Dr Faustine Ndugulile (centre) flanked by outgoing WHO Africa

The World Health Organization’s (WHO) Africa regional committee meets on Tuesday (14 January) to decide on the process for nominating a new regional director following the shock death of Dr Faustine Ndugulile.

Ndugulile was elected regional director at the WHO Africa regional conference in the Republic of Congo last August.

His appointment was due to be ratified by the WHO’s Executive Board meeting next month, but he died in India in late November while undergoing medical treatment for an undisclosed condition.

The sole focus of Tuesday’s special virtual meeting of the WHO Africa region is to work out how the next regional director, who serves for five years, should be chosen.

Ndugulile secured 25 of the 46 votes at the August conference, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

There are 47 member states in the WHO Africa region as seven North African countries that are predominantly Muslim are part of the WHO Eastern Mediterranean Region.

The regional meeting needs to decide whether it will re-open nominations for the position, hold new elections based on the three remaining candidates or simply choose the runner-up as the next regional director.

According to the WHO’s Constitution, regional committees “shall adopt their own rules of procedure (Article 49)”. 

Meanwhile, Article 52 stipulates: “The head of the regional office shall be the Regional Director appointed by the Board in agreement with the regional committee.” 

“Both the Regional Committee and the Executive Board have a role in the process.  The Regional Committee nominates a candidate, and the Executive Board appoints the Regional Director.  The Regional Committee and Executive Board are each responsible for their own part in the process,” according to a WHO spokesperson.

However, the WHO did comment on questions related to the likely process or whether the incumbent, Dr Matshidiso Moeti, will remain in the position until the new candidate is appointed. Moeti has served two terms (10 years) as regional director and is not eligible for re-election.

The remaining three candidates have all worked for the WHO in various capacities. 

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 has also worked for WHO Africa. 

Sambo is the WHO Representative to The Democratic Republic of the Congo.

Last year was the hottest on record, bringing a range of natural disasters including fires and floods.

Global temperatures increased by 1.6ºC above pre-industrial levels.in 2024, the first year that they have crossed the 1.5ºC threshold set by the global Paris Agreement.

Last year was the hottest since temperatures started being recorded in 1850, with a global average temperature of 15.1ºC. This was 0.12ºC hotter than 2023, the previous record-holder.

“Multiple global records were broken, for greenhouse gas levels, and for both air temperature and sea surface temperature, contributing to extreme events, including floods, heatwaves and wildfires,” according to the European Union’s Copernicus Climate Change Service (C3S) report for 2024, released on Friday.

“These data highlight the accelerating impacts of human-caused climate change,” according to the report released amid raging fires in Los Angeles in the US, fuelled by climate change.

About three-quarters of days in 2024 had air temperatures over 1.5°C above pre-industrial levels. There was also an increase in heat stress, which peaked on 10 July when around 44% of the globe was affected by ‘strong’ to ‘extreme heat stress’.

Europe recorded an increase of 1.47ºC (above 1991-2020 averages), its hottest year on record.

Sea Surface temperatures also increased

The annual average sea surface temperature (SST) over the extra-polar ocean reached a record high of 20.87°C, with  record highs across nearly one third (27%) of the extra-polar ocean.

Globally, the monthly average SST reached a new record in March of 21.07°C.

Warming covered vast regions of the Atlantic Ocean, most of the Indian Ocean, large parts of the Western Pacific, and portions of the Southern Ocean.

In Europe, record high SST were recorded in the central and eastern Mediterranean Sea, the Black Sea, and the Norwegian Sea.

The widespread occurrence of high SSTs led to a global coral bleaching event, declared by NOAA in April.

In contrast, the annual average SSTs across the eastern Pacific along the equator were close to the 1991–2020 average, reflecting a transition from El Niño conditions early in the year to La Niña conditions in the second half of the year.

Anomalies and extremes in sea surface temperature for 2024. Colour categories refer to the percentiles of temperature distributions for the 1991–2020 reference period. The extreme (‘coolest‘ and ‘warmest‘) categories are based on rankings for 1979–2024. Values are calculated only for the ice-free oceans.

The atmospheric concentrations of carbon dioxide and methane continued to increase and reached record annual levels in 2024.

Water vapour in the atmosphere also reached record levels in 2024, at 4.9% above the 1991–2020 average, which rom the enhanced greenhouse effect of additional water vapour in the atmosphere.

Heat also compounds air pollution’s toxic effects

The increased prevalence of heat waves due to climate change is leading to more frequent and intense periods of poor air quality, meaning more people are exposed to dangerous levels of pollutants. This is especially concerning for vulnerable populations, such as the elderly, children, and those with pre-existing respiratory or cardiovascular conditions. 

For instance, high temperatures act as a chemical catalyst, interacting with pollutants like nitrogen oxides (from sources like car exhaust) to produce ground-level ozone, a harmful respiratory irritant. Ozone is a major component of smog and can cause respiratory problems, especially for those with asthma or other lung conditions. Additionally, heat can exacerbate wildfires, releasing smoke and particulate matter into the atmosphere, further degrading air quality. 

Heatwaves can dry out vegetation, increasing the risk and intensity of wildfires, like the ones seen recently in the Los Angeles area. Wildfire smoke contains a mix of harmful pollutants, including particulate matter and gases that contribute to respiratory issues and other health problems. Besides ozone and wildfire smoke, heat can also increase the levels of other pollutants like particulate matter (PM2.5) and biogenic volatile organic compounds (BVOCs), further contributing to air pollution’s health impacts. 

Heat waves and high air pollution levels often coincide because they share similar weather patterns, like high-pressure systems with low wind speeds and little precipitation, which allows pollutants to accumulate. This creates a dangerous “compound effect,” where the combined impacts of heat and air pollution are more severe than the sum of their individual effects. 

