Honoring and Remembering Dr. María del Rocío Sáenz Madrigal

On behalf of the World Federation of Public Health Associations, we come together to honor and remember María del Rocío Sáenz Madrigal, an extraordinary physician, public health leader, educator, and steadfast advocate for equity whose life and work have left an indelible mark on Costa Rica, Latin America, and the global public health community.

Born on May 2, 1958, and passing away on March 15, 2026, in Puriscal, Costa Rica, Rocío dedicated her life to serving others. She trained as a medical doctor at the Universidad La Salle in Mexico and furthered her expertise with a Master’s in Public Health from the University of Costa Rica. From her earliest days assisting patients with chronic conditions, and serving as medical director of a refugee camp for Nicaraguans, director of Health Development for the Ministry of Public Health of Costa Rica, and the Pan American Health Organization (PAHO)’s Regional Advisor for the Central America Post-Mitch Program, she demonstrated a profound commitment to the most vulnerable, ensuring that health was not an abstract ideal, but a lived reality for all.

Her leadership shaped national systems and inspired international collaboration. As Minister of Health of Costa Rica from 2002 to 2006, and later as Executive President of the Costa Rican Social Security Fund from 2014 to 2017, Rocío guided transformative efforts grounded in equity, access, and human dignity. Her influence extended far beyond national borders through her work with PAHO, her role in health emergency response, and her leadership as director of the Health Equity Network of the Americas / Red de las Américas para la Equidad en Salud (HENA/RAES), based at the University of Costa Rica.

Rocío was also a devoted academic and mentor. As Professor of Health Promotion at the University of Costa Rica, she nurtured generations of public health professionals, led critical research initiatives, and advanced dialogue on primary health care, women’s health, and patient-centered systems. Her contributions, reflected in dozens of technical and scientific publications, continue to inform and inspire.

For the World Federation of Public Health Associations, Rocío was more than a collaborator. She was a trusted partner, an active contributor, and a guiding force. Through her engagement with our Working Groups and global initiatives, she brought clarity, wisdom, and a deep moral compass. She strengthened our collective mission and reminded us always of the human stories behind the policies we shape.

Her impact is perhaps best captured in the words of those who knew her closely.

Luis Eugenio de Souza, immediate Past President of the WFPHA, said:

“Dr. Rocio was a true leader in Costa Rica, Latin America, and the world, a highly competent and ethical professional who will continue to inspire public health professionals.”

Our President, Emma Rawson Te-Patu, shared:

“María del Rocío Sáenz was a force of nature. Her clarity of mind and strategic understanding of, and how to speak about, what should be addressed as a priority for equity, human rights, and effective health systems, health service delivery, and policy development was extraordinary. She was a true example of leadership and of empowering others to act for the greater good. Rocio could hold a room in the palm of her hand with her tone, a look, and indeed a few specific hand gestures that left you in no uncertain terms that you had been informed and must act. I was privileged to spend much time with and to learn and be guided by Rocio. I especially treasure the time we were together as Salzburg Global Fellows in Salzburg, Austria, in 2024 and more recently in Brasilia, Brazil, at Abrasco in November 2025. She will be missed by many, by our public health family and the global community at large. Tenei te mihi ki a koe e te Mareikura, Haere Haere Haere atu rā, Kua Wheturangitia! Arohanui ki te whānau pani… (We acknowledge you, leader of people, you are now part of the cloak of stars in the sky. Go now, rest now, be at peace. Sending love to your family and loved ones).”

Bettina Borisch, our CEO, adds:

“For all of us who had the privilege of working with Maria del Rocio Saenz, we got to know an exceptional human being, kindness and determination, knowledge and humanity, so many more combinations rarely found in one person: Rocio, we already miss you!”

Arachu Castro, Professor and Samuel Z. Stone Chair of Public Health in Latin America at Tulane University and member of the board of directors of the Health Equity Network of the Americas, wrote: 

“Rocío was an extraordinary woman who led with conviction, compassion, and integrity in the pursuit of health equity across Latin America. I had the privilege of working closely with her over the past seven years and of calling her a dear friend and a mentor. She was deeply inspiring and thoughtful in all that she did. In recent years, as director of HENA/RAES, Rocío built a vibrant technical secretariat at the University of Costa Rica composed of public health graduates, creating opportunities for young people to learn, grow, and thrive. She was committed to nurturing the next generation with care and intention. At our most recent HENA monthly meeting, two days before her passing, she shared her intention to transfer the directorship to a member of the technical secretariat, reflecting her commitment to continuity and collective growth, as well as her generosity. Through our regular conversations, she remained a constant source of clarity and inspiration. Her absence will be profoundly felt. I will miss her dearly.”

