Mr Chairman, Dr Shalala,
Ministers,
Dr Alleyne,
Excellencies,
Ladies and Gentlemen,

This first meeting in the new millennium is held at a time when there are both great opportunities and great challenges in front of us.

I sense that this year is a turning point in our collective effort to improve the health of the world’s poorest people. There is evidence of real change in international, as well as national, perceptions about the absolute importance of good health. Decision-makers are now appreciating the economic dimensions of improved health.

I have always believed that real changes in society will not take place unless those who make decisions appreciate the economic dimensions of major issues. This is how thinking about the environment has shifted. It used to be a cause for convinced environmentalists, but many of them were only on the margins when key decisions were made. As the cost of environmental damage has become clear, environmental issues now commands the attention of all major players within national and international society.

The same is happening in the field of health. Some of us met at the World Health Assembly in Geneva in May. There were already several promising signs, then, that world leaders recognized a new and important linkage. They saw that good health is of central importance to people’s economic and social development; that improving poor people’s health is key to breaking the cycles of poverty.

Since then we have seen early signs of a world willing to take decisive action. In July, the 13^th International AIDS conference in Durban established new norms: that all people living with HIV/AIDS world-wide should have access to adequate care, and that everyone, everywhere should be in a position to prevent themselves from HIV infection.

Also in Durban, the European Commission announced renewed support for the fight against HIV/AIDS, malaria and tuberculosis. They followed this up with a policy framework which addresses improved access for poor people to essential health goods and services; works to reduce prices of vital medicines and commodities; and aims to create incentives for strategic research to develop new and more cost effective products for prevention, diagnosis and treatment.

Later that same month in Japan, I joined leaders of the G8 nations as they met with leaders of key G77 countries. Subsequently the G8 committed themselves to support real improvements in health outcomes among poor communities. They committed to targets set by international fora for reducing the toll from HIV, from malaria from TB and from diseases of childhood by 2010.

There is now a real prospect that increased support will be available for Member States and UN agencies’ effort to reduce the impact of diseases on poor people’s well-being. We have to establish means to improve outcomes and to speed up the flow of new resources. It will require a massive effort all around.

The announcements are the fruits of the hard work by thousands of health professionals, by those involved in local as well as national political processes and by many of you here today. Your efforts, whether in local or national programmes, in international events or in regional initiatives, have drawn attention to the needless suffering of millions of the world’s poorest people.

Mr Chairman,

While health problems have dominated the headlines, we are also on the brink of several important achievements.

Let me first mention polio. Although polio belongs to the history books in this region, the effort for global eradication continues. We are on track to achieve a global certification of polio eradication by 2005 as planned, although we will not be able to see the last polio case this year, as we had hoped.

Still, the closer we are to success, the harder we need to work. We must keep in mind that as long as there are still cases of polio in the world, we are all vulnerable. We can achieve full global eradication if we work together. This is the message I will deliver at the Polio Partnership Summit in New York on Wednesday, when we launch the strategy for the next five years.

HIV/AIDS is a global pandemic. The Region of the Americas provides a complex and highly varied epidemiological picture. From the tragic figures of the Caribbean to the relatively positive situation among the Andes nations, we see a mosaic of dominant modes of transmission. The quality and detail of the surveillance data also vary widely, making it important to increase the surveillance efforts. If we are to implement better preventive action, we need to better understand the infection patterns, who the risk groups are and why they continue to get infected.

Also in terms of their approach to prevention and care the countries of this region vary widely. There is a very broad variety of experiences to draw on, which is both encouraging and gives reasons for optimism. In particularly on the issue of access to drugs for those living with HIV/AIDS, several countries in this region have taken bold and far-reaching steps. As we strive to widen access to care for those living with HIV/AIDS world-wide, we need to draw on the experiences – the opportunities and limitations – of the approaches you have pioneered in this region.

On the issue of HIV/AIDS care, there is a promise of further progress. Following the World Health Assembly in May, WHO - together with UNAIDS, and other UN agencies - has pursued its mandate and progressed in a dialogue with the pharmaceutical industry. A contact group, due to hold its first meeting in just a few days, will bring together Member States, UN agencies and representatives of the industry and NGOs, in what we hope will result in substantial increases in the numbers of people throughout the world who can access effective care within the context of wider development of sustainable health systems.

