18th World Congress on Public Health: What Cape Town Asked Us to Change

The 18th World Congress on Public Health brought the global public health community to Cape Town, South Africa, from September 6–9, 2026.

Its theme, Health Without Borders: Equity, Inclusion, and Sustainability, reflected a world in which the major threats to health increasingly cross the boundaries between countries, sectors, and disciplines.

Climate change does not stop at a border. Neither do infectious diseases, misinformation, forced migration, conflict, or economic shocks.

But the Congress raised a harder question: If the problems are interconnected, why are our responses still so fragmented?

Across plenaries, World Leadership Dialogues (WLD), workshops, oral presentations, posters and special sessions, participants returned to questions of power, access, trust, leadership and implementation.

The most interesting discussions rarely focused on whether a problem exists. We already know that.

They were about who has the power to change it, who gets left out, and what it takes to turn public health knowledge into action.

Health inequity starts long before someone enters a clinic

The Congress’s opening discussions on inequity and health challenged a familiar tendency in public health: focusing on the moment when someone encounters the healthcare system rather than the conditions that shaped their health long before that encounter.

Housing. Income. Education. Gender. Geography. Employment. Social exclusion. Caregiving. Political power.

These are not peripheral issues to health. They are part of the environment in which health is produced.

One speaker used the image of a woman living in an informal settlement to make the point. From the housing, infrastructure, and socioeconomic conditions surrounding a child from birth, it may already be possible to anticipate many of the challenges that child will face.

That is the power and the uncomfortable implication of the social determinants of health.

The Congress also examined how public health institutions themselves can reproduce inequity. Discussions of gender and leadership highlighted that public health leadership remains shaped by hierarchical, medically dominated structures, while caregiving responsibilities can interrupt traditional leadership pathways.

One reflection captured the nuance:

“Gender always matters, but it never acts alone.”

The implication is important. An intersectional approach cannot treat gender, race, class, geography, or other forms of disadvantage as separate variables.

They interact through systems of power.

That is why health equity requires looking both outward at the populations public health serves and inward at the institutions responsible for serving them.

Economic policy is public health policy

This question of structural inequality carried directly into Economics of Democracy and Public Health.

Asma Khan, whose all-female restaurant kitchen is staffed by mothers and grandmothers, challenged the audience to think about the economic value attached to care.

Women provide enormous amounts of paid and unpaid care worldwide. Yet the work of providing, nurturing, and healing has historically been undervalued, particularly when it is performed by women from economically marginalized communities.

Her message was deceptively simple: if equality means valuing women’s contribution, that value has to be economic as well as symbolic.

Dr. Mohamed Janabi, Director of the World Health Organization African Region, connected the argument to government decision-making:

“Economic decisions are health decisions.”

Taxation, public spending, employment and social protection determine the conditions in which people live.

That means a health budget cannot be neatly separated from an education budget, an employment policy, or a social protection program.

And democracy cannot mean participation only on election day. It must also mean having a meaningful voice in the decisions that determine whether communities have access to food, housing, employment, education and health care.

The Brazilian experience of the Sistema Único de Saúde (SUS) offered another lesson. A universal health system can expand rights on an enormous scale while still leaving significant inequalities in quality, access, and regional coordination.

Universal coverage is a destination. Equity requires constant attention to how the system actually works.

Can global health rules change who holds power?

The Congress then took the question of power from the national level to the international stage.

In International Law and Global Treaties in Public Health, Dr. Moeketsi Modiseyane asked:

“We share the world, but we don’t share the power.”

That question cuts to the heart of global health governance.

Countries may formally sit around the same negotiating table, but they do not necessarily arrive with the same financial resources, technological capacity, manufacturing capabilities, or political influence.

So what does “solidarity” mean when solidarity becomes expensive? What does “equity” mean if it has no mechanism for accountability?

And can international law actually redistribute power? Or does it simply formalize the distribution of power that already exists?

Prof. Flavia Senkubuge, Dean and Professor in the Faculty of Health Sciences at the University of Pretoria, brought the discussion back to the health system itself.

A treaty does not vaccinate a child. A treaty does not manufacture medicine. A treaty does not put a nurse in a rural clinic.

Those outcomes depend on institutions and people with the resources and capacity to implement international commitments.

COVID-19 exposed the gap dramatically. The world witnessed extraordinary scientific collaboration and rapid vaccine development, while access to those breakthroughs remained profoundly unequal.

Having a seat at the table is not necessarily the same as having the power to negotiate.

Innovation only matters if people can use it

That same tension between promise and implementation appeared in the WLD Digital Health in BRICS: Towards an Equity-Oriented Technological Development Model.

Artificial intelligence, telemedicine, digital surveillance and other technologies could transform access to health care.

But technology can also introduce new barriers.

As Dr. Lwando Maki, President of the Public Health Association of South Africa, emphasized, connectivity is not the same as equitable access.

A rural patient cannot benefit from telemedicine simply because a telemedicine platform exists. Reliable connectivity, appropriate infrastructure, affordable data, and a health system that can respond to the consultation are needed.

