{"id":24118,"date":"2025-01-20T09:11:49","date_gmt":"2025-01-20T09:11:49","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2025\/01\/JDN_Newsletter_November_2024.pdf"},"modified":"2025-01-20T10:39:44","modified_gmt":"2025-01-20T10:39:44","slug":"jdn_newsletter_november_2024-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/jdn_newsletter_november_2024-2\/","title":{"rendered":"JDN_Newsletter_November_2024"},"author":17,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

JDN_Newsletter_November_2024<\/a><\/p>\n

ABOUT US. 1
\nJANUARY 2025
\nI S S U E 3 0 T H
\nJUNIOR DOCTORS LEADERSHIP JUNIO 2023-2024 2
\nEDITORIAL TEAM 2023 – 2024 3
\nWORDS OF CHAIR 2024\/2025, JUNIOR DOCTORS NETWORK- WMA 4
\nWORDS OF IMMEDIATE PAST CHAIR 5
\nWORDS FROM THE INCOMING PUBLICATIONS DIRECTOR 6
\nMTRO.JOSE LUIS FUNES: ONE HEALTH 9
\nDR. ANKUSH K. BANSAL: CLIMATE CHANGE AND ITS IMPACT 17
\nSATHI INITIATIVE: ADDRESSING UNMET SURGICAL NEEDS IN 27
\nTRANSGENDER MENTAL HEALTHCARE IN PAKISTAN 31
\nLIKE TOBACCO, FOSSIL FUELS ARE A HEALTH HAZARD WE 39
\nBRIDGING GAPS IN PATIENT SAFETY: INSIGHTS FROM ALGERIA 45
\nTHE EVOLUTION OF TELEHEALTH AND THE ROLE OF JUNIOR 51
\nWHO CAN BECOME A JDN MEMBER? 56
\nJUNIOR DOCTORS NETWORK MEMBERSHIP CENSUS 2024 35
\nTABLE OF CONTENTS
\nTHE VIEWS AND OPINIONS EXPRESSED IN THIS NEWSLETTER ARE SOLELY THOSE OF THE AUTHORS
\nAND DO NOT NECESSARILY REFLECT THE OFFICIAL POSITIONS OR POLICIES OF THE JUNIOR
\nDOCTORS NETWORK (JDN) OR THE WORLD MEDICAL ASSOCIATION (WMA).
\nISSN (PRINT) 2415-1122
\nISSN (ONLINE) 2312-220X
\nSPECIAL FOCUS:
\nSPECIAL FOCUS:
\nAbout Us.
\nWhat is the JDN?
\nThe Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open
\ndialogue of global events and activities that are relevant to their postgraduate training and the World Medical
\nAssociation (WMA).
\nIt was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the inaugural
\nJDN meeting was held at the 62nd WMA General Assembly (October 2011) in Montevideo, Uruguay. The
\nnetwork, which started from a few motivated junior doctors, now has a total of over 500 members from more
\nthan 90 countries from all regions of the world.
\nJunior doctors are defined as physicians, within 10 years after their medical graduation or who are still in an
\nongoing postgraduate medical education program.
\nWhat is the mission?
\nThe purpose of the JDN is to empower young physicians to work together towards a healthier world through
\nadvocacy, education, and international collaboration.
\nWhat do we do?
\nNetworking:
\nDuring the regular JDN meetings, members get to know each other, discuss global health issues, share
\nchallenges, and start collaborations on global health issues. The JDN meets on several occasions during the
\nyear, both in-person and via online teleconferences:
\nBiannual meetings in conjunction with the Council Meeting and the General Assembly of the WMA (April
\n& October).
\nMonthly general membership and management team teleconferences
\nAd-hoc online and webinars organized by the JDN
\n1
\nDR. MARIE-CLAIRE WANGARI
\nCHAIR PERSON
\nDR. BALKISS ABDELMOULA
\nDEPUTY CHAIR PERSON
\nDR. DEENA MARIYAM
\nSECRETARY
\nDR. FRANCISCO FRANCO P\u00caGO
\nSOCIO-MEDICAL AFFAIRS OFFICER
\nDR. MERLINDA SHAZELLENNE
\nMEDICAL EDUCATION DIRECTOR
\nDR.SHIV JOSHI
\nMEDICAL ETHICS DIRECTOR
\nDR. PABLO ESTRELLA
\nMEMBERSHIP DIRECTOR
\nDR. JEAZUL PONCE H.
\nPUBLICATIONS DIRECTOR
\nDR. SAZI NZAMA
\nCOMMUNICATIONS DIRECTOR
\nDR. UCHECHUKWU ARUM
\nIMMIEDIATE PAST CHAIR
\nDR. LWANDO MAKI
\nIMMIDIATE PAST DEPUTY CHAIR
\n2
\nDR.DOUAA ROUFIA ATTABI DR. ARSALAN NADEEM DR. CAROL KANGETHE DR. SHRAVAN R. DAVE
\nDR. AMANUEL Y. NEGASH DR. JAMIE COLLOTY DR. MAYMONA CHOUDRY DR. MICHAEL JOHNSON
\nMAHA AWAN DR. JEANETTE GODINEZ YAHAYA DR. AQSA SHAFIQUE
\nDR. LUIS MIGUEL ALFONSO
\nFERN\u00c1NDEZ GUTI\u00c9RREZ
\nEDITOR-IN-CHIEF AND
\nRESPONSIBLE FOR THIS EDITION:
\nDR. JEAZUL PONCE HERN\u00c1NDEZ
\nEMAIL: JEAZULPONCE@GMAIL.COM
\nCOMMUNICATIONS.JDN@WMA.NET
\nLOCATION: SALAMANCA, SPAIN
\nPOSTAL CODE: 37006
\n3
\nWORDS OF CHAIR 2024\/2025, JUNIOR DOCTORS NETWORK- WMA
\nPABLO ESTRELLA PORTER (MD, MPH),
\nCHAIR 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nECUATOR\/SPAIN.
\nWORLD MEDICAL ASSOCIATION
\nDear JDN colleagues,
\nAs the newly elected Chair of the Junior Doctors Network (JDN), I am honored to share a few
\nwords of gratitude and encouragement in this milestone 30th edition of our newsletter, which
\nfocuses on the impact of climate change on global health.
\nThis edition is particularly special, not only because it highlights one of the most pressing issues of
\nour time, how climate change is directly influencing global health, but also because it marks the
\nculmination of the past term\u2019s extraordinary efforts. It serves as a document to the dedication and
\ncommitment of our publications team and our members, whose hard work has brought to life
\ninsightful discussions that shape and inspire our profession.
\nAs we celebrate this 30th edition, let us recognize the importance of fostering spaces for dialogue
\nand collaboration. These exchanges are vital as we grow into ethical, compassionate, and skilled
\nhealth professionals, ready to address the global challenges of our generation.
\nThank you for your ongoing dedication to the principles of the JDN community. Together, let us
\ncontinue to make an impact, building on the foundation laid by this edition and driving forward our
\nmission to strengthen global health.
\nWarm regards,
\nDr. Pablo Estrella Porter
\nChair 2024-25, Junior Doctors Network World Medical Association
\n4
\nDear JDN alumni and members,
\nAs we come to the final edition of our Junior Doctors Network (JDN) newsletter, I find myself
\nreflecting on the incredible journey we have taken together. Serving as the Chair of this dynamic
\nnetwork has been one of the most fulfilling experiences of my career. It has been a journey filled with
\nlearning, growth, collaboration, and an unwavering commitment to the betterment of junior doctors
\nworldwide.
\nThroughout my time as Chair, I have had the privilege of working alongside a dedicated team of
\npassionate doctors from diverse corners of the world. Together, we have championed the voices of
\njunior doctors, ensuring that our concerns are heard on global platforms such as the World Medical
\nAssociation (WMA), and advocating for better working conditions, professional development
\nopportunities, and equitable access to health resources for our patients.
\nThis final edition symbolizes both a conclusion and a beginning. As we close this chapter, we
\ncelebrate the remarkable milestones we have achieved\u2014successful advocacy efforts, impactful
\nmeetings, and the creation of an inclusive space where junior doctors can engage with one another.
\nWe have tackled complex global health challenges, from mental health to climate change, and I am
\nproud of how we have risen to these challenges with determination and resilience.
\nBut beyond the accomplishments, what stands out most to me is the sense of community we have
\nbuilt. The JDN has become more than just a network; it is a family of professionals bound by a shared
\npurpose to improve healthcare systems, uphold medical ethics, and foster collaboration across
\nborders. I am grateful for the friendships forged, the mentorship exchanged, and the encouragement
\nwe have provided one another through the highs and lows of this noble profession.
\nAs we wrap up the 2023\/24 mandate, I do so with immense gratitude and optimism for the future. The
\njunior doctors of today are the leaders of tomorrow, and I have full confidence that our network will
\ncontinue to thrive and grow.
\nTo those who will carry the torch forward, remember that our collective strength lies in our unity, our
\nempathy, and our relentless pursuit of excellence.
\nThank you all for your dedication, your contributions, and your trust. Let us continue to support one
\nanother, advocate for meaningful change, and most importantly, take care of ourselves as we care for
\nothers.
\nIn solidarity and with warm regards,
\nDr. Marie-Claire Wangari
\n2024\/25 Immediate past chair, Junior Doctors Network World Medical Association
\nWORDS OF IMMEDIATE PAST CHAIR
\nDR. MARIE-CLAIRE WANGARI
\nIMMEDIATE PAST CHAIR 2023\/2024,
\nJUNIOR DOCTORS NETWORK
\nKENYA
\nWORLD MEDICAL ASSOCIATION
\n5
\nWORDS OF FORMER PUBLICATIONS DIRECTOR
\nWORDS FROM THE FORMER PUBLICATIONS DIRECTOR (2023\/2024) AND
\nEDITOR-IN-CHIEF OF THE JDN NEWSLETTER 30TH ISSUE
\nDR. JEAZUL PONCE
\nFORMER PUBLICATIONS DIRECTOR
\n2023\/2024,
\nCOMMUNICATIONS DIRECTOR 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nMEXICO\/SPAIN
\nWORLD MEDICAL ASSOCIATION
\nDear JDN and WMA community,
\nAs part of the 30th edition of the Junior Doctors Network (JDN) newsletter, I want to close this cycle as
\nPublications Director by reflecting on one of the greatest challenges to global health: air pollution. As
\nhealthcare professionals, our duty is not only to treat diseases but also to advocate for a healthier
\nenvironment that prevents the causes of those diseases.
\nThe WMA Declaration on the Prevention and Reduction of Air Pollution to Improve Air Quality
\nemphasizes that air pollution is one of the main threats to global health, directly linked to respiratory
\nand cardiovascular diseases, cancer, and increased premature mortality. According to the WHO, nine
\nout of ten people breathe polluted air every day. This fact serves as a stark reminder of how the
\nenvironment impacts the health of our communities, especially the most vulnerable.
\nAs healthcare professionals, we have the responsibility to lead change from our trenches: educating our
\npatients about the risks associated with air pollution, supporting mitigation policies, and, most
\nimportantly, engaging in local and global initiatives that promote environmental sustainability.
\nCollaboration across disciplines and sectors is key to addressing this issue. We must recognize that
\nhealth and the environment are inseparable.
\nAs I bid farewell to this role, I want to express my deepest gratitude to the publications team and editors
\nof the 2023-2024 period. Your dedication and efforts have been fundamental to the success of our
\ninitiatives. I encourage you to continue submitting articles and actively engaging in the policies of the
\nWorld Medical Association (WMA). Do not limit yourselves to understanding them; work on their
\ndevelopment and adapt these guidelines into strategies applicable to your own environments.
