As we meet today, world attention has been on Mozambique for the last days as years of progress in that country is being swamped by ravaging rain and floods.

WHO is doing what it can to assist Mozambique in coping with the severe health challenges that follows floods and destruction of human infrastructure.

As I address you today, I wish to take Mozambique as a point of departure. About ten months ago, I visited a public health centre just outside Maputo. What I saw was impressive and uplifting. With very limited resources, a dedicated staff was successfully reducing the crippling effect of malaria on the local community by impregnating bed nets and distributing them to families in their district.

The centre, although coping with limited resources, illustrated why Mozambique after the years of war has been steadily heading towards a brighter future for its people. Step by step Mozambique was investing in health, seeing health as more than an expenditure – but rather fully understanding that health is an investment in progress.

In this perspective, the devastating effects of the flooding becomes all the more tragic and we need firmly to focus on the urgency of re-establishing primary health care facilities. Countries in Africa, the Caribbean and Pacific are all too familiar with natural disasters. These disasters must inspire rather than curb our efforts to promote sustainable, equitable development.

I am very pleased to have the opportunity today to address this important group of countries. The members of the ACP make up a substantial part of WHO’s Member States, and between you, you harbour some of the world’s gravest health challenges. My mission today ahs been to take forward an expanding collaboration between the EU and WHO. There are many ways in which these two organizations can complement and reinforce each other – in what we do in Europe – but also beyond this continent.

It is good to be here so soon after the conclusion agreement on the successor to the Lome IV Convention. The fact that this agreement has been reached allows both you and the European Union members to plan ahead and map the strategies needed to achieve lasting progress and a reduction in the number of people living in extreme poverty.

Excellencies,

When I took office some 20 months ago, my starting point was a broad reading of the role of health in development. WHO is the specialised agency in health. The purpose of our work is not merely to combat ill-health but also to promote healthy populations and communities – and indeed to demonstrate how wise health interventions can spur development.

I am here to suggest to you that we make the same conceptual shift that we did with the environment 25 years ago – that we stop regarding health as a sector issue, and integrate it into the broader context of development. That we stop regarding investments in health simply as a mere consumption expenditure – but rather as a major opportunity for growth, human progress and poverty alleviation.

There was a period in development thinking - not so long ago - when spending on so-called "softer" public services, such as health and education, would have to wait until countries had developed a certain level of physical infrastructure and achieved a certain level of economic strength. Once countries had become fully industrialised - the theory went - large outlays on health care seemed appropriate and necessary and were not much questioned. Indeed, it was seen as a sign of national prosperity and success.

Experience and research over the past few years have shown that such thinking was at best simplified, and at worst plain wrong.

We have seen that developing countries which invest relatively more on health in an effective manner are likely to achieve higher economic growth. In East Asia, for example, life expectancy increased by over 18 years in the two decades that preceded the most dramatic economic take-off in history. A recent analysis for the Asian Development Bank concluded that fully a third of the substantial Asian economic growth over the past two decades resulted from these gains.

What it all boils down to is this: Health is not only an important concern for individuals, it plays a central role in achieving sustainable economic growth and an effective use of resources.

There is a growing and solid body of evidence which shows that investing in health reduces poverty. Academic economists are now finding that health may be far more central to poverty reduction than macroeconomists have previously thought.

It is our role to define and present such key interventions. WHO has embarked on this work, and we are reaching out to partners such as the ACP to take it forward.

We are gathering the evidence, we are analysing it and we are preparing to start forwarding policy recommendations to Member States, the financial institutions and development agencies.

More precisely, we are studying the cost-effectiveness of health interventions that are likely to make the largest difference for the poor. We are also looking into how packaging of core interventions can facilitate the implementation of pro-poor policies. We will have an extensive dialogue with our Member States on these findings in the months ahead.

Earlier this year, we launched a Commission on Macroeconomics and Health. It is chaired by Professor Jeffrey Sachs, and it has gathered a number of distinguished economic and health experts from academia, sister UN agencies, the Bretton Woods institutions and developing countries, among them former Indian Finance Minister Manmohan Singh, Thai Vice Premier Supachai Panitchpakdi and Zephirin Diabré, the Burkina Faso national who is the Associate Administrator of UNDP.

