Director-General

Presentation of the Jan Evangelista Purkyne Award

Ceremony in the Karolinum Hall of Charles University

Prague, Czech Republic
4 May 2004

Professor Wilhelm, Professor Blahos, colleagues, ladies and gentlemen,

I would like to say a few words about how societies are shaped by individual discoveries and choices. I do not just mean discoveries such as the one made by St Wenceslas in the 10th century that being kind was more inspiring than being cruel, or by Charles IV in the 14th century that Prague needed a university. I also mean the common knowledge and awareness that grow as the result of individual efforts. Jan Evangelista Purkyne probably did not know that he was helping to invent experimental psychology and evidence-based medicine. He was just following up the ideas he found most interesting, and trying to answer questions as they arose.

Likewise there was no way for Vaclav Havel to know that writing about the power of the powerless in 1978 would play such a big part in changing what was then Czechoslovakia and the Soviet Union. He was just engaged in trying to find the best possible answers to difficult questions, like Purkyne and many others, in every generation — like ourselves in our capacities as doctors, administrators, teachers and researchers. That is what is so interesting about making an effort: we cannot know for certain what the result will be until later.

This is partly because it is never one person alone who determines the situation, but large numbers, although they may come to be represented by individuals. A change for the better or the worse depends on personal choices, but they are the choices of many people, not just the few who become famous for them.

I am honoured to receive this award, and well aware that it pays tribute not just to my efforts but to those of very many people. On behalf of all of them, thank you.

My current job is not what I had in mind when I graduated from medical school. I chose to work in a leprosarium in the Pacific Islands because it seemed like an area where I could be sure to make a contribution — just by being a doctor and available to provide treatment and care. In those days early detection and chemotherapy could already prevent deformity and reduce the transmission of leprosy, but treatment had to be long-term, and there were problems with drug resistance.

Health care in its essence always comes down to working with particular human beings, but most disease problems, leprosy included, can only be solved with a public health approach. This had been demonstrated very effectively already in the 19th century, when a cholera epidemic in London was stopped by cutting off a contaminated water supply.

Learning at first hand about the need for well-organized diagnosis and treatment systems led to my involvement with the World Health Organization and its leprosy elimination programme. Then came polio eradication in the Western Pacific, the Children's Vaccine Initiative, and then the global effort to stop the spread of tuberculosis.

These are big programmes, involving millions of people, but it is always the image of particular patients that give them meaning, whether it is Kafka in Prague with tuberculosis or Roosevelt in Potsdam with polio, or a relative or a friend or an acquaintance — or oneself — who is dying or disabled.

Just as systems exist to serve individuals, they need individuals to represent them and run them, or they remain an abstraction that no one can understand. Accordingly, last May the World Health Assembly appointed me as Director-General of WHO, to ensure that the organization continued to have a particular face and sense of direction.

WHO itself was invented to coordinate the work of the world's national health authorities and give that work a coherent identity. In 1946, when WHO's Constitution was drafted, there was no doubt about the need for international cooperation. The alternative had just been fully tried and found to be a catastrophe. "The health of all peoples is fundamental to the attainment of peace and security," the Constitution says, "and is dependent upon the fullest co-operation of individuals and States." WHO had 26 Member States when it came into existence in 1948. Now it has 192. The Czech Republic became a member in 1993.

No modern society can do without the large numbers of men and women working within national and international systems to provide treatment, care and preventive health services. Those health workers in their turn need people who represent them, and signs of recognition. It is a great pleasure and honour for me to be receiving such a warmhearted one now on their behalf from the Czech people through this university. It gives us all the moral support we need.

As I am sure you would like to encourage us to do even better in the future, I will tell you briefly about some of the things WHO is working on.

Later this month we hold our annual World Health Assembly, which will be attended by delegations from all our Member States. Items on the agenda include HIV/AIDS, the WHO Framework Convention on Tobacco Control, reproductive health, and road safety.

We have been particularly concerned with HIV/AIDS because it is the worst health threat the world has faced for several centuries. A global effort to contain this disease is now in progress. A central component of it is to make antiretroviral treatment available to the people who most urgently need it.