Michael Moore, Past President of the WFPHA and Chair of the Immunization Taskforce, shared:

“Not only has Costa Rica lost a great public health professional, but the world has as well. She was not only an outstanding professional but also a person full of compassion and humanity. We mourn the loss of María del Rocío Sáenz Madriga, a great friend to the World Federation of Public Health Associations for her commitment and expertise. She brought a unique blend of political experience and medical expertise to the Federation’s policy and advocacy work. The thoughtful and professional approach she applied in discussions and during WFPHA webinars provided clear insight into both the challenges and solutions regarding public health issues. Her premature death is particularly sad for those of us who understand the contribution that she has made, and should be continuing to make, to improve health across the life course and independent of wealth.”

And our Past President, Walter Ricciardi, added:

“Dr. Rocío Sáenz will be remembered for her unwavering dedication to public health, her compassion for others, and the lasting impact she made on so many lives—an impact I had the opportunity to witness firsthand through our work together in the Public Health Leadership Coalition of the World Federation of Public Health Associations, where she was one of the most active and respected leaders leaving behind a legacy that will continue to inspire future generations in the pursuit of equity and health for all.”

These words reflect what so many of us feel: that Rocío was not only brilliant, but deeply human. She led with conviction, spoke with purpose, and acted with compassion. She had the rare ability to challenge, to inspire, and to unite; always in the pursuit of a fairer, healthier world.

We mourn her passing, but we also celebrate her legacy. A legacy of courage, of integrity, and of unwavering commitment to health as a fundamental human right. A legacy that lives on in the systems she strengthened, the people she mentored, and the global movement she helped shape.

On behalf of the World Federation of Public Health Associations, we extend our deepest condolences to her family, her colleagues, and all who had the privilege of knowing her.

Rocío, thank you for your leadership, your wisdom, and your friendship. Your work continues through all of us.

Life Course Immunization: Why Lifelong Vaccination is Essential for Public Health

Immunization is a lifelong shield that goes beyond childhood. While pediatric vaccination programs have seen tremendous success, adult and adolescent immunization remains a dangerously overlooked pillar of global health. This critical gap leaves populations vulnerable to preventable diseases, pandemics, and needless suffering at every stage of life.

For decades, vaccination has been rightly celebrated for its role in conquering infectious diseases. A powerful new consensus from the world’s top health organization is expanding its mission: vaccination is a cornerstone of preventing non-communicable diseases (NCDS) like heart attacks, strokes, and diabetic complications.

The urgency to close this gap has never been greater. This paradigm shift is the driving force behind a new global initiative.

The 2024 Geneva Accord: A New Strategy for a New Health Reality

In November 2024, a pivotal meeting in Geneva, convened by the world’s most influential health and community NGOs, aimed to address a silent crisis: the alarming decline in adult vaccination rates and its cascading impact on global health.

The result was a Call to Action: International Health and Community NGOs Advocate for Life-Course Vaccination. This document represents a consensus among organizations that collectively represent millions of health professionals and citizens worldwide. It moves the conversation from why life-course immunization is essential to how we must achieve it. Now, with a vital new concept, life-course vaccination is necessary for NCD prevention and healthy aging.

Supported by a Coalition of Global Health Leaders:

This call to action is endorsed by the following organizations, representing millions of doctors, nurses, pharmacists, public health experts, medical students, and aging advocates worldwide:

• Adult Immunization Board

• All.Can

• Cittadinanzattiva-Active Citizenship Network

• Coalition for Life Course Immunisation (CLCI)

• EMR NCD Alliance

• European Academy of Paediatrics (EAP)

• European Interdisciplinary Council on Aging (EICA)

• European Specialist Nurses Organisation

• Federation of European Academies of Medicine (FEAM)

• Global Ageing Network 

• International Council of Nurses (ICN)

• International Federation of Medical Students’ Associations (IFMSA)

• International Federation of Social Workers (IFSW)

• International Federation on Ageing (IFA)

• International Pharmaceutical Federation (FIP)

• International Pharmaceutical Student’s Federation (IPSF) 

• Junior Doctors Network, World Medical Association (JDN, WMA)

• World Association for Infectious Diseases and Immunological Disorders (WAidid)

• World Federation of Public Health Associations (WFPHA)

• World Medical Association (WMA)

• World Obesity Federation

• World Organization of Family Doctors (WONCA)

• World Patients Alliance

The Growing Immunization Gap: How Vaccines Prevent Chronic Disease

The traditional benefits of vaccination, such as preventing outbreaks, reducing healthcare costs, and protecting the vulnerable, remain critically important. Yet, recent data reveal a concerning decline in vaccination rates, posing a threat to global health security.

