It is a great pleasure for me to be here in Beijing. At the doorstep to a new millennium, the world is facing a number of challenges. Countries will continue to look to China on how many of them are met. For WHO, China will also be an inspiration and an important partner.

Historically, China has made some of the most significant contributions to the advancement of medicine. Thousands of years of knowledge is there for the world community to tap and share.

Over the past fifty years, you have managed an extraordinarily rapid and comprehensive process towards better health for the world's largest population. 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.

Mental health is a central part of overall health. When I took office, 16 months ago, I was convinced that WHO should devote considerable energies to addressing the challenges posed by mental disorders. Since then, my resolve has only been strengthened.

Mr Chairman,

My task today is to share with you a global perspective on mental health.

As we gaze into the future, three features dominate. First of all: We are living in a world of rapid change. Even in the calmest and most prosperous corners of the world, people are facing a breath-taking pace of newness. From new technology, to new jobs, to new fashions in entertainment and culture, we are all being swirled along in what may well be the most rapid global transformation anyone has ever seen.

No country has seen more rapid change than China. Over the past 20 years, tiny villages have turned into bustling cities. New policy directions and billions of dollars in foreign investment have changed the economy. For hundreds of millions of Chinese, the "iron rice bowl" of old has been replaced by more affluence – but for many, less security.

Also outside China, urbanization, rapid economic development and environmental degradation are forcing billions of people to face a future so different from the life when they grew up that few of their acquired skills are able to assist them with their new challenges.

Change is in itself not a negative thing. After all, the human quest for progress is motivating much of our behaviour. And, much of the change we see today is for the better.

Yet with change also comes insecurity, unpredictability and apprehensions deeply rooted in the human mind. Although some people thrive on change, most of us cope with it less easily. Let us keep this in mind.

The second dominant feature I see is poverty. Over the past decades, the world has seen great progress on many fronts. Great technological breakthroughs. Large groups getting better off. Yes - what most of the media makes us see is richness, abundance, and expensive lifestyles.

But in spite of the spectacular growth we have seen in parts of the world since 1970, more than three billion people - that is half of the world’s population - still remain poor and live on less than two US dollars per day. Of these, 1.3 billion live on less than one dollar a day. Population growth may have increased these figures to four billion and nearly two billion respectively by 2025.

Of even more cause for concern is the prediction that most parts of the world cannot count on a substantial per capita income growth in the years to come, and that inequities prevent much of the growth we do expect from reaching the poorest.

The poor seek much more than an increased income. They seek a peace of mind that comes with good health, a sense of community, safety and predictability. They seek the freedom to influence their own lives and to make choices. In short, they seek a sense of well-being that often follows higher income, but is not necessarily a part of it.

The word well-being is a key one. When we talk about mental health, we are quick to stress that what we are aiming for is not only the absence of mental disorders. We want to ensure mental well-being, a state in which individuals can realize their abilities, can cope with the stresses of life, can work productively and satisfactorily and make a positive contribution.

Obviously, poverty, both real and relative, is a great obstacle to such mental well-being. The world has set a target of halving the number of absolute poor by 2015. That is a very tall order. It can be done - we need no magic pill to make it - we have all the knowledge to secure nutrition, basic health care, immunization of all children, clean water and basic education for all. But it will require real political will.

Agencies such as WHO can help and support this process by mapping out concrete interventions that will make a real difference. We need a portion of decency on the part of the richer countries to pay a fair share to bring the excluded billion on board. Only four out of the richest countries live up to their obligation of providing at least 0.7% of their GDP for development assistance. The average is falling towards a record low 0.2%. This is – in my view – a shame, and all groups in civil society committed to development should hold their leaders to account.

The third feature I see is a process of ageing. Over the coming decades, we will see a great demographic shift in developing as well as in industrialized countries. There are currently about 600 million people in the world aged 60 years and over, and this figure is expected to rise to 1020 million within the next 20 years - a 70% increase in that age group compared to a less than 25% increase in the world’s population as a whole. By 2020, approximately 70% of the elderly population will be living in developing countries. China, which has seen such a drastic fall in population growth over the past fifty years, will feel this change more than most.

We are talking of a demographic and social transformation of our societies. There will be changes, opportunities and challenges. One of the challenges comes from the fact that the risk of mental disorders increases with ageing.

Over the past several months, WHO has renewed its strategy to contribute to the improvement of global mental health. It is a result of a long process, including the consultation meeting in Geneva earlier this year. I would like to present this strategy to you today.

