Senators,
Members of Parliament
Professor Prasop,

It is a great pleasure for me to meet with you today. I will use this rare opportunity to briefly outline how I perceive the current global outlook for health and how this is reflected in the priorities we have set for the work of the World Health Organization.

Over the past few years, new research has in a dramatic way shown the central role health plays in the development of nations.

During the early 1990s, the world began to accept that there is a complex, but close-knit relationship between health and poverty. Being poor is bad for your health. But being ill also reduces your chances of getting out of poverty.

There is new data about the extent to which ill-health is impacting on the economy of some communities and nations. Much of this data focuses on Africa but the trends are universal. We now know that a few diseases, such as malaria, HIV/AIDS, tuberculosis, the traditional childhood killers and reproductive health conditions, are directly biting into the economic growth of developing countries. Malaria shaves off as much as one per cent of GDP growth in the hardest affected countries. When HIV/AIDS reaches endemic proportions it can reduce growth by nearly half a percentage point.

There is an increasing recognition of the sheer difficulty faced by developing nations as they seek to counter these health threats. It is becoming clear that health systems which spend less than $60 or so per capita per year are not able to even deliver a reasonable minimum of services, even through extensive internal reform. It doesn’t matter how good the structure is – as long as you can’t afford to pay your doctors and nurses proper salaries and fill the shelves with essential medicines and vaccines, a health system will not be performing at a reasonable level.

But data also suggest a direct relationship between health and economic development. As we saw in Europe at the end of the 19^th and beginning of the 20^th century, developing countries which invest relatively more, and well, on health are likely to achieve higher economic growth.

Here 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 phenomenal Asian economic growth between 1965 and 1997 resulted from investment in people’s health.

Another finding from recent research is that the way health systems are designed, managed and financed seriously affect people’s lives. The performance of a country’s health system is as important as the absolute amount of money spent.

Whatever standard we apply, it is evident that health systems in some countries perform well, while others perform poorly. That performance in the UK exceeds that in parts of sub-Saharan Africa is hardly surprising. That there is a 25 year difference in life expectancy between two countries that spend similar amounts on health should, however, give us real cause for thought. The difference between a well-performing health system and one that is failing can be measured in death, disability, impoverishment, impoverishment and despair.

The last stage-setting body of scientific evidence I would like to mention is the shift in the global burden of diseases towards non-communicable diseases. The challenge of prevention and control of heart diseases, diabetes and cancers are enormous.

In the developing world, these diseases are fast replacing the traditional enemies, in particular infectious diseases and malnutrition, as leading causes of disability and premature death. The rapid rise in the magnitude of these problems represents one of the major health challenges to global development in the 21^st century and threatens the lives and health of millions of people.

Changes in lifestyle and environment are among the reasons for this shift. But the single largest factor in the growth of non-communicable diseases in the developing world is tobacco.

We are facing an emerging epidemic. World-wide mortality from tobacco is likely to rise from about 4 million deaths a year last year to about 10 million a year in 2030. In public health terms, this is comparable to the HIV epidemic. Over 70 per cent of the deaths will be in the developing world.

The implications are obvious. Tobacco is not only a human tragedy. Tobacco also burdens our health systems. It costs taxpayers money. It hampers the productivity of our economies. We have seen this happening in the U.S. and in Europe. But now, these burdens are hitting developing countries, countries which need all their resources to build their social and physical infrastructure. As you know very well, developing countries have no extra money to spend on the unnecessary costs of a man-made epidemic.

What conclusions can we draw?

First of all, anyone who is concerned with the social and economic development of their nation must place health centrally in their thinking. Health is becoming an important issue for finance ministers, prime ministers, planning ministers – and indeed for law-makers.

Secondly, we have an increasing amount of firm scientific evidence that can help decision-makers to generate educated choices for health based on what works, what is most cost-effective and what are the most equitable solutions.

And, new ideas are emerging. We have a number of health interventions which dramatically reduce mortality from the main infectious killers. They have in common that they have proven effective on a local or national level. Quite simply, if we can take these interventions to scale - and by that I mean to a global scale - we have in our hands a concrete, well-measured and result-oriented way of starting to reduce poverty.

We also know that such action is crucial if hard-won health gains – and in the extension of these, social and economic gains – are to be sustained.

In Thailand, the impressive efforts you have made over the past decade to arrest the spread of HIV/AIDS require renewed commitment. Tuberculosis has regained a foothold in the wake of the HIV/AIDS pandemic – and it is spreading. Malaria is still a serious impediment to development in the northern and western border areas.

We need to use existing interventions in a more effective way and on a larger scale. In this context, the Roll Back Malaria Mekong Initiative is a trend-setter and its progress will be closely followed.

We must focus on ways to best make drugs and vaccines that exist but are not widely available affordable to as many as possible. This is in particular true for access to care for those living with HIV. As you know, WHO is working with UNAIDS and other UN agencies to facilitate a dialogue between five major pharmaceutical companies and individual countries to drastically lower prices on anti-retrovial drugs and drugs against opportunistic infections.

WHO is also advising countries on how best to gain access to the cheapest possible essential drugs for other conditions than HIV/AIDS and to improve import regimes and distribution systems in order to make drugs available to those who need them.

