WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-fIfth session Shanghai, China 13-17 September 2004
WPRlRC55/13
6 August 2004 ORIGINAL: ENGLISH
Provisional agenda item 19
COORDINATION OF THE WORK OF THE WORLD HEALTH ASSEMBLY, THE EXECUTIVE BOARD AND THE REGIONAL COMMITTEE
Four resolutions adopted by the Fifty-seventh World Health Assembly are presented with an explanation of their implications for the work of WHO in the Western Pacific Region. Members of the Regional Committee are requested to express their views on the relevance of these resolutions to WHO's programme of cooperation with countries and areas in the Region. A complete list of resolutions adopted by the World Health Assembly is attached as Annex 1. World Health Assembly resolutions directly related to other items on the provisional agenda of the current session of the Regional Committee are mentioned in and annexed to the documents covering those individual agenda items. The draft provisional agenda of the 115th session of the Executive Board is attached as Annex 2.
WPRJRC55/13 page 2
WORLD HEALTH ASSEMBLY RESOLUTIONS OF INTEREST TO THE REGION
The Fifty-seventh World Health Assembly adopted 19 resolutions, which are listed at the end of this paper (Annex 1). The attention of the Regional Committee is drawn to four in particular: resolution WHAS7.12 on reproductive health: draft strategy to accelerate progress towards the attainment of international development goals and targets, resolution WHAS7.16 on health promotion and healthy lifestyles, resolution WHAS7.17 on the global strategy on diet, physical activity and health, and resolution WHAS7.19 on international migration of health personnel: a challenge for health systems in developing countries. These are discussed below. The agenda of the IISth session of the Executive Board IS
attached as Annex 2. This draft
provisional agenda has been sent to Member States by the Director-General in a note verbale dated 23 June 2004. Following receipt of comments on the proposed agenda from Member States the Director-General will further consult with the Chairman of the Executive Board. This draft agenda is submitted to the Regional Committee for information.
WHA57.12 - Reproductive health: draft strategy to accelerate progress towards the attainment of international development goals and targets
Reproductive and sexual health is fundamentally important to individuals, couples and famlhes, as well as to the social and economic development of communities and nations. improvements to reproductive and sexual health in the Region have been slow. Attention is drawn to operative paragraphs 2(1)-(4), urging Member States to accelerate progress on reproductive and sexual health to achieve the development goals of the Millennium Declaration and other international development goals and targets. Most countries of the Region have developed national plans of action on reproductive health or population development in the 10 years since the International Conference on Population and Development (ICPD). However, the plans have not been implemented in some some countries because of a lack of financial or technical resources. In several Pacific island countries, access by adolescents to family planning services has improved in recent years, in part because of support by mt=ational agencies. Attention is also drawn to operative paragraphs 3(1)-(4). In the past five years, reducing maternal mortality; improving reproductive health services, including those related to the preventIon However,
WPR/RC55/13 page 3
of unwanted pregnancies; reducing the number of high-risk teenage pregnancies; and improving the quality of family planning services have been priorities of WHO's reproductive health programme. WHO has worked closely with Member States to develop national plans of action on maternal mortality reduction and has provided fmancial and technical support for improvements to the management of emergency obstetric complications and family planning services. WHA57.16 Health promotion and healthy lifestyles
Behavioural risk factors were highlighted in the World health report 2002. Effective health promotion can help to reduce these risks, bridge health inequalities and improve health outcomes. Yet many countries lack both comprehensive policies to ensure the sustainability of health promotion projects and appropriate structures for health promotion. Attention is drawn to operative paragraph 1(6), which urges Member States to establish innovative, adequate and sustainable fmancing mechanisms for health promotion with a firm institutional base for the management of health promotion. In the Western Pacific Region, a leadership development strategy called "Pro Lead" is being
piloted. The strategy focuses on sustainable fmancing (such as dedicated tobacco and/or alcohol taxes and social health insurance) and options for promoting health through health systems development and reform (such as health promotion foundations). Malaysia, Mongolia, the Philippines and Tonga. Pro Lead is being piloted in China, Fiji, It is an in-service training programme that
emphasizes problem-solving with the help of mentors from established health promotion foundations. Expansion of the strategy will be considered in 2005 and a regional workshop on the economic gains of promoting health will be held on November 2004. Capacity building through leadership development will be used to address other health promotion issues referred to in operative paragraph 1, including programmes with particular reference to poor and marginalized groups, mechanisms to strengthen the evidence base, health promotion for children and young people, and setting up tobacco cessation programmes. Networking and advocacy for leaders who can promote health is a key strategy for capacity building. A network for teacher training has been established and includes Hong Kong (China), Kiribati, the Lao People's Democratic Republic, Papua New Guinea, Tuvalu and Viet Nam . A webbased registry of health-promoting schools will be launched in late 2004. Leaders of Healthy Cities in Australia, China, Japan, Malaysia, Mongolia, the Philippines and the Republic of Korea launched an "Alliance for Healthy Cities" in 2003. WHO plays an advisory role in the Alliance and will be
WPRlRC55/13
page 4
providing technical assistance, recognition and awards for outstanding Healthy Cities at the inaugural general assembly in Kuching, Malaysia, in October 2004. Communication leaders participated in a Pacific workshop on health communications in Fiji in March 2004 and a Healthy Islands communications network has been established to encourage sharing of expertise in support of the Tonga commitment. 1 Attention is drawn to operative paragraph 1 (4), which urges Member States to include harmful use of alcohol in the list of lifestyle-related risk factors and to give attention to the prevention of alcohol-related harm and promotion of strategies to reduce the adverse physical, mental and social consequences of harmful use of alcohol. WHO recognizes the significant impact of the harmful use of alcohol on world health. A global database that documents global patterns of alcohol use, health consequences of harmful use of alcohol and national policy responses has been established and is updated regularly. The database permits WHO to provide an up-to-date assessment of the impact of alcohol use on health worldwide, and to respond to requests from Member States for comparative data and the status of alcohol problems within their borders. Australia, China, Japan and New Zealand from this Region have participated in a number of global initiatives, including epidemiological studies, srudies of alcohol and injuries, and alcohol problem screening. WHO has supported training activities in prevention, treatment and rehabilitation of alcohol use disorders in China, Mongolia, and Singapore. In collaboration with the Secretariat of the Pacific Community (SPC) and the New Zealand government, a meeting on alcohol and health in the Pacific is planned for September 2004. The meeting is designed to support countries to assess the extent of alcohol-related harm and to formulate appropriate responses.
WHA57.17
Global strategy on diet, physical activity and health
The World health report 2002 estimated that major chronic diseases are responsible for 60% of all deaths and 47% of the global burden of disease. Unhealthy diet, physical inactivity and tobacco use are leading causes of these diseases. In this resolution, the World Health Assembly adopted a
global strategy on diet, physical activity and health, designed to provide Member States with a range of policy options to address these major risk factors and to deal with diseases of "excess", at the same time as strengthening measures to end deficiency disorders.
1
Tonga commitment to promote healthy lifestyles and supportive environment. Manila, ',!lHO, 2003.
WPRlRCSS/13 pageS
Attention is drawn to operative paragraphs 2(2) which urges Member States to promote healthy diets and physical activity. Demonstration projects on the prevention and control of obesity have already begun in Fiji, Nauru and Tonga and these will be extended. Attention is further drawn to operative paragraph 2(3) on strengthening of existing or establishing new structures to implement the strategy. There are already many national food and nutrition committees in place to improve interventions for the prevention and control of noncommunicable diseases (NCO) in accordance with the World Plan of Action for Nutrition. Many countries also have national plans of action for nutrition (NPAN) which will prove an important source of support for implementation of the global strategy. A workshop on the "development and implementation of intersectoral food and nutrition plans and policies" was held in 2003 for Pacific countries, and a similar workshop is planned for November 2003. With regard to operative paragraph 2(4) on national goals and objectives, drafting of guidelines, and other matters, WHO has supported the establishment of national NCO strategies and performance targets, including dietary factors and physical activity in Mongolia, the Philippines and Viet Narn;the drafting of physical activity guidelines and intervention on obesity in schools; and the
implementation of a STEPwise surveillance framework for chronic disease progranunes, including diet and physical activity. With regard to operative paragraph 2(6) on the establishment of a favourable environment for health, WHO has supported, as part of the Healthy Cities and Healthy Islands approaches, the development of sustainable environments that are conducive to physical activity and health, including the establishment of an award for cities that promote healthy diets and physical activity. Attention is also drawn to operative paragraph 5 (1) which requests the Director-General to continue and strengthen work dedicated to undernutrition and micronutrient deficiencies. The recently completed Tibet IDD elimination project has led to major improvements in the iodine status of highrisk groups (women of reproductive age and children). The supporting agencies (Australian Agency for International Development, International Council for the Control of Iodine Deficiency Disorders, Word Health Organization, United Nations Children's Fund, and nongovernmental organizations) will continue to provide support to the progranune. Other recent and forthcoming initiatives to improve the nutritional status of the Region include an advocacy exercise in July 2004 in the Lao People's Democratic Republic, weekly iron/folic acid supplementation projects for the prevention of anaemia in women of reproductive age in Cambodia,
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the Philippines and Viet Nam, and a workshop on advocacy for nutrition interventions planned for 2005. Operative paragraph 5(2) requested the Director-General to mobilize support for the global strategy. In the Region, a working-group at an NCD meeting in August 2004 drafted a regional action plan for the implementation of the global strategy. Also in August 2004, WHO supported a workshop on the introduction of "5-a-day" programmes (five servings of fruits and vegetables per day) in developing countries in New Zealand. A WHO workshop on fruit and vegetables was held in Japan in September 2004. WHA57.19 - International migration of health personnel: a chaUenge for health systems in developing countries The migration of health professionals is becoming an increasingly important global issue, with implications for health outcomes, health system performance, and for the health workers who remain. In countries and areas where there is already a shortage of health professionals, the adverse effects include, delays in providing acute care and long waiting times for scheduled services, limited access to or unavailability of health care services because of a lack of expertise, and excessive workloads for remaining staff. These in turn result in demoralization, 'bum-out" and a deterioration in care. Attention is drawn to operative paragraph 1(1), which urges Member States to develop strategies to mitigate the adverse effects of migration of health personnel and minimize its negative impact on health systems. In 2000-2002, WHO commissioned a study of the migration of skilled health personnel from Pacific island countries. The study showed that the decision to migrate was influenced by many factors, particularly poor remuneration, working conditions and incentives, lack of career and professional development opportunities, family well-being and children's education. Attention is also drawn to operative paragraph I (2), on the need to frame and implement policies and strategies that could enhance the effective retention of health staff. At a WHO meeting on migration of skilled health personnel in Pacific island countries in June 2003, participants recognized that many factors, such as globalization, labour force movements, including freedom of movement as a basic human right, make it impossible to stop the migration of health personnel altogether. However, they also noted that the unregulated and aggressive recruitment of health to
personnel, mainly by external agencies, compounded the problem. The meeting stressed the need
focus on retaining health personnel, encouraging return migration, improving planning and management of health personnel, and seeking support to develop a regional protocol, similar to the
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Cornmonwealth Code of Practice for the International Recruitment of Health Workers (referred to in preambular paragraph 5 of the resolution). Attention is further drawn to operative paragraph 1(3) on use of government-to-government agreements as a mechanism for managing migration, and to operative paragraph 1(4) on mechanisms to mitigate the adverse impact on developing countries of the loss of health personnel through migration. Migration of health personnel will be an agenda item for discussion at the meeting of Ministers of Health of Pacific island countries in Samoa in March 2005.
WPR/RC55/13 page 8
WPR/RC551l3
ANNEXl RESOLUTIONS ADOPTED BY THE FlFfY-SIXTH WORLD HEALTH ASSEMBLY Resolution number WHA57.1 WHAS7.2 WHA57.3 WHAS7.4 Title of resolution Surveillance and control of Mycobacterium ulcerans disease (BuruJi ulcer) Control of human African trypanosomiasis Health conditions of, and assistance to, the Arab population in the occupied
Arab territories, including Palestine Financial report on the accounts of WHO for 2002-2003; report of the External Auditor and comments thereon made on behalf of the Executive Board Members in arrears in the payment of their contributions to an extent that would justifY invoking Article 7 of the Constitution Arrears in payment of contributions: Ukraine Agreement with the Office International des Epizooties Rules of Procedure of the World Health Assembly: amendment to Rule 72 Eradication of dracunculiasis Road safety and health Family and health in the context of the tenth anniversary of the International Year of the Family Reproductive health: draft strategy to accelerate progress towards the attainment of international development goals and targets Genomics and world health Scaling up treatment and care within a coordinated and comprehensive response to HIV/AIDS Scale of assessments for 200S Health promotion and healthy lifestyles Global strategy on diet, physical activity and health Human organ and tissue transplantation International migration of health personnel: a challenge for health systems in developing countries
WHA57.5 WHAS7.6 WHA57.7 WHAS7.8 WHAS7.9 WHA57.10 WHAS7.11 WHA57.12 WHAS7.13 WHAS7.l4* WHA57.15 WHAS7.l6 WHAS7.l7 WHAS7.l8 WHAS7.l9
*Annexed to the document covering the agenda item on this topic.
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.2
WHA57.1 21 May 2004
Surveillance and control of Mycobacterium ulcerans disease (Buruli ulcer) The Fifty-seventh World Health Assembly, Having considered the report on surveillance and control of Mycobacterium ulcerans disease (Buruli ulcer); 1 Deeply concerned about the spread of Buruli ulcer, especially among children, and its health and socioeconomic impact in poor rural communities; Aware that early detection and treatment minimize the adverse consequences of the disease; Noting with satisfaction the progress made by the Global Buruli Ulcer Initiative since its inception in 1998, in coordinating control and research activities among partners; Concerned that several factors, including late detection of cases and lack of effective tools for diagnosis, treatment and prevention, impede further progress; Mindful that achievement of two of the United Nations Millennium Development Goals, namely, to eradicate extreme poverty and hunger and to achieve universal primary education, may be hampered by the negative impact of neglected diseases of the poor, including Buruli ulcer, 1. URGES Member States in which Buruli ulcer is or threatens to become endemic: (1) (2) to assess the burden of Buruli ulcer and, where necessary, establish a control programme; to accelerate efforts to detect and treat cases at an early stage;
(3) where feasible, to build up effective collaboration with other relevant disease-control activities; (4) within the context of health-system development, to establish and sustain partnerships at country level for control ofBuruli ulcer;
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Document AS7/S.
