17-Apr-2019: WHO releases first guideline on digital health interventions
WHO released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.
Harnessing the power of digital technologies is essential for achieving universal health coverage. Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.
Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health.
One digital intervention already having positive effects in some areas is sending reminders to pregnant women to attend antenatal care appointments and having children return for vaccinations. Other digital approaches reviewed include decision-support tools to guide health workers as they provide care; and enabling individuals and health workers to communicate and consult on health issues from across different locations.
The use of digital technologies offers new opportunities to improve people’s health. But the evidence also highlights challenges in the impact of some interventions. If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of delivering health services.
For example, the guideline points to the potential to improve stock management. Digital technologies enable health workers to communicate more efficiently on the status of commodity stocks and gaps. However, notification alone is not enough to improve commodity management; health systems also must respond and take action in a timely manner for replenishing needed commodities.
Digital interventions, depend heavily on the context and ensuring appropriate design. This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.
Digital health interventions are not sufficient on their own
The guideline demonstrates that health systems need to respond to the increased visibility and availability of information. People also must be assured that their own data is safe and that they are not being put at risk because they have accessed information on sensitive health topics, such as sexual and reproductive health issues.
Health workers need adequate training to boost their motivation to transition to this new way of working and need to use the technology easily. The guideline stresses the importance of providing supportive environments for training, dealing with unstable infrastructure, as well as policies to protect privacy of individuals, and governance and coordination to ensure these tools are not fragmented across the health system.
The guideline encourages policy-makers and implementers to review and adapt to these conditions if they want digital tools to drive tangible changes and provides guidance on taking privacy considerations on access to patient data.
“Digital health is not a silver bullet,” says Bernardo Mariano, WHO’s Chief Information Officer. “WHO is working to make sure it’s used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.”
The guideline also makes recommendations about telemedicine, which allows people living in remote locations to obtain health services by using mobile phones, web portals, or other digital tools. WHO points out that this is a valuable complement to face-to-face-interactions, but it cannot replace them entirely. It is also important that consultations are conducted by qualified health workers and that the privacy of individuals’ health information is maintained.
The guideline emphasizes the importance of reaching vulnerable populations, and ensuring that digital health does not endanger them in any way.
WHO’s work on digital health
This guideline represents the first of many explorations into the use of digital technologies and has only covered a fraction of the many aspects of digital health.
In 2018, governments unanimously adopted a World Health Assembly resolution calling on WHO to develop a global strategy on digital health to support national efforts to achieve universal health coverage. That strategy is scheduled to be considered at the World Health Assembly in 2020.
Although WHO is expanding its focus on digital health, the Organization has been working in this area for years, for example, through the development of the eHealth Strategy Toolkit in 2012, published in collaboration with International Telecommunications Union (ITU).
To support governments in monitoring and coordination of digital investments in their country, WHO has developed the Digital Health Atlas, an online global repository where implementers can register their digital health activities. WHO has also established innovative partnerships with the ITU, such as the BeHe@lthy, BeMobile initiative for the prevention and control of noncommunicable diseases, as well as efforts for building digital health capacity through the WHO Regional Office for Africa.
Over the years, WHO has released a number of resources to strengthen digital health research and implementation, including the mHealth Assessment and Planning for Scale (MAPS) toolkit, a handbook for Monitoring and Evaluation of Digital Health, and mechanisms to harness digital health to end TB.
On 6 March 2019, Dr Tedros announced the creation of the Department of Digital Health to enhance WHO’s role in assessing digital technologies and support Member States in prioritizing, integrating and regulating them.
2-Apr-2019: Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age
Early childhood is a period of rapid physical and cognitive development and a time during which a child’s habits are formed and family lifestyle habits are open to changes and adaptations.
The WHO Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age provide recommendations on the amount of time in a 24-hour day that young children, under 5 years of age, should spend being physically active or sleeping for their health and wellbeing, and the maximum recommended time these children should spend on screen-based sedentary activities or time restrained. They were developed using the best available evidence, expert consensus and consideration of values and preferences, acceptability, feasibility, equity and resource implications.
To meet daily physical activity time recommendations, particularly in children, the pattern of overall activity across a 24-hour period needs to be considered, since every day is made up of sleep time, sedentary time and light-, moderate- or vigorous-intensity physical activity.
Young children should have opportunities to participate in a range of developmentally-appropriate, safe, enjoyable play-based physical activities. The quality of sedentary time matters and interactive non-screen based activities, such as reading, storytelling, singing and puzzles are important for social and cognitive development as well as recreation and relaxation. Regular sleep and wake-up times can help to ensure adequate, good quality sleep.
RECOMMENDATIONS FOR 24-HOUR PHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR AND SLEEP FOR CHILDREN UNDER 5 YEARS OF AGE
These guidelines are for all healthy children under 5 years of age, irrespective of gender, cultural background or socio-economic status of families and are relevant for children of all abilities; caregivers of children with a disability or those with a medical condition, however, may seek additional guidance from a health professional.
For the greatest health benefits, infants, and young children should meet all the recommendations for physical activity, sedentary behaviour and sleep in a 24-hour period. Replacing restrained or sedentary screen time with more moderate- to vigorous-intensity physical activity, while preserving sufficient sleep, can provide additional health benefits.
Infants (less than 1 year) should:
- Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake.
