Policy Tag: Public Health

Adopted by the 229th WMA Council Session, Montevideo, Uruguay, April 2025

PREAMBLE

Health care all over the world is under threat. Funding that has improved health by securing vaccines, medicines and health care professionals is being cut back or even completely dismantled. This creates a huge health risk, not only for those that cannot afford the costs themselves but also because this will increase the spread of communicable diseases like HIV, TB and malaria, and so puts everyone at risk. This is in addition to the threat that is caused by armed conflicts.

The WMA calls upon the leaders of the world to restore basic health care funding together. If the world sits back, we shall be confronted with a large increase of diseases and deaths.

Countries like the USA have made huge efforts in the last decades. Now, all nations shall have to contribute together to rescue our basic health system for those in need. 

RECOMMENDATION

The World Medical Association urges world leaders to contribute together to the funding of public health facilities that improve health by securing vaccines, medicines and health care professionals and by doing so, help prevent a potential increase in the spread of communicable diseases like HIV, TB and malaria, which pose a risk to everyone. Nations have to contribute together to rescue basic healthcare systems for those in need.

Adopted by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
And amended by the 67th WMA General Assembly, Taipei, Taiwan, October 2016
And reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

The World Medical Association: 

  1. Acknowledges the essential role of health professionals in tobacco control and urges its constituent members and other representatives of the medical community to use World No Tobacco Day each year to advocate for tobacco control measures; 
  2. Recognises the importance of the WHO Framework Convention on Tobacco Control (FCTC) as a mechanism to protect people from exposure and addiction to tobacco; 
  3. Encourages Member States to the Convention to recognize (ratify, accept, approve, confirm or accede) the Protocol to Eliminate Trade in Tobacco Products; 
  4. Encourages its constituent members to work assiduously and energetically to get their governments to implement the measures set out in the FCTC as a minimum; 
  5. In line with its Statement on Electronic Cigarettes, calls on Member States to include e-cigarettes and other electronic nicotine delivery systems in the scope of application of the WHO Framework Convention and to ensure that that these products be subjected to local regulatory approval and be entrenched in smoke free laws. 
  6. Urges governments to introduce regulations and other control measures as described in the FCTC including regulation of smokeless tobacco products. Governments should ban smoking and vaping in public places and workplaces as an urgent public health intervention and also consider additional measures, especially those tobacco control measures that have been proven to be successful in other countries; 
  7. Urges governments to introduce initiatives that break brand recognition, including plain packaging of cigarettes and other smoking products, as stated in its Resolution on Plain Packaging of Cigarettes, e-Cigarettes and Other Smoking Product 
  8. Strongly encourages governments to set a distinct method to ensure adequate funding for tobacco control and research; 
  9. Urges governments to promote ready access to smoking cessation advice and services to all smokers, including children; 
  10. Recognises the vital role of health professionals in public health education and in promoting smoking cessation; 
  11. Combats the tobacco industry’s predatory marketing tactics by adopting comprehensive bans on advertising, promotion and sponsorship, as set forth in the WHO FCTC, in order to protect the health of individuals and communities; 
  12. Contributes to the improvements and updating of international tobacco control regulations as needed. 

Adopted by the 200th WMA Council Session, Oslo, April 2015,
and adopted, with amendments by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021 

 

PREAMBLE

Trade agreements are treaties between two or more countries which include provisions addressing trade in goods and/or services. Trade agreements are tools of globalization and typically seek to promote global wealth through trade liberalization. They can have significant implications for the social, commercial, political and ecological determinants of health as well as the delivery of health care. 

International trade contributes significantly to increases in national wealth which is a key factor in building strong health care systems.  

While trade agreements are designed to produce economic benefits and global wealth, it is fundamental to identify public health implications that may arise from these agreements.  

Negotiations should take into account broad impact to ensure that the right to health and to a healthy natural and social environment are well-prioritized. Trade agreements should be directed at contributing to global health and equity. 

Trade agreements may have the ability to promote the health and wellbeing of all people when they are well-designed to protect health and preserve the ability of governments to legislate, regulate and plan for health promotion, health care delivery and health equity. 

Recent trade agreement negotiations have sought to establish a new global governance framework for trade and have been unprecedented in their size, scope and secrecy. A lack of transparency and the selective sharing of information with a limited set of stakeholders are anti-democratic. 

There must be recognition of the importance of innovation sharing in public health. This is particularly important during health emergencies. Access to medicines and medical supplies is essential to address the major public health problems such as pandemics and trade agreements must not act as a barrier to that access. 

Investor-state dispute settlement (ISDS) provides a mechanism for investors to bring claims against governments and seek compensation, operating outside existing systems of accountability and transparency. ISDS in existing trade agreements has been used to challenge evidence-based public health measures including tobacco plain packaging. Inclusion of a broad ISDS mechanism could threaten public health actions designed to support evidence-based tobacco control, alcohol control, healthy and safe food consumption including regulation of obesogenic foods and beverages, access to medicines, health care services, environmental protection/climate change and occupational / environmental health protections. Efforts by industry to challenge domestic public health laws and regulation have targeted nations with limited access to legal resources and some of the world’s most vulnerable populations. 

Access to affordable medicines is critical to controlling the global burdens of communicable and non-communicable diseases. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) established a set of common international rules governing the protection of intellectual property including the patenting of pharmaceuticals. TRIPS safeguards and flexibilities including compulsory licensing seek to ensure that patent protection does not supersede public health. 

The WMA Statement on Patenting Medical Procedures states that patenting of diagnostic, therapeutic and surgical techniques is unethical and “poses serious risks to the effective practice of medicine by potentially limiting the availability of new procedures to patients.” 

Trade agreements should not pose a new difficulty in accessing medicines, especially for developing countries and for the most vulnerable populations. 

There must be a fair balance established between the prices of medicines and the protection of intellectual property through patents. 

The WMA considers that patenting on medicines/vaccines must be regulated in accordance with the ethical principles and values of the medical profession in order to ensure effective and global action for public health and therefore recognizes that it may be necessary to temporarily waive patents in times of public health emergencies.  Moreover, to produce fast and comprehensive results, sustainable solutions for patent issues must be supplemented by the transfer of technology, knowledge, and manufacturing expertise, global investment in manufacturing sites, training of personnel, and quality control. 

The WMA Resolution on Medical Workforce states that the WMA has recognized the need for investment in medical education and has called on governments to “…allocate sufficient financial resources for the education, training, development, recruitment and retention of physicians to meet the medical needs of the entire population…” 

The WMA Declaration of Delhi on Health and Climate Change states that global climate change has had and will continue to have serious consequences for health and demands comprehensive action. 

The WMA Declaration on Fair Trade in Medical Products and Devices states that purchasing policies for medical goods should be fair and ethical, working conditions should be safe and modern slavery should be eradicated throughout supply chains. Health product manufacturers should establish a plan for continuity of supply of vital and life-sustaining products to avoid production shortages whenever possible. This plan should include establishing the necessary resiliency and redundancy in manufacturing capability to minimize disruptions of supplies. 

 

RECOMMENDATIONS 

 Therefore, the WMA calls on national governments and constituent member associations to: 

1.Call for transparency and openness in all trade agreement negotiations including public access to negotiating texts and meaningful opportunities for stakeholder engagement. 

2. Call for a proactive assessment of anticipated effects on health, human rights, and the environment for all trade agreements. 

3. Advocate for trade agreements that protect, promote and prioritize public health over commercial or political interests, and secure services in the public interest, especially those affecting individual and public health. This should include new modalities of health care provision including eHealth. 

4. Ensure that trade agreements do not have negative impacts on health systems, human resources for health and universal health coverage (UHC). Ensure trade agreements do not interfere with governments’ ability to protect and regulate health and health care, or to guarantee a right to health for all. Government action to protect and promote health should not be subject to challenge through an investor-state dispute settlement (ISDS) or similar mechanism.

5. Work to ensure that patents on medicines and vaccines are regulated in accordance with the principles of medical ethics, in order to protect public health in global emergency situations.  

6. Therefore, urge NMAs to promote the possibility of temporarily waiving patents on medicines and vaccines to protect public health in global emergency situations while ensuring fair compensation for the intellectual property of the patent holders, global investment in manufacturing sites, and knowledge transfer. Promote public health, equity, solidarity and social justice and protect countries and people who are weaker economically and health-wise, and therefore most vulnerable. 

7. Oppose any trade agreement provisions which would compromise access to health care services or medicines including but not limited to: 

  • Patenting (or patent enforcement) of diagnostic, therapeutic and surgical techniques; 
  • “Evergreening”, or patent protection for minor modifications of existing drugs; 
  • Patent linkage or other patent term adjustments that serve as a barrier to generic entry into the market; 
  • Data exclusivity for biologics; 
  • Any effort to undermine TRIPS safeguards or restrict TRIPS flexibilities including compulsory licensing; 
  • Limits on clinical trial data transparency. 

8. Oppose any trade agreement provision which would reduce public support for or facilitate commercialization of medical education. 

9. Oppose any trade agreement which would facilitate the inappropriate privatization of public services in areas such as conservation of natural environment, education, healthcare, and daily necessities such as energy and water. 

10. Ensure that trade agreements promote environmental protection and support efforts to reduce activities that cause climate change. 

 11. Ensure that trade agreements promote equity and human rights and include mechanisms for accountability following implementation. 

 

 

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
And rescinded at the 68th WMA General Assembly, Chicago, USA, October 2017

Evidence from epidemiological and other research demonstrates a clear link between the price of alcohol and levels of consumption, especially amongst young drinkers and those who are heavy alcohol users.

Setting a minimum unit price at a level that will reduce alcohol consumption is a strong public health measure, which will both reduce average alcohol consumption throughout the population and be especially effective in heavy drinkers and young drinkers.

Some states are intending to set a minimum unit price in order to reduce the medical and social effects of excessive alcohol consumption.

The WMA supports states seeking to use such innovative measures to combat the serious public and individual health effects of excessive and problem drinking.

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012,
reaffirmed with minor revision by the 217th WMA Council Session (online), Seoul, South Korea, April 2021

 

The WMA reaffirms its Resolution on Implementation of the WHO Framework Convention on Tobacco Control and emphasizes the importance of this global mechanism to protect people from exposure and addiction to tobacco and tobacco products such as nicotine. 

The WMA also reaffirms its statement on e-cigarettes and the recommendation that these products be subjected to local regulatory approval and be entrenched in smoke free laws. 

