Director-General

Russian Academy of Science

Overview of WHO

Moscow, Russia
21 October 2004

The 40 children in this orphanage are all on antiretrivirals provided by the Minister of Health, Russia.
The Director-General visited this orphanage in St Petersburg, as part of his official visit to Russia in October 2004.

Ladies and gentlemen,

It is a pleasure to be with you to share ideas about health in the world today and the role of science in health work. I can begin the discussion by telling you a little about the World Health Organization and what it is trying to achieve. Then I will be happy to try and answer your questions, and perhaps ask some of my own.

Foundation and purpose

The World Health Organization was founded in 1946 as a specialized agency within the United Nations system "to promote and protect the health of all peoples". The founders could see that unequal development in health in different parts of the world was a danger for the whole world. WHO came into existence officially on April 7 1948, when 26 of the 51 Member States of the United Nations had ratified its Constitution.

First 30 years: optimism

In the early years of WHO, many people thought that science and technology would solve the world's health major problems. Global campaigns were launched to control sexually transmitted diseases with penicillin, malaria with DDT, and smallpox with vaccine. The development of chemotherapy for tuberculosis and leprosy, and a vaccine for polio, soon added to the optimism.

In the 1970s the global eradication of smallpox was achieved. It was celebrated as a great victory for modern science and social solidarity.

Alma-Ata Declaration, 1978

Although it was clear that science could do wonders, many people were still dying from curable and preventable diseases. The emphasis shifted to social justice as the way to make the benefits of health science accessible to everyone. In 1978 the Declaration of Alma-Ata brought east and west together in an effort to achieve this globally through primary health care. The slogan was ‘Health for all’.

From 1978 to the present: challenges

In the 1980s major difficulties became apparent. Malaria resisted prevention efforts mainly because use of DDT had to be limited. Tuberculosis became harder to treat mainly because of drug resistance. A new disease, AIDS, had appeared, which science and technology were powerless to prevent or cure. It was spreading rapidly throughout the world.

In the 1990s two further difficulties arose. Centralized health financing systems controlled by government began to fail. Privatization schemes solved some of the problem but were unable to ensure equal access to health services. This was linked to the rise of chronic diseases and ageing populations, which increased the cost of care.

In response to these challenges, our current work is focused on three related areas: security, justice and unity.

Security

Last year SARS made the world highly aware of the danger of a global pandemic. SARS was controlled by an effective emergency response. It involved the combined effort of scientists and health professionals in many different countries. This kind of danger is still with us, however. There is the strong possibility of a global pandemic of avian influenza unless we very quickly find the means of preventing and controlling outbreaks in the Asian and Pacific regions.

In addition, we have to respond to disasters caused by accidents, conflict and natural events.

WHO’s work on security includes upholding international health regulations, coordinating information exchange and response activities, and supporting relief efforts in crisis areas.

Justice

Some disasters happen more slowly, and they are linked poverty. An example is the HIV/AIDS pandemic, which began in the 1980s. Thirty-eight million people are living with this disease and three million died of it last year. Most of those who are dying are poor, because the rich now have access to effective treatment.

HIV/AIDS has become a particular concern in Russia, where one million people are thought to be infected and the numbers are increasing rapidly. HIV/AIDS is also fuelling the TB epidemic through co-infection.

The response of WHO and its partners to the HIV/AIDS pandemic is a campaign to get three million people onto antiretroviral therapy by the end of 2005, as a first step towards universal access. We see this as an essential support for prevention activities, a catalyst for reform and renewal in health systems, and a matter of fundamental human justice.

Other major health hazards related to justice are tobacco use which currently kills nearly five million people a year, and unhealthy diets which are a major cause of cardiovascular diseases. In 2003, 60% of the deaths which occurred globally were from chronic diseases. The World Health Assembly adopted the Framework Convention on Tobacco Control last year, and the Global Strategy on Diet and Physical Activity this year.

There will be a Ministerial Summit on Health Research in Mexico next month. Early next year we will launch a Global Commission on the Social Determinants of Health. Both these activities are aimed at gathering scientific information that can help unblock the way to better health. Your participation, input and support for these activities would be highly valued.

Unity

In a globalized world, countries and communities have to support one another to maintain their own health. Unity is indispensable, as the founders of the United Nations system already saw in 1945.

For WHO now this means coordinating the health needs of Member States, and working with other organizations and other sectors.

Health work often unites people in a common cause that overrides the objectives of conflict. In Iraq earlier this month, 20 000 health workers and volunteers joined a campaign to immunize the nation’s 4.6 million children against polio. Because everyone can see the value of saving children from a crippling disease, combatants allowed this activity to take place.

Our special focus this year is on partnerships to reduce maternal and childhood deaths. A large number of United Nations and nongovernmental organizations have combined forces to take up this challenge. Our annual World Health Report and World Health Day will both be on this theme.

Conclusion

Compared to the needs, WHO is small. It has a staff of about 10 000 working in national and regional offices and at headquarters, and an annual budget of $1.4 billion. It cannot directly solve the world’s health problems but it can set standards, provide technical support and coordinate international cooperation. These activities help to give the world the security, the justice and the unity it so badly needs today.

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