WHO Director-General addresses Europe’s ministers of health

Dr Margaret Chan
Director-General of the World Health Organization

Address to the Regional Committee for Europe, Sixty-second session

11 September 2012

Mr President, excellencies, honourable ministers, distinguished delegates, friends and colleagues in public health, ladies and gentlemen,

I thank the government of Malta for hosting this Sixty-second Session of the Regional Committee for Europe.

This is my first visit to your beautiful and gracious country with its rich history visible in so many palaces and piazzas. You have contributed much to the comfortable atmosphere of this meeting, as well as to its efficient organization, and I want to thank all the staff in the country that contributed to this meeting.

Our comfort is further extended by Malta’s prohibition of smoking in all enclosed public places.

Last month, public health experienced a game-changing event in which the good guys won. Australia’s High Court upheld legislation, mandating plain packaging for tobacco products. Of course, this was aggressively challenged by the tobacco industry.

The court ruling was a huge victory for the Australian Government, but also for public health, opening a brave new world for tobacco control. In this case, concern about protecting the public’s health took precedence over issues of intellectual property rights put forward by a rich and ruthless industry.

We face ongoing battles with not only big tobacco but also other powerful industries, and with other powerful forces beyond our control.

The financial crisis of 2008 continues to affect a large number of countries. European economies are going through some turbulent times, as you heard from our OECD (Organisation for Economic Co-operation and Development) colleagues yesterday. For some, prosperity has been replaced by austerity, making the delivery of health services less generous than in the past.

I thank every country represented in this room for struggling to maintain your commitment to health at the domestic, regional and international levels.

To borrow a phrase, health is too big to fail.

I can make such a statement with confidence as this Region has done so much to gather the evidence, and make the arguments, that health is wealth.

You did this with the Tallinn Charter: Health Systems for Health and Wealth and, most recently, with the Health 2020 policy framework and strategy.

Health maintains its high profile in the Region, but money is tight and governments are careful with their spending. This puts a lot of pressure on ministries of health, and on WHO, to back up recommended strategies with solid evidence of their effectiveness and cost-effectiveness. Given the complex challenges we face today, this evidence must resonate well with non-health sectors and speak to their mandates.

I thank your Regional Director, my sister Zsuzsanna, her Secretariat, and their partners for the tremendous amount of work that has gone into preparation of documents for this session. These include background documents that draw together a considerable amount of evidence on the social determinants of health, intersectoral governance for health and the economic case for public health action.

Not surprisingly, chronic noncommunicable diseases (NCDs) are the principal focus of these documents. They offer practical evidence-based advice on how to actually implement whole-of-government and whole-of-society approaches, making good use of regulatory and fiscal measures.

We need this kind of how-to guidance if we want health concerns to penetrate the boundaries of other sectors. I see great value in drawing together economic evaluations of the impact of specific health interventions, including those that promote tobacco control and physical activity, reduce the harmful use of alcohol, improve road safety, address depression throughout the life course and tackle the root-causes of obesity and diet-related diseases.

We need these arguments to persuade other sectors. There is, of course, nothing new about intersectoral action for health. But back in 1978, when the Declaration of Alma-Ata was signed, the need was for collaboration with friendly, almost sister sectors, like education, nutrition, housing, and water supply and sanitation.

Today, the struggle to safeguard public health increasingly places health concerns in competition with the interests of powerful multinational corporations. Any health policy, no matter how sound or far-sighted, that is perceived to threaten a fragile economy, risks being put aside in the drive for economic growth and a strong GNP (gross national product).

For example, the best way for populations to lose weight is for the food industry to sell less unhealthy food, especially food that is cheap, convenient and tasty, but energy rich and nutrient poor. For obvious reasons, this will never happen all by itself.

Industrialized, highly processed food is becoming the new dietary staple around the world in what some researchers call the “snack attack”.

Marketing budgets are big and audiences very well targeted. Links to the prevalence of obesity and related diseases are well documented. As with tobacco control, reversing this trend depends on support from policies in multiple non-health sectors.

