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wmj201504<\/a><\/p>\n

COUNTRY
\nvol. 61
\nMedicalWorld
\nJournal
\nOfficial Journal of The World Medical Association, Inc.
\nISSN 2256-0580
\nNr. 4, December 2015
\nContents
\nClean Technologies Can Change the World . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t121
\nValedictory speech. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t122
\nInaugural Address as WMA President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t123
\nWMA 2015 General Assembly Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t126
\nWMA Resolution to Stop Attacks against Healthcare Workers and Facilities in Turkey. . . . \t140
\nWMA Resolution on Global Refugee Crisis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t140
\nWMA Resolution about the Bombing on the Hospital of MSF in Kunduz . . . . . . . . . . . . . . . \t141
\nWMA Declaration on Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t141
\nWMA Statement on Physicians Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t143
\nWMA Statement on Transgender People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t145
\nWMA Statement on Vitamin D Insufficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t147
\nWMA Guidelines on Promotional Mass Media Appearances by Physicians . . . . . . . . . . . . . . \t147
\nWMA Resolution on the Inclusion of Medical Ethics and Human Rights in the
\nCurriculum of Medical Schools World-Wide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t148
\nWMA Statement on Non-Discrimination in Professional Membership and Activities
\nof Physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t149
\nWMA Statement on Ethical Issues Concerning Patients with Mental Illness. . . . . . . . . . . . . \t150
\nWMA Declaration of Oslo on Social Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . \t151
\nWMA Statement on Supporting Health Support to Street Children . . . . . . . . . . . . . . . . . . . . \t152
\nWMA Statement on Mobile Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t153
\nWMA Statement on Nuclear Weapons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t154
\nWMA Statement on Riot Control Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t155
\nBody Cavity Searches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t156
\nThe Climate\/Health Nexus at COP21 & Beyond. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t158
\n121
\nEditorial
\nAs I reflect on the activities surrounding
\nCOP 21 \u2013 the United Nations Climate
\nChange Conference,currently being held in
\nParis \u2013 what disturbs me most is the man-
\nner in which climate change is being pre-
\nsented and discussed.
\nWe hear forceful declarations from stake-
\nholders in the debate that climate change
\nis a huge and expensive problem and that
\nwe have to act for the sake of future genera-
\ntions.
\nHow in the world can you motivate peo-
\nple by asking them to pay to solve a huge
\nproblem with no immediate benefit? Rath-
\ner than hearing about expensive problems,
\npeople are looking to be inspired by solu-
\ntions that provide an immediate economic
\nreward. And this is exactly what fighting
\nclimate change can offer today if we accept
\nto modify our understanding of the situation.
\nWhen I was trained as a medical Doctor, I learned that a \u2018problem\u2019
\nis called a \u2018symptom\u2019. Every symptom has an origin, and by studying
\nthat origin, we can find a treatment. In the case of climate change,
\nCO2
\nis not the problem; it\u2019s only the symptom \u2013 the symptom of our
\ncrazy manner of using and wasting energy.
\nNevertheless, we see people continuing to fight against the symp-
\ntom, citing CO2
\nemissions as the source of the problem. We have
\nthe ecologists who are advocating that we decrease our mobility, our
\ncomfort, our economic development and our growth.\u00a0 But really,
\nwho would want that?\u00a0 Then, we have those who resist measures to
\nreduce CO2
\nemissions for the sake of employment and profit. Hav-
\ning two camps fighting\u00a0each other will not solve the climate change
\nissue. It will continue to polarize the debate and lead to paralysis.\u00a0
\nLooking at how we consume energy and in particular the resulting
\nwaste will go a long way in helping us better understand the real
\nissues at stake. The technologies we use today are 100 years old!
\nThey present a complete lack of efficiency compared to the clean
\ntechnologies available: our combustion engines are three times less
\nefficient than electrical ones; light bulbs create more heat than light
\nand in turn require cooling devices; poor insulation of buildings and
\nsingle glazed windows continue to run up our monthly electricity
\nbills; and, heating and cooling systems, as well as industrial process-
\nes produce more losses than efficiency. Why are we so demanding
\nabout modern information technology and so relaxed about energy
\nefficiency? Could Paris be the first Climate Conference that looks at
\nenergy efficiency as a solution for climate change?
\nWhen I initiated the Solar Impulse project
\nto fly a solar powered airplane around the
\nworld without a drop of fuel,it was precisely
\nto demonstrate that clean technologies can
\nachieve the impossible. We can reach more
\nwith renewable energy and energy efficiency
\nthan with fossil fuel. And all the technolo-
\ngies we use in the sky could be used today to
\nrun a cleaner society.
\nUnfortunately, our world continues to react
\nto the issue of wasted energy by trying to
\nproduce more and more energy, either fossil
\nor renewable, instead of opting for efficien-
\ncy. Is this rational? Would you fix a leak in
\nyour bathtub by turning up the water fau-
\ncets or would you call a plumber to try and
\nidentify where the leak is coming from?
\nThis means governments should start to fo-
\ncus on how to replace these old polluting
\ndevices with clean technological solutions. Our society has regula-
\ntions for hygiene, health, taxes, justice and education, but nothing
\nprevents us from wasting energy with outdated technology.Can you
\nimagine how many jobs would be created, and how much profit
\nmade, if everyone rallied behind this new market? Lets stand up
\nagainst those who say that solving climate change will jeopardize
\nour economic development. It\u203as precisely the opposite!
\nMy fear for COP 21 in Paris is that climate change stakeholders will
\nlook at taking measures,which will be unacceptable.Developed coun-
\ntries will be asked to pay for the pollution they have caused, while
\npoorer countries will be asked to renounce on economic development
\nto which they are entitled. The result will be wide-scale resistance!
\nTargets for CO2
\nreduction and minimum temperature increases
\nbecome wishful thinking if they are not addressed with profitable
\nsolutions that will help reach them. That\u2019s where the focus of the
\ndebate is needed: discussing which clean technological solutions are
\nthe most relevant and directly profitable for which region of the
\nworld and what type of economy?
\nCan you imagine the motivation of every country that could then
\ntrade a costly sacrifice for a profitable investment? Clean technologies
\nimpact climate change while at the same time being profitable, creat-
\ning employment and stimulating economic development and growth.
\nThis is why we should choose the clean technology revolution, even
\nif we were not facing any climate change issue at all…
\nDr. Bertrand Piccard, Initiator,
\nChairman and Pilot of Solar Impulse, http:\/\/www.solarimpulse.com
\nEditor in Chief
\nDr. P\u0113teris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv, editorin-chief@wma.net
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld, Deutscher \u00c4rzte-Verlag, Dieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor
\nMaira Sudraba, Velta Poz\u0146aka; lma@arstubiedriba.lv
\nJournal design and
\ncover design by
\nP\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher, \u201cMedic\u012bnas apg\u0101ds\u201d, President Dr. Maija \u0160etlere, Skolas street 3, Riga, Latvia
\nPublisher
\nThe Latvian Medical Association, \u201cLatvijas \u0100rstu biedr\u012bba\u201d,
\nSkolas street 3, Riga, Latvia.
\nISSN: 2256-0580
\nSir Michael MARMOT
\nWMA President
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr. Donchun SHIN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nKorean Medical Association
\n46-gil Ichon-ro
\nYongsan-gu, Seoul 140-721
\nKorea
\nProf. Dr. Frank Ulrich
\nMONTGOMERY
\nWMA Vice-Chairperson of Council
\nBundes\u00e4rztekammer
\nHerbert-Lewin-Platz 1 (Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr. Xavier DEAU
\nWMA Immediate Past-President
\nConseil National de l\u2019Ordre des
\nM\u00e9decins (CNOM)
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nFrance
\nDr. Joseph HEYMAN
\nWMA Chairperson
\nof the Associate Members
\n163 Middle Street
\nWest Newbury, Massachusetts 01985
\nUnited States
\nDr. Masami ISHII
\nWMA Treasurer
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Heikki P\u00c4LVE
\nWMA Chairperson of the Medical
\nEthics Committee
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nFinland
\nDr. Miguel Roberto JORGE
\nWMA Chairperson of the Socio-
\nMedical Affairs Committee
\nBrazilian Medical Association
\nRua-Sao Carlos do Pinhal 324,
\nCEP-01333-903 Sao Paulo-SP
\nBrazil
\nDr. Ardis D. HOVEN
\nWMA Chairperson of Council
\nAmerican Medical Association
\nAMA Plaza, 330 N. Wabash,
\nSuite 39300
\n60611-5885 Chicago, Illinois
\nUnited States
\nDr. Otmar KLOIBER
\nSecretary General
\nWorld Medical Association
\n13 chemin du Levant
\n01212 Ferney-Voltaire
\nFrance
\nWorld Medical Association Officers, Chairpersons and Officials
\nOfficial Journal of The World Medical Association
\nOpinions expressed in this journal \u2013 especially those in authored contributions \u2013 do not necessarily reflect WMA policy or positions
\nwww.wma.net
\nClean Technologies Can Change the World
\nBertrand Piccard
\nBACK TO CONTENTS
\n122 123
\nWMA News WMA News
\nDear Presidents and Chairpersons,
\nDear Colleagues,
\nDear Friends,
\nI am particularly honoured and pleased to
\nwelcome here in Moscow the 116 members of
\nour world medical association or their repre-
\nsentatives.
\nAs it happens we are holding here in Moscow
\nnot only our 2015 General Assembly but also
\nthe 201st
\nWMA Council Session and the An-
\nnual meeting of junior doctors.
\nI wish to thank the Russian Medical Society
\nfor their friendly welcome and efficient organ-
\nisation.
\nThanks are also due to the Russian Government
\nand the Moscow City Council for their support.
\nAs I open this General Assembly, I believe it
\nis appropriate to recall the goals of the World
\nMedical Association.
\nOur aim is to serve mankind by striving to
\nachieve the highest international standards in
\nterms of medical education, medical science,
\nmedical art, medical ethics and medical care
\nfor all the peoples of the world.
\nThe world is currently undergoing major up-
\nheavals. More than ever the medical profes-
\nsion and our associations must be present and
\nplay an active role on the global scene.
\nClimate change.
\nA very last chance of reaching a consensus on
\nglobal warming will come up at the COP21
\nmeeting in December in Paris. Physicians are
\ncalled upon to deal with the consequences of
\nclimate change on human health worldwide.
\nGeopolitical upheavals
\nMigrant populations requiring immediate
\nhealth care, irrespective of their language, cul-
\nture, religion or skin colour.
\nUpheavals due to armed conflicts
\nHere again doctors should guarantee high
\nstandards of medical care in safe conditions,
\nfor both patients and medical staff, consistent
\nwith the ethical standards of our World Medi-
\ncal Association and our Health Care in Dan-
\nger programme.
\nScientific upheavals
\nWith a very rapid evolution of medical science
\nand new technologies requiring an urgent up-
\ndating of medical training.
\nThroughout our discussions at this General
\nAssembly, we must therefore insist on the
\nabsolute necessity of enforcing strong ethical
\nvalues, particularly as regards the autonomy of
\nphysicians.
\nMedical autonomy is without doubt an over-
\narching ethical value inasmuch as it guaran-
\ntees patient trust, professional confidentiality
\nand the protection of personal data.
\nIt also means a respect for human beings, for
\ntheir enlightened consent or acceptance, their
\nvulnerability and their rights as human be-
\nings.
\nI am, we are all, concerned by these upheav-
\nals which result in social and political situa-
\ntions that impact negatively on human health,
\nmainly on the poorest.
\nThe WMA, our National Associations, each
\nand every one of us individually, all must work
\ntogether, in a spirit of brotherhood, equity and
\nsolidarity, with full respect for the basic values
\nof medical ethics.
\nWe should avoid all forms of fundamentalism,
\nbe it social, political, professional or religious,
\nwhilst preserving our own personal profes-
\nsional freedom \u2013 such are the stakes if we are
\nto safeguard the physician\u2019s autonomy.
\nMedical autonomy impacts directly on all our
\npatients as well as on our ability to care for
\nforeign or migrant patients.
\nA flood of migrants is fleeing violence and the
\nfundamentalism of certain ideologies, bring-
\ning us back to the historical and ethical origins
\nof our World Medical Association.
\nLet us accept these people and give them the
\nmedical care they require.
\nFor such is our simple duty, our contribution
\nto the survival of peace in the world.
\nAmidst these upheavals the physician is at the
\nforefront of the quest for peace and equity, for
\nhe is expected to provide an immediate med-
\nico-social response to the social determinants
\nof health.
\nLet us help our medical associations, our phy-
\nsicians to provide quality medical care for all
\nhuman beings. In full independence, full con-
\nfidence, whilst such are the values I strove to
\npromote through my one-year mandate as
\nyour President.
\nBefore I conclude, I would like to express my
\npersonal gratitude to WMA Council mem-
\nbers, Chaired by Dr. Mukesh Haikerwal and
\nsubsequently by Dr. Ardis Hoven as well as
\nthe secretariat as a whole under Dr. Kloiber\u2019s
\nleadership. My thanks also go to our Past
\nPresident Margaret Mungherera for her brave
\ninvolvement in the African project. I also ex-
\ntend my best wishes to Sir Michael, who will
\ntake over the Presidency with his well-known
\ndynamism, enthusiasm, and joie de vivre.
\nMy warmest thanks also go to our devoted of-
\nfice staff, Sunny, Clarisse, Anne-Marie, Julia,
\nRoderic and Lamine.
\nThank you all for the high standard of your
\ncontributions. Let us continue to bear witness
\nto and actively enforce the ethical values of the
\nWorld Medical Association.
\nIn view of the serious problems we face, we
\nshould continue to provide leadership for all
\nour medical associations.
\nIt is our duty to combat violence relentlessly
\nby providing quality medical care for all.
\nLet us be proud of being physicians.
\nLet us be proud of our World Medical As-
\nsociation.
\nLet us be proud of serving peace for the wel-
\nfare of mankind.
\nValedictory speech
\nDr. Xavier Deau,
\nWMA General Assembly,
\nMoscow 16 September 2015
\nHonoured Guests, Colleagues,
\nIn May 2011 Mary hanged herself. She was
\nfound in the yard of her grandparents\u2019house
\non a First Nations Reserve in the province
\nof British Columbia in Canada. She was
\nfourteen. She was a First Nations, aborigi-
\nnal, Canadian.
\nHer story has particulars. All suicides do.
\nShe had been physically and emotionally
\nabused at home and in her community, and
\npossibly sexually abused. Her mother was
\nmentally unstable and heard voices telling
\nher to \u2018snap\u2019 her child\u2019s head. Officials at-
\ntributed the suicide to a dysfunctional child
\nwelfare system, and to the fact that no one
\ntook her complaints of abuse seriously or
\nacted on them.
\nThere is another way to look at Mary\u2019s sadly
\nforeshortened life, and that is to realise that
\nthough her personal tragedy was unique,
\nthere are many young aboriginal Canadians
\nwho experience similar tragedies. In fact,
\nthe aboriginal youth suicide rate in British
\nColumbia is five times the average for all
\nyoung Canadians. One cannot understand
\nfully why Mary saw no way out without also
\nasking why so many other young aborigi-
\nnal people in British Columbia reached the
\nsame desperate point.
\nThe starting point is poverty, bone-grinding
\npoverty, low educational levels and high
\nunemployment. But there were about 200
\nbands of aborigines in British Columbia,
\nmore or less all in poverty. Yet 90% of the
\nadolescent suicides occurred in 12% of the
\nbands. Why some and not others? The dif-
\nference was empowerment of communities.
\nEmpowered communities participated in
\nland claims; self-government, had control
\nover educational, police and fire, and health
\nservices; and establishment of \u2018cultural\u2019facil-
\nities. The results were clear: the greater the
\ncultural continuity and community control
\nover their destiny, the lower was the youth
\nsuicide rate. Poverty is bad, but poverty is
\nnot destiny. Empowerment of communities
\ncan save lives. I\u00a0draw similar lessons from
\nstudying the health of New Zealand Mao-
\nris, Indigenous Australians, Native Ameri-
\ncans or indeed that of excluded groups else-
\nwhere in the world.
\nIn January 2010,Haiti\u2019s earthquake wreaked
\nhavoc and 200,000 people died. Less than
\ntwo months later a quake 500 times stron-
\nger hit Chile and the death toll was in the
\nhundreds. Haiti was underprepared in every
\nway imaginable. Chile was well prepared,
\nwith strict building codes, well-organised
\nemergency responses and a long history of
\ndealing with earthquakes. True, the epicen-
\ntre of the Haitian earthquake was closer to
\npopulation centres than that of the Chilean
\nquake, but that was only part of the expla-
\nnation for the different scale of devastation.
\nWhat turns a natural phenomenon into a
\ndisaster is the nature of society. The num-
\nber of people who died had more to do with
\nHaiti\u2019s lack of societal readiness and re-
\nsponse than with the strength of the quake.
\nIn 2011 the London borough of Tottenham
\nbroke out in urban riots.The precipitant was
\nthe killing of a black man by police.But,un-
\nacceptable as that is, it was not the underly-
\ning cause. Inequality was the culprit. I\u00a0had
\nbeen citing an area of Tottenham as having
\nthe worst male life expectancy in London\u00a0\u2013
\n18 years fewer than in the best-off area. All
\nin one of the world\u2019s premier global cities.
\nLondon now has more high-end properties,
\na price tag more than $5million, than Man-
\nhattan, Hong Kong, Singapore or Sydney.
\nIt is not surprising that the riots broke out
\nin the area with the worst health. Ill-health
\ndoes not cause riots. Nor do riots cause
\nill-health\u00a0 \u2013 at least not directly. Relative
\ndeprivation causes both urban unrest and
\nill\u2013health. Ninety per cent of young people
\narrested in the riots were not in employ-
\nment, education or training.
\nSimilarly, in Baltimore in the US. When a
\nblack man was killed in police custody ri-
\nots broke out. Not uniformly across the city,
\nbut in the area with condemned houses,
\nlow levels of education and income and a
\ntwenty year disadvantage in life expectancy
\ncompared to the area with leafy opulence.
\nInequality strains the binds of a cohesive
\nsociety. In Baltimore, those binds snapped.
\nThe immediate effect is civil unrest. The
\nlonger term effecs is health inequity.
\nThese examples illustrate that the way we
\norganise our affairs, at the community level
\nor, indeed at the whole societal level, are
\nmatters of life and death. As doctors we
\ncannot stand idly by while our patients suf-
\nfer from the way our societies are organised.
\nInequality of social and economic condi-
\ntions is at the heart of it.
\nThere are three aspects of Mary\u2019s tragedy
\nworth emphasising. The first is the vital is-
\nsue of violence to girls and to women. It
\ncan be fatal, both because it drives women
\nto suicide and because they may be killed
\nby their partners. Second, I\u00a0 emphasised
\nempowerment of communities. But em-
\npowerment of individuals is also of vital
\nimportance. A\u00a0key route to female empow-
\nerment, globally, is education. Evidence
\nshows clearly: the greater the education
\nof women the less the likelihood of being
\nsubject to domestic violence. Third is the
\nimportance of mental illness. Mental ill-
\nInaugural Address as
\nWMA President
\nSir Michael Marmot,
\nWMA General Assembly,
\nMoscow 16 September 2015
\nBACK TO CONTENTS
\n124 125
\nWMA News WMA News
\nness and substance use disorders constitute
\nthe number one cause of years spent with
\ndisability, globally.We cannot be concerned
\nwith health, globally and in our countries,
\nand not be concerned with mental illness
\nand substance use.
\nMore generally we need to recognise the
\nimportance of the mind to health equity.
\nThe mind is the major gateway through
\nwhich social determinants exert their effect
\non health. Recognizing the importance of
\nthe mind takes us back to early child devel-
\nopment and what I\u00a0have called: equity from
\nthe start.
\nIn Aldous Huxley\u2019s dystopia, Brave New
\nWorld,there were five castes.The Alphas and
\nBetas were allowed to develop normally.The
\nGammas, Deltas, and Epsilons were treated
\nwith chemicals to arrest their development
\nintellectually and physically, progressively
\nmore affected from Gamma to Epsilon.The
\nresult: a neatly stratified society with intel-
\nlectual function, and physical development,
\ncorrelated with caste.
\nThat was satire, wasn\u2019t it? We would never,
\nsurely, tolerate a state of affairs that strati-
\nfied people, then made it harder for the
\nlower orders, but helped the higher orders,
\nto reach their full potential.Were we to find
\na chemical in the water, or in food, that was
\ndamaging children\u2019s growth and their brains
\nworldwide,and thus their intellectual devel-
\nopment and control of emotions, we would
\nclamour for immediate action. Remove the
\nchemical and allow all our children to flour-
\nish, not only the Alphas and Betas. Stop the
\ninjustice now4 Yet, unwittingly perhaps, we
\ndo tolerate such an unjust state of affairs
\nwith seemingly little clamour for change.
\nThe pollutant is called social disadvantage
\nand it has profound effects on developing
\nbrains and limits children\u2019s intellectual and
\nsocial development. Note, the pollutant is
\nnot only poverty, but also social disadvan-
\ntage.There is a clear social gradient in intel-
\nlectual, socia, and emotional development\u00a0\u2013
\nthe higher the social position of families the
\nmore do children flourish and the better
\nthey score on all development measures.
\nThis stratification in early child develop-
\nment, from Alpha to Epsilon, arises from
\ninequality in social circumstances.
\nThis social gradient in children\u2019s possibil-
\nity to fulfil their potential, in its turn, has a
\nprofound effect on children\u2019s subsequent life
\nchances. We see a social gradient in school
\nperformance and adolescent health; a gradi-
\nent in the likelihood of being a 20\u00a0year old
\nnot in employment, education, or training;
\na gradient in stressful working conditions
\nthat damage mental and physical health;
\na gradient in the quality of communities
\nwhere people live and work; in social condi-
\ntions that affect older people; and, central
\nto my concern, a social gradient in adult
\nhealth. A causal thread runs through these
\nstages of the life course from early child-
\nhood, through adulthood to older age and
\nto inequalities in health. The best time to
\nstart addressing inequalities in health is
\nwith equity from the start. But intervention
\nat any stage of the life course can make a
\ndifference. Relieving adult poverty, pay-
\ning a living wage, reduction in fuel poverty,
\nimproving working conditions, improving
\nneighbourhoods, and taking steps to reduce
\nsocial isolation in older people can save lives.
\nThe health gradient to which these life
\ncourse influences give rise is dramatic.There
\nis a cottage industry, taking subway rides in
\nvarious cities and showing how life expec-
\ntancy drops a year for each stop. I\u00a0have re-
\nferred to twenty year gaps in Baltimore and
\nLondon; but the health differences between
\nrich and poor, dramatic as they are, are only
\npart of the problem. Commonly, people say
\nto me: I\u00a0 am neither rich nor poor; what
\ndoes any of this have to do with me? The
\nevidence shows that there is a social gradi-
\nent in health that runs from top to bottom
\nof society. People in the middle have worse
\nhealth than those above them in the social
\nhierarchy, but better than those below. We
\ncalculated for England that if everyone en-
\njoyed the same life expectancy as the top
\n10%, based on education, there would be
\n202,000 fewer deaths each year; over 500 a
\nday.
\nOne problem, then, is poverty. Another is
\ninequality. Both damage health and lead to
\nan unjust distribution of health.I\u00a0have spent
\nmy research life showing that the key deter-
\nminants of health lie outside the health care
\nsystem in the conditions in which people
\nare born, grow, live, work and age; and in-
\nequities in power, money and resources that
\ngive rise to these inequities in conditions
\nof daily life. Since the establishment of the
\nWHO Commission on Social Determi-
\nnants of Health in 2005, I\u00a0have been using
\nresearch knowledge to argue for policies on
\nsocial determinants of health.
\nYet here I\u00a0am, humbled by assuming office
\nas President of the World Medical Associa-
\ntion.Is there not a contradiction?The World
\nMedical Association, WMA, upholds the
\nhighest ethical standards of the practice of
\nmedicine. It speaks out fearlessly when the
\nright of doctors to pursue their noble call-
\ning is threatened. As President, I\u00a0want the
\nWMA to use the same moral clarity to be
\nactive against the causes of ill-health and
\nwhat I\u00a0call the causes of the causes\u00a0\u2013 the
\nsocial determinants of health.
\nThe opening sentence of my recent book,
\nThe Health Gap: The Challenge of an Unequal
\nWorld, was: why treat people and send them
\nback to the conditions that made them
\nsick? No one is as concerned about health
\nand disease as we in the medical and other
\nhealth professions. It has been and will be
\nmy mission to encourage our concerns with
\nthe conditions that make people sick.
\nI am hugely encouraged already. My friends
\nin the Canadian Medical Association con-
\nducted Town Hall meetings across Canada
\nto engage the public in discussion on how
\nthe conditions of their lives related to their
\nhealth. The Canadian Medical Association
\nthen took the initiative to suggest a meet-
\ning at BMA House in London. Twenty
\ncountries and 200 people asked to come,
\nincluding our now-Chair of Council, Ardis
\nHoven, and then-president, Xavier Deau,
\nand participated with enthusiasm. I\u00a0apolo-
\ngise in advance: I\u00a0already have more invita-
\ntions from medical colleagues, enthusiastic
\nfor the health equity agenda, than I\u00a0could
\npossibly meet. We need a global social
\nmovement.
