Dr Masami ISHII Dr. Jörg-Dietrich HOPPE Dr. Jens Winther Jensen Dr. José Luiz GOMES DO
WMA Vice-Chairman of Council WMA Treasurer WMA Chairperson of the Medical AMARAL
Japan Medical Assn Bundesärztekammer Ethics Committee WMA Chairperson of the Socio-
2-28-16 Honkomagome Herbert-Lewin-Platz 1 Danish Medical Association Medical-Affairs Committee
Bunkyo-ku 10623 Berlin 9 Trondhjemsgade Associaçao Médica Brasileira
Tokyo 113-8621 Germany 2100 Copenhagen 0 Rua Sao Carlos do Pinhal 324
Japan Denmark Bela Vista, CEP 01333-903
Sao Paulo, SP
Brazil
Dr. Mukesh HAIKERWAL Dr. Guy DUMONT Dr. Karsten VILMAR Dr. Otmar KLOIBER
WMA Chairperson of the Finance WMA Chairperson of the Associate WMA Treasurer Emeritus WMA Secretary General
and Planning Committee Members Schubertstr. 58 13 chemin du Levant
58 Victoria Street 14 rue des Tiennes 28209 Bremen France 01212 Ferney-Voltaire
Williamstown, VIC 3016 1380 Lasne Germany France
Australia Belgium
www.wma.net
Opinions expressed in this journal – especially those in authored contributions – do not necessarily reflect WMA policy or positions
128
At the plenary session of the Assembly Following the meeting an advocacy kit was
Dr. Ketan D. Desai Dr. Ketan Desai was elected unopposed as circulated to NMAs, including a factsheet
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130
New Member
Other Business
Open Session
131
receive credits for completing the course practices, implementing joint recommenda-
as part of their continuing medical educa- tions for facilities and health workers and
tion programme. Although the course is establishing a working group with a plan of
available only in English at the moment, action to communicate the identified prac-
it will be translated into Spanish, French, tices and recommendations. The WMA,
Russian and Chinese. The new course is be- in collaboration with the South African
ing financed by an unrestricted educational Medical Association and the ICN, IHF
grant by the Lilly MDR-TB Partnership, and ICRC, organised the first workshop
which comprises several other organisations in Cape Town South Africa in November
working together to improve tuberculosis 2007. The second one took place together
control worldwide. with the Brazilian Medical Association in
Rio De Janeiro, Brazil in March 2009, and
Secretary General’s Report the third one was in Durban, South Africa
At the same time, the WMA launched a in June 2009.
new online refresher course for physicians, Dr. Otmar Kloiber reported on significant
providing basic clinical care information for activities and developments during the year. The WMA joined the implementation pro-
TB including the latest diagnostics, treat- cess of the WHO Framework Convention
ment and information about multidrug- A train-the-trainer course in MDR-TB on Tobacco Control (FCTC) http://www.
resistant TB. The new course was written had been developed to create champions in who.int/tobacco/framework/en/, the interna-
for the WMA by the New Jersey Medical the field of TB on a local level. Physicians tional treaty that condemned tobacco as an
School Global Tuberculosis Institute, USA. who were experts in TB received training addictive substance, imposed bans on adver-
It incorporates key strategies of interna- in adult learning and accelerated learning tising and promotion of tobacco, and reaf-
tionally accepted strategies for management principles in order to better teach their col- firmed the right of all people to the highest
and control of TB, will link to the WMA’s leagues. The first of a series of workshops standard of health. The first international
MDR-TB course which has been running took place in Pretoria, South Africa in treaty negotiated under the auspices of the
for the past two years. November 2008 in co-operation with the WHO, the FCTC entered into force in
Foundation of Professional Development. 2005 and was the most widely embraced
Dr. Julia Seyer, medical adviser at the A further workshop was due to take place treaty in UN history, with 168 signatories
WMA, said: “When we started an online in New Delhi before the Assembly together and 154 ratifications to date.
multidrug-resistant tuberculosis (MDR- with the Indian Medical Association.
TB) training course in 2006, we discovered WHO FCTC held its Third Conference of
that many physicians were missing the most The WHO was in the process of developing the Parties COP3 in Durban from in No-
basic knowledge about normal TB. With a policy on ethics in the TB setting, with vember 2008 to discuss articles of the treaty
the disappearance of the disease from large a goal for its adoption at the World Health and receive reports of the working groups
parts of the world, many physicians from Assembly in 2010. The WMA was invited created for specific articles. The WMA was
the developed world had never even seen to address the issues related to health pro- a member of the working groups on Article
a case of TB and had no basic training in fessionals in the policy. 12 - Education, Communication, Training
diagnosing and treating what is a prevent- and Public Awareness and Article 14: Mea-
able disease. Now that TB has re-emerged Given the already critical shortage of health sures Concerning Tobacco Dependence and
as a serious global disease, it is vital that providers and generally weak health sys- Cessation.
physicians around the world regain the ba- tems in the regions most affected by XDR-
sic knowledge they once had. The course TB and MDR-TB, anxiety about safety in The WMA continued its close involve-
will be useful in developing countries, where the health care environment ran high and ment in the Positive Practice Environ-
the majority of TB cases are, and will serve could dissuade health providers from ac- ment Campaign (PPE). This global five-
as a refresher of what physicians may have cepting assignments in these settings. A set year campaign - spearheaded by WHPA
learned some time ago.” of inter-professional workshops on health members together with the World Con-
care worker safety in the context of drug federation for Physical Therapy and the In-
The course is free of charge and can be used resistant TB in low and middle-income ternational Hospital Federation - aimed to
by physicians in private practice, as well countries addressed TB infection protec- ensure high-quality healthcare workplaces
as in the public. Physicians will be able to tion with the objective of identifying good worldwide. The appointment last March of
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133
the WMA to take part in a global consul- In November 2008, Dr. Kloiber, and Ms.
tation on the contribution of health pro- Delorme, participated in the WHO round-
fessions to primary health care and the table meeting with representatives of
global health agenda in June 2009. As one NGOs and health professionals on ways
of the outcomes the WHO was develop- they could contribute to reducing harmful
ing implementation guidelines to support use of alcohol. This was an opportunity to
governments in setting up primary health raise, amongst others issues, the WMA’s de-
care teams in a holistic health care system, sire that medical associations and individual
which would be sent out soon for comments. physicians be fully involved in the WHO
The WHO saw physicians as a strong pillar strategy on alcohol.
discussed and all member states stressed in this approach and was pleased to work
the importance of protecting public health closely with WMA. The World Medical Association had
against risks caused by counterfeit medica- developed, together with the Geneva Social
tions. An intense debate took place on the In May 2008, the World Health Assembly Observatory, a Workplace Strategy on Di-
definition of counterfeits versus substand- adopted a resolution requiring the WHO to abetes and Wellness. This was a guideline
ard medicines. So far WHO has focused intensify its work to curb the harmful use for employers and employees to educate and
on counterfeits while largely ignoring the of alcohol. Members States called on the raise awareness about diabetes, and provide
broader - and more politically sensitive - WHO to develop a global strategy for this examples of healthier lifestyles during work.
category of substandard drugs. purpose. The resolution also requested the The aim was to mitigate the ill effects of
WHO Director-General to consult with diabetes on personal health, workplace pro-
The World Health Report from 2008 intergovernmental organisations, health ductivity, and health care costs.
“Primary Health Care – Now More Than professionals, nongovernmental organisa-
Ever”- critically assessed the way that tions, and economic operators regarding The WMA Workgroup on Health and
health care was organised, financed, and ways in which they could contribute to re- the Environment, chaired by the Canadian
delivered in rich and poor countries around ducing the harmful use of alcohol. In line Medical Association, was established in the
the world. The WHO report documented with the WMA Statement on Reducing summer of 2008. For 2009, the workgroup
the failures and shortcomings over the last the Global Impact of Alcohol on Health agreed to focus its attention on health and
decades that had left the health status of dif- and Society, the WMA secretariat moni- climate change, in view of the global United
ferent populations, both within and among tored the drafting process of the WHO Nations conference on this topic in Co-
countries, dangerously out of balance. The strategy, informed WMA members on a penhagen in December 2009. In 2010, the
report urged the importance of an holistic regular basis of relevant developments in workgroup would focus on environmental
health care approach where primary health this area and had developed contacts with degradation and the built environment.
care played an important role as a facilitator relevant WHO officials and civil society or-
between prevention, secondary and tertiary ganisations to collaborate in the process. Following the adoption by the 2008 General
care. The report focused health care systems Assembly of the WMA Statement on Re-
on four pillars: universal coverage, people- In October 2008, the WMA Advocacy ducing the Global Burden of Mercury, the
centred health care, leadership reform to Advisor, Ms. Clarisse Delorme, moderated WMA joined the UNEP Global Mercury
make health authorities more accountable an NGO briefing on reducing the glo- Partnership to contribute to the partner-
and to promote and protect public health in bal harm caused by alcohol, organised by ship goal to protect human health and the
general. GAPA (Global Alcohol Policy Alliance). global environment from the release of
The objectives of the briefing were to un- mercury and its compounds.
