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Earlier this year, the World Health Organization (WHO) released its top 10 threats to global health in 2019 together with a new five-year strategic plan – the 13th General Programme of Work.

As the world faces multiple health challenges ranging from outbreaks of vaccine-preventable diseases like measles and diphtheria to growing rates of obesity and the health impacts of climate change, WHO’s plan focuses on a triple billion target – ensuring one billion more people benefit from universal health coverage, one billion more people are protected from health emergencies and one billion more people enjoy better health and wellbeing.

WHO says reaching the goal will require addressing the major threats and these are the top 10 in 2019.

1. Air pollution and climate change

In 2019, air pollution is considered by WHO as the greatest environment risk to health, with nine out of 10 people breathing in polluted air every day.

Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain and kill seven million people each year prematurely from diseases such as cancer, stroke, heart and lung disease.

2. Noncommunicable diseases (NCDs)

NCD’s such as diabetes, cancer and heart disease are collectively responsible for over 70% of deaths worldwide, or 41 million people.

Over 85% of deaths occur in low and middle-income countries, with the rise of the diseases triggered by five major risk factors – tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution.

3. Global influenza pandemic

WHO says the world will face another influenza pandemic, the only uncertainty is when it will hit and how severe it will be.

It says global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.

It currently monitors the circulation of influenza viruses to detect potential pandemic strains in over 100 countries.

4. Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in areas where protracted crises such as drought, famine and conflict leave them with weak health services and without access to basic healthcare.

Fragile settings exist in almost all regions of the world and this area is where half the key targets of the Sustainable Development Goals, including child and maternal health, remain unmet.

5. Antimicrobial resistance

WHO says antimicrobial resistance, the ability of bacteria, parasites, viruses and fungi to resist these medicines, threatens to turn back the clock to a time where infections such as pneumonia were unable to be treated easily.

Drug resistance is driven by the overuse of antimicrobials in people, and the inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.

6. Ebola and other high-threat pathogens

In 2018, the Democratic Republic of Congo saw two separate Ebola outbreaks, which spread to cities of more than one million people.

WHO has designated 2019 as the “Year of action on preparedness for health emergencies” and Ebola is on a watch list for priority research and development of diseases and pathogens that have the potential to cause a public health emergency but lack effective treatments and vaccines.

7. Weak primary healthcare

WHO believes health systems with strong primary healthcare are needed to achieve universal health coverage and that primary healthcare can meet the majority of a person’s health needs throughout their life.

However, many countries do not have adequate primary healthcare facilities and in 2019 WHO will work with partners to strengthen this area of health across the globe.

8. Vaccine hesitancy

WHO contends vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases.

Vaccination currently prevents 2-3 million deaths each year, and a further 1.5 million could be avoided if global coverage is improved.

9. Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be deadly, has been a growing threat for decades.

A high number of cases occur in the rainy seasons of countries such as Bangladesh and India, with an estimated 40% of the world at risk of dengue fever and about 390 million infections emerging each year.

10. HIV

Despite the enormous progress made against HIV over the past few decades, the epidemic continues to threaten with almost a million people every year dying of HIV/AIDS.

Today, around 37 million worldwide live with HIV, and people with the virus belong to groups often excluded from health services.

In 2019, WHO will work with countries to support the introduction of self-testing so more people living with HIV know their status and can receive treatment.