\nI have been arguing that we have the knowl-
\nedge of what to do to act on social determi-
\nnants and health equity; we have the means.
\nWe need to ensure that we have the will.
\nDo we really have the means? Consider.
\nWhat do the following have in common?
\n\u2022\t 48 million people of Tanzania
\n\u2022\t 7 million people of Paraguay
\n\u2022\t 2 million people of Latvia
\n\u2022\t top 25 US hedge fund managers
\nIn 2013 each of these four groups had a
\ntotal income of between $21 and 28 bil-
\nlion. Imagine with me something totally
\nfanciful: that the 25 hedge fund manag-
\ners gave up their income for one year. It
\nwould double the income of Tanzania. The
\nhedge fund managers wouldn\u2019t feel it, be-
\ncause they will earn an average of $1bil-
\nlion each the next year. I\u00a0am not suggesting
\nfor a moment that we simply pass the cash
\nto individual Tanzanians. But think of the
\nclean water that could be piped,the schools
\nthat could be built, the nurses trained and
\nemployed.
\nThere is a great deal of money sloshing
\nabout. Great inequality between countries
\nstops the money being spent in ways that
\nwould benefit the poor and the needy.
\nSuppose, though, that there was reluc-
\ntance to see ourselves as part of a global
\ncommunity.We would still have to address
\nstaggering levels of inequality of income
\nand wealth within countries. Here is an
\neven more fanciful thought. Suppose that
\nthe hedge fund managers of New York
\npaid a third of their $24 billion income in
\ntax\u00a0\u2013 unlikely I\u00a0know\u00a0\u2013 that money could
\nfund 80,000 New York schoolteachers.
\n80,000.
\nWhat has this to do with doctors? At the
\nmeeting of National Medical Associations
\nthat we held in London we heard inspir-
\ning examples of how doctors are already
\nworking with communities to deal with the
\nsocial causes of ill-health. In India I\u00a0 was
\ntaken by medical colleagues to a tribal area
\nin Gujarat where the doctors are not only
\ntreating people who, hitherto, had no access
\nto health care, but are working with others
\nin community development and education
\nto improve the conditions of daily life for
\nmarginalised people. In Brazil, the social
\ngradient in stunting of young children is be-
\ncoming progressively flatter. In Bangladesh
\nand Peru inequalities in child mortality
\nare decreasing. I\u00a0am excited by the interest
\ngenerated in social determinants of health
\nglobally in every region of the world: South
\nAfrica, Zambia, Morocco, Colombia, Cuba,
\nCosta Rica, Panama, Surinam, Taiwan,
\nSweden, Norway, Finland, Iceland and \u2026
\nI\u00a0could go on.
\nColleagues, we can make a difference to the
\ncauses of the causes of health equity, as part
\nof the practice of medicine.There is another
\nway we can make a difference, too. I\u00a0do not
\ngo for long without quoting the great Ger-
\nman pathologist, Rudolf Virchow, who said
\nthat \u201cphysicians are the natural attorneys of
\nthe poor\u201d. We can, we do, we should speak
\nup about inequity in social conditions that
\ndamage the health of the populations that
\nwe serve.
\nIt means to,that we should recognise and be
\nvocal about any societal trends that are like-
\nly to affect health equity: climate change,
\ntrade, financial crises.
\nI hold a Bernard Lown visiting professor-
\nship at Harvard. Bernard Lown, great car-
\ndiologist and co-founder of International
\nPhysicians for the Prevention of Nuclear
\nWar, said: never whisper in the presence of
\nwrong. Already WMA speaks up in a loud
\nvoice about the highest ethical standards of
\nour profession. We should not whisper at
\nthe gross inequities in the world that give
\nrise to health inequities.
\nIn fact, so close is the link between social
\nconditions and health that, I\u00a0argue, health
\nequity is a good measure of social progress;
\nmuch better than income growth. Senator
\nRobert Kennedy in a famous speech criti-
\ncised Gross National Product as a measure
\nof social progress. He said:
\nthe gross national product does not allow for
\nthe health of our children, the quality of their
\neducation or the joy of their play. It does not
\ninclude the beauty of our poetry or the strength
\nof our marriages, the intelligence of our public
\ndebate or the integrity of our public officials. It
\nmeasures neither our wit nor our courage, nei-
\nther our wisdom nor our learning, neither our
\ncompassion nor our devotion to our country, it
\nmeasures everything in short, except that which
\nmakes life worthwhile.
\nHealth and health equity are not only
\nworthwhile in themselves but they reflect
\nmuch else that makes life worthwhile: the
\nfreedom to lead lives we have reason to
\nvalue.
\nAs doctors, at our best, we flourish in the
\ncause of social justice. There is a great deal
\nof injustice in the world. Can we really be
\noptimistic? Let me quote from Nobel Prize
\nwinning poet Seamus Heaney:
\nHistory says, don\u2019t hope
\nOn this side of the grave.
\nBut then, once in a lifetime
\nThe longed-for tidal wave
\nOf justice can rise up,
\nAnd hope and history rhyme.
\nSo hope for a great sea-change
\nOn the far side of revenge.
\nBelieve that further shore
\nIs reachable from here.
\nBelieve in miracle
\nAnd cures and healing wells.
\nI have had much reason to praise our medi-
\ncal students at the IFMS, and our junior
\ndoctors. In the spirit of Heaney I\u00a0 say to
\nour younger colleagues: believe in miracle
\nand cures and healing wells not just for our
\npatients but for society, too. If this sounds
\nidealistic I\u00a0remember the words of Halfdan
\nMahler,former Director-General of WHO,
\nwho said when we published the report of
\nthe Commission on Social Determinants
\nof Health: remember, idealists are the real-
\nists in human progress. I\u00a0have another poet
\nwho has been my companion. When we
\nlaunched the Commission on Social De-
\nterminants of Health in Santiago, Chile,
\nI\u00a0quoted Pablo Neruda. I\u00a0did again at each
\nreport we have published and I\u00a0do so again
\nnow. I\u00a0invite you to:
\nRise up with me\u2026
\nAgainst the organisation of misery.
\nBACK TO CONTENTS
\n126 127
\nWMA News WMA News
\nWednesday, October 14
\nAt the invitation of the Russian Medical
\nSociety, delegates from 58 National Medi-
\ncal Associations met at the World Trade
\nCenter in Moscow, Russia, October 14\u201317,
\nfor the WMA\u2019s 2015 General Assembly.
\nCouncil
\nDr. Ardis Hoven, Chair of the WMA,
\nopened the 201st
\nCouncil session.
\nThe Secretary General, Dr. Otmar Kloi-
\nber, welcomed delegates from the Russian
\nMedical Society and a new member of the
\nCouncil, Dr. Steve Hambleton (Australian
\nMedical Association).There were no formal
\napologies of absence.
\nSecretary General\u2019s report
\nDr. Kloiber referred to the written Coun-
\ncil report that set out the secretariat\u2019s work
\nover the past six months.
\nHe highlighted three items. First was
\nthe close co-operation with the World
\nHealth Organisation on the prevention
\nand control of non communicable diseas-
\nes. A workgroup was being set up on the
\nstrengthening of health care systems and
\nthe WMA needed help from NMAs to en-
\nsure that physicians were included on the
\nworkgroup.
\nThe second was the WMA influenza
\ncampaign and the need for the WMA to
\nlearn from the activities and campaigns of
\nNMAs. He reminded delegates that the
\ntwo targets of the campaign were to get a
\nhigher penetration of immunisation in the
\ngeneral population and more importantly to
\nget health professionals and especially phy-
\nsicians immunised. The immunisation rate
\nof health professionals in many countries
\nwas simply not high enough and they all
\nowed it to their patients and their families
\nto be vaccinated.
\nThe third item was the United Nations new
\nsustainable development goals, a series of
\nobjectives to improve the lives of people
\nthrough economic, social and environmen-
\ntal dimensions and the eradication of pov-
\nerty in all forms. The goals were adopted in
\nSeptember to cover the period from 2016
\nto 2030 and they replaced the Millennium
\nDevelopment Goals which had been aimed
\nmainly at developing countries with varied
\nsuccess.The new goals were more ambitious
\nand holistic and were aimed to apply to
\nall countries. There were 17 goals and 169
\ntargets and all were extremely ambitious.
\nIt was important for the WMA to reflect
\nthese goals and to co-operate.
\nEmergency Resolutions
\nThe Council then heard arguments for three
\nitems to be considered as matters of urgency.
\nAttacks in Turkey
\nThe Turkish Medical Association proposed
\na resolution calling for an end to recent at-
\ntacks on healthcare personnel, patients, and
\nhealth care facilities in Turkey. Delegates
\nheard that a physician, a nurse and an am-
\nbulance driver had been killed within the
\nlast two months and there had been attacks
\nagainst health care facilities and ambulanc-
\nes. There were curfews and the wounded
\nwere not able to access health care facilities.
\nPreventable deaths were occurring as a re-
\nsult. The emergency resolution called for all
\nparties involved to respect the professional
\nautonomy and impartiality of healthcare
\nstaff, and to comply fully with international
\nhuman rights law and other relevant inter-
\nnational regulations.
\nThe Council agreed that this matter should
\nbe accepted as an emergency resolution.
\nGlobal Refugee Crisis
\nThe British Medical Association said it was
\nvery difficult to overestimate the degree of
\nurgency of this matter. They had seen over
\nthe past year the numbers of refugees in-
\ncreasing significantly. Recently this had
\nworsened and every country was close to
\nbreaking point. Politicians appeared not to
\nknow how to handle the matter. The es-
\nsential issue was one of humanity and look-
\ning after the interests of people who were
\nsuffering. At the end of day this became a
\nhealth problem if they did not treat people
\nwith humanity.
\nThe Council agreed that this matter should
\nbe accepted as an emergency resolution.
\nAfghan Hospital Bombing
\nThe Spanish Medical Association intro-
\nduced a resolution about the recent bomb-
\ning of a hospital in Kunduz, Afghanistan.
\nIt argued that the WMA should condemn
\nthis bombing which went against the Dec-
\nlaration of Human Rights. The resolution
\ndemanded an immediate investigation by
\nan independent organisation and investiga-
\ntion into those who had committed this act.
\nDr. Kloiber reminded the meeting that
\nwhen the bombing occurred the WMA had
\nissued a press release joining in the con-
\ndemnation and Dr. Xavier Deau, the Presi-
\ndent, had said: \u2018This latest tragedy strength-
\nens our determination to ensure the safety
\nof hospitals, health care facilities, patients
\nand healthcare personnel during armed
\nconflicts. It underlines the importance of
\nour work with the International Committee
\nof the Red Cross to urge all governments to
\ndo more to ensure the safety of health care
\nin situations of violence. Tragedies such as
\nthis shame us all.
\nThe Council agreed that the proposed reso-
\nlution should be accepted as an emergency
\nresolution.
\nChair\u2019s Report
\nDr. Ardis Hoven gave a brief oral report,
\nsaying that the WMA had continued to
\nachieve significant global recognition for
\nthe value it brought to world medicine and
\nto physicians and their patients throughout
\nthe world. It was a highly recognised global
\nleader in health, particularly through the
\nwork with the Declaration of Helsinki.
\nSocio-medical affairs committee
\nDr. Miguel Roberto Jorge (Brazilian Medi-
\ncal Association) took the chair.
\nDr. Kloiber brought the committee up to
\ndate with three items.
\nThere had been some movement on tobacco
\ncontrol with a focus on the effect of tobacco
\non children, especially banning smoking in
\ncars. This was being recognised more and
\nmore by lawmakers. He urged national
\nmedical associations to approach their gov-
\nernments to work on legislation to better
\nprotect children.
\nOn alcohol, more and more governments
\nwere considering minimum pricing and
\nagain it would be good if as many NMAs
\nas possible could discuss this with their law-
\nmakers.
\nFinally, the WHO was developing a new
\nGlobal Strategy on Human Resources for
\nHealt, which represented a strategic vision
\ntowards universal health coverage within
\nthe framework of the UN sustainable de-
\nvelopment goals. More effort was needed
\nto involve physicians in the development of
\nhealth policies and he again urged NMAs
\nto stress this when meeting their govern-
\nments.
\nHealth and Environment
\nDr. Dongchun Shin (Korea), Chair of the
\nEnvironmental Caucus, reported on the ac-
\ntivities of the caucus that had met the day
\nbefore. The meeting focused on the forth-
\ncoming United Nations Climate Change
\nConference in Paris in December 2015.
\nThere was a fruitful exchange of informa-
\ntion on the activities planned by partici-
\npants within the framework of the event.
\nThey had been trying to put health at the
\ncentre of the negotiations. It was also an
\nopportunity to present and discuss WMA
\nactivities planned in connection with the
\nParis conference.
\nHealth Care in Danger
\nProf. Vivienne Nathanson (British Medi-
\ncal Association), chair of the Workgroup
\non Health Care in Danger, reported on the
\nactivities of the group, which had met the
\nday before. Dr. Bruce Eshaya-Chauvin, co-
\nordinator of the International Committee
\nof the Red Cross Health Care in Danger
\nProject (HCiD), had updated the group on
\nthe activities taken over the past six months
\nand had emphasized that the ICRC was
\nnow trying to promote a move from a com-
\nmunity of concern on HCiD issues to a
\ncommunity of action. From this perspec-
\ntive, the workgroup encouraged constituent
\nmembers to take up the initiative and would
\ninvite them to report on their activities in
\nthis area.
\nAgeing
\nDr. Nivio Moreira (Brazilian Medical As-
\nsociation) reported on the activities of the
\nworkgroup that had been set up with the
\nmandate to produce a proposed policy on
\nageing.The members had worked on a pre-
\nliminary draft via email with the support
\nof an expert, Dr. Alexandre Kalache, and
\nwas now suggesting that the draft should
\nbe circulated to national medical associa-
\ntions.
\nThe committee agreed with this proposal.
\nRole of Physicians in Preventing the Traffick-
\ning with Minors and Illegal Adoptions
\nThe Spanish Medical Association reported
\nthat the workgroup had met the previous
\nday and discussed a preliminary draft which
\nit suggested should be finalized and submit-
\nted to the Council for consideration in Bue-
\nnos Aires next April.
\nThis was agreed by the committee.
\nPhysicians\u2019 Well-being
\nThe committee considered the proposed
\nStatement on Physicians\u2019 Well-being
\nwhich was introduced by Dr. Robert Wah
\n(American Medical Association), Chair of
\nthe Workgroup. The committee considered
\nseveral proposed amendments. One was a
\nsuggestion that because physicians suffer-
\ning ill health often tried to treat themselves
\nthey should get the right diagnosis from the
\nmost experienced physician in their depart-
\nment of practice. However, this suggestion
\nwas voted down.
\nAnother amendment was to change the
\nwording of the document to refer to \u2018edu-
\ncation\u2019 rather than \u2018training\u2019. It was argued
\nthat physicians were under considerable
\nrisk of losing their professional autonomy
\nand clinical independence. This was mainly
\ndone with words and the medical profession
\nwas in danger of being seen as a technical
\nservice. It was important therefore to talk
\nabout \u2018educating\u2019 physicians rather than
\n\u2018training\u2019physicians. It was agreed to review
\nthis point before the Council meeting on
\nFriday.
\nThe committee agreed that the document
\nshould be sent to the Council and then for-
\nwarded to the Assembly for adoption.
\nWMA 2015 General Assembly Report
\nMoscow, Russian Federation, October 14\u201317
\nBACK TO CONTENTS
\n128 129
\nWMA News WMA News
\nSmallpox Destructions
\nThe committee considered a proposed
\nStatement on the Destruction of Smallpox
\nVirus Stockpiles from the Junior Doctors
\nNetwork. It was proposed that the docu-
\nment be considered by a small workgroup.
\nBut the document failed to win support and
\nit was decided that the document should
\nnot be approved.
\nTransgender
\nThe Committee considered a proposed
\nStatement on Transgender People intro-
\nduced by the German Medical Association.
\nThe committee was told that the document
\nwas intended to serve as a guideline for pa-
\ntient-physician relations and to foster better
\ntraining to enable physicians to increase their
\nknowledge and sensitivity toward transgen-
\nder people. It acknowledged the inequities
\nfaced by the transgender community and the
\ncrucial role played by physicians in advising
\nand consulting with transgender people and
\ntheir families about desired treatments. Al-
\nthough the proposers of the document were
\naware of the cultural sensitivities in some
\nparts of the world with regard to this issue,
\nit was important for the WMA to stress
\nthat cultural, political or religious consid-
\nerations must not take precedence over the
\nrights, health and well-being of transgender
\npeople, or any patient for that matter. The
\nGerman Medical Association argued that
\nalthough the paper provided context by
\nbriefly addressing some of the broader so-
\ncial issues faced by transgender people, the
\noverall scope of the paper, and especially the
\nrecommendations, was focused on the role
\nof the physician and the healthcare system
\nat large in providing equitable treatment to
\ntransgender people. It was important for the
\nmedical community to highlight the poten-
\ntial health effects of negative social attitudes,
\nstigmatisation and discrimination towards
\nthe transgender community.
\nDuring the debate that followed it was
\nexplained that the issue of intersexuality
\nshould not be incorporated into this docu-
\nment but should be the subject of a separate
\npaper, which the Royal Dutch Medical As-
\nsociation had volunteered to prepare.
\nThe committee agreed to the document
\nbeing sent to the Council for forwarding
\nto the General Assembly for approval and
\nadoption.
\nVitamin D Insufficiency
\nThe committee considered the proposed
\nStatement on Vitamin D Insufficiency.This
\nurged national medical associations to sup-
\nport continued research into vitamin D de-
\nficiency which affected about a third of the
\npopulation.
\nThe committee agreed that the Statement
\nbe sent to the Council for approval and
\nthen forwarded to the General Assembly
\nfor adoption.
\nMass Media Appearances
\nThe committee considered proposed guide-
\nlines on Mass Media Appearances by Phy-
\nsicians, introduced by the Korean Medi-
\ncal Association. It was explained that the
\ndocument arose from serious concern over
\nthe increase of physicians\u2019 appearing on
\nthe mass media to recommend unproven
\ntreatments or products.The guidelines were
\naimed at preventing physicians from being
\ninvolved in commercial activities that might
\ncompromise professional ethics.They would
\nalso contribute to patient safety by ensuring
\nphysicians provided accurate, timely, and
\nobjective information.
\nDuring a debate, it was decided to amend
\nthe document to include the phrase that
\nphysicians should not introduce false fr ex-
\naggerated statements regarding their quali-
\nfications.
\nDiscussion also took place on the docu-
\nment\u2019s statement that \u2018When appearing in
\nmedia, physicians shall provide objective
\nand evidence-based information and shall
\nnot recommend medical procedures or
\nproducts that are not medically proven.\u2019 It
\nwas decided to leave in the words \u2018evidence-
\nbased information\u2019 but add the words \u2018or
\njustified\u2019 at the end of the sentence.
\nThe committee agreed to amend the docu-
\nment to say that \u2018Physicians should not
\nrecommend specific products\u2019 rather than
\n\u2018physicians should not recommend specific
\nfoods or health supplements\u2019. The commit-
\ntee also debated whether the wording that
\n\u2018Physicians shall not engage in the pro-
\nmotion, sale or advertising of commercial
\nproducts\u2019 should be changed to \u2018Physicians
\nshould take great care when engaging in the
\npromotion\u2026.\u2019But on a close vote it was de-
\ncided to keep the wording unchanged.
\nIt was also decided to change the title of the
\ndocument to \u2018Guidelines on Promotional
\nMass Media Appearances by Physicians\u2019.
\nThe committee agreed that the proposed
\nguidelines, as amended, be sent to the
\nCouncil for approval and forwarded to the
\nGeneral Assembly for adoption.
\nBoxing
\nThecCommittee considered a proposed
\nmajor revision of the WMA Statement on
\nBoxing submitted by the South African
\nMedical Association.
\nIt was agreed that the document be circu-
\nlated among constituent members for com-
\nment.
\nTobacco
\nThe committee considered a proposed revi-
\nsion of the WMA Resolution on the Imple-
\nmentation of the WHO Framework Con-
\nvention on Tobacco Control produced by
\nthe Australian Medical Association aimed
\nat encouraging national medical associa-
\ntions to get their governments to imple-
\nment the Framework and in particular to
\nintroduce a ban on smoking in enclosed
\npublic places and work places.
\nIt was agreed that the document be circu-
\nlated among national medical associations
\nfor comment.
\nFemale Genital Mutilation
\nThe committee considered a proposed revi-
\nsion of the WMA Resolution on Female
\nGenital Mutilation prepared by the British
\nMedical Association, encouraging national
\nmedical associations around the world to
\nbecome more active in campaigning to end
\nthe practice.
\nIt was agreed that the document be circu-
\nlated among constituent members for com-
\nment.
\nBody Searches of Prisoners
\nThe committee considered a proposed re-
\nvision of the WMA Statement on Body
\nSearches of Prisoners, also prepared by the
\nBritish Medical Association.
\nThe committee again agreed that the docu-
\nment be circulated among constituent
\nmembers for comment.
\nWorkers\u2019 Health & Safety
\nThe committee considered a proposed Res-
\nolution on Occupational Health & Safety
\nsubmitted by the Turkish Medical Asso-
\nciation, as well as a proposed Declaration
\non responsibility of employers for workers\u2019
\nhealth protection and occupational safety
\nsubmitted by the Russian Medical Society.
\nA proposed Declaration on Protection of
\nHuman Reproductive Health which ad-
\ndressed health reproductive issues in rela-
\ntion to challenging working condition, was
\nalso considered.
\nThe committee decided to recommend to
\nthe Council that a workgroup on Occupa-
\ntional Health be set up with the mandate
\nto look at the three proposed policies with
\nthe aim of preparing a single proposal,if ap-
\npropriate.
\nArmed Conflicts
\nThe committee then considered three pro-
\nposed Declarations \u2013 two from the Rus-
\nsian Medical Society on Priority of Human
\nLife and Health in Resolution of Territo-
\nrial Disputes and Armed Conflicts and on
\nChildren\u2019s Rights to Prioritized Evacuation,
\nMedical & Humanitarian Aid in the Areas
\nof Local Armed Conflict. A third proposed
\nDeclaration on Triggering and Carrying out
\nArmed Conflicts as a Measure of Achieving
\nObjectives of State Politics was submitted
\nby the Polish Medical Chamber.
\nIt was agreed that a workgroup be set up
\nwith the mandate to look at the three pro-
\nposals with the aim of preparing a single
\nproposal, if appropriate.
\nLife Environment
\nA proposed Declaration on Maintaining
\nSafety of Life Environment for Human
\nHealth, submitted by the Russian Medical
\nSociety, was briefly considered, but failed to
\nfind support.
\nPhysicians\u2019 Right to Information
\nThe committee considered a proposed Dec-
\nlaration on Physicians\u2019 Right to Information
\nabout the World Medical Association and
\nits Policies submitted by the Russian Medi-
\ncal Society. Its aim was to increase awareness
\nabout WMA policies among physicians.
\nThe committee agreed that the document
\nbe circulated to constituent members for
\ncomments.
\nProfessional Autonomy of Physicians
\nThe committee considered a proposed Dec-
\nlaration on Professional Autonomy of Phy-
\nsicians as the Main Condition for Imple-
\nmentation of the Human Right to Health
\nsubmitted by the Russian Medical Soci-
\nety and it was agreed that it be circulated
\namong constituent members for comments.
\nObesity in Children
\nThe committee considered a proposed State-
\nment on Obesity in Children proposed by
\nthe Israeli Medical Association. It was ex-
\nplained that the document brought together
\ndifferent aspects to combat childhood obe-
\nsity, such as education and economic incen-
\ntives through taxes on unhealthy foods.
\nIt was agreed that the proposed Statement
\nbe circulated among constituent members
\nfor comments.
\nAdvocacy
\nDr. Andr\u00e9 Bernard (Canadian Medical As-
\nsociation), Chair of the Advocacy Advisory
\nCommittee, reported on the activities of the
\nCommittee that had met the day before.
\nThe committee had discussed the issue of
\nsocial media and the use of twitter during
\nWMA meetings.
\nIt had also considered the proposal for an
\nInternational World Day on Combatting
\nViolence and it was agreed to explore what
\nopportunities might be provided by the
\nWorld Humanitarian Summit in 2016 to
\norganise an event.
\nFinally the committee considered how to
\nbuild on the success of the advocacy session
\nheld in Durban in 2014, and agreed to con-
\ntact the Taiwanese Medical Association to
\ndiscuss the possibility of holding an advoca-
\ncy training session during the next General
\nAssembly in Taiwan in 2016.
\nAttacks against Healthcare workers and facili-
\nties in Turkey
\nThe committee considered the proposed
\nurgent Resolution to stop attacks against
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\nWMA News WMA News
\nhealthcare workers and facilities in Turkey.
\nFollowing an explanation from the Turkish
\nMedical Association and a brief debate, it
\nwas agreed that the proposed Resolution be
\nsent to the Council for forwarding to the
\nGeneral Assembly for approval and adop-
\ntion.