- Not be restrained for more than 1 hour at a time (e.g. prams/ strollers, high chairs, or strapped on a caregiver’s back). Screen time is not recommended. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
- Have 14–17 hours (0–3 months of age) or 12–16 hours (4–11 months of age) of good quality sleep, including naps.
Children 1–2 years of age should:
- Spend at least 180 minutes in a variety of types of physical activities at any intensity, including moderate- to vigorous-intensity physical activity, spread throughout the day; more is better.
- Not be restrained for more than 1 hour at a time (e.g. prams/ strollers, high chairs, or strapped on a caregiver’s back) or sit for extended periods of time. For 1-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
- Have 11–14 hours of good quality sleep, including naps, with regular sleep and wake-up times.
Children 3–4 years of age should:
- Spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous intensity physical activity, spread throughout the day; more is better.
- Not be restrained for more than 1 hour at a time (e.g. prams/ strollers) or sit for extended periods of time. Sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
- Have 10–13 hours of good quality sleep, which may include a nap, with regular sleep and wake-up times.
Following the recommendations in these guidelines during the first 5 years of life is associated with better motor and cognitive development, psychosocial (emotional regulation) and cardiometabolic health, bone and skeletal health and reduced risk of injuries. Time spent restrained should be limited. Over the course of a day, a combination of more physical activity, less sedentary screen time and longer sleep duration results in the greatest benefits.
These guidelines are intended to assist all countries in the development of national plans and programmes aimed at increasing levels of physical activity, reducing sedentary time and improving time spent sleeping in young children.
The development of these new WHO guidelines was a recommendation of both the Commission on Ending Childhood Obesity and the Global Action Plan on Physical Activity 2018–2030.
25-Jun-2020: UNODC World Drug Report 2020: Global drug use rising
Around 269 million people used drugs worldwide in 2018, which is 30 per cent more than in 2009, while over 35 million people suffer from drug use disorders, according to the latest World Drug Report, released today by the United Nations Office on Drugs and Crime (UNODC). The Report also analyses the impact of COVID-19 on the drug markets, and while its effects are not yet fully known, border and other restrictions linked to the pandemic have already caused shortages of drugs on the street, leading to increased prices and reduced purity.
Rising unemployment and reduced opportunities caused by the pandemic are also likely to disproportionately affect the poorest, making them more vulnerable to drug use and also to drug trafficking and cultivation in order to earn money, the Report says.
“Vulnerable and marginalized groups, youth, women and the poor pay the price for the world drug problem. The COVID-19 crisis and economic downturn threaten to compound drug dangers further still, when our health and social systems have been brought to the brink and our societies are struggling to cope,” said UNODC Executive Director Ghada Waly. “We need all governments to show greater solidarity and provide support, to developing countries most of all, to tackle illicit drug trafficking and offer evidence-based services for drug use disorders and related diseases, so we can achieve the Sustainable Development Goals, promote justice and leave no one behind.”
Due to COVID-19, traffickers may have to find new routes and methods, and trafficking activities via the darknet and shipments by mail may increase, despite the international postal supply chain being disrupted. The pandemic has also lead to opioid shortages, which in turn may result in people seeking out more readily available substances such as alcohol, benzodiazepines or mixing with synthetic drugs. More harmful patterns of use may emerge as some users switch to injecting, or more frequent injecting.
Looking at further effects of the current pandemic, the Report says that if governments react the same way as they did to the economic crisis in 2008, when they reduced drug-related budgets, then interventions such as prevention of drug use and related risk behaviours, drug treatment services, the provision of naloxone for management and reversal of opioid overdose could be hard hit. Interception operations and international cooperation may also become less of a priority, making it easier for traffickers to operate.
Trends in drug use
Cannabis was the most used substance worldwide in 2018, with an estimated 192 million people using it worldwide. Opioids, however, remain the most harmful, as over the past decade, the total number of deaths due to opioid use disorders went up 71 per cent, with a 92 per cent increase among women compared with 63 per cent among men.
Drug use increased far more rapidly among developing countries over the 2000-2018 period than in developed countries. Adolescents and young adults account for the largest share of those using drugs, while young people are also the most vulnerable to the effects of drugs because they use the most and their brains are still developing.
Cannabis trends
While the impact of laws that have legalized cannabis in some jurisdictions is still hard to assess, it is noteworthy that frequent use of cannabis has increased in all of these jurisdictions after legalization. In some of these jurisdictions, more potent cannabis products are also more common in the market.
Cannabis also remains the main drug that brings people into contact with the criminal justice system, accounting for more than half of drug law offences cases, based on data from 69 countries covering the period between 2014 and 2018.
Availability of pharmaceutical opioids for medical consumption varies across the globe
The Report also points out that low-income countries still suffer a critical shortage of pharmaceutical opioids for pain management and palliative care. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018 comprising around 12 per cent of the global population, while the low and middle-income countries comprising 88 per cent of the global population are estimated to consume less than 10 percent of pharmaceutical opioids. Access to pharmaceutical opioids depend on several factors including legislation, culture, health systems and prescribing practices.
Socio-economically disadvantaged face greater risk from drug use disorders
Poverty, limited education and social marginalization remain major factors increasing the risk of drug use disorders and vulnerable and marginalized groups may also face barriers to getting treatment services due to discrimination and stigma.