Global Health Issues-2019

GLOBAL HEALTH ISSUES-2019
The world is facing multiple health challenges. These range from

outbreaks of vaccine-preventable diseases like measles and diphtheria,
increasing reports of drug-resistant pathogens, growing rates of
obesity and physical inactivity to the health impacts of environmental
pollution and climate change and multiple humanitarian crises.
To address these and other threats, 2019 sees the start of the World
Health Organization’s new 5-year strategic plan – the 13th General
Programme of Work. This plan focuses on a triple billion target:
ensuring 1 billion more people benefit from access to universal health
coverage, 1 billion more people are protected from health
emergencies and 1 billion more people enjoy better health and well-
being. Reaching this goal will require addressing the threats to health
from a variety of angles.
Here are 10 of the many issues that will demand attention from WHO
and health partners in 2019.
Air pollution and climate change
Nine out of ten people breathe polluted air every day. In 2019, air
pollution is considered by WHO as the greatest environmental risk to
health. Microscopic pollutants in the air can penetrate respiratory and
circulatory systems, damaging the lungs, heart and brain, killing 7
million people prematurely every year from diseases such as cancer,
stroke, heart and lung disease. Around 90% of these deaths are in low-
and middle-income countries, with high volumes of emissions from
industry, transport and agriculture, as well as dirty cookstoves and
fuels in homes.
The primary cause of air pollution (burning fossil fuels) is also a

major contributor to climate change, which impacts people’s health in
different ways. Between 2030 and 2050, climate change is expected to
cause 250 000 additional deaths per year, from malnutrition, malaria,
diarrhoea and heat stress.
In October 2018, WHO held its first ever Global Conference on Air
Pollution and Health in Geneva. Countries and organizations made
more than 70 commitments to improve air quality. This year,
the United Nations Climate Summit in September will aim to
strengthen climate action and ambition worldwide. Even if all the
commitments made by countries for the Paris Agreement are
achieved, the world is still on a course to warm by more than 3°C this
century.
Global influenza pandemic

The world will face another influenza pandemic – the only thing we
don’t know is when it will hit and how severe it will be. Global
defences are only as effective as the weakest link in any country’s
health emergency preparedness and response system.
WHO is constantly monitoring the circulation of influenza viruses to

detect potential pandemic strains: 153 institutions in 114 countries are
involved in global surveillance and response.
Every year, WHO recommends which strains should be included in

the flu vaccine to protect people from seasonal flu. In the event that a
new flu strain develops pandemic potential, WHO has set up a unique
partnership with all the major players to ensure effective and equitable
access to diagnostics, vaccines and antivirals (treatments), especially
in developing countries.
Non-communicable diseases, such as diabetes, cancer and heart

disease, are collectively responsible for over 70% of all deaths
worldwide, or 41 million people. This includes 15 million people
dying prematurely, aged between 30 and 69.
Over 85% of these premature deaths are in low- and middle-income

countries. The rise of these diseases has been driven by five major
risk factors: tobacco use, physical inactivity, the harmful use of
alcohol, unhealthy diets and air pollution. These risk factors also
exacerbate mental health issues, that may originate from an early age:
half of all mental illness begins by the age of 14, but most cases go
undetected and untreated – suicide is the second leading cause of
death among 15-19 year-olds.
Among many things, this year WHO will work with governments to
help them meet the global target of reducing physical inactivity by
15% by 2030 – through such actions as implementing the ACTIVE
policy toolkit to help get more people being active every day.
GLOBAL INFLUENZA PANDEMIC
The world will face another influenza pandemic – the only thing
we don’t know is when it will hit and how severe it will be.
Global defences are only as effective as the weakest link in any
country’s health emergency preparedness and response
system.
WHO is constantly monitoring the circulation of influenza

viruses to detect potential pandemic strains: 153 institutions in
114 countries are involved in global surveillance and response.
Every year, WHO recommends which strains should be