\nGlobal Refugee Crisis
\nThe committee considered the proposed
\nurgent Resolution on the Global Refugee
\nCrisis submitted by the British Medical
\nAssociation. Delegates were told it was
\nimportant that the WMA made the
\npoint that refugees were people and as
\npeople they were suffering. Doctors un-
\nderstood the suffering that had caused
\nthem to becoge refugees. The process of
\nbeing a refugee was worsening this suf-
\nfering. They needed to be treated with
\nhumanity. Yet much of the international
\ndebate had been very alienating. This was
\nan opportunity to switch the tenure of
\nthe debate.
\nThe committee agreed that the Resolution
\nas amended be sent to the Council and
\nforwarded to the General Assembly for ap-
\nproval and adoption.
\nBombing of the hospital run by M\u00e9decins Sans
\nFronti\u00e8res in Kunduz, Afghanistan
\nThe committee considered the proposed
\nurgent resolution on the bombing of the
\nhospital of M\u00e9decins Sans Fronti\u00e8res in
\nKunduz, Afghanistan submitted by the
\nSpanish and South African medical as-
\nsociations. The meeting heard of the con-
\ncern about continued attacks on health
\ncare workers and facilities around the
\nworld. The recent bombing of the hospi-
\ntal in Kunduz attested to this particular
\nconcern. It was important that the WMA
\nAssembly was part of the cry around the
\nworld to advocate for the setting up of an
\nindependent body to investigate the cir-
\ncumstances of the bombing of this hos-
\npital.
\nIt was agreed that the proposed resolution
\nbe approved and sent to the Council for for-
\nwarding to the General Assembly for ap-
\nproval and adoption.
\nMedical ethics committee
\nDr. Heikki P\u00e4lve (Finland Medical Asso-
\nciation) took the chair.
\nThe committee meeting opened with
\nDr.\u00a0Kloiber reporting on four items:
\nFirst,Hhe said that an international discus-
\nsion was taking place on end of life care,
\neuthanasia and physician assisted suicide
\nand the WMA had to enter the debate.The
\nWMA would organise a session on this
\ntopic at the Bioethics, Medical Ethics and
\nHealth Law Conference in Naples the fol-
\nlowing week.
\nSecond, he said the revised Declaration of
\nHelsinki had been discussed at many in-
\nternational conferences and very positively.
\nThe University of Harvard had now invited
\nthe WMA to speak about post-trial access
\nto care.
\nNext, the Olympic Committee had invited
\nthe WMA to take part in the revision pro-
\ncess of the Olympic Medical Code of Eth-
\nics and submit comments.
\nFinally, he said that the WMA was in-
\nvolved in the discussion at the WHO on
\nthe regulatory aspects of biosimilars, which
\ndealt with the classification, remunera-
\ntion systems and bioethics of biosimilars.
\nThe European Union had also invited the
\nWMA to speak about the ethical aspects of
\nbiosimilars.
\nDr. Jeff Blackmer (Canadian Medical As-
\nsociation) reported that the CMA and the
\nRoyal Dutch Medical Association were
\nworking on a paper to address end of life
\ncare and assisted dying. This would be pre-
\nsented in 2016.
\nPerson Centered Medicine
\nThe committee received an oral report
\nfrom the Chair of the Workgroup on
\nPerson Centred Medicine, Dr. Andrew
\nDearden (British Medical Association).
\nHe said the workgroup would develop a
\nnew policy to be presented at the Coun-
\ncil meeting in Buenos Aires in April
\n2016. This would be based on comments
\npreviously submitted on the draft polics
\npresented to the committee in Tokyo in
\n201, and the workgroup\u2019s background
\npaper.
\nHealth Databases
\nThe committee received an oral report
\nfrom Dr. Jon Sn\u00e6dal (Iceland Medical
\nAssociation), Chair of the Workgroup
\non Health Databases and Biobanks. The
\nWMA had received 90 comments from
\ninternational experts in response to a pub-
\nlic consultation on the workgroup\u2019s draft
\npaper this year. This was followed by a
\nseries of meetings. The next meeting to
\ndiscuss the topic would take place during
\nthe Bioethics, Medical Ethics and Health
\nLaw Conference in Naples. A workgroup
\nexpert meeting in Korea was planned for
\nFebruary 2016, along with a satellite ses-
\nsion during the World Congress of the
\nInternational Association of Bioethics in
\nEdinburgh in June 2016. It was hoped to
\nhave a draft version ready for discussion at
\nthe next Council meeting in Buenos Aires
\nin April 2016.
\nInclusion of Medical Ethics and
\nHuman Rights in the Curriculum
\nof Medical Schools
\nThe rapporteur, Prof. Vivienne Nathanson,
\nasked the committee to consider the revised
\nversion of the WMA Resolution on Inclu-
\nsion of Medical Ethics and Human Rights
\nin the Curriculum of Medical Schools,
\nwhich had been sent out for comments to
\nWMA members as part of the annual poli-
\ncy review. During a debate, delegates made
\nseveral detailed amendments to the word-
\ning.
\nThe committee agreed that the proposed
\nResolution, as amended, be sent to the
\nCouncil with the recommendation that it
\nbe forwarded to the General Assembly for
\nadoption.
\nDeclaration of Geneva
\nThe proposed revision of the Declaration of
\nGeneva was introduced by Dr. Ramin Parsa-
\nParsi (German Medical Association), Chair
\nof the workgroup. He asked the WMA\u2019s
\nethics adviser Prof. Urban Wiesing to report
\non the issue. Prof. Wiesing reminded the
\nmeeting that the Declaration was written
\nand adopted in 1948 as an answer to World
\nWar Two and the atrocity of physicians dur-
\ning the Nazi regime. It was intended as a
\nsubstitute to the Hippocratic Oath and was
\none of the most important documents of the
\nWMA.The Declaration had undergone mi-
\nnor amendments on several occasions. The
\ndecision to consider revising the document
\nwas not a response to any controversy. It was
\nsimply to investigate whether the document
\nwas still up to date. He outlined a number of
\nareas that might be examined.
\nThe workgroup recommended that the
\ncommittee start a careful revision process
\nand revise the policy only where there were
\nstrong arguments for a change.
\nThe committee agreed that the workgroup
\nshould proceed with its review process.
\nNon-discrimination in Professional Member-
\nship and Activities of Physicians
\nThe committee considered a proposed
\nminor revision to the Statement on Non-
\ndiscrimination in Professional Membership
\nand Activities of Physicians.
\nThe committee agreed that the revision of
\nthe proposed Statement, as amended, be
\nsent to the Council for forwarding to the
\nGeneral Assembly for adoption.
\nHCiD Toolkit for Doctors
\nThe committee considered the WMA pro-
\nposal for a toolkit for doctors working in
\nsituations of violence.
\nThe committee agreed that this be approved,
\nand that its publication on the WMA web-
\npage as an educational tool be approved by
\nthe Council.
\nMental Illness
\nThe committee considered the proposed
\nrevision of the WMA Statement on Ethi-
\ncal Issues concerning Patients with Mental
\nIllness. The guidelines were revised to take
\naccount of the progress in psychiatric treat-
\nment which now allowed for better care of
\npatients with mental illness.
\nThe committee decided that the document,
\nas amended, be approved by the Council
\nwith the recommendation that it be for-
\nwarded to the General Assembly for adop-
\ntion.
\nStatement on Conflict of Interest
\nThe committee considered a proposal for
\nrewording the WMA Statement on Con-
\nflict of Interest to align the policy with the
\nDeclaration of Helsinki. This was accepted
\nas an editorial amendment.
\nProtection of human reproductive health
\nThe committee considered a proposed revi-
\nsion of the WMA Declaration on Protec-
\ntion of Human Reproductive Health to
\nfurther complement the existing WMA
\npolicies on reproductive health.
\nIt agreed that the proposed Declaration be
\nreferred to the workgroup on occupational
\nhealth.
\nThe Participation of Physicians in Pre-natal
\nGender Selection
\nThe committee considered the proposed
\nWMA Resolution on the Participation of
\nPhysicians in Pre-natal Gender Selection
\nand it was agreed that the proposed Resolu-
\ntion be circulated to constituent members
\nfor comment.
\nHuman Rights
\nClarisse Delorme, WMA Advocacy Ad-
\nvisor, reported that the WMA had been
\ninvited by the UN Special Rapporteur on
\nTorture to participate in an expert meet-
\ning that would inform the drafting of a
\nnew thematic report by the United Na-
\ntions Special Rapporteur on Torture and
\nOther Cruel, Inhuman and Degrading
\nTreatment or Punishment, Professor Juan
\nE. M\u00e9ndez. The report would address
\ngender perspectives on torture and other
\ncruel, inhuman or degrading treatment or
\npunishment.
\nFinance and Planning Committee
\nDr. Dongchun Shin (Korean Medical As-
\nsociation) took the chair
\nFinancial Statement
\nThe Audited Financial Statement for 2014
\nwas agreed by the committee and sent to
\nthe Council for forwarding to the General
\nAssembly for approval and adoption.
\nWMA Budget and Membership Dues Pay-
\nments
\nThe budget for 2016 was agreed and sent to
\nthe Council for forwarding to the General
\nAssembly for approval and adoption.
\nThe committee also received the Dues Cat-
\negories 2016 and it was agreed to recom-
\nmend to the Council that this be forwarded
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\nWMA News WMA News
\nto the General Assembly for its informa-
\ntion.
\nStrategic Plan
\nDr. Shin referred to the fact that the cur-
\nrent WMA Strategic Plan was valid until
\nthe end of 2015 and should then be re-
\nnewed. The Secretary General suggested
\ndeveloping the Strategic Plan for the period
\n2016-2020 in a way which would enable the
\nWMA to be recognized as global medical
\nleaders and to increase its capacity to act,
\nrespond and lead. He said the strategic aims
\nhad to be supported by stronger business
\ndevelopment, allowing the Association to
\ngrow without limiting its independence.
\nThe committee agreed that the Secretariat
\nshould develop a Strategic Plan for 2016-
\n2020, coordinating with the Business De-
\nvelopment Group, and should report back
\nto the Council in Buenos Aires in April
\n2016.
\nBusiness Development
\nThe committee received an oral report and a
\nwritten report from Dr. Dearden, the Chair
\nof the Business Development Group. Dr.
\nDearden said the paper was not final but
\nrather was intended to provide direction.
\nThe committee recommended that the re-
\nport be approved by the Council.
\nWMA Statutory Meetings
\nThe committee considered arrangements
\nfor future WMA meetings. The Confeder-
\naci\u00f3n M\u00e9dica de la Rep\u00fablica Argentina re-
\nviewed plans for the 2016 Council Session
\nin Buenos Aires and the Taiwan Medical
\nAssociation welcomed delegates to attend
\nthe 2016 General Assembly in Taipei.
\nThe committee agreed to recommend the
\nCouncil to approve that the venue for the
\n209th
\nCouncil session in April 2018 be Riga,
\nLatvia.
\nWMA Special Meetings
\nThe committee received an oral report
\nfrom the Secretary General concerning two
\nmeetings. Firs aOne Health Conference
\nheld in Madrid in May 2015 was successful.
\nIt was planned to hold the next conference
\nin Japan in 2017. Secony, the H20+ Health
\nSummit in 2015, which was planned to be
\nheld in Turkey, could not take place due to
\nplanning constraints. There was a strong
\ncommon interest with the Turkish Medi-
\ncal Association (TMA) in the health of
\nrefugees and the Secretary General said he
\nwould look into the possibility of organiz-
\ning a meeting on 4this issue together with
\nthe TMA. He was also exploring the pos-
\nsibility of a H20+ Health Summit in 2016
\nin China.
\nThe committee agreed to recommend to the
\nCouncil that planning for the One Health
\nConference with the World Association of
\nVeterinarians in spring 2017 in Japan be
\ncontinued in cooperation with the Japan
\nMedical Association and the Japan Veteri-
\nnarians Association and that the Council
\nauthorizes the Secretariat to continue to
\norganize the H20+ Health Summit in 2016.
\nMembership
\nThe committee considered an application
\nfrom the Panhellenic Medical Association
\nand agreed to recommend to the Coun-
\ncil that the Association be admitted into
\nWMA membership.
\nGovernance Review
\nDr. Andr\u00e9 Bernard, on behalf of the Ca-
\nnadian Medical Association, proposed that
\na workgroup be established to review the
\ngovernance of the WMA. It should have a
\nbroad membership representation, includ-
\ning the Associate Membership, to examine
\npossibilities for a governance review.
\nThe committee recommended that the
\nCouncil approve the proposal..
\nThursday, October 15
\nAssociate members
\nDr. Joseph Heyman (American Medical
\nAssociation) took the chair.
\nThe meeting received reports on the Junior
\nDoctors Network from Dr. Elizabeth Wi-
\nley, JDN Deputy Chair, and on the Past
\nPresidents and Chairs of Council Network
\nfrom Dr. Jon Snaedal.
\nGlobal Medical Electives
\nA proposed Statement on Ethical Consid-
\nerations in Global Medical Electives was
\npresented by Dr. Xaviour Walker on behalf
\nof the JDN and the committee agreed that
\nthe Statement be considered by the General
\nAssembly.
\nFossil Fuel Development
\nThe meeting considered a proposed State-
\nment on Fossil Fuel Development pre-
\nsented by Dr. Peter Orris. A brief debate
\ntook place on the recommendation that
\nNMAs and other health organisations
\nshould begin a process of transferring
\ntheir investments from energy companies
\nwhose primary business relied on fossil
\nfuels to those providing renewable energy
\nsources.
\nThe committee agreed that the document as
\namended should be sent to the General As-
\nsembly for consideration.
\nScientific session
\nThe theme of the session was \u2018Medical Edu-
\ncation\u2019, with speakers from all parts of the
\nglobe addressing the meeting.
\nThe morning session opened with a speech
\nfrom President elect Sir Michael Marmot,
\nwho spoke about \u2018Social determinants of
\nhealth in undergraduate and postgraduate
\neducation\u2019.
\nHe talked about social justice, political em-
\npowerment and creating the conditions for
\npeople to have control of their lives. He
\nidentified six policy recommendations to
\nachieve this \u2013 giving every child the best
\nstart in life, enabling all children, young
\npeople and adults to maximise their capa-
\nbilities and have control over their lives,
\ncreating fair employment and good work
\nfor all, ensuring a healthy standard of liv-
\ning for all, creating and developing healthy
\nand sustainable places and communities
\nand strengthening the role and impact of
\nill health prevention. He illustrated his talk
\nwith statistics on life expectancy, under five
\nmortality, global disability and obesity. And
\nhe ended with the words \u2018Health is a Hu-
\nman Right. Do Something. Do more. Do
\nbetter\u2019.
\nProfessor David Gordon, President of the
\nWorld Federation for Medical Education,
\ntitled his speech \u2018Trends in Medical Edu-
\ncation: sometimes getting better, sometimes
\ngetting worse\u2019. He described medical edu-
\ncation as sometimes well planned, some-
\ntimes chaotic. He said the Federation was
\nnot primarily concerned with the detail of
\neducation and how it was taught, but more
\nwith the quality, management, organisation,
\nsupport and delivery of medical education.
\nAnd he spoke about the current growth of
\nmedical schools which was often bad and
\nuncontrolled.
\nProfessor Kenji Matsubara, Vice President
\nof the Japanese Medical Association, spoke
\nabout the CME system in Japan and said
\nthat continuing professional development
\nwas not carried out at the behest of oth-
\ners, but was rather pursued of one\u2019s own
\naccord to provide patients with safe and
\nhigh quality health care. Physicians had a
\nresponsibility to broaden their knowledge,
\nimprove their skills and continuously de-
\nvote themselves to study throughout their
\nlives in order to practice constantly advanc-
\ning medicine and health care. Physicians
\nshould be motivated to pursue a lifelong
\neducation on their own initiative. This was
\nwhy the Japanese Medical Association pro-
\nvided CME programmes to facilitate effec-
\ntive self-learning and training. Its purpose
\nwas to further raise physicians\u2019 desire for
\ntraining and to increase the public\u2019s trust by
\nhighlighting physicians\u2019 efforts to study.
\nDr. Robert Wah, Past President of the
\nAmerican Medical Association, spoke
\nabout accelerating change in medical edu-
\ncation and the medical school of the future
\nwith programmes focused on team-based
\ncare, population health and chronic disease
\nmanagement. He referred to the impor-
\ntance of technology to enhance learning
\nand the use of big data to understand health
\noutcomes. Dr. Leonid Eidelman, President
\nof the Israel Medical Association, spoke on
\nMedical Education in a Post-Modern Era
\nand compared modernist theory with post-
\nmodern theory. He said that each genera-
\ntion of medical students came with differ-
\nent expectations, different learning needs
\nand different styles. Today\u2019s Millennials,
\nborn after 1982 did better when given
\nspecific goals but needed constant stimula-
\ntion and direction. They wanted constant
\nfeedback and were interested in balancing
\npersonal and professional lives. He referred
\nto the extent of burnout among physicians
\nand said this was strongly associated with
\nmedical errors, prescribing habits and pa-
\ntient compliance.
\nHis conclusion was that the postmodern
\nera called for recognition of generational
\ndifferences and that adjustments to new
\nstyles could lead to better working condi-
\ntions, better patient care, delayed burn out
\nand professional fulfilment.
\nProfessor Lizo Mazwai, President of the
\nSouth African Medical Association, gave
\na talk entitled \u2018Transformation of Medi-
\ncal Education for the 21st
\nCentury\u2019. He
\nreferred to the five star doctor as being a
\ncare provider, a decision maker, communi-
\ncator, community leader and manager. He
\nsaid that the principles of medical educa-
\ntion or training would always evolve due to
\ninfluences of socio economic factors, disease
\nprofiles and the expanding role of science
\nand technology. The challenge was to adapt
\ncurricula to be relevant both locally,regional
\nand globally. Internationalisation of health
\nand globalisation of resources demanded
\nthat medical schools should continue to
\nshare knowledge and technology more for
\nbetter equipped doctors.
\nProfessor Florentino Cardoso, President
\nof the Brazilian Medical Association,
\nspoke about the importance of continuing
\nmedical education and the motivations for
\nlearning, while Professor Gia Lobhanidze,
\nChairman of the Georgian Medical Asso-
\nciation spoke about medical education in
\nGeorgia going back to 1919. He looked at
\nthe problems today, following the privati-
\nzation of medical institutions. As a result
\nthere were almost no university clinics,
\npoor mastering of clinical proficiency and
\na low quality of undergraduate and post
\ngraduate education.
\nProfessor Steve Hambleton, Immediate
\nPast President of the Australian Medical
\nAssociation, spoke about medical education
\nin Australia and the way it was embracing
\ndigital transformation. He referred to the
\ncountry\u2019s workforce and said there was a
\nhigh reliance on international health pro-
\nfessionals. There was a growing trend to-
\nwards specialisation and the medical train-
\ning pathway was poorly co-ordinated. The
\nGovernment was now investing in digital
\nhealth and this would enhance e-learning.
\nProfessor Sun Baozhi, from the Research
\nCenter for Medical Education and China
\nMedical University, spoke about his coun-
\ntry\u2019s handling of medical education, the
\nprogress made over the past 100 years and
\nthe challenges faced by the country over
\nthe past three decades. These included skill
\nimbalances and the shortage of nurses and
\nan insufficiency of education resources for
\nstudents.
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\nWMA News WMA News
\nClimate change
\nDuring a workshop session on climate change,
\nDr. Todd Sack, editor of My Green Doctor
\nand a gastroenterologist in Jacksonville, Flor-
\nida, talked about bringing environmental sus-
\ntainability to medical offices. He spoke about
\ncreating a healthier office and community
\nwith employee participation and team build-
\ning.He described a practice management tool
\nfor medical offices and said that My Green
\nDoctor showed offices how to create and
\nmanage an office green team. The result was
\na saving of money and a greener environment.
\nFriday, October 16
\nAdjourned council
\nThe Council resumed under the Chair
\nDr.\u00a0 Hoven to consider reports from the
\nthree committees.
\nSocio-medical affairs committee
\nPhysicians\u2019 Well-Being
\nFollowing on the debate in the committee
\nabout using the word \u2018education\u2019rather than
\n\u2018training\u2019, the Council approved amend-
\nments to the document.
\nA proposal was also made to delete a para-
\ngraph relating to physician autonomy that
\nread: \u2018Physician autonomy is one of the
\nstrongest predictors of physician satisfac-
\ntion. Increasing external regulatory pres-
\nsures such as undue emphasis on cost effi-
\nciencies and concerns about consequences
\nof reporting medical errors may unduly
\ninfluence medical decision-making and di-
\nminish a physician\u2019s autonomy.\u2019 It was ar-
\ngued that it was reasonable for physicians
\nto be cost efficient and to look into adverse
\nevents when they occurred.This was part of
\ntheir professional life. However, the propos-
\nal was defeated and the Council approved
\nthe document as amended and agreed that
\nit should be forwarded to the General As-
\nsembly for adoption.
\nMass Media Appearances
\nThe Council approved the proposed Guide-
\nlines.
\nThe remainder of the Socio-Medical Af-
\nfairs Committee report was approved by the
\nCouncil.
\nMedical ethics committee
\nThe Medical Ethics Committee report was
\napproved by the Council.
\nFinance and planning committee
\nThe Finance and Planning Committee re-
\nport was approved by the Council.
\nAssociate members
\nThe Chair,Dr.Joseph Heyman,said progress
\nhad been made in making Associate mem-
\nbership more meaningful, including more
\nconference calls, an educational webinar and
\na web forum for members. Calling for an in-
\ncrease in membership, he repeated what he
\nhad said before that no-one would be Coun-
\ncil membes for ever, but they could be Asso-
\nciate members for the rest of their lives.
\nJunior Doctors Network
\nDr. Ahmet Murt, Chair of the JDN, re-
\nported that junior members were now at-
\ntending the World Health Assembly meet-
\nings. The network had developed a close
\nworking relationship with the World Fed-
\neration of Medical Education. The juniors
\nhad published three newsletters and were
\nconsidering other publications. They were
\nalso organising more regional meetings and
\nactivities and following the WHO regional
\ncommittee meetings.
\nWorld Medical Journal
\nDr. Peteris Apinis, Editor in Chief of the
\nWMJ, said that this was the 61st
\nyear of the
\npublication of the World Medical Journal.
\nIt was the first year that the Journal has been
\npublished digitally,although they continued
\nto print 50 hard copies of the Journal to
\nmail to the WMA office and leading librar-
\nies. He said he intended to pursue the idea
\nof making a photo album featuring snap-
\nshots of various WMA events. The length
\nof the Journal remained unchanged\u00a0 \u2013 40
\npages plus a cover page. The contents had,
\nhowever, changed with more focus on opin-
\nion leaders and interviews.
\nAssembly ceremonial session
\nThe President, Dr. Xavier Deau, called to
\norder the Ceremonial Session.
\nThe Secretary General, Dr. Otmar Kloi-
\nber, welcomed the Honourable Dr. Tatiana
\nVladimirovna Yakovleva, Deputy Minister
\nof Health of the Russian Federation, Prof.
\nMikhail Paltsev, Chief Academic Secre-
\ntary of the Russian Academy of Sciences,
\nProf. Natalia Narotchnitskaya, Director of
\nthe Institute of International Collabora-
\ntion, Mr. Igor Khalevinskiy, President of the
\nRussian Association of Diplomats, Mr. An-
\ndre Mankowskiy, Chairman of the Guard-
\nianship Board of the Russian Medical So-
\nciety, Mr. Timofey Nizhegorodtsev, Head
\nof Department of the Social Sphere of the
\nAnti-Monopoly Service, Mr. Sergey Mura-
\nvyov, Head of Department of International
\nCollaboration of the Ministry of Health of
\nRussia,The Honorable Sir Tim Barrow, UK
\nAmbassador to the Russian Federation and
\nthe Honourable Mr. Kamil Mohamed Ali,
\nAmbassador of the Republic of Djibouti.
\nHe went on to introduce the official delega-
\ntions from each of the Constituent Mem-
\nbers present, as well as the observers from
\nnon-member medical associations and in-
\nternational organizations.
\nThe Honourable Dr. Tatiana Vladimirovna
\nYakovleva, Deputy Minister of Health of
\nthe Russian Federation, officially welcomed
\ndelegates to the 66th
\nGeneral Assembly, say-
\ning that it was an opportunity for a valuable
\nexchange of views and professional discus-
\nsion. She went on to stress that universal
\naccess to healthcare and improvements in
\nthe quality of medical services were the
\nresponsibility of the State, society and the
\nmedical community, and the importance of
\ncooperation between governmental bodies
\nand the medical community. She stated that
\nthe Russian Ministry of Health cooperated
\nclosely with medical professional bodies in
\nthe development of regulation, the develop-
\nment and approval of clinical recommenda-
\ntions on health issues, CPD, licensing and
\nregistration, policy development, health in-
\nsurance and medical ethics. She described
\nrecent developments in Russia leading to-
\nwards autonomous regulation of the medi-
\ncal profession, the representative organisa-
\ntion being the Russian Medical Chamber.
\nProf. Vladimir Dmitrievich Parshin, Presi-
\ndent of the Russian Medical Society, then
\naddressed the Assembly. He spoke about
\nthe importance of physicians being able
\nto travel abroad to meet their colleagues.
