Address to the Regional Committee for the Western Pacific Region (59th session)
Dr Margaret Chan
Director-General of the World Health Organization
Mr. Chairman, honourable ministers, distinguished delegates, Dr Omi, ladies and gentlemen,
First and foremost, let me pay a special tribute to Dr Omi as he concludes a decade of outstanding health leadership in this region. These 10 years have seen a long list of achievements for public health. Let me mention just a few.
When Dr Omi took office in 1999, he made tuberculosis control the flagship programme for this region. At that time, TB was causing around 1000 deaths per day, and health ministers were rightly concerned.
Today, this region is seeing a declining incidence of TB. You have not only met the global targets for control. You have surpassed them. The detection rate for new cases is now high at 78%, while the rate for treatment success has reached 92% – the highest of any region in the world.
With its established national TB programmes, this region is well-positioned to scale up care for multi-drug resistant TB, again in a leadership role. You are doing so in ways that strengthen overall health system capacity, especially for laboratories.
You have also developed innovative ways to integrate TB services with those for HIV/AIDS in a primary health care setting. This makes good sense, for efficient service delivery, but also for patients.
The Western Pacific is the first and only region in which all countries have ratified the WHO Framework Convention on Tobacco Control. This shows what can be achieved when political leaders exercise their regulatory power for the sake of better health.
The microbial world dealt this region a difficult hand and some heavy economic blows. You experienced the emergence, rapid spread, and rapid containment of SARS. You also experienced the first human cases of H5N1 avian influenza, and you continue to respond to the threat of an influenza pandemic.
The ability to use experiences during a crisis situation to craft a protective strategy is a mark of fore-sighted leadership. The Asia Pacific Strategy for Emerging Diseases provides a firm foundation for greater protection under the revised International Health Regulations. This is a model of best practice for other regions.
These and many other achievements paint a picture of efficiency and effectiveness, supported by a true spirit of cooperation and collaboration, in this region but also with colleagues in South-East Asia. But regional activities, under Dr Omi’s leadership, have also shown a warm heart and a compassionate soul.
Let me remind you of Dr Omi’s statement, some five years ago, about the need for a more holistic approach to health. The time has come, he said, “to put the heart back into medical practice.”
Let me draw your attention to a publication, issued late last year and jointly signed by Drs Omi and Samlee, that calls for reforms that put people at the centre of care. The report uses evidence to document vast unmet needs. And it uses compassion to argue for change.
As clearly stated: scientific advances, better technology, and economic progress are not enough to improve people’s health. Health systems need to change in ways that respond better to people’s comprehensive needs and expectations.
Ladies and gentlemen,
Prevention is the heart of public health. Equity is the soul.
The documents before this committee cover diverse issues – from health systems to dengue prevention and control, from chronic diseases to climate change. But all four agenda items share one feature: they demonstrate the enduring relevance of primary health care.
Thirty years ago, the Declaration of Alma-Ata articulated primary health care as a set of guiding values for health development, a set of principles for the organization of health services, and a range of approaches for addressing priority health needs and the fundamental determinants of health. Fairness in access to care and efficiency in service delivery were overarching goals.
With an emphasis on local ownership, primary health care honoured the resilience and ingenuity of the human spirit and made space for solutions created by communities, owned by them, and sustained by them.
Above all, primary health care offered a way to organize the full range of health care, from households to hospitals, with prevention equally important as cure, and with resources invested rationally in the different levels of care.
The approach was almost immediately misunderstood. It was a radical attack on the medical establishment. It was utopian. It was confused with an exclusive focus on first-level care. For some proponents of development, it looked cheap: poor care for poor people, a second-rate solution for the developing world.
Today, primary health care is no longer so deeply misunderstood. In fact, primary health care looks more and more like a smart way to get health development back on track.
Primary health care is built around the values of equity, social justice, and universal coverage. The Millennium Declaration and its goals breathed new life into these values, this time with a view towards ensuring that the benefits of globalization are more evenly distributed.
