IHP news #533 (May 24, 2019)

The 72nd World Health Assembly in Geneva

By on May 24, 2019



Dear Colleagues,

Like many, over the past week, I spent some days here at the 72nd World Health Assembly in Geneva, starting with civil society preparatory meetings last Friday already. My favourite quote from that meeting came from WHO director Public Health, Environmental and Social Determinants of Health,  Maria Neira:  “We are all the private sector !” (given how we all use Apple or other tablets/smartphones, take planes, eat Nestle stuff…)  Never had looked at it that way. I wouldn’t go that far, but will think of that, next time I start a rant about the private sector : )

IHP being about knowledge management first and foremost, I won’t try to reinvent the wheel here, as there’s been absolutely fabulous comments/summaries from PHM Watchers on the #WHA72 agenda, and some great reporting from among others Devex, Health Policy Watch & GHN teams. I’ll flag many of their (must-) reads in this week’s newsletter issue, and then you can basically immerse yourself as much as you want. And also, of course, in the rest of global health (policy) news & publications from this week.

Nevertheless, let me offer you a few fragmentary & idiosyncratic points that crossed my mind or struck me one way or another, the past week, even if I’m well aware that the World Health Assembly is for everybody a different experience, depending on which sessions, technical briefings, side events, High-Level Breakfasts you go to (I sadly only had ‘Express breakfasts’ in the place where I stayed, and felt very much Left Behind, as I was watching at the same time the Novotel guests indulge in their lavish breakfast buffets 😊 )  …, with whom you network (or “schmooze”, as journalists would have it), what your major global health interests or pet peeves are, which ‘hat’ (or hats) you wear, etc.

To be frank, given my rather lousy quality of sleep here, I felt a bit ‘off the pace’ in Geneva, like 33-year old David Silva from Manchester City nowadays in the Premier League, between all these global health rock stars (with many, like Anders Nordström and Stefan Peterson, apparently diligently following WHO’s NCD recommendations; maybe it’s a Scandinavian thing, though, as I’m less sure about Peter Sands, and @PeterASinger also seems to enjoy a healthy belly 😊 ) and glamourous power ladies in global health. At some point double espressos just don’t do the job anymore.   It’s a bit funny, I know, given that WHO and other global health actors propagate  ‘Healthy lives and wellbeing for all at all ages’ nowadays. As I was listening to a Japanese minister talking about the super-aging society in her country, I’m afraid that also goes for some of us, who are not in the best of shapes, at the WHA – it can be a bit of a ‘super-aging’ experience : )

And so, by 2 pm in the afternoon, I had usually already gotten a bit dizzy from all the rhetoric and PR, certainly at technical briefings, on ‘Leaving No One Behind’  (I seriously can’t stomach that phrase anymore), the need to ‘Go beyond the silos’, the relentless mantras on UHC & PHC ( plus ‘There’s no UHC without X…’) , the never-ending ‘paradigm shifts’ needed, and of course ‘business as usual won’t do it’ & ‘One size doesn’t fit all’ (duh). Also, “We need to Walk the Talk”, and as you might have guessed, ‘political will’ is ever needed (but is it also on the horizon?) 😊, …

Anyway. Like most, I was fairly blown away by the opening plenary, already starting with a neat Laotian music & dance performance  (the president of this year’s WHA proceedings is from Laos). I was less impressed by the rather laidback Laotian feel of the internet connection during that opening plenary 😊. The Zambian young activist blew away, among others, the translators, with her frantic pace of speaking, and showed with her powerful message how vital it is to have the young generation at these very high-level decision making tables as they are, indeed, the future. And of course, Richard Horton nailed it as only he can, while also sharing a bit of his medical story of the past months and good experience with the NHS. Based on feedback he had received from a Twitter request, “What would you say to the delegates if you had 10 minutes?” “, he kicked off with the need for WHO to declare a planetary (health) emergency. I obviously agree – it had been discussed already at the civil society meetings over the weekend, with Andrew Harmer as a key proponent. As I had mentioned, while joining the ‘Walk the Talk’ festivities for a while in the streets of Geneva, if dr. Tedros really wants to “Walk the Talk” on health SDG 3, he should do exactly that, declare a planetary health emergency. I don’t think it would be wise to declare a “PHEIC” on it though, we probably need a special category for this existential emergency which will be with us for the best part of this century. Such a WHO declaration would help to sustain the current momentum (by the likes of Greta Thunberg, the Guardian’s announcement of ditching the term ‘climate change’ for ‘climate breakdown/emergency’, or the call for a general strike globally on 20 September ).

