#WorldinTurmoil: A Timely Reflection on COVID-19 & Lessons Learned

The new publication of the #WorldinTurmoil series is out!

Dr Rüdiger Krech, Director of the Department of Health Promotion at the World Health Organization (WHO), is interviewed by Prof. Bettina Borisch, Executive Director of the World Federation of Public Health Associations (WFPHA), and shares some reflections on pandemic preparedness, lessons learned from past pandemics, including COVID-19, the WHO’s work, and how the 17th World Congress on Public Health (WCPH2023) can shape the future of Public Health.

By clicking on the link below, you can read the article on the Croakey Health Media website.

Watch the interview by clicking on the link below.

Interview

Public Health Is Not Ensured Once Forever!

By Geir Sverre Braut

“A world in turmoil” is the unifying headline of the upcoming World Congress on Public Health (WCPH 2023) in Italy in May 2023. This somewhat pessimistic statement is followed by a considerably more optimistic expression: “Opportunities to focus on the public’s health”. To take this a bit further, I will claim that the current situation in our world more than ever before calls for, or even cries for, public health work as science and practice to show its potential across geographical borders, political systems, and ideological standpoints.

The ongoing COVID-19 pandemic still reminds us that all countries and populations are interwoven when it comes to the most serious threats to the health of the people. Not only contagious diseases call for our attention across borders. We know that the climate is about to change. We know that such changes will influence health, even though the effects still are quite obscure. From history, we learn that severe deterioration of the health in the populations affected, always accompanies violence and armed conflicts.

Not merely the health is reduced by today’s threats. The differences between people will also increase. The consequences of public health threats are more difficult to handle for those worst off, than for those best off. This is a serious public health challenge in itself.

Even in a world in turmoil, proven strategies and methods for health protection must be maintained. Clean water, fresh air, enough food, and sound nutrition are of crucial importance, not least when physical and social surroundings are under pressure. Basic health care has to be ensured.

Effective preventive measures, like vaccination, have to be prioritized. This is not least important when people are moving or forced from their homes, and then often provided with substandard and crowded housing facilities.

The measures mentioned above build on linear causal chains, which we know well. Just like normal housework, the work can never be done once forever. We have to keep up the intensity from day to day, year to year, and not least from generation to generation.

In addition to known tactics and strategies, we have to think further. We need to enlighten the complex causal chains behind our new challenges. Updated health promotion has to rely upon a multitude of theories, knowledge from several sciences and not least creativity and a huge variety of competence among the public health workers.

What should be seen as the “glue” ensuring public health workers with varying backgrounds stick together? We have to look for the values behind public health as science and practice. Central to this aspect is realizing that the health of every single individual is not only based on individual genetics or personal lifestyle. Important predictors for staying well during a life span, we find in characteristics related to the population we belong to. By combining this population perspective with the right to life for every single human being, we create a solid ideological platform for public health.

Balancing measures based on mass strategies, aiming the whole population, with those aiming the persons at high risk, is at the core of the art of setting up a public health programme. If we focus only on a mass strategy, we may end up favouring those already best off. Therefore, we must ensure that all strategies also keep an eye on possible unwanted side effects.

How should we then analyze and interpret observations related to public health if we accept that public health work requires a multitude of scientific approaches and affects most sides of a society? Obviously, there is no way around making public health work a politically-based activity.

The population itself, every single individual, should have a saying in public health. The only accepted method we know today for this is through democratic processes, where freedom of speech, free elections, and mutual respect between populations and individuals are maintained. An important lesson learned from fighting the pandemic in Norway is that the combination of professional and political argumentations behind necessary public health measures makes the population listen and follow up.

What Is the Intergovernmental Negotiating Body (INB)?

The COVID-19 pandemic has had a profound impact on human lives, economies, and societies. To avoid a repeat of the past, the international community should collaborate to be much better prepared and aligned in responding to possible future pandemic threats.

In December 2021, the World Health Assembly Special Session (WHASS) took place in Geneva, Switzerland. This is only the second time in the history of the World Health Organization (WHO) that the Health Assembly (WHA) has met for a second time in the same year. The WHA established an Intergovernmental Negotiating Body (INB) to draft and negotiate a convention, agreement, or other international instrument under the Constitution of the WHO to strengthen pandemic prevention, preparedness and response. The INB’s work is based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus.

The INB should hold meetings to deliver a progress report to the 76th WHA in 2023, with the aim to adopt the instrument by 2024. In the decision establishing the INB, the WHA also requested the WHO Director-General to convene the INB meetings and support its work, including by holding public hearings to inform its deliberations. The United Nations system bodies, non-state actors, and other relevant stakeholders can participate in the process to the extent decided by the INB.

Together with other non-state actors, including the International Federation of Social Workers (IFSW), the International Hospital Federation (IHF), and the World Organization of Family Doctors (WONCA), the WFPHA provided several statements during the INB public hearing.

FIP Commitment to Leveraging Pharmacists to Build Vaccine Confidence & Address Vaccine Hesitancy & Complacency

Vaccine hesitancy is a major threat to global health and an important barrier to the success of vaccination strategies worldwide. Addressing this threat is an imperative for the global health community.

The International Pharmaceutical Federation (FIP) believes it is essential that pharmacy and other civil society organizations join forces and outline synergistic and complementary advocacy actions for broader access to and convenience of vaccination services through a diversity of providers and pathways, and to address vaccine hesitancy from multiple perspectives.