The Executive Board of the WHO in derstand the WHO process related to the
January 2009 discussed a draft resolution strategy, to begin discussions on substantive During the reporting period, the WMA
on primary health care, including health and political proposals to promote an ef- secretariat launched several lobbying ac-
care system strengthening. On behalf of fective, evidence-based global strategy, and, tions, based on information from Amnesty
the World Health Professions Alliance, finally, to develop further working relations international, to support physicians in dis-
the WMA made a public statement dur- between civil society actors involved in this tress worldwide:
ing the Executive Board session. Further area. • Two Egyptian doctors, Raouf Amin al-
debate took place during the World Health Arabi and Shawqi Abd Rabbuh, were
Assembly in May 2009. The WHO invited sentenced to 15 and 20 years in prison
134
treatment and permission for family visits In August 2008, Clarisse Delorme, WMA
were also required. They were released on advocacy advisor, was elected as indepen-
the 24 August 2009, but with restricted dent expert on the Council of the Interna-
liberty, required to report regularly to the tional Rehabilitation Council for Torture
authorities. Amnesty International con- Victims (IRCT) 2009-2012.
tinued to have serious concerns, given the
unclear process for their bail and possible In September 2009, the WMA secretariat
ongoing trial. The WMA Secretariat was together with the Danish Medical Asso-
in regular contact with Amnesty and was ciation contacted the Danish permanent
ready to take further actions, if appropri- Representative in Geneva to discuss po-
ate. tential follow-up from the resolution on
and 1500 and 1700 lashes respectively in the Role and Responsibility of Medical
Saudi Arabia for having facilitated the The WMA also intervened on behalf of and other Health Personnel in Relation
addiction of a patient to morphine after Majid Movahedi who was sentenced last to Torture, adopted by the Human Rights
prescribing the medicine for her pain March in Iran to be blinded in both eyes Council last March at its 10th session.
relief following an accident (December with acid – a process that would involve Based on their concerns that the resolu-
2008). The WMA sent letters calling on medical professionals. Recalling its firm tion adopted did not include references to
the authorities of Saudi Arabia to review opposition to punishments that constitute WMA core policies in this area, nor did it
the case or send it for retrial and to ensure cruel, inhuman and degrading treatment highlight the positive role of physicians and
that any such procedures were undertaken amounting to torture, WMA emphasised other health personnel in preventing and
in accordance with international fair trial in letters to Iran authorities that, according condemning torture and other inhuman
standards. to international medical standards, it was treatments, the WMA and DMA suggest-
• Dr. Arash Alaei and Kamiar Alaei (Re- unacceptable to involve physicians in this ed that the Permanent Representative work
public of Iran) were sentenced to six and inhuman and degrading treatment. with the Danish government on a further
three years of imprisonment respectively resolution highlighting the positive role of
for “co-operating with an enemy govern- The WMA was actively involved in physicians and other health personnel in
ment”, specifically with US institutions developing the “Right to Health as a preventing and condemning torture and
in the field of HIV & AIDS prevention Bridge to Peace in the Middle East” joint other inhuman treatments.
and treatment ( January 2009). In letters seminar, which was due to take place in
to the Iranian authorities, the WMA ex- October 2009 in Turkey. The seminar was In August 2008, the Commission on Social
pressed its serious concerns on the pro- being organised by the International Fed- Determinants of Health published its final
ceedings falling far short of international eration of Health and Human Rights Or- report “Closing the Gap in a Generation –
standards for fair trial and asked for the ganisations (IFHHRO), the Norwegian Health Equity through Action on the Social
immediate release of the two physicians, Medical Association (NMA), the Human Determinants of Health”. In this 200-page
as their imprisonment appeared to be po- Rights Foundation of Turkey (HRFT), the report, the Commission addressed global
litically motivated. Turkish Medical Association (TMA) and health through social determinants, i.e.,
• Three government employed doctors, the WMA. The objectives of the meeting are the structural determinants and conditions
Dr. T. Sathiyamoorthy, Dr. T. Varatharajah to discuss what role the medical profession of daily life responsible for a major part of
and Dr. Shanmugarajah, who had been can play in securing equal access to health health inequities among and within coun-
working in the conflict zone in northeast- care for the population and to facilitate the tries, and proposes a new global agenda for
ern Sri Lanka until 15 May 2009, were communication among health professionals health equity.
held under emergency regulations by the in the participating nations.
Sri Lankan government for providing On the occasion of the 124th session of
“false information“ to foreign journalists. The WMA maintained regular contact with WHO Executive Board ( January 2009),
At the end of May, the WMA sent letters Anand Grover, the UN Special Rappor- the WMA – on behalf of the World Health
urging the Sri Lankan authorities to give teur on Health in order to increase the role Professions Alliance (WHPA) - presented
to the three doctors immediate and unre- of health professionals in the promotion of a statement on this report, with a focus on
stricted access to lawyers of their choice the human rights to the highest attainable the health workforce. In this statement, the
and that they be promptly brought before standard of health. WHPA welcomed the recommendation
an independent court. Access to medical directed at national governments and do-
135
The CPW Project was extended to in- Based on a mutual agreement with the
clude a leadership course organised by the WHO, the WFME together with the Uni-
INSEAD Business School in Fontaineb- versity of Copenhagen (which hosted the
leau, France, in December 2007, in which WFME office), had taken over from WHO
32 medical leaders from a wide range of Headquarter the register of institutions
countries participated. The second Leader- for higher education in health care. The
ship Course was held at the same place in WFME now developed this register in an
December 2008 for one-week with 30 par- online database called Avicenna Directories,
ticipants, with continued successful results which would not only list the institutions as
and positive feedback. The third Leadership named by their governments, but also pro-
Course at the INSEAD Business School vide information about their accreditation
nors to “increase investment in medical and would be held in Singapore, 8-13 February status and the accrediting body.
health personnel”, but regretted that the 2010. The curriculum included training in
report in general does not give more atten- decision-making, policy work, negotiating In January 2009, the WMA signed a con-
tion to health professionals as key players in and coalition building, intercultural rela- tract with DGN Services to develop and
addressing the social determinants of health tions and media relations. The courses were install a new web portal for the WMA. The
and to the inequalities health professionals made possible by an unrestricted education- new web portal, launched in October 2009,
face in their daily work. al grant provided by Pfizer, Inc. would provide the platform for co-operation
with the members of WMA, allow online
Clinical research involving human subjects The World Health Professions Alliance payments for meetings, books and associate
had proliferated in developing countries in was now a decade old. The context within membership dues, and, most of all, it would
the recent past, increasing concerns about which it was working had evolved with its facilitate more timely presentation of con-
ethical and legal implications of misconduct continued development, and so had the or- tent on the public website.
and violations of subjects’ human rights and ganisations that made up the alliance. The
welfare due to inadequate scientific and WHPA had revised its strategy and priori- Speaking book on clinical trials
ethical review of protocols or as a result ties for the next few years and would focus
of poor or absent drug regulatory systems. mainly on human resources in health, pa- One of the fringe events of the Assembly
The WMA was invited to the international tient safety, public health, counterfeit medi- was an evening presentation of an Indian
Round Table - Biomedical Research in cal products and human rights in health. perspective of the WMA’s Speaking Book
Developing Countries: the Promotion of on Clinical Trials, aimed at patients and
Ethics, Human Rights and Justice - to The World Federation for Medical Edu- their relatives who do not read and write
compare and exchange expertise and expe- cation (WFME) brought together medical sufficiently well to understand what a clini-
riences between national and international faculties and the profession. During recent cal trial is for and how it works. Representa-
institutions, on the issue of protection of years it had focused on describing global tives from the WMA, the Indian Medical
human participants in biomedical research. standards for basic and post-graduate edu- Association, the Indian Council of Medical
Participants stressed the importance of cation of physicians, as well as for Continu- Research and Pfizer, spoke about the launch
building capacity in biomedical ethics re- ing Professional Development. The WMA of the English-Hindi books and Ms. Zane
views in developing countries by supporting General Assembly, Tokyo 2004 endorsed Wilson, from Books of Hope and the South
education and training curricula of health these standards. African Depression and Anxiety Group,
professionals and community health work- spoke movingly about the developments of
ers, in order to facilitate the creation of in- Currently, the WFME worked on encour- the project.
stitutional Research Ethics Committees. aging and supporting countries and medical WMA Public Relations Consultant
schools to further develop, or to improve, Mr. Nigel Duncan
The Caring Physicians of the World their accreditation. Although not itself an
(CPW) Initiative (Leadership Course) accrediting body, the WFME - together
began with the Caring Physicians of the with WHO - strongly supported the use of
World book, published in October 2005 accreditation as a method of documenting
in English and in Spanish in March 2007. and improving the quality of education and
Regional conferences were held in Latin achieving comparability in the international
America, Asia-Pacific and Africa regions. arena.
