KEY PLAYERS IN GLOBAL HEALTH

I. WORLD HEALTH ORGANIZATION (WHO)

WORLD HEALTH ORGANIZATION (WHO)- is an inter-governmental organization and works in

collaboration with its member states usually through the Ministries of Health and is concerned with
international public health

- is the primary UN agency responsible for health activities

Goals: a. to ensure that a billion more people have universal health coverage
b. to protect a billion more people from health emergencies
c. to provide a further billion people with better health and well-being.

 For universal health coverage:

 focus on primary health care to improve access to quality essential services
 work towards sustainable financing and financial protection
 improve access to essential medicines and health products
 train the health workforce and advise on labor policies
 support people's participation in national health policies
 improve monitoring, data and information.

 For health emergencies,:

 prepare for emergencies by identifying, mitigating and managing risks
 prevent emergencies and support development of tools necessary during outbreaks
 detect and respond to acute health emergencies
 support delivery of essential health services in fragile settings.

 For health and well- being:

 address social determinants

 promote intersectoral approaches for health
 prioritize health in all policies and healthy settings.

 Through THEIR work, they address:

 human capital across the life-course
 noncommunicable diseases prevention
 mental health promotion
 climate change in small island developing states
 antimicrobial resistance
 elimination and eradication of high-impact communicable diseases.
CONTRIBUTION/ PROGRAMS TOWARDS GLOBAL HEALTH
WHO, among its major initiatives have been immunization campaigns to protect populations in
the developing world, regulation of the pharmaceutical industry to control the quality of drugs and
to ensure the availability of lower-cost generics, and efforts to combat the spread of HIV/AIDS.
1. Communicable diseases, noncommunicable diseases, sustainable development and health
environments, family and community health, evidence and information for policy, health
technology and pharmaceuticals, and social change and mental health.
2. In 1948, WHO took over the responsibility for the International Classification of Diseases,
which has become the international standard for defining and reporting diseases and health
conditions. Since its creation WHO has contributed to many historic achievements in global
public health work. Some of them are:

Antibiotics: (1950) The great era of discovery of present-day antibiotics begins, and WHO
begins advising countries on their responsible use.

Polio: (1988) The Global Polio Eradication Initiative 1988 is established at a time when polio
paralyzed more than 350 000 people a year. Since then, polio cases have decreased by more
than 99% because of immunization against the disease worldwide.

Smallpox: (1979) Following an ambitious 12-year global vaccination campaign led by WHO,
smallpox is eradicated.

Tuberculosis: (1995) The strategy for reducing the toll of tuberculosis (TB) is launched. At
the end of 2013, more than 37 million lives had been saved through TB diagnosis and treatment
under this strategy.

AIDS, Tuberculosis and Malaria: (2001) The Global Fund to fight AIDS, Tuberculosis and
Malaria, a new partnership and funding mechanism initially hosted by WHO, is created in
collaboration with other UN agencies and major donors.

Children's mortality: (2006) The number of children who die before their fifth birthday
declines below 10 million for the first time in recent history.

Heart Disease, diabetes, cancer: (2012) For the first time WHO Member States set global
targets to prevent and control heart disease, diabetes, cancer, chronic lung disease and other
noncommunicable diseases

Ebola virus outbreak: (2014) The biggest outbreak of Ebola virus disease ever experienced
in the world strikes West Africa. The WHO Secretariat activates an unprecedented response to
the outbreak, deploying thousands of experts and medical equipment; mobilizing foreign
medical teams and coordinating creation of mobile laboratories and treatment centers. In 2016
 WHO announces zero cases of Ebola in West Africa, but warns that flare-ups of the disease
are likely to continue and that countries in the region need to remain vigilant and prepared

3. WHO's program for Primary Health Care comprises eight essential elements:

1. Education concerning prevalent health problems and the methods of preventing and
controlling them;
2. Promotion of food supply and proper nutrition;
3. Maintenance of an adequate supply of safe water and basic sanitation;
4. Provision of maternal and child health care, including family planning;
5. Immunization against the major infectious diseases;
6. Prevention and control of locally endemic diseases;
7. Appropriate treatment of common diseases and injuries; and
8. Provision of essential drugs.

