Tehran, Iran
3 March 2001

Joint Meeting at the Ministry of Health - Challenges in Global Health

The Islamic Republic of Iran has made great progress in increasing people's access to health care, and the result has been widespread improvements in health outcomes based on primary health care, particularly in relation to reducing the impact of communicable diseases, and maternal and childhood illnesses.

In making this progress, Iran has demonstrated some of the underlying principles for promoting equitable health outcomes:

• Good health stimulates human and economic development. It is a key to abating poverty.
• Health policies, and the actions that stem from them, should be guided by scientific evidence.
• Make the most of tried and tested interventions, scaling them up where indicated so that many more can benefit from them.
• Work in partnership with the people, with society: no government or organization can respond to the challenges alone.
• All sectors of government have a role in improving health: the Ministry of Health should provide "stewardship".
• Special efforts are needed to bring benefits all, including those who are poor people and marginalized communities.
• Proper levels of human and financial resources are to make this all happen.

The close links between the Health Ministry and the institutions responsible for medical education have been an important stimulus for change.

Future challenges

Countries that have made good progress in tackling health problems that contribute to poverty still face big challenges associated with their transition. Let us look at the evidence.

First: Noncommunicable diseases are an increasing cause of morbidity and mortality, including accidents and cardiovascular disease.

Second: There is an increasing threat of illness associated with risk factors in people's lifestyles. Tobacco-related deaths. Increasing concern about the impact of intravenous drug use, small in the overall population but high in particular groups, e.g. prisoners.

Third: Continued threats to poor people's wellbeing, including our important and unfinished work such as the eradication of polio, or the control of TB and malaria (often associated with cross-border movements)

Fourth: There are new demands made on health systems due to:

• long time lag between exposure to risk factors and illness, resulting in the need for all societies to be committed to the effective promotion of healthy lifestyles.
• increasing need for care for chronic illness, resulting in different demands on the health system, particularly in urban areas.
• special issues faced by young people – they are harder to reach, yet needing help to sustain health and wellbeing for the future.

We need to give special attention to tobacco as a global issue:

We are facing an emerging epidemic. Worldwide 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. These trends can now be seen in the US 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.

This year we are giving particular attention to the issue of mental ill health. We are increasingly aware of the burden of mental ill health for societies. We will reflect that burden in this year's World Health Report, encouraging policy-makers to recognize that much mental illness can effectively be treated, at low cost, not only for humanitarian reasons, but also increasing household productivity and wellbeing.

WHO has a strong partnership with the Government and people of Iran, expressed through the work of the WHO country team, the WHO Eastern Mediterranean Regional Office, and the WHO staff in Geneva.

WHO is working with Iran to enhance performance of health systems, and its response to the challenges of society, through focus on quality and responsiveness of health care. An important partnership with lessons that go way beyond Iran. There is an inevitable need to handle the expectations of a healthier population, and to handle growing diversity associated with the involvement of the private sector, particularly in urban areas.

There is joint work, too, on the promotion of healthy lifestyles and reduction of non-communicable diseases. Strong focus on tobacco, new emphasis on narcotics use and its consequences, especially in penal institutions. Attention to cardiovascular diseases (risk factors and management within the health care system) and, increasingly, accidents.

There are ongoing joint efforts to respond to the continuing challenge of polio, malaria, TB, schistosomiasis. Both during my visit to Pakistan and here in Iran, eradication of polio has been a key issue. We are at a crucial phase in a long haul investment to rid the world of polio as we did twenty years ago with smallpox. 2001 is crucial for success in southern Asia.

Objectives for the visit

During this visit we could take stock of the different facets of our partnership, and assess how it can be taken forward together by all concerned.

We could identify the key issues on which we should focus, and examine them both in our different meetings and as we travel to different communities and facilities.

We could analyse them, through open discussion, and move towards a joint understanding of their implications for the work required, not only in Iran but in other countries with similar circumstances.

We could identify areas of possible joint action over the next few years, and expected results of our working together - perhaps sharing them with a wider public through discussion that involves the media as well as officials, and reviewing them again, perhaps already at the time of the World Health Assembly, after a period of mutual reflection following this visit.

In the process, we would consider the innovations needed for more effective action - better functioning health systems; new therapies and vaccines; multi-sectoral efforts to promote healthy lifestyles; specific programmes for groups at high risk. WHO is involved in a range of initiatives that may be relevant, such as the Global Alliance for Vaccines and Immunization, the Alliance for TB Drug Development, the Medicines for Malaria Venture, and also a range of health promotion networks specifically applied to noncommunicable diseases. The Government and people of Iran have a vital role to play in advancing the regional and global effort in these areas.

There will always be a need for more resources. To overcome the challenges of the main infectious diseases, to respond to the new threats of noncommunicable illness. I look forward to hearing your plans for ensuring that the necessary human and financial resources are available over the following few years. I certainly anticipate an increase in the global availability of resources, as we work on putting health at the top of the policy agenda, binding the gaps and increasing resources, particularly for tackling the illnesses of poor people. This is why we try to tackle globalization issues of prices and of medicines.

Hence the need to make sure that health systems work as well as they can with the funds available, through the best use of evidence and intergovernmental political action.

The need for evidence about health systems effectiveness has led to 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 towards evidence and knowledge.

The debate that followed its publication has been 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 assessments of health systems performance are based on the best available evidence.

We are also seeing the potential intergovernmental action to counter global health threats. Iran, more than most countries, is vocal in its opposition to the spread of tobacco. In May, the second round of negotiations for an International Framework Convention on Tobacco Control will take place in Geneva. 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 Iran will continue to play an important role in efforts to improve health systems performance and the crafting of the Framework Convention.

Conclusion

At the begin/ning 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 improving global health and reducing poverty. At a time when health takes its rightful place at centre stage in the development arena.

Dr Gezairy and I look forward to an informative and mutually productive visit.