But before describing WHO’s approach to global mental health, let me highlight the current burden of mental disorders. The figures are grave:

• Five of the ten leading causes of disability worldwide are mental problems. They are major depression, schizophrenia, bipolar disorders, alcohol use and obsessive compulsive disorders. These causes are as relevant in developing countries as they are in high income countries.
• Worldwide, there are 340 million cases of major depressive disorders, 45 million cases of schizophrenia and between 10-20 million attempted suicides each year.
• Major depression ranks fifth in the 10 leading causes of the global disease burden including developing countries. By 2020, it will have jumped to second place if projections are correct.
• In spite of the fact that almost 140 Member States have an updated list of essential drugs, including psychotropic drugs, one third of the global population has no access to these essential drugs. In Africa, 50% of the population is unable to access necessary drugs; the situation is particularly serious in rural areas, where antidepressants, anticonvulsants and antipsychotic drugs are rarely available.

China, as every other country, is facing a growing burden of mental disorders. According to our estimates, mental disorders make up 14.3% of China’s burden of disease. By 2020, it is projected that there will be six mental disorders among the leading 20 diseases, amounting to 17.4% of the total burden.

Beyond the percentages, average estimates by field workers indicate that – like in many other countries - only a small fraction of those affected by mental disorders in China are receiving appropriate treatment. With population growth and the proportional increase of those affected by mental disorders, the proportion of persons receiving appropriate mental health care is bound to decrease unless effective action is taken.

I know that suicide is of great concern in China. 20% of all suicides committed in the world take place in China, meaning that nearly 200,000 lives are lost this way every year. Of course, these figures reflect the size of the Chinese population. But it is not just the figures which should catch our attention. China is the only country in the world where women are taking their own lives at a higher rate than men, particularly in rural areas. In urban areas, the rates of suicide are roughly the same. In the rest of the world, suicide in men rates 3 times greater than females, on average. This situation should be tackled as a matter of priority.

In a few months, WHO and the Chinese Ministry of Health will be jointly organizing a national workshop on suicide prevention. National and international experts will strive to identify specific determinants explaining the suicide rate in China, and to establish a strategy for its reduction, with a particular focus on women. Depression is one of the major factors behind suicide. It rates as one of the three leading contributors to the burden of disease. As such, it deserves special attention.

But depression and suicide are not the only mental health problems facing us.

Schizophrenia is a serious problem, and there is a lack of adequate treatment. A demonstration project in China has shown that simple family interventions in combination with psychotropic drugs can substantially reduce the cost of treatment of persons with schizophrenia; psycho-social rehabilitation programmes can help persons with severe mental disorders - such as schizophrenia - to become productive members of society.

Epilepsy is a neurological disease that affects approximately 6 million people in China and which can be effectively treated with phenobarbitone, a safe and inexpensive drug. However, a dramatic gap exists between the estimated number of cases and the ones actually receiving treatment. For developing countries, WHO estimates that 60% to 90% of people with epilepsy receive no treatment.

Mental retardation is perhaps the most frequent form of mental disorder in China – as it is in other developing countries. Experience has demonstrated that simply adding iodine to salt, at an extremely low cost, reduces the number of children born with mental deficiencies. Improved maternal care and delivery procedures would also help reduce the magnitude of these disorders.

Dementia can be expected to increase in China in the years to come, as a simple consequence of demography and increase in life expectancy due to better physical health. There are inexpensive and culture-sensitive interventions which can help families and communities to better deal with their members affected by dementia.

Mr Chairman,

So far I have highlighted available knowledge, of which, I must add, so many – even within the health professions – are not fully aware. There can be no doubt: Mental health has to be given increased attention by health authorities, politicians, policy-makers and decision-makers.

Nevertheless, we are in need of more relevant epidemiological information to assist us in defining focused policies and planning appropriate interventions. In this respect, WHO is now in the final planning stages of Mental Health Survey 2000, a large WHO initiative which aims to obtain empirical data that will assist us to decide how we can best deal with the increasing burden of mental disorders in different parts of the world.

Mental Health Survey 2000 will assess mental disorders in comparison with physical disorders in 19 countries worldwide, including China (Beijing, Guangzhou, and Shanghai provinces). Relying on modern epidemiological tools, WHO will gather real life data on both mental and physical disorders and disability, work loss, risk factors, service utilization and medications. This data is essential for WHO to monitor world health and develop evidence-based information for policy. This major and complex international initiative will better equip us for future actions.

Under the principle of equity, our first objective should be to strengthen the overall mental health care system, by generating policies and improving the provision of services and treatment. It is also necessary to strengthen the technical capacity of mental health care providers to utilize state-of-the-art data on mental health interventions.

This is work where governments need to take leadership and responsibility, but supporting mental health promotion and services is a task which cannot be limited to the public sector alone. Both local communities, non-governmental organizations and the private sector have an important role to play. We already see a number of excellent examples of this in different parts of the world. The 1995 "Barcelona Manifesto" of the EU Federation of Family Associations of Mentally Ill People, which outlines the needs and perceived rights of the family of the mental patient is but one example of such action.

The private sector, including the health industry, can also play vital roles. As an example, let me mention Eli Lilly and its considerable financial support to WHO’s own efforts to raise awareness and assist countries in their work on mental health. What we are seeking from the private sector is not altruism, but actions of "enlightened self interest". A mentally healthy society in the end also is a more productive society. And the private sector has a role to play which goes far beyond financial contributions. We need its active collaboration to make sure that the work place, and the communities the companies are situated in, reduce stigma and support mental health promotion and early interventions.

