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The World Economic Forum Global Agenda Council Summit: A Health Outlook

World Economic Forum, Summit on the Global Agenda 2013 - Abu Dhabi, November 18-20 2013

What can we expect from Abu Dhabi that will benefit dialogue and progress on global health?

Pre meeting blog: my thoughts as a member of the Global Agenda Council on Mental Health and Well-being

The Summit on the Global Agenda hosted by the World Economic Forum brings together a diverse and informed group of experts from the worlds of finance, development, health, technology, agriculture, politics and more. They are encouraged to consider major trends within the sector and from other fields that will have influence for good and bad on their sector's direction. If successful, they will identify ways of successfully addressing emerging risks and ideally, come up with pragmatic ideas that could then be implemented.

In preparation for the Summit, WEF released a report, Outlook on the Global Agenda 2014, which was intended to prepare participants for their deliberations. I will briefly consider which trends have implications for global health before ending with a few expectations I take into the meeting that I look forward to being addressed.

At first look, the top ten trends for 2014 do not appear to directly relate to health, yet many do have significant indirect impacts that if addressed could lever substantive change for good. Here are my views on how:

Table 1: Top 10 trends for 2014 as identified by 1592 WEF experts.

I. Rising societal tensions in the Middle East.
  1. Tensions and wars have been a major set-back for polio eradication which is now spreading in countries where it was previously controlled. Massive efforts to contain this will be under stress if instability continues, endangering the entire polio eradication mission despite billions of dollars invested over many years. What applies to polio applies to many other infectious diseases.
  2. The Middle East is experiencing some of the highest levels of risks for chronic diseases with obesity rates and diabetes exceeding levels in most other regions; little progress on tobacco control; and the WHO unable to devote the resources to these chronic disease threats amidst cycles of wars, violence and political instability.
II. Widening income disparities.
  1. This global reality is reflected in recent data for risks factors for chronic diseases. In the USA, the poorest counties in states like Mississippi and Tennessee have among the highest levels of tobacco use, obesity and hypertension in the nation. These states are the very same who have tended to opt out of the Affordable Care Act expansion of preventive programs, when they are the ones who need it the most.
  2. The recent Global Burden of Disease studies show that income and health outcomes are not directly related. Many countries at substantively lower levels of GDP per capita than the US for example have better health outcomes, suggesting that policies - and a strong political will to prevent and apply cost effective interventions to populations - matter.
III. Persistent structural unemployment
  1. With greater attention being given to workplace health program it is critical to recognize the power of employment per se for health. It provides income, social stability, growth, meaning to people's lives - and the workplace is where millions of people have access to preventive and basic curative care.
  2. In contrast, studies from across Europe in the wake of the recession have documented how unemployment kills with increasing suicide rates. The issue is compounded when governments cut back on the social safety nets.

IV. Intensifying cyber threats
The security leaks of the last few years have raised issues of privacy and information security at exactly the time that the opportunities to use the power of information technologies to improve health are set to explode. When the Human Genome project was launched in 1990, substantive investment was made to address the ethical, legal and social implications of the technologies in a proactive way. There is an urgent need for a similar initiative now in relation to the emergence of information and biotechnologies for health, before regulators kill off truly transformative opportunities opening up for the future.

V. Inaction on climate change
  1. This has a direct impact on the ability of the world to feed itself. It is often not fully appreciated that agriculture contributes disproportionately to climate change, accounting for up to 70% of water use and for about 30% of GHG emissions. What is eaten matters for the environment and for health. The same unhealthy foods that fuel heart disease and diabetes are destructive to the environment. Greater synergy between agriculture, nutrition and climate change policies is urgently required.
  2. The current unfolding natural disaster in the Philippines comes after a string of devastating severe weather events in other parts of the world that may all be a harbinger of what is to come as the impact of climate change becomes a reality. While continued efforts at prevention are needed, health and disaster preparedness experts need to redouble their efforts to adapt and predict where severe weather events are most likely to impact on large human population settlements, cities being particularly vulnerable.

VI. The diminishing confidence in economic policies
The erosion of confidence in economic policies is a reflection of recent failures and could entrench fatalistic views about the limits of what can be done to build for the future. This in turn has implications for how people live their lives, short term satisfaction often taking precedence over sustainable healthy living patterns. Why worry about health risks way off in the future when tomorrow's economic outlook looks so bleak? Many marketing messages play on this theme by encouraging people to consume now and "live in the moment". For chronic diseases, with their decadal long development period, "short term-ism" could undermine progress in addressing diet, activity, tobacco and alcohol related risks.