\nThe medical profession in Russia had long
\nretained the idea from the Soviet era that
\ntheir activities must be regulated by state
\nadministrative bodies, with professional
\nbodies playing a secondary role. However,
\nnew attitudes were developing with a grow-
\ning recognition of the principle of profes-
\nsional freedom and autonomy. This was the
\ncornerstone principle of the WMA and
\nwas connected with professional responsi-
\nbility and the right to health. He said that
\nthe Russian Medical Society was the only
\nmedical organisation in Russia which had
\nbeen pursuing the ideals of the WMA for
\nthe past 20 years, despite resistance from
\nsome powers. He stated that holding the
\nWMA Assembly in Moscow would help to
\nraise awareness of the importance of profes-
\nsional autonomy and expedite this process.
\nHe closed by inviting delegates to return to
\nMoscow, emphasising traditional Russian
\nhospitality derived from the many nations
\nwhich make up the vast federation, and
\nwished them every success at the meeting.
\nThe WMA Chair Dr. Ardis Hoven then
\npaid tribute to the retiring WMA Presi-
\ndent, Dr. Xavier Deau. She said he had
\npresided with great distinction over the af-
\nfairs of the Association. He was a highly re-
\nspected physician exemplifying the highest
\nethical standards of the profession and he
\nhad guided the WMA and the profession
\nover the past year, travelling exhaustively.
\nHe was a gentle man in manner, strong in
\nopinion,highly competent and wise in deci-
\nsions,commanding by his presence and pas-
\nsionate about his patients.
\nDr. Deau delivered his valedictory speech
\n(see box) and was given a standing ovation.
\nSir Michael Marmot, Professor of Epidemi-
\nology and Public Health at University Col-
\nlege London, was then installed as the 66th
\nPresident of the WMA to serve in 2015\/16.
\nHe took the oath of office as President and
\ndelivered his inaugural speech (box).
\nSaturday, October 17
\nGeneral assembly plenary session
\nThe Credentials committee reported that 58
\nWMA constituent members had been reg-
\nistered and recognised at the meeting and
\n57 were in good standing.The total number
\nof votes was 136.
\nGeneral report
\nDr. Kloiber introduced the written report
\nthat had been tabled, detailing the work of
\nthe WMA secretariat and the Council over
\nthe past year. He highlighted several items,
\nmentioning the advocacy work that had
\nbeen carried out in publicising the revised
\nDeclaration of Helsinki.A similar approach
\nwas now being taken in seeking public in-
\nput for the new WMA policy project on
\ndatabases and biobanks. The WMA had
\nreceived up to 90 well written and thought-
\nful comments on how stakeholders and in-
\nterested groups thought it should proceed
\nwith this policy.This had led to new insights
\nabout the policy.
\nIn addition to the work of developing policy,
\nthe secretariat had been involved more and
\nmore in human rights issues. It had been
\nvery active with the United Nation organ-
\nisations and with members in addressing
\nboth individual issues as well as more gen-
\neral political issues. The spread of activity
\nhad been extremely broad and reflected the
\nissues member organisations faced, ranging
\nfrom strictly medical problems such as vi-
\ntamin D to theoretical issues such as trade
\nagreements. However, the WMA secretari-
\nat at Ferney Voltaire was very small and it
\nhad to be highly selective and set priorities.
\nHe was disappointed not to be able to help
\nall the requests received.
\nCommittee Reports
\nThe Assembly adopted the following policy
\ndocuments without debate:
\n\u2022\t Resolution on the Inclusion of Medical
\nEthics and Human Rights in the Cur-
\nriculum of Medical Schools World-Wide
\n(see p.148)
\n\u2022\t Revised Statement on Non-Discrimi-
\nnation in Professional Membership and
\nActivities of Physicians (see p.149)
\n\u2022\t Statement on Ethical Issues concerning
\nPatients with Mental Illness (see p.150)
\n\u2022\t Declaration on Alcohol (see p.141)
\n\u2022\t Statement on Providing Health Support
\nto Street Children (see p.152)
\n\u2022\t Statement on Riot Control Agents (see
\np.155)
\n\u2022\t Statement on Mobile Health (see p.153)
\n\u2022\t Revised Statement on Nuclear Weapons
\n(see p.154)
\n\u2022\t Statement on Physicians\u2019Well-being (see
\np.143)
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\n136 137
\nWMA News WMA News
\n\u2022\t Statement on Vitamin D Insufficiency
\n(see p.147)
\n\u2022\t Guidelines on Promotional Mass Media
\nAppearances by Physicians (see p.147)
\n\u2022\t Declaration of Oslo on Social Determi-
\nnants of Health (retitled) (see p.151)
\n\u2022\t Attacks against Healthcare workers and
\nfacilities in Turkey (see p.140)
\n\u2022\t Global Refugee Crisis (see p.145)
\nStatement on Transgender People
\nProfessor Monsignor Pablo Requena (Vati-
\ncan Medical Association) said he would be
\nabstaining on the vote on this Statement.
\nHe explained that the Vatican delegation
\ncondemned absolutely any unfair discrimi-
\nnation and would resist any discrimination
\nagainst transgender people. However, in
\nsome parts of this document a number of
\nmatters that were not strictly medical were
\ndiscussed and the Statement proposed some
\nsolutions that they did not all share.
\nThe Assembly agreed to adopt the Statement.
\nBombing of the hospital run by M\u00e9decins Sans
\nFronti\u00e8res in Kunduz, Afghanistan (see p.141)
\nThe Japanese Medical Association referred
\nto the demand in the emergency Resolu-
\ntion for an immediate enquiry by an in-
\ndependent body into the attack. It asked
\nwhether it was possible for a third party to
\ninvestigate the bombing and suggested that
\nthis point be deleted. However, the Span-
\nish Medical Association argued that only
\nan independent investigation would shed
\nlight on what had occurred. If there was no
\nindependent investigation and no attempt
\nat trying to find a plausible explanation it
\nwould be disastrous. It urged that this point
\nbe maintained in the resolution. This was
\nsupported by speakers from Cote d\u2019Ivoire,
\nSouth Africa and India. Dr. Ved Prakash
\nMishra (Indian Medical Association) said
\nthe call for an independent investigation
\nmust be maintained. On such a human
\ntragedy which had shaken the feet of civil-
\nity and humanism if they deleted this they
\nwould just be bystanders and onlookers to
\nhuman devastation. If they did not call for
\nan independent investigation they would be
\nlosing relevance, consequence and impact.
\nBut Dr. Frank Ulrich Montgomery (Ger-
\nman Medical Association) said that the
\nAmerican President had already apologised
\nfor the bombing and therefore an indepen-
\ndent investigation was not necessary.
\nOn a vote, the proposal to delete the call for
\nan investigation was supported by 55 votes
\nto 45 with three abstentions and the emer-
\ngency Resolution as amended was support-
\ned by 76 votes to 13, with 26 abstentions.
\nTreasurer\u2019s Report
\nDr. Masami Ishii, the Treasurer, reported on
\nthe Financial Statement for 2014 and the
\nBudget for 2016. He referred to the positive
\nfinancial developments due to thrifty use
\nof budget means, efficient cost controlling,
\na risk-free investment policy and the full
\ncommitment of the Secretary General. Mr
\nAdi H\u00e4llmayer, the financial adviser, pro-
\nvided additional information on the 2014
\nstatement, drawing particular attention
\nto the savings made by the South African
\nMedical Association in their organization
\nof the General Assembly in Durban.
\nDr. Ishii reported on the dues increases
\nthat would be necessary to maintain the
\nfinancial stability of the Association, and
\nreminded the delegates that investment
\nwas necessary to maintain the important
\nactivities of the WMA. He said the budget
\nrepresented investment in the future of the
\nprofession, summarizing the ways in which
\nthe WMA was supporting physicians and
\npromoting the highest standards of medical
\nethics across the world. The money would
\nbe used to establish further communica-
\ntions and educational missions.
\nThe Audited Financial Statement for 2014
\nand the proposed Budget for 2016 were ap-
\nproved and adopted.
\nMembership
\nThe Assembly agreed to the admission of
\nthe Panhellenic Medical Association as a
\nWMA Constituent Member.
\nSocial Determinants of Health
\nThe Secretary General said that in view of
\nthe importance of this topic,the Council had
\nsuggested that the WMA Statement on the
\nSocial Determinants of Health be changed
\nto a Declaration entitled The Declaration of
\nOslo on the Social Determinants of Health.
\nThis was approved by the Assembly.
\nAssociate Members
\nThe Assembly received two proposed policy
\ndocuments from the Associate Members,
\nthe proposed Statement on Ethical Con-
\nsiderations in Global Medical Electives and
\nthe proposed Statement on Fossil Fuel De-
\nvelopment. It was agreed that these should
\nbe sent to the Council for consideration.
\nWorld Veterinary Association
\nDr. Zoran Katrinka, from the World Vet-
\nerinary Association, spoke about the WVA,
\nsaying that it was a global organisation and
\na federation of national and regional asso-
\nciations. It had member associations from
\nmore than 60 countries with 500,000 indi-
\nvidual members. Its mission was \u2018to ensure
\nand promote animal health and welfare and
\npublic health globally, through develop-
\ning and advancing veterinary medicine, the
\nveterinary profession as well as public and
\nprivate veterinary services\u2019.The three pillars
\nof veterinary medicine were animal health,
\npublic health and animal welfare. When
\nit came to animal health, prevention was
\nbetter than cure, through monitoring, sur-
\nveillance, early diagnosis and reporting of
\nanimal diseases. Animal welfare was a mat-
\nter of respecting freedoms and promoting
\nsustainable, high welfare agriculture. Pub-
\nlic Health related to the role veterinarians
\nplayed in food safety. He said veterinarians
\ndid much to maintain control of zoonotic
\ndiseases. Some 60 per cent of infections and
\ntransmissible human diseases were zoonotic
\nin their nature and some 70 per cent of the
\nnew emerging transmissible diseases were of
\na zoonotic nature or had a zoonotic poten-
\ntial. And up to 75 per cent of the potential
\nor actual bioterrorism agents were zoonotic
\nin nature. He also spoke about education
\nand lifelong learning and ways being devel-
\noped to strengthen the veterinary profes-
\nsion in the light of stress and the number
\nof suicides among veterinarians. He spoke
\nof the common challenges facing physicians
\nand veterinarians and for these reasons it
\nwas all the more important for the profes-
\nsions to work in unison, as exemplified by
\nthe success of the One Health conference
\nin Madrid this year.
\nMedical Women\u2019s International Association
\nProfessor Kyung Ah Park, President of the
\nMedical Women\u2019s International Association
\nand Professor of Anatomy at Yonsei Uni-
\nversity College of Medicine in Seoul, Korea,
\nthen addressed the Assembly. She said the
\nMWIA had around 20,000 members from
\n46 member countries. She gave the history
\nand structure of the organization. It was
\nfounded in 1919 with the aims of offering
\nmedical women the opportunity to meet,
\nto promote the general interest of medical
\nwomen by developing cooperation, friend-
\nship and understanding without regard to
\nrace, religion or political views, to overcome
\ngender-related differences in health and
\nhealthcare between women and men, girls
\nand boys throughout the world, to overcome
\ngender related inequalities in the medical
\nprofession and to promote Health for All
\nthroughout the world with particular interest
\nin women, health and development.
\nAs the current president, Dr. Park said her
\ntheme was the prevention and elimina-
\ntion of domestic and sexual violence and
\nshe mentioned the various projects she hsd
\noverseen in this area, as well as cooperation
\non a Canadian project to distribute birthing
\nkits in order to lower maternal and infant
\nmortality. She had also overseen a survey on
\nviolenc, to which 32 countries had respond-
\ned.Her aim was also to expand membership
\nof the organisation to include more coun-
\ntries, especially in central Asia.
\nCPME
\nDr. Katr\u00edn Fjeldsted, President of the
\nCPME (Standing Committee of European
\nDoctors), said her organization represented
\n34 countries in Europe.They were the voice
\nof the medical profession towards the Eu-
\nropean Commission where they were stake-
\nholders. They were consulted on matters
\nconcerning the medical profession, patients,
\nhealth in Europe, although matters of
\nhealth and health services belonged to the
\nmember states. She spoke about CPME\u2019s
\nwork and the joint activities with the WMA
\nand other organisations. She expressed her
\ngratitude to Dr. Deau for the close coop-
\neration he had facilitated over the past year
\nwith the WMA, highlighting the WMA
\npolicies CPME has endorsed and the areas
\nin which they shared similar policies, such
\nas professional autonomy, the TTIP agree-
\nment, alcohol and tobacco, patient safety,
\nhealthy aging, and eHealth.
\nInternational Trade Agreements
\nDr. Andrew Deardon (British Medical As-
\nsociation) opened a debate on current in-
\nternational trade agreements, designed to
\nallow NMAs to report on their activities in
\nthis area.
\nHe said the BMA was not anti-trade but
\nit was pro-health. A lot of work had been
\ndone by the WMA and a number of coun-
\ntries. The BMA wanted to get an idea of
\nwhat other countries felt about these agree-
\nments. The question was what more they
\ncould do.It was not that they should oppose
\ntrade, but that they should safeguard health.
\nDr. Kloiber reiterated that the WMA had
\nno fundamental opposition against trade
\nand trade agreements. Trade, if it was fair,
\ncould help to ease the burden of many
\ncountries. However, with some trade agree-
\nments there could be detrimental effects on
\nhealth, such as the attempts of the Mexican
\nGovernment to reduce the sugar intake by
\nchildren which had been stalled by some
\ncountries in north America. The Mexican
\nGovernment had to give up and yet Mexico
\nwas suffering a real obesity epidemic. The
\nsame thing had happened with tobacco
\nlegislation. Regulations against tobacco in
\nmany countries had been attacked on the
\nbasis of trade agreements and were being
\ndealt with in secret courts. They were a real
\nthreat to many countries. Trade agreements
\ncould have detrimental effects on social
\nconditions and could inhibit domestic legis-
\nlation on health issues.The WMA\u2019s concern
\nwas that these agreements were being made
\nin secret.
\nLeah Wapner (Israel Medical Association)
\nreminded the Assembly that this was not
\nthe first time the WMA had taken a stand
\non an issue of trade and health that was not
\nvery popular at the beginning. Its position a
\nfew years ago on patenting genes was simi-
\nlar. The WMA had said then it was against
\npatenting and everyone said this opposition
\nwas against trade. Since then the US and
\nAustralia had come out with a conclusion
\nthat genes could not be patented. At the
\nmoment the WMA had a very serious issue
\nof public relations and making its stand-
\npoint understandable. What it was doing
\nhere was a very important first step getting
\ninformation from the regions. The need
\nnow was to turn this into something more
\npractical by developing an advocacy strate-
\ngy.They could then advocate for this around
\nthe world.This would enable NMAs to have
\nan advocacy strategy within their country,to
\napproach their Parliamentarians to say why
\nit was so important to put safeguards for
\nhealth within these trade agreements.
\nDr. Sergio Isaza Villa (Columbia Medical
\nFederation) said it was vital that the WMA
\nmade known its stand with regard to high
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\n138 139
\nWMA News WMA News
\ncost treatments and the rights of physicians
\nto voice opinions regarding treatment.They
\nshould try to control exorbitant costs based
\non patents. Secondly, on physician autono-
\nmy, in Columbia a law had been passed to
\ndefend and protect the decisions of physi-
\ncians regarding treatment decisions. He
\nbelieved this was directly related to the is-
\nsue of physician autonomy and world trade
\nagreements.
\nDr. Steve Child (New Zealand Medical
\nAssociation) said that New Zealand had
\nsigned four free trade agreements in the last
\n20 years and many of the things being dis-
\ncussed had been present in these negotia-
\ntions throughout that time. He said it was
\nimportant that the WMA approached this
\nissue from a principled point of view rather
\nthan on individual issues. In the Trans-
\nPacific Partnership Agreement (TPPA)
\nsigned two weeks ago,tobacco was excluded
\nand public health policy provisions were
\nprotected. Countries were allowed to still
\nmandate their own public health policy pro-
\nvisions.nMoreover, biosimilars and biologic
\npatents had remained the same. Referring
\nto the issue of transparency with these ne-
\ngotiations, he said that all countries needed
\nto take the agreements back to their Parlia-
\nments for enabling legislation to be passed.
\nOther speakers reported on the approaches
\nthey had made to their governments and
\ncalled on the WMA to stand firm on this
\nissue. Dr. Juan Rodriguez Sendin from the
\nSpanish Medical Associatio, spoke about
\nthe difficulty in getting information about
\nthese trade agreements from their Parlia-
\nmentarians. So many issues were at stake
\nand unless the situation changed radically
\nand they got to know the content of these
\ntreaties the WMA should warn public opin-
\nion about the danger of these negotiations.
\nSpeakers from Malaysia, Argentina, India
\nand Nigeria added their voices in opposi-
\ntion to these agreements. Many speakers
\ncalled on the WMA to publicly state their
\nopposition to these agreements. Dr. Eliza-
\nbeth Wiley, deputy chair of the JDN, spoke
\nabout the threats to public health from these
\nnegotiations, whether it was to professional
\nregulations, access to medical education or
\nclimate change mitigation strategy,access to
\nmedicines and tobacco regulation.
\nAt the end of the debate Dr.Hoven said she
\nrecognised the many challenges facing the
\nWMA from these trade agreements and she
\nwould be asking the advocacy group to put
\nthis matter on its agenda.
\nOpen session
\nWMA Influenza Campaign
\nDr. Julia Tainijoki-Seyer, medical advisor
\nwith the WMA, gave an overview of the
\nWMA\u2019s influenza prevention campaign. In
\naddition to the global mortality, flu caused
\n3.5 million cases of illness. This presented
\nan economic burden with indirect and direct
\ncosts.Up to 60 per cent of health profession-
\nals had the virus, but 30 per cent were not
\naware they had the flu, yet they still saw pa-
\ntients.The aims of the campaign were to in-
\nspire health professionals to get immunised,
\nto be a role model for their patients and to
\nfocus on vulnerable groups. She stated that
\nthe focus of this year\u2019s campaign had been
\nchildren, due to their lack of prior immunity
\nand more frequent exposure to the virus. She
\npresented the materials developed for the
\nwebsite, including the motto \u201clet kids be
\nkids\u201d,and encouraged NMAs to use the ma-
\nterial, which were free of charg,or to link the
\nwebpages on their own websites. She closed
\nby presenting a video of Sophia,an animated
\nambassador for the WMA and she asked
\nNMAs to share information about their own
\nactivities on influenza with her.
\nTree of Hippocrates
\nDr. Yoshitake Yokokura (Japan Medi-
\ncal Association) described the legend that
\nHippocrates taught medicine underneath
\nan old plane tree which still stood on the
\nGreek island of Kos. The tree was almost
\ndead. However, tree doctors commissioned
\nby the Greek government and the Japanese
\nEmbassy had concluded that the tree could
\nbe saved. He said that Hippocrates was the
\nFather of Medicine and it was their duty
\nto save the life of this tree. He urged the
\nWMA to collect donations to regenerate
\nthe Tree of Hippocrates.
\nTurkey
\nDr. Ilhan Bayazit (Turkish Medical Asso-
\nciation) spoke about attacks on health care
\npersonnel and facilities in Turkey. Several
\nhealth care staff had been killed. He also
\nspoke about the previous week\u2019s bombing
\nin Ankara during a peace rally march. Po-
\nlice had used tear gas immediately after the
\nexplosion.
\nIsrael
\nDr. Leonid Eidelman (Israel Medical As-
\nsociation) reported on the issue of force
\nfeeding of hunger strikers in Israel. He said
\nthat over the last few years detainees held
\nin Israeli prisons had used hunger strikes as
\na tool for having their demands met. More
\nthan a thousand hunger strikes had taken
\nplace in recent years, lasting from several
\ndays to weeks and months. In June 2014
\naround 100 strikers were simultaneously
\nhospitalized.This prompted proposed legis-
\nlation in the Israeli Parliament allowing for
\nthe force feeding of hunger strikers in hos-
\npital with court permission and despite ac-
\ntive opposition from prisoners. Against this
\nbackground the Israeli Medical Association
\nhad convened a consensus conference with
\nall interested parties and the conference
\nhad reached several conclusions relating
\nto physicians\u2019 treatment of hunger strikers.
\nThese included emphasising that doctors
\nmust respect the free will of hunger strik-
\ners as people and patients while doing all
\nthey could to help the hunger striker to stay
\nalive, that forced medical treatment includ-
\ning force feeding was forbidden, and that
\nphysicians must maintain medical confi-
\ndentiality when treating patients. Following
\nthe conference the Israeli Medical Associa-
\ntion had prepared guidelines for physicians
\nand had set up a 24-hour emergency hotline
\nto provide advice to physicians.
\nDr. Eidelman said that the Israel Medical
\nAssociation could not support the proposed
\nlegislation on this issue which was in con-
\ntradiction with physicians\u2019 ethical obliga-
\ntions as set out in the WMA Declaration of
\nMalta, which said that force feeding was a
\nform of inhuman and degrading treatment.
\nCote d\u2019Ivoire
\nDr. Kroo Florent Aka (Ordre National Des
\nMedicines De La C\u00f4te D\u2019Ivoire) said that
\nthe buruli ulcer was one of about 15 tropical
\ndiseases which the WHO officially consid-
\nered as orphan or neglected illnesses due to
\na lack of a budget to treat them. It affected
\ntropical, sub-Saharan countries, including
\nChina and Australia.There were 2,197 cases
\nin 2014, 38per cent of which were in the
\nIvory Coast. He explained that the disease
\nwas caused by a micro bacteria from the same
\nfamily as TB and leprosy, with fresh water
\nbugs found in lakes and rivers as carriers. It
\nproduced blisters on the bodies of adults and
\nchildren which evolved into extensive ne-
\ncrosis of soft skin tissue and abscesses, with
\nsome resulting in the development of skin
\ncancer. Successful treatment was possible if
\nthe disease was caught in its early stages, but
\nthat access to treatment in many areas was
\nvery limited, meaning that by the time many
\npatients get to hospital the effects were ir-
\nreversible. He asked the WMA to raise this
\ntopic at the next WHO Assembly and re-
\nquested the development of a strategic plan
\nand sufficient funding to fight the disease.
\nAny other business
\nJunior Doctors Network
\nDr. Ahmet Murt, Chair of the Junior Doc-
\ntors Network (JDN), reported that the
\nNetwork had been growing continually and
\nexpanding the scope of its work, covering a
\nbroad range of issues,not only those directly
\nassociated with junior doctors. He com-
\nmented on the collaboration with medical
\nstudents and mentioned the recent regional
\nmeeting in Macedonia and forthcoming
\nmeetings in Istanbul and Malta. He went
\non to thank the Russian Medical Society
\nfor enabling the JDN to hold their meeting
\nin Moscow, which had enjoyed the high-
\nest participation ever. He congratulated his
\nJapanese colleagues, who had won the JDN
\nchampions award at this meeting.
\nBombing of the hospital run by M\u00e9decins Sans
\nFronti\u00e8res in Kunduz, Afghanistan
\nAt the suggestion from the Spanish Medi-
\ncal Association, the debate on the emer-
\ngency motion on the bombing of the MSF
\nhospital was reopened. Dr. Fernando Rivas
\nurged the Assembly to reconsider its earlier
\ndecision to delete the call for an indepen-
\ndent investigation. He said MSF were col-
\nleagues and allies of the WMA and they
\nhad requested an independent investigation
\ninto the bombing. Despite having received
\na message from the US president, MSF
\ncontinued to request that an international
\nhumanitarian fact-finding commission be
\nbrought in to conduct an independent in-
\nvestigation. He called for the WMA to take
\nthe side of physicians not governments.
\nDr. Mzukisi Grootboom (South Africa
\nMedical Association) said he was extremely
\ndisappointed at the outcome of the earlier
\ndebate to strike out the call for an indepen-
\ndent investigation. This was not just an at-
\ntack on a hospital. It was an attack on the
\nGeneva Convention. The WMA needed
\nto show leadership and support those doc-
\ntors who were at the hospital taking all the
\nrisks to save people\u2019s lives. Dr. Rutger Jan
\nVan der Gaag (Royal Dutch Medical As-
\nsociation) supported the call to reconsider,
\nsaying that they should not be put off by the
\nfact that the President of the United States
\nhad apologized. It was extremely important
\nto go further. Dr. Jeff Blackmer (Canadian
\nMedical Association) said that if the WMA
\ndecided not to call for an independent en-
\nquiry the Canadian Medical Association
\nwould be releasing a strongly worded press
\nstatement the following week urging an in-
\ndependent investigation and he encouraged
\nother NMAs to do likewise.
\nDr. Frank Ulrich Montgomery (German
\nMedical Association) said that detailed ac-
\ncounts of the bombing had already been
\npublished. An investigation committee had
\nalso been set up and he asked what an ad-
\nditional inquiry would add. It was not nec-
\nessary.
\nHowever, other speakers from India, Ar-
\ngentina and Nigeria supported the call for
\nan enquiry.
\nDelegates voted for the emergency resolu-
\ntion to be reconsidered. And they went on
\nto vote by 62 votes to 43 with nine absten-
\ntions in favour of the original resolution,
\nincluding the call for an independent inves-
\ntigation.
\nJunior Doctors
\nDr. Georgiana Luisa Baca (United King-
\ndom) spoke about government plans in
\nEngland to remove the regulation of the
\nworking hours of junior doctors, introduce
\na seven day working pattern and not recog-
\nnise university degrees or part-time work
\nas work experience. She thanked the BMA
\nand Royal Colleges for their strong support
\nof the junior doctors,holding it up as a posi-
\ntive example of collegial support.
