- Email: [email protected]
Webcast the World Health Assembly
Correspondence
2 3
Bennett TH, Holloway K. The impact of takehome naloxone distribution and training on opiate overdose knowledge and response: an evaluation of the THN project in Wales. Drugs Educ Prevent Policy 2012; 19: 320–28. Bird SM. Counting the dead properly and promptly. J R Stat Soc 2013; 176: 815–817. Gossop M, Griffiths P, Powis B, Williamson S, Strang J. Frequency of non-fatal heroin overdose; survey of heroin users recruited in non-clinical settings. BMJ 1996; 313: 402.
Webcast the World Health Assembly Once a year, delegates of WHO member states gather in Geneva for the World Health Assembly (WHA) to establish WHO’s priorities and programmes for the coming year. Those health practitioners, scholars, advocates, and journalists who are brave (or foolish) enough to come to the event jostle for credentials and queue for security, after spending thousands of dollars and burning tanks of jet fuel, with no guarantee of having a seat in the small public gallery. The expense and bother of attending the WHA have many negative consequences for international health governance. Many civil society organisations, especially those from low-income and middle-income countries for whom foreign travel is prohibitively expensive, are excluded, as are the vulnerable populations they represent. Few journalists have the resources to attend the WHA, so even important global health stories go unreported. Transparency, debate, and accountability all suffer as a result. We believe that a substantial improvement would be made by webcasting the WHA and, in due course, all WHO regional committee and member state meetings. This would allow many more people to observe and even to comment on the proceedings in real time with social media. Wider debate and extra publicity would also establish the WHA as an annual event of importance, and thereby reinforce the public perception of WHO. www.thelancet.com Vol 383 January 11, 2014
WHO is the untransparent exception in the UN for not webcasting its meetings. The UN Security Council and General Assembly webcast many proceedings; and so do most UN agencies (such as the Food and Agriculture Organization, the International Atomic Energy Agency, or the World Intellectual Property Organization, among others). Possibly the most enthusiastic is the International Telecommunications Union, which webcasts even its preparatory meetings and provides an open forum for public input.1 Plainly, WHO must catch up. Currently, some of WHO’s regional committees webcast parts of their proceedings.2 For a comprehensive webcasting as soon as the 2014 WHA, technical, legal, and political challenges need to be discussed. Technically, the WHA is already carried on closed-circuit video with simultaneous interpretation in the six UN languages. Live streaming these audio and video channels is easily done with a conventional internet connection, and need not be expensive, especially if the other UN organisations in Geneva share their technical facilities. Legally, there is nothing secret or proprietary about WHA proceedings (excluding closed-door diplomatic sessions). Observers range freely over the meeting hall, and there is no reasonable expectation of privacy over anything said or done. WHO has already taken the liberty of webcasting selected speeches and sights from the scene.3,4 Nothing would be transgressed by comprehensive webcasting in real time. Politically, many UN forums are webcast, so the WHA should be no different. A difficulty is that the WHO Secretariat has as recently as this year refused to enforce the organisation’s transparency rules when faced with opposition from some member states. A WHA Resolution passed by member states in 1987 gives officially recognised NGOs the “right...to participate” in committee
meetings convened under WHO’s authority.5 That this express legal right is sometimes being breached suggests that the WHO Secretariat is less committed to transparency than it might be. When the WHO’s Executive Board meets in January, 2014, we urge that it (and not the Secretariat) decide to webcast the comprehensive WHA 2014 proceedings. The Executive Board already makes all the basic decisions about convening the WHA, such as choosing the time and place, so it could easily stipulate webcasting too. It would then be up to WHO’s Director General, acting at the Executive Board’s request, to inform member states and to make the necessary arrangements. We expect these proposals to be popular all around. Although poor countries and smaller NGOs have the most to gain, in times of austerity all member states can save money by bringing fewer officials to the WHA. For health professionals, scholars, and activists, webcasts will often make the difference between being au courant with the WHA and global health governance or not at all. Indeed, the reasons are so compelling that it is surprising that the WHA has not already been webcast by public health “hacktivists” with camera phones. That might be the eventual outcome, although it would be better for WHO to do so first.
