Healthier Populations (UHP) Cluster

Overview

Message from Dr Adelheid W. Onyango

Director, Universal Health Coverage/Healthier Populations (UHP) Cluster

Since 1948, the World Health Organization (WHO) has been leading the movement towards enhancing population health and well-being. The global average life expectancy at birth has increased from 47 years in 1950–1955 to 72 years in 2015–2020 (united nations data), an increase of 25 years or 54%.

Today, we reap its benefits from an economic perspective, having witnessed a rise in the value of health capital, which is at par with all other forms of capital combined. Investing in well-being and health lays the foundation for a prosperous and happy nation.

The COVID-19 pandemic, a combined health and economic crisis, is the most significant challenge that the world has confronted in a century. The International Monetary Fund has estimated a cumulative economic loss of US$ 22 trillion due to the pandemic.

Apart from the pandemic, issues such as climate change, biodiversity loss, pollution, rapid urbanization, geopolitical conflict and militarization, demographic change, population displacement, poverty, and widespread inequity constitute a perpetual risk of future crises that could be more severe than those experienced to date.

Preparedness requires investments integrating ecological, societal, and community and individual health and wellbeing. This calls for strengthened social structures that enable people to take control of their lives and health.

The universal Health Coverage/Healthier Populations (UHP) Cluster was established in the WHo regional office for Africa in October 2019, bringing together five technical units to implement Pillar 3 of WHo’s thirteenth Global Programme of Work (GPW13). The Cluster works across five priority areas to address determinants of health and create safe and equitable societies, reduce risk factors through multisectoral action, and create healthy settings for populations in the African region. The UHP workstreams offer entry points for the intersectoral engagement required to advance the paradigm shift toward greater emphasis on health care rather than sick care, as the Director General’s top priority in supporting countries to accelerate health.

Investing in health is the basis of an equitable, safer, and more prosperous world. The ultimate measure of our success is thriving individuals, families, communities, and nations who enjoy the highest attainable level of health and well-being.

Climate Change, Health and Environment↑

Health and environmental issues of concern include access to safe drinking water, sanitation and hygiene, water management, soil and air pollution, vector control and management of chemicals and waste, workplace health and safety, and children’s environmental health. These issues are influenced by socioeconomic conditions and are adversely affected by climate change.

In sub-Saharan Africa, most environment-related deaths are primarily due to infectious diseases. Most Member States still grapple with traditional environmental health risks like poor access to safe drinking water, sanitation, and cooking fuels. Meanwhile, air pollution, tobacco smoke and chemicals are driving the burden of NCDs. An estimated 28% of all premature deaths in the region are attributed to environmental factors. Stronger intersectoral action to create healthier environments and strengthen healthcare systems and services is paramount.

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Objective

Guide Member States on addressing health and environmental linkages for achieving the Sustainable Development Goals (SDGs). The specific goals are:

Implement the Libreville Declaration on Health and Environment (2008), promote synergies and coordination between the health and environment sectors.
Elaborate and implement national joint action plans for managing environmental risk factors for human health and ecosystem integrity.
Strengthen national and regional capacities for integrated monitoring and surveillance of environmental determinants of health and ecosystem integrity.

Key Figures

Only four out of ten households have access to a hygienic toilet, with the majority using cesspits with no slab or an open hole. Only 16% of the population has a handwashing facility with water and soap.
An estimated 28% of all premature deaths in the region are attributed to environmental factors.
Available data suggest that every child under the age of 5 years in sub-Saharan Africa has been exposed to unsafe levels of air pollution, with lifelong consequences including a greater risk of chronic respiratory and cardiovascular diseases.
Warmer temperatures and higher rainfall increase habitat suitability for biting insects and the transmission of vector-borne diseases such as dengue fever, malaria, and yellow fever.
Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food, and secure shelter.
In Africa, more than 1 million people are estimated to die prematurely each year due to exposure to indoor and outdoor air pollution.
Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths yearly from malnutrition, malaria, diarrhoea, and heat stress.
The direct damage costs to health (i.e., excluding costs in health-determining sectors such as agriculture and water and sanitation) are estimated to reach US$ 2-4 billion a year by 2030.
Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope, prepare and respond without assistance.
Reducing emissions of greenhouse gases through better transport, food, and energy-use choices can result in improved health, mainly through reduced air pollution.
Most Member States still grapple with traditional environmental health risks like poor access to safe drinking water, sanitation, and cooking fuels. Meanwhile, air pollution, tobacco smoke and chemicals are burdening NCDs. All these are exacerbated by climate change which also influences the magnitude and frequency of wildfires, sand dust, heat waves, droughts, floods, and hurricanes.

