APRIL 7, 2023 is observed the world over as World Health Day. The World Health Organisation celebrates its 75th Anniversary. DR AMIT DIAS of the Department of Preventive Medicine, Goa Medical College, takes us down memory lane to reflect on all the milestones achieved by WHO on the road to health. Health is somehow not valued until sickness takes over life. On World Health Day we must all resolve to actively keep ourselves physically, mentally and socially fit and work towards health, wellbeing and happiness for everybody poor and rich!
HEALTH for All” envisions that all people enjoy good health parameters to be able to lead a fulfilling and sustainable life in peace and prosperity. We need to overcome the barriers to health care delivery. Thirty percent of the world’s population is unable to access essential health care. Everyone must have access to health care services they need without financial implications. There are estimates that almost two billion people face catastrophic or impoverishing health spending. Certain vulnerable groups are most at risk.
Universal Health Coverage helps to achieve the goal of health for all. It provides financial protection and ensures access to quality healthcare services for all. The State of Goa has been exemplary in providing free and efficient health care through its unique, people-centric services provided through the government healthcare system for several decades. Right from an OPD procedure to a bypass surgery would be performed free of cost.
Till recently, this healthcare was even free for people from another state or nationality. Now through the DDSSY scheme, launched by the government, people can access free services not only in government setups but also in private hospitals. This scheme provided universal health coverage to the community at a nominal premium of Rs200 per year. The theme this year for World Health Day is “Health for All” and emphasizes the need for universal health coverage.
The journey toward health for all has been quite challenging and WHO has achieved several milestones along the way. Let us re-visit some of the milestones and understand their impact on the state of health today. Let us also make up our minds to join WHO in its fight to achieve sustainable development by promoting health.
WHO MILESTONES
1948: On April 7, 1948 the constitution of the WHO came into force with a focus on the control of tuberculosis, malaria, yaws (a bacterial infection), syphilis (a sexually transmitted disease), leprosy, and smallpox. We have come a long way in eradicating smallpox. The last known case of smallpox in India was identified in May 1975. The last natural case in the world was in Somalia in 1977. Smallpox was declared eradicated in 1980. India has also achieved success in eradicating guinea worm (a disease caused by a worm that involved step-wells) and more recently polio.
We have eliminated leprosy and yaws — brought down the prevalence to an extent that it does not get transmitted. People would have heard about leprosy, it’s caused by the organism Mycobacterium leprae leading to hypopigmented patches with loss of sensation and in some cases a lot of disfigurement and disability.
Yaws, in contrast, is not well known. It was a major public health problem in the remote regions of India. There is a famous statement in public health – “Where our road ends, yaws begins,” highlighting the fact that it occurred in remote and hard-to-reach areas. India eliminated yaws from the country in 2004 thanks to the collaborative efforts of the WHO and the government of India. We are also working towards eliminating other common diseases.
In the last 75 years there has been considerable progress in our knowledge and capacity to deal with infectious and non-infectious diseases. But nature keeps us on our toes and backlashes with surprises like the most recent COVID-19 pandemic. There is a need for Global Response and action to achieve health for all and the WHO has been playing this role right from its inception.
ENTRY OF ANTIBIOTICS
1950: Antibiotics became popular and were game-changers in the management of infectious diseases. Ever since penicillin was accidentally discovered by Alexander Flemming from mold in 1928, a lot of other antibiotics discovered such as streptomycin, chloramphenicol, erythromycin and vancomycin have been used.
In recent years with the widespread use and abuse of antibiotics, WHO has alerted countries on responsible use of antibiotics. In today’s world, antibiotic resistance has become a major hurdle to health care. Drug-resistant tuberculosis, drug-resistant malaria, and hospital-acquired infections are major health concerns that need to be dealt with on a war footing.
1952: The first vaccine against polio was developed by Jonas Salk and paved the way for our fight against the disease, it led to the eradication of polio from most regions of the world, including India. This was followed by the development of the Oral Polio Vaccine in 1961 which is administered to all children under the age of five as part of the Pulse Polio program — a major strategy responsible for the eradication of polio.
1974: The Expanded Program on Immunization was initiated to ensure the prevention of vaccine-preventable diseases. Since there several other vaccines have been added to the program which has to be given the credit for keeping many diseases under control and taking others on the verge of elimination.
1975: The WHO established a special program on Training in Tropical Diseases (TDR) with the aim of building capacity to fight against neglected tropical diseases. By 2016, five of the eight diseases were close to elimination.
1978: for the first time the “Health for All” goal was set at a conference on primary health care in Alma Ata, Kazakhstan. It was the WHO’s push toward universal health coverage.
1980: Smallpox was eradicated. This gave us the hope that with global consistent and strategic efforts, we can fight against disease and win.
1983: HIV was discovered. When one disease goes, others emerge. HIV was discovered in 1983 and began to spread to all countries.
1988: WHO launched the Global Polio Eradication Initiative (GPEI) and since then 20 million cases of polio have been averted and 1.5 million deaths prevented. This is a major fight against a disease after smallpox. We have managed to eradicate polio in India, but since it still exists in neighboring countries, we have to be vigilant.
1995: WHO launched the Integrated Management of Childhood Illnesses (IMCI) together with UNICEF. This was to promote health and introduce preventive and curative services for children under five to reduce childhood mortality and morbidity. Over the last 25 years, childhood mortality has more than halved.
2000: WHO adopted the United Nations Millinium Development Goals with a lot of social and health goals to improve health by the year 2015.
2003: WHO recognized tobacco as a major health concern and the World Health Assembly adopted the WHO strategy for tobacco control. Since then there have been several initiatives for tackling non-communicable diseases including heart disease, stroke, obesity, diabetes, hypertension cancer and accidents.
2008: Heart disease and stroke emerge as the world’s number one killer — indicating a shift from infectious to non-infectious diseases.
2009: The infectious diseases gave a signal that they are here to stay. H1N1 emerged and began to spread and the WHO ensured preparation for the control of the pandemic. Later in 2014, we saw the Ebola virus reemerge in West Africa, and with global efforts we were able to keep it under control.
2013: The Global Mental Health action plan was endorsed (mhGAP) for integrating mental health at the primary healthcare level for the first time. This was an attempt to mainstream mental health care.
2015: The 17 goals of the United Nations, Sustainable Development Goals were adopted as a roadmap for better health care till 2030.
2016: WHO declared the zica virus as a public health emergency of international concern.
2020: WHO declared COVID-19 as a public health emergency of international concern. Since then we have seen the highs and lows of the pandemic and lost a lot of lives. Well-coordinated efforts from all the countries helped control one of the biggest pandemics in our lifetime.
2021: While the pandemic was still raging WHO did not ignore other diseases and launched a vaccine for malaria for children. It is a ray of hope for protection against malaria.
2022: WHO signed a quadripartite agreement with the UN, FAO, UNEP and the World Organisation for Animal Health to strengthen cooperation towards sustainable health of animals, plants, and humans – it’s called the One-Health approach.
2023: It’s been a long journey, with a lot of successful initiatives to improve health care throughout the world. Progress needs to be accelerated if our healthcare-related sustainable development goals need to be achieved.
Everyone has a role to play in achieving health for all!!!