WHA57.1
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(5) to ensure that sufficient nat~onal resources are available to meet control needs, including access to treatment and rehabilitatIOn services; (6) (7) 2. to provide training to general doctors to improve surgical skills; to provide training to all health workers in the prevention of disability;
ENCOURAGES alI Member States: (1) to participate in the Global Buruli Ulcer Initiative;
(2) to intensify research to develop tools to diagnose, treat and prevent the disease, as well as to integrate Buruli ulcer into the national disease surveillance system; (3) to intensify community participation in the recognition of disease symptoms;
3. CALLS UPON the international community, organizations and bodies of the United Nations system, donors, nongovemmental organizations, foundations and research institutions: (1) to cooperate directly with countries in which the disease is endemic in order to strengthen control and research activities; (2) to develop partnerships and to foster collaboration with organizations and programmes involved in health-system development in order to ensure that effective interventions can reach alI those in need; (3) 4. to provide support to the Global Buruli Ulcer Initiative;
REQUESTS the Director-General: (1) to continue to provide technical support to the Global Buruli Ulcer Initiative, in order particularly to advance understanding of the disease burden and to improve early access to diagnosis and treatment by general strengthening of health infrastructures;
(2) to foster technical cooperation among countries as a means of strengthening surveillance, control and rehabilitation services; (3) to promote research on better diagnostic, treatment and preventive tools through the coordination and support by the Special Programme for Research and Training in Tropical Diseases.
Seventh plenary meeting, 21 May 2004 A57NRJ7
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.3
WHA57.2 21 May 2004
Control of human African trypanosomiasis The Fifty-seventh World Health Assembly, Recalling resolutions WHA50.36 and WHA56.7; Having considered the report on human African trypanosomiasis; I Deeply concerned by the resurgence of African trypanosomiasis and its devastating effect on human and livestock populations on the African continent; Recognizing that the human form of this disease constitutes a major public health problem because of its invariably fatal outcome in untreated cases, the frequency of permanent neurological impairments in treated cases including, especially, permanent mental and psychomotor impairments in children, and its propensity to occur in epidemics; Further concerned by the growing problems of drug resistance and treatment failure; Welcoming the high level of political commitment to combat human African trypanosomiasis expressed by government leaders of countries in which the disease is endemic; Further welcoming the renewed commitment to control this disease expressed in recent initiatives and public-private partnerships, which have greatly relieved the problem of inadequate access to existing drugs; Noting that, although great strides are being made in controlling this disease, better control tools, including safer and more effective drugs and simplified diagnostic tests, are badly needed, 1. URGES Member States: (1) to continue to give high priority to the control of human African trypanosomiasis;
(2) in endemic areas, to increase human resources and dedicated financing, drawing as appropriate on funds previously used for the purchase of drugs; and to strengthen case detection, diagnosis and treatment, and the infrastructure for doing so;
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Document A57/6.
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WHA57.2
2.
REQUESTS the Director-General: (1) to continue to refine control strategies so as to make maximum use of national and international resources and to prevent further epidemic spread; (2) to promote among the various sectors and agencies concerned an integrated approach that takes into account the importance of vector control and of control of disease in livestock; (3) to continue to collaborate closely with all partners concerned, notably through the UNICEFIUNDPfWorld BanklWHO Special Programme for Research and Training in Tropical Diseases on research to develop safer and more effective drugs and simplified tests for trypanosomal detection; (4) to keep the Health Assembly informed of progress in every first year of the biennium.
Seventh plenary meeting, 21 May 2004 A57NRJ7
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
WHA57.3
Agenda item 19
21 May 2004
Health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine The Fifty-seventh World Health Assembly, Mindful of the basic principle established in the Constitution of WHO, which affinns that the health of all peoples is fundamental to the attainment of peace and security; Recalling all its previous resolutions on health conditions in the occupied Arab territories; Expressing appreciation for the report of the Director-General on the health conditions of, and assistance to, the Arab population in the occupied Arab territories, including Palestine; 1 Expressing its concern at the deterioration of health conditions and the humanitarian crises resulting from military activities which caused severe restrictions on the movement of Palestinian people and goods, including restrictions on the movement to and from Palestinian territories, particularly of ambulances, health workers, the wounded and sick; Expressing its concern at the continued use of excessive force by the Israeli military forces which resulted in the killing and injuring of thousands of Palestinians, including children; Expressing its concern at the serious deterioration of the economic and health situation resulting from closures and curfews imposed on the Palestinians by the Israeli occupying forces, which together with the withholding of Palestinian tax revenues, has resulted in unprecedented levels of unemployment, with implications for poverty, food insecurity and nutritional vulnerability; and at reports of malnutrition among children, and evidence of endemic anaemia among nursing mothers; Expressing its concern at the widespread destruction of civilian infrastructure during Israeli military incursions, and particularly at the continued construction by Israel of a "security fence", which is not being built on or near the 1967 borders, and which produces humanitarian and economic hardship for the Palestinians, and prevents access to hospitals and to health care; Expressing its concern at the grave violations of international humanitarian law by the Israeli occupation authorities in the occupied Arab territories, including the unlawful arrest of thousands of
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Document A57/30.
WHA57.3
Palestinian civilians, among whom hundreds of children locked up in Israeli jails, some of whom detained without charge and others sick, without receiving medical care; Affirming that the targeting of civilian populations by any party, in particular extrajudicial executions, is another violation of international humanitarian law; Affirming that the ongoing violence, closures and curfews and the continuing occupation of the Palestinian territories are among the main causes of acute psychological distress and emotional problems among Palestinian children and adults, including psychosomatic problems, rejection of authority, risk-taking behaviour, decreasing hope in the future, and those caused by the general atmosphere of hopelessness and frustration; Affirming the right of Palestinian patients and medical staffto be able to benefit from the health facilities available in the Palestinian health institutions in occupied east Jerusalem, I. CALLS upon Israel, the occupying power, to halt immediately all its practices, policies and plans which seriously affect the health conditions of civilians under occupation, particularly its excessive use of force and military actions against Palestinian civilians; 2. EXPRESSES gratitude to all Member States, and intergovernmental and nongovernmental organizations for their continued support in meeting the health needs of the Palestinian people; 3. EXTENDS its thanks and appreciation to the Director-General for his efforts to provide necessary assistance to the Palestinian people, the rest of the Arab population in the occupied Arab territories, and other peoples of the region; 4. REQUESTS the Director-General: (1) to dispatch as soon as possible to the occupied Arab territories, including Palestine, a fact-finding committee on the deterioration of the health and economic situation resulting from both the current crises and erection of the "security fence" in the occupied Palestinian territories;
(2) to take urgent steps, in cooperation with Member States, to support the Palestinian Ministry of Health and other medical service-providers in their efforts to overcome the current difficulties, in particular so as to guarantee the free movement of all health personnel and patients and the normal provision of medical supplies to the Palestinian medical premises; (3) to take steps, in cooperation with Member States, to ensure the free movement of goods, workers and people in order to allow trading, farming and other forms of economic activities inside the occupied Palestinian territories and the access by the population in general to basic services; (4) to continue providing necessary technical assistance to meet needs ansmg from the current crises, including health problems resulting from erection of the "security fence"; (5) to take the necessary steps and make the contacts needed to obtain funding from various sources, including extrabudgetary, to meet the urgent health needs of the Palestinian people;
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WHA57.3
(6) to take urgent action to implement the joint Ministry of HealthIWHO strategy for mental health; (7) to report on implementation of this resolution to the Fifty-eighth World Health Assembly.
Seventh plenary meeting. 21 May 2004 A57NRJ7
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
WHAS7.4 22 May 2004
Agenda item 15.1
Financial report on the accounts of WHO for 2002-2003; report of the External Auditor and comments thereon made on behalf of the Executive Board The Fifty-seventh World Health Assembly, Having examined the Financial report and audited financial statements for the period 1 January 2002 - 31 December 2003 and Report of the External Auditor to the World Health Assembly;l Having noted the report of the Administration, Budget and Finance Committee of the Executive Board to the Fifty-seventh World Health Assembly/ ACCEPTS the Director-General's Financial report and audited financial statements for the period 1 January 2002 - 31 December 2003 and Report of the External Auditor to the World Health Assembly.
Eighth plenary meeting, 22 May 2004 A57NR18
1 Documents 2
A57/20 and A57/20 Add. I.
Document A57/21.
FIFfY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 15.2
WHA57.5 22 May 2004
Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution The Fifty-seventh World Health Assembly, Having considered the second report of the Administration, Budget and Finance Committee of the Executive Board to the Fifty-seventh World Health Assembly on Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution;l Noting that, at the time of opening of the Fifty-seventh World Health Assembly, the voting rights of Afghanistan, Antigua and Barbuda, Argentina, Armenia, Central African Republic, Chad, Comoros, Dominican Republic, Georgia, Guinea-Bissau, Iraq, Kyrgyzstan, Liberia, Nauru, Niger, Republic of Moldova, Somalia, Suriname, Tajikistan and Turkmenistan remained suspended, such suspension to continue until the arrears of the Member State concerned have been reduced, at the present or future Health Assemblies, to a level below the amount that would justify invoking Article 7 of the Constitution; Noting that Solomon Islands and Uruguay were in arrears at the time of the opening of the Fifty-seventh World Health Assembly to such an extent that it is necessary for the Health Assembly to consider, in accordance with Article 7 of the Constitution, whether or not the voting privileges of these countries should be suspended at the opening of the Fifty-eighth World Health Assembly; Having been informed that as Uruguay had subsequently paid its arrears in full it would no longer be included on the list of Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution, DECIDES: (1) that, in accordance with the statement of principles in resolution WHA41.7, if, by the time of the opening of the Fifty-eighth World Health Assembly, Solomon Islands is still in arrears in the payment of its contributions to an extent that would justify invoking Article 7 of the Constitution, their voting privileges shall be suspended as from the said opening;
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Document A57122.
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WHA57.5
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(2) that any suspension which takes effect as aforesaid shall continue at the Fifty-eighth and subsequent Health Assemblies, until the arrears of Solomon Islands have been reduced to a level below the amount that would justifY invoking Article 7 of the Constitution; (3) that this decision shall be without prejudice to the right of any Member to request restoration of its voting privileges in accordance with Article 7 of the Constitution.
Eighth plenary meeting, 22 May 2004 A57NRJ8
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 15.2
WHA57.6 22 May 2004
Arrears in payment of contributions: Ukraine The Fifty-seventh World Health Assembly, Having considered the second report of the Administration, Budget and Finance Committee of the Executive Board on Members in arrears in the payment of their contributions to an extent that would justify invoking Article 7 of the Constitution, with respect to the request of Ulcraine for the settlement of its outstanding contributions, 1 1. DECIDES to restore the voting privileges of Ulcraine at the Fifty-seventh World Health Assembly on the following conditions:
(i) Ukraine shall pay its outstanding arrears of assessed contributions, totalling US$ 36 163 544 over 15 years, subject to payment of at least half the total amount of arrears, i.e. US$ 18081 772, by the end of2011; (ii) Ukraine shall make a minimum payment of US$ I 500000 per annum, which shall be applied first, against its current-year assessment, second, against the eight annual instalments of US$ 342 848 each, due under resolution WHA45.23, and third, against the balance of its arrears; 2. DECIDES that, in accordance with Article 7 of the Constitution, voting privileges shall be automatically suspended again if Ukraine does not meet the requirements laid down in paragraph 1 above; 3. REQUESTS the Director-General to report to the Fifty-eighth World Health Assembly on the prevailing situation; 4. REQUESTS the Director-General to communicate this resolution to the Government of Ukraine.
Eighth plenary meeting, 22 May 2004 A57!VRJ8
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 18.1
WHAS7.7
22 May 2004
Agreement with the Office International des Epizooties The Fifty-seventh World Health Assembly, Having considered the report on the agreement between WHO and the Office International des Epizooties; I Considering Article 70 of the Constitution of WHO, APPROVES the agreement between the World Health Organization and the Office International des Epizooties, subject to the replacement of "Member Countries" by "Members" whenever this term appears.
Eighth plenary meeting, 22 May 2004 A57NRJ8
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Document A57/28.
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 18.2
WHA57.8
22 May 2004
Rules of Procedure of the World Health Assembly: amendment to Rule 72 The Fifty-seventh World Health Assembly, Recalling resolution WHA33.17 on the study of WHO's structure in the light of its functions and resolution WHA54.22 on the reform of the Executive Board; Having considered resolution EBl12.Rl,
1. DECIDES to replace the existing text of Rule 72 of its Rules of Procedure with the following text:
Rule 72 Decisions by the Health Assembly on important questions shall be made by a two thirds majority of the Members present and voting. These questions shall include: the adoption of conventions or agreements; the approval of agreements bringing the Organization into relation with the United Nations and with intergovernmental organizations and agencies in accordance with Articles 69, 70 and 72 of the Constitution; amendments to the Constitution; appointment of the Director-General; decisions on the amount of the effective working budget; and decisions to suspend the voting privileges and services of a Member under Article 7 of the Constitution. 2. RESOL YES that in the Basic documents, in accordance with the generally accepted rules of interpretation, the use of one gender shall be considered as including a reference to the other unless the context otherwise requires.
