minister said that certification of indoor spaces would allow the public to gain confidence in monitoring of pollutants in those areas, and to ensure “transparent, reliable and comprehensive communication” about the air quality.

The pace of change is slow 

Particleboard found on buildings often contains formaldehyde, a carcinogen that can contribute to unhealthy indoor air exposure.

Jelle Laverge, an associate professor at Ghent University in Belgium, explained that the current pace of improvements in Europe is projected to be slow.

Projections by the International Network for Information on Ventilation and Energy Performance (INIVE) for the European Commission, forecast that only 20% of existing buildings will have adequate ventilation strategies by 2050.  

Working within the context of Belgium’s new legislation, Laverge set out with scientists to implement a strategy to provide data to occupants of public buildings through informed consent, by installing air monitors in the buildings, which was “a cheap and quick way” for people to check on indoor air quality.

However, the programme underscored certain challenges, such as building managers not being fully qualified to implement the monitoring strategy and even knowing which type of monitors to order for measuring key pollutants in real-time.

“Giving the right people (involved in implementing monitoring) the right kind of information is really challenging. As experts, we typically talk amongst ourselves and expect that everybody understands what we are talking about,” he said.

Indoor air quality should be evaluated in every public building 

CO2 monitors measure indoor levels of carbon dioxide; high levels have been associated with reduced cognitive performance.

For such a programme to be effective, Laverge said, “every owner of a public building needs to make or have someone make a risk assessment regarding indoor air quality of every public space in the building that then needs to go through a certification process. The outcome of that is a label that needs to be shown in every public space.” He said this could include levels of healthy and polluted air in indoor spaces, in terms of the calculated impact of the combined pollutants on health.

Catherine Noakes, professor of environmental engineering for buildings at the University of Leeds in the United Kingdom told Health Policy Watch that indoor air quality isn’t getting the attention it deserves,  even amongst engineers and architects. She said their focus is often more on sustainability and climate impact. 

“I don’t think we have health included in the same way,” Noakes said. “It’s important that air quality, water and all the ways in which our built environment affects our health be part of training.”

Cost vs benefits 

Catherine Noakes, professor of Environmental Engineering for Buildings at the University of Leeds, moderated the event.

Noakes lamented the “massive gaps” in guidance and regulations, pointing out that the latest European air quality directives will probably be pushed back due to conservative political opposition. ”We don’t have standards on our air quality and we have nothing to benchmark it against. Then we have this lack of awareness and enforcement, as air is invisible. It’s much more tangible to see your energy bills than it is to see the health consequences of the air quality.”

For Wargocki, improving indoor air quality, even marginally, through better ventilation and source control including particle filtration and elimination of other pollutants, could reap huge economic benefits due to superior work performance and better sleep.

“Every action has a cost, but the benefits here are significant, and they are measurable. We really need to have some economic calculations and involve the experts from the economy to take this into account,” he said. 

But for now, most people continue to be unaware of the health benefits. “We spend a lot of money in our houses, buying expensive beds, and invest more money in fitness and healthy food,” he told Health Policy Watch, “I think we should be educating people that clean aid will bring you similar benefits, but it is difficult for them to visualise.”

A panel combining Swiss parliamentarians and scientific experts at the Bern conference agreed that awareness of the health impacts of indoor air pollutants was key to driving concerted action.

Farrar, the WHO’s scientific lead, meanwhile, called for more cooperation. 

“It is crucial that we bring communities together: engineers, architects, urban planners, urban designers, people who work on infection and non-communicable diseases and in many other social sciences, behavioural sciences, as well as people who think about how our schools and transport is designed”, Farrar said.

“That is tough because we are all in our own individual silos. We need to come together and agree on some common language and a culture in the way we work together.” 

Image Credits: Pelle Sten/Flickr, Edna Winti/Flickr, Geneva Health Forum .

Cameroonian midwife Ashu Martha Agbornyenty speaks on stage at Goalkeepers 2023.

