4 Global Challenges For Health

The global nature of COVID-19 has called for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody has been exempted from the pandemic!

Since the rise of globalization, the world has become more closely connected, and people can easily interact with each other without facing any serious barriers. The free movement of people, goods, and services brought about by globalization has stimulated socio-economic development, but it has also become a channel for spreading diseases. As a result, because of the technological developments associated with globalization, an outbreak such as COVID-19 has turned into a major pandemic that has affected people worldwide regardless of their geographical location.?At least in normal times, the ease and accessibility of travel contribute to the rapid and wide-ranging spread of viruses. Once you are able to get back on an airplane, you will be able to reach anywhere in the world within a few hours, and a recently infected, asymptomatic traveler can bring a deadly virus from virtually anywhere in the world. This much is certain; we are connected. We have all the power in the world to talk to each other—distance, language, and geography offer no barriers—and yet we do not take advantage of it. It is clear that there is no better time than now to start really looking at healthcare from a global perspective. In an increasingly interconnected world, it is vital for every health care worker to recognize the challenges and opportunities presented by that interconnectivity. The topic of global health has come to the forefront of people’s minds as the COVID-19 pandemic has seriously impacted every nation around the world. Global health is important to each and every one of us.?Potential health risks can impact everyone around the world. If our neighbors do not have what they need to prevent and treat disease, it puts everyone at greater risk. The opposite is also true: when everyone can access health care, we are all better able to combat disease.

Here are 4 global challenges that Global Alliance for Infections in Surgery?identifies priorities.

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Speeding up global access to COVID-19 vaccines

Even before the COVID 19 pandemic, social, economic, and health inequities were the prevailing global narrative. COVID 19 amplified long-standing systemic inequalities, including access to health care. Infectious diseases should affect populations similarly, but COVID 19 demonstrated that low-income people, those who are less educated, and ethnic minorities are disproportionately affected. Everyone should have the opportunity to live a life that supports good health. However, vast differences in people’s environments, resources, and social statuses affect the choices available to them. Achieving equity in health means addressing social and environmental determinants and eliminating disparities in health systems and health care access.

Safe and effective COVID-19 vaccines were developed in record time.?Almost 18 months since the first administration of a COVID-19 vaccine, incredible progress has been made and low-income countries have administered billions of vaccines against COVID-19 in a historic global launch that is unprecedented in terms of people reached. However, despite these advances, inequalities between low- and high-income countries continue to cost lives and prolong the pandemic, increasing the threat posed by the emergence of new variants of the virus. potentially more dangerous.

Only 16% of people in low-income countries received a single dose of the vaccine, compared with 80% in high-income countries. In some low-income countries, many of society's most at-risk people - healthcare workers, the elderly, and people with poor health - are unprotected, while healthy young adults are receiving booster doses in wealthier countries. The world must act urgently to close this equity gap.

We are now in a situation that would have seemed impossible two years ago: the global supply is high enough to support the overall goal of helping fair and comprehensive vaccination of all adult and adolescent populations at the global.

Ending a global pandemic requires authentically global — and not just international — mechanisms for getting vaccines to unprotected people.?During crises, difficult choices are generally made to allocate scarce resources. How the global community makes these choices reflect our values, morals, and priorities. On the contrary, behind an apparent global sharing, we have also seen nationalistic counterproductive, and immoral stances. Trust is needed to leverage real solidarity and advance planetary health as a developmental framework for a healthy and fair post-pandemic world. Vaccine equity is the best place to start.

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Improving access to safe, timely, and affordable surgical care

We should always remember that over two-thirds of the world’s population lack access to surgical care. Improving access to surgical care is essential since surgery can successfully treat a wide variety of conditions including cancers, injuries, infectious diseases, and pregnancy-related complications. However, many people do not currently have access to safe, timely, and affordable surgical care and anesthesia worldwide. In many areas of the world, most people cannot access even the most basic surgical services. Through universal access to safe, timely, and affordable surgery, we could save many lives, prevent disability and also promote economic growth as a result. On 22 May 2015, the 68th World Health Assembly unanimously passed resolution 68.15 on strengthening emergency and essential surgical and anesthesia care as a component of universal health coverage. This?resolution?urges?countries to prioritize surgical and?anesthesia care as part of national health plans, emphasizing the importance of service delivery, quality, training, workforce, infrastructure, and data collection to support monitoring and evaluation. To begin to address these crucial gaps in knowledge, policy, and action, The Lancet Commission on Global Surgery (LCoGS) was launched based on five key messages.