Health Promotion and Social Determinants of Health↑

The WHO agenda to advance action on social determinants of health in 2008 stems from the WHO Commission on Social Determinants of Health (SDH) on closing the health equity gap The Commission defined SDH as conditions in which people are born, grow, live, work and age that can help create, protect, or destroy people’s health.

Factors such as income, wealth and distribution, early childhood care, education, working conditions, job security, food security, gender, housing, access to safe water and sanitation, and social safety nets directly affect health. The Health in All Policies (HiAP) approach supports the creation of healthy settings to address SDH.

The programme supports Members States applying the HiAP approach by conducting health inequity analyses that map the social, economic, environmental, and structural inequalities affecting defined population groups and their health. To ensure HiAP is successful, government coordination and stewardship are necessary to secure community engagement and the intersectoral action of all stakeholders whose activities impact health and wellbeing. An important objective of this approach is creating partnerships between communities and all government sectors in order to jointly define actions to address causes of ill health, as well as indicators to monitor progress.

Investing in promoting health, preventing diseases, and addressing all the determinants of health will advance equity and foster economic and climate resiliency. It will reduce the burden of diseases and outbreaks and their impacts on labour markets and productivity, reduce health expenditure, and embed wellbeing into the government’s decision-making process, leading to improved health and wellbeing.

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Objective

The Health Promotion and Social Determinants of Health (HPD) programme collaborates with and guides Member States on health promotion, disease prevention, and intersectoral action on the social determinants of health. The specific goals are:

Promote the wellbeing and health of all populations by addressing social determinants of health across the life course using intersectoral action on the HiAP approach, and accelerate the SDGs achievements.
Develop and implement policies and programmes that enhance health equity, integrate pro-poor and people-centred approaches to improve equitable access to quality health services and reduce stigmatization and discrimination of vulnerable populations linked with social, economic, commercial, political, and cultural factors.
Implement policies and strategies to improve health literacy, RCCE, and address the health needs of vulnerable and underserved population groups such as older people, women, children, migrants, and ethnic minorities.

The programme unit has, over the years :

Supported African Member States in developing scientific knowledge on health determinants.
Identified and prioritized emerging health problems in Africa due to societal changes.
Monitored the activities of other sectors that have an impact on health.
Created structures and mechanisms for dialogue within government and society.
Facilitated negotiations between sectors and with non-governmental stakeholders.
Overseen the implementation, monitoring, and evaluation of health.

Key Figures

Healthy life expectancy has reached 56 years, up from 46 years in 2000.
The adult mortality rate in sub-Saharan Africa has decreased from 440 deaths per 100,000 people in 1998 to 332 in 2020, surpassing the global reduction of 46 deaths per 100,000.
Under-five mortality has reduced by 54.2%, marginally higher than the global reduction of 53.7%.
The maternal mortality rate has declined by 40.7%, compared to the global reduction of 43.9%.

Nutrition and Food Safety↑

Nutrition is a critical part of health and development. Better nutrition is linked to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as diabetes and cardiovascular disease), and longevity. Healthy children learn better. People with adequate nutrition are more productive and can gradually create opportunities to break the cycles of poverty and hunger.

Malnutrition, in every form, presents significant threats to human health. Today the world faces a double burden of malnutrition that includes both undernutrition and overweight, especially in low- and middle-income countries.

Multiple forms of malnutrition include undernutrition (wasting or stunting), inadequate intake of vitamins or minerals, and obesity - resulting in diet-related noncommunicable diseases. The developmental, economic, social, and medical impacts of the global burden of malnutrition are severe and lasting for individuals and their families, communities and countries.