136
137
3.5 Increased burden of diarrheal diseases (medium). countries for climate change must include designated funds
3.6 Increased cardio-respiratory morbidity and mortality associated to support the strengthening of health systems.
with ground-level ozone (high). 1.2 As a profession, physicians & their medical associations will
3.7 Increased numbers of people at risk of dengue (low). encourage advocacy for environmental protection, reduction of
3.8 Social and health inequalities due to possible desertification, green house gas production, sustainable development and green
natural disasters, changes in agriculture, feeding and water pol- adaptation practices within their communities, countries/re-
icy which will have consequences on both human health and gions, especially for the right of safe water & sewage disposal
human resources in health. for all.
1.3 As professionals, physicians are encouraged to act within their
4. The authors note that climate change could bring some benefits professional settings (clinics, hospitals, laboratories etc.) to re-
to health, including fewer deaths from cold, although these will be duce the environmental impact of medical activities, & to de-
outweighed by the negative effects of rising temperatures world- velop environmentally sustainable professional settings.
wide, especially in developing countries (high confidence). 1.4 As individuals, physicians will be encouraged to act to minimize
their impact on the environment, reduce their carbon footprint
5. The WMA notes that climate change is likely to amplify inequali- and encourage those around them to do so.
ties in health and other existing problems within and between coun-
tries. 2. LEADERSHIP: Help people to mitigate
climate damage & adapt to climate change
6. Early research suggests that mitigation of the effects of climate change
may have a link with prevention such that mitigation might have signifi- 2.1 Support the Millennium Development Goals and commit to
cant health benefits for both individuals and populations* work to attain them.
2.2 Support and implement the principles outlined in the WHO
STATEMENT Commission on the Social Determinants of Health report,
Closing the Gap in a Generation and in the World Health As-
Given the consequences of global climate change on the health of sembly Resolution on climate change and health and work with
people throughout the world, the World Medical Association, on WHO and others to ensure implementation of the recommen-
behalf of its national medical association members and their physi- dations.
cian members supports and commits to the following actions: 2.3 Work to create resilience within health systems to ensure that all
health care providers are able to adapt and can fully utilize their
1. ADVOCACY to Combat Global Warming capacity to provide care to those in need.
1.1 The World Medical Association and National Medical Associa- 2.4 Urge local, national and international organizations focused on
tions urge national governments to recognize the serious con- adaptation, mitigation, and development to involve physicians
sequences for health as a result of climate change and therefore and the healthcare community to ensure that unanticipated
to strive for an intergovernmental agreement in Copenhagen in health impacts of development are minimized, while opportu-
December 2009 with the following components: nities for health promotion are maximized.
1.1.1 specific goals for reductions of climate altering emissions 2.5 Work to improve the ability of patients to adapt to climate
(mitigation); change and catastrophic weather events by:
1.1.2 a mechanism to minimize the harms and health inequalities 2.5.1 encouraging health behaviors that improve overall health;
that are globally associated with climate change (adaptation); 2.5.2 creating targeted programs designed to address specific
1.1.3 because climate change will exaggerate health disparities, exposures;
WMA recommends that resources transferred to developing 2.5.3 providing health promotion information and education on
self-management of the symptoms of climate-associated ill-
* In the context of this paper, Mitigation describes the actions to ness.
reduce human effects on the climate system: principally strategies
to reduce greenhouse gas emissions (analogous to primary preven- 3. EDUCATION & CAPACITY BUILDING:
tion) while Adaptation is understood to refer to the adjustment in 3.1 Build professional awareness of the importance of the environ-
natural or human systems taken in response to actual or expected ment and global climate change to personal, community and
climate stimuli or their effects, and that moderate harm or exploit societal health, and recognize that universal equitable education
beneficial opportunities (analogous to secondary prevention). (See improves health capacity for all.
WHO EB122/4, Jan 08)
138
3.2 Physicians have obligations for the health and health care of 4.1.3 describe the effects of poorly treated wastewater used for
individual patients. Collectively, through their national medical irrigation and
associations, and through WMA they also have obligations and 4.1.4 describe the most vulnerable populations, the particular
responsibilities for the health of all people. health impacts of climate change on vulnerable populations,
3.3 Work with others to educate the general public about the im- & possible new protections for such populations.
portant effects of climate change on health and the need to both 4.2 Advocate for the collection of vital statistics and the removal of
mitigate climate change and adapt to its effects. barriers to the registration of births & deaths, in recognition of
3.4 Add or strengthen routine health training on environmental the special vulnerability of some populations.
health/medicine and public health for all students in health re- 4.3 Report diseases that emerge in conjunction with global climate
lated disciplines. change, and participate in field investigations, as with outbreaks
3.5 The WMA and NMAs should develop concrete actionable of infectious diseases.
plans/practical steps as tools for physicians to adopt in their 4.4 Support and participate in the development or expansion of sur-
practices; health authorities and governments should do the veillance systems to include diseases caused by global climate
same for hospitals and other health facilities. change.
3.6 Incorporate tools such as a patient environmental impact assess- 4.5 WMA will and encourages all NMAs to collaborate in the col-
ment and encourage physicians to evaluate their patients and lection and sharing of local or regional health information with-
their families for risk from the environment and global climate in and between countries in order to encourage the adoption of
change. best practices and proven strategies
3.7 Advocate that governments undertake community climate
change health impact assessments, widely disseminate the re- 5. COLLABORATION: Prepare for climate emergencies
sults, and incorporate the results into planning for mitigation 5.1 Collaborate with governments, NGOs and other health profes-
and adaptation. sionals to develop knowledge about the best ways to mitigate
3.8 Encourage recruitment of physicians for work in public health climate change, including those adaptive and mitigation strate-
and all roles in emergency planning & response to extreme cli- gies that will result in improved health.
mate change, including the training of other physicians. 5.2 Encourage governments to incorporate national medical as-
3.9 Urge colleges and universities to develop locally appropriate sociations & physicians into country & community emergency
continuing medical and public health education on the clinical planning & response.
signs, diagnosis and treatment of new diseases that are intro- 5.3 Work to ensure integration of physicians into the plans of civil
duced into communities as a result of climate change, and on society, governments, public health authorities, international
the management of long-term anxiety and depression that often NGOs and WHO.
accompany experiences of disasters. 5.4 Encourage WHO and countries of the World Medical Assem-
3.10 Urge governments to provide training for climate-change-re- bly to review the International Health Regulations and Plan-
lated emergency response to physicians, particularly those living ning for Pandemic Influenza and obtain the perspective of clini-
in relatively isolated regions. cians in community practice to ensure that there are appropriate
3.11 Work with policy makers on the development of concrete ac- responses by practicing physicians to emergency alerts, and to
tions to be taken to prevent or reduce the health impact of cli- make recommendations regarding the most appropriate educa-
mate-related emissions, in particular those initiatives, which will tion, and tools for physicians and other healthcare workers.
also improve the general health of the population. This would 5.5 Call upon governments to strengthen public health systems in
include initiatives to stop the privatization of water. order to improve the capacity of communities to adapt to cli-
mate change.
4. SURVEILLANCE AND RESEARCH: 5.6 Prepare physicians, physicians’ offices, clinics, hospitals and oth-
4.1 Work with others, including governments, to address the gaps er health care facilities for the infrastructure disruptions that
in research regarding climate change and health by undertaking accompany major emergencies, in particular by planning in ad-
studies to: vance the delivery of services during times of such disruptions.
4.1.1 describe the patterns of disease that are attributed to cli- 5.7 Urge physicians, medical associations and governments to work
mate change, including the impacts of climate change on collaboratively to develop systems for event alerts in order to
communities and households; ensure that health care systems and physicians are aware of
4.1.2 quantify and model the burden of disease that will be climate-related events as they unfold, and receive timely accu-
caused by global climate change; rate information regarding the management of emerging health
events.
139
5.8 Call upon governments to plan for environmental refugees 5.10 WMA will work with others to identify funding for specific re-
within their countries. search programs on mitigation and adaptation related to health,
5.9 In collaboration with WHO, produce locally adapted fact sheets and the sharing of information/research within and between
on climate change for national medical associations, physicians, countries and jurisdictions.
and other health professionals.
