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On these pressing global health threats, what more of a wake-up call do we need?

Introduction by Croakey: The World Congress on Public Health was held in Rome from 3-6 May. The big issues discussed – from the planetary health crisis, to growing inequality, the impacts of war, and the spread of misinformation – need concerted, ongoing and collective responses, writes María Rojas.

Rojas is a final year student in a Master of Arts of Translation and Multilingual Communication at the University of Geneva, and was part of the World Federation of Public Health Associations’ communications team at #WCPH2023.


María Rojas writes:

Three days are not enough to solve the world’s health problems, but they might be enough to realise our potential as a public health community.

The 17th World Congress on Public Health featured eight plenary sessions where topics from climate change to war were covered, and they all put public health at the centre of discussions.

Here are some relevant key messages and call to actions from some of those plenaries.

No public health without planetary health

We are in the middle of a sixth mass extinction that is driven mainly by human activity. Disturbing ecosystems entails serious consequences such as food insecurity, drought, new strains of virus and bacteria, just to name a few.

Dr Samuel Myers from Harvard T.H. Chan School of Public Health described the reality we are facing, for which not enough has been done. The link between climate change and health cannot be ignored.

Dr Maria Neira from the World Health Organization made a clear call to action: “We need a new global public health architecture. We are facing a huge structural failure. We need to manage these failures that will allow us to build the base of what public health should be.”

Trust matters

Inequity is omnipresent in society. When it comes to health, improvements have been made.

However, during the COVID-19 pandemic, 92 percent of countries reported disruptions to essential services and around 25 million children under five years missed out on routine immunisation.

These are only two examples of inequalities in healthcare, but one cannot forget the gaps in maternal care, mental healthcare, the elderly, adult immunisation and many more.

Everyone is at risk of being left behind at some point, but there are populations that, systematically, are more at risk.

As Professor K Srinath Reddy from the Public Health Foundation of India pointed out: “Inequalities are growing, climate change threatens our lives, gender related crime is rising, democracy is under threat. In all of this, the poor are the most vulnerable”.

Dr Alejandro Jadad, a Canadian-Colombian physician, innovator, entrepreneur, and philosopher, shared his belief that one of the causes of these inequalities is a crisis of trust.

One way to close these gaps is through more inclusive health policies. These policies need to come from governments. To achieve that, we need to rebuild, defend, and strengthen democracy through trust. Trust between patients and healthcare workers, public health professionals and governments and governments and societies.

Artificial Intelligence and digital health

Before we even start talking about the benefits of artificial intelligence (AI) and digital health, we cannot forget that there are still millions of people who do not have access to Internet and that close to one billion people in low and lower-middle income countries are served by healthcare facilities with unreliable electricity supply or with no electricity access at all.

Dr Catherine Kyobotungi from the African Population and Health Research Center reassured us that even though too little has been done to make AI available for all (especially in the African continent), it is not too late.

Dr Emanuele Di Angelantonio from the University of Cambridge asked AI developers to keep in mind that one of the biggest challenges is that these apps are built for a certain population. He said: “Your model can work for the population you developed, but how can it perform in the rest of the population?”

COVID-19: the ongoing challenge

Politics and public health are intrinsically linked. Governments were not ready for a pandemic. It showed the need for a Pandemic Accord and negotiations started on March 2023.

Both Professor Luis Eugenio de Souza, the new president of the World Federation of Public Heath Associations, and Professor Walter Ricciardi, the WFPHA’s outgoing president, stated that scientific collaboration was extraordinary as well as the solidarity amongst civil society.

Nevertheless, governments failed to take effective action against the challenges they were facing, especially against the spread of misinformation and fake news.

Ricciardi and Professor Jeffrey V Lazarus at the University of Barcelona both maintain that an accountability mechanism should be included in the Pandemic Accord.

Mental health and social wellbeing

“We need to bring mental health out of the shadows. Mental health is everyone’s business. There will be no universal health if mental health is not part of the packages of care.” This statement was made by Dr Natasha Azzopardi-Muscat from the WHO.

Mental illness is a threat to public health, as Dr Rosana Onocko-Campos, from the University of Campinas, Brazil, explained: “People with mental health problems die 10 to 20 years earlier than the average population due to curable and preventable diseases.

“We must reject the social segregation that exist in the low and middle-income countries. We need to restore the dignity of our people, bodies, cultures, and names. We need to create safe spaces.”

Vaccine confidence

The last couple of years have been marked by a steady decline in vaccine confidence.

Dr Heidi J Larson stated that this decline has led to around 67 million children missing out on routine immunisation between 2019 and 2021. This is due to a lack of access to vaccination but also a lack of trust, amplified by misinformation, which is worrying because this less trusting generation will be the future parents.

A generation of unvaccinated children could bring serious consequences, that will push back all the advances that have been achieved over the last decades to control infectious diseases.

On conflict and power

There is no point in listing the facts of the several ongoing conflicts around the world. The call to action is so obvious, it feels wrong to have to remind you of it.

And yet, Professor Bettina Borisch, Dr Wahid Majrooh and Dr Ira Helfand participated in this plenary to remind us once more that war, a purely man-made problem, is also a public health one.

Professor Bettina Borisch

Borisch made it clear that the extremely violent international architecture is due to a hunger for power. A patriarchal mindset has led to the idea that it is acceptable to inflict violence upon others.

Nevertheless, she reminded us that those who have the power to tell stories have the power to change this mindset.

Her call to action was seconded by Majrooh, and his statement was clear:

“None of the ongoing conflicts in the world are fueled by infectious diseases, NCDs, but the ill decisions made by ill politicians. We have remained the only leaders who are still trustworthy in societies, who have proven to be competent. We need to believe we are the leaders our societies are looking for, to help to get out of the problems, disaster, and disorder that the politicians have left.”

Raise our voices

After reading this, what more of a wake-up call do we need to realise that our future as a society is in our own hands and that we can either choose to be the architects of our success or of our failure?

The World Congress on Public Health might be over, but these challenges are not.

More opportunities will come to gather and exchange information, whether it be at an international congress, at an office or a consultation with a patient.

Every day is an opportunity to work together, raise our voices and remind ourselves that we can change the course of things.

We have done it before; we can do it again.

• María Rojas is a last year student in Master of Arts of Translation and Multilingual Communication at the University of Geneva. She was part of the communication team that worked to promote and cover the WCPH2023.

Participants at #WCPH2023, including Dr Summer May Finlay from the University of Wollongong (centre)

This is the final article in the #WorldInTurmoil series, a collaboration between the WFPHA and Croakey. See previous articles in the series.