What do we do now?

-->

Sir Michael Marmot and USC students

"What did we learn from the World Health Assembly?"

It is a question with many answers, to which each of us would answer differently, but I can safely say that we all understood that it is here, in these kinds of meetings, that major global policies are voted then brought back home to be implemented. 

Some day, it will be us, future epidemiologists, environmentalists and health advocates, who will design interventions reflecting policies decided at the WHO, yet specific enough to the communities we work in to be successful. In other words, the resolutions and targets decided here will have to be translated into operational interventions to achieve specific goals.

An example: this year at the world health assembly, one major topic of debate was the reduction by 25% of premature deaths due to non-communicable diseases (NCDs) by 2025. 

The NCD alliance was one of the main lobbyists in this campaign. 

Many rejected the initial draft. Thailand, for example, considered that this resolution would be a burden to the poorest Southeast Asian countries. Denmark, speaking in the name of the 27 European Union members, wanted to see high cholesterol removed from the list of diseases. 

However, after several days of rough negotiations, the resolution was finally adopted.

Today, health ministers are back home. The question they are asking themselves, which is of interest to us MPH students, is:

"What do we do now in our communities to achieve this target?

Thoughts From the Second Day of the World Health Assembly

-->

Today our group attended the Committee A meeting on the prevention and control of NCDs, the first annual progress meeting on HIV, and an evening event put on by the Tobacco Free Initiative. Various speakers at the Committee A meeting rallied for an increased emphasis on non-communicable diseases (NCDs), as infectious diseases pose a decreasing threat throughout the world, opening the door for chronic diseases such as Alzheimer’s and cancer to affect an aging population. NCDs, many argued, should be at the forefront of the health agenda as they place a disproportionate and increasing burden on developing countries. This phenomena, however, is not widely understood by the greater community as NCDs have until recently been thought of as a “rich country” problem. This mentality contributes to a significant financial burden for organizations representing NCDs as donors throw their money into communicable diseases like HIV and malaria and are reluctant to consider NCDs in their gifting. The economic pinch has forced organizations such as the NCD Alliance to accept, to the dismay of many, financial contributions from the private sector. While many are concerned private sector donations will influence the values and agenda of the NCD Alliance, they and other organizations like them respond that the private sector has money and far reaching influence that can be of great service to their organization without affecting internal policy and decision making. In light of these tensions, I was not surprised to hear delegates repeatedly assert that partnerships between UN agencies, member states and the private sector should be forged “with due consideration where conflicts of interest arise.”

From Committee A, we meandered our way over to the First Annual Progress Meeting on HIV. Delegates rattled off the latest data on HIV status, developments, and recommendations from their respective countries as they endeavor to follow the Global Plan, which sets targets and 40 countries, 30 private sector, 15 national regional bodies to achieve the ultimate goal of eliminating new HIV infections among children via vertical transmission and keeping their mothers alive (the interim goal being the reduction of new infections among children by 90% by 2015). I was interested to hear a delegate emphasize the need for an increased emphasis on changing the cultural climate of HIV-affected communities. Many HIV-positive women are stigmatized for having HIV and will be thrown out of the home by her spouse or in-laws because of it.  So they hide it.  And hiding their condition means being less compliant with medication and follow up visits. So this session, for me at least, was an important reminder to consider the cultural and societal context in which the individual is embedded when tackling any health issue. The most revolutionary pharmaceutical breakthroughs for HIV will be completely obsolete if they aren’t taken.

WHO DG Margaret Chan and panelists at the Tobacco Free Initiative event.

The real treat of the day was attending the evening event put on by the Tobacco Free Initiative. Panel speakers and delegates brought their passion to the meeting as Uruguay, Norway, Australia, Namibia are each being subject to attack by the tobacco industry for introducing anti-tobacco legislation. WHO Director General Margaret Chan described the tobacco industry’s offensive strategies as belonging to “a theater of the absurd,” as tobacco representatives, in the death throws of a desperate industry, use political influence, marketing strategies, and other scare tactics to intimidate these countries. Douglas Bettcher, Director of the Tobacco Free Initiative for WHO, likened the tobacco industry to a malaria-ridden mosquito vector, mutating and becoming more despicable and difficult to manage with time. With a clear enemy in mind, the room was filled with a furious enthusiasm as delegates, panelists, NGO representatives and concerned individuals from all corners of the world felt their ideals and principles coalesce in solidarity. “Can we take this lying down!?” exclaimed an animated Chan. “No…” the audience murmured. “Say it again.” “No,” the audience replied, only slightly more audibly. “Louder!” she retorted, “why are you guys so quiet today?” And finally there was a resounding “NO!”