included in the flu vaccine to protect people from seasonal flu.
In the event that a new flu strain develops pandemic potential,
WHO has set up a unique partnership with all the major players
to ensure effective and equitable access to diagnostics,
vaccines and antivirals (treatments), especially in developing
countries.
FRAGILE AND VULNERABLE SETTINGS
More than 1.6 billion people (22% of the global population) live
in places where protracted crises (through a combination of
challenges such as drought, famine, conflict, and population
displacement) and weak health services leave them without
access to basic care.
Fragile settings exist in almost all regions of the world, and
these are where half of the key targets in the sustainable
development goals, including on child and maternal health,
remains unmet.
WHO will continue to work in these countries to strengthen

health systems so that they are better prepared to detect and
respond to outbreaks, as well as able to deliver high quality
health services, including immunization.
ANTIMICROBIAL RESISTANCE
The development of antibiotics, antivirals and antimalarials are

some of modern medicine’s greatest successes. Now, time with
these drugs is running out. Antimicrobial resistance – the ability
of bacteria, parasites, viruses and fungi to resist these
medicines – threatens to send us back to a time when we were
unable to easily treat infections such as pneumonia,
tuberculosis, gonorrhoea, and salmonellosis. The inability to
prevent infections could seriously compromise surgery and
procedures such as chemotherapy.
Resistance to tuberculosis drugs is a formidable obstacle to

fighting a disease that causes around 10 million people to fall
ill, and 1.6 million to die, every year. In 2017, around 600 000
cases of tuberculosis were resistant to rifampicin – the most
effective first-line drug – and 82% of these people had
multidrug-resistant tuberculosis.
Drug resistance is driven by the overuse of antimicrobials in

people, but also in animals, especially those used for food
production, as well as in the environment. WHO is working with
these sectors to implement a global action plan to tackle
antimicrobial resistance by increasing awareness and
knowledge, reducing infection, and encouraging prudent use of
antimicrobials.
EBOLA OUTBREAK
In 2018, the Democratic Republic of the Congo saw two

separate Ebola outbreaks, both of which spread to cities of
more than 1 million people. One of the affected provinces is
also in an active conflict zone.
This shows that the context in which an epidemic of a high-threat

pathogen like Ebola erupts is critical – what happened in rural
outbreaks in the past doesn’t always apply to densely populated urban
areas or conflict-affected areas.
At a conference on Preparedness for Public Health Emergencies held

last December, participants from the public health, animal health,
transport and tourism sectors focussed on the growing challenges of
tackling outbreaks and health emergencies in urban areas. They called
for WHO and partners to designate 2019 as a “Year of action on
preparedness for health emergencies”.
WHO’s R&D Blueprint identifies diseases and pathogens that have

potential to cause a public health emergency but lack effective
treatments and vaccines. This watchlist for priority research and
development includes Ebola, several other haemorrhagic fevers, Zika,
Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV)
and Severe Acute Respiratory Syndrome (SARS) and disease X,
which represents the need to prepare for an unknown pathogen that
could cause a serious epidemic.
WEAK PRIMARY HEALTHCARE
Primary health care is usually the first point of contact people

have with their health care system, and ideally should provide
comprehensive, affordable, community-based care throughout
life.
Primary health care can meet the majority of a person’s health

needs of the course of their life. Health systems with strong
primary health care are needed to achieve universal health
coverage.
Yet many countries do not have adequate primary health care

facilities. This neglect may be a lack of resources in low- or
middle-income countries, but possibly also a focus in the past
few decades on single disease programmes. In October 2018,
WHO co-hosted a major global conference in Astana,
Kazakhstan at which all countries committed to renew the
commitment to primary health care made in the Alma-Ata
declaration in 1978.
In 2019, WHO will work with partners to revitalize and

strengthen primary health care in countries, and follow up on
specific commitments made by in the Astana Declaration.
VACCINE HESITANCY
Vaccine hesitancy – the reluctance or refusal to vaccinate

despite the availability of vaccines – threatens to reverse
progress made in tackling vaccine-preventable
diseases. Vaccination is one of the most cost-effective ways of
avoiding disease – it currently prevents 2-3 million deaths a
year, and a further 1.5 million could be avoided if global
coverage of vaccinations improved.
Measles, for example, has seen a 30% increase in cases

globally. The reasons for this rise are complex, and not all of
these cases are due to vaccine hesitancy. However, some
countries that were close to eliminating the disease have seen
a resurgence.
The reasons why people choose not to vaccinate are complex;