Reports from the WHO, UNICEF, and other bodies show:

• Adult vaccination rates have stagnated or dropped since the pandemic, particularly among aging and at-risk populations.
• Measles outbreaks are resurging in countries where the disease was previously controlled.
• Low uptake of flu, COVID-19, and RSV vaccines in high-risk groups leads to preventable hospitalizations and deaths, straining healthcare systems.

This evidence underscores the urgent need for the coordinated strategy outlined in the new Call to Action.

What does this mean in practice?

• Influenza & COVID-19 increase heart attacks and strokes: These viral infections cause severe inflammation, which can destabilize arterial plaque, leading to cardiovascular events, risks that vaccinations can reduce.
• RSV & pneumonia can lead to respiratory decline: In older adults or those with COPD, a severe respiratory infection can result in permanent lung damage and a significant decline in functional health.
• HPV & cancer: The human papillomavirus (HPV) is a leading cause of cervical, oropharyngeal, and other cancers. HPV vaccination is, quite literally, a form of cancer prevention.
• Shingles & chronic pain: Reactivation of the varicella-zoster virus, the cause of chickenpox, can lead to debilitating, long-term nerve pain, drastically reducing quality of life.

By preventing the initial infection, vaccines directly prevent the chronic conditions that follow.

The 10-Point Plan: A Roadmap to Integrate Vaccination and NCD Prevention

The coalition’s document provides a clear roadmap. Here are the 10 critical actions it urges advocates and policymakers to implement:

1. Protect Health and Social Care Workers: Ensure they are prioritized to prevent the spread of disease to vulnerable patients.
2. Guarantee Equitable Access: Tailor vaccine access to every stage of life, removing financial and logistical barriers.
3. Mobilize the Health Workforce: Provide tools and resources for vaccine delivery across all care settings.
4. Establish Adult Vaccine Schedules: Develop clear, comprehensive, and equitable vaccination schedules for adults that complement existing pediatric programs.
5. Develop Robust Immunization Registries: Implement interoperable systems to track vaccine uptake in real-time.
6. Integrate Vaccination with NCD Prevention: Recognize the strategic role of vaccination in preventing complications from non-communicable diseases, such as heart disease and diabetes.
7. Expand and Simplify Vaccination Pathways: Make getting vaccinated easier through community-based and mobile clinics.
8. Raise Awareness and Build Confidence: Run public campaigns highlighting the value of vaccination throughout one’s life.
9. Embed Community Engagement: Involve communities in vaccine program design and development to ensure they meet real needs.
10. Leverage the Health Workforce: Empower health professionals, from students to retirees, to be champions for vaccination.

The Tangible Benefits of a Life-Course Immunization Approach

Adopting this framework offers profound advantages that strengthen societies:

• Prevents Deadly Outbreaks: High vaccination coverage across all ages creates a stronger herd immunity, protecting those who can’t be vaccinated.
• Dramatically Reduces Healthcare Costs: Preventing diseases such as shingles, pneumonia, and HPV-related cancers reduces hospitalizations, long-term care needs, and lost productivity.
• Protects Vulnerable Populations: A vaccinated community is a safer environment for older people, newborns, and individuals with weakened immune systems.
• Builds Resilient Health Systems: By preventing illness, health systems are less burdened and better able to handle other crises.
• Promotes Healthy Communities: Lifelong immunization supports well-being at every age and helps entire communities live healthier, more active lives.

From Call to Action to Reality: How We Can All Participate

Implementing this vision requires a commitment from all sectors. The Call to Action provides the blueprint, but we all have a role to play in its implementation.

• Policymakers: Must prioritize funding, establish national adult schedules, and remove regulatory barriers.
• Healthcare Providers: Can integrate vaccine discussions into every routine care visit, for every age group.
• Individuals & Communities: Should stay informed, advocate for access, and get recommended vaccines.
• Organizations: Can sign on to support the call to action and promote their messages internally and externally.

A Healthier Future for All Generations

Life-course immunization is a fundamental right and a shared societal responsibility. We can no longer silo infectious disease and chronic disease efforts. We must unite these two pillars of health.

Life-course immunization is the powerful and practical link that ties it all together. The 2024 Geneva Call to Action provides the definitive framework for achieving this goal. By embracing this strategy, we aren’t just preventing the flu or shingles; we are preventing heart failure, debilitating pain, and cancer. We aim to promote health throughout a person’s lifetime, rather than just treating a specific illness or condition.