140
Physicians know that the future of our world depends on our chil- • Affordable & accessible high quality primary & secondary educa-
dren: their education, their employability, their productivity, their tion.
innovation, and their love and care for one another and for this
planet. Early childhood experiences strongly influence future de- 3. A full range of health resources available to all means:
velopment including basic learning, school success, economic par- • The best interests of the child shall be the primary consideration
ticipation, social citizenry, and health3. In most situations, parents in the provision of health care;
and caregivers alone cannot provide strong nurturing environ- • Those caring for children shall have the special training and skills
ments without help from local, regional, national and international necessary to enable them to respond appropriately to the medical,
organizations.***Physicians therefore join with parents, and with physical, emotional and developmental needs of children & their
world leaders to advocate for healthy children. families;
• Basic health care including health promotion, recommended im-
The principles of this Declaration apply to all children in the world munization, drugs & dental health;
from birth to 18 years of age, regardless of race, age, ethnicity, na- • Mental health care and prompt referral to intervention when
tionality, political affiliation, creed, language, gender, disease or dis- problems identified;
ability, physical ability, mental ability, sexual orientation, cultural • Priority access to drugs for life- or limb-threatening conditions
history, life experience or the social standing of the child or her/his for all mothers and children;
parents or legal guardian. In all countries of the world, regardless of • Hospitalization only if the care and treatment required cannot be
resources, meeting these principles should be a priority for parents, provided at home, in the community or on an outpatient basis;
communities and governments. The United Nations Convention • Access to specialty diagnostic and treatment services when need-
on the Rights of Children (1989) sets out the wider rights of all ed;
children and young people, but those rights cannot exist without • Rehabilitation services and supports within community;
health. • Pain management and care and prevention (or minimization) of
suffering;
GENERAL PRINCIPLES • Informed consent is necessary before initiating any diagnostic,
therapeutic, rehabilitative, or research procedure on a child. In
1. A place with a safe and secure environment includes: the majority of cases, the consent shall be obtained from the
• Clean water, air and soil; parent(s) or legal guardian, or in some cases, by extended family,
• Protection from injury, exploitation, discrimination and from tra- although the wishes of a competent child should be taken into
ditional practices prejudicial to the health of the child, and account before consent is given.
• Healthy families, homes and communities.
4. Research**** & monitoring for continual improvement includes:
2. A place where a child can have good health and development • All infants will be officially registered within one month of birth;
offers: • All children will be treated with dignity and respect;
• Prenatal and maternal care for the best possible health at birth; • Quality care is ensured through on-going monitoring of services,
• Nutrition for proper growth, development and long-term health; including collection of data, and evaluation of outcomes;
• Early learning opportunities and high quality care at home and • Children will share in the benefits from scientific research rel-
in the community; evant to their needs;
• Opportunities and encouragement for physical activity; • The privacy of a child patient will be respected.
**** Proposed WMA statement on ethical principles for medical research on child
*** Canadian Charter for Child and Youth Health subjects
WMA Resolution on Task In health care, the term "Task Shifting" is used to describe a situa-
tion where a task normally performed by a physician is transferred
Shifting from the Medical to a health professional with a different or lower level of education
and training, or to a person specifically trained to perform a limited
Profession task only, without having a formal health education. Task shifting
occurs both in countries facing shortages of physicians and those
Adopted by the WMA General Assembly, not facing shortages.
New Delhi, India, October 2009
141
A major factor leading to task shifting is the shortage of qualified In addition, task shifting which deploys assistive personnel may ac-
workers resulting from migration or other factors. In countries facing tually increase the demand on physicians. Physicians will have in-
a critical shortage of physicians, task shifting may be used to train al- creasing responsibilities as trainers and supervisors, diverting scarce
ternate health care workers or laypersons to perform tasks generally time from their many other tasks such as direct patient care. They
considered to be within the purview of the medical profession. The may also have increased professional and/or legal responsibility for
rationale behind the transferring of these tasks is that the alternative the care given by health care workers under their supervision.
would be no service to those in need. In such countries, task shifting
is aimed at improving the health of extremely vulnerable populations, The World Medical Association expresses particular apprehension
mostly to address current shortages of healthcare professionals or tackle over the fact that task shifting is often initiated by health authori-
specific health issues such as HIV. In countries with the most extreme ties, without consultation with physicians and their professional
shortage of physicians, new cadres of health care workers have been representative associations.
established. However, those persons taking over physicians' tasks lack
the broad education and training of physicians and must perform their RECOMMENDATIONS
tasks according to protocols, but without the knowledge, experience
and professional judgement required to make proper decisions when Therefore, the World Medical Association recommends the follow-
complications arise or other deviations occur. This may be appropriate ing guidelines:
in countries where the alternative to task shifting is no care at all but 1. Quality and continuity of care and patient safety must never be
should not be extended to countries with different circumstances. compromised and should be the basis for all reforms and legisla-
tion dealing with task shifting.
In countries not facing a critical shortage of physicians, task shifting 2. When tasks are shifted away from physicians, physicians and
may occur for various reasons: social, economic, and professional, their professional representative associations should be con-
sometimes under the guise of efficiency, savings or other unproven sulted and closely involved from the beginning in all aspects
claims. It may be spurred, or, conversely, impeded, by professions concerning the implementation of task shifting, especially in the
seeking to expand or protect their traditional domain. It may be reform of legislations and regulations. Physicians might them-
initiated by health authorities, by alternate health care workers and selves consider initiating and training a new cadre of assistants
sometimes by physicians themselves. It may be facilitated by the under their supervision and in accordance with principles of
advancement of medical technology, which standardizes the perfor- safety and proper patient care.
mance and interpretation of certain tasks, therefore allowing them 3. Quality assurance standards and treatment protocols must be
to be performed by non-physicians or technical assistants instead of defined, developed and supervised by physicians. Credential-
physicians. This has typically been done in close collaboration with ing systems should be devised and implemented alongside the
the medical profession. However, it must be recognized that medi- implementation of task shifting in order to ensure quality of
cine can never be viewed solely as a technical discipline. care. Tasks that should be performed only by physicians must be
clearly defined. Specifically, the role of diagnosis and prescrib-
Task shifting may occur within an already existing medical team, ing should be carefully studied.
resulting in a reshuffling of the roles and functions performed by the 4. In countries with a critical shortage of physicians, task shifting
members of such a team. It may also create new types of personnel should be viewed as an interim strategy with a clearly formulat-
whose function is to assist other health professionals, specifically ed exit strategy. However, where conditions in a specific country
physicians, as well as personnel trained to independently perform make it likely that it will be implemented for the longer term, a
specific tasks. strategy of sustainability must be implemented.
5. Task shifting should not replace the development of sustain-
Although task shifting may be useful in certain situations, and may able, fully functioning health care systems. Assistive workers
sometimes improve the level of patient care, it carries with it signifi- should not be employed at the expense of unemployed and un-
cant risks. First and foremost among these is the risk of decreased deremployed health care professionals. Task shifting also should
quality of patient care, particularly if medical judgment and decision not replace the education and training of physicians and other
making is transferred. In addition to the fact that the patient may health care professionals. The aspiration should be to train and
be cared for by a lesser trained health care worker, there are specific employ more skilled workers rather than shifting tasks to less
quality issues involved, including reduced patient-physician contact, skilled workers.
fragmented and inefficient service, lack of proper follow up, incor- 6. Task shifting should not be undertaken or viewed solely as a cost
rect diagnosis and treatment and inability to deal with complica- saving measure as the economic benefits of task shifting remain
tions. unsubstantiated and because cost driven measures are unlikely
142
to produce quality results in the best interest of patients. Cred- as the gold standard. Task shifting should not replace the de-
ible analysis of the economic benefits of task shifting should be velopment of mutually supportive, interactive health care teams,
conducted in order to measure health outcomes, cost effective- coordinated by a physician, where each member can make his or
ness and productivity. her unique contribution to the care being provided.
7. Task shifting should be complemented with incentives for the 12. In order for collaborative practice to succeed, training in lead-
retention of health professionals such as an increase of health ership and teamwork must be improved. There must also be
professionals' salaries and improvement of working conditions. a clear understanding of what each person is trained for and
8. The reasons underlying the need for task shifting differ from capable of doing, clear understanding of responsibilities and a
country to country and therefore solutions appropriate for one defined, uniformly accepted use of terminology.
country cannot be automatically adopted by others. 13. Task shifting should be preceded by a systematic review, analysis
9. The effect of task shifting on the overall functioning of health and discussion of the potential needs, costs and benefits. It
systems remains unclear. Assessments should be made of the should not be instituted solely as a reaction to other develop-
impact of task shifting on patient and health outcomes as well ments in the health care system.
as on efficiency and effectiveness of health care delivery. In par- 14. Research must be conducted in order to identify successful train-
ticular, when task shifting occurs in response to specific health ing models. Work will need to be aligned to various models cur-
issues, such as HIV, regular assessment and monitoring should rently in existence. Research should also focus on the collection
be conducted of the entire health system. Such work is essential and sharing of information, evidence and outcomes. Research
in order to ensure that these programs are improving the health and analysis must be comprehensive and physicians must be part
of patients. of the process.
10. Task shifting must be studied and assessed independently and 15. When appropriate, National Medical Associations should col-
not under the auspices of those designated to perform or finance laborate with associations of other health care professionals in
task shifting measures. setting the framework for task shifting. The WMA shall con-
11. Task shifting is only one response to the health workforce short- sider establishing a framework for the sharing of information
age. Other methods, such as collaborative practice or a team/ on this topic where members can discuss developments in their
partner approach, should be developed in parallel and viewed countries and their effects on patient care and outcomes.
