I am here today to pledge the commitment of the World Health Organization to make a difference to the health of women.

The health of women matters, foremost to women themselves. It matters to their families, communities and societies. Indeed, the health of women is a fundamental pillar that underpins sustainable human development.

Promoting and ensuring women's health is a priority for WHO. WHO has been one of the many participants in the process that began in Mexico City - and even before - a process that did not end in Cairo nor Beijing. It is a process that has been led and nurtured by the international women's health movement, one of the most extensive and effective social movements in living history. You sitting here are part of that movement.

The issues we all had to address are at the heart of human development and equity. Briefly, let us review some of them:

The issue of poverty: 70% of the 1.3 billion people living in poverty are women;

The issue of illiteracy: of the 900 million illiterate people, women outnumber men, 2:1;

The issue of malnutrition: women are twice as affected by iron deficiency anaemia as men;

The issue of maternal mortality: women continue to die in childbirth, an unacceptable tragedy given our advances in technology. Today, there are more than half a million pregnancy-related deaths every year;

The issue of wage inequality: on average, women are paid 30 to 40% less than men for comparable work;

The issue of economic power: In developing countries, only one-seventh of administrators and managers are women. Developed countries have a long way to go to achieve gender parity as well;

The issue of political power: only 10% of seats in the world's parliaments and 6% in national cabinets are held by women.

• If development is about widening women and men's choices,

• If development is about ensuring an equitable distribution of resources, responsibilities and rewards that allow women and men to widen their choices, including those related to health,

• Then the interaction of gender and poverty constitutes the greatest limiting factor to human development.

Development strategies show that investment in women's health yields high returns, both economically and socially. If we wish to unlock women's potential, we must put an end to discrimination and address openly these key issues.

1. The first "reality" is that for long, and rightly so, the focus has been on the reproductive period. Primarily women have been considered as synonymous with "mothers". However, the time has come to focus beyond the sexual and reproductive health of women and view the different needs in the entire life-span.

While women's sexual and reproductive health are at the very heart of the issue of women's empowerment, Cairo and Beijing challenged us to broaden our focus.

Too much, I believe we have limited our scope to the provision of family planning services and providing contraceptives primarily to women. I am certainly not arguing that family planning services and access to contraceptive technologies are not badly needed, but we must acknowledge that access to reproductive health services, and the abilities to use technologies, are a function of the degree to which women are able to exercise their right to make these choices. We must incorporate into our thinking the concepts of women's rights and empowerment, and men's roles and responsibilities in conception, childbearing, and prevention and care of reproductive tract infections and sexually transmitted diseases including HIV/AIDS.

Last month, I participated in the review of ICPD in the Hague, listening to changes of policy and new programmatic approaches in sexual and reproductive health. Although much more needs to be done, sexual and reproductive health and rights are moving forward in most countries for women and for men.

2. The second "reality" is that the women's health agenda challenges our institutions to incorporate a multitude of partners. Certainly the Cairo and Beijing conferences were a global reminder that the time is over for using women as instruments of public policy without being participants in a process of consensus building for social change. I am committed to making WHO a partnership organization, one which draws upon, and is nurtured by, the comparative advantages of many interest groups.

3. The third "reality" is that while we talk about equity in health, we forget that this includes the way in which responsibilities are distributed in the health sector. Women's health is not just about the health of women; it is also about the women who work in health at all levels. I am not only referring to health workers, but also to the millions of women that we draw upon every day in conducting our work on health at the national and community levels. Where would we be without such women? Health professionals working at local levels are fully aware of the importance of women to the success of their interventions. But the focus has been on how to use women in order to gain access to others, be they family members or the communities in which they live. The volunteer participation of women is sought to cushion the impact of ever shrinking public resources as well as to ensure greater effectiveness in the use of those resources that are available.

While women, and men for that matter, must be involved in the events and processes that shape their lives, we must be cognisant of the multiple roles that women in particular carry out during a given day, ensuring that health activities do not represent an unbearable burden. Most importantly, we must make sure that women have the access and control of the resources needed to assume community responsibilities in health.

4. The fourth "reality" is that we have yet to expand our focus on women's health to include a life span approach. We tend to compartmentalise women's lives and their health into neat little boxes that make our organizational lives easier. We have yet to work in a way that fully acknowledges that there is a connection between the female foetus, the girl child, a young girl's development, her navigation through adolescence and adulthood, and the way in which she will enjoy her later years. We in health have yet to think more about the health of older women, particularly after our reproductive lives, which are becoming longer and can be fuller in good health.