Approximately 5 billion people do not have access to safe, affordable surgical and anesthesia care when needed. Access is worst in?low-income and middle-income countries?(LMICs), where nine of 10 people cannot access basic surgical care.

An additional 143 million surgical procedures are needed in LMICs each year to save lives and prevent disability. Of the 313 million procedures undertaken worldwide each year, only 6 percent occur in the poorest countries, where more than a third of the world’s population lives. Low operative volumes are associated with high case-fatality rates from common, treatable surgical conditions. Unmet need is greatest in eastern, western, and central sub-Saharan Africa and South Asia.

An estimated 33 million individuals face catastrophic health expenses to pay for surgical and anesthesia care each year. An additional 48 million cases of catastrophic expenditure are attributable to the nonmedical costs of accessing surgical care such as transportation, lodging, and food. A quarter of the people who have a surgical procedure will incur financial catastrophe as a result of seeking care. The burden of catastrophic expenditure for surgery is highest for LMICs and, within any country, lands most heavily on poor people.

Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth. To meet present and projected population demands, urgent investment in human and physical resources for surgical and anesthesia care is needed. If LMICs were to scale up surgical services at rates achieved by the present best-performing LMICs, two-thirds of countries would be able to reach a minimum operative volume of 5,000 surgical procedures per 100,000 population by 2030. Without urgent and accelerated investment in surgical scale-up, LMICs will continue to have losses in economic productivity, estimated cumulatively at $12.3 trillion (2010 U.S. dollars, purchasing power parity) between 2015 and 2030.

Surgery is an “indivisible, indispensable part of health care.”Surgical and anesthesia care should be an integral component of a national health system in countries at all levels of development. Surgical services are a prerequisite for the full attainment of local and global health goals in areas as diverse as cancer, injury, cardiovascular disease, infection, and reproductive, maternal, neonatal, and child health. Universal health coverage and the health aspirations set out in the post-2015 sustainable development goals (SDGs) will be impossible to achieve without ensuring that surgical and anesthesia care is available, accessible, safe, timely, and affordable.

The LCoGS recommended the measurement of six key indicators necessary to assess a country’s surgical system. These indicators of a surgical system are as follows:

Two-hour access to a facility offering surgical services

- Surgical workforce density

- Surgical volume

- Perioperative mortality rate

- Protection against impoverishing expenditure

- Protection against catastrophic expenditure

The Lancet Commission on Investing in Health pointed to ‘the possibility of achieving dramatic gains in global health by 2035 through a grand convergence around infectious, child, and maternal mortality; major reductions in the incidence and consequences of non-communicable diseases and injuries; and the promise of universal coverage.

Probably this lofty goal will not be achieved without the provision of safe, accessible, affordable, and essential surgical services.

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Supporting a “One Health” approach

In the last twenty years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 to 2003, and H1N1 influenza in 2009, have been recorded. Most recently, the Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia in 2012. In a timeline that reaches the present day, an epidemic of cases with unexplained low respiratory infections detected in Wuhan, the largest metropolitan area in China’s Hubei province, was first reported to the WHO Country Office in China, on December 31, 2019. According to the first genetic analyses of SARS-CoV2, the virus originating in a bat required an intermediate host to acquire, through recombination and mutation, the capacity to infect humans. Among the possibilities identified in the search for the intermediate host: the pangolin, a heavily poached endangered species. This type of virus transmission is possible but rare. However, in recent years, interactions between areas occupied by humans and natural areas have accelerated. The destruction and fragmentation of the habitats of certain species, their farming, and their illegal trafficking all increase health risks. In addition to the anthropization of areas (urbanization, transport, mining, etc.), the industrialization of agriculture, food production, and livestock farming – with, in particular, the intensive use of antibiotics creating resistance in bacteria –, are also implicated in the multiplication of infectious diseases incidents and the creation of conditions conducive to their globalization. To manage the ongoing crisis and to better anticipate the next one, it is needed to strengthen the foundations of the ecology of health, focusing on the interdependencies between the functioning of ecosystems, sociocultural practices, and the health of humans, animals, and plant populations took together. COVID-19 is a recent example of the complex threats of emerging infectious diseases. Emerging infections in humans and animals, along with other threats such as antimicrobial resistance, are difficult challenges to humanity, to a large extent driven by increasing food production and other issues related to a growing and more resource-demanding population.

The interdisciplinary “One Health “approach represents an attempt to deal with such complex problems by engaging professionals from many disciplines such as human, veterinary, and environmental health, as well as social sciences. The “One Health” approach recognizes the interrelationship between animals, humans, and the environment and encourages collaborative efforts to improve the health of people and animals, including pets, livestock, and wildlife.

