Address to the Regional Committee for the Western Pacific
Dr Margaret Chan
Director-General of the World Health Organization
Mr. Chairman, honourable ministers, distinguished delegates, our Regional Director, Dr Omi, ladies and gentlemen,
I am aware that I am standing before ministers and other leaders responsible for health in the largest and most diverse region of WHO.
This is my home region.
The gaps in health outcomes, that so often divide along the poverty line, are readily apparent here.
Wealthy countries are close neighbours with some of the least developed countries in the world.
And they are good neighbours, I might add. Some island nations have total populations roughly equivalent in size to that of a single city block in Tokyo.
Some countries are struggling to overcome a heavy burden of poverty.
Others enjoy some of the highest life expectancies in the world.
Still others are rapidly modernizing and gaining in economic might.
But here, as elsewhere in the world, rising income levels do not always translate directly into better outcomes for health.
Virtually all of the challenges confronting WHO at the global level can be found right here, in the Western Pacific Region.
Many of the solutions to these problems can also be found, right here.
These solutions are worthy models, especially as I believe they are driven by your greatest policy asset: shared responsibility in matters of health and solidarity in its pursuit.
This makes sense. Good health contributes to stability, and is a foundation for prosperity. A stable and prosperous region serves the interests of every country.
In this part of the world, it is particularly apt to say: no country is an island.
Infectious diseases spread. Water and air pollution spread.
The global reach of advertising and marketing spreads lifestyle changes, and these speed the rise of chronic diseases.
As a group of countries and areas, you have the full spectrum of health problems on your plate.
Malnutrition exists side-by-side with high rates of obesity. Neglected tropical diseases co-exist with chronic diseases, and outbreaks of emerging and epidemic-prone diseases.
Apart from the double burden of infectious and chronic diseases, this region faces a third burden of deaths and disability from road traffic crashes, injuries, violence, and high suicide rates.
Yet you still manage to lead the world in reaching many global targets.
Of all WHO regions, the Western Pacific has shown the highest case detection and cure rates for tuberculosis, with cure rates surpassing 90%.
The region is polio-free, and has been for ten years. You have the surveillance and response systems in place to keep it that way.
Most countries in this region eliminated leprosy as a public health problem nearly 7 years ago.
This ancient disease has been pushed back to just a few endemic pockets in six countries.
You have steamed full speed ahead in reaching global goals for the elimination of lymphatic filariasis.
I am aware of the commitment and determination it takes to carry out these mass drug administration campaigns.
I also know what it means to tackle diseases that affect the poorest of the poor, with very little political voice, living in the hardest-to-reach areas.
I know what caring for these people means in terms of overall health policies.
I admire the way countries in this region join forces, with the wealthier countries funding initiatives designed to improve health outcomes for the poor.
This is shared responsibility at its best.
Your experiences are diverse and you exchange them freely, to good effect.
The rise in chronic diseases seen in so many countries and areas was experienced in countries like Australia, Japan, and New Zealand decades ago.
This region knows what chronic diseases mean, when to sound the alarm and, most importantly, what to do, placing health promotion and prevention at the fore.
I also want to commend this region for the rational and well-managed way it goes about tackling problems, and the good use you make of evidence.
Surveillance finds where the problems reside. Pilot projects test what works. High-burden countries are selected, and efforts are concentrated there. For chronic diseases, this region has used the STEPwise approach to pinpoint problem areas where prevalence rates for risk factors are alarmingly high.
Again, this is an early warning system that allows you to concentrate prevention and treatment efforts on areas in greatest need.
Operational efficiency is achieved using essential packages of interventions delivered in an integrated approach.
A prime example is the Regional Child Survival Strategy, again focused on countries with the highest burden of childhood mortality.
Apart from global and regional strategies, Western Pacific countries make good use of networks, whether for knowledge management or the response to mental illness and the prevention of violence and suicides.
Efficiency also increases when you make solutions for addressing one problem work for other related problems.
