WHO Director-General addresses UN Security Council
Dr Margaret Chan
Director-General of the World Health Organization
Mr President, Mr Secretary-General, honourable ministers and ambassadors, ladies and gentlemen,
I deeply appreciate this opportunity to brief the Council, with full respect for the many heavy burdens on your shoulders.
You are looking at new challenges to peace and security and at ways to prevent conflict. I do not intend to make your burden heavier by suggesting a long list of health problems that should be placed under your watch.
Many health problems addressed by WHO cause deep human misery. Several clearly deepen poverty. But most do not directly threaten peace and security and rarely contribute to conflict.
Instead, I will concentrate on a few recent health trends that worry me, personally, the most.
These trends are part of what is happening in the world at large, where health nearly everywhere is being shaped by the same powerful, almost universal forces, like population ageing, population movement within and between countries, rapid urbanization, the globalization of unhealthy lifestyles, including substance abuse and, of course, climate change.
They are new because they arise from this century’s unprecedented interdependence and connectivity. The affairs, and fates, of nations are intertwined as never before.
Crises are increasingly global in their impact. They are highly contagious and profoundly unfair, frequently damaging countries that had nothing to do with the causes.
The world is getting dangerously out of balance. This worries me.
Annual government expenditures on health range from as little as $1 per person to nearly $7,000. The difference in life expectancy between the richest and poorest countries now exceeds 40 years.
The soaring costs of health care worry me. An estimated 2.7 billion people live in countries with no safety net to cover medical costs.
For a family living on the fringes, selling the main household asset, like a cow, to pay for health care, means ruin. WHO estimates that 100 million people are driven below the poverty line each year because of catastrophic medical bills.
Infectious diseases worry me, especially new diseases with pandemic potential.
In this year alone, WHO has investigated nearly 400 rumours of acute threats to health, mostly from infectious diseases. Of these, only 34 were false alarms, like rumours of smallpox or anthrax cases, 76 were judged to be of low risk to international health, and 230 were major events, like Ebola outbreaks, the multiple outbreaks that threatened to destabilize flooded Pakistan, and 54 cases and 29 deaths from bird flu.
Conflicts worry me, as they are the perfect breeding ground for outbreaks and malnutrition, and a perfect setting for the violation of human rights, especially when sexual violence is used as a weapon.
Public misperceptions worry me, like the belief that vaccines are dangerous. This is why we are seeing large measles outbreaks that never should have happened, especially in countries with a well-educated public.
These are some of my top worries. For some, I have good news to report.
In the past decade, after the fuel, food, and financial crises, the issue of governance was hotly debated. For the financial crisis, analysts cited a failure of governance, oversight, and risk management at every level of the system.
Since the start of this century, WHO and its Member States have been managing internationally shared health risks through the development of new global governance regimens.
We have the International Health Regulations, revised after the SARS outbreak of 2003. They move from a reactive response to outbreaks at borders and points of entry, to a proactive response aimed at snuffing out a threat at source, before it has a chance to spread internationally.
The Regulations adopt an all-hazards approach, on the lookout for any acute event where people suddenly fall ill, whether because of infections, food poisoning, or exposure to toxic chemicals or radioactive materials. Solid background data on what is usual for a season or area make it easier to pick up the unusual, such as illness caused by a new pathogen or caused by terrorism.
WHO gleans intelligence about potential outbreaks from constant, worldwide electronic surveillance, and responds through its Global Outbreak Alert and Response Network, which draws expertise from more than 300 technical institutions and high-level biosecurity laboratories.
And we have a new framework that sets out obligations for the sharing of influenza viruses and of benefits, like medicines and vaccines, during an influenza pandemic.
This is the newest governance instrument, approved just this May by the World Health Assembly. The negotiations behind the framework were the most intense and potentially explosive that I have ever witnessed during my 35 years in public health.
But a spirit of consensus and fair play eventually won, and we got a square deal for everyone, including the pharmaceutical industry.
These new governance regimes tell us that countries really want collective security against shared threats. They want risks to be proactively managed, with an emphasis on prevention. They want rules of proper, responsible conduct, and they want fairness, a square deal for everyone.
I have a final point.
This year’s protests in the Middle East captured world attention and toppled some governments.
Many analysts saw these events as uprisings against inequalities, in income levels and opportunities, especially for youth. Some experts now believe that greater equality must become the new economic and political imperative for a stable and more secure world.
I have no idea if this will happen. Personally, I would welcome such a policy imperative with wide-open arms.
Prevention is the heart of public health. Equity is its soul.