Director-General

54th Session of the Regional Committee for Europe

Copenhagen, Denmark
7 September 2004

Mr Chairman, Honourable Representatives, Members of the Diplomatic Corps, Marc - Bonne chance aujourd'hui.

First of all, I would like to add my voice to the many that have been raised in shock and sorrow at the recent events in southern Russia. Crises, whether naturally or humanly caused, require the utmost effort from all of us, both to prevent them and to be prepared to mitigate the damage they cause.

In May, just after the Czech Republic and nine other states joined the European Union, I had the privilege of meeting President Vaclav Havel in Prague. His concern was that the continuing global advance of technology could end up by creating more health problems than it was solving. He recognized the need for what he called 'a planetary organization' like WHO to help guard against that danger.

Equally important is the presence of realistic but visionary thinkers like him and like many others at work now in the 52 Member States of this Region.

The Regional Committee provides an excellent forum within which to share their concerns and ideas and coordinate strategies. Unprecedented potential for health exists in every country of this region and in the whole world, but mutual support is needed to fulfil it. Now is the time both to clarify the big picture and to work out some of the practical details. I would like to suggest three guiding principles to refer to in your discussions: security, equity and unity.

Security in health means protection both from ill-health and from its causes. As we are all too well aware, building and maintaining that security means responding to the urgent needs and dangers now facing us.

Equity has been WHO's fundamental principle from the very beginning, as our Constitution states. It needs to be strongly reasserted now, as the health effects of disparities between communities, nations and continents become more and more evident.

Unity is indispensable for effective action and, in the coming months and years, we will be working more closely than ever before with our partners.

If we are to put these principles into practice we also need to exercise hardheaded realism. The first thing to do is ensure that we have enough money to do our work. During this meeting, you will be discussing the proposed Programme Budget for 2006–2007. There are several important aspects of this budget we need to be aware of.

First, it builds on our experience with results-based budgeting and the lessons learnt from the performance assessment of the 2003–2004 Programme Budget. Second, it reflects the priorities expressed by Member States in recent World Health Assembly resolutions and has been drafted in consultation between the headquarters, regions and country offices. Third, it reinforces and accelerates the decentralization process I initiated last year. You will note that it proposes an overall increase of 12.8%, all of which will be allocated to countries and regions. The largest proportional increase is for the European Region.

The increase is accompanied by measures to ensure maximum efficiency in the use of resources. These measures delegate responsibility while calling for the highest standards of transparency and accountability.

Previous projections of budget growth have been matched by the generosity of our donors, enabling us to achieve the results to which we were committed. But essential activities cannot depend on generosity alone. I am, therefore, proposing an increase of 9% in assessed contributions from Member States.

The increase represents a break with the practice adopted some years ago of zero nominal growth in the budgets of UN agencies, which has been gradually turning WHO into an organization that depends mainly on voluntary contributions. At present, the Regular Budget, consisting of assessed contributions, represents only 30% of WHO's overall expenditure. If the current trend were to continue, it would be only 17% by 2015.

To carry out a well-balanced global policy, a significant regular budget, based on an equitable system of contributions, is indispensable.

The budget question becomes urgent in the context of our General Programme of Work for 2006 to 2015, which defines our activities and role as an organization. It must not only show how we will achieve the health-related Millennium Development Goals but set the directions for the future of global public health.

The Programme Budget and the General Programme of Work will both be on the agenda of the Executive Board at its next meeting in January. Your input through this session of the Regional Committee will make an essential contribution to the Executive Board's recommendations, which then go to the Health Assembly.

To return to the question of security, major outbreaks of disease continue to be a threat to this region and the world. The International Health Regulations are designed to minimize that danger. The revision now in progress has benefited from a high level of input from Member States through the regional consultations. The next step will be to agree on revisions in the open-ended Intergovernmental Working Group which meets from 1 to 12 November at the UN Palais des Nations in Geneva.