Human-induced heat

For 10 years, every year has been hotter than the previous one and a 2018 report from the Independent Panel on Climate Change (IPCC) predicted that the world would only exceed 1.5ºC of heat by 2030.

However, the report noted that the limit set by the Paris Agreement “refers to temperature anomalies averaged over at least 20 years” so this had not yet been breached, but “it underscores that global temperatures are rising beyond what modern humans have ever experienced”. 

Monthly contributions to the global surface air temperature anomalies by latitude band for land (left) and ocean (right) regions for 2005–2024. Anomalies are calculated relative to the average for the 1991–2020 reference period, with each region’s contribution weighted by its area on Earth’s surface.

Although there was an El Niño in 2023–2024, a natural weather event that warms the sea surface, this was “strong but not exceptional event”, according to the report.

Instead, the past two years “appear to be exceptionally warm because of accelerating human-induced climate warming and an unusually warm phase of oceanic variability”,  according to the report.

“Humanity is in charge of its own destiny but how we respond to the climate challenge should be based on evidence. The future is in our hands – swift and decisive action can still alter the trajectory of our future climate,” said Copernicus director Carlo Buontempo.

“Each year in the last decade is one of the 10 warmest on record. We are now teetering on the edge of passing the 1.5ºC level defined in the Paris Agreement and the average of the last two years is already above this level,” Samantha Burgess, climate lead at the European Centre for Medium-Range Weather Forecasts (ECMRW)

“These high global temperatures, coupled with record global atmospheric water vapour levels in 2024, meant unprecedented heatwaves and heavy rainfall events, causing misery for millions of people.”

Image Credits: Unsplash, C3S/ECMWF.

Indian farmworker Balaso Salokhe can no longer work because of severe asthma

YADRAV, India – Farmworker Balaso Salokhe predicts the severity of his asthma by observing the sky around him. 

“In the past four years, my health has deteriorated so much that I avoid travelling outside my village,” he shares. During this time, he was hospitalised six times. Every time, the severity of his asthma worsened.

Salokhe, who described himself as “extremely fit” before his frequent asthma attacks, was determined to find out what had exacerbated his condition.

So he consulted with over 10 doctors and community health workers and, during the process, he found that air pollution was a key reason, traced to an increase in automobile industries and textile mills in his area. 

Salokhe is one of over 34 million people affected by asthma in India, a country that accounts for half the asthma deaths globally. In 2019, asthma affected 262 million people, causing 455,000 deaths, with India bearing a significant burden.

Asthma triggers

Smoking, allergies, respiratory infections, and air pollution can trigger asthma. Although the link between air pollution and asthma has long been established, studies have remained inconsistent about the effect of long-term PM2.5 exposure on asthma. 

These tiny particles, 30 times smaller than the width of a human hair, can penetrate deep into the lungs and even enter the bloodstream, causing a range of respiratory and cardiovascular issues. 

Long-term exposure to PM2.5 significantly increases asthma risk in children and adults, contributing to 30% of cases, according to a recent study published in One Earth involving over 25 million people from more than 20 countries. When PM2.5 levels increased by 10 micrograms per cubic meter, the risk of developing asthma rose by 21.4%, the study found.

Asthma was responsible for 21.6 million Disability Adjusted Life years in 2019, and rising air pollution can further exacerbate this. This can create a public healthcare crisis for countries like India, where the PM2.5 concentration was 11 times the World Health Organization’s (WHO) recommended safe level in 2023.

Lack of rural air pollution warnings

“Long-term exposure to PM2.5 has been associated with an increased risk of asthma through a variety of biological mechanisms like chronic inflammation, oxidative stress, immune dysregulation, exacerbation of allergic sensitisation, epigenetic modifications, and structural changes in the respiratory system,” said Yuming Guo, one of the One Earth study authors and an environmental health scientist at Australia’s Monash University. 

India’s average annual particulate pollution has increased by 68% from 1998 to 2021, which has reduced life expectancy by 2.3 years. 

 In November 2024, South Asia reported hazardous air quality. Multan in Pakistan crossed the 2,100 mark on the Air Quality Index (AQI), far exceeding the threshold of 301. The PM2.5 concentration was 947 micrograms per cubic meter, roughly 190 times above the WHO guideline. 

In 2019, ambient PM2.5 pollution from residential combustion, industrial emissions, and power generation caused over a million deaths in South Asia, according to a study published in Environmental Science & Technology. The study identified solid biofuel as the leading combustible fuel contributor to PM2.5-related mortality, followed by coal, oil, and gas.

India’s capital, New Delhi, reported an Air Quality Index exceeding 1,500 last November. This led to schools being shut and construction work halted. 

But 1,600 kilometres from Delhi, in Salokhe’s village of Yadrav in Maharashtra state, the problem was severe yet overlooked because of lack of monitoring.

Alongside industrial and vehicular air pollution around his village, another major source of air pollution is sugarcane farming, which burns thousands of kilograms of sugarcane leaves and tops every alternate day. 

With a tight schedule of harvesting and sowing and a lack of space for residue to decompose, burning is the easiest option for farmers. However,  burning pre-monsoon and post-monsoon crop residue contributed 28% and 64% respectively of the total PM2.5 emissions from burning activities in India, a 2022 study published in Nature found.

Researchers estimated 69,000 premature deaths annually across India caused by ambient PM2.5 exposure due to crop residue burning. 

Burning the residue from crops such as sugarcane is driving air pollution in rural India.

Breathlessness

“During such times, I experience a lot of coughing and have to move to other parts of the village,” Salokhe said. His region has seen a proliferation in sugarcane production, which led to the establishment of even more nurseries, contributing heavily to air pollution.

Salokhe has also experienced severe breathlessness lately, particularly if he lifts anything heavy, and has stopped working in the field. 