What I learned from the leaders

Director General of the WHO, Dr. Chan, and me

After 4 days at the 65th World Health Assembly in Geneva. I have learned one very important thing from some of the health ministers and delegates that I met: “humbleness.” This one simple word encompasses so much. I got a very rare chance to meet and a take a picture with the Director General of the WHO, Dr. Margaret Chan. She is a petite woman filled with humor and determination. You could sense a special aura coming off of her. She gave a vibe of strength, yet at the same time humbleness. When we asked her for a picture, she did not hesitate and told us to go ahead. While we apologized for taking up her time, she just said “I am your servant.” Such words coming from one of the most important and powerful women in the world made me realize this is why she is a leader.

Another very important person made a lasting impression on me was the Australian Minister of Health and Aging, Professor Jane Halton. When we first met her she was talking passionately about Australia’s fight against the tobacco companies. They are being sued by the tobacco companies because of the new law on cigarette packaging. After her motivational talk against tobacco, we had a change to meet her and interviewed her. She gladly obliged to our request and was very excited about our work here at the WHA. I happened to meet her by chance the next day at a coffee lounge while our group was blogging. I thanked her for yesterday and told her that our group was here. Although her team was
waiting for her, she personally came over to our group to say hello and congratulate us on our works. Her friendliness and humbleness was very memorable.

Meeting many of these world leaders and delegates made me realize how important your attitude can change the whole conversation and situation. I remembered that my grandmother used to tell me that “money and education can only get you out the door, but humility and humbleness will get you far in life”. Meeting these wonderful health ministers and delegates has made me realize how true my grandmother words become.

Jenny Quynh Nguyen

(posted on Jenny's behalf)

Deep Thoughts at the WHA

The first week of our practicum trip to Geneva has flown by in a flurry of activity - coffee breaks with United Nations officials in the bustling Serpentine lounge, frantic note-writing in plenary sessions, delegate speeches from all over the world (as I listen in real-time translation through those highly-coveted UN headphones), and a plethora of top secret things that I simply can't recount in such a public forum. I can speak for myself when I say that after five days of hobnobbing with powerful figureheads, I feel like quite the well-connected, savvy public health professional.... but in reality, the learning curve was steep, the days were long, and it's now time to organize the many thoughts that have been floating - no, FLYING - around my cranium. Exposure to the many sectors represented at this Conference of all Conferences opened a door to the complex web of connections that exists between policy, advocacy, government, the private sector, and a plethora of other groups with varied interests and roles. Trying to connect the many dots is making my head spin - how can I possibly compartmentalize what I've learned, triage the facts and philosophies relayed to me, whittle the mountain of information into a relevant topic for my practicum project? I suppose I can leave all of that for later - one last opportunity to procrastinate as a graduate student - and spend today reflecting on my overall experience and the major themes that emerged along the way.

One of the most thought-provoking interactions I participated in this week was a discussion our MPH group was lucky enough to have with Doug Webb, of the United Nations Development Program (UNDP). A number of thoughtful insights were offered, but my interest was truly piqued when the conversation shifted to human rights and the ever-elusive balance between regulation and respect for the cultural norms and standards of the UN/WHO member countries. There is an inherent struggle when trying to protect populations, whether from bad policy, corruption, unhealthy environmental factors, or other issues of similar gravity; the boundaries are often fuzzy between "right" and "wrong," "human rights violation" and "widely-accepted tradition." How much power should an umbrella governing body have when it comes to international rule-setting? What role does the UN or WHO really play when it comes to setting standards? Is it possible to tread lightly and respect the unique values of individual nations when making broad, overarching regulatory strokes? And finally, is it more productive in the long run to passively encourage the herd to move in a certain direction or aggressively enact compulsory rules that members are required to follow? What options exist that are less extreme, but actually create tangible change?

While I recognize my "newbie" status in the realm of high-level global health decision making, I still continue to enjoy engaging in discussion and/or internal monologues that dissect existing policy challenges and attempt to re-invent the wheel in exciting new ways. As a fresh set of eyes and ears that is just entering the sacred inner circle of public healthers, perhaps my innovative perspective and healthy level of curiosity will lead to the best and brightest solutions the WHO has ever seen! Okay, maybe not - but I can dream, can't I? In the meantime, I'm set on enjoying the second leg of our trip, which will be chock full of tours, interviews, and inevitably an all-nighter next Thursday as I rush to prep for my competency/deliverables presentation the next day. Cross your fingers for me, folks!

