is the Executive Director of the (CHSL), and publisher of magazine
The new Director General (DG) of the World Health Organization (WHO) will soon be elected. If the upcoming election does not effectively hold to account all candidates, especially the successful one, the WHO risks losing its influence as the leading global public health authority.
On May 23, 2017, for the first time in WHO’s history, all 194 Member States of its governing body, the World Health Assembly, will cast a vote for the new WHO DG at its annual meeting in Geneva. (Previously, the DG was selected by the WHO's 34-member Executive Board.)
But, public health challenges are too great to allow the vote to descend into geo-political horse-trading and unchallenged controversy-dodging in an environment where opportunities for public vetting are few.
The WHO DG is head of a global staff of 7,000 and chief global ambassador to national health ministries world-wide. The WHO’s prominence and the need for its leadership in global public health have long been greatest in low- and middle-income countries where national health systems suffer a relative lack of financial resources and specialized technical expertise. But high-income countries draw on the WHO’s work, ranging from graded distillations of nutrition and alcohol research to annual advice about the best flu vaccine to administer globally.
The three candidates shortlisted for the position of DG have been persistently ambiguous about their stances on important governance issues. ...continue reading →
Dr Patrick O’Donnell is a Clinical Fellow at the University of Limerick and works on the . Last week he attended as the recipient of the 2015 WONCA Europe Montegut Scholarship
Nobody could have predicted the desperate state in Syria when the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe Conference for 2015 was awarded to the Turkish Family Medicine Organisation (TAHUD) a few years ago. Few could also have predicted that Turkey would be at the very centre of a mass exodus of people not seen in Europe since the Second World War. According to the UNHCR as of September 2015 the country now finds itself providing refuge to an fleeing conflict and destitution. I have heard the current situation being described as a ‘stress test’ of the European values of solidarity and collegiality, ...continue reading →
Dr. John Fletcher, editor-in-chief, gives you highlights of the . In this issue: ultrasound or near-infrared to guide peripheral IV catheterization in children, validation of a 1-hour rule-out rule-in algorithm for myocardial infarction, social media in medical education, global tobacco control, elder abuse, and more.
Dr. Moneeza Walji, editorial fellow, interviews , founding and current director of the Centre for Global Health Research in Toronto. In their commentary published in CMAJ, Dr. Jha and colleagues say that slowing tobacco sales in the next decade will depend on strengthening its implementation by increasing excise tax and improving anti-tobacco legislation. ...continue reading →
Today, February 27th 2015, marks the tenth anniversary of the coming into force of the (). To mark the historic treaty's first decade the WHO's Director-General, , gave in which she called the FCTC the 'single most powerful preventive instrument available to public health'. She wasn't exaggerating. I'll tell you why.
The FCTC was the first, and remains the only, legallybinding multilateral agreement ratified by WHO member states. Most of WHO's directives are delivered with the all the authority of a global governance institution but with none of the legal teeth that multilateral trade agreements, for example, enjoy. ...continue reading →
Baukje (Bo) Miedema is Professor and Director of Research at the Dalhousie University Family Medicine Teaching Unit and Adjunct Professor in the Sociology Department, University of New Brunswick
“The constitution” of primary health internationally, as a core component of the structure of health, care can be traced back to the , even though its origins go much further back in time: 1941 in the Netherlands and 1948 in the United Kingdom. The Declaration states that governments have to be responsible for the health of their people. Primary health care is seen as an important vehicle to deliver health care to the population, and is defined as care that “addresses the main health problems in the community, providing promotive, preventative, curative and rehabilitative services accordingly.” The Declaration of Alma-Ata also states that by the year 2000 there should be “health for all.” ...continue reading →
Silvina Mema MD MSc is a Senior Resident in Public Health and Preventive Medicine at the University of Calgary, Alberta
Lynn McIntyre MD MHSc FRCPC is Professor in the Department of Community Health Sciences, and Research Coordinator for the Public Health and Preventive Medicine program, at the University of Calgary, Alberta
I am sitting on a balcony in Mwanza, Tanzania looking out on Lake Victoria. This is the second public health and preventive medicine residency elective I have done here.
My institution, , embraces and by covering some or all of residents’ travel expenses and facilitating contact with potential host institutions.
The Canadian Association of Interns and Residents supports global health electives as well and . Their guidelines state that Postgraduate Medical Education Offices should offer residents predeparture training to address health, safety and “ethical challenges”; to designate a contact person; and to provide clear expectations. I have been thinking about these "ethical challenges" in addition to how sending institutions define their own responsibilities, not only towards their residents, but with regard to host institutions. ...continue reading →
Giovanni Apráez ippolito is Professorof Public Health at School of Medicine, National University of Colombia and Adviser in Primary Care in Cauca Region, Colombia. Carlos Sarmiento Limas MD MPH is Head of Public Health at School of Medicine, National University of Colombia, and ex-medical officer in Ministry of Health in Bogota-Colombia
Colombia pioneered primary health care (PHC) in the Latin American Region until the . There was then a crisis in PHC due to reform of the national Health system (by law 100 in 1993), which adopted a system based on the insurance model. This led to two decades of debate without any structural changes, and Colombia became the focus for and Health Organization models. During the past 60 years there was also a war in Colombia that appears to have ended during the current national government (2014-2018).
The international consensus is that health systems based on PHC have better results, lower costs, guarantee the right of health of individuals and communities, promote comprehensive care, promote health, and contribute to achieving the Millennium Development Goals (MDGs), among many other benefits. Primary care is organised according to the individual circumstances in each country () but, in our opinion, this structure must be predominantly public.
There's a quote from the film '', (Meg Ryan, Billy Crystal) that I always thought was rather profound. One of the supporting characters, a writer, says,
Restaurants are to people in the eighties what theatre was to people in the sixties.
That dates the movie, and me, but how much more true it is now, I think. In the past three or four decades food has come to define us socially and has evolved into entertainment more and more.
Earlier this week and I published an editorial in CMAJ called '', which garnered some criticism from two high profile Canadian bloggers. of CBC's "White Coat Black Art", , suggested that the idea of a donut tax was impractical given the ease of cross border shopping for Canadians. , who writes the daily blog "", was far . Dr Sharma misinterprets our editorial and suggests that we are naively arguing that taxation and regulation of high-calorie and nutrient-poor food products is the ONLY viable approach to the obesity epidemic. Which, clearly, it is not. We are in no way in denial about the need for a multi-pronged, multi-generational approach in response to rising obesity. In fact, perhaps Dr Sharma did not read the whole editorial before pronouncing judgement as we clearly state: "Strategies that include individual interventions, school-based nutrition and activity interventions, incentives for active commuting and changes to thebuilt environment should continue; however, we also need robust ways to restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products."
The problem of population level obesity is multifactorial and has been decades in evolution. Political solutions that involve laws and taxation will take years to show benefits - and obviously effective treatment and lifestyle-choice solutions will continue to be necessary. But that does not mean that we shouldn't back political solutions as part of a more comprehensive strategy for treating obesity and NCDs in the longer term. ...continue reading →