WHO Director-General assesses health situation in the Eastern Mediterranean Region
Dr Margaret Chan
Director-General of the World Health Organization
Mr Chairman, honourable ministers, distinguished delegates, Dr Gezairy, ladies and gentlemen,
This century began with unprecedented determination and commitment to improve health, supported by unprecedented cash for the massive distribution of commodities, like medicines, vaccines, and bednets, to the world’s disadvantaged populations.
Better health was seen as central to the overarching objective of poverty reduction set out in the Millennium Development Goals.
Tremendous progress has been made. Worldwide, young child and maternal deaths are now at their lowest levels in decades. The tuberculosis epidemic, once declared a public health emergency, has been turned around.
Malaria cases and mortality have dropped in some countries by more than 50%. And nearly 7 million people in low- and middle-income countries are seeing their lives revived and prolonged by antiretroviral therapy.
Yet this progress has been made against some ever-growing odds. In reality, the first decade of the century evolved in turmoil. A world of radically increased interdependence found itself beset by one global crisis after another.
The economic downturn has deepened. Food security has become a critical issue. Infectious diseases are a much larger health and economic menace in a world tied together by the speed of international travel, and live-wired by chat rooms, blogs, and Twitter.
The climate is warming. Natural disasters are becoming more frequent and destructive. And hot spots of civil strife and conflict, sometimes brief, sometimes sustained, mar nearly every region in the world.
Chronic noncommunicable diseases have spread everywhere, fuelled as they are by universal trends, like rapid unplanned urbanization and the globalization of unhealthy lifestyles. Diseases like heart disease, diabetes, and cancer know no north-south, tropical-temperate, or rich-poor divide.
These are the diseases that break the bank. Just last week, an expert study concluded that the costs of treating cancer are now unsustainable in even the richest nations. In some developing countries, the costs of treating diabetes alone devour 15% of the entire national budget for health.
The year 2011 has experienced these kinds of turmoil in concentrated form.
In the wake of last year’s devastating earthquake, Haiti remains crippled by the worst cholera outbreak in modern history. The triple tragedies in Japan quickly became the most costly natural disaster ever recorded.
In this region, drought, crop failure, livestock deaths, and human starvation ravage the Horn of Africa in the worst food security crisis experienced in decades. For multiple reasons, humanitarian agencies have been able to deliver only a fraction of the aid that is needed.
Again, monsoon rains and floods in Pakistan have displaced millions, intensifying the need for shelter and emergency health care. Right now, parts of Pakistan are experiencing an exceptionally severe outbreak of dengue, with catastrophic costs for households and health budgets.
These crises come in a country that has still not recovered from last year’s devastating floods and the massive destruction of the health infrastructure that occurred.
As I said, this has been a year of concentrated turmoil.
Ladies and gentlemen,
The face of the Middle East is changing. The protests that began at the start of the year captured worldwide attention, and social media elevated this attention to mega-publicity. Populations have risen up to demand democratic reforms and respect for human rights, and this includes the right to health.
As noted in a recent UN Arab Human Development Report, prepared by Arab scholars, “The Arab people are suffering from three huge deficits: a deficit of freedom, a deficit of knowledge, and a deficit of women’s empowerment.”
I have an additional observation. I am speaking as a medical doctor.
Most of us choose this profession out of a desire to help, to heal, to care, to relieve suffering. During our training and subsequent practice, this urge to help and to heal becomes almost instinctive.
In my view, a physician, in conducting his or her professional duties to treat and to care for the sick and injured, must maintain medical neutrality and be protected for doing so, as stated in the Geneva Convention. This medical neutrality must never be compromised.
Like the financial crisis of 2008, the Region’s swelling tide of uprisings and protests seemed to take the world by surprise. With the benefit of hindsight, political and economic analysts have identified root causes which make the turmoil understandable, even predictable.
They cite vast inequalities in income levels, in opportunities, especially for youth, and in access to social services as the cause. And they conclude that greater social equality must be the new political and economic imperative for a safer and more secure world.
I would add: responding to the legitimate aspirations of populations is the legitimate route to stability and security.
Public health is extremely well-positioned to improve equity, especially when health services are delivered according to the values, principles, and approaches of primary health care.
This was a bright side of last month’s high level meeting on chronic noncommunicable diseases held during the UN General Assembly. Consensus is now solid that a robust primary health care system is the only way that countries will be able to cope with the growing burden of chronic diseases.
Immunization is on your agenda. As noted, the current unrest in the region has had an impact on immunization programmes, including growth in the size of susceptible populations.
You will be considering a proposed regional strategy for addressing mental health and substance abuse. The strategy responds to issues that are becoming increasingly important in times of conflict, natural disasters, and political turmoil.
