Emergency services vital in a time of global crisis

Dr Margaret Chan
Director-General of the World Health Organization

Opening address at the Annual Session of the Executive Board of the World Food Programme
Rome, Italy
8 June 2009

Executive Director, Ms Josette Sheeran, honourable members of the Executive Board, ladies and gentlemen,

Thank you for this opportunity to address the Executive Board of a United Nations agency that is so greatly needed, so highly effective, and so widely respected.

I will speak about the complementarity of work between the World Food Programme and the World Health Organization. I will touch on three areas: our common vision, our common ground, and our common challenges, which are many and certain to grow.

On vision, let me refer to recent revisions in the strategic directions and structure of the World Food Programme. Over the years, you have expanded from a traditional function of saving lives through food aid during emergencies. Your work now includes a broader public health and development agenda.

Your mission statement says this best: the ultimate objective of food aid should be the elimination of the need for food aid.

This move resonates well with some approaches taken by WHO. Like the World Food Programme, WHO has needed to launch emergency responses to high-mortality diseases, like HIV/AIDS, malaria, and tuberculosis.

With support from our many partners, this work has unquestionably saved or prolonged the lives of many millions of people. But if we ever hope to catch up and get ahead of these and other emergencies, our work must take place in a broader context that aims to prevent as well as treat and cure, and recognizes the need to strengthen national capacities and foster self-reliance.

As I am sure we all agree, people in an emergency situation often need a hand-out, of food, essential medicines, shelter, or clean water. But they also need a hand up, out of poverty, and out of dependence on international aid. These are core development objectives.

Your growing success in procuring food locally is a welcome and smart trend on many levels. It saves time, reduces transportation costs, supports local agriculture, encourages economic recovery, and does so in compliance with the high standards of quality and safety you have set.

Moreover, as your Executive Director reminds the world, the task today is not just ensuring that people get enough to eat, but also that they get the right things to eat, nutritionally, culturally, and with a view towards sustainable local recovery.

Getting the right things to eat is apt advice when we know so much about the essential role of nutrients and have such good tools, like food fortification and supplementation. Getting the right things to eat is apt advice at a time when 85% of the burden of chronic diseases, which have a strong dietary component, is concentrated in low- and middle-income countries.

In our common vision, we share a focus on the most vulnerable and needy populations, and an appreciation of the need for community participation. We also share a respect for the unique significance of women as agents of change. We share a commitment to the Millennium Declaration and its Goals, which launched a multi-pronged attack on the root causes of poverty, malnutrition, and ill health.

We also share a common ground. As a specialized technical agency, much of the work of WHO goes to the formulation of international guidelines and norms, whether for the treatment of diseases, the safety of air, water, and food, or standards for nutrient intake and measuring the healthy growth of children.

But WHO is also operational, on-the-ground, in two main areas: when we respond to an outbreak, of a new disease, or an old one, like polio. And when we respond to health needs during disasters, such as those caused by conflict or by natural disasters.

For the neglected tropical diseases, which anchor more than 1 billion people in poverty, WHO staff have a direct hand in helping to orchestrate and run national campaigns aimed at elimination. These efforts include mass campaigns for drug administration, with enormous logistics challenges.

In these areas, our operational work often overlaps with that of the World Food Programme. Let me take this opportunity to express our appreciation for your collaboration, using only two of many, many examples.

In 1996, WHO began a collaboration with the World Food Programme in the field of helminth control. At that time, World Food Programme “troops”, in the form of donkeys, carried deworming tablets in their saddlebags as part of school feeding programmes in remote parts of Nepal.

This is an almost perfect synergy, with multiple value-added benefits. Deworming improves nutrient uptake, reduces anaemia, and improves overall nutritional status, thus stretching the benefits of food aid.

Together, the two programmes improve school attendance, cognitive performance, and overall growth and development, while also reducing the severity of common childhood infectious diseases.