By uniting behind this powerful consensus from the world’s leading health authorities, we can build healthier, more equitable, and more resilient communities for generations to come.

If your organization would like to endorse our Call to Action and join us in this effort, please get in touch with us at secretariat@wfpha.org

Click here to read the full, official Call to Action document supported by international NGOs

Oral Health in Humanitarian Crises: A Missing Link in Refugee Health and Peacebuilding

Oral health is a recognized component of overall health. Yet in humanitarian crises, it remains largely absent from emergency response frameworks. In contexts of conflict and forced displacement, oral healthcare infrastructure is often damaged, disrupted, or inaccessible.

Untreated oral disease is associated with cardiovascular conditions, diabetes complications, and adverse pregnancy outcomes, conditions already more prevalent in crisis-affected populations. Despite this, refugee dental care rarely appears in Emergency Health Minimum Service Packages.

As of 2024, more than 122 million people worldwide were forcibly displaced, including 43.7 million refugees. The burden of untreated oral disease among these populations is substantial and largely unaddressed.

The Global Burden of Oral Disease Among Refugees

Displaced populations are concentrated in:

• Africa: Sudan, South Sudan, Democratic Republic of the Congo, Somalia, Ethiopia, Nigeria
• Middle East: Syria, Yemen, Iraq, Palestine
• Europe: Ukraine
• Latin America: Venezuela, Colombia
• Asia: Afghanistan, Myanmar, Cambodia

Evidence shows consistently high levels of unmet oral health needs:

• In Canada, 85% of adult refugees have untreated dental decay, compared with 20% in the general population.
• In Massachusetts, refugee children have twice the rate of untreated dental caries as the national average.
• A global scoping review reported caries prevalence among refugees ranging from 5% to 99%, and gingivitis from 6% to 100%, reflecting wide but consistently high unmet need.

These figures reveal a persistent gap in humanitarian healthcare planning: oral health is treated as optional rather than essential.

Why Oral Health Is Excluded From Humanitarian Health Packages

Even in stable health systems, oral health is often separated from general healthcare. In crisis settings, where resources are stretched, and life-threatening conditions take precedence, this marginalization deepens.

Humanitarian responses prioritize:

• Food
• Shelter
• Water and sanitation
• Essential medical care

Oral health rarely features in Emergency Health Minimum Service Packages. A recent content analysis found little to no integration of oral health within refugee health policy frameworks.

Three factors contribute to this exclusion:

1. The “Non-Life-Saving” Misconception

Oral health is frequently categorized as non-essential. Yet severe dental infections can progress to sepsis, and unmanaged pain disrupts eating, sleeping, and daily functioning.

2. The Infrastructure Myth

Dental care is perceived as requiring specialist equipment and facilities. In reality, many urgent needs, including pain management, infection control, and simple extractions, can be addressed with basic equipment and trained health workers.

3. The Data Gap

Oral health indicators are rarely included in rapid health assessments. Without data on pain prevalence, untreated infection, or functional impairment, the burden remains invisible in planning and resource allocation.

The exclusion reflects how humanitarian systems define and prioritize health interventions, not the absence of need.

Health System Consequences in Conflict Settings

The omission of oral health has measurable consequences and aligns directly with the Global Public Health Week 2026 theme: “Peace for Health, Health for Peace.”

Emergency departments frequently see patients presenting with oral pain but lack the capacity to provide definitive treatment.

In Gaza by mid-2024, only 60 of approximately 1,500 licensed dentists were able to provide care, illustrating the collapse of oral health service capacity during the prolonged conflict.

Untreated oral disease restricts:

• Food intake
• Communication
• Social participation

In conflict-affected settings, social determinants such as housing, food security, and sanitation already heighten health risks. When treatable conditions remain unaddressed, trust in health systems declines.

Oral health influences nutrition, psychological well-being, and economic participation. Functional impairment caused by oral disease can slow community recovery and undermine longer-term peacebuilding efforts.

Oral health, dignity, and peace are interconnected.

Evidence That Integration Is Feasible

Multiple programs demonstrate that integrating oral health into humanitarian responses is feasible and effective.

The Refugee Crisis Foundation (RCF) operates in Cox’s Bazar, Bangladesh, home to nearly one million Rohingya refugees. RCF provides:

• Fixed and mobile dental services
• School-based prevention programmes
• Training for local health workers to manage oral emergencies

RCF also supports initiatives in Gaza and on the Greek island of Lesbos.

Comparable models exist elsewhere:

• In Brazil, NGO-public health partnerships provide fluoride varnish and sealants to Venezuelan and Haitian refugees.
• In Bangladesh, culturally adapted oral health education programs have improved hygiene practices among Rohingya communities.
• In Ukraine and New Zealand, oral health has been incorporated into emergency response and resettlement frameworks.

