Ten Threats to Global Health in 2019: WHO

• 24 Jan 2019

The World Health Organisation (WHO) has released a list of “Ten threats to global health in 2019”.

Ten Threats and India

• Air pollution, climate change
  • Nine out of 10 people are breathing polluted air across the world.
  • India, with 18% of the world’s population, sees 26% of the global premature deaths and disease burden due to air pollution.
• Noncommunicable diseases
  • Noncommunicable diseases, such as diabetes, cancer, and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people.
  • This includes 15 million people dying prematurely, aged between 30 and 69.
  • India has been named as the “diabetes capital of the world”. India’s current estimated cancer burden — over 1.5 million new cases — is predicted to nearly double in coming 20 years.
• Global influenza pandemic
  • WHO has said that the world may face another influenza pandemic. But, the only thing we don’t know is when it will hit and how severe it will be.
  • Until January 13, 1,694 cases of swine flu had been reported in India this year, with 49 deaths. In 2018, 14,992 cases and 1,103 deaths were reported countrywide.
• Fragile, vulnerable settings
  • More than 1.6 billion people (22% of the global population) live in places where challenges such as drought, famine, conflict, and population displacement and weak health services have left them without access to basic care.
  • The massive distress in India’s farm sector has engendered waves of internal migration for work. This migrant population often live in unhygienic conditions with very little access to basic care.
  • Natural calamities routinely bring health crises like the Kerala floods last year were followed by a leptospirosis outbreak.
• Antimicrobial Resistance (AMR)
  • The ability of bacteria, parasites, viruses, and fungi to resist antibiotics threatens our ability to fight with them.
  • Drug resistance is driven by the overuse of antimicrobials in people and in animals, especially those used for food production, as well as in the environment.
  • AMR is also a result of the rampant over-the-counter sale of medications without the prescription of a registered medical practitioner.
  • India, China, and the Russian Federation accounted for 47% of the global incidence of MDR-TB (Multidrug-Resistant- Tuberculosis) in 2016. India has an AMR policy but the implementation is poor.
• Weak primary healthcare
  • Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.
  • Many countries do not have adequate primary health care facilities. This neglect may be due to a lack of resources in low- or middle-income countries and possibly also due to focus on single disease programmes in the past few decades.
  • In India, the primary care arm of Ayushman Bharat, with a proposed 1,53,000 health and wellness centers, has received less attention than Pradhan Mantri Jan Arogya Yojana(i.e. The insurance aspect of Ayushman Bharat).
  • Rural health statistics for 2017, in India, show around 8,000 posts of doctors in primary health centers are vacant (against a requirement of almost 27,000), and almost 2000 of the total 25,000 Primary Health Centres’ have no doctors at all.
• Vaccine hesitancy
  • Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases.
  • Vaccination prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations is improved.
• Dengue
  • Dengue, a mosquito-borne disease that causes flu-like symptoms and is lethal and kills up to 20% of those with severe dengue.
  • WHO estimates 40% of the world is at risk of dengue, with around 390 million infections annually.
  • Dengue is endemic to India and its season is lengthening significantly. Until November 25, 2018, India saw 89,974 dengue cases and 144 deaths.
• HIV
  • According to the WHO, nearly a million people every year die due to HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV.
  • India has launched a test and treat policy, made HIV treatment the right of every individual. India has also enacted the HIV/AIDS Act, 2018 which makes anti-retroviral therapy a legal right for Indians with HIV/AIDS.
• Ebola, other high threat pathogens
  • WHO’s identifies diseases and pathogens that have the potential to cause a public health emergency but lack effective treatments and vaccines.
  • This list includes Ebola, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.
  • While India saw no case of Ebola, but several Indian states battled Zika in October-November 2018, and at least 17 people died of Nipah infection Kerala over April and May.