\nFurthermore, I am pleased to announce that I will take on the responsibility of managing our social
\nmedia as communications director 2024\/2025. I invite you to follow us and stay updated with the latest
\ndevelopments. also I encourage you to continue addressing topics like air pollution from a
\ncomprehensive and proactive perspective. Together, we can turn words into actions and make a
\ntangible difference in the health of our communities and the planet.
\nLet us keep moving forward with passion and commitment toward a future where air quality is not a
\nprivilege but a fundamental human right.
\nDr. Jeazul Ponce, MPH, MSc, PhD.
\nFormer Publications Director of JDN 2023\/2024,
\nEditor-in-Chief of the JDN Newsletter 30th Issue
\nCommunications Director 2024\/2025
\nJunior Doctors Network
\n6
\nWORDS FROM THE INCOMING PUBLICATIONS DIRECTOR 2024\/2025
\nDear Colleagues,
\nAs the newly elected Publications Director for the WMA Junior Doctors Network (JDN), it is my
\ngreat pleasure to address the future contributors and readers of our esteemed newsletter. The
\nWMA JDN newsletter serves as an unique platform connecting young doctors worldwide,
\ndisseminating knowledge and fostering dialogue on public health issues.
\nWriting and publishing are indispensable tools for young doctors. They not only enhance our
\nprofessional growth but also elevate our voice in the global medical community. Our newsletter,
\nread across the globe, offers a unique opportunity to share insights, research findings, and
\nperspectives. This is not just publication; it\u2019s a declaration of our commitment to advancing
\nhealthcare on an international scale.
\nThis upcoming year, I am thrilled to announce that we are planning two special editions\u2014one
\nfocusing on Antimicrobial Resistance and the other on Non-Communicable Diseases. These
\neditions aim to highlight the pressing challenges and innovative solutions in these critical areas of
\nhealth. Apart from our special editions, we will continue to bring you regular newsletters that
\ncapture a wide range of topics pertinent to medical science and public health.
\nI strongly encourage each one of you to seize this opportunity. Submit your research, insightful
\nopinions, and thought-provoking viewpoints. Let your voices be heard on a platform that celebrates
\nthe diversity and expertise of junior doctors around the world.
\nTogether, we can contribute to a body of knowledge that not only addresses the challenges of
\ntoday but also paves the way for healthier futures worldwide.
\nWarm regards,
\nDr. Venkatesh Karthikeyan
\nPublications Director (2024-25),
\nWorld Medical Association – Junior Doctors Network,
\n4852012@gmail.com
\nDR VENKATESH KARTHIKEYAN MD,
\nSENIOR RESIDENT,
\nCOMMUNITY AND FAMILY MEDICINE,
\nPUBLICATIONS DIRECTOR 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nINDIA
\nWORLD MEDICAL ASSOCIATION
\n7
\nARTICLES BASED ON
\nINTERVIEWS
\n8
\nMTRO.JOSE
\nLUIS FUNES
\nO N E H E A L T H
\nL A I N T E R S E C C I \u00d3 N E N T R E L A S A L U D
\nP \u00da B L I C A , Z O O N O S I S Y L A
\nC O N S E R V A C I \u00d3 N D E L O S E C O S I S T E M A S
\nP
\nR
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\n9
\nEl concepto de One Health ha cobrado relevancia en las \u00faltimas d\u00e9cadas debido a la creciente conciencia
\nsobre c\u00f3mo la salud humana, la salud animal y la salud de los ecosistemas est\u00e1n intr\u00ednsecamente
\ninterconectadas. Jos\u00e9 Luis Funes, abogado ambientalista y presidente de la Fundaci\u00f3n Saving Our Sharks,
\nha dedicado m\u00e1s de 30 a\u00f1os a abordar temas ambientales y de vida silvestre, trabaj\u00f3 en la Comisi\u00f3n de
\nCooperaci\u00f3n Ambiental (CCA) de Am\u00e9rica del Norte como consultor del Comit\u00e9 Consultivo P\u00fablico Conjunto;
\nsubrayando que la ruptura del equilibrio ecol\u00f3gico tiene implicaciones directas y graves en la salud global.
\nZoonosis: Una amenaza cada vez m\u00e1s presente
\nLa zoonosis, o enfermedades que se transmiten de animales a humanos, no es un fen\u00f3meno nuevo. Sin
\nembargo, lo que ha cambiado en las \u00faltimas d\u00e9cadas es la escala y la velocidad con la que estas
\nenfermedades han emergido. Seg\u00fan datos del Programa de las Naciones Unidas para el Medio Ambiente
\n(PENUMA), el 75% de las enfermedades emergentes provienen de la fauna silvestre. Este dato alarmante
\nrefleja el impacto de la actividad humana sobre el entorno natural (1).
\nLos pat\u00f3genos han existido en la naturaleza durante millones de a\u00f1os, coexistiendo en un equilibrio casi
\nperfecto en ecosistemas intactos. No obstante, la intervenci\u00f3n humana, especialmente a trav\u00e9s de la
\ndeforestaci\u00f3n y la comercializaci\u00f3n de animales silvestres, rompe ese equilibrio y propicia que virus,
\nbacterias y otros agentes infecciosos, que antes no supon\u00edan una amenaza para los humanos, crucen la
\nbarrera entre especies. Los mercados h\u00famedos en Asia, por ejemplo, han sido se\u00f1alados como el origen
\nprobable de la pandemia de COVID-19. Seg\u00fan Funes, la teor\u00eda m\u00e1s aceptada es que el virus surgi\u00f3 a ra\u00edz de
\nla destrucci\u00f3n de ecosistemas en el sudeste asi\u00e1tico, donde ciertos animales fueron extra\u00eddos de sus
\nh\u00e1bitats naturales para ser comercializados en mercados, como los de Wuhan, China (2,3).
\nEstos mercados, denominados \u201cwet markets\u201d, presentan un riesgo significativo, ya que agrupan especies
\nsilvestres en condiciones insalubres, debilitando sus sistemas inmunol\u00f3gicos y facilitando la propagaci\u00f3n de
\npat\u00f3genos entre los animales y hacia los humanos. A trav\u00e9s de estos mecanismos, el ser humano queda
\nexpuesto a una gama de enfermedades infecciosas con potencial pand\u00e9mico. Es as\u00ed como el COVID-19, el
\nSARS y otras enfermedades emergentes han encontrado su camino hacia la poblaci\u00f3n humana, desatando
\ncrisis de salud p\u00fablica a nivel global (3).
\nDestrucci\u00f3n de ecosistemas y la expansi\u00f3n de las zoonosis
\nMTRO. JOS\u00c9 LUIS FUNES
\nDIRECTOR DE SAVING OUR SHARKS
\nFOUNDATION.
\nMEXICO\/UNITED STATES OF AMERICA
\nONE HEALTH: LA INTERSECCI\u00d3N ENTRE LA SALUD P\u00daBLICA, ZOONOSIS
\nY LA CONSERVACI\u00d3N DE LOS ECOSISTEMAS
\nLa intervenci\u00f3n humana en los ecosistemas no se limita solo a la vida terrestre. Funes subraya que la vida
\nmarina tambi\u00e9n est\u00e1 siendo gravemente afectada, en particular los tiburones, que son especies clave para
\nmantener el equilibrio en los ecosistemas marinos. Los tiburones, al igual que los lobos en los ecosistemas
\nterrestres, controlan la poblaci\u00f3n de especies herb\u00edvoras y carn\u00edvoras, ayudando a preservar la
\nbiodiversidad. Su desaparici\u00f3n, impulsada por la sobrepesca y la demanda de aletas en mercados asi\u00e1ticos,
\nha provocado que los ecosistemas marinos est\u00e9n cada vez m\u00e1s desequilibrados (4).
\n10
\nUn ecosistema desequilibrado es un caldo de cultivo para la propagaci\u00f3n de pat\u00f3genos. El principio de
\ndiluci\u00f3n, que Funes describe, es clave para entender este fen\u00f3meno: en un ecosistema saludable y diverso,
\nlos pat\u00f3genos se mantienen bajo control gracias a la variedad de especies que interact\u00faan y regulan su
\nentorno. Cuando el ser humano destruye esos ecosistemas, las especies que quedan \u2014tanto silvestres como
\ndom\u00e9sticas\u2014 est\u00e1n m\u00e1s expuestas y vulnerables, aumentando el riesgo de que los pat\u00f3genos crucen la
\nbarrera de especies y afecten a los humanos(5).
\nOne Health: Una soluci\u00f3n integral
\nEl concepto de One Health busca ofrecer una soluci\u00f3n a este desaf\u00edo interconectado. Seg\u00fan Funes, la idea
\ncentral es que la salud del ser humano est\u00e1 directamente vinculada con la salud animal y la de los
\necosistemas. No podemos abordar problemas de salud global de manera aislada, pues la emergencia de
\npandemias, el cambio clim\u00e1tico y la p\u00e9rdida de biodiversidad est\u00e1n entrelazados en una red compleja que
\nexige una respuesta coordinada (2).
\nDesde el punto de vista de One Health, es imperativo proteger los pocos ecosistemas intactos que quedan y
\nrestaurar aquellos que han sido degradados. La creaci\u00f3n de \u00e1reas naturales protegidas, tanto marinas como
\nterrestres, es una de las estrategias m\u00e1s efectivas para lograrlo. Funes se\u00f1ala que M\u00e9xico ha tomado
\nimportantes pasos en esta direcci\u00f3n, como la creaci\u00f3n del Parque Nacional Revillagigedo en el Pac\u00edfico, una
\nde las \u00e1reas marinas protegidas m\u00e1s grandes del mundo. Sin embargo, como advierte, declarar un \u00e1rea
\nprotegida no es suficiente; es necesario aplicar la ley de manera efectiva para garantizar la conservaci\u00f3n de
\nestas \u00e1reas y prevenir la explotaci\u00f3n ilegal de los recursos naturales (2,5).
\nEl impacto del cambio clim\u00e1tico
\nEl cambio clim\u00e1tico agrava estos problemas de conservaci\u00f3n. En los ecosistemas marinos, los arrecifes de
\ncoral, que son fundamentales para la biodiversidad, han sufrido un blanqueamiento masivo debido al
\naumento de las temperaturas del oc\u00e9ano. Este fen\u00f3meno no solo afecta a los corales, sino a todas las
\nespecies que dependen de ellos para su supervivencia. Adem\u00e1s, Funes menciona la presencia de un
\npat\u00f3geno conocido como \u201cs\u00edndrome blanco\u201d que ha devastado colonias de corales en el Caribe, matando
\nm\u00e1s del 90% de algunas especies formadoras de arrecifes (4).
\nONE HEALTH: LA INTERSECCI\u00d3N ENTRE LA SALUD P\u00daBLICA, ZOONOSIS
\nY LA CONSERVACI\u00d3N DE LOS ECOSISTEMAS
\nEl v\u00ednculo entre cambio clim\u00e1tico y biodiversidad es innegable. En las \u00faltimas conferencias de las partes
\n(COP), los pa\u00edses han comenzado a reconocer la necesidad de abordar el cambio clim\u00e1tico y la p\u00e9rdida de
\nbiodiversidad de manera conjunta. Sin embargo, a\u00fan queda mucho por hacer. La sobreexplotaci\u00f3n de
\nespecies marinas, como los tiburones, se ve exacerbada por el cambio clim\u00e1tico, que desplaza a muchas
\nespecies de sus h\u00e1bitats naturales. Esto ha generado fen\u00f3menos como la sustituci\u00f3n de especies en
\nproductos alimenticios, donde tiburones son vendidos como \u201cbacalao\u201d o \u201cmarlin\u201d, afectando tanto la
\nbiodiversidad como la salud humana (5).
