High-level International Conference on Sickness Risk Coverage
Dr Margaret Chan
Director-General of the World Health Organization
Minister Girardin, distinguished ministers and ambassadors, my dear friend Joy Phumaphi, colleagues, ladies and gentlemen,
First, I would like to thank the organizes for the invitation to this meeting. I am pleased to be here. This meeting comes at an opportune time. We are in the midst of some important trends - some encouraging, others ominous.
Policy-makers in all countries are concerned about the way their health systems and services are financed. This universal concern has resulted in a wealth of experience and a wide range of options for securing funds and then using them for financial risk protection.
We know that there is no single "best" solution that can work in all contexts. At the same time, these experiences and this menu of options provide a very important head-start.
They serve as a vital guide for the many countries that are only now beginning to explore ways of improving financial risk coverage. At WHO, our main concern is with the financing of essential health care in the developing world, where the failure to provide some form of social health insurance can have life-or-death consequences.
Our statistics indicate that out-of-pocket spending on health accounts for more than 50% of total health expenditure in close to 50 countries. Most of this spending arises from user fees.
In areas where impoverished households and communities rely on out-of-pocket payments, access to health care is frequently curtailed by the costs. The burden of paying for care means that patients often wait until an illness is well-advanced, making treatment more difficult, more costly, or even impossible.
As a result, populations are pushed even deeper into poverty, because of either the costs of care or the lost productivity of advanced disease or premature death.
WHO further estimates that out-of-pocket payments for health care sink tens of millions of people under the poverty line every year.
I mentioned that this meeting comes at an opportune time. In May 2005, WHO Member States adopted a resolution on Sustainable health financing, universal coverage, and social health insurance.
That resolution was all about finding ways to guarantee access to necessary services while also providing protection against financial risk. Prepayment and pooling of resources and risks were identified as basic principles.
The objective was clearly stated: to avoid catastrophic health-care expenditure and impoverishment of individuals as a result of seeking health care. Simply put: health care should not make poor populations even poorer.
That resolution also called for mechanisms, such as conferences like this one, to facilitate the continuous sharing of experiences and lessons learned on social health insurance. This particular request was addressed to the Director-General. Again, I am very pleased to be here today.
Ladies and gentlemen,
Let me put some of these issues in perspective. I have referred to the issue of poverty. Poverty accounts for much of the huge gap in health outcomes we see in the world today. This is an issue we must address, and the international community is doing so, most notably through the Millennium Development Goals.
I have also mentioned some encouraging, and some ominous trends. Let us look at some of these trends.
During the past decade, health has achieved unprecedented prominence as a key driver of socioeconomic progress. Poverty contributes to poor health, and poor health anchors large populations in poverty.
But better health allows communities to work their way out of poverty, and spend household incomes on something other than illness.
Good health provides the very foundation for a productive life, and thus increasingly figures as a goal in poverty reduction strategies.
WHO, through its Constitution, has always promoted the highest attainable standard of health as a fundamental human right. Today, recognition of the clear links between health and development has brought much-needed additional attention, resources, and impetus.
We now benefit from an unprecedented number of partnerships, initiatives, foundations, philanthropists, and funding agencies. Health has never before received such attention, never before enjoyed such wealth.
The central place of health in the development agenda is formally recognized in the Millennium Development Goals, which provide an internationally agreed framework for reducing poverty by attacking its root causes.
The drive to meet the MDGs has stimulated the development of innovative mechanisms for securing predictable and substantial new funding.
Last year, UNITAID joined the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the International Financing Facility for Vaccines as a creative new source of funds for meeting international commitments for health development.
I want to take this opportunity to applaud the French government for its founding role in the establishment of UNITAID. This is innovative and imaginative leadership for a fair and just cause. We are pleased to host this drug purchasing facility at WHO.
The international community's concern with poverty alleviation also raises some policy issues, including the issue of equity. At WHO, the ethical principle of equity guides much of our work at the policy level.
What we mean by this is straightforward. People should not be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic or social causes.
This is not a new policy, but it has become all the more relevant today. As we all know, globalization creates wealth but has no rules that guarantee the fair distribution of this wealth.
In this regard, many of the new foundations and funding agencies can be viewed as a compensatory mechanism, a means of redistributing some of this wealth in a fair and equitable way. Without such mechanisms, we can expect the current great gaps in health outcomes to widen, dividing rather precisely along the lines of poverty and wealth.
This principle of equity also applies to the financing of health services.
In practical terms, equity calls for universal access to key promotive, preventive, curative, and rehabilitative interventions at an affordable cost. This is the principle of equity in access. A second principle, of protection from financial risks, aims to ensure that the cost of care does not put people at risk of financial catastrophe.
This brings us to a third principle: equity in financing. According to this principle, households contribute to the health system on the basis of ability to pay.
These are some of the issues we are addressing at WHO.
Ladies and gentlemen,
I mentioned some ominous trends. In terms of financing essential health care and reaching universal coverage, the trend that disturbs me most is the rising burden of chronic diseases.
Long considered the companions of affluent societies, chronic conditions such as cancer, heart disease, stroke, diabetes, asthma and other chronic respiratory diseases have risen dramatically throughout the developing world. The burden is now greatest in low- and middle-income countries.
In these countries, the age of onset is usually younger, health systems are ill-equipped to cope with the demands of chronic care, and the costs to households can be catastrophic.
In resource-poor settings, prospects for primary prevention of these diseases are problematic, as they often depend on improving socioeconomic status. In most developing countries, adherence to therapies is as low as 20%, resulting in poor health outcomes at a very high cost to households and national economies.
In countries experiencing rapid economic growth, heart disease, stroke, and diabetes alone hold back economic growth by about 1% to 5% per year.
These are some of the challenges we face together as we look for ways to make this world a fair and just place for health. Needless to say, I am deeply interested in the outcome of this high-level conference, and look forward to your deliberations today.