Mr Takasu,
President Chiluba,
Madame Nuriyah,
Ladies and Gentlemen,

Let me thank the Government of Japan for hosting this important meeting.

I would also like to congratulate the organizers. I know that today marks the culmination of several month’s preparation. I have every confidence, however, that your hard work will mean that the Okinawa meeting will be seen as a landmark event in international health.

But let us first reflect for a moment about why we are here. I believe it is because we share a vision of the future although we bring to the meeting different experiences, different concerns and different technical interests.

This is what we have in common: a vision of a future in which we develop new ways of working together at global and national level. A vision of the future which has poor people and poor communities at its centre. And a vision which focuses action on the causes and consequences of the health conditions that create and perpetuate poverty.

We are here in Japan to respond to the concerns expressed by the Heads of State and Health Ministers of the world's developing nations. They have told us, this year, about how illness hampers their people's prospects for development. In Abuja at the African Roll Back Malaria Summit during May. In Amsterdam in March, where the focus was on stopping TB. In Durban, in July, at the International Conference on AIDS. In Lomé, at the OAU Heads of State Summit, calling for action on AIDS and malaria. At the UN Security Council, the General Assembly Special Session on Social Development and at the Millennium Summit calling for action for health, with a particular emphasis on the impact of HIV infection.

We are following up on the call from G8 Heads of State. In their communiqué last July, they reflected the concerns of leaders throughout the developed and developing world in calling for a new partnership which would scale up the global response to diseases most closely linked to peoples’ poverty.

We all have to be much more effective if the targets are to be achieved. Business as usual it is not good enough.

We have a growing body of evidence, some of which will be presented today, on the severe economic consequences of ill health within poor communities. Most of us are convinced that if health gains reach poor people as well as those who are better off, the momentum of poverty reduction increases - dramatically. The consequence is faster rates of economic growth.

This is a long-term agenda. We are in for the long haul, and we must insist on a sustained response. We are ready to start, now.

Mr Chairman,

I believe that I speak on behalf of most of the agencies present here, when I say there is a growing consensus on what needs to be done.

Take the issue of resources. Poor countries cannot reduce the burden of diseases associated with poverty if they can only spend 5-10 dollars per person each year.

There is a gap between estimates of what is needed to help poor communities tackle individual causes of illness, and the resources currently available. In the case of malaria, we estimate that to reach agreed targets in Africa will require an additional $1 billion a year.

For TB, around half a billion dollars per year in high burden countries. For HIV/AIDS the gap is even larger - probably in the order of $3 billion for prevention, treatment and support in Africa alone. Add in antiretrovirals and the costs rise even more dramatically.

This is not the only way of showing there is a resource gap. Combating disease needs well-functioning health systems. In our analysis of health systems published in this year’s World Health Report, one of the strongest factors associated with the lowest levels of performance was a per capita health spending of less that 60 dollars a year.

Of course we know that money is not the whole story. Many countries could get far more health for the money they currently spend. But - whichever way you look at it - the gap in resources available to the poorest nations is huge. This gap can be partially filled by greater financial efforts on the part of countries themselves. But they face real constraints. They need a significant and sustained increase in development assistance for the better health of poorer people - including debt relief funds.

It is not enough for us to demonstrate the size of the gap and request those with the deepest pockets to fill it. We have to make the case for investment. We have to show that we can build consensus around genuine partnerships. We need to demonstrate results.

We know what works.

We are clear on what is needed. effective means for poor people to better access the services, the commodities and the information that they need for better health. Stewardship of effective actions for health by national governments: getting the best out of the public sector, and harnessing the energies of private, voluntary and community organizations.

We have a clear idea about the investments needed. We have studied the constraints to be overcome in going to scale.

We will show the results that can be achieved, using independent and reliable systems for monitoring progress.

We will not let the urgent displace the important - we will not forget the factors in society that increase people’s vulnerability to disease. To do so is the equivalent of cleaning up oil spills as the mainstay of environmental policy. We will use all the evidence at our disposal to promote healthy public policies - in employment, in housing, in trade, in education.

We will work through national development processes. Ensuring that health is properly located within national poverty reduction strategies, and specifically in Poverty Reduction Strategy Papers. Supporting priority health outcomes through sector-wide approaches. Promoting action for better health within support for communities in crisis, affected by societal instability or trapped in complex emergencies.

We will encourage the forces of globalization to work for the poor, so that they enjoy better health as a result of increased cross-border movements of products, people, services and information. We will respond to the new political commitment to link action at country level with international efforts for better access to essential medicines and commodities. In today’s world, we can no longer separate country and global action.

We will seek new incentives for research and development - for new vaccines, better medicines, more reliable diagnostics. This means policies and systems that helps to create markets for affordable products within poorer communities.

We will build on the converging interests of global public health, the research-based pharmaceutical industry, and those who set the rules for international trade. We will find opportunities for innovation and creative collaboration to overcome market failures. We will support the protection of patents as a necessary and effective incentive for research and development. Essential drugs, though, are an unusual commodity. The patents that apply to their development and production should be managed in ways that benefit the patent holders and the public.

We will be pragmatic. We will enable countries to access information on all the potential options for increasing peoples’ access to essential medicines, including tiered pricing when they are on-patent. We will encourage systemic approaches to improved access, not well-publicized exceptions to the usual inequities. This calls for a new series of relationships between the public and corporate sectors - designed to bring greater health benefits to those who need them the most.

We will re-examine arrangements through which development assistance contributes to better health. The international response to ill- health of poor people is far less than it should be. Ministers of Health and their delegations - at the World Health Assembly and WHO Regional Committees - illustrate that the present system leaves much to be desired.

International systems for financial transfer are slow and inefficient. Resources do not get to where they are needed. Donor projects and programmes require inputs from national governments that are disproportionately high. This distracts senior officials from the important business of improving their national health systems, making them more effective. Too often international agencies by-pass the national institutions that they are committed to strengthen.

We will work together to improve systems for health assistance. We will try to establish mechanisms that can do more, quickly, and really help national partners take health actions to scale. The mechanisms will be able to transfer an increased volume of resources and yield demonstrable benefits. We are ready for the challenge of gearing up the system. If we do not, development goals will not be fulfilled, lives will continue to be blighted, and the scourge of poverty will remain.

We will grasp this opportunity. The political support is unprecedented. We will help turn promises into commitments, commitments into actions, and actions into results that change peoples’ lives. The spirit of Okinawa, born of extraordinary political energy, fuelled by human concern, powered by technologies that work and delivered through a growing popular movement. We cannot raise expectations, then fail to act. As our hosts have said many times: we can do it, and as we are saying today, we will do it.