The principles of primary health care arise from a holistic approach to health that broadens the medical model to include social and economic factors and makes prevention as important as cure. True prevention attacks the root causes of ill health and disease, including causes in multiple sectors other than health.
The practical approaches flow logically from these values and principles: namely, multisectoral action, community participation, and technology choices aligned with priority needs.
The prevention and control of dengue depend on community engagement, multisectoral action, and a stronger focus on prevention. The main risk factors for chronic diseases lie outside the health sector. Prevention depends on multisectoral action. Moreover, as the document before you notes, primary health care is the best framework for shifting health systems from an acute-care model to one that balances prevention with long-term disease management.
For climate change, all the experts tell us: developing countries will be the first and hardest hit. The Intergovernmental Panel on Climate Change is clear on this point: protection from the social factors that place poor and deprived populations at special risk is far more important than structural protection.
Social protection of the poor must be a high priority as the health sector prepares for an inevitable increase in extreme weather events.
Ladies and gentlemen,
At the end of August, the Commission on Social Determinants of Health issued its final report. The striking gaps in health outcomes are its main concern, and greater equity is the objective.
The report challenges the assumption that economic growth alone will reduce poverty and improve health. On present trends, increased economic prosperity tends to benefit populations that are already well-off, leaving others further and further behind.
As the report notes, the most important determinants of health arise from the social conditions in which people are born, live, work, and age. And these conditions are shaped by government policies. Economic growth will improve the health of the poor only when policies are in place that explicitly address these underlying social conditions.
Gaps in health outcomes are not a matter of fate. They are markers of policy failure.
The report places the responsibility for reducing health inequalities squarely on the shoulders of policy-makers. And it does so in sectors well beyond health. The Commission calls for a whole-of-government approach that makes health a part of all government policies, in all sectors. In other words, health in all policies.
The report also has something to say about health systems. It recognizes that equity is strongly influenced by the way health systems are organized, financed, and managed. Not surprisingly, primary health care is championed as a model for a system that acts on the underlying social, economic, and political causes of ill health. As stated, health systems do most to improve health when services are organized around the principles of universal coverage.
Ladies and gentlemen,
When we think about the commission’s findings, we must also think about a fundamental paradox. At the international level, health has risen to a high place on the development agenda. Yet within most countries, the health ministry usually has less clout and negotiating power than other members of cabinet.
Let us be frank. In most countries, an appeal to the value of health equity will not be sufficient to gain high-level political commitment. It is naive to think that ministers of finance, housing, transport, education and others will include health on their agendas for ethical or moral reasons.
The health sector must produce solid evidence, and political and economic arguments that make it smart for governments to include health in all policies. Leaders and managers in health, at all levels, must equip themselves with the skills and competencies to make the case.
Your governments have ratified the WHO Framework Convention on Tobacco Control. But the credit goes to the health sector. As we all know, ministers of finance will not raise taxes on a consumer product, like tobacco or alcohol, unless the health sector makes a very strong case.
Let me commend this region for convening a high-level meeting on promoting health equity, and the emphasis placed on evidence, policy and action. This is absolutely a move in the right direction.
In October, The world health report on primary health care will be issued to commemorate the anniversary of Alma-Ata. The report offers practical and technical guidance for reforms that equip health systems to respond to health challenges of unprecedented complexity.
Like Dr Omi’s report on People at the Centre of Health Care, The world health report asks political leaders to pay close attention to rising social expectations for health care. As mounting evidence shows, people want care that is fair as well as efficient. People want health care that incorporates many of the values, principles, and approaches so brilliantly articulated at Alma-Ata 30 years ago.
Political leaders would be wise to heed these rising social expectations. This, too, may add to this region’s arsenal of arguments as we all work together to put the heart back into medical practice.
Thank you. And thank you, Dr Omi, for your leadership.