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Ladies and Gentlemen,
I would like use this opportunity to focus on the
factors that determine economic growth in our world.
I am talking about the new understanding of
health's role in development.
The new evidence gathered over recent years
concludes that health must be seen as a central factor not only in
social development, but also in countries’ ability to compete on the
global economic stage and achieve sustainable economic progress.
Health, therefore, must no longer be seen as an expenditure only the
rich countries can afford, but as a necessary investment by the
poorest countries of this world. I will also argue that this is an
investment we cannot leave to these countries to shoulder on their
own.
Simply, enlightened self interest compels both
industrialized country governments and private corporations to do what
it takes to drastically reduce the current burden of disease in the
developing world. To do so will be good for economic growth, be good
for health and be good for the environment. Not only for the three
billion people who have yet to benefit from the technological and
economic revolution of the past fifty years - but for us all.
A world in which the divide between the rich and
the poor continues to deepen; a world in which only a privileged few
have access to the fruits of the technological revolution, is a world
which will become ever more insecure. In the past, desperate
conditions on another continent might cynically be written out of
one’s memory. The process of globalization has already made such an
option impossible.
In the modern world, bacteria and viruses travel
almost as fast as money. With globalization, a single microbial sea
washes all of humankind. There are no health sanctuaries.
The separation between domestic and international
health problems is no longer useful. Millions of people cross
international borders every single day. A tenth of humanity each year.
It is not only the infectious diseases that spread
with globalization. Changes in lifestyle and diet can prompt an
increase in heart disease, diabetes and cancer. More than anything,
tobacco is sweeping the globe as it is criss-crossed by market forces.
Only weeks after the old socialist economies in Europe and Asia opened
up to Western goods and capital, camels and cowboys began to appear on
buildings and billboards.
If the growth in tobacco use goes unchecked, the
numbers of deaths related to its use will nearly triple, from four
million each year today, to 10 million each year in thirty years time.
Practically the entire growth in tobacco-related mortality, more than
70% of these ten million deaths, will take place in developing
countries.
Differences in health status dramatically
illustrate the divide between the rich and the poor in today’s
world.
We know, for instance, that the poor - those living
on less than $ 2 dollars a day - suffer disproportionately from the
ravages of communicable diseases. In 1998, communicable diseases were
responsible for about 34% of the total burden of disease world-wide,
but nearly twice that - 64% - among the fifth of the global population
living in countries with the lowest per capita income. Most of these
diseases can be prevented or easily cured with available vaccines and
drugs, but poor countries and poor people do not have access to them.
Health is not just one of the most potent symbols
of a divided world, it is an integral part of the remedy for healing
that divide.
HIV prevalence rates of 10-15% - which are no
longer uncommon - can translate into a reduction in growth rate of GDP
per capita of up to 1% per year. TB, which is made worse by HIV, takes
an economic toll equivalent to $ 12 billion dollars from the incomes
of poor communities.
Africa's GDP would probably be about $ 100 billion
more now if malaria had been tackled 30 years ago, when effective
control measures first became available.
Globalization does not have to lead to human
insecurity because of the spread of illness. Inequities in health are
not inevitable. Better health will result in major economic
benefits - for families and for nations. All this is now quite clear.
But to reap those benefits there is a need for a completely different
approach to investment.
A number of health interventions can dramatically
reduce mortality from the main killers. Supervised medication regimes
for TB; nets impregnated with insecticide against mosquitoes, and wide
distribution of malaria treatment among children and pregnant women;
prevention programmes for HIV/AIDS - or access to care programmes that
can substantially slow the mortality among those living with HIV.
There are many more interventions, proven to be effective on a local
or national level.
Once these interventions are taken to scale - and
by that I mean to a global scale - it becomes possible to create
conditions within which poverty can be reduced, and the new conditions
can both be measured and shown to lead to real benefits for the people
who are most in need. We have a measurable way of starting to reduce
poverty.
Ladies and Gentlemen,
No matter where they are - in Rio, in Lusaka, in
Mumbai or Moscow - people living with HIV know that now there are
drugs available which can effectively prolong their lives. They can
read news articles describing what they are called and how they work.
And they know that only the most privileged among them can afford to
buy them. This widespread knowledge, a consequence in part of
globalization, radically changes the social and economic context in
which these drugs are developed and sold.
