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As 2014 comes to an end, the international development community stands on the cusp of major new progress, particularly in global health and development—but the war and disease that marked this year could hinder that progress for decades to come.
Health workers labored on the front lines of some of 2014’s most prominent events, which will likely affect global health and the well-being of all 7 billion of us as we move into 2015 and beyond. So let's take a look back at some of 2014’s biggest global health and development stories. Some good, some bad, all illuminating as we enter the new year.
Today over 2.9 billion people—nearly half the world’s population—are under the age of 25.
“Never before have there been so many young people,” says Dr. Babatunde Osotimehin, executive director of UNFPA. “Never again is there likely to be such potential for economic and social progress. How we meet the needs and aspirations of young people will define our common future.”
What health workers have to do with it: Health workers and the care they provide will sway the future of this mammoth generation, not to mention the financial success of communities and economic progress around the world as young people join the workforce (and many will choose to join the health workforce).
One of the greatest health concerns for young people worldwide is family planning—or perhaps more appropriately, future planning. It takes health workers to provide high-quality counseling and services related to contraception and sexual health. Girls and young women especially need those services if they’re to be empowered to choose when and if they become pregnant.
This was a big year for social change. Public attitudes on race, gender, sexual orientation, and disease status have teetered back and forth between the inclusive and the divisive. In the United States, for instance, 11 states legalized same-sex marriage; at the same time, tension over racial discrimination and police-related violence flared across the country.
And 2014 brought a brand new type of discrimination: one related to Ebola. Survivors and family members of Ebola victims are often feared and shunned by their own communities. In many cases, that prejudice has extended to non-Africans against Africans—and even against anyone who’s traveled to Africa this year. (Take, for instance, the 1-year-old boy who was kicked out of his day care center in Baltimore, Maryland, during the height of the panic, all because his mother was planning a work-related trip to Senegal.)
We saw the same types of knee-jerk behaviors in the early days of HIV—and they still exist today.
What health workers have to do with it: Fear of the other and of illness can shape a society. It influences our social norms and prejudices, which in turn have a huge effect on health and well-being in our communities. Those norms determine our policies, our behavior, and even how we think about human rights.
Health workers inevitably get caught up in this.
In Uganda, for instance, a new 2014 law made homosexuality a crime punishable by life in prison—and by seven years in prison for anyone who offered aid to a lesbian, gay, or bisexual person. The law was struck down just a few months after it came into being. But during its existence, health workers had to decide whether to risk providing services to these clients—or to turn them in to the authorities.
Uganda’s law garnered a lot of attention. But dozens of countries have long had similar laws on the books.
New and ongoing conflicts in 2014 have brought about tragedy and humanitarian crises around the world, including in Syria, Ukraine, Gaza, South Sudan and the Central African Republic. In each of these cases, health workers were among the targeted victims of attack.
The violence and long-term effects of war will linger for decades as countries struggle to rebuild their health systems and other infrastructure.
And as long as the violence persists, so will attacks on those who try to help.
What health workers have to do with it: Attacks on aid workers have spiked over the last two years. According to the International Committee of the Red Cross, local health workers were involved in more than 80% of all violent incidents against health care in 2012. From polio vaccine workers in Pakistan to doctors and nurses struggling to contain Ebola in West Africa, health workers often put their lives on the line to provide care.
“Not a day goes by without news of a hospital attacked,” Stéphane Bonamy of the International Committee of the Red Cross said last month. “The fact that health care is targeted is increasingly perceived as a way to deprive the enemy of its resources—this denies the human character of the wounded and the capacity of medical staff to provide impartial care.”
The Safeguarding Health in Conflict Coalition is a group of international nongovernmental organizations that work to protect health workers and prevent attacks on them and their facilities. Not only do health workers have the right to safe working conditions, but they also need them to do their jobs; it’s next to impossible to provide good care when you’re scared, threatened, or injured. And communities need health workers more than ever during times of violence.