NEW YORK – While the world’s leaders set new global health goals and appraised existing ones at the United Nations (UN) last week, implementing these noble goals falls on the shoulders of people like midwife Ashu Martha Agbornyenty.

Agbornyenty works in poor communities in Cameroon, where the deaths of women and newborn babies are relatively common due to a lethal combination of poor resources, a shortage of health workers and a preference for traditional birth attendants.

The 24-year-old’s passion for uplifting both Cameroonian midwives and their pregnant patients won her the  Changemaker Award presented at a Goalkeepers event hosted by the Bill & Melinda Gates Foundation (BMGF) in New York last week.

Agbornyenty’s For Mom & Baby Foundation, that distributes kits containing essential birth supplies to pregnant women in crisis-stricken areas, runs workshops to prepare women for labour, and writes about the work of midwives and  pregnancy through a blog, Marthie’s Midwifery Diary.

“In the area where I work in Cameroon, there is a political crisis and a lot of the women deliver in bushes,” Agbornyenty told a media briefing last week.

“We partner with hospitals to provide medication to prevent postpartum haemorrhage, which is the leading cause of maternal mortality.

“I am also a young midwife leader working to curb the dropout rate of midwives. When I started as a midwife there was no one to guide me and I wanted to drop out. So far, I have personally guided 185 student midwives to stay in the profession and 40 of these are under my direct mentorship.”

Best practice to save lives

The UN held a summit last week to assess progress to achieve the Sustainable Development Goals(SDG) – 17 global goals adopted in 2015 to address poverty, development and climate by 2030.

The SDG targets were set in 2015, and the halfway assessment is depressing: just 15% of the 17 targets are on track to be achieved by 2030, and eight are going backwards. The target was to end all preventable child deaths by 2030, and cut the maternal mortality rate to less than 70 out of every 100,000 births – but the world is far off track to achieve these.

However, a series of relatively simple interventions could save the lives of millions of mothers and babies and put the world on course to achieve the SDGs related to child deaths and maternal mortality, according to the Gates Foundation’s Goalkeepers 2023 report.

The BMGF has funded research into the biggest killers of mothers and newborns – notably postpartum haemorrhage, the number-one cause of maternal death; anaemia and sepsis – and proposed a package of cost-effective measures to address these.

The key solutions involve: providing a V-shaped drape to health workers to enable them to easily measure a mother’s blood loss during and after labour; giving women in danger of haemorrhaging all five recommended treatments at once instead of sequentially; and replenishing an anaemic pregnant woman’s iron reserves via a five-minute intravenous infusion of iron.

BMGF CEO Mark Suzman said that the interventions had not been invented by his foundation, but that “somebody needed to sponsor the research to see whether, by implementing the various interventions together, you get a statistically significant outcome.”

The Foundation is currently working with the World Health Organization (WHO) to get these interventions introduced as best practices and rolled out as policy at global, regional and national levels – with the potential to save the lives of two million mothers and babies by 2030, added Suzman at a media briefing last week.

Mark Suzman, Gates CEO

PEPFAR re-authorisation

Suzman also said that his foundation was confident that the US Congress would reauthorise the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been being stalled by allegations that some PEPFAR grantees have used grants to provide and support abortion. 

“While we are concerned, we are confident and cautiously confident that the US will be providing the necessary determination,” said Suzman, who described the abortion allegations as “factually untrue”.

PEPFAR was launched in 2003 by President George W. Bush and reauthorized three times so far. According to its most recent report,  PEPFAR has saved 25 million lives primarily through its sponsorship of antiretroviral (ARV) medicine for people with HIV. Millions of people, particularly in Africa, are entirely dependent on PEPFAR for their ARVs.

The Gates Foundation has invested heavily in preventing HIV, and Suzman described PEPFAR as one of the most successful global health collaborations in recent history.

Image Credits: BMGF.

NCD
Group photo of the second annual gathering of the Global Group of Heads of State and Government for the prevention and control of NCDs at UNGA 78.

