What a difference 70 years can make in global health
This blog was first published on Diplomatic Courier on 11 April 2018.
1948 saw the birth of the UK’s National Health Service providing healthcare free for all at the point of delivery – and 55 countries meet for the inaugural World Health Assembly. Seven decades later, Ebola and Zika outbreaks, old diseases reappearing in conflict zones, polio that is still resisting eradication, chronic “life-style” diseases putting at risk hard fought-for health gains, superbugs threatening to make the simplest hospital operation a gamble with death: all seem to conspire to make us believe that things are getting worse, not better.
Uppermost in the minds of many politicians back in 1948 were the 20,000 Egyptians who died from a devastating cholera epidemic. The freshly-minted Bulletin of the World Health Organization published an exhaustive preliminary report that summarizes how the outbreak spread and the measures, including, crucially, mass inoculation of Egypt’s entire population, taken to control it.
Egypt’s cholera epidemic is a tragic milestone in the history of global health and it served as the WHO’s first testing ground, helping to prove its capacity to mobilize medical assistance, disseminate medical alerts and negotiate the abolition of quarantine restrictions. One of its greatest contributions was providing millions of cholera vaccines at discounted prices for the Egyptian government. In the new post-WWII world order of peace and hope, the USSR, China, Switzerland, Tunisia, France, the Netherlands, Brazil, Iraq and Italy all joined in the lead efforts of the U.S. and U.K. in overcoming the epidemic.
This episode reminds us that engaging and partnering – the collective key to meeting the Sustainable Development Goals by 2030 and delivering universal health coverage (UHC) is built into the WHO’s DNA. Politicians, companies and other stakeholders have the same genome.
How much has changed since the WHO was born? A lot, obviously. One of the greatest transformations is how many of us live healthier and longer lives. The Global Health Check website developed by the Bill & Melinda Gates Foundation highlights this dramatic change over the past 70 years. Of the babies born in 1948, only 3% would make it to their 70th birthday, today it’s 41%. Global life expectancy has increased by 20 years – from 52 in 1948 to 72 today or the equivalent of 17 return trips to Mars.
If you were born in Mali in 1948, your life expectancy was 28, compared to 74 in Norway. Nutrition, better sanitation and proper healthcare were the main reasons for this striking difference. Norwegian babies in 1948 benefitted from the medical breakthroughs of previous decades: vaccines to protect against TB, tetanus, and whooping cough. At ten, combination chemotherapy had been developed to prolong life for people suffering from acute leukaemia. By the time young Norwegian 1948ers were in their twenties, more medical breakthroughs were improving their lives and these – such as the birth-control pill, treatments for asthma, broad spectrum anti-biotics, and a pioneering new medicine to treat breast cancer. At that time, the now twenty year old WHO moved into its own headquarters, coinciding with the innovative pharmaceutical industry setting up an international association that I head today, to engage with the WHO and work with a common goal of bringing the transformative power of medical innovation to the world. A transformation in global health progress that means Malians have a life expectancy of 58 compared to 28 of the past.
A core force behind the improvement in global health witnessed in Mali and across many low and low-middle income countries is the innovative partnerships set up to eradicate or control infectious diseases such as the mass administration of drugs against neglected tropical diseases (The London Declaration on Neglected Tropical Diseases or NTDs) and widespread vaccination programmes (GAVI Alliance). These are just a couple of the hundreds of partnerships involving governments, civil society foundations and the pharmaceutical industry that aim to save lives and alleviate suffering among, predominantly, the world’s poorest people.
But we cannot stand still because, while infectious diseases still disproportionately affect the underprivileged, respiratory diseases, heart conditions and other chronic illnesses blight many lives in their most productive years. Why for example are medicines that are on the WHO’s list of essential medicines (95% of them generic and affordable) not reaching those who need them most?
Decades of market failure and governance issues have denied low-income countries efficient transport infrastructure for distributing and administering medicines, access to potable water, and trained health personnel. Not to mention the serious health damages inflicted on them by conflict, migration, natural disasters and, not least, climate change.
The WHO is as relevant today as it was back in 1948. Under the leadership of Dr Tedros Adhanom Ghebreyesus, its Director-General, it is firmly focussed on bold and ambitious future targets. To address the complex problems in global health today continued innovation is essential. Indeed, there is a pressing need to provide an innovation-friendly ecosystem especially in areas where it is not easy, such as discovering new antibiotics, finding a treatment for dementia, or vaccines and medicines for the next epidemic. But transformative innovation is badly needed to improve health care systems, innovation to alleviate the pressure of paying for health services out of pocket, and innovation in better using data to understand future needs. But none of this will achieve much unless countries put health as a top priority on their agendas and make the necessary investments.
Maybe, the post-WWII world that responded so swiftly to the cholera epidemic in Egypt was simpler but it certainly underlined how collective action and engagement by all stakeholders could overcome crises.
The WHO has a clear plan to put to the world’s governments at this 70th birthday World Health Assembly in May. The watch words of the 13th WHO program of work: “promote health, keep the world safe, service the vulnerable” provide a clear vision for what really matters for all our futures. Dr Tedros has a powerful vision to galvanize efforts: “we need 1 billion more people to have coverage every 5 years between 2016 and 2030”. It’s up to all of us to help where we can to put this vision into action and make a lasting legacy for future generations to judge us by. On my watch, the global innovative pharmaceutical industry will be looking at how innovation, transformation, partnership and engagement will continue to further global health progress.