His wife, Shanta, 66, said someone always needs to be around him as “he can get an asthma attack anytime.” 

In the last week of October, he experienced an acute attack and his sons rushed him to a hospital in the nearby town at midnight. 

“Had the treatment been delayed, the doctor warned, I might not have survived,” said Salokhe, who spent five days in the hospital.

His case isn’t an isolated incident. Another resident of the same village, Vasant Davade, 70, who worked as a farmworker, started suffering from asthma three years ago. His health has also deteriorated, and he had to quit farming a year after being diagnosed, taking away his livelihood and severely impacting the family. 

Limited research

Over the years, several studies have tried to unpack the complexity of long-term PM2.5 exposure and how it impacts asthma. However, research gaps remain.

 “While oxidative stress, inflammation, and immune dysregulation are recognized, the specific molecular and cellular mechanisms linking PM2.5 exposure to asthma development and exacerbation remain unclear,” said Guo. 

There is limited research on how genetic predispositions, such as polymorphisms in inflammation or antioxidant genes, interact with PM2.5 exposure to influence asthma risk, he added.

“More studies are needed to explore how long-term PM2.5 exposure induces epigenetic changes that affect asthma-related gene expression.”

A major challenge is that PM2.5 is a complex mixture of several pollutants, making it difficult to identify which components remain most harmful to asthma. 

Another challenge is the meagre amount of studies on low-income populations, racial and ethnic minorities, and the ones from low-and-middle-income countries. 

“The relationship between PM2.5 and asthma in rural settings, where pollutant sources and compositions may differ from urban areas, remains underexplored,” added Guo. What complicates the research further is a poor understanding of the impact of climate change on PM2.5 levels and composition and how it influences asthma risk. 

Lack of affordable solutions

Open fires contribute to air pollution in rural parts of Indian, such as this fire which Rajakka Tasgave lights each day to heat water for her household, 

Mitigating asthma risks from PM2.5 exposures requires interventions at several levels. 

Guo suggests using high-efficiency particulate air (HEPA) filters in homes and schools to reduce indoor PM2.5 levels. He also advocates avoiding the use of wood stoves, open fires, or unvented heaters indoors, wearing masks with high filtration efficiency during high pollution episodes, minimising outdoor activities during times of high air pollution, and calls for proper asthma management, ensuring people have access to inhalers. 

However, Salokhe said he did not wear a mask because he had no way to track pollution in the village. Without sensors and real-time data, many people can’t make the right decisions about stepping out or avoiding polluted areas. 

“I simply look at the sky to gauge the black smog. That’s my only way of understanding air pollution,” he said.

Many people can’t afford cleaner energy sources, forcing them to rely on burning firewood, plastic seedling trays, and whatever is available to cook food and heat water for bathing. 

“We even use a traditional stove as we can’t afford frequently refilling LPG (Liquefied Petroleum Gas) cylinder,” shares Shanta. “Almost all the village residents burn firewood daily to heat water.”

She burns firewood for an hour every morning, which has also started affecting her health. “How can you escape that air pollution, and who will stop it when people are burning so many things in and around their households?” she asks.

With the lack of affordable solutions and things beyond his control, Salokhe said his health has been declining quickly: “Anytime my lungs can give up, and that will be my last breath,” he said, looking sadly at his five-decades-old bicycle that he can no longer ride. 

Image Credits: Sanket Jain.

A widely cited study about the use of Hydroxychloroquine and azithromycin to treat COVID-19, published in March 2020, has been retracted by its publisher, Elsevier.

The study, published in Elsevier’s International Journal of Antimicrobial Agents, was retracted in the January 2025 edition of the journal (issued last month).

“Concerns have been raised regarding this article, the substance of which relate to the articles’ adherence to Elsevier’s publishing ethics policies and the appropriate conduct of research involving human participants, as well as concerns raised by three of the authors themselves regarding the article’s methodology and conclusions,” the publisher notes.

The study involved 20 French patients, some of whom were given the antimalarial medicine Hydroxychloroquine. Six were also given the anti-bacterial drug, azithromycin.

“Untreated patients from another center and cases refusing the protocol were included as negative controls,” according to the study.

Patients treated with hydroxychloroquine were recruited and managed in the Méditerranée Infection University Hospital Institute in Marseille Marseille centre. Control patients were recruited in Marseille, Nice, Avignon and Briançon centers, all in South France.

Ethical questions

But the patients were recruited to the”open label non-randomised trial” in “early March” – possibly before ethical approval for the trial was given on 5-6th of that month.

In addition, the journal has been unable to establish whether “all patients could have entered into the study in time for the data to have been analysed and included in the manuscript prior to its submission”.

There are also questions about whether informed consent was obtained from the patients, lack of clarity about whether all patients were enrolled in the study upon admission to hospital or if they had been hospitalised for some time and whether there was sufficient “equipoise” between the study patients and the control patients.

None of the control patients are reported to have received azithromycin. At the time of the study, azithromycin was not used as first-line prophylaxis against pneumonia in France “due to the frequency of macrolide resistance amongst bacteria such as pneumococci.”, according to Elsevier. For that reason, informed consent would have been necessary to use it.

Author disputes

Three of the authors, Dr Johan Courjon, Prof Valérie Giordanengo, and Dr Stéphane Honoré, contacted the journal with concerns “regarding the presentation and interpretation of results in this article and have stated they no longer wish to see their names associated with the article”, Elsevier reported.

Giordanengo was concerned with analysis bias, raising that PCR tests administered in Nice were interpreted according to the recommendations of the national reference center,while those carried out in Marseille “were not conducted using the same technique or not interpreted according to the same recommendations”. 

The corresponding author, Didier Raoult, did not respond to the deadline to address concerns.

