As the first African ever to be elected Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus now faces a key question: how will the WHO balance communicable disease programs, the traditional focus of health efforts in low- and middle-income countries, with the two exploding health needs of the 21st century, namely, aging-related loss of functional ability and non-communicable diseases (NCDs)? Indeed, global population aging is set to transform health needs around the globe, including in Africa, which demands a pivot towards enabling healthy, active aging and addressing the growing toll of NCDs in low- and middle-income, as well as richer, countries.
“Functional ability” is a critical concept for the future of global public health. The core premise was laid out in the WHO’s Health and Ageing Strategy: in our era of long lives, ensuring that we can maintain well-being and capacities across our life course is just as important as the absence of disease. This is a profound shift, which is about enabling all older adults to pursue an active, engaging, and independent life, while also addressing conditions of aging, such as skin, vision, bone, and oral health deterioration. And this emphasis on functional ability works in parallel with efforts to fight NCDs – such as cancer, Alzheimer’s, heart disease, diabetes, and respiratory disease – which are on the rise as people live longer lives. In other words, longevity across the planet transforms global public health.
So as an Ethiopian, who is better placed than Dr. Tedros to lead global public health at the moment when the WHO is turning its attention to exactly these demands? Already, the WHO has expressed its interest in functional ability with last year’s Ageing and Health Strategy, which was further accented this week by the Global Plan on Dementia at the 70th World Health Assembly. Both new strategies reflect how global public health realities are shifting, whether one lives in Africa, the U.S. or anywhere in between.
But, for Dr. Tedros to be successful, he will have to build on these early steps with further efforts to truly revamp the WHO for this century’s health challenges. Three steps are essential:
Raise the Ageing and Health Strategy to the top of the WHO’s agenda to prepare for the Decade of Healthy Ageing 2020-30. This shift is no small matter. It entails re-orienting global public health to go beyond merely fighting diseases to include the achievement of functional ability across our life course. This is as true for low- and middle-income countries as they modernize as it is for the OECD, as the entire world gradually shifts towards realizing 100-year lives. However, we need global health efforts to ensure that those lives are healthy, active, and happy – not just long – which will also seize health policy as a key driver of economic growth and wealth creation. To achieve this potential, Dr. Tedros should develop strategies based on the fact that there will soon be more old than young for the first time in the history of humanity, with 2 billion people over 60. Addressing conditions of aging and developing better, more effective elder care will become necessary parts of public health to ensure the fiscal sustainability of aging societies.
Recognize the near perfect correlation between the aging of global society and the explosion of Alzheimer’s. In the next 25 years, this disease will have hit almost 140 million people and cost trillions, with the most dramatic rise in prevalence occurring in Africa. Surely, this is the reason Member States passed their Dementia Strategy at the World Health Assembly this week. Around the world, leaders in health, government, and business are realizing that this is our 21st century pandemic, which threatens to outpace every other disease in human tragedy, social impact, and fiscal costs.
Smartly, wisely, but clearly and seriously reform the culture of the WHO – and public health itself. Currently, the WHO default is to go it alone, including an almost automatic dismissal of any real partnership with the private sector. There is a view that the public sector represents the public interest and the private sector, by contrast, is somehow ethically and morally inferior. But as health becomes ever more essential to the economic growth goals for all, the stakes become too high and the needs too great for the WHO not to make all parts of society – including business – a collaborating partner in its solutions. The private sector stands ready to collaborate even as the WHO leads a new era of public health for our new century.
Congratulations Dr. Tedros – now for the hard part.