Dr. Gro Harlem Brundtland
Director-General
World Health Organization |
Cuernavaca, Mexico
7 June 2000 |
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National Institute of Public Health |
Honourable Minister of Health,
Director-General of the National Institute of Public Health
Dr Soberon,
Faculty,
Students,
Ladies and Gentlemen,
I wish to extend my gratitude to the prestigious National Institute of Public Health for bestowing on me the degree of Doctor Honoris Causa. I feel honoured by your generosity.
Let me also extend to Dr Guillermo Soberon my appreciation for his generous words.
It is a great distinction for me to receive this honorary doctorate from such a highly respected institution. I see this honour as an acknowledgement of the efforts of all the dedicated people I have been fortunate enough to work with.
My very early choices in life were those of public service and to have an international outlook. My studies and early work were in the field of public health. Over the past 35 years, I have had the opportunity to participate in many aspects of public life, both at a national and international level. Yet, when looking back on these years today, a thread runs through all that I have said and done. It is the conviction that solid, evidence-based knowledge, combined with a clear set of values of participation, equity and fairness, is what will bring progress and human development.
Today, however, I do not wish to look back. From the rostrum of a distinguished institution of higher learning the view is to the future for global health
The health revolution of the 20th century was made possible by scientific advances and increased knowledge. Improved health for large parts of the world population counts as one of the most profound social changes in the history of humanity. One set of figures tells it all: Global average life expectancy is about 66 years today. It was 46 at the end of World War II.
We know that new and daunting advances will continue to challenge our imagination and provide new opportunities. And what is driving all of this is our ability to generate and process knowledge - to search for new knowledge and make the existing knowledge available to all.
The researcher has to strike a difficult balance. She needs to build on evidence. But she also needs to take risks. She needs to strive for her vision - to reach one step further than anyone has done before.
In health we have seen it so many times. Decades ago a vaccine against poliomyelitis was just a dream. Many people feared that the spread of polio would take on epidemic proportions. The debate was raging between those who fought for a vaccine against polio - a distant dream - and those who wanted better iron lungs and rocking beds to help alleviate the suffering of the polio victims.
Now, we are about to relegate polio to the history books. As we do so, let us not forget how difficult the decision was to keep investing in a dream - a vaccine - that no one could know would become a reality. Let us keep dreams alive.
All our knowledge is about the past, but all our challenges are about the future. This is what stimulates scientists and researchers to make the extra effort - and we need to move in the same spirit to develop new medicines and vaccines against mass killers such as malaria, tuberculosis and HIV/AIDS.
Developing country research has much to contribute to the advancement of medicine, public health and the social sciences. Despite the international nature of the scientific method and culture, research in developing countries is best performed by developing country researchers themselves. They are in the best position to understand the local disease problems, health priorities and limitations in research infrastructure so as to be able to develop the most effective and creative approaches to the research problems on hand.
Our understanding of the human and humane aspects of research involving human subjects has also been greatly improved through promoting health research in developing countries.
There is also another dimension which links research to development. A rethink of the objectives of international development aid has focused on the importance of capacity building in research in developing countries as a more effective, long-term and sustainable way to promote self-sufficiency.
Good research in developing countries may ultimately be one of the best products of international cooperation that will ultimately contribute to the advancement of global public health. The creation of centres of excellence - like this one will make unique contributions to new knowledge and add considerable value to the global body of scientific evidence.
Research in developing countries is one of the best ways of helping countries help themselves through development of a critical mass of researchers. This will stimulate the development of a strong scientific culture and, ultimately, make significant contributions to the advancement of public health on a global scale.
Developing a critical mass of researchers requires a body of competent teachers. Producing researchers in developing countries by undertaking graduate teaching programs, gives autonomy to the research process as developing countries no longer have to rely on foreign universities to train their researchers. Graduate teaching in developing countries increases the equity and fairness of knowledge generation by making higher education accessible to wider segments of the population and by reducing the likelihood of brain drain.
The World Health Organization champions the health of the poor. In doing so research is at the core of its work and mission, especially health research performed in the developing countries.
We have been closely involved in the promotion and coordination of a variety of research activities, including the crucial activity of research capacity building. Through the Tropical Diseases and Human Reproduction special research programmes, for example, WHO has worked closely with other agencies - such as UNDP, and the World Bank - and with Member States, to fund research projects and train numerous scientists in developing countries.
The recent creation of a Department of Research Policy and Cooperation in the Evidence and Information for Policy cluster, underscores the strong emphasis we place on the role of research. The
International Conference on Health Research for Development to be held in Thailand in October is expected to be a landmark event which will help to define health research for the development agenda of the next decades.
It is a special pleasure to talk about developing country research here at the National Institute of Public Health. It is a glowing example of how a developing nation with foresight and dedication can build a world-class research and teaching institution.
