WHO discloses 2019’s ten most critical health threats
The world is facing multiple
health challenges. These range from outbreaks of vaccine-preventable diseases
like measles and diphtheria, increasing reports of drug-resistant pathogens,
growing rates of obesity and physical inactivity to the health impacts of
environmental pollution and climate change and multiple humanitarian
crises.
To address these and other
threats, 2019 sees the start of the World Health Organization’s new 5-year
strategic plan – the 13th General Programme of Work. This plan focuses on a
triple billion target: ensuring 1
billion more people benefit from access to universal health coverage, 1 billion
more people are protected from health emergencies and 1 billion more people
enjoy better health and well-being. Reaching this goal will require addressing
the threats to health from a variety of angles.
Here are the 10 health issues
that will demand attention from WHO and health partners in 2019.
Air pollution and climate change
Nine out of ten people breathe
polluted air every day. In 2019, air pollution is considered by WHO as the
greatest environmental risk to health. Microscopic pollutants in the air can
penetrate respiratory and circulatory systems, damaging the lungs, heart and
brain, killing 7 million people prematurely every year from diseases such as
cancer, stroke, heart and lung disease. Around 90% of these deaths are in low-
and middle-income countries, with high volumes of emissions from industry,
transport and agriculture, as well as dirty cookstoves and fuels in homes.
The primary cause of air
pollution (burning fossil fuels) is also a major contributor to climate change,
which impacts people’s health in different ways. Between 2030 and 2050, climate
change is expected to cause 250 000 additional deaths per year, from
malnutrition, malaria, diarrhoea and heat stress.
In October 2018, WHO held its
first ever Global Conference on Air Pollution and Health in Geneva. Countries
and organizations made more than 70 commitments to improve air quality. This
year, the United Nations Climate Summit in September will aim to strengthen
climate action and ambition worldwide. Even if all the commitments made by
countries for the Paris Agreement are achieved, the world is still on a course
to warm by more than 3°C this century.
Noncommunicable diseases
Noncommunicable diseases, such as
diabetes, cancer and heart disease, are collectively responsible for over 70%
of all deaths worldwide, or 41 million people. This includes 15 million people
dying prematurely, aged between 30 and 69.
Over 85% of these premature
deaths are in low- and middle-income countries. The rise of these diseases has
been driven by five major risk factors: tobacco use, physical inactivity, the
harmful use of alcohol, unhealthy diets and air pollution. These risk factors
also exacerbate mental health issues, that may originate from an early age:
half of all mental illness begins by the age of 14, but most cases go
undetected and untreated – suicide is the second leading cause of death among
15-19 year-olds.
Among many things, this year WHO
will work with governments to help them meet the global target of reducing
physical inactivity by 15% by 2030 – through such actions as implementing the
ACTIVE policy toolkit to help get more people being active every day.
Global influenza pandemic
The world will face another
influenza pandemic – the only thing we don’t know is when it will hit and how
severe it will be. Global defences are only as effective as the weakest link in
any country’s health emergency preparedness and response system.
WHO is constantly monitoring the
circulation of influenza viruses to detect potential pandemic strains: 153
institutions in 114 countries are involved in global surveillance and response.
Every year, WHO recommends which
strains should be included in the flu vaccine to protect people from seasonal
flu. In the event that a new flu strain develops pandemic potential, WHO has
set up a unique partnership with all the major players to ensure effective and
equitable access to diagnostics, vaccines and antivirals (treatments),
especially in developing countries.
Fragile and vulnerable settings
More than 1.6 billion people (22%
of the global population) live in places where protracted crises (through a
combination of challenges such as drought, famine, conflict, and population
displacement) and weak health services leave them without access to basic care.
Fragile settings exist in almost
all regions of the world, and these are where half of the key targets in the
sustainable development goals, including on child and maternal health, remains
unmet.
WHO will continue to work in
these countries to strengthen health systems so that they are better prepared
to detect and respond to outbreaks, as well as able to deliver high quality
health services, including immunization.
Antimicrobial resistance
The development of antibiotics,
antivirals and antimalarials are some of modern medicine’s greatest successes.
Now, time with these drugs is running out. Antimicrobial resistance – the
ability of bacteria, parasites, viruses and fungi to resist these medicines –
threatens to send us back to a time when we were unable to easily treat
infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The
inability to prevent infections could seriously compromise surgery and
procedures such as chemotherapy.
Resistance to tuberculosis drugs
is a formidable obstacle to fighting a disease that causes around 10 million
people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000
cases of tuberculosis were resistant to rifampicin – the most effective
first-line drug – and 82% of these people had multidrug-resistant tuberculosis.
Drug resistance is driven by the
overuse of antimicrobials in people, but also in animals, especially those used
for food production, as well as in the environment. WHO is working with these
sectors to implement a global action plan to tackle antimicrobial resistance by
increasing awareness and knowledge, reducing infection, and encouraging prudent
use of antimicrobials.