Over a period of two years, it will generate an unprecedented collection of work on the relation between health and economic growth. It will provide concrete findings to crucial issues such as what kinds of health sector reform are the most cost-effective, what are the most equitable ways to finance health systems, and how do we overcome market obstacles to development and access to drugs and vaccines.

All this amounts to providing the evidence for policy decisions – just as we did for the environment and education in the past. Disease has a cost – and health holds a real opportunity.

We cannot mention the cost of ill health without talking about HIV/AIDS.

HIV/AIDS is now the leading cause of death in sub-Saharan Africa, but in other parts of the world the threat is also devastating. It calls for unprecedented responses from all stakeholders. It has never been higher on the international agenda: as a development issue but also as a crisis at the top of the world’s security attention as reflected by the unique discussion in the UN Security Council. We must capitalise on the momentum provided by this renewed international attention.

And let us not despair: despite the gravity of the situation, we are not powerless. We must learn lessons from those countries where infection rates are falling such as in Uganda and Thailand – countries that have shown how strong political leadership, an openness to confront sensitive issues, and a multi-sectoral response which links efforts across government and civil society, can start to turn the tide.

As a founding cosponsor of UNAIDS, WHO has an unshakeable commitment to the global response to HIV/AIDS. At the heart of our commitment is the objective of ensuring that the health sector – particularly in the worst affected countries – is technically and institutionally equipped to play an effective role in a society-wide response to the epidemic.

Work on HIV/AIDS cuts across many parts of WHO. Today I want to touch on three areas which merit particular attention, areas which are all key to an effective health sector strategy.

Firstly, care for the more than 30 million people currently living with HIV/AIDS. We cannot accept the argument that because most of these 30 million will die in the next 10 years that somehow their needs should be neglected. We cannot watch while fragile health systems break down under the strain of massive additional demands. We need to recognise the critical synergy that exists between care and prevention in the overall response to the epidemic.

We know what people living with AIDS and health care providers need: clinical management, nursing care, counselling, social and psychological support. The challenge is to help national authorities make these plans a reality. We will intensify our efforts in this area, and in Africa we will do so as part of the International Partnership against AIDS.

Secondly, mother to child transmission, which accounts for 90% of HIV infection in children, is a problem for which effective interventions exist. Research has demonstrated the effectiveness of different drug regimes, in combination with changes in feeding practices and, when favourable conditions prevail, elective caesarean section.

Pilot projects which link these interventions with primary prevention and access to information are underway in several countries, with support from WHO, other UN agencies and other partners.

The third area is drugs. Treatment in developed countries has led to a dramatic fall in deaths due to AIDS. But in Africa and the Caribbean, many people have no access to palliative medicines, let alone anti-retroviral therapies or drugs for treating opportunistic infections. Squarely put: the drugs are in the North and the disease is in the South. This kind of inequity cannot continue.

Access to drugs is a critical component of a health sector strategy. Governments face difficult choices: they cannot invest in a few costly drugs and ignore all the other aspects of care. It is our role to help make those choices less difficult.

WHO is working, with UNAIDS and other partners, to make HIV drugs more affordable. I wish to invite the pharmaceutical industry to join us in taking a fresh and constructive look at how we can considerably increase access to relevant drugs. There should be progress so that we can report on our findings to the upcoming AIDS conference in Durban in July.

Let me turn to malaria. More than 2000 people die from it every day. Each year there are more than 300 million cases.

AIDS and malaria are ravaging economies and social structures, especially in Africa. The direct and indirect cost of malaria in Africa exceeds 2 billion dollars every year. When we add in hard-to-measure costs associated with malaria’s impact on trade and foreign investment, the 2 billion dollars in losses per year is likely to be far too low an estimate.

We believe that malaria may be controlled in Africa for a fraction of this amount. WHO - together with its partners, the World Bank, UNICEF and UNDP - have launched Roll Back Malaria, an initiative that aims at halving the burden of malaria worldwide within ten years. We can achieve this by using solutions currently available – by providing insecticide impregnated bed-nets to every woman and child – by making existing drugs available to families and communities and by enabling communities and the health sector to respond.

I met President Obasanjo of Nigeria just after he was elected. He was extremely concerned about the advances of malaria and took an important initiative by arranging an African summit meeting on malaria in Abuja in late April. I have today called on President Prodi, and asked him to ensure that the EU be represented at a high level at this Summit.