Many of the concepts addressed in your documents have their roots in this Region. I find it entirely appropriate for Europe to continue its leadership role by giving these concepts a concrete body of evidence, supported by a diversified menu of policy options.

Ladies and gentlemen,

WHO and its Member States face two big assignments where we absolutely must get things right. The first is WHO reform. The second is placing health on the post-2015 development agenda. I value your guidance as we collaborate on both tasks.

This Region has always been at the forefront in addressing emerging health threats that eventually confront the rest of the world.

This Region has traditionally provided the most generous financial support to international health development in general and to WHO in particular.

I have already mentioned your leadership in promoting well-functioning, and fair, health systems.

You helped pioneer understanding of lifestyle-related factors that increase the risk of NCDs, culminating in last year’s Moscow Declaration.

As a tribute to the quality of life and health care in the Region, the median population age in Europe is the highest in the world. Healthy ageing is on your agenda, with a strategy and action plan proposed as guidance for the coming years. The document on healthy ageing emphasizes the need to approach ageing with a far more positive attitude; I fully support this document.

Statistics collected for this year’s World Health Day indicate that, within the next five years, and for the first time in history, the number of adults aged 65 and older will outnumber children under the age of 5.

In other words, being in the older age group is becoming the “new normal” for the world population. I am very honoured to be included in this group. A life-course approach, as advocated in Health 2020, is one of the best ways to keep the health needs of older people normal for as long as possible.

Under WHO reform, which is on your agenda, financing is a big driver of reform. I have asked Professor Thomas Zeltner of Switzerland to advise me on the preparation of documentation for the special meeting of the PBAC (Programme, Budget and Administration Committee) this year. He will seek input from all parties so that I can ground my proposals in your realities, making them pragmatic, implementable and acceptable to the shareholders in this Organization. Your document on this item notes that some reform initiatives, such as those linked to governance, can be implemented quickly, while others are developmental in nature and will require several years to become fully effective.

From the outset, the reform process has been in the hands of Member States. You have before you drafts of the 12th General Programme of Work and the next programme budget. These documents let you see how priority setting works in practice for the first time in the sixty-five-year history of WHO.

Member States have asked that these documents be reviewed and discussed by regional committees and subsequently revised by the Secretariat. We will, subject to consultation, revise these documents to send to the PBAC and the Executive Board in January. Please keep in mind that both documents are works in progress.

Ladies and gentlemen,

The target date for reaching the Millennium Development Goals (MDGs) is fast approaching. The debate about the post-2015 development agenda is in full swing. Rest assured, WHO is taking a leadership role in moving this debate through processes and procedures aimed at collecting a broad range of views. There are many political and technical processes under way. WHO is working with many partners, including other United Nations organizations.

Pursuit of the MDGs taught us many lessons. We learned the critical importance of a well-functioning and inclusive health system that offers financial protection against catastrophic health expenditures.

We learned that good aid builds self-reliance. It aims to eliminate the need for aid. It does so by channelling resources in ways that strengthen existing capacities and infrastructures, instead of circumventing, undermining, or overburdening them.

We learned the value of concentrating international efforts on a limited number of time-bound goals that resonate with the public and parliamentarians, and of course with the development community. Individual diseases benefited greatly from innovation, including new financing mechanisms and technical innovations, like new vaccines, better medicines, patient-friendly formulations and simplified point-of-care diagnostic tests.

These are some of the successes that helped drive dramatic reductions in morbidity and mortality. They have paved the way for a new agenda that builds on these achievements. And I’m happy to see our colleagues from GAVI and the Global Fund here; they are important partners.

But, as I said, we absolutely must get this right. The MDGs strongly influenced development priorities and directed resource flows. The temptation will be great to expand the number of goals, rather than keep the agenda sharp, focused, time bound and feasible. So competition is keen among sectors to get a goal on the list.

As we think about the post-2015 agenda, we must never forget that the health-related MDGs were largely an infectious disease agenda. At the start of this century, AIDS, tuberculosis, and malaria were public health emergencies that warranted sharply focused efforts to stop the epidemics from expanding further and reduce the number of deaths. This happened.

