Mr President,
Ministers,
Dr Gezairy,
Colleagues,
Ladies and Gentlemen,

It is a message of hope and inspiration to us all that the Regional Committee for the Eastern Mediterranean is meeting here today in Beirut. I am delighted to be in Lebanon to speak to this distinguished group of health leaders.

I hope to be able to share with you my vision of the future for WHO and world health and to listen and learn from your own ideas and concerns.

When WHO was created, only six nations of the Eastern Mediterranean were able to lay the foundations. Now there are 22 countries of the Region able to celebrate our 50^th Anniversary year. We can look back at impressive achievements: yet we enter a new century where no one could claim that our agenda was fulfilled. There is still so much to do. Our task is clear: to see to it that an effective WHO will be there to pave the way towards better health in all its Member States.

This is the sixth and last Regional Committee that I will have attended since the beginning of September. Harare, New Delhi, Manila, Copenhagen, Washington and now Beirut - they all represent an extraordinary opportunity to tap the experiences of health officials around the world.

To me this is key: WHO is complete - our identity intact, our course on target - only if we include the regional dimensions - if we add them up. I see this as a main challenge: to make WHO one, not seven organizations - Geneva and the six Regional Offices.

Let me take this opportunity to share with you a few issues which I believe are important for our organization and for the Region, and to share with you the process of change that I have initiated with my colleagues in the WHO Secretariat.

My first observation relates to the advantages of having a broad perspective on health. Important determinants of better health lie outside the health system. They include better education. A cleaner and safer environment. Sustained reductions in poverty. A stop to armed conflict and excessive military expenditures. We simply cannot appreciate or fully address the health challenges by only focusing on the health sector.

Right now there are many peoples in the Region who are faced with armed conflict. Infrastructure in a number of countries has been and continues to be destroyed, health centres are devastated and thousands and thousands of people are left with mental and physical scars.

We need to add our efforts to the prevention of conflict. And we can make a difference. For example a great service can be done to the health of this Region and the rest of the world by more countries ratifying the treaty to ban anti-personnel landmines which came into force last month with forty ratifications. I ask you to join with Djibouti and Yemen from your Region which were among those countries.

What can WHO do? We have to emphasise the message to the international community: peace is an absolute need for sustainable health and human development. And WHO has to aid the victims of conflict - support proper health services for refugees, emergency care, rehabilitation for those wounded or disabled.

Health workers are on the receiving end not only of the impact of war and conflict but of many of society's other problems and inequities. They are often left with dealing with the outcome of events. At the same time we know that making right and timely investments in health benefits society at large.

We have the evidence: investing in health gives tangible results. Less social and economic costs. More human progress. Enhanced capacity for society to harness the human resources that will be at the forefront of development in the 21^st century.

You, the Health Ministers, already know. Together we need to go beyond and tell the Presidents, the Prime Ministers and the Finance Ministers that they are really Health Ministers themselves.

I believe we can succeed in putting health at the center of the development agenda. Not alone. But by gathering our evidence, by matching it with that of others, by becoming better advocates, and by reaching decision-makers with a convincing case. This requires new momentum and new methods of work.

My second observation concerns the advantages of our reaching out - to other UN Agencies, to other key players in health, and to civil society. The very notion of a specialized agency makes little sense in this interdependent world. The projects and workplans of WHO will put specific emphasis on these partnerships. WHO can be a stronger lead agency in health by entering into partnerships of stakeholders.

WHO should focus on problems that cross boundaries, on generating and disseminating a global evidence base, on promoting research that goes beyond corporate or national agendas. That is how we can really be efficient and make a difference at a country level - in our technical work - and in our setting of norms and standards. That is how WHO will provide the intellectual and moral leadership required to ensure Health for All.

These themes of partnership and focus apply to our work in the Eastern Mediterranean Region. We need to maintain close contacts with the regional structures of our United Nations partners and with other regional institutions including those in the economic fields.

This will enable us to tackle a key issue that I know is of concern in the Region, namely to develop better strategies for linking health and trade issues. These include conventional areas of concern, such as harmonization of occupational and environmental health standards. They also involve balancing our mandate to protect the health of people from potential hazards with the imperative to avoid using health regulations as trade barriers. And they include new areas that are increasingly becoming crucial as globalization advances, such as the trade in health-related services and products.