The WMA recognises that : 

  • Cigarettes offer a serious threat to the life and health of individuals that use them, and a considerable cost to the health care services of every country; 
  • Those who smoke predominantly start to do so while adolescents; 
  • There is mounting evidence that e-cigarette use predicts initiation of the use of traditional tobacco products among young people and/or non-smokers, and of additional health risks from the use of e-cigarette products.
  • There is a proven link between brand recognition and likelihood of starting to smoke; 
  • Brand recognition is strongly linked to cigarette packaging; 
  • Plain packaging reduces the impact of branding, promotion and marketing of cigarettes and e-cigarette products. 

The WMA strongly encourages national governments to support the introduction of initiatives that break brand recognition, including plain packaging of cigarettes, other tobacco products, and e-cigarettes and deplores strategies from the tobacco industry to oppose the adoption and implementation of such policy. 

 

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
and reaffirmed by the 212th WMA Council Session, Santiago, Chile, April 2019

 

PREAMBLE

Vaccination use to prevent against disease was first done successfully by Jenner in 1796 when he used cowpox material for vaccination against smallpox.  Since then, vaccination and immunisation have been acknowledged as an effective preventive strategy for several communicable diseases and are now being developed for the control of some non-communicable diseases.

Vaccine development and administration are some of the most significant interventions to influence global health in modern times.  It is estimated that immunisation currently prevents approximately 2.5 million deaths every year, saving lives from diseases such as diphtheria, tetanus, whooping cough (pertussis) and measles. Approximately 109 million children under the age of one are fully vaccinated with the diphtheria-tetanus-pertussis (DTP3) vaccine alone.

Mostly the ultimate goal of immunisation is the total eradication of a communicable disease.  This was achieved for smallpox in 1980 and there is a realistic goal for the eradication of polio within the next few years.

The Global Immunisation Vision Strategy (GIVS) 2006-2015 was developed by the WHO and UNICEF in the hope of reaching target populations who currently do not have immunisation services or who do not have an adequate level of coverage.

The four strategies promoted in this vision are:

  • Protecting more people in a changing world
  • Introducing new vaccines and technologies
  • Integrating immunisation, other linked health interventions and
  • Surveillance in the health systems context
  • Immunizing in the context of global interdependence [1]

Vaccine research is constantly revealing new possibilities to protect populations from serious health threats.  Additionally, new strains of diseases emerge requiring the adaptation of vaccines in order to offer protection.

The process of immunisation requires an environment that is resourced with appropriate materials and health workers to ensure the safe and effective administration of vaccines.  Administration of vaccines often requires injections, and safety procedures for injections must always be followed.

Immunisation schedules can vary according to the type of vaccine, with some requiring multiple administrations to be effective.  It is vitally important that the full schedule is followed otherwise the effectiveness of the vaccine may be compromised.

The benefits of immunisation have had a profound effect on populations, not only in terms of preventing ill health but also in permitting resources previously required to treat the diseases to be redirected to other health priorities.  Healthier populations are economically beneficial and can contribute more to society.

Reducing child mortality is the fourth of the United Nation’s Millennium Development Goals, with immunisation of children having a significant impact on mortality rates on children aged under five. According to the WHO, there are still more than 19 million children who have not received the DTP3 vaccine. In addition, basic health care services for maternal health with qualified health care personnel must be established.

Immunisation of adults for diseases such as influenza and pneumococcal infections has been shown to be effective, not only in decreasing the number of cases amongst those that have received immunisation but also in decreasing the disease burden in society.

The medical profession denounce any claims that are unfounded and inaccurate with respect to the possible dangers of vaccine administration.  Claims such as these have resulted in diminished immunisation rates in some countries.  The result is that the incidences of the diseases to be prevented have increased with serious consequences for a number of persons.

Countries differ in immunisation priorities, with the prevalence and risk of diseases varying among populations. Not all countries have the same coverage rates, nor do they have the resources to acquire, coordinate, distribute or effectively administer vaccines to their populations, often relying on non-governmental organizations to support immunisation programmes.  These organizations in turn often rely on external funding that may not be secure.  In times of global financial crisis, funding for such programmes is under considerable pressure.

The risk of health complications from vaccine-preventable diseases is greatest in those who experience barriers in accessing immunisation services. These barriers could be cost, location, lack of awareness of immunisation services and their health benefits or other limiting factors.

Those with chronic diseases, underlying health issues or other risk factors such as age are at particular risk of major complications due to vaccine-preventable diseases and therefore should be targeted to ensure adequate immunisation.

Supply chains can be difficult to secure, particularly in countries that lack coordination or support of their immunisation programmes.  Securing the appropriate resources, such as qualified health professionals, equipment and administrative support can present significant challenges.

Data collection on vaccine administration rates, side effects of vaccines and disease surveillance can often be difficult to achieve, particularly in isolated and under-resourced areas. Nevertheless, reporting incidents and monitoring disease spread are vital tools in combating global health threats.

 

RECOMMENDATIONS

The WMA supports the recommendations of the Global Immunisation Vision Strategy (GIVS) 2006-2015, and calls on the international community to:

  • Encourage governments to commit resources to immunisation programmes targeted to meet country specific needs.
  • Recognise the importance of vaccination/immunisation through the continued support and adoption of measures to achieve global vaccination targets and to meet the Millennium Development Goals, especially four (reduce child mortality), five (improve maternal health) and six (combat HIV/AIDS, malaria and other diseases).
  • Recognise the global responsibility of immunisation against preventable diseases and support work in countries that have difficulties in meeting the 2012 targets in the Global Polio Eradication Initiative [2].
  • Support national governments with vulnerable populations at risk of vaccine-preventable diseases, and the local agencies that work to deliver immunisation services and to work with them to alleviate retrictions in accessing services.
  • Support vaccine research and development and ensure commitment through the adequate funding of vital vaccine research.
  • Promote vaccination and the benefits of immunisation, particularly targeting those at-risk and those who are difficult to reach. Comply with monitoring activities undertaken by WHO and other health authorities.Promote high standards in the research, development and administration of vaccines to ensure patient safety. Vaccines need to be thoroughly tested before implemented on a large scale and subsequently monitored in order to identify possible complications and untoward side effects. In order to be successful, immunisation programmes need public trust which depends on safety.

In delivering vaccination programmes, the WMA recommends that:

  • The full immunisation schedule is delivered to provide optimum coverage.  Where possible, the schedule should be managed and monitored by suitably trained individuals to ensure consistent delivery and prompt appropriate management of adverse reactions to vaccines.
  • Strategies are employed to reach populations that may be isolated because of location, race, religion, economic status, social marginalization, gender and/or age.
  • Ensure that qualified health professionals receive comprehensive training to safely deliver vaccinations and immunisations, and that vaccination/immunisations are targeted to those whose need is greatest.
  • Educate people on the benefits of immunisation and how to access immunisation services.
  • Maintain accurate medical records to ensure that valid data on vaccine administration and coverage rates are available, enabling immunisation policies to be based upon sound and reliable evidence.
  • Healthcare professionals should be seen as a priority population for the receipt of immunisation services due to their exposure to patients and to diseases.

The WMA calls upon its members to advocate the following:

  • To increase awareness of national immunisation schedules and of their own (and their dependents) personal immunisation history.
  • To work with national and local governments to ensure that immunisation programmes are resourced and implemented.
  • To ensure that health personnel delivering vaccines and immunisation services receive proper education and training.
  • To promote the evidence base and increase awareness about the benefits of immunisation amongst physicians and the public.

 

References

[1] World Health Organization and United Nations Children’s Fund. Global Immunisation Vision and Strategy, 2006-2015. Geneva, Switzerland: World Health Organization and United Nations Children’s Fund; 2005.  Available at: http://www.who.int/immunisation/givs/related_docs/en/index.html

[2] World Health Organization. Global Polio Eradication Initiative: Strategic Plan 2010-2012. Geneva, Switzerland: World Health Organization; 2010. Available at: http://polioeradication.org/who-we-are/strategy/

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012 and
revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

Electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) are products designed to deliver nicotine to a user in the form of an aerosol. These products are usually composed of a mouthpiece, a rechargeable battery-operated heating element, a replaceable cartridge that contains liquid nicotine and/or other chemicals, and an atomizer that, when heated, turns the contents of the cartridge into an aerosol. This aerosol is then inhaled by the user and exhaled. These products are often made to look like other tobacco-derived products like cigarettes, cigars, pipes, toys and electronics that appeal to young people. They can also be made to look like everyday items such as pens and USB memory sticks. ENDS and their risks are outlined in more detail in the WMA Statement on Health Hazards of Tobacco Products and Tobacco- Derived Products.

Nicotine exposure, no matter how it is delivered, can affect brain development and lead to addiction. No standard definition of e-cigarettes exists, and manufacturers use different designs and different ingredients. Quality control processes used to manufacture e-cigarettes are substandard or non-existent, and few studies have been done to analyze the level of nicotine delivered to the user and the composition of the aerosol or vapor produced. Unknown amounts of nicotine are delivered to the user, and the level of absorption is unclear, leading to potentially toxic levels of nicotine in the system, especially in children, adolescents and young adults. E-cigarettes and ENDS may also contain other ingredients toxic or carcinogenic to humans including delivery solvents, propylene glycol, glycerin, pulegone, formaldehyde, acetaldehyde, acrolein, and heavy metals, such as chromium, copper, zinc, tin and lead.

Manufacturers and marketers of e-cigarettes and ENDS often claim that use of their products is a safe or safer alternative to smoking cigarettes, particularly since e-cigarettes and ENDS do not produce carcinogenic smoke. However, no studies have conclusively determined that the aerosol is not toxic or carcinogenic. There is some evidence of a risk of carcinogenicity of the respiratory tract due to long-term, cumulative exposure to nitrosamines and to acetaldehyde and formaldehyde. As with tobacco products, the safest option is to abstain from using e-cigarettes and ENDS.

Evidence already exists that e-cigarettes and ENDS are harmful and not safe.  Risks include:

  • appeal to children, adolescents and young adults, through packaging and marketing designed to appeal to these age groups, and especially when flavors like strawberry or chocolate are added to the cartridges. These factors can increase nicotine addiction among young people, and may be a gateway to experimenting with other tobacco products. Packaging and marketing targeted to young people has contributed to the dramatic increase in e-cigarette and ENDS use which in some regions is more popular than tobacco smoking.
  • the belief promoted by manufacturers that these devices are acceptable alternatives to scientifically proven cessation techniques, when neither their value as therapeutic aids for smoking cessation nor their safety as cigarette replacements is established. Evidence reveals that these products are harmful to health and not safe. In addition, evidence on the use of ENDS as a way to decrease tobacco use in adults is inconclusive;
  • inconsistent and unknown dosage, manufacturing processes, and ingredients, including the potential for abusing or manipulating the product, e.g., by adding cannabis, and simultaneous use with other tobacco products (dual or poly use);
  • high potential of toxic exposure to nicotine by children, either by ingestion or dermal absorption from contents of a nicotine cartridge, because the cartridges and refill liquids are readily available over the Internet and are not always sold in child resistant packaging;
  • worse clinical outcomes in patients with the SARS-COV2 virus who also use e-cigarettes.