However, first author Dr. Philippe Gautret, and authors Professors Philippe Parola,  Philippe Brouqui, Philippe Colson, and Bernard La Scola, “disagreed with the retraction and dispute the grounds for it”.

Then US president Donald Trump touted Hydroxychloroquine several times as an effective treatment for COVID-19.

Midwife Neha Mankani attends to a mother and her newborn in a flood affected community in Pakistan.

In 2024, the world reached an alarming milestone: the hottest global temperatures ever recorded. Floods, heat waves, tropical storms, hurricanes, droughts, and wildfires are affecting everyone, everywhere, with devastating consequences. 

But behind the headlines of environmental catastrophe lies a quieter crisis: the health impacts of climate change on women, families and newborns, and the health providers at the forefront of this crisis.

Sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) needs don’t pause during crises. Babies are still being born, and women and girls can’t wait for care – whether it’s for contraception, treatment for a sexually transmitted infection (STI), or comprehensive abortion care. 

Midwives can provide up to 90% of essential SRMNAH services, even in the most challenging circumstances. Yet their voices are often left out of global climate discussions, and their potential as climate resilience leaders is overlooked.

Minimal infrastructure

“As the world becomes progressively more unstable over time, which it will, having care providers who can operate with minimal infrastructure to deliver care to clients will become increasingly important,” said a Canadian midwife in a new report by the International Confederation of Midwives (ICM). 

“Midwives are ideally positioned to provide flexible sexual and reproductive health and perinatal care to vulnerable populations. We are the face of climate mitigation.”

The report highlights the far-reaching health impacts of climate change and the critical role midwives are already playing in addressing them. It also showcases their vision for building climate-resilient health systems and calls on governments and policymakers to recognise midwives as integral to climate resilience.

A midwife checking a pregnant woman in a rural community clinic in Guatemala.

Impact of extreme heat

Midwives are experiencing first-hand the effect of heatwaves, floods, and other disasters on their patients, with increasing risks of preterm births, stillbirths, and maternal complications like dehydration and postpartum haemorrhage.

“Extreme heat is contributing to increased stillbirth rates, postpartum haemorrhage, and stunting,” shared a midwife from Ethiopia.

Three-quarters of respondents agreed that climate change is harming the communities they serve. These challenges hit marginalised and low-income populations hardest, where access to healthcare is already limited. 

“Low-income communities are more severely affected when there are heat waves. And women are at higher risk of dehydration and preterm labour as a result,” shared one respondent.

Displacement caused by climate disasters adds another layer of inequity. 

A midwife from Ontario, Canada, noted: “Forest fires in my country have displaced Indigenous people from their land. They already face removal from their community to give birth and access care.”

Midwives are already responding

Midwives are not passive observers of the climate crisis; they are active responders. From delivering care during floods and heatwaves to educating families about health risks, midwives are already adapting to the challenges posed by climate change.

“Midwives are vital agents of change in building climate resilience in vulnerable communities. Their multifaceted contributions are critical … they tirelessly educate communities about the health risks of climate change, promote adaptation strategies, provide emergency care during disasters, and integrate sustainable practices within healthcare facilities,” said a midwife from Kenya.

Respondents often reported using their time with clients to discuss environmental health, with 39% doing so regularly. However, 31% expressed a desire to engage in these conversations but felt they lacked the necessary information to do so effectively.

This vital work often comes at a personal cost. The report revealed that 76% of midwives said the climate crisis negatively impacts their work, leading to stress, burnout, and displacement. 

As one Ugandan midwife shared, “I am not able to provide services as I want, and this has affected me psychologically.” 

Jane Mpanga, a midwife checks on an expectant mother at her clinic in Kampala.

A sustainable model of care

Continuity of midwife care offers a sustainable model of care that aligns with global climate goals. Unlike resource-heavy obstetric models, midwifery puts women at the centre of care, while relying on fewer interventions, producing less medical waste, and being inherently community-focused.

“As midwives, we are low tech, high touch,” said a midwife from Australia. “We should continue to advance midwifery as climate activists because [midwifery is] good for the environment.”

Midwives are resourceful in their approach. “Midwives are judicious with their use of resources and resilient and resourceful with limited equipment and facilities,” noted a midwife from Australia. 

“Midwife-attended births at home, for example, generate significantly less waste than a similar birth in a hospital setting and are therefore much better from an environmental perspective.” 

Midwife Farhana Jany with Rohingya mothers at Hope Hospital in Cox’s Bazar, Bangladesh.

There is an extensive body of research that shows that in health systems where midwives are enabled and integrated, this type of care gives excellent outcomes.

Midwives also empower women to build their resilience. Through education and support, midwives help women make informed decisions about their health, fostering long-term stability for their families and communities.

An Ethiopian midwife noted, “Midwifery care offers a unique approach to supporting women and families in a climate-changing world. Their focus on community, resilience, and holistic care positions them as key players in ensuring healthy pregnancies and births even amidst growing instability.” 

Call to action

Midwives are key to addressing the health challenges of climate change and building sustainable, climate-resilient health systems. Yet, they remain excluded from most national climate strategies. 

Governments and policymakers must urgently integrate midwives into climate preparedness and response planning processes. This includes ensuring midwives are part of the process, and that when crisis strikes, they have the training, tools, and resources they need to address climate-related health risks and establish referral pathways and transport systems to use when needed.

The climate crisis is a public health emergency that demands immediate, coordinated action. National health strategies, especially those addressing climate resilience, cannot succeed without recognising the vital role of midwives.

The stakes couldn’t be higher. As one Canadian midwife aptly said: “It is hard to remain hopeful in a context where science demonstrates that we have a tiny window to act, but our leaders are not taking the necessary action.”

The time to act is now – for midwives, for the women and families they serve, and for a healthier, more resilient future.

Sandra Oyarzo Torrez is President of the International Confederation of Midwives

Ana Gutierrez is Communications Lead at the International Confederation of Midwives

Image Credits: International Confederation of Midwives.

