The WFPHA General Assembly 2023

After being held virtually last year, the General Assembly of the World Federation of Public Health Associations was able to be held hybrid on May 2, 2023, in Rome, Italy, during the 17th World Congress on Public Health.

A total of 101 participants from 31 different countries participated both in person and remotely. The General Assembly, made up of all members, offers a special setting for significant discussions about the direction of Global Public Health.

Hugh R. Leavell Award 2023

The Hugh R. Leavell Award is the highest honor bestowed by WFPHA. It is a true accolade of the profession, the recognition by an individual’s colleagues of her or his outstanding accomplishments in the field of global public health leadership. This award is presented at the World Congress on Public Health.

The WFPHA established this award as a memorial to one of its founding members, Dr Hugh Rodman Leavell (1902-1966). Dr Leavell was Executive Secretary of the WFPHA from 1968 to 1972. He was responsible for many of the early developments of the WFPHA, including its recognition as a non-governmental organization in official relations with the World Health Organization (WHO).

During 17th World Congress on Public Health (WCPH), the WFPHA has the honor to present the Hugh R. Leavell Award 2023 to Prof. Walter Ricciardi.

As a professor of Hygiene, Preventive Medicine and Public Health at Università Cattolica del Sacro Cuore of Rome since 2000, Prof. Ricciardi has been involved in several national and international commitments. He is the President of the Mission Board for Cancer of the European Commission and chairing the Scientific Committee of Human Technopole Foundation.

Prof. Ricciardi is also the Founder and Director of the Italian Observatory on Healthcare since 2002, which is an essential resource for monitoring the Italian healthcare system. He has also been an advisor to the Italian Minister of Health during the COVID-19 pandemic, providing strategic advice since the beginning and shaping the national response to the pandemic in terms of interventions.

Moreover, Prof. Ricciardi has held several prominent positions in the public health sector, including being the President of the European Public Health Association (EUPHA) from 2003 to 2004 and from 2010 to 2014, and the President of the WFPHA from 2020 to 2022. He was also a member of the Executive Board of the WHO from November 2017 to May 2020.

Throughout his career, Prof. Ricciardi has changed the vision of public health by emphasizing the importance of communication, leadership, networking, and team building at different levels. He has also been recognized for his outstanding contributions to public health, including receiving the “Laurea Honoris Causa” at Thomas Jefferson University in Philadelphia, USA, in 2019 and being appointed “Commendatore” of the Italian Republic in 2017.

Overall, Prof. Walter Ricciardi is an outstanding researcher and representative of the public health sector, not only in Italy but also globally. He has dedicated his career to improving public health, and his contributions have been widely recognized. The Hugh R. Leavell Award is a well-deserved recognition of his outstanding achievements and contributions to public health, and we congratulate him on this remarkable accomplishment.

Conflict and Public Health: Prevention, Responses, Recovery, Rehabilitation, and Reconciliation

“War is a man-made public health problem and it is preventable.” – Borisch (WFPHA)

“It will take decades for Ukraine to bring its public health system to the prewar level.” – Majrooh (Former Afghan Minister of Public Health)

The ongoing conflict in Ukraine has triggered a global health crisis, with people in the country experiencing death, suffering, and displacement, as well as, food and fuel insecurity. Moreover, the crisis has reduced donor funds for addressing other health issues. Unfortunately, the situation remains far from ideal at the global level as well.

According to the World Health Organization (WHO), nearly a quarter of the global population, which amounts to 1.8 billion individuals, currently resides in regions affected by conflict. The adverse effects of such circumstances on public health are significant. Warfare results in elevated mortality rates, the breakdown of social and economic systems, food scarcity, repeated disruptions to healthcare services, the collapse of medical supply chains, the flight of healthcare professionals, and severe epidemics.

The 17th World Congress on Public Health, taking place in Rome from May 2nd to May 6th, will feature Prof. Bettina Borisch, a WFPHA CEO, and Dr Wahid Majrooh, a Former Afghan Minister of Public Health, who will discuss war and conflicts during one of the Plenary sessions.

“Today under international humanitarian law we monitor more than 110 armed conflicts. Some of these make the headlines, while others do not. Some of them started recently, while others have lasted for more than 50 years. War is a man-made public health problem and it is preventable. War and armed conflicts have devastating consequences for the physical and mental health of all the people involved, for the social life within and surrounding the war regions, and for the health of the environment. War diverts, essential and often very scarce resources needed to survive. In addition, there is a vast amount of people that are also negatively impacted by the wider effects of war”, explains Prof. Borisch, a public health expert who proposed the session on war and global health.