\nThe Taiwan Medical Association presented
\na short video of Taiwan, inviting all dele-
\ngates to attend the next year\u2019s General As-
\nsembl, which will be held in Taipei.
\nThe Chair thanked the delegates for their
\nefforts, time, thoughtfulness and commit-
\nment to the WMA and the health of their
\npatients and concluded the meeting.
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\nWMA News WMA News
\nWMA Resolution to Stop
\nAttacks against Healthcare
\nWorkers and Facilities in Turkey
\nAdopted by the 66th
\nGeneral Assembly, Moscow, Russia, October 2015
\nPreamble
\nSeveral media report that over the last two months of conflict in
\nTurkey, healthcare workers have been killed, wounded or threatened
\nwith guns. Some physicians have been taken out of ambulances and
\nbeaten. Access to wounded people is prevented by security forces,
\nand ambulances as well as health facilities are regularly targeted.
\nA\u00a0rather comprehensive study conducted by the Turkish Medical
\nAssociation confirms these facts.
\nThere are indications that attacks on healthcare workers and the
\nobstructions of service delivery are used as a deliberate political in-
\nstrument to intimidate people, depriving them of their democratic
\nrights.
\nParties in armed conflict have the obligation to protect health care
\nprovision to wounded and sick and to prevent attack on or threat
\nto medical activities, healthcare workers and facilities. Physicians and
\nother healthcare workers should not be impeded to perform their du-
\nties. Such attacks constitute blatant violation of international human
\nrights law, in particular the inherent right to life that shall be pro-
\ntected by law, and the right to enjoy the highest attainable standard
\nof health [1].
\nThese attacks undermine gravely as well fundamental medical ethics
\nprinciples, in particular WMA international Code of Medical Eth-
\nics and the Ethical Principles of Health Care in Times of Armed
\nConflict and Other Emergencies endorsed by civilian and military
\nhealth-care organisations [2], stating that: \u201cHealth-care personnel,
\nas well as health-care facilities and medical transports, whether mil-
\nitary or civilian, must be respected by all. They are protected while
\nperforming their duties and the safest possible working environ-
\nment shall be provided to them\u201d (article 10).
\nRecommendations
\nThe WMA urges all parties to:
\n1.\t Stop attacks on healthcare workers and patients, health care fa-
\ncilities, and ambulances and ensure their safety,
\n2.\t Respect the professional autonomy and impartiality of health-
\ncare workers,
\n3.\t Comply fully with international human rights law as well as
\nother relevant international regulations that Turkey is a State
\nParty to, and
\n4.\t Document and record all violations and duly prosecute their
\nperpetrators.
\n[1]\tInternational Covenant on Economic, Social and Cultural Rights, article
\n12\u00a0\u2013 December 1966
\n[2]\tAdopted by the ICRC, the WMA, the International Committee of Military
\nMedicine (ICMM), the International Council of Nurses (ICN) and the In-
\nternational Pharmaceutical Federation (FIP) \u2013 June 2015
\nWMA Resolution on Global
\nRefugee Crisis
\nAdopted by the 66th
\nGeneral Assembly, Moscow, Russia,
\nOctober 2015
\nThe WMA recognises that mass movement of people often fol-
\nlows disasters that flow from armed conflict or natural phenomena
\nas populations seek to escape danger and deprivation. The current
\nmass movement of the populations, to escape the effects of armed
\nconflict including bombing, lack of access to utilities, clean water,
\nand the destruction of homes, schools and hospitals, has been nu-
\nmerically larger than any mass movement of populations in over
\n70 years.
\nWhile the WMA recognises that countries may have concerns
\nabout their ability to absorb significant numbers of new migrants,
\nwe recognise that people fleeing warfare or natural phenomena are
\ndoing so because they are desperate and often face life-threatening
\nconditions. They are afraid for their health, safety and welfare, and
\nthat of the family members who accompany them.
\nMost countries have signed international treaties giving them bind-
\ning obligations to offer aid and assistance to refugees and asylum
\nseekers. The WMA believes that when there are events, including
\non-going events, such as conflict which generate refugee crises gov-
\nernments must increase their efforts to provide assistance to those
\nin need.
\nThis should include ensuring safe passage for refugees and appro-
\npriate support after they enter countries offering refuge. Recognis-
\ning that the disaster from which they have fled and the vicissitudes
\nof the journey may have led to health problems it is essential that
\nreceiving countries establish systems to provide health care to refu-
\ngees.
\nGovernments should seek to ensure that refugees and asylum seek-
\ners are able to live in dignity within their country of refuge and
\nmake all efforts to enable their integration into their new society.
\nThe international community should seek to obtain a peaceful solu-
\ntion in Syria under which the population can either stay at home
\nsafely or, if they have already left, safely return home.
\nThe WMA recognises that mass population movement causes
\nsignificant stress on the existing populations of countries as well
\non those who become refugees. We believe that governments and
\ninternational agencies including the United Nations must make
\nmore concerted efforts to reduce the pressures that lead to such
\nmovements, including rapidly providing extensive relief after
\nnatural phenomena, and making more efforts to avert or stop
\narmed conflict. Re-establishing security of food, water, hous-
\ning, sewerage, education and health care, and improving public
\nsafety should make a significant impact and reduce the numbers
\nof refugees.
\nThe WMA:
\n\u2022\t Recognises that the process of becoming a refugee is damaging to
\nphysical and mental health;
\n\u2022\t Commends those countries that have welcomed and cared for
\nrefugees, especially those currently fleeing Syria;
\n\u2022\t Calls on other countries to improve their willingness to receive
\nrefugees and asylum seekers;
\n\u2022\t Calls on national governments to ensure that refugees and asylum
\nseekers are enabled to live in dignity by providing access to es-
\nsential services;
\n\u2022\t Calls on all governments to work together to seek to end local,
\nregional, and international conflicts, and to protect the health,
\nsafety and welfare of populations;
\n\u2022\t Calls on all governments to cooperate in providing immediate
\nhelp to countries facing the effects of natural phenomena, re-
\nmembering that those already the most socio-economically dis-
\nadvantaged will face the most challenges;
\n\u2022\t Calls upon global media to report on the refugee crisis in a man-
\nner that respects the dignity of refugees and displaced persons,
\nand to avoid bigotry and racial or other bias in reporting.
\nWMA Resolution about the
\nBombing on the Hospital of MSF
\nin Kunduz
\nAdopted by the 66th
\nGeneral Assembly, Moscow, Russia, October 2015
\nAfter the events of October 3 in Kunduz (Afghanistan), the WMA:
\n1.\t Extends its deepest condolences to families, colleagues and
\nfriends of doctors, healthcare workers and patients killed in the
\nbombing.
\n2.\t Deeply regrets and condemns the bombing of the Hospital of
\nMSF, considering it a violation of human rights.
\n3.\t Reaffirms its positional statements on \u201cHealthcare in Danger\u201d
\nand calls on all countries to respect healthcare personnel in con-
\nflict situations.
\n4.\t Demands an immediate enquiry into the attack by an indepen-
\ndent body and the assumption of responsibilities.
\nWMA Declaration on Alcohol
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\n1.\t The burden of disease and injury associated with alcohol con-
\nsumption is a critical challenge to global public health and de-
\nvelopment. The World Medical Association offers this declara-
\ntion on alcohol as its commitment to reducing excessive alcohol
\nconsumption and as a means to support its members to assist
\nthem in promulgating harm-reduction policies and other mea-
\nsures.
\n2.\t There are significant health, social and economic problems as-
\nsociated with excessive alcohol use. The harmful use of alcohol
\nkills approximately 2.5 million people every year (almost 4% of
\nall deaths worldwide), and is the third leading risk factor for
\npoor health globally, accounting for 5.5% of disability-adjusted
\nlife years lost. The WMA Statement on Reducing the Global
\nImpact of Alcohol on Health and Society addresses these prob-
\nlems in more detail.
\n3.\t Effective alcohol harm-reduction policies and measures will in-
\nclude legal and regulatory measures that target overall alcohol
\nconsumption in the populatio, as well as health and social policy
\ninterventions that specifically target high-risk drinkers, vulner-
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\nWMA News WMA News
\nable groups and harms to people affected by those who consume
\nalcohol.
\n4.\t There are many evidence-based alcohol policies and preven-
\ntion programmes that are effective in reducing the health,
\nsafety and socioeconomic problems attributable to harm-
\nful use of alcohol. However, many countries have rela-
\ntively weak alcohol policies and prevention programmes
\nthat are ineffective at protecting health and safet, and pre-
\nventing harm. International public health advocacy and
\npartnerships are needed to strengthen and support the
\nability of governments and civil society worldwide to com-
\nmit to, and deliver on, reducing the harmful use of alcohol.
\nHealth professionals have an important role to play in pre-
\nventing, treating and mitigating alcohol-related harm, using
\neffective preventive and therapeutic interventions.
\n5.\t The World Medical Association has a leadership role to en-
\ncourage and support the development and implementation of
\nevidence-based national alcohol policies by promoting and fa-
\ncilitating partnerships, information exchange and health policy
\ncapacity building.
\nObjectives
\nIn developing policy, the WMA recommends focusing on the fol-
\nlowing broad objectives:
\n\u2022\t Strengthen health systems to identify and improve a country\u2019s
\ncapacity to develop policy and lead actions that target excessive
\nalcohol consumption.
\n\u2022\t Promote the development and evaluation in all countries of na-
\ntional alcohol strategies which are comprehensive, evidence-
\nbased and include measures to address the supply, distribution,
\nsale, advertising and promotion of alcohol.
\n\u2022\t Through government health departments,accurately measure the
\nhealth burden associated with alcohol consumption through the
\ncollection of sales data, epidemiological dat, and per capita con-
\nsumption figures.
\n\u2022\t Support and promote the role of health and medical profession-
\nals in early identification, screening and treatment of harmful
\nalcohol use.
\n\u2022\t Dispel myths and dispute alcohol control strategies that are not
\nevidence-based.
\n\u2022\t Reduce the impact of harmful alcohol consumption in at risk
\npopulations.
\n\u2022\t Foster multi-disciplinary collaboration and coordinated inter-
\nsectoral action.
\n\u2022\t Raise awareness of alcohol-related harm through public educa-
\ntion and information campaigns.
\nPriorities
\nThe following priorities are suggested for WMA members, national
\nmedical associations and governments in the development of inte-
\ngrated and comprehensive policy and legislative responses.
\nRegulate affordability, accessibility and availability
\nPricing policies
\nIncrease alcohol prices, through volumetric taxation of products
\nbased on their alcohol strengt,and other proven pricing mechanism,
\nto reduce alcohol consumption at the population level, particularly
\nin heavy drinkers and high risk groups.
\nAccessibility and availability
\nRegulate access to, and availability of, alcohol by limiting the hours
\nand days of sale, the number and location of alcohol outlets and
\nlicensed premises, and the imposition of a minimum legal drinking
\nage. Governments should tax and control the production and con-
\nsumption of alcohol, with licensing that emphasises public health
\nand safety and empowers licensing authorities to control the total
\navailability of alcohol in their jurisdictions.
\nPublic authorities must strengthen the prohibition of selling to mi-
\nnors and must systematically request proof of age before alcohol can
\nbe purchased in shops or bars.
\nRegulation of non-commercial alcohol
\nThe production and consumption of non-commercial forms of al-
\ncohol, such as home brewing, illicit distillatio, and illegal diversion
\nalcohol to avoid taxes, should be curtailed.
\nReduce harmful alcohol use
\nRegulation of alcohol marketing
\nAlcohol marketing should be restricted to prevent the early adop-
\ntion of drinking by young people and to minimise their alcohol
\nconsumption. Regulatory measures range from wholesale bans and
\nrestrictions on measures that promote excessive consumptio, to re-
\nstrictions on the placement and content of alcohol advertising that
\nis attractive to young people. There is no evidence that industry
\nself-regulation and voluntary codes are successful at protecting vul-
\nnerable populations from exposure to alcohol marketing and pro-
\nmotion
\nIncrease public awareness of harmful alcohol consumption through prod-
\nuct labelling and public awareness campaigns.
\nIn conjunction with other measures, social marketing campaigns
\nshould be implemented to educate the public about harmful alcohol
\nuse, to support drink driving policie, and to target the behaviour of
\nspecific populations at high risks of harm. Public awareness mea-
\nsures can also include health warning labels on alcohol products,
\nmandated by an independent regulatory body.
\nThe role of health and medical services in prevention
\nHealth,medical and social services professionals should be provided
\nwith the training, resources and support necessary to prevent harm-
\nful use of alcohol and treat people with alcohol dependence, includ-
\ning routinely providing brief advice to motivate high-risk drinkers
\nto moderate their consumption. Health professionals also play a key
\nrole in education, advocacy and research. Specialised treatment and
\nrehabilitation services should be available and affordable for alcohol
\ndependent individuals and their families.
\nDrink driving measures
\nKey drink-driving deterrents should be implemente, which include
\na strictly enforced legal maximum blood alcohol concentration for
\ndrivers of no more than 50mg\/100ml, supported by social market-
\ning campaigns and the power of authorities to impose immediate
\nsanctions.
\nRespond to the alcohol industry
\nLimiting the role of the alcohol industry in alcohol policy development
\nThe commercial priorities of the alcohol industry are in direct conflict
\nwith the public health objective of reducing overall alcohol consump-
\ntion. Internationally, the alcohol industry is frequently included in al-
\ncohol policy development by national authorities, but the industry is
\noften active in opposing and weakening effective alcohol policies. In-
\neffective and non-evidence-based alcohol control strategies promoted
\nby the alcohol industry and the social organisations that the industry
\nsponsors should be countered.The role of the alcohol industry in the
\nreduction of alcohol-related harm should be confined to their roles
\nas producers, distributors and marketers of alcoho, and not include
\nalcohol policy development or health promotion.
\nWMA Statement on Physicians
\nWell-Being
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nPhysician well-being refers to the optimization of all factors af-
\nfecting biological, psychological and social health and preventing
\nor treating acute or chronic diseases experienced by physicians in-
\ncluding mental illness, disabilities and injuries resulting from work
\nhazards, occupational stress and burnout.
\nPhysician well-being could have positive impact on patient care,
\nbut more research is needed. The profession should therefore
\nencourage and support on-going research on physician\u2019s health.
\nEvidence that already exists should be implemented in policy and
\npractice. While physicians tend to have healthy habits, it is es-
\nsential to enhance their health as a way to improve health for the
\nwhole population.
\nPhysicians and medical students at all career stages are exposed
\nto both positive experiences as well as a variety of stressors and
\nwork injuries. The medical profession should seek to identify and
\nrevise policies and practices that contribute to these stressors and
\ncollaborate with NMAs in order to develop policies and practices
\nthat have protective effects. Like all human beings, physicians ex-
\nperience illness, and they also have family obligations and other
\ncommitments outside their professional lives that should be taken
\ninto account.
\nOne reason physicians delay seeking help is their concern about
\nconfidentiality and feeling ill at ease in the patient role.They experi-
\nence feelings of responsibility towards their patients and are sensi-
\ntive to external expectations on their health. Therefore, physicians
\nmust be assured of the same right of confidentiality as any other
\npatient when seeking and undergoing treatment. The health care
\nsystem may need to provide special arrangements for the care of
\nphysician-patients in order to uphold its duty to provide privacy and
\nconfidentiality. Prevention, early assistance and intervention should
\nbe available separately from any disciplinary process.
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\nWMA News WMA News
\nThreats, Barriers and Opportunities
\nfor Physician Well-Being
\nProfessional Roles and Expectations
\nThe medical profession often attracts highly driven individuals with
\na strong sense of duty. Successfully completing the long and intense
\neducational requirements often confers upon physicians a high de-
\ngree of respect and responsibility in their communities.
\nWith these high levels of respect and responsibility, physicians are
\nsubject to high expectations from patients and the public.These ex-
\npectations can contribute to prioritizing the care of others over care
\nof self and feelings of guilt and selfishness for managing their own
\nwell-being.
\nThere is a direct relationship between physicians\u2019 and patients\u2019 pre-
\nventive health practices.This relationship should encourage health-
\ncare systems to better support and evaluate the effects on patients of
\nimproving physician and medical student health.
\nWork Environment
\nWorking conditions, including workload and working hours, affect
\nphysicians\u2019motivation,job satisfaction,personal life and psychologi-
\ncal health during their careers.
\nPhysicians are often perceived as being immune to injury and
\ndiseases as they care for their patients, and workplace health and
\nsafety programs may be overlooked. Physicians who are employed
\nby small organizations or who are self-employed may be at even a
\nhigher risk for occupational diseases and may not have access to
\nhealth and safety programs provided by large health care establish-
\nments.
\nAs a consequence of their professional duties, physicians and physi-
\ncians in postgraduate education often confront emotionally chal-
\nlenging and traumatic situations including patients\u2019suffering, injury
\nand death. Physicians may also be exposed to physical hazards like
\nradiation, noise, poor ergonomics, and biological hazards like HIV,
\nTB and hepatitis.
\nSome healthcare systems may exacerbate stress because of the hier-
\narchies and competition inherent in them. Physicians in postgradu-
\nate education and medical students can be victims of harassment
\nand discrimination during their medical education. Due to their
\nposition within the medical hierarchy, they may feel powerless to
\nconfront these behaviours.
\nPhysician autonomy is one of the strongest predictors of physician
\nsatisfaction. Increasing external regulatory pressures such as undue
\nemphasis on cost efficiencies and concerns about consequences of
\nreporting medical errors may unduly influence medical decision-
\nmaking and diminish a physician\u2019s autonomy.
\nIllness
\nEven though medical professionals recognize that it is preferable
\nto identify and treat illness early, physicians are often adept at
\nhiding their own illnesses and may continue to function without
\nseeking help until they become incapable of carrying out their du-
\nties.There are many potential obstacles to an ill physician seeking
\ncare including: denial, confidentiality issues, aversion to the pa-
\ntient role, practice coverage, fear of disciplinary action, potential
\nloss of practice privileges, loss of performance based payment and
\nthe efficiencies of self-care. Because of these obstacles doctors are
\noften reluctant to refer themselves or their colleagues for treat-
\nment.
\nIllnesses can include mental and behavioural health problems,
\nburnout, communication and interpersonal issues, physical and
\ncognitive problems and substance use disorders. These illnesses
\nand problems can overlap and can occur throughout the profes-
\nsional life cycle from basic medical education to retirement. It is
\nimportant to acknowledge the continuum of physician well-being,
\nranging from optimal health, to minor illness, to debilitating ill-
\nness.
\nSubstance abuse may disrupt a physician\u2019s personal life and may also
\nsignificantly affect his or her ability to care for patients. Easy ac-
\ncess to medications may contribute to physicians\u2019 risk for abuse of
\nrecreational drugs and prescription medications. Assistance prior to
\nimpairment in the workplace is protective for physicians, their pro-
\nfessional credentials and their patients.
\nImproved wellness promotion, prevention strategies and earlier in-
\ntervention can help mitigate the severity of mental and physical ill-
\nnesses and help reduce incidence of suicide in physicians, physicians
\nin postgraduate education and medical students.
\nRecommendations
\nThe World Medical Association recommends that National Medi-
\ncal Associations (NMAs) recognize and, where possible, actively
\naddress the following:
\n1.\t In partnership with medical schools and workplaces, NMAs
\nrecognize their obligation to provide education at all levels
\nabout physician well-being. NMAs should collaboratively pro-
\nmote research to establish best practices that promote physician
\nhealth and to determine the impact of physician well-being on
\npatient care.
\n2.\t Physician well-being should be supported and provided
\nwithin and outside the workplace. Support may include but
\nis not limited to referral to medical treatment, counselling,
\nsupport networks, recognized physician health programs, oc-
\ncupational rehabilitation and primary prevention programs
\nincluding resiliency training, healthy lifestyles and case man-
\nagement.
\n3.\t NMAs should recognize the strong and consistent link between
\nphysicians\u2019 and patients\u2019 personal health practices, providing yet
\nanother critically important reason for health systems to pro-
\nmote physician health.
\n4.\t Physician health programs can help all physicians to proac-
\ntively help themselves via prevention strategies and can assist
\nphysicians who are ill via assessment, referral to treatment
\nand follow-up. Programs and resources to help promote posi-
\ntive psychological health should be available to all physicians.
\nEarly identification, intervention and special arrangements
\nfor the care of physician-patients should be available to pro-
\ntect the health of physicians. Fostering a supportive and ac-
\ncepting culture is critical to successful early referral and in-
\ntervention.
\n5.\t Physicians at risk for abuse of alcohol or drugs should have ac-
\ncess to appropriate confidential medical treatment and compre-
\nhensive professional support. NMAs should promote programs
\nthat help physicians re-enter medical practice with appropriate
\nongoing supervision at the completion of their treatment pro-
\ngrams. More research should be conducted to determine best
\npractices in preventing substance abuse among physicians and
\nphysicians in postgraduate education.
\n6.\t Physicians have the right to working conditions that help limit
\nthe risk of burnout and empower them to care for their per-
\nsonal health by balancing their professional medical commit-
\nments and their private lives and responsibilities.Optimal work-
\ning conditions include a safe and reasonable maximum number
\nof consecutive and total working hours, adequate rest between
\nshifts and appropriate number of non-working days. Relevant
\norganizations should constructively address professional au-
\ntonomy and work-life balance problems and involve physicians
\nin making decisions about their work lives. Working conditions
\nmust not put the safety of patients or physicians at risk, and
\nultimately physicians should be engaged in establishing optimal
\nworkplace conditions.
\n7.\t Workplaces should promote conditions conducive to healthy
\nlifestyles, including access to healthy food choices, exercise, nu-
\ntrition counselling and support for smoking cessation.
\n8.\t Physicians, physicians in postgraduate education and medical
\nstudents have the right to work in a harassment and violence-
\nfree workplace. This includes freedom from verbal, sexual and
\nphysical abuse.
\n9.\t Physicians, physicians in postgraduate education and medical
\nstudents have the right to a collaborative safe workplace. Work-
\nplaces should promote interdisciplinary teamwork, and commu-
\nnication between physicians and all other professionals in the
\nworkplace should be offered in a spirit of cooperation and re-
\nspect. Education on communications skills, self-awareness and
\nteam-work should be considered.
\n10.\tMedical staff should undergo training in recognizing, handling
\nand communicating with potentially violent persons. Health
\ncare facilities should safeguard against violence including rou-
\ntine violence risk audits, especially in mental health treatment
\nfacilities and emergency departments. Staff members who are
\nvictims of violence or who report violence should be supported
\nby management and offered medical, psychological and legal
\ncounselling.
\n11.\tMedical schools and teaching hospitals should develop and
\nmaintain confidential services for physicians in postgraduate
\neducation and medical students and to raise awareness of and
\naccess to such programs. Workplaces should consider offering
\nmedical consultations to physicians in postgraduate education
\nin order to identify any health issues at the outset of medical
\neducation.
\n12.\tWorkplace support for all physicians should be easily accessible
\nand confidential. Physicians evaluating and treating their medi-
\ncal colleagues should not be required to report any aspects of
\ntheir physician-patients\u2019 care in any manner not required for
\ntheir non-physician patients.
\nWMA Statement on Transgender
\nPeople
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nIn most cultures, an individual\u2019s sex is assigned at birth according
\nto primary physical sex characteristics. Individuals are expected to
\nidentify with their assigned sex (gender identity) and behave ac-
\ncording to specific cultural norms strongly associated with this
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\n(gender expression). Gender identity and gender expression make
\nup the concept of \u201cgender\u201d itself.
\nThere are individuals who experience different manifestations of
\ngender that do not conform to those typically associated with their
\nsex assigned at birth. The term \u201ctransgender\u201d refers to people who
\nexperience gender incongruence, which is defined as a marked mis-
\nmatch between one\u2019s gender and the sex assigned at birth.
\nWhile conceding that this is a complex ethical issue, the WMA
\nwould like to acknowledge the crucial role played by physicians in
\nadvising and consulting with transgender people and their families
\nabout desired treatments.The WMA intends this statement to serve
\nas a guideline for patient-physician relations and to foster better
\ntraining to enable physicians to increase their knowledge and sensi-
\ntivity toward transgender people and the unique health issues they
\nface.
\nAlong the transgender spectrum, there are people who, despite hav-
\ning a distinct anatomically identifiable sex, seek to change their pri-
\nmary and secondary sex characteristics and gender role completely
\nin order to live as a member of the opposite sex (transsexual). Oth-
\ners choose to identify their gender as falling outside the sex\/gender
\nbinary of either male or female (genderqueer). The generic term
\n\u201ctransgender\u201d represents an attempt to describe these groups with-
\nout stigmatisation or pathological characterisation. It is also used
\nas a term of positive self-identification.This statement does not ex-
\nplicitly address individuals who solely dress in a style or manner
\ntraditionally associated with the opposite sex (e.g. transvestites) or
\nindividuals who are born with physical aspects of both sexes, with
\nmany variations (intersex). However, there are transvestites and in-
\ntersex individuals who identify as transgender. Being transvestite or
\nintersex does not exclude an individual from being transgender. Fi-
\nnally, it is important to point out that transgender relates to gender
\nidentity, and must be considered independently from an individual\u2019s
\nsexual orientation.