 

RECOMMENDATIONS

  1. That e-cigarettes and ENDS be subject to the WHO Framework Convention on Tobacco Control, and to jurisdictional smoke-free laws and regulations.
  2. That the manufacture and sale of e-cigarettes and ENDS be subject to national regulatory bodies as either a new form of tobacco product or as a drug delivery device. At a minimum, regulations should address maximum strength of nicotine fluids, tank size on vaping devices, product labeling, and child-resistant packaging. This recommendation also applies to devices using synthetic nicotine.
  3. That clinical testing, large population studies and full analyses of e-cigarette ingredients and manufacturing processes be conducted to determine their level of risk, viability, and efficacy as tools for tobacco cessation.
  4. That e-cigarettes and other ENDS should never be marketed as a valid or efficacious method for smoking cessation without validated clinical research that is assessed by appropriate regulatory bodies. In all other instances, plain package marketing should be required, in accordance with the WMA Resolution on Plain Packaging of Cigarettes, e-Cigarettes and Other Smoking Product.
  5. That the sale, marketing, distribution, and accessibility of e-cigarettes and other tobacco products to children and adolescents be prohibited.
  6. That the production, distribution and sale of flavored e-cigarette cartridges and candy products that depict or resemble tobacco products be prohibited.
  7. That the sale of e-cigarettes and ENDS via the internet be prohibited in order to prevent access to these products by minors.
  8. That physicians, pediatric practitioners and dentists inform their patients of the potential risks of using e-cigarettes and ENDS, e.g., addiction, cardiovascular disease, lung disease, impact on brain development due to nicotine, physical injuries, etc., even if regulatory authorities have not taken a position on the efficacy and safety of these products.
  9. That the WMA and its members support further research on the harmful effects of e-cigarettes and ENDS, especially in children, adolescents and young adults.

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011

In the last decade, the attention of the world has been drawn to a number of severe events which seriously tested and overwhelmed the capacity of local healthcare and emergency medical response systems. Armed conflicts, terrorist attacks and natural distasters such as earthquakes, floods and tsunamies in various parts of the world have not only affected the health of people living in these areas but have also drawn the support and response of the international community. Many National Medical Associations have sent groups to assist in such disaster situations.

According to the World Health Organization (WHO) Center for Research on the Epidemiology of Disasters (CRED), the frequency, magnitude, and toll of natural disasters and terrorism have increased throughout the world.  In the previous century, about 3.5 million people were killed worldwide as a result of natural disasters; about 200 million were killed as a result of human-caused disasters (e.g., wars, terrorism, genocides).  Each year, disasters cause hundreds of deaths and cost billions of dollars due to disruption of commerce and destruction of homes and critical infrastructure.

Population vulnerability (e.g., due to  increased population density, urbanization, aging) has increased the risk of disasters and public health emergencies.  Globalization, which connects countries through economic interdependencies, has led to increased international travel and commerce. Such activity has also led to increased population density in cities around the world and increased movement of people to coastal areas and other disaster-prone regions.  Increases in international travel may speed the rate at which an emerging infectious disease or bioterrorism agent spreads across the globe.  Climate change and terrorism have emerged as important global factors that can influence disaster trends and thus require continued monitoring and attention.

The emergence of infectious diseases, such as H1N1 influenza A and severe acute respiratory syndrome (SARS), and the recent arrival of West Nile virus and monkey pox in the Western hemisphere, reinforces the need for constant vigilance and planning to prepare for and respond to new and unexpected public health emergencies.

The growing likelihood of terrorist-related disasters affecting large civilian populations affects all nations.  Concern continues about the security of the worldwide arsenal of nuclear, chemical, and biological agents as well as the recruitment of people capable of manufacturing or deploying them. The potentially catastrophic nature of a “successful” terrorist attack configures an event that may demand a disproportionate amount of resources and healthcare professionals preparedness..  Natural disasters such as tornadoes, hurricanes, floods, and earthquakes, as well as industrial and transportation-related catastrophes, are far more common and can also severely stress existing medical, public health, and emergency response systems.

In light of recent world events, it is increasingly clear that all physicians need to become more proficient in the recognition, diagnosis, and treatment of mass casualties under an all-hazards approach to disaster management and response.  They must be able to recognize the general features of disasters and public health emergencies, and be knowledgeable about how to report them and where to get more information should the need arise.  Physicians are on the front lines when dealing with injury and disease-whether caused by microbes, environmental hazards, natural disasters, highway collisions, terrorism, or other calamities. Early detection and reporting are critical to minimize casualties through astute teamwork by public- and private-sector health and emergency response personnel.

The WMA, representing the doctors of the world, calls upon its members to advocate for the following:

  • To promote a standard competency set to ensure consistency among disaster training programs for physicians across all specialties. Many NMAs have disaster courses and previous experiences in disaster response. These NMAs can share this knowledge and advocate for the integration of some standardized level of training for all physicians, regardless of specialty or nationality.
  • To work with national and local governments to establish or update regional databases and geographic mapping of information on health system assets, capacities, capabilities, and logistics to assist medical response efforts, domestically and worldwide, when needed. This could include information on local response organizations, the condition of local hospitals and health system infrastructures, endemic and emerging diseases, and other important public health and clinical information to assist medical response in the event of a disaster. In addition, systems for communicating directly with physicians and other front line health care providers should be identified and strengthened.
  • To work with national and local governments to ensure the developing and testing of disaster management plans for clinical care and public health including the ethical basis for delivering such plans.
  • To encourage governments at national and local levels to work across normal departmental and other boundaries in developing the necessary planning.

The WMA could serve as a channel of communication for NMAs during such times of crisis, enabling them to coordinate activities and work together.

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

Leprosy is a widespread public health problem, with approximately 200.000 new cases diagnosed annually worldwide. It is a curable disease and after starting treatment, the chain of transmission is interrupted. Leprosy is a disease that have been inadequately addressed from the point of view of investments in research and medical treatment. 

The World Medical Association recommends to all National Medical Associations to defend the right of the people affected with leprosy and members of their families, that they should be treated with dignity and free from any kind of prejudice or discrimination. Physicians, health professionals and civil society should be engaged in combating all forms of prejudice and discrimination. Research centers should acknowledge leprosy as a major public health problem and continue to research this disease since there are still gaps in understanding its patho-physiological mechanisms. These gaps in knowledge may be overcome through the allocation of resources to new research, which will contribute to more efficient control worldwide. Medical schools, especially in countries with high prevalence of leprosy, should enhance its importance in the curriculum. The public, private, and civil sectors should unify their best efforts in order to disseminate information that would counteract prejudice towards leprosy and that acknowledges its curability. 

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
and amended by the 60th WMA General Assembly, New Delhi, India, October 2009 and
rescinded and archived by the 70th WMA General Assembly, Tbilisi, October 2019

INTRODUCTION

Each country should have a health system with enough resources to attend to the needs of its population. However today, many countries across the world are suffering wide inequities and inequalities in health care and this is causing problems of access to health services for the poorer segments of society [the weak or underprivileged]. The situation is especially serious in low-income countries.

The international community has attempted to improve the situation. The 20/20 initiative of 1995, the 1996 Initiative for Heavily Indebted Poor Countries (HIPC), and Objectives for Millennium 2000 Development (MDGs) are all initiatives aimed at reducing poverty and dealing with poor health, inequities and inequalities between the sexes, education, insufficient access to drinking water and environmental contamination.

The objectives are formed as an agreement with acknowledgement of the contributions which developed countries can make, in the shape of trade relations, development assistance, reduction of the burden of debt, improving access to essential medication and the transfer of technology. Three of the eight objectives are directly related to health, which has a considerable influence on various other objectives that interact to support each of the others within a structural framework, these are designed to increase human development globally. The eight Millennium Development Objectives (MDO) foresee a development vision based on health and education, thus affirming that development does not only refer (allude) to economic growth.

Various reports from the World Health Organization have underlined the opportunities and skills [or techniques] which are currently involved in bringing about significant improvements in health, as well as helping to reduce poverty and encourage growth. Additionally, the reports highlight the fact that it is of fundamental importance to reduce limitations on human resources, in order to increase the achievements of the public health system, a situation which requires urgent attention. These limitations are related to work, training and payment conditions, and play a substantial role in determining capacity for sustained growth of access to health services.

RECOMMENDATIONS

The World Medical Association urges National Medical Associations to:

1. Advocate that their governments should adhere to and promote the proposals to increase investment in the health sector; and to adhere to and promote initiatives to reduce the debt burden for the poorest countries on the planet.

2. Advocate [defend] the inclusion of public health factors in all fields of policy provision, since health is mostly determined by factors that are external to the area of healthcare, for example, housing and education. [Health is not only medicine, it also depends on living standards].

3. Encourage and support countries in the planning and implementation of investment plans, which invest in health for the poor; guarantee that more resources be used for health in general, with greater efficiency and impact; and reduce limitations for the most effective use of the additional investments.

4. Maintain vigilance to ensure that the investment plans focus maximum attention on generating capacity, that they promote leadership skills and promote incentives to retain and place qualified personnel, whilst it is taken into consideration that the limitations in relation to the previous matter currently constitute the greatest obstacle for progress.

5. Urge international financial institutions and other important donors to: i) Adopt the necessary measures to help the countries that have already organised mechanisms to prepare their investment plans, and provide assistance to those countries that have begun to take the necessary steps, with the support and participation of the international community; ii) Help countries to obtain funds to develop and implement their investment plans; iii) Continue providing technical assistance to the countries for their plans.

6. Exchange information in order to coordinate efforts to change policies in these areas.

Adopted by the 48th WMA General Assembly, Somerset West, South Africa, October 1996,
revised by the 59th WMA General Assembly, Seoul, Korea, October 2008 and
by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019

 

PREAMBLE

AMR is a growing threat to global public health that transcends national boundaries and socioeconomic divisions. AMR affects human, animal and environmental health. It is a multi-faceted problem of crisis proportions with significant economic, health, and human implications.

