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Distinguished
Ministers,
Respected
Chair,
Regional
Director,
Ladies and
Gentlemen,
It is a great pleasure for me to be here in Riyadh.
Last year, we were in the new Regional Office building in Cairo and I
was delighted to join with Ministers from the Region and Dr Gezairy
for the formal opening of the office in March.
This is an important meeting - held against a
background of a sombre global mood, of high tension and of much fear
among millions of people in this region and around the world.
On Monday, I told the health ministers of the
Americas meeting in Washington that 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.
It is a reality the people of this region
understand well.
Within this context of fear, our global community
is being tested as never before.
How can we help nations to continue to work
together to tackle the great problems that affect the future of
humanity?
How can they be encouraged to sustain the impetus
for freedom and democracy so that all people can live and grow
together?
How can their leaders be supported, in order to
control the forces that provoke terror and promote human values?
How can all of us work together, maintaining our
vital campaign against global poverty, so essential for the future of
our world?
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, oppression
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, discrimination 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 deepening economic
hardship, we are inspired by the knowledge of what can be achieved. We
know that when governments, society and local organizations work
together in support of health action, success can be achieved. WHO has
a key role to play. Often, our joint efforts do not get the headlines
they deserve.
Many leaders put health at the center of human
development. They recognize that health is a critical contribution to
national development.
Health professionals are responding to their call.
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 promote human security.
Chair,
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 to foster a
context within society that promotes mental health, strengthen health
systems so that they offer better mental health services, and to work
through the media to increase awareness and reduce stigma.
Displacement and exile can cause stress and trauma.
So can violence and terror. Considered one by one, these are
experiences that need much attention and care for those affected, if
they are to have the possibility of surviving. But we are not talking
about isolated cases here. We are talking about thousands.
And yet I remain optimistic. For rarely have we
seen such willingness to work with and for people in complex
emergencies. Our accumulated experience and knowledge has grown over
the past decade. We know more about what needs to be done – and what
must be avoided.
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.
Earlier this year, during my visit to Pakistan, I
visited projects initiated under the Basic Development Needs
Initiative. In Iran, I witnessed an impressive, community-based health
infrastructure. Later during this meeting, we will hear more about the
Healthy Villages Initiative that our colleagues from Syria will
present. I know there are other innovative and novel initiatives and
practices that can stand as inspiration and model for the whole region
in our efforts to do more with always too limited resources.
We, at Headquarters, need to learn from such
initiatives to improve the Organization's ability to respond better to
needs for country-based poverty reduction work.
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,
WHO has an important function to perform before,
during and after emergencies. Our role is to assist nations with
accurate assessments of damage and needs. It is to ensure the best
possible coordination of agencies involved, and to make sure that
long-term health perspectives are built into the emergency relief, so
that money spent on an emergency can benefit long-term development
needs. And afterwards, we in WHO need to help countries share their
experiences.
Long-running conflicts and natural disasters,
combined with endemic country vulnerabilities have resulted in massive
population upheavals and migration throughout the Region. Afghanistan,
the Palestinian territories and Somalia, face economic uncertainty in
addition to alarming rates of mortality, morbidity and disability.
Moreover, the situation in Afghanistan is compounded by the effects of
the worst drought in 50 years and the prospects of an approaching
severe winter.
As with the rest of the UN agencies, the lack of
international staff within Afghanistan and the difficulties of
communication with our national field staff make it very difficult to
assess the health needs, as well as provide needed services. I would
like to commend our staff, in particular the Afghan nationals who are
working under very difficult circumstances to bring essential health
services to those who need it.
Nevertheless, WHO is continuing to scale up the
international effort to respond to the needs of the Afghan people, and
supporting the neighbouring countries as they struggle to cope with
the current crisis.
We have continued to provide support to Iraq within
the framework of Security Council Resolution 986, In addition to drug
and medical supplies, the operation also covers rehabilitation of
health facilities, water quality control activities and strengthening
of medical education.
In the Palestinian territories, the Regional Office
has played an important role in supporting the administration's health
system's ability to cope with the morbidity and mortality as a result
of the latest violence there.
We are doing our best to fulfil the role expected
of us in this region at the moment. We will do our outmost to reduce
suffering caused by emergencies and conflict in the months to come.
Despite the dark clouds of the ongoing emergencies,
we are also witnessing a shining light on the horizon of public
health. I am talking about the eradication of polio. Globally, we are
witnessing a public health sensation. Millions of children have been
immunized through repeated campaigns. Surveillance has been built up
to a level previously thought to be impossible. Hundreds of thousands
of volunteers have been mobilized around the world. They have worked
hard under difficult conditions, especially in conflict affected
regions.
The efforts now made to ensure the eradication of
polio are among the largest and most impressive public health
interventions the world has witnessed. Last year alone, 550 million -
85 per cent - of the world’s children were immunized. The Global
Polio Eradication Initiative, has reduced the number of cases by 99
per cent. 3,500 cases were reported world-wide in the year 2000. So
far this year, there were only 309 confirmed cases of polio globally.
This means that three million people in the developing world, who
would have been paralyzed, are walking today.
We are making progress in this Region. In the past
few days, health professionals and volunteers in Afghanistan and
Pakistan have been carrying out National Immunization Days under
extremely difficult circumstances. When I visited Pakistan in March, I
witnessed the dedication and energy of these brave and tireless
workers. But with the possibility of large movements of people and a
high level of insecurity and tension in the countries where polio is
still endemic, we are facing a formidable challenge indeed if we are
to reach our goal of certification of global polio eradication by our
target date.
Through the polio campaign, people are seeing how
health action brings results. In years to come, benefits of this
action will stretch beyond the eradication of polio. Health systems
will have been strengthened and made more effective. Public health
programmes will have a viable infrastructure. Thousands of health
personnel and volunteers will take on new tasks with pride and
commitment.
Let the progress with polio inspire us when we take
on other great challenges.
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.
In this region, the infection numbers are
relatively low, although they vary greatly among sub-regions. But WHO
has taken the lead in reminding Member States of the speed in which
infection rates can climb, first among vulnerable groups and later in
the general population. The good fortune and cultural cohesion that
have protected many populations within this region thus far must not
lead to complacency.
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 some of you next month in Washington at the first
Stop TB Partners' Forum. We will find a way forward for the global
partnership. We should also agree to 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,
Within this region, you have worked hard to improve
your health systems. System goals are being defined, and a diversity
of 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.
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.
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.
Surveillance is critical, also within this Region,
as we respond to the threat of Rift Valley Fever and other outbreaks.
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,
Many countries have indicated the need for
internationally standardized methods for data collection on health
system performance. 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.
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 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,
This region has taken many innovative steps to
reduce the spread of tobacco. I am particularly pleased to see
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 encouraged by the strong support countries in the region
give in the current negotiations to creating as strong and effective a
Framework Convention as possible.
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 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. Headquarters
and regional staff participated together in formulating the WHO plans
for country support
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 defining the expected results,
milestones, activities and allocation of regular budget resources for
the 2002-2003 biennium. We are now seeking better alternatives for
extra-budgetary finance for each region to assist with the planning of
country programmes.
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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