The initiative is being harmonized with other global and regional partnerships against AIDS. Efforts are initially being taken forward in Africa, but they will move elsewhere soon afterwards, and swiftly lead to some real change.

Several other priority health problems are now being addressed by different entities working together in new and effective ways. In my speech to the World Health Assembly in May, I presented the Global Alliance for Vaccines and Immunization - GAVI - as a prime example of a new model for partnerships in international health. During the Assembly, delegates from the 74 eligible countries received guidelines for the submission of proposals to the Global Fund for Children’s Vaccines, and I encouraged a quick response so that support could start to flow to countries by the end of this year.

This urge for expediency was heeded ... and how! Twenty four countries submitted proposals to the GAVI Secretariat in the very tight timeframe required. Of those proposals, an independent review committee found that 13 countries were ready to receive vaccines and/or direct financial support, with disbursements starting already in September. The rest will be submitting additional information for the next round so that they too can receive support as soon as possible. And another 20 or so countries are expected to submit proposals during the next review in October.

The Global Fund supports programmes that are designed by countries. It contributes to the sustainability of national health systems, and to synergy between immunization services and other health system components.

Mr Chairman,

We have by now clearly tied the concept of better health to that of economic and social progress – both on an individual and national level. Investments in health are investments in a better future.

Nowhere is the link more direct than in the field of child health. I am extremely pleased that you are discussing the subject of child health in its broadest sense, and that the region is making a concerted effort to strengthen child health and development activities by both looking at existing policies and legislation in the light of children’s rights and strengthening a wide range of actions and activities for improved child health in a changing economic and social environment.

In this context, I am impressed by the enthusiasm and ambitions of the "Meta 2002" campaign, and the embrace of Integrated Management of Childhood Illness in 19 countries so far. Using IMCI as a strategy to reduce the toll of malaria on children and infants stands to me as a great example of the cross-fertilization we are aiming for in an effective assault on the diseases of poverty.

As you know, WHO is working intensely to strengthen our fight against the diseases of poverty. In doing so, we are improving the exchange of experience, collaboration and synergy.

Countries throughout this region are contributing to evolving partnerships that are stopping TB, making pregnancy safer and rolling back malaria. Partners are learning from each other’s experiences. The partnerships have several common features: countries are at the hub, and partners reflect shared goals, strategies and values. They try to respond to people’s needs in ways that reflect these people’s interests as well as the best available evidence. Resources are used and accounted for with care. The process of implementing partnerships in international health lead to building of more effective health systems. It enables national authorities to set the agenda, giving partners opportunities to deepen their engagement in health development and to reactivate their financial and technical contributions to countries’ health services.

Yet, as our ambitions rise, we need better mechanisms to take proven effective interventions to scale. This means recognizing that the focus of prevention and care is most often in the home – not just within health services. It means that a wider range of partners must be involved. Governments have a central role to play – setting the environment and providing leadership.

This immense challenge calls for a massive international effort. I am delighted that many countries in this region are already engaged. I am delighted that the G8 have embraced the need for such an effort and committed to the targets to achieve this. I am delighted that the European Commission will discuss it at a roundtable on Thursday this week and that there will be a partner meeting on modalities hosted by the G8 in early December. WHO, will help identify channels through which resources for health reach those who need them, that resources are used effectively, and accountability is ensured.

Mr Chairman,

Earlier this year, Member States encouraged WHO to scale up activities in the area of food safety, sensing that this issue will grow in importance in the years to come as global trade increases and advances in science present us with new possibilities, choices and dilemmas.

The wisdom of this global move was supported by the weight the G8 nations gave to the issue of food safety during their last meeting in Okinawa in July. They specifically stressed the need for an active role by WHO and FAO in the work to ensure that the food we produce, trade and consume is safe.

As with many other areas of health, the resources and the technology to ensure food safety exist in the industrialised countries, while the vast majority of the 2 million annual deaths from food and water borne diseases take place in the developing world. Many developing countries do not have the technology, resources or infrastructure to ensure that the food they produce and import is safe. This makes the role of the international agencies particularly important, and WHO will see it as one of our main priorities to make information widely available and to share the advances in knowledge.