Addressing the threat of antimicrobial resistance is a fundamental global health priority, and the responsibility of all countries.

Antimicrobial drugs form an essential component of modern medicine, ensuring that complex procedures, such as surgery and chemotherapy, can be performed with lower risk.

AMR threatens the effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi.

AMR occurs when microorganisms develop the ability to resist the actions of antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).

Infections caused by bacteria that are resistant to multiple classes of antibiotic are increasingly being documented.

While AMR is a natural evolutionary phenomenon, it is exacerbated by the overuse and misuse of antimicrobials in medicine, as well as in veterinary practice and agriculture, and can be exacerbated when antimicrobials are given as growth promoters in animals or used to prevent diseases in healthy animals.

The emergence and spread of AMR is further enhanced by lack of access to effective drugs, access to antibiotics “over the counter” in some countries, the availability of substandard and falsified products, misuse of antibiotics in food production, increased global travel, medical tourism and trade, and the poor application of infection control measures.

Another major cause of AMR is the release of antibiotics into the environment. This can occur as either as a result of poor manufacturing practices, the improper disposal of unused medication, human and animal excretion, and the inadequate disposal of human and animal corpses.

In many countries, particularly in low-and middle-income countries, access to effective antimicrobials as well as complementary technologies including vaccines and diagnostics continues to remain a significant challenge, furthering AMR.

The ramifications of resistance manifest themselves not just in the impact on human health, but also in potentially heavy economic costs. The World Health Organization (WHO) has warned that resistance has reached alarming levels in many parts of the world, and that a continued increase in resistance could lead to 10 million people dying per year and a reduction of 2-3.5% in global gross domestic product by 2050.

At the rate at which resistance is growing globally, it poses a significant threat to successfully achieving the UN Sustainable Development Goals and undermines efforts to reduce health inequalities. Without harmonized and coordinated cross-sector action on a global, scale, the world is heading towards a post-antibiotic era in which common infections and minor injuries can once again kill.

AMR has reached great prominence at the highest political levels including the UN General Assembly, and the agenda of the G7 and G20.

There is a need for an effective ‘one health’ approach to minimize unnecessary or inappropriate use of antimicrobials and to prevent and control the transmission of existing resistance. A ‘one health’ approach recognizes that action is required across human medicine, veterinary practice and agriculture.

 

RECOMMENDATIONS

Global

  1. The primary prevention of community and healthcare associated infections is necessary to reduce the demand for antibiotics. Addressing the social determinants of infectious disease, such as poor living conditions and sanitation, will have co-benefits of reducing health inequalities and tackling AMR.
  2. Nations have varying resources available to combat antimicrobial resistance, and must cooperate with the WHO, Food and Agriculture Organization and World Organization for Animal Health that support the WHO Global Action Plan on AMR which provides the framework for national action plans.
  3. The World Medical Association and its constituent members should advocate for:
    • investment in the surveillance of drug resistant infections across human health, veterinary medicine, agriculture, fishing industry, and food production, and international cooperation for data-sharing procedures to improve global responses;
    • the WHO and other UN agencies should examine the role of international travel and trade agreements on the development of antimicrobial resistance, and promote measures in those agreements to act as safeguards against the globalisation of drug resistant pathogens in our food supply;
    • the WHO should continue to encourage the use of Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities to help ensure affordable access to quality medicines and oppose the proliferation of ‘TRIPS-plus’ provisions within trade agreements, which restrict the use of TRIPS flexibilities and limit their effectiveness;
    • the widespread application of verifiable technology such as track-and-trace systems to ensure the authenticity of pharmaceutical products;
    • equitable access to, and appropriate use of, existing and new quality-assured antimicrobial medicines. This requires effectively applying the Access, Watch and Reserve lists of the WHO Essential Medicines program. For the WHO global action plan and national action plans to be effective, access to health facilities, health care professionals, veterinarians, knowledge, education and information are vital;
    • greater use of vaccinations which will reduce the burden of infectious disease, reducing the need for antibiotics and therefore limiting the emergence of resistance;
    • for global health organisations and governments to scale up their action and coordination in promoting appropriate antibiotic use and work together to reduce AMR using a One Health approach, which recognises that human, animal and environmental health is inextricably linked. to reduce the spread of resistance.
  4. The World Medical Association and its constituent members should encourage their governments to:
    • fund more basic and applied research directed toward the development of innovative antimicrobial agents, diagnostic tools and vaccines (innovative antimicrobial vaccines), and on the appropriate and safe use of such therapeutic tools;
    • ensure parity between financial and technical resources towards the development of innovative antimicrobial medicines, vaccines, and diagnostics as well as innovative infection control and prevention methods across human health, veterinary, and agricultural sectors;
    • support Research and Development efforts for novel antimicrobial agents, vaccines, and rapid diagnostic methods that are needs-driven and guided by the principles outlined in the UN Declaration on AMR, adopted in September 2016, including affordability, effectiveness, efficiency, and equity;
    • initiate regulatory measures to control the environmental pollution that allows the spread of antibiotic-resistant genes across soil, water and air;
    • educate a sufficient number of clinical infectious disease specialists in every country, which is a fundamental requirement for tackling antimicrobial resistance and hospital-acquired infections.

National

  1. National medical associations should urge their governments to:
    • require that antimicrobial agents be available only through a prescription provided by healthcare professionals and/or veterinary professionals and dispensed or sold by professionals;
    • initiate national campaigns to raise awareness among the public of the harmful consequences of overuse and misuse of antibiotics. This should be supported through the introduction of national targets to raise public awareness;
    • support professional societies, civil society, and healthcare delivery systems to pilot and adopt proven behaviour change strategies to ensure appropriate use of antibiotics;
    • ensure access to appropriate and fit-for-purpose point-of-care diagnostics in hospitals and clinics to support decision making and prevent inappropriate prescribing of antibiotic;
    • mandate the collection of data on antibiotic use, prescriptions, prices, resistance patterns, and trade in both the healthcare and agricultural sectors. This data should be made publicly accessible;
    • promote effective programs of antimicrobial stewardship and training on the appropriate use of antimicrobials agents, and infection control;
    • actively pursue the development of a national surveillance system for the provision of antimicrobials and for antimicrobial resistance. Data from this system should be linked with or contributed to the WHO’s global surveillance network;
    • monitoring of antimicrobial use in food producing animals must be sufficiently granular to ensure accountability.
  2. National medical associations should:
    • encourage medical schools and continuing medical education programs to renew their efforts to educate physicians, who can in turn inform their patients, about the appropriate use of antimicrobial agents and appropriate infection control practices, including antibiotic use in the outpatient setting;
    • support the education of their members in areas of AMR, including antimicrobial stewardship, rational use of antimicrobials, and infection control measures including hand hygiene;
    • advocate for the publishing and communication of local information relating to resistance patterns, clinical guidelines and recommended treatment options for physicians;
    • in collaboration with veterinary authorities, encourage their governments to introduce regulations to reduce the use of antimicrobials in agriculture, in particular food producing animals, including restrictions on the routine use of antimicrobials for both prophylaxis and growth promotion, and on the use of classes of antimicrobial that are critically important in human medicine;
    • support regulation that prevents conflicts of interest among veterinarians, such as roles where veterinarians both prescribe and sell antibiotics;
    • consider the use of social media to educate and promote the proper use and disposal of antibiotic medications;
    • encourage parents to comply with the national recommended immunization schedules for children. Adults should also have easy access to vaccines against influenza and pneumococcal infections among others.

Local

  1. Health professionals and health systems have a vital role in preserving antimicrobial medicines.
  2. Physicians should:
    • have access to high-quality and reliable, evidence-based information free of conflict of interest and actively participate in and lead antimicrobial stewardship programs in their hospitals, clinics and communities to optimise antibiotic use;
    • raise awareness amongst their patients about antimicrobial therapy, its risks and benefits, the importance of adherence with the prescribed regimen, infection prevention practices, and the problem of AMR;
    • promote and ensure adherence hygiene measures (especially hand hygiene) and other infection prevention practices.

Adopted by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007
reaffirmed by the 206th WMA Council Session, Livingstone, Zambia, April 2017
and rescinded and archived by the 73rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

Noting information and reports of systematic and repeated violations of human rights, interference with the right to health in Zimbabwe, failure to provide resources essential for provision of basic health care, declining health status of Zimbabweans, dual loyalties and threats to health care workers striving to maintain clinical independence, denial of access to health care for persons deemed to be associated with opposition political parties and escalating state torture, the WMA wishes to confirm its support of, and commitment to:

  • Attaining the World Health Organization principle that the “enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”
  • Defending the fundamental purpose of physicians to alleviate distress of patients and not to let personal, collective or political will prevail against such purpose
  • Supporting the role of physicians in upholding the human rights of their patients as central to their professional obligations
  • Supporting physicians who are persecuted because of their adherence to medical ethics

RECOMMENDATION

Therefore, the World Medical Association, recognizing the collapsing health care system and public health crisis in Zimbabwe, calls on its affiliated national medical associations to:

  1. Publicly denounce all human rights abuses and violations of the right to health in Zimbabwe
  2. Actively protect physicians who are threatened or intimidated for actions which are part of their ethical and professional obligations
  3. Engage with the Zimbabwean Medical Association (ZiMA) to ensure the autonomy of the medical profession in Zimbabwe
  4. Urge and support ZiMA to invite an international fact finding mission to Zimbabwe as a means for urgent action to address the health and health needs of Zimbabweans

In addition, the WMA encourages ZiMA, as a member organization of the WMA, to:

  1. Uphold its commitment to the WMA Declarations of Tokyo, Hamburg and Madrid as well as the WMA Statement on Access to Health Care
  2. Facilitate an environment where all Zimbabweans have equal access to quality health care and medical treatment, irrespective of their political affiliations
  3. Commit to eradicating torture and inhumane, degrading treatment of citizens in Zimbabwe
  4. Reaffirm their support for the clinical independence of physicians treating any citizen of Zimbabwe
  5. Obtain and publicize accurate and necessary information on the state of health services in Zimbabwe
  6. Advocate for inclusion in medical curricula, teachings on human rights and the ethical obligations of physicians to maintain full and clinical independence when dealing with patients in vulnerable situations

The WMA encourages ZiMA to seek assistance in achieving the above by engaging with the WMA, the Commonwealth Medical Association and the NMAs of neighboring countries and to report on its progress from time to time.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and revised by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

PREAMBLE

Obesity is one of the single most important health issues facing the world in the twenty-first century, affecting all countries and socio-economic groups and representing a serious drain on health care resources.

Obesity in children is of increasing concern and is emerging as a growing epidemic in itself.

