Global wishes for 2024: Pay for family leave. Empower Black men. Respect rural voices

New Year's resolutions, it turns out, probably originate in the Global South. The Babylonians of 4,000 years ago threw a heck of a party on (their) New Year and would make promises to the gods to do various righteous actions.

Here at Goats and Soda, our New Year's tradition doesn't go back quite as far (dating to ca. 2022, some scholars say ...), but we are proud of it nonetheless: We ask global health and development leaders around the world to offer up a wish for the coming year. Through their responses, we can see the hope, determination and, sometimes, the frustration of these activists, scientists and thinkers.

Here are their global wishes for 2024.

My wish: Adopt paid family leave in the U.S. as most of the world already has

Thomas McDade, professor of anthropology and faculty fellow of the Institute for Policy Research, Northwestern University, and co-director of the CIFAR Child and Brain Development Program

The United States is one of only seven countries globally — and the only rich country — without a national paid family leave policy. It should come as no surprise that compared with other high-income nations we have the highest rates of infant and maternal mortality, despite spending the largest share of our gross domestic product on health care.

Paid family leave — job protection with guaranteed income after having a baby—improves birth outcomes and lowers the risk of rehospitalization for mothers and infants, increases uptake of breastfeeding and pediatric vaccination schedules and reduces postpartum depression. Paid family leave is good for babies and their families, and it can go a long way toward reducing societal inequalities in maternal and infant health outcomes.

My hope is that 2024 is the year when we catch up to the rest of the world and offer families the support they deserve.

My wish: Empower young Black men in concrete ways

Michael Onyango, Skoll Foundation fellow, agenda setter at 4BM

Over the last three decades, as women's initiatives and gains have increased phenomenally, young Black men are being overlooked. In 2024, envision a concrete roadmap for young Black men, where numbers become catalysts for meaningful change.

Picture a 15% surge in educational investments, resulting in a tangible impact on the lives of 75,000 individuals through tailored programs addressing their unique challenges. As we forge ahead into professional arenas, let's set a goal of achieving a 20% increase in leadership representation. This means not only breaking barriers but elevating at least 200 young Black men into influential positions, reshaping the narrative of success.

Through media, share the stories of 150 individuals, crafting a mosaic of inspiration that reaches far and wide. In the eloquence of numbers, let each digit represent a life empowered, a barrier dismantled and a leader emerging.

My wish: Make adolescent well-being a priority

Dr. Sabrina Bakeera-Kitaka, Department of Pediatrics, Makerere College of Health Sciences

My big dream for 2024 is to see adolescent health and well-being become a priority not only at the global level but also in the countries where the majority of adolescents live. In Uganda, for example, one of every three people is an adolescent – but training medical providers in adolescent health care has not been a priority, and funding is minimal.

As the Lancet Commission on Adolescent Health and Wellbeing puts it, "investing in adolescent health and well-being brings a triple dividend of benefits – benefits for adolescents now, for young people's future lives and for the next generation."

With over 25% of the world's population age 10 to 24, today's generation of young people is the largest in human history. The world in which today's adolescents are growing up is very different from that of previous generations. Advancements from globalization, urbanization, digital media and more accessible education have created new opportunities, but they also carry new risks related to mental health, nutrition and wellbeing.

My dream is that every adolescent in all corners of the world will grow up to reach their fullest potential and develop and transform the society in which they live. When we train adolescents to believe in themselves and build their dreams, we support them to become change agents.

My wish: Leverage 'One Health' framework to tackle known and unknown threats from climate change

Dr. Abraar Karan, infectious disease fellow, Stanford University

My biggest concern heading into 2024 is the impact of climate change on the spread of both known and unknown infectious diseases — and my hope is that we tackle this challenge through supporting and funding scientists working on the "One Health" framework, which brings together physicians, epidemiologists, veterinarians and climate scientists to work in collaboration. As an infectious disease doctor working in California and internationally, I see a concerning trend. We have documented increasing cases of the fatal Rocky Mountain Spotted Fever, with another recent outbreak on the California-Mexico border in December 2023. Research suggests that the tick that carries it is more likely to bite humans at higher temperatures. In sub-Saharan Africa, where I am doing research on Marburg virus (a relative of the Ebola virus), we have continued to be surprised by ongoing spillover [from animals to people] of both of these viruses in places where they haven't been detected before. Equatorial Guinea had its first Marburg virus outbreak in January-February 2023, with a case fatality rate of 75%, and Tanzania had its first in March 2023, with a case fatality rate of 67%.

Deforestation and increased human-animal interfacing increases this risk of zoonotic spillover, and there are many other bad bugs that will make the jump. The most dangerous creature on the planet — the mosquito — is also predicted to expand its range. Models suggest Aedes mosquitos, which transmit Zika, Chikungunya and Dengue viruses, are expected to threaten populations that haven't been exposed to them before. We have entered a new age of climate-related threats to health, with infectious disease being one of the greatest. My hope is that mobilizing researchers across disciplines will help us confront those threats.

