Current Affairs - WHO

• On 13^th January, 2020, the World Health Organization (WHO) released a list of 13 urgent health challenges the world will face over next decade.
• All the challenges included on the list are urgent, and several are interlinked and demand a response from more than just the health sector, including Governments, communities, and international agencies to work together in order to address the looming health challenges.

13 Health Challenges

1. Climate Crisis as a Health Crisis

• The world's climate crisis has major health implications, with air pollution alone killing an estimated seven million people annually, while it causes more extreme weather events, exacerbates malnutrition and fuels the spread of infectious diseases such as malaria.

2. Health Care Delivery in Areas of Conflict and Crisis

• In 2019, most disease outbreaks requiring the highest level of WHO response occurred in countries with protracted conflict.
• There is continuation of a disturbing trend in which health workers and facilities are targeted.

3. Making Health Care Fairer

• Persistent and growing socio-economic gaps result in major discrepancies in the quality of people’s health. There is an 18-year difference between the life expectancy of people in low- and high-income countries, as well as significant differences in life expectancies among people living within the same countries and cities.

4. Access to Medicines

• About one-third of the world’s people lack access to medicines, vaccines, diagnostic tools and other essential health products. Limited access to these products fuel drug resistance and threaten people's lives and health.

5. Preventing Infectious Diseases

• Infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases and sexually-transmitted infections will kill an estimated 4 million people in 2020, most of them poor.

6. Preparing for Epidemics

• An airborne and highly infectious virus pandemic is inevitable. The countries around the world continue to spend more on responding to these emergencies than preparing for them.
• This leaves countries unprepared for when another pandemic strikes and potentially threatens the lives of millions of people.

7. Protecting People from Unsafe Products

• Nearly one-third of today's global disease burden is attributed to a lack of food, unsafe food, and unhealthy diets.
• Further, there's been an increase in tobacco and e-cigarette use in most countries, raising additional health concerns.

8. Underinvestment in Health Workers

• Chronic under-investment in the education and employment of health workers, coupled with a failure to ensure decent pay, has led to health worker shortages all over the world. This jeopardizes health and social care services and sustainable health systems.
• An additional 18 million health workers, including nine million nurses and midwives, will be needed across the world by 2030.

9. Adolescent Safety

• More than 1 million adolescents aged 10-19 years die every year due to road injury, HIV, suicide, lower respiratory infections, and interpersonal violence.
• A number of factors including harmful alcohol use, unprotected sex, and lack of physical activity, increase the risks of these types of death.

10. Earning Public Trust

• Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions.

11. Harnessing New Technologies

• Genome editing, synthetic biology and digital health technologies such as artificial intelligence can solve many problems, but also raise new questions and challenges for monitoring and regulation.
• Without a deeper understanding of their ethical and social implications, these new technologies could harm the people they are intended to help.

12. Threat of Anti-Microbial Resistance

• Anti-microbial resistance (AMR) has the potential to undo decades of medical advancements and has increased due to a number of factors, including limited access to quality and low-cost medications, unregulated prescription and use of antibiotics and poor infection prevention control.

13. Keeping Health Care Clean

• Roughly one in four health facilities globally lack basic water services. The lack of these basics in health facilities leads to poor-quality care and an increased chance of infection for patients and health workers.

WHO’s Course of Action towardsChallenges

Challenge 1

• In 2020, WHO will work towards developing a set of policy options for governments to prevent or reduce the health risks of air pollution.

Challenge 2

• WHO is working to save lives and prevent suffering by working with countries and partners to strengthen health systems, improve preparedness and expand the availability of long-term contingency financing for complex health emergencies.

Challenge 3

• WHO is working with its partners to improve child and maternal care, nutrition, gender equality, mental health, and access to adequate water and sanitation.
• It is calling for all countries to allocate 1% more of their gross domestic product to primary health care, to give more people access to the quality essential services they need, close to home.

Challenge 4

• Coming year, WHO will sharpen its focus on priority areas for global access. These include fighting substandard and falsified medical products; enhancing the capacity of low-income countries to assure the quality of medical products through out the supply chain; and improving access to diagnosis and treatment for non-communicable diseases, including diabetes.

Challenge 5

• There’s an urgent need for greater political will and increased funding for essential health services; strengthening routine immunization; improving the quality and availability of data to inform planning, and more efforts to mitigate the effects of drug resistance.

Challenge 6

• WHO is advising countries on evidence-based investments to strengthen health systems and infrastructure to keep populations safe when health emergencies strike.