We must also reach out to the private sector. I have said that WHO will engage the private sector in constructive dialogue and this will be of critical importance with regard to the pharmaceutical sector. National and international drug policies should help extend access to essential drugs of good quality, safety, and efficacy. This requires strong national regulatory authority and intelligent government purchasing policies.

Your technical discussion this year on the regional initiative for self-reliance in the production of essential drugs and vaccines is very timely. Up-grading national capacities not only in production but also in the quality assurance of locally-manufactured drugs and vaccines is an important priority.

We are looking for the right balance. National strategies must ensure equity of access, rational use, and assured quality for existing drugs. Issues of drug financing and affordability are critical. At the same time, to meet pressing public health needs we need new drugs and vaccines. This is true for emerging diseases, but also true because of the serious threat from growing resistance to drugs for common killers such as tuberculosis, bacterial meningitis, and pneumonia. To develop new drugs we need innovative industry research, with appropriate incentives for innovation and protection of intellectual property rights.

International organizations and governments should address pharmaceuticals issues within their areas of competence and responsibility, in order for these important issues to be handled in a satisfactory and timely manner.

It is time for an increased and ongoing dialogue between WHO and the World Trade Organization. I have scheduled a meeting with Director-General Ruggiero to discuss how we can work together on ways to further both international commerce and international commitments to health.

My third observation concerns the shift in the global burden of disease from communicable to noncommunicable diseases. Countries in your Region are experiencing this. And scores of developing countries worldwide are moving in the same direction, posing an exceedingly hard challenge to their health systems.

The double burden of communicable and noncommunicable disease problems is already upon us. Many countries are suffering still with common infections and reproductive health problems. Without having fully solved these challenges, they are already facing the emerging problems represented by noncommunicable diseases and new infections.

Contrary to common misconceptions, inequalities do not follow a simple dividing line whereby communicable diseases would be mostly the problem of the poor and noncommunicable ailments would affect the rest of the population. The brutal fact is that the poor suffer higher rates of both types of diseases.

Let me make some references to health challenges of the Region.

The importance of markedly accelerating polio activities in the Region cannot be overstated. Although dramatic progress has been achieved in the most difficult areas of Afghanistan, Pakistan, Somalia, Yemen, southern Sudan and northern Iraq, much remains to be done.

The force of the worldwide initiative for elimination must be maintained. In 2010 we should be able to look back at the year 2000 and say that we reached the goal of eradicating polio. But we may also fail. We are now learning that the eradication campaign may be running critically short of funding.

That is not acceptable. This is a combat we simply cannot afford to lose on the last stretch. It is estimated that 600 million dollars will be needed till the end of 2000. Donors have to go the extra mile

with us and rid the world of polio and its tragic toll on death and disability. All countries have to make a reinforced effort led from the very top.

I have pledged WHO's determination to lead in a renewed international effort to Roll Back Malaria. I am pleased that one of your technical papers this year presents an analysis of the current situation. In some countries of the Region, eradication was possible but in others we have seen a resurgence. In the most heavily affected countries we need to attack the disease by focusing on strengthened health systems. The project staff is currently preparing the work in close dialogue with the Regional Offices and gradually with the countries concerned. I urge you to join us.

More than 90 per cent of the tuberculosis in the Region is concentrated in eight countries, of which Pakistan, Afghanistan and Sudan have the major burden. The efforts made by the Regional Office and Member States since your regional resolution last year have been commendable. But we will continue to see the incidence and mortality of tuberculosis in the Region expand over the next ten years unless we make a major effort. WHO will demonstrate leadership - by placing our TB efforts in a broader context, by focusing on the health sector and by working more closely with other partners.

Countries, and WHO, have no choice but to address the double burden of communicable and noncommunicable diseases simultaneously. We now know more about how to manage cases of noncommunicable diseases. We need to do more work on the initiatives that have already begun in some countries of the Region for community-based intervention programmes for primary care of noncommunicable diseases. We need to see if we can develop a regional network in this regard.

As we continue to improve case management, we must seriously focus on controlling risk factors. And let there be no secret: Tobacco is by far the most important.

Tobacco is already an importance cause of death in the Eastern Mediterranean Region. Thirty-five per cent of the male population smoked in the Region in 1990. It is estimated that the burden of disease attributable to tobacco use in the Region amounted to more than 100 000 deaths and more than one million years of life lost in the early 1990s.

