Director-General

WHO Director-General addresses health officials in South-East Asia

Dr Margaret Chan
Director-General of the World Health Organization

Address to the Regional Committee for South-East Asia, Sixty-fifth Session
Yogyakarta, Indonesia

5 September 2012

Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Samlee, colleagues in the UN family, ladies and gentlemen,

Let me begin with some well-deserved praise. On present trends, this region is set to be declared polio-free in January 2014.

India, the skeptics said it could not be done. But you did it. You stopped wild poliovirus transmission dead in its tracks. You have silenced the critics.

You have provided definitive proof that eradication is technically feasible, and you have done so in what was arguably the most challenging of all the remaining strongholds of this virus.

This is what your experience tells the world. The poliovirus is not permanently entrenched. It is not destined to remain a perpetual threat to each new generation of children. It can indeed be driven out of existence.

I fully agree with the assessment of the Independent Monitoring Board. This is a “magnificent” achievement. The Indian government succeeded because of its passionate engagement in a mission to protect its people from a vicious disease.

I appreciate, too, the specific lessons from the Indian experience set out in your report on polio eradication.

The most critical factor for success is ownership of the programme, from the local to the national level. The Indian government owned this programme, operating as the principal source of staff and funds. Other lessons include the importance of tight-knit partnerships, constant innovation, and a relentless drive to improve quality and accountability.

The May World Health Assembly elevated polio eradication to the level of a global public health emergency. This region has the expertise, bolstered by success, to lead the world in such an emergency response.

Medical officers from India, Bangladesh, and Nepal are now directly assisting countries that are still battling polio. I urge you to continue this leadership role. We can and must win.

As the IMB report noted, polio is now at its lowest level worldwide since records began.

Public health faces some heavy challenges, some bad trouble heading our way. Any longstanding problem that can be solved, once and for all, will free much-needed capacity and resources.

Ladies and gentlemen,

I also want to congratulate the region on the draft strategy for universal health coverage that you will be discussing during this session. This is an extremely ambitious and courageous strategy, and a smart path for your countries to follow.

The strategy rightly emphasizes equity as its core objective. It rightly singles out the principles and approaches of primary health care as the starting point for reform.

In this regard, the region has a head start. Several countries are long-standing models of how, with the right policies and strong political commitment, low-income countries can achieve health outcomes comparable to those seen in the wealthiest places in the world.

Like the World Health Report 2010, on health systems financing, the draft strategy sets out a richly diversified menu of options for moving towards universal coverage in any resource setting.

All of these options are firmly rooted in successful strategies and solutions worked out by countries. Again, this region shows its value as a resource of experiences and a repository of instructive best practices.

Universal coverage is the right thing to do from an ethical perspective. It is the smart thing to do in terms of improving the efficiency of the health system.

At a time of nearly universal financial austerity, improving efficiency is a far better option than cutting back on services or imposing fees that punish the poor.

And you can have both. That is: efficiency and equity. The economists will tell you there must be a trade-off between the two. Experiences, also in this region, tell us that the two goals are fully compatible.

I described the draft strategy as courageous. Universal coverage is the best way to tackle some major barriers to equity that are unique to this region. These include the exceptionally high reliance on out-of-pocket payments and the dominance of a largely unregulated private sector offering mainly curative care.

This region has millions of low-income households living on the margins of survival. For these people, it does not take major illness and catastrophic medical bills to push them deeper into poverty. Just paying for medicines can have the same tragic effect.

As data set out in the draft strategy show, mark-ups in the price of medicines, as they move through the supply and distribution chains, can increase the price charged by the private sector several hundred times.

As we all know, the costs of care can cause patients to delay seeking treatment until the disease or condition has become much more difficult and costly to treat, if treatment is still possible.

This is an extreme example of waste and inefficiency. And this is what you are tackling, head on.

Moving towards universal coverage improves health and fights poverty at the same time. It upholds the core values of solidarity, social cohesion, and human security.

Above all, universal coverage is a powerful social equalizer that helps correct gaps in health outcomes that have been growing, almost unchecked, for decades.

Market forces and incentives can be used to improve the efficiency of health systems. But market forces will never solve social problems all by themselves. This happens only when equity is an explicit policy objective, as set out in your draft strategy.

Universal coverage is a unifying concept that makes various pieces of the health care puzzle fit together in a focused and coherent way. A move towards universal coverage is a move to tackle some of the other items on your agenda.

Moving towards universal coverage depends on stronger, more efficient health systems, with access to essential medicines of good quality at affordable prices and a well-trained and motivated work force.