These examples demonstrate that success depends less on specialist infrastructure and more on integration with primary care, education, and community health platforms.

Practical Actions to Integrate Oral Health Into Humanitarian Response

To ensure refugee dental care is treated as essential healthcare, several actions are needed:

1. Include Oral Health in Emergency Health Minimum Service Packages

Baseline services should include:

• Pain relief
• Infection control
• Referral pathways
• Distribution of oral hygiene supplies

Standard-setting bodies such as the Sphere Association and UNHCR should incorporate this into their policy guidance.

2. Expand the Role of Community Health Workers

Task-sharing can extend access where dentists are unavailable. Training should include recognizing oral emergencies, performing basic interventions, and outlining referral pathways.

3. Collect Oral Health Data in Rapid Assessments

Indicators related to pain prevalence, untreated infection, and functional impairment should inform planning and funding decisions.

4. Integrate With Existing Health Platforms

Oral health can be embedded within:

• Maternal and child health services
• Non-communicable disease programs
• Primary healthcare systems

5. Reframe the Narrative

Urgent oral conditions must be recognised as essential medical needs rather than elective services.

Conclusion: Oral Health Is Essential in Humanitarian Crises

Oral health remains underrepresented in humanitarian policy and practice. Yet evidence shows that low-cost interventions, including daily oral hygiene support, access to fluoride, and emergency pain management, are feasible and effective.

Integrating oral health into humanitarian health frameworks aligns with commitments to:

• Equity
• Universal health coverage
• Health system resilience
• Peacebuilding

Oral health should be a standard component of humanitarian health responses, not an afterthought.

Written by the Chair of the WFPHA Oral Health Working Group, Abiola Adeniyi, and Working Group member Aya El Tahir

What Is the Intergovernmental Negotiating Body (INB)?

The COVID-19 pandemic exposed major gaps in global health preparedness, coordination, and response. In response, governments around the world began exploring stronger international cooperation to better prevent and manage future pandemics.

One of the most significant steps in this effort was the creation of the Intergovernmental Negotiating Body (INB). This body was established by the World Health Assembly to develop a global agreement to strengthen pandemic prevention, preparedness, and response.

Understanding the role of the Intergovernmental Negotiating Body helps explain how the international community is working to reduce the risks of future global health crises.

Why the Intergovernmental Negotiating Body Was Created

The COVID-19 pandemic had a profound impact on human lives, economies, and societies worldwide. The scale of disruption highlighted the need for stronger international alignment when responding to emerging health threats.

To avoid repeating the challenges experienced during COVID-19, the global community recognized the importance of building more coordinated mechanisms for pandemic preparedness.

As a result, countries agreed that a formal international framework could strengthen cooperation, information sharing, and response strategies during future pandemics.

The Historic World Health Assembly Special Session

In December 2021, the World Health Assembly Special Session (WHASS) took place in Geneva, Switzerland.

This meeting was historic: it was only the second time in the history of the World Health Organization (WHO) that the Health Assembly convened twice in the same year.

During this session, Member States agreed to establish the Intergovernmental Negotiating Body (INB).

The mandate of the INB is to draft and negotiate a convention, agreement, or other international instrument under the Constitution of the World Health Organization. The goal of this instrument is to strengthen global systems for pandemic prevention, preparedness, and response.

The Core Mandate of the Intergovernmental Negotiating Body

The Intergovernmental Negotiating Body is responsible for developing a global framework that helps countries work together more effectively during health emergencies.

Its work focuses on creating an international instrument that supports:

• Stronger pandemic prevention strategies
• Improved preparedness for emerging health threats
• More coordinated global response mechanisms
• Greater cooperation among countries and health systems

The INB’s work is guided by several core principles:

• Inclusiveness
• Transparency
• Efficiency
• Member State leadership
• Consensus-based decision making

These principles ensure that negotiations reflect broad international participation and collaboration.

Timeline for the Pandemic Agreement Negotiations

The Intergovernmental Negotiating Body was tasked with progressing negotiations within a clear timeline.

Key milestones include:

• Progress reporting to the 76th World Health Assembly in 2023
• Target adoption of the international instrument by 2024

These milestones allow Member States to evaluate progress and ensure that negotiations continue to move forward.

How the INB Process Includes Global Stakeholders

Although the INB is led by Member States, the process also involves participation from a wide range of stakeholders.

The decision establishing the INB requested that the WHO Director-General convene meetings and support the negotiation process. This includes organizing public hearings to gather perspectives from organizations and experts.

