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Distinguished Ministers,
Respected Chair,
Regional Director,
Ladies and Gentlemen,
Those who attacked New York and Washington on 11
September have brought unbearable grief. Their behaviour shows a
contempt for innocent lives - a ruthless use of pain and fear to
achieve their ends. They offend against everything for which we - as
public health professionals - stand.
We are proud of the thousands of doctors,
paramedics, nurses and psychologists who came together over the past
two weeks and are working ceaselessly to ease suffering and heal
wounds - on the bodies of those injured, and inside the minds of many
as they cope with the horror. These health workers face an enormous
and daunting task. Yet their dedication and stamina is an inspiration
to us all.
Those who attacked New York and Washington also
provoked widespread fear, threatening the basic building blocks of our
human security.
Fear - whether as a result of cruelty, of violence,
or of disease, undermines trust among people - and between
groups and communities that need to function together. It undermines
the safety and predictability we all need to grow,
develop and prosper. It undermines our very belief that people are
good - not evil, the belief that is essential if we are to give
meaning to what we do. It undermines our freedom to engage with
others to improve our societies.
Within this context of fear, our global community
is being tested as never before.
Can nations continue to work together to tackle the
great problems that affect the future of humanity?
Can they sustain the impetus for freedom and
democracy so that all people can live and grow together?
Can their leaders control the forces that provoke
terror and promote human values?
Can we all maintain the campaign against global
poverty, so essential for our global future?
Poverty is the most significant determinant of
suffering and grief in today's world. We must carry forward the fight
against global poverty with all the energy we can muster. We know that
poor people are bound to remain poor if they lack physical and human
security. This means that freedom from terror, violence and disease
are critical foundations for poverty reduction and a secure future for
our world.
Colleagues,
We are all part of a vast global community working
for a world free of suffering and fear. We know that good health - and
accessible health care - are vital for peace and security. We work
together for the common good, seeking the best ways to bridge the
health divide. As we confront economic hardship and ever shifting
world priorities, we are inspired by the knowledge of what can be
achieved. We know of numerous success stories, catalyzed from within
civil society, supported by governments and NGOs, sustained through
health systems and backed from within the UN. Like the pioneering
efforts to promote health or eradicate measles within this Region,
they often do not get the headlines they deserve.
Many of the world's leaders have put health at the
center of development action, because they recognize that investment
in health is a critical contribution to the human and economic
development of their nations.
Health professionals are responding to this new
visibility by striving harder.
We are doing more to roll back the diseases - like
HIV and malaria - that undermine well-being among poor and
marginalized populations. We focus particularly on the needs of women
and children.
We are ruthless in our attack on leading risk
factors for ill health, such as tobacco, violence and unsafe
environments.
We are reforming health systems so that they are
effective, responsive and fair for all.
And we work hard to ensure that development
policies in all sectors contribute optimally to better health.
In all these ways, we make a vital contribution to
reductions in poverty and human security.
Chair,
At the end of last week, US Secretary for Health
Tommy Thompson spoke of the increasing incidence of post-traumatic
syndrome following the wounds suffered on 11 September. He said that
this would require "increased counseling and mental health
services throughout the country," and "a lot more
funding." Indeed, the mental well-being of millions of people is
threatened by trauma, fear, stigma and uncertainty.
This year WHO launched a global campaign to end the
stigma surrounding mental health - stigma that denies people access to
the health care they need, leads to discrimination in job, housing and
other opportunities, and - still too often - to the neglect of the
area by health planners.
We have invited health professionals, voluntary
organizations and governments everywhere to stop excluding the
mentally ill, and to "Dare to Care".
The response is impressive. The World Health Day
this year showed an overwhelming desire and determination in almost
every country to strengthen health systems so that they offer better
mental health services, and to work through the media to increase
awareness and reduce stigma.
The countries of Latin America declared that they
would reform mental health policies in Caracas in 1990. Their
principles are right. The current and future burden of mental ill
health has been under-estimated. To respond, we need better strategies
for mental health. These should include access to effective prevention
and treatment and a focus on the family within its community.
Strategies are set out in more detail in this year's World Health
Report.
Chair,
WHO’s Commission on Macroeconomics and Health
will report at the end of the year on the need for dramatic and rapid
increase in action to improve the health - and prospects - of the
world's poorer people. Commissioners will indicate the levels of new
resources needed. At least ten billion dollars a year: perhaps as much
as twenty five billion.
We have heard commitments to the better health of
poor people from world leaders at this year's World Health Assembly,
at the UN General Assembly Special Session on HIV/AIDS, at regional
summits, and at the G8 Summit in Genoa. Governments, voluntary and
private bodies are undertaking to increase resources for health
action.
No government, agency, voluntary body or pressure
group can make a big difference to health through working alone. So we
link action and advocacy, through working both with civil society and
the political leadership. We encourage productive exchange between
Ministers of Health and Finance. We seek regular dialogue between
governments and providers of external resources within donor agencies,
foundations, development banks and voluntary organizations. We
increase effectiveness through joint efforts of groups within and
outside government, and alliances with the private sector that are
based on shared goals and values.