My wish: Reauthorize PEPFAR

Dr. Wafaa El-Sadr, director of ICAP at Columbia University, lead of the New York City Pandemic Response Institute

My wish for 2024 is that the United States Congress reauthorizes the President's Emergency Plan for AIDS Relief (PEPFAR). Established in 2003 with bipartisan support, PEPFAR has proved to be one of the most successful global programs the U.S. has ever launched. At its inception, only 50,000 people in sub-Saharan Africa living with HIV, the virus that causes AIDS, had access to lifesaving antiretroviral treatment. Today, thanks to this remarkable program that partners with ministries of health, non-governmental organizations, academic institutions, faith-based organizations and the private sector, that number has surpassed 20 million. PEPFAR has also transformed health systems globally through efforts that have trained hundreds of thousands of health care workers; improved laboratories and pharmacies; and introduced data and surveillance systems that offer a robust platform to face other major health threats, today or in the future.

Despite these achievements – much more remains to be done. With treatment still beyond the reach of millions of people living with HIV, and with hundreds of thousands of new infections every year, the HIV epidemic must continue to be a priority. Despite this urgency, Congress has yet to reauthorize PEPFAR due to misperceptions about the goals of the program [including that it promotes abortion]. The Biden administration supports a five-year extension of PEPFAR, and my fervent hope for the new year is that Congress will move forward to continue its support and full funding for this incomparable driver of global health. Millions of lives depend on it.

My wish: That the world listens respectfully to rural voices

Rodrigo Paris Rojas, CEO of Barefoot College International, a group that works in 93 countries to expand opportunities for rural women.

My dream for 2024 is that the voices of the rural world are heard more than ever: Indigenous people, women, peasants, farmers, environmental defenders. In them is the wisdom, the guidance, the light to effectively confront the climate crisis.

But their voices will have no impact if world leaders and large corporations do not open their ears, and listen with respect, empathy and a minimum of humility to what is being asked.

My wish: Meaningful investment in community health workers

Sheila Davis, CEO of Partners In Health

Community Health Workers (CHWs) are frontline public health workers with deep understanding of the communities they serve. Decades of research has documented the effectiveness of CHWs in addressing community health needs—especially in rural, impoverished, and other medically underserved areas—resulting in stronger health systems, substantial cost savings, and, most importantly, improved health outcomes.

Globally, health systems are starting CHW programs and the need for CHWs is increasingly recognized, but there are great disparities in access to care and a lack of long-term funding solutions from insurance and government-funded programs. In 2024, my wish is that CHW care becomes accessible to the people who need it most through comprehensive financial support, including Medicaid and insurance coverage in the U.S., and more equitable health systems globally.

My wish: Create more climate advocates through better messaging

Dr. Ifeanyi M. Nsofor, Senior New Voices Fellow at the Aspen Institute

The world needs more climate change advocates. For this to happen, climate change messaging must be simplified. A way to achieve this is to emphasize the negative health consequences of climate change. For instance, it is easy for people in east Africa to understand that childhood malnutrition may be due to food insecurity because of droughts or flooding caused by climate change. I have a personal experience of how flooding can lead to food insecurity. I come from Nanka in Anambra state, southeast Nigeria. For decades our villages have been affected by severe gully erosion due to floods, destroying farmlands and homesteads. Farming in my village has become an exercise in futility. Let's inform people on how climate change worsens their health and they will be more likely to join campaigns to mitigate it.

My wish: More controls, accountability for pesticide use in Brazil

Telma Nery, Brazilian physician and public health expert

Brazil is one of the biggest consumers of pesticides on the planet, including substances banned in other countries due to impacts on human health. My wish is that we lower the population's exposure to pesticides and better protect their health. To do that, we need to collect more data: which substances are being used, who is getting sick, how they are getting sick, how they are being monitored and treated, and which measures to mitigate harm are effective.

We also need to set up two teams of experts: one to monitor and inform the public about the effects pesticides have on health in general and another to act as a surveillance system to identify, notify and monitor populations most vulnerable to pesticide exposure. Banning substances that are already known to be likely carcinogens, as well as stopping aerial spraying of pesticides, are important steps to protect people's health. The president should also veto the bill known as the Poison Package: If it becomes law, regulations for the registration and use of pesticides in Brazil will be weakened, making it even easier to use more hazardous pesticides on crops here.

My wish: Realize COP28 commitments to make health systems 'climate-smart'

Dr. Renzo R. Guinto, director of Planetary and Global Health Program, St. Luke's Medical Center, Philippines, and Senior Fellow, Aspen Institute

Last December I participated in COP28 in Dubai – the first United Nations climate change conference in history that held a "Health Day." This is a powerful signal that health is no longer a footnote, but is central to the global climate agenda. Health systems around the world must begin preparing for climate-sensitive diseases, extreme disasters and worsening health inequalities that have already begun happening. Unfortunately, one report revealed that 1 out of 12 hospitals in the world is deemed not ready for climate-related disasters. Moreover, the global health sector, estimated to contribute around 5% of the world's greenhouse gas emissions – must also reduce its own environmental footprint and not be an accomplice to climate pollution.