We must also increase our efforts to produce new drugs and vaccines. We are fighting against time to achieve the best results possible with the drugs that exist as they slowly are becoming less effective due to microbial resistance. We need new drugs for malaria, TB and a range of other diseases. Last night, I had the pleasure of launching the Global Alliance for TB Drug Development here in Bangkok. Like the Medicines for Malaria Venture which was launched almost a year ago, this Global Alliance will provide financing to develop new, more effective TB drugs over the coming decade.

We also need to work on new vaccines. The Global Alliance for Vaccines and Immunization, GAVI, has already disbursed its first batch of funds for countries, less than eight months after its launch. It will continue its work to scale up and widen the immunization coverage of children world-wide. But it will also support the development of new vaccines. Let us take inspiration from the campaign against polio. Some decades ago, a polio vaccine was just a dream. Today, thanks to scientists and public health workers, the world-wide eradication of polio is within reach.

Thailand has taken a progressive and brave position on both drug and vaccine development, making valuable efforts to develop new combination therapies for malaria and testing promising HIV vaccines.

To overcome the challenges against the main infectious diseases, we will need a global, long-term commitment. In short, we will need a Massive Effort. Current estimates suggest that an additional $1 billion dollars annually will be required to combat malaria effectively. The situation with TB is similar. Another billion dollars annually spent on drugs - linked to work on health systems - could result in a 50% drop in mortality over the next five years. With HIV/AIDS, we need even more. Sums in the order of $2.5 billion dollars annually are needed for prevention alone. Add the cost of care, and the figures rise dramatically.

In July, the G8 leaders committed themselves to support step-by-step improvements in health outcomes among poor communities. They committed to targets set by international fora for reducing the toll from HIV, malaria, and TB by 2010.

The European Commission has shown a strengthened push to fight HIV/AIDS, malaria and tuberculosis. It has adopted a policy to increase access for poor people to essential health goods and services that aims to reduce prices of vital medicines and commodities; and to create incentives for strategic research to develop new and more cost effective products for prevention, diagnosis and treatment.

The key to progress however, lies in the developing countries who must take stewardship of this Massive Effort.

The fourth lesson we can draw from today’s world is that health systems do make a difference.

The effectiveness of health systems is the subject of intense public debate all over the world. This year’s World Health Report plugged into this debate. It contained the first ever index of health systems performance. The aim of compiling this index was to shift the focus of the debate from opinion and ideology toward evidence and knowledge.

What makes for a good health system? What makes a health system fair? How do we know whether a health system is performing as well as it could?

Tough questions: and the answers, of course, depend on where you stand. A Minister of Health defending the budget in parliament, a junior doctor trying to find a bed for an acutely ill patient in the middle of the night, a news editor looking for a story, a mother waiting several hours to see a nurse, a pressure group lobbying for special services. All of them will have their different views. This is why we in WHO have a responsibility to help all involved reach a balanced judgement.

The tough message in this Report was that virtually all countries are under-utilizing the health resources that are available to them. For ministers defending their systems performance to the public, and to colleagues in government, such a message is not always welcome. However, very few ministers have had a real chance to develop, set up and implement a system from scratch. A critical light can help them move ahead.

Not surprisingly, the Report led to wide-spread discussions both in national and international media and among health professionals about how to assess health systems, as well as a more fundamental debate about what makes a good health system.

This debate is good. Discussion about the concepts and analyses in the World Health Report has given us all new insights. To continue the global dialogue on how to get the most out of health systems, we will work closely with Member States to make better uses of existing data sources and where necessary to collect new information so that the annual assessments of health systems performance are based on the best available evidence.

In response to numerous requests, WHO will 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. Thailand is among four countries in this region which are already participating in the Initiative.

Not only did Thailand do relatively well in comparison with other countries’ health systems. This country has already invested impressive resources in the evidence-base needed to improve its health system. The College of Public Health at Chulalongkorn. The Faculty of Tropical Medicine at Mahidol University. The institute for Health System Research. Together they represent a solid institutional strength that the country can be proud of. And so does the research that emanates from these institutions.

Just over four months ago, I was at a mass meeting in Bangkok. Standing on a platform I looked out over a sea of blue caps and white T-shirts. Wave upon wave of slogans against tobacco. Ten thousand health volunteers from villages all over the country had marched or bicycled to the city to mark the World No Tobacco Day. From local level to regional, from regional level to national, people were mobilized.

The speeches, though, weren't just about telling people not to smoke. They were not about local, or even national issues. They were about levels of taxation, about world-wide bans on advertising and the Framework Convention on Tobacco Control. I saw the visible manifestation of a growing national movement in Thailand against a public health disaster now killing someone in our world every 8 seconds.

I don’t need to tell you that the threat from tobacco is global. Thailand more than most countries have fought this threat over the past decade. Next week, negotiations begin on an International Framework Convention on Tobacco Control. The treaty will provide an international framework to address both national health policies and to control the global reach of the tobacco companies. It will set standards that countries can adopt to control advertising, prevent smuggling and facilitate the global exchange of knowledge. That support for health is also a support for justice, equity and solidarity.

I hope and trust that Thailand will play an important role in helping us craft the Framework Convention on Tobacco Control.

At the beginning of this new century, we are facing both opportunities and challenges. The landscape in which we work is changing. We meet at a time of unprecedented international support for reducing poverty. And at a time when health takes its rightful place at centre stage in the development arena.

Let us all grasp these opportunities for the betterment of all people. In a globalized world, what you do in Thailand will also have importance for the rest of the world.