Director-General

Meeting of Commonwealth Health Ministers

Geneva, Switzerland
17 May 2003

It is a pleasure to join you once again at this Commonwealth Meeting before this year’s World Health Assembly.

We have a demanding agenda ahead of us, as we are in the midst of tackling the first new infectious disease epidemic of the 21st century – SARS. We talk often about the globalization of health. SARS, with its alarmingly rapid spread, epitomizes that concept. In a matter of weeks, this new coronavirus has travelled from one small area in China to countries on five continents. Almost 8,000 people are known to be infected. More than 600 have died. Due to infection of staff, hospitals have been paralyzed, entire nations made afraid.

But despite the fear of the unknown, despite nurses and doctors falling ill, and despite the differences in health systems, a global effort has identified this disease in record time and has helped contain it in many places.

Due to this global effort, we now see vastly improved situations in most of the areas which were hit earliest and hardest. In Vietnam and Toronto the outbreak is over. In Singapore and Hong Kong, new cases have substantively slowed.

By issuing a global alert early, by coordinating a global response, by sharing information and expertise, and by nations recognizing that each has a responsibility to protect not only their own populations, but the global community from SARS - we are demonstrating that this first epidemic of the 21st century can be contained. This is global public health at its best.

However, we are not finished yet. We must support China in its efforts to curb the spread and contain it. And, until that is done, SARS is still just a plane ride away from many countries. I urge continued vigilance everywhere. We do not want to see SARS get a toe-hold in countries which can least afford it, likely already struggling with a huge burden of other diseases.

Our response to SARS demonstrates our strengths. But it also points to areas where we must improve, not only for SARS, but for infectious disease identification and control world-wide. More capacity for surveillance and response. Regional laboratory networks linked to a strong global network. Hospital infection control. Capacity at country level – for it is the people on the front-lines – those who don the masks and treat the patients, who must be trained, and who must know how to protect themselves. I see this as the single most important challenge today – to have a public health system that is robust enough to respond to new threats as they arise, while delivering effective interventions against existing diseases that will help lift the poor out of poverty. Another powerful message resounding from our experience with SARS is the firm link between health, trade and economics. If they didn’t see it before, Presidents, Prime Ministers and Finance and Trade Ministers, are now seeing first-hand the impact of health on the economic, social and political fabric of nations.

For we know that support for public health is not just a moral obligation - it is sound economics. The Report of the Commission on Macroeconomics and Health, chaired by Professor Jeffrey Sachs, showed quite simply that disease is a drain on development and that, conversely, investments in health are a concrete input into economic development. Health may in fact be the single most important component for development in Africa. The emphasis, throughout, must be on results: on investing money where it makes a difference. The real challenge is to mobilize the necessary resources and technical expertise to make improved public health a central pillar of humanitarian and development policy. The Commission's Report is the first detailed costing of the resources needed to reach some of the key goals set in the Millennium Declaration. We are talking about an annual investment of $66 billion from the year 2007. Most of this will come from the developing countries’ own resources. But about half must be contributed by the rich countries of the world - in the form of effective, fast and result-oriented development assistance.

Malaria alone is still killing 3,000 African children every single day. The recent WHO Africa Malaria Report launched on Africa Malaria Day last month, details the growing malaria burden on the continent, affecting the poorest people the most. It tells us that one out of every five deaths of children under five is a result of malaria. The tools to reduce this exist – insecticide-treated bednets and effective drugs – but too many families simply do not have access. Donors and endemic countries alike must scale up efforts, to prioritize and invest in malaria control. Through the Global Fund to Fight AIDS, Tuberculosis and Malaria we have a tool to turn resources into effective action. Let us use all our opportunities.

Certainly, investing in training for people is essential. We must think about the immediate needs – skilled birth attendants to help mothers through safe deliveries. Doctors and nurses to help care for those ailing with HIV/AIDS, malaria and other diseases. And we must think to the future, to the professionals who will help care for an aging population. The brain drain is a well-known phenomena. We must all work together to ensure medical professionals have incentives to stay where their skills are most needed.