Reference: https://www.nationsencyclopedia.com/United-Nations-Related-Agencies/The-World-
Health-Organization-WHO-ACTIVITIES.html#ixzz65LGMKvaX

4. WHO has also launched programs to roll back malaria, stop the spread of tuberculosis, fight the
AIDS pandemic, and curtail tobacco use. A breakthrough in the drastic reduction of the cost of
AIDS treatment drugs is likely to impact the AIDS fight. Negotiation for a tobacco-control
convention may lead to greater success for WHO's Tobacco-Free Initiative. With additional
resources from private foundations, WHO, in partnership with the World Bank and UNICEF,
has launched an ambitious Global Alliance for Vaccines and Immunization (GAVI).
Malnutrition, which accounts for nearly half of the 10.5 million deaths each year among
preschool children, will continue to be a priority item in the years to come.
 II. UNITED NATIONS

UNITED NATIONS- is an intergovernmental organization responsible for maintaining

international peace and security, developing friendly relations among nations, achieving
international cooperation, and being a center for harmonizing the actions of nations.
-leading group who supports all the programs of WHO be it in the universal
health care, and the likes.

CONTRIBUTION/ PROGRAMS TOWARDS GLOBAL HEALTH

 The UN, through the United Nations Children’s Fund (UNICEF) and specialized agencies
such as the World Health Organization (WHO), works toward improving health and
welfare conditions around the world.

 UNICEF provides for the needs of children in areas devastated by World War II. UNICEF
was made a permanent UN organization in 1953. Financed largely by the contributions of
member states, it has helped feed children in more than 100 countries,
provided clothing and other necessities, and sought to eradicate diseases such
as tuberculosis, whooping cough, and diphtheria.

 UNICEF promotes low-cost preventive health care measures for children, including the
breast-feeding of infants and the use of oral rehydration therapy to treat diarrhea, the major
cause of death in children. UNICEF has key monitoring responsibilities under the
Convention on the Rights of the Child.

 The UN has responded to the AIDS epidemic through the establishment of UNAIDS, a
concerted program of cosponsoring agencies, including UNICEF,
WHO, UNDP, UNESCO, and the World Bank. UNAIDS is the leading advocate of global
action on AIDS, supporting programs to prevent transmission of the disease, providing care
for those infected, working to reduce the vulnerability of specific populations,
and alleviating the economic and social impact of the disease. In 2001 UNAIDS
coordinated a General Assembly special session on the disease.

 MILLENIUM DEVELOPMENTAL GOALS

1. Eradicate extreme poverty and hunger (Mdg 1). Poverty contributes to unintended
pregnancies and pregnancy-related mortality and morbidity in adolescent girls and women, and
under-nutrition and other nutrition-related factors contribute to 35% of deaths of children under
five each year, while also affecting women’s health. Charging people less for health services
reduces poverty and makes women and children more willing to seek care. Further efforts at the
community level must make nutritional interventions (such as exclusive breastfeeding for six
months, use of micronutrient supplements and deworming) a routine part of care.
 2. Achieve universal primary education (Mdg 2). Gender parity in education is still to
be achieved. It is essential because educated girls and women improve prospects for the
whole family, helping to break the cycle of poverty.

3. Promote gender equality and empower women (Mdg 3). Empowerment and gender
equality improve the health of women and children by increasing reproductive choices,
reducing child marriages and tackling discrimination and gender-based violence.
Partners should look for opportunities to coordinate their advocacy and educational
programs (including those for men and boys) with organizations focusing on gender
equality. Shared programs might include family-planning services, health education
services, and systems to identify women at risk of domestic violence.

4. Combat HIV/AIDS, malaria and other diseases (Mdg 6). Many women and children
die needlessly from diseases that we have the tools to prevent and treat. In Africa,
reductions in maternal and childhood mortality have been achieved by effectively
treating HIV/AIDS, preventing mother-to-child transmission (PMTCT) of HIV and
preventing and treating malaria. We should coordinate efforts on such interventions by,
for example, integrating PMTCT into maternal and child health services and ensuring
that mothers who bring children for immunization are offered other essential
interventions.

5. Ensure Environmental Sustainability (Mdg 7) – safe drinking water and sanitation

(Mdg 7). Dirty water and inadequate sanitation cause diseases such as diarrhea, typhoid,
cholera and dysentery, especially among pregnant women, so sustainable access to safe
drinking water and adequate sanitation is critical. Community-based health efforts must
educate women and children about sanitation and must improve access to safe drinking
water.

6. Develop a Global Partnership for Development (Mdg 8). Global partnership and the
sufficient and effective provision of aid and financing are essential. In addition,
collaboration with pharmaceutical companies and the private sector must continue to
provide access to affordable, essential drugs as well as to bring the benefits of new
technologies and knowledge to those who need them most.

