Developed with input from WHO experts around the world, the list is varied and includes stopping infectious diseases and preparing for epidemics, protecting adolescents, elevating health in the climate debate, and delivering healthcare in areas of conflict and crisis.
The list reflects a “deep concern that leaders are failing to invest enough resources in core health priorities and systems,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a statement. “This puts lives, livelihoods and economies in jeopardy. None of these issues are simple to address, but they are within reach,” he noted.
All of the challenges on the list “demand a response from more than just the health sector. We face shared threats and we have a shared responsibility to act,” Tedros said.
The top health challenges are not listed in order of priority. “All are urgent and many are interlinked,” Tedros said.
The climate crisis is a health crisis, the WHO says. Climate change causes more extreme weather events, exacerbates malnutrition, and fuels the spread of infectious diseases such as malaria. The same emissions that pollute the air and cause global warming are responsible for more than one quarter of deaths from heart attack, stroke, lung cancer, and chronic respiratory disease.
“Leaders in both the public and private sectors must work together to clean up our air and mitigate the health impacts of climate change,” the WHO says. In 2019, over 80 cities in more than 50 countries committed to the WHO’s air quality guidelines, agreeing to align their air pollution and climate policies.
This year, the WHO will work toward developing a set of policy options for governments to prevent or reduce the health risks of air pollution.
Delivering Health in Conflict and Crisis
Last year, most disease outbreaks that required the highest level of WHO response occurred in countries with protracted conflict. And the “disturbing” trend in which healthcare workers and facilities are targeted continued.
The WHO recorded 978 attacks on healthcare in 11 countries last year, with 193 deaths. Conflict is also forcing a record number of people out of their own homes, leaving them with little or no access to healthcare, often for years.
On this challenge, the WHO is working with countries and partners to strengthen health systems, improve preparedness, and expand the availability of long-term contingency financing for complex health emergencies.
“But health is only part of the equation. Ultimately, we need political solutions to resolve protracted conflicts, stop neglecting the weakest health systems, and protect health care workers and facilities from attacks,” the WHO says.
“Persistent and growing” socioeconomic gaps that result in major discrepancies in the quality of people’s health is also an urgent challenge. There is not only an 18-year difference in life expectancy between rich and poor countries, but also a marked gap within countries and even within cities, the WHO notes.
The WHO is working with its partners to improve child and maternal care, nutrition, gender equality, mental health, and access to adequate water and sanitation. The WHO has called on countries to allocate 1% more of their gross domestic product to primary healthcare, to give more people access to the quality essential services they need.
Expanding Access to Medicines
About one third of the world’s people lack access to medicines, vaccines, diagnostic tools, and other essential health products. Low access to quality health products threatens health and lives and contributes to drug resistance.
The WHO is working with countries to expand access to medicines, fight substandard and falsified medical products, enhance the capacity of low-income countries to assure the quality of medical products throughout the supply chain, and improve access to diagnosis and treatment for noncommunicable diseases, including diabetes.
Infectious diseases such as HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases, and sexually transmitted infections will take the lives of an estimated four million people in 2020, most of them poor.
Meanwhile, vaccine-preventable diseases continue to kill, including measles, which took 140,000 lives in 2019. Polio is also once again a concern, with 156 cases of wild poliovirus last year, the most since 2014. There’s an urgent need for greater political will and increased funding for essential health services and strengthening routine immunization, the WHO says.
Preparing for Epidemics
A pandemic of a new, highly infectious, airborne virus — most likely a strain of influenza — to which most people lack immunity is inevitable, according to the WHO. And vector-borne diseases like dengue, malaria, Zika, chikungunya, and yellow fever are spreading as mosquito populations move into new areas, fanned by climate change, the WHO says.
“Countries invest heavily in protecting their people from terrorist attacks, but not against the attack of a virus, which could be far more deadly, and far more damaging economically and socially. A pandemic could bring economies and nations to their knees,” Tedros said.
Lack of food, unsafe food, and unhealthy diets are to blame for nearly one third of the global disease burden. The WHO is working with countries to develop evidence-based public policies, investments, and private sector reforms to reshape food systems, and provide healthy and sustainable diets. Last year, the food industry committed to eliminating trans fat by 2023, but more is needed.
The WHO also cites mounting health risks of electronic cigarettes. The agency is working with countries to build political commitment and capacity to strengthen implementation of evidence-based tobacco-control policies.
Investing in People Who Defend Our Health
Another challenge is the global shortage of healthcare workers. The world will need 18 million more healthcare workers by 2030, mostly in low- and middle-income countries, including nine million nurses and midwives.
To prompt action and encourage investment in education, skills, and jobs, the World Health Assembly has designated 2020 the Year of the Nurse and the Midwife. The WHO and its partners will issue a comprehensive State of the World’s Nursing report on World Health Day in April and is working with countries to stimulate new investment to train health workers and pay them decent salaries.
Keeping Teens Safe
More than one million adolescents aged 10 to 19 years die every year. The chief causes are road accidents, HIV, suicide, lower respiratory infections, and interpersonal violence. Harmful use of alcohol, tobacco and drug use, lack of physical activity, unprotected sex, and previous exposure to child maltreatment all increase the risks for these causes of death.
In 2020, the WHO will issue new guidance for policymakers, health practitioners, and educators designed to promote adolescents’ mental health and prevent the use of drugs, alcohol, self-harm, and interpersonal violence as well as provide young people with information on preventing HIV and other sexually transmitted infections, contraception, and care during pregnancy and childbirth.
Earning Public Trust
Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions. The antivaccination movement has been a significant factor in the rise of deaths in preventable diseases, the WHO says.
The WHO is working with countries to strengthen primary healthcare so people can access effective and affordable services easily, from people they know and trust, in their own communities. The agency is working with popular social media platforms to ensure their users receive reliable information about vaccines and other health issues.
Harnessing New Technologies
New technologies such as genome editing and artificial intelligence are revolutionizing the ability to prevent, diagnose, and treat many diseases, but raise new questions and challenges for monitoring and regulation.
In 2019, the WHO set up new advisory committees for human genome editing and digital health, bringing together the world’s leading experts to review evidence and provide guidance. The WHO is also working to help countries plan, adopt, and benefit from new tools that provide clinical and public health solutions, while supporting better regulation of their development and use.
The rise of antimicrobial resistance (AMR) is a persistent and urgent challenge that threatens to send modern medicine back decades to the preantibiotic era. The WHO is working with national and international authorities in the environment, agriculture, and animal sectors to reduce the threat of AMR by addressing its root causes, while advocating for research and development into new antibiotics.
Clean Water, Sanitation, Hygiene
About one in four health facilities globally lack basic water, sanitation, and hygiene (WASH) services that are critical to a functioning health system. The lack of these basics in health facilities leads to poor-quality care and an increased chance of infection for patients and health workers.
The WHO and its partners are working with 35 low- and middle-income countries to improve WASH services in their health facilities. The global goal is for all countries to have included WASH services in plans, budgets, and implementation efforts by 2023, and by 2030 all healthcare facilities globally should have basic WASH services.
“With the deadline for the 2030 Sustainable Development Goals quickly approaching, the United Nations General Assembly has underscored that the next 10 years must be the ‘decade of action,’ ” Tedros said.
“This means advocating for national funding to address gaps in health systems and health infrastructure, as well as providing support to the most vulnerable countries. Investing now will save lives — and money — later. The cost of doing nothing is one we cannot afford.” he said.
“Governments, communities, and international agencies must work together to achieve these critical goals. There are no shortcuts to a healthier world. 2030 is fast approaching, and we must hold our leaders accountable for their commitments,” Tedros added.