\nMTRO. JOS\u00c9 LUIS FUNES
\nDIRECTOR DE SAVING OUR SHARKS
\nFOUNDATION.
\nMEXICO\/UNITED STATES OF AMERICA
\n11
\nLa necesidad de pol\u00edticas p\u00fablicas integrales
\nJos\u00e9 Luis Funes concluye que la implementaci\u00f3n de One Health debe ser transversal a todas las pol\u00edticas
\np\u00fablicas. El enfoque debe centrarse en la prevenci\u00f3n de futuras pandemias mediante la protecci\u00f3n de los
\necosistemas, la regulaci\u00f3n de la vida silvestre y la promoci\u00f3n de pr\u00e1cticas sostenibles en la agricultura y la
\npesca. Funes es claro al afirmar que la soberbia del ser humano, al creer que puede controlar todos los
\naspectos de la naturaleza, ha sido una de las causas principales de la crisis ambiental y de salud que
\nenfrentamos.
\nNo se trata solo de un imperativo \u00e9tico hacia la naturaleza, sino de una cuesti\u00f3n de supervivencia humana.
\nComo lo demuestra la pandemia de COVID-19, la destrucci\u00f3n de los ecosistemas puede desencadenar crisis
\nglobales que afectan no solo a la salud, sino tambi\u00e9n a las econom\u00edas y a las estructuras sociales. Si no se
\ntoman medidas inmediatas para restaurar y proteger los ecosistemas, la humanidad seguir\u00e1 enfrentando
\nestos desaf\u00edos una y otra vez.
\nConclusi\u00f3n
\nEl enfoque de One Health subraya que la salud p\u00fablica no puede desligarse de la conservaci\u00f3n ambiental y
\nel bienestar animal. Las zoonosis, como el COVID-19, son solo un ejemplo de lo que puede suceder cuando
\nignoramos esta conexi\u00f3n. A medida que enfrentamos los desaf\u00edos del cambio clim\u00e1tico, la p\u00e9rdida de
\nbiodiversidad y la sobreexplotaci\u00f3n de recursos naturales, es m\u00e1s urgente que nunca adoptar un enfoque
\nintegral para garantizar un futuro saludable tanto para los humanos como para el planeta.
\nEntrevista realizada y redactada en conjunto con la Dra. Delta Jeazul Ponce Hernandez.
\nONE HEALTH: LA INTERSECCI\u00d3N ENTRE LA SALUD P\u00daBLICA, ZOONOSIS
\nY LA CONSERVACI\u00d3N DE LOS ECOSISTEMAS
\nMTRO. JOS\u00c9 LUIS FUNES
\nDIRECTOR DE \u201cSAVING OUR SHARKS
\nFOUNDATION\u201d
\nMEXICO\/UNITED STATES OF AMERICA
\nReferences
\nUnited Nations Environment Programme (UNEP). Preventing the Next
\nPandemic: Zoonotic Diseases and How to Break the Chain of
\nTransmission. Nairobi, Kenya: UNEP; 2020. Available at:
\nhttps:\/\/www.unep.org
\n1.
\nWorld Health Organization (WHO). One Health: Joint Plan of Action
\n(2022\u20132026). Geneva: WHO; 2022. Available at: https:\/\/www.who.int
\n2.
\nDaszak P, Olival KJ, Li H. A strategy to prevent future epidemics similar to
\nthe 2019-nCoV outbreak. Biosaf Health. 2020 Mar;2(1):6-8. doi:
\n10.1016\/j.bsheal.2020.01.003. Epub 2020 Feb 5. PMID: 32562482;
\nPMCID: PMC7144510.
\n3.
\nIntergovernmental Science-Policy Platform on Biodiversity and Ecosystem
\nServices (IPBES). Pandemics: Escaping the Era of Pandemics. Bonn:
\nIPBES Secretariat; 2020. Available at: https:\/\/ipbes.net
\n4.
\nKeesing F, Holt RD, Ostfeld RS. Effects of species diversity on disease
\nrisk. Ecol Lett. 2006 Apr;9(4):485-98. doi: 10.1111\/j.1461-
\n0248.2006.00885.x. PMID: 16623733.
\n5.
\n12
\nPROF. JOSE
\nLUIS FUNES
\nO N E H E A L T H : T H E I N T E R S E C T I O N O F
\nP U B L I C H E A L T H , Z O O N O S E S , A N D
\nE C O S Y S T E M C O N S E R V A T I O N
\nP
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\nN
\n\u00bb
\n13
\nThe concept of One Health has gained significant relevance in recent decades due to the growing awareness
\nof the intrinsic connections between human health, animal health, and ecosystem health. Jos\u00e9 Luis Funes, an
\nenvironmental lawyer and president of the Saving Our Sharks Foundation, has dedicated over 30 years to
\naddressing environmental and wildlife issues. He worked as a consultant for the Joint Public Advisory
\nCommittee of the North American Commission for Environmental Cooperation (CEC), emphasizing that the
\ndisruption of ecological balance has direct and severe implications for global health.
\nZoonoses: An Increasingly Present Threat
\nZoonoses, or diseases transmitted from animals to humans, are not a new phenomenon. However, what has
\nchanged in recent decades is the scale and speed at which these diseases emerge. According to data from
\nthe United Nations Environment Programme (UNEP), 75% of emerging diseases originate from wildlife. This
\nalarming figure highlights the impact of human activity on the natural environment(1).
\nPathogens have existed in nature for millions of years, coexisting in near-perfect balance within intact
\necosystems. However, human intervention, especially through deforestation and wildlife trade, disrupts that
\nbalance, allowing viruses, bacteria, and other infectious agents that were previously harmless to humans to
\ncross the species barrier. Wet markets in Asia, for example, have been identified as the likely origin of the
\nCOVID-19 pandemic. According to Funes, the most accepted theory is that the virus emerged due to
\necosystem destruction in Southeast Asia, where certain animals were removed from their natural habitats for
\ntrade in markets like those in Wuhan, China(2,3).
\nThese markets, commonly referred to as \u201cwet markets,\u201d pose a significant risk as they bring together wild
\nspecies in unsanitary conditions, weakening their immune systems and facilitating the spread of pathogens
\namong animals and to humans. Through such mechanisms, humans become exposed to a range of infectious
\ndiseases with pandemic potential. This is how COVID-19, SARS, and other emerging diseases have made
\ntheir way into human populations, triggering global public health crises (3).
\nEcosystem Destruction and the Spread of Zoonoses
\nHuman intervention in ecosystems is not limited to terrestrial life. Funes emphasizes that marine life is also
\ngravely affected, particularly sharks, which are key species in maintaining balance in marine ecosystems.
\nSharks, much like wolves in terrestrial ecosystems, control populations of herbivorous and carnivorous
\nspecies, helping to preserve biodiversity. Their disappearance, driven by overfishing and the demand for
\nshark fins in Asian markets, has increasingly destabilized marine ecosystems (4).
\nAn unbalanced ecosystem becomes a breeding ground for pathogen proliferation. The dilution principle,
\ndescribed by Funes, is key to understanding this phenomenon: in a healthy and diverse ecosystem,
\npathogens are kept in check by the variety of species interacting and regulating their environment. When
\nhumans destroy these ecosystems, the remaining species\u2014both wild and domestic\u2014are more exposed and
\nvulnerable, increasing the risk of pathogens crossing the species barrier and affecting humans (5).
\nONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
\nECOSYSTEM CONSERVATION
\nPROF. JOS\u00c9 LUIS FUNES
\nPRESIDENT SENIOR CEO OF \u201cSAVING
\nOUR SHARKS FOUNDATION\u201d
\nMEXICO\/UNITED STATES OF AMERICA
\n14
\nOne Health: A Holistic Solution
\nThe One Health concept seeks to provide a solution to this interconnected challenge. According to Funes, the
\ncentral idea is that human health is directly linked to animal health and ecosystem health. Global health
\nissues cannot be addressed in isolation, as the emergence of pandemics, climate change, and biodiversity
\nloss are intertwined in a complex web requiring a coordinated response(2).
\nFrom a One Health perspective, it is imperative to protect the few remaining intact ecosystems and restore
\nthose that have been degraded. Establishing protected natural areas, both marine and terrestrial, is one of
\nthe most effective strategies to achieve this. Funes notes that Mexico has taken significant steps in this
\ndirection, such as creating the Revillagigedo National Park in the Pacific, one of the world\u2019s largest marine
\nprotected areas. However, as he warns, declaring a protected area is not enough; effective law enforcement
\nis necessary to ensure the conservation of these areas and prevent the illegal exploitation of natural
\nresources (2,5).
\nThe Impact of Climate Change
\nClimate change exacerbates these conservation challenges. In marine ecosystems, coral reefs, which are
\nessential for biodiversity, have suffered massive bleaching due to rising ocean temperatures. This
\nphenomenon affects not only corals but all species that rely on them for survival. Additionally, Funes
\nhighlights the presence of a pathogen known as \u201cwhite syndrome,\u201d which has devastated coral colonies in the
\nCaribbean, killing over 90% of some reef-building species (4).
\nThe link between climate change and biodiversity is undeniable. At recent Conferences of the Parties (COP),
\ncountries have begun to recognize the need to address climate change and biodiversity loss together.
\nHowever, much work remains. The overexploitation of marine species, such as sharks, is exacerbated by
\nclimate change, which displaces many species from their natural habitats. This has led to phenomena like
\nspecies substitution in food products, where sharks are sold as \u201ccod\u201d or \u201cmarlin,\u201d impacting both biodiversity
\nand human health (5).
\nThe Need for Comprehensive Public Policies
\nJos\u00e9 Luis Funes concludes that implementing One Health must be integrated across all public policies. The
\nfocus should be on preventing future pandemics by protecting ecosystems, regulating wildlife, and promoting
\nsustainable practices in agriculture and fishing. Funes is clear in stating that human arrogance, in believing
\nwe can control all aspects of nature, has been a primary cause of the environmental and health crises we
\nface.
\nONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
\nECOSYSTEM CONSERVATION
\nPROF. JOS\u00c9 LUIS FUNES
\nPRESIDENT SENIOR CEO OF \u201cSAVING
\nOUR SHARKS FOUNDATION\u201d
\nMEXICO\/UNITED STATES OF AMERICA
\n15
\nThis is not merely an ethical imperative toward nature but a matter of human survival. As the COVID-19
\npandemic has demonstrated, ecosystem destruction can trigger global crises that affect not only health but
\nalso economies and social structures. Without immediate action to restore and protect ecosystems, humanity
\nwill continue to face these challenges repeatedly.
\nConclusion
\nThe One Health approach underscores that public health cannot be separated from environmental
\nconservation and animal welfare. Zoonoses, such as COVID-19, are just one example of what can happen
\nwhen this connection is ignored. As we confront the challenges of climate change, biodiversity loss, and the
\noverexploitation of natural resources, adopting a holistic approach is more urgent than ever to ensure a
\nhealthy future for both humans and the planet.
\nInterview Conducted and Co-Written with Dr. Delta Jeazul Ponce Hernandez
\nONE HEALTH: THE INTERSECTION OF PUBLIC HEALTH, ZOONOSES, AND
\nECOSYSTEM CONSERVATION
\nPROF. JOS\u00c9 LUIS FUNES
\nPRESIDENT SENIOR CEO OF \u201cSAVING
\nOUR SHARKS FOUNDATION\u201d
\nMEXICO\/UNITED STATES OF AMERICA
\nReferences
\nUnited Nations Environment Programme (UNEP). Preventing the Next Pandemic: Zoonotic Diseases and
\nHow to Break the Chain of Transmission. Nairobi, Kenya: UNEP; 2020. Available at: https:\/\/www.unep.org
\n1.
