Editorial
What can the UN General Assembly do for global health?
5 years ago the most important international event in
global health was still the World Health Assembly, held
in Geneva each May. At that gathering, Ministers of
Health meet and decide global priorities and strategies
Joseph Sohm/Visions of America/Corbis
for improving the health and wellbeing of their peoples.
WHO visibly expresses and demonstrates its leadership
at the Assembly, with technical staff guiding ministers
in their decision-making and planning. The Assembly is
the platform from which global health’s supreme inter-
governmental authority—WHO’s Director-General—
See Comment pages 1001, speaks to the world about its collective successes,
1002, 1005, and 1006
See Articles page 1029
challenges, and opportunities. But that week in May
See Review page 1049 has now been eclipsed by a gathering with even greater
political weight: the UN General Assembly (UNGA), held in
New York next week.
Why has New York superseded Geneva? The UNGA is
where Heads of State, not merely Ministers of Health,
gather. It is sadly true that most health ministers lack
domestic political muscle. They might talk tough among
themselves, but back home they have to get in line
Action on ambient air pollution
In today’s Lancet we publish further evidence of the
damaging health effects of air pollution. Anoop Shah and
colleagues show a positive association between heart
failure hospitalisation and mortality and all gaseous
and particle air pollutants measured except ozone. Their
systematic review and meta-analysis of 35 studies,
mainly in high-income countries, found that heart
Ted Spiegel/Corbis
failure hospitalisation and death increases with increased
concentrations of coarse (<10 μm; PM₁₀) and fine
(<2·5 μm; PM2·5) particulate matter, with more persistent
See Comment page 1008 effects for PM2·5. They estimate that a mean reduction in
See Articles page 1039 PM2·5 of 3·9 μg/m3 in the USA would prevent 7978 heart
failure hospitalisations and save US$307 million a year.
The negative impact of air pollution on acute
For the 2011 study on
myocardial infarction see
cardiovascular events is now becoming clear. This latest
Articles Lancet 2011; finding adds to a 2011 Lancet study, which showed
377: 732–40
that ambient air pollution was an important trigger
For more on lung cancer and air
pollution see Articles for myocardial infarction and of similar magnitude to
Lancet Oncol 2013; 14: 813–822 excessive physical exertion, coffee, and alcohol. Evidence
For the Global Burden of
Disease Study 2010 see Articles
for respiratory damage also continues to grow. In
Lancet 2012; 380: 2224–60 August, the European Study of Cohorts for Air Pollution
1000
behind colleagues in finance, defence, trade, and even
education. In New York, if a Head of State chooses to
lead his or her delegation on a health topic, others stop,
listen, and pay attention. In New York next week, Prime
Minister Shinzo Abe of Japan will lead on Universal Health
Coverage. Prime Minister Stephen Harper of Canada and
President Jakaya Kikwete of Tanzania will lead on women’s
and children’s health. They will get the kind of attention
and audience their health ministers can only dream about.
New York also matters because this is where an
increasing number of critical reports are published and
debated among policy makers, agencies, and politicians.
For example, UNICEF uses the UNGA to publish and
disseminate its latest numbers for child mortality, thereby
drawing maximum high-level political attention to
child survival. Indeed, it is at the UNGA where the future
of the post-2015 agenda will be forged. The General
Assembly is now an event that cannot be ignored by the
health community. Keep an eye on New York next week.
Interesting things are likely to happen. „ The Lancet
Effects found a higher risk of lung cancer with increasing
exposure to PM10. Overall, ambient particulate matter
pollution accounted for more than 3 million deaths in
2010, according to the Global Burden of Disease Study.
Good news then that China has unveiled new measures
to help clear its notoriously polluted skies. It plans to cut
total coal consumption to less than 65% of total primary
energy use by 2017 and speed up the closure of old and
polluting industrial sectors. This announcement follows
on from other initiatives, including new standards
for fuel production to reduce vehicle emissions and
substantial expansion of ground-level monitoring of
PM2·5 in cities. India, which does not have a similar system
of monitoring, could learn from the Chinese example. But
it is not just the emerging economies that need to take
heed of the mounting evidence against air pollution. The
USA and Europe should lower their regulatory limits for
particulate matter concentrations, which are presently
above WHO’s recommendations. Even small reductions
in these could confer substantial population health
benefits. „ The Lancet
www.thelancet.com Vol 382 September 21, 2013