MICHELLE AMRI & MELKAMU DEDEFO
When we think about global health, the World Health Organization (WHO) is inarguably one of the most prominent players. Acting as the specialized health agency of the United Nations, the WHO operates across a broad array of areas—from working towards polio eradication to healthy urbanization initiatives. How these areas for action are determined largely comes down to the resolutions and decisions of the World Health Assembly (the Health Assembly).
The Health Assembly is WHO’s decision-making body. Hosted in May annually, the Health Assembly brings together high-level delegations from all WHO Member States, to converge at agency Headquarters in Geneva, Switzerland.Convening for between five and ten days, the Health Assembly endorses resolutions on WHO’s programmatic areas of work, organizational and financial policies, and appoints the WHO Director-General (every five years). Past Health Assembly resolutions have allowed for the creation of global strategies, such as that for violence and health, which grew out of a Health Assembly resolution in 1996.
Looking forward to the 72nd Health Assembly, it is expected that many issues highlighted at the 71st Health Assembly will re-emerge and continue to secure funding, including central discussions around: public health preparedness and response; health, environment, and climate change; addressing the shortage of, and access to, vaccines and essential medicines; prevention and control of noncommunicable diseases; tuberculosis; physical activity; women’s, children’s, and adolescent’s health; and maternal, infant, and young child nutrition. Perhaps most importantly, Universal Health Coverage (UHC) will take the spotlight at the Health Assembly, given Dr. Tedros Adhanom Ghebreyesus’ (the Director-General of the WHO) top priority of UHC.
But aside from traditional vertical programs the WHO addresses—while all are important—this Health Assembly holds promise to re-center the focus to the most marginalized of groups—those who may have been left behind. Being the second Health Assembly under Tedros, who has a secured five-year term, this is the right platform to one who may seek to ignite long-term change leading up to the last decade before the SDG targets aspire to be met (2030). The 72nd Health Assembly holds promise to address contemporary issues such as migration, the opioid crisis, and working towards health equity –what predecessor Dr. Margaret Chan called for to be a “guiding ethical principle” of the Health Assembly.
The 72nd Health Assembly is a platform for the WHO to devise a long-term plan for advancing health equity. UHC—if well-executed—is one such strategy for reducing disparities in access to health systems, and the provision of primary care services.Another such approach is applying a social determinants of health lens to consider what the fundamental causes of ill health are—or the “causes of causes”. For example, while it may seem people are dying from malnutrition, is this a consequence of not having the means to purchase healthy foods to maintain a sufficient diet—leading to poverty being truly the fundamental cause of poor health? Strengthening social safety nets is certainly one method towards raising healthy communities, although support for this approach may vary largely between Member States.
Equity can also be achieved by focusing on vulnerable groups from previous health platforms. For example, when looking at UHC, health systems should be directed to include health promotion, prevention, and the control of NCDs and mental health services based on national contexts and needs with a focus on those most negatively impacted. In this regard, WHO should emphasize assistance to those within lowest socio-economic status, encouraging Member States to invest in the long-term provision of services to elevate disadvantaged populations. In order to achieve this admittedly lofty goal, WHO should seek to gain consistent and sustainable government support, work on establishing clear tracking and accountability mechanisms, and tailor efforts towards highest impact programs conducive to SDG targets.
Indeed, there are many approaches to undertaking global health programmes with a focus on equity. However, there is not one clear and widely accepted definition of what health equity encompasses.Looking to WHO’s 13th Global Programme of Work, the overarching theme of “leaving nobody behind” resonates, but the lack of global definition of what equitable health programming entails leaves room for interpretation. Perhaps, what is needed from the 72nd World Health Assembly is a clear definition of health equity that the WHO seeks to follow to achieve the SDGs, particularly Goal Three: “Good Health and Well-Being”.
We look forward to the 72nd Health Assembly delineating a concerted, long-term action plan in combating health inequalities—for the next year and beyond.