In what we can perhaps call the first generation of bio-technological engineering, a number of improved products came on the market. These have been said to benefit producers, rather than consumers. For all these products, the main challenge is to ensure safety to consumers and to the environment.

Now we are seeing the coming of a new generation of bio-engineered products. These discoveries have potential for higher production as well as better nutritional value. However, they present new and more complicated questions in relation to their safety and benefits for consumers. It will be a major challenge to ensure proper scrutiny of all potential issues associated with these products.

Together with FAO, WHO will do all it can to provide decision makers with the information they need to decide on such matters. WHO will ensure that high quality, independent science is assembled, coordinated and disseminated into existing intergovernmental mechanisms, like the Codex Alimentarius Commission.

Let me dwell on the issue of high-quality, independent science. Food safety is only one of the many areas where WHO’s responsibilities consist of providing the best possible scientific evidence and making it available to all who need it. This is the value we add. While economic, political or ideological considerations colour much of the information that exists on a range of health issues, WHO stands – and must continue to stand – as the voice of good, independent science and the defender of a simple set of values – those of the right of all to good health.

Good, independent science and access for all also underlie our work in health research. Next month, I will attend the International Conference for Health Research in Bangkok. The challenge ahead of us is to improve coordination, set clear priorities and support developing country research while preserving the varied and vibrant plethora of health research entities that together drive health research forward.

I am very pleased to see that the pioneering effort on bioethics are being acknowledged and evaluated at this meeting. Through its publications, its specialised educational programmes and its research programmes, the Regional Program on Bioethics has become a key resource in bioethics for all of Latin America and an inspiration for other regions.

Mr Chairman,

A renewed effort to address diseases associated with poverty should contribute to the development of health systems.

The management of any health system is a balancing act: coping with competing demands, matching resources to need, and attempting to ensure that all have access to the care necessary for good health. The balancing act is particularly difficult for those countries whose per capita spending on people's health is less than, say, $100 per person per year. It is even more difficult in settings where the institutions of government are undermined - or even paralysed - by conflict.

I have sensed a need to help health ministers assess the performance of health systems in ways that reflect three vital purposes: improving health outcomes, responding to the people and fairness of financing. As you know, this year, WHO attempted such a first assessment, using the limited data available, in the World Health Report 2000.

I appreciate that the report has led to wide-spread discussions both in national and international media and among health professionals about how best to assess health systems, as well as a more fundamental debate about what makes a good health system. This was in particular the case in this region.

I hope that the debate has been helpful to legislators as well as to health professionals. It has certainly provided me and my staff with new insights. We will work closely with Member States to make better use of existing data sources and where necessary to collect new information for the annual assessments of health systems performance.

WHO will also be working closely with a number of Member States in an Initiative to Enhance the Performance of Health Systems to apply the new WHO assessment framework at national and also sub-national levels; to use this analysis as an aid to national policy formulation; and to work together to facilitate positive change.

Mr Chairman,

Non-communicable diseases seriously challenge health systems and provoke difficult decisions on resource allocations.

For most noncommunicable conditions, there is a lag between exposure to risk and visible outcomes, but policy decisions to deal with this shifting burden of disease are required now. During the next 12 months we will be looking particularly at mental health.

No country and no community is immune to mental disorders and their impact in psychological, social and economic terms is huge. Yet, societies raise barriers to both care and the reintegration of people with mental disorders. What makes our task doubly urgent is that there is no reason for inaction - much less exclusion. World Health Day on April 7 2001, the World Health Assembly in May that year and the World Health Report 2001 - all will focus on mental health. Together, we will find solutions and strive to make the necessary changes.

We will also achieve change in another key priority area, namely in tobacco control. WHO is at the front of this global public health struggle.

We are not interested in tobacco wars. We want tobacco solutions.

We have the evidence to convince. We know that higher excise taxes make economic sense in addition to reducing smoking, in particular among the young and the poor. We know that smuggling is a problem that must be dealt with independently of the price issue. And we know that in the long term, government divestment of tobacco holdings is responsible policy - both economically and health-wise.

