Isaac Newton once said, “if I have seen a little further, it is by standing on the shoulders of giants”.
When we look back through history, significant periods of change are marked by a series of turning points and the gradual embracing of new ideas as normal. as we reflect on the past two decades under VISION 2020: Right to Sight and successive World Health Assembly resolutions, we can see that perhaps its greatest achievement, has been the normalising of the need to take action to address avoidable blindness and vision impairment around the world. It is standing on this platform and the shoulders of progress across so many sites of eye health, that we are challenged to look towards the next horizon and the landscape that lies between.
Drawing upon the World Health Organization’s (WHO) World Report on Vision, the newly adopted World Health Assembly resolution, ‘Integrated people-centred eye care, including preventable vision impairment and blindness’ (IPEC resolution), marks the next major mile stone for global eye health. Adopted by the 194 Member States of the WHO and cosponsored by over 45 countries, the IPEC resolution transforms the World Report on Vision from a simple document, into a political commitment to take action on its recommendations. Its central message – to make eye care an integral part of Universal Health Coverage (UHC) and to implement ‘integrated people-centred eye care’ within health systems, across the spectrum of services from health promotion, prevention, treatment and vision rehabilitation.
While the words are important and have meaning in their own right, it is perhaps what these words signal and the declaration they make as a collective that is most instructive. The IPEC resolution at its core, is a cry to embed eye health within the principal health agenda of UHC and to expand the scope of eye care into the mainstream as an integral issue for sustainable development.
Along with restating the cornerstone messages of eye health; the disproportionate burden faced by low and middle-income countries, the existence of effective treatments and the fact that the majority of cases of blindness and vision impairment can be prevented or treated – three key themes punctuate the mainstream narrative.
First, blindness and vision impairment are not peripheral issues, but affect almost a third of the global population today and this burden is expected to rise. With at least 2.2 billion people living with vision impairment and at least one billion of those people living with a condition that could have been prevented or is yet to be addressed, governments are being forced to recognise the true magnitude of eye care needs within their populations.
Second, while eye health is most commonly linked to the Sustainable Development Goals (SDGs) through SDG3 on health and wellbeing, eye care intersects with the achievement of many other goals. Advancing IPEC and removing disparities within and across countries in the availability and access to eye care services, has direct implications to the achievement of other SDGs on poverty, education, Gender equity, water and sanitation, employment and economic growth and reducing inequality. Stepping further on this front than the World Report, the resolution brings into stark focus the interlinked nature of eye health and development.
Third, vision impairment and blindness is pervasive and touches every corner of the globe, yet the maldistribution of resources across the world and within borders, means that the experience of living with vision loss does in fact discriminate. The IPEC resolution elevates inequity as a watershed issue in eye care, highlighting higher rates among low socio-economic groups, rural and remote areas and other vulnerable groups. To work to address inequities in eye health, is to speak to the central tenant of the SDGs in ensuring no one is left behind.
To truly stride forward as a serious political tool for directing governments and arming advocates, every global agreement must have clear targets and indicators to measure progress. The IPEC resolution falls short on this front, however, it does instruct WHO to develop feasible global targets and to report back to the Assembly in 2021. It states that these targets are to project out to 2030 and to focus on the effective coverage of cataract surgery and the correction of refractive error. These two indicators recognise the important nexus between coverage and quality, the ability to proximate progress across eye care and in speaking to UHC more broadly. The resolution also instructs the WHO to develop technical tools to guide Member States and their partners in implementing the IPEC approach, and many of these tools are already under development.
All this and the chapters of further detail both written in the World Report and still to be penned, the trials and tribulations undoubtedly waiting around the corner and what all this means as we navigate a global pandemic, hinge on one common thread – the collective will and action of the eye health sector to embrace the change and to march it forward. To meet the needs of those currently without care, the millions coming in and out of focus and the millions still to come. To find a home within health plans, budget ledgers and sectors beyond health. To close the gap between those who have and those who don’t and to grow the information ecosystem to keep us on the path.
In 2030 and years to come, will we be the giants others stand on, to rise up high and look to a new horizon? This is our challenge for the next decade.
By Brandon Ah Tong, The Fred Hollows Foundation; Jessica Crofts-Lawrence, IAPB; and Juliet Milgate, Sightsavers.