Margaret Chan (left), Director-General of the World Health Organization visiting Sierra Leone during the Ebola crisis in December 2014.

By Lyndal Rowlands
UNITED NATIONS, Oct 24 2016 (IPS)

Health problems increasingly transcend the borders of the World Health Organization’s 194 member states, a challenge which the six candidates vying to lead the global body must address with care.

Those 194 member states will pick the next Director-General of the world’s peak health body in May 2017, after the current six candidates are whittled down by the World Health Organization (WHO) Executive Board in January. The successful candidate will replace current Director-General Dr Margaret Chan, of China in July 2017.

The ninth Director-General of the world’s peak health body will play a key role in ensuring global responses to an increasingly complex and contrasting list of global health problems: the spread of mosquito borne diseases due to climate change, multi-drug resistant tuberculosis, the unfinished business of AIDS and HIV, air pollution, domestic violence, the global rise in noncommunicable diseases such as diabetes as well as the inevitable emergence of the next Ebola-like pathogen.

She, or he, will need to navigate a delicate balance between serving each of the global body’s member states while also ensuring that the world’s only global health body is greater than the sum of its parts.

“Today when we talk about WHO’s role it really transcends states, it goes into a global response category,” Esperanza Martinez, Head of the Health Unit at the International Committee of the Red Cross (ICRC) told IPS.

“What you need is someone who is able to lead the organisation – not to confront the states – but to challenge the states to do better, to challenge the states to fulfill their obligations, to challenge the states to be more efficient and effective,” she said.

Yet, like any other UN body, the WHO “is no better or worse than the governments who make it up,” Susannah Sirkin Director of international policy and partnerships at Physicians for Human Rights told IPS.

The new Director-General will take over after a period of heavy soul searching for the Geneva-based organisation following deep criticism of the WHO’s handling of Ebola in West Africa.

“There is an enormous call for increased transparency and efficiency within the organisation,” said Sirkin.

In order to address emerging epidemics, such as Ebola and Zika, Martinez says that it is essential that the WHO is ready and able to spring into action.

“The fact that WHO has to wait for minsters of health and governments to qualify crisis really can delay interventions in critical moments,” said Martinez.

The new Director-General will also need to be prepared to “hit the ground running,” meaning that they should be “someone who already understands how the UN system works and how the WHO works,” she added.

“We need someone who understands the dynamics of humanitarian and emergency responses today.”

For Sirkin, the new Director-General will also need to transcend the “historic limitations” which have often seen the WHO adopt “relative silence” towards matters that are seen as within the control of national governments.

Health is politicised, said Sirkin, when governments fail “to invest to an adequate degree in the provision of both preventative and curative health care, or (fail) to invest a proportionate or reasonable amount of their national budget in health care.”

“The next Director-General has to really have some political courage and the ability to galvanise,” to overcome the constraints which have historically limited the WHO from speaking out.

“Somehow the WHO as an agency needs to transcend that.”

For example, she said the WHO should be able to speak out when the Syrian government “overtly obstructed the delivery of humanitarian including medical aid in an alarming way.”

She welcomed the WHO’s new role in addressing the global problem of attacks on health workers and health facilities, but noted that this is another area where the new Director-General will be required to have political courage.

Beyond humanitarian crises, the new Director-General will face many other challenges, including emerging threats such as antimicrobial resistance, as well as much older health challenges such as maternal mortality.

Two of the six candidates for the position of Director-General are women. Unlike the position of Secretary-General of the United Nations, which has always been held by men, two women, Chan and Gro Harlem Brundtland of Norway, have already led the WHO.

However although women and children’s health have been considered priorities of the UN and the WHO, Sirkin says that it is important for the WHO to do more than pay lip service to gender inequality in health, whether a man or a woman holds the role of Director-General, “especially since there is now known an enormous correlation between women’s rights and health.”

“Basic women’s rights – including reproductive rights, violence against women (and) sexual violence – over the long run is going to be a continuing enormous barrier to the development of global health,” she said.

The six candidates will address the members of the World Health Organization as well as members of the public on November 1 and 2.

More than half, 4 hail from Europe – Italy, France, Hungary and the United Kingdom – the other two come from Ethiopia and Pakistan. The hopefuls all share backgrounds as medical doctors, and most have extensive experience in public health or politics.

Margaret Chan, Director-General of the World Health Organization (WHO), during the WHO Executive Board's special session on the Ebola emergency. Credit: UN Photo/Violaine Martin.

By Lyndal Rowlands
UNITED NATIONS, May 24 2016 (IPS)

Putting economic interests over public health is leading the world towards three slow-motion health disasters, Margaret Chan, Director-General of the World Health Organization’s warned the world’s health ministers on Monday.