The “One Health” concept summarises an idea that has been known for more than a century: animal health, human health, and environmental health are intrinsically intertwined and interdependent. The health of one affects the health of all. Implement “One Health” should be envisaged as a collaborative global approach to understanding and managing risks for planetary health and encouraging a more sustainable ecosystem balance.

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Combating Antimicrobial Resistance

As the world grapples with the Covid-19 pandemic, many lessons are being learned, not the least of which is how to better prepare for future pandemics. This includes addressing the ongoing antimicrobial resistance (AMR) pandemic, which at a global scale has potential similar to COVID-19.

COVID-19 and AMR are parallel and interacting health emergencies that have similarities and offer opportunities for mutual learning with regard to their control.?

Like COVID-19, AMR is also a global threat — potentially it may be a still greater one. Based on broad estimates, deaths from antimicrobial-resistant infections are projected to increase from the current toll of 700,000 to 10 million every year by 2050.

Like COVID-19, AMR can affect us all. It does not care who we are, or where we are: everyone is at risk.

But unlike COVID-19, the danger of AMR has been creeping up on us silently and gradually and it has taken time for the seriousness of this threat to trickle down to the public consciousness. Further, the complexity of the problem and the need for an integrated response across human, animal, and environmental sectors can prove challenging. In many countries, AMR is still perceived more as a?human health problem?and there is insufficient coordination across sectors.

AMR has emerged as one of the principal public health problems of the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi no longer susceptible to the common antimicrobial agents used to treat them. The problem of AMR is especially urgent regarding antibiotic resistance in bacteria. Antibiotics played an unprecedented role in social and medical development, and at present, antibiotics are obligatory in all health care systems. The success of modernized medicine, namely organ transplantation, cancer therapy, management of preterm babies, or a surplus of advanced major surgeries, might not have been possible without effective antibiotic treatment to control for bacterial infections.

AMR develops across the animal, human, and environment triangle or niche and there is interlinked sharing of these pathogens in this triad.?

The plausible causes of AMR include overuse and misuse use of antibiotics in animals (food, pets, aquatic) and humans, antibiotics sold over-the-counter, increased international travel, poor sanitation/hygiene, and release of nonmetabolized antibiotics or their residues into the environment through manure/feces. These factors contribute to selection pressure for the emergence of AMR in the community. AMR shows no signs of decline, though it may perhaps shift direction.

The etiology of AMR is multifaceted, and its consequences pose an impact across the globe.

Actions against resistance should focus firstly on local needs and plans because each country is different. However, resistance is everyone’s problem and all countries have a role in solving the problem.

The countries that have crafted inclusive national plans have been successful in controlling AMR. These approaches include cautious use of antibiotics, surveillance of antibiotics by employing the “One Health Approach,” advancement of health care setup, restricted drug promotion, consistent disease control strategies, and stewardship plans. On the other hand, these strategies demand patience and time to be organized. Furthermore, these require a comprehensive endorsement from the government authorities with ample funds.

Like Covid-19, AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of AMR through travel and trade.?Working alone is not sufficient and international partnerships to seek global solutions to tackle AMR are mandatory.

By collaborating there are opportunities for disseminating the best approaches for prevention and management. The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem, nor from playing a role in the solution. This means wider engagement the wider, healthcare workers, vets, and farmers around the world.

AMR is universal, affecting anyone and everyone, at any age and in any country and misuse is worsening the situation globally. Urgent action is needed. Public health education and changes in behavior are critical as we begin to enter a post-antibiotic era where the simplest of infections will kill, as we only know too well with Covid-19.

The current pandemic shows that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no therapies. However, it shows that if sufficiently motivated, we can make huge changes in short timeframes.

There is no doubt COVID-19 currently represents the most obvious and urgent issue for global health security and the world is rightfully focused on tackling this pandemic. However, the challenges posed by COVID-19 may be only a foretaste of what AMR can mean to the world without appropriate interventions. AMR, the silent pandemic, can impact many of the global health achievements of past decades and jeopardize efforts to deliver on many of the Sustainable Development Goals.

The COVID-19 pandemic provides governments and global institutions with an unprecedented opportunity to address the failures of both health systems and the global Research and Development systems. The unprecedented focus on global health as an imperative for wellbeing and prosperity by governments should be used to prepare for – and prevent as much as possible – other pandemics, in particular those that are slowly unfolding right in front of us, such as AMR.

Although AMR hasn’t gotten our attention in the same way that COVID-19 has, AMR presents a growing global menace.?AMR is a silent pandemic that often goes unnoticed by a majority of people around the world.