Obesity has complex origins linked to economic and social changes in society including the obeso-genic environment within which much of the population lives.

Therefore the WMA urges physicians to use their roles as leaders to advocate for recognition by national health authorities that reduction in obesity should be a priority, with culturally and age appropriate policies involving physicians and other key stakeholders.

THE WMA RECOMMENDS THAT PHYSICIANS:

  • Lead the development of societal changes that emphasize environments which support healthy food choices and regular exercise or physical activity for all people, with a specific focus on children;
  • Individually and through medical associations, express concern that excessive television viewing and video game playing are impediments to physical activity among children and adolescents in many countries;
  • Encourage individuals to make healthy choices and guide parents in helping their children to do so;
  • Recognise the role of personal decision making and the adverse influences exerted by current environments;
  • Recognise that collection and evaluation of data can contribute to evidence based management, and should be part of routine medical screening and evaluation throughout life;
  • Encourage the development of life skills that contribute to a healthy lifestyle in all persons and to better public knowledge of healthy diets, exercise and the dangers of smoking and excess alcohol consumption;
  • Advocate for appropriately trained professionals to be placed in educational facilities, highlighting the importance of education on healthy lifestyles from an early age;
  • Contribute to the development of better assessment tools and databases to enable better targeted and evaluated interventions;
  • Ensure that obesity, its causes and management remain part of continuing professional development programmes for health care workers, including physicians;
  • Use pharmacotherapy and bariatric surgery consistent with evidence-based guidelines and an assessment of the risks and benefits associated with such therapies.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and rescinded by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

MINDFUL that the WMA Statement on HIV/AIDS and the Medical Profession was adopted at the 57th WMA General Assembly in Pilanesberg, Republic of South Africa, on 14 October 2006; and RECOGNIZING the alarming statistic from UNAIDS that some 37-38 million people worldwide are infected with HIV, with the number increasing daily, and that 60% percent of them live in sub-Saharan Africa; and

NOTING that there exist evidence-based methods for preventing the spread of the infection and also for life-prolonging treatment; therefore

The WMA urges governments to work closely with health professionals and their representative organizations to identify and implement the critical steps to ensure

  1. that all efforts are made to prevent the spread of HIV/AIDS;
  2. that the diagnosis, counselling and treatment of patients for HIV/AIDS is undertaken only by appropriately trained physicians and other healthcare personnel, according to established evidence-based principles;
  3. that patients be given accurate, relevant and comprehensive information to enable them to make informed decisions about their health care treatment; and
  4. that barriers preventing people from coming forward for testing and treatment be identified and eliminated.

The WMA calls on National Medical Associations to use this resolution in their advocacy efforts to their governments, their patients and the public.

Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988,
revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and reaffirmed by the 203rd WMA Council Session, Buenos Aires, Argentina, April 2016 

 

INTRODUCTION

  1. The effective practice of medicine increasingly requires that physicians and their professional associations turn their attention to environmental issues that have a bearing on the health of individuals and populations.
  2. More than ever, due to diminishing natural resources, these problems relate to the quality and protection of resources necessary to maintain health and indeed sustain life itself. In concrete terms, the key environmental issues are as follow:
    1. The degradation of the environment, which must be halted as a matter of urgency so that resources essential to life and health – water and pure air – remain accessible to all.
    2. The ongoing contamination of our reserves of fresh water with hydrocarbons and heavy metals, along with the contamination of ambient and indoor health by toxic agents, which have serious medical consequences, especially in the poorest segments of the globe. Moreover, the greenhouse effect with its concomitant proven rise in temperature should drive our discussions forward and prepare us for increasingly serious environmental and public health consequences.
    3. The need to control the use of non-renewable resources such as topsoil, which should constantly be at the forefront of our minds, as should the importance of safeguarding this vital heritage so that it can be passed on to future generations.
    4. The need to mobilise resources beyond national frontiers and to co-ordinate global solutions for the planet as a whole, so as to formulate a unified strategy to confront these worldwide medical and economic problems.
    5. The foremost objective is to increase awareness of the vital balance between environmental resources on the one hand, and on the other, biological essentials for the health of everyone everywhere.
  3. Our growing awareness of these issues today has, however, failed to prevent an increase in our societies’ negative impact on the environment, e.g., melting of glaciers and increasing desertification, nor has it halted the over-exploitation of natural resources, e.g. pollution of rivers and seas, air pollution, deforestation and diminishing arable land. In this context, the migration of people from disadvantaged or developing countries, together with the emergence of new diseases, exacerbates the lack of socioeconomic policies in many parts of the world. From a medical point of view, growth of the population and irresponsible destruction of the environment are unacceptable, and medical organisations throughout the world should redouble their efforts, not only to speak out about these problems, but also to suggest solutions.

PRINCIPLES

  1. In their role as representatives of physicians, medical associations are duty bound to grapple with these environmental issues. They have a duty to produce analytical studies that include the identification of problems and current international regulations on environmental issues, as well as their impact on the field of health.
  2. As physicians operate within the framework of ethics and medical deontology, the environmental regulations advocated should not seek to limit individual autonomy, but rather to enrich the quality of life for all and to perpetuate life-forms on the planet.
  3. The WMA should therefore act as an international platform for research, education, and advocacy to help further sustain the environment and its potential to promote health.
  4. Thus, when new environmental diseases or syndromes are identified, the WMA should help coordinate the scientific/medical discussions on the available data and their implications for human health. It should foster the development of consensus thinking within medicine, and help to stimulate preventive measures, accurate diagnosis and treatment of these emerging disorders.
  5. The WMA should therefore provide a framework for the international co-ordination of medical associations, NGOs, research clinicians, international health organisations, decision-makers and funding providers, in their examination of the human health effects of environmental problems, their prevention, remediation and treatment for individuals and communities.

Adopted by the 47th WMA General Assembly, Bali, Indonesia, September 1995
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016

 

The health of a community or population is determined by several factors that go beyond traditionally understood causes of disease. Social determinants of health include factors that affect behavioural lifestyle choices; the physical, psychosocial and economic environments in which individuals live; and the health services available to people. Public health involves monitoring, assessing and planning a variety of programs and activities targeted to the identified needs of the population, and the public health sector should have the capacity to carry out those functions effectively to optimise community health. A key tenet of public health policy should be inclusivity and health equity; public health agencies must pay specific attention to populations and communities whose social, economic, and political conditions put them at greater risk of poor health than the general population.

Physicians and their professional associations have an ethical and professional responsibility to act in the best interests of patients at all times. This involves collaboration with public health agencies to integrate medical care of individual patients with a broader promotion of the health of the public.

The key functions of public health agencies are:

1. Health promotion:

  • Working with health care providers to inform and enable the general public to take an active role in preventing and controlling disease, adopting healthful lifestyles, and using medical services appropriately;
  • Assuring that conditions contributing to good health, including high-quality medical services, safe water supplies, good nutrition, an unpolluted atmosphere, and opportunities for exercise and recreation are accessible for the entire population;
  • Working with the responsible public authorities to create healthy public policy and supportive environments in which healthy behavioural choices are the easy choices, and to develop human and social capital.
  • Prevention: assuring access to screening and other preventive services and curative care to the entire population.

2. Protection: monitoring and protecting the health of communities against communicable diseases and exposure to toxic environmental pollutants, occupational hazards, harmful products, and poor quality health services. This function includes the need to set priorities, establish essential programs, obtain requisite resources and assure the availability of necessary public health laboratory services.

3. Surveillance: identifying outbreaks of infectious disease and patterns of chronic disease and injury and establishing appropriate control or prevention programs;

4. Population Health Assessment: assessing community health needs and marshalling the resources for responding to them, and developing health policy in response to specific community and national health needs.

The specific programs and activities carried out in each jurisdiction (local or national) will depend on the problems and needs identified, the organization of the health care delivery system, the types and scope of the partnerships developed and the resources available to address the identified needs.

Public health agencies benefit greatly from the support and close cooperation of physicians and their professional associations. The health of a community or a nation is measured by the health of all its residents, and the preventable health problems that affect an individual person affect the health and resources of the community. The effectiveness of many public health programs, therefore, depends on the active collaboration of physicians and their professional associations with public health agencies and other governmental and nongovernmental agencies.

The medical sector and the public health sector should effectively co-operate on the dissemination of public health information and education programs that promote healthful lifestyles and reduce preventable risks to health, including those from the use of tobacco, alcohol and other drugs; sexual activities that increase the risk of HIV transmission and sexually transmitted diseases; poor diet and physical inactivity; and inadequate childhood immunization levels. For example, health education can substantially reduce infant morbidity and mortality (e.g. through the promotion of breast-feeding and providing nutrition education to parents together with providing supportive conditions, both at work and in the community).

The formal responsibility of public health agencies is primarily disease surveillance, investigation and control. These activities cannot be conducted effectively, however, without the active cooperation and support of physicians at the community level who are aware of individual and community illness patterns and can notify health authorities promptly of problems that might require further investigation and action. For example, physicians can help identify populations at high risk for particular diseases, such as tuberculosis, and report cases of communicable diseases such as measles, whooping cough, or infectious causes of diarrhoea, as well as cases of exposure to lead or other toxic chemicals and substances in the community or work place. Close collaboration between public health agencies and physicians as well as other health professionals is critical for an efficient disease monitoring system.

Regardless of the effectiveness of existing public health programs in a jurisdiction, professional medical associations should be aware of unmet health needs in their communities and nations and advocate for activities, programs and resources to meet those needs. These efforts might be in areas of public education for health promotion and disease prevention; monitoring and controlling environmental hazards; identifying and publicising adverse health effects resulting from social problems, such as interpersonal violence or social practices that affect health; or identifying and advocating for services such as improvements in emergency treatment preparedness.

In jurisdictions in which basic public health services are not being provided adequately, medical associations must work with other health agencies and groups to establish priorities for advocacy and action. For example, in a country or area with limited resources in which potable water and sewage facilities are not available to most residents, these needs should be given priority over medical technologies that would provide service to only a small portion of the population.

Some health-related issues are extremely complex and involve multiple levels of response. For example, those diagnosed with high blood lead levels need not only appropriate medical treatment, but the source of contamination must also be determined, and measures need to be taken to eliminate the danger. At times policies that promote public health create concern because of their potential economic impact. For example, strong opposition to the potential economic impact of tobacco control policies could come from regions or groups that derive significant revenue from growing or processing tobacco. However, economic concerns should not deter a strong public health advocacy program against the use of tobacco products. The promotion of tobacco products should be rigorously opposed, and every effort should be made to reduce tobacco consumption in both developed and developing countries.

