Michelle Imison and Anna Dé
“The pandemic has undermined progress towards the health-related targets in Sustainable Development Goals and laid bare inequities within and between countries. Sustained recovery will require more than ‘getting back on track’ and reinvesting in existing services and systems. We need a new approach, which means shifting priorities and focusing on the highest-impact interventions.”
Introduction
Towards the end of May 2022, the pandemic’s true death toll has been estimated at over 25 million, taking into account excess deaths. COVID-19 stretched health services to breaking point across the world, diverted their focus from other areas of prevention and treatment, and wound back years of progress in key areas of global health.
The pandemic is likely to halt two decades of global progress towards universal health coverage (UHC), having triggered the worst economic crisis since the 1930s and badly disrupted health services.
In terms of the UN Sustainable Development Goal (SDG) Goal 3 on Health, before the pandemic, progress had been made in many health areas, including improving the health of mothers and children, increasing immunisation coverage and reducing the incidence of communicable diseases albeit not fast enough to meet most Goal 3 targets by 2030. The disruption caused by the pandemic has now halted progress and even reversed some gains made.
Cancer, heart diseases, diabetes and lung disease, commonly known in the global health community as noncommunicable diseases (NCDs), together with mental health conditions, are one of the most significant challenges in global health today. Insufficient global action on NCDs, combined with the COVID-19 pandemic, are creating the very real possibility that SDG targets 3.4 (NCDs) and 3.8 (UHC) will not be met. Just 14 countries are on track to achieve SDG target 3.4, to reduce by one-third the premature mortality from NCDs through prevention and treatment and promote mental health and well-being by 2030. According to the World Health Organization (WHO), the pandemic also triggered a 25% increase in prevalence of anxiety and depression worldwide.
However, there are some more optimistic voices.
For instance, a recent Lancet Study puts forward that despite COVID, it is still possible to reduce NCD Mortality by one-third by 2030.
The pandemic has also sharpened concern on both global health security (GHS) and universal health coverage (UHC), and increased understanding of the importance of health system strengthening as a strategic means to achieve both GHS and UHC. It has also greatly renewed attention on pandemic preparedness, at global, regional and national levels.
However, at this point in 2022, political focus to prepare for more waves of COVID-19 seems to be flagging. As highlighted by the Independent Panel for Pandemic Preparedness and Response, now is the time to transform the international system for preparedness and response — and not merely tinker with it. Currently, the world is at risk of a new pandemic with the same devastating consequences.
There have been great advances in health innovation, as demonstrated by the first vaccines for COVID-19 that were developed in under twelve months; and digital health and precision medicine offer great hopes for the future. However, will everyone be able to benefit? Global failure to share vaccines equitably took its toll on some of the world’s poorest and most vulnerable people.
What’s clear is that resilience in these uncertain times requires global solidarity. Looking back into the not-too-distant past, we know that solidarity and commitment to shared goals in health is possible: Gavi, the Vaccine Alliance (founded in 2000) has vaccinated more than 888 million children in 77 countries and the work of the Global Fund to Fight AIDS, TB and Malaria (formed in 2001) has, at the end of 2020, saved 44 million lives.
We’re living in a time of great challenges, from the Russian invasion of Ukraine, conflicts around the world, the plight of refugees worldwide, an emerging food security crisis, an energy crisis, the cost of living crisis, the climate change crisis to the threat of World War III and even a nuclear war, in the shadow of Russian aggression.
The health implications will be massive. This was very much encapsulated by the theme of this year’s World Health Assembly – “Health for Peace, Peace for Health” for recovery and renewal.
New and ever-more complex threats are emerging: climate change increases the risks of cross-species viral transmission and it is one of the drivers of population movements globally. Recent cases of monkeypox in Europe, the Americas and Australia are being watched closely.
2022 Russian invasion of Ukraine
On 24 February 2022, Russia launched a large-scale invasion of Ukraine.