Since then, deworming activities have been systematically included in your school feeding programmes. Today, through this collaboration, around 2 million schoolchildren are being treated every year.

As a second example, let me mention our use of World Food Programme logistics expertise, which is unmatched, whether by air, land, or sea. In 2005, Angola experienced the largest, and the deadliest, outbreak of Marburg haemorrhagic fever on record, with more than 370 cases and a case-fatality rate approaching 90%.

Our ability to tap into your on-the-spot logistics infrastructure and expertise, including use of your aircraft, made a truly life-and-death difference in a dangerous, urgent, and difficult-to-access emergency.

Ladies and gentlemen,

Let me turn to our common challenges, which are multiple, global in scope, and growing.

Last year, our imperfect world delivered, in short order, a fuel crisis, a food crisis, and a financial crisis. It also delivered compelling evidence that the impact of climate change has been seriously underestimated.

As the economists tell us, the financial crisis is so contagious because it comes at a time of radically increased interdependence among nations. The consequences are global, but are not evenly felt. Developing countries, which have the greatest vulnerability and the least resilience, will be hit the hardest and take the longest to recover.

Because of the financial crisis, people in affluent societies are losing their jobs, their homes, and their savings, and this is tragic. In developing countries, people will lose their lives. Likewise, the countries that have contributed least to greenhouse gas emissions will be the first and hardest hit by climate change.

We know what this means: more extreme weather events, more droughts, floods, food shortages, and a growing need for humanitarian assistance at a time when all countries are stressed by climate change.

Health officials concerned about the financial crisis are also concerned about food security and nutrition, and rightly so. When times are hard, processed foods, high in fats and sugar and low in essential nutrients, become the cheapest way to fill a hungry stomach. These foods contribute to obesity and to diet-related chronic diseases, and they starve young children of essential nutrients.

These global crises come at a time when our world is greatly out of balance. We see this clearly with health outcomes, where the difference in life expectancy between affluent and developing countries is now greater than 40 years.

We also see this with food and nutrition, where the growing and severe problem of obesity, also in poor countries, exists together with the enduring problems of hunger, malnutrition, and starvation.

People are feasting and fasting, thriving and dying in a world where differences in income levels, opportunities, and health status are greater than at any time in recent history.

As you are well aware, around one billion people in the world are already living on the margins of survival. It does not take much to push them over the brink. This can happen because of the financial crisis, or because of climate change, or because of pandemic disease.

Ladies and gentlemen,

We are near the start of the first influenza pandemic of this century. Up to now, cases of the new H1N1 virus have been detected, investigated, closely tracked, and reported in well-off countries.

On present evidence, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity in countries with good health infrastructure and adequate resources.

But we are wise to anticipate a bleaker picture in the developing world. Mortality at present is low, but we are seeing some disturbing signs.

This is a contagious virus that shows a preference for younger age groups. Most cases are concentrated in people under the age of 20.

Cases of severe and fatal infection are occurring in young adults between the ages of 30 and 50, and not in the frail elderly, as is usually seen during epidemics of seasonal flu. We know, too, that the risk of severe illness is greater during pregnancy and when certain underlying chronic conditions are present.

Around 99% of maternal mortality, which is a marker of poor quality health care during pregnancy and delivery, occurs in the developing world. As I mentioned, poor countries bear the greatest burden of chronic diseases, where the average age of onset is also earlier than seen elsewhere.

We must all be deeply concerned about the impact that even a moderate pandemic will have on vulnerable populations.

Once again, it does not take much to push people living on the margins of survival over the brink.

With support from the United Nations Secretary-General, we at WHO are doing our utmost to help ensure that developing countries are not, once again, left to bear the brunt of yet another great global contagion.

Continuity of emergency services, such as those provided by the World Food Programme, will be absolutely vital in this global crisis, as in many others.

Let us all work to ensure that core, long-term development priorities, including the Millennium Development Goals, with their underpinning values of equity, solidarity, and social justice, do not fall by the wayside in these times of crisis.

Thank you.