\nWorld Health Organization (WHO). One Health: Joint Plan of Action (2022\u20132026). Geneva: WHO; 2022.
\nAvailable at: https:\/\/www.who.int
\n2.
\nDaszak P, Olival KJ, Li H. A strategy to prevent future epidemics similar to the 2019-nCoV outbreak.
\nBiosaf Health. 2020 Mar;2(1):6-8. doi: 10.1016\/j.bsheal.2020.01.003. Epub 2020 Feb 5. PMID: 32562482;
\nPMCID: PMC7144510.
\n3.
\nIntergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). Pandemics:
\nEscaping the Era of Pandemics. Bonn: IPBES Secretariat; 2020. Available at: https:\/\/ipbes.net
\n4.
\nKeesing F, Holt RD, Ostfeld RS. Effects of species diversity on disease risk. Ecol Lett. 2006 Apr;9(4):485-
\n98. doi: 10.1111\/j.1461-0248.2006.00885.x. PMID: 16623733.
\n5.
\n16
\nDR. ANKUSH K.
\nBANSAL, MD, FACP,
\nFACPM, SFHM
\nC L I M A T E C H A N G E A N D I T S I M P A C T O N
\nH E A L T H : R E F L E C T I O N S A N D L E S S O N S
\nF R O M C O P 2 9 I N B A K U
\n\u00bb
\nC
\nH
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\nF
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\nM
\nA
\n17
\nClimate change has firmly established itself as one of the most pressing threats to global health in the 21st
\ncentury. The recent United Nations Climate Change Conference (COP29) held in Baku, Azerbaijan, not only
\nhighlighted environmental challenges but also emphasized the profound impact of this crisis on public health.
\nDuring this event, global leaders and experts explored the intersection of health and climate change, with Dr.
\nAnkush K. Bansal, head of the World Medical Association (WMA) delegation, providing key insights into the
\ncritical role of healthcare professionals in tackling this issue.
\nCOP29: Progress and Agreements
\nCOP29 concluded with a historic commitment: nearly 200 countries agreed to triple climate financing for
\ndeveloping nations, reaching $300 billion annually by 2035. This increase aims to support vulnerable nations
\nin mitigating climate change effects and adapting to phenomena such as droughts, storms, and floods.
\nDespite this progress, critics argue that the funding remains insufficient to address the global scale of the
\ncrisis.
\nFrom a health perspective, Dr. Bansal highlighted how climate change directly affects patients through
\nheatwaves, air pollution, and extreme weather events that exacerbate respiratory, cardiovascular, and chronic
\ndiseases. \u00abThe health case for climate action is growing stronger with every COP,\u00bb he remarked (1).
\nAir Pollution and Respiratory Health
\nOne of the most significant health risks associated with climate change is air pollution, particularly fine
\nparticulate matter (PM2.5), which can penetrate deep into the lungs and bloodstream. These particles are
\nlinked to conditions such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. They
\nalso contribute to higher mortality rates from cardiovascular and respiratory diseases. According to the World
\nHealth Organization (WHO), approximately 4.2 million premature deaths in 2016 were attributed to air
\npollution (2,3).
\nDr. Bansal underscored the crucial role of healthcare professionals in addressing these challenges. \u00abWe can
\ncollect data, conduct research, and provide scientific evidence showing how extreme climate events worsen
\nhealth outcomes. This evidence is vital for educating patients, communities, and policymakers,\u00bb he explained.
\nThe Role of Healthcare Professionals in Climate Action
\nHealthcare professionals are not only on the frontlines of treatment but also at the forefront of advocacy and
\nclimate action. According to Dr. Bansal, their responsibilities include educating patients about the health
\nimpacts of climate change, advocating for evidence-based policies, and collaborating with communities to
\nimplement sustainable solutions.
\nCLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
\nLESSONS FROM COP29 IN BAKU
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFUNDADOR, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nPRESIDENTE DEL GRUPO DE TRABAJO
\nSOBRE MEDIO AMBIENTE DE LA WMA
\nASOCIACI\u00d3N M\u00c9DICA MUNDIAL.
\n18
\nDr. Bansal also stressed the importance of integrating climate change into medical education. \u00abIt\u2019s not a
\nstandalone course. Climate change is a cross-cutting issue that affects every healthcare system and should
\nbe part of the core medical curriculum worldwide,\u00bb he stated.
\nKey Lessons from Baku
\nOne of the major takeaways from COP29 is the transformative power of youth in driving climate action.
\n\u00abYoung people, including junior doctors, are the most powerful force for change globally. They are more
\naffected by climate change and, therefore, more motivated to act,\u00bb Dr. Bansal affirmed.
\nAnother critical lesson is the need to build resilient and sustainable healthcare systems. This means not
\nonly reducing the sector’s carbon footprint but also ensuring operational capacity during climate disasters
\nsuch as hurricanes, floods, or wildfires (4).
\nCLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
\nLESSONS FROM COP29 IN BAKU
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFOUNDER, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nCHAIR – WORKGROUP ON ENVIRONMENT
\nOF WMA
\nWORLD MEDICAL ASSOCIATION
\nPhoto
\nDr. Ankush K. Bansal (right) alongside Dr. Jeazul Ponce Hern\u00e1ndez (left) at the
\nBaku Stadium during COP29. November, 2024
\n19
\nJDN at the COP29
\nDuring the COP29, the participation of the only representative in person from the Junior Doctors Network
\n(JDN), Dr. Delta Jeazul Ponce Hern\u00e1ndez, stood out as she attended the conferences organized by the WHO
\nPavilion. These sessions showcased the active role of Youth Council members as speakers and organizers,
\nproviding a clear example of how youth can engage in high-impact events. Dr. Ponce Hern\u00e1ndez emphasized
\nthe importance of not only attending such spaces in the future, also actively participating in the organization of
\nactivities, such as side events or even creating a pavilion led by the World Medical Association (WMA).
\nInitiatives like these would strengthen political inclusion and the leadership of younger generations, ensuring
\ntheir contributions to shaping key strategies to address climate change and its effects on global health.
\nConclusion
\nCOP29 marked significant progress toward climate action, but challenges remain. The financial commitments,
\nwhile encouraging, must translate into concrete actions that prioritize both climate mitigation and public health
\nprotection.
\nAs Dr. Bansal aptly stated: \u201cIf not us, then who? It is our responsibility as doctors, leaders, and citizens to
\nensure a healthy and sustainable future for the next generations.\u201d
\nInterview Conducted and Co-Written with Dr. Delta Jeazul Ponce Hernandez
\nCLIMATE CHANGE AND ITS IMPACT ON HEALTH: REFLECTIONS AND
\nLESSONS FROM COP29 IN BAKU
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFOUNDER, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nCHAIR – WORKGROUP ON ENVIRONMENT
\nOF WMA
\nWORLD MEDICAL ASSOCIATION
\nReferences
\nUnited Nations Framework Convention on Climate Change. Outcomes of COP29:
\nClimate finance commitment tripled for developing nations [Internet]. UNFCCC; 2024
\n[cited 2024 Dec 10]. Available from https:\/\/unfccc.int\/
\n1.
\nWorld Health Organization. Air pollution and its health effects [Internet]. WHO; 2016
\n[cited 2024 Dec 10]. Available from: https:\/\/www.who.int\/news-room\/fact-
\nsheets\/detail\/ambient-(outdoor)-air-quality-and-health
\n2.
\nSchraufnagel DE, Balmes JR, De Matteis S, Hoffman B, Kim WJ, P\u00e9rez-Padilla R, et
\nal. Health benefits of air pollution reduction. Ann Am Thorac Soc. 2019;16(12):1478-
\n87. DOI: 10.1513\/AnnalsATS.201907-538CME
\n3.
\nWatts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The
\n2020 report of The Lancet Countdown on health and climate change: Responding to
\nconverging crises. Lancet. 2021;397(10269):129-70. DOI: 10.1016\/S0140-
\n6736(20)32290-X
\n4.
\n20
\nDR. ANKUSH K.
\nBANSAL, MD, FACP,
\nFACPM, SFHM
\nE L C A M B I O C L I M \u00c1 T I C O Y S U I M P A C T O
\nE N L A S A L U D : R E F L E X I O N E S Y
\nL E C C I O N E S D E L A C O P 2 9 E N B A K \u00da
\nP
\nR
\nE
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\nD
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\nM
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\nM
\nM
\n21
\nEl cambio clim\u00e1tico se ha consolidado como una de las amenazas m\u00e1s urgentes para la salud global en el
\nsiglo XXI. La reciente Conferencia de las Naciones Unidas sobre el Cambio Clim\u00e1tico (COP29), celebrada en
\nBak\u00fa, Azerbaiy\u00e1n, no solo destac\u00f3 los desaf\u00edos ambientales, sino tambi\u00e9n el profundo impacto de esta crisis
\nen la salud p\u00fablica. Durante este evento, l\u00edderes y expertos globales exploraron la intersecci\u00f3n entre la salud
\ny el cambio clim\u00e1tico, con el Dr. Ankush K. Bansal, jefe de la delegaci\u00f3n de la Asociaci\u00f3n M\u00e9dica Mundial
\n(WMA), proporcionando perspectivas clave sobre el papel crucial de los profesionales de la salud en abordar
\neste problema.
\nCOP29: Progresos y acuerdos
\nLa COP29 concluy\u00f3 con un compromiso hist\u00f3rico: cerca de 200 pa\u00edses acordaron triplicar la financiaci\u00f3n
\nclim\u00e1tica para las naciones en desarrollo, alcanzando los 300 mil millones de d\u00f3lares anuales para 2035.
\nEste aumento tiene como objetivo apoyar a los pa\u00edses vulnerables en la mitigaci\u00f3n de los efectos del cambio
\nclim\u00e1tico y la adaptaci\u00f3n a fen\u00f3menos como sequ\u00edas, tormentas e inundaciones. A pesar de este progreso,
\nlos cr\u00edticos argumentan que la financiaci\u00f3n sigue siendo insuficiente para abordar la magnitud global de la
\ncrisis.
\nDesde una perspectiva de salud, el Dr. Bansal destac\u00f3 c\u00f3mo el cambio clim\u00e1tico afecta directamente a los
\npacientes a trav\u00e9s de olas de calor, contaminaci\u00f3n del aire y eventos clim\u00e1ticos extremos que agravan
\nenfermedades respiratorias, cardiovasculares y cr\u00f3nicas. \u201cEl argumento de la salud a favor de la acci\u00f3n
\nclim\u00e1tica se fortalece con cada COP\u201d, coment\u00f3 (1).
\nContaminaci\u00f3n del aire y salud respiratoria
\nUno de los mayores riesgos para la salud asociados con el cambio clim\u00e1tico es la contaminaci\u00f3n del aire,
\nparticularmente las part\u00edculas finas (PM2.5), que pueden penetrar profundamente en los pulmones y el
\ntorrente sangu\u00edneo. Estas part\u00edculas est\u00e1n vinculadas a afecciones como el asma, la enfermedad pulmonar
\nobstructiva cr\u00f3nica (EPOC) y el c\u00e1ncer de pulm\u00f3n, adem\u00e1s de contribuir a mayores tasas de mortalidad por
\nenfermedades cardiovasculares y respiratorias. Seg\u00fan la Organizaci\u00f3n Mundial de la Salud (OMS),
\naproximadamente 4.2 millones de muertes prematuras en 2016 se atribuyeron a la contaminaci\u00f3n del aire
\n(2,3).
\nEl Dr. Bansal subray\u00f3 el papel crucial de los profesionales de la salud en la atenci\u00f3n de estos desaf\u00edos.
