Address to the Fifty-third session of the WHO Regional Committee for Europe
Mr Chairman, Honourable Ministers, Distinguished Representatives, Colleagues,
I am honoured to be with you here in Vienna, and to join your discussions on our work in the 52 countries of the European Region. Let me thank our hosts, the Government of Austria, and say a word of welcome to the delegation of Cyprus to their new region..
We live in a time of great challenges. I feel a great responsibility being in charge of WHO, an important part of the UN system, and am grateful for your support and expressions of good wishes for success.
The United Nations system is going through a testing time. We were profoundly shocked by the bombing of the UN premises in Baghdad and by the deaths and injuries of so many of our colleagues. Despite these terrible losses, we continue our missions with great determination.
On this 25th Anniversary of the Alma-Ata Declaration on Primary Health Care, it is good to remind ourselves that health is for all. Everyone equally needs health, and, when society fails massively through negligence to meet that need, it is in very serious trouble. I am looking forward to going to Almaty at the end of next month to mark the anniversary.
"Unequal development in different countries in the promotion of health and control of disease... is a common danger," our Constitution says. In some countries, conditions associated with poverty are bringing life expectancy down to 40 years, while in others, wealth and health technology are enabling it to rise towards 80. Inequalities of this magnitude are not just a danger but an injustice which itself undermines human well-being.
The greatest challenge facing us now is the catastrophe of HIV/AIDS. More than 42 million people in the world are HIV-positive. More than one and a half million of them are in this Region, in some parts of which the epidemic is growing rapidly. Each of those infected urgently needs treatment. This has to come through an integrated global HIV/AIDS strategy linking prevention, care and treatment.
I am working with local, national and international partners to design the necessary programmes to treat three million people with antiretrovirals by the end of 2005. "Three by five" will not solve the problem but it will mark the beginning of a solution, and be proof that it is possible. A comprehensive strategy for making this happen will be announced on the first of December, World AIDS Day, three months from now; and our work with countries will be initiated immediately.
We are working with many partners, including UNAIDS and the Global Fund, to mobilize the resources to put these plans into action. We are encouraged by the latest WTO developments concerning better access to medicines. Overall success will require the commitment of civil society, United Nations agencies, the private sector and Member States. Above all, it will require the commitment of each one of us here today.
TB is exploding in parts of Europe, especially drug resistant strains in prisons in Eastern Europe. Rapid expansion of DOTS and more aggressive management of drug resistance is essential. Europe's achievement in eradicating polio last year has made a tremendous contribution to the effort worldwide. The financial support pledged by four countries in this Region, through the G8, will greatly help us to press home our hard-won advantage on this front to complete eradication during this year and next.
The need for health care starts at birth. Protection during pregnancy, childbearing and motherhood forms the core of the health system. Half a million women die every year from giving birth. Skilled attendants are needed in pregnancy and childbirth, with access to emergency obstetric care when complications arise.
Despite the struggle of parents for their children's survival, ten million children in low- and middle-income countries die every year before reaching the age of five. Seven million of those deaths are from five preventable and treatable conditions: pneumonia, diarrhoea, malaria, measles and malnutrition. We can reduce this toll substantially by working with countries to build up strategies such as Making Pregnancy Safer and Integrated Management of Childhood Illnesses. Reducing child mortality worldwide by two-thirds by 2015 is probably achievable. But it will not happen without major rethinking and commitment.
A vitally important part of this entails making the health system work as an integrated whole. Many of the problems that beset adolescence in particular, such as teenage pregnancy, injecting drug use, and violence, are inseparable from maternal and child health. Low birth weight babies are one outcome, rapid transmission of HIV is another. A high prevalence of violence, alcohol abuse and mental disorders, is also associated with this age group.
At the other end of life, the health needs of the elderly have been made dramatically apparent during the heat wave this summer in Europe.
All of this shows the need for integrated health systems at the heart of any viable society - not just as an investment but as recognition of the value of human life and health in their own right.
In addition, good health care calls for good surveillance systems in WHO and our Member States. These showed their effectiveness in the eradication of smallpox and, earlier this year, in stopping the SARS epidemic. They are a key to success now, both for the eradication of polio and for the control of new and re-emerging infections. We also need to finalize the important work on the Revision of the International Health Regulations.
Meanwhile, noncommunicable diseases and injuries account for a growing share - now about 60% - of the burden of disease worldwide. In May, the World Health Assembly adopted the Framework Convention on Tobacco Control. This was a global achievement in the fight against tobacco-related diseases. The Convention has now been signed by fifty countries, and ratified by one, Norway. I urge you all to follow suit without delay. It will give the world the means to protect people from tobacco harm by banning advertising, preventing smuggling, raising tobacco taxes and enforcing more visible warning notices on packages. We must do everything we can to speed the process to the ratification by forty countries that will bring the Convention into force.
The unbalanced nutrition now affecting all societies, rich and poor, poses a major challenge for health. Our objective is integrated approaches that work against malnutrition - from deficiencies and excesses. WHO's Global Strategy on Diet, Physical Activity and Health will be presented to the World Health Assembly next May.
This year's Health Assembly reviewed the work of the Codex Alimentarius and concluded that the health sector should play a more prominent role in setting safety standards for food. The Health Assembly also stressed that developing countries should be given more support to participate fully in the process of international food standard-setting. In many cases, this is a matter not just of food safety but of food security - of ensuring intake of the minimum calories essential for survival and health.
Every year, more than a million people die in traffic accidents around the world making it a leading cause of death in all regions. What is needed is to raise awareness and strengthen our response. World Health Day 2004 will be dedicated to road safety.
All that we are doing has to do with reinforcing national health systems. Our work everywhere is important, but the real centre of it has to be countries. We have to give our country offices more people, more realistic budgets, and more authority. At the same time, we also have to ensure sound management and financial practices, as well as transparent budgeting.
At headquarters, all the Assistant Directors-General are looking at the global issues under their responsibility, to see which of their activities could be better carried out in regional and country offices. Overall, I want to see these changes completed for the 2006–2007 budget. Strengthening country offices is a major objective for me because, having worked for 20 years in WHO, I can see very clearly that strengthening our work in countries is by far the most effective way to help achieve the goals of our Member States. We will work in close partnership with the Regions towards this goal.
Health systems depend most of all on skilled and dedicated personnel, and here we face a major challenge: the brain drain. It is, above all, good staff that will enable us to reach "3 by 5", and achieve the Millennium Development Goals, and everyone is short of human resources. We will be working closely with countries on innovative methods to train, deploy and supervise health workers, with particular emphasis on the community and primary health care level. That is where we can make the swiftest progress in getting results.
In most countries, the systems for providing reliable health information are also inadequate. This is one area in which the trend is on our side: the means for building effective information systems are becoming more powerful and more affordable all the time. I believe this problem can be effectively addressed with the health metrics network being formed by WHO's information partnership with Member States, foundations, the World Bank and UNICEF.
Over the years, WHO has built strong and effective working relations with Member States, foundations, nongovernmental organizations, the private sector and fellow multilateral organizations. Our work depends on partnerships; some long-standing and some more recent. By combining our strengths we can do so much more.
There is a commitment to partnership by global leaders on a scale we have not seen before. At the United Nations Millennium Summit in September 2000, the global community committed itself to eight goals. Three of them were directly about health: to reduce child mortality, improve maternal health, and control major infectious diseases. The five others are about poverty, education, gender equality, the environment and global partnership. All these, as we have seen, have a direct bearing on health.
I look forward to listening to our debate.
Better health for all is our common goal. Let’s work together to achieve this.
Thank you.