VII. A lack of values in leadership
  1. Today we see a distrust of governments who failed to prevent the economic crisis, of corporate leaders linked to the many scandals and financial crises, and of media found meddling in people's lives. In this climate, the voice of those seen as having strength in their technical areas has maintained a level of trust that is so needed. Health experts capable of building arguments based on evidence have the potential to be taken seriously if they can rise above the cacophony of mixed messages found in today's popular media.
  2. When people reflect on values they strongly believe in, honesty, transparency and the importance of health for individuals and families are commonly given priority. The old phrase "health isn't everything but without it we have nothing" should be the basis to ensure that economic and development policies are always assessed for their impacts on health, and where conflicts occur (as they always do) greater efforts to maintain and advance health should in my view be take priority. The same is true within companies. When CEOs start reporting on the health of their workforce within financial reports, its material and nonmaterial value to companies' long term growth will become clearer.

VIII. The expanding middle class in Asia
The rapid reduction in poverty in many Asian countries over the last 20 years is a massive victory for health. The recent Global Burden of Disease analyses show how many common preventable causes of death in children (especially under-nutrition, diarrhea and acute respiratory infections) have sharply declined. At the same time, the middle class consumption trends and lifestyles are rapidly changing and several major risks for chronic diseases are either increasing or not changing. Tobacco use remains common across the region and girls and women are now using tobacco commonly; physical activity has decreased and diets rich in saturated fat, sugar and salt have become the most marketed, aspirant and desired sources of calories in Asian cities with dire consequences for heart disease and diabetes in countries where genes and early childhood stunting will markedly increase risks for chronic diseases in adults. The rapid increased used of saturated fat rich palm oil places hearts and forests at risk; and the rapid demand for beef in China threatens to make the future demand for grains more precarious even as it contributes to heart disease. If Asian consumption trends continue to draw upon those common in OECD countries in the 1980s, their health will continue to suffer. Development paths that offer healthier and more sustainable lifestyles are critically needed.

IX. The growing importance of megacities
The health implications of megacities have been well described over the last few years. Some cities, notably New York, provide a window into what can be done to promote health, environmental sustainability and economic development together. The "Bloomberg era" has applied evidence-based policies across infectious and chronic disease spheres and evaluations show the benefits to citizens. However the pace of development and growth of the most rapidly growing cities in Asia, Latin America and Africa, the lack of clarity on the best infrastructural and health policies to implement and the lack of engagement by health experts in city and town planning has led to the populations being at increased risk for both infectious and chronic diseases. Asian cities engineer mobility out of city life causing a collapse in physical activity; traffic injuries effecting drivers and pedestrians are common; and many cities are becoming vast shanty towns in areas at great vulnerability to rising seas and severe weather events. However, the concentration of innovation if coupled with sound government and corporate investment can tackle the many health crises that growing cities will face.

X. The rapid spread of misinformation online
A Google search for any disease, treatment or policy immediately brings up a bewildering array of options. Discerning effective and appropriate advice from anecdote and harmful interventions is proving difficult; something which is unlikely to be solved any time soon. There is a need for authoritative sites to be more visible and responsive to the changing ways individuals are seeking cures for themselves are seeking basic information about health. Several such sites now exist but the space is still very fragmented.

The structure of the Global Agenda Council encourages and facilitates the search for and development of networked decisions. As can be seen from the above, all the major trends will impact on health. The challenge is to ensure that solutions place health consideration at their core. That was the original philosophy underpinning the evolution of sustainable development 20 years ago: "health is the center of concerns for sustainable development. It is both an input into and an outcome of sustainable development". And that is why Adrian Gore, CEO Discovery, is calling for metrics on health of the workforce to be included alongside financial and other sustainable measures in Annual Reports and in indices of the UN Global Compact, Dow Jones Sustainability Index and the FTSE4Good - as a start!

I would hope that we see progress in advancing this powerful vision in Abu Dhabi. Moving health from being seen and regarded as a critical investment in development, growth and happiness and not as an expense to be minimized could change the focus on discussions on the complex challenges the world faces.