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Dr Pokrovskiy,
Distinguished Scientists,
Colleagues,
It is a great pleasure for me to meet with this
distinguished gathering of Russia’s leading scientist.
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.
Russia has played an important role in this
revolution. As we face the challenges of this new century to finish
the work left undone in the past one, Russia will continue to be a
significant player.
As it did in the past century, science will stand
at the centre of the changes in this one.
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.
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 biomedicine.
Colleagues,
As we look into the future, we see the outlines of
a world where the main infectious diseases can be controlled given the
wise use of substantial extra resources. We see a world where
tobacco-related diseases, injuries and mental disorders will demand
considerably more resources of health systems than they do today. We
see a world where developing and rich countries alike must focus on
using the resources at their disposal better to deliver more cost
effective and fair health services to their populations.
In the wealthy industrialized countries, which
already spend substantial amounts on health, we are talking about more
health for the money rather than more money for health. In the
countries less well off, we need to spend more on health, but we must
do so in a cost-effective, result oriented way.
WHO sees the need for concerted, global action in
order to achieve these tasks. We have therefore taken a more active
approach to health questions, by pointing out the political
implications of global health, the resource needs and the possible
strategies needed to make progress with the main health issues of the
coming years. This has perhaps been an unexpected turn of events, and
WHO has certainly become more involved in controversy, but it is a
direction our Member States have appreciated. They expect this
leadership from WHO, and they wish WHO to be an Organization that
gives advice on the difficult health issues all countries face.
The political leaders of the world have responded.
The year 2000 will be remembered for heads of state committing their
governments to tackling the health problems that provoke and sustain
poverty. Commitments were made by the Organization for African Unity,
at the UN special session on social development, at the millennium
summit and when the G8 met in Okinawa in June. Russia, as a member of
the G8, promoted this position – a commitment to socially
responsible globalisation.
Of course, Russia is undergoing a process of
profound social and cultural transformation. Its people face a unique
set of health issues. Its health systems are trying to respond to the
challenges. Both the issues and responses should be analysed within
their geographical, demographic, social and economic context.
Health systems should improve health, respond to
people’s interests and be financed fairly. Scientific evidence
states that the structure and emphasis of the health system will need
to change. This is, inevitably, a long-term reform process. Abrupt
changes will not succeed: they may lead to back-lash and set-backs.
There is no doubt that increased resources are needed to help address
the health challenges faced by Russia’s people.
Complex problems need visionary solutions. We must
not be deterred from difficulties we encounter on the way. We will
apply the best science, learn the lessons of experience and keep the
context firmly in our minds.
I would like to focus on Tuberculosis. This has
long been a serious health issue in Russia, but the incidence and
prevalence has increased dramatically over the past ten years. Adding
to this is the increasing incidence of multi-drug resistant TB, which
is difficult and forbiddingly expensive to treat.
It is becoming clear that the number of people
infected with TB is overwhelming the current capacity for treatment.
Russia need to implement a new control strategy for TB treatment,
based on general principles of direct observation of patients but
adopted to the specific needs and conditions of Russia.
Through pilot projects, such as the one in Tomsk
oblast, we have seen the potentials and limitations of such
direct-observation treatment. They have made it clear that TB control
is intimately linked with health sector reform. TB now makes up nearly
a quarter of the total public health spending in Russia. Effective TB
control programmes, that take into consideration the need to make use
of the capacity and expertise that exist under the current system,
will in itself be a significant contribution to health system reform.
In TB control and treatment, as in other areas of
the health system in Russia, you face a problem of a top-heavy
structure, with too many doctors and too few nurses – too many
hospitals and sanatoria deteriorating because of insufficient budgets,
while there is an acute lack of primary health stations.
The key to improving cure rates and reducing
incidence of multi-drug-resistant TB is to ensuring a adequate and
steady drug supply. This must be an absolute priority that cut through
all work by both donors and Russian authorities.
There is also an acute need to carry out pilot
projects that can suggest strategies to fight multi-drug resistant TB.
Multi-drug resistant TB poses some very difficult questions. Unless we
have more knowledge about what works we will not be able to deal with
it in an effective way.
The current prison regime undermines attempts to
reduce infection levels of tuberculosis in the general population.
Currently, nearly one per cent of the Russian population is behind
bars. Of these 10% are ill with TB, and within those who are ill, a
shocking 30% develop multi-drug resistant TB. A thorough reform of the
current system of incarceration will be a essential part of any action
to reduce the prevalence of TB in the country as a whole. I welcome
the draft legislation on penal reform.
Now to another infectious disease that is
threatening to take on epidemic proportions. If we allow it to, it
will cause more damage to society that even a TB epidemic. It has no
cure and there is no vaccine. I am of course talking about HIV/AIDS
Over the past five years, there has been an
exponential increase in HIV infection in Russia. Registered infections
have doubled each year and have reached a level of nearly 60,000
people. The estimated infected population is ten times that number.
So far, infections have spread predominantly among
the rapidly growing group of intravenous drug users. But at the
infections rates we are now experiencing and with the close link that
exists between drug use and commercial sex, there is an imminent
danger of the virus spreading more widely. This, I need not tell you,
is a public health emergency.
We know about it. We can see it coming. We can
prevent it. But to do so will mean making a series of difficult
decisions, many of which lie outside the area of health.