The history of the creation of the National Institute of Public Health of Mexico illustrates many of the lessons that I have highlighted. The history is long and visionary. The recognition of the need for graduate teaching in public health in Mexico led, in the 1920s, to the foundation of the School of Public Health - one of the first five institutions of this kind in the world. In the 1940s, the establishment of the first National Institutes of Health created a vigorous space for research and specialized training.
In 1987, the establishment of a new National Institute of Public Health on the foundations of the original School of Public Health opened the way for a renewal of public health in Mexico - and indeed in Latin America - through the integration of research, higher education and service. This Institute was built on the premise that it is possible to combine academic excellence with effective decision making.
The fact that the work was consolidated during the exceptionally hard years of the 1980s, when Mexico went through two severe economic crises and suffered a damaging earthquake, makes this feat all the more impressive. It also illustrates how adversity can produce opportunities for sowing the long-run seeds of development. It makes me think of the words of
Jawaharlal Nehru, India's first Prime Minister and a true visionary. He stated:
"I see no way out of our vicious cycle of poverty except through the means that science and technology has placed at our disposal". Nehru also said that "... because we are poor, we cannot afford not to do research ..."
Yet, the fact remains that although developing countries carry 90% of the disease burden, their total health expenditure makes only up ten per cent of the world's total. There continues to be a serious brain-drain from developing country universities to campuses and corporate research centres in the richest countries. And research into the main diseases of the poor continue to receive far less attention and resources than even the most luxurious of the medical problems of the rich.
This has to change. This has been said over and over again during the past decades. But I am optimistic that the economic environment of our time can be turned in our favour. We need to strike a new balance between national and international regulation, on the one hand, and economic incentives, on the other. We need to clearly state our public health values, our priorities and our needs. And we need to broaden the mobilization of resources and innovation.
We cannot predict the breakthroughs. But we can prepare our ability to handle them as they come. To an increasing extent, the scientific advances will challenge our ability to make innovation available to all and to take ethical and well-informed decisions in new areas of science such as genetics and biotechnology.
The role of health in spurring development and alleviating poverty is one such idea - gaining in strength and increasingly catching the interest of key decision-makers.
Looking at the world, we can afford no illusions: So far the war on poverty has largely failed. Differences are spreading inside countries and between countries. This degrades us and threatens us. It looms as a threat to the environment - not only that of the poor - but of all of us.
Yes - the 20th century brought about a health revolution. But a thousand million fellow human beings did not reap the benefits of those advances. People who are poor experience neglect of fundamental human rights. Health is key among them.
But health is at the same time part of the solution - a new and potentially powerful exit route out of poverty. The world has committed to halving the number of people living in poverty by 2015. The major development conferences of the 1990s have defined a set of concrete targets to reach that goal, and many of them focus on health - on child and maternal health and access to primary and reproductive health care.
We must now strengthen our focus on how health actions, including those that affect the broad determinants of health, can help reduce poverty. WHO is committed to make this the focus of our efforts in the years to come.
We may be standing at the threshold of a major shift in thinking. Until recently, many development professionals argued that the health sector itself is only a minor player in efforts to improve the overall health of populations. And the overwhelming majority of finance officials and economists have believed that health is relatively unimportant as a development goal or as an instrument for reducing poverty. Health was seen as a consumption rather than an investment cost.
But this is changing. Health may be far more central to poverty reduction than our macroeconomist colleagues have previously thought.
Poverty breeds ill-health - that we know. But we now know much more about how ill-health also breeds poverty, triggers a vicious cycle, hampers economic and social development, and contributes to unsustainable resource depletion and environmental degradation. The persistent problem of malnutrition and the unfolding AIDS crisis in Africa tell this story in its most stark form.
So this is our message to decision makers: Investing in health to reduce poverty could provide the kind of sharp focus we need to mobilize the resources and the attention of the international community.
WHO is working with a growing number of partners to take forward our efforts, be it in our struggle against diseases such as malaria, tuberculosis or HIV/AIDS - be it in our efforts to help countries strengthen their health systems and build their own capacity - be it in driving forward the debt relief process which might free up additional resources for health and education, or be it in addressing the key ethical issues of today and tomorrow.
Through research, scholarly reflection and advanced training, academic institutions like this one have been a major source of creativity to generate the knowledge and the solutions required for a better future. Through analysis and advocacy, institutions like WHO have been and will continue to be your partners in transforming those dreams into action.
Developing country research has much to contribute to the advancement of medicine, public health and the social sciences
It can provide important scientific insights into disease mechanisms, risk factors and the workings of health systems. It can make an even larger impact by ultimately contributing to economic development through research capacity building and the building up of human capital. Most importantly, it can contribute to enhanced international goodwill, understanding and cooperation.
Mexico's National Institute of Public is a shining example of such achievements. Let me again thank you for bestowing on me such an honour. And let me wish you all the best as this dynamic country continues to invest in research and higher education to prepare itself for the twenty-first century.
Thank you.
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