\nAlthough being transgender does not in itself imply any mental im-
\npairment, transgender people may require counseling to help them
\nunderstand their gender and to address the complex social and re-
\nlational issues that are affected by it. The Diagnostic and Statistical
\nManual of Mental Disorders of the American Psychiatric Associa-
\ntion (DSM-5) uses the term \u201cgender dysphoria\u201d to classify people
\nwho experience clinically significant distress resulting from gender
\nincongruence.
\nEvidence suggests that treatment with sex hormones or surgi-
\ncal interventions can be beneficial to people with pronounced and
\nlong-lasting gender dysphoria who seek gender transition.However,
\ntransgender people are often denied access to appropriate and af-
\nfordable transgender healthcare (e.g. sex hormones, surgeries, men-
\ntal healthcare) due to, among other things, the policies of health
\ninsurers and national social security benefit schemes, or to a lack of
\nrelevant clinical and cultural competence among healthcare provid-
\ners. Transgender persons may be more likely to forego healthcare
\ndue to fear of discrimination.
\nTransgender people are often professionally and socially disadvan-
\ntaged, and experience direct and indirect discrimination, as well as
\nphysical violence. In addition to being denied equal civil rights, an-
\nti-discrimination legislation which protects other minority groups
\nmay not extend to transgender people. Experiencing disadvantage
\nand discrimination may have a negative impact upon physical and
\nmental health.
\nRecommendations
\n1.\t The WMA emphasises that everyone has the right to deter-
\nmine one\u2019s own gender and recognises the diversity of pos-
\nsibilities in this respect. The WMA calls for physicians to up-
\nhold each individual\u2019s right to self-identification with regards
\nto gender.
\n2.\t The WMA asserts that gender incongruence is not in itself a
\nmental disorder; however, it can lead to discomfort or distress,
\nwhich is referred to as gender dysphoria (DSM-5).
\n3.\t The WMA affirms that, in general, any health-related proce-
\ndure or treatment related to an individual\u2019s transgender status,
\ne.g. surgical interventions, hormone therapy or psychotherapy,
\nrequires the freely given informed and explicit consent of the
\npatient.
\n4.\t The WMA urges that every effort be made to make individual-
\nised, multi-professional, interdisciplinary and affordable trans-
\ngender healthcare (including speech therapy, hormonal treat-
\nment, surgical interventions and mental healthcare) available
\nto all people who experience gender incongruence in order to
\nreduce or to prevent pronounced gender dysphoria.
\n5.\t The WMA explicitly rejects any form of coercive treatment or
\nforced behaviour modification. Transgender healthcare aims to
\nenable transgender people to have the best possible quality of
\nlife. National Medical Associations should take action to iden-
\ntify and combat barriers to care.
\n6.\t The WMA calls for the provision of appropriate expert train-
\ning for physicians at all stages of their career to enable them
\nto recognise and avoid discriminatory practises, and to provide
\nappropriate and sensitive transgender healthcare.
\n7.\t The WMA condemns all forms of discrimination, stigmatisa-
\ntion and violence against transgender people and calls for ap-
\npropriate legal measures to protect their equal civil rights. As
\nrole models, individual physicians should use their medical
\nknowledge to combat prejudice in this respect.
\n8.\t The WMA reaffirms its position that no person, regardless of
\ngender, ethnicity, socio-economic status, medical condition or
\ndisability, should be subjected to forced or coerced permanent
\nsterilisation (WMA Statement on Forced and Coerced Sterili-
\nsation). This also includes sterilisation as a condition for recti-
\nfying the recorded sex on official documents following gender
\nreassignment.
\n9.\t The WMA recommends that national governments maintain
\ncontinued interest in the healthcare rights of transgender people
\nby conducting health services research at the national level and
\nusing these results in the development of health and medical
\npolicies. The objective should be a responsive healthcare system
\nthat works with each transgender person to identify the best
\ntreatment options for that individual.
\nWMA Statement on Vitamin D
\nInsufficiency
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nVitamin D has major role in calcium and bone metabolism. Normal
\nvalues are 75-100 nmol\/L (30-40 ng\/ml). Vitamin D deficiency is
\ndefined if serum hydroxyvitamin D levels are less than 50\u00a0nmol\/L
\n(20 ng\/ml), insufficiency as 50-75 nmol\/L (20-30 ng\/ml).
\nStudies demonstrate that vitamin D is essential also for overall
\nhealth and well-being. In the body vitamin D is produced during
\nexposure to sunlight and in lesser degree by food intake.
\nVitamin D exists in two forms: vitamin D3
\n(cholecalciferol in hu-
\nmans and other mammals) and vitamin D2
\n(ergocalciferol in plants),
\nbut both are similarly metabolized. Vitamin D3
\nis more active than
\nvitamin D2.
\nThe serum concentration of the hepatic metabolite of vitamin D3,
\nthe 25-hydroxyvitamin D, is considered as the best biomarker of
\nvitamin D status.
\nVitamin D deficiency is an important health issue globally. About
\none third of the population is estimated to have lower serum con-
\ncentration of vitamin D.
\nMany studies have shown that vitamin D deficiency is linked to
\nimpaired growth and development. Because vitamin D receptors
\nare broadly distributed in tissues, vitamin D deficiency is associated
\nwith musculoskeletal disorders (osteoporosis), falls, fractures, auto-
\nimmune disorders, chronic inflammatory diseases, type 2 diabetes
\nmellitus, and cardiovascular, neurologic and psychiatric disorders.
\nHigh risk groups are young children,the elderly and pregnant wom-
\nen. Primary factors, contributing to vitamin D deficiency, include
\nreduced sunshine exposure, poor quality diet, availability of fortified
\nfoods and supplement use.
\nRecommendations
\nBecause of widespread occurrence of vitamin D deficiency\/insuf-
\nficiency it is desirable to focus attention on adequate preventive ac-
\ntions in populations at risk. Determining vitamin D levels requires
\nonly a blood test, and oral supplementation is a simple treatment
\nmethod. Sun exposure is not generally recommended because it can
\nincrease the risk of skin cancer.
\nThe World Medical Association recommends that national medical
\nassociations:
\n1.\t Support continued research in vitamin D and its metabolites.
\n2.\t Educate physicians about the evolving science of vitamin D and
\nits impact on health (documents, brochures, posters).
\n3.\t Encourage physicians to consider measuring the serum con-
\ncentrations of 25-hydroxyvitamin D in the patients at risk of
\nvitamin D deficiency.
\n4.\t Monitor development of dietary recommendations for vita-
\nmin\u00a0D.
\nWMA Guidelines on
\nPromotional Mass Media
\nAppearances by Physicians
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nMass media can effectively play diverse roles in medical commu-
\nnication. Physicians, as professionals and experts, can contribute to
\nimproved public health by providing the public with accurate health
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\nWMA News WMA News
\nrelated information. Mass media provides a channel through which
\nphysicians may contribute to society by leveraging mass media ap-
\npearances in positive ways.
\nHowever, the increase in instances of physicians\u2019 frequent appear-
\nances on mass media to recommend unproven treatments or prod-
\nucts and to use such appearances for marketing purposes is posing
\na serious concern. The public may readily accept groundless recom-
\nmendations by physicians and may develop unrealistic expectations.
\nThe subsequent confusion and disappointment can damage the
\npatient-physician-relationship.
\nThis issue is more serious in some countries where there are differ-
\nent systems of medicine, including alternative medicine.
\nRecommendations
\nThe WMA recommends the following guidelines regarding mass
\nmedia appearances by physicians to prevent them from being in-
\nvolved in commercial activities that may compromise professional
\nethics and to contribute to patient safety by ensuring physicians
\nproviding accurate, timely, and objective information.
\nAccurate and Objective Delivery of Scientifically
\nProven Medical Information
\nWhen appearing in media, physicians shall provide objective and
\nevidence-based information and shall not recommend medical pro-
\ncedures or products that are not medically proven or justified.
\nA physician shall not use expressions that may promote unrealistic
\npatient expectations or mislead viewers about the function and ef-
\nfect of medical procedures, drugs or other products.
\nPhysicians shall include important information including possible
\nadverse effects and risks when explaining medical procedures,drugs,
\nor other products.
\nNot Abusing Mass Media as a Means of Advertisement
\nPhysicians should not recommend specific products by either spe-
\ncifically introducing or intentionally highlighting the name or
\ntrademark of a product.
\nPhysicians shall practice prudence regarding personal appearances
\non home shopping program..The physician should have no financial
\nstake in the products being sold.
\nPhysicians shall not be a part of mass media advertisement on any
\nproduc, which is harmful to huma, and\/or environment.
\nMaintaining Professional Integrity
\nPhysicians shall not require or receive economic benefits for mass
\nmedia appearances other than a customary appearance fee.
\nPhysicians shall not provide economic benefits to broadcasting per-
\nsonnel in order to secure mass media appearances.
\nPhysicians shall not engage in the promotion, sale or advertising of
\ncommercial products and shall not introduce false or exaggerated
\nstatements regarding their qualifications such as academic back-
\nground, professional experience, medical specialty and licensure as
\na specialist, for the benefit of the economic interests of any com-
\nmercial entity.
\nWMA Resolution on the
\nInclusion of Medical Ethics and
\nHuman Rights in the Curriculum
\nof Medical Schools World-Wide
\nAdopted by the 51st
\nWorld Medical Assembly, Tel Aviv, Israel,
\nOctober 1999
\nand revised by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nMedical School curricula are designed to prepare medical stu-
\ndents to enter the profession of medicine. Increasingly, in addi-
\ntion to core biomedical and clinical knowledge, they teach skills
\nincluding critical appraisal and reflective practice.These additional
\nskills help to enable future doctors to understand and assess the
\nimportance of published research evidence, and how to evaluate
\ntheir own practice against norms and standards set nationally and
\ninternationally.
\nIn much the same way that anatomy, physiology and biochemistry
\nare a solid base for understanding the human body, how it works,
\nhow it can fail or otherwise go wrong, and how different mecha-
\nnisms can be used to repair damaged structure and functions, there
\nis a clear need for physicians in training to understand the social,
\ncultural and environmental contexts within which they will practice.
\nThis includes a solid understanding of the social determinants of
\nhealth.
\nMedical ethics includes the social contract made between the
\nhealth care professions and the societies they serve, based upon
\nestablished principles, on the limits that apply to medical practice.
\nIt also establishes a system or set of principles through which new
\ntreatments or other clinical interventions will be sieved before de-
\ncisions are made on whether elements are acceptable within medi-
\ncal practice. There is a complex intermingling of medical ethics
\nand the duties of physicians to patients, and the rights patients
\nenjoy as citizens.
\nAt the same time physicians face challenges and opportunities in
\nrelation to the human rights of their patients and of populations,for
\nexample, occasions for imposing treatments without consent, and
\nwill also often be the first to observe and to itemize the infringe-
\nment of these rights by others, including the state. This places very
\nspecific responsibilities upon the observing physician.
\nPhysicians have a duty to use their knowledge to improve the well-
\nbeing and health of patients and the population.This will mean con-
\nsidering social and societal change, including legislation and regula-
\ntion, and can only be done well if doctors can take a holistic view
\nwithin clinical and ethical parameters.
\nPhysicians should press government to ensure legislation supports
\nprincipled medical practice.
\nGiven the core nature of health care ethics in establishing medical
\npractice in a manner that is acceptable to society and that does not
\nviolate civil, political and other human rights, it is essential that all
\nphysicians are trained to perform an ethics evaluation of every clini-
\ncal scenario they may encounter, while simultaneously understand-
\ning their role in protecting the rights of individuals.
\nPhysicians\u2019ability to act and communicate in a way that respects the
\nvalues of the individual patient is a prerequisite for successful treat-
\nment. Physicians must also be able to work effectively in teams with
\nother health c are professionals including other physicians.
\nFailures of individual physicians to recognize the ethical obliga-
\ntions they owe patients and communities can damage the reputa-
\ntion of doctors both locally and globally. Therefore it is essential
\nthat all doctors are taught to understand and respect medical eth-
\nics and human rights from the beginning of their medical school
\ncareers.
\nIn many countries ethics and human rights are an integral part of
\nthe medical curriculum, but this is not universal. Too often teach-
\ning is undertaken by volunteers, and can fail if those volunteers are
\nunable or unavailable to teach, or if that teaching is unduly idiosyn-
\ncratic or inadequately based upon clinical scenarios.
\nThe teaching of medical ethics should become an obligatory and
\nexamined part of the medical curriculum within every medical
\nschool.
\nRecommendations
\n1.\t The WMA urges that medical ethics and human rights be taught
\nat every medical school as obligatory and examined parts of the
\ncurriculum, and should continue at all stages of post graduate
\nmedical education and continuing professional development.
\n2.\t The WMA believes that medical schools should seek to ensure
\nthat they have sufficient faculty skilled at teaching ethical en-
\nquiry and human rights to make these courses sustainable.
\n3.\t The WMA commends the inclusion of medical ethics and hu-
\nman rights within post graduate and continuing medical educa-
\ntion.
\nWMA Statement on
\nNon-Discrimination in
\nProfessional Membership
\nand Activities of Physicians
\nAdopted by the 37th
\nWorld Medical Assembly, Brussels, Belgium, October
\n1985
\nand editorially revised by the 170th
\nWMA Council Session,
\nDivonne-les-Bains, France, May 2005
\nand revised by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nThe World Medical Association is in favour of equality of opportu-
\nnity in medical association activities, medical education and train-
\ning, employment, and all other medical professional endeavours
\nregardless of any factors of discrimination.
\nThe World Medical Association is unalterably opposed to the denial
\nof membership privileges and responsibilities in National Medical
\nAssociations to any duly registered physician because of any factors
\nof discrimination.
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\nWMA News WMA News
\nThe World Medical Association calls upon the medical profession
\nand all individual members of National Medical Associations to ex-
\nert every effort to prevent any instance in which such equal rights,
\nprivileges or responsibilities are denied.
\nWMA Statement on Ethical
\nIssues Concerning Patients with
\nMental Illness
\nAdopted by the 47th
\nWMA General Assembly, Bali, Indonesia, September
\n1995
\nand revised by the 57th
\nWMA General Assembly, Pilanesberg, South Af-
\nrica, October 2006
\nand by the 66th
\nWMA General Assembly, Moscow, Russia, October 2015
\nPreamble
\nHistorically, many societies have regarded patients with mental ill-
\nness as a threat to those around them rather than as people in need
\nof support and care. In the absence of effective treatment, to prevent
\nself-destructive behaviour or harm to others, many persons with
\nmental illness were confined to asylums for all or part of their lives.
\nToday, progress in psychiatric treatment allows for better care of
\npatients with mental illness. Efficacious drugs and psychosocial in-
\nterventions offer outcomes ranging from complete recovery to re-
\nmission for varying lengths of time.
\nThe adoption in 2006 of the United Nations Convention on the
\nRights of Persons with Disabilities constituted a major step towards
\nviewing them as full members of society with the same rights as ev-
\neryone else. It is the first comprehensive human rights treaty of the
\n21st
\ncentury. It aims to promote, protect and reinforce the human
\nrights and dignity of all persons with disabilities, including those
\nwith mental impairments.
\nPersons with major mental illnesses and those with learning dis-
\nability have the same right to preventive services and interventions
\nto promote health as others members of the community, for which
\nthey often have greater need because they are more likely to live
\nunhealthy lifestyles.
\nPatients with psychiatric morbidity may also experience non- psy-
\nchiatric illness. Persons with mental illness have the same right to
\nhealth care as any other patient. Psychiatrists and health care pro-
\nfessionals who provide mental health services should refer patients
\nto other appropriate professionals when patients need medical care.
\nHealth care professionals should never decline to provide needed
\nmedical care solely because the patient has a mental illness.
\nPhysicians have the same obligations to all patients, including pa-
\ntients with mental illness.Psychiatrists or other physicians who treat
\npatients with mental illness must adhere to the same ethical stan-
\ndards as any physician.
\nThe physician\u2019s primary obligation is to the patient and not to serve
\nas agents of society, except in circumstances when a patient presents
\nclear danger to himself\/ herself or others due to mental illness.
\nPhysicians\u2019 Ethical Responsibilities
\nThe stigma and discrimination associated with psychiatry and the
\nmentally ill should be eliminated. Stigma and discrimination may
\ndiscourage people in need from seeking medical care, thereby ag-
\ngravating their situation and placing them at risk of emotional or
\nphysical harm.
\nPhysicians have a responsibility to respect the autonomy of all pa-
\ntients. When patients who are being treated for mental illness have
\ndecision-making capacity, they have the same right to make deci-
\nsions about their care as any other patient.Because decision-making
\ncapacity is specific to the decision to be made and can vary over
\ntime, including as a result of treatment, physicians must continually
\nevaluate the patient\u2019s capacity. When a patient lacks decision-mak-
\ning capacity, physicians should seek consent from an appropriate
\nsurrogate in accordance with applicable law.
\nThe therapeutic relationship between physician and patient is
\nfounded on mutual trust, and physicians have a responsibility to
\nseek patients\u2019 informed consent to treatment, including patients
\nwho are being treated for mental illness. Physicians should inform
\nall patients of the nature of the psychiatric or other medical con-
\ndition, and the expected benefits, outcomes and risks of treatment
\nalternatives.
\nPhysicians should always base treatment recommendations on their
\nbest professional judgment and treat all patients with solicitude and
\nrespect, regardless of the setting of care. Physicians who practice
\nin mental health facilities, military or correctional institutions may
\nhave concurrent responsibilities to society that create conflicts with
\nthe physician\u2019s primary obligation to the patient. In such situations,
\nphysicians should disclose the conflict of interest to minimize pos-
\nsible feelings of betrayal on the patient\u2019s part.
\nInvoluntary treatment or hospitalization of persons with mental
\nillness is ethically controversial. While laws regarding involuntary
\nhospitalization and treatment vary worldwide, it is generally ac-
\nknowledged that this treatment decision without the patient\u2019s in-
\nformed consent or against the patient\u2019s will is ethically justifiable
\nonly when: (a) a severe mental disorder prevents the individual from
\nmaking autonomous treatment decisions; and\/or (b) there is signifi-
\ncant likelihood that the patient may harm him\/her self or others.
\nInvoluntary treatment or hospitalization should be exceptional and
\nphysicians should utilize it only when there is good evidence that it
\nis medically appropriate and necessary and should ensure that the
\nindividual is hospitalized for the shortest duration feasible under
\nthe circumstances. Wherever possible and in accordance with local
\nlaws, physicians should include an advocate for the rights of that
\npatient in the decision process.
\nPhysicians must protect the confidentiality and privacy of all patients.
\nWhen legally required to disclose patient information, the physician
\nshould disclose only the minimum relevant information necessary
\nand only to an entity legally authorized to request or require the in-
\nformation.When databanks allow access to or transfer of information
\nfrom one authority to another, confidentiality must be respected and
\nsuch access or transfer must comply fully with applicable law.
\nThe participation of individuals with psychiatric illness in research
\nneeds to be in full accordance with the Recommendations of the
\nDeclaration of Helsinki.
\nPhysicians must never use their professional position to violate the
\ndignity or human rights of any individual or group, and should nev-
\ner allow their personal desires, needs, feelings, prejudices or beliefs
\nto interfere with a patient treatment. Physicians must never abuse
\ntheir authority or take advantage of a patient\u2019s vulnerability.
\nRecommendations
\nThe World Medical Association and National Medical Associations
\nare encouraged to:
\n1.\t Publicize this Statement and affirm the ethical foundations for
\ntreatment of patients with mental illness.
\n2.\t While doing so,call for full respect \u2013 at all times \u2013 of the dignity
\nand human rights of patients with mental illness.
\n3.\t Raise awareness of physicians\u2019 responsibilities to support the
\nwell-being and rights of patients with mental illness.
\n4.\t Promote recognition of the privileged relationship between pa-
\ntient and physician based on trust, professionalism and confi-
\ndentiality.
\n5.\t Advocate for appropriate resources to meet the needs of persons
\nwith mental illness.
\nWMA Declaration of Oslo on
\nSocial Determinants of Health
\nAdopted by the 62nd
\nWMA General Assembly, Montevideo, Uruguay,
\nOctober 2011
\nand the title (Statement to Declaration) changed by the 66th
\nWMA Gen-
\neral Assembly, Moscow, Russia, October 2015
\nThe social determinants of health are: the conditions in which peo-
\nple are born, grow, live, work and age; and the societal influences
\non these conditions. The social determinants of health are major
\ninfluences on both quality of life, including good health, and length
\nof disability-free life expectancy. While health care will attempt to
\npick up the pieces and repair the damage caused by premature ill
\nhealth,it is these social,cultural,environmental,economic and other
\nfactors that are the major causes of rates of illness and, in particular,
\nthe magnitude of health inequalities.
\nHistorically, the primary role of doctors and other health care pro-
\nfessionals has been to treat the sick \u2013 a vital and much cherished
\nrole in all societies.To a lesser extent, health care professionals have
\ndealt with individual exposures to the causes of disease \u2013 smoking,
\nobesity, and alcohol in chronic disease, for example. These familiar
\naspects of life style can be thought of as \u2018proximate\u2019causes of disease.
\nThe work on social determinants goes far beyond this focus on proxi-
\nmate causes and considers the \u201ccauses of the causes\u201d. For example,
\nsmoking, obesity, alcohol, sedentary life style are all causes of illness.
\nA social determinants approach addresses the causes of these causes;
\nand in particular how they contribute to social inequalities in health.
\nIt focuses not only on individual behaviours but seeks to address the
\nsocial and economic circumstances that give rise to premature ill
\nhealth,throughout the life course: early child development,education,
\nwork and living conditions, and the structural causes that give rise
\nto these living and working conditions. In many societies, unhealthy
\nbehaviours follow the social gradient: the lower people are in the so-
\ncioeconomic hierarchy,the more they smoke,the worse their diet,and
\nthe less physical activity they engage in. A major, but not the only,
\ncause of the social distribution of these causes is level of education.
\nOther specific examples of addressing the causes of the causes: price
\nand availability which are key drivers of alcohol consumption; taxa-
\ntion, package labelling, bans on advertising, and smoking in public
\nplaces which have had demonstrable effects on tobacco consumption.
\nThe voice of the medical profession has been most important in these
\nexamples of tackling the causes of the causes.
\nThere is a growing movement, globally, that seeks to address gross
\ninequalities in health and length of life through action on the so-
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\nWMA News WMA News
\ncial determinants of health.This movement has involved the World
\nHealth Organisation, several national governments, civil society or-
\nganization, and academics. Solutions are being sought and learning
\nshared. Doctors should be well informed participants in this debate.
\nThere is much that can happen within the practice of medicine that
\ncan contribute directly and through working with other sectors.The
\nmedical profession can be advocates for action on those social con-
\nditions that have important effects on health.
\nThe WMA could add significant value to the global efforts to ad-
\ndress these social determinants by helping doctors, other health
\nprofessionals and National Medical Associations understand what
\nthe emerging evidence shows and what works, in different circum-
\nstances. It could help doctors to lobby more effectively within their
\ncountries and across international borders, and ensure that medical
\nknowledge and skills are shared.
\nThe WMA should help to gather data of examples that are working,
\nand help to engage doctors and other health professionals in trying
\nnew and innovative solutions. It should work with national associa-
\ntions to educate and inform their members and put pressure on na-
\ntional governments to take the appropriate steps to try to minimise
\nthese root causes of premature ill health. In Britain, for example,
\nthe national government has issued a public health white paper that
\nhas at its heart reduction of health inequalities through action on
\nthe social determinants of health; several local areas have drawn up
\nplans of action; there are good examples of general practice that
\nwork across sectors improve the quality of people\u2019s lives and hence
\nreduce health inequalities. The WMA should gather examples of
\ngood practice from its members and promote further work in this
\narea.
\nWMA Statement on Supporting
\nHealth Support to Street
\nChildren
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia, October
\n2015
\nPreamble
\nThe WMA recognises that having children living on the streets is
\nunacceptable in society even though this phenomenon is difficult to
\navoid in many communities around the world.
\nThe WMA intends to raise awareness within civil and medical so-
\nciety about the fundamental role played by medical contact in im-
\nproving the situation of street children. In this regard, it is impor-
\ntant that the initial contact with street children be based on trust.
\nTherefore, together with other healthcare professionals and social
\nworkers, medical contact should be viewed as the first step towards
\nresocialising street children by building trust between the physician
\nand the street child. Once achieved, a more global multidisciplinary
\nand multidimensional approach can follow to improve the well-
\nbeing of street children.
\n\u2022\t Childhood and adolescence are the beginnings of a long physical,
\nmental, cultural and social growth process;
\n\u2022\t The health of young people shapes the health of tomorrow\u2019s pop-
\nulation;
\n\u2022\t Young people play a part in social cohesion and they are an asset
\nto any country;
\n\u2022\t Addressing the social determinants of health is essential to
\nachieving equity in healthcare.The social determinants leading to
\nthe appearance and growth of the phenomenon of street children
\nare varied and complex;
\n\u2022\t The negative health impact of living on the streets for children,both
\nin terms of the additional health risks to which these children are
\nexposed and their lack of access to healthcare and prevention; street
\nchildren are, in particular, more vulnerable to acute illnesses and
\ntraumatic injuries. In addition, preventive care and continuity of
\ncare are non-existent for street children due to frequent relocation;
\n\u2022\t The health of street children remains critical and has been ex-
\nacerbated by the global financial and economic crisis which has
\ncontributed to family break-ups, social upheaval and disruptions
\nin healthcare and education;
\n\u2022\t Children may be victims of discrimination arising from their gen-
\nder, ethnic origin, language, religion, political opinion, handicap,
\nsocial status or population migration;
\n\u2022\t Street children are especially vulnerable to abuse,violence, exploi-
\ntation and manipulation, including trafficking;
\n\u2022\t Child homelessness often goes unrecognised at a national and
\ninternational level since it is difficult to quantify and assess.
