Despite financial constraints, health must remain at the top of the international agenda
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,
We are meeting at a challenging time for public health, full of uncertainties and real but unpredictable risks. News headlines since the start of this year make the point very clear. This is a world beset by one global crisis after another.
The year 2008, with its fuel, food, and financial crises, was the tipping point in terms of demonstrating the perils of living in a world of radically increased interdependence.
These crises were highly contagious, rapidly sweeping around the world. And they were profoundly unfair in their consequences, adversely affecting countries that had nothing to do with the causes.
These crises are still very much with us, with profound implications for national health budgets, financial support for health development, food security, the number of people living in poverty, and the future of financing for WHO.
In just the past few months, the global economic downturn has deepened, ushering in a new era of financial austerity. Today, talk about swift recovery of the global economy sounds more like wishful thinking than a frank look at reality.
Global food prices reached an historical high this past February, surpassing the spike of 2008, which was already the highest price peak in two decades. During this session, you will be discussing how soaring food prices have undermined dietary diversity, which is so important for healthy nutrition, from gestation through old age.
This year has seen drought and famine in the Horn of Africa, resulting in population movements, of people fleeing starvation and violence, on a scale unmatched in recent history.
The earthquake and tsunami in Japan, compounded by an accident at a nuclear energy plant, quickly became the most expensive natural disaster ever recorded. Haiti and Pakistan have still not recovered from last year’s devastating earthquake and floods.
The year has witnessed wave after wave of civil unrest and protest. The Arab awakening, in particular, has been deeply inspiring in some cases, and deeply disturbing in others.
The year’s events have included hot spots of war under conditions that have made humanitarian assistance extremely difficult and dangerous.
It also included senseless acts of destructive terrorism, including the bombing of the UN compound in Nigeria, in which many WHO staff were severely injured or lost their lives.
Although we still have some months to go, it is tempting to conclude that 2011 has been an exceptionally bad year, with consequences that are likely to be felt for some time to come.
On the positive side, this unprecedented cascade of calamities, crises, and uprisings has had an impact on high-level thinking about the way our 21st century world has been designed to work.
Some are beginning to question whether economic growth for its own sake is the solution to all problems. Some are beginning to acknowledge that market forces alone will not solve social problems.
Political leaders and economic analysts are waking up, beginning to voice some views that public health has been shouting, to deaf ears, for decades.
As we are hearing, greater equality, in income distribution, in opportunities, especially for youth, and in access to social services must be the new political and economic imperative for creating a more stable and secure world.
Public health would certainly welcome some high-level changes in thinking along these lines.
We are all aware of the policies, including fiscal ones, that have shrunk the capacity of public health services and encouraged the growth of the private sector, where neither the quality of care nor the prices charged are regulated.
We all know the consequences. To name just a few: the persistence of malaria monotherapies, sub-standard TB care, the paucity of essential medicines and the abundance of non-essential ones, and the households impoverished because they turn first to the private sector, even for routine care.
As noted in your documents, over 60% of health expenditure in the Region is paid out of pocket, and this already makes a significant contribution to widespread poverty.
With the rise of chronic noncommunicable diseases, especially in the cities of this region, the ability of diseases to drive people into poverty is certain to increase exponentially.
This is a bitter irony in a century that began with a Millennium Declaration and Goals aimed at substantial poverty reduction, with better health given a high place as a driving force.
Ladies and gentlemen,
I have referred to real but unpredictable risks. Much hangs in the balance. It is our job to tip the balance in favour of continuing the unprecedented momentum for better health, especially for the poor, that marked the start of this century.
I personally believe that we are in a good position to do so. Looking at the items on the agenda for this session, and the strategies proposed in your documents and reports, I believe that this region‘s position is especially strong.
At a time of financial austerity, public health must show a thirst for efficiency and an intolerance of waste. The phrase “improve efficiency and effectiveness” runs like a red line throughout your documents, underscoring the objective of your strategies.
The consistent and shared aims for health in this region are clearly stated by your Regional Director. That is, the strengthening of health systems, and fair and equitable access to health care by all.
Guided by your Regional Director’s passionate commitment to primary health care, health ministries in this region have been doing some smart thinking and are on the right track.
