Inequity in Sustainable Health Today: A Global Perspective

The global healthcare landscape is fraught with inequities, especially in achieving sustainable health outcomes. This article is brought to you by the Sustainable Health Equity Movement (SHEM), a coalition dedicated to advancing health equity globally. It includes contributions from Professor Luis Eugenio De Souza, Immediate Past President of the World Federation of Public Health Associations.

Inequity in Sustainable Health: The Global Context

The COVID-19 pandemic starkly highlighted global health inequities, disproportionately affecting socio-economically vulnerable communities. Disadvantaged populations faced higher infection and mortality risks, compounded by systemic inequities that treat health as a commodity. In high-income countries, overwhelmed healthcare systems foreshadowed dire challenges for low- and middle-income nations. The stockpiling and profiteering of wealthy nations led to a global outcry, prompting an open letter to the UN, supported by over 120 entities representing five million public health professionals. This letter called for ethical worldwide leadership and the establishment of a Global Health Equity Task Force within WHO to coordinate an equity-focused pandemic response.

The Birth of the Sustainable Health Equity Movement (SHEM)

Two years later, the Sustainable Health Equity Movement (SHEM) was founded, emphasizing the need to address social inequality and the climate crisis to achieve sustainable health equity. SHEM advocates for embedding health equity principles in all policies, highlighting how unequal power dynamics, economic disparity, environmental damage, and conflicts exacerbate health inequities through inadequate access to health services, environmental risks, and unmet educational needs. SHEM’s call for a globally binding framework promotes health equity and economic reforms, including fair taxation, worker protection, and environmental equity. The movement also proposes establishing a Sustainable Health Equity Commission with a UN Rapporteur to monitor progress.

SHEM’s Vision for the Future

Three years later, SHEM reiterated that sustainable health equity means achieving and maintaining equitable health outcomes for all people, including future generations. This vision encompasses three main actions: ensuring the right to health by providing access to comprehensive health services for all; creating conditions for a healthy life by addressing social and environmental determinants of health; and fulfilling all human rights, including economic, social, cultural, civil, and political rights.

The Urgency of SHEM’s Mission Today

Despite unprecedented advances in reducing mortality rates and increasing life expectancy over the past 60 years, health inequities persist. There are signs that global life expectancy could decrease due to the ongoing impact of climate change. Current global governance often prioritizes economic interests over human well-being, as evidenced by insufficient and delayed agreements such as the 2030 Agenda, the COP climate agreements, the UN Tax Treaty, and the recently failed Pandemic Treaty. The inaction against ongoing acts of genocide, such as in Gaza (Palestine) and Darfur (Sudan), further reveals a broken human deal.

A Call to Action

As founding members of SHEM, we, along with Prof. Luis Eugenio De Souza, Immediate Past President of the Brazilian Association of Collective Health, emphasize the need for a profound transformation of global, national, and local political, economic, and knowledge governance to uphold human democracy, peace, justice, and dignity. This transformation is essential to preserving human life in balance with other life forms on our shared planet.

The fight against inequity in sustainable health is far from over. SHEM must intensify its call for ethical principles of equity, ensuring everyone has access to the health services they need regardless of socioeconomic status. By addressing the root causes of health inequities, we can build a healthier, more equitable world for future generations. 

Please note that this article initially appeared in Science Direct.

Tackling Plastic Pollution: 4th Session of the Intergovernmental Negotiating Committee Insights

As the global plastic pollution crisis intensifies, the need for decisive action has never been more critical. Approximately 10 billion tonnes of plastic have been produced since the 1950s, but over 8 billion tonnes have turned into waste. Alarmingly, 10-15 million tonnes of this waste leak into the marine environment each year, a figure projected to triple by 2050. This growing environmental threat demands urgent, coordinated global efforts.

The Global Response to Marine Plastic Pollution

Recognizing the severity of plastic pollution, particularly in the marine environment, the United Nations Environment Assembly (UNEA) has been at the forefront of global efforts to combat this issue. UNEA Resolution 3/7, for instance, established an Ad Hoc Expert Group (AHEG) to explore various response options, ranging from innovative approaches to legally binding governance strategies.