UIG via Getty Images
1
We declare that we have no conflicts of interest.
*Amir Attaran, David Benton, James Chauvin, Martin McKee, Valerie Percival [email protected] University of Ottawa, Faculty of Law, Ottawa, ON, Canada (AA); International Council of Nurses, Geneva, Switzerland (DB); World Federation of Public Health Associations, Geneva, Switzerland (JC); London School of Hygiene and Tropical Medicine, London, UK (MM); and Norman Patterson School of International Affairs, Carleton University, Ottawa, Canada (VP) 1
International Telecommunications Union. World Conference on International Telecommunications (WCIT-12); Dubai, United Arab Emirates Dec 3–14, 2012. http://www.itu. int/en/wcit-12/Pages/default.aspx (accessed Sept 11, 2013).
125
Correspondence
2 For the World Health Summit statement see http://www. worldhealthsummit.org/ fileadmin/downloads/2013/ WHS_2013/Publications/M8_ Statement%20Berlin.pdf
3
4 For more on the Association of Academic Health Centers International see http://www. aahci.org/
5
WHO Regional Office for Europe. Regional Committee 2013 (RC63); Çeşme Izmir, Turkey, Sept 16–19, 2013. http://www.youtube.com/ playlist?list=PLL4_zLP7J_mhHB4mR9Rmh6TLaIpgFj-t (accessed Nov 4, 2013). WHO. 64th World Health Assembly (time lapse). http://www.youtube.com/ watch?v=1bUkk1Z4b1Y (accessed Sept 11, 2013). WHO. Sixty-Sixth World Health Assembly. http://www.who.int/mediacentre/ events/2013/wha66/en/ (accessed Sept 11, 2013). WHO. Principles Governing Relations Between the World Health Organization and Nongovernmental Organizations (Resolution WHA40.25), 1987. http://apps.who.int/gb/bd/ PDF/bd47/EN/principles-governing-rela-en. pdf (accessed Sept 11, 2013).
Ocean/Corbis
Students’ reflections on the World Health Summit
For more on the Qatar National Health Strategy see http:// www.nhsq.info
126
The World Health Summit (WHS) was held in Berlin, Germany, on Oct 20–22, 2013, allegedly gathering 1200 delegates from academia, civil society, and the private sector to discuss global health topics. After the success of previous years’ event, four student organisations organised a student-led satellite workshop “Towards health in all policies—building future leaders” and daily briefings during the summit. About 40 students interested in global health from different backgrounds, representing 20 different countries, attended this informal setting to discuss the most relevant topics of the summit. As members of the organising committee of the above-mentioned workshop, we would like to draw attention to some essential shortcomings of the WHS. Despite the steps taken in the past years to ensure youth participation— namely the integration of students in panels and our workshop—there is still a large generation gap, with young professionals partly absent from discussions. There were also severe issues in sex representation (with panels where women were notably absent) and geographical
representation (with few speakers from developing countries). A statement was issued at the end of the summit in which neither concrete actions nor recommendations are mentioned, and no critical analysis of the summit was made. We, the future generation of professionals, continue, strongly committed, to contribute to global health worldwide, and we hope to have contributed towards a more efficient summit. We declare that we have no conflicts of interest.
