Second Consultation on Macroeconomics and Health

Geneva, Switzerland
29 October 2003

Honourable Ministers, Delegates, Colleagues,

It is a pleasure to welcome you all again to this main part of our consultation.

Health continues to make headlines. The outbreak of SARS earlier this year showed us that a disease outbreak has consequences that go beyond health, and can include profound economic loss, social disruption, and political difficulties. SARS also showed us that it is imperative that we work together to overcome such challenges.

Collaboration is just as important nationally as it is globally, and is demonstrated by this extraordinary gathering. I cannot think of another occasion when we have hosted such a diverse and influential group.

Many countries are implementing the recommendations of the Report of the Commission on Macroeconomics and Health. Its message was simple: one of the most effective ways to reduce poverty is to improve health. The fatalistic argument that health was unaffordable for most people was discredited. In robust economic terms the opposite was shown to be true: it is the neglect of national health systems that is unaffordable. In fact it ruins countries and communities, probably more effectively than any other negative force. That argues powerfully for investment in health infrastructure, human resources and technologies on a far larger scale than was previously thought necessary, or even possible.

The global community had already acknowledged this fact by agreeing to the Millennium Development Goals a year earlier. The welcome increase in official development assistance for health during the last two years is probably due in part to this clearer understanding of what is needed. But it is still only a very small fraction of what is required every year to reach those goals. For instance, at the current rate of expenditure it will take not 12 but 150 years to reduce child mortality in Africa by two thirds.

The CMH Report rightly said that AIDS would "devastate society and cripple economic development in Africa and other high-prevalence regions unless brought under control". It estimated the total costs for prevention and treatment combined at US$ 14 billion a year by 2007. The need is widely recognized. The possibility of meeting it, especially through the use of antiretroviral therapy, is well known. Yet at present, in sub-Saharan Africa alone, there are 4 million people who need that therapy and only 50 000 who are getting it. This spells catastrophe, not only for the societies hardest hit, but for the world as a whole.

It led us last month to declare a global health emergency caused by the failure to get these medicines to the people who need them. WHO is committed to the goal of “3 by 5” – getting 3 million people in developing countries on antiretroviral treatment by the end of 2005. The 3 by 5 effort now under way is designed to bring care to those in the most urgent need of it, and in so doing help to reverse one of the most dangerous trends in the world at present. In highlighting the 3 by 5 initiative I am not saying that this is our only priority. There is much work to be done in many other areas. But 3 by 5 provides several examples of the way in which we must change the way we work.

By focusing on results. Our measure of success will be health outcomes for the poor. We must therefore improve our tools and systems for measurement, and use these measures for better management.

By being realistic about resource needs. Human and financial resources are the pillars of any health system. Lack of them is the main obstacle to progress. Health care budgets remain inadequate in most developing countries, and the financial burden on the poor is unacceptable. But the value of investment in health extends far beyond economic returns, to the social benefits of healthy families and communities. Many countries also lack human resources. Many skilled workers are leaving the public health services in search of better career prospects, contributing to this crisis. A recent report released by the Stop-TB Partnership showed that 17 of the 22 high-burden countries found their efforts to reach their targets hampered by staffing problems. But during a recent visit to one country, a WHO 3 by 5 team discovered that 4000 nurses were currently unemployed due to macroeconomic policies that have restricted the recruitment of health workers into the public sector. 3 by 5 is the catalyst that can mobilize these nurses by refocusing policy and providing a national health framework in which they can be effectively used.

By working with greater speed and determination. There are only 795 days remaining till the end of 2005. But the SARS epidemic was stopped in 120 days. Emergencies and outbreaks force us to work in different ways. What we have learnt from one emergency we can apply to another.

And finally, 3 by 5 will strengthen health systems by coordinating their work. The people now making a huge contribution to health care come from a wide variety of sectors, professions and types of organizations, as this meeting here today illustrates. Civil society, business and academia are playing a vitally important part in making health systems work. But the leadership and principles must continue to come from those charged with the responsibility of ensuring the well-being of the society as a whole — i.e. the government.

We are sending 3 by 5 emergency teams into several countries. These teams need to be fully engaged with the national CMH commissions. They can help you to provide a specific and urgent focus for your work on mobilizing resources. And you can help them with two kinds of coordination: to organize the political and economic support needed, and to ensure that this effort complements other national health priorities rather than competing with them.

We will work with International Financing Institutions and highly-indebted countries to transfer debts to increased investments for 3 by 5 and other health needs. These other health needs include the fight against TB and malaria; the completion of polio eradication; prevention of tobacco-related and other noncommunicable diseases; and the reduction of maternal and child mortality. Poverty Reduction Strategy Papers provide an important opportunity to reflect these important health priorities in intersectoral approaches to poverty reduction.

Madam Chair,

Last week I was in Kazakhstan to celebrate the 25th Anniversary of the Declaration of Alma-Ata, which challenged the world to recognize the needs of all people, and to meet them by applying the principles of primary health care. We reviewed some of the achievements that followed with the health-for-all movement, as well as some of the setbacks, and some of the ways in which the world has changed since then. In particular, the world’s demography, epidemiology, health financing, and information systems have changed dramatically. But the principle that health is for all people without exception remains a constant in our work. It does not change. Likewise it is an unchanging fact of human life that every society needs strong health systems based on primary health care.

Now, as before, reaching the poor requires a clear sense of social justice combined with imagination and innovation. I congratulate the organizers of this consultation for providing such a great opportunity for thinking and acting creatively. I look forward to hearing your specific proposals on how we can combine our strengths and support each other's work on strengthening national health systems.

Thank you.