The global population will balloon from 7.6 billion to 9.7 billion by 2050, according to the United Nations while the number of people over the age of 60 will increase to 2 billion by that point.
The world is currently ill-equipped to respond to these trends, and the global health system will have to undergo major transformation, and attract greater amounts of investment in disease prevention and health promotion, in order to ensure that an expanding global population can live better and longer lives.
Key Challenges and Their Optimal Solutions
- Environmental Health and Climate Change
-Air pollution and climate change are having a serious impact on global health.
- Healthcare Technology
-New tools are curing previously fatal diseases and making chronic disease more manageable.
- Global Health Governance
-New ways of improving global health are emerging thanks to partnerships with the private sector.
- Healthcare Delivery Systems
-More innovative forms of delivery are needed to expand access to care.
- Keeping Populations Healthy
-New technologies and techniques are needed to maintain health, particularly for the elderly.
1. Environmental Health and Climate Change
Air pollution and climate change are having a serious impact on global health
Twenty-five percent of all global deaths are a result of the environment, according to the World Health Organization’s (WHO) 2016 report Preventing Disease Through Healthy Environments: A Global Assessment of the Burden of Disease from Environmental Risks.
One of the greatest environmental threats to human health is Air pollution. Many low- and middle-income countries do not monitor air quality, and either lack effective emission control legislation or simply fail to enforce legislation.
As a result, their populations face a disproportionate disease burden. In addition to outdoor exposure to air pollution, WHO estimated in 2016 that almost 3 billion people around the world were still burning biomass fuel and coal indoors, in order to cook or to heat their homes, which resulted in more than 4 million deaths annually.
In 2018, WHO estimated that more than 80% of people living in urban areas (that monitor air pollution) are exposed to air quality levels that exceed the organization’s limits and that 97% of cities in low- and middle-income countries with more than 100,000 inhabitants do not meet WHO air quality guidelines (the figure falls to 49% for high-income countries).
Air pollution is also a primary contributor to climate change, which has generated global health risks including changes in vector-borne disease patterns, water scarcity, food insecurity, and violence.
These threats are most severe for vulnerable populations like children, the elderly, and the poor. Additional measures are needed to reduce exposure to air pollution and mitigate the effects of climate change and decrease disease rates and mortality.
United Nations Sustainable Development Goals, and the Paris Agreement on climate change, have recognized this need and provide goals and targets in order to prioritize action (though one of the world’s biggest sources of carbon emissions and pollution, the US, has announced plans to withdraw from the Paris Agreement).
New and expanding research disc-iplines including Planetary He-alth(which takes into consid-eration all the natural systems that human health depends upon) and the collaborative approach known as One Health, have drawn increased focus to the complex, interconnected relatio-nships between the earth’s natural systems and species.
These approaches recognize that the health of humans, animals, and the environment are closely interr-elated, and promise to broadly advance our understanding of environmental impacts.
2. Healthcare Technology
New tools are curing previously fatal diseases and making chronic disease more manageable.
Health technology innovation has given us basic tools like the electr-onic medical record, as well as futuristic developments like robotic surgery and precision medicine (which makes use of a patient’s genetic profile and environment in order to diagnose and provide treatment).
While biomedical research is offering up new medicines, devices, and mobile applications that can cure once-fatal diseases and more effectively manage chronic disease many parts of the world still lack access to even the most basic healthcare.
According to World Health Organi-zation Global Health Observatory data, more than half of the deaths in the African Region during 2015 were the result of maternal, neonatal, and nutritional conditions.
Expanding access to care and health technologies across the globe remains a challenge; the use of mobile technology presents intriguing related opportunities.
The overall “mHealth” market was worth an estimated $23 billion by 2017, according to SNS Research, and is expected to grow significantly.
In sub-Saharan Africa, which bears the highest disease burden in the world, and where mobile phone penetration rates have increased significantly in recent years, only 15% of the population has access to private health care, according to a report published by Deloitte in 2014, while more than 80% of private health care payments are made out of pocket.
In response, mobile operators in sub-Saharan Africa have begun to better position themselves to facilitate health payments that are made via mobile devices, according to the Deloitte report; in Kenya, for example, the operator Safaricom has partnered with insurer Changamka Micro health to enable health care payment via the M-PESA mobile money service. Meanwhile the deployment of so-called eHealth is also expanding.
According to a report published by the World Health Organization in 2016, by 2015, 70% of European Union member states had national eHealth policies or strategies, and nearly all of them had financial support specifically for implementing these efforts.
However, in 2018, the European Commission published a communication on the digital transformation of health and care, which cited slow and varied uptake of digital health solutions within the EU to date, and identified three areas for improvement:
- Secure access to health data across borders.
- Better access to advanced research.
- Disease prevention and “personalized” health care (another term for precision medicine); and digital tools for citizen empowerment.
3.Global Health Governance
New ways of improving global health are emerging thanks to partnerships with the private sector
Historically, the government coalitions and nongovernmental organizations trying to address global health challenges (like pandemics) have been primarily motivated by foreign policy interests.
However, organizations and initiatives have emerged that take a novel approach to focusing on global health issues. These entities incorporate multi-stakeholder governance structures and innovative financing models.
Gavi, for example, was created in 2000 to combine public and private sector efforts to expand access to new and under-used vaccines for children in poor countries.
