Director-General

WHO Director-General addresses the UN Economic and Social Council

Dr Margaret Chan
Director-General of the World Health Organization

Keynote address to the UN Economic and Social Council
The changing development landscape: what will it mean for specialized agencies in a post-2015 era with focus on sustainable development?
New York, USA

25 February 2014

Distinguished representatives of missions, fellow UN agencies, ladies and gentlemen,

In pursuit of the health-related MDGs, WHO and the international health community have produced many good results, useful lessons, and best practices to guide our work in the post-2015 era.

Commitment to the MDGs left a legacy of innovative facilities and mechanisms for mobilizing funds, like GAVI, the Global Fund, and UNITAID, for purchasing and distributing life-saving commodities, and for developing badly needed new products for diseases of the poor.

Health has profited from a new breed of results-driven multi-stakeholder global initiatives like Every Woman, Every Child with built-in mechanisms for ensuring transparency and accountability. This builds confidence for investment in health by governments and development partners.

The epidemics of AIDS, tuberculosis, and malaria peaked and began a slow decline. The number of childhood deaths, stuck above 10 million per year for decades, dropped by nearly half. The introduction of novel incentives for R&D resulted in new vaccines for the two biggest killers of children, new diagnostics for TB, and new medicines for malaria. The price of medicines for treating AIDS dropped 100-fold.

These are some successes, sometimes stunning successes. The challenges that lie ahead will be more difficult.

The world has changed dramatically since the start of this century. The biggest threats to development are now much more complex and challenging. They can no longer be addressed by the health, education, energy, or food sectors acting alone.

Discussions on the evolving roles of governments, the UN, its agencies and other stakeholders are urgently needed for sustainable development in the post-2015 era.

Let me share with you our experiences at WHO. WHO is in the midst of a reform process to make the Organization fit-for purpose in addressing the unique challenges of the 21st century.

It is important to note that many Quadrennial Comprehensive Policy Review recommendations are highly convergent with the WHO reform measures, including our focus on country needs and country impact, on efficiency and effectiveness, and on improving coordination and coherence.

Reform is not easy, but it must be done, and in a thoroughly inclusive process. Transparency and accountability have become part of the new model for our work in norm-setting and development cooperation.

I will be happy to provide more details about WHO reform and answer questions during the discussion. For now, I want to shape the discussion by drawing your attention to three high-level trends that I find especially worrisome.

The first is the world’s growing social and economic inequalities. These inequalities are bad for development.

According to the OECD, inequalities, in income levels and opportunities, are at the most extreme level seen in half a century. Leading economists and policy analysts view inequality as an especially dangerous force that squeezes the middle classes, disrupts social cohesion, and destabilizes society.

In its global wealth report, issued last October, the Swiss bank Credit Suisse estimated that the world’s poorest 3.5 billion people possess less than 1% of global wealth, while the richest 1% account for nearly half of total wealth.

Put another way, the combined wealth of the world’s richest 85 people equals the combined wealth of the world’s poorest 3.5 billion people. This is a startling statistic.

In its latest assessment of risks to the global economy, issued last month, the World Economic Forum ranks income inequalities as number four in its list of the top ten risks.

Inequality is also the focus of UNDP’s latest report, on Humanity Divided, which explores the significance of inequality for development and development policies.

All of us in this room who care about development need to be deeply concerned by this lopsided way that wealth and opportunities are being distributed. The world does not need any more rich countries full of poor people.

The second trend that worries me is the rise of chronic noncommunicable diseases. These diseases are certain to increase the world’s inequalities, in economic wealth as well as health, even further.

For decades, diseases like heart disease, cancer, diabetes, and chronic respiratory diseases were thought to be closely linked to affluent lifestyles and largely confined to the wealthy world. Not anymore. Today, 80% of the burden of premature deaths from NCDs is concentrated in low- and middle-income countries.

The fact that NCDs have overtaken infectious diseases as the world’s leading killers is a seismic shift in the disease burden, with vibrations felt in economies all around the world.

Left unchecked, these costly diseases, with their need for long-term care, have the power to devour the benefits of economic gain, and move development backwards.

This is an unprecedented situation.

Beginning in the 19th century, improvements in hygiene and living conditions were followed by vast improvements in health status and life-expectancy. Today, the situation is much more complex.

Instead of diseases vanishing as living conditions improve, socioeconomic progress is actually creating the conditions that favour the rise of noncommunicable diseases. Economic growth, modernization, over-consumption, and urbanization have opened wide the entry point for the globalization of unhealthy lifestyles.

The UN Political Declaration on NCDs, issued in 2011, clearly stated that prevention must be the cornerstone of the global response to these diseases. But prevention faces forceful opposition.

Opposition comes from powerful economic operators that depend on the aggressive marketing of tobacco, alcohol, and unhealthy foods and beverages, also to children. Economic power readily translates into political power.

Governments must ensure policy coherence and multisectoral collaboration among agriculture, trade, education, and health to achieve balance between economic growth and public protection. Governments must provide the social environments to make healthy lifestyle choices the easy choices.

In the UN, the creation of a UN Agency Task Force for the Prevention and Control of Non-communicable Diseases, with ECOSOC engagement, is a smart and welcome move for improving coherence and coordination.

Ladies and gentlemen,

In a world of radically increased interdependence, countries are closely interconnected, but so are policy spheres.

The lines that distinguish different sectors and actors have become blurred. Actions in the public sector are no longer able, on their own, to influence all the forces that shape development.

Multisectoral collaboration and multi-stakeholder engagement with civil society and the private sector are the reality for sustainable development in the future, whether for securing health, education, energy, or an appropriate food supply.

This brings me to a third trend of concern. The influence of stakeholders, especially the private sector, in multiple sectors is growing very rapidly at a time when the institutional and regulatory capacity of many countries remains weak.

In the absence of adequate legislation, human and regulatory capacity, the private sector takes on an enlarged role, with little control by the government over the quality and costs of the services being provided. The vital role of government in protecting the public interest is diminished.

In one especially alarming trend, provisions for the settlement of investor-state disputes are being used to handcuff governments and restrict their policy space. For example, tobacco companies are suing governments for lost profits when national legislation, aimed at protecting health, interferes with their business interests.

When private economic operators have more say over domestic affairs than the policies of a sovereign government, we need to be concerned.

If multisectoral collaboration and multi-stakeholder engagement are the reality for sustainable development in the post-2015 era, we need to debate what type of mechanisms are required to allow all stakeholders to make contributions and to protect against the influence of vested interest. We also need to consider the UN’s role as an honest broker that promotes fair play.

Thank you.

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