The publication of the World Health Organization’s (WHO) first “Global Status Report on Rehabilitation” has been effectively paused after the Executive Board concluded that the proposed methodology for measuring progress failed to capture the complex realities of health systems, particularly those in conflict zones.

In a politically charged debate on Thursday, member states argued that simplifying global rehabilitation metrics to “chronic low back pain” as a primary tracer condition could inadvertently distort health priorities and funding allocations.

The Secretariat had proposed low back pain as a reasonable proxy due to its status as the leading contributor to years lived with disability. Delegates contended that this indicator was insufficient for measuring the diverse and acute needs found in crisis regions and many low- and middle-income countries.

Accepting the limitations of its approach, the WHO Secretariat had asked the Board to approve postponing the report’s publication, originally mandated for release before the end of 2026.

Dr Jeremy Farrar, WHO Chief Scientist, conceded that while low back pain was a reasonable starting point, member states had raised valid concerns regarding “more complex issues to take on.”

Distorting priorities in war zones

The most significant critique focused on the “complexity gap” between the proposed metric and the reality of trauma care.

Against the backdrop of the ongoing war, the Ukrainian delegate warned that a target focused on low back pain might incentivise health systems to prioritise low-intensity services over the complex, multidisciplinary care required for crisis and war-torn regions. A multi-tracer model that includes stroke, traumatic injury and amputation would be more appropriate, he argued.

This position was reinforced by Israel, whose delegation noted that while the low back pain indicator might suit community care settings, it is “less applicable to hospital care” and fails to capture the realities of acute and complex disorders requiring specialized rehabilitation.

For the Eastern Mediterranean Region, an area where an estimated 190 million people require rehabilitation, delegates highlighted that technical guidance must address fragmented governance and weak information systems.

They stressed that in crisis regions, resource-constrained and fragile settings, indicators must be feasible to integrate into existing health information systems.

Calls for ‘evidence-based’ and flexible approaches

Beyond conflict settings, a broader coalition of member states questioned the readiness of the data. Thailand advocated for postponing the report, insisting that indicators must be “evidence-based and adaptable to national contexts”.

Nigeria, aligning with the African region, supported this delay. The delegation argued that the collection of more complete and robust baseline data would ultimately strengthen the “credibility and usefulness” of the global monitoring framework.

While the delay was driven by a desire for better data, Ethiopia expressed concern regarding the loss of political momentum, and proposed establishing a “clear timeline” instead of “indefinite postponement.”

The Handicap International Federation, supported by the World Rehabilitation Alliance, warned that funding cuts and reduced engagement are already threatening progress in low- and middle-income countries.

They urged member states to ensure that the delay in reporting does not lead to a delay in investment.

The Executive Board formally noted the report without objection. However, the debate resulted in a clear directive to the Secretariat to refine its data collection before going to print.

Isolation declared a structural rather than individual failure

In a parallel discussion regarding the report on the “Outcome of the WHO Commission on Social Connection”, the board moved decisively to reframe loneliness from a personal struggle to a structural failure of governance and modern technology.

In the debate, the European Union and its member states declared social isolation an “urgent public health issue.” They emphasized that the issue affects “people across all ages and demographic categories” and is inextricably linked to mental health problems.

The Brazilian delegation asserted that digital technologies must be regarded as a “new determinant of health.” They argued that algorithmic management and the spatial separation of workers are actively weakening social bonds, urging the WHO to monitor the relationship between digital transformation and isolation.

However, the consensus was challenged by Movendi International. The civil society organization criticized the Secretariat’s report for framing alcohol merely as a “coping mechanism” for loneliness.

They argued that the alcohol industry’s products and practices are structural drivers of social disconnection, demanding that alcohol be explicitly recognized as a risk factor interacting with loneliness across the life course.

The board formally noted the report without objection, endorsing the Secretariat’s roadmap for the next phase of implementation.

Image Credits: Felix Sassmannshausen, Pexels/ali Saleh.