Let me underline that many effective interventions are available to treat mental disorders. However, there is a wide gap between their mere availability and their actual implementation in practice. Several barriers to implementation urgently need to be overcome.

• The first is the low priority given to mental health in most public health agendas. This has obvious consequences on budget and policy planning.
• The second relates to stigma and discrimination towards persons with mental disorders. They have several consequences: they limit the degree to which patients attend treatment; they limit the degree to which health workers are being trained adequately to identify, assess and treat disorders; they may even limit the willingness of mental health care providers to intervene.
• The third is the traditional centralization of mental health services, resulting in large, ineffective and often harmful psychiatric institutions providing the main source of treatment. This leaves scarce resources for more effective community-based mental health services.
• As important is the poor or limited application of state-of-the-art and cost-effective mental health treatment, prevention and promotion strategies. The causes are many. There is lack of awareness, education and adequate skills of health workers and policy makers; often poor organization and financing of services; absence or poor implementation of quality assurance standards and monitoring; and limited availability of essential psychotropic drugs.

In short, improving knowledge and overcoming barriers to implementation are the two major challenges we face.

To this end, WHO is now shaping a new, global and more effective strategy to respond to these challenges. It aims to build a bridge over the barriers I just described by using the effective interventions we already know.

• First, develop guidelines for mental care. The service system should incorporate the use of primary health care, day-care centres, supported living facilities, inpatient hospitalization for acute symptomatic stabilization, self-help and professional support of families, crisis support, vocational training, and other social support services.
• Second, community support should be maximized through public education and action to reduce stigma and discrimination against people with mental illness.
• Third, the evidence-base for generalizing cost-effective models of mental health promotion and prevention/treatment for neuropsychiatric disorders needs to be developed and disseminated, including the evidence base for including lay persons and families in the detection and management of mental disorders.
• Fourth, the capacity of the health workers to effectively use the evidence-base for cost-effective intervention must be enhanced;
• And last, but not least, essential drugs for the treatment of priority mental disorders must be available in a sustainable manner. To this end, WHO’s Action Programme on Essential Drugs is currently undertaking initiatives which address supply strategies and health reform, generic substitution, price information, effective regulation and quality assurance of drug insurance.

To make sure all these interventions succeed, we need a conducive policy environment.

We will integrate mental health into the health sector and in the context of health sector reform, with clear recommendations for national and local level mental health organization and management.

Several dimensions are critical. They include decentralization, financing, primary care, private/public sector mix, procurement and regulation of psychotropic drugs and human resources, linkages to sectors outside health – such as housing, pensions, employment, education – as well as strategies to address the diverse barriers to implementation at all levels of the health system.

We will also contribute to communities’ social cohesion, through institutions such as schools, workplaces and community support networks. This is an important mental health promotion strategy and policy direction. Social cohesion is a protective factor for mental illness and leads to better patient outcomes and to enhanced economic growth.

Legislation is needed so that adequate standards can be promoted. Mental health legislation is distinct from other health legislation. Legislation is required to protect the rights of persons made vulnerable because their ability to care for themselves and defend their rights may be diminished due to a mental disorder. Legislation is also needed to assist families, to support the work of mental health care providers and to protect society in case of violent episodes.

To achieve these changes to the policy environment, we will raise the profile of mental health on the political, health and development agenda of governments and international and national organizations, with the potential to positively impact on mental health. It also means to fight human rights violations, stigma and discrimination, all of which are detrimental to access to care, quality of care, recovery from illness, and equal participation in society.

WHO will intensify its advocacy efforts to place mental health on the international political agenda and to improve the human rights of those suffering from mental illness. In the coming months, WHO will reach out to secure the commitment and involvement of other key international organizations (such as the World Bank, UNDP, ILO, UNHCR), professional organizations, international NGOs and the private sector in this effort.

December 2001 will mark the 10th anniversary of existence of the Principle for the protection of persons with mental illness and for the improvement of mental health care, adopted by the UN General Assembly in December 1991. WHO will mark this year by dedicating the 2001 World Health Report to mental health. This occasion should also be seized as a starting point to launch concerted measures to foster the implementation of these principles.

I am pleased to announce today that WHO will support the development and launching of global campaigns targeting depression and suicide prevention, schizophrenia and epilepsy. These important campaigns should involve key international and national NGOs, professional organizations, academic institutions and civil society. They should attract attention and provide information on the burden of these mental disorders to give them their proper place in the national and the international health agenda.

Mr Chairman,

The scope of the problem and the nature of the strategy we are proposing do not forecast an easy task ahead of us. But it is ‘doable’. It requires our determination, our efforts, our strength and our creativeness. May I invite you, technicians, politicians and representatives of society, together to make a difference and improve the mental health of the world.