\nRecommendations
\n1.\t The WMA strongly condemns any violations of the rights of
\nchildren living on the streets and any infringements of these
\nrights, in particular discrimination and stigmatisation and their
\nexposure to abuse, violence, exploitation and manipulation, in-
\ncluding trafficking.
\n2.\t The WMA calls upon governments to address the factors which
\nlead to children living on the streets and to take action to im-
\nplement all applicable legislation and systems of protection to
\nreduce the health implications for street children. National au-
\nthorities have an obligation to provide care for all children and,
\nwhere necessary, to support their return to a living environment
\nappropriate for a child.
\n3.\t Reducing health implications includes not only direct treatment
\nof health issues but also protection of Street Children from
\nhealth risks such as exposure to drugs, HIV infection, smoking
\nand drinking.
\n4.\t The WMA calls upon governments, national medical associa-
\ntions and healthcare professionals to acknowledge the scale of
\nthis phenomenon and to instigate prevention and awareness
\ncampaigns. These children must be able to access the full range
\nof necessary health and social protection.
\n5.\t The WMA urges all national medical associations to work with
\nlegal counterparts, governments, health care professionals and
\npublic authorities to ensure the fundamental rights of children,
\nwho are a particularly vulnerable population in need of protec-
\ntion, particularly access to healthcare and education. The right
\nto food and housing should be guaranteed, and any form of dis-
\ncrimination or exploitation should be forbidden.
\n6.\t The WMA condemns any improper age-assessment practices
\nthat make use of insufficiently reliable clinical or paraclinical
\ninvestigations. Until they reach adulthood, adolescents must be
\nable to enjoy their status as minors, as recognised by the UN
\nInternational Convention on the Rights of the Child.
\n7.\t The WMA urges physicians to remain vigilant in terms of de-
\nlivering all the support required to provide suitable and compre-
\nhensive care for street children. Physicians should be aware that
\nhomelessness is a pervasive problem. They should be knowl-
\nedgeable about the existence of homelessness in their own com-
\nmunities and are encouraged to establish a relationship of trust
\nbetween the physician and the street child to become involved
\nin local relief and advocacy programs.
\n8.\t The WMA maintains that every effort should be made to pro-
\nvide all children, and particularly those that are homeless, with
\naccess to a suitable and balanced psycho-social environment, in
\nwhich their rights, including the right to health, are respected.
\nWMA Statement on Mobile
\nHealth
\nAdoptedbythe66th
\nWMAGeneralAssembly,Moscow,Russia,October2015
\nPreamble
\nMobile health (mHealth) is a form of electronic health (eHealth)
\nfor which there is no fixed definition. It has been described as medi-
\ncal and public health practice supported by mobile devices such as
\nmobile phones, patient monitoring devices, personal digital assis-
\ntants (PDAs), and other devices intended to be used in connection
\nwith mobile devices. It includes voice and short messaging services
\n(SMS), applications (apps), and the use of the global positioning
\nsystem (GPS).
\nSufficient policies and safeguards to regulate and secure the collec-
\ntion, storage, protection and processing of data of mHealth users,
\nespecially health data, must be implemented. Users of mHealth ser-
\nvices must be informed about how their personal data are collected,
\nstored, protected and processed and their consent must be obtained
\nprior to any disclosure of data to third parties, e.g. researchers, gov-
\nernments or insurance companies.
\nThe monitoring and evaluation of mHealth should be imple-
\nmented carefully to avoid inequity of access to these technologies.
\nWhere appropriate, social or healthcare services should facilitate
\naccess to mHealth technologies as part of basic benefit packages,
\nwhile taking all the required precautions to guarantee data security
\nand privacy. Access to mHealth technologies should not be denied
\nto anyone on the basis of financial status or a lack of technical
\nexpertise.
\nmHealth technologies cover a wide spectrum of functions. They
\nmay be used for:
\n\u2022\t Health promotional (lifestyle) purposes, such as apps into which
\nusers input their calorie intake or motion sensors which track ex-
\nercise.
\n\u2022\t Services which require the medical expertise of physicians such
\nas SMS services providing advice to pregnant women or wearable
\nsensors to monitor chronic conditions such as diabetes. mHealth
\ntechnologies of this nature frequently meet the definition of a
\nmedical device and should be subject to risk-based oversight and
\nregulation with all its implications.
\nmHealth may also be used to expedite the transfer of information
\nbetween health professionals, e.g. providing physicians with free,
\ncross network mobile phone access in resource poor settings.
\nTechnological developments and the increasing prevalence and af-
\nfordability of mobile devices have led to an exponential increase in
\nthe number and variety of mHealth services in use in both devel-
\noped and developing countries.At the same time,this relatively new
\nand rapidly evolving sector remains largely unregulated,a fact which
\ncould have potential patient safety implications.
\nmHealth has the potential to supplement and further develop exist-
\ning healthcare services by leveraging the increasing prevalence of
\nmobile devices to facilitate access to healthcare, improve patient
\nBACK TO CONTENTS
\n154 155
\nWMA News WMA News
\nself-management, enable electronic interactions between patients
\nand their physicians and potentially reduce healthcare costs. There
\nare significant regional and demographic variations in the potential
\nuse and benefits of mHealth. The use of certain mHealth services
\nmay be more appropriate in some settings than others.
\nmHealth technologies generally involve the measurement or
\nmanual input of medical, physiological, lifestyle, activity and envi-
\nronmental data in order to fulfil their primary purpose. The large
\namount of data generated in this way also offers huge scope for
\nresearch into effective healthcare delivery and disease prevention.
\nHowever, this secondary use of personal data also has great poten-
\ntial for misuse and abuse, of which many users of mHealth services
\nare unaware.
\nThe expansion of mHealth services has been largely market driven
\nand many technologies have been developed in an uncoordinated,
\nexperimental fashion and without appropriate consideration of data
\nprotection and security or patient safety aspects. It is often im-
\npossible for users to know whether the information provided via
\nmHealth stems from a reliable medical source. Major challenges
\nfaced by the mHealth market are the quality of mHealth technolo-
\ngies and whether their use ultimately helps patients or physicians
\nachieve the intended purpose.
\nComprehensive regulation and evaluation of the effectiveness, qual-
\nity and cost effectiveness of mHealth technologies and services is
\ncurrently lacking, which has implications for patient safety. These
\nfactors are crucial to the integration of mHealth services into regu-
\nlar healthcare provision.
\nRecommendations
\n1.\t The WMA recognises the potential of mHealth to supplement
\ntraditional ways of managing health and delivering healthcare.
\nWhile mHealth may offer advantages to patients otherwise un-
\nable to access services from physicians, it is neither universally
\nappropriate nor always an ideal form of diagnosis and treatment
\noption. Where face-to-face treatment is available this is almost
\nalways advantageous to the patient.
\n2.\t The driving force behind mHealth must be the need to elimi-
\nnate deficiencies in the provision of care or to improve the qual-
\nity of care.
\n3.\t The WMA urges patients and physicians to be extremely dis-
\ncerning in their use of mHealth and to be mindful of potential
\nrisks and implications.
\n4.\t A clear distinction must be made between mHealth technol-
\nogies used for lifestyle purposes and those which require the
\nmedical expertise of physicians and meet the definition of medi-
\ncal devices.The latter must be appropriately regulated and users
\nmust be able to verify the source of information provided. The
\ninformation provided must be clear, reliable and non-technical,
\nand therefore comprehensible to lay people.
\n5.\t Concerted work must go into improving the interoperability,
\nreliability, functionality and safety of mHealth technologies,
\ne.g. through the development of standards and certification
\nschemes.
\n6.\t Comprehensive and independent evaluations must be carried
\nout by competent authorities with appropriate medical expertise
\non a regular basis in order to assess the functionality, limitations,
\ndata integrity, security and privacy of mHealth technologies.
\nThis information must be made publicly available.
\n7.\t mHealth can only make a positive contribution towards im-
\nprovements in care if services are based on sound medical ra-
\ntionale. As evidence of clinical usefulness is developed, findings
\nshould be published in peer reviewed journals and be reproduc-
\nible.
\n8.\t Suitable reimbursement models must be set up in consultation
\nwith national medical associations and healthcare providers to
\nensure that physicians receive appropriate reimbursement for
\ntheir involvement in mHealth activities.
\n9.\t A clear legal framework must be drawn up to address the issue
\nof identifying potential liability arising from the use of mHealth
\ntechnologies.
\n10.\tPhysicians who use mHealth technologies to deliver healthcare
\nservices should heed the ethical guidelines set out in the WMA
\nStatement on Guiding Principles for the Use of Telehealth for
\nthe Provision of Health Care.
\n11.\tIt is important to take into account the risks of excessive or in-
\nappropriate use of mHealth technologies and the potential psy-
\nchological impact this can have on patients.
\nWMA Statement on Nuclear
\nWeapons
\nAdopted by the 50th
\nWorld Medical Assembly, Ottawa, Canada,
\nOctober 1998
\nand amended by the 59th
\nWMA General Assembly, Seoul, Korea, Octo-
\nber 2008
\nand by the 66th
\nWMA General Assembly, Moscow, Russia, October 2015
\nThe WMA Declarations of Geneva, of Helsinki and of Tokyo make
\nclear the duties and responsibilities of the medical profession to pre-
\nserve and safeguard the health of the patient and to consecrate itself
\nto the service of humanity.The WMA considers that it has a duty to
\nwork for the elimination of nuclear weapons.
\nTherefore the WMA:
\n\u2022\t Condemns the development, testing, production, stockpiling,
\ntransfer, deployment, threat and use of nuclear weapons;
\n\u2022\t Requests all governments to refrain from the development, test-
\ning, production, stockpiling, transfer, deployment, threat and use
\nof nuclear weapons and to work in good faith towards the elimi-
\nnation of nuclear weapons;
\n\u2022\t Advises all governments that even a limited nuclear war would
\nbring about immense human suffering and substantial death toll
\ntogether with catastrophic effects on the earth\u2019s ecosyste, which
\ncould subsequently decrease the worlds food supply and would
\nput a significant portion of the world\u2019s population at risk of fam-
\nine; and
\n\u2022\t Requests that all National Medical Associations join the WMA
\nin supporting this Declaration, use available educational re-
\nsources to educate the general public and urge their respective
\ngovernments to work towards the elimination of nuclear weap-
\nons.
\n\u2022\t Requests all National Medical Associations to join the WMA in
\nsupporting this Declaration and to urge their respective govern-
\nments to work to ban and eliminate nuclear weapons.
\nWMA Statement on Riot
\nControl Agents
\nAdopted by the 66th
\nWMA General Assembly, Moscow, Russia,
\nOctober 2015
\nPreamble
\nThere has been a long-standing concern regarding the use of chemi-
\ncal weapons. Despite this concern, poison gas was used fairly exten-
\nsively during World War I, leading to a call from the International
\nCommittee of the Red Cross (ICRC) in February 1918 for cessa-
\ntion of its use.
\nThis led to the Geneva Protocol of 1925, the Biological and Toxin
\nWeapons Convention of 1972 (BTWC) and the Chemical Weap-
\nons Convention of 1993 (CWC).
\nAll but six countries in the world have signed and ratified the
\nCWC; two more have signed but not yet ratified, making it a nearly
\nuniversally accepted Convention.
\nThe conventions prohibit the development, production and stock-
\npiling of chemical weapons in addition to their usage in warfare
\nand call for measures to decommission or destroy existing stores.
\nHowever,the CWC allows the use of specific chemicals in domestic
\nlaw enforcement including riot control situations, which means that
\ngovernments might hold stockpiles of certain agents. Even so, riot
\ncontrol agents cannot be used in warfare; the exclusion has reached
\nthe status of customary law which allows their use only in domestic
\nor national jurisdictions.
\nAlthough there is academic and military interest in what is often
\ncalled non-lethal weapons, the incidence of morbidity and mortal-
\nity caused by weapons are not criteria used in prohibition. A tiered
\napproach based upon degrees of lethality of specific weapons is con-
\ntrary to the ethos of both conventions.
\nIn situations of widespread public unrest and political or other up-
\nrisings governments unfortunately may choose to deploy riot con-
\ntrol agents in a domestic setting. Although this is not in conflict
\nwith the principles of the CWC their use may still give rise to spe-
\ncific medical, legal and ethical challenges.
\nWhile riot control agents are designed to make remaining within
\nthe riot unpleasant and impractical,they are not expected to directly
\ncause any injuries or deaths. As with all other agents, how they are
\nused determines the concentration to which individuals are exposed.
\nThe ability to take evasive actions, such as leaving the area, to reduce
\nexposure may also have an impact. It is recognised that individual
\ndeterminants including general health and age will affect an indi-
\nvidual\u2019s response to chemical agent.
\nRelease of chemical agents such as tear gas in a small enclosed space
\nexposes individuals to concentrations far higher than those expected
\nin normal deployment in riot situations, causing higher levels of
\nserious morbidity and potentially death.
\nMisuse of riot control agents, leading to serious harms or deaths
\nof demonstrators, exposing individuals excessively or using them
\nfor oppressing non-violent peaceful demonstrations, may lead to a
\nbreach of the human rights of the individuals concerned, in par-
\nticular the right to life (article 3), the right to freedom of expression
\n(article 19) and of peaceful assembly (article 20) of the Universal
\nDeclaration of Human Rights.
\nGovernments, who authorize the stockpiling and use of such agents
\nby their police and security forces, are urged to consider that there
\nmight be fatal results of their usage. Governments are required to
\nensure that they are used in a manner which minimise their likeli-
\nhood of causing serious morbidity and mortality.
\nBACK TO CONTENTS
\n156 157
\nUNITED KINGDOMUNITED KINGDOM Body Cavity SearchesBody Cavity Searches
\nRecommendations
\n1.\t The WMA recognises that the inappropriate use of riot con-
\ntrol agents risks the lives of those targeted and exposes peo-
\nple around, amounting to a potential breach of human rights
\nstandards, in particular the right to life, the right to freedom of
\nexpression and of peaceful assembly as stated in the Universal
\nDeclaration of Human Rights.
\n2.\t In case of use of riot control agents, the WMA urges States
\nto do so in a manner designed to minimise the risk of serious
\nharm to individuals, and to prohibit its use in the presence of
\nvulnerable populations, such as children, older people or preg-
\nnant women;
\n3.\t The WMA insists that riot control agents should never be used
\nin enclosed spaces where chemical concentrations may reach
\ndangerous levels, and where people cannot move away from ar-
\neas with high concentrations of the agent;
\n4.\t The WMA insists that governments train police and other secu-
\nrity forces in the safe and legal use of riot control agents,in order
\nto minimise the risk of harm when they are deployed.This must
\ninclude the rapid evacuation of any individual who is apparently
\nsuffering from a high level of exposure, not aiming people, and
\nnot using the agent excessively;
\n5.\t The WMA insists that States penalise individuals who misuse
\nriot control agents and who deliberately endanger human life
\nand safety by using the agents. Such misuse leading to serious
\nphysical harms or death of individuals should be investigated by
\nindependent experts.
\n6.\t The WMA calls for unimpeded and protected access of
\nhealthcare personnel to allow them to fulfil their duty of at-
\ntending to the injured as set forth in the \u201cWMA Declara-
\ntion on the protection of healthcare workers in situations of
\nviolence\u201d.
\n7.\t The WMA recommends that because of the significant difficul-
\nties and risks to health and life associated with the use of such
\nriot control agents States should refrain from using them in any
\ncircumstances.
\nThe BMA prepared a revised version of
\nan old WMA policy for consideration
\nat the Committee Meetings in Moscow.
\nEarlier consideration had made it clear
\nthat revision was necessary; the BMA
\nagreed to undertake the work. Hernan
\nReyes, lately of the ICRC worked with
\nthe author, to ensure that the version
\nsubmitted was in accordance with inter-
\nnational norms.
\nWhy does this matter?
\nBody cavity searches are a reality of life with-
\nin detention settings worldwide. At their
\nleast harmful they are rarely performed, but
\ndone when it is considered that a detainee
\nmight have concealed within a body cavity
\ndrugs, weapons or other contraband items.
\nThese items might pose a risk of immedi-
\nate harm to the detainee him\/herself, to
\nthose around the detainee including prison
\nguards, or might post a future threat within
\nthe detention environment.
\nThere are a number of simple ethical prin-
\nciples that need to be observed during the
\nsearch, regardless of who carries it out.
\nWhere doctors are asked to become in-
\nvolved, the ethical principles are added to
\nby consideration of the patient-doctor rela-
\ntionship.
\nBefore any search
\nAll body cavity searches are, at least, poten-
\ntially demeaning, generating psychosocial
\nharm at some level. They can also result
\nin actual physical harm to the detainee, es-
\npecially if carried out by someone without
\ntraining, or by someone not using appropri-
\nate care and attention.
\nThe fact that there is a potential risk is not
\na reason to insist that doctors carry out all
\nsuch searches; but it is an imperative to re-
\nquire that those performing searches are
\nproperly trained and carry out their search-
\ning in a safe manner.
\nWhy not a doctor
\nperforming the search?
\nIn most cases the searches are carried out
\nfor non-medical reasons. Although the
\ndetainee could suffer harm from some
\nconcealed items in most cases the harm
\nwould be caused by their later use on the
\nBody Cavity Searches
\nVivienne Nathanson
\ndetainee him\/herself or on their use by
\nthe detainee against others. The search is
\ntherefore performed for reasons associ-
\nated with the good order of the place of
\ndetention, for reduction in the presence of
\nweapons, drugs or other contraband and
\nother associated reasons. If doctors per-
\nform the search they are becoming simple
\narms of the institution, rather than the dis-
\npassionate medical professional. This risks
\nundermining the separation of the role of
\nthe doctor and thus the patient (detainee)-
\ndoctor relationship. If the detainee sees
\nthe doctor as just another part of the
\nprison system s\/he is unlikely to trust the
\ndoctor, and ultimately that breakdown in
\ntrust raises significant risks to both patient
\nand doctor, and to public health within the
\nprison community.
\nWherever a search is carried out it should be
\nin private. This means within a room or fa-
\ncility where the only people present are the
\ndetainee, the person performing the search
\nand at most one witness. More witnesses
\nrisks the procedure becoming a spectacle,
\nand demeaning the detainee. A witness
\nmay be necessary to protect both the de-
\ntainee and the searcher. From the perspec-
\ntive of the detainee this should be someone
\nwho can be trusted to tell the truth\u00a0\u2013 and to
\ntherefore prevent an abusive search. From
\nthe searchers point of view the witness
\nshould be someone who will stand up to
\nbullying within the prison and protect him
\nfrom accusations of carrying out an abusive
\nsearch (provided of course that this is the
\ntruth).
\nGender of the searcher
\nIn an ideal world the gender of the searcher
\nshould be the same as that of the detainee.
\nBut this does not protect completely from
\nthe reality that searches could be carried out
\nin asexually inappropriate manner \u2013 in gen-
\neral it is likely to lessen the embarrassment
\nof the detainee that might help to prevent
\npsychosocial harms.
\nWhen the detainee requests
\na doctor as searcher
\nOn occasion the detainee might ask for a
\ndoctor to perform the search; doctors can
\nagree with this, and should ensure before
\nthey search that the detainee is aware that,
\non this occasion, the doctor is acting for
\nthe place of detention and not as a prisoner
\nadvocate. Doctors are faced with a difficult
\ndecision when this request is made as doc-
\ntors are likely to sympathise with the de-
\ntainee but have to be aware of the risk that
\nthis will undermine the trust that is needed
\nbetween detainee as patient and his\/her
\ndoctor.
\nConsent
\nDoctors should only carry out searches with
\nthe consent of the detainee. They should
\nseek to persuade detainees who are reluc-
\ntant to be searched that consent and com-
\npliance is in their best interest if it is clear
\nthat the prison authorities will carry out
\nsuch searches regardless of consent. They
\nshould also seek to ensure that those carry-
\ning out such searches do so only where there
\nis good reason to perform them, and then
\nto use the most ethically correct and non-
\ntraumatic approach possible.
\nAbusive searches (rectal
\nexaminations)
\nThere is emerging evidence that in some de-
\ntention settings regular, routine ano-rectal
\nexaminations are being performed. This is
\nclearly abusive as there is no relationship
\nwith specific perceived threats or evidence
\nof concealments. The \u201ctests\u201d are being con-
\nducted without regard to the ethical prin-
\nciples and with a clear intent of humiliating
\nthe detainees. This is abuse and unaccept-
\nable in any jurisdiction. Doctors who are
\naware of such abuses must report it or they
\nbecome complicit in a serious abuse of hu-
\nman rights.
\nThe subject of searches is complex \u2013 issues
\naround non-compliance by the detainee,
\nimmediate risk to others, the management
\nof transgendered persons all raise consider-
\nable questions.
\nTransgender persons
\nThe draft includes a clause about the man-
\nagement of searches in transgender persons.
\nThis is included to flag up the fact that this
\ngroup of detainees need to be treated with
\nspecial care, in particular as they are likely
\nto be especially sensitive to such searches,
\nincluding to the gender of the person per-
\nforming the search. The clause is there-
\nfore intended to sensitise both doctors and
\nprison authorities reading the guidance to
\nthe specific broader needs of this group of
\ndetainees.
\nThe purpose of the revised WMA guide-
\nlines is to introduce as a basic concept the
\nseparation wherever possible of the doctor
\nfrom the machinery of the place of deten-
\ntion and the importance of recognizing that
\nthis process might be occasionally essential
\nbut it is always problematic and can be seri-
\nously abusive and harmful. That encourages
\nthe WMA member associations and their
\nmembers to attempt to preserve the dignity
\nand bodily integrity of their patients \u2013 the
\ndetainees.
\nAs the redrafters of the resolution the Brit-
\nish Medical Association will be interested
\nto see whether the current draft covers is-
\nsues with sufficient clarity and in enough
\ndepth to be of use to WMA members.
\nProf. Vivienne Nathanson,
\nChairman, Nathanson Health
\nAssociates Limited;
\nConsultant to the BMA
\non WMA matters; Principle adviser
\non public health to the WMA
\nE-mail: viv.nathanson@googlemail.com
\nBACK TO CONTENTS
\n158 159
\nClimate ChangeClimate Change
\nThe health risks posed by climate change
\nare well-recognised, and threaten popu-
\nlations of both low- and high-income
\ncountries [1, 2, 3, 4]. They range from the
\ndirect health impacts of more frequent
\nheatwaves, flooding and extreme weather
\nevents such as storms and bushfires to less
\ndirect impacts such as spreading vector-
\nborne diseases, worsening food security
\nand malnutrition and population dis-
\nplacement [3, 5]. At the same time, tack-
\nling climate change has been called \u201cthe
\ngreatest global health opportunity of the
\n21st
\ncentury\u201d [4] due to the significant
\nhealth co-benefits of low-carbon solu-
\ntions.
\nFor instance, there is now growing at-
\ntention on short-lived climate pollutants
\n(as compared to carbon dioxide, which is
\nlong-lived) such as black carbon and meth-
\nane, which result in air pollution that kills
\n7\u00a0million people annually. Specifically, ris-
\ning global car use and the use of polluting
\nfuels such as coal for energy are both ma-
\njor contributors to outdoor air pollution,
\nwhich is responsible for 3.7 million pre-
\nmature deaths worldwide [6], so a transi-
\ntion to renewable energy and active travel
\n(walking and cycling) could save millions
\nof lives each year attributable to reductions
\nin cardiovascular and respiratory mobid-
\nity over the short term alone. These twin
\nimperatives to protect and promote health
\nin the face of climate change lie behind a
\nnumber of recent health sector declarations
\nand initiatives, from the WHO\u2019s Call To
\nAction\u00a0[7] to the \u2018Doctors for Climate Ac-
\ntion\u2019campaign led by the Royal Australasian
\nCollege of Physicians [8].
\nEarlier this month, a historic and unprec-
\nedented international agreement was ad-
\nopted at the United Nations (UN) climate
\nchange negotiations in Paris (COP21).This
\nagreement established a critical new frame-
\nwork for curbing greenhouse gas emissions
\nand transitioning away from carbon-in-
\ntensive economies\u00a0 \u2013 thus ultimately tack-
\nling climate change and protecting public
\nhealth. The Paris agreement is not perfect,
\nbut it is a monumental step toward a co-
\nordinated and effective global response and
\npresents a critical moment for physician and
\nhealth sector leadership and engagement on
\nclimate change.