Physicians and their associations should collaborate with political authorities and other organizations to encourage the media to send positive messages for health education regarding diet, drug use, sexually transmitted diseases, cardiovascular risk, etc.

Medical associations should ask their members to educate their patients on the availability of public health services.

Adopted by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

PREAMBLE

Childhood obesity is a serious medical condition and a major public health concern affecting many children.  Childhood obesity is emerging as a growing epidemic and is a challenge in both developed and developing countries.  Due to its increasing prevalence and its immediate and long-term impact on health, including predisposition to diabetes and cardiovascular abnormalities, childhood obesity should be viewed as a serious concern for public health. The increase in childhood obesity may be attributed to many factors:

  • Recent studies show that marketing targeted at children has a wide influence on the shopping trends and food preferences of households all over the world. Special offers, short-term price reductions and other price promotions and advertising on social as well as traditional media all play a role in increasing product demand.
  • Many advertisements are in conflict with nutritional recommendations of medical and scientific bodies. TV advertisements for food and drink products with little or no nutritional value are often scheduled for broadcast hours with a large concentration of child viewers and are intended to promote the desire to consume these products regardless of hunger. Advertisements increase children’s emotional response to food and exploit their trust. These methods and techniques are also used in non-traditional media, such as social networks, video games and websites aimed at children.
  • Unhealthy dietary patterns, together with a sedentary lifestyle and lack of exercise, contribute to childhood obesity.  The sedentary lifestyle is the most predominant one in the developed world today. Many children typically spend more time than ever in front of screens, rarely engaging in physical activities.
  • International corporations and conglomerates that manufacture foods and beverages are not always subject to regional regulations that govern food labeling. Concern for profits may come at the expense of corporate responsibility for environmental and public health issues.
  • Products containing large amounts of added sugar, fat, and salt can be addictive, especially when combined with flavor enhancers. In some countries, not all ingredients are required to be listed on food labels and manufacturers often refuse to release data on methods employed to maximize consumption of their products.  Governments should require that all ingredients in food and beverages be clearly labeled, including those proprietary ingredients intended to increase consumption of the product.
  • Socioeconomic disparities also correlate with increasing rates of childhood obesity. The link between living in poverty and early childhood obesity continues to negatively affect health in adult life.[1] Exposure to environmental contaminants, sporadic medical checkups, insufficient access to nutritious foods and limited physical activity lead to obesity and other chronic illnesses that are all more prevalent among children living in poverty.

RECOMMENDATIONS

  1. A comprehensive program is needed to prevent and address obesity in all segments of the population, with a specific focus on children.  The approach must include initiatives on price and availability of nutritious foods, access to education, advertising and marketing, information, labeling and other areas specific to regions and countries.  An approach similar to that on tobacco in the WHO Framework Convention on Tobacco Control is advocated.
  2. International studies stress the importance of adopting an integrated approach to education and health promotion.  Investment in education is key to minimizing poverty, improving health and providing economic benefits.
  3. Quality education offered in formal settings to children aged 2 to 3 years, combined with enrichment activities for parents, and sufficient supply of nutritious food and beverages may help to reduce the rate of adolescent obesity and reduce its health implications throughout the life course. Developing early healthy eating practices and experiencing flavors of healthy food when very young appear to be positive factors in prevention of childhood obesity.
  4. Governments should invest in education related to menu design, food shopping including budget setting, storage and preparation so that people are better equipped to plan their food intake.
  5. Governments should seek to regulate the availability of food and beverages of poor nutritional value, by a range of methods including price.  Attention should be paid to the availability close to schools of establishments selling products of poor nutritional quality.  Governments should seek to persuade manufacturers to reformulate products to reduce their obesogenic effects.  Where possible government and local authorities should seek to manage the density of such establishments in the area.
  6. Governments should consider imposing a tax on non-nutritious foods and sugary drinks and use the additional revenue to fund research and epidemiological studies aimed at preventing childhood obesity and reducing the resulting disease risk.
  7. Ministries of health and education should regulate food and beverages that are sold and served at educational and healthcare facilities.
  8. Given the scientifically proven link between the extent of media consumption and adverse effects on body weight in children, the WMA recommends that the advertising of non-nutritious products be restricted during television programming and other forms of media that appeal to children.  Regulators should be aware that children access television programs designed for adults and ensure that legislation and regulation also limits marketing associated with such programs.
  9. Governments should work with independent health experts to produce sound guidance on food and nutrition, with no involvement of the food and drink industry.
  10. Governments and local authorities should subsidize and encourage activities that promote good health among their residents, including providing safe spaces for walking, bike riding and other forms of physical activity. 
  11. Parents have a crucial role in fostering physical activity in their children. Schools should incorporate daily physical activity into their daily routine.  Participation in sport activities should be possible for everyone regardless of their economic situation.
  12. National Medical Associations should support or develop guidelines and recommendations to ensure that they reflect current knowledge of prevention and treatment of childhood obesity.
  13. National Medical Associations should work to raise public awareness on the issue of childhood obesity and highlight the need to tackle the rising prevalence of obesity and its health and economic burden.
  14. Clinics and Health Maintenance Organizations should employ appropriately trained professionals to offer classes and consultation in selecting appropriate amounts of nutritious foods and beverages and attaining optimal levels of physical activity for children.  They should also ensure that their premises are exemplars in the provision of healthy food options.
  15. Educational facilities should employ appropriately trained professionals who educate for healthy lifestyles from an early age and allow all children, whatever their social environment, to practice regular physical activities.
  16. Physicians should guide parents and children in how to live healthy lives and emphasize the importance of doing so, and must identify as soon as possible obesity in their patients, particularly children. They should direct patients suffering from obesity to the appropriate services at the earliest possible stage, and conduct regular follow-ups.
  17. Physicians and health professionals should be educated in nutrition assessment, obesity prevention and treatment. This could be accomplished by strengthening CME activities focused on nutritional medicine.

[1] WHO Commission on Social Determinants of Health (Closing the Gap in a Generation) 2008.

Adopted by the 56th WMA General Assembly, Santiago, Chile, October 2005
And rescinded at the 68th WMA General Assembly, Chicago, USA, October 2017

PREAMBLE

  1. Alcohol use is deeply embedded in many societies. Overall, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco or hypertension. Overall, there are causal relationships between alcohol consumption and more than 60 types of disease and injury including traffic fatalities. Alcohol consumption is the leading risk factor for disease burden in low mortality developing countries and the third largest risk factor in developed countries. Beyond the numerous chronic and acute health effects, alcohol use is associated with widespread social, mental and emotional consequences. The global burden related to alcohol consumption, both in terms of morbidity and mortality, is considerable.
  2. Alcohol-related problems are the result of a complex interplay between individual use of alcoholic beverages and the surrounding cultural, economic, physical environment, political and social contexts.
  3. Alcohol cannot be considered an ordinary beverage or consumer commodity since it is a drug that causes substantial medical, psychological and social harm by means of physical toxicity, intoxication and dependence. There is increasing evidence that genetic vulnerability to alcohol dependence is a risk factor for some individuals. Fetal alcohol syndrome and fetal alcohol effects, preventable causes of mental retardation, may result from alcohol consumption during pregnancy. Growing scientific evidence has demonstrated the harmful effects of consumption prior to adulthood on the brains, mental, cognitive and social functioning of youth and increased likelihood of adult alcohol dependence and alcohol related problems among those who drink before full physiological maturity. Regular alcohol consumption and binge drinking in adolescents can negatively affect school performance, increase participation in crime and adversely affect sexual performance and behaviour.
  4. Alcohol advertising and promotion is rapidly expanding throughout the world and is increasingly sophisticated and carefully targeted, including to youth. It is aimed to attract, influence, and recruit new generations of potential drinkers despite industry codes of self-regulation that are widely ignored and often not enforced.
  5. Effective alcohol social policy can put into place measures that control the supply of alcohol and/or affect population-wide demand for alcohol beverages. Comprehensive policies address legal measures to: control supply and demand, control access to alcohol (by age, location and time), provide public education and treatment for those who need assistance, levy taxation to affect prices and to pay for problems generated by consumption, and harm-reduction strategies to limit alcohol-related problems such as impaired driving and domestic violence.
  6. Alcohol problems are highly correlated with per capita consumption so that reductions of use can lead to decreases in alcohol problems. Because alcohol is an economic commodity, alcohol beverage sales are sensitive to prices, i.e., as prices increase, demand declines, and visa versa. Price can be influenced through taxation and effective penalties for inappropriate sales and promotion activities. Such policy measures affect even heavy drinkers, and they are particularly effective among young people.
  7. Heavy drinkers and those with alcohol-related problems or alcohol dependence cause a significant share of the problems resulting from consumption. However, in most countries, the majority of alcohol-related problems in a population are associated with harmful or hazardous drinking by non-dependent ‘social’ drinkers, particularly when intoxicated. This is particularly a problem of young people in many regions of the world who drink with the intent of becoming intoxicated.
  8. Although research has found some limited positive health effects of low levels of alcohol consumption in some populations, this must be weighed against potential harms from consumption in those same populations as well as in population as a whole.
  9. Thus, population-based approaches that affect the social drinking environment and the availability of alcoholic beverages are more effective than individual approaches (such as education) for preventing alcohol related problems and illness. Alcohol policies that affect drinking patterns by limiting access and by discouraging drinking by young people through setting a minimum legal purchasing age are especially likely to reduce harms. Laws to reduce permitted blood alcohol levels for drivers and to control the number of sales outlets have been effective in lowering alcohol problems.
  10. In recent years some constraints on the production, mass marketing and patterns of consumption of alcohol have been weakened and have resulted in increased availability and accessibility of alcoholic beverages and changes in drinking patterns across the world. This has created a global health problem that urgently requires governmental, citizen, medical and health care intervention.