First of all, we cannot consider the health of women in isolation. Men, fathers, brothers, husbands, sons are important. Women live in complex social contexts, and gender roles and relations are embedded within that context. In order to improve the health of women, we have to analyse the determinants of women's health status in the reality of their lives. This is why I am committed to incorporating a gender perspective in health across WHO's work.

In order to realise this, we are working to establish a gender policy for WHO. This will be discussed in Cabinet next week, Regional Committees this autumn and by the Member States at the World Health Assembly in the year 2000.

Why is gender perspective important and what does it mean? A gender perspective focuses on the roles and relations between men and women and how these affect their health and development. It is also important to remember that gender not only refers to the relations between the sexes at an individual, personal level. It also takes into account the values and norms that permeate societies and institutions, organizational systems, including the health and the legal systems.

What we will do in WHO is to recognise how gender interacts with biological sex differences to place women or men at risk for poor health and disease, and to this I am committed.

Let me give you some specific examples of how a gender lens can help us do better what we do across WHO.

In malaria, we know that biology is largely responsible for aggravating the severity of the consequences for women. But gender colours the experience of women at risk and suffering from the disease. Insecticide-impregnated bed-nets have been recommended widely as a way of protecting people in disease endemic communities. We need to be sure that women's lower status does not dictate who sleeps under the limited number of nets available to a poor family.

In the area of sexually transmitted diseases, including HIV/AIDS, gender exercises a deadly influence, exacerbating women's biological vulnerability to these diseases. Social acceptance of male promiscuity, social assignment of greater value to what is masculine and the positive support for women's passivity and social denial are some of those gendered risk factors that put women at greater peril.

In the area of health systems and services, when men and women seek care for the same disease, for example, diabetes or hypertension, we need to understand how gender influences the way in which health workers respond to male or female clients. Our research shows us that women wait longer than men in clinics, are often provided with less information than men about their illnesses, and tend to take more responsibility for ensuring their partners' compliance than do men.

Violence and mental disorders are also experienced differently by men and women. With respect to violence, the data indicate a predominance of male mortality through accidents and violent acts. We need to know more about the influence of attitudes and behaviours stereotypically defined as "masculine", such as aggressivity and risk-taking, to be able to respond with effective intervention that begin in childhood. Data show that these behaviours are at the root of the alarming statistics of domestic violence against women in both developed and developing countries. In terms of mental disorders, depression affects women twice as often as men. Some of this difference can be attributed to biological differences. But women's lack of control over their lives can be an exacerbating gender factor.

In relation to environmental health, we need to know more about how biology interacts with gender to differently expose or protect men or women from the risks of a toxic environment. We also need to further our knowledge as to how biological differences between the sexes can produce different health outcomes in men and women who are exposed to the same environmental hazard.

How do the development policies that our governments pursue, differentially affect the health and well-being of men and women? Some apparently gender-neutral formulations referring to objectives such as "cost reduction", frequently include hidden gender implications. They imply transfers of costs from the formal sector of the economy to the informal economy often based on utilisation of the unpaid labour of women.

Aggressive tobacco companies use gender stereotypes to tailor messages specifically to women and girls to entice their initiation and maintenance of smoking. Research indicates that women are not as successful as men in kicking the tobacco habit. A gender approach can help us improve such programmes.

As you can see, there is much to be gained from incorporating a gender approach and gender analysis into all that we do in WHO. It will give additional information to policy makers, programme managers, to communities, to women themselves. It will bring about and accelerate change.

Members of the Committee, Distinguished Delegates,

To be able to look through the gender lens, we need information. The basis for a gender approach is sex disaggregated data. We cannot know what is going on with men and women if we cannot count on information on which to base a comparative analysis. You must contribute to the global knowledge base in this regard. The data that your countries collect on major health issues must be sex differentiated. By providing us with this information, WHO can produce information about men and women separately that will allow you to more equitably and effectively address health needs.

But sex disaggregated data is not enough. We must learn to analyse what that data means. This is why I am examining the best way to mainstream a gender perspective in all the work of WHO. I encourage you to do the same within your institutions.

In addition to initiating a gender policy for the Organization, I have established a new Cluster on Evidence and Information for Policy which has the responsibility for providing global sex and age specific data on all health matters. The Gender mainstreaming focal point is also in that Cluster, co-ordinating activities across programmes, regions and countries. I, myself and my office are participating and following this process very closely.

As you may know, I have strongly increased the number of senior women at the highest levels of the Organization as well as at other senior levels. I shall continue to close the gender gap in my Organization.

We at WHO are committed to moving forward the women's health agenda. We must learn from, and draw upon, the myriad of initiatives that women are undertaking world-wide to overcome economic hardship and to gain recognition of their rights to insist on making public, a discussion of values and dreams that ultimately influence women's health decisions.