Last May, I had the wonderful opportunity to represent the Noncommunicable Disease Alliance (NCDA) as a note-taker at the 75th Meeting of the World Health Assembly (WHA) hosted in Geneva, Switzerland.
No, unfortunately, I was not able to attend the meeting physically due to COVID-19. However, over the course of several days, many of them spent on my living room couch, I was able to attend the assembly virtually.
During the assembly, I learned a great deal about the importance of multilateral cooperation, the need for a strong and efficient WHO, and the necessity for resource sharing and transfer for the future of global health.
For those who might be new to the WHA or international dialogues at large, no need to worry if these meetings seem foreign. WHA75 was my first time tuning into an international meeting of this nature, and as a note-taker, I am eager to share with you everything I learned and observed during the assembly.
Health for peace, peace for health
Each WHA meeting has a theme. The theme for WHA75 was health for peace and peace for health, a fitting message that drew attention to the interdependence of health and peace in realizing global health goals, especially as conflict and violence rages across the world. This year’s theme also highlighted the inequalities and tensions that emerged in the face of the COVID-19 pandemic, especially around vaccine inequity. The importance of this year’s theme was paramount for Director General Tedros Ghebreyesus, as he expressed his dreams for peace and realizing health for all.
“Unless we dream of a better world, we will keep waking up in this one;
Unless we aim higher, we will land lower;
Unless we show solidarity, we will reap division;
Unless we seek peace, we will find war.
Today, and everyday, we have a choice—we make the choices.
And today and everyday we must health for peace and peace for health.
Peace, peace, peace”. — WHO Director General, Tedros Ghebreyesus
The Director General’s words echo a future of global health that not only demands sustained peace but also requires collective action. Thus, as WHA75 deliberations got underway, health for peace and peace for health served as a constant reminder of what was at stake.
Getting the World Back on Track
During the assembly meeting, Member States’ discussions focused on getting the world back on track to reach the WHO Triple Billion Targets. Member States across the WHO’s six regions noted setbacks due to the pandemic as a major deterrent and obstacle in realizing health goals. The pandemic also increased tensions and conflicts within and between countries, while also putting considerable strain on already weak healthcare infrastructure.
To move forward and regain momentum, Member States focused on improving their relationship with the WHO, where Member States would better finance and strengthen cooperation with the WHO, and in turn, the WHO would offer greater financial and technical resources. These sentiments were echoed across the WHA and the Executive Board, with Director General Tedros Ghebreyesus calling on Member States to reshape WHO financing and work towards more comprehensive structural reforms.
Regarding the WHO strengthening, as an outsider to previous WHA deliberations, I was moved by the level of Member States’ participation, honesty and resolve to get back on track and work harder to achieve national and international health targets. One particular takeaway from discussions on WHO reform was the shared agreement by many Member States to help improve WHO financing by gradually increasing their assessed contributions to 50% of the WHO base budget by 2030-2031. For years the WHO has faced financing challenges as a result of nearly 80% of its budget coming from earmarked voluntary contributions, which constrained the organization’s ability to finance its programs—leaving many global health issues without the necessary attention and funding. However, with this change in financing, many hope that WHO will be able to fund its programs and give attention to underfunded health issues more effectively.
NCDs and WHA75
On this note, a salient issue that required my special attention as a note-taker during the assembly was non-communicable diseases (NCDs). Falling under Triple Billion Target Pillar 1, one billion more people benefiting from universal health coverage, NCDs are an emerging global health issue.
NCDs are the leading cause of premature death, disease, and disability and cause 41 million deaths a year globally, representing 77% of deaths in low- and middle-income countries. They are set to soon overtake infectious diseases as the leading cause of death and disability. While these figures are daunting, it is important to note that 80% of NCDs are preventable. Many NCDs emerge from underlying modifiable risk factors including but not limited to tobacco and alcohol use, unhealthy diet, physical inactivity, and air pollution. However, for years, prospects toward NCD prevention are gravely underfunded and lack consolidated international action.