It also requires reliable information systems for generating data and evidence, and support from a well-functioning regulatory authority.

Universal coverage stresses equity in entitlement to services and gives a prominent role to compulsory or public funding to ensure social protection.

At a time when the international community sees better health as a poverty reduction strategy, we cannot let the costs of health care drive millions of people below the poverty line each and every year.

I commend SEAR countries for taking such an ambitious, courageous, and timely step forward.

Ladies and gentlemen,

The target date for reaching the Millennium Development Goals is fast approaching. The debates about the next generation of internationally-agreed development goals are already under way.

As we learned with the MDGs, international goals shape political agendas and attract resources. We need to get this right, just as we need to get the process of WHO reform right.

From the outset, the reform process has been in the hands of Member States. You have before you drafts of the next programme budget and the 12th general programme of work. These documents let you see how priority setting works in practice.

Member States have asked that these documents be reviewed and discussed by Regional Committees and subsequently revised by the Secretariat. Please keep in mind that both documents are works in progress.

Concerning the post-2015 debate, evidence supports a central place for health 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.

Changes in health status will also be the most readily and reliably measured signal that policies need to be adjusted.

The MDGs have been a powerful force in focusing implementation efforts and maintaining political support for development. They have been good for public health.

They demonstrated the value of concentrating international efforts on a limited number of time-bound goals. They brought impressive results, sometimes stunning results.

For example, at the start of this century, AIDS, tuberculosis, and malaria were public health emergencies. This is no longer true. All three diseases are showing a slow but steady decline, though the battle is by no means over.

The health-related MDGs were largely an infectious disease agenda. Most agree that we dare not reduce the current drive to expand childhood immunization and combat AIDS, tuberculosis, malaria, and the neglected tropical diseases.

As we know from deep experience, complacency creates a perfect opportunity for these diseases to roar back with a vengeance.

Pursuit of the MDGs has left a legacy of innovations, including the GAVI Alliance, the Global Fund, UNITAID, the International Health Partnership Plus, and numerous other global health initiatives focused on individual diseases.

Most recently, the UN strategy for women’s and children’s health, Every woman, every child, has responded to calls for accountability in tracking resources and using them.

Among its objectives, the strategy aims to build capacity for vital registration as the foundation for accountability within countries. The need for accountability is just one of many lessons that are part of the MDG legacy.

Here is another one. If the international community wants better health to work as a poverty-reduction strategy, good quality interventions must reach the poor. If we miss the poor, we miss the point.

At their outset, single-disease initiatives depended on a well-functioning health system to reach their goals. Yet these initiatives rarely made the strengthening of health systems an explicit or budgeted goal. This, too, is no longer true.

Most donors now appreciate the need to channel aid for health development in ways that build capacities and move countries towards self-reliance. This is the best exit strategy for aid.

Developing countries do not want charity. They want capacity.

Given the success of the MDGs, most agree that the post-2015 agenda should likewise focus on a limited number of measurable goals.

Most also agree that the current focus on human development and poverty alleviation should remain at the core of the new agenda, together with an emphasis on respect for human rights, equality, and sustainability.

While diseases targeted by the MDGs remain extremely important, today’s health challenges are much broader, and this should be reflected in any new development agenda.

The Millennium Declaration and its goals were basically 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 have-nots aimed at reducing gaps in living conditions and relieving vast human misery.

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

I mentioned some bad trouble heading our way.

I am talking about a changing climate, more emergencies and disasters, 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. Many of them are fuelling the relentless rise of chronic noncommunicable diseases, which are hitting this region especially hard.

For nearly all, the root causes lie beyond the direct purview of the health sector.

In my view, one of the best ways to respond to these challenges is to make universal health coverage part of the post-2015 development agenda.

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.

Ladies and gentlemen,

As I have said before, the job of public health keeps getting harder.

More and more, we are on the receiving end of policies made in other sectors. Our ability to shape these policies is often limited, especially at a time when so many economies are fragile. If a health-promoting policy is perceived to threaten the profits of an economically important industry, we can expect to have a battle on our hands.

Sometimes we win those battles. As I conclude, let me mention one encouraging case.

Last month, Australia’s High Court upheld legislation mandating plain packaging, with no branding, for tobacco products. The legislation had been aggressively challenged by several large tobacco companies.

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.

As Australia’s Attorney-General Nicola Roxon noted, “The message to the rest of the world is that big tobacco can be taken on and beaten.”

I think we can all take heart from a game-changing story where the good guys win.

Thank you.

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