What We Can Take Away From the WHA

By Danielle Pappas

These past two weeks encompassed a whirlwind of emotions ranging from excitement, inspiration, and passion to doubt, frustration, and anger. For some of us, the WHA was a shocking revelation of the frustratingly slow and political nature of public health on a global scale, where bureaucracy can trump progress and minimize idealistic notions of how health should function worldwide. Many of us have expressed deep frustration and even depression over these politics and shallow representations of public health issues and solutions. Others, however, were captivated by the opportunity to attend the WHA and stimulated by the side events, technical briefings, or committees to pursue their public health passions. Nevertheless, there was a fragile balance amidst a fray of emotions, making it easy to tip the scale and lose oneself in either the negative or positive ends of the spectrum. Some of us have reflected on these negative emotions in conversations and some have been so bothered they had trouble getting to sleep. I want to address these feelings of devastation and lack of hope because I believe there is an imperative message of public health here that must not be forgotten by future leaders in the field.

Overall, the WHA caused us to grapple with the field of public health, question everything, and confront our ignorance in many ways. We were forced to evaluate where we stand on certain issues, what we want to learn, and where we wish to see the world go from here.  Many of us were challenged in why we hold certain beliefs or passions, and pushed to analyze and defend these beliefs. In the process, opportunities arose for us to engage with global leaders and hear their perspective, as we began really evaluating our own perspectives and even discovering new passions. Because of this, the past couple of weeks represent a huge culmination of all we have learned/haven’t learned, expected/ didn’t expect, along with our passions, fears, hopes, and anxieties. The complicated entanglement of all these aspects makes the World Health Assembly experience both the most exhausting yet relevant and rewarding experience we could ask for.

Although what each person walks away with is a highly personal and subjective, I really believe it is critical to see the whole picture of what we just experienced. This was an incredible, unforgettable opportunity that most students do not get to have. Yes, it was frustrating to stare global health problems head on and feel as though countries were dancing around the crux of the issues. Yes, it was frustrating to see how human rights and obvious public health concerns are essentially non-existent or not addressed in certain regions. Yes, it was frustrating to hear delegates talk of their countries’ vague ideas and plans that don’t seem to have tangible goals or outcomes.

It is important to acknowledge and accept that there are many problems in public health and in addressing critical issues worldwide. However, if the conversation stops here, then these negative feelings stew inside us, impeding progress. If we let global issues dismantle us, then what is there to say about those actually suffering the atrocities we are so enraged about? Where is the hope for these people, if even those with the duty of addressing these issues cannot handle the reality? These issues SHOULD bother us and shake our world. They should enrage us and make us question everything. This means we are in the right field! Instead of letting these issues tear us down and stir apathy or hopelessness, we must re-channel our energy into passion, advocacy, and commitment to making global change.

Letting these global issues discourage or jade us only lets the evils of this world win. I’m not saying public health strides in on a white horse to “save the world”, but it recognizes and shoulders the burden of harsh realities in order to achieve the good it sets out to do. Part of being in this field is knowing and accepting you will carry a burden for the rest of your life, but letting this fuel your passion to create change. Hope cannot be lost, no matter how hard the journey becomes. I believe this is an essential concept to grasp at the core of what it means to work in public health, as we are trained to identify and address core problems from a holistic perspective. Understanding and accepting this responsibility is what will ultimately lead to real, tangible change.

We must also remember how incredible it is that these countries are meeting in the first place. How amazing is it that every country in the world can come together annually and agree on health priorities for the world? They bring together diverse cultures, languages, and beliefs and agree to resolutions and programs to address some of the worlds most challenging public health problems. While these discussions and progress might be slow, the alternative of not meeting is far worse.

It is also important to realize that the WHO has very little power to implement programs and enforce guidelines, but the meeting of countries sets the agenda for the entire world. The WHA has also stirred countless ideas and discussions that delegates will take back to their countries and consider when setting their health priorities. In addition, some of us have been discouraged with the WHA without realizing that we did not have the opportunity to see the working bodies debate these issues. Working groups and regional meetings were conducted every morning and multiple times throughout the day. This is where the real blood, sweat, and tears over global health problems and priorities were revealed. While we saw very little of this work in action, progress was made daily.
Despite some feelings of discouragement, our USC group has also made progress. The WHA meetings and organization visits spurred us to have continual conversations about public health issues- from late night arguments in bars to early morning discussions annoying the fellow Swiss bus riders. As students and emerging professionals in this field, these conversations are essential to not only process our ideas and feelings, but also figure out our passions and where we will enter the conversations upon graduation. Countless times in the midst of these conversations, we saw each other swell up with anger and excitement. This is something to celebrate.