\nThe Paris Agreement:
\nWhat it is and what it
\nmeans for health\u2026
\nThe Paris Agreement was adopted on
\n12\u00a0 December 2015 and represents one
\nof the most seminal international agree-
\nments affecting health to date. Indeed,
\nWorld Health Organization Director Gen-
\neral Dr.\u00a0Margaret Chan has described the
\nAgreement as \u201ca significant public health
\ntreaty, with a huge potential to save lives
\nworldwide\u201d [9]. Described as \u201ca health in-
\nsurance policy for the planet\u201d [10] by UN
\nSecretary General Ban Ki-Moon, the
\nAgreement is a product of years of nego-
\ntiations under the UN Framework Conven-
\ntion on Climate Change (UNFCCC).
\nThe UNFCCC was established as part of
\nthe Rio Convention (1992) and includes
\n196 parties which represent 195 countries
\nand the European Union which have agreed
\nto work towards realizing the ultimate ob-
\njective of the Convention, \u201cstabilization of
\ngreenhouse gas concentrations in the atmo-
\nsphere at a level that would prevent danger-
\nous anthropogenic interference with the
\nclimate system\u201d [11]. Each year, the Con-
\nference of Parties (COP) is held to assess
\nprogress under the UNFCCC. Recogniz-
\ning the urgency of action on climate change
\nand using the framework provided by the
\nAd Hoc Working Group on the Durban
\nPlatform for Enhanced Action (ADP),
\nthis year\u2019s COP21 in Paris was preceded
\nby months of negotiations in anticipation
\nof a fair, ambitious and binding agreement
\nto establish an agreement for a coordinated
\nglobal response.
\nTable 1 summarizes key provisions of the
\nAgreement text that are relevant to health.
\nHealth is explicitly included in terms of the
\n\u201cright to health\u201dboth in the preamble of the
\nAgreement as well as the decision adopted
\nin Paris:
\n\u201cAcknowledging that climate change is a com-
\nmon concern of humankind, Parties should,
\nwhen taking action to address climate change,
\nrespect, promote and consider their respec-
\ntive obligations on human rights, the right to
\nhealth, the rights of indigenous peoples, local
\ncommunities, migrants, children, persons with
\ndisabilities and people in vulnerable situations
\nand the right to development, as well as gender
\nequality, empowerment of women and inter-
\ngenerational equity.\u201d
\nThis language implies that parties, when
\ntaking climate action, should consider and
\npromote \u201cthe right to health\u201das well as prin-
\nciples of human rights and equity.Thus, this
\nlanguage at least implicitly recognizes and
\ncompels health sector engagement in action
\non climate change.
\nNational Climate Action:
\nThe Foundation of the
\nParis Agreement
\nLeading up to the UN Framework Con-
\nvention on Climate Change (UNFCCC)
\nClimate Conference (COP21), par-
\nties submitted national commitments to
\ntackle climate change, called Intended
\nThe Climate\/Health Nexus at COP21 & Beyond
\nNationally Determined Commitments
\n(INDCs). These voluntary commitments
\nare designed to support the Paris Agree-
\nment and to succeed the Kyoto Protocol
\nin curbing greenhouse gas emissions. The
\nUNFCCC conducted an analysis of IN-
\nDCs submitted prior to 1st
\nof October
\n2015 including 119 INDCs, reflecting
\ncommitments of 147 parties to the Con-
\nvention, and representing 86% of global
\nemissions in 2010. It concluded that these
\nsubmissions were insufficient to meet the
\ntwo degree Celsius mitigation goal while
\nalso noting that many parties\u2019 contribu-
\ntions were conditional on anticipated in-
\nternational support [13]. A recent INDC
\nsubgroup analysis by the NewClimate
\nInstitute identified potential missed co-
\nbenefits including approximately 150, 000
\npreventable premature deaths from ambi-
\nent air pollution\u00a0[14].
\nIn the context of engagement of the health
\nsector in national action to address climate
\nchange, the World Health Organization
\n(WHO) recently launched the Climate and
\nHealth country profile initiative, through
\nwhich it strives to \u201cprovide relevant and
\nreliable country-specific information about
\nthe current and future impacts of climate
\nchange on human health, the opportunities
\nfor health co-benefits from climate mitiga-
\ntion actions, and current policy responses at
\ncountry level\u201d to inform engagement and
\nadvocacy [15]. Currently 15 countries from
\ndifferent regions have created their coun-
\ntry profile. Identified indicators of national
\nprogress in protecting health from climate
\nchange include:
\n\u2022\t Identification of a national focal point
\nfor climate change in the Ministry of
\nHealth;
\n\u2022\t Approval of a National Health Adapta-
\ntion Strategy;
\n\u2022\t Inclusion of health implications of miti-
\ngation policies in national strategy for
\nclimate change;
\n\u2022\t Completion of a national assessment of
\nclimate change impacts, vulnerability and
\nadaptation for health;
\nTable 1. Summary of Selected Key Health-related Provisions of the Paris Agreement [12]
\nHealth Paris Agree-
\nment Preamble,
\nCOP Decision
\nCOP Decision
\n(Workstream 2)
\n\u2022\u2002\u0007Acknowledges the right to health in context of action
\nto address climate change
\n\u2022\u2002\u0007Recognizes \u201cthe social, economic and environmental
\nvalue of voluntary mitigation actions and their co-
\nbenefits for adaptation, health and sustainable develop-
\nment.\u201d
\nHuman
\nRights
\nParis Agree-
\nment Preamble,
\nCOP Decision
\n\u2022\u2002\u0007Acknowledges human rights in the context of action to
\naddress climate change
\nEquity Paris Agree-
\nment Preamble,
\nArt. 2 & Art. 4
\n\u2022\u2002\u0007Recognizes that implementation of the Agreement
\nshould \u201creflect equity and the principle of common but
\ndifferentiated responsibilities and respective capabili-
\nties.\u201d
\nMitigation Paris Agree-
\nment Art. 2 &
\nArt. 4
\nCOP Decision
\n(Workstream 2)
\n\u2022\u2002\u0007Sets the long term goal to \u201c[h]olding the increase in
\nglobal average temperature to well below 2\u00b0C\u201d and pur-
\nsuing efforts to \u201climit the temperature increase to 1.5
\n\u00b0C above pre-industrial levels\u201d
\n\u2022\u2002\u0007Recognizes mitigation cobenefits
\n\u2022\u2002\u0007Recognizes the mitigation co-benefits during the pre-
\n2020 period
\nAdaptation Paris Agree-
\nment Art. 2
\n\u2022\u2002\u0007Includes the ability to adapt to the adverse impacts of
\nclimate and foster climate resilience and low green-
\nhouse gas emissions development, in a manner that
\ndoes not threaten food production as part of the long-
\nterm goal of the Agreement
\nLoss &
\nDamage
\nParis Agree-
\nment Art. 8
\n\u2022\u2002\u0007Includes recognition of the importance of \u201caverting,
\nminimizing and addressing loss and damage associated
\nwith the adverse effects of climate change\u201d
\n\u2022\u2002\u0007Identifies areas of cooperation and facilitation to
\nenhance understanding, action and support which can
\ninclude: emergency preparedness, non-economic losses,
\nresilience of communities
\nFinancing COP Decision \u2022\u2002\u0007Sets a new collective quantified goal from a floor of
\nUSD 100 billion per year by 2025, taking into account
\nthe needs and priorities of developing countries
\nNon-party
\nStakehold-
\ners
\nCOP Decision \u2022\u2002\u0007Invites non-party stakeholders to scale up efforts and
\nsupport actions to reduce emissions and\/or to build re-
\nsilience and decrease vulnerability to the adverse effects
\nof climate change
\nTranspar-
\nency
\nParis Agree-
\nment, Art. 13
\n\u2022\u2002\u0007Establishes an enhanced transparency framework for
\nthe Agreement implementation
\nEducation Paris Agree-
\nment, Art. 12,
\nCOP Decision
\n\u2022\u2002\u0007Calls on countries to take measures to \u201cenhance
\nclimate change education, training, public awareness,
\npublic participation and public access to information\u201d
\nBACK TO CONTENTS
\n160
\n\u2022\t Investment in institutional and technical
\ncapacities relevant to climate change and
\nhealth;
\n\u2022\t Implementation of projects\/programs
\nto address health adaptation to climate
\nchange;
\n\u2022\t Implementation of activities to increase
\nclimate resilience of health infrastruc-
\nture;
\n\u2022\t Allocation of domestic and international
\nfunds to build health resilience to climate
\nchange; and
\n\u2022\t Assessment of the health co-benefits of
\nclimate mitigation policies [16].
\nThese indicators are an important tool to
\nassess national action and progress on cli-
\nmate and health over the next few years.
\nA recent study of World Federation of
\nPublic Health Associations (WFPHA) of
\nnational governments\u2019 climate and health
\npolicies found a majority of respondent
\ncountries have not comprehensively identi-
\nfied health risks of climate change, while,
\nmore than 40% have not involved the health
\nsector in mitigation planning or invested in
\nclimate-health research.These findings sug-
\ngest a need for more effective health sector
\nintegration and engagement in national ac-
\ntion to address climate change and protect
\nhealth [17]. Similarly, a preliminary analysis
\nof INDCs by the World Medical Associa-
\ntion shows that nearly two-thirds of parties
\n(121) included health in some form in their
\ninitial commitments, however only about
\nhalf mention health adaptation (90) and
\nvery few (28) mention health in relation to
\nmitigation. The analysis found significant
\nvariation across regions with African States
\n(88.9%), Asian States (69.1%) and Latin
\nAmerican & Caribbean States (81.8%)
\ndemonstrating leadership in integrating
\nhealth, while Western European & Other
\nStates (13.8%) and Eastern European
\nStates (13%) less frequently incorporating
\nhealth in INDCs [18].
\nClimate and Health Summit
\n2015: Engaging with Health
\nin a Post-2015 World [19]
\nThe Climate and Health Summit at COP21
\nbrought together health professionals,
\npolicy-makers, negotiators, and academics
\nworking at the climate and health nexus
\naround the theme of \u2018Engaging with Health
\nin a Post-2015 World\u2019. Coordinated by the
\nGlobal Climate and Health Alliance in col-
\nlaboration with the WHO and a number of
\npartner organizations, the Summit included
\na diverse array of sessions ranging from
\nhealth adaptation and community resilience
\nto communicating climate change through
\nhealth to exploring how the health sector
\ncan best engage with other sectors. During
\nthe Summit, an unprecedented alliance of
\nHealth Sector @ COP21
\nThe health sector has been involved in the negotiations leading up to the Paris climate
\nchange conference [17] and had a significant presence both within the negotiating space
\nas well as in the surroundings with many health-focused events. Some of the key health
\nsector events during COP21 include:
\n\u2022\t The Paris Conference on Climate Change and Healthcare (Organized by Health
\nCare Without Harm with the French Hospital Federation) [18]
\n\u2022\t Health professionals in action for Healthy Energy and Climate (Organized by
\nthe Health and Environment Alliance \u2013 HEAL in collaboration with the Con-
\nseil National de l\u2019Ordre des M\u00e9decins (CNOM), the World Medical Associa-
\ntion (WMA) and the International Federation of Medical Students Associations
\n(IFMSA) [19]
\n\u2022\t Sustainable energy for all and the climate-health- development nexus: Lancet
\nCommission on Health and Climate Change (Organized by The Lancet Com-
\nmission on Health and Climate,the Global Alliance for Clean Cookstoves,Helio
\nInternational and the United Nations Foundation)
\n\u2022\t Evaluating the Health and Climate Benefits of Clean Cooking (Organized by
\nthe UN Foundation, the Global Alliance for Clean Cookstoves, the Fondation
\nMaison des sciences de l\u2019Homme)
\n\u2022\t Why the Climate Change Agreement is critical to Public Health (World Health
\nOrganization)
\n\u2022\t Effects of Climate change on the Social and Environmental Determinants of
\nHealth in Africa: What can communities do to strengthen their climate resil-
\nience? (Organized by the WHO AFRO Regional Office)
\n\u2022\t Health Central to Climate Change Action (Organized by the Principality of
\nMonaco and the Health and Environment Alliance (HEAL))
\n\u2022\t Healthy Lives on a Healthy Planet: What is Next for Research and Policy? (Or-
\nganized by The Universit\u00e9 Sorbonne Paris Cit\u00e9 (Centre Virchow-Villerm\u00e9 for
\nPublic Health Paris-Berlin) together with The University of Geneva, the Lon-
\ndon School of Hygiene and Tropical Medicine, the University of Heidelberg, the
\nWorld Health Organization, the Rockefeller Foundation, and The Lancet)
\n\u2022\t The Cost of Coal Film Festival (Pacific Environment, Greenpeace East Asia,
\nHealthcare Without Harm, Ecodefense, groundWork, Climate and Health Al-
\nliance (CAHA))
\nThere was a wide range of additional side events covering the intersection between cli-
\nmate change and public health which are not listed above.
\ndoctors, nurses, and other health profes-
\nsionals from every part of the health sector
\ncame together to announce declarations
\nrepresenting over 1,700 health organiza-
\ntions, 8,200 hospitals and health facilities,
\nand 13 million health professionals, bring-
\ning the global medical consensus on climate
\nchange to a new level. The event issued a
\nresounding message that the health sector is
\nnow engaged and is committed to continu-
\ning to work to protect health from climate
\nchange, and to advocate for public policy
\nwhich puts health at the centre of climate
\naction.
\nPost-Paris: What\u2019s Next?
\nThe Paris Agreement establishes a new mul-
\ntilateral framework for effective and coordi-
\nnated global climate action across sectors.
\nDrawing on the momentum of COP21,
\nit is critical that parties work to meaning-
\nfully integrate health by promoting health
\nsector engagement, incorporating health in
\nadaptation, mitigation, and loss and dam-
\nage, as well as ensuring adequate financing
\n[20]. This includes, for example, technical
\nassistance to the UNFCCC in order to best
\nintegrate health in relevant areas of work
\nas well as assistance offered on the national
\nlevel for adequate consideration of health in
\nnational climate change planning.
\nInternationally, health professionals can
\nmeaningfully engage in:
\n\u2022\t Collaboration with non-health profes-
\nsionals to ensure appropriate valuation of
\nhealth co-benefits of mitigation policies;
\n\u2022\t Development and implementation of ad-
\naptation initiatives within and beyond the
\nhealth sector to consequences of climate
\nchange;
\n\u2022\t Engagement with the Warsaw Inter-
\nnational Mechanism, the mechanism
\ntasked by the UNFCCC to address loss
\nand damage associated with impacts of
\nclimate change, in ensuring adequate
\nvaluation of health losses due to climate
\nchange.
\nNational medical associations and similar
\norganizations are well-positioned to engage
\nin post-Paris climate action and the Agree-
\nment implementation. Relevant avenues for
\nfuture engagement include:
\n\u2022\t Educating members on the climate-
\nhealth nexus and opportunities for cli-
\nmate action;
\n\u2022\t Integrating climate-health education
\nand competencies into medical school
\ncurricula, licensure\/credentialing and\/or
\ncontinuing medical education require-
\nments;
\n\u2022\t Engaging in the development and imple-
\nmentation of national climate plans;
\n\u2022\t Participating in climate and health advo-
\ncacy through organized national climate
\nand health groups, such alliances where
\none exists, or consider forming an advo-
\ncacy alliance;
\n\u2022\t Engaging media on the numerous health
\nsequelae of climate change,and the health
\nopportunities of acting on the causes of
\nclimate change;
\n\u2022\t Promoting local and national policies and
\ninitiatives to address climate change\u2019s ad-
\nverse health effects;
\n\u2022\t Mainstreaming climate change and
\nhealth into existing horizontal and verti-
\ncal public health programs, such as uni-
\nversal health coverage [21], maternal and
\nchild health, infectious and non-commu-
\nnicable disease prevention and control,
\netc.
\n\u2022\t Undertaking local research to better
\nquantify the health-related risks of cli-
\nmate change and the health co-benefits
\nof mitigation;
\n\u2022\t Addressing the carbon footprint of the
\nhealth sector itself and to build climate
\nClimate ChangeClimate Change
\nThe World Medical Association participated in climate change negotiations as observers. The WMA
\ndelegation included Dr. Xavier Deau (WMA Immediate Past President), Dr.\u00a0Peteris Apinis (Lat-
\nvian Medical Association), Dr. Peter Orris (University of Illinois\u00a0\u2013 Chicago), Dr.YassenTcholakov
\n(Junior Doctors Network), Dr.\u00a0Elizabeth Wiley (Junior Doctors Network), Dr. Knut Erling Mok-
\nsnes (Norwegian Medical Association), Dr. Jaroslav Blahos (Czech Medical Association), Dr.\u00a0Ma-
\nrie Colegrave (French Medical Council),Dr.\u00a0Bjorn Oscar Fagerberg (Swedish Medical Association),
\nDr. Lujain Al-Qodmani (Kuwait Medical Association\/Junior Doctors Network), Mardelangel
\nZapata Ponze de Leon (Colegio Medico de Peru\/Junior Doctors Network), Dr.\u00a0Georgiana Luisa
\nBaca (Junior Doctors Network), Dr. Otmar Kloiber (WMA Secretary General), Clarisse Delorme
\n(WMA Advocacy Advisor), Dr. Bayazit Illhan (Turkish Medical Association). (although not all
\npictured)
\nBACK TO CONTENTS
\nIV
\nresilience in order to help withstand cli-
\nmate impacts which cannot be avoided;
\nand
\n\u2022\t Continuing to advocate for 1.5o
\nC to pro-
\ntect public health and engage with coun-
\ntries\u2019 mitigation strategies to ensure this
\naim is included in national policies.
\nThe Paris Agreement is a significant sym-
\nbolic and substantive accomplishment with
\nthe potential to catalyze a coordinated glob-
\nal response to climate change. It is essential
\nthat physicians and organized medicine rec-
\nognize the relevance of this victory to our
\npatients and public health\u00a0\u2013 and, as mem-
\nbers of the health sector, engage in imple-
\nmentation on a local, national and\/or global
\nlevel to ensure the Agreement\u2019s success.
\nReferences
\n1.\t Patz JA, Frumkin H, Holloway T, Vimont DJ,
\nHaines A. Climate change: challenges and op-
\nportunities for global health. JAMA. 2014 Oct
\n15; 312(15):1565\u201380.
\n2.\t Costello A, Abbas M, Allen A, Ball S, Bell S,
\nBellamy R, et al. Managing the health effects of
\nclimate change: Lancet and University College
\nLondon Institute for Global Health Commis-
\nsion.Lancet.2009 May 16; 373(9676):1693\u2013733.
\n3.\t Intergovernmental Panel on Climate Change\u00a0\u2013
\nWorking Group. Climate Change 2014: Im-
\npacts, Adaptation and Vulnerability. 2014.
\n4.\t Watts N, Adger WN, Agnolucci P, Blackstock J,
\nByass P,Cai W,et al.Health and climate change:
\npolicy responses to protect public health. Lancet
\n[Internet]. 2015 Jun 24; Available from: http:\/\/
\ndx.doi.org\/10.1016\/S0140-6736(15)60854-6
\n5.\t McMichael AJ. Globalization, climate change,
\nand human health. N Engl J Med. 2013 Jul 4;
\n369(1):96.
\n6.\t WHO | 7 million premature deaths annually
\nlinked to air pollution [Internet]. World Health
\nOrganization; 2014 Mar [cited 2015 Dec 18].
\nAvailable from: http:\/\/www.who.int\/mediacen-
\ntre\/news\/releases\/2014\/air-pollution\/en\/
\n7.\t World Health Organization. WHO call to
\nAction [Internet]. World Health Organiza-
\ntion; 2015 [cited 2015 Dec 18]. Available from:
\nhttp:\/\/www.who.int\/globalchange\/global-cam-
\npaign\/call-for-action\/en\/
\n8.\t Royal Australasian College of Physicians. Doc-
\ntors for Climate Action: An Initiative of the
\nRoyal Australasian College of Physicians [Inter-
\nnet].[cited 2015 Dec 18].Available from: http:\/\/
\ndoctorsforclimateaction.org\/?doing_wp_cron=1
\n450429180.7544848918914794921875
\n9.\t World Health Organization. WHO Director-
\nGeneral addresses event on climate change and
\nhealth [Internet]. World Health Organization;
\n2015 [cited 2015 Dec 18]. Available from:
\nhttp:\/\/www.who.int\/dg\/speeches\/2015\/climate-
\nchange-paris\/en\/
\n10.\tUnited Nations. Ban hails Paris climate accord
\nas \u201chealth insurance policy for the planet.\u201d UN
\nNews Centre [Internet]. 2015 Dec 14; Avail-
\nable from: http:\/\/www.un.org\/apps\/news\/story.
\nasp?NewsID=52812#.VnMT3Rp95mA
\n11.\tUnited Nations. United Nations Framework
\nConvention on Climate Change [Internet].
\n1992. Available from: http:\/\/unfccc.int\/files\/es-
\nsential_background\/background_publications_
\nhtmlpdf\/application\/pdf\/conveng.pdf
\n12.\tUnited Nations Framework Convention on Cli-
\nmate Change. Adoption of the Paris Agreement.
\nFCCC\/CP\/2015\/L.9\/Rev.1 [Internet]. [cited
\n2015 Dec]. Available from: http:\/\/unfccc.int\/
\ndocumentation\/documents\/advanced_search\/
\nitems\/6911.php?priref=600008831
\n13.\tUnited Nations Framework Convention on Cli-
\nmate Change. Synthesis report on the aggregate
\neffect of the intended nationally determined
\ncontributions [Internet]. 2015. Available from:
\nhttp:\/\/unfccc.int\/focus\/indc_portal\/items\/9240.
\nphp
\n14.\tDay T, Hohne N, Gonzales S. Assessing the
\nmissed benefits of countries\u2019 national contribu-
\ntions: Quantifying potential co-benefits [In-
\nternet]. NewClimate Institute; 2015. Available
\nfrom: https:\/\/newclimateinstitute.files.word-
\npress.com\/2015\/10\/cobenefits-of-indcs-octo-
\nber-2015.pdf
\n15.\tWHO | The Climate and Health country pro-
\nfiles\u00a0\u2013 2015 [Internet]. World Health Organiza-
\ntion; 2015 [cited 2015 Dec 15]. Available from:
\nhttp:\/\/www.who.int\/globalchange\/resources\/
\ncountries\/en\/
\n16.\tCLIMATE AND HEALTH COUNTRY
\nPROFILES\u00a0\u2013 2015 A GLOBAL OVERVIEW
\n[Internet]. World Health Organization; 2015.
\nAvailable from: http:\/\/www.who.int\/global-
\nchange\/resources\/country-profiles\/climat-
\nechange_global_overview.pdf?ua=1
\n17.\tChand A, Orris P, Armstrong F, Purcell R, Tait
\nP, McGirr J, et al. Climate Change and Health
\nPolicy Assessment Project Report: A Global
\nSurvey 2015 [Internet]. World Federation of
\nPublic Health Associations ; 2015. Available
\nfrom: http:\/\/www.wfpha.org\/images\/news\/WF-
\nPHA-Global-Climate-Health-Policy-Survey.
\nFINAL.pdf
\n18.\tWiley E, Tcholakov Y, Petrin-Desrosiers C,
\nAl-Qodmani L. Health in Intended Nationally
\nDetermined Contributions (INDCs). World
\nMedical Association; 2015 Dec.
\n19.\tClimate & Health Summit, Global Climate
\n& Health Alliance [Internet]. 2015. Available
\nfrom: http:\/\/www.climateandhealthalliance.org\/
\nevents\/summit-cop21
\n20.\tBraithwaite I. Health and Climate at COP21
\nand Beyond [Internet]. Global Climate &
\nHealth Alliance; 2015. Available from: http:\/\/
\nwww.climateandhealthalliance.org\/asset\/down-
\nload\/287\/Health%20and%20Climate%20in%20
\n2015%20and%20Beyond.pdf
\n21.\tHealth Systems Global. Available from: http:\/\/
\nhealthsystemsglobal.org\/blog\/83\/UHCandClimate-
\nHealthsisteragendastowardsHealthForAll.html
\nElizabeth Wiley, MD, JD, MPH,
\nUniversity of Maryland, Baltimore, USA,
\nYassen Tcholakov, MD, MIH, McGill
\nUniversity, Montreal, Canada
\nIsobel Braithwaite, MPH BSc,
\nUniversity College London, UK
\nClaudel P-Desrosiers, University of
\nMontreal, Montreal, Canada
\nPablo Vega, MD, MPHc,
\nUniversidad de Chile, Chile
\nEdgardo Vera, MD, MPHc,
\nUniversidad de Chile, Chile
\nLujain Alqodmani, MD, BMSc,
\nUniversity of Kuwait, Kuwait
\nKimberly Williams MD, MSc,
\nUniversity of Calgary, Canada
\nSudhvir Singh, MBChB, BMedSci,
\nUniversity of Auckland, New Zealand
\nLuisa Georgiana Baca, MD, MSc
\nMedEd candidate, UCL, London, UK
\nCharlotte Holm-Hansen, MD,
\nUniversity of Copenhagen, Denmark
\nRenzo Guinto, MD, Health Care
\nWithout HarmAsia and Reimagine
\nGlobal Health, Philippines<\/p>\n"},"caption":{"rendered":"

wmj201504 COUNTRY vol. 61 MedicalWorld Journal Official Journal of The World Medical Association, Inc. ISSN 2256-0580 Nr. 4, December 2015 Contents Clean Technologies Can Change the World . . . . . . . . . . . . . . . . . . . . . . . . . . . . […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":727,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/wmj201504.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3683"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=3683"}]}}