It was slow to make the headlines after the first cases were confirmed in West Africa in March, and it’s been quick to fade into the background. While media coverage of the ongoing Ebola epidemic has declined over the last two months, the threat has not.
“Although we should feel optimistic about our capacity to solve the Ebola crisis, we cannot be complacent simply because the news attention on it has waned,” U.S. President Barack Obama told his Ebola response team last month. “We have to stay with it.”
The outbreak has infected over 19,000 people and killed more than 7,300, including 365 of the health workers who have fought to control the epidemic. Ebola has brought widespread panic, misinformation, and lengthy talk of travel bans in 2014—all signs that West African countries weren’t the only ones unprepared for it.
Ebola has overwhelmed health workers and facilities in Liberia, Guinea and Sierra Leone, meaning staff can’t offer the routine services communities need, such as malaria diagnostics and drugs, immunization, family planning, and delivering babies. And even if they could, people are afraid to go to the health facilities.
As the countries’ limited resources are funneled to the outbreak response, their already fragile health systems are becoming weaker. The ongoing epidemic could very well stunt global development efforts for years to come.
What health workers have to do with it: TIME magazine named Ebola fighters the 2014 Person of the Year this month. If Ebola has done one thing for the good of global health, it’s that it has shone a spotlight on front-line health workers and their vital role in disease response and prevention.
Frontline health workers are the first defense in any outbreak, which often makes them the most vulnerable to infection, as well. And if they get too scared or sick to come to work—or if they die of the very disease they’re working to treat—that leaves even fewer health workers behind to continue fighting the epidemic.
Cracks in one country’s health system affect us all. So shoring them up in vulnerable countries around the world will be imperative in 2015 and beyond.
“We really should be investing in the primary health care systems of all countries, and in Africa in particular,” Bill Gates said at the annual conference of the American Society for Tropical Medicine and Hygiene last month. “When those systems are weak, it means our ability to understand what is happening and our capacity to respond is likewise weak.”
Mobile technology is one promising tool that could strengthen health systems today and in the future. The government of Liberia is testing mHero, for example—a new mobile technology created by IntraHealth International, UNICEF, and other partners—to send timely messages and information to health workers who may be isolated from the national response efforts. And health workers can talk back, asking questions and sharing messages with the government about infections, deaths, and shortages of supplies and personnel. The new technology will soon be rolled out to other countries in the region, as well.
Since 2000, the Millennium Development Goals have given the world a shared blueprint for change, one that unified the global community and accelerated progress like never before. And while not all countries will reach their goals by 2015, that blueprint has helped build a world that is very different today than it was just 25 years ago. Worldwide since 1990:
● The proportion of people who suffer from hunger has fallen by half.
● 2.3 billion people have gained access to drinking water sources.
What health workers have to do with it: Setting ambitious, long-term goals and carefully measuring progress works. But as global leaders finalize the upcoming sustainable development goals, the focus must shift away from specific diseases and conditions toward wider, more systemic global changes.
“We who work in global health must integrate our efforts with the fields of education, food security, women’s rights, and many others,” says Pape Gaye, president and CEO of IntraHealth International. “We must embrace a systems-thinking approach. One way to do that will be to set indicators to measure our progress in strengthening health systems the way we did for measuring progress in maternal health and reducing child mortality in 2000.”
And the global health workforce must be part of the new systems-based approach. There is a worldwide shortage of 7.2 million doctors, nurses, and midwives, according to the World Health Organization. The shortfall is global, and it calls for a global focus and a global strategy.
Countries must give health workers a voice, ramp up domestic investments in them, and create systematic policies and short- and long-term strategies that will help build their workforces. It’s the only way we’ll achieve one of our most ambitious goals for global health and well-being: universal health coverage.
In 2015, health workers could bring us one step closer.
By Margarite Nathe, senior editor/writer, IntraHealth International