Issue #16
76th World Health Assembly, Rabat Declaration, Malaria, Meghalaya’s State Tobacco Control Cell, and Plastic Pollution
Dear readers, welcome back to the sweet 16th issue of Parks & Bhore. Monsoons and rains usually remind a public health student of multitude of infectious diseases, most notably Dengue and Malaria. But it is also a perfect time to get intimate with that old dusty book lying on your self for months, to make a cup of warm tea and curl up by the window side. If you like travelling, it’s the perfect time to explore India through its constantly expanding highways. Like I always say, make the best use of time-space continuum because now and here won’t repeat again.
Moving on, as you’d have noticed there is some underlying theme in all my newsletters. Since geopolitics is a burning issue, India recently had a historic US state visit, and international relations is one of my key interests, we’ll focus this letter on some global issues. If you find it a lengthier letter, take your time reading it, because we won’t meet again until the end of July.
This time we discuss: 76th World Health Assembly, Rabat Declaration, Malaria elimination and emergence, Meghalaya’s State Tobacco Control Cell receives WHO award, and Intergovernmental Negotiating Committee (INC) on Plastic Pollution. Parts of the newsletter– pieces on Meghalaya’s State Tobacco Control Cell, and Intergovernmental Negotiating Committee (INC) on Plastic Pollution– has been written by my fellow resident and environmental health enthusiast Dr. Shalini Singh.
What’s in the News?
76th World Health Assembly
World Health Organization and its member states last month concluded the 76th World Health Assembly (WHA) with many landmark discussions and unprecedented resolutions. Here are some of the key resolutions in brief:
The health of Indigenous Peoples
An unprecedented resolution on the health of indigenous peoples was proposed by member states and approved by the WHA. The resolution requests the Director-General WHO to develop a global action plan, in consultation with indigenous peoples, for the health of indigenous peoples and to present it to the Seventy-ninth World Health Assembly in 2026. It also asks WHO to provide support to Member States for improving indigenous health; and that the improvement of indigenous peoples’ health be included in the development of the Fourteenth WHO General Programme of Work. It urges Member States to develop knowledge about the health situation of indigenous peoples in an ethical manner; develop, fund and implement national health plans and strategies for indigenous peoples; and encourage the attraction, training, recruitment and retention of indigenous peoples as health workers taking into account the traditional knowledge and practices. Indigenous people in India are referred to as tribal people and there were some early attempts to improve tribal health through the 2013 report by Expert Committee on Tribal Health but lately the progress on this front has been lacking and we need to do more to make our health system inclusive of indigenous or tribal people.
Accelerating action on global drowning prevention
A resolution to accelerate action on global drowning prevention was adopted by the delegates at the World Health Assembly. The resolution requests Member States to assess their national drowning situation and to develop and implement multisectoral drowning prevention programmes. WHO will also coordinate multisectoral actions within the UN system on drowning prevention- by setting up a Global Alliance for Drowning Prevention- and facilitate the observance of World Drowning Prevention Day on 25 July each year. WHO will prepare a global status report on drowning prevention to better understand the burden and impact of drowning. Drowning is a leading global cause of injury-related child deaths and a serious and neglected public health issue. 90% of drowning happen in low- and middle-income countries and highest drowning rates occur among children aged 1–4 years.
Behavioural sciences for better health
Member States adopted the first ever resolution on behavioural sciences for better health. The resolution was on the backdrop of a broad consensus towards the need for integrating behavioural science theory, methods and approaches across health topics and public health functions. The resolution urges Member States to acknowledge the role of behavioural science in achieving better health outcomes, to identify opportunities for increased use and, to establish functions and units for generating and translating evidence to inform policies and programmes. WHO was urged to mainstream the use of behavioural science within the organization, to build capacity in regional offices, to create a repository of evidence and synergies between sectors, and to provide guidance and technical support to Member States. Behavioural sciences is a multidisciplinary scientific approach towards protecting and improving people’s health using human action. This field has a great potential in public health, despite inherent complexities and challenges in measuring human behaviour and implementing the evidence, which could be bridged by this resolution.
Well-being and health promotion
Member States agreed to adopt a "Global framework for integrating well-being into public health utilizing a health promotion approach". The global framework strives to enable all people to flourish and achieve their full physical and mental health potential throughout their lives and across generations. It recommends six key strategic directions that focus on: universal health coverage, equitable economies, protecting the planet, social protection systems, digital systems to enable health, and measuring and monitoring well-being. The framework is built on the 2030 Agenda for Sustainable Development and recognises that many of the actions to promote and protect health lie outside of the health sector and require close collaboration with other sectors. It will act as a guidance document for multi-sectoral engagement for advancing societal well-being and development. Together with behavioural sciences resolution, both of these resolutions advance our holistic understanding of health and de-medicalisation of healthcare.
