Wills Pritchard, Sir Walter Murdoch School of Public Policy and International Affairs
The most common theme of my 72nd World Health Assembly experience has been the need for more expansive collective action on the most challenging global health issues currently experienced by member states. Whilst it is hardly surprising that such a message would be so strongly advocated, the immense range of global health issues to which this applies was particularly striking, and this was demonstrated in numerous settings throughout day two.
Two key elements stood out: firstly, the wide range of challenges that the World Health Organisation (WHO) is currently responsible for addressing; and secondly, the ongoing institutional challenges it faces, such as maintaining public trust and advancing evidence-based practice.
In terms of the former category, it was readily apparent that the collective action problems faced by the WHO reach far beyond the headline issues, such as anti-microbial resistance (AMR) and climate change. For example, the nuanced issue of how best to develop and implement emerging medical technologies was a subject that was expanded upon through a number of technical briefings. Within these it was made clear that the potentially transformative effect of data collection and health information systems is well understood, however, there remains a substantial deficiency in the WHO’s current capacities to manage the ethical and security dimensions that inevitably arise in their implementation. Similarly, the strong interest shown in artificial intelligence (AI) and machine learning, in both clinical and analytical settings, was largely discussed through the lens of how they can be responsibly managed and, critically, equitably deployed. It became readily apparent that a robust global health governance structure was an essential component of the incorporation of these technological developments not only in the establishment of ethical codes of conduct, but through being able to cut through the hype that often accompanies them, a phenomenon that has previously been counterproductive.
Another arm of the WHO’s operations that was discussed in some detail, was how best to prepare for and manage humanitarian crises from a health care perspective. Particular emphasis to this end was placed on the implications of these events on universal health coverage (UHC). It was encouraging to see key representatives in attendance affirm that objectives concerning peace, security and equity cannot be disentangled from those of UHC and emphasise the need to take an intersectional approach for more holistic international cooperation. While the discussions of technological change were typically concerned with centralised approaches, those regarding humanitarian crises placed considerable emphasis on the empowerment of communities to develop resilience in managing these crises. Local capacity building largely in human resources for health (HRH) was a central consideration in this policy space, with the expansion of locally derived expertise being an essential component of providing continuity of health services after the initial shock of these crises dissipates.
Interestingly, whilst there was some future focus to these discussions, they were heavily oriented towards the humanitarian crises caused by armed conflicts and geopolitical violence. Consequently, little mention was made of the intersection between humanitarian crises and climate change, both as an imminent threat to human safety and an accelerant of insecurity. Whilst the global health response to climate change driven humanitarian crises will no doubt be considered in great detail elsewhere in the 72nd WHA, greater cognisance of these linkages would have been highly beneficial in this setting.
Finally, the importance of building legitimacy and trust in the WHO was a part of all the discussions I observed on day 2 of the 72nd WHA and was crystallised in a youth-oriented discussion concerning tokenism and hierarchy in global governance settings. Cognisance of how the current design of global governance institutions may be shaped by inherently unequal structures (both economic and cultural) is absolutely essential in fostering legitimacy going forward. More broadly, the required responses to these institutional challenges - such as greater public engagement, inclusion and the greater advancement of evidence-based practice - can only be achieved through sustained and increased cooperation on the international level; an area in which the WHO plays a central role.