WMJ_2024_04

Official Journal of The World Medical Association, Inc. Nr. 4, December 2024
vol. 70
Contents
Editorial   3
Valedictory Speech by the WMA President, Dr. Lujain Alqodmani 4
Inaugural Address by the WMA President, Dr. Ashok Philip 6
Information about the 229th WMA Council Session, Montevideo 2025   8
Information about the World Federation for Medical Education Conference 2025   9
Information about the 17th World Conference in Bioethics, Medical Ethics & Health Law   10
WMA General Assembly Report, Helsinki, Finland, 16-19 October 2024   11
WMA Declaration of Helsinki – Ethical Principles
for Medical Research Involving Human Participants   26
WMA Resolution on Anti-LGBTQ Legislation   31
WMA Resolution on Plastics and Health   32
WMA Declaration on Prevention and Reduction of Air Pollution to Improve Air Quality   32
WMA Resolution on the Protection of Healthcare in Israel and Gaza   34
WMA Statement on Epidemics and Pandemics   34
WMA Resolution in support of the Turkish Medical Association   37
WMA Statement on Human Papillomavirus Vaccination   37
WMA Statement on Adolescent Suicide   39
WMA Resolution on Organ Donation in Prisoners   40
WMA Declaration of Kigali on the Ethical Use of Medical Technology   41
WMA Statement on Assisted Reproductive Technologies   43
WMA Resolution on the Revocation of WHO Guidelines on Opioid Use   45
WMA Guidelines on Promotional Mass Media Appearances by Physicians   46
Entering the Fourth Decade of Independence:
Post-Socialism Development of Mental Healthcare   47
Comparative Analysis of Healthcare Coverage Trends
in South Africa and Similar Middle-Income Countries   54
HIV/AIDS in South Africa: Understanding the Present to Strengthen Future Efforts   57
Navigating the Complex Labyrinth: Multifactorial Challenges
Experienced by Asian Junior Doctors in the Workplace   60
Climate Change and Children’s Health: An Overview and Call to Action   70
Enhancing One Health Communication in the Environmental Sciences   74
WMA Members Recognise International Doctors’ Day 78
Obituaries 91
WORLD MEDICAL ASSOCIATION OFFICERS,
CHAIRPERSONS AND OFFICIALS
Dr. Ashok PHILIP
President
Malaysia Medical Association
4th Floor, MMA House,
124 Jalan Pahang
53000 Kuala Lumpur
Malaysia
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Jack RESNECK
Chairperson,
Finance and Planning Committee
American Medical Association
AMA Plaza, 330 N. Wabash,
Suite 39300
60611-5885 Chicago, Illinois
United States
Dr. Jacqueline KITULU
President- Elect
Kenya Medical Association
KMA Centre, PO Box 48502,
Chyulu Road, 4th Floor, Upper Hill
Nairobi
Kenya
Dr. Tohru KAKUTA
Vice-Chairperson of Council
Japan Medical Association
113-8621 Bunkyo-ku, Tokyo
Japan
Dr. Zion HAGAY
Chairperson,
Socio Medical Affairs Committee
Israeli Medical Association
2 Twin Towers, 35 Jabotinsky St.,
P.O. Box 3566
52136 Ramat-Gan
Israel
Dr. Lujain ALQODMANI
Immediate Past President
Kuwait Medical Association
123 Fifth Avenue,
1202
Kuwait
Mr. Rudolf HENKE
Treasurer
German Medical Association
(Bundesärztekammer)
Herbert-Lewin-Platz 1
(Wegelystrasse)
10623 Berlin
Germany
Dr. Jacques de HALLER
Chairperson,
Associate Members
Swiss Medical Association
(Fédération des Médecins Suisses)
Elfenstrasse 18, C.P. 300
3000 Berne 15
Switzerland
Dr. Jung Yul PARK
Chairperson of Council
Korean Medical Association
Samgu B/D 7F 8F 40
Cheongpa-ro,
Yongsan-gu
04373 Seoul
Republic of Korea
Dr. Steinunn
THÓRDARDÓTTIR
Chairperson,
Medical Ethics Committee
Icelandic Medical Association
Hlidasmari 8
201 Kópavogur
Iceland
www.wma.net
OFFICIAL JOURNAL OF THE WORLD
MEDICAL ASSOCIATION
Editor in Chief
Dr. Helena Chapman
Milken Institute School of Public Health, George Washington University, United States
editor-in-chief@wma.net
Assistant Editor
Mg. Health. sc. Maira Sudraba
Latvian Medical Association
lma@arstubiedriba.lv, editor-in-chief@wma.net
Journal design by
Erika Lekavica
dizains.el@gmail.com
Publisher
Latvian Medical Association
Skolas Street 3, Riga, Latvia
ISSN 0049-8122
Opinions expressed in this journal – especially those in authored contributions –
do not necessarily reflect WMA policies or positions
3
Editorial
Editorial
BACK TO CONTENTS
Over the past year, our global medical community reflects on
the valuable contributions to clinical and surgical practice,
as shown through successful research initiatives, stakeholder
communication, and knowledge sharing and networking
at professional meetings. Physicians also recognise their
dedicated efforts to strengthen medical education and
training in clinical and community settings, where they
prepare medical trainees to identify and manage endemic and
emerging risks to population health. Hence, they understand
the urgent need to develop multidisciplinary collaborations
that incorporate novel data and technology and community
stakeholder engagement to examine the determinants of
health that influence global morbidity and mortality rates.
As we celebrate the 70th anniversary of the World Medical
Journal, we commend World Medical Association (WMA)
members who have published high-quality scientific articles
related to adhering to evidence-based clinical practices to
reduce risk of antimicrobial resistance, delivering medical
care in conflict settings, ensuring safe work environments,
exploring the use of novel technologies in education and
clinical care, and fostering training opportunities for health
professionals. In fact, three interviews with 12 national
medical association (NMA) presidents representing the
African, European, and Latin America and Caribbean regions
have presented strengths and existing challenges in medical
education and shared future perspectives toward strengthening
regional and international collaborations. Notably, WMA
members from 19 countries have contributed to workgroup
discussions at regional and global expert meetings over
the past 30 months, resulting in the unanimous adoption
of the revisions to the WMA Declaration of Helsinki at a
historical moment (60 years after the adoption of the original
declaration). They have also participated in scientific discourse
on emerging health risks at United Nations and World
Health Organization events, demonstrating the critical role of
physicians at these global meetings. As we reflect on these
WMA accomplishments, one question remains: How can
WMA members stimulate regional and global collaborations
that tackle medical education and training challenges across
our regions?
We recognise the Finish Medical Association for their
leadership to organize the 75th WMA General Assembly
in Helsinki, Finland, from 16-19 October 2024. The event
provided a timely opportunity for WMA members to discuss
and debate timely medical ethics and global health topics
and network with other NMAs. It is a tremendous honour
to share this issue of the World Medical Journal, where WMA
leadership presents the adoption of 14 WMA declarations,
guidelines, statements, and resolutions, ranging from epidemic
and pandemic preparedness to ethical use of medical
technology, at the 75th WMA General Assembly.
In this issue, Ms. Janice Blondeau summarised the event
proceedings, and Dr. Lujain Alqodmani and Dr. Ashok
Philipp shared their invigorating valedictory and inaugural
speeches on WMA milestones, respectively. Dr. Liene Sile,
Dr. Māris Taube, Ms. Zane Egle, and Ms. Linda Šeldere
provided a historical overview of mental healthcare services
in the post-socialism era. Dr. Michael Mncedisi Willie and
Mr. Mfana Maswanganyi prepared a comparative analysis
of healthcare coverage trends in South Africa and similar
middle-income countries. Dr. Mhlengi Vella Ncube presented
a brief overview of HIV/AIDS epidemic in South Africa.
Dr. Yujin Song, Dr. Wunna Tun, Dr. Merlinda Shazellenne,
Dr. Shiv Joshi, Dr. Minku Kang, Dr. Aravind Swamy, and
Dr. Poorvaprabha Patil highlighted workplace challenges
experienced by junior doctors in the Asia-Pacific region. Dr.
Cara Lembo, Dr. Daniel Mendoza, and Dr. Shana Godfred-
Cato underscored the effects of climate change on children’s
health. Finally, Dr. Helena Chapman and Dr. Muge Akpinar-
Elci described challenges and proposed best practices in using
the One Health concept to strengthen environmental health
communication.
Across the globe, WMA members are admired for their
daily contributions to medical practice, advocacy efforts to
increase awareness of inequalities and injustices, empathetic
listening and humanistic touch in patient care, and leadership
at national and international meetings. Their compassionate
service to patients’ health is exemplified by the words of Sir
William Osler: “The good physician treats the disease; the great
physician treats the patient who has the disease.” In this issue,
the German Medical Association and the Belgian Association
of Medical Unions prepared two obituaries that recognise the
scholarly achievements, caring nature, and passionate service
of Dr. Karsten Vilmar and Dr. Vincent Lamy, respectively.
Furthermore, WMA members representing 12 countries
of the African, Americas, Asian, European, and Pacific
regions shared perspectives and reflections on physicians’
indispensable role in caring for patients and communities,
as part of a commemoration to the International Day of the
Medical Profession and International Doctors’ Day.
We wish you and your families a healthy, restful, and reflective
holiday season, and we are excited to connect at the 229th
WMA Council Meeting in Montevideo!
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
editor-in-chief@wma.net
4
Distinguished colleagues, honoured
guests, and friends,
I remember one day my daughter
Yasmin, at just five months old, was
the reason for a major security alert
at the United Nations headquarters
in New York. We were there for the
multi-stakeholder consultation on
universal health coverage.
So, at the gate, the UN security
force had everything ready for
Michele, my husband, who would
be taking care of Yasmin while I
was on stage, but they didn’t have a
digital pass for my baby. “We’re not
used to having babies in the UN
premises,” they said, as if my tiny
Yasmin could pose a security threat
to the building. After a lot of back-
and-forth, and a few chuckles, we
finally made it inside. The whole
situation caused quite a stir, but in
the end, everyone smiled as they
saw her.
I remember breastfeeding her in the
nursing room, a surreal but tender
reminder that even amidst complex
negotiations and international
discourse, the most simple and
profound moments of care are what
connect us all.
My presidency journey hasn’t been
without its struggles. Navigating the
inherent gender imbalance within our
organisation-one that is still very
male-dominated-was challenging.
As only the fifth woman president
of the WMA, I was deeply aware
of the honour and responsibility of
representing so many others who
still lack a seat at the table.
We need to make leadership
accessible for women and mothers,
and create support structures and
leadership avenues that are gender
equal and accessible to all.
Let us establish more flexible
meeting arrangements, providing
childcare support during key
events, and creating mentorship
opportunities specifically targeted at
young women physicians.
These steps can ensure that the
voices of women are not just heard
but are leading the conversation.
Reflections on Achievements and
Challenges
Throughout my tenure, I have seen
both incredible progress but also
daunting challenges.
These challenges were a constant
reminder that we as physicians, as
leaders and as advocates for health,
must constantly challenge the status
quo.
We must transform the long-
standing systems to equal ones
that accommodate all with no
discrimination. I take pride in the
Leadership Through Mentorship
initiative that connects members of
our Junior Doctors Network with
the experience of our Past Leaders
Network, bridging generations to
create a continuum of learning
and growth. We also made great
strides through the Women-in-
Medicine Luncheon, creating a
space for mentorship, peer learning,
and celebrating women leaders in
organised medicine.
However, our advocacy did not stop
there.
We raised our collective voices
through open letters-one to
safeguard healthcare personnel
during conflicts and another urging
world leaders to divest away from
fossil fuel divestment on behalf of
46 million health professionals.
These were not mere formalities;
they were calls for action, for
safeguarding lives, and for
upholding our ethical duty to future
generations.
We faced resistance in implementing
some of these initiatives, but it was
through resilience, collaboration, and
unwavering belief in our mission
that we overcame these obstacles.
Current State of Global Healthcare
and Progress
The challenges facing global
healthcare today are immense.
Conflicts rage, climate change,
economic crises, and violations of
human rights continue.
We have not learned enough from
the devastations of the past, and
the world is more fragmented than
ever. Despite the shared experience
of COVID-19, we have yet to reach
a pandemic accord, and we still lag
behind on the Paris Agreement
and the Sustainable Development
Goals, including Universal Health
Coverage.
Lujain Alqodmani
Valedictory Speech by the WMA President, Dr. Lujain Alqodmani
Helsinki, Finland, 18 October, 2024
Valedictory Speech by the WMA President, Dr. Lujain Alqodmani
BACK TO CONTENTS
5
This year, healthcare has faced
immense dangers, with over 980
attacks reported by the WHO
surveillance system in areas such
as Lebanon, Ukraine, Sudan, and
Gaza.
Doctors from Kenya to Korea, the
UK to India, took to the streets
demanding safer working
environments. These are not isolated
incidents; they are cries for systemic
change, for respect, and for their
right to serve their moral duty.
During my tenure, we successfully
brought together stakeholders to
discuss safer working environments
for healthcare personnel, ensuring
healthcare system resilience to
climate change, and bringing
important voices to demand actions
to combat antimicrobial resistance.
We also played a role in fostering
international collaboration to
advance the goals of all the SDGs,
particularly the Universal Health
Coverage, ensuring that health
remains a right, not a privilege.
Core Reflections and Moral Duty
As physicians, our duty is not just
to our patients but to the health and
well-being of all. No matter how
bleak the world may seem, we must
not lose our passion for this moral
duty.
This GA is historic. Following a
long and extensive review process,
we have an updated draft of the
Declaration of Helsinki for your
approval. This document embodies
our commitment to integrity,
respect, and the highest standards
in medical ethics, reminding us
that our duty extends beyond
individual patients to the broader
advancement of health, and we
eagerly await its adoption.
Future Plans and Support for
Incoming Leadership
My journey is far from over.
I will continue advocating for gender
equality, for action on climate and
health, and for the rights of health
for all and the rights of physicians
everywhere. You will still see me
around-because there is still much
work to be done, and I am far from
finished.
To the incoming president, I offer
my wholehearted support. This is
not a solitary journey; it is one that
we walk together.
Acknowledgments and Thanks
I want to take a moment to thank
those who have been instrumental
during my presidency.
To the Executive Council, to
our Secretary General, and to
the Secretariat members–your
dedication and support have been
the backbone of our achievements.
To the National Medical
Associations (NMAs), associate
members and Junior Doctors
Network, thank you for your
unwavering support and for being
the pillars of our global efforts.
To my family, my friends, and
especially my mother, who is
here with me in Helsinki to care
for Yasmin, thank you for your
unending love and strength.
And to Michele, my husband, and
Yasmin – my travel companions and
my heart. Michele, thank you for
being my rock and all the sacrifices
you made to help me fulfil my role.
And to Yasmin, thank you for being
my little source of joy and for your
patience and presence throughout
this journey.
Calls to Action for Global Health
We live in a troubled world, with
more conflicts now than at any time
since 1944. The importance of our
call for peace cannot be overstated.
Speaking today, with representatives
from over 50 countries gathered
here in the form of NMAs, I see a
symbol of unity–a reminder of
what the world should strive to
be. Our strength lies in our shared
commitment, in our unity, and in
our determination to act, regardless
of the political complexities
involved.
I would like to leave you one final
message as this is the last time
I stand before you today as the
WMA President:
Let us continue to fight – for our
rights, for our safety, for the right
to a safe working environment,
and for the dignity of every
individual. The WMA must take
the lead in this fight and continue
to advocate for stronger health
protections, resilient healthcare
infrastructure, equal capacity
building opportunities and most
importantly right to health, and
right to healthy environment. Let
us be loud about our call to peace
as a public health priority and an
important determinant of health.
Let us be the voice that speaks
for those who cannot, and the hands
that heal those who are forgotten.
Thank you.
Lujain Alqodmani,
BMSc, MBBS, MIHMEP
Past President (2023-2024),
World Medical Association
lujainalq@gmail.com
Valedictory Speech by the WMA President, Dr. Lujain Alqodmani
BACK TO CONTENTS
6
My dear friends and colleagues, I
am very grateful to you for the
honour you have bestowed upon
me by allowing me to assume this
prestigious post. In particular, my
gratitude goes to my long-suffering
wife, Premah, and my somewhat
bemused children, Mira, Anila,
and Rohan. I would also like to
mention Andrew Gurman and Leah
Wapner, who helped to clarify my
mind about seeking this post. The
Presidents before me also helped me
make this decision. I also thank the
Malaysian Medical Association for
their nomination and support.
What I say now represents my
own views, but I believe many of
you, my colleagues, will hear my
words and recognise the problems
I speak of, and perhaps agree with
my sentiments. The issues that face
the profession are many and serious.
For instance, antimicrobial resistance
threatens to push us back to an age
when the slightest scratch or sniffle
might presage death. Climate change
has begun to affect our health
and may threaten the continued
thriving of our species and many
others. The security and future
development of the health workforce
faces challenges around the world.
Non-communicable diseases are
sweeping the world. The next
pandemic is coming. You will be
relieved to know that I have been
given 10 minutes to talk, so I must
set these topics aside for another
time.
Instead, I would like to focus on
another topic, which I believe is
fundamental to the entire practice of
medicine – professional autonomy.
We have all heard of it, we all want
it, we all have some restrictions
preventing us from having full
autonomy. To a greater or lesser
extent, I believe most of us feel it
is under threat. I agree with that
assessment.
Before we can discuss it, we
should define what we mean by
it. Professional autonomy means
primarily the freedom to make
clinical decisions about the care of
individual patients. This is what
most of us think of when we
mention autonomy, and in my
opinion, it is the aspect most under
threat. However, the right to have a
voice in health policy development
and healthcare system change is
also a part of professional
autonomy. These aspects are
perhaps not under such threat. The
WMA Declaration of Seoul goes
into great depth and detail about
why autonomy is important, and
I recommend this document to
you if you get into an argument or
discussion with administrators or
insurers.
Professional autonomy developed
and continues to exist because
it serves the interests not of the
profession but of the patients. We,
as doctors, wield this autonomy
for the benefit of patients, and we
stand in a fiduciary relationship
to them, always considering what
investigations, interventions, and
treatments are best for them – not
for us, the healthcare authority
or insurance company. If we let
this autonomy be taken away or
diminished, our patients will suffer
– and eventually everyone will be
a patient, so everyone will suffer.
When you are sick, the extra profit
that you made for your company,
the bigger bonus you got, the
political agenda you helped
advanced will not help you
when your doctor’s hands are
tied.
Why is autonomy threatened? A
major reason is that it is becoming
more and more expensive to treat
patients. In part, this is a result of
the success of medical science.
People live longer, so we have
an increasing pool of sick elderly
people who can be quite expensive
to manage.
Diseases that were impossible or
difficult to treat even a few decades
ago are now manageable, if not
curable. Unfortunately, though, these
new treatments are often extremely
expensive. Healthcare systems may
end up paying more and more to
treat fewer and fewer patients.
Financing these treatments will be
difficult whether the government
or private insurers do the paying.
When governments are the payers,
profit is not a consideration.
However, issues of accessibility and
rationing may arise, and again it is
our responsibility to bring evidence
to the table to help guide
policymakers in making their
decisions. We must also be alert
for the intrusion of political agendas
into healthcare.
When private enterprise pays for
medical care, the situation can be
Ashok Philip
Inaugural Address by the WMA President, Dr. Ashok Philip
Helsinki, Finland, 18 October, 2024
Inaugural Address by the WMA President, Dr. Ashok Philip
BACK TO CONTENTS
7
complicated by the profit motive.
This is not to disparage something
that has helped build the world,
but we should very carefully consider
if profit-seeking as seen in the
commercial arena should be allowed
free rein in medical situations.
Nobody chooses to get sick.
Patients have little choice but to
take the treatments available.
Allowing supply and demand to
set prices seems unkind, even cruel,
and may lead to some patients
not getting the treatments they
need. There must be guidelines,
independent of purely financial
considerations, to decide how
patients are treated, and these
guidelines must be drawn up by
doctors. Additionally, flexibility
to vary treatments and avenues
for appeal must be built in and
must be responsive. Ill health cannot
wait for five to seven working days.
Delivery of care has always involved
teams of healthcare professional led
by doctors. We have noticed
movements towards removing or
excluding doctors in some situations,
ostensibly to handle shortages of
doctors, but more obviously to
reduce costs. This is also an
abridgement of our autonomy and
must be resisted at all costs. Every
team member is valuable, but a
leaderless team is ineffective. The
natural leaders in healthcare should
be those who can look at the whole
picture, and that generally means
doctors. It is not in the best interests
of patients individually or systems
as a whole that doctors be removed
from their leadership roles.
We have not yet lost our professional
autonomy, but I believe the chains
to bind us are being forged. They
might be chains of gold, but they
will bind us none the less, and our
profession and our patients will
suffer. We must be on the alert.
Those seeking to bind us will do so
covertly, under the benevolent guise
of improving healthcare access. Let
us always look deeply into any such
moves, and let us always remain
involved in policy and guideline
development. It may be tedious and
take us away from direct patient
care, but in the long term it
protects our patients, and that is
what we have sworn to do.
Please note that I am not
advocating carte blanche for doctors
in everything. Our autonomy only
applies to the management of
patients, broadly construed. It must
be based on agreed professional
opinion. There may be varying
opinions, but these must rest
on sound scientific and ethical
foundations. Doctors are entitled to
their own opinions, of course, but
where they differ significantly from
the accepted professional view or
views, this must be made clear, and it
should be understood that the shield
of professional autonomy no longer
protects them in such a situation.
Where maverick doctors use
professional autonomy to advance
non evidence-based (or even anti
evidence-based) views, associations,
such as ours, must be prepared to
speak out and correct public
perceptions. If we hesitate to do so,
the public can rightly ask if it is
our patients or our colleagues who
are our priority.
I know I can count on every one of
you, as associations and individuals,
to do the right thing and lead the
way to a better future for our
patients, our communities and our
profession. I look forward to working
with you, in the next year and
beyond.
Thank you again, and to our hosts,
kiitos.
Ashok Philip,
MBBS, MRCP
President (2024-2025),
World Medical Association
ashokphilip17@gmail.com
Inaugural Address by the WMA President, Dr. Ashok Philip
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8
Information about the 229th WMA Council Session,
Montevideo 2025
Information about the 229th WMA Council Session, Montevideo 2025
BACK TO CONTENTS
Dear colleagues of the World Medical Association,
On behalf of the Sindicato Médico del Uruguay (SMU),
we cordially invite you to participate in the 229th
Council Session of the World Medical Association,
which will be held on 24-26 April 2025, in Montevideo,
Uruguay. The SMU is honored and humbled to serve as
the host for this event, and we know that the event will
be successful.
In addition to preparing an agenda of significant
themes relevant to our medical profession, including
diverse global health issues, rest assured that there will
be sufficient time to get to know and enjoy our city, its
culture, and its hospitality.
Please mark your calendars and join us in Montevideo
for this important event.
Sindicato Médico del Uruguay
Montevideo, Uruguay
secretaria@smu.org.uy
9
Information about the World Federation for
Medical Education Conference 2025
Information about the World Federation for Medical Education Conference 2025
BACK TO CONTENTS
We are thrilled to invite you to the World Federation
for Medical Education conference 2025, which will be
held in the vibrant city of Bangkok. Thailand, on 25-
28 May 2025. The conference will be organised in
cooperation with the Institute for Medical Education
Accreditation (IMEAc).
Mark your calendars, and stay tuned for more details
on registration, speakers, and programme highlights. For
more information, please visit the event website.
10
Information about the 17th World Conference in
Bioethics, Medical Ethics & Health Law
Information about the 17th World Conference in Bioethics, Medical Ethics & Health Law
BACK TO CONTENTS
Start Date: November 24, 2025
End Date: November 26, 2025
Location: Ljubljana, Slovenia
The International Chair in Bioethics (ICB), in
collaboration with the World Medical Association
Cooperating Centre, will host this prestigious event
covering bioethics, medical ethics, and health law in
Ljubljana, Slovenia, on 24-26 November 2025.
For more information, please visit the event website.
11
The 77th General Assembly of
the World Medical Association
(WMA), which took place in
Helsinki, Finland, from 16-19
October 2024, brought together
delegates from 46 National Medical
Associations (NMAs) (Photo 1).
Wednesday, 16 October
Council Session
The 227th Council Session was
called to order by the Chair of
Council, Prof. Jung Yul Park (Korean
Medical Association). The Secretary
General, Dr. Otmar Kloiber,
welcomed Prof. Steve Robson
(Australian Medical Association)
and Dr. Mary McCarthy (British
Medical Association), as newly
attending Council members.
The Council approved the Summary
Minutes of the 226th Council
Session held in Seoul, Republic of
Korea, from 18-20 April 2024. The
Secretary General informed the
Council that the members selected
for the Credentials Committee
were Dr. Wonchat Subhachaturas
(Medical Association of Thailand),
Dr. Philip Cathala (Conseil National
de l’Ordre des Médecins), and Dr.
Carlos Serrano (Brazilian Medical
Association), as three individuals
from constituent members covering
each of the three official WMA
languages: English, French, and
Spanish. Dr. Serrano was elected
Chairperson of this Committee. The
Council approved the appointment
of the Credentials Committee.
President’s Report
The Council received the report of
the WMA President, Dr. Lujain
Alqodmani (Kuwait Medical
Association), on her activities
from May to September 2024. Dr.
Alqodmani referred to her written
report, categorised according to the
key priorities of her presidency:
support for NMAs, relations with
the World Health Organization
(WHO), climate change, gender
equality, universal health coverage,
and safety of healthcare personnel
and facilities in conflicts.
Dr. Alqodmani spoke to two specific
priorities. Firstly, she thanked
NMAs who responded to the
survey initiated by the International
Federation of Medical Students’
Associations (IFSMA) intern to
the WMA Secretariat, Ms. Matilda
Sabljak, on women’s presence in
leadership positions in NMAs. She
noted that the results of the survey
would be announced at the Women
in Medicine lunch on Saturday, 19
October. Secondly, Dr. Alqodmani
outlined WMA’s work on the
climate and health agenda with
several civil society organisations,
particularly regarding the COP30
which will be held in Brazil in
November 2025. She stated that
this will be a key moment to ensure
that the Paris Agreement targets
(including the 1.5°C target) are not
missed.
In closing, Dr. Alqodmani said
that the past six months of her
Presidency have included intense,
enriching experiences with engaging
dialogues, networking opportunities,
and collaborative ventures,
showcasing the impactful work of
the WMA to the global community.
She thanked the Secretary General
and the WMA Secretariat staff for
their support during her leadership
term in office.
Secretary General’s Report
The Council received the oral
report of the Secretary General
to the Council, complementing
the written Council Report. Dr.
Kloiber stated that the WMA
had two opportunities this year
to be part of the health section of
the Organization for Economic
Co-operation and Development
(OECD) surveys, as OECD
makes extremely influential
recommendations concerning
the structuring of health policies
and health systems. The first and
second surveys focused on artificial
intelligence and the financialisation
of outpatient services, respectively.
Dr. Kloiber urged WMA members
to take advantage of opportunities
(like these surveys) to have our
voices heard in the international
health agenda setting.
Dr. Kloiber also said that there
would be a special session on Friday,
18 October, on health workforce
migration, a topic which is at the
heart of the collaborative work
between the WMA and WHO.
He reminded WMA members that
updates on WMA external activities
and international policies will be
presented on Saturday, 19 October,
during the General Assembly
plenary session.
Janice Blondeau
WMA General Assembly Report
Helsinki, Finland, 16-19 October 2024
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Chair of Council’s Report
The Council received the report by
the WMA Chair of Council from
May to September 2024. Prof. Park
referred to his written report, noting
the many local and global challenges
that WMA members face, such as
violence against health professionals,
climate change, achieving universal
health coverage, racism and
other human rights abuses, and
polarisation. He urged WMA
members to continue to tackle
these challenges with determination
and collective wisdom. He called
on more junior doctors to come
together within the larger WMA
family, saying that together we can
make a stronger future.
The Council meeting was adjourned.
Finance and Planning Committee
Dr. Jack Resneck Jr., Chair of the
Finance and Planning Committee,
called the meeting to order and
welcomed the committee members.
He advised that the committee
would follow the same voting
procedure as the Council. The
committee approved the report of
the previous meeting held in Seoul
in April 2024.
Financial Statements
The committee agreed that the
Audited Financial Statement for
2023 be approved by the Council
and forwarded to the General
Assembly for adoption, and that
the proposed WMA Budget for
2025 be approved by the Council
and forwarded to the General
Assembly for adoption. The
committee received the WMA
Dues Categories 2025 document,
which would be forwarded to the
General Assembly for information.
The committee considered the
oral report of the Finance Group,
which met on 15 October. Prof.
Jung Yul Park, Chair of the Finance
Group, reported that the group
had a comprehensive discussion
on the WMA’s financial situation.
The committee recommended that
the Council appoint KPMG as
the auditor of the 2024 WMA
Financial Statement.
WMA Strategic Plan
Dr. Kloiber reported that current
activities are in line with the WMA
Strategic Plan for 2020-2025. The
Finance and Planning Committee
Chair stated that there will be a
dedicated open session, as part of
the next strategic planning session,
for a more inclusive planning
process.
WMA Statutory Meetings
Dr. José Minarrieta (Sindicato
Médico del Uruguay) extended an
invitation to all members to attend
the Council Session in April 2025
in Montevideo, Uruguay. Prof.
Alberto Caldas Afonso (Portuguese
Medical Association) extended an
invitation to all members to attend
the General Assembly in October
2025 in Porto, Portugal.
WMA Special Meetings
Dr. Kloiber thanked member
associations and individuals who
have engaged in the process of
the revision of the Declaration of
Helsinki (DoH). He thanked WMA
partner organisations and ethics
advisers, who provided invaluable
help and input to the process. He
highlighted the contributions of
those who hosted the series of
regional meetings, especially the
American Medical Association, Dr.
Jack Resneck Jr. and his office team,
who worked tirelessly stemming
this huge task in an outstandingly
transparent, open, and respectful
manner.
Membership
The committee recommended that
the Hungarian Medical Chamber
(HMC) be admitted to the WMA
Constituent Membership.
Associate Membership
The committee received the Report
of the WMA Associate Membership
2023 and the Report of Chair of
Associate Members, presented by
Dr. Jacques de Haller, Chair of the
Associate Members.
The committee received the Report
of the Junior Doctors Network
(JDN) presented by Dr. Sazi
Nzama (Associate Member from
South Africa), on behalf of Dr.
Marie-Claire Wangari (Associate
Member from Kenya), outgoing
JDN Chair. Dr. Resneck Jr., FPL
Chair, congratulated Dr. Pablo
Estrella Porter, the newly elected
JDN Chair, on his election, and
thanked Dr. Wangari and her team
for their term contributions.
The committee received the Report
of the Past Presidents and Chairs
of Council Network (PPCN)
presented by Dr. Kati Myllymäki
(Finnish Medical Association),
PPCN Chair. Dr. Myllymäki stated
that the database of the PPCN
expertise is available at the WMA
Secretariat, and it can be shared
when needed by the members. Dr.
Jón Snædal (Associate Member
from Iceland) reported that he had
met with junior doctors as part of
the mentorship program between
the JDN and the PPCN, and that
the group will have an in-person
meeting on 18 October in Helsinki.
Dr. Kloiber thanked all these
voluntary activities from the
individual members.
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Review Committee
The committee received the report
from the Chair of the Review
Committee, Ms. Elizabeth LaRocca
(American Medical Association).
Rules Applicable to WMA Associate
Membership
The committee considered the
proposed revisions of the Rules
Applicable to WMA Associate
Membership, presented by Dr.
Kloiber and Dr. de Haller, and
recommended that these revisions
be approved by the Council and
forwarded to the General Assembly
for adoption.
World Medical Journal
The committee received the World
Medical Journal (WMJ) Report by
the WMJ Assistant Editor, Ms.
Maira Sudraba (Latvian Medical
Association). Ms. Sudraba spoke
on behalf of the WMJ Editor-
in-Chief, Dr. Helena Chapman,
thanking contributors to the most
recent issues of the journal and
encouraging members to actively
share their ideas and articles for
future issues.
Public Relations
The committee received the Public
Relations Report by the WMA
Communications and Media
Consultant, Ms. Janice Blondeau.
Ms. Blondeau encouraged members
to use the WMA communications
materials for their own advocacy
and media activities.
Medical Ethics Committee
The Chair called the meeting
to order and welcomed the
new Committee Members. The
committee approved the report of
the previous meeting held in Seoul,
Republic of Korea.
Declaration of Helsinki
The committee considered the
proposed revision of the WMA
Declaration of Helsinki. Dr.
Steinnun Thordardottir (Icelandic
Medical Association), Chair of the
MEC committee, thanked everyone
involved for their contributions.
Dr. Jack Resneck Jr. (American
Medical Association), Chair of
the workgroup, thanked all the
members of the workgroup, the
WMA constituent members who
have hosted the regional and topical
meetings, external experts, and
especially his American Medical
Association team. He highlighted
the main principles of the
Declaration, which were discussed
during the revision process and
the reasoning for the suggested
amendments. The committee
recommended that the revision of
the proposed WMA Declaration
of Helsinki be approved by the
Council and be forwarded to the
General Assembly for adoption.
Assisted Reproductive Technologies
The committee considered the
proposed revision of the WMA
Statement on Assisted Reproductive
Technologies and comments. The
committee recommended that the
proposed WMA Statement on
Assisted Reproductive Technologies
be approved by the Council and be
forwarded to the General Assembly
for adoption.
Ethical Guidelines for the
International Migration of Health
Workers
The committee considered the
proposed major revision of the
WMA Statement on Ethical
Guidelines for the International
Migration of Health Workers.
The committee recommended that
the WMA Statement on Ethical
Guidelines for the International
Migration of Health Workers,
as amended, and be circulated to
constituent members for comments.
Conflict of Interest
The committee considered the
proposed minor revision of the
WMA Statement on Conflict
of Interest. The committee
recommended that in view of the
large number of amendments, the
proposed revision of the WMA
Statement on Conflict of Interest be
considered a major revision, and that
the German Medical Association
would be the rapporteur.
Promotional Mass Media Appearance
by Physicians
The committee considered the
proposed minor revision of the
WMA Statement on Promotional
Mass Media Appearance by
Physicians. The committee
recommended that the proposed
revision of the WMA Statement
on Promotional Mass Media
Appearance by Physicians be sent to
the Council for approval and to the
General Assembly for information.
New Items
Medical Neutrality
The committee considered
the WMA Statement on the
Protection of Medical Neutrality
in Times of Armed Conflict and
other Situations of Violence. The
committee recommended that the
proposed WMA Statement on the
Protection of Medical Neutrality
in Times of Armed Conflict and
other Situations of Violence be
circulated to constituent members
for comments.
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WMA Human Rights
The committee received the Report
of the Council to the General
Assembly, Helsinki 2024.
Socio-Medical Affairs Committee
The meeting was called to order
by the Chair of the Socio-Medical
Affairs Committee (SMAC). The
committee approved the report of
the previous meeting of the Socio-
Medical Affairs Committee held in
Seoul, South Korea, in April 2024.
Health and Environment
The committee received the
report from Dr. Yassen Tcholakov
(Associate Member from Canada),
in the absence of the Chair of the
Workgroup on Environment and
Associate Member, Dr. Ankush
Bansal. The workgroup has been
active since the 226th Council
meeting in April in Seoul, and
members have coordinated two
virtual meetings.
Global Advocacy
At the World Health Assembly,
in collaboration with other
international health stakeholders,
the workgroup members and JDN
successfully advocated for the
adoption of a resolution on actions
related to climate change and health.
In September 2024, the WMA
President, Dr. Lujain Alqodmani,
was present at New York Climate
Week in conjunction with the
79th UN General Assembly and
represented the WMA on several
climate-related issues.
In November 2024, the WMA
plans to have a delegation of five
members attending the meeting of
COP29 in Baku, Azerbaijan.
In March 2025, Dr. Alqodmani will
represent the WMA at the Second
WHO Conference on Air Pollution
and Health in Cartagena, Colombia.
The workgroup started a thorough
review of the WMA policies
on environment and health,
particularly mapping these
policies for duplication, revision
or replacement with the help of
Ms. Sabljak, IFMSA intern to the
WMA Secretariat. The goal of the
workgroup is to review these policies
over the next several months to
present to this committee in future
Council meetings.
Medical Technology
The committee received the report
of Dr. Jesse Ehrenfeld (American
Medical Association), in the
absence of Dr. Leah Wapner
(Israeli Medical Association), Chair
of the workgroup on Medical
Technology. The workgroup is
currently planning a webinar series
on artificial intelligence, which will
begin by focusing on some key areas
of its application in medicine.
The workgroup is planning to
propose a revision of the WMA
Statement on Augmented
Intelligence in Medical Care. The
workgroup aims to have a draft
revision to submit at the next
Council Meeting in April 2025.
The OECD conducted a survey
of WMA members on artificial
intelligence and the healthcare
workforce in 2023, and the report
of the survey is available on the
website (https://www.oecd.org/en/
publications/artificial-intelligence-
and-the-health-workforce_9a31d8af-
en.html). As part of this research,
the OECD Digital Health division
is organising a follow-up webinar
by early November 2024, and is
seeking physicians with experience
in the field of artificial intelligence
as webinar panelists.