I worry a bit what would be the follow-up by WHO, though, if that indeed were to happen.  A lot of lip service is being paid here to Greta Thunberg, I notice, but my guess is that @PeterASinger would then immediately make an ‘Investment Case’, trying to turn the whopping 3 % of the immense WHO budget going to climate change into ‘Impact’. And then, to finish it off in style, a Planetary Health Emergency ‘Partnership’ would be established 😊.  That wouldn’t do it, clearly. But it’s a serious question, what would WHO have to change, in its programmes, discourse, normative guidelines, functioning, … if dr. Tedros really declared a planetary health emergency? For example, if they hired a Chief Economist, as Ilona Kickbusch and many others would like, would he/she propagate a thorough change of the global economic system (incl postgrowth/degrowth,  certainly for “developed” countries…)? Would, for example, Anthony Costello’s tweet from last weekend be seriously considered ?  “One massive issue for the United Nations is how to cut the carbon footprint of their meetings: the UN hosts 36 major meetings in May alone….over 400 global meetings per year. @antonioguterres Thousands of delegates flying into each one. This cannot continue.”  (or, perhaps, in WHO terms, as the health minister from the DRC put it, ‘There are now as many Ebola cases as WHA delegates’… ). Would the Global Action Plan for healthy lives and well-being for all (GAP) be as “transformative” as it actually should be, including on this need to truly transform the global economic system, if we really want to achieve SDG 3 within our lifetime (as compared to collectively staring in the abyss)? …

Other themes from the WHA you’ll find covered in this newsletter are, among others: UHC (& the build-up to the UN High Level Meeting on UHC, with the  zero draft of the political declaration   now released), and with PHC now embraced by pretty much every important global health actor, (even if I they don’t all mean the same 😊),  but with also a big financing gap remaining for UHC in LICs, especially in sub-Sahara Africa (and speculation behind the scenes that this might lead to some insidious plan from a certain actor for sneaking in private health insurance, and other forms of ‘creeping privatization’ (the term was used at the civil society meetings), or is it ‘creepy privatization’?) – instead, the paradigm shift needed is to get governments spend much more on PHC; access to medicines & the fair pricing debate (incl the already notorious ‘transparency resolution’); the NCD tsunami/pandemic/…  ( I went to a rather informative symposium on a possible Catalytic Fund for NCDs & other innovative financing for NCDs); the remarkable and heartfelt testimony of an NCD patient who had suffered from breast cancer & depression (at an NCD Alliance event on Monday evening) showed how important it is to have these ‘experience experts’, like young people (see above), in these panels, at decision making tables and in Boards; mental health (now also part of the NCD agenda, and rising on the global health agenda   – our own queen Mathilde popped up at the technical briefing on Wednesday !); the health of refugees/migrants; the WHO reform/transformation (and funding) of course; meaningful engagement of civil society, the Ebola outbreak in the DRC (with among others the appointment of a UN Ebola “czar”  this week) & GHS (+ AMR); gender equality/equity, including in global health governance, …  And I probably forget a dozen other worthy global health causes.

As Kickbusch & Arush Lal pointed out, almost every global health issue now is political.  Another obvious point here in Geneva: if you listen to some of the panels, it’s clear that the Minister of Finance is considered the current global health equivalent of a ‘hunk/hot lady’. We in the global health community expect so much from these men & women, nowadays (and also from heads of state, Central Bankers, …) and while I understand why, you have to keep in mind that these are some of the very people that tend to be the most immersed in ‘neoliberal thinking’ and ways, thus propping up the current (thoroughly dysfunctional) system as it is. See the havoc caused in Greece for example some years ago. So I wouldn’t put all my global health eggs in this basket…

A final comment perhaps on UHC, the key theme of this WHA, and an issue very dear to dr. Tedros’ heart (who, I have to say, is doing a great job here at the WHA, and in general). I quote, from the current zero draft of the political declaration:

“…Recognize that UHC is fundamental for achieving the SDGs related not only to health and well-being, but to end poverty, ensure quality education, achieve gender equality, provide decent work and economic growth, reduce inequalities, ensure just, peaceful and inclusive societies and to build and foster partnerships, while reaching the goals and targets included 3 throughout the 2030 Agenda for Sustainable Development are critical for the attainment of healthy lives and wellbeing for all at all ages…”

Now, if UHC can pull all that off, especially in the current difficult international circumstances, by 2030, then I’m sure I’ll go straight to global health heaven after passing away, having fulfilled diligently my IHP duties.  It’s just ridiculous how much is expected from this single SDG target 3.8., even if, as dr. Tedros likes to say, ‘All roads lead to UHC’ (his version of J. Krishnamurti’s “Truth is a pathless land”). Having said that, however, I fully agree with a quote made by “@KKoffeld (Kjersti Koffeld) at the UHC Town Hall meeting: „We need to move beyond asking what UHC HLM can do for our individual issues to what we can do in support of UHC. #HealthForAll

Enjoy your reading.

Kristof Decoster



(PS: you find the pdf of the full newsletter here: IHPn523 )

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