The key to limiting the spread of HIV lies in harm
reduction among intravenous drug users. In other words, efforts to
stem the spread of drug use must contain an acceptance of the need to
provide needles and condoms to those who already are addicted to these
drugs.
Research has shown that in order for such
programmes to be effective, at least 60% of the high-risk groups must
be covered. There is already important experience gained from several
pilot projects, but the projects which work well need to be taken to
scale.
This means that harm reduction must become a
central element in the public drug treatment centres, clinics for
sexually transmitted diseases and AIDS centres. But it also means
involving Non Governmental Organizations and outreach groups in the
main HIV/AIDS prevention strategy. And it means cooperation across
ministries, involving police and prosecutors in this strategy.
There is strong evidence that harm reduction
programmes work better if they are done in the wider context of
effective drug treatment. We therefore need to develop effective
methadone treatment programmes, drawing on the best practices from
other countries, but adopting them to the special Russian context.
In short, Russia needs a multi-sectoral response to
HIV, to which all concerned Ministries are fully committed. Moreover,
the response needs to become an integrated part of the core activities
of the Ministry of Health. WHO is willing to support this process in
every way we can.
Additional funds are crucial in this effort. I
encourage intensive effort by all concerned to meet the needs for
funding HIV/AIDS prevention activities in the coming year, and to
co-ordinate their responses around agreed strategies.
Let it be clear: many of Russia’s health problems
can only be eased through changes that lie outside the field of
health. We must for example understand the role alcohol plays in
coping with the process of social and economic transformation large
parts of the Russian population are currently going through.
Price increases have adverse side effects, such as
the danger of poisoning through illegal alcohol production. But price
increases coupled with information campaigns would lead to an overall
reduction in alcohol consumption and therefore an easing in the burden
of disease caused by excessive consumption. It worked in the
mid-1980s, leading to an almost instantaneous jump in life expectancy
of two years. It can work again.
Yet the largest cause of serious non-communicable
diseases in Russia may be tobacco. The smoking rates of Russian men
are among the highest in the world. The rate of youth smoking is also
alarming. And here, the opening up to the capitalist world has brought
only harm: between 1995 and 1997 alone, there was a 30% increasing in
tobacco use – clearly a result of the strong marketing powers of
international tobacco companies. This is translating into a major
health problem, taking a big toll of suffering and economic loss.
New knowledge has demonstrated how tobacco use is
growing in countries in tradition and in developing countries and how
young people in these countries take up the habit. A devastating
global epidemic of tobacco use is now threatening the developing
world. We also have the knowledge about how to control this threat. As
we speak, nations are working on a Global Treaty that will help put
the knowledge into practice.
Firm action to tackle issues of tobacco, alcohol
and drug addiction will go a long way in stemming the decline in life
expectancy and the general demographic development of Russia in the
years to come. But there is also a need to look at the other end of
the life-spectrum. Of course, as Russia works itself out of the
transition period and onto a more firm economic and social setting,
couples will feel more inclined to have more children. But we also
need to ensure that maternal, infant and child mortality is reduced.
This is a complex issue that can briefly be summarized in two basic
elements: more and better primary health care; and a steady supply of
essential drugs. These two issues are intimately linked with health
sector reform and they will take some time to accomplish. But the
priorities must be set now if change is to follow later.
Next year, mental health will be the focus of World
Health Day on April 7. 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
integration 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, the World Health Assembly in May 2001 and
the World Health Report 2001 - all will focus on mental health.
Colleagues,
I want to stress that although Russian scientists
have tremendous challenges at home, they are also part of an
increasing globalized exchange of information and research. We will
encourage a wider Russian participation in the discussion around
global health issues.
One such central issue is: how do we deal with
knowledge that is relevant to the public's health. Is it a private
good, to be traded in markets, closely guarded, tightly protected
and used to enrich its owners? Or is it a global public good,
openly available to all who need it and make good use if it? The
cold war limited the access to knowledge. Today, we are threatened by
another limitation – between the have and the have-nots. Currently
there is an imbalance of knowledge goods, leading to an
under-provision of such knowledge among those who need it the most.
If we accept that medical knowledge is a
global public good, then all countries stand to benefit equally from
its equitable distribution. All countries should share and cooperate
in the creation and utilisation of knowledge for the collective
benefit of humankind.
WHO is promoting and supporting the world that is
being done world-wide to increase our knowledge base.
WHO will contribute to the effectiveness of
regional and global health research efforts. Hence, we will
continue work with others, bringing together the health research
capacity within countries, within other organizations, and within both
public and private entities.
WHO will continue to play a role in research
capacity strengthening, and in supporting strategic research in
key areas where gaps remain.
We have confirmed that Expert Committees are
one of the key links between WHO and the scientific community. We will
do what we can to ensure that the science is of highest quality and
relevance. We are updating the links with WHO collaborating centres
and optimizing their important contribution of relevant and quality
knowledge.
Russia currently has 53 WHO collaborating centres,
which make important contributions to our work. We hope to strengthen
this collaboration in the years to come.
The researcher has to strike a difficult balance
– building on evidence, taking risks, striving for a vision – and
contributing to a better society.
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.
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.
We have a chance, now, to establish better ways of
working together, more effective ways of responding to need. We can
build on extraordinary improvements in recent years, on substantial
health gains for so many people. But the hardest part is yet to come.
Let us turn aspirations into realities. This requires superhuman
effort by all. I can assure you that WHO is ready and willing to
support this effort.
Thank you. |