RECOMMENDATIONS

The WMA urges National Medical Associations and all physicians to take the following actions to help reduce the impact of alcohol on health and society:

  1. Advocate for comprehensive national policies that
    1. incorporate measures to educate the public about the dangers of hazardous and unhealthy use of alcohol (from risky amounts through dependence), including, but not limited to, education programs targeted specifically at youth;
    2. create legal interventions that focus primarily on treating or provide evidence-based legal sanctions that deter those who place themselves or others at risk, and
    3. put in place regulatory and other environmental supports that promote the health of the population as a whole.
  2. Promote national and sub-national policies that follow ‘best practices’ from the developed countries that with appropriate modification may also be effective in developing nations. These may include setting of a minimum legal purchase age, restricted sales policies, restricting hours or days of sale and the number of sales outlets, increasing alcohol taxes, and implementing effective countermeasures for alcohol impaired driving (such as lowered blood alcohol concentration limits for driving, active enforcement of traffic safety measures, random breath testing, and legal and medical interventions for repeat intoxicated drivers).
  3. Be aware of and counter non-evidence-based alcohol control strategies promoted by the alcohol industry or their social aspect organizations.
  4. Restrict the promotion, advertising and provision of alcohol to youth so that youth can grow up with fewer social pressures to consume alcohol. Support the creation of an independent monitoring capability that assures that alcohol advertising conforms to the content and exposure guidelines described in alcohol industry self-regulation codes.
  5. Work collaboratively with national and local medical societies, specialty medical organizations, concerned social, religious and economic groups (including governmental, scientific, professional, nongovernmental and voluntary bodies, the private sector, and civil society) to:
    1. reduce harmful use of alcohol, especially among young people and pregnant women, in the workplace, and when driving;
    2. increase the likelihood that everyone will be free of pressures to consume alcohol and free from the harmful and unhealthy effects of drinking by others; and
    3. promote evidence-based prevention strategies in schools.
  6. Undertake to
    1. screen patients for alcohol use disorders and at-risk drinking, or arrange to have screening conducted systematically by qualified personnel using evidence-based screening tools that can be used in clinical practice;
    2. promote self-screening/mass screening with questionnaires that could then select those needing to be seen by a provider for assessment;
    3. provide brief interventions to motivate high-risk drinkers to moderate their consumption; and
    4. provide specialized treatment, including use of evidence-based pharmaceuticals, and rehabilitation for alcohol-dependent individuals and assistance to their families.
  7. Encourage physicians to facilitate epidemiologic and health service data collection on the impact of alcohol.
  8. Promote consideration of a Framework Convention on Alcohol Control similar to that of the WHO Framework Convention on Tobacco Control that took effect on February 27, 2005.
  9. Furthermore, in order to protect current and future alcohol control measures, advocate for consideration of alcohol as an extra-ordinary commodity and that measures affecting the supply, distribution, sale, advertising, promotion or investment in alcoholic beverages be excluded from international trade agreements.

Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002,
editorially revised by the 164th WMA Council Session, Divonne-les-Bains, France, May 2003,
reaffirmed by the 191st WMA Council Session, Prague, Czech Republic, April 2012, and
revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

Rapid advances in microbiology, molecular biology, and genetic engineering have created extraordinary opportunities for biomedical research and hold great promise for improving human health and the quality of life. However, the proliferation of these technologies provides the opportunity to create novel pathogens and diseases and simplified production methods for biological weapons. The technologies are relatively inexpensive and, because production is similar to that used in biological facilities such as vaccine manufacturing, they are easy to obtain. Capacity to produce and effectively disperse biological weapons exists globally, threatening governments and endangering people around the world.

The consequences of a biological attack would be insidious and devastating. Their impact might continue with secondary and tertiary transmission of the agent, weeks, months or years after the initial epidemic. Given the ease of travel and increasing globalization, an outbreak anywhere in the world could be a threat to all nations. A great many severe, acute illnesses occurring over a short span of time could overwhelm the capacities of health systems worldwide.

Physicians and other health personnel are on the frontline in alleviating human suffering caused by epidemic disease and will bear primary responsibility for dealing with the victims of biological weapons.

Participants in biomedical research have a moral and ethical obligation to consider the implications of possible malicious use of their findings. Through deliberate or inadvertent means, genetic modification of microorganisms could create organisms that are more virulent, are antibiotic-resistant, or have greater stability in the environment. Genetic modification of microorganisms could alter their immunogenicity, allowing them to evade natural and vaccine-induced immunity. Advances in genetic engineering and gene therapy may allow modification of the immune response system of the target population to increase or decrease susceptibility to a pathogen or disrupt the functioning of normal host genes.

Nonproliferation and arms control measures can diminish but cannot completely eliminate the threat of biological weapons. Thus, there is a need for the creation of and adherence to a globally accepted ethos that rejects the development, production, possession and use of biological weapons. International collaboration is critical to build such a universal consensus.

The United Nations Biological Weapons Convention (BWC) prohibits the development, production, acquisition, transfer, stockpiling and use of biological and toxin weapons. Having reached almost universal membership, the BWC constitutes a key element in the international community’s efforts to address the proliferation of weapons of mass destruction and has established a strong norm against biological weapons.

Medical associations and physicians have a responsibility in educating the public and policy makers about the implications of biological weapons and to mobilize universal support for condemning research, development, or use of such weapons as morally and ethically unacceptable. They have important societal and ethical roles in demanding the full respect of the BWC, stigmatizing the use of biological weapons, guarding against unethical and illicit research, and mitigating harm from use of biological weapons.

 

RECOMMENDATIONS

Recognizing the growing threat of biological weapons, the WMA and its constituent members condemn the development, production, or use of toxins and biological agents that have no justification for prophylactic, protective, therapeutic or other peaceful purposes, and makes the following recommendations:

Strengthening global preparedness and response to health emergencies

Governments and national health authorities:

  1. To develop a strategy for the effective coordinated and timely access to vital protective measures for new pathogens, whatever their origin, for all populations at risk. The strategy should assure surge capacity to address mass casualty care.
  2. In line with the WMA Statement on Epidemics and Pandemics, to meet the critical needs for:
  • Adequate investment in public health systems, including resources and supplies, to enhance capacity to effectively detect, investigate and contain rare or unusual disease outbreaks.
  • An operative global surveillance program to improve response to naturally occurring infectious diseases and to permit earlier detection and characterization of new or emerging diseases.
  1. To provide to WHO adequate means to fulfill its leadership role in ensuring appropriate international cooperation and coordination for surveillance and action on emerging infectious diseases.
  2. To support the development of a WHO legally binding instrument on pandemic prevention, preparedness and response, integrating principles of equity and human rights.
  3. To develop adequate and targeted health education and training for health professionals, civic leaders, and the public alike, as well as collaborative programs of research to improve disease diagnosis, prevention, and treatment.
  4. To develop communications strategies to inform health care professionals and the public about acts of bioterrorism and infectious disease outbreaks, including local information on available medical services.
  5. To fund research and development to counteract biological weapons, including:
  • to improve understanding of the epidemiology, pathogenesis, and treatment of diseases caused by potential bioweapon agents and the immune response to such agents;
  • for new and more effective vaccines, pharmaceuticals, and antidotes against biological weapons; and
  • for improving biological agent detection and defense capabilities.

Physicians, Medical Associations and other health entities:

  1. To participate with local, national, and international health authorities in developing and implementing disaster preparedness and response protocols for acts of bioterrorism and natural infectious disease outbreaks. These protocols should be used as the basis for physician and public education.
  2. To support and fulfill the critical role of physicians in early detection of unusual clusters of diseases or symptoms, potentially resulting from the use of biological weapons, so that they can promptly report it to the appropriate institutions.
  3. Physicians in relevant specialties should:
  • be alert to the occurrence of unexplained illness and death in the community;
  • be knowledgeable of disease surveillance and control capabilities for responding to unusual clusters of diseases, symptoms, or presentations;
  • be familiar with the clinical manifestations, diagnostic techniques, isolation precautions, decontamination protocols, and therapy/prophylaxis of biological agents likely to be used in an attack;
  • utilize appropriate procedures to prevent exposure to themselves and others; and
  • understand the essentials of risk communication so that they can communicate clearly and nonthreateningly about issues such as exposure risks and potential preventive measures.

Counteracting biological weapons research

Governments and national health authorities:

  1. To develop and implement national and global raising awareness strategies on the potential development of biological weapons among researchers and practitioners, with comprehensive information on the reporting system to be used if needed.
  2. To reinforce accountable and transparent supervision mechanisms and regulation of biological and toxin laboratory work with the potential for weaponized applications.

Physicians:

  1. Recognizing the societal responsibility of physicians as scientists and humanitarians, to decry scientific research for the development and use of biological weapons and to advocate against the use of biotechnology and information technologies for potentially harmful purposes.

Researchers:

  1. To consider the implications and possible applications of their work and carefully balance the pursuit of scientific knowledge with their ethical responsibilities to society.

Fostering global mechanisms monitoring the threat of biological weapons

Governments:

  1. To take necessary measures to guarantee the respect and implementation of the BWC and to reinforce its implementation with appropriate means, ensuring transparency and adequate accountability mechanisms for Member State Parties.

Physicians, Medical Associations and other health entities:

  1. To advocate, in cooperation with the United Nations, including the WHO, and other appropriate entities, for strengthening of the Implementation Support Unit under the BWC, including medical and public health leaders in order to monitor the threat of biological weapons, to identify actions likely to prevent biological weapons proliferation, and to develop a coordinated plan for scrutinizing the worldwide emergence of infectious diseases. This plan should address:
  • international monitoring and reporting systems so as to enhance the surveillance and control of infectious disease outbreaks throughout the world;
  • the development of an effective verification protocol under the BWC;
  • education of physicians and public health personnel about emerging infectious diseases and potential biological weapons;
  • laboratory capacity to identify biological pathogens;
  • availability of appropriate vaccines and pharmaceuticals; and
  • financial, technical, and research needs to reduce the risk of use of biological weapons and other major infectious disease threats.

 

 

Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002
and rescinded at the 63rd WMA General Assembly, Bangkok, Thailand 2012

PREAMBLE

  1. On December 2, 2002, the Pan American Health Organization (PAHO) will celebrate its 100th Anniversary.
  2. PAHO was the first international health organization to organize a united front against the spread of pestilence and disease that engulfed the Hemisphere at the turn of the century. Founded by eleven countries, PAHO’s first task was to eliminate yellow fever and malaria in the Panama Canal Zone. Since then, the Organization has cooperated with its Member States to eliminate or reduce the occurrence of epidemic diseases including smallpox, polio, and measles.
  3. In 1924, its functions and responsibilities were broadened by the Pan American Sanitary Code which was signed by eighteen countries. The Code, which remains in force today, was eventually ratified by all republics of the Americas, and still represents one of the great achievements in health policy-making.
  4. PAHO is now a coalition encompassing 30% of earth’s land mass and 14% of the world’s current population. It operates 29 country offices and eight scientific centers in 35 countries. PAHO’s scope has also continued to grow. The initial focus on controlling epidemic diseases has broadened to include non-communicable diseases, better health education, and environmental improvements designed to help all people, especially the poor.
  5. PAHO’s purpose as stated in its Constitution remains the same: to help the countries of the Western Hemisphere work together to combat diseases, lengthen life and promote the physical and mental health of people. With both old and new threats to health in the hemisphere, PAHO is more important today than ever.

