Director-General

Meeting of Commonwealth Health Ministers

Geneva, Switzerland
16 May 2004

Honourable Ministers, colleagues ladies and gentlemen,

I'm delighted to be with you on the eve of our Health Assembly.

Your theme of improving maternal health goes to the heart of WHO's current aims and activities. As well as being the fifth Millennium Development Goal, it is central to achieving the other seven. Improved maternal health reduces injustices and suffering and can be achieved through global partnership.

In addition, maternal and child health are the starting point for lifelong health. For this reason, it is the area in which the health services can make perhaps their most important long-term contribution to individual and social well-being.

Maternal mortality can be reduced by three-quarters by 2015, as the Development Goal recognizes. But, as many women die in pregnancy and childbirth today as they did a decade ago. Ninety-nine percent of these deaths occur in the developing world.

Here in Switzerland, the chances of a woman dying from complications in pregnancy and childbirth is one in 7900. In Sierra Leone the chances are one in 6. The difference is not just because one country is rich and the other is poor. Even in low-income countries, innovative approaches can achieve significant improvements. Sri Lanka, for example, halved its maternal mortality in three years while it was still a low-income country. This was achieved because maternal health was given the priority it needs, by the government and the population as a whole.

In the Health Assembly next week, you will be discussing the strategy to accelerate progress in improving maternal health. The strategy builds on commitments already made by Member States to setting up and strengthening reproductive health programmes. WHO's Making Pregnancy Safer initiative provides the core for this strategy.

These activities will get added attention next year by being the theme of both the World Health Report and World Health Day. The Partnership for Safe Motherhood and Newborn Health has been housed in WHO, here in Geneva, since the beginning of this year. It will provide a wealth of energy and practical knowledge for these events.

In some communities, close to half of the young adults are infected with HIV. They will die in the next few years unless they receive effective treatment. Towards stopping the advance of HIV/AIDS, WHO has launched an ambitious strategy to accelerate access to antiretroviral treatment. The initial target is to get three million people in developing countries on to treatment by the end of 2005. We are working with the health services in countries to achieve this, following a double imperative: universal access to simplified treatment and ever more effective methods of prevention.

The Millennium Development target for HIV/AIDS is to have halted the spread of HIV and begun its reverse by 2015. The ratio of treatment to prevention is not yet known but, if we can ensure that for every case receiving treatment there is just one new case averted, universal access to treatment will make a major contribution to achieving this target.

Reproductive health services are important entry points for prevention of HIV infection through counselling, testing, condom distribution and prevention of mother-to-child transmission of HIV. The treatment initiative, called "3 by 5", is a framework for collective action. It includes WHO and a broad alliance of people and organizations engaged in the fight against HIV/AIDS.

During February and March, WHO deployed staff members to twenty-five countries to assist with making national plans and applications for Global Fund grants. With the help of our partners we have pre-qualified fixed-dose drug combinations and simplified treatment approaches.

The needs are clear and so are the ways in which we can meet them. Scaling up treatment and prevention will break the vicious cycle of disease causing social breakdown which causes further disease. It will start the opposite process, a virtuous cycle, in which restored health rebuilds societies and strengthens health systems, which further protect and strengthen people's health.

An unprecedented amount of political will and financial resources are now focused on the fight against HIV/AIDS, particularly through the Global Fund and bilateral support. Canada announced last week that it is contributing 100 million Canadian dollars to the "3 by 5" initiative, which gives a much appreciated boost to these activities. The work of scaling up the full set of health interventions - prevention, treatment and long-term care - has begun in earnest.

We will make our first detailed progress report on "3 by 5" to the International AIDS Conference in Bangkok in July. In the meantime, this year's World Health Report explains how we are now in a position to save the lives of millions of people from HIV/AIDS and why we must seize this opportunity.

In the fight against tuberculosis, the DOTS strategy has made great progress but we have much more to do in order to reach our current targets. Though the success rate of treatment is high, not enough cases are receiving it.

With our partners in Stop TB, we have embarked on a major effort to bring case detection up to the necessary level during the coming months. The Global Drug Facility is now supplying drugs to treat three million patients through grants and direct procurement services.