NEW YORK – With lifestyle and diet risk factors for noncommunicable diseases (NCDs) exacerbated by climate change and air pollution, a group of national and global health leaders called for more intensive action on  NCD prevention and control on the sidelines of the 78th UN General Assembly. 

“NCDs continue to be a public health threat that requires concerted efforts, great investments and prioritization to put countries back on course towards achieving global targets as we inch towards 2030,” said Kwaku Agyemang-Manu, Minister of Health of Ghana, who co-chaired the second annual gathering of the Global Group of Heads of State and Government for the prevention and control of NCDs. 

The gathering on September 21, coinciding with the UN High-Level Meeting on Universal Health Coverage, builds on the first such meeting in Accra, Ghana in 2022, which coincided with the launch of the Global NCD Compact 2020–2030.  The Compact aims to align countries around scaled-up commitments and action on the prevention and control of NCDs essential to achieving both UHC and other health-related Sustainable Development Goals (SDGs).

The meeting was convened and led by the Global Group of Heads of State and Government for the Prevention and Control of NCDs – an informal, voluntary collaboration of countries that signed onto the Global NCD Compact, and committed to developing specific national responses on NCDs, with the aim of reducing related mortality one-third by 2030 in line with SDG target 3.4. 

“You [The Global Group] are on the front line to accelerate and scale up efforts to prevent and control NCDs and mental health conditions and achieve universal health coverage in your countries. Your leadership and the public health effort taken by your countries can save tens of millions of lives in years to come,” said WHO Director-General Tedros Adhnanom Ghebreyesus in opening remarks at Thursday’s gathering. 

Speakers highlighted the progress seen and barriers faced in low- and middle-income countries and regions, with countries such as Barbados, Timor Leste, and Ghana relating stories of the national experiences in the fight against NCDs. 

Alarming Levels of NCD Risk Factors 

Unhealthy, unregulated food is one risk factor for NCDs

The latest edition of the World Health Statistics reflects alarmingly high levels of risks related to many of the key factors that contribute to NCDs, such as heart disease, hypertension, chronic respiratory disease, cancer and diabetes – which together represent some 74% of premature mortality worldwide. Those risks include tobacco and alcohol use, physical inactivity, unhealthy diets laden with sugar, salt and fats, as well as air pollution.

Nearly one in four people (22.3%) globally still use tobacco. Obesity, driven by unhealthy diets and lifestyles, has been on the rise since the 1970s, with the greatest increases in obesity levels now being seen in WHO’s Southeast Asia Region, up from 1.9% to 4.7% (an almost 150% increase) and the Western Pacific Region, up from 2.7% to 6.4% (an almost 140% increase). Hypertension is also on the rise globally, and one of the biggest drivers of deaths from cardiovascular disease. 

Every year, NCDs cause 41 million deaths worldwide, which corresponds to 74% of total deaths, including 17 million ‘premature deaths’ before the age of 70 years.  Of the premature deaths, 86% occur in low- and middle-income countries (LMICs). 

This burden is notably felt in the African region, where between 50% and 88% of deaths in at least seven African countries are due to NCDs, according to the 2022 World Health Organization (WHO) Noncommunicable Disease Progress Monitor. Around two-thirds of Africans with non-communicable diseases (NCDs) die prematurely – before the age of 70. And yet, despite this burden, there remains a large research gap on the continent. 

Climate and Air Linkage 

Prime Minister of Barbados Mia Mottley (on left) speaking at the second gathering of states aligned with the Global NCD Compact.

Additionally, climate change and air pollution add to NCD risks and burden and may worsen mental health conditions. People living with NCDs are especially vulnerable to climate- and pollution-related risks.

In their comments at the meeting, Both Norway and Barbados highlighted the need to bring the linkage between climate and health to the forefront of NCD policies. 

“The question of the effects of climate change in this context is very timely, we have to raise awareness to the threat of climate change on health, not at least on NCDs. Climate change and NCDs are interlinked in many ways,” said Ingvild Kjerkol, Minister of Health of Norway. 

