2018's Biggest Global Health Issues

2018 wasn’t a quiet year in global health. Between human rights atrocities, reemerging diseases, and climate change, we’ve pulled together our list of problems that couldn’t be conquered in 2018, setting a busy agenda for 2019.
 
Thanks to everyone who weighed in on Twitter with suggestions. We would love to hear from more readers; if you share what issues you want GHN to highlight and cover in 2019, please email us at dkerecm1 [at] Jhu.edu and you might see your name in our first issue of the new year.

CLIMATE CHANGE
A climate history of 2018 reads like an end-of-times novel: catastrophic floods in Bangladesh, lethal heatwaves across Europe and China, a punishing drought in East Africa, epic hurricanes and wildfires in the US.

Even as they avoid blaming an individual event on climate change, scientists confidently say climate change makes extreme weather more likely, as The Bulletin of the American Meteorological Society reported.

 After diplomats from nearly 200 countries agreed on Saturday on to guidelines for governing the 2015 Paris climate accord, environmental groups criticized the deal as too little, too late and “morally unacceptable,” according to The Independent.  

EBOLA
Ebola tore back into Africa in last May, with a deadly twist—it reemerged in a war zone in the Democratic Republic of the Congo. 

Initially public health officials were optimistic they’d be able to contain it quickly, especially with an experimental vaccine in the toolkit. But such hopes soon faded, with attacks on medical teams and hampered access to the areas most in need of support and supplies, as Max Bearak’s account in The Washington Post illustrates powerfully.

It’s now the world’s second worst Ebola outbreak, with close to 500 confirmed cases as of yesterday.
 
YEMEN
The Saudi-led coalition’s attacks on Yemen’s population have led to unrelenting horror: from the destruction of the country’s public health system, to the starvation deaths of an estimated 85,000 children, and a 2-wave outbreak that led to more than 1 million cases of cholera.
 
As the massive humanitarian crisis still unfolds, few observers have any hope for change. In late August, a UN Human Rights Council report pointed to the obvious: possible war crimes by the conflict’s players.

ROHINGYA
Burma’s Rohingya have endured a long history of oppression, culminating in waves of violence that pushed them into camps in Bangladesh in 2017—leading Joanne Liu, president of Médecins Sans Frontières International, to call the Rohingya crisis a “public health time bomb.” But 2018 exposed painful evidence of the terror endured by this Muslim minority, including graphic footage of the Burmese government destroying evidence of mass graves. A 400-page UN report in September detailed the military’s campaign of terror, and called for top officials to be investigated and prosecuted for genocide and crimes against humanity. Groups including Fortify Rights are putting fresh pressure on countries to refer the case to the UN Security Council.

OPIOID CRISIS
In 2018, the extent of America’s opioid crisis became clear when it was revealed that in the previous year drug overdose deaths topped 70,000—the most in a single year in US history. The sky-high numbers contributed to a decline in the US overall life expectancy.

As health leaders pushed for a public health approach to the opioid crisis, debate stirred about the best solutions—from needle exchanges to blockchain to scaling back stigma. Many also looked to the past, demanding accountability for a crisis decades in the making: Scandal has embroiled the Sackler family around its links to OxyContin, a painkiller that ushered in an era of opioid addiction.

GUN VIOLENCE
From Parkland to Pittsburgh to Thousand Oaks, 2018 was yet another year marked by horrific mass shootings, and the ongoing scourge of everyday gun violence.
 
The year also saw survivors and health practitioners doubling down in the fight for tighter gun laws. ER staff shared images of gun violence with #ThisIsOurLane; millennials toured the US pushing stricter gun policies, and survivors described living with shrapnel lodged in their bodies. Amid a changing conversation, momentum has grown around approaching gun violence as a public health crisis.
 
TUBERCULOSIS
TB kills more than any other infectious disease—1.6 million by the WHO’s count—yet the fight against this entirely preventable disease has been long underresourced. It finally received well-deserved attention at the High-Level UN meeting this past September, leading to commitments to redouble efforts to ensure care and preventive treatment—but MSF’s Sharonann Lynch called the pledges empty promises, noting that the 30 high-burden countries did not attend.
 
@DrLyeCW also urged GHN to highlight how attempts to understand and control tuberculosis are complicated due to the co-infection with HIV, explored in a Lancet Infectious Diseases series published last week.
 
NONCOMMUNICABLE DISEASES
As 2018 draws to a close, so have the lives of 41 million people claimed this year by noncommunicable diseases. Though NCDs result in more than 2.5X as many deaths as other causes, they commonly draw less notice than dramatic infectious disease outbreaks.
 
Still NCDs took a turn in the limelight in September during the UN’s Third High-Level Meeting. The UN General Assembly adopted a declaration that committed to cutting NCD deaths by one-third by 2030, IP-Watch reported. There certainly are successful models out there for how to address NCDs, as GHN reported after UNGA. The question is: Will countries deliver on their goals?

MEASLES
The return of measles—and deaths from measles—is another major global health story of 2018, suggested by Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. Measles deaths had fallen significantly since the introduction of the measles vaccine in 1963, but those gains are being erased, Hotez and others have warned. He highlighted the 50,000 cases in Europe, outbreaks in the US due to the antivax lobby, and reemergence in Venezuela, Brazil, and Colombia due to economic collapse and political instability.

#METOO
2018 was the year #MeToo made its mark on global health and science. Allegations of sexual assault and systemic abuse of power surfaced among development’s top brass, with UNAIDS deputy chief Luiz Loures stepping down amid sexual assaults allegations. Weeks before, the Lancet had slated 2018 as “the year of reckoning for gender equality” in science.

They weren’t wrong. Throughout the year, global health events highlighted #MeToo movement (which @Preethi_Health suggested we cover) and its spin-off, #AidToo. This year, the Lancet also highlighted more generalized gender inequity, from uncompensated household labor to unpaid UN internships.

REFUGEES
Outgoing UN High Commissioner for Human Rights Zeid Ra'ad Al Hussein—“Humanity’s Compass”—called out human rights abuses in Yemen, Burma, Syria, and North Korea as he closed out his term.
 
He also denounced the US—for its “unconscionable” policy of forcibly separating children from migrant parents. “People do not lose their human rights by virtue of crossing a border without a visa,” he said.

We move into 2019 with no solution to that crisis.

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