Global Health Council

"Health systems — putting the pieces together" Plenary 2, June 2. "Turning rhetoric into reality"

Washington DC, USA
2 June 2005

Last week the World Health Assembly took a large number of decisions. The areas covered include: The health action to be taken in the event of crises and disasters, the revised International Health Regulations, WHO's Programme Budget for next year and the year after, the establishment of World Blood Donor Day, preparedness for pandemic influenza, laboratory safety and state of polio eradication.

In addition to delegations from our 192 Member States we heard from invited speakers who included President Gayoom of the Maldives; Ann Veneman, the new Executive Director of UNICEF; Bill Gates; and the Vienna Philharmonic Orchestra, who spoke with music. These events were not a direct part of the decision-making process but they made an important contribution to setting the context. They spoke about the large number of urgent health needs in the world today, but also to the large amount of goodwill and intelligence available to meet them.

I would like to contribute to the discussions here today by telling you how we have been putting knowledge into practice in the World Health Organization. I will refer to just four of them: negotiating, responding to emergencies, setting objectives, and tackling the social determinants of health.

First, negotiating. The WHO Framework Convention on Tobacco Control is an example. It entered into force in February and now has 66 Contracting Parties. It is the outcome of patient and purposeful discussion, which combined the efforts of many partners. Our immediate task now is to enable the greatest possible number of Member States to become Contracting Parties so as to maximize the impact of the Convention and fulfil its potential for saving lives.

This treaty was agreed on and put into effect more quickly than many people had expected, but that is only the beginning. The effort has to continue till we have achieved its ultimate objective, which is worldwide end of tobacco-related illness and deaths.

The day before yesterday was World No Tobacco Day. It reminded us that tobacco is still the biggest cause of preventable death in the world. But the struggle for prevention now has the major advantage of a legal framework and the support of a growing social consensus to drive it forward.

Since May 23 we have had a second shining example of how persistence in negotiation can result in the agreement necessary for action, with the adoption by the World Health Assembly of the revised International Health Regulations. These provide the rules and mechanisms needed for a coordinated response to international public health threats. They spell out the roles of countries and of WHO in preventing and containing health emergencies and sharing information about them.

The hard-won agreement on these Regulations is a landmark event for public health. But their significance, like that of the convention on tobacco, will only be fully seen when their requirements are put into practice. Responding to the needs specified in the Regulations will require strong national and international capacities for detection, verification and response to disease outbreaks. Building up those capacities is one of our major tasks now and in the coming months.

Second, responding to emergencies. Agreement on how to coordinate operations is one thing; actually coordinating them is another. To help bridge the gap, we have built a Strategic Health Operations Centre in Geneva. This is an international "situation room" which provides an instant access to the logistic and health information needed in an international emergency. It applies the most advanced technology available to facilitating instant communication, coordination and decision-making between countries and technical partners.

Following the Tsunami in Asia, our Health Action in Crises team used it to its maximum advantage to coordinate responses. It enabled us to act quickly to avert many of the health dangers faced by the survivors. Its primary function, however, is to serve as the focal point for our Global Outbreak Alert and Response network, which now consists of 130 institutions around the world. The network provides real-time surveillance and updates on disease outbreaks and the measures taken to contain and stop them.

The impending global disaster that we know most about at present is avian influenza. A meaningful estimate of how much damage this disease could do is not possible, but the death toll in the Spanish influenza epidemic of 1918 can give us some idea of an order of magnitude. It was between 20 and 50 million people, in the days when steam-driven trains were still the fastest means of public transport.

Today’s volume and speed of travel have multiplied the danger, but the technical capacity to avert and contain pandemics has also multiplied. Agreement on the International Health Regulations has put us in a better position to use that capacity. The most favourable time to use it effectively is now, when the conditions for a pandemic already exist but the pandemic has not yet begun. Preparedness means drastically increasing the world’s capacity for vaccine development, production and distribution, as well as for diagnosis, surveillance, prevention and control. If rhetoric can help the world to recognize a real danger and take the necessary action without delay, I am in favour of it.

A third way of turning opportunities into reality is by pursuing concrete objectives. That was how the inspiring idea of smallpox eradication became a hard fact in the 1970s. The last case of endemic smallpox was detected in 1977. Millions of lives were saved by that campaign and its eventual success.

It inspired confidence not only in medical science but in the capacity of human beings to make good use of it. That led to the campaign to eradicate polio, which has also saved millions of people, in this case from severe disability as well as premature death. There are three countries left from which the virus can continue to spread. One of them is Nigeria, where immunization had stopped because of socially motivated opposition to the campaign, but has now restarted immunization and cut cases by 50% since last year. The other two are India and Pakistan, which are both gaining ground and are on the verge of completing eradication. Our greatest danger now is the funding gap, which must be closed rapidly to ensure that children in the Horn of Africa and other high-risk areas are protected.

Like the Millennium Development Goals, and the current campaigns against tuberculosis and HIV/AIDS, polio eradication is driven by specific objectives. These serve as a focus for effective action and a source of motivation. Where people have clear objectives, and can see the value and purpose of achieving them, great things can happen.

This brings me to my fourth and last example of how to get from good ideas to realities: by tackling the social determinants of health. The means exist to prevent or cure most of the causes of illness and premature death that occur in our world today, but they are not reaching the people who need them. Their availability and accessibility are determined to a significant extent by social factors such as position in society, living conditions and education. This is as true for the chronic diseases as it is for the infectious ones. Not enough is known about how those factors work and how they can be modified to protect health and control disease. The health sciences now need to give much more attention to the human causes of preventable illness and death.

That is the mandate of the Commission on Social Determinants of Health, which we launched in March in Santiago, Chile. We are not looking for a new theory of health and social justice from this Commission (though that could be a valuable by-product) but for more effective and sustainable ways to provide for public health. The Commission is gathering information and disseminating its findings through knowledge networks and communities of practice. The validity of those findings will be measured by improvements in health indicators through the WHO and other programmes in which they are used.

In sum, I propose four kinds of action for your attention today: negotiate, respond to needs, set objectives, and act on the underlying causes of ill-health. There are many other approaches, but these can provide a good starting point to turn rhetoric into reality.

Thank you.