La salud global en 2018: algunos signos alentadores y muchos temores confirmados

Global Health in 2018: Some Encouraging Signs Amid Many Confirmed Fears

19.12.2018
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The Ebola outbreak in DRC, the wildfires in California, the first high-level meeting on tuberculosis and the #Metoo movement were some of the events that marked 2018 in terms of global health 

In last year’s post, we expressed our worries for a world where isolationism and alternative truths were on the rise, and our hope that 2018’s post would be more optimistic. At the end, it has been a year without major surprises, in which many of our fears are being confirmed. Maybe an encouraging sign has been the (re)emergence of a feminist movement, driven by the #Metoo movement, that has drawn attention to the abuse of men in power and the persisting inequality in salaries and opportunities for women. Science was not an exception, with campaigns such as #WomeninStem and #WomeninScience.

The response to climate change: slowly and not so surely 

With regard to climate change- one of the greatest threats to our health- UN secretary-general, Antonio Guterres, recognised himself that increasing isolationism across the world had reduced the political will of some countries to tackle the problem. Indeed, the agreements reached at the COP24 meeting fall short of what is required, especially after the publication of a UN scientific report warning that the world is not doing enough to meet the goals set by the Paris treaty.

The world is not doing enough to meet the goals set by the Paris treaty

On top of that, president Trump dismissed a report, presented by his own administration, on the impact of climate change on the country’s economy. This, in spite of the heavy human and economic losses caused by the worse wildfires in California’s history. Let us hope that the Democrats’ victory in Congress manages to curb the current administration’s efforts to systematically destroy all past achievements in health coverage, women’s rights and environment, among others.

Non infectious diseases: more visible than ever 

The truth is that this has been a good year for raising visibility of non-communicable diseases (NCDs) and their environmental determinants. The UN celebrated in September its third high level meeting on NCDs, and a newly created partnership was launched to favour the role of cities as engines of change. A report published by the WHO in June warned that no country has met the requirements to achieve the goal of reducing premature deaths by NCDs. In fact, an estimated 9 out of 10 people in the world breathe highly polluted air, and 7 million people die every year because of this, most of them in low and middle-income countries.

9 out of 10 people in the world breathe highly polluted air, and 7 million people die every year because of this, most of them in low and middle-income countries

Some encouraging initiatives regarding NCDs include the investment of 20 million USD by Bloomberg Philanthropies into Stop, a tobacco industry watchdog, and the commitment made during the Bloomberg American Health Summit to invest 50 million USD in the fight against the opioid epidemic, which is behind the decline in life expectancy in USA for the third consecutive year.

Any new bugs in the picture?

This year, the WHO included disease X in its priority list of pathogens, recognizing that the next pandemic could be caused by a yet unknown pathogen against which we are not prepared. Precisely, 2018 marked the centenary of the “Spanish flu” epidemic that infected one third of the world population and claimed 20 to 50 million lives.  Knowing that it is a virus that mutates in an unpredictable manner, the scientific community is working on the difficult task of developing a universal flu vaccine, an initiative supported by a 12 million USD investment by the Bill&Melinda Gates Foundation.   

Meanwhile, Ebola made a comeback, this time in the Democratic Republic of Congo, who in August declared its 10th outbreak of the disease. This time, the response of the international community was fast and coordinated (a lesson learned from the West African outbreak) and, for the first time in history, a vaccine was available from the beginning of the outbreak. But, also for the first time, the cases occurred in a conflict zone, greatly hindering the response in the field. With more than 520 cases and 300 deaths, the outbreak is not yet controlled and has become the worse in the country’s history and the second worse globally, after the West African outbreak in 2014. 

However, the leading cause of infectious diseases continues to be tuberculosis, and for the first time the UN held a high level meeting on the disease. The meeting, celebrated in September, resulted in the commitment to ensure care for 40 million people by 2022, but some experts were disappointed by the absence of several leading countries and actors.   

The leading cause of infectious diseases continues to be tuberculosis, and for the first time the UN held a high level meeting on the disease

Finally, the virus of misinformation continued to wreak havoc. Since the beginning of this year, Europe has reported a record number of 53,000 measles cases (more than double the cases in Africa, in the same period), largely due to disparities in vaccine coverage and to vaccine hesitancy among parents as a result of fake information spread by anti-vaxxers.   

The migratory crisis, a challenge for all 

In 2018, the number of people displaced by force has risen to a record 68.5 million worldwide. Only in Latin America, close to 2 million people have fled Venezuela to neighbouring countries (particularly Colombia) due to hyperinflation and food and medicine shortages, which have had serious health consequences (the number of malaria cases in Venezuela in 2017 rose to almost half a million, five times more than in 2013).

In 2018, the number of people displaced by force has risen to a record 68.5 million worldwide

In turn, Afghanistan’s worst drought in decades has driven 200,000 people from their homes. As a result, the number of children out of school increased for the first time since 2012 and many families were pushed to marry their daughters in exchange for dowries in order to survive. 

Where are we going?

This has been a year of geopolitical shift, where the USA has retreated from its role as champion and model of democracy and civil liberties. At the global level, institutions, rules and norms are being defied by a society marked by deepening inequalities. The OECD identifies 56 fragile countries where 80% of the world’s poorest will live by 2030. In this context, the world will have to tackle the main global health challenges that lie ahead: access to medicines, antimicrobial resistance, environmental drivers of non-communicable diseases, migrant health, and climate change. We need to be better prepared to handle the complexity of these interconnected challenges, and we need to do it in a solidary way. 

In this context, the world will have to tackle the main global health challenges that lie ahead: access to medicines, antimicrobial resistance, environmental drivers of non-communicable diseases

The progressive recovery of the ozone layer, according to a report published this year, illustrates what a multilateral agreement can achieve when the political will exists. Let us see if 2019 marks the beginning of a decade where the same political will is applied to achieving the Sustainable Development Goals (SDGs) signed three years ago by 150 countries.