The main consequences of the armed conflicts include:

• Displaced populations
• Limited access to clean water, food, and sanitation – the basis of public health
• Increased risk of communicable diseases
• Impacts on women’s and children’s health: According to a recent study, in 2017, at least 10% of women and 16% of children globally were either displaced by conflicts or lived dangerously close to conflict areas, making them vulnerable to sexual assault, early marriage, harassment, isolation, and exploitation.
• Impacts on mental health: The psychological consequences of war are devastating, with post-traumatic stress disorder (PTSD), anxiety, depression, and somatoform disorders becoming more prevalent in wartime and post-conflict situations.

“Epigenetics taught us that even for generations after the war the mental health consequences are there”, specifies WFPHA CEO.

Furthermore, wars seldom affect only local areas but instead, have worldwide repercussions. The global consequences of war can range from food and energy crises to inflation and financial speculation, as demonstrated by the recent conflict in Ukraine, which extended its impacts beyond national borders.

The impact of the war on the Ukrainian healthcare system:

The war in Ukraine has increased the need for healthcare services while simultaneously reducing the system’s capacity to provide them, particularly in active conflict areas. As a result, the Ukrainian health system must deal with an increasing number of injured and polytraumatized patients, as well as health services that suffer from a lack of medical equipment maintenance, shortages of drugs and medical supplies, and inadequate personnel. The quality of health care varies from region to region.

Given that the overall nature and impact of war on the health and well-being of societies and health systems are similar, Dr Wahid Majrooh provides a comparative analysis of the the Afghan and Ukrainian contexts.

“Prior to the conflict the health system of Ukraine was operational and was at a fairly good level but unfortunately because of the conflict, there are several impacts which the system and people are suffering from. There is a huge division of political focus and concentration in leadership on how to oversee and meet the health needs of communities and people. The risk of a pandemic is still there while the level of the required leadership and political attention is not. It means that there is a competition of priorities: security prevails now over other human needs including health care. Unlike Ukraine, in Afghanistan, we had decades of experience in managing health emergencies. Our experience on the ground has proven that the resilience of human capital and the resilience of the system play a crucial role because it takes courage and a new way of thinking, and a new way of managing resources and providing more supportive leadership”, – explains Dr Wahid Majrooh.

The WHO has sent large shipments of medical supplies to Ukraine and released $5.2 million from its Contingency Fund for Emergencies to address the country’s urgent health needs. Numerous other international donor programs are also aimed at achieving the same goal. However, are they truly capable of resolving all the aforementioned issues?

“People may say that there are a lot of donations from international agencies and State members but the problem with donations in such a context is that they are not aligned with the national agenda on public health policy and do not fill all the gaps. For example, in some areas, where the conflict is going on, the human capital both in terms of number and morale is badly affected. A humanitarian aid that focuses on urgent needs (e.g. infectious diseases and emergency healthcare and treatment of victims of war) does not look into long-term systematic issues (e.g. mental care and maternity care). It creates a parallel system which in the mid-term weakens the national health system. It also creates a lot of expectations while the system in the state is not able to sustain that.” specifies Dr Majrooh.

The Former Afghan Minister of Public Health believes that given the lack of optimistic forecasts regarding the resolution of the conflict, the aforementioned issues will continue to worsen. How many years will it take for the Ukrainian healthcare system to recover quality parameters similar to those that existed before the conflict?

“The problem of post-conflict is the reconstruction of the system, including the health system, is that it is not only the financial cost which will matter but the time and the level of trust are really huge challenges to cope with. Because in nations that suffer from protracted conflicts, the social fabric is very badly affected. Thus, if the conflict continues, it would take decades for Ukraine to resolve all those problems. For instance, it took us two decades but we still weren’t able to fulfill all the health needs of our society.” estimates Dr Majrooh.

The 1948 WHO founding document states: “The health of all peoples is a fundamental condition of world peace and security; it depends on the closest possible cooperation between individuals and between states”. Similarly, the Ottawa Charter also considers peace to be the primary determinant of health.

What role should public health professionals play in the armed conflict context?

As suggested by Prof. Bettina Borisch, public health professionals must play a vital role during times of armed conflict by raising awareness of the devastating consequences of war, advocating for peace, and working to prevent outbreaks of war and their most severe outcomes.

Prof. Bettina Borisch emphasizes that “Wars are preventable and we, as public health people have to do everything to prevent armed conflicts. Our finest task is to do promotion to prevent diseases. In the context of war and armed conflicts, we have to act against the underlined causes of war: inequity, poverty, and unequal distribution of power, thus it’s very important for the public health people to understand the political background of the problems that we face.”