Epidemics and Pandemics
The committee considered the
proposed revision of the WMA
Statement on Epidemics and
Pandemics and comments. The
committee recommended that the
proposed revision of the WMA
Statement on Epidemics and
Pandemics, as amended, be approved
by the Council and forwarded to
the General Assembly for adoption.
Air Pollution
The committee considered the
proposed revision of the WMA
Declaration on Prevention and
Reduction of Air Pollution to
Improve Air Quality and comments.
The committee recommended
that the proposed revision of the
WMA Declaration on Prevention
and Reduction of Air Pollution to
Improve Air Quality, as amended,
be approved by the Council and
forwarded to the General Assembly
for adoption.
Adolescent Suicide
The committee considered
the proposed (minor) revision
of the WMA Statement on
Adolescent Suicide. The committee
recommended that the proposed
revision of the WMA Statement
on Adolescent Suicide, as amended,
be approved by the Council and
forwarded to the General Assembly
for information.
Abuse of the Elderly
The committee considered the
proposed (minor) revision of
WMA Declaration of Hong Kong
on the Abuse of the Elderly. The
committee recommended that the
proposed revision of the WMA
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Declaration of Hong Kong on the
Abuse of the Elderly, as amended,
be approved by the Council and
forwarded to the General Assembly
for information.
Support of the Turkish Medical
Association
The committee considered the
proposed (minor) revision of
WMA Resolution in support of
the Turkish Medical Association.
The committee recommended that
the proposed revision of the WMA
Resolution in support of the Turkish
Medical Association, as amended,
be approved by the Council and
forwarded to the General Assembly
for information.
WHO Guidelines on Opioid Use
The committee considered the
proposed (minor) revision of
the WMA Resolution on the
Revocation of WHO Guidelines
on Opioid Use. The committee
recommended that the proposed
revision of the WMA Resolution on
the Revocation of WHO Guidelines
on Opioid Use be approved by
the Council and forwarded to the
General Assembly for information.
Non-Discrimination in Professional
Membership
The committee considered the
proposed (minor) revision of
the WMA Statement on Non-
Discrimination in Professional
Membership. The committee
recommended that the proposed
revision of the WMA Statement
on Non-Discrimination in
Professional Membership, as
amended, be approved by the
Council and forwarded to the
General Assembly for information.
Mental Health of Physicians
The committee considered the
proposed revision of the WMA
Statement on Specific Care for
the Mental Health of Physicians
and comments. The committee
recommended that the proposed
revision of the WMA Statement on
Specific Care for the Mental Health
of Physicians and comments be
circulated within the membership
for further comments.
Aging Physicians
The committee considered the
proposed revision of the WMA
Resolution on Aging Physicians
and Comments. The committee
recommended that the proposed
revision of the WMA Resolution on
Aging Physicians, as amended, be
circulated within the membership
for further comments.
Task Shifting
The committee considered the
proposed (major) revision of
WMA Resolution on Task Shifting
from the Medical Profession. The
committee recommended that the
proposed revision of the WMA
Resolution on Task Shifting
from the Medical Profession be
circulated within the membership
for comments.
Physicians’ Well-Being
The committee considered the
proposed (major) revision of the
WMA Statement on Physicians’
Well-Being. The committee
recommended that the proposed
revision of the WMA Statement
on Physicians Well-Being be
circulated within the membership
for comments. As part of the
consultation process, the committee
recommended that the rapporteur
of the proposal (American Medical
Association) coordinate with the
rapporteur of the proposed WMA
Statement on Specific Care for
the Mental Health of Physicians
(Spanish Medical Association),
to avoid duplication and ensure
consistency between the two texts.
Health Support to Street Children
The committee considered the
proposed (major) revision of the
WMA Statement on Providing
Health Support to Street Children.
The committee recommended that
the proposed revision of the WMA
Statement on Providing Health
Support to Street Children, as
amended, be circulated within the
membership for comments.
Obesity
The committee considered the
proposed revision of the WMA
Statement on Obesity, as merging
the WMA Statements on Obesity
in Children and on the Physician’s
Role in Obesity). The committee
recommended that the proposed
revision of the WMA Statement on
Obesity, as amended, be circulated
within the membership for
comments.
Reproductive Health
The committee considered the
proposed revision of the WMA
Statement on the Protection of
Reproductive Health Rights of
Women and Girls, which extends
the scope of the WMA Resolution
on Legislation against Abortion
in Nicaragua to reproductive
health worldwide. The committee
recommended that the proposed
revision of the WMA Statement
on the Protection of Reproductive
Health Rights of Women and Girls
be circulated within the membership
for comments.
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Vitamin D Insufficiency
The committee considered the
proposed (major) revision of the
WMA Statement on Vitamin
D Insufficiency. The committee
recommended that the proposed
revision of the WMA Statement
on Vitamin D Insufficiency be
circulated within the membership
for comments.
Aging
The committee considered the
proposed (minor) revision of the
WMA Statement on Aging. In view
of the large number of amendments,
the committee recommended that
the proposed revision of the WMA
Statement on Aging be considered
as a major revision and be circulated
to members for comments.
Aesthetic Treatment
The committee considered the
proposed (minor) revision of the
WMA Statement on Aesthetic
Treatment. In view of the large
number of motions to amend, the
committee recommended that the
proposed revision of the WMA
Statement on Aesthetic Treatment,
as amended, be considered as a
major revision and be circulated to
members for comments.
Global Medical Electives
The committee considered
the proposed (minor) revision
of the WMA Statement on
Ethical Considerations in Global
Medical Electives. The committee
recommended that the proposed
revision of the WMA Statement on
Ethical Considerations in Global
Medical Electives, as amended,
be considered as a major revision
to be circulated to members for
comments, and that the advisor to
the committee, Dr. Caline Mattar,
serve as rapporteur for this proposed
revision.
Transgender People
The committee received the oral
report from the German Medical
Association, as rapporteur, on the
revision of the WMA Statement on
Transgender People. The German
Medical Association has held
discussions with experts in this field
over the last few months and plans
to submit a proposal for revision to
the next Council meeting in April
2025. They invited WMA members
wishing to contribute to the revision
to join an informal group to discuss
the draft proposal. The medical
associations from the following
countries expressed interest: France,
Tunisia, United Kingdom, United
States, and Uruguay, as well as
Associate Members.
New Items
Nuclear Weapons
The committee considered the
proposed revision of the WMA
Statement on Nuclear Weapons.
The committee recommended that
the proposed revision of the WMA
Statement on Nuclear Weapons
be circulated to members for
comments.
Plastics and Health
The committee considered the
proposed revision of the WMA
Resolution on Plastics and Health.
The committee recommended
that the proposed revision of the
WMA Resolution on Plastics and
Health be circulated to members for
comments. In view of the upcoming
intergovernmental meeting in
November 2024, to develop an
international instrument on plastic
pollution, the Kuwait Medical
Association and the Royal Dutch
Medical Association submitted an
urgent motion for a resolution to
the Council Plenary Session on
Friday, 18 October, to enable the
WMA to advocate on the impact
of plastics on health and the role of
plastic products in the health sector.
Thursday, 17 October
Associate Members Meeting
The Plenary Meeting of the WMA
Associate Members was called to
order by the Chair, Dr. Jacques
de Haller. The Chair announced
that Dr. Ankush Bansal had sent
apologies for his absence. The
minutes of the previous report and
the report on Associate Membership
for 2023 were approved.
Elections
Election (via mail) of a Member
of the Steering Committee (Student
Member-at-large)
The Chair informed the Associate
Members that the election of
the Student Member to the
Steering Committee took place
electronically in September 2024,
under the supervision of the
WMA Legal Advisor. Mr. Eugene
Opiyo (Associate Member from
Kenya) was elected as the Student
Member-at-large.
Election of a Member of the
Steering Committee (Independent
Member-at-large)
The Associate Members received
applications from three candidates:
Dr. Mahesh Bhatt (India), Dr.
Parth Patel (Malawi), and Dr.
Natalia Solenkova (United States).
Dr. Natalia Solenkova was elected
to the Steering Committee as an
Independent Member-at-large.
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Reports
The Associate Members received
the reports of the Chair of Associate
Members, JDN, and PPCN, as
well as the reports from Associate
Members active in WMA taskforces
and workgroups:
• Workgroup on Environment,
reported by Dr. Yassen Tcholakov,
in the absence of the Chair of the
workgroup, Dr. Ankush Bansal
• Workgroup on the Revision of
the Declaration of Helsinki,
reported by Dr. Natalia Solenkova
• Workgroup on Epidemics and
Pandemics, reported by Dr.
Yassen Tcholakov
• Dr. Caline Mattar outlined
the WMA’s activities on
antimicrobial resistance over the
past year
Rules Applicable to WMA Associate
Membership
The Chair of Associate Members
reported that the proposed revision
of the Rules Applicable to WMA
Associate Membership had been
considered the previous day by the
Finance and Planning Committee.
The committee had recommended
that the Council approve the
revision at its next plenary session
on 18 October, and forward it to
the General Assembly for adoption.
Assembly Business
The Associate Members elected
Dr. Julie Bacqué and Dr. Yassen
Tcholakov, by acclamation as
representatives to the WMA
General Assembly 2024, as well
as Dr. Pablo Estrella Porter as
alternate. The Associate Members
thanked Dr. Ankush Bansal for his
major contribution to the work of
the Steering Committee during the
past year.
Other Business
Associate Members had a follow-
up discussion on the Statement on
Registration fees adopted by the
Steering Committee last Spring
and sent to the WMA Secretary
General. The Chair concluded that
the Plenary Meeting supported
further action by the Steering
Committee.
The Associate Members thanked
Dr. Brenda Obondo (Kenya Medical
Association) and Dr. Helen Gofwan
(Associate Member from Nigeria)
for their important contribution as
members of the Associate Members
Steering Committee for the term
2023-2024.
Scientific Session
The Scientific Session incorporated
the topic, “Inequalities in health and
healthcare – How to tackle them?”
Opening remarks were given by
the WMA President, Dr. Lujain
Alqodmani, while the President of
the Finnish Medical Association,
Dr. Niina Koivuviita, gave welcome
and introductory words.
In his keynote speech, the WMA
Past President, Sir Michael Marmot,
presented the topic, “Social justice
and health equity.” Prof. Marmot
examined the questions of the
global context for health equity, the
Commission on Social Determinants
of Health conceptual framework, the
context in the United Kingdom over
time, and England’s widening health
gap. He spoke about inequalities
in mortality and social inequalities
in mortality rates in various
countries and areas. The impacts
of the COVID-19 pandemic on
life expectancy in various regions
were also examined. He illustrated
concrete actions that have been
implemented with partnerships
and cooperation between local
government, healthcare providers,
public services, business and
the private sector, and national
governments and institutions.
Following the keynote speech,
panel discussions addressed relevant
topics for WMA members. The
first panel session was moderated
by Dr. Juha Mikkonen, the
Executive Director of the Finnish
Association for Substance Abuse
Prevention (EHYT), highlighting
the topic, “How can prevention
provide more equity in healthcare?”
The first panelist, Prof. Dr. Carlos
Vicente Serrano Jr., Director of
International Relations of the
Brazilian Medical Association,
presented the topic, “How can
prevention and primary healthcare
provide more equity in healthcare?”
Next, Dr. Koji Watanabe, Executive
Board Member of the Japan
Medical Association, described the
theme, “Health checkup system in
Japan – Contributing to equity on
healthcare”. The final panelist, Dr.
Sofia Rydgren Stale, President of
the Swedish Medical Association,
discussed the topic, “How to bring
equitable access to maternal and
new-born care – The Swedish
experience”.
The second panel session was
moderated by Dr. Ashok Philip
(Malaysian Medical Association),
the WMA President-Elect,
addressing the topic, “Advancements
in healthcare – how to make access
to health care more equitable?”
The first speaker was Dr. Markku
Satokangas, Senior Researcher,
Finnish Institute for Health and
Welfare, who presented the subject,
“Structural inequities in the Finnish
health system: Universal coverage
but parallel pathways to care”.
Next, Dr. Diana Marion Secretary
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General of the Kenya Medical
Association, explored the theme,
“The evolution of health financing
in Kenya: A transformative journey
towards health equity”. The final
panelist, Dr. Jesse Ehrenfeld, Past
President of the American Medical
Association, spoke on “Techquity:
Enabling health equity through
innovation”.
The third panel session was
moderated by Dr. Muha Hassan,
WMA Associate Member and JDN
member, examining the topic, “How
to mitigate the effects of climate
change on inequalities?”. After Dr.
Lujain Alqodmani, WMA President,
presented the introduction, an open
discussion was held with three
panelists: Dr. Hector M. Santos Jr.,
President of the Philippine Medical
Association, Dr. Stephen Robson,
Immediate Past President of the
Australian Medical Association, and
Dr. Mvuyisi Mzukwa, Chairperson
of the South African Medical
Association.
Concluding remarks of the scientific
session were given by Dr. Janne
Aaltonen, CEO of the Finnish
Medical Association.
Friday, 18 October
Briefing Session on Human
Resources for Health
Dr. Caline Mattar, WMA
Advisor,​and Dr. Julia Tainijoki,
WMA Senior Medical Advisor,
presented this session, outlining
the importance of engagement in
the Human Resources for Health
(HRH) ​agenda​. They described
the global policy scene for HRH
and opportunities for engagement
through the WMA. Specifically,
they highlighted the WMA
Migration project, which aims to
provide national perspectives from
physicians on physician migration,​
which is largely absent from global
conversations​. Through country
case studies​and data collection
via an online form, the report will
inform key advocacy messages for
WMA. They encouraged NMAs to
participate in this project.
Main Meeting of the 227th
Council Session
The Council reconvened to
consider the reports of the Standing
Committees.
Item to be considered as a Matter
of Urgency
Plastic and Health
The Council considered and
approved the proposed urgent
Resolution on Plastics and Health
and forwarded it to the General
Assembly for adoption.
Committee Reports
The Council agreed to use a consent
calendar to consider the Committee
reports.
Medical Ethics Committee
The Council considered the report
of the Medical Ethics Committee.
No items were extracted, and the
Council approved the report.
Items approved via the Consent
Calendar:
Declaration of Helsinki
The proposed revision of the
WMA Declaration of Helsinki
was approved and forwarded to the
General Assembly for adoption.
Assisted Reproductive Technologies
The proposed revision of the
recommendation 14 of the WMA
Statement on Assisted Reproductive
Technologies was approved and
forwarded to the General Assembly
for adoption.
Promotional Mass Media Appearance
by Physicians
The proposed (minor) revision
of the WMA Statement on
Promotional Mass Media
Appearance by Physicians was
approved and forwarded to the
General Assembly for information.
The following documents are to be
circulated within the membership
for comments:
• WMA Statement on Ethical
Guidelines for the International
Migration of Health Workers
• WMA Statement on the
Protection of Medical Neutrality
in times of Armed Conflict and
Other Situations of Violence
• WMA Statement on Conflict of
Interest
Finance and Planning Committee
The Council considered the Report
of the Finance and Planning
Committee. Items on WMA Budget
and Membership Dues Payments
were extracted for individual
consideration. All the other items
were accepted, and the Council
approved the report.
Items approved via the Consent
Calendar:
Financial Statement
The Audited Financial Statement
for 2023 was approved and
forwarded to the General Assembly
for adoption.
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WMA Budget and Membership Dues
Payments
The Council approved the waiver
of the membership dues of the
Myanmar Medical Association
(MMA) and the Ukraine Medical
Association (UMA) for the year
2023 and forwarded it to the
General Assembly for approval.
The Council approved the increase
of the membership dues rates for all
categories over a three-year term, i.e.
increase in 2025 by 2.5%, then in
2026 by 2.5% and in 2027 by 2.5%,
and forwarded it to the General
Assembly for approval.
Auditor
The Council appointed KPMG
as the auditor of the 2024 WMA
Financial Statement.
Constituent Membership
The Council approved the
Hungarian Medical Chamber
(HMC)’s admission to the WMA
Constituent Membership and
forwarded it to the General
Assembly for approval.
Rules Applicable to WMA Associate
Membership
The Council approved the proposed
revisions of the Rules Applicable
to WMA Associate Membership
and forwarded them to the General
Assembly for adoption.
Socio-Medical Affairs Committee
The Council considered the Report
of the Socio-Medical Affairs
Committee. Items on Adolescent
Suicide and Plastics and Health
were extracted for individual
consideration.
Adolescent Suicide
The proposed (minor) revision of
the WMA Statement on Adolescent
Suicide, as amended, was approved
and forwarded to the General
Assembly for information.
Plastics and Health
The proposed WMA Resolution on
Plastics and Health was withdrawn
by the proposer. The Kuwait
Medical Association and the Chair
of Council accepted it.
All the other items were accepted,
and the Council approved the report.
Items approved via the Consent
Calendar:
Epidemics and Pandemics
The proposed revision of the
WMA Statement on Epidemics
and Pandemics was approved and
forwarded to the General Assembly
for adoption.
Air Pollution
The proposed WMA Declaration
on Prevention and Reduction of Air
Pollution to Improve Air Quality
was approved and forwarded to the
General Assembly for adoption.
Support of the Turkish Medical
Association
The proposed (minor) revision of
the WMA Resolution in support
of the Turkish Medical Association
was approved and forwarded to the
General Assembly for information.
Abuse of the Elderly
The proposed (minor) revision of
the WMA Declaration of Hong
Kong on the Abuse of the Elderly
was approved and forwarded to the
General Assembly for information.
WHO Guidelines on Opioid Use
The proposed (minor) revision
of the WMA Resolution on the
Revocation of WHO Guidelines
on Opioid Use was approved and
forwarded to the General Assembly
for information.
Non-Discrimination in Professional
Membership
The proposed (minor) revision of
the WMA Statement on Non-
Discrimination in Professional
Membership was approved and
forwarded to the General Assembly
for information.
The following documents were
approved to be circulated within the
membership for further comments:
• The proposed WMA Statement
on Specific Care for the Mental
Health of Physicians
• The proposed WMA Resolution
on Aging Physicians
• The proposed WMA Statement
on Obesity
• The proposed WMA Statement
on the Protection of Reproductive
Health Rights of Women and
Girls
• The proposed revision of the
WMA Statement on Nuclear
Weapons
• The proposed (major) revision
of the WMA Statement on
Physicians’ Well-Being
• The proposed (major) revision
of the WMA Statement on
Providing Health Support to
Street Children
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• The proposed (major) revision of
the WMA Statement on Vitamin
D Insufficiency
• The proposed (major) revision
of the WMA Resolution
on Task Shifting from the
Medical Profession. As part
of the consultation process,
the rapporteur of the proposal
(American Medical Association)
should coordinate with the
rapporteur of the proposed
WMA Statement on Specific
Care for the Mental Health of
Physicians (Spanish Medical
Association), to avoid duplication
and ensure consistency between
the two texts.
• The proposed revision of the
WMA Statement on Aging be
considered as a major revision
• The proposed revision of the
WMA Statement on Aesthetic
Treatment be considered as a
major revision
• The proposed revision of the
WMA Statement on Ethical
Considerations in Global Medical
Electives be considered as a major
revision with Dr. Caline Mattar,
advisor to the committee, as the
rapporteur.
World Veterinary Association Address
Dr. John De Jong, President of
World Veterinary Association,
gave his presentation, which was
originally scheduled on 19 October.
The Chair asked for the volunteer
rapporteurs on the WMA
Statement on Aging and the WMA
Statement on Aesthetic Treatment,
to be considered as major revisions,
as stated in the Socio-Medical
Affairs Committee report. Although
there were no confirmed volunteers
during the Council meeting,
Associate Members and the Swedish
Medical Association volunteered to
serve as rapporteurs for the WMA
Statement on Aging and the WMA
Statement on Aesthetic Treatment,
respectively.
The Secretary General informed the
Council that the translations of the
Declaration of Helsinki into French
and Spanish will be finalised after
the adoption of the English version.
It would take some time since they
will be circulated to the French-
and Spanish-speaking members, to
ensure the translations are consistent
with the adopted English version.
Dr. Jacques de Haller informed
that Dr. Sebnem Fincanci, former
President of the Turkish Medical
Association, has been nominated as
one of the supported human rights
activists for the European continent
in a campaign by Amnesty
International. This campaign will
start on 10 December, recognised
as Human Rights Day, and Dr. de
Haller asked for support from the
WMA membership.
Ceremonial Session
The Assembly Ceremonial Session
at the Scandic Marina Congress
Center was called to order by
the WMA President, Dr. Lujain
Alqodmani (Kuwait Medical
Association).
Dr. Otmar Kloiber, the WMA
Secretary General, introduced the
official delegations from each of the
46 constituent members present,
as well as the observers from the
non-member medical associations
and international organisations.
Reverend Ramón Goyarrola Belda,
the Bishop of the Diocese of
Helsinki, was welcomed as a special
guest.
Then, Dr. Niina Koivuviita,
President of the Finnish Medical
Association, extended a warm
welcome to WMA leadership,
colleagues, and distinguished guests.
She stated that the health sector’s
capacity to address current and
future challenges is deeply rooted
in medical research, development,
and innovation. Highlighting the
importance of public trust and a
positive attitude toward clinical
research, Dr. Koivuviita referred to
the Declaration of Helsinki, which
has guided ethical standards for
medical research involving humans
for six decades. She emphasised
that ethical guidelines in medical
research must remain steadfast
in protecting individuals while
adapting to an evolving global
landscape. She highlighted that the
significance of medical research and
innovation lies in the benefits they
deliver. Concluding her remarks,
Dr. Koivuviita underscored the
importance of close collaborations
and information sharing to
transform these advancements into
improved care and health outcomes
for everyone.
Next, at the start of his address, the
Honorable Mr. Alexander Stubb,
President of Finland, welcomed
attendees of the General Assembly
to Finland and to Helsinki. He
noted that 60 years ago, the WMA
had convened in Helsinki to adopt
the ethical principles that continue
to guide medical research today.
Mr. Stubb said that these principles
became known as the Declaration
of Helsinki, and during this General
Assembly, the WMA was poised
to adopt an updated version of
the Declaration. Drawing from
his perspective in international
relations, he remarked that we
are living in a time that demands
greater multilateral cooperation and
compromise, yet many nations are
stepping back from such a course.
He highlighted that the medical
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profession is a prime example of
how international collaboration
can foster agreement on shared
principles and establish frameworks
that benefit everyone.
Mr. Stubb pointed out that trust in
physicians ranks consistently high
worldwide, including in Finland,
which he attributed this to the core
mission of the medical profession:
to improve and save lives. He
described this vocation as one of the
most noble professions a person can
pursue. He concluded by wishing
attendees a successful meeting, wise
decisions, and a bright future for
the medical profession, adding that
he deeply admires their work.
Then, Dr. Riku Metsälä, a junior
doctor from Finland, led the
General Assembly in reciting
the Declaration of Geneva: The
Physician’s Pledge in Finnish, as it
was displayed on the screen in the
three official WMA languages.
Prof. Jung Yul Park, Chair of
Council, said that he was privileged
to pay tribute to Dr. Lujain
Alqodmani as the 74th President of
the WMA, who has presided with
great distinction over the affairs
of the WMA for the past year.
He stated that there were many
highlights during the period of her
Presidency, and that Dr. Alqodmani
has shown passion and enthusiasm
as well as whole-hearted empathy
and sympathy, coupled with tireless
commitment and dedication. Prof.
Park noted that this leadership
has provided much inspiration and
insight to WMA members and to
the medical profession worldwide.
He paid tribute to Dr. Alqodmani,
mentioning her ability to keep
perfect balance between the position
of WMA President with many tasks
at hand. As the mother of a small
daughter, with an ever-supportive
husband, she has managed to
successfully finish her WMA
Presidency with very important and
memorable achievements.
In her Valedictory Address, the
outgoing WMA President, Dr.
Lujain Alqodmani, highlighted the
immense challenges that physicians
face, citing international conflicts,
climate change, economic crises,
and violations of human rights. She
stated that this year, healthcare has
faced immense dangers, with over
980 attacks reported by the WHO
surveillance system in conflict areas
such as Lebanon, Ukraine, Sudan,
and Gaza. Doctors from Kenya
to Korea, the United Kingdom to
India, are taking to the streets to
demand safer working environments.
Dr. Alqodmani noted that these are
not isolated incidents; they are cries
for systemic change, for respect, and
for their right to serve their moral
duty.
Dr. Alqodmani spoke about the role
of WMA to foster international
collaboration to advance progress to
attain the sustainable development
goals (SDGs), particularly universal
health coverage, ensuring that health
remains a right, not a privilege. She
said that as physicians, our duty is
not just to our patients, but also to
the health and well-being of all. She
added that no matter how bleak the
world may seem, we must not lose
our passion for this duty.
On a personal note, Dr. Alqodmani
said that as only the fifth woman to
be elected President of the WMA
in 77 years, she was deeply aware
of the honour and the responsibility
of representing so many others
who still lack a seat at the table.
Balancing duties as a mother and
as WMA President was not always
easy, she said, adding that these
challenges only strengthened her
resolve to create a more inclusive
and equitable environment.
Following Dr. Alqodmani’s address,
Prof. Park presented her with
the Past President’s medal, which
entitles her to lifetime membership
in the WMA, with all the rights
and privileges afforded by the
WMA Bylaws.
Prof. Jung Yul Park invited Dr.
Ashok Philip to the rostrum. Dr.
Philip took the oath of office and
was installed as the 75th President
of the WMA. In his Inaugural
Address as the new President,
Dr. Ashok Philip highlighted the
necessity of the medical profession
to stay actively engaged in the
evolution of healthcare delivery
and health systems, to ensure the
best outcomes for patients and to
safeguard professional autonomy.
He explained that while policy and
planning could be seen as be tedious
work and “take us away from direct
patient care, but in the long term,
it protects our patients, and that
is what we have sworn to do.” He
detailed threats to the professional
autonomy of physicians, which
have been exacerbated by increasing
healthcare costs as life expectancy
increases.
Continuing, Dr. Philip stressed
the importance of guidelines,
independent of purely financial
considerations, to decide how
patients are treated, and said that
these guidelines must be developed
by physicians. He added that steps
towards removing or excluding
physicians from healthcare delivery
teams, ostensibly to handle shortages
of medical professionals, but as cost-
cutting measures, must be resisted.
In conclusion, Dr. Philip called on
medical professionals to lead the
way to a better future for patients,
communities, and the profession.
The Ceremonial Session then
adjourned.
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Saturday, 19 October
General Assembly Plenary Session
The Plenary Session of the 2024
General Assembly was called to
order by the Chair of Council, Prof.
Jung Yul Park.
The Declaration of Helsinki:
Development of the Current Proposed
Revisions
Dr. Jack Resneck Jr., Chair of
Workgroup on the Declaration
of Helsinki, explained the key
highlights in the proposed revision
of the Declaration of Helsinki to
the Assembly and thanked those
who contributed to this 30-month
revision process.
Report of the Credentials Committee
The Chair invited Dr. Carlos Serano
(Brazilian Medical Association),
Chair of the Credentials
Committee, to deliver the report
of the Credentials Committee. The
other members of the Credentials
Committee were Dr. Wonchat
Subhachaturas (Medical Association
of Thailand) and Dr. Philip Cathala
(Conseil National de l’Ordre des
Médecins).
The Committee reported that 46
WMA Constituent Members were
duly registered and recognised. Of
these, 45 Constituent Members
present at the Assembly were in
good standing and entitled to full
voting rights. The total number of
votes for those constituent members
registered as Assembly delegations
was 127.
Approval of the Minutes of the 2023
WMA General Assembly, Kigali,
Rwanda
The General Assembly approved
the minutes of the 2023 WMA
General Assembly held in Kigali,
Rwanda, from 4-7 October 2023.
Election
The Secretary General informed
the General Assembly that two
candidates had been nominated
for President. These candidates
were Dr. Jaqueline Kitulu (Kenyan
Medical Association) and Prof.
Alberto Caldas Afonso (Ordem dos
Médicos). The election was carried
out by paper ballot following the
two candidate’s speeches. A total
of 43 Constituent Members cast
votes out of 45 eligible Constituent
Members. Dr. Kitulu was elected
with a majority of votes (100 out of
125 votes). The Secretary General
and Chair thanked both candidates
and congratulated Dr. Kitulu on
being elected to serve as WMA
President in 2025-2026. She will
take up the post at the General
Assembly in Porto, Portugal, in
October 2025.
In her acceptance speech, Dr.
Kitulu said that she was filled with
immense gratitude and humility,
and that this moment symbolised
the collective power of collaboration,
dedication, and shared vision within
the global medical community.
She presented heartfelt thanks to
the delegates from the General
Assembly, regional caucuses, and
NMAs for their confidence. Dr.
Kitulu confirmed that she was
committed to fostering inter-
regional collaboration and gave her
support to mentorship and capacity-
building for junior physicians
through the JDN and NMAs. She
also reaffirmed her dedication to
global policy advocacy for robust
primary healthcare systems. She
said that she was deeply honoured
to serve as President and pledged to
lead with transparency, compassion,
and unwavering commitment to
the principles of medical ethics and
health equality.
Report of the Council to the General
Assembly
The Chair reviewed the process for
proceeding through the Report of
the Council to the WMA General
Assembly, explaining that action
items for the General Assembly
were contained in the Action Items
document, which had been finalised
during the Council meeting. Then,
the Chair informed participants of
the importance of adhering to the
WMA Bylaws with its rules and
procedures. He reiterated that he
would begin each agenda point by
asking if there was any opposition.
In the absence of opposition, he
would consider the point as having
been accepted unanimously.
Action Items for the General Assembly
Council
The following documents were
adopted:
• Council Resolution on Anti-
LGBTQ Legislation as a WMA
Resolution
• Council Resolution on Organ
Donation in Prisoners as a WMA
Resolution
• Council Resolution on the
Protection of Healthcare in Israel
and Gaza as a WMA Resolution
• WMA Resolution on Plastics
and Health
Medical Ethics Committee
The following documents were
adopted:
• WMA Declaration of Helsinki
– Ethical Principles for Medical
Research Involving Human
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Participants, as amended with
one editorial error correction on
paragraph 19
• WMA Declaration on the
Ethical Use of Medical
Technology, renamed to the
‘WMA Declaration of Kigali’
• WMA Statement on Assisted
Reproductive Technologies
The following document was sent
to the Assembly for information
• WMA Guidelines on
Promotional Mass Media
Appearance by Physicians
Socio-Medical Affairs Committee
The following documents were
adopted:
• WMA Declaration on Prevention
and Reduction of Air Pollution
to Improve Air Quality
• The revision of the WMA
Statement on Human
Papillomavirus Vaccination
• The revision of the WMA
Statement on Epidemics and
Pandemics
The following documents were
presented to the Assembly for
information
• WMA Resolution in Support
of an International Day of the
Medical Profession, October 30
• The minor revision of the WMA
Statement on Adolescent Suicide
• The minor revision of the WMA
Declaration of Hong Kong on
the Abuse of the Elderly, renamed
Declaration of Hong Kong on
the Abuse of Older People
• The minor revision of the WMA
Resolution in support of the
Turkish Medical Association
• The minor revision of the WMA
Resolution on the Revocation of
WHO Guidelines on Opioid Use
• The minor revision of the
WMA Statement on Non-
Discrimination in Professional
Membership
Report of the Council
Report of the Treasurer
WMA Treasurer, Mr. Rudolf
Henke, presented a report on the
financial results for 2023 and the
budget for 2025. He reported that
the WMA finished 2023 with a
solid surplus, and that expenses
were well-regulated, monitored, and
controlled. The Audited Financial
Statement for the year ending 31
December 2023 was adopted.
Finance and Planning Committee
The following items were adopted:
WMA Statutory Meetings
• The proposal that the 79th
General Assembly in 2028 will be
held from 18-21 October 2028.
• The theme, “The Impact of
Artificial Intelligence on Medical
Practice”, as amended, was
selected for the Scientific Session
at the General Assembly in Porto,
Portugal, in October 2025.
Constituent Membership
• The waiver of the membership
dues of the Myanmar Medical
Association (MMA) and the
Ukraine Medical Association
(UMA) for the year 2024
• The increase of membership
dues rates for all categories over
a three-year term, i.e. increase in
2025 by 2.5%, then in 2026 by
2.5% and in 2027 by 2.5%
• The Hungarian Medical Chamber
(HMC) was admitted to the
WMA Constituent Membership.
The General Assembly welcomed
the HMC with applause, and Dr.
Péter Álmos, President of the
HMC, thanked for the admission.
Rules Applicable to WMA Associate
Membership
• The proposed revision of the
Rules Applicable to WMA
Associate Membership
The following items were presented
to the Assembly for information
WMA Statutory Meetings
• The Council informed the
General Assembly that the date
for the 238th Council Session in
2028 is 27-29 April 2028.
• The Council informed the
General Assembly that the
invitation from the Pakistan
Medical Association (PkMA) for
Karachi, Pakistan. to host the
235th Council Session in 2026
was declined, because Pakistan
does not issue visas to one of
the countries represented in
the WMA Council, according
to the questionnaire responses
provided by the Pakistan Medical
Association.
Membership Dues, Categories
• The WMA Dues Categories
2025
• The Report on Membership
Dues Payments for 2024
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WMA Procedures and Operating
Policies
• The Council informed the
General Assembly that the
proposed revision of WMA
Procedures and Operating
Policies to include a Code of
Conduct during WMA meetings
was approved.
Council Report
The General Assembly adopted the
Council Report in its entirety.
Report of WMA External Activities
and International Policy
Dr. Caline Mattar, Dr. Julia
Tainijoki, Dr. Yassen Tcholakov,
and Dr. Lujain Alqodmani
presented the WMA external
activities on antimicrobial resistance,
human resources for health, non-
communicable diseases, pandemic
preparedness, the Intergovernmental
Negotiating Body (INB), and WHO
Civil Society Commission. Members
were encouraged to contact the
WMA Secretariat for any questions
or future collaboration.
Report of the 2024 Associate Members
Meeting
Dr. Jacques de Haller, the Chair of
Associate Membership, delivered a
report on the Associate Members
meeting. The General Assembly
approved the Associate Members
Report.
Presentations from International
Organisations
Dr. Christian Keijzer, President
of the Standing Committee of
European Doctors (CPME), gave
a presentation which focused
on how CPME represents the
medical profession’s point of view
to European health policymaking
through proactive cooperation. Dr.
Keijzer explained that the CPME
brings the voice of European
doctors to the European Union´s
health policy.
Dr. Catharina Boehme, Assistant
Director-General for External
Relations and Governance of the
WHO, said that it was an honour
and pleasure to address the General
Assembly and be present for the
adoption of the revised Declaration
of Helsinki. In terms of the WHO,
she said that the meaning that
the Declaration of Helsinki has
brought over the years cannot be
overstated. In her presentation, Dr.
Boehme spoke of WHO’s work on
the global health agenda, and she
outlined future priorities, including
strengthening and protecting
the global health workforce,
reinforcing global health security,
and strengthening pandemic
preparedness.
Dr. Kati Juva, Co-President of
the International Physicians for
the Prevention of Nuclear War
(IPPNW), and Ms. Stella Ziegler,
medical student and International
and German Student Representative,
shared information about the
history and work of IPPNW. They
highlighted how physicians have
an important role to play in the
prevention of nuclear war and its
devasting effects, as there is still
much to be achieved.
Dr. John de Jong, President of
the World Veterinary Association
(WVA), gave his presentation that
introduced the WVA’s activities
during the 227th Council Session
on 18 October, due to his travel
plans.
Open Session
Dr. Péter Álmos, President of the
Hungarian Medical Chamber,
explained the current challenging
situation in Hungary, in regards
to physicians’ autonomy and self-
governance. He reported that
the Hungarian Government had
cancelled the obligatory membership
of Physicians to the Chamber and
stripped the Chamber of Physicians
of its role as supervising and
regulating body. Fortunately, the
Chamber was able to retain the
majority of members on a voluntary
basis. The Secretary General
responded that a similar attack
on physician self-governance has
recently been seen in Albania.
Dr. Sanjeeb Tiwari, General
Secretary of the Nepal Medical
Association, gave a short
presentation entitled, “Recent Floods
in Nepal Response and Relief”. He
explained how the Nepal Medical
Association had been instrumental
in flood relief actions following the
serious flooding that occurred from
late September to early October
2024.
Dr. José Harmon Huerta, Spanish
Medical Association (CGCOM),
thanked the Assembly for
reaffirming the WMA Resolution in
Support of an International Day of
the Medical Profession, adopted in
October 2020, to recognise October
30 as the International Day of the
Medical Profession. He expressed
that this day demonstrates a tribute
to the commitment of physicians
to the service of humankind, to
the health and well-being of their
patients, in the respect the ethical
values of the profession. The
CGCOM plans to celebrate this
International Day through a series
of press conferences and media
activities. Dr. Huerta encouraged
all WMA members to celebrate the
International Day of the Medical
Profession, so that it can become
internationally recognised.
Dr. Latifa Patel, Chair of the
representative body of the British
Medical Association, thanked the
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WMA for organising the strategic
planning session on 17 October,
giving members the opportunity
to engage in the planning process.