Unsettling practices of injured persons being taken to prisons, with- 2. Reaffirms its Declaration of Hamburg: Declaration Concern-
out adequate medical treatment or the consensus of the attending ing Support for Medical Doctors Refusing to Participate in, or to
physicians; Condone, the Use of Torture or Other Forms of Cruel, Inhuman
or Degrading Treatment, which encourages doctors to honor their
Physicians being hindered from treating patients; commitment as physicians to serve humanity and to resist any pres-
143
sure to act contrary to the ethical principles governing their dedica- • ensure that detainees or victims of torture or cruelty or mistreat-
tion to this task. ment have access to immediate and independent health care;
• ensure that physicians include assessment and documentation of
3. Reaffirms its Declaration of Tokyo: Guidelines for Physicians symptoms of torture or ill-treatment in the medical records us-
Concerning Torture and other Cruel, Inhuman or Degrading Treat- ing the necessary procedural safeguards to prevent endangering
ment or Punishment in Relation to Detention and Imprisonment, detainees.
which:
• prohibits physicians from participating in, or even being present 5. Refers to the WMA International Code of Medical Ethics,
during the practice of torture or other forms of cruel or inhuman which states that physicians shall be dedicated to providing com-
or degrading procedures; petent medical service in full professional and moral independence,
• requires that physicians maintain utmost respect for human life with compassion and respect for human dignity.
even under threat, and prohibits them from using any medical 6. Urges the government of the Islamic Republic of Iran to respect
knowledge contrary to the laws of humanity. the International Code of Medical Ethics and the standards in-
cluded in the aforementioned declarations to which physicians are
4. Reaffirms its Resolution on the Responsibility of Physicians in committed.
the Documentation and Denunciation of Acts of Torture or Cruel 7. Urges National Medical Associations to speak out in support of
or Inhuman or Degrading Treatment; which states that physicians this resolution.
should attempt to:
There are currently significant shortages in the area of health hu- Recognizing that health care systems require adequate numbers of
man resources. These shortages are present in all countries but are qualified and competent health care professionals, the World Medi-
especially pronounced in developing countries where health human cal Association asks all National Medical Associations to partici-
resources are more limited. pate and be active in addressing these requirements and to:
The problem is made more severe by the fact that many countries 1. Call on their respective governments to allocate sufficient finan-
have not invested adequately in the education, training, recruitment cial resources for the education, training, development, recruitment
and retention of their medical workforce. The ageing population in and retention of physicians to meet the medical needs of the entire
developed countries has also been reflected by an ageing medical population in their countries.
workforce. Many developed countries address their medical work-
144
2. Call on their respective governments to ensure that the educa- 4. Take measures to attract and support individuals within their
tion, training and development of healthcare professionals meets countries to enter the medical profession and also call on their re-
the highest possible standards including: spective governments to take such action.
• The training and development of medical/clinical assistants where 5. Actively advocate for programs that will ensure the retention of
this is applicable and appropriate and physicians within their respective countries and ensure governments’
• Ensuring clear definitions of scope of practice and conditions for recognition of this need.
adequate support and supervision. 6. Call on governments to improve the health care working environ-
ment (including access to appropriate facilities, equipment, treat-
3. Call on governments to ensure that appropriate ratios are main- ment modalities and professional support), physician remuneration,
tained between population and the medical workforce at all levels, physician living environment and career development of the medi-
including mechanisms to address reduced access to care in rural and cal workforce at all levels.
remote areas, based on accepted international norms and standards 7. Advocate for the development of transparent memoranda of un-
where these are available. derstanding between countries where migration of trained health
care professionals is an issue of concern and enlist where possible the
NMA of origin and receiving NMA’s to support these physicians.
WMA Statement on significant role for the health care system in their prevention and
reduction. This role can be summarized as follows:
Inequalities in Health • To prevent the health effects of socio-economic and cultural in-
equality and inequity – especially by health promotion and dis-
Adopted by the WMA General Assembly, ease prevention activities (Primary Prevention)
New Delhi, India, October 2009 • To Identify, treat and reduce existing health inequality, e.g. early
diagnosis of disease, quality management of chronic disease, reha-
PREAMBLE bilitation (Secondary and Tertiary Prevention).
For over 150 years, the existence of health inequality has been ac- RECOMMENDATIONS
knowledged worldwide. The recently published Final Report of the
WHO Commission on Social Determinants of Health has high- The members of the medical profession, faced with treating the re-
lighted the critical importance of health equity to the health, econ- sults of this inequity, have a major responsibility and call on their
omy and social cohesiveness of all countries. It is clear that while national medical associations to:
there are major differences between countries, especially between the 1. Recognize the importance of health inequality and the need to
developing and developed countries, there are also substantial dis- influence national policy and action for its prevention and re-
parities within countries with respect to various measures of socio- duction
economic and cultural diversity. Disparities in health can be defined 2. Identify the social and cultural risk factors to which patients and
as either disparities in access to healthcare, disparities in quality of families are exposed and to plan clinical activities (diagnostic
care received, or both. The differences manifest themselves in a wide and treatment) to counter their consequences.
variety of health measures, such as life expectancy, infant mortality, 3. Advocate for the abolishment of financial barriers to obtaining
and childhood mortality. Particularly disturbing is evidence of the needed medical care.
gradual and ongoing widening of specific disparities. 4. Advocate for equal access for all to health care services irrespec-
tive of geographic, social, age, gender, religious, ethnic and eco-
At the core of this issue is the healthcare provided by physicians. nomic differences or sexual orientation.
National medical associations should take an active role in combat- 5. Require the inclusion of health inequality studies (including the
ing social and health inequalities in order to allow their physician scope, severity, causes, health, economic and social implications)
members the ability to provide equal, quality service to all. as well as the provision of cultural competence tools, at all lev-
els of academic medical training, including further training for
The Role of the Health Care System those already in clinical practice.
145
RECOMMENDATIONS
WMA Resolution on Improved
The World Medical Association urges National Medical Associa-
Investment in Public Health tions to:
Adopted by the 50th World Medical Assembly, Ottawa, 1. Advocate that their governments should adhere to and promote
Canada, October 1998 and amended by the WMA the proposals to increase investment in the health sector; and to
General Assembly, New Delhi, India, October 2009 adhere to and promote initiatives to reduce the debt burden for the
poorest countries on the planet.
INTRODUCTION
2. Advocate [defend] the inclusion of public health factors in all
Each country should have a health system with enough resources to fields of policy provision, since health is mostly determined by fac-
attend to the needs of its population. However today, many coun- tors that are external to the area of healthcare, for example, housing
tries across the world are suffering wide inequities and inequalities and education. [Health is not only medicine, it also depends on liv-
in health care and this is causing problems of access to health servic- ing standards].
es for the poorer segments of society [the weak or underprivileged].
The situation is especially serious in low-income countries. 3. Encourage and support countries in the planning and implemen-
tation of investment plans, which invest in health for the poor; guar-
The international community has attempted to improve the situ- antee that more resources be used for health in general, with greater
ation. The 20/20 initiative of 1995, the 1996 Initiative for Heavily efficiency and impact; and reduce limitations for the most effective
Indebted Poor Countries (HIPC), and Objectives for Millennium use of the additional investments.
2000 Development (MDGs) are all initiatives aimed at reducing
poverty and dealing with poor health, inequities and inequalities 4. Maintain vigilance to ensure that the investment plans focus
between the sexes, education, insufficient access to drinking water maximum attention on generating capacity, that they promote lead-
and environmental contamination. ership skills and promote incentives to retain and place qualified
personnel, whilst it is taken into consideration that the limitations
The objectives are formed as an agreement with acknowledgement in relation to the previous matter currently constitute the greatest
of the contributions which developed countries can make, in the obstacle for progress.
shape of trade relations, development assistance, reduction of the
burden of debt, improving access to essential medication and the 5. Urge international financial institutions and other important
transfer of technology. Three of the eight objectives are directly re- donors to: i) Adopt the necessary measures to help the countries
lated to health, which has a considerable influence on various other that have already organised mechanisms to prepare their investment
objectives that interact to support each of the others within a struc- plans, and provide assistance to those countries that have begun to
tural framework, these are designed to increase human development take the necessary steps, with the support and participation of the
globally. The eight Millennium Development Objectives (MDO) international community; ii) Help countries to obtain funds to de-
foresee a development vision based on health and education, thus velop and implement their investment plans; iii) Continue provid-
affirming that development does not only refer (allude) to economic ing technical assistance to the countries for their plans.
growth.
6. Exchange information in order to coordinate efforts to change
Various reports from the World Health Organization have un- policies in these areas.
derlined the opportunities and skills [or techniques] which are
currently involved in bringing about significant improvements in
health, as well as helping to reduce poverty and encourage growth.