Efforts to control these diseases can now address them not as emergencies, but as part of general health services. In turn, general health services can benefit broadly from the refined and simplified strategies developed to control these diseases.

As just one example, the recent WHO policy requiring diagnostic confirmation of malaria before medicines are dispensed has strengthened detection capacity for all diseases.

My advice is this. We dare not reduce the current pressure on vaccine-preventable diseases, AIDS, tuberculosis, malaria, and the neglected tropical diseases. Constant mutation and adaptation are the survival mechanisms of the microbial world.

Complacency gives infectious diseases the perfect opportunity to return with a vengeance. I need only mention the problems we are already facing with antimicrobial resistance. The momentum to control these diseases must not stop in 2015.

The MDGs also taught us that health deserves a high place on any development agenda.

Health is a precondition of development. It is a powerful driver of socioeconomic progress.

Because its determinants are so broad, health is a sensitive indicator of the impact that policies in all sectors of government have on the well-being of citizens.

As just one example, if trade policies, tariffs and agricultural subsidies cause food prices to soar, the adverse effects will be most visible in the health sector, presented either as hunger, as we now see in the Sahel, or malnutrition. Changes in health status will also be the most readily and reliably measured signal that policies need to be adjusted.

As I said, health is too big to fail. If health fails, all else fails.

We can be pleased that the final outcome document of the Rio+20 summit gave health a central place as a precondition for development and an indicator of development. That document also stressed the importance of universal health coverage in enhancing health, social cohesion and sustainable human and economic development.

However, more work needs to be done to give health its proper place in the next development agenda.

The MDGs were a compact between developing countries and their needs, and wealthy countries that promised to address these needs through the commitment of funds, expertise and innovation: in short, a compact between the haves and the have-nots aimed at reducing gaps in living conditions and relieving vast human misery.

When we consider the nature of today’s threats to health, a simple compact between the haves and have-nots fails to capture the complexity of these threats.

Many of these threats arise from the realities of a world characterized by radically increased interdependence and interconnectedness.

In the very recent past, public health has moved into a unique political space. More and more, the conditions that threaten health are shaped by forces that govern the entire world. Today, international systems have more power than a sovereign government to influence the lives and opportunities of citizens, including the chances they have to enjoy a healthy life expectancy.

Again, think about obesity, especially childhood obesity, and the clever marketing of unhealthy foods and beverages to children, beamed by satellite TV. You may ban unethical marketing of unhealthy foods to children in your country, but your people may get such messages from other countries.

Our world is in bad trouble. Multiple troubles have multiple consequences for health.

I am talking about a changing climate, more emergencies and disasters, more hot zones of conflict, soaring health care costs, soaring food prices, demographic ageing, rapid urbanization and the globalization of unhealthy lifestyles.

I am talking about an enduring economic downturn, financial insecurity, shrinking opportunities, especially for youth and the middle classes, poverty that keeps getting deeper and social inequalities that keep growing wider.

These are universal trends, and many of them are driving the relentless rise of NCDs.

As I have said before, health is on the receiving end of policies made in other sectors. I have no illusions. Likewise, we understand the daunting challenges for you as ministers of health. Within governments and internationally, the health sector will never have as much power, or as many resources, as sectors like finance, trade or defence.

This likely reflects the tendency of political leaders to define a very narrow national progress agenda, as measured by economic growth and a rising GNP.

Still, I believe we can outsmart some of these trends, or at least counterbalance them, with clever policies and convincing arguments, guided by the abundant evidence and practical examples set out in your documents.

Money is important, but it does not make all the difference in the world. For health, policies that make equity an explicit objective do more to improve health outcomes and promote social cohesion than money alone.

In my view, one of the best ways to respond to all these challenges is to make universal health coverage part of the post-2015 development agenda. In my view, universal coverage is the single most powerful social stabilizer and equalizer. In many of your countries, you are already doing so well. WHO is working with the World Bank to advise more than 60 countries on achieving universal coverage.

At a time when policies in so many sectors are actually increasing social inequalities, I would be delighted to see health lead the world towards greater fairness in ways that matter to each and every person on this planet.

Ministers, ladies and gentlemen, I thank you for your attention.