*Sofia Ribeiro, Christopher Schürmann, Christian Kraef, Philipp Munzert sofiafi[email protected] European Medical Students’ Association, Brussels 1040, Belgium (SR); German Medical Students’ Association and Hannover Medical School, Hannover, Germany (CS); German Medical Students’ Association and University of Münster, Münster, Germany (CK); and International Federation of Medical Students’ Associations and Charité University Medicine Berlin, Berlin, Germany (PM)
Improving health care in the Middle East and North Africa Health-care delivery, education of health professionals, and health research are rapidly changing. Trends— such as an ageing population, an increasing burden of chronic diseases, and economic shifts—are generating new needs, and academic health centres are at the nexus of these important changes. It is now generally recognised that the best education, research, and care models result when these three areas are inter-related in what has been described as a virtuous cycle.1 Health equity and efficiency are a prerequisite for driving regional social justice and economic development.2 Health inequality has to be balanced against current investments (an estimated US$1 trillion programme in the region in the next decade). Although these investments will undoubtedly bring economic and social benefits to the region, they will
also generate population growth and fuel the demand for more regionally relevant research, education, and evidence-based clinical practice. At the recent Association of Academic Health Centers International (AAHCI) conference held in Doha, Quatar, in March 2013, the key challenges identified were: educating a skilled and flexible workforce able to adapt to the rapidly changing healthcare environment; building capacity and capability through recruitment, retention, education, and partnership; locally relevant research supported by international partnerships; and driving improved clinical performance through a focus on quality and safety. A potential unifying solution is to align academic and clinical missions by creating academic health centres and systems. This is the approach taken by Qatar—where academic health partnership is the vehicle that underpins the delivery of the National Health Strategy. There is support for these nascent developments by established medical centres along with AAHCI and other leading international health-care institutions. Health-care development in the region has not kept pace with the economic growth and the international health-care community has a great opportunity to engage in the region for the benefit of patients and communities. SW is president and EH is consulting director of AAHCI.
*Edward Hillhouse, Steven Wartman [email protected] Department of Medicine, Weill Cornell Medical College, New York 1021, USA (EH); Hamad Medical Corporation, Doha, Qatar (EH); and Association of Academic Health Centers, Washington DC, USA (SW) 1
2
3
Wartman SA. Towards a virtuous cycle: the changing face of academic health centers. Guest Editorial. Acad Med 2008; 83: 797–99. World Bank. Achieving better health equity and efficiency in the Middle East and North Africa. http://go.worldbank.org/NI4HTZRAL0 (accessed Sept 14, 2013). World Bank. Infrastructure and employment creation in the Middle East and North Africa. http://siteresources.worldbank.org/INTMENA/ Resources/QN54-infrastructure-andemployment-creation-in-MENA.pdf (accessed Sept 14, 2013).
www.thelancet.com Vol 383 January 11, 2014
2 3
Bennett TH, Holloway K. The impact of takehome naloxone distribution and training on opiate overdose knowledge and response: an evaluation of the THN project in Wales. Drugs Educ Prevent Policy 2012; 19: 320–28. Bird SM. Counting the dead properly and promptly. J R Stat Soc 2013; 176: 815–817. Gossop M, Griffiths P, Powis B, Williamson S, Strang J. Frequency of non-fatal heroin overdose; survey of heroin users recruited in non-clinical settings. BMJ 1996; 313: 402.
Webcast the World Health Assembly Once a year, delegates of WHO member states gather in Geneva for the World Health Assembly (WHA) to establish WHO’s priorities and programmes for the coming year. Those health practitioners, scholars, advocates, and journalists who are brave (or foolish) enough to come to the event jostle for credentials and queue for security, after spending thousands of dollars and burning tanks of jet fuel, with no guarantee of having a seat in the small public gallery. The expense and bother of attending the WHA have many negative consequences for international health governance. Many civil society organisations, especially those from low-income and middle-income countries for whom foreign travel is prohibitively expensive, are excluded, as are the vulnerable populations they represent. Few journalists have the resources to attend the WHA, so even important global health stories go unreported. Transparency, debate, and accountability all suffer as a result. We believe that a substantial improvement would be made by webcasting the WHA and, in due course, all WHO regional committee and member state meetings. This would allow many more people to observe and even to comment on the proceedings in real time with social media. Wider debate and extra publicity would also establish the WHA as an annual event of importance, and thereby reinforce the public perception of WHO. www.thelancet.com Vol 383 January 11, 2014
