Address to the Commonwealth Health Ministers Meeting 2007
Dr Margaret Chan
Director-General of the World Health Organization
Distinguished ministers, colleagues, ladies and gentlemen,
I would like to express my deep appreciation for this invitation.
I appreciate this opportunity to speak with you on the eve of the World Health Assembly.
In public health today, we have many good reasons to be optimistic. We have been given unprecedented opportunities to build a healthier world.
The wide gap in health outcomes, closely linked to poverty, is being addressed. Multiple partners are working to tackle the diseases of poverty. In fact, the vast majority of agencies working in countries are doing so for health.
Health has never before received such attention or enjoyed such wealth.
Foundations are contributing funds on a scale we have not seen in the past. These funds have helped achieve record levels of childhood immunization coverage. They are supplying essential medicines for the poor.
They are supporting research for badly needed new tools, also for diseases of the poor. More and more, I am seeing how presidents and prime ministers in wealthy countries, and increasingly in developing countries, are devoting resources to control the neglected diseases. This is a sign of our global solidarity in matters of health.
Innovative ways to generate sustainable new funds have been created. Health initiatives are using proven financing models from capital markets to leverage money. Advance market commitments are being used by the GAVI Alliance.
The latest facility, UNITAID, draws revenue from taxes on airline tickets, with higher rates applied to the more expensive tickets. Funds are used to purchase drugs and diagnostics for HIV/AIDS, tuberculosis, and malaria.
This, to me, represents a deliberate effort to channel some of the wealth from globalization towards unmet health needs in the developing world.
This is a sign of our shared desire for greater fairness in matters of health.
All of these initiatives are helping to deliver the best vaccines and drugs in the world to the people who need them most. And this is all happening on an unprecedented scale.
Today, we see every indication that the world is determined in its efforts to tackle the diseases of poverty. The time-bound Millennium Development Goals have brought added urgency.
We need this commitment. The problems we face are daunting.
Many health problems have been fuelled by globalization. As our interdependence as nations continues to increase, these problems are likely to grow more acute.
This is true for emerging and epidemic-prone diseases. As we saw with SARS, these diseases are a much larger menace in a world where businesses and financial markets are closely interdependent.
New diseases are now emerging in unprecedented numbers, and the huge volume of air travel increases opportunities for their rapid international spread.
The emergence of new diseases is linked to profound changes in the way humanity inhabits the planet. This trend is certain to continue.
The intensive farming practices needed to feed the world’s growing population exert evolutionary pressures on the microbial world. Of the emerging pathogens capable of infecting humans, around 75% originated as diseases of animals.
We must be prepared to see more new diseases in the coming years.
In just the past three decades, 39 new agents capable of causing disease in humans have been newly detected. This is an historically unprecedented trends.
Globalization of the labour market has contributed to the acute shortage of health workers. This crisis is compromising essential care in many developing countries.
It is also one barrier that prevents successful programmes from scaling up to reach universal coverage.
Globalization and urbanization combine to create new problems for health. Modernization is occurring faster than the ability of governments to provide the essential supporting infrastructures.
We see this in the urban shantytowns that lack water, sanitation, electricity, roads and often law enforcement. These are ideal conditions for the diseases of filth to flourish. They are also ideal for epidemics of violence.
In sub-Saharan Africa, for example, 37% of the population now lives in cities. Of these city-dwellers, 72% live in shantytowns.
We also see the result of rapid modernization on the roads. Road traffic crashes cause an estimated 1.2 million deaths and up to 50 million injuries each year. Of these deaths and injuries, 90% now occur in low- and middle-income countries.
In these places, pedestrians, cyclists, motorcyclists, and users of public transport are at greatest risk. It is the people with the money to buy cars who hold the lethal weapon in their hands.
Demographic and epidemiological transitions have combined with nutritional and behavioural transitions to create ominous new trends for health.
As developing countries experience rapid urbanization, they are losing two of their most important health assets: healthy diets and the high levels of physical activity seen when livelihoods depend on farming and herding.
Chronic diseases, long considered the companions of affluent societies, are now causing an additional burden in low- and middle-income countries.
High rates of obesity are now seen in countries where chronic malnutrition and childhood stunting remain major problems.
Health systems can often manage the intermittent emergencies caused by infectious diseases. The patient either survives or dies.
Health systems have a much more difficult time managing chronic conditions such as heart disease, stroke, cancer, diabetes, asthma, and other respiratory disorders.
In the developing world, these diseases usually appear at a younger age. The costs of chronic care can be catastrophic for households, further deepening poverty.
