|
Ladies and Gentlemen,
In the modern world, bacteria and viruses travel
almost as fast as money. With globalization, there are no health
sanctuaries.
Even the richest of countries cannot isolate
themselves to keep out infectious diseases. The separation between
domestic and international health problems is no longer useful. Two
million people cross international borders every single day, about a
tenth of humanity each year. And, of these, more than a million travel
from developing to industrialized countries each week.
This is an accelerating trend. It is not only the
infectious diseases which spread with globalization. Changes in
lifestyle and diet, stimulated through mass marketing, prompt an
increase in rates of heart disease, diabetes and cancer. The use of
tobacco is also marketed across the globe. 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.
Let me summarize the impact of global illness and
risks to health.
First - sickness and death. Excessive levels of
disability, illness and death are experienced by the billions of poor
people in our world.
They are also undermining the development of whole
societies. High levels of HIV/AIDS infection, tuberculosis and
malaria, maternal illness and injury, childhood illness and
non-communicable diseases, are all undermining the productivity of
nations.
Then we experience interference with international
trade. The spread of new variant Creutzfeldt-Jakob disease through
BSE-infected meat products has had devastating consequences for
agriculture, particularly in Britain. The economies of countries like
India and Peru have been severely dented by outbreaks of plague and
cholera.
We have seen the economic and political
consequences of the possibility that biological and chemical agents
can be used as weapons.
There are other impacts too, such as the way fear
of illness affects the choices people make in their daily lives,
and their perceptions of what the future holds in store.
A good diet, access to clean water and sanitation,
protection against mosquitoes and other disease vectors all provide
people with a sense of security. This is increased through ready
access to effective health care, with essential medicines and
functioning services. The person who enjoys good health can expect to
live long, and to have some confidence about the future. She or he is
better able to shape the future than one who is persistently exposed
to the risk of illness and counts only on good fortune to survive the
next rainy season.
A dramatic rise in the risk of illness - as a
result of an epidemic, for example - provokes fear, especially among
those who have minimal access to services. The threat of the
intentional spread of illness is frightening too.
Fear - whether as a result of cruelty, of violence,
of disease or as a malicious combination of all three - undermines
people's ability to trust those who are charged with
safeguarding their societies - particularly their governments.
At the same time, fear and mistrust - whether
between peoples, or between nations - are stoked by divisions in
society. The most pernicious division is the gap between the haves and
the have-nots. Within today's world, eighty per cent of the population
struggles to survive while the other twenty per cent live in robust
affluence. This gaping injustice is painfully evident to the millions
who are worst off. They die young, suffer more and miss out on so many
of life's opportunities. Such poverty steals hope, breeds despair and
provokes frustration.
I sense there is new hope for change. At the
millennium summit in New York, the world's Heads of States agreed on a
set of global development goals. Earlier this year, in Monterrey, they
agreed to start mobilizing the funds for achieving these goals. Donor
governments showed a new willingness to support national development
efforts that are effective and deliver results.
It is no coincidence that the Monterrey consensus
comes at a time when we are confronting those who are bent on sowing
fear and uncertainty in our midst.
Not long after September 11, British Prime
Minister, Tony Blair, said "The test of any decent society is not
the contentment of the wealthy and strong, but the commitment to the
poor and weak."
How can we reflect such a commitment? In 1999, I
asked leading economists and health experts from around the world, to
come together and consider the links between health and economic
development. Five months ago, this Commission on Macroeconomics and
Health delivered its Report, based on the work of several hundred
leading scientists. It concludes, quite simply, that disease is a
drain on development, and that investments in health are a concrete
input into economic growth and global security.
The Commissioners estimated that an annual
investment of US$ 66 billion over fifteen years could save eight
million lives each year, and create six-fold returns in the form of
economic growth. Of that annual investment, more than half could come
from developing nations themselves, leaving foreign development
assistance with an annual bill of US$ 29 billion.
The Commissioners argue that such investments would
bring immediate benefits to countries now shaken by the AIDS epidemic,
burdened by high malaria transmission or affected by non-communicable
diseases and injuries. Children with better health will get better
education. This lays better foundations for lower population growth
and a democratic society.
The implication of the Commission's report is that
investments in people, and their health, is the cornerstone of good
development policy. But, it has a cost. Electorates are wary of
empowering their legislators to increase development assistance. They
need convincing that it can be effective. We who do the work must be
called to account.
Within WHO, we are working with donor nations, as
well as public and private sector partners, to develop funding
mechanisms that are driven by results. The Global Alliance for
Vaccines and Immunization has blazed a trail. And the new Global Fund
to Fight HIV/AIDS, TB and Malaria is showing great promise.
Right now we are working with comparatively small
sums of new money - a few billion dollars a year. Much more is needed.
