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Madam Chair,
Dr Danzon,
Distinguished Ministers,
Ladies and Gentlemen,
We were all shocked by the dreadful events that
took place in the US this week. We feel deep sorrow over the tragic
loss of life and terrible human suffering. In these circumstances, it
is all the more important that we strengthen ways in which we work
together at all times. We must pursue the principles and values that
have always guided our work for world health.
You have already heard a detailed report from the
Regional Director, and discussed several issues of common concern that
he covered. I shall therefore concentrate on a few themes that I know
are relevant to this Committee.
The challenges of ill-health and poverty have
already taken a central place in your discussions. You will not be
surprised to hear me reiterate that illness denies millions of people
the chance of achieving their life potential. The plight of these
"denied millions" is a profound challenge to the world's
leaders as they shape the world for future generations.
Within the European Region the number of people who
are classed as poor has increased in the past decade. As you have
already indicated, poverty features within even the most prosperous
Member States. Health inequalities within, and between, societies have
repercussions for all who live within them. Globalization means that
the consequences of poverty can also be felt far away, influencing
both health outcomes and people's perceptions about their prospects
for a healthy future.
Yet - as we meet here today - the divide between
the haves and the have-nots continues to widen. Only a privileged few
have access to the fruits of innovation and new technologies. This gap
is painfully clear within the European Region, in countries that are
starting to see positive economic growth rates after a decade
characterised by dramatic declines. The challenge facing you, the
health leaders of the region, is to take advantage of the upturn and
start to bridge the health divide.
The WHO Secretariat is helping you as you respond
to the challenge. We share your commitment to improving all people's
access to effective health systems. This means a focus on individuals
and communities most in need. Ensuring they can access essential
health care. Health promotion. Vital commodities. Means to ensure that
health professionals provide good quality care to individuals and
populations. Enabling the public, those who make decisions about
service provision, to access information that is useful. Supplying the
technology which makes this information available. Building the
infrastructure and institutions that power health systems. Setting up
mechanisms to increase the likelihood that these systems work as they
should. We know that you want more of WHO. We are gearing up to
support you as best we can.
Colleagues,
However it is defined, poverty is the most
significant determinant of ill health. At the same time, there is
increasing evidence that unless poor people enjoy good health, their
prospects for emerging from poverty are reduced. Hence the growing
recognition that freedom from ill health is an important foundation
both for poverty reduction and for human security.
Within the last year we have seen growing global
awareness of the need to invest much more in the health of all people.
Effective investments in equitable health outcomes are now recognized
as critical for the human and economic development of disadvantaged
societies.
This new thinking has been carefully analysed by
WHO’s Commission on Macroeconomics and Health and the six working
groups that support it. The Commissioners, led by Professor Jeffrey
Sachs of Harvard University, are due to publish their report at the
end of the year. I expect them to call for a dramatic and rapid
increase in the intensity of action to improve the health - and
prospects - of the world's poorer people.
Nations are already starting to respond to this
call. They are undertaking to invest more in health, building on
efforts that are already underway when these are shown to work. They
seek additional resources from elsewhere - from donor agencies,
foundations, development banks and voluntary organizations. They
nurture partnerships based on shared goals and values, bringing
together groups within and outside government. They seek new - and
principled - alliances with private entities. For they know that no
government, agency, voluntary body or pressure group can mount the
response alone - certainly not without combining efforts with both
civil society and its political leaders.
The international community is responding too, and
not just with words. At this year's World Health Assembly, at the UN
General Assembly Special Session on HIV/AIDS, and at the G8 Summit in
Genoa, we heard firm commitments to an increase in the level of
resources available for global health. Governments, voluntary and
private bodies are already making new commitments.
The levels of new resources needed for health are
enormous. At least ten billion dollars a year. This means that
whatever resources are available must be used as effectively as
possible. To do this, we in WHO bring governments, research
institutions, private sector companies and international organizations
together. We do this in ways that promote synergy of goals and
strategies. We recognize that such alliances are uneven, and may
change over time. We appreciate that each party has its own
priorities, its need to be seen to be effective, and its comparative
advantage.
