I am happy once again to be here in Japan, this time in the beautiful city of Shimano-Seki. Over the past half-century Japan, as well as many other parts of the world, has made some great achievements. People live longer. They live better. They have more choices than before, both in their private lives and in the societies they are part of. There is great reason to celebrate these achievements.

Yet, there is still a long way to go before we can say that the successes of the past fifty years are shared by everyone all over the world. And there is still a long way to go before we can say that men and women have shared those successes equally.

To change this, we need the resourcefulness of a society that knows how to rise from destruction to prosperity, we need the power of science properly linked to the economy, and we need the ability to pursue a just cause until it succeeds. Japan has an important international role to play: as an example and as a partner.

The UN international conferences, the last one in Beijing four years ago, have highlighted the key role of women in ensuring sustainable development. No doubt much of the impetus for this came from the international women’s movement which may be the largest social movement in human history.

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

First, poverty: 70% of the 1.3 billion people living in poverty are women;

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

What about malnutrition? Women are twice as affected by iron deficiency anaemia as men;

The tragedy of maternal mortality: women continue to die in childbirth, an unacceptable situation given our advances in technology. Today, there are more than half a million pregnancy-related deaths every year. One key reason is this: the majority of poor women in developing countries do not have access to a skilled health care provider during labour and delivery ;

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

Not to forget 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;

In the key area of political power, how is the situation? Only 10% of seats in the world’s parliaments and 6% in national cabinets are held by women. No wonder the news hit around the world, and not least here in Japan, when in 1986 a women’s government took office in far-away Norway, a rich elderly gentleman, struck by this symbolic and, in his view, fundamental change in history, announced that he would raise a monument to the event! A monument that can be seen today in a little town here in Japan.

Let me expand further on gender equality, using health as a first example.

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.

Of course, 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 within the reality of their lives. This is why I am committed to incorporating a gender perspective in health across WHO’s work.

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

If we do not design health programmes and policies with a gender perspective, we may reach only half the population.

It may seem unbelievable that in some parts of the world, mothers give preference to ensuring that their male infants are immunized, yet this is so.

It may seem equally surprising that women in many cultures feed the men and boys in the family first, and will give the bigger and better portions to males. This practice may have arisen when men traditionally were involved in heavy labour, but it stays on, and we need to address it and take it seriously.

We all need to think carefully about our own societies and how our own ways of living may harm the health of girls and women. Depression for example affects women twice as often as men. Some of this may be due to biological factors. But women’s lack of control over their lives can be an important factor.

What about education? Access to education for girls, as well as the type of education they receive, is also often affected by gender norms. Despite undeniable proof that educating women is one of the most important health and development investments a country can make, girls are still prevented from completing even primary education in many countries.

Further up the scale of economic development, gender biases affect women’s choice of studies, and there is still a tendency in many countries to encourage boys towards careers in sciences and mathematics, and girls towards careers in the sectors associated with caring, such as teaching and nursing. This limits choice and limits the expression of resources, both in men and women. But first if all, it is to the disadvantage of girls and women in our societies.

Fortunately, we have seen a marked increase in the number of women who become doctors in many countries around the globe. This is important not only because many women prefer dealing with a woman doctor – and in some countries are required to only see woman doctors. It is also significant because women doctors can bring a better understanding of women’s problems and special needs into the hospitals and health ministries. This can over time influence decision-making in a way that favour women and children.

In Japan, where women are highly educated, equal opportunity for entrance into careers of choice, on the same footing as men, still remains elusive. We have a long way to go, in most countries.

There are several other ways to counter gender bias. At WHO, I have decided to require that 60% of all new appointments should be women. Already, five of the ten Executive Directors of the Organization are women. Affirmative action like this can be a necessary agent to initiate change. This is what we did in Norway in the early 80s.

Despite the problems, in Japan, women’s lives have changed dramatically as a result of low mortality and low fertility. Consider the following which give women greater freedoms for playing new roles in society:

1. In 1920, a Japanese woman had her first child, on average, at 23, spent just over 12 years pregnant and giving birth and 27 years raising children. By 1992, her first child was born when she was 28, she spent slightly less than 3 years pregnant and giving birth and 22 years raising her children.
2. Her period of retirement from remunerated work has increased almost threefold, from 6 years in 1920 to 17 years in 1992. And her years as a widow have doubled since 1920, from 4 to 8.4 years.

We also should be aware today of the threats that women can experience in their new roles. Nowhere is this as evident as in the threat that tobacco poses to Japanese women, indeed, to Asian women in general. Smoking has become a misplaced symbol of women’s liberation and freedom. The rates of smoking among Asian women are increasing dramatically, in large part due to the fact that transnational tobacco companies have identified women and girls as a potentially lucrative target for their market strategies. The proliferation of seductive tobacco advertising worldwide, and the use of themes related to body image, fashion and independence, are in fact luring many girls and women to become addicted to tobacco.

WHO, together with governments, NGOs such as Japan’s Women’s Action on Smoking, and media groups, are working to raise women’s awareness about the deadly effects of tobacco on women and their children. Tomorrow I will be speaking in Kobe on this very topic.

What are the messages that we can draw from all of these examples across all societies?

We need to recognize that women need to be involved in the events and processes that shape their lives. A world where men and women were to share more equally in political and economic decision-making might be a world where health and social welfare were given greater weight and where education for all was paramount.

We must learn from, and draw upon, the myriad of initiatives that women are undertaking worldwide to overcome economic hardship, and gain recognition of their rights to insist on making public a discussion of universal values and dreams that ultimately influence our societies.

We need to go away from this symposium with the idea that these things do not happen by chance. It takes committed people and far-sighted leaders to push at the closed doors and to ask why things should not change. There is ample evidence now to show that all of our lives and futures will be better if men and women have the opportunity to play an equal part in society.