\n\u201cPodemos recopilar datos, realizar investigaciones y proporcionar evidencia cient\u00edfica que muestre c\u00f3mo los
\neventos clim\u00e1ticos extremos empeoran los resultados de salud. Esta evidencia es vital para educar a los
\npacientes, las comunidades y los responsables de pol\u00edticas\u201d, explic\u00f3.
\nEl rol de los profesionales de la salud en la acci\u00f3n clim\u00e1tica
\nLos profesionales de la salud no solo est\u00e1n en la primera l\u00ednea del tratamiento, sino tambi\u00e9n a la vanguardia
\nde la defensa y la acci\u00f3n clim\u00e1tica. Seg\u00fan el Dr. Bansal, sus responsabilidades incluyen educar a los
\npacientes sobre los impactos del cambio clim\u00e1tico en la salud, abogar por pol\u00edticas basadas en evidencia y
\ncolaborar con las comunidades para implementar soluciones sostenibles.
\nEL CAMBIO CLIM\u00c1TICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
\nLECCIONES DE LA COP29 EN BAK\u00da
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFUNDADOR, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nPRESIDENTE DEL GRUPO DE TRABAJO
\nSOBRE MEDIO AMBIENTE DE LA WMA
\nASOCIACI\u00d3N M\u00c9DICA MUNDIAL.
\n22
\nEl Dr. Bansal tambi\u00e9n destac\u00f3 la importancia de integrar el cambio clim\u00e1tico en la educaci\u00f3n m\u00e9dica. \u00abNo es
\nun curso independiente. El cambio clim\u00e1tico es un tema transversal que afecta a todos los sistemas de salud
\ny debe formar parte del curr\u00edculo m\u00e9dico b\u00e1sico a nivel mundial\u00bb, afirm\u00f3.
\nLecciones clave desde Bak\u00fa
\nUno de los aprendizajes m\u00e1s importantes de la COP29 es el poder transformador de la juventud para
\nimpulsar la acci\u00f3n clim\u00e1tica. \u00abLos j\u00f3venes, incluidos los m\u00e9dicos en formaci\u00f3n, son la fuerza m\u00e1s poderosa
\npara el cambio a nivel global. Son los m\u00e1s afectados por el cambio clim\u00e1tico y, por ende, los m\u00e1s motivados
\npara actuar\u00bb, asegur\u00f3 el Dr. Bansal.
\nOtra lecci\u00f3n crucial es la necesidad de construir sistemas de salud resilientes y sostenibles. Esto implica no
\nsolo reducir la huella de carbono del sector, sino tambi\u00e9n garantizar la capacidad operativa durante
\ndesastres clim\u00e1ticos como huracanes, inundaciones o incendios forestales (4).
\nEL CAMBIO CLIM\u00c1TICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
\nLECCIONES DE LA COP29 EN BAK\u00da
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFUNDADOR, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nPRESIDENTE DEL GRUPO DE TRABAJO
\nSOBRE MEDIO AMBIENTE DE LA WMA
\nASOCIACI\u00d3N M\u00c9DICA MUNDIAL.
\nFoto
\nDr. Ankush K. Bansal (derecha) junto con la Dr. Jeazul Ponce Hern\u00e1ndez
\n(izquierda) en el estadio de Baku durante la COP29. Noviembre, 2024
\n23
\nJDN en la COP29
\nDurante la COP29, destac\u00f3 la participaci\u00f3n presencial de la \u00fanica representante de la Junior Doctors
\nNetwork (JDN), la Dra. Delta Jeazul Ponce Hern\u00e1ndez, quien asisti\u00f3 a las conferencias organizadas por el
\nWHO Pavilion. En estas conferencias, se evidenci\u00f3 el papel activo de los miembros del Youth Council como
\nponentes y organizadores, mostrando un claro ejemplo de c\u00f3mo la juventud puede involucrarse en eventos
\nde alto impacto. La Dra. Ponce Hern\u00e1ndez subray\u00f3 la importancia de que, en el futuro, los j\u00f3venes m\u00e9dicos
\nno solo asistan a estos espacios, sino que tambi\u00e9n participen activamente en la organizaci\u00f3n de actividades
\ncomo \u201cside events\u201d o incluso la creaci\u00f3n de un pavilion liderado por la Asociaci\u00f3n M\u00e9dica Mundial (WMA).
\nEste tipo de iniciativas fortalecer\u00edan la inclusi\u00f3n pol\u00edtica y el liderazgo de las nuevas generaciones,
\nasegurando su contribuci\u00f3n en la definici\u00f3n de estrategias clave para abordar el cambio clim\u00e1tico y sus
\nefectos en la salud global.
\nConclusi\u00f3n
\nLa COP29 marc\u00f3 un progreso significativo hacia la acci\u00f3n clim\u00e1tica, pero los desaf\u00edos persisten. Los
\ncompromisos financieros, aunque alentadores, deben traducirse en acciones concretas que prioricen tanto la
\nmitigaci\u00f3n del cambio clim\u00e1tico como la protecci\u00f3n de la salud p\u00fablica.
\nComo afirm\u00f3 el Dr. Bansal: \u00abSi no somos nosotros, \u00bfentonces qui\u00e9n? Es nuestra responsabilidad como
\nm\u00e9dicos, l\u00edderes y ciudadanos garantizar un futuro saludable y sostenible para las pr\u00f3ximas generaciones.\u00bb
\nEntrevista realizada y redactada en conjunto con la Dra. Delta Jeazul Ponce Hern\u00e1ndez
\nEL CAMBIO CLIM\u00c1TICO Y SU IMPACTO EN LA SALUD: REFLEXIONES Y
\nLECCIONES DE LA COP29 EN BAK\u00da
\nDR. ANKUSH K. BANSAL, MD, FACP,
\nFACPM, SFHM.
\nFUNDADOR, FLORIDA CLINICIANS FOR
\nCLIMATE ACTION.
\nPRESIDENTE DEL GRUPO DE TRABAJO
\nSOBRE MEDIO AMBIENTE DE LA WMA
\nASOCIACI\u00d3N M\u00c9DICA MUNDIAL.
\nReferencias
\nUnited Nations Framework Convention on Climate Change. Outcomes of
\nCOP29: Climate finance commitment tripled for developing nations [Internet].
\nUNFCCC; 2024 [cited 2024 Dec 10]. Available from https:\/\/unfccc.int\/
\n1.
\nWorld Health Organization. Air pollution and its health effects [Internet]. WHO;
\n2016 [cited 2024 Dec 10]. Available from: https:\/\/www.who.int\/news-room\/fact-
\nsheets\/detail\/ambient-(outdoor)-air-quality-and-health
\n2.
\nSchraufnagel DE, Balmes JR, De Matteis S, Hoffman B, Kim WJ, P\u00e9rez-Padilla
\nR, et al. Health benefits of air pollution reduction. Ann Am Thorac Soc.
\n2019;16(12):1478-87. DOI: 10.1513\/AnnalsATS.201907-538CME
\n3.
\nWatts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al.
\nThe 2020 report of The Lancet Countdown on health and climate change:
\nResponding to converging crises. Lancet. 2021;397(10269):129-70. DOI:
\n10.1016\/S0140-6736(20)32290-X
\n4.
\n24
\nJDN’S VOICES: KEY
\nARTICLE
\nCONTRIBUTIONS
\n25
\nMEHR MUHAMMAD
\nADEEL RIAZ
\nELELETA SURAFEL
\n26
\nIntroduction
\nOn June 20, 2024, Primary Health Care working group arranged a webinar to discuss a pilot
\nproject on addressing unmet surgical needs in LMICs through Primary Health Care providers
\ncapacity building and investing at prevention. The webinar was presented by Prof. Rahul M.
\nJindal, MD, PhD, MBA, FRCS, FACS, from Uniformed Services University Bethesda, USA.
\nThe webinar focused on addressing the critical unmet surgical needs in low- and middle-
\nincome countries (LMICs) through primary health care. The session highlighted the challenges
\nin accessing safe surgical care, the role of task-shifting, and the need for global and local
\ncollaborations to enhance surgical volumes and quality of care.
\nThe key topics discussed during the webinar are summarized as follows:
\n1. Surgical care is an essential component of a functioning health system, yet access is
\nseverely limited in LMICs. Many LMICs have surgical volumes significantly below the Lancet
\nCommission’s benchmark of 5000 procedures per 100,000 population, averaging only 877
\nsurgeries annually. This highlights a pressing need for scalable solutions to expand surgical
\ncapacity.
\n2. The Lancet Commission on Global Surgery established the importance of integrating
\nsurgery within the global health agenda. To meet global surgical demands, the Commission
\nhas set a target of performing 5,000 surgical procedures per 100,000 population annually.
\nAchieving this goal is crucial for addressing the vast unmet surgical needs in LMICs [1].
\n3. Research has revealed significant disparities in surgical needs between urban slums and
\nrural or tribal areas, with unmet needs often higher in urban environments. These issues
\nhighlight the complexity of surgical care delivery in different settings . [2].
\n4. Key barriers preventing patients in LMICs from receiving needed surgical care include
\nfinancial difficulties, fear of surgery, lack of social support, and a deficit of trust in medical
\nsystems. Overcoming these challenges is essential for expanding access to surgical services
\nand improving health outcomes in resource-limited settings [3].
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nFAISALABAD, PAKISTAN
\nELELETA SURAFEL
\nTHE UNIVERSITY OF EDINBURGH
\nSATHI INITIATIVE: ADDRESSING UNMET
\nSURGICAL NEEDS IN LMICS THROUGH
\nCOMMUNITY ENGAGEMENT AND TASK SHIFTING
\n27
\n5. Task shifting, a strategy where certain tasks are transferred from highly specialized health
\nworkers to those with more general qualifications, has emerged as a practical approach to
\nmitigate the shortage of healthcare professionals in LMICs. This model has proven particularly
\neffective for addressing common surgical conditions, optimizing the use of available human
\nresources to meet patient needs in underserved areas.
\n6. The SATHI (Surgical Accredited & Trained Healthcare Initiative) – a pilot project to address
\nthe unmet surgical needs of communities in urban slums at primary healthcare level through
\ntraining of community health workers with the skills to identify and refer patients requiring
\nsurgical care. Through task shifting and community engagement, SATHI builds trust between
\nhealthcare providers and marginalized communities while improving access to surgical
\nservices [4].
\nConclusion
\nThe webinar emphasized the critical need to address the gap in surgical care access in LMICs
\nthrough innovative solutions like task shifting, community health worker programs, and
\ninternational collaborations. Ensuring surgical care is accessible and affordable is vital for
\nachieving Universal Health Coverage (UHC) and meeting Sustainable Development Goals
\n(SDGs).
\nKey Takeaways
\nThe SATHI Initiative demonstrates the power of task shifting and community engagement in
\naddressing unmet surgical needs in LMICs at primary healthcare level. By training community
\nmembers to provide essential surgical care and fostering trust within underserved
\ncommunities, the initiative has improved access to life-saving procedures. The success of this
\nmodel underscores the importance of innovative, community-based approaches in enhancing
\nsurgical care in resource-limited settings, offering valuable lessons for stakeholders seeking to
\naddress similar challenges elsewhere.
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nFAISALABAD, PAKISTAN
\nELELETA SURAFEL
\nTHE UNIVERSITY OF EDINBURGH
\nSATHI INITIATIVE: ADDRESSING UNMET
\nSURGICAL NEEDS IN LMICS THROUGH
\nCOMMUNITY ENGAGEMENT AND TASK SHIFTING
\n28
\nReferences:
\nThe Lancet, 2015; 386:569 (https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-
\n6736(15)60160-X\/fulltext)
\n1.