But when different organizations come together to
promote health and well being, they are frequently affected by what
each other does. Consequences of poor coordination are measured in
human suffering. WHO sees poorly coordinated international assistance
as a sign of failure. On the other hand, the power of shared goals and
synergy can be quite remarkable.
The Global AIDS and Health Fund will be an
important stimulus to coordinated international health action. It is
planned that the Fund be operational by the end of the year. WHO sees
the need for this Fund to live up to its name and be a global
fund. This means that it should bring benefits to people in need
within all regions, including this one.
We anticipate that the Fund will encourage the more
effective operation of under-funded health systems. This means
improving the capacity of a variety of different provider groups to
deliver essential services and goods through a diversity of private,
voluntary and public channels. The emphasis must be on stewardship by
governments, even in complex emergencies, so that quality is assured
and intended benefits reach poor people.
Many countries have initiated health system reform.
It is clear that if reforms do not lead to better results, they have
not succeeded. There is much experience of focused - and successful -
health system reform within this region. The work of the European
Health Observatory offers analysis and syntheses from which we are all
learning.
Health system reform is unlikely to succeed without
popular involvement in health action at local, national,
regional and global levels. This calls for credible and upbeat
programmes of advocacy and catalysis. Experience within this region
shows that professional leaders, politicians, the media and public
figures all have a critical role to play in movements for health -
whether in cities, in workplaces, or in schools. Typically,
governments and local authorities work with NGOs, professional
associations and the media. All recognize the need to work together -
to "make the forces of globalization work for the secure future
of humanity ".
Madam Chair, Distinguished Representatives,
The world's leaders have focused on the devastating
impact of HIV infection, and acquired immune deficiency syndrome, on
our global society. The challenge of AIDS concerns all health
professionals. In this region the absolute infection rates are still
relatively low. That is good news. But if we do not act now, in a
decisive and concerted manner, the news will turn bad very quickly.
Several countries in Central and Eastern Europe and among the Newly
Independent States, are already seeing worrying increases in HIV
infection rates. Ten years ago, we saw similar figures in some African
countries. Our collective response was not sufficient to halt the
increase. The dimensions of the human and economic consequences faced
by the people of some nations are extreme. We must prevent a similar
catastrophe in this Region.
The UN General Assembly Special Session on HIV/AIDS
in June this year addressed the strategies and interventions that can
halt the spread of HIV infection. All of us are committed to
responding better - helping people protect themselves from infection,
and increasing the proportions of HIV-affected people who can access
care for their illnesses.
Scaling up calls for an extraordinary and
courageous response.
We must intensify prevention efforts that focus on
known risks, and be guided through better surveillance of infections.
We must do this in ways that respect people's rights and dignity. We
must improve access to effective diagnosis and therapy as part of the
overall response to HIV.
I have directed that WHO scales up its contribution
to the struggle. Our goal is to help identify more effective responses
and implement them in ways that take account of people's cultural
traditions and social realities.
Linked with HIV/AIDS is the spreading epidemic of
TB in this region. Last November in Moscow, I was able to observe
personally the tragedy of TB spreading through prison populations and
the growth of multi-drug-resistant TB.
Recently, the Global TB Drug Facility has been able
to reduce drastically prices of key TB drugs, including some needed to
fight multi-drug-resistant strains. Observed treatment regimens are
showing their effectiveness. We are making progress in laying the
conditions for reaching everyone who needs it with affordable
treatment. Countries will be able to draw on this progress as they
develop their action plans. We are looking forward to reports of
progress at the upcoming Stop-TB Partners Forum in Washington next
month.
