Policies in non-health sectors can have a profound impact on health
Dr Margaret Chan
Director-General of the World Health Organization
Mr Chairman, excellencies, honourable ministers, distinguished delegates, Dr Samlee, colleagues in the UN family, ladies and gentlemen,
During this session, you will be discussing a number of region-wide frameworks and strategies for addressing shared health problems or improving region-wide capacities. This makes good sense. It allows you to share experiences and best practices, compare results, and provide mutual support.
But your documents and reports also reveal the growing vulnerability of health to policies made in non-health sectors, and to global trends and crises, beyond our direct control, that have a profound impact on health.
Risks that have been present throughout human history have become much larger, and more universally disruptive, in a highly interdependent and interconnected world. More and more, health is the unwitting victim of policies made in the international systems that tie countries, economies, commerce, and trade together. This is the new source of setbacks in the 21st century.
These days, politics must be the bedside manner of health officials if they want to get results. To tackle many root causes of ill health, officials need to diagnose causes and consequences in a language that speaks to the core interests of non-health sectors. This is a new task for health officials, and it is not an easy one.
Policy spheres are no longer distinct. Lines of responsibility are blurred. A policy that makes perfect sense for one sector can have a highly negative impact on others, including health. Food policies provide a telling example. The industrialization of food production has, up to now, made it possible to feed the world’s growing population. This is unquestionably good.
But intensive crop production requires heavy use of agro-chemicals, which can contaminate the environment in health-harming ways. Confined animal feeding operations involve heavy use of antibiotics, and this contributes to the problem of antimicrobial resistance, as you will be discussing during this session.
The intensive production of food and its global distribution increase the risk of outbreaks of foodborne disease that spread over wide geographical areas, are costly to investigate, and can lead to massive food recalls.
The globalization of food marketing and distribution has brought processed foods, rich in fat, sugar, and salt, and low in essential nutrients, into every corner of the world. Processed foods, with their long shelf lives, are usually the cheapest and most convenient way to fill a hungry stomach.
They also increase the risk for chronic diseases and contribute to the astonishing prevalence of obesity, yet deprive growing children of essential nutrients. These trends help explain why chronic diseases, once associated with affluence, now impose their heaviest burden on poor and disadvantaged populations.
Where was the preventive thinking, especially for health, when these policies were made? The lesson is obvious. If policies that serve economic goals want to improve the human condition, they must include health as an explicit policy objective.
Think about climate change, another global crisis of deep concern in this region. The world is paying dearly for policies that favoured the growth of economic wealth over the protection of ecological health. I have seen, first hand, in my visits to Bangladesh and Maldives, the impact of climate change on populations in this region.
Skeptics who doubt the reality of climate change would do well to look closely at recent events in China, Pakistan, and Russia. The heat waves, drought, wildfires, downpours, floods, and ruined crops closely match the predictions of climate scientists. They have warned the world to expect more frequent and intense extreme weather events, and this is what we are seeing. More and more, these events are being described as the worst in a century, or the worst in recorded history. Records are being broken a record number of times.
The stress is felt internationally. The United Nations has struggled to secure emergency funds on a scale that matches the magnitude of suffering and loss in Pakistan. Grain prices on the international markets already reflect the huge crop losses in that country and in Russia. We have to anticipate another global crisis of soaring food prices that can hit poor households in this region especially hard.
The global economy has not yet recovered from the financial crisis of 2008. 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.
I can assure you: the austere economic outlook is also affecting WHO. The aspirations set out in the proposed programme budget for 2012–2013 may need to be adjusted in line with the reality of the global economic situation.
And we face other problems. Aided by new communication technologies and social media, public demand for good quality, affordable, and people-centered health care is growing, as noted in one of your documents. These are worthy expectations, but can we meet them?
Moreover, decisions that affect health and health care are now subject to a new form of electronic scrutiny, whereby individuals draw instant information from a range of different sources.
People make their own decisions about which information to trust and which advice to follow. The days when public health could issue advice, based on the best scientific evidence, and expect the public to comply may be coming to an end. The health sector faces tough new communication challenges. Many countries experienced these challenges during the influenza pandemic.
People in all regions of the world are living longer, and the medicines and technologies that keep them alive are becoming increasingly expensive. Advances in medicine and science continue to race ahead, yet an ever greater proportion of the world’s population is left behind for a host of reasons, including those with economic and social causes.
Let me thank the government of Thailand, and its Ministry of Public Health, for hosting the first Global Forum on Medical Devices, which is being held in Bangkok later this week. On that occasion, WHO will be launching a new report that can help set the agenda for a more rational approach to the acquisition and use of medical devices.
Ladies and gentlemen, we face many complex challenges, often with global dimensions. But we have some good policy tools for managing them, and we have some solid reasons for optimism.