Not the only one here to learn...

-->

On Sunday evening, mere hours before the start of the 65^th World Health Assembly, I attended a strategy meeting of the NCD Alliance with Professor Wipfli and the two other team leaders. I left flustered, confused and worried that I was in over my head. While I was unsure what, if any, contribution I would be able to make to this team throughout the week, I knew one thing for sure—I was here to learn and this was the place to do it.

            What I realized pretty quickly about the World Health Assembly is that most people are here to learn. Delegations from developing nations chat over coffee and croissants in the Serpent Lounge about the health problems their people face. Ideas are shared and lessons learned. I can only imagine that health ministers leave Geneva each year with a fresh perspective and a better understanding on how to deliver health affordably and efficiently in their respective countries.

            While it seems that representatives from NGOs attend the WHA to push their own agenda, it turns out, many of them are here to learn as well. Stephen Prudhomme, Vice-President of Global Strategies for the American Heart Association spent some time chatting with our group earlier in the week. Prudhomme is at the WHA this week as part of the NCD Alliance. There is really no question, his organization has an interest in making NCDs a priority of the WHO. That said, he told us that the American Heart Association is still learning about how they can best work with WHO and they’re learning how the processes of the WHA work from year to year. “We are here to learn as well,” he said. “You are not the only ones.”

So, it turns out… I probably wasn’t the only one who was a little lost that first day. Here in Geneva, everybody has something to learn--and perhaps something to teach as well.

Did you know...?

-->

Our group of MPH students came to the 65th World Health Assembly to learn about health diplomacy, to see how policies are discussed and adopted, and experience behind the scene negotiations between countries. 

Professor Wipfli joked that most of the negotiations occur in the hallways, lounges and cafeterias of the United Nations building, but I realized that it is very much true. For example, I saw Benin’s Minister of health participate in an animated meeting for several hours at the “Bar Serpent” lounge surrounded by members of other delegations.

This experience is unique. In just a few days, we have talked to many senior officials of member countries and organizations. Those people are accessible and with a little bit of luck, good social skills and boldness, it is possible to ask them questions directly and obtain a more or less political answer on the spot.

The world health assembly is held in a very particular atmosphere and the protocol must be followed rigorously. I wanted to tackle this aspect of the assembly for a first post on this blog because these anecdotes are worth being revealed. Here are a few of them:

When a country wants to speak, they turn their country tag vertically, a staff member registers their demand and they are added to the list of speakers if time permits. If they are not seen, delegates don’t hesitate to raise their hand holding their tag up high.

Countries are allowed 3 min to speak. A light pole is standing by the podium and turns from green to orange to red as the allocated time diminishes.

It happens very often that a country speaks on behalf of others. During a plenary session, Congo spoke on behalf of sub-Saharan Africa, and Denmark spoke on behalf of the European Union.

It might seem trivial but perfectly knowing the protocol is very important to be successful and efficient in such assemblies.

-->

Day two of the World Health Assembly

Tuesday, May 22

I have to admit. Everyone was a little slow getting up this morning, but excitement filled our group again as we walked into the UN for day two of the 65^th World Health Assembly.  We started the day by attending a Committee A meeting with delegates convening on NCD interventions. Within this, many countries such as Norway, Argentina, and Thailand had a few minutes to discuss with the floor what they thought about tactics laid out for NCD control and their concerns with the text. They also mentioned the amendments they would make in terms of targets for NCDs laid out for the Assembly. In this regard, it was especially interesting to hear Thailand speak as were one of the first to raise concerns about the achievability of targets as they thought that countries such as theirs did not have the capacity to obtain some of the goals set forth. Thailand stated that the targets were too ambitious for many regions in South East Asia and that the health systems in developing countries may be burdened further by the addition of the targets. Although they agreed to them, Thailand believed that targets set forth by the Assembly on NCDs would be difficult to achieve and more regional approaches should be understood.

Committee A meeting:

            After this meeting, my group went to a plenary hearing where countries really emphasized their work towards providing universal coverage, the health achievements they have made, and the health topics they believe should be focused on. Of course more was discussed than this but this is a broad idea of the topics discussed. We heard from countries such Vietnam, Japan, Panama and Senegal, and it was definitely interesting listening to what they had to say.  It was quite a contrast to hear such importance placed on universal coverage from every country that spoke because of the relative inaction on this topic made in the U.S., but it highlighted health as a perspective right, which was nice to see. 