As just one example, the healthy marketplace approach, devised to reduce human exposure to avian influenza, will also help prevent other foodborne diseases. This is an ideal way to increase overall capacity.
Health policy in this region uses successful results to maximum advantage.
Success in one country spreads to others. Region-wide success leads to more ambitious targets.
Tremendous improvements in immunization coverage encouraged this region to set the new goals of eliminating measles and bringing hepatitis B under control.
This, too, makes sense.
This, too, is a rational way to go about the business of improving population health.
When a region has such a diversity of problems, it is good to tidy-up in this way, get some problems behind you for good.
Out of all your vast achievements and ways of tackling problems together, if I had to extract two lessons of global importance, it would be these.
First, even countries with limited resources can make great progress.
Second, shared responsibility, solidarity, and a commitment to fairness and social justice are among the most important qualities for health leadership today.
You are close neighbours in health, and you are good neighbours.
Ladies and gentlemen,
In this region, as is increasingly the case worldwide, health issues are being shaped by the same powerful forces.
In my eight months in office, I have been impressed by the commonality of health challenges, and the common ambitions of health leaders, seen all around the world.
All of us working in public health are engaged in basically the same struggles on three fronts. These struggles have regional nuances, of course, but they are basically the same.
First, we struggle to hold the constantly changing microbial world at bay.
Second, we struggle to change human behaviours in ways that protect health and diminish risks and dangers.
Third, we struggle for attention and resources.
This is nothing new, of course, This has been the nature of public health since the beginning. But the challenges have grown enormously, on each of these fronts, in little more than a decade.
Changes in the way humanity inhabits the planet have disrupted the natural equilibrium of the microbial world.
Constant mutation and adaptation are the survival mechanisms of pathogens.
These organisms are well-equipped to take advantage of any opportunity we give them to evolve, invade, and evade.
The opportunities are numerous, and growing.
Population growth, urbanization, intensive farming practices, the misuse of antibiotics, environmental degradation, and incursion into previously uninhabited areas have exerted enormous pressure on the microbial world.
As a result, new diseases are emerging at an unprecedented rate. Old diseases are resurging, or spreading to new areas.
Resistance to mainstay antimicrobials is occurring at a rate that outpaces the development of replacement drugs.
Simultaneously, emerging and epidemic-prone diseases have become a much larger menace under the conditions of our highly mobile, interdependent, and interconnected society.
This region knows about the consequences first-hand, most notably from the SARS experience and from current outbreaks of avian influenza.
We have lived under the looming threat of an influenza pandemic for four years.
When resources are scarce and priorities are numerous, it is difficult to balance concern about an unpredictable yet potentially catastrophic event against the need to address so many real and pressing problems.
I am often asked if the effort invested in pandemic preparedness is a waste of resources. Has public health cried “wolf” too often and too loudly?
Not at all. Pandemics are recurring events. We do not know whether the H5N1 virus will cause the next pandemic.
But we do know this: the world will experience another influenza pandemic, sooner or later.
Recent concern has stimulated enormous research, and we know much more about influenza viruses and pandemics than we did four years ago. Moreover, public health must pay close attention to any severe new disease, like H5N1 avian influenza.
This disease is poorly understood, takes its toll on previously healthy children and young adults, and kills close to 64% of those infected.
Most importantly, preparedness for a pandemic has strengthened national and international capacities in fundamental ways.
We all welcome the greatly strengthened International Health Regulations, which came into force in June.
The revised Regulations move away from the previous focus on passive barriers at national borders, to a strategy of pro-active risk management.
This strategy aims to detect an event early and stop it at source, before it has an opportunity to become an international threat.
This strategy greatly strengthens our collective security, and raises the preventive power of these Regulations to new heights.
We must never again allow a disease such as HIV/AIDS to slip through our surveillance and control networks.
Last month’s outbreak of Marburg haemorrhagic fever, in Uganda, was stopped dead in its tracks, before it had a chance to become a national or international threat.
As the minister of health informed me, the outbreak was promptly controlled by activating the preparedness plans for pandemic influenza. All the procedures were in place, and worked flawlessly.