We must also keep in mind that so much progress has already been made, and we cannot be shortsighted by forgetting to take joy in all victories in the midst of pushing for further action. For example, we have been afforded the privilege of seeing public health for what it is today. By definition, public health addresses health concerns in a multi-dimensional, holistic approach. I remember my first day of college when my professors defined public health as “meeting people where they are”. It accepts rather than judges, creating an atmosphere in which public health professionals can work with people to better their lives. Because of this, I went through college believing public health by definition must address the social injustice that fosters vulnerability among populations. These concepts are all integrated into what public health means today.

However, this is just the standard of present day, and it actually took years of growing to get to this place. Public health by definition used to be coercively quarantining and isolating people with no regard to social conditions, inequalities, or human rights. Now, we have the privilege of seeing it as an accepting, non-judgmental and holistic approach to health. It wasn’t always obvious that human rights concerns were relevant and morally reprehensible. It wasn’t always obvious that everyone should have universal, non-discriminatory access to health services. It wasn’t always obvious that those with HIV should be guaranteed universal access to ARVs.

In fact, Jonathan Mann’s work through the Global Program on AIDS helped set the stage for our current definition of public health. Human rights became a very relevant concern in the 1980s, as evidence emerged depicting how discrimination drove people away from essential HIV services. Thus, it was important to rule out discrimination in order to better control the epidemic. Although the solution to address discrimination was initially just the most pragmatic way to improve health, it helped set the current foundation for public health. Over time, addressing social determinants such as discrimination became a moral obligation of public health rather than just a pragmatic method to control disease. Other, like-minded individuals furthered this progress by addressing public health through the lens of social conditions that foster health concerns and vulnerability, leading us to where we are today.

When you consider these aspects, it is absolutely amazing to see how UN member states signed international human rights treaties, or agreed on issues of universal health coverage and access to care for everyone. The fact that the post-2015 agenda was even created is incredible, since it is really the first global commitment and shared acknowledgement of the critical role social determinants play in health. There were countless WHA meetings prioritizing the most marginalized, forgotten communities for the first time in an overall theme of  “leaving no one behind”. This is amazing, as the burden of disease typically falls on the most marginalized groups. Because social determinants play the largest role in health outcomes, the global consideration of the SDGs are a HUGE step forward in our field.

Yes, it will come with many challenges, as many have already pointed out how the SDGs are overly broad, have way too many components, or are unrealistic. We cannot let this discourage us. Instead, we need to understand limitations and capitalize on strengths as we continue to strive towards progress in the field in public health.  While attending the WHA and absorbing all the information we hear, whether it is good or bad, it is important to remember people like Jonathan Mann and Paul Farmer dedicated their lives to seeing the world acknowledge the social determinants and rights-based components of public health. They were enraged with the injustices they saw, just like we are enraged now. This anger fueled dedicated commitment to seeing the world change, as they spent years working to define public health the way we learn it today.

Thus, seeing public health in its current state is both a privilege and a curse, as there has been so much progress yet always much more that needs to be done. We are fortunate enough to be able to analyze current issues of our world and see major problems as intuitively wrong, as the way we identify, analyze, and approach these problems was not intuitive just a short time ago. Concurrently, these analyses enable us to dig even deeper into health issues, exposing great injustices in the world that shake and enrage us. Good!

Again, we are in the right field.

As Former Ambassador Lange described, those that leave the field are those that get frustrated and let it take over their morale. Others, however, use this energy to create change using the system. Lange argued that making change is easier to do in the system than outside of it. For instance, with well-respected and established organizations like the WHO and the UN, the guidelines for the entire world are set and change can be made.

Furthermore, when three of us spoke privately with Dr. Claudia Garcia-Moreno, she reiterated the idea that frustration must fuel passion. We discussed the role of women in the world relevant to gender-based violence, equality, and rights, and how there seems to be little progress despite a global acknowledgment of the need to empower women and improve their status. She spoke of the frustrations in her own work, and how she ultimately needed to use her anger to inspire her commitment to see change. She advised us to do the same, letting the anger motivate us to make a difference rather than dishearten us. If we can learn to harness our sadness and frustration, we can empower ourselves and others to move forward and resiliently fight and advocate for public health and equality for all.

As emerging leaders, we can be heartbroken or frustrated with the politics of global public health, but it has to be what enrages us and energizes us to keep working. It needs to be fuel to the fire.  Public health is a collaboration of everyone enraged about health issues throughout the world in an effort to address them. It is an entire community of people willing to deal with the politics, slow progress, and lack of understanding in order to make improvements in the world and promote health. Together, we work hard every day to further progress in this field, and maybe the next generation of public health students will define public health in an incredible way that seems unfathomable to us now.

If we can really grasp all of this, we will be strong global leaders in our field, as we dedicate our lives to creating positive change as those before us have done, letting the anger and frustration inspire passion and hope. Then, we really can make a difference.