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A timely reflection on COVID, and lessons learnt

Introduction by Croakey: The world needs to learn the lessons of the COVID pandemic, including the importance of addressing misinformation and disinformation, and ensuring that health promotion strategies – such as co-design and community engagement – are central to public health responses.

These are some reflections shared by Dr Rüdiger Krech, Director of Health Promotion at the World Health Organization, who is interviewed below by Dr Bettina Borisch, Executive Director of the World Federation of Public Health Associations (WFPHA).

This interview and an edited transcript are published as part of the #WorldInTurmoil series. Krech also highlights how commercial interests sought to capitalise on the pandemic, as well as the need to improve health communications to the public during health crises.

This series is a collaboration between Croakey and the WFPHA in the lead up to the 17th World Congress on Public Health, to be held in Rome next May with the theme, ‘A World in Turmoil: Opportunities to Focus on the Public’s Health’.

Watch the interview

COVID lessons

Bettina Borisch: I think and I know that you, at WHO, have been hyper involved into the pandemic, hyper-busy. So, now that we have already over two years, my question to you: What is your experience with the pandemic? And what have you seen as barriers, as problems? What could have governments done better?

Ruediger Krech: Good question! And let me start a little earlier than this pandemic, because we had another epidemic and pandemic during this young millennium.

I was very humbled too, to be the secretary of the Review of the Ebola outbreak and response in 2015. And having been involved in this work, looking what went right but what also went wrong during the Ebola crisis in 2015, there were unanimous recommendations by global experts on what the world needs to do, what WHO also needs to do, but also what the world needs to do to prevent the next pandemic from happening and to prepare well should this happen.

Out of those recommendations, very, very few were taken up. And very incremental changes were made. And we are now paying the bill for it.

That the world knew that the risk was very high, that the pandemic would hit the world, and not preparing well enough the societies to then, once it hits the world, to react properly.

So, what are my lessons from the COVID crisis? Well, it’s a mixed bag. I have seen, like many of you, especially at the start, you know, very good signs of solidarity. And especially at the start, also a quite good compliance with Public Health measures. Which then in many countries evaded in many population groups.

And I’ve been seeing the fallback into very nationalist reactions. Solidarity was exchanged by charity. So, especially when the vaccines were scarce at the start. And everybody looked at his own population first. And what couldn’t be vaccinated, then was donated. So, a matter of charity instead of solidarity.

Now, out of this, the world needs to learn.

The damage that was done in many countries that politicised the crisis is huge and has contributed to separating and dividing the world.

Hate, misinformation, disinformation in the net, was then very much, you know, spreading and we, in WHO, had to face a pandemic above the pandemic, which was the pandemic of mis and disinformation, fake news and that also is a lesson to be learned now, when member states recover from this pandemic. How we need to reboot societies.

So, it’s not good enough to just have a pandemic plan, but we need to see that all strands of society are affected by a pandemic. And every strand of society, therefore, needs to reboot. We cannot go on as before.

Commercial determinants and chronic conditions

Bettina Borisch: My question: were there barriers to your work as WHO?

Ruediger Krech: We had a lot of these barriers, in fact. As you said, I’m heading the health promotion work of WHO and that contains also the work on tobacco, on alcohol, on physical inactivity, on legal measures, fiscal measures and, of course, all the settings as that is where health is created or broken.

Now, let me start with tobacco. Tobacco industry interfered at the start of the pandemic, claiming that tobacco smoke would have a preventative factor to not getting infected. I mean, how crazy is that, right?

So, I mean that is abusing a crisis in which we are all suffering, where there’s a lot of uncertainty as well, and the, you know, industry which is criminal and which kills so many people, then had the guts to actually spread this misinformation knowingly.

And another issue is, let’s look at alcohol consumption. Also a mixed bag. While at the start of the crisis, we had seen a reduction in alcohol consumption. We had seen, especially in some population groups, younger people, throughout then the crisis, actually consuming more than before.

And in physical inactivity, at the start, people downloaded the apps and doing a fitness workout. On, you know, screen. And did physical activities in their living rooms. Again, the longer the crisis went, the less people did this.

In addition, parks were closed in the shutdown, in a lot of countries and cities. And so, you didn’t have the opportunity of, you know, going out, enjoying the nature and having physical activity, as you should have. That has, therefore, led to more sedentary lifestyles and more chronic illness.

