Breaking: US to Exit World Health Organization, Halting Millions in Funding 21/01/2025 Maayan Hoffman President Donald Trump has signed an executive order to withdraw the United States from the World Health Organization (WHO), citing its handling of the COVID-19 pandemic and other global health crises. Trump criticised the WHO for failing to operate independently of what he called “inappropriate political influence” from its member states. He also took issue with the financial burden on the US, the organization’s largest contributor, providing about 18% of its total funding. “The World Health Organization has taken advantage of us, just like everyone else,” Trump said during the signing. “That stops now.” The WHO responded by expressing “regret” over Trump’s decision and reminding the administration that America was a founding member of the organisation in 1948 and has helped shaped WHO’s work ever since. “For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats,” the organisation said in a statement. “Together, we ended smallpox, and together we have brought polio to the brink of eradication. American institutions have contributed to and benefited from membership in WHO.” The organisation stressed the role it plays in protecting health and security for everyone, including Americans, “by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go.” The withdrawal will take effect in 12 months, with the US ceasing all financial contributions to the agency’s $6.8 billion 2024–2025 budget. Trump argued that the organisation demanded “unfairly excessive payments” from the U.S., especially compared to contributions from other major nations, such as China. This is a developing story. WHO Calls on ‘All Parties’ to Honor Gaza Ceasefire and Hostage Release Deal 20/01/2025 Elaine Ruth Fletcher Moment at which three Israeli hostages, Doron Steinbrecher, Romi Gonen and Emily Damari, are turned over by Hamas to the Red Cross in Gaza City on Sunday. WHO welcomed Sunday’s Israel-Hamas ceasefire and hostage release deal as the first Israeli hostages – three young women – were released to the Red Cross amidst throngs of masked Hamas operatives, who brandished guns atop the Red Cross vehicles and fired shots at times into the air to ward off the crowds of people that gathered to watch the handoff in Gaza City. Footage of the Al-Qassam Brigade (Hamas’ military wing) handing over 3 female Israeli hostages to the Red Cross as part of the ceasefire deal with Israel Hamas’ objective of using Israeli captives as bargaining chips to secure the release of just some of the thousands of… pic.twitter.com/S1WWrbVU4K — Going Underground (@GUnderground_TV) January 19, 2025 The Israeli hostage release, followed by Israel’s release of some 90 Palestinian prisoners, all women and minors, came as the shaky ceasefire deal took effect on Sunday. The deal ushered in a 42-day halt in the fighting and a partial Israeli military withdrawal away from Gaza’s dense population centers and parts of Gaza’s Rafah crossing to Egypt – which is supposed to be accompanied by a massive surge in humanitarian aid. The six week-long period is supposed to see the release of some 33 Israeli hostages in all, including remaining women, children and elderly hostages, some already presumed dead, along with more than 1700 Palestinian prisoners from Israeli jails. Negotiations that will continue during the first phase are supposed to lead to a second stage, including what Qatari mediators have described as a complete Israeli military withdrawal from Gaza and the release of the remaining 65 Israeli and foreign hostages, all men, as well as several thousand more Palestinian prisoners in Israeli jails. “The ceasefire in #Gaza and the start of the hostage and prisoner release process bring great hope for millions of people whose lives have been ravaged by the conflict,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post. “It is a moment I have been calling and hoping for.” “However, addressing the massive health needs and restoring the health system in Gaza will be a complex and challenging task, given the scale of destruction, operational complexity and constraints involved,” said Tedros, citing a lengthy WHO statement focused on the challenges of Gaza reconstruction. Tent camps of displaced Gazans amidst piles of garbage, and contaminated water supplies, raises infectious disease risks. WHO European Region release separate statement on Israeli hostages release In a separate statement, WHO’s European region welcomed the release of “WHO welcomes the release of traumatized hostages taken from Israel, after enduring 470 days of brutal captivity in Gaza.” It was a rare WHO statement on the hostage situation in a conflict where the deaths of over 46,000 Palestinians in Gaza, and it’s near physical destruction, has overshadowed the plight of Israeli hostages held by Hamas since their bloody 7 October, 2023 incursion into Israeli border communities that killed nealry 1200 people and took over 240 captive. “WHO is acutely aware that the hostages face complex mental and physical health needs and may take years to recover. The families of hostages also require sensitive mental health care,” said the WHO European Region statement. “WHO is reassured that Israel – a WHO/Europe Member State – possesses the resources and relevant expertise to respond to the medical, mental, and nutritional challenges to restore the health of the hostages, and the well-being of their families. “In Gaza, WHO and partners are scaling up operations to deliver critical medical supplies and resources, addressing urgent health needs and contributing to recovery efforts including the process of rebuilding the shattered health system,” the WHO European statement also said. “We reaffirm our readiness to support affected communities on all sides.” Fears of potential breakdown in ceasefire running high Fears about a potential breakdown in the ceasefire arrangements have been running high on all sides as armed Hamas fighters emerged from refugee encampments and hospital compounds in a visible display of force. Meanwhile, Israel’s hard-right politicians vowed that the country would return to fight Hamas in Gaza to its total destruction, following the initial six-week cease fire period. Aljazeera documented how Hamas’s al-Qassam Brigade fighters emerged from the Nasser Hospital complex with their weapons and vehicles in Khan Younis, southern Gaza, as soon as the ceasefire went into effect, similar to how they emerged from displacement tents 3 days ago. pic.twitter.com/7rYftKYBlS — Ahmed Fouad Alkhatib (@afalkhatib) January 19, 2025 A third phase of the cease fire deal, if finalized,l is supposed to see a permanent cessation of the conflict, opening the way for the massive task of rebuilding Gaza’s shattered housing, education, water and sanitation infrastructure. It’s estimated that more than 90% of the enclave’s two million Palestinians have been displaced from their homes – many of which no longer exist at all. And rebuilding the health infrastructure, alone, will cost an estimated $10 billion, according to initial estimates by WHO, with only about one-half of the enclaves hospital’s functioning, even partly, and most of the primary health care system destroyed. “More than 46 600 people have been killed and over 110 000 have been injured. The real figures are likely much higher,” the WHO HQ statement noted. “Only half of Gaza’s 36 hospitals remain partially operational, nearly all hospitals are damaged or partly destroyed, and just 38% of primary health care centres are functional. “An estimated 25% of those injured – around 30 000 people – face life-changing injuries and will need ongoing rehabilitation. Specialized health care is largely unavailable, medical evacuations abroad are extremely slow. Transmission of infectious diseases has massively increased, malnutrition is rising, and the risk of famine persists. The breakdown of public order, exacerbated by armed gangs, raises further concerns.” Indeed, the elephant in the room remains the governance of Gaza. In his final press conference last week, outgoing US Secretary of State Anthony Blinken, a key architect of the deal, said that Gaza should not be left in Hamas hands, leaving Israel open for future missile attacks and border threats such as the ones experienced on 7 October 2023 and since. That stance has been echoed by members of new US President Donald Trump’s incoming administration. But much-discussed proposals for turning Gaza’s governance over to a regional coalition or back to the internationally-recognized Palestinian Authority have failed to pick up steam – partly due to the PA’s own record of corruption and ineffectual government, as well as it’s lack of regional political support. And so as the fragile cease-fire took hold, the Islamist group that has controlled the 365 square kilometer enclave for nearly 20 years, remains the only visible Palestinian force on the ground. Image Credits: @nabilajamal, UNRWA . Tanzania Confirms Marburg Outbreak 20/01/2025 Kerry Cullinan Health workers during a Marburg outbreak Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. “Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. “We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.” Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories. Emergency funds Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country. “Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing. “Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added. The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country. “ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC. “To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya. “Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”. Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda. Image Credits: WHO. WHO Africa Re-opens Nominations for Regional Director 20/01/2025 Kerry Cullinan & Paul Adepoju Dr Matshidiso Moeti, outgoing Africa regional director The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board. According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February. A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board. Fast-tracked The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations. Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. “This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week. “If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed. However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution. The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges. Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee. The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022. Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC). Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership. Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health. Is ‘White Saviorism’ Blocking Progress in Global Health? 18/01/2025 Maayan Hoffman How do you define “white saviorism?” According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.” This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them. In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said. Quote by Themrise Khan on the Global Health Matters podcast Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan. Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system. Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations. One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded. “The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said. So, is there hope for change? While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: TDR | Global Health Matters Podcast. Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Calls on ‘All Parties’ to Honor Gaza Ceasefire and Hostage Release Deal 20/01/2025 Elaine Ruth Fletcher Moment at which three Israeli hostages, Doron Steinbrecher, Romi Gonen and Emily Damari, are turned over by Hamas to the Red Cross in Gaza City on Sunday. WHO welcomed Sunday’s Israel-Hamas ceasefire and hostage release deal as the first Israeli hostages – three young women – were released to the Red Cross amidst throngs of masked Hamas operatives, who brandished guns atop the Red Cross vehicles and fired shots at times into the air to ward off the crowds of people that gathered to watch the handoff in Gaza City. Footage of the Al-Qassam Brigade (Hamas’ military wing) handing over 3 female Israeli hostages to the Red Cross as part of the ceasefire deal with Israel Hamas’ objective of using Israeli captives as bargaining chips to secure the release of just some of the thousands of… pic.twitter.com/S1WWrbVU4K — Going Underground (@GUnderground_TV) January 19, 2025 The Israeli hostage release, followed by Israel’s release of some 90 Palestinian prisoners, all women and minors, came as the shaky ceasefire deal took effect on Sunday. The deal ushered in a 42-day halt in the fighting and a partial Israeli military withdrawal away from Gaza’s dense population centers and parts of Gaza’s Rafah crossing to Egypt – which is supposed to be accompanied by a massive surge in humanitarian aid. The six week-long period is supposed to see the release of some 33 Israeli hostages in all, including remaining women, children and elderly hostages, some already presumed dead, along with more than 1700 Palestinian prisoners from Israeli jails. Negotiations that will continue during the first phase are supposed to lead to a second stage, including what Qatari mediators have described as a complete Israeli military withdrawal from Gaza and the release of the remaining 65 Israeli and foreign hostages, all men, as well as several thousand more Palestinian prisoners in Israeli jails. “The ceasefire in #Gaza and the start of the hostage and prisoner release process bring great hope for millions of people whose lives have been ravaged by the conflict,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in an X post. “It is a moment I have been calling and hoping for.” “However, addressing the massive health needs and restoring the health system in Gaza will be a complex and challenging task, given the scale of destruction, operational complexity and constraints involved,” said Tedros, citing a lengthy WHO statement focused on the challenges of Gaza reconstruction. Tent camps of displaced Gazans amidst piles of garbage, and contaminated water supplies, raises infectious disease risks. WHO European Region release separate statement on Israeli hostages release In a separate statement, WHO’s European region welcomed the release of “WHO welcomes the release of traumatized hostages taken from Israel, after enduring 470 days of brutal captivity in Gaza.” It was a rare WHO statement on the hostage situation in a conflict where the deaths of over 46,000 Palestinians in Gaza, and it’s near physical destruction, has overshadowed the plight of Israeli hostages held by Hamas since their bloody 7 October, 2023 incursion into Israeli border communities that killed nealry 1200 people and took over 240 captive. “WHO is acutely aware that the hostages face complex mental and physical health needs and may take years to recover. The families of hostages also require sensitive mental health care,” said the WHO European Region statement. “WHO is reassured that Israel – a WHO/Europe Member State – possesses the resources and relevant expertise to respond to the medical, mental, and nutritional challenges to restore the health of the hostages, and the well-being of their families. “In Gaza, WHO and partners are scaling up operations to deliver critical medical supplies and resources, addressing urgent health needs and contributing to recovery efforts including the process of rebuilding the shattered health system,” the WHO European statement also said. “We reaffirm our readiness to support affected communities on all sides.” Fears of potential breakdown in ceasefire running high Fears about a potential breakdown in the ceasefire arrangements have been running high on all sides as armed Hamas fighters emerged from refugee encampments and hospital compounds in a visible display of force. Meanwhile, Israel’s hard-right politicians vowed that the country would return to fight Hamas in Gaza to its total destruction, following the initial six-week cease fire period. Aljazeera documented