Gavi estimates that it has helped prevent more than ten million future deaths since its inception and has immunized more than 690 million children including sixty-five million children in 2017 alone.
According to a study published in the journal Health Affairs in 2016, for every $1 spent on immunization, $18 is saved in terms of healthcare costs, lost wages, and lost productivity due to illness.
Gavi’s partners include Merck, GlaxoSmithKline, and the Bill & Melinda Gates Foundation, which pledged an initial $750 million to set up the alliance in 1999. In addition, groups such as the Global Fund for HIV, Tuberculosis and Malaria and Unit aid have helped to boost participation across sectors and helped generate sustainable private funding for programs in order to establish viable revenue streams.
The rise of new, multi-stakeholder governance models and innovative financing calls for similarly novel approaches to accountability and transparency.
As noted in an article published in The New England Journal of Medicine in 2013, the world faces threats that are difficult to address due to inequality and significant social, cultural, and political differences.
To that end, the United Nations’ Sustainable Development Goals, adopted in 2015 in order to guide global development through 2030, are central to the future of global health governance and must be better supported through continued innovation in financing, micro-level programming within communities, and the harnessing of big data in order to increase efficacy.
Sustainable Development Goal 3, Good Health and Well-Being includes targets such as reducing premature deaths due to non-communicable diseases (such as cancers and diabetes) by one third by 2030.
According to a UN progress report published in 2017, the decline in premature deaths from cancer, diabetes and other diseases was not occurring rapidly enough to meet the 2030 target.
4.Healthcare Delivery Systems
More innovative forms of delivery are needed to expand access to care
People are living longer, and the quality of treatment for diseases like diabetes and cancer has improved, according to the Organization for Economic Co-operation and Devel-opment.
However, at least partly because of these improvements, healthcare spending has increased and now accounts for about 9% of GDP on average in OECD countries:
Meanwhile there is ample evidence of lingering inequality and inefficiency in terms of healthcare delivery, according to an OECD report published in 2017.
According to the report, the percen-tage of the population covered by government and private health insurance for core services (such as doctor consultations and surgical procedures) is less than 95% in seven OECD countries, and is lowest in the US, Greece, and Poland.
Greece, where 86% of the population was covered as of 2015, is still being affected by a lack of coverage for the long-term unemployed following the fiscal crisis, according to the report.
The cost of healthcare continues to be a serious impediment for many people around the world.
The share of the population in OECD countries foregoing consultations due to cost is as high as 33% in Poland, according to the OECD report, 22.3% in the US, and 20.9% in Switzerland.
The cost of prescribed medicines is also limiting access – 18% of the US population reported foregoing prescribed medicines, as did 11.6% in Switzerland, according to the report (the figure was as low as 2.3% in the United Kingdom, and 3.2% in Germany).
In developing countries, the fact that health coverage tends to be paid for through taxes and salaries means it is inaccessible for the as much as 70% of the people in these places working in the unregulated, grey economy, according to an article published by the World Economic Forum in 2015.
Coupled with a rise in chronic disease in these countries, there is a growing need to figure out ways to address related issues such as a lack of preventive care.
Some solutions being developed involve bringing care directly to people India’s Social Health Activist program is designed to train one million community health workers, for example.
Meanwhile digital solutions are also being devised; like many developing countries, Gabon is experiencing a surge in internet and mobile phone use and it has sought to capitalize on that by boosting public access to health apps, according to a report published by the World Bank in 2016.
5. Keeping Populations Healthy
Modern technologies and techniques are needed to maintain hea-lth, particularly for the elderly.
The surplus of data being generated every day using cell phones and social media can be used to better track and contain the outbreak of illness and disease.
A report published by researchers at Northeastern University in 2017 showed that Twitter posts can be monitored in order to predict the spread of seasonal flu in real time, for example, while mobile phone data has been used to track the contacts of people with Ebola in order to contain its spread in West Africa.
While the quality of available data can help decision makers respond more efficiently, improved communications efforts can help keep people better informed.
Officials in the US have struggled in recent years to communicate effectively about health threats, according to a report published in the journal Health Security in 2017.
During the 2014 Ebola outbreak, some depictions of the threat posed to the US caused unnecessary public concern, according to the report, which recommended being more explicit about uncertainty, and avoiding the phrase “out of an abundance of caution.”
Increasing life expectancy will lead to a doubling of people in the world who are at least 60 years old by 2050, and then a tripling of that age group fifty years after that, acco-rding to the United Nations.
This is triggering a number of healthcare-related concerns. The current global healthcare workforce is rarely trained to work with older people to ensure they can increase control over their own health, according to a report published by the World Health Organization in 2016.
In addition, there is a lack of sufficiently qualified instructors in gerontology and geriatrics, according to the report, and a general lack of funding for related training.
In addition, as people live longer they are being afflicted with a growing number of non comm-unicable diseases such as cancer and diabetes.
In the Americas, the projected home to 200 million older adults by 2020 (compared with about 100 million as of 2006), non-communicable dise-ases are responsible for 7 out of 10 deaths among people aged 70 or older, according to the Pan American Health Organization and the WHO;
In the US, more than 90% of older adults have at least one chronic disease. The PAHO and WHO are supporting related efforts to strengthen prevention, increase early detection, and ensure universal access to quality care.