And to mention also that, because of the pandemic, many people with chronic illness did not receive the health services they needed. They were diagnosed too late and we saw a lot of more morbidity and also mortality due to that lack of treatment.

And last not least, going to the settings, to the everyday life settings where health is created or broken. And also, where we gather experiences on empowerment and community engagement and health-literacy.

Now, health promotion was not really at the table when Public Health measures were decided upon. And that is very visible, because they forgot about the key lessons in health promotion which is a co-design and which is a community  engagement.

That means that, with Public Health measures, you can give a framework at, let’s say, a global level like WHO or a national level in countries, but you need to adapt it. You need to adapt it to your environment.

So, that you are engaged as a community and listened to. What would work and what would not work in your community, your school, your hospital, your workplace, your restaurant, your hairdresser, you know.

So, all that has been forgotten and we could have added our experiences from health promotion on what works and what doesn’t work in health promotion to these Public Health measures.

And last not least, had the same effect of health literacy been put to the development of a vaccine. I’m sure that the compliance rates of vaccination would have been much, much higher.

Public health futures

Bettina Borisch: Thank you for this. And you will be at the conference, the World Congress of Public Health in Rome. An invited speaker. You mentioned here a lot of challenges. What do you think? How can delegates, who come to the Rome Congress, use this meeting to help address some of these challenges?

Ruediger Krech: So, we need to understand that health is created or broken outside of the health sector. Especially the healthcare sector, right?

So, we need to better understand, as a Public Health community, what the mega trends are. So, first of all, what are these risk conditions?

The commercial interests that we need to address and not just for the, you know, for the bad. So, to disinvest from the unhealthy products, but also to invest in healthy ones.

And we need to much better understand and, therefore, have better skills of being able to advise, you know, the banking system, for instance, where they should disinvest and where they should invest in.

And the other is just looking at the technological transformation. A wonderful thing that we can use for Public Health, but there is also a risk that we are leaving some people behind who will not have access to this technological transformation or just in designing the digital virtual spaces in which we will meet in, Bettina, in a couple of years’ time.

And I’m looking forward to that, but the way they will be designed can either be healthy or unhealthy.

So, we, as Public Health community, should be at the table when these technological innovations are now designed and advise on how the world could look like when health is taken into account.

And last not least, I was talking about the economies and there, we need to understand that we have planetary boundaries. It’s not new this idea. It actually comes from the club of Rome in the 1970s. That they said: well, we need to be careful about the boundaries of this planet.

And, we in Public Health, need to embrace this thinking now and advocate and work with macro economists on an economy that is nurturing the planet while we’re satisfying the needs that we all have. If we do this, I think it will be a fantastic area of work to be in Public Health.

Communications matters

Bettina Borisch: So, your take-home message to the delegates in the Congress would be?

Ruediger Krech:  Let’s think of, you know, what creates health. Let’s advocate for this intersectoral cooperation that we then need in order to reach out to other sectors who are actually decisive in creating health. And not shy away from that area of Public Health at all. It’s fantastic.

We all know the do’s and the don’ts now. It’s just to make it happen.

Bettina Borisch: So, inspiring as you are, what would be your advice to young professionals?

Ruediger Krech:  It’s, I think, the most attractive area you can work in. You know, if you light the fire in yourself to actually advance people’s health, you can do so much. And so much more than we can do, let’s say, in a hospital where we’re treating individual patients.

We can save lives with the Public Health measures that we do and create. And so be part of creating health and saving lives.

Bettina Borisch: Public Health has been high on the agenda with the pandemic. How could we even improve the position of Public Health?

Ruediger Krech:  I think we can improve in having, of course, very heated debates amongst ourselves. Because it’s not a given that there’s only one solution, there’s many options in Public Health and how you can actually advise politicians and decision-makers.

But once we have really debated hard, we need to come to a conclusion. And we need to communicate this very, very well, how we got to the different options and how we got to the conclusions. And, I think, that this area of health communication needs to be improved amongst ourselves and between ourselves and journalists. Because it’s not entertainment when we’re actually responding to a pandemic. It is serious work.

Bettina Borisch: Thank you very much, Ruediger. That interview was really a pleasure. Looking forward to meeting you in Rome.


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