            The afternoon of day two steadily continued as my group and I went to a meeting on opiate use and prevention, listened to Mike Splaine about alzheimer’s disease, listened to a member of the Brazilian coalition against tobacco use, interviewed the minister of health of Uruguay, and then went to a talk about the fight countries are taking against the obstacles the tobacco industry has put in front of their tobacco control efforts.  It was a lot of information, but it was very informative. The interview with the health minister of Uruguay was a particularly great experience for me as I was able to interview him along with members of my group about his thoughts on the interference tobacco industries have created on tobacco control in country and the “25 by25” goal of the NCD alliance to reduce the mortality rate of NCDs by 25% by the year 2025.  I was a bit intimidated at first to interview the health minister because I had to do the interview in Spanish. Although I can understand Spanish well and have taken it for many years, I have not spoken in a long time and forgot much of it, but the interview went well.  He was very nice, and at his talk after our interview, he even gave USC students a shout out! It was a great way to end the day.

                                                            The talk on tobacco control:

The minister of health for Uruguay (middle/blue suit):

                                      

-Nathalie Nguyen

"Listening to the World"

                The first plenary session today began with the continuation of the statements from a number of countries. I enjoyed this formal tradition of the Assembly because I do believe that this chance, albeit short, allows each country to present their concerns and also share their successes and knowledge. I really believe that with a more and more interactive global community, times such as these are the great opportunities to understand and educate ourselves about the background, concerns, and reasoning of our neighbors.

                 One commonality of the delegates that I had the opportunity to listen to, was their support of universal health care. This was interesting to me as I reflected upon our own country of the United States. We definitely have a different system in comparison to the rest of the world but are we willing to change or re-interpret the definition of universal healthcare? Looking to the politics back home, we can see that the Affordable Care Act has brought about a large amount of debate and conflict so it makes me wonder if a health system transition is possible. I found myself sitting amongst the American delegation yesterday evening during my Clean cookstove meeting but unfortunately did not get a chance to speak with them. I was a little disappointed when they left a little early, so my approach, that I’ll admit I had been planning throughout the session, went to waste. I wonder what their thoughts are about the priorities of the WHO and what we as a country will take back from the Assembly. I shall find them yet.

"There's free food in Geneva???"

Hi everyone, Helen here...yesterday was the very first day of our adventure at WHA at the United Nations. It goes without saying that everyone was very excited to finally start our journey.  In fact we were so excited that we arrived 30 minutes earlier than proposed all very eager to get in the building and get started. This is extra impressive considering we have 11 girls and only three outlets and one bathroom (with dirty mirrors. yuck!)

Jenn Kotlewski and me (right) on our first day at the WHA

The morning started with the plenary meeting where we sat in the UN for the first time amongst delegates from around the world. We witnessed the election of the new president and selection of members for the general committee before we parted in different groups to listen to talks varying in topics. Our group participated in the talk in regards to maternal, infant and young child nutrition: global targets and national success stories. Not going to lie, the talk was kind of long and hard to keep up with after a large lunch. Oh! A story about the large lunch. We had thought we would starve because food might be expensive at the UN and we would have no time for dinner so we all went to the cafeteria and purchased lunch.  But to our wonderful surprise, there was FREE food provided at all these talks! Definitely no more buying lunch for the next few days.  Got to save when we can to last in this expensive city! :)

After the maternal talk I was very excited to hear Dr. Margaret Chan's Director General's Address. Of course the room was packed like sardines so we could not get seats. Luckily some of the faculties were able to grab seats for 3 people (thanks!) and I jumped at the chance so I can snap some pictures of the speaker. I thought the speech was very succinct and to the point and there were definitely some memorable quotes to which I will end this post with.

Dr. Margaret Chan giving the Director General's Address

"Saving a life with a vaccine is unquestionably far cheaper and more immediate than keeping someone with AIDS alive. It is also less demanding on health services.  In my view, human life cannot be valued, or devalued, or discounted in this way.  These medicines are a lifeline for a lifetime. The only ethically acceptable exit strategy is to stop new infections in the first place."

Looking forward to a busy week!

El Fin. Helen



(posted on Helen's behalf)

First day at the 65th Annual World Health Assembly

Hi everyone, I'm Cammie Ahles. Today was our first day at the 65^th Annual World Health Assembly! After touring around beautiful Geneva for a few days, I was really excited to actually start working on our practicum experience today. We ended up getting to the UN earlier than expected.