The working draft will be available next month. If progress continues at the current rate, the revised Regulations can be adopted at the World Health Assembly in May 2005. The fullest participation possible of Member States in the Working Group discussions will be our best guarantee of success.

This form of cooperation in health began with the First International Sanitary Conference in Paris in 1851, which met to draw up an international sanitary code, mainly to contain the spread of cholera. The long historical perspective is a valuable asset, which is helping the countries of this region to make a special contribution to the drafting of these regulations. Ultimately, the challenge is to ensure that the regulations are followed. This will require strong commitment within regions and countries, with the necessary investment in early warning and response systems.

These systems will be supported by WHO's Operations Centre, which opened in August at headquarters. Using the most up-to-date technology, it enables us to respond rapidly to the earliest signs of outbreaks, natural or manmade and other health emergencies by circulating the information and coordinating the necessary action.

Recently, we have seen early and effective responses to outbreaks of Ebola and Lassa fever in parts of Africa, and to avian influenza in several Asian countries. Laboratories in this region played an important role in the response to SARS and avian influenza. However, we are still in the early stages of building an adequate global outbreak alert and response system. It will require a major and sustained effort of investment. It involves not only the national, regional and global information hubs but also our many collaborating centres in the relevant areas of expertise. A large and important component of the system will be the European centre for disease control, when it opens in Stockholm next year.

We will shortly be contacting Member States with further information on ways in which you can access and add to the information available through these networks.

Inequity is the root cause of much of the danger we face in the world today. Lack of access to AIDS treatment and prevention methods continues to be a glaring example of both insecurity and inequity.

As we saw in Dublin in February and Bangkok in July, Europe is well aware that it has the fastest-growing HIV/AIDS epidemic in the world. Though 30 European countries have achieved universal access to antiretroviral therapy, there are still 22 in which access is partial or almost nonexistent. I warmly welcome your commitment to correcting this in the shortest possible time.

At the Bangkok conference there was plenty of debate over methods of prevention and treatment, but absolute agreement about the need for both. We know that prevention bolsters treatment and vice versa, and that they must be integrated in a comprehensive way.

Globally, with all sources combined, almost 20 billion dollars have been pledged for integrated AIDS prevention and care over the next five years. At the same time, drug prices continue to fall, with the lowest-price triple-drug regimen coming down towards $140 per person per year. HIV treatment is now financially within reach for more countries, and more people, than ever before.

Enormous logistical and technical difficulties remain, but there are signs that they too are yielding to the persistent efforts of our many partners working towards the "3 by 5" target within countries and internationally.

Twelve countries have now set targets for 2005 to get treatment to 50% or more of the people who need it. Guidelines for high-quality treatment using standardized regimens and simplified clinical monitoring are now available. We have developed training and monitoring systems to ensure the quality of treatment, and to increase the involvement of nurses and community workers in providing care and support. Fifty-six countries have appealed to WHO through the Regional Offices for technical assistance in scaling up treatment, ten of them in Europe. We are very actively supporting them. We expect the Canadian Government to give us 100 million Canadian dollars this month. We expect to have at least 20 "3 by 5" country officers in place by the end of this year, greatly increasing our effectiveness on the ground.

Improving human resource capacity is one of our most pressing challenges, not only to support HIV treatment but across the health sector. This means retaining, training and deploying health care workers, and creating new types of treatment supporters, including people living with HIV/AIDS themselves.

The "3 by 5" target itself has also provoked much discussion. What seemed to many like an over-ambitious idea one year ago is now a strong commitment made by many countries, many organizations and many individuals. To speculate about whether we will meet the deadline is to miss the point. The point in the AIDS treatment emergency is the same as in other emergencies: to do as much as is humanly possible to save lives and reduce danger in the shortest possible time.

The initiative has helped to focus the world's attention on dealing with this emergency, and has galvanized action within our own organization. We must not relent in our efforts to reach the target for treatment and to accelerate HIV/AIDS prevention well beyond December 2005. I am committed to continuing to mobilize all the human and material resources at our disposal to support you in this.

