For the first time in recorded memory, the race to lead the World Health Organization is playing out in the unlikeliest of places: Twitter.
Equipped with infographics, hashtags and slogans, the top candidates to become Secretary General of the world's largest public health agency have used social media to try to engage with the world community.
— Tedros Adhanom (@DrTedros) April 25, 2017
But with growing concerns about the effectiveness of public health policy by other institutions, will the mandate of the WHO build a "better, healthier future" still ring true?
The short-listed candidates are now down to three, each with their own diverse backgrounds and visions for how public health policy should be shaped.
Tedros Adhanom Ghebreyesus, the candidate from Ethiopia, seems intent on reforming the WHO to focus on deadly diseases which have taken a toll on his continent. "When reforming, we have to focus on getting things done, also, because the world expects quick results, quick wins," he said.
David Nabarro, the U.K. candidate who oversaw the WHO's ebola and flu efforts at its peak, wants a bigger emphasis on mitigating climate change. He's gotten public support from Russian health officials, including Minister of Health Veronika Skvortsova.
The last candidate, Sania Nishtar of Pakistan, has the broadest resume as a cardiologist, reformer and health entrepreneur. She's staked her campaign on the developing world and not being too presumptuous with public health policy. "I realize that every attempt at priority setting in the past has only come up with a longer wish list," she said in an interview with Science magazine.
A lot is at stake in this election, including the future of global health. Many countries, such as Canada, are focused on implementing the United Nations' Sustainable Development Goals and universalizing coverage. Others, pushed by the WHO, are leading anti-tobacco efforts. But many are seeking a reduced role for determining health policy at the very top level.
Last month, European Commission President Jean-Claude Juncker released the much-anticipated white paper on the "Future of Europe."
Its conclusions startled some, specifically the aims of public health policies which have been at the center of EU policy in recent years.
The fate of public health could very well be at stake.
The EU will do "less in domains where it is perceived as having more limited added value, or as being unable to deliver on promises," the commission concludes. "This includes areas such as regional development, public health, or parts of employment and social policy not directly related to the functioning of the single market."
As such, the white paper urges that "more flexibility" be left to member states to experiment in certain areas.
For many public health activists, that conclusion was alarming.
"It is extremely disappointing that public health has been used as an example of an area where the EU should consider doing less," balked the European Public Health Association in a statement. "We cannot understand how the white paper proposes to do less on public health, when the health is a matter that European citizens cherish dearly."
Some countries such as Italy, however, celebrated the commission's efforts to give member states more breathing room -- something the public health establishment is leaning towards, especially once the costs are considered.
World Health Organization (WHO) Director-General Margaret Chan speaks during the Neglected Tropical Diseases Summit in Geneva, Switzerland, April 18, 2017. (Photo: Pierre Albouy/Reuters)
This is especially true in the realm of global tobacco policy, spearheaded by the WHO's Framework Convention on Tobacco Control.
According to a study published in the health journal The Lancet last month by Canadian researchers at the University of Waterloo, global smoking rates have decreased by just 2.5 per cent in over a decade, despite a nearly $18 million budget of the FCTC and massive spending by national governments.
"The researchers were unable to account for how well enforced the policies were," researchers said in the media release accompanying the report. "Although progress in combatting the global tobacco epidemic has been substantial, this progress has fallen short of the pace of global tobacco control action called for by the treaty."
Not only have these efforts proved to be less than effective, it seems they haven't affected the places most plagued by smoking.
A 2016 study by the Reason Foundation revealed that smoking rates in developing countries have actually increased, specifically China and India. "It is fair to say that, 11 years after the FCTC came into force, it has not proven to be a stellar success on its own terms," concludes the report.
Source: The Reason Foundation
As to whether a policy shift for the FCTC and similar efforts would be included in reform, the top candidates for WHO's leadership have not yet released any public statements to this effect. Which could certainly precipitate a crisis for public health.