This is where the phrase “digital divide” can be too simplistic. The issue is not just whether someone is connected. It is whether they can meaningfully use the connection to improve their health.

Dr. Minghui Ren argued that digital health should be understood as an instrument of health-system transformation rather than a collection of new technologies. That means using it to strengthen primary health care, integrate services, support health workers and improve access across the life course.

Meanwhile, Dr. Rômulo Paes-Sousa emphasized that digital health sits inside a much larger ecosystem involving politics, markets, culture, regulation and clinical practice.

This raises a question worth carrying beyond Cape Town: When does technology become a public good, and when does it simply become another layer of inequality?

The vaccine conversation needs to move beyond “hesitancy”

The WLD Strengthening Vaccine Confidence: A Global Public Health Imperative pushed the vaccine debate into more complicated territory.

Prof. Heidi Larson, Founder and Director of The Vaccine Confidence Project, highlighted declining confidence among younger adults and a changing political and information environment.

But one useful insight was that trust in science does not exist in isolation.

People may trust science while also placing enormous confidence in family members, friends, religious leaders and community figures.

That means public health communication cannot assume information moves directly from expert to individual. It moves through relationships.

Prof. Katie Atwell, Professor of Political Science and Public Policy at the University of Western Australia, also challenged the language used to describe vaccine uptake.

Instead of automatically framing low uptake as individual “hesitancy,” public health needs to examine access barriers, structural conditions and the responsibilities of governments.

This changes the question.

Rather than asking only: Why aren’t people accepting vaccines?

We should also ask: What makes vaccination difficult, inaccessible, or untrusted in the first place?

That distinction becomes even more important as misinformation and disinformation become more sophisticated.

Prevention needs to follow people across the life course

The WLD Closing the Prevention Gap through Adult HPV Vaccination: From a Women-Only Narrative to Universal Cancer Prevention applied a similar principle to HPV vaccination.

For years, HPV vaccination has often been framed predominantly around girls and cervical cancer prevention.

The discussion in Cape Town challenged that narrow framing.

A universal cancer prevention approach recognizes the wider population affected by HPV and asks how adult vaccination strategies can close gaps in protection across genders and across the life course.

That is a broader public health proposition:

Prevention works better when the strategy reflects how disease actually moves through populations rather than how health programs have traditionally been organized.

The same life-course thinking appeared elsewhere at WCPH, from pediatric immunization to chronic disease prevention and healthy aging.

The science may be advancing faster than the systems delivering it

The WLD Healthy Beginnings, Protected Futures: Scaling Impact in Pediatric RSV and Pneumococcal Immunization examined the challenge of translating immunization advances into population-level protection.

The scientific development of vaccines and preventive tools is only one part of the equation.

A product still needs to reach a child.

That requires financing, procurement, supply chains, trained health workers, community confidence, primary care infrastructure, and systems that can identify who is being missed.

The same challenge surfaced in the WLD, The Convergence Imperative: From Innovation to Implementation Equity in Ending TB and HIV.

New diagnostics, vaccines, therapeutics, artificial intelligence, and digital health could accelerate progress against TB and HIV. But tools alone cannot end epidemics.

The implementation gap is where equity is won or lost.

Prof. Yogan Pillay emphasized the need for stronger population surveys and surveillance, while speakers highlighted local capacity, leadership, financing, and primary health care.

The underlying lesson was consistent: The question is no longer only whether we can develop better tools. It is whether we can build systems that can deliver them fairly.

Primary health care needs leadership, data and resources

This is why primary health care remained one of the strongest threads running through the Congress.

In discussions on Primary Health Care, Public Health Systems for Equity and Universal Access, speakers emphasized task shifting, supply-chain innovation, workforce development and the need to remove practical barriers to care.

But they also made a less technical point: Primary health care needs political leadership.

Former Namibian Minister of Health Dr. Bernard Haufiku emphasized the importance of leadership, local capacity building and adequate resourcing.

Primary health care cannot be something governments endorse rhetorically while leaving communities to deal with under-resourced services.

And leadership cannot remain concentrated at the top. Distributive leadership comes with accountability.

The Congress also returned to the need to develop younger public health leaders, not simply as people who inform today’s decision-makers, but as people who will eventually make the decisions themselves.

That raises another uncomfortable question: Are public health institutions doing enough to prepare the next generation to lead?

Mental health: stop asking individuals to adapt to unhealthy institutions

The WLD Promoting Mental Well-Being in Academia: Evidence, Tools and Action Plans brought the question of institutional responsibility into universities and research environments.

Prof. Anna Odone, Principal Investigator of Health Mode On at the University of Pavia, introduced evidence examining student and researcher mental health and well-being.

The findings presented during the session were difficult to ignore. Among the 11,676 students included in the analysis, 63.1% reported at least one mental disorder in the previous 12 months. Nearly four in ten reported loneliness, and almost one in five reported hopelessness about the future.

But perhaps the most revealing finding concerned access to help. Nearly half of students did not know that support services existed.

