|
Mr Chairman,
Ministers,
Dr Gezairy,
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 command
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 the 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 13th 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 for step-by-step 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’ efforts 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. 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. The
report you have received for this meeting still indicates a number of
countries in the region where indigenous wild polio viruses are being
detected. 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 delivered at the
Polio Partnership Summit in New York earlier this week, when we launched
the strategy for the next five years.
HIV/AIDS is a global pandemic. This region has a very low percentage
of the estimated cases worldwide and we must keep it that way. But we
must also recognize the vulnerability of certain high risk groups and
the possibility of this eventually affecting the general population. The
quality and detail of the surveillance data 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.
There is a very broad variety of experiences to draw on, which is
both encouraging and gives reasons for optimism. In particular on the
issue of access to drugs for those living with HIV/AIDS, several
countries across the world 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 these approaches.
On the issue of HIV/AIDS care, there is a promise of further
progress. Over the past few months, governments and development agencies
have worked together to enable many more people living with HIV to
access the care they need. Rhetoric is becoming reality.
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 has
just held it first meeting. It brings 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
the African Region, 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.
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 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 discussed it at a roundtable on Thursday this week
and that there is to 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, 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.
As with many other areas of health, the resources and the technology
to ensure food safety exist in the industrialized countries, while the
vast majority of the 2 million annual deaths from food and water borne
diseases take place in the developing world. Most developing countries
possess neither the technology, nor the resources nor the 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 its main priorities to make information widely
available and to share the advances in knowledge about what is safe and
what is not.
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 these
products, the main challenge has been 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. It will
be a major challenge to ensure proper scrutiny of all potential issues
associated with change to 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. We will ensure
that high quality, independent science is assembled through WHO auspices
and disseminated into existing intergovernmental mechanisms, like the
Codex Alimentarius Commission.
An important element of any health system is the process through
which the quality, safety, and effectiveness of pharmaceuticals is
regulated. Governments face difficult choices, specifically in the case
of newer essential drugs; they cannot invest in a few costly drugs and
ignore the other aspects of care. WHO continues to establish and develop
clear and practical norms and standards to assist countries in the
assurance of the quality and safety of drugs. In line with the Revised
Drug Strategy, we continue to provide advice to Governments on how to
assess the public health consequences of international trade agreements
and to inform them on provisions relating to public health safeguards
included as part of the TRIPS agreement.
Good, independent science and access for all also underlie our work
in health research. In a few days time, I will attend the International
Conference for Health Research in Bangkok. The challenge ahead 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.
Mr Chairman,
A renewed effort to address diseases associated with poverty should
contribute to the development of health systems. I was very pleased to
attend the Council of Arab Health Ministers in Beirut earlier this year
and to speak with you on the subject of health systems reform. Since
then we have been working hard on this subject.
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.
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 now 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,
Noncommunicable 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 illness and its
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. Quite simply, we want
to help reduce tobacco use.
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 two weeks, 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 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. In EMRO, we are faced for example
with the continuing long years of conflict in Afghanistan and in
Somalia, as well as the struggle in the southern region of Sudan. We are
assisting with the oil for food and medicines programme in Iraq. We are
providing assistance and advice on the health sector to the Palestinian
Authority. Natural disasters of earthquakes, floods and droughts have
also affected some of these countries as well as others in the region
.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.
Health can also serve as one of the important bridges for peace,
bringing together those with opposing views to share such common values
as vaccinating children against disease and caring for the infirm.
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.
I wish to thank Dr Gezairy and to all of the EMRO staff for their
work in ensuring that we are able to meet today in the new regional
office premises. The building was a joint effort of many, and I thank in
particular the host government for its generous support, as well as the
other donors from the region.
The new premises will greatly facilitate our ability to work in a
modern environment to serve you.
At all times we try to ensure that we are guided in our work 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.
I have been greatly encouraged by the support which the new budget
has received in the five regional committees which I have attended over
the last month and I hope that you will be able to share these views. It
has meant some adaptation of previous approaches and structures at
regional level and we will need to pursue this as we finalize the
proposals. We will all stand to benefit through this cooperative effort.
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.
Thank you. |