Additionally, the reports highlight the fact that it is of fundamental
importance to reduce limitations on human resources, in order to
increase the achievements of the public health system, a situation
which requires urgent attention. These limitations are related to
work, training and payment conditions, and play a substantial role
in determining capacity for sustained growth of access to health
services.
146
147
148
149
150
151
152
153
HIFA2015 Forums HIFA2015 Knowledge Base Promote evidence- provider in different contexts, and ways of
based solutions meeting those needs. A prototype is avail-
able at www.hifa2015.org/knowledge-base.
Communication Understanding Advocacy
“HIFA2015 is needed as a global forum
which provides space for professionals
from all parts of the world to exchange
views and share knowledge.” Dr Najeeb
Al-Shorbaji, Director of Knowledge
Management and Sharing, World Health
Organization, HIFA2015 Foundation
Strengthened, independent action by Document 2008
HIFA 2015 members and others
Better health information production and delivery world The HIFA2015 Knowledge Base will pro-
wide, based on: vide the evidence we need to persuade gov-
• better und understanding of information needs ernments and funding agencies to commit
and barriers, and how to address them
political and financial support for diverse
• more sharing of experience and expertise,
efforts to improve availability and use of
and lessons learned
healthcare information, especially where it
• increased investment in evidence-based,
cost-effective solution is most needed. For too long, the informa-
tion needs of healthcare providers in low-
income settings have been neglected.
154
155
• To overcome gender-related inequalities MWIA has been on the forefront of work tions are always welcome, as the physicians
within the medical profession. on female genital mutilation, with one of our volunteer their time at the hospital.
• To promote health for all throughout the members from Sierra Leone having written
world with particular interest in women, a book back in the 1980’s on the topic and MWIA is pleased to attend the annual
health and development. appearing in the Danish film entitled The meetings of the World Medical Association
Silent Pain. MWIA participated recently in as an observer. MWIA would be pleased
The Association is composed of eight geo- a large meeting organized by the WHO on to partner with the World Medical Associa-
graphical regions: Northern Europe, Central this subject in Kenya. tion in projects of mutual interest.
Europe, Southern Europe, North America,
Latin America, Near East and Africa, Cen- In many countries, women physicians have Shelley Ross, MD, Secretary-General, MWIA
tral Asia and Western Pacific. Each region been instrumental in developing govern-
is represented on the Executive Committee ment-funded programs for prevention
by its regional Vice-President. The Presi- of cervical cancer by the use of the HPV
dent, President-Elect, Treasurer, Secretary- vaccines, early detection and treatment.
General and the Vice-Presidents are elected MWIA was represented in October in Lu-
by the members for a term of three years. saka, Zambia, at a meeting of cervical can-
The MWIA Secretariat in Burnaby, Cana- cer prevention and treatment strategies.
da, coordinates the interests and activities of
the Organization. MWIA has recently partnered with the
International Osteoporosis Foundation
Dr. Atsuko Heshiki is the current President to make women aware that osteoporosis
and Dr. Shelley Ross is the Secretary-Gen- is a silent killer. MWIA participated in a
eral. survey conducted in Europe, Mexico and
Canada to assess the public’s perception
Every three years, the MWIA holds an in- of the osteoporotic woman. Much to the
ternational meeting. The last meeting was in surprise of physicians, this is no longer as-
Accra, Ghana, in 2007 and the next meeting sumed to be a disease of the old and frail,
will be in Munster, Germany, in July, 2010. but one that affects women who are active
The theme of the 2010 conference will be and who want to be in charge of their lives.
“Globalisation in Medicine - Challenges and A second survey was done to see if mothers
Opportunities,” with a focus on four sub- and daughters were aware of the dangers of
topics: Gender Strategies, Addiction, Epi- osteoporosis.
demic Plagues and Nutrition. Please visit
the website at www.mwia2010.net and With an increasingly large proportion of
plan to join us. women in medical schools, MWIA has
sought to ensure the training of women
MWIA has advocated on numerous for in leadership roles to ensure that medicine
gender and health issues for many years. continues to have significant influence on
MWIA wrote a Training Manual on Gen- policy decisions in the health field. MWIA
der Mainstreaming in Health for physicians feels that medicine must not be allowed to
and helped the World Health Organiza- become a Pink Collar Profession.
tion Department of Gender Women and
Health develop their gender training mod- MWIA is active in primary health care de-
ules. MWIA’s manual can be accessed on livery, with several of its members on the
the webpage at www.mwia.net. Numer- front lines of delivering health care in vari-
ous workshops on gender and health have ous areas around the world.
been held at regional and national meetings.
MWIA has also written a Training Manual In Calcutta, the West Bengal Branch of
on Adolescent Sexuality, which can be ac- MWIA runs a Mission Hospital. Dona-
cessed on the website.
156
157
the expected coverage. Even though Bar- tro, 21 745 Cuban health “cooperantes” were threats such as violence, drug addiction and
rio Adentro increased the coverage of the working, and now with 24 000 “cooperantes”, problems arising from population explosion.
primary care level, in practice it duplicated 2000 health centres have been closed? Environmental sanitation and the quality
the existing coverage. The question is, how of housing is poor. Public hospitals are in
efficient, effective and sustainable has this It is the duty of the President and of the ruins, Venezuelan mothers are giving birth
policy been? How much has it contributed State Controller Agencies to promptly or- on the street, health information has been
to reduce the regional inequities in terms of der investigations to establish responsibili- arbitrarily restricted, all of which weaken
coverage? In addition, there has never been ties in the neglect and abandonment of Bar- the response capacity of the system. In ad-
enough information to evaluate the results, rio Adentro Mission that gave rise to the dition, there is a deliberate policy to destroy
nor transparency in the management and aforementioned declaration of emergency, the national health manpower, which has
rendering of accounts by those who have led and what share of the responsibility belongs morally damaged the health workers and
and managed this parallel health system. to the Cuban Government. their families.
For all these reasons, the dismantling of A wrong answer To make matters worse, in these past 10
Barrio Adentro is not a “health emergency”. years of President Chavez and his ruling
It is a fact known for over three years by the The solution is not to bring more Cuban party in government, despite having an am-
President, the health authorities and most doctors and students to join those already ple majority in the National Assembly, he
Venezuelans, a fact that adds to other ills of here, and who are not showing results in has been unable to foster a broad debate to
the national health system. We regret that improving the health care in our Nation. approve health legislation that would con-
the President accepts it as true only when This will only compound the errors and will tribute to make the right to health an effec-
the Cuban Government corroborates this delay the actions to start a systematic ap- tive right for all Venezuelans.
information. It would have been enough proach to improve the Venezuelan health
for him to listen to the Venezuelan people, care system. The critical social reality
those who support him, those who support-
ed him, and those who do not agree with After 10 years in power, President Chavez The problems related to the health sector af-
his administration, but particularly, to those does not seem to realise that the severe fect other social policy areas, which in turn
people with scant resources that benefited problems of the Venezuelan health care decisively affect the health of the popula-
from Barrio Adentro and who now feel de- system are not limited to the appalling tion and their quality of life.
ceived and cheated. neglect of Barrio Adentro. During this
decade of President Chavez’s government, We are deeply concerned that the political
Responsibilities of the announced many critical health system functions were environment, the democratic shift towards
abandonment abandoned, deteriorated or improvised. De- an authoritarian regime, the fragile social
bilitating policies, such as reorienting the peace, the loss of civil liberties and the re-
The responsibility of the President in this objectives of health campaigns, fragment-
matter is not transferable. He cannot trans- ing, segmenting and centralising health care
fer blame to the rest of his Cabinet, his services have produced inequity and exclu-
governors and his mayors. He and he alone sion, in addition to reducing the coverage
is responsible for having delegated to a for- and the quality of health care. Never before
eign government, the Cuban Government, has so much money been spent in health,
through the Cuban Medical Mission, the in a disorganised, uncontrollable, and non-
management, supervision and evaluation of transparent way. And never before have the
this Parallel Health System. results, as measured by health indicators,
been so poor.
How can the President explain to the coun-
try that in January 2008 in his Annual Mes- Fundamental health programs do not show
sage to the Nation [8], he stated that 6531 results, epidemiological surveillance is weak
primary health centres were in operation and and the capacity to respond to endemic dis-
seven months later, he said 2000 had been eases, epidemics, emerging and re-emerging Unsanitary conditions near an aban-
abandoned? How can he explain that on 25 diseases is poor and inefficient. There are no doned popular clinic in the “El Hediondito”
January 2006, at the height of Barrio Aden- integrated plans against new social health (The Stinky) neighborhood
158
References
1. Organización Mundial de la Salud (2006). Regla-
mento Sanitario Internacional 2005, Ediciones de la
OMS, Ginebra, Suiza.