There is no doubt that these changes add to the
pressures placed on the global pharmaceutical and health technology
sector, which is among the most competitive and profitable in the
modern economy.
We cannot ignore the fact that essential drugs are
not an ordinary commodity. Access to health care is a human right and
governments and international agencies have an obligation to see that
this right is progressively realized. Access to essential drugs is
part of this obligation.
We have been witnessing an unprecedented effort,
driven by committed people from governments, nongovernmental
organizations, UN agencies and the private sector, to dismantle the
obstacles that are preventing essential drugs from reaching the
millions who need them.
Popular outrage, political will, market forces and
the best science are enabling the pursuit of a fundamental principle
of public health: the supply of essential medicines on the basis of
need rather than on the ability to pay.
Ladies and Gentlemen,
I have focused so far on the present: what we know
about inequality in health and what they cause in terms of suffering
and economic loss. Let me now turn to the future.
Scaling up our response to the diseases that create
and perpetuate poverty. Creating the conditions which will allow more
equitable access to the information, services and technologies that
have the potential to transform peoples lives. Pursuing a more
inclusive agenda for research and development. These are the
challenges as I see them today.
There are signs that world leaders have grasped the
necessity of such investments. Both the European Commission and the G8
leaders have agreed to targets for reducing the mortality caused by
malaria, TB and HIV/AIDS. Currently, detailed discussions among these
countries’ governments focus on how a new flow of money can best be
disbursed and invested. I would be surprised if we will not see
commitments of substantial amounts of funds by the time the G8 leaders
meet again in Genoa in July.
No matter how low the prices of medicines and
commodities fall, a massive increase in funding is needed to improve
the poorest people’s access to prevention and care for malaria,
tuberculosis, HIV, together with childhood and maternal illnesses.
Most of this money must come through increased development assistance
as well as debt relief. This has to be new money. Early results from
WHO's Commission on Macroeconomics and Health suggest that it must be
of the order of $ 10 billion per year. We can’t take from the little
that is already being spent on other development priorities.
To trigger such a massive increase in funding, WHO
is working with officials from developing countries and donor agencies
to develop new systems for efficient handling and monitoring the use
of resources. For example, we are working with countries to help
improve the performance of their health services to prevent and treat
those at risk, and their capacity to purchase medicines and other
commodities, distribute them and ensure they are well used.
We are talking about a fundamental break from
"business as usual". It will mean that governments go beyond
their traditional avenues for dealing with bilateral and international
questions. By shaping a global response to global health issues, we
are exploring new ways to collaborate.
Some times individual countries take a lead and
inspire others, such as Brazil’s effort to build a comprehensive
care system for people living with HIV.
Some times the world unites to regulate global
negatives, such as the growing sale and marketing of tobacco, through
the International Framework Convention for Tobacco Control, which is
currently being negotiated.
This break also includes a realization that
governments can only do so much. The private sector and civil society
play a crucial role if we are to succeed. New partnerships are formed;
partnerships where all parties are out to find the best possible
solutions. Partnerships that are driven by enlightened self interest,
not charity.
This is the way forward. Often the best
partnerships are those that are forged between unorthodox entities.
When people with vastly different backgrounds come together with a
shared purpose, creativity is released and expertise is used in
innovative and constructive ways.
We see such partnerships taking shape in the
discussions between countries, international agencies and major
pharmaceutical companies to find ways of increasing access to
essential drugs and vaccines.
This is just the beginning. As it becomes more
commonplace to consider health one of the prerequisites for
development and economic growth, along such basics as physical
infrastructure, good governance and a proper educational system, I
expect we will see a wide variety of new interventions and
collaborations. Most of them will involve the private sector in one
way or the other. Many will present governments with unorthodox
challenges, but all - if they are well designed an executed - will
yield significant, measurable, returns in terms of better health and
reduced poverty.
Better health provides people with an opportunity -
both as a good in its own right, and as a means which can enable many
of the world’s poorest to emerge from poverty. Better health is a
duty in the sense that we cannot ignore or condone growing inequity.
But my key conclusion is straightforward: We have an unprecedented
opportunity to make a difference, and we should grasp it now.
Thank you. |