She requested that the Association
consider holding the WMA
meetings in a hybrid format so that
they are more inclusive and so that
more members who cannot travel
can participate. Dr. Patel offered
to share the BMA’s experience and
expertise on the technical challenges
of hybrid meetings. The Chair of
Council acknowledged Dr. Patel’s
request, which was supported by
other members, and he will bring it
to the ExCo’s further consideration
and try to find a possible solution
within WMA’s capacity.
Any Other Business
Dr. René Héman, President of the
Royal Dutch Medical Association
(RDMA), shared that the RDMA
is hosting the CPME meeting
in Amsterdam on 7-9 November
2024, including the Conference on
the European Doctor and Digital
Health. He also welcomed the
members’ participation to celebrate
RDMA´s 175th anniversary. He
stated that, as the 172nd President
of RDMA, he has attended the
WMA meetings for the last nine
years, and that this meeting would
be his last one, thanking all WMA
members for their support and
cooperation. The Chair of Council
expressed his gratitude, on behalf of
the WMA members, to Dr. Héman
for his contributions to the WMA.
The Ordem dos Médicos shared
a video in anticipation of the 76th
General Assembly, which will be
held in October 2025 in Porto,
Portugal.
Adjournment
The Chair of Council thanked
all members for their active
engagement. He also expressed
thanks to the Finnish Medical
Association, the Secretary General,
and the WMA Secretariat staff for
their tireless efforts to make this
General Assembly such a success.
The Secretary General continued,
thanking the Finnish Medical
Association and its president, Dr.
Niina Koivuviita, CEO Dr. Janne
Aaltonen, Ms. Mervi Kattelus, Ms.
Riikka Rahkonen, and other staff
members for hosting this General
Assembly. He expressed his special
thanks to Ms. Ana Rodrigues and
Ms. Carla Febrónio, seconded by
the Portuguese Medical Association,
the host of the General Assembly
next year. He thanked other guests
from partner organisations for their
attendance and contributions on
the Declaration of Helsinki revision
process. He recognised the valuable
contributions of WMA delegates
and officers, speakers of the
Scientific Session, WMA officers,
Associate Members (including
past presidents and the JDN), Dr.
Rudolf Henke (WMA Treasurer),
Mr. Adi Hällmayr (WMA Financial
Advisor), Ms. Mervi Kattelus
(WMA Legal Advisor), Ms.
Michelle Glekin (facilitator), Ms.
Janice Blondeau (Communications
and Media Consultant), interpreters,
and the entire WMA staff.
228th Council Session
The meeting was called to order by
the Chair of Council, and as there
was no business arising from the
General Assembly and no other
business, the meeting was adjourned.
Janice Blondeau, BBus(Comn)
Communications and
Media Consultant,
World Medical Association
janice.blondeau@wma.net
Photo 1. Group photo during the 77th General Assembly in Helsinki. Credit: WMA
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WMA General Assembly Report
26
WMA DECLARATION OF HELSINKI – ETHICAL
PRINCIPLES FOR MEDICAL RESEARCH
INVOLVING HUMAN PARTICIPANTS
Adopted by the 18th WMA General
Assembly, Helsinki, Finland, June 1964
and amended by the:
29th WMA General Assembly, Tokyo,
Japan, October 1975
35th WMA General Assembly, Venice,
Italy, October 1983
41st WMA General Assembly, Hong
Kong, September 1989
48th WMA General Assembly, Somerset
West, Republic of South Africa, October
1996
52nd WMA General Assembly, Edinburgh,
Scotland, October 2000
53rd WMA General Assembly,
Washington DC, USA, October 2002
(Note of Clarification added)
55th WMA General Assembly, Tokyo,
Japan, October 2004 (Note of Clarification
added)
59th WMA General Assembly, Seoul,
Republic of Korea, October 2008
64th WMA General Assembly, Fortaleza,
Brazil, October 2013 and by the 75th
WMA General Assembly, Helsinki,
Finland, October 2024
PREAMBLE
1. The World Medical Association
(WMA) has developed the Declaration
of Helsinki as a statement of ethical
principles for medical research involving
human participants, including research
using identifiable human material or
data.
The Declaration is intended to be read
as a whole, and each of its constituent
paragraphs should be applied with
consideration of all other relevant
paragraphs.
2. While the Declaration is adopted by
physicians, the WMA holds that these
principles should be upheld by all
individuals, teams, and organizations
involved in medical research, as these
principles are fundamental to respect
for and protection of all research
participants, including both patients and
healthy volunteers.
GENERAL PRINCIPLES
3. The WMA Declaration of Geneva
binds the physician with the words,
“The health and well-being of my
patient will be my first consideration,”
and the WMA International Code of
Medical Ethics declares “The physician
must commit to the primacy of patient
health and well-being and must offer
care in the patient’s best interest.”
4. It is the duty of the physician to
promote and safeguard the health, well-
being and rights of patients, including
those who are involved in medical
research. The physician’s knowledge
and conscience are dedicated to the
fulfilment of this duty.
5. Medical progress is based on research
that ultimately must include participants.
Even well-proven interventions should
be evaluated continually through
research for their safety, effectiveness,
efficiency, accessibility, and quality.
6. Medical research involving human
participants is subject to ethical
standards that promote and ensure
respect for all participants and protect
their health and rights.
Since medical research takes place in the
context of various structural inequities,
researchers should carefully consider
how the benefits, risks, and burdens are
distributed.
Meaningful engagement with potential
and enrolled participants and their
communities should occur before,
during, and following medical research.
Researchers should enable potential
and enrolled participants and their
communities to share their priorities
and values; to participate in research
design, implementation, and other
relevant activities; and to engage in
understanding and disseminating results.
7. The primary purpose of medical
research involving human participants
is to generate knowledge to understand
the causes, development and effects of
diseases; improve preventive, diagnostic
and therapeutic interventions; and
ultimately to advance individual and
public health.
These purposes can never take
precedence over the rights and interests
of individual research participants.
8. While new knowledge and interventions
may be urgently needed during public
health emergencies, it remains essential
to uphold the ethical principles in this
Declaration during such emergencies.
9. It is the duty of physicians who are
involved in medical research to protect
the life, health, dignity, integrity,
autonomy, privacy, and confidentiality
of personal information of research
participants. The responsibility for the
protection of research participants must
always rest with physicians or other
researchers and never with the research
participants, even though they have
given consent.
WMA POLICIES
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WMA POLICIES
10. Physicians and other researchers
must consider the ethical, legal and
regulatory norms and standards for
research involving human participants
in the country or countries in which
the research originated and where it is
to be performed, as well as applicable
international norms and standards. No
national or international ethical, legal
or regulatory requirement should reduce
or eliminate any of the protections for
research participants set forth in this
Declaration.
11. Medical research should be designed and
conducted in a manner that avoids or
minimizes harm to the environment and
strives for environmental sustainability.
12. Medical research involving human
participants must be conducted only by
individuals with the appropriate ethics
and scientific education, training and
qualifications. Such research requires
the supervision of a competent and
appropriately qualified physician or
other researcher.
Scientific integrity is essential in the
conduct of medical research involving
human participants. Involved individuals,
teams, and organizations must never
engage in research misconduct.
13. Groups that are underrepresented in
medical research should be provided
appropriate access to participation in
research.
14. Physicians who combine medical
research with medical care should
involve their patients in research only
to the extent that this is justified by
its potential preventive, diagnostic or
therapeutic value and if the physician has
good reason to believe that participation
in the research will not adversely affect
the health of the patients who serve as
research participants.
15. Appropriate compensation and treatment
for participants who are harmed as a
result of participating in research must
be ensured.
Risks, Burdens, and Benefits
16. In medical practice and in medical
research, most interventions involve risks
and burdens.
Medical research involving human
participants may only be conducted
if the importance of the objective
outweighs the risks and burdens to the
research participants.
17. All medical research involving human
participants must be preceded by careful
assessment of predictable risks and
burdens to the individuals and groups
involved in the research in comparison
with foreseeable benefits to them and to
other individuals or groups affected by
the condition under investigation.
Measures to minimize the risks and
burdens must be implemented. The
risks and burdens must be continuously
monitored, assessed, and documented by
the researcher.
18. Physicians and other researchers may
not engage in research involving human
participants unless they are confident
that the risks and burdens have
been adequately assessed and can be
satisfactorily managed.
When the risks and burdens are found
to outweigh the potential benefits
or when there is conclusive proof of
definitive outcomes, physicians and
other researchers must assess whether
to continue, modify or immediately stop
the research.
Individual, Group, and Community
Vulnerability
19. Some individuals, groups, and
communities are in a situation of more
vulnerability as research participants
due to factors that may be fixed or
contextual and dynamic, and thus are
at greater risk of being wronged or
incurring harm. When such individuals,
groups, and communities have
distinctive health needs, their exclusion
from medical research can potentially
perpetuate or exacerbate their disparities.
Therefore, the harms of exclusion must
be considered and weighed against
the harms of inclusion. In order to
be fairly and responsibly included in
research, they should receive specifically
considered support and protections.
20. Medical research with individuals,
groups, or communities in situations of
particular vulnerability is only justified
if it is responsive to their health needs
and priorities and the individual, group,
or community stands to benefit from
the resulting knowledge, practices, or
interventions. Researchers should only
include those in situations of particular
vulnerability when the research cannot
be carried out in a less vulnerable group
or community, or when excluding them
would perpetuate or exacerbate their
disparities.
Scientific Requirements and Research
Protocols
21. Medical research involving human
participants must have a scientifically
sound and rigorous design and execution
that are likely to produce reliable, valid,
and valuable knowledge and avoid
research waste. The research must
conform to generally accepted scientific
principles, be based on a thorough
knowledge of the scientific literature,
other relevant sources of information,
and adequate laboratory and, as
appropriate, animal experimentation.
The welfare of animals used for research
must be respected.
22. The design and performance of all
medical research involving human
participants must be clearly described
and justified in a research protocol.
The protocol should contain a statement
of the ethical considerations involved
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WMA POLICIES
and should indicate how the principles
in this Declaration have been addressed.
The protocol should include information
regarding aims, methods, anticipated
benefits and potential risks and burdens,
qualifications of the researcher, sources
of funding, any potential conflicts of
interest, provisions to protect privacy
and confidentiality, incentives for
participants, provisions for treating
and/or compensating participants
who are harmed as a consequence of
participation, and any other relevant
aspects of the research.
In clinical trials, the protocol must also
describe any post-trial provisions.
Research Ethics Committees
23. The protocol must be submitted for
consideration, comment, guidance, and
approval to the concerned research ethics
committee before the research begins.
This committee must be transparent
in its functioning and must have the
independence and authority to resist
undue influence from the researcher, the
sponsor, or others. The committee must
have sufficient resources to fulfill its
duties, and its members and staff must
collectively have adequate education,
training, qualifications, and diversity to
effectively evaluate each type of research
it reviews.
The committee must have sufficient
familiarity with local circumstances
and context, and include at least one
member of the general public. It must
take into consideration the ethical, legal,
and regulatory norms and standards
of the country or countries in which
the research is to be performed as well
as applicable international norms and
standards, but these must not be allowed
to reduce or eliminate any of the
protections for research participants set
forth in this Declaration.
When collaborative research is
performed internationally, the research
protocol must be approved by research
ethics committees in both the
sponsoring and host countries.
The committee must have the right
to monitor, recommend changes to,
withdraw approval for, and suspend
ongoing research. Where monitoring
is required, the researcher must provide
information to the committee and/or
competent data and safety monitoring
entity, especially about any serious
adverse events. No amendment to
the protocol may be made without
consideration and approval by the
committee. After the end of the
research, the researchers must submit a
final report to the committee containing
a summary of the findings and
conclusions.
Privacy and Confidentiality
24. Every precaution must be taken
to protect the privacy of research
participants and the confidentiality of
their personal information.
Free and Informed Consent
25. Free and informed consent is an essential
component of respect for individual
autonomy. Participation by individuals
capable of giving informed consent in
medical research must be voluntary.
Although it may be appropriate to
consult family members or community
representatives, individuals capable of
giving informed consent may not be
enrolled in research unless they freely
agree.
26. In medical research involving human
participants capable of giving informed
consent, each potential participant must
be adequately informed in plain language
of the aims, methods, anticipated
benefits and potential risks and burdens,
qualifications of the researcher, sources
of funding, any potential conflicts of
interest, provisions to protect privacy
and confidentiality, incentives for
participants, provisions for treating
and/or compensating participants
who are harmed as a consequence of
participation, and any other relevant
aspects of the research.
The potential participant must be
informed of the right to refuse to
participate in the research or to
withdraw consent to participate at
any time without reprisal. Special
attention should be given to the specific
information and communication needs
of individual potential participants as
well as to the methods used to deliver
the information.
After ensuring that the potential
participant has understood the
information, the physician or another
qualified individual must then seek
the potential participant’s freely given
informed consent, formally documented
on paper or electronically. If the
consent cannot be expressed on paper
or electronically, the non-written
consent must be formally witnessed and
documented.
All medical research participants should
be given the option of being informed
about the general outcome and results of
the research.
27. When seeking informed consent for
participation in research the physician
or other researcher must be particularly
cautious if the potential participant is
in a dependent relationship with them
or may consent under duress. In such
situations, the informed consent must
be sought by an appropriately qualified
individual who is independent of this
relationship.
28. In medical research involving human
participants incapable of giving free and
informed consent, the physician or other
qualified individual must seek informed
consent from the legally authorized
representative, considering preferences
and values expressed by the potential
participant.
Those persons incapable of giving free
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and informed consent are in situations
of particular vulnerability and are
entitled to the corresponding safeguards.
In addition to receiving the protections
for the particularly vulnerable, those
incapable of giving consent must only
be included if the research is likely to
either personally benefit them or if it
entails only minimal risk and minimal
burden.
29. When a potential research participant
who is incapable of giving free and
informed consent is able to give assent
to decisions about participation in
research, the physician or other qualified
individual must seek that assent in
addition to the consent of the legally
authorized representative, considering
any preferences and values expressed by
the potential participant. The potential
participant’s dissent should be respected.
30. Research involving participants who
are physically or mentally incapable
of giving consent (for example,
unconscious patients) may be done only
if the physical or mental condition that
prevents giving informed consent is a
necessary characteristic of the research
group. In such circumstances the
physician or other qualified individual
must seek informed consent from the
legally authorized representative. If no
such representative is available and if the
research cannot be delayed, the research
may proceed without informed consent
provided that the specific reasons for
involving participants with a condition
that renders them unable to give
informed consent have been stated in
the research protocol and the research
has been approved by a research ethics
committee.
Free and informed consent to remain in
the research must be obtained as soon
as possible from a legally authorized
representative or, if they regain capacity
to give consent, from the participant.
31. The physician or other researcher must
fully inform potential participants which
aspects of their care are related to the
research. The refusal of a patient to
participate in research or the patient’s
decision to withdraw from research
must never adversely affect the patient-
physician relationship or provision of the
standard of care.
32. Physicians or other qualified individuals
must obtain free and informed consent
from research participants for the
collection, processing, storage, and
foreseeable secondary use of biological
material and identifiable or re-
identifiable data. Any collection and
storage of data or biological material
from research participants for multiple
and indefinite uses should be consistent
with requirements set forth in the
WMA Declaration of Taipei, including
the rights of individuals and the
principles of governance. A research
ethics committee must approve the
establishment and monitor ongoing use
of such databases and biobanks.
Where consent is impossible or
impracticable to obtain, secondary
research on stored data or biological
material may be done only after
consideration and approval of a research
ethics committee.
Use of Placebo
33. The benefits, risks, burdens, and
effectiveness of a new intervention
must be tested against those of the best
proven intervention(s), except in the
following circumstances:
• If no proven intervention exists, the
use of placebo, or no intervention, is
acceptable; or
• If for compelling and scientifically
sound methodological reasons the use
of any intervention other than the best
proven one(s), the use of placebo, or no
intervention is necessary to determine
the efficacy or safety of an intervention;
and the participants who receive any
intervention other than the best proven
one(s), placebo, or no intervention
will not be subject to additional risks
of serious or irreversible harm as a
result of not receiving the best proven
intervention.
Extreme care must be taken to avoid
abuse of this option.
Post-Trial Provisions
34. In advance of a clinical trial, post-
trial provisions must be arranged by
sponsors and researchers to be provided
by themselves, healthcare systems, or
governments for all participants who
still need an intervention identified as
beneficial and reasonably safe in the
trial. Exceptions to this requirement
must be approved by a research ethics
committee. Specific information about
post-trial provisions must be disclosed to
participants as part of informed consent.
Research Registration, Publication, and
Dissemination of Results
35. Medical research involving human
participants must be registered in a
publicly accessible database before
recruitment of the first participant.
36. Researchers, authors, sponsors,
editors, and publishers all have
ethical obligations with regard to the
publication and dissemination of the
results of research. Researchers have
a duty to make publicly available the
results of their research on human
participants and are accountable for the
timeliness, completeness, and accuracy
of their reports. All parties should
adhere to accepted guidelines for ethical
reporting. Negative and inconclusive as
well as positive results must be published
or otherwise made publicly available.
Sources of funding, institutional
affiliations, and conflicts of interest must
be declared in the publication. Reports
of research not in accordance with the
principles of this Declaration should not
be accepted for publication.
WMA POLICIES
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WMA POLICIES
Unproven Interventions in Clinical
Practice
37. When an unproven intervention is
utilized in an attempt to restore health
or alleviate suffering for an individual
patient because approved options are
inadequate or ineffective and enrollment
in a clinical trial is not possible, it
should subsequently be made the object
of research designed to evaluate safety
and efficacy. Physicians participating in
such interventions must first seek expert
advice, weigh possible risks, burdens,
and benefits, and obtain informed
consent. They must also record and
share data when appropriate and avoid
compromising clinical trials. These
interventions must never be undertaken
to circumvent the protections for
research participants set forth in this
Declaration.
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WMA RESOLUTION ON ANTI-LGBTQ LEGISLATION
Adopted by the 223rd WMA Council
Session, Nairobi, Kenya, April 2023
Revised and adopted by the 74th WMA
General Assembly, Kigali, Rwanda,
October 2023
Revised as Council Resolution by the
226th WMA Council Session, Seoul,
Korea, April 2024 and adopted by the
75th WMA General Assembly, Helsinki,
Finland, October 2024
PREAMBLE
The WMA is gravely concerned about the
“Anti-Homosexuality law” that was passed
in the Ugandan parliament on March 21,
2023, and signed into law by Ugandan
President Yoweri Museveni in May 2023.
The WMA originally condemned the bill in
a press release issued on March 24, 2023.
While the Uganda Constitutional Court did
strike down sections of the law that restricted
healthcare access for LGBT people,
criminalised renting premises to LGBT
people, and an obligation to report alleged
acts of homosexuality, on April 3, 2024,
the court upheld the abusive and radical
provisions of the Anti-Homosexuality Act,
including sections which criminalise certain
consensual same-sex acts and makes them
punishable by death or life imprisonment.
A provision on the “promotion” of
homosexuality is also of grave concern,
exposing anyone who “knowingly promotes
homosexuality” to as much as twenty years
in prison.
Similarly, an “Anti-Gay” bill was passed by
the parliament of Ghana on February 28,
2024. The bill has its origins in British
colonial law which criminalizes “unnatural
sex”, and broadens the scope of criminal
sanctions against lesbian, gay, bisexual,
transgender, transsexual, and pansexual
people, including their allies.
The so-called “Human Sexual Rights
and Family Values” bill also allows for
criminalizing medical professionals’
work. The bill prohibits the provision
of or participation in the provision of
surgical procedures for sex or gender
reassignment, as punishable by fines or
imprisonment. Distribution and other
broadcast of any information that promote
activities that are prohibited under bill,
including teaching children any gender
or sex beyond male and female, could
result in 10 years imprisonment. The bill
would also require anyone with knowledge
of prohibited activities to report these
activities to the police or other authorities.
In July 2024, the Ghana Supreme Court
upheld the bill. Ugandan President Nana
Akufo-Addo has not yet signed the bill
into law.
Similar troubling legislation and laws
have arisen in countries including but not
limited to Georgia, the United States,
Bulgaria and Iraq.
These kinds of laws and bills challenge
the role of physicians to objectively
provide information to patients and, where
appropriate, those close to them. Physicians
could face disciplinary action or retribution
for pointing out in the context of treatment
that homosexuality is a natural variation
of human sexuality. This can impact the
professional practice of a physician, as can
be seen in other countries that have
implemented similar legislation. It can
also impact the health of individuals and
the population as a whole if patients of
the LGBTQ+ community are fearful of
accessing healthcare or of being forthcoming
with information when they require medical
care.
As stated in its Statement on Natural
Variations of Human Sexuality and
supported in its Statement on Transgender
People, the WMA condemns all forms
of stigmatisation, criminalization of and
discrimination against people based on their
sexual orientation.
The WMA reasserts that being lesbian,
gay, or bisexual are natural variations within
the range of human sexuality and that
discrimination, both interpersonally and at
the institutional level, anti-homosexual or
anti-bisexual legislation and human rights
violations, stigmatisation, criminalization of
same-sex partnerships, peer rejection and
bullying continue to have a serious impact
upon the psychological and physical health
of lesbian, gay or bisexual people.
Further, the WMA emphasises that
everyone has the right to determine one’s
own gender, recognises the diversity of
possibilities in this respect and calls for
appropriate legal measures to protect the
equal civil rights of transgender people.
RECOMMENDATIONS
Therefore, the WMA, reaffirming its
statements on Natural Variations of
Human Sexuality and Transgender People,
calls on:
Ugandan authorities to immediately repeal
the Anti-Homosexuality law in its entirety;
Ghanaian authorities to immediately veto
or rescind the Human Sexual Rights and
Family Values bill; and
WMA Constituent members to condemn
the Ugandan law and Ghanaian bill, and
advocate against any similar legislation
that is proposed or enacted.
WMA COUNCIL RESOLUTIONS
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WMA RESOLUTION ON PLASTICS AND HEALTH
Adopted by the 75th WMA General
Assembly, Helsinki, Finland, October 2024
PREAMBLE
Plastic poses an ongoing challenge to human
and planetary health, which will inevitably
worsen unless coordinated global action is
taken. Global production of plastics has
grown to 400 million metric tons in 2022
and is projected to quadruple by 2050. In
2019, global plastics production released
1.8 billion tons of greenhouse gases and 22
million tons of plastic solids into the
environment.
Plastics are used in all aspects of healthcare,
and there has been a dramatic shift towards
single-use items in recent decades.
Referring to the WMA Statement on
Environmental Degradation and Sound
Management of Chemicals, which also deals
with plastic waste leading to environmental
degradation and potentially harmful effects
on health, it is important to consider the
potential health impacts at every stage
of the plastic life cycle.
RECOMMENDATION
The World Medical Association urges
countries, and especially those present at
the fifth session of the Intergovernmental
Negotiating Committee (INC-5), to commit
to a just Plastic Treaty to end plastic
pollution, address the impacts of plastics on
human and planetary health and consider
the role of plastic products in the health
sector.
WMA COUNCIL RESOLUTIONS
WMA DECLARATION ON PREVENTION
AND REDUCTION OF AIR POLLUTION
TO IMPROVE AIR QUALITY
Adopted by the 75th WMA General
Assembly, Helsinki, Finland, October 2024
PREAMBLE
The impact of air pollution on health –
especially among vulnerable populations –
necessitates targeted guidelines for healthcare
professionals. By recognising air pollution’s
unique characteristics, this declaration aims
to advocate for better health, foster cross-
border collaboration, and reinforce the
connection between environmental quality
and human well-being.
Air pollution and its impact on health
Air pollution poses a major global
environmental risk to human health,
contributing significantly to avoidable
morbidity and mortality worldwide. 8.1
million premature deaths occur each year
due to the combined effects of ambient
and household air pollution.
Air pollutants are a leading risk factor for
the burden of non-communicable diseases,
leading to stroke, myocardial infarctions,
lung cancer as well as chronic respiratory
illnesses. It also increases the risk of
childhood asthma and asthma severity.
Air pollutants are a diverse range of harmful
substances that contaminate the air we
breathe. These include gases such as sulphur
dioxide, nitrogen oxides, carbon monoxide,
methane, and volatile organic compounds,
as well as particulate matter like smoke, soot
(black carbon), and fine dust.
In 2022, WHO estimated that 99% of
the global population was exposed to air
pollution concentrations that exceeded
WHO’s air quality limits.
While no region of the world has been
spared, low and middle-income countries
bear the largest burden of premature
mortality associated with air pollution.
Without implementation of aggressive
interventions, the number of premature
deaths caused by ambient air pollution is
projected to rise by over 50% by the year
2050.
The sources of air pollution
Fossil fuel combustion, petrol- and diesel-
powered vehicle emissions have been
highlighted as the major contributor to air
pollution-related mortalities, particularly in
urban areas.
Diesel soot is a proven carcinogen with toxic
effects on cardiovascular and respiratory
systems.
Household air pollution, caused largely by
open cooking fires and inefficient stoves, is
a leading risk factor for childhood mortality,
contributing to approximately 50% of
deaths from acute lower respiratory
infections, including pneumonia, in
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children under the age of five.
Beyond traditional airborne pollutants,
biological air pollution – airborne pathogens
such as bacteria, viruses, and fungi,
particularly indoors – has gained attention.
Infected individuals can contribute to such
air contamination, emphasizing the need
for appropriate prevention strategies and
comprehensive air quality control.
Plastics contribute to air pollution directly
through its open-air combustion and
through microplastics carried by wind and
air currents.
RECOMMENDATIONS
The WMA acknowledges the severity of
consequences stemming from air pollution
and urges the following stakeholders to
promptly take action to achieve clean air:
The WMA and its constituent members
should:
1. Engage with local, regional, and national
authorities to raise public awareness
about the health impacts of air pollution
and the importance of its prevention.
2. Work together with governments to
develop and implement strategies to
improve air quality, as identified in the
WHO air quality guidelines, and mitigate
the effects of air pollution. These
strategies should consider the local
context and reflect the latest scientific
evidence.
3. Advocate for and support the integration
of health impacts of air pollution and
its solutions into medical curricula
and professional educational programs,
fostering a comprehensive understanding
and proactive approach among
healthcare professionals.
4. Encourage collaboration between
organised medicine and other
stakeholders, including government
agencies and international organizations,
to develop best practices for minimising
greenhouse gas emissions and plastic
use in healthcare settings.
The WMA urges governments to:
5. Recognise that air pollution
negatively impacts human health and
environmental sustainability and that
existing health inequities exacerbate
susceptibility to environmental hazards.
6. Recognise the important role of social
and environmental determinants of
health and strive to include these in
policy-making processes, for example
by conduction of health equity impact
assessments.
7. Allocate resources and funding for
reducing and monitoring air quality and
implement effective pollution prevention
and control measures, particularly in
densely populated areas, in line with
WHO’s air quality standards.
8. Enhance early warning systems for
anticipated poor air quality periods
and prepare health systems to handle
air pollution-related health impacts
effectively.
9. Implement measures that improve air
quality, such as increasing access to clean
energy and creating green spaces.
10. Take measures toward sustainable
healthy transport by implementing
strategies to decarbonise the
transportation sector, such as enforcing
stricter vehicle emission standards,
promoting public transportation and
implementing cycling and walking
infrastructure.
11. Invest in and support research and
innovation for cleaner healthcare sector
technologies and practices.
12. Establish guidelines and standards
for acceptable levels of biological
contaminants in indoor air, including
policies to reach those objectives such
as by ensuring adequate ventilation and
air filtration.
13. Strive towards good environmental
governance by developing sustainable
strategies, policies, and measures to
address environmental hazards and take
a precautionary principle approach to
protect health.
The WMA recommends that international
and intergovernmental agencies:
14. Recognise and promote access to
clean, breathable air free from harmful
pollutants as a basic human right for
all people worldwide.
15. Work with governments to update public
health policies, prioritize air pollution
control and strengthen efforts in health
promotion and pollution reduction.
16. Advocate for the maximum reduction of
all sources of air pollution, recognising
that it is critical for sustainability that
anthropogenic (human) activities operate
within the safe limits of the Earth’s
ecosystem.
17. Promote and support governments in
conducting health impact assessments
across relevant policy sectors, empowering
them to proactively reduce exposure to
air pollution and safeguard public health.
The WMA urges individual physicians to:
18. Stay informed regarding health effects
of air pollution.
19. Consider air pollution as a potential
environmental risk factor in relevant
patient consultations and where relevant,
promote lifestyle modifications and
preventive measures that minimize
exposure to pollutants.
WMA COUNCIL RESOLUTIONS
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WMA RESOLUTION ON THE PROTECTION
OF HEALTHCARE IN ISRAEL AND GAZA
Adopted by the 226th WMA Council
session, Seoul, Korea, April 2024 and
adopted by the 75th WMA General
Assembly, Helsinki, Finland, October
2024
PREAMBLE
In response to the ongoing conflict in Israel
and Gaza, the WMA is gravely concerned
by the deepening healthcare and
humanitarian crisis in Gaza, the growing
starvation and the lack of medical care
and deeply concerned about the continued
imprisonment and abuse of hostages.
RECOMMENDATIONS
The WMA Council and its constituent
members call for:
1. A bilateral, negotiated and sustainable
ceasefire in order to protect all civilian
life, secure the release and safe passage
of all hostages and to allow the transfer
of humanitarian aid for all those in
need.
2. The immediate and safe release of all
hostages.
3. Pending their release, humanitarian aid
and healthcare attention to be provided
to the hostages.
4. All parties to abide by international
humanitarian law and the principle
of medical neutrality to safeguard the
rights and protection of healthcare
facilities, healthcare personnel and
patients from further threat, interference
and attack.
5. Unimpeded and accelerated
humanitarian access throughout
all of Gaza, including the entry of
humanitarian aid and safe passage
of medical personnel. This also
includes the evacuation of urgent
medical cases to reduce secondary
morbidity and mortality, public health
risks, and alleviate pressure on hospitals
inside Gaza.
6. The re-establishment of access to
healthcare and the creation of a safe
working environment for healthcare
personnel to work in through the
restoration of medical capacity and
essential services.
7. Verified investigations into alleged gross
violations and abuses of human rights
and international humanitarian law
including attacks on healthcare staff
and facilities and the misuse of those
facilities for military purposes.
8. The upholding by physicians of the
principles in the WMA Declaration
of Geneva 
and other documents that
serve as guidance for medical personnel
during times of conflict.
WMA COUNCIL RESOLUTIONS
WMA STATEMENT ON EPIDEMICS AND PANDEMICS
Adopted by the 68th General Assembly,
Chicago, October 2017 and revised by
the 75th WMA General Assembly,
Helsinki, Finland, October 2024
PREAMBLE
History demonstrates that new diseases
will emerge, and old diseases re-emerge
unpredictably and pose significant threats to
global health.
Epidemics and pandemics highlight deep-
rooted inequalities, hitting less-resourced
regions hardest due to their constrained
resources, fragile health systems, and
significant disease burdens. The common
but differentiated responsibilities (CBDR)
principle can be applied to pandemic
prevention, preparedness and response
(PPPR) in order to bring equity and justice
in cooperation between states.
The accelerating pace of epidemic-prone
diseases, compounded by the repercussions
of geopolitical conflicts, environmental
degradation, climate change, increased
human encroachment into natural
ecosystems, antimicrobial resistance,
widening socio-economic disparities,
global travel, and the intrinsic link
between the health of humans, animals,
and our shared environment, underscores
the vulnerability of global health security.
Integrating the One Health approach
acknowledges the critical interdependence
of all living organisms and their habitats,
essential for understanding the emergence
and spread of diseases and highlighting the
need for a multisectoral, interdisciplinary
and evidence-based approach to global
health threats.
Robust and effective global surveillance is
pivotal for improving the prevention and
response to infectious diseases, enabling
earlier detection and identification of
emergent threats. The rapid spread of
epidemics and pandemics in regions with
underfunded and underdeveloped public
health infrastructures highlights the urgent
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need for a global cooperative framework.
Such a framework must prioritise the
development of resilient health systems
capable of withstanding the challenges
posed by infectious diseases, thereby
safeguarding the health and well-being of
populations worldwide.
An investment in strengthening public
health, primary care and other aspects of
health systems is crucial for enhancing
the capacity to prevent, detect, contain,
and manage disease outbreaks, laying a
solid foundation for core public health
functions essential.
Particular attention should be paid to
individuals in fragile, conflict-affected,
and vulnerable settings; additionally other
individual vulnerabilities factors should
also be addressed including but not limited
to disability, age, gender, indigeneity,
ethnicity, etc..
RECOMMENDATIONS
The WMA calls on the following
stakeholders to:
WHO and United Nations
1. Global Pandemic Infrastructure: Strengthen
global infrastructure for preventing,
monitoring, and responding to
pandemics under the leadership of the
World Health Organization (WHO).
Ensure that this bolsters WHO’s
pivotal role in leading international
health efforts, while fostering a
comprehensive commitment across all
levels of government and society.
2. Political Commitment: Ensure
engagement at the highest level in each
country for political commitment to
pandemic prevention and preparedness
between emergencies and to respond
during emergencies.
3. Global Health Equity: Promote global
equity by addressing social determinants
of health and tackling inequalities that
may drive epidemics and pandemics. Put
in place mechanisms to ensure timely
and equitable access to countermeasures
for all, while prioritizing resource
allocation to public health needs.
Strengthen health systems and continue
broader societal efforts to enhance
equity and the effectiveness of the global
response.
4. Communication and Misinformation:
Ensure consistent public messaging and
monitor public discourse including on
social media and combat misinformation
and disinformation.
5. Legal Frameworks: Strengthen means
of implementation and enforcement
of international legal instruments
for pandemic response, ensuring the
effectiveness of the International
Health Regulations and developing a
comprehensive international pandemic
legal instrument.
6. Data Collection, Sharing, and Universal
Reviews: Strengthen data collection on
infectious diseases and ensure its sharing
across stakeholders, including health
personnel, non-state actors (NSAs),
and governments. Implement Universal
Health and Preparedness Reviews with
strengthened independent monitoring.
Define benchmarks for equitable
resource distribution, healthcare access,
and outcomes across populations.
Monitor disparities to guide equitable
interventions.
7. Stakeholder Collaboration: Broaden
partnerships with governments and
NSAs for an effective multi-sectoral
response, focusing on pathogen and
benefits sharing, and addressing
intellectual property regulations for
equitable resource distribution.
8. Other Sources of Pandemic Risk: Enhance
global health security by integrating
climate change, environmental
degradation, and conflict risk into
pandemic preparedness giving particular
attention to vulnerable populations
through health system strengthening
in climate and conflict-affected regions
to improve resilience and response
capabilities.
National Governments
9. Preparedness, Response, and Governance:
Develop a robust national preparedness
architecture by learning from previous
pandemics, including local and regional
manufacturing of health products,
local stockpiling, and enhance national
governance with anti-corruption
measures. Medical associations and
physicians from all specialties must
be involved in epidemic planning,
preparedness, and response at all levels
to enhance health system effectiveness
during crises.
10. Financing: Provide sufficient and
sustainable funding for global PPPR
including for the WHO, for research
and development, and for national
health systems strengthening.
11. Equitable Resource Allocation: Use a
common but differentiated approach in
establishing obligations for financing.
Ensure resources are directed to those
most in need while maintaining critical
health services in order to mitigate the
severity and duration of pandemics.
12. Health Workforce Strengthening: Support
the health workforce with appropriate
education on PPPR and support for
response, including mental health, safe
working environments including access
to protection measures, and sufficient
human and material resources to deliver
the services required.
13. Health System Strengthening: Ensure
health system continuity so that regular
healthcare services continue to be
provided and that the viability of
services is not compromised by public
health measures.
14. Mental Health Service: Expand mental
health services to ensure comprehensive
support for all affected populations
WMA COUNCIL RESOLUTIONS
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during and after pandemics including
integrating mental health care into
primary health services, establishing
dedicated mental health teams, and
facilitating access to psychological
support for patients, health personnel,
and communities.
15. Digital Technology: Continue to develop
digital health infrastructure to enhance
PPPR capabilities while ensuring
equitable and secure access to digital
health services for all populations, with
particular attention to remote and
underserved communities.
16. Social Protection: Implement socio-
economic support measures during
pandemics to protect populations from
the adverse effects of health crises.
17. Manufacturing infrastructure: Develop
infrastructure for pandemic-related
research and production of critical
equipment, diagnostics, therapeutics,
vaccines and personal protective
equipment (PPE).
18. Science-Guided Response: Guide response
measures by scientific and expert
recommendations, adapting to local
contexts as necessary. Develop National
Pandemic Preparedness Plans.
19. Communication Management: Invest
in public health education to improve
health literacy. Implement laws,
regulations, and administrative rules
targeting the spread of disinformation.
Provide prompt, accurate and
transparent crisis communication
guided by science.
Medical associations and scientific
societies
20. Education and Training: Promote the
integration of pandemic preparedness
and response into higher education
curricula and continuous professional
development education for health
personnel, including courses to integrate
knowledge and skills related to
emerging infectious diseases.
21. One Health: Collaborate with
organizations in the animal
environmental health fields to
implement a One Health approach to
epidemic risk management in order
to establish new methods for
surveillance and control of epidemics
and pandemics.
22. Research and Innovation Dissemination:
Advocate for information sharing
platforms that foster collaborative
research and the exchange of data
across the global scientific community.