\nSurgical Unmet Need in a Low-Income Area of a Metropolitan City in India: A Cross-
\nSectional Study (https:\/\/link.springer.com\/article\/10.1007\/s00268-020-05502-5)
\n2.
\nTrust Deficit in Surgical Systems in an Urban Slum in India (https:\/\/www.ssph-
\njournal.org\/articles\/10.3389\/ijph.2022.1604924\/full)
\n3.
\nSATHI: Surgical Accredited and Trained Healthcare Initiative for Task Shifting in India
\n(https:\/\/academic.oup.com\/jsprm\/article\/2022\/3\/snac018\/6672907)
\n4.
\nFurther Reading and Recommended Resources:
\nThe Lancet Commission on Global Surgery
\n(https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(15)60160-X\/fulltext)
\n1.
\nAre LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A
\nSystematic Review (https:\/\/link.springer.com\/article\/10.1007\/s00268-020-05502-5)
\n2.
\nCommunity Participation in Global Surgery (https:\/\/gh.bmj.com\/content\/6\/4\/e005044)
\n3.
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nFAISALABAD, PAKISTAN
\nELELETA SURAFEL
\nTHE UNIVERSITY OF EDINBURGH
\nSATHI INITIATIVE: ADDRESSING UNMET
\nSURGICAL NEEDS IN LMICS THROUGH
\nCOMMUNITY ENGAGEMENT AND TASK SHIFTING
\n29
\nMEHR MUHAMMAD
\nADEEL RIAZ
\nI N C O M E S O C I O – M E D I C A L A F F A I R S O F F I C E R
\n2 0 2 4 \/ 2 0 2 5 ( F A I S A L A B , P A K I S T A N )
\n30
\nTransgenders are among one of Pakistan’s most marginalized communities, encountering
\nsevere mental health issues exacerbated by systemic discrimination, state-led violence, and
\nsocio-economic marginalization. (1) Despite the Transgender Persons Act of 2018′ (2) being a
\nmajor advancement in the legal recognition of transgender people’s rights, gender recognition
\ns gender \u201cX\u201d instead of gender male (M) or female \/F), and existence, it has not resulted in
\nbroad societal acceptance or equitable access to necessary medical care, including mental
\nhealth services. (3)
\nTransgender communities experience high rates of physical violence, social exclusion and
\neconomic marginalization (1) that may lead to trauma, anxiety, and depression. (4) As most
\ntransgenders are forced to leave their houses in childhood by their parents, the only available
\noption for them to sustain themselves economically is to work with fellow transgenders as
\ndancers or sex workers. The growing effects of climate change exacerbate these problems
\neven further. Droughts, heatwaves, and flooding are among the increasingly extreme climate
\ndisasters that Pakistan has been facing. (5) Gender and Sexual minorities like transgender
\ncommunities, are disproportionately affected by these occurrences, which exacerbate their
\nmental health issues by displacing them, taking away their means of subsistence, and
\nobstructing their access to mental healthcare. (5)
\nOften, junior doctors in primary healthcare are the first point of contact for transgender
\nindividuals seeking care in the healthcare system hierarchy. However, the current training or
\nthereof lack of transgenders care curriculum and resources available to junior doctors are
\ninsufficient to address the complex mental health needs arising from the intersection of gender
\ndiscrimination and lack of understanding of climate-induced stressors. This inadequacy leaves
\ntransgender individuals without the comprehensive, empathetic care they need to navigate
\ntheir unique challenges.
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nINCOME SOCIO-MEDICAL AFFAIRS
\nOFFICER 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nWORLD MEDICAL ASSOCIATION
\nFAISALABAD, PAKISTAN
\nTRANSGENDER MENTAL HEALTHCARE
\nIN PAKISTAN: THE CRUCIAL ROLE OF
\nJUNIOR DOCTORS AT THE PRIMARY
\nLEVEL AMID CLIMATE CHANGE BURDEN
\n31
\nRecommendations:
\n1. Improved Education for Junior Physicians: Undergraduate and graduate programs for junior
\ndoctors should include a comprehensive, inclusive curriculum that addresses the effects of
\nclimate change and its impact on transgender healthcare. Understanding gender dysphoria
\nand the particular mental health issues that transgender people confront as a result of sexual
\nassault, in addition to the psychological effects of climate change and basic terminology like
\neco-anxiety, solastalgia etc, should be covered in this curriculum. Role-playing exercises and
\ncase studies of actual patients can support the development of empathy and useful skills for
\nmeeting these requirements. Transgender-specific comprehensive care protocols should be
\ndeveloped and implemented by health institutions and the domestic health ministry. These
\nprotocols ought to contain instructions for trauma-informed care, mental health assessments,
\nand psychological stress management.
\n3. Integration of Mental Health Services into Primary Treatment: Providing comprehensive
\ntreatment requires the integration of mental health services into primary care settings. As part
\nof this integration, primary care physicians will receive training on how to identify and handle
\nmental health concerns affected by climate change. They will also set up referral processes
\nfor more specialized care as necessary. Transgender patients can obtain prompt and efficient
\ninterventions if mental health assistance is a regular feature of primary care.
\n4. Community Involvement and Support Systems: Establishing robust community support
\nsystems for transgender people can offer supplementary forms of assistance beyond health
\ncare. Health programs should work with neighborhood associations to provide advocacy, peer
\nsupport, and counseling services. These networks can assist with more general social support
\ndifficulties as well as emergency mental health requirements.
\n5. Advocacy for Policy Change: It’s critical to push for legislative reforms that take into
\naccount the concerns of transgender people in the context of climate change. This entails
\nadvocating for laws that guarantee persons impacted by climate disasters fair access to social
\nservices, healthcare, and financial assistance. Bringing up the unique difficulties that the
\ntransgender community faces when interacting with legislators can spur systemic
\nimprovements that enhance well-being in general.
\nTRANSGENDER MENTAL HEALTHCARE
\nIN PAKISTAN: THE CRUCIAL ROLE OF
\nJUNIOR DOCTORS AT THE PRIMARY
\nLEVEL AMID CLIMATE CHANGE BURDEN
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nINCOME SOCIO-MEDICAL AFFAIRS
\nOFFICER 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nWORLD MEDICAL ASSOCIATION
\nFAISALABAD, PAKISTAN
\n32
\nIn conclusion, a comprehensive strategy is needed to address the mental health needs of
\ntransgender people in Pakistan. As front-line medical professionals, junior doctors play a
\ncritical role in providing high-quality treatment. Domestic governments and state medical
\nlicensing and curriculum agencies can attempt to lessen the mental health burden
\nexperienced by this vulnerable population amid the ongoing challenges of climate change by
\nimproving their training, creating comprehensive care protocols, integrating mental health
\nservices, cultivating community support, and advocating for policy changes.
\nReferences :
\n1- Shah, H. B. U., Rashid, F., Atif, I., Hydrie, M. Z., Fawad, M. W. B., Muzaffar, H. Z.,
\nRehman, A., Anjum, S., Mehroz, M. B., Haider, A., Hassan, A., & Shukar, H. (2018).
\nChallenges faced by marginalized communities such as transgenders in Pakistan. The Pan
\nAfrican medical journal, 30, 96. https:\/\/doi.org\/10.11604\/pamj.2018.30.96.12818
\n2- Transgender Persons Act 2018 see
\nhttps:\/\/na.gov.pk\/uploads\/documents\/1526547582_234.pdf
\n3- Riaz MMA, Awan MM. Transgender rights in Pakistan: implications of Federal Shariat Court
\nruling. Lancet Psychiatry. 2023 Aug;10(8):e20. doi: 10.1016\/S2215-0366(23)00191-8. PMID:
\n37479343.
\n4- Ridley M, Rao G, Schilbach F, Patel V. Poverty, depression, and anxiety: Causal evidence
\nand mechanisms. Science. 2020;370(6522):eaay0214. doi:10.1126\/science.aay0214.
\nAvailable from: https:\/\/economics.mit.edu\/sites\/default\/files\/2022-09\/poverty-depression-
\nanxiety-science.pdf
\n5- UNHCR-IOM Pakistan. Flash update #28 on arrest and detention\/flow monitoring (15
\nSeptember 2023 \u2013 7 September 2024). ReliefWeb. Available from:
\nhttps:\/\/reliefweb.int\/country\/pak
\nTRANSGENDER MENTAL HEALTHCARE
\nIN PAKISTAN: THE CRUCIAL ROLE OF
\nJUNIOR DOCTORS AT THE PRIMARY
\nLEVEL AMID CLIMATE CHANGE BURDEN
\nMEHR MUHAMMAD ADEEL RIAZ
\nPUNJAB MEDICAL COLLEGE,
\nINCOME SOCIO-MEDICAL AFFAIRS
\nOFFICER 2024\/2025
\nJUNIOR DOCTORS NETWORK
\nWORLD MEDICAL ASSOCIATION
\nFAISALABAD, PAKISTAN
\n33
\nPABLO ESTRELLA
\nPORTER
\nW M A F O R M E R M E M B E R S H I P D I R E C T O R , J D N
\nC H A I R 2 0 2 4 \/ 2 0 2 5 ( V A L E N C I A , S P A I N ) .
\n34
\nUnderstanding membership data in a platform like the Junior Doctors Network (JDN) is
\nessential to track its evolution and respond to changes over time. Membership data not only
\nreflects the reach and inclusivity of the network but also provides critical insights for informed
\ndecision-making that supports the strategic direction of the JDN.
\nIn the recently conducted Membership Census of September 2024, the JDN recorded an
\nimpressive 979 members, marking a significant rise from previous years\u2014515 members in
\n2022 and 763 members in 2023. This remarkable growth, a 28% increase from 2023,
\nunderscores the growing relevance and appeal of our network, as junior doctors worldwide
\nrecognize the value of joining and contributing to this vibrant community.
\nRegional Representation: Diversity Across the Globe
\nThe JDN is a global network, not bound by geographical borders, and this is clearly reflected
\nin the diversity of its membership. As of the 2024 Census, there are members from 113
\ndifferent countries, representing 63% of the world\u2019s nations. The highest representation was
\nfrom the South-East Asian Region, which accounted for 32.8% of total membership, followed
\nby the African Region (18.9%), the Region of the Americas (16.8%), and the Eastern
\nMediterranean Region (14.9%).
\nPABLO ESTRELLA PORTER (MD, MPH),
\nPUBLIC HEALTH RESIDENT AND
\nJUNIOR DOCTORS NETWORK – WMA
\nCURRENT CHAIR AND FORMER
\nMEMBERSHIP DIRECTOR (VALENCIA,
\nSPAIN).
\nJUNIOR DOCTORS NETWORK
\nMEMBERSHIP CENSUS 2024: A
\nSNAPSHOT OF GROWTH AND DIVERSITY
\n35
\nThe strong representation across most regions shows that the JDN continues to attract
\nmembers from a wide range of countries. However, some regions still show potential for
\ngrowth, particularly the Western Pacific Region, which currently represents only 4.1% of the
\ntotal membership, with 33% of its countries represented.
\nFigure 1. Membership Census 2024
\nJUNIOR DOCTORS NETWORK
\nMEMBERSHIP CENSUS 2024: A
\nSNAPSHOT OF GROWTH AND DIVERSITY
\nKey Challenges and Responsibilities
\nAs the Membership Director over the past two terms, I have been tasked with managing this
\ngrowing and diverse membership base. My responsibilities include maintaining an up-to-date
\nmembership database, coordinating with the World Medical Association (WMA) Secretariat,
\nand engaging both new and prospective members. In this role, I’ve faced several challenges,
\nincluding:
\nIncomplete Applications: A high rate of incomplete applications has historically been a
\nproblem. However, in the 2023-2024 term, we’ve successfully reduced this issue by
\nproviding clearer application instructions.
