The place of health on the post-2015 development agenda
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, ambassadors, representatives from the missions, ladies and gentlemen,
Welcome to this informal consultation on health in the post-2015 development agenda. This meeting is being held to gather your views. It is part of a larger global consultation
Finding the right way to position health on a new agenda is by no means easy. We are looking for ways to capture a complex world situation, with vastly different challenges than those seen at the start of this century.
We are hoping to do this with just a few overarching goals that make sense and are likely to have an impact, especially on the health of people who have been bypassed by progress. And we want this impact to be something that is readily and reliably measured.
Ideally, we would like to see goals that restore some balance to this world, that create greater fairness in the way benefits are distributed, and that contribute to social cohesion and stability.
Last December, OECD released a report showing how differences in wage earnings and income levels, in OECD countries and beyond, have reached their highest levels seen in half a century.
As that report concluded, wealth will not somehow automatically trickle down to reach the poor in the absence of policies that make equity an explicit objective. Given the well-documented links between income status and health outcomes, this is not at all a healthy situation.
We can be confident that health deserves a high place on the post-2015 agenda because of its own intrinsic worth, but also because changes in health indicators are a good way to gauge the effectiveness of policies in multiple other sectors.
Ladies and gentlemen,
I am familiar with at least some of your thinking. Many of you are worried about what will happen to the current goals when the target date comes and goes. Will they be brushed aside, even if the job is far from done? You are worried that the current momentum will stall or falter altogether.
We can all be thrilled by the progress that followed commitment to the health-related MDGs. Those goals focused development efforts and stimulated considerable innovation and resource flows. Health, especially of the poor, benefitted enormously.
At the start of the century, AIDS, tuberculosis, and malaria were major public health emergencies. Though by no means defeated, these diseases are beginning to contract rather than continue to expand.
But we can say with certainty that not all countries will reach all of the goals. Some may not meet any. We must remain concerned.
The health-related MDGs are largely an infectious disease agenda: AIDS, tuberculosis, and malaria, the vaccine-preventable diseases of childhood, and pneumonia and diarrhoeal disease in children.
I fully accept that any new health-related goals will need to be positioned in the broader context of world conditions, including the need to use finite resources in sustainable ways.
I am also aware of some reasons put forward for the success of the MDGs. First, the goals were limited in number and easy to understand in substance. They made sense, also to parliamentarians and the public.
Second, methodologies were in place to measure the results. Progress could be tracked.
Third, high-impact interventions were available to support most of the goals. This increased the prospects of success but also invested efforts with a clear sense of moral purpose. People should not be allowed to die for lack of access to existing, effective, and largely affordable interventions.
Finally, the goals were widely embraced, representing a true international consensus about the best ways to reduce poverty and relieve human suffering.
I am further aware of how much the world has changed in just the past decade. All around the world, health is being shaped by the same powerful forces, like demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles. The distinctions between health problems in wealthy and resource-constrained countries have become blurred.
In such a world situation, a compact, like the MDGs, between the haves and the have-nots loses some of its power to capture current challenges to development and shape their solutions.
As a string of global crises demonstrated, this is a world in which the international systems that govern trade, financial markets, and business relations can have a greater impact on the opportunities of citizens, also for better health, than the policies of their sovereign governments.
Chronic noncommunicable diseases have overtaken infectious diseases as the leading cause of mortality worldwide. Health has moved into a new political space in which the main causes of ill health and premature death have their roots in non-health sectors beyond the direct purview of health officials.
Ladies and gentlemen,
I have personal views about the place of health in the post-2015 agenda. This is no secret. I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.
I will say no more. The purpose of this meeting is to listen to you and benefit from your thinking and experience.
Just one final comment. Any new goals must have unbeatable political appeal. Without strong political commitment, no goal on the new agenda can leverage real progress.