Changes in the world’s climate, the failure of more and more antibiotic drugs and the increase in so-called lifestyle diseases caused by poor diet and exercise, are all growing health disasters related to the prioritisation of the economy over public health.

“These are not natural disasters. They are man-made disasters created by policies that place economic interests above concerns about the well-being of human lives and the planet that sustains them,” she said.

Chan’s warnings were part of her speech at the opening of the 69th World Health Assembly in Geneva. Some 3500 delegates from the WHO’s 194 member states will participate in meetings at the assembly about some of the world’s most pressing health issues from May 23 to 27.

During her speech Chan also acknowledged the world’s many recent public health successes, however overall she argued that advances in health services and systems could not keep up with the global changes which mean health threats are increasingly traversing borders.

“The burning of fossil fuels powers economies,” said Chan, contributing to changes in climate, which have led to the spread of mosquito-borne diseases, as well as to air pollution which the WHO says kills millions of people every year.

“Highly processed foods that are cheap, convenient, and tasty gain a bigger market share than fresh fruits and vegetables,” she added, noting that the resulting non-communicable diseases such as diabetes, obesity and heart disease are now the “leading killers worldwide.”

However antibiotic resistance may be the problem that has the global health community most concerned, threatening to throw the world back into the dark ages of health care said Chan.

The over-prescription and incorrect use of antibiotics has led to the once wonder drug failing with increasing frequency.

Chan noted that infectious diseases are also becoming more volatile, and that the global health system was not as prepared as it should be for a true global health emergency.

She pointed to examples of recent surges in infectious diseases such as Ebola, Zika, Dengue, Yellow Fever and Chikungunya.

She described the spread of mosquito-borne diseases such as dengue as “the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s.”

She noted the connection between Zika virus and microcephaly had taken the medical community by surprise.

“The possibility that a mosquito bite during pregnancy could be linked to severe brain abnormalities in newborns alarmed the public and astonished scientists.”

“Confirmation of a causal link between infection and microcephaly has transformed the profile of Zika from a mild disease to a devastating diagnosis for pregnant women and a significant threat to global health.”

However she said that the re-emergence of Zika have decades of slumber in part reflected “changes in the way humanity inhabits the planet (that) have given the volatile microbial world multiple new opportunities to exploit.”

Chan reserved some of her harshest criticisms for the world’s failure to prevent the current re-emergence of yellow fever in Africa, an outbreak the WHO is currently monitoring closely.

She described the conditions in urban environments fueling the current outbreak as a powder-keg.

“For more than a decade, WHO has been warning that changes in demography and land use patterns in Africa have created ideal conditions for explosive outbreaks of urban yellow fever,” she said.

Chan noted that beyond the failure to control mosquitos, the re-emergence of yellow fever also reflected a failure to adequately vaccinate against the disease.

“The lesson from yellow fever is especially brutal. The world failed to use an excellent preventive tool to its full strategic advantage,” she said, noting that there has been a safe low-cost yellow fever vaccine available since 1937.

Chan’s speech is not the only recent stand taken by the medical community showing increasing frustration with the current state of global politics.

Chan also alluded to the medical community’s increasing frustration with the deteriorating conditions of warfare which have seen hospitals bombed, in violation of humanitarian law.

“It also falls to the health sector to show some principled ethical backbone in a world that, for all practical appearances, has lost its moral compass,” she said.

However the successes that Chan highlighted, proving the potential of the world’s health system to address global challenges. also showed that another reality is possible.

“We can celebrate the 19,000 fewer children dying every day, the 44 percent drop in maternal mortality, and the 85 percent of tuberculosis cases that are successfully cured,” said Chan.

She also highlighted the 60 percent decline in malaria mortality in Africa, showing that the fight against mosquito-borne diseases is having success, in at least one area.

By José Graziano da Silva
ROME, May 5 2015 (IPS)

In the last half-century, people’s lifestyles have changed dramatically. Life expectancy has risen almost everywhere, but this has been accompanied by an increase of so-called non-communicable diseases (NCDs) – such as cardiovascular diseases, cancer, respiratory diseases, and diabetes – causing more and more deaths in all corners of the world.

José Graziano da Silva. Credit: FAO/Alessandra Benedetti

My distinguished colleague Dr Margaret Chan, Director-General of the World Health Organization (WHO), has called the worldwide rise of NCDs a “slow-motion catastrophe”. If NCDs were once considered the scourge of the developed world, this is no longer true; they now disproportionally affect low- and middle-income countries where nearly three-quarters of NCD deaths – 28 million per year – occur.