It has been crucial for me that African nations take ownership of the Roll Back Malaria campaign. This is now happening. What we see emerging is a social movement to control malaria, and President Obasanjos initiative is a heartening sign that this is happening. I urge those of you who represent African nations to argue the importance of your own head of state’s participation in the April Malaria summit as a proof that your country shows its commitment to reduce the crippling effects of this disease.

Let me let me mention another example: tobacco. We know it is bad for health. A detailed study by the World Bank now explains how it is also bad for the economy. Three million people will have died from tobacco-related diseases this year. By around 2020, tobacco-related diseases are likely to kill 9 million people a year and tobacco will climb the ladder to be the leading cause of disease and premature death worldwide - bypassing communicable diseases such as AIDS, malaria and tuberculosis.

These are the dry but dramatic facts. Some say: But this is an issue for the North – for the industrialized countries. Poor countries have other and more pressing worries.

I say that perspective is wrong. Yes, there are pressing issues, but the tobacco epidemic is spreading, and it is first of all coming in the developing world - countries in which the health systems are already overburdened. One out of three Chinese men under 30 will eventually die from tobacco-related disease – not in old age but in middle age, after having caused considerable expense for their health services.

We have the evidence. We know what works and we need to let developing countries know all the facts in time. Tightening legislation against advertising, increasing tobacco taxes and controlling the marketing of cigarettes will make a difference for the health of future generations worldwide. Enhanced efforts to help smokers quit can work and can make a difference for the current generation.

Some voice concern for the tobacco growers. What we are talking about is a long term transition. Unfortunately we cannot reverse the tobacco consumption trends over night. So there will be ample time to adjust.

WHO is now leading in the elaboration of the first international public health convention ever. The Framework Convention on Tobacco Control is much inspired in its methodology by the environmental conventions that came out of Rio. I hope that the ACP members will devote interest to this critical issue of both a public health and an economic nature.

We have cost-effective health interventions to reduce dramatically the excess burden of disease among the poor. Remember smallpox eradication. It saved us from tremendous suffering, and it also saved the world more than 2 billion dollars in immunization costs. Witness the great reductions in mortality from the spread of other immunizations. We are likely to eradicate polio by the end of the year, eventually freeing the world from $1.5 billion in annual traditional vaccination costs, and giving substantially higher savings in treatment and loss of productivity.

Whether we succeed in keeping our own deadlines will to a large extent depend upon the efforts of a few countries in Africa and we trust that these countries governments – as well as the insurgency groups that contest some of these governments, see both their responsibilities and the opportunities for eradicating polio in their country.

I am arguing that investments in health can have lasting positive effects on economy and social development. This is a matter of priority setting and strategy building by governments, but it is clear that without an increase in the funds spent on health, we will not see results that will really make a difference.

There are signs that donor countries are waking up to these facts. The share of development assistance going to health is going up. But, as you know from OECD’s Development Assistance Committee – the general commitment to invest in development has been fading over the years, declining to a disappointing average of around 0.2 % of GDP.

This has happened during a decade where both the World Bank and the International Monetary Fund have warned that trade and private-sector investment alone are not sufficient to ensure economic growth or poverty reduction in low-income countries. Reductions in poverty will not happen by themselves or even as a consequence of economic growth.

The recent successor agreement to Lome is a step in the right direction. But we need firm and lasting commitment from the rich countries to improve health and reduce poverty. Moral imperatives must be part of the argument, but we must also appeal to the concept of enlightened self interest in order to persuade these countries that investing in global health benefits rich and poor nations alike.

Increasingly in a global economy, one region’s poverty is another region’s opportunity loss, and more than that: With globalization, all of humankind today paddles in a single microbial sea. There are no health sanctuaries.

This is an accelerating trend, and is not likely to be reversed. Health is transportable – as is ill-health. At the same time health may be the single most important bridge to tie together – whether we like it or not – the destinies of the fortunate and the unfortunate.

Many have realized this, and the private sector is waking up to a new reality. Bill Gates has committed $750 million to financially back the new Global Alliance for Vaccines and Immunization, which is another result of the World Bank, UNICEF and WHO working together in partnership. The Medicines for Malaria Venture, a venture capital fund which will finance the development of new malaria drugs, provides another example. WHO, the pharmaceutical industry, bilateral and private donors have come together to overcome the lack of market incentives to developing and bringing drugs to populations who cannot afford to pay high prices.