a vaccines advisory group to WHO identified complacency,
inconvenience in accessing vaccines, and lack of confidence
are key reasons underlying hesitancy. Health workers,
especially those in communities, remain the most trusted
advisor and influencer of vaccination decisions, and they must
be supported to provide trusted, credible information on
vaccines.
In 2019, WHO will ramp up work to eliminate cervical

cancer worldwide by increasing coverage of the HPV vaccine,
among other interventions. 2019 may also be the year when
transmission of wild poliovirus is stopped in Afghanistan and
Pakistan. Last year, less than 30 cases were reported in both
countries. WHO and partners are committed to supporting
these countries to vaccinate every last child to eradicate this
crippling disease for good.
DENGUE
Dengue, a mosquito-borne disease that causes flu-like
symptoms and can be lethal and kill up to 20% of those with
severe dengue, has been a growing threat for decades.
A high number of cases occur in the rainy seasons of countries

such as Bangladesh and India. Now, its season in these
countries is lengthening significantly (in 2018, Bangladesh saw
the highest number of deaths in almost two decades), and the
disease is spreading to less tropical and more temperate
countries such as Nepal, that have not traditionally seen the
disease.
An estimated 40% of the world is at risk of dengue fever, and

there are around 390 million infections a year. WHO’s Dengue
control strategy aims to reduce deaths by 50% by 2020.
HIV
The progress made against HIV has been enormous in terms of

getting people tested, providing them with antiretrovirals (22
million are on treatment), and providing access to preventive
measures such as a pre-exposure prophylaxis (PrEP, which is
when people at risk of HIV take antiretrovirals to prevent
infection).
However, the epidemic continues to rage with nearly a million

people every year dying of HIV/AIDS. Since the beginning of
the epidemic, more than 70 million people have acquired the
infection, and about 35 million people have died. Today, around
37 million worldwide live with HIV. Reaching people like sex
workers, people in prison, men who have sex with men, or
transgender people is hugely challenging. Often these groups
are excluded from health services. A group increasingly
affected by HIV are young girls and women (aged 15–24), who
are particularly at high risk and account for 1 in 4 HIV infections
in sub-Saharan Africa despite being only 10% of the
population.
This year, WHO will work with countries to support the

introduction of self-testing so that more people living with HIV
know their status and can receive treatment (or preventive
measures in the case of a negative test result). One activity will
be to act on new guidance announced In December 2018, by
WHO and the International Labour Organization to support
companies and organizations to offer HIV self-tests in the
workplace.

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GLOBAL HEALTH ISSUES-2019

The world is facing multiple health challenges. These range from

Air pollution and climate change

The primary cause of air pollution (burning fossil fuels) is also a

Global influenza pandemic

WHO is constantly monitoring the circulation of influenza viruses to

Every year, WHO recommends which strains should be included in

Non-communicable diseases, such as diabetes, cancer and heart

Over 85% of these premature deaths are in low- and middle-income

GLOBAL INFLUENZA PANDEMIC

WHO is constantly monitoring the circulation of influenza

Every year, WHO recommends which strains should be

FRAGILE AND VULNERABLE SETTINGS

WHO will continue to work in these countries to strengthen

The development of antibiotics, antivirals and antimalarials are

Resistance to tuberculosis drugs is a formidable obstacle to

Drug resistance is driven by the overuse of antimicrobials in

In 2018, the Democratic Republic of the Congo saw two

This shows that the context in which an epidemic of a high-threat

At a conference on Preparedness for Public Health Emergencies held

WHO’s R&D Blueprint identifies diseases and pathogens that have

WEAK PRIMARY HEALTHCARE

Primary health care is usually the first point of contact people

Primary health care can meet the majority of a person’s health

Yet many countries do not have adequate primary health care

In 2019, WHO will work with partners to revitalize and

Vaccine hesitancy – the reluctance or refusal to vaccinate

Measles, for example, has seen a 30% increase in cases

The reasons why people choose not to vaccinate are complex;

In 2019, WHO will ramp up work to eliminate cervical

A high number of cases occur in the rainy seasons of countries

An estimated 40% of the world is at risk of dengue fever, and

The progress made against HIV has been enormous in terms of

However, the epidemic continues to rage with nearly a million

This year, WHO will work with countries to support the

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