how Hamas’s al-Qassam Brigade fighters emerged from the Nasser Hospital complex with their weapons and vehicles in Khan Younis, southern Gaza, as soon as the ceasefire went into effect, similar to how they emerged from displacement tents 3 days ago. pic.twitter.com/7rYftKYBlS — Ahmed Fouad Alkhatib (@afalkhatib) January 19, 2025 A third phase of the cease fire deal, if finalized,l is supposed to see a permanent cessation of the conflict, opening the way for the massive task of rebuilding Gaza’s shattered housing, education, water and sanitation infrastructure. It’s estimated that more than 90% of the enclave’s two million Palestinians have been displaced from their homes – many of which no longer exist at all. And rebuilding the health infrastructure, alone, will cost an estimated $10 billion, according to initial estimates by WHO, with only about one-half of the enclaves hospital’s functioning, even partly, and most of the primary health care system destroyed. “More than 46 600 people have been killed and over 110 000 have been injured. The real figures are likely much higher,” the WHO HQ statement noted. “Only half of Gaza’s 36 hospitals remain partially operational, nearly all hospitals are damaged or partly destroyed, and just 38% of primary health care centres are functional. “An estimated 25% of those injured – around 30 000 people – face life-changing injuries and will need ongoing rehabilitation. Specialized health care is largely unavailable, medical evacuations abroad are extremely slow. Transmission of infectious diseases has massively increased, malnutrition is rising, and the risk of famine persists. The breakdown of public order, exacerbated by armed gangs, raises further concerns.” Indeed, the elephant in the room remains the governance of Gaza. In his final press conference last week, outgoing US Secretary of State Anthony Blinken, a key architect of the deal, said that Gaza should not be left in Hamas hands, leaving Israel open for future missile attacks and border threats such as the ones experienced on 7 October 2023 and since. That stance has been echoed by members of new US President Donald Trump’s incoming administration. But much-discussed proposals for turning Gaza’s governance over to a regional coalition or back to the internationally-recognized Palestinian Authority have failed to pick up steam – partly due to the PA’s own record of corruption and ineffectual government, as well as it’s lack of regional political support. And so as the fragile cease-fire took hold, the Islamist group that has controlled the 365 square kilometer enclave for nearly 20 years, remains the only visible Palestinian force on the ground. Image Credits: @nabilajamal, UNRWA . Tanzania Confirms Marburg Outbreak 20/01/2025 Kerry Cullinan Health workers during a Marburg outbreak Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. “Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. “We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.” Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories. Emergency funds Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country. “Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing. “Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added. The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country. “ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC. “To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya. “Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”. Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda. Image Credits: WHO. WHO Africa Re-opens Nominations for Regional Director 20/01/2025 Kerry Cullinan & Paul Adepoju Dr Matshidiso Moeti, outgoing Africa regional director The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board. According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February. A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board. Fast-tracked The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations. Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. “This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week. “If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed. However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution. The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges. Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee. The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022. Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC). Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership. Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health. Is ‘White Saviorism’ Blocking Progress in Global Health? 18/01/2025 Maayan Hoffman How do you define “white saviorism?” According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.” This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them. In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said. Quote by Themrise Khan on the Global Health Matters podcast Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan. Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system. Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations. One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded. “The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said. So, is there hope for change? While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: TDR | Global Health Matters Podcast. Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Tanzania Confirms Marburg Outbreak 20/01/2025 Kerry Cullinan Health workers during a Marburg outbreak Tanzania has confirmed an outbreak of Marburg virus disease in the northwestern Kagera region after one case tested positive for the virus following investigations and laboratory analysis of suspected cases of the disease. Tanzanian President Samia Suluhu Hassan announced this during a press briefing on Monday with World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. “Laboratory tests conducted at Kabaile Mobile Laboratory in Kagera and later confirmed in Dar es Salaam identified one patient as being infected with the Marburg virus. Fortunately, the remaining suspected patients tested negative,” the president said from the country’s capital, Dodoma. A total of 25 suspected cases have been reported, all of whom have tested negative and are currently under close follow-up, the president said. The cases were reported in Biharamulo district in Kagera. “We have demonstrated in the past our ability to contain a similar outbreak and are determined to do the same this time around,” added the president. “We have resolved to reassure the general public in Tanzania and the international community as a whole of our collective determination to address the global health challenges, including the Marburg virus disease.” Last week, Tanzanian health authorities disputed a WHO report of a suspected outbreak, noting that five suspected cases had tested negative in its laboratories. Emergency funds Tedros announced that he has made $3 million available from the WHO Contingency Fund for Emergencies to assist Tanzania in addressing the outbrea, and pledged the WHO’s support for the country. “Since the first suspected cases of Marburg were reported earlier, Tanzania has scaled up its response by enhancing case detection, setting up treatment centres and a mobile laboratory for testing samples, and deploying national response teams,” Tedros told the media briefing. “Tanzania has gained strong experience in controlling Marburg as this is the second reported outbreak of the disease in Kagera. The first outbreak was almost two years ago, in March 2023, in which a total of nine cases and six deaths were reported,” he added. The Africa Centres for Disease Control and Prevention (Africa CDC) also pledged support for the country. “ A team of 12 public health experts will be deployed as part of an advance mission in the next 24 hours. The multidisciplinary team includes epidemiologists, risk communication, infection prevention and control (IPC), and laboratory experts to provide on-ground support for surveillance, IPC, diagnostics, and community engagement,” said Africa CDC. “To support the government’s efforts, we are committing $2 million to bolster immediate response measures, including deploying public health experts, strengthening diagnostics, and enhancing case management,” said Africa CDC Director General Dr Jean Kaseya. “Building on Tanzania’s commendable response during the 2023 outbreak, we are confident that swift and decisive action, combined with our support and those of other partners, will bring this outbreak under control.”