23. Partnerships in innovation: Promote
partnerships between public institutions
and private entities as appropriate to
drive innovation, ensuring that the
management of intellectual property
rights promotes universal access to
crucial medical technologies and
treatments. Advocate for equitable
and affordable access to innovations
including medicines and patient-
oriented technology.
24. Community Involvement: Promote
strong relationships between the public
and healthcare providers for inclusive
pandemic management.
25. Resource Forecasting: Assist governments
in resource forecasting and advocate
for safe work environments and the
access to quality assured PPE, and
countermeasures with a specific focus on
the protection in all clinical workplaces.
26. Misinformation Counteraction: Support
the fight against misinformation and
disinformation including by partnering
with social media and online platforms
to effectively identify incorrect
information and disseminate accurate,
evidence-based information. Treat the
spread of disinformation by healthcare
professionals as an unethical behavior
with relevant sanctions.
27. Health Literacy: Organize campaigns to
increase health literacy and awareness
about medical misinformation and
disinformation.
28. Research Acceleration: Encourage
investment in research and fast-track
ethical and peer review processes
for pandemic-related research, while
ensuring full respect for the principles
in the WMA Declaration of Helsinki –
Ethical Principles for Medical Research
Involving Human Participants.
Physicians
29. People-Centred Communication Skills:
Physicians should cultivate clear,
empathetic communication skills to
effectively convey accurate and evidence-
based medical information, address
misconceptions, and educate patients
on identifying credible information in
accordance with the WMA Declaration
of Cordoba on Patient-Physician
Relationship.
30. Advocacy: Report critical resource
shortages, health system failures,
misinformation and disinformation, and
inequities in access to health and public
health.
31. Contribution to public health: Stay
informed about epidemics and
collaborate with public health
authorities on PPPR while meeting
obligations of declaring pathogens of
concern and facilitating appropriate
interventions in the communities served.
WMA COUNCIL RESOLUTIONS
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WMA RESOLUTION IN SUPPORT OF THE
TURKISH MEDICAL ASSOCIATION
Adopted by the 71st WMA General
Assembly (online), Cordoba, Spain,
October 2020 and reaffirmed with minor
revisions by the 227th WMA Council,
Helsinki, Finland, October 2024
The WMA and its members are deeply
concerned about the continuing coercion
of the Turkish Medical Association by the
Turkish authorities.
The Turkish Medical Association is
a dedicated member of the WMA,
recognised for its commitment to serve
public health interests and to protect
patients and physicians with respect for
the ethical values of the profession.
Recalling its Resolution on the
Independence of National Medical
Associations, the WMA opposes such
governmental interference with the
independent functioning of a medical
association and urges the government of
Turkey and the members of the parliament
to:
1. Protect the establishment of the
Turkish Medical Association as a
national independent association and
main representative of all physicians in
the country, and prevent any
legal regulation that will harm its
professional autonomy;
2. Respect the universal professional
values of medicine, which were built
upon thousands of years of experience
and aim to prioritise patient and public
health;
3. Comply fully with international human
rights instruments that Turkey is a State
Party to.
WMA COUNCIL RESOLUTIONS
WMA STATEMENT ON HUMAN
PAPILLOMAVIRUS VACCINATION
Adopted by the 64th General Assembly,
Fortaleza, Brazil, October 2013 and revised
by the 75th WMA General Assembly,
Helsinki, Finland, October 2024
PREAMBLE
Human papillomavirus (HPV) vaccination
presents a unique and valuable opportunity
for physicians to substantially prevent
morbidity and mortality from certain cancers
in all populations, and to improve maternal
health. This may result in economic benefits
for countries who achieve widespread
HPV vaccination in their population in
the current move towards preventive and
promotive healthcare. The HPV vaccine
therefore merits consideration by the World
Medical Association (WMA) separately
from other vaccines.
HPV is, for the most part, sexually
transmitted virus and is so common
that most sexually active adults become
infected at some point in their lives. Most
infections are asymptomatic and resolve
without medical intervention. However,
HPV is the cause of nearly 100% of
cervical cancer cases. Thirteen of the 40
types of HPV are oncogenic and, when they
cause a persistent infection can produce
cervical cancer as well as cancer of the
vagina, vulva, anus, penis, the head and
neck, oropharynx and anogenital area.
Few diseases reflect global inequities as
much as cancer of the cervix. It is the
fourth most common cancer in females
globally, and most cervical cancer cases
and deaths are in low and middle-income
countries.
HPV vaccines protect against infections
caused by targeted HPV types. All available
vaccines afford protection against types
16 and 18, which are the most oncogenic
types and can also offer protection
against anogenital warts. HPV
vaccination is recommended for
females and males from 9-45 years
of age and the immunocompromised
people. HPV vaccines are safe, effective,
and well tolerated.
WHO recommends a one or two-dose
schedule HPV vaccination for females
between 9-14 and 15-20 years old. Females
older than 21 years require two doses with a
6-month interval.[1] Benefits of vaccinating
young males include protection against
genital warts and cancer in addition to
preventing transmission of HPV to sexual
partners.
In 2020 the World Health Assembly
adopted the Global Strategy for cervical
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cancer elimination. To achieve accelerated
elimination of cervical cancer, by 2030,
90% of girls will be fully vaccinated
with the HPV vaccine by the age of 15,
screening programs using a
high-performance test will be running to
screen 70% of women by the age of 35
and again by the age of 45 and 90% of
women with invasive cancer will be
managed.
School-based vaccination or systematic
community programs are strategies that
will increase vaccine accessibility to
the appropriate age groups, particularly
targeting youths prior to the
commencement of sexual activity to
ensure maximum benefit.
RECOMMENDATIONS
1. Reaffirming its Statement on Access
of Women and Children to Healthcare
and its Statement on the Prioritisation
of Immunisation, the WMA insists
on the rights of all women, children,
and indeed all people to adequate, safe
medical care and urges governments
to commit resources to immunisation
programs.
2. The WMA encourages expedited
development and funding of programs
to make safe, high quality HPV
vaccines widely available to both
females and males.
3. The WMA strongly advocates for the
provision of reliable, fast, and accessible
cervical cancer screening programs for
the detection and treatment of
precancerous lesions in all countries,
especially in those that have high
mortality rates from cervical cancer.
4. WMA clearly points out that HPV
vaccination should not replace cervical
cancer screening programs.
5. WMA advises that cancer treatment
and palliative care should be accessible
to all individuals diagnosed with cervical
cancer.
6. A key recommendation is for school-
based vaccination or systematic
community programs to increase vaccine
accessibility to the appropriate age
groups, particularly targeting youths
prior to the commencement of sexual
activity to ensure maximum benefit.
7. The WMA urges national health
authorities, in collaboration with
health professionals’ associations and
other relevant health actors, to carry
out intensive education and advocacy to:
• In all individuals regardless of sex,
improve awareness and understanding
of HPV and associated diseases (such
as, but not limited to, cervical cancer,
head and neck cancer, anal cancer,
and genital cancer), the availability
and efficacy of HPV vaccinations,
and the need for routine HPV related
cancer screening in the general public;
• Improve awareness that condoms
do not provide sufficient protection
against HPV infection because they
do not cover the entire anogenital
area and that HPV also causes cancers
of the oropharynx, anus and penis;
• Communicate the availability and
efficacy of HPV vaccines to educate
the population about the importance
of getting the HPV vaccination;
• Recommend HPV vaccination and
routine cervical cancer screening
and treatment for all eligible people
regardless of the socioeconomic,
cultural, or religious background,
including those that are hard to
reach (including for example those
with disability, refugees and asylum
seekers, and people of diverse sexual
orientation and gender identity);
• Support the availability of the
HPV vaccine and routine cervical
cancer screening for patient groups
that benefit most from preventive
measures, including but not limited to
low-income and pre-sexually active
populations;
• Integrate HPV vaccination (either
primary or catch-up immunisation)
into all appropriate health care
settings and visits involving eligible
people; Routine cervical examination
(whether vaccinated or not against
HPV) should also be incorporated;
• HPV vaccination and routine cervical
cancer screening should also be offered
to people who are incarcerated;
• Integrate and understand the crucial
need for routine cervical cancer
screening in all appropriate health care
settings and visits, and the enhanced
sensitivity and effectiveness of HPV
based screening compared with
Pap smears, VIA (visual assessment
with acetic acid), and VILI (visual
assessment with lugols iodine);
• Integrate HPV cancer prevention
methods, early detection, early
screening, diagnosis, treatment and
palliative care into existing programs
and pre-service training. Such training
will leverage existing support for
HPV programs and help to increase
vaccination efforts;
• Fund research aimed towards
discovering screening methodology
and early detection methods for other
non-cervical HPV associated cancers;
• Encourage and provide training for
cervical cancer survivors to advocate
for HPV vaccination and screening;
• Sustain vaccination efforts to work
towards and raise awareness of the
WHO’s 90-70-90 Global Strategy to
accelerate the elimination of cervical
cancer as a public health problem;
• Support and promote advocacy for
HPV vaccination campaigns.
8. The WMA urges physicians to educate
themselves and their patients about
HPV, associated diseases, HPV
vaccination and routine cervical cancer
screening.
WMA COUNCIL RESOLUTIONS
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WMA STATEMENT ON ADOLESCENT SUICIDE
Adopted by the 43rd World Medical
Assembly, Malta, November 1991, revised
by the 57th WMA General Assembly,
Pilanesberg, South Africa, October 2006
by the 67th WMA General Assembly,
Taipei, Taiwan, October 2016 and
reaffirmed with minor revisions by the
227th WMA Council, Helsinki, Finland,
October 2024
PREAMBLE
The past several decades have witnessed
a dramatic change in causes of adolescent
mortality. Previously, adolescents mostly died
of natural causes, whereas now they are more
likely to die from preventable causes. The
suicide rate among adolescents has risen in
all regions of the world. In the adolescent
population, suicide is currently one of
the leading causes of death. Suicides are
probably under-reported due to cultural and
religious stigma attached to self-destruction
and to an unwillingness to recognise certain
traumas, such as some automobile accidents,
as self-inflicted.
Adolescent suicide is a tragedy that affects
not only the individual but also the family,
peers and larger community in which
the adolescent lived. Suicide is often
experienced as a personal failure by parents,
friends and physicians who blame themselves
for not detecting warning signs. It is also
viewed as a failure by the community,
serving as a vivid reminder that modern
society often does not provide a nurturing,
supportive and healthy environment in
which children can grow and develop.
Factors contributing to adolescent suicide
are varied and include: affective disorders,
trauma, emotional isolation, low self-
esteem, excessive emotional stress, eating
disorders, physical disease, discrimination
and harassment (school bullying, cyber
bullying and sexual harassment), romantic
fantasies, thrill-seeking, drug and alcohol
abuse, the availability of firearms and
other agents of self-destruction, and media
reports of other adolescent suicides, which
may inspire imitation acts. In addition, the
prolonged exposure to electronic media,
which predominantly affects adolescents
through their use of computer games
and social media, can contribute to social
isolation, school failure and malaise amongst
young people.
Youth within correctional facilities are at
a higher risk for suicide than the general
population, yet they have fewer resources
available to them. The lack of resources
makes it difficult to identify those at risk for
suicide.
The incidence of adolescent suicide is
observed to be greater in the “first peoples”
of some nations. The reasons for this are
complex.
The health care of adolescents is best
achieved when physicians provide
comprehensive services, including both
medical and psychosocial evaluation and
treatment. Continuous, comprehensive care
provides the physician the opportunity to
obtain the information necessary to detect
adolescents at risk for suicide or other self-
destructive behaviour. This service model
also helps to build a socially supportive
patient-physician relationship that may
moderate adverse influences adolescents
experience in their environment.
In working to prevent adolescent suicide,
the World Medical Association recognises
the complex nature of adolescent bio-
psycho-social development; the changing
social world faced by adolescents; and the
introduction of new, more lethal, agents of
self-destruction.
In response to these concerns, the World
Medical Association recommends that its
constituent members adopt the following
guidelines for physicians. In doing so,
we recognise that many other players
– parents, governmental agencies, schools,
communities, social services – also have
important roles in this area.
RECOMMENDATIONS
1. All physicians should receive, during
medical school and postgraduate
training, education in child psychiatry
and adolescent bio-psycho-social
development, including education in
the risk factors for suicide.
2. Physicians should be educated to
identify early signs and symptoms of
physical, emotional, and social distress
of adolescent patients. They should
also be educated to identify the signs
and symptoms of psychiatric disorders,
like depression, bipolar disorder and
substance use disorders, that may
contribute to suicide as well as other
self-destructive behaviours.
3. Physicians should be taught how and
when to assess suicidal risk in their
adolescent patients, taking into account
the adolescent’s environment, including
the potential availability of firearms.
4. Physicians should be taught and keep
up-to-date on the treatment and referral
options appropriate for all levels of
self-destructive behaviours of their
adolescent patients. The physicians
with the most significant education
in adolescent suicide are child and
adolescent psychiatrists, so the patient
should be referred to one if available.
5. Physicians should collaborate with the
families or guardians of the adolescents
as well as other relevant stakeholders,
such as social workers, school officials,
and psychologists who bear expertise in
child and adolescent behavior.
6. When caring for adolescents with
any type of trauma, physicians should
WMA COUNCIL RESOLUTIONS
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consider the possibility that the injuries
might have been self-inflicted.
7. When caring for adolescents who
demonstrate deterioration in thinking,
feeling or behaviour, the possibility of
substance abuse and addiction should
be considered, and the threshold should
be lower, with reference to adequate
scientific evidence, for urine toxicology
assessment.
8. Health care systems should facilitate
the establishment of mental health
consultation services aimed at preventing
suicide and should pay for the socio-
medical care given to patients who
have attempted suicide. Services should
be tailored to the specific needs of
adolescent patients. A medical
consultation for adolescents is highly
recommended to enable doctors to
detect any disorders in their patients.
9. Epidemiological studies on suicide, its
risk factors and methods of prevention
should be conducted, and physicians
should keep up-to-date with such
studies.
10. When caring for adolescents with
psychiatric disorders or risk factors
for suicide, physicians should educate
parents or guardians to watch for the
signs of suicide and about the options
for evaluation, and encourage them to
seek support for themselves.
11. Physicians should advocate for the
identification of at-risk groups of
adolescents with the mobilization of
specifically targeted resources directed
at prevention and risk reduction.
WMA COUNCIL RESOLUTIONS
WMA RESOLUTION ON ORGAN
DONATION IN PRISONERS
Adopted by the 173rd WMA Council
Session, Divonne-les-Bains, France, May
2006 and reaffirmed by the 203rd WMA
Council Session, Buenos Aires, Argentina,
April 2016 and revised by the 226th
WMA Council Session, Seoul, Korea,
April 2024 and adopted by the 75th
WMA General Assembly, Helsinki,
Finland, October 2024
PREAMBLE
Whereas the WMA Statement on
Human Organ and Tissue Donation and
Transplantation stresses the importance of
free and informed choice in organ donation
and
Whereas the statement explicitly states
that prisoners and other individuals in
custody are not in a position to give
consent freely, and therefore, their organs
must not be used for transplantation and
Whereas, prior to 2014, there were reports
of Chinese prisoners being executed and
their organs procured for donation; and
Whereas the WMA reiterates its position
that organ donation be achieved through
the free and informed consent of the
potential donor; and
Whereas the WMA General Assembly in
Copenhagen in 2007 was informed that
the Chinese Medical Association (ChMA)
stated in a letter by Dr. Wu Mingjang, (then)
Vice President and Secretary General of
the ChMA that
1. the Chinese Medical Association agrees to
the WMA Statement on Human Organ
Donation and Transplantation, in which
it states that organs of prisoners and other
individuals in custody must not be used
for transplantation, except for members
of their immediate family. The Chinese
Medical Association will, through
its influence, further promote the
strengthening of management of human
organ transplantation and prevent
possible violations made by the Chinese
Government.”[1]
Whereas the Chinese Medical Association
(ChMA) gave a statement regarding the
proposed WMA Declaration on Organ
Donation for Transplantation from
Executed Prisoners at the 223rd Council
meeting in Nairobi 2023, stating:
1. “The Chinese Medical Association (ChMA)
fully supports China’s complete prohibition
on the use of organs from death penalty
prisoners for transplantation, implemented
on January 1st, 2015. This policy has
significantly contributed to the successful
development of voluntary deceased organ
donation in China, propelling the nation
to rank second globally in annual deceased
organ donation and benefiting numerous
Chinese patients.
2. ChMA firmly supports and adheres
China’s comprehensive legal and regulatory
system, as well as the technical capacity
developed to facilitate the legal enforcement,
ensuring the continued prohibition of
using organs from executed prisoners and
the ongoing success of the national organ
donation program.
3. ChMA encourages all her members (to)
actively participates (in) China’s efforts to
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establish a self-sufficient organ donation
system in line with WHO guiding
principle, condemns the practice of using
organs from executed prisoners for
transplantation. ChMA will continue,
and also call upon all national medical
associations, particularly those with
legislation permitting the practice of the
use of organs from executed prisoners, to
educate physicians on ethical values and
conduct in order to prevent such a practice.”
Whereas the WMA reiterates paragraphs
17, 18 and 19 of the undisputed WMA
Statement on Organ and Tissue Donation,
last revised at the WMA 68th. General
Assembly in Chicago, United States,
October 2017, which read:
1. 17. Prisoners and other people who are
effectively detained in institutions should be
eligible to donate after death where checks
have been made to ensure that donation
is in line with the individual’s prior, un-
coerced wishes and, where the individual is
incapable of giving consent, authorisation
has been provided by a family member
or other authorized decision-maker. Such
authorisation may not override advance
withholding or refusal of consent.
2. 18. Their death is from natural causes and
this is verifiable.
3. 19. In jurisdictions where the death
penalty is practised, executed prisoners must
not be considered as organ and/or tissue
donors. While there may be individual
cases where prisoners are acting voluntarily
and free from pressure, it is impossible to
put in place adequate safeguards to protect
against coercion in all cases.
Whereas there have been reports of
purported inappropriate organ procurement
from prisoners within several nations and
the WMA should remain firmly on record
to condemn inappropriate organ
procurement from prisoners and other
people who are effectively detained in
institutions in all nations.
The WMA will amend the title of the
WMA Council Resolution on Organ
Donation in China (2006) to the WMA
Council Resolution on Organ Donation
in Prisoners.
Therefore, the Workgroup on Organ
Procurement (November 2023) proposes to
amend the WMA Council Resolution on
Organ Donation in China (2006), to read as
follows:
The WMA reiterates its position that
organ donation be achieved through the
free and informed consent of the potential
donor.
The WMA calls on its Constituent
member associations to condemn any
practice of using prisoners and other
people who are effectively detained in
institutions as organ donors in any manner
that is not consistent with the WMA
Statement on Organ and Tissue Donation
and ensure that physicians are not involved
in the removal or transplantation of organs
from executed prisoners, and
the WMA demands all national
governments to immediately cease the
practice of using prisoners and other people
who are effectively detained in institutions
as organ donors in any manner that is not
consistent with the WMA Statement on
Organ and Tissue Donation.
[1] WMA News, Chinese Medical
Association reaches agreement with WMA
against transplantation of prisoner’s organs.
Copenhagen, 2007 replace by original
message.
WMA COUNCIL RESOLUTIONS
WMA DECLARATION OF KIGALI ON THE
ETHICAL USE OF MEDICAL TECHNOLOGY
Adopted by the 53rd WMA General
Assembly, Washington, DC, USA,
October 2002, and revised by the 63rd
WMA General Assembly, Bangkok,
Thailand, October 2012 and by the
74th WMA General Assembly, Kigali,
Rwanda, October 2023, and renamed
“Declaration of Kigali” by the 75th WMA
General Assembly, Helsinki, Finland,
October 2024
PREAMBLE
Medical technology has come to play
a key role in modern medicine. It has
helped provide significantly more effective
means of prevention, diagnosis, treatment
and rehabilitation of illness, for example
through the development and use of
information technology, such as telehealth,
digital platforms and large-scale data
collection and analyses, or the use of
advanced machinery and software in
areas like medical genetics and radiology,
including assistive, artificial, and augmented
intelligences.
The importance of technology for medical
care will continue to grow and the WMA
welcomes this progress. The continuous
development of medical technologies –
and their use in both clinical and research
settings – will create enormous benefits for
the medical profession, patients, and society.
However, as for all other activities in the
medical profession, the use of medical
technology for any purpose, must take
place within the framework provided by the
basic principles of medical ethics as stated
in the WMA Declaration of Geneva: The
Physician’s Pledge, the International Code
of Medical Ethics and the Declaration of
Helsinki.
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Respect for human dignity and rights, patient
autonomy, beneficence, confidentiality,
privacy and fairness must be the key
guiding points when medical technology
is developed and used for medical purposes.
The rapidly developing use of big data
has implications for confidentiality and
privacy. Using data in ways which would
damage patients’ trust in how health
services handle confidential data would be
counterproductive. This must be borne in
mind when introducing new data driven
technology. It is essential to preserve high
ethical standards and achieve the right
balance between protecting confidentiality
and using technology to improve patient
care.
Additionally, bias through for example social
differences in the collection of data may
skew the intended benefits of data driven
medical treatment innovations.
As medical technology advances and the
potential for commercial involvement
grows, it is important to protect
professional and clinical independence.
RECOMMENDATIONS
Beneficence
1. The use of medical technology should
have as its primary goal benefit for
patients’ health and well-being. Medical
technology should be based on sound
scientific evidence and appropriate
clinical expertise. Foreseeable risks and
any increase in costs should be weighed
against the anticipated benefits for the
individual as well as for society, and
medical technology should be tested or
applied only if the anticipated benefits
justify the risks.
Confidentiality and privacy
2. Protecting confidentiality and respecting
patient privacy are central tenets of
medical ethics and must be respected in
all uses of medical technology.
Patient autonomy
3. The use of medical technology must
respect patient autonomy, including
the right of patients to make informed
decisions about their health care
and control access to their personal
information. Patients must be given the
necessary information to evaluate the
potential benefits and risks involved,
including those generated by the use of
medical technology.
Justice
4. To ensure informed choices and avoid
bias or discrimination, the basis and
impact of medical technology on
medical decisions and patient outcomes
should be transparent to patients and
physicians. In support of fair and
equitable provision of health care, the
benefits of medical technology should
be available to all patients and
prioritized based upon clinical need
and not on the ability to pay.
Human rights
5. Medical technology must never be
used to violate human rights, such as
use in discriminatory practices, political
persecution or violation of privacy.
Professional independence
6. To guarantee professional and clinical
independence, physicians must strive to
maintain and update their expertise and
skills, i.e., by developing the necessary
proficiency with medical technology.
Medical curricula for students and
trainees as well as continuing education
opportunities for physicians must be
updated to meet these needs. Physicians
shall be included in contributions to
research and development. Physicians
shall remain the expert during shared
decision making and not be replaced by
medical technology.
7. Health care institutions and the medical
profession should:
• help ensure that innovative practices or
technologies that are made available to
physicians meet the highest standards
for scientifically sound design and
clinical value;
• require that physicians who adopt
innovations into their practice have
relevant knowledge and skills;
• provide meaningful professional
oversight of innovation in patient care;
• encourage physician-innovators to
collect and share information about
the resources needed to implement
their innovations safely, effectively, and
equitably; and
• assure that medical technologies are
applied and maintained appropriately
in accordance with their intended
purpose.
8. The relevance of these general
principles is stated in detail in several
existing WMA policies. Of particular
importance are:
• WMA Declaration of Seoul on
Professional Autonomy and Clinical
Independence
• WMA Declaration of Helsinki –
Ethical Principles for Medical Research
Involving Human Subjects
• WMA Declaration of Taipei on Ethical
Considerations regarding Health
Databases and Biobanks
• WMA Statement on Augmented
Intelligence in Medical Care
• WMA Statement on Digital Health
• WMA Statement on Cyber-Attacks
on Health and Other Critical
Infrastructure
• WMA Statement on Access to Health
Care
• WMA Declaration of Lisbon on the
Rights of the Patient
• WMA Declaration of Oslo on Social
Determinants of Health
The WMA encourages all relevant
stakeholders to embody the ethics
guidance provided by these documents.
WMA COUNCIL RESOLUTIONS
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WMA STATEMENT ON ASSISTED
REPRODUCTIVE TECHNOLOGIES
Adopted by the 57th WMA General
Assembly, Pilanesberg, South Africa,
October 2006, revised by the 73rd
WMA General Assembly, Berlin,
Germany, October 2022, and revised
in its recommendation 14 by the 75th
WMA General Assembly, Helsinki,
Finland, October 2024
PREAMBLE
Assisted Reproductive Technology [ART]
encompasses a wide range of techniques
designed primarily to aid individuals
unable to conceive without medical
assistance.
ART is defined as any fertility treatment
in which either gametes or embryos are
handled.
Assisted reproductive technologies may raise
profound ethical and legal issues. Views and
beliefs on assisted reproductive technologies
vary both within and among countries
and are subject to different regulations in
different countries.
Central to much of the debate in this area
are issues around the moral status of the
embryo, the way in which ART is viewed
morally, societally and religiously, the child/
ren born from ART, and the rights of all
participants involved, i.e. donors, surrogates,
the child/ren and the intended parents are
just some of the issues central to the debate
in ART. Whilst consensus can be reached
on some issues, there remain fundamental
differences of opinion that are more
difficult to resolve.
Assisted conception differs from the
treatment of illness in that the inability
to become a parent without medical
intervention is not always regarded as an
illness. Notwithstanding, the inability to
conceive may also be a result of prior illness.
In many jurisdictions, the process of
obtaining consent must follow a process
of information giving and the offer of
counselling and might also include a formal
assessment of the patient in terms of the
welfare of the potential child.
Faced with the progress of new
technologies of assisted reproduction,
physicians should keep in mind that not
everything that is technically feasible is
ethically acceptable. Genetic manipulation
that does not have a therapeutic purpose
is not ethical, nor is the manipulation on
the embryo or foetus without a clear and
beneficial diagnostic or therapeutic purpose.
RECOMMENDATIONS
1. Physicians involved in providing assisted
reproductive technologies should always
consider their ethical responsibilities
towards all parties involved in a
reproductive plan, which may include
the future child/ren, donor, surrogate or
parents. If there is compelling evidence
that a future child, donor, surrogate
or parent would be exposed to serious
harm, treatment should not be provided.
2. As with all other medical procedures,
physicians have an ethical obligation to
limit their practice to areas in which
they have relevant expertise, skill, and
experience and to respect the autonomy
and rights of patients.
3. In practice this means that informed
consent is required as with other
medical procedures; the validity of
such consent is dependent upon the
adequacy of the information offered to
the patient and their freedom to make
a decision, including freedom from
coercion or other pressures or influences
to decide in a particular way.
4. The consent process should include
providing the participant/s with
understandable, accurate and adequate
information about the following:
• The purpose, nature, procedure, and
benefits of the assisted reproductive
technology that will be used.
• The risks, burdens and limitations of
the assisted reproductive technology
that will be used.
• The success rates of the treatment and
possible alternatives, such as adoption.
• The availability of psychological support
for the duration of the treatment
and, in particular, if a treatment is
unsuccessful.
• The measures protecting confidentiality,
privacy and autonomy, including data
security measures.
5. The following should be discussed
during the informed consent process:
• Detailed medical risks;
• Whether or not all biological samples
involved in ART, including but not
limited to donor eggs, sperm, gametes
and genetic information, may be used
for research purposes;
• The risks of multiple donations and
donating at multiple clinics;
• Confidentiality and privacy issues;
• Compensation issues.
6. Donors, surrogates and any resulting
child/ren seeking assisted reproductive
technologies are entitled to the same
level of confidentiality and privacy as
for any other medical treatment.
WMA COUNCIL RESOLUTIONS
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7. Assisted reproductive technology
involves handling and manipulation of
human gametes and embryos. There
are different levels of concern with the
handling of such material, yet there is
general agreement that such material
should be subject to specific safeguards
to protect from inappropriate, unethical,
or illegal use.
8. Physicians should uphold the
principles in the WMA Statement on
Stem Cell Research, WMA Statement
on Human Genome Editing, the WMA
Declaration of Helsinki, and the WMA
Declaration of Reykjavik – Ethical
Considerations Regarding the Use of
Genetics in Health Care.
9. Physicians should, where appropriate,
provide ART in a non-discriminatory
manner. Physicians should not
withhold services based on nonclinical
considerations such as marital status.
Multiple pregnancies
10. Replacement of more than one embryo
will raise the likelihood of more than
one embryo implanting. This is offset
by the increased risk of premature
labour and other complications in
multiple pregnancies, which can
endanger the health of both the
mother and child/ren. Practitioners
should follow professional guidance on
the maximum number of embryos to be
transferred per treatment cycle.
11. If multiple pregnancies occur, selective
termination or fetus reduction will only
be considered on medical grounds and
with the consent of all participants
involved to increase the chances of the
pregnancy proceeding to term, provided
this is compatible with applicable laws
and codes of ethics.
Donation
12. Donation should follow counselling and
be carefully controlled to avoid abuses,
including coercion or undue influence
of potential donors. Explicit instructions
should be provided about what will be
done with any donated samples if the
donor is known to have died prior to
implantation.
13. The WMA holds the view that
gamete donation should at best
not be commodified, thus serving a
humanitarian benefit.
14. Appropriate controls and limits on
methods used to encourage donations
should be ensured. All donations must
comply with national legislation and
appropriate ethical guidance, including
the maximum amount of gamete
donations per person. Guidance on the
maximum number of children allowed
through donation from a single donor
should be developed and adhered to,
to avoid unintended incest, inbreeding
and psychological harm to those
involved. Physicians should advocate
for and contribute to the development of
such ethical guidance, if such guidance
does not exist.
15. Due to the widespread use of genetic
technology and registries, it has become
possible to identify donors, despite
clinics and donors’ attempts to maintain
strict confidentiality.A child/ren born
as a result of donation may in future
contact donors. Potential donors must be
made aware of this possibility as part of
the consent process.
16. Where a child is born following
donation, families should be encouraged
and supported to be open with the child
about this, irrespective of whether or
not domestic law entitles the child to
information about the donor. This may
require the development of supportive
materials, which should be produced to
a national normative standard.
Surrogacy
17. Where a woman is unable, for medical
reasons, to carry a child to term,
surrogate pregnancy may be used
to overcome childlessness unless
prohibited by national law or the
ethical rules of the National Medical
Association or other relevant
organizations. Where surrogacy is
legally practiced, great care must be
taken to protect the interests of all
parties involved.
18. Prospective parents and surrogates
should receive independent and
appropriate legal counsel.
19. Medical tourism for surrogacy purposes
should be discouraged.
20. Commercial surrogacy should be
condemned. However, this must not
preclude compensating the surrogate
mother for necessary expenses.
21. The rights of surrogate mothers must
be upheld, and great care must be taken
to ensure that they are not exploited.
The rights of surrogate mothers
include, but are not limited to:
• Having her autonomy respected;
• Where appropriate, having health
insurance;
• Being informed about any medical
procedure and the potential side effects;
• Where possible, choosing her medical
team if side effects develop;
• Having psychological help at any point
during the pregnancy;
• Having medical expenses such as
doctor visits, the actual birthing
process, fertilization and any
examinations related to the surrogacy
covered by the intended parent/s;
• Loss if income covered if unable to
work during the pregnancy;
• Receiving the compensation and/or
reimbursements agreed to in any legal
agreement
WMA COUNCIL RESOLUTIONS
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Pre-implantation Genetic Diagnosis
(PGD)
22. Pre-implantation genetic diagnosis
(PGD) and pre-implantation genetic
screening (PGS) may be performed
on early embryos to search for the
presence of genetic or chromosomal
abnormalities, especially those
associated with severe illness and
very premature death, and for other
ethically acceptable reasons, including
identifying those embryos most likely
to implant successfully in women who
have had multiple spontaneous abortions.
23. It is recommended to encourage
screening for infectious diseases in
sperm donors and to determine
whether to inform donors of positive
tests.
24. Physicians must never be involved
with sex selection unless it is used to
avoid a serious sex-chromosome related
condition, such as Duchenne’s Muscular
Dystrophy.
Research
25. Physicians have an ethical duty to
comply with such regulation and to
help inform public debate and
understanding of these issues.
26. Research on human gametes and
embryos should be carefully controlled
and monitored and in accordance with
all applicable national laws and ethical
guidelines.
27. Views and legislation differ on
whether embryos may be created
specifically for, or in the course of,
research. Physicians should act in
accordance with the declarations of
Taipei and Helsinki, as well as all
applicable local laws and ethical and
professional standards advice.
28. The principles of the Convention
on Human Rights and Biomedicine
should be followed.
WMA COUNCIL RESOLUTIONS
WMA RESOLUTION ON THE REVOCATION
OF WHO GUIDELINES ON OPIOID USE
Adopted by the 70th WMA General
Assembly, Tbilisi, Georgia, October
2019 and reaffirmed with minor revisions
by the 227th WMA Council, Helsinki,
Finland, October 2024
The World Medical Association remains
concerned about the abrupt discontinuation
of WHO 2011 guidance “Ensuring balance
in national policies on controlled substances:
Guidance for availability and accessibility
of controlled medicines”, as well as its 2012
“WHO guidelines on the pharmacological
treatment of persisting pain in children
with medical illnesses.”
This revocation, which took place in June
2019 without consulting the medical
community, deprives many physicians
of support and regulation in countries
without related national legislation, thus
endangering their medically justified use
of such substances. Ultimately, suffering
patients will not have access to proper
medication.
The WMA notes that the withdrawal was
decided unilaterally, without providing
any supporting evidence and without
including any replacement or substitution.
Moreover, the discontinued guidelines
were fully removed from the WHO online
publications portal, thus impeding the
ability of physicians to justify and
validate retrospectively the use of
controlled substances, exposing them
potentially to criminal prosecution.
The WMA demands the adherence to
the principle of evidence-based development
of treatment guidelines. This should
apply to the definition, amendment and
discontinuation of such guidance, in
addition to the application of a
precautionary principle. Evidence
supporting the revocation of the opioid-
guidelines must be published and made
available for scientific scrutiny.
The WMA demands that the announced
revision process by WHO for the two
discontinued guidelines be promptly
completed in an open and transparent
process, including a reliable mechanism to
ensure the disqualification of experts with
conflicts of interest.
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WMA GUIDELINES ON PROMOTIONAL MASS
MEDIA APPEARANCES BY PHYSICIANS
Adopted by the 66th WMA General
Assembly, Moscow, Russia, October 2015
and reaffirmed with minor revisions by
the 227th WMA Council, Helsinki,
Finland, October 2024
PREAMBLE
Mass media, including social media, can
effectively play diverse roles in medical
communication. Physicians, as professionals
and experts, can contribute to improved
public health by providing the public with
accurate health related information. Mass
media provides a channel through which
physicians may contribute to society by
leveraging mass media appearances in
positive ways.
However, the increase in instances of
physicians’ frequent appearances on mass
media to recommend unproven treatments
or products and to use such appearances
for marketing purposes is posing a serious
concern. The public may readily accept
groundless recommendations by physicians
and may develop unrealistic expectations.
The subsequent confusion and
disappointment can damage the patient-
physician relationship.
This issue is more serious in some
countries where there are different systems
of medicine, including alternative medicine.
GUIDELINES
1. The WMA recalls its Statement on
the Professional and Ethical Use of
Social Media and recommends the
following guidelines regarding mass
media appearances by physicians to
prevent them from being involved in
commercial activities that may
compromise professional ethics and to
contribute to patient safety by ensuring
physicians providing accurate, timely,
and objective information.
Accurate and Objective Delivery
of Scientifically Proven Medical
Information
2. When appearing in media, physicians
shall provide objective and evidence-
based information and shall not
recommend medical procedures or
products that are not medically proven
or justified.
3. A physician shall not use expressions
that may promote unrealistic patient
expectations or mislead viewers about
the function and effect of medical
procedures, drugs or other products.
4. Physicians shall include important
information, such as possible adverse
effects and risks, when explaining
medical procedures, drugs, or other
products.
Not Abusing Mass Media as a Means of
Advertisement
5. Physicians should not recommend
specific products by either specifically
introducing or intentionally
highlighting the name or trademark
of a product.
6. Physicians shall practice prudence
regarding personal appearances on
home shopping programs. The
physician should have no financial
stake in the products being sold.
7. Physicians shall not be a part of mass
media advertisement on any product
which is harmful to humans and/or the
environment.
Maintaining Professional Integrity
8. Physicians shall not require or receive
economic benefits for mass media
appearances other than a customary
appearance fee.
9. Physicians shall not provide economic
benefits to broadcasting personnel in
order to secure mass media appearances.
10. Physicians shall not engage in
the promotion, sale or advertising
of commercial products and shall
not introduce false or exaggerated
statements regarding their
qualifications, such as academic
background, professional experience,
medical specialty and licensure as
a specialist, for the benefit of the
economic interests of any commercial
entity.