Eighth plenary meeting, 22 May 2004 A57NR18
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.16
WHA57.9
22 May 2004
Eradication of dracunculiasis The Fifty-seventh World Health Assembly, Having considered the report on eradication of dracunculiasis; I Noting with satisfaction the excellent results achieved by the endemic countries in decreasing the number of dracunculiasis cases from an estimated 3.5 million in 1986 to 32000 reported cases in 2003; Noting also that only 12 countries are endemic, all in sub-Saharan Africa, 1. CONGRATULATES Member States, the Organization and partner bodies, particularly UNICEF and The Carter Center, for increasing the availability of safe and potable water, improving surveillance for case detection, strengthening interventions and expanding public awareness of the disease;
2. CONGRATULATES the 168 countries and territories that have been certified free of dracunculiasis transmission since the International Commission for the Certification of Dracunculiasis Eradication was established in 1995; 3. RECALLS that ministers of health from the remaining endemic countries signed, at the time of the Fifty-seventh World Health Assembly, the Geneva Declaration for the Eradication of Dracunculiasis by 2009; 4. URGES the remaining endemic countries to intensify their eradication efforts, including active surveillance and prevention measures; 5. URGES Member States, the Organization, UNICEF, The Carter Center and other appropriate entities to capitalize on current successes and opportunities by continuing their commitment, collaboration and cooperation, to ensure political support at the highest level, and to assure that the much-needed resources are mobilized for the completion of eradication by 2009; 6. RECOMMENDS the Director-General to provide support for mobilization of adequate resources required for the eradication of dracunculiasis through the last steps of the programme and for its verification and certification activities for a world free of dracunculiasis. Eighth plenary meeting, 22 May 2004 A57NRJ8
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Document A57/33.
FIFfY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.7
WHAS7.10 22 May 2004
Road safety and health The Fifty-seventh World Health Assembly, Recalling resolution WHA27.59 (1974), which noted that road traffic accidents caused extensive and serious public health problems, that coordinated international efforts were required, and that WHO should provide leadership to Member States; Having considered the report on road safety and health;' Welcoming United Nations General Assembly resolution 58/9 on the global road-safety crisis; Noting with appreciation the adoption of resolution 58/289 by the United Nations General Assembly inviting WHO to act as a coordinator on road safety issues within the United Nations system, drawing upon expertise from the United Nations regional commissions; Recognizing the tremendous global burden of mortality resulting from road traffic crashes, 90% of which occur in low- and middle-income countries; Acknowledging that every road user must take the responsibility to travel safely and respect traffic laws and regulations; Recognizing that road traffic injuries constitute a major but neglected public health problem that has significant consequences in terms of mortality and morbidity and considerable social and economic costs, and that in the absence of urgent action this problem is expected to worsen; Further recognizing that a multisectoral approach is required successfully to address this problem, and that evidence-based interventions exist for reducing the impact of road traffic injuries; Noting the large number of activities on the occasion of World Health Day 2004, in particular, the launch of the first world report on traffic injury prevention/ 1. CONSIDERS that the public health sector and other sectors - government and civil society alike - should actively participate in programmes for the prevention of road traffic injury through injury surveillance and data collection, research on risk factors of road traffic injuries, implementation and evaluation of interventions for reducing road traffic injuries, provision of prehospital and trauma I
Document A57/1O. World report on road traffic injury prevention. Geneva, World Health Organization, 2004.
2
WHA57.10
care and mental-health support for traffic-injury victims, and advocacy for prevention of road traffic injuries; 2. URGES Member States, particularly those which bear a large proportion of the burden of road traffic injuries, to mobilize their public-health sectors by appointing focal points for prevention and mitigation of the adverse consequences of road crashes who would coordinate the public-health response in terms of epidemiology, prevention and advocacy, and liaise with other sectors; 3. ACCEPTS the invitation by the United Nations General Assembly for WHO to act as a coordinator on road safety issues within the United Nations system, working in close collaboration with the United Nations regional commissions; 4. RECOMMENDS Member States: (1) to integrate traffic injuries prevention into public health programmes;
(2) to assess the national situation concerning the burden of road traffic injury, and to assure that the resources available are commensurate with the extent of the problem; (3) if they have not yet done so, to prepare and implement a national strategy on prevention of road traffic injury and appropriate action plans; (4) to establish government leadership in road safety, including designating a single agency or focal point for road safety or through another effective mechanism according to the national context; (5) to facilitate multi sectoral collaboration between different ministries and sectors, including private transportation companies, communities and civil society; (6) to strengthen emergency and rehabilitation services;
(7) to raise awareness about risk factors in particular the effects of alcohol abuse, psychoactive drugs and the use of mobile phones while driving; (8) to take specific measures to prevent and control mortality and morbidity due to road traffic crashes, and to evaluate the impact of such measures; (9) to enforce existing traffic laws and regulations, and to work with schools, employers and other organizations to promote road-safety education to drivers and pedestrians alike; (10) to use the forthcoming world report on traffic injury prevention as a tool to plan and implement appropriate strategies for prevention of road traffic injury; (11) to ensure that ministries of health are involved in the framing of policy on the prevention of road traffic injuries; (12) especially developing countries, to legislate and strictly enforce wearing of crash helmets by motorcyclists and pillion riders, and to make mandatory both provision of seat belts by automobile manufacturers and wearing of seat belts by drivers;
2
WHA57.10
(13) explore the possibilities to increase funding for road safety, including through the creation ofa fund; 5. REQUESTS the Director-General: (1) to collaborate with Member States in establishing science-based public health policies and programmes for implementation of measures to prevent road traffic injuries and mitigate their consequences;
(2) to encourage research to support evidence-based approaches for prevention of road traffic injuries and mitigation of their consequences; (3) to facilitate the adaptation of effective measures to prevent traffic injury that can be applied in local communities; (4) to provide technical support for strengthening systems of pre hospital and trauma care for victims of road traffic crashes; (5) to collaborate with Member States, organizations of the United Nations system, and nongovernmental organizations in order to develop capacity for injury prevention; (6) to maintain and strengthen efforts to raise awareness of the magnitude and prevention of road traffic injuries; (7) to organize regular meetings of experts to exchange information and build capacity;
(8) to report progress made on the promotion of road safety and traffic injury prevention in Member States to the Sixtieth World Health Assembly in May 2007.
Eighth plenary meeting, 22 May 2004 A57NR18
3
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.9
WHAS7.11
22 May 2004
Family and health in the context of the tenth anniversary of the International Year of the Family The Fifty-seventh World Health Assembly, Having considered the report on family health in the context of the tenth anniversary of the International Year of the Family;! Recalling that the Constitution of the World Health Organization states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition; Recognizing and promoting the equal rights of men and women and emphasizing that equality between women and men and respect for the rights of all family members are essential to family wellbeing and to society at large; Recalling also the commitments, goals, and outcomes of United Nations conferences and summits that address health issues related to family members, individuals, and communities; Recalling further that relevant United Nations instruments on human rights and relevant global plans and programmes of action call for the widest possible protection and assistance to be accorded to the family, bearing in mind that, in different cultural, political and social systems, various forms of the family exist; Also recognizing that parents, families, legal guardians and other caregivers have the primary role and responsibility for the well-being of children, and must be supported in the performance of their child-rearing responsibilities; and that in all actions related to children, the best interests of the child shall be a primary consideration; Further recognizing that cultural norms, socioeconomic conditions, gender equality and education are significant determinants of health; Acknowledging that strong and supportive families and social networks have a positive impact on the health of all family members, while inadequate access to health care, child abuse, neglect, and violence in all its forms, especially spousal and domestic violence, alcohol and substance abuse,
I
Document A57112.
WHA57.11
neglect of older persons and persons with disabilities and the potential effects of prolonged periods of separation, such as those resulting from migration, are a significant concern; Noting with concern the devastating effects of the HIV/AIDS pandemic on families, family members, individuals and communities, especially in families headed by children and older persons; Noting that the tenth anniversary of the International Year of the Family is being observed in 2004, 1.
URGES Member States: (1)
to assess government policies with a view to assisting families to provide a supportive environment for all their members;
(2) to ensure the availability of appropriate legal, social and physical infrastructures to support mothers and fathers, families, legal guardians and other caregivers, particularly older women and men, to strengthen their capability to provide care, nurturing and protection in the best interest of every child in their care, the views of the child being given due weight in accordance with the age and maturity of the child; (3) to take measures to ensure that gender-sensitive health policies, plans and programmes recognize and address the rights and comprehensive health and development needs of each family member, with special attention to families at risk of being unable to meet the basic needs of their members, such as those families in which child abuse, violence in general, domestic violence or neglect, including members with disability and older persons occur; (4) to develop, use, and maintain systems to provide data, disaggregated by sex, age and other determinants of health, to underpin the planning, implementation, monitoring and evaluation of evidence-based health interventions relevant to all family members; (5) to develop or strengthen alliances and partnerships with all relevant govemmental and nongovernmental partners to assist families to meet the health and development needs of all their members; (6) to strengthen national actions to ensure sufficient resources to fulfil the international commitments, goals and outcomes of relevant United Nations conferences and summits related to the health of family members; (7) to fulfil their obligations under international instruments relevant to family and health development, such as the Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of the Child, as specified in resolution WHA46.27 on the International Year of the Family; 2. REQUESTS the Director-General: (1) to raise awareness of health issues relevant to families, family members, individuals and the community and to support Member States in increasing their efforts to strengthen health policies on these issues;
2
WHA57.11
(2) to support Member States, upon request, in developing, using, and maintaining systems to provide data, disaggregated by sex, age and other determinants of health, that underpin the planning, implementation, monitoring and evaluation of evidence-based health interventions relevant to families and their members; (3) to support Member States in their efforts to establish or strengthen programmes on parenting through relevant research and international forums for sharing country experiences; (4) to support Member States in their efforts to fulfil their commitments to the goals and outcomes of relevant United Nations conferences and summits related to the health of family members, in collaboration with relevant partners; (5) to pay due attention to the care and support issues related to the health of family members, including men and the elderly in relevant policies and programmes of the Organization, and ensure that initiatives focusing on family and health take into account the role of the schools in educating the children, especially the girl child; (6) to work closely with the United Nations Department of Economic and Social Affairs and other relevant organizations of the United Nations system, such as UNICEF and UNFP A, on issues related to families and their members by sharing experiences and findings; (7) to report to the Fifty-ninth World Health Assembly, through the Executive Board, on progress made in implementing this resolution.
Eighth plenary meeting, 22 May 2004 A57NRJ8
3
FIFfY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.10
WHAS7.12 22 May 2004
Reproductive health: draft strategy to accelerate progress towards the attainment of international development goals and targets The Fifty-seventh World Health Assembly, Having considered the draft strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health; I Recalling and recognizing the Programme of Action of the International Conference on Population and Development (Cairo, 1994) and key actions for the further implementation of the Programme of Action of the International Conference on Population and Development adopted by the twenty-first special session of the United Nations General Assembly in July 1999; Recalling and recognizing further the Beijing Platform for Action (Beijing, 1995) and the further actions and initiatives to implement the Beijing Declaration and the Platform for Action adopted at the twenty-third special session of the United Nations General Assembly in June 2000; Reaffirming the development goals as contained in the Millennium Declaration adopted by the United Nations General Assembly at its fifty-fifth session in September 2000,1 and in the Road Map towards the implementation of the United Nations Millennium Declaration/ and other international development goals and targets; Recognizing that attainment of the development goals of the United Nations Millennium Declaration and other international goals and targets require, as a priority, strong investment and political commitment in reproductive and sexual health; Recalling that resolution WHA55.19 requested the Director-General, inter alia, to develop a strategy for accelerating progress towards attainment of international development goals and targets related to reproductive health, 1. ENDORSES the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health; I
Document A57113, Annex. United Nations General Assembly resolution 55/2. Document N56/326.
2
3
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2.
URGES Member States, as a matter of urgency: (1)
to adopt and implement the strategy as part of national efforts to achieve the development goals of the United Nations Millennium Declaration and other international development goals and targets, and to mobilize political will and financial resources for that purpose;
(2) to make reproductive and sexual health an integral part of national planning and budgeting; (3) to strengthen the capacity of health systems with the participation of community and nongovernmental groups to achieve universal access to sexual and reproductive health care, with particular attention to maternal and neonatal health in a11 countries; (4) to monitor implementation of the strategy to ensure that it benefits the poor and other marginalized groups, including adolescents and men, and that it strengthens reproductive and sexual health care and programmes at all levels; (5) to ensure that all aspects of reproductive and sexual health including, inter alia, adolescent reproductive health and maternal and neonatal health, are included within national monitoring and reporting of progress towards attainment of the development goals of the United Nations Millennium Declaration; 3. REQUESTS the Director-General: (I) to provide support to Member States, on request, in implementing the strategy and evaluating its impact and effectiveness; (2) to devote sufficient organizational priority, commitment and resources to supporting effective promotion and implementation of the reproductive health strategy and the "necessary actions" that it highlights; (3) to assist Member States in ensuring reproductive health commodity security;
(4) to give particular attention to maternal and neonatal health in WHO's first progress report on reproductive and sexual health in 2005, as part of its contribution to the Secretary-General's report to the United Nations General Assembly on progress towards attainment of the development goals of the United Nations Millennium Declaration; (5) to provide regular (at least biennial) progress reports on implementation of the strategy to the Health Assembly, through the Executive Board.
Eighth plenary meeting, 22 May 2004 A57NRJ8
2
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.13
WHA57.13 22 May 2004
Genomics and world health The Fifty-seventh World Health Assembly, Having considered the report on genomics and world health;l Acknowledging the remarkable progress in genomics research and the fact that many Member States are not well prepared for this new approach to medical research and practice; Wishing to promote the potential benefits of the genomics revolution for the health of populations in developed and developing countries alike; Aware that genomics raises concerns about safety and has complicated and new ethical, legal, social and economic implications; Reaffirming that advances in genomics must be considered in the context of their value added in the practice and delivery of health care; Recognizing the urgent need for research into, and applications of, genomics in order to promote benefits that accrue to human beings; Recognizing that genomics has a significant contribution to make in the area of public health; Convinced that it is time for governments, the scientific community, civil society, the private sector and the international community to pledge their commitment to ensuring that the advances of genomics are equitably shared by all, 1. TAKES NOTE of the recommendations contained in the report of the Advisory Committee on Health Research on genomics and world health;2
2. ADOPTS, for the purposes of the present resolution and all subsequent activities of WHO, the following definition of genomics: genornics is the study of genes and their functions, and related techniques;
I
Document A571J6.
2 Genomics and world health: report of the Advisory Committee on Health Research. Geneva, World Health Organization, 2002.