. Marburg virus, a highly infectious and often fatal disease, is similar to Ebola and is transmitted to humans from fruit bats. It spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Although several promising candidate medical countermeasures are currently undergoing clinical trials, there currently is no licensed treatment or vaccine for Marburg. However, early access to treatment and supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival. Previous outbreaks and cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, Rwanda, South Africa and Uganda. Image Credits: WHO. WHO Africa Re-opens Nominations for Regional Director 20/01/2025 Kerry Cullinan & Paul Adepoju Dr Matshidiso Moeti, outgoing Africa regional director The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board. According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February. A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board. Fast-tracked The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations. Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. “This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week. “If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed. However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution. The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges. Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee. The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022. Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC). Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership. Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health. Is ‘White Saviorism’ Blocking Progress in Global Health? 18/01/2025 Maayan Hoffman How do you define “white saviorism?” According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.” This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them. In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said. Quote by Themrise Khan on the Global Health Matters podcast Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan. Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system. Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations. One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded. “The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said. So, is there hope for change? While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: TDR | Global Health Matters Podcast. Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Africa Re-opens Nominations for Regional Director 20/01/2025 Kerry Cullinan & Paul Adepoju Dr Matshidiso Moeti, outgoing Africa regional director The World Health Organization (WHO) Regional Committee for Africa resolved to reopen nominations for a regional director at a special session last week. This follows the unexpected passing of director-elect Dr Faustine Ndugulile in November 2024. He was due to assume the post in February once his election had been confirmed by the WHO Executive Board. According to the resolution passed by the regional committee, member states will receive a letter from the WHO Director-General by tomorrow (21 January) inviting them to nominate candidates by 28 February. A virtual live candidates’ forum is planned for 2 April. Thereafter, the region has requested the Director General to convene an in-person special session of the Regional Committee in Geneva on 18 May for member states to elect the next Regional Director who will then be nominated to the Executive Board. Fast-tracked The fast-tracked process requires the suspension of Rule 52 of the region’s election procedures, which mandates a process of no less than six months for nominations. Derek Walton, WHO legal counsel in Geneva, confirmed that the regional committee had determined the next steps, with a final selection in May during another special session of the Regional Committee for Africa. “This session will be held just before the World Health Assembly, and at that point, the committee will make a fresh nomination for the position of Regional Director,” Walton told Health Policy Watch last week. “If all goes to plan, we should have a new Regional Director for Africa in place by 1 June,” Walton confirmed. However, the regional director-elect will still need to be formally appointed by the WHO Executive Board when it meets in February 2026, according to the region’s resolution. The role of WHO Regional Director for Africa is crucial in guiding the organization’s public health efforts across the continent, including responses to disease outbreaks, strengthening health systems, and implementing WHO policies tailored to African health challenges. Ndugulile secured 25 of the 46 votes at the WHO Africa regional conference in the Republic of Congo, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). A former deputy health minister and ICT minister in Tanzania, Ndugulile represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee. The three candidates could be renominated by their respective countries. Socé Fall is currently Director of the Department of Control of Neglected Tropical Diseases at WHO headquarters in Geneva. Mihigo is the vaccine alliance, Gavi’s Senior Director of Programmatic and Strategic Engagement with the African Union and Africa CDC, but worked for WHO Africa until March 2022. Sambo serves as the WHO’s Head of Mission and Representative to the Democratic Republic of the Congo (DRC). Whoever is ultimately selected will have big shoes to fill, succeeding Matshidiso Moeti, who is retiring after making a name for herself during the COVID pandemic. She was also the first female Regional Director for WHO AFRO, leaving behind a legacy of resilience and leadership. Africa faces numerous public health challenges, including infectious disease outbreaks, vaccine distribution disparities, and the worsening effects of climate change on health. Is ‘White Saviorism’ Blocking Progress in Global Health? 18/01/2025 Maayan Hoffman How do you define “white saviorism?” According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.” This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them. In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said. Quote by Themrise Khan on the Global Health Matters podcast Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan. Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system. Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations. One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded. “The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said. So, is there hope for change? While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: TDR | Global Health Matters Podcast. Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Is ‘White Saviorism’ Blocking Progress in Global Health? 