Much of the rise of NCDs can be attributed to unhealthy diets. WHO estimates that 2.7 million deaths every year are attributable to diets low in fruits and vegetables. Globally unhealthy diets are estimated to cause about 19 percent of gastrointestinal cancer, 31 percent of ischaemic heart disease, and 11 percent of strokes, thus making diet-related NCDs one of the leading preventable causes of death worldwide.

In other words, diet determines health – just as bad diets can lead to disease, healthy diets can contribute to good health.

But what exactly is a healthy diet? This is a difficult question. Generally, a healthy diet must provide the right nutrients in the right balance and with sufficient diversity, limiting the intake of free sugars to less than 10 percent of total energy requirements, and keeping salt intake to less than 5 grams per day.“There is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences”

However, there is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences. For over 20 years, FAO, together with WHO, has worked with governments on national Food-Based Dietary Guidelines: short, science-based, tips on healthy eating, in accordance with local values, customs and tradition.

Healthy meals do not always taste or look the same. Take, for example, the Mediterranean and Japanese diets: very healthy and completely different.

The Mediterranean diet revolves around the consumption of legumes, cereals, fruits and vegetables, olive oil, fish, and moderate consumption of dairy products (mostly cheese and yogurt). It emphasises unprocessed, plant-based foods, such as fruits and vegetables, in addition to the consumption of beans, nuts, cereals and other seeds; olive oil is the main source of (unsaturated) fat.

Japanese cuisine, on the other hand, is often associated with sushi (raw fish with rice), and sashimi (fresh raw seafood). The Japanese diet emphasises at least seven ingredients: fish as a major source of protein; vegetables including daikon radish and sea vegetables; rice; soya (tofu, miso, soya sauce); noodles; fruit; and tea (preferably green).

The Japanese and Mediterranean diets are examples of healthy diets. They use a great variety of ingredients; they are rich in plant foods including vegetables and fruit, legumes and fibres; they are modest in red meat; and they utilise many natural herbs and spices instead of salt to flavour food.

Both diets are linked to peoples and cultures as much as to their natural environment: it therefore comes as no surprise that both the Mediterranean diet and the Japanese diet have made it onto UNESCO’s World’s Intangible Cultural Heritage list.

The health benefits of the Japanese and Mediterranean diets are promising. Japanese enjoy one of the longest average life spans in the world – 87 years for women and 80 for men. In Mediterranean countries such as Italy and Spain, women have a life expectancy of 85 years. The figure for Italian men is 80 years, the same as their Japanese counterparts. All of them are above the average of high-income countries: 82 years for women and 76 years for men.

Medical research also indicate that that the Japanese diet leads to the lowest prevalence in the world of obesity – only 2.9% for Japanese women – and other chronic diseases like osteoporosis, heart ailments and some cancers. On the other hand, the Mediterranean diet, if followed for a number of years, is known to reduce the risk of developing heart disease, cancer, hypertension, Type 2 diabetes, Parkinson’s and Alzheimer’s disease.

In sum, adhering to a healthy diet helps you to not only to live longer, but also to have a better quality of life. Conversely, a bad diet causes malnutrition and can expose you to a range of NCDs.

A modern paradox is that many countries – including developing countries – suffer from undernourishment on the one hand, and obesity and diet-related diseases on the other. And while FAO’s chief concern is to eradicate hunger in this world, we cannot separate food security from nutrition. FAO – together with our U.N. agencies – considers food and nutrition security a basic human right.

In all cases, the cost of malnutrition goes beyond the health of the individual: it affects society as a whole in terms of public health costs and loss of productivity, and, therefore, is an issue that must be addressed through public and coordinated action.

Last year’s Second International Conference on Nutrition (ICN2), organised jointly by FAO and WHO, sent a clear message in that direction. The two outcome documents of ICN2, the Rome Declaration on Nutrition and the Framework for Action that commit world leaders to establishing national policies aimed at eradicating malnutrition and making nutritious diets available to all.

A key message from ICN2 is: governments have a central role to play in creating a healthy food environment to enable people to adopt healthy dietary practices. Yes, it is consumers who choose what to eat, but it is the government’s role to provide the enabling environment that encourages and makes healthy choices possible. (END/COLUMNIST SERVICE)

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

By Martin Khor
GENEVA, Apr 10 2014 (IPS)

The growing crisis of antibiotic resistance is catching the attention of policy-makers, but not at a fast enough rate to tackle it. More diseases are affected by resistance, meaning the bacteria cannot be killed even if different drugs are used on some patients, who then succumb.