RECOMMENDATIONS

The World Medical Association recommends:

  1. that PAHO be congratulated for its unparalleled contribution to world health;
  2. that member National Medical Associations send congratulatory letters to PAHO on the occasion of its 100th Anniversary;
  3. that member National Medical Associations in the Americas continue to offer their support to PAHO as it undertakes its mission to improve the health of people in the Hemisphere.

Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988
Revised by the 49th WMA General Assembly, Hamburg, Germany, November 1997,
the 58th WMA General Assembly, Copenhagen, Denmark, October 2007,
the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and the 73rd WMA General Assembly, Berlin, Germany, October 2022

 

PREAMBLE

Over 80 percent of the world’s 1.3 billion smokers live in low- and middle-income countries. Smoking and other forms of tobacco use adversely affect every organ system in the body, and are major causes of cancer, heart disease, stroke, chronic obstructive pulmonary disease, fetal damage, and many other conditions. Smokers have up to a 50% higher risk of developing severe disease and death from COVID-19. Eight million deaths occur worldwide each year due to tobacco and tobacco- derived products. Tobacco will kill one billion people in the 21st century unless effective interventions are implemented.

Exposure to secondhand smoke occurs anywhere the burning of tobacco products occurs in enclosed spaces. There is no safe exposure level to secondhand smoke, which causes millions of deaths each year. It is especially damaging to children and pregnant patients. On May 29, 2007, the WHO called for a global ban on smoking at work and in enclosed public places to eliminate secondhand smoke and encourage people to quit.

The phenomenon known as “thirdhand smoke” occurs when nicotine and other chemical residues occur on indoor surfaces from smoking, which can persist long after the smoke itself has cleared. It is increasingly recognized as a potential danger, especially to children, who not only inhale fumes released by these residues but also ingest residues that get on their hands after crawling on floors or touching walls and furniture.

World Health Organization Action

With the hope of mitigating the effects of tobacco use, the World Health Organization (WHO) Member States unanimously adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. In force since 2005, it currently has 182 parties covering more than 90 percent of the world’s population. Further strengthening implementation of the milestone treaty is specifically included in the 2030 Agenda for Sustainable Development Goals (SDG) as Target 3.a. The WMA has long supported the WHO FCTC (see WMA Resolution on Implementation of the WHO Framework Convention on Tobacco Control). The Protocol to Eliminate Illicit Trade in Tobacco Products, the first protocol to the WHO FCTC, was adopted in 2012 in response to the growing international illicit trade in tobacco products. The objective of the Protocol is the elimination of all forms of illicit trade in tobacco products, in accordance with the terms of Article 15 of the WHO FCTC.

 New and Emerging Nicotine Products

 The WMA Statement on Electronic Cigarettes and Other Electronic Nicotine Delivery Systems outlines the still-unknown risks associated with these products.  The use of e-cigarettes by young people has risen dramatically, and in some regions is more popular than tobacco smoking.  Nicotine exposure, no matter how it is delivered, can affect brain development and lead to addiction.

New and rediscovered forms of tobacco and nicotine ingestion are also emerging, including:

  • dissolvable tobacco, from sweet, candy-like lozenges that contain tobacco and nicotine that are held in the mouth, chewed, or sucked until they dissolve;
  • snus, a finely ground form of moist snuff that that contains carcinogens and is usually packaged in small pouches;
  • hookahs, a water pipe that burns tobacco mixed with flavors such as honey, molasses or fruit, where the smoke is inhaled through a long hose. The WHO reports that one hookah smoking session is the same as smoking 100 cigarettes, largely due to the length of time a user smokes;
  • bidis, flavored cigarettes that are unfiltered and deliver up to five times more nicotine than regular cigarettes, and clove cigarettes (also called Kreteks) also deliver more nicotine, carbon monoxide, and tar than regular cigarettes;
  • other heated tobacco products that typically use an electronic heating element to heat specially designed sticks, plugs, or capsules containing tobacco. The heat releases nicotine (and other chemicals) that can then be inhaled into the lungs, but the tobacco does not get hot enough to burn. These devices are not the same as e-cigarettes, and
  • Nicotine pouches, tobacco free pouches of nicotine with different flavors which are placed in the mouth.

Pregnant Patients and Children

Smoking or using nicotine during pregnancy is linked with a range of poor birth outcomes including low birth weight and preterm birth, restricted head growth, placental problems, increased risk of still birth and increased risk of miscarriage. Breathing secondhand smoke during pregnancy also increases the risk of having a low-birth-weight baby, and babies who are exposed to secondhand smoke have an increased risk of Sudden Infant Death Syndrome.

Health and developmental consequences among children have also been linked to prenatal smoke exposure, including poorer lung function, (including coughs, colds, bronchitis and pneumonia), persistent wheezing, asthma and visual difficulties such as strabismus, refractive errors and retinopathy. Children who breathe more secondhand smoke have more ear infections, coughs, colds, bronchitis and pneumonia. Children who grow up with parents who smoke are themselves more likely to smoke and to have long term health effects similar to adults who smoke.

Health Equity

Health equity in tobacco prevention and control focuses on the opportunity for all people to live a healthy life, regardless of their race, level of education, gender identity, sexual orientation, occupation, geographic location, or disability status. Tobacco control programs, including evidence-based cessation services, can work toward health equity by focusing efforts on decreasing the prevalence of tobacco use, and second-hand and thirdhand smoke exposure, and by improving access to tobacco control resources, among populations experiencing greater tobacco-related health and economic burdens.

Tobacco Industry Marketing

 The tobacco industry spends billions of dollars annually around the globe on advertising, promotion and sponsorship. The tobacco industry’s manipulative and predatory marketing tactics increase consumption of its products and replace smokers who quit or die. By investing huge sums of money in low- and middle-income countries, the industry hopes to increase the social acceptability of tobacco and tobacco companies. The tobacco industry has also long employed strategies targeting children, from developing special packaging or candy-flavored cigarettes and e-cigarette cartridges, and has used the internet, text messaging and youth-oriented social networking sites to advertise sponsored events or promotions.

The best strategy to combat the tobacco industry’s marketing tactics is to adopt and enforce comprehensive bans on tobacco advertising, promotion and sponsorship, as set forth in the WHO FCTC.

The tobacco industry claims that it is committed to determining the scientific truth about the health effects of tobacco, both by conducting internal research and by funding external research through jointly funded industry programs. However, the industry has consistently denied, withheld, and suppressed information concerning the deleterious effects of tobacco smoking.

Tobacco companies also manipulate the public’s attitude about their reputation and have often engaged in so-called ‘corporate social responsibility’, which are activities to promote their products while portraying themselves as good corporate citizens.

 

RECOMMENDATIONS

The WMA recommends that national governments:

  1. Increase taxation of tobacco and tobacco-derived products, which is the single most effective tobacco control measure to reduce tobacco use according to the World Health Organization (WHO). Taxation is also a highly cost-effective and inexpensive tool. Increased revenues should be used for prevention programs, evidence-based cessation programs and services, and other health care measures.
  2. Urge the WHO to add tobacco cessation medications with established efficacy to the WHO’s Model List of Essential Medicines.
  3. Ratify and fully implement the WHO Framework Convention on Tobacco Control.
  4. Implement comprehensive regulation of the manufacture, sale, distribution, and promotion of tobacco and tobacco-derived products, including total bans on tobacco advertising, promotion and partnership, including abroad. Require plain packaging of tobacco products (as set forth in the WMA Resolution on Plain Packaging of Cigarettes, e-Cigarettes and Other Smoking Products), and packaging that includes prominent written and pictorial warnings about health hazards of tobacco.
  5. Prohibit smoking in all enclosed public places, including public transportation, prisons, airports and on airplanes. Require all medical schools, biomedical research institutions, hospitals, and other health care facilities to prohibit smoking, and the use of smokeless tobacco and other tobacco-derived products on their premises.
  6. Prohibit the sale, distribution, and accessibility of cigarettes and other tobacco products to children and adolescents. Ban the production, distribution and sale of candy products that depict or resemble tobacco products.
  7. Prohibit all government subsidies for tobacco and tobacco-derived products and assist tobacco farmers in switching to alternative crops. Exclude tobacco products from international trade agreements, and work to curtail or eliminate illegal trade in tobacco and tobacco-derived products and the sale of smuggled tobacco products.
  8. Provide for research into the prevalence of tobacco use and the effects of tobacco and tobacco-derived products on the health status of the population.

The WMA recommends that national medical associations:

  1. Refuse funding or educational materials from the tobacco industry, and urge medical schools, research institutions, and individual researchers to do the same.
  2. Adopt policies opposing smoking and the use of tobacco and tobacco-derived products and publicize the policy. Endorse or promote clinical practice guidelines on the treatment of tobacco use and dependence.
  3. Prohibit smoking, including use of smokeless tobacco and vaping, in national medical association premises and at all business, social, scientific, and ceremonial meetings of national medical associations, in line with the decision of the World Medical Association to impose a similar ban.
  4. Develop, support, and participate in programs to educate the profession and the public about the health hazards of tobacco use (including addiction) and exposure to secondhand smoke.
  5. Introduce or strengthen educational programs for medical students and physicians to prepare them to identify and treat tobacco dependence in their patients.
  6. Speak out against the shift in focus of tobacco marketing from developed to less developed nations, from adults to youth, and urge national governments to do the same.
  7. End investment in companies or firms producing or promoting the use or sale of tobacco or tobacco-derived products. Divest current assets that support tobacco production or promotion.

The WMA recommends that physicians:

  1. Be positive role models by not using tobacco or tobacco-derived products, and by acting as spokespersons to educate and raise the awareness of the public about the deleterious health effects of tobacco use and the benefits of tobacco-use cessation.
  2. Support widespread access to evidence-based treatment for tobacco dependence through individual patient encounters, counseling, pharmacotherapy, cessation classes, telephone quit-lines, web-based cessation services, and other appropriate means.
  3. Recognize that tobacco and second-hand smoke exposure to adult tobacco use cause harm to children. Special efforts should be made by physicians to:
  • promote tobacco-free environments for children
  • target parents and pregnant patients who smoke for tobacco cessation interventions
  • promote programs that contribute to the prevention and decreased use of tobacco and tobacco-derived products by youth
  • support policies that control access to and marketing of tobacco and tobacco-derived products and make pediatric tobacco-control research a higher priority.