The fourth Intergovernmental Negotiating Committee (INC-4) session took place in Ottawa, Canada, from April 23 to 29, 2024. This crucial gathering aimed to develop an international legally binding instrument (ILBI) on plastic pollution, with a significant focus on the marine environment. The event attracted over 2,500 participants, including representatives from governments, academia, civil society organizations, private sector entities, UN bodies, and international organizations. Many others participated virtually via webcast. Professor Peter Orris represented the World Federation of Public Health Associations (WFPHA) from its Environmental Health Working Group.

Key Discussions and Divergences at INC-4

Throughout the seven-day session, delegates engaged in intensive negotiations within five Subgroups, guided by a Revised Draft Text developed after INC-3. While some areas of convergence emerged—such as plastic waste management and just transition—sharp divergences remained. Contentious issues included the inclusion of primary plastic polymers, the treatment of chemicals and polymers, and the integration of existing processes.

Despite these challenges, delegates agreed to use the outcomes of INC-4 as a foundation for further negotiations at the upcoming INC-5, scheduled for November 2024 in Busan, Republic of Korea.

The Health Sector’s Role in the Plastics Treaty

The health sector’s relationship with plastic pollution was a significant focus during INC-4. WHO and various civil society health groups actively participated in discussions, addressing the proposal to exempt the health sector from the treaty due to its extensive use of plastic products. Health organizations, united in their stance, argued against this exemption, emphasizing the need for special consideration rather than a blanket exclusion.

A letter from Health Care Without Harm, endorsed by WHO and signed by over 600 clinicians and 18 international professional associations, including WFPHA, called for an ambitious and just treaty to tackle plastic pollution within the health sector. The letter highlighted the sector’s heavy reliance on plastics, particularly single-use items, and urged governments to explore programs that eliminate non-essential uses and promote reusable, non-toxic alternatives.

Looking Ahead: The Road to INC-5

The negotiations at INC-4 made it clear that the road to an effective and comprehensive treaty on plastic pollution remains challenging. With the entire treaty still under discussion, decisions are only final once a consensus is reached. The upcoming INC-5 in Busan will be critical in these negotiations as the world watches to see how rapidly and effectively the international community can address the mounting plastic pollution crisis, particularly in our oceans.

As the journey towards a legally binding instrument continues, the global community remains hopeful that these efforts will lead to significant progress in protecting the marine environment from the devastating impacts of plastic pollution.

Tobacco Legislation Reform and Industry Response in Israel: A Comprehensive Overview

Israel has implemented progressive tobacco control legislation to curb the influence of tobacco and related products, including heated tobacco products and electronic cigarettes. The legislation, effective in phases from March 2019 to January 2020, encompasses three primary elements: advertising bans, point-of-sale display bans, and plain packaging requirements. This comprehensive effort aims to reduce tobacco consumption and mitigate public health risks associated with tobacco use.

Please note that the following is not a summary of the webinar but Professor Bar-Zeev’s academic paper on Tobacco legislation reform and industry response in Israel. Scroll to the bottom for the full webinar which was held on Thursday, July. 18, 2024 at 3 PM CEST. This is one of many webinars hosted by our Non-Communicable Disease Working Group. 

Key Elements of the Legislation

1. Advertising Bans:

– Prohibited in all media channels, including broadcast, outdoor, internet, and print media, except newspapers.

– Effective March 2019, this measure aims to reduce the visibility and attractiveness of tobacco products to the public.

2. Point-of-Sale Display Bans:

– Effective January 2020, this ban applies to all retail environments except specialized tobacco and alcohol outlets.

– This measure seeks to reduce impulse purchases and the normalization of tobacco products in everyday settings.

3. Plain Packaging:

– Also effective January 2020, this requirement mandates plain packaging for all tobacco products, including heated tobacco and electronic cigarettes, using the color Pantone 448 C.

– The packaging must include textual health warnings covering a significant portion of the package.

Industry Response and Tactics

During the initial implementation phase, the tobacco industry employed various tactics to circumvent the new regulations

– Print Media Loopholes: Industry advertisements included small branded elements and full-size previous packaging visuals to bypass plain packaging rules.

– QR Codes and Direct Advertisements: QR codes in advertisements led consumers to direct marketing content not covered by the legislation.

– Point-of-Sale Displays: Attractive, non-hermetically closed display cases allowed products to be partially visible, undermining the display ban.

– Branded Accessories: Distribution of branded tin cases and inclusion of branding inside packages to mitigate the impact of plain packaging.

