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Medscape
9 hours ago
- Health
- Medscape
WHO Resolution Aims to Bridge Global Gap in Skin Care
A medical resident in the South Pacific will soon make history. After he graduates in 2026, he's slated to become the first dermatologist to serve the Solomon Islands, a nation of 800,000 people. His training is both a breakthrough and the product of an international effort to improve access to skin care. As they gathered in Fiji in late May to support the resident's regional training program, visiting dermatologists got thrilling news: In Geneva, the World Health Organization (WHO) unanimously passed a landmark resolution to support global skin health. Dermatology trainee Joseph Sangatu, slated to become the first dermatologist in the Solomon Islands, and American dermatologist Esther Freeman, MD, PhD, in the patient ward at the Pacific Dermatology Trainin Cengter in Suva, Fiji. 'We're here 2 days after the resolution passed, already implementing it,' said Claire Fuller, a London-based consultant dermatologist and chair of the International League of Dermatological Societies (ILDS) in an interview. 'The timing is fantastic.' Addressing a Global Care Crisis The resolution aims to tackle stark disparities in global dermatological care. Africa and the Pacific islands have only zero to three dermatologists per million people, Esther Freeman, MD, PhD, associate professor of dermatology at Harvard Medical School and director of Global Health Dermatology at Massachusetts General Hospital, Boston, said in an interview from Fiji. 'Many countries have zero dermatologists. There are two dermatologists in Papua New Guinea for 10 million people,' she said. In May, at the annual meeting of the Society for Investigative Dermatology in San Diego, Freeman told colleagues about other gaps in care: In parts of Africa, people with albinism can't find sunscreen, and moisturizer for atopic dermatitis costs double the typical monthly salary. In Australia, only six dermatologists serve rural areas. At least a billion patients with skin disease have no access to dermatologic care, she said, and many more can't afford it. The WHO's 'Skin Diseases as a Global Public Health Priority' resolution, proposed by the Ivory Coast and backed by Nigeria, Togo, Micronesia, and China, aims to implement a coordinated global strategy through initiatives like Fiji's regional training program. The resolution, which passed without the support of the absent US delegation, doesn't come with funding. But José Ruiz Postigo, MD, PhD, a Neglected Tropical Diseases medical officer with WHO, told Medscape Medical News from Fiji that the vote is still transformative. A resolution comes with a high level of mandate, he said. 'When you approach someone at a ministry of health and they ask why you are doing this, to what extent is this a priority, you show them the resolution.' What Will the Resolution Do? One goal of the resolution is to boost the training of dermatologists around the world through programs such as the Fiji's Pacific Dermatology Training Center . It's the first dermatology training program ever established in the Pacific islands, and three Fijians are graduating as the region's inaugural dermatologists. The center, supported by a 5-year ILDS agreement, is similar to programs that have been implemented in other parts of the world. A regional center in Tanzania, for example, serves 16 countries across Africa. Fuller emphasized that training isn't just a matter of producing dermatologists: '80% of dermatology burden is caused by about 10 diseases. We've got an achievable curriculum, and we can train community frontline workers on these 10 diseases.' Freeman agreed, noting that a focus on 10 diseases is 'much more manageable . ' 'We definitely need dermatologists to train the trainers, but they're not the only key players. We'll never have enough dermatologists,' she said. 'Using Papua New Guinea as an example, we need to acknowledge who's on the ground. It could be nurses, medical officers, pharmacists. There's a lot of different cadres of health workers, and this gives us an opportunity to think about the big picture of how we treat people on the front line.' Funding Isn't Allocated — But It's Encouraged Even though it doesn't allocate funding, the resolution specifically recommends that member states increase investment and financing for skin health. 'We in the dermatology community can go to WHO members and say, 'You signed up for this resolution, how can we help you deliver it?'' Fuller said. 'We're not waiting for governments to just act on this; we're going to help them do it.' In addition, the resolution 'opens the door' toward nongovernmental funding, she said. 'Everyone can go to a donor, a university, and say 'Look, in view of this resolution, we want to do this, but we need money.' It's something concrete to point to.' The resolution also mandates WHO to develop internal dermatological resources. 'There's no dermatology department,' Fuller added. 'An obvious solution is to develop a dermatological resource within WHO.' As for the ultimate goal, she said, 'we'd like to be able to say that access to dermatological care is a standard: Any person with a common skin disease would be able to go to their frontline healthcare provider and get it addressed, and there would be specialist services available to refer to when needed.'