18/01/2025 Maayan Hoffman How do you define “white saviorism?” According to Themrise Khan, white saviorism is “imprinted psychologically in the minds of anyone who wants to be a saviour, anyone who thinks that they are superior to others and thinks that it is only them who can bring betterment into the lives of others.” This phenomenon often manifests in the global health system when researchers, scientists, and even NGO staff and volunteers from the Global North parachute into the Global South, attempting to “save” people without genuinely collaborating with them. In simpler terms, white saviorism is “the idea of how the white industrialised Western world wants to save the non-Western marginalised world,” Khan said. Quote by Themrise Khan on the Global Health Matters podcast Khan, a Pakistani independent development professional and researcher with nearly 30 years of experience in international development, aid effectiveness, gender, and global migration, recently discussed this topic on the Dialogues segment of the Global Health Matters podcast with Dr. Garry Aslanyan. Khan said that little to no progress has been made in the decolonization of healthcare, largely due to the pervasive influence of white saviorism. She believes the only way forward is to “burn it all down” and start afresh, emphasizing the need for a complete overhaul of the system. Khan is also the co-editor of the book Preventing the next pandemic, White Saviorism in International Development: Theories, Practices and Lived Experiences. In both the book and the podcast, she provides specific examples of how white saviorism impacts autonomy, perpetuates global power imbalances, and shapes race relations. One striking example she shared involved visits from white Westerners to her community to oversee projects they had funded. “The white foreigner who had all the money, who was coming in with the money to make sure that everything was going well so they could continue getting the money, was the one who was feted like royalty. That really stuck out for me in terms of how international development as a profession has created this dynamic of royalty versus the people,” Khan said. So, is there hope for change? While Khan describes herself as inherently pessimistic, she explained that her call to “burn it all down” is not entirely negative. On the contrary, she believes that embracing this concept allows us to “rebuild properly again, so there is hope in that.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: TDR | Global Health Matters Podcast. Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Bangladesh to Investigate Appointment of WHO Regional Director for South East Asia 17/01/2025 Kerry Cullinan & Chetan Bhattacharji Saima Wazed, Regional Director for WHO SEARO with Dr Tedros Adhanom Ghebreyesus, WHO-Director General, during her swearing in ceremony in January 2024. As Bangladesh presses for its former prime minister, Sheikh Hasina, to be extradited to face charges of human rights abuses, her daughter, the World Health Organization (WHO) regional director for South East Asia (SEARO), is also under scrutiny. Saima Wazed was elected to the WHO position by regional leaders in November 2023 amid allegations that her mother had improperly influenced the election process. Last August, Hasina fled the country after a revolt against her government following its harsh crackdown on student protests. She is currently in India as is her daughter, who is based at the WHO SEARO office in New Delhi. This week the director of Bangladesh’s Anti-Corruption Commission (ACC), General Akhtar Hossain, confirmed to The Business Standard that his commission’s probe into Hasina would include Wazed’s election. Hossain told the newspaper that corruption was suspected to be involved in Wazard’s appointment. SEARO has 11 member countries including India and Pakistan, yet only tiny Nepal put up a candidate to contest for the regional director position. In an article published by Health Policy Watch before Wazed’s election by member states, public health specialist Mukesh Kapila noted that her own capability statement “does not reveal the ‘strong technical and public health background and extensive experience in global health’, required by the official criteria for the role”. Neither did she have “the mandatory substantive track record in public health leadership and significant competencies in organisational management”, required by WHO. “But being introduced by her mother at recent high-level summits such as BRICS, ASEAN, G20 and the UN General Assembly to craft deals in exchange for votes may be seen as crossing the fine line between a government’s legitimate lobbying for its candidate and craven nepotism,” Kapila wrote. Wazed is a psychologist with a special interest in autism. Code of conduct The 2024 Executive Board recommended that the code of conduct of all regional directors should be expanded to include provisions on “sexual misconduct and other abusive conduct and a disclosure of interests by candidates”, more stringent reference checks and due diligence review of qualifications and employment history. It also recommended that nominating member states should “disclose grants or aid funding for candidates” in the two years before their appointment. In response to the news reports that Wazed’s appointment was being investigated, the WHO said: “If there are allegations of wrongdoing by or within a member state in connection with a WHO election campaign, it is appropriate for these to be investigated by the competent national authorities. We would not comment on such investigations or any consequential legal processes while they are ongoing.” According to Article 52 of the WHO Constitution, regional directors are appointed by the WHO’s Executive Board, “in agreement with the regional committee”. A note from the WHO’s legal counsel flags that, despite a decision by the 2012 World Health Assembly, to implement “a process for the assessment of all candidates’ qualifications”, only the European Region has done so. Image Credits: X, X/Saima Wazed. WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WEF: Armed Conflict, Environment Are Key Concerns of Global Leaders 15/01/2025 Kerry Cullinan A Palestinian child in the rubble of a bombed building in Gaza. State-based armed conflict is the Number 1 current concern of respondents. Armed conflict, mis- and disinformation and environmental risk dominate the World Economic Forum’s (WEF) Global Risks Report, released on Wednesday. The report, released on the eve of WEF’s annual meeting in Davos next week, is based on a Global Risks Perception Survey (GRPS) of over 900 global leaders in academia, business, government and civil society polled in September and October 2024. “We seem to be living in one of the most divided times since the Cold War,” the report notes. “Over the last year, we have witnessed the expansion and escalation of conflicts, a multitude of extreme weather events amplified by climate change, widespread societal and political polarisation, and continued technological advancements accelerating the spread of false or misleading information.”. The survey results reveal a bleak outlook across all periods respondents were questioned about – current, short-term and long-term. Current risks State-based armed conflict is the most pressing immediate global risk for 2025, according to the respondents. “The current geopolitical climate, following Russia’s invasion of Ukraine and with wars raging in the Middle East and in Sudan, makes it nearly impossible not to think about such events when assessing the one global risk expected to present a material crisis in 2025,” the report notes. The “escalation pathways” for conflict in Ukraine and the Middle East depend on how the new Trump administration in the United States (US) responds, the report notes. “Will the US take a firmer stance towards Russia, counting on such a move acting as a deterrent to further Russian escalation, and/or will it increase pressure on Ukraine, including reducing financial support?” it asks. “The spectrum of possible outcomes over the next two years is wide, ranging from further escalation, perhaps also involving neighbouring countries, to uneasy agreement to freeze the conflict.” In the Middle East, an escalation of Iran-Israel conflict will draw the US in more and “generate more long-term instability in the entire region, including the Gulf economies, where US military bases could become targets”. Conflict over Taiwan also cannot be ruled out, it notes. “The growing vacuum in ensuring global stability at a multilateral level will lead governments around the world increasingly to take national security matters into their own hands,” it warns. Extreme weather events and “geo-economic confrontation” are the next biggest current concerns. Short-term risks Misinformation and disinformation remain the top short-term risks for the second consecutive year, posing risks to “societal cohesion and governance by eroding trust and exacerbating divisions within and between nations”. The report also notes that it is “becoming more difficult to differentiate