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Mr
Chairman,
Distinguished
Delegates,
It is a great pleasure for me to be able to address
a congregation of people with such an extraordinary power to improve
global health.
Such a statement may surprise you, since I would
imagine not many of you consider improving public health part of your
job description. But let me spend the next twenty minutes explaining
why I believe that the private sector - and employers in particular -
have a crucial role to play in improving the health of our population.
A few years back, there was a wave of
consolidations and lay-offs in several industries, in particular in
Europe and North America. Always quick to spot a trend, news magazines
like Time and Newsweek summed up the reductions of 10,000 workers
here, 15,000 there as the dawn of an age were new technology would
increasingly make workers superfluous. The possession of technology -
not manpower, would be the critical factor in determining the success
of countries in the 21st century.
Since that time, we have seen the tightest labour
markets for several decades in both Europe and North America. And, of
course, Time and Newsweek, unrepentant as the media always is,
announce in dramatic front-page spreads how access to the right
work-force is key to success in our new century.
We can now return to the basic truths: people
are the most important asset of any economy.
We have all seen the physical manifestations of a
struggling economy - half-completed building projects, with cranes and
steel rods rusting, graveyards of pillaged trucks and construction
equipment, large, empty factory buildings, their yards littered with
scrap metal. It is painful to see such assets wasting away. Yet, the
most serious erosion of resources in the poorest countries of the
world is invisible. Invisible, unless one goes to the overcrowded
hospitals, children’s clinics and the cemeteries.
Over the past few years, a growing body of
scientific evidence shows that a relatively short list of diseases are
undermining the economic and social growth potential of most
developing countries.
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 exacerbated by HIV, takes an annual
economic toll equivalent to $12 billion dollars from the incomes of
poor communities.
Africa's GDP would be an estimated $100 billion
higher today if malaria had been tackled 40 years ago, when effective
control measures first became available.
In addition, childhood conditions, maternal
mortality, and regional scourges, such as sleeping sickness or dengue
fever, kill millions and severely tax the life quality, productivity
or learning capacity for millions more.
But the causative relationship between health and
development can also go the other way. 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.
In one concrete case, plantation workers in
Indonesia were treated for chronic anaemia. Results showed a 20%
increase in productivity, increasing the earnings of the workers and
the output of the plantation.
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 in
development in the poorest countries of this world.
In a globalized world, enlightened self interest
compels both industrialized and developing country governments as well
as 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, good for health and 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.
Despite what the critics may say, it is not
inevitable that globalization will lead to inequity. If it does, it is
a sign of failure. Our challenge is to make positive things happen. To
shape the world. To make certain that the forces of globalization
contribute to a more just and inclusive global society.
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.
Globalization is about much more than trade. It is
about communicating with an infinity of new people, about relating to
them - and therefore also getting involved in their lives.
One large engineering company ran an advertising
campaign some time ago saying that being global meant being local
world-wide. They are right. The international company which sets up a
production plant in Vietnam or Peru may do so based on an evaluation
of economic opportunities, but it will soon find itself having to
relate to the political, social and economic reality of the country it
has chosen to invest in. As communication and social activism become
globalized, large companies find that the welfare of their workers is
important. Ignoring it can be costly both to public image and stock
prices.
But globalization functions on a wider scale as
well. In the modern world, bacteria and viruses travel almost as fast
as money. There are no health sanctuaries. The separation between
domestic and international health problems is no longer useful.
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.
Mr Chairman,
Over the past year, the renewed public concern over
HIV/AIDS and the devastation it is bringing on large parts of the
developing world has brought the link between disease and development
onto the global political agenda.
As many of you know, governments from
industrialized and developing countries alike are coming together with
a coordinated United Nations family to create a Global Fund for AIDS
and Health. This is a new and path-breaking mechanism for action
against diseases that perpetuate poverty.
As a matter of fact, I have taken time out to join
you this morning from a meeting of stakeholders for this new Fund.
Representatives from developing countries, G8 and other donor
countries and a number of other interested parties are meeting here in
Geneva to discuss concrete ways of making the Fund work. I expect that
the momentum this new Fund will create once it is up and running, will
change the way we work on health and development issues in the future.
How can you as employers best play a role in this
massive effort?
Let me use HIV/AIDS as an example.
In Africa in particular, large employers are deeply
concerned about HIV and other health issues among their work force.
The effect of the pandemic is devastating on economic prospects of
some companies - even on whole industries.