Participants in the process may include:

• United Nations system bodies
• Non-state actors
• Civil society organizations
• Global health stakeholders

This inclusive approach ensures that negotiations consider diverse expertise and perspectives from across the global health community.

Public Health Organizations Contributing to the INB Process

Public health organizations have played an active role in the consultation process surrounding the Intergovernmental Negotiating Body.

During INB public hearings, several organizations submitted statements to contribute to the discussions, including:

• The World Federation of Public Health Associations (WFPHA)
• The International Federation of Social Workers (IFSW)
• The International Hospital Federation (IHF)
• The World Organization of Family Doctors (WONCA)

These contributions help ensure that public health expertise informs the development of the international pandemic instrument.

Why the Intergovernmental Negotiating Body Matters for Future Pandemics

The creation of the Intergovernmental Negotiating Body reflects a global recognition that stronger international cooperation is essential to address future health threats.

By working toward a shared framework for pandemic preparedness and response, the INB aims to help countries:

• Strengthen health system resilience
• Improve coordination during emergencies
• Reduce global health inequalities
• Respond more rapidly to emerging threats

Ultimately, the work of the Intergovernmental Negotiating Body represents an important step toward building a more coordinated and effective global system for pandemic preparedness.

Protecting Ecosystems Through Nature-based Solutions for Improved Public Health

The relationship between the natural world and human health is foundational. From the food we eat and the water we drink to the air we breathe and the environments where we live, human survival depends on the health of ecosystems.

This reality underpins the growing global focus on nature-based solutions for improved public health. Protecting biodiversity and restoring ecosystem functions are environmental priorities and public health imperatives.

The World Federation of Public Health Associations (WFPHA) highlighted this urgency in its official statement during the 27th Conference of the Parties to the UN Framework Convention on Climate Change (COP27), calling for a stronger global commitment to ecosystem protection and nature-positive climate strategies.

The Invisible Infrastructure Supporting Human Health

The interconnectedness between natural and human systems is well-documented and observable in the sheer breadth of our interactions with nature. Ecosystems provide food, water, shelter, and virtually every critical resource needed for human survival and prosperity.

The health benefits derived from ecosystems are delivered through biodiversity, species composition, and complex ecological processes performed by natural systems.

These processes enable ecosystems to deliver what are commonly known as ecosystem services, typically grouped into four categories:

• Provisioning services: such as food, freshwater, and medicinal resources

• Regulating services: including climate regulation, flood control, and disease regulation

• Supporting services: such as nutrient cycling and soil formation

• Cultural services: including recreation, mental wellbeing, and social connection

More recently, these benefits have also been described as nature’s contributions to people, emphasizing how ecosystem health directly influences human well-being.

When Ecosystems Fail, Public Health Suffers

When ecosystems cannot function optimally, the consequences are immediate and far-reaching for human health.

Examples illustrate how ecological degradation directly undermines well-being:

• Soil microbial depletion reduces the nutritional quality and yield of agricultural crops.

• Pollinator decline disrupts plant reproduction, threatening food production and medicinal resources.

• Deforestation destroys habitats needed to maintain biodiversity and ecological balance.

• Ocean pollution damages marine ecosystems and diminishes cultural, recreational, and psychological benefits associated with coastal environments.

Each of these disruptions weakens the ecological systems that support human life.

Environmental Degradation Is Reversing Public Health Gains

Over the past 70 years, economic and technological growth, often described as the “great acceleration,” has lifted millions from poverty and extended life expectancy worldwide. Yet these gains have come at a profound environmental cost.

Because public health is fundamentally intertwined with ecosystem health, environmental degradation threatens to reverse decades of progress.

Research shows that ecological breakdown can:

• Reduce the nutrient content and productivity of food systems

• Harm agriculture-based livelihoods

• Trigger severe mental health consequences, particularly among Indigenous communities

• Disrupt planetary systems necessary for climate stability

These intersecting pressures illustrate how environmental damage represents a systemic threat to human survival and well-being.

Biodiversity Loss and the Rising Burden of Disease

Even when examined individually, ecological disruptions can have enormous public health consequences.

For example:

• Pollinator loss could place 71 million people at risk of vitamin A deficiency and 173 million people at risk of folate deficiency, contributing to 1.42 million additional deaths annually from malnutrition and non-communicable diseases.

• Urban areas without adequate green space experience higher air pollution, more frequent heat waves, elevated stress levels, and increased rates of non-communicable diseases.

• Deforestation has been linked to increased waterborne diseases due to reduced flood control and contamination of surface water sources.

• Tropical forest loss increases interactions between humans and wildlife, raising the risk of emerging infectious diseases that could trigger epidemics or pandemics.

