Vaccination: a clinic in the Indian state of Bihar © Romana Manpreet/AP/Gavi Alliance

Health in 2017 will be significantly affected by two of last year’s most striking events: the UK referendum to leave the EU and the US election of Donald Trump. Because of matters such as international aid payments and the global fight against diseases, the impacts of the changes these will bring will be felt far beyond these countries’ borders.

Here are six areas vulnerable to buffeting by the changing political winds.

1. Healthcare coverage

President-elect Donald Trump has pledged to dismantle the Affordable Care Act. Despite concerns over the way “Obamacare” was implemented, efforts to curtail the care it provided will trigger political opposition. Mr Trump is already showing signs of backtracking in some areas, such as support for those with pre-existing conditions and ensuring young Americans can be covered by their parents’ plans.

In other rich nations that offer comprehensive coverage, cost pressures will increase at a time of slowing economic growth — such as in the UK’s National Health Service. Many lower and middle-income countries — including India and Nigeria — have an expanding and vocal middle class keen for more extensive, affordable and equitable universal health coverage. But that will require domestic political funding.

2. Development funding

The US (at around $18bn a year) and UK (which commits 0.7 per cent of GDP) are among the largest contributors of foreign aid, including via multilateral agencies such as Gavi, the Vaccine Alliance, and the Global Fund to Fight Aids, Tuberculosis and Malaria. But rising wealth means middle-income countries risk becoming ineligible for such funds.

The UK is redirecting and trimming development aid funding, while Mr Trump has warned the UN system risks being “a waste of time and money”. Optimists say that Rex Tillerson, the US secretary of state nominee, supported ambitious malaria programmes while running ExxonMobil, and may still view global health as a useful form of wielding influence over developing nations.

3. Migrants and health

Conflict and global inequality continue to create record numbers of migrants and displaced people: more than 65m people were classified as forcibly displaced last year and there were 21m refugees. The result is huge disruption to the lives of millions, who suffer inadequate access to health and education services, and a lack of work. As a consequence they face a rising burden of disease and instability.

But a populist backlash against immigration of any sort, including across much of Europe, risks backfiring on nations trying to repel migrants. The dangers include a brake on economic growth and making it difficult to recruit essential workers, including doctors, nurses and carers, from abroad.

4. Global health leadership

A shortlist to replace Margaret Chan as director-general of the World Health Organisation will be agreed in January, ahead of a final selection by ministers at the World Health Assembly in May.

Failure to select a strong leader who is able to improve the agency’s reputation and raise core funding from national governments could result in erosion of the UN body and a shift to other agencies and initiatives.

Mr Trump’s administration will also have an important say in the nomination of new heads of other important agencies, including the Global Fund to Fight Aids, Tuberculosis and Malaria — the largest multilateral funder combating three of the most lethal infectious diseases — and the Centers for Disease Control and Prevention, pivotal for public health matters in the US and beyond.

5. Health efficiency

Rising medicine prices will come under renewed scrutiny following the sharp increases of products such as Martin Shkreli’s Daraprim, used to treat malaria, from $13.50 to $750 per pill, and Mylan’s EpiPen, which has risen in price by almost 500 per cent since 2007.

Internationally there is a growing desire to encourage health innovations, and to judge how much value for money drugs and medical procedures provide, as the UK’s National Institute for Health and Care Excellence is already doing.

6. Spread of infectious diseases

Outbreaks of existing and new diseases, from flu to the Mers virus, are likely. Some are spreading as a result of climate change, including mosquito-borne malaria and dengue. Inappropriate drug use and poor infection control will fuel further antimicrobial resistance to medicines, including in tuberculosis.

There is growing discussion of “one health”, which recognises and responds to infection between humans and animals. Initiatives, including the Coalition of Epidemic Preparedness Innovations, to be discussed at the World Economic Forum this week, aim to build resilience in health systems, anticipate outbreaks and prepare a more robust response.

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