 Global Strategy for Women's and Children's Health (MDG 4 AND 5)

The ‘Global Strategy for Women’s and Children’s Health’ sets out how we can work
together to save women and children. The document was developed under the auspices
of the United Nations Secretary-General, Ban Ki-moon, with support and facilitation by
The Partnership for Maternal, Newborn & Child Health.
References: World Health Statistics 2018: Monitoring health for the SDG’s
https://www.un.org/en/chronicle/article/advancing-global-health-agendaun
 III. WORLD BANK Group (WBG)
WORLD BANK- is one of the world’s largest sources of funding and knowledge for developing
countries. Its five institutions share a commitment to reducing poverty, increasing shared
prosperity, and promoting sustainable development.
A. International Bank for Reconstruction and Development (IBRD)
B. International Development Association (IDA)
C. International Finance Corporation (IFC)
D. Multilateral Investment Guarantee Agency (MIGA)
E. International Centre for Settlement of Investment Disputes (ICSID)

Mission: a. To end extreme poverty by reducing the chare of the global population that lives in
extreme poverty to 3 percent by 2030.
b. To promote shared prosperity by increasing the incomes of the poorest 40 percent

AIM: To help countries build healthier, more equitable societies as well as improve their fiscal
performance and country competitiveness to build human capital, end poverty and boost shared
prosperity.

- In line with global strategy for health, nutrition and population, the World Bank supports
countries’ efforts to achieve universal health coverage and provide quality, affordable health
services to everyone regardless of their ability to pay by reducing the financial risk associated
with ill health and increasing equity.

CONTRIBUTION/ PROGRAMS TOWARDS GLOBAL HEALTH

Global Tobacco Control Program
- This is done by increasing the taxes of cigarettes in the market.

 Higher taxes on tobacco products was implemented by the World Bank so as to reduce
tobacco consumption especially for those poor families thus improving the public health
as a whole. According to WBG, this is a WIN-WIN situation for the economy and health
by means of reducing risk of people from developing the negative effects of smoking
thereby improving the health of the people in the community.
 Also, by increasing the percentage of taxes on tobacco comes along with the increase in
the government revenues that can be used to fund priority investments and programs that
benefit the entire population.
 The World Bank Group’s Global Tobacco Control Program assists countries
in designing tobacco tax policy reforms and increasing tobacco tax rates as a win-win-
win policy measure to: (i) achieve public health goals by hiking prices, reducing
smoking, and preventing initiation among youth, (ii) raise domestic resources for
 investments that benefit the entire population, and (iii) enhance equity by reducing health
risks associated with tobacco-attributable diseases and the risk impoverishment due to
high out-of-pocket expenditures among the lowest income population groups, who tend
to be more responsive in reducing consumption when facing higher tobacco prices. In
addition, it supports countries in addressing illicit tobacco trade by strengthening customs
systems.
 The Bank team engaged in this program is multi-sectoral, and includes experts in health,
macro- economics and financial management, governance, as well as poverty and equity,
agriculture, and trade. Collaboration with the International Monetary Fund’s Fiscal
Affairs team has been established. The Bank team is also working closely with other
international partners, such as the World Health Organization and the Campaign for
Tobacco-Free Kids
Reference: https://www.worldbank.org/en/topic/tobacco#6

Infectious Disease and Vaccination

- Infectious diseases can lock people into poverty, undermine the resilience of
communities, and have devastating consequences for a country’s economy.
STRATEGIES:
1. The WBG works with countries to ensure that essential health interventions for
infectious diseases, including surveillance, prevention, early detection, and
treatment, are adequately planned, costed, and budgeted for in national health sector
plans and carried out in a sustainable manner. The WBG has also made important
contributions towards the immunization of children and vulnerable populations
against preventable infectious diseases.
2. The WBG strongly supports childhood immunizations, as expanding access to
vaccines is crucial for eliminating infectious diseases and achieving UHC. In
addition to this, the Bank is a global partner in eradicating polio working with the
Global Polio Eradication Initiative (GPEI). It invested almost $US 600 million in
projects to strengthen routine immunization and to help eliminate polio in the three
countries where the disease remains endemic: Nigeria, Pakistan, and Afghanistan
3. HIV/AIDS- The WBG offers financing, specialized technical support, and
knowledge to countries for effective prevention of new HIV infections, care and
treatment for people living with HIV/AIDS, the alleviation of social and economic
consequences for affected communities, and programs that address the underlying
social and structural drivers of HIV. Since 1989, WBG financing for HIV and AIDS
has totaled over $US 5 billion. Specifically, through the International Development
Association (IDA), the WBG’s fund for the poorest, between 2000 and 2014 the
WBG ensured that 1.3 million adults and children received antiretroviral
combination therapy; purchased and/or distributed 386 million condoms for the
prevention of HIV, sexually transmitted diseases, and unwanted pregnancies; and
 trained 2.6 million health personnel to improve the quality of health services
delivery. The WBG has funded about 50,000 community AIDS organizations
globally, helping to create effective community responses in more than 50
countries.
4. Malaria- The WBG treats financing for malaria control as an integral part of
financing for essential health services in the context of UHC. The most cost-
effective interventions against malaria include the use of long-lasting, insecticidal-
treated mosquito nets, seasonal malaria chemoprevention (SMC), effective case
management (rapid diagnosis and effective treatment), and indoor residual
spraying.
5. TUBERCULOSIS- WBG does this by supporting TB control programs directly and
by strengthening health and social protection systems, public housing and
environment, and tobacco control measures. The WBG also supports the goals of
the WHO’s End TB Strategy.
REFERENCE: https://www.worldbank.org/en/topic/infectiousdiseases