WHA57.13
3. URGES Member States to consider adopting the said recommendations and to mobilize all concerned scientific, social, political and economic parties in order: (1) to frame national genomic policies and strategies, and to set up mechanisms for assessing relevant technologies, cost-effectiveness, ethical review structures, legal, social and economic implications, regulatory systems particularly with regard to safety, and the need for public awareness;
(2) to strengthen existing, or establish new, centres and institutions engaged in genomics research with a view to strengthening national capacity and accelerating the ethical application of the advances in genomics relevant to countries' health problems; 4. CALLS UPON Member States to facilitate greater collaboration among the private sector, the scientific community, civil society, and other relevant stakeholders in particular within the United Nations system, and engagement in dialogue in order to [md creative and equitable ways of mobilizing more resources for genomics research targeted at the health needs of developing countries and building capacity in such areas as bioethics and bioinformatics; 5. REQUESTS the Director-General: (1) to provide support to Member States for framing national policies and strategies and strengthening capacity so that they can benefit from the advances in genomics relevant to their health problems and regulatory systems, particularly with regard to safety and the need for public awareness; (2) to promote WHO's role in collaboration with relevant United Nations bodies in convening regional and international forums and fostering partnerships among the main stakeholders in order to mobilize resources, contribute to building capacity, and find innovative solutions to issues associated with advances in genomics research; (3) to facilitate exchange between developed and developing countries in the use and application of genomic technologies, in order to tackle both local and region specific problems through, for example, training and technical support activities.
Eighth plenary meeting, 22 May 2004 A57NRJ8
2
FIFfY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.1
WHAS7.14 22 May 2004
Scaling up treatment and care within a coordinated and comprehensive response to HIV/AIDS The Fifty-seventh World Health Assembly, Having considered the report on HIV/AIDS;! Noting with great concern that by the end of 2003 about 40 million people were living with HIV/AIDS, the pandemic had claimed an estimated three million lives in 2003, and that HIV/AIDS affects women and children with particular severity; Also concerned that, although about six million people in developing countries need antiretroviral treatment, only 440 000 currently receive it; Noting with concern that other health conditions also cause high morbidity and mortality in developing countries; Acknowledging that antiretroviral therapy has reduced mortality and prolonged healthy lives and that the feasibility of delivering antiretroviral treatment has been demonstrated in several resource-constrained settings; Recognizing that treatment and access to medication for those infected and affected by HIV/AIDS, as well as prevention, care and support are inseparable elements of a comprehensive health-sector response at the national level, and require adequate financial support from States and other donors; Recognizing that social stigma, discrimination, lack of affordability of antiretroviral medicines, economic constraints, limitations in health care capacity and human resources are some of the major impediments to access to treatment and care and social support for people living with HIV/AIDS; Also recognizing the need to further reduce the costs of antiretroviral medicines; Recalling the Declaration of Commitment on HIV/AIDS adopted at the United Nations General Assembly special session on mv/AIDS (27 June 2001), which acknowledges that prevention of HIV infection must be the mainstay of national, regional and international responses to the epidemic and calls for significant progress, by 2005, in implementing comprehensive care strategies, including for access to antiretroviral drugs; I
Document A57/4.
WHA57.14
Recalling also resolution WHA55.12 on the contribution of WHO to the follow-up of the United Nations General Assembly special session on HIV/AIDS, resolution WHA55.14 on ensuring accessibility of essential medicines, resolution WHA56.27 on inteIlectual property rights, innovation and public health, and resolution WHA56.30 on the global health-sector strategy for mY/AIDS; Recalling and recognizing the Programme of Action adopted at the International Conference on Population and Development (Cairo, 1994), commitments made at the World Summit for Social Development (Copenhagen, 1995) and the World Summit for Children (New York, 1990), the Beijing Declaration and Platform for Action (1995), the Declaration on the Elimination of Violence against Women (1993), and the Millennium Declaration (2000), their recommendations and respective followups and reports; Noting with satisfaction the agreement of 2S April 2004 among development partners to improve coordination and harmonization in the response to HIV/AIDS at country level, through the "Three Ones" principle, namely, one agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners; one national AIDS coordinating authority, with a broad-based multisectoral mandate; and one agreed country-level monitoring and evaluation system; Recognizing the central role of the health sector in the response to HIV/AlDS and the need to strengthen health systems and human capacity development so that countries and communities may contribute fully to realization of the global targets set out in the Declaration of Commitment on HIV/AIDS and to develop public health systems with a view to minimizing the emergence of drug resistance; Underlining the importance of WHO's work, including through the WHO-initiated procurement, quality and sourcing project, to facilitate access by developing countries to safe, effective and affordable antiretroviral drugs and diagnostics at the best price; Recalling the Declaration on the TRIPS Agreement and Public Health adopted at the WTO Ministerial Conference (Doha, November 2001), and welcoming the decision taken by the General Council of WTO on 30 August 2003 on the implementation of paragraph 6 in that Declaration; 1 Acknowledging WHO's special role within the United Nations system to combat and mitigate the effects of mY/AIDS, its responsibility in the follow-up of the Declaration of Commitment on HIV/AIDS and, as a cosponsor ofUNAIDS, in leading United Nations efforts in relation to treatment and care for HIV/AIDS and playing a strong role in prevention; Welcoming the progress made by many Member States in beginning to scale up treatment for HIV/AIDS in their countries; Welcoming also the increased support of Member States for programmes to combat HIV/AIDS, 1. WELCOMES the Director-General's "3 by S" strategy to support developing countries, as part of WHO's follow-up to the comprehensive global health-sector strategy for HIV/AIDS, in securing access to antiretroviral treatment for three million people living with mY/AIDS by the end of 2005, and notes the importance of mobilizing financial resources from States and other donors including for WHO to achieve this target;
I
Document WflU540, available at http://docsonline.wto.org.
2
WHA57.14
2.
URGES Member States, as a matter of priority: (1) to establish or strengthen national health and social infrastructure and health systems, with the assistance of the international community as necessary, in order to assure their capacity to deliver effectively HIV/AIDS prevention, treatment, care and support services; (2) to strengthen national planning, monitoring and evaluation systems in order to deliver HIV/AIDS prevention, treatment, care and support services within the context of the overall national health strategy, ensuring an appropriate balance between services for HIV/AIDS and all other essential health services; (3) to pursue policies and practices that promote: (a) sufficient and adequately trained human resources with the appropriate skillmix to invoke a scaled-up response; (b) human rights, equity, and gender equality in access to treatment and care;
(c) affordability and availability, in sufficient quantities, of pharmaceutical products of good quality, including antiretroviral medicines and medical technologies used to treat, diagnose and manage mY/AIDS; (d) accessible and affordable treatment, testing and counselling with informed consent, prevention and care services for all, without discrimination, including the most vulnerable or socially disadvantaged groups of the population; (e) good quality and scientific and medical appropriateness ofpharrnaceutical products or medical technologies for treatment and management of mY/AIDS, irrespective of their sources and countries of origin, inter alia by making the best use of WHO's list of prequalified drugs that meet international quality standards; (f) further investments in medicines, including microbicides, diagnostics and vaccine research, in social science and health systems research, and in traditional medicines and possible interactions with other medicines, in order to improve effective interventions; (g) development of health systems designed to promote access to antiretroviral medicines and to facilitate adherence to treatment regimens with a view to minimizing drug resistance as well as protection of patients against counterfeit medicines; (h) integration of nutrition into a comprehensive response to mY/AIDS;
(i) promotion of breastfeeding in the light of the United Nations Framework for Priority Action on mv and Infant Feeding and the new WHOIUNICEF Guidelines for Policy-Makers and Health-Care Managers; (4) to consider, whenever necessary, adapting national legislation in order to use to the full the flexibilities contained in the Agreement on Trade-Related Aspects of Intellectual Property Rights;
3
WHAS 7. 14
(5) to apply the "Three Ones" principle with a view to improving coordination and harmonization in the response to HIV/AIDS; (6) to encourage that bilateral trade agreements take into account the flexibilities contained in the WTO TRIPS Agreement and recognized by the Doha Ministerial Declaration on the TRIPS Agreement and Public Health; 3. REQUESTS the Director-General: to strengthen the key role of WHO in providing technical leadership, direction and support to health systems' response to HIV/AIDS, within the United Nations system-wide response, as a cosponsor of UNAIDS; (1)
(2)
to take action within the framework of the "Three Ones" principle: (a) to provide support to countries in order to maximize opportunities for the delivery of all relevant interventions for prevention, care, support and treatment of HIV/AIDS and related conditions, including tuberculosis; (b) to support, mobilize and facilitate efforts of developing countries to scale up antiretroviral treatment in a manner that focuses on poverty, gender equality, and the most vulnerable groups, within the context of strengthening national health systems while maintaining a proper balance of investment between prevention, care and treatment; (c) to provide guidance on accelerating prevention in the context of scaled-up treatment, in line with the global health-sector strategy for HIV/AIDS;
(3) to take measures to improve access of developing countries to pharmaceutical and diagnostic products to diagnose, treat and manage HIV/AIDS, includmg by strengthening WHO's prequalification project; (4) to ensure that the prequalification review process and the results of inspection and assessment reports of the listed products, aside from proprietary and confidential information, are made publicly available; (5) to support developing countries in improving management of the supply chain and procurement of good-quality AIDS medicines and diagnostics; (6) to provide support to countries to embed the scale-up of the response to HIV/AIDS into a broad effort to strengthen national health systems, with special reference to human resources development and health infrastructure, health system financing and health information; (7) to provide a progress report on implementation of this resolution to the Fifty-eighth World Health Assembly, through the Executive Board.
Eighth plenary meeting, 22 May 2004 A57NRJ8
4
FIFTY-SEVENTH WORLD HEALm ASSEMBLY Agenda item 15.3
WHA57.15 22 May 2004
Scale of assessments for 2005 The Fifty-seventh World Health Assembly, Having considered the report of the Director-General,l
1. DECIDES to adopt a revised scale of assessments for 2005, reflecting the latest available United Nations scale as shown below: Members and Associate Members Revised WHO scale for 2005
% Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Annenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil 1 Document
0.00200 0.00500 0.07600 0.00500 0.00100 0.00300 0.95600 0.00200 1.59200 0.85900 0.00500 0.01300 0.03000 0.01000 0.01000 0.01800 1.06900 0.00100 0.00200 0.00100 0.00900 0.00300 0.01200 1.52300
A57/23.
WHA57.15
Members and Associate Members
Revised WHO scale for 2005
% Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala 0.03400 0.01700 0.00200 0.00100 0.00200 0.00800 2.81300 0.00100 0.00100 0.00100 0.22300 2.05300 0.15500 0.00100 0.00100 0.00100 0.03000 0.01000 0.03700 0.04300 0.03900 0.18300 0.01000 0.00300 0.71800 0.00100 0.00100 0.03500 0.01900 0.12000 0.02200 0.00200 0.00100 0.01200 0.00400 0.00400 0.53300 6.03010 0.00900 0.00100 0.00300 8.66230 0.00400 0.53000 0.00100 0.03000
2
WHAS7.J5
Members and Associate Members
Revised WHO scale for 2005 %
Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Morocco Mozambique Myanmar
0.00300 0.00100 0.00100 0.00300 0.00500 0.12600 0.03400 0.42100 0.14200 0.15700 0.01600 0.35000 0.46700 4.88510 0.00800 19.46830 0.01100 0.02500 0.00900 0.00100 0.16200 0.00100 0.00100 0.01500 0.02400 0.00100 0.00100 0.13200 0.02400 0.07700 0.00300 0.00100 0.20300 0.00100 0.00200 0.01400 0.00100 0.00100 0.01100 1.88300 0.00100 0.00300 0.00100 0.04700 0.00100 0.01000
3
WHA57.15
Members and Associate Members
Revised WHO scale for 2005 %
Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka
0.00600 0.00100 0.00400 1.69000 0.22100 0.00100 0.00100 0.04200 0.00100 0.67900 0.07000 0.05500 0.00100 0.01900 0.00300 0.01200 0.09200 0.09500 0.46100 0.47000 0.00100 0.06400 1.79600 0.00100 0.06000 1.10000 0.00100 0.00100 0.00200 0.00100 0.00100 0.00300 0.00100 0.71300 0.00500 0.01900 0.00200 0.00100 0.38800 0.05100 0.08200 0.00100 0.00100 0.29200 2.52000 0.01700
4
WHA57.15
Members and Associate Members
Revised WHO scale for 2005
Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan
% 0.00800 0.00100 0.00200 0.99800 1.19700 0.03800
0.00100 0.20900 0.00600 0.00100
0.00100 0.00100 0.00100 0.02200 0.03200 0.37200
Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela VietNam Yemen Zambia Zimbabwe Total
0.00500 0.00100 0.00600 0.03900 0.23500
6.12720 0.00600 22.00000 0.04800
0.01400 0.00100 0.17100 0.02100 0.00600 0.00200 0.00700 100.00000
2. DECIDES to implement the amounts available under the adjustment mechanism for 2005, shown below, modified to reflect the revised assessments for 2005, and in accordance with the method of calculation established in resolution WHA56.34, the amounts to be proportionally reduced, if necessary, to ensure that the total claimed, on the basis of notifications received by 31 October 2004, is fully covered by the amount appropriated for the adjustment mechanism in 2004-2005.