Colleagues,
WHO has catalysed - and now supports - a range of
partnerships for health action. The Global Alliance for Vaccines and
Immunization is already having an impact. The polio eradication
campaign is making outstanding progress: in large parts of the
European Region, polio is already considered a threat of the past. The
isolated cases discovered in Bulgaria earlier this year remind us that
none of us are really safe until the whole world is declared
polio-free.
WHO also facilitates action by others that can have
a far reaching impact. This summer we presented a new initiative to
improve access to health information. Specifically, WHO has helped to
set up an agreement between some of the major international publishers
of biomedical literature to make around 1000 journals available free
of charge through the internet. Thousands of health professionals and
researchers are thus enabled to access vital information. Several
countries in this region are participating in the initiative.
Colleagues,
Within the European Region, WHO has taken the lead
in work on environment and health, with particular emphasis on the
health of children, transport and health, and - importantly - better
access to potable water and safe sanitation. Lessons from EURO are
being applied in other WHO Regions by a range of committed partners.
WHO is now working with you all to address the
burden of mental ill health and brain disorders. In most countries the
resources and the manpower available to tackle mental ill health are
sparse. But new and more effective means are now available to
treat and prevent brain disorders and mental illness. As a result,
modern mental health care is focusing more on supporting the family
within the local community. It is geared to prevention, early
detection and treatment and uses effective and relatively inexpensive
medicines.
Europe has come relatively far in developing and
implementing new strategies for prevention and treatment of mental ill
health. Some countries' efforts stand as models for a more effective,
professional and also a more humane approach to mental ill health.
But, as most recently pointed out in the "Declaration of
Athens" in June this year, there is still a long way to go also
in this Region before our knowledge about prevention, effective use of
medication, community support and reduction of stigma and
discrimination is turned into action that will improve the lives of
the millions who suffer from mental illness.
The forthcoming World Health Report, to be released
on 4 October, will provide a global overview of the current and future
burden of mental ill health and its main contributing factors. The
report offers strategies for ensuring that effective prevention and
treatment are both put in place and adequately funded.
This Region has taken the lead in focusing on the
potential for alcohol to damage the lives of young people. Many of us
met to plan a response in February at the European Ministerial
Conference in Stockholm.
The background to that meeting was serious. There
are alarming signs of worsening drinking habits among young people
across the whole region. I am very pleased to see signs of a response
to this challenge. A clear declaration has been adopted. Some
countries have already implemented new policies - involving young
people in the policy making process, and keeping a proper distance
from commercial interests.
I am also pleased that the European Union adopted
two alcohol-related measures in June that are in line with the
European Alcohol Action Plan. The EU called for international
cooperation - particularly with WHO - to monitor progress and share
experiences.
Colleagues,
Tobacco continues to be a tremendous threat to the
health of people throughout the European Region. I am in
particular concerned by the rapid increase in tobacco-related diseases
and deaths among women.
Many countries in Central and Eastern Europe and
among the Newly Independent States have become major targets for the
tobacco industry in their search for new markets. But I am pleased
that WHO is working with countries to implement responses that help
reduce the number of young people who begin smoking, or help those who
wish to quit to do so. Much more needs to be done. That is why
governments must remain fully engaged in negotiations of WHO's
Framework Convention on Tobacco Control - until the Convention has
been finalized, hopefully in 2003.
We are now confronted, each day, with controversies
about access to health care, and to the results of medical research.
Much biomedical research is now carried out in the
industrialized world, and is primarily market-driven. This is
ethically unacceptable. Unless this pattern is changed, the knowledge
and technology gap between industrialized and developing countries
will widen. The health needs of poor nations will fail to get the
attention they deserve.
WHO’s research programmes help bridge this divide
through building international networks that involve researchers from
all over the world, working together in ways that maximize the
probability of success. Researchers from the countries of this Region
are playing a key role.
However, health professionals within the region are
constantly involved in difficult choices about how to allocate the
resources they control. These are complex, and frequently have ethical
dimensions.
WHO's Regional Offices and departments in
Headquarters are helping countries start to handle complex ethical
issues such as codes of conduct for research involving human subjects.