In this regard, the Asia-Pacific strategy for emerging diseases, endorsed by the Regional Committees of both the South-East Asia region and the Western Pacific region, represents a major advance in the implementation of the Regulations.
Our struggle to change human behaviour has also become more complex.
Demographic and epidemiological transitions now combine with nutritional and behavioural transitions to create ominous new trends.
The globalization of the food supply, and the global reach of marketing and distribution, are contributing to the loss of two natural assets in many developing countries: healthy diets, and healthy lifestyle behaviours. A single statistic from Dr Omi’s annual report makes this point most vividly.
In Cambodia, a country still struggling against infectious diseases, one in ten adults now has diabetes, and one in four adults has hypertension.
But, also on this front, we have a powerful international instrument.
The Framework Convention on Tobacco Control has become one of the most widely embraced treaties in the history of the United Nations.
This is preventive medicine, on a global scale, at its best.
Next year, the Commission on Social Determinants of Health will issue its report. This will be another powerful tool as we seek to address the complex social factors that influence health.
On the third front – the struggle for attention and resources – the situation looks far more optimistic, especially at the international level.
Ladies and gentlemen,
In just the past decade, health has received unprecedented support from a growing number of partnerships, implementing agencies, foundations, and funding mechanisms.
There will always be unmet needs. But health has never before received such attention or enjoyed such wealth.
The Millennium Declaration and its Goals represent the most ambitious commitment ever made by the international community.
They place health at the centre of the development agenda and champion its role as a key driver of socioeconomic progress.
In so doing, they elevate the status of health. Health is no longer a mere consumer of resources. It is also a producer of economic gains.
For the first time, health has political commitment, determination, funds from new sources, powerful interventions, and proven strategies for their implementation.
With so much working in our favour, we can see what is holding us back.
If we want health to work as a poverty-reduction strategy, we must reach the poor. Health systems are not able to do so.
As we near the midpoint in the count-down to 2015, the health-related Millennium Development goals are the least likely to be met. These are the goals that make the most immediate life-and-death difference for so many millions of people. These are the goals that have the most powerful tools – first-rate drugs and vaccines – to support their attainment.
How can we fail?
Here is the problem, which is increasingly recognized internationally.
The power of existing interventions is not matched by the power of health systems to deliver essential care to those in greatest need, on an adequate scale, in time.
In this region, as elsewhere, the goals calling for reductions in maternal and neonatal mortality present a major challenge.
As is so aptly stated in documentation before this Committee, the emotional appeal of preventing maternal and child mortality is high, but it is not always matched by equally high commitment.
Moreover, to prevent maternal and neonatal deaths, the need for a well-functioning health system is absolute.
Interventions – like bednets, pills, or vaccines – will not suffice to bring this mortality down.
The stubbornly high figures for maternal mortality will not go down until more deliveries are attended by skilled birth attendants, and more women have access to emergency obstetric care.
Fortunately, the need to strengthen health systems, based on primary health care, is beginning to receive deserved attention in high places.
Last week, I participated in the launch of the International Health Partnership in London, with Prime Minister Gordon Brown and Prime Minister Jens Stoltenberg of Norway.
This new initiative seeks to address, on the most urgent basis possible, two critical barriers to the attainment of the health-related Millennium Development Goals: ineffective aid, and failure to invest in health systems.
This, then, is the test of true commitment. When progress stalls, step back, assess the reasons, shift gears, and accelerate action.
Unquestionably, health has much more attention, and far more resources, than in the recent past. But challenges on this front have also increased.
As action accelerates, the responsibility on the health sector increases.
We have a great responsibility to use these unprecedented resources and this momentum wisely, and in ways that have a maximum impact on health outcomes.
I have mentioned three common struggles. We are now embarking on a fourth struggle, with profound global implications.
It may turn out to be the most ominous struggle of them all.
I am referring to climate change
Ladies and gentlemen,
At the start of this century, a group of journalists ran a competition for the best news item depicting what might lie ahead in this 21st century.
Here is one of the winners.