EUPHA Joined WFPHA to Stand in Solidarity with the Ugandan LGBT Community – Denounce the Ugandan Anti-Homosexuality Act (2023)

On March 21, 2023, the Ugandan Parliament passed the Anti-Homosexuality Act (2023). By criminalizing same-sex conduct, the Act criminalizes all lesbian, gay, bisexual, and transgender (LGBT) Ugandans, the provision of services to LGBT Ugandans, and the dissemination of information about the LGBT community. The Act also requires Ugandans to report any individual who is suspected of being LGBT and forbids the sheltering of a LGBT person. The Act also provides for the death penalty for the crime of ‘aggravated homosexuality’. By undermining access to medical services by at-risk populations, the Act also threatens to undermine Uganda’s proud record of HIV prevention and control built over three decades. President Museveni has agreed to assent to the Act after changes are made regarding ‘rehabilitation’.

LGBT persons have existed throughout human history and across cultures. Natural variations of sexual orientation and gender identity exist regardless of enacted laws and policies. Beyond the direct and obvious consequences that the law will have on the health and human rights of those prosecuted, it will also have broader detrimental public health impacts. Research has shown that structural anti-LGBT legal climates further promote hostility, violence, and harassment against LGBT individuals (Hatzenbuehler et al. 2019; Van der Star et al. 2020) as well as directly jeopardize a plethora of health outcomes across the entire community, including psychological distress (Van der Star et al. 2021), life satisfaction and wellbeing (Van der Star & Bränström, 2015; Pachankis & Bränström, 2018), risk for psychiatric disorders (Hatzenbuehler et al. 2010), and suicidal ideation (Pachankis et al. 2021).

In addition to these direct ramifications for LGBT health in Uganda, the negative public anti-LGBT discourse surrounding the Act may also instigate harassment and discrimination (Hatzenbuehler et al. 2019) as well as reduce psychological wellbeing (Frost & Fingerhut, 2016) among LGBT Ugandans and their families, friends, and close communities.

In 1995, Uganda acceded to the United Nations’ (UN) International Covenant on Civil and Political Rights (ICCPR; UN Treaty Collection, 2023). For some 30 years, the Covenant has been interpreted to include protections against discrimination based on sexual orientation, gender identity or expression, and sex characteristics (UN OHCHR, 2019). UN legal experts have stated that the imposition of the death penalty based on the Act is per se an arbitrary killing and a breach of article 6 of the ICCPR (UN OHCHR, 2023). An official Ugandan Parliamentary briefing on the Bill incorrectly asserted that international law does not apply because the Constitution of Uganda ‘specifically bars sexual acts between sexual minorities’, while it does not. As a matter of international law, no country’s national constitution or other laws can be assumed to override its international legal obligations.

The European Public Health Association (EUPHA) has joined the WFPHA to call on the Ugandan President, Parliament and Government to foster an inclusive and safe environment for all citizens, while safeguarding the human rights of each individual, irrespective of their sexual orientation or gender identity.

The Role of Thought Experiments as Sources of Insight and Lessons to Tackle Pandemics and Other Existential Challenges

“We invite people to exercise their imagination and think collectively on the failures of the current global health governance.” – De Souza (WFPHA) and Jadad (Center for Digital Therapeutics)

In February 2022, the World Federation of Public Health Associations (WFPHA) encouraged the use of thought experiments to improve humanity’s ability to manage pandemics and other existential threats. Delegates of the 17th World Congress on Public Health (2nd – 6th May, Rome), the overall public health community, and civil society members are invited to contribute to the further exploration of this method.

“What we tend to see is that the public health problems become visible only during the crisis and that’s why somebody needs to clean the mess. But it’s extremely difficult to do because the mess is getting bigger and bigger. The public health community is pretty powerless to deal with this problem. I think that the 17th World Congress on Public Health provides an opportunity for the public health community to reflect upon its role“, underlines Prof. Alejandro Jadad, a physician from the Center for Digital Therapeutics and one of the promoters of the Thought Experiment.

The imaginative capabilities of the human mind enable us to travel through time and space. Scientists and philosophers use this ability to create hypothetical situations, also known as Thought Experiments, to explore alternative approaches to complex issues, particularly when challenging the existing norm.

The creation of a Thought Experiment, which Albert Einstein used in some of his most important studies, involves five steps: beginning with a hypothesis or question, followed by assumptions, a hypothetical scenario, mental analysis, and communication of findings to others.