Russia’s invasion of Ukraine has changed the world. We are moving from the post–Cold War era into a new geopolitical landscape. The war has sparked Europe’s biggest refugee crisis since World War II, forced nations to rethink their military positions and rocked the global economy.
Higher fuel and food prices from the war have affected countries across the world. Ukraine and Russia are key exporters of wheat, barley, corn and cooking oil. Given how important Ukraine and Russia are to global food supply, Russia’s invasion of Ukraine could soon cause a global food crisis that may last for years, the UN has warned.
The escalation of conflict in Ukraine has caused civilian casualties and destruction of civilian infrastructure, forcing people to flee their homes seeking safety, protection and assistance. Over 6 million people have fled the country since 24 February. Refugees (mostly women, children and the elderly) and host countries face challenges with access to food, housing, healthcare and education.
Russia, as the world’s second-largest producer of natural gas and the third-largest producer of oil, is forcing some countries to reassess their reliance on Russian energy, particularly in Europe.
Russia has more nuclear weapons than any other country in the world. This fact has brought new life and meaning to NATO. Furthermore, countries all over the world are rethinking their military plans.
The effects of this war, particularly on health and healthcare within and outside Ukraine, will continue long after violent conflict ends.
The war could have ripple effects on progress towards the SDGs globally, with particular impacts on food security, poverty, nutrition, and social unrest.
Health in Europe
“These are dark times for the European Region, as we are confronted with unthinkable levels of human suffering. In the long shadow cast from over two years of a pandemic, we are now experiencing war and the greatest humanitarian crisis our European countries have experienced for more than 70 years.”
A grim milestone was passed in May 2022 as reports confirmed COVID-19 deaths from countries in the WHO European Region have exceeded 2 million people. While this number is devastating, it represents a fraction of the overall deaths directly and indirectly associated with COVID-19.
The war in Ukraine has had a devastating impact on the health and well-being of millions of civilians, and the Ukrainian health system is facing multiple challenges.
Beyond these threats, Europe also faces the ongoing issues of ageing, greater prevalence of NCDs, and pressure on healthcare services. Indeed, the COVID-19 pandemic exacerbated mental health issues, and delayed access to screening and care for chronic conditions. The full impact of this will only be known in the years to come.
The commitment of the EU institutions to health policy matters is at an all-time high. We can see this in terms of policy, legislative proposals and funding. The Pharmaceutical Strategy, Europe’s Beating Cancer Plan, EU NCD Initiative, AI strategy, the European Health Data Space, and the European Health Emergency preparedness and Response Authority (HERA) will shape the European health framework for years to come.
The planned European Health Union will:
- better protect the health of our citizens
- equip the EU and its Member States to better prevent and address future pandemics
- improve resilience of Europe’s health systems
Health in the UK
“In the decade before the pandemic, improvement in health in the UK slowed dramatically, inequalities increased, and health for the poorest people got worse. This was all amplified by the pandemic. Unless we deal with the inability of people to meet their basic needs, by adequate income and services, we are in danger of inflicting a humanitarian calamity in one of the richest countries in the world.”
The COVID-19 pandemic shone a light on the public health and social care challenges in the UK.
The UK COVID-19 Inquiry was set up to examine the UK’s preparedness and response to the COVID-19 pandemic, and to learn lessons for the future. Proposed changes have been put forward in key areas, such as a wider consideration of the impact on children and young people, the broader impact on the mental health of the population, including care in the home, and by unpaid carers; regulatory control, support for victims of domestic abuse, and first contact with the NHS, as well as the need to address inequalities.
NHS waiting lists in England were already problematic before the pandemic. Prior to the pandemic, in February 2020, there were already 4.43 million people on a waiting list for care. The latest figures for February 2022 show a record number of people – over 6.1 million – now waiting for treatment. More patients than ever are waiting for treatment and it will take years to clear the backlog.