She used the example of extreme heat exposure, extreme weather events, and related to that, the physical and mental stress of displacement and trauma as events that worsen NCDs. 

“The weakest are, as always, at most risk. Climate change will also produce shocks to the health system and to deal with that you need the resilience that comes from universal health coverage.”

In 98% of African countries, the future health, development and safety of children are severely threatened by the effects of climate change, said Mia Mottley, Prime Minister of Barbados, in remarks to the group. 

Mottley’s  “Bridgetown Initiative” has been advocating for creative forms of debt relief to heavily indebted developing nations in Africa and elsewhere, so as to free up funds for more investments in both health and climate.   

“Africa spends more money on debt service than it is now spending on health care. That is a completely unacceptable set of circumstances,” Mottley told the group.    

“In the context of the consequences that we expect to flow from the climate crisis, it becomes even more acute, because there has to be the capacity to respond in ways that we might not otherwise have had to do in the past because of the extreme heat, the extreme cold, extreme droughts, etc. and its impact on households and individuals.”  

Milestones of progress 

Mottley and other national leaders at the meeting provided snapshots of the recent initiatives their countries had undertaken in the fight against NCDs. 

Barbados, for instance, has committed to eliminating trans fats and partially hydrogenated oils by December 2024. They’ve also been working with the Caribbean Community (CARICOM) and the NCD Commission to address front-of-package labelling, which has challenges that Mottley acknowledges.

“[Front-of-package labelling] is one of the areas for small states that is going to be very difficult because we are not producers of goods. We are takers of goods and we therefore would wish to see a hemispheric approach or global approach to this to ensure that those goods which we import, comply with [regulations] and not simply to put regulations in place that cannot be met,” Mottley said.  

Tobacco control and physical activity in Timor Leste

Tobacco products increase the risk of coronary heart disease

In regards to tobacco control, Timor Leste’s first tobacco cessation center, opened last year, has now expanded to six more municipalities. Warning size labels on cigarette packaging have increased, as well as the tax on tobacco, which has increased five-fold, from $19/kg to $100/kg in January 2023. 

In recognition of these achievements, the Minister of Health, Dr. Odete Maria Freitas Belo, was awarded the WHO Director General’s World No Tobacco Day award back in May. 

“If we are sincere about improving the health of our people, the prevention and control of NCDs must remain a top priority,” said President of Timor Leste, José Ramos-Horta. 

He also pointed to Timor Leste’s efforts to promote more physical activity. WHO has supported the Ministry of Health in establishing open-air gymnasiums in various communities, encouraging citizens to embrace an active lifestyle. 

“Our health is decided outside the health sector on where we are born, live, work and play. The cost effective way to battle the scourge of NCDs is to move upstream on the prevention agenda. It is easier to close the tap than to mop the floor,” said Ramos-Horta.  

Vice President of Tanzania Philip Mpango pointed to rapid urbanization and changing lifestyles in Tanzania as among the reasons for the rise in NCDs in the country. While awareness-raising initiatives and early detection programs can make a difference, the fight against NCDs must be a systemic, global effort, he emphasized. 

“As we navigate these challenges, we must acknowledge that the battle against NCDs is not one that Tanzania can fight alone. It is a global issue that requires global solidarity and cooperation,” said Mpango.

“As leaders, we are duty-bound to confront this crisis head-on. Through the measures we have implemented and the support of our international community, we can turn the tide on NCDs in Tanzania and ensure a healthier future for people.”

Image Credits: Sven Petersen/Flickr, Chris Vaughan.

UN Deputy Secretary-General Amina Mohammed holds back tears after revealing that her father died from tuberculosis.

An emotional Amina Mohammed, Deputy Secretary-General of the United Nations (UN), revealed that her father had died of tuberculosis (TB) as she thanked advocates for their work to secure the adoption of the UN political declaration on TB at the high-level meeting (HLM) on Friday.

Urging UN member states to devote the necessary resources to ending one of the world’s oldest and deadliest infectious diseases, Mohammed said that her commitment to ending TB was personal.