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Key Figures

In 2020, up to 264.2 million people living in sub-Saharan Africa were undernourished (24% of the region’s population).
In 2021, wasting in sub-Saharan Africa affected 12.1 million children, of whom 3 million were severely wasted.
In Africa, the number of overweight children under 5 years of age has increased by 24% since 2000.
Around 91 million Africans fall ill each year due to foodborne diseases, and 137,000 of them die of the same cause, representing one third of the global death toll of foodborne illnesses.
Around 25 million people in Africa cannot afford a basic healthy diet.

Objective

Guide the Member States to address malnutrition and food safety, with a focus on the following:

Implementing the Comprehensive Implementation Plan on maternal, infant, and young child nutrition to achieve six WHA targets by 2025 and end all forms of malnutrition by 2030.
Reducing obesity and noncommunicable diseases by promoting healthy, safe, and sustainable diets and regulating food and non-alcoholic beverages.
Integrating essential nutrition life course services through existing healthcare delivery platforms. This includes maternal nutrition interventions for women of reproductive age, and appropriate infant and young child feeding to reduce life-long risks of undernutrition and overweight, such as supporting initiatives for the prevention and management of overweight and obesity.
Transforming food systems to provide sustainably produced safe and healthy diets, supporting countries in preventing undernutrition and treatment of acute wasting, accelerating actions on reduction of anemia, and supporting and strengthening the capacity of nutrition data systems and use.
Reducing the burden of foodborne diseases through improved food safety systems that include up-to-date food laws, regulations, and standards.
Increasing capacity to implement risk-based food inspection, foodborne disease surveillance, and contaminant monitoring programmes.
Supporting implementation of food safety training programmes for food business operators in formal and informal markets; and raise consumer awareness and education programmes in communities, schools, and other settings to drive enhanced food safety practices.
Promoting the One Health approach to address food safety concerns and reduce zoonotic diseases and antimicrobial resistance.
Supporting the integration of nutrition and food safety actions in the Emergency Response Framework and respond to emergencies and outbreaks. Countries facing nutrition and food crises receive priority support throughout the response’s planning, implementation, and monitoring. Promoting environmentally sustainable diets while improving health has become a global priority. WHO is working with the African Union Commission and the FAO to integrate food safety in implementing the Africa Continental Free Trade Area Agreement.

Tobacco and reduction of other noncommunicable disease risk factors↑

The UN High-Level Meeting on NCDs (2011) recognized that prevention must be the cornerstone of the global response to NCDs. The forum also recognized the critical importance of reducing individuals’ and populations’ exposure to the common modifiable risk factors for NCDs and their determinants while strengthening their capacity to make healthier choices and follow lifestyle patterns that foster good health.

Collaboration with other UN Agencies such as the Food and Agriculture Organization (FAO), UN Development Programme (UNDP) and World Food Program (WFP), and other inter-governmental organizations, helps to promote programmes for preventing NCDs.

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Objective

Guide the Member States on tobacco control and reduction of any other noncommunicable disease risk factors, especially to:

Reduce tobacco use and exposure to second-hand smoke with full implementation of the WHO Framework Convention on Tobacco Control, its Protocol and related strategies and guidelines.
Prevent and tackle the harmful use of alcohol with policies addressing all alcohol-related harms and the levels, patterns, context, and quality of consumption.
Promote healthy diets to ensure good health and nutrition and prevent NCDs, including measures to reduce salt, sugar, and trans-fats.
Promote physical activity to prevent NCDs and maintain and improve mental health, quality of life and wellbeing through policy actions that support, retain, and increase physical activity.
Strengthen multisectoral partnerships and collaboration to prevent and reduce the NCD risk factors and implement ‘Best Buys’ interventions and technical packages on salt, alcohol and other high-risk products (MPOWER, SAFER, SHAKE, REPLACE, etc.) with a sustained surveillance system and efficient price and tax measures.
Build capacity for adoption and enforcement of laws and regulations on the production, marketing, and consumption of tobacco and nicotine products, electronic nicotine and non-nicotine delivery systems, alcoholic beverages, sugar-sweetened beverages, salt, and trans fats.
Reducing the major risk factors for NCDs, namely tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity, is the focus of WHO’s work to prevent illnesses, disabilities, and deaths from NCDs.