WMA COUNCIL RESOLUTIONS
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Mental healthcare in Latvia has
a long and eventful history, after
gaining independence from the
Soviet Union in 1991. The country
has undergone significant policy
reforms, changes in public attitudes,
and efforts to align with European
Union (EU) standards. Joining
the EU in 2004 and Organization
for Economic Co-operation and
Development (OECD) in 2016
was crucial in shaping psychiatric
care policies and attracting EU
funding for mental healthcare
services, which required shifting
away from institutional care,
developing outpatient services,
improving standards of care, and
emphasising patient rights. To
enhance the development of
professionals trained in psychiatry
and addiction psychiatry, strong
healthcare system leadership is
needed to identify gaps in academic
and clinical training, financial
resources, and stakeholder support,
to meet the needs of the 1.9
million residents.
Development of the Mental
Healthcare System in Latvia
Although the restoration of
Latvia’s independence occurred
more than 30 years ago, some
features of the Soviet Union system
are still visible today. For example,
patients arrive without appointments
and form waiting lines at doctors’
offices, resulting in limited
confidentiality, and physicians
tend to work individually without
collaborating with other specialists
in patient care management.
Despite these challenges following
the restoration of Latvia’s
independence, Latvian psychiatry
rapidly and irrevocably entered the
European and world psychiatric
communities. The Latvian
Psychiatric Association became a
member of the World Psychiatric
Association, European Psychiatric
Association, and Nordic Psychiatric
Association, demonstrating the
active and productive cooperation
with psychiatrists from Germany,
Canada, Sweden, Norway, and other
countries. On 6-7 June 2024, Latvia
hosted the Congress of the Nordic
Psychiatric Association for the first
time with speakers and audience
members from Denmark, Estonia,
Finland, Iceland, Latvia, Lithuania,
Norway, and Sweden.
Mental Health as a Public Health
Priority
As a country with a high-income
level and 1.9 million residents,
strengthening mental health services
in Latvia has remained a top public
health priority in recent years.
During the coronavirus disease 2019
(COVID-19) pandemic, national
support for mental health services
was forefront in public discourse,
when society experienced direct and
indirect challenges to mental health,
such as increased anxiety about
the unknown reality, socialisation
restrictions, workplace changes,
decreased access to healthcare
services, and worsening socio-
economic situations.To help mitigate
the mental health impacts of the
COVID-19 pandemic, the Latvian
government expanded government-
funded services in May 2021, where
citizens could seek consultations
for state-funded psychological and
psychotherapeutic support, upon
referral from general practitioners
Liene Sile
Entering the Fourth Decade of Independence:
Post-Socialism Development of Mental Healthcare
Maris Taube
Zane Egle
Linda Seldere
Post-Socialism Development of Mental Healthcare
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Post-Socialism Development of Mental Healthcare
or psychiatrists. Various community
activities were coordinated to
encourage the public to become
more aware of their mental health,
recognise the importance of
promoting and preserving their
mental health across the lifespan,
and gain confidence to discuss these
topics with healthcare professionals
[1].
Psychiatry Nowadays
Until the 2000s, psychiatry in
Latvia was hospital-based to provide
healthcare services to manage acute
and severe mental health disorders.
Over the past two decades, modern
psychiatry in Latvia has transitioned
to a biological, psychological, and
social approach, providing patients
with medical treatment, social
support, and psychotherapeutic
help. This approach recognises that
assistance to psychiatric patients
promotes patients’ maximum
inclusion in society while respecting
their autonomous wishes and
interests. With advancements
in pharmaceutical agents based
on evidence-based research,
the global availability of these
modern medications has enhanced
the capacity to manage clinical
symptoms with fewer side effects
and hence improve patients’ quality
of life.
Mental healthcare services are
provided in outpatient and inpatient
settings, and social stigma is
still associated with the need for
psychiatric care. Patients with
milder conditions are frequently
treated in primary care. Outpatient
psychiatric care in Latvia is provided
by independent psychiatric practices,
outpatient departments at psychiatric
and general hospitals, and municipal
psychiatric consulting rooms in
primary care centres (Figure 1)
– with a total of 50 outpatient
psychiatric care providers in 2022
[1,2].
Psychiatric hospitals are government
funded and function as self-sufficient
institutions, where healthcare
providers help manage acute- and
long-term treatment (including
addition) of psychiatric patients,
and hospital admissions are by
referral from a psychiatrist, general
practitioner or emergency physician.
Long-term treatment, which is
considered social care provided
by the Ministry of Welfare of the
Republic of Latvia, aims to stabilise
treatment-resistant patients with
psychiatric diagnoses that cannot
be managed in acute or subacute
hospital settings or at home [3,4].
For example, the National Centre of
Mental Health, State LTD, as the
largest mental healthcare provider
in Latvia, provides laboratory
testing, electrocardiography,
electroencephalography, x-ray
examinations, and specialist
consultations (e.g. gynaecology,
dentistry, neurology), which
facilitates the supervision of financial
resources.
As out-patient departments have
a long waiting time (e.g. up to
two months), the organisation
of emergency care represents an
existing regulatory framework that
allows walk-in consultations in
hospital emergency care departments.
Notably, this framework can increase
the workload and risk of burnout for
emergency psychiatrists. If patients
arrive at the emergency department
with health conditions that do
not require hospitalisation or 24-
hour observation, these services are
covered by the government [5].
Mental healthcare has traditionally
focused on inpatient care, and
attempts to move towards outpatient,
community-based mental health
services were mainly triggered by
calls from the World Health
Organization (WHO) [6]. Over
the past few decades, the number
of psychiatric hospital beds in
Latvia has decreased, and treatment
time has shortened. For example,
the average number of inpatient
beds (per 100,000 habitants) has
decreased from 114 in 2010 to 101
in 2022, and the average number
of bed days per one patient day
has decreased from 39.6 in 2010 to
Figure 1. Coverage of mental health care facilities in Latvia, 2022. Credits: Cabinet of Ministers of Latvia Regulation
No. 939 (adopted 13 December 2022) [2]
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Post-Socialism Development of Mental Healthcare
29.2 in 2022 [7]. The number of
patients attending day care clinics is
increasing, as it facilitates a timely
start of treatment and cooperation
during the post-hospitalisation
period and promotes continuity of
treatment.
To reduce the number of hospital
admissions and length of hospital
stays, the Ministry of Health of the
Republic of Latvia established three
outpatient centres in Riga in 2005,
2013, and 2024, covering a care area
of approximately 700,000 habitants.
These centres provide outpatient
psychiatric appointments, multi
professional team treatment in out-
patient setting, and day clinics with
rehabilitation. Notably, two centres
have an open-door inpatient ward
[8].
Mental Healthcare Pilot Projects
Pilot projects and community-
based treatment methods are
successfully implemented, such as
early intervention programme for
first-time schizophrenia spectrum
psychosis patients, transition of
children to adult psychiatry, and
a mobile methadone unit [9].
On 1 June 2023, the National
Centre of Mental Health, State
LTD, implemented an important
pilot project to strengthen mental
health care in Latvia: the state-
funded early intervention program
for patients with schizophrenic
spectrum disorders. This six-month
program provides patients with
outpatient mental healthcare, active
involvement of a multiprofessional
team of specialists, and patient
transfer from psychosis inpatient
treatment to outpatient care without
any waiting time.
Policies and National Plans
Over the past two decades, the
Government of Latvia has been
working on mental health reforms
to improve the quality and
accessibility of care, including
deinstitutionalisation and the
development of community-based
services. As a member of the
European Union (EU), Latvia’s
psychiatric care system is influenced
by EU policies and standards,
pushing for modernization and
alignment with best practices
in mental healthcare. The first
national mental healthcare guideline
(Improving Mental Health of the
Population, 2009-2014) was adopted
in 2008, with funding from the
European Social Fund, marking a
significant breakthrough for mental
healthcare in Latvia. It highlighted
challenges related to limited access
to high-quality mental healthcare,
lack of community-based mental
health services, insufficient number
of medical personnel, and uneven
regional distribution [10]. After the
launch of these guidelines, the first
national planning document was
issued for 2013-2014.
Since 2008, mental healthcare
has been one of the main
priorities in Latvian healthcare
system. In December
2022, the latest plan for the
improvement of the organisation
of mental healthcare services (Plan
for Improving the Organization of
Mental Healthcare in Latvia, 2023-
2025) was approved, but not yet
implemented due to limited funding
resources [2,4]. As the plan intends
to reduce the number of psychiatric
hospital beds, it also focuses on
the development of outpatient and
community-based mental health
services, promoting early diagnosis
of mental illnesses, ensuring timely
and subsequent treatment, and
providing high-quality medical
rehabilitation.
Financing
After regaining independence,
Latvia experimented with
introducing Social Health Insurance,
but later moved to a National
Health Service (NHS)-type system,
with a purchaser-provider split and a
mix of public and private providers.
The NHS is the central national
institution for administering the
public budgetary funds of the health
sector, and contracting services from
health service providers. Regulatory
functions are concentrated mainly
in the central government (e.g.
Parliament, Cabinet of Ministers,
Ministry of Health of the Republic
of Latvia, government agencies), and
financing is mainly through general
taxation. The total current health
expenditure remains among the
lowest in Europe, as state financing
comprises only 54% of total health
expenditure, and the rest is financed
by out-of-pocket (OOP) payments
[3].
A detailed range of services and
regulations for the provision of
services and tariffs for state-paid
healthcare interventions are defined
by the Cabinet of Ministers, in
accordance with Regulation No. 555.
The scope of services included in
the state-paid services is determined
by a number of explicit inclusion and
exclusion lists as well as by certain
implicit criteria. Mental healthcare
in outpatient and inpatient settings
is included in state-funded services.
Although healthcare service users
pay co-payments (fixed amount
per consultation visit or hospital
stay), where mental healthcare
services are exempt from co-
payments, the NHS reimburses
providers for these co-payments [5].
However, limited state financing
leads to long waiting lists for
outpatient visits, especially in Riga
and for paediatric psychiatrists.
Depending on the diagnosis,
50
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Post-Socialism Development of Mental Healthcare
medications for patients with
mental and behavioural disorders are
fully or partially (75%) compensated
from the state budget.
Medical Education and Shortage
of Specialists
The undergraduate medical
education program in Latvia is
six 
years long and leads to the
award of the Medical Doctor (MD)
degree (EQF Level 7), preparing
highly qualified clinicians, scientists,
and academicians to serve the
Latvian healthcare system. The
medical education system in Latvia
is being constantly evaluated,
adjusted, and updated based on
recent technological and biomedical
advancements [11]. Upon the
successful completion of state
examinations, students can continue
their medical education through a
residency programme in more than
70 specialties, subspecialties, and
additional specialties. The Ministry
of Health of the Republic of Latvia
determines the annual availability
of government-subsidised positions
for each specialty, considering the
demand for the specialties from
hospitals, health needs of the society,
and existing and projected supply
of doctors in each specialty. Upon
completion of medical residency,
students become licensed specialists,
commence their professional careers
in their respective specialty, and
participate in continuing professional
development opportunities.
Currently, there are three basic
specialities in mental health with
four-year residency programs
(psychiatry, child psychiatry,
addiction psychiatry) and
one subspeciality with an
additional two-year residency
program (forensic psychiatry).
Starting in 2025, the educational
reform will transition to two basic
specialities (psychiatry and child
psychiatry with four-year residency
programs) and two additional
subspecialities (forensic psychiatry
with an additional two-year residency
program and addiction psychiatry
with an additional one-year
residency).
For medical residents, policies
related to the order of admission,
distribution of residency specialities,
and financing are set in accordance
with the regulations of the
Cabinet of Ministers. Although
many factors are considered when
confirming the annual number of
residency positions, the number
of psychiatry residency positions
remains insufficient [12]. In 2023, a
total of 70 adult psychiatrists were
providing outpatient consultations
in five mental health hospitals,
and together covering 26.3 shifts.
However, to improve quality and
extend direct time with patients,
there should be 64 full time shifts
covered. In 2024, a total of 66 adult
psychiatrists in these five hospitals
covered 72.6 shifts (or one doctor
per 23 inpatient beds). Hence, by
reducing the number of patients,
one doctor must cover an additional
73 shifts.
Community-Based Mental
Healthcare
Although progress has been slow
over the past few years, Latvia
has been transitioning towards
a community-based approach to
psychiatric care, reflecting broader
trends in mental healthcare
reform across Europe. Similar to
other post-socialism countries,
Latvian psychiatric care was
heavily institutionalised, with a
focus on large psychiatric hospitals.
However, in recent years, there
has been change towards
deinstitutionalization and the
development of community-
based services aimed at better
integrating mental healthcare
into the community. These
changes include reducing
long-term beds in psychiatric
hospitals, improving outpatient
services, inventing mobile mental
health teams, working on primary
care integration and rehabilitation
services, transitioning from long-
term social institutions to group
apartments, and providing more
social assistance. Despite these
advances, existing challenges are
limited funding, insufficient number
of mental health professionals,
stigma, and regional disparities
related to healthcare service access
and availability. Furthermore, one
primary problem is that patients are
receiving basic healthcare services
in tertiary-level hospitals, leading
to overworked specialists and high
healthcare expenditure.
Mental Healthcare System
Registry
In Latvia, the mental healthcare
system includes a centralised mental
health registry with data from
various healthcare institutions, as
an official record of mental health
diagnoses, treatments, and outcomes.
The registry operation is governed
Diagnosis​
(ICD-10)
Percentage
of Latvian
population
(%) [8,13]
Percentage
of global
population
(%) [14]
Bipolar disorders
(F31)
0.05 0.5
Depressive
disorders
(F32, F33)
0.57 ​ 4 .0​
Anxiety disorders
(F40-F48)
0.72 ​ 4.4 ​
Eating disorders
(F50)
0.01 0.2 ​
Table 1. Data from the Latvian Mental Health Registry,
compared to global data, 2021 [8,13,14]
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Post-Socialism Development of Mental Healthcare
by national laws and regulations
that define how data are collected,
stored, and used. Specifically,
government-funded institutions
have mandatory reporting
obligations, where doctors must
add patients’ names to the registry.
The general society (especially low-
income populations) fears visiting
psychiatrists, as these reports may
restrict their rights to attain drivers’
licences or seek job opportunities.
Health professionals have engaged,
albeit unsuccessfully, in dialogue
with the Ministry of Health of
the Republic of Latvia to close the
government registry.
Like many mental health systems
globally, the mental health registry
in Latvia faces challenges such
as stigmatising individuals with
mental health issues, underreporting,
and ensuring data accuracy and
reporting timeliness. When
comparing data between the Latvian
and global registries about mental
health diagnosis, it suggests that a
significant percentage of patients has
left government-funded healthcare
and chose to pay OOP for private
sector psychiatrist consultations in
the private sector (Table 2).
Narcology to Addiction Psychiatry
Psychiatrists are collectively
advocating for replacing the terms
“narcology” and “narcologist” with
“addiction psychiatry” and “addiction
medicine”, as a broader shift
toward more scientifically grounded
and internationally recognised
specialties. The term “narcology”,
has fallen out of favour in most
parts of the world. Historically, the
term “narcology” was traditionally
used in Russia and some post-
socialism countries to describe the
medical disciplines dealing with
substance abuse. However, it has
been associated with outdated or
ineffective treatment practices like
detoxification and “coding” (form
of aversive therapy). These practices
have contributed to the field’s
reputation as being regressive and
isolated from global advances in
addiction treatment [15].
In contrast, the terms “addiction
medicine” and “addiction psychiatry”
have gained recognition as modern,
evidence-based specialties that
address substance use disorders
through a combination of medical,
psychological, and social approaches.
This evolution reflects a growing
understanding of addiction as
a complex, chronic condition
that requires comprehensive
care rather than just punitive or
simplistic treatment methods.
Countries outside of Russia
have adopted these newer terms,
emphasising a more holistic
and research-based approach to
treating addiction, as a transition
that aligns with the WHO’s
recommendations for treating
substance use disorders [16].
Latvia has reported the highest
per capita registered alcohol
consumption rate among the
EU and OECD countries [17].
The rate of illicit drug use is
increasing within society, reflecting
the youth’s low health literacy
[18]. These statistics suggest
that addiction medicine has not
been previously effective, whether
managed by hospital-based services
for acute cases or outpatient services
for routine consultations. Notably,
health professionals working
in addiction psychiatry within
the government sector use the
Minnesota model (known as the
abstinence model) of addiction
treatment. With dedicated efforts
and hope for the future, albeit
existing challenges, they recognise
that improvements in this field,
including robust psychosocial
interventions, are urgent.
Professional Medical Associations
and Methodological Institutions
The Latvian Medical Association
and its professional associations have
led efforts to evaluate and update
professional standards in mental
health. The Latvian Psychiatric
Association, which commemorates
its 100th anniversary this year,
has published guidelines on key
psychiatry disorders, including
anxiety disorders, bipolar disorders,
depression, schizophrenia, and
sleep disorders. In 2019, Latvia
participated in a project co-financed
by the European Social Fund,
which resulted in the publication of
quality indicators as well as clinical
algorithms and pathways on diverse
mental health topics. These topics
included alcohol addiction treatment,
double diagnoses in addiction
medicine and psychiatry, and
treatment of opioid-dependent
patients, as well as diagnosis and
treatment of clinical disorders
in all ages (schizophrenia,
depression, dementia, autism
spectrum disorder) and in
children and adolescents (eating
disorders, neurodevelopmental
disorders, suicidal and non-
suicidal self-harm, attention deficit
hyperactivity disorder) [19]. These
achievements are attributed to
voluntary contributions from health
professionals; however, there are no
formal policies to ensure that these
standards and guidelines (including
quality criteria) are implemented in
clinical practice.
In 2024, the Ministry of Health of
the Republic of Latvia supported
a leadership paradigm shift with
government and EU financial
support to designate nine priority
professions (oncology, cardiology,
psychiatry, paediatrics, traumatology,
family medicine, rehabilitation,
gynaecology, radiology) – with
selected clinicians (without
52
Post-Socialism Development of Mental Healthcare
BACK TO CONTENTS
pharmacological or private
sector conflicts) – to serve as
methodological experts and lead
the development of standards for
clinical practice. These national
steps aim to support that evidence-
based standards are implemented
by all Latvian healthcare providers
with long-term sustainability across
institutions.
Conclusion
Since the 1990s, Latvia’s psychiatric
care system has made substantial
progress, with the transition from
institutionalisation to community-
based mental healthcare services,
marking mental health as a national
priority. Despite existing challenges
such as stigma, limited resources, and
the need for expanded community-
based services, mental healthcare
services continue to move towards a
more modern, humane, and patient-
centred approach. National reform
in medical education and training
has highlighted that additional
medical residency positions in
adult and child psychiatry as
well as forensic and addiction
psychiatry are required to support
the healthcare system. Successful
implementation of pilot projects
and government-funded reforms
(e.g. financing methodological
expert teams) will reinforce the
role of the psychiatrists and other
mental health professionals to serve
the 1.9 million residents. As the
experience in Latvia demonstrates
that every healthcare system
experiences changes over time, the
most important driving force is that
professionalism and enthusiasm can
truly make a positive difference in
psychiatry medicine.
References
1. Skrule J, Stale M, Rozkalne G.
Mental health in Latvia in 2015-
2021 [Psihiskā veselība Latvijā
2015.-2021.gadā]. Riga: Latvia
Centre for Disease Prevention
and Control; 2022. Latvian.
Available from: https://www.sp-
kc.gov.lv/lv/psihiska-veseliba-0
2. Government of Latvia. Plan
for improving the organization
of mental health care in 2023-
2025 in Latvia [Par Psihiskās
veselības aprūpes organizēšanas
uzlabošanas plānu 2023.–2025.
gadam] [Internet]. Riga: Cabinet
of Ministers of Latvia; 2022 [cit-
ed 2024 Aug 28]. Latvian. Avail-
able from: https://likumi.lv/ta/
id/338032
3. Organisation for Econom-
ic Co-operation and Develop-
ment, European Observatory
on Health Systems and Policies.
Latvia: health systems in tran-
sition (HiT) profile [Internet].
2024 [cited 2024 Aug 28]. Avail-
able from: https://eurohealthob-
servatory.who.int/monitors/
health-systems-monitor/coun-
tries-hspm/hspm/latvia-2019/
provision-of-services/mental-
health-care/
4. Organisation for Econom-
ic Co-operation and Develop-
ment, European Observatory
on Health Systems and Policies.
Latvia: country health profile
2023. Paris: OECD Publishing;
2023. Available from: https://doi.
org/10.1787/bf2b15d6-en
5. Government of Latvia.Organisa-
tion of and Payment for Health
Care Services [Veselības aprūpes
pakalpojumu organizēšanas un
samaksas kārtība]. Riga: Cabi-
net of Ministers of Latvia; 2018.
Latvian. Available from: https://
likumi.lv/ta/id/301399-veseli-
bas-aprupes-pakalpojumu-or-
ganizesanas-un-samaksas-kartiba
6. Taube M, Quentin W. Provi-
sion of community-based mental
health care, Latvia. Bull World
Health Organ. 2020;98(6):426-
30.
7. Latvia Centre for Disease Pre-
vention and Control. Health sta-
tistics database [Internet]. 2023
[cited 2024 Aug 28]. Available
from: https://statistika.spkc.gov.
lv/pxweb/lv/Health/
8. Taube M. The potential of psy-
chiatric outpatient centers to
reduce the length of stay in in-
patient facilities and the negative
impact of COVID-19 on the
availability of psychiatric services:
the case of Latvia. Front Health
Serv. 2024;4:1348919.
9. Taube M. Psychiatry in Lat-
via throughout the centuries.
The Nordic Psychiatrist. 2023;2.
Available from: https://www.
thenordicpsychiatrist.com/post/
psychiatry-in-latvia-through-
out-the-centuries
10. Government of Latvia. About
the guidelines “Improving the
mental health of the population
in 2009-2014” [Par pamatnos-
tādnēm “Iedzīvotāju garīgās ve-
selības uzlabošana 2009–2014.
gadā”]. Riga: Cabinet of Min-
isters of Latvia; 2008. Latvian.
Available from: https://likumi.lv/
ta/id/179405-par-pamatnostad-
nem-iedzivotaju-garigas-veseli-
bas-uzlabosana-20092014gada
11. Jain N, Jersovs K, Safina T, Pil-
mane M, Jansone-Ratinika N,
Grike I, et al. Medical education
in Latvia: an overview of current
practices and systems. Front Med
(Lausanne). 2023;10:1250138.
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12. Government of Latvia. The
order of admission, distribu-
tion and financing of residents
[Rezidentu uzņemšanas, sadales
un rezidentūras finansēšanas
kārtība]. Riga: Cabinet of Min-
isters of Latvia; 2014. Availa-
ble from: https://likumi.lv/ta/
id/235421-rezidentu-uznemsan-
as-sadales-un-rezidenturas-fi-
nansesanas-kartiba
13. Government of Latvia. [Of-
ficial statistics portal of Lat-
via: population and population
change] [Internet]. 2024 [cit-
ed 2024 Aug 28]. Available
from: https://stat.gov.lv/lv/
statistikas-temas/iedzivotaji/
iedzivotaju-skaits/247-iedzivota-
ju-skaits-un-ta-izmainas
14. Our World in Data. Mental
illnesses prevalence, world, 2021
[Internet]. 2024 [cited 2024 Aug
28]. Available from: https://our-
worldindata.org/grapher/men-
tal-illnesses-prevalence
15. Elovich R, Drucker E. On drug
treatment and social control: Rus-
sian narcology’s great leap back-
wards.Harm Reduct J.2008;5:23.
16. Nunes EV, Kunz K, Galanter M,
O’Connor PG. Addiction psy-
chiatry and addiction medicine:
the evolution of addiction phy-
sician specialists. Am J Addict.
2020;29(5):390-400.
17. Organisation for Economic
Co-operation and Development.
Alcohol consumption [Internet].
2022 [cited 2024 Aug 28]. Avail-
able from: https://www.oecd.
org/en/data/indicators/alco-
hol-consumption.html?oecdcon-
trol-b84ba0ecd2-var3=2022
18. Organisation for Econom-
ic Co-operation and Develop-
ment. Health at a glance 2023.
Paris: OECD Publishing; 2023.
Available from: https://www.
oecd-ilibrary.org/social-is-
sues-migration-health/health-at-
a-glance-2023_3f97f180-en
19. Latvia Centre for Disease Pre-
vention and Control. Clinical
algorithms, patient pathways,
indicators (ESF project)] [Inter-
net]. 2020 [cited 2024 Aug 28].
Latvian. Available from: https://
www.spkc.gov.lv/lv/kliniskie-al-
goritmi-pacientu-celi-indika-
tori-esf-projekts
Authors
Liene Sile, MD, PhD
Head, Scientific Institute
of Mental Health,
National Centre of Mental
Health, State LTD
Riga, Latvia
liene.sile@npvc.lv
Maris Taube, MD, PhD
Head, Department of
Psychosomatic Medicine and
Psychotherapy,
Rīga Stradiņš University
Lead researcher and professor,
Rīga Stradiņš University,
Chief, Community Mental Health
Clinic, Hospital Department “Veldre”
Riga, Latvia
maris.taube@npvc.lv
Zane Egle, BHSc
Methodological Work Coordinator,
Scientific Institute of Mental Health,
National Centre of Mental
Health, State LTD
Riga, Latvia
zane.egle@npvc.lv
Linda Seldere, BHSc
Methodological Work Coordinator,
Scientific Institute of Mental Health,
National Centre of Mental
Health, State LTD
Riga, Latvia
linda.seldere@npvc.lv
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Post-Socialism Development of Mental Healthcare
54
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South Africa’s healthcare system
operates on a dual structure,
comprising a relatively well-funded
private sector and an overburdened
public sector [1]. The private health
care industry only serves a small part
of the population, mostly wealthy
people with medical plan coverage
[2]. In contrast, the public sector
provides services to most citizens,
often with limited resources and
varying quality of care [2]. This
duality underscores significant
inequalities in healthcare access,
with stark disparities in service
delivery between urban and rural
areas.
Even though South Africa has made
a lot of progress since the end of
apartheid, there are still significant
challenges with the health system.
These problems are mostly caused
by socioeconomic issues that make
it hard for poor communities to
obtain optimal care [3,4]. To address
these disparities, the government
has initiated transformative National
Health Insurance (NHI) reforms
aimed at achieving Universal Health
Coverage (UHC) (https://www.
health.gov.za/nhi/) [5]. The NHI
aims to give all South Africans,
no matter their income, equal
access to high-quality medical care
by combining public and private
healthcare providers into a single
system and sharing their resources.
Considering these reforms, this
paper explores the evolution of
healthcare coverage in South Africa
from 2005 to 2022. It focuses on
trends in public sector utilisation,
medical scheme enrolment, and the
mixed use of public and private
healthcare services. Using data from
Statistics South Africa (StatsSA),
the Council for Medical Schemes
(CMS), and the General Household
Survey (GHS), the author
investigates how healthcare access
and utilisation patterns have shifted
over nearly two decades [6].
Between 2005 and 2022,
South Africa experienced both
demographic growth and significant
shifts in healthcare access, as
depicted in Figure 1 below. The
population increased from 47
million in 2005 to 62
million in 2022, while public
sector healthcare coverage expanded
from 64.3% (30 million people) in
2005 to 73.6% (45.6 million people)
in 2022. Despite this growth in
public sector utilisation, private
medical scheme enrolment remained
relatively static, covering 14.9% (7
million) of the population in 2005
and only slightly declining to
14.6% (9 million) by 2022. A
noticeable trend is the reduction in
the proportion of individuals who
use both public and private
healthcare services, which decreased
from 20.9% (9.8 million) in 2005
to 12% (7.3 million) in 2022. This
decline indicates an increasing
reliance on public healthcare
services, likely driven by economic
constraints and limited access to
private healthcare, especially in rural
areas.
Data also reveal stark disparities in
healthcare expenditure between the
Comparative Analysis of Healthcare Coverage Trends in
South Africa and Similar Middle-Income Countries
Michael Mncedisi Willie
Mfana Maswanganyi
Comparative Analysis of Healthcare Coverage Trends
64,3
14,9
20,9
73,6
14,6
12
0
10
20
30
40
50
60
70
80
Public sector Private sector Mixed public and private sector
Percentage
of
coverage
(%)
Categories of healthcare services
2005 2022
Figure 1. Population health coverage by sector in South Africa, 2005 and 2022. Sources: Statistics South Africa (Stats SA),
National Treasury, Council for Medical Schemes (CMS), and McLoed cited in Willie, Masekela, and Iyaloo (2024) [7].
55
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public sector and private medical
schemes. In 2005, the public sector
expenditure per person was R1,300
(estimated US$72.39), compared
to R9,500 per person (estimated
US$529.33) for those covered by
private medical schemes. By 2022,
public sector spending increased
to R5,400 per person (estimated
US$300.88), while private medical
scheme spending surged to R25,700
per person (estimated US$1,391.91).
These disparities underscore the
inequities in resource allocation and
access to healthcare services, with
those covered by private schemes
receiving substantially higher
spending and potentially better-
quality care.
Policy Implications
Despite a growing population,
the stagnation in medical scheme
enrolment suggests that affordability
and accessibility remain significant
barriers to private healthcare access.
The rising dependence on public
healthcare indicates a need for
urgent policy interventions to
strengthen the public health sector’s
capacity. As South Africa moves
towards implementing the NHI,
these insights highlight critical
areas for reform. The significant
expenditure gap between public
and private healthcare needs to be
addressed to reduce inequalities. The
enactment of the NHI Act, signed
into law by President Cyril
Ramaphosa in May 2024, represents
a commitment to addressing
healthcare disparities by pooling
resources to guarantee equitable
access to healthcare services for all
South Africans [6]
Comparative Perspectives
To provide a comparative perspective,
South Africa’s healthcare coverage
patterns are examined alongside
those of Brazil, India, and Thailand
– three middle-income countries
with similar challenges related to
healthcare access, socio-economic
disparities, and resource constraints.
Brazil, Thailand, and India
encounter healthcare challenges akin
to those in South Africa, marked
by socio-economic disparities and
unequal access between urban and
rural regions, despite initiatives
to broaden universal coverage.
Similarly, the United States, despite
its high healthcare expenditure,
faces substantial coverage gaps due
to its largely privatised system,
underscoring persistent inequities in
access to care.
Brazil: The Unified Health System
(SUS)
Brazil operates the Unified Health
System (Sistema Único de Saúde,
SUS), instituted in 1988, as a dual
healthcare system with both public
and private sectors that guarantees
universal access to healthcare [8,9].
As of 2022, approximately 75%
of Brazilians relied on the SUS,
paralleling South Africa’s 73.6%
dependence on public healthcare
[6,8]. About 25% of Brazilians hold
private health insurance for access to
private facilities, in contrast to only
14.6% of South Africans covered by
medical schemes [6,8]. Lessons for
South Africa from Brazil include
leveraging a decentralised healthcare
model that empowers local
governments to enhance service
delivery.
India: The Ayushman Bharat Scheme
India’s fragmented healthcare
system has historically resulted
in disparities between public and
private sector service delivery [10].
The Ayushman Bharat Pradhan
Mantri Jan Arogya Yojana (PM-
JAY), which was unveiled in 2018,
expanded health insurance coverage
to more than 100 million families
[11]. Public healthcare utilisation
in India stands at 65%, compared
to South Africa’s 73.6% reliance
on public services [6,12]. With
only 20% of Indian residents using
private health insurance, the focus
on ensuring vulnerable populations
has substantially increased coverage
[12].
Thailand: Universal Coverage Scheme
(UCS)
Implemented in 2002, Thailand’s
Universal Coverage Scheme (UCS)
has achieved nearly universal health
coverage [13]. Around 75% of Thai
residents rely on public healthcare
services, surpassing South Africa’s
73.6% rate [6,14]. Thailand’s success
is mainly due to its capitation-
based funding model and a strong
emphasis on primary healthcare
services, which ensures optimal
resource utilisation [15].
Additionally, the UCS prioritises
preventive care, enabling early
intervention and reducing long-term
healthcare costs [15]. This system’s
strong regulatory framework and
efficient allocation of resources
have been pivotal in maintaining
equitable access to essential health
services across the country [13,14].
Conclusion
South Africa’s ongoing journey
towards achieving UHC through the
NHI framework highlights both the
progress made and the challenges
that persist. Despite significant
strides in expanding public
healthcare access, there remain
substantial inequities, particularly
between public and private
healthcare expenditures. The
comparative analysis with Brazil,
Thailand, and India underscores
that while these countries also face
socio-economic disparities,
their innovative health system
reforms such as decentralisation,
Comparative Analysis of Healthcare Coverage Trends
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capitation-based funding, and
targeted insurance schemes offer
valuable lessons that could inform
South Africa’s NHI strategy. To
close the gaps, South Africa needs
to address systemic inefficiencies
and resource imbalances. Equitable
funding, expanded primary
healthcare, and insights from global
models are key to strengthening
the NHI, ensuring that all South
Africans, regardless of socio-
economic status, have access to
high-quality healthcare.
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1. Michel J, Tediosi F, Egger M,
Barnighausen T, McIntyre D,
Tanner M, et al. Universal health
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6. Ramaphosa C. Remarks on the
signing of the National Health
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Presidency, Republic of South
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11]. Available from: https://
www.gov.za/news/speeches/
president-cyril-ramaphosa-sign-
ing-national-health-insur-
ance-bill-15-may-2024
7. Willie M, Iyaloo S, Maseke-
la S. Persistent inequalities in
healthcare access in South Afri-
ca [Internet]. Council for Med-
ical Schemes. 2024 [cited 2024
Nov 9]. Available from: https://
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sistent-inequalities-in-health-
care-access-in-south-africa/
8. Silva B, Hens N, Gusso G, La-
gaert S, Macinko J, Willems S.
Dual use of public and private
health care services in Brazil. Int
J Environ Res Public Health.
2022;19(3):1829.
9. Tikkanen R, Osborn R, Mos-
sialos E, Djordjevic A, Whar-
ton GA. International health
care system profiles: Brazil [In-
ternet]. The Commonwealth
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Available from: https://www.
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national-health-policy-center/
countries/brazil
10. Kumar A. The transformation
of the Indian healthcare system.
Cureus. 2023;15(5): e39079.
11. Garg S, Bebarta KK, Tripathi N.
The Ayushman Bharat Pradhan
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(AB-PMJAY) after four years of
implementation – is it making
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care and financial protection in
India? BMC Health Serv Res.
2024;24(1):919.
12. Ghia C, Rambhad G. Imple-
mentation of equity and access
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13. Limwattananon S, Tangcharoen-
sathien V, Tisayaticom K, Boon-
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P. Why has the universal cover-
age scheme in Thailand achieved
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health care? BMC Public Health.
2012;12(Suppl 1): S6.
14. Thammatacharee N,Suphanchai-
mat R, Tangcharoensathien V,
Patcharanarumol W. Thailand’s
universal health coverage scheme.
Econ Polit Wkly. 2012;47(8):20-
3.
15. Blecher M, Pillay A, Patchara-
narumol W, Panichkriangkrai W,
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tananon Y, et al. Health financing
lessons from Thailand for South
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versal health coverage. S Afr Med
J. 2016;106(6):4-5.
Authors
Michael Mncedisi Willie,
DBA, MBA, MPhil, MSc
Executive for Policy, Research
and Monitoring,
Council for Medical Schemes
Pretoria, South Africa
m.willie@medicalschemes.co.za
Mfana Maswanganyi,
MML (Constitutional and
Administrative Law),
MML (International Law)
Acting Registrar and Chief Executive/
Executive for Regulation
Council for Medical Schemes
Pretoria, South Africa
m.maswanganyi@medicalschemes.co.za
Comparative Analysis of Healthcare Coverage Trends
57
South Africa, a nation of 63 million
residents, has the largest number of
people living with HIV (PLHIV)
in the world, estimated at 8
million individuals or 12.7% of the
population in 2024 [1]. In 2024,
the overall HIV prevalence in
adults aged 15-49 years is 16.7%,
and with a growing population in
KwaZulu-Natal and Mpumalanga
provinces, which share borders with
Mozambique and Swaziland. The
government should remain vigilant
in the implementation of relevant
HIV/AIDS policies and programs
and of the impacts of international
migration on the HIV/AIDS
programs [1]. Notably, the country
is in line to achieving the Joint
United Nations Programme on
HIV/AIDS (UNAIDS) 95-95-95
targets, as among South Africans
aged 15 years and older living with
HIV, 90% knew their HIV status,
91% of those who knew their status
were receiving antiretroviral therapy
(ART), and 94% of those on ART
had achieved viral suppression in
2022 [2].
The history of HIV/AIDS in
South Africa is intertwined with
the colonial activities that began
1652, the diamond rush of 1866,
and the gold rush of 1876. A shift
of indigenous African tribesman
from subsistence farmers to
migrant labourers occured so as
to meet colonial obligations such
as monetary taxes and pursuit of
economic well-being [3]. Labourers
worked in mines and cities far from
home (for almost an entire year)
and lived in male-only hostels,
with a small income and limited
transportation [3]. The added
migration of some African females
to serve in the homes of European
families (for almost an entire year)
created a fertile ground for multiple
sexual partnerships and indeed
sexually transmitted infections [3,4].
These circumstances persisted into
the Apartheid era during which the
first HIV case was recorded in 1982
[3].