Other key deliverables from the WHA included, but not limited to– a resolution on substandard and falsified medical products (Indian Pharma may have something to say on this); a resolution on accelerating efforts to prevent micronutrient deficiencies through safe and effective food fortification; and a resolution addressing environmental determinants of health, including management of chemicals and waste- the impact of chemicals, waste and pollution on human health.
Rabat Declaration
At the Third Global Consultation on the Health of Refugees and Migrants, held on 13-15 June in Rabbat, Morocco, a watershed political declaration was adopted to advance the health and rights of refugees and migrants globally. The Rabat Declaration aims to advance refugees and migrants health by committing to accelerate efforts to improve the health of refugees, migrants and their host communities; address the root causes that negatively influence their health; and work towards including health and social protection considerations in national policies related to refugees and migrants.
This declaration is a key symbol of political willpower and an unprecedented move to mainstream refugees and migrants health in global health deliberations and national health systems. Around one in eight people globally is a migrant. Migrants face significant barriers to access care and suffer negatively from multiple social determinants. While the declaration primarily focuses on inter-country migrants, intra-country migration is another concern as was seen during COVID-19 pandemic in India.
Other than nearly 50 member states, key stakeholders of refugees and migrants health like WHO, IOM, the UN Migration Agency, and UNHCR, the UN Refugee Agency were also present at the meeting. The declaration adhere to principles inscribed in SDGs, the Global Compact on Refugees, the Global Compact for Migration and the WHO GAP.
Malaria eliminated and resurfaces
We discussed in our 13th issue in April how Azerbaijan and Tajikistan were certified by WHO as having eliminated Malaria in their territories. Well, moving from Central Asia to South America, Belize has now been certified as malaria-free by the WHO. With this, a total of 43 countries or territories have been certified as malaria-free, three of them in 2023. Belize achieved this milestone on the back of a strong surveillance, access to diagnosis, and effective vector control methods including insecticide-treated mosquito nets and indoor spraying of insecticides. All three countries that have eliminated Malaria in 2023 are members of the E-2025 initiative- 25 countries identified with potential to eliminate Malaria by 2025. Belize is also part of PAHO’s Disease Elimination Initiative which aims to eliminate over 30 communicable diseases in PAHO region by 2030.
In a very paradoxical and ironical moment, while Belize from the global south of Americas eliminated Malaria, the disease made news for different reason in the North America. The United States has identified at least five cases of Malaria in the states of Florida and Texas within last two months, with, -very crucial- no history of international travel. This establishes the local transmission of Malaria in USA for the first time in 20 years, although the country reports around 2000 cases every year- all of them from international travellers. All five cases have been linked to plasmodium vivax. While we are yet to establish how wide is this local transmission, there is no doubt that climate change has played a role here. Due to rising temperatures and changing climate, more and more diseases and vectors are emerging or reemerging in regions usually outside their endemicity. Over long term, this will slow down eradication of diseases like Malaria.
Meghalaya’s State Tobacco Control Cell receives WHO award
The State Tobacco Control Cell (STCC) of Meghalaya received World No Tobacco Day Awards last month, for its exemplary tobacco control initiatives. WHO recognises individuals or organisations in each of the six WHO Regions for their exceptional efforts to reduce tobacco consumption in the form of World No Tobacco Day Awards.
Meghalaya won the award under South-East Asia Region category for its successful campaign against tobacco. The signature campaign received active participation of nearly five lakh students from around 8000 schools across the state and reached out to more than 3,500 villages to increase awareness about ill-effects of tobacco consumption. In addition to this, 7,388 rallies were held over a span of several months to help mobilise communities in the fight against tobacco. The activities were a part of state’s Comprehensive Tobacco Control Program and were implemented by STCC in collaboration with the Education and Police Department. It is worth noting that the North-East, in general, reports a high prevalence of tobacco use and Meghalaya specifically reported a prevalence of tobacco use in as many as 57% men aged 15 years and above in NFHS 5- one of the highest in all over India.
Centre for Multi-Disciplinary Development Research, Dharwad, Karnataka was another awardee in the SEAR category for its valuable research in the area of tobacco control. (Trivia: STCC Ranchi, Jharkhand was the recipient of this award last year.)
Additionally, a new category was introduced this year in the form of WHO Director-General's Special Recognition Certificate and was awarded to His Excellency Prof Ali Mrabet, Minister of Health, Tunisia. His contributions include mandating 70% graphical health warnings on packaging of tobacco products and establishing a high-level multisectoral national anti-smoking committee for training of stakeholders. Notably, Mrabet is a military doctor and a professor in epidemiology and public health.
Intergovernmental Negotiating Committee (INC) on Plastic Pollution
At the resumed fifth session of United Nations Environment Assembly in Feb 2022, a historic resolution was adopted to develop an international legally binding instrument on plastic pollution, including in the marine environment. The instrument is to be based on a comprehensive approach that addresses the full life cycle of plastic (including production, design, and disposal), with the ambition to complete the negotiations by end of 2024. An Intergovernmental Negotiating Committee was formed to continue the negotiations on this instrument.