But when we compare it to current investments in defence, barriers to
trade, and the bills for international relief and reconstruction
efforts as a consequence of armed conflict and failed states, our
suggested annual outlay of US$ 29 billion for health looks
fairly modest.
There are some who question whether good
development policy is also good foreign policy. What is the political
advantage, to a wealthy nation, of investing in global health? How
does it compare with the application of sanctions, the supply of
peacekeepers and the promotion of good government? Are not the
outcomes of investing in health frustratingly vague, imprecise and
long-term? The simple answer is NO.
Careful investments in health serve as a bridge for
peace. Last November I visited North and South Korea. The leadership
in both countries value their collaboration to reduce malaria and TB
in the North. They see it as a key opportunity to re-establish
communications and nourish a dialogue and will use such campaigns to
melt ice that has built up between them.
The global polio eradication campaign has
successfully negotiated days of tranquillity to carry out mass
immunizations, offering opportunities for further dialogue among
warring parties.
Investments in health are also good for diplomatic
relations. The Scandinavian countries have made conscious decisions to
offer long-term support to many nations, particularly in Africa. We
stuck with them while they sought to protect their health systems
against the after-effects of economic and political change in the
80's. We called for structural adjustment with a human face, and
proposed that a minimum of 20% of development assistance be earmarked
for the social sectors. We promoted access to essential medicines,
reproductive health care and safe pregnancy. We were quick to help
countries confront the emerging horrors of HIV/AIDS. We made similar
investments in education, environment, women's rights and civil
society.
We can now see the fruits of this investment. They
have brought real benefits to people, especially when their
governments made the right policy choices. The investments also helped
train some of the leaders of today, and those leaders remember that
the Scandinavian nations stood by them during hard times. Not easily
quantified, I grant you, but it is a reality.
Questions are being asked, even in Scandinavia. Is
it reasonable to be in the lead, alone? Why are other rich nations not
following suit? Monterrey is one step forward. Now, let’s stay our
course and convince others!
The challenge is to demonstrate the benefits to all
those whose taxes make them possible.
Friends,
That is not the only challenge. We also need to
come to terms with new demands being made on those who implement
foreign policy. The lines between diplomacy, trade, development
assistance, defence, environment and health have blurred.
Trade negotiators have scrambled to understand the
intricacies of access to medicines. Defence attaches have taken
crash-courses in the epidemiology of smallpox, anthrax and botulism.
Development economists struggle to measure the economic effects of
malaria. Diplomats are learning the intricacies of treating people
with AIDS. Whether we like it or not, health is deeply embedded in
foreign policy, and set to stay there.
The separation of foreign and domestic policies are
becoming blurred, too. School children and chat-show guests debate how
trade can be fair. Rock stars speak out on the evils of globalization.
Companies vie with each other to show corporate responsibility -
seeking to convince their workforce and their customers, as well as
the activists. This is reflected by legislators who want to be engaged
effectively on the global scene.
Governments are responding by reshaping the
international architecture. New global mechanisms are designed to
bring real benefits to those in our global village who are most in
need. New tools and collaborations feature in the lexicon of foreign
policy. Public-private partnerships for life-saving medicines and
technology. New thinking about patents and pricing structures, seeking
to ensure that poor people can access the medicines they need. Doha
was just the beginning.
New - and effective - alliances have been put in
place to help countries identify, and respond to, global health
threats. WHO is supporting them, but we do not run them.
We are hosting regular meetings between governments
as they negotiate a new Framework Convention for Tobacco
Control to curb the ability of tobacco companies to market their
lethal products wherever they wish. We anticipate it will be ready by
next summer. We are now preparing to revise the International Health
Regulations, and this - too - will require intense negotiation between
governments. The work will be done by foreign policy specialists, who
are now boning up quickly on the intricacies of health legislation.
Diplomats from wealthy nations are having to keep
pace with a changing agenda, and move into uncharted waters. They no
longer argue that it is "outside their national interest" to
be involved in international health issues. They are showing new
leadership, and drawing on their reserves of wisdom, to grasp new
opportunities. They focus on results as well as process, fighting to
avoid supporting initiatives that are destined to wither and be
ineffectual. Global health is now firmly embedded in their objectives.
Their next challenge is to find better ways to meet
the costs of investing in health. Few are yet prepared to support the
concept of global taxation to pay for security in the face of health
threats. But what is the Global Fund to Fight HIV/AIDS, TB and
Malaria? Is it not a voluntary levy for enlightened self-interest?
It is now no longer a question of whether to make
investment in global health an element of foreign policy. It is a
question of how to turn policy into measurable results - and how to
ensure the benefits reach future generations of world citizens. That,
I sense, is our challenge for the weekend.
Thank you.
|