In Zambia, for example, 60% of the work force in
the country’s copper mines may be HIV positive. With copper making
up 90% of export earnings and 25% of GDP, the impact of HIV/AIDS is
devastating. In South Africa, it is estimated that, if current
epidemic trends continue, with 1 in 5 workers of the mining
sector infected with HIV, HIV/AIDS will cost the country 1% of its GDP
by the year 2005.
Large employers or employers associations can be a
powerful stimulus for change.
- Companies are directly concerned about their productivity
:
so they need to pay attention to the welfare of their labour force;
-
Companies have a major interest in
national development and human well-being;
-
Companies are influential . By being
open and direct in addressing HIV/AIDS issues they can play a
major role in changing attitudes;
-
Companies can access people who are at
high risk of HIV : They do this in an environment where it is
easy to disseminate information and create positive interaction
among peers.
Large employers can make a major contribution:
By creating innovative schemes to extend and
finance prevention activities, such as providing bed nets and
prophylactics against malaria and condoms and information against
HIV/AIDS and by offering health care services to the whole community,
these large companies can play a crucial role far beyond the people
they directly employ.
But the private sector can also participate in a
range of focused and recently established partnerships, such as the
Global Alliance for Vaccines and Immunization (GAVI), Roll Back
Malaria, Stop TB, Integrated Management of Childhood Illnesses, the
WHO Strategy for Making Pregnancy Safer, the International Partnership
against AIDS in Africa, the Polio Eradication Programme or the Tobacco
Free Initiative.
All of the new initiatives have broken new ground
by involving corporate partners, by mobilizing new resources, by
linking research and in-country action and by setting up systems that
reward well-performing programmes.
Mr Chairman,
Finally, I would like to raise three other issues:
injuries, tobacco and mental health. They each contribute drastically
to the global burden of disease, and they are areas where action in
the work place can make a great difference.
Each year, injuries account for more than five
million deaths globally, but the number of long-term and permanently
disabled survivors of accidents is of course many times higher.
Seven of the fifteen leading causes of death for
men between the age of 15 to 44 are injury-related. The poor are
considerable more likely to get injured than those better off. The
work place is among the places where accidents are most likely to
happen.
But accidents are preventable. Often the smallest
of actions, such as a cover for a moving machine part, protective
glasses or clothing or proper training and information, can cut
accident rates drastically.
We all know that tobacco kills. At last week's
World No Tobacco Day, we focused on the fact that tobacco kills
non-smokers as well.
Scientists agree that there is no safe level of
exposure to second hand smoke. It should simply be avoided. Neither
air conditioning nor separation of smoking areas completely clears the
air. We are all exposed to second-hand smoke nearly everywhere we go.
In our homes, in cafes, in airports, in shopping malls, often in the
workplace.
Tobacco kills half of its users - and half of those
who die do so in middle age - at the peak of their productivity. In
addition, thousands of non-smokers also die due to tobacco. Losses in
productivity, due to the cost of care, are staggering. Making working
environments smoke-free costs little or nothing. The choice for all of
you should be very easy.
Today, more than 400 million people world-wide are
estimated to be suffering at any given time from some kind of mental
and neurological disorder, including alcohol and substance abuse
disorders.
Mental disorders account for more than 10% of the
burden of all disease in 1999. It is one of the dominating causes of
years lost to disease, something too few people realize. The overall
figure is expected to increase to 15% over the next 20 years.
Depression is ranked fourth among the 10 leading
causes of the global burden of disease. By 2020, it will have jumped
to the second place. Between 10 and 20 million people attempt suicide
each year. One million die. That death toll is as high as from
malaria!
In mental illness, prevention and early detection
is crucial and can mean the difference between a short illness and
lifelong disability. Today, we have cost-effective interventions to
treat the majority of mental and neurological disorders. Yet, there is
a great gap between the number of people who suffer from these
diseases and the number who receive treatment and care.
In many countries, insurance companies discriminate
between physical and mental disorders. Labour policies are less open
to welcoming people with a history of mental disorders than those with
physical ones. Often, the mentally ill are outcasts in their local
society
With this discrimination follows stigma, to the
detriment of those who need help, treatment, care and prevention.
Stigma also creates a hidden burden of mental problems, which need to
be added to the burden we can measure. Only when we address the stigma
and discrimination together will we be able to make real progress.
These are not impossible tasks.
Stigma can be reduced by openly talking about
mental disorders in the community and in the work place. But we also
need to constantly counter the negative stereotypes and misconceptions
surrounding mental disorders. Employers have a very important role to
play here.
Mr Chairman,
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 the key point I want to leave you with is this: We have an
unprecedented opportunity to make a difference.
Thank you. |
