I’m sleep deprived from weeks of preparation, but energised by the knowledge that I am on the brink of another WHO World Health Assembly (WHA). I anticipate my arrival at the airport - I can’t forget to collect the free public transport ticket at the exit from baggage claim, knowing to turn left out the doors to find the buses and trains. I am a relative newbie compared with many other global health advocates - yet after 4 years I’m getting to know the ropes as my mental beeline from security to the ticket machine reminds me.

I remember my first year at WHA - I really had no idea where to go, what would be happening, and felt quite nervous, but thankfully I had some terrific seasoned ‘shepherds’ in our team to show me around and explain the places and processes. Now I know more, let me share some insights for those new to the the rituals of WHO’s ‘supreme decision-making body’, the WHA.

Everything revolves around the official agenda

Every year the agenda for WHA proceedings changes. We monitor the WHO governing bodies website diligently, as it is usually published by the WHO late the year before, refined round the Executive Board (a mini WHA held biennially) and then finalised around 4 weeks before WHA is set to commence with the preliminary WHA journal. The agenda sets the themes of the debate, based on global emergencies, emerging health threats, strategic long term priorities and milestones. NCDs are on the agenda every year, though traditionally shunted to the end of the agenda (notoriously the Saturday) although in 2018, because NCDs were the subject of a UN High-Level Meeting (HLM), they were a strategic priority and elevated up the agenda. The official proceedings of a WHA roughly follow the set agenda, divided between Plenary and two large committee rooms in Palais des Nations. Access to the Palais is carefully managed, with special event passes given in advance to accredited individuals, as well as some public passes. For the many who can’t be inside those rooms (including many in Geneva!) proceedings are live-streamed on WHO’s website.

Around 2-4 weeks before WHA, WHO publishes reports, and proposed resolutions, which will be under consideration and discussion. 194 Member States will express their positions, country experiences, concerns, and occasionally commitments, usually through submission and delivery of statements. Behind the scenes, member states spend significant time preparing, and where they have the resources, diplomatically negotiating aspects of resolutions. Sometimes they are uncontentious, while others provoke extensive debate, especially where geopolitics or conflicting priorities such as when Appendix III of the Global Action Plan on NCDs (Best Buys) was updated in 2017, and on a resolution on Infant and Young Child feeding in 2018. Typically, civil society isn’t privy to these proceedings, which take place behind closed doors and can go on for days, but relations between some civil society and member states in these negotiations enables civil society to support member states to ensure strong and meaningful global policy documents.

Advocacy collaborating and coordinating

Once we get the agenda, our own advocacy planning ramps up. At NCDA we draw from our consistent positioning, and continuously consult experts, advocates, and people living with NCDs in our network where novel concerns or issues are raised, with the purpose of developing an advocacy brief to support member states - missions and delegations, fellow advocates, and development of joint statements with other partner organisations built upon our own consensus. Usually we divvy up the work based on our specialisation; this year Priya Kanayson, our New York UN-expert is focused on the UN HLM on Universal Health Coverage (last year it was the two HLMs on Tuberculosis and NCDs); Jess Beagley has been working on air pollution and engagement with non state actors; Nina Renshaw examined the report from the UN HLM on NCDs and budget, while my focus has been more on nutrition (last year it was physical activity and nutrition), among others.

Our advocacy briefing is useful for informing our statements and communications efforts. As a civil society organisation with a broad network coming from diverse NCD interests and corners of the world, we seek to coordinate as well as support other organisations.

We hold a webinar for our members in advance of WHA, for a deep dive into what is to come and NCD related priorities, and to support advocates in their countries. On the eve of WHA, we host an in-person coordination briefing with our members in Geneva. We can’t be in all places at once, our team is relatively small and we rely on member organisations to be sharing intelligence and information to strengthen our collective impact.

Even when we think we have anticipated how intensely busy the weeks before and during WHA will be, we frequently find we have underestimated what has been referred to by many as a 'circus' (or perhaps have conveniently forgotten the traumas of years gone by), especially with our planning so dependent on external factors like publication of documents and event speaker confirmations! But everyone in the global health community seems to 'get it' and while tensions can be high, understanding and patience are, thankfully, similarly abundant. And we are lucky to have a special camaraderie in our team that shines at especially peak-busy times.

Exercising mind and body is crucial to survival!

Annually, we host a Monday night event centred around the theme of NCDs. Coordinating these is an immense team effort of reflecting on previous events, conceptualising the event’s themes, format and objectives in line with advocacy priorities; selection, invitation and liaison with speakers; comms developing invitations and live coverage; and planning running order, support team and logistics. That doesn’t even scratch the surface. With around 300 people listening to captivating discussions, we have taken to live streaming the event to expand the reach to those who can’t be with us in Geneva.

Our main event is often one of the biggest WHA side events, but is only one of dozens of WHA side events - from the official ones selected by WHO from member state and non state actor submissions, and held in the Palais during lunch times and after hours, to the unofficial side events organised by NGOs, academia and private sector.

Side events contribute to momentum around hot-topics - they are often designed to expose policy makers and influencers to issues, concerns and solutions, spark debate and discussion, with the added benefit of providing space for networking.