During COP28, more than 120 countries expressed commitments to build climate-resilient and low-carbon – or "climate-smart" – national health systems. The World Health Organization, along with major funders, created a global initiative called Alliance for Transformative Action on Climate and Health (ATACH). My home, the Philippines, is the 80th country to "attach" to ATACH – our health secretary likes the number 8, which is deemed lucky in most Asian cultures. Often ranked one of the top 10 countries in terms of climate risk, the Philippines is already experiencing not only devastating typhoons and massive flooding but also coastal inundation due to sea level rise and high heat indices that were never felt before.

All these climate change hazards will undoubtedly affect not only the physical but also mental health of my fellowmen. One study revealed that the Filipino youth experience the highest levels of "climate anxiety" around the world. These promises to establish climate-smart health systems are a welcome development. My 2024 prayer is that governments, funders and the global health community will keep these promises to protect and save lives in an era of a warming planet.

My wish: Innovative technology for people at risk from climate change

Jacqueline Muna Musiitwa, legal expert, Aspen New Voices Fellow, adjunct professor at Georgetown University

My wish for 2024 is for innovators to push the bounds on technology solutions to climate challenges in an ethical, safe, transparent and secure way. Amid both the excitement and the reservations about artificial intelligence, I hope we are able to use data to create innovative financial solutions to help plan and better manage risks in the event of a crisis (for instance through parametric insurance, which insures against a possible predetermined event such as a flood or drought). I also wish that tech solutions will become more affordable, accessible and practical for people in the most climate-vulnerable communities. For instance, I want to see more smallholder farmers in Tanzania and Sri Lanka get access to weather data to help them plan when to plant the most appropriate crops.

My wish: Health, prosperity and follow-through on vaccinations

Dr. Firdausi Qadri, International Centre for Diarrhoeal Disease Research, Bangladesh

2023 was a year when the world started getting back to normalcy again. What we all wanted was health, prosperity, growth and most of all, peace.

Public health scientists have worked together on plans to meet these needs. In Bangladesh, we started our efforts to fight cholera and typhoid and to make vaccines available for low- and middle-income countries. We now have a plan to use oral cholera vaccines provided by GAVI, the international vaccine alliance. to make Bangladesh less prone to epidemics. Similarly, typhoid fever, a disease rampant in urban slum settings, will soon be tackled with typhoid conjugate vaccine (or TCV, a long lasting, one-shot vaccine) starting this year through the Expanded Programme on Immunization.

Another success in 2023 was progress among school-age girls and young adolescents in getting the HPV vaccine for prevention of cervical cancer. Large campaigns are underway and we are marching ahead with covering the country.

In 2024, we will tackle new challenges but also renew pledges to complete all the efforts that we have begun. We will need collaboration, togetherness and understanding within and outside our institutions, and beyond borders, nationalities, race and color. Most of all we need peace and more peace, since the measures that we are taking and planning are so dependent on approaching people in a timely manner with love, warmth and kindness. We will find solutions, and we will overcome the challenges in 2024 and beyond.

Two wishes: Study and teach the health effects of war ...

Dr. Sriram Shamasunder, professor of medicine at University of California, San Francisco

I like the song "I ain't gonna study war no more," a spiritual that dates to the Civil War. But the time has come to bring the health effects of war into every training program of every health worker, everywhere.

I want all health workers in 2024 to study the health effects of war, the impact of violence on children, the trauma and mental health effects that last throughout life. There is incredible work being done by Physicians for Human Rights (PHR) and others, and it needs to inform a generation. Perhaps truly understanding war might impact our willingness to engage in war.

Our research institutions, international global health bodies and large foundations should all make studying and understanding the health effects of war a priority, and put extensive resources into communicating these findings widely in simple graphics.

... Protect health workers around the world

Health workers are suffering greatly during conflict. We don't want to be martyrs. We deserve protection. U.N. Security Council Resolution 2286, passed in 2016 and calling for all parties in conflicts to ensure safe passage for sick, wounded and medical personnel, must be enforced. We need an international body dedicated to protecting health workers and amplifying the stories of those targeted.

Your turn: What is your global wish for 2024?

What do you wish the world could achieve this year? Let's assume money is not an object and global leaders will line up to make it happen. Tell us about a global health and development problem you would tackle, why you think it's important to address in the coming year and what you wish the world would do to solve it. Parents and teachers, ask your kids/students to draw a picture of their wishes! We may feature your wishes on NPR.org. Email your idea to goatsandsoda@npr.org with the subject line "2024 wishes." The deadline for submissions is Thursday, January 11.

Ari Daniel, Jill Langlois, Marc Silver and Gabriel Spitzer contributed to this story.

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