In October, Member States will begin the negotiations on the Framework Convention on Tobacco Control. This will be the first time that the public health community has led treaty negotiations. The process we set in motion has already fostered a global debate and pushed countries as well as tobacco companies to think about their actions from a public health perspective. The success of the FCTC will depend on our ability to link compelling data to robust decisions.

First, there will be two days of public hearings in Geneva. We will listen to the views of all interested parties, including the tobacco producers and the tobacco industry. Then the negotiations will start.

Many countries in this Region have shown a strong and active support for the work towards a Framework Convention. I appreciate this and count on you to continue this support so that the FCTC can become a strong and effective tool for tobacco control.

Mr Chairman,

There is no need to remind anyone in this Region that disasters and crises, both natural and man-made, are on the increase, affecting a growing number of people world-wide.

There is no short cut to dealing with emergencies. Spending on preparedness for disaster may seem like resources not being fully used, but the lesson is always that each of our countries will be affected one day in one way or another. There needs to be focus on training, hospital and health services planning, and stockpiling of supplies.

WHO has an important function to perform before, during and after emergencies. Our role is to assist nations with accurate assessments of damage and needs. It is to ensure the best possible coordination of agencies involved, and to make sure that long-term health perspectives are built into the emergency relief, so that money spent on an emergency can benefit long-term development needs. And afterwards, we in WHO need to help countries share their experiences.

Mr Chairman,

Given the major challenges that face us all - governments and technical agencies - how will we respond, and what can you, our Member States, now expect from WHO?

WHO continues to have a unique role. At all times we pursue the best interests of our constituency - the optimum health of all the people within our 191 Member States.

At all times we try to ensure that we are guided by the best available evidence - based on the careful analysis of experience, on the results of relevant research.

The clearest reflection of how WHO is changing to serve Member States better is the upcoming budget, which you will discuss later. The Programme Budget 2002-2003 is a key instrument for advancing the process of change and reform in WHO. Both in its content and in the way it is being prepared, it marks a significant departure from previous biennia.

The budget is a manifestation of the new corporate strategy, which sets out the ways in which WHO’s Secretariat intends to address the challenges of rapid evolution in international health. The programme and budget for each area of work has been worked out through an Organization-wide process, jointly between staff from Regional Offices and from Headquarters.

Thirty-five areas of work have been identified for the whole Organization and constitute our common building blocks. In the process, we clearly identify the 11 priorities endorsed by the Executive Board and have moved additional resources to those priorities.

The proposals for 2002-2003 also follow the decision of the Health Assembly in 1998 to reallocate some regular budget resources between regions. In line with the flexibility given by the Health Assembly, I have however proposed a somewhat lower level of reallocation in the coming biennium. This will benefit those regions, like this one, which are contributing considerably to the transfers.

All of this will also give greater importance to the need to focus on a strategic approach to our work in countries. Your region has of course a strong country presence, which we will build on.

Mr Chairman,

We are seeing a change in perceptions. Health is bigger news. Health is accepted as a central and necessary element in reducing poverty and ensuring economic growth and social progress. There is movement among donors to allocate more money towards interventions that will fight diseases. There is a growing realization that we need international agreements and co-operation to fight threats to health, such as from tobacco. In short - health has been placed at the centre of the development agenda.

The first decade of this century can become the one in which the world’s two billion poorest can share in the health revolution.

But there is nothing irreversible in this process. We need to continue our hard work to maintain the momentum. The tiniest sense of complacency may turn health’s central role in development from a permanent paradigm shift to little more than this year’s fashionable theory.

We are on the brink of seeing real and substantial gains for the health of the poorest, but to do so we need to have realistic perceptions of what we can all achieve and what will be necessary for us to succeed.

First of all, we need to see increases in resources for poor people’s health, not only from governments but also from donors and foundations. The contribution should add to and not replace existing financial commitments.

Secondly, the demand for improved results and measurable outcomes will be relentless. Additional funding will dry up unless it can be shown that increased activities have led to improved indicators within a relatively short period of time.

Thirdly, of course, the challenge is more than anything for governments of all Member States. A new focus on health will put increasing demands on countries funding, on absorption capacity, and on governance. To make substantial and lasting improvements to health, people themselves and their governments will always be the main driving force.

Let us work together to grasp this opportunity. Let us make this decade the decade that spread the health revolution to all.