These backlogs are likely to result in worsened conditions down the line, leading to greater demand on health services. The backlog in cancer treatment in England is set to last until September 2027.
COVID-19 brought into sharp focus the challenges facing adult social care, and in many cases exacerbated them, but it has also powerfully highlighted the essential value of social care. We shouldn’t forget the vital role played by unpaid carers, and we must take steps to ensure they have the support, advice and respite they need.
As the UK has entered the ‘living with COVID-19’ phase, the focus is now on the ‘cost of living crisis’. Now many households face the choice between eating and heating. This choice is a dilemma already being faced by two in five of us — even before soaring fuel and food prices come into effect. Nearly one in 10 parents are “very likely” to use a food bank to feed their children over the next few months.
COVID-19 exacerbated pre-existing socio-economic and health inequalities. The cost of living crisis represents another great threat to health and wellbeing. Over half of Brits say their health has worsened due to rising cost of living.
The government has faced criticism for not doing enough to address these burning issues, from the NHS backlog to the cost of living crisis. After specific calls to do more regarding the cost of living crisis, the government eventually bowed to months of pressure on 26 May announcing a £15bn package of support for households struggling with the cost of living crisis, part-funded by a £5bn windfall tax on energy companies.
An obesity crisis also represents a ticking time bomb. New analysis suggests that if current overweight and obesity trends continue, the number of UK adults who are overweight or obese could reach as high as 7 in 10 people, or 42 million people, by 2040. This research follows a recent decision by the government to delay its commitment to implement restrictions on junk food marketing and volume-based price promotions – a key pillar to its obesity strategy and commitment to tackling health disparities.
For England, the government has committed to a Plan for Mental Health and Well-Being, a Women’s Health Strategy, a 10-year Cancer Plan, a Plan to tackle Health Disparities, set out proposals for Adult Social Care, and promised a Dementia Strategy.
Within the UK, public health and the NHS are largely the responsibility of the devolved regions and nations. England, Scotland, Wales and Northern Ireland have therefore developed their own distinct laws and policies.
The Health and Care Act 2022 proposes health reforms in England. It marks an important step in the government’s ambitious health and care agenda, setting up systems and structures to reform how health and adult social care work together, tackle long waiting lists built up during the pandemic, and address some of the long-term challenges faced by the country including a growing and ageing population, chronic conditions and inequalities in health outcomes.
Health in the Asia-Pacific region
The pandemic is by no means over in Asia and the Pacific. Indeed, in places it is essentially just beginning: some of the smallest Pacific Island Countries (PICs) – remote, with small populations and often-fragile health systems – only saw their first cases of COVID-19 earlier this year. Some low- and middle-income countries in the region dealt well with COVID-19 during the early days of pandemic uncertainty, and went on to achieve vaccination rates that compare favourably in global terms.
At the other end of the scale, China continues to pursue its hardline ‘zero COVID’ approach, with a large-scale lockdown, ongoing in Shanghai and surrounding cities, slated to end by 1 June. The zero-COVID policy has been among the strictest approaches to tackling the pandemic anywhere in the world, with various reasons having been suggested for the strategy: stamping out COVID-19 as a matter of national pride, the fact that such measures were so successful against SARS in 2002, and because (following recent widespread deaths in Hong Kong and lower vaccination rates among the elderly) this would be an inopportune moment to open up in China.
This continued action against, and a focusing of health resources upon, COVID-19 occurs against the backdrop of a growing burden of NCDs in the region: they are the leading cause of death and disability in the Western Pacific, as well as a cause of significant economic burden in the larger economies among the PICs. In addition, the urgent and existential threat of climate change remains, with its implications for food security, agriculture, safety and livelihoods on what are small, low-lying land masses already living uneasily with the numerous effects of rising sea levels.
Health in Australia
Lengthy lockdowns in many states and both domestic and international border closures were wearying features of much of the last two years in Australia. A loosening of COVID-related restrictions in recent months mean the country currently has among the world’s highest per-capita rates of COVID-19 infection, though in the context of vaccination levels that are high by global standards.