Mental Health

- To highlight the scale of these issues, and the gains from addressing them, the
World Bank Group, in partnership with WHO and other national and international
organizations, is supporting efforts to put mental health at the center of global
health and development agendas. These efforts are geared to:

A. increase awareness about mental health as a development challenge

and the associated economic and social costs of inaction;

B. debate the economic and social benefits of investing in mental

health; and identify ways for stakeholders to act across sectors.

-
Nutrition

- The World Bank Group is committed to supporting client countries by building the
knowledge base, providing technical assistance for policy/program design and
prioritization, and financing the scale up evidence-based nutrition interventions.
STRATEGIES:
1.The World Bank has led the effort to estimate the cost and cost-effectiveness of nutrition
interventions to support advocacy and increase investment in nutrition at the global and
country levels. At the global level, the World Bank, in partnership with R4D, 1000 Days,
the Bill and Melinda Gates Foundation, and the Children’s Investment Fund Foundation
published An Investment Framework for Nutrition which provides a roadmap,
including estimates of resources required and possible financing scenarios to achieve the
 global nutrition targets set out by the World Health Assembly and enshrined in the
Sustainable Development Goals.

Reference: https://www.worldbank.org/en/topic/nutrition/overview#2
Pandemic preparedness and health Systems Strengthening
- The World Bank supports countries in their efforts to prevent pandemics by
strengthening veterinary and human health systems, as well as the bridges between
them.
- Under IDA 18 , the World Bank committed to help at least 25 countries develop
pandemic preparedness plans and strengthen their governance and institutional
arrangements for multisectoral health emergency preparedness, response, and
recovery. To date, 37 IDA countries have already developed, costed, and prioritized
these plans, with work underway in at least 14 more.

Reproductive, Maternal, Newborn, Child and Adolescent Health

- Ensuring that every woman and child has access to health care is pivotal for human
capital formation, building robust economies, and ending poverty. It is also
fundamental to achieving Universal Health Coverage.
- Improving reproductive, maternal, newborn, child and adolescent health
(RMNCAH) supports these outcomes. To propel this agenda and harmonize
fragmented RMNCAH approaches, the WBG and partners launched the Global
Financing Facility (GFF) in 2015, a multi-stakeholder partnership that supports
country-led efforts to improve the health of women, children, and adolescents
Reference: https://www.worldbank.org/en/topic/reproductivematernalchildhealth

Universal Health Coverage

- Universal health coverage (UHC) is about ensuring that people have access to the
health care they need without suffering financial hardship
- The WBG does this through global, regional, and country-level research and
knowledge generation, financial investments and technical assistance, and global
convenings.
- Ongoing WBG research is helping to evaluate UHC progress globally, including
the quality of primary care, health coverage expansion initiatives, and inequalities
in health outcomes. The WBG and WHO jointly released Tracking Universal
Health Coverage: 2017 Global Monitoring Report, which found that despite some
progress on UHC, at least half of the world’s population still cannot obtain essential
health services
Reference: https://www.worldbank.org/en/topic/universalhealthcoverage#2
Projects 2019:
Water supply and sanitation Access Project
Regional Disease Surveillance System Enhancement Project Phase IV
Investing in Maternal, Child and Adolescent Health
Maternal and Child Cash Transfers for improved nutrition project
Improved Feeding Practices for first 1,000 days
Romania Health Program for Results

 Reference:https://projects.worldbank.org/en/projects-operations/projects-
summary?searchTerm=health%20projects (WORLD BANK GROUP PAGE)
 IV. EUROPEAN UNION (EU)
EUROPEAN UNION- is a coalition of 28 (soon to be 27 following Britain's bow out from the union in
2019) European countries, designed to tear down trade, economic and social barriers and promote
flourishing in these areas

As of 2018, the European Union has 28 members - all European countries. The countries
comprising the European Union are Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic,
Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the
United Kingdom. However, in 2019, Britain is set to leave the European Union, bringing the total
down to 27 countries.

