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First Mile Headlines, Last Mile Challenges

Co-authored by Fiona Walsh, the Executive Managing Director of Last Mile Health.

This is a pivotal year for global health. After the United Nations (UN) wrapped its ambitious 15-year effort to realize its Millennium Development Goals (MDGs), those focused on global health are rightly encouraged by its headline wins: both child and maternal mortality rates approximately halved, the number of new HIV infections down about 40 percent since the turn of the century, the goal of halving the proportion of global citizens living without access to clean water realized five years ahead of schedule. Meanwhile, the environmental community should likewise be lauded for the historic agreement coming out of the 21st Conference of Parties (COP21), convened in Paris last year.

With 2016 well underway, attention turns to both the UN's Sustainable Development Goals (SDGs) and achieving the targets set in Paris. The shared question is how to proceed, and unfortunately the international community runs the risk of foiling its own best efforts: without swift action, climate change stands to wipe out some of the biggest gains made in global health.

Experts have long forecast that the most vulnerable will experience the effects of climate change first. Now that the United States Department of Housing and Urban Development (HUD) is resettling its pioneer "climate refugees" via a first-of-its-kind "climate resilience" grant, it is clear that the families on Louisiana's Isle de Jean Charles are feeling that future today. From the disappearing Solomon Islands to severe drought in southern Africa and beyond, they are not alone.

Not only will extreme weather increase, but warmer climates will intensify the spread of mosquito-borne diseases like malaria and dengue fever. Drier conditions and high temperatures will stress crops, the very livelihoods of rural families. Reductions in food production and overfishing will lead to higher prices and worsen nutritional outcomes, especially in marginalized or remote communities.

At the same time, these are the very individuals who are often far from the reach of their cash-strapped governments. Of the 1.4 billion poor in developing countries in 2014, 78 percent live in areas where access to basic health care is toughest. People living in the last mile travel for hours, and sometimes days, by foot or motorcycle, along bumpy dirt roads and across rivers to reach the nearest health facility.

The world has now witnessed the results of an unexpected shock to under-resourced health systems. In 2014, the deadliest Ebola outbreak in history struck West Africa, spreading to six countries and claiming nearly 12,000 lives. Liberia was among the hardest hit nations, suffering nearly 10,100 cases and 5,000 deaths.

The Ebola crisis struck at the heart of Liberia's healthcare system, taking the lives of hundreds of health workers and crippling health infrastructure. Organizations such as Last Mile Health worked hand-in-hand with community members, local government officials, global policy-makers, and other aid agencies at the frontlines to meet the needs of the hardest-to-reach communities.

As the Zika crisis captures the world's attention, already disrupting travel plans and raising concerns for expectant families, public health experts are faced with eerily familiar challenges. Executive Director of the American Public Health Association Dr. Georges Benjamin recently reminded health officials convened at the United States Centers for Disease Control and Prevention's "Zika Summit" that in contrast with Ebola, and West Nile virus 15 years prior, that today there is "an opportunity to get ahead of the curve."

As the world celebrates the Paris agreement, countries now have an opportunity to act on their financial pledges to invest in adapting the world's health systems for climate change--starting with a focus on stretching primary health systems to cover the most remote and most vulnerable. While it is encouraging that funding is allocated for health systems, there remains a lack of clarity for what precisely that means moving forward.

Building resilient health systems requires long-term, sustained investments. Such efforts may not look "sexy" as headlines on the evening news or on Twitter feeds, but they are precisely what is called for to address not only the latest disease but to identify and respond to health crises well into the future.

At the 2008 World Health Assembly, health ministers passed a critical resolution, committing to action to protect human health from climate change. Later this month, Member States will meet again to discuss health threats affected by the environment, such as pandemic influenza preparedness and responding to the adverse effects of air pollution.

The upcoming World Health Assembly presents a prime opportunity for leaders to set the World Health Organization's priorities and corresponding budget. Decision-makers are discussing "resilient health systems" but must now articulate how to quantify what is needed to bolster the existing systems and allocate funds accordingly.

With significant funding available, those assembling in Geneva must be get down to brass tacks: what use is surveillance without an integrated referral network into a reliable, quality, affordable health system? What are the innovative financing mechanisms that will allow resource-limited governments to close the national funding gaps that must be covered in order to achieve universal primary health care? How do we invest in the future, understanding the economic, environmental, and medical realities of today and tomorrow?

International dialogues rarely trickle down to influence national-level health budgets, let alone to the city or village level - but they must. Whether Stateside or far further afield, our work requires us to toggle between 30,000-foot strategies and the muddy realities on the ground. We recognize that this is never easy, but it is both urgent and important.

Ecological and epidemiological phenomena do not respect political boundaries. With climate-exacerbated transmission from warming temperatures, the global community runs the risk of repeating expensive mistakes. As we turn our attention to this next opportunity to coordinate and collaborate, there is no time to waste in investing together in the last mile.