5
WHA57.J5
Members and Associate Members
Adjustment mechanism Members eligible
2005 (new scale) US$
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Annenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Repubhc Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cote d' Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti
3435 1715 1 715
228355
22320 3435
3435 3435 130490 24035 10 300
I 715 214620
152810 I 844 005 82415
24035 1 715 13735 32620 10300 66960
63525
6
WHAS7.1S
Members and Associate Members
Adjustment mechanism Members eligible
2005 (new scale) US$ Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahirya Lithuania Luxembourg
34340 96150 17 170 1 715
317 635 20605
1 715 3435 13 735 5150 218055
223205 211 185 3435 8585 3435 61810
13735
17 170 15455 17170
7
WHAS7.J5
Members and Associate Members
Adjustment mechanism Members eligible 2005 (new scale) US$
Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kins and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia
39490
3435 1 552125
12020 3435
144 225 6870
18885 135640 34340
10 300
25755 460 145 78980 54940 1 383 860 8585 68680
1 715
1 715 274710
8
WHA57.15
Members and Associate Members
Adjustment mechanism Members eligible 2005 (new scale) US$
Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela VietNam Yemen Zambia Zimbabwe
363995 29190 37775
8585 1 715
1 715
72 110 3435 1715
10300 8585
3435 103 015 1 916460 5150
1 715
24035 24035
Total
11 182830
Eighth plenary meetmg, 22 May 2004 A57NRJS
9
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.8
WHA57.16
22 May 2004
Health promotion and healthy lifestyles The Fifty-seventh World Health Assembly, Recalling resolutions WHA42.44 and WHA51.12 on health promotion, public information and education for health and the outcome of five global conferences on health promotion, from Ottawa (1986), Adelaide, Australia (1988), Sundsvall, Sweden (1991), Jakarta (1997), to Mexico City (2000), and the Ministerial Statement for the promotion of health (2000), and the adoption of the WHO Framework Convention on Tobacco Control (2003); Having considered the report on health promotion and healthy lifestyles; I Noting that The world health report 2002 2 addresses major risks to global health, and highlights the role of behavioural factors, notably unhealthy diet, physical inactivity, tobacco consumption and the harmful use of alcohol as key risk factors for noncommunicable diseases which constitute a rapidly growing burden; Noting that promotion of mental health constitutes an important component of overall health promotion; Recognizing that the need for health promotion strategies, models and methods is limited neither to a specific health issue nor to a specific set of behaviours, but applies to a variety of population groups, risk factors and diseases, and in various cultures and settings; Recognizing that, in general, the overriding efforts in health promotion should be geared to reducing health inequalities by comprehensively tackling the determinant chain, including societal structures, environmental factors and lifestyles; Recognizing the need for Member States to strengthen the policies, human and financial resources, and institutional capability for sustainable and effective health promotion that addresses the major determinants of health and their related risk factors, with a view to building national capacity, strengthening evidence-based approaches, developing innovative means of financing, and drawing up guidelines for implementation and evaluation; Recalling the importance of primary health care and the five areas of action set out in the Ottawa Charter for Health Promotion, I
Document A5?/l!. The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
2
WHA57.16
1.
URGES Member States: (1) to strengthen existing capability at national and local levels for the planning and implementation of gender sensitive and culturally appropriate, comprehensive and multisectoral health-promotion policies and programmes, with particular attention to poor and marginalized groups;
(2) to set up appropriate mechanisms to collect, monitor and analyse national experiences in order to strengthen the evidence base for the effectiveness of health promotion interventions as an integral part of health systems with a view to achieving effective societal and lifestyle changes; (3) to give high priority to promoting healthy lifestyles among children and young people boys and girls both in and out of school or other educational institution - including healthy and safe recreational opportunities and creation of supportive environments for such lifestyles; (4) to include harmful use of alcohol in the list of lifestyle-related risk factors as stated in The world health report 2002, and to give attention to the prevention of alcohol-related harm and promotion of strategies to reduce the adverse physical, mental and social consequences of harmful use of alcohol, especially among young people and pregnant women, in the workplace, and when driving; (5) to set up tobacco-cessation programmes;
(6) to consider actively, where necessary and appropriate, the establishment of innovative, adequate and sustainable financing mechanisms for health promotion with a firm institutional base for the management of health promotion; 2. REQUESTS the Director-General: (1) to give health promotion highest priority in order to support its development within the Organization as requested in resolution WHA5 1. 12, with a view to supporting Member States, in consultation with involved stakeholders, more effectively to address the major risk factors to health, including harmful use of alcohol and other major lifestyle-related factors; (2) to continue to advocate an evidence-based approach to health promotion and to provide technical and other support to Member States in building their capacity for the implementation, monitoring, evaluation and dissemination of effective health promotion programmes at all levels; (3) to provide support and guidance to Member States in relation to the challenges and opportunities stemming from the promotion of healthy lifestyles and the management of related risk factors, as outlined in The world health report 2002; (4) to provide support to all Member States for development and implementation of tobacco-cessation programmes; (5) to support Member States, where necessary and appropriate, in their attempt to establish an innovative, adequate and sustainable fmancing mechanism with a firm institutional base in order to coordinate effectively and monitor systematically their health promotion efforts;
2
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(6) to report on progress made in the promotion of healthy lifestyles to the Executive Board at its 115th session and to the Fifty-eighth World Health Assembly, including a report on the Organization's future work on alcohol consumption.
Eighth plenary meeting, 22 May 2004 A57NRJ8
3
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.6
WHAS7.17
22 May 2004
Global strategy on diet, physical activity and health The Fifty-seventh World Health Assembly, Recalling resolutions WHAS1.18 and WHAS3.17 on prevention noncommunicable diseases, and WHASS.23 on diet, physical activity and health; and control of
Recalling The world health report 2002,1 which indicates that mortality, morbidity and disability attributed to the major noncommunicable diseases currently account for about 60% of all deaths and 47% of the global burden of disease, which figures are expected to rise to 73% and 60%, respectively, by 2020; Noting that 66% of the deaths attributed to noncommunicable diseases occur in developing countries where those affected are on average younger than in developed countries; Alarmed by these rising figures that are a consequence of evolving trends in demography and lifestyles, including those related to diet and physical activity; Recognizing the existing, vast body of knowledge and public health potential, the need to reduce the level of exposure to the major risks resulting from unhealthy diet and physical inactivity, and the largely preventable nature of the consequent diseases; Mindful also that these major behavioural and environmental risk factors are amenable to modification through implementation of concerted essential public-health action, as has been demonstrated in several Member States; Acknowledging that malnutrition, including undernutrition and nutritional deficiencies, is still a major cause of death and disease in many parts of the world, especially in developing countries, and that this strategy complements the important work of WHO and its Member States in the overall area of nutrition; Recognizing the interdependence of nations, communities and individuals and that governments have a central role, in cooperation with other stakeholders, to create an environment that empowers and encourages individuals, families and communities to make positive, life-enhancing decisions on healthy diet and physical activity;
1 The
world health report 2002. Reducing risks. promoting healthy life. Geneva, World Health Organization, 2002.
WHA57.17
Recognizing the importance of a global strategy for diet, physical activity and health within the integrated prevention and control of noncommunicable diseases, including support of healthy lifestyles, facilitation of healthier environments, provision of public information and health services, and the major involvement in improving the lifestyles and health of individuals and communities of the health and relevant professions and of aU concerned stakeholders and sectors committed to reducing the risks of noncommunicable diseases; Recognizing that for the implementation of this global strategy, capacity building, financial and technical support should be promoted through international cooperation in support of national efforts in developing countries; Recognizing the socioeconomic importance and the potential health benefits of traditional dietary and physical activity practices, including those of indigenous peoples; Reaffirming that nothing in this strategy shall be construed as a justification for the adoption of trade-restrictive measures or trade-distorting practices; Reaffirming that appropriate levels of intakes for energy, nutrients and foods, including free sugars, salt, fats, fruits, vegetables, legumes, whole grains, and nuts shall be determined in accordance with national dietary and physical activity guidelines based on the best available scientific evidence and as part of Member States' policies and programmes taking into account cultural traditions, and national dietary habits and practices; Convinced that it is time for governments, civil society and the international community, including the private sector, to renew their commitment to encouraging healthy patterns of diet and physical activity; Noting that resolution WHA56.23 urged Member States to make full use of Codex Alimentarius Commission standards for the protection of human health throughout the food chain, including assistance with making healthy choices regarding nutrition and diet, 1.
ENDORSES the Global Strategy on Diet, Physical Activity and Health annexed herewith; URGES Member States: (1) to develOp, implement and evaluate actions recommended in the strategy, as appropriate to national circumstances and as part of their overall policies and programmes, that promote individual and community health through healthy diet and physical activity, and reduce the risks and incidence of noncommunicable diseases; (2) to promote lifestyles that include a healthy diet and physical activity and foster energy balance; (3) to strengthen existing, or establish new, structures for implementing the strategy through the health and other concerned sectors, for monitoring and evaluating its effectiveness and for guiding resource investment and management to reduce the prevalence of noncommunicable diseases and the risks related to unhealthy diet and physical inactivity;
2.
2
WHA57.17
(4)
to define for this purpose, consistent with national circumstances: (a) (b) (c) national goals and objectives, a realistic timetable for their achievement, national dietary and physical activity guidelines,
(d) measurable process and output indicators that will permit accurate monitoring and evaluation of action taken and a rapid response to identified needs, (e) measures to preserve and promote traditional foods and physical activity;
(5) to encourage mobilization of all concerned social and economic groups, including scientific, professional, nongovernmental, voluntary, private-sector, civil society, and industry associations, and to engage them actively and appropriately in implementing the strategy and achieving its aims and objectives; (6) to encourage and foster a favourable environment for the exercise of individual responsibility for health through the adoption of lifestyles that include a healthy diet and physical activity; (7) to ensure that public policies adopted in the context of the implementation of this strategy are in accordance with their individual commitments in international and multilateral agreements, including trade and other related agreements, so as to avoid trade-restrictive or trade-distorting impact; (8) to consider, when implementing the strategy, the risks of unintentional effects on vulnerable populations and specific products; 3. CALLS UPON other international organizations and bodies to give high priority within their respective mandates and programmes to, and invites public and private stakeholders including the donor community to cooperate with govemments in, the promotion of healthy diets and physical activity to improve health outcomes; 4. REQUESTS the Codex Alimentarius Commission to continue to give full consideration, within the framework of its operational mandate, to evidence-based action it might take to improve the health standards of foods consistent with the aims and objectives of the strategy; 5. REQUESTS the Director-General: (1) to continue and strengthen the work dedicated to undernutrition and micronutrient deficiencies, in cooperation with Member States, and to continue to report to Member States on developments made in the field of nutrition (resolutions WHA46.7, WHA52.24, WHA54.2 and WHA55.25);
(2) to provide technical advice and mobilize support at both global and regional levels to Member States, when requested, in implementing the strategy and in monitoring and evaluating implementation;
3
WHAS7.17
(3) to monitor on an ongoing basis international scientific developments and research relative to diet, physical activity and health, including claims on the dietary benefits of agricultural products which constitute a significant or important part of the diet of individual countries, so as to enable Member States to adapt their programmes to the most up-to-date knowledge; (4) to continue to prepare and disseminate technical information, guidelines, studies, evaluations, advocacy and training materials so that Member States are better aware of the costlbenefits and contributions of healthy diet and physical activity as they address the growing global burden of noncommunicable diseases; (5) to strengthen international cooperation with other organizations of the United Nations system and bilateral agencies in promoting healthy diet and physical activity throughout life; (6) to cooperate with civil society and with public and private stakeholders committed to reducing the risks of noncommunicable diseases in implementing the strategy and promoting healthy diet and physical activity, while ensuring avoidance of potential conflicts of interest; (7) to work with other specialized United Nations and intergovernmental agencies on assessing and monitoring the health aspects, socioeconomic impact and gender aspects of this strategy and its implementation and to brief the Fifty-ninth World Health Assembly on the progress of this activity; (8) to report on the implementation of the global strategy at the Fifty-ninth World Health Assembly.
4
WHAS7.17
ANNEX
GLOBAL STRATEGY ON DIET, PHYSICAL ACTIVITY AND HEALTH (endorsed by resolution WHA57.17) 1. Recognizing the heavy and growing burden of noncommunicable diseases, Member States requested the Director-General to develop a global strategy on diet, physical activity and health through a broad consultation process. 1 To establish the content of the draft global strategy, six regional consultations were held with Member States, and organizations of the United Nations system, other intergovernmental bodies, and representatives of civil society and the private sector were consulted. A reference group of independent international experts on diet and physical activity from WHO's six regions also provided advice.
2. The strategy addresses two of the main risk factors for noncommunicable diseases, namely, diet and physical activity, while complementing the long-established and ongoing work carried out by WHO and nationally on other nutrition-related areas, including undernutrition, micronutrient deficiencies and infant- and young-child feeding.
THE CHALLENGE 3. A profound shift in the balance of the major causes of death and disease has already occurred in developed countries and is under way in many developing countries. Globally, the burden of noncommunicable diseases has rapidly increased. In 2001 noncommunicable diseases accounted for almost 60% of the 56 million deaths annually and 47% of the global burden of disease. In view of these figures and the predicted future growth in this disease burden, the prevention of noncommunicable diseases presents a major challenge to global public health. 4. The world health report 2002 2 describes in detail how, in most countries, a few major risk factors account for much of the morbidity and mortality. For noncommunicable diseases, the most important risks included high blood pressure, high concentrations of cholesterol in the blood, inadequate intake of fruit and vegetables, overweight or obesity, physical inactivity and tobacco use. Five of these risk factors are closely related to diet and physical activity. 5. Unhealthy diets and physical inactivity are thus among the leading causes of the major noncommunicable diseases, including cardiovascular disease, type 2 diabetes and certain types of cancer, and contribute substantially to the global burden of disease, death and disability. Other diseases related to diet and physical inactivity, such as dental caries and osteoporosis, are widespread causes of morbidity. 6. The burden of mortality, morbidity and disability attributable to noncommunicable diseases is currently greatest and continuing to grow in the developing countries, where those affected are on average younger than in developed countries, and where 66% of these deaths occur. Rapid changes in
1 Resolution 2
WHA55.23.
The world health report 2002. Reducing risks. promoting healthy life. Geneva, World Health Organization, 2002.