The year 1982 is recognised as
the beginning of the first HIV/
AIDS epidemic which was driven
by Clade B. More cases of HIV
were reported later in 1982, mostly
among homosexual men, although
there some cases diagnosed between
1982 and 1985 had a suspected
transmission via blood transfusion
[5]. The second epidemic (driven
by Clade C) was identified in
1989, predominantly affecting
black people [6]. Since the
conservative apartheid government
perceived that HIV/AIDS only
affected Africans and men sleeping
with men (MSMs), no federal
support or services were prioritised
for these population groups [3].
As a result, the stage was set for
the massive spread of HIV/AIDS
in South Africa. The first antenatal
HIV survey was conducted in 1990,
reporting HIV prevalence in mostly
African pregnant women of 1%,
and the epidemic grew with a
prevalence reaching 22.8% in 1998
[6].
HIV/AIDS as a Policy Priority
South Africa’s democratic
government inherited an
HIV/AIDS crisis, following years
of inaction and social stigma
toward AIDS in South Africa. Prior
to South Africa’s independence,
some political parties established
the National AIDS Convention of
South Africa (NACOSA) in 1993
[7]. Upon establishing its
independence in 1994, NACOSA
created a comprehensive plan to
control the HIV/AIDS epidemic,
recognising the need for urgent
HIV prevention and control
measures [8]. However, the
implementation of this plan
faced major challenges, including
financial constraints,
limited resources, and uneven
provincial capabilities, which
hampered the rollout of preventive
measures and education campaigns.
In 2000, the South African National
AIDS Council (SANAC), chaired
by the Deputy President of South
Africa, was launched, providing a
platform for collaborative policy
development, strategic planning,
and resource mobilisation (https://
sanac.org.za). The council included
representatives from government,
civil society, private sector, and other
key stakeholders. SANAC developed
the HIV/AIDS/STD Strategic Plan
for South Africa, 2000-2005, to
address the epidemic with a multi-
sectoral approach, and continues
to support the implementation of
progressive Strategic Plans for HIV,
tuberculosis (TB), and sexually
transmitted infections (STIs) in
South Africa [9].
HIV/AIDS in South Africa: Understanding the
Present to Strengthen Future Efforts
Mhlengi Vella Ncube
HIV/AIDS in South Africa
BACK TO CONTENTS
58
Antiretrovirals for HIV/AIDS
Control in South Africa
The role of ART has helped curb
the HIV epidemic, which had
already cost the country millions
of lives, and now South Africa has
the largest ART program in the
world [10]. The Universal Test and
Treat policy (UTT) which was
adopted in 2016, encourages all
HIV-positive persons to initiate
treatment that prevents progression
of HIV to AIDS regardless of
their CD4 count or viral loads.
The country hopes to adhere to the
UTT policy and hence achieve the
UNAIDS 95-95-95 targets [11].
Interestingly, more women than
men are seeking HIV diagnostic
testing and treatment, most likely
due to societal norms where women
stay at home and can benefit
from health promotion programs
and access to healthcare services.
HIV programs targeting men are
being implemented. Challenges
in adherence to ART have been
observed and are being resolved
through adherence strategies which
include adherence clubs, where
people on ART can engage in peer
support activities, and the Central
Chronic Medicine Dispensing and
Distribution (CCMDD) program,
which makes ART medication
accessible at convenient pickup
points. As research advances, the
country looks forward to the
discovery and implementation of
the long-acting injectable ART.
HIV Prevention in South Africa
Over the years, South Africa has
championed non-chemotherapeutic
prevention of HIV, including
condoms as the preventative option
of choice. The government provides
free condoms at strategic points,
such as public and university
bathrooms, and sponsors widespread
community health campaigns on
the use of both male and female
condoms. These campaigns, while
targeted at the general population,
are often enhanced to target key
vulnerable populations, including
MSMs, transgender individuals,
commercial sex workers, and young
women and girls.
Presently, these initiatives are
anchored on the SANAC National
Strategic Plan, 2023-2028, which
aims to ensure fair and equal access
to services and solutions for these
diseases as well as remove obstacles
to achieving positive outcomes for
HIV, TB, and STIs. The strategic
plan also intends to integrate HIV,
TB, and STIs within health, social
protection, and pandemic response
frameworks and hence strengthen
resilient systems. It also proposes
to secure federal funding to sustain
an effective national strategic plan,
led by renewed, inclusive, and
accountable institutions (https://
sanac.org.za).
The South African HIV
Clinicians Society has developed
clinical guidelines for the use
of post-exposure prophylaxis
(PEP) for occupational and
non-occupational exposures.
The society advices that
individuals who repeatedly request
PEP should be given the pre-
exposure prophylaxis (PrEP), as
the PrEP policy was approved
in 2016 [12]. In the future,
South Africa hopes to have
introduced a tri-month anti-HIV
ring by 2026. To date, most PrEP
programs target key vulnerable
populations, including young women
and girls, as the HIV transmission
cycle in South Africa has been
observed from men (aged 25-34) to
young girls (under the age of 20)
in transactional relationships [13].
These young girls then can transmit
HIV to their romantic partners who
are typically their own age [13].
Role of Development Partners
in HIV/AIDS Control in South
Africa
The government and development
partners have supported the
widespread roll out of ART. The
Department of Health has ensured
the availability of nursing training
on Nurse-Initiated and Managed
Antiretroviral Therapy (NIMART)
to improve access to HIV care.
The Departments of Health are
also mandated to report on HIV/
AIDS, TB, and STIs at different
administrative levels, to ensure
timely interventions to curb HIV
transmission. Development partners,
with funding by the Global Fund,
U.S. Agency for International
Development (USAID), UNAIDS,
the Global Fund and the Bill and
Melinda Gates Foundation are
among the several development
partners that provide invaluable
expertise and human resources
support to promote the UTT policy
and the country’s efforts towards
achieving the 95-95-95 targets.
South Africa has made major gains
in educating HIV/AIDS patients
about the importance of ART
adherence. These efforts are a result
of strong political will, collaborative
role of civil society, and dedicated
healthcare professionals. Although
HIV incidence rates remain difficult
to control, the number of people
who progress to AIDS has declined,
and PLHIV are living longer,
quality lives. Notably, the
coronavirus disease 2019
(COVID-19) pandemic slowed
some gains of the HIV programs,
but effective catch-up plans were
implemented. Doctors and other
healthcare professionals must
continue to play a crucial role in
curbing the HIV/AIDS epidemic
by providing comprehensive testing,
early diagnosis, and consistent
ART management to ensure viral
HIV/AIDS in South Africa
BACK TO CONTENTS
59
suppression. Additionally, through
patient education, preventive care,
and reducing stigma, they
must empower individuals and
communities to take proactive steps
in preventing new HIV infections
and improving overall health
outcomes.
References
1. Department of Statistics South
Africa, Government of South
Africa. 2024 mid-year population
estimates. 2024 [cited 2024 Nov
8]. Available from: https://www.
statssa.gov.za/?p=17440
2. Human Sciences Research Coun-
cil. New HIV survey highlights
progress and ongoing disparities
in South Africa’s HIV epidem-
ic [Internet]. 2023 [cited 2024
Nov 8]. Available from: https://
hsrc.ac.za/press-releases/phsb/
new-hiv-survey-highlights-pro-
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ties-in-south-africas-hiv-epi-
demic/
3. Abdool-Karim Q,Abdool-Karim
SS. The evolving HIV epidemic
in South Africa. Int J Epidemiol.
2002;31(1):37-40.
4. Crush J, Williams B, Gouws E,
Lurie M. Migration and HIV/
AIDS in South Africa. De-
velopment Southern Africa.
2005;22(3):293-318.
5. Gilbert L, Walker L. HIV/AIDS
in South Africa: an overview.Cad
Saude Publica. 2002;18:651-60.
6. Puren AJ. The HIV-1 epidemic
in South Africa. Oral Dis. 2002;8
Suppl 2:27-31.
7. Whiteside A. First step to a
multi-racial black-and-white
policy on AIDS. Report from
South Africa 1. AIDS Anal Afr.
1993;3(6):2.
8. African National Congress, Uni-
versity of Pennsylvania.A nation-
al health plan for South Africa
[Internet]. 1994 [cited 2024 Nov
8]. Available from: https://www.
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cal/ANC_Health.html
9. Butler A. South Africa’s HIV/
AIDS policy, 1994–2004: how
can it be explained? African Af-
fairs. 2005;104(417):591-614.
10. Chigwedere P, Seage GR 3rd,
Gruskin S, Lee TH, Essex M.
Estimating the lost benefits of
antiretroviral drug use in South
Africa. J Acquir Immune Defic
Syndr. 2008;49(4):410-5.
11. Nicol E,Jama NA,Mehlomakulu
V,Hlongwa M,Pass D,Basera W,
et al. Enhancing linkage to HIV
care in the “Universal Test and
Treat”era: barriers and enablers to
HIV care among adults in a high
HIV burdened district in Kwa-
Zulu-Natal, South Africa. BMC
Public Health. 2023;23(1):1756.
12. Horak J, Venter WDF, Wattrus
C, Papavarnavas N, Howell P,
Sorour G, et al. Southern Afri-
can HIV Clinicians Society 2023
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prophylaxis: updated recommen-
dations. South Afr J HIV Med.
2023;24(1):1522.
13. De Oliveira T, Kharsany AB,
Gräf T, Cawood C, Khanyile D,
Grobler A, et al. Transmission
networks and risk of HIV infec-
tion in KwaZulu-Natal, South
Africa: a community-wide phy-
logenetic study. Lancet HIV.
2017;4(1):e41-50.
Mhlengi Vella Ncube, PhD
Head, Unit for Health
Policy and Research
South African Medical Association
Pretoria, South Africa
MhlengiN@samedical.org
BACK TO CONTENTS
HIV/AIDS in South Africa
60
The Asian continent, with a
population of 4.8 billion people or
60% of the global population, is
recognised as the most populated
geographic region. Within the
Asia Pacific region, there is an
unequal number and distribution
of doctors, such as South Asian
countries with 0.9 doctors per 1,000
people, and East Asian and
Pacific countries with 1.6 doctors
per 1,000 people [1]. Most doctors
work in metropolitan regions, which
leaves rural areas with a paucity
of doctors [2]. The World Health
Organization (WHO) reported that
between 8% and 38% of healthcare
professionals suffer physical violence
at some point in their careers, with
some being threatened or exposed
to verbal aggression, while others
experience acts perpetrated by
patients and visitors.
As the region adapts to shifting
demands of health services, Asian
junior doctors experience unique
and common challenges throughout
their clinical training. This article
aims to describe the obstacles that
Asian junior doctors currently face
across their countries, including
workplace bullying and harassment,
violence and mental health, excessive
working hours and maldistribution
of the workforce, poor working
conditions, workforce shortage
in rural health, task shifting,
doctor’s migration, and hardships
to participate in international
conferences. It offers a platform
for World Medical Association
(WMA) and Junior Doctors
Network (JDN) members to discuss
potential solutions to address
this burden across health systems
in the Asia-Pacific region.
Workplace Bullying and
Harassment
Within health systems, junior
doctors frequently report bullying
and harassment, often stemming
Navigating the Complex Labyrinth: Multifactorial Challenges
Experienced by Asian Junior Doctors in the Workplace
Yujin Song
Wunna Tun
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
BACK TO CONTENTS
Shiv Joshi
Minku Kang
Aravind Swamy
Poorvaprabha Patil
Merlinda Shazellenne
61
from inappropriate interactions with
senior department and management
leadership. These incidents range
from verbal and mental abuse
to sexual harassment. Extreme
micromanagement, verbal criticism,
name-calling and shaming, insults,
hearsay victim blaming, and gossip
are all common experiences of
workplace bullying. However, many
junior doctors choose to remain
silent about these mistreatments,
due to the fear of losing training
opportunities or being expelled from
their post-graduate training program.
In addition, the strict and rigid
workplace environment present in
many Asian cultures further inhibits
junior doctors from speaking up
and confronting these bullying
issues.
Republic of Korea. The Confucian
value of hierarchy still widely
influences social interactions
within Korean society, and medical
professionals are no exception.
Implemented in 2019, the workplace
anti-bullying law has helped
decrease the number of workplace
harassment reports, but cases
continue to be reported across health
institutions [3]. Junior doctors have
requested assistance from the Korea
Intern Resident Association (KIRA)
for reporting workplace bullying
and harassment. Although national
hospitals have planned immediate
investigations, the ability to switch
junior doctors’ training hospitals is
challenging, especially with limited
resources in the middle of the year.
Myanmar. As a common trend
across Myanmar hospitals, senior-
level doctors often take advantage
of their younger colleagues’ lack
of expertise or knowledge with
fundamental elements of the job,
and they verbally rant in front of
patients. The widespread power
difference causes a justifiable fear
of reprisal, which might ruin years
of hard work and jeopardise post-
graduate careers. If department
heads and supervisors are the
prevalent culprits, junior doctors
believe that reporting these
unpleasant experiences would harm
their career prospects.
Malaysia. Over the past 10
years, the independent Malaysian
Medical Association and the
Malaysian Ministry of Health have
implemented significant efforts
to overcome workplace bullying
and harassment [4]. They have
administered surveys on bullying
and harassment, launched a
helpline, and organised two town
hall meetings with the Ministry of
Health and the Malaysian Medical
Association [5]. Despite these
actions, conditions are worsening, as
drones of junior doctors are quitting
government service and transferring
to other fields, private practice or
international employment.
India. Incidents of being physically
bullied and harassment have long
been a troubling issue in the Indian
medical fraternity. In the clinical
workplace, if patients perceive that
medical negligence has occurred,
they commonly respond by
assaulting the doctors, rather than
filing an official complaint with the
relevant medical department. One
situation was reported in mainstream
media in February 2018, when
relatives of a patient in Kolkata,
who died due to alleged medical
negligence, physically assaulted the
attending doctors. In response, the
doctors alleged that the patient
had been attended appropriately,
and they referred the patient to the
relevant medical department [6].
Violence and Mental Health
Workplace violence is the intentional
use of power, threatened or actual,
against another person or a group
in work-related circumstances that
may result in injury, death
or psychological harm [7]. It
jeopardises the victim’s health,
safety, and well-being and can have
mild, moderate or severe effects
on physical and mental health,
morale, and productivity. Although
many measures have been taken
to prevent workplace violence, it
remains a persistent issue, especially
in healthcare settings. According to
the U.S. Occupational Safety and
Health Administration (OSHA), it
is reported that more than 11,000
cases of assaults by persons in the
United States had occurred in
2010, as a 13% increase compared
to 2009. As junior doctors have
been increasingly exposed to
workplace violence in their working
institutions, these acts negatively
impact their personal safety and
mental health during their clinical
training.
Republic of Korea. Over the past
five years, 2,610 individuals have
been arrested for inflicting physical
assaults or threatening medical
professionals in emergency rooms
[8]. Some perpetrators were under
the influence of drugs or alcohol,
while others were dissatisfied with
the services (including treatment)
that they received. Standing on the
frontline of patient treatment, junior
doctors easily become the target of
these imprudent actions. Lawmakers
at the National Assembly have
recently proposed the revision of
the Emergency Medical Service Act, to
find measures to prosecute
offenders, even when they are
under the influence of alcohol
[9]. In 2018, KIRA conducted
a survey on workplace violence,
which revealed that 10% of junior
doctors had experienced violence
from a colleague [10]. Given the
gravity of the status quo, KIRA
developed the Guidelines for the
Prevention and Management of
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
BACK TO CONTENTS
62
Violence and Sexual Harassment
for Residents in 2020, which acts
as a legal base against offenders,
especially fellow doctors.
Myanmar. Since February 2021, as
a result of the Myanmar military
coup, civilian areas including
hospitals have been heavily bombed,
and this unsafe environment
has hindered how the Myanmar
populace can seek medical attention
[11]. Junior doctors in Myanmar
face immense danger while trying to
provide care during these ongoing
violent attacks, and many have
been forced to flee or work in
secret, which severely disrupts their
training and compromises patients’
safety [12]. This demanding
schedule and workload places junior
doctors’ physical and emotional
health at risk, especially as they
are burdened by anxiety over the
potential arrest of loved ones.
This stress is compounded by
compassion fatigue from witnessing
colleagues’ imprisonment or death,
which can impede the provision of
effective care and lead to emotional
exhaustion.
Malaysia. Violence against junior
doctors in Malaysia is significant,
despite the fact that the police are
quick to respond upon any reported
violent acts [13]. Reports indicate
that a significant percentage of
healthcare professionals experience
physical violence at some point
in their careers, with many also
facing threats or verbal aggression,
predominantly from patients and
visitors. However, as the incidence
of this violence increases each year,
there is a risk of increasing mental
health concerns. If not addressed
proactively, this growing trend will
continue to negatively affect the
wellbeing of junior doctors as well
as threaten to impact the overall
quality of healthcare service delivery.
India. In India, workplace violence,
including verbal and physical
assaults, is alarmingly present,
ranging from 40-78% across various
healthcare settings [14]. Research
studies have shown that the vast
majority of resident doctors have
experienced or witnessed some form
of workplace violence during the
past 12 months, with the highest
number of incidents in emergency
departments and wards [15].
Although no central legislation or
act prevents violence against doctors
in India, albeit repeated demands
made by the JDN of the Indian
Medical Association, 19 states
have adopted legislation for the
protection of medical professionals
and healthcare facilities. To date,
few cases have been reviewed in the
courts, and no person who has been
convicted of assault on a medical
professional has been penalised
under such acts until 2015. Notably,
a total of 30 suicides, where 80%
were in doctors younger than 40
years, were reported between March
2016 and 2019, raising questions
related to mental health and well-
being during medical training [16].
Excessive Working Hours and
Maldistribution of Workforce
During their training, junior
doctors often endure long clinical
shifts, unpaid working hours or
overtime, poor living conditions,
and detrimental work environments.
Studies have shown that prolonged
working hours are associated with
higher risks of mental health
issues, including depression and
burnout among junior doctors
[17]. The negative impacts of poor
working conditions and excessive
working hours can extend beyond
individuals themselves, as it can also
compromise patient safety.
Republic of Korea. With the
introduction of the Special Act on
the Resident Training Environment
in 2015, junior doctors are
required to work a maximum of
80 hours per week. However, due
to intense workplace schedules and
understaffing problems, the upper
limit of working 80 hours per week
is frequently surpassed. Although
many junior doctors have 36-hour
consecutive shifts at least two or
three times each week, this overtime
payment is not paid to junior
doctors. Furthermore, these longer-
working junior doctors are expected
to see more patients and work
more night shifts than specialists,
and hence hospitals naturally want
to recruit more junior doctors to
manage patient care. Currently,
KIRA is working to revise the
Medical Residents Act, to provide the
appropriate overtime payment to
junior doctors.
Myanmar. Even before the military
coup, junior doctors at Myanmar
public hospitals were required
to complete their daily clinical
weekday schedules as well as
work consecutive 24-hour shifts
for five to 15 days depending on
staff availability. Junior doctors at
station-level public hospitals are
required to be on call every day,
defined as 24 hours a day in case
of any emergency, since only one
doctor is usually available at these
hospitals. The maldistribution of the
workforce contributes to excessive
working hours, compelling young
doctors to work in unsocial hours
under immense pressure. Despite
the ongoing fear of violence, these
dedicated individuals strive to
uphold the Physician Pledge and
their commitment to patient care,
often prioritising their patients’
needs over their own.
Malaysia. The Malaysia health
system faces challenges toward
improving the work-life balance
for doctors. Long, unpaid working
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
BACK TO CONTENTS
63
hours are the norm, especially
in larger hospitals, as there is a
maldistribution of the workforce
across the nation. Although House
Officers (trainee doctors) have a
cap (61 hours per week) on the
minimum number of work hours,
House Officers and Medical
Officers do not have a cap on
the maximum number of work
hours. With doctor shortages,
junior doctors frequently work 80
to 100 hours a week, and most
Medical Officers at tertiary-level
centres work between 100 to 120
hours. Notably, Medical Officers are
assigned several on-call periods (e.g.
three to eight periods per month of
32- to 36-hour shifts), sometimes
working back-to-back shifts that
leave 12 hours in between shifts
for rest before returning to duty
the next day. Although various
studies have demonstrated an
underpaid, understaffed, and
overworked workforce, significant
efforts are needed to overcome
these issues, especially as many
doctors are leaving clinical practice
after the coronavirus disease 2019
(COVID-19) pandemic [18].
India. Junior doctors in India
experience poor working conditions
that are influenced by the higher
mean number of working hours
(80 hours), when compared to their
counterpart faculty members (53
hours) [19]. The Post-Graduate
Medical Education Regulations
(PGMER) has no specific working
hour maximum for junior doctors,
but rather states that medical
institutions should allow junior
doctors to work only for ‘reasonable’
hours and rest for ‘reasonable time’
in one day. Since junior doctors
typically work 24 hours per day
during their posting in Casualty
wards, and even up to 48 hours in
some departments like surgery and
emergency medicine, the JDN of
the Indian Medication Association
has demanded (without resolution)
that junior doctors should not be
required to work beyond 60 hours
per week with at least 30 vacation
days per year. This excess work
schedule can lead to work-related
burnout for junior doctors, along
with impacts on physical and mental
health due to limited access to food,
water, and rest [20].
Workforce Shortage in Rural
Health
Access to healthcare services is a
crucial element of good health, yet
the healthcare workforce is usually
concentrated in cities, leaving
the rural areas with limited staff
[21]. This shortage impacts rural
community members who may
face barriers to healthcare that
negatively impact their general
physical, social, and mental health
status, as well as their quality of life
and life expectancy. They may face
financial barriers to paying for the
services, finding transportation to
reach medical facilities, and securing
enough time to use such services.
Republic of Korea. Male junior
doctors, who are required to fulfil
their mandatory military service
duty, are usually dispatched as public
health doctors to geographic areas
with poor health infrastructure.
Since these job posts are temporary
and last three years, the cyclic
turnover hinders the ability to
preserve the continuity of patient
management in these rural areas.
Nonetheless, these public health
doctors remain pivotal leaders in
supporting rural health across the
country.
Myanmar. Myanmar junior
doctors lead public health
interventions, support disease
control programs, and offer
clinical services in their assigned
stations, regardless of the remote
location or workload. Although
double pay has been offered to
civil servant doctors who serve
in marginalised locations, there
are no incentive programs for
junior doctors. Doctors are usually
appointed as the charge in these
rural areas, and if junior doctors
take on these supervising roles, they
are likely to face much frustration
and disappointment from the lack
of resources and support that may
lead to further neglect of rural
communities.
Malaysia. Several strategies have
been implemented to encourage
junior doctors to serve in rural
Malaysia communities, including
offering permanent employment
positions for those who volunteer
to serve at the rural areas,
shortening the waiting time
from Housemanship to Medical
Officer-ship placements, and
increasing chances of obtaining
a postgraduate degree after
completing the rural posting
[22]. Medical Officers are
doctors who are confirmed in
their service (after two years of
serving as Housemanship trainee
doctors) and prior to becoming
a specialist, they are addressed as
Medical Officers. Medical Officers
usually choose to work in major
hospitals, located mostly in large
cities as these are highly specialised
and will ensure good training in
their fields of choice. Hence, this
timeline further fuels the lack of
Medical Officers working in the
rural healthcare facilities.
India. Recognising that 65% of
the population resides in rural
areas, the shortage of healthcare
professionals poses a significant
challenge for India. To address this
challenge, state governments have
implemented service bonds for
medical and postgraduate students
to serve a designated period (up
to 10 years) in state-run hospitals
or peripheral health centres upon
completion of their undergraduate
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
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64
or postgraduate training [23].
These health centres, however,
often lack adequate infrastructure
and resources, leading to poor
quality healthcare service delivery.
Failure to comply with this service
requirement may result in penalties,
such as forfeiting a predetermined
bond amount or degree cancellation.
Task Shifting
The term ‘task shifting’ is used to
describe a situation where a task
normally performed by a doctor
is transferred to a healthcare
professional with a different or lower
level of education and training, or
to a person specifically trained to
perform a limited task only, without
having a formal health education. It
involves the delegation of specific
healthcare tasks from highly skilled
professionals, such as doctors,
to a wider array of healthcare
professionals with less extensive
training, including nurses,
community health educators,
and pharmacists. This delegation
is founded on the principles of
efficiency, cost-effectiveness, and
improved access to healthcare
services, especially in regions where
healthcare resources are scarce or
unevenly distributed. Task shifting
can occur in countries regardless of
whether they are facing shortages of
doctors [24].
Republic of Korea. Due to a chronic
shortage of doctors in several areas
of medicine, namely paediatrics and
surgery (e.g. general, cardio-thoracic,
trauma, neurosurgery, obstetrics and
gynaecology), hospitals have either
suspended services or have resorted
to employing physician assistants
(PA). The PAs in the Republic
of Korea are usually registered
nurses who are trained to assume
the clinical workload of junior
doctors, ranging from inpatient care
to surgical procedures. Recently,
KIRA has conducted several surveys
that have highlighted how junior
doctors have felt overlooked during
their training, as more hospitals
have demonstrated a preference
for PAs over junior doctors. Once
PAs have been trained, they can
work longer hours and more closely
with senior doctors. However, PAs
in the Republic of Korea are not
explicitly incorporated into the
current medical law, making their
status unlawful and unqualified [25].
Moreover, they do not receive formal
education or training, which differs
from PA programs in other countries
like the United States or Canada.
The conflicts between PAs and
junior doctors, the legal liability of
PAs, and the lack of PA training
programs are key task shifting issues
that should be promptly addressed.
Myanmar. With few competent
doctors providing healthcare services
in rural Myanmar communities,
tasks are delegated to less qualified
healthcare professionals [26]. If
health leaders do not monitor health
service delivery, task shifting will
pose a double burden on an already
fragile health system. Over time,
financial restrictions and the amount
of participation by external players
are placing a double pressure on the
health infrastructure and provision
of essential services to the populace.
The military coup has exacerbated
these challenges, jeopardising the
access to reliable and high-quality
healthcare services.
Malaysia. Despite the human
resources for health shortage,
the Malaysia Ministry of
Health continues to complete
administrative tasks in silo, without
communicating or collaborating
with other ministries on similar
tasks. During the COVID-19
pandemic, triage and contact tracing
were completed by the Ministry
of Health staff, requiring a diverse
team of healthcare professionals
(nurses, medical assistants,
doctors, ambulance drivers,
hospital attendants) [27]. This
contact tracing job, however,
could have been conducted by
the Telecommunications and
Multimedia Department, rather
than solely by the Ministry of
Health, since staff were actively
managing acute COVID-19 cases,
and hence reduce the workload for
all parties.
India. The Ministry of Health and
Family Welfare in India created a
cadre of community health officers
of nursing or traditional medicine
graduates who can practise limited
modern medicine after taking a
six-month bridge course [28]. The
move has received criticism from the
Indian Medical Association and
the JDN, as it has the potential
to develop crosspathy (practice of
modern medicine by traditional
medicine doctors) and unregulated
medical practitioners without
adequate training in modern
medicine. While junior doctors
practising modern medicine have
always supported the consultations
between and within different
systems of medicine, an attempt
to allow cross-pathy is strongly
condemned.
Doctor Migration
The global health system faces
a deficit of 6.4 million doctors
necessary to achieve universal health
coverage (UHC) goals. Specific data
reveal a 10-fold variation in the
density of healthcare professionals
across and within regions worldwide.
Significant shortages are observed
in South Asia, with a gap of 2.57
million doctors; Southeast Asia, East
Asia, and Oceania lacking 995,000
doctors; sub-Saharan Africa with a
shortfall of 1.91 million doctors; and
North Africa and the Middle East
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
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65
with a deficit of 636,000 doctors
[29]. The migration of junior doctors
from low- and middle-income
countries (LMICs) to high-income
countries (HICs), such as Australia,
the United States, and the United
Kingdom, is driven by a range of
factors, including the pursuit of
better career opportunities, safer
workplace environments, and higher
salaries.
Additionally, the attraction of
advanced training programs, the
desire for better work-life balance,
economic instability in LMICs,
access to research opportunities,
professional development, and
inadequate health infrastructure also
compel doctors to migrate. This
migration allows some HICs to
draw as much as one-fifth of their
doctor workforce from LMICs.
Consequently, this global trend
highlights the broader systemic
issues in LMICs’ healthcare systems,
raising concerns about equity,
sustainability, and the long-term
impact on healthcare delivery in
vulnerable regions.
Republic of Korea. Although doctor
migration is an uncommon practice
in the Republic of Korea, some
doctors choose to migrate to the
United States and Japan. Junior
doctors tend to finish their training
at their alma mater university
hospital and prioritise establishing
a good balance between life
and clinical training, despite the
hardships of overcoming language
barriers and adjusting to different
cultures. Many prestigious Korean
university hospitals aim to expand
the size of their hospitals by opening
branches in other countries, such
as China, Saudi Arabia, Singapore,
and Vietnam [30]. These proposed
actions help expand the global
market to export the expertise of
Korean healthcare, which can also
encourage Korean junior doctors to
work abroad.
Myanmar. Myanmar junior
doctors recognise the unsafe work
environments and frequently migrate
to HICs, like Australia, South
Africa, the United Kingdom, and
the United States, although lower
migration rates when compared
to other countries [31]. Some
junior doctors, however, feel a
sense of duty and commitment
and choose to provide essential
medical treatment and support
colleagues amid the military coup
and deteriorating healthcare system.
Many doctors who leave Myanmar
for improved working conditions
may experience “survivor guilt”,
witnessing the ongoing violence
and chaos from afar, which prompts
them to return home out of a sense
of responsibility. Their dedication
reflects a profound ethical belief
in prioritising the health and well-
being of their community, often
above personal safety or career
opportunities abroad.
Malaysia. A large number of
Malaysian doctors are moving to
other countries to pursue training,
further studies, and employment
opportunities. The worsening
working conditions coupled with
poor wages are further fueling the
brain drain, with doctor migration
increasing annually [32]. This
migration not only depletes the
country of its skilled healthcare
professionals, but also strains the
healthcare system as it struggles to
meet the needs of its population.
Although the Malaysia Ministry
of Health has recognised this brain
drain, leaders are working with the
Malaysian Medical Association to
develop a policy reform specifically
to address this situation at hand.
Although these efforts will publicly
increase awareness of the brain
drain, they are still inadequate to
fully overcome the problem.
India. After India gained
independence in 1947, the
post-liberalization era occurred in
the 1990s, and the private sector
investments led to the expansion
of the healthcare sector. Notably,
the number of registered medical
colleges (86 in 1965 to 539 in 2019),
and now, more than 67,200 students
begin medical school each year.
With limited residency placements
upon graduation, medical graduates
are seeking training and employment
opportunities outside of India, which
has now become one of the world’s
top exporters of doctors. The India
Ministry of Health and Family
Welfare has implemented measures
to limit the migration of doctors,
including halting the issuing of
the No Obligation to Return to
India (NORI) certificate, which is
necessary for medical graduates to
J-1 visa applications to the United
States. These mere bureaucratic
efforts remain futile, however, and
the migration of Indian junior
doctors is expected to continue.
Hence, systemic reform should
consider the underlying employment
context as well as the demographic
and healthcare workforce shortage
challenges across the Organization
for Economic Cooperation and
Development (OECD) countries
[33].
Hardships to Participate in
International Conferences
Junior doctors in Asia encounter
challenges when participating
in WMA events and serving on
WMA delegations for World
Health Assembly events. The
official registration announcement
for these events often open three
months prior to the scheduled
event, posing significant logistical
difficulties for participants to
arrange travel, accommodations, and
other necessary preparations. The
WMA meetings are also expensive
– for example, registration of 400
Euros for junior doctors – whether
held in Africa or Europe. From
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66
2014-2023, more than 70 percent
of WMA General Assemblies
and Council Meetings were held
in Europe and Africa, and less
than 10 percent were held in Asia.
Without the support of national
medical associations, junior doctors
are often unable to afford travel and
join the in-person WMA meetings.
Further inflation and the lower rate
of currencies of various Asian
countries add to this significant
financial burden.
Republic of Korea. Over the past
few years, KIRA members have
been enthusiastic and passionate
to participate in JDN and WMA
activities, although most conferences
have been located outside of the
Asia region. Their participation,
however, has been generally
recognised as a low priority and
not directly related to their training.
Although KIRA has encouraged
junior doctors to attend conferences
with partial financial support,
competing challenges remain such
as gaining permission to travel,
allocating vacation time to attend
a conference, finding a colleague
to perform their assigned clinical
duties, and covering any incidental
expenses.
Myanmar. High conference
registration costs to attend WMA
meetings present hardships to
Myanmar junior doctors. For
example, conference fees are
equivalent to approximately one
month’s salary of a junior doctor
working in a public hospital or
two weeks’ salary of a junior doctor
working in a private hospital in
Myanmar. Additional logistical
concerns include approvals
from departmental heads, visa
appointments, and visa processing
time (3-4 months).
Malaysia. Registration costs to
participate in WMA meetings is
estimated at one-third to one-half of
the salary of a Malaysia junior doctor.
In order to travel internationally,
government doctors need to apply
for special permissions at least 60
days prior to the proposed
departure date. Despite these
logistical challenges, applications
can also be cancelled by the
Head of the Department or other
higher administrators, as deemed
necessary. Late notices, invitations,
and announcements add to the
challenges in travelling to in-person
meetings.
India. Junior doctors from
India actively participate in the
conferences and meetings in
India and neighbouring countries.
However, their participation in
international conferences or WMA
meetings that are organised in HICs
represents challenges due to the
high costs of travel, accommodation,
and registration fees, especially as
these costs do not consider the
national purchase power parity
parameters. Additionally, requests
to secure permission to attend these
conferences and meetings are often
dismissed in view of understaffing
and high patient loads in hospitals,
with variable support from faculty.
Conclusion
In the realm of global medical
activities, Asian junior doctors
encounter formidable challenges
rooted in societal expectations and
prevailing bureaucratic cultures.
These challenges pose significant
barriers, impeding their full and
meaningful participation in the
international medical arena. This
article shines a light on these
obstacles, advocating for increased
awareness and proactive measures
to address and mitigate the adverse
impacts on the promising trajectory
of Asian junior doctors in the
global health landscape. As a call to
action, the WMA and JDN should
advocate for policies and programs
that create more opportunities for
junior doctors in Asia.
First, providing clear guidelines
on working hours and staffing in
healthcare settings can establish
a foundation for the robust
enforcement of regulations in these
areas. The development of WMA or
JDN standards or guidelines would
offer stronger tools to national
member associations for their
advocacy and reform efforts. Second,
establishing a comprehensive
WMA/JDN mentorship program
can offer invaluable guidance and
role models for junior doctors.
While the recent WMA initiative,
the Past Presidents and Chairs
of Council Network (PPCN)
mentorship program, is a step in
the right direction, we recommend
implementing mentorship programs
at a regional level. This would
address unique challenges in the
region, such as issues stemming
from generational hierarchies and
bureaucratic structures. Regional
mentorship programs would
promote better communication
and understanding among junior
doctors and other healthcare
professionals in clinical settings.
Finally, fostering WMA/JDN
networking among Asian national
member countries would help
Asian junior doctors broaden their
perspectives, exchange knowledge,
and forge meaningful professional
connections. These networks
could also advocate for financial
aid, sponsorships, or reduced fees,
enabling junior doctors to attend
conferences, engage in discussions,
and build relationships with
colleagues at both national and
international levels. These three
initiatives – setting standards,
establishing mentorship programs,
and encouraging networking – will
Multifactorial Challenges Experienced by Asian Junior Doctors in the Workplace
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67
empower junior doctors to excel
and thrive in the global medical
landscape.
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Authors
Yujin Song, MD
Past Director of International Affairs,
Korean Intern Resident Association
Department of Family Medicine,
National Medical Center Seoul,
Republic of Korea
yujin.song.kr@gmail.com
Wunna Tun, MBBS, MD
Secretary, Junior Doctors Network,
World Medical Association
Yangon, Myanmar
onlinewunna@gmail.com
Merlinda Shazellenne, MBBS, OHD
Medical Education Director,
Junior Doctors Network,
World Medical Association
Past Chairperson,
Junior Doctors Network Malaysia
Department of Occupational
Safety and Health
Seremban, Malaysia
dr.merlinda@gmail.com
Shiv Joshi, MD
Past National Convener &
Member of the Standing Committee,
Junior Doctors Network,
Indian Medical Association
Delhi, India
drshivjoshi93@gmail.com
Minku Kang, MD
Past President,
Korean Intern Resident Association
Department of Preventive Medicine,
Korea University College of Medicine
Department of Public Health,
Korea University Graduate School
Seoul, Republic of Korea
mk7man@gmail.com
Aravind Swamy, MBBS, MPH
Former Joint Secretary JDN,
Liaison, Indian Medical Association
Headquarters Member,
Junior Doctors Network India,
Indian Medical Association
Madurai, Tamil Nadu, India
draravind.akkayasamy@gmail.com
Poorvaprabha Patil, MBBS, MSPH
Kasturba Medical College,
Manipal Academy of Higher Education,
Manipal, Karnataka, India
London School of Hygiene
and Tropical Medicine,
University of London,
London, United Kingdom
poorvapatil01@gmail.com
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70
The science on climate change
is clear. According to the Sixth
Assessment Report (AR6) of
the Intergovernmental Panel on
Climate Change, “human activities,
principally through emissions of
greenhouse gasses, have unequivocally
caused global warming, with global
surface temperature reaching 1.1°C
above 1850-1900 in 2011-2020”
[1]. Adverse global impacts from
human-induced climate change
will continue to intensify, and the
health effects of the global surface
temperature rise are extensive and
clear [1].
