Memo to Dr. Tedros: Your WHO Leadership

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How peculiar that the World Health Organization does not get that global health needs have been transforming over the last 2-3 decades as a consequence of its own brilliant and groundbreaking work in the last century. Too bad they cannot seem to be able to make even minor changes to account for the revolution in global health brought about by 21st-century longevity, which they themselves have helped to create. We know that there are nearly 1 billion of us over 60 today, moving inexorably to 2 billion by mid-century, and yet the WHO’s 13th General Program of Work – their work plan for the next 5 years during Director General Dr. Tedros Adhanom Ghebreyesus’s first term – does not account for this profound shift in the population mix of more old than young. How can this be?

Sadly, that’s the conclusion we must draw from this work product of the WHO Secretariat: that the only segment that really matters in public health is the children. But, with the proportion of old to young shifting, where there will be more over the age of 60 than under 15 by 2025, it is self-defeating, including for the children, not to give serious attention to the exploding health needs of their grandparents. By virtually ignoring older adults, the General Program effectively abandons this growing demographic to struggle with their health needs on their own, without needed support from the WHO. An ever-growing age-related disease burden and unfathomable explosion in otherwise manageable costs are surely to be the result of the current Work Program’s path.

But, memo to Dr. Tedros: there’s still time in the early days of your new role as DG of WHO to show leadership and change course. There’s still time to revise the 13th General Program of Work to reflect the reality that older people are at least as important as the children. That change would empower policy advocacy not only to treat disease, but as your own WHO Ageing and Health Strategy smartly advocates, also to achieve functional ability as we age.

In other words, wellness, prevention, and disease mitigation are critically important principles for good public health policy when we’re addressing such huge proportions of our global population who are “old” and for whom, therefore, health policy is an enabler of engagement, activity, and independence. If the WHO doesn’t recognize these priorities in its General Program, the costs associated with caring for this large portion of our global population will leave little room for any spending on the children, unless we effectively opt for early death, which we must assume no one is really suggesting.

So, Dr. Tedros, there are some pretty simple, but profoundly important fixes to your General Program:

  1. Don’t be so coy about spending time, money, and resources on older populations. The phrasing in that section – “for all ages” – is a silly compromise the Sustainable Development Goals applied to suggest that unlike in the Millennial Development Goals, they were now recognizing population segments other than “the children.” Go for it. Call it what it is: public health policy for older populations 60+. It’s ok. There are enough of us to warrant this recognition. Certainly, if good public policy is defined by (a) helping people who cannot much help themselves and/or (b) applying to people and places that are so large as to have broad impact, then 1-2 billion older adults surely meets that bar. Besides, it is guaranteed that if there is not better care and treatments for such age-related diseases as Alzheimer’s and other NCDs, the trillions we will have to spend to take care of these really sick old people will crowd out every possible spend on the children.
  2. Give some specificity to the values put forward in the WHO’s own Ageing and Health Strategy, on which all 194 of your constituents unanimously voted YES. It’s time to leave behind a 20th-century approach to public health data and narrow-minded thinking. The MDGs were developed 10 years before their adoption, now 17 years ago. That their successors, the SDGs, have not recognized the real demographic changes in the 25-30 years since is a problem that you should not accept. Do not frame your health policy goals based on a set of ideas and demographic realities which are so out of date as to be dangerous, but instead update these measurements to reflect the demographic realities of the 21st century, which are only growing more urgent.
  3. Pick a few key areas where you might make a difference: progress on cures and better care for NCDs, including Alzheimer’s; essential new long-term care models; innovative work on elder caregiving; and a new standard of innovative care that uses technologies where we live, and not just in those hospitals or physicians’ offices that are a holdover from previous care paradigms. To get started, look to the details provided by your colleagues in the Ageing and Life Course Department, who so courageously developed that Ageing and Health Strategy.

So, of course Dr. Tedros, let’s have health policy for the children. Not least if we want all of us to have healthier aging in the 21st century where our children and theirs will have 100-year lives that must include healthy living that starts as babies. But the nearly 1 billion of us over 60 are not to be ignored, either.

Ask your staff who created the latest Program of Work to read the Ageing and Health Strategy your own organization developed, and your own member governments unanimously voted for. And once they’ve read it, re-think the Work Program.

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