Another key investment for the future – adopting the Framework Convention on Tobacco Control. Simply put, smoking and other tobacco use is killing people. By 2020, at current rates, tobacco will kill twenty people every minute. Ten million every year, in all corners of the world. But by joining forces globally, we can stem this daunting increase.

This Wednesday, we have the opportunity to mark, and to celebrate an historic milestone for global public health. When it comes into force, the Tobacco Convention gives participating nations the legal muscle to ban advertising, to raise tobacco taxes, and to enforce the use of more effective labels. The Convention also asks that financing be made available, to assist poorer countries in their efforts to stop the tobacco epidemic.

It has been a challenge to bring it this far. But the long months, the late nights of debate and legal expertise required to arrive at a common text, have resulted in a Tobacco Convention which could substantially reduce tobacco deaths for lifetimes to come. I urge you all to adopt it, to quickly bring it into force and to take the actions which will save so many lives.

By facing tobacco head-on, we are dealing with one of the major risk factors for non-communicable diseases. This year, through a broad consultation with Member States, civil society, industry and UN agencies, we are also devising a strategy aimed at reducing the overall burden of chronic diseases including cardiovascular disease, overweight and obesity and the diseases they foster. At the request of our Member States, the Global Strategy on Diet, Physical Activity and Health will be presented to World Health Assembly in 2004. This demand again shows that the world is increasingly prepared to mount global responses to global threats to public health.

Today, you are examining other areas which, if acted upon now can also shape global public health in this century. Ensuring the best possible health for children and adolescents is key to a healthy and more secure future. 10.8 million children under the age of five died in 2000. One out of two children died of a preventable communicable disease, likely exacerbated by malnutrition.

Children and adolescents in poor families are affected most. Our work must support them. We must also pay special attention to the young people who fall out of the usual line of sight - those who must resort to life on the streets, subject to exploitation, those who are disabled, or those caught in man-made or natural disasters.

We must remember that a child born healthy, who remains healthy, has much more likelihood of bearing healthy children. The life-course approach must consider not only children today, but the health of children in future generations.

To be serious about child and adolescent health means ensuring mothers and their newborns are cared for and well. Good nutrition, at all stages of young lives, makes the difference between a child who can withstand measles and other diseases, and those who will die from them. Immunization, integrated management of childhood illness and school-based programmes will protect children from communicable diseases. Young people must be protected from injuries, including those caused by violence. Adolescents need guidance to help them through difficult moments – when drugs, alcohol and tobacco might tempt them. Support for mental health – from infancy to adulthood are crucial. And a healthy environment – where children live, learn and play – is the foundation for it all.

This afternoon you are also examining violence. In 1996, the WHA first declared violence a leading worldwide public health problem. The groundbreaking World Report on Violence and Health, released last October by WHO, showed us that every day 4,000 people around the world die violently. Homicide, suicide, and conflict cause the most deaths. And, those that survive may be disabled, or psychologically traumatized. Sadly, it is pervasive in countries the world over. Domestic violence for example, depending on the country, has affected anywhere from one, to seven of ten women. The Report on Violence offers recommendations on interventions that can work to prevent violence. While the risk factors resulting in violence are complex, the world does not have to accept it as an inevitable part of the human condition.

Of course, all countries cannot tackle all of these issues at once. In southern Africa, people are facing poverty, extreme food shortage and drought, compounded by the devastation of HIV. Humanitarian assistance is crucial in the short-term. But we need to recognize – at the national, regional, and international level - that there will be no enduring solution to southern Africa’s challenges - or any troubled region for that matter - without a serious, steady and sustained commitment to investing in people. The people now struggling against the odds should be able to look forward to prosperous and healthy lives once the worst is over.

I look forward to further looking at all of these issues with you, and many more, in the ten days ahead. Access to medicines and pricing, intellectual property rights, measles control, the risks to polio eradication - and important administrative issues, including the budget.

Member States are here representing almost every nation in the world. The world is watching and counting on the WHA to move the public health agenda forward in a way that will benefit a globalized community.

Thank you.

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