– Coalition Efforts and Recommendations
A coalition of civil society and professional organizations from various disciplines, including public health and communications, actively communicated to counter these industry tactics. The coalition shared information and strategies on platforms like WhatsApp.

Key recommendations include:

– Enhanced Specificity: Legislation should be highly specific to prevent industry exploitation of loopholes.

– Complete Advertisement Bans: Avoid exemptions in advertising bans to ensure comprehensive coverage.

– Regulatory Oversight: Implement pre-publication requirements for industry advertisements and prohibit QR codes.

– Proactive Enforcement: Establish detailed implementation guidelines and enforcement plans to ensure compliance.

– National Authority for Tobacco Control: Create a dedicated body to oversee and enforce tobacco control measures, similar to the US FDA’s role.

– Legal Challenges and Future Directions The legislation faced legal challenges from entities like Juul Labs, which sought exemptions for vaping products. However, the Supreme Court upheld the law, validating the legislative process and highlighting the importance of transparent and regulated industry participation.

Conclusion

Israel’s experience underscores the importance of detailed legislation, proactive enforcement, and the need for mechanisms to address industry tactics quickly. By learning from these efforts, other countries can enhance their tobacco control measures to protect public health more effectively.

Enhancing Vaccine Uptake Among the Health Workforce: Key Strategies for Public Health Prevention

Vaccination is one of the most effective tools for preventing infectious diseases and safeguarding public health, saving millions of lives annually. However, vaccine hesitancy and skepticism have increasingly posed challenges to achieving high vaccination rates worldwide in recent years. The World Health Organization (WHO) named vaccine hesitancy one of the top ten threats to global health in 2019, highlighting the urgency of this issue. Combatting vaccine hesitancy is consequently on the WHO’s Immunization 2030 agenda.

Healthcare workers play a pivotal role in global vaccination uptake as the primary administrators of vaccines and in shaping public opinion and confidence around healthcare measures. Alarmingly, the current trend of decreasing vaccine uptake also applies to healthcare professionals. Several studies exploring factors contributing to hesitancy in this group found a combination of concerns, including the safety and efficacy of vaccines, self-perception of low susceptibility, lack of time, and insufficient knowledge about vaccines.

The following is a summary of the original Science Direct article “Strategies used to improve vaccine uptake among healthcare providers: A systematic review” written by  Rosaline de Koning, Mariana Gonzalez Utrilla, Michael Moore, and Marta Lomazzi.

Key Strategies to Boost Vaccine Uptake

It is crucial to develop targeted strategies tailored to this population to counteract vaccine hesitancy among healthcare professionals. 

Here are some of the most effective strategies identified:

1. Educational Initiatives: Dedicated lectures address knowledge gaps and misunderstandings about infectious diseases and vaccination. Tailoring educational materials to specific misconceptions can significantly improve vaccine confidence. Public commitments to vaccination by healthcare leaders can also enhance trust.

2. Improved Access: Facilitating easy access to vaccines is essential. Strategies such as mobile vaccination units, extended vaccination hours, and on-site vaccination clinics have significantly increased uptake. A systematic review of Italian studies supports the finding that mobile clinics lead to higher vaccination rates.

3. Motivational Incentives: Encouraging vaccination through incentives, regular feedback on vaccination rates, and new vaccination policies can boost uptake. Although controversial, mandatory vaccination policies are highly effective, often leading to coverage rates over 90%. However, less extreme policies like mandatory declination forms or mask mandates can enhance vaccination rates without causing significant controversy.

4. Tailored Campaigns: Identifying the specific barriers to vaccination in each setting and tailoring the campaign accordingly is essential. Many successful campaigns begin with a survey to identify misconceptions and barriers among healthcare workers. These barriers can generally be categorized into confidence, access, and motivation.

The Role of Influenza Vaccination Campaigns

Influenza vaccination is critical to public health prevention, especially among healthcare workers at higher risk of transmitting infections to vulnerable populations. Educational lectures, mobile vaccination units, and extended vaccination hours effectively promote influenza vaccination. Studies have shown that multi-faceted campaigns combining these strategies increase vaccination rates.

