Health priorities for the Pacific: Insights from WHO's Regional Committee for the Western Pacific

BRISBANE, Australia — Food marketing and safety, immunization, mother-to-child disease transmission, and strengthened health workforce and services are among the health priorities of member states at the 68th session of the World Health Organization Regional Committee for the Western Pacific, held in Brisbane this week.

The diversity of the Western Pacific region — economically, geographically, and socially — provide a unique challenge in implementing and supporting health measures for the region, home to 1.9 billion people, including some of the poorest in the world. Both obesity and malnutrition are health challenges, and small island nations, including Nieu, are already responding to the social and health challenges of climate change.

In Brisbane, members discussed their priority challenges moving forward. Here are some of the key issues.

Targeting food marketing and safety

Protecting children from the harmful impact of food marketing is critical in a region where more than 6.3 million children are overweight or obese. Member countries are focusing on marketing of food products, many of which are high in fat, salt, and sugar — with some countries noting more than 90 percent of their food is imported.

Member states cited a report that discusses issues in food marketing targeted at children, impacts on health, and successful measures implemented by countries targeting food marketing, including regulatory interventions. Countries were asked to develop a regional action plan to provide greater protection for children and support better health and nutrition, from birth onwards.

“When children are exposed to food marketing, their diets change,” Dr. Shin Young-soo, WHO regional director for the Western Pacific, explained to press on Monday. “And when parents are exposed to formula marketing, this undermines breastfeeding.”

Countries on the whole were supportive, noting the declining health and increasing financial burden childhood obesity and malnutrition was creating. But there was some concern over how food-related regulations could affect business and politics.

Countries including Singapore noted that self-regulated code of conducts and public-private partnerships were creating action in this space. The U.S. delegates, at the meeting to represent the interest of Guam and Northern Mariana Islands, which are strongly reliant on imported food, were concerned about the impact of regulations. They instead preferred non-binding action with the food marketing plan, combined with diversity of action to target malnutrition and no restriction on marketing of nutrition-rich foods.

And Fiji noted that while it is important, there are a range of policy and political challenges — including impact on sponsorship of sport by food and beverage companies, as well as online advertising, which is reaching more and more children.

“Fiji supports the action plan, but we need to be practical about what is realistic in all countries and contexts,” the delegate for Fiji told the session.

At the end of the day, the session adopted resolutions to enable regional action in this space, as well as food safety. The draft Regional Framework for Action on Food Safety in the Western Pacific proposed actions to help ensure safe and healthy food is available in the region by strengthening national food safety systems.

Shin explained that the health impacts of unsafe food varied from diarrhea to cancer, with people living in poverty most at risk. But strengthened national food safety systems that target conditions under which food is produced, traded, distributed, and consumed can improve health qualities. And by working together, emerging food safety issues in the region can be identified and addressed.

Achieving health SDGs

Following a commitment of counties to the Shanghai Declaration on Promoting Health in the 2030 Agenda for Sustainable Development — agreed to as an outcome of the recent 9th Global Conference on Health Promotion — member countries were asked to endorse a Regional Action Plan on Health Promotion in the Sustainable Development Goals 2018–2030. The plan aims to translate commitments into practical action to accelerate health literacy with timelines.

Despite progress in the Western Pacific region on quality of life — including improved access to clean and safe water, higher education, and health services — there were a range of issues impacting action and increasing the risk of disease, injury, disability, and premature death.

Rapid and unplanned urbanization, population ageing, trade liberalization, new technologies, and climate change were identified as issues creating inequality in health access for the region.

Member states are expected to adopt the WHO plan to translate the Shanghai commitment into concrete action with timelines. Representatives of the U.S., Australia, and China called both the private sector and civil society key to achieving goals within the set timeframes. The delegate with the U.S. noted that encouraging private sector involvement in this space would enable “inclusive governance.”

The importance of data was also highlighted, with Australia’s delegate saying strong evidence should underpin health promotion activities.

Tackling mother-to-child disease transmission

HIV, hepatitis B, and syphilis are diseases commonly transmitted from mother to child during pregnancy, birth, and breastfeeding.

But these are treatable and preventable, and by making interventions more accessible throughout member state countries, global targets — including a total of 0.1 percent or less of children under age 5 with hepatitis B — could be met.

“Too many mothers and babies still aren’t getting the vaccines they need,” Shin explained.

Member states strongly endorsed plans to address the issue, while noting again the importance of strengthening the health systems to implement critical action.

Eamonn Murphy, director of the UNAIDS regional support team for Asia and the Pacific, explained in the session that across the globe, there is renewed energy around this issue.

“We cannot take the eye off the ball for any of our infectious diseases,” he said.

Murphy highlighted HIV in particular as a public threat, especially to newborn children, that requires strong commitment to eliminate. He explained that AIDS was far from over and the Western Pacific needed to once again be the leader in the response, just as they were in the early days.

Financing and safety for health services, workers, and medicine

Financing of public health services is an issue in the region, where populations are becoming more urbanized and health needs are changing. Growing public need for services means a growing burden on government budgets.

But for the WHO, it is important to ensure that member states are committed to adopting a framework guaranteeing the continuation of essential public health services — including immunization and HIV treatment. WHO has also been encouraging government support for safer medicine and health workforces.

“To make sure medicine is safe and health workers are qualified, you need regulations,” Shin explained. “This week, member states will agree on how to work together to strengthen systems for regulating medicine and the health workforce.”

Papua New Guinea highlighted the particular issues they face in this space. Their delegate explained that the procurement of medicine is a political challenge of the highest order — but they face regulatory framework challenges

Resourcing is a huge problem. “We are behind the eight ball,” the delegate explained, saying that despite requiring a workforce of around 60,000 to 70,000 people, they only have about 20,000.

Member states flagged a range of challenges they face in these areas, including the rise of private sector training institutions and how to accredit courses. And creating a workforce that was “fit for purpose” — with the purpose evolving as health challenges change — is difficult. Bringing traditional medicine within WHO frameworks for the region was considered important by countries including Samoa and Tuvalu, where traditional medicine is extensively used and important in primary health care.

For the U.S., the discussion of the issue highlighted the national rather than regional specific concerns. The U.S. delegation was quick to highlight that external demand for health services are increasing in opposition to government funding. They encouraged strategic planning for all health priorities, a “sustainable increase” of government budgets for health, and better effectiveness in health funding from foreign aid — including eliminating the reliance on it.

For WHO, the challenges were acknowledged but representatives said they were encouraged by the response of member states to continue advancing the agenda, including by providing education and support for parliamentarians to understand the issues.

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