We left the Cite at a bright and early 7:30 AM, which is pretty amazing considering 11 girls had to get ready using only one bathroom! At the UN, we started our day with the welcoming plenary session. I was thrilled to learn that the assembly is focusing heavily on implementing global strategies for women and children’s health, as I’m on the Maternal and Child Health track of the MPH program and particularly interested in this topic. Several speakers addressed the importance of improving infant and child nutrition and focusing on prevention. 

We watched the election of the new president of the 65^th World Health Assembly and the 5 vice presidents. Interesting side note, there are earpieces with translators for all the major languages, which was really impressive!

After the welcoming plenary session, we toured the various information booths and set out to interview delegates. Our group interviewed Ntsime Jafeta from Lesotho and Alexandre Manguele from the Republic of Mocambique. Jafeta, who works with the Lesotho mission of Geneva, discussed human rights, specifically HIV/AIDS in South Africa. He expressed that the biggest barriers include increasing access to medical treatment and eliminating the stigma associated with HIV/AIDS testing. Many Lesotho natives are scared to check their HIV/AIDS status, which Jafeta hopes to overcome through education. Alexandre Manguele discussed the growing problem of NCDs. He emphasized that NCDs are a global problem, regardless of the economic status of the country.

In the afternoon, we attended a session titled “Maternal, Infant, and Young Child Nutrition: Global Targets and National Success Stories.” They outlined 4 targets for improving child and maternal nutrition, which include reducing the number of women affected by anemia, reducing the number of infants born with low birth weight, decreasing childhood obesity rates, and increasing exclusive breastfeeding rates. This session was particularly motivating, as delegates discussed several targets in maternal and child health that I learn about in my classes.

Our last session of the day included an event sponsored by the NCD Alliance. This event consisted of a panel including several diplomats from various public health organizations. The Minister of Mexico presented an exceptionally compelling speech, revealing several aspects of Mexico’s health care system of which I was unaware. For example, I learned that Mexico is striving to incorporate public health content in 25% of the board exams for physicians continuing onto specialties, in effort to increase physicians' awareness to and subsequent practice of public health principles. 

After the session we met Richard Horton, editor of The Lancet, who gave us his business card and told us he loves hearing opinions from young minds and is partial to Americans because his wife is from Chicago. All in all, it was a great first day at the WHA!

(Posted on Cammie's behalf)

“Remember the People”: First day at the 65th Annual World Health Assembly!

Monday May 21^st, 2012
And so concludes our first day at the 65^th World Health Assembly!!! Thanks to Dr. Heather Wipfli and the entire USC Global Health Institute, 14 of us MPHers were lucky enough to come to Geneva, Switzerland to attend the 65^th annual WHA this whole week.  As soon as we stepped into the United Nations, we were surrounded by delegates from over 160 member countries and states—everything from ministers and secretaries of health to delegates from NGOs and the World Health Organization…

Me inside the UN Assembly Hall

Ministers of Health from Iraq and Iran

World Health Assembly panel, with DG Margaret Chan in the middle

The opening speeches by the President of the WHA Dr. Christos Patsalides and the Director General of the UN Mr. Kassym-Jomart Tokayev emphasized that each country has a “duty to do its best” to provide the best possible care for all people and that we need to strive for universal health care because after all, health is the most important social good and should be “enjoyed equally by all”… We then went to a few special topic sessions that included “Breaking Down Barriers: Addressing stigma and discrimination in health care for lesbian, gay, bisexual and transgender (LGBT) persons” led by Dr. Mirta Roses, Director of the Pan American Health Organization, we met with the Director of Health from Iraq and the Department of Public Health minister from Iran, we interviewed the US Secretary of Health and Human Services Kathleen Sebelius about LGBT issues and NCDs, and listened to the WHO Director General Margaret Chan formally address the Assembly… There were so many highlights from the day, but my favorite was meeting the US Secretary of HSS Kathleen Sebelius— she was kind enough to do an interview with us and updated us on LGBT issues in the US and the effectiveness of the It Gets Better Campaign. She also talked about the importance of NCDs as they are becoming an escalating public health topic all over the world. Please check out our interview with her here: http://www.youtube.com/watch?v=ec6C9uLd39I  

This entire day has been a whirlwind of  interviews, meetings, speeches, heel-induced blisters, dinner invitations, excitement, and I can’t wait for more!! Let’s see what Day 2 of the World Health Assembly brings us… to be continued tomorrow :-)