5
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Annex
diets and patterns of physical activity are further causing rates to rise. Smoking also increases the risk for these diseases, although largely through independent mechanisms. 7. In some developed countries where noncommunicable diseases have dominated the national burden of disease, age-specific death and disease rates have been slowly declining. Progress is being made in reducing premature death rates from coronary artery disease, cerebrovascular disease and some tobacco-related cancers. However, the overall burden and number of patients remain high, and the numbers of overweight and obese adults and children, and of cases, closely linked, of type 2 diabetes are growing in many developed countries. 8. Noncommunicable diseases and their risk factors are initially mostly limited to economically successful groups in low- and middle-income countries. However, recent evidence shows that, over time, patterns of unhealthy behaviour and the noncommunicable diseases associated with them cluster among poor communities and contribute to social and economic inequalities. 9. In the poorest countries, even though infectious diseases and undernutrition dominate their current disease burden, the major risk factors for chronic diseases are spreading. The prevalence of overweight and obesity is increasing in developing countries, and even in low-income groups in richer countries. An integrated approach to the causes of unhealthy diet and decreasing levels of physical activity would contribute to reducing the future burden of noncommunicable diseases. 10. For all countries for which data are available, the underlying determinants of noncommunicable diseases are largely the same. Factors that increase the risks of noncommunicable disease include elevated consumption of energy-dense, nutrient-poor foods that are high in fat, sugar and salt; reduced levels of physical activity at home, at school, at work and for recreation and transport; and use of tobacco. Variations in risk levels and related health outcomes among the population are attributed, in part, to the variability in timing and intensity of economic, demographic and social changes at national and global levels. Of particular concern are unhealthy diets, inadequate physical activity and energy imbalances in children and adolescents. 11. Maternal health and nutrition before and during pregnancy, and early infant nutrition may be important in the prevention of noncommunicable diseases throughout the life course. ExclUSIve breastfeeding for six months and appropriate complementary feeding contribute to optimal physical growth and mental development. Infants who suffer prenatal and possibly, postnatal growth restrictions appear to be at higher risk for noncommunicable diseases in adulthood. 12. Most elderly people live in developing countries, and the ageing of populations has a strong impact on morbidity and mortality patterns. Many developing countries will therefore be faced with an increased burden of noncommunicable diseases at the same time as a perSisting burden of infectious diseases. In addition to the human dimension, maintaining the health and functional capacity of the increasing elderly population will be a crucial factor in reducing the demand for, and cost of, health services. 13. Diet and physical activity influence health both together and separately. Although the effects of diet and physical activity on health often interact, particularly in relation to obesity, there are additional health benefits to be gained from physical activity that are independent of nutrition and diet, and there are significant nutritional risks that are umelated to obesity. Physical activity is a fundamental means of improving the physical and mental health of individuals.
6
Annex
WHA57.17
14. Governments have a central role, in cooperation with other stakeholders, to create an environment that empowers and encourages behaviour changes by individuals, families and communities, to make positive, life-enhancing decisions on healthy diets and patterns of physical activity. 15. Noncommunicable diseases impose a significant economic burden on already strained health systems, and inflict great costs on society. Health is a key determinant of development and a precursor of economic growth. The WHO Commission on Macroeconomics and Health has demonstrated the disruptive effect of disease on development, and the importance for economic development of investments in health.' Programmes aimed at promoting healthy diets and physical activity for the prevention of diseases are key instruments in policies to achieve development goals.
THE OPPORTUNITY 16. A unique opportunity exists to formulate and implement an effective strategy for substantially reducing deaths and disease worldwide by improving diet and promoting physical activity. Evidence for the links between these health behaviours and later disease and ill-health is strong. Effective interventions to enable people to live longer and healthier lives, reduce inequalities, and enhance development can be designed and implemented. By mobilizing the full potential of the major stakeholders, this vision could become a reality for all populations in all countries.
GOAL AND OBJECTIVES 17. The overall goal of the global strategy on diet, physical activity and health is to promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels that, when taken together, will lead to reduced disease and death rates related to unhealthy diet and physical inactivity. These actions support the United Nations Millennium Development Goals and have immense potential for public health gains worldwide. 18. The global strategy has four main objectives: (1) to reduce the risk factors for noncommunicable diseases that stem from unhealthy diets and physical inactivity by means of essential public health action and health-promoting and disease-preventive measures; (2) to increase the overall awareness and understanding of the influences of diet and physical activity on health and of the positive impact of preventive interventions; (3) to encourage the development, strengthening and implementation of global, regional, national and community policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive, and actively engage all sectors, including civil society, the private sector and the media;
I
Macroeconomics and health: investing in health lor economic development. Geneva, World Health Organization,
2001.
7
WHA57.17
Annex
(4) to monitor scientific data and key influences on diet and physical activity; to support research in a broad spectrum of relevant areas, including evaluation of interventions; and to strengthen the human resources needed in this domain to enhance and sustain health.
EVIDENCE FOR ACTION 19. Evidence shows that, when other threats to health are addressed, people can remain healthy into their seventh, eighth and ninth decades, through a range of health-promoting behaviours, including healthy diets, regular and adequate physical activity, and avoidance of tobacco use. Recent research has contributed to understanding of the benefits of healthy diets, physical activity, individual action and population-based public health interventions. Although more research is needed, current knowledge warrants urgent public health action. 20. Risk factors for noncommunicable disease frequently coexist and interact. As the general level of risk factors rises, more people are put at risk. Preventive strategies should therefore aim at reducing risk throughout the population. Such risk reduction, even if modest, cumulatively yields sustainable benefits, which exceeds the impact of interventions restricted to high-risk individuals. Healthy dIets and physical activity, together with tobacco control, constitute an effective strategy to contain the mounting threat of noncommunicable diseases. 21. Reports of international and national experts and reviews of the current scientific evidence recommend goals for nutrient intake and physical activity in order to prevent major noncommunicable diseases. These recommendations need to be considered when preparing national policies and dietary guidelines, taking into account the local situation. 22. For diet, recommendations for populations and individuals should include the following: • achieve energy balance and a healthy weight limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids • increase consumption of fruits and vegetables, and legumes, whole grains and nuts limit the intake of free sugars • limit salt (sodium) consumption from all sources and ensure that salt is iodized. 23. Physical activity is a key determinant of energy expenditure, and thus is fundamental to energy balance and weight control. Physical activity reduces risk for cardiovascular diseases and diabetes and has substantial benefits for many conditions, not only those associated with obesity. The beneficial effects of physical activity on the metabolic syndrome are mediated by mechanisms beyond controlling excess body weight. For example, physical activity reduces blood pressure, improves the level of high density lipoprotein cholesterol, improves control of blood glucose in overweIght people, even without significant weight loss, and reduces the risk for colon cancer and breast cancer among women. 24. For physical activity, it is recommended that individuals engage in adequate levels throughout their lives. Different types and amounts of physical activity are required for different health outcomes:
8
Annex
WHA57.17
at least 30 minutes of regular, moderate-intensity physical activity on most days reduces the risk of cardiovascular disease and diabetes, colon cancer and breast cancer. Muscle strengthening and balance training can reduce falls and increase functional status among older adults. More activity may be required for weight control. 25. The translation of these recommendations, together with effective measures to prevent and control tobacco use, into a global strategy that leads to regional and national action plans, will require sustained political commitment and the collaboration of many stakeholders. This strategy will contribute to the effective prevention of noncommunicable diseases.
PRINCIPLES FOR ACTION 26. The world health report 2002 highlights the potential for improving public health through measures that reduce the prevalence of risk factors (most notably the combination of unhealthy diets and physical inactivity) of noncommunicable diseases. The principles set out below guided the drafting of WHO's global strategy on diet, physical activity and health and are recommended for the development of national and regional strategies and action plans.
27. Strategies need to be based on the best available scientific research and evidence; comprehensive, incorporating both policies and action and addressing all major causes of noncommunicable diseases together; multisectoral, taking a long-term perspective and involving all sectors of society; and multidisciplinary and participatory, consistent with the principles contained in the Ottawa Charter for Health Promotion and confirmed in subsequent conferences on health, promotion, 1 and recognizing the complex interactions between personal choices, social nonns and economic and environmental factors. 28. A life-course perspective is essential for the prevention and control of noncommunicable diseases. This approach starts with maternal health and prenatal nutrition, pregnancy outcomes, exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools, adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular physical activity from youth into old age. 29. Strategies to reduce noncommunicable diseases should be part of broader, comprehensive and coordinated public health efforts. All partners, especially governments, need to address simultaneously a number of issues. In relation to diet, these include all aspects of nutrition (for example, both overnutrition and undernutrition, micronutrient deficiency and excess consumption of certain nutrients); food security (accessibility, availability and affordability of healthy food); food safety; and support for and promotion of six months of exclusive breastfeeding. Regarding physical activity, issues include requirements for physical activity in working, home and school life, increasing urbanization, and various aspects of city planning, transportation, safety and access to physical activity during leisure. 30. Priority should be given to activities that have a positive impact on the poorest population groups and communities. Such activities will generally require community-based action with strong government intervention and oversight.
1
See resolution WHA51.l2 (1998).
9
WHA57.17
Annex
31. All partners need to be accountable for framing policies and implementing programmes that will effectively reduce preventable risks to health. Evaluation, monitoring and surveillance are essential components of such actions. 32. The prevalence of noncommunicable diseases related to diet and physical actIvity may vary greatly between men and women. Patterns of physical activity and diets differ according to sex, culture and age. Decisions about food and nutrition are often made by women and are based on culture and traditional diets. National strategies and action plans should therefore be sensitive to such differences. 33. Dietary habits and patterns of physical activity are often rooted in local and regional traditions. National strategies should therefore be culturally appropriate and able to challenge cultural influences and to respond to changes over time.
RESPONSIBILITIES FOR ACTION 34. Bringing about changes in dietary habits and patterns of physical activity will require the combined efforts of many stakeholders, public and private, over several decades. A combination of sound and effective actions is needed at global, regional, national and local levels, with close monitoring and evaluation of their impact. The following paragraphs describe the responsibilities of those involved and provide recommendations deriving from the consultation process.
WHO 35. WHO, in cooperation with other organizations of the United Nations system, will provide the leadership, evidence-based recommendations and advocacy for international action to improve dietary practices and increase physical activity, in keeping with the guiding principles and specific recommendations contained in this strategy. 36. It will hold discussions with the transnational food industry and other parts of the private sector in support of the aims of this global strategy, and of implementing the recommendations in countries. 37. WHO will provide support for implementation of programmes as requested by Member States, and will focus on the following broad, interrelated areas: • facilitating the framing, strengthening and updating of regional and national policies on diet and physical activity for integrated noncommunicable disease prevention • facilitating the drafting, updating and implementation of national food-based dietary and physical activity guidelines, in collaboration with national agencies and drawing upon global knowledge and experience • providing guidance to Member States on the formulation of guidelines, norms, standards and other policy-related measures that are consistent with the objectives of the global strategy • identifying and disseminating information on evidence-based interventions, policies and structures that are effective in promoting healthy diets and optimizing the level of physical activity in countnes and communities
10
Annex
WHA57.17
• providing appropriate technical support to build national capacity in planning and implementing a national strategy and in tailoring it to local circumstances • providing models and methods so that interventions on diet and physical activity constitute an integral component of health care • promoting and providing support for training of health professionals in healthy diets and an active life, either within existing programmes or in special workshops, as an essential part of their curricula providing advice and support to Member States, using standardized surveillance methods and rapid assessment tools (such as WHO's STEPwise approach to surveillance of risk factors for noncommunicable diseases), in order to measure changes in distribution of risk - including patterns in diet, nutrition and physical activity - and to assess the current situation, trends, and the impact of interventions. WHO, in collaboration with FAO, will provide support to Member States in establishing national nutrition surveillance systems, linked with data on the content of food items • advising Member States on ways of engaging constructively with appropriate industries. 38. WHO, in close collaboration with organizations of the United Nations system and other intergovernmental bodies (FAO, UNESCO, UNICEF, United Nations University and others), research institutes and other partners, will promote and support research in priority areas to facilitate prograrnme implementation and evaluation. This could include commissioning scientific papers, conducting analyses, and holding technical meetings on practical research topics that are essential for effective country action. The decision-making process should be informed by better use of evidence, including health-impact assessment, cost-benefit analysis, national burden-of-disease studies, evidence-based intervention models, scientific advice and dissemination of good practices. 39. It will work with FAO and other organizations of the United Nations system, the World Bank, and research institutes on their evaluation of implications of the strategy for other sectors. 40. The Organization will continue to work with WHO collaborating centres to establish networks for building up capacity in research and training, mobilizing contributions from nongovernmental organizations and civil society, and facilitating coordinated, collaborative research as it pertains to the needs of developing countries in the implementation of this strategy.
Member States 41. The global strategy should foster the formulation and promotion of national policies, strategies and action plans to improve diet and encourage physical activity. National circumstances will determine priorities in the development of such instruments. Because of the great variations in and between different countries, regional bodies should collaborate in formulating regional strategies, which can provide considerable support to countries in implementing their national plans. For maximum effectiveness, countries should adopt the most comprehensive action plans possible. 42. The role of government is crucial in achieving lasting change in public health. Governments have a primary steering and stewardship role in initiating and developing the strategy, ensuring that it is implemented and monitoring its impact in the long term.
11
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Annex
43. Governments are encouraged to build on existing structures and processes that already address aspects of diet, nutrition and physical activity. In many countries, existing national strategies and action plans can be used in implementing this strategy; in others they can form the basis for advancing control of noncommunicable diseases. Governments are encouraged to set up a national coordinating mechanism that addresses diet and physical activity within the context of a comprehensive plan for noncommunicable-disease prevention and health promotion. Local authoritles should be closely involved. Multisectoral and multidisciplinary expert advisory boards should also be established. They should include technical experts and representatives of government agencies, and have an independent chair to ensure that scientific evidence is interpreted without any conflict of interest. 44. Health ministries have an essential responsibility for coordinating and facilitating tbe contributions of other ministries and government agencies. Bodies whose contributions should be coordinated include ministries and government institutions responsible for policies on food, agriculture, youth, recreation, sports, education, commerce and industry, finance, transportation, media and communication, social affairs and environmental and urban planning. 45. National strategies, policies and action plans need broad support. Support should be provided by effective legislation, appropriate infrastructure, implementation programmes, adequate funding, monitoring and evaluation, and continuing research. (1) National strategies on diet and physical activity. National strategies describe the measures to promote healthy diets and physical activity that are essential to prevent disease and promote health, including those that tackle all aspects of unbalanced diets, including undernutrition and overnutrition. National strategies should include specific goals, objectives, and actions, similar to those outlined in the global strategy. Of particular importance are the elements needed to implement the plan of action, including identification of necessary resources and national focal points (key national institutes); collaboration between the health sector and other key sectors such as agriculture, education, urban planning, transportation and communication; and monitoring and follow-up. (2) National dietary guidelines. Governments are encouraged to draw up national dietary guidelines, taking account of evidence from national and international sources. Such guidelines advise national nutrition policy, nutrition education, other public health interventions and intersectoral collaboration. They may be updated periodically in the light of changes in dietary and disease patterns and evolving scientific knOWledge. (3) National physical activity guidelines. National guidelines for health-enhancing physical activity should be prepared in accordance with the goals and objectives of the global strategy and expert recommendations. 46. Governments should provide accurate and balanced information. Governments need to consider actions that will result in provision of balanced information for consumers to enable them easily to make healthy choices, and to ensure the availability of appropriate health promotion and education programmes. In particular, information for consumers should be sensitive to literacy levels, communication barriers and local culture, and understood by all segments of the population. In some countries, health-promoting programmes have been designed as a function of such considerations and should be used for disseminating information about diet and physical activity. Some governments already have a legal obligation to ensure that factual information available to consumers enables them to make fully informed choices on matters that may affect their health. In other cases, actions may be specific to government policies. Governments should select the optimal mix of actions in accordance 12
Annex
WHA57.17
with their national capabilities and epidemiological profile, which will vary from one country to another. (1) Education, communication and public awareness. A sound basis for action is provided by public knowledge and understanding of the relationship between diet, physical activity and health, of energy intake and output, and healthy choice of food items. Consistent, coherent, simple and clear messages should be prepared and conveyed by government experts, nongovernmental and grass-roots organizations, and the appropriate industries. They should be communicated through several channels and in forms appropriate to local culture, age and gender. Behaviour can be influenced especially in schools, workplaces, and educational and religious institutions, and by nongovernmental organizations, community leaders, and mass media. Member States should form alliances for the broad dissemination of appropriate and effective messages about healthy diet and physical activity. Nutrition and physical activity education and acquisition of media literacy, starting in primary school, are important to promote healthier diets, and to counter food fads and misleading dietary advice. Support should also be provided for action that improves the level of health literacy, while taking account of local cultural and socioeconomic circumstances. Communication campaigns should be regularly evaluated.