\nLimited Contact with National JDNs: Engaging some National JDNs has been difficult,
\nlimiting communication and collaboration.
\nLow Post-Joining Engagement: Despite high membership numbers, keeping members
\nactively engaged after they join remains a challenge.
\nInstitutional Memory: The need for better continuity from previous terms has been evident,
\nas a lack of structured transition processes hinders institutional memory.
\nPABLO ESTRELLA PORTER (MD, MPH),
\nPUBLIC HEALTH RESIDENT AND
\nJUNIOR DOCTORS NETWORK – WMA
\nCURRENT CHAIR AND FORMER
\nMEMBERSHIP DIRECTOR (VALENCIA,
\nSPAIN).
\n36
\nThese challenges highlight the importance of not just growing our membership but ensuring
\nongoing involvement and engagement within the network.
\nLooking Ahead: Strengthening Engagement
\nOur membership data paints a compelling picture of growth and diversity within the JDN. Yet,
\nnumbers alone cannot define our success. We invite all members to actively participate in
\nJDN activities, whether through joining working groups, representing the network in
\ninternational delegations, attending online events, or contributing to member consultations.
\nYour active involvement is essential to sustaining the strength and dynamism of the Junior
\nDoctors Network.
\nBy fostering greater engagement, we can ensure that the JDN continues to be a platform that
\nempowers junior doctors around the world, giving them the tools and support to make a
\nmeaningful impact on global health.
\nPABLO ESTRELLA PORTER (MD, MPH),
\nPUBLIC HEALTH RESIDENT AND
\nJUNIOR DOCTORS NETWORK – WMA
\nMEMBERSHIP DIRECTOR (VALENCIA,
\nSPAIN).
\nJUNIOR DOCTORS NETWORK
\nMEMBERSHIP CENSUS 2024: A
\nSNAPSHOT OF GROWTH AND DIVERSITY
\n37
\nCAROLINE
\nLEE
\nS Y D N E Y , A U S T R A L I A
\n38
\nWhen doctors sound the alarm on climate change, we are not talking about what will happen
\nin the future, but what is happening right now. Halfway through 2024, we have witnessed
\nalarming climate related events including heat waves and extreme weather events. July 2024
\nwas the warmest July on record in 175 years and the 14th consecutive month of record-
\nhighest temperatures [1].
\nClimate change is a health emergency and fossil fuels, the key driver of climate change, are
\nhealth hazards. This has been declared in a recent report by Doctors for the Environment
\nAustralia, calling on governments, private sector, and individuals to take urgent action to
\naddress the harms of fossil fuels on our health and environment (Table 1) [2]. Likened to
\ntobacco, fossil fuels are an addiction that humanity must urgently quit. The impacts of climate
\nchange are already occurring globally, and are unequally and unjustly experienced far distal to
\nthe places where largest consumptions occur [3].
\nThere are a myriad of ways in which fossil-fuel related climate change harms health (Figure 1)
\n[2]. Extreme heat and heatwaves cause contribute to cardiovascular disease and strokes,
\nmental illness, and increased domestic and community violence. An estimated 5 billion people
\nworldwide experienced extreme heat in June 2024 [4]. Those most vulnerable in our
\ncommunity are particularly susceptible to heat, including elderly people, those with chronic
\nhealth conditions and disability, pregnant people, young children, and those with limited
\naccess to cool environments for housing, work and transport [2]. There is increasing
\nrecognition of the impacts of climate change on mental health, including direct impacts such
\nas extreme weather events, and indirect impacts such as eco-anxiety, drought and food and
\nwater insecurity [5, 6].
\nAn estimated 5 to 10 million premature deaths are estimated to occur due to fossil fuel air
\npollution every year [7]. Fossil fuel burning produces pollutants including participate matters
\nless than 10 micrometres (PM10), carbon monoxide, nitrogen oxides, sulphur dioxides, and
\nheavy metals [2]. These exacerbate respiratory conditions such as asthma and chronic
\nobstructive pulmonary disease, cardiovascular disease, and cancer.
\nCAROLINE LEE, MD MPHTM
\nINFECTIOUS DISEASES REGISTRAR
\nDOCTORS FOR THE ENVIRONMENT
\nAUSTRALIA, SYDNEY, AUSTRALIA
\nLIKE TOBACCO, FOSSIL FUELS ARE A
\nHEALTH HAZARD WE MUST QUIT
\n39
\nBiodiversity loss is an under-recognised consequence of climate change with serious health
\nharms [2]. Climate change drives biodiversity loss through several pathways including
\ntemperature changes, extreme weather events, and subsequent impacts on insect
\npopulations, pollination, biodiversity, and threatened ecosystems. The implications for human
\nhealth range from threatened food security and water quality, to increased risk of zoonotic
\nevents, infectious diseases and risk of future pandemics.
\nCAROLINE LEE, MD MPHTM
\nINFECTIOUS DISEASES REGISTRAR
\nDOCTORS FOR THE ENVIRONMENT
\nAUSTRALIA, SYDNEY, AUSTRALIA
\nLIKE TOBACCO, FOSSIL FUELS ARE A
\nHEALTH HAZARD WE MUST QUIT
\nFigure 1: Fossil Fuel life cycle analysis, Doctors for the Environment Australia, 2024 (2)
\n40
\nStakeholder
\nRecommended actions
\nGovernment
\nBan all new fossil fuel projects and accelerate
\ninvestment in renewables
\nStop financial subsidies to fossil fuel industries
\nand redirect them to carbon-free initiatives
\nBan fossil fuel advertising and industry
\nsponsorship
\nBan single use and non-recyclable plastics and
\nswitch to reusable and\/or compostable products
\nProtect biodiversity and ban native forest logging
\nPrepare healthcare and the wider community for
\nwhat we can no longer avoid
\nPrivate sector
\nBe leaders in the transition to carbon free
\ntechnologies, including the health sector
\nDivestment from fossil fuels
\nMitigation and adaptation options in buildings,
\nenergy, transport, trees, electronics and
\nreduce\/reuse\/recycle
\nIndividuals
\nUse active and public transport
\nElectrify homes and transport with renewable
\nenergy
\nReduce meat consumption and transition to plant
\nbased diets
\nDivestment from fossil fuels
\nAdvocacy with elected representatives
\nCAROLINE LEE, MD MPHTM
\nINFECTIOUS DISEASES REGISTRAR
\nDOCTORS FOR THE ENVIRONMENT
\nAUSTRALIA, SYDNEY, AUSTRALIA
\nLIKE TOBACCO, FOSSIL FUELS ARE A
\nHEALTH HAZARD WE MUST QUIT
\nTable 1: Actions to phase out fossil fuels, adapted from Doctors for the Environment
\nAustralia, 2024 [2]
\n41
\nActions and conclusions.
\nUrgent action to phase out fossil fuels is necessary to avert the current and ongoing threats
\ncaused by climate change.
\nJunior doctors are the front line workforce of current and future. We cannot serve and
\nadvocate for the health of our patients and communities yet ignore the intrinsic
\ninterconnectedness between climate change and health.
\nJunior doctors can contribute to progress on climate change and health in several ways [2, 8].
\nThese include education of students and health professionals about climate change and
\nhealth \u2013 whether through formal or informal avenues [9]. We can contribute to advocacy
\nglobally through networks such as the World Medical Association working groups and
\nattendance at relevant meetings, and locally through community and not for profit
\norganisations. Junior doctors can contribute to growing research on climate change and health
\nincluding healthcare sustainability (e.g. low carbon healthcare, carbon foot printing
\nhealthcare) [10]. We can also advocate for changes within our place of work and study,
\nincluding climate change and disaster preparedness and response, advocating for leadership
\nto transition away from fossil fuels (e.g. electrification of hospitals, divestment), and local
\nsustainability actions. Other examples of individual actions that junior doctors can take to
\ncontribute on an individual level include preventing over-investigation and its associated
\ncarbon costs, promoting strong preventative health measures (including immunisation), and
\nantibiotic stewardship. Regardless of the actions taken, collaboration is important to establish
\ncommunity and maximise influence.
\nThough the task is daunting, there is no other alternative so long as we wish to realise a
\nliveable future in this world. Rather than being weighed down by pessimism or despair, I argue
\nthere are multiple actions we can all take. If we have historically failed to imagine a healthier,
\nsustainable future, then that is something we can change.
\nCAROLINE LEE, MD MPHTM
\nINFECTIOUS DISEASES REGISTRAR
\nDOCTORS FOR THE ENVIRONMENT
\nAUSTRALIA, SYDNEY, AUSTRALIA
\nLIKE TOBACCO, FOSSIL FUELS ARE A
\nHEALTH HAZARD WE MUST QUIT
\n42
\nReferences
\nNational Oceanic and Atmospheric Administration (NOAA) National Centers for
\nEnvironmental Information [Internet]. [place unknown]: NOAA; 2024. National Monthly
\nGlobal Climate Report for July 2024, published online August 2024 [cited 2024 Sep 6];
\nAvailable from: https:\/\/www.ncei.noaa.gov\/access\/monitoring\/monthly-
\nreport\/global\/202407.
\n1.
\nDoctors for the Environment Australia (DEA). Fossil fuels are a health hazard. Australia.
\nDEA, 2024 [August 2024, cited 2024 Sep 6]. Available from:
\nhttps:\/\/www.dea.org.au\/fossil_fuels_are_a_health_hazard_report
\n2.
\nTaconet N, M\u00e9jean A, Guivarch C. Influence of climate change impacts and mitigation
\ncosts on inequality between countries. Climatic Change. 2020 May;160(1):15-34.
\n3.
\nClimate Central. [Place unknown]: Climate Central, 2024. Analysis: Global extreme heat in
\nJune 2024 strongly linked to climate change, published online June 19, 2024 [cited 2024
\nSep 6]; available from https:\/\/www.climatecentral.org\/report\/global-heat-review-june-2024
\n4.
\nThompson R, Lawrence EL, Roberts LF, et al. Ambient temperature and mental health: a
\nsystematic review and meta-analysis. The Lancet Planetary Health. 2023;7(7):e580-e589.
\nhttps:\/\/doi.org\/10.1016\/S2542-5196(23)00104-3
\n5.
\nHayes K, Blashki G, Wiseman J, Burke S, Reifels L. Climate change and mental health:
\nrisks, impacts and priority actions. International Journal of Mental Health Systems.
\n2018;12(1). https:\/\/doi.org\/10.1186\/s13033-018-0210-6
\n6.
\nLelieveld J, Haines A, Burnett R, Tonne C, Klingm\u00fcller K, M\u00fcnzel T, Pozzer A. Air pollution
\ndeaths attributable to fossil fuels: observational and modelling study. bmj. 2023 Nov
\n29;383.
\n7.
\nHo T. The drive for sustainable healthcare must be led by students and junior doctors BMJ
\n2022; 377 :o896 doi:10.1136\/bmj.o896
\n8.
\nMaxwell J, Blashki G. Teaching about climate change in medical education: an opportunity.
\nJournal of public health research. 2016 Apr 26;5(1):jphr-2016.
\n9.
\nMcGain F, Kayak E. [Place unknown]:MJA Insight. Hospital environmental sustainabillity:
\nEnd of the beginning, published 2021 May [cited 2024 Sep 6]; available from
\nhttps:\/\/insightplus.mja.com.au\/2021\/19\/hospital-environmental-sustainability-end-of-the-
\nbeginning\/
\n10.