The Roll Back Malaria partnership has been restructured. WHO's recommendation of artemisinin-based combination treatment (ACT) for drug-resistant malaria has now received endorsement from a wide range of partners. It is being adopted in many countries. The huge challenge now is to finance and implement treatment and prevention.

The options for treating drug-resistant malaria have received a great deal of attention, but they should not eclipse the need for prevention. Bednets, especially those treated with long-lasting insecticide, can massively reduce the need for treatment.

Our other long-term disease control programmes include polio eradication. Here the key to success will be tenacity, in our colleagues running the immunization campaigns and maintaining surveillance, in the health authorities on whom they depend, and in our donors. We are on the verge of eradication, with just twenty-two cases to date this year in all of Afghanistan, Egypt, India and Pakistan.

On the other hand, we have had setbacks in west and central Africa, with an explosive outbreak that has paralysed over five hundred children. The leaders in these areas have now planned to restart mass synchronized immunization campaigns across twenty-one countries. This emergency measure will require additional resources.

Five million children, who would otherwise been paralysed, will be walking in 2005 because of the polio eradication effort. The addition of vitamin A to the polio campaigns is estimated to have averted over a million child deaths.

Regarding new diseases, there is no way to say yet whether SARS has finally been brought under control, or whether avian influenza will make a comeback in Asia or elsewhere. In April, there were nine confirmed cases of SARS in China. In January, there was a historically unprecedented outbreak of avian influenza (H5N1) in eight Asian countries, with thirty-four human cases and twenty-three deaths. WHO experts provided prompt support for national authorities to contain these epidemics. Their combined efforts have been successful so far.

We cannot know what the next global disease threat will be, but we can be prepared to take action swiftly to prevent or stop an outbreak as soon as the danger is detected.

For this purpose, we have set up a Strategic Health Information Centre at WHO headquarters. It consists of the most rapid and powerful information and communication facilities currently available for the management of crises and outbreaks. This will enable individuals, teams and Member States to take more effective action in emergencies. The Centre will also provide ongoing support for information management and dissemination.

Through our Health Action in Crises programme, WHO is present in most of the areas in the world where armed conflict is going on. Civilians are increasingly the targets and victims in these conflicts. Those who are injured or killed are a small fraction of those who lose their health when essential services break down, especially children, women, and people with chronic conditions. Health workers and health authorities have a vitally important responsibility in these areas, both to limit the damage and to insist that the health services be allowed to do their work.

At the other extreme of our activities, but equally important, is the steady cumulative work of reinforcing health systems through health promotion and disease prevention. This area is particularly important for the early prevention of cancer, cardiovascular diseases, diabetes and other chronic conditions.

The Framework Convention on Tobacco Control, adopted a year ago, has now been signed by 110 countries plus the European Union, and ratified by 12. When 40 countries have ratified it, the Convention will come into force and help governments and health authorities to protect the public from one of today's most serious and most unnecessary health hazards.

We have prepared the Global Strategy on Diet, Physical Activity and Health, for the consideration of the Health Assembly this coming week. When the strategy is adopted, we will work with Member States to implement it according to their particular needs.

I attended the World Conference on Health Promotion and Health Education in Melbourne last month, and was happy to see the high level of support there for healthy lifestyles. Community involvement is a central principle in the health-for-all approach and now, more than ever, it can make an enormous contribution to reducing some of the current major causes of death and disability.

The theme of World Health Day this year was Road Safety. It coincided with the launch of our World Report on Road Traffic Accidents. Globally these cause 1.2 million deaths, 20 to 50 million injuries a year. The majority of these occur in developing countries, where they are increasing rapidly. Member States and the United Nations General Assembly made strong commitments to reducing the number of deaths and injuries that occur on our roads each year.

Last year I pledged to move more resources to the countries we are working in, because it is in countries that the world's health services must be built and maintained. Seventy percent of our overall resources for the biennium of 2004–2005 are allocated to regional and country offices. WHO's presence in countries is being strengthened, particularly through the "3 by 5" initiative. With the regional and country offices, we are planning a number of other moves in this direction.

Strengthening local and national health services is a common theme for all of these activities. These services uphold perhaps the most elementary form of social justice there is, which is to recognize the right of everyone to the highest attainable standard of health. That is the meaning of health for all through primary health care and it begins with maternal health. Your discussions here today can make a great contribution where it is most needed: at the heart of the health services.

Thank you.

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