Ebola and other high-threat pathogens
In 2018, the Democratic Republic
of the Congo saw two separate Ebola outbreaks, both of which spread to cities
of more than 1 million people. One of the affected provinces is also in an
active conflict zone.
This shows that the context in
which an epidemic of a high-threat pathogen like Ebola erupts is critical –
what happened in rural outbreaks in the past doesn’t always apply to densely
populated urban areas or conflict-affected areas.
At a conference on Preparedness
for Public Health Emergencies held last December, participants from the public
health, animal health, transport and tourism sectors focussed on the growing
challenges of tackling outbreaks and health emergencies in urban areas. They
called for WHO and partners to designate 2019 as a "Year of action on
preparedness for health emergencies".
WHO’s R&D Blueprint
identifies diseases and pathogens that have potential to cause a public health
emergency but lack effective treatments and vaccines. This watchlist for
priority research and development includes Ebola, several other haemorrhagic
fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV)
and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents
the need to prepare for an unknown pathogen that could cause a serious
epidemic.
Weak primary health care
Primary health care is usually
the first point of contact people have with their health care system, and
ideally should provide comprehensive, affordable, community-based care
throughout life.
Primary health care can meet the
majority of a person’s health needs of the course of their life. Health systems
with strong primary health care are needed to achieve universal health
coverage.
Yet many countries do not have
adequate primary health care facilities. This neglect may be a lack of
resources in low- or middle-income countries, but possibly also a focus in the
past few decades on single disease programmes. In October 2018, WHO co-hosted a
major global conference in Astana, Kazakhstan at which all countries committed
to renew the commitment to primary health care made in the Alma-Ata declaration
in 1978.
In 2019, WHO will work with
partners to revitalize and strengthen primary health care in countries, and
follow up on specific commitments made by in the Astana Declaration.
Vaccine hesitancy
Vaccine hesitancy – the
reluctance or refusal to vaccinate despite the availability of vaccines –
threatens to reverse progress made in tackling vaccine-preventable diseases.
Vaccination is one of the most cost-effective ways of avoiding disease – it
currently prevents 2-3 million deaths a year, and a further 1.5 million could
be avoided if global coverage of vaccinations improved.
Measles, for example, has seen a
30% increase in cases globally. The reasons for this rise are complex, and not
all of these cases are due to vaccine hesitancy. However, some countries that
were close to eliminating the disease have seen a resurgence.
The reasons why people choose not
to vaccinate are complex; a vaccines advisory group to WHO identified
complacency, inconvenience in accessing vaccines, and lack of confidence are
key reasons underlying hesitancy. Health workers, especially those in
communities, remain the most trusted advisor and influencer of vaccination
decisions, and they must be supported to provide trusted, credible information
on vaccines.
In 2019, WHO will ramp up work to
eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine,
among other interventions. 2019 may also be the year when transmission of wild
poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30
cases were reported in both countries. WHO and partners are committed to
supporting these countries to vaccinate every last child to eradicate this
crippling disease for good.
Dengue
Dengue, a mosquito-borne disease
that causes flu-like symptoms and can be lethal and kill up to 20% of those
with severe dengue, has been a growing threat for decades.
A high number of cases occur in
the rainy seasons of countries such as Bangladesh and India. Now, its season in
these countries is lengthening significantly (in 2018, Bangladesh saw the
highest number of deaths in almost two decades), and the disease is spreading
to less tropical and more temperate countries such as Nepal, that have not
traditionally seen the disease.
An estimated 40% of the world is
at risk of dengue fever, and there are around 390 million infections a year.
WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.
HIV
The progress made against HIV has
been enormous in terms of getting people tested, providing them with
antiretrovirals (22 million are on treatment), and providing access to
preventive measures such as a pre-exposure prophylaxis (PrEP, which is when
people at risk of HIV take antiretrovirals to prevent infection).
However, the epidemic continues
to rage with nearly a million people every year dying of HIV/AIDS. Since the
beginning of the epidemic, more than 70 million people have acquired the
infection, and about 35 million people have died. Today, around 37 million
worldwide live with HIV. Reaching people like sex workers, people in prison,
men who have sex with men, or transgender people is hugely challenging. Often
these groups are excluded from health services. A group increasingly affected
by HIV are young girls and women (aged 15–24), who are particularly at high
risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being
only 10% of the population.
This year, WHO will work with
countries to support the introduction of self-testing so that more people
living with HIV know their status and can receive treatment (or preventive
measures in the case of a negative test result). One activity will be to act on
new guidance announced In December 2018, by WHO and the International Labour
Organization to support companies and organizations to offer HIV self-tests in
the workplace.
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