Sugary drinks have become popular in Africa, driving type 2 diabetes and cardiovascular disease.

Sugary drinks are driving new cases of diabetes and cardiovascular disease, particularly in sub-Saharan Africa, Latin America and the Caribbean, according to a study published in Nature this week.

One in five new type 2 diabetes cases in Sub-Saharan Africa and a quarter of those in Latin America and the Caribbean are attributable to sugary drinks, according to researchers from Tufts University’s School of Nutrition Science and Policy.

They estimate that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur globally each year due to the consumption of sugary beverages.

Around 11% of new cardiovascular diseases in the Caribbean and over 10% in sub-Saharan Africa are also the result of these drinks. 

The researchers compiled data about 184 countries between 1990 and 2020 using the Global Dietary Database, including 450 surveys with data on sugary drinks totaling 2.9 million individuals from 118 countries.

Biggest increase in sub-Saharan Africa

The biggest increases in diabetes and CVD occurred in sub-Saharan Africa, reflecting changes in the consumption patterns of the region.

Colombia, Mexico, and South Africa have been particularly hard hit.  Almost half (48%) of Colombia’s new diabetes cases, 30% of Mexico’s cases and 27.6% of South Africa’s cases were attributable to sugary drinks.

Meanwhile, sugary drinks were to blame for 23% of Colombia’s CVD cases, 14,6% of those in South Africa and 13,5% of Mexico’s cases. 

“Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Professor Dariush Mozaffarian, senior author on the paper and director of Tufts’ Food is Medicine Institute.

‘Clarion call’ to cut consumption

The study describes its findings as “a clarion call that the ‘nutrition transition’ from traditional toward Western diets has already occurred in much of the [sub-Saharan] region”, yet most African nations have not implemented any measures to curb sugary drinks intakes, “perhaps owing to both industry opposition and previous lack of credible country-specific data”.

Those most at risk varied from region to region. In Latin America, the Caribbean, South Asia and sub-Saharan Africa better educated people were most at risk. But in the Middle East and North Africa, lower educated people consumed more sugary drinks. Younger people and men were also more at risk.

There were “modest decreases” in cardio-metabolic burdens related to sugary drinks in Latin America and the Caribbean, which is consistent with slowly decreasing consumption of sugary drinks.

“Nations in this region have implemented several policy efforts targeting sugar-sweetened beverages, including taxes, marketing regulations, front-of-package warnings and education campaigns,” the researchers note.

However, the impact of sugary drinks on health remains high and absolute burdens per million adults continue to rise “owing to continuing increased rates in obesity, type 2 diabetes and CVD” as well as other risks such as high consumption of refined grain and physical inactivity.

Taxes on sugary drinks

South Africans campaign in favour of a tax on sugary drinks in 2017

The authors call for public health campaigns, regulation of sugary drink advertising, and taxes on sugar-sweetened beverages.  

Mexico, which has one of the highest per capita rates of sugary drink consumption in the world, introduced a tax on the beverages in 2014. 

South Africa followed suit with a tax called a Health Promotion Levy in April 2018, taxing all sugary drinks with over 4 grams of sugar per 100 millilitres. 

Colombia’s tax on sugary drinks, which took effect on November 1, 2023, also varies according to the amount of added sugar in the drink:

“Much more needs to be done, especially in countries in Latin America and Africa where consumption is high and the health consequence severe,” says Mozaffarian, who is also Professor of Nutrition. 

Due to their liquid form, sugary drinks are “rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain”, according to the study.

“High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain.”

Image Credits: Heala_SA/Twitter, Kerry Cullinan.

Chinese doctors perform remote surgeries on patients thousands of kilometres away.

Chinese surgeons have used a surgical robotic system and a high-speed satellite to perform five operations on patients thousands of kilometres away from them, according to China Global Television Network (CGTN), China’s global news  broadcaster.

The surgeons, who were based in the Chinese cities of Lhasa, Dali and Sanya, performed procedures on the Beijing patients’ liver, pancreas and gallbladder.

“The surgeon’s movements would be translated into data, which would be sent up to the satellite, then down to the robotic system working on the patient,” according to CGTN.

“Feedback data would then be sent in the opposite direction. All in all, the data would travel nearly 150,000 kilometers, and yet the surgeons could do their jobs as if they were in the same room as their patients.”

The Apstar-6D broadband communication satellite was the conduit for the surgeons’ movements. Satellites are faster and more stable than ground-based systems.

“This series of remote surgeries spanned China’s mountains and straits, demonstrating the feasibility, safety and effectiveness of performing complex long-distance operations using home-grown satellite technologies and robotic systems,” according to CGTN.

China has raised the possibility that such technology can be used to operate on people in dangerous conflict zones.

“The technology could connect patients with surgeons in ways we’ve never seen before. For example, it’s possible that doctors could treat injured soldiers without going anywhere near the front line,” the CGTN report noted.

However, patients still need to be in a health facility with sophisticated infrastructure including the surgical robotic systems. 

“There may be some way to go, but these operations suggest that one day, a satellite surgeon could save someone’s life.”

Image Credits: China Global Television Network (CGTN).

Evidence of the links between alcohol and cancer is “extensive”.

Alcohol is the third leading cause of cancer in the United States, yet less than half of US citizens polled are aware of its link to cancer, according to the US Surgeon General.

To mitigate this, the warning labels on alcoholic beverages should be updated to include the risk of cancer, advised Surgeon General Dr Vivek Murthy this week.

By 2019, almost 100,000 cancer cases in the country “were related to alcohol consumption including 42,400 in men and 54,330 in women”, according to the Surgeon General’s advisory on alcohol and cancer issued this week. 