Children, particularly socially
disadvantaged children, are uniquely
susceptible to the health effects
of climate change. In comparison
to adults, children spend more
time outside, have less efficient
thermoregulation, and have higher
respiratory rates. They also are
growing and developing immunity,
resulting in this susceptibility.
As physicians, we have a unique
responsibility to advocate for
practices that mitigate the effects
of climate change on children,
our most vulnerable patients [2].
To address this challenge, it is
critical that we understand climate
stressors like extreme heat, changing
seasons, air quality, severe weather
events, and expansion of vector
habitats, and their disproportionate
health effects on children [3].
Extreme heat. An increasing body
of worldwide evidence suggests
that high temperatures during the
prenatal period are correlated with
increased rates of preterm birth,
low birth weight, and stillbirth
[4]. In Spain, infant mortality
(particularly in the first week of
life) was 25% higher on extremely
hot days, when compared to all
deaths (1986-2006) in the Catalonia
region [5]. In the United States,
extreme heat was associated with
a 17% increase in emergency
department visits by children for all
complaints, with heat-related illness,
bacterial enteritis, and otitis media
and externa showing significant
increases [6]. Furthermore, urban
heat islands in the United States
disproportionately impact non-white
and economically disadvantaged
children, resulting in both increased
physical health effects and decreased
school performance [7]. Physician
awareness of heat and its impact on
children’s health is critical for both
advising families on safe practices
on hot days as well as preparing for
heat-related conditions that present
to the clinic or hospital.
Changing seasons. The
warming planet will result in
shorter cold seasons and longer
hot seasons. Birch, oak, and
grass pollen are all projected
to increase substantially with longer
hot seasons [8]. As there is a
significant association between the
birth month and the risk of allergic
sensitization or asthma later in life,
children exposed to high allergen
levels during the first three months
of life are more likely to develop
early wheezing and allergic
sensitization [8-10]. Primary care
physicians, therefore, should be
prepared to manage allergies and
asthma cases, while emergency
providers should be aware of
increased asthma complications
as the surrounding environment
continues to change.
Air quality. Changes in temperature,
precipitation, and wind patterns
are contributing to worsening
air quality. Air pollution impacts
children by increasing preterm birth,
pneumonia and other respiratory
infections, asthma, cancer, and
neurodevelopmental disorders [11].
In 2021, for children under five,
15% of all global deaths were linked
to poor air quality, and the air
pollution related death rate in Sub-
Saharn Africa was 100 times higher
than the rate reported in high-
income countries [12]. As physicians,
we need to educate families on the
Climate Change and Children’s Health:
An Overview and Call to Action
Cara Lembo
Climate Change and Children’s Health
Daniel Mendoza Shana Godfred-Cato
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71
health effects of harmful emissions
and strategies to improve air quality
in the home and limit outdoor
exposure on poor air quality days.
Severe weather events. As
temperatures rise, natural disasters,
such as floods, droughts, wildfires,
and intense storms, are increasingly
displacing children from their
homes [1]. The United Nations
Children’s Fund (UNICEF) found
that weather-related disasters were
linked to an estimated 43.1 million
internal displacements of children
worldwide (approximately 20,000
per day) from 2016-2021 [13].
People in low- and lower-middle-
income countries are approximately
five times more likely to be
displaced [14]. Child displacement
exposes children to the elements
(e.g. heat, cold, poor air quality,
infectious disease) as well as causes
negative impacts on mental health,
underscoring the need for awareness
and advocacy in reducing these
impacts.
These climate stressors can increase
children’s risk of exposure to
infectious diseases and negative
psychological health outcomes. Shifts
in seasonal weather patterns and
more frequent flooding, including
the influence of anthropogenic
factors like human mobility and
land use changes, can lead to an
associated increase in vector-borne
diseases spread by flies, mosquitoes,
and ticks. Over the last 50 years,
the global incidence of dengue has
increased 30 times, largely due to
climate change related factors such
as rainfall, temperature, and
urbanization [15,16]. The incidence
of malaria is inversely proportional
to a country’s per capita gross
domestic product, though it remains
unclear whether poverty increases
the spread of malaria or higher
malaria rates inhibit economic
growth [17]. The morbitity and
mortality of vector-borne diseases
are particularly high in children. For
example, malaria attributable death
rates have been reported to be as
high as 25-30% in children under
five years old in some regions of
Africa [17]. Hence, physicians
should be aware of how these
dynamic environmental factors
are influencing the expansion of
vector habitats and risk of disease
transmission, as well as the unique
health effects of these vector-borne
diseases on children.
The psychological toll of climate
stressors on child and adolescent
mental health is immense. In 2022,
one study examined 10,000 young
people (aged 16-25) across 10
countries, revealing that 84% were
at least moderately worried about
climate change, 50% perceived that
climate change negatively affected
their daily life and functioning, and
more than half reported feeling that
governmental responses to climate
change were inadequate [18]. In
addition to their unique physical
and emotional vulnerability, children
will live longer to feel the effects of
climate change, as a child born in
2024 will be just 26 years old in 2050
and 76 years old in 2100. In even
the most optimistic greenhouse gas
emission scenarios, the planet will
be a vastly different place at the
turn of the century than it is today
[1].
As health professionals, it is our
moral responsibility to seek high-
quality evidence-based sources on
the direct and indirect health impacts
of climate change on children’s
health, which can prepare us for
providing optimal clinical care to
our patients. For example, UNICEF
and the World Health Organization
(WHO) developed a free children’s
environmental health course for
healthcare providers, which aims to
provide foundational knowledge to
make healthcare providers effective
communicators and advocates [19].
In our daily clinical practice, it
is imperative that we encourage
children and families to manage
their chronic medical conditions and
medications meticulously, which can
be exacerbated by climate stressors.
We must also incorporate climate
change counseling into our clinical
practice, by educating families on
regional health risks and disaster
preparedness strategies. As trusted
members of society, we should
encourage the adoption of healthy
habits, such as using active modes of
transportation (e.g. walking, biking)
and consuming plant-based diets
to increase nutritional intake and
reduce carbon emissions[2].
To support urgent action to combat
the climate crisis, physicians can
lead global discourse, help develop
international policies, and share
climate and health information
with patients, their families, and
communities. Across the globe,
health systems have prepared and
launched action plans to serve as a
framework to implement climate
mitigation and adaptation measures
that meet national and international
indicators like the Sustainable
Development Goals. Likewise,
professional medical associations
have taken significant strides to
leverage their clinical expertise
and offer collective stances. The
American Medical Association
signed the U.S. Call to Action on
Climate, Health, and Equity: A Policy
Action Agenda in 2019, recognising
the need to work across government
agencies, sectors, and communities
to address the climate and health
emergency. The World Medical
Association (WMA) adopted
the WMA Resolution on Climate
Emergency in October 2019,
highlighting the need to protect
the future generation’s right to
live in a healthy environment, and
Climate Change and Children’s Health
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72
empowering health professionals to
act on a broader societal scale [20].
Together, our medical community
can contribute to this timely call to
action and advocate for policies to
stop climate change in the name of
children’s health on local, national,
and international legislative levels.
The future needs us.
References
1. Calvin K, Dasgupta D, Krin-
ner G, Mukherji A, Thorne PW,
Trisos C, et al. IPCC, 2023: Cli-
mate Change 2023: Synthesis
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Groups I, II and III to the Sixth
Assessment Report of the Inter-
governmental Panel on Climate
Change [Core Writing Team, H.
Lee and J. Romero (eds.)]. Gene-
va: IPCC; 2023. Available from:
https://www.ipcc.ch/report/ar6/
syr/
2. Ahdoot S, Baum CR, Cataletto
MB, Hogan P, Wu CB, Bernstein
A, et al. Climate change and chil-
dren’s health: building a healthy
future for every child. Pediatrics.
2024;153(3):e2023065504.
3. U.S. Environmental Protection
Agency.Climate change and chil-
dren’s health and well-being in
the United States [Internet].2023
[cited 2024 Nov 10]. Available
from: https://www.epa.gov/sys-
tem/files/documents/2023-04/
CLiME_Final%20Report.pdf
4. Zhang Y,Yu C,Wang L.Temper-
ature exposure during pregnancy
and birth outcomes: an updated
systematic review of epidemio-
logical evidence. Environ Pollut.
2017;225:700-12.
5. Basagaña X, Sartini C, Barre-
ra-Gómez J, Dadvand P, Cu-
nillera J, Ostro B, et al. Heat
waves and cause-specific mor-
tality at all ages. Epidemiology.
2011;22(6):765.
6. Bernstein AS, Sun S, Weinberg-
er KR, Spangler KR, Sheffield
PE, Wellenius GA. Warm sea-
son and emergency department
visits to U.S. children’s hospi-
tals. Environ Health Perspect.
2022;130(1):017001.
7. Voelkel J, Hellman D, Sakuma
R, Shandas V. Assessing vulner-
ability to urban heat: a study of
disproportionate heat exposure
and access to refuge by socio-de-
mographic status in Portland,
Oregon. Int J Environ Res Public
Health. 2018;15(4):640.
8. Harley KG, Macher JM, Lip-
sett M, Duramad P, Holland
NT, Prager SS, et al. Fungi
and pollen exposure in the first
months of life and risk of ear-
ly childhood wheezing. Thorax.
2009;64(4):353-8.
9. Kihlström A, Lilja G, Pershagen
G, Hedlin G. Exposure to birch
pollen in infancy and develop-
ment of atopic disease in child-
hood. J Allergy Clin Immunol.
2002;110(1):78-84.
10. Kihlström A, Lilja G, Pershagen
G, Hedlin G. Exposure to high
doses of birch pollen during preg-
nancy, and risk of sensitization
and atopic disease in the child.
Allergy. 2003;58(9):871-7.
11. Landrigan PJ, Fuller R, Fish-
er S, Suk WA, Sly P, Chiles TC,
et al. Pollution and children’s
health. Sci Total Environ.
2019;650:2389-94.
12. Health Effects Institute. State of
Global Air 2024. Boston: Health
Effects Institute; 2024. Available
from: https://www.stateofglo-
balair.org/resources/report/state-
global-air-report-2024
13. United Nations Children’s Fund.
Children displaced in a chang-
ing climate [Internet]. 2023 [cit-
ed 2024 Jul 15]. Available from:
https://www.unicef.org/reports/
children-displaced-changing-cli-
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14. Oxfam America. Climate
change and inequality [Inter-
net]. 2024 [cited 2024 Jul 28].
Available from: https://www.
oxfamamerica.org/explore/is-
sues/climate-action/climate-
change-and-inequality/
15. Bhatia S, Bansal D, Patil S, Pan-
dya S, Ilyas QM, Imran S. A
retrospective study of climate
change affecting dengue: evi-
dences, challenges and future
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2022;10:884645.
16. Franklinos LHV, Jones KE, Red-
ding DW, Abubakar I. The effect
of global change on mosqui-
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Dis. 2019;19(9):e302-12.
17. Gallup JL, Sachs JD. The eco-
nomic burden of malaria. In: The
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new look at the numbers: sup-
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brook: American Society of
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www.ncbi.nlm.nih.gov/books/
NBK2624/
18. Hickman C, Marks E, Pihkala
P, Clayton S, Lewandowski RE,
Mayall EE, et al. Climate anxiety
in children and young people and
their beliefs about government
responses to climate change:
a global survey. Lancet Planet
Health. 2021;5(12):e863-73.
Climate Change and Children’s Health
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19. World Health Organization.
UNICEF-WHO introducto-
ry course on children’s environ-
mental health [Internet]. 2024
[cited 2024 Nov 7]. Availa-
ble from: https://www.who.
int/teams/environment-cli-
mate-change-and-health/set-
tings-and-populations/children/
capacity-building/e-course
20. World Medical Association.
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Emergency [Internet]. 2019
[cited 2024 Nov 19]. Availa-
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net/policies-post/wma-resolu-
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Authors
Cara Lembo, MD, MSc
University of Utah
Salt Lake City, Utah, United States
Cara.Lembo@hsc.utah.edu
Daniel Mendoza, PhD
University of Utah
Salt Lake City, Utah, United States
Daniel.Mendoza@utah.edu
Shana Godfred-Cato, DO
University of Utah
Salt Lake City, Utah, United States
Shana.Godfred-Cato@hsc.utah.edu
Climate Change and Children’s Health
BACK TO CONTENTS
74
BACK TO CONTENTS
One Health Day (https://www.
onehealthday.com/) is recognised
annually on 3 November, and
this year marks the ninth global
celebration. This day offers a
moment to highlight the One
Health approach, by reflecting on the
direct connections between humans,
animals (domestic and wild), plants,
and our surrounding environment,
as well as understanding that
multiple disciplines and sectors
can collectively accelerate scientific
advancements related to endemic
and emerging global risks. Published
in October 2022, the One Health
Joint Plan of Action 2022-2026
promotes the importance of the
4C’s – communication, collaboration,
cooperation, capacity building –
that can help align how we can
operationalize One Health in
practice [1]. As the sixth action track
(integrating the environment into
One Health) prioritizes biodiversity
protection and restoration efforts
that support the human-animal-
environment nexus and sustainable
development, health professionals
can help galvanize global efforts to
better understand the natural and
anthropogenic phenomena affecting
the delicate ecosystem balance
and how to best communicate the
health-related impacts with patients
and communities.
Illustrating and Communicating
Ecosystem Changes
Over the past decades, the effects
of climate change have been
monitored and acutely observed,
including sea level rise, record-
breaking temperatures, widespread
drought and flooding, and other
severe weather events [2]. For
example, increased temperatures can
cause earlier bloom seasons with
greater exposure to pollen and other
allergens, changes in soil moisture
and nutrient cycling, and expanded
vector habitat suitability with risk
of disease transmission. The higher
frequency and duration of droughts
can impact the agricultural sector
(including food security and wildfire
risk), as well as increase the risk of
dust storms affecting air quality,
highway safety, and exposure
to Coccidioides spores. Land-use
changes due to agricultural and
industrial practices or deforestation
can force animals to seek and
adapt to new environments that are
proximal to humans, just as urban
landscape modifications from green
space to asphalt can absorb more
solar radiation and influence urban
heat island effects.
To address these single or concurrent
incidents, health systems are
challenged by workforce shortages,
inadequate infrastructure, and
limited resources, which may
exacerbate or amplify communicable
and non-communicable disease
risks. Since the Institute of
Medicine published the framework
of six domains of healthcare
quality (safe, effective, patient-
centered, timely, efficient, equitable)
in 2001, health professionals have
observed healthcare trends and
emerging gaps in service delivery
(including shortcomings during the
COVID-19 pandemic) and have
suggested revisions, such as weaving
“patient-centered” elements in
each domain (rather than patient-
centered as a separate domain)
and incorporating new domains
(e.g. ecology, transparency) into
the model [3-5]. Similarly, one
proposed seventh domain of patient
connectedness underscored the need
to dedicate time to build meaningful
provider-patient rapport and genuine
connections albeit busy workplace
schedules and responsibilities
[6]. Renewing trust in healthcare
systems, reinforced by effective
teamwork and empathetic
communication, can ultimately
support shared clinical decision-
making, improve cultural
competence, and promote healthy
literacy.
Harnessing new data, tools, and
technologies to identify the primary
drivers of emerging and reemerging
health risks is paramount in
capturing a comprehensive
understanding of the complex
and intricate connections of our
changing Earth’s systems and
public health. This information
can help guide health professionals
in the development of relevant
Enhancing One Health Communication
in the Environmental Sciences
Helena J. Chapman
Muge Akpinar-Elci
Enhancing One Health Communication
75
health messages on recommended
prevention practices to mitigate
exposures to climate-related risks.
Collectively, health professionals can
empower patients and community
members to adopt healthy behaviors,
such as seeking protective cover
and staying hydrated in extreme
temperatures and wearing protective
clothing and using repellent to
prevent mosquito or tick bites. Their
indispensable role in One Health
communication on environmental
health topics, however, may be met
with skepticism amidst the growth
of digitalization (including social
media technology), which may
provoke the diffusion of inaccurate
and misleading health messaging for
target audiences.
Defining Constructs
As health professionals tailor
their health communications,
including incorporating audio
and visual elements and using
diverse communication channels,
they should ensure that they
simultaneously understand, listen
to, and motivate target audiences
[7]. Efforts to develop accurate,
easy to understand and access, and
actionable messages, nonetheless,
may be associated with the
constructs of misinformation,
disinformation, and malinformation.
These unexpected outcomes can
undermine trust, distort facts,
and create barriers to promptly
sharing information and adopting
recommended health behaviors [8].
Misinformation, defined as the
spread of false or inaccurate
information without intention to
harm, can unintentionally mislead
the public about health information.
Disinformation is the act of
deliberately misleading information,
because of specific motives (e.g.
economic, political), which can be
weaponized to create distrust and
block timely health interventions.
Malinformation, a relatively newer
term, represents the dissemination
of correct information used out
of context to harm or attack an
idea, and simultaneously increases
distrust by emphasizing negative
aspects without proper framing or
context [8]. Addressing these threats
requires proactive tactics, including
engaging diverse audiences and
venues, exiting disciplinary silos to
broaden scientific discourse, and
building trust and rapport with
stakeholders, which can equip
health professionals during their
direct patient interactions in clinical
and community settings.
Identifying and Addressing Gaps
in Communication Approaches
Engaging diverse audiences and
venues. Communicating within the
One Health framework is inherently
complex due to its interdisciplinary
nature, involving multiple sectors
such as public health, medicine,
nursing, veterinary science, and
environmental sciences. While
this connectedness is crucial for
addressing One Health challenges,
each discipline brings its own
terminology and knowledge to the
collective discussion. This path,
however, can lead to confusing
or fragmented communication,
which can hinder the ability to
craft accurate messages for diverse
audiences. Health professionals can
tailor messaging when seeking new
audiences at community outreach
activities, including families (e.g.
community family days or public
library events), university students
(e.g. campus activities), agricultural
communities (e.g. local or state
fairs, farm stores, zoos), and local
policy agencies (e.g. community
council meetings) [9]. Aligning
messaging with community
engagement has been highlighted in
the comprehensive reports on
prioritized zoonotic diseases
through more than 35 U.S. Centers
for Disease Control and Prevention
(CDC)’s One Health Zoonotic
Disease Prioritization (OHZDP)
workshops that describe collaborative
steps working with One Health
partners to mitigate zoonotic
disease risk [10]. Also, incorporating
environmental principles into One
Health messaging has been observed
in the National Aeronautics and
Space Administration (NASA)
Earth Science Applications Guidebook
(https://appliedsciences.nasa.
gov/guidebook/) and the U.S.
interagency-supported Earth
Information Center (https://earth.
gov/), which offer specific examples
on using Earth science applications
across agricultural, disasters, health,
and water sectors.
Exiting disciplinary silos. The impact
of disciplinary silos and conflicting
stakeholder priorities can create
significant barriers to advancing
One Health communication. As
health professionals engage with
different stakeholder groups (e.g.
agriculture, industry, policy, trade),
shared discourse of cost-effective
solutions may result in contradictory
perspectives on short- and long-
term health and environmental
sustainability. Political cycles and
frequent leadership changes can
bring uncertainty to the sustained
investment, commitment, strategic
priorities, and communication
needed to support the development
and implementation of One Health
initiatives. Also, with the academic
pressure to contribute to scholarly
publications (“publish or perish”),
researchers may select high-impact
journals recognised in their fields,
leading to academic or knowledge
silos. To promote robust
transdisciplinary collaborations
among diverse sectors and
stakeholders, co-designed projects
with equal and meaningful
BACK TO CONTENTS
Enhancing One Health Communication
76
participation can offer a valuable
platform to leverage expertise, data,
and tools, as well as discuss mutual
goals that align with optimal human,
animal, and environmental health
[11]. Bridging gaps and building
trust across multiple disciplines will
require strategic and transparent
communication, commitment to
fostering interdisciplinary dialogue,
and ethical data sharing and
reporting policies [12].
Building trust and rapport. Effective
communication among One
Health stakeholders requires clear,
transparent, and evidence-based
information sharing among relevant
parties to help build interpersonal
connections and trust. Culturally,
ethically, and language appropriate
strategies should be integrated into
community engagement activities,
which can help resonate one’s
lived experiences with support for
One Health efforts. For example,
visual storytelling or role-playing
exercises can capture the audience’s
attention, presenting scenarios with
multiple branches for the discussion
of complex health topics. Health
professionals have a crucial role
in building trust with community
leaders and achieving meaningful
public engagement across One
Health activities [13]. For example,
stimulating community interest on
One Health partnerships has been
observed through artistic creativity
and scientific precision in the
CDC’s One Health in Action stories
(https://www.cdc.gov/one-health/
php/stories/index.html) as well as
through community-driven health
fairs and workshops that provide
hands-on learning experiences.Also,
the Earth Observing Dashboard,
a tri-agency collaboration between
NASA, the European Space Agency
(ESA), and the Japan Aerospace
Exploration Agency (JAXA), which
provides easy-to-use data portal for
the public to explore the interactive
dashboard and narratives addressing
changes to global ecosystems.
Conclusion
As the world commemorates the
ninth annual celebration of One
Health Day 2024, global leaders
continue to raise awareness of
the impacts of natural and
anthropogenic phenomena on
the delicate balance of our global
landscapes. Significant momentum
has propelled leaders to build
sustainable collaborations and
develop novel, nature-based, and
cost-effective solutions to mitigate
further biodiversity loss and
degradation and exposure to harmful
pollutants or pathogens. Despite
clear scientific evidence of climate-
related risks, however, health
professionals remain challenged to
effectively share creative messaging
with tangible actions, as part of
their One Health communication
strategies [2,14]. Access to
broadband internet access, proposed
as a social determinant of health,
offers essential opportunities to
acquire health information and
digital health services, employment
and virtual learning, and community
and social networks [15]. Aside
from the multiple advantages of
information and communication
technologies, the rapid spread of
incorrect information on these
virtual platforms, coupled with
the “digital divide” (gap related
to unequal access to digital
technologies), can hinder One
Health communication efforts to
improve health literacy.
As World Medical Association
(WMA) members, our moral and
ethical responsibilities to care for our
patients’ physical and mental health
and well-being as well as support
their healthcare decision-making are
based on several landmark policies.
First, the WMA Declaration of
Geneva, adopted in September 1948
and amended in October 2017,
describes the professional and ethical
responsibilities of physicians, noting
that “The health and well-being of
my patient will be my first
consideration” [16]. Second, the
WMA Statement on Healthcare
Information for All, adopted in
October 2019, emphasizes that
health professionals, patients, and
the general public must have access
to evidence-based, relevant, reliable,
and unbiased health information,
to help inform decision-making
about healthcare services over the
lifespan [17]. These policies offer
a solid framework, where health
professionals can collectively leverage
clinical and surgical expertise
to develop catchy messaging –
accurately describing health risks
and illustrating concrete actions to
minimize morbidity and mortality
rates – to support One Health
communication and recommended
climate mitigation and adaptation
strategies.
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trol and Prevention. One Health
Zoonotic Disease Prioritiza-
tion (OHZDP) [Internet]. 2024
[cited 2024 Nov 15]. Availa-
ble from: https://www.cdc.gov/
one-health/php/prioritization/
index.html#cdc_generic_sec-
tion_2-about-the-workshops
11. Dos S Ribeiro C, van de Burgw-
al LHM, Regeer BJ. Overcom-
ing challenges for designing and
implementing the One Health
approach: a systematic review
of the literature. One Health.
2019;7:100085.
12. Wardle C, Derakhshan H. In-
formation disorder: toward an
interdisciplinary framework
for research and policymak-
ing. Strasbourg: Council of
Europe; 2017. Available from:
https://rm.coe.int/informa-
tion-disorder-report-novem-
ber-2017/1680764666
13. Chapman HJ, Veras-Estévez BA.
Integrating One Health topics to
enhance health workers’ leader-
ship in health promotion activ-
ities. Global Health Promotion.
2023;30(2):40-5.
14. World Health Organization.
WHO demands urgent integra-
tion of health in climate negotia-
tions ahead of COP29 [Internet].
2024 [cited 2024 Nov 15]. Avail-
able from: https://www.who.int/
news/item/07-11-2024-who-de-
mands-urgent-integration-of-
health-in–climate-negotiations-
ahead-of-cop29
15. Benda NC, Veinot TC, Sieck
CJ, Ancker JS. Broadband inter-
net access is a social determinant
of health! Am J Public Health.
2020;110(8):1123-5.
16. World Medical Association.
WMA Declaration of Geneva
[Internet]. 2017 [cited 2024 Nov
15]. Available from: https://www.
wma.net/policies-post/wma-dec-
laration-of-geneva/
17. World Medical Association.
WMA Statement on Healthcare
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able from: https://www.wma.net/
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all/
Authors
Helena Chapman,
MD, MPH, PhD
Milken Institute School
of Public Health,
George Washington University
Washington, DC, United States
hjchapman@gwu.edu
Muge Akpinar-Elci,
MD, MPH
Dean, School of Public Health,
University of Nevada Reno
Reno, Nevada, United States
makpinar@unr.edu
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Enhancing One Health Communication
78
From the development of modern
medicine in ancient Greece to
present day, the empirical method
emerged as a systematic approach
to observe phenomena, collect and
analyse data (e.g. hypothesis testing),
and conclude findings [1]. These
steps underline the unique vantage
point of physicians, who endure
comprehensive training in evidence-
based medical sciences to attain a
high level of competency in their
clinical, surgical, and public health
practice. Their direct interactions
and evaluation of patients’ underlying
physical and mental health concerns,
coupled with the close examination
of the social and structural
determinants of health, reflects the
need to build physician-patient
rapport and cultivate authenticity in
communications [2]. Incorporating
robust communication techniques,
like the Four Habits Model
(invest in the beginning, elicit the
patient’s perspective, demonstrate
empathy, invest in the end) or
PEARLS (partnership, empathy,
apology or acknowledgment,
respect, legitimation, support),
into the clinical encounter,
reflects the sentiments expressed
by Hippocrates, known as the
Father of Modern Medicine:
“Cure sometimes, treat often, comfort
always.” [3,4]. Physicians, who are
cognizant of this moral conduct
and accountability and understand
the health system as a whole, can
leverage their expertise to articulate
gaps in healthcare service delivery,
advocate for community needs, and
contribute to the development of
timely interventions and policies
with local and national leaders [5].
Since the World Medical Association
(WMA) was founded in September
1947, WMA members have adopted
two landmark declarations, which
serve as guidance to ensure that
high-quality ethical standards are
prioritised and upheld in daily
clinical interactions (including
research initiatives) with patients,
families, and community members.
The WMA Declaration of Geneva
(adopted in 1948 and amended
in 2017), which emphasises
the physicians’ professional
responsibilities guided by ethical
principles, focuses on elements of
confidentiality, medical knowledge,
physician-patient rapport,
professionalism, and respect [6].
Also, the WMA Declaration of
Helsinki (adopted in 1964 and
amended in 2024) underscores the
essential ethical principles needed
for medical research involving
human participants, for physicians,
research teams, and participants [7].
Building upon these declarations,
the WMA adopted the WMA
Resolution in Support of
an International Day of the
Medical Profession, October
WMA Members Recognise International Doctors’ Day
WMA Members Recognise International Doctors’ Day
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79
30, at the 71st WMA General
Assembly (virtual) in Cordoba,
Spain, in October 2020 [8].
This resolution was reaffirmed
by the 226th Council Session
in the Seoul, Republic of Korea,
in April 2024. With emerging
and reemerging global threats,
physicians will be called to lead and
contribute to efforts that promote
multidisciplinary and multisectoral
collaborations, support shared
decision-making with patients, and
reinforce healthcare service delivery
across nations. Their dedicated
efforts follow the sentiments of Sir
William Osler: “The good physician
treats the disease; the great physician
treats the patient who has the disease.”
In this article, physicians from 12
countries – Bulgaria, Côte d’Ivoire,
Ecuador, India, Kenya, Malaysia,
Myanmar, Nepal, Philippines,
Republic of Korea, Trinidad and
Tobago, and Türkiye – shared
their perspectives on International
Doctors’ Day, identified existing
challenges and described local
and national actions to strengthen
medical education and practice, and
expressed optimism related to the
future of medicine. Notably, they
shared a symbolic reflection that
resembles physicians’ leadership,
expertise, passion, and compassion
across their nations.
Bulgaria
Bulgarian Physician’s Day is
celebrated annually on 19 October
since 1996, paying tribute to St.
John of Rila, the revered healer
and patron of the Bulgarian people
who symbolizes the compassion,
dedication, and moral duty that
define a doctor’s life. The idea for
the celebration was suggested by Dr.
Totko Naydenov, to acknowledge
and praise Bulgarian doctors
who perceive medicine as their
calling. Each year, the Bulgarian
Medical Association marks the
occasion by honouring exceptional
doctors with awards, including
Physician of the Year (recognising
outstanding achievement), You are
our Future (highlighting promising
young doctors), Contribution
to the Prestige of the Profession
(acknowledging those who elevate
the reputation of Bulgarian
physicians and medicine), and
Commitment to Innovation
(identifying professionals who drive
novel adoption of new techniques
and promote growth within the
field), and Dedication and Medical
Ethics (recognising physicians’
courage and commitment to
patient care and professional
values). Complementing Bulgarian
Physician’s Day, Bulgarian physicians
recognise the Day of Salvation on
15 August, paying tribute to all
doctors who lost their lives in the
line of duty, in remembrance of Dr.
Stefan Cherkezov’s selfless actions
in 1963, who lost his life after
saving 47 passengers from a burning
bus accident.
Like other countries across the
globe, Bulgaria faces a critical
shortage of healthcare professionals,
as the workforce is aging, and the
number of young physicians entering
the national healthcare system is
dwindling. Combined with the push
and pull factors driving professional
migration, Bulgaria is experiencing
a significant reduction of physicians
and nurses, which in turn affects
access to quality healthcare services.
The newly elected Chairperson of
the Bulgarian Medical Association,
Dr. Nikolay Branzalov, stated that
“Young physicians seek three things:
job opportunities, specialised training,
and career advancement. Currently,
remuneration is inconsistent with the
efforts, but the bigger issues are the
complexity of specialisation and career
growth. The current specialisation
rules are designed as if there were an
excess of healthcare professionals, rather
than stimulating young physicians to
specialise.” For example, the Bulgarian
medical community has observed
the limited number of health
professionals serving in paediatric
medicine among other specialties.
Recognising these challenges, the
Bulgarian Medical Association is
committed to supporting the well-
being of all physicians, enhancing
the profession’s prestige, and
increasing support for junior doctors
and medical students (and hence,
recruitment and retention), which
can ensure sustainable, quality care
for future generations.
The newly elected leadership (2024-
2027) of the Bulgarian Medical
Association is committed to
continuing the Association’s work
and long-term priorities (including
improving working conditions for
Bulgarian physicians) in a spirit of
continuity and collegiality. First,
the Bulgarian Medical Association
advocates for a more equitable
compensation structure, addressing
undervalued physician labour
within the current National Health
Insurance Fund (NHIF) model.
With input from academic experts,
a proposed methodology has been
submitted to the Bulgaria Ministry
of Health and the Council of
Ministers, and is currently awaiting
review and implementation. Second,
the Association seeks legislative
amendments to make continuing
medical education (CME) and
continuing professional development
(CPD) mandatory, fostering
ongoing improvement and removing
barriers that restrict doctors’ access
to professional growth opportunities.
Finally, the Bulgarian Medical
Association continues to negotiate
with the NHIF, on behalf of various
medical specialties, to balance the
needs of primary, specialised, and
hospital care in service to Bulgarian
patients and society. For example,
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WMA Members Recognise International Doctors’ Day
80
the Association successfully
advocated for the inclusion of the
prohibition of transferred funds
from the NHIF budget to other
budget lines in the NHIF Budget
Act.
Bulgaria’s healthcare professionals
remain dedicated to preserving the
future of their field and the well-
being of their patients. First, the
Bulgarian Medical Association
recognises that the next generation
of physicians will serve as a vital
source of inspiration, reminding the
medical community of the higher
calling that defines their work.
Alexander Sidjimov, a third-year
medical student, refers to medicine
as “the key that unlocks the doors
of health and hope, transforming
knowledge into action for the benefit
of humanity.” Second, Bulgaria
remains one of the European
countries that has the smallest
healthcare spending per capita,
while providing comparable quality
and access for Bulgarian residents.
Finally, observing the shortage of
health professionals, the Bulgarian
Medical Association will continue
to advocate for prioritising
healthcare services for children
in the negotiation process of the
National Framework Agreement.
“The Day of Bulgarian Physicians is
a time to reflect on our commitment,
devotion, and labour, which will
remain our lifelong companions in this
noble calling.” – Zahari Iliev, sixth-
year medical student
“There is a moment that has always
touched me deeply. If, even for an
instant, you feel togetherness, positivity,
and energy, that can be the most
precious moment… The fate of a doctor
is imprinted in the eyes and posture of
the older generations… Just one look or
a moment is enough to understand how
many lives they have saved, how much
responsibility they have shouldered.”
– Dr. Hristina Dimitrova, general
practitioner with over 30 years of
experience, from Varna, Bulgaria
Côte d’Ivoire
International Doctors’ Day,
celebrated globally on 30 March,
offers a unique opportunity to
honour the hard work, dedication,
and sacrifices made by physicians
around the world. In Côte d’Ivoire,
this day holds particular significance
for its healthcare professionals, who
are the backbone of the nation’s
health system and play a critical
role in ensuring the well-being of
Ivorian communities. It serves as a
moment for physicians to reflect on
their mission to provide high-quality
healthcare to residents, especially in
a challenging environment marked
by economic constraints, disease
outbreaks, and limited resources.
This day is an acknowledgment of
their resilience, leadership, and the
sense of responsibility they carry to
improve the health outcomes of the
population.
In the Ivory Coast, the shortage of
trained medical professionals due
to the low doctor-to-patient ratio
(1.8 physicians per 10,000 people)
places immense pressure on existing
healthcare providers. Also, limited
access to training materials, outdated
curricula, and a lack of medical
infrastructure in universities makes
it difficult for aspiring doctors to
receive the quality education they
need. To address this challenge,
the Université Félix Houphouët-
Boigny, the largest public university
in the country, has served as
a leader in updating medical
curricula (clinical and public health
education) to align with World
Health Organization (WHO)
competencies and standards.
Ivorian medical institutions have
also partnered with international
organisations (like the African
Medical and Research Foundation,
AMREF) to provide training to
healthcare professionals and build
capacity for medical education
across the continent (including in
the Ivory Coast).
With restricted access to medicines,
diagnostic tools, and specialised
treatments, doctors often face
difficult decisions about prioritising
patient care and maintaining
medical ethics (e.g. fairness,
compassion, informed consent)
in a resource-scarce environment.
Ivorian medical associations (like
the Syndicat National des Médecins
de Côte d’Ivoire, SYNAMCI)
have actively promoted ethical
training and workshops, emphasised
patient-centred care, and supported
guideline development to assist
doctors in providing equitable
healthcare services.
In the coming years, Ivorian doctors
can strengthen their impact on
local and national health efforts
through several key actions. First,
doctors can organize and lead
community health programs aimed
at preventive care (e.g. vaccination,
nutrition education, maternal
health services) across urban and
rural areas. Second, together with
their national medical association
or participation in medical unions,
physicians can amplify their voices
and advocate for relevant health
policies and reforms, such as
improved healthcare funding and
working conditions. Third, the
current medical community can
invest in mentoring junior doctors
and medical students, ensuring
that they have access to practical
experiences and ethical leadership,
which may help alleviate the
current healthcare workforce
shortage. Finally, strengthening
public-private partnerships can lead
to innovative healthcare service
delivery, including telemedicine
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WMA Members Recognise International Doctors’ Day
81
initiatives and advanced clinical
services.
“Our role as doctors goes beyond treating
disease; we are healers of society. Every
day we stand at the intersection of
life and death, using our knowledge,
compassion, and resilience to restore
hope. The challenges are many, but
the passion for healing our people will
always be greater.” – Senior physician
working at the Centre Hospitalier
Universitaire in Abidjan, Côte
d’Ivoire
Ecuador
In Ecuador, International Doctor’s
Day, celebrated on 21 February,
holds a deep significance for
the nation’s physicians, as it
commemorates the birth of Dr.
Eugenio Espejo, a pioneering
figure in Ecuadorian medicine and
public health. Dr. Espejo, born
in 1747 in Quito, is revered not
only as the father of Ecuadorian
medicine, but also as the first
medical hygienist, educator, and
founder of scientific journalism
in the Spanish colonies [9]. His
foundational works on smallpox
and quinine treatment and his
influence on early medical education
underscore his legacy. On this day,
Ecuadorian doctors honour his
contributions and reflect on their
own responsibilities toward
advancing health in Ecuador,
especially by drawing from his
spirit of scientific rigor and social
advocacy.
Ecuadorian doctors face challenges
in healthcare infrastructure and
resident physician welfare that
affect both clinical practice and
patient outcomes. First, Ecuador
has a limited number of hospital
beds (only 1.4 beds per 1,000
people), compared to the regional
average (1.9 beds per 1,000 people),
creating bottlenecks in care delivery,
especially during public health crises
like the COVID-19 pandemic [10].