The report of the Commission on Social Determinants of Health is a strong support in the quest for greater fairness in access to health care and greater equity in health outcomes. Its evidence legitimizes the need to negotiate with non-health sectors, to argue for health in all government policies, and to stress the importance of upstream prevention.
The Commission places the responsibility for huge and growing gaps in health outcomes firmly on the shoulders of policy-makers, also at the international level.
The Millennium Development Goals (MDGs) are another force driving the international community in the right direction. The MDGs represent the most ambitious attack on human misery in history, and they have been good for public health.
The first decade of this century saw the creation of numerous global health initiatives, new funding mechanisms, and new financial instruments. The results have been measureable and significant. They tell us that increased investment in health development is working. Our job now is to maintain the momentum, despite financial hardship in many quarters.
We see some encouraging signs. In the homestretch to 2015, we see the momentum continuing to build, especially to combat maternal and neonatal mortality, another item on your agenda.
The documents prepared for this session illustrate some of the region’s strengths as you strive to improve health for very large numbers of people, including many who are poor.
South-East Asian countries have long experience in the development and implementation of national health plans and strategies, often with assistance from WHO. This gives you a strong advantage in terms of national ownership of the health agenda. It also helps ensure that development assistance is channeled in ways that strengthen existing capacities and promote self-reliance.
An equally important safeguard is the rigorous, analytical, and evidence-based way that countries in this region decide which interventions are appropriate to national health needs. In this way, you truly own the health agenda.
The region is strongly committed to primary health care, as an approach to strengthening health systems, but also as an articulation of principles and values. You are committed to equity, to universal coverage, to people-centered care, to prevention, and to participation which respects the voice and the aspirations of communities.
You see an explicit need to align health plans more closely with development plans, and you recognize the absolute necessity of collaboration with other sectors.
These strengths, and your commitments, are readily apparent in the documents and reports prepared for this session. Let me mention two in particular.
You will be discussing a coordinated approach to the prevention and control of acute diarrhoea and respiratory infections. These are high-burden diseases in this region, and a significant cause of young-child mortality. The document calls for a coordinated approach to both that gives a much stronger emphasis to prevention.
It calls for a more aggressive and strategic implementation of cost-effective interventions, like oral rehydration therapy, antibiotics, micronutrient supplements, exclusive breastfeeding, and simple hand hygiene. In addition, it argues for the inclusion all age groups, and not just under-fives.
In other words, it uses primary health care to get the burden down. This is the kind of approach that tackles the diverse dimensions of a problem, and multiplies the return on the investment, many times over.
As explicitly stated, the prevention and control of such high-burden conditions can serve as an entry point for the revitalization of primary health care as the basic tool for building and improving health systems. Needless to say, I find this a very smart approach. In reality, it is a corrective strategy, and a model for tackling other high-burden diseases.
You will also be discussing a proposed regional strategy for universal health coverage, a sign of your determination to improve health equity.
The problems being addressed are familiar: high out-of-pocket spending on health, large employment in the informal labour market, service delivery dominated by a vast and mostly unregulated private sector, and costly new demands that accompany the rise of chronic diseases.
The phase-wise approach, proposed as a realistic way to move towards universal coverage, aligns well with the recommendations and advice set out in this year’s World Health Report, which will be launched later this year in Berlin.
The report, on health systems financing, offers a menu of options for raising sufficient resources and removing financial barriers to access, especially for the poor. Direct payments, including user fees, are identified as the greatest obstacle to progress.
In a key achievement, the report estimates that from 20% to 40% of all health spending is currently wasted through inefficiency. It points to ten specific areas where better policies and practices could increase the impact of expenditures, sometimes dramatically.
At a time when money is tight, cutting waste and improving efficiency is a far better option that cutting health budgets.
Ladies and gentlemen,
Let me conclude with some encouraging results in this region that are good news everywhere. This region is now winning on the polio front. Since last year, success in India has been striking. Cases are down by 87%. In Uttar Pradesh and Bihar, the two states where transmission has been most tenacious, the most dangerous serotype has not been detected at all during the first seven months of this year.
This breakthrough affirms the unshakable resolve of the Government of India and its formidable spirit of innovation.
Obstacles remain. Millions of people are moving across this vast country every day, seeking opportunity in a dynamic economy. The government is now working to ensure vaccination of this high-risk migrant population so that the last polioviruses do not move with them and compromise the gains of 2010.
India is poised to complete the eradication of polio from South-East Asia, the most technically challenging region in the world. The lessons learned from this historic effort, particularly in finding and vaccinating impoverished and hard-to-reach populations, provide a roadmap for solving many other, seemingly intractable, health problems.
This breakthrough in India is inspiring the world. We can definitely eradicate polio and, in so doing, prove that we can do so much more for the health of our children and our people.