2. Chávez declara en emergencia sistema de salud.
Avalaible from: http://www.eud.com/2009/09/19/
Inside an abandoned popular clinic pol_ava_chavez-declara-en-em_19A2760687.
shtml
3. Chávez declaró en emergencia la salud en Ven-
cently approved unconstitutional laws that ezuela. Avalaible from: http://www.eluniversal.
impose a national model stamped with the Poster on the wall of a fully operating popu- com.ve/2009/09/20/pol_art_chavez-declaro-en-
personal ideology of President Chavez, have lar clinic with a list of materials requested of em_1574464.shtml
4. Rachel Jones, Hugo Chavez's health-care programme
all advanced simultaneously with repres- the community:broom; syringes 5cc, 3cc; white misses its goals. Lancet. 2008 Jun; 371( 9629):
sion and threats to the freedom of speech. sheets of paper; staplers; magic markers; toilet 1988.
The increasingly unsatisfied social demands paper; soap powdered and bathroom; Clorox 5. Aceptación de Barrio Adentro descendió pero
sigue alta. Avalaible from: http://www.guia.com.
stimulate conflict and have contributed to a and masking tape.
ve/noti/50545/aceptacion-de-barrio-adentro-de-
disrupted social dialog, particularly with the scendio-pero-sigue-alta
public authorities. These conditions fertil- ing political decisions sustained by sound 6. Fernando Bianco: "La misión Barrio Adentro se
ise the way towards greater poverty, deeper technical and scientific criteria. This is a vino abajo". Avalaible from: http://www.aporrea.
org/misiones/n108067.html
conflicts, greater insecurity, more exclusion, hard reality for all Venezuelans, a reality 7. Organización Panamericana de la Salud -OPS
less health, fewer opportunities for produc- from which we cannot escape. A shared (2006). Barrio Adentro: derecho a la salud e inclusión
tive work and less development. destiny forces us to humbly offer wise and social en Venezuela, Caracas, Venezuela
timely responses. 8. Mensaje Anual a la Nación del Presidente de la
República. Avalaible from: www.abn.info.ve/
Thus, it is critical to enable a space for so- mensaje_anual_2009.doc
cial dialogue in order to reach fundamental The construction of Venezuela requires
agreements. Amongst these, health is a crit- tolerance, respect for personal dignity, will- Carlos Walter V.
ical condition for equitable development, ingness to a civilised understanding within Ex-Minister of Health of the
and this value is the best drive in combating our society that cannot continue oscillating Bolivarian Republic of Venezuela
exclusion and poverty. between extremes of endless and fruitless Ex- Institutional Development Advisor of
confrontation, and indifference or social the Pan American Health Organization
The necessary correction autism, driven by hatred, resentment and Director of the Centre for Development
thoughtlessness. There is still time to rectify, Studies (CENDES) of the Central
The Venezuelan health system has serious to invoke more freedom and more democ- University of Venezuela.
deficiencies. Improving them requires mak- racy, and in this way call on all Venezuelans Caracas. Venezuela
159
160
Blood Donation camps are being organized No Tobacco Day Rally organized by various Laparascopic sterilization camp
from time to time by IMA Branches IMA Branches all over the country
Swine Flu
programme on the various modes of avail- An ADR / AE reporting form has been
able contraceptives and their use in most of circulated amongst members of IMA on Despite of the efforts of the Government to
the States is on the anvil. Further we will which reports of ADR/AE are being sent control the spread of Swine Flu, it has taken
identify members who will be interested in to us by them. the form of an epidemic in our country.
taking up training in No Scalpel Vasectomy IMA has already sensitised all its members
(N.S.V) and Laparoscopic Sterilization in Aao Gaon Chalen Project about the Swine Flu epidemic and issued
near future. guidelines through its News Letter. General
“India lives in villages”. However, due to public has been informed and sensitised about
Pharmaco Vigilance and Drug Safety various socio-economic and other reasons, the methods to prevent the Swine Flu. An
the basic healthcare needs of these citizens Information Cell at IMA HQs. is working
The efficacy and safety of a new drug are of the country cannot be looked after due to round the clock to respond to various queries
generally studied on a few thousand care- the poor facilities available to them. of general public and our members.
fully selected and followed up trial subjects.
Therefore, only very frequent adverse reac- Therefore, IMA considered its first duty to Tobacco De-addiction and Control
tions are observed during its clinical devel- cater to the healthcare needs of the masses
opment. Once, the medicine is placed on living in these villages. Hence, it was decid- Identifying tobacco as a giant killer with 5.4
the market and the population is exposed, ed that every State and local branch of IMA million global and around 10 lakhs Indian
its actual safety profile is known. To iden- will adopt villages in their area of jurisdic- tobacco related deaths, IMA undertook a
tify and tackle these risks, the new adverse tion to provide medical facilities to them at nationwide campaign against tobacco. To
reactions should be reported immediately their doorstep. sensitise health providers about the dangers
as a contribution to an incomplete safety of tobacco products and generate awareness
profile. Under the project implementation plan, cre- on tobacco related health issues, IMA or-
ation of health awareness (general health & ganised Public rallies, workshops and lec-
An IMA Pharmaco Vigilance cell was hygiene, adolescent health, FP, MCH care tures on Tobacco Control & De-addiction
formed at IMA HQs, IMA House, New especially ANC & anaemia, gender sensiti- on 31 May 2009 all over the country on
Delhi with an Advisory committee to mon- zation, quackery, sex determination, female “World No Tobacco Day”.
itor and report such adverse reactions ob- infanticide etc.) plays a pivotal role. This is
served by the members of the Association done through Puppet shows; Nukkad nat- Blood Donation
to the competent authorities and related aks, School health talks; essay & painting
organisations. Nearly 1200 members from competitions, debates in schools and col- Voluntary blood donation is one of IMA’s
all States have been trained and sensitised leges, social meetings involving pradhans, regular activities with IMA running its own
in the need and procedure of Adverse Drug gram sabha members, community leaders state-of-art blood banks all over the country
Reporting (ADR) / Adverse Event (AE) and religious leaders. to cater to the needs of patients.
reporting through various sessions during
events of IMA at National, State and Dis- We have been quite successful in achieving Dr. Dharam Prakash, Hon. Secretary General
trict levels. our expected outcomes from this project. Indian Medical Association
161
According to the classic indicators of mor- According to official publications, sec- As to relatives, they are specifically included
tality, the health situation in Uruguay has toral measures were geared towards creat- in the social insurance health coverage, chil-
been comparable to that in various devel- ing a national integrated health system, by dren are immediately covered, and as from
oped countries. However, upon observation strengthening the connection between sub- 2010 spouses will be included according to
of its historical evolution, we maintain that sectors, favouring greater equality based on the regulations in force. The system consists
there has been a severe stagnation in regard the strong contribution of resources and in making social insurance into a universal
to health indicators, particularly those that strengthening the main public health care coverage plan that provides for a graded
are more specific and closely related to the centre, thus aiming to improve access of admission of citizens to the system that is
transitional model. Up until a few decades more vulnerable sectors of population and funded by the national insurance, turning it
ago, Uruguay was among the top coun- to encourage complementary bonds be- into a life insurance, since insurance rights
tries in the Americas for the good results tween sub-sectors. The State’s main health survive upon the beneficiaries retirement.
obtained in the health of its population, al- care services provider is decentralised, and
though the fact that it failed to follow the through the reinforcement of financial re- 3. The price reimbursed to providers of
dynamics created by several countries in the sources, priority was given to the salaries of health care centres who ensured and ren-
region resulted in slowdown of progress in physicians, which increased substantially. dered health care services was regulated by
the field. The latter is probably the most relevant a single monthly payment by the State. In
change in terms of human resources, an this way, the social sickness insurance and
It is said that the health system failed to re- aspect that has not been prioritised in the a large portion of the remaining population
spond to the needs of the Uruguayan popu- agenda for change. paid their insurance via this system, ignoring
lation. Demographical, epidemiological and the risk associated with the covered popula-
social transformations that took place ulti- 2. Likewise, only employees from the for- tion and the expected cost differential, thus
mately define a new needs profile. Increase mal private sector – without including their weakening the sustainability of the health
in life expectancy and decrease in fertility relatives – were covered by a social health care service system itself. Simultaneously,
are reflected in an aged population, where insurance they paid for together with their
162
the price of important supplies was under 4. It is believed that the system portrays a Ministerial authorities reassure that the sys-
no regulation whatsoever. health care model that fails to emphasise tem has managed to level the quality and
strategies for primary health care services, quantity of benefits by means of the specific
From the point of view of payment to health and is instead eminently a therapeutic, hos- definition of the national integrated health
care centres, the national health insurance pital-cantered model. system that becomes an explicit guarantee
pays according to risk – even partially, as a whose enforcement can be demanded from
stage in the transition process - as distinct The official document suggests the transfor- the health authorities.