WHO is the untransparent exception in the UN for not webcasting its meetings. The UN Security Council and General Assembly webcast many proceedings; and so do most UN agencies (such as the Food and Agriculture Organization, the International Atomic Energy Agency, or the World Intellectual Property Organization, among others). Possibly the most enthusiastic is the International Telecommunications Union, which webcasts even its preparatory meetings and provides an open forum for public input.1 Plainly, WHO must catch up. Currently, some of WHO’s regional committees webcast parts of their proceedings.2 For a comprehensive webcasting as soon as the 2014 WHA, technical, legal, and political challenges need to be discussed. Technically, the WHA is already carried on closed-circuit video with simultaneous interpretation in the six UN languages. Live streaming these audio and video channels is easily done with a conventional internet connection, and need not be expensive, especially if the other UN organisations in Geneva share their technical facilities. Legally, there is nothing secret or proprietary about WHA proceedings (excluding closed-door diplomatic sessions). Observers range freely over the meeting hall, and there is no reasonable expectation of privacy over anything said or done. WHO has already taken the liberty of webcasting selected speeches and sights from the scene.3,4 Nothing would be transgressed by comprehensive webcasting in real time. Politically, many UN forums are webcast, so the WHA should be no different. A difficulty is that the WHO Secretariat has as recently as this year refused to enforce the organisation’s transparency rules when faced with opposition from some member states. A WHA Resolution passed by member states in 1987 gives officially recognised NGOs the “right...to participate” in committee
meetings convened under WHO’s authority.5 That this express legal right is sometimes being breached suggests that the WHO Secretariat is less committed to transparency than it might be. When the WHO’s Executive Board meets in January, 2014, we urge that it (and not the Secretariat) decide to webcast the comprehensive WHA 2014 proceedings. The Executive Board already makes all the basic decisions about convening the WHA, such as choosing the time and place, so it could easily stipulate webcasting too. It would then be up to WHO’s Director General, acting at the Executive Board’s request, to inform member states and to make the necessary arrangements. We expect these proposals to be popular all around. Although poor countries and smaller NGOs have the most to gain, in times of austerity all member states can save money by bringing fewer officials to the WHA. For health professionals, scholars, and activists, webcasts will often make the difference between being au courant with the WHA and global health governance or not at all. Indeed, the reasons are so compelling that it is surprising that the WHA has not already been webcast by public health “hacktivists” with camera phones. That might be the eventual outcome, although it would be better for WHO to do so first.
UIG via Getty Images
1
We declare that we have no conflicts of interest.
*Amir Attaran, David Benton, James Chauvin, Martin McKee, Valerie Percival [email protected] University of Ottawa, Faculty of Law, Ottawa, ON, Canada (AA); International Council of Nurses, Geneva, Switzerland (DB); World Federation of Public Health Associations, Geneva, Switzerland (JC); London School of Hygiene and Tropical Medicine, London, UK (MM); and Norman Patterson School of International Affairs, Carleton University, Ottawa, Canada (VP) 1
International Telecommunications Union. World Conference on International Telecommunications (WCIT-12); Dubai, United Arab Emirates Dec 3–14, 2012. http://www.itu. int/en/wcit-12/Pages/default.aspx (accessed Sept 11, 2013).
125
Correspondence
2 For the World Health Summit statement see http://www. worldhealthsummit.org/ fileadmin/downloads/2013/ WHS_2013/Publications/M8_ Statement%20Berlin.pdf
3
4 For more on the Association of Academic Health Centers International see http://www. aahci.org/
5
WHO Regional Office for Europe. Regional Committee 2013 (RC63); Çeşme Izmir, Turkey, Sept 16–19, 2013. http://www.youtube.com/ playlist?list=PLL4_zLP7J_mhHB4mR9Rmh6TLaIpgFj-t (accessed Nov 4, 2013). WHO. 64th World Health Assembly (time lapse). http://www.youtube.com/ watch?v=1bUkk1Z4b1Y (accessed Sept 11, 2013). WHO. Sixty-Sixth World Health Assembly. http://www.who.int/mediacentre/ events/2013/wha66/en/ (accessed Sept 11, 2013). WHO. Principles Governing Relations Between the World Health Organization and Nongovernmental Organizations (Resolution WHA40.25), 1987. http://apps.who.int/gb/bd/ PDF/bd47/EN/principles-governing-rela-en. pdf (accessed Sept 11, 2013).