You are acting - and I lend you my full support. The day I took office, I launched the Tobacco Free Initiative, a Cabinet project to add momentum to this critical public health struggle.

I told the World Health Assembly back in May: I am a doctor. I believe in science and evidence. Let me state it clearly: Tobacco is a killer. It should not be advertized, subsidized or glamourized. Adolescents should not be allowed to mortgage their lives to the seductive advertisements of the industry.

WHO's Tobacco Free Initiative aims at galvanizing global support for tobacco control. We need to ensure that our policy is backed by people, money and institutions, not just in Geneva, but also in the Regions and within all Member States. We need to reach in and reach out to build "partnerships with a purpose" for combating this epidemic.

Because of the importance of cessation, I have designated World No-Tobacco Day 1999 to focus on this problem. This should create opportunities for health professionals, governments, NGOs, media and pharmaceutical companies to work together towards a common goal.

Through your EMR 1995 Action Plan on Tobacco or Health, you are providing leadership and inspiration at the regional level in the fight against tobacco. Some countries in your Region have already banned tobacco promotion, created smoke-free areas in public places, and have raised tobacco taxes which discourages youth smoking.

How can we build sustainable health systems that can stand the test of changing times and economic constraints? How can we ensure access to basic health services in situations where the base of public finance is under pressure?

Each country must choose its own path - based on its pattern of disease, its institutions, its resources, and the needs of its people. But WHO must always be there, ready and able to assist you, and to share with you the experiences gathered through different models applied in various countries.

Recent years have witnessed the emergence of a world-wide movement for health system reform. Half a century after most current arrangements for organizing health care were set in place, we are again living through a period of innovation. Most countries seek to find better ways of facing the complex health challenges of our times.

What goals should guide health sector reform? By what criteria should we judge success or failure?

I see three concrete goals:

• Measurable reduction in the huge inequities that still plague us - inequities both within and across countries;
• Sustained, measurable reduction in the burden of disease;
• Universal access to efficient health services that respect the needs and dignity of each individual.

A key responsibility for Governments should be to secure access to care. Only the public sector can guarantee basic universal rights. That is a useful reminder in this year of the 50^th Anniversary of the Declaration of Human Rights as well as of our own Constitution.

The performance of market forces has enormously increased productivity in many sectors of the world economy. The health sector is also benefiting. But just as the private for-profit sector may be good at allocating resources cost-effectively, it is seldom the key provider of primary health care or the guarantor of securing health services to the poor. Neither will it assure universal access.

We need to start a discussion on norms and standards of a "new universalism" - a new way of addressing universal coverage. This will be a major issue on the agenda of each country. Accordingly it has to be a WHO priority, and we are organizing part of our work to deal with it effectively. Everything we do should contribute to health sector development.

Universal access to quality services is a bedrock principle. Governments should provide strategic leadership - through setting priorities - accepting that there are limits to the care Governments can finance, limits that each country must decide for itself. But setting priorities and defining limits require knowledge of which efforts will make the best impact, reach the most people, and achieve the most effective results.

WHO should be there to advise you in this process. The new universalism embraces all potential contributors to better health - public sector, private sector or NGOs. Provision of government financed service must come from the most efficient source, not necessarily from public sector providers.

In order to make health system reform a sustainable process, we must engage in a process of shared learning. Every reform experience contains valuable lessons for other countries. Systematic information on such experiences is an international public good. An essential function of institutions like WHO is to mobilize international collective action to ensure that such public goods are effectively produced and disseminated.

In everything we do there is a growing need to underpin our work with solid facts. We must have the right figures and the best evidence - not only the moral conviction that health is essential. We have created a special Cluster called Evidence and Information for Policy. This knowledge base is there for you to use. And to enrich. We will report important facts. And the fact is that healthy people help build healthy economies.

On 21 July I took office and appointed a new senior management team at headquarters level. We are five members from the South and five from the North. Six women and four men. All WHO's Regions are represented in a strong global team.

Together with the Regional Directors, the WHO Representatives and more than 3 500 staff we are embarking on a process of change along the lines I presented to the World Health Assembly in May.

We must secure a better unity of purpose of what we do. We should be very good at what we decide to do - and ready to say that we cannot do all.