“It is important to note that this scenario is entirely fictional and not a recommendation or proposal for action. Our main goal is to help people to reflect collectively on the failures of the current global health governance. What really strikes us is that in 2019 we had international health regulations in place and nevertheless the best-valued countries in terms of capacity to respond to the epidemical crisis failed. Thus, it’s not a problem of the text of the regulation itself but how the members of the World Health Organization (WHO) and the United Nations (UN) took their responsibilities regarding the protection of people’s health”, – explains Prof. Luis Eugenio de Souza, the WFPHA president.

“The Thought Experiment is a very powerful tool. We invite people to exercise the power of their imagination and create situations that due to the knowledge acquired during the pandemic will allow us to come up with solutions to the problems that we face today”, specifies Prof. Jadad.

In a hypothetical scenario, a team of public health experts in 2023 discovers a time machine that could take them back to the beginning of the pandemic.

After conducting extensive research, the team identified a trustworthy group of people to represent humanity’s interests and ensure the equitable and efficient use of resources to halt the virus’s spread and mitigate consequences of the pandemic. This group was named the Planetary Health Protection Council (PHPC). The team was transported via the time machine to the UN headquarters in New York City, where they arrived on March 11, 2020, during the President of the Security Council’s presidential statement.

To explore the potential of thought experiments in pushing boundaries and stimulating fresh thinking about how to tackle pandemics and other existential threats, a hypothetical question was formulated:

If we had the power to travel back in time and add one resource to the available resources on March 11, 2020, to improve our response to the COVID-19 pandemic, what resource would we choose?

• “The response to this question can be summed up in two words: a coordination failure. We are failing to coordinate our response and it makes us unable to deal not only with the pandemic but also with climate change, with drought, with hunger, and with the war”, Prof. Jadad says.
• “We came to the conclusion that humanity lacked a species-wide governance system in 2020. There was a lack of accountability on the issues that went beyond the national jurisdiction. To be able to move towards effective global governance, we need to raise some specific questions to promote further reflection on the subject: 1) how far can national sovereignty go? 2) what could be done to protect the democratic decision-making mechanism, and how it can couple with the global one?”, Prof. de Souza adds.

Prof. Luis Eugenio de Souza notes that during the pandemic, the decision-making process was unbalanced. Therefore, it is extremely important to create a completely new, transparent, and impartial system. This role can be potentially fulfilled by the Planetary Health Protection Council (PHPC).

The imaginary composition of the PHPC:

• The government sector: Heads of state of all members of the UN
  Role: Providing high-level political leadership for rapid and coordinated action, advised by UN specialized agencies

• The corporate sector: Members of the World Economic Forum (WEF)
  Role: Facilitating the deployment of privately-owned technical and financial resources within and across national boundaries

• The academic sector: Experts selected by the International Association of Universities
  Role: Strengthening of evidence-informed decision-making by the other groups

• Civil society: Leaders selected from the 24,000 entities registered in the Integrated Civil Society Organizations System
  Role: Involving communities, especially giving voice to disadvantaged populations

“I would like to stress that our proposal to create the PHPC is not mature enough and thus it can be modified. We just want to put it on the table and open the discussion not only with the experts and political leaders but also to listen to the local communities and the people that suffered a lot but weren’t given the possibility to express themselves so far. We want to create such a representation which would give the floor to everybody who wants to participate“, specifies the WFPHA president.

Two independent and closely-related structures complement the PHPC:

• A digital platform to facilitate transparent and equitable participation of representative samples of the world’s population in key decisions (e.g., lockdowns, vaccine certification)
• A system of in-person and virtual tools designed to encourage and facilitate community engagement in controversial issues and adversarial situations, from villages to the entire globe.

One Health Commission Thanks WFPHA for the Climate and Health Action Award

The World Federation of Public Health Associations (WFPHA) recognizes outstanding contributions to public health through its annual awards program. The program aims to acknowledge and honor individuals and organizations that have made significant achievements in promoting health, preventing diseases and injuries, and ensuring safe and healthy conditions for people around the world.

This year, the WFPHA presents a series of awards during the 17th World Congress on Public Health (WCPH), held in Rome, Italy, on May 02 to 06, 2023.

One of the recipients of this year’s awards was the One Health Commission, which received the Climate and Health Action Award. This organization has done remarkable work in addressing the presence of climate change as an imminent public health threat.

While Dr Cheryl Stroud, the Executive Director of the One Health Commission, was unable to attend the event, she sent a heartfelt letter expressing her gratitude to the WFPHA.

Dr Annapaola Rizzoli from the Research and Innovation Center of the Edmund Mach Foundation, the first One Health center in Italy, received the award on behalf of Dr Stroud.