We are staring at a future in which antibiotics don’t work, and many of us or our children will not be saved from TB, cholera, deadly forms of dysentery, and germs contracted during surgery.

Martin Khor

The World Health Organisation (WHO) will discuss, at its annual assembly of health ministers in May, a resolution on microbial resistance, including a global action plan. There have been such resolutions before but little action.

This year may be different, because powerful countries like the United Kingdom are now convinced that years of inaction have cause the problem to fester, until it has grown to mind-boggling proportions.

The UK-based Chatham House (together with the Geneva Graduate Institute) held two meetings on the issue, in October and last month, both presided over by the Chief Medical Officer for England, Dame Sally Davies.

This remarkable woman has taken on antibiotic resistance as a professional and personal campaign. In a recent book, “The Drugs Don’t Work”, she revealed that for her annual health report in 2012, she had decided to focus on infectious diseases.

“I am not easily rattled, but what I learnt scared me, not just as a doctor, but as a mother, a wife and a friend. Our findings were simple: We are losing the battle against infectious diseases. Bacteria are fighting back and are becoming resistant to modern medicine. In short, the drugs don’t work.”

Davies told the meetings that antibiotics add on average 20 years to our lives and that for over 70 years they have enabled us to survive life-threatening infections and operations.

“The truth is, we have been abusing them as patients, as doctors, as travellers, and in our food,” she says in her book.

“No new class of antibacterial has been discovered for 26 years and the bugs are fighting back. In a few decades, we may start dying from the most commonplace of operations and ailments that can today be treated easily.”

At the two Chatham House meetings, which I attended, different aspects of the crisis and possible actions were discussed. In one of the sessions, I made a summary of the actions needed, including:

– More scientific research on how resistance is caused and spread, including the emergence of antibiotic-resistance genes as in the NDM-1 enzyme, whose speciality is to accelerate and spread resistance within and among bacteria.

– Surveys in every country to determine the prevalence of resistance to antibiotics in bacteria causing various diseases.

– Health guidelines and regulations in every country to guide doctors on when (and when not) to prescribe antibiotics, and on instructing patients how to properly use them.

– Regulations for drug companies on ethical marketing of their medicines, and on avoiding sales promotion to doctors or the public, that leads to over-use.

– Educating the public on using antibiotics properly, including when they should not be used.

– A ban on the use of antibiotics in animals and animal feed for the purpose of inducing growth of the animals (for commercial profit), and restrictions on the use in animals to the treatment of ailments.

– Promoting the development of new antibiotics and in ways (including financing) that do not make the new drugs the exclusive property of drug companies.

– Ensuring that ordinary and poor people in developing countries also have access to the new medicines, which would otherwise be very expensive, and thus only the very rich can afford to use them.

On the first point, a new and alarming development has been the discovery of a gene, known as NDM-1, that has the ability to alter bacteria and make them highly resistant to all known drugs.

In 2010, only two types of bacteria were found to be hosting the NDM-1 gene – E Coli and Klebsiella pneumonia.

It was found that the gene can easily jump from one type of bacteria to another. In May 2011, scientists from Cardiff University who had first reported on NDM-1’s existence found that the NDM-1 gene has been jumping among various species of bacteria at a “superfast speed” and that it “has a special quality to jump between species without much of a problem”.

While the gene was found only in E Coli when it was initially detected in 2006, now the scientists had found NDM-1 in more than 20 different species of bacteria. NDM-1 can move at an unprecedented speed, making more and more species of bacteria drug-resistant.

Also in May 2011, there was an outbreak of a deadly disease caused by a new strain of the E Coli bacteria that killed more than 20 people and affected another 2,000 in Germany.

Although the “normal” E Coli usually produces mild sickness in the stomach, the new strain of E Coli 0104 causes bloody diarrhoea and severe stomach cramps, and in more serious cases damages blood cells and the kidneys. A major problem is that the bacterium is resistant to antibiotics.

Tuberculosis is a disease making a comeback. In 2011, the WHO found there were half a million new cases of TB in the world that were multi-drug resistant (known as MDR-TB), meaning that they could not be treated using most medicines.

And about nine percent of multi-drug resistant TB cases also have resistance to two other classes of drugs and are known as extensively drug-resistant TB (XDR-TB). Patients having XDR-TB cannot be treated successfully.

Research has also found that in Southeast Asia, strains of malaria are also becoming resistant to treatment.

In 2012, WHO Director General Margaret Chan warned that every antibiotic ever developed was at risk of becoming useless.

“A post-antibiotic era means in effect an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”

The World Health Assembly in May is an opportunity not to be missed, to finally launch a global action plan to address this crisis.
(END/COPYRIGHT IPS)

Excerpt: