I am particularly pleased to be back visiting China, and here in Beijing, to visit this great University.

This is my first official country visit to a Member State of the World Health Organization since I took office as Director-General in July. That we opted for China was no coincidence.

Historically, China has made some of the most significant contributions to the advancement of medicine. Long before Europeans addressed medicine in a scientific manner, China had developed advanced techniques of diagnosis and treatment. Many of these traditional techniques are today applied around the world. Thousands of years of knowledge is there for the world community to tap and share.

China means a lot to the World Health Organization. In this second part of the 20^th century you have managed an extraordinarily rapid and comprehensive process towards better health for the world's largest population. Since the creation of the People's Republic of China, life expectancy at birth has doubled, and infant mortality has dropped from 200 to 35 per 1000 live births, an astounding result.

We know that these achievements were not just granted - they were earned.

China tells the story of the critical link between gradual improvement of the health status of the population, and the gradual social and economic improvement for the Chinese people. This is key: Health is a primary resource for the advancement of a dynamic economy. Better health is the lead strategy to lift populations out of poverty.

At the doorstep to a new millenium, China is also facing a number of challenges. Countries will continue to look to China on how they are met. How can the access to health care among the rural and urban population in the different parts of the country be further improved? How can China cope with the double burden of disease - addressing the communicable diseases such as tuberculosis and HIV/AIDS, and at the same time face the shift in the morbidity pattern to noncommunicable diseases such as cancer and cardiovascular diseases? And furthermore, in which way can the health system adjust itself to the rapid ageing of society?

Mr Minister: These are all fundamental questions facing China - they are facing a large number of countries, and consequently they are facing WHO. These are the issues we have to work on to gather the best evidence and to give our best advice to Member States - in their quest for combating ill health and building healthy communities.

That is why China will remain so important to us. This great country is a crossroads for today's global health agenda.

Today I would like to share with you our current thinking on some of these key issues.

First, there is the principle of universal access to health care. This is a bedrock principle of WHO.

Universal access is a value which we cherish in its own right. But it is more. Universal access is also a way to fight poverty. Without basic quality care for all, ill health will rise among the poorest. Vulnerable people in other groups of society, citizens with low or no income, the disabled, the aged, mothers with young children, will also suffer from poorer health without an accessible health system.

Ill health is costly. It means missed opportunities and untapped potential. We know the equation: Ill health leads to poverty and poverty breeds ill health. That is the cycle we need to break - and China has come very far. Ill health hampers economic growth. Poor and ill farmers are not able to work on their farms as usual. They have less time to market their products. Ill workers in industry are weaker and frequently absent from work. Ill children and students perform less well, drop out of school and risk being excluded later on in life from economic opportunities.

And above all - permanent ill health and poverty runs against fundamental human rights - human dignity and equity.

Looking to China and Asia as a whole, no one single factor explains the rapid growth process during the last decades. Part of the explanation undoubtedly lies in rising standards of living and improved levels of education. But enlightened health policies have also allowed countries to share the powerful potential of modern medicine and public health. That is a major part of the explanation.

In China, health conditions have improved far beyond what one might expect from income growth alone. Good health policies can achieve remarkable results, and with the tools that science has given us today, not only at the higher income levels.

Health, like schooling, is a form of human capital. An emerging literature tells the story: Increases in health result in increases in GDP per capita and in higher rates of growth. The effects of improved health are likely to be greatest for the most vulnerable - the poorest and those with little education. Health matters. Removing financial barriers to health matters.

This is the message WHO will take to decision-makers around the world - backed by our new and strengthened emphasis on evidence and information for policy. We need to tell Presidents, Prime Ministers and Finance Ministers that they are truly Health Ministers themselves. I am glad to have been offered the opportunity to discuss this with China's Leaders during this visit.

Millions of Chinese families have been lifted out of poverty and vulnerability. It is appropriate to compliment the Chinese Government and its Leaders on their commitment in achieving results that are crucial to people's welfare. The world is watching when you move ahead with the National Immunization Days every December, backed by the President, the Government, as well as teachers, police and health workers in villages, who all take part in this Day.

That is a great encouragement and the results are obvious. China is now close to eradicating polio - well before the ambitious target for global elimination 25 months from now - at the end of the year 2000.

Important public health programmes have been intensely implemented in the 1990s with high level political support, multisectoral and mass involvement. China deserves congratulations for the enormous effort which has lead to these successes.

A major challenge ahead concerns the reform of the health system - and more particulary the health financing system. China is not alone in facing this challenge - as the disease patterns change - as our population pattern changes - and as our public financing sources change.

In WHO we are starting to address what we see as the need for "a new universalism" - a new way of addressing universal coverage. Universal access to quality care remains the bedrock principle. Governments should be responsible for securing access to care. Only the public sector can guarantee this basic universal right. Governments should provide strategic leadership - through setting priorities - accepting that there are limits to the care governments can finance, limits that each country - including China - has to define for itself.

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 will be ready to advise countries in this process.

In China, a core structure is there, with insurance schemes for civil servants, workers, farmers, students and for the financing of preventive care. For the schemes in urban areas, a prime target would be to ensure that family members of workers receive social protection as well. In other words, their inclusion in insurance schemes is crucial.

Through social insurance, we can protect the population against the problem of user fees. It will be a significant relief if health insurance protects against high hospital care bills. However, insurance for outpatient care is an issue that should also be studied. If outpatient care is inadequately insured, people will delay their seeking of basic care. This may impact on total health care costs as a result of delaying or omitting health care. Insurance of outpatient care is a key, if properly designed, to avoid expensive hospital costs.

China's major challenge lies with the health financing reforms that will affect the great majority of the its people, namely in the rural areas.

When the pooled insurance system in the rural areas was abandoned in the 1980s, many poor farmers saw their condition worsened because they had to pay most of their medical costs themselves. I believe it was a wise decision by the Ministry of Health and the State Council to re-establish the Rural Cooperative Medical Systems in 1994. That decision improved access to health services among the rural population.

You have tested your case. Important work has been carried out by a Project Team that supported the establishment of new schemes in 14 pilot counties of 7 provinces, covering a total of about 8 million people.

Several of these pilot counties have performed well, offering some form of protection to farmers where there was none or little before. The experiences gained also enabled the Ministry of Health to formulate a series of regulations and guidelines. The further expansion of these rural systems has now been listed in China's long-term development targets for 2010.

The team has worked with decision-makers at the central, provincial, county and village level. WHO has given its support. It has been a pleasure for all levels of the Organization - the Country Office, the Regional Office and Headquarters, to be strongly associated in launching this rural health insurance Project, and you can count on our continued support.

My second observation relates to the double burden of disease. China will have to face the threats from communicable diseases - and at the same time face the new epidemics from the noncommunicable diseases. This places new pressures on the health system as a whole - on how we train health workers, on how we plan our hospital infrastructure and on how we structure our financing system.

For WHO - fighting communicable diseases remains a critical part of our mandate.

China has come far. The world will be able to learn from China's successful fight against malaria as WHO now takes on its Roll Back Malaria Project. I appreciate China's active support. In this Region, about 110 million people are at risk from malaria in 10 countries, with unacceptably high incidence rates in several countries and a growing problem of increasing drug resistance. About one million clinical cases are reported in Eastern Asia and Oceania.

The objective of the Roll Back Malaria Initiative, which is a joint effort of UNICEF, the UNDP, the World Bank and WHO, is to significantly reduce the global malaria burden through interventions adapted to local needs and by strengthening the health services to affected populations. China will be an important partner in this Initiative. It can help other countries in the Region to help fight malaria. In this way, any sizeable reintroduction of malaria in China can also be avoided.

China has an impressive track record for the development of anti-malarials. The benefits of Qing Hao Su, which has been used as a fever treatment for 2000 years, are noteworthy. The hope is that China would help the world with the production and distribution of anti-malarial compounds.

There are still important diseases that need to be fought with new vigour in China - such as tuberculosis, which is now also closely linked to the HIV pandemic.

China shares an important part of the TB burden in the Western Pacific Region. It is currently the most deadly infectious disease in China, claiming 288 000 deaths per year. Annual new infectious TB cases in China total 630 000. The TB problem is worst in rural populations in the most disadvantaged counties and among migrant workers in areas of high economic activity.

But good things are happening. In 1992 the Chinese Government, together with the World Bank and WHO, has been able to implement the Directly Observed Treatment Short-Course - also called DOTS - strategy in 13 provinces, covering about half of China's population. By 1995, DOTS has been successfully expanded to more than 1 200 counties in the project's provinces.

Since the project's start, over one million infectious TB cases have been cured, and care is now provided to approximately 300 000 cases per year. Of all the countries in the world implementing the DOTS strategy, China has been the most successful, with the involved provinces achieving more than 95% success in the treatment of infectious TB cases.

Still, more needs to be done - in China and at a global level. WHO is in the final stages of launching its Stop TB Initiative - aimed at mobilizing support and new commitment for reinvigorated efforts against this killing disease which now is appearing as drug resistant in an increasing number of cases.

WHO is ready to work on implementing sustainable TB control in the whole of China. We will support interministerial discussions, involving also the Ministry of Finance and Provincial Finance Departments. The public sector must be the driving force. Free or subsidized treatment of DOTS to everyone in China who needs it can be contemplated, especially for those living in the most disadvantaged counties and the migrant workers.

HIV/AIDS needs our continued strong attention. WHO supports the Government's recent identification of priority issues for HIV/AIDS control.

The lessons are similar in most countries. Education of the general public using the mass media is a very important preventive measure. Halting blood transfusion-related HIV transmissions, as well as needle sharing among intravenous drug users is indeed a must. Efforts to decrease the incidence of sexually transmitted diseases so as to decrease sexual HIV transmission has to be upheld and intensified. WHO is ready to support the Government further in the development of HIV surveillance, management of sexually transmitted diseases, blood safety, and training on adolescent sexual and reproductive health.

When addressing the second part of the double burden of disease - the emergence of noncommunicable diseases and their threat to human lives - today I wish to focus on one single issue.

We urgently need to address one major cause of premature death which is dramatically increasing - killing 3.5 million people in the world this year - and likely to rise to10 million into the next century. Seventy percent of those deaths will be in the developing world. In China, this epidemic may well kill about 100 million of the 300 million Chinese men now under twenty-nine years of age, with half of these deaths in middle age.

I refer to tobacco. I told the World Health Assembly in May: I am a doctor. I believe in science and evidence. We have to be frank about it: Tobacco is a killer. Tobacco should not be advertised, subsidized or glamourized.

Habits start in youth. The tobacco industry knows it and acts accordingly by the way it targets its advertisements. In China, most people begin using tobacco in their early twenties.

What we are facing is a tobacco epidemic. One of the basic challenges facing us is to place tobacco control initiatives at the top end of international and national political and economic agendas. WHO has decided to act. We have launched a new project called the Tobacco Free Initiative - bringing with us partners from other UN Agencies - such as UNICEF - from non governmental organizations and civil society.

The project has two basic goals: To increase global awareness about tobacco and as a corollary to that, decrease its consumption. Last month I asked the TFI team to begin examining options for an international Framework Convention on Tobacco Control.

We are exploring new and innovative ways to reach young people. In addition to schools, university and youth organizations we are also hoping to reach the young through the entertainment industry, film and media organizations.

Yesterday I visited Tsinghua University. They are paving an important way forward. The launching of a "Tobacco Free Campus'' will carry the message that it is neither fashionable nor healthy for young people to smoke. This is a message that will resonate beyond China.

At Government level, WHO will work with Ministries of Education, Finance and Health to strengthen institutional capacity and galvanise public support for tobacco control.

My last remark here today relates to ageing and health.

The ageing of populations has become a major challenge for economies and health services throughout the world, where rapid declines in fertility are accompanied by increases in life expectancy. This transition is particularly pronounced in China.

China, being the most populous country in the world, already has the largest percentage of the world's "oldest old" - rising to 18 per cent of those of 75 and older. It is estimated that by 2020 the proportion of Chinese aged 60 years and above will increase to about 230 million older people. The proportion of people aged 65 years and older will surpass the proportion of the young up to 19 years old.

At present, the contributions of older Chinese to family, society and economy are considerable. Many households contain extended families, with grandparents providing shelter and childcare, thus freeing parents to enter the work force. Extended families also are an opportunity for sons and daughters to take care of their elderly parents or relatives.

The rapid population ageing will present an immense challenge for China's health and social services. Health service systems need to adjust to this transition. Not all of the services to older people have to be provided by medical care institutions. Innovative systems of palliative and social care will need to be studied and introduced.

WHO is focusing on ageing - as we are with the broad themes of social change processes in global health - such as the rising burden from mental health. Many of the questions facing the countries of the world will be the same. WHO will seek to be there with a pool of experience and knowledge.

Mr Minister,
Ladies and Gentlemen,

There are several reasons for seeing China as a crossroads for the world health agenda as we strive towards Health for All into a new century. China will remain an essential partner for WHO - and let me briefly summarize four broad areas where WHO will lend its support:

• WHO will help monitor, roll back and where possible eradicate communicable diseases; and in China we need to give a particular focus on tuberculosis and HIV/AIDS.
• We will help fight and reduce the burden of noncommunicable diseases; I refer specifically to the fight against tobacco use, especially among the young.
• We will advise on building a sustainable health system that can help reach equity targets and render quality services to all.
• We will assist in putting health in a broader perspective. Health workers themselves are often on the receiving line - left to deal with the results of activities in other sectors of society. We need to establish and understand a broad range of links - from sanitation and hygiene in people's homes, to environmental problems linked to agricultural and industrial development, and on to impacts of globalization and world trade on people's health.

And finally - we need to speak out for health and human development. We need to bring health to the core of the global development agenda. We did that four years ago here in Beijing at the Women's conference with a clarion call for change - calling for unleashing women from the chain of poverty - calling for women's right to health - calling for the right of the girl child - so often neglected - reiterating what we called for in Cairo two years earlier - that we needed empowerment of women and a caring society where all women can safely have their children.

The key to this great country's future lies with the quality of its people and the management of the human resources base. You and we have ample evidence to prove that health matters - that health can make a real difference in the way societies develop.

The World Health Organization looks forward to its partnership with China.