With growing attention towards NCDs within the global health community, NCDs were center stage within the WHA75 agenda, falling under item 14.1. Discussion around NCD action was rich and showcased the need for action, while also recognizing the compounding effects of the pandemic and NCDs on health care infrastructure. This caused many to propel actions that would ensure that NCDs become a core aspect of future pandemic preparedness mechanisms. NCD discussion also stressed the importance of technical and financial support between Member States and the WHO alongside the regional and national implementation of NCD guidelines.
Numerous successes came from the discussion, including the adoption of a road map for NCD prevention and control which would support MS in implementing the WHO NCD Global Action, and the adoption of a global strategy on oral health, which addresses unsung but prominent NCDs related to oral health.
Another laudable achievement was the adoption of a resolution by small island developing states (SIDs). The first-of-its-kind resolution would allow SIDs to work together with other Member States to support initiatives to tackle urgent health challenges facing SIDs and target and combat effects of climate change, with emphasis on financial support by Member States through the establishment of a voluntary SIDs Fund. Welcomed as these changes and initiatives maybe, time is something that remains a luxury in conversations about climate change.
A fund is great—and resources are even better—but ending the use of fossil fuels and reimagining our relationship with the planet and resources would be world-changing. This also applies for NCDs, as efforts to shift plans and policy frameworks to action are process-driven. However, as a result, that may take time that many may not be able to afford.
An Accessible WHA?
While from the outside, WHA75 deliberations may appear serious and unengaging to everyday viewers, I am glad to report that watching the Member States’ discussion was very interesting and at times humorous. In the same way that you and I struggle with presentations or fangirl over friends and esteemed colleagues, so did Member States’ representatives speak on behalf of their countries.
Representatives at times spoke too fast, they made minor mistakes, mispronounced names, or joined discussions late. Moreover, I recall one particular moment when a language interpreter told a Member State’s representative, in a joking manner, that they were speaking too fast for them to interpret. I found this moment hilarious and so did other Member States and Secretariat members who laughed and proceeded to give special thanks for the work of the interpreters. I can therefore speak to the fact that Member State representatives, no matter how esteemed, are imperfect just like you and me.
To this point, I think the rawness of interactions like these made such a high-level discussion feel more approachable and more digestible to me.
Pivoting slightly, it is also important to consider who wasn’t there when thinking about accessibility. Sitting in these sessions, it was easy to see that many of the conversations were dominated by Member States. There was a strong civil society presence, but this was limited to call to action statements.
Ultimately, the high level discourse of global health favors states but the role of civil society is not lost. However, not all non-state actors are treated the same just look at the Gates Foundation. Although all is fair and philanthropy, in a setting where money sets agendas, not people, something is off. Thus, outside of WHA75, the presence of non-state actors in shaping global health warrants a conversation on who gains access and who is heard, especially when lives are at stake.
Conclusion
WHA75, for me, was a welcome introduction to the ins and outs of high-level international meetings.
From the rich discussion by Member States to the notable achievements and humor of the assembly meeting, I was inspired and given hope for the future.
However, there is still a lot of work that has to be done to address the most challenging issues in global health and create tangible change. Conversation only goes so far. Thus, Member States have to do more than just convene and exchange commitments—they must put word to action by ensuring collaboration and instituting policy changes and programs that improve health systems and assure care access.
On that note, I leave readers with this. As we continue to learn and develop as students or transition into your professional fields, I urge you to keep up to date with international dialogue, be it about health, politics or other affairs. They all intersect, so give yourself the time to reflect and consider your position and capacity to act because whether we realize it or not health goes beyond the clinical or public health space. Health is as much about urban planning, as it is running treatment diagnostics.
With that in mind, there are many avenues to approach and engage with the global health space, whether you’re a global health major or just interested in joining the conversation. I leave it up to you to decide—the ball is in your court.