The calendar we curate of NCD-related side events demonstrates that it’s a smorgasbord of exclusive insights, numbing fingers with live tweeting, challenging brains to absorb and capture snippets of wisdom, moments of exasperation, and sparks of inspiration.

There are so many side events though, that the logistics of getting to everything one would like to - while juggling monitoring official agenda as it swaps and changes in sequence - means both brain and body are well and truly exercised. Many would say their step count during WHA doubles with the extensive need for active transport between official and unofficial proceedings. By the end of the week, you are super grateful for Google maps and the Geneva Transport Card which supports those staying in hotels with free use of the efficient buses, trams and trains.

There is time for fun and organised exercise too, and plenty of mingling. In 2018, Dr Tedros introduced a terrific initiative to coincide with the launch of the Global Action Plan on Physical Activity “Walk the Talk: The Health For All Challenge”. For those in Geneva the morning of the day before WHA officially commences, individuals from all sectors, together with Geneva’s wider community, convenes at the Place de Nations - around the iconic legless chair, and flanked by flagpoles reflecting the UN Member States, from where groups set off for fun runs and walks, exemplifying the health promoting opportunity of physical activity. In recent years, exemplifying the 'walk the talk' mantra, much welcomed stretch and dance physical activity breaks have been smattered throughout WHO governance meetings.

Like a giant global health conference - advocate and network!

Truth be told, the World Health Assembly sometimes feels a little like one giant global health conference*. Hotels and couches reach capacity in Geneva, and calendars fill up rapidly with bilateral meetings with country delegations, ministers and officials from country capitals or health attachés from Geneva based missions. Unexpected opportunities for coffee and a chat often arise in the prime advocacy and networking hub of the WHA, "the Serpentine” cafe and communal area outside Committee A, where officials from up to 194 countries mingle with advocates, activists, academics, students, UN staff, and more. You can look forward to expanding your network of civil society allies, and have your advocacy talking points ready!

Like most global health gatherings, twitter is one of the most important tools during WHA.

Following and using the annual WHA hashtag (this year #WHA72) has alerted me to what is happening when and where, controversies as they are emerging, country remarks worth noting or celebrating (or conversely, challenging), and organisations to network with and see where we can enhance each others’ advocacy.

In addition to providing a platform to reinforce advocacy messages with digital diplomacy, twitter also digitally archives an overview of the event, that anyone anywhere can refer to afterwards. Meanwhile, those who can’t be at WHA follow #WHA72, vicariously living through delegates' experiences, amplifying what resonates, also able to feed back to national health officials, media, and to monitor if their advocacy has permeated WHA. The emergence of twitter as a powerful communications tool, and the 24 hour news cycle means and anyone, anywhere, can potentially have real-time influence (find some tips here).

Making connections with officials is fundamental to ensuring that what happens at each WHA doesn’t stay at each WHA. Agenda items may be deferred to a forthcoming meeting such as a WHO regional committee meeting (RCM), resolutions require leadership from spearheading countries, the WHO secretariat may be charged with developing an action plan and need support in doing this, and action plans need national implementation and reporting. Advocates thus plan beyond the WHA meeting itself, organising to follow up by meeting with governments and other key stakeholders to make sure they are reminded of what happened at WHA and what got agreed - holding them to account! The most effective advocates don’t waste a minute leveraging the momentum built at WHA.

Get outside and remember to take it all in

If you are lucky, you’ll spend some time outside of the Palais and side event walls, perhaps opportunistically on your walk between activities or sitting on the lawns near the Serpentine, watching the peacock parade around, while chatting with friends, new and old. If you find yourself with a spare hour you might manage to enjoy the botanic gardens in spring bloom, or walk down to and around Lake Geneva, admiring the Jet d'Eau Fountain and backdrop of snow capped mountains. Don’t forget to pack comfortable shoes, suncream, and an umbrella - it is spring, after-all, and can be unpredictable! And please, remember to eat. 

If you do get the opportunity to slow down, do; take a deep breath and take in the moment, whether you are a regular or a one time attendee. It’s pretty humbling - you’re right where global health power is played out, and consensus and decisions are reached on global health priorities, direction and action. You may not have grown up saying “when I am older I want to go to a WHO World Health Assembly to advocate for stronger global health policy to improve health of all people everywhere” but maybe, like me, you’ll still pencil it on to the bottom of your bucket list, together with a big tick.

About the Author

Lucy Westerman (@lewest) joined NCDA in 2015, and is Senior Policy and Campaigns Officer. Lucy leads NCD Alliance’s NCD prevention and health promotion policy activities, particularly focusing on alcohol, nutrition, physical activity, and cross-cutting issues such as the influence of social, commercial and environmental determinants on health. Lucy also co-ordinates global campaigns across NCDA, especially linking the work of the advocacy and communications teams to maximise impact, such as through the ENOUGH. campaign.

*(in fact, the 145th Executive Board in May 2019 will consider recommendations regarding non-state actor participation in governing body meetings, referring to a possible World Health Forum alongside the WHA, among other changes. See our advocacy briefing to learn what we think on this issue and others)