UN body also lists newer challenges related to adolescents, emerging technologies and food among others
Antimicrobial resistance (AMR), climate crisis, eventuality of an influenza epidemic and spread of infectious diseases such as malaria, HIV and tuberculosis have topped the list of top global health challenges for 2020 released by the World Health Organization (WHO) on January 13, 2020.
This is the second straight year that these challenges have topped the WHO’s list.
Rather than talk about just diseases as ‘threats’, the list also takes into account infrastructure, social media, new tech and human resources in health.
A new entrant to the list of 13 potential threats is the lack of access. About a third of the world’s people lack access to medicines, vaccines, diagnostic tools and other essential health products, the report says.
“Medicines and other health products are the second-largest expenditure for most health systems (after health workers) and the largest component of private health expenditure in low- and middle-income countries,” it adds.
Delivering healthcare in conflict-ridden areas has remained one of the biggest challenges just not for the WHO but the global health fraternity. The WHO recorded 978 attacks on healthcare personnel in 11 countries last year, with 193 deaths of health workers.
This has been more pronounced in the ongoing outbreak of Ebola in the Democratic Republic of Congo (DRC), which started in August 2018 (killing 2,000 people) as well as the measles outbreak since January 2019 (killing 6,000 people). According to this report, as many as 390 attacks have taken place in the DRC from August 2018.
The shortage of healthcare workers has been flagged as a major concern. “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,” the report says.
It notes that the world will need 18 million additional health workers by 2030, primarily in low- and middle-income countries, including nine million nurses and midwives.
Protecting people from unhealthy food diets also finds a mention as threat for 2020:
Lack of food, unsafe food and unhealthy diets are responsible for almost one-third of today’s global disease burden. Hunger and food insecurity continue to plague millions, with food shortages being perniciously exploited as weapons of war. At the same time, as people consume foods and drinks high in sugar, saturated fat, trans fat and salt, overweight, obesity and diet-related diseases are on the rise globally
Another challenge that has been highlighted in the report is situation of adolescents around the globe. More than a million adolescents aged 10-19 years die every year due to road injury, HIV, suicide, lower respiratory infections, and interpersonal violence.
In 2020, the WHO will issue new guidance for policymakers, health practitioners and educators, called Helping Adolescents Thrive. The aim is to promote adolescents’ mental health and prevent the use of drugs, alcohol, self-harm and interpersonal violence, as well as provide young people with information on preventing HIV and other sexually-transmitted infections, contraception, and care during pregnancy and childbirth
Emerging technologies such as genome editing, synthetic biology and artificial intelligence for preventing, diagnosing and treating diseases might be a ‘tightrope walk’, according to the report.
These can solve many problems, but also raise new questions and challenges for monitoring and regulation, it continues. “Without a deeper understanding of their ethical and social implications, these new technologies, which include the capacity to create new organisms, could harm the people they are intended to help,” it warns.
It also talks about healthcare associated infections (HAIs), without referring to the term. “One in four health facilities globally lack basic water services. The lack of these basics — water, sanitation and hygiene — in health facilities leads to poor quality care and an increased chance of infection for patients and health workers,” it says.
An interesting trend the report sees emerging is the rise in misinformation related to health in social media, which has directly or indirectly decreased the trust of people in health institutions, and their messages.
It cites the example of the ‘anti-vaccination movement’ and says the movement became largely popular due to social media. However, the WHO admits the blame is not entirely social media’s.
“There’s a need, too, for self-reflection: scientists and the public health community need to do a better job of listening to the communities they serve. Finally, we must invest in better public health data information systems,” it says.
A number of threats found mention again, after last year like climate crisis for instance. “The same emissions that cause global warming are responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease,” it says.
Another ‘repeat offender’ is AMR. It threatens to send modern medicine back decades to the pre-antibiotic era, when even routine surgeries were hazardous, the report says.
The factors which created AMR include unregulated prescription and use of antibiotics, lack of access to quality and affordable medicines, and lack of clean water, sanitation, hygiene and infection prevention and control, among others.
Like last year, the report warns of another influenza pandemic. “A pandemic of a new, highly infectious, airborne virus — most likely a strain of influenza — to which most people lack immunity is inevitable. It is not a matter of if another pandemic will strike, but when, and when it strikes it will spread fast, potentially threatening millions of lives,” it says.
Add to this, the spread of vector-borne diseases like dengue, malaria, zika, chikungunya, and yellow fever thanks to the expansion of mosquito populations to newer areas due to climate change, and the situation becomes grievous.
Measles, an infectious disease, killed 0.14 million people and caused outbreaks even in those countries where it was declared eliminated.
Listing measles and other infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases and sexually-transmitted infections as a challenge, the report says four million people will die due to them. Significantly, non-communicable diseases are not mentioned as a top threat individually, for 2020 as it was done for 2019.
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