Breast cancer accounted for the “largest burden of alcohol-related cancer in the US”, with an estimated 44,180 cases in 2019, according to the advisory. This was 16.4% of the total breast cancer cases for women that year.

Cancer of the colorectum, oesophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx) are also linked to alcohol consumption. 

At least seven cancers are associated with alcohol

There are around 20,000 annual alcohol-related cancer deaths – significantly higher than the approximately 13,500 alcohol-associated traffic crash deaths. Only tobacco consumption and obesity cause more cancer than alcohol.

“The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day,” the advisory notes.

Almost three-quarters of US citizens (72%) reported having at least one alcoholic drink a week (2019-2020).

According to the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries, in the region of the Americas, Canada (21.5) and the USA (20.8) topped the list of alcohol consumption.

Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres.

But in a 2019 survey, only 45% of people in the US were aware of the relationship between alcohol consumption and cancer risk.

Only 45% of US citizens were aware of the link between alcohol and cancer

‘Extensive evidence’

There is extensive evidence from biological studies that ethanol (the pure alcohol found in all alcohol-containing beverages) causes cancer in at least four distinct ways, according to the advisory.

First, alcohol breaks down into acetaldehyde in the body. This causes cancer by binding to DNA and damaging it. 

Alcohol also generates “reactive oxygen specie”s, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation. 

Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer. 

Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier for them to be absorbed into the body, increasing the risk for mouth and throat cancers. 

The World Health Organization (WHO) has said that there is no safe level of alcohol consumption, calling for global action to combat the consumption of alcohol and and narcotic drugs.

Mitigation of risk

In  order to reduce alcohol-related cancers in the US, the Surgeon General recommends updating the warning labels on alcoholic beverages to include the risk of cancer and making the labels “more visible, prominent, and effective”.

He also suggests reassessing recommended limits for alcohol consumption based on the latest evidence on alcohol consumption and cancer risk.

Other suggestions include stronger and more educational efforts to increase general awareness that alcohol consumption causes cancer, informing patients of their risks and promoting alcohol screening, intervention and treatment referral.

Image Credits: Stanislav Ivanitskiy/ Unsplash, US Surgeon General, US Surgeon-General.

Extreme weather events reached dangerous levels in 2024 due to record-breaking temperatures.

The year 2024 is set to be the warmest year on record, the United Nations’ (UN) weather agency, the World Meteorological Organization (WMO), said in an end-year statement on 30 December. This year caps a decade of unprecedented heat fuelled by human activities, the WMO said.

“In my first year as WMO Secretary-General, I have issued repeated Red Alerts about the state of the climate,” said WMO Secretary-General Celeste Saulo.

“This year we saw record-breaking rainfall and flooding events and terrible loss of life in so many countries, causing heartbreak to communities on every continent. Tropical cyclones caused a terrible human and economic toll, most recently in the French overseas department of Mayotte in the Indian Ocean. Intense heat scorched dozens of countries, with temperatures topping 50°C on a number of occasions. Wildfires wreaked devastation,” Saulo said.

Her comments foreshadowed the expected findings of WMO’s formal consolidated global temperatures report for 2024, due to be published in early January.

In a close-up look at just 26 of the 219 major weather events of 2024, climate change-related extremes contributed to the deaths of at least 3,700 people in floods, typhoons, hurricanes, heat waves and wildfires, while leading to the displacement of millions.

This, according to a separate report by World Weather Attribution (WWA), an international consortium of scientists.

“It’s likely the total number of people killed in extreme weather events intensified by climate change this year is in the tens, or hundreds of thousands,” the report stated.

Extreme heat more and more devastating

Climate change also was responsible for an additional 41 days of dangerous heat exposure, per person, on average, in 2024 as compared to pre-industrial exposure levels, the WWA scientists found.

World Weather Attribution studied 26 weather events closely out of the 219 events in 2024.

What is worse is that the countries that experienced the highest number of dangerous heat days are overwhelmingly small islands and developing states that tend to have limited resources to cope.

“Today I can officially report that we have just endured a decade of deadly heat. The top ten hottest years on record have happened in the last ten years, including 2024,” said UN Secretary-General António Guterres in his own New Year message.

“This is climate breakdown – in real time. We must exit this road to ruin – and we have no time to lose. In 2025, countries must put the world on a safer path by dramatically slashing emissions, and supporting the transition to a renewable future,” Guterres said.

Runaway emissions locking in even more heat

Trends are only getting worse, according to the WMO. Currently, the world is at 1.3°C of human-induced warming. In the next five years the annual global temperature is very likely to temporarily breach the 1.5°C target above pre-industrial era that was the target set as a part of the Paris agreement.

And with the most recent UN climate conference COP in Azerbaijan’s capital Baku this November failing to set any new targets for reining in record high fossil fuel burning and emissions, while delivering only $300 billion annually of the $1trillion in climate finance demanded by the poor countries to make a green energy transition, the chances of halting and reversing those trends any time soon looked grim at year’s end.

“Every fraction of a degree of warming matters, and increases climate extremes, impacts and risks,” WMO’s Saulo also said in her a chilling warning. “Temperatures are only part of the picture. Climate change plays out before our eyes on an almost daily basis in the form of increased occurrence and impact of extreme weather events,” she said.

Better monitoring of GHG concentrations 

WMO is in the process of rolling out the Global Greenhouse Gas Watch initiative that will track the GHG concentrations and monthly net fluxes in the atmosphere, for carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) at a 1° × 1° geographic latitude-longitude grid resolution (about 100×100 km spatial resolution).

The aim is to “reduce uncertainties and improve the reliability of GHG monitoring,” the organization said, thus helping countries track the atmospheric impacts of greenhouse gas emissions, while addressing data gaps.

Climate change also added 41 days of dangerous heat in 2024, according to a report jointly produced by the team at World Weather Attribution (WWA) and Climate Central.

