Commonwealth Health Ministers Meeting

Geneva, Switzerland
15 May 2005

Honourable Ministers,

Thank you very much for the opportunity to be with you all today and say a few words about some of our current activities.

Maternal health is at the forefront of our present activities. It is also at the heart and soul of the health system, and of society itself. Where pregnancy and delivery receive the care they need, life can start well for the child, and the mother is protected at perhaps the most demanding and dangerous moments in her life. The exclusion of mothers from the basic necessities of care is the initial cause of many of the health problems that afflict children and adults later in life.

At the Health Assembly this week we will be looking at a large number of these challenges, in addition to that of maternal, newborn and child health itself.

One such challenge, for child health in particular, is polio eradication. It is in the headlines again because children are being paralysed in Yemen and Indonesia – countries which had been polio-free for a decade. This underscores the urgency of finishing the job we started many years ago. None of our children are safe until polio is eradicated everywhere. The greatest risk to eradication is not these imported cases but the areas of the world where polio remains endemic, and from where the virus can continue to spread.

However, all our efforts to reach those in need of health services depend on systems that have the capacity, the resources and the staff to provide the necessary services of prevention, care and treatment.

When prevention and control fail, epidemics become emergencies. The national and international systems needed to manage emergencies are a major topic of this Health Assembly this year. The revised International Health Regulations are under intense scrutiny and discussion. Member States continued negotiations until the early hours of Saturday morning to reach agreement on the revised Regulations. Adoption of them will be a great event for global public health. But its significance will only be fully realized when the Regulations are in place and being followed.

This will require strong national capacities for detection, verification and response to disease outbreaks. Building those capacities will continue to be a very high priority for us in the immediate future.

I would like to draw your attention in particular to the four Policy Briefs that accompany the 2005 World Health Report; 'Make Every Mother and Child Count'.

First, the Report emphasizes the need for a double continuum. The continuum of the life cycle, through adolescence, pregnancy, child-bearing and childhood. Children’s needs cannot be met without meeting those of their mothers, and vice versa. And the continuum of health care, through the home, the community, the health centre and the hospital. This double continuum provides the rationale for organizing health programmes.

Second, we have to rehabilitate the workforce to make these services available. The lines of action needed for this are to stabilize the existing workforce, expand it, and build up the productivity and morale of nurses, doctors and all the others who work for health.

That is easily said, and it is useful to have these objectives clearly in mind, but in many cases it is extremely difficult to put into practice. In situations of severe hardship it often seems impossible. And even where there are enough supplies, equipment, facilities and money, ensuring the availability and commitment of competent staff is one of the toughest challenges for health in the 21st century.

Several initiatives are in progress for tackling the global health workforce crisis, and you will be hearing about some of them during the Assembly. The next World Health Report will be on this subject, and it will also be the theme of World Health Day next year. The preparations involve many different constituencies. The World Health Report 2006 will launch the Decade of Human Resources for Health, and set strategic directions for tackling this worldwide challenge.

Third, care and financial protection must be accessible to everyone. Universal access is perhaps the current expression for “Health for All” and it remains the guiding principle for all our work.

Like “Health for All”, it is often seen as an ideal or a vision or a dream, and it can indeed be an inspiring goal to work for. But it is also a necessity, and to work for it is simply to come to terms with harsh realities. Where one society or part of society is at risk, the whole society and all societies are at risk. You only have to think of SARS in the recent past, or avian influenza in the probable near future – or of polio, or of HIV/AIDS, or of TB – to see that this is true for the infectious diseases. For the conditions that cause cancer, heart disease and death or disability by accidents and violence it is equally clearly a fact of life.

Fourth, governments need to work with civil society organizations. Government institutions benefit from the versatility and special skills of nongovernmental organizations. Those organizations likewise need the guidance and support of the state to work effectively. It is policy dialogue and creative synergies that will form the kinds of partnership we need today. And it is these new partnerships that will make universal access to essential health services a reality.

I would like to end with a word about the social dimension of health. You will have noticed that in all the campaigns and initiatives I have been talking about, social factors play a central part. Last March we published an article in the Lancet entitled “Public health is a social issue”. That was not to deny that medical science will always be at the core of our responsibility for health, but to stress the point that the social determinants of health are in urgent need of attention.

We launched the Commission on Social Determinants of Health in Santiago, Chile, in March. Eminent practitioners from all six of our regions are contributing their outstanding abilities as leaders, scientists and thinkers to this effort. Their mandate is to devise initiatives to make health systems work better and more fairly. They are doing this in the context of defining and confronting major underlying causes of ill-health in the 21st century.

This initiative, like many of the others now in progress, represents the strongly felt need for better approaches, stronger alliances and the power that flows from well-defined common objectives and ideas.

Maternal health is the ideal context in which to be thinking about all these issues. It is all about how to protect and strengthen existing health programmes, and bring new initiatives and new life safely into the world. I hope we will have many opportunities to follow up these ideas during the next 10 days, and in the coming months and years as we work together for health in the Member States you represent here today.

Thank you for your many and varied contributions to these efforts. With your support and creativity we will rise to the demands now facing us, and turn them into great achievements. I look forward to our discussions over the coming days. Thank you.