The World Health Organisation (WHO) has a list of urgent, global health challenges for the new decade. This list, developed with input from experts around the world, reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.

“We need to realise that health is an investment in the future. Countries invest heavily in protecting their people from terrorist attacks, but not against the attack of a virus, which could be far more deadly, and far more damaging economically and socially. Governments, communities and international agencies must work together to achieve these critical goals,” it said in a statement.

1. Elevating health in the climate debate

The climate crisis is a health crisis. Air pollution kills an estimated 7 million people every year, while climate change causes more extreme weather events, exacerbates malnutrition and fuels the spread of infectious diseases such as malaria. The same emissions that cause global warming are responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease. This year, WHO will work towards developing a set of policy options for governments to prevent or reduce the health risks of air pollution.

2. Delivering health in conflict and crisis

In 2019, most disease outbreaks requiring the highest level of WHO response occurred in countries with protracted conflict. WHO recorded 978 attacks on health care in 11 countries last year, with 193 deaths. At the same time, conflict is forcing record numbers of people out of their own homes, leaving tens of millions of people with little access to health care, sometimes for years.

3. Making health care fairer

Persistent and growing socio-economic gaps result in major discrepancies in the quality of people’s health. There’s not only an 18-year difference in life expectancy between rich and poor countries, but also a marked gap within countries and even within cities. Meanwhile, the global rise in non-communicable diseases, such as cancer, chronic respiratory disease and diabetes has a disproportionately large burden in low and middle-income countries and can quickly drain the resources of poorer households. WHO will provide guidance on how countries can better reduce inequality in health care, such as by improving the governance and management of public and private health services.

4. Expanding access to medicines

About one-third of the world’s people lack access to medicines, vaccines, diagnostic tools and other essential health products. Medicines and other health products are the second-largest expenditure for most health systems (after health workers) and the largest component of private health expenditure in low and middle-income countries.

5. Stopping infectious diseases

Infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases and sexually transmitted infections will kill an estimated 4 million people in 2020, most of them poor. Meanwhile, vaccine-preventable diseases continue to kill, such as measles, which took 140,000 lives in 2019, many of them children. Although polio has been driven to the brink of eradication, there were 156 cases of wild poliovirus last year, the most since 2014.

6. Preparing for epidemics

Every year, the world spends far more responding to disease outbreaks, natural disasters and other health emergencies than it does preparing for and preventing them. A pandemic of a new, highly infectious, airborne virus - most likely a strain of influenza - to which most people lack immunity is inevitable. Meanwhile, vector-borne diseases like dengue, malaria, Zika, chikungunya and yellow fever are spreading as mosquito populations move into new areas, fanned by climate change.

7. Protecting people from dangerous products

Lack of food, unsafe food and unhealthy diets are responsible for almost one-third of today’s global disease burden. At the same time, as people consume foods and drinks high in sugar, saturated fat, trans fat and salt, overweight, obesity and diet-related diseases are on the rise globally. WHO is working with countries to develop evidence-based public policies, investments and private sector reforms to reshape food systems, and provide healthy and sustainable diets.

8. Investing in the people who defend our health

Chronic under-investment in the education and employment of health workers, coupled with a failure to ensure decent pay, has led to health worker shortages all over the world. This jeopardises health and social care services and sustainable health systems. The world will need 18 million additional health workers by 2030, primarily in low and middle-income countries, including 9 million nurses and midwives. To trigger action and encourage investment in education, skills and jobs, the World Health Assembly has designated 2020 the Year of the Nurse and the Midwife.

9. Keeping adolescents safe

More than 1 million adolescents aged 10-19 years die every year. The leading causes of death in this age group are road injury, HIV, suicide, lower respiratory infections and interpersonal violence. Harmful use of alcohol, tobacco and drug use, lack of physical activity, unprotected sex and previous exposure to child maltreatment all increase the risks for these causes of death. In 2020, WHO will issue new guidance for policymakers, health practitioners and educators, called Helping Adolescents Thrive.

10. Earning public trust

Trust helps to shape whether patients are likely to rely on health services and follow a health worker’s advice - around vaccinations, taking medicines or using condoms. Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions. The anti-vaccination movement has been a significant factor in the rise of deaths in preventable diseases. WHO is working with countries to strengthen primary health care, so people can access effective and affordable services easily, from people they know and trust, in their own communities.

11. Harnessing new technologies

New technologies are revolutionising our ability to prevent, diagnose and treat many diseases. Genome editing, synthetic biology and digital health technologies such as artificial intelligence can solve many problems, but also raise new questions and challenges for monitoring and regulation. Without a deeper understanding of their ethical and social implications, these new technologies, which include the capacity to create new organisms, could harm the people they are intended to help.

12. Protecting the medicines that protect us

Antimicrobial resistance (AMR) threatens to send modern medicine back decades to the pre-antibiotic era, when even routine surgeries were hazardous. The rise of AMR stems from myriad factors that have come together to create a terrifying brew, including unregulated prescription and use of antibiotics, lack of access to quality and affordable medicines, and lack of clean water, sanitation, hygiene and infection prevention and control.

13. Keeping health care clean

Roughly one in four health facilities globally lack basic water services. Water, sanitation and hygiene services are critical to a functioning health system. The lack of these basics in health facilities leads to poor-quality care and an increased chance of infection for patients and health workers. WHO and its partners are currently working with 35 low and middle-income countries to improve the water, sanitation and hygiene conditions in their health facilities.

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