These examples demonstrate how ecosystem health functions as a protective barrier for global public health.

Climate Change Is Intensifying Ecosystem and Health Risks

At COP27, global discussions emphasized the accelerating impacts of climate change on ecosystems and human wellbeing.

The IPCC Sixth Assessment Report highlights that climate change is already affecting:

• Marine and coastal ecosystems

• Terrestrial and freshwater ecosystems

• Global food production systems

These changes are expected to produce cascading public health impacts.

For example:

• Climate change could increase the number of people at risk of hunger by 8 to 80 million by mid-century, with the highest impacts in Sub-Saharan Africa, South Asia, and Central America.

• Extreme temperature, rainfall variability, droughts, flooding, and sea-level rise will likely increase outbreaks of aquatic pathogens in coastal populations.

• Shifts in ecosystem conditions and vector ranges are expected to significantly increase the global burden of vector-borne diseases.

In many regions, these combined pressures may ultimately render areas increasingly difficult or impossible to inhabit.

Environmental and Social Determinants of Health Are Interconnected

The forces driving environmental degradation are closely tied to the same social and economic factors that shape health outcomes.

As a result, the current socio-ecological crisis is also a crisis of inequality. Communities that contribute the least to environmental damage often face the greatest health consequences.

This dynamic places particular burdens on:

• Vulnerable populations

• Indigenous communities

• Low-income regions

• Future generations

Delaying action is therefore not an option. Protecting biodiversity and restoring ecosystem functions are essential to safeguarding public health worldwide.

Why Nature-based Solutions for Improved Public Health Matter

A biosensitive approach to development recognizes that human wellbeing depends on living in balance with natural systems.

Transitioning toward a nature-positive economic framework can simultaneously strengthen ecosystems and support economic development. The World Economic Forum estimates that such a transition could generate $10.1 trillion in annual business value and create 395 million jobs by 2030.

Nature-based solutions for improved public health include strategies such as:

• Reforestation and afforestation

• Habitat protection and ecosystem restoration

• Regenerative and restorative agricultural practices

• Mangrove conservation

• Expansion of urban green spaces

• Protection of natural carbon sinks such as forests, oceans, wetlands, and peatlands

These approaches strengthen ecosystem resilience while reducing climate and health risks.

Indigenous Knowledge Is Essential for Sustainable Ecosystem Management

Effective environmental stewardship also requires recognizing the leadership and knowledge of Indigenous communities.

Indigenous groups have long practiced forms of land stewardship that promote biodiversity, ecosystem restoration, and sustainable environmental management.

Supporting Indigenous leadership in conservation efforts ensures that community-based solutions remain central to long-term environmental resilience.

A Global Call to Protect Nature for Public Health

The WFPHA supports the United Nations’ warning that humanity is “losing our suicidal war against nature” and emphasizes that the world faces a stark choice: collective action or collective suicide.

In response, the organization affirms the human right to a clean, healthy, and sustainable environment and calls for global commitment to nature-based climate solutions and ecosystem protection.

This call to action aligns with the principles of One Health, which recognizes the deep interdependence between human, animal, and environmental health, an interconnection highlighted clearly by the COVID-19 pandemic.

The Path Forward

Protecting ecosystems is not solely an environmental responsibility; it is one of the most powerful public health interventions available.

Nature-based solutions for improved public health offer a pathway to:

• Reduce climate risks

• Prevent emerging diseases

• Strengthen food and water security

• Improve mental and physical well-being

• Protect the health of future generations

The global public health community now faces a decisive moment. Acting to protect biodiversity and restore ecosystems is essential to ensuring a healthy and sustainable future for humanity.

Primary Dental Care During COVID-19: Global Guidance for Safe Oral Health Services

Oral health is an integral part of primary care. While oral diseases pose a major health and financial burden globally, oral health is widely neglected and considered optional or specialty care. Recognizing the global public health importance of major oral disease, the World Health Organization’s governing body adopted resolution WHA74.5 on Oral Health in 2021, affirming that oral health is an integral part of the health and healthcare system.

The COVID-19 pandemic has infected almost 400 million people worldwide and caused approximately 6 million deaths, fundamentally changing daily life and healthcare delivery. Oral health practitioners are among the professionals most at risk of infection due to exposure to airborne droplets and aerosols generated during dental procedures.

In response to inconsistent dental practice guidelines during the pandemic, the World Federation of Public Health Associations (WFPHA) Oral Health Working Group recognized the need for clear global guidance on the delivery of dental care during pandemics and future airborne disease outbreaks. A group of 24 public health–focused dental professionals from 13 countries collaborated to publish a resolution titled “Urgent, Essential and Primary Dental Care during COVID-19 and Future Airborne Pandemics.”

