Reflecting upon these past weeks in Geneva, I can genuinely say that this experience has been enlightening. My eyes have been opened to both the political structure and bureaucracy of the World Health Assembly. I have learned that decision making from an international standpoint is a slow and tedious process. Diplomacy is vital as delegates from across the globe must come together to communicate their perspective and point of view effectively. While positions on various topics may differ, member states must be open to understanding the perspective of others in order to make progress on a global scale.
Power relations may be unequal outside of the assembly, creating opportunities for countries to become tactful in developing strategies to form alliances that can push for policy. Whether during coffee breaks at the Serpentine Lounge or in side events at the Intercontinental Hotel, people are constantly in conversation about issues that matter. During these interactions people come together to network and form alliances. Perceptions change and friendships form.
From my observations of these interactions –both formal during committee meetings and informal during side events—I have taken away many topics of discussion. Most importantly, I have recognized the value of cultural awareness and disease surveillance.
Cultural awareness is a theme that was discussed throughout the assembly. For example, it was emphasized that having access to cultural knowledge is critical in order to communicate and facilitate change globally. This was illustrated with the Ebola outbreak. Due to cultural and religious practices, Ebola spread rapidly becoming more difficult to control. The handling of the deceased in some of the impacted African regions led to the exchange of bodily fluids catalyzing the spread of disease amongst human vectors. Questioning the cultural norms of these burial practices contributed to the native populations’ distrust of public health officials. Ultimately, community leaders and those who understood the culture well had to be used to educate and inform the public about safe practices to prevent the further spread of disease.
Furthermore, the importance of understanding cultural norms was emphasized in side meetings as well. For instance, we met with the retired ambassador John Lange who worked in Botswana on HIV/AIDs during the 1990’s. He discussed how in Botswana, individuals did not want to get tested for HIV because of fear that they would lose sleep over discovering that they were HIV positive. At the time, HIV affected approximately 30% of the population. While common, it was still culturally stigmatized and therefore, difficult to get people to be tested. People viewed this disease as either a death sentence or something that prevented someone from working and supporting their families. Over time these views changed, but progress was slow as it was necessary to truly understand why people would not get tested as well as any cultural or social barriers to doing so. Thus, when trying to create behavior change it is important to understand perceptions and views from the population of interest.
Therefore, it may be useful to live in the country of interest for an extended period of time or to consult a cultural anthropologist.
Another theme that was emphasized over these past weeks was that of surveillance. It was repeatedly stated that disease knows no boundaries. This is exacerbated by the fact that globalization and modern technology have contributed to the increasing movement of people across borders. We live in an interconnected world with a rising exchange of goods and services. The outcome is potentially hazardous, as with travel comes disease. It is impossible to stop this movement absolutely as no one power or country can account for every single potential vector in exchange.
Therefore, surveillance is crucial, along with the global sharing of information worldwide. Countries must work together in assessing and tracking the landscape during current outbreaks as well as for potential epidemics in the future. Data should be collected frequently and then shared for the well being of populations overall. The problem then arises in moving from theory to action. A global system of efficient and effective disease surveillance and information sharing is no easy feat and requires complex and coordinated efforts. There will be many challenges and work to be done now and in the future. However, raising awareness to the next generation of policy members and public health officials may be the first step forward in creating positive change. #WHA68