WHO Director-General asks think tanks to explore health challenges under the Sustainable Development Goals
Dr Margaret Chan
Director-General of the World Health Organization
Experts and colleagues in public health, ladies and gentlemen,
I was asked to challenge you. I can ask for your help with issues that keep me awake at night. Some are politically contentious, as we see every time they are raised during the World Health Assembly.
The world has changed dramatically since the 8 Millennium Development Goals were agreed at the start of this century. The results of that sharp focus, and all the energy, resources, and innovations it released, exceeded the wildest dreams of many. This was an instrument for global health governance that demonstrated the power of international solidarity and brought out the best in human nature.
The factors that now govern the well-being of the human condition, and the planet that sustains it, are no longer so discrete. The agenda for sustainable development, with its 17 goals and 169 targets, will try to shape a very different and more complex world.
This is a world that is seeing not the best in human nature, but the worst: international terrorism, senseless mass shootings, bombings in markets and places of worship, ancient and priceless archaeological sites reduced to rubble, and the seemingly endless armed conflicts that have contributed to the worst refugee crisis since the end of the second World War.
The new agenda is certainly ambitious. It seeks nothing less than to transform the way the world works. Through its 169 interactive and synergistic targets, the SDGs seek to move the world towards greater fairness that leaves no one behind. In pursuing such lofty ambitions, it will inevitably cross paths with the international systems that govern finance, business relations, foreign investment, and trade.
The 13 targets under the health goal continue the unfinished business of the MDGs with even higher ambitions, and add important new health concerns of universal relevance, such as noncommunicable diseases, mental health, and road safety. What are our chances of success?
Ladies and gentlemen,
Leaving no one behind, ending epidemics, and ending preventable deaths require a massive scaling up of interventions. Who will implement? Who will pay?
Intellectual property rights and the patent system continue to raise questions about fairness. I have been hearing some serious concerns that the Trans-Pacific Partnership, the biggest trade agreement ever, may adversely affect the market for generics and biosimilars and increase the cost of medicines.
I would like to hear your views. If these agreements open trade yet close access to affordable medicines, we have to ask: Is this really progress at all, especially with the costs of care soaring everywhere?
And they are soaring. Genuine therapeutic breakthroughs increasingly come at an astronomical cost. Some of the new drugs for hepatitis C cost US$ 1000 a pill. In poorer countries, adding 1 new drug to the standard regimen for treating breast cancer greatly increases the cost.
High prices block access. Hepatitis C affects around 150 million people, mostly living in poor countries. Unless we get these prices down, many millions of people will be left behind.
Let me ask you. What is a fair profit for a pharmaceutical company? To what extent does the market exclusivity conferred by patent protection actually stimulate innovation? I have heard this widely-held assumption challenged by several economists.
I worry about interference, by powerful economic operators, in the new targets for alcohol, tobacco, and noncommunicable diseases, including many that are diet-related. Economic power readily translates into political power.
Let me give you a single example. Of all the demand-reduction measures set out in the WHO Framework Convention on Tobacco Control, increasing taxes and prices for tobacco products is by far the most effective. It is also the least implemented, largely because of interference by the tobacco industry.
In some US cities, efforts to impose taxes on soda were effectively blocked by the beverage industry. However, extensive media coverage of the issues, including the risk that consumption of sugary beverages increases the risk of obesity, diabetes, and other diseases, led to a sharp reduction in consumption.
In the end mayors got what they wanted, though not through the intended way. Is public opinion, sometimes outrage at industry practices, a resource we ought to use more?
Since the start of this century, the poverty map has changed. Today, 70% of the world’s poor live in middle-income countries. Economic growth has long been the principal measure of progress. If the economy is doing well, where is the pressure or incentive to pursue equitable health care? What happens to the poor when middle-income countries lose their eligibility for international assistance?
The political and financial contexts in the new era are less promising than they were 15 years ago. In much of the rich western world, economic insecurity, domestic cuts in public services, and growing inequality reduce political interest in international development and increase public hostility to foreign aid.
Only if governments in wealthy countries tackle inequality and insecurity at home will they have the political space to pursue the spirit of solidarity that underpins the new agenda.
Consensus is growing that the SDGs will not be primarily financed from aid budgets. Moving forward, countries are expected to make their tax systems more efficient and introduce measures to combat tax evasion and illicit tax flows. This marks a fundamental change in patterns of health financing, where more of the burden is placed on domestic budgets.
Let me conclude with a statistic. Worldwide, an estimated 2.7 billion people live in countries with no safety net to cover health care costs. In such a situation, how can health work as a poverty-reduction strategy, especially when low- and middle-income countries bear 80% of the costly burden of noncommunicable diseases? This tells us something about the magnitude of the challenge.
For me, the most encouraging prospect for better health is the inclusion of universal health coverage (UHC) in the Sustainable Development Goals. UHC is the pro-poor health target that underpins all others and is key to their achievement. Countries at any stage of development can implement people-centred, integrated health services based on primary health care.
Thailand provides a good example of a country that is not yet middle-income yet has successfully reached UHC.
As members of think tanks, you have the liberty to speak your mind. We need a global conversation in which countries welcome and embrace the role of civil society.