Key Figures

13 million women in the African region use tobacco products, including chewing tobacco and snuff.
13% of young adolescent girls use tobacco products in Africa.
About 22,000 women die every year in Africa from tobacco-related diseases.
Between 2002 and 2030, tobacco-attributable deaths are projected to double in Africa, especially in low- and middle-income countries.
In Africa, about two thirds (64%) of adult deaths due to second-hand smoke are among women working and living with men who smoke.
African women have unique and higher risks of cervical cancer, breast cancer, and coronary artery disease.
Globally, one in four adults does not meet the global recommended levels of physical activity, and up to 5 million deaths a year could be averted with the required physical activity.
Insufficiently active people have a 20%- 30% increased risk of death compared to sufficiently active people. More than 80% of the world's adolescent population is insufficiently physically active.

Violence, Injuries and Disabilities↑

The 74th World Health Assembly (WHA74) resolution on ending violence against children has given renewed impetus to efforts by WHO, UNICEF, child protection advocates and governments to mainstream violence prevention through health, education, and social protection sectors.

At the WHA74, Member States adopted a landmark resolution on the highest attainable standard of health for persons with disabilities, providing WHO with a mandate to continue its commitment to promote disability inclusion in the health sector and calling on Member States to focus on four key areas:

Strengthening their health systems to ensure access to effective health services
Ensuring access to cross-sectorial public health interventions
Protection during health emergencies
Improving collection and disaggregation of reliable data on disability

The UN General Assembly session (74/299) on improving global road safety proclaimed the second decade of action for road safety 2021-2030 and a new target of reducing road traffic deaths by at least 50% by 2030, mandating WHO and UN regional economic commissions to develop a global plan of action for road safety for 2021-2030. The global plan for road safety calls for multisectoral and coordinated action to reinforce and implement the safe systems approach for safer roads, vehicles, and road use, post-crash response, and multimodal transport and land use planning.

Furthermore, collaboration with governments and civil society groups is being pursued to advocate for road safety regulations and prevent other forms of injury, such as drowning.

Learn more about violence Learn more about injuries Learn more about disabilities

Key Figures

In Africa, 50% of the child population is estimated to have experienced or witnessed some form of violence (physical, sexual, or emotional).
The African Region accounts for 20% of global road traffic deaths, with nearly 272,000 deaths, and has the highest road traffic fatality rate among WHO regions, at 26.6 per 100,000 population.
Unintentional and violence-related injuries take the lives of 4.4 million people worldwide each year and constitute nearly 8% of all deaths.
27% of all child homicides occur in the African region, making it the second highest rate of child homicide after the Americas.
For people aged 5-29, three of the top five causes of death are injury-related, namely road traffic injuries, homicide, and suicide.
Males in Africa have the highest drowning mortality rates in the world, at 19.2 per 100,000 people.
Injuries and violence are responsible for an estimated 10% of all years lived with disability.
Injuries and violence burden national economies, costing countries billions of US dollars each year in healthcare, lost productivity, and law enforcement.
12% of the African population is estimated to live with a significant disability.
For every US$ 1 spent on disability-inclusive NCD prevention and care, the return on investment could be US$ 10.

Objective

Help Member States reduce violence, injuries and disabilities, with specific goals to:

Reduce all forms of violence (all forms of child maltreatment, neglect and abuse, youth violence, and elder abuse) through capacity building and supporting countries in developing and implementing policies and strategies for reducing and responding to violence against children.
Coordinate data collection and analysis on violence and injuries to raise awareness, generate evidence-based solutions and improve decision-making.
Prevent road traffic and other forms of injury, including drowning, burns and falls, and mitigate their consequences by guiding countries to implement evidence-based interventions.
Improve emergency care for victims of trauma and rehabilitation for all, supporting countries to strengthen rehabilitation services, workforce capacity and financing within the healthcare system.
Support people with disabilities to fully participate in society by improving access to health and rehabilitation services, education, and employment.

News from countries

News from countries

Healthier Populations (UHP) Cluster