We know that the resources available for health
will never be enough. So we must use what we have as effectively as
possible. That explains our emphasis on coordinated action by
governments, research institutions, private sector companies and
international organizations.
We seek that elusive mix of shared goals and
strategies, respect for each others' mandates and priorities, and the
need to reflect "comparative advantage" in all that each of
us does.
The power of shared goals and synergy in health
action is remarkable. On the other hand, consequences of poor
coordination are measured in human suffering, and that - for all of us
- is a clear sign of failure.
Chair,
We must all do more to reduce the impact of HIV on
human security. When Heads of State met together in New York in June,
there was powerful political commitment to a much stronger response.
We agreed on priority strategies to halt the spread of HIV infection.
We made commitments to help individuals better protect themselves from
infection, and to increase the number of people who can access care
for HIV-related illness.
Within this Region there are examples of strong
responses to HIV infection that offer care for people with HIV using
well-tested and effective treatments. They take advantage of the
increasing availability of low-cost anti-retroviral medicines - made
possible through the combined efforts of national governments,
pharmaceutical companies, NGOs and the manufacturers of generic
medicines.
As a result, the regional response to HIV is firmly
anchored within the health system, involves the full range of health
professionals, and reflects a comprehensive approach. Increased access
to care is reported to improve the impact of preventive actions -
particularly among those most at risk - and reduce the proportion of
hospital beds occupied by persons with HIV.
HIV infection and AIDS still pose extraordinary
challenges for the Americas and the Caribbean. We must intensify
efforts to reach those in need, particularly in poorer communities. We
must always confront stigma and discrimination, two adversaries of an
effective health system response. We must remember that special
efforts are needed to reach women, especially adolescent women, and
help them avoid the twin threats of HIV infection and reproductive ill
health.
WHO is scaling up its contribution to the struggle.
Our goal is to help identify more effective responses and support
their implementation in ways that take account of people's cultural
traditions and social realities.
TB is spreading globally, in the wake of HIV. I
expect to meet with many of you next month here in Washington at the
first Stop TB Partners' Forum. We will find a way forward for the
global partnership. We should also agree strategies for better
implementing country actions to Stop TB in pursuit of national and
global TB control targets.
The omens are good. Prices of key TB drugs,
including some needed to fight multi-drug-resistant strains, are
falling. Observed treatment regimens are working. We know better, now,
how to reach everyone who needs affordable treatment. And, national TB
action plans have been developed, though they do need financial
resources.
The Global AIDS and Health Fund will help national
health systems respond better to HIV, TB and malaria. In helping with
the design and operation of the Fund, WHO will seek to ensure the fund
has a global reach, uses resources effectively, and builds capacity
for sustained and effective action within countries. It is vital that
the fund's effort are successful and that it is in a position to
attract the kinds of resources it needs for years to come. It can't
just be a flash in the pan.
Chair,
Health systems within this Region are being
reformed. System goals are being defined, and a diversity of private,
voluntary and public channels is being used to deliver essential care
to those in need.
In many countries, health financing questions
dominate the agenda. The challenge is to extend financial risk
protection while ensuring that services provided are of good quality.
WHO is developing model health financing policies for use by countries
as they address such issues. Much is being learnt from the quality of
care initiatives now under way within the Region.
As stewards for health, governments are accountable
for the extent to which the health system's outcomes match up to the
goals they have set and for getting the best from their health systems
with the funds available. This explains the increasing importance
given to effective health system stewardship within this Region.
Health stewardship involves difficult decisions:
WHO offers decision makers technical guidance based on global or
regional analyses of health issues. For example, we are now pulling
together benchmark information about the contribution of different
risk factors to people's health, and the cost-effectiveness of
different population-based health interventions.
Health stewards are also dependent on reliable
intelligence from within their countries. This has to cover both the
burden of disease experienced by different population groups, and ways
in which the health system responds.
Decisions about when to respond to specific health
threats are best based on reliable population-based information.
Within this Region, countries are working together on national disease
surveillance and response systems.
These national systems are networked together as a
global system, backed by WHO, with expertise, pre-positioned resources
and support from more than 250 laboratories. The global system is
linked to the International Health Regulations - the legally-binding
instrument which governs the reporting of epidemic-prone diseases and
the application of measures to prevent their spread. The global system
also has the capacity to work with countries - investigating dangerous
pathogens and confirming case diagnoses.
Scientists and laboratories from this Western
Hemisphere are critical to the global disease surveillance system.
They have also joined the international response to many outbreaks -
including containment of the largest recorded outbreak of Ebola, which
began in Uganda in October last year.
Surveillance is critical, within this Region, as we
respond to the threat of dengue and dengue haemorrhagic fevers.
Responding is not easy. There is no simple effective intervention for
preventing and controlling dengue, and - again - the key is joint
action through organizations working in partnership.