The resolution outlines core elements for the safe delivery of dental care during pandemics and proposes a working definition of urgent, essential, and primary dental care during COVID-19. It was accepted and approved by the WFPHA General Council in May 2022.

The WFPHA Oral Health Working Group calls for coordinated oral health action during pandemics to protect oral and overall health for all. The following recommendations outline how dental services can be safely maintained.

Strategic Planning and Clear Communication in Dental Care

All oral health programs should establish clear plans and communication strategies to screen for or identify confirmed cases and potential exposures, in line with national and regional public health guidelines.

Oral health professionals should also be recognized as an essential part of the broader public health workforce. This includes supporting public health initiatives and maintaining preparedness during pandemics and other public health emergencies.

PPE and Facility Measures to Reduce Airborne Transmission

Personal protective equipment (PPE) and facility design play a critical role in infection prevention during pandemics.

All healthcare facility personnel should wear well-fitting surgical masks that cover the mouth and nose to reduce the spread of respiratory droplets. Dental practitioners and care staff should use face masks or respirators approved by national guidelines.

These protective measures help reduce transmission risks while maintaining safe dental services.

Urgent Dental Care During COVID-19

Urgent dental care refers to medically necessary treatment that addresses:

• Acute oral infections
• Severe pain that cannot be controlled with analgesia
• Dental or orofacial trauma

Urgent care and associated diagnostic examinations should be provided for all patients.

Aerosol-generating procedures (AGPs) should be avoided or minimized whenever possible. Instead, atraumatic restorative treatments (ART) using hand instruments should be prioritized to reduce aerosol production while ensuring necessary care.

Essential Dental Care and Preventive Treatments

In 2021, the World Health Organization defined essential dental care as the use of:

• Fluoride toothpaste
• Glass ionomer cement
• Silver diamine fluoride

These materials allow preventive and restorative care with minimal or no aerosol generation. Treatments such as ART using glass ionomer cement and the use of silver diamine fluoride are also recognized in basic dental care packages by the FDI World Dental Federation.

Essential dental care, including fluoride application, should be provided for all patients, including those with confirmed infection, if the treatment falls under urgent care.

What Primary Dental Care Includes During a Pandemic

Primary dental care during COVID-19 includes a wide range of routine dental services, such as:

• Routine dental examinations
• Professional cleaning
• Radiographs
• Permanent restorations
• Periodontal treatment
• Endodontic treatment

These services are provided in addition to urgent and essential dental care.

Providing primary dental care with minimal risk during pandemics is recommended. However, for patients with COVID-19 or other highly infectious airborne diseases, only urgent and essential dental care should be delivered on an emergency basis.

When aerosol-generating procedures are necessary for low-risk patients, mitigation strategies should be used, including:

• Four-handed dentistry
• High-volume evacuation suction
• Isolation devices to reduce droplets and aerosols

Providers may also consider oral antiseptic rinses based on scientific evidence.

Protecting Oral Health in Hospitals and Long-Term Care Facilities

Hospitalized patients and individuals living in long-term care facilities are particularly vulnerable to oral health deterioration during pandemics.

Daily oral hygiene practices should be maintained, with assistance from nurses or caregivers when necessary. Consistent oral care helps reduce infection risks and supports overall health outcomes for these populations.

Oral Health Education for Mothers, Children, and Caregivers

Oral health should be integrated into primary and prenatal care for mothers, children, and individuals with special needs.

Preventive strategies should emphasize:

• Dental caries prevention
• Proper home oral hygiene practices
• Low-cariogenic diets

Education for mothers is particularly important because it helps establish lifelong healthy habits and dietary practices for children.

Oral health education should also be provided to caregivers of people with disabilities to support consistent oral hygiene and preventive care.

Integrating Dental Care into the Broader Health System

Oral health services should continue even during global health crises. Dental care must be recognized as a fundamental component of primary care and integrated into broader health systems, including:

• Primary health care
• Perinatal health care
• Long-term care facilities
• Schools
• Nutrition programs

Ensuring access to oral health services strengthens both individual health outcomes and public health resilience during pandemics.

A Call for Global Collaboration on Oral Health

The WFPHA Oral Health Working Group invites collaboration with dental and non-dental health organizations to advance these goals and improve oral health globally.

For collaboration inquiries, please contact the former Chair of the Oral Health Working Group, Dr. Hyewon Lee, at hyewon@idasociety.org

By Hyewon Lee & the WFPHA Oral Health Working Group Members