Push for early warning systems, more data

The UN also is pushing countries to ramp up their own early warning extreme weather systems. Under the Early Warnings for All initiative, WMO plans to support countries in developing their climate services and delivery programmes.

Other multilateral agencies are also doing the same. In Asia, the Asian Development Bank Institute is pushing countries in the Asia and Pacific region to collect more climate data that could  help prioritize vulnerable communities and respond effectively.

Image Credits: WMO, WWA, WMO.

They reached out for a dialogue at the height of the COVID pandemic: Michelle Williams, then dean of Harvard’s School of Public Health, and Margaret Chan, dean of China’s Vanke’s School – face to face in  Geneva in May 2024.

In April 2022, amidst the continuing uproar of the COVID pandemic, four deans of schools of public health from the USA, China, Switzerland and Singapore, first got on a call with each other to see how they could ramp up cooperation – remotely.

Barred by lockdowns from the usual academic meetings and conferences, the urge to link up was stronger than ever.

Co-founders of the high-powered group were Michelle Williams, then dean of Harvard’s School of Public Health, and former WHO Director General  Margaret Chan, now dean of Beijing’s brand-new Vanke School of Public Health.

“At the height of the pandemic, my good friend here, Margaret and several others amongst us, decided that we needed to come together with deans of schools of public health, to promote solidarity, and to continue to be assertive about what global health diplomacy means for all of us,” said Williams at the first face-to-face Coalition meeting in May 2024.

“We were surprised at the lack of dialogue, the lack of cooperation and collaboration worldwide,” said Chan, of that difficult pandemic period. So, she was delighted when Williams reached out about a conferring virtually. “We felt that change is necessary, and we can make a contribution as universities – which represent the creation and translation of knowledge, through science, to policymaking.”

Other founding members included Antoine Flahault, director of the Zurich-based Swiss School of Public Health and long-time actor in Geneva, the world’s “global health hub”. And the deans of public health schools at the University of Cape Town; Mahidol University, Thailand. Heads of public health institutes in Huazhong, China, Mexico, Sydney, Chile and Singapore.

Online hosted by China

Vanke School of Public Health, Tsinghua University, China.

 That first encounter, organized online by Chan at the Vanke School, was naturally focused on health issues related to the COVID crisis – but with an eye beyond the immediate issues of vaccines, travel restrictions and lockdowns to the long-term challenges that everyone knew lay ahead.

Challenges like the need for countries to come together on the all-important task of building more resilient health systems, better prepared for the next pandemic.

“Working with Dr. Margaret Chan to co-create the Coalition was one of the few bright spots during the early part of the pandemic,” Williams, who recently stepped down as dean, told Health Policy Watch by email from California, where she is currently on sabbatical.

“I was delighted that Margaret, and I joined forces and then had other deans join us. I felt it was important that we academic leaders needed to redouble our efforts to break down real and perceived barriers to global health collaboration, cooperation and diplomacy.

“All around us, in political and public health practice spaces, I observed decision makers looking inward and sometimes missing the important imperatives and values of global public health,” Williams said.

“Vaccine nationalism, unthoughtful border closings and some other policies ran counter to public health, global health diplomacy and practice.  This was disheartening especially as pandemic threats, threats from climate change and other threats like antimicrobial resistance are global threats that require global cooperation.”

Linking academia’s public health leadership

‘Our aim is not to duplicate’, Antoine Flahault, dean of the Swiss School of Public Health (on left), with Geneva University’s Alexandra Calmy at a meeting of the Coalition in May, 2024

Indeed, while there are other established coalitions of Public Health Schools, mostly US-based, such as the American Association of Schools of Public Health, the World Federation of Schools of Public Health, and the Consortium of Universities for Global Health, one unique aspect of the GHF-based Coalition of Deans has been the way it links public health leaders, and not only the institutions, says Flahault.

“Our aim is not to duplicate, but to be complementary to all of these groups, with which we coordinate,” he said.

The loosely-knit group now includes about a dozen institutions, as well as the leading European and American associations or federations of Public Health universities and schools.

“Our vision is that this Global Coalition will allow us to learn more from each other, sharing our experiences, facilitating exchanges of students and faculty among schools and fostering joint research programs,” Flahault observed.

Adds Michel Kazatchkine, a physician, academic and former French diplomat, who also spoke at the group’s last meeting on the margins of the World Health Assembly:

‘Increasing interest in health diplomacy’: Michel Kazatchkine, physician and former diplomat.

“We’re now seeing an increasing interest in health diplomacy. But in this context, academia is particularly important because science is essential in evaluating the impact of policies and providing feedback analysis to politicians so that they can correct trajectories if needed.

“And academia provides the freedom to do research on any topic, even the most sensitive – to collect, analyze and speak about the findings of your data. So, we should not underestimate the role of academia as a fundamental pillar of knowledge-based, democratic societies.”

Focusing on planetary health and other neglected topics

The Sydney School of Public Health’s Flagship planetary health initiative in Fiji was one example featured at the Geneva Health Forum. A study of watershed interventions, it aims to reduce incidence of typhoid, dengue and other deadly diseases in Pacific Island countries.

This year, after two years of remote meetings organized by the Vanke School and Harvard in succession, members of the coalition convened face-to-face, for the first time in Geneva, on the margins of the World Health Assembly, hosted by the Geneva Health Forum and the University of Geneva.

The group focused on planetary health as their principal topic.

“We shared experiences from Australia, China, and the USA about academic programmes dedicated to this issue – and asked the question: how do schools of public health integrate planetary health into their curriculum?” Flahault said. Doctoral and masters’ students from selected schools were also invited to speak along with faculty about lessons learned, he noted.