 The European Union (EU) has an important role to play in improving public health,
preventing and managing diseases, mitigating sources of danger to human health and
harmonizing health strategies between Member States.

CONTRIBUTION/ PROGRAMS TOWARDS GLOBAL HEALTH

The European Union has implemented a comprehensive policy, through the Health Strategy ‘Health for
Growth’ and its action program (2014-2020) and a body of secondary legislation.

The three strategic objectives of EU health policy are:

 Fostering good health — to prevent diseases and promote healthy lifestyles by addressing the issues
of nutrition, physical activity, alcohol, tobacco and drug consumption, environmental risks and
injuries. With an ageing population, the specific health needs of older people also require more
attention;
 Protecting citizens from health threats — to improve surveillance and preparedness for epidemics
and bioterrorism and increase capacity to respond to new health challenges such as climate change;
 Supporting dynamic health systems — to help Member States’ healthcare systems respond to the
challenges of ageing populations, rising citizens’ expectations, and mobility of patients and health
professionals.

EU Public Health Policy includes: (Past Actions)

 Medicines: Legislation introduced since 1965 has sought to ensure high standards of research into
and manufacturing of medicines and the harmonization of national drug licensing procedures, and
to introduce rules on advertising, labelling and distribution. The ‘Pharmaceutical Package’
concerned with pharmacovigilance, among other topics, was approved by Parliament in 2011.
Medicines and medical devices are products subject to the rules of the single market and therefor
the EU holds competency for their authorization through evaluation and supervision.
  Research: Medical and public health research program date back to 1978, and have covered subjects
such as ageing, environment- and lifestyle-related health problems, radiation risks and human
genome analysis, with a special focus on major diseases. These health issues and other emerging
topics were tackled in the 7th EU Framework Program. Further work has been undertaken within
the framework of its successor, the Horizon 2020 program.
 Mutual assistance: Member States agreed to offer mutual assistance in the event of disaster or
extremely serious illness. Many such issues have come into the spotlight of public concern over the
last two decades: ‘mad cow disease’ (BSE), swine flu, H1N1 influenza, Zika virus and others.

The past actions made had led to the configuration of the EU current health policy. The emergence of drug
addiction, cancer and AIDS (among others) as major health issues coupled with the constant increase in the
free movement of patients and health professionals within the EU have meant that public health now
occupies an ever more prominent position on the EU agenda.

8 Major Initiatives Programs (1996- 2002)

 Health promotion: healthy lifestyle; nutrition; alcohol, tobacco and drugs; and medication.
 Health monitoring: programme based on cooperation, including a center for data collection.
 ‘Europe against Cancer’: epidemiological studies and research.
 Drugs: EU centre in Lisbon; UN Convention; bilateral contacts with producer countries.
 AIDS and communicable diseases: information, education and preventive measures.
 Injury prevention: leisure accidents; focus on children, adolescents and older people.
 Pollution-related diseases: improving data; risk perception; focus on respiratory conditions and
allergies.
 Rare diseases: EU database; information exchange; early detection.

EU Public Health Programme (2003-2008)- single integrated horizontal scheme after the 8 separate
programmes and was considered the first phase

Programme of Community Action in the field of Health and Consumer Protection (2007-2013) which
had a budget of EUR 312 million
Health for Growth and spans the period (2014-2020)- current programme

‘Together for Health’ strategy- to fight against antimicrobial resistance (AMR) and is part of the
‘protection against health threats’ objective of the EU’s. The use (and misuse) of antimicrobial agents is
linked to an increasing prevalence of micro-organisms that have developed resistance to such agents,
thereby posing a threat to public health. The Antimicrobial Resistance Surveillance System was
established under Decision 2119/98/EC, and in 2001 the Commission adopted a strategy against
antimicrobial resistance (COM (2001) 0333)

In summary, with respect to the various pieces of legislation related to medicines, Parliament has made
significant improvements to the proposals presented by the Commission, contributing to the creation of a
safer context for the use of pharmaceutical products for the health and wellbeing of EU citizens.

Reference: https://www.thestreet.com/politics/what-is-european-union-14690672
 KEY PLAYERS

IN GLOBAL HEALTH
Cristine Mae A. Hipolito, RN

MSN-1 Major in Primary Health Care

Subject: Global Context and Initiatives in Nursing

Saint Paul University Philippines