Challenge 7

• WHO is engaged in developing evidence-based public policies, investments and private sector reforms to reshape food systems, and provide healthy and sustainable diets.

Challenge 8

• To trigger action and encourage investment in education, skills and jobs, the World Health Assembly has designated 2020 the ‘Year of the Nurse and the Midwife’.

Challenge 9

• In 2020, WHO will issue new guidance for policymakers, health practitioners and educators, called ‘Helping Adolescents Thrive’. The aim is to promote adolescent’s mental health and preventive measures towards better health.

Challenge 10

• WHO is working with countries to strengthen primary health care, so people can access effective and affordable services easily, from people they know and trust, in their own communities.

Challenge 11

• In 2019,WHO set up new advisory committees for human genome editing and digital health, bringing together the world’s leading experts to review evidence and provide guidance.

Challenge 12

• WHO, along with national and international authorities, is working to reduce the threat of AMR by addressing its root causes, while advocating for research and development into new antibiotics.

Challenge 13

• WHO and its partners are currently working with 35 low and middle-income countries to improve the water, sanitation and hygiene conditions in their health facilities. The global goal is for all countries to have included WASH services in plans, budgets and implementation efforts by 2023 and by 2030 all health care facilities globally should have basic WASH services.

• Recently, World Health Organisation (WHO) released its first world report on vision, addressing the increasing eye problems across the globe.

Aims

• To raise awareness of the global magnitude and impact of eye conditions and vision impairment.
• To draw attention to effective strategies to respond to eye care needs
• To take stock of progress, and identify the main challenges facing the field of eye care
• To make recommendations for action to be implemented by all countries to improve eye care.

Key Findings of the Report

• Globally, at least 2.2 billion people have a vision impairment or blindness.
• More than 1 billion people worldwide are living with vision impairment because they do not get the care they need for conditions like short and far sightedness, glaucoma and cataract.
• Rates of cataract and trachomatous trichiasis are higher among women, particularly in low- and middle-income countries.
• The burden of eye conditions is far greater in people living in rural areas, those with low incomes, women, older people, people with disabilities, ethnic minorities and indigenous populations.
• Vision impairment in low and middle-income regions is estimated to be four times higher than in high-income regions.
• Low- and middle-income regions of western and eastern sub-Saharan Africa and South Asia have rates of blindness that are eight times higher than in all high-income countries.
• US$14.3 billion is needed to address the backlog of 1 billion people living with vision impairment or blindness.
• The report hailed India’s National Programme for Control of Blindness (NPCB). NPCB has provided cataract surgery to 6.5 million people- a cataract surgical rate of over 6,000 per million population in 2016-17.

Causes of Rising Vision Impairment

• Due to weak or poorly integrated eye care services, many people lack access to routine checks that can detect conditions and lead to the delivery of appropriate preventive care or treatment.
• Eating habits are also a factor, since, in type 2 diabetes, the number of retinopathy cases increase.
• Increased time spent indoors and increased “near work” activities are leading to more people suffering from myopia. Increased outdoor time can reduce this risk.

Impact

• Young children with early onset severe impairment can experience delayed motor, language, emotional, social and cognitive development with lifelong consequences.
• School-age children with vision impairment can also experience lower levels of educational achievement and self-esteem.
• Vision impairment severely impacts quality of life (QoL) among adult populations.
• Adults with vision impairment often have lower rates of workforce participation and productivity and higher rates of depression and anxiety than the general population.
• In the case of older adults, vision impairment can contribute to social isolation.
• It can lead to higher rates of violence and abuses, including bullying and sexual violence are more likely to be involved in motor vehicle accidents and can find it more difficult to manage other health conditions.
• Vision impairment also poses an enormous global financial burden as it impacts the loss of productivity and efficieny.

Suggestive Measures

• Integrated Eye Health System: The report sets out concrete proposals to address challenges in eye care. The key proposal is to make integrated people centred eye care, embedded in health systems and based on strong primary health care, the care model of choice and scale it up widely
• Integrated People-Centred Eye Care (IPCEC): It seeks to stimulate action in countries to address these challenges by proposing integrated people-centred eye care (IPCEC) as an approach to health system strengthening that builds the foundation for service delivery to address population needs
• Universal Health Coverage: IPCEC will also contribute to achieving universal health coverage (UHC) and Sustainable Development Goal 3 (SDG3): “Ensure healthy lives and promote well-being for all at all ages”.