“Heads of state, meeting today on the tropical island of Switzerland, have reached consensus. Predictions of global warming have no foundation in science.”
In reality, the science is now overwhelming. Heads of state are increasingly concerned.
Switzerland may not be a tropical island, but this region has multiple islands under direct threat.
The world’s best scientists tell us: human activities have committed this planet to climate change.
The effects are already being felt.
Even if greenhouse gas emissions were to stop today, the changes we are already seeing will progress throughout this century.
The emphasis now is on the ability of our human species to adapt to changes that have become inevitable.
The nature of these changes goes beyond the history of human experience.
The warming of the planet will be gradual, but the increasing frequency and severity of extreme weather events – intense storms, heat waves, droughts, and floods – will be abrupt and the consequences will be acutely felt.
Rising sea levels, increasing salinization of water tables, and heat stress in association with air pollution are just some of the consequences of great concern in this part of the world. The health sector must add its voice – loud and clear – to the growing concern.
Just as we fought so long to secure a high profile for health on the development agenda, we must now fight to place health issues at the centre of the climate agenda.
We have compelling reasons for doing so.
Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, water.
Developing countries will be the first and hardest hit. Subsistence agriculture will suffer the most. Areas with weak health infrastructures will be the least able to cope.
Imagine the impact on health in areas where the food supply is already precarious, rural areas are populated with subsistence farmers, and the capacity to cope with any emergency is already fragile.
Imagine the situation in cities, where water scarcity combines with heat stress and air pollution to impair the health of millions, increasing the burden on health services that are already strained.
As the scientists tell us: the nature of climate change during this century will go beyond human experience.
But public health has abundant experience on which to base its concern.
At a time when we are still trying so hard to shrink the presence of malaria, we know what an expanded geographical range of vector-borne diseases as a result of climate change, will mean.
This region, in particular, knows the costs and disruption caused by outbreaks of dengue and Japanese encephalitis.
Public health knows what massive population displacement means. We know the consequences of malnutrition, also in terms of higher mortality from childhood infections.
We know how water scarcity translates into diseases of filth.
These burdens are – right now – among the largest.
What will this mean if all our great efforts to reach the Millennium Development Goals are cancelled out by the health consequences of climate change?
Public health has experience in this area as well. Just think about how HIV/AIDS has set back development in sub-Saharan Africa.
But the opposite is also true. Continuing progress in health development will increase the capacity to cope with climate change.
Let me give you just one example, pertinent to this region.
If countries continue to press ahead with campaigns to interrupt the transmission of lymphatic filariasis, that will be one less threat on the horizon as conditions grow more favourable for mosquitoes and other vectors to proliferate.
I personally believe that the inevitability of climate change makes it all the more urgent for us to reach the Millennium Development Goals.
This, too, must be an argument as we voice our concerns.
Countries that have achieved a basic standard of living, supported by adequate health infrastructures, will be best able to adapt.
They will be best able to cope with dramatic changes that are already on their way.
Ladies and gentlemen,
I will make one final observation.
Global solidarity is enshrined in instruments like the International Health Regulations and the Framework Convention on Tobacco Control, and in commitments, like the Millennium Development Goals.
The two instruments are all about shared vulnerability, and shared responsibility for collective protection.
Both raise prevention – the greatest power of public health – to new heights.
The Millennium Development Goals are all about fairness.
To quote from the Declaration: “Those who suffer or who benefit least deserve help from those who benefit most.”
Emerging and epidemic-prone diseases, unhealthy behaviours, poverty, and gaps in health outcomes deserve solidarity, and are best addressed by collective, concerted action.
This need for solidarity arises partly because of our shared vulnerability, but also partly because of our common humanity.
There is no sector better placed than health to fight for social justice.
You are health leaders in a part of the world that reflects the global stage.
As I said at the beginning, shared responsibility, solidarity, and a commitment to fairness and social justice are among the most important qualities for health leadership today.
This is the great policy asset of this region, and no doubt one reason why you give us so many worthy models for managing complex – and diverse – health problems.