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, Dr Shin, Director-General Emeritus Dr Nakajima, Regional Director Emeritus Dr Han, ladies and gentlemen,
It is a great pleasure for me to be back in my home region, back in my home town. I thank the government of Hong Kong for its hospitality in hosting this sixtieth session of the Regional Committee for the Western Pacific.
Let me also extend my congratulations to Dr Shin for his first report to this committee and for the clear priorities it defines. The report reinforces this region’s commitment to the Millennium Development Goals, the tenets of primary health care, and the plight of the poor.
It is encouraging to see a record of progress in many areas. This is a tribute to the region’s cohesion and spirit of mutual support among countries at vastly different levels of development. Grounds for optimism and encouragement are especially welcome right now.
We are meeting at a challenging time, as public health struggles to position itself in a cross-current of strong trends.
On one side, prospects for progress are battered by global crises on multiple fronts. The world faces the most severe economic downturn in at least three decades, a climate that is changing for the worse, and an influenza pandemic that is now unstoppable. All of these crises have profound implications for health.
On the other side, prospects for progress are bolstered by unprecedented determination to solve long-standing problems and achieve greater equity in health outcomes. The Millennium Declaration and its Goals give this world its best chance ever to introduce greater fairness and balance into the very fabric of societies, especially for health.
We cannot allow this momentum to stall. Precisely because of these global crises, the price of failure keeps getting higher.
At the international level, I see some reasons for optimism. Commitment to the health-related Millennium Development Goals is steadfast. Efforts to accelerate progress are actually increasing. And they are doing so with a solid awareness of the challenges.
In the nine years since the Millennium Declaration was signed, countries and donors have come face to face with two fundamental problems that consistently block progress: weak health systems and ineffective aid. The importance of these problems is readily apparent in the reports before this committee.
In the absence of well-functioning health systems, powerful interventions and the money to purchase them will not be enough to reduce the great gaps in health outcomes. The Millennium Declaration revitalized the values of equity, social justice, and universal coverage set out in the Declaration of Alma-Ata thirty years ago.
Last year’s report of the Commission on Social Determinants of Health concluded that health systems organized to achieve universal coverage do the most to improve health outcomes. The Commission recognized that equity is strongly influenced by the way health care is organized, financed, and managed. It endorsed primary health care as a model for a system that acts on the underlying social, economic, and political causes of ill health.
Ladies and gentlemen,
Progress in health development is not measured by national averages. True progress is measured by how well we reach the people left behind and enrich their lives through better health. The best way to do this is through people-centred primary health care.
We know this. As noted in your reports, improvements in health status in this region have been especially great in countries where health systems have maintained effective primary health care.
The need for stronger health systems is closely linked to the need for more effective aid. The logic is straightforward. Good aid builds the foundation, the capacity, and the infrastructure needed to move towards self-sufficiency. Good aid aims to eliminate the very need for aid. If aid does not explicitly aim for self-sufficiency, the need for aid will never end.
Both of these realities are fully reflected in the health financing strategy for the Asia Pacific Region, which you will be discussing. As noted, one way to stretch limited funds is through greater efficiency in the performance of health systems. As further noted, greater efficiency is not only badly needed. It is also entirely feasible.
Let me give just two examples. Your report cites evidence that more than half of medical product use is irrational use. Last year’s World Health Report, on primary health care, cites evidence that effective use of available preventive measures could reduce around 70% of the global disease burden.
Again, these estimates recall the advantages of primary health care as a strategy that stresses the need for appropriate technologies, promotes the rational use of essential medicines, and places prevention on a par with curative care.
At the same time, you do not underestimate the challenges. Countries in this region are deeply concerned about the effects of the economic downturn on health. You are rightly concerned, for all the right reasons. The conclusions of your report on the global financial crisis are stark.
Some hard-won economic and social gains have already been erased. Countries in this region, with their strong reliance on export-oriented sectors and on tourism, are especially vulnerable to job losses and to reduced employment-related social benefits.
The Asia Pacific region has the world’s highest reliance on user fees, co-payments, and out-of-pocket expenditures as a strategy for financing health care. This is an unfortunate legacy from policies introduced during previous economic crises.
Such a strong reliance on user fees is incompatible with your policy objectives of universal coverage and equitable access to quality health services. It is incompatible with strategies for poverty reduction as a route to better health.
As noted, countries in this region are under strong pressure to reduce health budgets and extend user fees and co-payments. You are painfully aware of what this means: a further deterioration in access, equity, quality, and utilization of health services.
This region, which struggled so long to lift millions of people out of poverty, does not need a setback that again pushes millions below the poverty line. This region, which has struggled against the unfairness inherent in user fees, does not need to see the situation grow even worse. We simply must not make the same mistakes again.
Sadly, the policies and international systems that contributed to the economic crisis are beyond the influence of the health sector. Sadly, health bears the brunt of the consequences.