One potential reform potential for the WHO lies in be adopting measures for harm reduction, specifically vaping and e-cigarette technologies which are proving to be less harmful than tobacco smoke.
The Tobacco Harm Reduction Expert Group, formed last year and made up of public health experts from Greece, Italy, the United Kingdom and India, says that opposing alternative technologies is harming public health.
"The WHO has an opportunity now to improve radically the life expectancy of today's smokers by applying the principle of harm reduction that is already one of the core principles of WHO's tobacco control strategy," they said in a statement released in India last year.
If the candidates to lead the WHO want to embrace reform, it's clear that harm reduction will prove more effective in combating the disastrous health effects of tobacco.
The election to become the next Secretary General of the World Health Organization will be held at the next general assembly in May. The fate of public health could very well be at stake.
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People who suffer from this acquired neurological disorder experience repeated, often painful, muscle spasms as well as muscular rigidity and stiffness. According to the National Organization of Rare Diseases, spasms can occur at random or they can be caused by something as seemingly benign as light physical contact or an unexpected noise. The cause of Stiff Person Syndrome isn't yet known, but symptoms can be stabilized with medication. Left untreated, however, a person can lose the ability to walk.
This disease, which according to the NIH is most often caused by a begnin tumor in the pituitary gland, results in an excess of GH, or growth hormone. This causes sufferers to grow abnormally large, not just in terms of height, weight but also organ size. It results in complications like delayed puberty, increased sweating, and secretion of breast milk.
Characterized as an eating disorder, Pica causes people to eat what the National Organization for Rare Disorders describes as "non-nutritive" things. That umbrella term can include (but isn't limited to) dirt, clay, paper, and paint. Interestingly, it's not unusual for young kids to experience transient pica as a kind of phase, and pregnant women are also known to develop temporary pica cravings. The cause? Unknown. But in order to be diagnosed with full-blown Pica, a person's symptoms must last for more than a month.
MSUD, which is passed down through families, is a life-threatening metabolic disorder passed down through families that stems from the body's inability to process certain amino acids, leading to a build-up of them in the body. According to the NIH, symptoms usually surface in early infancy and can include vomiting, lack of energy, seizures, and developmental delays. MSUD takes its name from another symptom -- the urine in affected infants smells like caramel or maple syrup.
Situs Inversus is a congential condition in which internal organs of stomach and chest lie in mirror image of their normal body position -- something many sufferers aren't aware of until they seek medical help for an unrelated problem. People with Situs Inversus typically wear some form of identification to help doctors in the case of a medical emergency.
Trigger thumb, or trigger finger as it's sometimes known, causes a person's finger or thumb to get caught in a locked position. According to the Mayo Clinic, it can then stay stuck or straighten with a painful "snap." The cause? It depends. Trigger Thumb is the result of a narrowing of the sheath around the tendon in the problem figure, but that can be caused by a lot of things, including any activity that requires people to grip things frequently. Trigger Thumb is also more frequent in women.
Once the disease of sailors and pirates, scurvy does still exist in the United States, though predominantly in older, malnourished adults. It usually stems from a Vitamin C deficiency, which can result in gum disease, skin leisons, and swelling of the joints.
This progressive genetic disorder causes sufferers to store excess copper in tissues, including the brain and liver. Though the Mayo Clinic says that the body depends on copper in order to use iron and sugar, too much of it in the body can have real consequences. Which is why sufferers of Wilson's Disease are prone to liver failure.
According to researchers at the University of Texas at Dallas, this speech disorder causes people to experience a sudden shift in their accents and though it is known to be caused by things like brain trauma, conversion disorder, or multiple sclerosis, an exact reason behind the syndrome is unknown. Sufferers of FAS dramatically shift their speech in terms of timing and intonation, which often causes them to sound foreign, but they remain totally comprehensible. Documented accent shifts include from American English to British and from British to French.