between AI- and human-generated misinformation and disinformation”, and that AI tools are enabling “a proliferation in such information”. Extreme weather events, state-based armed conflict, societal polarisation, cyber-espionage and warfare are other key risks over the next two years. Pollution is ranked the sixth biggest risk. To complement the GRPS short-term (two-year) data, the report also draws on the WEF’s Executive Opinion Survey (EOS) to identify risks to specific countries over the next two years, as identified by over 11,000 business leaders in 121 economies. Longer-term risks Environmental risks dominate the longer-term, 10-year outlook, with extreme weather events, biodiversity loss and ecosystem collapse, critical change to Earth systems and natural resources shortages leading the 10-year risk rankings. There was near-unanimous identification of “extreme weather events” as the biggest threat in the coming decade across the different stakeholder groups and regions surveyed. The third highest risk, critical changes to the Earth systems, covers issues such as sea level rise from collapsing ice sheets, carbon release from thawing permafrost, and disruption of oceanic or atmospheric currents. While pollution ranked 10th, younger people were much more concerned with this and those under the age of 30 listed it as their third biggest threat. Extreme weather events are becoming more common and expensive, with the cost per event having increased nearly 77% (inflation-adjusted) over the last 50 years, the report notes. Biodiversity loss and ecosystem collapse has “experienced one of the largest increases in ranking among all risks, moving from number 37 in 2009 to number 2 in 2025”, the report notes. “Respondents are far less optimistic about the outlook for the world over the longer term than the short term,” according to a media release from WEF. “Nearly two-thirds of respondents anticipate a turbulent or stormy global landscape by 2035, driven in particular by intensifying environmental, technological and societal challenges.” Global fragmentation However, the WEF warns that, as experts anticipate “a fragmented global order marked by competition among middle and great powers”, multilateralism will face ‘significant strain”. But in response, the WEF urges leaders to “rebuild trust, enhance resilience, and secure a sustainable and inclusive future for all” by prioritising dialogue, strengthening international ties and fostering conditions for renewed collaboration. “Rising geopolitical tensions and a fracturing of trust are driving the global risk landscape” notes WEF’s managing director, Mirek Dušek. “In this complex and dynamic context, leaders have a choice: to find ways to foster collaboration and resilience, or face compounding vulnerabilities.” Ironically, WEF’s Davos meeting, themed “Collaboration for the Intelligent Age”, opens on the same day as the inauguration of US President-Elect Donald Trump, who is widely predicted to disrupt multilateral organisations and deepen global divisions. Image Credits: UNICEF/UNI501989/Al-Qattaa. Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Experts Propose New Criteria for Diagnosing Obesity 15/01/2025 Kerry Cullinan Obesity is growing fastest among children and adolescents Diagnosing obesity should extend beyond body mass index (BMI) to include measures such as waist circumference and individual physical symptoms. So says the Commission on Clinical Obesity, comprising 58 experts from a range of medical institutions and countries in an article published in Tuesday’s The Lancet Diabetes & Endocrinology. There has long been a debate in the medical fraternity about whether obesity is a disease itself, or a cause of disease. The commission introduces a definition for “clinical obesity” which it classifies as a disease, but argues that its diagnosis should be far more nuanced than BMI. BMI should rather be used to screen for obesity. It also introduces “pre-clinical obesity”, which is associated with a variable level of health risk, but no ongoing illness. All-or-nothing “The question of whether obesity is a disease is flawed because it presumes an implausible all-or-nothing scenario where obesity is either always a disease or never a disease,” says commission chair Professor Francesco Rubino. “Evidence, however, shows a more nuanced reality. Some individuals with obesity can maintain normal organs’ function and overall health, even long term, whereas others display signs and symptoms of severe illness here and now,” adds Rubino, from the School of Cardiovascular and Metabolic Medicine and Sciences a King’s College in London. “Considering obesity only as a risk factor, and never a disease, can unfairly deny access to time-sensitive care among people who are experiencing ill health due to obesity alone,” he adds. “On the other hand, a blanket definition of obesity as a disease can result in overdiagnosis and unwarranted use of medications and surgical procedures, with potential harm to the individual and staggering costs for society.” Nuanced approach The commission defines “clinical obesity” as being associated with “symptoms of reduced organ function, or significantly reduced ability to conduct standard day-to-day activities, such as bathing, dressing, eating and continence, directly due to excess body fat”. The Commission sets out 18 diagnostic criteria for clinical obesity in adults and 13 specific criteria for children and adolescents. These include breathlessness, obesity-induced heart failure, knee or hip pain, with joint stiffness and reduced range of motion as a direct effect of excess body fat on the joints. Pre-clinical obesity is defined as “obesity with normal organ function”. “People living with pre-clinical obesity do not have ongoing illness, although they have a variable but generally increased risk of developing clinical obesity and several other non-communicable diseases (NCDs) in the future,” according to the commission BMI limitations Although BMI is useful for identifying individuals at increased risk of health issues, the commission stresses that BMI is “not a direct measure of fat, does not reflect its distribution around the body and does not provide information about health and illness at the individual level”. “Relying on BMI alone to diagnose obesity is problematic as some people tend to store excess fat at the waist or in and around their organs, such as the liver, the heart or the muscles, and this is associated with a higher health risk compared to when excess fat is stored just beneath the skin in the arms, legs or in other body areas,” says commissioner Professor Robert Eckel. “But people with excess body fat do not always have a BMI that indicates they are living with obesity, meaning their health problems can go unnoticed,” adds Eckel, who is from the University of Colorado Anschutz Medical Campus in the US. “Additionally, some people have a high BMI and high body fat but maintain normal organ and body functions, with no signs or symptoms of ongoing illness,” Appropriate care “This nuanced approach to obesity will enable evidence-based and personalised approaches to prevention, management and treatment in adults and children living with obesity, allowing them to receive more appropriate care, proportional to their needs. This will also save healthcare resources by reducing the rate of overdiagnosis and unnecessary treatment,” says Commissioner Professor Louise Baur from the University of Sydney, Australia. Image Credits: Commons . If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