Your agenda is essentially a primary health care agenda. As noted, a community-based health workforce is the backbone of a health system based on primary health care.
Childhood immunization is an early opportunity, with exceptionally good outreach, to deliver a range of primary health care interventions that improve child survival.
Your regional health sector strategy on HIV lists five critical priorities for the region. Revitalization of primary health care heads the list.
Nutrition, previously profiled as a main pillar of primary health care, has been notoriously and dangerously neglected in recent years.
All too often, simple low-cost interventions that make a huge difference in population-wide health outcomes, like exclusive breastfeeding for the first six months of life, or iodization of salt, get overshadowed by spectacular new technologies that prolong life for a few at a very high price. In many countries, 90% of the health budget goes to hospital-based services, with primary health care and preventive services left by the wayside.
None of the strategies you will be discussing will be easy to implement. The documents make this very clear with their frank and critical assessment of abundant problems and obstacles.
These range from the simple fact that public health services are perceived by the public as providing low-quality, second-rate care, to the complex reality of multiple financial incentives that fuel the irrational use of medicines, to the difficulty of extending immunization coverage beyond the region’s current average of 80%.
The document on national essential drug policies, including the rational use of medicines, expresses well that thirst for efficiency and intolerance of waste I just mentioned.
I likewise ask some of same the questions raised by the document. Why have we made so little progress in this area? Why is improving the rational use of drugs so hard?
Even the rise of antimicrobial resistance and the growing threat of a post-antibiotic era have not been sufficient to stimulate the broad and urgent actions needed to protect our fragile arsenal of front-line medicines.
I believe the obstacles you have identified and the solutions you have proposed will be useful well beyond the South-East Asia Region.
And I agree entirely with your Regional Director. Primary health care is the best way to address the double burden of infectious and chronic noncommunicable diseases, and the growing numbers of the elderly.
It is the best way to address the added challenges of natural disasters, to which this region is especially prone, and the health threats arsing from more frequent and extreme weather events as the climate continues to change.
Ladies and gentlemen,
I have another comment about the regional health sector strategy for HIV. It is consistently faithful to the objectives, approaches, and spirit of the global HIV strategy adopted in May, and yet is tailored to fit the epidemiological situation and country-specific challenges in this region.
This is a very welcome adaptation, as greater consistency in the work of this Organization, at all three levels, is one objective of reform.
Your report on the programme of reform for WHO, which will be discussed shortly, refers to the need to identify country-specific roles and responsibilities for WHO.
Rest assured. The need to improve the impact on health outcomes within countries is the most important measure of WHO’s overall performance and a driving force behind many of the proposed reforms.
I am eager to hear your views about reforms needed at WHO, and will be listening most attentively.
I have already expressed my personal appreciation to your Regional Director for his enthusiastic engagement in the reform process, his wise counsel, and his many constructive proposals.
Ladies and gentlemen,
I have a final comment, which I find especially fitting for a session of this Regional Committee hosted by India.
This region is winning the battle against polio, thanks to India’s hardnosed determination and success. This year, only a single case of polio was reported, in January, from what we know is the world’s most technically challenging area for the interruption of transmission.
At the request of the May Health Assembly, an Independent Monitoring Board was established to track progress towards the agreed eradication milestones, identify barriers, and recommend adjustments in strategies.
As stated in the Board’s second report, which has just been released, “Our view of the Global Polio Eradication Initiative remains: polio eradiation is feasible and vital.”
And here is what that report says about India. “All that we see from India looks positive.” As noted, the scale of the government’s response has been immense. The Board heartily commended India on what has been achieved to date.
Moreover, India stands out as having fully achieved its country-specific goals for the end of 2010.
India’s success inspires the world. India’s hard-won know-how will no doubt help finish the job in the remaining areas of established transmission. Already, experienced polio fighters from India have been deployed to polio-affected areas in Africa.
Thank you, India, for giving the world some much needed encouragement.
It can be done. Polio eradication is feasible, and it is feasible in the near term.
And thank you, ministries of health in this region, for your unwavering commitment to equity, fairness, and social justice, to prevention as well as cure.
Thank you for your smart approach to solving some long-standing problems that stand in the way of universal coverage, as promoted by primary health care.
This is how public health can not only keep up the momentum, but keep getting better.