It is now time to draw together this work.
I therefore propose to establish a WHO-wide
initiative on health ethics, based - initially - in my office. It will
focus on Ethics in Public Health, Health Research Ethics and Biotechnology
Ethics. It will address ethical aspects of work on the human
genome, stem cell research, cloning and other ethical areas of
biomedical science. It will help increase Member States' capacities to
handle ethical issues, and to provide support for inter-governmental
action - whether within the UN, regional institutions, or through
partnerships with institutions like the Council of Europe. We will
work closely with the UN General Assembly, other UN agencies
(including UNESCO) and draw on some of the pioneering work being
undertaken by this Region's Member States and the European Regional
Office.
Colleagues,
In March, I addressed an important meeting on food
safety in Uppsala.
There, I outlined three major challenges in the
area of food safety for Europe:
- We need to accept that the systems we use in Europe to ensure
food safety are not as good as we have come to believe. To improve
these systems and re-establish consumer confidence, we must
reassess them all the way from the farm to the table;
-
We need to ensure reasonable food safety
standards that apply throughout the world and assist all countries
to reach these standards. In the long run, this is in our own
interest. Unless we do so, developing countries cannot participate
in global trading systems;
-
We must develop global standards for pre-market
approval systems of genetically-modified food to ensure that these
new products not only are safe, but also beneficial for consumers
and more efficient than existing products.
I am glad to read of the regional initiatives on
food safety that have been taken forward with support from WHO -
particularly the role of Ministries of Public Health in championing
the interests of consumers within regulatory processes and legal
frameworks.
Colleagues,
All WHO's work is for countries, but only a
part of it is in countries. Country work, though, is critical,
and our country representatives are at the centre of all we seek to
do.
We are committed to improving the capacity of the
WHO teams in countries who need us most, so that they are better
equipped to contribute to better and more equitable health outcomes.
WHO country representatives and Regional Offices will play a central
role in making this happen. They will build on our recent experiences
with establishing strategies for cooperation with individual
countries, and this Committee's decision to increase the emphasis
given to effective country-level working.
The work of WHO's Regional Offices and departments
in Headquarters is summarized within the corporate strategy for WHO's
Secretariat that was agreed by Member States during 1999. This is the
basis of the General Programme of Work for 2002-2005.
During 2000, the Secretariat established a
Strategic Programme Budget, identifying 35 areas of work across the
Organization. This formed the basis for the expected results,
milestones, activities and allocation of regular and extra-budgetary
resources for the 2002-2003 biennium.
I will be working with the Regional Directors over
the coming months to develop a proposed set of global priorities for
the next period, 2004-2005. We will draw on your deliberations at this
Regional Committee. My proposals will then be presented to the
Executive Board when it meets in Geneva in January 2002.
WHO and the European Union are natural
collaborators in the field of health, and I am very pleased with the
way our cooperation has developed over the past two years. The
cooperation is expressed through EU Member States' links with WHO’s
European Regional Office and our Headquarters in Geneva. In addition,
WHO’s collaboration with the European Commission is being enhanced
through the Exchange of Letters that was signed late last year. This
builds on a very open and positive dialogue between us - on the new
policy framework for action on major communicable diseases and access
to medicines, and in the fields of tobacco control, environmental
health and food safety.
The Exchange of Letters will enable us to establish
a broad and systematic collaboration on a wide range of issues. It
provides for annual meetings at the political and technical levels in
order to take stock of the existing cooperation, review priorities and
build plans for the future.
Colleagues,
As health professionals, we all face enormous
challenges. People's expectations are greater than ever. We respond to
their legitimate expectations in ways that promote equity of health
outcomes and contribute to reductions in levels of poverty.
These values underlie all our actions - as WHO
Member States and as the Secretariat.
Let us work together for a constructive and
successful meeting, and for effective health action throughout the
Region in the coming year.
Thank you.
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