Improving Vaccine Uptake to Protect All

Enhancing vaccine confidence and boosting vaccination rates among healthcare professionals necessitates a tailored, multi-dimensional campaign strategy. Hospital and health center managers should prioritize identifying and analyzing barriers to vaccination specific to their settings. By adopting a holistic approach—encompassing educational initiatives, reminder systems, incentives, improved access, feedback mechanisms, and, when suitable, policy enactment—institutions can more effectively address hesitancy and foster a culture of vaccination.

Boosting vaccine uptake among the health workforce is not just about protecting healthcare providers; it is about safeguarding the broader public health and ensuring the success of vaccination programs. By implementing these strategies, we can move closer to achieving high vaccination rates and a healthier, more protected global population.

By focusing on these evidence-based strategies, we can significantly improve vaccine uptake among healthcare professionals, enhance public health prevention efforts, and protect communities worldwide.

Interview with WFPHA Leaders: Shaping the Future of Global Public Health

Executive Director of WFPHA, Bettina Borisch, sets the scene in an intimate interview* with Immediate Past President Prof. Luis Eugenio De Souza from Brazil and current President of the World Federation of Public Health Associations (WFPHA) Emma Rawson-Te Patu from New Zealand to discuss how our leaders shape the future of global public health. 

Reflecting on Progress: A Conversation with Luis Eugenio De Souza

Bettina: Luis, you have been president for two years and are now the immediate past president. What has your view been over the last two years?

Luis: The WFPHA has made significant strides over the past fifty years. In the last two years, we have introduced a pivotal change by integrating the promotion of peace and sustainable development into our core mission. This complements our ongoing efforts to promote health, prevent disease, and enhance well-being. We have set seven goals to guide these initiatives, marking a major achievement. I am proud to have coordinated this shift with our Working Chairs, Governing Council, and Advisory Board alongside our global partners.

Looking Forward: Emma Rawson Te-Patu’s Vision for the Future

Bettina: Emma, you inaugurated your presidency with a beautiful ceremony reflecting your heritage. How do you see the next two years? What are your plans for the WFPHA?

Emma: Our inaugural ceremony was indeed special, showcasing the cultural practices of New Zealand. As an Indigenous woman, I bring a unique perspective to this role. My focus will be on improving Indigenous health equity and outcomes. Despite numbering over 400 million, Indigenous people worldwide bear a disproportionate burden of illness and disease. The WFPHA, with its extensive network and influence, including partnerships with organizations like the WHO, is well-positioned to advocate for the health of indigenous communities. Promoting peace as a prerequisite for health and sustainable development remains a priority.

Bridging Local and Global Health: Insights from Luis and Emma

Bettina: Luis, how have you seen your work as president in balancing local and global perspectives over the past two years

Luis: Organizing the World Health Congress 2026 in Cape Town is our biggest challenge, serving as a platform to merge regional, local, and global perspectives. This event will bring together diverse health scenarios from South America, New Zealand, Australia, Asia, Europe, and Africa. Our main goal is to identify common principles that unite health workers globally and find actionable solutions to ensure the highest possible health standards for everyone.

Bettina: Emma, what local insights from New Zealand can be applied to the global stage?

Emma: New Zealand offers a unique context, allowing us to effectively control our public health and environment. This gives us a distinctive voice in the global arena, sharing successful practices while supporting countries with fewer resources. The public health community must remain humble, recognize our strengths, and lead by example. By understanding our place, we can better support others and achieve improved health outcomes worldwide.

A Message of Solidarity and Bravery

Bettina: As we progress through different presidencies, what is your message to our audience?

Luis: The WFPHA represents our community of over five million people, and we can drive significant change if we unite with one voice. Solidarity is key to our success.

Emma: My message centers on bravery. Public health faces many challenges, especially regarding resources. We can maximize our impact by working authentically and collaboratively and supporting each other’s strengths. Bravery means recognizing when to step aside and let others lead, ensuring that our collective efforts yield the best possible outcomes.

Conclusion

This dialogue underscores the shared vision and dedication of the WFPHA leaders. Prof. Luis Eugenio De Souza and Emma Rawson-Te. Patu bring diverse perspectives but are united in their commitment to advancing global public health. Their insights highlight the importance of integrating local experiences with global strategies, promoting equity, and fostering solidarity within the public health community. As we look to the future, their leadership will continue to shape a healthier world for all.

*Please note that this interview has been edited for clarity and brevity.