On other campaigns, Europe has been a great strength in the polio eradication effort, both by achieving eradication regionally and by supporting the work in Africa and Asia. That continuing support will be indispensable in the coming months.

Tuberculosis control remains a top priority for Europe. Though some countries are progressing well towards full implementation of the DOTS strategy, others are lagging dangerously behind. Rapid scale-up of DOTS is urgently needed. Otherwise, vulnerable populations will be at increasing risk of multidrug-resistant TB, as well as the growing co-epidemic of TB and HIV. In both cases, treatment becomes difficult and expensive.

As we see in the case of HIV/AIDS, malaria and tuberculosis, making adequate health services available where they are needed is an enormous challenge in itself. But it is only one part of what it takes to promote health for all. Health also depends to a very significant extent on socially determined factors such as the environment, education and employment. As we saw in June, in Budapest, at the Conference on Environment and Health, intersectoral action is not only a necessity but an area of enormous potential for health.

Knowledge about how these factors affect health enables us to target our activities for maximum effect. To gather and consolidate the evidence needed for effective policies, the Commission on the Social Determinants of Health will begin its work in December. Europe has already done pioneering work in this area, and your regional and country-level input will make a very important contribution to the Commission's work.

The WHO Framework Convention on Tobacco Control, also aimed at tackling social and economic determinants of health, is proceeding steadily towards coming into force. It has 168 signatories, which include the European Union and 40 of the 52 countries of this region. Globally, 30 countries have become parties to the Convention. With the European Community's formal confirmation of the Convention in June, we now expect to see quick developments. Six of the 30 states parties are in this region: Hungary, Iceland, Malta, Norway, San Marino and Slovakia. I urge all the rest of you to follow their excellent example without delay. When the Convention has been ratified by 40 countries it can start to fulfill its great potential for saving lives.

The value of international negotiations and intergovernmental processes has been made clear in the case of tobacco. For the WHO Strategy on Diet and Physical Activity, the work is still in its early stages. In May, the Strategy was strongly endorsed by the Health Assembly and it too has far-reaching implications for health. As countries take up its recommendations, international knowledge-sharing and mutual support will be a vitally important asset for preventing and controlling noncommunicable diseases. Europe's strong contribution to this effort has been vitally important and will continue to be so, both for this region and for the world. Preventing and controlling obesity, in particular, will require innovative and vigorous intersectoral work.

It is research that has led to public recognition of these problems and of the ways in which they can be tackled. The Ministerial Summit on Health Research, to be held in Mexico in November, will attempt to accelerate the same process for other causal factors of disease, especially those that block the way to the Millennium Development Goals. I urge you to attend this meeting. In addition, the Sixth Global Conference on Health Promotion will be held in Bangkok in August 2005. Its title will be Policy and Partnership for Action. Unity is the key to achieving the security and equity the world so desperately needs now. In the coming months, our focus on maternal and child health will provide special opportunities to achieve it.

A large number of key organizations have combined forces to tackle the problems in this area, especially high mortality rates. Their first step, earlier this year, was to draft a road map for attaining the Millennium Development Goals for maternal and child health. The World Health Report and World Health Day for 2005 will build on this momentum. We are working closely with our colleagues in UNICEF, UNFPA, the Partnership for Safe Motherhood and other organizations.

The focus on maternal and child health is reinforced by our country-specific cooperation strategies, which are aimed primarily at strengthening health systems. Here each programme and each level of activity is defined in terms of how it can contribute to national health development goals through one WHO country budget and plan. The European Region has made a good start on this. While speeding up the decentralization process, it is giving a strong sense of direction to our work.

This Regional Committee itself has made a vital contribution to building unity in Europe over the years. Your wise decisions, recommendations and suggestions, during this session will enable it to continue to do so for many years to come.

I wish you every success. Thank you.

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