from single payment reimbursement. mation of the advanced health care model
based on the implementation of strategies 7. Finally, reference is made to the fact that
Prior to the process of change, a distortion for primary health care services, according historically there has been no social partici-
in the price of co-payments grew stronger to regulations that encourage these strate- pation in the running of systems or institu-
(care-order payments, medicine tickets gies and additional payments associated tional management.
and multiple diagnose and treatment tech- with achieving health care goals that need
niques), evolving from a way to regulate de- to be carried out by the first level of assis- Changes suggest the incorporation of social
mand – under State provisions – into a way tance. participation as a system and institutional
to fund the private health care system, and guideline. In this way, the participation of
thus creating great barriers for the access of 5. The document further explains that the users and workers of the National Integrated
users. administration and control system is weak- Health System is strongly encouraged at the
ened in the different tasks required, there macro level of the National Health Council,
Thanks to modifications introduced into the being no management contracts or incen- and at the micro level of institutions provid-
system, the prices of a number of medicine tive programs based on goal accomplish- ing health care services. Private institutions
tickets controlled by the State were mainly ment (health/economic-financial goals). will do it by means of Counselling Consult-
brought down, although they still hinder ing Councils, and public institutions will
access to consumption by a large portion of At the official level, the change process is rely on the participation of the board of the
users. to provide the system with a real adminis- main health care services centre.
trative and control policy, mainly by means
High-cost non-frequent techniques, gen- of the execution of management contracts Ec. Luis Lazarov, Executive
erally associated to high-technology, are and their enforcement and sanctions frame- Committee Consultant;
covered by the so-called National Resource work, whereby institutions providing health Dr. Julio Trostchansky, MD, President
Fund, a combined fund (public and private) care services commit to fulfil the health SINDICATO MÉDICO del URUGUAY;
and reimbursement system – according to programs defined as priority programs. Alarico Rodríguez, MD, Head
different modalities – for highly specialised of Foreign Relations
medical institutions. 6. The quality and quantity of services that
the whole structure commits to render was
not clearly defined.
163
The problem The health sector itself also makes a signifi- toward carbon neutrality will also create
cant contribution to the problem of climate major benefits for public health. The extent
There is increasingly powerful scientific evi- change. Healthcare is a major consumer of of these benefits is only gradually becoming
dence that climate change is not only a real- energy, water, computers, chemicals, phar- known.
ity now but is threatening to become a far maceuticals, food and other resources. This
more destructive phenomenon much more consumption leaves a significant climate Reducing our reliance on fossil fuels and
quickly than even recently predicted. footprint. moving toward clean, renewable energy can
have the added benefit of reducing local
One of the most disturbing implications of A leadership role pollution generated by the combustion of
climate change is its potentially dramatic coal, oil and gas. This in turn would reduce
impact on human health around the world. Precisely because the healthcare sector’s cli- the number of respiratory illnesses related
As the Lancet Commission report says: “the mate impact is so far-reaching, it must play to such energy consumption, thereby im-
effects of climate change on health will af- a leadership role in developing and model- proving public health. Visionary action to
fect most populations in the next decades ling solutions for the rest of society. mitigate climate change now will go a long
and put the lives and well-being of billions way toward avoiding major health challeng-
of people at increased risk.” Many healthcare institutions are already es in the future.
employing a diversity of cost-effective cli-
Overall, the health impacts of climate mate-mitigation measures including energy The Prescription for a Healthy Planet, if
change will be disproportionately felt by the efficiency, on-site alternative energy genera- implemented, would both help mitigate
most vulnerable populations – the poor, the tion, green building design and construc- climate change’s most severe impacts while
very young, the elderly and the medically tion, along with more climate-friendly pro- ensuring major benefits to society by pro-
infirm. curement, transportation, food, waste and tecting public health.
water-use policies.
The World Health Organization predicts that
climate change will lead to a series of signifi- Done correctly, these efforts to reduce our
cant health impacts, including: higher levels of
climate footprint and to move healthcare
some air pollutants and concomitant increased
respiratory disease; the spread of diseases such
as cholera, malaria, dengue and other infec-
A prescription for a healthy planet gas, nuclear power, waste incineration and
tious diseases; the compromising of agricul- fossil-fuel-intensive agriculture. The Co-
tural production and food security in some of penhagen treaty should foster energy ef-
the least developed countries leading to greater • Protect Public Health: Take into account ficiency as well as clean, renewable energy
malnutrition; an increase in extreme weather the significant human health dimensions that improves public health by reducing
events like floods and droughts with dramatic of the climate crisis along with the health both local and global pollution.
impacts especially on the health of people liv- benefits of climate change mitigation • Reduce Emissions: In order to protect
ing in coastal communities. policies. In conjunction with this, a por- human and environmental health, the
tion of climate mitigation and adaptation world’s governments must take urgent
funds should be targeted for the health action to drastically reduce world-wide
The health sector on the front lines sector.This is needed to ensure evidence emissions by 2050. Over the next decade,
of the health impacts of climate change developed countries must significantly
Healthcare providers and public health is continuously updated and brought to reduce their greenhouse gas emissions
practitioners will be on the front lines, policy makers, so that the health sector below 1990 levels. Developing countries
confronting and adapting to this changing can adapt to the health impacts of cli- must also commit to stabilizing and re-
landscape and shifting burden of disease. mate change while reducing its own cli- ducing their emissions.
Such adaptation will come at a cost: the mate footprint. To assure a strong voice in • Finance Global Action: A fair and eq-
more severe the health-related symptoms the debate, the health sector should also uitable agreement in Copenhagen should
of climate change, the greater the outlay of be adequately represented on all national also provide new and additional resources
financial and human resources that will be delegations to Copenhagen. for developing countries to reduce their
required to treat them. • Transition to Clean Energy: A viable climate footprint and adapt to the im-
accord must promote solutions to the cli- pacts of climate change.
mate crisis that move away from coal, oil,
164
165
“Angel in a White Coat,” as “Person of the President Barack Obama praised Dr. Ben- through whatever changes may come with
Week” on ABC's World News Tonight with jamin’s dedication to providing health care health care reform”.
Peter Jennings, as “Woman of the Year” by for her rural community in the face of ad-
CBS This Morning, and in People Magazine. versity, naming her a “relentless promoter Dr. Benjamin is worthy of recognition
She was featured on the December 1999 of prevention and wellness programs” who among the World Medical Association’s
cover of Clarity Magazine, and on the Janu- “represents what's best about health care Caring Physicians of the World. She too, ex-
ary 2003 cover of Reader's Digest. Dr. Ben- in America -- doctors and nurses who give emplifies the three enduring traditions of
jamin received the Nelson Mandela Award and care and sacrifice for the sake of their the medical profession, caring, ethics and
for Health and Human Rights in 1998. She patients”. Dr. Benjamin explained that as science, which inspire hope and trust.
received the 2000 National Caring Award Surgeon General she hopes “to be Ameri-
which was inspired by Mother Teresa, as well ca's doctor, America's family physician” and Yank D. Coble, MD. Director and
as the papal honor Pro Ecclesia et Pontifice she promised to “communicate directly with Distinguished Professor Center for Global
from Pope Benedict XVI. She is also a recent the American people to help guide them Health and Medical Diplomacy
recipient of the MacArthur Genius Award.
166
167
Contents
WMA General Assembly, New Delhi 2009 . . . . . . . . . . . . . . 128 Anthropedia’s initiatives to promote person centered care . . . . 152
Declaration of Delhi on Health and Climate Change. . . . . . . 137 Lack of access to healthcare information is a hidden killer . . . 153
Declaration of Madrid on Professionally-led Regulation . . . . 140 The Medical Women’s International Association (MWIA) . . 155
Declaration of Ottawa on Child Health . . . . . . . . . . . . . . . . . 140 A strange form of declaring a health emergency:
the case of Venezuela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
WMA Resolution on Task Shifting
from the Medical Profession . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Indian Medical Association:brief report of all projects . . . . . . 159
WMA Emergency Resolution supporting the Rights Changes in the Uruguayan health system . . . . . . . . . . . . . . . . 162
of Patients and Physicians in the Islamic Republic of Iran . . . 143
Prescription for a Healthy Planet . . . . . . . . . . . . . . . . . . . . . . 163
WMA Resolution on Medical Workforce . . . . . . . . . . . . . . . . 144
Regina M. Benjamin, MD, MBA,
WMA Statement on Inequalities in Health . . . . . . . . . . . . . . 145 United States Surgeon General . . . . . . . . . . . . . . . . . . . . . . . . 165
WMA Resolution on Improved Investment in Public Health 146 Standing Commitee of European Doctors – 50 . . . . . . . . . . . 166
Hindi – English bilingual “Speaking Book”. . . . . . . . . . . . . . . 147 Average of one doctor per 64 000 inhabitants . . . . . . . . . . . . . 167
Impact of climate change in Asia and
Oceania region and challenges ahead . . . . . . . . . . . . . . . . . . . 148