Medscape
21-05-2025
- Health
- Medscape
New Project Aims to Document Worldwide Skin Care Crisis
SAN DIEGO — In Burundi, East Africa, desperate patients protect their skin from the sun with petroleum jelly because they can't find sunscreen. In the Democratic Republic of the Congo, Central Africa, patients with atopic dermatitis face an impossible choice: Pay double their monthly salary for a basic moisturizer or go without. And in a wealthy nation — Australia — only six dermatologists are available to treat patients in remote rural areas, while 44 cluster in a single urban shopping mall. Across the world, at least a billion patients with skin disorders have no access to dermatologists, and many can't find — or afford — even the most basic skin treatments. 'Less than half of patients will have access to healthcare for their skin disease, which means that right now, access to healthcare is functioning much more like a privilege than the human right that we know it to be,' said Esther Freeman, MD, PhD, director of Global Health Dermatology at Massachusetts General Hospital and associate professor at Harvard Medical School, Boston, in a presentation here at the annual meeting of the Society for Investigative Dermatology. Esther Freeman, MD, PhD Now, Freeman told colleagues, the groundbreaking Skin Observatory Study aimed to document the world's skin health disparities and light the path toward a better future. 'The most important half of any problem is beginning to understand it in order to start thinking about solutions,' said Freeman, who's leading the project. 'Right now, there is no comprehensive assessment that characterizes access to care and delivery of dermatological care across different regions in the world. The overall goal of the study is to look at defining access to care on a truly global level.' The project, funded by the International League of Dermatological Societies and L'Oreal Dermatological Beauty, was launched last year and is already transforming understanding of global skin health. It was previously known that while Europe had about 50 dermatologists per million residents and the United States had approximately 34 per million, Sub-Saharan Africa had 0-3 per million. Several small nations had no dermatologists at all. Now, the project is producing new statistics. It's already collected numbers from 147 countries representing 95% of the world's population, Freeman said, and preliminary data highlighted the lack of dermatologic resources in many countries. To date, the findings reveal that while nations typically offer antibiotics and steroids to patients, access to biologics is much rarer. Sunscreen access is severely limited in some countries because there's no local manufacturing, and this can be fatal. In Tanzania, East Africa, Freeman noted, 90% of patients with albinism 'will die a premature death before the age of 30 if they don't have access to sun protection.' What's being done in terms of solutions? Freeman highlighted GLODERM (International Alliance for Global Health Dermatology), which now operates in 60 countries with 2000 members, with a mission statement that includes providing health care providers access to training, support, and resources needed 'to offer appropriate care of skin diseases for patients and communities' with limited resources, according to its website. 'I firmly believe that the people closest to the problems are those closest to the solutions,' Freeman explained. 'My job is to think about how we can train and empower people closest to the problems to come up with their own solutions.' Unlike traditional clinical mentorship programs, GLODERM focuses on leadership development. 'What we are teaching is: How do you negotiate with your government if you are trying to establish a department? If you're going to build a residency program for the first time in your country, how do you talk to the Ministry of Health? How do you talk to donors?' Freeman urged dermatologists at all career stages to contribute to global skin health equity through mentoring, ensuring representation in research, and joining existing organizations dedicated to the cause. She ended on a hopeful note, noting that the World Health Assembly, the decision-making body of the World Health Organization, will soon vote on a resolution declaring skin diseases a global public health priority. Freeman said this is a major milestone after 20 years of advocacy. 'I hope I've convinced you today that together, all of us in this room can be part of changing the landscape of access to dermatologic care on a truly global level, even if that means starting right exactly where you are, all the way from student to very senior PI [principal investigator],' Freeman said.