According to the National Organization of Rare Diseases, about 10 percent of people with carcinoid tumors -- which the Mayo Clinic says are slow growing tumors that produce excess serotonin and usually appear in the gastrointestinal tract or lungs -- get this syndrome. It occurs only in patients whose tumors have metastasized to the liver. The symptoms? Wheezing, hotness, and extreme facial blushing.
Children and adults afflicted with CVS experience recurrent episodes of severe vomiting, which can last for days, followed by sudden periods of no vomiting. While kids are likely to experience more frequent attacks, adults's often last longer. To date, the cause of CVS is unknown.
This obscure, genetic skin disorder does exactly what its name implies: causes sufferers to experience constant shedding of their skin. (In some patients, peeling is limited to the feet and hands.) Along with that, sufferers often feel itching and redness -- symptoms that can appear from birth or develop later in life. Although the exact cause is unknown, a mutation in the TGM5 gene has been identified in many sufferers.
This is a blanket designation for several rare platelet abnormalities, most of which lead to mild or moderate bleeding disorders. According to the NIH, the problem stems having limited granules -- the parts of platelets that, among other things, store ADP -- the energy released when a molecular bond is broken. That reduction in storage space inhibits the platelets' ability to secrete ADP in a speedy fashion, which is thought to be what causes the bleeding. Classic symptoms of a Platelet Storage Pool Deficiency are nosebleeds, excessive bruising, and profuse bleeding in surgery.·
Only nine people in the United States are known to have this disease, which was just given a name in a recent study in the New England Journal of Medicine. ACDC, or arterial calcification due to CD73 deficiency, results in calcium build-ups in the arteries below the waist of sufferers and in the joints of their hands and feet. According to the NIH, the breakthrough discovery found that the disease is related to a variant in the NT5E gene.3
This condition, which typically occurs after an extremely stressful emotional event, causes a person to experience sudden blindness or paralysis that can't be otherwise explained. People with mental illlnesses are at particularly high risk and psychological treatment can help lessen the symptoms.·
Ochronosis results in black or blue external tissues, often the ear cartilage or eye, though it can occur throughout the body. It affects people who suffer from certain metabolic disorders, but it can also be caused by exposure, though scientists aren't exactly sure to what. Not just a cosmetic issue, the affected areas can become brittle and degenerate over time.
This condition, which is caused by genetic mutations in the so-called ACADVL gene, keeps people from converting certain fats to energy. According to the NIH, the deficiency often presents during infancy in symptoms including low blood sugar, weakness, and lethargy.
As the name suggests, Hairy Tongue is a condition in which the tongue develops a black, hairy texture. According to the Mayo Clinic, the disease is "harmless" and is caused by an overgrowth of bacteria in the mouth, which can be treated with antibiotics. The NIH reports that hairy Tongue can also present as brown, yellow, or green discoloration. ·
This obscure, inherited disorder presents at birth and causes infants to grimace when, in fact, they are attempting to smile. The disorder also includes an extreme urinary abnormality: an obstruction that interrupts the connection between nerve signals in the spinal cord and bladder, leading to incontinence. Though treatment does exist in the form of antibiotics and bladder re-education, some patients can develop renal failure in their teens and 20's, which can be life-threatening.
This syndrome, caused by a particular calcified ligament or elongated bone, frequently causes sufferers to feel that something is stuck in their throat. (Scientists don't know the reason behind said elongation/calcification.) Other symptoms can include ear and throat pain as well as difficulty swallowing. According to the NIH, it can be treated surgically or non-surgically with steroid injections and other anti-inflammatories.
According to the Mayo Clinic, only around 130 cases of this devastating genetic disorder have been documented since it was discovered in 1886. Affected babies normally appear normal at birth, but within 12 months begin to have symptoms like hair loss and wrinkles. According to the Mayo Clinic, progeria is caused by a genetic mutation, but not one that's passed down through families; it's a chance event that affects only one egg or sperm. The average life expectancy for sufferers is 13.
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