WMJ 05 2011 - World Medical Association

Editorial
Window of Hope
This editorial is being written just days before
the UN summit on Non-Communicable
Diseases (NCDs), which marks only the
second time in history that the UN General
Assembly has set aside significant time to
discuss a health issue. Preparations have
been underway for more than a year and the
expectations are high.
Non-Communicable diseases now represent
the greatest proportion of the global burden
of disease. The World Health Organisation,
in it approach to NCDs, has focused
its attention on four disease groups: heart
disease, lung disease, cancer and diabetes.
Without doubt, these are crucial problems
worldwide, but there is much more to it.
Mental health, muscular-skeletal diseases, Otmar Kloiber
accident and trauma are just a few examples
of non-communicable diseases that are tremendously important but
do not enjoy the same level of visibility within the WHO – including
in its planning for the NCD summit. Some, such as mental
health, have been pushed into the Summit agenda by governments,
while others are largely being ignored. This piece-meal approach to
NCDs resurrects critical concerns about a flawed approach to global
health that we believed we had begun to move past.
In the post-Alma Ata period, the work of international organisations,
including WHO, was marked by donor-driven vertical programs
tackling specific diseases like HIV/AIDS, tuberculosis, river
blindness and malaria. These programs were all well-meaning humanitarian
efforts, driven by immediate, visible needs that health
funders and the public found very compelling. Yet, as physicians
concerned for the full health of our patients, we criticized the imbalanced
prioritization of these discrete programs over other programs
that would address the overall health needs in the affected regions
and contribute to the build-up of comprehensive health care systems.
We were encouraged by a sobering series of analyses and reports –
most importantly, the World Health Reports on Human Resources
for Health in 2006 and on Primary Care 2008, and a brilliant analysis
on the Social Determinants of Health in 2009 – in which the
WHO recognised the failures inherent in
the silo-based paradigm and recommended
an epochal shift to a more systematic, primary
care-based approach to health. This
new paradigm would focus on personcentred
care and people-centred public
health, building and strengthening health
systems around a solid core of primary care.
The WMA welcomed and supported this
new approach. Thus, we are concerned and
disappointed by the current NCD strategy,
which appears be taking us back down the
road of vertical programs and away from
the holistic approach to human health that
we believed that WHO was committed to
pursuing. Certainly, a strong focus on heart
disease, lung disease, cancer and diabetes is
warranted. These are massive health problems
that affect large populations and consume enormous amounts
of health resources. And many of their causes are preventable
through lifestyle changes, such as smoking cessation, reduction of
alcohol consumption, increased physical activity, and better nutrition.
However, preventive care can and should be addressed in the
context of quality health systems, alongside the full complement of
primary, secondary, and tertiary care. Building such comprehensive
systems will simply not be achievable if funding is disproportionately
funnelled into disease-specific programs. We have learned this
lesson once already.
During the upcoming Summit, the national leaders in New York
have a chance to turn the focus back toward improved investment
in health and in health care across the board – not only where there
are donor-driven programs, but at the national level in each country.
They can choose to apply the available resources toward the goal of
building real health systems that take in account the social determinants
of health and provide effective, accessible, quality health care
for all persons. It is our sincere hope that they will recognize and
seize the opportunity to do exactly that.
Dr. Otmar Kloiber,
Secretary General WMA
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