Faced with this trend, the best strategy for public health is population-wide prevention. Fortunately, chronic diseases are largely caused by a small number of shared risk factors: improper diet, inadequate physical activity, tobacco use, and excessive alcohol consumption.
These risk factors are linked to human behaviours. We know how hard it is to change behaviour. The challenge for public health is to make healthy choices the easy choices.
To support prevention, we have the Framework Convention on Tobacco Control. This is now one of the most widely supported treaties in the history of the United Nations. This is primary prevention at its best.
Member States of WHO have also adopted a Global Strategy on Diet, Physical Activity and Health.
We have other important tools for prevention.
Cervical cancer, which is caused by a sexually transmitted virus, is the leading cause of cancer among women in the developing world. A protective vaccine against this virus was licensed last year.
WHO is supporting efforts to introduce this vaccine where it is needed most. High price and logistic problems are important obstacles to overcome.
We have a good vaccine for the hepatitis B virus, which is responsible for a huge burden of liver cancer in the developing world. Together with the GAVI Alliance, WHO is implementing immunization campaigns in more than 150 countries.
Treatment is the second challenge.
As I have mentioned earlier, health systems can often manage the intermittent emergencies caused by infectious diseases, but have a much more difficult time managing chronic conditions.
The WHO strategy for Integrated Management of Adolescent and Adult Illness provided the platform for a milestone achievement last year. For the first time, more than one million people in sub-Saharan Africa are receiving antiretroviral drugs.
This represents a ten-fold increase in access to treatment in the region since December 2003. This proves that complex care can be delivered in resource-constrained settings.
This integrated approach to common causes of illness is also being used by a large number of countries to deliver packages of care for chronic diseases. The strategy is specifically designed for use in resource-constrained settings.
It uses the referral system as a central component in the continuum of care. And it is designed to operate within the limitations of the existing health system.
The strategy addresses the shortage of health staff through a process of task shifting. Responsibilities move from clinicians, to nurses, to communities, and then to patients, where the ultimate responsibility for long-term care resides.
This approach has a strong technical base, supported by modular training manuals, and it uses essential lists of quality-assured drugs.
This is first-rate clinical medicine being delivered through a public health approach, according to the principles of primary health care.
I was asked to give you an overview of the situation with HIV/AIDS, tuberculosis, and malaria.
Human society has never experienced a disease like AIDS. This is a disease that can incubate silently, and spread silently, for as long as 10 years.
It kills people in the prime of life, and has orphaned millions of children. It destabilizes nations. It threatens to rip apart the fabric of social life, especially in sub-Saharan Africa.
When drugs are available, treatment is life-long. This makes sustainability a profoundly ethical issue. If we cannot sustain the current flow of drugs, these people will die very quickly.
Because of immune suppression, patients undergoing treatment are susceptible to the development of several cancers, such as leukaemia. This adds yet another problem to the already daunting treatment challenge.
HIV/AIDS has become a disease of the developing world, imposing its greatest burden on the African people. Of the people currently living with this disease, 95% reside in the developing world. Of the 4.3 million new infections in 2006, 65% occurred in sub-Saharan Africa.
Also in Africa, last year saw the first documented cases of extensively drug-resistant tuberculosis. This form of the disease is virtually impossible to treat. In some reports, mortality approaches 98%.
Known as XDR-TB, this form of the disease has also been detected in other regions of the world, including North America and Europe. Its emergence is linked to poor compliance with the recommended DOTS strategy for treatment.
In turn, the failure of directly-observed treatment is linked to the shortage of health care workers. Progress has not been good for malaria. Again, sub-Saharan Africa bears the greatest burden. These countries account for more than 80% of the annual one million deaths from this disease.
No country met the targets for malaria control set for Africa for 2005.
At the start of last year, WHO adopted an aggressive new strategy for malaria control. We also took the controversial step of recommending a return to the use of DDT for indoor residual spraying. The use has to be properly controlled.
International acceptance of this step, which is firmly supported by evidence, has been surprisingly good.
We introduced a strong policy against the use of monotherapies in order to protect the last remaining class of effective drugs for treatment.
Bednets are now being distributed as part of childhood immunization campaigns, which traditionally do the best job of delivering interventions to hard-to-reach populations.
In conclusion, we have many reasons to be optimistic. The world is taking action in a spirit of global solidarity.
I regard equity as the highest ethical principle that should guide our work. Access to life-saving and health-promoting interventions should not be denied by unfair reasons, including those with economic or social causes.
As an international community, we have made some great strides forward. But much more needs to be done to improve access and reduce the gaps in health outcomes.
I look forward to the guidance you and others will be providing to us during the coming Health Assembly.
I thank you for your attention.