Ladies and gentlemen,
As I mentioned at the start, grounds for optimism are very welcome now. Let me refer to two trends in this region, evident in your agenda, that I find especially encouraging.
First, you are building on success and setting your sights ever higher. This is true for your progress in reducing child mortality and especially in setting even higher goals for the elimination of measles and the control of hepatitis B infections. This is true for malaria and the goals set for elimination.
This is also true for tobacco control, where this region has long been a leader. This is the first and only region in which all eligible member states have ratified the WHO Framework Convention on Tobacco Control. You are now moving on to the next level, the highest one: complete implementation of the Framework Convention within the next five years.
In a second welcome trend, countries in this region are taking command of the health agenda through comprehensive cross-cutting strategies that tackle the need for stronger capacities.
With the Asia Pacific strategies, whether for the response to emerging diseases or the upgrading of laboratory services, you offer a clear direction forward in a step-wise approach, with indicators for measuring progress that match conditions in your countries. In this way, you put countries in a much stronger position when aligning aid with national priorities and capacities.
Support for stronger health systems and more effective aid is also growing at the international level. Major sources of financial support, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, and the World Bank, have established platforms for strengthening health systems.
Instruments, such as the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, support efforts to make aid for health more effective, also through responsible actions by donors.
Momentum to reach the Millennium Development Goals continues to be propelled by a strong sense of urgency. Later this week, a forceful and focused drive is being launched in New York to accelerate progress towards improving maternal, newborn, and child health.
In just a few months, world political and financial leaders have put together a series of ambitious recommendations for the innovative funding of stronger health systems. These recommendations will also be announced this week.
While we need optimism, we also need to be frank and realistic, especially when we consider the health impact of faulty or short-sighted policies made in other sectors.
In a sense, the Millennium Development Goals are a corrective strategy. They aim to compensate for international systems and policies that create benefits, but have no rules that guarantee the fair distribution of these benefits.
The Goals and the many initiatives and funding mechanisms launched to support them are badly needed and do much good. But they do not address the root cause of inequities in health outcomes. As we know from the Commission on Social Determinants of Health, the root causes lie in flawed policies.
Greed seeded the financial crisis, which sprang out of control as corporate governance and risk management failed at every level of the system. Climate change is now the price the world will inevitably pay for short-sighted policies. The pursuit of economic wealth took precedence over the protection of the planet’s ecological health. As we all know, this region is especially vulnerable to the effects of climate change.
In a world of radically increased interdependence among nations, the consequences of mistakes made in one country or in one sector are highly contagious. The consequences of this contagion are profoundly unfair. Developing countries have the greatest vulnerability and the least resilience. They are hit the hardest and take the longest to recover.
As the influenza pandemic continues to sweep around the world, I believe we will see what the world’s collective failure to care about equity really means. A virus that causes manageable disruption in wealthy countries is very likely to cause devastation elsewhere.
Ladies and gentlemen,
In June, when WHO announced the start of the 2009 pandemic, many eyes looked to countries in the southern hemisphere for clues about how the pandemic might evolve.
Let me thank countries in this region for their intensive surveillance and rapid and comprehensive reporting. This response has helped countries elsewhere know what to expect and how to prepare.
As a technical discussion of the pandemic is scheduled for tomorrow, let me focus on just a few issues that I find important at the international level. The past two weeks have brought some good news. Evidence is growing that antiviral drugs can reduce the risk of severe disease. And results of early clinical trials suggest that a single dose of pandemic vaccine may be sufficient to confer protection in healthy adults.
If confirmed, this finding will literally double the amount of vaccine available. Here is the big question: will this result in more equitable distribution of vaccines? Let me assure you: I am pursuing this opportunity from several angles.
I am concerned on another issue. Evidence from all outbreak sites confirms that pregnant women are at increased risk of severe or fatal infection. This increased risk becomes all the more important for a virus, like this one, that preferentially affects a young age group.
The deaths of pregnant women during the pandemic will be tragic everywhere, but most especially so in the developing world, where the numbers will be so much higher.
Since taking office, the health of women has been one of my priority concerns. A renewed commitment to primary health care underpins efforts to improve the health of women. This relationship is starkly evident in a report on Women and Health that I have commissioned. The report, which will be issued in November, explores the many health risks that women face throughout the life course, and sets out an agenda for change.
Ladies and gentlemen,
As we all know, weak health systems are wasteful. They waste money, and dilute the return on investments. They waste training when workers are lured away by better working conditions or better pay. They waste resources when needless procedures are performed, or when regulatory systems fail to control the price and quality of medicines.
They waste opportunities for poverty reduction when poor people are driven even deeper into poverty by the costs of care or the failure of preventive services. Above all, weak health systems waste lives.
I believe we will see, in a measurable and tragic way, what inequities really mean as the pandemic sweeps through a world where differences in health status and standards of care are greater than at any time in recent history.
Perhaps now, some of our long-standing arguments about equity, fairness, and social justice will have a greater chance of being heard, though the price for such attention will be measured in human lives.