Furthermore, resident physicians
contend with excessive working
hours and insufficient remuneration,
which restrain both their well-being
and professional development [11].
To address these issues, there have
been calls to regulate work hours,
improve resident compensation,
and provide mental health support,
drawing from frameworks such as
Canada’s CanMEDS program to
structure professional growth.
Looking forward, Ecuadorian
physicians can play a transformative
role by advocating for better
healthcare infrastructure and a
more supportive environment for
medical trainees. Actions such
as fostering partnerships with
international medical bodies for
infrastructure support, actively
participating in national health
policy dialogues, and prioritising fair
compensation working conditions
and dignified postgraduate training
for resident doctors will reinforce
their contributions to public health.
Additionally, by embracing evidence-
based frameworks for professional
development and advocating for
improved working conditions,
Ecuadorian doctors can continue
Espejo’s legacy of advancing medical
education and ethical practice.
“In every challenge we face, we find
an opportunity to innovate and better
serve our community. Our passion for
humanity is the driving force behind
positive change in Ecuador’s health.”
– Dr. Pablo Estrella Porter, public
health resident in Valencia, Spain
India
International Doctors’ Day,
celebrated on the first Monday of
October each year, holds a special
place for physicians worldwide,
symbolising the recognition and
respect that they have earned
for their tireless dedication to
public health. This day highlights
the extraordinary efforts
of doctors who commit their lives
to the well-being of others, often
facing long work schedules, high
levels of stress, and immense clinical
responsibilities. In India, Doctors’
Day is celebrated annually on 1 July,
commemorating the birth and death
anniversaries of Dr. Bidhan Chandra
Roy, an esteemed physician,
politician, statesman, and the
former Chief Minister of West
Bengal. This day reaffirms doctors’
purpose and values that they
uphold, provides an opportunity
for communities and healthcare
organisations to express appreciation
and gratitude, and acknowledges
the pivotal role doctors play in
enhancing healthcare quality and
access. Doctors’ Day underscores
their commitment to advancing
medical knowledge and
compassionate care, reminding
everyone of the profound impact
that physicians have on society.
In India, doctors encounter
significant challenges affecting
medical education and public
health practice. First, the limited
and uneven distribution of medical
training institutions restricts access to
well-trained healthcare professionals,
especially in rural regions. Despite
India having approximately 750
medical colleges and producing
around 150,000 medical graduates
each year, underserved areas still lack
adequate healthcare resources. In
response, medical associations and
government initiatives are striving
to improve infrastructure and
implement policies that encourage
doctors to serve in these under-
resourced areas. Second, increasing
violence against healthcare
professionals threatens doctors’
safety and compromises patient care.
Medical organisations are leading
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WMA Members Recognise International Doctors’ Day
82
efforts to address workplace violence,
by advocating for stronger legal
protections (including policies) and
promoting public awareness on the
importance of respecting healthcare
providers. These proactive measures
highlight the medical community’s
commitment to fostering a safe,
equitable, and ethical healthcare
environment across the country.
With the increasing
commercialisation of healthcare,
the medical profession has also
continued to face challenges
that influence the doctor-patient
relationship. Nonetheless, the
Sanskrit phrase (“Vaidyo Narayano
Harihi”) reflects the dedication,
expertise, and selflessness of
doctors in India, who continue to
tirelessly work to uplift the health
of their communities. It embodies
the spirit of Indian physicians,
whose leadership, compassion,
and commitment to their patients
remain steadfast, even amidst
changing times. It underscores the
respect and honour traditionally
commanded by doctors in Indian
society, recognising their vital role as
healers and protectors of life.
Looking into the future, doctors in
India can take impactful steps to
strengthen their contributions to
local and national health initiatives,
but a significant shift is needed in
how healthcare policies are formed.
Since medical professionals are not
often treated as key stakeholders
in policymaking, unfeasible,
unscientific, and sometimes
unsustainable policies result, which
can hinder long-term public
health goals. By actively involving
doctors in policy discourse, the
government can leverage their
expertise to address critical issues
like healthcare accessibility and
resource distribution in underserved
areas and serve India’s diverse
population. Doctors could also
drive preventive care efforts through
community education programs
focused on chronic diseases, maternal
health, and hygiene and sanitation,
empowering citizens to adopt
healthier lifestyle choices.
Furthermore, by embracing digital
health technologies (such as
telemedicine), doctors can extend
their healthcare services to rural
areas, which can help bridge gaps in
healthcare access.
“Vaidyo Narayano Harihi.” (“The
doctor is to be regarded as next only to
God.”) – Sanskrit phrase
Kenya
International Doctors’ Day,
celebrated on 1 July in Kenya,
allows doctors to reflect on our
important clinical and public health
initiatives and our commitment
to our patients. This day reminds
Kenyan doctors to celebrate one
another as colleagues in this
esteemed profession, analyse current
health system challenges, and
identify best practices for sustainable
change in our discipline. It also
offers an opportunity to reflect
on our journeys in the medical
profession and recognise our career
achievements in advancing science
and caring for our patients and
society.
In Kenya, the internship period
has been marred by challenges,
including delayed posting
and remuneration, leading to
feelings of demoralisation among
interns [12]. This sentiment
is compounded by the already
present shortage of doctors in
public facilities, which results in
excessive workloads for clinical
teams. With a significant number
of the population living below the
poverty line and corruption within
the national health insurance, there
are insufficient resources to support
health financing for universal health
coverage. Hence, Kenyan doctors
advocate for health system reforms
through professional associations,
such as the Kenya Medical
Association and the Young Doctors
Network [13].
As Kenyan doctors, we must not
turn a blind eye to the challenges
in the health sector. We must seek
leadership positions in our local
institutions and communities, where
we can leverage our expertise,
contribute to national discourse,
and help inform relevant and
ethical health policies. We should
become more active in professional
associations, where we can identify
community needs, amplify our
voices, and network with
other health professionals.
Using social media and other
technologies to help educate
the public on health system
challenges, we can collectively lead
sustainable change that prioritises
patient care.
“We are the custodians of healthcare
in our country. Politicians come and
go by, but we are here to stay. We
must be at the forefront of fixing our
healthcare system. That is the best way
to fulfill our oath as doctors.” – Dr.
Mutonyi, Convener, Young Doctors
Network
Malaysia
In Malaysia, Doctors’ Day was
first launched by the Federation of
Private Medical Practitioners
Associations in 2014. Celebrated
annually on 10 October, it
recognises the unbreakable spirit
and commitment of doctors to
their patients, as well as the unique
bond between doctors and patients.
As doctors reflect upon why they
chose the medical profession, they
understand that they must never
lose sight of their passion, amidst
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WMA Members Recognise International Doctors’ Day
83
challenging situations in the clinical
workplace and healthcare system.
Additionally, Doctors’ Day provides
a valuable opportunity for the
Malaysian Medical Association to
advocate for doctors and highlight
the challenges that they face within
the Malaysian healthcare system.
On Doctors’ Day 2024, members
adopted a Declaration to prevent
workplace bullying and harassment
reinforcing the belief in their slogan,
“Happy Doctors, Happy Patients”.
Malaysian doctors face significant
challenges, including the ongoing
workforce shortage, high levels of
burnout, and caring for the aging
demographics. First, with limited
staffing across public hospitals,
doctors often work long hours
under intense pressure, leading to
physical and emotional exhaustion
and impacting the quality of patient
care. Second, caring for Malaysia’s
aging population challenges doctors
working with local community
members (known as the “Rakyat”
in the Malay language), who often
cannot afford health insurance and
rely on the healthcare system.
To address these challenges,
policymakers and healthcare
institutions can collaborate to
ensure a sustainable workforce,
improved work-life balance, and
supportive mental health resources,
which can ultimately benefit doctors
and the communities they serve.
The Malaysian government has
introduced initiatives to promote
healthier lifestyles and reduce risk
of non-communicable diseases,
including encouraging reduced
sugar consumption and offering tax
incentives for gym memberships
and fitness equipment. In
collaboration with the Association,
the government and Ministry of
Health have focused initiatives
on the recruitment and retention
of healthcare professionals and
continued training to support
a stronger, more sustainable
healthcare workforce and reduce the
brain drain.
Doctors in Malaysia can help shape
the healthcare system by coming
together to support each another and
advocate for sustainable solutions to
solve urgent healthcare challenges.
Through active engagement with
the Malaysian Medical Association,
they can build trust, collective
strength, and momentum for
healthcare system reforms that
provide the highest quality of
care to citizens of all ages and
collectively advocate for improved
work-life balance and career
growth. Malaysian doctors can
lead public health campaigns
that aim to improve elder
care policies and create better
public awareness on elderly care.
Supervising doctors can provide
mentorship to junior doctors in
the clinical setting, help expand
telemedicine and home healthcare
services, and contribute to medical
research. These efforts can be
further strengthened with the full
commitment from the government,
healthcare system, and policymakers,
acknowledging that healthcare
should always be a top priority for
any nation. As described in
the Malaysian proverb, doctors’
selfless actions and commitment
to community health will be
remembered long after they are
gone, honouring their role as
compassionate leaders in society.
Their expertise, dedication, and care
leave behind a meaningful legacy in
the lives they touch.
“Harimau mati meninggalkan belang,
manusia mati meninggalkan nama.”
(“A tiger dies leaving its stripes: a
person dies leaving their name.”) –
Malaysian proverb
Myanmar
For Myanmar doctors, International
Doctor’s Day on 3 October, serves
as a reminder of their critical role
in providing clinical management
amidst adversity and highlights
the urgent need for international
support and recognition of their
efforts. According to the WHO,
Myanmar, a country of 54 million
population, has an estimated 7.5
doctors per 10,000 population in
2019 (compared to 3.8 doctors
per 10,000 population in 2004).
Since the military coup in
February 2021, Myanmar military
attacks have directly targeted
healthcare facilities and personnel,
violating the principles of medical
neutrality [14]. Although many
Myanmar doctors are unable
to fully celebrate this day, they use
this opportunity to demonstrated
their ongoing commitment to patient
care amidst adversity and advocate
for international support, as
supported by the WMA declaration
[15].
Myanmar doctors continue to face
significant challenges in medical
education and clinical practice, due
to the military coup, with airstrikes
and heavy weaponry affecting
medical schools and training
hospitals. First, damaged and
destroyed facilities, limited resources,
and overburdened medical teachers,
coupled with the transition to online
learning, have severely hindered
trainees’ learning opportunities and
essential hands-on clinical training
[16]. Second, ethical dilemmas arise
as health professionals navigate
resource scarcity (including essential
medicine and medical equipment),
due to power and telecommunication
outages and the continued supply
chain blockage by Myanmar
military and security forces [17,18].
Myanmar doctors often express
a strong moral commitment to
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WMA Members Recognise International Doctors’ Day
84
remain in the country, following
the Physician Pledge, with an
unwavering duty of care to ensure
the safety and well-being of patients
requiring treatment (albeit risk of
arrest, violence or capture) [19].
To support Myanmar doctors,
establishing collaborative networks
with international health
organisations (like WHO and
WMA) can help identify best
practices for medical care and
facilitate resource sharing, including
the provision of medical equipment,
diagnostic tests, medications, and
personal protective equipment.
These resources, together with
deploying qualified medical
personnel to the Myanmar border,
can effectively address supply chain
disruptions that impact essential
medications and equipment as well
as ensure continuity of care. Also,
Myanmar doctors can partner with
the WMA and JDN to identify
specific community health needs
(including social determinants of
health) for the development of
educational workshops and targeted
interventions. By appointing
Myanmar doctors with authorisation
to practice in border towns, they
can help treat displaced Myanmar
civilians without overburdening
neighbouring countries’ healthcare
systems. Finally, international
organisations can pursue legal action
through the International Criminal
Court (ICC) or the International
Court of Justice (ICJ), holding
Myanmar military and security
forces accountable for their actions.
“Myanmar medical students, trainees,
fellows, and healthcare professionals
are dedicated to saving and healing
the injured, often at great personal
and familial risk, even as they face
opportunities to migrate abroad. Their
unwavering commitment to providing
care during the darkest times in
Myanmar serves as a powerful
reminder that hope and resilience can
prevail when we strive to do our best
for those in need.” – Dr. Wunna Tun
Nepal
Since the Nepal Medical
Association was established on 4
March 1951, members celebrate
Doctor’s Day on the Nepali date
of Falgun 20 (usually 4 March), as
an occasion to recognise doctors’
successful leadership and clinical
contributions to their patients and
the general society each day. This
day also reminds policymakers and
the public about the need to address
challenges experienced by healthcare
professionals, such as workplace
violence and resource shortages,
as well as ensure supportive and
safe clinical environments. Doctor’s
Day also promotes unity among
the medical fraternity, including
the importance of professional
development, ethical practice, and
patient-centered care. Moreover,
this day provides an opportunity to
appreciate Nepali doctors working
abroad, who represent Nepal and
contribute in global healthcare.
As Nepali doctors help advance
the nation’s health and access
to healthcare services, their
commitment aligns with Sustainable
Development Goal 3 (ensure healthy
lives and promote well-being for all at
all ages), as well as the Nepal Health
Sector Strategic Plan 2023-2030 that
aims to strengthen health equity,
promote patient safety, and ensure
quality care for all [20]. By
combining compassion with
integrity, Nepali doctors set
inspiring examples of resilience
and leadership in healthcare.
For example, Dr. Sanduk Ruit
is a renowned ophthalmologist,
known as “God of Sight,” who
has transformed lives through
thousands of free cataract surgeries
for Nepalese patients. Despite
this robust infrastructure, Nepali
doctors have experienced significant
workplace challenges, including
multiple incidents of verbal and
physical assaults (even damage to
hospital property) that have created
unsafe environments, and they
have responded by participating in
widespread community protests and
strikes [21]. Also, many doctors are
reluctant to work in the rural areas,
due to low financial compensation
and limited resources across facilities
[22].
In response to these challenges,
the Nepal Medical Association has
led advocacy efforts to improve
public awareness of healthcare
challenges (e.g. violence against
doctors), including partnering
with communities and government
agencies. The Medical Education
Commission has been consistently
supporting doctors in their demand
for increased pay for resident doctors.
However, there is a potential risk of
800 residency seats being allocated
elsewhere, raising concerns about
future opportunities [23]. Improving
healthcare involves implementing
strict rules to ensure doctors’ safety,
increasing postgraduate placements,
and offering more government
job opportunities. Hence, political
commitment is essential to address
salary adjustments, secure safe
working environments, reduce the
clinical workload, properly develop
and execute relevant policies, and
manage resources [24].
Looking forward into the profession,
Nepal Medical Association
members believe that improving
clinical facilities and adopting
telemedicine can help expand access
to populations living in remote
areas of the country. By establishing
sustainable collaborations with
federal agencies, leaders can help
develop relevant policies that
can mitigate workplace violence
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WMA Members Recognise International Doctors’ Day
85
faced by doctors. Finally, building
networks with international health
organisations can provide valuable
knowledge-sharing opportunities,
allowing Nepali doctors to
incorporate global standards and
innovative practices into local
healthcare.
“A doctor’s mission is to heal with
compassion and lead with integrity, a
path that Nepali physicians walk every
day despite challenges.” – Dr. Anil
Bikram Karki
Philippines
For the Filipino physician,
Physicians’ Day signifies the
recognition and appreciation for
their dedicated service to the health
and well-being of the nation.
Physicians across the archipelago
utilize this day to reflect on their
achievements and renew their
commitment to patient care and
community welfare. It is a moment
to honour their relentless efforts,
particularly amid challenges such
as natural disasters and pandemics,
where they have stood as beacons of
hope and resilience. The celebration
reinforces the noble calling of being
a physician in a country where
healthcare needs are vast, and
resources often limited. Over the
past 70 years, the Government of
the Philippines and Philippine
Medical Association have supported
several proclamations related to
the medical profession. These
proclamations include Proclamation
No. 407 in 1953 (proclaiming
Philippine Medicine Day on 15
September, aligned with the 50th
Foundation Day of the Philippine
Medical Association on 15
September 1903), Proclamation
No. 330 in 1956 (declaring 15-
21 September as Medicine Week),
Proclamation No. 439 in 1957
(declaring the fourth week of
September as Medicine Week),
and Proclamation No. 1789 in
1978 (declaring 27 September as
Physician Day) (https://lawphil.
net/). Over time, the focus has
shifted from celebrating the medical
profession to honoring the Filipino
physicians.
Under the Commission on Higher
Education (CHED), there are 77
medical schools in the Philippines,
of which 24 of the country’s state
universities and colleges offer a
Doctor of Medicine program. As of
2023, the Professional Regulation
Commission (PRC) revealed that
only 59.7% (or 95,039) of 159,283
registered physicians are active [25].
Following the Republic Act No. 7722
and the “Doktor Para Sa Bayan”
Act (RA No. 11509), CHED
encourages all eligible state
universities and colleges offering
medical programs to join the
CHED Medical Scholarship
and Return Service (MSRS)
Program. This program provides
opportunities for deserving Filipino
medical students who are willing to
complete mandatory post-graduate
service in low-resource areas without
physicians, especially the top 20%
of provinces or municipalities
identified as geographically isolated
and disadvantaged areas by the
Philippine Statistics Authority
[26]. To address these challenges,
physicians are leading efforts
to advocate for policy reforms,
contribute to updating ethical
guidelines and frameworks
(guided by the Philippine Medical
Association – PRC’s adoption
of the Code of Ethics of the
Medical Profession), and engage in
professional development to adapt
to modern-day challenges of the
medical profession [27].
As physicians grapple with these
challenges, the Philippine Medical
Association is committed to
make its governance participatory,
consensus-oriented, accountable,
transparent, responsive, effective and
efficient, equitable and inclusive.
Its leadership vows to exercise
prudence in policy-setting and
decision-making, follow the rule
of law, exhibit innovation and
responsiveness to change while
addressing the present and future
needs of the organisation, and
ensure that the best interests of all
stakeholders, physicians, and patients
are considered. Filipino doctors can
strengthen their contributions to
community health by advocating
for policy reforms, improving
access to care in underserved areas,
and addressing health inequities
through preventive care, education,
and interdisciplinary collaborations.
They can also promote mental
health well-being, educate on
environmental health risks, and
encourage professional development
while fostering transparency,
research, and public-private
partnerships to align with the
Philippine Medical Association’s
commitment to responsive and
inclusive governance.
“We are ONE PMA: Empowering
the Filipino Physician for Nation
Building.” – Philippine Medical
Association phrase
Republic of Korea
Although “Doctors’ Day” is not
widely recognised among the
Republic of Korea citizens, some
local medical associations (such as the
Seoul Medical Association)
coordinate annual events on 3
June, while some hospitals observe
World Doctors’ Day on 30 March.
By contrast, World Health Day has
been observed as a national day since
7 April 1973, consolidating existing
health-related commemorative days
to enhance public health awareness
and honour healthcare professionals.
Traditionally, the Ministry of
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WMA Members Recognise International Doctors’ Day
86
Health and Welfare hosts events
and campaigns, including awards
for exceptional contributions to
healthcare. However, this year, no
significant events took place, and
both Doctors’ Day and World
Health Day passed with little public
acknowledgment.
Republic of Korea physicians,
particularly junior doctors, are
facing significant challenges rooted
in diminishing public trust and
recurring disputes with policymakers.
First, the government has confirmed
a unilateral decision to increase the
medical school admissions quota by
66%, starting in 2025. Physicians
widely believe that this policy,
implemented without addressing
the poor training and working
conditions of junior doctors, risks
harming the national healthcare
system in the long run. Second,
as junior doctors are increasingly
avoiding specialisation, essential
medical fields (e.g. paediatrics,
surgery) have a shortage of
physicians and medical facilities
equipped to provide critical care.
Contributing factors include
inadequate reimbursement rates for
essential services and the burden
of excessive legal liability on
practitioners.
To address these challenges,
doctors are striving to uphold their
commitment to patient welfare
despite adverse conditions and
hostile public sentiment. The
rapid decline in trust, following
the widespread admiration for
healthcare professionals as “true
heroes” during the COVID-19
pandemic, poses a serious threat
to future public health crises.
Rebuilding this trust requires
societal acknowledgment of
physicians’ dual roles as caregivers
and clinicians, including respect
for their right to advocate for
improved conditions. The individuals
celebrated for their heroism during
the pandemic are now leading the
fight for sustainable healthcare
reforms. Mutual respect and
reconciliation between doctors
and the public are essential to
overcoming these shared challenges
and advancing community health.
“True heroes are not those who
seek glory but those who persevere
in adversity to serve others.” –
Christopher Reeve
Trinidad and Tobago
Doctors frequently work long
hours, and mentally and physically
tiring shifts, to provide quality
care for their patients. Sometimes,
however, their dedicated efforts may
go publicly unnoticed. National
Doctors’ Day is celebrated on 30
March in Trinidad and Tobago,
as a reminder of dedicated health
professionals who work as a team
supporting the health system and
their patients. As a Caribbean
nation, we have a rich culture and
versatile history, especially within
the medical fraternity, and we must
recognise doctors’ contributions to
form the best clinical decisions and
policies moving forward as well
as manage workplace challenges
(including dynamic brain-drain
and brain-gain). Despite doctors’
long arduous hours in the clinical
workplace, including efforts leading
and navigating the COVID-19
pandemic, doctors nationally
serve to protect communities and
save lives. Notably, during the
COVID-19 pandemic, the Trinidad
and Tobago Medical Association
collaborated with some organisations
(like Starbucks) to acknowledge the
hard work of frontline healthcare
professionals throughout the country
with a small gift [28].
Two major obstacles of the
medical profession in Trinidad and
Tobago remain the local retention
of medical professionals and the
provision of specialty training
programmes, which have led to
a brain drain and need to obtain
specialists, even sourcing from
other nations (like Cuba) [29-
31]. To encourage retention within
the health system, one national
strategy is that doctors who received
academic scholarships must serve
their country for five years after
their training [32]. Also, the
Trinidad and Tobago Medical
Association and the University of
the West Indies have actively
collaborated to develop mentorship
programmes for medical students,
which can dually help retain
physicians after graduating and
encourage those who train abroad
to return to serve the nation. The
Caribbean Medical Journal, the
official journal of the Trinidad
and Tobago Medical Association,
has promoted and contributed to
the medical academia locally and
regionally, by offering a local avenue
for physicians to publish their work
and hence promote professional
identity and pride within the
Caribbean region.
Looking ahead, Trinidad and
Tobago doctors can promote
a more nurturing environment
for junior physicians locally and
regionally, as they learn from
the past, effectively deal with
the obstacles they face, and direct
future steps to uplift the healthcare
fraternity. For example, they can
advocate and help strengthen
local programmes that encourage
physicians to visualize local avenues
for professional development
without necessarily having to
seek international training. Also,
incentives for physicians to return to
Trinidad and Tobago and serve their
communities include the creation
of new job placements, mentorship
programmes, and teaching posts,
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WMA Members Recognise International Doctors’ Day
87
which foster a sense of identity
and pride in the development of
Trinidad and Tobago’s healthcare
system. They can actively promote
sustainable community health
initiatives, contribute to local and
regional research activities, and
publish their findings in peer
reviewed journals like the Caribbean
Medical Journal and the West Indian
Medical Journal.
“In understanding the past, we gain
insight into the present and can shape
a brighter future.” – Dr. Eric Eustace
Williams, first Prime Minister of
Trinidad and Tobago and a famous
Caribbean historian
Türkiye
Medical Day in Türkiye has been
celebrated each 14 March since
1919, inspired by the opening
of the first medical schools and
start to modern medical education
on 14 March 1827. Notably, the
first celebration was held in 1919,
when medical students in Istanbul
protested against the British
occupation, and this sentiment
aligns with the struggle for
independence and freedom in
present day. Today, 14 March
represents a day to celebrate the
country’s legacy in the medical
profession and discuss pressing
healthcare issues for patients and
health professionals. The Turkish
Medical Association, established in
1953, has supported Medical Day
(and Medical Week) and organised
numerous events each year, such as
meetings, seminars, artistic activities,
rallies, and demonstrations, to
increase awareness of important
public health topics and challenges
faced by physicians.
Today, doctors in Türkiye face
numerous challenges that have
reflected the perceived devaluation
of the medical profession, including
exposure to violence, inadequate
educational opportunities,
insufficient income, and unsafe
working conditions. Since the 1990s,
policies in Türkiye have aimed to
commercialize healthcare, which
appears to devalue doctors’ clinical
responsibilities across public and
private sectors. Public statements
from government officials that
target doctors and belittle their
work have severely damaged the
profession’s reputation. Likewise,
the government has implemented
various regulations aimed at reducing
the value of medical labour and
hindering doctors’ professional
independence. Each year, 20,000
doctors graduate from 128 medical
schools, many of which provide poor
education because of inadequate
teaching staff and infrastructure. By
increasing the number of medical
schools, more doctors graduate
from medical schools, but it hinders
the quality of education, further
devalues the profession, and can
negatively impact public health.
Since 1953, the Turkish Medical
Association has prepared legal
initiatives and actions, even filing
lawsuits (when appropriate) against
legal regulations introduced by
the Ministry of Health. The team
also conducts meetings with both
government and opposition parties
to discuss legal arrangements,
submits reports, engages in media
efforts to inform doctors and the
public about the consequences
of misguided health policies, and
organises various actions (including
strikes). For example, doctors and
other health professionals at family
health centres conducted a three-
day strike between 5-7 November
2024, aligning their actions with
the “protecting public health and
our profession” motto. As Turkish
Medical Association members,
we will continue to strive for a
healthier society in our country and
for the rights of physicians and all
healthcare professionals.
“Entrust me to Turkish doctors.” –
Mustafa Kemal Atatürk (1881-
1938), founder of the Republic of
Turkey
Conclusion
The global celebration of physicians
– whether International Day of the
Medical Profession or International
Doctors’ Day – presents a special
opportunity to distinguish the
dedicated efforts of the medical
community, including the deep sense
of responsibility and commitment
to serve individual patients and
protect community health, while
navigating challenges within complex
health systems [33]. The exponential
pace of technological innovation
and medical advancements,
including the use of artificial
intelligence, machine learning
models, and genomic sequencing,
continue to revolutionize the
speed and accuracy of clinical
diagnostics and treatment, which
can subsequently lead to lower
morbidity and mortality rates,
improved quality of life, and reduced
healthcare expenditure. Hence,
physicians hold a pivotal leadership
role, where they can leverage their
clinical expertise to expand scientific
discovery through multidisciplinary
and multisectoral collaborations,
and ultimately advocate for urgent
global collective action to mitigate
emerging and reemerging health
risks.
Each day, WMA members
demonstrate essential leadership
skills in the face of adversity,
such as improving pandemic
preparedness (including reducing
risk of antimicrobial resistance),
understanding the primary drivers
of climate-related health risks
and crafting catchy messaging
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WMA Members Recognise International Doctors’ Day
88
BACK TO CONTENTS
for patients and the public,
and advocating for timely
policies to protect physicians’
well-being and reduce risk of
burnout [34,35]. They continue
to inspire future generations and
strengthen the foundation of a more
resilient and equitable health system,
while upholding the fundamental
principle of medical ethics, “first, do
no harm” (“primum non nocere”). This
collective article showcases a regional
overview of how physicians have
supported high-quality healthcare
service delivery, promoted direct
interactions and communication
techniques to strengthen physician-
patient rapport, developed
community partnerships that
support health messaging and public
awareness on pressing concerns, and
addressed challenges in medical
education and practice. Specifically,
it highlights physicians’ commitment
to improving health outcomes
across the African, Americas, Asian,
European, and Pacific regions, by
illustrating symbolic reflections
related to physicians’ indispensable
role across national health systems.
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Authors
N’dri Anderson, MD
Psychiatry resident, Psychiatric
Hospital of Bingerville,
University Felix Houphouët
Boigny of Cocody
Chair person, JDN Ivory Coast
Abidjan, Republic of Côte d’Ivoire
R. V. Asokan, MBBS, MD
(Internal Medicine)
National President, Indian
Medical Association
New Delhi, India
Alpay Azap, MD
President, Turkish Medical Association
Ankara, Turkiye
Damion Basdeo, MD
Past President (2023), Trinidad
and Tobago Medical Association
Port of Spain, Trinidad and Tobago
Bulgarian Medical Association
Sofia, Bulgaria
Maria Minerva Calimag,
MD, MSc, PhD
Departments of Pharmacology and
Clinical Epidemiology, Faculty
of Medicine and Surgery,
University of Santo Tomas
Immediate Past President,
Philippine Medical Association
Manila, Philippines
Helena Chapman, MD, MPH, PhD
Milken Institute School
of Public Health,
George Washington University
Washington DC, United States
Maymona Choudry, MD, MPH
School of Medicine, Ateneo de
Zamboanga University,
Zamboanga City, Philippines
Basilan General Hospital, Isabela,
Basilan, Philippines
Pablo Estrella Porter, MD, MPH
General physician, Quito, Ecuador
PhD student, Universidad de Valencia
Public Health resident, Hospital
Clínico Universitario de Valencia
Valencia, Spain
Jay Bhushan Jha, MBBS
Clinical Research Officer,
Nepal Medical Association
Kathmandu, Nepal
Anil Karki, MD
President, Nepal Medical Association
Kathmandu, Nepal
Christine Mutonyi, MD, MBChB
Convener, Young Doctors Network
Nairobi, Kenya
Anilkumar J. Nayak,
MBBS, MS (Ortho)
Honorary Secretary General,
Indian Medical Association
New Delhi, India
Martina Rodriguez, MD
Secretary (2024),
Trinidad and Tobago
Medical Association
Port of Spain, Trinidad and Tobago
Yujin Song, MD
Past Director of International Affairs,
Korean Intern Resident Association
Department of Family Medicine,
National Medical Center
Seoul, Republic of Korea
Sanjeeb Tiwari, MD
General Secretary, Nepal
Medical Association
Kathmandu, Nepal
Wunna Tun, MBBS, MD
Fellow, Medical Education
JDN Secretary
Yangon, Myanmar
M. Venkatachalapathy,
MBBS, MD (Pediatrics)
Honorary Joint Secretary,
Indian Medical Association
New Delhi, India
Loke Xi-Mun, MBBS
Chair, JDN Malaysia
Kuala Lumpur, Malaysia
khush.xi-mun@msn.com
WMA Members Recognise International Doctors’ Day
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For more than two decades, Professor Dr. Karsten Vilmar stood
at the helm of the German medical profession after which he
continued to serve the German Medical Association (GMA)
and the German Medical Assembly as its honorary president.
Sadly, he passed away in October 2024 at the age of 94.
“The German Medical Association is deeply saddened by
the news of Karsten Vilmar’s death. We remember him as a
longtime leader, a patient mentor and a reliable friend.
Karsten Vilmar was a man of consistency who tirelessly worked
to uphold the independence of the medical profession and
the personal nature of the patient-physician relationship as
the foundation of a patient-centred healthcare system. With
foresight and unwavering perseverance, he placed issues on
the political agenda, which are still relevant today. As a person,
as a physician, and as an advocate for the medical profession,
Karsten Vilmar achieved great things,” as expressed by Dr Klaus
Reinhardt, the President of the GMA.
Born in Bremen, Germany, on 24 April 1930, Professor Vilmar
studied medicine at the Ludwig Maximilian University in
Munich from 1950 to 1955, where he subsequently obtained
his doctorate. He completed his specialty training in surgery in
his hometown. From 1964 to 1995, he was senior consultant at
the trauma surgery clinic of the Sankt-Jürgen-Straße municipal
hospital in Bremen. His involvement in professional policy
began in 1970, when he assumed the role of Chair of the
Marburger Bund (MB) physicians’ union in Bremen, a position
that he held until 1996. At the national level, Professor Vilmar
chaired the MB from 1975 to 1979. He was President of
the Bremen Chamber of Physicians from 1976 to 1996, and
President of the GMA and the German Medical Assembly
from 1978 to 1999.
“In his daily interactions, his colleagues remember him as
fact-based and steadfast, yet diplomatic in his approach. He
upheld agreements and represented them with conviction
within and beyond the medical profession,” described
Reinhardt.
After becoming President of the GMA, Professor Vilmar
continued his professional political activities. He was involved
in the field of transplant medicine as a member of the Board
of Trustees of the German Organ Procurement Organisation.
As Chair of the Kaiserin Friedrich Foundation, he was
committed to continuing medical education and, as Chair of
the Hans Neuffer Foundation, to collegial exchange between
German physicians and their colleagues abroad. At the
international level, Professor Vilmar assumed leadership roles
in the Board of Directors of the European Doctors (CPME)
and the Council of the World Medical Association (WMA).
Among other things, he served as the CPME President and
WMA Treasurer for many years.
“We should remember Karsten Vilmar’s tireless efforts
to explain that the age distribution of the population and
increasing multimorbidity will inevitably increase the need
for medical and nursing care, and thus the expenditure on
healthcare services. While these correlations were long denied by
politicians and cost bearers,no one questions them anymore,”said
Reinhardt.
A hospital physician by training, Professor Vilmar vehemently
championed the interests of physicians in all areas of the
healthcare system. He was honoured with the highest award of
the German medical profession, the Paracelsus Medal, at the
103rd German Medical Assembly in Cologne, for his
extraordinary commitment to the medical profession in Germany
and around the world.
“As the medical professional recognises Karsten Vilmar’s
significant contributions to the medical profession and
healthcare, we mourn the loss of a wonderful colleague and
great person,”expressed Reinhardt.
German Medical Association
Prof. Dr. Karsten Vilmar
Obituary
Obituary
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Dr. Vincent Lamy, a Belgian gastroenterologist and active
member of the Belgian Association of Medical Unions (ABSyM)
for many years, passed away on 10 October 2024. During his
relentless, almost two-year battle with myeloblastic leukaemia,
he always remained lucid but optimistic. Forced to stop his
professional activity when his illness was announced, he devoted
all his strength to fighting his illness, and was supported by
close family members, including his wife Geneviève, his three
daughters, his eight grandchildren, and even his mother at almost
100 years old.
At the end of the 1980s, Dr. Lamy became involved in the
ABSyM. At the time, Dr. André Wynen, an emblematic figure
of the World Medical Association (WMA), served as President
from 1973 to 1976 and General Secretary from 1976 to 1993.
Later, Dr. Lamy became Secretary General and was appointed
to represent Belgian physicians at the WMA. He was also
Vice-President of ABSyM Wallonia, the union of Walloon
general practitioners and specialists, and President of Mdeon, a
deontological platform comprising 29 medical and paramedical
associations.
For Dr. Lamy, medicine was a whole and a matter of sharing!
The transmission of knowledge was of paramount importance
to him, and he firmly believed in the medicine of tomorrow
and the new generation of doctors. For this reason, he was an
honorary gastroenterology training supervisor at one of the many
hospitals,where he was still working before his illness.As a fervent
defender of medical ethics based on trust and patients’ interests,
professional autonomy and clinical independence were not
empty words for our colleague. As he was firmly convinced that
medicine was a matter of transferring knowledge and know-how,
he was keen to encourage and contribute to regional, national,
and international exchanges.
Dr. Lamy’s career accomplishments span across the
gastroenterology specialty and geographic borders, including:
• Member of the European Board of Gastroenterology and
Hepatology at the European Union of Medical Specialists
(UEMS) and the European Society of Digestive Endoscopy
(ESGE)
• President of the Royal Belgian Society of Gastroenterology
(SRBGE)
• Active and long-standing member of the Belgian Group of
Specialists (GBS/VBS)
• Member and Treasurer of the Belgian Society of Gastro-
Intestinal Endoscopy (BSGIE)
• Representative on the Belgian Medicomut Agreement at
the National Institute for Health and Disability Insurance
(INAMI/RIZIV)
• Co-founder member and Education Officer of the World
Gastroenterology Organisation (WGOE)
• Active member of the Belgian Helicobacter pylori group
(BHMSG) of Endofic, an association of endoscopy nurses
and numerous national gastroenterology associations (e.g.
United States, Italy)
• Co-founder of the African Society of Hepato-Gastro-
Enterology (SAHGE)
Notably, Dr. Lamy was born in Burundi in 1950, studied in
Africa, and spoke several languages, including Swahili. As he
was passionate about the history of the Congo and neighbouring
countries, some locals even called him the White Zulu!
Dr. Lamy was also the author of numerous scientific publications,
as he was determined to develop his discipline and share his
thoughts with the scientific community. Indeed, he always
worked with discretion and humility, without boasting of his
accomplishments. Right up to his last moments, he kept abreast
of the latest medical developments, giving pertinent advice to
colleagues, and even organizing events and conferences from
his bedside. Until recently, he was also involved in the
comprehensive revision of the Declaration of Helsinki.
As the son of a member of the Resistance, he was part of the
Group Mémoire, formerly chaired by Dr. Wynen, who was
also a survivor of the Nazi camps, and a committed defender of
democracy and human rights.
For all his colleagues and friends, Dr. Vincent Lamy’s kindness,
availability, and devotion to his profession will always be
remembered. It is with deep sadness that his colleagues bid him
farewell and pay him a vibrant tribute.
Association Belge des Syndicats
Dr. Vincent Lamy
Obituary
Obituary
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