The publication of the World Health Organization’s (WHO) World Report on Vision last week was a landmark moment for the eye health sector. The report brings to a conclusion a 30-month study from the premier global health institution. There have been decades of darkness on the world's largest unaddressed disability. Now, at long last, this report shines a light upon this issue.
The report establishes three critical arguments that all public health and development professionals must heed. First, it finds that at least 2.2 billion people have poor vision – nearly a third of the world’s population. Of these, at least one billion have vision impairment that could have been prevented or has yet to be addressed. The number is huge but intuitive. Imagine how many people’s lives would be blighted in the developed world if eye care and the use of opticians was the preserve of a wealthy elite. Yet this is precisely the predicament for people in low- and middle-income countries. The WHO concedes that the estimate is ‘conservative’ and points to the gaps in knowledge, particularly about children’s vision. Previous estimates by respected bodies such as the World Economic Forum and lens manufacturer, Essilor, of 2.5 billion people with uncorrected poor vision may be closer to the mark.
Second, the World Report outlines how poor vision affects a person’s quality of life and negatively impacts education attainment, workplace productivity and road safety. It points out that women are more likely to have vision-related problems and less likely to get treatment. As WHO boss Dr Tedros writes: ‘We take vision for granted, but without vision, we struggle to learn to walk, to read, to participate in school, and to work.’ I have often argued that vision is the ‘golden thread’ through the Sustainable Development Goals that ties all of these areas together. If we are to get serious about tackling the SDGs, which are already a third of the way through their lifespan, we must tackle poor vision.
Third, the report argues that eye care must become part of universal health coverage. This argument should be tautological: how can health coverage be truly universal if it excludes eye health (or any area of healthcare for that matter)? But for too long eye health has been seen as an optional extra. The UK is a prime example. Cost-cutting measures in the early days of the National Health Service ended a brief period of fully integrated optometric services. Instead, the UK has a fragmented eye service where the poorest have the worst access to necessary services. The US is even worse with the precise type of health insurance determining the availability and cost of eye care services.
As the WHO report makes clear, the rest of the world has an opportunity to leapfrog markets such as the UK and US by putting in place systems of primary eye care for all. In 2012, I began working with the Rwandan Ministry of Health to do just that. We created a three-day training programme for community nurses to carry out basic sight tests; dispatched 2,600 nurses to 15,000 villages around the country, and have – to date – screened 2.5 million Rwandans, around 20 per cent of the population. This seemed impossible just a decade ago since Rwanda had just eight eye doctors in total. Without the innovation, it would have taken them four centuries to examine this number of people. Given the positive results, the Rwandan government has absorbed all of the costs into its own health budget.
Rwanda’s next step is piloting sight screenings in schools. Childhood myopia (or short sightedness) is growing rapidly. By 2050, it will nearly double to affect 500 million kids worldwide. Many more children struggle with eye allergies such as conjunctivitis, which become highly distracting and incapacitating when left untreated. As noted in the WHO report, the impact on education attainment of uncorrected poor vision is profound.
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