\nCAROLINE LEE, MD MPHTM
\nINFECTIOUS DISEASES REGISTRAR
\nDOCTORS FOR THE ENVIRONMENT
\nAUSTRALIA, SYDNEY, AUSTRALIA
\nLIKE TOBACCO, FOSSIL FUELS ARE A
\nHEALTH HAZARD WE MUST QUIT
\n43
\nDOUAA ROUFIA
\nATTABI
\nM D . A L G E R I A
\n44
\nWorld Patient Safety Day is particularly significant for Algerian physicians as it highlights both
\nthe progress and ongoing challenges in ensuring patient safety within the country.
\nPatient Safety Day holds a special significance for me as a primary care physician from
\nAlgeria, currently furthering my education and experience in the United States. This day is a
\nreminder of our commitment to ensuring the highest standards of care and safety for patients
\nworldwide.
\nSignificance in My Country
\nIn Algeria, patient safety is a critical issue that we continually strive to address. My
\ninvolvement in scientific associations in Algeria highlighted the importance of public health
\neducation and patient awareness. These organizations focus on various health issues,
\nincluding metabolic syndrome, blood pressure, diabetes, and infectious diseases like AIDS
\nand sexually transmitted infections (STIs) [1]. We worked closely with teachers and professors
\nto provide free patient visits on special days, educating the community about symptoms,
\nprevention, and the importance of proper medical practices.
\nFor instance, we emphasized the risks associated with unclean hairstyling tools and the
\nnecessity of sterilizing equipment to prevent infections. Additionally, educating patients about
\ndrug interactions and the dangers of self-medication, particularly the risk of antibiotic-resistant
\nbacteria was a key part of our outreach.
\nExperience in the United States
\nAfter moving to the United States, I continued my commitment to patient safety as a volunteer
\nin the Emergency Department at Good Samaritan Hospital in San Jose, California. Here, I
\ngained hands-on experience in providing patient support, comfort, and comprehensive
\nservices crucial for patient safety. My role included assisting with administrative tasks,
\nfacilitating patient admissions, and ensuring effective communication between patients and
\nhealthcare providers.
\nDR.DOUAA ROUFIA ATTABI. MD. ALGERIA
\nWORLD MEDICAL ASSOCIATION
\nCOMPLETION, SAN JOS\u00c9 STATE UNIVERSITY
\nSTUDENT IN THE PUBLIC HEALTH PROGRAM
\nAT SAN JOS\u00c9 STATE UNIVERSITY SAS, SJSU
\nBRIDGING GAPS IN PATIENT SAFETY:
\nINSIGHTS FROM ALGERIA AND THE U.S
\n45
\nThis experience has been invaluable in understanding and contributing to patient care quality
\nand satisfaction.
\n\u201cSafety is a promise we make every day to our patients, and this award stands as a testament
\nthat we keep our promise,\u201d said Tomi Ryba, CEO of Good Samaritan Hospital (as cited in
\nGood Samaritan Hospital, n.d.). [ 2 ]
\nPatient Safety Statistics and Gaps in Algeria:
\nThe biggest gaps in Algeria are healthcare associated infection and maternal and child health
\nissues.
\nHealthcare-Associated Infections: Studies indicate that a significant percentage of infections
\nin Algerian hospitals are healthcare-associated, with these infections contributing to increased
\nmortality and morbidity rates. The need for better infection control practices is crucial to
\nimproving patient outcomes. \u201c This first molecular epidemiology study of VRE in Algeria was
\nuseful in delimiting an outbreak involving three of the four HAI cases and revealed rarely
\nencountered genotypes. Considering the threat and burden of VRE infections worldwide,
\nparticularly in the USA, and the late emergence in Algeria, our study supports the urgent need
\nfor improved and early adequate infection control measures to avoid VRE spread in North
\nAfrican hospitals.\u201d (Benammar S et al.2018) [3] . Nevertheless, the prevalence of urinary
\ninfection demonstrates an upward trend from 2001 to 2005. \u201c The prevalence of urinary tract
\ninfection was 0.7% and 4.5% in two studies from Algeria and Senegal, respectively,11,15
\nwhile
\nA retrospective study from Nigeria reported a frequency of 12.3%.18 The study from Algeria
\nreported that the prevalence of UTI decreased from 3% to 0.7% in 2001 and 2005,
\nrespectively, following an infection control intervention.\u201d( Bagheri et al.2011). [4]
\nDR.DOUAA ROUFIA ATTABI. MD. ALGERIA
\nWORLD MEDICAL ASSOCIATION
\nCOMPLETION, SAN JOS\u00c9 STATE UNIVERSITY
\nSTUDENT IN THE PUBLIC HEALTH PROGRAM
\nAT SAN JOS\u00c9 STATE UNIVERSITY SAS, SJSU
\nBRIDGING GAPS IN PATIENT SAFETY:
\nINSIGHTS FROM ALGERIA AND THE U.S
\n46
\n2. Maternal and Child Health: Although Algeria has made strides in reducing maternal and
\nchild mortality rates, inconsistencies in care quality, especially in rural areas, pose ongoing
\nchallenges. The maternal mortality rate, although improved, still points to gaps in ensuring
\nconsistent, high-quality care across the country . Nevertheless, the mortality rate experienced
\na downward trend from 1998 to 2017 \u201cAccording to recent updates on the maternal mortality
\nratio in Algeria \u2014 it has gradually dropped from 179 deaths per 100,000 live births in 1998 to
\n112 deaths per 100,000 live births in 2017\u201d .[5]
\nIn Algeria, several initiatives have been implemented to promote patient safety across the
\npopulation. One of the key initiatives is the Carte Shifa program, which provides citizens with
\na health insurance card that ensures timely access to healthcare services, accurate record-
\nkeeping, and financial protection, all of which are crucial for patient safety. Additionally, the
\ngovernment has introduced a National Patient Safety Policy that establishes guidelines for
\nhealthcare providers on best practices, helping to reduce the risk of medical errors.
\nFurthermore, various public awareness campaigns have been launched to educate the
\npopulation on health and safety practices, empowering patients to take an active role in their
\nhealthcare and improve overall safety outcomes.
\nAccording to an announcement by the Minister of Labor, Employment, and Social Security, Mr.
\nFay\u00e7al Bentaleb, the second version of the Carte Chifa has been launched in Algeria. This
\nnew version increases the reimbursement per prescription from 3,000 DA to 5,000 DA (Algerie
\nEco, 2023) .[6]
\nOur Call to Action as Physicians to Improve Patient Safety
\nIn my country, the healthcare system is often stretched thin, with nurses and healthcare staff
\nfacing heavy workloads and limited resources. As physicians, one of our critical roles in
\nimproving patient safety is to alleviate this pressure by promoting and participating in auxiliary
\nmissions, such as volunteer services and patient support initiatives.
\nDR.DOUAA ROUFIA ATTABI. MD. ALGERIA
\nWORLD MEDICAL ASSOCIATION
\nCOMPLETION, SAN JOS\u00c9 STATE UNIVERSITY
\nSTUDENT IN THE PUBLIC HEALTH PROGRAM
\nAT SAN JOS\u00c9 STATE UNIVERSITY SAS, SJSU
\nBRIDGING GAPS IN PATIENT SAFETY:
\nINSIGHTS FROM ALGERIA AND THE U.S
\n47
\nBy encouraging volunteer services, we can mobilize medical students, community members,
\nand even ourselves to provide additional hands-on support within hospitals and clinics. This
\ncan involve tasks like patient education, administrative assistance, and direct patient comfort
\nservices, which free up nurses and other medical professionals to focus on critical care tasks.
\nAdditionally, engaging in patient services initiatives allows us to bridge communication gaps
\nbetween patients and healthcare providers, ensuring that patients are well-informed about
\ntheir care plans and are more likely to adhere to safety protocols. In a broader context, by
\nsetting this example and advocating for these supportive roles, we can create a culture where
\nthe community becomes more involved in healthcare, ultimately leading to a safer and more
\nresilient healthcare system. This approach is not only vital in our country but can also serve
\nas a model for other regions facing similar challenges.
\nAs a physician, I am actively working to implement telehealth solutions in our healthcare
\nsystem. This initiative will help facilitate remote consultations, reduce the burden on urban
\nhealthcare facilities, and ensure continuous care for patients in isolated regions. My
\nexperience as a primary care physician in Biskra, known as \u201cThe Door of the Desert,\u201d
\nhighlighted the challenges faced by patients who live far from the hospital. I noticed that many
\ncould benefit from having their initial consultations via telemedicine, allowing them to receive
\ntimely advice and care without the need for immediate travel. In urgent cases, they can be
\nadvised to visit the hospital, and after discharge, telehealth can ensure continuous follow-up,
\nespecially for vulnerable groups like mothers and newborns.
\nFurthermore, integrating artificial intelligence (AI) into telehealth can enhance diagnostic
\naccuracy and streamline workflows, making it easier for doctors to provide high-quality care
\nefficiently. By championing telemedicine and AI, we can revolutionize healthcare delivery in
\nAlgeria, making it more accessible, efficient, and safe for all patients, regardless of their
\ngeographic location. This effort aligns with our broader goals of improving patient outcomes
\nand promoting a culture of safety and innovation in healthcare.
\nDR.DOUAA ROUFIA ATTABI. MD. ALGERIA
\nWORLD MEDICAL ASSOCIATION
\nCOMPLETION, SAN JOS\u00c9 STATE UNIVERSITY
\nSTUDENT IN THE PUBLIC HEALTH PROGRAM
\nAT SAN JOS\u00c9 STATE UNIVERSITY SAS, SJSU
\nBRIDGING GAPS IN PATIENT SAFETY:
\nINSIGHTS FROM ALGERIA AND THE U.S
\n48
\nReferences:
\n1\/ IFMSA-Algeria. HIV and AIDS advocacy [Internet]. IFMSA; 2024 [cited 2024 Aug 1].
\nAvailable from: https:\/\/ifmsa.org\/hiv-and-aidsvocacy-ifmsa-algeria\/
\n2\/ Good Samaritan Hospital. Good Samaritan Hospital recognized for excellence in patient
\nsafety [Internet]. San Jose: Good Samaritan Hospital; [cited 2024 Jul 29]. Available from:
\nhttps:\/\/goodsamsanjose.com\/about\/newsroom\/good-samaritan-hospital-recognized-for-
\nexcellen ce-in-patient-safety
\n3\/ Benammar S, Pantel A, Aujoulat F, Benmehidi M, Courcol R, Lavigne JP, Romano-Bertrand
\nS, Marchandin H. First molecular characterization of related cases of healthcare-associated
\ninfections involving multidrug-resistant Enterococcus faecium vanA in Algeria. Infect Drug
\nResist. 2018 Sep 17;11:1483-1490. doi: 10.2147\/IDR.S164487. PMID: 30271181; PMCID:
\nPMC6149901
\n4\/ Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection
\nin Africa: a systematic review. Bull World Health Organ. 2011 Oct 1;89(10):757-65. doi:
\n10.2471\/BLT.11.088179. Epub 2011 Jul 20. PMID: 22084514; PMCID: PMC3209981.
\nhttps:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3209981\/#:~:text=The%20study%20from%20Al
\ng eria%20reported%20that%20the,c
\n5\/ Shreeya Sharma, MATERNAL HEALTHCARE IN ALGERIA: 4 FACTS EVERYONE
\nSHOULD KNOW,borgen project, https:\/\/borgenproject.org\/maternal-healthcare-in-algeria\/ 6 \/
\nAlgerie Eco. (2023, December 12). Lancement de la deuxi\u00e8me version de la carte Chifa.
\nRetrieved from<\/p>\n

Lancement de la 2e version de la carte Chifa, le plafond des remboursements passe \u00e0 5000 Da par ordonnance<\/a><\/p><\/blockquote>\n