(2) Adult literacy and education programmes. Health literacy should be incorporated into adult education programmes. Such programmes provide an opportunity for health professionals and service providers to enhance knowledge about diet, physical activity and prevention of noncommunicable diseases and to reach marginalized populations. (3) Marketing, advertising, sponsorship and promotion. Food advertising affects food choices and influences dietary habits. Food and beverage advertisements should not exploit children's inexperience or credulity. Messages that encourage unhealthy dietary practices or physical inactivity should be discouraged, and positive, healthy messages encouraged. Governments should work with consumer groups and the private sector (including advertising) to develop appropriate multi sectoral approaches to deal with the marketing of food to children, and to deal with such issues as sponsorship, promotion and advertising. (4) Labelling. Consumers require accurate, standardized and comprehensible information on the content of food items in order to make healthy choices. Governments may require information to be provided on key nutritional aspects, as proposed in the Codex Guidelines on Nutrition Labelling. l (5) Health claims. As consumers' interest in health grows, and increasing attention is paid to the health aspects of food products, producers increasingly use health-related messages. Such messages must not mislead the public about nutritional benefits or risks. 47. National food and agricultural policies should be consistent with the protection and promotion of public bealth. Where needed, governments should consider policies that facilitate the adoption of healthy diet. Food and nutrition policy should also cover food safety and sustainable food security. Governments should be encouraged to examine food and agricultural policies for potential health effects on the food supply.
I
Codex Alimentarius Commission, document CAC/GL 2-1985, Rev. 1-1993.
13
WHAS7.17
Annex
(1) Promotion of food products consistent with a healthy diet. As a result of consumers' increasing interest in health and governments' awareness of the benefits of healthy nutrition, some governments have taken measures, including market incentives, to promote the development, production and marketing of food products that contribute to a healthy diet and are consistent with national or international dietary recommendations. Governments could consider additional measures to encourage the reduction of the salt content of processed foods, the use of hydrogenated oils, and the sugar content of beverages and snacks. (2) Fiscal policies. Prices influence consumption choices. Public policies can influence prices through taxation, subsidies or direct pricing in ways that encourage healthy eating and lifelong physical activity. Several countries use fiscal measures, including taxes, to influence availability of, access to, and consumption of, various foods; and some use public funds and subsidies to promote access among poor communities to recreational and sporting facilities. Evaluation of such measures should include the risk of unintentional effects on vulnerable popUlations. (3) Food programmes. Many countries have programmes to provide food to population groups with special needs or cash transfers to families for them to improve their food purchases. Such programmes often concern children, families with children, poor people, and people with HIVI AIDS and other diseases. Special attention should be given to the quality of the food items and to nutrition education as a main component of these programmes, so that food distributed to, or purchased by, the families not only provides energy, but also contributes to a healthy diet. Food and cash distribution programmes should emphasize empowerment and development, local production and sustainability. (4) Agricultural policies. Agricultural policy and production often have a great effect on national diets. Governments can influence agricultural production through many policy measures. As emphasis on health increases and consumption patterns change, Member States need to take healthy nutrition into account in their agricultural policies. 48. Multi sectoral policies are needed to promote physical activity. National policies to promote physical activity should be framed, targeting change in a number of sectors. Governments should review existing policies to ensure that they are consistent with best practice in population-wide approaches to increasing physical activity. (1) Framing and review of public policies. National and local govemments should frame policies and provide incentives to ensure that walking, cycling and other forms of physical activity are accessible and safe; transport policies include nonmotorized modes of transportation; labour and workplace policies encourage physical activity; and sport and recreation facilities embody the concept of sports for all. Public policies and legislation have an impact on opportunities for physical activity, such as those concerning transport, urban planning, education, labour, social inclusion, and health-care funding related to physical activity. (2) Community involvement and enabling environments. Strategies should be geared to changing social norms and improving community understanding and acceptance of the need to integrate physical activity into everyday life. Environments should be promoted that facilitate physical activity, and supportive infrastructure should be set up to increase access to and use of suitable facilities. ' , ),
14
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Annex WHA57.17
(3) .Partnerships. Ministries of health should take the lead in fOnning partnerships with key agencies, and publIc and pnvate stakeholders in order to draw up jointly a common agenda and workplan aimed at promoting physical activity. (4) Clear public messages. Simple, direct messages need to be communicated on the quantity and quality of physical activity sufficient to provide substantial health benefits. 49. School policies and programmes should support the adoption of healthy diets and physical activity. Schools influence the lives of most children in all countries. They should protect their health by providing health information, improving health literacy, and promoting healthy diets, physical activity, and other healthy behaviours. Schools are encouraged to provide students with daily physical education and should be equipped with appropriate facilities and equipment. Governments are encouraged to adopt policies that support healthy diets at school and limit the availability of products high in salt, sugar and fats. Schools should consider, together with parents and responsible authorities, issuing contracts for school lunches to local food growers in order to ensure a local market for healthy foods. 50. Governments are encouraged to consult with stakeholders on policy. Broad public discussion and involvement in the framing of policy can facilitate its acceptance and effectiveness. Member States should establish mechanisms to promote participation of nongovernmental organizations, civil society, communities, the private sector and the media in activities related to diet, physical activity and health. Ministries of health should be responsible, in collaboration with other related ministries and agencies, for establishing these mechanisms, which should aim at strengthening intersectoral cooperation at the national, provincial and local levels. They should encourage community participation, and should be part of planning processes at community level. 51. Prevention is a critical element of healt.h services. Routine contacts with health-service staff should include practical advice to patients and families on the benefits of healthy diets and increased levels of physical activity, combined with support to help patients initiate and maintain healthy behaviours. Governments should consider incentives to encourage such preventive services and identify opportunities for prevention within existing clinical services, including an improved financing structure to encourage and enable health professionals to dedicate more time to prevention. (1) Health and other services. Health-care providers, especially for primary health care, but also other services (such as social services) can play an important part in prevention. Routine enquiries as to key dietary habits and physical activity, combined with simple information and skill-building to change behaviour, taking a life-course approach, can reach a large part of the population and be a cost-effective intervention. Attention should be given to WHO's growth standards for infants and preschool children which expand the definition of health beyond the absence of overt disease, to include the adoption of healthy practices and behaviours. The measurement of key biological risk factors, such as blood pressure, serum cholesterol and body weight, combined with education of the population and support for patients, helps to promote the necessary changes. The identification of specific high-risk groups and measures to respond to their needs, including possible pharmacological interventions, are important components. Training of health personnel, dissemination of appropriate guidelines, and availability of incentives are key underlying factors in implementing these interventions. (2) Involvement with health professional bodies and consumer groups. Enlisting the strong support of professionals, consumers and communities is a cost-effective way to raise public awareness of government policies, and enhance their effectiveness.
15
Annex
WHA57.17
52. Governments should invest in surveillance, research and evaluation. Long-term. and continuous monitoring of major risk factors is essential. Over time, such data also provIde the baSIS for analyses of changes in risk factors, which could be attributable to changes m polIces and strategtes. Governments may be able to build on systems already in place, at either national or regtonal levels. Emphasis should initially be given to standard indicators recognized by the general sCIentIfic community as valid measures of physical activity, to selected dietary components, and to body weIght in order to compile comparative data at global level. Data that provide insight into within-country patterns and variations are useful in guiding community action. Where possible, other sources of data should be used, for example, from the education, transport, agriculture, and other sectors. (1) Monitoring and surveillance. Monitoring and surveillance are essential tools in the implementation of national strategtes for healthy diet and physical activity. Monitoring of dietary habits, patterns of physical activity and interactions between them; nutrition-related biological risk factors and contents of food products; and communication to the public of the information obtained, are important components of implementation. Of particular importance is the development of methods and procedures using standardized data-collection procedures and a common minimum set of valid, measurable and usable indicators. (2) Research and evaluation. Applied research, especially in community-based demonstration projects and in evaluating different policies and interventions, should be promoted. Such research (e.g., into the reasons for physical inactivity and poor diet, and on key detenninants of effective intervention programmes), combined with the increased involvement of behavioural scientists, will lead to better informed policies and ensure that a cadre of expertise is created at national and local levels. Equally important is the need to put in place effective mechanisms for evaluating the efficacy and cost-effectiveness of national diseaseprevention programmes, and the health impact of policies in other sectors. More information is needed, especially on the situation in developing countries, where programmes to promote healthy diets and physical activity need to be evaluated and integrated into broader development and poverty-alleviation programmes. 53. Institutional capacity. Under the ministry of health, national institutions for public health, nutrition and physical activity play an important role in the implementation of national diet and physical activity programmes. They can provide the necessary expertise, monitor developments, help to coordinate activities, participate in collaboration at international level, and provide advice to decision-makers. 54. Financing national programmes. Various sources of funding, in addition to the national budget, should be identified to assist in implementation of the strategy. The United Nations Millennium Declaration (September 2000) recognizes that economic growth is limited unless people are healthy. The most cost-effective interventions to contain the epidemic of noncommunicable diseases are prevention and a focus on the risk factors associated with these diseases. Programmes aimed at promoting healthy diets and physical activity should therefore be viewed as a developmental need and should draw policy and financial support from national development plans.
International partners 55. The role of international partners is of paramount importance in achieving the goals and objectives of the global strategy, particularly with regard to issues of a transnational nature, or where the actions of a single country are insuffiCIent. Coordinated work is needed among the organizations of
16
Annex
WHA57.17
the Uni~ed Nations system, intergovernmental bodies, nongovernmental organizations, professional aSsocIatIons, research institutions and private sector entities. 56. The process of preparing the strategy has led to closer interaction with other organizations of the United Nations system, such as FAO and UNICEF, and other parhIers, including the World Bank. WHO will build on its long-standing collaboration with FAO in implementing the strategy. The contribution of FAO in the framing of agricultural policies can playa crucial part in this regard. More research into appropriate agriculhIre policies, and the supply, availability, processing and consumption of food will be necessary. 57. Cooperation is also planned with bodies such as the United Nations Economic and Social Council, ILO, UNESCO, WTO, the regional development banks and the United Nations University. Consistent with the goal and objectives of the strategy, WHO will develop and strengthen partnerships, including through the establishment and coordination of global and regional nelWorks, in order to disseminate information, exchange experiences, and provide support to regional and national initiatives. WHO proposes to set up an ad hoc committee of partners within the United Nations system in order to ensure continuing policy coherence and to draw upon each organization's unique strengths. Partners can play an important role in a global network that targets such areas as advocacy, resource mobilization, capacity building and collaborative research. 58. International parhIers could be involved in implementing the global strategy by: • contributing to comprehensive intersectoral strategies to improve diet and physical activity, including, for instance, the promotion of healthy diets in poverty-alleviation programmes • drawing up guidelines for prevention of nutritional deficiencies in order to harmonize future dietary and policy recommendations designed to prevent and control noncommunicable diseases • facilitating the drafting of national guidelines on diet and physical activity, in collaboration with national agencies cooperating in the development, testing and dissemination of models for community involvement, including local food production, nutrition and physical activity education, and raising of consumer awareness • promoting the inclusion of noncommunicable disease prevention and health promotion policies relating to diet and physical activity in development policies and programmes • promoting incentive-based approaches to encourage prevention and control of chronic diseases. 59. International standards. Public health efforts may be strengthened by the use of international norms and standards, particularly those drawn up by the Codex Alimentarius Commission. l Areas for further development could include: labelling to allow consumers to be better informed about the benefits and content of foods; measures to minimize the impact of marketing on unhealthy dietary patterns; fuller information about healthy consumption patterns, including steps to increase the consumption of fruit and vegetables; and production and processing standards regarding the nutritional 1
See resolution WHA56.23.
17
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Annex
quality and safety of products. Involvement of governments and nongovernmental organizations as provided for in the Codex should be encouraged.
Civil society and nongovernmental organizations 60. Civil society and nongovernmental organizations have an important role to play in influencing individual behaviour and the organizations and institutions that are involved in healthy diet and physical activity. They can help to ensure that consumers ask governments to provide support for healthy lifestyles, and the food industry to provide healthy products. Nongovernmental orgamzatlOns can support the strategy effectively if they collaborate with national and international partners. Civil society and nongovernmental organizations can particularly: • lead grass-roots mobilization and advocate that healthy diets and physical activity should be placed on the public agenda • support the wide dissemination of information on prevention of noncommunicable diseases through balanced, healthy diets and physical activity • form networks and action groups to promote the availability of healthy foods and possibilities for physical activity, and advocate and support health-promoting programmes and health education campaigns • organize campaigns and events that will stimulate action • emphasize the role of governments in promoting public health, healthy diets and physical activity; monitor progress in achieving objectives; and monitor and work with other stakeholders such as private sector entities • play an active role in fostering implementation ofthe global strategy • contribute to putting knowledge and evidence into practice.