This year, the world has entered a new era of financial austerity. The consequences are being severely felt in the region.
These consequences have also affected the financing of WHO at every level. I look forward, in particular, to your discussion of the item on WHO reform for a healthy future.
Let me repeat a statement made in your documents. “Now is the time to emphasize the cost-effectiveness and public health benefits of a comprehensive primary health care approach as opposed to a disorganized clinical approach.”
I was pleased to see primary health care mentioned so frequently in the documents prepared for this session. I was pleased, but not surprised, given the passionate views of your Regional Director and his strong support for community-based initiatives.
Ladies and gentlemen,
Dengue is on your agenda as a matter of urgency. You will also have a technical discussion on managing the use of public health pesticides as the Region’s burden of vector-borne diseases continues to grow.
Dengue is the world’s most rapidly spreading mosquito-borne viral disease. The disease is a relative newcomer to this region, but outbreaks are now hitting Eastern Mediterranean countries with a vengeance.
This comes as no surprise. Like diabetes, which is likewise hitting this region hard, dengue is strongly associated with rapid unplanned urbanization. The mosquito vector, the so-called “container breeder”, thrives on stagnant water contained in urban litter, trash, and receptacles, also for storing household water. These conditions can be tackled by urban sanitation.
In Pakistan, Saudi Arabia, and Yemen, dengue is highly visible as a leading cause of morbidity and hospitalization among children and young adults, and has led to a number of deaths.
The disease may be even more widespread, yet not on the radar screen because of weak surveillance and laboratory capacity, especially as symptoms mimic many other common diseases.
Dengue is a complex disease, with its four serotypes. Preparedness and response demand collaboration from multiple sectors and demand good laboratory-based surveillance for both the virus and its mosquito vector.
In fact, vector control is the one and only preventive measure. A firm diagnosis cannot be made without skilled laboratory support. Surveillance for preparedness and alert must be tailor-made and fine-tuned for dengue.
Integrated disease surveillance is the smart approach but, with dengue, you cannot simply “piggy-back” on systems set up for other mosquito-borne diseases, like malaria.
These are just some of the challenges you will be discussing.
In Pakistan, the number of confirmed and suspected cases of dengue has risen, in just the past few weeks, with extraordinary speed. This is a disease that can take advantage of any weakness in the health infrastructure.
But Pakistan is doing the right things, especially in its civil awareness campaign aimed at ridding households, streets, and bazaars of stagnant water. We appreciate the frank and open reporting and the attention being given to vector control.
The WHO representative in Pakistan is an expert in vector control. He is now backed up by experts from headquarters, sent at the request of Pakistani authorities. The objective is to control the current outbreak, but also to build deep capacity for vector control, especially integrated vector management that rationalizes the use of resources, including pesticides.
This has to be done. The conditions are ripe for outbreaks of dengue to ravage parts of this region time and time again.
Ladies and gentlemen,
Your region continues to intensify efforts on polio eradication, despite challenging conditions in the two countries, Afghanistan and Pakistan, where transmission of the virus has never been interrupted.
At the request of the World Health Assembly, an Independent Monitoring Board of the Global Polio Eradication Initiative was established to keep close track of progress and setbacks in the drive to rid the world forever of this disease.
The Board’s most recent report, issued in July, expressed grave concern over the increasing challenges facing Pakistan. This year, Pakistan is experiencing a significant increase in new cases, and now accounts for nearly a quarter of all cases worldwide.
It is also the only place in Asia with type 3 polio, a strain which is on the verge of elimination on the continent. The country’s President has launched an Emergency Action Plan on Polio Eradication, and we commend this initiative.
Last month, we received confirmation that polio from Pakistan has spread into China. Again, we see that endemic transmission anywhere in the world threatens the world everywhere. Given these challenges, the Independent Monitoring Board has gravely warned that Pakistan risks becoming the last global outpost of this disease.
In Afghanistan, concerted and tactical efforts at the community level in the Southern Region are targeted at reaching more children with polio vaccine in areas that are difficult to access.
Nonetheless, the increased number of new cases observed over the past two months reveals the fragility of such progress. The Independent Monitoring Board cautions that the programme has not yet sufficiently overcome its access challenges.
WHO will support Afghanistan and Pakistan in implementing novel community-based approaches that we know can work in security-compromised areas.
We will help foster political commitment at the critical union-council level, to ensure that more children are immunized in all areas. We know the challenges you face. But we also know they can be overcome. No challenge anywhere can be allowed to jeopardize the goal of permanently improving the world by driving out a truly awful disease.
I know your Regional Director agrees with this view, and agrees with his characteristic passion.
Dr Gezairy, as you step down at the end of this term, I join a multitude of others, within this region and well beyond, in thanking you for so many jobs for the good of public health so very well done. You will be sorely missed.