Alongside these pandemic-induced changes to the nation’s health practices and policies, the results of a federal election held on 21 May promise to alter the domestic health landscape still further. Australia now has a new federal government led by the left-leaning Labor party, which had been in opposition for nearly ten years. However at the time of writing, it is too soon to say if they will govern in their own right (which would require 76 of 151 possible seats in the Parliament’s lower house) or will need to negotiate to form a minority government with smaller parties and independent parliamentarians.
Several health issues were important during the election campaign. Aged care was the subject of a national Royal Commission established just before the onset of COVID-19, and this sector has been further in focus as the setting for a disproportionately large number of the deaths from COVID-19 in Australia. As a consequence, aged care – with its intertwined and urgent issues of pay rates, staffing levels and service quality – became a central element of Labor’s election platform.
The National Disability Insurance Scheme (NDIS) was established in 2013 to provide financial support that would improve the quality of life for Australians with a disability. The NDIS’ budget, now around AU$25 billion (and growing), and the sustainability and future shape of the scheme became a major election issue after persistent claims of funding cuts, changes to the appeals process and complaints about attempts to re-design the scheme in recent years.
Additionally with massively-increased demand for mental health services over the last two years, both the new government and now-opposition Liberal and National (conservative) Parties announced new funding commitments in this area during the election campaign.
Alongside the ‘headline’ of a change in government, other changes in the Australian political landscape that surfaced as a result of this election are likely to play out for some years to come:
- The success of the ‘teal independents’ (so-called for the colour many used in their campaign materials) – all professional women, new to politics, who won in about half a dozen, previously very ‘safe’ urban Liberal seats – was in large part due to community anger over the previous government’s inaction on climate change, political integrity and issues of gender at all levels of society.
- The Australian Greens who, together with these independents, favour stronger climate action than that promised by Labor, saw its best-ever federal political result, with three new lower-house seats added to one it retained, and a near-doubling of its number of seats in the Senate (upper house), where it will hold the balance of power.
- Overall first-preference votes for the two major-party groupings were at a record low in this election, having been falling over the last several electoral cycles, speaking to a widespread dissatisfaction with both politics-as-usual (the quality and selection of candidates, the extent to which they reflect an increasingly-diverse population, and the dominance of the major parties since about the time of World War II) and the political process itself (with its factional brawling, back-room deals and sense that it was failing to deliver for or ‘speak to’ the many concerns of ordinary people).
Conclusion
On 24 May 2022, WHO Member States re-elected Dr Tedros Adhanom Ghebreyesus to serve a second five-year term as Director-General of the world’s leading public health agency.
He has outlined five priorities for the next five years:
- Promoting health – by addressing the root causes of disease and creating the conditions for good health and well-being;
- Providing health services – by reorienting health systems towards primary health care as the foundation of universal health coverage;
- Protecting health – by strengthening the global architecture for health emergency preparedness, response and resilience;
- Powering progress – by harnessing science, research, innovation, data, and digital technologies;
- And performing – by building a stronger WHO that delivers results, and is reinforced to play its leading role in global health.
There has been much talk recently on improving global health security and about overhauling the global health architecture, with a range of actors responsible for different elements of governance, prevention, preparedness and response, including WHO, the G20 and World Bank.
“Our core recommendation is for international institutions to focus on fulfilling their unique capabilities by sharing knowledge between countries; pooling resources and distributing benefits equitably between countries; monitoring the preparedness of health systems within and across countries; and convening national actors effectively and in real time.”
It will be fascinating to see how the future of global health evolves. If you need guidance in navigating the complexities of the ever-changing global health environment, we are ideally placed as independent consultants (based in the UK and Australia) to be your expert guides.
We bring global health policy expertise, complemented with our deep knowledge of regional / national contexts, together with our ability to be flexible and work across time zones to really get things done.