We need to be able to say that WHO is one: setting its priorities as one, raising additional resources as one, speaking out as one. Let us not forget: WHO is a small organization if we measure it against its mandate - and against the scores of unmet needs. WHO is not a deliverer of health services: national and regional authorities are. NGOs, private providers and communities are. You are. It is through our combined efforts that we can make a difference.

Changes are nevertheless being made in our budgets. At the World Health Assembly, Member States decided after long discussions to change the regional allocations and to increase resources from the regular budget going to the African and European Regions.

I know this has faced the other Regions with some difficult decisions, especially at times of financial and economic problems. I know that there are particular concerns in this Region that Dr Gezairy has personally written to me about and we have discussed them. I shall do everything I can, looking beyond the regular budget, to mobilize funds to support our activities, especially towards the countries in greatest need.

At Headquarters, we have now grouped the programmes into nine Clusters - each sending a clear message of what business we are in. In the coming months, under the supervision of the Executive Directors, each Cluster will streamline its activities in order to optimize what we can do together - across the Organization and in partnership with others.

We continue to focus on communicable diseases and noncommunicable diseases. And we are moving to address the challenges of a changing world. The Cluster on Social Change and Mental Health will try to capture the health challenges from changing and aging societies, with a particular focus on the unmet needs within the field of mental health. The Cluster on Sustainable Development and Health Environment will strive to make the link between a globalized world and the strains on people's health from poverty and a growing burden on our environment.

In everything we do we have to remind ourselves: What we do in Geneva or in Alexandria matters very little if it does not have an impact in the countries in terms of better WHO collaboration, better pooling of knowledge, better global advocacy for health and better resource mobilization.

Not long ago, I met with the Regional Directors for a first discussion of our common work. I see the Regional Directors as an integral part of the senior management team of the Organization and I intend to establish and maintain a closer contact with them. We have started a major modernization of our information technology network which will enable us to link the six corners of the world by the push of a button, by voice or by image in real time. There will be better communication and there will be money saved from doing away with unnecessary travel.

I will establish more direct relations with the WHO country representatives and in a few months, I will invite country representatives to Geneva to learn from their experience and to introduce them to the new WHO and what it has to offer - in order to strengthen the bridges to the Member States - and in particular those in greatest need.

I will invite the Executive Board to closer contact and more focused debates on the challenges facing us. Two weeks from now, I will meet the Board at an informal retreat to introduce the change process and share ideas on the strategic way ahead.

I will establish closer relations with the private sector by inviting industry to roundtable discussions and exchange - to explore what we can do in common and where our views and interests differ. And I will meet more regularly with the NGOs and define new opportunities of working together.

You know it from the numerous calls from the Governing Bodies; Member States want more relevant and tangible results from our efforts at the country level. The time has come for the Secretariat to make its response. We have initiated a fast track task force to make concrete recommendations on how we can turn the ambitions into reality.

Gradually you will see that we are changing the way we work. More of our work will be organized in projects that cut across Clusters and Regions and that frequently engage other partners. High visibility, intensive efforts, tangible targets. We have launched two such projects since 21 July - Roll Back Malaria and the Tobacco Free Initiative, which I referred to earlier.

The bottom line is this: We need to make WHO more user-friendly, more evidence-based - for you, the Member States, who need it most, so that you can get more out of your health policies. This is a process of hope. We can do better. We will do better.

Yes, there are scores of unmet needs. But the health sector has a track record of success over the past half century; it is our mandate, yours and mine, to carry that record forward. Progress in the next century will depend on our ability to explore the potential of the human resource. We go nowhere unless we succeed in building healthy populations in healthy communities.

Science has given us powerful tools. The need now is for political, financial and ethical commitment. Commitment and responsible use of science can aid us in our search for ever better ways to prevent and treat the constantly evolving disease challenges we face.

Your Region has a long history of cooperation for health. We can look back with legitimate satisfaction to our accomplishments. But we must also look forward to the challenges that are already with us, many of which derive from the very progress that we achieved during the 20^th century.

Others are the result of the agenda that we have not been able to fulfill. Still others will emerge as unprecedented problems of the future, and we must be prepared today in order to anticipate them.

These challenges are a call for action - evidence-based and value-driven. Together we can make a difference for health - today and in the times to come.