The discussions continued a thread from the 2023 remote meeting, which examined climate-driven food insecurity in the global health context – another cutting- edge issue that rarely gets much attention in classic public health school textbooks or classrooms.

“The Coalition of Deans have already been instrumental insofar as bringing attention to the importance of creating multi-national and interdisciplinary collaboration to bring multiple perspectives into designing curriculum,” reflected Williams.

“We’ve also provided a platform (as seen in the meeting hosted by Prof Flahault last spring) for showcasing junior faculty members and graduate students working in the fields of global planetary health and environmental justice,” Williams pointed out.

The effort is all the more topical insofar as Harvard’s Chan School of Public Health just launched a concentration in climate and planetary health in 2024.

In China, the Vanke School is also planning to pilot a planetary health course in 2025. That course will bring together students of public health with those in students from economics, urban design, environmental health sciences and engineering to examine multi-sectoral challenges and design solutions, said Chan, speaking with Health Policy Watch.

Chan: Vanke’s new planetary health course will bring together students of diverse disciplines.

“Everyone knows about how John Snow stopped the cholera epidemic [by breaking the pump on a contaminated water cistern], but what about the sanitary engineer who helps to renovate and overhaul the London sewage system,” Chan said.

Tsinghua University, where the Vanke School is located, is world famous for its engineering school, she observes.  “So. this will train future decision-makers to bridge between disciplines such as engineering and health.”

Indoor air pollution and wastewater epidemiology

Along with partners in the WHO, the GHF and European Universities, Coalition members have also supported the development of a series of events on other interdisciplinary health topics over the past year.

These included a conference on Indoor Air Pollution, in September 2023 in Berne, as well as a recent Conference in Paris on Wastewater-based Epidemiology. See related story:

Post Pandemic: Wastewater-based Surveillance of Diseases Comes of Age 

 

“Of course we have moved on from the pandemic to other topics,” noted Chan, speaking with Health Policy Watch recently in a phone interview. “The change in the conversation is a reflection of the changes in the current trends in Public Health. And it’s going to be more diverse as we move along.

One topic she’d like to see the Coalition tackle at some point would be the challenges of harnessing AI for good in the broad context of public health research and policymaking.

“There is a lot of talk about AI in clinical work, but what about AI in public health?” she asks. “Patient confidentiality is important. But we also need policies in place to enable the use of AI in research and outreach, but also to protect people’s privacy.”

Whatever the theme may be, the approach is the same, says Williams, who was instrumental in establishing a student exchange programme between Harvard and the Vanke School in 2021.

“Sharing of teaching materials and experiences related to launching new courses and concentrations are ways we can facilitate the spread of ideas across other universities.

“Developing and supporting annual workshops, and supporting student and faculty exchanges, are another. It is hoped that the Deans can secure resources to help operationalize these collaborative initiatives.”

Looking forward to 2025

Cabo Verde's Minister of Health, Filomena Mendes Gonçalves.
Geneva Health Forum 2024 session on malaria elimination with Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Looking forward, Flahault says the group aims to maintain its informal modus operandi, to facilitate exchange across borders – and keep the focus on meaningful meetings and liaisons.

“We are a lean organization without any budget and staff and not competing with any other organizations,” Flahault said.

At the same time, he envisions the Coalition playing an advisory role in a soon-to-be-formed Think Tank that aims to continue dialogue and problem-solving around the themes of the Geneva Health Forum throughout the year. “One major fruit or byproduct of this will be the GHF Think Tank, which we are launching this spring, and will tap the academic network the Global Coalition assembles,” he said.

That, in addition to their annual meetings, on the margins of the Geneva Health Forum’s annual conference during the World Health Assembly – with the next event organized by Teo Yik-Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Now that face-to-face meetings are once more feasible, working from the Geneva axis offers a unique vantage point that can transcend some of the sharp geopolitical divides that academic leaders face in dialogues at other venues, Flahault also points out.

Says Chan, who served as WHO Director General from 2006-2017, “I’m very biased – to me, Geneva is the capital of public health. And all countries come to the World Health Assembly. So, it’s natural that all of us in the Coalition would meet here, to make our voices heard.”

Returning to basics of infectious disease elimination

A child paralyzed by polio breathes in an iron lung – the best available intervention before the polio vaccine’s discovery in 1955.

Along with emerging global health issues around climate and planetary health – Flahault sees a future role for the group in reviving interest around some of the world’s longstanding, and unsolved public health challenges – such as elimination of polio, cholera and other preventable infectious diseases.

“Personally, I would love to see a WHA resolution against the three major diseases, polio malaria and cholera – with the same sense of determination we displaced against smallpox in the 1950s and 60s, with the same sharp formulation, we want to eradicate these diseases as soon as possible,” he said in a recent interview.

 “All of the major actors would push and row together to make this successful. For polio it’s already done but we have to say we have to end the job.

“We need to be modest and realistic,” Flahault admitted. “Surely, eradicating cholera from the planet, which has already been the subject of one WHA resolution, needs a huge political commitment. This is not in the portfolio of the Global Coalition or schools of public health.

“But we could still play a role. With players in the media ..we could try to mobilize political leadership which is lacking today. We don’t have many political leaders embracing global health issues, as happened during the pandemic, but today global health issues remain a source of power for promoting multilateral commitments.

“And in the coalition, we have a great opportunity for liaison between China, the USA and Europe and all of the other constituencies that are in the room, which give us an opportunity to push public health as a form of ‘soft power’ to move forward agendas.

After all, we succeeded in the 20th century to eliminate smallpox at the height of the cold war between the USSR and the USA.  It was not easy, but we succeeded thanks to a shared commitment to health.”

–Written as part of a Health Policy Watch collaboration with the Geneva Health Forum.

Image Credits: Vanke School of Public Health , Aaron Jenkins, Sydney School of Public Health, Geneva Health Forum, Paul Palmer/ WHO.