If US Pulls Out of WHO, Will Other Member States Step Up? 14/01/2025 Kerry Cullinan A motley alliance of organisations converged on Geneva in June 2024 to protest against the WHO and its pandemic agreement, urging their governments to pull out of the global health body. Now the US president-elect is poised to do just that. If the United States withdraws from the World Health Organization (WHO) when Donald Trump assumes the presidency next week (20 January), will other member states – particularly China – step up to safeguard global health? “The signs coming out of Trump’s transition team paint a bleak picture for the WHO. Trump tried to pull out of WHO during his first term, and his surrogates have strongly suggested that he will complete a US withdrawal during his second term. That could come as early as Day One,” says Professor Lawrence Gostin, O’Neill Chair in Global Health Law at Georgetown University. According to US law, the president has to give a year’s written notice of the withdrawal in a letter to the United Nations (UN) Secretary-General. “But instead of sending a letter, I hope he will do a deal. That deal might mean continued US membership and funding in exchange for significant reforms of WHO such as increased transparency and accountability,” Gostin told Health Policy Watch. However, he concedes that “most indications are that he will withdraw”, describing this as “catastrophic for the WHO, as well as US security”. “The world would be far less safe without WHO. And a US withdrawal would make Americans far more vulnerable to pandemic threats. I cannot imagine a world in which we do not have an empowered WHO.” US is by far largest donor The WHO’s budget for the two-year 2024-2025 period is $6.83 billion, made up of assessed and voluntary contributions. Assessed contributions are the mandatory membership fees calculated by the UN, based largely on countries’ gross domestic product (GDP). Of the 194 WHO member states, the US is by far the largest funder. It is due to pay over $261 million in “assessed contributions” during 2024/5. US contribution to WHO in the 2024-25 biennium China, the second-largest contributor in terms of assessed contributions, is due to pay $181 million for the period. As China is still classified as a “developing country”, it benefits from lower rates. But assessed contributions only cover around 20% of the budget, with the bulk coming from voluntary contributions, most of which are earmarked for specific programmes. Here the US runs rings around China. In 2023, the US made voluntary contributions to WHO amounting to over $367 million. In comparison, China’s paltry offering was slightly less than $4 million. China’s contribution to WHO in the 2024-2025 biennium Not even during the COVID-19 pandemic, widely regarded to have started in China, did that country make any significant contribution to WHO. When assessed and voluntary contributions are combined, the European Commission, Germany and the United Kingdom all contribute more to the WHO than China. Ironically, when Trump tried to pull out of the WHO in 2020, he claimed it was because China had “total control” over the global body. Yet from its low financial investment and the demure conduct of its WHO representatives, China does not seem that interested in the global body. WHO’s top 25 donors for 2024/25 China favours bilateralism Chinese President Xi Jinping boasted this week that his country has $1 trillion trade surplus, so China is better positioned than most other member states to step up to fill the gaping hole the US withdrawal will leave. But China has shown little interest in supporting global health multilateralism. Its interactions at the WHO are muted and lack initiative. In negotiations for a pandemic agreement, for example, the Chinese representatives have situated themselves with the group of countries advocating for equitable access to pandemic-related products, but its representatives seldom make significant proposals. Instead, China prefers bilateral agreements which enable it to wield direct influence over the countries it assists, “[China] is active in bilateral collaboration, South-South collaboration and the Belt Road Initiative, and has dispatched medical teams, built infrastructure and provided assistance with health technology overseas,” according to academics from China and Thailand in Journal of Global Health article. “Despite its bilateral health initiatives, China has invested little in established multilateralism mechanisms. Although several university global health institutes have been established, China’s participation on the global health stage, such as at the World Health Assembly, has been limited.” While the US also uses bilateralism as a political tool to ensure support and loyalty, it has simultaneously asserted its dominance on the global stage through multilateral bodies of the UN. Europe is preoccupied by Ukraine; turns to the right Europe is also unlikely to come to the aid of the WHO. The region is preoccupied with, and financially stretched by, Russia’s war in Ukraine. “Since the start of the war, the EU and our member states have made available over $140 billion in financial, military, humanitarian, and refugee assistance,” according to the EU. With Trump’s threat to end US military assistance to Ukraine, the EU may feel compelled to increase its financial support to Ukraine. In addition, key European nations that have supported multilateralism in the past now have right-wing parties within government intent on slashing foreign aid. Croatia, the Czech Republic, Finland, Italy, the Netherlands and Slovakia join Hungary as right-wing ruled countries. In virtually all other European countries, support for right-wing parties has grown considerably – most notably in Germany, Austria, France and Portugal. The EU has thus neither the means nor the will to cough up more for global health. ICRC members unload supplies in Ukraine. ‘Anti-globalist’ Trump to chop UN fees Trump has claimed that the WHO’s pandemic agreement currently being negotiated is “a pretext to advance a global government”. An avowed “anti-globalist”, he has little interest in multilateral institutions unless they directly benefit the US. In addition, he wants more money for the US domestic budget, partly because he will be short of cash if he fulfils election promises to cut taxes. Cutting membership fees to global bodies is an easy way to get this, and the WHO is not the only body in Trump’s sights. During his last presidency, Trump cut US funding to the UN Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. Once again he raised the China bogeyman, erroneously accusing the agency of supporting population control programs in China that include coercive abortion. During his first term in office, Trump stopped implementing all aspects of the Paris Agreement – the global commitment to confine global warming to 1.5°C – with immediate effect in June 2017. He claimed that it undermined the US economy, hamstrung its ability to open new oil and coal fields, and put the US “at a permanent disadvantage to the other countries of the world”. During last year’s election campaign, Trump officials told Politico that he intends to do this in his second presidency, and may also withdraw the US from the UN Framework Convention on Climate Change. Leadership vacuum But if Trump sees through his isolationist threats and withdraws the US from global forums, this will leave a leadership vacuum that may empower rivals China and Russia. The expanding BRICS Group, set up to counter Western domination in multilateral forums, may well be interested in assuming greater global prominence. Initially comprising of Brazil, Russia, India, and China at its inception in 2009, its membership has swelled to include South Africa, Iran, Egypt, Ethiopia, the United Arab Emirates and Indonesia – covering 45% of the world’s population. The US may also weaken its own health if its steps outside the WHO. It is less likely to get timely information about pathogens with pandemic potential, for example, if it is outside the fold. However, Trump claimed in a speech a few months back that he is going to “form a new coalition of nations strongly committed to protecting health while also upholding sovereignty and freedom”. Perhaps he intends the anti-abortion Geneva Consensus Declaration, signed by some of the most right-wing countries on the planet, to form the springboard for this lofty ambition. “Under my leadership, the United States will also rejoin the Geneva Consensus Declaration, created by my administration and signed by 36 nations, to reject the globalist claim of an international right to abortion.” pic.twitter.com/1r4R4l23Pg — Team Trump (Text TRUMP to 88022) (@TeamTrump) September 20, 2023 Trump’s supporters have been pushing hard for more countries to support this Declaration in the past four years. But this will also cost the US dearly if it is its convenor and it has to start a new global body from scratch. So perhaps Trump’s desire to pull out of the WHO is less about the cost of membership fees and more about ideology and ensuring US dominance in whatever global forums it is part of. Image Credits: https://open.who.int/2024-25/contributors/top25, ICRC. Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Los Angeles Wildfires Smother Region in ‘Hazardous’ Smoke 14/01/2025 Sophia Samantaroy Firefighters battle a blaze in California’s September, 2020 record-breaking fires. Smoke from at least three fires in Los Angeles has caused unhealthy and hazardous air quality, causing school closures and official warnings. “In my lifetime I have not seen something this destructive,” said Rachel Ibrahim, a student at the University of Californina, Los Angles (UCLA). Forced to leave campus as the fires raced within five miles of the California university, Ibrahim told Health Policy Watch that it was “not healthy for us to be here while it was happening, while it was at its peak.” Even in her home east of the city, the wildfires blew large quantities of ash and smoke, causing her family to leave the city for the weekend for Newport Beach “where the air quality was much, much better.” The Eaton, Palisades, and Hurst fires, which roared through homes, businesses, and schools in the US city last Tuesday have sent billows of toxic smoke throughout the region. “Wildfire smoke is one of the most complex aerosol exposures that exists,” said Dr Daniel Croft, a pulmonologist and researcher at the University of Rochester. “The particles such as PM 2.5, and gasses such as NO2 have well established risks to respiratory disease like COPD [Chronic Obstructive Pulmonary Disease] and asthma and cardiovascular diseases like heart attack and stroke.” Fine particulate matter that is 2.5 microns or less in diameter (PM 2.5) is the most concerning aspect of wildfire smoke. PM 2.5 from burning homes, cars, asphalt and other materials contain high levels of carcinogens, according to the University of Utah. Exposure to an AQI of 200, which much of LA reached last week, is equivalent to smoking five cigarettes. The fires, exacerbated by hurricane-force Santa Ana winds and extreme drought, are less than a third contained and have killed 24 people. Nearly 150,000 others have been forced to evacuate, and over 12,000 structures are destroyed. The spike in poor air quality caused the LA Unified School District to shut schools last week, universities to send students home, and public health officials to issue warnings about the danger of wildfire smoke. A map of the Los Angeles region showing the three active fires, wind, evacuation orders, and haze from CalFire. “Predicting where ash or soot from a fire will travel, or how winds will impact air quality, is difficult, so it’s important for everyone to stay aware of the air quality in your area, make plans, and take action to protect your health and your family’s health,” said Muntu Davis, MD, MPH, Health Officer for Los Angeles County in a press release Friday. “Smoke and ash can harm everyone, even those who are healthy. However, people at higher risk include children, older adults, pregnant individuals, and those with heart or lung conditions or weakened immune systems.” Wildfire smoke: Gases, particles, and toxic chemicals Particulate matter can settle deep in the lungs and circulatory system, causing negative health effects. Wildfires can produce unhealthy, very unhealthy, or hazardous criteria levels of pollution – standards set by the US Environmental Protection Agency (EPA) Air Quality Index (AQI) to measure a range of particles and gases hazardous to human health. Wildfire smoke – a mix of gases, hazardous pollutants, water vapor, and particulate matter – can cause both short and long-term health effects. This smoke is often undetectable, with no obvious smell or haze. “While the direct exposure to nearby wildfire smoke is a health risk, the smoke undergoes chemical changes as it travels in the air that can potentially even increase its toxicity to cities many miles away,” said Croft. Furthermore, “many homes were built prior to 1970 and have lead,” noted Martina Zaghloul, a physician associate student in LA. “So there’s a lot of toxins and lead particles in the air from the burning paints and plastics.” The highest hourly level of PM 2.5 spiked at over 480 micrograms per cubic meter last Wednesday, as reported in the LA Times. The EPA limit for a daily average concentration is 35. The toxicity of these particles increases the risk of negative health impacts. Respiratory distress, asthma attacks, heart attacks, and strokes are all associated with wildfire smoke. Longer-term issues include adverse pregnancy outcomes, lung disease, cancer, and asthma. Wildfires ‘reversed’ clean air gains PM2.5 concentrations in the western US. The spike in 2020 is due in part to the record-setting wildfires in California. Since the Clean Air Act of 1970 and stricter vehicle and factory emissions, air quality in the US has improved. However, this is being reversed by wildfires. Researchers at Stanford write that in the past 10 years, wildfire events “dominate” dangerous particulate matter exceedances, and have eroded air quality by 50% in western states. Record-breaking wildfires in 2020 contributed 20-30% of particulate matter in the contiguous United States. Smoke can travel thousands of miles, degrading air quality, and spiking hospital admissions for asthma, respiratory distress, and heart attacks. The Canadian wildfires of 2023, the effects of which were felt in New York City, triggered a nearly 20% increase in asthma emergency department visits, according to the US Centers for Disease Control and Prevention. Climate change, which has brought hotter temperatures and drought conditions, paired with a century of fire suppression policy has meant California has abundant fuel in arid conditions. Mitigation strategies urged on homeowners, like maintaining five feet of cleared vegetation around homes, is sometimes not enough to combat the intensity of these fires. This reversal in air quality gains is especially concerning to high-risk groups, such as children, older adults, pregnant people, and those with pre-existing health conditions. Masking, staying indoors, using air filters Wildfires on the scale of those in LA generate enough smoke to reach the atmosphere and travel thousands of miles, according to the EPA. This means that wildfire smoke poses a risk beyond the immediate region affected–and why the EPA and other health agencies recommend visiting sites like Airnow.gov to check local air quality conditions. The LA Public Health Department has urged everyone in areas where there is “visible smoke or the smell of smoke or unhealthy air quality” to avoid unnecessary outdoor exposure and to limit physical exertion. The department also recommends those in sensitive groups stay indoors as much as possible even in areas where smoke, soot, or ash cannot be seen or “there is no smell of smoke,” noting in a statement to Health Policy Watch that its guidance extends beyond wildfire burn areas and ash.” Air quality fluctuations in Santa Monica, California, in the past week, on the US Interagency Wildland Fire Air Quality Response Program. Wind conditions remain variable, but for now, the LA Unified School District has reopened schools as air quality appears to have improved over the weekend for the city. “Kids are back in school and they still have to leave their homes, meaning they are exposed even if the air filters have been changed out,” said Zaghloul. “These particles are still travelling, making it difficult to protect yourself.” This is a developing story. For more information, visit CalFire. Image Credits: Daria Devyatkina/Flickr, CalFire, NASA/JPL-Caltech, EPA, U.S. Interagency Wildland Fire Air Quality Response Program. Posts navigation Older postsNewer posts