The FIP has advocated a greater participation of pharmacists in the vaccination space through a variety of roles to overcome vaccine hesitancy, complacency, misinformation, and disinformation around the world.

The FIP has published a document stating the FIP’s commitment to leveraging pharmacists to build confidence and address vaccine hesitancy and complacency. This document has been endorsed by the WFPHA and other organizations worldwide.

WFPHA Supports the International Hospital Federation Statement on Sustainability

On November 8, 2022, the General Assembly of the International Hospital Federation approved a statement that focuses on the role of hospitals and healthcare organizations in addressing sustainability challenges.

The statement calls upon all hospital and health system leaders to incorporate every effort to decarbonize and build climate resilience into their decisions, strategic and operational plans.

The WFPHA has endorsed this statement to join forces to generate positive impacts for the generations to come.

The New Operating Environment for Public Health

By Georges Benjamin

The COVID-19 pandemic has brought clarity to the fact that public health practitioners worldwide are now working in a new operating environment. Many components of this changing environment have been introduced over several years, but collectively they define a new milieu in which public health practitioners must work. This new operating environment has key changes in the following: the visibility of the work, how public health practitioners communicate to the public the influence of disruptive technologies, the public’s trust in science, the overt politization of public health decisions and the role of globalization of health threats.

Public health practitioners are often very proud to say – when they do their best work; nothing happens – this statement demonstrates the value of prevention and the fact that most of the time they are also anonymous because they have prevented illness or death. Specifically, ensuring the water is safe to drink, the air safe to breath and the food is safe to eat is a taken for granted. Injuries are often prevented because of public health measures and years of productive life have been extended because of these efforts. Even when a health threat presents itself public health often addresses it without fanfare or visibility. The COVID-19 pandemic has brought great visibility to public health practice health such that the work done is a kitchen table issue. In the past most people probably did not even know public health was here, today everyone has heard of the term public health and has a sense of what they do. But with that visibility comes much debate about what they do, how it is done and the recommendations or requirements they impose. Public health is now at the forefront of public debate on a daily basis and creates a new operating environment in which it practices in a fish bowel every day.

We now operate in an environment of rapid and public communication. Social media and the internet have profoundly changed the way the public gets and exchanges information. From a public health perspective, social media and the internet have significantly altered the way information about health is delivered as well and has become a major driver of health behavior. Accurate and creditable health information is available in vast amounts on the web but, disinformation and misinformation are also abundant. Regrettably, many public health systems and practitioners are not equipped or trained in how to engage using the new online social media and communication tools and are challenged to address incorrect information that has the potential to result in behaviors that are a threat to one’s health.

Disruptive technologies can both aid and impend health. Social media is one example of a new technology that has changed the way we interact with the public in both positive and negative ways. Many social media tools help people learn new knowledge and more effectively interact with systems that improve their health, but other new technologies can be disruptive in negative ways. For example, we have made important inroads in reducing combustible tobacco use particularly in youth, but vaping technology has emerged and now threatens to undermine these gains. Many saw vaping as a tool for harm reduction or to wean people off of combustible tobacco but in many situations, it has resulted in dual use in existing smokers as well as a tool to initiate or enhance youth nicotine addiction. Cell phones have replaced land line telephones and have increased the flexibility and communications capacity worldwide. However, their use in society has emerged as a new form of distracted walking and driving with the resultant increases in injury from car-pedestrian and vehicle collisions.

The good news is we are now having a public debate about the value of science and discovery. The bad news is the debate is complicated and often impacted by poor risk communication and misunderstanding about the evolving knowledge that research brings us. This misunderstanding plus the ability of others to purposely misuse scientific facts and misrepresent nonpeer reviewed studies as settled science resulted in a growing trust gap in science. In some situations, we are seeing a growing effort to undermine the credibility of science facts that has been labelled the “war on science.”

This effort threatens to undermine trust in both scientific information and the researchers, practitioners and policy makers that use good science and facts to make decisions. In some situations, this debate has developed a political overlay that threatens the very foundations of public health – public trust. Public health has always operated in a political environment, but it was usually structured engagement in a nonhostile environment. Over the last few years public health decisions and recommendations are being questioned through a political lens that undermines the value of public health guidance and regulations. On occasion, this politization has become hostile and threatening to the practitioners who are now being accused of having a political and not public health agenda. While this accusation around motive is not correct, it shows that public health which does a lot of its work through policy and systems change, does operate in an increasingly hostile political environment. To that end, public health needs to find ways to work in this environment focusing on the public health motives of the work.

Finally, globalization and the ability to move people and materials vast distances as well means health threats like infectious diseases, adulterated or faulty products can also impact the health of large number of people on multiple millions of people. COVID-19 has demonstrated the importance of addressing health problems globally and that disease anywhere impacts us all everywhere. Globalization has sparked new calls for more engagement in global health by high income countries. Public health is indeed working in a new operating environment. This environment requires a strengthening of many of our existing skills as well as the development of new ones if public health is going to be successful. Skills in using social media tools and enhanced risk and science communication, enhanced training in working with political leaders in a political milieu as well as improved skills in community engagement to enhance trust are essential. Leadership skills that help the field become more effective at managing new disruptive technologies is also needed.