I mention these examples to highlight that interventions do exist – that they are not costly – and that they work. Comparisons of costs can sometimes send a message. The world is spending less on AIDS in Africa than a fraction of what it costs to run a University hospital in Europe. Or consider the billions and billions of dollars spent to stop a millennium bug, when a small percentage of these sums could successfully conquer those bugs that routinely kill millions – generation after generation.

Excellencies,

Health makes up a large share of the world economy. This year, 2,500 billion dollars will be spent on health throughout the world – that represents almost 10 percent of the global GDP. So how we invest in health is key – and what is certain is that the expenditure in most countries is far from optimal.

These are the questions that I most frequently get from Health Ministers, Finance Ministers and Prime Ministers around the world: How do we effectively finance our health system, how do we cost-effectively tailor the health system and what is the optimal private-public mixture? WHO, working with its partners, must gear up to assist Member States with realistic and evidence based answers to these questions.

For developing countries where the health system rarely reaches half of the population and where expenditure does not exceed 10 dollars per person – especially in these countries it will matter how the health system is organised and financed.

Around the world – between and within countries - health outcomes vary widely. Even among countries at similar levels of income, some health services are more cost effective and provide better services than others. Differences in the design, content and management of health systems determines how well they work. Understanding the consequences of this variation is essential for decision-makers at all levels if system performance and therefore also population health are to be improved.

First, improving population health is not merely a matter of spending more and more on health services. The United States is struggling with the paradox that it spends 15% of its GDP on health and still has 40 million people with no health coverage. Most Western European countries have achieved full coverage while spending an average of 8% of GDP on health.

A second point is related to the first: Universal coverage – financed publicly or by public mandate – not only meets the equity goal of health for all but provides an institutional environment that facilitates the efficient attainment of health and responsiveness. The challenge we share is to find ways to create such universal coverage finance systems in countries where tax revenues are meagre and the poor traditionally have had to rely on out-of pocket payments for health services small and large.

Third, I think we have learned that health for everyone implies that not everything can be provided. Our budgets constrain our choices and in deciding what the public sector should – and should not – finance, hard attention to cost-effectiveness is required.

Finally, we are learning that many models of provision of services, including a major role for the private sector, can be fully consistent with public sector finance. The competitive environment bringing efficiency to market economies can – with care – also help improve the responsiveness and efficiency of health systems.

WHO will be addressing a number of these issues in the upcoming World Health Report 2000, which is dedicated to the issue of health systems and the need to make them as cost-effective, as responsive to actual health needs of a nation’s population, and as equitable as possible.

Beginning in 2000, WHO will be reporting on the performance of national health systems in achieving these goals. The aim of such a league table is not to expose and embarrass countries about their health sector performance. We believe the data will be useful tools for any government in their analysis and planning of their health systems. It allows Member States to compare themselves with other states of similar economic resources and it breaks down performance in several categories that will enlighten the debate about cost-effectiveness, equity and performance.

Excellencies,

For the last decades the social sector in the ACP member countries has had to do more with less resources. Many of the countries, especially in Africa, have seen more money leaving to pay for goods and service debt than they have received in aid and for the sale of their products. The average African household consumes far less today than it did 25 years ago.

A story of remarkable achievement is all too often ignored against the reporting of daunting health challenges. Africa, as well as many Caribbean and Pacific countries, has built a remarkable surveillance system against disease. Your countries have paved the way in controlling complex diseases such as river blindness or Chaga’s disease. Pacific countries have achieved drastic improved indicators of public health over the past decades. Africa has given glowing examples of how regional cooperation and donor resilience can lead to drastically improved health conditions.

Before the AIDS epidemic so tragically began to erode the health gains made through decades of hard work, infant mortality had been significantly reduced in many countries. Against powerful odds, your countries have demonstrated that the tides of ill-health can be turned.

There is solid evidence to prove that investing wisely in health will help the world take a giant leap out of poverty. We can drastically reduce the global burden of disease. If we manage, hundreds of millions of people will be better able to fulfil their potential, enjoy their legitimate human rights and be driving forces in development. People would benefit. The economy would benefit. The environment would benefit. It is a complex process – but it can be done. It is in our hands. If we fail, future generations will judge us harshly. But if we succeed, the early part of the 21^st century can truly be described as a time of progress.