Most of the very severely affected countries are in sub-Saharan Africa, but AIDS is also a major concern in Eastern Europe and Central Asia. There has been a fifty-fold increase in infections there in the space of eight years - from 30 000 people in 1995 to 1.5 million in 2003. This is the fastest rate of infection in the world at present - first seen in Ukraine and Russia, more recently in the Central Asian Republics of Kazakhstan, Kyrgyzstan and Uzbekistan. The numbers are easy to say but each one of those cases represents a person whose life has been devastated, to say nothing of their friends' and relations' lives.

In February of this year I attended a European Union conference in Dublin on this subject. Many famous people made good speeches at that event but I think the most important statement was made by someone who was not well known at all. This was Anastasia Kamylk, who belongs to an NGO called "Positive Movement" in Belarus. She told us in a very simple way how she had come to be HIV-positive, and how access to treatment was making it possible for her to live a normal life nevertheless. She also said, however, that she lived in fear of not having access to the right medical care in the future.

There are many statistical and moral arguments to show how universal access to antiretroviral treatment is an absolute necessity, but by deciding to talk about her own experience, she made the case more clearly and convincingly than any of them. She also told us exactly why providing treatment has to be accompanied by building reliable health systems, and how it helps to do this. In fact she made these points so clearly by illustrating them with her own life that I invited her to the World Health Assembly to do the same for the delegations there the week after next.

The WHO Framework Convention on Tobacco Control was adopted last year. It is the first health convention of its kind to be adopted under the auspices of WHO. It has now been signed by 105 countries and ratified by 11. It will come into force when the 40th country ratifies it. The Czech Republic signed last June, and I hope your government will see its way to ratifying it very soon. It is true that everyone is free to avoid smoking or give it up, but it is also true that everyone needs reasonable policies to support them, especially when they are children and adolescents.

That brings us to reproductive health, the starting point for a healthy life. It is particularly associated with the primary relationships of couples, parents and children. If I have enjoyed good health as an adult it was in large part because I was well looked after as a child, in spite of political and economic instability. Where these primary relationships deteriorate health problems increase.

Maternal and child health have therefore always been an important concern for WHO. We work closely with UNICEF, the United Nations Children's Fund, on these issues. This is another aspect of the public health approach, which consists in helping to provide an immediate environment in which individuals can live in a state of health, which WHO defines as "a state of complete physical, mental and social well-being".

April 7 was World Health Day, and this year the theme was road safety. It is a major health issue because over a million people die on the roads each year, and up to 50 million are injured.

The BBC posted a brief historical note that the first person to be killed by a motor car in the UK was Bridget Driscoll. She was 44 years old and a mother of two. She was knocked down outside the Crystal Palace in London on 17 August in 1896. The car was travelling at 12 km per hour. She never knew what hit her. The coroner recorded a verdict of accidental death. Speaking at the inquest, he warned the public: "This must never happen again."

Twenty years ago, Michel Zoller was driving to work when his car collided with a truck. He was not killed but he was in a coma for six months. He attended our World Health Day celebration in Geneva, in a wheelchair, as his injuries have left him paralysed for life. His wife spoke on his behalf, because he has lost the use of his voice. She herself found it very difficult to speak ¬¬— not because of any injury, but because of the trauma of recalling what had happened. Her message was that this must never happen to anyone again.

Safer roads, cars and traffic systems can save many people from disasters of this kind. We absolutely need better systems to protect our lives and our health. But equally important are the choices made by individuals to look out for their own well-being and that of other people.

I chose this subject of how the individual and society interact because it has been such an important factor in your own recent history, and in your case an inspiring one for people all over the world. It has been an important factor in my own country as well, which, when I was growing up was also struggling to define itself in relation to its more powerful neighbours.

Three days ago the Czech Republic became a member of the European Union. This will give you many further opportunities to play a pivotal role in international relations, and for everyone to benefit from it.

WHO will continue to support the health system of the Czech Republic in every way it can. Thank you for honouring me and the World Health Organization in this eloquent way. Please continue to support us. The world's health needs your brains, your courage and your sense of humour.

Thank you.

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