At the second of five planned sessions of Intergovernmental Negotiating Committee (INC) on Plastic Pollution, concluded at UNESCO headquarters in Paris on 2nd June, a mandate was passed to prepare a zero draft of the agreement ahead of the third session, to be held at UNEP headquarters in Nairobi, Kenya in November 2023. At the first INC session, held in Uruguay in December 2022, participating member states had first acknowledged the global plastic pollution crisis.
However, the Paris session ended without a fruitful conclusion as there was a stalemate over age-old “voting vs consensus” debate in rules of procedure. Saudi Arabia led coalition, including India, were in favour of consensus in the rule of procedure- which although more inclusive is time-consuming, and has been used as a tactic to slow or halt environmental actions. Other coalition, principally USA and European nations, were in favour of voting as a decision-making tool. Worth noting that traditionally successful international legal instruments, like Montreal Protocol and FCTC, have used voting as only or part of decision making tool. The committee decided to form an Open Ended Working Group to deliberate on the issues regarding the rules of procedure.
Petrochemical Industry, a major exporter and producer of plastic polymers, has emerged as one of the promise bearers for India’s 5 trillion USD economy. Major petrochemical industry have invested considerable amount into India’s economy. Any environmental negotiations will have bearings on this industry, and on India’s economy. So it should not be surprise, though disappointing, that India- a major plastic polluter, is part of the group trying to halt or delay the negotiations.
Recommended Reading
World Health Statistics report is WHO’s annual compilation of the most recent available data on health and health-related indicators. It is the WHO’s “annual check-up on the state of the world’s health”, being published annually since 2005. I present just some of the salient findings from more than 50 health-related indicators in the 2023 report:
Maternal Mortality: Global maternal mortality ratio has stagnated at 223 per lakh live births, with an ARR of -0.04% between 2016-20. South-East Asia maintained the fastest reduction rate while there is a trend reversal in Americas, Western Pacific and Europe.
Child Mortality: Both the NMR and U5MR has declined to 18 and 38 deaths per thousand live births. However NMR declined at a slower rate compared to U5MR and both declined slower in last decade compared to the decade before.
NCDs: Impact of NCDs continue growing with an estimated 74% of deaths and 63% of DALYs globally attributed to NCDs. Prevalence of HTN globally has declined to 33% with all regions showing a decline, except SEAR where HTN continues to rise unchecked since 1990.
Risk Factors: Total alcohol per capita consumption has declined at global level (5.5 ltrs per capita in 15+). The prevalence of current tobacco use among 15+ has also declined to 22.3% globally. Obesity prevalence continues increasing globally, with more rapid increase in male obesity than female.
COVID-19: Major updates on estimates of excess mortality due to COVID-19 show that globally 14.9 million excess deaths could be attributed to COVID-19. More excess deaths occurred in 2021 than in 2020, and SEAR had the highest number of excess deaths for both 2020 and 2021. The pandemic disproportionately affected women and those aged 45 years and above.
Infectious Diseases: New HIV infections and HIV-related deaths continue to decline. COVID-19 pandemic has had negative impact on access to TB diagnosis and treatment, leading to global increase in TB burden.
Nutrition: Global prevalence of stunting in children under 5 fell to 22.3%, with highest prevalence in Africa region. Global prevalence of wasting in children under 5 was 6.8%, with highest prevalence in SEAR. Global prevalence of overweight in children under 5 has stagnated at 5.6%, with highest prevalence in Americas. Global prevalence of anemia in women 15-49 years has only slightly reduced to 30%, with highest prevalence in SEAR.
Climate Change: This year’s report includes for the first time a dedicated section on climate change and health. LICs, LMICs, and SIDS face greatest health consequences of climate change, despite contributing least to historical global emissions. By 2030, climate change would cause around 250,000 additional deaths per year from malaria, heat exposure, undernutrition, diarrhoea, and coastal flood. Health sector is responsible for 4-5% of global GHG emissions.
WASH: Safe drinking-water and safe sanitation was accessible to only 74% and 54% of the global population respectively.
Resources for you
Global Digital Health Monitor (GDHM) is an interactive digital tool that was launched at the World Health Assembly last month. Formerly, Global Digital Health Index (GDHI), GDHM monitors digital health progress at the country, regional, and global levels by tracking the use of digital technology for health across countries. Built on the framework of WHO/ITU eHealth Strategy Toolkit, it monitors the progress using 23 key indicators aligned with WHO Global Digital Health Strategy.
Quote to Go
“It's hard to remember that this day will never come again. That the time is now and the place is here and that there are no second chances at a single moment.”
– Jeanette Winterson
That's all for this issue.
Until next letter,
Ankit
You can connect with me on Twitter or on LinkedIn or just hit comments to let me know your thoughts or if you would like to guest write an issue. You can connect with fellow writer for this issue, Shalini Singh, on LinkedIn.