Ocean/Corbis
Students’ reflections on the World Health Summit
For more on the Qatar National Health Strategy see http:// www.nhsq.info
126
The World Health Summit (WHS) was held in Berlin, Germany, on Oct 20–22, 2013, allegedly gathering 1200 delegates from academia, civil society, and the private sector to discuss global health topics. After the success of previous years’ event, four student organisations organised a student-led satellite workshop “Towards health in all policies—building future leaders” and daily briefings during the summit. About 40 students interested in global health from different backgrounds, representing 20 different countries, attended this informal setting to discuss the most relevant topics of the summit. As members of the organising committee of the above-mentioned workshop, we would like to draw attention to some essential shortcomings of the WHS. Despite the steps taken in the past years to ensure youth participation— namely the integration of students in panels and our workshop—there is still a large generation gap, with young professionals partly absent from discussions. There were also severe issues in sex representation (with panels where women were notably absent) and geographical
representation (with few speakers from developing countries). A statement was issued at the end of the summit in which neither concrete actions nor recommendations are mentioned, and no critical analysis of the summit was made. We, the future generation of professionals, continue, strongly committed, to contribute to global health worldwide, and we hope to have contributed towards a more efficient summit. We declare that we have no conflicts of interest.
*Sofia Ribeiro, Christopher Schürmann, Christian Kraef, Philipp Munzert sofiafi[email protected] European Medical Students’ Association, Brussels 1040, Belgium (SR); German Medical Students’ Association and Hannover Medical School, Hannover, Germany (CS); German Medical Students’ Association and University of Münster, Münster, Germany (CK); and International Federation of Medical Students’ Associations and Charité University Medicine Berlin, Berlin, Germany (PM)
Improving health care in the Middle East and North Africa Health-care delivery, education of health professionals, and health research are rapidly changing. Trends— such as an ageing population, an increasing burden of chronic diseases, and economic shifts—are generating new needs, and academic health centres are at the nexus of these important changes. It is now generally recognised that the best education, research, and care models result when these three areas are inter-related in what has been described as a virtuous cycle.1 Health equity and efficiency are a prerequisite for driving regional social justice and economic development.2 Health inequality has to be balanced against current investments (an estimated US$1 trillion programme in the region in the next decade). Although these investments will undoubtedly bring economic and social benefits to the region, they will
also generate population growth and fuel the demand for more regionally relevant research, education, and evidence-based clinical practice. At the recent Association of Academic Health Centers International (AAHCI) conference held in Doha, Quatar, in March 2013, the key challenges identified were: educating a skilled and flexible workforce able to adapt to the rapidly changing healthcare environment; building capacity and capability through recruitment, retention, education, and partnership; locally relevant research supported by international partnerships; and driving improved clinical performance through a focus on quality and safety. A potential unifying solution is to align academic and clinical missions by creating academic health centres and systems. This is the approach taken by Qatar—where academic health partnership is the vehicle that underpins the delivery of the National Health Strategy. There is support for these nascent developments by established medical centres along with AAHCI and other leading international health-care institutions. Health-care development in the region has not kept pace with the economic growth and the international health-care community has a great opportunity to engage in the region for the benefit of patients and communities. SW is president and EH is consulting director of AAHCI.
*Edward Hillhouse, Steven Wartman [email protected] Department of Medicine, Weill Cornell Medical College, New York 1021, USA (EH); Hamad Medical Corporation, Doha, Qatar (EH); and Association of Academic Health Centers, Washington DC, USA (SW) 1
2
3
Wartman SA. Towards a virtuous cycle: the changing face of academic health centers. Guest Editorial. Acad Med 2008; 83: 797–99. World Bank. Achieving better health equity and efficiency in the Middle East and North Africa. http://go.worldbank.org/NI4HTZRAL0 (accessed Sept 14, 2013). World Bank. Infrastructure and employment creation in the Middle East and North Africa. http://siteresources.worldbank.org/INTMENA/ Resources/QN54-infrastructure-andemployment-creation-in-MENA.pdf (accessed Sept 14, 2013).
www.thelancet.com Vol 383 January 11, 2014