Photo: Sean Gallup/ Getty.

Earlier this week, the World Health Organisation (WHO) released its annual list of the top threats to global health. The list, which is meant to inform policies and action plans, included a list of challenges including vaccine hesitation, weak primary healthcare, non-communicable diseases, and environmental factors.

In its release, the WHO wrote that it will address these threats via a five-year plan dubbed the 13th General Programme of Work. This goal of the plan is to ensure ensures “1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies, and 1 billion more people enjoy better health and well-being.”

Here, in no particular order, are the threats to global health in 2019.

Vaccine hesitation, perhaps better known as anti-vaxxing, could reverse progress made in eliminating vaccine-preventable diseases.

As of now, the WHO notes that vaccines prevent between 2 and 3 million deaths a year, and an addition 1.5 million lives could be saved if coverage improved.

But despite these stats, people still refuse vaccines for a number of reasons. One study cited religious and philosophical beliefs as concerns among parents, while the WHO list cited inconvenience and lack of confidence as others. Regardless of the reason, this decision could be putting hundreds of thousands at risk for developing diseases to which they could have been immune.

In 2018, for example, measles cases surged 30% worldwide, with some cases being reported in “countries that had achieved or were close to achieving measles elimination.” The reason: gaps in vaccine coverage.

“Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or un-immunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease,” Soumya Swaminathan, deputy director general for programs at the WHO, said in a December 2018 statement.



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Air pollution is considered the greatest environmental risk to health.

Kevin Frayer/Getty Images A Chinese woman wears a mask as she waits for a bus on a polluted day in Beijing, China, December 12, 2016.

According to WHO, nine of 10 people breathe polluted air worldwide, leading to lung and heart damage. But difficulty breathing isn’t the only effect – air pollution has been linked to diabetes and lower test scores as well.

Overall, air pollution kills an estimated 600,000 children every year. Pollution is more deadly than smoking and kills nearly 15 times more people than all the world’s wars and violence combined.

The primary cause of air pollution – the burning of fossil fuels – is also the reason Earth’s climate is changing, which can lead to its own list of health consequences.

In an effort to address the problem, the United Nations Climate Summit in September will aim to strengthen climate action worldwide.



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Noncommunicable diseases are responsible for over 70% of all deaths worldwide.

Noncommunicable diseases (NCD) are chronic diseases that are caused by a combination of genetic, physiological, environmental and behavioural factors. There are four main types:cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Combined, they account for 80% of NCD-related deaths.

As the WHO reports, NCDs are responsible for 41 million deaths worldwide, 15 million of which are premature deaths (people between 30 and 69 years old). People of any age group, region, and country can be affected by NCDs, especially if they are impacted by these risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets, and air pollution.

The WHO plans to implement several strategies to reduce the prevalence of NCDs, with a particular focus on reducing physical inactivity by 2030. This will be done via a four-policy action plan called the ACTIVE policy toolkit.

A flu pandemic is expected to hit sometime in the near future.

Mario Tama/Getty Images A package of Tamiflu in a pharmacy.

Experts aren’t sure when or how, but they expect a deadly flu epidemic to hit sometime in the future. Bill Gates has been sounding the alarm about this threat.

In his 2018 “What I learned at work this year” letter, the Microsoft founder said that “if anything is going to kill tens of millions of people in a short time, it will probably be a global epidemic.” Specifically, that could be the flu because ” the flu virus spreads easily through the air.”

Gates’ concerns are warranted. An estimated 80,000 Americans died from the flu last winter, and 180 of them were children, according to the Centres for Disease Control and Prevention (CDC).

In order to prepare for a pandemic, Gates wrote that “we need a plan for national governments to work together” – something the WHO is working towards.

The organisation is working with 153 institutions in 114 countries to monitor and detect potential pandemic strains. Additionally, the WHO is partnering with various organisations to “ensure effective and equitable access to diagnostics, vaccines and antivirals (treatments), especially in developing countries.”

That said, these vaccines and antivirals will only work if people receive them – including those who are vaccine hesitant.



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80,000 people died from the flu last winter – the highest number in over 40 years



People in places undergoing crises struggle to access quality healthcare.

According to the WHO, roughly 22% of the global population lives in places impacted by protracted crises – which are defined the UN Food and Agriculture Organisation as environments where a significant proportion of the population is vulnerable to death, disease, and disruption of livelihoods over a prolonged period of time.

The crises can be caused by a number of factors, including conflict, poverty, famine, drought, or population displacement.

These areas are also affected by weak health services that leave many people without access to basic care. The WHO plans to work with governments in these locations to strengthen health systems.

Drug-resistant bacteria, parasites, viruses, and fungi could undo years of medical advancements.

Joe Raedle/Getty Images Antibiotic resistance could make it difficult, if not impossible, for doctors to easily treat infections

Over the last 100-plus years, scientists have come a long way in fighting various bacteria, parasites, and viruses. But we are now living in a time of antimicrobial resistance, and germs are developing the ability to defeat the drugs designed to kill them, according to the CDC.

This, as the WHO wrote, is largely due to the overuse of antimicrobials in people, as well as in the animals we consume. Such resistance could make it difficult, if not impossible, for doctors to easily treat infections like pneumonia and gonorrhea. Additionally, antimicrobial resistance could compromise surgery and treatments such as chemotherapy.

The WHO plans to implement a global action plan that increases awareness and knowledge about this threat, reduces the incidence of infection, and encourages more sensible use of antimicrobials.

Outbreaks of Ebola and other high-threat pathogens are putting people in danger.

The Democratic Republic of the Congo faced two Ebola outbreaks in 2018, one in May and one in December that spread to cities of more than 1 million people. This, the WHO wrote, has shown experts what happens when outbreaks occur in densely populated urban areas and places that may be visited by tourists who can then carry the disease to other countries.

As a result, various groups from the sectors of public health, animal health, transport and tourism have asked the WHO to focus on “preparedness for health emergencies” in 2019.



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Limited access to primary healthcare puts people at risk.

According to the WHO, primary healthcare should “provide comprehensive, affordable, community-based care throughout life.” Unfortunately, this is not a reality around the world and people in low- or middle-income countries are sometimes deprived of basic care.

In 2019, the WHO plans to work toward revitalizing and strengthening primary healthcare in such countries.

A mosquito-borne illness is on the rise.

Dengue fever, a deadly mosquito-borne disease, presents itself in the form of flu-like symptoms such as high fever, severe headaches, and joint pain, according to the CDC. It is spread via Ae. aegypti mosquitoes, which often live in tropical climates. But as the WHO notes, the disease is spreading to less tropical and more temperate countries that have not seen many cases before.

There are currently 390 million dengue infections a year, but the WHO has implemented a dengue control strategy in hopes of reducing deaths by 50% by 2020.

Though we’ve made progress in HIV testing and prevention, it is still a threat.

According to UNAIDS, 36.9 million people are living with HIV worldwide. (And that doesn’t include the individuals who have gone untested.) Part of the prevention problem, according to the WHO, is that groups deemed to be at higher risk – sex workers, people in prison, men who have sex with men, or transgender people – are often excluded from health services.

As part of a set of plans to end HIV/AIDs for good, the WHO plans to work with governments to introduce self-testing so more people living with HIV can know their status and receive treatment.

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