Way Forward

• The government not only in India but across the globe should reorient the model of care based on a strong primary care by engaging and empowering the people and communities in order to raise awareness about eye care needs.
• It should focus on creating an enabling environment, specifically the inclusion of eye care in national health strategic plans, the integration of relevant eye care relevant data within health information systems, and the planning of the eye care workforce according to population needs.
• In addition, International organizations, donors, and the public and private sectors must work together to provide the long-term investment and management capacity to scale up integrated people-centred eye care.

• On 23^rd September, 2019, the United Nations General Assembly held the first ever high-level meeting on Universal Health Coverage (UHC) under the theme- Universal Health Coverage: Moving Together to Build a Healthier World.

Aim

• The meeting aims at mobilizing the global community to secure political commitment from Heads of State and Government to accelerate progress toward achieving UHC by 2030.
• It aims to accelerate progress toward universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Background

• In 2015, Heads of States and Governments made a bold commitment to achieve universal health coverage by 2030.
• The September 23^rd, 2019 meeting was called for in December 2017 when the UN passed a resolution on global health and foreign policy, addressing the health of the most vulnerable for an inclusive society.

Source: ESMO

Key Outcomes

• The World Leaders adopted a high-level United Nations Political Declaration on universal health coverage (UHC).
• In adopting the declaration, U.N. Member States committed to advance towards UHC by investing in major areas around primary health care. These include mechanisms to ensure no one suffers financial hardship and implementing high-impact health interventions to combat diseases and protect women’s and children’s health.
• In addition, countries must strengthen health workforce and infrastructure and reinforce governance capacity.

Significance

• The declaration comes the day after the World Health Organization (WHO) and partners stressed the need to double health coverage between now and 2030 or leave up to 5 billion people unable to access health care.
• This declaration represents a landmark for global health and development. The world has 11 years left to make good on its sustainable development goals (SDGs) and universal health coverage is key to achieve within the given tine framework.

India’s Effort towards UHC

• Indian Prime Minister while addressing first ever high-level meeting on UHC stressed the importance of UHC as healthy life is every person’s right.
• He highlighted the bold steps taken by India to achieve UHC by adopting a holistic approach on four main pillars of healthcare which are:
  • Preventive Healthcare:
    • In order to promote preventive healthcare, special emphasis on Yoga, Ayurveda and Fitness and wellness centers have been made, helping in controlling life style diseases such as diabetes, blood pressure, depression etc.
    • Immunization campaigns and greater awareness through Clean India campaign have also contributed to health promotion.
  • Affordable Healthcare:
    • To ensure affordable healthcare, India has rolled out the world’s largest health insurance scheme - Ayushman Bharat Scheme.
  • Supply Side Improvement:
    • The government has taken several important steps for quality medical education and medical infrastructure development in the country.
  • Mission Mode Intervention:
    • Among mission mode interventions, the Poshan Abhiyan (National Nutrition Mission) has been launched to improve nutritional status of mother and child.

Recent Initiatives in UHC

National Digital Health Blueprint (NDHB)

• On 16th July, 2019, the government released the National Digital Health Blueprint (NDHB), bringing in the National Digital Health Eco-system (NDHE) that can ensure the availability of healthcare services on a wider scale.
• It encapsulates the goals of National Health Policy-2017 and aims to leapfrog to the digital age by providing a wide range of digital health services.
• It will support the quality of healthcare, universal health coverage (UHC) in an efficient, accessible, inclusive, affordable, timely and safe manner through the provision of a wide range of data, information, and infrastructure services

Ayushman Bharat (National Health Protection Mission)

• Launched in September, 2018, it is a national initiative as the part of National Health Policy 2017, in order to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no one behind”.
• It comprises two inter-related components:
  • Establishment of Health and Wellness Centres: The first component, pertains to creation of 1,50,000 Health and Wellness Centres which will bring health care closer to the homes of the people.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): It is one significant step towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal-3. It aims to provide health protection cover to poor and vulnerable families against financial risk arising out of catastrophic health episodes.

Poshan Abhiyan (National Nutrition Mission)

• Launched in March, 2018, it aims to improve nutritional outcomes for children, pregnant women and lactating mothers. The POSHAN (Prime Minister’s Overarching Scheme for Holistic Nutrition) Abhiyaan directs the attention of the country towards the problem of malnutrition and address it in a mission-mode.
• Four point strategy/pillars of the mission are:
  • Inter-sectoral convergence for better service delivery
  • Use of technology for real time growth monitoring and tracking of women and children
  • Intensified health and nutrition services for the first 1000 days
  • Jan Andolan

National Health Policy, 2017

• The policy envisages as its goal the attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services across the country.

