A consistent resolve can improve public health despite crises
Dr Margaret Chan
Director-General of the World Health Organization
Mr Chairman, honourable ministers, distinguished delegates, Dr Gezairy, ladies and gentlemen,
The situation in Pakistan is the focus of concern in this region, as it should be everywhere. Like the earthquake in Haiti earlier this year, the floods in Pakistan show the magnitude of harm, and the difficulty of recovery, when disaster strikes an area with weak capacities and fragile health status.
UN Secretary-General Ban Ki-moon has described the Pakistan floods as “the worst disaster the United Nations has responded to in its 65-year history.”
The media spotlight has moved on to other world crises, and much of the suffering in Pakistan is no longer in the public eye, mind, or conscience.
I thank this regional office, its regional director, its staff, and the countries it represents for their unwavering support to the people of Pakistan. This support will be needed for some time to come.
Ladies and gentlemen,
The first decade of this century may very well go down in history as the time when nations came face to face with the perils of interacting in a world of radically increased interdependence.
The stress of events in one part of the world, whether a financial crisis or a natural disaster, is felt internationally.
Climate scientists have repeatedly warned the world to expect an increase in the frequency and intensity of extreme weather events, and this is what we are seeing. Records, for heat waves, droughts, storms, and floods, are being broken a record number of times.
The UN has struggled to secure emergency funds on a scale that matches the magnitude of needs in Pakistan and the very real threats to health, especially in malnourished children and pregnant women.
Grain prices on the international markets already reflect the huge crop losses in the Russian Federation and Pakistan. We have to anticipate another global crisis of soaring food prices that hit the poor the hardest.
Nutrition is on your agenda. You know what high food prices mean for health. When children are inadequately nourished during their first two years of life, the damage to their mental and physical development is irreversible.
The current economic downturn is global. It is the worst in a generation. And it is by no means over.
Money is tight, and public health is feeling the pinch. It is being felt at levels ranging from national health budgets, to commitments of official development assistance, to funds available to support the work of the Global Fund, the GAVI Alliance, and other global health initiatives.
Two weeks ago, I attended the UN summit on the Millennium Development Goals and participated in several events.
The world received its report card. High marks go to initiatives, like the Global Fund and the GAVI Alliance, for significant reductions in deaths from AIDS, TB, malaria, and vaccine-preventable diseases. Countries’ commitment and domestic investment are critical for these achievements.
High marks go to aid that is building fundamental capacities and infrastructures, thus moving countries towards self-reliance.
But low marks go to wealthy countries for failing to deliver on their promises and commitments, including financial ones.
The Global Fund and the GAVI Alliance introduced the principle of results-based funding. And yet despite their own significant and measurable results, both are now strapped for cash.
In the midst of a battle, you do not deplete the war chest, especially when you are on a winning streak.
Many governments used the MDG summit to announce significant funding commitments, especially to support a new global strategy for women’s and children’s health.
This raises some familiar questions. Will countries deliver on these promises? We have heard them before. Is the funding coming from new sources? Or are donors simply shifting from one priority to another?
Neglecting any of the goals jeopardizes the entire agenda for reducing poverty and introducing greater fairness in the way opportunities, wealth, and health are distributed.
The beauty of the MDGs is that they are interactive and synergistic. If you reduce parasite infections in children you improve nutrition. If you improve nutrition, you improve educational outcomes. If you improve educational outcomes, especially of girls, you improve the health of families and entire communities. In this way, the chain of poverty, ill health, and misery, passed from one generation to the next, is broken.
The biggest question remains unanswered. Will a financial crisis, seeded by greed, cancel out the gains for health made by so much good will and innovation? Will the worst in human nature win over the best?
Ladies and gentlemen,
The agenda for this session focuses on several areas where countries in this region want to make progress: in preventing health problems, in extending coverage with essential care, and in improving the fairness and efficiency of health services. In addition, you have a special session on tobacco economics – focusing on the tobacco taxes experience of Thailand and Egypt.
I was struck by several statements and statistics set out in your technical papers. They capture well some of the challenges being faced.
This is a region where health expenditure ranges from less than $25 per person to nearly $3,000. Your focus on poverty and on populations in greatest need makes perfect sense.
This is a region where nearly 40% of the population is affected by complex emergencies. Mental health is on your agenda. Not surprisingly, studies carried out in countries experiencing conflict show significantly higher rates of neuropsychiatric disorders among children and adolescents. In studies throughout the region, women show significantly higher rates of common mental disorders than men.
The region has one of the highest frequencies of health-care associated infections in the world, with major implications for costs, the quality of care, and patient safety. This, too, is being addressed.
Nutrition is on your agenda. In this region, as elsewhere, under nutrition and micronutrient deficiencies coexist with problems of overweight and obesity. Nutrition deserves a much higher place on the development agenda. The health sector, acting alone, cannot counter trends that are governed by powerful food production, processing, marketing, and distribution practices, and by international trade agreements.
HIV is on your agenda. Fortunately, this region continues to show a low prevalence of HIV/AIDS in the general population. But the epidemic is gaining ground in certain sub-groups at special risk. In this region, only 10% of people needing antiretroviral therapy are receiving it, representing the greatest treatment gap in the world.
Your technical discussions will explore ways of financing equitable health care, which is also the topic of this year’s World Health Report. The emphasis is firmly placed on moving towards universal coverage. The report identifies direct payments, including user fees, as the greatest obstacle to progress.
As noted in your technical paper, the share of health expenditure that comes from out-of-pocket payments approaches 80% in some countries in this region.
The overarching message of the World Health Report is one of optimism. All countries, at all stages of development, can take immediate steps to move towards universal coverage and to maintain their achievements. All health systems, everywhere, could make better use of resources, through better procurement practices, for example, or through better incentives for providers.
In times of economic austerity, cutting waste and inefficiency is a far better option that cutting health budgets.
Ladies and gentlemen,
Let me conclude with an example that shows what can be achieved when the right policies are in place.
Lebanon is the only country in this region where out-of-pocket expenditure on health has actually dropped in recent years. It is worth repeating some of the reasons why.
Generic medicines were substituted for brand-name medicines. Every country can do this.
A well-functioning regulatory authority was established for health care products and biomedical technology, including regulation of services in the private sector. Every country can strengthen its regulatory capacity.
And primary health care was strengthened.
These innovations improved health outcomes, but they also brought a bonus: both government and household spending on health dropped considerably.
Such results show the impact of good policies and the wisdom of regional commitment to primary health care, as articulated in the Qatar Declaration.
Moreover, by monitoring successive changes using the national health accounts tool, Lebanon had the data to demonstrate these results.
As with the MDGs, money is important, but not uniquely so. When the will is present and the policies are right, progress towards better health is always possible.
I wish you a most productive meeting.