Palais des Nations in GenevaBy Dr Ashley Bloomfield
HGI Executive Learning Set Member and Director & Acting General Manager
NZ Capital & Coast District Health Board (NZ)

The Palais des Nations in Geneva is the venue for the World Health Assembly each May. Built in the Classic style in the 1930s as the headquarters of the League of Nations, it is now the headquarters for the UN in Geneva and hosts over 10,000 intergovernmental meetings each year.

This year’s 67th World Health Assembly (WHA) from 19 to 24 May was attended by most of the 194 Member States of the World Health Organization. Both Australia and New Zealand have a history of strong involvement in these meetings and the work of WHO more widely. The Directors-General of Health, Jane Halton and Chai Chuah, were leading their countries’ delegations this year and Jane was the outgoing Chair of the WHO Executive Board.

While the format for the six day meeting can be very formulaic, there are always a few surprises in store! In her opening address, WHO Director-General Dr Margaret Chan emphasised that health has an ‘obligatory’ place on any post-2015 agenda. She was referring specifically to the post-2015 development agenda, currently being negotiated in New York, to replace the Millenium Development Goals. This was a major topic for discussion at the WHA and both New Zealand and Australia participated actively in the development of a resolution, which was adopted by the Assembly on the last day.

A key theme in these discussions was that of universal health coverage, which was the focus for the 2013 World Health Report.

Dr Chan is always challenging and during her time as DG she has championed the health of women and girls. This focus was reflected in the choice of guest speakers at this year’s Assembly – Dr Christine Kaseba-Sata, First Lady of the Republic of Zambia, and Melinda Gates, Co-chair of the Gates Foundation. Their speeches can be viewed online.

I found Dr Kaseba-Sata particularly impressive. A trained gynaecologist, she has campaigned fearlessly against gender-based violence and made an impassioned plea to the assembled world health leaders to address this issue. The most intensely debated resolution during the week was on the topic of “Preventing interpersonal violence, particularly against women and girls”. Many long hours were spent negotiating wording that all countries could agree to – one session went until 3am! Tricky issues included early and forced marriage and female genital mutilation. However, as with many difficult issues previously, consensus was achieved, emphasising the importance of WHO’s role in global norm setting on health issues.

The Assembly also saw the launch of a Commission on Ending Childhood Obesity, which will be co-chaired by Prof Sir Peter Gluckman, the Chief Science Advisor to the NZ Prime Minister. This is a major development and it will be interesting to see how the work unfolds over the next 9 months – the Director-General is expecting advice from the Commission in early 2014. Many people in the health community will have high hopes for this initiative but it will not be straightforward. I imagine that intense lobbying will have already started by global food and beverage multinationals to ensure their views are heard. The focus on childhood obesity is deliberate, not just because of the emerging evidence that intervention needs to occur during pregnancy and infancy. It is hard to argue that children are informed decision-makers with full control over their food intake.

New Zealand has played an on-going role in WHO’s work on the Prevention and Control of non-communicable diseases (NCDs), another major topic this year. NCDs were the topic of a UN General Assembly High-Level Meeting in September 2011, only the second time ever that a health topic has been debated at this level (the first was HIV/AIDS in 2001). Progress since 2011 with NCD prevention and control will be reviewed back at the UN in New York in July this year.

Why are NCDs important? Well, this group of diseases (primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) are responsible for 63% of all deaths worldwide – some 36 million out 57 million global deaths each year. What’s more, these are not just the diseases of rich countries as 80% of NCD-related deaths occur in low and middle income countries. While mortality rates from most NCDs are declining in developed countries (hence our ongoing increases in life expectancy), this is not the case in developing countries and there are many preventable early deaths.

To return to the topic of the post-2015 development agenda, there is a big push to ensure that NCDs are part of this agenda as they were missing from the Millennium Development Goals. While there is still unfinished business with communicable diseases and maternal and child health, the next 15 years will require sustained global action on NCDs. Both Australia and New Zealand have a major role to play in supporting developing countries – perhaps particularly in the Pacific – with this challenge.