Dr. Laura Magaña, President and CEO of the Association of Schools and Programs of Public Health and Founding President of the Global Network for Academic Public Health, framed the institutional question:

“How do we create institutions in which people grow?”

That is different from asking how we can teach individuals to cope with stressful environments.

Academic competition, workloads, financial insecurity, supervision, career uncertainty, and institutional culture all shape wellbeing.

Yoga and mindfulness may have a role. They cannot substitute for institutional change.

You cannot build a resilient public health workforce by normalizing nervous exhaustion as the price of excellence.

Decolonization asks who gets to define public health

The question of institutional power extended into Restoring Balance: Indigenous Knowledge Systems & Decolonizing Global Health.

Decolonization is sometimes reduced to a question of representation: who is on the panel, whose name appears on the paper, or which perspectives are included in a curriculum.

The deeper issue is authority.

Who decides what counts as knowledge? Who determines the research questions?

Who controls funding? Who owns the data?

Who decides which interventions are appropriate for a community?

And who gets to say whether an intervention actually worked?

These questions also connect to the Congress’s discussions on global health partnerships and migration, including the movement from brain drain to brain gain.

A more equitable global health system cannot simply depend on expertise flowing from wealthier institutions toward lower-resource settings.

It must create conditions in which local institutions, communities, and professionals have genuine authority over the work being done in their own contexts.

Health without borders also means health beyond humans

The One Health in a Changing World plenary pushed the Congress beyond conventional definitions of public health.

Human health cannot be separated from animal health or ecosystem health.

Climate change, emerging infectious diseases, food systems, biodiversity loss and environmental degradation increasingly interact.

The implication is practical: public health cannot solve these problems by working within the health sector’s traditional boundaries.

The Congress also explored how cities, buildings, transportation and the design of healthcare environments shape health.

A hospital can treat disease.

But a city’s design can influence whether people become sick in the first place. That distinction is central to prevention.

The environments we build are part of the health systems we create.

Conflict makes every health system vulnerability visible

Few issues make the gap between health as a right and health as a reality more visible than war.

The Congress addressed Public Health in Conflict, War and Peace Building, the protection of public health in armed conflict, and the role of nurses working in conflict zones.

These discussions brought health workers and health infrastructure into the center of the conversation.

During conflict, the need for health services increases at precisely the moment when hospitals, supply chains, staff and communities are under extraordinary pressure.

The Congress therefore treated peace, human rights and health as interconnected rather than separate policy areas.

This also connects to the broader question of global governance:

What is the value of international commitments if the institutions expected to uphold them cannot protect people when they are most vulnerable?

From innovation to implementation

Perhaps the strongest thread connecting the Congress was the distance between what we know and what we do.

We know social determinants shape health. We know primary health care matters.

We know vaccines prevent disease. We know digital technologies can expand access.

We know climate change threatens health. We know mental health needs institutional attention.

We know conflict destroys the foundations on which health depends. We know that communities need a voice.

The harder question is why implementation remains so uneven.

The WLD Political Leadership for Integrated Financing of Social and Behavior Change in African Health Systems: A Call to Action addressed one part of that problem directly: resources and political commitment.

Public health strategies require more than declarations.

They need budgets, institutions, trained people, coordination, data, and accountability. And they need political leaders willing to sustain action beyond the next news cycle or funding cycle.

That is why the Congress repeatedly returned to leadership. Not leadership as a title.

Leadership as the ability to make difficult choices, distribute power, invest for the long term, and remain accountable for what happens after the policy is announced.

What does “Health Without Borders” mean after Cape Town?

The 18th World Congress on Public Health did not produce one simple answer.

It produced a set of questions that are harder and potentially more useful.

Can international law redistribute power? Can technology become a genuine social good? Can public health rebuild trust? Can health systems innovate without widening inequality?

Can global health partnerships become more equitable? Can academic institutions pursue excellence without sacrificing wellbeing? Can public health associations turn evidence into political influence? Can young professionals be given real opportunities to lead?

Can governments finance the systems needed to deliver on their commitments?  And can the public health community move quickly enough from innovation to implementation?

The Congress Statement makes the direction clear: achieving health equity requires action across governments, international organizations, academia, civil society, public health associations and communities. It calls for stronger primary health care, investment in the public health workforce, meaningful community participation, greater accountability and a fairer distribution of resources and decision-making power.

The challenge now is to carry those commitments beyond Cape Town.

The work continues

The 18th World Congress on Public Health ended on September 9, but the issues it brought together will continue to shape public health for years to come.

The value of a Congress is not ultimately measured by how many sessions took place or how many people attended. It is measured by what changes afterward.

If a new partnership begins, a policy changes, a young professional finds a mentor, a community gains a stronger voice, a health system removes a barrier, or a public health leader asks a different question because of something they heard in Cape Town, then the conversation has moved beyond the conference room.

That may be the most important challenge WCPH 2026 leaves behind: We know the world is changing. Are our public health systems changing with it?

The 19th World Congress on Public Health will take place in Auckland, New Zealand, in 2028.

Until then, Cape Town leaves the global public health community with something more demanding than a conclusion: a responsibility to act.