“My commitment is my personal story: losing my father to TB at 50, 37 years ago this week,” said Mohammed, blinking away tears. 

“Today we have the tools to diagnose and treat TB, and what we need right now is a vaccine. Let’s end TB now. It is possible.”

Earlier, she described TB as “a major cause of global antibiotic resistance” and “a global health security threat” aggravated by” armed conflicts, economic upheavals and climate disasters”. 

“We must work to address the main drivers of TB: poverty, undernutrition, a lack of access to health services, the prevalence of HIV infections, diabetes, mental health and smoking,” said Mohammed.

Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General, joined TB activists chanting “Stop TB” before addressing the HLM.

None of the targets set by the previous HLM on TB in 2018 have been met, largely due to the COVID-19 pandemic, said Tedros.

Member states committed to treating 40 million people for TB between 2018 and 2022, but only 34 million people were reached (84% of target), said Tedros.

However, the biggest failure involves the target of treating 1.5 million people for multidrug or rifampicin-resistant TB  – with slightly over half this target reached (55%). 

While we have new and powerful tools we didn’t have five years ago including a rapid TB test that gives results in two hours and effective treatment “one important thing that we do not have is a new vaccine”, said Tedros.

The BCG vaccine given to infants was developed over 100 years ago and is inadequate for protecting adults and teens.

“That is why the WHO has established the TB Vaccine Accelerator Council to develop, licence and ensure equitable use of a vaccine,” said Tedros, adding that the council had met for the first time this week.

Tedros addressing the UN HLM on TB on Friday

Some new wins for TB

“This declaration contains clear targets for the fight against TB. The TB community should be proud of their amazing work done to secure these targets. However, we know commitments alone aren’t enough and declarations will gather dust without further action,” said Lucica Ditiu, executive director of the Stop TB Partnership.

“In 2018 member states promised to provide $13 billion a year in annual TB funding by 2022, yet they’re providing less than half that amount – who is accountable for the failure to follow through on this promise?”,

The declaration offers a number of new wins for patients, notably “specific, measurable and time-bound targets to find, diagnose, and treat people with TB with the latest WHO recommended tools, as well as time-bound and specific targets for funding the TB response and R&D,” according to a civil society analysis of the TB declaration,

Another big win for the TB community is stronger language around a commitment “to strengthen financial and social protections for people affected by TB and alleviate the health and non-health related financial burden of TB experienced by affected people and their families” and to ensure that by 2027 100% of people with TB “have access to a health and social benefits package so they do not have to endure financial hardship because of their illness”.

There is also the explicit recognition that it is a human right to enjoy the benefits of scientific progress.

But some key targets have also been watered down, such as the erosion of language around gender and human rights with  none of the key asks related to ensuring that all national TB responses are “equitable, inclusive, gender-sensitive, rights-based and people-centred” being secured.

The Stop TB Partnership said that it was working on translating the global targets and commitments to national level commitments,  and ensuring that civil society and TB communities have the resources and tools to ensure leaders follow through on their commitments.”

Future disruptions?

The three political declarations on health adopted this week – on pandemics, universal health coverage and tuberculosis – will be referred to the UN General Assembly for formal ratification, said UNGA president Dennis Francis. It is possible that the 11 member states including Russia, Syria and Venezuela that disputed consensus had been reached on these declarations in a letter sent to the UN Secretary General earlier this week will object then.

“Our delegations oppose any attempt to pretend to formally adopt any of the draft outcome documents in question, during the meetings scheduled for 18, 20, 21 and 22 September 2023, respectively,” the 11 warned.

“In addition, we reserve the right to take appropriate action upon the formal consideration of these four draft outcome documents in the coming weeks, after the conclusion of the High-Level Segment of the 78th Session of the General Assembly, when they must all be considered by the General Assembly in accordance with its rules of procedures.”

However, none of the 11 contested the adoption of the declarations in the HLMs despite some of them speaking during the proceedings.