Challenges in Achieving Universal Health Coverage

• Disparity in Quality of Healthcare Services: Wide disparity in the quality of healthcare services in the public and private sector is prevalent as regulatory standards are neither established nor enforced properly by the Government of India.
• Lack of Medical Professionals: The issue of under trained and traditional healers treating patients at the grass-root level is a serious concern which reflects the poor availability of healthcare services and service providers in rural areas.
• Non-affordability of Health Services: Given the large number of people still living below the poverty line in India, the affordability of quality healthcare is a major problem across the country leading to serious health situations.
• Lack of Adequate Infrastructure: The existing healthcare centres especially in rural areas are under-financed, with below quality equipment, lack of beds, etc. which provide a major challenge towards delivering effective health care system.

Way Forward

• It is high time for India as well as other countries to acknowledge the need for redefining health in light of the SDGs. Universal health coverage should be designed based on the revised definition of health. That will lead to a better understanding, and attainment, of holistic health and well-being.
• Universal Health Care is expected to bridge inequalities relating to health and its access. As UHC evolves, it must take into consideration providing additional benefits to poor and vulnerable belts of people.

The World Organization of Animal Health, commonly known as OIE (an abbreviation of its French title), summarises the One Health concept as “human health and animal health are interdependent and bound to the health of the ecosystems in which they exist”.

Relevance of the News: One health concept highlights the interdependence of all living creatures on earth and the concept of ecological inter-connectedness.

What is One Health?

• One Health recognises inter-connectivity among human health, the health of animals, and the environment and the importance of each for the sustainability of the other two.
• It is not a new concept as in 400 BC, Hippocrates in his treatise On Airs, Waters and Places had urged physicians that all aspects of patients’ lives need to be considered including their environment and disease was considered a result of imbalance between man and environment.

Why it has received interest now?

• With the expansion of populations around the world, greater contact is established among living creatures including humans, animals and environment which provides more opportunities for diseases to pass from one to the other.
• Climate change, deforestation and intensive farming further disrupt environment characteristics, while increased trade and travel result in closer and more frequent interaction, thus increasing the possibility of transmission of diseases.

Facts highlighted by the World Organization of Animal Health:

• 1.60% of existing human infectious diseases are zoonotic i.e. they are transmitted from animals to humans;
• 2.75% of emerging infectious human diseases have an animal origin.
• 3.Of the five new human diseases appearing every year, three originate in animals.
• 4.It is estimated that zoonotic diseases account for nearly two billion cases per year resulting in more than two million deaths — more than from HIV/AIDS and diarrhoea.
• 5.One-fifth of premature deaths in poor countries are attributed to diseases transmitted from animals to humans.

Concern for India:

• 1.Developing countries like India rely too much on agricultural systems which results in uncomfortably close proximity of animals and humans.
• 2.The size of India’s human and animal populations is almost the same; 121 crore people (2011 Census) and 125.5 crore livestock and poultry.
• 3.A network of 1.90 lakh health institutions in the government sector form the backbone of health governance, supported by a large number of private facilities but there are only 65,000 veterinary institutions which tend to the health needs of 125.5 crore animals which includes 28,000 mobile dispensaries and first aid centres with bare minimum facilities.
• 4.Private sector presence in veterinary services is close to being nonexistent.
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The World Organization of Animal Health highlights the following Steps that can be taken as a Safeguard:

• 1.Veterinary institutions and services must be strengthened.
• 2.The most effective and economical approach is to control zoonotic pathogens at their animal source.
• 3.Close collaboration at local, regional and global levels among veterinary, health and environmental governance is needed and also greater investment in animal health infrastructure.
• 4.Humans require a regular diet of animal protein.
• 5.There could not be a stronger case for reinventing the entire animal husbandry sector to be able to reach every livestock farmer, not only for disease treatment but for prevention and surveillance to minimise the threat to human health.
• 6.Early detection at animal source can prevent disease transmission to humans and introduction of pathogens into the food chain, so a robust animal health system is the first and a crucial step in human health.
• 7.Disease surveillance has to go beyond humans and encompass preventive health and hygiene in livestock and poultry, improved standards of animal husbandry for greater food safety, and effective communication protocols between animal and public health systems.