Private sector 61. The private sector can be a significant player in promoting healthy diets and physical activity. The food industry, retailers, catering companies, sporting-goods manufacturers, advertising and recreation businesses, insurance and banking groups, pharmaceutical companies and the media all have important parts to playas responsible employers and as advocates for healthy lifestyles. All could become partners with governments and nongovernmental organizations in implementing measures aimed at sending positive and consistent messages to facilitate and enable integrated efforts to encourage healthy eating and physical activity. Because many companies operate globally, international collaboration is crucial. Cooperative relationships with industry have already led to many favourable outcomes related to diet and physical activity. Initiatives by the food industry to reduce the fat, sugar and salt content of processed foods and portion sizes, to increase introduction of innovative, healthy, and nutritious choices; and review of current marketing practices, could accelerate health gains worldwide. Specific recommendations to the food industry and sporting-goods manufacturers include the following: promote healthy diets and physical activity in accordance with national guidelines and international standards and the overall aims of the global strategy
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18
Annex
WHA 57. 17
• limit the levels of saturated fats, trans-fatty acids, free sugars and salt in existing products • continue to develop and provide affordable, healthy and nutritious choices to consumers • consider introducing new products with better nutritional value • provide consumers with adequate and understandable product and nutrition information practise responsible marketing that supports the strategy, particularly with regard to the promotion and marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, especially to children • issue simple, clear and consistent food labels and evidence-based health claims that will help consumers to make informed and healthy choices with respect to the nutritional value of foods • prOvide information on food composition to national authorities • assist in developing and implementing physical activity programmes. 62. Workplaces are important settings for health promotion and disease prevention. People need to be given the opportunity to make healthy choices in the workplace in order to reduce their exposure to risk. Further, the cost to employers of morbidity attributed to noncommunicable diseases is increasing rapidly. Workplaces should make possible healthy food choices and support and encourage physical activity.
FOLLOW-UP AND FUTURE DEVELOPMENTS 63. WHO will report on progress made in implementing the global strategy and in implementing national strategies, including the following aspects: • patterns and trends of dietary habits and physical activity and related risk factors for major noncommunicable diseases • evaluation of the effectiveness of policies and programmes to improve diet and increase physical activity • constraints or barriers encountered in implementation of the strategy and the measures taken to overcome them • legislative, executive, administrative, financial or other measures taken within the context of this strategy. 64. WHO will work at global and regional levels to set up a monitoring system and to design indicators for dietary habits and patterns of physical activity.
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Annex
CONCLUSIONS 65. Actions, based on the best available scientific evidence and the cultural context, need to be designed, implemented and monitored with WHO's support and leadership. Nonetheless, a truly multisectoral approach that mobilizes the combined energy, resources and expertise of all global stakeho lders is essential for sustained progress. 66. Changes in patterns of diet and physical activity will be gradual, and national strategies wi1l need a clear plan for long-term and sustained disease-preventive measures. However, changes in risk factors and in incidence of noncommunicable diseases can occur quite quickly when effective interventions are made. National plans should therefore also have achievable short-term and intermediate goals. 67. The implementation of this strategy by all those involved will contribute to major and sustained improvements in people's health.
Eighth plenary meeting, 22 May 2004 A57NRJ8
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.14
WHA57.18 22 May 2004
Human organ and tissue transplantation The Fifty-seventh World Health Assembly, Recalling resolutions WHA40.13, WHA42.5 and WHA44.25 on organ procurement and transplantation; Having considered the report on human organ and tissue transplantation; Noting the global increase in allogeneic transplantation of cells, tissues and organs; Concerned by the growing insufficiency of available human material for transplantation to meet patient needs; Aware of ethical and safety risks arising in the transplantation of allogeneic cells, tissues and organs, and the need for special attention to the risks of organ trafficking; Recognizing that living xenogeneic cells, tissues or organs, and human bodily fluids, cells, tissues or organs that have had ex vivo contact with these living xenogeneic materials, have the potential to be used in human beings when suitable human material is not available; Mindful of the risk associated with xenogeneic transplantation of the transmission of known or as yet unrecognized xenogeneic infectious agents from animals to human beings and from recipients of xenogeneic transplants to their contacts and the public at large; Recognizing that transplantation encompasses not only medical but also legal and ethical aspects, and involves economic and psychological issues, I Allogeneic transplantation 1.
URGES Member States: (1) to implement effective national oversight of procurement, processing and transplantation of human cells, tissues and organs, including ensuring accountability for human material for transplantation and its traceability;
WHA57.18
(2) to cooperate in the formulation of recommendations and guidelines to .harmonize global practices in the procurement, processing and transplantation of human ~ells, tIssues and organs, including development of minimum criteria for suitability of donors of tIssues and cells; (3) to consider setting up ethics commissions to ensure the ethics of cell, tissue and organ transplantation; (4) to extend the use of living kidney donations when possible, in addition to donations from deceased donors; (5) to take measures to protect the poorest and vulnerable groups from "transplant tourism" and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs; 2. REQUESTS the Director-General: (1) to continue examining and collecting global data on the practices, safety, quality, efficacy and epidemiology of allogeneic transplantation and on ethical issues, including living donation, in order to update the Guiding Principles on Human Organ Transplantation; I (2) to promote international cooperation so as to increase the access of citizens to these therapeutic procedures; (3) to provide, in response to requests from Member States, technical support for developing suitable transplantation of cells, tissues or organs, in particular by facilitating international cooperation; (4) to provide support for Member States in their endeavours to prevent organ trafficking, including drawing up guidelines to protect the poorest and most vulnerable groups from being victims of organ trafficking; II
Xenogeneic transplantation
1.
URGES Member States: (1)
to allow xenogeneic transplantation only when effective national regulatory control and surveillance mechanisms overseen by national health authorities are in place;
(2) to cooperate in the formulation of recommendations and guidelines to harmonize global practices, including protective measures in accordance with internationally accepted scientific standards to prevent the risk of potential secondary transmission of any xenogeneic infectious agent that could have infected recipients of xenogeneic transplants or contacts of recipients, and especially across national borders; (3) to support international collaboration and coordination for the prevention and surveillance of infections resulting from xenogeneic transplantation; I
Document WHA4411 99 I IRECII , Annex 6.
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WHA57.18
2.
REQUESTS the Director-General: (1) to facilitate communication and mternational collaboration among health authorities in Member States on issues relating to xenogeneic transplantation; (2) to collect data globally for the evaluation of practices in xenogeneic transplantation;
(3) to inform proactively Member States of infectious events of xenogeneic origin arising from xenogeneic transplantation; (4) to provide, in response to requests from Member States, technical support in strengthening capacity and expertise in the field of xenogeneic transplantation, including policymaking and oversight by national regulatory authorities; (5) to report at an appropriate time to the Health Assembly, through the Executive Board, on implementation of this resolution.
Eighth plenary meeting, 22 May 2004 A57NRJ8
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FIFTY-SEVENTH WORLD HEALTH ASSEMBLY Agenda item 12.11
WHA57.19 22 May 2004
International migration of health personnel: a challenge for health systems in developing countries The Fifty-seventh World Health Assembly, Recalling United Nations General Assembly resolution 2417 (XXlIn of 17 December 1968; Recalling United Nations General Assembly resolution 58/208 on International migration and development, and the decision therein that, in 2006, the General Assembly will devote a high-level dialogue to international migration and development; Further recalling resolutions WHA22.51 of 1969 and WHA25.42 of 1972; Noting that the African Union declared 2004 "Year for Development of Human Resources in Africa"; Taking note of the Commonwealth Code of Practice for the International Recruitment of Health Workers, which was adopted at the meeting of Commonwealth health ministers (Geneva, 18 May 2003); Noting the work in progress on international labour migration in the International Organization for Migration, the Global Commission on Migration, and in other international bodies; Recognizing the importance of human resources in strengthening health systems and in successful realization of the internationally agreed goals contained in the United Nations Millennium Declaration; Noting with concern that highly trained and skilled health personnel from the developing countries continue to emigrate at an increasing rate to certain countries, which weakens health systems in the countries of origin; Being aware of the work undertaken in United Nations organizations and in other international organizations with a view to strengthening the capacity of governments to manage migration flows at national and regional levels, and the need for further action to address, both at national and international levels, as an integrated part of the Sector Wide Approaches and other development plans, the issue of migration of trained health-care personnel;
WHA57.19
Noting further that many developing countries are not yet technically equipped to assess adequately the magnitude and characteristics of the outflow of their health personnel; Recognizing the significant efforts and investment made by developing countries in training and development of human resources for health; Further recognizing the efforts made to reverse the migration of health personnel from developing countries and aware of the need to increase these efforts; Concerned that HIV/AIDS, tuberculosis, malaria and other such cornmunicable diseases are placing additional burdens on the health workforce; 1. URGES Member States: (1) to develop strategies to mitigate the adverse effects of migration of health personnel and minimize its negative impact on health systems;
(2) to frame and implement policies and strategies that could enhance effective retention of health personnel including, but not limited to, strengthening of human resources for health planning and management, and review of salaries and implementation of incentive schemes; (3) to use government-to-government agreements to set up health-personnel exchange prograrnmes as a mechanism for managing their migration; (4) to establish mechanisms to mitigate the adverse impact on developing countries of the loss of health personnel through migration, including means for the receiving countries to support the strengthening of health systems, in particular human resources development, in the countries of origin; 2. REQUESTS the Director-General: (I) to establish and maintain, in collaboration with relevant countries, institutions/organizations, information systems which will enable the appropriate international bodies to monitor independently the movement of human resources for health; (2) in cooperation with international organizations within their respective mandates, including the World Trade Organization, to conduct research on international migration of health personnel, including in relation to trade agreements and remittances, in order to determine any adverse effects, and possible options to address them; (3) to explore additional measures that might assist in developing fair practices in the international recruitment of health personnel, including the feasibility, cost and appropriateness of an international instrument; (4) to support Member States to strengthen their planning mechanisms and processes in order to provide for adequate training of personnel to match their needs; '/
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WHAS7.19
(5) to develop, in consultation with Member States and all relevant partners, including development agencies, a code of practice l on the international recruitment of health personnel, especially from developing countries, and to report on progress to the Fifty-eighth World Health Assembly; (6) to support efforts of countries by facilitating dialogue and raising awareness at the highest national and international levels and between stakeholders about migration of health personnel and its effects, including examination of modalities for receiving countries to offset the loss of health workers, such as investing in training of health professionals; (7) to mobilize all relevant programme areas within WHO, in collaboration with Member States, in order to develop human resources capacity as well as improve health support to developing countries by setting up appropriate mechanisms; (8) to consult with the United Nations and specialized agencies on the possibility of declaring a year or a decade of "Human Resources for Health Development"; to declare the theme of World Health Day 2006 to be "Human Resources for Health (9) Development"; (10)
to include human resources for health development as a top-priority programme area in WHO's General Programme of Work 2006-2015; (11) to submit a report on implementation of this resolution to the Fifty-eighth World Health Assembly.
Eighth plenary meeting, 22 May 2004 A57NRl8
I It is understood that, within the United Nations system, the expression "code of practice" refers to instruments that are not legally binding.
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WPRlRC55113
ANNEX 2
WORLD HEALTH ORGANIZATION EXECUTIVE BOARD
115th Session Geneva, 17-25 January 2005
EB115/1(draft) 23 June 2004
Draft provisional agenda
1.
Opening ofthe session and adoption of the agenda Report by the Director-General • Discussion on issues raised
2.
3. 4.
Report of the Programme, Budget and Administration Committee Technical and health matters 4.1 4.2 4.3 4.4 Revision of the International Health Regulations: update Achievement of health-related Millennium Development Goals: status report Responding to health aspects of crises Infant and young child nutrition Further to discussion at WHA57 Social health insurance Further to discussion at EB 114 Blood safety: proposal for establishment of World Blood Donor Day Procedures and guidelines • National inspection of pharmaceutical manufacturing sites for starting materials: model certification scheme • International Nonproprietary Names: revised procedures • Dependence-producing psychoactive substances: supplementary guidelines Deferred from EB 114
4.5
4.6 4.7
. EB11511(draft)
•
5.
Programme and budget matters 5.1 5.2 Programme budget 2002-2003: performance assessment report Guiding principles for regular budget allocations to regions Decision WHA57(lO)
5.3 5.4
Proposed progranune budget 2006-2007 General Progranune of Work 2006-2015: review of process and draft outline
6.
Financial matters 6.1 Assessed contributions • Status of collection, including Members in arrears in the payment of their contributions to an extent that would justifY invoking Article 7 of the Constitution • Assessments for 2006-2007 6.2 Amendments to the Financial Regulations and Financial Rules [if any]
7.
Management matters 7.1 7.2 7.3 Appointment ofthe Regional Director for Africa Appointment of the Regional Director for Europe Governing body matters • Working methods of the Health Assembly Provisional agenda of the Fifty-eighth World Health Assembly and date and place of the 116th session of the Executive Board 7.4 Report of the Standing Committee on Nongovernmental Organizations, including reconsideration of two applications for admission into official relations with WHO As agreed at EB 114 Reports of the foundation committees Reports of the Joint Inspection Unit Previous JIU reports: implementation of recommendations • Recent JIU reports, including multilingualism and access to information in WHO
7.5 7.6
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EB115/J (draft)
8.
Staffing matters 8.1 Human resources • Annual report • Amendments to the Staff Rules [if any1
8.2
Statement by the representative of the WHO staff associations
9.
Matters for information 9.1 Reports of advisory bodies • Report on forty-second session of the global Advisory Committee on Health Research (ACHR) • Expert committees and study groups 9.2 Poliomyelitis International Plan of Action on Ageing: report on implementation World Summit on Health Research (Mexico City, 16 to 20 November 2004) Reports requested by earlier resolutions A.
9.3 9.4 9.5
Promotion of healthy lifestyles, including WHO's future work on alcohol consumption (resolution WHA57.l6) Violence and health (resolution WHAS6.24) Smallpox eradication: destruction of Van'ola virus stocks (resolution WHASS.1S) Traditional medicine (resolution WHA56.31) Scaling up treatment and care within a coordinated and comprehensive response to HIViAlDS (resolution WHAS7.14) Strategic approach to international chemicals management (resolution WHAS6.22)
B. C. D.
E.
F.
10.
Closure of the session.
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