World Health Day, celebrated on 7 April, marks the anniversary of the founding of the World Health Organization in 1948. This year’s theme ‘Together for Health: Stand with Science’ is a reminder that science is central to protecting health.
It highlights the role of science-led innovations in improving outcomes, with particular focus on the One Health approach – an integrated multi-sectoral approach that takes interdependence of health of humans, animals, and the environment into account.
Science is about seeking, generating, translating, and sharing knowledge. It is the foundation of a strong and resilient health system, and is central to the prevention, detection, and treatment of diseases. It spans a wide range of areas, including research, discovery, health technology, digital health, patient safety, ethics, and policy-making.
SL’s public health achievements
Scientific advancements account for numerous public health achievements. To cite an example from Sri Lanka, vaccines are responsible for the elimination of several vaccine-preventable diseases such as poliomyelitis, rubella, neonatal tetanus, and congenital rubella syndrome.
Science is the catalyst for Sri Lanka’s widely recognised public health achievements. Sri Lanka has made significant gains in life expectancy, improvements in maternal and child health, malaria elimination, and the control and elimination of various infectious and vaccine-preventable diseases.
These have been possible because Sri Lanka adopted the proven strategy of investing in the public health system. It is established that a competent public health system can deliver on all four important dimensions of health care: efficiency, quality, equity, and accountability.
Sri Lanka is renewing its focus on strengthening Primary Health Care (PHC). Evidence shows that health systems built on PHC are more equitable and cost-effective. They provide comprehensive quality care close to where people live. Strengthening PHC is one of the most important steps to protect health gains and respond to challenges.
In Sri Lanka, science is at work in the daily functions performed by a diverse range of health workers: doctors, nurses, dentists, midwives, pharmacists, occupational therapists, physical therapists, speech and language therapists, etc. Public health midwives provide quality care practising the principles of safe motherhood. Public health inspectors ensure food safety. The public health laboratory workforce provides quality diagnostics. Doctors, nurses, pharmacists, and other health workers play a crucial role in prevention, diagnosis, and treatment of disease. Their work turns evidence into action every single day.
Sri Lanka faces a double burden of disease. While communicable diseases such as tuberculosis, dengue, and chikungunya remain a concern, there is a rise in Non-Communicable Diseases (NCDs) such as diabetes, heart disease, cancers, and chronic lung diseases.
Social and commercial determinants play a crucial role in determining health. Social determinants of health are the conditions in which people are born, grow, work, live, and age. These include economic policies and social policies, while commercial determinants of health refer to the actions of commercial actors that affect health.
The social and commercial determinants are the key drivers of behavioural risk factors that increase the risk of NCDs: tobacco use, unhealthy diets, harmful use of alcohol, and insufficient physical activity. Therefore, combatting communicable and Non-Communicable Diseases requires a multi-sectoral strategy.
Misinformation campaigns
Science is under constant attack from the tobacco, alcohol, and food industries. They have sponsored misinformation campaigns amplified by digital platforms, think tanks, and bloggers. These actors have also tried to derail public health initiatives through lobbying, lawsuits, and campaigns. Sustained attacks on science and misinformation campaigns by vested interests need immediate attention. These require strong institutions and public trust in evidence.
The alcohol industry is consistently promoting deceitful and dishonest pro-drinking messages using taglines like ‘enjoy responsibly,’ ‘drink in moderation,’ ‘drink properly,’ ‘drink smart,’ ‘drink positive,’ etc. Alcohol causes cancer and is addictive. These messages undermine public health messages by deflecting attention from the proven harm of alcohol consumption.
The tobacco industry funds and promotes false evidence to argue that e-cigarettes reduce harm, while heavily promoting these products to children and non-smokers. Sri Lanka has banned e-cigarettes, based on scientific evidence.
Today’s health challenges
Addressing mental health is an urgent priority. Despite the high prevalence of mental illness, the majority in need do not get care.
Most of those who receive treatment do not have access to rehabilitation. Under-resourced mental health services, high out-of-pocket expenses, and stigma and discrimination are major barriers to access. A science-based approach to integrating mental health into primary health care supports early identification, helps reduce stigma, and facilitates access close to home, without fear or shame.
Meanwhile, zoonosis is an infectious disease which jumps from a non-human animal to humans, which accounts for a large percentage of both new and existing diseases. Over 30 new human pathogens have been detected in the last three decades, 75% of which have originated in animals.
Human activities and stressed ecosystems have created new opportunities for diseases to emerge and spread. These factors include animal trade, agriculture, livestock farming, urbanisation, extractive industries, climate change, and habitat encroachment into wild areas.
Climate change presents a fundamental threat to human and animal health by affecting all factors essential for good health: clean air, water, soil, food systems, and livelihoods. Dengue and chikungunya continue to affect communities across Sri Lanka, underlining the need for multi-sectoral collaboration in environmental management, community engagement, early detection, and research.
The rise in Antimicrobial Resistance (AMR) poses a growing threat. When antibiotics and other antimicrobials are misused or overused, they become less effective. Common infections become harder to treat, and hospital stays become longer and more costly.
The way forward
Addressing climate change and the rise in antimicrobial resistance, along with zoonotic, vector-borne, and foodborne diseases requires the adoption of the One Health approach.
Multi-sectoral collaboration is central to it. The One Health approach recognises that the health of people, animals, and the environment are closely interconnected. Diseases can spread between animals and humans. Environmental changes can affect food safety, water quality, and disease transmission.
No single sector can manage these risks in isolation. Effective prevention and response require coordination across human health, agriculture, animal health, environment, education, Local Government, and other partners. In an interconnected world, science also highlights the need for collaboration beyond national borders to address common threats.
The Covid-19 pandemic reinforced its importance. Gaps in One Health knowledge, prevention, and integrated approaches were key drivers of the pandemic.
Digital technologies offer an opportunity to improve health services. These technologies must be safe, cost-effective, and equitable – and their adoption should be guided by public health, not commercial interest. Adequate safeguards are a prerequisite to prevent misuse of technology and protect privacy.
Erosion of trust in science is a global crisis. Misinformation, amplified by social/digital media, has flourished, and undermines public health. Lifesaving vaccines, treatments, and public health measures have been falsely portrayed as harmful. This has weakened confidence in public health measures.
Rebuilding trust in science requires public engagement and clear and accessible communication. It is important to highlight that science is a work in progress, subject to scrutiny and revision. Health workers can serve as trusted voices, as science is reflected in their daily actions. It is important to counter myths with evidence. Scientific institutions and professional societies have an important role in this. Science literacy programmes can encourage curiosity and critical thinking.
Protecting Sri Lanka’s public health achievements requires continued investment in science, strong institutions, and collaboration across sectors. It is important that we all stand up for science, as our existence depends on it.
(The writer is the WHO Representative to Sri Lanka and has over three decades of experience in public health. He previously served as WHO Representative to Nepal and Timor-Leste, and has served the South-East Asia Regional Office, the Maldives, and Timor-Leste in different roles. He is also the recipient of WHO Director-General’s Awards. In 2023 he was conferred the Order of Timor-Leste, the country’s highest civilian honour, for his nearly decade-long service in the country)
(The views and opinions expressed in this article are those of the writer and do not necessarily reflect the official position of this publication)