As with malaria, the nature and combination of
these actions may vary from country to country. But what is universal
is the need to mobilize political commitment for doing what is
necessary to control the spread of Dengue, and the suffering it
causes.
Surveillance becomes all the more vital as we must
prepare for the possibility that people are deliberately harmed with
biological or chemical agents. The right response is important.
Protocols for containing the resulting disease outbreaks - whether
caused by anthrax, haemorrhagic viruses, other pathogens, biological
toxins or noxious chemicals - are available to the medical profession
through the WHO web-site. During the last week we have upgraded our
procedures for helping countries respond to suspected incidents of
deliberate infection.
Chair,
Within this Region, PAHO's programme of supporting
national health information systems has contributed to the range of
indicators available for monitoring health system performance.
At the same time, many countries have indicated the
need for internationally standardized methods for data collection. WHO
is responding with support for regular national health surveys through
helping countries adapt different elements of the protocol for the
World Health Survey developed during the last year.
Another kind of information may be needed to help a
Head of State, or Health Minister, answer the question "How well
is our health system working", and to permit the comparison of
health system performance between different provinces or states within
a country. To this end, WHO has been working on composite indices of
health system performance which take account of the extent to which a
health system produces health, responds to people's expectations, is
fairly financed and contributes to equity.
Preliminary results were published within the World
Health Report 2000. Many Member States valued this new approach,
though some also have had questions about methodology, data sources,
ranking procedures and utility. Concerns were expressed in this
Regional Meeting last fall.
At the Executive Board in January this year, I
proposed a series of consultations on approaches to assessments of
health system performance, a peer-review of the methodology used by
WHO, and the provision of expert advice on how to take this work
forward. This is now under way, and many of you are involved.
I also note the recent wish by some countries that
this review be expanded to cover measures like
"disability-adjusted life expectancy" which have been in use
for some years, and recently renamed "healthy life
expectancy".
I am taking a personal interest in the
consultations and peer review, and will be submitting a report based
on their findings to the Executive Board in January 2002. I anticipate
that we will then be able to conclude on a well-accepted approach for
the assessment of the overall performance of national health systems
to be published by WHO in 2002.
Chair,
Tobacco continues to be a tremendous threat to the
health of people throughout this Region. Yet, I must commend the
Region, and Dr Alleyne in particular, for the expanded emphasis on
activities to reduce tobacco use over the past few months.
I am pleased to see the number of countries taking
action to reduce the number of young people who begin smoking, or to
help those who wish to quit to do so. You will agree that much more
needs to be done given the increased efforts by tobacco companies to
circumvent these efforts. 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.
I am particularly encouraged by the efforts of
Brazil's Health Minister José Serra to find a common approach among a
group of Latin American countries in Rio during November.
We face other controversies as well as those
associated with tobacco. Public-private research partnerships,
regimens for disease management, the revision of lists of medicines
essential to tackle priority health problems, strategies for procuring
quality medicines at low cost, and recommendations on nutritional or
environmental health issues are all the subject of intense debate.
Member States want increased interaction with the Secretariat on these
issues - both directly, and through the Executive Board and the World
Health Assembly. The challenge is to ensure that WHO's normative work
always reflects the best available evidence, while enabling Member
States to debate ways in which this normative work is taken forward.
Further controversies surround the difficult
choices made by health professionals about how to allocate resources
for health. These are complex, and frequently have ethical dimensions.
Human Genome studies show that not only are we all
of one race with one shared humanity and gene pool: despite our
diverse builds, colours, shades and shapes we are more alike then we
ever thought. Our common nature needs protection and nurturing. That
is why I would like to upgrade WHO's work on ethics, and - in the
words of the US Surgeon General, David Satcher, make sure that
"our ethics are as good as our science".
So we will gear up to support Member States more on
health and ethics - to help with Ethics in Public Health and Health
Research. We will also address ethical aspects of biomedical science,
including work on the human genome, stem cell research and cloning.
The initiative will link up with other UN system agencies,
particularly UNESCO. Initially, it will report directly to me. I look
forward to discussing plans with the Executive Board and the Health
Assembly next year.
Chair,
All our 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 center 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.
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
link effectively with the global initiatives established in support of
country action.
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.
Chair,
As health professionals, the challenges we face
today are greater than ever. We are united in our struggle against
poverty and inequity, and intensifying our response. We know that the
actions to tackle terror, hunger and disease will require careful
decisions and sensitive responses. Demands for humanitarian action are
already on the rise, and we can expect them to increase further.
The WHO secretariat will respond as best it can to
the legitimate expectations of all - wherever they live, whatever
their beliefs, whether wealthy or poor, woman, child or man - in ways
that reflect our underlying respect for the dignity and potential of
all people everywhere. This is what all people expect of our
Organization, and the professions we represent.
I wish you well as you take forward the important
agenda of this week, and of the coming year.
Thank you.
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