Choosing health for everyone

Choosing health for everyone

The Covid-19 pandemic is a stark reminder that health is the singular foundation of prosperous, peaceful and secure societies – and we must not forget the lessons it has taught us

More than two and a half years since Covid-19 turned our world upside down, reported cases and deaths are near their lowest levels since the pandemic began, and in many countries, life looks much like it did before the virus struck.

But the pandemic is by no means over: at the time of writing, Covid-19 is still killing more than 13,000 people every week; more than three-quarters of the population of low-income countries remain unvaccinated against Covid-19, including two-thirds of health workers and older people; and a precipitous drop in testing and sequencing is blinding us to how the virus might be changing to become more transmissible or more deadly. These dynamics continue to pose a risk to all people, in all countries.

An even greater risk is that the world moves on to the next crisis – and there are plenty demanding its attention – and forgets the painful and costly lessons the pandemic has taught us.

At this year’s World Health Assembly, I outlined five priorities for countries and the World Health Organization as collectively we recover and rebuild.

To recover and rebuild

The first is promoting health, by making an urgent paradigm shift in all countries towards an approach to health centred on creating the conditions in which health can thrive and addressing the root causes of disease.

Making this shift begins with recognising that health starts not in the clinic or the hospital, but in schools, streets, supermarkets, households and cities. Much of the work that ministries of health do is dealing with the consequences of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health.

This requires empowering and enabling individuals, families and communities to make healthy choices and it requires governments to create the legislative, regulatory and commercial environment in which people can make those choices. In particular, it requires radical action to safeguard the health of the planet on which all life depends, by addressing the existential threat of climate change.

Such a shift could cut the global disease burden in half, but it would also offer massive economic gains, by reducing the burden on health systems and increasing the productivity of populations.

The second priority is providing health, by reorienting health systems towards primary health care as the foundation of universal health coverage.

The pandemic has demonstrated that a resilient health system is not the same thing as an advanced medical care system. Some countries with the most sophisticated medical care were overwhelmed by Covid-19. By contrast, some middle-income countries with fewer resources fared much better, thanks to investments in public health after outbreaks of SARS, MERS, H1N1 and others.

The backbone of public health is robust primary health care, for detecting outbreaks at the earliest possible stage, as well as for preventing disease and promoting health at the community level.

The third priority is protecting health, by strengthening the global architecture for health emergency preparedness, response and resilience.

The pandemic has exposed serious vulnerabilities in the world’s defences against epidemics and pandemics, and the global monkeypox outbreak is yet more evidence – if any were needed – that the world’s collective failure to address neglected diseases in neglected communities puts us all at risk.

Building on several reviews of the global response to the pandemic, in May the WHO published a white paper with 10 key proposals for making the world safer, in the areas of governance, financing and systems and tools, under the umbrella of a new legally binding international instrument on pandemic preparedness and response, which the WHO’s member states are now negotiating.

Several of those proposals are already being acted on, including the recent establishment at the World Bank of the new Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, to provide catalytic and gap-filling funding to strengthen global, regional and national capacities. The WHO is grateful for Indonesia’s leadership in prioritising the establishment of the FIF as part of its G20 presidency.

The fourth priority is powering health through science, research, innovation, data and digital technologies.

Advances in science and research are constantly pushing back the boundaries of the unknown and the impossible, increasing our understanding and opening new possibilities. Innovations in health products and service delivery are helping to provide care in new ways. Developments in big data and machine learning are helping us to see who is being left behind and where the biggest gaps are, and to track progress against our targets. And digital technologies offer huge potential for delivering health services in new ways, to more people, especially in hard-to-reach areas.

The fifth priority is performing and partnering for health, by building a stronger, empowered and sustainably financed WHO.

A historic commitment

At this year’s World Health Assembly, the WHO’s member states made a historic commitment to gradually increase assessed contributions to 50% of the base budget over the next decade, from just 16% currently.

This commitment will transform the WHO’s ability to deliver results where it matters most – in the lives of the people we serve.

Of course, it is incumbent on us to return the trust our member states have put in us by providing value for money, with enhanced governance, accountability, transparency and efficiency. Even before the pandemic, we had already made major progress in these areas, and we are committed to further improvements. In particular, our focus in the coming years is to significantly strengthen our country offices to support greater country capacity and greater country ownership.

More than 70 years ago, the WHO’s founders wrote in our constitution that “the health of all peoples is fundamental to the attainment of peace and security, and is dependent upon the fullest cooperation of individuals and States”.

The Covid-19 pandemic is a brutal reminder that health is not simply a by-product of development, but the foundation of prosperous and secure societies.